What would it take to convince you?

Hard at work
Hard at work

 

I am currently working on both a fellowship and a manuscript, so instead of writing a longer piece here, I’m issuing everyone a challenge. I have seen it repeated multiple times throughout the comments here that there seems to be evidence “on both sides” of the vaccines issue, and therefore people should just “go with their gut.” I reject that approach as lazy (at best). Whether or not vaccines are safe and effective is an empirical question, and therefore it should be answerable with data.

If there is any theme to this blog, it would be:  Not all evidence is equivalent, and it takes training and a willingness to admit to ignorance in order to be able to identify good evidence from bad evidence. So how can the average person begin to sort out which information is good, and which is bad? There are many approaches to this question, which I will be exploring further in the coming weeks. But the first one is to honestly take inventory of one’s own knowledge: do you actually understand this issue? Do you, for example understand how the immune system works? No? Then you’d better read more and learn more on the subject before wading into the debate.

A second important step is assessing other people’s knowledge on the subject. This can can be difficult as it’s awfully easy to sound “smart” on the internet. I want to simplify this step here by asking everyone (anti-vaccine, pro-vaccine, or “undecided”) a single question: What kind of evidence would change your mind on this issue? This question has come up several times in our discussions (most recently, I believe, in the comments of gewisn), and I think the answers are so revealing that I want to devote an entire post to it.

Please be as specific and honest as possible. Please define any jargon. If you are talking about specific studies, please cite them so everyone can read them. This comments section will be more heavily moderated than usual in order to keep the discussion on track. Comments that do not answer the question, or go off on tangents will be deleted (although I won’t ban you from discussions unless you violate my general commenting policy).

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78 thoughts on “What would it take to convince you?

  1. Joe Seatter April 28, 2014 / 4:15 pm

    I’d settle for a large scale study (not 20 people) that showed that both the potential for ill effects from a vaccine was high relative to the diseases being vaccinated against, or that the vaccine in question was very limited in its effectiveness. One that showed that the societal cost of a vaccination program was higher than the cost of treating the disease itself.

    Right now, it’s largely the opposite of that. The MMR vaccine saves about $20 for every dollar spent on the program.

    http://jid.oxfordjournals.org/content/189/Supplement_1/S131.long

  2. Scott Nelson April 28, 2014 / 4:35 pm

    What would it take to convince me of the danger of a vaccine(s)? Bill Nye’s answer-evidence. Show me a risk benefit calculation, identify the at risk population (woman, child, certain genotype, ect…) identify the pathology(s) resulting from vaccination, give me a biological mechanism and I’ll agree that a vaccine is totally unnecessary or contraindicated. In fact, I’ll identify a couple right now that are totally unnecessary. Smallpox -unless you work at the CDC in a BSL4 facility or rabies-unless you are going to an area where the disease is endemic or are in a profession that is at high risk of exposure, like a veterinarian or anthropologist. That’s prophylactic vaccination. If bitten by a rabid animal-all the calculations change.

  3. Gabriel April 28, 2014 / 6:30 pm

    Good data is all it takes. With every study there are outliers [things that don’t fall in the expected result] and in some cases bias, but good data is key.

    So what does good data look like? It is well in the case of vaccines it would be making a hypothesis, such as vaccines cause autism from some unknown immunological response.

    Finding a way to test the hypothesis, in this case that would be fairly difficult since you would need to identify a mechanism for the cause, but you could argue that it was the mercury for example [which would change the hypothesis but is a much better hypothesis anyway].

    Then just look at the data, in this case since mercury was removed from most [if not all?] vaccines then you should see a decrease in the report of autism in children correlating with the change. Since you do not see a decrease you can safely determine that IF vaccines caused autism the mercury had nothing to do with it.

    The better way to solve this problem though would be determining a cause for autism [which this google scholar search: http://goo.gl/rzP6ap shows that there are numerous scientists who suggest that it is genetic, which makes sense].

    In my opinion vaccines are the most studied and researched type of medicine out there, if the data shows that it is safe despite the rise in autism we should focus our efforts toward finding the cause [because correlation is not causation, just because something happens before something else does not mean they are related] instead of just throwing darts at a board and saying well we started using X before the spike so that must be the cause. It would be like trying to fix a car by draining the gas tank because it wouldn’t start again after you filled up.

    Sorry for the long comment, I get easily worked up over the topic 🙂

  4. armothe April 28, 2014 / 7:03 pm

    The first thing I would like is for the CDC to be honest with their results. When they claim 189 people (.0000006%) were infected with Measles in 2013 I’d like to know how many of them were vaccinated vs. non. When my county in Ohio sees the largest spike of Pertussus cases for 2013, I’d like to know how many children were vaccinated vs. non. (I do know that two of them were). If we can’t expect public agencies to be forthright with the information then the studies/data become irrelevant.

    Secondly, I believe the data/studies over the last 100 years were not mutually exclusive from other factors. Ideally, a study would take a group of non-vaccinated children and a group of vaccinated children from the same region and follow them through adulthood, recording their health. How many contracted the diseases, any side effects, diet, etc. I understand this is a very hefty study, perhaps impossible; but it would remove doubt on either side, whichever way the conclusions swung.

    Lastly, we really need to get to the bottom of these childhood epidemics: Autism, Asthma, Allergies, Obesity, etc. Science can’t simply just prove that vaccines don’t cause these things, it also must conclude what does. Also, this still doesn’t address the ‘bad batches’ of vaccines in the late 70’s and early 80’s, which caused several cases of infant encephalitis. The producers of these vaccines must do business with the same amount of risk as other businesses and not shielded by the government. They must remain accountable for their mistakes.

    • spector567 April 28, 2014 / 8:21 pm

      This is an interest set of criteria.

      I hope you realize that statistcally the number of infected would be almost equal if vaccinated vs unvaccinated.

      Assuming 100% transmission. 90% vaccine coverage with a 90% effectiveness rate it would mean that in a population of 100,000.
      10,000 of the infected would be unvaccinated.
      9,000 if the infected would be vaccinated.

      Producing an almost 1 to 1 ratio.

      Of coarse 81,000 would be completely healthy.

      A better metric might be to compare the the infection rate between each population. I think this had already been done when you compare the infection rates of pre vaccine populations vs post.

      That all being said I’m not sure if the government had the right to delve into your personal medical history and run an invasive analysis of history. Maybe an insurence company might have better access to this data.

      And with respect to your last one.
      It’s kinda like saying you’ve been accused of murder and your iron Clad alliby supported by a hundred people isn’t good enough so we are going to hang you anyway unless you can pin it on someone else.

      • armothe May 8, 2014 / 11:59 am

        You are assuming the effectiveness rate before its even measured. Whereas I am asking for the results to measure the effectiveness rate. If 150 of the 189 were vaccinated, then we are dealing with a much lower effectiveness rate, which would call a a few things into question. Scientific Method at work. Why is this number hidden from us when the CDC & most school districts already know who is vaccinated and who isn’t.

        I’m not a big fan of government delving into anyone’s personal business. But if the choice is between forcing vaccinations on the population vs. performing an analysis on the effectiveness of vaccines, then you would agree that the latter is less invasive (and I’m pretty sure already being done to a large extent).

        Arriving at the cause of Autism will help to confirm or deny the link to vaccines, which I would think those on either side of the issue desire.

        • Chris May 8, 2014 / 12:13 pm

          “If 150 of the 189 were vaccinated, then we are dealing with a much lower effectiveness rate, which would call a a few things into question.”

          What is missing is the total who are vaccinated, and the total who are not.

          So the effectiveness would be 150 divided the total number of vaccinated in the community. And then the other ratio would be (189-150) divided by the total number those who are not vaccinated in the community’s population. You need to make sure you have the correct denominator, so you are not comparing apples and oranges.

          “Arriving at the cause of Autism will help to confirm or deny the link to vaccines, which I would think those on either side of the issue desire.”

          We are very sure is it not vaccines.

