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Comment by SeanDav | Hacker News Reader

Bottom line: vaccines are good for society but fault lines occur because vaccines are not always good for individuals and government are conditioned to not admit this or keep it as quiet as possible.

My daughter had complications 10 days after her MMR in the UK. She had episodes of going floppy and eyes rolling back in her head while making strange mewing sounds. 10 days is around the time that the measles component of the MMR can manifest side effects. We took her to the hospital where doctors absolutely refused to admit that the MMR vaccine could have anything to do with these symptoms she has never had before or since.

I found out later that in fact these exact symptoms were a known side effect of MMR in some cases. I also found out later that doctors are "encouraged" to not admit side-effects to MMR.

I also know that the UK government were using vaccines with a mercury preservative that had been banned in countries like Japan for years.

My point is, examine any claims by government or big Pharm or sensational reports about autism very carefully and make up your own mind.

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Buddy, do you know how thoroughly disproven thimerisol complications are? Even mainstream (if they can be called that) vaccine denial has moved away from this claim. You get more environmental mercury average urban life.

And let's say this might have been a legit concern (it is proven that it isn't) for the sake of argument. Thimerisol hasn't been used in single-dose vaccines in the West for the last 7-10 years! It's only used as a stabilizing agent in multi-dose vials; Vials typically seen as part of low-budget vaccination programs in Africa and Asia.

There are potential side effects from the MMR vaccine. Autism is not one of them. A mountain of money and research effort has gone into this. There is no credible correlation.

He'll, the man who proposed this correlation (Wakefield) has been forbidden to practice in the UK because he was illegally taking spinal fluid sample from children without consent or a proper medical review of his study. He recklessly endangered the lives of children and caused them undue pain to try and prove his theory. He then lied about his data because it didn't show what he wanted it to show.

PLEASE let this crazy idea rest. Any rational person examining the evidence can only find overwhelming evidence to the contrary. If you want to claim that you're a responsible adult worthy of making reasonable decisions then you should demonstrate that you've examined even a few of the salient facts about the subject. My reading of your comments suggests you have not.

People are protective of their kids but they are not always very rational about the relative risks their children face. Vaccines are good for society and they are good for individuals, but like all medical treatments that occur to millions, even tiny risks will affect some individuals.

Measles kills. Polio cripples. Faking research to show a false result about vaccines doesn't protect children, it is tantamount to murdering children and adults by making them susceptible to dangerous diseases.

As you yourself admit, your daughter had a possible temporary reaction ("these symptoms she has never had before or since"). Temporary symptoms are hard to diagnose, especially in children who can't describe their symptoms. It was probably very scary but since I'm related to people who spent time in iron lungs because of polio, my family knows that there are other equally scary things. Watching your child succumb to a horrible easily preventable disease is probably pretty scary.

About the mercury:

The mercury in the preservative is ethylmercury not methylmercury, ethylmercury behaves differently and clears the body faster leading to a shorter period of exposure than methylmercury.

The bans in Japan and other countries weren't based on toxicity studies but on a precautionary approach and pressure from non-scientists. The bans may have been sensible or pointless but it doesn't prove things one way or the other.

Can you please provide credible (i.e. peer-reviewed) references to the symptoms you describe being a known side-effect of MMR vaccination? And to doctors being "encouraged" not to admit said side-effects? I'm not saying you are wrong, I'm just saying what you are describing is really unusual.

Which brings me to my next point: any decision has consequences. If there is a 1 in 1 billion chance of a side-effect, and a 1 in 5000 chance of getting a debilitating disease, I think it's still fair to make the argument that the treatment is not just for society but also for the patient. Who is "society" if not "all the patients?"

> Who is "society" if not "all the patients?"

In your hypothetical case, the treatment is beneficial both for society and for the patient. On the other hand, if there is a 1 in 100 chance of a side effect versus a 1 in 1000 chance of getting a debilitating disease, the vaccination may not be good for the patient. But if the chance of getting the debilitating disease would be 1 in 10 without herd immunity, then the vaccination is good for society.

It's just that most of the benefits of the vaccination flow not to the patient but to the other people they don't infect, and transitively.

Just to adjust your calculations a bit since side effects aren't all equal, the ranges are likely much higher than you mentioned.

