In this post I explain how one goes about proving a case in the National Vaccine Injury Compensation Program (NVICP), and how that differs from proving a case in the civil courts, focusing on what it means to have a no-fault program and proving causation. I will use a case that started with the tragic death of a young child after a vaccine to illustrate the complexity and operation of the program, and also to address the idea of federal preemption, and how it limits the ability of those claiming vaccine injuries to use state courts for their claims.
I’m a couple of months late with this article because of life and reasons, but a bit over 20 years ago, in February 1998, Andrew Wakefield published his infamous article in Lancet, which was eventually retracted in 2010. He stated that “onset of behavioural symptoms was associated, by the parents, with measles, mumps, and rubella (MMR) vaccination in eight of the 12 children.” Because Wakefield claimed that most of the behavioral problems were autism, that became the rallying cry of the anti-vaccine religion for the past 20 years – the MMR vaccine, if not all vaccines, cause autism.
I actually remember getting that particular issue of Lancet 20 years ago, and I ran across that article. My first thought was, “why in hell would Lancet publish such a troublesome article with just 12 freaking (not the word I used) data points.” Then I wondered who that Wakefield character was – was he an expert on vaccines and childhood behavioral issues? Well, the internet in 1998 didn’t have search engines like we do today, so finding out anything about Andrew Wakefield was difficult at best. I just assumed that if the Lancet, one of the top medical journals in the world, published it, Wakefield must have some level of respect.
Even though the internet was as much a bastion of pseudoscience and conspiracists as it is now, you would never “do your research” on the internet. But our local newspaper had a blurb about the Wakefield study in a Sunday health section, and my wife read the article. She got panicked that our two young daughters, who were having upcoming MMR vaccines, would become autistic. That was my first experience in having to defend vaccines against nonsense (don’t tell my wife I called her worries were nonsense).
My daughters eventually got that vaccine (and received all subsequent vaccines up to and including the HPV vaccine), although even I monitored my children for a few weeks for any behavioral changes. Knowing what I know now, I should have just a fun dad, but I admit to worrying.
Let’s remind everyone about the frauds and lies of Andrew Wakefield because it has led to the return of vaccine-preventable diseases. Continue reading “20th anniversary of the Andrew Wakefield vaccine fraud – no celebrations”
Jenny McCarthy was once the MTV drunk college dating game hostess and former “journalist” on The View. I remember when she joined The View – there was widespread condemnation of her hiring from scientists, journalists, and yours truly because of her loud and annoying antivaccine rhetoric. Clearly, no one of any note supported her being hired on the View, except for websites like the Age of Pushing Nonsense To Harm Children. Continue reading “Jenny McCarthy, with help from Oprah Winfrey, lies about vaccines”
Several of the ongoing memes, tropes and fabrications of the vaccine deniers is somehow, somewhere, in some Big Pharma boardroom, a group of men and women in suits choose the next vaccine in some magical way, and foist it upon the world just to make billions of dollars through vaccine profits. Of course, while magically concocting this vaccine brew, these pharmaceutical execs ignore ethics and morals just to make a profit on hapless vaccine-injured victims worldwide.
The Big Pharma vaccine profits conspiracy trope ranges across the junk medicine world. Homeopathy, for example, claims that Big Pharma suppresses the data that shows water cures all diseases. Like Ebola.
But the Big Pharma vaccine profits conspiracy is still one of most amusing myths of the antivaccination world.
In 1994, the Vaccines for Children program (VFC) was created by a Federal budget authorization in direct response to a measles resurgence in the United States that caused tens of thousands of cases and over a hundred deaths, despite the availability of a measles vaccine since 1963. The net effect of the VFC program was that it provided (and continues to provide) vaccines to children whose families or caregivers couldn’t otherwise afford them, such as those who are uninsured or Medicaid eligible. These are vaccines that have saved 700,000 children’s lives.
It was one of America’s great social healthcare programs in the history of the USA. VFC had an immediate and positive effect on the health of America’s children. Continue reading “It’s simple math – vaccines saved 700,000 children’s lives”
One of the age-old tropes of the anti-vaccine statistics world is that kids who have been vaccinated against the measles are more likely to get measles than those who are not vaccinated. I squashed this myth several times; unfortunately, those are old articles with broken links and such.
Now, the anti-vaccine statistics monsters persevere with their alternative facts. So, once more unto the breach, dear friends, once more. We will take down this trope. Continue reading “Anti-vaccine statistics – back to simple math again”
There are so many annoying issues about the antivaccination cult, that most of us can’t even keep up with it. If only they would provide evidence published in high quality, peer reviewed journals (yes, a high standard, but if we’re talking about public health, a high standard is required), the fake debate would move into a real scientific discussion. One of their favorite feints against real evidence is to push people, like Tetyana Obukhanych, who appear to have great credentials, but once you dig below the surface, not much is there.
