Six Reason to Question Vaccinations

[MinorityView]

Oh, I know, I know. I was just agreeing with you and being happy that you had clarified what I was clumsily trying to say

No, I'm perfectly happy to have my ideas about rational decision making for child health be developed further.

What I'm opposed to is irrational decision making. Vaccination is okay. Adding every new vaccine to the schedule without considering whether it is the best use of time, energy and money is idiotic. Unfortunately, that seems to be the approach in the U.S.

For example, there is good evidence that breastfeeding has tremendous results for long-term child health, overall physical and mental development and for reducing infant mortality. There was actually a plan to do a large scale promotional campaign in the U.S. to get the word out on how breastfeeding can make a difference...but it was gutted by the formula companies. You see, you can't say how good breastfeeding is, without implying that formula is not as good.

Some changes would indeed be very difficult. But saving children's lives is worth some effort, right? Not an area where we should be easily discouraged by challenges. I guess it is a matter of balance. Some changes would be so tricky to implement that it is necessary to move on down the list to the next opportunity.

I gather no one objects to using successful countries as models rather than less successful countries?

 

[Ivor the Engineer]

<snip>

For example, there is good evidence that breastfeeding has tremendous results for long-term child health, overall physical and mental development and for reducing infant mortality. There was actually a plan to do a large scale promotional campaign in the U.S. to get the word out on how breastfeeding can make a difference...but it was gutted by the formula companies. You see, you can't say how good breastfeeding is, without implying that formula is not as good.

<snip>

I think the more extreme feminists wouldn't like that idea either. They would complain it stigmatizes women who do not breastfeed their children.

 

[Eos of the Eons]

New vaccines aren't added odd willy nilly. To suggest they are shows how much one doesn't care about facts.
Vaccination doesn't interfere with breastfeeding. It also does not pose any challenges to anyone that can receive them.

 

[Sinope]

]New vaccines aren't added odd willy nilly. To suggest they are shows how much one doesn't care about facts. [/B]Vaccination doesn't interfere with breastfeeding. It also does not pose any challenges to anyone that can receive them.

Well if only that were true. Unfortunately it's not. I am not sure how Prevenar (prevnar) got onto the UK schedule for example, after the JCVI looked at the US results. (they initally rejected it 4 months before it was passed) "Willy Nilly" would be a good description I think

What "facts" do you mean?

 

[Eos of the Eons]

http://www.apologia.com/vaccines/vac_test.html

 

[Skeptic Ginger]

I don't know - is it? I know ours isn't.




Actually, no - I didn't miss it. But I'll be quite sure to mention that, when I give my epidemiology lecture to the masters' students on Wednesday.

In case you misunderstood my post, I think all governments insert politics into their public health infrastructure, perhaps to different degrees. That doesn't mean the public health systems are totally corrupt. I can't quite tell from your post what you meant.



[sidetrack]Just as an FYI, we were discussing the unusual outbreak of a respiratory disease that was rumored to be killing health care workers in a hospital in Guangdong China on the ProMed (International Society for Infectious Disease) mail website before it spread to the elevator group in Hong Kong.

PNEUMONIA - CHINA (GUANGDONG): RFI

Date: 10 Feb 2003
From: Stephen O. Cunnion, MD, PhD, MPH <cunnion@erols.com>


This morning I received this e-mail and then searched your archives and found nothing that pertained to it. Does anyone know anything about this problem?

"Have you heard of an epidemic in Guangzhou? An acquaintance of mine from a teacher's chat room lives there and reports that the hospitals there have been closed and people are dying."

--
Stephen O. Cunnion, MD, PhD, MPH
International Consultants in Health, Inc
Member ASTM&H, ISTM

And in the same post:

....Commenting on the problem of pneumonia on the Mainland, Dr Yeoh said the Department of Health has already touched base with the Guangdong authorities to learn more about the type of infection prevalent there. The department will also determine whether there is any particular risk of that infection coming to Hong Kong.

He assured the public that the Government is always on the alert, as the Department of Health has a very good communicable disease surveillance system.

