Rand Paul vaccine denial – hidden costs

 

There are actually people out there in the world who think there’s a “debate” about vaccines. On one side, the ignorant, the uneducated, and the logical fallacy lovers, without any evidence whatsoever, invent some dubious and truly head shaking nonsense about the safety and effectiveness of vaccines.

On the other side (as if there really are two sides), are the educated, the logic lovers, and the skeptics who value published scientific evidence as the most important and fundamental guide to determining a scientific consensus. This scientific consensus has determined that the earth is 4.5 billion years old, that all organisms on this earth have evolved from a single organism 3 billion years or so ago, and that vaccines are safe and effective. A scientific consensus exists not because I say it, it exists because a vast majority (not 51-49, more like 99-1) of experts in the field agree to this consensus.

There’s one “writer” on Medium who conflates political consensus with scientific consensus, idiotically assuming that a scientific consensus is based on some vote, political maneuvering, without understanding that a consensus in the US Congress (as if that’ll ever happen) is almost the opposite of how science works, and eventually arrive at a scientific consensus.

If there were a debate about vaccines, the pro-science/pro-vaccine side would score about 1547 points to 1 pity point for the deniers. In other words, it would be a world record victory for the real science side. The journalistic hacks at the Toronto Star, who essentially lied about Gardasil (then mocked and lied about anyone who said they lied) and may have destroyed a lot of positive momentum regarding the cancer preventing vaccine are an example of how the science denier side works–in lieu of real published evidence, lie. Then shower invectives of all sorts on those who point out the lie. I hope the writer and editors from the Toronto Star all end up in prison, but that’s just my opinion.

But let’s move on from this asinine imaginary debate that truly only exists in the heads of F list actors and actresses and lunatic science deniers. We forget that not only is there no debate about vaccines, but they save lives, and by extension, save money. Lots of it.

What’s that about Rand Paul?

Republican presidential candidate and Kentucky Senator Rand Paul (who is a physician, but is not board-certified by one of the three accepted certifying boards in American medicine) says that whether children are vaccinated is a matter of freedom. Maybe it is.

I actually don’t care about these adults who refuse to vaccinate. If they get seriously ill from  polio or HPV induced cancer or some other vaccine-preventable disease, that’s on them and their ridiculous beliefs about vaccines. But the official Rand Paul vaccine denialism is quite scary, if you’re concerned about the health of our children.

Of course, we adults who do vaccinate will pay for these adults who catch vaccine preventable diseases through either taxes to pay for emergency care or higher insurance costs to cover them. Ironically, it is clear that Rand Paul likes bigger government and more taxes to pay for all this vaccine denialism. Well, I never thought that a Republican wasn’t going to be a hypocrite.

But there’s more. Rand Paul also said that vaccines cause mental disorders. Although irrelevant to my story here, it does indicate a lack of scientific knowledge. How did Duke University ever accept this raving nut job into its medical school? And there is absolutely no evidence supporting his delusion. None.

Senator Paul is so committed to his libertarian nonsense he actually overlooks one important point. Children don’t get to choose. They’re the ones that pay the horrific price for not being vaccinated. That’s why we’ve created a massive vaccination program over the past 50 years, because we care about our kids, and we have been successful in reducing the infant mortality rate through vaccination. Few kids die anymore from these diseases, because of vaccines. The only reason I write these posts about vaccines is because we need to protect the children who have no choices in this important matter.

Senator Paul is so full of his irresponsible beliefs, so committed to them, that the only logical thing I can say is that he doesn’t care about taxpayer money, and he certainly could care less about the country’s children if all that matters is some elusive “freedom” trope. Sorry, but parents don’t get to stand on some principle if it harms their children. That’s why we don’t allow parents to beat their children. Or make them work in factories at 10. Or not get an education. We do care about our children, and that’s why many of us fight for vaccinations.

 

But the hypocrisy of the beliefs that surround the Rand Paul vaccine denialism is much more than “parental choice.” If we took him at his word, and we stopped vaccinations, his whole libertarian belief system would collapse on itself.

Let’s look at it more carefully.

Public Health costs

vaccines-cash

I was going to write all about the monetary costs of vaccine preventable diseases, as I’ve done before, but Tara Haelle, in an article in Forbes, did it better than I, so I’ll be lazy for a bit (though I will get other hidden costs that she didn’t mention), and quote some of what she wrote.

