Friday, December 31, 2010

Ho! How did I miss this?

A poster asked in the comment section of our blog, whether the index patient in the San Diego measles outbreak had been a patient of "Dr. Bob" Sears. I recalled that Bob had been asked that directly on his board:
San Diego meales outbreak by San Diego mommy - posted on 3/26/2009

Someone told my that the child who started the San Diego measles outbreak last year was one of Dr Bob's unvaccinated patients. Is that true? That is so sad for the families affected by the outbreak, especially for the babies that were too young to be protected by the vaccine.
and Bob had answered in his usual flippant and evasive manner:
Ya, she wanted the MMR, but I wouldn't give it to by Dr. Bob - posted on 3/27/2009

So, it's totally my fault that the outbreak happened.

No, seriously, I do know who the family is and have interacted with them. I'll leave it at that, since it doesn't actually matter if they were actually my patient or not.

Seth Mnookin, the author of the soon to be released "The Panic Virus" pointed me to an Orange County Register piece that is much more candid than Dr. Bob:
An unvaccinated 7-year-old boy traveled to Switzerland and unknowingly contracted the virus. Almost 100 children (including babies who were too young for the MMR vaccine) were quarantined or hospitalized after they were exposed at the pediatrician’s office, Whole Foods or day care. In all, 11 children caught the measles. As it turns out, the boy who spread measles is a patient of Dr. Bob Sears
(my bold)

Dr. Bob himself downplays the severity of the situation in his 2008 blog by saying:
The recent measles outbreak (if you can call it that) in San Diego last month,
(my bold)

Fact check for Dr. Bob:
A recent study by researchers on the role of vaccine refusal in this outbreak was staggering: 839 people were exposed, 11 additional measles cases were reported (all in unvaccinated children); one infant, too young to be vaccinated, had to be hospitalized. At a time when the state of California is in devastating financial straits, it cost San Diego serious health care dollars: $10,376 per case, for a total of $124,517 (and the hospitalized infant's bill was nearly $15,000). Forty-eight children too young to be vaccinated were quarantined for several weeks, meaning parents had to miss work and wages at an average cost of $775 per child.

In his blog, Dr. Bob claims:
Fortunately, all cases passed without complications, as is usually the case with measles.

Lost in the depth of his own board is the reality check by Wilbert Mason, MD
Minimization of the effects of measles by Wilbert Mason MD - posted on 4/3/2008

As a pediatric infectious disease physician I feel I must comment on statements made in your March 27th commentary on the New York Times article. First, you infer that the cases in San Diego did not constitute an outbreak ("...if you can call it that..."). This is a highly contagious infection that spreads by small droplets that remain suspended in a closed room for over an hour. Indeed, 4 of the cases acquired the infection just by being in the pediatrician’s office at the same time as the first case. Three of these were infants and one of them had to be admitted to the hospital for dehydration.
Elsewhere you have observed that “all of the cases of measles passed without complications, as is usually the case with measles”. Let me share with you our experience with measles at Childrens Hospital Los Angeles during the measles epidemic in 1990. We diagnosed 440 cases between January 1st and June 30th. Of these cases 195 (44%) had to be admitted for one or more complications of measles. We documented the complications in all 440 cases and they included 63% with ear infections, 45% with diarrhea, 39% with dehydration, 36% with pneumonia, 19% with croup, and about 3% with other bacterial infections. Three children died all of pneumonia. Measles is not a trivial infection as you inferred. We would not be having a debate about vaccines at all if people realized the tremendous costs in suffering and human life we incurred before vaccines became available. To adequately protect a population against measles >90% of the population must be effectively immunized against the disease. If individuals defer vaccines as you suggest we will rapidly fall below that level putting large numbers of infants and children at risk of an outbreak if measles is introduced into the community. This is a free country but we should all feel some responsibility to our fellow citizens and their children.

Thank you Dr. Mason, that says it all, really, about the irresponsible behaviour of Dr. Bob Sears (and the patients' parents who believe him).

Saturday, December 11, 2010

Measles - actual - not hypothetical

another Dr. Bob "gem", I am afraid.

A poster on Bob's forum asked:

dr. sears hypothetical question... by - posted on 12/10/2010

my kids are 3 and a half and 1- both boys. we live in ny, and they havent had any vaccines. i would like to eventually travel with them, normal family spots- carribean, europe.... would you vax if you were me, and if so, which would you do? thanks!

Dr. Bob relishes these opportunities - here is his answer:
DR. Bob Answers by Dr. Bob - posted on 12/10/2010

Hypothetically, if I was a doctor answering a forum question pretending to be the person asking the question, my answer would be that I wouldn't do any vaccines just for disease coverage for the type of vacation travel that you, I mean "I", would be doing.

The OP thinks that is a reason to "lol" - I think it is a reason to facepalm. Unvaccinated children travelling out of the US, for example to Europe, are the major source of importation of measles - last demonstrated by the San Diego outbreak.

The index patient was an unvaccinated boy aged 7 years who had visited Switzerland with his family, returning to the United States on January 13, 2008. He had fever and sore throat on January 21, followed by cough, coryza, and conjunctivitis.
During January 31--February 19, a total of 11 additional measles cases in unvaccinated infants and children aged 10 months--9 years were identified. These 11 cases included both of the index patient's siblings (rash onset: February 3), five children in his school (rash onset: January 31--February 17), and four additional children (rash onset: February 6--10) who had been in the pediatrician's office on January 25 at the same time as the index patient. Among these latter four patients, three were infants aged over 12 months. One of the three infants was hospitalized for 2 days for dehydration; another infant traveled by airplane to Hawaii on February 9 while infectious.

Great job, who ever had suggested to the parents of that index case that it was ok to travel to Switzerland (in the middle of an ongoing measles outbreak with more than 3400 cases, 8 encephalitis and a pediatric death) with unvaccinated children.
To suggest, even "hypothetically" that no vaccination was necessary to travel outside the US is highly irresponsible. Parents who leave their children unvaccinated when taking them into the middle of an outbreak potentially make their children murder weapons – we posted the story of the pre-teen who spread measles in a waiting room as a consequence of which two children are now dying a very slow and horrific death.

Friday, December 10, 2010

Tetanus in an unvaccinated teen

The availability and wide us of vaccines and the resulting low incidence of the diseases which these vaccines prevent make a lot of parents perceive the disease as "low risk" in general. In late 2008, we could "watch" online how wrong this perception is, when a mother turned to an anti-vaccine board, whose son was developing lock jaw. Here is the link (for those of you who speak German or want to put the text through a translation site - my translations and summaries of the board posts are in blue):

The thread is entitled "Jaw problems after Tetanus vaccination".

Mein Sohn (13 Jahre) hat sich am Knie eine mind. 1,5 cm tiefe Wunde zugezogen. Da es auch noch schmutzig war, (Sand etc.) habe ich den Hausartzt erlaubt ihn gegen Tetanus zu impfen. Er war bis jetzt noch gar nicht geimpft gewesen. 2 Tage später klagte mein Sohn das er sein Mund kaum öffnen könne, essen wurde schwierig, auch Zähneputzen. Alles ist verspannt, Kiefer und Hals tun Weh, vor allem beim kauen.
Meine Frage ist jetzt, ob das eine Folge von Impfen sein kann, oder eine Zufall?
Wenn, ist es alarmierend oder geht`s vorbei automatisch?
Wäre heilfroh, wenn jemand Erfahrung hat mit sowas. Ich würde ungern zu den Arzt gehen, er ist Impffanatiker und ich kämpfe schon seit Jahren mit diese Thema.

In the first post the mom describes that her 13 year old, unvaccinated son sustained a knee injury (1.5 cm deep, dirty, sandy) and because he had not been vaccinated, she allowed his GP to "vaccinate him against tetanus". Two days later, the boy has problems opening his jaw, neck and jaw hurt when he tries to eat or brush teeth. She fears vaccine damage and wonders whether this will pass alone. She is also afraid to take her son to the doctor, because he is "vaccine fanatic".

At this point, I am thinking "OMG, this boy has tetanus - go see a doctor, but I am just watching, never got a password on this board, since reason is being heavily "moderated" by the board owner and his little helpers. However, the mum's post is immediately being picked up by the resident vaxxaloons - a poster by the name of Gaston remarks:

"This sounds just like Tetanus Symptoms"
(wait if you think "well spotted, now he is going to send her to the doctor") - he continues "I would assume that your son would not have gotten these symptoms without the vaccine. After all, Tetanus Toxins are injected. So it is not surprising that here we are looking at something like beginning Tetanus."..

Mum responds "That is just what I thought. So I probably did the wrong thing again.
It is worse today. The boy can hardly eat. I will take him to the doctor at 6pm. I assume he will give a cortisone injection or something like that and tells me that he should have been vaccinated much earlier.
I really don't know what to do. This has been going on for 4 days and for the child it is very irritating. If at least I knew this is going to pass.
Well, at least I know for sure that none of my children will be vaccinated (this was the first time)

A poster called "Anke" confirms the mother in her feelings and encourages her to report this as an adverse vaccine event. She also claims to have "heard of such symptoms associated with the tetanus vaccine".

