8/08/2005

Immunizations

I promise I'm not trying to hog the blog. Heather is on an extended trip out of state with inconsistestent internet access, and the Wiz is on a little get-away.
Recently I've had several conversations and seen a couple of news pieces about childhood immunizations and the controversy that surrounds them. I believe the MMR shot is the one that is specifically alleged to be linked to autism.

I have had all my children immunized thus far, but all this talk does make me nervous. My pediatrician insists that there is no proof at all that immunizations cause autism. (It would be nice if they had proof it didn't cause autism.) He said that children with autism begin manifesting their autism around the age they get the MMR shot (which is 1 yr. isn't it?) and therefore parents automatically link it to the shot.

The uproar in the news I've seen little tidbits of is about the fact that they use Mercury as a preservative in immunizations which they feel could be the culprit to causing autism.

Obviously, my knowledge is extremely limited, so please enlighten me. Do any of you have any experience or educated views on this topic?

46 Comments:

Anonymous Sara R said...

I thought they phased out mercury in vaccines a year or two ago. I think the exception was some flu shot vaccines. But please correct me if I'm wrong.

If you have haven't read any pro vaccine articles that counters the information given by the anti's, here's a site for you. http://www.highschoolscience.com/vaccines.htm

8/08/2005 11:17:00 AM  
Blogger Julie M. Smith said...

I find this a terribly difficult issue. The antis makes arguments that look good, but I don't think most doctors or researchers are interested in harming their patients! And not having a science background, I feel in no position to really weigh the arguments, but I have to, because we have to make a decision.

(I also have a brother who had meningitis, and a friend whose child died from it. That affects one's viewpoint.)

But--by the time my oldest was three, he had been given three (and almost a fourth) immunization that was later discontinued because they found a safer way to do it. Now I'm clear on the concept that science advances and we do the best we can with the knowlwedge we have, but those kind of changes over a short period suggest to me that someone might be jumping the gun on their recomendations.

My main concern is that the number of vaccines currently given is huge. And they are given early, during a time of lots and lots of development, esp. neural. The somewhat unhappy compromise that we have reached is to delay vaccines for a few years for those things things that the child is NOT likely to get, such as Hepatitis.

8/08/2005 12:20:00 PM  
Blogger Keryn said...

Oddly enough, I've been reading a lot about this. There are many interesting ideas out there, but as a scientist, my favorite is the blog of a cancer doctor. He isn't a shill for big medicine, he knows the science, and he has a great writing style. Hopefully you will find his information as helpful as I have.
http://oracknows.blogspot.com/2005/06/saloncom-flushes-its-credibility-down.html

8/08/2005 12:29:00 PM  
Anonymous JLS said...

This really is a dicey issue. I get a little nervous around immunization time--outside or rare circumstances, I'm sure immunizations are safe; but I can't help thinking about the possiblities that something could go wrong.

Regarding mercury, I'm not sure if it's phased out yet. As I understand it, the mercury used for immunizations is not biologcially usable or is of such a low conentration that it has no side effects (or both).

Recently, biologically available mercury has been linked to tuna. Tuna contains appreciable amounts of mercury (from natural sources and pollution). The EPA has suggested limits on it's consumption, especially for pregnant women and children.

8/08/2005 01:13:00 PM  
Anonymous Anonymous said...

FYI, according to my aunt who is a RNP, Thimerosol (mercury preservative) is the chemical that was used in immunizations. It is NO LONGER used in childrens vaccines. It is, however, still used in flu-vaccines. There was also recently published a new study on the autism/vaccine controversy, by some doctors in England. I dont have the URL, but you can google it.
I have had all my children immunized, but I have waited until they are older. I dont have the MMR until they are 2, and I have it given alone. It's a good compromise for us. When I was contemplating to immunize or not, my above mentioned aunt invited me to the NICU at her hospital to see the babies with whooping cough. I decide pretty quickly to get the vaccine. It is a very personal decision.

8/08/2005 01:30:00 PM  
Blogger William Morris said...

This Slate article is also very useful.

It argures:

Correlation doesn't equal causation.

The correlation isn't actually all that strong (see the article) -- but basically the figures behind the scare studies misread much of the data and are not scientists.

There are much stronger factors to point to the explosion in reported cases of autism -- namely public awareness of it and funds to treat it.

The type of mercury used as a preservative -- thimersol -- is not the same as the type that is known to cause problems (what anon says above).

Finally, vaccination has vastly improved the health and viabillity of children across the world.

8/08/2005 01:46:00 PM  
Anonymous claire said...

Count me in as one who also delayed vaccinations, some until school age (varicella, hepatitis). We did the MMR starting at about 2 as well. Breastfed babies have more protection from diseases you've had than artificially fed babies, and also have better immune responses to the vaccines they have. One of the other 'benefits' of delayed vaccination is that you end up needing fewer doses of some of them. The drawback is your kids remember getting the shots and worry about going to the doctor....

8/08/2005 02:10:00 PM  
Blogger Kim Siever said...

FWIW, I just want to point out that it is a little presumptuous to refer to vaccinations as immunisations since they do not guarantee the receiver is immune.

I should also point out that there are some who think the MMR vaccine can be responsible for the early onset of arthritis. I tend to think there is something to it since I started having arthritic symptoms when I was 20, a year after I received my pre-mission MMR shot.

