Anti-Vaccinationists: A case study in pseudoscience - PowerPoint PPT Presentation


Title: Anti-Vaccinationists: A case study in pseudoscience


1
Anti-VaccinationistsA case study in
pseudoscience
  • Donald Miller, Pharm.D.
  • Professor and Chair,
  • Department of Pharmacy Practice
  • NDSU

2
What is Science?
  • The scientific method is a self-correcting method
    of making and testing hypotheses through
    experiments (or the best available methods) that
    can be readily verified or rejected.
  • At least ideally, science is an objective
    approach in which the best available evidence is
    accepted, regardless of whether it is consistent
    with ones prior beliefs. It also critically
    compares rival theories rather than seeking to
    prove one specific theory.
  • Science is a method not a belief system. Its
    strengths are the ability to make predictions,
    openness to peer review and the performance of
    experiments that challenge beliefs and working
    hypotheses.

3
Science vs Belief
  • Science involves peer review to protect against
    influence of personal biases in doing and
    interpreting studies.
  • Scientists regard constructive criticism of their
    ideas and hypotheses as standard operating
    procedure.
  • Scientific research is not about proving the
    truth, but about testing our understanding of
    the truth by testing the alternatives. Paradigms
    are modified or even rejected once a better
    understanding of reality comes along. The entire
    body of evidence must be considered.
  • Communities of faith naturally look for
    confirmation of their beliefs, not for
    improvement of their understanding.

4
What is Pseudoscience?
  • The selective use, and misuse, of scientific
    evidence to support a predetermined conclusion or
    point of view (typically based on ideology or
    authority), rather than the unbiased use of
    evidence to draw logical conclusions.
  • Sometimes called junk science. Junk science
    also refers to badly done research that is set up
    to support a predetermined outcome.
  • But the term junk science has been hijacked by
    pseudoscientists and politicians to disparage any
    evidence with which they disagree.
  • Pseudoscientific conclusions typically do not
    change with new evidence. Since evidence is used
    selectively to support an argument anyway, new
    evidence may be ignored or dismissed.

5
Legal Analogy
  • If you were selected for a jury you would be
    obligated to weigh all the evidence both for and
    against the defendant.
  • Lawyers for each side would take a
    pseudoscientific approach of presenting the best
    selective evidence for their side, but the judge
    and jury must be impartial.
  • Assume there are ten witnesses to a car accident
    2 say the first car was speeding and 8 say it
    was traveling at a normal speed before the crash.
    The police must interview all witnesses and then
    all must be allowed to testify.
  • If only testimony of the first 2 is considered we
    are being biased and pseudoscientific.

6
Why Are People Attracted to Pseudoscience?
  • Humans are not naturally critical thinkers or
    adept at using evidence most people judge a
    proposition by whether it makes sense or feels
    right.
  • Pseudoscientific explanations of phenomena tend
    to be much simpler and more emotionally
    satisfying than complex explanations.
  • We are also highly egocentric using our
    personal experience and the beliefs of our
    friends and family to judge what seems right.
  • Furthermore, we are highly disposed to preserve
    our current beliefs rather than to challenge them.

7
Background on Vaccinations
  • Established by Edward Jenner with vaccination for
    smallpox in late 1700s.
  • Polio vaccine in 1950s
  • Very cost-effective (cost saving)
  • Consistent with preventative medicine
  • Vaccinations have been called the most important
    single contributor of any medical advance to
    reduced global morbidity and mortality1

1. JAMA 20022883155-58
8
Todays Vaccines
  • U.S. policy set by the Advisory Committee on
    Immunization Practices, an advisory group to the
    U.S. Public Health Service and the CDC.
  • Additional guidelines by American Academy of
    Pediatrics and American Academy of Family
    Physicians.
  • Childhood vaccinations series recommended for
    measles, mumps, rubella, varicella, polio,
    diptheria, tetanus, pertussis, haemophilus
    influenza type B, pneumococcus, hepatitis B,
    rotavirus, and HPV.
  • Adult vaccinations recommended for measles,
    mumps, rubella, tetanus, diptheria, varicella,
    hepatitis B, plus populations at risk of
    hepatitis A, influenza, and pneumococcus.

