Friday, November 16, 2012

Move the Goalposts... It's Time to Talk Aluminum

Spend more than five minutes on an anti-vaccination website and you will soon realize that most antivaxxers aren't exactly fans of aluminum.  No we aren't talking about aluminum cans or cookware, but rather we are talking about aluminum in a salt form which is commonly used in vaccines to act as an adjuvant.  In simple terms, the aluminum increases the effectiveness of a vaccine due to how it triggers a reaction within the immune system.

Aluminum has been used within vaccines for over 80 years, so you might ask yourself why are antivaxxers suddenly so focused upon aluminum when it isn't exactly a new ingredient?

Well to answer that, you first need to realize where we have been.  Antivaxxers have previously attempted to single out other ingredients such as thimerosal as they blamed it for various conditions up to and including autism in children.  They used scare tactics to associate thimerosal with mercury poisoning due to a misunderstanding of the differences between ethylmercury and methylmercury.

However, even prior to these cries of mercury poisoning from the antivaxxer community, the Food and Drug Administration (FDA) was already in the process of reviewing the use of thimerosal in vaccines.  Under the FDA Modernization Act (FDAMA) of 1997, the FDA carried out a comprehensive review of the use of thimerosal in vaccines.  The review found no evidence of harm from the use of thimerosal other than local hypersensitivity reactions near the injection site.

In the early 2000's, the Immunization Safety Review Committee of the Institute of Medicine (IOM) performed a review of all available research including studies in the United States, the United Kingdom, Sweden, and Denmark and they specifically focused upon the hypothesis that thimerosal was a contributing factor to childhood diseases such as autism.  The committee concluded that the available data and studies rejected the casual relationship between thimerosal (or vaccines containing thimerosal) and autism.

This is probably a good time to mention the fact that the IOM is part of the National Academy of Sciences and is a non-governmental institution. That may not seem particularly relevant, but since antivaxxers have a severe distrust for the federal government or any three letter agency (CDC, FDA, EPA et al), it should be clarified that the IOM is an independent organization and therefore would not share the same perceived bias(es) as a government agency.

Even though the IOM rejected the relationship between thimerosal and autism the FDA, as a preventative measure which had begun years earlier, was already in the process of removing thimerosal from vaccines.  As of 2001 thimerosal was removed from all childhood vaccines recommended for children six years of age or younger (keep in mind autism generally presents itself between ages two and four), and the only exception to this were some versions of the inactivated flu vaccine (although thimerosal-free versions are available).  In addition to this, all new non-influenza vaccines licensed since 1999 contain no thimerosal.

So what was the end result of removing thimerosal from childhood vaccines? Did we see a significant drop in the rates of autism? Nope. In fact, since 2001 the rates have actually gone up, and thus the theory that thimerosal was responsible for the "autism epidemic" was quite obviously no longer popular to rally behind. Children who had never received even trace amounts of thimerosal were still being diagnosed with autism and therefore antivaxxers realized they could no longer place blame upon thimerosal. It soon became obvious it was time to try something new.

Move the goalposts - we have another new theory!

When antivaxxers realized that pinning their hopes upon thimerosal might not exactly pan out, they shifted gears a bit and started focusing on one specific vaccine (the MMR vaccine) which they claimed was directly responsible for autism in children.  It was around this time that they started professing that Andrew Wakefield was a genius and seemed to have the secret to unlocking the root cause of autism due to a study he published in 1998 which attempted to link the MMR vaccine with autism.

Of course after Wakefield was discredited and stripped of his medical license, and after his "study" was retracted, and after he was found guilty of fraud and manipulation of data.... well he didn't exactly seem like the great savior afterall and he soon found himself the laughing stock of the scientific community.  It was around this time that many antivaxxers decided to back-peddle a bit and distance themselves from Wakefield (although in some extreme antivaxxer circles, Wakefield continues to be considered a favorite son).

So at that point the antivaxxers decided that instead of focusing on the MMR vaccine specifically, they should simply talk about vaccines or vaccine ingredients in more general terms because scaring people by talking about mercury poisoning or "toxicity" is generally more effective than trying to convince people that a discredited doctor was right all along.

You guessed it - time to pick up those goal posts and slide them back just a bit further!

A few years ago around the time many antivaxxers decided to stop talking about thimerosal or the MMR vaccine, they decided to start talking about other vaccine ingredients such as formaldehyde.  Why the focus on formaldehyde?  Well it surely had nothing to do with science, but rather it was about perception.  It seems most people associate formaldehyde with high school Biology class where a fetal pig or a frog was stored in it prior to dissection.  They recall the strong odor and the fact there were warning labels which stated severe over-exposure to the liquid could result in death.  They also associate formaldehyde with embalming fluid and dead bodies... so surely this isn't something that should be in a vaccine should it?

