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May 24, 2010

Why I Don’t Listen To Jenny McCarthy — Or the CDC

by Brad Warbiany

The journalist responsible for the original uproar about the MMR vaccine and autism has been shown to have produced very shoddy research, and widely discredited. He was even recently banned from the practice of medicine in the UK. This has, of course, not quieted the debate. In fact, it’s gotten even worse, with his vaccine supporters claiming the science is settled, and vaccine opponents acting as if this is all a big cover-up.

The problem with this debate, for most people, is that they don’t have the training to actually view the real research and make an informed decision. They’re trying to decide whether to listen to their usual source of information, an emotionally-charged celebrity (Jenny McCarthy) or to trust the authorities, who just naturally have that stink of “they must be hiding something” about them. Add a dash of humanity’s propensity to swallow conspiracy theories, and nobody knows what to believe.

As a parent, I decided it was my job to educate myself and make the decision for my kids, regardless of what the CDC said. Nothing is riskless. It is my job to weigh the risk of vaccinating against the risk of not vaccinating, both for specific vaccines, for the age of administration of those vaccines, even to the level of possibly discriminating against brands of vaccine based upon ingredient levels (you may laugh, but I have asked my pediatrician which brand they use).

Some anti-vaccine folks in my extended family supplied me with the crackpot books they’ve read (i.e. books where the author was denouncing the entire germ theory of disease as bogus), and it was clear reading these that the authors had an axe to grind. A book written from an ideological perspective is not necessarily a disqualification, but books where the ideology trumps the science are out of the question.

I ended up on a book published by my kid’s pediatrician. I chose it because it seemed to honestly and neutrally discuss the relative diseases guarded against, the ingredients of the vaccines in question, and the safety record of the vaccine. The author supports vaccination, but it was clear that he did his level best to offer the evidence without bias, separate from his own recommendations pro/con on each vaccine.

I ended up choosing the vaccine schedule that I put my kids through based on that information — i.e. a cost/benefit analysis of the likelihood my child might contract the disease in question, the severity of the disease if he did catch it, and the relative risks of the vaccine in relation to the above.

As an example, I chose that my children get the polio vaccine. While it’s a rare disease, it’s a particularly nasty disease, and the vaccine is one of the safest available. I also chose to get vaccines such as HiB and Rotavirus, because they’re relatively harmful diseases, particularly in infancy, and also diseases that my kids aren’t that unlikely to contract.

On the other hand, I chose against MMR. While measles, mumps, and rubella are common, they’re also typically mild diseases. The vaccine has a higher prevalence of adverse reactions than most, and there is a worry that some of the vaccines for “mild” diseases can lead to complications later in life, with a more virulent and dangerous form of a disease affecting the individual in adulthood. Thus I didn’t believe taking risks to protect my kids from diseases that seemed relatively innocuous in most kids made a lot of sense, especially since the long-term effect is unknown. I had the same rationale for the chickenpox vaccine.

I also opted for a more spread-out vaccine regimen (i.e. not necessarily later in life, but more visits and less shots per visit), because I think the likelihood of an adverse reaction may be increased when you subject a body to the stress of several vaccines at once.

This, of course, is done with the unique attributes of my family taken into account. It’s a low-risk household, with the kids breast-fed until 12 months, no day care, and not a huge amount of interaction with hordes of other youth. Further, they’re well-nourished and healthy kids, so I feel they’d be far better than “average” at weathering the storm of a disease like measles or chickenpox. This, of course, also makes them less likely to have an severe adverse reaction to a vaccine, so it affects the risk/benefit of vaccinating just as much as not vaccinating.

I know that this decision is my responsibility as a parent. I know that I am weighing some risks against others, and that there’s a chance that things could go wrong. It is because of that responsibility that I read 3 books cover-to-cover on the subject, discarding two of them as trash and settling on one that I thought trustworthy before making my decisions. At the end of the day, I feel like I made the best decision I could, given the evidence I had, and I and my family are going to be the ones who have to live with the consequences, right or wrong. That’s a heady weight, and one that most parents probably don’t want to bear. But that’s the responsibility that comes with raising a child.

The problem will come when the kids need to go to school. The schools typically demand that you’re current with all or most of the vaccines on the CDC schedule. Most public schools will allow you to let your unvaccinated child attend if you claim a philosophical objection to vaccinations. It’s a major hassle, but they do allow it. The problem for me is that I don’t have a philosophical objection to vaccination (especially as an atheist — no religious reasons for me). One of the pieces of evidence against a philosophical objection is to give your child any vaccines — i.e. my piecemeal approach is not philosophical.

I do have a philosophical objection to bureaucratic one-size fits all government mandates, though, and thus I don’t accept that the government should be the one demanding that I follow their cost-benefit analysis for “most” kids when it doesn’t fit my family’s particular situation. My philosophical objection is being forced to take risks with my children that the CDC wants me to take, when I’ve evaluated the research myself and I disagree. That objection, though, is less well accepted in California than Scientology.

PS – Above left as a comment to this post at Reason. It’s a topic that I’ve wanted to cover here for a long time, so I expanded the comment slightly and presented it here.

