The Lancet article was thoroughly unconvincing even if the data behind it was sound. A study on TWELVE children was used to make broad conclusions regarding the safety of the MMR vaccine. Well, it turns out that the fundamentals of this limited study were not sound – they were exaggerations and complete fabrications.

Thanks to Wakefield and the hysteria he created, measles is a resurgent problem in the U.K. According to the Times, in 1998, when Wakefield’s “study” was published, there were 56 cases of measles in the U.K. In 2008, there were 1348. In 2006, a 13 year old boy in northwest England became the first measles DEATH reported in the U.K. in 14 years. We’re starting to have measles outbreaks here because more & more people are delaying or avoiding vaccines based on “science” from attention-seeking cretins like Wakefield.

I certainly hope that this story serves as a wake-up call, but I fear that Wakefield’s lies and their dangerous consequences will unravel far too slowly.

Hat Tip: the Pundit

No matter how you slice it, the vaccine schedule represents a miniscule exposure to antigens and organims compared to what people encounter as part of life. Worrying about the exposure from the vaccine schedule is like worrying about a thimble of water getting you wet when you are swimming in an ocean.

Dr. Mark Crislip, Science-Based Medicine. Dr. Crislip also produces QuackCast.

Check the link and read the whole post. It’s an enlightening exposure of the absurdity of anti-vaccine rhetoric.

Hat Tip: Respectful Insolence.

Dr. Weller died Saturday, August 23, 2008 … one of the greatest heroes of American history whose name would only register head shakes and quizzical stares from most folks. It’s a great shame that sports legends and actors receive more kudos than this man.

Cheers, Dr. Weller … and thank you so much for your great work.

Hat Tip: the Pundit.

According to the current guidelines, all children between 6 months and 5 years and all those who care for children in that age range (or younger) should receive the influenza vaccine. Adults over 50 should also get vaccinated, and anyone between 5 & 50 with a chronic medical condition such as asthma, heart disease, renal failure, diabetes or neurological conditions should also be vaccinated. Healthcare workers and their families should be vaccinated as well.

Let me clear up a common misconception … influenza does not usually involve vomiting and diarrhea (gastroenteritis). While such illnesses are commonly called “the stomach flu”, they are not caused by influenza. Influenza is a respiratory illness presenting with nasal congestion and dry cough, although often the dominant and debilitating features are high fevers, headaches and muscle pain. Flu has the nasty tendency to cause prolonged high fevers … usually 3 to 5 days, but sometimes up to a week, often with temps of 103+.

There are treatment options available … if you get to your doctor within 48 hours of symptom presentation, and if you have insurance. Illinois Medicaid won’t cover Tamiflu (oseltamivir) or Relenza (zanamivir), the only treatments recommended by the CDC.

According to my Epocrates Rx, a course of Tamiflu costs $84.99 and a course of Relenza costs $63.99. Amantadine is covered on the public aid formulary, but the CDC does not recommend the use of amantadine or its cousin rimantadine since resistance rates to these antivirals are so high as to make the drugs nearly useless. The adamantane derivatives are also ineffective against Influenza B, while Tamiflu and Relenza have activity against A & B.

None of the available antiviral therapies are spectacular. At best, they might reduce symptom severity somewhat and shorten the course of the illness by a day or two. Their best use may be for chemoprophylaxis … using the drug in a “healthy” contact who is exposed to the flue. This use may prevent a high risk individual from acquiring the flu if they are exposed to a sick family member.

If your child is otherwise healthy, often the best (and only) solution to the flu is some TLC, lots of fluids and ibuprofen (NO ASPIRIN!!!) every 6 to 8 hours. Be on the lookout for the development of secondary bacterial infections, however. If your child seems to be getting better and then takes a turn for the worse, you should definitely seek medical attention. Ear infections are a common secondary infection associated with influenza in children, and bacterial pneumonias are frequently the cause of influenza-related deaths.

