One More Time, with Big Data: Measles Vaccine Doesn’t Cause Autism
nytimes.com
nytimes.com
/s
I really want to understand the logic that goes on the head of an anti-vax parent. I can't wrap my head around "This injection will make sure, with a very high degree of certainty, that my child does not die from a disease thought eradicated."
It seems that their arguments are changing [1].
The gist, as I understand it, of their changed argument: The media has overblown the recent measles outbreak, there are things way worse for our children than measles and we should not be influenced by this media hysteria. Measles is uncommon and treatable so we should not be forced to vaccinate our children.
[1] https://www.oregonlive.com/opinion/2019/02/readers-respond-m...
[EDIT] Changed "evolved" to "changed".
However, I recently had to do a risk assessment for myself for Japanese Encephalitis, which is a $400-800 vaccine that only has a few years of effective dosage at best, and has a mortality rate of 16,000 per year out of 4 billion exposed.
If there's any chance that the vaccine has some type of chemical or substance that would cause an adverse effect in me, even if it was free, I would take my chances without the vaccine.
Similarly, I haven't received a tetanus shot in decades, despite really wanting to. I simply don't have the money because I don't have insurance, but I feel the risks of the vaccine are worth the benefit of not having tetanus.
Funnily enough, that's about the same time frame as when the kid receives their first vaccinations.
To the nonscientific mind, correlation=causation a lot of the time. Add to that the increased difficulty in caring for an autistic child, the belief that autistic people are "soulless" or somehow not capable of empathy, the desire of parents for their children to live a "normal" life, and the significant subset of parents who view their children as lifestyle accessories rather than independent people and so are embarrassed by a child with special needs, and you have enough fear and dread that things might've been different had I made the choice not to vaccinate to kick off a worldwide movement.
...and then right after the vaccine they are completely mentally retarded, can't make eye contact, and no longer speak the words they spoke prior to the vaccination.
Screening specifically for autism isn't recommended before then, but that seems to because differentiating autism from other development delay or disorder is difficult then; it seems to often manifest detectable signs as early as 2 months, though they are mostly signs that could be associated with other developmental conditions.
> because it takes that long for the brain subsystems involved to be wired up in more or less their final configuration.
> Funnily enough, that's about the same time frame as when the kid receives their first vaccinations.
No, it's not. The first recommended vaccine (HepB first dose) is at birth, and there are a lot before 18 mo., by 18 mo. they are hitting the fourth dose for some vaccines.
https://www.cdc.gov/vaccines/schedules/hcp/imz/child-adolesc...
What are the risks of a particular vaccine? What are the risks to my child if they get the disease?
The answers to those vary per vaccine and could result in some parents deciding to not vaccinate their children for one or more vaccines.
Medical researchers know more than you about which vaccines are safe and should be administered.
> What are the risks of a particular vaccine? What are the risks to my child if they get the disease?
For all of the regularly scheduled vaccines the answer is the risks of not vaccinating greatly outweigh those of receiving it, unless you have an allergy to something in that particular vaccine.
This is only true for healthy people who have had no reactions to vaccines, nor have their family members.
There are people who have life-long debilitating reactions. What is being proposed is to make it impossible to opt-out if you have a personal or family history with negative reactions to vaccines. Medical exemptions are impossible to get except for the very wealthy who can afford the appropriate testing to prove it's an issue.
That's what I said. Allergy, reaction, same thing.
He said it was a mistake looking back but they weren’t sure if vaccines caused autism so they erred on the side of caution in the 2000s. It’s remarkable they believe pseudo-science over medicine that quite literally eradicated terrible diseases.
- Many people believe their social network over authoritative sources.
- There is a general (and many times legitimate) distrust of "Big Pharma", especially in the US.
- Protecting children triggers a deep emotional instinct in parents. This provides a strong motivator for people to do research into what substances are being put in their childs bodies.
- Autism is scary for many, in part because its not currently well-understood, nor are its causes. Anti-vaxxers capitalize on this fear to present causal arguments in absence of an authoriative science-based one. People who need answers will find one, one way or another.
- Reported cases of autism are on the rise, this is a generally-accepted fact. This is most likely due to our improved understanding of what autism is of course, and not due to the rise of vaccines. We can shout "Correlation != Causation" all we want, but at the end of the day, scientific education is quite poor all over the world (especially in the US where its actively demeaned by many groups, whether for financial, ideological, or religious reasons), and a lot of people quite simply just don't think this way. We are hard-wired to find patterns in the world, and the world is complex - many people will quite simply find the wrong ones.
