Back Goldfinch looking backwards

There has been quite a measles scare in the winter of 2014-2015. I’m reacting to it in an ad hoc way here, for now.

Let’s start first with Dr. Paul Offit on the Democracy Now! show for February 5, 2015. Here is the link to the whole show, which included a preceding interview with Mary Holland to which he is responding here. I will insert my own emphasis and commentary, both in the transcript and in the right margin. I am interested in finding out if I can chase down his claims and check up on them.

Here is a link to a first Age of Autism response to the same interview

AMY GOODMAN: We go to Philadelphia, where we’re joined by Dr. Paul Offit, professor in the Division of Infectious Diseases and the director of the Vaccine Education Center at the Children’s Hospital of Philadelphia. Dr. Offit is also professor of vaccinology and a professor of pediatrics at the University of Pennsylvania School of Medicine, also the co-inventor of the rotavirus vaccine, RotaTeq, recommended for universal use in infants by the CDC, author of numerous books, including Autism’s False Prophets: Bad Science, Risky Medicine, and the Search for a Cure and Deadly Choices: How the Anti-Vaccine Movement Threatens Us All.

Well, Dr. Offit, you have heard our show today. Can you talk about why you feel vaccines are so important?

DR. PAUL OFFIT: Well, because they’ve saved our lives. If you look at how long we lived, say, a hundred years ago, we lived 30 years less long—less long then than we do today. So, the reason—the main reason for that is vaccines. We no longer have to see 50,000 children hospitalized and 500 die from measles every year as we did before the vaccine. We no longer have to see diphtheria as a common killer of teenagers. We no longer have to see 20,000 children suffer severe and permanent defects caused by rubella virus, so-called German measles virus. We no longer have to see children die or suffer permanent disability from bacterial meningitis from diseases like meningococcus, pneumococcus, Haemophilus influenzae type B. Vaccines, I think, were the single best preventive measure that we’ve ever had. The problem, as clearly reflected by your previous caller, is that we don’t appreciate them. I think vaccines are a victim of their success, and they’re obviously being blamed for things that they don’t cause.

AMY GOODMAN: Well, what about the issue of the connection between MMR and problems in children? Our last guest, Mary Holland, talked about her own son who ended up with autism, and she feels there was a direct connection between MMR and autism.

DR. PAUL OFFIT: I think it’s perfectly reasonable for a parent to ask the question: "My child was fine, they got a vaccine, then they weren’t fine anymore. Could the vaccine have done it?" As Ms. Holland has argued, it is a temporal connection. But it’s not a causal connection. I mean, there have now been 14 studies done, looking at hundreds of thousands of children either who did or did not receive the MMR vaccine, and the results have been clear and consistent and reproducible: MMR vaccine does not increase your risk of autism. All you do by choosing not to get an MMR vaccine is increase your risk of getting measles, mumps or rubella.

You know, what is upsetting to me about this—and I honestly think the last 10 minutes of your program set a new record for consecutive statements that were incorrect—is that when you do the science, when you do these excellent, retrospective, huge studies that answer the question, that people don’t believe them. And the reason Ms. Holland doesn’t believe them is she’s a conspiracy theorist. I mean, listen to what she says. There’s this guy who was a fraud , and then there’s this whistleblower at the CDC . I mean, there are 14 studies on three continents involving hundreds of thousands of children. Is she claiming that there is a massive international conspiracy to hide the truth? I think she is. And that’s what makes her, to me, a classic anti-vaccine person.

AMY GOODMAN: Well, what about the issue, for example, of the combined vaccine, the MMR—measles, mumps, rubella—the argument for separating them? And what was the—why were they put together? Talk about how vaccines came to be what they are and why they are mandated or not mandated in this country.

DR. PAUL OFFIT: Right, so, the measles vaccine was developed in 1963, the mumps vaccine in '67. There was a second measles vaccine, the last, best vaccine, in ’68. And then we had the rubella vaccine in ’69. In 1971, those three vaccines were put together because you could, because you could do it safely, as was proven, that when you combine those vaccines, that you didn't interfere with or change the safety profile or immunogenicity profile of those vaccines when they were given separately. So now you had to give one shot instead of three. Now we have a two-dose vaccine, so that means you give two doses instead of six. There’s no reason to separate those vaccines out, because all you do by separating them out is increase the number of shots without in any way changing the safety profile.

