After yesterday’s post, I wasn’t planning on writing about SB 276 and SB 714 again—or even vaccines. I really wasn’t. Leave it to antivaxer Robert F. Kennedy, Jr., though, to drag me back in just when I thought I was out. When I saw this from RFK Jr.’s antivax group, Children’s Health Defense complaining about New Yorker Magazine:
Yes, Children’s Health Defense was promoting an article by RFK Jr., who, apparently, is cheesed that New Yorker Magazine didn’t publish his response to an article it published a week and a half ago by Nick Paumgarten entitled The Message of Measles. It’s actually a pretty decent article about the latest measles outbreaks and the misinformation promoted by the antivaccine movement that fuels them. So RFK Jr., given that he has a website, decided to publish his article there. His decision to do so makes it abundantly clear that, in this case at least, the editors of New Yorker demonstrated excellent judgment. It’s the same sort of misinformation that RFK Jr.’s been peddling for decades now, a veritable antivax BINGO card.
I’m not going to belabor RFK Jr.’s pharma shill gambit (that much), his harping on “conflicts of interest,” and his claims that, in essence, big pharma controls everything and distorts the risk-benefit ratio of vaccines, all in order to profit. It’s the predictable conspiracy theory of antivaxers. No, I’m not claiming that big pharma is in any way pure or free from problems and greed. I am, however, pointing out that there is plenty of independent evidence out there to demonstrate that vaccines are safe and effective and do not cause the myriad health problems that antivaxers attribute to them. Of course, RFK Jr. is a man who has risibly declared himself “fiercely pro-vaccine” on more than one occasion, yet trafficks in the most overblown fear mongering based on pseudoscience over vaccines, autism, autoimmune diseases, and all sorts of other conditions, diseases, and neurodevelopmental disorders.
Mr. Paumgarten falls into this trap by parroting the industry canard that measles will kill 1 in 1000 infected Americans. But CDC’s mortality and morbidity data suggest that measles fatalities in the pre-vaccine era were 1/500,000 population wide; 1 in 10,000 among infected individuals. In fact, no one can say, scientifically, that any one of the 70 vaccine doses currently recommended for American children saves more lives than it costs. That question can only be answered by studies that compare long-term health outcomes in vaccinated versus unvaccinated populations. Despite concerns over inadequate safety science by the Institute of Medicine, the ultimate arbiter of vaccine safety science, captive regulators at HHS have refused to perform such studies and have exempted vaccine-makers from performing randomized placebo-controlled tests prior to licensing. HHS requires such studies for virtually all other pharmaceutical products. That means that no one knows vaccine risk profiles. Mr. Paumgarten makes little effort to advance the debate. He makes no mention of the MMR’s well-documented danger signals.
That part about only one in 500,000 people “population-wide” is a transparent attempt to make the measles death rate seem as low as possible though an obvious and intellectually dishonest ploy: Dividing the deaths by the whole population, rather than the infected population. We don’t care. Vaccines are intended to prevent the deaths from the disease by preventing the disease in the first place. Amusingly, that “1 in 10,000” figure links to an infographic from Physicians for Informed Consent. It’s a group I’ve discussed before, and it’s an antivax advocacy group. Indeed, it’s an embarrassment to me personally as a physician that an antivax physicians’ group like this exists.
But what about the figure itself? It’s based on figures from the CDC that, before the vaccine, approximately 500,000 cases a year were reported to the CDC out of what was estimated to have been around 3-4 million cases, resulting in around 400 to 500 deaths. So, let’s say that the mortality was “only” 1 in 10,000. RFK Jr. conveniently forgets to mention that there were also 1,000 cases of encephalitis and 48,000 hospitalizations for the complications of measles, such as pneumonia. Indeed, as I mentioned just last week, Sir Graham Wilson, a prominent vaccine scientist 50 years ago, someone who even wrote a book about the risks of immunization, had this to say about measles:
Measles presents an interesting example of a disease in which the mortality in relation to morbidity in Great Britain is extremely low but in which respiratory and neurological complications leaving behind them permanent damage are not infrequent.
As I said at the time, so much for the idea, frequently parroted by antivaxers, that 50 or 60 years ago everyone, doctors included, considered measles to be a mild, self-limited “benign” disease. It wasn’t and isn’t, and indeed the past and present rebuke antivaxers who try to make that argument. The measles is not benign. Today, the CDC estimates that one in four who get the measles require hospitalization, while 1 in 1,000 suffer the complication of encephalitis and roughly 1 in 1,000 die. That’s not even counting the risk of subacute sclerosing panencephalitis (SSPE), whose risk, according to recent studies, appears to be considerably higher than previously thought. SSPE, for those who don’t remember, is a late complication of measles in which encephalitis develops a decade or even longer after measles. That encephalitis is virtually always fatal. It turns out that SSPE, previously thought to occur at an incidence of 1-2 in 100,000 cases, could be as common as 1:1,367 for children less than 5 years, and 1:609 for children less than 12 months at time of measles disease. This is not uncommon.
