The vaccination ‘debate’

By Siouxsie Wiles 14/04/2011 18


A few days ago I blogged about the very sad case of Chace Topperwien, a little boy who is undergoing treatment for acute myaloid leukaemia (AML). Chace’s story made the news because his family believe that the AML must be related to his accidentally being given the Gardasil vaccine as a baby.

The post generated quite a bit of discussion and a few of the comments really made me despair. The first relates to the pro and anti-vaccine ‘camps’:

Imop your just asking me to trust your facts over their facts — neither of which I have the knowledge or skill to do so

I find this comment fascinating. The belief that each side are dealing in facts. My experience of the anti-campers is that they very rarely deal in facts. They deal in misinformation. I would even go so far as to say some of them lie. One of the anti’s left this comment:

This article was an expected discourse from the pharmaceutical industry, which causes more deaths every year than all the illegal drugs combined (over 25 million deaths last year in the US alone).

25 million? That seemed like an impossibly huge number to me. Less than a minute on google and I found the US population clock which says there is a death every 12 seconds in the USA. By my maths this equates to 2.628 million deaths per year ([60/12=5 deaths per minute] x 60 minutes x 24 hours x 365 days). And that is deaths due to ALL causes. So according to my anonymous commentator, the pharmaceutical industry caused ten times more deaths than the number of people who actually died. That is quite some achievement.

Another posted this:

I think being a non scientist, and faced with descisions that essentially require us to put our faith in professionals in the one point of failure that most, myself included, can often not surmount.

As a couple of my fellow Scibloggers pointed out, we do this all the time. Electricians, plumbers, pilots? What is it about health that leaves people unable to trust the doctors and scientists who have made medicine what it is? But many of those same people can trust vitamin peddlers and homeopaths? Astonishing.

Another commentator said:

We are overvaccinated, and it is simply propaganda and money making by pharmaceutical companies that drive this…

This is another fascinating one for me. Surely the pharmaceutical companies would be better off staying well clear of vaccines and stick to producing diagnostic tools and antibiotics and antivirals? Bugger trying to prevent people catching these things in the first place. No, what would really make money is having to treat all those infected people. And the fact that bacteria continually develop drug resistance means the pharmaceutical industry have the opportunity to keep developing new drugs*.

I’m going to wrap up with one last point. One commentator posted this:

Why are we led to believe that this is all safe and for the betterment of man kind? There is something good people that those in positions of power won’t tell you, well openly at least, and that is: It isn’t about our individual welfare they concern themselves with, it is the statistical signifigance that is the determining factor, call it friendly fire, someone will and does get hurt or die, but the majority is safe and that is all that matters.

This is the point. That the (very small) risks (though they may be devastating to those involved) are outweighed by the benefits to society as a whole. It brings to my mind the increasing problem of extreme drug resistant tuberculosis. There are people who are infected with strains of Mycobacterium tuberculosis which are resistant to pretty much all antibiotics. These people can be highly infectious and so will spread their drug resistant bacteria to anyone they cough on. The infectious dose is 1-3 bacteria. In some cases the only treatment option left is to cut out the infected bits of lung. But if the disease has progressed too far that this would leave the patient without enough lung left. So the only alternative is to quarantine them. Forever. For the betterment of mankind. The common good. I’d be interested to know if those people who don’t want to vaccinate because of the potential risks to their children would be willing to sit next to an infectious TB patient? Or would they be happy for the greater good to take precedence then?

*If only it where that simple. The drug discovery pipeline is a long and expensive one and almost not worth pursuing from a financial point of view.


18 Responses to “The vaccination ‘debate’”

  • As a couple of my fellow Scibloggers pointed out, we do this all the time. Electricians, plumbers, pilots? What is it about health that leaves people unable to trust the doctors and scientists who have made medicine what it is? But many of those same people can trust vitamin peddlers and homeopaths?

    Maybe with health people feel more ‘personal involvement’ in that the decisions they make (or others make) in that area can have an immediate & personal impact? Yes, I know you could say that about pilots, but they’re away up there in the cockpit! And sometimes what the doctors recommend may not be very nice; it’s just that the alternative -when you think about it rationally – is much worse. Personal anecdote: Poppa’s about to start radiotherapy, which is going to see him lose both his sense of taste & his appetite, but he’s decided to do this because the alternative is a 1 in 3 chance of his original tumour reoccurring.
    Why people trust homeopathy & vitamin pedlars? Because, I think, they claim to provide 100% certainty of a cure, & no medical doctor can do that, they can just give you the odds.

  • Alison,

    Extending your points a bit, perhaps because homeopaths and vitamin peddlers have very little to offer scientifically they make an effort to relate to the patient – a lot of homeopaths offer 1 hour consultations.
    Whereas, perhaps many doctors, because they know the science works, do not bother to engage personally with the patient. I have a really good doctor who explains things quite well but I must admit I find the whole process very rushed – usually 20 minutes max.
    I would suggest that if the medical profession wants to fend off woo peddlers they need to seriously thing about how they relate to patients.