9
Efficacy of Vaccines
  • Smallpox and polio have been completely
    eradicated in the U.S., while incidence of
    several other diseases such as measles and
    pertussis have been reduced by 98-99 compared to
    their baseline annual incidence.
  • Protect both the individual and the community
  • Yet almost 50,000 people/year die in the U.S.
    from vaccine preventable diseases.1

1. Ann Intern Med 2007147735-7
10
So Why Would Anyone Oppose Vaccines?
  • Individual rights and distrust of government
    (childhood vaccines are mandatory for school
    enrollment)
  • Distrust of organized medicine and belief in
    alternative natural healing paradigms.
  • Actual adverse effects
  • Sore arms, fever, flu-like illnesses,
    Guillain-Barre Syndrome (1.8 cases/million)
  • Older pertussis vaccine often caused fever,
    crying, limpness, and occasionally seizures.
  • Actual infection with virus - the Cutter incident
  • Alleged adverse effects
  • sudden infant death syndrome (SIDS), autism,
    multiple sclerosis, vague claims of neurologic
    disorders.

11
The Cutter Incident
  • Initial Salk vaccine developed with inactivated
    polio virus and was successful in field trials
  • In conversion to mass commercial distribution,
    Cutter Laboratories produced a vaccine in which
    some virus was still active, leading to 164 cases
    of paralysis and 10 deaths
  • Cutter was found legally liable, though not
    negligent (establishing a precedent that still
    inhibits vaccine manufacturers)
  • Getting the disease itself is still a remote risk
    with all vaccines that use live (attenuated)
    virus, thus immunocompromised patients cannot
    receive them.

12
Risk Benefit of Vaccines
  • Actual risks of vaccines are well known and are
    much less than the risks associated with the
    corresponding diseases that are prevented.
  • Costs of adverse effects can be compensated by
    the vaccine adverse events reporting system
    (VAERS)
  • Accurate information readily available through
    pediatricians and government web sites

13
Tactics of Pseudoscientific Opponents of
Vaccination
  • Appeals to morality
  • Conspiracy theories
  • Appeals to free choice
  • Appeals to authority
  • Scientism
  • Appeals to emotion (anecdotes)
  • Errors in logic
  • Deception and outright lies

14
Appeals to Morality
  • New vaccines (Gardasil, Cervarix) are licensed
    for human papilloma virus, the leading cause of
    cervical cancer. Optimal vaccination must occur
    prior to sexual activity, but conservatives
    oppose this as encouraging sexual activity.
  • Two vaccines (varicella, rubella) were developed
    from viruses originally grown in human cell
    cultures from aborted fetuses. No ongoing embryo
    destruction occurs.
  • Interestingly, even 2 centuries ago, early
    opponents of vaccination felt it was immoral
    because it interfered with Gods plans.

15
Conspiracy Theories
  • A common tactic of pseudoscience is to talk of a
    conspiracy by organized medicine to hide the
    true risk of vaccines.
  • In fact, the established risks of vaccines are
    easy to find in the literature and are publicized
    by the Centers for Disease Control at
    http//www.cdc.gov/vaccines/vac-gen/side-effects.h
    tm

16
Appeals to Freedom, Informed Choice or Free
Choice
  • A free, informed choice requires accurate
    information not something that anti-vaccination
    web sites generally provide.
  • Critics of mandatory vaccinations fail to
    understand the role of public health in
    protecting populations. Individual freedoms may
    be reasonably limited to protect the greater
    public (e.g. public smoking bans, quarantine)
    under the 10th amendments police power granted
    to states.1