A day later, she is taking her son to the doctor again. The doctor does not diagnose tetanus, but a throat infection and (because mom does not want him on antibiotics) she takes her son to the local pediatric hospital where he stays for observation. Doctors there think vaccine reaction AND tetanus are "unlikely".

In the thread, a poster called "Uschi" then shares her experience with jaw problems which she assumes were from her tetanus vaccination, which she later "chelated with the help of her homeopath".

"Gaston" pitches in with a terrible rant about the doctor. I feel like ranting about that doctor, after all, he did not diagnose the tetanus in a rather unambiguous presentation, but that is not what "Gaston" means. He is on a roll "if this was my child, I would do everything to hold this scumbag accountable. .../... The penicillin treatment, which is counter-indicated in this case, is the worst, because your son could have sustained further damage from it!"

Most further posters share these sentiments, however, "Sonnenlicht" asks whether the boy had received active or passive immunisation, because post-exposure, the boy would have needed immunoglobulins.

Four days have passed since the mum's first post.

Finally, the child is transferred to the next large University Hospital as the doctors clue in that he has tetanus. The boy can still talk, but cannot eat or drink. In that post, mom also says that her son had the active and passive immunisation a week earlier (that post is on page 2 of the thread). She assumes, her son's illness is from either of the the two.

Poster "Babsi" refers the mum to a vaccine-critical doctor in Bavaria. Poster "Kat" "knows" from her naturopathic pediatrician that the tetanus vaccine given "in case it has become serious, is particularly critical, i.e. badly tolerated." She is also adamant that if the wound had been bleeding "it is impossible that this was tetanus, it is vaccine damage!!!"
(the three exclamation marks make it true, you know). Apart from that, she recommends a vaccine critical "expert" or "any naturopathic doctor for further help". "Gaston" totally shares her feelings. "The wound alone did not cause the problems, that was unambiguously the vaccine. It is generally known that vaccines cause the disease they are supposed to protect from in some. Some people are more susceptible for this." He suggests contacting the media "Tetanus after vaccination! Because Tetanus is really rare here in Europe." "Anke" pitches in and recommends Arnica globules in the 200C and consulting a homeopath. General rambling ensues.

A day later we get a chronological account. It appears that the wound was cleaned and sutured soon after the accident, but the immunisations were not given until the control visit 3 days later. The tetanus symptoms started another couple of days after that, so 5 or 6 days after the injury. Mum reports "Everyone in the University Hospital is convinced that he has tetanus from the wound, although it cannot be proven. I do believe it, too. The wound was very deep and got sutured = closed air tight. This disease is very rare. Even in the University Hospital no one had ever seen a single case. My son is better today. He was released from ICU and is on a normal ward now. He can still not open his mouth, but he could drink a little bit."

After this account, "Sonnenlicht" is also convinced that the tetanus was caused by the wound and that tetanus is an important vaccine after all. However, "presonic" would still not vaccinate in such a situation. S/he doesn't understand why "the dead flesh was not removed before the wound was sutured.". "Sonnenlicht" does not buy that. "Anke" just cannot believe that such a wound did not bleed profusely and the mother explains that her son had a bicycle accident on an asphalted path and a deep wound next to the knee that did bleed. She is unsure whether the doctor cleaned the would appropriately.

Two weeks later, we get the resolution that the boy is home again, after nearly two weeks in the hospital on antibiotics, tetanus immunoglobulins and "lots of other medicines". The mother describes that her son had "not fared as poorly as she was told to expect" - he could breathe on his own and did not get "bad" cramps. He could not open his mouth and his tongue hurt. He started to make an effort to eat when the doctors discussed giving him a stomach probe to feed him.

This story is shocking on several levels. Obviously, I pity the child. An injured knee should not put a 13 year old in the hospital with tetanus. He was obviously very uncomfortable the whole time and mum sounds very desperate, too. The doctors' reactions in hindsight (which is always 20/20 ;)) were not stellar, the reaction of the resident anti-vaccine posters on that board are so out-worldly that they look almost staged. They may even have contributed to the delay until the boy was taken to the hospital.

Tetanus in children is very rare - so rare in fact, that doctors do no longer necessarily clue in when they are faced with a child with a locked jaw. However, 80% of the few pediatric cases of tetanus occur in unvaccinated children. They don't need dramatic injuries, blunt trauma, or minor splinters can be enough of a cause. Tetanus in children is very rare, however, we need to remember that most toddlers (over 96% according to the latest US figures, European figures are similar) have had at least 3 vaccines against tetanus - protection up to the school booster is near perfect, see also here, and most kids in the US will get that first school booster that protects them into adolescence, when 75% of US kids are getting another booster.

So the bottom line is: parents who do not vaccinate against tetanus need to be aware that the low incidence of tetanus is in part due to the high vaccination coverage. They themselves need to keep tetanus in mind when their unvaccinated children have an accident, since doctors might not automatically assume that s/he is looking at one of the 4/100 children who does not have tetanus protection and will almost certainly not have experience with tetanus. If worrying about tetanus with every splinter is too stressful for the parents, the alternative is NOT to post on an anti-vaccine board for encouragement that "head in the sand" is the best option, because 1. vaccines are teh ebil and 2. they are particularly evil after exposure.

The reasonable alternative is to consider vaccination.

20 Aug 2014: links repaired

Saturday, December 4, 2010

Say "hello" to the new Stat Girl on the Block

Media, TV, newspapers, but also online communities and blogs shape our opinions on health topics (all topics, really). In this busy world, we rarely take the time to read much beyond the sensational headline and the first couple of paragraphs. This is a dangerous trend, news items rarely contain the full information, journalists often cherry pick information from an original source and "fit" it to the desired headline (as eloquently described by Ben Goldacre here). Caveats and disclaimers are most often hidden at the bottom of the piece (Ben Goldacre again). References to original sources/publications, if they are given, are tedious to follow up. The whole exercise follows a stereotypical goal oriented (and the goal is NOT information) pattern (wonderfully spoofed by Martin Robbins here).

Evidence based bloggers, some online media and universities are pushing for less sensationalistic and more factual reporting. Recently, a campaign to add a "report an error" button to each news page was launched. Britain's National Health Service even runs a "Behind the Headlines" page that explains what is really in that paper.

Basically, as a "modern consumer" you need to know the basics of statistics, including the most important:

Correlation does NOT imply causality (or causal relationship).

We would probably suspect the (fictional) media headline "Storks deliver babies", based on the (true) fact that number of storks in Europe is strongly correlated with the local birth rate (the p-value is an impressive 0.008) wasn't true. But what about the many other health headlines, that tell us which herb/behaviour cures which disease, what is best for baby, what is best avoided for baby? Vaccines cause autism?

Enter Stat Girl, who "skewers the news, reminding the world that correlation is not causality one headline at a time".

With this "agenda" in mind, she is tackling the issues and outlets that target young mothers with their headlines.

Visit her blog and say "hello"! We need more analyses of media content and pressure for better reporting.

Friday, December 3, 2010

Behold - the idol of millions

well, at least several tens of thousands, which had catapulted "The Vaccine Book" near the top 50 on Amazon. Stand in awe at the depth of research (13 years, he claims in his book) that he bases his recommendations on - actually, let us look at how Bob sees himself:

VACCINE BOOK HITS #53 ON AMAZON!!!! by Dr. Bob Sears - posted on 3/12/2008

How cool is that? 53 out of all books. God has really answered my prayers of wanting to reach America's (and England's too, Catherina) families with complete and objective info about the all-important decision. Yeah!

Hold on to this thought (ignoring the ever so slightly delusional "God has answered my prayers") - Bob claims: complete and objective info
Last night, Dr. Bob answered the question on how many MMR shots are needed if the first one is given at age four years with:

Dr. Bob Answers by Dr. Bob - posted on 12/2/2010

2 doses are still required, BUT one dose, in my opinion, is all that is really needed. One dose gives full protection from measles in 95% of kids, mumps in 98% of kids, and rubella in 99% of kids, regardless of age of vaccination. So, I think one dose is good enough. Getting it older, such as age four, MAY be more effective than getting it younger (such as age one), but I don't know a lot of details on that.
The ONLY reason we do two doses is to try to get the 5% who don't respond to one dose for measles to get protected from the second dose (most do respond to the second dose). That's better for public health/herd imunity, but as individuals I think one dose is fine.
shall we?

2 doses are still required, BUT one dose, in my opinion, is all that is really needed.: really? Enlighten us, why you have come to a different opinion than health experts in any other country in the world, based on "complete and objective info"?

One dose gives full protection from measles in 95% of kids, mumps in 98% of kids, and rubella in 99% of kids, regardless of age of vaccination.: I think, contrary to what he claims, Bob does read our blog.

So, I think one dose is good enough.: This from the man who claimed earlier this week that "most adults had lost their immunity". And how are his "thoughts" supported by "complete and objective info"?

Getting it older, such as age four, MAY be more effective than getting it younger (such as age one), but I don't know a lot of details on that.: Getting it older, such as age four, MAY be more effective than getting it younger (such as age one), but I don't know a lot of details on that. There, fixed that for you. Honestly, someone is pushing a vaccine "strategy" that will leave millions of kids unprotected, based on lack of knowledge?! Anyone else scared yet? I am.

