Sunday, August 28, 2005

Beyond thimerosal -- A question of arrogance

Posted by Craig Westover | 11:45 AM |  

A bill passed by the New York state legislature, similar to the bill that died in committee in the recent Minnesota legislative session, is on Governor George Pataki’s desk awaiting signature or veto by August 30th. Below is an alert issued by the American Academy of Pediatrics calling on its members to urge Gov. Pataki to veto the bill.

The AAP alert is interesting; it follows the form of the arguments made against the Minnesota legislation. It reflects both arrogance and a somewhat frightening proposition that individuals ought to surrender “informed consent” to government mandated programs established for their own good. Note that nowhere in the alert is there an expressed concern for the safety of any individual child. Collective benefit is “good” that takes priority.

From the AAP:

Contact Governor Pataki Immediately and Urge him to Veto the Thimerosal

Bill A.5543/S.2707 which is based on pure junk science and would implement bad public health policy. Please click on the link below that will take you to a prepared letter to be sent directly to the Governor. We at the AAP District II believe this bill is bad for our patients and bad for all New Yorkers, so please act now.

As a pediatrician in New York, I urge you to veto A.5543/S.2707. This legislation represents very bad public health policy that is based on junk science and mass hysteria, not on the evidence of science.
I have never been one that is overly complimentary of legislators, but the implication of the alert is that the New York State legislature was taken in by bill proponents; either they are stupid, or the issue is so complex that only people like the memo’s author can make judgments about what is, or is not, junk science and bad public policy, although the case for either is not made. But this is just the first hint of the arrogance to come.
This bill, designed to protect individuals from alleged adverse effects of thimerosal which contains ethyl mercury, is completely unnecessary. To legislate based on fear and misinformation is an anathema to those of us who work tirelessly for the health and welfare of our communities. To enact this legislation implies that the vaccines that have virtually eradicated many diseases, constituting one of the greatest public health accomplishments of the past century, are dangerous. This bill denigrates our informed scientific and medical communities while supporting all of the anti-vaccine factions in our society. This legislation potentially jeopardizes our most vulnerable communities.
There is a fallacy and an attitude in this paragraph that are found throughout dismissals of the thimerosal controversy. The fallacy is that because the vaccine program has accomplished great goods (which it certanly has), it is ipso facto impossible of creating great harm. This fallacy extends itself to the concept that if some immunization is good, then more (and more) must be better. The safety of that objective is secondary to its achievement.

The attitude is that questioning the fallacy denigrates science. The major concern thus far expressed in the memo is not vaccine safety, but the good name of the medical community, the purity of its intent and the worthiness of its objectives.

Vaccine formulations that are either thimerosal-free or have only trace amounts of thimerosal are currently licensed for use by the Food and Drug Administration (FDA). All recommended childhood vaccines are already thimerosal-free. Influenza vaccine with greatly-reduced thimerosal content is already licensed and available for use in young children and pregnant women. And most importantly, despite the headlines in the media, there is no evidence that thimerosal is harmful.

Update: A reader emails that claiming there are no longer childhood vaccines containing thimerosal may be a false assumption. Some manufacturers, he asserts, did not get FDA approval to begin manufacturing thimerosal free versions until 2003 and 2004. That would mean that any vaccines they produced in 2003 and even as late as early 2005 might contain thimerosal. The email notes -- "I have heard many stories of parents who are told there is no mercury in the shot their child is about to get, and when asking to see the insert, the nurses and doctors act shocked to see that they were wrong. "

This same point was made to me by a physician, citing the Johns Hopkins' Institute for Vaccine Safety as her source.

Returning to the AAP alert --
This legislation would abolish the use of thimerosal-containing vaccines in children under age three and in pregnant women, except under specified declared exceptional circumstances. In the absence of influenza vaccine shortages, this is a non-issue. Should we again experience influenza vaccine shortages and face an issued exception to this rule, families are likely to believe that vaccine is dangerous (for why else would there be such a law?) and refuse such immunization.

These paragraphs expose an element of this controversy that extends beyond the thimerosal issue; government health agencies have lost sight of individuals and are focused almost exclusively on the safety of the herd. “Informed consent” is a non-issue. So are any market-force checks and balances on vaccine safety. To question safety is unacceptable. To refuse immunization is not just ignorant -- it is selfish in that it endangers the herd.

In addition, our vulnerable adult populations should receive influenza vaccine each year to protect themselves, their families, and their communities. This legislation suggests that the vaccine they receive is dangerous.
If one goes back to last fall’s flu vaccine shortage, prior to the shortage everyone was urged to have a flu shot. During the shortage, we were reassured that only the most vulnerable required such shots and others should not get the shot so there would be supplies for the most vulnerable. Then suddenly we had excess shots available and everyone was again urged to get vaccinated. At that point, many did not and vaccine had to be destroyed. The message changed to fit the capability of the government program to provide vaccine.

Again, individual health was not so much the concern as the health of the vaccine program. In fact, extension of the flu vaccine program and government control of prices is a likely culprit in recent shortages.

To allow fear and misinformation to jeopardize the robustness of our immunization efforts, particularly around influenza, does our public health efforts a disservice, endangers our children, families, and communities, and is ill advised.
Case in point. The danger as the AAP sees it is a danger to “our immunization efforts,” not a concern for individual safety. It does “public health efforts a disservice.” This is not the sound of government conspiracy; it is the voice of arrogance. Questioning safety does not endanger children, families and communities. It only endagers a program that cannot provide satisfactory responses to questions of safety.

Update: From a reader email --

That [attitude toward biomedical treatment] isn't going to change until someone studies our kids, especially kids like mine who regressed after vaccinations and got better on biomed/chelation, and some reputable, brave journal actually prints it. I have tried to talk to my own pediatrician about it, and he gives me kudos for all [my child's] progress, but says he is not going to make any changes in the way he assesses and referrs until he hears different from the AAP. "I figure that they are a hell of a lot smarter that I am".