Okay, this may be a stupid question, but still...I'm curious. I thought that if one receives his/her measels shot, he/she is immune to measels. So why would being exposed to an unimmunized child with measels be catastrophic? I understand that the hospital had to notify all the parents, etc. at the school, but if the children received their proper immunizations, wouldn't they be safe from infection?

-- LeeS (leestein@goudarock.com), February 15, 2001

Answers

The answer is - not necessarily. Even with adequate immunization about 10% of people never respond to the immunization & do not make adequate antibodies to the disease. Patients are not typically screened to see if the vaccinations were effective. This is done by a blood test to see if there was an appropriate antibody response. Then, not everyone had to have the proper immunization. Immunity can 'wear off' placing the children at risk again. There were a situation early in the history of vaccinations where the guidelines for vaccinations were not yet understood. There for a while anyone born before 1960 had to be either re-vaccinated or have titers checked to make sure they had the proper immunity. There were outbreaks of mumps on a few college campuses in the 1990's because of this. This would apply to the staff & parents of the children. And now there had been a significant number of people who have opted out of immunizing their children. They are obviously at risk for contracting these communicable diseases. There are also strains of wild measles & other things that are not covered by their respective vaccines. I thought this was handled reasonably well. I did not believe that Deb would know the mortality rate of measles off hand after being away from work for 6 weeks. It's hard to remember the dose of Tylenol after 2 weeks off. And the majority of children get the measles with no adverse effects. So of course this kid has every adverse sequella in the book including death. That was unbelieveable but consistent with this show these days. They could show the effects of not immunizing kids without all this drama. Then again, I'm only glad we were spared having the entire daycare center & relatives descending upon the ED at the same time during a blizzard with no electricity.

-- (ripwoman@aol.com), February 15, 2001.

Jing-Mei has a photographic memory, we learned in season one, so I have little doubt that she'd remember a fact like mortality rate.

-- Phyl (erfan@flash.net), February 16, 2001.

If an immunized person is exposed to measles, could s/he "carry" the virus to un-immunized people?

As one of the Ancient Ones born before measles vaccination, I had measles at about age 7. It was considered dangerous to the eyes, so I had to stay away from bright lights for about 2 weeks and was not allowed to read, which was very frustrating.

-- Driad (driad@mailcity.com), February 16, 2001.

Children can carry home contagious diseases and it can be very bad for infant siblings and pregnant moms. Measles are very dangerous -- they had to disinfect that whole exam room. It's certainly a choice that a parent gets to make, but in reality, they're making that choice for a whole lot of other people, too.

-- sdw (me@noemail.com), February 16, 2001.

Re: ripwoman's post: I had the MMR vaccine shortly after I was born, but it was later determined by the county health department that I, along with everyone else vaccinated during that three-week period, had received a faulty batch. I was re-vaccinated again at 14, and tested for the antibodies which were found to be non-existent. So, I received the vaccination again. It finally stuck, but I suffered from encephalitis as a side-effect. (Encepahlitis is often a complication of measles.) So, granted, my story doesn't explain why anyone would flat-out refuse to have their child vaccinated, but it does explain why measles had been irradicated.

-- Cathy (cybercathy@wi.rr.com), February 16, 2001.

Okay, that should say hasn't been irradicated. And I used to be a proofreader... Sheesh.

-- Cathy (cybercathy@wi.rr.com), February 16, 2001.

Maybe I'm being judgemental, but I was appalled at the parents who didn't immunize their children. Someone didn't read Little House on the Prairie, or Little Women, or any other historical fiction. Measles, and mumps are very serious and can be deadly. Uh, hello, back in the bad old days parents lived in fear of these illnesses. Kids DIED. There is a REASON we have vaccines. (And this mother thought she was being "educated" and "informed". Grrr.. I had to agree with Cleo's comments on this one.)

Even chicken pox can be very serious. I had it at 17 and it damn near put me in the hospital. I know there are some reservations about the new vaccine, but I for one am getting my future children immunized, thank you very much.

And ripwoman, I was at one of the colleges that had a measles scare in 1990. I think that the vaccine changed in the late 60s. I don't remember the cutoff year, but one of my friends was apparently immunized before the vaccine changed, so she went down to the student health center and got re-vaccinated. I checked with my mom and I was ok for vaccinations.

-- S. Trelles (trelles@ix.netcom.com), February 16, 2001.

Hi, I'm normally a lurker, but yeah, measles vaccines do wear off. I remember having to be revacinnated in high school because of an outbreak in my area.

-- Cynthia (petitecosette@yahoo.com), February 16, 2001.

The problem is not that the show was trying to educate people but in fact, continuing the process of pulling the wool over people's eyes.

Measles started declining significantly before the vaccine was ever started. Better water quality, less out houses, and better living conditions are all factors in that.

In 1958, there were 800,000 cases of measles in the US. By 1962, that number had dropped to 500,000--that's one year before the vaccine was introduced. During the next four years, children were vaccinated with an ineffective and now abandoned "killer virus" vaccine. Yet the cases dropped again, to 200,000.

What really bothered me what the one-sided view they gave. My 8 and 10 year old daughters are both immunized but one of them has medical problems I know came the vaccines. I was so angered to hear all the actors spouting out righteous lines like "Rich people think that all the poor children are vaccinated so they don't have to." When is being concerned about your child's welfare a property of the poor people? I was also concerned that Carter countered the mom's arguments by saying there is no connection between autism and the vaccine. Yes, there is no proof of that but there is proof of a connection between encaphalitis, the very thing that measles can cause. In fact, there is a growing movement among doctors who choose not to have their own children vaccinated to avoid possible health risks but continue to vaccinate other people's children.

Finally, I would point out that there has never been a study about the long term effects of having these vaccines in your body. With all the money we spend research things like cow flatulation, wouldn't it make sense to know what we are putting in our children's systems?

-- Amy (amy@interversity.com), February 16, 2001.

