Search This Blog

Saturday, November 30, 2013

How Girls With Autism Are Being Shortchanged

From The Huffington Post

By  Pearson
Catherine.Pearson@huffingtonpost.com

November 26, 2013

"...a growing body of research hints that the significant sex-based differences in autism diagnoses are a result not just of biological differences, but of a failure to recognize ASD in girls."

Suzanne Amara's daughter, Janey, was 3 years old when she was diagnosed with autism.

These days, no one would mistake that her daughter has the neuro-developmental disorder, Amara said. Janey, who is now 9, is nonverbal and has what is considered severe autism. But there were signs early on that Amara believes she may have overlooked simply because of her daughter's sex.

"There might've been things she was demonstrating that I didn't see because she was a girl," said the mother of three, who writes the blog Rarer In Girls ... My Daughter With Autism.

"Maybe, I sort of comforted myself with thinking, 'Well, she's not autistic, because she's a girl,'" Amara said.

According to the Centers for Disease Control and Prevention, autism spectrum disorders, or ASDs, are five times more common among boys than girls. One in 54 boys in the U.S. has been diagnosed with autism, compared to just 1 in 252 girls. But 
a growing body of research hints that the significant sex-based differences in autism diagnoses are a result not just of biological differences, but of a failure to recognize ASD in girls.

One study, published in the November edition of the Journal of the American Academy of Child and Adolescent Psychiatry, analyzed data from more than 3,600 children, many of whom were considered to exhibit autism-like traits, according to a checklist scoring various social behaviors.

The children were then given two tests. In one, they were shown photos of other children and asked to identify whether those kids were happy, sad, angry or fearful. In a second, they were shown an animated triangle and circle that moved across a screen and asked to describe what the movement revealed about the shapes' "emotions." A triangle moving in a purposeful manner, for example, was meant to evoke a happy feeling.

Both girls and boys with autism-like traits struggled to identify the correct emotions in the triangle task, and boys with autism-like traits also struggled with the facial recognition task.

However, girls with autism-like traits were able to recognize emotions from photos just as well as girls without autism did. Because many experts believe failure to recognize facial expressions is one of the more direct signs of autism, the researchers argue that doctors may need to use more subtle assessments to accurately diagnose the disorder in girls.

"If girls with ASD are developing strategies to compensate for ASD like traits (such as [difficulty with] emotion recognition), then it is possible that they are less likely to be diagnosed," study researcher Radha Kothari, a research associate with University College London's Institute of Child Health, wrote in an email to HuffPost.

"Much of the research conducted on autism, which defines our idea of the disorder, is conducted on males rather than females," Kothari wrote. "This creates a cyclical system, in which our understanding of ASD is mainly based upon presentation of it in males, which means that more males are likely to be diagnosed."

"It's likely that we are missing girls who are high-functioning and don't have additional co-morbid problems," echoed Francesca Happe, a professor of cognitive neuroscience at King's College London and president of the International Society for Autism Research.

Happe cautioned against overstating the new study's potential implications but called it interesting. In February 2012, she was an author on another autism investigation, which found that girls who had similarly high levels of autism-like traits as their male counterparts, but who did not have additional intellectual or behavior problems, were less likely to meet diagnostic criteria. Those results suggested the girls might be "fly[ing] under the radar," Happe said.

With so much about autism still a mystery and so many questions about its causes unanswered, experts warn that it is difficult to tell whether sex-based differences in autism rates are a reflection of biology, under-diagnosis or both. Evidence does suggest there is a "female protective effect." In other words, it may take more genetic or environmental risk factors to "tip [girls'] brain development into the realm of autism," as the nonprofit Autism Speak's website puts it.

Whatever the reasons, parents of girls with autism, like Amara, say the experience can be a lonely one. "I've thought, 'Are there no other girls like Janey?'" she said. Amara has connected with families in similar situations online, but day-to-day she and Janey have never encountered another girl with similarly severe autism.

"It's pretty isolating," Amara said. "It's almost all parents of boys."

Friday, November 29, 2013

The Top Six LEAST Logical Anti-Vaxx Arguments

From Married to Medicine

By ElleMura
November 25, 2013

After a little rant I wrote went viral, I found myself mired in the black hole of vaccine "debates." And I'm putting "debates" in quotations because it pains me to even elevate much of what is being said to "debate," where so many "points" and "counterpoints" make no sense whatsoever.

It was hard to narrow it down but I think I've found the six least-logical anti-vaccination points of all. Here they are, in no particular order.

1.) We can't trust the researchers or the doctors because they're all part of a vast "Big Pharma" conspiracy to make money off of vaccines.

There are at least five good and obvious reasons why this is clearly not true, but I'll make room here for just one: The "naive" parent who didn't "do her homework" by running a Google search or listening to her friends is not, in fact, the one paying for her child's vaccines.

Vaccinations are paid for largely by private health insurance companies and, for uninsured children, the government. Hopefully we can all agree that health insurance companies are not an innocent, naive, duped party in this or any other equation. Not only is the health insurance industry a major political powerhouse, but health insurance companies employ hundreds of physicians whose sole jobs are to find ways to deny coverage for any medical care that is even arguably not "medically necessary."

If you must have a conspiracy theory, and you really don't believe vaccines work, maybe you should consider the idea that the "Big Health Insura" put out all the anti-vaxx internet quackery so that fewer people would vaccinate. *I* know that's not true, because *I* know that health insurance companies don't want to pay for babies hospitalized with pertussis. But if you're a vaccine-denier, then I have to tell you that my conspiracy theory is far more likely than yours.