1. Stewart AM. NEJM 20093612015-17
17
Appeals to Authority
  • Celebrities and peripheral scientific figures

18
Scientism
  • The use of, and belief in, the trappings of
    science (big words, p values, journal citations,
    etc.) to give the false impression of accuracy
    and honesty.
  • Most anti-vaccine web sites are slick and
    convincing to an uninformed user.
  • Journal citations are frequent (and the sheer
    volume superficially impressive), but are almost
    all outdated, selective, or used to support
    statements not implied by the actual reference.
    E.g. http//thinktwice.com/s_autism.htm

19
Claims That Several Vaccines At Once Can
Overwhelm the Immune System
  • Todays vaccines mostly use highly purified and
    specific viral proteins, in comparison to the
    nonspecific proteins or whole viruses formerly
    used, so the total burden of immunologic
    stimulation is minimal and has not increased.
  • In addition, children are naturally exposed to
    many infectious agents that provide a high number
    of antigenic viral and bacterial proteins.

NEJM 20083582089-91
20
Emotional Appeals Through Anecdotes
  • Web sites often contain personal stories and
    pictures of children allegedly injured by
    vaccines, as well as pictures of menacing
    needles.
  • E.g., http//www.nvic.org/Vaccine-Memorial.aspx
  • Anecdotes are misleading because there is no way
    to know if the alleged adverse effect is related
    to the vaccine (confusing association with
    causation).
  • Even if a vaccine did cause the injury, anecdotes
    give no sense of how common the injury is, or the
    overall risk/benefit ratio.

21
From http//thinktwice.com/faq.htm8
  • In 10, down three. A lot of adult vaccines are
    really problematic too. I was recommended by a
    travel clinic to have the Japanese encephalitis
    vaccine for a luxury trip to India and Nepal.
    We're retired and this is the trip we've dreamed
    about. I went in on September 24 and had shot 1
    of 3. They do a before and after blood pressure
    check. Before was 130/80. After was 140/80. Ten
    days later, I returned for shot 2. Before was
    150/80. The nurse said she didn't want to
    administer it so I went home. The doctor said to
    go ahead and complete the series. I didn't. A
    week later my blood pressure was up to 160/80.
    Then yesterday it was 170/80, and they gave me a
    prescription for medication.

22
Errors in Logic
  • Association between events assumed to mean
    causation (vaccinations are given around the time
    in life when autism can first be diagnosed and
    SIDS occurs.
  • Recall bias. It is normal to want to find a cause
    for unsettling events and one may inaccurately
    recall the onset of an event like autism,
    multiple sclerosis, etc. to coincide with the
    vaccination.

23
The Autism Controversy
  • Since vaccines are given at about the same age
    that autism is able to be diagnosed, naturally
    many diagnosed children will have received one or
    more vaccines very recently. An apparent spike in
    autism cases has occurred since the 1980s.
  • The link between MMR vaccine and autism received
    wide publicity in 1998 with publication of 12
    cases of children developing gastrointestinal and
    developmental problems shortly after vaccination
    (Lancet 1998351637-41) The authors hypothesized
    that the vaccine or its thiomersal preservative
    were causative.
  • The speculation caused a collapse of confidence
    in the vaccine and thiomersal, especially in
    Great Britain.

24
The Autism Controversy
  • Not only was speculation of cause and effect
    inappropriate, the study and publication took
    place about 8 years after vaccination and
    involved parents recollection of events.
  • Several prospective studies subsequently found no
    association between the vaccine and autism or
    other problems.
  • The publication was retracted in 2004 after
    coauthors discovered that the main author had
    been paid by an organization to look for evidence
    to support a lawsuit over immunizations.
  • Thiomersal has been gradually removed from
    vaccines, not due to proven harm, but to increase
    acceptance of vaccines and assure the public that
    everything possible is being done to assure
    safety (but new cases of autism continue to
    occur!).

25
The Autism Controversy
  • Similar controversies have existed about DPT
    vaccine and Sudden Infant Death Syndrome,
    hepatitis B vaccine and multiple sclerosis, HiB
    vaccine and childhood diabetes, anthrax vaccine
    and Gulf War Syndrome, etc., all without
    confirmation.
  • Such scares are typically precipitated by
    clusters of the disease in question, where people
    look for associations to explain the cluster.
    What is not generally appreciated is that
    apparent clusters of any disease can occur at
    random from time to time, with no causal etiology
    at all.

