The nice Onken people...

sent me some goodies in the post and assured me that they're launching new yogurt flavours soon. (This in reply to my earlier letter to Onken.) In the meantime I've discovered that Sainsbury's do a really great hazelnut one. Now I just have to sort out some of the mysteries of supermarkets in the UK including:
- why can't you buy bags of bran in supermarkets here? (the stuff you add to bran muffins)
- why is buttermilk a rarity?
- where do you find ordinary white spirit vinegar?
Funny, all the things you'd find in the most basic general dealer in the tiniest outpost of southern Africa seem to be regarded as oddities here.

Why the anti-vaccination brigade hasn't convinced me

I don't have kids. Yet. But, at six months pregnant, I'm discovering that the path of the parent is beset on all sides by the iniquities of the various parenting-related industries, and the tyranny of other parents. In the past few months, I've learned terms I never heard before: attachment parenting, controlled crying, sleep nazi, elimination communication, baby signing - and vaccination injury.

What is a vaccination injury? A slip of the needle? No, say the proponents of the anti-vaccination lobby, there's more to it than that (1, 2). Their objections to the vaccination industry are somewhat more serious. They regard routine vaccinations as a disturbing extension of pharmaceutical companies and government strategies who would profit from making sure the greatest number of people get injected with their drugs, whatever the risk. It’s a minefield, and a compelling one, especially when you’re a parent and you want the best for your children. What follows are their claims, and a discussion of how seriously we can take them.

CLAIM #1: Children today are sicker - physically, emotionally, educationally and developmentally - than ever before. Since the 1950s, most children have been getting routine vaccinations. In the same time frame we've seen exponential rises in obesity, diabetes, asthma, autism, allergies, ADD and even nutrient deficiencies. Therefore the aggressive vaccination schedule must be (at least partly) to blame.

This argument is the starting point for most vaccine-risk literature (1). Drawing a link between increased vaccination rates and raised illness levels is a fast way to get an emotional reaction out of a parent. Do you want your kid to be sick? No. Do you know EXACTLY what was in that injection? Of course not. Do you see the stats about increased juvenile disease all around? Um, yeah. Feeling nervous yet? Well, yes.

Not so fast. Noticing that two things both happened within the same time frame does NOT imply a causal relationship between them. To do that, you'd need some research that carefully examines the incidence of these diseases and conditions both in groups that were and weren't vaccinated. I've never seen vaccine-risk literature that provides this evidence. At best, you'll get a quote from a paediatrician saying that parents should know the risks, or the name of an article or a book (seldom even an active URL).

You'll certainly never see them point to other major changes that have taken place over the last 30 years: the massive injection of sugar, fat and processed additives into fast food and convenience food, and the aggressive marketing of those products to children (a much better-researched area, and one which IS more convincingly linked to juvenile diabetes, obesity and allergy levels). Or, say, the massive increase in the time kids spend sitting in sedentary and isolated activity watching TV or playing computer games instead of outside developing muscular and social co-ordination through games and activities.

What about autism? Well, a scout around the National Autism Society will get you some of the statistics about autism rates in the UK (3) and possible causes of the little-understood condition (4). Vaccines themselves do not come into it (aside from the suggested link between the preservative thimerasol; see claims 2 and 3 below). Genetics do. But try telling that to someone that watched their child develop autism and believes it was caused by a vaccination. Which brings us to the next point of argument:

CLAIM #2: When you meet the parents of a child who mysteriously developed regressive autism within 2 to 3 weeks of his/her MMR vaccination, it's hard to discount their story as anything but 'proof' of links between vaccines and autism.

Once the literature has frightened you with juvenile disease stats, it’ll point you in the direction of a family whose child reacted badly to the MMR vaccine, and, typically, who developed regressive autism within a few weeks of their vaccination. Is it heartbreaking? Yes. Is it frightening? Yes. Does it provide sufficient evidence to link the vaccines to the condition? Unfortunately not.

Around 95% of children are vaccinated in the first 2 years of their lives. Regressive autism, which occurs in around 6 out of every 10 000 children, usually becomes evident around 18 months. What is the probability that this is going to happen within a few weeks of a vaccination? You do the math. It doesn't make the individual cases any less upsetting for the families of autistic children. Three medical studies (one of which has been officially retracted by its authors) have claimed a link between the MMR vaccine and autism Twenty-three medical studies have refuted this link, finding no convincing links between the vaccine itself and the development of the disorder (12, 14).

Still, faced with their personal tragedy, parents whose children developed autism within weeks or months of receiving a vaccination tend to draw the conclusion that there is a link. They find other parents in a similar situation, and conclude further that autism rates are on the rise. In fact, they are not. Before 1980, about 1 in 2,500 children was diagnosed with autistic spectrum disorders. Today, the figure is closer to 1 in 250. The subtle fact behind this stat, however, is the fact that the increase in diagnosis comes from a broader definition of autism, and wider recognition of symptoms rather than an actual increase in incidence. (5) The incidence of regressive autism - the type of autism allegedly linked to the MMR jab - has not changed.