        • jgc56 May 8, 2014 / 12:36 pm

          He didn’t assume a 90% effectiveness rate before it has been measured: he instead described a hypothetical situation, assigning that rate, to illustrate why it’s inappropriate to compare numbers of infection rather than rates of infection, when comparing vaccinated to un-vaccinated populations.

          And the effectiveness rates of vaccines are hardly hidden–you just ahve to go looking for them. For example, iwith 2 minute googlesearch on the CDC website I found:

          a single dose of MMR vaccine is known to generate a protective titer in 95% of those receiving it, which rises to 99% upon receiving a second vaccination

          protection against rubella, also 99% after two doses

          protection against mumps is lower, 90 to 95% after two doses

          DTAP is 80 to 90% effective, again varying with the number of doses received

          “Arriving at the cause of Autism will help to confirm or deny the link to vaccines,”

          Over more than a decade large scale epidemiological studies by multiple independent researchers and public health agencies in multiple nations were conducted which already have rebutted the existence of a causal association between vaccination and autism spectrum disorder. The existing body of evidence at this point is pretty much sufficient to indicate that should we ever identify all the causative factors associated with ASD’s, vaccines won’t be on the list.

          • armothe May 12, 2014 / 4:12 pm

            Sorry. I’m not going to blindly trust these 90%, 95% or 99% rates from the CDC. And I can’t seem to locate these ‘thousands’ of other sites with this information. I’d specifically like to know that out of the published number of those recorded as having symptoms of a disease, how many were vaccinated vs non-vaccinated. I’m surprised nobody else is curious. Rather, due to bias such a request is tossed aside on a thread asking ‘What would it take’?

          • Chris May 12, 2014 / 4:35 pm

            Arrgh… my comment was placed wrong. See below.

            But essentially, I want armothe to explain clearly why we should not trust the data from a taxpayer funded agency, and to tell us where we should get the data.

          • Skeptiquette May 13, 2014 / 9:27 am

            Hi Armothe,

            If you look below, I provided you with exactly what you were looking for.

            The reference is:

            “Higher risk of measles when the first dose of a 2-dose schedule of measles vaccine is given at 12-14 months versus 15 months of age.”

            De Serres G1, Boulianne N, Defay F, Brousseau N, Benoît M, Lacoursière S, Guillemette F, Soto J, Ouakki M, Ward BJ, Skowronski DM.

            Clin Infect Dis. 2012 Aug;55(3):394-402.

            You can see for yourself that in this outbreak of measles in a Canadian high school, the un-vaccinated were 20 times more likely to contract measles. Out of 60 unvaccinated teens, 51 of them got measles. Out of 1245 vaccinated teens, only 60 got measles.

            The purpose of this study was to actually look at how the timing of the first dose impacted effectiveness. The study found that those individuals that received the first dose after 15 mos of age were better protected than those receiving the first dose at 12 months.

            if you type in “measles outbreak” into pubmed, you will get a ton of very recent informative articles. It definitely looks like we have to revisit how to best implement the measles vaccination program to effectively prevent outbreaks.

            skeptiquette

        • Skeptiquette May 8, 2014 / 2:23 pm

          One recent study looking at the outbreak in a Canadian secondary school found this:

          Number of kids in school: 1306
          Number of kids unvaccinated: 61
          Number of unvaccinated that contracted measles: 50 out of 61 or 82%
          Number of kids vaccinated (either 2 , 1 or no written proof): 1245
          Number of vaccinated that contracted measles: 60 out of 1245 or about 5%

          So, clearly measles attacked the unvaccinated at a much higher rate. This seems to be pretty strong evidence in favor of the measles vaccine doing its job.

          Wouldn’t you agree that it would require coincidences of a strange order for this to occur?

        • spector567 May 9, 2014 / 9:01 am

          With respect Armthe as others pointed out I assumed nothing. I was just trying to point out that you metric didn’t make any sense and that you were accusing the CDC of hiding information that they never had in the first place.

          There are literally a thousand other source for the information or effectiveness rates that are currently available so it seems to me rather silly to demand that the CDC perform a gross invasion of privacy of epic proportions in order to provide you information that is already available to you.

          As to what causes Autism…… gentics is a HUGE factor, other factors include age of the mother and that 2/3rd or more of the increase in autism rates can be attributed to increased testing and the widening of the spectrum.

          There are a tonn of studies that prove that it’s not vaccines.

          but you could be right entill we fully know we can’t say with 1000% certainty that it’s not. (the extra 0 is on purpose)

          Just like we can’t say that it’s not the alkali metals in bananas, or the arsenic in apples.

          Maybe its wifi, TV, manufactured clothing or any of the other MILLION options.

          It seems beyond bizarre to focus on a source that has already been heavily studied and insist that it could be a cause when there are A MILLION other options that you are ignoring.

          • armothe May 12, 2014 / 4:37 pm

            ‘accusing the CDC of hiding the information that they never had in the first place’

            Can you say this with utmost certainty? The numbers the CDC releases are what the media panics about. That’s what seems to matter most to that side of the discussion. Yet…they don’t have all of the information? So now we need to dig up ‘independent’ studies from the internet and draw a link to the CDC numbers? Sorry, seems a bit disconnect to me..to assume a rate developed by a study performed by a medical journal and impose it upon the CDC reports. Forgive me for requesting specifics.

            As far as autism goes…yes, it is probably caused from a combination of factors ranging from DNA to environment. Ultimately it has to do with brain development which means a reaction (swelling) to some substance. Those on the non-vacc side of the discussion would argue that minimizing the amount of ‘unnatural’ environmental substances is a reasonable precaution.

          • jgc56 May 12, 2014 / 10:51 pm

            “Ultimately it has to do with brain development which means a reaction (swelling) to some substance.”

            Uhhh…no, armothe: that isn’t what it means, and I’m aware of no evidence that suggests edema is causally associated with autism spectrum disorders.

        • Chris May 12, 2014 / 4:34 pm

          “Sorry. I’m not going to blindly trust these 90%, 95% or 99% rates from the CDC”

          Why? Be specific as to why the numbers in the JAMA paper are suspicious.

          And what data would you find acceptable? Tell us what other agency than the taxpayer funded CDC should be doing disease surveillance. Provide the name of the person or institution and explain why we should trust them over the several public health research organizations around the world in the Europe, North America and elsewhere.

          “I’d specifically like to know that out of the published number of those recorded as having symptoms of a disease, how many were vaccinated vs non-vaccinated.”

          Well for starters there is the information provided by public health departments to the CDC, and they are often written up in the Morbidity and Mortality Weekly Report (MMWR), like Measles — United States, January 1–August 24, 2013. Which says:

          Most cases were in persons who were unvaccinated (131 [82%]) or had unknown vaccination status (15 [9%]).

          Perhaps you would prefer researchers from Japan, Measles vaccine coverage and factors related to uncompleted vaccination among 18-month-old and 36-month-old children in Kyoto, Japan:

          In Japan, measles vaccine coverage has remained low, and either small or moderate outbreaks have occurred repeatedly in communities. According to an infectious disease surveillance (2000), total measles cases were estimated to be from 180,000 to 210,000, and total deaths were estimated to be 88 [11,12]. Measles cases are most frequently observed among non-immunized children, particularly between 12 to 24 months.

          Then there are investigations in specific measles outbreaks like that included the local public health departments like these (all available free online through PubMed):

          Pediatrics. 2010 Apr;125(4):747-55. Epub 2010 Mar 22.
          Measles outbreak in a highly vaccinated population, San Diego, 2008: role of the intentionally undervaccinated.

          N Engl J Med. 2006 Aug 3;355(5):447-55.
          Implications of a 2005 measles outbreak in Indiana for sustained elimination of measles

          West J Med. 1993 Oct;159(4):455-64.
          Measles epidemic from failure to immunize.

          If you have an issue with any of the authors of the above five citations please provide specifics of why they should not be trusted. Then explain very clearly where we can find better data, with verifiable documentation that they would be valid. Provide facts, not opinion. Sorry. I’m not going to blindly trust your opinion without data. (italics is directly quoting you)

          • armothe May 12, 2014 / 4:46 pm

            Hi Chris. In good faith I gave my answer to the author’s question. It’s clear you’d rather cross-examine than discuss. You aren’t doing your side any favors.

