Pseudoscience about the MMR vaccine pervades all corners of the internet. Many of us have spent years (I have been doing it for nearly two decades) debunking the ridiculous myth that the MMR vaccine causes autism. Now we have a radical anti-vaccine religious group claiming that the MMR vaccine causes seizures, based on an opinion (not scientific evidence) from a renowned anti-vaccine activist.
The organization making this ridiculous claim is Physicians for Informed Consent, a California-based anti-vaccine group, that makes absurd claims that either vastly overstate the risks of vaccines, or vastly understate the benefits of vaccines. And they do this without a stitch of scientific evidence, meaning that their value in the discussions about vaccines approaches zero.
It’s time to take a look at their newest assertion that the MMR vaccine causes seizures. Let’s just say that, once again, they exaggerate the risk of vaccines while completely ignoring the benefits. I guess that is what happens when you’re a science denying group.
About Physicians for Informed Consent
I’ve written about Physicians for Informed Consent (PIC) before, and without a doubt, pseudoscience and science denial is a core tenet. Their fundamental religious belief is a “vision…to live in a society free of mandatory vaccination laws.”
Their “scientific” leadership is made up of some of the most reprehensible acolytes of the anti-vaccine religion. It includes Tetyana Obukhanych, a false authority in vaccines whose background betrays her nonsensical claims about vaccines. It also includes Christopher Shaw, a “vaccine researcher” who is infamous for retracted articles (and here), for his “research” being utterly discredited by the World Health Organization, and for being funded exclusively by anti-vaccine money. Even worse, it includes Jane Orient, an anti-vaccine right winger who heads up the notorious Association of American Physicians and Surgeons, a group dedicated to ending Medicaid, Medicare, and healthcare for everyone.
Furthermore, “informed consent” is one of those thinly veiled code-words used by the anti-vaccine religion, especially in the fight against SB277, California’s recently enacted law that removes personal belief exemptions to vaccinations for school-age children.
Informed consent has become an absurd false flag for the anti-vaccine radicals because they are claiming that nurses and physicians are not providing parents with sufficient information about vaccines to constitute informed consent. A frequent contributor to this blog, Professor Dorit Rubinstein Reiss, has strongly argued that the anti-vaccine world falsely states that reasonable vaccine informed consent is not given to patients (especially parents).
PIC loves to stand for what it believes is a moral high ground – then, they cherry pick bad studies or attempt to mine data that doesn’t exist from higher quality articles to invent concerns about vaccines. Then they insist that healthcare workers inform patients or parents of this bad information, while completely ignoring the benefits of vaccines. In fact, they are standing firmly on the low moral ground – presenting bad data that may lead children from being protected from vaccine-preventable diseases.
Professor Reiss has this to say about vaccine informed consent– parents do not have unlimited rights to accept or reject informed consent about a healthcare procedure. She says:
The situation is a little different for children: they do not consent directly for treatment, and while the rights of their parents to consent are protected, they are not as absolute as an adult’s right over her body – parents do not have unlimited right to throw a child’s life or health away.
Nonetheless, consent is important in these contexts, too. Parents are usually the ones that make medical decisions for the child. And absent the unusual circumstances where the state intervenes, it’s just as important that parents’ consent be informed: they need to get the information that will help them make the appropriate decision in their child’s interest.
Parents currently receive a substantial amount of details before they give consent to vaccinating their children. The exaggerated claims of adverse events by groups like PIC are not and should not be part of the informed consent process. This is not to say that adverse events do not happen, they happen in every single medical procedure. Informed consent for vaccines states that there are some minor risks, but they are eclipsed by the incredible benefits of vaccines. It’s not even close in a cost-benefit calculation for our children’s health.
PIC’s newest false claim – MMR vaccine causes seizures
The MMR vaccine (for measles, mumps, and rubella) is a critical vaccine that prevents dangerous infectious diseases. Measles, for example, is not some benign disease with no consequences as PIC would make you believe.
Much of the problem is that most people weren’t around 30 years ago when frequent measles epidemics hit children in school. We don’t see those epidemics because of, wait for it, vaccines.
The CDC estimates that approximately 3 out of 10 adults or children who get measles will develop one or more complications including pneumonia, ear infections, or diarrhea. The myth that measles is “nothing” is just that – a myth, a lie, and a meme. The CDC states that the risks of major complications from measles are:
- About 1 out of 20 children with measles get pneumonia, the most common cause of death from measles in young children. Pneumonia often requires hospitalization, sometimes in a pediatric intensive care unit.
- About 1 out of 1000 children who get measles will develop encephalitis, a swelling of the brain that can lead to convulsions, and neurodevelopmental disorders.
