So, the other day I’m scrolling through Facebook, and I come across this article posted by a Facebook friend. I’ll give you a moment to read it, if you’d like. *sips beverage* Did you read it? Ah, who cares, you knew I was going to explain it to you anyways, didn’t you? I’m more predictable than my toddler when I ask her what she wants to wear (Red. So much red every bull in the tri county area takes notice).
Basically, it details an interview between Tucker Carlson and Robert F. Kennedy Jr. In it, Mr. Kennedy rages against the vaccine industry, lamenting how “Big Pharma” is essentially above the law, claiming they have “blanket legal immunity,” so vaccine makers could make the big bucks. They also get to make their own rules, making it impossible to find out the facts. He rages against the fact that the number of vaccines children get has increased from the 3 he got (he’s almost 70). He’s baffled that we give children the Hepatitis B vaccine, and he claims it is loaded with mercury. He “cites” (I use that word loosely, as you’ll see why later) a recent study and claims that it shows the Tdap vaccine is killing children in Africa. He whines that he is being silenced by the vaccine industry and that no one on TV wants him on their show. Finally, he finishes by surprising the dickens out of me by providing common ground and what I take as an open invitation to go to town, scholar-style, on him: “We ought to be having a responsible debate. A debate that is real, that is based on science.”
Well, in a fit of “someone on the internet is wrong” I decide to comment on this friend’s post with my reassurance that vaccines are safe, that the presence of mercury in vaccines is misunderstood, that the science is being misrepresented and misunderstood, and that the media giving a platform to folks like Mr. Kennedy continues to sew confusion and prevent people from vaccinating their children, which hurts us all. I was surprised when this led to me discovering this person suspects a link between vaccines and autism, that they would advocate for not vaccinating children, and that they suspect the pharmaceutical industry is pulling the wool over our eyes. I really did not know that the belief vaccines cause autism is still a thing. As I later discovered through some surfing of the interwebs with a quick little Google search, though, there are plenty of websites out there making these claims, and some even come complete with references (or, for some, “references”). You can see for yourself examples here and here. There are plenty more if you’re truly curious, but I’ll let you explore for yourself.
Remember my reaction when just one friend on the internet was wrong? You can imagine, then, my reaction to finding whole pages and websites of the internet devoted to being wrong. To quote that rouge-necked sage, Lawrence the Cable Person (this is a scholarly and, let’s be honest, left-leaning blog, so we use formal names and don’t assume gender), I was madder than a skinhead watching the The Jeffersons. So, I decided to attempt to funnel that rage into a blog post, and hopefully avoid bursting a blood vessel in my eye.
Before I go any further down this rabbit hole, though, I need to clarify 2 things. First, I am going to mention autism at several points here, as I’ll be presenting evidence autism, in fact, IS NOT caused by vaccines. Sometimes, I fear, in the process of discussing epidemiology of different disorders, diseases, and conditions, it is all too easy to dehumanize the people we talk about. So, please, if I do a bad job of this further along, let me be good about this now. Autism spectrum disorder is a mental health diagnosis many children and some adults carry. For some, it is mild, for others, it is quite severe. However, no matter how mild or severe, it does not reduce the humanity, worth, or value of any life it affects. It can be quite impairing, but I truly believe each and every person who carries the diagnosis can live a full and meaningful life (especially when connected with the right services or treatment), or at least they absolutely deserve the right to pursue such a life. If my words below make you doubt I believe this, please forgive me, and know that this is certainly not my intention.