2.) They've never done a study of vaccinated versus un-vaccinated children and autism rates.

They have, in fact, and it was done in Denmark - here it is. It studied all children born in Denmark from 1991-1998. What they haven't done is a double-blind study. And that's not because Big Pharma is preventing one - it's because it would be considered unethical to randomly assign babies to not be vaccinated.

3.) It's actually the vaccinated children who are dangerous - they are the ones most commonly infecting other people.

One good argument against that is that it's factually not true. See also this: ("The second [CDC] report provided additional data on the 159 measles cases reported in 16 states and New York City this year, through August. ... Most of the measles cases occurred in people who were unvaccinated (131) or had unknown vaccination status (15). Among unvaccinated U.S. residents in the group, 79% remained unvaccinated because of 'philosophical objections' to the practice.")

But let's imagine it were true, and vaccines were only ("only"), say, 85% effective. Now imagine a town of 100 people. Ninety of them are vaccinated and ten are not. Everyone is exposed. If this were to happen, in theory, 10 unvaccinated people would contract the illness, but thirteen vaccinated people would. It's simple math.

Oh yeah, the pertussis vaccine. That one has its own ironic twist. In 1997 we switched over to an acellular vaccine formula in order to appease vaccination fears. The cellular formula was more effective but it had more side-effects - more fevers, and thus more febrile seizures. But febrile seizures are not actually dangerous and if you're prone to them, you're not going to avoid them by not getting vaccinated.

My 13-month old inherited them from her father, and while she never experienced one after a vaccination, she had one anyway when she caught a simple passing illness that spiked her fever. She's perfectly fine and was never in any danger. So now to avoid a false danger we've increased the real danger: a less effective vaccine where vaccination rates are declining.

4.) If vaccines are actually effective, vaccinated people shouldn't care whether some people don't vaccinate.

Is this how you feel about hand-washing?

5.) It's better to be "naturally" infected than to receive a vaccine.

This reasoning is so circular it makes my head hurt: It's better to risk death, brain damage, paralysis, birth defects, and various kinds of cancer by getting a full-blown "natural" case of one or more of these diseases because... because it's a more effective way of making sure you don't ever get the disease you already had.


And if you do subscribe to this theory, I certainly hope you're formula-feeding. Antibodies passed to your infant through your breast milk won't be quite as effective or long-term as the antibodies your baby's own body would produce in response to full-on "natural" infections of various illnesses.

You wouldn't want to jeopardize his developing immune system by nursing, would you? (Disclaimer: This is sarcasm; I'm nursing my 13 month old through this winter JUST to give her any antibodies I happen to acquire).

6.) We shouldn't blindly trust our doctors.

Agreed. Physicians make mistakes, and we as patients can optimize our medical care by staying informed and by self-advocating where appropriate. Thankfully, though, we have very little such work to do when it comes to vaccination. Contrary to what anti-vaxxers would have you believe, vaccines are some of the most thoroughly studied medications out there and there is not just a national but a global consensus on their safety and efficacy.

Really, people, you might find my vaccination posts a little too snarky for your tastes. But at least admit that it's not exactly humble to ignore the consensus of every legitimate medical and public health group in the world.

Some Online Journals Will Publish Fake Science, For A Fee

From NPR's Health Blog "Shots"

By Richard Knox
October 3, 2013

Many online journals are ready to publish bad research in exchange for a credit card number.

That's the conclusion of an elaborate sting carried out by Science, a leading mainline journal. The result should trouble doctors, patients, policymakers and anyone who has a stake in the integrity of science (and who doesn't?).

The business model of these "predatory publishers" is a scientific version of those phishes from Nigerians who want help transferring a few million dollars into your bank account.


You could do all that brain work.
Or you could make it up.

To find out just how common predatory publishing is, Science contributor John Bohannon sent a deliberately faked research article 305 times to online journals. More than half the journals that supposedly reviewed the fake paper accepted it.

"This sting operation," Bohannan writes, reveals "the contours of an emerging Wild West in academic publishing."

Online scientific journals are springing up at a great rate. There are thousands out there. Many, such as PLoS One, are totally respectable. This "open access" model is making good science more accessible than ever before, without making users pay the hefty subscription fees of traditional print journals.

(It should be noted that Science is among these legacy print journals, charging subscription fees and putting much of its online content behind a pay wall.)

Open-Access Journals Hit By Journalist's Sting

But the Internet has also opened the door to clever imitators who collect fees from scientists eager to get published. "It's the equivalent of paying someone to publish your work on their blog," Bohannan tells Shots.

These sleazy journals often look legitimate. They bear titles like the American Journal of Polymer Science that closely resemble titles of respected journals. Their mastheads often contain the names of respectable-looking experts. But often it's all but impossible to tell who's really behind them or even where in the world they're located.

Bohannan says his experiment shows many of these online journals didn't notice fatal flaws in a paper that should be spotted by "anyone with more than high-school knowledge of chemistry." And in some cases, even when one of their reviewers pointed out mistakes, the journal accepted the paper anyway — and then asked for hundreds or thousands of dollars in publication fees from the author.



This journal offered to publish a fake cancer
research paper for a $1,000 fee.

A journalist with an Oxford University Ph.D. in molecular biology, Bohannan fabricated a paper purporting to discover a chemical extracted from lichen that kills cancer cells. Its authors were fake too — nonexistent researchers with African-sounding names based at the fictitious Wassee Institute of Medicine in Asmara, a city in Eritrea.

