The Anti-Vaccine Movement Is A Preventable Disease

Once again, vaccination is back in the news. On the heels of a new law passed in California that requires children to be vaccinated in order to attend schools and daycare centers, a woman in Washington has died of measles, marking the first death from this disease since 2003. The law also spurred shortsighted tweets from celebrities who think they are infectious disease experts, such as Jim Carrey (Dumb and Dumber, no pun intended), all of which have been thoroughly debunked. In light of this series of recent events, we're re-running Dr. Mark Lasbury's post on the anti-vaccine movement - consider it a "booster" shot. --Bill Sullivan

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Scientific data can be interpreted many ways. That’s why scientists have conferences, to hash out the different reasons behind some observation…. plus the buffets and travel. One of the most famous arguments over interpretation of data was a series of debates between Albert Einstein and Nils Bohr at the Solvay conferences concerning the nature of quantum mechanics.

Bohr side held that at a quantum level, particles were undetermined until observed; the quantum world was one of probabilities, not observable realities. Einstein retorted, “God does not play with dice.” They both had the same data and they both agree on the data – it was the interpretation that was being debated (Bohr turned out to be right).

Because of multiple interpretations, science doesn’t like to say, “A caused B,” or even, “A correlates with B” unless they have the data to prove it. Premature interpretation can lead to bad data, bad hypotheses, and bad conclusions. And since so much of our culture today is based in science, bad conclusions lead to bad policy.

This means that when NO data exists to support a hypothesis, scientists have a duty to speak out against those making wild assertions. Especially when it leads to dangerous conclusions and actions. Vaccines causing autism is such a situation.

Just this week another scientific paper in the vaccine/autism controversy was withdrawn. A biochemical engineer named Hooker took data from an older CDC study and reinterpreted it. The CDC study had found no link between MMR vaccine and development of autism in children around two years old. They had looked at many factors to see if it occurred in subsets of patients as well, including race. But Hooker’s reanalysis showed that early MMR vaccination in African American boys was related to higher incidence of autism.

Lies, damn lies, and statistics. Do you really think organic

foods cause autism? Well there’s the data. CORRELATION

DOES NOT IMPLY CAUSATION.

The paper from Hooker was withdrawn by the editors of the very obscure journal Translational Neurodegeneration because there are serious questions about his methodology and conclusions. Many scientists argue that if you parse the data in enough ways and do it enough times, you will always find a statistically significant number somewhere. As Gregg Easterbrook of the Atlantic Monthly said, “Torture numbers enough and they’ll confess to anything.” The question is whether it actually means anything.

For Hooker (the father of an autistic boy who he describes as "vaccine injured"), this meant taking a case control set of data and running a different style of study with the data (a cohort study). Also, his choice of statistical tests was wrong and he ended up comparing diagnosis at different ages instead of vaccination age versus diagnosis. Of course he found more autism diagnosis at 36 months than at 24 months – autism isn’t usually diagnosed until about 36 months! A great discussion of flaws in this paper is found here.

The vaccine/autism controversy started in the 1980’s, when the Urabe strain of mumps was being used in the MMR. But this was related to other brain lesions, not autism. Andrew Wakefield really got the ball rolling in a Lancet article in 1998. His conclusion was that the triple vaccine was the culprit and it should be given one at a time – anecdotally, the parent so his 12 subjects had said that autism started within days of their vaccination around 14 months.

Thimerosal used to be used as a preservative in vaccines.

It is 42% mercury by weight, and this used to be blamed

for autism. However, even though many studies have

shown it was not harmful, it is no longer used in

vaccines in the West.

Wakefield followed the idea that the MMR should be given separately with papers in 2001 and 2002 that said vaccination should be stopped and that vaccine had been found in the gastrointestinal tissues of children he said had “autistic enterocolitis.” But the papers included no new data, they were just rehashes of his initial paper with more dire conclusions. The media picked on these and more than 1500 articles were written about the “controversy” in 2002.

His co-authors withdrew their names when it became apparent that something was hinky – he was getting paid by a law firm that was suing the vaccine manufacturers (to the tune of a half million dollars). But he stuck by his guns. Then it was discovered that he was a major investor in a company ready to roll out vaccine-alternative products.

Then his data was reviewed in 2009 and was found fraudulent. He had manipulated data, including changing tissue sample results and making up parts of the histories of his child subjects. His license to practice medicine was taken from him in 2010 and I can’t for the life of me figure out why he isn’t in jail.

Anti-vaccine proponents say that vaccination during the months before two years of age alters the development of the brain and predisposes to autism spectrum effects. However, all the data on brain development suggests that the alterations that lead to autism take place in utero either as a result of genetics, trauma, or toxins – long before vaccination takes place.