One of the most irritating problems I have with the antivaccination movement is their over-reliance on false authorities, where they trumpet the publications or commentary from someone who appears to have all of the credentials to be a part of the discussion on vaccines, but really doesn’t. Here’s the thing – it simply does not matter who the authority is or isn’t, all that matters is the evidence.
For example, Christopher Shaw and Lucija Tomljenovic, two researchers in the Department of Ophthalmology at the University of British Columbia, have, for all intents and purposes, sterling credentials in medicine and science. However, they publish nonsense research (usually filled with the weakest of epidemiology trying to show population level correlation between vaccines and adverse events) in low ranked scientific journals.
Now the anti-vaccine world has a new hero – Tetyana Obukhanych. Continue reading “Tetyana Obukhanych – another anti-vaccine appeal to false authority”
Here we go again, another anti-vaccine trope based on one paper without adequate scientific criticism of said paper. What is this trope? Mumps and measles infections prevent heart disease and stroke. Let me jump right to the conclusion – wrong.
By my calculations, natural infection with the measles and mumps will prevent millions of heart attacks and strokes. Why is this information not all over the TV and internet? I will tell you why. Because mainstream media is in bed with Big Pharma who pay their bills. The politicians are slaves to their corporate masters. Our children should be exposed to every virus and bacteria for which a vaccine exists.
The author’s shrill claim is based on a 2015 article published in the lower impact factor journal, Atherosclerosis. The authors concluded that “measles and mumps, especially in case of both infections, were associated with lower risks of mortality from atherosclerotic CVD (cardiovascular disease).”
Now, it’s time to turn a critical and skeptical eye towards that article.
Mumps and measles infections prevent heart disease – the paper
The study evaluated lifestyle questionnaires from 43,689 men and 60,147 women who were aged 40-79 years at the baseline period of 1988-1990. Individuals of that age probably were not vaccinated against measles or mumps, since that vaccine wasn’t available for children until the late 1960s, when the individuals in the study would have been 20-50 years old. The questionnaire included history of measles and mumps, and were followed until 2009.
The authors then determined hazard ratios (HR, see Note 1) for mortality from cardiovascular disease (CVD) between groups with history of measles and/or mumps infection versus those who did not have those infections. Here are some of the results of the analysis:
- Men with history of measles had an HR for all CVD deaths of 0.92.
- Men with history of both measles and mumps had an HR for CVD deaths of 0.80.
- Women with both infections had an HR for all CVD deaths of 0.85.
The researchers also looked at comparisons between infected and non-infected groups for various types of CVD, but these data probably are the most important.
The study also attempted to show that there was no difference in infected and non-infected groups for a series of confounding variables. They include:
- Body mass index
- Previous history of CVD
- Exercise level
- Stress level
Taken at face value, the research does seem to support the contention that we shouldn’t get the MMR vaccine to protect ourselves against measles and mumps, because catching those diseases may protect us against cardiovascular disease when we get older. But really, does it really gives us evidence to quit vaccinating? Let’s take look.
- This is a one-off primary study that has not been confirmed by any other researchers. This places it at the lower end of the hierarchy of scientific research.
- The authors did not propose a biologically plausible explanation. If one is to propose a correlation between two events, especially when the temporal difference is over 50-70 years, one must also propose a plausible reason why you might assume there is correlation. Is there a plausible reason for anyone to believe that a mumps or measles infection will protect someone from cardiovascular disease? I have a scientific bias towards plausibility, otherwise we can propose inane scientific hypotheses that waste the time of everyone involved.
- There is simply little evidence that measles or mumps is correlated with CVD – a review of PubMed for any articles that might establish a relationship between mumps and/or measles with CVD provided me with two articles. The first is the one we are discussing herein. The second, also published in Atherosclerosis, seems to indicate that mumps and measles is related to higher rates of CVD. This is why cherry picking is bad – you seek out articles that support your pre-conceived conclusion rather than let all of the evidence lead you to a conclusion.
- The use of questionnaires for epidemiological studies is frowned upon by many researchers. The reasons for this are many, but they include a reliance upon the memory of the participant for events that may be 50 or 60 years in the past. For a highly infectious disease like measles, it’s hard to believe that 50% of the participants in this survey caught neither mumps or measles as a child. It’s more likely that they actually had caught the disease but forgotten about it. A properly designed study would have measured measles and mumps antibodies then determined the HR. Or used actual medical records (like a lot of vaccine studies use for case control studies of vaccine effectiveness and safety).
