Tag: evidence

Making the Right Choice About Vaccines

Most parents vaccinate their kids.

For them, it is an easy choice. They know that vaccines work, that vaccines are safe, and that vaccines are necessary.

Making the Right Choice About Vaccines

Some folks aren’t so sure though. They may either be against vaccines or might still be on the fence, not knowing for sure what to do.

“When my third child was born, I had more questions than answers and a huge reluctance to choose immunizations without certainty that the benefits outweigh the risks.”

Suzanne Walther on A Parent’s Decision on Immunization: Making the Right Choice

Mark Zuckerberg posted a photo when he took his daughter to their pediatrician for vaccines.
Mark Zuckerberg posted a photo when he took his daughter to their pediatrician for her vaccines.

Parents can be confident that all of the evidence points to the facts that:

  1. Vaccines are effective at preventing disease. Vaccines work.
  2. Our kids do not get too many vaccines and do not get them at too early an age. The current immunization schedule helps protect young children from life-threatening diseases. Vaccines are necessary.
  3. Vaccines are safe and are extensively tested before they are approved.
  4. After they are approved, there are ongoing clinical trials and safety systems in place to rule out the possibility that vaccines could cause diseases later in life.
  5. Claims of adverse reactions are well investigated and easily disproved. Vaccines are not associated with SIDS, ADHD, eczema, autism, peanut allergies, or any other so-called vaccine induced diseases.
  6. There are plenty of places to go to get truthful, clear answers to questions about vaccines.
  7. Everything you hear that scares you about vaccines is likely not true, especially things about toxins, shedding, herd immunity, and package inserts, etc.

With all of the anti-vaccine information that is regularly posted on Facebook and anti-vaccine books listed on Amazon, it is no surprise that some parents would be scared though.

“I have discovered along the way that it is easy for parents to be misinformed. It is a real challenge to be well informed.”

Suzanne Walther on A Parent’s Decision on Immunization: Making the Right Choice

Make the effort to be well informed about vaccines.

More on Making the Right Choice About Vaccines

Do Anti-Vaccine Parents Ever Change Their Minds?

Most anti-vaccine folks think that nothing could ever change their minds and get them to vaccinate and protect their kids ever again.

Even if they don’t believe any of the current evidence that vaccines are safe and necessary, what if we showed them some new evidence?

Nope.

They have ‘woken up’ and won’t be convinced.

Do Anti-Vaccine Parents Ever Change Their Minds?

Of course, folks change their minds all of the time.

They learn to see past the myths and propaganda of the anti-vaccine movement and they eventually get their kids vaccinated.

A megachurch in Texas that was the site of a large measles outbreak quickly hosted free vaccination clinics.
A megachurch in Texas that was the site of a large measles outbreak quickly hosted free vaccination clinics.

Unfortunately, it sometimes takes an outbreak to get them motivated to do so, or their child actually catching a vaccine-preventable disease.

Remember the Disneyland measles outbreaks in California?

“I’ve given more measles, mumps, rubella vaccines in the past 10 days than I gave in the entire 12 months previously.”

Dr. Jay Gordon on Demand for Measles Vaccine Sends Crowds Even to Anti-Vax Docs

Other times, it is a good pediatrician who doesn’t pander to their fears, and instead, answers their questions about vaccines and helps them understand the risks (very small) and benefits (very big) of getting vaccinated and protected.

Or they might have a friend, family member, or other immunization advocate that helps them be more skeptical of the information and advice that is scaring them away from vaccines.

Remember. The great majority of parents vaccinate their kids. And those that don’t, do often change their minds.

More on When Anti-Vaxxers Change Their Minds

How To Counter Vaccine Hesitancy

There is nothing wrong with having questions about vaccines. And there is certainly nothing wrong with doing a little, or even a lot of research about vaccines.

“We are not against vaccines. Just because we have hesitancies and valid concerns about injecting our baby with specific chemicals and toxins does not mean we are anti anything…

As a soon-to-be-parent [and especially as a first-time-mom] I do feel it my responsibility to have questions, and to listen to my motherly instinct to question things, and do my research.”

Kat Von D

The problem comes when the answers folks get come from misinformation, and it leads them to skip or delay their child’s vaccines, leaving them unprotected.

What is Vaccine Hesitancy?

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?

Not exactly.

“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.”

