Re: Preventing overdiagnosis: how to stop harming the healthy
The first article James D Cole [BMJ Rapid Responses 6 June 2012] cites is Offit et al 'Addressing parents concerns: do multiple vaccines overwhelm or weaken the infant's immune system?' [1] in which he notoriously proposes that an infant's immune system has the spare capacity to cope with the challenge of 10,000 vaccines at a time. The UK head of vaccines policy, Dr David Salisbury, took up the theme in a Newsnight programme in 2004 where he stated [2]:
"The immune system of a baby has got huge spare capacity to deal with
challenge. If we didn't, the human race wouldn't survive. But let's look
specifically at vaccine. This has been studied carefully. A baby's immune
system could actually tolerate perfectly well 1,000 vaccines".
However, he elaborated on this to me in an email exchange shortly afterwards and I reported in these columns [2]:
"I subsequently had the opportunity to ask Dr Salisbury about this
statement, and while I cannot quote him directly he made a distinction
between overload - which was the point that he was apparently making in
the interview - and the enhanced risk of adverse reaction which he
accepted would be the consequence of such an action."
What is possibly delusional - semantics aside - is that there is no risk to these products and that the risk does not necessarily escalate the more of them there are. So, perhaps the question is when a reassurance is not really a reassurance? It is, by the way, not easy to get compensation on the US Vaccine Injury Compensation Programme but nevertheless nearly $2.5b has been paid out since 1989 [3].
It is also rather obvious that any single one of these products can on occasion trigger an encephalopathy. As the Health Resources and Services Administration told Sharryl Attkisson of CBS News [4]:
"We have compensated cases in which children exhibited an encephalopathy, or general brain disease. Encephalopathy may be accompanied by a medical progression of an array of symptoms including autistic behavior, autism, or seizures."
Or as Julie Gerberding, late Director of the Centers for Disease Control, and now Director of Merck's vaccine division told CBS in relation to the Hannah Poling case [5]:
"Well, you know, I don't have all the facts because I still haven't been able to review the case files myself. But my understanding is that the child has a -- what we think is a rare mitochondrial disorder. And children that have this disease, anything that stresses them creates a situation where their cells just can't make enough energy to keep their brains functioning normally. Now, we all know that vaccines can occasionally cause fevers in kids. So if a child was immunized, got a fever, had other complications from the vaccines. And if you're predisposed with the mitochondrial disorder, it can certainly set off some damage. Some of the symptoms can be symptoms that have characteristics of autism."
A 2006 study disclosed that approx. 1 in 17 toddlers given MMR 2 developed a temperature 39.5C or greater. LeBaron, who works for the Centers for Disease Control, also recorded nearly one quarter of toddlers in the study (23%) were routinely vaccinated despite being unwell prior to vaccination with fever (7%), diarrhea (12%) and rash (7%). There was no follow to find out what happened to the children beyond 1 month after vaccination [6]
My own view is that a system which was actually listening would not be dismissive, and I was not reassured Lucija Tomljenovic's recent paper: 'The vaccination policy and the Code of Practice of the Joint Committee on Vaccination and Immunisation (JCVI): are they at odds?' presented to the British Society of Environmental Medicine: it evidences nothing better than a culture of sweeping things under the carpet.
It is, of course, very easy not to find things if you are not looking.
[6] Charles W. LeBaron, Daoling Bi,
Bradley J. Sullivan, Carol Beck,
Paul Gargiullo, 'Evaluation of Potentially Common Adverse Events Associated With the First and Second Doses of Measles-Mumps-Rubella Vaccine', http://pediatrics.aappublications.org/content/118/4/1422.full
[7] Lucija Tomljenovic, 'The vaccination policy and the Code of Practice of the Joint Committee on Vaccination and Immunisation (JCVI): are they at odds?' BSEM conference 'The Hazards of Disease Prevention' March 2011, http://www.ecomed.org.uk/wp-content/uploads/2011/09/3-tomljenovic.pdf
Rapid Response:
Re: Preventing overdiagnosis: how to stop harming the healthy
The first article James D Cole [BMJ Rapid Responses 6 June 2012] cites is Offit et al 'Addressing parents concerns: do multiple vaccines overwhelm or weaken the infant's immune system?' [1] in which he notoriously proposes that an infant's immune system has the spare capacity to cope with the challenge of 10,000 vaccines at a time. The UK head of vaccines policy, Dr David Salisbury, took up the theme in a Newsnight programme in 2004 where he stated [2]:
"The immune system of a baby has got huge spare capacity to deal with
challenge. If we didn't, the human race wouldn't survive. But let's look
specifically at vaccine. This has been studied carefully. A baby's immune
system could actually tolerate perfectly well 1,000 vaccines".