The ONLY reason we do two doses is to try to get the 5% who don't respond to one dose for measles to get protected from the second dose (most do respond to the second dose).: And that is not a good reason already? Apart from the fact that mumps immunity is now thought to wane and needs boosting to maintain high community immunity (see for example here).

That's better for public health/herd imunity, but as individuals I think one dose is fine. : Really? Because his readers/patients all live in a bubble? We have already let our a collective gasp at the "don't tell your neighbors if you are eroding their safety by following my home made advice", but the above statement reveals fundamental misunderstanding of the workings of herd immunity and basic concepts of public health paired with the confident call for selfishness that tops his previous "insights".

Remember? Bob claimed to provide complete and objective info.
Gut feeling based on hanging out with the anti-vaccine crowd too much, amplified into the Gospel by a deluded sense of being The Chosen One seems much closer to reality.

Wednesday, December 1, 2010

Evidence trumps blanket statements (or whack-a-bob)

I have a number of other blogs planned, but this little gem needed treating first. On The Vaccine Book discussion forum, a poster asked a couple of days ago:
Dr. Bob - the other day you answered a question for me regarding titers and MMR. You mentioned that immunity could last up to 10-15 years. Someone had a follow up question as follows:
does that mean that we would have to re-vaccinate when child is 14 or older? (Having been originally vaccinated at age 4). Will the one MMR not last a lifetime? Or would we just check titers again after the ten to fifteen year mark?
These are very relevant questions, given the dangerous MMR recommendations that Dr. Bob spreads on his board and blog. Here is his answer:
I'd check titers. It's fairly unpredictable and individual as far as how long titers will stay positive. You could check every 5 years starting around age fifteen. OR, knowing that the diseases are so rare, you could just not bother after checking at fifteen. MOST adults have lost their imunity, and no one checks (unless a person's occupation requires it, or during pregnancy for rubella).
Wow - there is so much wrong with that, lets take in in bits:

I'd check titers.: Yes, you would, as a doctor in private practice, that sounds like a very attractive way forward. Not sure how appealing this is to parents and children, though.

It's fairly unpredictable and individual as far as how long titers will stay positive.: It is funny he should say that, when the current Dr. Bob recommendation is to vaccinate children once with MMR when they are four since that is sufficient then ("for State requirements", in the small print).

You could check every 5 years starting around age fifteen.: A blood draw and expensive titers (not sure how expensive, but his vaccine visits cost $80 to $200) every five years, mmh, ok.

OR, knowing that the diseases are so rare, you could just not bother after checking at fifteen.: Dr. Bob logic at work. I have called him a public health threat before - here is a quick recap of one of the reasons why:
Why are M, M, and R rare? Because of the 2xMMR vaccine policy in developed countries.
What will happen if everyone followed Dr. Bob's recommendation? M, M, and R would resurge - his 1xMMR vaccinated patients would provide the ideal breeding ground. Dr. Bob's home visits for measles patients do not come cheap.

MOST adults have lost their imunity: That one left me almost speechless. Luckily, while Bob's anonymous sycophants were busy name calling, cbe did a minute of research:
the evidence? by cbe - posted on 11/30/2010
All the evidence I see for rubella and measles says adults have MAINTAINED their immunity. Where is the evidence on the other side?

Is it "rude" to ask for that evidence? Here we see measles immunity of 81-89% of adults and higher...and these are in birth cohorts that DID NOT receive the 2 dose schedule. So we know that many of these individuals are not immune because the 2 dose schedule came into effect later.

this study looks at mumps 21 years after 2 dose vaccination. 70%+ immune. This is consistent with what SM is saying about mumps being the least effective part of the vaccine. BUT even here Dr Bob's assertion that "most" are not immune is not playing out in the numbers. I assume "most" would mean at least 50% + 1.

93%+ canadian mothers were found to be immune to rubella:

Again 90%+ immune to rubella:

I can show tons more for measles, too.'

But where is the evidence that most adults have lost immunity?
That was easy, right? Turns out that Dr. Bob had never invested that minute:
Hey CBE - thanks for the info by Dr. Bob - posted on 11/30/2010
I haven't looked at this research. I was answering simply on the general belief among the medical community that most vaccines don't last into adulthood. Since I don't do adult medicine, I've never had to counsel parents through this type of information and I've never actually looked it up. It looks like you are right about the MMR titers though - it seems that they do last into adulthood for more people. Thanks for pointing that out. I appreciate you doing so in a straightforward, respectful manner - very adult of you.

I haven't looked at this research.: now that was blindingly obvious.

I was answering simply on the general belief among the medical community that most vaccines don't last into adulthood.: I was answering simply on the general belief I didn't bother to look up the evidence before I posted utter nonsense in the forum (there, I fixed that for you).

Since I don't do adult medicine, I've never had to counsel parents through this type of information and I've never actually looked it up.: So Dr. Bob doesn't consider the consequences of his "alternative vaccination schedule" for his patients when they become adults? Wow.

This anonymous poster expresses their frustration:
Cath, This is bizarre to me - if the diseases are by - posted on 11/30/2010
"so rare" as Dr. Bob says, and most adults have lost immunity, then why do we bother vaccinating at all? It seems that older kids and teens would be at much MORE risk from mumps and measles, and we would want to make sure that they remained immune to these diseases all through adulthood. If adults have lost immunity, aren't babies at risk from adults from than from children? Where is the ratinale in this thinking?
as does this:
I don't think SM posted a rude comment at all by - posted on 11/30/2010
The thinking is illogical to expect parents to keep checking titers every five years, or not check at all since most of us are not immune anyway! I think for myself, it makes no sense at all to keep checking titers, when I know with almost certaintly that immunity will "wear off" after 5-10 years or so according to Dr. Bob. If we know that immunity from MMR wears off after several years, how can we safely get by with just one dose? I want my children to be protected when they are older and more prone to serious risks from measles and mumps. Same feeling with chickenpox. I think we will do one MMR at age four, and check titers once soon after to make sure it worked, then the second dose at age 12, before puberty. This was the old recommendation from AAP, since these diseases are MORE dangerous as kids pass adolescence, and they wanted to insure immunity into the later years.
and this:
Then if someone is going to make money by - posted on 12/1/2010
by offering that advice as an "expert" on the topic in print form, shouldn't they be willing and able to look up accurate information about said topic? Particularly if offering blanket statements? That is more rude than any attacks I've seen.

This site is a money-making venture.

No further comment needed.

Sunday, November 21, 2010

Catherina and Science Mom Need to Come with a Warning!

Last week, Dr. Bob Sears issued "IMPORTANT INFORMATION FROM DR. BOB".  It had never been my intent to write about him as much as I have but the statements he makes create such a target-rich environment.  He has offered such disclaimers before, one being so mock-worthy, going so far as to call us 'secret agents' for pharma,  that Respectful Insolence couldn't even resist.  His entire "Disclaimer and warning about Catherina and Science Mom" appears as the indented text.
Thank you for being a part of our vaccine forum. I appreciate your questions and comments. Please be aware that the only person officially affiliated with the forum is Dr. Bob Sears (usually posts as just "Dr. Bob"). There are two people on this site who have been unofficially involved since the beginning - Science Mom and Catherina. Please be aware of several things:
1. These two have absolutely no official affiliation with this website. I have no idea who they are or what their credentials are.
 Dr. Bob needed to clarify this as Catherina and I seem to have a greater dedication for answering parents' questions on his forum than he has. 
2. In the vast majority of circumstances, I DISAGREE with the advice they choose to give. So, take their advice with a few grains of salt. Having said that, they do happen to give accurate medical information when it comes to diseases. You can generally trust that info. But when it comes to things like "what should I do about a particular vaccine, vaccines in general, alternative vaccine approaches, and worries about vaccine side effects," they often give advice that I disagree with.
Dr. Bob agrees that we "give accurate medical information when it comes to diseases" and even goes on to say that you should "trust that info".  But he DISAGREES with the "vast majority" of the advice that we give.  The embuggerance is that the the advice he DISAGREES with is firmly rooted in the "accurate medical information" he praises us for.  The good doctor is essentially saying that our advice based upon "accurate medical information" is not to be trusted but that his advice based upon... um, well something, should be relied upon.
3. I have stopped reading info posted by SM and Cath because it's just too annoying to read. Unless you ask them a direct question yourself, I suggest you do the same (unless you like debates that go around in circles).
Athough Bob has stopped reading our annoying "accurate medical information" he hasn't gone so far to stop telling others to stop reading our "accurate medical information" (fingers in ears; "NANANANANA I CAN'T HEAR YOU!!!").  Of course it's annoying, it is always "annoying" when someone calls you out on your bullshit.
4. It is my opinion that SM and Cath are being paid to play an active and daily role by one or more companies that have a financial interest in the success of vaccines. I have no direct evidence of this. But given then way they treat most people who doubt or question vaccines, I just can't believe that they would spend hours each day, almost every day, for THREE YEARS answering questions out of the goodness of their hearts.
Well, it is "my opinion that SM and Cath" should be paid by the evil drug companies (and the evil oil companies and the evil auto companies and the evil defence contractors any other evil companies who are giving away free money), unfortunately, that ain't happening.  It would be nice to think that the pharma companies care enough about Dr. Bob's blog to pay shills to post there as much as we do, it's nice to believe in the tooth faerie too.  Anyway, the good doctor says he has "no direct evidence of this", but honestly, when has that ever stopped him from giving his opinion.  He can't believe that we would spend "THREE YEARS" taking time to answer parents' concerns out of the "goodness of their hearts" because if he wasn't getting paid to write books, he sure as fuck wouldn't.
5. I trust the judgement of the site administrator (a personal friend of mine) who will be routinely deleting unnecessary and unproductive posts.
Amazingly, Dr. Bob and I agree on something.
6. As a final, and slightly unrelated note, my primary role here is to answer specific questions to help guide you in your understanding and decisions. As a full-time practicing pediatrician, husband, and father of three, I don't have extra time to engage in online discussions or debates. So you will rarely see me jump into such.