Trivial side effects (small temporary rash) are probably in the 1-in-100 range. Moderate non-life-threatening are probably in the 1-in-3000 range.

Dangerous or life-threatening side effects are in the one in a million+ range.

This varies a lot by vaccine. The typhoid-fever vaccine I took in 2003 has "trivial side effects" in the 90-in-100 range, I think --- namely, you feel sick for a few days.

You're absolutely right, I should have been more specific by saying that in the case of the MMR vaccine, trivial side effects are in that lower range, but --as you've pointed out-- that isn't true in all vaccines.

Sure the "peer" review you require is on the long list of side-effects on one of the MMR manufacturer's own packaging. Look it up.

The doctors being encouraged comes from the mouth of a doctor friend of ours that used to work for the NHS. Sorry you are just going to have to take my word on this. I can't prove this.

Disagree with you on individual verse society point, but this is a discussion for another day.

I will continue to search, but I also want to point out a common misperception: adverse events in the PDR or on product packaging are simply a list of all reported adverse events, with little data to demonstrate causality. Common medications often have dozens to hundreds. Clearly, some of these are valid, but with more rare events it becomes harder to say. This kind of data is important, but should be viewed in context.

Some of what you describes sounds a bit like Guillain-Barré Syndrome, but there are some more idiosyncratic elements. Either way, I hope your daughter is safe and feeling better.

My point here is not to be argumentative, but I really do feel that as a physician I have a duty to point out that the overwhelming majority of available data suggests that routine vaccines for common childhood illnesses (those recommended by the CDC and NSH) are safe and effective. Clearly, sometimes people have adverse side-effects, but the data support that the risk of a bad outcome is worse without the vaccine than with. Either decision has consequences.

The side-effects shown on a package of Bayer aspirin are pretty scary, too.

> I'm not saying you are wrong, I'm just saying what you are describing is really unusual.

How do you know it's unusual if the symptoms in question haven't been studied ? If there's no study, all you have is anecdotal evidence. It could be happening all the time, perhaps to a lesser degree.

edit: dear mr. downmodder. I appreciate your response ! I understand the rationale of doctors who shrug off what their patients tell them much better now, thanks, and I now have a deeper respect for their wisdom when they tell me my symptoms are all in my head or something similar.

Perhaps 10 seconds of using your favorite search engine would have found you this link:

http://www.cdc.gov/vaccines/vac-gen/side-effects.htm

The approximate odds of having a specific reaction, are listed. Seizure (jerking or staring) are listed as 1 in 3000 .

The problem with anecdotal evidence is that what you are saying may be 100% true, but statistically, it was bound to happen that two unrelated episodes would coincide the way you describe them. What you don't see in this thread is millions of people sharing their experience that they had the MMR vaccine, and nothing happened after 10 days.

That is unusual. The doctor I know (she is sat on my lap :)) tells me that it was probably just a doctor mistaking the danger signs of "vaccine moaner" and trying to avoid an argument.

Which is inexcusable "bedside manner" and they should be held up for it.

But the bottom line is; yep, maybe it was caused by the MMR vaccine. Maybe not.

The real secret is that medicine, even tried and tested medicine, causes all sorts of random and unexpected results in a tiny amount of people - which is why those boxes list silly numbers of symptoms (i.e. I challenge you to find a medicine that doesn't potentially cause nausea :)). It's not so much that doctors are encouraged not to admit these side effects, it is that they know it is a product of random variance.

The actual problem is; you can't rationally explain this to people. The majority simply don't "get it" and it risks persisting fear over proven (and safe) medicines. So the question is; is it morally right or wrong to do so?

So... yeh it could have been a Vaccine. It could have been a random coincidence (that happens a LOT, particularly in young children when parents happen to be looking for a change). It could have been simply the fact someone stuck a needle in her triggering some medical phenomena (also relatively common).

The doctor should have told you all this, and they need a kicking for failing to be open with you :)

However:

My point is, examine any claims by government or big Pharm or sensational reports about autism very carefully and make up your own mind.

Is a point I wholeheartedly agree with.

Bottom line: vaccines are good for society but fault lines occur because vaccines are not always good for individuals

Bottom line: vaccines are good for society but fault lines occur because some vaccines are not always good for individuals, however the MMR vaccine has been found completly safe.

Absolute rubbish, there is no such thing as a completely safe vaccine.