The news isn’t all bad with autism. The new paper concerning

mTor has an upside. An antibiotic called rampamycin can

restore mTor activity and bring back synaptic pruning. The

authors ay it is reducing autism symptoms in mice, including

adult mice. You see the needed reduction in neural connections

in the above cartoon is between 2 and 4 years of age – right when

autism is diagnosed.

This includes a very recent paper that links autism to defects in a protein (mTor) that works to cut back synaptic connections in the developing brain. Too many connections leads to altered brain function and all too often, autism. But these changes are prior to vaccination or around time of autism recognition.

Research using 1^st birthday party videos shows that many children show signs and symptoms of autism by 12 months, many months before most parents see the signs and a full year before autism can be reliably diagnosed. This may be a reason that people anecdotally link vaccines and autism – parents note it about the time a good number of vaccines are given. Some parents see it later using videos and use this regression of ability to damn vaccines - but the mTor paper addresses this well.

Unfortunately, some parents have used the erroneous data to draw a dangerous conclusion – they shouldn’t vaccinate their children. This has led to outbreaks of whooping cough, measles, mumps and other preventable diseases.

You might say that it doesn’t matter; if some parents choose not to vaccinate, then they're only hurting their own kids - but that isn’t so. For a small percentage of the population, especially the young and old, vaccination may not work properly or completely. This doesn’t matter if everyone vaccinates, because the presence of the disease in the population will be so low that their chances of being exposed remain low.

Jenny McCarthy has a son with autism. One can’t blame her

for her initial conclusion that vaccines might have been

involved, since fraudulent papers were out there. Now we

know better, but she hasn’t altered her “view” (although

she claims she has). Too often, I think we look for

something to blame.

But when more people that choose not to vaccinate their children, the presence of the disease goes up. Those who were vaccinated but did not receive full immunity, elderly patients who have lost some of their immunity due to an age-related decline in immune function, and even those people who are immune suppressed due to cancer or immune related diseases then run a much higher risk of being exposed.

Therefore, the “policy” of non-vaccination by some parents is flawed, in that there's no evidence to support their reason for withholding the vaccine, and because it injures other people in the community. Not a big deal? Mumps in adolescent and adult males can lead to sterility.

That isn’t scary enough? Then maybe it will be your child who isn’t as protected as they should be and becomes one of the 150 people a year who die each year of complications due to chickenpox, just because little Johnny’s mother “concluded” that vaccines were dangerous.

 

Contributed by Mark E. Lasbury, MS, MSEd, PhD

As Many Exceptions As Rules

 

Hooker, B. (2014). Measles-mumps-rubella vaccination timing and autism among young african american boys: a reanalysis of CDC data Translational Neurodegeneration, 3 (1) DOI: 10.1186/2047-9158-3-16

Tang G, Gudsnuk K, Kuo SH, Cotrina ML, Rosoklija G, Sosunov A, Sonders MS, Kanter E, Castagna C, Yamamoto A, Yue Z, Arancio O, Peterson BS, Champagne F, Dwork AJ, Goldman J, & Sulzer D (2014). Loss of mTOR-Dependent Macroautophagy Causes Autistic-like Synaptic Pruning Deficits. Neuron PMID: 25155956

Outbreak! Time To Review The Origins Of Vaccination

The US is currently experiencing an alarming spike in the number of measles cases. Yes, measles! Don’t we have a vaccine for that virus? Yes, we do. It first became available in 1963 and was so effective that by 2000 the US declared it had eliminated measles. But in 2014, a record 644 cases suddenly appeared in 23 distinct outbreaks.

Measles is caused by a very contagious virus that infects the respiratory system, causing high fevers, coughing, and a nasty rash. Complications are common and can lead to life-threatening situations, especially in undeveloped nations. Measles has rarely been seen in the US in recent decades, but has made an alarming resurgence in 2014-15.

Unfortunately, 2015 is shaping up to be a bad year for measles, too, largely due to a multi-state outbreak propagated by so-called anti-vaxxers attending Disneyland in California. A study published last month showed that this single incident has spread measles to seven states and two additional countries and was due to parents who declined to vaccinate their children. Sadly, many of those who were infected were innocent bystanders of this misguided decision - they could not be vaccinated due to age or a legitimate medical condition.

We’ve recently discussed some of the fears the anti-vaccine movement cites to justify their opposition to vaccination, much of which stems from the completely fraudulent studies of the disgraced doctor, Andrew Wakefield. But perhaps it is worthwhile to take a trip back in time to review the origins of vaccination, which begin with the horrifying disease called smallpox.