However, he elaborated on this to me in an email exchange shortly afterwards and I reported in these columns [2]:
"I subsequently had the opportunity to ask Dr Salisbury about this
statement, and while I cannot quote him directly he made a distinction
between overload - which was the point that he was apparently making in
the interview - and the enhanced risk of adverse reaction which he
accepted would be the consequence of such an action."
What is possibly delusional - semantics aside - is that there is no risk to these products and that the risk does not necessarily escalate the more of them there are. So, perhaps the question is when a reassurance is not really a reassurance? It is, by the way, not easy to get compensation on the US Vaccine Injury Compensation Programme but nevertheless nearly $2.5b has been paid out since 1989 [3].
It is also rather obvious that any single one of these products can on occasion trigger an encephalopathy. As the Health Resources and Services Administration told Sharryl Attkisson of CBS News [4]:
"We have compensated cases in which children exhibited an encephalopathy, or general brain disease. Encephalopathy may be accompanied by a medical progression of an array of symptoms including autistic behavior, autism, or seizures."
Or as Julie Gerberding, late Director of the Centers for Disease Control, and now Director of Merck's vaccine division told CBS in relation to the Hannah Poling case [5]:
"Well, you know, I don't have all the facts because I still haven't been able to review the case files myself. But my understanding is that the child has a -- what we think is a rare mitochondrial disorder. And children that have this disease, anything that stresses them creates a situation where their cells just can't make enough energy to keep their brains functioning normally. Now, we all know that vaccines can occasionally cause fevers in kids. So if a child was immunized, got a fever, had other complications from the vaccines. And if you're predisposed with the mitochondrial disorder, it can certainly set off some damage. Some of the symptoms can be symptoms that have characteristics of autism."
A 2006 study disclosed that approx. 1 in 17 toddlers given MMR 2 developed a temperature 39.5C or greater. LeBaron, who works for the Centers for Disease Control, also recorded nearly one quarter of toddlers in the study (23%) were routinely vaccinated despite being unwell prior to vaccination with fever (7%), diarrhea (12%) and rash (7%). There was no follow to find out what happened to the children beyond 1 month after vaccination [6]
My own view is that a system which was actually listening would not be dismissive, and I was not reassured Lucija Tomljenovic's recent paper: 'The vaccination policy and the Code of Practice of the Joint Committee on Vaccination and Immunisation (JCVI): are they at odds?' presented to the British Society of Environmental Medicine: it evidences nothing better than a culture of sweeping things under the carpet.
It is, of course, very easy not to find things if you are not looking.
[1] Offit PA, Quarles J, Gerber MA, Hackett CJ, Marcuse EK, Kollman TR, Gellin BG, Landry S, 'Addressing parents' concerns: do multiple vaccines overwhelm or weaken the infant's immune system?', Pediatrics. 2002 Jan;109(1):124-9. http://pediatrics.aappublications.org/content/109/1/124.long
[2] John Stone, 'What David Salisbury said, and the DOH's position on multiple vaccine safety' BMJ Rapid Responses 20 September 2004, http://www.bmj.com/rapid-response/2011/10/30/what-david-salisbury-said-a...
[3] Health Resources and Services Administration, http://www.hrsa.gov/vaccinecompensation/statisticsreports.html#Note:2
[4] http://www.cbsnews.com/8301-31727_162-20016356-10391695.html
[5] CNN Transcripts, House Call with Dr Sanjay Gupta, Aired March 29, 2008 - 08:30 ET, http://transcripts.cnn.com/TRANSCRIPTS/0803/29/hcsg.01.html
[6] Charles W. LeBaron, Daoling Bi,
Bradley J. Sullivan, Carol Beck,
Paul Gargiullo, 'Evaluation of Potentially Common Adverse Events Associated With the First and Second Doses of Measles-Mumps-Rubella Vaccine', http://pediatrics.aappublications.org/content/118/4/1422.full
[7] Lucija Tomljenovic, 'The vaccination policy and the Code of Practice of the Joint Committee on Vaccination and Immunisation (JCVI): are they at odds?' BSEM conference 'The Hazards of Disease Prevention' March 2011, http://www.ecomed.org.uk/wp-content/uploads/2011/09/3-tomljenovic.pdf
Competing interests: Autistic son