As for the call for a study of vaccinated versus unvaccinated children looking at long term health outcomes, I hate to tell RFK Jr., but, contrary to what he thinks, there are studies that have done just that. They don’t show what RFK Jr. apparently thinks they would show—just the opposite, in fact. If anything, vaccinated children are healthier, with less asthma, probably less SIDS, and no difference in allergic diseases.
RFK Jr.’s whole argument is despicable and deceptive. Let’s say, for the sake of argument, that he’s correct and that the mortality from measles is only 1 in 10,000, not 1 in 1,000. So what? It’s still very much worth preventing that many deaths. RFK Jr. appears to be arguing that it’s not worth preventing 1:10,000 deaths compared to 1:1,000, particularly when you take into account all of the morbidity in terms of pulmonary complications due to measles. Of course, RFK Jr.’s about more than that:
Studies support an unconscionably high injury rate from MMR. Merck’s own MMR pre-licensure studies found that 40% of children receiving the MMR suffered gastrointestinal illnesses within 42 days of the injection and 55% suffered respiratory illnesses – symptoms that might persuade rational consumers to choose the infections over the vaccine.
This is the same distortion that Del Bigtree tried out in May and that I discussed in detail then. (Read the post at the link if you want the details.) The short version is that this figure is not as out of the ordinary as RFK Jr. tries to make it seem just in a random sample of children whose mothers are carefully paying attention to their every health issue. More pertinently, I like to counter with a double blind placebo controlled twin study of MMR in which “respiratory symptoms, nausea, and vomiting were observed more frequently in the placebo-injected group than in the MMR vaccinated group.”
Next up, RFK Jr. can’t resist the “appeal to the package insert”:
The MMR’s package insert includes an almost two-page listing of over 60 adverse reactions ranging from vomiting and irritability to permanent brain damage to anaphylaxis. The Institute of Medicine has repeatedly pointed out CDC’s failure to perform the studies necessary to confirm whether MMR is causing these injuries. Merck acknowledges that an astonishing 26% of post-pubertal females might develop arthritis and arthralgia from the MMR.
One more time: The package insert is a legal, not a medical document. It’s a CYA document. It lists every health issue observed in the clinical trials done to apply for licensure of the vaccine, whether those health issues were thought to be due to the vaccine or not. The appeal to the vaccine package insert is nothing more than deceptive nonsense. Indeed, contrary to RFK Jr.’s characterization, in reality the MMR package insert favors vaccination.
Then RFK Jr. can’t help but invoke another hoary antivax trope:
A 2017 letter published in the British Medical Journal cited research showing that children receiving the MMR vaccine had five times the seizure rate of children with measles infections. A 2004 JAMA study found that an additional 1 in 640 children has seizures after MMR compared to unvaccinated children; about 5% of these will progress to epilepsy.
Note the deception going on here. That 2017 letter was from Shira Miller, of Physicians for Informed Consent, the aforementioned antivax physicians group. As for the study, yes, that study showed a risk of febrile seizures after MMR. What that study showed was that there is a transient increased risk of febrile seizures after MMR vaccination, but that, contrary to RFK Jr.’s implication, these febrile seizures do not increase the child’s risk of epilepsy. Let me quote the paper itself:
MMR vaccination was associated with a transient increased rate of febrile seizures but the risk difference was small even in high-risk children. The long-term rate of epilepsy was not increased in children who had febrile seizures following vaccination compared with children who had febrile seizures of a different etiology.
We found no increased rate of epilepsy among children who had febrile seizures after MMR vaccination compared with children who had febrile seizures of a different etiology. The rate of recurrent febrile seizures was slightly increased, possibly because the MMR vaccination introduced an extra febrile episode during the window of highest susceptibility and the total number of febrile episodes is a well known risk factor for recurrence.
Finally, RFK Jr. lays down a howler of an argument. No, really, I laughed out loud when I read this:
HHS’s voluntary post-marketing surveillance program on vaccines, VAERS, reports over 89,000 adverse reactions to MMR through March 31, 2018, including 445 deaths. However, VAERS is a voluntary and notoriously ineffective system. VAERS captures “fewer than 1% of vaccine injuries” according to a 2010 HHS funded study performed by another federal agency, the Agency for Health Care Research and Quality (AHRQ). If you multiply the known adverse events from the MMR by 100, you get 44,500 deaths and 8,900,000 injuries making the measles vaccine far worse than measles. That AHRQ pilot study reported a possible reaction for 2.6% of vaccinations. When CDC officials saw these alarming figures, they quickly cancelled a machine-counting system that would have provided better tracking of vaccine safety.
