When it comes to vaccines, perhaps the most frequent question I get is some version of “As a naturopath, do you recommend vaccines?” If you don’t have time to read the whole article you can stop here: my answer is always “yes”.
Why? Because above all else I am a physician. This transcends any “naturopathic” or “conventional” categorization and requires that I present accurate and unbiased information about medicine to my patients. Evidence informed practice demands unflinching review of medical interventions both naturopathic and conventional. On both sides there are many techniques which fail to be strictly evidence based [1], and those found to be without sufficient evidence must be either validated or discarded without undue sentimentality.
To this end, the evidence is clear: vaccines are safe and effective. Furthermore vaccines are consistent with the tenets of naturopathic practice. To explain this connection, I have listed the precepts of naturopathic practice below and will discuss the ways in which they align with vaccination.
The Healing Power of Nature
While the broadly beneficial aspects of the natural environment has been the subject of many a philosophical debate (and more than a few authors’ greatest works), we have recently been able to quantify some of the genuinely salubrious effects of time spent in a nature [2, 3]. I can only speak for myself, but cytokine production and NK cell activity aside, an afternoon outside can produce a fair amount of beneficial cardiovascular exercise as well.
Our immune systems have evolved over the history of life on our planet to protect us from illness by responding to quickly and effectively against external threats to our health. Historically, the idea of vaccination came from exposing an individual to a small amount of cowpox, which was discovered to prevent smallpox, a much more serious and debilitating disease [4]. With refinements in technique and the advent of molecular medicine, we don’t need to slather children with cowpox to prevent smallpox (and not just because vaccination effectively eradicated the scourge of the vaccinia virus). Instead we can administer the necessary antigens in a quick, safe, and only slightly uncomfortable way: the intramuscular or subcutaneous injection. Not to mention oral vaccines and the now defunct inhaled vaccines. All of this benefit comes with a vanishingly small level of risk per dose of vaccine administered [5].
Given the mechanism behind vaccination, I can’t think of anything more “natural” than using your body’s innate ability to create lasting immunity to diseases. Vaccines also have the added public health benefit of reducing the incidence of disease.
Identify and Treat the Causes
The source of vaccine-preventable illnesses are the causative organisms. Through the progress of modern research and the numerous scientific advancements since the inception of naturopathic practice we are able to not only understand the specific cause of these illnesses, but also engineer a precise and naturally-derived method to prevent these diseases in the first place. The idiom “an ounce of prevention is worth a pound of cure” comes to mind.
First Do No Harm
Failing to recommend preventive medical interventions which in turn contributes to both increased disease prevalence and reduced herd immunity is harmful, full stop. I would also contend that throwing patients out of our practices for vaccine hesitancy or refusal also causes a quantifiable harm to both personal and public health. The solution is education, and this dovetails with our next tenet: doctor as teacher.
Doctor as Teacher
We have a responsibility to educate our patients about the safety and efficacy of vaccines. It is likewise important that we meet our patients where they are to discuss the importance of vaccination, as well as the risks present when vaccination rates fall. We must take the time to carefully diffuse the minefield of disinformation, profiteering, fear mongering, and yes, even “fake news” found in the anti-vaccine havens of the internet. No vaccine hesitant patient has ever had their mind changed by a stern lecture and paternalistic attitude from their provider, and in my personal experience the best route has always been to systematically address specific concerns with the real evidence. This takes time, and not always possible when combined with the constraints of daily medical practice. So it becomes essential to curate a good educational resource list for patients. Vaxopedia is a fantastic place to start.
Treat the Whole Person
By taking a holistic view of the person as more than a collection of interrelated systems and associated symptoms, the physician can address an overall clinical gestalt and treat accordingly. From a hierarchical perspective, preventing debilitating illnesses allows our patients to pursue their higher order needs and self fulfilment. Furthermore, vaccines benefit not only the person receiving them, but their community as well. Health is not simply the absence of disease, but rather well being and freedom to focus on life’s other joys and challenges. Vaccination ensures that our patients maintain their health and can spend their time and resources affecting their communities in positive ways.
Prevention
Vaccination is without a doubt one of the crown jewels of preventive medicine. By utilizing our immune system’s automatic response to antigenic material, we can confer a natural immunity to illness, without having to suffer the potentially deleterious effects of the illness in the first place. Vaccines are good for individuals, for populations, and for those who have true contraindications to vaccination and rely on herd immunity. Preventing illness is far superior to treating it, and vaccines give the physician a powerful tool to keep healthy patients healthy, and protect others passively.
