Applying Science to Dr. Sears

UPDATE: For anyone who wants a somewhat digested version of the article I mention below, The Stats Blog does an excellent review of Snyder's article.

This post has to do with something I have been feeling increasingly passionate about the longer I've been a mother. Unfortunately, parents with my point of view we are woefully underrepresented both in the media and in the blogosphere. Up until now, I've held back posting anything much about vaccines, besides the occasional flu shot post. However, I have come to see my reticence as irresponsibility. Let me explain.

My son recently started a Montessori program. He's about two and a half and has never been in daycare, so he has not been exposed to many "germs." Let's put it this way: until he started preschool, he never had so much as a cold. I don't think this is a good thing--kids need to be exposed to illness to build up immunity. So I wasn't surprised when he fell ill after beginning preschool and has been feverish on and off since then. He is also fully vaccinated, completely up to date, and he gets his flu shot. When he was an infant, I was concerned, like many new parents, about the information swirling around the Internet about vaccines. They're poisonous! They cause autism! We get too many! Of course these reports gave me pause, like they would anyone. However, I am someone who relies on science (as anyone who reads this blog can tell) to guide my decisions as a consumer. There are certainly big businesses with much at stake who try to distort science; however, in my years as a journalist and researcher, I have come to specialize in unearthing these conflicts of interest and looking at the science (and consulting scientists much, much smarter than me) to see if it holds up or is biased. Hence the subtitle of my blog: ...and the manipulation of science.

So I get a lot of people coming to my blog because they search "thimerosal" or "vaccines" or "toxicity." And I am grateful for that, because much of what we are surrounded by, much of what we consume, have toxic properties: high levels of formaldehyde in cabinetry; parabens and phthalates in personal products; BPA in baby bottles. So many people assume I am also anti-vaccine. Nothing could be further from the truth. Precisely because I do concern myself with science, I am passionate about vaccination. I live in a state where nearly 5% of the population chooses not to vaccinate their children, which brings us teetering to the edge of the loss of herd immunity. Which means children will die. I can't sit back and leave this uncommented upon.

When I enrolled my son in Montessori, I asked the Head of School the following question:
"So, vaccines--"
She interrupted me, smiling: "Oh, they're not mandatory."
"Actually, I was hoping they were. I am not comfortable having a child in my son's class who is not vaccinated." She seemed taken aback, at first, and then suddenly appeared more at ease. She explained to me that in Minnesota, vaccinations are mandatory for children entering a daycare or school settings--unless you conscientiously object to vaccines and can provide a notarized statement to that effect.
"So it's not really mandatory," I said to my pediatrician. She rolled her eyes and said nothing more. I stopped short of asking the Head of School to consider instituting her own mandatory vaccination requirement, but I've considered asking her about it several times.

This brings me to Dr. Sears. His book is the one I find cited to me by anti-vaccine parents as the "science-based" reason for their decision not to vaccinate. Taking him point by point on a scientific level is beyond my abilities, but thankfully a doctor did just that. In his article on Science-Based Medicine, a website I highly recommend, John Snyder, M.D. wrote a thoughtful, unbiased, and rational response to Dr. Sear's THE VACCINE BOOK. Dr. Snyder is the Chief of the Section of General Pediatrics and Medical Director of Pediatric Ambulatory Care at Saint Vincent's Hospital in New York City. He is also Assistant Professor of Pediatrics at New York Medical College.

It's natural for an intelligent parent to question medication and vaccinations. In an ideal world, we would all have access to and the ability to understand the raw scientific data regarding the medications and vaccinations we get. However, it is reckless to ignore science in favor of celebrity advice and scare tactics used by doctors who rely so little on science that they have been ostracized by the medical community. If you are a concerned parent, especially one who has read Dr. Sears' book, please read Dr. Snyder's scientific review of THE VACCINE BOOK. You will not find here a shrill attack, an "opinion," or admonishments. You will get a point-by-point examination of Dr. Sears' "science" and advice to parents regarding vaccination. Note: you will get some strong, and, frankly, fascinating opinions in the comment section mainly from other physicians and scientists. My son's pediatrician is very tight-lipped about her opinions regarding vaccinations--she doesn't judge but I'm not sure if she refuses to see children whose parents don't vaccinate. So it's terribly interesting to read these comments from doctors who, under cloak of semi-anonymity, can unburden themselves of their opinions on parents who listen to Sears.