In 2011, the cost of 107 cases spread across 16 outbreaks cost local and state health departments an estimated $2.7 million to $5.3 million. Because measles is so contagious, infecting 90 percent of susceptible individuals and remaining airborne up to two hours after an infectious person has left the area, the number of contacts a single case can generate grows exponentially once an outbreak begins. The cases in 2011 involved contacting somewhere between 8,900 and 17,450 individuals, which required 42,000 to 83,000 personnel hours.

Now, $2.7 million to $5.3 million may not seem like a lot. Most state governments probably spend that amount of money mailing out driver’s licenses and automobile registrations. But that’s 16 small outbreaks with 107 cases. What if the vaccination rate for measles drops below the herd effect threshold of around 90%? We could have 1000X that many cases with the cost totaling $5 billion. At that point, most state governments (and the CDC along with the US Public Health Service) would run out of money and ability to manage the epidemic.

Hospital costs

But it becomes even more than the cost to public health, there is a cost to the family. According to the CDC, one hospitalization for a serious measles complication costs more than US$142 thousand. Again, according to the CDC, about 30% of children infected by measles end up being hospitalized, 5% will contract a severe complication that requires NICU or ICU admission, and about 0.2% will die (even after treatment in the ICU). So, if we have an epidemic of 1 million kids with measles, because the vaccine deniers cause the vaccination rate to drop into the 80% range, the total cost to the Federal and state governments, insurance companies, and parents could approach $7-10 billion at least.






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So right now, we’ve hit $12-15 billion in public health and hospital costs after one serious measles epidemic (and the deniers can make up all kinds of stuff like measles can be stopped with a good diet or whatever, it’s just their lies). And we’re not counting costs such as lost productivity and wages for the parents, and, let’s be frank, funerals for children. Let that sink in.

But I’m far from being done yet.

Healthcare system

One thing that people forget is that the US healthcare system (irrespective of some of the crazy myths of both the left and right side of the political system) is built for the world of 2015. We don’t have epidemics today, because of vaccines. We don’t need smallpox and diphtheria hospitals any more. We don’t need wards in every hospital with ventilators (called iron lungs) for polio victims. Things have changed.

In 1960, the USA had about 9 hospital beds for every 1000 population. In 2010, it had fallen to about 3 beds. Now part of the reasons are that the US population has doubled with precious few hospitals built. Part of it is that many procedures are now outpatient, so they don’t require beds. And another part is that insurance companies limit hospital stays without medical reasons. But a big part of the reduction in beds is that they aren’t needed to care for millions of sick children (and very often adults) because vaccines have eliminated those diseases.

Look at the infant mortality rate in the USA. In 1960, the infant death rate was 26 out of 1000 live births. In other words, about 3% of infants born that year died. From today’s perspective, with an infant mortality rate of around 6 per 1000 live births (a 70% drop), I am horrified to think that 3% of newborns would die that year. And why did it drop by 70%? Yes, modern medicine, including vaccines, medical technology, and prenatal nutrition.

I am not smart enough to figure out the cost of building an healthcare infrastructure that would be able to treat and care for a massive influx of children who are sick from diseases that we had mostly eliminated a generation or even two generations ago. But think in 100’s of billions of dollars. And that’s just the USA. If our massive vaccine ignorance hit other countries (I know that the vaccine denier mentality is endemic throughout white, privileged countries from Australia to Canada to Germany), the costs would probably collapse the world economy. Or there will be millions of funerals for children.

Wait I’m not done yet.

Clinical research

I was recently reminded of the costs of vaccine denier ignorance. Gardasil, the cancer preventing vaccine that should be as important to teenagers as not smoking, has been saddled of lots of unscientific nonsense, almost always debunked by real medicine. Apparently, someone said that Gardasil caused multiple sclerosis, so stop taking it. Sadly, there is no plausible pathway that would lead one to assume that Gardasil could cause multiple sclerosis. Nevertheless Sweden and Denmark spent millions of dollars (well, kroner, but I’m translating) to determine that HPV vaccines did NOT cause multiple sclerosis after looking at over a million medical files.

