... I don't trust the experts as much as you want me to. I try to avoid getting into that, because I don't harbor any suspicions about people's motivations. I think that the people that serve on the ACIP are intelligent educated dedicated professionals doing their best to make solid public policy.
But I haven't been happy with what I've learned about that committee over the past twenty years. I not happy about how many of the members of that committee, at least in the past, have had close financial ties with the manufacturers of such vaccines. Ties sufficient to require that many of the members of that committee file for exceptions from the conflict of interest rules in order to serve on the committee.
Either you had bad information or it was before my time in the infectious disease world.
ACIP Committee Member Profiles
Searching the ACIP site for "conflict of interest" I got the following citation: (midway down the page)
CENTERS FOR DISEASE CONTROL AND PREVENTION NATIONAL IMMUNIZATION PROGRAM RECORD OF THE MEETING OF THE ADVISORY COMMITTEE ON IMMUNIZATION PRACTICES June 23-24, 2004 Atlanta Marriott...
It's a WORD DOC describing the meeting minutes:
A.C.I.P. Protocol: The quorum of A.C.I.P. members must be maintained to conduct committee business. The A.C.I.P. Charter allows the Executive Secretary to temporarily designate ex officio members as voting members in the absence of a quorum (eight appointed members) of members qualified to vote. If voting, they are asked to disclose any potential conflicts of interest. Meeting time is reserved for public comment at scheduled intervals, but may also occur during open discussion if a speaker is recognized by the Chair. A.C.I.P. members with potential conflicts of interest are asked to disclose all vaccine-related work and financial interests, and to refrain from any discussion or vote that is related to such matters. When needed, however, limited waivers of such conflicts of interest are granted, to enable members’ expertise to be provided in their service on the Committee. Waivers may be issued, for example, to members who also conduct clinical vaccine trials or serve on Data Monitoring Boards (D.S.M.B.).
The members and liaisons then introduced themselves (see Attachment number 1). Those reporting potential conflicts of interest were Doctor Abramson (a one-time consultation for Merck in 2003), Doctor Poland (Merck and VaxGen), Doctor Treanor (Protein Sciences Corporation, Viscount, MedImmuune and VaxGen, and Doctor Levin (clinical trials for GlaxoSmithKline [GSK], Merck, and Merck’s D.S.M.B.).
Considering how many people are on the committee, whether attending this meeting or not, this can hardly be considered a group with heavy ties to the vaccine industry.
There needs to be manufacturer medical experts involved. Not everyone in industry needs to be viewed with total distrust. A healthy dose of skepticism maybe, but not total suspicion.
For example, there have been huge issues with flu vaccine production quantity. When the vaccine shortage occurred 2 years ago with the loss of Chiron's 50% of the supply, much of the remaining supply of vaccine was already distributed and in private hands. Local health departments issued emergency regulations telling me who I could vaccinate. But the health department didn't take the step of confiscating vaccine. That would have created a legal quagmire. The result was some control over vaccine rationing but not full control. Hospitals did not all have vaccine supplies for the highest risk patients and health care workers.
Since then, public health has changed its relationship with the manufacturers so it has first priority in purchasing vaccines and then controlling distribution. Those details involve a partnership with the manufacturers so of course the manufacturers are involved. And ACIP recommendations have to take into account vaccine supply. They cannot recommend flu vaccine to broader populations unless there is supply to match.
If I am capable of reading a manufacturer's research with appropriate skepticism, these committee members are as well. So to categorize any representatives from the manufacturers on the committee as necessarily suspect would be incorrect. Of course we all hope GW won't install his cronies there like he has in the FDA. If he does, the infectious disease community will protest very loudly.
I'm not happy about the mistakes that have been made in the past. Vaccines that were withdrawn from the market and later replaced with safer versions.
Besides the Rotovirus vaccine that had unexpected reaction in a very few patients, just which vaccines are you referring to? DPT was the best available until a better one produced later. Live polio vaccine is better for controlling large endemic disease burden and the killed vaccine adequate when only imported cases are occurring. Just what are you calling a "mistake"?
I'm not happy about how they never concerned themselves about any potential cumulative effects until the whole thimersol things came up. Maybe thimersol didn't have any bad effects, but it doesn't give me confidence in the committee that they never considered the possibility of a cumulative effect prior to the thimersol debate coming up. Are there any other possible cumulative effects that ought to be looked at prior to putting a vaccine on the schedule? I don't know and I no longer trust that they do.
Again, absolutely untrue. VAERS is geared toward acute vaccine reactions but that doesn't mean it is the only monitoring of vaccine safety and effectiveness that goes on. There was no reason to address thimerisol until more recently. There is not a single case of a thimerisol caused adverse reaction except allergic reactions, no matter how many people believe there are. And allergic reactions have been addressed quite a ways back.
Thimerisol was removed for two reasons. One was that
future additional vaccines could raise the cumulative dose, and the second was mostly PR. The fuss over autism and vaccines has truly put kids at needless risk.
In Indonesia and some African countries, there is a substantial number of people who believe the polio vaccine is secretly making Muslim women sterile. There are polio epidemics resurging in several countries. I assume that sounds absurd to you, but can you see the parallels to other versions of suspicion of vaccines?