  • Michael,
    Ben Goldacre makes this point too (I think it was in ‘Bad Science’), and extends it to arguing that if homeopaths acknowledge the central importance of the ‘therapeutic relationship’ to what they claim as being the success of their treatments, how can there be any justification for selling off-the-shelf homeopathic remedies at pharmacies?
    (I’m sure he put it better than I have just done).

  • What struck me, when I had my first serious engagement with the health system a couple of years ago, was the emphasis on choice. Info was presented as “here are the options, here’s what experts recommend, IT’S YOUR CHOICE”. That’s a better approach, I think, than railroading people into treatment like in the old days, but it did place an odd sort of burden on me, and the sense that my choice is as good as the next person’s. For a moment I felt like choosing not to take the experts’ advice would be really making a choice, rather than just following along. There’s some subtle psychology involved, something that really devious marketers rather than innocent health professionals might have some insight into.

  • Carol,

    Yes, I tihnk I’ve read Ben Goldacre’s arguments along these lines. I’m told that several years ago, when the NZ Council of Homeopathy was under different leadership they had criticised the selling of homeopathic remedies in pharmacies along side the NZ Skeptics, however, I think the relationship between the two organisations is far to adversarial to try this again 🙂

  • Pretty much every choice we make has an element of risk associated with it. Whether you get a vaccine or not both have a risk of things going wrong, and you have to weight up one option versus the other. In the vaccination example you have to weight up the risk with taking it (say perhaps the vaccine batch is tainted somehow or that you will have an adverse reaction or there will be other complications associated with it) against the risk of not taking it (which comes down to the probability you will come into contact with, or be at risk of contracting whatever you are vaccinating against) and the potential effects each choice could have: sickness, ongoing effects death.
    By following the advise of a doctor you’re pretty much allowing him to make that decision for you and you have to assume they are more qualified and unbiased in their decision making. Can you say the same about homeopaths and their ilk?

  • A question for Siouxsie as the resident expert: do you think the flu jab for children a good idea?
    I asked about this when I got my flu jab last week, and the medical staff at the centre said, yes, we do recommend it for healthy children. So I took my 11 year old in for his jab yesterday and the amount of fuss he made I couldn;t help wondering if it would have been less fuss just to run the risk of the flu. (this last point facetious, but initial question intended seriously).
    Do you have a view on this? Do children need special protection or are they more at risk?

    • Hi Carol

      Your question and the comment by Argon miss what I feel is one if the most important point about vaccination: that of herd immunity. It isn’t just about the healthy child running the risk of getting the flu or children needing special protection. Its about trying to get a critical mass of people vaccinated so that potential ‘outbreaks’ are stopped in their tracks, thereby protecting the vulnerable who cannot be vaccinated.

      I think flu suffers from that fact that people don’t think it is as serious as it can be. The numbers of times I’ve heard people with a runny nose say they have the flu is astonishing. No. You have a cold. If you had flu, you wouldn’t be here complaining, you would be in bed.

      If you are struggling with getting your 11 year old to have the jab, try explaining it to them. North and South did a fantastic issue last year on vaccination. The cover featured a little girl called Charlotte who had meningitis as a baby and had to have her arms and legs amputated. My four year old is fascinated by Charlotte’s story and I’ve used it to explain about vaccination (prickles she calls them) and why we have to have them (to protect babies like Charlotte). She knows they are going to hurt (why lie about that?!) and that she may not feel so great for a couple of days but I’ve explained that this means her body is making its antibody soldiers and that’s something to be proud of. We also make sure she gets a treat at the end of it. Usually a lollipop works but an 11 year old may have other demands!

  • In the earlier thread I mentioned that I might review a paper that surveyed those who vaccinated and those that didn’t. It turns out that ‘Orac’ of Respectful Insolence fame has already done an extensive take on it. I’m not sure there is much more I could add to what he has written, so maybe I won’t write about this after all. (Besides, it’s a good excuse for me to keep working!)

    Carol,

    Word I’ve heard is that in general the main at-risk groups to influenza are the elderly, the very young, and those with other disposing factors (e.g. gross obesity, pregnancy). By contrast, one of the unusual features of the ‘swine’ flu (etc.) are the comparatively high proportion of people in the “middle” age groups affected.

    I’ve heard that in Christchurch they’re recommending the flu vaccine to under 18s on the basis of more crowded housing conditions than usual; I presume this is an effort to prevent the spread of the virus. I’m not sure if I’m being helpful here, as you’d want to confirm what I’m saying from a better source!

  • Fair enough, Siouxsie. My little lad does understand the importance of the flu shot, he’s just not very keen at all on needles (who is?). I did resort to treats – after a chocolate bar and a Simpsons comic, his outlook on life improved!
    You don’t need to convince me of the importance of immunisation – really, I do get it.