Thank you for your participation. I look forward to answering your questions.
"unrelated", I do not think it means what you think it means.   He'll answer your questions as long as they aren't difficult ones.  He just doesn't "have extra time to engage in online discussions or debates".  Dr. Bob put this community together, it would be selfish to expect him to have the time to get involved with parents' "discussions" or "debates".  He is far too busy as a "practicing pediatrician".  But he has enough time to tell parents that they shouldn't listen to "SM and Cath" whom he can't believe would spend "hours each day, almost every day, for THREE YEARS answering questions out of the goodness of their hearts."  Come on, he's a busy guy.   And actually, we're quite busy too but it doesn't take hours each day out of our schedules to answer these questions.  It probably just seems like that to Dr. Bob because it would take HIM that long to even attempt to answer those questions.

Tuesday, November 16, 2010

I'm Really Bonnie Offit

This morning, J.B. Handley, one of Age of Autism's mouthpieces wrote a hilarious 'investigative report' about uncovering the true identity of Sullivan, a contributor to LeftBrain/RightBrain.  What makes it so hilarious is that he is obviously so disturbed by Sullivan's dissemination of information about quackery regarding autism aetiologies and treatments, namely those touted by Handley's brain trust, that he has 'outed' him as, get this,

Bonnie Offit, paediatrician wife of Dr. Paul Offit

As stellar as a piece of investigative work as this is, J.B. Handley is off the mark.  Because,

I am Bonnie Offit.

That's right J.B. Sherlock, back to the drawing board.  But it is worth noting that the comments about this are equally hilarious.  J.B.'s loyal flock believes him and congratulates him for such a stellar post, all except one.  Craig Willoughby  bravely goes against the tide and denounces the post for what it really is, a silly smear campaign.

Poor J.B., here's a hint, don't take investigative reporting tutorials from Jake Crosby.  Or do so we can all point and laugh.

I am Bonnie Offit

Both Orac and Kev have posts up as a reaction to Age of Autism's weird allegation that Sullivan is Dr. Bonnie Offit, Paul Offit's wife. Both claim that in fact, they are Bonnie Offit - that, of course, is total and utter rubbish. It is quite clear that I am Bonnie Offit and I am happy to say so!

Sunday, November 7, 2010

Vaccine Awareness Week

A couple of weeks ago, NVIC and Joseph Mercola announced a Vaccine Awareness Week for November 1-6, 2010.  Science-blogger, Orac put out a call to other science and sceptical bloggers to co-opt this week for vaccine awareness, just not in the way that Mercola and Barbara Loe Fisher (BLF) intended.  People like Mercola and BLF sell fear; it's their bread and butter, their pay check, literally.  They don't actually present vaccine information, but rather pure deception.  A number of us wish to counter this with facts, but since we hold ourselves to a higher standard of information, our facts and evidence can appear apathetic and tedious compared to their emotional, yet misleading rhetoric.  But as a parent trying to make vaccine decisions for your children, you must ask yourself which is more important to make truly informed decisions.

I had hoped to present a detailed list comparing adverse vaccine reactions and corresponding disease complications this week but time constraints prevented that.  However, Science-Based Medicine has a partial list of reactions that accompany both disease and corresponding vaccination.  A Photon in the Darkness also ran the numbers for the probability of measles infection as they exist currently.  This should help to put some real risks into perspective.

I came across a post on a forum that, I believe, sums up what parents are concerned with:
"I actually don't buy into the idea that any one vaccine causes autism. I know science is revealing a certain susceptible group that have genetic issues which, when combined with a load of vaccines, have triggered it.
That darn Wakefield study had to go and put a blemish on the MMR vaccine, so now in the back of my mind, I can't help but be haunted by it. Plus, all of the parents who swear to have their children get "lost" after it. It's just so scary when it comes to your babies and it gets really personal. I'm sorry if I get so angry sometimes, it's only out of fear and frustration."
To paraphrase Dr. Paul Offit, it is easy scare parents but nearly impossible to unscare them.  So even though the science has spoken, so to speak, that MMR, thimerosal and to some extent, vaccines in general, do not increase the risk of autism or adverse neurophysiologic outcomes, anti-vax organisations are still trying to beat this dead horse.  The result is that many parents are thrown into a stasis regarding vaccine decisions for their children, either delaying rather important ones or not vaccinating at all.  So let me address some of those reasons why and also to present some resources to use and not to use when making vaccine decisions.

Vaccines Versus the Vaccine Schedule
Looking at the CDC Recommend Infant Vaccine Schedule is daunting.  One of the criticisms I hear is that it is "one size fits all".  Well yes, it is and this is why; it is a recommendation for public health and as such, is designed for what is in the interest of the majority.  Such a schedule attempts to take all risk factors into account, has determined what ages will have the best 'catchment', or success at vaccine uptake, along with efficacy, and ages at which vaccine preventable diseases pose the greatest risk.  Contrary to some belief, the paediatric vaccine schedule has been tested for safety and efficacy (scroll down halfway for list of studies).  Numerous vaccine experts have developed the schedule to assist physicians and take the guesswork out of their vaccine recommendations as it addresses the collective of potential exposures.

Where I believe the problem lies, is that several vaccines have been added over the past 15 years so parents are given the impression that a relatively minor childhood disease such as hepatitis A is on par with the more serious hepatitis B disease, or chicken pox is on par with measles or rubella, or rotavirus disease is a scourge on par with Haemophilus influenzae b (Hib) disease.  Don't get me wrong, people in developed countries do suffer from these diseases that can have serious complications.  It comes down to risk analyses, which is not something that most parents are equipped to undertake.  This is where the 'kindly', 'sympathetic' and 'passionate' self-proclaimed experts like to insert themselves.  I have criticisms of and concerns with the CDC schedule, which would take several blogposts to outline; but that doesn't mean that Dr. Bob Sears, Dr. Jay Gordon or Jenny McCarthy should be dictating public health decisions and issuing proclamations.  So what can parents do?  Well for starters, don't throw the baby out with the bath water.

Speak to Your Doctor
It sounds very evasive but doesn't have to be.  You have undoubtedly heard stories of paediatricians tossing clients out of their practices for refusing to vaccinate or refusing to vaccinate 'on schedule'.  And I'm sure there are physicians that would do that on that basis alone, but I also don't believe that we are getting the full story for most cases.  Not vaccinating is only part of why physicians feel the need to dismiss parents from their practices.  The AAP's official policy is for physicians to work with families that are either concerned about vaccines or refuse them all together.

Broach the subject in a respectful manner and develop a partnership with your physician.  Call them ahead of your first well visit and schedule a consult (preferably without children), be sure to let the office know the reason for the consult.  You are demonstrating respect for your physician's time and giving yourself an opportunity to work with your physician instead of at cross-purposes. You aren't going to be well-received if you arrive at a scheduled well visit waving your copy of The Vaccine Book and telling your physician, "Well Dr. Bob says so."  Don't become so wedded to a particular course that you dismiss sound advice from your own physician, be flexible.  Take advantage of combination vaccines that will provide your infant with the protection they need in a timely fashion and reduce the number of jabs and vaccine excipients.  Ultimately, your children's healthcare decisions are your own but consulting with your physician on vaccines may reassure you.

Herd Immunity
You have undoubtedly read about herd immunity and how important it is to reduce or eliminate transmission of vaccine-preventable diseases.  It is also referred to as 'community immunity', for those who don't wish to be equated with cows.  In any term, it is real and irrefutable; based upon several factors, we know what levels of vaccine uptake are required to reduce or interrupt disease transmission.  But to be perfectly honest, I don't care to use the herd immunity argument as an inducement for vaccine uptake even though it is a valid argument and very true.  We are inherently selfish creatures, particularly about our children.  When one who is concerned about vaccines is being ramrodded with 'you need to do this for the protection of those that cannot get vaccinated', it tends to shut down the discussion and heels get dug in, even though it is a technically correct point.  We are driven to consider our own children's safety first.  While herd immunity is important, for you as a parent, protecting your own child is more important.