I followed the events daily as it progressed. The central Chinese government cooperated most of the time but there were clearly some local administrators who hid the problems. And in China as well as India, national pride interfered occasionally with allowing the WHO in to provide assistance as well as how the events were being reported.

Funny thing that national pride.[/side track]

Edited to add, that respiratory disease was the beginning of the SARS epidemic.

 

[Skeptic Ginger]

I really want to know which world you live in where economic realities, such as finite resources being distributed fairly and efficiently in the face of infinite demand, does not impact what treatments are worth implementing for which members of society.

I have no quibble with the concept, it's your calculations I find lacking.

The cost benefit analysis is always done in this country before the ACIP recommends a vaccine. Disease burden has more costs than you are putting in your limited evaluation and you are claiming to have done a superior analysis to that of an entire team of health care experts. You accuse them of being vaccine company pimps without any proof other than your preconceived perception of health care professionals.

Earlier, I posted a link to a study that has indicated reducing the Men. C vaccination to 1 dose at 12-months and a catch-up campaign for under-18 year-olds, can save a huge sum of money (100's of millions of £) for a tiny increase in the number of cases of meningitis, compared to a 3-dose infant strategy.

It is you and EoE who appear to think that to just keep on spending more and more on vaccination will automatically be efficient use of health care expenditure. Well, I'm sorry to tell you, but you are wrong. All of the recent vaccination programs cost a lot more money that they save.

I refer you to the extensive discussion of the cost benefit done by the ACIP and cited earlier. There is no reason to expand upon their very extensive evaluation.

When I use the word 'efficient', I am talking about reducing suffering and death in a society by the greatest amount for the minimum expenditure. If all treatments were implemented this way, suffering would be reduced to a minimum given the expenditure people are prepared to pay for health care. This has to be balanced against emotionally-driven 'wants' of spending millions to, for example, save a single child's life, even though the money could relieve more suffering or extend more people's lives if spent on other treatments.

I really don't know where you are getting the idea I don't understand the severity of the risk for such things as chickenpox. I have looked at the numbers and studies in the UK and it does not make health-economic sense to vaccinate all infants. If a vaccination is introduced, it makes far more sense to delay it until adolescence, so only those individuals who have not had chickenpox are offered the vaccine.

You exclude many of the costs of the disease burden and cherry pick those you find worthy of inclusion. You have not made any case for excluding the economic burden of disease. And you continue to ignore the risks in early childhood of varicella, particularly that of invasive bacterial infections in the child with a chicken pox rash.

As far as your claims about efficiency, I find them unrealistic. It is quite reasonable in my opinion to purchase the vaccines which I gave my child to reduce the rare but completely unacceptable risk of those infections.

But as usual, Ivor, you continue to repeat your same arguments over and over. I am not convinced for the reasons I stated here among other reasons. So, if you have anything new to say, fine, otherwise it is useless to argue with you.

 

[Skeptic Ginger]

Go back and look at my graph. The 'pretty clear' connection I referenced in my graph was the inverse correlation of mortality for children under 5 with the vaccination rate. In other words, I was saying the graph supports your stance. Sorry I didn't make that explicit. Please stop the baseless accusations. Thank you.

Apparently you can't see the error in your logic. I hope other people reading your posts can because it's a doozy.

You claim, there is an "inverse correlation of mortality for children under 5 with the vaccination rate". Is it the term "correlation" you and I are defining differently? In this case, absolutely without a single doubt, there is no "inverse correlation" in vaccine rates and the child mortality rates. The term "correlation" implies you are claiming there is a relationship.

This is complete tripe in no uncertain terms. I really didn't think you were that dense, Beth.

 

[Skeptic Ginger]

How can I do that when you haven't provided me with enough information about what he thinks? Why should it be assumed he's free from bias?



I would probably wait to see if they get chickenpox before they are older and at increased risk of complications. Exactly what age, I don't know. Not having to worry about booster vaccinations every 10-20 years for the rest of their lives seems quite an advantage to me.

No response once again to the invasive group A strep. You just ignore what you can't address.

