Wednesday, August 29, 2018

Soledad O'Brien's New Show - Matter of Fact

and why the first show's take on vaccines and autism is NOT likely to change minds.

She asked why the average person who questioned the Official Scientific Answer did so.

Her guest, Dr. Peter Hotez, a professor of pediatrics and vaccine scientist, who has a child with autism, responded that the science was clear, and unquestionable. They both agreed that the people opposing that research were driven by fear, ignorance, and nasty Internet mis-information.

In some cases, that might be true. It's also true of such idiocies as the anti-straw mandate, demonization of Trump and his allies, and many of their other 'crusades' - women's pay 'inequity', the homeless 'problem', AntiFa, and the #MeToo.

It's not that problems don't exist, it's that their significance has been blown wildly out of proportion.

While, at the same time, completely ignoring REAL problems - over-regulation of government, the collapsing family/community, sexual abuse of children, invasion by foreigners, just to mention a few.

Is the Anti-Vaxxer driven by ignorance?

Perhaps. But they ignore the bigger cause of that resistance.

Distrust of Government. Many Americans no longer trust the government to act in their interests. And, increasingly, they also don't have high confidence in scientific research (this could be a valid reason for that), medical advice, or educational authorities.

So, unlike Soledad and Hotez's confident explanation that dim-witted mouth-breathing hillbillies are the whole problem with this issue, it's more nuanced that that.

At least a few of the vaccine opposers are more concerned about:

  • Timing - vaccine schedules are largely driven by the need to bunch multiple vaccines into one visit. That's both to facilitate convenience for parents who cannot make multiple trips, and the doctor's recognition that it may be the only way to get parent cooperation. Spreading the immunizations out significantly reduces the number of children receiving all of the vaccines.
  • When types of shots are mixed, a reaction is harder to trace back to a single cause - it might have been allergy to eggs (a common component of vaccines), reduced tolerance due to low-grade infection unrelated to the vaccines, or other problems.
  • Children 2 and under are a swarming petri dish of icky germs. Any shots are as likely to trigger an immune response that is excessive, as they are to be helpful. Shot schedules have been set up as they have because the medical community realizes that most of the children will be exposed to germs in day care, and their motivation is to reduce the chances of dangerous infections - measles, hepatitis, and a host of other potentially deadly illnesses.
  • Not all of the shots are necessary. Here is the CDC-directed schedule. 
    • Hep-B - this is spread by bodily fluids from a person infected with it. If a child is at home (not in day care, not cared for by a person who is infected), it just is not necessary. This could easily be put off until later in childhood. Hep-A is given from 12 months on, with the same way of spreading. You decide.
    • RV - this is the Rotavirus - it's spread by contact with fecal material from an infected person. Day Cares are notorious for spreading it, as the staff, when changing diapers or coming into contact with children, often don't implement sanitary procedures every time. If the kid is at home, could be put off until a later time, or eliminated.
    • Hib - this is a potentially deadly disease, if the bacteria enters the bloodstream or lungs. It can cause meningitis. However, according to the CDC, "Children over 5 years old and adults usually do not need Hib vaccine. But it may be recommended for older children or adults with asplenia or sickle cell disease, before surgery to remove the spleen, or following a bone marrow transplant. It may also be recommended for people 5 to 18 years old with HIV." So, unless your kid is in community-type care before 5, or in contact with someone who is a potential source - family member, neighbor - this MIGHT not be necessary. I'd probably err on the side of caution with this one, and have the vaccine given. It's given in 3 doses, from 2-6 months.
    • PCV13 - immunizes against 13 strains of pneumonia. Given to both children and adults. Here is the important part (from the CDC): 
      • "Anyone who has ever had a life-threatening allergic reaction to a dose of this vaccine, to an earlier pneumococcal vaccine called PCV7, or to any vaccine containing diphtheria toxoid (for example, DTaP), should not get PCV13.
      • Anyone with a severe allergy to any component of PCV13 should not get the vaccine. Tell your doctor if the person being vaccinated has any severe allergies.
      • If the person scheduled for vaccination is not feeling well, your healthcare provider might decide to reschedule the shot on another day.
      • Now, the DUMB part of the schedule? The DTaP is scheduled to be given ON THE SAME DAY AS THE PCV13. How would a parent, OR the doctor, know if the kid is allergic to the DTaP vaccine, when it wasn't given before that? If it were my kid, I'd separate this shot to be given AFTER it was shown that the kid wasn't allergic to DTaP.
    • IPV - this is polio. I grew up when there was no vaccine. I went to school with a survivor, who used braces and crutches. He died much younger than he should have, before he was 40. It's one that has low incidence of problems, and, with the rise in unmonitored immigration, it's growing in many communities. I'd get it, on schedule.
    • Influenza - suggested from 2 months to 4-6 years. This is tricky. The illness is quite debilitating, and, for children and vulnerable adults, can be deadly. If the kid is not in day care, and you are SURE that he will not be exposed, use your own best judgement. I'd, again, err on the side of caution, particularly if he is one of those kids with nasal/ear infections, and get the vaccine BEFORE the flu season starts. If you decide not to, be prepared to quarantine any members of the household that are stricken.
    • MMR - measles, mumps, rubella. Your choice. Low incidence of reactions. If you are opting out, please warn any women your child might come in contact with - pregnant women, before they are showing, or may even know, are at high risk of birth defects.
    • Varicella - chickenpox. If a person catches it, they are unlikely to die, although a few might be hospitalized. They will be QUITE uncomfortable in the short term. Those who catch this may suffer from herpes zoster (shingles). It's a painful disease.
      • Warnings from the CDC: "
        • Tell your vaccine provider if the person getting the vaccine:
        • Has any severe, life-threatening allergies. A person who has ever had a life-threatening allergic reaction after a dose of chickenpox vaccine, or has a severe allergy to any part of this vaccine, may be advised not to be vaccinated. Ask your health care provider if you want information about vaccine components.
        • Is pregnant, or thinks she might be pregnant. Pregnant women should wait to get chickenpox vaccine until after they are no longer pregnant. Women should avoid getting pregnant for at least 1 month after getting chickenpox vaccine.
        • Has a weakened immune system due to disease (such as cancer or HIV/AIDS) or medical treatments (such as radiation, immunotherapy, steroids, or chemotherapy).
        • Has a parent, brother, or sister with a history of immune system problems.
        • Is taking salicylates (such as aspirin). People should avoid using salicylates for 6 weeks after getting varicella vaccine.
        • Has recently had a blood transfusion or received other blood products. You might be advised to postpone chickenpox vaccination for 3 months or more.
        • Has tuberculosis. 
        • Has gotten any other vaccines in the past 4 weeks. Live vaccines given too close together might not work as well.
        • Is not feeling well.  A mild illness, such as a cold, is usually not a reason to postpone a vaccination. Someone who is moderately or severely ill should probably wait. Your doctor can advise you."
        • This is one that I'd be cautious about - talk to your doctor, and make SURE that the kid is healthy (assuming that no contra-indications as listed above are present). Shingles is, indeed, nasty, but adults can get the vaccine.
Am I anti-vax? Generally, no. However, at least a few of these are necessary because people put their kids in day care. The schedule does not make sense in bunching too many vaccines together at once. For kids who have allergies, this can be a problem. While I'm generally in favor of using your doctor for guidance, I also know that, these days, they are busy, and won't always know every detail of every vaccine, and contra-indications.

I'm on the fence with this. My kids are grown, and I have only one grandchild who could be affected by this (well, and a great-grandchild). My kids got the immunizations - which, at that time, did NOT include Varicella, RV, Hib, Hep-B/A, or PCV13. They were fine.

In that time, reasonable rules about cleanliness were sufficient. Plastic gloves were not always used, towels were shared, you might feed your child with the same spoon or fork that you used to taste with.

Today, you have to be vigilant. If your pre-school child is around non-family members, or family members with immuno-compromised systems, you have to follow higher levels of cleanliness. In fact, hospital-level of care - gloves, washing anytime you touch a surface not known to be sterile, masks around those with runny noses, sneezing, fever, or coughing.

And, that is a problem. Not to pick on day care, but the level of protection just is NOT present on any given day. Workers wipe noses, and MAY use disinfectant gel, but NOT full soap and water washing, nor plastic gloves. Gloves are seldom used to change diapers, and disposal will not get the full 15 seconds or more soap and water washing. There just is NOT time.

I'm not even going to mention the snotty-nosed kids who pass along their germs every time they touch a community toy.

