Writing balanced posts can be tricky, especially in relation to vaccines. Vaccines, like religions and politics, have become a hot-button topic in social discussions, and these three areas are absolutely polarized, definitely enter-at-your-own-risk sorts of discussions that can quickly turn to pissing matches. Ah, but they don't have to, I don't think, and not all disagreement is about that sort of thing.

Plenty of people out there engage in inflammatory rhetoric that inflates the risks from vaccines; I think it's incredibly dangerous and I often counter it in my writings. Age of Autism and SafeMinds are made up of individuals who are fervent, true believers. In their heart of hearts, they believe their cause to be right, their actions to be moral, their intentions pure. Against such convictions all who would naysay are, in their minds, at the least sheople and trolls, paid to stand against martyrs to a noble cause, or worse, we are deliberate evil-doers who wish to commit eugenics and kill innocent children.

We cannot prevail in an information war against people with this mentality. Even if science and reason do, indeed, prevail, so that all in the world recognize that vaccines, while carrying some risk, are far safer for public health and the average individual than the risks involved in catching infectious and preventable illnesses, they will remain as an island of conviction that the world is against them, that we are the brainwashed masses and that they are the valiant defenders of truth.

So we cannot reach them, no reason is possible, and simply by pointing out that this is true, that their information is factually inaccurate, their conclusions wildly implausible, we are the enemy. The enemy.

Never mind that we also are parents of children with autism and other issues. Never mind that we offer supportive community. We do not walk the same path of convictions and there is, therefore, no mutually respected relationship, no commonality and no support. It is a scorched-earth policy from that side; don't think it's not. The loudest voices, the ones who attract the most followers, are extremists who are trying to dismantled the vaccination program bit by bit.

Fundamentalists, whether they be religious, political, or anti-science, are dangerous.

For accurate information on flu vaccines, don't look to SafeMinds; that's a video designed to inspire fear. It's no different than Mercola's screed from this weekend. It is fearmongering run rampant. If they were not true believers, they would not be proud of this video nor the posts. Instead of going to people who have forsaken reasoning and evidence-based practices, look to the CDC and studies published on PubMed. For a good, science-based piece on flu vaccines by Dr.Crislip, read this Science-Based Medicine piece. Search SBM and you'll find several other highly readable pieces.

While we cannot change fundamentalists' belief systems, we must stand and counter, offering reason and rationality, and above all else, evidence. Let them be an island. A very small one. However, let it also be an island we continue to reach out to, to offer emotional support for them so that, while we firmly reject their belief system, we embrace them and offer our compassion. It's a complicated maneuver, but it's one I work at each day.

I acknowledge that adverse events do happen, and I always have. As to whether I give enough attention to adverse events (a charge made by a reader at Countering, where these two combined posts originally appeared), each individual, depending on their particular polarity, will have a different assessment as to whether I do the topic justice or not. It’s my blog, though, and my offhand response to that question is that other than acknowledging the reality that adverse events do occur that I don't need to devote more space to that than I tend to.

In the past, I've devoted blog posts to adverse events and had individuals share their stories on Countering. The problem with the internet and anecdotes is that, well, it can be hard to know the truth, and it’s so easy for so many to invent things. I try to bear this in mind when reading people’s stories while still trying to honor them and treat them as true. It’s messy, no doubt, and I’ve had that trust broken. Ah well.

I’ve argued repeatedly on my blog Countering in its 18 months and 806 posts that people claiming adverse reactions simply because their child has autism and had vaccines takes away greatly from those who have truly suffered from adverse reactions. You know, it’s like those folks claiming adrenal fatigue taking away from the life-threatening seriousness of Addison’s. Color me obstinate, if you will, but that does tend to irk me.

I try to arm my students with tools that will help them think critically and make informed decisions. I teach about availability heuristic in my courses; we have this amazing tendency to put so much faith the in the veracity of what we can easily recall. I grant that it’s exceptionally easier to go with our guts and off the top of our heads than it is to put in the time and the effort to slog through databases and websites in search of reliable numbers, especially when no finite, precise, easy answer may be found. It is tremendously frightening to realize that there may not be clearcut easy answers to all our questions. No cures, nor magic pills to wake us up out of reality and plop us into a reality more of our choosing.

