The Age-Old Struggle Against the Egghead Do-Gooder

Recently Dr. Gregory Poland* wrote an article for the New England Journal of Medicine entitled The Age-Old Struggle against the Antivaccinationist. In the piece he labeled anyone questioning the use of vaccines as essentially half-wits, incapable of thinking or acting for themselves. The doctor claimed:

Today, the spectrum of antivaccinationists ranges from people who are simply ignorant about science (or “innumerate” — unable to understand and incorporate concepts of risk and probability into science-grounded decision  making) to a radical fringe element who use deliberate mistruths, intimidation, falsified data, and threats of violence in efforts to prevent the use of vaccines and to silence critics. Antivaccinationists tend toward complete mistrust of government and manufacturers, conspiratorial thinking, denialism, low cognitive complexity in thinking patterns, reasoning flaws, and a habit of substituting emotional anecdotes for data.

Luckily, Dr. Poland has a solution for our intellectual failings: he's going to think and make decisions for us.
With the goal of making this solution acceptable - and to defend any challenges to the vaccine establishment upon which he depends - he uses his article to further disparage "antivaccinationists" and, likely referring to a number of death threats Paul Offit has received, expresses concern over “a radical fringe element who use…threats of violence in efforts to prevent the use of vaccines…”

Dr. Poland apparently feels it’s only appropriate to use force to compel the use of vaccines. After all he directs no criticism towards states that use threats of violence to coerce parents into vaccinating their children: the most egregious recent example of such behavior occurred in Maryland in 2007. The Washington Post, in a story entitled Get Kids Vaccinated Or Else..., reported:

The parents of more than 2,300 Prince George's County students who failed to get needed vaccinations could face fines of $50 a day and up to 10 days in jail if their children do not meet the state's immunization requirements, county officials said yesterday..

Poland then, in an effort to create fears about what would happen if large numbers of people decided not to vaccinate, mentions an increase of pertussis incidence that occurred in the 70s and 80s when DTP vaccination, due to safety concerns, either declined or ended in countries such as England, Japan and Sweden, He fails however to report that actual pertussis deaths remained low, hovering from single to low double digits - numbers comparable to those occurring in highly vaccinated populations

He goes on to imagine that, "the H1N1 influenza pandemic of 2009 and 2010 revealed a strong public fear of vaccination, stoked by antivaccinationists

Due to his love of vaccines, he's unable to get his [egg] head around the idea that, despite the endless and fanatical hype, his miracle drugs are simply unwanted. For him, only someone mesmerized by a “movement” or caught up in a wave of “fear” could turn down a flu shot.

Returning to the fear mongering, he repeats the Paul Offit / Seth Mnookin myth that Andrew Wakefield’s 1998 MMR / autism study has led to low vaccination rates and as a result the California pertussis epidemic of 2010

Then in an attempt to find a solution to the troublesome antivaccinator Poland asks "…what can we do to hasten the funeral of antivaccination campaigns?"

His answer, "first, we must continue to fund and publish high-quality studies to investigate concerns about vaccine safety.

Oddly, Dr. Poland imagines studies conducted with the expressed purpose of achieving a political end, in this case hastening the funeral of antivaccination campaigns, could in anyway be though of a “high quality.”

And where would Dr. Poland get the funding for his “high quality” studies? Most likely from the vaccine industry itself – after all, his Mayo clinic received in 2008 over $300 million dollars from government and industry.

Another way to hasten the funeral of antivaccination campaigns is, according to the doctor, "public education and persuasion." In other words propaganda - since this education is goal, rather than knowledge, oriented. These definitions of propaganda are enlightening:

information that is spread for the purpose of promoting some cause

Propaganda is a form of communication aimed at influencing the attitude of a community toward some cause or position. As opposed to impartially providing information, propaganda in its most basic sense, presents information primarily to influence an audience. ...

Wanting to eggsamine what drives his eggstremism, I turned to the internet and found a revealing Mayo clinic article detailing a disturbing portrayal of fanticism. The article's sycophantic author reported:

Dr. Gregory Poland is at once a warrior and a healer. He needs to be, he believes, because the war is real—too real—and the enemy is relentless.