The second thing I need to clarify is that I know this may change absolutely no one’s mind. As much as I wish simply providing overwhelming evidence and citing consensus among the scientific community was enough, I recognize that it isn’t. I’m not saying the belief vaccines cause autism or are unsafe is a delusion, but I’ve worked with enough patients who had delusions to recognize that sometimes no amount of evidence is enough. As frustrating as this is, I understand it a little more easily when it comes to matters where I don’t really think evidence is the point, like matters of faith or spirituality. I have a harder time accepting it with matters of science, but I also am willing to own that science is not as objective in practice as it is in theory. Still, on this topic, I am baffled by how people who are educated, intelligent, and have access to (and often have even read) all the literature have chosen to turn their backs on the evidence and embraced quackery, anecdotal evidence, and conspiracy theories. But, it is what it is; I’m not perfect and likely have my own blindspots (I’d list them, but then they wouldn’t be blindspots, would they?). That’s not why I am writing this blog post. I am writing this for me; I’m going to address the points I want to address and say what I want to say. The vaccine topic is so huge, there’s no way I could reasonably cover all angles in one post, so I’ll just address the ones I see as being more obvious or more important. You’re welcome to come along for the ride, but feel free to pull the rip cord at any point in time. Unless you’re my mom, in which case I view your reading my blog as the same sort of maternal dutifulness as keeping EVERY. SINGLE. THING. I. EVER. BROUGHT. HOME. FROM. SCHOOL. Mom, I’m sorry you raised such a pedantic, loquacious scholar, but at least I’m happy.
So, on with the show. First, let’s address the mercury issue. Vaccine ingredients have long been an area of misunderstanding. In the particular case of mercury, it is an element that can come in many forms. The form associated with vaccines is ethylmercury, which passes through the body quickly and multiple studies have found to be generally be safe for humans. This is different from methylmercury, which is the form of mercury associated with mercury poisoning and IS NOT in vaccines. Perhaps you’ve heard this before, but talk of mercury in vaccines in the way Mr. Kennedy is doing would be similar to me suggesting table salt (sodium chloride) is dangerous because it contains sodium and chlorine. Separately, sodium and chlorine are dangerous, but in the form of sodium chloride, they are completely safe (unless, of course, you ate a diet too high in salt, but shoot, even drinking too much water could kill a person – my dad says that fish copulate in water, so that’s why he drinks beer, though I’m not sure that’s what makes too much water dangerous). I am not a chemist, but chemistry is a fascinating thing and this is a great example of how a little bit of knowledge can be a dangerous thing. Finally, I’ll also mention that the vaccine ingredient associated with mercury, thimerosal, was removed from almost all vaccines, except the flu vaccine, around the turn of the century, according to the AAP and the College of Physicians of Philadelphia. Despite its removal, autism rates continued to rise; it is pretty hard to posit a link between to variables if you remove one variable and the other variable continues to increase.
For that matter, let’s also examine this claim that rising rates of autism coincide with rising rates of vaccinations. This is wrong on at least two levels. One, from a theoretical level, almost any good student of science and statistics can tell you that correlation does not equal causation (even if they don’t know what it means; it’s a catchy little jingle that sticks in your head). Put another way, just because rates of two variables change at the same time does not mean there is necessarily any cause and effect connection between the two. We live in a universe of coincidences, and we have to be careful about assigning cause and effect where no such relation exists. For example, Mr. Kennedy points out that his kids have received more vaccines than he did when he was a child. Estimating from his age as stated in the article, since his childhood, there has also been a rise in the number of vehicles equipped with airbags, a rise in the number of iPhones, and a rise in the average temperature of the planet (ooh, snuck one in there without you even seeing it coming, climate change high five). These also are correlations, but I don’t see anyone crying for the truth from the airbag industry, unless it’s about defective Takata airbags, but that’s not the point. The point is correlation does not equal causation.
But, recall, if you didn’t slip into a coma from boredom or tune out when I said the magic words “climate change,” that I said this was wrong on more than one level. The next level is to ask, “Is there even a statistically significant correlation between vaccines and autism?” Well, at least when it comes to the MMR vaccine and rates of autism among kids in California, the answer from this 2001 article in JAMA is no heck no. Well, actually, the answer is “Essentially no correlation was observed between the secular trend of early childhood MMR immunization rates in California and the secular trend in numbers of children with autism enrolled in California’s regional service center system.” But, heck no is a lot catchier, and I like to imagine one of these authors saying such a thing over cocktails at a conference. “Hey Loring, is there a correlation between the MMR vaccine rates and autism rates?” “Heck no, Frank.” “Great, but my name isn’t Frank.” “It doesn’t matter what your name is; you’re talking to a first author of a paper in JAMA.” *mic drop* …and scene (that’s totally how it plays out in my mind).
