Tag: autism

Expert Statements on Vaccines and Autism

All of the organizations that help autistic people agree that there is no association between vaccines and autism.
All of the organizations that help autistic people agree that there is no association between vaccines and autism.

Some parents are still confused about who they should listen to for advice about vaccines and autism.

Is there any controversy or a real debate going on about whether vaccines are associated with autism?

What do the experts say?

They say that vaccines are not associated with autism.

More and more, experts are also stating that continuing to focus attention on vaccines is hurting autistic families.

And no, it’s not just one or two of them and it is not just your pediatrician…

Autism Science Foundation

“Multiple studies have been completed which investigated the measles, mumps and rubella vaccination in relation to autism. Researchers have also studied thimerosal, a mercury-based preservative, to see if it had any relation to autism. The results of studies are very clear; the data show no relationship between vaccines and autism.”

American Academy of Pediatrics

The American Academy of Pediatrics, an organization of 66,000 primary care pediatricians, pediatric medical subspecialists and pediatric surgical specialists, has long advocated for the health and safety of our children.

“Claims that vaccines are linked to autism, or are unsafe when administered according to the recommended schedule, have been disproven by a robust body of medical literature. Delaying vaccines only leaves a child at risk of disease. Vaccines keep communities healthy, and protect some of the most vulnerable in our society, including the elderly, and children who are too young to be vaccinated or have compromised immune systems.”

The AAP has consistently emphasized the safety and importance of vaccines to help reassure parents who are scared by anti-vaccine misinformation.

Autistic Self-Advocacy Network

“Vaccinations do not cause autism – but the use of autism as a means of scaring parents from safeguarding their children from life-threatening illness demonstrates the depths of prejudice and fear that still surrounds our disability. Autism is not caused by vaccines – and Autistic Americans deserve better than a political rhetoric that suggests that we would be better off dead than disabled.”

Autism Society of America

“There is no known single cause for autism spectrum disorder, but it is generally accepted that it is caused by abnormalities in brain structure or function. Brain scans show differences in the shape and structure of the brain in children with autism compared to in neurotypical children. Researchers do not know the exact cause of autism but are investigating a number of theories, including the links among heredity, genetics and medical problems.”

Autism Women’s Network

“Vaccines do not cause autism. Neither does thimerosal.”

National Autistic Society

“In the light of concern around the continuing activities of anti-vaccine campaigners, including promotion of the film ‘Vaxxed’, we feel it’s important to restate that research has comprehensively shown that there is no link between autism and vaccines…

We believe that no further attention or research funding should be unnecessarily directed towards examining a link that has already been so comprehensively discredited. Instead, we should be focusing our efforts on improving the lives of the 700,000 autistic people in the UK and their families.”

Autistica

“The biggest myth of all is that vaccines, specifically the MMR vaccine, cause autism. The safety of vaccinations has been repeatedly tested across large groups of people. High quality research studies involving hundreds of thousands of people have consistently shown that vaccinations do not cause autism.”

Thinking Person’s Guide to Autism

“So I want to ask you to be careful about how you make your pro-vaccine arguments when autism is involved — because when we use our many many mountains of evidence in statements such as “there is NO evidence linking vaccines to autism” without adding the statement “and fear of autism hurts autistic people,” then we’re actually contributing to negative stereotypes about autism and autistic people, rather than furthering autistic people’s acceptance and inclusion in our society.”

American Medical Association

The American Medical Association, which was founded in 1847, has just over 240,000 members.

“Each year vaccines prevent an estimated 2.5 million deaths among children under age 5, according to the World Health Organization. The AMA adopted policy this week continuing its efforts to promote public understanding and confidence in the safety of vaccines in order to prevent resurgence in vaccine-preventable illnesses and deaths. The new policy specifically supports the rigorous scientific process undertaken by the Advisory Committee on Immunization Practices and its development of recommended immunization schedules for the nation. The policy also recognizes the substantial body of scientific evidence that has disproven a link between vaccines and autism.”

Centers for Disease Control and Prevention

“There is no link between vaccines and autism.”

March of Dimes

“The implication that vaccinations cause autism is irresponsible and counter productive,’ said Michael Katz, M.D., senior vice president for Research and Global Programs for the March of Dimes…

Although several carefully performed scientific studies have searched for a link between autism and the use of thimerosal in vaccines, no such link has been found.”

Autism Speaks

“Each family has a unique experience with an autism diagnosis, and for some it corresponds with the timing of their child’s vaccinations. At the same time, scientists have conducted extensive research over the last two decades to determine whether there is any link between childhood vaccinations and autism. The results of this research is clear: Vaccines do not cause autism.”

National Association of Pediatric Nurse Practitioners

“Despite an abundance of evidence that there is no correlation between the vaccine and autism, the story noted in the movie has unfortunately made a lasting impact. It is the responsibility of pediatric-focused advanced practice registered nurses (APRNs) and colleagues to speak out against false information and educate patient families about vaccine safety and efficacy to prevent unnecessary and potentially fatal outbreaks.”

