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Antivaxxer Plague

....antivaxxers are potentially the Number One health hazard in America.--Phil Plait*

On this day (26 Oct) thirty-two years ago, the last naturally occurring case of indigenous smallpox (Variola minor) was diagnosed in Ali Maow Maalin, a hospital cook in Merca, Somalia.*

1

26 Oct 2009. A few weeks ago I had an exchange with "Jan" about colloidal silver, vaccines, and the post hoc fallacy. Most reasonable people would probably consider it a waste of time to engage someone whose first words to you are:

If I didn't think that writing you was a waste of time because of your pea-sized brain and vision I wouldn't be writing.

I know Jan is trying to insult me, but her words are such a jumble of unintentional self-deprecating humor that I found myself laughing instead of getting riled. Anyway, I made no headway in getting Jan to think about how easy and natural it is to form beliefs about causal connections based on flimsy evidence and how easy it is to find confirmation for our beliefs. She was having none of it. She knows colloidal silver is the key to her health and she knows that vaccines are harmful. She's armed with anecdotes to prove her beliefs. Nothing I had to say about the value of scientific studies sunk in. To people like Jan, it is irrelevant that scientific studies demonstrate that vaccines are safe and effective. No amount of data showing that the odds of dying from the flu are greater than the odds of dying from the flu shot have any weight with the Jans of the world. They know what they know and they know they're right. One anecdote trumps a thousand scientific studies.

Of course, the news media whether it be Fox (that arm of the Republican Party) or the liberal elite media (that arm of the Democratic Party) report the anecdotes, not the scientific studies. Two recent stories illustrate the kind of evidence Jan counts and the kind that the media thrive on.

One story involves a young woman who allegedly developed a weird neurological disorder (dystonia) ten days after getting a flu shot. The nature of the story makes it clear that there must be some connection between the young woman's health problems and the flu shot. The reporters don't have to come right out and say that the shot caused her problems. That's clearly implied by having the report at all. Reporters aren't paid to encourage viewers to think, however. So, don't expect them to investigate other possible causes of the young woman's problems. They won't report that 9 days before her illness, she drank 20 shots of tequila. [For those of you who can't figure it out for yourselves, I'm making this stuff up about the nine days of Christmas for illustration purposes.] Eight days before her illness, someone spiked her drink with ecstasy. Seven days before her illness, she ate a hamburger at McDonalds. Six days before her illness, she spent time in a toxic building where the DMV is located. Five days before her illness, she fell out of bed. Four days before her illness, she drank some bottled water that a friend gave her. Three days before her illness she watched a whole movie in fast forward mode. Two days before her illness, she took a neuroleptic for facial pain. And the day before she got ill, she rode a roller coaster for three hours. Why didn't the reporters note these things? Why didn't they go back eleven days and beyond to see if there might not be something people might causally connect to the illness? Because the flu shot is the current bogeyman. Next year it could be ground beef. In any case, the odds are near zero that this woman's health problems are indicative of dystonia as reported, according to the Dystonia Medical Research Foundation, or that the flu vaccine had anything to do with her (most likely) psychogenic disorder. For the full scoop on this story, which may be the worst reporting ever, see Orac and Steven Novella.

The other story is about a man who developed an autoimmune disorder (Guillain-Barré syndrome or GBS) after some shots. He says that last June he got a tetanus shot and a pneumonia shot, and they caused paralysis in his legs and weakness in his arms. No mention was made of how much time elapsed between shots and symptoms; nor was any effort made to identify the 1,001 other things that happened before the symptoms occurred. How can he be certain it was the shots that caused his problems? He can't. According to the Mayo clinic:

Guillain-Barré syndrome is an uncommon disorder in which your body's immune system attacks your nerves. Weakness and numbness in your extremities are usually the first symptoms. These sensations can quickly spread, eventually paralyzing your whole body.

The exact cause of Guillain-Barré syndrome is unknown, but it is often preceded by an infectious illness such as a respiratory infection or the stomach flu. Luckily, Guillain-Barré syndrome is relatively rare, affecting only 1 or 2 people per 100,000.

