7/16/2013

07-16-13 - Vaccines

Every parent these days has to face the question of vaccines, and whether they will blindly follow the standard CDC schedule or choose any modifications.

Obviously most of the anti-vaccine movement is total nutjobs, based on no science. They're an odd mix of the crazy christians and the crazy liberal/organic types who are part of a general insane granolay anti-science movement. The scaremongering has become so widespread, that even the sane parent has to ask themselves "is there anything to this?".

Unfortunately, the pro-vaccine side is not really without faults. They also are dishonest and misrepresent the facts, and make lots of arguments that aren't helping their side.

A few links on the pro-vaccine (anti-Dr. Bob) side :

The Problem With Dr Bob's Alternative Vaccine Schedule
CDC - Vaccines - Immunization Schedules for Children in Easy-to-read Formats
Cashing In On Fear The Danger of Dr. Sears � Science-Based Medicine

Let me make a few points :

1. Some vaccines may be in the best interest of society, but not of the child. A parent making a purely selfish decision for the best interest of their child would logically choose not to get that vaccine.

The pro-vaccine people really don't want you to know this, so they lie about it or try to hide it.

Let's consider the MMR shot. The pro-vaccine people will say something like : the rate of severe complications (mainly encephalopathy and other high-fever side effects) from the MMR vaccine is something like 1-3 per million (*). However if you actually do get measles the rate of severe side effects (eg. death) is around 1-3 per thousand.

(* = there is some debate about whether the rate is actually higher than placebo, but let's ignore that question for the purpose of this point)

That's a slam dunk for vaccines, right? One per thousand vs one per million! So they claim, but no it is not. The problem is that you are getting a vaccine 100% of the time, but assuming that everyone else continues to get the MMR shot so that the diseases remain vanishingly rare (**), the chance of you getting measles is only something like 1 in a million. So in fact the chance that you will die from measles in your lifetime is only 1 in a billion, much lower than the complication rate of the vaccine. (of course the complication is worse and you have to weigh that somehow)

(** = I know perfectly well there have been recent outbreaks due to the non-vaccinating nutters, but it's still vanishingly rare at this point)

Now, obviously if you choose to fuck over society for such a marginal +EV for your child, you're an asshole. But that is the American Way. It could practically be on our national seal - "Take what you want and fuck the greater good".

I think this is the most interesting point of the whole post; theoretically let us imagine there is a vaccine that is actually on average harmful for each individual, but as a whole provides a massive benefit to society. Should you get it? Would people actually get it? I believe that the demonstrated behavior of the modern vaccine-abstainer movement is that no, people would in fact not get it. So then, should it be required by law?

BTW I suspect that there probably is not a currently existing vaccine (of a major disease; I'm not talking about chickenpox, hpv, or flu, which are in a separate category) where it is in fact +EV for the child to abstain, but I think it's close in a few cases and it's an interesting theoretical question. (the main question for it being "close" is that I suspect the supposed MMR side effects, and the settlements under the table injury law, are mostly not actually MMR side effects (*!*)).

(*!* = The primary question is about the cases of encephalopathy that have been compensated under the NCVIA based solely on them occuring shortly after the injection. In these cases, the government pays a settlement automatically without admitting fault or requiring any proof that the encephalopathy was caused by the vaccine. Some on the anti-vaccine side incorrectly interpret these settlements as courts finding that the vaccines did harm, but that is not the case. It's unclear whether the rate of encephalopathy following MMR is in fact statistically significant compared to the rate following a placebo shot; there're lots of paper on this in case you want to waste a day).

2. The pro-vaccine people claim that combo shots are perfectly safe and there's no reason to separate them. However, we know that quite a few of the combo shots that have been sold by the major pharmaceutical companies in the last 40 years have in fact been *not* safe. And during that time they were saying "oh yeah sure ProQuad (or whatever) is totally safe, trust us". So we're supposed to believe that despite the safety net failing repeatedly in the past, it's worked now and the current set of shots is fine.