With help from collaborators at Harvard, Bohannan made the paper look as science-y as possible – but larded it with fundamental errors in method, data and conclusions.

For starters, the purported new cancer drug was tested on cancer cells – but not healthy cells. So there's no way to tell whether its effect was cancer-specific, or if it's simply toxic to all cells.

A graph in the paper purports to show that the more lichen drug that was added to test tubes of cancer cells, the more effective it was at killing. But in fact the actual data show no such difference.

Bohannan says it wasn't easy to write a convincing fake. Initially he made the data "too crazy," he says. His Harvard collaborators worried it made the paper look too interesting. "So we rewrote it, making boring rookie mistakes," he says.

The final touch was to make the paper read as though it had been written by someone whose first language is not English. To do that, Bohannan used Google Translate to put it into French, then translated that version back into English.

In the end, the paper's fictitious authors got 157 acceptance letters and 98 rejections – a score of 61 percent. "That's way higher than I expected," Bohannan says. "I was expecting 10 or 15 percent, or worst case, a quarter accepted."

For the privilege of being published, the paper's authors were asked to send along a publishing fee of up to $3,100.

The highest density of acceptances was from journals based in India, where academics are under intense pressure to publish in order to get promotions and bonuses. To learn the location of online journals that accepted or rejected Bohannan's paper, see this interactive global map.

Bohannan says the exercise is a damning indictment of the way peer review works (or doesn't) at many online journals. Peer review is the time-honored system of having outside experts comb through submissions to identify flaws in method, data or conclusions. It's the way scientific journals do quality control.

"Peer review is in a worse state than anyone guessed," he says.

Bohannan says he doesn't mean to suggest that the whole business model of online open-access journals is a failure. "You can't conclude that from my experiment, because I didn't do the right control – submitting a paper to paid-subscription journals," he says.

As he acknowledges, it's not as if peer review is always up to snuff at subscription journals – even the top subscription journals have been embarrassed by lapses in their peer review processes. But he says online publishing makes poor-quality journals easier to set up. And the sheer volume of online publications these days makes it harder to distinguish between legitimate and shady journals.



Another journal asked the authors to
wire 80 Euros to a Turkish bank.

Jeffrey Beall of the University of Colorado wasn't surprised in the least by the outcome of Bohannan's sting. "He basically found what I've been saying for years," he tells Shots.

A growing number of online open-access journals "are accepting papers just to earn publishing fees, and as a result science is being poisoned by a lot of bad articles," Beall says.

Beall, a research librarian, is a self-appointed watchdog over open-access publishing. He maintains a list of what he calls "predatory publishers" – those who "exploit the open-access model of publishing for their own profit."

He points out that online publishers operate under an incentive that's just the opposite of traditional scientific journals. Print journals have rigid constraints on how many articles they can publish, so they have to screen out all but the best. And they have subscribers to keep happy, so they have to cultivate reputations as curators of high-quality research.

But online journals don't have to worry about subscribers; they make their money by charging contributors – who have a strong incentive to get published. So "the more papers they publish the more money they make," Beall says.

Two big questions arise out of all this: What damage is done by publish-anything journals? And what can be done about it?

The potential damage is both far-reaching and difficult to quantify. Bohannan points out that universities and government agencies, particularly in developing countries, may hire researchers based on resumes packed with sleazy citations. Determining which of those CV entries is high-quality and which aren't is no easy task.

Beall notes that lawyers often use scientific citations in briefs and trials. Government officials draw on published research to set policy. Drug companies have a strong incentive to manipulate research to bolster their claims. And researchers may be led down futile paths on the basis of poor research.

As to what can be done, Beall says poor-quality research can probably only be driven out by naming and shaming.

Bohannan thinks there might be a sort of Consumer Reports to survey the quality of online journals and call out those that fall short. And he thinks maybe such an enterprise might regularly carry out stings like his to keep everyone in the field on their toes.

Thursday, November 28, 2013

Happy Thanksgiving!



Have a wonderful holiday!

Trauma-Sensitive Schools Are Better Schools

From The Huffington Post
via TraumaSensitiveSchools.org

By Jane Ellen Stevens
Founder, AcesTooHigh.com

June 26, 2012

"Trauma-sensitive schools. Trauma-informed classrooms. Compassionate schools. Safe and supportive schools. All different names to describe a movement that's taking shape and gaining momentum across the country. And it all boils down to this: Kids who are experiencing the toxic stress of severe and chronic trauma just can't learn..."

The first time that principal Jim Sporleder tried the New Approach to Student Discipline at Lincoln High School in Walla Walla, WA, he was blown away. Because it worked. In fact, it worked so well that he never went back to the Old Approach to Student Discipline.

This is how it went down:

A student blows up at a teacher, drops the F-bomb. The usual approach at Lincoln -- and, safe to say, at most high schools in this country -- is automatic suspension. Instead, Sporleder sits the kid down and says quietly:

"Wow. Are you OK? This doesn't sound like you. What's going on?"

The kid was ready. Ready, man! For an anger blast to his face..."How could you do that?" "What's wrong with you?"... and for the big boot out of school. But he was NOT ready for kindness. The armor-plated defenses melt like ice under a blowtorch and the words pour out: "My dad's an alcoholic. He's promised me things my whole life and never keeps those promises." The waterfall of words that go deep into his home life, which is no piece of breeze, end with this sentence: "I shouldn't have blown up at the teacher."

Whoa.

And then he goes back to the teacher and apologizes. Without prompting from Sporleder.