American Academy of Child and Adolescent Psychiatry

“Years ago, some people questioned whether the onset of characteristic symptoms of autism coincided with the timing of immunizations. Since then, multiple studies conducted in several different countries have demonstrated that there is no causal association between vaccines and autism. Neither vaccines nor their preservatives increase the rate of autism compared to unvaccinated children. Vaccines do not change the timing of autism symptoms, nor is there any effect on autism severity. Even in families at greater risk for autism, for example, where there is already a child with autism, there is no increase in the likelihood that the second child will have autism if he or she is vaccinated. Recent studies have also demonstrated that brain changes associated with autism risk most likely occur before birth and well before any immunizations are ever administered.”

World Health Organization

“Available epidemiological data show that there is no evidence of a link between measles-mumps-rubella (MMR) vaccine and autism spectrum disorders. Previous studies suggesting a causal link were found to be seriously flawed.

There is also no evidence to suggest that any other childhood vaccine may increase the risk of autism spectrum disorders. In addition, evidence reviews commissioned by WHO concluded that there was no association between the use of vaccine preservatives such as thiomersal and autism spectrum disorders.”

Institute of Medicine

“Based on a thorough review of clinical and epidemiological studies, neither the mercury-based vaccine preservative thimerosal nor the measles-mumps-rubella (MMR) vaccine are associated with autism… Furthermore, the hypotheses regarding how the MMR vaccine and thimerosal could trigger autism lack supporting evidence and are theoretical only .”

Child Neurology Foundation

“There are many myths linked to vaccines that this article hopes to have helped dispel. As discussed, any potential risk associated with vaccines administered to healthy children is small and outweighed by the risk of the naturally occurring disease. Maintenance of herd immunity and avoidance of vaccine exemptions are critical. Both of these practices disproportionately affect, at times with deadly consequences, our youngest and most vulnerable citizens.”

Canadian Paediatric Society

“Thus, the evidence is in, and the assessment of purported causality is clear. The MMR vaccine and immunization with thimerosal-containing vaccines are not causally associated with, nor are they a cause of, autism or ASD. There is mounting evidence that ASD has a strong genetic component – a very plausible cause for the disorder.”

European Centre for Disease Prevention and Control

“Autism is such a strong and emotive issue and something we all care about. However, the link made by one doctor to autism has been firmly discredited, and I can show you study after study that demonstrates that there is no link between the MMR vaccine and autism. Unfortunately, once a seed of doubt has been planted it tends to grow, and is fueled by sensational media and internet coverage that isn’t concerned with the facts. The real issue here is the very real risks from not being protected. I wish the voices of those who have been victims of not getting vaccinated could be heard more loudly and clearly.”

Robert Koch Institute

“There has been an ongoing debate in recent years whether autism, diabetes and even multiple sclerosis could be triggered by vaccinations. To date, there is no evidence for this and there are numerous studies that suggest that there is no link between vaccinations and these diseases.”

Hopefully it is clear that these position statements about vaccines and autism come from experts around the world, including many that directly take care of and support autistic families.

What to Know About Expert Statements on Vaccines and Autism

There is no debate and it is not a controversy – experts agree – vaccines are not associated with autism.

More on Expert Statements on Vaccines and Autism

 

Vaccines and Autism Redux

Is it true that only one ingredient (thimerosal) and one vaccine (MMR) has ever been looked at for its relationship to autism?

No, as you can probably guess, it is not.

“This meta-analysis of five case-control and five cohort studies has found no evidence for the link between vaccination and the subsequent risk of developing autism or autistic spectrum disorder. Subgroup analyses looking specifically at MMR vaccinations, cumulative mercury dosage, and thimerosal exposure individually were similarly negative, as were subgroup analyses looking specifically at development of autistic disorder versus other autistic spectrum disorder.”

Taylor et al on Vaccines are not associated with autism: An evidence-based meta-analysis of case-control and cohort studies

Since much of the original focus about vaccines and autism was on the MMR vaccine and thimerosal, that’s where a lot of the research to reassure parents went first.

Other research has been done though too, so it really is safe to say that vaccines are not associated with autism, even though some may continue to see a correlation.

“To try to isolate the effects of thimerosal from other vaccine constituents, we performed a subanalysis comparing risks associated with diphtheria-tetanus-whole cell pertussis vaccine or diphtheria-tetanus-acellular pertussis vaccine and Haemophilus influenzae type b vaccine given separately or combined.”

Verstraeten et al on Safety of Thimerosal-Containing Vaccines: A Two-Phased Study of Computerized Health Maintenance Organization Databases

The great majority of parents know that:

  • it is not the MMR vaccine
  • it is not thimerosal or thimerosal containing vaccines
  • it is not the overall number of vaccines that are given to a child
  • it is not the timing of when the vaccines are given to children

And it hasn’t been just one or two studies that have shown that there is no association between vaccines and autism. There are dozens. There is also a comprehensive review by the Institute of Medicine and a very large meta-analysis that have come to the same conclusion.

