Fooling Ourselves: On the Fundamental Value of Vaccines 0987084712, 9780987084712

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on the fundamental value of vaccines

Greg Beattie A sequel to ‘Vaccination - A Parent’s Dilemma’

1st Print Edition (revised edition of eBook first released Feb 2011) © Copyright Greg Beattie 2012 Cover design and book layout by Roxanne Iwinski ISBN: 978-0-9870847-1-2 All rights reserved. No part of the book, either in part or in whole, may be reproduced, by any means, without permission in writing from the publisher, except for brief quotations embodied in literary articles and reviews, and copying for personal use. Readers are invited to reproduce any of the images (graphs) that are marked “© Greg Beattie” provided the reproduction is accompanied by a prominent display of the source and web address – e.g. Source: “Fooling ourselves: on the fundamental value of vaccines” http://vaccinationdilemma.com

FOOLING OURSELVES ON THE FUNDAMENTAL VALUE OF VACCINES

by Greg Beattie Queensland, Australia Email: [email protected] Website: www.vaccinationdilemma.com

Acknowledgements Many have assisted with the preparation of this book. Apart from those mentioned in the text, I wish to acknowledge the following: Sarah Lee, for unbounded encouragement and support, as well as countless hours reviewing and proof-reading. Roxanne Iwinski for cover design and book layout. Mary Clarke for constructive criticism. Of special note are Tiger and Diane, for ensuring my tone was non-adversarial and my message, clear. Special thanks to Viera Scheibner Ph.D. (http://vierascheibner.org), Meryl Dorey (http://avn.org.au) and Magda Taylor (http://informedparent.co.uk) for review. Also, the many ‘posters’ on the AVN discussion forum: of note, Robert Webb, Punter, Bawdy and Michael for their engaging discussion. Finally, thank you to my children and grand-children for enduring my preoccupation with the task.

This book is lovingly dedicated to Louise, Luke, Sam, Kiro Lewis, Lennan, Charley Charlie, Lailah and Ava

Contents Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 1

The belief . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5

2

A new chapter . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21

3

The reality . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35

4

The data . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 55

5

Revisiting the paradigm . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 67

6

Inventing new diseases . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 77

7

The peculiar story of polio . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 89

8

Conclusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 109

Appendix I – Smallpox . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 115 Appendix II – What’s in a shot? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 119

Introduction In mid-2010 I pondered the possibility of updating “Vaccination—a Parent’s Dilemma”. I had written the book 14 years earlier, and in the intervening period had well and truly distanced myself from the vaccine issue. Although never far from my thoughts, for ten years I had rarely spoken to anyone about vaccines. The thought of updating the book filled me with dread. It was a task I was not looking forward to, as I knew it would take much time and money, both of which I could ill-afford. After much encouragement and support I finally bit the bullet and decided to give it my best. Before long, I realised the issue had not changed in essence. There were a few more vaccines in the schedule, and some new tactics were being used to encourage parents to conform, but the underlying message was still the same: Take the vaccine. It will prevent the illness, and it is very safe. Of course, the social responsibility issue had become bigger. Now, grandparents and family friends were being asked to submit to adult vaccination. A bigger change for me though was I now had greater access to data. That which would have taken me days writing letters and following threads in libraries 20 years ago, was now achievable in hours from the comfort of my own home. Some national and even international data was available to me for interactive querying on-line! And the picture it painted meant I could never look back. The update would frame a story that had to be told. Some way through the project, the update actually outgrew the book, and Fooling Ourselves was born. A significant link to the earlier book remains, as well as a degree of repetition, out of necessity. It is a sequel in some ways, although A Parent’s Dilemma is not pre-requisite reading. Fooling Ourselves stands on its own as a critique of vaccines, or more importantly, a critique of our beliefs concerning them. Readers of both will gauge a difference in approach between the two books but the basics are still the same, and even after 25 years I remain convinced that my decision to avoid vaccines for my children was a sensible one. Sensible, despite a Human Rights Commission ruling which upheld a government-run childcare centre’s decision to exclude my healthy, non-vaccinated children from their facility. You can read about the hearing in Part 2 of A Parent’s Dilemma.1

1

http://vaccinationdilemma.com

This book is not about harm caused by vaccines, which may surprise some readers. There is not even one chapter about harm. In fact, harm is rarely mentioned. In these pages we examine the claim of benefit, and in some ways I believe this can be more confronting than the issue of harm, especially when we acknowledge that evidence of harm exists. I decided to focus on the benefits for a few reasons; chiefly, because I feel it is there that we lay bare the root of the argument. Some startling revelations await us, and I believe we will begin to understand why there has been seemingly endless disagreement for more than two hundred years. I must stress that my decision to focus on benefit was certainly not because I felt the issue of harm was less important. The truth is: I believe it is impossible for us, as a community, to undertake an unbiased assessment of harm. By the time you finish reading Chapter One, you will understand why I say this. But don’t stop there, as Chapter One merely sets the stage for the rest of the book. The subsequent chapters will unravel the vaccine conundrum in an orderly fashion. While the book is written in an easy-to-follow manner, be prepared to be confronted from time to time. In particular, a comprehensive review in Chapter Four examines the integrity of the main data-set used to market vaccines to parents. Chances are, this is the same data-set you were shown to illustrate the benefits. I trust you will find the book enlightening and thought provoking. As stated in my first book, I do not wish to provide advice on whether you should have your child vaccinated. My aim is to precis and pass on information. As a parent, I find this information compelling, and perhaps you will, but what you decide to do with it remains your choice. And whilst your choice is not something I wish to influence, I do care about the quality of information you receive, and hope your final choice is a truly informed one. Above all, I hope this book can add to the body of understanding on issues surrounding vaccines. Ideally, I would like to think it may be of value to policy-makers who seek a greater awareness of the controversy. At the very least, if the book encourages further debate, I will be happy with my contribution. After you have finished reading, I would love to receive your feedback via the “Contact” form at: http://vaccinationdilemma.com Thank you, Greg Beattie

The great enemy of the truth is very often not the lie—deliberate, contrived and dishonest—but the myth—persistent, persuasive and unrealistic. – John F. Kennedy.

