September 2nd, 2009 by KevinMD in Better Health Network, Health Tips
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by Steve Perry, MD
I recently read a post by Dr. Bob Sears which listed several “Vaccine Friendly Doctors” in Colorado and across the nation.
As a pediatrician and vaccine advocate, I thought I’d be on this list. I am “vaccine-friendly doctor” who works with moms and dads to find the best health care plan for their babies. I read the information on both sides of the issue and weighed the science against the emotional worry that so many parents feel about vaccines. While I always recommend vaccination by the CDC schedule, I always listen to parents concerns.
But, much to my surprise, I was not on this list. After a looking closer, I found that those on the list are a small population of physicians that are “friendly” to the “alternative” or delayed vaccine schedule outlined in Dr. Sears’ The Vaccine Book. The delayed vaccine schedule calls for a drawn-out vaccine plan based on Dr. Sears’ beliefs on calming parental vaccine fears. This delayed schedule has no research or science backing it, it is simply one pediatrician’s opinion.
The biggest medical problem with the delayed schedule is that it leaves babies open to disease for a longer period of time. If a baby is vaccinated by the CDC’s tried, tested and true vaccine schedule, that baby will have immunity to over 14 diseases by the age of two! With the CDC recommended schedule, babies visit their doctor five times in the first 15 months and receive protection against up to 14 diseases in as little as 18 shots if using combination vaccines, or as many as 26 shots if using individual antigens.
We immunize children so young against these diseases because infancy is the time period that kids are MOST vulnerable to life-threatening diseases. The people at greatest risk of dying from vaccine-preventable disease are the very young and the very old. We vaccinate to save lives.
On the delayed schedule, by 15 months of age children will have only received immunity against eight diseases. They miss out on measles, rubella, chickenpox, Hep A, and Hep B. By 15 months, children on this delayed schedule are given 17 shots and visit the doctor’s office 9 times – almost twice as many visits to the doctor as the CDC schedule.
Beyond Dr. Sears advocating for a medically untested vaccine schedule, I was dismayed at his classification of physicians like myself who vaccinate according to the CDC schedule. Because we follow the American Academy of Pediatrics and the CDC’s vaccine guidelines we are “unfriendly” doctors? Because I am following the science of my colleagues I am an “unfriendly” doctor?
This type of misinformation is damaging to families and physicians. It is the power of words that plant seeds of doubt in the minds of parents to fear vaccines. It’s this misleading information that manipulates parents into feeling that they are bad parents if they don’t question the safety and validity of vaccines.
As a pediatrician, I know it can be confusing for parents who get so much information about vaccines every day online and on TV. We all want to be informed advocates for our children’s health. Reading a balance of both sides allows parents to make an informed choice.
The best place to start the conversation about vaccines is with your pediatrician or by reading reputable sites like the Colorado Children’s Immunization Coalition at www.childrensimmunization.org. This non-profit does not accept donations from pharmaceutical companies and works to improve childhood vaccination rates across Colorado.
The reason I became a pediatrician was to protect children from illness and disease. Dr. Bob may only define “vaccine-friendly doctors” as those who promote his book, but the overwhelming data on the effectiveness and safety of vaccination makes it easy for us all to become a vaccine-friendly community. I hope that parents take time to read information on both sides of the issue, brings their questions to their physician and makes fully informed decisions about their child’s health.
Steve Perry is a pediatrician at Cherry Creek Pediatrics in Denver, Colorado and co-chair of the Colorado Children’s Immunization Coalition’s Policy Committee.
*This blog post was originally published at KevinMD.com*
August 4th, 2009 by John Snyder, M.D. in Better Health Network, Quackery Exposed
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I generally know what’s coming next when a parent asks about altering their child’s vaccine schedule: “I was reading Dr. Sears….”
Dr. Sears is a genius. No, not in an Albert Einstein or Pablo Picasso kind of way. He’s more of an Oprah or a Madonna kind of genius. He’s a genius because he has written a book that capitalizes on the vaccine-fearing, anti-establishment mood of the zeitgeist. The book tells parents what they desperately want to hear, and that has made it an overnight success.
Dr. Robert Sears is perhaps one of the best-known pediatricians in the country. The youngest son of Dr. Bill Sears, the prolific parent book writer and creator of AskDrSears.com, Dr. Robert Sears has become the bane of many a pediatrician’s existence. He has contributed to his family dynasty by co-authoring several books, adding content to the family website, and making myriad TV appearances to offer his sage advice. But Dr. Bob is best known for his best-selling The Vaccine Book: Making the Right Decision for your Child. This book, or at least notes from it, now accompanies many confused and concerned parents to the pediatrician’s office. Parents who have been misled by the onslaught of vaccine misinformation and fear-mongering feel comforted and supported by the advice of Dr. Sears, who assures parents that there is a safer, more sensible way to vaccinate. He wants parents to make their own “informed” decisions about whether or how to proceed with vaccinating their children, making sure to let them know that if they do choose to vaccinate, he knows the safest way to do it. And for $13.99 (paperback), he’ll share it with them.
