Yes, the BMJ, formally the British Medical Journal, just published a piece, Are injections part of the “mystery” of acute flaccid myelitis/AFM? Is the CDC interested in finding out?
Those familiar with the BMJ understand that this is not a real editorial or article though.
It is one of their Rapid responses to another article – basically a letter to the editor. Unfortunately, some folks use these Rapid responses as evidence for their anti-vaccine talking points and arguments.
The BMJ Asks If Injections Are Part of the “Mystery” of Acute Flaccid Myelitis/AFM…
The AFM patient summary form asks for a vaccination record and current studies have found no association with recent vaccines.
“They also say that they are continuing to investigate the possibility of an association, but the AFM Patient Summary Forms that they supply to US state health departments contain no questions about injections or vaccinations.”
Allan S. Cunningham on Are injections part of the “mystery” of acute flaccid myelitis/AFM? Is the CDC interested in finding out?
“According to patients’ vaccination records, all but one had been vaccinated according to Advisory Committee on Immunization Practices recommendations. The median interval between receipt of the last vaccination and onset of neurologic symptoms was 1.9 years (range = approximately 2 months–7 years).”
Acute Flaccid Myelitis Among Children — Washington, September–November 2016
What are those exactly? That the protection babies get from their mother’s pregnancy flu shot doesn’t last until they go to college?
What’s the greatest evidence that they might not support vaccines? I mean, besides anti-vaccine La Leache League leaders who actively say that they are against vaccines?
Bob Sears is giving two lectures on vaccines at an upcoming La Leche League breastfeeding conference.
Will he really discuss the benefits of vaccines for pregnant and post-partum mothers and their families?
“Dr. Bob Sears, a renowned Dana Point pediatrician who has been sought out by parents who wish to opt out of the state’s mandatory vaccine requirements, has been placed on probation for 35 months by the Medical Board of California.”
Dr. Bob Sears, renowned vaccine skeptic, placed on probation for exempting child from all vaccinations
“Remember that La Leche League is exclusively focused on breastfeeding support and has no stance on vaccinations.”
La Leche League USA
No stance on vaccinations?
Actually, with bringing Dr. Bob to their conference, it seems like they made a very clear stance…
“Nursing also allows your baby to give germs to you so that your immune system can respond and can synthesize antibodies! This means that if your baby has come in contact with something which you have not, (s)he will pass these germs to you at the next nursing; during that feeding, your body will start to manufacture antibodies for that particular germ. By the time the next feeding arrives, your entire immune system will be working to provide immunities for you and your baby. If you are exposed to any bacteria or viruses, your body will be making antibodies against them and these will be in your milk.”
Can Breastfeeding Prevent Illnesses?
And they have also done a good job of making it sound like breastfeeding infants don’t need vaccines.
To counter vaccine hesitancy, you likely first need to understand what it means.
“Vaccine hesitancy refers to delay in acceptance or refusal of vaccines despite availability of vaccination services. Vaccine hesitancy is complex and context specific varying across time, place and vaccines. It includes factors such as complacency, convenience and confidence.”
SAGE Vaccine Hesitancy Working Group
So it means someone who is anti-vaccine, right?
“Although many may characterize all individuals who eschew vaccines as “anti-vaccine” or “vaccine deniers,” in reality there is a broad spectrum of individuals who choose not to have themselves or their children vaccinated.”
Tara C Smith on Vaccine Rejection and Hesitancy: A Review and Call to Action
Many of the folks who are vaccine hesitant aren’t truly anti-vaccine. They are likely being misled by anti-vaccine myths and propaganda, but at least they aren’t the ones spreading it across Facebook or on their own blogs and anti-vaccine websites.
How To Counter Vaccine Hesitancy
How do you counter vaccine hesitancy?
“It’s unfair for anyone to expect me [or any parent] to take the word of the pharmaceutical companies who have much to gain from and industry worth billions without question – and then have to dismiss any concerns of my own.”
“Well, if you’re going to inform yourself about vaccines, I think anybody who’s truly informed will realize that getting a vaccine is much better than not getting one. If you’re choosing not to vaccinate your child, it’s because you’re getting, frankly, bad information about vaccines.”
Paul Offit, MD
You also make sure that parents, teachers, nurses, doctors, pharmacists, reporters, and everyone else gets good information about vaccines.
There is plenty of evidence that the standard immunization schedule is safe and effective.
What about the alternative vaccine schedules that some folks push?
Is there any evidence that is safe to delay or skip any of your child’s vaccines?
Alternative Vaccine Schedules
Many people think of Dr. Bob Sears when they think of alternative vaccine schedules.
He created both:
Dr Bob’s Selective Vaccine Schedule
Dr Bob’s Alternative Vaccine Schedule
He didn’t invent the idea of the alternative vaccine schedule though.
Well before Dr. Bob appeared on the scene, Dr. Jay Gordon had been on Good Morning America with Cindy Crawford to discuss vaccines and how she had decided to delay vaccinating her baby.
Where did she get the idea?
After the segment, Dr. Jay stated:
“They edited the segment to make me sound like a vaccination proponent. We also have to understand the impact of a person as well-known as Cindy Crawford delaying vaccines for over six months.”
Dr. Jay has long talked about only giving infants one vaccine at a time and waiting until they are “developmentally solid” before vaccinating.