Here's some cost per QALY of various treatments:

Treatment £s Cost/QALY

Cholesterol testing and diet therapy 280
Advice from GP to stop smoking 350
Heart pacemaker implantation 1,420
Hip replacement 1,520
Coronary artery bypass graft 2,700
Kidney transplant 6,080
Breast cancer treatment 7,460
Heart transplant 10,110
Continuous ambulatory peritoneal dialysis 25,630
Neurosurgery for brain tumour 139,040

None of those are going to save many children. Nor are we neglecting any of those measures for vaccines. (And BTW, diet therapy has a dismal rate of return.)

I'll repeat myself again even though I am tiring of this. But Rolfe expressed it and I'd like to support her comment

Ivor, to my mind, had a point when he suggested that the cost of chickenpox vaccine might be better spent on medical aid to the third world. I then asked him which other healthcare items available in the UK he would like to see discontinued in order to increase medical aid to the third world. Didn't get an answer.

Now we're back to the chickenpox vaccination not being cost-effective in the context of UK healthcare per se.

The point I made earlier, which you overlooked when you accused me of not getting your point is if you look at the current vaccines individually, chicken pox vaccine is cost effective (see ACIP evaluation). But if your argument is where do you put your limited health care resources, then you don't assess that one intervention at a time. The argument itself requires assessing everything in relation to everything else.

Vaccines are well up on the list in return on investment. What is way down on the list are heroic measures for the sickest patients and all the money wasted on worthless remedies.

 

[Skeptic Ginger]

In the case of disease that only exist in humans, it would seem sensible to try to eradicate them. So let's send skeptigirl and the other members of the vaccination squad over to the third world and rid the world of measles before we think about chickenpox in the West. Once a disease has disappeared, no one has to be vaccinated against it.

BTW, on IHS the budget does not have a sharp cut-off for treatment Cost/QALY, but rather a graded allocation over various ranges. I.e. there are many Low Cost/QALY treatments available, fewer Medium Cost/QALY treatments and so on. This allows IHS to somewhat meet people's 'wants', as well as remaining reasonably efficient.

Measles, while the typical reservoir is humans, can infect non-human primates. Are you going to vaccinate all the susceptible primates as well? And delivery of the vaccine to third world children has the barrier that a vaccine which must remain frozen has. That's why we have a worse record when it come to measles vaccine programs in rural areas of third world countries.

But your plan has soooooo many other holes as to be unrealistic. First, we are trying to vaccinate the world's children against measles. But do you seriously believe people in the developed world are going to give up their children's varicella vaccine in order to pay for someone else's kids' measles vaccines? Why not have those parents give up their SUVs and lattes instead?

 

[Skeptic Ginger]

Thanks for demonstrating my point so well Skepticgirl! Indeed, vaccines are not the solution to all health problems, which was the point I was trying to make. Every country that wants to have low infant mortality and good childhood health outcomes has to make choices. The choices that the U.S. has made haven't been as successful as the choices that Sweden has made, or Norway, or Hong Kong. Preventing childhood poverty and malnutrition are healthcare choices, just as vaccinating is a healthcare choice. Preventive actions that keep children from becoming sick or lessen the likelihood of their dying if they become sick are equally effective approaches.

The rational approach to having healthy children is to look at what is actually causing children to die. Top cause of death. Next cause of death. Make a list. Figure out what can be changed in each case and put money and effort into changing it. Sometimes the best change may be a vaccine. Other times it may be improving drinking water safety. Upgrading housing. Getting crap out of the food supply. Ending the civil war. Providing emergency rations in a famine. The assumption that more vaccines will always result in fewer deaths just doesn't always hold up.

If varicella is not a major cause of death in children and low birth weight is, then why not put more effort into trying to prevent babies being born below a viable weight?

Just seems to me that any country trying to improve their infant and child outcomes would do much better to take Sweden or Norway as a model than the U.S., judging by current results.

So, do you all think that Sweden and Norway and Hong Kong would have lower infant and childhood mortality rates if they added all the vaccines currently on the U.S. schedule? Or not? And why? And, of course, what should they cut back on so that they can pay for all of the additional vaccines? Think carefully on this one, because we wouldn't want to cut back on something that is already working to keep children alive and healthy.

