Before we start: Some of this post touches the case on a girl who was born in 1998, who likely had a pre-existing, genetic condition -- a mitochondrial disorder. In the Vaccine Court (more here for beginners )--but not, perhaps in areas with higher standards of evidence--the girl's maladies were found to be a result of vaccination.
What is clear: this child continues to have severe and multiple challenges, relative to health, physical, and cognitive function. Not only has this girl -- now a teen--been suffering, her parents and other family members have been suffering as well. As for every family with such challenges, I am deeply sympathetic to this child's suffering and life limitations.
That does not mean I cannot or should not challenge any family member's narrative about the cause of those challenges.
What is important here: the author of the opinion piece is that girl's great-aunt, and has a specific view, not grounded in research or science, that vaccines may be causal in autism or may have more risks than benefits.
The article by Margaret Dunkle claims "We don't know enough about childhood vaccines"
The mendaciousness starts with the headline, the deck, and the byline. (Keep in mind that the author of a given newpaper article isn't responsible for the headline or deck -- but is responsible -- for the most part -- for his or her bio.)
Margaret Dunkle is a very accomplished woman, but not in the area of vaccinology or vaccine safety. She has a batchelor's degree in psychology, and appears to have spent the 1970s and 80s as an advocate for women's equality, especially in athletics. She also has an interest in gender equality in school health programs. Later, her professional focus turned to the coordination of services for children with disabilities, and establishing early developmental screenings for children -- especially low-income children -- who might be at risk for developmental delays.
While her faculty page lists her areas of expertise as
- Civil Rights
- Health Disparities
- Public Policy
- Vaccine Safety
I would say her accomplishments and publications make her an expert in vaccine safety in the same way I am an expert in vaccine safety.
The following is the text of Ms. Dunkle's opinion piece. Her article is indented, in italics. My comments are in roman; quotes from others are indented in roman.
The topics of vaccines and vaccine safety spark emotional outbursts at scientific meetings and family dinner tables alike. ....
I don't doubt that there are emotional intra-family discussions; I've had a few of them myself. But Dunkle is mistaken, or disingeneous, to allege "emotional outbursts" at scientific meetings. The topic of vaccines and autism risk has been studied at length, with dozens of studies with hundreds of thousands of subjects. No increased risk for autism has been associate with vaccines. The overall subject of the safety of the recommended pediatric vaccines -- especially compared with the risks from the diseases they protect against -- is likewise not a topic that raises much interest, let alone "outbursts".
But many of these debates are remarkably fact-free.
I highly doubt that discussions about vaccine safety in scientific meetings are "fact-free".
Surprisingly few people — not just concerned parents but also doctors, policymakers and even immunization experts — can answer this seemingly simple question: How many immunizations does the federal government recommend for every child during the first two years of life?
I am not sure of her point here. If you stopped the average pediatrician in the street, I doubt she would be able to answer the question off the top of her head. I usually have to look it up and count to make sure I am remembering correctly. Centers for Disease Control's recomendations are available in multiple formats to prompt the memory of of health care providers and parents. There's even an iPhone app for parents to help them keep to the schedule.
The answer is important because most states, including Maryland, faithfully follow the recommendations of the federal Centers for Disease Control and Prevention, codifying CDC guidelines into requirements for children to enroll in school, kindergarten, preschool and child care.
As if policy-makers can't be troubled to go to the CDC's website and print out any of many charts of the recommended vaccine schedules. Of course the states follow the CDC's recommendations -- they are formulated for the most public health.
A new Journal of Toxicology and Environmental Health study reports that the higher the proportion of infants and toddlers receiving recommended vaccines, the higher the state's rate of children diagnosed with autism or speech-language problems just a few years later. This analysis is sure to rekindle the debate about vaccine safety.
Oh my. The "study" Dunkle is referring to is the deeply flawed paper written by Gayle deLong, an attorney, whose two daughters have autism. A list of articles detailing the paper's flaws are at the bottom of this post. The short answer is that the paper is so flawed that many question how it even passed peer review and came to be published. The DeLong paper is so weak that it does nothing to "rekindle the debate", and Ms. Dunkle should know that.
For that conversation to produce useful results, we must start by defining terms. A "dose of vaccine" refers to each vaccine or antigen given to increase immunity against one specific disease. For chicken pox, a child receives one dose of vaccine through one shot.