Vaccines are not associated with autism.

Vaccines and Autism Redux

Could it be aluminum though?

Why aluminum? Because anti-vaccine experts cite some poorly done studies that try to say it is.

Bob Sears appeared on Fox & Friends in 2010 for the segment "Vaccines: A Bad Combination?"
Bob Sears appeared on Fox & Friends in 2010 for the segment “Vaccines: A Bad Combination?”

Aluminum has become the new formaldehyde, which used to be the new thimerosal. It is apparently where the goalposts have shifted when some folks talk about vaccines and autism now that every knows it is not the MMR vaccine, thimerosal, vaccine overload, or the timing of vaccines.

But if studies have shown that it is neither the number of vaccines nor the timing of vaccines, then how could it be aluminum, an adjuvant in many vaccines?

It isn’t.

Aluminum is not the smoking gun or the missing puzzle piece that anti-vaccine folks will continue to look for.

What other myths about vaccines and autism have been coming up lately?

Have you heard the one about the court ruling confirming a vaccine autism link? It didn’t.

Did you know that the FDA officially announced that vaccines are causing autism? They didn’t, but do you know why some folks are now saying they did? Because of the old package insert for the Tripedia vaccine, which lists autism as a possible adverse event (without evidence of causation). The vaccine was discontinued years ago, but it continues to pop up as ‘new’ evidence for some as an association between vaccines and autism.

Or maybe you have heard these other new theories from the anti-vaccine movement as they desperately try to prove an association between vaccines and autism:

  • vaccines block folate uptake
  • MTHFR gene mutations
  • maternal immune activation
  • cytokine storms
  • glutathione depletion
  • glyphosate
  • DNA fragments
  • microbiota alterations
  • GI barrier defects
  • blood brain barrier permeability problems

You don’t even have to pick just one theory anymore (the fact that the MMR vaccine doesn’t contain thimerosal or aluminum kind of puts these theories into opposition with each other, doesn’t it?). You can choose for any or all of them to be true if you want. Using synergistic toxicity, you pick a few of your favorite theories and make them 100 times more likely to damage your child! Not really, but that’s how some anti-vaccine folks think.

“Autism is not an immune-mediated disease. Unlike autoimmune diseases such as multiple sclerosis, there is no evidence of immune activation or inflammatory lesions in the CNS of people with autism. In fact, current data suggest that genetic variation in neuronal circuitry that affects synaptic development might in part account for autistic behavior. Thus, speculation that an exaggerated or inappropriate immune response to vaccination precipitates autism is at variance with current scientific data that address the pathogenesis of autism.”

Gerber et al on Vaccines and Autism: A Tale of Shifting Hypotheses

Of course, none of them are true.

Vaccines are still not associated with autism.

What to Know About Vaccines and Autism

Vaccines are still not associated with autism, even though anti-vaccine folks continue to come up with new ideas for how it might be, from glyphosate and DNA fragments in vaccines to MTHFR mutations and maternal immune activation.

More on Vaccines and Autism

Is It a Vaccine Reaction?

Why do anti-vaccine folks think that there are so many vaccine reactions?

It is mostly because they think that anything bad that happens after someone is vaccinated, even if it is weeks or months later, must have been caused by the vaccine.

“Differentiation between coincidence and causality is of utmost importance in this respect. This is not always easy, especially when an event is rare and background rates are not available.”

Heininger on A risk-benefit analysis of vaccination

Of course, this discounts that fact that most people have a basic risk, often called the background rate, for developing most of these very same conditions, and they can just coincide with getting vaccinated.

Put more simply, the “reaction” would have happened whether or not they had been vaccinated.

“…when a number of well-controlled studies were conducted during the 1980s, the investigators found, nearly unanimously, that the number of SIDS deaths temporally associated with DTP vaccination was within the range expected to occur by chance. In other words, the SIDS deaths would have occurred even if no vaccinations had been given.”

WHO on Six Common Misconceptions About Immunization

That doesn’t mean that everything automatically gets blamed on coincidence though.

Is It a Vaccine Reaction?

Vaccine adverse events can be reported to VAERS online or using a downloadable form.
Vaccine reactions can be reported to VAERS online or using a downloadable form.

When trying to determine if a child has had a vaccine reaction, experts typically go through a series of questions, looking at the evidence for and against :

  • How soon after the vaccine was given did the reaction occur? Was it minutes, hours, days, weeks, months, or years later?
  • Is there any evidence that something else could have caused the reaction?
  • Is there a known causal relation between the reaction and the vaccine?
  • Is the reaction a table injury?
  • Is there evidence that the vaccine does not have a causal association with the reaction?
  • Do any lab tests support the idea that it was a vaccine reaction?

Why is it important to consider these and other questions?

Because most of us are very good at jumping to conclusions, are quick to place blame, and like to know the reasons for why things happen.

We don’t like to think that things are just caused by coincidence.

Post hoc ergo propter hoc (after this, therefore, because of this).

We are especially good at linking events and often automatically assume that one thing caused another simply because it occurred afterwards.

