Tag: correlation

The Bob Sears Snare

Dr. Sears has been a well-known pediatrician for many years, writing books about breastfeeding, fussy babies, and sleep, and advocating for co-sleeping and attachment parenting before most people even knew what those things were.

He also advocates for vaccines.

“Because of my “historical” perspective, I have grown to appreciate the value of vaccines as a necessary public-health measure. Currently in our pediatric practice, we follow the vaccine schedule recommended by the American Academy of Pediatrics.”

Dr. William Sears on Ask Dr. Sears: Vaccination/Immunization Concerns

If you are a little confused, that’s because you may not have known that Dr. Bob Sears’ father is also a pediatrician. In fact, they practice together, even if they don’t seem to agree on everything.

Who is Bob Sears?

Dr. Bob Sears believes that alternative immunization schedules are safer than getting vaccinated on time, mostly because he seems to think that most vaccine-preventable diseases aren’t that serious.

“I created my alternative vaccine schedule that allows parents to go ahead and vaccinate, simply in a more gradual manner. And I find a lot of worried parents who otherwise would refuse vaccines altogether are very happy to go ahead and vaccinate if they’re doing it in a way that they feel safer about.”

Dr. Robert W. Sears: Why Partial Vaccinations May Be an Answer

Dr. Bob appeared to have noble goals when he wrote his vaccine book – to convince more parents who were on the fence to get vaccinated – or at least to eventually get vaccinated, even if they had to delay some vaccines to get there.

“As parents’ fears of vaccines grow, I think we may see fewer and fewer parents decide to vaccinate. And then we could see what used to be very rare illnesses become more common. We might see measles escalate. We might see diphtheria come back into the United States. God forbid, we might see polio come back. Then children are going to start dying. And then a lot of those parents that had chosen not to vaccinate might change their mind, and they might start vaccinating again, and then new parents might be more inclined to vaccinate their babies if we see these diseases come back.

Now, I hope and pray that doesn’t happen. I hope that we can maintain adequate herd immunity in our country so we don’t see these diseases return. But that worry of diseases coming back into our country, and the worry of diseases running rampant and killing a lot of babies, I don’t think that supersedes the parents’ basic right to choose what they want to do for their children. And if parents want to accept the disease risk because they don’t trust the vaccines, I think they have the right to make that choice.”

Dr. Robert W. Sears: Why Partial Vaccinations May Be an Answer

It didn’t work.

It may just be a correlation, but vaccine rates went down after he wrote his book, especially among clusters of worried parents, some of whom would walk into their pediatrician’s offices carrying his book or the immunization schedule he made up.

The Bob Sears Snare

More than anything though, it seems like he has contributed to parents not trusting vaccines.

“What I do instead is I give two vaccines at a time, at 2 months, 4 months and 6 months. I also give two of the vaccines that I’m skipping on alternative months: 3 months, 5 months and 7 months. And I’m avoiding a big overload. I’m giving only a couple vaccines at a time. I feel that babies will experience fewer vaccine reactions; I think babies’ bodies can handle them better. Their immune system can handle them better that way, and I think a lot of parents simply feel more safe about that kind of approach.”

Dr. Robert W. Sears: Why Partial Vaccinations May Be an Answer

See what he did?

Instead of reassuring parents that vaccines don’t overload a baby’s immune system, Dr. Bob tells them that his schedule avoids a “big overload.”

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?”

If they weren’t scared about vaccines before they heard of Dr. Bob, they probably were after reading some of his stuff.

And once you fall into the snare and get scared, it is hard to get out.

What makes it even more frustrating?

The things he scares parents about aren’t even true!

Dr. Bob misrepresents science and gets parents to believe that vaccines aren’t well tested, that vaccine-preventable diseases aren’t dangerous, and that vaccine ingredients, like aluminum are dangerous.

And although he talks about choice and informed consent all of the time, by misinforming parents about vaccines and vaccine-preventable diseases, he is actually taking away their ability to make an informed choice.

Not surprisingly, even Dr. Bob seems to have been snared by his rhetoric about vaccines.