Chapter ONE

THE BELIEF Scientific criticism has no nobler task than to shatter false beliefs. Ludwig von Mises There is a belief which lies at the heart of vaccination; one which predicates all discussion, investigation and appraisal of it. The importance of this belief is not generally appreciated but not only is it the foundation of vaccination, it also serves as one of the cornerstones of the temple of modern medicine. If it moves, the walls of the temple shake and devotees rush to stay the structure. While the stone stays firm, we continue forging opinion, formulating hypotheses, conducting “research and review” and even building policy upon it. So what is this belief and why is it so powerful? More importantly, how does it shape our community?

Beliefs about our past It was October 1996. Charley (the cover boy on A Parent’s Dilemma) would be born in five weeks. My Human Rights Commission hearing had concluded a little under three months earlier and I was eagerly awaiting the decision. It would take a further three months to arrive. A friend called excitedly to tell me that Norman Swan’s The Health Report (Radio National - ABC) was broadcasting a special show on vaccination that night, and was promising to air both sides of the debate. Who’s Norman Swan, I asked? The caller gasped disbelief at my ignorance before assuring me “this guy will do a good job”. I jotted down the particulars and went about finding a radio. For the benefit of those who share my past radio ignorance, Dr Norman Swan is a highly regarded paediatrician. He is also a multi-award winning broadcaster, having received Australian Radio Producer of the Year in 1984, among many other accolades and recognitions. I caught the show. It opened dramatically. Church music played while the presenter, Sharon Carleton, wandered through a graveyard, reading from headstones... 2

2

The Health Report: 7th Oct 1996; Radio National http://www.abc.net.au/rn/ talks/8.30/helthrpt/hstories/hr071096.htm

To the memory of Alice Ellen Olivia, who died November the 10th, 1874, aged 1 year and 16 days. Also Frederic Charles, died November the 14th, 1877, aged 2 years and 9 months. The beloved children of … Walter Charles, died 19th October 1883, aged 7 months... Frances Martha Roper died May 12th 1860 aged 17 months. Also John Joseph Roper died 1862, age 9 months… A stroll through any Australian cemetery provides a silent reminder of how often families in the past mourned their very young. What these weathered old headstones don’t tell us of course, is what caused the children’s deaths: scarlet fever, measles perhaps, diphtheria, whooping cough. A century ago they were all common, often fatal, childhood diseases. Then, the voice of authority cuts in: What changed, Sharon, was that we introduced immunisation. Immunisation has prevented more suffering and saved more lives than any other medical intervention in this century, even antibiotics. Therein lies the focus of this chapter. There was a time in our history when the threat of death from acute illness was enormous. And it was ever-present. Loss of children and other family members to the likes of measles or whooping cough was the norm, rather than the exception. It was a long time ago; the examples in the radio show above were well over 100 years ago. Thankfully, we were delivered from this situation. Death rates fell, and the illnesses ceased to be the threat they once were. How did this change come about? Well, it is generally attributed to several influences but first and foremost is the advent of vaccination (also called immunisation), as we heard above. Vaccination has been written into the history books, alongside clean water, as being our greatest weapon in the fight against the acute killer diseases of our past.

The corollary As a natural corollary to this, we believe that in order to avoid returning to those days, we must keep vaccinating our children. If we fail to do this, the image of those frightening days serves as a reminder of what will happen. The belief that vaccination arrived and transformed our world from one where death from acute illness was common, to another where it is rare, is seldom discussed. It is a belief that lies at the heart of all thought on vaccines. It is also possibly one of the most universally accepted medical beliefs of our time. The voice of authority in the radio broadcast above was that of Dr Margaret Burgess, one of our nation’s most respected spokespersons on vaccination. Professor of Paediatrics, with a long list of credentials, awards, memberships,

published papers etc in the field of vaccines, she was to receive a Queen Elizabeth II Silver Jubilee Medal one year after this broadcast. Six years after that, she received the Order of Australia. In a nutshell, she was eminently qualified to make all sorts of pronouncements regarding vaccines. However, one doesn’t need qualifications to make statements such as: What changed... was that we introduced immunisation. Why? Because that statement is the most well-accepted and cherished aspect of our collective belief in vaccines. Ask almost anyone why deaths from measles or whooping cough plummeted, and you will hear “vaccination” or “immunisation”. If you had asked me twenty-five years ago, I would have joined in the chorus. I was raised on the same belief. But there is a problem. The belief is not correct. And this can be easily demonstrated. In this chapter, I will show you clear and compelling evidence that the belief is completely without foundation. Fourteen years ago when A Parent’s Dilemma was written, I realised that this belief underpinned almost all thought on vaccination. I knew it had a significant impact on our collective evaluation of the practice. Since then, I have come to an even greater understanding of its role in the debate, and decided to dedicate a whole chapter to it.

Statistical evidence Let’s have a look at the evidence now. We will plot the death rate for each illness on a graph, and point to the spot where the vaccine was introduced. Figures for death in Australia going back as far as 1907 are found in the Commonwealth Year Books. Population figures are available from the Australian Bureau of Statistics. For the following graphs, I obtained death data going back well before 1907, for some of the illnesses.3 The rates on the graphs represent deaths per 100,000 population. The figures are five-yearly totals, and the introduction of the vaccine is indicated on each graph.

Measles The graph for measles (Figure 1) shows us that the five-yearly death rate, 100 years before the vaccine was introduced, was around 170. One hundred years later, and immediately prior to introducing the vaccine, it was less than one. That’s a reduction of 99.5%—before the vaccine arrived. The remainder of less than 1% is therefore the only portion of the decline to which the vaccine can

3

Cumpston JLH; The History of Diphtheria, Scarlet Fever, Measles, and Whooping Cough in Australia, 1788-1925: Commonwealth of Australia, Service Publication No. 37, 1927

Measles - Australia

© 2011 Greg Beattie. Plot points are 5 yearly totals. Sources: Data published by Commonwealth of Australia in The History of Diphtheria, Scarlet Fever, Measles, and Whooping Cough in Australia, 1788-1925 (Cumpston, 1927) and Commonwealth Year Books, plus Australian Bureau of Statistics population data.