It is incident to physicians, I am afraid, beyond all other men, to mistake subsequence for consequence.

Dr Samuel Johnson

But we also know that correlation does not imply causation. And because of the great benefits of vaccines, it is important to find strong evidence for a correlation before we blame vaccines for a reaction.

Too often though, the opposite happens. Despite strong evidence against a correlation, parents and some pediatricians still blame vaccines for many things, from SIDS and encephalitis to autism.

Background Rates vs Vaccine Reactions

Although anti-vaccine folks are always calling for vaccinated vs unvaccinated studies to further prove that vaccines are indeed safe, much of that work is already done by looking at the observed rate of possible reactions and comparing them to the background rate of reactions and conditions.

We often know how many people are expected to develop certain conditions, from seizures and type 1 diabetes mellitus to acute transverse myelitis and juvenile and rheumatoid arthritis.

“On the basis of the reviewed data, if a cohort of 10 million individuals was vaccinated in the UK, 21.5 cases of Guillain-Barré syndrome and 5.75 cases of sudden death would be expected to occur within 6 weeks of vaccination as coincident background cases. In female vaccinees in the USA, 86.3 cases of optic neuritis per 10 million population would be expected within 6 weeks of vaccination. 397 per 1 million vaccinated pregnant women would be predicted to have a spontaneous abortion within 1 day of vaccination.”

Black et al on Importance of background rates of disease in assessment of vaccine safety during mass immunisation with pandemic H1N1 influenza vaccines

Intussusception is a good example of this.

This might surprise some folks, but we diagnosed and treated kids with intussusception well before the first rotavirus vaccines were ever introduced. And then, it was only after the risk of intussusception after vaccination exceeded the background rate that experts were able to determine that there was an issue.

Background rates also explain why unvaccinated kids develop autism. It’s not a coincidence.

“Knowledge of the background incidence rates of possible adverse events is a crucial part of assessing possible vaccine safety concerns. It allows for a rapid observed vs expected analysis and helps to distinguish legitimate safety concerns from events that are temporally associated with but not necessarily caused by vaccination.”

Gadroen et al on Baseline incidence of intussusception in early childhood before rotavirus vaccine introduction, the Netherlands, January 2008 to December 2012

Fortunately, studies have never found an increased risk above the background rate for SIDS, non-febrile seizures, and other things that anti-vaccine folks often blame on vaccines. So when these things happen on the same day or one or two days after getting vaccinated, it almost certainly truly is a coincidence. It would have happened even if your child had not been vaccinated, just like we see these things happen in the days before a child was due to get their vaccines.

For example, using background incidence rates in Danish children, one study found that if you vaccinated a million children with a new flu vaccine, you could expect that naturally, after seven days, you would see:

  • facial nerve palsy – one case
  • seizures – 36 cases
  • multiple sclerosis – one case
  • type 1 diabetes – three cases
  • juvenile and rheumatoid arthritis – three cases

After six weeks, those numbers of course go up. In addition to 4 kids developing MS, 20 develop diabetes, 19 develop arthritis, and 218 have seizures, and there would have been at least two deaths of unknown cause.

Would you blame the flu shot for these things?

What flu shot?

This was a “hypothetical vaccine cohort” that used 30 years of data from the Danish healthcare system to figure out background rates of each condition.

“In addition, the expected number of deaths in Japan following an estimated 15 million doses of H1N1 vaccine administered would be >8000 deaths during the 20 days following vaccination, based on the crude mortality rate.”

McCarthy et al on Mortality Rates and Cause-of-Death Patterns in a Vaccinated Population

Looking at background rates is especially helpful when folks report about vaccine deaths.

Using the Japan example that McCarthy studied, if they had looked at background rates, then all of a sudden, the 107 deaths they found after 15 million doses of H1N1 vaccine were given in 2009 would not have been so alarming. Background rates would have predicted a much, much higher number of deaths to naturally occur in that time period simply based on crude mortality rates.

Again, none of this means that possible vaccine reactions are dismissed as being coincidences. They just aren’t immediately assumed to have been caused by vaccines, because vaccines are necessary and a lot of research has already gone into demonstrating that vaccines are safe and vaccines continue to go through routine safety monitoring to make sure they stay safe.

What to Know About Evaluating Vaccine Reactions

Vaccines are safe and many of the things that folks think are vaccine reactions can be explained by looking at the background rates for these conditions and understanding that they would have happened anyway.

More on Evaluating Vaccine Reactions

Precautions vs Contraindications When Vaccinating Your Kids

Believe it or not, there are some anti-vaccine folks who believe that all vaccines are dangerous and unnecessary. And they believe that pediatricians push vaccines on kids in all situations, using a one-size-fits-all kind of immunization schedule.

Of course, neither is true.

Vaccines are safe and necessary.

There are some true medical contraindications and precautions to getting vaccinated though. Still, it is important to remember that even more things are simply “conditions incorrectly perceived as contraindications to vaccination.”