“As a doctor, I don’t like to undermine the CDC and to help parents mistrust the CDC. Obviously the CDC does so much good for us. They have our best intentions in mind, and they do so much research. And I think parents can overall trust what the CDC says.”

Dr. Robert W. Sears: Why Partial Vaccinations May Be an Answer

He went from saying in a 2010 interview that parents should trust the CDC and that “There’s so much safety research behind vaccines that most parents should feel very confident in their safety” to now giving presentations at anti-vaccine conferences on How to Counter the Lies Politicians and the Media Use to Pass Mandatory Vaccination Laws.

What’s the worst thing about Dr. Bob though?

Bob Sears warned everyone that measles would come back if too many people listened to him in The Vaccine Book
Bob Sears warned everyone that measles would come back if too many people listened to him in The Vaccine Book

It’s not that he actually predicted what would happen if too many people began to follow non-standard, parent-selected, delayed protection vaccine schedules, but that he thinks he is an expert on autism.

“By trying to say that there is no significant increase, is the government hoping to reassure people that autism isn’t a significant problem? That the rising number of children with autism isn’t something that anyone has to worry about? Are they trying to avoid a panic?”

Dr. Bob Sears

In a recent report about autism rates, there was no conspiracy, as Dr. Bob suggests. Unlike Dr. Bob and some others, the CDC was simply trying to not mislead people into thinking that the change from 2.24 to 2.76% meant something that it did not.

What to Know About The Bob Sears Snare

The Bob Sears Snare is a technique that anti-vaccine folks use to misrepresent science so that you actually think you are doing the right thing for your kids by skipping or delaying vaccines and leaving them unprotected.

More on Bob Sears

Should I Blame the Vaccine If I’m Sick and I Just Got Vaccinated?

We all know the saying, correlation equals causation, right?

So if you get an MMR vaccine and get the measles a week later, it has to be the vaccine, right?

Should I Blame the Vaccine If I’m Sick and I Just Got Vaccinated?

Actually, no.

“Correlation does not imply causation.”

Although it would be very easy to blame the vaccine, if you keep in mind that the saying is actually “correlation does not imply causation,” maybe you will do a little investigating and see if something else is to blame.

Some things to consider and ask yourself:

  1. Do I really have measles? Remember that it is not uncommon to develop a fever and a rash about 7 to 12 days after getting an MMR vaccine. This is a very common, mild vaccine reaction. It doesn’t mean that you have measles or even a mild case of the measles.
  2. Was I recently exposed to someone with measles? If you were vaccinated because you were exposed to measles during an outbreak, then there is a good chance that the vaccine hasn’t had a chance to work yet and you actually developed measles from being exposed to the wild virus.
  3. Do I have the wild type or a vaccine strain of measles? Testing can be done to tell which strain of measles you have and to see if it is a wild type or vaccine strain.

Are there any examples of folks having wild type disease if they get sick shortly after being vaccinated?

Not surprisingly, there are a lot of these types of examples.

“Vaccine strains are poorly or not transmissible and prompt differentiation between wild-type and vaccine strains allows for optimal management and public health action.”

Pabbaraju et al on Simultaneous Detection and Differentiation between Wild-Type and Vaccine Measles Viruses by a Multiplex Real-Time Reverse Transcription-PCR Assay

What about examples of folks getting sick with vaccine strain measles and other diseases? Not so many.

The clinical diagnosis could just as easily have been wild type measles and not a vaccine strain, as there was a lot of measles in the the UK in 1988.
The clinical diagnosis could just as easily have been wild type measles, as there was a lot of measles in the the UK in 1988.

Most of the published examples are case reports without evidence of a vaccine strain.

What about the kid in Canada that got measles after her MMR vaccine?

“We describe a case of vaccine-associated measles in a two-year-old patient from British Columbia, Canada, in October 2013, who received her first dose of measles-containing vaccine 37 days prior to onset of prodromal symptoms.”

Murti et al on Case of vaccine-associated measles five weeks post-immunisation, British Columbia, Canada, October 2013.