          • Chris May 12, 2014 / 5:11 pm

            I know you said: “The first thing I would like is for the CDC to be honest with their results. When they claim 189 people (.0000006%) were infected with Measles in 2013 I’d like to know how many of them were vaccinated vs. non. ”

            What we want to know is what evidence do you have that the CDC is not honest. Plus who you would rather trust for evidence. This you have not answered.

            And I provided you the reference where they said as of August 2013 the numbers that were not vaccinated (82% by that time, plus a few more when the vaccination status was unknown). And I also you gave four more references where the numbers of vaccinated and unvaccinated were tabulated. So why can’t you trust those answers, be specific?

            By the way, when you posted “.0000006%”, that is as part of a highly vaccinated population. If you have a low probability of getting measles, it is because you live in an area with high community immunity to measles. Though, as you can see by the article on the Indiana outbreak, that immunity goes down quite a bit if you attend a church picnic where only a few are immune. Denying the protection by others who vaccinate is not exactly honest.

            So, have you thanked your responsible neighbors who vaccinate for providing your family protection from measles by increasing community immunity?

          • gewisn May 12, 2014 / 5:57 pm

            Armothe,
            Actually, I don’t think you did answer the question in the title.
            You seem to be answering what you don’t find convincing.

            So, I’ll ask again,
            “What would it take to convince you?”
            What sort of evidence would it be?
            Where would it come from?
            Who would be publishing it?
            And how would you determine that it is more informative, reliable, important (or whatever other adjective you’d like to use) than the evidence you’ve seen so far?

    • Erik June 24, 2014 / 1:19 am

      Such a study as following a large group is being done at the moment in the Netherlands in the lifelines research. I had to look up the number of participants, but saw it’s at a satisfying 167.729 as of last April. It’s set to run on for many more years, answering lots of questions that haven’t been properly researched so far. Hopefully it’ll turn out vaccines are in no way part of the problem.

  5. theauthorrwfoster April 28, 2014 / 9:35 pm

    What would persuade me? A meta review (meaning a review of the reviews) of the results of about 20-30 large scale (consisting of 30-40 people in each) studies.

    The great thing about science is that it is self-correcting.

  6. leclerc35 April 28, 2014 / 9:43 pm

    I’m presently making a junior in physics and the first thing we learn is to realize that a lot of what we think true is in fact not ! According to me the problem is that people have a hard time admitting that in certains field they dont have any knowledge and that most of the ting they think are true are not. People have to learn that ignorance is not bad a thing and they have to admit to that ignorance instead of seeing patterns that do not exist ! Even if you think that vaccination is dangerous you should still get your child vaccinated ! Data has proven that in almost any case, vaccination brings a hole lot more of positive side than negative sides effects !

    I most admit, I know nothing about vaccination ( exempt a few biologie class ). But one thing a know for sure is that the world we live in would be a lot worse whiteout those engineering revolution !

  7. sothisisholland April 28, 2014 / 9:51 pm

    Honestly, as most have said, good data. Real studies that actually prove something. By people who are trying to advocate for the public health as a whole. Not by people who have an agenda.

    However, if it came out that vaccinations are causing autism, I’d continue to vaccinate. So I guess my real answer is nothing.

    • notnearlysoanonymous May 3, 2014 / 12:45 am

      Sothisisholland,
      I’ve been thinking about your response for a few days now.
      My first thought was, “You’re just a closed-minded as the most avid anti-vaxxer.” But then I kept re-reading it (lucky for me it wasn’t long, I’m a slow reader), and I realized maybe you meant that autism is not as bad as the illnesses prevented, so the cost is still worth it. And then I re-read the part about “not by people who have an agenda.” Who doesn’t? I tend to think that if a person has zero agenda, then why is he wasting his breath and my time? But that’s just me.

      So, would you please elaborate some?
      I’m pretty sure I didn’t understand what you were getting at, your agenda.

      • sothisisholland May 5, 2014 / 1:01 am

        Hi. No problem.

        As for my response that I would vaccinate regardless….I would. My child has autism. I’d choose our life in the now over the potential risks associated with vaccine preventable illnesses. Not many children die of chicken pox, not many children die of measles, etc…..but some do. If there is a 20% chance of autism with vaccination and a .001% chance of death…..well, I will stand in line for the fucking autism. My daughter might be different, but she is healthy. She is here. When I go to bed tonight, I can check on her first and lie down with peace of mind. We might have therapy tomorrow and she may insist on stopping ten times to fix her pants on her way into school….but I’ll be grateful. That’s what I mean. I accept who she is and if vaccines caused autism, I’d accept the risk to keep her healthy.

        To touch on the “agenda” part of my comment…..everyone has an agenda. But I do not believe the agenda behind immunization is monetary. I DO believe much of the agenda behind promoting homeopathic medicine is completely monetary, as the practice of homeopathy has not been lucrative or respected for quite some time.

        Hope that helps!

        • notnearlysoanonymous May 5, 2014 / 1:38 am

          Sothisisholland,
          It helps in several ways.
          It reminds me that people often mean something different than what I got in my first reaction. It also helps remind us of the terrible price that would be paid if vaccine programs are abandoned, not just here but in places of the world where sanitation and safe water/food systems are years away, but vaccines can be implemented now. And it reminds me of concept that autism is quite possibly not a “disease” in any classic sense, any more than being short or tall is a disease but just one end of the “normal” spectrum. When our culture demands uniformity and only one set of responses, it is the job of the rest of us to help them through those challenges – not discard or separate them. When my very short wife can’t reach something in a store, it warms my heart to see someone just automatically assist without making a big deal or treating her like a novelty who is there for amusement.

          So, yes, it helps.

          And now back to our regularly scheduled program…
          So what sort of evidence would make you change your mind?
          What source, type, variety and quantity of evidence would make you think vaccines might be more dangerous than stopping them?

          • sothisisholland May 5, 2014 / 11:38 am

            I would have to see valid, peer reviewed research repeatedly finding that the risks outweigh the benefits. I’m not going to stop vaccinating my child because ONE study says the side effects are more dangerous. But if qualified professionals started studying children who were vaccinated as well as children who were not and found evidence that the risks are high enough (much higher than they are now) and dangerous enough (meaning more dangerous than complications related to VPD), then I may be swayed. And I would want to see GLOBAL evidence of this. Not something that is only occurring in the US or only occurring in Japan. Only then would I consider the other side of the issue valid enough to look into.

            But autism wouldn’t fall into that category of “risk” that would stop me from choosing to immunize.

  8. Colin April 28, 2014 / 11:08 pm

    Let me give a slightly different answer. I’m not well equipped to follow a scientific debate–given two different publications reaching incompatible conclusions, it would be hard for me to suss out which one was more credible. In practice, therefore, I tend to follow a consensus where one exists. The existence of such a consensus is relatively easy to determine.

    So to change my mind, I’d need to see experts start to change theirs. Particularly I’d look for epidemiologists, immunologists, and legitimate autism experts coming to the conclusion that vaccines are more harmful than helpful. The fact that the anti-vaccine movement is built on non-experts and experts in tangential fields is an indictment of its credibility.

    I’d also look to outlying voices to test whether the consensus is legitimate and built on solid science. The anti-vaccine movement fails to persuade me that it has its feet under it. For example, it seems unwilling or unable to expel charlatans and frauds, which suggests that it doesn’t rest on a serious and sober examination of the evidence.

    • armothe May 8, 2014 / 12:04 pm

      Colin, I don’t think it is as easy as saying whether vaccines are more harmful than helpful. I believe each population needs to be evaluated separately to arrive at such a conclusion. There are certain countries where the conditions are worse, genetics are different and the risks greater. It truly is a risk/benefit analysis based on populations.

      • Jennifer Raff May 8, 2014 / 2:04 pm

        Do you know how genetically different each country’s populations are from one another?