The Bottom Line
It is our duty to empower our patients to make decisions about their health with confidence that they are given the best available information. Vaccines are an essential, effective and elegant component of preventive medicine. Vaccination aligns with the all of the core tenets of naturopathy and anti-vaccine rhetoric is antithetical to the practice naturopathic medicine. We must work together to support our patient’s decisions to vaccinate, and educate those who are hesitant. NDs are in a unique position due to the perception that we are “outsiders” and therefore not “in the pocket of big pharma”. This perception sets a (false) dichotomy between “conventional” and “naturopathic”, and many patients look to us as a source of information that is free from the biases of “conventional medicine”. The educational pedigree of a medical provider should not influence vaccine endorsements, but the recommendation to vaccinate from an ND may carry more weight for those who preferentially select a naturopathic approach in their healthcare. Every additional patient protected with immunizations is a credit to the philosophy and foundations of our practice, and a benefit to the communities we serve.
References
- Kane, Robert L, et al. “Examining the Quality of Evidence to Support the Effectiveness of Interventions: an Analysis of Systematic Reviews.” BMJ Open, BMJ Publishing Group, 2016, www.ncbi.nlm.nih.gov/pmc/articles/PMC4861106/.
- Li, Qing. “Effect of Forest Bathing Trips on Human Immune Function.” SpringerLink, Springer. Japan, 25 Mar. 2009, link.springer.com/article/10.1007/s12199-008-0068-3
- Reynolds, Gretchen. “How Walking in Nature Changes the Brain.” The New York Times, The New York Times, 22 July 2015, well.blogs.nytimes.com/2015/07/22/how-nature-changes-the-brain/?ref=health.
- “The History Of Vaccines And Immunization: Familiar Patterns, New Challenges.” Health Affairs, www.healthaffairs.org/doi/abs/10.1377/hlthaff.24.3.611.
- “WHO Vaccine Reaction Rates Information Sheets.” World Health Organization, World Health Organization, www.who.int/vaccine_safety/initiative/tools/vaccinfosheets/en/.
Maxwell Cohen, ND
Max Cohen, ND is a naturopathic physician in Portland, Oregon. He currently works for a Federally Qualified Health Center (FQHC) providing primary care for a wide variety of patients. He is a member of the Board of Directors of the Naturopathic Academy of Primary Care Providers (NAPCP), as well as the Scientific Advisory Board for Boost Oregon.He completed his medical training and residency at the National University of Natural Medicine. Prior to medical school he worked as a microbiologist in a tuberculosis vaccine development lab. Twitter @MaxwellCohenND
Linda
December 30, 2017 at 9:43 amYou accuse Bernadette of cherry picking yet you are doing the same. You completely ignore thousands of MDs and scientists around the world who know and understand all the science and have called for safer vaccines. You completely ignore Dr William Thompson, senior scientist at CDC. You completely ignore the two scientists suing Merck for falsifying data.
You completely ignore the billions of dollars paid in fines from the pharmaceutical companies mostly for fraud. Injecting known neurotoxins can not in anyway be healthy or advantageous. I would go to an ND to receive a root problem cure done by nutrition and health targeted protocols and never to inject drugs of any kind, especially vaccines. You need to do some research on the vaccine rate for smallpox, about 10%, that didn’t irradicate the disease, obviously.
Bernadette
December 28, 2017 at 12:21 pmDr. Cohen,
I sincerely thank you for engaging in dialogue about this very important subject. Open, factual dialogue is desperately needed to move beyond the pro and anti arguments so that the fully informed consent in vaccination can take place.
I agree that “belief” is irrelevant. It is the scientific facts we disagree about. More to the point, it is the interpretation and status of the science that we disagree about.
In your reply to my comment, you acknowledge the potential for adverse reactions and that no practitioner should blindly recommend vaccines without consideration of contraindications. Yet your article mentions none of this. Why is it important to me that this information was not included in your article? Because everyone—CDC, WA DOH, WithinReach, drug-company funded Action Immunization Coalition—are putting out the same “vaccines are safe and effective” messages without any qualifications, without any distinction between individual vaccines, as if any product labelled a “vaccine” works in the same way. This overly-simplistic messaging has created a deep divide between those who have researched vaccines and those who have not.
You say that “vaccine safety is extensively studied, with an emphasis on rapid analysis to identify risks.” I appreciate that you don’t link to VAERS since it is a passive system that suffers from extreme under-reporting. You link to the CDCs VSD system, which has the potential to find more adverse reactions. If VSD data was readily available to independent researchers, I would agree that non-biased safety research was being done, although not rapidly. Years go by before adverse trends are evaluated in studies. But independent access to VSD is very limited, and the public-private entanglements of the CDC and HHS creates unacceptable conflicts-of-interest in what gets studied, and how it is studied.
VSD data is not a collection of information from clinical trials in which subjects were given fully informed consent. It is a collection of data gathered from members of the general public who were vaccinated and told simply that the vaccines are safe and effective. The VISs created by the CDC do not contain enough information for fully informed consent to occur. Physicians are required by law to be learned intermediaries – and perhaps in your practice that is happening – but in the majority of doctor’s offices around the country, and at the local grocery store pharmacy, no learned intermediary is ensuring safety or informed consent. To the contrary, scripts are now provided by the CDC to teach vaccine providers how to persuade hesitant patients into vaccination.
