Review — The Vaccine Book (#vaccination, #health)

[amazon text=The Vaccine Book: Making the Right Decision for Your Child&asin=0316180521]

by Dr. Robert W. Sears, published 2011

How many people who are “pro-vaccine” have read a book about vaccines?

How many people are aware of the frequency, severity and treatability of diseases which have vaccines available before deciding to take the vaccine? How many people understand the common, rare and potentially severe side effects, the physical components in the vaccines, the method by which the vaccine is manufactured and the availability of competing vaccine brands and production methods?

How many people understand the common vectors of each vaccine treatable disease and thus how to potentially avoid exposure to it entirely?

Who is likely to be better read on the subject of vaccines (even if you argued that they are ultimately misinformed) — your average vaccine taker, or your average vaccine skeptic?

Dr. Bob Sears is “pro-vaccine” — he believes vaccines have done more good than harm in the history of medicine and that they are an important part of individual and public health practices and he believes the standard vaccine schedules for infants and adults should be followed with few exceptions. So why is he having his medical license put under review because he supposedly gave a “non-evidence based” recommendation to a family to not vaccinate their child?

Because it’s hard to imagine a world in which a doctor would come under the scrutiny of authorities for giving a pro-intervention recommendation to a patient that was “non-evidence based”, perhaps we can assume that it is because Dr. Bob has challenged the medical establishment on the most fundamental level possible by writing a book which posits that patients should be informed about their choices and should ultimately provide knowledgeable consent before proceeding with a potentially dangerous treatment regimen such as infant vaccination. Sadly, if you ask most doctors to explain why they want to treat you the way that they do, what you get is not “evidence based” dialog about your choices, but sarcastic reminders about whose medical school plaque is on the wall.

It’s sometimes more like a priesthood than a profession, even though that doesn’t necessarily mean their advice is wrong or should be ignored.

So that is the controversy, but what does Dr. Sears actually say about vaccines?

The first twelve chapters of the book are dedicated to one disease each and its respective vaccine; the remaining chapters explore vaccine research, vaccine safety, vaccine ingredients, vaccine side effects and other topics.

The disease chapters outline the common course of each disease including symptoms, severity and treatment, followed by the common vaccine options available on the market including their preparation method and ingredients and common and rare side effects. There is a “pro” and “con” section exploring reasons to consider administering the vaccine and reasons why people/parents have not wanted to take the vaccine, and then Dr. Sears weighs in with his own take on how important the vaccine is. Each chapter helpfully summarizes the information with simple boxed call outs indicating whether the disease is common, severe and treatable (without a vaccine).

The common/severe/treatable approach is interesting. I found a lot of the diseases covered not-threatening because of the various combinations they “checked” in each category: a disease might be severe and treatable, and not common, or common, but not severe and treatable. The worst combination would be common, severe and untreatable — I don’t remember any disease with that profile. Just the opposite, in fact. According to Dr. Sears, with thanks mostly to widespread vaccination, most of the diseases mentioned are not common (to the point that they’re actually or practically eradicated in the US/West) so there is almost no chance of catching it, vaccinated or not. Several others are typically so minor in their symptoms, especially in infants (versus adults), that they might be mistaken for a common cold if caught. And those that are potentially severe seem to be treatable with antibiotics in most cases, especially if diagnosed early in the course of the illness.

That being said, some of these diseases have the potential to put the victim in the hospital if the disease is not checked early, or it happens to be especially challenging to an individual’s immune system. In such a situation, even with a full recovery and no lasting damage the experience itself is likely to be stressful, costly, traumatic for the child and heartbreaking for the parents to watch — it’s not a joke as far as risks go, and it needs to be considered seriously. And a few of the diseases, if caught and if particularly intense in the course of the disease, do risk permanent neurological or organ damage even if successfully treated. That’s a terrifying possibility!

Reading between the lines a little bit here, Dr. Sears seems pretty clear that whatever risks there are for an unvaccinated child in contracting and fighting any of these diseases, they are even smaller for a child who is breastfed and avoids day care or other germ-ridden public child environments. Assuming this is the course a parent is following with their infant (as we are), it seems a lot more like a judgement call between accepting the risks of rare disease complications the child is likely never to get, or accepting the risks of vaccine side effects (short and long-term) which are inevitable and seemingly random in their frequency and severity. There are several diseases/vaccines mentioned which simply pose no risk whatsoever (chickenpox), or for which the illness can not be contracted by the infant without an infected mother who transmits it during pregnancy or birth, or for which the illness and vaccine do not become relevant until adolescence or adulthood (such as HPV, a sexually-transmitted disease). Taking what’s left, and given our commitment to breastfeeding and homecare/homeschooling, it just doesn’t look like vaccines make a lot of sense for our family.

That was the part of the book I struggled with the most, when Dr. Sears recommended a vaccine not for the infant’s safety, but for public health reasons, such as to maintain low prevalence of a disease across a population, or to protect at-risk family members or caregivers who could catch the disease from the infant and have a more difficult time fighting it (for example, Dr. Sears talks about how a pregnant school teacher could catch a disease from unvaccinated students that could harm her unborn child). This is all good information to have and consider in the event of one of these complicating circumstances actually being relevant to a family’s situation, and certainly the “moral” issues are worth considering and debating, but it seems clear that if the question is simply put as “Does this vaccine represent a worthwhile risk/reward profile to the individual being vaccinated?” the answer we arrived at was often “No.” That’s a very different question from “Is it our job to take health risks with our child to protect other people/children from health risks?”