      • jgc56 May 8, 2014 / 2:31 pm

        I’m unaware that there’s sufficient genetic differences between national populations that risk versus benefit analyses for vaccines are significantly dissimilar and even in the most developed countries (i.e., the ones where conditions are “better” rather than ‘worse’) the risk associated with vacination is still orders of magnitude lower than the risks associated with remaining vulnerable to infection.

        • Jennifer Raff May 8, 2014 / 2:41 pm

          “I’m unaware that there’s sufficient genetic differences between national populations that risk versus benefit analyses for vaccines are significantly dissimilar.”

          Exactly–there aren’t.

    • Strangemonkey June 3, 2014 / 10:45 am

      I’d agree with that with the addition that I think there are basic evaluations of risk that can legitimately enter into this calculation. These evaluations aren’t immune to authority and consensus, but we can’t avoid the need for individual judgement and valuation.

      So, to give an example, if I believed that measles were a disease I shouldn’t fear, I would need narratives that would enable fear in addition to a context for taking legitimate action to mitigate that fear.

  9. jgc56 April 29, 2014 / 10:46 am

    Well, first it’s important to state what position I currently hold, that would be subject to change: It’s that the risks associated with being vaccinated prophylactically are much, much less (on the scale of orders of magnitude) than the risks associated with remaining vulnerable to infection by the diseases they protect against. For convenience Ill ignore issues regarding whether it’s more cost-effective to prevent disease than treat it when it occurs.

    So changing my position would require evidence demonstrating not only that vaccinating conferred an increased overall risk of experiencing a serious adverse outcomes but also that this increase in overall risk associated with immunization was equal to or greater than the overall risk of experiencing a serious adverse outcome as a consequence of remaining vulnerable to infection by the pathogen(s) the vaccine was directed against.

    So by way of illustration it would not be enough to demonstrate that the MMR vaccine causes encephalopathy (it does, in roughly 1 out of every million doses). You’d also have to demonstrate that it would be more likely one would experience encephalopathy as a result of MMR vaccination than as a result of a measles infection itself ( one wouldn’t: measles causes encephalopathy in roughly 1 out of every thousand infections, three orders of magnitude more frequently than is observed with vaccination.)

    Retrospective epidemiologic studies, CDC and WHO mortality and morbidity demographics, post-marketing vaccine surveillance, etc., all are capable of identifying and quantifying these risks, thereby generating the evidence it would take to change my mind. In fact, they’ve been sufficient in the past to identify vaccines with associated risk that argued against continued administration (the Urabe MMR vaccine, Rotashield).

  10. David April 29, 2014 / 6:58 pm

    Hi Jennifer,
    Id settle for a controlled experiment – You, the subject, receiving the 33 odd shots and infant receives, over the recommended time frame, with an adult volume determined by comparative weights, overseen by a qualified neutral person.
    All and any medical reactions would be managed again by a neutral combination of medical practitioners and qualified alternative therapists only over a 5 year time frame – If you’re agreeable please contact me.
    If you do not agree, I will conclude that you’re a shill being paid by the medical industry that profits by the vaccination concept and you have no concern for the principle of “do no harm”
    PS I will give you the option of including a Gardasil shot
    Rgds
    David

    • Jennifer Raff April 29, 2014 / 7:06 pm

      David, that experiment has been done already. I received all of those vaccinations (including a few extra that kids don’t typically get, but admittedly minus Gardasil, which wasn’t available) over the recommended time frame when I was a child. No damage. Is one person’s experience enough to convince you?

      • David April 29, 2014 / 7:16 pm

        So have I – But how can I compare my physical state now to that of my physical state had I not been vaccinated – Scientific evaluation means comparing the hypotheses with physical observation- I wish to observe an adult getting all of the “vaccinations” and their reactions to them – I realize in your case there may need to be some compensation in viewing the results, but hey your article EMPHASISED the safety of the process and The BENEFITS – what harm can befall you? – or are you concerned?

        • confusedbylogic April 29, 2014 / 7:52 pm

          David,
          How many people would doing this would change your mind? Just one you say?
          I’d be happy to volunteer for this. If you want, I’ll give Jennifer my address and we can arrange this – if 1 person doing it will change your mind. Would it? Will one person living through this with zero long-term problems change your mind? I don’t need any care arranged ahead of time, because the risk would be less than I’m about to take by driving across town. But I’d be happy to see a provider every week for a few weeks just to prove I’m fine.

          Would that change your mind? Would you announce publicly that your mind was changed by an experiment with only 1 subject?

          If that’s true, that an experiment with one subject would change your mind, why doesn’t an experiment with several thousand, or a few million?

          I’ll admit that I’m lost on what you’re getting at, but I’m willing to volunteer.

          • Shank April 30, 2014 / 12:12 pm

            I’ll also volunteer, on the proviso that you sign a binding contract to the effect that you pay a $100,000.00 penalty if you do not publicly recant your views after the experiment is over.

            Fair?

          • Chris April 30, 2014 / 12:54 pm

            This kind of reminds me of Jock Doubleday’s bogus challenge. Of course he had lots strange requirements, and lots of excuses (he shows up in the comments).

        • confusedbylogic May 1, 2014 / 10:23 pm

          David,
          So, you have a few volunteers.
          But I’m still wondering, why would you trust an experiment with a n of just 1?

  11. Chris April 29, 2014 / 8:11 pm

    As a toddler my oldest suffered had a horrible seizure (full body shaking, convulsions and then he became unconscious). The cause was due to a disease he was suffering from, and this was years before the vaccine was available. So in my experience, the diseases are dangerous.

    What could convince me are PubMed indexed studies from reputable qualified researchers that a vaccine on the American pediatric schedule causes more seizures than the disease.

    I would also need to be convinced that Wakefield did not come up with the idea that the MMR caused autism by the legal aide funds provided by a lawyer to come up with “evidence” to support a lawsuit. The MMR vaccine was introduced in the USA in 1971, and was the preferred vaccine for the 1978 Measles Elimination Program. If the MMR caused autism it would have been noticed in the USA before the UK because it is both much larger and was using the vaccine much longer.

    What I would need is verifiable documentation dated before 1990 that autism increased in the USA corresponding to the use of the MMR vaccine during the 1970s and 1980s.

  12. sothisisholland April 29, 2014 / 9:31 pm

    I think the mention of seizures is important. I have read in many places that parents blame the febrile seizure their child had after an immunization for their ASD or other condition. Even though febrile seizures are not harmful. I had one as a child. I guess the assertion that I’m neurotypical is debatable, lol.

  13. Skeptiquette May 5, 2014 / 11:43 am

    Personal statement: I do not have a child with autism or a child that I feel was vaccine injured. I do believe that vaccines work as intended and that they have been primarily responsible for the drop in childhood disease incidence in the 20th century. I do not advocate anti-vaccinationism. I do have an undergraduate degree in medical microbiology and immunology. I have spent a large chunk of my time looking at the immunological and microbiological components of autism and therefore have a bias to that degree. I have also spent a lot of time looking at genetic studies as I feel they are the bellwethers for further critical thought on environmental contribution.

    I think that the question “what kind of evidence will change your mind on this issue” is similar to the question of “how would you best criticize your own position?”

    How would those that believe there is no connection between vaccines and autism best criticize their position? Where are the gaps in knowledge? What are the shortcomings in evidence or approaches to interrogation?

    What are the criticisms that we can make:

    1. Evidence is largely epidemiological and most notable for the MMR and Thimerosal but lacking for other specific vaccinations or combinations of vaccinations.

    2. Autism is multifactorial and heterogenous in its etiology, therefore modern
    epidemiological approaches (Cartesian reductionist) are not adequate for establishing general understandings of causation or non-causation. Looking at an exposure, vaccination, as a single causal factor of an effect, autism, is the wrong approach and will lack sensitivity, and result in possibly missing significant associations. An approach that is informed more deeply about both vaccination and autism, prospective in nature and inclusive of both biomarker and genetic information would be better. (I will elaborate on this further below)

    What are the gaps in knowledge and is there any new knowledge to consider?