It makes you a bit cynical when right after the measles scene they show a commercial about the new pneumococcal vaccine. My children have been vaccinated but I am not totally comfortable with vaccinations because too little research has been done on possible long term side effects. And it is wrong for this show to be so one sided in its view. Parents are not criminals for being concerned about vaccines. Too many parents of autistic children swear there is a relationship between MMR and autism. I thought the child dying of the measles, while possible, was pushing things too far. I think we got the message that measles is a serious disease. ALso, here in New York it would be highly unlikely that a child would be allowed into any daycare or preschool without having proof of all immunizations.

-- Cheryl W. (cfaz13@optonline.net), February 16, 2001.

Wyeth Lederle probably loved this episode - what better moment to air a commercial on your new vaccine? (Prevnar - "protect them from certain pneumococcal bacteria that can cause life-threatening meningitis and blood infections") As to the measles story line - I suppose it's a bit of a gamble anyway you look at it. Administer the vaccine and risk possible side effects or rely on herd immunity and risk contracting the disease. Is there an absolutely correct choice? (I had my two children vaccinated.) Still, the story line was a bit heavy handed. And wow, I would never want one of my children going to County - the odds of survival are pretty bleak!

-- Stacy (kistro@yahoo.com), February 16, 2001.

I have a 10 month old who is due for that MMR vaccine in 2 months. I have to decide if I want her to get it. The chances of catching measles AND dying of it are probably one in a million, and the risk of dying (yes dying) of the vaccine itself is also about 1 in a million. Not to mention, when the 4 year old would have been due for that vaccine (about 3 years ago) there was no research to prove that it did not cause autism. The research has only been released recently and did not get nearly the press that the scare stories did. I was appalled by Carter's smirk at the parents in the PICU. As if to say "see you got what you deserved" I wish he could see the results of a vaccination gone bad where you start with a perfectly normal and healthy baby and after a "routine" shot they die. Maybe he would be more understanding about why some parents feel that their kids are more at risk from the shot than the disease.

I would have liked to have seen some real dialog about the real risks and benefits of vaccines instead of a manipulative PSA.

On a slightly different note, they said the family had been in France and caught it there, don't you have to have those shots for foreign travel?

-- Joann F (felczan@msn.com), February 16, 2001.

Proof that the vaccine can not cause autism?

I don't think so. A good friend of mine certainly has seen proof that the vaccine can cause autism.

That proof is her brother.

-- Rusty Priske (rusty.priske@hrdc-drhc.gc.ca), February 16, 2001.

I have been reading a bit about the measles since we're having an outbreak in our city, and most of the literature says that BEFORE the spots starts there are flu like symptoms... runny nose, fever etc... and then white spots in the mouth.

So... if the kid was having flu-like symptoms, why was he in the preschool?

Other info I've found on measles: http://aepo-xdv-www.epo.cdc.gov/wonder/prevguid/m0053391/body001.htm http://www.cdc.gov/nip/publications/pink/meas.pdf http://www.immunize.org/ http://www.pathguy.com/antiimmu.htm

-- Chris (LansdaalFamily@home.com), February 16, 2001.

None of the preschools, daycares, or schools in my area will take a child without proof that he/she has been immunized.

About it spreading...the ambulance drivers were mad that they were not told and didn't decontaminate their rig and then transferred an immuno- depressant patient in it. So it must stick around in the air for awhile?!

-- amanda (amanda.rehm@home.com), February 16, 2001.

Proof that the vaccine can not cause autism? I don't think so. A good friend of mine certainly has seen proof that the vaccine can cause autism. That proof is her brother.

And I'm proof of exactly the opposite: I've had every single one of my shots (and a number that most of you have probably not had), and I'm not autistic. Neither are any of my co-workers, friends, siblings, their kids, my kids, and an awful lot of other people on this planet who have all been vaccinated and haven't developed autism, or any other serious complications from being vaccinated (except maybe a sore arm from my last HepB series).

Vaccination is a medical procedure. Like all such procedures, there is a finite non-zero risk. You have to decide whether that risk is acceptable compared to the potential benefits; it drives me nuts to see people talk about a 1:1,000,000 risk as though it were somehow significant to the general population and that it's an unacceptable risk compared to the proven benefits of the procedure. Yes, I suppose it's significant if you're that person, but without closely controlled studies it's impossible to prove causation or to say definitively that a particular procedure caused a particular bad outcome. Vaccination is a particularly picky issue for me because it has impacts far beyond yourself -- I'm a huge advocate of flu vaccination, not necessarily because it will keep you from getting sick, but because it will prevent you from becoming a carrier and infecting other people.

(People worry about Ebola, or anthrax, and think they're going to be the bugs that wipe us out. I worry about the flu. It has happened before; it will happen again. Vaccination is how you prevent it from being as bad as it was in 1918.)

This really is one of those "if you're not part of the solution, you're part of the problem." And if I'm a part of some conspiracy between the drug companies and the government, I want my check. I have bills to pay this month.

With respect to autism, I doubt we'll ever know because there's no way to get a randomized cross-over controlled study going (I can't give you the vaccine to see if you develop autism, then take it back and see if the autism goes away), and any research into the area is necessarily going to be based on anecdotal and retrospective evaluations, which are inherently unreliable and lack the power to prove anything. There may well be a correlation between the use of a particular vaccine and autism, but I bet you I can show a correlation between autism and parents watching Rush Limbaugh during pregnancy, or power lines, or hanging around fluorescent lights, driving SUVs, or eating Doritos. It doesn't mean there's a causal relationship. I'm deeply suspicious of people who fail to understand a basic tenet of statistics and science; it makes me wonder exactly what their agenda is and why they're pushing so hard.

-- Mike Sugimoto (phloem@fumbling.com), February 16, 2001.

Mike,

And I'm deeply suspicious of something that the medical profession has to push so hard. If the vaccines were everything they were cracked up to be, why do doctors have insurance to protect themselves from lawsuits involving the effects of vaccines.

And why do you feel it necessary to put some sort of "conspiracy theory" spin if someone has some basic questions about a "medical procedure" as you call it?

-- Amy (amy@interversity.com), February 16, 2001.

The fact that it doesn't cause autism in every case equals proof that it never happens? That's pretty faulty logic Mike.

What I said is that there is proof that it _can_ happen.

What made me angry about the show is not that they took a stand that immunization is worth the risk (I actually tend to agree). What made me angry is that they claimed that there was _no_ risk with immunization. That is blatantly false and incredibly irresponsible of them.