Other things there is no such thing as a completely safe version of: Cars. Airplanes. Computers. Lamps. Electricity in general. Boats. Food. Ovens. Buildings. Knives. Trees. Swimming pools. Public transportation. Flash cameras. Paper. Other people.

Nothing is completely safe. NOTHING. However, when something is safe for the vast majority of people and there's no demonstrable correlation between using it and detrimental effects (and if there is such a correlation but the net detrimental effects are outweighed by the benefits), then it doesn't matter that it's not completely safe.

That is the most uninformed comment on this discussion.

Unless you are a trained medical professional in this particular area of study, you have absolutely no business making up your own mind.

Most doctors get their information about medical issues by reading the marketing pamphlets from drug companies. If you actually read the relevant journal articles then you'd be significantly more knowledgeable about any given topic than the average doctor.

That's just not true. Is it necessary for me to say any more about this?

I dunno, it squares with my experience, at least until you reach a specialist.

Admittedly this is anecdotal evidence, but ...

I have diagnosed several medical issues with myself and my wife by web research, only to have to pay to go to a family doctor, who hems and haws, then gives a referral to a specialist, who agrees with what I have already stated.

Specialists in my area will not take you in without a referral from the family doctor, so basically the family doctor is collecting a fee for being a gatekeeper, since he/she adds zero value.

Something similar occurred many years ago with an eye problem I had (tear in retinal wall) - the regular eye doctor had me coming back week after week, collecting his fee each time, until I specifically asked for a referral.

The specialist saw in 3 minutes, the tear that the doctor had missed from the beginning and on each subsequent visit - the reason - the specialist had me recline to flat on my back and used a very powerful magnifying glass, while the hack ^H^H^H^H regular doctor did not.

The symptoms (large eye blockage in one eye due to large black cloudy thing that appeared one morning) clearly pointed to only this cause.

Think about it this way: you want someone to design a website for you so you go off and find someone to do it. Now, you don't know how to program, don't really know anything about computers aside from how to perform a few functions (certainly nothing about how they actually work), and don't really have a professional frame of reference for evaluating the developers skill level.

This is basically what you have to deal with with doctors. There are doctors who are very, very good and doctors who are just barely bright enough to continue to practice. The major problem is how you distinguish between the two or, in other terms, how do you find a good programmer if you don't really know anything about programming? Honestly, I don't have an easily cut-and-dried answer. I generally rely on my family (a large subset of my family are highly skilled physicians) to use their professional expertise and circles to find a very highly respected physician in the area. Similarly, I generally help in evaluating technical issues for them.

This is what I found within a couple minutes of Googling. Do you have any contrary information suggesting that the majority of doctors are in fact up-to-date with the latest academic journal articles published within their fields?

"One New England Journal of Medicine study found that patients get only 55 percent of the care that's recommended for the leading causes of death and disability. Similar research in children showed they get just 47 percent—and a mere 41 percent of preventive steps that are proved to help."[1]

"Despite 15 years of advances about what is known of [sinusitis], the information isn't making its way to internists because it is not been published in journals or other sources often reviewed by internists, who most often treat sinusitis. For instance, many internists are unaware that chronic sinusitis can cause serious chronic fatigue, Chester says."[2]

"It’s unrealistic to expect the majority of physicians to go back to the original literature or even to go back to systematic reviews of the original literature,” said Gordon Guyatt, MD, of McMaster University in Hamilton, Ontario, who is credited with coining the term “evidence-based medicine."[3]

"In a 2005 systematic review in the Archives of Internal Medicine, most studies found a correlation between increasing years in practice and decreasing quality of care."[3]

[1]http://www.rd.com/living-healthy/is-your-doctor-out-of-date/...

[2] http://www.upi.com/Health_News/2010/08/17/Doctors-need-more-...

[3] http://www.kevinmd.com/blog/2009/12/doctors-stay-date-curren...

"the information isn't making its way to internists because it is not been published in journals or other sources often reviewed by internists"

Implying that doctors do keep up to date with peer reviewed journals, and that if all you're doing is trying to read journals with none of the medical background require to understand them, you're certainly not going to be any more informed than your average doctor.

Gordon Guyatt, MD, of McMaster University in Hamilton, Ontario, who is credited with coining the term "evidence-based medicine."