Most case control or other types of epidemiological studies require access to large numbers of medical records with experts to review each record to find whether the patient is vaccinated or not (at least for vaccine research), then look for the target effect (say multiple sclerosis). They also have to find and sort for confounding data (like smokers vs. not, etc.). Yes, in a world of digital medical records, this could be fast, say a few months. Then to analyze the data, perform statistical analysis, and determine if the research missed something could take 18-24 months. Millions of dollars.

On the other hand, full-blown clinical trials (with actual patients tracked after randomization for vaccination, if that were ethical, which it isn’t) for vaccines could cost $100 million to $1 billion each depending on size of cohort and amount of follow-up.






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As I’ve written before, there are at least 100 papers published in the past few years that completely debunk and destroy the myths that vaccines cause autism. But here’s the problem–the only reason that thousands of researchers had to spend more than a nanosecond discrediting this issue can be placed at the feet of that cunning swindlerMrAndy Wakefield who fraudulently alleged a connection between the MMR vaccine and autism based on no evidence. Brian Deer, a British journalist who has been sued by Wakefield so many times that it should be world record, recounted all of Wakefield’s unethical (if not illegal) actions in a series of articles titled “Secrets of the MMR Scare”.

If Wakefield had just disappeared into exile somewhere in the Antarctic, this ridiculous notion could have been forgotten. But it became a thing, and suddenly the default hypothesis was that vaccines caused autism–instead of the Wakefield sycophants having to provide evidence that Wakefield was right, it was up to real science to prove the negative, that is, vaccines do not cause autism. So, at least 110 studies were performed (from outright clinical trials to case-control epidemiological studies)–I estimate the total cost was at least $1.5 billion to $5 billion dollars in real money.

Which is why I loathe lunatics like the Age of Not Caring about Autism, the National Vaccine Ignorance Center, or the Quack Doctor who Doesn’t Know Anything About Vaccines. Real science spent billions of dollars and thousands of man-years to debunk a fraudulent claim, basically, a lie. If the vaccine denier cult actually cared about autistics, they would have demanded that not a dime be spent on this stupidity (well, maybe one or two studies, just to confirm that Wakefield is a lying criminal), and that the money be spent on researching DNA and genetic links to autism, researching better techniques to manage the condition, investing in schools to help autistic children fulfill their educational potential, and determining how environmental effects may modify genetic predisposition to autism. Maybe take a few million and ask the psychiatrists rewrite the section on autism in the DSM 5, the most important psychiatric diagnostic tool available today.

Much of the research today looking at vaccines is not targeted to determining better vaccine schedules (it’s clear that for some diseases, we need boosters into adulthood), whether XYZ vaccine may need changes to be more effective or many other issues, but is focused on the moving target of pseudoscience pushed by the vaccine deniers.

Every time someone invents a new claim about a vaccine, real scientists, dedicated to the field, work to debunk it. Not because they’ll get rich from some imaginary graft from Big Pharma, but because they are convinced that vaccines are one of the most (if not the most) critical medical advances available to humans. And they want to know if XYZ vaccine really causes death or diabetes or autism–so despite their skepticism, they invest their lives to make sure. But what a waste, when most of these myths and ridiculous claims are based on nonsense pushed by people who either have an agenda or are committing fraud or are just plain ignorant. Money better spent in other healthcare issues.

 

TL;DR

Let’s make this simple. The vaccine denier industry is a huge black hole of cost to the taxpayers of the USA (and any other country who has a big group of these antivaccine lunatics). There are costs to public health budgets, to hospitals, and to individuals. There is also a transfer cost from research that could help people (billions for autism research, as an example) to essentially debunking delusional beliefs of a tiny group of people. And one fraudster.

And Rand Paul is a science-denying idiot who has no scientific knowledge. Why am I surprised?

Editor’s note: This article was originally published in February 2015. It has been completely revised and updated to include more comprehensive information, to improve readability and to add current research.

Key citations:

The Original Skeptical Raptor
Chief Executive Officer at SkepticalRaptor
Lifetime lover of science, especially biomedical research. Spent years in academics, business development, research, and traveling the world shilling for Big Pharma. I love sports, mostly college basketball and football, hockey, and baseball. I enjoy great food and intelligent conversation. And a delicious morning coffee!
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  • Daniel Chase

    I have some constructive criticism for you to consider regarding this piece.

    In your introduction, you divide the world into two categories. The inferior side includes the ignorant, uneducated, and ” logical fallacy lovers”. In contrast the superior side is reserved for the educated “logic lovers”.