In the final chapter of his book (entitled “What should you do now?”), after reinforcing the common vaccine myths of the day, Dr. Sears presents his readers with “Dr. Bob’s Alternative Vaccine Schedule.” He places this side-by-side with the schedule recommended by the American Academy of Pediatrics and the CDC’s Advisory Committee on Immunization Practices. He then explains why his schedule is a safer choice for parents who chose to vaccinate their children. Without a doubt, the alternative vaccine schedule is among the more damaging aspects of this book. It’s the part that gets brought along to the pediatrician’s office and presented as the the plan going forward for many parents today. But the book is also dangerous in the way in which it validates the pervasive myths that are currently scaring parents into making ill-informed decisions for their children.
Dr. Sears discusses these now common parental concerns, but instead of countering them with sound science, he lets them stand on their own as valid. He points out that most doctors are ill-equipped to discuss vaccines with parents, being poorly trained in the science of vaccine risks and benefits. He then claims to be a newly self-taught vaccine expert, a laughable conceit given the degree to which he misunderstands the science he purports to have read, and in the way he downplays the true dangers of the vaccine-preventable diseases he discusses in his book. He then provides parents with what he views as rational alternatives to the recommended vaccination schedule, a schedule designed by the country’s trueauthorities on vaccinology, childhood infectious disease, and epidemiology.
So what does Dr. Sears have to say, exactly, about the risks of vaccines, and just how out of touch is he with medical science and epidemiology? Read more »
*This blog post was originally published at Science-Based Medicine*
June 18th, 2009 by Medgadget in Better Health Network
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Directly imaging dynamic biomolecular processes can reveal secrets which scientists have been trying to uncover in indirect ways. The interaction between various virus species and the immune system is one of those topics that would benefit from novel visualization techniques. Now researchers from the Howard Hughes Medical Institute have imaged, with considerable detail, a rotavirus as it is grabbed by an immune system molecule. The technique may allow the development of better vaccines against not only rotavirus, but open a large range of research possibilities in the life sciences.
In the new experiments, Howard Hughes Medical Institute (HHMI) researchers have mapped the structure of an antiviral antibody clamped onto a protein called VP7 that stipples the surface of rotavirus. The structural map reveals intimate new details about how the antibody interferes with VP7, a protein that helps the virus infect cells. The information may be useful in designing a new generation of rotavirus vaccines that could be easier to store and administer than current vaccines, said the researchers.
Rotaviruses replicate mainly in the gut, where they infect cells in the small intestine. The virus has a triple-layered protein coat, which allows it to resist being chewed up by digestive enzymes or the gut’s acidic environment. Rotavirus does not have an envelope covering its protein shell. A virus’ envelope helps it enter host cells, and viruses without envelopes face significant hurdles in penetrating the membrane of the cells they infect. “Since they have no membrane of their own, they must therefore perforate a cellular membrane to gain access to the cytoplasm (the interior of the cell),” [HHMI investigator Stephen C. Harrison] said.
The new research shows that as rotavirus matures inside an infected cell, it assembles a kind of “armor” coating made principally of VP7 and a “spike” protein called VP4. When the mature virus particle exits one cell to infect a new cell, it perforates the endosomal membrane of the target cell by thrusting in its VP4 spike like a grappling hook.
The virus’ ability to infect cells depends on a critical structural change that quickly removes the coat from the interconnected VP7 proteins — an event that unleashes the spike protein. Although researchers still do not know precisely what triggers the uncoating of VP7, they do know that it appears to happen when the virus senses a lowered concentration of calcium in its environment.
“VP7 sort of closes over VP4 locking it in place like the metal grills that surround a tree planted on a city sidewalk,” explained Harrison. “And it is the loss of VP7 in the uncoating step that triggers VP4 to carry out its task.”
To get a closer look at how antibodies latch onto VP7 and neutralize the virus, Harrison and his colleagues used x-ray crystallography to examine the molecular architecture of VP7 in the grasp of a fragment of the antibody. X-ray crystallography is a powerful tool for “seeing” the orientation of atoms and the distances separating them within the molecules.
