Mailbag: Anti-Vaccine Myths, Pharma Shill Gambit and Vaccine Court

Recently, an anti-vaccine activist by the name of “peter” posted a comment on my article Irrefutable Evidence Shows That Anti-Vaccine Activists Still Have No Clue (were I destroyed some anti-vaccine propaganda written by Dave Mihalovic). It did not address any arguments and attacked me directly, yet I think it can still be useful to unravel and debunk his claims about scientific skeptics, vaccines and the U.S. legal system. This exercise also highlights some of the common rhetorical devices that anti-vaccine activists make use of in their efforts to undermine modern medicine.

The basics flaws in his approach are (1) the use of the “pharma shill” gambit, (2) the gross ignorance about the Office of Special Masters of the U.S. Court of Federal Claims (also known as “vaccine court”) and the Vaccine Injury Compensation Program (VICP) and (3) the deployment of anti-vaccine crankery about the alleged negative health effects of vaccines.

As we shall see, the pharma shill gambit is just a vacuous rationalization to psychologically shield anti-vaccine beliefs, vaccine court / VICP are more beneficial to individuals who have suffered a genuine adverse effect of vaccines (faster, cheaper and requires a much lighter burden of evidence to be met) and the peer-review literature as well as scientific reports by the Institute of Medicine (IOM) and others show that vaccines are not linked to the conditions he claims.

Here is what Peter has to say about me and vaccines:

Peter accuses me of being a moronic pharma shill and that I support criminal drug companies. Further, he triumphantly states the rhetorical question why the U. S. government does not let people who claim to have gotten a vaccine injury if vaccines are safe. Finally, the spouts the same old canards about how vaccines allegedly cause a great number of disease in children and adults.

Let us examine these three categories of claims.

The pharma shill gambit

The pharma shill gambit consists of condescendingly dismissing arguments by asserting that the person making those arguments are somehow paid off by the pharmaceutical industry (Gorski, 2009). This is based on the preconceived notion that no independent thinker could possibly come to the conclusion that vaccines are safe and effective. When an anti-vaccine activist come across such individuals, cognitive dissonance strikes and the only way to make their worldview consistent against is to dismiss the science-based arguments and evidence in favor of vaccines by investing and attacking the motives of the person presenting those arguments and that evidence.

Throughout my time as a skeptical debunker of pseudoscience, I have been accused of being a shill for companies producing vaccines (because I point out that vaccines are safe and effective), companies producing antiretroviral medication against HIV/AIDS (because I criticize HIV/AIDS denialists), companies producing psychiatric medication (because I refute anti-psychiatry cranks), Al Gore, the EPA and Greenpeace (because I debunk climate change denialists), Israel and the Anti-Defamation League (because I reject Holocaust denial), NASA (because I explain that the evidence for humans having been to the moon is very strong), Monsanto (because I find the assertions by anti-GMO zealots to be highly flawed and unpersuasive) and NSA (for dismissing crank 9/11 conspiracy theories).

So I just have one question for the people constantly spouting various shill gambits: where is my money!? Surely, I should be a multi-billionaire by now?

Vaccine court is cheaper, faster and requires a lighter burden of evidence for compensation

The Vaccine Court was established because the irrational litigations of parents who falsely believed that their children had been damaged by the vaccine against diphtheria, tetanus and pertussis (DTP) vaccine. Juries awarded parents extremely large financial compensations despite the fact that either there was no evidence for a causal association or the evidence favored the rejection of such an association.

These false litigation claims nearly eliminated vaccine production in the U. S. all-together. This is because, contrary to the assertion of anti-vaccine cranks, pediatric vaccines are not really that profitable in comparison with other medical products. This is because such vaccines are only given a couple of times per individual per lifetime. Compare this with medication against high cholesterol etc. that people need to take every day. So many companies stopped producing the DTP vaccine and this threatened vaccine manufacturing in the U.S.