PPS – Do vaccines cause autism? I don’t think there is a direct correlation. Some adverse reactions have included extreme fever and meningitis, though, two things that can cause permanent brain injury. I don’t know that there’s any correlation between mercury or aluminum and autism, but there may be a link with severe reactions and autism, or at the very least, with severe reactions and non-autism brain injury.

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8 Comments

  1. And as such, why no one should listen to you either. Your constant use of how you “feel” and “believe” isn’t scientific at all, you’ve basically picked the path you want to take and taken it. Your “worry” about it causing bigger problems down the road is baseless. This vaccine has been in use for 40 years and works off existing vaccine methods, this would be a baseless and irrational worry that can’t be properly measured. I honestly don’t see how this is any different to the zillion other people giving entirely unqualified medical advice, just on a smaller scale.

    The risks also aren’t static. With a large decrease in the rates of immunity, we’d likely see a rise back to pre-immunization days of several hundred thousand cases a year in the US (with hundreds of deaths). So, ironically, the more people who listen to you, the less effective this method is.

    There are plenty of parents who deny their child medical help due to religious or philosophical beliefs only to have their child die. It’s occasionally a crime, depending on how irrational their actions were and how contributory to their deaths the action was. But if we take your thinking at face value, as they are a parent and as they’ve made what they believe to be a rational decision, they’ve done nothing wrong.

    It’s also worth noting that a virus will rely on immune response, no amount of healthy eating will prevent a child from contracting a virus. Not having a strong immune system due to lack of interaction with others isn’t much of a helper in that regard.

    Comment by Rob — May 24, 2010 @ 10:26 pm
  2. As parents we always want to be sure we’ve done everything possilble to protect them. I had my son vaccinated for all immunizations required and yet the one he lacked is the disease that took his life. That disease is called meningococcal disease, commonly known as meningitis. I wished someone would have told me as my son would be alive today. There was an outbreak at the university my son was attending with 6 students contracting this disease with tragic results. Lifestyle factors common among adolescents and young adults seem to be linked to the disease. CDC recommendations are made but seem to fall upon deaf ears especially in our doctors office. In our case we did not know about the meningococcal vacciantion, but the family of another student who died after our son did and what is so sad is that their doctor advised that the immunization was not needed resulting with the students death. I’ve met many parents throughout the U.S. with similar stories. The Centers for Disease Control and Prevention recommends meningococcal immunization for ALL adolescents 11 through 18 years of age. Meningococcal conjugate vaccinations are available for ages two through 55. I’ve experienced how horrible this disease is and urge parents not to ignore that this disease is preventable. Make sure that the meninngococcal vaccination is on your list. For more information about meningitis, visit http://www.nmaus.org

    Comment by MOM Louisiana — May 25, 2010 @ 6:11 am
  3. Agree mostly with the above comments, and also not a huge fan of how you and some other contributors here refer to so many people as crackpots and take a little too much pride in separating yourselves from “conspiracy theorists.” But other than that, good write-up.

    Comment by Procopius — May 25, 2010 @ 1:17 pm
  4. And as such, why no one should listen to you either. Your constant use of how you “feel” and “believe” isn’t scientific at all, you’ve basically picked the path you want to take and taken it.

    “Constant”? Let’s look at the critical four paragraphs where I discuss the decision-making process (the polio/HiB/rota paragraph up to the risks of my household). In those paragraphs I use “believe” once and “feel” once. Both sentences, the context they’re used implies that there is evidence for the belief/feeling.

    Your “worry” about it causing bigger problems down the road is baseless.

    At least with chickenpox, it’s well-known that contracting the disease later in life is typically more severe than as a child, and there is valid evidence that the varicella immunity (as provided by the vaccine) decreases over time in a way greater than through natural immunity. For MMR, we are talking about diseases with very low and very well-known risks naturally. In particular, mumps is dangerous for males after puberty (thus likely better to develop immunity in childhood), and rubella isn’t about protecting kids, it’s about protecting pregnant women. While that’s a laudable social goal, it doesn’t necessarily induce me to expose my children to the potential adverse reactions of the vaccine.

    I honestly don’t see how this is any different to the zillion other people giving entirely unqualified medical advice, just on a smaller scale.

    I don’t give anyone medical advice. I’m not a doctor, and have never claimed to be. My advice to people is that they should read as much of the evidence as they can stomach and make up their own minds. My advice is also that as a father, it is MY responsibility to make these choices, not the CDC. The risk/benefit calcuation made is an individual one; the CDC is balancing my personal individual risk/benefit calculations against those of the rest of society (i.e. “herd immunity”), and I’m not sure they weigh one vs. the other in the same way that I, as a parent, will.

    The risks also aren’t static. With a large decrease in the rates of immunity, we’d likely see a rise back to pre-immunization days of several hundred thousand cases a year in the US (with hundreds of deaths).

    This is true. I’m not arguing that herd immunity doesn’t exist. I doubt we’d get anywhere near the pre-vaccine levels, but if more people do as I do (again I object to your charactization of people “following my advice” when none is offered), we’d undoubtedly see the overall societal numbers of certain diseases rise.

