DISQUS

IndianCowboy · 10 months ago

Dr. Stryer,

Thanks for responding to my comment. I appreciate the fact that you took the time to do so.

That said, I feel that justice wasn't done to the concerns I raised, particularly the short length of pre-licensure trials (the safety arms of which, do in fact only last 5-14 days according to the primary literature), the failure to use a proper placebo (an immunologically and inflammatorily reactive aluminum adjuvant is not a placebo), the low capture rate of VAERS and VSD, or the fact that contrary to common assertion, potential causal relationships between certain vaccines (and aluminum within vaccines) and neurologic and autoimmune disease have been voiced at a theoretical level, demonstrated in animal models and human case reports, histopathology, and serology, and defended in challenge-rechallenge studies.

A more complete response can be found here.

Again, I think we both have the best interests of our patients in mind. But I think that the potential evidence of harm, while not great enough to remove certain vaccines from the market, is more than enough to take a more cautious stance on their use and safety, and to investigate possible sources of toxicity. This becomes more important as we vaccinate for less prevalent and more individually-preventable diseases with lower overall morbidity and mortality.

Edwin Leap · 10 months ago

Val,

Indian Cowboy seems to believe that we are now in an era of 'science' whereas the last was an era of mystery and magic.

The term 'evidence-based medicine' is a much abused term, and I'm finding that it often serves as a kind of dismissive term. 'Oh, I don't know about that...I believe in evidence-based medicine.' Well, the truth is that EBM is valuable, but only truly valuable if we all read the methods of every study; and understand them. Without that, we practice what is, in effect, authority-based medicine. That is, someone we respect tells us it's the right thing to do because it looked like a good study. I'm OK with that. I trust some certain docs to make that interpretation.

But more than that, much of what we do and know was never based on studies but on experience. Tacit truth is real, and experiential medicine has carried us far along the path toward life-saving interventions. We may be 4th decade Neanderthals, but we're darn good at what we do.

Ask Indian Cowboy if he's ever tried to intubate a swollen airway. I have. It's profoundly icky and anxiety provoking. For that reason alone, let's keep immunizing for H. Influenzae B.

Thanks,

Edwin

albatross · 10 months ago

As another datapoint: Our pediatricians' office has handouts explaining the potential problems with the vaccines our kids get, and those discuss the low-probability really bad stuff. But the only warnings I have gotten from the doctors and nurses themselves have been for mild stuff ("his arm may be sore for a day or two; give him ibuprofin if it's a problem"), never for the low-probability scary stuff like encephalitis. I assume if I had asked about the scary risks, they'd have discussed them with me, but I've never tried it.

IndianCowboy · 10 months ago

Dr. Leap,

I'd appreciate it if you actually read the comments in question. You're free to read what I wrote myself in my blog and address it. When I used the term 'evidence-based medicine' I was in fact making fun of the fact that its become a buzzword more than anything else.

I never implied that older doctors don't practice intelligent medicine. And I don't much appreciate words being put in my mouth (or my fingers as the case may be).

But authority-based practice is antithetical to science. I realize medicine isn't itself a science, but I think everyone can agree that it is a science-based pursuit, just as engineering is. Remember, knowledge is gained not by asserting what we believe to be true, but exposing the areas of our ignorance and studying them.

I find it disheartening that my concerns are blown off and instead doctors who I respect and whose blogs I read on a regular basis resort to name-calling and rhetoric.

You're right, I've never had to intubate a swollen and inflamed airway. I have on the other hand lived with the consequences of a vaccine injury for the past 11 years. Now, if you'll excuse me I have to pick up x-rays for a surgical consult regarding one of the sequelae of that vaccine injury, and then hit the gym for rehabilitation.

Stacy Beller Stryer · 10 months ago

I hear what you are saying. And I agree that we do not know everything about vaccines and their potential side effects. However, these side effects you discuss are rare, whereas the infections are not. For instance, the likelihood of developing enephalitis after a DPaT shot is less than 1 in a million. The number of children who would develop one of these infections without a vaccine is much, much greater, as is the risk that they would suffer permanent sequelae or die. You also mention concern regarding vaccines for less common infections, such as cervical cancer. The likelihood that a woman will develop cervical cancer is 1 in 10,000.

I understand that you have blogged about a neurologic problem reportedly due to a vaccine, and I am truly sorry for that. Yet, you are alive and in medical school - you have survived and done well. My husband passed away from a glioblastoma, which occurs slightly more frequently than cervical cancer. If I were told there was a vaccine to prevent a glioblastoma, my family would be the first to stand in line.

Millions of children have been vaccinated. It is obvious that severe side effects are not common. Children must continue to receive their vaccines in a timely manner while researchers must continue to monitor side effects and perform quality research.

Stacy Beller Stryer

Stacy · 10 months ago

Thank you so much for blogging about vaccine safety. The anti vax camp is so much more vocal than the pro vax camp and this needs to change.