Some people sacrificed jobs, scholarships or marriage for their missions. I sacrificed my health. :)

8/08/2005 02:51:00 PM  
Anonymous Anonymous said...

This comment has been removed by a blog administrator.

8/08/2005 03:55:00 PM  
Blogger Jen said...

I am not a scientist, but I have a 2 1/2 year old recently diagnosed with mild autism. I've done a lot of reading on the subject ..... mostly because I have an 8 month old son as well and I don't want to subject him to this horrible illness unnecessarily. Personally, I don't believe there is a strong link.

Most kids show some signs of autism in their first year, even if they are diagnosed with the regressive type (which is what most of the diagnoses have been as of late). My son falls into this category. Personally, I believe that there is a strong genetic predisposition to the illness, but some other environmental trigger is causing the epidemic.

Anyways, my younger son is getting his immunizations, but we only do one at a time and NEVER if he has as much as sneezed on the day of his doctors appointment. That is my compromise....along with a REALLY long prayer before we go.

8/08/2005 04:02:00 PM  
Anonymous JKS said...

Jen,
I have a 5 year old with a speech disorder and probably auditory processing disorder. I don't know your son's symptoms, but it is very difficult to accurately diagnose delays and disorders in children that young. I've done lots of research since it was obvious the school district thought he was autistic spectrum at his age 3 testing. I hope you are getting good support and good advice. I'm always available and I have tons of advice--from EFAs to Hanan Language info, etc.
Is your son talking at all?

I've read about autism and vaccinations. There are many scientists who have studied the issue and say that there is no evidence about a link but the people who believe in it won't give up. It is hard to have a child with a disability and it is natural to search for a cause. That is why the issue won't die down.
Of course vaccinations keep getting better and "safer." The polio vaccine used to be live, now it is not. Any parent can tell you that science changes really fast, in between kids. While it is a little alarming to know that my older child got the less safe vaccine and my younger ones got the safer kind, I am used to the improvements and I am HAPPY that scientists are always looking for new and better ways to protect kids.

8/08/2005 04:20:00 PM  
Blogger Andrea Wright said...

Wow, thank you all so much for your excellent comments as well as links to other resources.

I'm confused though, if there is no more thimersol used in vaccines, why all the controversy now?

Jen, another lady I know of who has an autistic son said almost exactly what you've said. She believes there's a definite genetic predisposition. Thank you so much for your insight. Do you mind me asking what treatments are available for your son? Also, what symptoms would a child with a mild case of autism exhibit?

8/08/2005 04:26:00 PM  
Anonymous J. Stapley said...

Well, I am a scientist, and the anti-vaccination camp is much less reliable than the anti-mormon camp. Distortions? Yep. Scare tacticts? Yep. But at least the anti-mormons are often starting with challenging material and not simple crap-science.

8/08/2005 05:18:00 PM  
Blogger Jen said...

jks -

I feel fairly confident that he is in the autism spectrum (although at the very low end...thank goodness!). We received our diagnosis from a reputable developmental neurologist. However, I would be very interested in anything you had to say and any research you would be willing to share. My son has only a couple of words. He had around 20 words at 18 months and has lost all of his words and gestures. My email is jrazz22@aol.com.

Andrea -

There are a lot of excellent behavioral therapies, the most popular and proven is ABA. It is basically extremely structured learning (one-on-one at a table) with a lot of positive reinforcement. The idea is to "rewire" the brain at a young age to learn or relearn basic skills such as language and imitation.

There are also less proven treatments like special gluton-free diets, etc. that work for some and not for others.

The frustration is that it's extremely difficult to find experienced people to do the therapies. We have had 3 ABA instructors quit on us in 3 months. It is also extremely expensive. We live in NYC and are looking to move to the DC area largely in hopes of finding better services.

As far as symptoms, to be in the autistic spectrum, a child must have deficits in two areas - language and social interaction and also exhibit repetitive behaviors. Some symptoms include poor eye contact, lack of gestures, not playing with toys appropriately (if the child is old enough to know how) and, of course, delayed speech. There are lots of different varieties of autism, however, and no two kids have the same symptoms.

My son, for example, was very serious and very quiet as a baby and he enjoyed looking at things more than people. He would gaze at the ceiling fan in our apartment for hours. I didn't have enough experience with young kids to know this was unusual. As a 2 year old, he ignores kids his own age and prefers to play alone or with his parents. He is afraid of a lot noises like the blender and my hairdryer, so I go around with wet hair a lot! He can put together complex puzzles but if I give him a simple direction, he stares at me blankly. He used to line his toys up in long rows, but luckily he stopped doing that....

8/08/2005 05:20:00 PM  
Blogger Julie M. Smith said...

j. stapley--

You need to realize that your comments are not helpful.

Reread my experience about the 4 changes in recommended vaccines that occured in the space of three years and directly affected my son. That's why I feel hesitant about the current vaccine schedule. It has nothing to do with antis, but the apparent willingness of the CDC et al to make and then quickly change recommendations. This does not inspire confidence in them.

(For the curious, my son, born in 1998, had DTP--later changed to DTaP, oral polio--later eliminated, newborn Hep B--later delayed, and suggested Rotovirius (not given)--later eliminated). The 'anti' lit. that I had read--mostly Mothering Magazine and their recommended sources--disapproved of ALL of these vaccines for the same reasons that the CDC later changed them.