Figure 1. Measles, Australia

possibly lay claim, because it simply was not around for the first 99.5%. How much claim can it lay to this last little bit? We will see in Chapter Three. Measles vaccine was introduced in 1968 and added to the childhood schedule in 1971.4 Unlike measles, most of the other vaccines went through a period of gradual introduction.

Diphtheria Diphtheria vaccine (Figure 2), although introduced in the late 1920s, did not come into widespread use until the late 1930s at the earliest, and some say it was not until 1953, when the DTP 5 vaccine was licenced. The delay was due to an event in 1928, which came to be known as the Bundaberg tragedy6, and from

4

Measles in an era of measles control; Med J of Aust 2000; 172: 103-104 http://www. mja.com.au/public/issues/172_03_070200/mcintyre/mcintyre.html

5

‘D’ is for diphtheria, ‘T’ is for tetanus, and ‘P’ is for pertussis (also known as whooping cough)

6

In Bundaberg on one afternoon 21 children were injected. 12 of them died within 34 hours. A lengthy discussion can be found in “Vaccination – a Parent’s Dilemma” http://vaccinationdilemma.com

which the country was slow to recover. In the graph, we see the death rate had already declined by roughly 80% prior to any use of the vaccine.

Diphtheria - Australia

© 2011 Greg Beattie. Plot points are 5 yearly totals. Sources: Data published by Commonwealth of Australia in The History of Diphtheria, Scarlet Fever, Measles, and Whooping Cough in Australia, 1788-1925 (Cumpston, 1927) and Commonwealth Year Books, plus Australian Bureau of Statistics population data.

Figure 2. Diphtheria, Australia

You will notice two extra lines in the graph for diphtheria. One of these is for croup, and the other for the combined total of croup and diphtheria. There is a point in the early 1900s from which only the combined line remains. The reason for these lines is that diphtheria and croup were not always differentiated. Diphtheria was sometimes referred to as membranous croup 7. According to Rudolph’s Fundamentals of Pediatrics8, “Early in the 1900s, the term croup was synonymous with laryngeal diphtheria”. Prior to the early 1900s, figures for diphtheria and croup were recorded separately. After this, they were lumped together.

7

http://www.lilyblog.com/membranous-croup.html

8

Rudolph’s Fundamentals of Pediatrics: Third Edition by Abraham Rudolph, Robert Kamei, and Kim Overby (Feb 14, 2002) p338

Whooping Cough - Australia

© 2011 Greg Beattie. Plot points are 5 yearly totals. Sources: Data published by Commonwealth of Australia in The History of Diphtheria, Scarlet Fever, Measles, and Whooping Cough in Australia, 1788-1925 (Cumpston, 1927) and Commonwealth Year Books, plus Australian Bureau of Statistics population data.

Figure 3. Whooping Cough, Australia

Whooping cough Next, to whooping cough (Figure 3). This was another vaccine introduced gradually from the 1940s. Its routine use in infants came with the licensure in 1953 of DPT vaccine (the ‘P’ is for pertussis, or whooping cough). As can be seen from the graph, there was roughly 95% reduction in mortality from the 1870s, prior to the DTP vaccine being licenced in 1953, and close to 90% reduction before earlier vaccines were used, during the 1940s.

What about other illnesses? I have decided to present graphs with death rates of two illnesses—one with a vaccine, and the other without—side by side for comparison. Measles is compared with scarlet fever in Figure 4. Both had similar death rates in the 1800s. With no vaccine, the death rate for scarlet fever declined just as efficiently as that of measles, and did not return to previous levels. Similarly, I have selected typhoid fever to be compared with whooping cough in Figure 5. The comparisons seem ludicrous on one hand; after all, none of the illnesses had a vaccine until the end. But just in case we thought measles or whooping cough may have made a last minute dash and sprung back up to the levels of 100 years ago had we not invented a vaccine, the other two are there to remind us that that was unlikely. Typhoid fever and scarlet fever were once as great a problem

Measles and Scarlet Fever - Australia

© 2011 Greg Beattie. Plot points are 5 yearly totals. Sources: Data published by Commonwealth of Australia in The History of Diphtheria, Scarlet Fever, Measles, and Whooping Cough in Australia, 1788-1925 (Cumpston, 1927) and Commonwealth Year Books, plus Australian Bureau of Statistics population data.

Figure 4. Measles and Scarlet Fever, Australia

as the other two; in fact, greater. They declined and became relatively insignificant just the same, and without a vaccine. Data for typhoid fever deaths from 1910 onward show similar rates to whooping cough, as can be seen in Figure 5. One last graph—tetanus (Figure 6). This one was not included in A Parent’s Dilemma, as I did not have the data at the time. Tetanus is not a contagious illness, and it is almost unheard of in children. This graph is plotted from data kindly supplied by the Australian Institute of Health and Welfare9. Please note: the graph covers all ages and, like the typhoid fever graph in Figure 5, it commences in 1910, whereas all the previous graphs commence 40 years earlier. As we can see, tetanus mortality followed a steady decline, similar to the diseases already mentioned. There are more peaks and troughs visible, because the plot points are yearly, rather than 5-yearly as in the earlier graphs. As with the previous illnesses, we are likely observing the tail end of a significantly greater decline, but without the benefit of the earlier 40 years data, it is difficult to be certain.

9

Australian Institute of Health and Welfare (AIHW) 2010. GRIM (General Record of Incidence of Mortality) Books. AIHW: Canberra; Original author Dr Paul Jelfs, updated by Karen Bishop http://aihw.gov.au/grim-books/

Whooping Cough and Typhoid Fever - Australia

© 2011 Greg Beattie. Plot points are 5 yearly totals. Sources: Data published by Commonwealth of Australia in The History of Diphtheria, Scarlet Fever, Measles, and Whooping Cough in Australia, 1788-1925 (Cumpston, 1927) and Commonwealth Year Books, plus Australian Bureau of Statistics population data.

Figure 5. Whooping Cough and Typhoid Fever, Australia

Tetanus - Australia

© 2011 Greg Beattie. Sources: Australian Institute of Health and Welfare (AIHW) 2010. GRIM (General Record of Incidence of Mortality) Books; Original author Dr Paul Jelfs, updated by Karen Bishop.