But, why so many vaccines? For example, as Mr. Kennedy suggests, why vaccinate against Hepatitis B? Although HBV is spread through bodily fluid and can be contracted through needles and intercourse, it also can be passed from mother to child at birth, and vaccinating the infant can prevent this. As people can carry the HBV vaccine and not show any symptoms, depending on what level of prenatal care a mother received, she could easily have HBV, not know it, and transmit it to her child. This is especially concerning because while many people with a fully functioning immune system can fight off infection, it can be quite devastating and deadly in infants who are still working on building a fully functioning immune system.
But, what about the evidence that vaccines cause autism or are unsafe? For example, what about the study Mr. Kennedy mentions about children in Africa. Well, I know this may come as a surprise to absolutely no one who knows anything about science publishing and citation of research when pushing an agenda, but it would appear Mr. Kennedy is cherry-picking research that fits with his narrative, as opposed to actually critically looking at the entire literature as a whole. Also, even the study he has chosen actually provides evidence that vaccines are beneficial, as mortality went down when children received the DTP vaccine and the polio vaccine. You can read this fantastic take down of the article and Mr. Kennedy’s misrepresentation for a much better explanation than I can give.
My larger point, though, is that it is not hard with the proliferation of scientific literature, particularly with some open access journals with minimal or non-existent peer-review where all you have to do is pay to publish, to find an article or two to fit your narrative or back up your claim. Even well done research carried out by intelligent, well-meaning scientists with integrity can make mistakes or succumb to statistical errors, as almost all science works in probability instead of certainty. In such a climate, we can turn to the experts to diligently sift through the mounds of research, to weigh not just the quantity but also the quality of the research, and to help us arrive at a reasonable conclusion.
What do the experts have to say, then, about vaccines and their general safety and autism in particular? As should come as no surprise, if I’m taking the time to write this blog, that the evidence has been pretty overwhelming. Among those all aboard the vaccine train to avoiding-preventable-disease-town, we can include research published in a little rag called the New England Journal of Medicine, the American Academy of Pediatrics (AAP), the Centers for Disease Control and Prevention (CDC), and the World Health Organization (WHO). Even organizations who are dedicated to understanding and developing better ways to address autism, such as Autism Speaks, say that vaccines do not cause autism. Again, you can cite other research all you want, but in the science community, it would be like saying that even though most major film critics agree that the Godfather is one of the better films of all time, your friend Broccoli Rob said it was super boring and too long, so it must be lame. Sure, everyone is entitled to their opinion, and Broccoli Rob can watch the Fast and the Furious films as many times as he wants, but it still doesn’t mean his opinion is equally valid. And we’re talking about the cinematic taste of a horribly nick-named friend and matters of art, not science.
Of course, some who support not vaccinating children like to substitute anecdotal “evidence” for scientific consensus. Their children, or children they know, who have not been vaccinated, are fine and healthy. So, take that, CDC & WHO. The problem with that, of course, is that (as almost inevitably is the case with anecdotes) other stories exist that tell the exact opposite tale, such as this great story written in Slate in 2014, by someone who grew up unvaccinated, was sick often, and because of their experience, definitely is all for vaccinating their own children. The problematic rationale and logic of using anecdotes to make your case is that it only takes one exception to make the whole house of cards cave faster than my three-nager when I grill her, Law and Order style, on who took the last cookie (on a side note, I’m relieved that she apparently will have zero future in organized crime, although I am concerned with her getting stiches for being a snitch in school). That’s why we turn to the systematic collection of observations and data in science to help provide answers in which we can have more confidence.
