An Apple A Day

Long-time readers of this newsletter are aware of my skepticism regarding the flu vaccine. At the same time, headlines shouting about the looming flutastrophe can’t fail to grab my attention.

The other day I walked past one of the televisions at my gym, and a graphic about hospitals turning away flu victims caught my eye. How horrible! Oh, wait. The routine emergency room advice in flu season is to “stay away”, because 1) most likely there is nothing an emergency room doc can do for you, 2) the flu is almost certainly not a medical emergency but 3) you WILL pass the illness along to other people waiting in the hospital. Some of them are barely clinging to life and so, please, just leave before your unpleasant illness leads to someone else’s death.

It is strange that my viewpoint seems so out of sync. After all, the scientific evidence is that influenza vaccine does not do the job. In the past 10 years the flu vaccination rate in the US has doubled, but the death rate is unchanged. All evidence points to the fact that those who are most likely to die from the flu, the elderly and infants, are the least likely to be helped by flu vaccination. There is limited evidence that the vaccine is of significant benefit in any way.

Furthermore, there have been a series of controversies and governmental hearings in Europe and the US about medical organizations acting as advertising agents of companies producing influenza-related vaccines and drugs, abdicating their ethical responsibilities.

ONE possible explanation for vaccine ineffectiveness arises from the nature of the ever-mutating flu virus. Each year a panel of experts determine which specific forms of flu virus are likely to be the cause of the coming year’s epidemic. Then manufacturers produce that year’s vaccine against those strains. They have not been able to be particularly accurate, probably then compromising the vaccine.

This year the CDC claims that the vaccine is spot on. That makes me unusually receptive to the possibility that this year’s vaccine might be effective. HOWEVER, such predictions have been wrong many times in the past. Furthermore, the CDC is not the independent body it should be. The Influenza Division at the CDC receives funding from the companies that make flu vaccines and antiflu drugs. Just as with the antiflu drugs, the CDC Influenza Division has ignored the determinations of truly independent experts, like the Cochrane Collaboration, when those determinations have been unfavorable to influenza vaccine. I have difficulty blindly trusting their pronouncements at this point.

Another example comes from the Center for Infectious Disease Policy and Research at the University of Minnesota, http://www.cidrap.umn.edu/cidrap/files/80/ccivi%20report.pdf

In the preface to the 150 page report, the leader of the group (former head of the Minnesota Department of Public health) Michael Osterholm included a pertinent quote -

“The greatest obstacle to discovering the shape of the earth, the continents, and the oceans was not ignorance but the illusion of knowledge.”

–Daniel Boorstin

The CIDPR report noted that the ineffectiveness of the present vaccine should lead us to look for a better vaccine or some better approach. In an interview with the New York Times, Osterholm commented, “I’m an insider. Until we started this project, I was one of the people out there heavily promoting influenza vaccine use. It was only with this study that I looked and said, ‘What are we doing?’ ”

That is an excellent question and reassurance that my own judgment is sound. Go ahead and get the vaccine if you wish. This year the vaccine might actually work, but that would be something new. Just make certain that you take a healthy dose of skepticism along with the vaccine.

As you are probably aware, and I have written about previously, the US is in the midst of a whooping cough epidemic. With a “business-as-usual” bias, a number of agencies, individuals within the medical community and representatives of major media outlets have blamed “ignorant and irresponsible” parents choosing not to vaccinate their children as the cause of this outbreak. That criticism is unfair, because, as many studies show, parents who choose to limit the vaccinations their children receive are better educated than other parents. Calling these parents ignorant shows that these commentators are themselves uninformed. It goes further than that, though. As I so often find myself writing, opinion is shifting and those “authorities” are beginning to see their own ignorance, or at least redirecting their blame cannons.

In the past week compelling new data have been published, supporting the contentions of many (including me), that the vaccine is not doing its job. One expert speculated that as many as 95% of those currently developing whooping cough got the disease because their vaccine-created immunity waned. Some are then suggesting a return to the old vaccine, forgetting all of the serious reactions it created and data showing that it was not that effective.

But, hold on. 95% of cases? Nowhere in the US are 95% of children vaccinated for whooping cough. Statistically, that would mean that children receiving the whooping cough vaccine would be MORE likely to get the disease than unvaccinated children. Sounds odd, but that very thing happened with the first version of the HIB meningitis vaccine. I have a lot of patients who are not vaccinated for pertussis. Although I have seen many patients with whooping cough over the years, I have yet to see one during this epidemic. Also, an anonymous public health official, working in an area where a very high percentage of children are not vaccinated for whooping cough, told me that every case of whooping cough she had seen in this current outbreak occurred in a vaccinated child.

Who is ignorant?