Figure 6. Tetanus, Australia

Facing the truth Before I continue, I would like to say a few words about reactions to this. I presented similar graphs (excluding tetanus) at my Human Rights Commission hearing. To my surprise, they were received with disinterest, dismissed as irrelevant, and totally disregarded by the expert witnesses from the medical establishment, and thus the Commissioner. When I subsequently published them in A Parent’s Dilemma, the opposite occurred. They were received with great interest by readers, and quickly spread around the world. If you search the Internet today, you will find numerous sites where the original graphs have been reproduced, alongside many for other countries. Why the vast disparity between the reactions? I can group the public reaction into two distinct types. The first, which has also been the most common, is shock or disbelief. This reaction is from those who find it difficult to believe what they are seeing. It is the same feeling I had when I first saw evidence of this; the experience of having a cherished belief pulled apart, in front of my eyes. It is common for people with this reaction to question the figures, and the graphing technique. Where did you say these figures are from? Why have I not seen graphs like this before? Did you double check the figures? In my opinion, this is a perfectly normal reaction. We, as a community, have a deep faith in medicine, especially vaccination. The second is the that doesn’t prove a thing reaction. This is a declaration of rejection. It is less common, and often comes from those who are actively involved in marketing and promoting the use of vaccines. When asked to explain this reaction, these people tend to argue one thing—that this data cannot be used to assess vaccine performance. And they are correct. These graphs do not make any attempt whatsoever to measure the performance of a vaccine. They simply put things into historical perspective for us. This perspective illustrates that vaccines were unimportant influences in the bigger picture; that they arrived too late to be considered potential contributors of any significance. In Chapter Three we will examine (under a microscope) the contribution that vaccines made to the tail end of the declines. For now, let us simply acknowledge that, in historical perspective, vaccination made little if any contribution to the decline in deaths from each illness.

Conclusions The death rates from diseases for which we developed vaccines fell substantially and consistently since the mid 1800s. Most of this decline occurred well before vaccination was introduced. Routine vaccination was in fact not even available for some of the diseases until they had almost disappeared. Each death rate was declining substantially prior to vaccination and, as we have no reason to suspect that trend would have changed, we have no reason (yet) to

credit the small remainder of the decline to vaccination, especially when we can see that other diseases continued their decline, without vaccines. The story is similar for the rest of the developed world. By following this footnote10 on the Internet, we can peruse numerous historical graphs from England, the USA and Europe, which confirm this. THE BELIEF What changed... was that we introduced immunisation. THE TRUTH What changed... had little, if anything to do with immunisation. This information is freely available, and some medical historians have previously published reports correcting the belief. But the message does not appear to have been loud enough or strong enough, because we all still seem to believe that vaccines brought about the declines. I will go a little further. Although it is not strictly the subject of this book, in a wider sense, it would appear modern medicine has contributed surprisingly little to the overall health transition that has seen our life expectancy increase, from 35 years in the 1700s to around 80 years at present; although various spokespersons claim that the improvements are the result of modern medicine in general, and vaccination in particular. At least, that is the view of several well-known and respected authors.

Three influential books This perceived insignificance of medicine in the past, was first officially acknowledged in the 1970s. It was a decade which saw the release of three influential books; probably the first mainstream works to bring the matter to the attention of the profession. The first was Archie Cochrane’s “Effectiveness And Efficiency: Random Reflections On Health Services” in 1972, which ultimately led to the formation of the Cochrane Collaboration, and the birth of evidence-based medicine. Then, Ivan Illich, famous Austrian philosopher and historian, followed with “Medical Nemesis: The Expropriation Of Health” in 1976. Finally, “The Role Of Medicine: Dream, Mirage Or Nemesis” by Thomas McKeown, was first released in 1976, and subsequently expanded and re-released in 1979. (McKeown was later appointed Chairman of the WHO Advisory Group on Health Research Strategy).

10

http://childhealthsafety.wordpress.com/graphs http://healthsentinel.com

All three books carried essentially the same message—that medicine’s impact on health has been historically very small, and greatly exaggerated, and that many therapies were routinely used, despite either being known to be ineffective, or having not been studied to assess effectiveness. This may surprise us. It certainly did me, and it still does. We all know someone who would not be here today, if it were not for some life-saving, medical intervention 11. However, these authors, after exhaustive study of the situation, concluded that the influence of medicine over the period from the late 1800s to the late 1900s, was much less than that of nutrition, sanitation, and other social reforms. Cochrane was gentle and humorous, ultimately offering us a way out, via the formation of the Cochrane Collaboration12, and the new discipline of evidence-based medicine. McKeown’s work was noted 13 as the “single exception” in a landscape which had ignored the epidemiology of medical treatment. He studied a period which saw a 23-year increase in life expectancy, and concluded that medicine could only take credit for 1-2 years of this. But McKeown didn’t factor harm from medicine in his assessment. Illich did, and he found that when harm was considered, medicine’s influence became worse than nil. A reviewer commented on the books as follows: The implications for public health of McKeown’s and Illich’s books have been largely ignored or considered irrelevant by clinicians, who are busy taking care of patients one at a time. Basic scientists appear not even to have noticed their existence14. I want to speak briefly about Illich’s book. The Lancet medical journal commented on its release with the following15: Medical Nemesis is an important book. What gives Illich impact is an ability to provide a focus for our increasing doubts. The headings of the first three chapters read like a volley of grapeshot across the bows of our mechanistic philosophy of health care.... there is indeed a strong case to answer.

11

I am one of these. At 16 years of age I suffered acute appendicitis and had emergency surgery “just in time”.

12

http://www.cochrane.org/

13

Bunker J. The role of medical care in contributing to health improvements within societies; Int. J. Epidemiol. (2001) 30 (6): 1260-1263 http://ije.oxfordjournals.org/ content/30/6/1260.full

14

Ibid

15

Illich I. Limits to Medicine—Medical Nemesis: the Expropriation of Health; (Penguin Books 1976) Back cover

As I mentioned earlier, Illich described the impact of modern medicine on health as worse than nil. His was the book which ultimately inspired me to plot the graphs we have just seen. Regarding influence over disease epidemics, he said16: The study of the evolution of disease patterns provides evidence that during the last century doctors have affected epidemics no more profoundly than did priests during earlier times. Epidemics came and went, imprecated by both but touched by neither. They are not modified any more decisively by the rituals performed in medical clinics than by those customary at religious shrines. Discussion of the future of health care might usefully begin with the recognition of this fact. The reason I have chosen to share this particular quote from his book was not because it was one of the more savage. It wasn’t. In fact, the book was a blow by blow humiliation, which medicine largely took on the chin. I chose this quote because of its last sentence. I will repeat it: Discussion of the future of health care might usefully begin with the recognition of this fact.