Contraindications To Vaccinating Your Kids

There are actually some good reasons to delay or skip one or a few of your child’s vaccines, but only in some very specific situations.

These very specific situations are called contraindications and are what count as medical exemptions.

“A vaccine should not be administered when a contraindication is present; for example, MMR vaccine should not be administered to severely immunocompromised persons.”

CDC on Vaccine Contraindications and Precautions

Fortunately, there are not that many of these contraindications, they are usually specific to just one or a few vaccines, and they are usually, but not always, temporary.

That’s why it would be really unusual to get a true permanent medical exemption for all vaccines. Even if you had a severe allergy to a vaccine that contained yeast, latex, or gelatin, since vaccines contain different ingredients, you would very likely be able to safely get the others.

Remember, your doctor can’t, or at least shouldn’t, just make up contraindications and exemptions to help you avoid getting your kids vaccinated and help you keep them in school.

“I do not believe vaccines had anything to do with my child’s autism. I never noticed any change in his speech, behavior or development with vaccines. I believe the protection and benefits of vaccines far outweigh the risks!”

Michele Han, MD, FAAP

Autism, for example, has been shown to not be associated with vaccines, so it is not a contraindication to getting vaccinated. That’s why many parents vaccinate and protect their autistic kids!

Precautions To Vaccinating Your Kids

In addition to contraindications to getting vaccinated, there is an accompanying list of  precautions.

“A precaution is a condition in a recipient that might increase the risk for a serious adverse reaction, might cause diagnostic confusion, or might compromise the ability of the vaccine to produce immunity (e.g., administering measles vaccine to a person with passive immunity to measles from a blood transfusion administered up to 7 months prior). A person might experience a more severe reaction to the vaccine than would have otherwise been expected; however, the risk for this happening is less than the risk expected with a contraindication. In general, vaccinations should be deferred when a precaution is present. However, a vaccination might be indicated in the presence of a precaution if the benefit of protection from the vaccine outweighs the risk for an adverse reaction.”

CDC on Vaccine Contraindications and Precautions

Again, we are fortunate that most of the conditions that are listed as precautions are temporary.

The vaccine information sheet that you get with each vaccine will list contraindications and precautions on who should not get the vaccine.
The vaccine information sheet that you get with each vaccine will list contraindications and precautions on who should not get the vaccine.

In fact, the most common is having a “moderate or severe acute illness with or without fever.”

Don’t want to get your child vaccinated when he or she has a severe illness?

Don’t worry.

Your pediatrician usually doesn’t want to vaccinate your child in that situation either.

It is easy enough to wait a few days or a week to get vaccinated, when the illness has passed, keeping in mind that a “mild acute illness with or without fever” is neither a precaution nor a contraindication to getting vaccinated. So you can still get your child their recommended vaccines if they just have a cold, stomach bug, or ear infection, etc.

What to Know About Precautions and Contraindications to Vaccines

Although there are some true medical exemptions or contraindications and precautions to getting vaccinated, most are vaccine specific and many are temporary, so they shouldn’t keep you from getting your child at least mostly vaccinated and protected.

More on Precautions and Contraindications to Vaccines

But If It Wasn’t the Vaccines…

Do you know why some folks still think vaccines are associated with autism?

It is simply because we can’t tell them what does cause autism.

“In the absence of a specific etiology for ASDs, and a tendency among parents of children with a disability to feel a strong sense of guilt, it is not surprising that parents attempt to form their own explanations for the disorder in order to cope with the diagnosis.”

Mercer et al on Parental perspectives on the causes of an autism spectrum disorder in their children

So if we don’t have another answer – then it must be vaccines.

That helps explain a lot of vaccine injury stories too.

For example, doctors often can’t tell you why your child has allergies, asthma, Celiac disease, diabetes, eczema, multiple sclerosis, POTS, SIDS, or thyroid problems, etc., which makes some people look to the mistaken theory that they were triggered by vaccines.

Of course, the answer isn’t that these are vaccine-induced diseases.

It simply demonstrates the limits of medical technology. Even if we don’t know what does cause many of these diseases, in almost all cases, it has been shown that they are not associated with vaccines.

Limits of 21st Century Medical Technology

Even in the 21st Century, science and medicine don’t have all of the answers.

And sometimes the answers are there, but are misinterpreted.

For example, the National Association of Medical Examiners makes the following distinctions on a medical certificate between manner of death:

  • Natural — “due solely or nearly totally to disease and/or the aging process.”
  • Accident — “there is little or no evidence that the injury or poisoning occurred with intent to harm or cause death. In essence, the fatal outcome was unintentional.”
  • Suicide — “results from an injury or poisoning as a result of an intentional, self-inflicted act committed to do self-harm or cause the death of one’s self.”
  • Homicide — “occurs when death results from…an injury or poisoning or from… a volitional act committed by another person to cause fear, harm, or death. Intent to cause death is a common element but is not required for classification as homicide.”
  • Could not be determined — “used when the information pointing to one manner of death is no more compelling than one or more other competing manners of death when all available information is considered.”
  • Pending investigation — “used when determination of manner depends on further information”

Why is this important to know?