You provide a link to VSD studies of vaccination during pregnancy. Who were the subjects in those studies? Pregnant women who had no idea their experiences would be used to evaluate the safety of vaccination during pregnancy. Pregnant women who were told by their OBGYNs that vaccination during pregnancy is necessary, safe, and effective. They were not told that research is ongoing, that the FDA has not approved any vaccine for protection of the infant because the appropriate studies have not yet been done, that ACIP began recommending vaccination during pregnancy in the absence of safety studies and that the general public is in essence being used as test subjects.
You provided a link to a recent BMJ study related to maternal outcomes from Tdap in pregnancy which did appear to have informed consent as it was a small prospective observational study. But the authors themselves point out the weaknesses of the study: there was no non-vaccinated comparison group and the study was too small to explore serious adverse events. The abstract states “Clinician assessment of all SAEs found none likely to be vaccine related.” That is opinion, not fact, as is appropriate at this stage of research. “None likely” should not be translated to “not related.” Further research, including biological research is required. Epidemiological studies alone cannot determine causation except when a reaction is common and when the study is adequately powered and designed.
The other study you linked has the same weaknesses, and the authors wrote:
“Despite its widespread use in the USA and the UK, there is still limited safety data on the use of Tdap vaccine during pregnancy. This is the largest study to date investigating individual health outcomes and prospectively monitoring for adverse events in infants whose mothers had received Tdap vaccine during pregnancy.” This was in 2016 and there were just 403 infants followed, for just 1 year. Most developmental disorders are not diagnosed until at least age 2.
Every new study published about vaccination during pregnancy explains that safety data is still limited. But pregnant women are not told this at the time of administration. They are assured the vaccines are safe and effective during pregnancy, and they are highly pressured to get them. Why? In the U.S., in an average year, there are just 5 deaths during pregnancy related to the flu. And the flu vaccine is highly ineffective, this year predicted to be just 10%.
In the U.S., in 2012, what was considered an epidemic year for pertussis, there were 15 infant deaths. While every death is a tragedy, wouldn’t it be more prudent to find better ways of ensuring good outcomes for infants infected with pertussis than to recommend every woman in every pregnancy take the risk of a vaccine? Hyper-immunization with tetanus is a known problem. What other problems might there be that we simply don’t yet know? As I mentioned before, the Tdap has 250mcg of aluminum, a known neurotoxin. Animal studies have only barely begun. This 2017 study states:
“Our data demonstrate that 60-day subchronic exposure to low doses of Al from feed and added to the water, which reflect human dietary Al intake, reaches a threshold sufficient to promote memory impairment and neurotoxicity. The elevation of oxidative stress and cholinergic dysfunction highlight pathways of toxic actions for this metal.” https://www.ncbi.nlm.nih.gov/pubmed/27473855
That is from INGESTED aluminum—only .3% is absorbed. 100% of INJECTED aluminum is absorbed. What impact might that have on a developing fetus? We don’t yet know. In the absence of long-term vaccinated verses non-vaccinated studies, we cannot know the role maternal and pediatric vaccination play in the epidemic of childhood developmental and immune disorders.
Links to citations to my statements can be found at: http://informedchoicewa.com/vaccination-during-pregnancy/ and on other pages on the website.
You say there is no evidence of a relationship between Th2 immunogenicity and increased incidence of allergies/autoimmunity and provided two links. One paper is from 2003 and the other from 2005. Tremendous amounts of research have taken place since then. Researchers create animal models of allergy and asthma every day in labs around the world – by injecting them with antigens and aluminum adjuvants. In the IOM’s Adverse Effects of Vaccines: Evidence and Causality (2012), it was stated:
pg. 12 “Although the committee is optimistic that more can and will be known about vaccine safety in the future, the limitations of the currently available peer-reviewed data meant that, more often not, we did not have sufficient scientific information to conclude whether a particular vaccine caused a specific rare adverse event.”
pg. 72 “It is important to note that a specific study could be well designed and well conducted but also have very serious limitations for the purposes of this committee’s analysis. A specific study could have fewer limitations for some vaccines or some outcomes than for others. Small clinical studies can be well conducted but the number of subjects may be too small to detect most adverse events. Although most efficacy studies include a safety component, the results are often nonspecific (e.g., “no serious adverse events were detected”). Even some larger safety studies failed to detect an adverse event. Studies in which no cases of a specific adverse event were identified are uninformative for this review, because if the vaccinated cohort does not include enough cases to approximate background rates, the study is underpowered to inform an assessment.”
pg. 72/73 “Although randomized clinical trials aiming to study vaccine efficacy may provide the most valid, controlled circumstances in which to also study vaccine safety, such trials inevitably enroll too few study participants to be able to detect anything but extreme increases in the risks of relatively rare adverse events of potential concern.”