In its most severe form, Guillain-Barré syndrome is a medical emergency requiring hospitalization. There's no known cure for Guillain-Barré syndrome, but several treatments can ease symptoms and reduce the duration of the illness. And most people do recover completely.

Most people recover completely. Yet, if you read some of the hysterical writings of anti-vaxxers you'd think most people who get GBS get it from vaccinations and then die from it.

Obviously, an emotional anecdote will be more persuasive than a dry report on scientific studies and statistical probabilities of being harmed versus being protected by a vaccination. Also, the fear of possible harm carries more weight that the hope of possible protection from harm. Further complicating the data is the values issue that's involved here. Getting vaccinated or not affects the whole community, not just oneself. For most people, protecting themselves and their children is a higher priority than protecting strangers. By getting a vaccination and avoiding the flu I not only protect myself but prevent myself from infecting others who aren't vaccinated and who might be greatly harmed by the flu. You might say, well, if they aren't vaccinated that's their tough luck if you give them the flu. That's true. It is their tough luck, but many of these unvaccinated people will be children whose parents have been frightened into not vaccinating their kids. Many will be people with weakened immune systems. So what, you might say. Let natural selection pick these folks off. If it was just one flu shot, I'd say why bother trying to persuade the antivaxxers of anything. But it's not just one shot, it's all shots, and by having ten or twenty percent or more of the population avoiding vaccinations the whole community is put at risk. Natural selection is always at work, and the greater the spread of a virus, the greater the probability of new strains of the virus developing. Plus, the newly born are vulnerable to many preventable diseases and can be protected by herd immunity until they are old enough to get vaccinated.

Anyway, the issue with the antivaxxers is more a matter of emotion than evidence. It doesn't matter that 28 pregnant women in the US have already died from the H1N1 virus this season (dubbed "swine flu" by the media) and no pregnant woman has been harmed by the vaccine. It doesn't matter to antivax parents that the chance of their child being harmed by a vaccination is near zero. It doesn't matter that there is an almost certain benefit to their child and the community at large by having the child vaccinated. It doesn't matter that 43 children in the US have died recently from swine flu* and none have been harmed by the swine flu vaccination. They have an anecdote: an 8-year-old boy died a week after his flu vaccination. It must have been the vaccine that killed him even if health department officials deny it. Their denial is proof they're covering up something. And so it goes.

What's interesting, though, is that anecdotes that show harm done from not having children vaccinated have no effect on the antivaxxers. The fact that four-week-old Dana McCaffery died from whooping cough has no weight with antivaxxers. No infant should get whooping cough any more, but this unfortunate child happened to live in an area where there is very little vaccination compliance and was provided no herd immunity. (Infants aren't given the vaccination for this preventable disease until they are six weeks old.) As one blogger put it: "The fact that other parents didn’t vaccinate their kids gave that little girl a death sentence."*

I find it interesting that in this case the media reported on the event accurately, but the video of the reporting has been taken down. My guess is that it was the antivaxxers who initiated the take-down.

2

Jan's alternative to the flu vaccine is colloidal silver, a popular panacea with the alternative crowd. According to Marilynn Marchione of the Associated Press, the federal Agency for Toxic Substances and Disease Registry says silver "may cause harmful health effects," depending on the amount and type of exposure. Marchione also notes that the FDA has issued a warning that scam artists are flooding the Internet with bogus claims about preventing or treating swine flu. The one thing these scam artists have in common is that they are taking advantage of the fear many people have about the dangers of vaccinations.