You are making the same mistake Beth made but with a tad more logic.

Basic science review:

When you have multiple variables, you can't start claiming the data is showing the one you cherry pick as having the effect. You have to control for the variables and first see which ones actually have an effect.

Both you and Beth are cherry picking one variable in a multi-variable problem and claiming that is the variable that matters, either alone or together with the other variables.

Gee, we have a different transportation system than Sweden and Norway and Hong Kong, maybe that's what we should be looking at. Our countries have different climates, maybe thats what we should be looking at. We wear more Nikes. That could be it.

You have no case that vaccines are anything here except Beth's cherry picked charts. When you research why it is the US has a high infant mortality rate, get back to me. I tried to tell you why but you've both ignored the facts. Here's a clue: White middle class or better off kids who get all their vaccinations DO NOT HAVE A HIGH INFANT MORTALITY RATE.

So, does the US take proper care of our poorer kids? No. Is it because we are wasting money on vaccines? No. It's because the rich in this country don't want to pay for the health care for the poor. Like I said, they have SUVs and lattes to pay for.

 

[Skeptic Ginger]

How about developing a safer delivery system for nicotine which still gives the instant 'hit' smoking does?

We have it, it's called Nicorette gum and the Nicoderm patch.

And BTW, there are many fewer smokers in this country than in the other Western countries I traveled in (England, Spain, and especially Australia.)

And for the record, nicotine by itself is also unhealthy. It is a vasoconstrictor and has bad effects on the heart as well.

 

[Skeptic Ginger]

No, I'm perfectly happy to have my ideas about rational decision making for child health be developed further.

What I'm opposed to is irrational decision making. Vaccination is okay. Adding every new vaccine to the schedule without considering whether it is the best use of time, energy and money is idiotic. Unfortunately, that seems to be the approach in the U.S.

Have you ever looked at what goes into the decision to recommend a new vaccine or are you just guessing?

For example, there is good evidence that breastfeeding has tremendous results for long-term child health, overall physical and mental development and for reducing infant mortality. There was actually a plan to do a large scale promotional campaign in the U.S. to get the word out on how breastfeeding can make a difference...but it was gutted by the formula companies. You see, you can't say how good breastfeeding is, without implying that formula is not as good.

I see you've been reading Media Matters. Don't assume it applies to everything.

 

[Skeptic Ginger]

Well if only that were true. Unfortunately it's not. I am not sure how Prevenar (prevnar) got onto the UK schedule for example, after the JCVI looked at the US results. (they initally rejected it 4 months before it was passed) "Willy Nilly" would be a good description I think

What "facts" do you mean?

I'd like to welcome you to the board if I wasn't so tired of this less than informed opinion.

But welcome anyway.

You guys are reading news articles and internet opinions. Try actually reading the extensive decision making hearings and reports.

 

[Skeptic Ginger]

Well, I did answer...I answered with a question, though. ["How can cases of IPD go down three or fourfold, and deaths not decrease?"]

When I was misreading the " * " on the meningitis part, I was thinking it was deaths AND meningitis that had gone up or not changed, ....

There, you said it. That wasn't so hard now was it?

The incidence of the vaccine preventable disease clearly decreased. Whether it had an impact on the overall fatality rate is a different issue and requires more than a simple body count to compare due to multiple variables which have to be sorted out if you are going to claim the vaccine had no impact.

When heart attacks in men went down suicides and homicides went up and the death rate remained unchanged in the very large Framington heart study. So, if men live longer will they just kill themselves with their natural rate of violence anyway? It's not such a simple thing to determine just from the numbers.

 

[Ivor the Engineer]

Skeptigirl,

Why do you think the ACIP recommendations are the gold standard? Can they never be wrong or biased? If I ask electronics engineers for a solution to a problem, they will produce a solution biased toward electronics. If I ask mechanical engineers for a solution to the same problem, they will produce a solution biased toward mechanics. When the ACIP (or JCVI in the UK) give their advice it will biased toward recommending vaccination.

