THE VACCINATION DEBATE: Sorting Through the Bias and Fear Edwin Hofmann-Smith, PhD, ND Natural...
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Transcript of THE VACCINATION DEBATE: Sorting Through the Bias and Fear Edwin Hofmann-Smith, PhD, ND Natural...
THE VACCINATION DEBATE: Sorting Through
the Bias and Fear
Edwin Hofmann-Smith, PhD, NDNatural Childbirth and Family Clinic
10360 NE Wasco, Portland, OR 97220
503 252 8125
Public Health Point of View
Vaccination protects the individual AND OTHERS, potentially eliminates epidemics
Measles: 1/1000 death rate (pneumonia, encephalitis, nerve damage, etc.)
Cost of doctors, hospitals, etc. greater than cost of vaccines
Risks of vaccination less than risk of disease One of the “greatest achievements of
medicine/public health”. Smallpox, polio, diphtheria, measles, rubella, mumps, tetanus, all practically eliminated
Public health perspective
Pregnant mom picked up pertussis, her newborn got it, spent next five weeks in NICU, permanent lung damage
Child picks up measles in Switzerland, exposes plane full of people, many quarantined, some cases, no epidemic
Individual family’s perspective
Risk of disease may be minimal (since there are no epidemics)
Risk of vaccination is underestimated by officialdom
Don’t trust the vaccine authorities Can control exposure (hep B, HPV) Our situation isn’t typical, we eat
healthy, use homeopathy,
BIAS
A preference or an inclination, especially one that inhibits impartial judgment
Helps us understand why there is such a wide divergence of opinions
For instance, did you believe the cigarette manufacturers when they say smoking doesn’t cause cancer?
BIAS: vaccine manufacturers
Obvious, everybody knows this There are safeguards regarding conflict
of interest, but revolving door is reality Like military-industrial complex Donate much money to political
campaigns, lobbyists, media Regulators get captured by regulatees.
(It’s an axiom.)
BIAS: media
Advertising dollars are extremely persuasive
When was the last time you heard of a media outlet go against both government and advertisers?
BIAS: CDC/Federal Government
Vaccines for Children Program: Federal government supplies vaccines for free if clinic agrees to vaccinate according to the standard schedule
Tends to keep pediatricians in lock-step
BIAS: Vaccine Injury Compensation Program
Vaccine injury table - compensation only for accepted injuries with specific timing after vaccination
Large cost to program if additional injury added to table
Adversarial program - litigant must prove causation
Poling case - autism and seizures, “mitochondrial defect”
BIAS: scientific method
Hard to prove causation for adverse effects
Hard to prove causation if effect is delayed, infrequent, subtle, not obviously related to disease
Publication bias Funding bias Adverse effects research is a tough
road
BIAS: Public health officers
Vaccination is one of the “greatest achievements of medicine”
Federal grants to states’ public health departments based on vaccination rates
Keeps public health departments motivated to push vaccination
BIAS: pediatric community
Don’t want to think that what they do every day could be harming (some) kids
Vaccinations are an integral part of practice, keep numbers up
Vaccine objectors are seen as uninformed “conspiracy theorists”
“Don’t worry, they’re completely harmless”
VACCINE APPROVAL
Try to balance cost of development with safety
Very brief followup in safety trials Autoimmune and other adverse
effects may take weeks to months to develop.
Generally look for immediate adverse effects, then rely on post-marketing surveillance
Vaccine adverse events reporting system
Reporting is required for serious effects
Anyone can report Rate of reporting is between 1 and
10%
Vaccine safety datalink
Some managed care organizations report data on adverse effects, etc.
First hard evidence of an adverse effect from mercury (thimerasol)
Quickly advised removal of thimerosal
“SAFE”
“The U.S. Food and Drug Administration defines a safe product as ‘one that has acceptable risks, given the magnitude of the benefit expected in a specific population and within the context of alternatives available.’ Determining what degree of risk is 'acceptable' is a particular challenge for regulators and policy-makers” (and parents)
BIAS: Fear Unknown contaminants Stories of adverse effects have “legs”,
not even necessarily true Internet sites - no peer review, have “ax
to grind” Consequences are huge: lifetime of care
for disabled child Personal knowledge of vaccine-injured
child
Mechanisms of adverse effects
Autoimmunity Microglial activation Unintended contamination: virus,
DNA/RNA, enzymes (hypothesized) Chemical toxicity:
mercury/thimerosal, aluminum, formaldehyde
ASD and Developmental Disabilities
1/110 current rate of autism spectrum (CDC)
13% with developmental disabilities ASD lifetime cost of care is $3.2 million Medical care cost about 5 times more
than normal kids About 700,000 with ASD 50 - 60% of their parents believe illness
was triggered by vaccination
ASD causation
Doctors treating ASD estimate 20-50% have clear-cut vaccine injury. Most parents blame vaccination.