My opinion on medication in general is to not trust anything that's new. If it's new, not only has it not been tested much in the field (and for many reasons you should not trust the manufacturer's own tests), but more than that there's a profit motive. The generic combinations that have been in use for a long time are no longer cash cows, so they try to bring out some new combination that puts even more together, and when there is a profit opportunity there is often pharmaceutical companies making people sick. I'd much rather get a 20 year old drug than a new one that's supposed to be better (though it's hard to find doctors that go along with this).

And the whole pro-combo-shot argument seems illogical to me on the face of it. What they generally argue is that the number of antigens in the vaccines is low, in fact very low compared to the number of antigens that babes get environmentally all the time (***). They also contend that baby's immune systems are perfectly capable of handling the load. Sure sure. But in fact vaccines do sometimes trigger high level immune responses, a very small fraction of the time. Each separate type of antigen is capable of doing that, and if you get unlucky and the body responds badly to several at the same time, that's more likely to be a higher and longer lasting fever.

(*** = and of course that's a specious argument; the daily environmental antigen exposure is obviously not the same thing as an injection of very specific antigens related to a major disease. They're not the same kind of antigens, your body doesn't have the same reaction, they aren't introduced the same way, it's just a retarded argument. The way the pro-vaccine group constantly tried to make its argument "stronger" by adding more points that aren't quite right doesn't help).

They put up this absurd straw man argument, claiming the objection to combos is that the infant immune system will be "overwhelmed", and in fact it will not be, QED combos are fine. Umm, what?

3. The "Aluminum is safe" arguments are weak. There is no good data on whether the Aluminum in the new vaccines is safe or not long term. It simply hasn't been used long enough to know if there is a low level long term toxicity.

In order to contend that it is safe, they compare it to the ingestable aluminum recommended limits and slow exposure limits and things like that which are not the same thing. Of course there's never any long term testing of any new medicine, so any new drug you take could have bad long term effects. And even for drugs that are on the market a long time, it can be very hard to attribute long term complications to them (eg. the mercury carriers that were used before aluminum probably were in fact perfectly safe, but it's hard to tell for sure).

It sort of reminds me of when dental fillings all switched from mercury amalgam over to epoxy resins. There was zero evidence that the mercury fillings were actually harmful, but because it has the scary word "mercury" in the name people thought they must be toxic. So instead we all of a sudden get some new chemical reaction happening inside our mouths, that due to being new of course had no long term health results. So essentially you're putting your whole population to a new risk for no good reason (eg. dental resins release various VOCs during initial curing, which may or may not have health consequences).

4. The CDC schedule is in fact not made with the health of your infant in mind.

This is one of the big dishonesties in the pro-vaccine camp that bothers me. Lots of the pro-vaccine people say "follow the CDC, they're the experts, the schedule is made in the best way". Well, yes, sort of, but they made the schedule with several different factors in mind. One is the best interest of your child. One is herd immunity. Another one is protecting babies from parents that are dishonest or cheaters; eg. things like the early Hep B vaccine is important even for parents who claim they are clean because many parents are either secret drug users or having secret extramarital sex. If you know you are not doing those things, it's probably fine to skip it.

Another major factor in the CDC schedule is compliance. They want you to get all the vaccines early and in few appointments, because they know that is the only chance to get most people to see their doctors. If it took lots of appointments, and continued into later childhood, there would be huge compliance failures. A large part of the CDC schedule is behavioral engineering. In fact the best schedule for your child's health is probably slower and more sparse than the CDC schedule (assuming you would actually stick to the slower schedule).

Shots like Polio are given early not because the infant needs them at that age, but just to make sure that person gets them *ever*, because the early shots are the least likely to be missed. It's probably better to get those shots later (though only microscopically since the harm of getting them early is minimal (in fact so minimal that I suspect the extra doctors visits of a spaced out schedule like Dr. Bob's are probably more harmful than just going ahead and getting all the shots early even though you don't need them early)).

Unfortunately the pro-vaccine people don't want to admit this fact and provide a well researched science based slower schedule that is designed with the best interest of the child in mind, so parents are left with things like the non-scientific ad hoc Dr. Bob schedule.

5. Lots of pro-vaccine people in the end resort to "they're the experts, they know more than you, trust them". LOL yeah right, because pharmaceutical companies have never tried to sell us poison, and our government has always given us good science-based health policies.

