Thursday, May 31, 2012

Vaccines or epidemics - do we really have a choice?

kw: book reviews, nonfiction, medicine, vaccination, polemics

Lewis Thomas wrote an essay that I well remember, probably thirty years ago. He described the three kinds of medicine. The first is palliative, where all you can do is try to help the patient feel better, when the best you can do is comfort someone and "let nature take its course." In cases of chronic disease, this can be incredibly costly, both financially and emotionally. The second is corrective, which includes surgical procedures such as heart bypasses, though it also includes syndromes that you can medicate. The cost may be low for some conditions, but for many it can also be quite costly. Finally, there is effective prevention, and Thomas held up vaccines as examples of effective prevention. By contrast to the other two kinds of medicine, prevention is very inexpensive, and usually saves many more lives than any corrective medical method.

I remember the incredible relief of all the parents when the Salk vaccines for Polio were announced. We lived in Utah at the time, and I had, unknowingly, been one of Dr. Salk's experimental subjects. Among thousands of names of children published in the newspaper that day, I found mine. I have never been mentioned in the newspaper since! The funny thing is, when I was a teenager an orthopedic doctor measured my bones and told me I had had polio. I went to the doctor to get his advice about learning to walk straight. I had grown up with a slightly gimpy leg and one foot much smaller than the other. Now we knew why. The infection occurred when I was one year old, about seven years before Dr. Salk's experimentation on the children in my school (and many other schools). I was probably not the only child who had already had polio before being in the vaccination experiments.

Fast-forward about forty years. It came time to have our son vaccinated for quite a variety of diseases, and polio was on the agenda. I had heard that the oral vaccine, named for Dr. Sabin, very rarely causes polio, because the serum contains living but weakened virus. I learned that about ten children yearly contract polio from the vaccine. I wrote a letter to our doctor, telling him I'd had polio as an infant and preferred that our son receive the Salk vaccines (there are three). They are made from killed viruses. Though injection costs more, I was willing to pay extra for a reliably safe vaccine. Here is the bottom line, though. If I had not had a choice, if the Salk vaccine were no longer available, for example, I would have allowed my son to receive the Sabin vaccine, though breathing a prayer for him.

So our son received them all: Salk for polio, plus vaccines for DTP, MMR, Hepatitis (I don't recall how many kinds), and maybe another one or two. He had a bout of chicken pox before they finished developing the vaccine. When I was a kid, I received the DTP vaccine, but there was no MMR so I had measles and mumps at a young age. Fortunately not rubella.

I didn't hear at the time about the flap over Pertussis vaccine that began in the 1960s. There was a lot of other stuff going on. I didn't know about anti-vaccination organizations that were formed during that time, some of which still exist. I learned quite a lot about it in the opening chapters of Deadly Choices: How the Anti-Vaccine Movement Threatens Us All by Paul A. Offit, M.D. In fact, there was much too much there to learn. I do believe Dr. Offit would have done better to select a smaller set of cases to discuss. Before I was halfway through, I was overwhelmed, and stopped reading. Also, it is a bit of a downer. The story is not over, and the forces of ignorance are winning.

Unlike many vaccines, the early pertussis (whooping cough) vaccine contains whole, killed bacteria. That means it also contains thousands of their metabolic proteins, because in 1906 it was not known which proteins or other biochemicals were causing the problem. They just knew that you could prime the immune system with dead bacteria and nearly anyone would then be immune to the infection. This is one key point: nearly anyone, but not exactly everyone, not quite 100%. Because of allergic reactions, the vaccine has a lot of side effects. Many kids get feverish, or feel sore, and some cry for a long time; a few even had fever-induced seizures. Some kids died within a few months or years, and the vaccine was blamed. It took more than twenty years for scientists to determine that there were no "extra" deaths, nor "extra" cases of epilepsy or other brain damage. The dead and injured children were going to die or be harmed anyway. But that twenty years was plenty long enough for a powerful political movement to arise and drive all but one or two vaccine makers right out of business.

Sadly, it also led to hundreds of thousands of people declining to have their children vaccinated. Even at the time, this didn't make sense. At most, less than one hundred children were thought to have been killed over the years that the 1906 vaccine was used (It has since been shown that the vaccine did not kill anyone). In the 1970s and 1980s, there were epidemics of pertussis that caused tens of thousands of cases of permanent harm and took several thousand lives. And remember that the vaccine isn't 100% effective? A few of those who died had been vaccinated years before! In a population that is 95% immune to a disease, a few people will get it, but it won't be able to spread. When the immune portion drops to 80%, 70%, or less, epidemics can occur.

Well, doctors didn't just learn about the vaccine's effects. They also improved it. A lot was learned about pertussis infections, and modern pertussis vaccine just contains those proteins the body needs so it can recognize the germ and destroy it. But people are still declining DTP for their children. The word hasn't gotten through to them.

It was in the middle of the book's discussion of the Salk and Sabin vaccines that I ran out of steam. I had learned that the anti-vaccine movement is still with us. I suspect there is a closing chapter or two about combating the misinformation the movement delivers. But I am not a political animal. It does no good to call me to arms; I don't bear arms, literally or figuratively. The closest I can come to political action is a statement such as this one:

Take advantage of every vaccine available. Without it, the chances of death or permanent disability are 100 to a million times greater than any harm the vaccine might cause.

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