Tuesday, October 13, 2009

New Immunization Guidelines -- Who Makes Them?

On September 22, 209, Medscape reported:

"New Guidelines Issued for Immunization of Infants, Children, Teens, Adults

An Expert Panel of the Infectious Diseases Society of America (IDSA) has prepared updated, evidence-based guidelines for immunization of infants, children, adolescents, and adults. The new guidelines, which are published in the September 15 issue of Clinical Infectious Diseases, replace the previous IDSA clinical practice guideline for quality standards for immunization, published in 2002."

This apparently officious body now recommends a host of new vaccines:

"New vaccines that have been licensed since 2002 include human papillomavirus vaccine; live, attenuated influenza vaccine; meningococcal conjugate vaccine; rotavirus vaccine; tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis vaccine; and zoster vaccine. New combination vaccines that have become available are measles, mumps, rubella, and varicella vaccine; tetanus, diphtheria, and pertussis and inactivated polio vaccine; and tetanus, diphtheria, and pertussis and inactivated polio/Haemophilus influenzae type b vaccine.

For young children, hepatitis A vaccines are now universally recommended. All children aged 6 months through 18 years and adults who are 50 years or older should receive annual administration of influenza vaccines. The routine childhood and adolescent immunization schedule now includes a second dose of varicella vaccine. The adolescent and adult immunization schedules have expanded to accommodate many of these new recommendations."

The Infectious Diseases Society of America sounds impressive, eh? When you get to the end of the article, you find this:

"The IDSA supported formulation of these guidelines. Some of the guidelines (sic) authors report various financial relationships with Merck, GlaxoSmithKline, Sanofi Pasteur, the Advisory Committee on Immunization Practices working group for Influenza and HPV, Astellas, MedImmune, Wyeth, AstraZeneca, the National Institute of Health, the Centers for Disease Control and Prevention, Novavax, Protein Sciences, Novartis, CSL Limited, PowderMed, and/or Avianax."

So we have people who profit from the sale of immunizations setting the guidelines for immunizations. On top of that, they endorse making some immunizations mandatory. How convenient to have the State make your products mandatory. Wouldn't Coca Cola like Congress to pass a law requiring that every U.S. citizen purchase 4 liters of Coca Cola every week?

How about giving us an opinion from a disinterested third party?

If immunizations work, i.e. really make immunized people immune, what do those people have to fear from non-immunized people? In 1922, when smallpox still occurred regularly, Henry Lindlahr, M.D. wrote about vaccinations:

"From England vaccination gradually spread over the civilized world and during the nineteenth century the smallpox disease (variola) constantly diminished in virulence and frequency until today it has become of comparatively rare occurrence.

'Therefore vaccination has exterminated smallpox,' say the disciples of Jenner.

Is that really so? Is vaccination actually a preventive of smallpox? This seems very doubtful when the advocates of vaccination themselves do not believe it. 'What,' I hear them say, 'we do not believe in our own theory?' Evidently you do not, my friends. If you believe that vaccination protects you against smallpox, why are you afraid of catching it from those who are not vaccinated? If you are thoroughly protected, as you claim to be, how can you catch the disease from those who are not protected? Why do you not allow the other fellow to have his fill of smallpox and then enjoy a good laugh on him? The fact of the matter is you know full well that you are not safe, that you can catch the disease just as readily as the unprotected.

I have yet to find a single proponent of vaccinations who can answer this simple question asked more than 75 years ago by Lindlahr. Sometimes they talk of "herd" immunity being the key to vaccine effectiveness. I find this funny. If you actually get a disease, like chickenpox, and let it run its course, you build immunity for life, regardless of whether or not the 'herd' has immunity.

Not so if you get the vaccine. On March 15, 2007, the New York Times reported on a study done by CDC researchers (and published in the New England Journal of Medicine) that found that the chickenpox vaccine "has sharply reduced the number of cases in children but that its protection does not last long." The Times article states:

With fewer natural cases of the disease, the study says, unvaccinated children or those whose first dose of the vaccine fails to work are getting chickenpox later in life, when the risk of complications is higher.

“If you’re unvaccinated and you get it later in life, there’s a 20-times greater risk of dying compared to a child, and a 10- to 15-times greater chance of getting hospitalized,” said Dr. Jane Seward of the Centers for Disease Control and Prevention in Atlanta, who worked on the study.