Referred to as “the Speckled Monster”, smallpox is caused by an extremely contagious virus with a signature “dumb-bell” appearance.

Once infected with the smallpox virus, the victim becomes covered head to toe with burning pustules. The virus can also infect internal organs, which usually meant death in less than a month. Those lucky enough to survive the infection were left badly scarred and disfigured. Humanity has been struggling with this dreadful affliction since at least 1100 BC. We know this because the mummy of Egyptian pharaoh Ramses V contains the signature pockmarks caused by smallpox. Recent genetic studies suggest that the smallpox virus emerged 3000 to 4000 years ago in east Africa.

Smallpox is one of a number of infectious agents that has been a major factor in steering the course of history. Smallpox was instrumental in the conquering of the Aztecs in 1521 by Hernan Cortes and the Incas by Pizarro in 1533. Disturbingly, the early Puritan settlers in North America considered smallpox a “miracle” that purged their “New World” of the Native Americans.

The first advance in treating smallpox, which hinted at a new era of medicine, was made around 950 AD in China. Someone took note that smallpox survivors never got the disease twice and got the idea that maybe by giving someone a tiny bit of the disease on purpose would protect them from the real thing. To do this, they took the scabs from someone who looked like they were beating the infection, ground them into a powder, and blew them up the nose of someone who hadn’t caught smallpox yet. It sounds disgusting, but it worked! The scab-sniffers got very mild cases of smallpox but recovered.

By the late 1600s, the Chinese practice of delivering smallpox scabs into healthy people to prevent the disease had been refined and spread to the Turkish Empire. As shown above, a drop of pus from a person beating smallpox was scratched into the skin to “inoculate” another person and prevent him or her from getting the full-blown disease. The technique spread to England thanks to Lady Mary Wortley Montagu, wife of the ambassador to Turkey in the early 1700s.

These primitive vaccination efforts carried a great deal of risk compared to today’s methods. Since the individual was being inoculated with live smallpox virus, there was always a chance of developing full-blown smallpox and dying, along with the risk of transmitting smallpox to others. To offset the latter, England instituted “inoculation stables”, woeful low-cost sheds where peasant children were sent to stay until they either died or recovered from the smallpox inoculation.

Enter Dr. Edward Jenner. Born in 1749, he did time in an “inoculation stable” as a young lad. Smallpox may not have scarred his skin, but his experience in the stable scarred him psychologically. He decided to dedicate his life to finding a better way to beat the “Speckled Monster”. Just like the Chinese in 950 AD, keen observation is what led Jenner to an amazing breakthrough. But Jenner’s eureka moment didn’t occur in the lab or in the hospital. It came to him while observing…milkmaids.

Milkmaids had a reputation for always being pretty, with clear and smooth skin, largely because they never seemed to suffer smallpox and the extensive scarring it left in its wake. There was even a saying at the time, “If you want to marry a woman who will never be scarred by the pox, marry a milkmaid.”

In talking to milkmaids, Jenner learned that they frequently caught cowpox, a very mild disease carried by the cattle they handled every day. The milkmaids who caught cowpox would develop a few pustules on their hands that resolved on their own fairly quickly. But when Jenner proposed that cowpox was protecting the milkmaids from smallpox, most people wrote the idea off as superstitious nonsense.     

Jenner knew he had to conduct an experiment to prove the naysayers wrong. Jenner somehow convinced the parents of a young boy named James Phipps to be the guinea pig in his experiment. Jenner took cowpox pus from a milkmaid’s hand and scratched it into James’s arm. As expected, the boy developed a mild case of cowpox and recovered from it, unscathed. He called the process "vaccination" based on the Latin word for cow, "vacca". 

The next step was to see if the cowpox vaccination protected the boy from real live smallpox. So Jenner, probably with shaking hands, inoculated James with smallpox pus taken fresh from a victim at the height of the illness. Each day they waited for what must have seemed like an eternity, but James never came down with smallpox. Jenner was not only right, but his success also inspired others that we do not have to take infectious disease lying down. We can fight it.

Jenner tried 20 more times to inoculate James Phipps with smallpox, but the boy never showed a single pustule. What did James get for being used as a lab rat? Jenner built him a cottage, which is today the Jenner Museum.

So what is actually happening here? How does vaccination protect someone against an infectious disease? Unbeknownst to Jenner, we now know that microbes cause infectious disease – viruses, bacteria, fungi, and parasites. We also know that we are equipped with an immune system that battles these foreign invaders. A vaccine trains the immune system to recognize an invader before it conquers too much territory. Microbial invaders consist of foreign proteins (called antigens) that are recognized by immune cells as “non-self”. These immune cells take up to two weeks to fully kick into gear and destroy the invaders. In some cases, the invaders grow too fast or produce toxins and the immune system just can’t outpace the infection.

