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Despite Carson and Trump’s Sidestepping, No, Vaccines Don’t Cause Autism

By September 17, 2015 4 Comments
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There were major face-palms happening during one of the early GOP Debates here at The Scientific Parent’s headquarters when former presidential hopeful Dr. Ben Carson massively sidestepped a pretty simple question about vaccines and autism.

I’m not going to get into the specifics of the debate or comment on the politics, just the piece that concerns us here on our blog, which is all about science-based parenting.

When CNN’s Jake Tapper asked Dr. Carson if he thought Donald Trump should “stop saying that vaccines cause autism,” Carson avoided challenging Donald Trump’s stance directly, (which has been highly public and scientifically incorrect) and said:

ben_carson“Well let me put it this way…there have been numerous studies, and they have not demonstrated that there is any correlation between vaccinations and autism. This was something that was spread widely 15 or 20 years go and it has not been adequately… revealed to the public what is actually going on.”

-Dr. Ben Carson, GOP Debate 9/16/2015

Carson, an incredibly educated physician, went on to redirect the conversation before being interrupted by Tapper, who once again pushed him to disagree with Trump. Which Carson would not do.

While that’s in essence not a problem (challenging someone’s opinion when you would prefer not to engage in a battle), language and presence is persuasive, particularly when you’re an expert in front of tens of millions of viewers. It’s what these debates are all about. You put potential leaders in a room with cameras and you listen to how they command power, expertise, and thoughts on issues that are relevant to the public. And then viewers at home are left with new information, some correct, some not-so-correct, and to make the best judgment call they can about the candidates and the issues from what they know, and what they heard.

Carson is a former pediatric neurosurgeon who has dealt with some of the most medically fragile patients around during his tenure at Johns Hopkins Hospital. He knows the science surrounding the safety of vaccines as he touched on it in his initial response, referencing studies which you can read about in this quick crash course compiled by the CDC. He’s an expert, so one would assume that what he says is accurate.

Posed with the same question, Donald Trump, whose command of authority is essential to his business image, did not stand down from the question:

trumpface“Autism has become an epidemic. Twenty-five years ago, 35 years ago, you look at the statistics, not even close [to what it is now]…I am totally in favor of vaccines but I want smaller doses over a longer period of time.”

–  Donald Trump, GOP Debate 9/16/2015

And, after alluding to a baby being “pumped” with vaccines in the amount “meant for a horse,” he pointed to evidence of an employee of his, whose child “…went to have the vaccine and came back and a week later got a tremendous fever, got very, very sick, now is autistic.”

Trump concluded by pointing to vaccine spacing as what will reduce autism in America. Since vaccines aren’t linked to autism, and science backs that, how does spacing non-autism-causing shots reduce autism? It’s a mystery to us. But it does have an undercurrent of the conspiracy theory about pediatricians we’ve addressed before on The Scientific Parent. And I’m not even going to touch the epidemic and anti-autistic language here. That’s for another time, and another post.

Where I nearly flipped a table over is when Carson followed up to Trump’s comments by agreeing with Trump about vaccine spacing, and then reiterating his stance that vaccines don’t cause autism. The doctor said WHAT?

Though children get nearly two dozen vaccination shots by the time they are two years old (for a series of deadly, preventable diseases), there’s no general belief in the medical community that this nationally applied schedule of vaccines is a problem for healthy children. In fact, the CDC and American Academy of Pediatrics recommend the current vaccine schedule based on what is considered safe and prudent according to a wide array of factors, most important being what a child’s immune system is able to tolerate at different points in their growth and development, and what’s absolutely essential to protect them against at the earliest possible age.

Vaccines from 0-6

Example vaccine schedule from CDC, ages 0-6: http://ow.ly/SkmZM

Not convinced yet? Take a look at this document, which explains what the Advisory Committee on Immunization Practices is. It’s a panel of experts who are rigorously vetted and have a range of expertise, and they have multiple public meetings a year where they review a range of information, research, and clinical data to determine what’s safest for children. They’re the ones who provides the CDC with schedule recommendations. And I’m pretty sure they know a lot more than either Mr. Trump or Dr. Carson could dream about vaccine science and safety.

So again, challenging someone you don’t want to challenge is in essence, not a problem. What is a problem however, is for a nation that’s worked hard to eradicate so many tragic infectious diseases, to have Dr. Carson publicly representing pediatric medicine and not correcting something that is a matter of life, death, and severe disability through disease injury for millions of Americans and their children. We’ve covered that elsewhere on this blog, which you can read here, here, here, and here. We really, really hope he moves to correct this in upcoming public statements, and we’re not alone.