You accuse me of not addressing your points, yet I've not seen you raise any flaws with the cost-effectiveness study done in the UK for the varicella vaccine. Why is that? If you want me to take your arguments seriously, please indicate where you think the experts who did this study got it wrong.

No response once again to the invasive group A strep. You just ignore what you can't address.

No, you just conveniently forgot. I did.

Here's the info. (again):

http://www.ncbi.nlm.nih.gov/sites/e...bmed_ResultsPanel.Pubmed_RVAbstractPlusDrugs2

OBJECTIVES: To describe the incidence and clinical features of invasive group A streptococcal (GAS) disease in children in Ontario and determine the risk of invasive GAS infection following chickenpox. METHODS: During 1992-1996, we conducted prospective, active, population-based surveillance for pediatric invasive GAS disease in Ontario, Canada (population: 11 million; 2.5 million children) and reviewed clinical and laboratory records. RESULTS: There were 1.9 cases of invasive GAS disease per 100,000 children per year. Streptococcal toxic shock syndrome (STSS) occurred in 7% of cases and necrotizing fasciitis (NF) in 4% for incidences of.08 and.13 per 100,000 per year, respectively. Case-fatality rates were 56% for STSS, 10% for NF, and 4% overall. The presence of chronic underlying illness other than asthma was associated with death (relative risk [RR]: 11; 95% confidence interval [CI]: 2.4-45). Fifteen percent of children identified had preceding chickenpox infection, which significantly increased the risk for acquisition of invasive GAS disease (RR: 58; 95% CI: 40-85). Children with invasive GAS and recent chickenpox were more likely to have NF (RR: 6.3; 95% CI: 1.8-22.3). CONCLUSIONS: Childhood invasive GAS disease occurs at an incidence similar to the adult population but has a lower rate of STSS and case-fatality. Chickenpox dramatically increases the risk for acquiring invasive GAS disease, and universal chickenpox vaccination could potentially prevent up to 15% of all pediatric invasive GAS disease.

So chickenpox accounts for 15% of case of GAS in 1.9 children per 100,000 per year, or 1 case per 350,000 children per year. In the UK, that would make up about 34 of the 102 serious complications of chickenpox that occur each year in children. To put that figure into perspective, you are 7 times more likely to be killed walking down the street in the same time period.

We have it, it's called Nicorette gum and the Nicoderm patch.

Nicorette gum and nicoderm patch are nothing like smoking a cigarette.

And BTW, there are many fewer smokers in this country than in the other Western countries I traveled in (England, Spain, and especially Australia.)

In the UK, about 25% of people smoke. According to the CDC, 21% of Americans smoke. Many European countries are introducing a ban on smoking in public places, which should bring the numbers down.

And for the record, nicotine by itself is also unhealthy. It is a vasoconstrictor and has bad effects on the heart as well.

Yes, I know. Most activities carry risks to health. But you seem to be saying nicotine addicts should be forced to take significantly higher risk that necessary to get their fix.

And it's not my idea:

http://news.bbc.co.uk/1/hi/health/7027853.stm

Measles, while the typical reservoir is humans, can infect non-human primates. Are you going to vaccinate all the susceptible primates as well? And delivery of the vaccine to third world children has the barrier that a vaccine which must remain frozen has. That's why we have a worse record when it come to measles vaccine programs in rural areas of third world countries.

So you appear to be saying that we will be vaccinating childrenn against measles forever? That there is no hope of eradicating this disease?

But your plan has soooooo many other holes as to be unrealistic. First, we are trying to vaccinate the world's children against measles. But do you seriously believe people in the developed world are going to give up their children's varicella vaccine in order to pay for someone else's kids' measles vaccines? Why not have those parents give up their SUVs and lattes instead?

If I was told the money spent on vaccinating my single child against varicella was going to be used to vaccinate 3 or 4 other kids against Measles, Mumps and Rubella in the third world, I would support that decision.

If you've been reading some of the other threads you will know that, if it were up to me, I'd bring in minimum standards on fuel efficiency for street-legal vehicles.

I don't drink coffee, but if it's fair-trade then surely parents not drinking lattes would harm as many kids in the third world as it saves?