In regards to allergies, they stated:
pg. 93 “Subsequent exposure of allergen to receptor-bound IgE leads to cross-linking of IgE, activation of mast cells and basophils, and release of inflammatory mediators (Simons, 2009).”
pg. 94 ” Antigens in the vaccines that the committee is charged with reviewing do not typically elicit an immediate hypersensitivity reaction (e.g., hepatitis B surface antigen, toxoids, gelatin, ovalbumin, casamino acids). However, as will be discussed in subsequent chapters, the above-mentioned antigens do occasionally induce IgE-mediated sensitization in some individuals and subsequent hypersensitivity reactions, including anaphylaxis.”
In total, the phrases below were used by the committee 80 times to acknowledge potential vaccine-adverse event relationships that require further research:
“Autoantibodies, T cells, and molecular mimicry may contribute”
“Autoantibodies, T cells, and complement activation, may contribute to”
“Autoantibodies, T cells, immune complexes, and complement activation may contribute”
“Autoantibodies, T cells, immune complexes, direct viral infection, and molecular mimicry may contribute”
“Autoantibodies, T cells, immune complexes, persistent viral infection, and complement activation may contribute”
“Autoantibodies, T cells, immune complexes, persistent viral infection, and molecular mimicry may contribute”
“Autoantibodies, T cells, immune complexes, direct viral infection, persistent viral infection, and complement activation may contribute”
“Autoantibodies, T cells, immune complexes, direct viral infection, persistent viral infection, and molecular mimicry may contribute”
146 times : “The evidence is inadequate to accept or reject a causal relationship”
108 times: “evidence is insufficient or absent to assess an association”
As these quotes indicate, the science of vaccine safety is far from settled. It is the ethical imperative of every doctor to critically examine the claims and citations of those who are heavily vested in high vaccine uptake. Vaccines are highly profitable, mostly liability-free, potent, man-made, genetically altered and chemical-laced products. A blanket description of “safe and effective” is not appropriate. When it was only discovered in 2015 that the lymphatic system is directly tied to the brain, how can anyone claim vaccine science is settled? The science has only just begun.
Kathy H
December 28, 2017 at 6:06 pmBernadette,
“This overly-simplistic messaging has created a deep divide between those who have researched vaccines and those who have not.” No, it has not. The vast majority of vaccine researchers and scientists and doctors are all provax. I am not going to refer to what you do as research because you cherry pick your way through studies you do not understand and you have no background in statistics, data analysis, or any science.
In Washington state, our Immunization Action Coalition is Within Reach and they are NOT funded by drug companies. Their funding comes from the state, children’s hospital, Kaiser, and other non-profit health organizations.
VSD data comes from VAERS. All VSD members are independent of both pharma companies and government. They are not biased. In Seattle, Kaiser is a member of VSD. Other researchers can access the VSD data by applying to CDC.
Again, you mention informed consent. That is provided to all vaccine recipients at all times because they can, at any moment, ask their provider any question and then evaluate the answer before getting the vaccine.
You and I have discussed your fears about pregnant women’s data being used in VSD studies. You seem to think they were vaccinated without any health warnings and then their medical information stolen from them for use in VSD studies. That is not how these things work. These women agreed to be studied and hospitals routinely use medical records to study health outcomes. Again, you are proving you do not really understand much about research.
“Epidemiological studies alone cannot determine causation except when a reaction is common and when the study is adequately powered and designed.” Bernadette, you have no expertise whatsoever to be criticizing how science is done.
You cite a rat study where rats were given aluminum at these levels: “aluminum at 1.5 mg/kg b.w., and (c) aluminum at 8.3 mg/kg b.w. ” Bernadette, do you know how to do math? Humans get 250 micrograms of aluminum salts and you are comparing them to rats. If a rat was 10 lbs, like a newborn, that rat would be getting up to 37 milligrams of elemental aluminum. Compare 250 MICROgrams of aluminum salts to 37 milligrams of elemental aluminum. HUGE difference. No comparison.
The rest of your cherry picked science is just as bad and should be completely ignored.
Bernadette
December 30, 2017 at 6:52 pmKathy, you state: “In Washington state, our Immunization Action Coalition is Within Reach and they are NOT funded by drug companies.”
Please see this WithinReach webpage which clearly lists Merck, Pfizer, and Sanofi, as well as dozens of organizations with a financial interest in vaccination. http://www.withinreachwa.org/get-involved/sponsors/
Also, WithinReach is a member of the national Action Immunization Coalition (IAC), which receives major funding from drug companies. http://www.immunize.org/aboutus/corporate-members.asp WithinReach and the WA DOH use IACs promotional and informational resources, their forms, and link to their websites.
You state: “VSD data comes from VAERS.” It does not. https://www.cdc.gov/vaccinesafety/ensuringsafety/monitoring/vsd/index.html
You and I will never agree on what constitutes fully informed medical consent.
