Measles vaccine: A real immunity super-booster

The Pediatric Insider

© 2015 Roy Benaroch, MD

What if there was an intervention that could reduce a child’s risk of death from infection—from any infection—by half? And that one intervention’s immune-boosting power lasted 2 or 3 years. It’s also very safe, with a very small risk of any serious side effects.

Pat yourself on the back. Your child has probably already had it, and your entire community is getting benefit from fewer circulating infections.

A recent study published in Science looked at long-term changes in immunity following measles vaccination in populations worldwide. It’s known that measles infection put people at risk for other infections for several weeks or months afterwards – natural infection seemed to suppress the immune system. Using data correlating vaccinations, measles cases, and infectious disease deaths, the authors found that the immune suppression had a much more serious and lasting impact than had been thought. For two to three years after natural measles, the all-cause infectious mortality spiked upwards. Measles vaccination, in other words, doesn’t just prevent measles deaths—it prevents deaths from any infection. For years.

The effect is striking in its intensity. Overall, when measles was common years ago, it accounted for about half of all deaths from infection (combining the direct effect of measles infection itself with the immune suppressive effect.) In some of the most resource-poor countries, it probably accounted for up to 90% of all infectious deaths. Think about that. One vaccine, preventing all of those deaths. The authors only looked at mortality—if you consider other morbidity, hospitalizations, costs, and misery, the positive effect of measles vaccinations would be much, much higher.

Boosting immunity doesn’t just help the individual child. The entire community is protected when the risks of infection drop, including the risk to newborns and elderly people, or people who are already sick.

Don’t be fooled by the fake immune-boosters—the colon cleanses, the “Airborne”, the pills and potions pushed by the multi-billion dollar supplement industry. Real immune boosting does not rely on magic. Get enough quality sleep, eat a healthy diet, get some exercise, and take reasonable precautions like washing your hands and avoiding sick people. And, please, make sure you and your children have received all of the recommended vaccines. Protect yourself, protect your kids, protect your communities. Vaccinate!

MMR litigants’ new target: their own lawyers

The Pediatric Insider

© 2014 Roy Benaroch, MD

This would be funnier if it weren’t so sad.

Back in 1998, British gastroenterologist Andrew Wakefield published The Study That Started It All: 12 children he claimed had developed autism as a result of the MMR vaccine. Since then, that execrable “study” has been shown to have been an “elaborate fraud”, with findings faked to support Dr. Wakefield’s own patent application for a competing vaccine. He was also collecting payoffs from plaintiffs’ attorneys suing vaccine manufacturers. It was, simply, always about money.

Now, a British gentleman who was the first plaintiff in a huge, failed class action lawsuit is suing his own attorneys—really, the attorneys hired by his family—for pursuing a claim based on bad science, bilking the British government out of millions of pounds.

Matthew McCafferty, who developed autism three years (!) after receiving the MMR vaccine, is now suing his attorneys for “unjust enrichment as officers of the court by litigating a hopeless claim funded by legal aid by which you profited.” The class action lawsuit fell apart in 2003, after Wakefield’s research was fully discredited (he later lost his medical license because he lied and took advantage of vulnerable children.)

McCafferty’s attorney said:

“The original MMR vaccine litigation was supposed to be worth billions in compensation, not mere millions, but it cost millions in legal aid,” Shaw told the Times. “There was also a huge personal cost for the families involved – all the raised hopes and expectations, driven by the irresponsible media frenzy based on an unsubstantiated health scare and junk science. Not one penny in compensation was obtained for any child. The families are now just beginning to recover and take stock. They are scrutinising the actions of their former lawyers and medical advisers.”

It was supposed to be worth “billions.” Again, it was always about the money. It was never about the health of children.

And yet, here we are. Vaccine-preventable diseases are roaring back. Parents are fearful of one of the safest, most effective public health interventions ever developed. And, the biggest losers of all, millions of families affected by autism, distracted by false hope, lured into distrust by charlatans taking advantage of their children for profit. Just imagine:  if not for all of this manufactured, fake vaccine-worry, how much more progress we could have made developing a better understanding of the real causes of autism, and the best ways to help identify and treat it.

The evidence for the safety of vaccines and the lack of any connection with autism is overwhelming. I suppose the lawyers will continue to fight over the money. Can the rest of us move along now, and work together towards actually helping children?

Vaccine messages can backfire

The Pediatric Insider

© 2014 Roy Benaroch, MD

Vaccine coverage rates, overall, remain very strong in the USA. Well over 90% of kids are well-vaccinated, and the rates of vaccine-preventable diseases remains very low. Newer vaccines have proven especially safe and effective, including immunizations against severe diarrheal illness and cancers of the cervix and throat. In many ways, we are staying ahead in our battle against vaccine-preventable disease.