- Anti-vax is partially due to the success of vaccines, people of parenting age today were born into a world without polio, measles, smallpox, etc. This may lead people to believe the vaccine "didn't do anything" (which is kind of the point!). Preventative measures (vaccines) don't have the same response as reactive measures (cures), we're just not hard-wired for it emotionally.
- There exist a number of sources online that imply vaccines cause more harm than good. This is the first google result I found when searching "number of vaccines in usa", a realistic search term a concerned parent might use:
https://www.fourteenstudies.org/nowwhat.html
These present a number of studies that appear to show a link between vaccines and autism. As I sit here, I could not refute each study one-by-one, and other than the goofy styles, I could not articulate to an anti-vax parent, or even an undecided one, why these are bad science.
In fact, it doesn't even seem like an unreasonable hypothesis to me that "Big Pharma" is pushing vaccines of dubious necessity for profits - the incentive is clearly there.
So its not as illogical as it might seem - Fixing these attitudes is a difficult problem, and not one with an easy solution. We can start by improving scientific education, and improving the way that institutionalized knowledge is distributed. We need to somehow figure out how to collectively "remember" why these vaccines are necessary in the first place, well after the people affected by these diseases in the past are gone.
This is the first google result I found when searching
- Industry trial funding and other conflicts of interest
- No real placebo test - and it is normal according to the expert.
- etc.
"No included trial in the Cochrane review used a placebo comparator All 26 trials included in the Cochrane review used active comparators: adjuvants (aluminium hydroxide (Al[OH]3) or amorphous aluminium hydroxyphosphate sulfate [AAHS]) or hepatitis vaccines."
"The Cochrane authors mistakenly used the term placebo to describe the active comparators. They acknowledged that ‘The comparison of the risks of adverse events was compromised by the use of different products (adjuvants and hepatitis vaccines) administered to participants in the control group’. Nevertheless, this statement can easily be overlooked, as it comes after 7500 words about other issues in the discussion and under the heading ‘Potential biases in the review process’. Active comparators was not a bias in the review process but a bias in the design of the HPV vaccine trials."
source:
"The Cochrane HPV vaccine review was incomplete and ignored important evidence of bias"
BMJ Evidence-Based Medicine October 2018 | volume 23 | number 5 |
Science denial is fairly common, a surprising amount of the population engages in it at some degree selectively. Depending on your personal belief systems and political persuasions, you may engage in science denial yourself, and if so and you recognize it, you might better understand that logic.
A few common examples of science denial from around the political spectrum:
- Evolution, Darwinism, and Creationism
- Climate change denial
- Age of the Earth
- Sex / gender differences
- Flat earth
- Excess calories causes obesity
- Denial of obesity as a severe health disorder
- AIDS denialism
- Animal consciousness
- Moon landing
There are plenty of other examples, many of which are popular with educated peoples.
http://icandecide.org/wp-content/uploads/whitepapers/ICAN Reply - December 31%2C 2018.pdf
(mind the spaces in the url)
While there are fanatics, there seems to be a lot of the the movement which is people who are ignorant and misled and can be effectively engaged from a position of respect.
It’s a matter of faith, further studies will never make people change their minds.
Take a look at this picture: https://www.nejm.org/na101/home/literatum/publisher/mms/jour...
There were 440,655 vaccinated children and 96,648 unvaccinated. Among the vaccinated 621 were autistic (of any kind), 117 among unvaccinated. Which gives us 0.14% and 0.12% respectively.
Why doesn't this prove that vaccination has some impact on autism?
Please refrain from attacking me, I just want to know the science explanation.
Say you pick two groups of people from a population, two groups of 10 000 people at random.
Imagine then that you count the proportion of autistic people in each group. You might get say, 0.15% in group A and 0.14% in group B.
If by chance the people in groups A and B had been partitioned differently between the two groups, i.e.: if enough autistic people in group A had instead ended up in group B, you can easily imagine that the numbers would change. Or even that they could flip.
Some differences between the two were simply due to random chance. Statistical significance is a concept used to try to tease apart how much of an effect is due to a suspected cause (vaccination in this case) vs chance.
Now in the case of this study, you might say, well there was no other way to partition the data, since all the vaccinated kids had to go in group A. While this is true, if autism has a different cause or causes than the partitions you chose effectively, your partitioning into groups would still be random with respect to the true cause of autism.
So to 'prove'[3] whether a vaccines cause autism, we would prefer to see large effect sizes, which would strongly suggest that the effect is due to the cause we suspected.
If instead, we had seen numbers like this: group A 15% and group B 7% then you could argue that the effect size is large enough to go beyond the effect caused by the sampling.