    1. Our understanding of vaccination is really in its infancy and the understanding that is both relevant to safety and efficacy is often overlooked, quite possibly because its importance is just beginning to emerge. I am referring to a detailed understanding of the innate immune system contribution during an immunization event. The innate immune response is immediate and is the orchestrator of the adaptive response that ensues. Therefore, it is responsible for both the efficacy of a vaccine as well as its safety profile, and should be the center of discussion. Some important questions:
    a. How do vaccines affect the developing innate immune system
    b. How does the timing of a vaccine affect the innate immune response
    c. Does a vaccine affect the microbiome?
    d. Does the microbiome affect the outcome of a vaccination?

    2. Our understanding of Autism is in its infancy as well. There is a growing agreement that autism is a result of genetic, environmental, prenatal and early post natal developmental contributions that result in a dysfunctioning of normal synapse function (synaptopathy) and abnormal neuronal connectivity. There is also an emerging understanding that one commonality in autism, affecting both neural connectivity and synapse function, is dysfunctioning immune system, most notably immune signaling.

    3. There is an emerging understanding that the immune system is absolutely critical for normal brain development and functioning and may therefore underlie a number of neuropsychiatric disorders. Early life immune insults may be an important contributor to later life behavior. The nature and source of these insults will be an important area of investigation.

    So, IMHO, it is integral that a framework of knowledge be constructed to properly investigate vaccinations and autism. Based on what I have laid out above and with no restrictions on time/money/technology this is what I would propose as a starting point:

    Prospective collection of biomarkers related to the innate immune response after vaccination, on as large a scale as possible. The data that would be collected would be collated in a large database in a binary fashion. I can envision a spreadsheet where one row is representative of an individual and the columns would represent different biomarkers or genetic information. For example, column one could represent the vaccine response in terms of the cytokine IL-6 (a-b range), column two IL-6 (b-c range), etc. If a child fell into range one then a 1 would be entered in that cell, and 0 for the other ranges of that biomarker. It would also be important to include information from the pregnancy as it is becoming much more clear that immune events during pregnancy, termed maternal immune activation (MIA), is a risk factor for future development of autism and schizophrenia and predisposes the offspring to a more reactive immune response. On top of biomarker information a number of genetic polymorphisms, CNV’s and other genetic info would be surveyed and cataloged as well. There would also have to be longer term follow up that cataloged information related to behavior, the simplest being a 0 for no autism diagnosis and a 1 for an official autism diagnosis. But I would suggest that the behavioral criteria be further refined, such as repetitive behavior, speech/communication difficulties, regression, etc.

    This would allow researchers to look for associations using an objective (more so) bioinformatic approach, which could reveal trends or associations that could be tested in a more hypothesis driven fashion.

    From what I can tell, this is what parents are asking for: How does the vaccine affect the individual? What are the individual differences that could lead to an adverse event or lack of vaccine efficacy?

    Skeptiquette

    • gewisn May 5, 2014 / 12:48 pm

      Despite the fact that this blog belongs to Dr Raff and I have no say in it…
      I nominate Skeptiquette to author the next blog entry in this series.

      I, for one, want to hear more about how such an approach differs, in terms of the types of questions asked and the information theory involved in seeking those answers. These ideas are critical to understanding the various factors that can affect the complex systems of biology and medicine, and the ability to think beyond the simplistic cause-and-effect relationship with which most of us old folks grew up is ushering in a new world of thought and, therefore, experimental design.

      I see from this post that we are finally reaching a point where it is common and expected to think beyond the idea that the skeletal system and the cardiovascular system and the immune system can/should be treated as distinct and separate. It appears we are teaching students to think in terms of complex interactions between the internal environment, others of the species, other organisms and even with the non-living environment.

      The details of what Skeptiquette proposed may well turn out to need adjustment or complete change. But the process by which this new generation is asking questions is putting many of us old folks to shame.

      I could not be more pleased to get the hell out of the way.

        • skeptiquette May 15, 2014 / 10:44 am

          Chris,

          Antaeus is not a research scientists, nor does he have any background in immunology or any real grasp of the current state of knowledge regarding immune contributions to autism.

          On top of that he got just about everything wrong in the post you linked to.

          Sorry, it is hard to take him seriously.

          • Chris May 15, 2014 / 11:03 am

            So what? It is an accurate description of someone who puts the cart in front of the horse, and continues to go on and on and on and on about immune function and autism relating to vaccines… even though there is no real evidence that vaccines have anything to do with autism.

          • skeptiquette May 15, 2014 / 11:51 am

            Chris,
            It is an accurate illustration of misunderstanding and miscontruing someones position with a bit of emotional appeal to the RIgulars.

          • Antaeus Feldspar May 21, 2014 / 7:27 am

            “He doesn’t have a background in immunology” is only a valid rebuttal to a criticism if the criticism depends on immunological knowledge to be correct.

            What part of “she has no evidence that phenomenon X even occurs, but she still insists that somehow, factor Y must cause phenomenon X” requires immunological knowledge?

            No part, that’s what part.

            If you have no evidence that star 309.895 in the Arugula Satoris constellation went supernova, but you’re insisting that it must have been gravitational waves from a nearby black hole that caused it to go supernova, I don’t need to know astrophysics to see the hole in your logic. I don’t even need to know enough to make up a convincing star name.

            If you have no evidence that millionaire Fenton Haggerty is even missing, let alone dead, let alone murdered, and yet you’re telling us that we should be subjecting the butler to intense interrogation because he had motive, means and opportunity, then I don’t need to be Sherlock Holmes or even John Watson to see where you’re going wrong.

            A chain is only as strong as its weakest link. You keep showing us a chain in which the first link is missing entirely, and complaining that we don’t have the requisite knowledge to appreciate how incredibly strong the last link is. No matter how much detail you bombard us with about that last link, it’s not going to make up for the first link being missing.

        • Chris May 15, 2014 / 12:42 pm

          Then clarify your position by honestly answering the following question:

          What causes more of an impact on the immune system: a vaccine or the disease the vaccine is for? In other words does measles affect the immune more or less than the MMR?

      • skeptiquette May 15, 2014 / 11:15 am

        Hi Gewisn,

        Thanks for the gracious suggestion!

        Unfortunately, as an undergrad this was not how I was taught. This is more a result of intellectual curiosity and just plain being skeptical.

        One example, as an undergrad for my Bio 152 (UW Madison, sophomore, the year 2001) research paper I was exploring the relationships between neonatal nutrition (breast milk or formula) and how this impacted the development of the microflora and immune system and then how this ultimately impacted the potential for developing asthma or allergy.

        So, I have had this type of slant towards thinking in complex interactions for quite some time, but it was not a result of my secondary schooling.

        Since then I have cultivated this type of mindset and my basic 10,000 foot view is that everything health and disease has to fit into the model: G X E X D X S (genes, environment, development, sex)

        Each of these factors will contribute and interact in different ways to produce a state of health or disease.

        Take for example autism, in some cases there will be a highly penetrant genetic contribution, some cases there will be a highly penetrant environmental contribution. Sex of the individual is also a major factor, which couldn’t be better illustrated by the 4:1 ratio of males to females that are affected. Of course, development is extremely important as well, what happens in the womb? what happens during periods of major development (infancy/childhood, puberty) and how do those contribute to outcomes. Again, autism is a great example, specifically how maternal immune activation during pregnancy increases the risk for future development of autism. How does MIA alter the programming of the fetus? how does this alteration impact future development? etc.

        I guess I just remain skeptical based on both the weakness of the current data as well as the amazing amount of new information that we have access to.

        One thing that we cannot forget is that the accumulation of knowledge takes place on an exponential scale and we are either getting to the point on the curve where the rate increases rapidly (or we may be there already). If you put this into context, this means that the amount of scientific knowledge accumulated over the past 200 years (lets say this is 1 unit of knowledge) may be doubled(2 units)in 5 years (depending on where we are on this curve).

        This means that there is no better time to remain open minded and be both resourceful and intellectually curious.

        The biggest disservice to science and progress is to NOT criticize our current understandings and positions.