In Dr. Poland's war, there are no rules of engagement; anything goes. The enemy is what Dr. Poland calls "unwarranted death." These are deaths caused by infectious diseases that could have been prevented by vaccinations. It is an enemy that is as ruthless as it is resourceful. Says Dr Poland:

"I was born into a Marine Corps family, and I spent my childhood growing up on military bases. As I went through medical school and residency, I knew right then and there that the warrior I was meant to be was the warrior taking on infectious diseases, to prevent them—because I just have a really hard time with death. Unwarranted death, the unexpected death."

He describes those wanting to choose whether or not to have their children medicated as a “radical fringe element” yet his own words reveal him to being far more radical than any so-called “anti-vaccinator”

Do-gooders such as Dr. Poland are perpetually at war; fighting drugs, poverty, obesity and the like. But as blogger and author Christopher Chantrill points out:

when you conduct domestic politics using the moral equivalent of war metaphor you do not just conduct a War on Poverty or a war for Energy Independence. Wars are not conducted against an idea but against people. You end up making your fellow Americans into a hated enemy.

Conduct your war Dr Poland; just do it without me. For when you force people to participate, your War on Bugs becomes a war against the very freedom upon which this country was built.

* The article was coauthored by Dr. Robert Jacobson. This post focuses on Dr. Poland because, based on his history [described below] it's my belief that he is the driving force behind the piece.

Dr Poland

Serves as the President of the International Society for Vaccines. The groups aim is "to encourage, establish and promote the development and the use of vaccines..."

He's the American Editor for the journal Vaccine.

In 1998, he received a joint award from the Centers for Disease Control and Prevention and the Health Care Financing Administration for his contribution to increasing adult immunization rates in the U.S. which was awarded by the Surgeon General of the United States.

He's a member of the National Network for Immunization Information's steering committee

Dr. Poland participates on many national and academic review committees and actively peer-reviews journal articles for over 26 different publications such as The Lancet, Annals of Internal Medicine and New England Journal of Medicine.

A prolific writer, Dr. Poland has published over 160 peer-reviewed scientific articles and book chapters.

Quackery Has Its Rewards

Last week I blogged about a number of either false or misleading statements made by Nancy Snyderman (pictured above) over the years regarding vaccines and infectious illnesses. I was embarrassed for her and thought others would be too. Yet one group, immunize.org, instead of distancing itself from her wild ramblings, has chosen instead to embrace and celebrate them. They thought it fitting to issue Nancy a letter of appreciation for deceiving parents

Here it is:

Letter of appreciation to Dr. Nancy Snyderman, MSNBC's Chief Medical Editor, who appeared on The Today Show to discuss the recent pertussis outbreak in California and the dangers of vaccine exemptors and how they put others around them at risk of disease outbreak as well.

July 29, 2010

To Dr. Snyderman and producers of The Today Show:

On behalf of the entire staff of the Immunization Action Coalition, ... I'd like to thank you for your vigorous advocacy of the power of vaccination to save lives, most recently in your appearance on yesterday's Today Show discussing the current pertussis spike concentrated in California.

The urgency you feel is palpable. We applaud your forthright and fearless condemnation of the false beliefs that lead people to reject vaccination. We wish that all medical correspondents discussed immunization issues with such clarity. It was particularly helpful that you mentioned pertussis vaccination is not just for children, but that adults also need booster doses to protect the infants and immune-compromised individuals around them.

No parent who saw your segment yesterday could fail to appreciate that vaccines are vital and that vaccine refusal is a life -threatening violation of the social compact. While we struggle to communicate this message effectively, you accomplished it with panache. Again, thank you for informing the public so powerfully about the deadly threat of pertussis.

With appreciation,

Lisa H. Randall, JD, MPH
Associate Executive Director


Why shower praise on such demonstrably false statements? Because immunize.org, funded by pharmaceutical companies and advised by Paul Offit,  is interested, not in truth or accuracy when dealing with parents. They're interested in one and one thing only: moving vaccine. Snyderman is simply a tool that can communicate all of the Machine's ridiculous talking points to a wide audience.

Ironically, when the vaccine pushers warn of the "misinformation" on the internet, they, to "protect" us, recommend credible sites from which to garner information. Immunize.org is a mainstay of those lists. So much for credibility.