Mathematical techniques in statistics and probability theory exist which allow you to choose a threshold (p value) in order to consider an effect to be statistically significant.
[1] https://en.wikipedia.org/wiki/Statistical_significance
[2] https://towardsdatascience.com/statistical-significance-hypo...
[3] 'Prove' in quotes, because you can't really prove cause and effect using a study like this. To get closer to proof, you'd need an experiment where the conditions are specifically assigned to each group.
However, like the Jain study (https://jamanetwork.com/journals/jama/fullarticle/2275444), this new study focuses primarily on MMR vaccination, which is a shame. Focusing on once vaccine in a heavily vaccinated population kinda proves nothing. They also captured data on vaccination with pentavalent vaccine, which is great, but unfortunately it seems that it is completely useless ...
As usual a control group of completely unvaccinated probably is not included because the study states that "We evaluated the association between MMR and autism in children with no DTaP -IPV / Hib vaccinations in the first year of life; we found no support for an association in this vaccine-naive subpopulation "- so the "no DTaP-IPV / HiB" field in the tables probably means "no DTaP-IPV / HiB in first year of life"(haha, sneaky!). I view positively that they included other covariants (eg parents' age, etc.), but again, unfortunately, the covariant combination is missing and there are no groups with more variables (shame).
As with the Jain study, there is a "healthy user bias": the authors did not take into account the possibility that parents of children showing signs of ASD do not start / stop vaccinating the MMR and fall automatically into the "unvaxx" group. At least the authors mention this in the discussion.
And as usual: epidemiological studies are NOT a good tool for verifying the safety of a product (or to disprove possible causality), this is the job of clinical trials (unfortunately, vaccines' safety clinical trials are very very bad pseudoscince with no placebos).
That hypothesis is the mercury and aluminum exposure. The current MMR vaccine does not contain mercury or aluminum.
A hypothesis of how vaccines could cause autism would only be worth evaluating if there were evidence presented of an effect that that hypothesis was necessary to explain.
protocol: "Aluminium adjuvants used in vaccines versus placebo or no intervention"
https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD...
Cochrane Systematic Review - Intervention - Protocol Version published: 24 September 2017
"More than 10 years has passed since the systematic review by Jefferson and colleagues, new adjuvants are being introduced continuously, and FDA and WHO do not require genotoxicity or cardiotoxicity studies of new aluminium adjuvants (WHO 2014b; FDA 2015). Lately, symptoms following HPV vaccination have been suspected of being caused by the addition of aluminium adjuvant (Tomljenovic 2011; Lee 2012; Poddighe 2014; Brinth 2015b; Gruber 2015; Martinez‐Lavin 2015). A recent animal study by Inbar and colleagues managed to spark further controversy by demonstrating behavioral abnormalities in mice administered the aluminium‐containing HPV vaccine Gardasil (Inbar 2016a). Compared to previous animal studies on HPV vaccines, the authors included two control groups: one where mice were administered aluminium adjuvant alone and another with placebo without adjuvant (Inbar 2016a). Inbar and colleagues concluded that Gardasil via both its aluminium adjuvant and HPV antigens can trigger neuro‐inflammation and autoimmune reactions, leading to behavioural changes in mice (Inbar 2016a). Upon submission to a peer‐reviewed journal, the paper was accepted with revisions, and published. However, it was soon withdrawn by the editor (Inbar 2016), only to be published in a competing journal shortly thereafter (Inbar 2016a). The initial withdrawal was allegedly due to "unsound scientific results"; an assertion which was not supported by the final publisher.
The theory that aluminium adjuvant is responsible for symptoms following HPV vaccination is impossible to refute or prove based on the current data. Aluminium adjuvant has been administered to both experimental and control group in the vast majority of randomised clinical trials on HPV vaccines, thus masking its potentially harmful effects (Exley 2011). Clinical trials designed to administer vaccine adjuvants to the experimental group as well as the placebo group do, de facto, not compare an intervention against a true placebo, and therefore, do not adequately assess safety (Exley 2011). Indeed, aluminium adjuvants, new or old, should be evaluated for benefits and harms on their own merits.
Aluminium is the most frequently used adjuvant, introduced in vaccination programmes worldwide (Tritto 2009). While the consequences of adding aluminium to vaccines have been discussed broadly, no systematic review has been conducted to assess the effects of aluminium adjuvants across vaccines. The effects of aluminium adjuvants remain to be properly assessed using Cochrane methodology to determine whether they are beneficial, or causally linked to the numerous adverse events reported following immunisation."