You quote him, yet you are so quick to discredit all evidence that you don't agree with.

"Implying that doctors do keep up to date with peer reviewed journals"

This implication, assuming that really is what they are trying to imply, is nothing more than speculation. But if you have better information then by all means post it.

The point is that your previous post does not imply what you thought it did, whatsoever. The original assertion was that by reading peer review journals you would be more qualified to preform medicine than a doctor. You have yet to provide any supporting evidence that shows that doctors don't read peer reviewed journals as well. The only thing that it indicates is that if information isn't published, then doctors are unlikely to know about it. What a fucking shocker.

I can't really say I'm surprised to encounter inexplicable lapses in critical thinking and logic here though.

That's not what you said at all. Here's what you said:

The first statement is trivially provable by looking at how well the popularity of treatments correlates with corporate marketing budgets, e.g. the list on page 2 here: http://www.erowid.org/general/newsletter/erowid_newsletter18...

Why would doctors be so eager to prescribe Lexapro as late as 2009 even though they knew that the manufacturer had faked the science behind it, for which it was later fined over 300 million dollars? Especially since the drug was unambiguously shown to be no more effective than previous generic versions of the drug, which were only a fraction of the price? Obviously because they are getting most of their information from the marketing campaigns and not the science, plus the massive amounts of bribes and kickbacks. There are tons of examples like this.

As for the second statement, if doctors aren't up to date on the research about any given condition, then it shouldn't be that difficult to learn more about your doctor about any given condition. Almost all of the academic research in medicine is written for a lay audience, unlike in physics or continental philosophy where you really can't understand it unless you're an expert. Plus there are tons of other resources to help you make sense of the research, everything from wikipedia to academic search engines that show you which papers are cited by which other papers.

Heh OK why don't I make you a deal: you read this paper[1], tell me what it studies and what the consequences are, and then I'll forward your response to my father and he can tell you all the things you got wrong.

If there's one thing I've learned reading papers it's that the way the author phrases things or what the author conspicuously leaves out is worth just as much as what's there. Even in my domain area I'm nowhere near qualified to judge academic papers as an expert.

[1] http://annonc.oxfordjournals.org/content/21/6/1203.abstract

A sufficiently intelligent and reasonable person should be able to, with enough consideration, make up his mind about just about anything that lives in a knowledge domain. It's not like the medical profession emerged fully-formed from the head of Zeus.

If someone just has to make up his mind, then he needs to be neither intelligent nor reasonable. I suspect you mean that a person can come to some sort of opinion that would be "good" in the sense that they have chosen the one that most likely prolongs their life, prevents illness, etc.

Perhaps that is true, if "enough consideration" is equivalent something like 2 years of basic medical education and 2 years of clinical experience. Instead, most people have to make do with their own trusts, biases, limited information, etc. I think it's unreasonable to think that an untrained person is going to catch up enough after reading a few articles that they are going to make an informed decision. That's why we have doctors, to help us make informed decisions about our health. We can use their synthesis of education and experience to guide our values to make decisions that are not only self-satisfying but also reasonably accurate.

Any sufficiently intelligent and reasonable person could decide for themselves if gravity exists, It's not like our understanding of physics emerged fully-formed from the head of Zeus.

Any sufficiently intelligent and reasonable person wouldn't be questioning the established medical fact that vaccines provide an overwhelming net benefit. If they are, they almost certainly are not qualified to make an educated decision about it.

It's fine and dandy to play expert without a formal education in almost every situation, but in this case the lives of people, _and not just your own children_ is in play.

>Any sufficiently intelligent and reasonable person wouldn't be questioning the established medical fact that vaccines provide an overwhelming net benefit.

The problem with your position is that people still die from taking medication. Low statistical significance of harm doesn't matter to you if you're one of the statistically few that ends up harmed.

Statistics are valid over populations. Yes, if one looks simply at the greater good then vaccination to prevent epidemic is a good idea. However imagine a scenario where everyone else is vaccinated but you aren't - you're not exposed to the pathogen as the disease doesn't spread nor exposed to the risk of the vaccine, you win. This is of course not a scalable response.

Disease control requires those involved to consider the population and not the individual it would be beneficial to this end to pretend the vaccine is perfect and incapable of harm, this produces the best results for the whole population.