Similarly, other folks have pushed ideas about delaying and skipping vaccines before Dr. Bob, including:
Donald Miller and his User-Friendly Vaccination Schedule – no vaccines until age two years and no live vaccines and when you begin vaccinating your child, give them one at a time, every six months (first published in 2004)
Stephanie Cave – starts at 4 months and delays many vaccines
homeopaths with immunization schedules that say to wait until six months and then start giving nosodes every five days
chiropractors with immunization plans that say to get regular chiropractic adjustments instead of vaccines
Of course, Dr. Bob is the one who popularized the idea of the alternative vaccine schedule in 2007, when he published The Vaccine Book: Making the Right Decision for Your Child.
That’s when parents started to bring copies of his schedule into their pediatrician’s office, requesting to follow Dr. Bob’s schedule instead of the standard immunization schedule from the CDC.
What’s the Evidence for Alternative Vaccine Schedules?
There is no evidence that following an alternative vaccine schedule is safe for your kids.
“No alternative vaccine schedules have been evaluated and found to provide better safety or efficacy than the recommended schedule, supported by the Advisory Committee on Immunization Practices of the CDC and the Committee on Infectious Diseases of the AAP (the committee that produces the Red Book).
Pediatricians who routinely recommend limiting the numbers of vaccines administered at a single visit such that vaccines are administered late are providing care that deviates from the standard evidence-based schedule recommended by these bodies.”
American Academy of Pediatrics
What’s the first clue that these so-called alternative vaccine schedules have absolutely no evidence behind them?
They are all different!
Paul Thomas, for example, doesn’t even offer his patients the rotavirus vaccine. Dr. Bob, on the other hand, has it on his list of vaccines that “that could protect a baby from a very potentially life-threatening or very common serious illness” and is sure to give it at 2, 4, and 6 months.
How slow should you go?
Both Dr. Bob and Dr. Paul give two vaccines at a time with their schedules, but Dr. Jay and Dr. Miller say to give just one at a time.
“Would any scientist give SIX vaccines at once to a baby? Asking for trouble. One at a time makes so much more sense.”
And while some start their schedules at 2 or 4 months, others delay until 6 months or 2 years.
There is also the fact that the folks who create these schedules admit that there is no evidence for what they are doing…
“No one’s ever researched to see what happens if you delay vaccines. And do babies handle vaccines better when they’re older? This is really just a typical fear that parents have when their babies are young and small and more vulnerable. Since I don’t know one way or the other, I’m just happy to work with these parents, understand their fears and their worries, and agree to vaccinate them in a way that they feel is safer for their baby.”
Unvaccinated kids aren’t healthier – they just get more vaccine preventable diseases. Most of which are life-threatening, even in this age of modern medicine, with access to good nutrition and sanitation.
So whether you only get one or two vaccines at a time; delay until four months, six months, or two years before you get started; skip all live vaccines or just wait until your child is “developmentally solid” to give them; or go with some other non-standard, parent-selected, delayed protection vaccine schedule, the only things that you can be sure of is that there is no evidence to support your decision and that you will leave your kids unprotected and at risk for getting a vaccine-preventable disease.
“…when I give your six-week-old seven different vaccines with two dozen antigens, I am supposed to try to convince you that the adverse reactions you have heard about are just coincidences.”
Better yet though. Find a pediatrician who will listen and answer your questions about vaccines, concerns about vaccine myths and misinformation, explain that no vaccine is optional, and not just simply pander to your fears.
What to Know About the Evidence for Alternative Vaccine Schedules
There is no evidence that skipping or delaying any vaccines with an alternative vaccine schedules can keep your kids safe from vaccine preventable diseases.
More on the Evidence for Alternative Vaccine Schedules
For any study, you have to review and judge the quality of the evidence it provides.
Is it a case report (a glorified anecdote), case series, or animal study (lowest quality evidence)?
Or a systemic review or meta-analyses (highest quality evidence)?
“The first and earliest principle of evidence-based medicine indicated that a hierarchy of evidence exists. Not all evidence is the same. This principle became well known in the early 1990s as practising physicians learnt basic clinical epidemiology skills and started to appraise and apply evidence to their practice. Since evidence was described as a hierarchy, a compelling rationale for a pyramid was made.”
Murad et al. on the New Evidence Pyramid
What about case control studies, cohort studies, and randomized controlled trials?
They lie somewhere in between on the hierarchy of evidence scale or pyramid.
And there are other factors to consider when judging the reliability of a study.
“Ultimately, the interpretation of the medical literature requires not only the understanding of the strengths and limitations of different study designs but also an appreciation for the circumstances in which the traditional hierarchy does not apply and integration of complementary information derived from various study designs is needed.”
Ho et al. on Evaluating the Evidence
For example, you might also have to take into account the sample size of the study.
A study can be underpowered if it doesn’t have enough subjects. Unfortunately, even an underpowered study will give you results. They likely won’t be statistically significant results, but folks don’t always realize that.
Even a meta-analysis, usually considered to be at the top of the hierarchy of evidence pyramid, can have problems that make their results less useful, such as not using appropriate inclusion criteria when selecting studies and leaving out important studies.
All in all, there are many factors to look at when reading a medical paper and considering if the results are valid and should influence what you do and how you think. This is especially true when looking at low quality vaccine papers, many of which the anti-vaccine movement uses to scare people, even though they are often poorly designed, and several of which have been retracted.
What to Know About the Hierarchy of Evidence
Learning about the hierarchy of evidence can help you better evaluate medical studies and vaccine papers and understand that there is more to doing your research about vaccines than searching PubMed and reading abstracts.