By contrast, an "immunization event" refers to each separate administration of a vaccine or bundle of vaccines — through a shot, orally, or nasally. The MMR shot for mumps, measles and rubella involves three doses of vaccine but is one immunization event.
The critical number is how many doses of vaccine a child receives. Why? If a vaccine is strong enough to confer immunity against a disease, it is important enough to count separately.
This passage reveals either Dunkle's ignorance, her bias, or both. The critical issue is not "doses" or "immunization events" but the number of antigens a child is exposed to through vaccination. If you are unclear on this (and many lay people are) I highly recommend the resources at the History of Vaccines project, specifically How Vaccines Work.
Clear definitions, analysis of CDC's "General Recommendations on Immunization," and confirmation by Dr. Andrew Kroger, lead author of the definitive report on these recommendations, produce the answer to the not-so-simple-after-all question posed above.
In all, the federal government recommends 36 doses of vaccine, addressing 14 different diseases, for every U.S. child under age 2. An on-schedule child will receive a dose of vaccine for hepatitis B at birth, eight doses of various vaccines at 2 months, seven additional doses at 4 months, and four to seven more doses at 6 months.
Infants and toddlers receive these vaccine doses through 26 separate immunization events — mostly shots. If a child misses vaccinations because of illness or scheduling problems, following CDC's catch-up schedule usually results in extra doses at a later date.
The federally recommended doses of vaccine for every child during the first two years of life are: three doses each for hepatitis B, polio, flu, and HIB (12 doses in all); two doses each for hepatitis A and rotavirus; four doses for pneumococcal infections; one dose for chicken pox; three doses through the combination MMR vaccine for measles, mumps and rubella; and 12 doses through four separate administrations of the combination DTaP vaccine for diphtheria, tetanus and pertussis (whooping cough).
Put that way, it seems to be overwhelming. But why is the vaccine schedule the way it is? Readers might peruse The Infection Schedule versus the Vaccine Schedule, by infectous disease specialist Mark Crislip. Dunkle's argument is just a of the "too many, too soon" argument that has been refuted, over and over again.
Going back to antigens: children are exposed to fewer antigens in today's vaccines than they were in the past. The 1980s CDC schedule exposed children to over 3,000 antigens in the course of protecting against seven diseases; the 2000 recommendation exposed children to approximately 130 antigens inc the course of protecting against eleven diseases.
How else could one state it? How about, "the federally-recommended vaccine schedule protects infants and toddlers from 14 serious illnesses. Prevention of these illnesses has demonstrably improved individual or public health."
Some infants and toddlers receive still more doses of vaccine — if they switch to pediatricians who use different "combined" vaccines, if they are at high risk for certain diseases, if lost or incomplete records lead to duplicate immunizations, and depending on the time of year they were born (for flu shots) or the brand of vaccine used.
While testing is routine for individual vaccines as they are licensed, research on the both short- and long-term effects of multiple doses of vaccine administered to very young children during the critical birth-to-2 developmental window is sparse to nonexistent.
First, the paragraph above is a variation on the "too many, too soon" gambit. Second, it is not quite true. In the course of vaccine development and after approval, vaccines are evaluated for safety, including post-marketing surveillance. as to the "sparcity" of research, one merely needs to read the references in On-time Vaccine Receipt in the First Year Does Not Adversely Affect Neuropsychological Outcomes to see that Dunkle is making much of little.
In addition to the number of doses, vaccine ingredients can be problematic, especially for susceptible subgroups. First are adjuvants, substances added to boost effectiveness and allow smaller doses of vaccine antigen to be used. The most common adjuvant is aluminum, which is found in vaccines for hepatitis and diphtheria-pertussis-tetanus.
First -- Dunkle essays another foray into begging the question. What is the evidence for "susceptible subgroups"? Who are in those those subgroups, what are they susceptible to, and how do we know?
Second -- oh no, the toxins!!! gambit.
Third -- aluminum as scary toxin, Dr. Bob Sears' favorite bogeyman to move parents away from vaccination. Dunkle omits key facts, such as that aluminum (the third most common element on earth) is ubiquitous. It's even in breast milk, in far larger quantities than a child will recieve if vaccinated on the CDC schedule.
Second are preservatives — such as thimerosal, which is 49.6 percent mercury. Thimerosal is still contained in many flu shots, although it was, except for trace amounts, removed from other child vaccines a decade ago. Many child vaccines (including those for diphtheria-pertussis-tetanus, HIB, and hepatitis) contain formaldehyde, which was just added to the government's list of known human carcinogens.