In order to refine this argument, I will use a parent's concern that I just came across; she wanted to know what her child's risk for Hib disease was now.  That risk estimation is 0.13 - 0.5/100,000 in children less than 5 years old depending upon the survey and geographical area, but the risk is higher in children less than 2 years old.  The risk is higher in unvaccinated children with an attack rate of ~3.7% in children less than 2 years old.  Prior to mass vaccination with Hib, the disease incidence was 1/200 children less than 5 years old with 5% mortality and 15-30% left with permanent complications and that is even with prompt and effective treatment.  So this is a very clear case of the reduction in illness, permanent injuries and death as a direct result of vaccination and herd immunity subsequently created.  The risk has been dramatically reduced, to the tune of 96% but even a brief interruption in vaccine uptake can result in disastrous consequences.

I prefer to emphasise that herd immunity also assumes equal distribution of susceptible people.  This means that a non-immune person, for whatever reason, is well-surrounded by immune people, creating a fire-wall of sorts.  The most recent estimate of 19-35 month old children that aren't vaccinated is ~1%.  However, that is just for complete vaccine refusal; vaccine coverage estimates for the individual vaccines are highly variable by vaccine and geographical area.  Due to the collection methods of this survey, it is likely that the proportion of vaccine refusers stand at a higher rate than reported.  So I will use the 1% as a minimum reliable estimate for vaccine refusal in the U.S.  Using the birth cohorts from the MMWR report, that is representative of ~10,692,000 children.  One percent of those are completely unvaccinated is ~106,920 children.  Add to that:

769,800 (7.2%) children 19-35 months old were not vaccinated for polio.
1,069,000 (10%) children 19-35 months old were not vaccinated for MMR.
844,600 (7.9%) children 19-35 months old did not receive the primary Hib vaccine series.

This doesn't include those younger than 19 months or older than 35 months and those who are undervaccinated or with waning immunity.  Now to put this into context; refer back to how herd immunity theory assumes equal distribution of susceptibles.  Not only is there a growing number of susceptibles, but they are geographically clustering.  This pattern seriously undermines the strength of herd immunity.  Even though overall vaccine uptake is high, it is too variable to be relied upon for protection of one's un- or undervaccinated children.  Since ideologically like-minded parents do tend to aggregate, such a situation can and does lead to large clusters of unvaccinated children that your child could be living in the midst of.  A parent needs to start thinking about their own children and what they can do to protect them because herd immunity should not be relied upon.  Think of it as enlightened self-interest in that while vaccinating your own child helps the "herd", more importantly, it protects your own child.

Information Resources
It is important to vet your sources, particularly those that can be found on the internet since that is where most parents go to obtain information about vaccines now.  Science-Based Medicine just posted an analysis of two studies that evaluated population-level perceptions on the H1N1 vaccine, dominant sources of vaccine information and the effectiveness of anti-vaccine tactics.

Regarding the H1N1 vaccine:
During the survey period, 23.4% of Canadians considered the vaccine safe, compared to 41.4% who indicated it was unsafe, and 35.2% who expressed no opinion.
Vaccine information sources that dominated during the survey period:
But based on the methodology used, articles questioning the safety of the H1N1 were circulated widely, and anti-vaccine articles and sources dominated.
And finally, the impact of anti-vaccine websites on perceptions of readers:
The authors found that viewing anti-vaccine material for only five to ten minutes increased the perception of risk of vaccination, and decreased the perception of risk of omitting vaccines, compared to viewing neutral websites. It also lowered vaccination intentions.
Obtaining information from the internet requires some filters to help establish the potential credibility of the site.  Some websites have become very savvy and sophisticated so that it can be rather difficult for the layperson to identify them as anti-vaccine websites.  To give you a couple of examples, the International Medical Council on Vaccination looks slick and professional.  But behind the scenes are the usual suspects such as Sherri Tenpenny and Joseph Mercola, along with contributors with formidable letters after their names who want to give you the impression that legions of healthcare professionals and scientists are united in their efforts.  Read the articles, they are bush-league, overwrought and completely unreferenced opinion pieces.  Citations to the scientific literature and the proper interpretations of studies are crucial for establishing credibility.  Another website is the National Vaccine Information Center or NVIC.   This site is very much the same as the aforementioned website.  They have some kernels of factual information but these are obfuscated by unreferenced opinion pieces and misrepresented statistics.

As a general rule, be very leery of websites and/or self-proclaimed vaccine experts that wish to sell you something, whether that be books, products or services and rely upon testimonials.  Verify that they provide references for their information and if so, are the references from reputable sources (i.e. legitimate peer-reviewed journals or government publications) and do they represent these sources accurately.  If you are unsure of information that you have received or just have questions to ask about vaccines, please feel free to visit our forum here (you may do so anonymously) and we would be happy to answer your questions.

Some reputable resources that I recommend are:
The Pink Book (Epidemiology and Prevention of Vaccine Preventable Diseases)
The Immunization Action Coalition
The CDC: Some Common Misconceptions
The Institute of Medicine:  Immunization Safety Review Reports
The CDC: Vaccines and Preventable Diseases
The CDC: Morbidity and Mortality Weekly Report (MMWR)
Johns Hopkins: Institute for Vaccine Safety
The CDC: Vaccines and Immunizations
The FDA: Thimerosal in Vaccines
Center for Infectious Disease Research and Policy (CIDRAP)
The CDC: Vaccine Safety
The American Academy of Pediatrics (AAP): Red Book (subscription only)
The College of Physicians of Philadelphia: The History of Vaccines
The Children's Hospital of Philadelphia (CHOP): Vaccine Education Center

Monday, October 11, 2010

Dr. Bob Sears and Fox Friends

On Saturday, 2 October 2010, Dr. Bob Sears appeared on Fox Friends with Fox News Anchor, Alisyn Camerota (AC) .  Ms. Camerota begins the segment with the question:
AC:  Is there a connection between vaccines and autism?  Thousands of families with autistic kids think there is.  But the Centers for Disease Control has always maintained that no research supports a link.  Now one famous paediatrician has written a book about vaccines who charges the government's studies on vaccines is woefully inadequate.
Ms. Camerota introduces Dr. Bob Sears (BS), author of The Vaccine Book, which was published three years ago. 
AC:  The government says they have studied vaccines and they do not cause autism.  But has the government ever studied the amount of vaccines that our children get in 1 sitting?
BS:  That is what me and my colleagues at SafeMinds are a little worried about...there is a CDC report that says that usually simultaneous vaccination has not been completely studied for safety and that's what we're worried about.  Babies get as many as 6 or 7 vaccines altogether...and the CDC is admitting that they aren't always researched that way.  The prime example is the flu vaccine.  They've researched the flu vaccine in great detail when given alone, but the CDC has never researched it when given in conjunction with all the other shots...and that's what we're worried about.
Interestingly, SafeMinds is a notorious anti-vaccine organisation, also known as the 'mercury militia', that maintains that autism is caused by thimerosal, a preservative used in vaccines that contains ethylmercury.  However, mercury toxicity does not resemble autism, and autism rates around the world have been increasing in spite of thimerosal removal from paediatric vaccines and immunoglobulins starting in 1999 in the U.S. and even years earlier in other countries.  SafeMinds rejects any studies that demonstrate that thimerosal does not contribute to neurological disorders, even going so far as to storm off a study team, in a huff, the day the results were announced and not to their liking.

Dr. Bob alludes to some CDC report that states that simultaneous vaccination has not been completely studied for safety yet doesn't provide any further information about this.  However, the CDC information regarding simultaneous vaccination does not support what Dr. Bob claims.  For instance, from the CDC's Vaccine Safety Page:

Is simultaneous vaccination with multiple vaccinations safe? Wouldn't it be safer to separate combination vaccines and spread them out, vaccinating against just one disease at a time?