One of the rallying cries of many who believe autism to have been caused by vaccines is that not enough research is being done, or the right kind of research isn’t being done. The more extremist the views, the more strident the cries, and then when research is reported on and not to that group’s liking, calls that it’s been paid for by industry and government are put out.
Research into vaccines is on-going and prolific. Past research has shown that serious adverse events are rare. The Vaccine Court has table injuries that it pays out for, no contest, even though in many cases it appears that the table injuries and vaccines have only been temporally correlated rather than the vaccines actually causing the injury.

I would recommend Stratton, et al., Adverse Events Associated with Childhood Vaccines, Evidence Bearing on Causality. Washington, DC: National Academy Press, 1993, located here for free.

I am confident that scientists will continue to work to deliver the safest, most effective vaccines possible and not because they are profit hungry shills but because they want to save lives.

It is reasonable to be concerned about adverse events dealing with medications and vaccines. It isn’t reasonable to inflate risks of vaccination because one has read one-too-many anecdotes on forums and websites designed to foster that competitive one-upping the Joneses. There’s a place for anecdote, certainly, but not being aware of how they can sway our decision making process and how likely it is than any causal assessments made by an individual based on observation are likely to be inaccurate can make it hard to make informed decisions based on factual information. Anecdotes may be compelling, but it doesn’t mean they’re right. So I’m personally not going to make my healthcare decisions based on anecdotes.

All medications, everything we ingest or inject, carries risks. Over 16,500 people a year die from NSAIDS and around 500 from Tylenol (estimated numbers). And yet, these products remain over the counter. Compared to these deaths, the risks of vaccinations are, indeed, slight. I would especially direct folks to the chapter on deaths in the above report by Stratton et al., which found 159 substantiated reports of death in a 13 month period on VAERS; the committee found that these deaths were temporally correlated but not causally.

This report notes that even though encephalopathy is a table injury for the MMR, that “The evidence is inadequate to accept or reject a causal relation between measles vaccine and encephalitis, encephalopathy, or residual seizure disorder (see Chapter 6). In the committee's judgment the evidence is inadequate to accept or reject a causal relation between measles vaccine and death from encephalitis, encephalopathy, and residual seizure disorder.” It notes when there are known risk factors: “There is evidence that some severely immunocompromised children, such as those with severe combined immunodeficiency syndrome, dysgamma-globulinemia, or leukemia, are susceptible to overwhelming measles infection and subsequent death, even from attenuated measles vaccine. Infection with HIV has not been associated with death from measles vaccine-strain viral infection.”

To suggest that because one doesn’t know of information means it therefore doesn’t exist and isn’t being done is availability heuristic at play. The Stratton report is from 1994, long before Wakefield initiated this current feeding frenzy.

There are 3,503 currently ongoing studies involving vaccines in the US alone.  When I narrow it to risk factors and vaccines, there are 126 ongoing studies.

Emotions are difficult to set aside, especially when they are intense. It’s so hard when you care, when you’re passionately invested in the subject matter to set aside those emotions that get in the way of getting close to reality as possible. It is imperative, vital, that we do so, though.

Medical decisions should not be made because of emotion and the gut feelings we have. They should be made through an impartial, rational assessment of all the available information at hand, with an attempt to weigh out the relative risks, recognizing that we are horribly bad at doing just that. It is why emotions HAVE TO be pushed off, why I will not allow fear to guide my actions. I have sat by my son’s hospital bed and wondered on more than one occasion if he would live. I have sat next to my middle child’s crib in the NICU and watched her struggle to breathe and wondered if we would lose her. I will not let fear control my decisions, nor will I risk the errors that going with my gut and what I can recollect off the top of my head convey.

We all do the best we can. When we know better, we do better. As parents, we should feel a moral imperative to know better so that we can do the best we can. My children, especially my son, rely on me to make the best decisions I can for their welfare. For me, that means going with rationality over emotion and making sure that I am accessing the best, most verifiable information that I can. It means checking my gut and going with the evidence. It isn’t easy, and I’m not perfect, but it’s my best chance for making the best decisions I can for my children.