VAERS? RFK Jr. is invoking VAERS? Yes, he’s doing what antivaxers love to do: Dumpster dive in the VAERS database. VAERS is a passive reporting system, it’s true, but it’s also a system to which anyone can submit a report, and it’s well known that lawyers representing antivaxers wanting to sue for “vaccine injury” have hopelessly distorted the VAERS database by reporting autism and all sorts of conditions not caused by vaccines. One of the most famous examples illustrating this is that of Jim Laidler, who famously reported that the flu vaccine had turned him into the Incredible Hulk. (These days, he’s known as the Immortal Hulk.) Here’s how he described it:
The chief problem with the VAERS data is that reports can be entered by anyone and are not routinely verified. To demonstrate this, a few years ago I entered a report that an influenza vaccine had turned me into The Hulk. The report was accepted and entered into the database.
Because the reported adverse event was so… unusual, a representative of VAERS contacted me. After a discussion of the VAERS database and its limitations, they asked for my permission to delete the record, which I granted. If I had not agreed, the record would be there still, showing that any claim can become part of the database, no matter how outrageous or improbable.
Since at least 1998 (and possibly earlier), a number of autism advocacy groups have, with all the best intentions, encouraged people to report their autistic children—or autistic children of relatives and friends—to VAERS as injuries from thimerosal-containing vaccines. This has irrevocably tainted the VAERS database with duplicate and spurious reports.
Laidler wasn’t the only one. Kevin Leitch, to show that Laidler could have done what he claimed, entered a report claiming that a vaccine had turned his daughter into Wonder Woman. The report was accepted. Basically, it’s a fool’s errand to extrapolate the number of death reports in VAERS to mean anything. Undoubtedly, most of those reports are about victims of sudden infant death syndrome, which we know not to be caused by vaccines. Indeed, if anything, vaccines likely protect against SIDS. It’s even more hilariously ignorant of RFK Jr. to assume that, because it’s thought that only 1% of adverse reactions are reported in passive reporting systems, he should just multiply the number of deaths by 100 and call it a day. Of course, RFK Jr. ignores, as he has in the past, the existence of three active reporting systems that do not depend upon reports submitted to them but automatically looks for adverse events in electronic medical records. Why does he ignore them? Because they don’t show anyone dying from the MMR vaccine, much less 44,500 children.
As for the AHRQ issue? Basically, the CDC gave a grant to investigators at Harvard Pilgrim Health Care to turn VAERS into more of an active reporting system by identifying required data elements and developing systems to monitor ambulatory care EMRs for adverse events following vaccine administration; prepare and securely submit clinician approved, electronic reports to the national Vaccine Adverse Event Reporting System (VAERS); comprehensively evaluate ESP:VAERS performance in a randomized trial and compare it with existing VAERS and Vaccine Safety Datalink data. Why didn’t the CDC followup on it? Who knows? Maybe the CDC thought that existing active reporting systems (e.g., the Vaccine Safety Datalink or PRISM) were adequate and that there was no need to turn VAERS into such a system. Whatever the CDC’s reason, its failure to further fund Harvard Pilgrim Health Care to continue to develop its system has been cited by antivaxers for several years as “evidence” that adverse events due to vaccines are very much more common than the CDC “admits.”
This article wasn’t all that RFK Jr. has been doing in the wake of the passage of SB 276 and SB 714. For instance, he’s been pushing this video:
I was going to go through it, but this post had already ballooned larger than I had expected. Fortunately, Dr. Vincent Ianelli took it on so that I don’t have to. I can see just from his treatment that RFK Jr. repeated his usual lies about the current generation of children being the “sickest generation,” repeated the appeal to vaccine package inserts, and, of course, the usual rants about government in which RFK Jr. compares it to China. Gee, I wonder why he chose China, of all authoritarian countries. Why not Nazi Germany, as he’s done in the past, or other authoritarian countries or other dictators? It couldn’t be because the driving force behind SB 276, Sen. Richard Pan, was born to a Taiwanese family that had immigrated to the US, could it? Could it be that RFK Jr. is subtly echoing the racist attacks against Sen. Pan that antivaxers have been laying down since SB 277 in 2015? One wonders, one does.
In any event, RFK Jr. is as antivax as antivax can be, all his claims to be “fiercely pro-vaccine” notwithstanding.