The available scientific data show that simultaneous vaccination with multiple vaccines has no adverse effect on the normal childhood immune system. A number of studies have been conducted to examine the effects of giving various combinations of vaccines simultaneously. These studies have shown that the recommended vaccines are as effective in combination as they are individually, and that such combinations carry no greater risk for adverse side effects. Consequently, both the Advisory Committee on Immunization Practices and the American Academy of Pediatrics recommended simultaneous administration of all routine childhood vaccines when appropriate. Research is underway to find methods to combine more antigens in a single vaccine injection (for example, MMR and chickenpox). This will provide all the advantages of the individual vaccines, but will require fewer shots.
Another advantage is that combination vaccines result in fewer shots and less discomfort for children. In addition, spreading out the administration of separate vaccines may leave children unnecessarily vulnerable to disease.
Dr. Bob mentions that influenza vaccine has not been tested with the childhood schedule as the 'prime example', when, in fact, it's the only example.  Vaccine safety studies are addressed later.  Ms. Camerota continues:
AC:  Let me show (CDC Infant Vaccine Schedule) our viewers how many different vaccines some children can get in one sitting.  At two months they get five or six, same at four months.  At six months they get tons!  At 12 months they get up to six, at 15 months they get up to six.  Why isn't the CDC looking at these combinations?
BS:  (Nodding in agreement and not providing any corrections to these assertions.)  Well I think the CDC is just assuming that they are safe.  Because there is no real evidence that they causes [sic] any harm...But I would like to see more research on it and I think that parents want to be confident in vaccines.  And as a paediatrician, I give vaccines in my office every day.  But I want to know that these large combinations are safe.  And what I do as a paediatrician, is I spread the vaccines out.  I give no more than two vaccines at a time to any babies in my office.  It takes longer to vaccinate them that way but I think it's a safer way to go.
Here is the CDC Infant Schedule:
There are not 'tons' of vaccines at six months; actually the same at two and four months and as a matter of course, three or four at 12 months and two or three at 15-18 months.  Dr. Bob not only spreads these out but omits some as well, and not necessarily ones that can or should be omitted and not some that should be as delayed as he has them.  He also eschews combination vaccines which reduce the number of jabs and vaccine constituents, while getting infants protected more timely than his recommendations.  Here are his evidence-free justifications for his recommendations:
  • By only giving two vaccines at a time (instead of as many as 6), I decrease the chance of chemical overload from grouping so many vaccines chemicals all together at once. This allows a baby's body to better detoxify the chemicals one or two at a time.
  • I give only 1 aluminum-containing vaccine at a time (instead of the recommended 4). Overloading on this metal can be particularly toxic to the brain (See Resources, page 250 of The Vaccine Book to view the research on this).
  • I give only one live-virus vaccine component at a time to allow the body's immune system to better handle the live viruses in these vaccines.
  • Giving fewer shots at a time may decrease the side effects, in my experience.
  • Giving fewer shots at a time also makes it easier to figure out which vaccine a child is reacting to if a severe reaction occurs.
Since Dr. Paul Offit and Dr. John Snyder have already critiqued Dr. Bob's schedules, I don't feel compelled to reiterate their reviews.  However, it does bear repeating that Dr. Bob's schedules have not been tested for safety and efficacy; he merely assumes that his recommendations are better because he has set up numerous faulty assertions that the CDC schedule is bad.  He cannot say that his schedules are safer because he has never put them through the rigours of testing, namely, do they protect infants from vaccine preventable diseases that they would otherwise not have and do his schedules prevent all of the bogey-man disorders that he claims fully vaccinating do or may cause?  He has done nothing to alleviate the fears and concerns that parents have since his book is rife with dubious studies that only serve to incite parental concerns and fears about vaccinating.

Dr. Sears creates controversy surrounding vaccine excipients where there really isn't any, by either misinterpreting or omitting relevant scientific literature.  It is a shame that Dr. Bob has chosen to pander to anti-vaccine rhetoric, for the premise of his book seemed appropriately timely, however his execution was sophomoric and clearly intended to further his own agenda and biases.  Ms. Camerota continues:
AC:  It's interesting that you say that because the CDC in part says that they have combined all these vaccines because parents have clamoured for that...parents say, we don't want to have to keep bringing our kids in every two months and giving them different shots, let's just get it all over with.  So perhaps they have acquiesced to parents desires but in a dangerous way.
BS:  Right, you know 20, 30 years ago we only gave babies two vaccines at a time with a total of about eight injections throughout their childhood.  Now we give babies six or seven vaccines each time and over 50 injections spread throughout their childhood.  So I think parents would rather go the extra mile and and [sic] spread the vaccines out cause [sic] I think parents feel like their babies are being overloaded.
Thirty years ago, infants and children received five DTP, four OPV and one MMR.  The U.S. also had about 20,000 Haemophilus influenzae b (HIb) cases in children annually with about 1,000 deaths each year and approximately 16,000 cases of hepatitis b infection in children less than 10 years old each year.  Twenty years ago, infants and children received 18 vaccinations with four given at visits for two, four, and six month olds, three or four given at 12 -18 months old and three given from four to six years old.  They were DTP, Hib, Hep B, OPV and MMR.  There had also been a huge resurgence of measles during that time with more than 55,000 cases and at least 259 deaths.

Today, children are receiving about 30 vaccines by six years old and three of those are not injections, 36 if parents diligently vaccinate their children for influenza, which are actually very few,  less than 30% most years.  So it is very difficult to determine how Dr. Bob calculated 50 injections, however, his own recommendation to split MMR up into six as opposed to two injections would get children closer to that.

But onto his argument that vaccines have not been tested together.  I don't know how he can make this statement when a quick and easy review of the literature reveals quite the opposite.  There are numerous studies that examine the safety and efficacy of new vaccines with existing ones, for example:
Hexavac with Hepatitis A
Hexavalent vaccine with Rotateq
DTaP with Hib
PCV-13 with all infant vaccines
MMR and Varicella
PCV-7 with MMR, Hib and Varicella
Pediarix with Hib and Infanrix-hexa
New Hib with all infant vaccines
MMR with Varicella
MMR-V with Hib-HepB
MMR-V with all infant vaccines
Meningococcal-C with Hep B and Pentacel
Pentacel with PCV-7
This is not, by far, an exhaustive list.  Additionally, the Vaccine Adverse Event Reporting System (VAERS) and the Vaccine Safety Datalink (VSD) exist to monitor vaccine safety after licensure.   Dr. Bob promotes himself as a vaccine expert yet continues to omit relevant facts.  There are valid criticisms of vaccines and policy that are supported by the scientific literature but  Dr. Bob chooses to raise the spectre of misinformation that he has the solution for. 
AC:  Certainly if they're educated, I think you're right about that.  We asked the CDC for their response to that fact that you say their research has been woefully inadequate, here is their response to us:
 "Vaccination is the single most important step parents can take to protect their children from life threatening diseases which once killed thousands of children each year.  Scientific data from years and years of research show that vaccines are safe and effective.  Vaccines do not overload the immune system.  Vaccines contain only a tiny fraction of the antigens that babies encounter in their environment every day.  We do know that delaying vaccines puts children at known risk of becoming ill with vaccine-preventable diseases."
- Tom Skinner, CDC Spokesperson, 1 October 2010
BS:  Well I agree with most of that, especially you don't want to delay vaccines for very serious diseases like meningitis or whooping cough.  However I think the CDC's argument about the thousands of germs that we can tolerate every day...I think that's scientifically invalid because I think they are talking about germs that we inhale, or germs that we swallow.  Those germs are exposed to our immune system in a natural way, in our intestines and our respiratory passages, our immune system processes those germs.  But when you inject germs directly into the body you by-pass the immune system completely and internal part, the bloodstream immune system has to see the germs and attack them, it's a very unnatural type of germ exposure.
It appears as though Dr. Bob has attended the 'Jenny McCarthy School of Immunology' .  His statements regarding 'natural' versus vaccine immune responses invoke one of the most erroneous and overused canards of anti-vaccinationists.  I can't quite parse what Dr. Bob is saying because his description of immunity isn't corroborated by anything known about how the immune system works.  How could he possibly explain an immune response to antigens (or germs as he puts it) that are introduced 'directly into our bodies' via cuts or insect vectors?  Is this also 'unnatural'?  He also seems to believe that this 'natural way' is completely infallible and compartmentalised such that pathogens cannot breech this.  So how does he explain the fact that pathogens have adapted to evade our innate immune system and requiring our adaptive immunity (perhaps what he is referring to as 'bloodstream immune system') creating antibodies to rid ourselves of them?

Vaccination does by-pass some front line non-specific immune defences, but certainly don't 'by-pass the immune system completely', for if they did, we wouldn't produce antibodies and immune memory defences against pathogens when we encounter them.  The whole point of vaccination is to 'teach' our immune system how to deal with the real thing, by using parts of bacteria or inactivated or attenuated viruses.  And they work!  Which shouldn't be the case according to Dr. Bob's primer on the immune system.  It takes quite a bit of knowledge on a topic to be able to reduce complex concepts down to a few sound bites.  So Dr. Bob's conjecture about vaccine versus natural immunity is the chasmic difference between dumbing something down and just sounding dumb. 
AC:  The CDC also said that they have done lots of's interesting because they, they CDC has long cited 2 studies done by these Danish researchers that show that mercury in vaccines does not cause autism.  Well now the lead researcher is being investigated.  Why?
BS:  Right, he was kind of double-dipping so to speak.  He was taking money from the CDC to do this research, he was also under salary from the Danish Universities [sic] and that was against his contract and apparently that went against the rules and now, according to Danish newspapers, he has skipped town with 2 million dollars worth of Danish research money and that sort of calls into question the validity of his research.
Let's take a look at those publications first:
Madsen KM, Hviid A, Vestergaard M, Schendel D, Wohlfahrt J, Thorsen P, Olsen J, Melbye M. A population-based study of measles, mumps, and rubella vaccination and autism. N Engl J Med. 2002 Nov 7;347(19):1477-82.

Madsen KM, Lauritsen MB, Pedersen CB, Thorsen P, Plesner AM, Andersen PH, Mortensen PB. Thimerosal and the occurrence of autism: negative ecological evidence from Danish population-based data. Pediatrics. 2003 Sep;112(3 Pt 1):604-6.