Misinformation of this nature spreads quickly and keeps its hold for a long time, because oftentimes it’s rooted in fear. Trump’s vaccination stance has been highly visible and what he says, if it were true, is scary to even consider. A few snapshots of his comments on Twitter, for example:

Trump Twitter 3

 

Trump Twitter 1

When you’re an expert in medicine and you allow misinformation to linger as Dr. Carson did, particularly misinformation that can be fatal if in the wrong hands, it can have massive impacts. It can lead to malpractice if you’re an actively practicing or teaching physician. And in front of a nation of attentive TV viewers, it can lead to a whooooole lot of people listening to the more bold candidate and believing that he or she is speaking the truth. It’s what terrifies the masses that leads to situations such as what happened with Tara Hills, the formerly anti-vaccination advocate mother of 7 children who ended up with whooping cough, who was misinformed and fearful by messages similar to what Trump said on stage last night.

The damage is done, though many, many websites and blogs such as our own took to the interwebs that night, as we do often, to argue in favor of science and safety.

Ask anyone who works or has worked in broadcast and we’ll tell you the same thing. People (myself included) tune out after the first few seconds of a soundbites, and they surely did given how circular political-speak can get during those debates.  Lets just hope that for a nation dependent on vaccinations for so much of its basic health protection, we can keep the facts straight from the opinions. Cast your vote where you may, but protect your kids, please, they’re our most precious candidates for this nation’s future.

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Categories: Infectious Disease + Vaccines, Policy, Politics, + Pop Health

What “Fear the Walking Dead” Gets Right About Public Health

By August 24, 2015 No Comments
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When I was 16 weeks pregnant with my son I caught a nasty head cold. Unable to take any of the traditional over the counter cold medications (because, pregnancy), I was forced to ride it out in misery on the couch praying for my own swift demise. The cold knocked me down hard and by the second or third day of misery on the couch I had binged watched just about everything I could binge watch.

Then I came across The Walking Dead on Netflix. Now, I had very particularly avoided watching the show because my fellow #publichealthnerd colleagues had pressured me to watch it, and urging me to do something is the best way to get me to not do that thing. I’d also avoided watching it because I’m not a fan of horror.  Blood and guts are not my preferred form of entertainment. Sure, give me intrigue, drama, suspense and I will eat it up (hello House of Cards and Mad Men) but toss in zombies or vampires? I’m out.

But it was a few days before Hallowe’en* and I was 16 weeks pregnant, miserable, and out of binge-worthy TV. I decided to give the first episode a watch…and I haven’t looked back since. Well, except during the really gory scenes. Where I literally look backwards.

As a public health nerd, I can say that there have been times where from a public health standpoint the show has been laughable. The season one finale where our group of survivors winds up at the CDC?(OH COME ON!) Nothing that the show depicted about the CDC’s facilities in Atlanta is even remotely accurate. Even the evidence the CDC researcher claims to have (as in, shooting someone while in an MRI machine? OH COME ON!!) was preposterous.

Don’t even get me started on the idea that the CDC somehow, somewhere, has billions of dollars squirreled away for a state-of-the-art underground command center. Please show me the line item for that in the annual congressional allocation. I’m sure if Congress did earmark funds for a Dr. Evil-like underground lair, there would be a deafening outcry from both within and without the CDC for the desperate need for that funding to go towards more pressing public health concerns. Like anything not secret-underground-lair-ish.

I digress.

When the announcement came early this year that there would be a spin-off show of The Walking Dead, detailing the beginnings of the zombie apocalypse, I was intrigued, if not concerned. After the complete media fail that was the news coverage for Ebola in America I was suspicious about how the show would portray public health infrastructure, and to be frank after the premiere I still am, but the premiere gave me much to be hopeful about.

*** WARNING, VERY MILD SPOILERS BELOW ***

The family at the center of Fear the Walking Dead c/o AMC.com

The family at the center of Fear the Walking Dead c/o AMC.com

The premiere episode does do a great job of highlighting the world as it currently is. We have made accommodations, and in fact are comfortable with, symbols of fear in our daily lives against things like violence (metal detectors in high schools, bars on the windows of homes, police activity). Likewise, we’re somewhat oblivious to more insidious threats like drug abuse and infectious disease.

What the show does get right in terms of science in its first episode is the emergence of the Walking Dead’s infamous zombie virus in an intravenous drug using population. A variety of infectious diseases have presented first or early among members of this group, including HIV/AIDS and numerous bacterial infections.