Snyderman's letter of appreciation further demonstrates that those supporting vaccination are not independent agents all recognizing independently the value of the vaccination. They are instead cogs making up a single, and single-minded, entity: The Vaccine Machine.

Trust Me, I'm a Medical Corporation

Yesterday it was reported that Guidant LLC, a maker of heart defibrillators and a division of Boston Scientific Corp, was required to pay a $296 million fine - the highest ever levied against a medical products company - to settle charges of deceiving regulators in regards to a 2002 and 2004 recall involving a number of its defibrillator products. No patients were directly harmed by the deception but the Associated Press did report:

Guidant officials made deliberate decisions to conceal information from regulators.

Guidant came clean only after two Minnesota doctors — investigating the death of a 21-year-old patient whose defibrillator short-circuited — went to the media upon learning that the company did not reveal the product defects.

The company eventually pleaded guilty to submitting a false and misleading report to the Food and Drug Administration about one defibrillator model

Sadly, whenever I hear a story like this emerging from the world of medicine, I can understand why more and more of us are becoming less and less likely to trust to those who prove themselves to be, on a regular, almost daily basis, so untrustworthy.

Nancy Snyderman Exposed

I became aware of Dr. Snyderman in 2009 when she asked:

“What are we going to do to address the crazy people….who’ve decided that vaccines are not good enough for their kids?”

Last week she, along with a number of vaccine fan boys and cheerleaders, blanketed the airwaves extolling the virtues of vaccination and the imagined consequences befalling those failing to embrace the practice. I thought today we'd take a look at her recent comments as well as reflect on what Snyderman's had to say about vaccines and infectious illnesses over the last several years. Doing so should allow us to discover who the crazy one really is.

On Tuesday of last week she appeared with Matt Lauer on a Today Show segment entitled Prepare for Winter Illnesses . Matt wanted to know the difference between having the flu and having a cold. The ever- authoritative (yet consistently incorrect) Snyderman replied, when you have the flu you’re “usually out of work for two weeks”. Two weeks? Really? That seems strange. After all when I was a school child none of my classmates missed school for two weeks due to the flu. And have you ever heard of or seen a hockey or basketball player missing two weeks of their season due to the flu. Do news anchors or anyone else appearing on live TV generally disappear from our living rooms for two weeks each winter? Sadly, there seems to be nothing supporting Dr. Snyderman’s wild claim. But wait those are just anecdotes. Have any studies been done. Well, I’m glad you asked. This is from Flu Prevention Partners, a site encouraging flu vaccination: 

Flu: Work Loss (days/case): Work Loss Days are the number of work days absent, per episode of influenza illness. A study of the impact of influenza and influenza-like illness on productivity and healthcare resource utilization in a working population by Keech, et al. found that the mean of lost workdays was 2.8, with a range of +/- 2.0. 

The discussion then moved to whooping cough. When Matt asked if it could develop from a cold she replied it's a different virus - since pertussis is a bacterium, she again demonstrated she knows as much about infectious illness as she does vaccination: nothing.

Matt then asked why we’re seeing whooping cough outbreaks. Nancy gave two answers that, as could be expected, were both demonstrably wrong. Answer one was that it was Winter and were all inside coughing on one another. Unfortunately for Nancy, pertussis’ peak season is, according to the Textbook of Pediatric Infectious Diseases, between July and October.

Nancy’s second answer was as predictable as it was incorrect: vaccine refusal and pockets of unvaccinated children. Here's a quote from her that appeared last week on the Today Show's website expounding on the her explanatory fantasies. She wrote:

Since that first erroneous report [a study linking the MMR vaccine to autism] was published, we have seen outbreaks of measles and whooping cough in various cities around the country. In fact, California in 2010 broke a 55-year-old record for the number of cases of whooping cough. That's directly related to parents who haven’t vaccinated their children.