Yet: there are still pockets of intense resistance to vaccines, resistance that’s based on fear and lies and a willingness of anti-vaccine propagandists to say anything to decrease public confidence in vaccinations, doctors, scientists, and the parents who vaccinate their children. We’ll call these folks the “pro-disease lobby.”

In my practice, almost all families get all of their kid’s vaccines. We talk about what they’re for, we talk about the expected side effects (most babies have none, a small minority have some fussiness or fever), and we make sure parents know how to handle those and when to call if anything worrisome happens. We give out Vaccine Information Statements, which also list potential side effects, trivial and serious. Then we get the babies and children protected.

There are some families who have sincere questions, and those get extra time to get their questions answered, respectfully and patiently.

Then there are those 100% devoted to the pro-disease lobby. They don’t want questions answered—at least not by their pediatrician, not when the internet tells them what they want to hear. Frankly, I don’t even know why they come see me. If they think I’m evil or stupid or thoroughly misguided, why would they trust me with any aspect of child care?

Is there any way to convince these families that vaccines are a good idea? A new study, published today, looked at different vaccine messages: which ones work, which ones help, which ones hurt. The results are discouraging. Web-based surveys were conducted with about 1800 parents in 2011, who were then randomized to receive one of four pro-vaccine interventions.  The four different messages were: 1) information explaining the lack of evidence that MMR causes autism; 2) information about the dangers of vaccine-preventable diseases; 3) images of children who had diseases that could have been prevented with vaccines; or 4) a dramatic narrative about an infant who almost died of measles.

None of these messages, none of them, increased parents willingness or intent to vaccinate. In fact, among parents who were already vaccine-hesitant, these messages boosted vaccine misperceptions. For instance, specific evidence about the lack of a credible MMR-autism link further decreased the intent to vaccine among the parents who were already the most skeptical prior to the study. And the dramatic story about the child sick with measles increased the perception of MMR side effects among parents who already distrusted the vaccine—even though that story had nothing to do with side effects of any vaccine.

Among parents who have the strongest anti-vaccine views, no approach seemed to soften their stance. Instead, most of these attempts to communicate science-based information backfired—increasing anti-vaccine sentiment, in many cases reinforcing specific wrong beliefs that were not even relevant to the message given.

This jibes with my own experience, and what pediatricians say around the water cooler (more likely, honestly, the coffee maker.) The true anti-vaccine, pro-disease parent is essentially in a cult, with fixed delusional beliefs far outside reality. Talking with them only increases their anger and hardens their stance. People do not like to believe that they’re possibly wrong, and would rather listen to viewpoints that agree with their own, even at the cost of their own health. That’s too bad, because their children suffer, and our children suffer too.

Diet and ADHD: Anything new?

The Pediatric Insider

© 2011 Roy Benaroch, MD

The Lancet has published another terrible, worthless study guaranteed to confuse parents.

Back in 1998, the world-renowned British medical journal The Lancet published a study that singlehandedly created the entire MMR-autism “manufacturversy.” The study itself was an absolute fraud based on fake data, designed to make money for its lead author. Red flags about the study were ignored by The Lancet’s editorial board for years; but finally most of its authors retracted the study, and then The Lancet withdrew it. Still, the damage was done. Falling vaccine rates led to a return of measles and surging rates of pertussis. Fooled by an unscrupulous liar and a media relishing any opportunity to sensationalize garbage, many parents still distrust vaccines.

And now, The Lancet has done it again. A terrible, worthless study has been published, guaranteed to confuse parents. Maybe their motto ought to be “anything that’s fit to make headlines.”

The study, titled “Effects of a restricted elimination diet on the behaviour of children with attention-deficit hyperactivity disorder (INCA study): a randomised controlled trial”, was supposed to examine the relationship between diet and behavior in ADHD. It’s an important topic. Many children have trouble with focus and attention, and many parents feel that diet may play a role. Though many older studies have been unable to confirm a consistent effect of foods on behavior, a 2007 BMJ study did show at least a small effect of preservatives and dyes in worsening behavior in children.

What has made studying diet and behavior difficult is separating out what is called “confirmation bias.” Parents who are convinced that, say, a sugary meal will worsen their child’s behavior are very apt to notice when bad behavior follows a junk food meal. But those same parents probably don’t notice when relatively good behavior occurs after sugar, or when bad behavior doesn’t really come after a meal. This isn’t because those parents are dumb or delusional—it’s just human nature. We all subconsciously find evidence to support what we already believe, and ignore evidence to the contrary.