-- Rusty Priske (rusty.priske@hrdc-drhc.gc.ca), February 16, 2001.

I think it is very interesting that you consider cases where no one got hurt from vaccines to be proof that it is not dangerous, but cases where something bad did happen to be irrelevant.

A causal relationship is hard to prove no matter what the question is, and if the complication is rare, all the more difficult. For instance, here in Cincinnati, this year there was a shortage of flu vaccine and it did not become widely available until January. On the last day of January the local news reported that this year there had been the lowest number of flu cases in 25 years. I doubt the 2 are connected, but how do we go back and prove it?

Vaccines are a sticky point for me because any other medical procedure I am given full disclosure on the risks and benefits and I am never forced by law to do something I don't consider to be in my child's best interest. The state of Ohio requires the Hep B vaccination to get into school, but the research was not all in about whether or not it could cause CP when my son was starting school. Both my kids are up to date on their shots, but not without a great deal of lost sleep over whether I would be that 1 in a million.

-- Joann F (felczan@msn.com), February 16, 2001.

Rusty,

You made my point quite nicely. I'm not saying get the vaccines--I'm not saying don't get them. I was just very angry at the way the parents were portrayed on the show and the heavy-handed message. I don't like it when any one's integrity or sanity is questioned just because they don't agree with the powers that be. Especially on a show viewed by so many people. I completely agree that it was irresponsible on the part of the show's creators and network.

Amy

-- Amy (amy@interversity.com), February 16, 2001.

And I'm deeply suspicious of something that the medical profession has to push so hard. If the vaccines were everything they were cracked up to be, why do doctors have insurance to protect themselves from lawsuits involving the effects of vaccines.

Well, maybe you should be deeply suspicious of seat belts and child restraints, 'cause we're pushing those pretty hard too. Oh, and proper nutrition, and exercise, and universal access to health care.. need I go on?

Physicians carry insurance to protect themselves from lawsuits resulting from anything. We live in a hyper-litigious society; people will sue for anything and everything. It has nothing to do with vaccines and everything to do with the sense that you should be able to file a lawsuit when things don't work out the way you want.

A friend of mine was sued as a resident because he performed a thoracotomy on a moribund patient (alcohol-involved MVA, should have been pronounced dead at the scene but wasn't). The family alledged that my friend lacked the requisite experience to safely complete the procedure and that the patient died as a direct result. It wasn't even remotely true (I would have called it on arrival then yelled at the medics for transporting, that's how dead he was), but before the suit got tossed it cost my pal something like $25,000 in legal fees (which as a resident he didn't exactly have sitting around in the bank). That's why you have insurance: Because it costs you money even if you haven't done anything wrong.

And why do you feel it necessary to put some sort of "conspiracy theory" spin if someone has some basic questions about a "medical procedure" as you call it?

I don't. I was responding to the general perception among opponents of vaccination that physicians are colluding with the pharmaceutical industry to knowingly push a harmful product on a society that is deliberately being kept in the dark.

The fact that it doesn't cause autism in every case equals proof that it never happens? That's pretty faulty logic Mike. What I said is that there is proof that it _can_ happen.

No, what you said was, basically, "my friend's brother was vaccinated and then he developed autism," the implication being that because your friend's brother was vaccinated and then became autistic, the vaccine was to blame. This is the post hoc ergo propter hoc fallacy: The fact that one event follows another does not mean the first one caused the second. In the absence of solid, causative data, what you have presented is a coincidental correlation, and I have to say that having reviewed a good chunk of the literature on this subject, that's all that has been offered as "proof" that MMR vaccinations (and DTP, in case anyone was wondering) "cause" autism.

If that's not what you meant, I apologize pre-emptively; please clarify your position under those circumstances.

To prove that the vaccine causes autism, you would have to reliably demonstrate that there is a higher incidence of autism in children who have been vaccinated versus children who have not using roughly equal sample sizes (in this case, you'd need 10,000+ kids in each group). I wish you luck.

Autism is going up. Nobody knows why. Vaccination is at an all-time high among kids. It is normal to expect that some of these kids who have been vaccinated will later develop autism. It's irrational to conclude that because they were vaccinated, they developed autism. That's my point.

What made me angry is that they claimed that there was _no_ risk with immunization. That is blatantly false and incredibly irresponsible of them.

I'd agree, and I've complained about this kind of thing in the past (particularly with Greene's astrocytoma), but I also realize that it's not their job to show both sides of the story. Anyone remember "Love's Labor Lost"? It scared the crap out of pregnant women all over the place, but there wasn't ever a discussion of relative risk factors involved. In the interests of drama and time, some things get sacrificed; you might not like what got scrapped, but it happens, and obviously you can do something about it since you're here complaining.

I think it is very interesting that you consider cases where no one got hurt from vaccines to be proof that it is not dangerous, but cases where something bad did happen to be irrelevant.

You must account for the effects in all patients who undergo a particular procedure in order for your results to be valid. If you tell me that pornography causes men to go out and rape women, you also have to explain why there are plenty of porn-addicts who are not sexual offenders. Folks claiming that vaccinations are harmful need to explain why there are so many people who have suffered no ill effects from them, as well as explaining why they're harmful in certain people.

The preponderance of evidence to refute claims of the dangers of vaccine carry more weight than isolated cases that cannot be conclusively linked. Such is the nature of science.

I don't like it when any one's integrity or sanity is questioned just because they don't agree with the powers that be.

Going back to the example I used at the beginning of this post, there are some people out there who think seat belts are a violation of their civil rights and freedom and thus don't wear them, or require their children to wear them; they won't put their kids in car seats because The Man has no right to tell them what to do. Are they sane? Are they rational?

Remember that this is a show about doctors who, despite their inherent diversity, generally think and feel the same way about a number of things. It is written from their perspectives; expecting a show like this to be a comprehensive examination of a particular subject is a bit like asking Nova and PBS to include equal time for people think the moon landings were a hoax in a documentary on NASA.

-- Mike Sugimoto (phloem@fumbling.com), February 16, 2001.