And as for the rat study, you failed to include in your math that only .3% of INGESTED aluminum is absorbed while 100% of INJECTED aluminum is absorbed. And you switched units for measure from kg to lbs. A 10lb baby weighs 4.5 kg. A baby given the very lowest level of ingested aluminum in the study, 1.5mg/kg–which the study found was “sufficient to promote memory impairment and neurotoxicity” when given daily for 60 days– would be getting 6.75 mg. of aluminum per day. Of that, only .3% would be absorbed. That comes to .02 mg, or 20 mcg. per day.
As you noted, the HepB shot on the day of birth contains 250mcg of aluminum. That exceeds ten times more. On the average 2-month-old visit (60 days later), an infant on the CDC schedule gets 1,225 mcg of aluminum — and that is fully absorbed. So in 60 days, the rats in the study absorbed 1200mcg in small daily doses; but our vaccine exposed infant will get 1,475mcg of aluminum in 2 large doses that overwhelm the newborn’s detoxification systems. Two months later, infants get another 975mcg, two months later 1,000mcg, and 6 months later 600mcg. Aluminum adjuvants also contain nanoparticles, which persist and travel to the brain. It’s criminal that injected aluminum adjuvants have not been studied for safety until recently, and then is only being done by independent researchers — and that the CDC is remaining silent rather than taking action to protect children.
http://informedchoicewa.com/aluminum/
Maxwell Cohen
December 28, 2017 at 8:13 pmBernadette, it is clear you feel strongly about this topic and it is unlikely that any amount of evidence I can present will change your mind.
I do not delve into the granular details in a blog post written for to be understandable to the medical layperson for obvious reasons. The overwhelming gestalt of current vaccine science is clear: they are safe and effective, but like all medical treatments, inherently carry a small risk. Like many people, I drive a car, which also carries a definable but unpredictable risk. Cars can be unsafe, but that does not mean that they are categorically unsafe.
No one is suggesting that the science is settled, because science is never settled. As it stands, the studies I have seen attempting to link a specific negative outcome to vaccines have been some combination of poorly conducted, poorly analyzed, and/or produced by research organizations that have an obvious anti-vaccine bias.
You assert — working as many scary adjectives into your description of vaccines as possible — that because science is not settled that vaccines must be viewed as categorically harmful until we can prove to your satisfaction that they are completely, 100% without any risk. This is not possible, and you must realize that this assertion is not a good-faith argument. The goalposts move to suit your claims. To wit; it is just as unreasonable for me to ask you to prove (to my satisfaction) that there is not a small china teapot orbiting the sun. You say you cannot find it with the Hubble telescope, I can simply say that you need to wait for science to design a more powerful telescope, ad infinitum. It is a Sisyphean undertaking to argue every point.
The IOM report you mention states clearly: “Vaccines are not free from side effects, or ‘adverse effects,’ but most are very rare or very mild. Importantly, some adverse health problems following a vaccine may be due to coincidence and are not caused by the vaccine”. Their use of the phrase “evidence is inadequate to accept or reject a causal relationship” does not imply causality should be presumed until sufficient evidence to disprove it exists. They further note “For the vast majority, (135 vaccine-adverse event pairs), the evidence is inadequate to accept or reject a causal relationship. In many cases, the adverse event being examined is an extremely rare condition, making it hard to study. In these cases, there was not adequate evidence to determine if the vaccine was or was not causally associated.” A paucity of evidence is not in-and-of-itself proof positive that more evidence will unearth causation. Rare events are difficulty to study with sufficient statistical power, and I might argue — with the caveat that I am not an epidemiologist — the fact that these events remain so rare suggests that epidemiologically we would see a discernible uptick if they were due to increased vaccination.
Bernadette
December 28, 2017 at 11:15 pmDr. Cohen — I don’t have unrealistic expectations, and yes, I believe in the “Precautionary Principle.”
Vaccines should be tested with at least as much vigor as other pharmaceutical products, with “gold standard” saline placebo trials, and studies by truly independent researchers that look more deeply, more broadly, and for a much longer time at their impact on individual and public health. There should be a mandatory automated adverse event reporting system. In this modern age, there is no excuse for a passive, voluntary system like VAERS. Assessment of net-benefits should be perpetually ongoing. If a vaccine is reducing a targeted antigen but causing a rise in non-target strains, or if the replacement of long-lasting natural immunity with shorter duration, less effective protection is leading to net health deficits, vaccination programs should be amended accordingly. If a vaccine, such as the pertussis vaccine, is unable to stop colonization and transmission, the public should be made fully aware they may become asymptomatic carriers. If a vaccine-targeted infection is spreading among fully vaccinated people, I want the media to report that fact rather than make a call for another round of a failed vaccine. These are all reasonable expectations for a category of products that are injected into healthy people.
I expect accurate, up-to-date, fully informed consent, and I expect honesty and no conflict-of-interest in science and public health policies.