26
Outright Lies and Distortions
  • Claims that vaccines are ineffective or just
    temporarily effective.
  • Claims that vaccine policy is motivated by
    enormous profits to the vaccine industry and
    individual physicians.
  • Adverse effects of vaccines are underreported
    (implying a cover-up)
  • Claims that vaccine preventable disease have
    declined for other reasons such as improved
    nutrition or hygiene.
  • The majority of people who get disease have been
    vaccinated

27
Outright Lies and Distortions
  • The credo Vaccines are more dangerous than the
    disease.
  • This is true only in so far as vaccines have
    largely eliminated many diseases. From an
    individual perspective, the actual dangers of
    each disease are considerably higher than the
    risks associated with the corresponding vaccine.
  • From a societal perspective, the current rarity
    of the diseases may in fact mean that more
    persons are injured by vaccines than the
    corresponding diseases. But this is the price we
    pay for keeping the diseases rare.

28
Outright Lies or Distortions
  • Claims that vaccine-associated illnesses have no
    spontaneous cause. (But all the alleged illnesses
    such as autism - do, in fact occur
    spontaneously and without clear precipitating
    causes).
  • Claims that vaccination in general, or too many
    vaccinations, weaken the immune system and causes
    autoimmune diseases.
  • Claims that disease outbreaks in unvaccinated
    areas are rare or exaggerated by the media.
  • Claims that vaccines are loaded with extra toxic
    ingredients like aluminum.

29
Outright Lies and Distortions
  • Blatant distortions such as citing an article
    that actually says mumps is now more common in
    older people than children, and twisting it to
    falsely claim that mumps is now more common among
    the elderly than prior to vaccinations.
  • Even attacks on the germ theory of disease!

30
From http//thinktwice.com/faq.htm8
  • Recently vaccinated children do carry the
    disease germ and are able to spread it to other
    children. Many so-called epidemics are initiated
    and spread in this manner, even though the
    unvaccinated are blamed. some authorities
    argue that parents who do not vaccinate their
    children reap the benefits without taking the
    risks -- a curious argument since they also argue
    that such parents are irresponsible by
    unnecessarily exposing their children to greater
    risk by choosing not to vaccinate.

31
From http//thinktwice.com/angry.htm
  • Regarding polio, over 95 of the population can
    be exposed to the poliovirus and will not
    contract polio. This indicates that the
    poliovirus is not responsible for the illness
    that is associated with it. The health of the
    organism is the more significant factor. Doctors
    should be more concerned with promoting health
    than pushing drugs.

32
Conclusions
  • Vaccines in general are very safe and effective.
    The risk of adverse effects is greatly
    exaggerated by irresponsible parties.
  • The distinction between scientific evaluation of
    claims and pseudoscience is crucial for all
    educated persons to understand.

33
Additional Anti-Vaccination Web Sites
  • http//www.gulfwarvets.com/anthrax.htm
  • http//nyvic.org/nyvic/
  • And pro-vaccine information sites
  • http//www.pathguy.com/antiimmu.htm
  • http//www.immunizationinfo.org/
  • http//www.jennymccarthybodycount.com/Jenny_McCart
    hy_Body_Count/Home.html

34
Further Information
  • General recommendations from ACIP
    http//www.cdc.gov/mmwr/pdf/rr/rr6002.pdf
  • Immunization Action Coalition http//www.immunize.
    org/safety/index.htm
  • Lo B, Katz MH. Clinical decision making during
    public health emergencies Ethical
    considerations. Ann Intern Med 2005143493-8.
  • Wolfe RM, sharp LK, Lipsky MS. Content and design
    attributes of antivaccination web sites. JAMA
    20022873245-8
  • Davies P, Chapman S, Leask J. Antivaccination
    activists on the world wide web. Arch Dis Child
    20028722-5.
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Title: Anti-Vaccinationists: A case study in pseudoscience