Because many people confuse a natural cause of death as meaning that there was nothing wrong. That’s actually the opposite of what it means! A natural cause of death in a child means that they died because of a disease or condition.

Which disease or condition?

What was the underlying or immediate cause of death in these cases?

Limits and Uncertainty in Medicine

That’s where the limits of modern medicine and modern medical technology come in…

Maybe technology will change the future of healthcare – hopefully for the better, but there are still many things it can’t do.

Sure, we have indexed or mapped the entire human genome, but we still can’t often tell you why your child has a cough or runny nose, has developmental delays, or didn’t make it out of the PICU.

“…finding an underlying diagnosis for many conditions can be a very long and frustrating experience. A diagnosis can take as many as five years, and occasionally may never happen, especially with rare conditions. In addition, some experts say that between 30 to 40 percent of children with special needs do not have an exact diagnosis.”

NIH on Learning About An Undiagnosed Condition in a Child

Everyone wants answers when a child is sick or has unexplained signs and symptoms, especially when a child dies.

Unfortunately, while it may not get talked about often enough, there are many limits to modern medicine. There is often some uncertainty too.

“…when parents perceive greater uncertainty, they perceive less control over their child’s condition.”

Madeo et al on Factors Associated with Perceived Uncertainty among Parents of Children with Undiagnosed Medical Conditions

Just because futuristic medical tools like Tricorders are on the way doesn't mean that we will have all of the answers.
Just because futuristic medical tools like Tricorders are on the way doesn’t mean that we will have all of the answers.

Doctors don’t know everything.

The best doctors are the ones that actually know that they don’t know everything.

But just because they don’t know everything, that doesn’t mean that they don’t know anything.

For example, not knowing what does cause autism doesn’t mean that we don’t know many of the things that aren’t linked to autism.

And it certainly doesn’t mean that you should use this an excuse to blame vaccines or to skip or delay any vaccines. Continuing to try and associate vaccines with autism doesn’t just frighten parents and leave kids unprotected, it hurts autistic families.

What to Know About Uncertainty in Medicine

While there is much uncertainty in modern medicine and doctors don’t have all of the answers, there is no evidence that vaccines are associated with autism.

More on Uncertainty in Medicine

The Vaccine-Friendly Plan Book Review

The Vaccine-Friendly Plan is the latest book about vaccines that claims to offer a “safe and effective approach to immunity and health.”

What’s the problem with it?

In addition to the fact that there doesn’t seem to be any evidence in the book to support that any of its ideas are indeed safe or effective, the book pushes just about every anti-vaccine talking point out there today.

Misinformation in The Vaccine-Friendly Plan

If you want to skip or delay some of your child’s vaccines and are looking for something to help you feel better about your decision, then this is the book for you.

While Dr. Thomas and Jennifer Margulis talk about providing balanced information, it was right after he stated that “I realized we had poisoned a generation of children with a mercury-derived preservative called thimerosal” and then goes on to talk about how kids are overvaccinated.

So much for balanced information…

But Dr. Thomas isn’t just worried about vaccines. He is also worried about Tylenol, that the chemicals in plastics are endocrine disruptors, GMOs, flame retardants, pesticides, fluoride, artificial sweeteners, chemical dyes, and all of the other toxins that other doctors and the CDC supposedly ignore.

What about the “science” that supports his ideas?

Sure, he is quick to cherry pick studies that support the ideas he likes and label them as “important studies” among “a growing body of evidence,” but if the studies don’t, then they are “a handful of poorly designed, anecdotal studies.”

We see a lot of other anti-vaccine propaganda techniques in the book too.

“Giving a quadruple live-virus vaccine to a toddler is a mistake. When a toddler catches an illness naturally, he does not catch all four at once. I have serious concerns about hitting the immune system of a twelve-month-old baby with four live viruses, even though they are weakened.”

Does Dr. Thomas understand how the immune system works or how many different things our immune systems get “hit” with each and every day? Children are exposed to a lot of live, unweakened viruses and other germs every day and fight them off just fine.

Dr. Thomas also routinely downplays the risks of vaccine-preventable diseases (they all seem to be easily treatable in his world), overstates the risks of vaccines (they all seem to be full of horrible poisons in his world), makes heavy use of anecdotes, repeatedly makes it sound like every other pediatrician is doing something wrong, and again, makes full use of anti-vaccine talking points to scare parents:

To see how silly his arguments are, consider that when talking about giving any amount of formula to a baby, he is quick to say that “Cow’s milk is for calves, human milk is for human babies.”

“I also know several strapping young people who drank bottles of raw goat’s milk (instead of store-bought formula) when their breastfeeding mothers needed to be away from them for several hours…”

Raw goat milk is for kids = baby goats. Don't give it to your baby!
Raw goat milk is for kids = baby goats. Don’t give it to your baby! Photo by Shannon McGee (CC BY-SA 2.0)
But what about goat milk?

Is it just for baby goats?