MMR is worst one Can be multiple illness/antibiotics Gut flora probably involved in some Some have bizarre immunological
abnormality Family history: autoimmune, neurological
Neurodevelopmental Disorders: Etiology
Mercury? - rates not dropping Aluminum - not much research Autoimmune - auto-antibodies not
found in convincing frequency, no delay in some cases
Gut connection Microglial activation
Hannah Poling case
Multiple ear infections (food allergy, antibiotics, immune dysfunction?)
Tympanostomy tubes At 19 months, “We need to catch her
up on her vaccinations”. Got 9 vaccines.
Prompt and profound decline Mitochondrial defect
Mitochondrial dysfunction
Mitochondria as cellular “batteries” They generate free radicals, also soak
up free radicals by antioxidants Free radicals damage the
mitochondria Genetic mitochondrial dysfunction?
Unlikely. Nitric oxide generates free radicals
Microglial/excitotoxin hypothesis for ASD
Proposed in 2003 by Russell Blaylock, MD Microglia and astrocytes become
activated when the systemic immune system becomes activated
Secrete inflammatory chemicals (cytokines), excitotoxins (glutamate and quinolinic acid), free radicals and lipid peroxidation products (damage mitochondria)
Similar to nitric oxide mechanism of CFS, etc. Can get stuck “on”
Nitric oxide and chronic disease
The proven mechanism of chronic fatigue syndrome, multiple chemical sensitivities, post-traumatic stress disorder, gulf war syndrome, etc. (Martin Pall)
Over production of nitric oxide (eg. in inflammation) leads to damaging free radicals, etc. and can lead to positive feedback loop.
Overproduction can be local. Autism has damage notably in cerebellum and frontal cortex.
Vitamin D hypothesis
Vitamin D has effects on about 10% of human genes
Rise in autism parallels recommendation of sun avoidance
More prevalent in dark-skinned, etc. Pregnant women should get 4000
IU per day, babies 800IU/day
Aluminum toxicity The calculated body burden of aluminum from vaccinations exceeds that from dietary sources, however, it is below the minimal risk level equivalent curve after the brief period following injection.
In young children, vaccines with aluminium hydroxide caused significantly more erythema and induration than plain vaccines (odds ratio 1·87) and significantly fewer reactions of all types (0·21)
Aluminum toxicity
Impairs mercury excretion Impairs glutathione synthesis Maximum dose per vaccine (850
mcg) not based on safety studies Vaccines with aluminum: DTaP,
Hib, Prevnar, Hep B, Hep A, HPV
US Recommended Vaccines
Hep B (3 doses); Polio (4 doses) DTaP (5 doses); Rotavirus (3 doses) Hib (3 or 4 doses); Pneumococcus (4
doses) Varicella (2 doses); MMR (2 doses) Hepatitis A (2 doses) Total doses - 28 Total vaccines 42
Japanese schedule 2004
Polio: 3 shots starting around 3 months DTaP: 3 shots starting around 3 months Measles, rubella: age 1 Japanese encephalitis: 4 shots BCG: 3 shots starting at 4 mo. Total doses - 14 Total vaccines - 21
Timing
Immune system not mature till 1 year of age
Maternal antibodies protect against disease in the infant and inhibit antibody response, last about 6 months
Breast feeding protects against some diseases like Hib and PC
Hepatitis B
Childhood infection: usually asymptomatic but 25-90% risk of chronicity
Chronic infection: liver cancer, cirrhosis Common in Asia, Africa, Eastern Europe,
Pacific Islanders, Central America, and the Carribean
Transmitted by contact with blood, semen and vaginal secretions
Hepatitis B vaccine
Risk of autoimmunity Extremely low risk of disease -
very weak justification for vaccination
Not recommended
Pertussis (whooping cough)
Increasing d/t lower vaccination rates
Newborns not protected (lack of maternal antibody)
Ordinary cough for a week then paroxysmal
Serious in babies: pneumonia, seizures, pulmonary hypertension
Pertussis vaccine
Start 3 - 6 months depending on exposure, etc.