The reason for this is simply because of the behaviors associated with the practice; needles are often shared, and blood and other bodily fluids are exchanged,making it the perfect scenario for bacteria and viruses to replicate and mutate.

The demographics of IV drug users also interferes with what public health nerds call epidemiological surveillance. Epidemiological surveillance is how public health officials monitor what viruses, infections, and diseases are prevalent in a given population. The most common form of this surveillance is through passive surveillance, which is when an individual reports to their health care provider with an illness or concern and its documented, instead of public health officials actively seeking out cases.

If this sounds a little creepy, it’s actually not. Typically, and depending on the disease, your doctor or hospital isn’t reporting to the CDC that you, Jane Doe, born on this date, had the flu. What they’re reporting are generalities, so that public health officials can assess where resources would be best allocated. What your doctor or hospital reports is that a female, in this age range had this strain of flu at this time.

But the fatal flaw in passive surveillance is that it requires people to actually go to their health care provider. Unfortunately IV drug users tend to lack the means to seek out timely medical care. In many cases, a lack of a regular income, health insurance, fear of being reported to the police, or simply fear of judgment means that people often wait until an illness has reached a crisis point before they seek medical care. This means that illnesses can circulate undetected in the population for a longer period of time than they would in a population without similar barriers to accessing health care.

When looking for their son, whom they fear has fled hospital to score heroin, the main characters of Fear The Walking Dead drive through several rough neighborhoods where “Missing” posters have gone up on walls and fences. The implication the audience is meant to intone from these posters is that there is a massive outbreak underway that the powers-that-be are not yet aware of, because of who the missing (we know to be zombified) individuals are.

The genesis of the zombie virus in an intravenous drug using population was something I wasn’t expecting from the show, but something I find completely plausible (as plausible as a zombie virus can be).  I was concerned considering the show’s previous ridiculous portrayal of the federal public health infrastructure, that the writers would go in the direction of a government-engineered virus released on an innocent and unsuspecting public.  If they’d done that, I would have been out immediately and I have to admit, it probably would have ruined the original Walking Dead series for me as well.

I have to say, Fear the Walking Dead has stepped up its game in terms of scientific accuracy, which I greatly applaud.  But I’m obviously not watching it for that – or maybe just partially. As my husband can tell you, I’ve spent a good chunk of time watching The Walking Dead yelling at Rick and his crew “FOR THE LOVE OF GOD, HOW HAS NO ONE DIED OF A STAPH INFECTION YET?!”  Robert Kirkman, if you’re listening, someone on the show needs to step on a rusty nail and die of tetanus.

*I’m Canadian, so I spell Hallowe’en with an apostrophe

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Categories: Policy, Politics, + Pop Health

This Post Isn’t About Bristol Palin: Why Teens Aren’t the Ones With the Unplanned Pregnancy Problem

By July 1, 2015 No Comments
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 At this point, you’ve probably heard about Bristol Palin’s second pregnancy. She announced her news via a blog post last week. She originally suggested that this pregnancy wasn’t planned but followed up that post a few days later with a second one clarifying that her pregnancy was planned…just mistimed.

Planned, unplanned, or mistimed, this post isn’t about judging Bristol Palin or her choices about sex and motherhood. She’s an adult now and deserves to have both the autonomy to make her own decisions about her own body and the privacy to go through whatever she’s dealing with. But I just cannot wrap my brain around how she found herself in this situation. Again.

Bristol’s situation brings up some interesting points that, as a 10-year veteran of reproductive health, I cannot stop considering; mainly, why in the year 2015 do women often struggle to manage their reproductive health? What I really want to talk about is unplanned pregnancy and how incredibly easy it is to prevent with just a little bit of education.

What would you say if I asked which age group has the highest rates of unplanned pregnancy in the nation? If you’re like 70% of Americans, you’d answer “teens.” And like 70% of Americans, you’d be dead wrong. Rather than skyrocketing as most US adults believe, the teen birth rate is in fact dropping like a rock. In 2014 alone, US teen births declined 9% and rates have dropped a staggering 61% since peaking in 1991.

While we like to blame teens for so many of our nation’s ills (get off my lawn!), they’re actually doing a fantastic job of not getting pregnant. The group with the highest rates of unplanned pregnancy in the US are actually right in Bristol’s demographic; young women age 18-29. Bristol is smack in the middle of the current unplanned pregnancy crisis (think crisis is too strong a word? Consider this: more than half of all unplanned pregnancies* in the US occurred for women in their 20s and, of those unplanned pregnancies, 65% were women in their early 20s). She is part of the club of women who are having sex, not effectively using birth control (or at all), and—shocker—getting pregnant before they’re ready.