Well the truth is there is very, very little formaldehyde in vaccines, and it just so happens that we already have far greater quantities of formaldehyde in our bodies at any given point than we ever receive from any vaccine.  It turns out we have around about 2.5 ug of formaldehyde per ml of blood.
Per the Children's Hospital of Philadelphia's (CHOP) Vaccine Education Center: "Assuming an average weight of a 2-month-old of 5 kg and an average blood volume of 85 ml per kg, the total quantity of formaldehyde found in an infant's circulation would be about 1.1 mg, a value at least five-fold greater than that to which an infant would be exposed in vaccines".
In fact, we as humans actually NEED formaldehyde to survive since it is required for the synthesis of DNA and amino acids, thus suggesting the amount in vaccines would somehow be harmful was at best ignorant, and most likely simply dishonest.  Thus after antivaxxers realized the amount of formaldehyde found in vaccines was insignificant, they actually went so far as to suggest there is a difference between "natural" formaldehyde, and "synthetic" formaldehyde... once again showing that antivaxxers seem to ignore even the most basic tenets of chemistry.

The formaldehyde argument didn't seem to gain much traction however - most likely since anyone who has ever taken a basic chemistry course understands what formaldehyde really is - so the antivaxxers soon decided it was time for something new.

Get the shovel out... those goalposts need to be moved yet again!

This brings us to present day - when many antivaxxers have decided the one ingredient within vaccines which is REALLY, REALLY harmful (for reals this time), and the one ingredient that has the potential to cause the most damage is none other than aluminum.  Per the Centers for Disease Control (CDC), "[a]luminum salts, such as aluminum hydroxide, aluminum phosphate, and aluminum potassium sulfate have been used in vaccines for more than 70 years" so you might think the antivaxxers are a bit late to the game... but hey - better late that never right?

I suppose to the layman, telling them you are going to inject them with aluminum sounds about as appealing as telling them you are going to inject them with mercury.  Saying these things scares people... and isn't that the point?  We can't expect people to realize that the aluminum is the most common metal on the entire planet can we?  Can we expect them to know that there is a vast difference between a chemical compound containing aluminum and an actual piece of aluminum that may be used to form a soda can?

The truth is, aluminum is actually all around us, and even in us.  Aluminum is found in our water, it is found in our the soil, it is found in the air, it is commonly used in antacids, aspirin, and yes it is even found in our food including fresh fruits, vegetables, and meat.

So what is an antivaxxer to do when they soon realize that aluminum is all around us? What can they do when they find out the average human contains between 50 and 150 mg of aluminum at any given time?  What do they do when the find out the average daily intake of aluminum may range from 10-110 mg?   Well... they simply decide to focus on the amount of aluminum in vaccines rather than the amount of aluminum anywhere else in our body or our environment. Seems legit.

The problem is, vaccines really don't contain very much aluminum.  A typical vaccine contains no more 0.85 mg of aluminum per dose.  To put this in perspective, aluminum is also found in soy-based infant formula (0.46–0.93 mg/L) and milk-based infant formula (0.058–0.15 mg/L) which means an infant will consume more aluminum in a few days of drinking formula than it would receive from a typical vaccine.
Per CHOP, "During the first 6 months of life, infants could receive about 4 milligrams of aluminum from vaccines. That’s not very much: a milligram is one-thousandth of a gram and a gram is the weight of one-fifth of a teaspoon of water. During the same period, babies will also receive about 10 milligrams of aluminum in breast milk, about 40 milligrams in infant formula, or about 120 milligrams in soy-based formula.
Even more shocking, a common over the counter antacid has around 300-600 mg of aluminum hydroxide (approximately 104–208 mg of aluminum) per tablet, capsule, or 5 milliliter (mL) liquid dose! That means if you take a single tablet of a commonly available antacid, you are consuming as much as 245 times more aluminum than you would get out of a typical vaccine.

So why aren't antivaxxers out there protesting against antacids?  If you consider how much aluminum a typical adult human might consume in a 24 hour period as a result of some heartburn, it would seem to be the equivalent of hundreds and hundreds of vaccinations, yet antivaxxers fail to even mention it.  Why are these same antivaxxers not signing petitions to have soy-based infant formula removed from store shelves when it exposes infants to 30 times as much aluminum as vaccines within the child's first six months of life?  Could it be the antivaxxers are just slightly biased due to all of their previously failed attempts at pinning the root cause of autism on the vaccine industry?

The truth is, even if someone does ingest 2000 mg of aluminum in a single day, it will quickly leave their body via their feces and urine, which results in over half being flushed out of the body within 24 hours and over 70% of the aluminum being flushed out of the body within five days.  There have been some reports of long term complications surrounding high levels of aluminum exposure which I am certain many antivaxxers have latched on to, but unfortunately for them there have been long term complications from exposure to every element and chemical compound known to man.  As it turns out, the number one cause of drowning in humans is a result of too much exposure to H2O (commonly called "water"), yet I don't hear many people asking for the government to investigate Evian or Aquafina to see if they are killing people.  Go figure.

Sort of makes you wonder where the goalpost will move next doesn't it?

Wednesday, November 7, 2012

Will Antivaxxers Embrace the HIV Vaccine?

I was reading the latest news about one of the many HIV vaccines in development, and even though the results of the initial phase of testing appear to be very positive, I couldn't help but wonder to myself... how will the antivaxxers spin this to make something as beneficial as a HIV vaccine to be a bad thing?