Notice the dates of publication and the order of the authors.  Ms. Camerota and Dr. Bob have referred to the lead author which is Dr. Madsen for both, well he isn't the author in question.  That would be Dr. Poul Thorsen, the sixth and fourth author, respectively.  Respectful Insolence has explained this relevance in great detail, but an author that far down on the list has not made a very significant contribution.  In fact, Dr.s Madsen and Melbye, the senior authors of the studies released a statement to the Philadelphia Inquirer several months ago regarding Dr. Thorsen's involvement:
"Poul Thorsen had absolutely no influence on the conclusions regarding this paper," wrote Mads Melbye, head of the division of epidemiology at the Statens Serum Institut in Copenhagen and senior author of the study, in response to e-mailed questions.
"Thorsen was not actively involved in the analysis and interpretation of the results of this paper," Melbye said.
The second study, published in Pediatrics in 2003, examined 956 Danish children diagnosed with autism from 1971 to 2000. It concluded the incidence of autism increased in Denmark after thimerosal was removed from vaccines.
Kreesten Meldgaard Madsen, the lead author, said Thorsen played a minor role.
"Dr. Thorsen was not in a position to change or compromise the data," Madsen wrote. "Dr. Thorsen was part of the review cycle, but never very active in giving input. Dr. Thorsen never had access to the raw data nor the analysis of the data."
As for the dates, the studies were published in 2002 and 2003 but Dr. Thorsen's resignation under dubious circumstances did not occur until March, 2009.  Furthermore, the grant money in question was not part of the 2 studies in question at all, but rather part of a cooperative between the US National Center for Birth Defects and Developmental Disabilities,CDC and Odense and Aarhus Universities.  And absolutely nothing at all questionable about that; it was the discovery of forged documents by (allegedly) Dr. Thorsen that may constitute fraud.  Apparently, Dr. Thorsen held a full-time post at Emory University, Georgia, USA while still employed by Aarhus University in Copenhagen, Denmark and that is what comprised of his 'double-dipping', not a grant from the CDC as Dr. Bob stated.  Dr. Thorsen is not missing as he continues to publish studies.  We don't know what the funding irregularity was but we do know it has nothing to do with the 2002 and 2003 studies and we do know that Dr. Thorsen's involvement with those studies is being inflated to extremes for the purpose of disparaging them.  It is as though Dr. Bob read the Huffington Post and Age of Autism, didn't bother to ask himself if it made sense, didn't do a little fact-checking and merely parroted extremely questionable sources. 

But Dr. Bob acts as though these 2 studies were the lynch pins for  exonerating vaccines in the role of autism.  Even if we were to dismiss these studies, Dr. Bob completely ignores the numerous other studies by other investigators, in numerous countries that replicate Madsen et al.'s research and then some.  A hat tip to Chris (comment #63) for putting this list together (I have added some recent studies) Addendum 04.18.11 added more studies:

Lack of Association Between Measles-Mumps-Rubella Vaccination and Autism in Children: A Case-Control Study.
Budzyn D, et al.
Pediatr Infect Dis J. 2010 May;29(5):397-400.
Subjects: 96 children with autism, ages 2 to 15, as well as 192 children in a control group. For children diagnosed before a diagnosis of autism, the autism risk was lower in children who received MMR vaccine than in nonvaccinated children. A similar result was achieved for the single-antigen measles vaccine.

U.S. Court of Federal Claims decision in Omnibus Autism Proceeding
On Feb. 12, 2009, the “vaccine court” ruled in three test cases on the theory that MMR vaccine and the vaccine preservative thimerosal are linked to autism. The court found the scientific evidence is overwhelmingly contrary to this theory.

Lack of Association between Measles Virus Vaccine and Autism with Enteropathy: A Case-Control Study.
Hornig M et al.
PLoS ONE 2008; 3(9): e3140 doi:10.1371/journal.pone.0003140
*Subjects: 25 children with autism and GI disturbances and 13 children with GI disturbances alone (controls)

Measles Vaccination and Antibody Response in Autism Spectrum Disorders.
Baird G et al.
Arch Dis Child 2008; 93(10):832-7.
Subjects: 98 vaccinated children aged 10-12 years in the UK with autism spectrum disorder (ASD); two control groups of similar age: 52 children with special educational needs but no ASD and 90 children in the typically developing group

MMR-Vaccine and Regression in Autism Spectrum Disorders: Negative Results Presented from Japan.
Uchiyama T et al.
J Autism Dev Disord 2007; 37(2):210-7
*Subjects: 904 children with autism spectrum disorder
(Note: MMR was used in Japan only between 1989 and 1993.)

No Evidence of Persisting Measles Virus in Peripheral Blood Mononuclear Cells from Children with Autism Spectrum Disorder.
D’Souza Y et al.
Pediatrics 2006; 118(4):1664-75
*Subjects: 54 children with autism spectrum disorder and 34 developmentally normal children

Immunizations and Autism: A Review of the Literature.
Doja A, Roberts W.
Can J Neurol Sci. 2006; 33(4):341-6
*Literature review

Pervasive Developmental Disorders in Montreal, Quebec, Canada: Prevalence and Links with Immunizations.
Fombonne E et al.
Pediatrics. 2006;118(1):e139-50
*Subjects: 27,749 children born from 1987 to 1998 attending 55 schools

Is There a ‘Regressive Phenotype’ of Autism Spectrum Disorder Associated with the Measles Mumps-Rubella Vaccine? ACPEA Study
Richler et al.
J Autism Dev Disord. 2006 Apr;36(3):299-316.
Subjects: A multi-site study of 351 children with Autism Spectrum Disorders (ASD) and 31 typically developing children used caregiver interviews to describe the children’s early acquisition and loss of social-communication milestones. No evidence that onset of autistic symptoms or of regression was related to measles, mumps and rubella vaccination.

No Effect of MMR Withdrawal on the Incidence of Autism: a Total Population Study.
Honda H, et al.
J Child Psychol Psychiatry. 2005 Jun;46(6):572-9.
Subjects: Study examined incidence of Autism Spectrum Disorders (ASD) to age 7 for children born between 1988 and 1996 in Yokohama, Japan. The measles, mumps and rubella (MMR) vaccination rate in Yokohama declined significantly in the birth cohorts of years 1988-92, and no MMR vaccines were administered in 1993 or thereafter. In contrast, cumulative incidence of ASD up to age 7 increased significantly in the birth cohorts of years 1988 through 1996 and most notably rose dramatically beginning with the birth cohort of 1993.

Relationship between MMR Vaccine and Autism.
Klein KC, Diehl EB.
Ann Pharmacother. 2004; 38(7-8):1297-300
*Literature review of 10 studies

Immunization Safety Review: Vaccines and Autism. Institute of Medicine.
The National Academies Press: 2004
( *Literature review

MMR Vaccination and Pervasive Developmental Disorders: A Case-Control Study.
Smeeth L et al.
Lancet 2004; 364(9438):963-9
*Subjects: 1294 cases and 4469 controls

Age at First Measles-Mumps-Rubella Vaccination in Children with Autism and School-Matched Control Subjects: A Population-Based Study in Metropolitan Atlanta.
DeStefano F et al. Pediatrics 2004; 113(2): 259-66
*Subjects: 624 children with autism and 1,824 controls

No Evidence for Links Between Autism, MMR and Measles Virus.
Chen W, et al.
Psychol Med. 2004 Apr;34(3):543-53.
Subjects: Study compared 2,407 persons with autism born between 1959 and 1993; to 4,640 Down syndrome subjects born between 1966 and 1993. No increased risk of autism was found following exposures to wild measles and vaccinations with monovalent measles, and Urabe or Jeryl-Lynn variants of measles, mumps and rubella (MMR) vaccine.

Prevalence of Autism and Parentally Reported Triggers in a North East London Population.
Lingam R et al.
Arch Dis Child 2003; 88(8):666-70
*Subjects: 567 children with autistic spectrum disorder

Neurologic Disorders after Measles-Mumps-Rubella Vaccination.
Makela A et al.
Pediatrics 2002; 110:957-63
*Subjects: 535,544 children vaccinated between November 1982 and June 1986 in Finland

A Population-Based Study of Measles, Mumps, and Rubella Vaccination and Autism.
Madsen KM et al.
N Engl J Med 2002; 347(19):1477-82
*Subjects: All 537,303 children born 1/91–12/98 in Denmark

Relation of Childhood Gastrointestinal Disorders to Autism: Nested Case Control Study Using Data from the UK General Practice Research Database.
Black C et al.
BMJ 2002; 325:419-21
*Subjects: 96 children diagnosed with autism and 449 controls

Measles, Mumps, and Rubella Vaccination and Bowel Problems or Developmental Regression in Children with Autism: Population Study.
Taylor B et al.
BMJ 2002; 324(7334):393-6
*Subjects: 278 children with core autism and 195 with atypical autism

No Evidence for a New Variant of Measles-Mumps-Rubella-Induced Autism.
Fombonne E et al.
Pediatrics 2001;108(4):E58
*Subjects: 262 autistic children (pre- and post-MMR samples)

Measles-Mumps-Rubella and Other Measles-Containing Vaccines Do Not Increase the Risk for Inflammatory Bowel Disease: A Case-Control Study from the Vaccine Safety Datalink Project.
Davis RL et al.
Arch Pediatr Adolesc Med 2001;155(3):354-9
*Subjects: 155 persons with IBD with up to 5 controls each

Time Trends in Autism and in MMR Immunization Coverage in California.
Dales L et al.
JAMA 2001; 285(9):1183-5
*Subjects: Children born in 1980-94 who were enrolled in California kindergartens (survey samples of 600–1,900 children each year)

Mumps, Measles, and Rubella Vaccine and the Incidence of Autism Recorded by General Practitioners: A Time Trend Analysis.
Kaye JA et al.
BMJ 2001; 322:460-63
*Subjects: 305 children with autism

MMR and Autism: Further Evidence Against a Causal Association.
Farrington CP, et al.
Vaccine. 2001 Jun 14;19(27):3632-5.
Subjects: Data from an earlier measles, mumps and rubella (MMR) vaccine study (Taylor et al, 2000) were reanalyzed to test a second hypothesis. Results provide further evidence against a causal association between MMR vaccination and autism.