 

[Acleron]

Skeptigirl,

Why do you think the ACIP recommendations are the gold standard? Can they never be wrong or biased? If I ask electronics engineers for a solution to a problem, they will produce a solution biased toward electronics. If I ask mechanical engineers for a solution to the same problem, they will produce a solution biased toward mechanics. When the ACIP (or JCVI in the UK) give their advice it will biased toward recommending vaccination.

You ask an electronics engineer to solve a problem in electronics.
If you want to ask an expert panel about the validity of vaccination you select people who know a lot about it.

Do you seriously think that the fifteen members sit around a table and start with the proposition. 'Hey, we've got a new vaccine, let's think of a way of getting everyone vaccinated with it'?

Apart from two, they all have academic status and are perfectly capable of reaching good solutions. I know it is almost a pejorative term for some people but these are experts, and unless it is shown that they are biased in their conclusions I'd rather accept their conclusions than those of an unqualified group of non-experts. If you chose a group of anti-vaxxers, then you would see what happens in a group with conclusions already settled before the data is examined.

Of course they could be wrong, but they are less likely than others to be so.

 

[Beth]

Apparently you can't see the error in your logic. I hope other people reading your posts can because it's a doozy.

You claim, there is an "inverse correlation of mortality for children under 5 with the vaccination rate". Is it the term "correlation" you and I are defining differently? In this case, absolutely without a single doubt, there is no "inverse correlation" in vaccine rates and the child mortality rates. The term "correlation" implies you are claiming there is a relationship.

This is complete tripe in no uncertain terms. I really didn't think you were that dense, Beth.

Yes, I understand that there are confounding variables, but the fact that the correlations DO exist imply that there IS a relationship there, one strong enough to show up over time when I looked for it. However, it's perfectly reasonable to claim that vaccines are not the cause of the reduction in child mortality, but something else, such as a general improvement in health services, that is causing both effects. Correlation does not imply causation, only a relationship.

Why are you arguing this point? If there is no relationship between mortality rates and vaccination, why are we bothering with it? I thought it was supposed to be saving lives?

Please stop the insults, or I'll stop responding to your posts. Thank you.

 

[Beth]

You ask an electronics engineer to solve a problem in electronics.
If you want to ask an expert panel about the validity of vaccination you select people who know a lot about it.

Many problems are amenable to different types of solutions. Ivor has a valid point regarding the bias different types of experts have towards particular methods of solving problems.

Do you seriously think that the fifteen members sit around a table and start with the proposition. 'Hey, we've got a new vaccine, let's think of a way of getting everyone vaccinated with it'?

No. I don't think Ivor is suggesting this. I certainly am not when I try to discuss my concerns with bias on the part of the committee that makes recommendations for vaccines. This is basically what is called a 'straw man' argument.

Ivor's point about different types of backgrounds leading experts to different types of solutions is not only a valid point, but a solid argument for discounting (not ignoring) the policy recommendations of the ACIP committee here in the U.S. (I don't know about the U.K.) when they add a new vaccine to the schedule. If the risk of the disease is low for my child, then I am inclined to wait 10 years or more before getting my child the vaccine. That allows additional time for problems to surface and be corrected.

 

[kellyb]

The incidence of the vaccine preventable disease clearly decreased. Whether it had an impact on the overall fatality rate is a different issue and requires more than a simple body count to compare due to multiple variables which have to be sorted out if you are going to claim the vaccine had no impact.

When heart attacks in men went down suicides and homicides went up and the death rate remained unchanged in the very large Framington heart study. So, if men live longer will they just kill themselves with their natural rate of violence anyway? It's not such a simple thing to determine just from the numbers.

Your analogy isn't valid. Reducing heart attacks doesn't cause suicides and homicides.
And I was talking about mortality from invasive pneumococcal disease or bacterial meningitis...not all cause mortality.

I guess the real questions are:
1) How effective is PCV at preventing bacterial meningitis, pneumococcal and otherwise
2) What impact has it had on death from bacterial infections, pneumococcal and otherwise.
If it reduces the vaccine serotypes so well, but the overall trend is not affected, that implies a huge problem with replacement disease.