So, J. Stapley, not all of the anti stuff is bunk. Please recognize that this is an agonizing decision for parents, and use your science background to enlighten us, not mock our concerns.

8/08/2005 05:38:00 PM  
Anonymous JKS said...

Jen
I will email you.

8/08/2005 06:11:00 PM  
Blogger Keryn said...

Kim Siever,

I agree that "immunizations" may not be theh best word for the vaccination shots. My sister, for example, has been given the German measles shots at least three different times, and still has no antibodies. She has to be extra careful whenever she is pregnant.

And that's why it is so important to vaccinate everyone. So that people who can't be vaccinated (immune problems) or who don't develop antibodies will be protected by the "herd" immunity.

8/08/2005 06:27:00 PM  
Anonymous J. Stapley said...

Julie M. Smith (No longer Julie in Austin?), I appreciate your mild reproach. I tend to get a little frustrated with topics like this. I also appreciate your experience. I have two children and are aware of the controversies which you describe. In fact, we have participated in the new rotavirus vaccine trial that is designed to improve the current medical offering and save millions of children's lives.

The rotavirus vaccine is a great talking point. Here is a virus that really doesn't kill very many kids in the First World, but does kill millions throughout the world. Last I read, the scientific community doesn't know why it had the side effects that it did (intussusception).

I would recommend reading the link above. We have to ask ourselves, whether it is worth it to support vaccinations and save millions of lives in the world or rebel against something that has a low relative cost. Sadly, just about everything has a cost associated with it.

Rotavirus is also interesting in that the initial results were statistically insignificant. Further data revealed a slight but definitive correlation (20 to 30 x risk). The government took action.

The autism scare and other concerns like it are not based in such science. The autism scare was based on a study of 12 children with crappy analyses (which 10 of the 13 authors later retracted). "Anti's" typically don't mention that.

Interestingly in these instances, I argue against my typically individualistic libertarianism and vote for a utilitarian compliance. If no one complies, then many, many people die.

8/08/2005 10:38:00 PM  
Anonymous JKS said...

I agree with what J Stapley was trying to say.
The "evidence" is not there. The emotions and drama come from parents whose children have autism and the parents are looking for answers. The anti-vaccine people have given them what they want. So even though there is no real evidence, and current or subsequent studies show there is no causation, the issue keeps being tossed around.
Yes, there are some risks in vaccines. But they have eliminated greater risks.

8/08/2005 10:47:00 PM  
Anonymous claire said...

J. Stapley bring up an interesting point that has colored my perception o of the vaccination issue. Vaccines are important as a public health issue. We as parents are expected/asked/required in many cases to subject our individual child to potential risk in order to promote public health/contribute to 'herd immunity.' What does this say for about the 'pro' vaccination camp? Scare tactics are a big factor. If preventing illness in my individual child was the main point, why aren't doctors doing more to make sure that tiny babies are breastfed? I bet that would prevent more rotovirus hospitalizations that the vaccine did. Oh, wait, no money is made by people breastfeeding.....

8/09/2005 08:59:00 AM  
Blogger Julie M. Smith said...

J. Stapley,

On blogger, I'm Julie M. Smith. Everywhere else, I'm Julie in Austin.

You wrote, "we have participated in the new rotavirus vaccine trial that is designed to improve the current medical offering and save millions of children's lives."

Yeah, millions of lives *in Africa*. In the US, kids with diarreah drink Pedialyte and watch DVDs until they feel better. (Not that saving lives in Africa isn't a worthwhile goal, but a rotavirus vaccine in the US is not needed.)

I see that you addressed this to some extent in your further comments, but you really have to question why would we test the vaccine in the US and not in Africa. Would it make sense to try malaria cures in the US? I think not. To really know if the vaccine works in the population that needs it, you test it in the population that needs it. Can you provide me with reasons to think otherwise?

You are talking about rotavirus and autism. You aren't addressing my bigger issue which has nothing to do with either of these: Why did the CDC schedule 4 vaccines that had to be yanked in less than three years? Does this not suggest that they are a little too trigger happy (needle happy?)? One senses that they are going on the momentum of the immense success of past vaccines (such as polio and the tremendous good it did) and not perhaps evaluating them as carefully as they could, and not taking the combined effect of 26 doses (I think that is the recommended total now before age 4). Have you any response to this?

"We have to ask ourselves, whether it is worth it to support vaccinations and save millions of lives in the world or rebel against something that has a low relative cost."

What advantage did oral polio have that was worth the 'relatively low cost' of 1/2 dozen people per year getting polio in the 1980-1990's? What advantage did rotavirus have (Pedialyte costs about 3$!) that was worth the intestinal blockage that killed some children (if I recall correctly)?

My bigger issue than these specifics, though, is the larger issue of the CDCs apparent over-willingness to schedule vaccines that haven't been properly tested. I think people are also suspicious of the--what's the exact name?--adverse reaction fund that pays people who claim to have reactions but keeps it relatively quiet.

8/09/2005 11:39:00 AM  
Blogger annegb said...

My grandson was showing symptoms of autism when he was very young. The pediatrician advised stopping his immunizations and he got better. He's still got problems, but he started talking and communicating.

8/09/2005 11:43:00 AM  
Blogger Keryn said...

Claire,
You said, If preventing illness in my individual child was the main point, why aren't doctors doing more to make sure that tiny babies are breastfed?