Uh, Mike, you can do a study to see if there is a greater incidence of autism with vaccination. You need matched comparison groups, not randomized cross-over controlled studies (what that is) (which is why when doctors do research, they should run the research design by psychologists or sociologists who are trained to do them, because it takes a few years of graduate work to learn how to do research design, and doctors simply don't have the time to learn it properly, although they are the ones who get the MRC and NSERC funding, while we have to pay out of our own pockets..... sorry, got off track). I have a lot of respect for your medical opinions. But in this thread, your homework is clearly on medical issues, not research ones.

My point about this story line is that it is unnecessarily hysterical. As I said in another thread, my child developed measles 6 weeks before her scheduled immunization, and her doctor (head of paeds at a teaching hospital) basically said "Okay, here is what you do" and didn't call out the SWAT teams or the National Guard or whatever else this show wanted. Measles is not Ebola, which is how this episode treated it.

It is established that there is a risk to immunizations, however minimal. Parents must be educated so that they can make informed decisions. Hysteria is not helpful.

-- Kate (yfpy0050@york.ca), February 16, 2001.

All right folks. Let's just agree that everything living/dead on this earth is theory...no right answers, no wrong answers! Everybody makes their own decision based on what they've learned. Let's move on!

-- LeeS (leestein@goudarock.com), February 16, 2001.

Kate, I've been trying to send you some e-mail directly (research methodology question re: randomizing comparative groups; no point in cluttering the bboard), and your address is bouncing. Could you drop me a note privately so I can get in touch with you?

-- Mike Sugimoto (phloem@fumbling.com), February 16, 2001.

Mike,

The difference between seat belts and vaccines is that the seat belts have been proven to save lives. You can't show that with vaccines.

Last time on this subject--I promise.

-- Amy (amy@interversity.com), February 16, 2001.

The difference between seat belts and vaccines is that the seat belts have been proven to save lives. You can't show that with vaccines.

I only have one question for you: Are you really sure you want to make that claim? Think long and hard about the answer before you say anything, and be sure to take a formerly very lethal disease that has now been totally eradicated into consideration when you do.

-- Mike Sugimoto (phloem@fumbling.com), February 16, 2001.

I agree with both Kate and Mike. My third (and, as you can see, LAST) child is now 10 weeks old and we are going through the vaccination series at each well baby visit we like to call mutilation (because that's what happen's to mom's heart when those three needles go in that tiny leg)! Vaccinations are a matter of weighing the odds - plain and simple. I choose the route of vaccinations because I have seen some horrible suffering from not getting them. I have friends who choose not to get the chickenpox shot because of some rumor of spinal side effects and that "it really doesn't protect them". Well I had a close friend's son almost die from complications from chickenpox. He suffered for a long time. My best friend has cycstic fibrosis and can't leave the house for fear of contracting anything. And just because the vaccinations exist doesn't mean everyone is protected and you can safely not vaccinate your child. There are an awful lot of immigrants, legal and illegal, who bring in disease everyday. Yes, the episode was overkill. But so is unproven rumors and scare tactics (on both ends of the issue).

-- Sharon (my3sonsand_done@hotmail.com), February 16, 2001.

Mike,

I believe we will have to agree to disagree because we will never see eye to eye on this subject.

Amy

-- Amy (amy@interversity.com), February 16, 2001.

Go Mike! The voice of reason!

Quote "The chances of catching measles AND dying of it are probably one in a million, and the risk of dying ... of the vaccine itself is also about 1 in a million."

But the vaccine you're talking about immunizes against measles, mumps and rubella. What are your odds of getting one of the three and dying? I bet they're higher than your odds of dying from the vaccine itself.

Quote "if the kid was having flu-like symptoms, why was he in the preschool?"

Yeah. 'Cuz I don't know ANY parents who drop their kids off at preschool when they're sick. (Rolls eyes).

Quote "If the vaccines were everything they were cracked up to be, why do doctors have insurance to protect themselves from lawsuits involving the effects of vaccines."

As Mike so eloquently stated, it's because people will sue for virtually any reason, and doctors need insurance to help pay the costs to defend against any suit, even a frivolous one. Part of my legal practice is medical malpractice defense work. On average, it can cost between $15,000 and $20,000 to defend a doctor against a baseless suit where the plaintiff's claimed injuries are minimal. The numbers get much higher in a baseless suit where the plaintiff claims catastrophic injuries. (Mike's friend got off lucky if his fees were only $25,000).

In other types of defense work, the defendant's insurer will often settle based on a cost/benefit analysis -- how much will it cost to defend a frivolous claim versus simply paying the plaintiff "nuisance value" just to get rid of the lawsuit? Unfortunately, doctors don't have that option, because any settlement is reported to the medical licensing board, and stays on the physician's record as if he or she had actually committed malpractice.

-- Beth (bsmith@internet-95.com), February 16, 2001.

Regarding a couple of the above comments:

I was wondering, too, how a child could be enrolled in school w/o required immunizations- I thought it was the law. There is an alternative for parents who don't want to immunize: home-school your kids.

When it came time for my kids' immunizations, I had heard about the autism possibility and was worried about other risks, too. I was very unsure, and I really didn't have all the research at hand, and I didn't understand both sides of the issue. Ultimately I placed all my faith in the pediatricians, and my children's well-being in their hands. I wasn't comfortable with it, but I had to make a decision. It was not an easy one to make.

-- Maureen (shepcaff@ix.netcom.com), February 16, 2001.

Different states have different laws regarding requred immunizations for school. There are some states that allow children to attend school unimmunized based on religious reasons & I guess philisophical reasons that do not require the children to be home schooled.

Going to Europe, particularily western Europe, does not require immunizations or any kind of shots.

The episode was very heavy-handed in favor of immunizations. It probably does reflect the majority opinion of the medical establishment. It was overdone in that the kid died the same day. I didn't think Carter was smirking as much as he was just looking at the parents as the child died. I mean, what can you say to these people at this point that does not sound like I-told-you-so?