Further Evidence of the Absence of Measles Virus Genome Sequence in Full Thickness Intestinal Specimens from Patients with Crohn’s Disease.
Afzal MA, et al.
J Med Virol 2000; 62(3):377-82
*Subjects: Specimens from patients with Crohn’s disease

Autism and Measles, Mumps, and Rubella Vaccine: No Epidemiological Evidence for a Causal Association.
Taylor B et al.
Lancet 1999;353 (9169):2026-9
*Subjects: 498 children with autism

Absence of Detectable Measles Virus Genome Sequence in Inflammatory Bowel Disease Tissues and Peripheral Blood Lymphocytes.
Afzal MA et al.
J Med Virol 1998; 55(3):243-9
*Subjects: 93 colonoscopic biopsies and 31 peripheral blood lymphocyte preparations

No Evidence for Measles, Mumps, and Rubella Vaccine-Associated Inflammatory Bowel Disease or Autism in a 14-year Prospective Study.
Peltola H et al.
Lancet 1998; 351:1327-8
*Subjects: 3,000,000 doses of MMR vaccine

Exposure to Measles in Utero and Crohn’s Disease: Danish Register Study.
Nielsen LL et al.
BMJ 1998; 316(7126):196-7
*Subjects: 472 women with measles

Immunocytochemical Evidence of Listeria, Escherichia coli, and Streptococcus Antigens in Crohn’s Disease.
Liu Y et al.
Gastroenterology 1995; 108(5):1396-1404
*Subjects: Intestines and mesenteric lymph node specimens from 21 persons from families with a high frequency of Crohn’s disease

Neuropsychological Performance 10 years after Immunization in Infancy with Thimerosal-Containing Vaccines
Tozzi AE, Bisiacchi P, Tarantino V, De Mei B, D'Elia L, Chiarotti F, Salmaso S.
Pediatrics, February 2009, Vol. 123(2):475-82

Mercury Levels in Newborns and Infants after Receipt of Thimerosal-Containing Vaccines
Pichichero ME, Gentile A, Giglio N, et al
Pediatrics, February 2008; 121(2) e208-214

Mercury, Vaccines, And Autism: One Controversy, Three Histories
Baker JP
American Journal of Public Health, February 2008;98(2): 244-253

Continuing Increases in Autism Reported to California's Developmental Services System: Mercury in Retrograde
Schechter R, Grether JK
Arch Gen Psychiatry, January 2008; 65(1):19-24

Early Thimerosal Exposure and Neuropsychological Outcomes at 7 to 10 Years
Thompson WW, Price C, Goodson B, et al; Vaccine Safety Datalink Team
N Engl J Med, Sep 27, 2007; 357(13):1281-1292

Pervasive Developmental Disorders in Montreal, Quebec, Canada: Prevalence and Links with Immunizations
Fombonne E, Zakarian R, Bennett A, Meng L, McLean-Heywood D
Pediatrics, July 2006, Vol. 118(1):e139-e150

Vaccine Adverse Event Reporting System Reporting Source: A Possible Source of Bias in Longitudinal Studies
Goodman MJ, Nordin J
Pediatrics, February 2006, Vol. 117(2):387-390

Thimerosal in Vaccines: Balancing the Risk of Adverse Effects with the Risk of Vaccine-Preventable Disease
Bigham M, Copes R
Drug Safety, 2005, Vol. 28(2):89-101

Comparison of Blood and Brain Mercury Levels in Infant Monkeys Exposed to Methylmercury or Vaccines Containing Thimerosal
Burbacher TM, Shen DD, Liberato N, Grant KS, Cernichiari E, Clarkson T
National Institute of Environmental Health Sciences, April 21, 2005

Thimerosal Exposure in Infants and Developmental Disorders: A Prospective Cohort Study in the United Kingdom Does Not Support a Causal Association
Heron J, Golding J, ALSPAC Study Team
Pediatrics, September 2004, Vol. 114(3):577-583

Thimerosal Exposure in Infants and Developmental Disorders: A Retrospective Cohort Study in the United Kingdom Does Not Support a Causal Association
Andrews N, Miller E, Grant A, Stowe J, Osborne V, Taylor B
Pediatrics, September 2004, Vol. 114(3):584-591

Thimerosal-Containing Vaccines and Autistic Spectrum Disorder: A Critical Review of Published Original Data
Parker SK, Schwartz B, Todd J, Pickering LK
Pediatrics, September 2004, Vol. 114(3):793-804

The Evidence for the Safety of Thimerosal in Newborn and Infant Vaccines
Clements CJ
Vaccine, May 7, 2004, Vol. 22(15-16):1854-1861

Safety of Thimerosal-Containing Vaccines: A Two-Phased Study of Computerized Health Maintenance Organization Databases
Verstraeten T, Davis RL, DeStefano F, et al
Pediatrics, November 2003, Vol. 112(5):1039-1048

The Toxicology of Mercury--Current Exposures and Clinical Manifestations
Clarkson TW, Magos L, Myers GJ
New England Journal of Medicine, October 30, 2003, Vol. 349(18):1731-7

Association Between Thimerosal-Containing Vaccine and Autism
Hviid A, Stellfeld M, Wohlfahrt J, Melbye M
Journal of the American Medical Association, October 1, 2003, Vol. 290(13):1763-6

Thimerosal and the Occurrence of Autism: Negative Ecological Evidence from Danish Population-Based Data
Madsen KM, Lauritsen MB, Pedersen CB, et al
Pediatrics, Sept. 2003, Vol. 112(3 Pt 1):604-606

Autism and Thimerosal-Containing Vaccines. Lack of Consistent Evidence for an Association
Stehr-Green P, Tull P, Stellfeld M, Mortenson PB, Simpson D
American Journal of Preventive Medicine, August 2003, Vol. 25(2):101-6

Impact of the Thimerosal Controversy on Hepatitis B Vaccine Coverage of Infants Born to Women of Unknown Hepatitis B Surface Antigen Status in Michigan
Biroscak BJ, Fiore AE, Fasano N, Fineis P, Collins MP, Stoltman G
Pediatrics, June 2003, Vol. 111(6):e645-9

Vaccine Safety Policy Analysis in Three European Countries: The Case of Thimerosal
Freed GL, Andreae MC, Cowan AE, et al
Health Policy, December 2002, Vol. 62(3):291-307

Mercury Concentrations and Metabolism in Infants Receiving Vaccines Containing Thimerosal: A Descriptive Study
Pichichero ME, Cernichiari E, Lopreiato J, Treanor J
The Lancet, November 30, 2002, Vol. 360:1737-1741

An Assessment of Thimerosal Use in Childhood Vaccines
Ball LK, Ball R, Pratt RD
Pediatrics, May 2001, Vol. 107(5):1147-1154

Prenatal and Infant Exposure to Thimerosal From Vaccines and Immunoglobulins and Risk of Autism
Price CS, Thompson WW, Goodson B, Weintraub ES, Croen LA, Hinrichsen VL, Marcy M, Robertson A, Eriksen E, Lewis E, Bernal P, Shay D, Davis RL, DeStefano F Pediatrics, October, 2010, Vol. 126(4): 656-664

On-time Vaccine Receipt in the First Year Does Not Adversely Affect Neuropsychological Outcomes
Smith MJ and Woods CR
Pediatrics, June, 2010, Vol. 125 (6):1134-1141

This is, obviously, a lot of reading to do but considering the totality of evidence it is the responsible tact to take when advising the public about vaccine issues.  There are concerns and criticisms regarding the CDC vaccine schedule, but they are rather mundane when compared to the misleading and downright false conjectures that self-proclaimed experts would have us believe.  There seems to be an anti-intellectual movement afoot but with the taskmasters absurdly co-opting the esteem of education and credentials to propagate it.

It is encouraging to see that this interview was done by Fox News since they are renowned for their unapologetic biases and don't even bother to offer up any pretence of presenting a fair balance of issues.  An appearance on Fox News is akin to has-been and never-were celebrities breathing their last gasp on Dancing With the Stars.  It signifies the downward spiral of the anti-intellectual, anti-vaccine movement.  And that is a good thing.

Addendum (16 October 2010):  Rahul K. Parikh, M.D. has weighed in on Dr. Bob Sears' Vaccine Book and appearance on Fox News.