I'm pretty sure you didn't mean it this way, but it sounds like you believe that doctors don't care about preventing illness in individual children. That idea smacks of conspiracies of drug companies and doctors and probably the government, too, everyone trying to make as manny children sick so that they can make money. I have a hard time believing that.

I bet that[breastfeeding] would prevent more rotovirus hospitalizations that the vaccine did. If, as J. Stapley said, rotovirus strikes and kills many children in Third World nations, wouldn't most of those children be nursing, anyway?

It's scary to think about my child being the one in 1,000,000 who might have a severe reaction to a vaccination. But it's also scary to take my child to see her grandparents, since we have to drive six hours on a busy interstate. There are risks in this world. I'd rather take the risks associated with vaccinations then the risks associated the pre-vaccination days.

8/09/2005 12:10:00 PM  
Blogger Julie M. Smith said...

"I'd rather take the risks associated with vaccinations then the risks associated the pre-vaccination days."

But that's not what the choice is. No one is offering you a ticket to 1850. The question is whether current vaccine practice could be made safer.

8/09/2005 12:37:00 PM  
Blogger Keryn said...

Julie,

I'm sorry, I think I have been reading too many anti-vax websites. You are right, no one here is proposing going back to the 1850s or even the 1950s.

I just get frustrated at people who are willing to forgo the risks of vaccination on the assumption that they or their children won't get sick because the rest of us don't forgo the risks.

8/09/2005 01:00:00 PM  
Anonymous J. Stapley said...

As a conversation with Julie:

Would it make sense to try malaria cures in the US?

Nope, because people in the US don't get malaria. However, plenty of kids get Rotavirus. My eldest did and was miserable. The bottom line is that it is very difficult to get good medical data in the third world, so vaccines will be the safest when tested in US/Canada/Europe.

Yeah, millions of lives *in Africa*. In the US, kids with diarreah drink Pedialyte and watch DVDs until they feel better.

and later:

What advantage did oral polio have that was worth the 'relatively low cost' of 1/2 dozen people per year getting polio in the 1980-1990's?

These go together. There is a huge possibility that there will be a polio outbreak in Africa. If there is, SARS will look like the common cold. I don't believe we can look at this isolationisticaly. If we quit immunizing before it is eradicated, then there is the possibility of a global epidemic.

As far as the CDC goes, I think they are going off of the data they have. The reality is that the risks are very small or the CDC wouldn't have pulled the trigger. That said, our tolerance for risk is very low and there was pressure to change because our tolerance has waned.

Are we willing to tolerate 1 in a millions deaths? What about one in one hundred thousand? As was mentioned, do we let our children ride in cars? typically yes, because we view the risk as "worth it". We tolerate the risk because of the value of convenience. Some don't. It seems that many don't view the value of immunizations, so the risk isn't tolerated.

8/09/2005 02:59:00 PM  
Blogger Julie M. Smith said...

J. Stapley-

You totally misread me. I didn't question the need for the polio vax, but for the ORAL polio vax. Which means you didn't answer my question.

"The bottom line is that it is very difficult to get good medical data in the third world, so vaccines will be the safest when tested in US/Canada/Europe."

As long as one is clear that rotavirus et al are basically medical experiments on one's children, I have no problem with it (but perhaps they should). But to present it as 'required' or 'for the child's benefit' is dishonest.

"As was mentioned, do we let our children ride in cars? typically yes, because we view the risk as "worth it"."

Again, apparently the risks of the oral polio, DTP, rotavirus, or newborn hep b WEREN'T justifiable.

8/09/2005 07:27:00 PM  
Anonymous JKS said...

"You totally misread me. I didn't question the need for the polio vax, but for the ORAL polio vax. Which means you didn't answer my question."

To answer your question, the need for the Oral polio vax before the newer better one was, if children weren't immunized someone could easily pick up the disease in another country (or someone from another country could bring it here) and very quickly it could be spread in an epidemic.
Polio is a very contagious disease. My mother was not allowed to have birthday parties growing up because her town had laws against large groups of children gathering together in the summer months in order to help reduce the spread of polio.
!!!

8/09/2005 07:57:00 PM  
Anonymous JKS said...

Some facts:

A 1916 polio epidemic in the United Stated killed 6,000 people and paralyzed 27,000 more. In the early 1950's there were more than 20,000 cases of polio each year. Polio vaccination was begun in 1955. By 1960 the number of cases had dropped to about 3,000, and by 1979 there were only about 10. The success of polio vaccination in the U.S. and other countries sparked a world-wide effort to eliminate polio.
Some children who get polio don’t feel ill at all. For others, polio simply feels like a cold, with symptoms appearing about 6-20 days after exposure. Sometimes these children will also feel some pain and stiffness in their neck, back, and legs, but this soon goes away.

However, some children who get polio become paralyzed — that is, they lose the use of their muscles. This is called paralytic polio. Paralytic polio can start like a common cold, but often with severe muscle pain. Paralysis usually comes within the first week. Most often it affects the child’s legs, but sometimes it affects other muscles including those that control breathing. Some children recover from their paralysis, but many will be permanently disabled. There is no treatment for polio, and some children die from it.
****************************
Polio is most contagious from about 7-10 days before symptoms appear till about 7-10 days afterward.
****************************
Most of us don’t remember how terrified parents were that polio would leave their children unable to walk or force them to spend the rest of their life in an iron lung. Since polio vaccine became available in 1955 the disease has disappeared from the U.S., and may soon be gone from the rest of the world as well. The number of cases of paralytic polio in the United States has fallen from more than 20,000 in 1952 to only a few cases a year today.