She had symptoms of measles and a vaccine strain and was reported as “the first case of MMR vaccine-associated measles.” Well, at least the first case that occurred so long after getting vaccinated. Still, they note that “clinically significant vaccine-associated illness is rare.”

What about all of the people in California and Michigan who supposedly had vaccine-strain measles?

This is not vaccine strain measles! It is people with a rash or fever after being vaccinated. They don't have measles though.
This is not vaccine strain measles! It is people with a rash or fever after being vaccinated. They don’t have measles though.

Anti-vaccine folks made that up!

When It’s a Wild-Type Virus

What’s the most obvious evidence against the idea that vaccines and shedding are responsible for causing outbreaks?

For one thing, despite the recent uptick, cases of vaccine-preventable diseases are way down from the pre-vaccine era. That’s not what you would expect if vaccine-induced disease was common or if contacts of those who were recently vaccinated could easily get sick from shedding.

And we have evidence against vaccine induced disease.

When kids get chicken pox shortly after being vaccinated, they often have a wild strain. They don’t have breakthrough chicken pox.

“All of 57 vaccinees with breakthrough varicella, clinically diagnosed on the basis of a generalized maculopapular or vesicular rash, in which there was amplifiable DNA [corrected], had wild-type VZV infection based on analysis of viral DNA. “

LaRussa on Viral strain identification in varicella vaccinees with disseminated rashes.

Same thing with measles.

Want to avoid these situations in which you could get a wild strain of a vaccine-preventable disease?

Don’t skip or delay your child’s vaccines!

More On Wild-Type and Vaccine Measles Viruses

Side Effects and Adverse Events Following Immunizations

Vaccines are safe, but they do have some side effects, mostly mild, and they rarely cause some serious and severe adverse reactions.

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

To help keep our vaccines safe, it is important that all “clinically important adverse events that occur after vaccination of adults and children” be reported to VAERS, not just the ones that are known to be side effects.

Wait.

Isn’t an adverse event the same as a side effect?

Adverse Events Following Immunizations

To better understand that, let’s first look at how we define an adverse event following immunization (AEFI):

“An Adverse event following immunization (AEFI) is any untoward medical occurrence which follows immunization and which does not necessarily have a causal relationship with the usage of the vaccine. The adverse event may be any unfavourable or unintended sign, abnormal laboratory finding, symptom or disease.”

Classification of AEFIs

So it should be clear that not all adverse events are actually caused by vaccines.

Many are coincidental events that simply occur after a vaccine is given.

What’s the Difference Between Side Effects and Adverse Events Following Immunizations?

Others are true vaccine reactions though, including fever, pain, fainting, and allergic reactions, etc.

“A side effect is any health problem shown by studies to be caused by a vaccine. Like any medication, vaccines can cause side effects. Usually vaccine side effects are minor (for example, a sore arm where a shot was given or a low-grade fever after a vaccine) and go away on their own within a few days.”

Understanding Side Effects and Adverse Events

These are the reactions that we call side effects or adverse reactions of the vaccine.

Still, just because a sign or symptom can be a side effect of a vaccine doesn’t mean that it always will be.

“A vaccine reaction is an individual’s response to the inherent properties of the vaccine, even when the vaccine has been prepared, handled and administered correctly.”

Vaccine reactions – WHO Vaccine Safety Basics

Here are some other definitions:

  • adverse event – Medical occurrence temporally associated with the use of a medicinal product, but not necessarily causally related.
  • adverse reaction/side effect – A response to a drug which is noxious and unintended, and which occurs at doses normally used in man for the prophylaxis, diagnosis, or therapy of disease, or for the modifications of physiological function.
  • unexpected adverse reaction – Not consistent with applicable product information or characteristics of drug.
  • severe adverse event or reaction – are rarely life-threatening and usually do not result in long-term problems
  • serious adverse event or reaction – Any untoward medical occurrence that at any dose is life-threatening, results in death, requires inpatient hospitalization or prolongation of existing hospitalization, or results in persistent of significant disability or incapacity

Does understanding those definitions make it easier to see why you should be skeptical when folks try to scare you with VAERS reports and data from package inserts?