In terms of mandates, your question about mandates, I think you’re starting to see why it is that mandates are so important. There is no good reason to choose not to get a vaccine. If you’re choosing not to get a vaccine, then you’re basing it on a misperception or a series of false beliefs, as Ms. Holland has, about vaccines. She says, for example, that vaccines are never tested together. Of course they’re tested together. You cannot put a new vaccine on the schedule without proving that your vaccine doesn’t interfere with the safety and immunogenicity profile of existing vaccines, and vice versa. Those are called concomitant use studies. Ms. Holland says that there have been no studies looking at sort of relatively vaccinated or unvaccinated children. That’s not true. There are several studies that have looked at that, including that of Peter Aaby, which suggests that the highly vaccinated child has better health than the child who is less vaccinated.

I mean, Ms. Holland says that the hepatitis B virus is only transmitted by sexual contact. That’s not true. Children less than 10 years of age in this country, before the hepatitis B vaccine, 18,000 would suffer hepatitis B. Half got it by traveling through a birth canal that was infected with hepatitis B, but the other half got it from relatively sexual contact—relatively casual contact. You know, those children who were less than 10 weren’t getting it from getting tattoos or using intravenous blood, intravenous blood transfusions or intravenous drugs, and they certainly weren’t getting it from sexual contact. They were getting it from Uncle Bob, who had hepatitis B but didn’t know it, who gives them a little kiss. That’s how they were getting hepatitis B.

So there’s so much misinformation out there that causes people like Mary Holland to make bad decisions for her children. If vaccines were unsafe, I think this would be an interesting and reasonable discussion. But vaccines are remarkably safe and remarkably effective. And when you watch herd immunity erode, as it clearly is in this country—we eliminated measles by the year 2000, and now, because parents are choosing not to give vaccines based on their false, or at least ill-founded, concerns, other people are suffering. I think Professor Reiss, who was just spot on, on what she said earlier, I think, said it best. Is it your right to catch and transmit a potentially fatal infection? I think the answer is no.

NERMEEN SHAIKH: But, Dr. Offit, can you explain how it is that so many parents came to make an association between vaccines and autism, given all of the scientific research and the studies that you cite? Is it because such a large number of children were suffering after having received vaccines? Or what do you attribute this to?

DR. PAUL OFFIT: I think it’s—the analogy could be made for diabetes in the 1800s. In the 1800s, people suffered diabetes, and nobody knew why. And many things were blamed, including vaccines, right? "I got a vaccine. Now, you know, within six months, my child has type 1 diabetes. I think the vaccine did it." And at the time, it was a smallpox vaccine or the rabies vaccine, which was introduced in the late 1800s. Vaccines are always sort of the universal scapegoat. Then, in 1920, Banting and Best isolated insulin, and all that nonsense went away.

I think maybe this nonsense doesn’t go away until we clearly have a cause or causes for autism or, I think much more difficult, a cure for autism. Then it will all go away. I mean, clearly, if you look at the science of autism, it’s clearly at least genetic. I mean, we know that it appears to be an in utero event. So, I don’t think there’s any evidence that an environmental influence, especially vaccines, have ever been shown to increase the rate of autism.

But, you know—and I think the answer to the question, "Why is it that people aren’t convinced?" I think the media is perfectly willing to put the sort of, you know, man-bites-dog story out there, which is Mary Holland’s rant that vaccines cause autism, and she knows it because that’s what she saw. You know, I’ll give you a story. My wife is a private-practicing pediatrician. She goes into the office one day, and she’s helping the nurse give vaccines. There’s a mother who has a four-month-old that’s sitting on her lap along the side wall. While my wife was drawing the vaccine up into the syringe, the four-month-old had a seizure, went on to have a permanent seizure disorder, epilepsy. If my wife had given that vaccine five minutes earlier, I don’t think there are any amount of statistical data that would have convinced that mother of anything other than what she believed to be true. "What do you think? I’m stupid? My child was fine. They came in here, they got a vaccine, now they have epilepsy. I know what I saw"—even though it was a temporal association.