Influenza is estimated to kill an average of 36,000 Americans every year. These deaths are mostly among the elderly, but a few hundred children die each year as well. Many deaths could be prevented if a comprehensive vaccination strategy were instituted. Such a strategy would also reduce the loss of work days and productivity, increase winter school attendance rates, reduce hospitalizations & medical office visits and reduce the use of antibiotics (which are often prescribed to flu sufferers out of misrecognition or to treat secondary bacterial infections).

Get your flu shots while they’re still available!

She’s probably really regretting it now.  She has a post about the unfounded and extremely dangerous MYTH that autism is linked to vaccination. I, of course, went on a rant.

Breastfeeding, when successful, is the best source of nutrition for an infant’s health, and I encourage every mother to breastfeed in accordance with the recommendations from the American Academy of Pediatrics (exclusive breastfeeding for the first 6 months of life). Along with being a nutritionally complete and balanced food source, breast milk also contains maternal antibodies that protect infants from many childhood infections. That immunological benefit will never be replicated by formula because it’s just too cost prohibitive.

However, I recognize that breastfeeding is a challenge in today’s stressful, fast-paced world. I think Diane Vespa did a good job on PI’s site outlining the reasons for this. For moms in financially secure families who have a good support system and are able to stay at home with their children, it’s relatively easy to breastfeed. That same task becomes nearly impossible for an impoverished single working mom with zero support other than brief visits to her pediatrician. Some moms in that situation still manage it (to my amazement), but we shouldn’t make mothers who are already stressed and struggling to support their children feel like failures because they can’t sustain breastfeeding. There can also be medical and/or psychological issues that make it impossible for a mother to nurse, so we shouldn’t be overly judgmental.

In this country most children do fine on formula, although there are risks. Constipation is a relatively common problem with formula-fed infants that’s almost non-existent in breastfed children. There is some evidence suggesting links between formula feeding and increased risk for obesity, high cholesterol, SIDS, asthma, diabetes (both type 1 and type 2) and even leukemia & lymphoma (the AAP Policy Statement contains links to the various studies if you’re interested).

However, these increased risks with formula vs. breastfeeding are all very small, and all require further study and confirmation. While the short-term benefits vs. infection are clear, there are just too many confounding variables to link these long-term protective effects definitively, no matter how fervently breastfeeding supporters wish to do so. If you eat Super-Sized Combo Meals from your local fast food joint for every meal, it doesn’t matter whether you were breastfed or formula fed as an infant – you’re going to become obese.

Formula does carry the risk of triggering allergic sensitivity to the cow protein in the formula, but that can also occur in breastfed children if the mother consumes dairy products. Sometimes milk protein allergy can be so severe that children require elemental formula or even IV nutrition for part of their lives. Fortunately this severe allergy is quite rare. It’s also often true that children who have THAT strong of an allergic tendency will be become atopic no matter what they’re fed as an infant, although earlier sensitization does make things worse.

There are also times when breastfeeding is not a good idea. In countries where clean drinking water is readily available, HIV positive mothers absolutely should not breastfeed. There is a significant risk that they will pass the virus to their infant. In developing countries this risk is outweighed by the risk of death from dysentery because the formula is reconstituted with contaminated water, but that’s not the case here in the United States.

I’ve also seen one case where the infant of a Vegan breastfeeding mom ended up in the pediatric intensive care unit at 9 months old with failure to thrive and cerebral edema due to severe malnutrition, profound iron-deficiency anemia requiring multiple transfusions and severe rickets (bone demineralization and malformation from vitamin D deficiency). These cases are quite rare, but it does happen.

Breastfeeding isn’t for everyone, and its protective effect on a child’s immune system is certainly NOT an adequate substitute for childhood vaccination. It frustrates me that many of the same folks that are militantly pro-breastfeeding are often also militantly anti-vaccination. I support both breastfeeding and vaccination, but if I had to choose between one or the other, then I would choose vaccination any day of the week.

Some obviously don’t agree with that choice, but I think the 300-500 million people killed by smallpox in the first 77 years of the 20th century would agree with me. They can’t, of course … because they’re dead.

I think the 20,000 afflicted with congenital rubella syndrome during the last large-scale rubella epidemic in the U.S. would also agree with me. Of course they couldn’t understand the discussion … because they’re mentally retarded, blind and deaf.