- The hazard ratios were tiny. Yes, it appears that mumps and measles infections prevent heart disease – the data seem to show a 8-20% reduction in CVD risk. But is that clinically significant? If being vaccinated against measles and mumps showed a 200-300% increase in the risk of CVD, I would be impressed and troubled by the results. But such a tiny reduction in the risk could be explained by anything. A missing confounder. Other infectious diseases. Nutritional levels. In fact, I can go on and on. Furthermore, is an 8% reduction in risk of CVD, if it is valid, worth the risk of death or disabling conditions from contracting measles or mumps? Although the question is rhetorical, it’s actually necessary to come to a conclusion based on the results provided.
- Speaking of vaccines, why wasn’t vaccine status asked (although the same memory issues that would plague this questionnaire would still bother me here)? Even though most of the participants probably would have missed the vaccine, some may have gotten it.
- The results also showed a 5-20% increase in risk of CVD for women who had either mumps or measles. That result alone throws into question the whole study, because the results are all over the place.
Can one use this article to claim that mumps and measles infections prevent heart disease and stroke? Not really. The best I can say, and I’m doing this with a lot of trepidation, is that this study provides us with observational data, not a confirmation or refutation of a hypothesis about mumps and measles infections. It certainly does not give us any reason whatsoever to change public health priorities in vaccinating against mumps and measles despite the anti-vaccine tropes.
- A hazard ratio describes a ratio of hazard rates between two events. In the case of this study, if the rate of cardiovascular disease mortality for the mumps infected group is 1.0 and it’s 2.0 for the non-infected group, then the hazard ratio is 0.5. That is the mumps infected group is only 50% as likely to have died of cardiovascular disease as the non-infected group.
- Kubota Y, Iso H, Tamakoshi A; JACC Study Group. Association of measles and mumps with cardiovascular disease: The Japan Collaborative Cohort (JACC) study. Atherosclerosis. 2015 Aug;241(2):682-6. doi: 10.1016/j.atherosclerosis.2015.06.026. Epub 2015 Jun 18. PubMed PMID: 26122188.
- Pesonen E, Andsberg E, Ohlin H, Puolakkainen M, Rautelin H, Sarna S, Persson K. Dual role of infections as risk factors for coronary heart disease. Atherosclerosis. 2007 Jun;192(2):370-5. Epub 2006 Jun 15. PubMed PMID: 16780845.
About two years ago, California’s governor, Jerry Brown, signed SB277 into law, which mandated that all school age children must have all vaccines appropriate for their age before they could enter private or public schools. The law nearly eliminated the ability to get personal belief exemptions (PBE), which allowed parents to object to vaccinations for almost any reason. The new law does allow for medical exemptions, that is, children who have some medical condition that contraindicates a vaccine may be exempted from these rules. As a result of this law, it was predicted that the California vaccine uptake for school age children would increase substantially, while reducing the incidence of vaccine preventable diseases.
Those of us who have been keen observers and supporters of SB277 were hoping for the best – that the vaccination rate in the state would show increases quickly. And it did.
Data released this week (pdf), from the California Department of Public Health, showed an exceptional increase in the percentage of California’s kindergarteners who were fully vaccinated (for their age group) – it rose from 92.8% to 95.6%. But, there’s even more astonishing data underneath that. With the advent of the new law, 97.3% of California’s kindergartners have received both MMR vaccinations, up from 94.5% in 2016 and 92.6% in 2014. The same was shown for diphtheria, tetanus and pertussis (whooping cough) vaccine – it went from 94.2% in 2015 to 96.9% in 2016. There should be cheering in the streets of California for the success of SB277.
The increase in vaccine uptake for all mandated vaccines is dramatic – not only does it show that SB277 has stemmed the overuse of personal belief exemptions that was slowly reducing California vaccine uptake, but it also has increased that uptake to levels far above historical. This graph illustrates how well the law has worked in a short period of time:
The best part of the law is that it’s increasing vaccine uptake in areas of the state where the overuse of PBEs was pushing the vaccination rate down. Most California’s counties have vaccination rates above 95%, which is considered the level at which the herd effect for measles vaccinations prevent the rapid spreading of the disease. Furthermore, only 4 relatively small counties in California have rates below 90%.
California state Senator Richard Pan (D-Sacramento), who is also a pediatrician and who was one of the primary supporters of SB277, tweeted out “Great News.” Obviously he’s ecstatic with this data on California vaccine uptake across the state.