Kat Von D

You learn to answer all of the questions and concerns that these parents might have about vaccines and vaccine-preventable diseases, including the risks and benefits of vaccines and the risks of being unvaccinated.

“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.

And you call out the misinformation and out-right lies of the anti-vaccine movement, especially when they say that vaccines never work, are always dangerous and full of toxins, or aren’t necessary.

You don’t let parents get manipulated by the anti-vaccine industry, which has gotten very good at selling fear – literally.

Like the card trick in My Cousin Vinny, anti-vaccine talking points are easy to explain because they are all an illusion.
Like the card trick in My Cousin Vinny, anti-vaccine talking points are easy to explain away, because they are all an illusion.

Remember, there is not one anti-vaccine argument or talking point that ever holds water.

Why not?

Because unless you go cherry picking, the evidence overwhelmingly shows that vaccines work, vaccines are safe, and vaccines are necessary.

What to Know About Countering Vaccine Hesitancy

If you are on the fence or scared to vaccinate your kids, let us help you learn why vaccines are safe and necessary and arguments against vaccines never hold water.

More on Countering Vaccine Hesitancy

What Is the Evidence for Alternative Vaccine Schedules?

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.

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

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.”

Jay Gordon

Dr. Jay has long talked about only giving infants one vaccine at a time and waiting until they are “developmentally solid” before vaccinating.

1983 historical immunization schedule
When Bob Sears came out with his vaccine book, Jenny McCarthy was also pushing the too many too soon myth and rallying folks to go back to the 1983 schedule that left kids at risk for meningitis, pneumonia, blood infections, severe dehydration, epiglottitis, and cancer from Hib, pneumococcal disease, rotavirus, hepatitis B, hepatitis A, chicken pox, HPV, and meningococcal disease.

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
  • Paul Thomas‘ vaccine friendly plan
  • Jenny McCarthy and Generation Rescue’s Turn Back the Clock immunization plan which recommends substituting the latest schedule with the 1983 immunization schedule or a schedule from another country, like Denmark, Sweden, Finland, or Iceland.

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.”

Jay Gordon

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.”

Bob Sears on The Vaccine War

But there has been research on delaying vaccines.

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.”

Jay Gordon

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

Hierarchy of Evidence and Vaccine Papers

Evidence is evidence, right?

Nope.

There is a hierarchy of evidence, from weakest to strongest, that help folks make decisions about science and medicine.

That’s why you can’t just search Google or PubMed, read abstracts, and say that you have done your research.

Hierarchy of Evidence

For any study, you have to review and judge the quality of the evidence it provides.

A meta-analysis with over 1.2 million kids found that vaccines were not associated with autism, while Wakefield's retracted case series included only 12 children.
A meta-analysis with over 1.2 million kids found that vaccines were not associated with autism, while Wakefield’s retracted case series included only 12 children.

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.

More on the Hierarchy of Evidence

 

Can Vaccines Cause Multiple Sclerosis?

Multiple Sclerosis is thought to be an autoimmune disease, with symptoms typically starting when you are between 20 to 40 years old.

“MS symptoms are variable and unpredictable. No two people have exactly the same symptoms, and each person’s symptoms can change or fluctuate over time. One person might experience only one or two of the possible symptoms while another person experiences many more.”

National Multiple Sclerosis Society on MS Symptoms

From fatigue, weakness, and problems walking to vision problems, including the onset of blurred vision, MS can have many different symptoms.

What Causes Multiple Sclerosis?

Some people may be surprised that doctors have known about Multiple Sclerosis since the 1870s. They recognized people with the symptoms of MS even earlier.

Unfortunately, we still don’t know what causes it.

Can Vaccines Cause Multiple Sclerosis?

Without a known cause, it is easy to understand why some folks blame vaccines.

How many infants got hepatitis B in France because of low levels of vaccination after they blamed the vaccine for causing MS?
How many infants got hepatitis B in France because of low levels of vaccination after they blamed the vaccine for causing MS?

We see the same thing with many other conditions.

Remember though, just because you don’t know what causes something doesn’t mean that you can’t eliminate things that don’t cause it.

“Concern about hepatitis B vaccination arose from France in the mid 1990s. Following a mass hepatitis B vaccination program in France there were reports of MS developing in some patients a few weeks after receiving the vaccine. In 1998, the French government stopped the school-based hepatitis B component of the vaccination program while they investigated a possible relationship between hepatitis B vaccine and demyelinating disease. When studies of the French vaccine recipients were completed they showed that there was not a significant increase in the number of vaccinated people who developed MS as compared with those who had never received hepatitis B vaccine.”