Polio Fact:
The “March of Dimes” began in 1938 as a fund-raising campaign for polio. People were asked to send one dime directly to the White House to help fight the disease. In the first 3 days, the White House received 230,000 dimes.

http://www.ecbt.org/polio.htm

8/09/2005 08:04:00 PM  
Anonymous JKS said...

Julie,
I'm a little confused, are you saying there are 3 vaccines that were approved but then yanked within three years of being put on the market?
Or did you mean that over 3 years there have been 3 changes?
Because they are ALWAYS making changes. As soon as a better vaccine is proved to be better, they approve it. It takes time.
Yes, it would have been nice if my 1997 born child hadn't had to have the oral polio, but that was the only choice at the time.
And if they come up with a safer MMR or a safer DTaP, etc. I hope they go through the proper process and then start using that.
I'm a little unsure as to what about this process bothers you.

8/09/2005 08:12:00 PM  
Blogger Julie M. Smith said...

JKS--

You, too, are misreading me.

I am not questioning the need to vaccinate against polio. I am questioning the need for the ORAL as opposed to the injectible vax. For years (including for my 1st son), the ORAL vax was given, even tho it meant (this is NOT debated by anyone) that about 1/2 dozen people in the US per year would get polio (usually these were immunocompromised people who changed the diapers of babies who had been vaxed in the previous week) when the injectible polio vax (which didn't have this risk) was available.

As for your final post, my point is that, yes, science is always improving and changes will be made (as I mentioned in my very first post on this subject), but for there to be three huge changes in the space of less than 3 years suggests that someone (many someones) is/are a little too quick to put things (such as newborn hep b) into the schedule.

Another newborn heb b story: by the time #3 was born, I knew enough to write REFUSE in huge letters across the consent form when I was taken into the hospital to give birth. Because we had switched drs. since #2 was born, I expected to have to explain about our choice to delay hep b to the ped. when we went for the first newborn appt. Instead, this is about what happened:

Dr. (reviewing chart): "I see you refused to hep b at the hospital. That's no big deal, our office prefers to hold off on that anyway."

Me: "Really? They knew the baby was your patient--why did they give me the consent form then?"

Dr. "It's too much aggravation for them to keep straight what the different peds want, so they just vax them all unless the mother says something."

This bugs the daylights out of me because it represents the carefree we we go about injecting powerful stuff into brand new human beings without enough thought.

You know those 6 people who got polio every year? If anyone had bothered to tell them that immunocompromised people shouldn't be around babies who have just gotten their ORAL polio vax, they wouldn't have gotten sick. But informed consent for vax is a joke in this country, and they never bother to give you many details.

We tend to treat people who raise *any* question about vax as nut cases and trot out polio stats--it is always polio--and stories about poor little 1950s kids. Again, I think a lot of the anti vax stuff is junk science, but I also think the pro-vax camp is also lazy--too lazy to get informed consent, too lazy to carefully decide whether something belongs in the schedule, and too lazy to listen to people with questions and actually hear those questions before dismissing them.

All these comments and no one has addressed my core issue: Why should we put complete trust in the CDC when they have a pattern of frequent, profound changes in the vax schedule that show an over-eager attitude toward vaxing babies?

8/09/2005 09:43:00 PM  
Blogger Demi said...

I have a friend whose son is autistic and she has heard the same things we all have. She's question weather or not it was the right thing to do, immunize or not when her mother said, "sweetheart autism is nothing like watching your child die of smallpox or any other disease you could have prevented with a vaccine".

8/09/2005 11:18:00 PM  
Blogger Julie M. Smith said...

Demi,

Once again, that's a false choice. The options for that mother weren't 'vax and get autism' or 'die of smallpox.'

While *I* am not persuaded by the vax-autism link, let's assume for a minute that it *is* true and look at what the choices *really* were: had the gov't used data that it has had since the 1930s showing thimerisol is dangerous, it could have packaged vax in single serving containers (which don't require thim.) and no one would get autism OR it could save a little money and package in multi-dose containers, thus requiring thim. and leading to autism. That was the choice.

(Again, I am *not* persuaded by the vax-autisim link, but since that presumption underlied your friend's conversation with her mother, I'm taking it as a given in order to show that once again the pro-vax people are using terribly sloppy reasoning.)

8/10/2005 09:54:00 AM  
Anonymous Sara R said...

Julie, I agree with you on those points--not that vaccines are bad, but that medical science is prone to jump too early to conclusions. Hepatitis B is a perfect example. As I understand it, unless the mother has Hep B, that disease is transmitted via sex or injected drug use. If so, then the risk of a newborn getting this illness is virtually nil. So why the rush to inject new babies? Well, only for practical reasons. It's a 3 shot series and it's most convenient to get them in at newborn, 2 months, and 6 months (or whatever the recommendations were). Kids don't go to the doctor that often when they are adolescents, and so they figure in order to conveniently get that much vaccine in the population, they need to do that to them as newborns. But is that really a good enough reason to give a relatively new vaccine to newborns? As a parent I look at it from a risk/benefit perspective. The benefit of a newborn (as opposed to a risk-taking adolescent) receiving this vaccine is very small, and the risk is as of yet not completely known. It takes time for the full consequences of medical decisions to be shown; this is just the nature of scientific knowledge. And so my younger kids don't have the Hep B vaccine. I intend to exert my best efforts as a parent to keep my children from choosing the kind of lifestyle that can lead to Hep B and lots of other non-vaccine-preventable sorrow. If a child looks like he's going down that path despite my best efforts, we'll do the Hep B vaccine then.