AMY GOODMAN: I mean, to be fair, we wanted to have both of you on together to have a conversation, because there are many in this country, and a growing movement of parents, who are deeply concerned. But you wanted to have this conversation separately, Mary Holland and you separately. So, it’s important to, I think, have this kind of dialogue on all of these issues. Dr. Offit, on this issue of vaccines now being—

DR. PAUL OFFIT: I’ll tell you—can I just address that?

AMY GOODMAN: Yes, sure.

DR. PAUL OFFIT: Can I address that for one second? I think that it is not important to have a debate about the science with someone who clearly doesn’t know the science. I’m sorry, Ms. Holland misrepresented the science again and again and again. I don’t think that in any way helps your viewer. I don’t think it’s fair to have a debate where two sides are presented, when only one side is really supported by the science. I think—I’d like to think we’re beyond that.

AMY GOODMAN: But I think what’s—

DR. PAUL OFFIT: If you ask the question, why is it that—go ahead.

AMY GOODMAN: Dr. Offit, what I think is important, it’s not only about science. We’re talking about science. We’re talking about the practice of medicine in this country. We’re talking about public policy. I mean, after all, this has now become a presidential campaign issue, with possible presidential candidates taking on the issues. And I want your comment on that. But you’re combining all of this, and it’s important to bring all the various expertises of parents, of lawyers, of doctors together in a conversation on these issues.

DR. PAUL OFFIT: Right, but what Ms. Holland does is she presumes to represent the science. I actually agree with you. I think we’re at a tipping point. And I think the critical discussion now is the one that was brought up by Professor Reiss, which is: How far do we go here?

I mean, I happen to have survived the 1991 Philadelphia measles epidemic. I was a doctor at Children’s Hospital of Philadelphia. During a four-month period in Philadelphia in 1991, we had 1,400 cases of measles and nine deaths. And it centered on two fundamentalist churches that chose not to vaccinate their children. We got to the point of compulsory vaccination. And believe me, no one in Philadelphia had a problem with that. It was—people were so scared of that disease, because it was so common and so fatal, that we got to compulsory vaccination. By that, I mean those children in that school who were unvaccinated were made wards of the state, vaccinated, and then given back to the parents. And the American Civil Liberties Union, who is perfectly comfortable representing pretty unpopular causes, never stepped in. They were asked to step in by Charles Reinert, who was the pastor of one of those churches. And remember, there was a religious exemption to vaccination on the books for 10 years at the time this happened. And the American Civil Liberties Union said, "While we believe it is your right to martyr yourself to your religion, we don’t believe it is your right to martyr your child to your religion." And I give the ACLU credit for that, at the time. But you had to be here. I’m not sure they would feel the same way.

How bad does it have to get before you say, you know, it is your right to swing your fist wildly, but that right ends at the tip of my nose? And I think that’s what’s true here. We were offended when that man got on a plane with tuberculosis and was coughing and had, you know, so-called multidrug-resistant tuberculosis. We thought he had done something that was awful. And I think this is no different.  I don’t think it is your right to expose your child needlessly to infection and to expose those with whom they come in contact needlessly with infection. And if vaccines were a safety issue, I would get it. But it’s not. They’re remarkably safe.

AMY GOODMAN: What about the vaccine compensation board? Talk about what that is all about, how families get compensated.

DR. PAUL OFFIT: Yes, so, in early—in the early 1980s, there was born the notion, which was since refuted by scientific study, that the whole-cell pertussis, or whooping cough vaccine, caused permanent brain damage. It was a documentary that was made by Lea Thompson, a veteran newsmaker from NBC, called DPT: Vaccine Roulette. And it showed a series of children who supposedly were permanently brain-damaged by pertussis vaccine. Now that was wrong. Study after study showed it was wrong, but it was a vivid image, and it brought a ton of litigation against pharmaceutical companies that made vaccines, to the point that they were out. I mean, they weren’t going to make vaccines for American children anymore, because they didn’t want to have to fight all this in civil court based on a false notion, that was vaccines were causing permanent harm. And, you know, juries were perfectly willing to side against the pharmaceutical companies. And so, what was put in place was the National Childhood Vaccine Injury Act in ’86, which became the Vaccine Injury Compensation Program in 1988, to basically give people who may have suffered a permanent harm from a vaccine compensation. Fair enough. But that is not the place to determine scientific truths.