The widely disseminated comments of many organizations and authorities would lead one to believe that any possible linkage between vaccination and autism has been entirely disproven. That is not so. The theory that there might be a connection is biologically plausible. One of the most consistent biological abnormalities among children with autism is their limited ability to detoxify heavy metals. It would be a real possibility then that repeated doses of a heavy metal like the mercury preservative, which had been used in nearly all vaccines, would lead to autism in some individuals. However, a theoretical possibility means just a hair more than nothing. A newly published study supports the view that there may well be a connection between vaccinations and autism.

The authors of this study analyzed nationwide data to investigate the connection between total vaccination exposure, autism and speech or language impairment (SLI). Other studies have typically looked for associations between autism and some specific immunization. When the intent of an investigation is to test the theory that some component, present in many vaccines, might be an autism-causing factor, the design of this study, utilizing the sum of vaccination exposure, makes much more sense.

These researchers took into account the potential confusion created by the timing of vaccine and diagnosis of autism or SLI. Autism begins before age 2 but is typically diagnosed years later. If vaccinations were causative, those first two years are when the child would have received them. So, these researchers used total vaccination exposures up to two years of age. Accounting for the delay in diagnosis, they used the rates of autism and SLI at age 8 for their analysis. Because the effect would become evident in individuals 6 years after their exposure, researchers compared rates of vaccinations in 1999 with autism/SLI rates 6 years later (2005). They then analyzed these data, controlling for known and suspected autism risk factors. They also performed statistical tests for potentially confounding health conditions and access to medical care (which might lead to higher rates of diagnosis), finding that these factors did not influence the rates of autism and SLI.

These researchers identified what we call a linear dose-response. For every 1% increase in vaccination rates there was a 1.7% increase in the number of children having either autism or speech/language impairment. This study does not prove that childhood vaccinations cause autism. It does prove that the issue is unresolved and that caution about all vaccinations is warranted.

Thimerosol, the standard mercury preservative formerly used in childhood immunizations, is the preservative in flu shots. As the institutional authorities of conventional medicine push childhood vaccination for flu, despite little research support of effectiveness, these findings suggest that we might be perpetuating a problem. Dropping thimerosol from vaccines was an excellent idea. Why would it be okay to give it to our children in a different shot?

Immunizations have been all over the news lately, even entering the political debates. A couple of the discoveries have confirmed clinical impressions, including some I shared with you before.

As I mentioned in an earlier newsletter, the current whooping cough (pertusis) epidemic has been remarkable to me because, while I have had patients with whooping cough almost every year for the last 25 years, I have not had a single patient with whopping cough during what is supposedly a revolutionary epidemic. Why is that?

Data now show that at least 80% of the children developing whooping cough in the current epidemic have been immunized as officially recommended. A brand new study of this outbreak, conducted in Marin, found that immunity is lasting only 3 years after completing the full 5 shot DTaP immunization series. Older, previously vaccinated children are now the most vulnerable to the disease. One public health response has been a call to vaccinate an even higher percentage of the population, because those who are not vaccinated must be spreading the disease, overwhelming the vaccination.

I would think that the correct conclusion would instead be to reconsider the relationship between the vaccine and the disease. Maybe the disease is evolving to outrun the vaccine? Might there even be MORE vulnerability to whooping cough among those immunized, at least after a few years, than the rest of us? Clearly the vaccine, even five shots worth, is not doing the job.

I have never been a fan of the chicken pox vaccine, and research data makes me feel like even harsher criticism is deserved. Research now indicates that immunity from the vaccine disappears after only 5 -7 years. That is a triple “ouch”, the first for the shot, the second because the shot did not protect for very long, and you can read the third in the next paragraph.

Adding to the uncertainty, there are data indicating that lowering the rate of chicken pox has increased the rate of shingles suffered by adults. Projections are that as high as many as 50% of adults will develop shingles because their immune systems will not be not “reminded” about the virus, due to lack of virus exposures in daily life. Formerly the incidence was believed to be under 5%.

Of course, most of us would choose to risk our health in favor of our children’s health. However the small to moderate risk of serious problems with each could make this rationale debatable. Chicken pox is usually a mild illness, and many times parents of children who have gotten chicken pox have expressed their surprise to me, as what they had read of the disease had made them quite afraid. That said, as many as 5,000 children a year were hospitalized in the USA with complications before the vaccine became available. Then again, in the same time period, we averaged 100,000 pediatric hospitalizations annually for diarrhea. Postherpetic neuralgia, a complication which occurs in about 13% of shingles cases, typically causes pain for months and sometimes years. Unfortunately, at this point I think there is more justification for shingles vaccine in our aging population as a consequence of vaccinating children.

It seems to me that, even without questioning immunizations for other reasons, there is rising cause for skepticism and critical reappraisal. The bottom line is that these immunizations are, at best. not as advertised. They are not working very well and it is unwarranted to simply blame those who choose to limit vaccinations for failure of the vaccinations. Many physicians were surprised by a recent study which found that almost 3/4 of parents had concerns about immunizations. I am surprised also, but by the minority who did not have questions.