- About 1-2 out of 1000 children who get measles will die. Let that sink in, because measles is a dangerous disease with a rather high rate of death.
Despite all of these risks of the disease, the Physicians for Informed Consent love to only focus on adverse events and are pushing a new one that states that the MMR vaccine causes seizures:
The California-based nonprofit organization, Physicians for Informed Consent (PIC), recently reported in The BMJ that every year about 5,700 U.S. children suffer seizures from the measles, mumps and rubella (MMR) vaccine.
This finding is derived from results of the most statistically powered safety study ever to measure the association between MMR vaccination and febrile seizures. More than half a million children were evaluated, both vaccinated and unvaccinated, from a Danish population that is relied upon globally to examine vaccine safety. The results showed that seizures from the MMR vaccine occur in about 1 in 640 children up to two weeks following MMR vaccination. Applying this risk of seizures to the 3.64 million U.S. children vaccinated with a first dose of MMR every year results in about 5,700 annual MMR-vaccine seizures.
There is a five-fold higher risk of seizures from the MMR vaccine than seizures from measles, and a significant portion of MMR-vaccine seizures cause permanent harm. For example, 5% of febrile seizures result in epilepsy, a chronic brain disorder that leads to recurring seizures. Annually, about 300 MMR-vaccine seizures (5% of 5,700) will lead to epilepsy.
Now, some of you are going to read that press release and think that PIC has published a peer-reviewed article in BMJ that states that the MMR vaccine causes seizures – 5,700 of them in the USA annually. Well, the Physicians for Informed Consent has not published a peer-reviewed article that makes that claim. And there is strong evidence that the risk of seizures is quite small.
So what is this so-called article?
PIC’s claims, essentially, are based on an online letter to the editor published by BMJ. Letters like this are not peer-reviewed – I could write one, if I were so inclined, to claim that vaccines improve your annual income by 28%, and your success in dating by 47.3%. OK, it’s possible that my claims would be deleted, but it’s clear that their bar for these letters is set very low.
These letters are not considered important published science. And they rank near the bottom of the hierarchy of scientific research. The letter, written by PIC’s science denier leader, Shira Miller, MD, makes the claim that 5,700 children get the seizures every year as a result of the MMR vaccine.
I do not want to pile on, but you know the feathered dinosaur, piling on is a reason for his existence. Shira’s letter to the editor was published in reference to an article by Peter Doshi, a history researcher that has made a name for himself in anti-vaccine circles by publishing opinion pieces about vaccines in respected journals. He does not do original scientific research, he has no background in anything close to vaccines (like epidemiology, immunology, virology, microbiology, public health), and he has attended numerous anti-vaccine meetings paid for by anti-vaccine money.
To be fair, Shira has no other evidence, so pretending that a letter to the editor is real science is better than nothing. Barely. We know that she did not pull those numbers of seizures out of thin air. She must have had some basis for these numbers.
MMR vaccination was associated with a transient increased rate of febrile seizures but the risk difference was small even in high-risk children. The long-term rate of epilepsy was not increased in children who had febrile seizures following vaccination compared with children who had febrile seizures of a different etiology.
There are several issues that arise from the methodology that Shira used to invent these numbers.
- Clearly, Shira Miller used the data from this study and applied it to US MMR vaccination rates to come up with the 5,700 number. It is wholly inappropriate to utilize incidence numbers from one study and transitively apply it to another population.
- This invented number does not give us an indication how it compares to the background rate of febrile seizures. The original Danish study is an actual relative risk between two populations, vaccinated and unvaccinated, over time. It’s not clear how Shira, who is neither an epidemiologist or a statistician obviously, derived 5,700 from the complex results of the study, but she makes no effort to give us context with the background rate of febrile seizures.
- The PIC press release makes obvious use of the word “seizures.” Actually, the Danish study looks at febrile seizures which is a different medical condition. Generally, when someone says “seizure,” they mean an epileptic seizure, which is a brief episode that results from an abnormal excessive or synchronous neuronal activity in the brain. “Dr.” Shira Miller knows better than to conflate febrile seizures with epileptic seizures, but scare tactics are so much better in promoting anti-vaccine tropes. A febrile seizure, although it can scare parents when it happens to their babies, is associated with a high body temperature, but lacks any serious underlying health issue (like epilepsy). In almost all cases, a child that has a febrile seizure is better within a few minutes and will completely recover in about 60 minutes.