This is obviously a very touchy subject. It is true that the diseases we vaccinate against for the most part are pretty life- threatening - like polio & diptheria. The vaccines themselves are better now that technology has improved. For instance, the Heptavax [vaccine against Hepatitis B] used actual virus particles that could potentially give you Hepatitis - I don't remember the infection rate. The new vaccine - Recombivax - uses recombinate DNA & no actual virus. There is absolutely no risk of contracting Hepatitis B from it. However, as with any medicine, there are allergic side effects, risk of infection at the injection site, any number of risks. In general, the risk outweight the benefits. With any medication, test or proceedure the physician & the patient must weight the risk of the test versus the benefit. If the risk outweights the benefit - don't do it. If the benefits outweights the risk - then consider doing it. Those parents felt the risk, for whatever reason - real or imagined, outweighed the benefits of the vaccine. That's all there is to it. We live in a free society & people are allowed to make decision other people may not aggree with but that's the way it is. The discussion is interesting though.

-- (ripwoman@aol.com), February 17, 2001.

I did not think Carter was smirking either. Anyone with any respect for life could not have been smirking while a child (or anyone) was dying right in front of them.

-- Maureen (shepcaff@ix.netcom.com), February 17, 2001.

To weigh in on this issue, I must say that I'm appalled by the people running around screaming "MMRs cause autism" simply because this is the connection they personally have put together in their heads without any proof. It's irresponsible. The truth is that vaccines like the MMR are administered to children at the same age that autism symptoms are typically first noticed--whether the child is vaccinated or not. The truth is that the few scientists who have investigated the autism/MMR connection have done research that does not conform in any way to a rigorous use of the scientific method; in other words, it's shoddy. The truth is that autism is more prevalent in the children of middle- and upper-class families. Guess what? If what I've read here and heard on the show is to be believed, these children are not vaccinated at a higher rate than poor children. I understand that parents who have children with autism would like there to be an easy answer as to the cause of the disease, because then we could start to work on finding a cure. But the *scientifically demonstrated facts* point to the conclusion that autism's cause is probably going to be monumentally hard to pin down, and that it, like schizophrenia, may be caused by a multitude of factors. The *real* research indicates this. It's shocking the way that hysterical parents are latching onto the pseudoscience in this area. I have no problem at all with questioning medical authority--I do it all the time, to my doctor's dismay--but do it based on *real* research. If you can't evaluate the relative merit and reliability of scientific studies for yourself, either acquire those skills or have someone else evaluate it for you before you go off half-cocked and assume that you can better make a decision based on the evidence than medical professionals who went to school for years, were rigorously trained, and yes, learned how to evaluate the relative merit of the scientific evidence.

Cleo finally said something on the show that made me like her character at least a little bit: that it is only relatively safe not to have your children immunized because the vast majority of other people out there are immunized. This is what is called a "free rider problem" here in law school. A few people act like parasites and enjoy the benefits that the many have worked to create. I guarantee you that if fewer people are immunized, the probability that your child will die from measles will no longer be one in a million, as someone stated earlier. That figure takes into account the fact that you are very unlikely to catch the disease in a country where most people are immunized. As your likelihood of catching measles goes up, the probability that any one child will catch measles and die will go up to 1 in 100,000, 1 in 10,000, and finally approaching the 1 in 500 death rate that Chen cited as we reach the scenario where no child is immunized and nearly everyone catches the disease. And Cleo is right--when all these hysterical, half-informed parents see every five hundredth child dying from measles, they'll all be begging to have their kids immunized.

So don't go around claiming that you've made "an informed choice" for your kids until you consider these immutable facts. The truth of the matter is, if you make the decision not to vaccinate your kids with the basics that have been around long enough for us to know that they are far more than reasonably safe, you're probably not evaluating the evidence properly.

And so far as the claim that the show went too far in showing a child die of measles--this totally bewilders me. We've seen ER go arguably "too far" in other storylines. Remember Jody O'Brien dying in childbirth? Nobody was implying then that the ER writers were trying to convince all women not to get pregnant because they were prejudiced on the issue of whether getting pregnant was good or bad! They are writing a *show*. It was more dramatic to have the child die. It can happen in real life; they're not being irresponsible. It's funny to hear the same people who scream things like "vaccinations are dangerous" without any proof whatsoever for the purpose of swaying people to their side of the issue claiming that a show shouldn't depict an outcome that there is a truckload of proof to back up is relatively frequent because it's a black mark on their view of things.

-- Laura Lindstrom (llindstr@law.harvard.edu), February 17, 2001.

Laura,

Gosh, it's not every Saturday morning I can get up and find myself being referred to as a parasite. Thanks!

Amy

-- Amy (amy@interversity.com), February 17, 2001.

Vaccines aren't safe. The risk is not zero, read the info from the manufacturers or the CDC. Bad outcomes from vaccines do occur. Then again getting measles isn't safe either. There are no guarantees either way. That conflict is real, and not to be dismissed lightly. That is the problem with this episode. According to the CDC website someone posted earlier, in most outbreaks 95% of the people did get the shot. So I am risking my child's life for something that doesn't work that well anyway!

-- Joann F. (felczan@msn.com), February 17, 2001.

The fact remains: when you evaluate all the evidence in a rational manner, vaccines are safer than getting measles. I, nor any proponent of vaccinations, never said that they were 100% safe. Nothing in this world is 100% safe.

Reality is harsh.

-- Laura Lindstrom (llindstr@law.harvard.edu), February 17, 2001.

Amy: I call 'em like they are. How else would you describe the situation?

-- Laura Lindstrom (llindstr@law.harvard.edu), February 17, 2001.

I believe I would call the situation as this:

The debate over vaccinations bears the same strong feelings and personal attacks as did Ignaz Semmelweis revolutionary idea that doctors should wash their hands between patients. Semmelweis came up with this "theory" over a hundred years ago. His ideas were rejected by the medical community and he was driven to obscurity. Doctor's hands were actually considered almost sacred and certainly not capable of transferring germs.

Today we know that germs are transferred by hands (and other ways), whether a doctor or not.

Perhaps it will take a century to show that vaccines are not the golden items that the medical community has declared to be. Heaven knows, the medical community has made its share of mistakes. Did you know that the last 30 years that the smallpox vaccine was injected into the bodies of small children, the vaccine was the only source of the disease? It took 30 years for doctors to stop causing smallpox.