Apparently now unvaccinated children have a higher risk of adult chickenpox due to the influence of the vaccine, whereas unvaccinated children did not have such a risk by contact with people who actually had chickenpox. So the vaccination converted a non-life threatening childhood disease into a life-threatening adult disease.

The NEJM authors admitted that vaccinated children still get the chickenpox, and that vaccinated individuals who get chickenpox have a more severe form of the disease:

And when vaccinated children were infected [with chickenpox], they tended to be sicker, probably because they were older. “Children between the ages of 8 and 12 years who had been vaccinated five years or more previously were two times as likely to have moderate-to-severe breakthrough disease as were those who had been vaccinated less than five years previously,” the researchers wrote.

Yet people still "believe" in vaccines. As this article in The Atlantic discusses, many authorities 'beleive' in flu vaccination as a 'public health' measure, despite lack of evidence for efficacy or safety. This reminds me of the 'belief' in high-carbohydrate low-fat diets and cholesterol-lowering drugs, also pushed on the public without evidence for efficacy or safety.

Lindlahr again:

"But," our opponents insist, "you cannot deny that smallpox has greatly diminished since the almost universal adoption of vaccination."

Certainly the disease has diminished. But so have diminished and, in fact, nearly disappeared the plague, the Black Death, cholera, the bubonic plague, yellow fever and numerous other epidemic pests which only recently decimated entire nations.

Not one of these epidemics was treated by vaccination. Why, then, did they abate and practically disappear?

Not vaccination, but the more universal adoption of soap, bathtubs, all kinds of sanitary measures, such as plumbing, drainage, ventilation and more hygienic modes of living generally have subdued smallpox as well as all other plagues.

Lindlahr has part of the answer. Not only hygienic measures, but also the replacement of horses with autos (removing manure from city streets), improved nutrition, and simple evolution contributed to the subsidence of epidemic diseases. When these diseases ravaged populations, the people affected had poor quality nutrition. In every case, the diseases ran their course through the populations, affecting all who had low immunity, causing them to either build immunity or die, and thus leaving in their wake a population having immunity to the disease. As well, the disease entity itself evolves. A disease that kills its hosts will eventually eradicate itself.

So far as I can tell, all the "evidence" in favor of vaccinations is epidemiological, that is, correlative, in this vein: "We gave this population the vaccine for X disease and the disease incidence declined, therefore the vaccine eliminated the disease." This is classic mistaking of correlation with causation, along with the fallacy post hoc ergo propter hoc, i.e. y happened after x, therefore x caused y. Lindlahr pointed it out more than 75 years ago.

I formed my opinion after examination of evidence such as this graph posted at Child Health Safety :

This shows that vaccines for measles, pertussis, and diphtheria all got introduced during the natural waning of the epidemics, making it impossible for me to conclude that the vaccine had any dramatic benefit. Child Health Safety has similar graphs referring to other vaccines.

And if you look deeply into this, you will find that changes and fashions in diagnosis also influenced the "decline" of epidemics "observed" after vaccines. Before the vaccine for measles, physicians were on the lookout for measles, and so diagnosed it frequently. After the introduction of the vaccine for measles, for example, physicians believed that the vaccine eliminated measles so they simply were less likely to diagnose an infection as measles. But doctors are notoriously bad at diagnosis. They overdiagnose or underdiagnose based on fashions, such as when the incidence of arteriosclerotic heart disease "increased" in 1948 after this diagnosis was added to the ICD.

And, I notice that if the incidence of infection goes down even in unvaccinated folks, rather than questioning whether the vaccination did the job, vaccine proponents attribute this to herd immunity conferred by vaccination. Its like giving treatment A to one group and a placebo to the other; both groups get better equally, so you conclude that treatment A works so well, it even helps people who didn't receive it by having a “herd” effect. In any other investigation, people would conclude that the treatment works no better than a placebo or no treatment. I understand the rationale given for this explanation in respect to vaccinations, but for vaccine proponents, it conveniently excludes the possibility of a control group, or of concluding that no treatment worked as well as treatment--possibilities necessary for scientific evaluation.

But who cares about science when you can get politicians to force everyone to take your product by government decree, and at taxpayer expense?