On the other hand, DTaP is still one of the riskiest vaccines. But pertussis is still relatively common, and it's a scary disease for a new little baby to get. So the kids get that vaccine.

Hep A is a newer vaccine, but we (including me) chose to get that one because that disease is food-borne, and so I see our risk of getting that disease to be greater than getting Hep B.

8/10/2005 11:38:00 AM  
Anonymous claire said...

I said: If preventing illness in my individual child was the main point, why aren't doctors doing more to make sure that tiny babies are breastfed?

You said: I'm pretty sure you didn't mean it this way, but it sounds like you believe that doctors don't care about preventing illness in individual children.

Me again: Keryn, I meant what I said... I don't think preventing illness in MY CHILD is the main point... I think peds promote vaccinations as a public health issue. Is that such a shocking thing? I agree with Julie: we need to be clear about what the purpose of the vaccination program is.


I said: I bet that[breastfeeding] would prevent more rotovirus hospitalizations that the vaccine did.

You said: If, as J. Stapley said, rotovirus strikes and kills many children in Third World nations, wouldn't most of those children be nursing, anyway?

Me again: Oh, don't get me started on formula marketing in third world countries! Especially in sub-saharan Africa, where HIV/AIDS is rampant and + mothers are told not to breastfeed, many babies are unsafely formula-fed (no clean water, no energy to sterilize feeding/mixing equipment, low literacy means families can't read directions on the can, not to mention not being able to spend huge amounts of their food budget on infant formula). Unsafe formula feeding is a recipe for rotovirus/other diarrheal diseases.

I was actually referring to rotovirus hospitalizations in the US, of which there are many, but very few among exclusively breastfed infants. In fact, recent studies show that many EB infants test positive for rotovirus infection with out showing ANY SYMPTOMS.

8/10/2005 02:06:00 PM  
Anonymous Amber M said...

This has been a great discussion, thank you all for your views. I want to add a question I have always thought was key to this problem -- a question I have not found any answer to:

What can we learn from those extremely adverse reactions to vaccines?

There is agreement from both the pro- and anti- sides that, rarely, there ARE catastrophic adverse reactions to vaccines. As I understand it (and I'm no expert), autopsies reveal damage to the myelin sheaths in the brain. Again, I'm no scientist, but this is very interesting because myelin is like insulation on electrical cords -- insuring that the electrical impulses of the brain don't short out. People who have myelin problems are people with many neurological problems including MS and Guillain-Barre syndrome.

So, if there are extreme reactions where the myelin is damaged, my logic leads me to ask:

Isn't it likely that a vast range of milder reactions exist but are unattributed to vaccination? Why not other neurological problems that show up immediately or even take a lifetime to show up. Autism, Asperger's, ADD (all of which are rampant in my family -- and all of which can be treated but not cured)... how about Alzeimer's?

Sorry if my spelling is off, rushing to finish while kids run wild around me. :)

Anyway, both sides seem to delight in scare -- and as a mother who has delayed and separated the giving of vaccines to my kids, I have been attacked particularly by the pro- side. But if you want to talk fear, I'm more afraid of my children ending up with incurable neorological disorders than measles or mumps.

8/10/2005 04:30:00 PM  
Anonymous JKS said...

Julie
I didn't realize you were referring to giving the ORAL polio with the other was available. I am not sure how long they overlapped, but continuing to give the oral when there was the safer one available was a poor choice. I'm sure it happened for a longer time than was necessary.

8/10/2005 05:00:00 PM  
Blogger The Wiz said...

My cousin was of the school of thought that vaccinations should be spread out.

Her junior high boy contracted whooping cough this season. He gave it to the new baby, who was past the scheduled time for being vaccinated, but hadn't been, because her mother didn't want to give the baby that many shots.

The entire family was quarantined in their house for weeks (no grocery shopping, nothing) and the baby was alone in a hospital room for the same amount of time, fighting for her life. Fortunately, she did not die.

Had she been vaccinated, it would have been a nonissue, the teenager would have been sick for a few days, that's all.

I know it's not statistical evidence, just anecdotal, bit it's enough for me to keep my kids vaccines updated.

8/10/2005 06:34:00 PM  
Blogger Jen said...

Claire,

So when did this post become the soap box for your pro-breastfeeding rants?

Breastfeeding is a great choice for mothers and babies, but not a cure-all for every disease and disorder that might strike your baby.

I thought we were talking about public awareness and safety issues surrounding immunizations.

8/10/2005 11:10:00 PM  
Anonymous claire said...

Hmm.. certainly didn't feel like I was ranting. To me, breastfeeding is intricately related to public health issues and immunizations. I certainly never posed it as a "cure-all."

But I understand other people might not see it that way.

8/11/2005 12:32:00 AM  
Blogger Heather O. said...

Whoa, nelly! You go away for a few weeks, and all hell breaks loose on my blog! Love it, though.