"The kid still got a consequence," explains Sporleder -- but he wasn't sent home, a place where there wasn't anyone who cares much about what he does or doesn't do. He went in-school suspension, a quiet, comforting room where he can talk with the attending teacher, catch up on his homework, or just sit and think about how maybe he could do things differently next time.


Jim Sporleder, principal of Lincoln High School

Before the words "namby-pamby", "weenie", or "not the way they did things in my day" start flowing across your lips, take a look at these numbers:

2009-2010 (Before new approach)
• 798 suspensions (days students were out of school)
• 50 expulsions

2010-2011 (After new approach)
• 135 suspensions (days students were out of school)
• 30 expulsions

"It sounds simple," says Sporleder about the new approach. "Just by asking kids what's going on with them, they just started talking. It made a believer out of me right away."

Trauma-sensitive schools. Trauma-informed classrooms. Compassionate schools. Safe and supportive schools. All different names to describe a movement that's taking shape and gaining momentum across the country. And it all boils down to this: Kids who are experiencing the toxic stress of severe and chronic trauma just can't learn. It's physiologically impossible.

These kids express their toxic stress by dropping the F-bomb, skipping school, or being the "unmotivated" child, head down on the desk or staring into space. In other words, they're having typical stress reactions: fight, flight or freeze.

In trauma-sensitive schools, teachers don't punish a kid for "bad" behavior -- they don't want to traumatize an already traumatized child. They dig deeper to help a child feel safe so that she or he can move out of stress mode, and learn again.

Pick any classroom in any school in any state in the country, and you'll find at least a handful -- and sometimes more than a handful -- of students experiencing some type of severe trauma.

What's severe trauma? We're not talking falling on a playground and breaking a finger here. This trauma is gut-wrenching, life-bending and mind-warping: Living with an alcoholic parent or a parent diagnosed with depression or other mental illness. Witnessing a mother being abused (physically or verbally). Being physically, sexually or verbally abused. Losing a parent to abandonment or divorce. Homelessness. Being bullied. You can probably name a few others.

Since at least 2005, a few dozen individual schools across the U.S. have adopted some type of trauma-sensitive approach. But the centers of gravity for most of the action are in Massachusetts and Washington. These two states lead the way in taking a district-wide approach to integrating trauma-informed practices, with an eye to state-wide adoption.

Without a school-wide approach, "it's very hard to address the role that trauma is playing in learning," says Susan Cole, director of the Trauma an Learning Policy Initiative, a joint project of Harvard Law School and Massachusetts Advocates for Children.


Cole is co-author of a seminal book: Helping Traumatized Children Learn, sometimes known as "The Purple Book."


With a school-wide strategy, trauma-sensitive approaches are woven into the school's daily activities: the classroom, the cafeteria, the halls, buses, the playground. "This enables children to feel academically, socially, emotionally and physically safe wherever they go in the school. And when children feel safe, they can calm down and learn," says Cole.

"The district needs to support the individual school to do this work. With the district on board, principals can have the latitude to put this issue on the front burner, where it belongs."


Many teachers have known for years that trauma interferes with a kid's ability to learn. But school officials from both states cite two research breakthroughs that provide the evidence and data. One was the CDC's Adverse Childhood Experiences Study (ACE Study).

It uncovered a stunning link between childhood trauma and the chronic diseases people develop as adults. This includes heart disease, lung cancer, diabetes and many autoimmune diseases, as well as depression, violence, being a victim of violence, and suicide.

The study's researchers came up with an ACE score to explain a person's risk for chronic disease. Think of it as a cholesterol score for childhood toxic stress. You get one point for each type of trauma. The higher your ACE score, the higher your risk of health and social problems.

A whopping two thirds of the 17,000 people in the ACE Study had an ACE score of at least one;
87 percent of those had more than one. With an ACE score of 4 or more, things start getting serious. The likelihood of chronic pulmonary lung disease increases 390 percent; hepatitis, 240 percent; depression 460 percent; suicide, 1,220 percent. Public health experts had never seen anything like it.

(By the way, lest you think that the ACE Study was yet another involving inner-city poor people of color, take note: The study's participants were 17,000 mostly white, middle and upper-middle class college-educated San Diegans with good jobs and great health care - they all belonged to Kaiser Permanente.)

The second game-changing discovery explains why childhood trauma has such tragic long-term consequences: Toxic stress
physically damages a child's developing brain. This was determined by a group of neurobiologists and pediatricians, including neurobiologist Martin Teicher and pediatrician Jack Shonkoff, both at Harvard University, neuroscientist Bruce McEwen at Rockefeller University, and Bruce Perry at the Child Trauma Academy.

Together, the two discoveries reveal a story too compelling for schools to ignore:

Children with toxic stress live their lives in fight, flight or fright (freeze) mode. They respond to the world as a place of constant danger. Their brains overloaded with stress hormones and unable to function appropriately, they can't focus on schoolwork. They fall behind in school or fail to develop healthy relationships with peers or create problems with teachers and principals because they are unable to trust adults.


With despair, guilt and frustration pecking away at their psyches, they often find solace in food, alcohol, tobacco, methamphetamines, inappropriate sex, high-risk sports, and/or work. They don't regard these coping methods as problems. They see them as solutions to escape from depression, anxiety, anger, fear and shame.

When Sal Terrasi, director of pupil personnel services for the Brockton Public Schools, learned about this research, it really didn't surprise him that trauma interfered with a kid's ability to learn. A 40-year veteran of public schools, "I wasn't unaware of this," he says.