But pockets of unvaccinated children did not cause or worsen the 2010 outbreak. The real reasons for it were increased awareness and weak vaccine. I addressed this issue last week but thought a few more bits of evidence would be of interest. A 2008 article appearing in Future Microbiology entitled Factors Contributing to Pertussis Resurgence stated: 

A resurgence of pertussis is observed in highly immunized populations. Many studies have shown that the causes for the resurgence are multiple, such as increased awareness of disease, use of better diagnostic tools, improved surveillance methods and waning vaccine-induced immunity. 

While the Mayo Clinic offered this explanation:

Whooping cough is thought to be on the rise for two main reasons. The whooping cough vaccine you receive as a child eventually wears off, leaving most teenagers and adults susceptible to the infection during an outbreak — and there continue to be regular outbreaks. In addition, children aren't fully immune to whooping cough until they've received at least three shots, leaving those 6 months and younger at greatest risk of contracting the infection. 

And according to the California State Department of Health, as of March 2010

Vaccination coverage in California is at or near all-time high levels 

Finally immunizeca.org reports:

Pertussis is the only disease that despite high levels of vaccination in early childhood continues to remain widespread in California

Nancy concluded the segment by going into a vaccination sales pitch, imagining pertussis to be totally preventable with a simple childhood vaccination. Yes Nancy, all we need is the initial series of three shots at 2, 4 and 6 months, then one at 15-18 months, then one at 4-6 years, then one at 11, then an adult shot and then one possibly  every ten years thereafter.  

Maybe Nancy was just having a bad week. Maybe previous TV appearances show her to be knowledgeable and authoritative Let's travel back in time and see.

In 2010 she reported on a number of measles deaths in Philadelphia. These deaths turned out to have been nothing more than figments of her own vaccine-drenched imagination. She repeated the claim in February 2010 on Morning Joe:

Right now we have children dying in the united states of America from measles, mumps…

While in May of 2009 Snyderman appeared on a particularly misleading and error-riddled segment Today Show segment. The hype began with NBC imagining a non-existent scenario:

As more parents are choosing to refuse immunizations, at least one serious childhood illness is on the rise. NBC’s chief medical editor Dr. Nancy Snyderman talks with TODAY’s Meredith Vieira. 

Meridith began:

According to recent studies an increasing number of parents are refusing vaccines…and new research out this morning says that decision has led to a sharp increase in at least one serious childhood illness.

The entire statement was either false of misleading. First there's the problem with the implication that an increasing number of parents are refusing vaccines. Here's why. If for example if 5,000 more parents fill out an exemption form (remember, the population of children in California is almost ten million) and the exemption rate goes from 1 to 2% the overall rate can rise due to other factors occurring in the community. It's therefore disingenuous to imply "more parents are choosing to refuse immunizations" when one could just as easily, and more accurately, say increasing numbers of parents are choosing immunization.

Second, the research to which Meridith referred said nothing about "a sharp increase in at least one serious childhood illness". The study to which she referred simply reported and association between unvaccinated children and an increased likelihood of contracting pertussis(these unvaccianted children were,as opposed to vaccinated children, three times more likely to be tested for pertussis when presenting with an upper respiratory infection and therefore more likely to be diagnosed) So Viera's "new research" did not say there were enough of these children  to offset generally high vaccination rates elsewhere and therefore set the state ablaze.

The two ladies then engaged in a discussion of pertussis then Nancy misinformed Meridith that pertussis was “an easily to die from illness” but failed to explain how that made any sense when, out of one million estimated cases each year, only ~20 deaths occur. Perhaps she was estimating severity based on only reported cases. But during last years California epidemic only 8 deaths occurred out of ~8,000 cases.

Finally, she, echoing her theme of last week, went on to lament:

“We nearly wiped it[pertussis] out but we’ve become complacent and now so complacent such that in 1994 there were about 1000 cases of whooping cough in this country a decade later 26k cases” Yet she did not elaborate as to how we became so complacent when rates were and are at all-time highs?

The lesson Snyderman drives home is that those comprising the Machine, regardless of qualification or so-called expertise, have either no idea what they're talking about or no compunction about misinforming parents in order to simply move more vaccine off the shelves.

I Love This Baby!