Looking further, you rightly say "vaccines" provide a net benefit. Of course one is being vaccinated with a particular vaccine which, by the nature of vaccines may not have been tested beyond cursory short term tests. We can't wait 5 years for the results of double blind experiments on a vaccine when it's been rushed in to mass production to match a particular strain of pathogen. Yes the variations may be small but small variations matter.

>It's fine and dandy to play expert without a formal education in almost every situation, but in this case the lives of people, _and not just your own children_ is in play.

Driving in the snow, say, would you do it without a formal education?

That's an extremely funny statement if it's meant to be ironic. Almost like "unless you are a %w[Politician, Clergyman, Philosopher] you have no business making up your own mind about %w[politics, religion, the meaning of life]."

Unlike politicians, clergymen or philosophers, scientists have pretty universally established standards for establishing when "your own mind" about a causal relationship between x and y is almost certainly wrong; rejecting their approach to doing it (i.e. go to school and learn for several years so you can critique the research rather than basing your view on anecdotes collected by yellow journalists) is tantamount to rejecting science as a discipline. Yes, it's elitist, but there's a reason I don't ask the man on the street to prescribe me medicine whilst being perfectly willing to debate the merits of the current government with him.

The thing is that this article isn't about how the public was wrong, it's an example the rampant corruption in mainstream science. And it's one of hundreds of examples of how the current states of science, peer review, and publishing are horrifically broken.

Let's look at the facts of this case. The author didn't cite his financial connections, but the journal failed to catch this. The author made up data, but the journal failed to catch this. The public demanded an investigation into the vaccines, but the government refused to start an investigation or even answer their questions. When the government finally did start an investigation many years later they did it behind closed doors, and the public wasn't even allowed to read the transcript of the conversation for several more years. The scientific establishment has been in the wrong here at literally every turn, and yet you're spinning the story and trying to use it as an example of how the general public shouldn't be allowed to make their own medical decisions. Yes, the anti-vaccine crowd was also in the wrong for putting excessive weight on this study in the first place, but this apologism for the scientific establishment is completely unwarranted.

I think it's pretty evident the scientific establishment isn't perfect and thus has differences of opinion, and you make a good point about lack of openness. But the pertinent facts are that the majority of medical professionals and the NHS that paid for the treatments stood behind the drug companies' testing and the vaccination's safety record whilst the angry parents' law firm, their outspoken shill medic and the media coverage all encouraged large segments of the British public to wrongly challenge the balance of medical opinion.

"media coverage encouraged large segments of the British public to wrongly challenge the balance of medical opinion."

This study came out in 1998, and the media coverage didn't peak until late 2005. The vast majority of those in the anti-vaccine movement had never even read the original article, and only gave it credence because of the lack of transparency. In between when the study was released and when the media hype peaked:

* The largest companies in the world were going bankrupt because the government was encouraging them to use fraudulent mark-to-market accounting methods

* The government prevented any investigation into 9/11 for over a year, and then stonewalled and lied to the investigating committee once it was finally formed.

* The government lied about the safety of the air at ground zero.

* The government lied about Iraq having WMDs and being connected to 9/11, and started a war based on these lies.

Even if it was scientifically unjustified to believe that vaccines caused autism based on one study, there was nothing unreasonable about parents avoiding the vaccinations once they heard that the government was once again lying.

You don't get to claim that people should trust you if you are constantly lying to them. What happened with regards to falling vaccination rates was completely reasonable and predictable given the circumstances, whether scientifically justifiable or not. And it was only after an epic government fuckup of 7+ years that the issue went from being a fringe concern to a mainstream panic.

In that environment, whether medical professionals or the NHS were for or against the treatments was really not pertinent at all.

The 2005 media coverage was all over Wakefield's attempts to pretend he wasn't in the pocket of trial lawyers fighting drug companies over the MMR vaccine. The peak hysteria over the threat of the vaccine itself was pre-Iraq war.

But I'm finding it hard to see an argument in your post against the original point that people without medical backgrounds really shouldn't be making medical judgements. Especially if they consider the views of medical professionals and the NHS less pertinent to their kid's health than knee-jerk distrust in anything government-approved provoked by entirely irrelevant military intelligence scandals...