A few thoughts:

Speech, language, and cognitive delays can be diagnosed and even treated well before 2. Some therapists even believe that a child as young as 5 months can manifest delays, but I don't know enough about working with young babies to support that. I wouldn't really doubt it, though. The diagnosis for autism, however, often comes at age 2, when more social behaviors that should be developed are found lacking, most notably something called joint attention. There are, if I recall, something like 7 symptoms that have to be present to warrant an actual "autism" diagnosis, but it tends to become sort of a garbage pail term for kids that are just not behaving normally. The MMR is also given at around the same time that neurologists feel comfortable labeling a child as "autistic", so I personally believe that there is more of a correllation factor rather than a causal one with regards to the vax/autism question. Still, if my son were autistic, I would do everything I could to figure out where he got it, if it could be fixed, and how to deal with it. The world of therapy and services is a huge quagmire, even in the best of circumstances, and it's no wonder moms want to try and get some clarity and protection for their children.

Gotta go feed the kid right now, I'll respond to other thoughts later.

8/11/2005 07:52:00 PM  
Blogger neuropsyd2be said...

Let me begin by explaining that my training as a neuropsychologist is not yet complete (lacking only dissertation and internship; the "psyd" part is the degree: doctor of psychology; the "neuro" part is the concentration) but my comments are based in my training, my 140 hours of CEUs specific to autism spectrum disorders (and a master's class on the treatment of such) and my personal experience as a mother of six, three of whom have Asperger's Disorder.

We must recognize, as Saints, that the Lord's will is done, and that those who come to earth to take imperfect bodies agreed to do so, and may well be of the most valiant of us. I have had multiple spiritual experiences that have supported this. The "causation question," then, is irrelevant to me. The purpose of such difficulties is unique to each person, but I believe may well rest within the realm of "life is a test" not only for those with autism, etc., but for those of us who must interact with them (family members or not). I hope to pass this test and be able to face them on the other side of the veil with full confidence that I have done everything I could to serve them, help their sojourns go more easily, and succeed at their missions here.

That being said, the vaccination question was initiated by a woman in Denmark over 20 years ago who claimed that her son's autism was caused by vaccinations. From that point, there have been multiple studies conducted on the issue. Wakefield et al initially claimed that the MMR was at fault, but as one person already mentioned, most of the authors involved have separated themselves from Wakefield (who lost his post at the university over the controversy and his poor science). Wakefield had made inappropriate leaps of logic in his conclusions as he spoke in interviews and conferences after the study was published. Buie (pediatric gastroenterologist at Harvard) explained that the gut-lining inflammation Wakefield claimed was caused by measles molecules taking up residence in the gut simply was not found in subsequent studies (and Wakefield had to retract the claim).

Singh is another researcher trying to prove the vaccination connection. I've critically read his work; he always has to admit that the results are always found in the genetically predisposed (therefore vulnerable) individuals with autism.

A recent study in Japan (where thimerosal was never used) revealed no vaccination connection, and a similar "explosion" of diagnoses of autism. There are other, similar studies, but I have not had the time to critically review them all. I will in the near future, for the sake of my dissertation, but have been a bit busy trying to finish up my coursework.

I have had all of my children vaccinated, but not always on the strict schedule recommended. The Spirit dictated to me that I should wait on those who eventually were found to have Asperger's Disorder. It is my belief that this delay facilitated their growth and helped them avoid some setbacks that would have made their Asperger's Disorder more severe. Immune system dysfunction is common in autism spectrum disorders; adding the stress on that system that vaccinations cause at a time when genetically the brain is struggling is, in retrospect, something I am glad I did not do. I, too, argue that we give far too many vaccinations at too rapid a pace. I believe Utah's "Vaccinate by Two" program is an example of medical emphasis for convenience and c-y-a for the doctors, rather than good practice.

But, vaccinations are important. All other arguments taken into consideration, I add: If we were to take the stance that vaccinations caused autism, then not vaccinating would leave the children vulnerable to the more potent viruses that may maim or kill. On the flip side, if vaccinations cause autism, why are my three who were vaccinated more on schedule free of the disorder?

The MMR is usually scheduled for the same time period that neurotypical brains are undergoing dendritic pruning. Dendrites are the receiving arms of neurons, and grow (and die) all the time. They represent the changes in our brains caused by the learning process. The first 18-24 months of a child's life are replete with learning experiences that are usually not well differentiated or organized. The pruning process re-organizes the brain. It also developmentally moves the child from the habit memory-dependent infancy/early toddlerhood brain stage to the representational memory-dependent later toddler/early childhood stage (remember how your children began to roleplay at about age 2? that's representational memory system activity). It is not coincidental that children with autism regress at this age (with or without an MMR to affect the process), because social skills are dependent upon representational memory systems. Some researchers, such as Bauman and Kemper at Harvard, believe that the pruning process does not happen in children with autism (or is inadequate), with impact upon developmental processes. They point to the brain volume studies conducted in the last decade as evidence. Individuals with autism tend to have larger, denser brains through age twelve than does the neurotypical population; at that point, the brains are about equal, and then the neurotypical brains are larger from there on out (compared to untreated autistic brains). Research in this area is in its infancy.

FYI: some severe autism symptomology can now be identified in days, not months, after birth. The recognition of such symptomology should not lend a diagnosis of autism, but should alert parents and clinicians to watch more closely and to begin preventative treatment where indicated.