Why is that level of care so important? Simply the high volume of kids in a single place. At home, you can handle the germs with reasonable caution, knowing that the number and type of germs is less of an issue, as well as the fact that your kid is acclimated to the family germs.

How does Soledad O'Brien's Matter of Fact enter into this discussion?

Simply this: her show spent less than 10 minutes on the topic, much of that dedicated to 'proving' that parents questioning the current vaccination schedules were stupid sheep.

I just spend over an hour writing this, including finding sources for my points. It's far more informed, and less hysterical than O'Brien's propaganda.

So, who should you trust?

UPDATE: I changed the coloring on some of the quotations - too hard to see them before.


Amy Bowersox said...

Soledad O'Brien was OK as the host of the original MSNBC program The Site, a technology news show. (Where she appeared alongside a CGI animated figure, "Dev Null.") She rapidly reached her level of incompetence in subsequent assignments.

Francis W. Porretto said...

All praise to /dev/null! My favorite device! I do all my backups to it. They run really fast.

James said...

Yeah, I forgot about Dev Null.

One itty bitty point - mercury was never mentioned. A lot of us home school parents tried to get zero mercury vaccines for our children. My wife is a nurse, I am a network admin, we were still looked at as if we were wearing foil hats along with Art Bell t-shirts. They just don't get it.

If you do not swallow the dogma, you are the problem. We were dangerous enough ditching the government schools.

Laura said...

If I may comment on a few of your statements:

Hepatitis A is usually spread by contaminated food, not bodily fluids (although it certainly CAN spread that way, of course). There have been a number of outbreaks in the news lately, caused by everything from homeless people soiling the streets, to infected people working in restaurants, to contaminated fresh produce in markets. It's very contagious, and only some of these are under your control. Very few cases are caught in day cares.

Measles is also extremely contagious (the average person with measles spreads it to 14 other people). In the US, the main vectors are young adults who travel to third world countries, and who then visit crowded places-- Disneyland, cruise ships, Church picnics, etc. Again, not day cares. It can be dangerous for young children, the elderly, and immune-compromised people, and as you noted, it can cause stillbirth or severe birth defects if a pregnant woman catches it. I'd further note that this risk is true even if the infectious person is still asymptomatic, and the woman doesn't know she's pregnant yet. Also, once you're pregnant, you can't take the vaccine, so pregnant women can't "defend themselves" so to speak.

You've described Hib and Pneumococcus well; I would only add that it turns out that they are also a main cause of ear infections in young children and bronchitis in adults. Nobody expected that, but it turns out to drastically reduce the number of recurrent ear, nose and throat infections that result in a doctor's office visit (roughly 85% drop). So if your munchkin, or anybody in your household, is prone to these infections or has reason to think that they'd suffer more than usual from them (e.g. have asthma, immune-compromised, elderly, etc.) then you should definitely consider that when thinking about this.

Ditto for chickenpox-- while it's usually "merely" miserable for children, the disease is much more severe in adults (not even counting shingles, just the initial infection) and can be very dangerous for vulnerable people (e.g. the elderly, chemo patients, etc.) On a personal note, both my mother and my mother-in-law had shingles, and both suffered permanent nerve damage in their arms (lifelong pain/itch). So for me personally, I'm getting the Shingrix vaccine the day I become eligible-- you do what you want, but for me, it's a no-brainer.

Two additional points: if you're concerned about your child getting too many vaccines at one go, and want to spread them out over several visits-- just tell your doctor that. They're usually happy to comply, if you're willing to come back multiple times. (You don't need to see the doc more than once; the nurse or tech can give you the shot on the subsequent visits.) Second, mercury (thimerosal) has been removed from all childhood vaccines since 2001. It's only used in certain multi-dose vials of influenza vaccines, given to adults. If you want a flu vaccine without thimerosal, just ask. If they don't have the single-dose versions-- go somewhere else.

Linda Fox said...

Thank you, Laura, for your thoughtful additional comments - this could be very helpful for parents wanting to make a decision.

I hadn't thought about the ear infection problem, but it does make sense. Probably the best advice is to spread this all out, and never take a kid in if they are sick/sniffling. The sad fact is, too many kids are chronically sick in the pre-school years, not because they started out life with a poor health condition, but because too many day care situations are NOT healthy. Too many potentially infectious kids in one place.