So why are teens kicking so much butt and young adults—who are older (and we assume?) wiser—falling so far behind?

Comparison of birth control method efficacy via The National Campaign to Prevent Teen and Unplanned Pregnancy

Comparison of birth control methods used by female family planning providers via The National Campaign to Prevent Teen and Unplanned Pregnancy

There’s no magic bullet answer to explain why the teen birth and pregnancy rates are plummeting while the rates for 20-somethings remain so stubbornly high. Some suggest that the recession forced many families to take stock of their finances and teens, who witnessed the day-to-day financial struggles their parents dealt with, and took notice—babies are pretty expensive, after all. Some suggest that shows like MTV’s 16 and Pregnant and Teen Mom have been instrumental in demonstrating the harsh reality of having a baby as a teen; rather than glamorizing these young moms, these shows provided a window into an incredibly challenging and rough time and, again, teens took notice. Some point to the recent American Academy of Pediatrics recommendation that pediatricians begin recommending long-acting methods like the IUD and implant to their teenage patients (there has been a modest uptick in adoption of these methods among teens but it’s still too early to tell if there is a causal relationship to decreases in the teen birth rate). I like to think the best answer is also the simplest: simply put, teens are having less sex AND using contraception more carefully and consistently when they do have sex. So bravo young people!

They are also, to some extent, being exposed to more education about the most effective methods of contraception available to them and they’re taking notice. In 2009, the Obama Administration signed the Consolidated Appropriations Act of 2010, which included $110 million for the President’s Teen Pregnancy Prevention Initiative (TPPI). TPPI created the first federal funding stream available for more comprehensive (ie—abstinence AND birth control) approaches to sex education. Currently, the federal government has recognized nearly 30 programs that have been rigorously evaluated and shown to help teens delay sex and/or use birth control more effectively. Since the implementation of TPPI, the teen birth rate has seen steady and sharp declines…coincidence? Maybe…but it seems unlikely.…**

So, teens are (for the moment) getting all this great education and learning about better methods and/or how to delay sex more effectively and the rates show that things are humming along nicely, but what about those 20-somethings like Bristol?

Well, as most of us know, once you hit adulthood—i.e. graduate high school—everyone assumes you’re good to go on the human body, how it works, and how it reproduces. Beyond a bowl of freebie condoms at the local clinic, there is rarely sexual health education in college curricula and there certainly isn’t much for those young people who skip college for other things. This forces 20-somethings to be proactive about their sexual health—if they want to find a better method (or ANY method) it’s on them to make it happen. For many women, this is just fine. But for many, many more, the stigma, fear, embarrassment, and other issues attached to simply admitting one is sexually active prevents them from seeking out even the simplest methods of birth control or learning about how their bodies really work. They may have grown up in a culture that forbids sex before marriage and so they wouldn’t dream of getting birth control…even when they know they may become sexually active. Or perhaps they simply rely what they know: the humble condom (that they may hate) or perhaps the pill they’ve been taking since high school (that they may not take consistently). Some think they can’t get pregnant during their periods, trust that the man is pulling out on time, they think they can’t get pregnant at that time (or that this will be the ONLY time they have sex), or they just believe that it won’t happen to them. This myth-believing and misinformation about their bodies affects all kinds of women from all different socio-economic backgrounds. Unplanned pregnancy doesn’t have a type; it can (and does) happen to anyone.

It can even happen to a young woman with a famous name, and famous mother who stands on a platform of pro-abstinence rhetoric. Because you don’t know what you don’t know and it can happen to you. So Bristol—best wishes on your new addition; I hope this next adventure is a fun and rewarding one…as a mom myself, I know just how much fun kids can be. But when you’ve had your child, please think seriously about birth control; there is nothing wrong with taking charge of your sexual health and your future and actively planning when you want to next get pregnant. – Edited by Leslie Waghorn

* In this case, “unplanned” indicates that the women themselves reported that they either did not want to get pregnant at that time or did not want to get pregnant ever.

…**As an aside, despite this remarkable progress and clear evidence that the programs funded by this money actually, you know, work, Congress is currently gunning to defund both TPPI and Title X, the nation’s low-income family planning funding stream. I could spend a whole other post detailing how those funding cuts impact millions of Americans but I’ll let this issue brief do it for me.)

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Categories: Ages + Stages, Policy, Politics, + Pop Health, Pregnancy, Birth + Family Planning, Tweens + Teens