1
Anti-VaccinationistsA case study in
pseudoscience
  • Donald Miller, Pharm.D.
  • Professor and Chair,
  • Department of Pharmacy Practice
  • NDSU

2
What is Science?
  • The scientific method is a self-correcting method
    of making and testing hypotheses through
    experiments (or the best available methods) that
    can be readily verified or rejected.
  • At least ideally, science is an objective
    approach in which the best available evidence is
    accepted, regardless of whether it is consistent
    with ones prior beliefs. It also critically
    compares rival theories rather than seeking to
    prove one specific theory.
  • Science is a method not a belief system. Its
    strengths are the ability to make predictions,
    openness to peer review and the performance of
    experiments that challenge beliefs and working
    hypotheses.

3
Science vs Belief
  • Science involves peer review to protect against
    influence of personal biases in doing and
    interpreting studies.
  • Scientists regard constructive criticism of their
    ideas and hypotheses as standard operating
    procedure.
  • Scientific research is not about proving the
    truth, but about testing our understanding of
    the truth by testing the alternatives. Paradigms
    are modified or even rejected once a better
    understanding of reality comes along. The entire
    body of evidence must be considered.
  • Communities of faith naturally look for
    confirmation of their beliefs, not for
    improvement of their understanding.

4
What is Pseudoscience?
  • The selective use, and misuse, of scientific
    evidence to support a predetermined conclusion or
    point of view (typically based on ideology or
    authority), rather than the unbiased use of
    evidence to draw logical conclusions.
  • Sometimes called junk science. Junk science
    also refers to badly done research that is set up
    to support a predetermined outcome.
  • But the term junk science has been hijacked by
    pseudoscientists and politicians to disparage any
    evidence with which they disagree.
  • Pseudoscientific conclusions typically do not
    change with new evidence. Since evidence is used
    selectively to support an argument anyway, new
    evidence may be ignored or dismissed.

5
Legal Analogy
  • If you were selected for a jury you would be
    obligated to weigh all the evidence both for and
    against the defendant.
  • Lawyers for each side would take a
    pseudoscientific approach of presenting the best
    selective evidence for their side, but the judge
    and jury must be impartial.
  • Assume there are ten witnesses to a car accident
    2 say the first car was speeding and 8 say it
    was traveling at a normal speed before the crash.
    The police must interview all witnesses and then
    all must be allowed to testify.
  • If only testimony of the first 2 is considered we
    are being biased and pseudoscientific.

6
Why Are People Attracted to Pseudoscience?
  • Humans are not naturally critical thinkers or
    adept at using evidence most people judge a
    proposition by whether it makes sense or feels
    right.
  • Pseudoscientific explanations of phenomena tend
    to be much simpler and more emotionally
    satisfying than complex explanations.
  • We are also highly egocentric using our
    personal experience and the beliefs of our
    friends and family to judge what seems right.
  • Furthermore, we are highly disposed to preserve
    our current beliefs rather than to challenge them.

7
Background on Vaccinations
  • Established by Edward Jenner with vaccination for
    smallpox in late 1700s.
  • Polio vaccine in 1950s
  • Very cost-effective (cost saving)
  • Consistent with preventative medicine
  • Vaccinations have been called the most important
    single contributor of any medical advance to
    reduced global morbidity and mortality1

1. JAMA 20022883155-58
8
Todays Vaccines
  • U.S. policy set by the Advisory Committee on
    Immunization Practices, an advisory group to the
    U.S. Public Health Service and the CDC.
  • Additional guidelines by American Academy of
    Pediatrics and American Academy of Family
    Physicians.
  • Childhood vaccinations series recommended for
    measles, mumps, rubella, varicella, polio,
    diptheria, tetanus, pertussis, haemophilus
    influenza type B, pneumococcus, hepatitis B,
    rotavirus, and HPV.
  • Adult vaccinations recommended for measles,
    mumps, rubella, tetanus, diptheria, varicella,
    hepatitis B, plus populations at risk of
    hepatitis A, influenza, and pneumococcus.