But having empirical data gave him a good reason to try something in Brockton's 23 schools that had never been attempted: Create a trauma-informed school district that works in tandem with the local police department, and the departments of children and family services, mental health, youth services and a group of local counseling agencies.

Oh, he ran into resistance all right. Some teachers' knee-jerk reaction to an angry 15-year-old yelling in their faces is to yell back, kick the kid out of class, and talk with other teachers about how to punish the punk. Or, as Terrasi puts it: they regard the behavior as willful disobedience instead of a manifestation of trauma.

The same teacher is not likely to have the same attitude toward a six-year-old girl who's lost in a daze and will not participate in any class activities.

And yet both children might be responding in their own way to a similar event: awakening to a mother's screams in the middle of the night, calling 911 in despair and watching in terror as police cart dad off to jail.

Wednesday, November 27, 2013

28% Increase in US Children Taking Medication for ADHD: CDC Study

From Before It's News

November 23, 2013

Continued increases in ADHD diagnoses and treatment with medication among US children.

A new study published in the Journal of the American Academy of Child and Adolescent Psychiatry (JAACAP) found that an estimated two million more children in the United States (U.S.) have been diagnosed with attention-deficit/hyperactivity disorder (ADHD) between 2003-04 and 2011-12. One million more U.S. children were taking medication for ADHD between 2003-04 and 2011-12.

According to the study conducted by the Centers for Disease Control and Prevention (CDC): 6.4 million children in the U.S. (11 percent of 4-17 year olds) were reported by their parents to have received an ADHD diagnosis from a healthcare provider, a 42 percent increase from 2003-04 to 2011-12.


Over 3.5 million children in the U.S. (6 percent of 4-17 year olds) were reported by their parents to be taking medication for ADHD, a 28 percent increase from 2007-08 to 2011-12.

Attention-deficit/hyperactivity disorder (ADHD) is one of the most common neurobehavioral disorders of childhood. It often persists into adulthood. Children with ADHD may have trouble paying attention and/or controlling impulsive behaviors. Effective treatments for ADHD include medication, mental health treatment, or a combination of the two.

When children diagnosed with ADHD receive proper treatment, they have the best chance of thriving at home, doing well at school, and making and keeping friends.

According to CDC scientists, children are commonly being diagnosed at a young age. Parents report that half of children diagnosed with ADHD were diagnosed by 6 years of age, but children with more severe ADHD tended to be diagnosed earlier, about half of them by the age of 4.

“This finding suggests that there are a large number of young children who could benefit from the early initiation of behavioral therapy, which is recommended as the first-line treatment for preschool children with ADHD,” said Susanna Visser, of the Centers for Disease Control and Prevention, lead author of the study.

The study increases our knowledge of ADHD treatment. Nearly 1 in 5 or 18 percent of children with ADHD did not receive mental health counseling or medication in 2011-2012. Of these children, one-third were reported to have moderate or severe ADHD.

“This finding raises concerns about whether these children and their families are receiving needed services,” said Dr. Michael Lu, Senior Administrator, Health Resources and Service Administration (HRSA).

The study also found that:
  • Seven in 10 children (69 percent) with a current diagnosis of ADHD were taking medication to treat the disorder.
  • Medication treatment is most common among children with more severe ADHD, according to parent reports.
  • States vary widely in terms of the percentage of their child population diagnosed and treated with medication for ADHD. The percentage of children with a history of an ADHD diagnosis ranges from 15 percent in Arkansas and Kentucky to 4 percent in Nevada.

Nearly one in five high school boys and one in 11 high school girls in the U.S. were reported by their parents as having been diagnosed with ADHD by a healthcare provider.

For this study, data from the 2011-2012 National Survey of Children’s Health (NSCH) were used to calculate estimates of the number of children in the U.S. ages 4-17 that, according to a parent, had received a diagnosis of ADHD by a healthcare provider and were currently taking medication. The NSCH is conducted in collaboration between HRSA and CDC.

........................................................................

The article is available ‘open access’ at:
http://jaacap.org/webfiles/images/journals/jaac/visser.pdf.

Vaccination: A Layperson's Perspective

From Married to Medicine

By Lisa Murakami
September 26, 2013


Needles:  Scary. 
No medication, not even Tylenol, is
100% safe or side-effect free. 
Neither is highway driving, for that matter. But
vaccines are a thousand times safer than driving.  

As a medical "layperson," it's ironic that I'm blogging about vaccination - or at least I think it is.

While my husband slaved away on all the pre-med courses in college, I avoided science like the plague (terrible pun, I know.). When he scored within the top 2% of MCAT takers I was pretty impressed, but truthfully I don't know much about the MCAT. While he busted his butt - to put it politely - through four years of medical school and two years of grant-funded medical research, I studied the health care system... in law school. And over the past 4.5 years that he's been putting in 60-100 hour weeks in medical training at the #1 hospital in the U.S., I've thankfully managed to continue to ... not study or practice any medicine.

That means that he has 14.5 years of grueling medical training that I don't have. And - conservatively estimated - 28,160 hours. My father has infinitely more; he's seen tens of thousands of patients over the course of his forty-year career as a pediatrician.

Clearly, I can't run a google search on a complex medical topic and eventually cobble together a better answer on it than these two can. Not even if I spent ten hours on it. Not even if I spent forty. Not even if I spent weeks. They don't hand out medical degrees for running google searches. Or for talking to midwives... or doulas... or anybody else. Imagine if they did though, and you got in a car accident or you had a heart attack, or you needed a liver transplant or something. Um... yikes.