But when the immune system wins, it remembers the invader. If the pathogen dare challenge you again, your immune system reacts much more quickly, usually destroying the invader before you even experience symptoms. Vaccination allows your immune system to preview antigens from a weakened form of the virus (like smallpox from a pustule of a recovering patient) or a related virus that causes little or no disease (like cowpox), so it will be “primed and ready” for the real invader if it should come along.
 

With the first vaccination came the first anti-vaxxers. James Gillray, who drew this infamous cartoon in 1802, misled people into believing that Jenner’s cowpox inoculation would “bovinize” people, causing them to give birth to calves or have them spring out of the body. 

The word “virus” comes from a Latin word meaning “poisonous force”. Humanity has been battling these forces for thousands of years and through persistence and hard work, we finally hit upon a remarkably safe and effective antidote. To refuse the antidote may seem like a personal choice, but as evidenced by the recent measles outbreak, it puts all of us in danger.

Contributed by:  Bill Sullivan

Follow Bill on Twitter. Google+.

Majumder, M., Cohn, E., Mekaru, S., Huston, J., & Brownstein, J. (2015). Substandard Vaccination Compliance and the 2015 Measles Outbreak JAMA Pediatrics DOI: 10.1001/jamapediatrics.2015.0384

Babkin, I., & Babkina, I. (2015). The Origin of the Variola Virus Viruses, 7 (3), 1100-1112 DOI: 10.3390/v7031100

Marrin, Albert. “Dr. Jenner and the Speckled Monster”, Dutton Children’s Books, New York, 2002.

The Anti-Vaccine Movement Is A Preventable Disease

Albert Einstein made mistakes and misinterpreted data.

He said that his own cosmological constant was a big

personal embarrassment. He put it in, he took it out, he

died. Now we think he was right to include it. It was all in

how he changed his interpretation of his data.

Scientific data can be interpreted many ways. That’s why scientists have conferences, to hash out the different reasons behind some observation…. plus the buffets and travel. One of the most famous arguments over interpretation of data was a series of debates between Albert Einstein and Nils Bohr at the Solvay conferences concerning the nature of quantum mechanics.

Bohr side held that at a quantum level, particles were undetermined until observed; the quantum world was one of probabilities, not observable realities. Einstein retorted, “God does not play with dice.” They both had the same data and they both agree on the data – it was the interpretation that was being debated (Bohr turned out to be right).

Because of multiple interpretations, science doesn’t like to say, “A caused B,” or even, “A correlates with B” unless they have the data to prove it. Premature interpretation can lead to bad data, bad hypotheses, and bad conclusions. And since so much of our culture today is based in science, bad conclusions lead to bad policy.

This means that when NO data exists to support a hypothesis, scientists have a duty to speak out against those making wild assertions. Especially when it leads to dangerous conclusions and actions. Vaccines causing autism is such a situation.

Just this week another scientific paper in the vaccine/autism controversy was withdrawn. A biochemical engineer named Hooker took data from an older CDC study and reinterpreted it. The CDC study had found no link between MMR vaccine and development of autism in children around two years old. They had looked at many factors to see if it occurred in subsets of patients as well, including race. But Hooker’s reanalysis showed that early MMR vaccination in African American boys was related to higher incidence of autism.

Lies, damn lies, and statistics. Do you really think organic

foods cause autism? Well there’s the data. CORRELATION

DOES NOT IMPLY CAUSATION.

The paper from Hooker was withdrawn by the editors of the very obscure journal Translational Neurodegeneration because there are serious questions about his methodology and conclusions. Many scientists argue that if you parse the data in enough ways and do it enough times, you will always find a statistically significant number somewhere. As Gregg Easterbrook of the Atlantic Monthly said, “Torture numbers enough and they’ll confess to anything.” The question is whether it actually means anything.

For Hooker (the father of an autistic boy who he describes as "vaccine injured"), this meant taking a case control set of data and running a different style of study with the data (a cohort study). Also, his choice of statistical tests was wrong and he ended up comparing diagnosis at different ages instead of vaccination age versus diagnosis. Of course he found more autism diagnosis at 36 months than at 24 months – autism isn’t usually diagnosed until about 36 months! A great discussion of flaws in this paper is found here.

The vaccine/autism controversy started in the 1980’s, when the Urabe strain of mumps was being used in the MMR. But this was related to other brain lesions, not autism. Andrew Wakefield really got the ball rolling in a Lancet article in 1998. His conclusion was that the triple vaccine was the culprit and it should be given one at a time – anecdotally, the parent so his 12 subjects had said that autism started within days of their vaccination around 14 months.