9
Efficacy of Vaccines
  • Smallpox and polio have been completely
    eradicated in the U.S., while incidence of
    several other diseases such as measles and
    pertussis have been reduced by 98-99 compared to
    their baseline annual incidence.
  • Protect both the individual and the community
  • Yet almost 50,000 people/year die in the U.S.
    from vaccine preventable diseases.1

1. Ann Intern Med 2007147735-7
10
So Why Would Anyone Oppose Vaccines?
  • Individual rights and distrust of government
    (childhood vaccines are mandatory for school
    enrollment)
  • Distrust of organized medicine and belief in
    alternative natural healing paradigms.
  • Actual adverse effects
  • Sore arms, fever, flu-like illnesses,
    Guillain-Barre Syndrome (1.8 cases/million)
  • Older pertussis vaccine often caused fever,
    crying, limpness, and occasionally seizures.
  • Actual infection with virus - the Cutter incident
  • Alleged adverse effects
  • sudden infant death syndrome (SIDS), autism,
    multiple sclerosis, vague claims of neurologic
    disorders.

11
The Cutter Incident
  • Initial Salk vaccine developed with inactivated
    polio virus and was successful in field trials
  • In conversion to mass commercial distribution,
    Cutter Laboratories produced a vaccine in which
    some virus was still active, leading to 164 cases
    of paralysis and 10 deaths
  • Cutter was found legally liable, though not
    negligent (establishing a precedent that still
    inhibits vaccine manufacturers)
  • Getting the disease itself is still a remote risk
    with all vaccines that use live (attenuated)
    virus, thus immunocompromised patients cannot
    receive them.

12
Risk Benefit of Vaccines
  • Actual risks of vaccines are well known and are
    much less than the risks associated with the
    corresponding diseases that are prevented.
  • Costs of adverse effects can be compensated by
    the vaccine adverse events reporting system
    (VAERS)
  • Accurate information readily available through
    pediatricians and government web sites

13
Tactics of Pseudoscientific Opponents of
Vaccination
  • Appeals to morality
  • Conspiracy theories
  • Appeals to free choice
  • Appeals to authority
  • Scientism
  • Appeals to emotion (anecdotes)
  • Errors in logic
  • Deception and outright lies

14
Appeals to Morality
  • New vaccines (Gardasil, Cervarix) are licensed
    for human papilloma virus, the leading cause of
    cervical cancer. Optimal vaccination must occur
    prior to sexual activity, but conservatives
    oppose this as encouraging sexual activity.
  • Two vaccines (varicella, rubella) were developed
    from viruses originally grown in human cell
    cultures from aborted fetuses. No ongoing embryo
    destruction occurs.
  • Interestingly, even 2 centuries ago, early
    opponents of vaccination felt it was immoral
    because it interfered with Gods plans.

15
Conspiracy Theories
  • A common tactic of pseudoscience is to talk of a
    conspiracy by organized medicine to hide the
    true risk of vaccines.
  • In fact, the established risks of vaccines are
    easy to find in the literature and are publicized
    by the Centers for Disease Control at
    http//www.cdc.gov/vaccines/vac-gen/side-effects.h
    tm

16
Appeals to Freedom, Informed Choice or Free
Choice
  • A free, informed choice requires accurate
    information not something that anti-vaccination
    web sites generally provide.
  • Critics of mandatory vaccinations fail to
    understand the role of public health in
    protecting populations. Individual freedoms may
    be reasonably limited to protect the greater
    public (e.g. public smoking bans, quarantine)
    under the 10th amendments police power granted
    to states.1