I think the 10-20 million people worldwide permanently disabled by polio would also agree with me … but then again, some wouldn’t hear my query over the noise of their iron lung.

The victims of vaccination’s lack are quite effectively silenced, and our cultural memory of these horrible epidemics is rapidly fading. Vaccination has become a victim of its own success.

Then again, you shouldn’t listen to me. My soul has been sold for a $55 copy of the Harriet Lane Handbook and a few carry-out lunches provided to me by the companies that sell formula and vaccines. I’m utterly corrupted.

Vaccination is the most important thing that I do as a pediatrician. Absolutely, positively, bar none. Small pox – the disease estimated to have killed 300-500 million people in the 20th century and largely responsible for wiping out the First Nations of America in the 18th and 19th centuries – has been eliminated except for a few lab specimens. Polio, the horrific crippler of millions, is on its way to being eradicated. I’ve never seen congenital rubella or measles. Even chicken pox is now on its way to rare obscurity – I only saw 2 or 3 cases while I was in training. Vaccines are supremely effective preventative measures that have made infectious disease a relatively uncommon cause of death in this country. Thus, all of my children are vaccinated.

The only reason parents with unvaccinated children get away with it is by taking advantage of the “herd immunity” built up by everyone that has vaccinated their children. However, by not vaccinating their children, they chip away at that herd immunity and increase the risks for everyone that an outbreak will become established in the population. In other words, aside from putting their own children in jeopardy, the anti-vaccination crowd also increases the risks for everyone else. Exhibit A – the recent mumps outbreaks in Iowa and the U.K. (scroll to the end of the mumps article for discussion of recent outbreaks).

Have there been cases of vaccine-associated encephalitis (inflammation of the brain)? Yes. They are exceedingly rare … literally one in a million or less. Most were associated with the old whole-cell DPT vaccine that’s no longer in use in this country. Most vaccine side effects are mild and quite tolerable (irritability, tenderness at the site of injection, low grade fever lasting 1-2 days). The recent development of various combination vaccines has reduced the number of injections necessary. On the other hand, if you contract measles (for example), your chances of getting encephalitis with permanent neurological sequelae are 1 in 100 1 in 1000 and your chances of dieing are 1 in 1000 1-3 in 1000 (or 10-50 in 1000 if you’re malnourished or immunosuppressed).  In the most recent major measles outbreak in the United States (1989-1991), there were over 55,000 cases and 123 deaths – so 1 in 447 died despite the modern medical interventions available [italicized corrections and clarifications added 7/3/07].

One of the pediatricians I trained with in St. Louis came from a very successful, professional family. Her father was an oncologist, her mother a lawyer. She was a developmental pediatrician (specializing in the treatment of Autism, among other developmental disorders). Her siblings are all well-educated professionals, except her brother. He was the smartest one of the bunch … until he contracted measles in the pre-vaccine era and developed encephalitis. Now he is mentally retarded and will never live independently. Where do you think she stands on the vaccine debate?

One of the leading proponents of the original MMR-Autism link was a British gastroenterologist named Andrew Wakefield. To my knowledge, all the other initial proponents of that now-debunked link (based on findings in only 12 children and published in the Lancet in 1998; the actual article requires registration and login) have since recanted in the face of overwhelming contrary evidence.

Not Wakefield – he’s sticking to his guns, and profiting handsomely from it. He’s now working at an institute down in Austin, Texas. They charge $390 per hour consultation fees (not covered by insurance and not including costs of their “treatment” and lab testing) to hawk unproven mega-vitamin and detoxification regimens. They also recommend 20-40 hours per week of intensive ABA (applied behavior analysis) and other behavioral therapies that are proven to help with Autism. If the kids treated at this snake-oil institute improve, that’s why … the intensive behavioral therapy, not the thousands of dollars of vitamins and voodoo medicine that they sell to them. Feh!

There is no credible link between Autism and vaccination, the vaccine preservative thiomersal or environmental mercury. It’s all baseless, hysterical voodoo that’s dissuading thousands of Americans from participating in vaccination, one of the greatest medical miracles of the last century.