Follow general recommendations: one shot at a time, not when sick or if gut is unhealthy, family history of neurological or autoimmune diseases, silicea 200C as preventive. Don’t repeat if reaction to first shot.
Recommended
Diphtheria
Bacteria cause sore throat and liberate a toxin
Very rare except some foreign countries
Recommended because can’t get pertussis vaccine without it. Available as DTaP, Tdap, etc.
Tetanus
Anaerobic bacterium found in soil, manure
Infection due to dirty wound causes generalized muscle spasm
Recommended: DTaP, Tdap Can’t get pertussis vaccine without
it
Polio
Disease eradicated from the Western Hemisphere, Europe, etc. No risk of disease
Vaccine is now relatively safe but not needed. Disease may be eradicated world-wide in future
Can vaccinate later before foreign travel
Haemophilus influenza type B
Bacterium is normal flora for nose and throat. Can become invasive and cause meningitis, pneumonia, cellulitis, epiglottis, etc.
Now rare due presumably to vaccination
Largely prevented by maternal antibody and breast feeding
Hib: not recommended
Have seen some neurological reactions, but none permanent
Risk of disease very low
Strep. pneumoniae (Prevnar)
More than 90 separate strains exist Causes pneumonia, otitis media,
sinusitis, sepsis, septic arthritis, meningitis, etc.
Vaccine is directed against the 13 worst strains
Now other strains are causing more disease (serotype replacement) and Staph carriage is increased
Prevnar: not recommended
Risk of disease is very low in the absence of specific risk factors like immune dysfunction
Breast feeding is protective Serotype replacement Vaccine is relatively reactogenic
Rotavirus
Almost all kids get this by the time they’re 5 years old
Vomiting 12 to 18 hours, then usually diarrhea
Self limited 37 deaths per year in US
Rotavirus vaccine
Live virus vaccine Rotarix (GlaxoSmithKline) contains parts
of a pig virus that doesn’t make pigs sick Rota Teq (Merck) contains parts of a pig
virus that kills baby pigs Increase in intussusception with Rota Teq Not recommended
Hepatitis A
Fecal-oral transmission Very common in third world, rare in
US Usually asymptomatic in kids but
more severe in adults No chronic state Vaccine relatively safe but not
recommended unless a high risk group
Measles
Measles: 1/1000 death rate, neurological damage
Virtually eliminated in US d/t vaccine
Drop in vaccination rate associated with many-fold increase in cases
Measles vaccine
MMR is the most common vaccine trigger of autism, but usually was given with other vaccines and kid was already sick
Recommended to support public health effort
Give after age 2 - 3 Give 50 - 75,000 IU vitamin A, good
vitamin D status, healthy, not with other vaccines
Mumps
Relatively mild disease Self limited Vaccine: can’t get it without
measles and rubella Recommended after age 2
Rubella
If pregnant mom contracts it in first trimester, fetus gets it and might die or have severe birth defects
Our public health approach - vaccinate all kids. Prevents epidemics. Successful.
Essentially eradicated from US
Rubella vaccine
15% of adolescent and adult women will get acute arthrisis, usually transient
Worse with wild virus infection Can’t get it without M and M Recommend: start after age 2 Don’t re-vaccinate if seronegative
as adult
Varicella Zoster (Chickenpox)
Epidemics among young children Occasional severe disease Susceptibles like immuno-
suppressed, chemotherapy at risk for severe disease
Carrier state with 30% getting shingles later
Exposure to children with chickenpox boosts immunity
CHICKENPOX (VARICELLA)
Disease is usually mild but virus persists Asymptomatic re-activation of vaccine
virus Risk of shingles later in life less with
vaccine? Likely. Shingles vaccine necessary because
less boosting of immunity from epidemics.
Risk of “serious” reaction to vaccine is 0.03 to 0.3%
Chickenpox vaccine program
Best information says, shingles less frequent and milder after vaccination than wild disease
Live virus, slight risk of mild disease after shot
Risks less after shot than from disease
Recommend after age two or three with usual preventive for live virus