Fluoridation: From Miracle to Debacle

Today the government finally concluded it could no longer pretend it's actions didn't cause damage to the teeth of millions of American children. It admitted to what I, and other critics of the practice of fluoridation, have been saying for years: fluoride harms children

MSNBC reports:

Too much fluoride in water, government says

High levels causing spots on teeth; recommended limit to be lowered 

...the splotchy tooth condition, fluorosis, is unexpectedly common in kids ages 12 through 15. And it appears to have grown much more common since the 1980s.

As one who criticizes the government for clinging to practices already in place in order to save face, I must commend The Department of Health and Human Services for admitting that the public health miracle of fluoridation has actually been harming America's children for decades

Their decison to change fluoridation policy - a tragic mistake from the beginning - is a scathing indictment of the public health activists who first implemented the misguided and foolish policy of adding a toxic chemical to our children's drinking water.

AC Mnookin 5150

Yesterday I had the great pleasure to come across, in both print and on TV, vaccination's newest fan boy: Seth Mnookin. Mnookin, a former music critic, has just written The Panic Virus: a forthcoming book exploring the controversy surrounding vaccinations and autism. I’d just finished reading a Newsweek article he’d written when I noticed that CNN’s Anderson Cooper was hosting a segment on the topic of Mnoonkin’s book: vaccines and autism. The article, and appearance with Cooper, found Mnookin reciting a number of vaccine establishment talking points (if these guys were in high school they’d all get kicked out for copying each others work) Chief among these talking points was that vaccination rates are "plummeting" and this is causing, throughout the country, enormous suffering and death.

There’s only one problem with Mnookin's scenario: vaccination rates are today incredibly high.

In September 2010 Anne Schuchat, M.D., director of CDC's National Center for Immunization and Respiratory Diseases stated

it's encouraging to see immunization rates remaining high...Nearly all parents are choosing to have their children protected against dangerous childhood diseases through vaccination," 

As a result of a mismatch between reality and expedience the establishment has found it necessary to create a scenario in which a decline – no matter how small - in one segment of the population has the power to offset high levels of compliance in the larger population

These small declines - significant statistically but miniscule in terms of actual numbers - are purported to be taking place in "enclaves" of affluent and well educated. The "enclave" claim serves not only the purpose of perpetuating the myth that vaccination rates are collapsing but that those responsible for the non-existent collapse are somehow strange, different and weird. Not like the rest of obedient America

One particular result of the imagined disintegration of vaccination rates is, according to Mnookin, a pertussis outbreak which occurred in California in 2010.

But when we step outside of the world of fantasy and into the one of reality we find it’s The Enclaves of Affluence thesis that disintegrates. Here’s why:

The brunt of the epidemic was borne, not by the affluent, but by Hispanic Americans, a group whose median income is about half that of non-hispanic whites. According to ABC News

Three-quarters of hospitalizations occurred in infants younger than 6 months, and of those, three-quarters were Hispanic

And nine of the ten deaths in California were in Hispanic children. This even though the group comprises only 37% of the state's population

Additionally The New York Times in a story entitled "Vaccination Is Steady, but Pertussis Is Surging" reports

The rise in pertussis doesn’t seem to be related to parents’ refusing to have their children vaccinated for fear of potential side effects. In California, pertussis rates are about the same in counties with high childhood vaccination rates and low ones. And the C.D.C. reports that pertussis immunization rates have been stable or increasing since 1992.

Nothing about enclaves, pockets of non-compliance or increasing exemptions

What then are the real reasons for this recent outbreak? They're quite simple and, unlike the enclave argument, have actually evidence supporting them.

The Vaccine Isn’t Very Good

An initial series of five shots administered between the ages of 2months and 6years is followed by a booster at ten or eleven. Then a single adult vaccination that may, according to Dr. Mark Sawyer, a pediatric infectious disease specialist at the University of California San Diego, eventually be given every ten years. That is until at some point our public health masters simply hook up to a pertussis vaccine IV

So what is it that we get for all these injections? Well according to Michael Sicilia, a spokesman for the California Department of Public Health “the pertussis vaccine isn't perfect and its protection wanes after about five years.”

And even five years of protection may be an overly optimistic assessment. According to The San Diego Union-Tribune

Health officials launched the study after realizing that a significant number of 7- to 10-year-olds who got the recommended five-dose series of pertussis immunizations between the ages of 2 months and six years are coming down with whooping cough this year. 