Of course I could be wrong. Do the research and think for yourself.


jon w said...

hey guy, I'm with ya, I'm a skeptic too. people make money off vaccines, and there's conflict of interest all over this. but vaccination is based in sound science, and sometimes just a little protection is enough to reduce the growth rate of an infectious disease so that it dies out. it's basic population biology.

hell, modern factory meat farming wouldnt be possible without vaccinations. you think the vets are pulling a scam on the feedlot farmers?

and by the way, "a good yankee scrubbing" didnt do shit for yellow fever. that virus is carried by mosquitoes, and all the handwashing and sterilizing in the world wont stop them.

Don said...


Is yellow fever still epidemic in Havana?

Was there a vaccination against it?

Do vaccinations control mosquitoes?

Handwashing and sterilizing aren't the only methods of "scrubbing and scouring" that Lindlahr had in mind.

"you think the vets are pulling a scam on the feedlot farmers?"

Not the vets. Most of whom, by the way, don't appear to have a clue about evolutionary nutrition.

jon w said...

Hi Don, sorry I couldn’t figure out your name from the home page. To answer your questions, Cuba is currently free of yellow fever; there is a yellow fever vaccine that has been used in Cuba among other places, mosquitoes are still in Cuba and of course vaccine has no impact on mosquitoes, and I’d have to concede that farm-vets probably are clueless about anything besides getting animals to grow big and survive to slaughter time.
I’ll try to focus on Lindlahr’s fallacies and leave it at that.

Regarding the “simple question asked more than 75 years ago,” immunizations don’t make all immunized people completely immune, and nobody with any credibility claims that they do. This is a straw man argument and a medical doctor like Lindlahr is dishonest to use it. [A little more on the credibility of your source: he’s also dishonest or negligently ignorant to imply (writing in 1922) that filth and sanitation has anything to do with yellow fever. After the US invasion of Cuba in 1898, typhoid and dysentery declined with improved sanitation, but the Army couldn’t do a thing about yellow fever, losing thousands more troops and civilians in the next years until Walter Reed’s team revealed that mosquitoes were spreading it.]

However, even if a treatment doesn’t make everyone who receives it invulnerable to a disease, it might still be effective as a public health tool, as long as it slows the spread of the disease…

For any infectious disease to spread, it must be a fact that, on average, each infected person infects at least one other person. (If this were not true, a disease that started with 100 cases would eventually be 99 cases, 98, and so on down to extinction.) In epidemiology, the average number of new infections generated by each sick person is called the “R-zero” of an epidemic. Any effective strategy in controlling an epidemic will reduce this number. We can wash our hands more, isolate contagious people, burn infected clothes, wear condoms, etc. None of these methods are foolproof, and neither is vaccination. But they don’t need to be. All we have to do is slow down the spread. Do this comprehensively enough, by any method, vaccine or no vaccine, and you can make a pathogen extinct.

As a member of society, a parent, a businessman, health professional, whatever, I have an interest in NOT having an epidemic rage through my community. Even if I drink magic immunity boosting compounds 24 times a day and know that I personally am 100% safe, I can still rationally have a preference that the plague not to destroy my town. If there is a safe and effective method to reduce the risk that this happens, any responsible person should approve of it.

Where responsible people may disagree is on what constitutes “safe and effective.” And it’s difficult, because safety must be a relative term. Of course there’s risk when you break the skin and inject a mixture of dead/modified pathogens and chemicals into your body. However, there’s also risk in having a novel disease organism inhabit your body (assuming you believe in the germ theory of disease), so in choosing how to fight a disease, it makes sense to weigh all the risks against each other. A dangerous or expensive vaccine against a mild disease might not be worth it; a cheap or safe vaccine against a deadly disease might be a better bet.

Again, Don, I don’t doubt for a minute that pharmaceutical companies are out there scheming to make money and will distort the facts if they can get away with it. But unless I’ve misunderstood you, you’re implying to your readers that vaccination never has and never does contribute to public health, and using some slippery logic to get there.

Don said...


While I agree that Lindlahr exaggerated, I don't see a fundamental incompatibility between your description of what happened and Lindlahr's general principle. It was control of the mosquito, largely by elimination of its breeding grounds that brought yellow fever under control, not vaccination. I would consider elimination of mosquitos and breeding grounds for mosquitos a matter of 'sanitation' in the broadest sense.