But the problem is that lay people are blogging about vaccination. And they're meeting up and talking about "vaccine choice." They're imagining conspiracy theories and refusing to trust anyone other than each other. And they've managed to convince others of their "practice of medicine" to the point where there are schools at which only about half of the children are vaccinated and many states are falling below vaccination levels considered to provide herd immunity.

"Herd immunity" is real and it protects us all, especially those who are too young to receive their first vaccines or who are immunocompromised because of a childhood illness like cancer (see the comments for further discussions on this). Herd immunity even protects the vaccinated, as vaccines are "only" 90+% effective, not 100%. Herd immunity is the reason we're not currently in this situation (or this one, or countless others). Would anti-vaxxers still refuse vaccines if they had to travel to one of those nations? And if not, are they only refusing them here since the rest of us do vaccinate?

This topic is so vast and so complex that I'm not going to pretend to be able to address it in single coherent blog entry (unlike so many anti-vaxxers). But I do want to put together a bullet-pointed list of what I, as a layperson with personal access to the medical community, believe that you, as a layperson without that same access (clearly - if you're considering not vaccinating) might want to know. I've followed and participated in many discussions on this topic and there are some repeat misconceptions or missed points that are worth cobbling together.

Here are a few of them:

1.) Vaccines do not cause autism. See also this, this, this, this, this and this. Kudos to Dr. Andrew Wakefield for getting published in a legitimate medical journal, since everything else on this topic either wasn't, or has been misleadingly taken out of context and interpreted by non-medical minds to mean something it doesn't mean to any other physicians, who are also parents themselves.

Too bad though - after other labs were unable to get any results by repeating his study, and after he was unable to reproduce the results himself, the original study was found to have fraudulently falsified its data (this "caught ya!" process is called peer review, and it's why we can rely on science). He made millions and children died. Not sure what that makes him in your book, and I don't want to mention what that makes him in mine. Maybe we should honor those deaths... by vaccinating.

Here's some more persuasion though, if that's not enough:

We've been vaccinating since the 1950s, so we vaccinated for many decades before autism rates went up. The spike has been most significant over the past five years, in spite of the decline in vaccination rates. Hmm. Doesn't seem that vaccines are the cause, does it?

Maybe you know or have heard about someone who went from "normal" to autistic right after his shots. Well, autism is an early-childhood onset condition, and it happens that we vaccinate early in childhood. There are lots of children out there whose symptoms started shortly BEFORE their shots, too; they're just not organizing themselves and speaking out about their experiences. Anecdotal evidence, while compelling to those personally experiencing it, does not show or prove correlation (let alone causation). Medical studies do, but they have repeatedly disproven that vaccines have any relation to autism - every single legitimate, peer-reviewed study (see the links above).

If that weren't true, and this was, then your pediatrician wouldn't be vaccinating his or her own children - at rates even *higher* than the official recommendations.

Okay okay, you still can't be convinced, and perhaps you would like to speak at the next national AAP conference on this topic, and present to them the articles you found on the internet. Well how about the point that my friend made? Her brother is autistic. She loves him just the way he is, and would much rather an autistic brother than a dead one; she takes more than a little offense when people don't vaccinate for fear of autism. I'd rather an autistic child than a dead one myself, personally. But thankfully, we don't have to choose ... because vaccines do not cause autism!


Watching your baby struggle with or
die of suffocation by whooping cough:
Much, MUCH Scarier.
Did you know that kids who miss doses of their
DTaP vaccine are 18x as likely to get it
?

2.) On "alternative schedules." Some people acknowledge that vaccines don't cause autism, but remain convinced that all those pediatricians out there who are vaccinating their children "on time" - meaning, on the schedule created and monitored by the AAP and the CDC, among other professional organizations - are sadly mistaken. They believe there is a "true" best vaccine schedule out there but that pediatricians aren't recommending it - or using it on their own children - because:

(a) it's more convenient for doctors to lump the shots together; or,

(b) the U.K. gives fewer vaccines so the U.S. must be "shot-happy" since we're "for-profit"; or

(c) they read one book by one physician, Dr. Sears, the "schedule" in which has been completely discredited (see also this, this and this for further confirmation of the safety of the current schedule); or

(d) they think we are vaccinating too early because we want to get kids vaccinated before irresponsible parents stop bringing their children to medical checkups.


Well, (a) and (b) cannot possibly both be true, since more visits means more money. So pick just one first, please.

(a) is not true. Doctors wouldn't care if people came in a few more times to get shots; what's it to them? And again, they vaccinate their own children on the AAP/CDC recommended schedule. It's actually more convenient for your child to be poked less with a needle.

But none of this is about convenience; vaccines are simply given as early as they can be, because the sooner a baby is vaccinated, the sooner he or she is safe. Just last winter a baby boy at Boston Children's contracted whooping cough from an unvaccinated toddler. He died - just days away from his first vaccination. So did this child, and many others. Pediatricians are now advising parents on how best to protect their newborns, until their babies are vaccine-eligible

(b) varies by vaccine and is far too complex for this blog entry. Suffice it to say that the U.K. is a different country with a different population, and if our vaccines weren't medically necessary, our insurance companies would be the first to let us know by not covering them. You can also check out this story about a mom in the UK whose daughter died of chicken pox, not having been vaccinated since the chicken pox vaccine (Varicella) isn't on on their vaxx schedule.

(c) why are you trusting someone with whom no other expert agrees, and who is making millions off of this, instead of your own moderately-salaried pediatrician(s)? Okay I get it - you've had a crappy doctor (or doctors) before. Me too. Not everyone is willing to bust their butt like my husband does. But this debate isn't pediatrician-to-pediatrician. This debate involves a clear, essentially unanimous medical consensus among all our leading experts.