Where do we go from here? The book you are reading now is not critical of health professionals, but of the system of thought underlying our collective belief in vaccines. The research world has indeed witnessed many significant contributions from committed individuals who find ways to help lift humanity from suffering. However, there have also been many displays, not so prominently paraded, of the insignificance of medicine in some fields of endeavour. These are often not acknowledged to a degree where the public is aware of them. Nowhere is this lack of integrity more blatant than in our recollection of the role of vaccines in the historical decline of deaths. It is time we changed that. It is time we, as a community, stopped regurgitating tales of how vaccines saved us from our past. It is also time we insisted all future consideration of policy begins with a recognition of the fact that vaccines made little, if any, contribution to the historical decline in deaths.

The real reason for the decline Whatever brought about the massive decline in deaths before vaccines were introduced, no doubt maintained its influence after they were introduced. Professor Thomas McKeown in The Role of Medicine (mentioned above), says17:

16

Ibid p23

17

McKeown T. The Role of Medicine: Dream, Mirage or Nemesis (Basil Blackwell 1979) p162

Experience of the last two centuries indicates that infectious deaths fell to a small fraction of their earlier level without medical intervention, and suggests that had none been available they would have continued to decline, if not so rapidly in some diseases. The reasons most medical historians give for the decline in deaths from these diseases, are improvements in nutrition, hygiene and sanitation; nutrition being foremost. A very influential report by Dr Moises Behar, published in World Health, explains as follows18: In the now developed countries, mortality due to tuberculosis, measles, whooping cough, typhoid fever, diarrhoeal diseases and many other infections began to fall long before the responsible microbial agents had been identified and before specific measures of control or treatment were known. This decline – much greater than anything achieved since through the use of vaccination and antimicrobial drugs – paralleled the improvement in general living conditions. Microbes and the diseases caused by them prosper, therefore, only in environmental conditions favourable to them. Regarding nutrition, Dr Behar went on to say: A debilitated organism is far less resistant to attack by invading microorganisms. Ordinary measles or diarrhoea – harmless and short-lived diseases among well fed children – are usually serious and often fatal to the chronically malnourished. Before vaccines existed, practically every child in all countries caught measles, but 300 times more deaths occurred in the poorer countries than in the richer ones. The reason was not that the virus was more virulent, nor that there were fewer medical services; but that in poorly nourished communities the microbes attack a host which, because of chronic malnutrition, is less able to resist. The report concluded: For the time being, an adequate diet is the most effective “vaccine” against most of the diarrhoeal, respiratory and other common infections.

A cultural trance Let me return briefly to the opening quote from our voice of authority: What changed... was that we introduced immunisation. I do not wish to make a spectacle of the show, nor of the highly respected expert who uttered those words. Indeed, we all know they were not the first to publicly express this belief; nor have they been the last. Countless books, articles, televi-

18

Behar, M. A deadly combination; World Health Feb-Mar, 1974

sion shows, advertisements and, dare I say, peer-reviewed research and review articles in medical journals, one way or another, make a point of propelling this belief as an opening statement. I could have picked from a multitude of examples. But in the radio broadcast we were presented with a very powerful image. Gravestones were used as the evidence. The tragic story was told. The expert arrived to assure us things had been fixed, and we need not worry any more, as long as we continue to take our vaccines. I chose the quote from this broadcast because I thought it was the perfect articulation of the belief. It came from one of our nation’s foremost experts, was broadcast on Radio National by a celebrated investigative journalist, and it was not questioned. But then, no-one questions it. Well, almost no-one. The public don’t question it. Doctors don’t question it. Journalists don’t question it. As I indicated earlier, it is an axiom of medical belief. And it is certainly the trump card in discussions of risks and benefit. Any debate, concern, or questioning of vaccines is ultimately met with.... hey, where would we be today if it weren’t for vaccines? Because it is hardly ever questioned, it is the most compelling evidence offered to support vaccination. Our National Health and Medical Research Council (NHMRC) promote this belief in their book, “Immunisation Procedures”. How do they validate it? They actually don’t. Those who promote the belief rarely present evidence to support it. Regarding diphtheria, the NHMRC summarised Australian history in the following manner 19: Earlier this century diphtheria caused more deaths in Australia than any other infectious disease, but increasing use of diphtheria vaccines since World War II has led to a progressive decline in mortality. The NHMRC is our nation’s authority on vaccination. Here they describe the trend in death rate from diphtheria, and inform us that the vaccine was the influence which brought about change. As an exercise, take a moment to turn back to the graph for diphtheria, and check for yourself. You will see the major part of the decline occurred well before World War II. That part of the decline following the war will be discussed in Chapter Three. Some authors who promote the belief take the trouble to provide figures or graphs to support their view. However, they usually only show smaller pictures—the part which supports the view. For example, take the graph for whooping cough and cover the left side of it with another book, leaving only the portion from 1940 onward exposed. You can now see that since the introduction of a vaccine during the 1940s, the deaths declined. This is a convincing graph to use if we are wanting to promote the belief. It is not until we take the book away that we get the whole picture. Removing the book gives us perspective.

19

The Australian Immunisation Procedures Handbook - 5th Edition: NHMRC, p25

The question often asked is why would someone do that? Why present information in a way that distorts or hides the true picture? This is a complex question, and it has attracted much speculation. It is also the source of some of the heat in the public debate about vaccines. Many people are concerned there are financial motives. Whilst I accept that, I am convinced that more altruistic motives predominate. The primary goal for our health system is to promote vaccination. For those involved in this, correcting a fundamental error that has always been the trump card in getting parents to consent, is perhaps not important. Simply acknowledging the error seems to be something few will do. I guess for some, why not keep it going? This belief is undoubtedly the most effective tool for achieving increased vaccination rates, which is their target. Whatever the reason, bear in mind that many who promote the belief do not have all the information. Many are not even aware that they are promoting a belief which is unsound. They are simply repeating what we have all been taught. Those who have the information, but decide to suppress it... I guess that is where it becomes complex. I can only assume they have been so indoctrinated with the belief that they subconsciously reject the evidence, to prevent it interfering with what they believe to be true. When a belief becomes entrenched in an entire community, it is known as a cultural trance. A cultural trance can stifle healthy growth. It can prevent us making open and honest appraisals. It can lead us to distort evidence to suit herd-belief. We cannot make informed choices on vaccination while such a fundamental error exists in the debate. Nor can we develop sound policy.