Furthermore, while the more widespread recognition of autism may mean we see a rise in actual case numbers, it does not prove links between vaccines and autism rates. In fact, in recent studies, Hiroshi Kurita, of the Zenkoku Ryoiku Sodan Centre in Tokyo, said genetic factors were the most important cause of autism, but "no study has ever clarified the rising prevalence of pervasive developmental disorders from this aspect" (6).

CLAIM #3: Vaccinations may contain dangerous stuff.

You will find these very broad claims about the dangers of 'animal proteins' and 'animal virusus' in most vaccination risk literature. These sorts of statements are so broad they barely contain any useful information. Yes, vaccines are cultivated in animal cells. Some vaccinations, including MMR, influenza and yellow fever vacs, are made using hens' eggs. (Strict vegetarians might have an ethical problem with this, which is a separate issue.) But where exactly are medical researchers supposed to cultivate vaccinations? Which precise dangers are these fearmongers referring to? Trying to pin them down to evidence usually leaves blank trails.

The one closer-to-accurate point made under this point is that vaccinations contain toxic chemicals. The culprit here is mercury - specifically, a compound called thimerasol, which is 50% ethyl mercury (a derivative of organic mercury) by weight and has been used as a vaccine preservative since the 1930s. Thimerasol was commonly used in the DTP (diphtheria, tetanus, pertussis shot), as well as vaccines against hepatitis B and haemophilus bacteria. By the early 90s, these were both routine vaccinations for American infants. (9)

Studies into the use of thimerasol have not shown it to have any safety risks, but it came under the spotlight in the late 1990s in the midst of environmental concerns about mercury-tainted fish and worries that increased vaccination schedules for American infants might mean that they were getting exposed cumulatively to dangerous mercury levels.

Although organic mercury is indeed a neurotoxin, thimerasol contains ethyl mercury in such trace quantities per million parts of the relevant vaccines that most vaccinologists are convinced that there is no danger of mercury poisoning from it. Most cases of mercury poisoning require levels of mercury hundreds to thousands of times higher than those to which routinely vaccinated infants are exposed. There is simply no research that conclusively links the preservative to any known danger.

However, around 1999, there was a spike in reported cases of regressive autism in the US. One of the hypotheses put forward to explain the sudden increase in the number of cases was the widespread use of thimerasol as a preservative in several vaccines plus the presence of higher-than-usual mercury levels in fish consumed by pregnant mothers (11). Although the link was, at most, an untested hypothesis, in 1999 the American Academy of Pediatrics and the Public Health Service urged vaccine manufacturerers to remove the preservative from their vaccines, and advised pediatricitions to postpone hep B shots. Inevitably, anti-vaccination crowd leapt on the story with more triumph (and lawsuits) than was warranted by the evidence. They did not focus on the cost of the decision, which created vaccine shortages and led some babies to become infected with hep B.

Today, most vaccines are free of thimerasol anyway, as manufacturers quickly sought to free their products from the much-maligned mercury derivative despite the fact that the claims have NOT been substantiated in any conclusive way. (7, 9)

CLAIM #4: Vaccine injuries/deaths are underreported; many children have adverse reactions to vaccines. Immunisation programs either ignore or suppress these reports, assuming that "it is good to sacrifice the wellbeing of a few for the many".

The most common reactions to vaccination is some itching or swelling at the site of the injection. This IS a common side effect of the vaccination itself, with no lasting ill effect. Yes, a vaccine does involve injecting toxins into a healthy child in order to stimulate an immune reaction. Many parents will balk at the prospect of injecting toxins into their healthy child's body: why introduce a risk of any sort into a perfectly healthy child?
Dr Stephen Basser, in his excellent analysis of the arguments put forward by high-profile campaigner against immunisation, Dr Viera Scheibner, points out that ‘the paradox of a successful immunisation program is that the more widespread immunisation becomes the more attention will be given to vaccine-related illness’ (15).

Vaccination, like any medical procedure, does carry an element of risk. One in every million children immunised can have a more serious reaction known as anaphylaxis (severe allergic reaction) to the vaccine (10). Basser says:
“I am prepared to agree that, like any medical procedure, there are occasional individuals who suffer a seriously adverse reaction to immunisation. This reality, though, is not an argument for cessation of all immunisation, just as the occasional tragic outcome from coronary bypass graft surgery is not a valid argument for stopping all such surgery.”

Anti-immunisation advocates like to wave this point away, calling it mainstream propaganda, designed to value ‘herd immunity’ over individuals whose lives get placed at risk. However, if you look astutely at the evidence (and Basser does), it becomes evident that the risks faced by unvaccinated children are greater than those faced by vaccinated children. The only factor that reduces their risk of catching contagious diseases is the rate of vaccination amongst their peers.

Conclusion
There are articles, there are reports, there are studies, and there are arguments. The only material about vaccination that can really tell you what works and what doesn’t are the studies. The rest offer little more than invective. The studies are all available (14) – many of them online – but they aren’t what you’ll find on the anti-vaccination sites. What you’ll find there is a blurry mix of emotion from parents of mentally and physically ill children, pseudo-science and ill-substantiated arguments. The one point they have right is that parents have the right to be informed about the risks they’re taking when they vaccinate. Where they fall terribly short is in overlooking the far greater risks that parents take when they don’t.