I mean, the—so, for example, there was a rotavirus vaccine that was introduced in this country in 1998. It was on the market for a year. It was found to be a rare but real cause of intestinal blockage, something called intussusception. I think parents were fairly compensated for that, because I think if we’re asking our citizens to get vaccines, there should be this sort of compensation system. But believe me, there are many compensations in that program that are wrong. I mean, they have compensated people for multiple sclerosis caused by hepatitis B vaccine, when it clearly doesn’t do that, and two New England Journal of Medicine studies show it don’t, which is to say that the courts are not a place to determine scientific truths. Scientific studies are the place to determine scientific truths. The courts are simply a place to settle disputes. A lawyer shouldn’t be making a decision about whether or not one thing causes another. I think that’s the province of scientists and academicians.

AMY GOODMAN: We have 10 seconds.

NERMEEN SHAIKH: Dr. Offit, yeah, just very quickly before we conclude, do you think that there should be compulsory vaccination across the U.S. now?

DR. PAUL OFFIT: I agree with—I agree with Professor Reiss. I think we should certainly, as a first up, make it much more difficult to get a philosophical or religious exemption, both of which, as far as I’m concerned, are misnamed. I mean, philo, love, sophos, wisdom—

AMY GOODMAN: We have five seconds.

DR. PAUL OFFIT: Where’s the wisdom that says—sorry. And, you know, it’s an unreligious act to get—to not get a vaccine. But I think we should make that harder. And yes, I think, eventually, we should make it so that you pay some sort of price for doing something that puts your child and other people at risk.

AMY GOODMAN: Dr. Paul Offit, we thank you for being with us, of the University of Pennsylvania.

Entirely and obviously false. Rather stunning that he can bring himself to say this. See the many, many sources showing very little reduction in deaths following the introduction of vaccines, but a very large reduction over decades and following the introduction of improved hygiene, better nutrition and better care for the diseases in question.

Also check out this graph that is linked below as well.

He can scarcely name the 14, but he might have given us one or two. I notice there is a website devoted to refuting Fourteen Studies. Haven’t had time to check that out yet. I have checked out several studies used by the IOM in its 2004 report devoted to the austism-MMR question, and concluded that they were either deliberately falsified in order to hide a significant MMR association (there is whistle blower testimony for this) or deliberately misleading in the way they used data or did in fact show a significant correlation with MMR but explained it away in a single sentence without any offering of support.

An obvious red herring. He fails to address the actual claims Holland makes.

“As was proven” appears to me to be false, judging from my readings in the Wakefield case, and from reading even contemporary accounts of testing for efficacy and safety comparing other vaccines. However, we need, of course, to know if Dr. Offit is in fact referring to specific safety tests comparing the combined and single vaccines. Perhaps those tests were much different.

The studies that “prove” this are highly inadequate to address the actual concerns that Ms. Holland is expressing. This is a major issue within the vaccine-opposition discussions and cannot be rejected out of hand this way by reference to the very studies that are challenged as proof.

Better say which Peter Aaby studies he has in mind. Some are cited to show significant mortality consequences for mixing certain vaccines.

In Guinea-Bissau, Dr. Peter Aaby has studied and administered vaccines to thousands of children for more than three decades and has published research on vaccine safety and effectiveness, including research on measles and measles vaccine.26 He found that there can be marked differences in the way that boys and girls respond to vaccines. For example, he found there was an increased mortality risk for girls if they received the DTP and measles vaccines together.27 He also found that fatality rates were increased for children ages 6 months to 17 months old, if they had received the DTP vaccine simultaneously with or after receiving measles vaccine.28

Source: NVIC. See that original, accessed 02-11-15, for the fn references.