So, as I said in one of my earlier posts, it is a personal decision. I am not telling anyone what to do--it's everyone's decision and I don't disrespect myself for vaccinating my children (when I was less informed) or any of my friends who chose not to vaccinate.

I find it interesting that many seem so afraid that vaccinations might not be so good that they defend them by attacking other's sanity or integrity. I have tried really hard not to attack anyone. Even Mike, who disagrees with me wholeheartedly, didn't attack anyone by calling them "parasites."

Amy

-- Amy (amy@interversity.com), February 17, 2001.

Gee, I don't remember getting "hysterical" when I was trying to decide about getting my kids vaccinated. Most parents don't get hysterical, rather we try to make calm and informed choices.

-- Maureen (shepcaff@ix.netcom.com), February 17, 2001.

Even Mike, who disagrees with me wholeheartedly, didn't attack anyone by calling them "parasites."

True enough, but it's an accurate description: People who won't vaccinate their kids are a bunch of freeloaders.

This pisses me off because the people who decide not to vaccinate their kids get self-righteous and say, "Well, it's my decision and it only affects me and my family." Wrong. It affects everyone.

The only way this is a personal decision is if you live in a hermetically sealed bubble. Isolated, yes, it's a personal decision, and on your own, it probably won't make much of a difference one way or another. But we are not isolated creatures; we live in a society and interact with dozens of people every day. What if everyone started thinking the same way? That's the danger in relying on heard immunity to protect yourself -- you're depending on other people to do something you won't, and if enough people stop vaccinating their kids (either because they think everyone else is doing it, or because enough of the anti-vaccination propaganda gets through), suddenly we have an outbreak, a bunch of dead bodies, and we're all pointing fingers.

We've been allowed to forget how dangerous most of these diseases are precisely because vaccination works so well. Nobody's had to look them in the eye for two, maybe three generations. This complacency is a mistake. The price of freedom is eternal vigilance; the price of health is continual protection.

Make no mistake about this: We are at war with the bugs. And they'll win unless we all fight them together, because they're much smarter than we are; the last thing we humans need is to have people making it easier for them to kill us, either by abusing antibiotics (whoops, too late) or by providing willing and unprotected hosts. It's like driving drunk with the whole of humanity -- you might get lucky and not hit anything, but if you do hit something, chances are that an awful lot of people are going to get hurt.

-- Mike Sugimoto (phloem@fumbling.com), February 17, 2001.

I've not attacked anyone's sanity or integrity. I've attacked the ignorance of people who claim that vaccines are more harmful than helpful, and of the people who claim that MMRs cause autism.

I realize that most parents who try to make an informed decision about vaccinations are calm. But the few who have seized on anecdotal evidence and flawed scientific studies as "proof" that vaccinations are dangerous and/or that MMRs cause autism are hysterical. They've let their emotions overrule their logic. Logical evaluation of all the evidence shows that vaccinations are more helpful than harmful.

No, they're not 100% safe, but they're safer than getting the diseases that these vaccinations prevent. And no, medical science doesn't have a record of being 100% correct on these issues. I never claimed doctors were gods. But we have a huge record of properly conducted research into the safety of the vaccinations that doctors currently recommend, and the unbiased scientific evidence points to the conculsion that vaccinations are the safest choice for children.

-- Laura Lindstrom (llindstr@law.harvard.edu), February 17, 2001.

Laura and Mike,

Isn't it interesting that you all find the scientific basis "flawed" for showing how immunizations can be harmful and possibly not as effective as the doctors make them to be. But your support of immunizations is based on "correct" scientific studies. Have you even read both sides? Because I know I have.

-- Amy (amy@interversity.com), February 17, 2001.

You know what, one person suggested this and I said I was going to do it but I didn't. Let's just stop this line of conversation because obviously, there are strong emotions involved and it is, after all, supposed to be a discussion about a TV show. Everyone is entitled to their beliefs. Mike and Laura very strongly disagree with me but I'm sure they are nice people. I know I'm a nice person. So let's just agree to disagree and change the subject.

-- Amy (amy@interversity.com), February 17, 2001.

To answer your question, Amy: yes, I have read the scientific evidence involved, and furthermore, I have an extensive background in science and statistics. I have been schooled in how to evaluate and interpret a scientific study and in probabilities. I do not pretend to know what the background of other participants in this debate is; however, I will venture an educated guess that I have had more experience in this area than most.

I know that I'm going to get myself in trouble by adding this, but I feel it should be said: just reading the various literature on the topic isn't enough to make anyone informed. You must have the tools to evaluate the relative merit of the evidence. All studies aren't created equal.

Furthermore, I don't have any vested interest in promoting vaccinations. I'm not a doctor, I'm not a scientist, and I don't work for a drug company. Therefore, I have no motivation to find some studies flawed and others correct based on anything other than their true relative scientific merit. I'm not finding the evidence of the dangers of vaccinations flawed just because I want to. I'm doing it because the studies truly are flawed.

I'm happy to end the debate if no one else feels like going on with it. I agree that the people on the other side of this issue are most likely good, if misguided, people. And I can see that we're not going to convince one another. Perhaps we should stop flogging the dead horse.

-- Laura Lindstrom (llindstr@law.harvard.edu), February 17, 2001.

I work with many children with autism and would be very interested if Amy could cite her sources (either here or by e-mailing me privately) for the link between vaccines and autism. I am under the impression that it has not be proven, and that most of the studies are flawed. I'm interested particularly in journal articles, not websites or anecdotal information. I've asked this of people on the newsgroup as well, people who are stating they have evidence to support their positions, but as of yet, no one has responded with the articles, research, etc. Thanks.

-- Phyl (erfan@flash.net), February 19, 2001.

I know that both of the articles about the alleged link between autism and MMRs have appeared in The Lancet. The first one postulated the connection; the second debunked it. I don't remember the exact dates, but I think the first appeared in 1997 and the second a couple of years after that.

-- Laura Lindstrom (llindstr@law.harvard.edu), February 19, 2001.

Phyl,

I wasn't the one who said there was a connection between autism and the vaccinations. I said there was a connection between encephalitis and other things--those are all listed in the warning sheet you have to sign when your child gets the shot. So I can't quote you any articles about autism.