I understand full well we are a long way away from an actual usable and functional HIV vaccine, but the initial clinical trials suggest that such a vaccine could be right around the corner.  So if we assume a HIV vaccine is within our grasp, and we already know over 33,000 people a year are diagnosed with HIV / AIDS and over 9,000 die from the disease annually, will there be a major push from the antivaxxer community to proclaim the vaccine is more harmful than HIV itself?

Perhaps it is too early to tell.  We don't yet know of any potential side effects of the HIV vaccine so we can't say what harm it may cause.  However if we look to other vaccines as examples of what we might expect it seems highly unlikely that antivaxxers will support such a vaccine even if it is shown to save thousands of lives.

How do we know this?  Simple... just look at something like the HPV vaccine (Gardasil). We know the lifetime risk of developing cervical cancer in the US is 1 in 147 for those women who are unvaccinated while it is only 1 in 400 for those women who are vaccinated.  Knowing the fatality rate of cervical cancer is around 35%, we can use simple math to determine that the HPV vaccine could potentially save approximately 2,500 lives per year in the US alone.  Now antivaxxers are quick to point out that within one year of receiving a Gardasil vaccine there have been at least 68 reported deaths.  Some sources cite slightly higher numbers, some cite lower numbers, but the 68 number is accurate as of June 2011 and came directly from the Vaccine Adverse Event Reporting System (VAERS).  What they fail to tell you however, is that that total includes all deaths... even those which were a result of suicide, car accidents, or unrelated medical conditions.

Now in case you are curious, even if we use the full 68 deaths, and we consider that at that point in time over 35,000,000 doses of the Gardasil vaccine were given it would mean that 68 works out to be 0.0004%.  It is probably also a good time to mention that 0 of those deaths (0.0000000000%) have actually been attributed to Gardasil... and that number doesn't change no matter who has reviewed the data.

However, I'm in generous mood and I'm trying to make a point, so for the sake of discussion, let's just go ahead and assume out of those 68 deaths that the vast majority were a direct result of the vaccine.  For the sake of argument, we will ignore all common sense and logic and simply assume that 50 of those 68 deaths were a direct result of Gardasil.  Now let's also assume that VAERS only captures about 10% of the actual adverse events tied to vaccines, and therefore we need to now extrapolate that 50 deaths to be a total of 500.  So out of 35,000,000 doses of the vaccine given, we are making a wild assumption of 500 deaths.  In case you are curious that works out to be an effective rate of 0.00142%

Do you have any idea how small a number 0.00142 really is? That is roughly one out of 70,000.  That means  if you injected one person each day with Gardasil, you could continue to do so for 192 years before someone might actually die as a result - and that is under the huge assumption that all of these deaths can be directly linked to the vaccine (which we know they cannot).

Great - so the chances of dropping dead within one year of receiving a Gardasil vaccine are 0.00142%.  Fine... I know it is a huge stretch, and we know the numbers are nowhere near that level, but even if we use worse case scenario logic coupled with idiotic assumptions, we still come up with a value which is incredibly small.

So how many lives have been saved by the vaccine during that same period of time?  The Gardasil vaccine was approved by the FDA in June of 2006, so five years later in June 2011 by the time those 35,000,000 doses were distributed, we could have potentially saved 12,500 lives from the vaccine.

So let's be clear - if the vaccine saves 2,500 lives a year (12,500 lives over five years) and if the vaccines results in 500 deaths during that same period, that tells us the end result is a net increase in lives saved.  This means the Gardasil vaccine actually saved at least 12,000 lives.  Yes you can argue the number is larger or smaller, but in the theme of keeping things simple, this is a fairly conservative figure.

So what do antivaxxers say when presented with these numbers?  Do they admit that the net effect of the vaccine is that lives are saved?  No.  Do they admit that even if the vaccine isn't perfect that it is still better than nothing?  Nope.  Instead of looking at the net impact, antivaxxers do what antivaxxers always do when the numbers don't help their cause.  They deny the numbers and claim the math doesn't add up.... or better yet they simply refuse to talk about it.

Now we know it is impossible for even the most diehard antivaxxer to deny basic arithmetic, so instead they simply flatly deny that the vaccine saves any lives.  They even go so far as to claim there is no connection between HPV and cervical cancer.  Yes seriously.  (In case you are wondering, the claim about HPV not causing cervical cancer is flatly untrue and stems from a misunderstanding of the virus.  It is true that not all strains of HPV cause cancer and it is also true that many HPV infections are short-lived and don't result in cervical cancer, but it is widely know that some strains of HPV (namely HPV 16 and HPV 18) do in fact cause more than 99% of all cervical cancers).

So we can see with our own eyes that antivaxxers with do anything and say anything rather than admit a vaccination is actually beneficial.  They will misinterpret data, they will misreport the facts, they will misrepresent scientific studies and even cherry-pick statements out of context.  Even worse, when all else fails... they will just flat out lie.

So if one day we are presented with a HIV vaccine that could potentially save tens of thousands of lives each year, is it possible that antivaxxers would actually embrace the vaccine and admit that it benefits the health of the human race?

Considering many antivaxxers don't even believe that the HIV virus causes AIDS... not bloody likely.