References

1. The National Vaccine Information Centre website, February 2009.
http://www.nvic.org.

2. The Vaccination Risk Awareness Network website, February 2009.
http://www.vran.org

3. How many people have autistic spectrum disorders? National Autistic Society, May 2007.

4. What causes autism? National Autistic Society, May 2007.

5. Autism rates 'not rising'. BBC News. 15 February 2001.

6. Autism could affect twice as many children as previously believed. The Independent, 14 July 2006.

7. Doing the right things for the wrong reasons. www.blissfulknowledge.com

8. A Population-Based Study of Measles, Mumps and Rubella Vaccination and Autism. New England Journal of Medicine. November 7, 2002.

9. 'The Not-So-Crackpot Autism Theory' by Arthur Allen, published in the New York Times, 10 November 2002.

10. NHS Immunisation information. February 2009.

11. 'Autism Rates Drop After Mercury Removed from Childhood Vaccines' published in Medical News Today, 3 March 2006.
http://www.medicalnewstoday.com/articles/38784.php

12. 'Mercury and autism: a briefing,' the National Autistic Society, March 2006. http://www.nas.org.uk/nas/jsp/polopoly.jsp?d=115&a=3227

13. Offit et al. ‘Addressing Parents’ Concerns: Do Multiple Vaccines Overwhelm or Weaken the Infant’s Immune System?’ published in Pediatrics, 1 January 2002.
http://pediatrics.aappublications.org/cgi/content/full/109/1/124

14. ‘MMR vaccine does not cause autism’. A full list of the 23 medical studies that refute the link between MMR and autism, and the 3 articles that claim a link (1 of which has been officially retracted by its authors). This is as a downloadable .pdf file from:
http://www.immunize.org/mmrautism/index.htm

15. Basser, Dr S. ‘Anti-immunisation scare: the inconvenient facts’. Published in Australian Skeptics, Vol 17 No 1.
http://www.skeptics.com.au/journal/1997/1_immunise.htm

16. Allied Vaccination Group
http://www.vaccine.org/

Facebook-free

I wonder how many people went and killed their Facebook accounts after yesterday's article in the NY Times (1) about how difficult it is to get out of the site's sticky grip. Perhaps nearly as many as the time that the Guardian took a look at the guys behind facebook (2), and what they're doing with the profit and power they gain from all our incessant social networking.

I've been meaning to get round to it, but somehow it was easier to log on and check my Warbook level than it was to opt out. It's been a while already since the constant barrage of status updates lost their lustre. The latest sleep and poo updates of friends with newly borns; the latest hangover and party updates from those still on the rave circuit; the American Psycho quotes. Occasionally funny or thoughtful; mostly banal.

Eventually, though, I decided that for every reason to use Facebook, there is somewhat more compelling reason not to. Feel free to add yours to the list.

Reasons to use Facebook:
1. It's fun. Well, for about a month or so. While you get unexpected emails from old school and varsity friends you've always wondered about.
2. It's cool and funny. You can track who's connected to whom. While they throw the occasional sheep at you.
3. It's useful for mobilising groups. You can set up an event and invite a bunch of people along. As many or as few as you like. You can publicise big events. In other words, you can be clever and use it for networking.
4. You can avoid work and other stuff. Facebook provides premium work-avoidance opportunities. Spend hours posting notes and photos, and playing Warbook or Scrabulous. If you can bear the slow download times for the heavily framed FB pages.
5. If you're a software developer, you can get loads of people using your applications really fast.
6. You like feeling like you're part of the wired generation.

Reasons to quit Facebook:
1. You've had enough fun. You've remembered that there's a reason you lost touch with some people. You don't actually care about your colleague's newborn's latest nappy change.
2. It's not actually that cool or that funny. Actually, it's boring and a waste of time.
3. If people actually want to invite you to something, the ones that matter tend to have your phone number or email address.
4. You're wasting more time on it than you'd like to admit.
5. You're not a software developer, are you?
6. You've heard enough about FB's dubious privacy policy (or lack thereof), and you're starting to get uneasy about quite how much personal information they have about you, and quite how much revenue your internet traffic is generating for the sites owners.

Still, there were so many reasons to put it off. Not least the groups and events applications. How will I know when the next extraordinary flash mob event is? What if a bunch of people I know are organising, I don't know... a house party. Yes, well. Maybe they'll get in touch via email or phone. Maybe I just won't know about the next Big Underground Happening. I'm sure I'll find something to fill the time.

References

1. Aspan, Maria. New York Times, February 11, 2008

How Sticky is Membership on Facebook? Just Try Breaking Free

2. Hodkinson, Tom. The Guardian, 13 January, 2004.
With friends like these...

3. How to break out of Facebook's sticky grip.
http://www.wikihow.com/Quit-Facebook

4. Jason' Preston's somewhat more subversive approach - getting out of it by violating the terms of service.

5. Randall, David and Richards, Victoria. Facebook can ruin your life. The Independent, Sunday 10 February 2008.