I also want public health agencies to look beyond vaccines for non-invasive solutions to communicable disease. Prevention is always preferred — and we know enough about the human immune system now to understand that prevention doesn’t require taking the risk of a pharmaceutical product. That is a choice some can make. But the future of immunity lies in individuals optimizing their immune system with healthy lifestyle choices, in respecting the microbiome, avoiding immune suppressors (such as chemicals, pesticides, drugs like Tylenol), and creating healthy environments, so that all infection can be resisted or overcome, not just infections industry has targeted with products. The science on the human immune system and epigenetics in the past few years has been astounding. To me it reveals that respecting nature, not fighting or artificially altering nature, is the future of health.
I encourage you to read the investigative article published in Slate about the HPV vaccine. It epitomizes why we need vaccine safety and industry reform. https://slate.com/health-and-science/2017/12/flaws-in-the-clinical-trials-for-gardasil-made-it-harder-to-properly-assess-safety.html
Kathy H
December 30, 2017 at 5:05 pmBernadette, you have been told many times that it is unethical to run clinical trials on vaccines with only saline placebos, because it would be denying participants life-saving vaccines. Since vaccines have been around for decades, some even longer, it is perfectly acceptable to use other, fully -tested vaccines, as placebos. The World Health Organization recognizes this fact and also notes how unethical it would be to deny clinical trial participants vaccines.
That being said, vaccines go through much MORE strict safety testing than other pharmaceuticals. Again, this has been explained to you many times.
The reason we have a passive reporting system is because anyone can use it and that gives the public more confidence in vaccines. An automated system would mean that if a doctor disagrees with you that you are having a vaccine reaction, you are out of luck and your health issue cannot be reported and will not be reported at all. So, there would be less reporting than there is now. I don’t think you have thought this through. An automated reporting system will not mandate doctors report whatever patients wish.
You have also had it explained to you that the baboon studies showed the asymptomatic carriers were not passing pertussis along to any other baboons. The unvaccinated baboons, however, got severely ill when exposed to wild pertussis. Therefore, the vaccinated baboons, who may have had pertussis bacteria in their throats, were no threat to the other baboons and were no getting sick themselves. Yes, we need a better pertussis vaccine. Scientists are hard at work at that right now. Until they are done, we have no reason to stop using the one we have.
I would remind you that all public health agencies do work very hard on prevention of diseases. Every single disease for which we currently vaccinated had high morbidity rate until vaccination campaigns began. Healthy lifestyle choices don’t prevent these diseases. The best thing to do to keep healthy is live a healthy life, wash your hands often, stay home when sick, and get your vaccines.
Nature wants us to have a 50% infant mortality rate. Vaccines helped us get to a .58% infant mortality rate and an all-time low SIDS rate. You might like to see my new blog post, which demonstrates just how dramatically vaccines help save lives.
https://vaccinesworkblog.wordpress.com/2017/12/29/vaccines-save-lives/
As for that HPV vaccine article, Slate did a very poor job publishing an opinion piece that was very poorly researched. It is nothing more than the author’s opinion. No reason to pay any attention to it. He left out a great many facts.
Maxwell Cohen
January 1, 2018 at 11:10 amIf not unreasonable, your expectations appear to be disingenuous: you require that vaccine safety studies are conducted perfectly, in large-cohort randomized placebo controlled trials by “independent” researchers, with no conflicts of interest (as perceived by you). All this, yet you have no trouble citing poorly conducted studies with small sample sizes done by biased anti-vaccine research groups with obvious methodological flaws or outright fraud as proof that vaccines are not safe. You cannot have it both ways. The difficulty with designing studies like the ones you propose has been discussed extensively, and I will not re-invent the wheel in stating these challenges:
https://sciencebasedmedicine.org/the-perils-and-pitfalls-of-doing-a-vaccinated-versus-unvaccinated-study/
http://www.redwineandapplesauce.com/2013/12/21/the-one-study-or-why-the-anti-vaccine-movement-doesnt-really-understand-science/
Intentionally ignoring the logistical difficulty of these types of studies, and demanding that they be conducted perfectly (and high above the standards that anti-vaccine folks set for evidence of negative outcomes) before anyone can say vaccination is effective or safe is an irrational argument to make, especially when ample evidence for safety already exists.
The ‘net benefits’ of vaccination are evident and unambiguous in the current body of research. Like any medical intervention there are defined risks, and no one is arguing otherwise.
Vaccines save lives, prevents cancers, and preserve medical resources in the developing world:
http://www.who.int/bulletin/volumes/95/9/16-178475/en/
https://www.cdc.gov/mmwr/volumes/65/wr/mm6544a6.htm
http://www.pnas.org/content/114/16/4031.full
http://www.slate.com/articles/health_and_science/medical_examiner/2015/04/mmr_vaccine_complication_itp_vaccines_save_lives_despite_rare_side_effects.html
https://academic.oup.com/jnci/article/107/6/djv086/872092
Yes, with regard to the pertussis component of Dtap/Tdap vaccines the acellular pertussis vaccines are less effective than the cellular vaccine (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3896208/) but the old whole-cell DPT vaccine caused more adverse reactions. The decision was made to use a less effective acellular vaccine, because it was shown to be safer. Which is to say a vaccine which had issues with adverse events was identified and altered to improve safety, an expectation you list in your comment.