My dissertation looks closely at the neurological underpinnings of autism, the controversies regarding causation (especially versus correlation, a point well made by someone else), and the two main therapies for autism. Some of the fruits of that work: ABA (Applied Behavior Analysis) is the most well-known, and certainly the most researched, of the two. However, being heavily researched and being empirically sound are two different matters. NY State recognized this a few years ago, calling most of the research poorly designed (therefore, the results are highly questionable). The problem stems from the ethics involved in doing the best research design (true experimental design). Only one true experimental design study in autism has been conducted, by Smith at the U of Rochester, NY. This study took eight years, and was unable to demonstrate anything more than a statistical increase in IQ scores. IQ, as you know, is not a diagnostic criteria for autism.

What ABA does well is create behavioral scripts, structured (strictly controlled) environments, and a sense of security from all that sameness for the individual with autism. What ABA does NOT do well is help the individual with autism truly resolve the developmental delays that are keeping him/her from as neurotypical behavior as he/she can achieve. ABA does not take into consideration the neurological underpinnings of the disorder, and is not easily adaptable to that information. That's one reason there are so many eclectic therapies out there, because such are attempts to overcome this glaring deficit in the ABA model.

For those who are wondering, I have elected to include TEACCH, Project PACE, and other eclectic models (such as Rogers' work) under ABA-styled therapies, because they, too, are based on behaviorism principles. Schopler at U of NC may object, but reality is reality.

In contrast, the Developmental, Individual-difference, Relationship-based (DIR) model of therapy helps the individual with autism to overcome the developmental deficits as far as the neurology will allow. I have used both therapies, and find DIR to be much more powerful and much more satisfying all around. It takes into consideration the multiplicity of autistic presentations (the "individual difference" part), where each individual has strayed from the best developmental track, and helps the individuals overcome their social deficits by helping them understand how to build relationships.

Claims that DIR is not well-researched are ill advised. DIR is based on research results on the developmental course of neurotypical children, and on results of clinical experiences with techniques designed to facilitate that growth. What empirical research on the model itself that has been conducted in the last few years has been quite impressive (see www.playproject.org, a DIR-based therapy model originating at the U of Michigan, for an example. I hope I have the URL correct, as I am working off of memory.)
What DIR does NOT do well is build behavior scripts. Life is not scriptable. Osgood and colleagues (www.celebratethechildren.org) found that ABA's script-making was only a stopgap, not a true resolution. Indeed, there is much controversy surrounding whether individuals with autism, treated via ABA-style therapies, can generalize the scripts. From what I've learned, some individuals can, most cannot. Scripts lend a time-limited sense of security, and when the scripts fail, I believe the person with autism is worse off than if he had never learned the script in the first place. Trust has been destroyed, and trust is a central issue in autism.

Diagnoses for autism spectrum disorders have multiplied significantly since 1994. Many people think this is due to the toxic environment in which we live. There is some correlational evidence between environmental levels of mercury (from exhaust, mostly) and prevalence rates of autism in Texas and California. These are new reports that I have not yet evaluated, and must be taken under serious consideration. PCBs are also suspected as causational; this arises from the thyroid studies done by individuals at the World Wildlife Foundation (esp. Colborn). But the baseline always comes back to genetics. If not so, then ALL individuals living in these areas would have autism, not 1:150 (at worst count, a level that has also been questioned).

In 1994, the American Psychiatric Association published an update to the Diagnostic and Statistical Manual of Mental Disorders (DSM; notated DSM-IV for 4th edition). This was the first edition to include Asperger's Disorder. The edition also held a vastly different criteria set for the diagnosis of autism than did the DSM-III. The 2001 DSM-IV-TR only changed some text, but did not change criteria sets. The DSM-V is due out soon; there is some indication (anecdotally communicated to me) that the children's section may well use "autism spectrum disorders" as an umbrella diagnostic category, with autism, Asperger's, Rett's, and other childhood disorders falling underneath it. Will that now create an even greater prevalence rate, similar to what we have seen in the last decade? I think it may well do so, as clinicians in many fields who are not experts in autism continue to diagnose because those experts are unavailable for some reason.

As a mother of individuals with Asperger's Disorder, I can attest to the difficulty in childrearing that this can bring. I can also attest to the wonders and beauties of the disorder. My sons with Asperger's struggle with social skills, but have made significant progress since we started using DIR principles in our home. They also have a way of looking at the world and at the gospel that simply amazes me at times. I find the DIR principles to be remarkably gospel-friendly (as opposed to many of the ABA techniques that I find rather abusive). The gospel of Jesus Christ is all about relationships, the value of such, how to conduct such, and the eternal nature of such. DIR gives tools for the development and nurturance of relationships.

DIR was actually designed as a child rearing method for all children. I do not find it coincidental that it was a pair of Jewish clinicians (Greenspan and Wieder) who devised it out of their combined nearly 60 years of work in child development. Greenspan is unarguably the nation's foremost child psychiatrist, and Wieder is a leading child psychologist.

I would be glad to continue this discourse privately, so as to not take up so much room here again. Please contact me at gmacdowellboyer@mac.com if you would like more information. For those ABA-defendant individuals who take umbrage at my comments, I am glad that ABA techniques have given you a sense of progress. I encourage you to remember that Joseph Smith said all individuals were capable of advancement (to paraphrase him). ABA has facilitated some growth; DIR will give you more. May God bless you as you prayerfully consider your options.

8/15/2005 11:36:00 AM  
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