See, also cited above, this, this, and this. When you vaccinate on time, you're not "just" trusting your pedi; you're trusting all the top experts on topics including virology, microbiology, statistics, epidemiology, pathogenesis ... and of course, medicine and pediatrics. We're talking the guys who went to Harvard and the like, and got M.D.'s and Ph.D.'s and devoted their careers to research, which generally pays much less than private practice. These tend to be, FYI, super nice and super nerdy guys (and gals) - and most of them are also parents.

They make up the AAP and the CDC and other organizations that put their heads together and come out with the schedule. I truly hope that you don't think that you or I could come up with a better answer than they have, by Googling or by doing other layperson "research."

See also this article - delaying vaccines can increase your chance of having a reaction because your body is better able to mount a stronger immune response; see this, too, for a further discussion. See also this video on the dangers of under-vaccination - children who skip doses of their DTaP vaccine are 18x as likely to get whooping cough.

(d) We aren't vaccinating earlier than "we should" just because some parents might "flake out" on later appointments; we're vaccinating as early as possible because unvaccinated newborns are unprotected and they could, and do, catch things like whooping cough in hospitals and at checkups (and from relatives and friends - especially those who haven't had their boosters) and die. Do you really think that the CDC, AAP, etc., came out with a "truly ideal" schedule, but are keeping it secret because of flakey parents? If so, why do you think that all these physicians and experts follow the recommended schedule on their own children? Again, pediatricians are now advising parents on how to protect their newborns until they are vaccine-eligible.

What about Hep B, they give that one at birth, why?? That's because the Hep B vaccine also protects against "vertical" transmission, meaning transmission from the mother (or father ... or father to mother to child), which usually (but not always) occurs perinatally (meaning at birth).

Because there's no risk in giving this vaccine at birth (none proven, other than the mildest of reactions for this vaccine - see discussion in comments below and what I quote from UpToDate, and ignore what you read on non-reputable websites), and because doing so for the entire population will prevent cases of this terrible disease (and probably eventually eradicate it), that's standard procedure.

Studies on this topic have shown that prenatal maternal testing is not a good way of preventing or predicting perinatal transmission, or childhood acquisition of unknown origin - this is discussed in greater detail in the comments following the post.

NPR article from 9/30/2013: Study confirms that
a recent whooping cough epidemic in California
that killed ten babies was due to failure to
vaccinate and receive boosters.

People who lived in areas with high
"personal belief exemptions" from public school
vaccination requirements were 2.5 times as likely
to live in areas with high incidents of whooping cough.
Link to original study appearing in Pediatrics.

3.) Won't breastfeeding offer the same or better protection? No. How would there have been polio epidemics in the early 1900s if that were true? Polio (as one example) was eradicated in the 1950s when we started vaccinating for it. People actually nursed less in the 1950s than they do now; nursing fell out of favor when commercially marketed formula was presented as and believed to be "better" than breastmilk. My mother-in-law was breastfed, but she still remembers how horribly sick she was with the measles.

4.) What if you keep your kids largely at home with you, should you still vaccinate? Yes. You and your children could end up in a medical waiting room at any time, and that's where the sick kids will also be. See the story above, about the boy who died last year here in Boston. Plus, even if you home school, your kids will be at museums and basically, in public. These diseases are highly contagious. You don't have to share a toy or even a doorknob to catch them.

5.) But my pediatrician approved my proposed alternate schedule. Ask your pediatrician: How would he or she vaccinate his own children? That's the truth of the matter. Delaying a vaccine leaves you vulnerable until you take it, while offering no proven benefit whatsoever. It's a small chance, but it's getting bigger as we've seen in the news lately. Skipping doses is even worse - again, see this video on the dangers of under-vaccination - skipping a DTaP dose makes your child eighteen times more likely to get whooping cough.

6.) But what if it's just a hoax that vaccines are even effective at all? I mean why else would vaccinated people care whether I vaccinate? If you really believe that all our nation's pediatricians and scientists, and those of all the other nations too, and all the legitimate peer-reviewed medical studies, and every history textbook you can get your hands on are all mistaken, there might just be no hope for you.

But in case your common sense can be appealed to, the answer is that vaccines are not 100% (more like 90+). They don't work for everybody, and they can wear off. That doesn't mean that they don't work at all. We've already seen what happens when nobody vaccinates.


If this guy found out that you could vaccinate
your children but chose not to... 

7.) Medical Malpractice. Here's another point, since I'm a lawyer and I studied health law: Physicians these days practice medicine defensively, in fear of getting sued. Yet they continue to advise their patients to vaccinate and to vaccinate on time. Don't you think that pediatricians would stop recommending vaccinations if vaccinating was anywhere near as dangerous as not vaccinating? Or perhaps their liability carriers would force them to do so, or jack up their premiums??

Instead, doctors are increasingly fearing a new kind of lawsuit: Lawsuits from their immuno-compromised patients and newborns who might come into contact with infected, un-vaccinated children in their waiting rooms. They're discussing a new ethical dilemma: Do they deny care to the unvaccinated, or do they risk creating a highly contagious, potentially lethal waiting room for their other patients?

8.) False Sense of Control. I see a lot of anti-vaxxers say "You can always vaccinate later, but you can't take a vaccine back." Of course, the problem with this thinking is that you cannot vaccinate yourself after you get sick. In this way, the vaccination fears are much like fearing flying more than driving. Driving is far, far more dangerous than flying, but people are more comfortable driving because driving gives them the false sense that they will be able to prevent or minimize any collision because they are in control of their own car.

