2/21/2011

The Horror: Dr. Jay Against Preventing Infectious Disease "just because...we can"

Over at Orac's today, Dr. Jay continued to demonstrate his failure to think critically. After a string of comments that should be somewhat embarrassing, Dr. Jay offers this stunning failure: "And, I think it's wrong to vaccinate against an illness just because . . . we can. We should be more judicious in our use of this medical intervention."


Why "should be more judicious in our use" of vaccines? Why would we want to have children suffer diseases when their suffering can be prevented? Here are four of the diseases vaccines protect against. I wonder which ones of these diseases Dr. Jay thinks kids should get?


Measles:


"The number of measles cases reported during January 1--July 31, 2008, is the highest year-to-date since 1996. This increase was not the result of a greater number of imported cases, but was the result of greater viral transmission after importation into the United States, leading to a greater number of importation-associated cases. These importation-associated cases have occurred largely among school-aged children who were eligible for vaccination but whose parents chose not to have them vaccinated. One study has suggested an increasing number of vaccine exemptions among children who attend school in states that allow philosophical exemptions (6). In addition, home-schooled children are not covered by school-entry vaccination requirements in many states. The increase in importation-associated cases this year is a concern and might herald a larger increase in measles morbidity, especially in communities with many unvaccinated residents.


In the United States, measles caused 450 reported deaths and 4,000 cases of encephalitis annually before measles vaccine became available in the mid-1960s (1). Through a successful measles vaccination program, the United States eliminated endemic measles transmission (1). Sustaining elimination requires maintaining high MMR vaccine coverage rates, particularly among preschool (>90% 1-dose coverage) and school-aged children (>95% 2-dose coverage) (7). High coverage levels provide herd immunity, decreasing everyone's risk for measles exposure and affording protection to persons who cannot be vaccinated. However, herd immunity does not provide 100% protection, especially in communities with large numbers of unvaccinated persons. For the foreseeable future, measles importations into the United States will continue to occur because measles is still common in Europe and other regions of the world. Within the United States, the current national MMR vaccine coverage rate is adequate to prevent the sustained spread of measles. However, importations of measles likely will continue to cause outbreaks in communities that have sizeable clusters of unvaccinated persons."


Mumps:
"Before the mumps vaccine was introduced, mumps was a major cause of deafness in children, occurring in approximately 1 in 20,000 reported cases. Mumps is usually a mild viral disease. However, serious complications, such as inflammation of the brain (encephalitis) can occur rarely. Prior to mumps vaccine, mumps encephalitis was the leading cause of viral encephalitis in the United States, but is now rarely seen.
Serious side effects of mumps are more common among adults than children. Swelling of the testes is the most common side effect in males past the age of puberty, occurring in up to 37 percent of post-pubertal males who contract mumps. An increase in miscarriages has been found among women who develop mumps during the first trimester of pregnancy.
Before there was a vaccine against mumps, mumps was a very common disease in U.S. children, with as many as 300,000 cases reported every year.  After vaccine licensure in 1967, reports of mumps decreased rapidly. In 1986 and 1987, there was a resurgence of mumps with 12,848 cases reported in 1987. Since 1989, the incidence of mumps has declined, with 266 reported cases in 2001. This recent decrease is probably due to the fact that children have received a second dose of mumps vaccine (part of the two-dose schedule for measles, mumps, rubella or MMR).  Studies have shown that the effectiveness of mumps vaccine ranges from 73% to 91% after 1 dose and from 79% to 95% after 2 doses and that 2 doses are more effective than 1 dose."

"Rubella, whose name means "little red," was thought to be a type of measles until 1814, when German researchers described it as a completely different illness. From 1963-1965, a rubella epidemic swept across the globe. In the United States alone, there were about 11,000 fetal deaths and 20,000 infants born with congenital rubella syndrome, a group of birth defects that can occur in an infant when its mother is infected with rubella during pregnancy."


"Pertussis is most severe for babies; more than half of infants younger than 1 year of age who get the disease must be hospitalized. About 1 in 5 infants with pertussis get pneumonia (lung infection), and about 1 in 100 will have convulsions. In rare cases (1 in 100), pertussis can be deadly, especially in infants."

"Pertussis can lead to hospitalization, pneumonia, dehydration, weight loss, sleep disturbance, seizures, and, rarely, encephalopathy or death.1 These complications vary depending on patient age (Figure 26). Most pertussis related hospitalizations occur in the first year of life.4 Young infants are at the greatest risk of secondary bacterial pneumonia, the most common cause of pertussis-related deaths.4,7 Acute dehydration and malnutrition occur in patients with cough that limits food and fluid intake. Cerebral hypoxia from severe paroxysms1 can cause seizures and encephalopathy. Refractory pulmonary hypertension can be a late sequela in infants with pertussis.1,7"


I can understand some of the folks at Age of Autism and the like not getting the dangers. I do not, however, get how a pediatrician could wish "natural immunity" and possible death on children. I'm deeply disappointed in Gordon and I can't help but wonder how the AAP would feel about his position regarding vaccines and not safeguarding his patients.

9 comments:

Ren said...