Amy

-- Amy (amy@interversity.com), February 20, 2001.

It seems to me that vaccines get a lot of the credit that should be given to things such as better living conditions, improved diets, better hygiene ect. If vaccines are such wonders, than why should there be any worry about "outbreaks" except for with those who are not vaccinated?

-- Amie (worry_not@hotmail.com), February 20, 2001.

It seems to me that vaccines get a lot of the credit that should be given to things such as better living conditions, improved diets, better hygiene ect.

The CDC tackles this in a document I referenced off of this week's commentary. This statement is partly true -- changes in sanitation and diet helped control disease -- but the rest is fairly easy to debunk. One only has to look at what happens when developed countries stop vaccinating large numbers of their citizens. (Examples given by the CDC are the UK, Japan, and Sweden. Free hint if you don't want to read: Infection rates went up, and I wouldn't call the UK, Japan and Sweden dirty or unhealthy countries).

If vaccines are such wonders, than why should there be any worry about "outbreaks" except for with those who are not vaccinated?

I don't understand this question. If it means what I think it does, we should worry because of microbiology and the way the bugs move.

True, outbreaks would be limited to people who are not vaccinated (for whatever reason). But don't forget that the more a pathogen is passed around, the more likely it is to mutate and become something new; you cannot, by definition, protect yourself against new diseases as effectively as you might like. An outbreak that begins in non- immune populations could very well end up affecting previously immune individuals because of antigenic shifts. (This is what is responsible for widespread influenza epidemics, by the way. Although we don't know where the shifting occurs, it would be eminently sensible to keep the number of locations and hosts where it could happen as small as possible. We think it's an avian virus, but why give it another playground?)

Like I said, I don't understand this question.

-- Mike Sugimoto (phloem@fumbling.com), February 20, 2001.

"It seems to me that vaccines get a lot of the credit that should be given to things such as better living conditions, improved diets, better hygiene ect. If vaccines are such wonders, than why should there be any worry about "outbreaks" except for with those who are not vaccinated? "

Obviously you are not old enough to remember when measles and mumps were common place. I do, and I'm "only" 43.

I got mumps during the year there were the most reported, 1968... I also got chicken pox around 1964.

Now... my kids all got chicken pox in 1994, but none of them have ever had mumps (nor measles). I do not know of any child in my kids's school who have had mumps (nor measles).

What major sanitation change has occured in the United States in the past 30 years that would have wiped out mumps but not chicken pox in 1994?

Also, Seattle is experiencing an outbreak of measles (11 cases so far): http://seattletimes.nwsource.com/cgi- bin/WebObjects/SeattleTimes.woa/wa/gotoArticle? zsection_id=268448412&text_only=0&slug=measles20m0&document_id=1342687 55 (www.seattletimes.com, click on "health", look for measles article)

What sanitation situation changed in this city to create the present measles outbreak?

Also, since vaccination is not perfect (95% effective), folks who were vaccinated for measles prior to 1968 are susceptable AND a child does not get the MMR until age 1... an infectious person can transmit to a susceptible person without even knowing it. If you read the Seattle Times article, you'll see many of the infected persons are between the ages of 30 and 40... and one is only 14 months old, probably infected just before getting an MMR at 15 months.

-- Chris (LansdaalFamily@home.com), February 20, 2001.

Amy, the literature that I have read on this issue concludes that while better sanitation, etc has contributed to the drop in infectious diseases, we did not see the remarkable and lasting decreases in infection rates until vaccines were introduced.

-- Laura Lindstrom (llindstr@law.harvard.edu), February 20, 2001.

If anyone would like to read further on this issue, but does not want to struggle with journal articles that are out of their league, I recommend starting by going to BabyCenter.com and typing in "vaccination" in the search engine. There is a doctor on that site who discusses the relative merits and dangers of vaccinations and summarizes quite well the research in this area.

Of course, if you won't believe the summary of yet another elitist member of the Western medical establishment, I recommend doing a literature search at the library of your local university and digging into the scholarly publications in this area. I challenge those of you who are so staunchly anti-vaccination to do some *real* reading and educate away your ignorance.

-- Laura Lindstrom (llindstr@law.harvard.edu), February 20, 2001.

Laura,

I thought we were going to agree to disagree. I really resent you continuing to argue that those who don't agree with you are ignorant. I don't care what you think--I have done the reading and it doesn't agree with your reading. That doesn't mean I am ignorant; it just means I read things differently (NOT BETTER and NOT WORSE) than you do. Please back off.

Amy

-- Amy (amy@interversity.com), February 21, 2001.

God if you all didn't care about what anybody thought SO MUCH, why do you keep writing back?! This issue is like millions of years old now, it's not worth turning this site into a set of the Jerry Springer Show. Jesus! Now I wish I never asked the question in the first place!

-- LeeS (leestein@goudarock.com), February 21, 2001.

Lee,

To answer your question--I keep responding because I feel like I am under attack. All I did was point out that vaccinations may not be the way to go. (Please note once again--my children have been vaccinated.) And Mike and Laura, among others, have called me a parasite, a freeloader, and an ignorant uneducated person. I have a problem with that--especially since I have tried to be reasonable and several times suggested that we should agree to disagree. It seems that they are really defensive about their position if they have to resort to personal attacks in order to make their point.

-- Amy (amy@interversity.com), February 21, 2001.

Saying that someone is ignorant ("lacking knowledge") is not a personal attack. Ignorance is nothing to be ashamed of. We are all ignorant on some issues. None of us is omniscient. What we *should* be ashamed of is pretending to knowledge that we don't have, or refusing to educate ourselves for fear of finding out that our preconceptions were wrong. I, for example, know nothing about quantum physics. However, I do not go to forums like this one and claim that what the physicists say about the matter "must be wrong" when I have no knowledge to draw upon.

As for the term "parasite": according to Webster, one who takes advantage of another's generosity without reciprocating. This is a perfect description of people who do not vaccinate their children, taking advantage of the herd immunity that has been provided by people who *do* vaccinate their children. There is no inherent judgment in the term's use. If you choose to give it a negative connotation, well, those are your values at work.