You won’t hear this from Dr. Thomas, but unless your ‘kid’ is a baby goat, don’t give him raw goat milk!

So what’s the take home message about Dr. Thomas and his book?

Despite his frequently using the word science in the book, the only “science” in The Vaccine-Friendly Plan is that it is full of pseudoscience.

You can even see this in his ideas about gluten sensitivity. Why do so many of his patients show a sensitivity to gluten? He uses an IgG food sensitivity test that most experts say is basically worthless.

Making a Case for Getting Vaccinated

Perhaps the only good thing about Dr. Paul Thomas’ book is that he makes some very good cases for why you should vaccinate your kids.

Wait, what?

His introduction starts off with the story of the death of his three-year-old playmate in Africa. Tragically, the child died of measles.

Like many other pediatricians, he also talks about “the miracle that the Hib vaccine was when it was introduced in 1985.”

“Then in 2012 I had about twenty children in my practice with pertussis: eighteen were school age kids, and two were infants. Interestingly, fifteen of the twenty were fully immunized for pertussis, and the other five were from the small group of families in my practice who refuse all vaccines.”

His story about pertussis in his practice is also very interesting, but not for the reason that Dr. Thomas believes.

Consider that most kids are vaccinated, even in Dr. Thomas’ practice, so the fact that 25% of the kids who got pertussis are unvaccinated means a very high attack rate among unvaccinated children. So even with the problems of waning immunity with the pertussis vaccine, you are still much better off to be vaccinated and protected, even if that protection isn’t perfect.

“Since I opened my practice in 2008, not a single child has received the rotavirus vaccine. I refuse to stock it. Yet only one child in seven years has been hospitalized for severe dehydration. The unvaccinated children in my practice either are not getting rotavirus, or the illness is so mild that it requires no intervention.”

And so much for vaccine choice. How can his patients make a decision to get vaccinated if he doesn’t even have the vaccine?!?

But why don’t they get rotavirus? It is not because the vaccine doesn’t work or isn’t necessary. It is actually called being a free-rider or hiding in the herd.

Like most vaccines, the rotavirus vaccine works and helps create community immunity.

The Most Dangerous Advice in The Vaccine-Friendly Plan

Unfortunately, the dangerous advice in this book extends well beyond repeatedly telling parents to “say no thank you” to multiple vaccines and to delay others.

The advice to “decline vaccines” during pregnancy has to be right up there with the most dangerous advice in his book, but you be the judge…

“It depends on the medication, but the short answer is that it’s best to avoid all over the counter and prescription medications during pregnancy.”

Unbelievably, Dr. Thomas really seems to say that pregnant mothers should try to stop their antidepressants because “women respond differently to pregnancy hormones and some who struggle with mental health issues find the high estrogen and progesterone of pregnancy actually improve mood and mental health.”

He also thinks that it is “reasonable” to skip your baby’s vitamin K shot because of “worrisome ingredients,” like polysorbate 80 and aluminum.

“If bilirubin levels remain extremely high – above 20 – for over a week or two, some of the bilirubin can enter the brain, where it can cause permanent brain damage called kernicterus.”

Hopefully most parents are aware that you don’t want to wait “a week or two” to seek treatment if you baby’s jaundice level is above 20.

And hopefully most parents also understand that:

  • the cutoff for fever in newborns is 100.4°F (38°C) or higher, not 100.6°F (38.4°C)
  • co-sleeping and letting your baby sleep on your chest are not safe things to do
  • skipping an evaluation and antibiotics when mom is GBS positive after delivery and she develops a fever (possible chorioamnionitis) is not a safe thing for baby, especially if mom already skipped getting antibiotics during her delivery  – it’s called gambling that the baby won’t develop early-onset invasive group B streptococcal disease. Several studies have found very high numbers of newborns in this situation with positive blood cultures, even though they had no symptoms.
  • if your pediatrician recommends that your child needs treatment for congenital hip dysplasia (which is actually now called Developmental Dysplasia of the Hip), then you should probably listen, instead of hoping it goes away on its own by wearing “your baby on your front or back with his legs splayed.”
  • you shouldn’t put your baby in direct sunlight without sunscreen for ten to fifteen minutes every day
  • there is no need to routinely check your baby’s vitamin D level – just give a supplement if you are exclusively breastfeeding
  • until polio is eradicated, the risk of getting polio is higher than zero and that all of his unvaccinated kids are at risk even if they don’t travel outside the US, like the outbreak among the Amish in 2005
  • children die from meningococcal disease because it is a severe and terrible disease that progresses very quickly, not because “we pediatricians – so quick to intervene in other, unnecessary ways – fail to listen to a worried mother, dismiss her concerns as “hysterical,” and send a sick child home…” In one study, “Most children had only non-specific symptoms in the first 4-6 h, but were close to death by 24 h.”
  • preschoolers do not need to routinely take 2,000IU of vitamin D each day – the current recommendation is 600IU if they are not getting enough from the foods they are eating and drinking and 2,000IU only if they have been diagnosed with a vitamin D deficiency
  • about 4,200 women die of cervical cancer in the United States each year, something Dr. Thomas fails to mention when he says that “some strains of HPV can lead to slow-growing, highly treatable cancers.”