Another problem was that pharmaceutical companies could spend a lot of money on lawyers and drag out the legal proceedings to the detriment of families. This mean that families with children who had gotten actual vaccine side-effects had to wait a long time for the trials to finish and the entire process was presumably quite expensive for them, both in terms of time and money. Furthermore, some (but not all) legal claims required evidence of fault from the pharmaceutical company. This meant that the burden of evidence was fairly high.

The government understood these problems and established the Vaccine Court to handle it. In the Vaccine Court, the burden of evidence is much lower and does not require that the plaintiffs demonstrate fault. This means that it is a lot easier for parents to get financial compensation because they do not have to prove beyond all reasonable doubt that the pharmaceutical company did something wrong or demonstrate a massive amount of scientific evidence for a causal connection. It is also cheaper and faster for the plaintiffs as cases are handled much more rapidly and they do not risk having to pay the legal costs of the pharmaceutical companies if they lose.

In other words, Vaccine Court probably saved U. S. vaccine production and it is more beneficial for parents than the previous system were they could sue the pharmaceutical companies directly (U. S. Court of Federal Claims, 2004).

Vaccines do not cause autism

Around a dozen independent researcher studies published in the peer-reviewed scientific literature has shown that there is no link between vaccines and autism. This research is reviewed in Gerber and Offit (2009) and the fact that it converges on the same conclusion means that the evidence strongly favors a rejection of a causal link between the MMR vaccine and autism. The same conclusion was reached by the independent Institute of Medicine in their 2004 report entitled Immunization Safety Review: Vaccines and Autism (Institute of Medicine, 2004):

The committee concludes that the body of epidemiological evidence favors rejection of a causal relationship between the MMR vaccine and autism. The committee also concludes that the body of epidemiological evidence favors rejection of a causal relationship between thimerosal-containing vaccines and autism. The committee further finds that potential biological mechanisms for vaccine-induced autism that have been generated to date are theoretical only.

The source behind the claim that the MMR vaccine cause autism was a paper published in the Lancet back in 1998 by Andrew Wakefield. However, the interpretation section was retracted in 2004 (and most co-authors distanced themselves from the paper) and the entire paper retracted in 2010. Investigations (see Deer, 2011 for an overview) revealed that Wakefield had performed painful and medically unnecessary tests on children with autism without approval of an ethical review board, he manipulated and altered research data (thus committing scientific fraud) and received over 400 000 GBP from lawyer Richard Barr (who was working on an anti-vaccine lawsuit against GlaxoSmithKline). In addition, the study did not have a control group and many of the children subjects of the study had developed problems prior to getting th MMR vaccine. Wakefield was later struck off the Medical Register and banned from practicing medicine in the U. K.

As a final note in this section, it is ironic for anti-vaccine cranks to oppose the MMR vaccine if the fear autism. This is because one of the complications of rubella infection in pregnant women is the child may develop autism (Muhle, Trentacoste and Rapin, 2004). So by vaccinating against rubella, some future children are actually being protected against autism.

Vaccines do not cause asthma or allergies

Allergies are thought to develop by insufficient stimulation of Th1 cells (and thus too little inhibition of Th2 cells that can contribute to allergies) as well as insufficient stimulation of regulatory T cells by infection. Yet no vaccines are given for the most common childhood infection (upper-respiratory viral infections) and children get over half a dozen infections per year on average (Offit and Hackett, 2003). This means that vaccines are probably not a factor for the development of allergies.

Many studies have been performed that also show no link between vaccines and allergies (reviewed in Offit and Hackett, 2003). This paper also discusses the lack of association between vaccines and asthma:

One well-controlled study was performed using the computerized records of children born between 1991 and 1997 who were enrolled in 4 large health maintenance organizations (HMOs). This cohort was used to identify 18 407 children with asthma. Relative risks of asthma in vaccinated children were determined by comparison with children who did not receive vaccines. The relative risk for asthma was 0.92 for the combination diphtheria-tetanus-whole-cell pertussis vaccine, 1.09 for the oral polio vaccine, and 0.97 for the combination measles-mumps-rubella vaccine. In children who had at least 2 medical encounters during their first year of life, the relative risk for asthma was 1.07 after receipt of the Haemophilus influenzae type b (Hib) vaccine and 1.09 for the hepatitis B vaccine.