        Skeptiquette

        • jgc56 May 15, 2014 / 8:54 pm

          “Take for example autism, in some cases there will be a highly penetrant genetic contribution, some cases there will be a highly penetrant environmental contribution.”

          Citations needed.

        • gewisn May 15, 2014 / 10:36 pm

          Agreed. The trick is being skeptical and inquisitive in a useful and informed way, and not just contrarian or anti-science.

    • JerryA May 7, 2014 / 11:33 am

      Skeptiquette, while I appreciate the effort it took you to write that highly detailed proposal for an in depth study of autism, you’re skipping over a critical point. Highly detailed, invasive, and expensive studies on cause and effect, in this case vaccines versus autism, are only performed when earlier and much simpler studies show there is any connection at all. Those simpler studies were done. They showed no, zero, zilch connection between autism and vaccines. I realize that you side-stepped, discussing the immune system and autism, a somewhat different question, but others may not. Your bringing up your proposal here makes it seem like the lack of detailed knowledge about the causes of autism is somehow a weakness in the case for vaccination. It is not.

      • skeptiquette May 15, 2014 / 10:41 am

        Hi Jerry,

        Thanks for appreciating the effort.

        However, I am not skipping over that critical point. I acknowledged it and offered two criticisms as to why the simple approach in this case may not be adequate.

        ” I realize that you side-stepped, discussing the immune system and autism, a somewhat different question, but others may not.”

        What are you trying to say here? (honest question)

        Would you like me to go into a detailed explanation regarding the current state of evidence linking immune system and autism?

        “Your bringing up your proposal here makes it seem like the lack of detailed knowledge about the causes of autism is somehow a weakness in the case for vaccination. It is not.”

        It is actually the combination of a lack of detailed knowledge about both autism and vaccination that leads me to be skeptical about the certitude that has been offered thus far.

        • jgc56 May 15, 2014 / 10:55 am

          “Would you like me to go into a detailed explanation regarding the current state of evidence linking immune system and autism?”

          Actually, given that the first ‘gaps in our knowledge’ you brought up in your post all had to do with vaccines (how do vaccines affect the developing innate immune system; does the timing of a vaccine affect the innate immune response, etc.) I think it would be best if you started with the evidence supporting the existence of a causal association between routine childhood vaccination and autism spectrum disorders. In the absence of such evidence, after all, while we might still wish to consider the possibility a link between the immune system itself and autism exists we can reasonably ignore the premise vaccines may be a part of such a link.

          • skeptiquette May 15, 2014 / 11:26 am

            JGC,

            Chris has now accused me of putting the cart before the horse. In reality, interrogating a complex question such as do vaccines have any contribution (big or small) by using a reductionist approach that in not informed by any understanding of the immune contributions to autism or detailed understandings of vaccines is putting the cart before the horse.

            When you have more knowledge you should use it.

            I am not saying vaccines cause autism, I have no friggin clue, I am just saying that the approach that everybody seems to hang there certitude on is weak sauce and we could do better by using a less reductionist approach and one that incorporates new information.

          • skeptiquette May 15, 2014 / 11:41 am

            JGC,

            Give it a shot, criticize the existing position.

            If you could do things differently or better, how would you do it?

            Or is the existing state of evidence so perfect and infallible as to be axiomatic?

          • jgc56 May 15, 2014 / 12:56 pm

            I disagree that the question is either complex or that a ‘reductionist’ analysis (your term) would be putting the cart before the horse.

            Whether vaccines are causally associated with increased incidence of autism (or more precisely increased incidence of the diagnosis of autism) is a straightforward question even if identifying excatly how they act to do so might require more complex analysis, and the ‘reductionist methods’ you’re dismissing have proven to be entirely sufficient to indentify such causal relationships in the past without the need to first specualte regarding mechanisms (after all, the increased incidence of intussusception associated with the first rotavirus vaccine was detectable and demonstrable without any prior necessity to investigate how the vaccine might possibly act to cause it.)

  14. Carina May 6, 2014 / 12:27 pm

    Given the recent study that I believe tried four different, yet similar, approaches to change the mind of someone opposed to vaccines, this is a timely question. And, one that I appreciate draws out a discussion as opposed to a forum for dogma.

    From my own perspective, I’ll speak from an experience of being convinced to take a vaccine I didn’t think was necessary, but I should disclose that in general I already didn’t think vaccines were dangerous. I have 3 kids, none with any adverse reactions to any vaccines and a general assumption on my part that my doctor is smart, knows more about the human body than I do, and is not trying to rake in big bucks for pushing pharmaceuticals.

    When my oldest was a baby and the vaccine schedule called for the varicella vaccine, I questioned it’s need. Me to the Pediatrician: “Isn’t this just being silly? Is there a vaccine for skinned knees too? I had chicken pox when I was 2 and the fall-out was a scar on my forehead and a very sad little girl who missed a birthday party. But now I have full immunity – how come we need to vaccinate against something that is no big deal? Plus, I heard that if you don’t get a severe enough case, you could get re-infected as an adult and it is very bad for adults. This vaccine hasn’t been around very long. How do we know adults aren’t going to get chicken pox and it will be worse? I get rashes from poison oak all the time – now that’s a vaccine I’d sign up for!” Doctor to me (paraphrased to fit my memory). “Not all kids have a case that is no big deal. Some kids have long term negative consequences (examples were given, but they’ve slipped my mind now that I’ve been convinced.) Adults who had chicken pox as a kid carry that around inside and it crops back up as Shingles – which is super painful and can have consequences (now I wish I’d had a vaccine and am relieved when he tells me I can sign up for Shingles Shots). And, they’ve been studying this for X years, immunity has stayed as strong as it started off, even into adult hood – and if we find that at 30 years it wears off, we can give a booster!”

    Essentially, my change of heart has 100% to do with my confidence in the medical doctor giving me the advice. I trust him. I recognize that I cannot read all the studies, likely won’t understand all the scientific nuances in the studies I do read, but I can talk to him about my concerns. And, as has been the case on non-vaccine related questions, if I ask him a medically related question where he doesn’t know the answer, he says as much and then goes and researches it and gets back to me. Over the three kids and 10 years I’ve had enough conversations where he’s referenced new findings, changes in medical practice, changes in his own medical practice based on new information, etc. that I am confident he takes his job as my kids doctor seriously and cares about good information directing his decisions – he wants us to stay healthy. So, again, I trust my doctor.

    I think in general, all the data in the world is only valuable if you trust its source.

    • Jennifer Raff May 6, 2014 / 1:07 pm

      Thank you for sharing your thoughts. I’ve been thinking about the question of “Why trust the experts?” quite a bit lately. I’m glad that you gave your answer to it here in your comment! So if I might paraphrase that part of your answer, you trust your doctor because he’s shown that he continues to improve his knowledge on the subject and changes his practice to fit new developments in the field? And that you have a history as his patient that’s long enough to make you feel that you understand his abilities and motivations well? Is that a fair characterization?

      • carinabell May 6, 2014 / 1:34 pm

        Absolutely. And to be honest, I’ve trusted him from the beginning because of his approach to answering my questions. I had a mid-wife with my first pregnancy (supposed to be much more attentive) respond to my questions about the need for flax seed at a specific week in pregnancy by handing me the photocopy of “This month in your baby’s development” – I can get more from parenting.com and I would have been much happier if she said, “I know very little about flax seed as important at a specific point in the baby’s development, but it’s good for you, so go for it!” In contrast, when my baby’s iron level was low at only our second visit with this new doctor (our now long standing pediatrician), I asked, “Drops, really? I’ve read that the body absorbs nutrients better when you get them from naturally occurring sources. And, I’m still nursing him; how low is too low and why is that a problem? shouldn’t I be increasing my iron consumption?” He patiently gave me the history on why doctors researched low iron to begin with, why the tests are done at this age, what they found, what the natural sources are, how much egg yolk or spinach my 9 month old would need to eat, how much passes from my food sources through the breast milk, etc. I walked out completely confident that he knew his stuff and was not speaking blindly from a chapter on “Tests to give and Prescriptions to Write at 9 months.” He had me at “Let me share what I’ve learned…”

    • Chris May 6, 2014 / 10:43 pm

      “But now I have full immunity – how come we need to vaccinate against something that is no big deal?”