Tortora's Microbiology defines "vaccination" with this sentence: "The process of conferring immunity by administering a vaccine; also called immunization."

I searched pubmed and found a number of recent RCTs on vaccinations, and I found that the authors commonly make statements like these:

"In all women in the two groups, protective immunity for tetanus was acquired..."


"For the Hib component of the study, there was 100% seroprotection"


These appear to clearly claim that vaccination achieved immunity (based on serum antibodies) in "all" and "100%" of vaccinees. Their claims passed peer-review, so I guess their peers consider them credible.

To substantiate the claim that vaccinations brought an end to epidemics I would have to have a single-variable, double-blinded, placebo controlled demonstration that vaccines prevented infection in the vaccinees while unvaccinated folks continued to suffer an epidemic. I don't know of any such studies.

I notice that if the incidence of infection goes down even in unvaccinated folks, rather than questioning whether the vaccination did the job, vaccine proponents attribute this to herd immunity conferred by vaccination. Its like giving treatment A to one group and a placebo to the other; both groups get better equally, so you conclude that treatment A works so well, it even helps people who didn't receive it by having a “herd” effect. In any other investigation, people would conclude that the treatment works no better than a placebo or no treatment. I understand the rationale given for this explanation in respect to vaccinations, but it apparently excludes the possibility of a control group, or of concluding that no treatment worked as well as treatment.

It seems to me the very nature of mass vaccination used in the early days of its practice prevents scientific evaluation of its effectiveness. The presence of multiple confounding variables/inteventions that also influenced the outcome, like the cessation or wars, improved nutrition, general sanitation, and, not least, natural waning of epidemics (known from study of pre-vaccination epidemics) apparently precludes any firm conclusion about what role vaccines played.

Regardless of intervention, epidemics simply run their courses; so if a vaccine was introduced during the natural wane of the epidemic, it will appear that the vaccine did something when it may have done nothing. The following site provides graphic evidence that this happened with measles, mumps, pertussis, tuberculosis, diphtheria, and smallpox. I formed my opinion based on examination of such evidence.


Although today we do have randomized controlled trials of vaccines that appear to show vaccine efficacy (often by measuring serum antibody levels, such as quoted above), these don't give me direct evidence that the vaccines played important roles in bringing an end to their epidemics. So I remain a skeptic.

jon w said...

Thanks Don for the thoughtful response. Although I am already a flu vaccine avoider, you have prompted me to look a lot deeper into the standards of evidence here. One question - are you updating the original post as we go, or am I having memory lapses?

I think 100% "seroprotection" or whatever similar terms they use, are an indication of how many people showed antibodies in the blood, after receiving a treatment. Very true that the people are not then exposed to live pathogen (would be unethical); but rather the test is done in a blood sample. I'd have to agree there's a weak link there, whereby researchers are able develop and market a "proven" product, without proving that it works in the real world. I'd say they are just doing their jobs, but then public health officials or policymakers start spinning and often take it further than the science actually warrants.

As far as "herd immunity" I think it would be pretty hard to challenge as a principle. If fewer susceptible people are out there, there is less fuel for the wildfire to spread, so to speak. The same epidemic doesnt infect the same people over and over again. Again the weak link in the chain of logic, is that vaccines actually enhance herd immunity by reliably (and safely) converting susceptible people to protected people.

I wouldn't expect to find a double-blind, placebo controlled study in humans for ethics reasons, but hope it's been done in animal populations and will look for one.

Don said...


You aren't having memory lapses. I decided to put some of my responses to your comments into the original so that anyone who reads only the post will get them.

elhnad said...

Hi Don,
Just wondering if you've come across this very popular post on intellectual dishonesty in possibly some popular graphs used by the antivaccine people. Haven't read the comments yet myself, but from the main post, I think the author just tries to pick the most dishonest statment made and extrapolate that the entire argument is flawed. would love to hear the opinion.

Also, the blogger cites quackwatch as a source which makes me very skeptical of his arguments since i believe it has so little credibiltiy.

elhnad said...

post here, my bad http://www.sciencebasedmedicine.org/index.php/vaccines-didnt-save-us-intellectual-dishonesty-at-its-most-naked/