    There are plenty of parents who deny their child medical help due to religious or philosophical beliefs only to have their child die. It’s occasionally a crime, depending on how irrational their actions were and how contributory to their deaths the action was. But if we take your thinking at face value, as they are a parent and as they’ve made what they believe to be a rational decision, they’ve done nothing wrong.

    They most assuredly might have done something wrong. I might be doing something wrong here, as I admitted in the post. If I am doing something wrong, all I can say is that I’m doing so in the best possible faith and with my eyes as open as I can make them.

    But what is the alternative? Follow the government’s edict, or face the criminal justice system? While the choices I am making may be wrong, there is no guarantee that the government’s choices are right. After all, I could lather my kids up with sunscreen to prevent them from getting skin cancer, only to find out now that it might actually be causing cancer*?

    I’m trying to do the right thing. The fact that the MMR/autism link has pretty definitively been blasted to pieces as shoddy research actually may cause me to change my mind on that one. I.e. that changes the risk/benefit calculation. I see no reason, though, to change the decision at this time on varicella.

    It’s also worth noting that a virus will rely on immune response, no amount of healthy eating will prevent a child from contracting a virus. Not having a strong immune system due to lack of interaction with others isn’t much of a helper in that regard.

    Agreed, and I’d be an idiot if I thought that being well-nourished meant that my kids wouldn’t contract a viral disease. What it will do, however, is make their bodies more successful at being able to fight that disease.

    And I’d point out that they’re not insulated from the world, they’re just not exposed to the constant barrage of germs in a typical day care environment. I have no reason to suspect they’re not getting normal exposure to the environment to support a healthy immune system.

    * Note — I am not taking the accusations that sunscreen may increase risk of cancer at face value — I’m only using as a timely reminder that “consensus” may be wrong, and most assuredly scientific and medical truth is quite usually a work-in-progress.

    Comment by Brad Warbiany — May 25, 2010 @ 2:53 pm
  5. Procopius,

    While I say in my previous comment that science is a work in progress, there are certainly areas of crackpottery. Two of the authors I read made serious accusations against the entire germ theory of medicine. Here’s an example. The arguments are full of holes that anyone with moderate understanding of logic and the scientific method can drive trucks through. And the arguments are often used to suggest that vaccination is by its very nature ineffective, when all evidence points to the contrary. I see no harm in calling a crackpot a crackpot.

    As for conspiracy theorists, I chalk most of them up to a natural human necessity to assign coordinated plan to things that do not require them. I don’t deny the existence of conspiracies, I simply withhold belief in specific conspiracies without some pretty solid proof. In the absence of evidence, Occam’s Razor often points away from conspiracies rather than towards.

    Comment by Brad Warbiany — May 25, 2010 @ 3:08 pm
  6. I’m not going to argue medicine or science with you, as the voluminous content would crowd out the principle of the issue. I am content enough that you at the very least ascribed, at the end, to the correct philosophy of the societal issue of vaccination. That is, that no government or corp-govt alliance can force vaccinations on you.

    On conspiracy theories, or “conspiracy” and “theory”, there are several different concepts that arise to make a conspiracy. If you assume that a presenter of information and a conclusion is always implying that a Dr. Evil (to paraphrase) is the source of an action or movement or phenomenon, then your argument will almost always exclude an entire arena of facts to the audience. And every now and then there actually is a “Dr. Evil” behind it no matter how simple that may seem.

    Finally, there are several situations in which Occam’s Razor would actually favor a conspiracy over chance.

    Comment by Procopius — May 26, 2010 @ 10:02 am
  7. “Do vaccines cause autism?”

    More and more disorders have been included in the autism spectrum, most prominently Asperger’s. I’m not going to judge this right out, but this includes alot of kids (mostly boys) who would have been regarded as erratic and socially awkward years ago, but are now classified as a disorder. When we read of skyrocketing autism rates, the automatic reaction by many might be that there are now boatloads of kids that grind their teeth, don’t talk and have to be observed all of the time.

    A little disclaimer – I’ve been diagnosed with Asperger’s syndrome, and have done fairly well for myself, mostly because I’m very skilled in one area and am well liked by my friends. I’ve also worked with autistic children are really unable to function.

    Comment by Michael O. Powell — May 27, 2010 @ 11:09 pm
  8. While yor article is well “thought” out. It is alarming how people are claiming “NO” link, and then go on to acknowledge may casual relationships. It is great you got vaccinated. I got vaccinated. My oldest got vaccinated. My youngest got vaccinated and fell into her own world. She did NOT even get the MMR. We are trying very hard to fix her. It is the a sad experience for any human to witness. I just simply want the 1% of kids who are falling into Neverland to serve as a platform to REALLY figure out WHAT is happening. A 1% rate is Epidemic.
    There are other countries with less agressive
    immunization schedules which have better mortality than we do in the U.S.A. why are smaller poorer countries doing better than we are.

    Comment by mmlowe — June 7, 2010 @ 9:09 pm

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