Funny, but I bet this is exactly the way flat earthers argued earlier in history - "Everyone knows the Earth is flat! Unless you're a trained natural philosopher, keep your mouth shut!" Questioning 'facts' is only natural, and right. You should only take as fact that which you are ready to accept - what you've verified, however inexpertly, on your own.

Experts have known that the earth is round since the ancient Greeks. It has only been amateur uneducated "experts" claiming otherwise since then.

Actually, that entire story is a myth invented in modern times to paint ancient thinkers as "backwards." And I quote:

The myth that people in the Middle Ages thought the earth is flat appears to date from the 17th century as part of the campaign by Protestants against Catholic teaching. But it gained currency in the 19th century, thanks to inaccurate histories such as John William Draper's History of the Conflict Between Religion and Science (1874) and Andrew Dickson White's History of the Warfare of Science with Theology in Christendom (1896).

I have 2 words for you : Lorenzo's Oil

> My daughter had complications 10 days after her MMR in the UK.

A one-in-a-million coincidence happens 7,000 times in the world's population. There will always be anecdotes, correlation doesn't prove causation.

Exactly the point the doctors used (without the statistics). Sure, it could have been coincidence but why say there was no chance it was a side effect? In fact, since her symptoms are a known side effect it is more likely it was not just a coincidence, not so?

As another person pointed out, "adverse events in the PDR or on product packaging are simply a list of all reported adverse events, with little data to demonstrate causality."[1] It is not implausible that the same symptom occurred in another person the vaccine was tested on while being entirely unrelated to the vaccine. If you throw away statistics - say that while it could be correlation it is much more likely to be causation - you replace science with superstition.

[1] http://news.ycombinator.com/item?id=2076200

>As another person pointed out, "adverse events in the PDR or on product packaging are simply a list of all reported adverse events, with little data to demonstrate causality."

Which country is this in?

I don't really buy that the pharma corps would print a huge list of negative side-effects without any causality demonstrated unless of course it's to hide the known side-effects by making it all appear absurd ...?

Is it encouraging to know that the reported negative side-effects weren't even investigated enough to establish if they were likely to be caused by the drugs taken? My instinct is that this is a very bad thing.

If this is true they're basically saying we get lots of reports from patients who've taken this and get side-effects that they report and that medical professionals then collate and report to us but we can't be bothered to look and see if there's any credence to those reports.

Something seems wrong here.

> I don't really buy that the pharma corps would print a huge list of negative side-effects without any causality demonstrated unless of course it's to hide the known side-effects by making it all appear absurd ...?

Why not? It's likely a governmental requirement.

>Why not? It's likely a governmental requirement.

I guess I imagine that as in my country the pharmas managed to get a special extension to patent terms just for themselves and no other industry that they have enough sway with government to push it so they at least only publish proven side-effects.

Why would gov make this a requirement, that's part of my question?

This sounds like if someone gets run over wearing support stockings the support stockings have a document with them saying "may cause you to be hit by a car". This is strictly true but not helpful and the causal connection is decidedly tenuous.

Downplaying known complications does not serve your argument ...

seizure occurrence for MMR is listed as 1 in 3000; mild fever (1 in 6), rash (1 in 20), temporary stiffness in joints (up to 1 in 4) , etc.

Note this is MMR, not MMRV, which is listed separately, and for which seizure is listed as a 1 in 1250 occurrence ...

http://www.cdc.gov/vaccines/vac-gen/side-effects.htm

Seizure from MMR is due to high fevers, which mumps and measles both have as main symptoms. Given that 90% of people exposed to measles wind up getting it, the complication rate from the MMR diseases is going to be far, far higher than that of the vaccine.

There are decades of research on this.

> We took her to the hospital where doctors absolutely refused to admit that the MMR vaccine could have anything to do with these symptoms she has never had before or since.

What did the doctors say was wrong with her and what do they think caused it?

If you only have one explanation, the natural tendency is to latch on to it. But there are probably millions or more different things that can go wrong with the human body and nobody knows them all.

"My point is, examine any claims by government or big Pharm or sensational reports about autism very carefully and make up your own mind."

Being careful to consider who paid for any studies you examine, as that is very important.

Do you know if the UK has the equivalent of the US government's vaccine event reporting system?

Perhaps at the least, there is a UK website that you can report the event at (link is the US site): http://vaers.hhs.gov/index

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