There is evidence that some Tdap vaccinated individuals may be colonized with pertussis and asymptomatic. There are more hypotheses as to the reason than “vaccines aren’t effective” (https://bmcmedicine.biomedcentral.com/articles/10.1186/s12916-015-0382-8), but asymptomatic transmission is certainly a possibility. This information is not a secret, and is something that I have absolutely discussed with my patients. Acellular priming followed by whole-cell vaccination may be a better strategy moving forward, but this research is ongoing (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5088088/). All of this is beside the point, since the protection from tetanus and diphtheria provided by the Tdap vaccine are robust and durable (https://academic.oup.com/cid/article/62/9/1111/1745278).
Appropriately individualized medicine is a goal of most practitioners I know, and using all available tools to improve health is part of this objective. Proper nutrition, physical exercise, healthful diet, mental healthcare, avoiding unnecessary antibiotic use (which coincidentally, vaccines help with: https://ourworldindata.org/vaccines-antibiotic-dependence), and general preventive lifestyle measures should all be used in synthesis to maintain and improve a state of health. Vaccines are another tool in the toolbox to prevent disease, and the overwhelming preponderance of evidence supports that they are very good at doing so, with risks the are minimal compared to those of the diseases they prevent.
It is clear that you do not intend to discuss this topic in good faith, but with selective data sources in concert with intellectually dishonest arguments. Your standards for evidence are not internally consistent. Laying out spurious claims and requesting specific data that you know full well cannot be furnished as the singular condition under which you will accept the any claims that contradict your view is a shrewd debate tactic, however “vaccines cannot be made perfectly safe, therefore all vaccines are categorically unsafe” is not a valid argument. I will not continue to engage in dialog in the context of dishonest debate tactics.
Maxwell Cohen
December 27, 2017 at 8:24 pmThank you for the feedback, Bernadette.
You ask if I believe what I wrote? Of course, but my belief is irrelevant: belief is for things that cannot be supported with evidence. My position on vaccinations does not require my personal belief, because there is ample evidence that vaccines are safe and effective. When I present the evidence it is not because I “believe” in it, but because the evidence stands on its own.
Of course there is potential for adverse reactions from vaccination. The CDC and ACIP do not say otherwise. In fact, they have a long list of contraindications and precautions for the vaccines they recommend: https://www.cdc.gov/vaccines/hcp/acip-recs/general-recs/contraindications.html
No one should be blindly recommending vaccines to every person without consideration of these contraindications. It is the medical provider’s job to address these with patients before recommending they vaccinate.
Moreover, the chance of a negative outcome is present with all medical interventions, even seemingly benign ones: Advising someone with congestive heart failure to drink more water could be deadly. This does not mean that we don’t consider these interventions, but that we assess risks and benefits before recommending them.
If a patient feels that the material risks of a negative reaction to a vaccination are not a chance they’re willing to take, and I have fully discussed the risks of this decision, then their right to self-determination is paramount. What I don’t want is for my patients to make their healthcare decisions out of fear. I’d rather empower them with knowledge, and if they still do not want to vaccinate then I certainly can’t compel them to do so.
Vaccine safety is extensively studied, with an emphasis on rapid analysis to identify risks. This dataset is updated weekly for accelerated detection of adverse events: https://www.cdc.gov/vaccinesafety/ensuringsafety/monitoring/vsd/index.html#evaluate
A list of publications citing safety of vaccines during pregnancy (there were 4 published in 2017 alone): https://www.cdc.gov/vaccinesafety/ensuringsafety/monitoring/vsd/publications.html
Here’s one related to maternal outcomes from Tdap in pregnancy: http://bmjopen.bmj.com/content/6/4/e010911
And one related to outcomes in infants exposed to Tdap vaccine during pregnancy: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4716252/
There is no evidence of a relationship between Th2 immunogenicity and increased incidence of allergies/autoimmunity:
http://pediatrics.aappublications.org/content/111/3/653
http://pediatrics.aappublications.org/content/116/Supplement_2/542.2
It would be a fool’s errand to try to respond to each and every individual point you have in your comment. You’ve preemptively labeled me as an unwitting, brainwashed mouthpiece of big pharma, so any point I make can be argued down as invalid. All I can say is this: I have no incentive to promoting vaccines aside from the fact that it is my ethical imperative as a physician to prevent disease whenever possible.
Kathy H
December 28, 2017 at 5:51 pmExcellent blog post and followup. Unfortunately, Bernadette is a cherry picker and doesn’t actually understand the studies very well. She doesn’t understand that Del Bigtree and Andy Wakefield lie a lot. She doesn’t understand that what the people at CSRMI and Dwoskin Foundation do is not valid science. Everything that does not fit her agenda is a conspiracy. But, we have to pay attention to her and her group, Informed Choice Washington, lest they gain any momentum and hamper immunization programs in our state. These are people who believe allergies and autism and literally everything bad under the sun is caused by vaccines, without valid reasons to support their beliefs. It is vital that doctors like you all and advocates like me do our best to make sure the public knows the facts.