Thus, the risk for the vaccinated group was not clinically significantly larger than the risk for the unvaccinated group.

Vaccines do not cause Sudden Infant death syndrome (SIDS)

An Institute of Medicine immunization safety review from 2003 concluded the following after reviewing the existing literature (Institute of Medicine, 2003):

Based on this review, the committee concluded that the evidence favors rejection of a causal relationship between some vaccines and SIDS; and that the evidence is inadequate to accept or reject a causal relationship between other vaccines and SIDS, SUDI, or neonatal death.

Although the precise cause(s) of SIDS has not yet been identified, researchers have shown that risk factors for SIDS include brain abnormalities, low birth weight, respiratory infections, sleeping on stomach or side, sleeping on a soft surface, sleeping in the same bed as parents, having a mother below the age of 20, having a mother that smokes and a family history of SIDS (Mayo Clinic, 2011).

No evidence that vaccines cause mitochondrial dysfunction

Here is what the CDC has to say about the claim that vaccines cause mitochondrial disorders (CDC, 2010):

Do vaccines cause or worsen mitochondrial diseases?

As of now, there are no scientific studies that say vaccines cause or worsen mitochondrial diseases. We do know that certain illnesses that can be prevented by vaccines, such as the flu, can trigger the regression that is related to a mitochondrial disease. More research is needed to determine if there are rare cases where underlying mitochondrial disorders are triggered by anything related to vaccines. However, we know that for most children, vaccines are a safe and important way to prevent them from getting life-threatening diseases.

The remaining claims (neurological disorders, childhood gastrointestinal disorders and cancers) are too broad vaguely phrased to be subject to a proper refutation, but Peter has not provided a shred of evidence that vaccines are linked with these categories of diseases. Thus, there is no reason to take what he says seriously.

Conclusion:

This is a the debating rhetorics of a typical anti-vaccine activist: never provide any real scientific evidence, angrily accuse defenders of science-based medicine to be pharma shills, claim that vaccines cause all sorts of diseases and promote conspiracy theories about a solution that is actually beneficial both for vaccine production and those that have had real vaccine side-effects.

References and further reading:

CDC. (2010). Mitochondrial Disease – Frequently Asked Questions. Accessed: 2013-07-03.

Deer, Brian. (2011). How the case against the MMR vaccine was fixed. BMJ, 342.

Gerber, J. S., & Offit, P. A. (2009). Vaccines and Autism: A Tale of Shifting Hypotheses. Clinical Infectious Diseases, 48(4), 456-461.

Gorski, D. (2009). The Pharma Shill Gambit. Science-Based Medicine. Accessed: 2013-07-03.

Institute of Medicine. (2003). Immunization Safety Review: Vaccinations and Sudden Unexpected Death in Infancy. Washington, D. C: National Academies Press.

Institute of Medicine. (2004). Immunization Safety Review: Vaccines and Autism. Washington, D. C: National Academies Press.

Mayo Clinic. (2011). Sudden infant death syndrome (SIDS). Accessed: 2013-07-03.

Muhle, Rebecca, Trentacoste, Stephanie V., & Rapin, Isabelle. (2004). The Genetics of Autism. Pediatrics, 113(5), e472-e486.

Offit, Paul A., & Hackett, Charles J. (2003). Addressing Parents’ Concerns: Do Vaccines Cause Allergic or Autoimmune Diseases? Pediatrics, 111(3), 653-659. doi: 10.1542/peds.111.3.653

U. S. Court of Federal Claims. (2004). Vaccine Program/Office of Special Masters. Accessed: 2013-07-03.