Just how deep-rooted is it? As mentioned earlier, I realised before writing A Parent’s Dilemma that the belief had a profound impact on the debate about vaccines. In the intervening 14 years, I have had an opportunity to ponder further, and observe more fully, the sometimes unseen role it plays. Certainly, the most obvious outgrowth of it is the reasoning that if we stop vaccinating, the deaths will go back up. Ask yourself what would happen if we all stopped vaccinating tomorrow. I mean completely stopped. What would happen to the death rates? Try and think back, to before you saw the graphs. If you are picturing a scene of calamity, littered with measles-ridden corpses, don’t be too hard on yourself. I think that’s what most people picture. The truth is the data show otherwise. There appears to be no reason for us to think deaths will go up at all. These graphs, together with the magnified versions you will see in Chapter Three, show us that deaths were already declining and they continued that decline after vaccines were introduced. Even the diseases without vaccines followed the same trend. That means we may have no reason to attribute any savings in mortality whatsoever to the vaccines.

Could you imagine if everyone knew that vaccines had nothing to do with the drop in deaths, and if it were openly acknowledged that abandoning them would not make the deaths go back up? Can you picture how different the marketing of vaccines would have been had there been widespread acknowledgement of this? The bottom line is this: if the illnesses were conquered before vaccines were used, or at least looked like they were on the way to being conquered, then we do not have to fear their return if we stop vaccinating. Yet, articles on vaccination frequently begin with a statement in their introduction, along the lines of: Immunisation has saved more lives and prevented more suffering than any other medical intervention... Even articles that present an unpleasant aspect of the practice, such as babies with bad reactions, or children getting an illness despite being vaccinated, still tend to commence with a declaration such as that above. It is almost a disclaimer, with the writer declaring up front “Hey, I know these things are unquestionably great, so please don’t think I’m questioning them, but...”. And it seems that, without such a declaration, the writer runs the risk of being branded “anti-vaccine”, and their views not taken seriously by the mainstream. Even peer-reviewed medical journal articles often commence with this type of declaration. While professing to embrace objectivity, research and review is tainted with a flawed belief from the outset. What credibility can we expect to flow from such a system? Observations and analyses conducted in this beliefcloud inevitably lead to conclusions which are forged in the same cloud. These are then swallowed by peer-reviewers, who readily digest the lot. Remember, peer-reviewers live in the same belief-cloud as the rest of us. The conclusions are finally cast in the scientific literature, to be paraded as “evidence”. The temple was built brick-by-brick in this manner, on a foundation which we now know was a flawed belief. But rather than acknowledge the flaw in the belief, which would threaten the whole structure, we busy ourselves cementing around it whenever it becomes exposed. More than this, we build new rooms and even entire wings on top of it—all adorned with monumental fittings, and grand décor. All this, while we continue to propagate a fundamentally flawed belief, with words such as: What changed, Sharon, was that we introduced immunisation. Immunisation has prevented more suffering and saved more lives than any other medical intervention in this century, even antibiotics. How do we continue our evaluation of something when our foundational belief in it is flawed? We are all a product of our conditioning. What happens when that conditioning is wrong?

Chapter TWO

A NEW CHAPTER Man is a credulous animal, and must believe something; in the absence of good grounds for belief, he will be satisfied with bad ones. Bertrand Russell By allowing a flawed belief in vaccines to dominate our thinking, we have left ourselves open to all sorts of claims, prejudices, coercion, pressure, and restrictive laws. We have also allowed spurious reports and conclusions to be published, without proper scrutiny. One of these reports has been worked up over the past few years, and has taken the world by storm. We are destined to write another erroneous belief-chapter in our history books, unless we can acknowledge and correct it. If you are not one to follow the news, you may have missed it. Others will have undoubtedly seen a stream of good-news stories over the past few years, such as:

Measles Deaths In Africa Plunge By 91% 20, 21 There have been many versions on the theme; the percentage rates have changed over time. However, the bodies of the stories leave us in no doubt as to the reason for their headlines. Here are some direct quotes: In a rare public health success story on the world’s most beleaguered continent, Africa has slashed deaths from measles by 91 per cent since 2000 thanks to an immunization drive. The Measles Initiative said Thursday that worldwide measles deaths fell from an estimated 757,000 to 242,000 between 2000 and 2006, a reduction of 68 per cent made possible by the remarkable gains in Africa, which cut fatalities from an estimated 396,000 to 36,000. ….”The clear message from this achievement is that the strategy works,’’ said CDC director Dr. Julie Gerberding of the drive to vaccinate all

20

Medical News Today 30Nov 2007; http://www.medicalnewstoday.com/articles/90237.php

21

UNICEF Joint press release; http://www.unicef.org/media/media_41969.html

children against measles before their first birthday and provide a second opportunity for measles vaccination through mass vaccination campaigns. An ambitious global immunization drive has cut measles deaths... Measles deaths in Africa have fallen as child vaccination rates have risen. These stories represent a modern-day version of the belief which we discussed in the previous chapter. They are not merely good-news stories, but triumphant overtures, seemingly offering up-to-date proof of the value of vaccines; strong images of a miracle transforming a world where death is common, into one where lives are saved. Sound familiar? The stories have been faithfully repeated by all and sundry. The general media from the BBC and ABC, to the US Federal News, World Health, local papers, television shows, magazines, and medical journals have joined in.