      But then you say: “Adults who had chicken pox as a kid carry that around inside and it crops back up as Shingles – which is super painful and can have consequences (now I wish I’d had a vaccine and am relieved when he tells me I can sign up for Shingles Shots.”

      Thank you. Two very important sentences.

      My daughter got chicken pox when she was six months old in 1994. It was several months before the vaccine was available, and she would have been too young to get it the first place. She now has a much higher probability of getting shingles as a young adult. Woo hoo. She is now twenty years old, and last year heard one of her instructors give the story of getting shingles as a college student. I really really hope it does not happen to her. Especially since her chicken pox infection could have been avoided if she was just a year or so older.

      Le sigh.

      I got my shingles shot last year. They now give them to those just over fifty if you are willing to shell out twenty dollars.

  15. Bruce Bookman May 19, 2014 / 11:15 am

    IMO evidence is not the issue. Emotion is the key. If evidence was the issue, this blog would not exist. There seems overwhelming anecdotal evidence that evidence does not move the needle.

    So what does move the needle? I’m assuming that the massive and well funded world of media and advertising are on to something. As dumb humans, we pay more attention to things that move us emotionally. Anything that is entertaining; or flashy; or sexy. Hence my hypothesis is that the critical thinking community should embrace those forms.

    It would be interesting to dig up summaries on the studies around attempting to use catchy / pop media types to move opinion on science based topics.

    Again, thank you for all you do. I wish my skeptical blog had even a trickle of your traffic.

    http://CritcalArmy.com

  16. gewisn May 20, 2014 / 7:58 am

    What if there was evidence that delaying vaccines increased the risk to your child in ways above and beyond risking the illness itself? What if it turned out that delaying vaccines increased the risk of seizures, in addition to endangering your child with the vaccine-preventable illness and endangering others with transmission of the illness?

    Would that change your mind about delayed vaccination?

  17. malavian June 1, 2014 / 7:56 pm

    I believe what would be needed to convince me is for the CDC and other agencies to deal with the immunization critics on something other than MMR vaccines and thimerasol (sp? sorry). My needs would be the following to convince me there is no risk in the current immunization regimen:

    1) When there is a scientific paper related to these studies such as in the Annals of Epidemiology that it should be open source and accessible to anyone who cares to read it. I am not a member and I do not want to pay the fees to read one article. Transparency of research papers is not what it should be. Universities and Journals hoard their information and it needs to be easily accesible for the public. Just because someone has a Doctorate doesn’t make them my special keeper due to their belonging to the intellectual elite. I’d like to make my own informed judgements based on data thank you.
    2) While there has been a series of arguments about establishing herd immunity I have not heard the explanations as to how a Newborn to 5 y/o is transporting themselves so readily and creating a possible disease vector that threatens the bulk of society. Can’t immunizations be delayed or spread out more to allow for possible study? Currently there are 28 injections with 11 different vaccines against 15 diseases. If there are concerns about there being a permanent debilitating impact on a human life that will span some 60 yrs, then what’s the hurry?
    3) If there is nothing relational between immunizations and autism why has there been such a dramatic increase in the number of autism cases since the introduction of the Hepatitis B Vaccine? http://www.huffingtonpost.com/david-kirby/new-study-hepatitis-b-vac_b_289288.html The Huffington Post article sited makes reference to a study in the Annals of Epidemiology by Carolyn Gallagher and Melody Goodman of the Graduate Program in Public Health at Stony Brook University Medical Center, NY. While there study is not broad enough to be definitive it should not be side tracked or ignored simply because big pharmacy has a stake in immunizing every possible child to increase their profits. Further, there have been papers that also discuss dymelinazation not only from the Hepatitis B Vaccine made by GlaxoSmithKline.
    4) Finally, if anyone wants me to genuinely believe that there is no risk in the immunization policy that currently exists in the United States, then it would be a great motivator if they would stop dismissing the voices of those who are raising concerns and objections as being “crackpots” “naive” “emotional” or “out of touch”. Perhaps, they are observing data from their personal experience and trying to convey that to you in the only way they know how. Stop being dismissive of complaints out of hand. Speak to the protestors, ask them to help fund studies and find what the cause for the increase of Autism is with a specific focus on the immunization process in place at this time.

    Thank you.

    • Chris June 1, 2014 / 11:02 pm

      “I believe what would be needed to convince me is for the CDC and other agencies to deal with the immunization critics on something other than MMR vaccines and thimerasol (sp? sorry).”

      Here are some studies, many are open access that explore other things:
      http://www.cdc.gov/vaccinesafety/library/vsd_pubs.html

      Now to your concerns:

      1) Apparently there is some rule that PubMed indexed studies paid by American taxpayers should be free to access after a year. This has made many of the epidemiological studies available online, like these: Vaccine Safety: Examine the Evidence.

      2) Newborn through five year old kids go to parks and stores. Do you expect a parent, usually a mother, to stay home all day, every day? What about getting groceries? What, no play dates? Doesn’t anyone go to the library? Doesn’t your city have community centers and pools where there are programs for toddlers and preschoolers? What about well child checkups? Do you never see children under age five out in the open in your neighborhood? By the way, many of the diseases that are vaccinated against are only crucial during the young ages, like pertussis, tetanus, diphtheria, Hib, pneumococcal, and rotavirus. My oldest one got one of those before the vaccine was available and he did not go to daycare. Ambulance and hospital bills are not cheap (I had the health insurance company phone number memorized).

      3) Where did David Kirby get his medical degree? My son had seizures from a now vaccine preventable disease as a toddler (see #3). We have no idea if it is related to his severe speech and language disabilities. The neurologist assured us he was not autistic in 1991, which is before the DSM IV came out. The psychologist at his high school said he seemed autistic to her. So was it the vaccines, or the differing criteria for diagnosis. You tell me. And when you do, could you give me good resources for a 25 year old young man who is much more like a fourteen year old who still has speech issues and some interesting “stims.”

      4) Learn about John Salamone and how his son was affected by the oral polio vaccine. Did he sue the government or do something much more constructive?

      Now to your very last statement: “Speak to the protestors, ask them to help fund studies and find what the cause for the increase of Autism is with a specific focus on the immunization process in place at this time.”

      Yes, of course they should do that. SafeMinds has funded studies. Often I have heard that such and such study has not been done. To this I tell them to design a study, make sure it complies with the Belmont Report, get approved by a real IRB, and then write a grant. Send that grant to SafeMinds, Autism Speaks, Autism Trust, Generation Rescue, and the Dwoskin Family Foundation for funding. Then get it done!

    • jgc56 June 3, 2014 / 3:05 pm

      “While there has been a series of arguments about establishing herd immunity I have not heard the explanations as to how a Newborn to 5 y/o is transporting themselves so readily and creating a possible disease vector that threatens the bulk of society.”

      Children in your experience spend the first five years of their lives in near total isolation, never attending church services or going to playgroups, preschools, family gatherings? They aren’t taken to the grocery, the mall, museums etc. by their parents or travel with them on public transport buses, trains, subways? They spend no time in waiting rooms when visiting their pediatrician?

      ” If there are concerns about there being a permanent debilitating impact on a human life that will span some 60 yrs, then what’s the hurry?”

      Unless there’s evidence demonstrating those concerns are legitimate, the only thing delaying vaccination accomplishes is to leave children with vulnerable to the infectious diseases they protect against for an extended period of time.

      “If there is nothing relational between immunizations and autism why has there been such a dramatic increase in the number of autism cases since the introduction of the Hepatitis B Vaccine?”

      It isn’t clear at all that there’s actually been a significant increase in the number of autism cases over that tie period, only that the number of individuals who receive a diagnosis of having an ASD has increased. Much of that perceived increase appears to be a function of factors unrealted to vaccination status, such as broadened diagnostic criteria (individuals who previously would not have receive any diagnosis at all who now are diagnosed with high functioning autistic disorders such as Asperger’s), diagnostic substitution (individuals who in the past would have received a diagnosis other than autism such as mental retardation) and increased surveillance (if you look harder for something you will find more of it.)