1. Stewart AM. NEJM 20093612015-17
17
Appeals to Authority
  • Celebrities and peripheral scientific figures

18
Scientism
  • The use of, and belief in, the trappings of
    science (big words, p values, journal citations,
    etc.) to give the false impression of accuracy
    and honesty.
  • Most anti-vaccine web sites are slick and
    convincing to an uninformed user.
  • Journal citations are frequent (and the sheer
    volume superficially impressive), but are almost
    all outdated, selective, or used to support
    statements not implied by the actual reference.
    E.g. http//thinktwice.com/s_autism.htm

19
Claims That Several Vaccines At Once Can
Overwhelm the Immune System
  • Todays vaccines mostly use highly purified and
    specific viral proteins, in comparison to the
    nonspecific proteins or whole viruses formerly
    used, so the total burden of immunologic
    stimulation is minimal and has not increased.
  • In addition, children are naturally exposed to
    many infectious agents that provide a high number
    of antigenic viral and bacterial proteins.

NEJM 20083582089-91
20
Emotional Appeals Through Anecdotes
  • Web sites often contain personal stories and
    pictures of children allegedly injured by
    vaccines, as well as pictures of menacing
    needles.
  • E.g., http//www.nvic.org/Vaccine-Memorial.aspx
  • Anecdotes are misleading because there is no way
    to know if the alleged adverse effect is related
    to the vaccine (confusing association with
    causation).
  • Even if a vaccine did cause the injury, anecdotes
    give no sense of how common the injury is, or the
    overall risk/benefit ratio.

21
From http//thinktwice.com/faq.htm8
  • In 10, down three. A lot of adult vaccines are
    really problematic too. I was recommended by a
    travel clinic to have the Japanese encephalitis
    vaccine for a luxury trip to India and Nepal.
    We're retired and this is the trip we've dreamed
    about. I went in on September 24 and had shot 1
    of 3. They do a before and after blood pressure
    check. Before was 130/80. After was 140/80. Ten
    days later, I returned for shot 2. Before was
    150/80. The nurse said she didn't want to
    administer it so I went home. The doctor said to
    go ahead and complete the series. I didn't. A
    week later my blood pressure was up to 160/80.
    Then yesterday it was 170/80, and they gave me a
    prescription for medication.

22
Errors in Logic
  • Association between events assumed to mean
    causation (vaccinations are given around the time
    in life when autism can first be diagnosed and
    SIDS occurs.
  • Recall bias. It is normal to want to find a cause
    for unsettling events and one may inaccurately
    recall the onset of an event like autism,
    multiple sclerosis, etc. to coincide with the
    vaccination.

23
The Autism Controversy
  • Since vaccines are given at about the same age
    that autism is able to be diagnosed, naturally
    many diagnosed children will have received one or
    more vaccines very recently. An apparent spike in
    autism cases has occurred since the 1980s.
  • The link between MMR vaccine and autism received
    wide publicity in 1998 with publication of 12
    cases of children developing gastrointestinal and
    developmental problems shortly after vaccination
    (Lancet 1998351637-41) The authors hypothesized
    that the vaccine or its thiomersal preservative
    were causative.
  • The speculation caused a collapse of confidence
    in the vaccine and thiomersal, especially in
    Great Britain.

24
The Autism Controversy
  • Not only was speculation of cause and effect
    inappropriate, the study and publication took
    place about 8 years after vaccination and
    involved parents recollection of events.
  • Several prospective studies subsequently found no
    association between the vaccine and autism or
    other problems.
  • The publication was retracted in 2004 after
    coauthors discovered that the main author had
    been paid by an organization to look for evidence
    to support a lawsuit over immunizations.
  • Thiomersal has been gradually removed from
    vaccines, not due to proven harm, but to increase
    acceptance of vaccines and assure the public that
    everything possible is being done to assure
    safety (but new cases of autism continue to
    occur!).

25
The Autism Controversy
  • Similar controversies have existed about DPT
    vaccine and Sudden Infant Death Syndrome,
    hepatitis B vaccine and multiple sclerosis, HiB
    vaccine and childhood diabetes, anthrax vaccine
    and Gulf War Syndrome, etc., all without
    confirmation.
  • Such scares are typically precipitated by
    clusters of the disease in question, where people
    look for associations to explain the cluster.
    What is not generally appreciated is that
    apparent clusters of any disease can occur at
    random from time to time, with no causal etiology
    at all.