If you are in fact right, you should be able to argue the facts without resorting to "because we know best". Also the argument that "it's the only schedule that's been tested" is a cheap way out, since you don't allow any other schedule to be tested.


BTW in case it's not clear, my personal belief is that of course you should vaccinate (don't be ridiculous; vaccines are one of the very best things that medical science has ever done (in close competition with antibiotics and antiseptics)), and lacking any better information you should probably just use the CDC schedule. Any -EV in it for your child is very very small, and the risk of trying to make up your own schedule that would be better for your child is greater than any potential benefit.

Of course good decision making also considers the meta-decision of "should I spend my time thinking about this" and I believe in this case the answer is "no".

6 comments:

Tom Forsyth said...

Phew! I'm glad you got to both of the correct conclusions in the end. But still an interesting summary of the arguments on each side.

cbloom said...

There's a general point that's very interesting to me that I first really noticed in poker study.

(I'm sure I've written about this before)

If you just go along with the standard wisdom and do what you're "supposed to", you will do pretty well. 99% of the time it's close even to optimal, and the advantage is you don't do anything massively wrong, and you save tons of time thinking about things.

OTOH if you try to reason out every decision from first principles, if you take nothing for granted and try to prove it to yourself and understand it - you will quite often get things massively wrong, because a straightforward analysis of very hard problems will quite often turn up conclusions that are completely backward from the real best answer. Furthermore you will spend tons of time on it, and be full of doubts and constantly questioning yourself. Even when you do figure out something that's better than the "standard line", the edge is usually very small.

Graphics Online said...

Cheers for the insightful observations, cbloom. My wife is due to give birth to our first child in October so I really appreciate your contributions on this matter.

super friend said...

I thought the observations were interesting as well and I learned some things.

I disagree with your final conclusion, that this issue was so clear that it's not worth thinking about. I think the fact that you were able to write several paragraphs about it demonstrates that this is not the case.

In particular I keep in mind that as you pointed out, pharmaceutical corporations are not altruists, they are not people, and they must increase shareholder value to the exclusion of anything else (by law). Also, I think there are large portions of our government that are effectively captured by industry. Often the same people work on both sides. Can we trust this coalition to act exclusively in our best interests every time? Maybe I'm presuming here but I think you would agree with me that the answer is no.

cbloom said...

"I disagree with your final conclusion, that this issue was so clear that it's not worth thinking about"

- yeah you're right, I guess I didn't mean that. I certainly don't spend like it was time ill spent.

I guess a more correct statement would be :

I don't think it's worth the time to try to do a lot more research on each vaccine and try to formulate your own alternative schedule which is better for the child than the CDC schedule. I also don't think it's worth the time to really carefully study the Dr. Bob Alternative Schedule and try to figure out if it is in fact a good schedule.

cbloom said...

I was sent this link -

http://www.whydontyoutrythis.com/2013/08/courts-quietly-confirm-mmr-vaccine-causes-autism.html

and I think it's a good example of the nonsense used by the anti-vaccine side, so I'll talk about it for a second.

The link refers to this original article -

http://www.thelibertybeacon.com/2013/06/21/new-published-study-verifies-andrew-wakefields-research-on-autism-again-mmr-vaccine-causes-autism/

which is primarily claiming that this court case -

http://www.uscfc.uscourts.gov/sites/default/files/CAMPBELL-SMITH.MOJABI-PROFFER.12.13.2012.pdf

is a settlement by the government and vaccine makers that acknowledges that MMR caused autism.

It is absolutely nothing of the sort.

In fact the court case is a settlement under the NVICP table injury law. The child in question seems to have suffered from encephalopathy within the required time window after vaccination. When that happens, government compensation is automatic, by law. There is not even an investigation into whether the vaccine was the cause (it's pretty impossible to do so given that it's far in the past).

Furthermore, autism really has nothing to do with it. The vaccine may or may not have caused the encephalopathy. The encephalopathy may have caused the autism.

(encephalopathy is a very bad thing that causes brain damage; but it also occurs after normal colds with high fevers)

The scaremongerers want you to believe that all vaccinations are somehow contributing to the widespread "autism epidemic", eg. even in cases without encephalopathy. There is no evidence of that.

old rants