  18. Michelle Grewe June 1, 2014 / 11:01 pm

    I read a study I can’t find for the life of me now and I could kick myself for not bookmarking it, but they were trying to see what persuaded people in a debate, and I believed they at some point used vaccinating as their topic, at least for one portion of the study, and their conclusions were that it seemed the more you show facts to un-informed people, the more they rebutted and the stronger they got about being wrong. They think it’s because people often take things like vaccinations and make it a self-identity thing, so attacking it with facts is attacking their identity.

    What changed my mind, I blogged about it here… http://www.crumpetsandbollocks.com/2013/10/vaccines-and-autism-why-i-vaccinate.html

  19. Cindy June 3, 2014 / 6:01 am

    http://www.sciencedirect.com/science/article/pii/S0264410X14006367
    a new study about vaccine and autism. It’s a meta-analasys of 5 studies of , in total, 1,260 000 children, and on top of that, 5 case-controlestudies of 9920 children. This in answer to some people that are asking for a large study.
    There is no evidence for autism caused by vaccines.

  20. becky June 4, 2014 / 10:53 am

    As a parent of a child with autism I stand behind my decision to vaccinate 100%!
    Do I think vaccines cause autism? No, I don’t. What would change my mind? Plain and simple, my daughters Dr. I am not a science scholar, just an everyday parent. I do have a basic understanding of our body’s immune system. I read what I can about the topic. I did my research prior to deciding to vaccinate and am well aware of the history of the topic. I also rely on a group of highly educated medical professionals to provide important care for my child. I trust these people with my daughters life, so why would I not trust them when they say vaccines are safe and important? An opinion repeated throughout the medical and scientific community. If there was enough credible evidence, enough comprehensive studies done or papers published (how ever these things happen) that every Dr. and scientist could unanimously agree. If it were published in medical text books as proof positive that vaccines cause autism. If every Dr. I spoke to all had the same opinion then I would change my mind.

  21. shaunamom June 7, 2014 / 8:04 pm

    As I believe was mentioned above by another responder, I’m responding from the perspective of what would change my mind at a personal level; what would make ME more likely to vaccinate or not vaccinate, or do the same for my children.

    My own perspective for this is as someone with an auto-immune disorder, along with a rare disorder, that impacts how my body reacts to allergens, chemicals, and vaccines, among other things.

    So what I would need to change my opinion (or what DOES change my opinion when I come across it, might be a better way to say it).

    1. Studies done by entities that do not have a great financial gain or loss based on the outcome of the research. I trust these much more than studies done by, say, the company that is producing a vaccine, for example.

    2. Whether or not the study has looked at populations at least somewhat similar to myself, in terms of the differences that can affect things like how one might react to a vaccine. Or if they at least have some theoretical extrapolation about how the vaccines would affect people with conditions similar to my own. I know that research is never going to be on people who match me ‘exactly.’ But my body does not always respond the same way a healthy person’s would, so this is a legitimate concern, for me and my children both. As a quick example, the higher level of non-responsiveness to the Hep B vaccine with celiac disease has come up recently – (http://www.ncbi.nlm.nih.gov/pubmed/23430309). It’s also recommended that people with my disorder (a mast cell activation disorder) do not get live vaccines due to the potential for a serious reaction – but there aren’t studies on this at all. It’s simply the recommendation from experts in the disease due to their patients’ experiences.

    I am active in the communities of fellow auto-immune disease and allergic folks, and I know a lot of anti-vaccine folks from this same community. The concern that research is more relevant to healthy populations but that there may be less research done for people with their specific type of condition is something that comes up at least once a month in our various forums, if not more. And these are people who are at the same time very worried about GETTING the disease vaccinated against, because they are often more vulnerable to infection. With the growing number of auto-immune disorders and allergies, people’s concern about research relevancy could potentially have an impact on the vaccinated portion of the population in the future, I would think.

    3. This is going to sound a bit cheesy, but I’m honestly expressing what changes my opinion, or at least makes me consider things more carefully: an expert willing to state an honest appraisal of the limitations of their knowledge base, either in the study or if asked. I may get the exact same evidence from two different sources, but if one source says, ‘this is what we know vs. this is what we don’t know,’ and the other source tends to dismiss what they don’t know as irrelevant, I am less likely to trust the second source.

    Even if they told me the same thing, I will trust the first source more. I’d say it’s likely because I know that our research is 1) done by fallible human beings and 2) usually more complex than I can fully understand. Which means that when I’m reading a research paper and the conclusions, I may not be educated enough in the topic to judge whether the research supports the conclusions; I have to rely on the researchers’ competency for this. And if I see researchers who seem to be more objective about their research, and more able to admit to flaws and possible problems in their research, then I have more trust that their study IS more objective.

    This does not always hold true obviously, but without knowing the researchers personally, I know that I tend to judge research this way.

    Although again, this is from the perspective of someone who falls on the far end of the bell curve in terms of potential reactions to vaccinations. A lot of my medical decisions have to be based on ‘best guesstimates’ of what will happen, even by my doctors, because there hasn’t BEEN research on it.

    • Chris June 7, 2014 / 8:50 pm

      “Studies done by entities that do not have a great financial gain or loss based on the outcome of the research.”

      Are studies by the National Institute of Health, the CDC, the World Health Organization and other public health entities around the world okay? What about private foundations like Gangarosa International Health Foundation and Rollins School of Public Health, Emory University, Atlanta, GA, USA? (from Impact of anti-vaccine movements on pertussis control: the untold story).

      How about those done by insurance companies like Kaiser-Permanente that want to spend less money to pharmaceutical companies? They even participate in the Vaccine Safety Datalink Program.

      “It’s also recommended that people with my disorder (a mast cell activation disorder) do not get live vaccines due to the potential for a serious reaction – but there aren’t studies on this at all.”

      You are in a population that needs protection from community immunity. People with your issues need to encourage the healthy to stay current with their vaccines.

      “A lot of my medical decisions have to be based on ‘best guesstimates’ of what will happen, even by my doctors, because there hasn’t BEEN research on it.”

      A good place to start would be the Vaccine Safety Datalink Program. Click on a few links like some of the studies that have been done, Then see if someone who researches your disorder would look into the kind of research you are interested in. Then perhaps find the funding.

      I know the geneticist who we consulted for my son’s genetic heart disorder would have have liked to see us pay for a full genetic scan, to see if there was a relationship with his neurological issues, especially since the eighteen known sequences were not found in him (so we could not test our other kids for it). She typically works on the genetics of autism, and he had a combination to two things. Unfortunately I don’t think the insurance would pay for it, and we did not think the cost was worth it for us. We did tell her that if she got a grant, she could have more of his blood.

      Good luck with your efforts, and with your health.

      • shaunamom June 8, 2014 / 12:49 am

        “Are studies by the National Institute of Health, the CDC, the World Health Organization and other public health entities around the world okay?…”

        Typically, yes, I tend to look at these more frequently and trust them more. The only reason I might have reservations for one would be if, say, some of the researchers have previous ties to companies or organizations that, again, have stronger financial motive for desiring a particular outcome from the study. Current ties are obviously noted in the study, but sometimes there may be previous ties that may still be influential. In that case, however, I simply search for more research to corroborate.

        “You are in a population that needs protection from community immunity. People with your issues need to encourage the healthy to stay current with their vaccines.”

        Oh heck yeah. I actually caught whooping cough a couple years ago due to an outbreak in my area. It was an interesting discussion to have with folks who talked about how little a risk there was for catching a certain disease so they would never get their kids vaccinated; it was as though they had never considered WHY there is less risk now, or that this could ever change through their actions.

        A few folks had children in my situation, where they were unable to be vaccinated against certain things, and I had to stay away for months to make sure I didn’t pass it on, it took me so long to recover. :-/

        “A good place to start would be the Vaccine Safety Datalink Program”

        Thank you for the name – I haven’t explored them before. I hope that the researcher some day can get a grant and be able to discover something to help your little one.

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