And, what about a lack of government oversight and blanket legal immunity? Well, I’m sure this is going to make your jaw hit the floor faster than if I said those are my twins Beyoncé is pregnant with (they’re not; sorry for your loss Queen Bey), but again here, Mr. Kennedy is not really accurately representing reality. What I suspect he is referring to is the National Vaccine Injury Compensation Program (VICP), which you can read more about at their website here. In the mid 1980s, there was a flood of lawsuits against vaccines. Not too many people like to spend time engaged in activities that are likely to result in multiple lawsuits (Have you seen how many lawsuits NBA stars tend to have brought against them? It’s the only reason I didn’t go pro. That and I only hit the backboard 50% of the time). So, people stopped making and giving vaccines. As a vaccination shortage loomed, and with it the loss of herd immunity, the government took action. Rather than offer legal immunity, the VICP recognizes that vaccines, although safe, are still a medical treatment, and as such, can never be 100% without risk. For example, in rare cases, people can have an allergic reaction. So, to help both sides out, a special legal process was set up, by which people can petition for compensation if they can provide evidence they were hurt by a vaccine. Even if the petition doesn’t “win,” legal expenses can still be covered. So, in this system, how often are awarded compensation? According to the data collected by VICP, “for every 1 million doses of vaccine that were distributed, 1 individual was compensated.” Over the course of the program, this has resulted in a pay out of over $3 billion dollars – hardly a case for those injured by vaccine being left without any recourse to compensation. Additionally, if you want to keep score on the autism front, there has been one case that was won. So, that totally rips a hole right in the middle of the “vaccines are safe and don’t cause autism” argument, right? Well, actually, no. Not in the least. Legal decisions are not scientific decisions, and the science at the time was pretty clear that the case did not have scientific merit, as written about here in the New England Journal of Medicine much better than I can. What I can suggest though, is that if you’re willing to overturn mounds of scientific evidence and consensus on vaccine safety for one court case, you better also be willing to say with absolute confidence OJ didn’t kill Nicole, as he was acquitted on criminal charges. Otherwise, perhaps we can agree that the VICP does not amount to a lack of government oversight or blanket legal immunity, or to people injured by vaccines having no recourse. Also, this doesn’t even mention the FDA has a fairly rigorous process to ensure multiple steps have been taken as reasonable precautions to ensure drugs are safe before they are even given to consumers.
Hopefully by now, you’re beginning to see why perhaps Mr. Kennedy doesn’t get invited on-air a lot to share his ideas: in a word, it’s because he is wrong. I certainly am no fan of “big pharma,” but I think they are being invoked here by Mr. Kennedy as a boogeyman that confuses the issue (i.e., if you say big pharma is the enemy, then it could easily make someone arguing against you appear as if they support big pharma, when they, like me, might be making points that have nothing to do with support or opposition to the pharmaceutical industry, and simply are questioning the science and validity of his claims). On top of that, although I have never met or spoken with him personally, it also sounds like he might not be the most reasonable or pleasant person if you dare disagree with him. So, hopefully we’ve taken a successful trip with Scooby, Shaggy, and the rest of the gang in the Mystery Machine and solved the case of Old Man Kennedy and why he doesn’t get more air time (“And I would have gotten away with it, too, if it hadn’t been for you meddling kids and your dog… and overwhelming amounts of evidence that contradict my claims”).
However, I’d like to wrap up with a nod to the title of this post. As you saw, I vaccinate my kids. Despite having a child with special health needs, I’m fortunate his health problems (which blessedly, are very well-managed by a wonderful team of health care professionals) don’t prevent him from being vaccinated. I’m grateful that, not only can I help keep my own children safe, but I can also help protect other children who are not able to be vaccinated, and even kids who could be vaccinated but whose parents choose not to vaccinate them (see herd immunity above). Beyond that, though, I also believe actions have consequences. When misinformation gets spread, it’s awfully hard to take it back. And when people act on this misinformation, you have situations like what has happened recently in Minnesota. People who should know better (looking at you with my stankiest stink eye, Andy Wakefield) give people who may not have the education and access to information (or even the English language proficiency) misinformation, and the consequence is an outbreak of a preventable disease in a community already marginalized by much of society.
I am my brother’s/sister’s keeper, and I see myself as responsible for the education of and provision of correct information to my brother/sister when it comes to vaccines. So, I suppose that maybe I did write this blog for more people than myself; even if I’m afraid my brothers/sister will never listen, it doesn’t forgive my obligation to try. And more than that, I love my brother/sister, and I want the best for them. Most of the time, I think that should be up to my brother/sister, but in this case, the evidence is pretty clear, and I feel obligated to speak the truth. “And you will know the truth, and the truth will set you free.” (John 8:32, NLT) And, now, I really do feel free from that “someone on the internet is wrong” feeling. For those of you still with me, thank you for reading along.