“Reports of all possible associations between vaccines and adverse events (possible side effects) are filed in VAERS. Therefore, VAERS collects data on any adverse event following vaccination, be it coincidental or truly caused by a vaccine. The report of an adverse event to VAERS is not documentation that a vaccine caused the event.”

Guide to Interpreting VAERS Data

They both can include reports about adverse events, not just side effects. So they both include events that can very well be coincidental, and not caused by a vaccine.

So when doing your research about vaccines, focus on real side effects, or things that are known to be caused by vaccines. You will find that most vaccine side effects are mild and that more serious or severe side effects are very rare.

More on Side Effects and Adverse Events

Do Vaccines Cause Psoriasis?

Even with all of the so-called vaccine-induced diseases that anti-vaccine folks come up with, few people likely think that vaccines cause psoriasis.

Bob Sears is being investigated by the California Medical Board for giving these medical exemptions because he thinks vaccines cause psoriasis.
Bob Sears is being investigated by the California Medical Board for giving these medical exemptions. Were they legitimate?

Some do though…

Do Vaccines Cause Psoriasis?

Bob Sears thinks that these kids shouldn’t be vaccinated because “vaccines can trigger psoriasis or make existing psoriasis worse.”

Dr. Bob did his research and thinks that vaccines are a risk to cause lifelong psoriasis.
Dr. Bob did his research and thinks that vaccines are a risk to cause lifelong psoriasis.

He even provided a list of studies that he thinks support his case.

“Nevertheless, the likely very low incidence of psoriasis following vaccination emphasizes the safe profile and the relevance of vaccination strategies in psoriasis patients, especially in candidates for immunosuppressive treatments.”

Sbidian et al on National survey of psoriasis flares after 2009 monovalent H1N1/seasonal vaccines.

Do they?

“The risk of psoriasis was also increased in subjects who reported a history of a recent infectious episode. The analysis by individual diagnosis pointed to acute pharyngitis as the disease with the strongest association and the only one providing statistically significant results…”

Naldi et al on Family history of psoriasis, stressful life events, and recent infectious disease are risk factors for a first episode of acute guttate psoriasis: results of a case-control study

Let’s see, although I’m not sure he actually read more than the abstracts or understands that guttate psoriasis isn’t the same as plaque psoriasis…

  1. Possible Triggering Effect of Influenza Vaccination on Psoriasis – a small group of patients (36) either had an exacerbation of their psoriasis, or new onset of psoriasis (7), within a couple of weeks to months after getting a flu shot.
  2. Psoriasis triggered by tetanus-diphtheria vaccination – a case report of a 50-year-old with chronic psoriasis for 6 years who developed an exacerbation a week after getting a tetanus booster.
  3. Psoriatic skin lesions induced by BCG vaccination – a case report of a 6-month-old who developed a BCG-induced tuberculid-like eruption accompanied by psoriatic skin changes one month after vaccination. They went away without treatment within 3 months.
  4. Guttate psoriasis-like lesions following BCG vaccination – a case report of a 7-year-old who developed guttate psoriasis-like lesions one week after his BCG vaccination. He was treated with steroid creams and the rash went away within three weeks.
  5. New Onset Guttate Psoriasis Following Pandemic H1N1 Influenza Vaccination – a case report of a 26-year-old who developed guttate psoriasis after getting a flu shot. Her rash went away within three weeks.
  6. National survey of psoriasis flares after 2009 monovalent H1N1/seasonal vaccines – a small group of patients (10) who either developed new onset psoriasis or had an exacerbation after getting a flu shot.
  7. Psoriasis vaccinalis; report of two cases, one following B.C.G. vaccination and one following vaccination against influenza – from 1955, two case reports of psoriasis after BCG vaccine and the flu shot.
  8. Family history of psoriasis, stressful life events, and recent infectious disease are risk factors for a first episode of acute guttate psoriasis: results of a case-control study – a case control study that “confirmed that recent pharyngeal infection is a risk factor for guttate psoriasis. It also documented the strong association between guttate psoriasis and a family history of psoriasis. Finally, the study added evidence to the belief that stressful life events may represent risk factors for the onset of psoriasis.” The study doesn’t mention vaccines, but does remind us that “it has been estimated that only one third of cases of guttate psoriasis progress to chronic plaque psoriasis, whereas a history of guttate psoriasis is not frequent in patients with psoriasis.”
  9. Genetic background of psoriasis – doesn’t mention vaccines.