26
Outright Lies and Distortions
  • Claims that vaccines are ineffective or just
    temporarily effective.
  • Claims that vaccine policy is motivated by
    enormous profits to the vaccine industry and
    individual physicians.
  • Adverse effects of vaccines are underreported
    (implying a cover-up)
  • Claims that vaccine preventable disease have
    declined for other reasons such as improved
    nutrition or hygiene.
  • The majority of people who get disease have been
    vaccinated

27
Outright Lies and Distortions
  • The credo Vaccines are more dangerous than the
    disease.
  • This is true only in so far as vaccines have
    largely eliminated many diseases. From an
    individual perspective, the actual dangers of
    each disease are considerably higher than the
    risks associated with the corresponding vaccine.
  • From a societal perspective, the current rarity
    of the diseases may in fact mean that more
    persons are injured by vaccines than the
    corresponding diseases. But this is the price we
    pay for keeping the diseases rare.

28
Outright Lies or Distortions
  • Claims that vaccine-associated illnesses have no
    spontaneous cause. (But all the alleged illnesses
    such as autism - do, in fact occur
    spontaneously and without clear precipitating
    causes).
  • Claims that vaccination in general, or too many
    vaccinations, weaken the immune system and causes
    autoimmune diseases.
  • Claims that disease outbreaks in unvaccinated
    areas are rare or exaggerated by the media.
  • Claims that vaccines are loaded with extra toxic
    ingredients like aluminum.

29
Outright Lies and Distortions
  • Blatant distortions such as citing an article
    that actually says mumps is now more common in
    older people than children, and twisting it to
    falsely claim that mumps is now more common among
    the elderly than prior to vaccinations.
  • Even attacks on the germ theory of disease!

30
From http//thinktwice.com/faq.htm8
  • Recently vaccinated children do carry the
    disease germ and are able to spread it to other
    children. Many so-called epidemics are initiated
    and spread in this manner, even though the
    unvaccinated are blamed. some authorities
    argue that parents who do not vaccinate their
    children reap the benefits without taking the
    risks -- a curious argument since they also argue
    that such parents are irresponsible by
    unnecessarily exposing their children to greater
    risk by choosing not to vaccinate.

31
From http//thinktwice.com/angry.htm
  • Regarding polio, over 95 of the population can
    be exposed to the poliovirus and will not
    contract polio. This indicates that the
    poliovirus is not responsible for the illness
    that is associated with it. The health of the
    organism is the more significant factor. Doctors
    should be more concerned with promoting health
    than pushing drugs.

32
Conclusions
  • Vaccines in general are very safe and effective.
    The risk of adverse effects is greatly
    exaggerated by irresponsible parties.
  • The distinction between scientific evaluation of
    claims and pseudoscience is crucial for all
    educated persons to understand.

33
Additional Anti-Vaccination Web Sites
  • http//www.gulfwarvets.com/anthrax.htm
  • http//nyvic.org/nyvic/
  • And pro-vaccine information sites
  • http//www.pathguy.com/antiimmu.htm
  • http//www.immunizationinfo.org/
  • http//www.jennymccarthybodycount.com/Jenny_McCart
    hy_Body_Count/Home.html

34
Further Information
  • General recommendations from ACIP
    http//www.cdc.gov/mmwr/pdf/rr/rr6002.pdf
  • Immunization Action Coalition http//www.immunize.
    org/safety/index.htm
  • Lo B, Katz MH. Clinical decision making during
    public health emergencies Ethical
    considerations. Ann Intern Med 2005143493-8.
  • Wolfe RM, sharp LK, Lipsky MS. Content and design
    attributes of antivaccination web sites. JAMA
    20022873245-8
  • Davies P, Chapman S, Leask J. Antivaccination
    activists on the world wide web. Arch Dis Child
    20028722-5.
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