- In rare cases, febrile seizures can lead to epilepsy. Shira uses her fun transitive properties logic to conclude that these febrile seizures will lead to an additional 300 cases of epilepsy in children in the USA every year. But she ignores the conclusion of her favorite Danish study, which says that the “long-term rate of epilepsy was not increased in children who had febrile seizures following vaccination compared with children who had febrile seizures of a different etiology.” Who do I trust? A renowned anti-vaccine priestess who lacks any experience or education in epidemiology and statistics and who not a single published paper on vaccines? Or actually published researchers (I mean real published research, not a letter to the editor)?
But there’s more
Cherry picking is bad, not because we hate cherries, but because it allows for confirmation bias. You choose the data or research that confirms your beliefs. Real science is looking at all the data and all the research, then determine if there is evidence to support a hypothesis. The body of evidence matters, not choosing one study out of dozens.
Here are a few studies that show the absolute risk of febrile seizures is small after MMR vaccines:
- A cohort study in Canada found that “absolute level of risk was small. Policy-makers need to balance these findings with the potential benefits of administering the combination vaccine or determine whether the choice of vaccine rests with clinicians and/or parents.”
- Another large study in Denmark found that there is a 0.03% incidence of febrile seizures up to 7 days post vaccination.
- In another large study in Denmark (the reason Denmark is used is that they keep detailed medical records of all citizens, making these type of studies relatively easy to do), the researchers pointed out that febrile seizures could mark existing susceptibility to epilepsy. In other words, as opposed to Shira’s beliefs, it is plausible that vaccines are not causal but are coincidental to pre-existing conditions that lead to febrile seizures and epilepsy.
- The issues with febrile seizures and the MMR vaccine are not some hidden conspiracy. The CDC reports publicly that around 1 in 3000 vaccinated children is at risk for this adverse reaction.
I know what many are thinking when they read what I’ve just written. “I am not going to put my child at risk of this febrile seizure thing. No way. Full stop.”
And that would be a valid concern. But the most important matter to remember is that medicine does not and cannot imply 100% safety or 100% perfect outcomes. It’s a matter of risk vs. benefit, and in this case, even if the risk of febrile seizures is 1 in 3000, the risk of death from measles is 1 in 1000. Another 1 in 1000 kids who contract measles also gets encephalitis, a dangerous brain disease. The risk of complications from measles far outweighs the risk of febrile seizures.
Furthermore, from 2001-2013, 28% of children younger than 5 years old who had contracted measles had to be treated in a hospital. This is a point that I don’t get about anti-vaccine groups like the Physicians for Informed Consent – they don’t seem to care about children’s health when trying to advocate for some imaginary standard for informed consent.
What I’ve written in this section is actual informed consent. I am explaining to the reader, who may be considering whether to vaccinate their children with the MMR vaccine, that yes, there are risks from the vaccine. But it is far less than the risk from the disease itself.
Because if you listen to Shira and her crew at PIC, her idea of informed consent is one-sided – talk about the risks and ignore the benefits. And that would be unfair to the parents, and dangerous for our children.
- Doshi P. The unofficial vaccine educators: are CDC funded non-profits sufficiently independent? BMJ. 2017 Nov 7;359:j5104. doi: 10.1136/bmj.j5104. PubMed PMID: 29113985.
- MacDonald SE, Dover DC, Simmonds KA, Svenson LW. Risk of febrile seizures after first dose of measles-mumps-rubella-varicella vaccine: a population-based cohort study. CMAJ. 2014 Aug 5;186(11):824-9. doi: 10.1503/cmaj.140078. Epub 2014 Jun 9. PubMed PMID: 24914115; PubMed Central PMCID: PMC4119141.
- Rasmussen TA, Jørgensen MR, Bjerrum S, Jensen-Fangel S, Støvring H, Østergaard L, Søgaard OS. Use of population based background rates of disease to assess vaccine safety in childhood and mass immunisation in Denmark: nationwide population based cohort study. BMJ. 2012 Sep 17;345:e5823. doi: 10.1136/bmj.e5823. PubMed PMID: 22988304; PubMed Central PMCID: PMC3444137.
- Vestergaard M, Hviid A, Madsen KM, Wohlfahrt J, Thorsen P, Schendel D, Melbye M, Olsen J. MMR vaccination and febrile seizures: evaluation of susceptible subgroups and long-term prognosis. JAMA. 2004 Jul 21;292(3):351-7. PubMed PMID: 15265850.
- Vestergaard M, Pedersen CB, Sidenius P, Olsen J, Christensen J. The long-term risk of epilepsy after febrile seizures in susceptible subgroups. Am J Epidemiol. 2007 Apr 15;165(8):911-8. Epub 2007 Jan 30. PubMed PMID: 17267419.
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