Oh, boy. Just because we can? Yes, Dr. Gordon. Just. Because. We. Can. See, if we couldn't, entire populations would be at risk of being obliterated. And you know very well that I'm not exaggerating. Think of polio in the early 1900's in the US... BUT ALL OVER.
Think of chickenpox and smallpox and the American Indians... BUT ALL OVER.
Think of the Daycroft School in Connecticut in 1972... BUT... Oh, dammit. You know what I mean.
Come on, man!

kathleen said...

Once again Dr. Jay visits Orac and pretends to be earnest..The "gosh gee whiz I'm just a regular doc who is trying to learn" routine has grown boring..There is a saying that no publicity is bad publicity..and publicity is what he is about. His "image" has become more important than common sense. Frightening.

Sirenity said...

One wonders what population Dr. Gordon objects to us giving vaccinations to? And who should decide who gets medical interventions? Will those rules apply worldwide? will there be an appeal system? what is the criteria to be approved to receive said medical interventions?
Obviously not well thought out...

bbsmum said...

Whilst I absolutely, totally, 100% agree with what you say about the need to vaccinate every child against these diseases, I'm wary of supporting the 'just because we can' way of thinking, because it can so easily be extended to other areas. I'm sure you'd agree that things like genetic testing, pre-natal screening, termination of affected fetuses etc should not be done 'just because we can'. That's not to say that any of these proceedures are inherently wrong, simply that there are more things to be considered than 'we can so we should'.
I do think that just because in the case of vaccines, that consideration still produces a resounding 'yes, we should do it' doesn't mean that we should shout down someone who says 'Let's think first, the benefits may not necessarily outweigh the disadvantages'.
'We can so we should' is a reasonable attitude when it comes to the vaccines you are referring to, but I think it's a dangerous mindset to condone without stipulating that we're talking about this particular area only.
Maybe I've misunderstood. Sorry.

KWombles said...

We can't vaccinate every child against these diseases; some will be immune-compromised and be unable to receive the vaccines.

The article is about vaccines and diseases we can prevent through vaccines; I didn't go beyond that. And Dr. Jay wasn't talking about risks vs benefits. His idea of natural immunity vs immunity gained through the disease state being "better" is bunk.

I think you read a lot of stuff into the post that's not there; there's a big difference between preventing disease and preventing a person from being born. This is about preventing infectious diseases that maim and kill. This is about the uninformed and inaccurate belief system of a doctor who treats children and has an obligation as a Fellow of the AAP to do better than he has done. That's all it's about. I don't understand how you went beyond that when it's very clear that the discussion is about preventing infectious disease through the use of vaccines; I believe it was very clear that this was specifically stipulated, but it was probably because you focused on the "because we can" instead of the topic.

bbsmum said...

Sorry, I thought there was a general principle to think about over and above the vaccine question (about which I do agree with you, and yes, I do know that vaccines aren't medically appropriate for all), but I do have a tendency to extrapolate from the specific to the general. Whoops, I probably ought not to do that so much, right? Sorry! :)

Life in the House That Asperger Built said...

Oh, really well done, Kim. Very nice.

KWombles said...

Ah, bbsmum, yes, in that light, asking that particular question in regards to other situations is appropriate; I was focused narrowly on that specific question in relation to protecting against infectious disease through the use of vaccines and answering that question only. :-)

I'd be the first to agree that just because we can do certain fetal genetic testing doesn't mean we have to or necessarily should; I personally did not do any fetal genetic testing because I would not have had an abortion regardless of the results, but I respect that this an intimately personal issue and don't tend to weigh in those areas. Parents have to decide for themselves what the right answers are for them.

:-)

@Laura, thanks.

@Ren, I'm kinda surprised he didn't chime in.

@Kathleen, your comment is kinda funny in light of him going over to Orac's and saying he couldn't find any common sense in the responses to him. He ignores my comments there as if they don't exist.

Sirenity, nope, it wasn't, was it?

Prometheus said...

While I can understand the point of resisting the "technological imperative" (see, I took humanities courses, too) and its push to "do something" simply because we can, I fail to see the logic in Dr. Gordon's position...if, indeed, there is any.

It would be one thing if he was talking about vaccines against acne or breast augmentation in pre-teens, but Dr. Gordon is arguing that we shouldn't vaccinate children against diseases that are KNOWN to cause death and permanent diability simply because he THINKS (based on his recollection of 30+ years as a general paediatrician) that they MIGHT, POSSIBLY cause autism IN A FEW CHILDREN.

The fact that there is NO data supporting Dr. Gordon's position, by the way, hasn't appeared to alter his conviction in the slightest.

In keeping with Dr. Gordon's recent "don't you have something better to do" approach when he comments on 'blogs, I'd like to suggest to his that he use his time and energy in a more productive way. In fact, I'd like to suggest that he turn his time and attention to ANOTHER injected product: tattoo ink.

The incidence of serious complications after tattooing is MUCH higher than that after vaccination (e.g. hepatitis B, hepatitis C, HIV-1, etc.) and tattoos - for all their edgy counter-culture appeal - have no known benefits.

Advocating that people not get tattoos would be a far better use of Dr. Gordon's time and energy than his current Quixotic attacks on vaccines.

Just a suggestion...

Prometheus