You are correct. This is not about beliefs. This is about evidence and the quality of that evidence.
Kathy H
December 28, 2017 at 7:14 pmExcellent blog post, Dr Cohen, and very good response to Bernadette. I am sorry she has found your blog. She is a cherry picker and doesn’t truly understand the literature as well as she thinks. She is also co-president of Informed Choice Wa so, sadly, we must pay attention to her activities lest they influence immunization policies in our state. Your post is very well done and I am please to know that here are so many provax naturopaths.
Bernadette
December 23, 2017 at 10:00 amDr. Cohen ~ Drug companies’ marketing departments have billion dollar budgets which they use to hire the best social-engineers to saturate major and social media with culture-shaping messages — such as the message you are conveying here. NPs for vaccines? NPs are “outsiders” and not “in the pocket of Big Pharma” when they promote vaccines? Not everyone caught up in their engineering schemes know they are being used. Do you? Do you genuinely believe what you have posted here? I tend to believe that most people are good at heart, and so I will give you the benefit of the doubt — and ask you to please step back and consider your stance. If vaccines were like homeopathy, consisting of nothing but a highly reduced antigen, then perhaps they could be compatible with naturopathy. But they are not. They are genetically modified, chemically altered antigens, cultured in human and animal fetal cells, often combined with aluminum in nano-particle form, and injected into muscle thus bypassing the first stages of immune reaction. The immune response is not the same as with wild exposure, and the protection afforded is limited, of short duration, and often merely suppresses symptoms but does not stop the colonization or transmission of the targeted infection so unable to provide “herd immunity.” No doctor, MD or ND, should speak of vaccines as if they are all the same. Vaccines are not safe for all, they are not effective for all, and they come with risks far greater than you acknowledge. They are potent pharmaceutical products and their makers and providers, like you, are given full liability protection by the 1986 National Childhood Vaccine Injury Act and subsequent legislation that has stripped fully informed consent from Americans. Provisions of that 1986 Act that required HHS to perform safety studies, monitoring, and to locate population groups susceptible to vaccine injury have not been fulfilled. Did you know? The ACIP often makes recommendations based on “perceived” safety in the absence of actual scientific evidence, such as when they began recommending vaccination during pregnancy. This is not “fake news.” This is stated quite clearly by the ACIP themselves if you take the time to go beneath the surface and read their published reports and statements and follow their citations. Can you show me a single study that shows that exposure to 250mcg of aluminum adjuvant, as is in the Tdap, is safe for a developing fetus? Can you provide evidence that prematurely skewing an infant’s immune system toward Th2 does not lead to allergies, asthma, and autoimmune disorders? Human beings are not “vaccine deficient.” Human beings did not evolve to require the injection of pharmaceutical products pre-cradle to grave to attain health and wellness. Quite the opposite. Pre-cradle to grave vaccination and the reckless overuse of vaccination is undermining the health of everyone. It is unethical for any doctor to treat any medical intervention with such callous disregard for the scientific facts.
Kathy H
December 28, 2017 at 5:47 pmBernadette, I am sure you have been told many times that vaccine immunity is better than wild disease immunity because it comes with far fewer risks. There is literally 100% international scientific consensus that vaccines have greater benefits than risks. For many vaccines, immunity does last a lifetime and I would send you to The Pink Book for the data and references for that. For most vaccines, the immunity does stop the colonization and transmission of those targeted infections. We have seen dramatically lower rates of all VPDs since vaccines were invented. In just the last decade, chicken pox, rotavirus, and HIB have all become rare, thanks to vaccines. Ear infection rates are down, thanks to PCV13 vaccine.
And you know full well that everyone who gets vaccines gets informed consent. As with any drug, you have the opportunity, before you take it or it is administered, to ask any question you like about side effects and risks. That is informed consent.
And I am sorry but you misread and misinterpret scientific studies and ACIP’s findings all the time. You cherry pick. I have pointed this out to many times. Since we all pay little to no attention to studies from CSMRI and Dwoskin Foundation, we don’t fear aluminum adjuvants. We know they are proven safe and that vaccine ingredients don’t even get near the developing fetus. The reason we give TDaP to pregnant mothers now is for their immunity help cocoon the newborn.
There is ample evidence vaccines have nothing to do with allergies, asthma, and autoimmune disorders and you have been told this many times. But, this does not fit with your agenda.
“Human beings did not evolve to require the injection of pharmaceutical products pre-cradle to grave to attain health and wellness.” Yes, humans evolved to die and suffer from infectious diseases. That is why the human brain also evolved to create medical science.
I am very proud that Bastyr graduates are finding science and proving naturopaths are not all quacks. Drs Cohen, et al, should be commended for their amazing work. Maybe next year they will all win the CDC Immunization champion award!