I think it's a fascinating but unfortunate occurrence. Why are people suspicious of vaccines? There aren't equivalent movements of anti-antibiotic believers? There are anti-medicine groups suspicious of all modern medicine but there aren't specific targets like vaccines are.
Chickenpox vaccine has actually been out long enough I feel pretty confident about it. .... But I find the disease pretty innocuous too. The risk of serious adverse effects is very low. So, I'll wait....When he gets old enough to be sexually active, I'll inform him of the possibility of contracting various STD's and that there is a vaccine for Hep B if he wants to get vaccinated....
Given the increase in immigrants in this country from countries with high rates of hepatitis B, I wouldn't wait on that one. Sexual intercourse is not the only place an exposure can occur. I provide exposure follow up for a couple of school districts. I've had disabled kids who bite, bloody noses where the gloves could not be found, kids sticking each other with tacks or putting tacks on chairs, one case where some kids stole another's epi-pen and a janitor ended up with the needlestick after the kids left it sticking through a plastic trash can but otherwise hidden, and one case where a well meaning but unthinking teacher used a child's glucose testing device on another teacher thought to be having a severe hypoglycemic episode. It didn't dawn on the teacher that diabetics use their lancets more than once.
Then there's the Dept. of Transportation here that tells me they fill about 6- 1 gallon sharps containers a year from syringes thrown onto the side of the road. And there are the parks departments and the shopping mall that have all had needles found which they called me about. My neighbor brought me a box of unused syringes her child found on the school grounds. The barber shop nicked my son's skin with the clippers that aren't supposed to break the skin and of course their disinfecting procedure isn't done on the clippers between every customer, nor does Barbicide do a very good job on hep B virus. And I had a construction company call me for an exposure. A guy was bleeding from a common injury they experience, and was on a ladder with a guy underneath handing him something when the blood dripped in the lower man's eye.
Here are a few more. The retail garment industry here had the union insist each person be given their own stapler or whatever it was they were clipping tags on clothes with because they got concerned at how often the device nicked their fingers knowing the same devices were shared by everyone. Some people think nothing of rinsing a toothbrush and sharing it. Once at a sleepover another mother had my child brush with a used toothbrush because he didn't have one. But she "washed it"
So far, cases of hep B have been low from these kind of events. But the events are very common and the increase in the population of hep B carriers really needs to be looked at. HIV and Hep C are not spread with minute amounts of blood like Hep B is. I think that's why people have not considered these casual blood exposures to be common or worrisome. But I get called when they happen so I know how common they are.
The hep B vaccine has been in use since ~1980 here and a couple of years before that in Taiwan where it has been used in the general population (meaning in kids) for 30 years now. Newborns have been receiving the vaccine for >10 years. The vaccine has one of the lowest rates of adverse reactions.
I think you are mistaken to risk wild chickenpox virus over the attenuated vaccine strain. The vaccine just ensures a mild case, there isn't some big mysterious immune system reaction. It's like breeding a different dog, it's still a dog.
... I just don't trust the 'experts' who make the recommendations as much as you do and thus, I rate the potential unknown harm of vaccines considerably higher than either you or they do....
.... maybe in 5 years, we'll be reading headlines about how the chickpox vaccine has been discovered to be linked to some serious adverse outcome. ... I wouldn’t be terribly surprised to see headlines about some vaccine at some point in the next few years. Thus, I give that risk a higher probability than apparently anyone else reading this thread. High enough that I’d rather risk my child coming down with chicken pox versus getting him vaccinated at this age.
....In statistical parlance, I’m lowering alpha (type I error probability) in order to increase beta (the power of the test) by adjusting the risk I’m willing to tolerate from disease to compensate for the bias I perceive in the committee that makes the recommendations. Sorry for the technical derail. I just got caught up in trying to explain why I feel the way I do.
It may just be time to revisit that belief about the committee. Maybe if you find more cause to be concerned you could share it with us. I was really disgusted to find out the FDA had Bush appointees and the CDC now has a 'faith based' issues web page. Raven commented that she believed the committee's information to be biased but never identified any specific incident or preponderance of citations on one side while omitting citations with counterpoints.
Not only do I have confidence in the ACIP, they spell out every detail of their decision making rationale for all to evaluate. Why rely on experts when you can look directly at the evidence? You think it's the value assigned to potential risk. In reading your posts, you have not talked about the actual potential risks as much as distrust of vaccine manufacturers, distrust of the ACIP, and distrust of the information provided by those sources. That leads you to perceive a potential risk. The way I assign a value to potential risk is to look at the vaccine research, not at the experts. Get rid of the middleman. Explain to yourself why you wouldn't hesitate to take an antibiotic, (I assume), but you think about vaccines differently.
You are still "perceiving" the risk based on beliefs about vaccines and/or the ACIP rather than on the evidence. It isn't a matter of I trust the committee more than you. It's a matter of the numbers. The chickenpox vaccine has never killed 100 people a year, or the relative equivalent. The vaccine strain can have a breakthrough rash but no cases of secondary infection with invasive strep or drug resistant staph have to my knowledge been reported. Post vaccine shingles has occurred but then post infection shingles most definitely occurs as well. Of those 100 deaths, didn't the citation in my earlier post say 40% were kids?
Well maybe one little edit. I am waay too compulsive....must go to bed.....