Thimerosal used to be used as a preservative in vaccines.

It is 42% mercury by weight, and this used to be blamed

for autism. However, even though many studies have

shown it was not harmful, it is no longer used in

vaccines in the West.

Wakefield followed the idea that the MMR should be given separately with papers in 2001 and 2002 that said vaccination should be stopped and that vaccine had been found in the gastrointestinal tissues of children he said had “autistic enterocolitis.” But the papers included no new data, they were just rehashes of his initial paper with more dire conclusions. The media picked on these and more than 1500 articles were written about the “controversy” in 2002.

His co-authors withdrew their names when it became apparent that something was hinky – he was getting paid by a law firm that was suing the vaccine manufacturers (to the tune of a half million dollars). But he stuck by his guns. Then it was discovered that he was a major investor in a company ready to roll out vaccine-alternative products.

Then his data was reviewed in 2009 and was found fraudulent. He had manipulated data, including changing tissue sample results and making up parts of the histories of his child subjects. His license to practice medicine was taken from him in 2010 and I can’t for the life of me figure out why he isn’t in jail.

Anti-vaccine proponents say that vaccination during the months before two years of age alters the development of the brain and predisposes to autism spectrum effects. However, all the data on brain development suggests that the alterations that lead to autism take place in utero either as a result of genetics, trauma, or toxins – long before vaccination takes place.

The news isn’t all bad with autism. The new paper concerning

mTor has an upside. An antibiotic called rampamycin can

restore mTor activity and bring back synaptic pruning. The

authors ay it is reducing autism symptoms in mice, including

adult mice. You see the needed reduction in neural connections

in the above cartoon is between 2 and 4 years of age – right when

autism is diagnosed.

This includes a very recent paper that links autism to defects in a protein (mTor) that works to cut back synaptic connections in the developing brain. Too many connections leads to altered brain function and all too often, autism. But these changes are prior to vaccination or around time of autism recognition.

Research using 1^st birthday party videos shows that many children show signs and symptoms of autism by 12 months, many months before most parents see the signs and a full year before autism can be reliably diagnosed. This may be a reason that people anecdotally link vaccines and autism – parents note it about the time a good number of vaccines are given. Some parents see it later using videos and use this regression of ability to damn vaccines - but the mTor paper addresses this well.

Unfortunately, some parents have used the erroneous data to draw a dangerous conclusion – they shouldn’t vaccinate their children. This has led to outbreaks of whooping cough, measles, mumps and other preventable diseases.

You might say that it doesn’t matter; if some parents choose not to vaccinate, then they're only hurting their own kids - but that isn’t so. For a small percentage of the population, especially the young and old, vaccination may not work properly or completely. This doesn’t matter if everyone vaccinates, because the presence of the disease in the population will be so low that their chances of being exposed remain low.

Jenny McCarthy has a son with autism. One can’t blame her

for her initial conclusion that vaccines might have been

involved, since fraudulent papers were out there. Now we

know better, but she hasn’t altered her “view” (although

she claims she has). Too often, I think we look for

something to blame.

But when more people that choose not to vaccinate their children, the presence of the disease goes up. Those who were vaccinated but did not receive full immunity, elderly patients who have lost some of their immunity due to an age-related decline in immune function, and even those people who are immune suppressed due to cancer or immune related diseases then run a much higher risk of being exposed.

Therefore, the “policy” of non-vaccination by some parents is flawed, in that there's no evidence to support their reason for withholding the vaccine, and because it injures other people in the community. Not a big deal? Mumps in adolescent and adult males can lead to sterility.

That isn’t scary enough? Then maybe it will be your child who isn’t as protected as they should be and becomes one of the 150 people a year who die each year of complications due to chickenpox, just because little Johnny’s mother “concluded” that vaccines were dangerous.

Contributed by Mark E. Lasbury, MS, MSEd, PhD

As Many Exceptions As Rules

Hooker, B. (2014). Measles-mumps-rubella vaccination timing and autism among young african american boys: a reanalysis of CDC data Translational Neurodegeneration, 3 (1) DOI: 10.1186/2047-9158-3-16

Tang G, Gudsnuk K, Kuo SH, Cotrina ML, Rosoklija G, Sosunov A, Sonders MS, Kanter E, Castagna C, Yamamoto A, Yue Z, Arancio O, Peterson BS, Champagne F, Dwork AJ, Goldman J, & Sulzer D (2014). Loss of mTOR-Dependent Macroautophagy Causes Autistic-like Synaptic Pruning Deficits. Neuron PMID: 25155956