Unbelievable results However, there is something deeply disturbing about the stories, and it is not immediately apparent. The fact is: no-one knows how many people died of measles in Africa. No-one! Not last year and not ten years ago. I will repeat that. No-one knows how many measles deaths have occurred in Africa. So, where did these figures come from? I will explain that in this chapter. In a nutshell, they were calculated on a spreadsheet, using a formula. You may be surprised when I show you how simple the method was. We all believe these stories, because we have no reason to doubt them. The only people who would have questioned them were those who were aware that the deaths had not been counted. One of these was World Health Organisation (WHO) head of Health Evidence and Statistics, who reprimanded the authors of the original report (on which the stories were based) in an editorial published in the Bulletin of the WHO, as I will discuss shortly. Unfortunately, by then the train was already runaway. The stories had taken off virally, through the worldwide media. First, an overview of the formula. The authors looked at it this way: for every million vaccines given out, we hope to save ‘X’ lives. From that premise, we simply count how many million vaccines we gave out, and multiply that by ‘X’ to calculate how many lives (we think) we have saved. That is how the figures were arrived at.

if

1 million shots = 50,000 lives saved

then 100 million shots = 5,000,000 lives saved!

The stories and the formula are both products of a deep belief in the power of vaccines; the same belief that Chapter One exposed. We think the stories report facts, but instead they report hopes.

The nuts and bolts Hardly any of the willing participants in spreading the stories bothered to check where the figures came from, and what they meant. That was possibly understandable. Why would we need to check them? After all, they were produced by experts: respected researchers, and reputable organisations such as UNICEF, American Red Cross, United Nations Foundation, and the World Health Organisation. However, I did check them. I checked because I knew the developing world wasn’t collecting cause of death data that could provide such figures22. In fact, it is currently estimated that only 25 million of the 60 million deaths that occur each year are even registered, let alone have reliable cause-of-death information 23. Sub-Saharan Africa, where a large proportion of measles deaths are thought to occur, still had an estimated death registration of only around 10%24 in 2006, and virtually no reliable cause-of-death data. Even sample demographic surveys, although considered accurate, were not collecting cause-of-death data that allowed for these figures to be reported. Simply put, this was not real data: the figures had to be estimates. I was curious as to how the estimates were arrived at, so I traced back to the source—an article in The Lancet, written by a team from the Measles Initiative25. The article described the method used to create the figures presented in all of these stories. After reading the article, I realised the reports were not measles deaths at all. They were planning estimates, or predictions. In other words, they represented outcomes that the people at the Measles Initiative had hoped to achieve, through conducting vaccination programs.

22

Jaffar et al. Effects of misclassification of causes of death on the power of a trial to assess the efficacy of a pneumococcal conjugate vaccine in The Gambia; International Journal of Epidemiology 2003;32:430-436 http://ije.oxfordjournals. org/cgi/content/full/32/3/430

23

Save lives by counting the dead; An interview with Prof Prabhat Jha, Bulletin of the World Health Organisation 2010;88:171–172

24

Counting the dead is essential for health: Bull WHO Volume 84, Number 3, March 2006, 161-256 http://www.who.int/bulletin/volumes/84/3/interview0306/en/index. html

25

Launched in 2001, the Measles Initiative is an international partnership committed to reducing measles deaths worldwide, and led by the American Red Cross, CDC, UNICEF, United Nations Foundation, and WHO. Additional information available at http://www.measlesinitiative.org

Don’t get me wrong. We all know that planning and predicting are very useful, even necessary activities, but it is obvious they are not the same as measuring outcomes. The title of the original report from the Measles Initiative reads, “Has the 2005 measles mortality reduction goal been achieved? A natural history modelling study.” 26 The authors took one and a half pages to explain how natural history modelling applied here. I will simplify it in about ten lines. I realise that in doing so, some may accuse me of editorial vandalism, however, I assure you what follows captures the essence of the method. The rest is detail. If you are interested in confirming this, I urge you to read the original article for that detail. Here we go... the formula at the heart of the stories:

My interpretation of the Measles Natural History Modelling Study (2007) 1. Open a blank spreadsheet 2. Enter population data for each year from 2000 to 2006 3. Enter measles vaccine coverage for each of the years also 4. Assume all people develop measles if not vaccinated 5. Assume vaccination prevents 85-95% of measles cases 6. Calculate how many measles cases were ‘prevented’ each year (using the above figures) 7. Calculate how many measles deaths were ‘prevented’ each year (using historical case-fatality ratios) There, simple. As you can see, this is a typical approach if we are modelling, for predictive purposes. Using a spreadsheet to predict outcomes of various plans helps us set targets, and develop strategies. When it comes to evaluating the result of our plan, we need to go out into the field and measure what happened. We must never simply return to the same spreadsheet. However, this is precisely what the Measles Initiative team did. And the publishing world swallowed it— hook, line and sinker. As mentioned earlier, WHO Health Evidence and Statistics head, Dr Kenji Shibuya, saw the problem with this method. Writing editorially in the Bulletin

26

Wolfson et al. Has the 2005 measles mortality reduction goal been achieved? A natural history modelling study; Lancet 2007; 369: 191–200 http://www.measlesinitiative.org/mi-files/Reports/Measles%20Mortality%20 Reduction/Global/Wolfson%20Lancet2007_Measles_Mortality_Reduction.pdf

of the WHO, under the title “Decide monitoring strategies before setting targets”, Shibuya had this to say27: Unfortunately, the MDG 28 monitoring process relies heavily on predicted statistics. The same applies to monitoring progress in major disease interventions. For example, the assessment of a recent change in measles mortality from vaccination is mostly based on statistics predicted from a set of covariates such as the number of live births, vaccine coverage, vaccine effectiveness and case-fatality ratios. It is understandable that estimating causes of death over time is a difficult task. However, that is no reason for us to avoid measuring it when we can also measure the quantity of interest directly; otherwise the global health community would continue to monitor progress on a spreadsheet with limited empirical basis. This is simply not acceptable. [emphasis mine] This mismatch was created partly by the demand for more timely statistics (i.e. on an annual basis) from their users and partly by a lack of data and effective measurement strategies among statistics producers. Users must be realistic, as annual data on representative cause-specific mortality are difficult to obtain without complete civil registration or sample registration systems. If such data are needed, the global health community must seek indicators that are valid, reliable and comparable, and must invest in data collection (e.g. adjusting facility-based data by using other representative data sources). Regardless of new disease-specific initiatives or the broader WHO Strategic Objectives, the key is to focus on a small set of relevant indicators for which well defined strategies for monitoring progress are available. Only by doing so will the global health community be able to show what works and what fails. In simple terms, Shibuya was saying:

the plan—and that is unacceptable!