  • I think flu suffers from that fact that people don’t think it is as serious as it can be.

    I agree. I’ve run into this several times myself; it’s surprising that people think they affect you to the same degree. Influenza hits a lot harder. (I can also speak from personal experience, too, but then that’s anecdotal.)

    I should add to my previous comment: although an 11 year old may not be in the worst at-risk groups that doesn’t mean the vaccine doesn’t offer anything. It’d still protect them from what is a nasty illness to have. (The at-risk groups will be focusing more on what groups need hospitalisation than who gets infected I would think.)

  • Siouxsie – yes, I did read that North and South article on vaccination last year, and thought it was excellent, and recommended it to several other people.

    I did tell my lad that it would hurt, like a bee sting, but only for about three seconds, and that if he counted to three it would all be over. Thank you for the suggestion about how to explain it to children, it’s very helpful.

    I also agree with you and Grant that people under-rate the seriousness of the flu. A colleague of my partner’s had it last winter and she was home alone and felt so ghastly it became quite frightening. Needless to say, she gets the flu shot now.

    On the subject of herd immunity, it’s my impression that most children my son’s age probably don’t get the flu shot. Would children be more at risk of exposure to the flu if the group they spend most time in (ie their class) has a lower level of coverage than the general population? (not sure if I expressed that very clearly).

  • Grant,

    “I’ve heard that in Christchurch they’re recommending the flu vaccine to under 18s on the basis of more crowded housing conditions than usual.”

    Yes, there was an article in the Christchurch Press which said that this was important. As an asthmatic, I get a free shot each year on the recommendation of my doctor.
    I have not so fond memories of being admitted to hospital with a bad dose of the flu in my early 20’s. They weren’t sure if it was flu or meningitis, so they dosed me up on paracetamol and said if my temperature didn’t drop overnight they would be doing a lumbar puncture (luckily it did drop). The disorientation and hallucinations that came with the high fever were not pleasant!

  • On the issue of time spent with patients by GPs I know I would like to be able to sepnd more time, but the fact is there is a shortage of GPs. I have about 1600 registered patients ageing from 1 day to 104 years old. Of course one of the things we have is have a long term therepeutic relationship, so issues can be covered over time, as the evolve.

  • YOUR EXAMPLE of “extreme drug resistant tuberculosis” – How is it still in our midst? Because it is injected daily into someone in every community (BCG (Bacillus Calmette-Guérin) is a living attenuated strain- yes that means it is LIVE and will be spread by the person it is injected into, through snot, poo, and urine – sorry about that, but that’s what babies do a lot of – Watch out, those babies aren’t as sweet as they look) “extreme drug resistant tuberculosis” – How common? Extremely RARE – so yes, keep those people away from others – disease can minimised if very sick people are isolated from others. Actually practice self-protection. International travel is a main way disease is spread, and people do very little to avoid contamination with recently arrived friends, family and visitors. People would do well to assess the health of anyone before they get close enough to share microbes. Seriously.

    and as for Pharmaceutical Companies – can you not see the wealth of damage they create – Invent a Drug and Create the Market, Supply the Market, which in Time Creates Future Needs
    WAKE UP

    • Thom,

      You are wrong on a number of points.

      BCG is not M. tuberculosis but a related organism M. bovis. Over many many years of growth in the laboratory BCG has lost the crucial factors that Mtb and M. bovis have to cause disease, in particular the region of difference (RD) 1. I can provide more info on this if you are interested. As a result it is not spread by babies through their snot, poo and urine. It in injected, usually into the thigh, of babies and hangs around long enough to trigger an immune response and then is killed by the immune system. Its a pretty weedy bug so isn’t capable of spreading rampantly from person to person. It is important to say that protection from BCG does not last a lifetime and many scientists are trying to develop a better vaccine.

      It is well understood why drug resistant TB is in our midst. The drugs that are effective against Mtb are old and have to be taken for a long time. The ‘short’ course therapy is 6 months to 2 years of a combination of drugs. They do have side effects so people often stop taking them before they have had time to clear all the Mtb. Or people feel better so stop taking them too early. This leads to the emergence of drug resistant strains. Its why it is crucial to always finish a course of antibiotics.

  • Thom,

    I think you are looking at pharmaceutical companies with only one eye open. Yes, there have been pharmaceutical companies which have been “oversold” and created products of unproven effectiveness. However, pharmaceutical companies in general produce effective antimicrobials, treatments for pain, anti-cancer drugs, etc with proven effectiveness.
    drug companies invest billions of dollars into research so they must make money to continue to develop new products. It is a commercial model, therefore sometimes “dodgy” practices occur (“creating a market”). But what is the alternative for drug development.
    It is also worth pointing out that the homeopathic and vitamin industries pull in millions of dollars a year based on products with absolutely no proven effectiveness.