— Dr. Richard Pan (@DrPanMD) April 12, 2017
Dr. Pan was interviewed by the Los Angeles Times, and said,
Measles certainly hasn’t gone away. We need to be sure to have our immunization levels high enough. The fact that this class and the state overall has now achieved this level is one further step to restore the community immunity we had before.
He also noted that the data shows the significant increase in very young children, kindergartners. He mentioned that there are still significant number of older children who are not vaccinated because of the lax requirements in previous vaccine laws, which made PBEs very easy to get. SB277 also requires 7th graders to be completely up-t0-date on their vaccines, so all children should eventually be caught up with their vaccines. Unfortunately, many students who have passed that 7th grade vaccination checkpoint may be insufficiently vaccinated. Or not vaccinated at all.
The University of California (UC) system has stated that it will require vaccines for all new enrollees at its 10 campuses (along with the UC Hastings College of Law which has decided to comply with the UC requirements). Like the state law, it eliminates all personal belief exemptions, but does allow medical ones. Eventually, this mandate will cover the over 230,000 students in the system.
The anti-vaccine forces have tried several tactics to block implementation of the new law. Opponents of SB277 filed a lawsuit last summer claiming the law violated California children’s right to an education under the state’s Constitution. A judge denied their demand for an injunction against the law – the plaintiffs eventually withdrew their case. These opponents also failed to gather enough signatures last year to put a referendum on the November ballot to overturn the law.
There are reasons to cheer all of this news out of California regarding immunization rates. But that’s just one state, albeit the largest and arguably the most influential state in the country. Other than California, only two other states have laws that have eliminated personal belief exemptions for immunizations – Mississippi and West Virginia, both of which have high vaccine uptake. And the easy availability of personal belief exemptions have lead many states to have vaccination rates of the MMR vaccine that are far below the 95% target. This graphic shows which states have significant deviations from the 95% standard for MMR vaccine (thanks to BuzzFeed News):
Sadly, it may not be possible for a lot of states to copy California’s success with vaccines. One of the worst performing states for the MMR vaccine is Colorado, and, according to BuzzFeed News,
Vaccine advocates in Colorado are envious of their counterparts in California. “We are watching California very closely, and kudos to them for getting that bill through,” Stephanie Wasserman, executive director of the Colorado Children’s Immunization Coalition, told BuzzFeed News.
She believes it would be very difficult to enact similar legislation in Colorado, which has libertarian conservatives who reject government mandates on vaccines, as well as liberal enclaves like Boulder where many parents seek out alternative health care and see vaccines as a tool of Big Pharma.
Libertarian conservatives and liberals on the same side of the fence on vaccines? The problem with both groups is that they ignore the health of children just to be “politically virtuous” about vaccines. Except they are scientifically and medically wrong.
So let’s give an ovation for hard working politicians of California, who decided that the health of the state’s children was the paramount consideration for vaccinations. Dr. Pan and many other state legislators decided that the most effective way of increasing the California vaccine uptake was to reduce the availability of personal belief exemptions. And they were right – California’s immunization rate has increased appreciably because of SB277.
Vaccines save lives.
Recently, an anti-vaccine doctor from Oklahoma, Dr. Jim Meehan, wrote an online post about why he would no longer vaccinate his children. It’s pretty clear that his post is not so much a discussion of his own children (most of whom are adults) as an attempt to deter other parents from protecting their children from preventable diseases. His post is basically a set of claims trying to convince parents that vaccinating is very dangerous.
The claims used to do so are nothing new: they are strictly out of the anti-vaccine playbook. But the post has received some attention in the anti-vaccine world, and was shared several thousand times, likely because many people treat an MD as an authority on the subject. So I decided to take a few minutes to explain why his claims are not good reasons to reject expert opinion and not protect children from disease.
Dr. Meehan’s claims fall into several categories (which will be discussed individually below):
- The diseases we vaccinate against are not dangerous, and it’s okay, even good, to encounter them naturally.
- Vaccines have toxic ingredients.
- Vaccines are dangerous to children.
- The science behind vaccines is corrupt because the pharmaceutical industry controls it and corrupts it.
- We should listen to him because he is a doctor and knows what he is talking about.
Note: Dr. Meehan’s post doesn’t present these claims in that order. I have changed the order, because I want to address the claims in a logical order, that is, first his claims about vaccine safety, then the conspiracy theory that underlies them, and finally, his appeal to authority. Continue reading “Dr. Jim Meehan anti-vaccine rant – examining his claims”