Unfortunately this “protection” pales in comparison to natural immunity. According to a study appearing in PLOS Pathogens:

Our results support a period of natural immunity that is, on average, long-lasting (at least 30 years) but inherently variable. 

In light of the above, it’s not surprising that between 66 and 75% of cases were in the vaccinated

Adults Don’t Want It 

Normal adults, not just those living in enclaves, don't want the pertussis vaccine. According to the CDC just 6-14% of adults have received it.

San Diego public health officials claim:

...we need 90 percent of the population to be vaccinated to have sufficient group immunization... based on our surveys in San Diego, we believe that just 10 percent of adults have had the booster. 

A Million Unreported Cases Each Year 

It been long known that every year there are several million cases most of which go undiagnosed. According to a 2003 commentary appearing in Pediatric by leading pertussis expert James D. Cherry, MD:

There are about 1 million cases of pertussis in adolescents and adults in the United States each year and about 13% of all prolonged cough illnesses in adolescents and adults are attributable to B pertussis infection.

It's hard to have herd immunity when the herd has pertussis.

The Normal 5 Year Cycle

Pertusis epidemics occur in cycles of approxamately five years. The last epidimic in 2005 lead to eight deaths in California: almost the same number as 2010. For the country as a whole, it appears overall deaths in 2010 will fail to exceed 2005's total

Mom's with Vaccine-Induced "Immunity"

If you contract pertussis at ten and therefore obtain at least thirty years of natural immunity, it's unlikely your baby will contract the illness from you. If on the other hand, your vaccine-induced immunity was obtained at eleven, your five years of protection will have expired by the time you have children.

So based on the evidence, it seems Mnookin's borrowed thesis is not a viable theory but rather a simple contrivance designed to do nothing more than push more and more unwanted vaccine on a skeptical public

Overtreat Me

MSNBC reported yesterday on yet another overused medical intervention that may be putting our children at risk. The headline read “kid's radiation exposure is common and dangerous” while the story reported

The first large study to examine the use of X-rays, CT scans and other medical radiation in children estimates the average child will get more than seven radiation scans by age 18, a potentially worrisome trend.

More troubling is a child’s unique vulnerability to these tests

Children's developing tissues are more sensitive to radiation and their longer life spans allow more time for risk to build up. 

The main source of concern emerging from the study was the use of CT scans

And while the MSNBC piece does not state directly that these tests are being over-performed other sources have addressed the issue. In 2007 USA Today quoted the author of a study examining the necessity of these tests: 

About one-third of all CT scans that are done right now are medically unnecessary," says David Brenner of Columbia University, lead author of the study reported in today's New England Journal of Medicine.

As to the possible consequences, the paper went on:

Overuse of diagnostic CT scans may cause as many as 3 million excess cancers in the USA over the next two to three decades, doctors report...

  

Further, in August of last year, Fierce Health care reported on a story appearing in the Chicago Tribune quoting doctors expressing their concerns over excess radiation attributable to CT scan overuse:

Children often have scans at other hospitals that were not needed or the right area wasn't imaged, said Dr. James Donaldson, chairman of medical imaging at Children's Memorial. Worse yet, many scans involve high radiation doses that weren't adjusted for a child's size or weight.

  

This in not to say CT scans and other radiation-emitting procedures should always be avoided. Time magazine’s Dr. Scott Haig, in 2007, examined the radiation issue in its entirety and in regards to evaluating the appropriateness of CT scanning had this to say:

  

CT is absolutely necessary with head trauma and acute abdominal conditions. Minutes can make a difference in these cases — if, say, there's bleeding around your brain and you can't get an MRI — and the speed of a CT scan makes it worth the risk. But in most other situations, it's wise to let the doctor convince you it's worth it, before consenting to the scan
 

The wheels of medicine turn slowly so institutional change is unlikely to arrive anytime soon. Therefore if you find yourself in a situation that my require radiation exposure, make the medical professionals with whom you deal aware of your concerns regarding the capricious and improper use of radiation-emitting devices. After all, the more informed and aware we are as patients the better we can navigate a medical system that does not always act either rationally or in our best interests.