Interestingly, smallpox has been eradicated but the vaccine is no longer given to preserve herd immunity. Instead it is controlled by the US government as a national defense reserve. In identical situations where a disease, such as polio, has been practically eradicated, Dr. Sears still recommends getting the vaccine for public health reasons, but with smallpox there is no suggestion that the public needs to keep getting vaccinated to be protected from an eradicated illness. Why the different logic?

Another item I made special note of was the relationship between traveling, domestically and internationally, and vaccination of an infant. Dr. Sears is explicit in saying that flying around on airplanes is not an easy way to catch a vaccine-preventable disease, and that there is essentially no risk of this happening for travel within the US, and there is very little chance of this happening for travel outside the US. He does suggest that people who are essentially “living in the bush”, doing missionary work in remote locations or areas where these diseases are endemic in the population, are at special risk for some of these illnesses, but again this doesn’t apply to us because we aren’t going to be traveling to poverty-ridden areas or where access to clean water might be an issue. It was comforting to know that travel as part of our lifestyle doesn’t really need to be changed because of our decision not to follow the recommended infant vaccination schedule.

The other thing I wanted to mention is Dr. Sears’s opinion about the state of vaccine safety research. In short, he says a lot of the studies are wanting. Here are some especially troubling quotes:

Some vaccines aren’t studied alone. Instead, they are given along with several other vaccines, so there is no way to know what their actual side effects may be.

[…]

Most vaccine side effects are monitored for a short time via parent questionnaires.

[…]

Out of the twenty-three major studies done to date that show no link between vaccines and autism, eighteen have some conflict of interest involving vaccine manufacturers. Similarly, the addition of the hepatitis B vaccine to the infant schedule was driven largely by research done by doctors who worked for the vaccine manufacturers.

[…]

What about the statistical chance that your child might get a severe, life-threatening case of one of these diseases? To my knowledge, that information has never been determined accurately through precise scientific statistical analysis. [… Dr. Sears estimates these risks as follows:] A very rough total of 55,000 cases of severe diseases each year in children. We know that the current US population of kids twelve and under is about 60 million. Dividing 60 million by 55,000 cases means that each child has a 1 in 1090 chance of suffering a severe case of a vaccine-preventable illness over the first twelve years of life. Note that flu and rotavirus are responsible for most of these cases. If one were to run the numbers without those two diseases, the risk of suffering a severe case of one of the uncommon disease is only about 1 in 6000. Most severe pediatric cases occur during the first two years of life. An estimation of severe cases in children two years and younger would be about 34,000 cases divided by 10 million kids, or about 1 in 300.

[…]

What is very clear, however, is that vaccines have triggered autism in a very small number of children. A phrase I recently heard sums it up very well: Vaccines don’t cause autism… except when they do.

[…]

If we were to throw out all research that has some conflict of interest, we would actually be left with very little on either side of the [vaccine-autism] debate […] the right type of research has not been done yet.

In addition, here is what Dr. Sears would consider to be the minimum standard for a valid safety research study, which might be helpful for people trying to evaluate various studies in making up their mind about the risks posed by diseases and their vaccines:

• Prospective: the study group is selected and then followed in real time. Virtually all current research has been retrospective, looking back into the past at data on groups of children who have since grown up (for which the outcome is already known).
• Randomized: test subjects are selected at random and placed in either the study or the placebo group in a random manner to avoid bias.
• Placebo-controlled: a study group exists that is not receiving the treatment in question (in this case, vaccines). This is the primary way to be able to draw conclusions with a high degree of accuracy.
• Double-blind study: the researchers and the study subjects don’t know who is receiving the test treatment (vaccines). This prevents bias as the researchers observe and collect, and the test subjects report, data.
• Large-scale research: this is needed for a study to be considered statistically significant and to prove the findings aren’t simply due to chance.

Interestingly, he explains why these studies haven’t been performed to date, and I am not surprised to report it is not an example of “market failure”! The government, as usual, plays a big role here.

A final note: There are several instances where Dr. Sears refers to a disease which has been practically eradicated, but which in recent memory has experienced a sudden outbreak in a localized community before being contained. Aside from a generic geographic description, such as “a neighborhood in Ohio” or something like that, there is no demographic data given about these outbreaks, if it is even collected and publicly known. Wouldn’t it be interesting to know that? If these periodic outbreaks are restricted to specific socio-economic populations, wouldn’t that change the implied incidence of risk for the population as a whole? I’d want to know that information, but the current state of medical research in our country considers this unscientific and irrelevant, so much so that it is politically incorrect to wonder about it. How can facts be offensive? It seems like there is an attempt to control political dialogue here, which I find disturbing.

This book has many virtues but its greatest one is that the information is both comprehensive and well organized, while still remaining succinct. It’s very easy to approach the question of vaccination, its risks and benefits, from a number of angles and find all of them anticipated by this book, and more.

4/5

[amazon asin=0316180521&template=iframe image2]