Before Harrison’s team could use x-ray crystallography, however, they first had to crystallize VP7 in complex with the antibody fragment. Only after that step was completed, could they move on to bombarding those crystallized proteins with x-rays. Computers helped capture the diffraction patterns that emerged as the x-rays scattered from the crystal lattice. By rotating the crystallized protein complexes through multiple exposures, the researchers could record enough data to calculate three-dimensional models, which exposed the underlying architecture of VP7 and the antibody fragment.
The resulting detailed structural map of the VP7-antibody protein complex revealed that the antibody neutralizes the virus by preventing the VP7 proteins from dissociating, said Harrison. “Normally, calcium creates a bridge between VP7 molecules that holds them in place until uncoating,” he said. “Our structure revealed that the antibody makes an additional bridge, cementing the subunits together, making the virus resistant to the uncoating trigger and preventing it from infecting cells.”
Current rotavirus vaccines consist of weakened live virus that triggers the immune system to produce neutralizing antibodies. However, the new structural findings suggest how researchers might engineer a different type of rotavirus vaccine consisting only of immune-triggering protein, said Harrison. This protein-only vaccine could be made of a chemically linked complex of VP7 molecules that would stimulate the immune system more vigorously to produce anti-rotavirus antibodies.
While live-virus-based vaccines have been effective, said Harrison, they have drawbacks that a protein-based vaccine might overcome. The virus-based vaccines are perishable and require refrigeration, but vaccines based on proteins are more stable and can be stored at room temperature. Another benefit, said Harrison, is that protein-based vaccines could be combined with other protein vaccines in a “cocktail” that would cut down on the number of clinic visits since blending cannot be done so readily with virus-based vaccines. These advantages could make protein vaccines especially useful in developing countries that lack an extensive public health infrastructure and where the vast majority of childhood deaths from rotavirus occur, Harrison said.
HHMI press release: New Images May Improve Vaccine Design for Deadly Rotavirus
Abstract in Science: Structure of Rotavirus Outer-Layer Protein VP7 Bound with a Neutralizing Fab
*This blog post was originally published at Medgadget*
June 7th, 2009 by David H. Gorski, M.D., Ph.D. in Better Health Network, Quackery Exposed
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Unfortunately, a frequent topic on SBM has been the anti-vaccine movement, personified these days by celebrity spokesmodel for Generation Rescue Jenny McCarthy and her boyfriend comedian and actor Jim Carrey. Unfortunately, it is a topic that is unlikely to go away. We’ve all speculated why the anti-scientific emotion-based notion that vaccines somehow must cause autism persists in spite of mountains of evidence to the contrary, but I think the question goes much deeper than that because it’s not just about vaccines. The anti-vaccine movement is but one of the most visible components of a much deeper problem in our public discourse, a problem that values feelings and personal experience over evidence, compelling stories and anecdotes over science.
I’m referring to the Oprah-fication of medicine in America.
Why Oprah? you may ask. I’m happy to tell you. Oprah Winfrey has been the host of the highest rated syndicated talk show in television history, her self-named The Oprah Winfrey Show. The show has been running for nearly 23 years, with over 3,000 episodes. Winfrey is so famous that she is one of those rare celebrities who is known instantly by just her first name. Say “Oprah,” and virtually everyone will know to whom you’re referring, and her show is often colloquially known as simply Oprah. Given this unprecedented level of success, which has made Oprah a billionaire and a ubiquitous presence on TV, her own magazine, her own satellite radio station, and, soon, her own cable channel, Oprah has developed a media empire that few single individuals can match or beat. Indeed Rupert Murdoch is the only person that I can think of who likely has a wider reach than Oprah. Personally, I have no problem with Oprah’s level of success. Clearly, she is a very talented and savvy TV host and businesswoman.
Unfortunately, in marked contrast, Oprah has about as close to no critical thinking skills when it comes to science and medicine as I’ve ever seen, and she uses the vast power and influence her TV show and media empire give her in order to subject the world to her special brand of mystical New Age thinking and belief in various forms of what can only be characterized as dubious medical therapies at best and quackery at worst. Arguably there is no single person in the world with more influence pushing woo than Oprah. Indeed, she puts Prince Charles to shame, and Kevin Trudeau is a mere ant compared to the juggernaught that is Oprah Winfrey’s media empire. No one even comes close. No one, and I mean no one, brings pseudoscience, quackery, and antivaccine madness to more people than Oprah Winfrey does every week. (She doesn’t discuss such topics every day, but it seems that at least once a week she does.) Naturally, Oprah doesn’t see it that way and likely no one could ever convince her of the malign effect she has on the national zeitgeist with respect to science and medicine, but that’s exactly what she does. Consequently, whether fair or unfair, she represents the perfect face to put on the problem that we supporters of science-based medicine face when trying to get the message out to the average reader about unscientific medical practices, and that’s why I am referring to the pervasiveness of pseudoscience infiltrating medicine as the “Oprah-fication” of medicine.