Given the obvious falsehood of his earlier statements about measles deaths and the vaccine, I suspect this one is false in the same way, but I do not have the evidence at hand. We should definitely suspect this is the case. Once you have been found out in a lie, you lose the credibility that you might otherwise expect to have extended to you as a doctor.

In his own tirade here, Dr. Offit raises the well-known defense that “association does not mean causation.” One reason it is well-known is that the tobacco companies used it for years to defend cigarette smoking.

Notice that Dr. Offit used the association = causation argument himself earlier when he said vaccines save lives and “We no longer have to see 50,000 children hospitalized and 500 die from measles every year as we did before the vaccine.” It is true that measles mortality before introduction of the vaccine was significantly greater. But study the graph linked to this icon and ask yourself if there might be other causes at work.

Anyone seriously involved in the vaccine controversies, as Dr. Offit is, must know that mortality reduction for measles was due to improved hygiene, medical care and diet. Who is the person then, who “clearly doesn’t know the science”? Who is misrepresenting the science?

Socrates long ago gave people who knowingly misrepresent the truth and also make a profit from doing so, as sophists.

More on Association

Obviously some associations do not indicate cause and some do. All the studies purporting to show the safety of vaccines do so by demonstrating the lack of an association between the vaccine and unsafe effects.

A good case in point is the testimony of William Thompson as to the cover-up of certain associations discovered in the well-known DeStefano study that he was part of and that is one of the studies used by the IOM and CDC to demonstrate no causal link between the MMR vaccine and autism. Ms. Holland made reference to this whistleblower in her comments.

When DeStefano, Thompson and the other scientists doing this study discovered that comparing African-American boys in Metropolitan Atlanta, of the same age and socio-economic status, who differed in terms of having autism or not showed that those with autism were 3.4 times more likely to have first received the MMR vaccine between the ages of 24 and 36 months, they found an association. Given the number of children in the study, they knew also that they had a statistically significant association, not at all likely to be due to chance alone.

Even though these scientists, like you and me, or like the parents of children who develop autism right after receiving the MMR vaccination, knew very well that association is not the same thing as causation, something moved them to revise their pre-study methodology in favor of another one (using a smaller number of black boys, those who had Georgia birth certificates) that allowed them to ignore that finding of association and not to publish it in their paper. This according to Thompson, who has contemporaneous notes on the meetings in which this problem was discussed.

For a detailed exposition of this and other falsifications of results in the DeStefano 2004 study used by the IOM and CDC to “prove” that there is no causal link between MMR and autism, see this formal complaint from Hooker and Wakefield to the CDC and the US Dept of Health and Human Services. The original version is dated October 14, 2004.

For another extensive summary of the William Thompson case, see this article by Robert Kennedy, Jr, CDC Scientist Still Maintains Agency Forced Researchers To Lie About Safety Of Mercury Based Vaccines. Dated February 12, 2015.

The orginal study itself can be found as a pdf here. The Institute of Medicine study that bases itself in part on that DeStefano et al. study,  Immunization Safety Review: Vaccines and Autism (2004), may be downloaded for free as a pdf here. Notice that the other studies used by the IoM in that book are also strongly countered by the vaccine-caution movement.

The herd immunity argument has no application to vaccine use. See here.

The MMR itself sometimes causes measles in those who get it. This is not wild type measles but looks the same clinically, apparently. In the current outbreak it has not been made clear what the source of the measles cases has been. And in any case, if the source was wild-type virus, the vaccinated kids got it because their vaccine did not work. If the unvaccinated children got it, and it was not the MMR measles, which can be transmitted to others by the vaccinated themselves, then, of course, that was the risk their parents let them take. However, that was not putting the vaccinated children at risk – apparently the vaccine did not work for them.

England and Wales measles mortality rate from 1838 to 1978. Source.

See this Dissolving Illusions web page for a long series of such graphs. The book, Dissolving Illusions, by Roman Bystrianyk and Suzanne Humphries, is an in-depth and persuasive study of vaccine illusions. It starts with the history of the smallpox vaccine.