    Ironically, you directly follow this bombast with a two-for-the price-of-one set of logical fallacies, namely the appeal to authority and the appeal to the majority. Bombast itself can also be a fallacy, but we shall ignore that little debate.

    Overall I enjoy your blog. Keep writing

    • One thing you’re missing about logical fallacies is that they only matter if you have no fucking evidence. Well, the evidence behind the safety and efficacy of vaccines is irrefutable. So I get to call the dumbasses that hate vaccines dumbasses, idiotic, and ignorant liars. Case closed dude.

      Seriously, I have the evidence. They don’t. I win. They need to STFU and go back into their holes.

    • And there is no appeal to an authority. And you conflate scientific consensus with some bullshit “appeal to majority.” Maybe you need to move along.

      • Daniel Chase

        Temper temper! Dude, I was simply taking your offer at face value, namely, “Please comment on a post if you agree, disagree, or just think I misspelled a word. It’s what makes blogging fun and thought-provoking”.

        But hey! Its your blog. Knock yourself out!

        • Hey I like when someone attacks. But this is a tough place. If I don’t like it, or it lacks supporting quality evidence, I invoke the false dichotomy, and call a spade a thingamajig. If I agree, I’ll pat you on the back and buy you a beer.

          Unfortunately, you hit right in the middle. Some of what you said was right. Some pissed me off. So, we all need thick skins.

          And yup, it is my blog. And I don’t edit anything. Well, there was a jackass who made some inappropriate accusations against another person, so they had to go. But that’s it, one person kicked in three years!

          • Daniel Chase

            Like I said, I enjoy your blog and you’ll see me comment. I’m harmless. But you’ll probably have a love hate relationship with me given that I’m one of those awful Christians! lol

  • Sandy Perlmutter

    Some issues do not have two sides. Is lynching good/bad? Do we all have the freedom to drive either on the right or the left? Should we be freely allowed to drive on bald tires?

    Oh yeah, and do you own your kids?

    Rand Paul is an ophthalmologist. He probably has not looked at a whole human patient since his residency. His father was an OB/GYN. Randy is certified by his own board: http://en.wikipedia.org/wiki/Rand_Paul.

    Having an MD is not evidence of knowing anything much about biology. The immunology part of biology is very complex, and the statistical understanding required for this entire subject is not something Randy would have, either.

    Let’s face it, ignorance in MDs is not unheard of! My poor little doctor “believes” in homeopathy!

    • I didn’t want to get into all of the issues of Rand Paul being a physician, starting with his lack of a bachelor’s degree, and his being an ophthalmologist, which means he has no clue about epidemiology, virology, etc. etc. He’s no different that Tenpenny, if we’re discussing public health and vaccines.

      • Daniel Chase

        I agree with you on Rand Paul about his stance on vaccines. He doesn’t recognize the limits of Libertarianism, namely that the right to swing one’s fist ends where the knuckles meets the nose. If someone wants to refuse a vaccine for a non-communicable disease, I have no issue. But a communicable one is an issue when there is no facts to reasonably warrant an objection.

        With that said, we have another fallacy: Its an ad hominem argument to argue about Paul’s lack of a bachelor’s degree. He was accepted to Duke U Medical School (no small feat) without finishing it. There was no point in getting a B.S.

        • But it’s also an Argument from Authority to say that he’s somehow endowed with brilliance about epidemiology, vaccines, virology, public health, microbiology, immunology (you get my drift?) just because he went to Duke.

          But I hate Duke for other reasons. No, they didn’t reject me for graduate or medical school (never applied). I just hate their basketball team.

          • Daniel Chase

            I was a huge fan of the ACC back in the 80s. Didn’t really hate Duke back then. When Christian Laettner showed up, that’s when I began hating them

        • No, it’s not an ad hominem to say that Rand Paul doesn’t have a bachelor’s degree. Because that’s factual. It’s a strawman argument. But again, he’s an idiot about vaccines, so I could call him Satan (if I actually believed in that religious nonsense), because in the context of vaccines, he’s seriously delusional.

          • Daniel Chase

            I can see your point about it not being ad hominem. BTW shortly after I posted that, I saw a story related to it. I guess in an interview, he claimed to have two bachelors, one in Biology and one in English. Ummmmm…..