Fraudulent products emerged shortly after swine flu did last spring, at the rate of about 10 a day, according to Alyson Saben, head of the FDA's swine flu consumer fraud team. The products include air sterilizers, photon machines that deliver "energy waves," supplements of all sorts, and shampoos and masks that can't protect against viruses. (As of 20/11/09 the FDA lists 143 fraudulent products on its Fraudulent 2009 H1N1 Influenza Products List.) Dr. Andrew Weil leads the pack with his Immune Support Formula. The FDA warned Weil about making the following claim on his website: "...during the flu season, I suggest taking a daily antioxidant, multivitamin-mineral supplement, as well as astragalus, a well-known immune-boosting herb that can help ward off colds and flu. You might also consider ... the Weil Immune Support Formula which contains both astragalus and immune-supportive polypore mushrooms." In response to the FDA, Weil issued a statement saying the website content "was primarily educational" about how to avoid the flu, and that he had directed his website team to remove and review it for compliance with federal rules.

Tamiflu and Relenza are the only drugs recommended for treating swine flu, but there are several fake Tamiflu products being sold on the Internet. There is also good reason to question the reliability of the data supporting Tamiflu's effectiveness, according to Dr. Ben Goldacre.

It's bad enough that the usual suspects are preying on the fears of people. Marchione notes:

Rogue Web sites are not the only ones trying to cash in on flu fears. Makers of some well-established products are making claims that may be close to the line, the FDA says.

This week, the makers of Dial Soap, Kleenex, Clorox and other big brands launched a joint promotional campaign costing up to $1 million. The FDA is reviewing the campaign, which includes a video that says:

Germs are tiny organisms that can cause disease. According to the CDC, up to 80 percent of infectious diseases, like the flu, are spread by your hands. That's why frequent, proper handwashing is so important in preventing spread of the flu, other viruses and germs. An antibacterial soap like Dial Complete foaming hand wash kills 99.9 percent of germs.

Flu is caused by a virus, so killing bacteria is of uncertain benefit.

In this week's New England Journal of Medicine, three FDA doctors caution against prescribing ribavirin for swine flu patients. The drug has been approved in the U.S. for treating hepatitis C and respiratory syncytial virus, but not swine flu. It can cause "a dangerous type of anemia and cannot be used in pregnant women because of the risk of birth defects," said the FDA's Dr. Debra Birnkrant.

See also Andrew Wakefield, the anti-vaccination movement, detoxification therapies, Barbara Loe Fisher, Jay Gordon, Joseph Mercola, supplements, Defending Falsehoods, and Belief Armor."

update: 27 Oct 2009. The antivaxxers aren't having much impact in Canada. Here's one headline: Calgarians flood clinics for first H1N1 flu shots Thousands Vaccinated In Calgary On Day 1; Long Lineups Lead To Waits Of Up To Six Hours; Many complain four locations too few for city

Perhaps the news from Nova Scotia had some effect: Nova Scotia reports 80 new H1N1 cases, as may the sad news from Toronto: "Public health officials confirmed that the sudden death of 13-year-old Evan Frustaglio was a direct result of swine flu."

further reading

Orac recommends

An anniversary worth celebrating by Phil Plait

Wallace, Amy. (2009). An Epidemic of Fear: How Panicked Parents Skipping Shots Endangers Us All, Wired. To hear his enemies talk, you might think Paul Offit is the most hated man in America. A pediatrician in Philadelphia, he is the coinventor of a rotavirus vaccine that could save tens of thousands of lives every year. Yet environmental activist Robert F. Kennedy Jr. slams Offit as a “biostitute” who whores for the pharmaceutical industry. Actor Jim Carrey calls him a profiteer and distills the doctor’s attitude toward childhood vaccination down to this chilling mantra: “Grab ‘em and stab ‘em.” Recently, Carrey and his girlfriend, Jenny McCarthy, went on CNN’s Larry King Live and singled out Offit’s vaccine, RotaTeq, as one of many unnecessary vaccines, all administered, they said, for just one reason: “Greed.”

....So what has this award-winning 58-year-old scientist done to elicit such venom? He boldly states — in speeches, in journal articles, and in his 2008 book Autism’s False Prophets — that vaccines do not cause autism or autoimmune disease or any of the other chronic conditions that have been blamed on them. He supports this assertion with meticulous evidence. And he calls to account those who promote bogus treatments for autism — treatments that he says not only don’t work but often cause harm.

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