Why bring up thimerosal, which has been removed from all vaccines except some flu shots? Why not mention that thimerosal-free flu vaccinations available? Because Dunkle's aim in this essay is to repeat the anti-vaccine message that there are unsafe ingredients in vaccines.
Then Dunkle emits another of the toxins!!! gambit -- formaldehyde. It certainly sounds vile -- it's used in embalming fluid, after all -- but she omits the fact that the body -- even babies' bodies--naturally produce formaldehyde at levels up to ten times the amount in a vaccine.
Third are ingredients to which some people have severe allergies: stabilizers such as gelatin, and eggs or other proteins that are used to prepare vaccines for flu, MMR, and other immunizations.
Dunkle is partially correct. "Some people" are allergic to eggs and gelatin, which limits their access to the protections provided by the vaccines that are grown in eggs, or use gelatin as a stabilizer. But first, the percentages are very small. About 0.5% of people are allergic to eggs, and a somewhat larger percentage are allergic to gelatin. But here's where Dunkle gives away her true identity: she isn't a "vaccine safety expert" (or advocate), she's merely a garden-variety anti-vaccinationist. A true vaccine safety advocate would be advocating for change in vaccine manufacture. It's possible to make vaccines without growth in eggs; it's possible to find other stabilizers than gelatin. The manufacturers (given the small size of the at-risk population) need to be goaded into making the changes.
The ongoing debate about vaccines and their safety needs to incorporate these basic facts as our country seeks to answer the critical Goldilocks question: Too many? Too few? Or just right?
"Needs to incorporate these basic facts". As I have indicated, many of Dunkle's facts...aren't factual. The points Dunkle failed to make are the reasons for the recommended CDC vaccine schedule: the protection of children (and adults) from serious infectious disease with high risks of adverse outcomes. Dunkle completely ignored the relative risks of infectious disease compared to vaccination.
The Baltimore Sun has in recent months done good work on exposing another set of anti-vaccine quacks, Mark Geier MD and his physician-imitating son David Geier. It's a pity that the editorial board squandered that good work by approving Dunkle's flight of misinformation and spin.
Update: also please read
- David Gorski MD at Science-Based Medicine Antivaccine Propaganda in the Baltimore Sun
- Dr. Sandeep Rao at the Baltimore Sun Misinformation about Vaccine Risks is Making Us Less Safe
- Dunkle, Margaret. Papers, 1957-1993: A Finding Aid Papers of Margaret Dunkle, advocate for women's equality in sports, education, and the delivery of health services.
- First5LA Champion Profile: Margaret Dunkle is a Voice for Children in Need (2008)
- Margaret Dunkle: Faculty Directory, School of Public Health and Health Policy, The George Washington University
Critical Evaluations of deLong's A Positive Association found between Autism Prevalence and Childhood Vaccination uptake across the U.S. Population. Journal of Toxicology and Environmental Health, Part A. 2011 74(14):903-916
- May 31, 2011 Neuroskeptic at Neuroskeptic Vaccines Cause Autism, Until You Look at the Data
- June 7, 2011 Emily Willingham at The Biology Files Gayle deLong, Safeminds Board member and a Vax = Autism Study
- June 8, 2011 Sullivan at LeftBrain/RightBrain: A Positive Association found between Autism Prevalence and Childhood Vaccination uptake across the U.S. Population. first post
- JUne 8, 2011 Orac at Respectful Insolence More bad science in the service of the discredited idea that vaccines cause autism
- June 11, 2011 Sullivan at LeftBrain/RightBrain: Speech impairment and autism, inseparable?
- June 28, 2011 Prometheus at Photon in the Darkness Another Worthless Autism "Study"
- July 8, 2011 Sullivan at LeftBrain/RightBrain A Positive Association found between Autism Prevalence and Childhood Vaccination uptake across the U.S. Population. (2nd post)
Background reading on the Hannah Poling decision
- February 29 2008 Steven Novella MD at Neurologica Has the Government Conceded That Vaccines Cause Autism?
- May 15, 2008 Paul Offit MD at The New England Journal of Medicine Vaccines and Autism Revisited: The Hannah Poling Case
- October 3, 2008 Kathleen Seidel at Neurodiversity The Appalling Poling Saga