So, none of Bob’s studies were in children, they are mostly about flu shots and the BCG vaccine (which isn’t used in the United States), they are mostly case reports (low on the hierarchy of evidence), and a few don’t mention vaccines…

And most aren’t about chronic psoriasis!

Explaining the Correlation of Psoriasis After Vaccines

Is there anything that might explain the case reports that do show an association between vaccines and psoriasis flares?

“Psoriasis can appear in areas of the skin that have been injured or traumatized. This is called the Koebner [KEB-ner] phenomenon. Vaccinations, sunburns and scratches can all trigger a Koebner response. The Koebner phenomenon can be treated if it is caught early enough.”

National Psoriasis Association on Causes and Triggers

Experts also talk about Th1- and Th17-predominant immunologic responses of flu shots and the BCG vaccine’s Th17 activity. It is known that Th17 cells play a role in psoriasis.

Are there any other studies about vaccines and psoriasis that Dr. Bob left out?

  1. Yellow fever vaccine used in a psoriatic arthritis patient treated with methotrexate: a case report – “A case of yellow fever vaccine used in a 27-year-old Slovenian male with psoriatic arthritis during treatment with methotrexate is described. We demonstrate a positive case, since there were no adverse effects in concurrent administration of yellow fever vaccine and methotrexate.”
  2. Live attenuated varicella vaccine: A new effective adjuvant weapon in the battlefield against severe resistant psoriasis, a pilot randomized controlled trial – a study of 35 patients which found that the “use of chickenpox vaccine with low-dose cyclosporine seems to have value for the treatment of resistant psoriasis.”
  3. [Psoriasis is no obstacle to smallpox vaccination] – (I haven’t found the full article yet, but the title is intriguing, since eczema is a contraindication to getting the smallpox vaccine…)
  4. Factors associated with 2009 monovalent H1N1 vaccine coverage: a cross sectional study of 1,308 patients with psoriasis in France – mentions that more than twice as many people with psoriasis in France got a flu shot than the general population.
  5. Immune response to pneumococcus and tetanus toxoid in patients with moderate-to-severe psoriasis following long-term ustekinumab use – vaccines work when you have psoriasis!
  6. From the Medical Board of the National Psoriasis Foundation: monitoring and vaccinations in patients treated with biologics for psoriasis – addresses vaccination practices for folks with psoriasis.
  7. Challenges in the treatment of psoriasis with biologics: vaccination, history of malignancy, human immunodeficiency virus (HIV) infection, and pediatric psoriasis – actually talks about how UNDERVACCINATION is a challenge in treating kids with psoriasis, as you might have to interrupt therapy to get them caught up!
  8. Vaccinations in patients with immune-mediated inflammatory diseases – is very clear that the “Clinical evidence indicates that immunization of IMID patients does not increase clinical or laboratory parameters of disease activity. Live vaccines are contraindicated in immunocompromized individuals, but non-live vaccines can safely be given.”

The bottom line is that experts that treat people with psoriasis recommend that they be fully vaccinated.

“Psoriasis is a treatable, chronic dermatosis. The very low absolute risk of new-onset or relapsed psoriasis following influenza vaccination should not change its universal recommendation, particularly for patients with psoriasis on immunosuppressive therapy. We present this case to highlight clinical manifestations of this rare association.”

Shi et al on Widespread psoriasis flare following influenza vaccination

There is even talk of development of a vaccine to treat psoriasis!

It should be clear that neither psoriasis nor a family history of psoriasis should be a reason to get a medical exemption for vaccines.

More on Vaccines and Psoriasis