Another good analogy for vaccination is seatbelt wearing. In almost all situations, it is far safer to wear a seatbelt, and seatbelts have saved hundreds of thousands of lives since they became standard in all cars in the early 1960's. But there are occasional cases in which a seatbelt causes injury ... probably even cases where a seatbelt effectively traps someone in a burning car, causing death. That doesn't make it safer to never wear your seatbelt - or to "selectively" wear it!


Polio: A vaccine success story; completely eradicated
in the U.S. (though not globally, yet). Smallpox too;
Smallpox eradication has been so successful that
we no longer vaccinate for it. Even though there's
an alleged pharmaceutical conspiracy
forcing us to get vaccines we don't need...

9.) Social Contract. Anti-vaxxers get really offended when you try to appeal to their sense of social justice. (Note: If social justice on a certain topic offends you, you might be on the wrong side of things. Just sayin'.).

But the fact is that choosing not to vaccinate is at best paranoid and at worst selfish; anti-vaxxers only have the (false) luxury of not vaccinating because the rest of us continue to vaccinate, thus keeping epidemics back in the history books where they belong (herd immunity). Meanwhile they're endangering not only their own children, but they are especially endangering children who are already suffering from childhood illnesses and conditions like cancer and HIV. These children cannot safely be vaccinated with any live vaccines; their immune systems are compromised, so they would risk contracting the illness rather than having a successful vaccination.

And non-live vaccines are less likely to work for them - plus, they have less of a chance of fighting off any serious illness they contract. I'm sorry, but how horrible would you feel if your paranoid choice resulted in the death of a child who was trying to fight cancer?? Plus, like I said before, vaccines can fail - whether you're immunocompromised or not. Could you live with yourself if your paranoid choice killed someone else's child, or your own?

Because it happens a lot more often than even just the the alleged internet "vaccine deaths." And I think it should be considered negligent homicide. (See this for a discussion of the potential legal ramifications for failure to vaccinate your child).

I'm not writing this blog entry to convince the unconvinceable - and that's why I'm not sugar-coating it. I'm writing it for the people who are on the fence: the middle ground that we've been losing by being too nice about this because there is such an outrageous amount of false and misleading information on the internet that appears reliable.

I have absolutely no bias or financial gain in this equation (neither, by the way do the salaried pediatricians or pediatricians in small practices that sometimes lose money on vaccines, or the history textbooks). I'm not a physician and my husband is going into cancer research. My father is nearing retirement. I have nothing to gain but what I do have is access to two brilliant medical minds who carefully considered this issue when choosing to vaccinate their own children.

My father and my husband have heard, through me, all the arguments brought up against vaccines and expertly batted them away. Perhaps your pediatrician isn't taking the time to do so with you; that might be because hospitals and insurance companies don't pay for or structure lengthy "scientific education" sessions with parents into well-child visits.

Or perhaps your pediatrician has simply given up because it's so rare that he or she changes the mind of someone who is already trying to find their own internet answers rather than trusting the unanimous opinion of all of our leading experts and scientists - see also this recent article on the frustrations physicians are facing out near me in Western Massachusetts.

What I would love to see happen is for each pediatric office to publish a brochure on vaccines that answers the most common questions and addresses the most common misconceptions.

Until then, here's a brief list of resources for the curious.

** And I'd like to just note here that I am unable to "link to" a lot of the sources provided to me for this blog entry. That's because you have to have to pay for a subscription to a lot of the major medical journals and other legitimate scientific sources - or make the big trek to your nearest medical school's library.

In other words, a lot of the best stuff out there isn't available by Googling the internet. And in fact, some of the very worst stuff is- check out this recent sting operation that found that some of the online journals will actually publish fake science for a fee.

** Also, comments will be disabled as of Friday, October 18th. With nearly 500 comments, I can't imagine we haven't covered it all... and I need to get back to doing other stuff with the limited free time I have as a busy mom of two healthy, vibrant, fully vaccinated children.

Many of the comment threads are fascinating and informative, with lots of physicians and other experts responding. A Command+Find search *after* you scroll and upload to the end of all the comments - which you now have to do several times to reach the end - might help you find threads that are of interest to you.

I took care during the nearly one full month since this was originally published not to delete a single comment. So you can rest assured that the integrity of the comment threads is fully preserved.

  • Two articles (this and this) discussing studies that have found that delaying vaccines increases your child's chance of having an adverse reaction (but note that all but ultra, ultra rare adverse vaccine reactions are fairly benign).
  • Pakistan polio outbreak puts global eradication at risk - "Health teams in Pakistan have been attacked repeatedly since the Taliban denounced vaccines as a western plot to sterilize Muslims and imposed bans on [them] in 2012 ... dozens of children, many of them under the age of 2, have been crippled by this disease in the past six months."
  • On vaccine package inserts: "Inserts are a problematic source of information for a number of reasons. They are legal documents, not scientific documents. They do not include science done after the insert was approved. They include ingredients, but do not show you that you are already exposed to those ingredients naturally and how tiny the amounts in vaccines are. They have to report on every adverse event that allegedly happens after a vaccine, whether or not causally related. In short, they are usually more misleading than useful, and my experience is that most readers get them wrong. My favorite was the anti-vaccine proponent who insisted that the vaccine insert said a child cannot eat fruit and vegetables for six weeks after getting the vaccine."