What finally convinced me to "come clean" about my decision to fully vaccinate my child? Several things, one of which I'm including below. Dr. Snyder responded to another physician who commented that after several years of trying to deal with parents who came into his practice with Dr. Sears' book in hand, asking for an alternative vaccination schedule, he decided simply to not see patients whose parents were not vaccinating them. I can't have you bringing pertussis or measles into my waiting room and infecting vulnerable patients (like babies too young for the vaccine, for example). Dr. Snyder responded this way:

I can absolutely appreciate your stance with vaccine-refusing parents. I have opted to keep them in my practice as I think I am more likely to get them to vaccinate than others might be. I posted a sign the other day in my waiting room, referencing a recent local measles outbreak, asking parents of under/unvaccinated children to immediately notify the front desk as they enter, so that they can be removed from the waiting room. It makes it clear that they are a risk to the other families. We’ve reached a point at which it’s important for these parents to feel a bit ostracized, and for the other parents to feel some outrage.

Dr. Snyder is right. It's time for the heretofore-quiet vaccinating parents to speak up. I think we do feel outrage, but it's often not worth the trouble to argue with someone who eschews real science in favor of pseudo-science. And for a non-scientist, non-physician parent, it can be very difficult to parse out the difference, of course--one must understand statistics, epidemiology, and so on, to even detect the flaws in the science, which is why Dr. Snyder's piece is so important.

Finally, I plan on writing to my local representatives regarding the bogus mandatory vaccination requirements for preschool and school-age children. These folks have heard from far too few parents like me and far too many parents who don't vaccinate, giving these legislators a skewed idea of what the demographic is doing. Thankfully, the vast majority of us vaccinate our children, which is the only reason the parents who don't vaccinate their children do so. As Dr. Snyder points out in his review, Dr. Sears actually advises parents who are scared of the MMR vaccine and don't plan to get it for their child not to tell their neighbors. This is because Sears knows that the only thing standing between pertussis, measles, tetanus, etc., and your child is herd immunity. And if too many parents think like those who don't vaccinate their children, children are going to die. For anyone who thinks these diseases are dead, know that in addition to recent domestic outbreaks of pertussis and measles, polio is a serious global disease that is only a plane flight away.

I made my decision to vaccinate my child based on the following hypothetical question I asked myself one sleepless night: If I didn't vaccinate him because I was scared of side-effects that have been suggested on blogs and by celebrities but never backed up by science and he became seriously ill or died, would I ever forgive myself?

The answer was no. And as one physician, Dr. Amy Teuter, wrote on her own blog,

Vaccine rejectionism is dangerous. It harms the children who are not vaccinated, and it harms unrelated children who are too young to be vaccinated. Make no mistake about it, vaccine rejectionism is unethical as well as the result of scientific ignorance. Parents who reject vaccines implicitly rely on other people being vaccinated. They are willing to accept the benefits, without partaking of the risk. They expose their own children to life threatening illness, and they expose other people’s children to life threatening illness. The government should act to restrict vaccine waivers to only those with medical indications for forgoing vaccination. The right to indulge one’s philosophical beliefs ends at the point where it threatens the life and health of other people’s children.

One final note--and thanks to one of the commenters for posing this great question, unvaccinated children are a danger to vaccinated children, even though, in theory, vaccinated children should be immune and therefore safe. This is a dangerously false assumption for many reasons, among them: a.) herd immunity: it is an epidemiological fact that if more than 5% of a population is unvaccinated for any one disease, that disease will make a comeback and pose a threat to the population at large. In Minnesota, we are nearing that threshold for several childhood diseases. b.) unvaccinated children may come in contact with the disease in many ways, including from children coming here from other countries where immunization is not standard or is unavailable and where these diseases still exist ( polio is still a huge issue in India for example) Sometimes, it's adults who contract the disease: as this 2009 measles outbreak reminds us. The Red Cross blog took this story up with this commentary:

Six people in Allegheny County, Pennsylvania contracted the highly-contagious disease from an infected Indian traveler. An adult male, who contracted measles during a visit to China, spread the disease to at least one adult and an infant in Montgomery County, Maryland upon his return.
Parents, living in the United States, have a choice whether to vaccinate their children. What they fail to realize is that until families everywhere have the opportunity to immunize their children, ours will face the threat of contracting this preventable disease.
If an unvaccinated person travels to a country where measles is still endemic or comes in contact with an infected visitor from such a country, they may be exposed to measles and become ill.

And should we need a reminder of how close more serious measles outbreaks are, take a look at this story from February, out of Germany.

c.) And this is the most frightening to me, as the mother of a two-week old: a vaccinated child might come in contact with an infected unvaccinated child in a preschool setting, carry home the virus and/or bacteria and remain immune: however, the infant, who is too young to be vaccinated for these diseases, will not be immune and could fall seriously ill or even die.
NOTE: I've chosen to moderate comments for this posting in this way: if you post something that has to do with claims of toxicity, mortality, and other scientific information, I will not post it unless you have cited your information. I will check that citation to be sure it is accurate and will then post it.