Hepatitis B and multiple sclerosis FactSheet

And more than a few studies have shown that vaccines do not cause Multiple Sclerosis.

From the hepatitis B vaccine to the HPV vaccines, it has been shown that vaccines do not cause Multiple Sclerosis.

It has also been shown that vaccines don’t increase the risk of relapses for people who already have MS.

“…vaccines are able to prevent some infections in MS patients known to accelerate the progression of the disease and increase the risk of relapses.”

Mailand et al on Vaccines and multiple sclerosis: a systemic review

And yes, since new infections may trigger MS relapses, vaccines have an added benefit for MS patients.

And that’s why it is recommended that patients with MS follow the standard Centers for Disease Control immunization schedule. They may need to avoid getting live vaccines while taking specific MS medications though, as some of these can suppress their immune system.

“In the last few years a number of MS-focused vaccines have shown promising results in early phase clinical trials, and with each success the technology is closer than ever to offering a viable treatment option.”

Dr. Karen Lee on MS vaccines: Thinking outside the box for new treatments

While everyone hopefully now understands that any talk about MS being associated with vaccines is just another myth or scare tactic of the anti-vaccine movement, vaccines may one day really be associated with MS – therapeutic vaccines are in development that can treat people with Multiple Sclerosis!

What to Know About Vaccines and Multiple Sclerosis

Although it is still not known what does cause Multiple Sclerosis, we do know that it is not vaccines, which may actually reduce the risk of relapses for folks who already have MS.

More on Vaccines and Multiple Sclerosis

Anecdotes as Evidence

Evidence is evidence, right?

Not really.

There is a hierarchy of evidence, from weakest to strongest, that help folks make decisions about science and medicine.

In an age when everything is evidence of something, remember that anecdotes are not scientific evidence.

That’s why you can’t just search PubMed, read abstracts, and say that you have done your research. 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)?

What about case control studies, cohort studies, and randomized controlled trials? They lie somewhere in between on the hierarchy of evidence scale.

Anecdotes as Evidence

And where do anecdotes fit in?

“Anecdotes are uncontrolled subjective observations. I have often criticized reliance on anecdotes, which is especially problematic in medicine. The problem with anecdotes is that they are subject to a host of biases, such as confirmation bias. They are easily cherry picked, even unintentionally, and therefore can be used to support just about any position. For every anecdote, there is an equal and opposite anecdote.”

Steven Novella on The Context of Anecdotes and Anomalies

Anecdotes are not scientific evidence.

Unfortunately, some people use anecdotal evidence to make some very serious decisions, including skipping or delaying their children’s vaccines, leaving them unvaccinated and unprotected.

“An anecdote is a story – in the context of medicine it often relates to an individual’s experience with their disease or symptoms and their efforts to treat it. People generally find anecdotes highly compelling, while scientists are deeply suspicious of anecdotes. We are fond of saying that the plural of anecdote is anecdotes, not data.”

Steven Novella on The Role of Anecdotes in Science-Based Medicine

Believing that anecdotes are important scientific evidence is also what often drives some pediatricians to pander to fears that parents may have about vaccines, helping them create non-standard, parent-selected, delayed protection vaccine schedules.

What else do you need to know about anecdotal evidence?

Anecdotes are basically the fuel of the anti-vaccine movement.

“With little or no evidence-based information to back up claims of vaccine danger, anti-vaccine activists have relied on the power of storytelling to infect an entire generation of parents with fear of and doubt about vaccines. These parent accounts of perceived vaccine injury, coupled with Andrew Wakefield’s fraudulent research study linking the MMR vaccine to autism, created a substantial amount of vaccine hesitancy in new parents, which manifests in both vaccine refusal and the adoption of delayed vaccine schedules.”

Shelby et al on Story and science

Well, anecdotes and fear – often combined in vaccine scare videos.

If you have been making your vaccine decisions based on anecdotes, it is time to do a little more research and get better educated about vaccines.

What to Know About Anecdotes as Evidence

Anecdotes, although they are easy to believe, are not scientific evidence, and certainly shouldn’t persuade you that vaccines aren’t safe, that vaccines aren’t necessary, or that vaccines are associated with autism.

More on Anecdotes as Evidence