Good science seeks to minimize the effects of this kind of bias by using “blinded control groups”, where the observers don’t know if the child was exposed to a surgary diet or not. In the older 2007 BMJ study, the families were truly blinded: neither they nor the researchers knew which kids received a supplement that was a preservative-n-chemical cocktail, versus which ones got a supplement of “nothing”. Only after the parents made their behavioral observations, and after the researchers performed their statistics, were they allowed to know which kids got which diet. That’s good research. The BMJ study did show a statistically significant change in behavior, though the effect was fairly small. Still, it’s a tantalizing start, and the group is now pursuing a more-specific study trying to identify which chemicals and preservatives might be the culprit. It’s a slow process, but carefully-done, well-controlled research should give us a clear answer on this topic.

Unfortunately, the research group publishing in The Lancet didn’t feel the need to bother with these sorts of protocols. In the initial phase of their study, 100 kids were divided into two groups of 50. One group continued to get an ordinary diet (though they did receive counseling about healthy food choices), and the other group was put on a highly restrictive diet of mostly rice, meat, vegetables, pears, and water. But all of the parents knew exactly what group their child was in. At the end of this study period, about 60% of parents of children in the restricted diet group had improved, compared to “none” of the children in the non-restricted diet.

Wait a minute here. If something completely random happens—let’s say I ask parents to flip a coin, and tell me heads or tails—about 50% of the parents should report “tails.” In this behavioral study, if I ask parents to just decide, “did things get worse or better,” if there was just a random scatter of observations, 50% of the parents should say “worse”, and 50% should say “better.” How could “none” of the parents have seen any improvement? Surely at least some of the children had a few good weeks, even with no change in diet, no?

And if 60% improved in the restricted group, that means 40% didn’t improve, or got worse. A 60-40 split isn’t really that impressive, is it?

Besides, with no blinding whatsoever, what does it even mean?

The study gets worse. There was a phase 2 that took the “diet responders” and put them on even more restricted diets based on blood testing for allergies—but using an outdated, worthless test that’s been invalidated for years. This further phase found that the blood tests didn’t help guide parents to diets that would help, which is no surprise because those blood tests don’t work. We already knew that.

There you have it, another terrible study from The Lancet, which demonstrates nothing in a perniciously misleading way. Perhaps there is a link between diet, chemicals, preservatives, and behavior—and certainly, trying to put children on a diet that avoids these sorts of chemicals can’t do any harm. But these authors, and the editorial board of The Lancet, ought to be ashamed of publishing such a worthless study. Do you think the media, and the public, are ready to get duped again?

Welcome back, Measles

(with apologies to Gabe Kaplan and the Sweathogs)

Welcome back,

We had a vaccine to knock you out.

Welcome back,

They’re the same families who once laughed about.

Though it’s safe, MMR, it’s been kicked around

You waited for your chance, now you’re back around.

Who’d have thought we’d meet you? (Who’d have thought we’d meet you?)

We’d already beat you. (We’d already beat you.)

The mortality’s a lot, yeah it’s more than just some spots

Welcome back.

Welcome back, welcome back, welcome back.

It’s a travesty. A vocal but entirely misguided minority is succeeding in bringing back a once-vanquished, deadly disease. Measles is truly back, in the United States, Great Britain, and other countries where anti-MMR hysteria has replaced sound science and good thinking.

For more details about how bad science, money, and media hysteria combined to create the illusion that there is controversy whether MMR is safe, read this detailed and very revealing account.

Better safe than sorry? Vaccinate!!

Katie posted, “While most doctors agree that vaccinations are necessary, there has been a lot of talk about spacing them out. I.E. the more necessary or severe diseases first or not giving “group” shots such as MMR, but doing one at a time spaced out. How do you feel about this? Is it possibly a ‘better safe than sorry’ approach worth entertaining?”

If you’d rather be safe than sorry, the best thing to do is get your child vaccinated, and encourage every parent in your community to do the same. If all of our children remain fully vaccinated, we’ll maintain the great protection against these diseases that we’re all taking for granted now. But as soon as a sizable number of children go unvaccinated, the diseases will return.

MMR does not cause autism

Bobbie posted: “I’ve heard that the MMR vaccine has been linked to Autism in several studies over the past few years but it is not recognized formally as an issue with the Pediatric Association. My 18 month old son is due to get his shots tomorrow and I am not sure if he really needs the MMR. Is it worth the risk? What are your thoughts?”

Many excellent studies have confirmed that MMR is NOT a cause of autism. Your child should receive his dose of MMR.