I’ve been following this discussion in Orac’s comments for a few days now. Dr. Jay Gordon, a AP-friendly Santa Monica pediatrician whose website flirts with anti-vaccinationism, herbal medicine for HIV, and other such woo, and who is a supporter of folks like Jenny Mcarthy and her “Green our Vaccines” campaign, is debating Orac’s commenters in a very uneven battle of wits…and losing, by the looks of it 😀 .
Dr. Gordon’s argument in support of the comments he made in an interview for Cookie Magazine – to quote, “I think that the public health benefits to vaccinating are grossly overstated. I think that if we spent as much time telling people to breastfeed or to quit eating cheese and ice cream, we’d save more lives than we save with the polio vaccine.” – rests upon two main points:
1) Vaccines are no longer necessary in the numbers given today in the developed world because those diseases are no longer present in the community, therefore the risk/benefit analysis changes, especially if giving scientifically unproven credence to patient fears that the number of vaccines given today is “too many, too soon” (why a pediatrician practicing for nearly 30 years is unfamiliar with the concept of herd immunity* , and the copious evidence of what happens when it is eroded, remains a mystery).
2) In his nearly 30 years of practicing medicine, he has personally seen children who’ve “changed” (I assume he means they developed autistic symptomatology) after immunization – or at least, that is what their parents attributed their children’s change to. In other words, anecdotal evidence.
I’ve already said my piece about Dr. Gordon’s claims in the interview, which are similar to those made by a like-minded pediatrician. And I really can’t help him if he chooses to ignore what will happen when his actions (vaccinating with fewer vaccines later, or outright support of non-vaccination due to superstition) help erode herd immunity. But I’d like to relate to point #2 of his argument – the supposedly convincing anecdotes.
It so happens that I have such an anecdotal story to tell, one I’ve been hearing since I could first comprehend spoken language. The injured party has graciously allowed me to tell her story, and has stressed she believes 100% that vaccines caused her to fall ill (having looked over the medical records that remain, I’m not so sure. But that was the story told me in my childhood). While this story is an anecdote, to be taken as such, it can illustrate why anecdotal evidence, even in the plural, is not proof of an association between two events such as vaccination and disease.
In June of 1964, my mother had everything going for her: a pretty, completely healthy, exceptionally bright young woman, she was admitted at age 15.5 years to an Ivy League women’s college. As there were students from all over the world who came to study at this college, and there had been reports of smallpox epidemics in the preceding year, smallpox vaccination was a requirement for attending college. Mom complied with that requirement (I am not sure, but am assuming this was a repeat vaccination, as all infants were vaccinated for smallpox in those days. That first vaccine was apparently completely unremarkable, to the point my grandmother can’t even remember if she’d actually gotten it, though).
Approximately 1.5-2 weeks later, she became ill, with fever, a blotchy rash on her face and a sore throat. Antibiotics were administered and the fever resolved, but she became progressively drowsy and confused, and a seizure disorder developed. To excerpt a quote from a clinical summary written by one of her pediatric neurologists:
The subsequent 2 weeks were marked by severe seizure activity, dystonic choreiform and other abnormal movements, transient ocular-motor paralysis with dilated fixed pupils, a second rise in fever to over 105-6 not responding to salicylates.
If you get the impression that she was very sick and nearly died, you’d be quite right. Laboratory tests, however, revealed nothing except slightly elevated white blood cells in the spinal fluid, which could indicate non-specific encephalitis. There were a couple of oral ulcers that presented during her illness consistent with the rare Behçet’s disease, however she did not meet the full diagnostic criteria for this syndrome (most notably, she had no eye involvement).
My mother spent 5 weeks in the hospital, emerging with a permanent seizure disorder (which has been controlled with medication, with variable success) and a moderate to severe short-term memory loss which persists to this day. Her IQ was thought to have dropped some 50 points in mathematical ability and 20 on the verbal score. In the first few years, her mental status fluctuated, but it is a tribute to her resolute personality that she managed to attend the Ivy League college (and when I was a teenager, recieved a master’s degree from an Israeli university), get married, have and care for a child, and in general, lead a semi-normal life despite some rather profound handicaps.
Just so you don’t think I’m making this up, you can view the first page of a medical summary by her neurologist dated 1967, detailing her vaccination and subsequent events. Names and other identifiers have been obscured for privacy, naturally.
According to Mom and other family members, she’d had a smallpox vaccine and her disease was, in effect, a vaccine reaction (and Mom, at least, is not really open to discussing any other possibility). The presumptive diagnosis of post-vaccinial encephalitis (which occurs in reaction to the weakened cowpox virus introduced during such vaccination, in 1:300,000 doses given) is possible, though there were no reliable methods to tests this hypothesis in 1964. Equally possible, if not more likely, was that my mother had been unlucky enough to be stricken by another unidentified virus which was the cause of her encephalitis, or that she’d had Behçet’s disease after all. My impression is that most of her physicians thought it was another viral encephalitis, and what information I have makes me tend to agree: the only real connection to the vaccine is a temporal one. However, there is no doubt that had she been vaccinated in the US today with these subsequent developments, she would have been eligible for compensation from the government, regardless, merely because of the temporal relation. However, that still would not be proof the government had conceded the injury was vaccine-related.
Not to mention that though my mother’s case was severe. and as a result, the temporal relationship was documented precisely, many anecdotes of this kind rely mostly on the parent’s memories, which as I’ve pointed out before, may be tricky and subject to recall bias. e.g the symptoms may have started before vaccination, but remembered as showing up only afterwards because the event of the vaccinations stood out in their minds. I’ve mentioned this before in regard to the thimerosal/autism causation theory.
To her great credit, Mom did not become anti-vaccine as a result. I was given all the standard vaccines, including the then-newfangled MMR, at my doctor’s office (she did stipulate that all my vaccines, including those normally given by the school nurse, were to be given at the pediatrician’s office only; I remember those doctor’s visits as frought with tension on her part). The smallpox vaccine had been discontinued by then, so she didn’t have to worry about that one. Having grown up in the 50’s and 60’s and having personally known victims of polio and measles, she did not cave into the comfortable sensation of panic that I might share her fate as a result of a vaccine. It was a freak occurrence, not likely to happen again.
One can, however, surmise what would have happened if the Internet, the parents with their anecdotes, and the Dr. Jay Gordons of this world had been around back then…
*Great Flash animated demo of herd immunity, well worth the click-on and to use as a debate resource. Just sayin’.