Amy, that you've been so offended by these terms indicates to me that perhaps *you* are the defensive one. I did not mean them as attacks, merely as descriptions.

And this is the last time I am posting on this topic.

-- Laura Lindstrom (llindstr@law.harvard.edu), February 21, 2001.

Laura,

But you see, by saying that you would not go on a physics forum and tell them they are "wrong", you imply that I know nothing about what I say when it comes to vaccinations (I just don't agree with you; that doesn't make me ignorant.). I am not "reading" things into your statements--you have flat out said anyone who has done reading on vaccinations and thinks they might be wrong, needs to read the right studies and "educate their ignorance away." How presumptous of you to go through life believing that anyone who doesn't agree with you is either ignorant or just plain wrong. Most of the evils of the world have been sprung from that mentality.

You have a right to your own opinion. You just don't have the right to shove it down everyone else's throat.

How ironic that anyone who supports a close look at vaccinations is accused of being "self-righteous." Take a look in the mirror.

-- Amy (amy@interversity.com), February 21, 2001.

Damn, Amy. If I were you I wouldn't put up with all of these terrible personal attacks. There are so many other ER boards you can post at....

-- Beth (bsmith@internet-95.com), February 22, 2001.

Oooh, oooh, let's all take turns trying to get the last word before Mike deletes this thread! ;)

-- Cecelia (evilstoat@hotmail.com), February 22, 2001.

I win! :D

-- Beth (bsmith@internet-95.com), February 22, 2001.

Has anyone noticed lately how I have been staying out of these threads that turn into flaming threads? I just felt like pointing that out before this thread is deleted.

-- Cammie (rmaelhorn@home.com), February 22, 2001.

Words fail me, Smurfette.

-- Cecelia (evilstoat@hotmail.com), February 22, 2001.

Good for you, Cammie. I still win! :-D

-- Beth (Bsmith@internet-95.com), February 22, 2001.

...All I did was point out that vaccinations may not be the way to go.

All right then, Amy, do you have a better suggestion?

We've been allowed to forget how dangerous most of these diseases are precisely because vaccination works so well.

I'm not a lawyer, a research scientist, a doctor or anything professional like that. My college major was history. My readings focused on the past, and more important, the present consequences of that past.

One of the consequences (and joys!) of modern medicine is that it has allowed us to forget about the horrors of the bad old days, where nearly every parent lived in fear of measles, smallpox, diphtheria, scarlet fever (strep), polio, mumps and hosts of other nasties, such as tuberculosis (consumption), which even then, attacked people with compromised immune systems. (Like people who were sick with measles, scarlet fever, etc.) Make no mistake, people, these diseases killed. On a regular basis. Or, they blinded you or took your hearing. (Helen Keller, anyone? I think she had measles, correct me if I'm wrong.) If you were lucky, they ruined your complexion. (Well, smallpox, and measles did anyway. And don't get me started on chickenpox.)

So, when was the last time you heard of someone dying of strep? This is now considered a non-life threatening ailment. Take a few pills and its gone. Smallpox, for all intents and purposes, has been eradicated; to the point of no longer requiring the vaccine. (Check the insides of your passports if you don't believe me.) Most of the rest are nearly unheard of now because of vaccines. (except for TB, which is giving an encore performance due to the AIDS pandemic, among other reasons.) Which is Mikes point. And I'd like to add the following:

If we don't study our past, we tend to forget it. And when we forget our past, we are often condemned to repeat it.

On another note. This relates to my earlier post. :

Also, since vaccination is not perfect (95% effective), folks who were vaccinated for measles prior to 1968 are susceptable AND a child does not get the MMR until age 1...

This is my quote: And ripwoman, I was at one of the colleges that had a measles scare in 1990. I think that the vaccine changed in the late 60s. I don't remember the cutoff year, but one of my friends was apparently immunized before the vaccine changed, so she went down to the student health center and got re-vaccinated. I checked with my mom and I was ok for vaccinations.

1968 was the cutoff year. I had forgotten. I was born in late 67 and my friend was a few years older than me. Thanks for refreshing my memory!

-- S. Trelles (trelles@ix.netcom.com), March 02, 2001.

This pisses me off because the people who decide not to vaccinate their kids get self-righteous and say, "Well, it's my decision and it only affects me and my family." - quote from Mike.(sorry don't know how to put quote in italics) :)

Mike is absoultely right here!!!. People who choose not to vaccinate their children are not only putting their children's health and life at risk, but everyone else's. I know of this case where a child contracted whooping cough. The child was in a serious condition and almost died. The difference here was that the parents wanted to vaccinate their child, however, at that point in time the child was too young. So basically this child would have caught the disease off someone who had made the choice not to vaccinate themselves or their childen. This choice almost cost the other child's life. How selfish can you be?.

Thank's Mike for the links to the CDC with information on MMR vaccines and autism, plus more!. I showed my Dad who actually used the table that displayed "the risk of death from the disease compared to the risk of death from the vaccine" to encourage one of his patients to vaccinate her children. From what I heard she was impressed with the results and is now considering vaccinating her kids!........BONUS!!!

-- Anna (annave8@hotmail.com), March 19, 2001.

I must be older than anyone else responding to this board. I have had measles (more than once- something about German measles and three day measles- I was a little kid, what would I know), chicken pox and mumps. I remember that none of these experiences were fun. With one of these someone even sent me pink roses from a florist. Let me asure you that didn't happen very often in the late 40's- so I must have been a very sick little girl. I also remember my mother's panic about polio-iron lungs and braces were things that happened to real people not just a TV drama. Mom's joy that I was going to get the "polio shot" with the other little kids was very evident. People younger than I don't realize that fear that those illness created. The only vacinations I received as a child before that were smallpox, and rabies (I was attacked by a dog). The point I am trying to make is that while most people survived "childhood" illnesses. Why put a child at risk of getting any of them? They are potentially dangerous and very unpleasant. As a side note to the differences between medicine 50 years ago and now, German measles was something parents wanted their daughters to get when they were little, same with mumps for boys because the risks of either illness for adults are horrific. Those who avoid immunizations are deliberately going back to the old days. Been there, done that, don't recommend it at all.

-- Anna More (phs1971@Yahoo.com), May 29, 2001.