Although the whole book is dangerous, these are serious errors that can harm kids, and it is unbelievable that Penguin Random House would publish this book as a Medical/Parenting book. After all, this is the same company that published NeuroTribes!

Conspiracy Theories in The Vaccine-Friendly Plan

No good anti-vaccine book would be complete without some good old conspiracy theories.

Dr. Thomas doesn’t disappoint!

“It took me years to realize something I still wish were not true but which you cannot ignore if you want to have a healthy baby in America today: Our government officials and a handful of well-positioned M.D.’s who advise them have ignored some of the most important peer-reviewed studies and most relevant scientific information about immunity and health, both during pregnancy and throughout infancy.”

Dr. Paul Thomas

What else has he got?

  • the polio vaccines didn’t eliminate polio in the US, instead, it could have been “chlorinating water in public swimming pools” – it wasn’t
  • “severe reactions to the HPV vaccine are actually much more common than parents are being told” – they aren’t, even Diane Harper says the HPV vaccines are safe
  • rotavirus deaths in the pre-vaccine era are “inaccurate and misleading” because they are estimated numbers “based on a retrospective study that looked at morbidity associated with diarrheal disease between 1968 and 1991,” – except that Dr. Thomas looked at the wrong study. The estimates for hospitalizations and deaths in the pre-vaccine era come from a different study that looked at “Hospitalizations and Deaths from Diarrhea and Rotavirus among Children <5 Years of Age in the United States, 1993–2003.” Oops.
  • most flu-like illnesses are not really the flu, which “makes it impossible to distinguish influenza infections from other viruses,” unless you go to his office, where he tests kids for the flu – except that using the influenza-like illness (ILI) case definition has a high positive predictive value during flu season and many doctors and hospitals also do rapid flu testing

Do you really believe that it was the chlorine in swimming pools that eliminated polio in the United States? Or that he has found a magic way to avoid autism by drinking filtered water, avoiding GMOs, eating organic, whole foods, and following a non-standard, parent-selected, delayed protection vaccine schedule?

What to Know About The Vaccine-Friendly Plan

The Vaccine-Friendly Plan is a dangerous book that not only panders to parent’s fears about vaccines, it goes out of its way to increase those fears by pushing misinformation, telling parents to skip and delay vaccines, and giving other unsafe pediatric and parenting advice.

The only reason to pick it up is because you are looking for some confirmation bias to make you feel better about a decision to not vaccinate your child. If you read it because you were on the fence about vaccines, please consider doing a little more research.

More on The Vaccine-Friendly Plan

What Is Cherry Picking?

Everyone has heard of cherry picking.

If you are talking about vaccines, this probably isn’t that kind of cherry picking though.

What Is Cherry Picking?

Have you ever been to a cherry orchard?

“Pick only the cherries that are fully red (or whatever color they are supposed to be when ripe!). Part the leaves with your hands to look for hidden cherries ready for harvest.”

Cherry Picking Tips and Facts

Cherries don’t continue to ripen off the tree, so you want to pick them at exactly the right time. Not too early and not too late.

So when you go cherry picking, you are looking for the perfect cherries.

That’s what folks do when they go cherry picking for just the right information to fit their beliefs, but ignore any and all other information that might prove them wrong.

“Whatever one might think about Andrew Wakefield, he was just one man: the MMR autism scare has been driven for a decade now by a media that over-emphasises marginal views, misrepresenting and cherry picking research data to suit its cause. As the Observer scandal makes clear, there is no sign that this will stop.”

Ben Goldacre on MMR: the scare stories are back

It shouldn’t come as a surprise that most anti-vaccine folks are very good at cherry picking.

A cherry picker isn't going to save you from a bad argument.
D’oh! A cherry picker isn’t going to save you from a bad argument.

Someone is cherry picking when they:

  • uses only one or a few out-of-context quotes that seem to support their argument, but ignores the rest of the article or study that doesn’t
  • talks about the one study that supports their position, but ‘forgets’ to mention the ten that don’t
  • mentions a few years of data that support their argument, but leave out the years that don’t

Need a good example?

Have you ever heard someone say that the package insert for Tripedia vaccine proves a link to autism?

SIDS and autism are listed in Tripedia package insert, but are not causally linked to the vaccine.
SIDS and autism are listed in Tripedia package insert, but are not causally linked to the vaccine.

This is classic cherry picking because they are ignoring all of the other information in the package insert, all of the other package inserts that don’t list autism as an adverse reaction, and all of the other evidence that autism is not associated with vaccines! It is also a bad argument against vaccines because they don’t explain why it is in the package insert.

How can you easily spot when someone is cherry picking?

You have to get educated and do your own research.

What to Know About Cherry Picking

Cherry picking occurs when someone chooses to use just the right information to fit their beliefs, but ignores any and all other information that might prove them wrong.

More on Cherry Picking