Read more »
*This blog post was originally published at Science-Based Medicine*
June 5th, 2009 by Steve Novella, M.D. in Better Health Network
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The Centers for Disease Control (CDC) currently recommends that children 6 month to 18 years old receive an annual flu vaccine. There are two types of flu vaccines used in the US: a live attenuated virus (LAIV) and a trivalent inactivated virus (TIV) vaccine. Both are safe and effective – while efficacy varies from year to year, they are 70-90% effective in healthy adults. Efficacy is young children appears to be slightly less, about 66%.
There remains, however, many sub-questions about the flu vaccines and by the time researchers have thoroughly explored them vaccine technology is likely to have progressed, and therefore any new vaccines will have to be tested all over again.
One of those sub-questions about vaccine safety and efficacy is the net effect of the flu vaccine in children with asthma. Some have raised concerns that the vaccine may exacerbate asthma, a 1-2% increased wheezing and 3% increased hospitalizations have been reported, although so far the bulk of the data suggests that both types of flu vaccines are safe in children with asthma. There is evidence to suggest that the LAIV may be superior to the TIV in children, particularly with asthma.
A new study, presented but not published, further explores the safety and efficacy of the TIV in children. Study author, Avni Joshi, M.D., of the Mayo Clinic, reports:
“The concerns that vaccination maybe associated with asthma exacerbations have been disproved with multiple studies in the past, but the vaccine’s effectiveness has not been well-established. This study was aimed at evaluating the effectiveness of the TIV in children overall, as well as the children with asthma, to prevent influenza-related hospitalization.”
The study is a retrospective study of 263 children who presented to the Mayo clinic with laboratory confirmed influenza. They found that children who had recieved the TIV vaccine had a 3 times greater risk of hospitalization than those who were not vaccinated. These results raise concerns about the safety and effectiveness of the TIV in children with asthma.
Dr. Joshi concludes:
“While these findings do raise questions about the efficacy of the vaccine, they do not in fact implicate it as a cause of hospitalizations. More studies are needed to assess not only the immunogenicity, but also the efficacy of different influenza vaccines in asthmatic subjects.”
That may seem like a curious conclusion given the results of this study, but it is accurate. The key to understanding the implications of this study is that it is retrospective. That means it looks at children who have the flu and then looks back to see who was vaccinated and who wasn’t. This in turn means that children were not randomized to either be vaccinated or not, and this opens the door to any number of variables that cannot be controlled for in the study.
The authors did look as obvious factors, such as severity of asthma and insurance status, and found that they did not correlate with risk of being hospitalized. But what other factors might there be? The flu vaccine is optional, which means that parents decide whether or not to vaccinate their children, perhaps with advice from their pediatrician. It is likely that sicker or more frail children are more likely to get vaccinated. It is also likely that children who had a bad reaction to the flu in the past are more likely to get vaccinated. The flu vaccine is recommended especially for those who are at high risk for complications if they get the flu.
Therefore while this study raises important questions, it is not designed to answer them definitively. A prospective trial is required for that, and that is what Joshi means by “more studies are needed.” In general, retrospective studies are useful to find correlations and generate hypothesis, but are not capable of determining causation – there are simply too many variables that are not controlled for.
As expected, the anti-vaccinationists have already jumped on this study and misinterpreted its significance. They did not recognize its retrospective nature nor put it into the context of existing research on the safety and efficacy of the flu vaccines.
Clinical trials are complex, and there are many types that each have their own strengths and weaknesses. Often, many independent lines of basic science and clinical evidence need to be brought together to form a reliable conclusion about a specific intervention. That is the essence of science-based medicine. Individual studies typically only provide a tiny slice of information, but are often presented to the public as if they are definitive. This creates a constant background noise of misinformation about medical questions.
It also provides a rich source of data from which to cherry pick, allowing proponents to support almost any notion by shopping from the vast store of often conflicting medical research. This reinforces the need to look thoroughly at the totality of scientific evidence on any claim or question.
When that is done on the question of the flu vaccines, it is clear that both types of vaccines are safe and effective. However, there is also much room for improvement in the vaccine technology itself, as well as evidence-based recommendations for who, exactly, should get which type of vaccine.
This current study adds incrementally to our knowledge on this question, and suggests questions for future research. It is not the kind of evidence, however, that should lead to changes in the current recommendations.
*This blog post was originally published at Science-Based Medicine*