27

Kenji Shibuya. Decide monitoring strategies before setting targets; Bulletin of the World Health Organization June 2007, 85 (6) http://www.who.int/bulletin/ volumes/85/6/07-042887/en/index.html

28

MDG – Millennium Development Goals, to be discussed shortly in this chapter.

outcomes and collect valid data Unfortunately, by the time Shibuya’s editorial was published, the media had already been trumpeting the stories for more than a year, because the Measles Initiative team announced their news to a waiting media before subjecting it to peer-review. So, without scientific scrutiny, the stories were unleashed into a world hungry for good news, especially concerning the developing world. The result... the reports were welcomed, accepted, and regurgitated to a degree where official scrutiny now seems to have the effect of a drop in a bucket. The question of who was responsible for this miscarriage of publishing justice plagued me for a while. Was it the architects of the original report? Or was it the robotic section of our media (that part that exists because of a lack of funds for employing real journalists) who spread the message virally to every corner of the globe, without checking it? The original Lancet report was correct in a sense. Its title was “Has the 2005 measles mortality reduction goal been achieved? A natural history modelling study.” It asked a question, and attempted an answer via modelling on a spreadsheet. The authors had no real data to go on, yet the world was waiting on a progress report. If you read the report, you will find it seems to say we’ve done a lot of vaccinating, and on paper our model suggests we may have already achieved our target. When we look at the media reports we see a much more confident message. One quote which really stands out in the stories is from former director of the United States Centers for Disease Control (CDC). “The clear message from this achievement is that the strategy works,’’ said CDC director Dr. Julie Gerberding What strategy works? Is she talking about modelling on a spreadsheet? Or, using the predictions in place of real outcomes? More recent reports from the Measles Initiative indicate the team are continuing with this deceptive approach. In their latest report29 it is estimated 12.7 million deaths were averted between 2000-2008. All were calculated on their spreadsheet, and all were attributed to vaccination, for the simple reason that it was the only variable on the spreadsheet that was under their control. And still, there is no scrutiny of these claims. Furthermore, the authors make no effort to clarify in the public mind that the figures are nothing but planning estimates.

29

Dabbagh et al. Global Measles Mortality, 2000–2008; Morbidity & Mortality Weekly Report. 2009;58(47):1321-1326 http://www.medscape.com/viewarticle/714345

No proof Supporters of vaccination might argue that this does not prove vaccines are of no use. And again, I agree. In fact, let me say it first: none of this provides any evidence whatsoever of the value of vaccination. That is the crux of the matter. The media stories have trumpeted the success of the plan, and given us all a pat on the back for making it happen. But the stories are fabrications. The only aspect of them that is factual is that which tells us vaccination rates have increased. In essence, we have seen a modern-day triumph, portrayed in similar fashion to the earlier claim that vaccines were the magic bullets that saved us from our past. Perhaps this will also become enmeshed in the fabric of our beliefs. Perhaps it already has. THE BELIEF Vaccines have reduced measles deaths in Africa by 91% THE TRUTH Vaccination rates have increased in Africa

Rubber data As an example of how poor the data in these areas is, let us look briefly at the seven countries of southern Africa, where an “elimination” program was undertaken by the Measles Initiative, in 1996-2000. The team reported triumphantly that measles deaths in the seven countries had been reduced to zero by the end of the program30. However, nowhere do the authors reveal the source of the “reported measles deaths” data, showing zero. We are left to assume it was their own counting. This is troubling because, despite gross under-reporting of deaths, South Africa alone reported seven measles deaths in the year 200031. The other six countries simply didn’t report. In addition, the WHO estimated just two years later that there were 6900 measles deaths in the region32... not zero! Someone is seriously wrong!

30

Biellik et al. First 5 years of measles elimination in southern Africa: 1996–2000; Lancet 2002; 359: 1564–68 http://www.measlesinitiative.org/mi-files/Reports/Measles%20Mortality%20 Reduction/Global/Biellik%20Lancet%202002%20359(9317)1564.pdf

31

We can verify this here http://apps.who.int/whosis/database/mort/table1.cfm

32

Estimated total deaths by cause and WHO Member State 2002; Spreadsheet available here http://www.who.int/entity/healthinfo/statistics/bodgbddeathdalyestimates.xls

A clue as to how the “zero” count may have been conceived is revealed in a closer study of one of the countries—Zimbabwe33. After mass vaccination, the rules were changed. Measles cases now had to be confirmed through laboratory tests, before they could be recorded. A laboratory was appointed, and the cases were tested. Only 1-2% tested positive for measles virus, so only 1-2% were recorded. In other words, they recorded a 98-99% decrease, through administrative means alone. This appears to have been the success. This concept of changing the rules will be discussed at length, as we make our way through the book. By and large, it appears that many of the stories of success we hear, are preceded by a change in the rules. Although the significance of this may elude you at the moment, it will begin to make sense later in the book.

Some ‘real’ good-news? Some may think I am simply being negative. In Chapter One, we examined the claim that vaccines saved the developed world from the measles, whooping cough and diphtheria scourges of the past, and found it to be flawed. Now we have examined the good-news about measles deaths plummeting in poorer countries, and discovered the same. However, I do have something positive to report. I am quite sure measles deaths are in fact going down. How do I know this? Well, I don’t because nobody is counting them. But I do know that mortality rates in general are going down, significantly. That means deaths from all causes are reducing. How do I know that deaths in general are reducing? Because an inter-agency group, led by UNICEF and WHO, has been evaluating demographic surveys in countries that do not have adequate death registration data. These surveys have been going on for more than 50 years. One of the reasons they do this is to monitor trends in mortality; particularly infant, and under-five mortality. Although the health burden in developing countries is inequitably high, there is reason to be positive when we view these trends. Deaths are declining, and according to the best available estimates, they have been steadily doing so for a considerable time; well over 50 years. One of the most commonly quoted indicators of a country’s health transition is its under-5 mortality rate: that is, the death rate for children below five years old. The best estimates available for Africa show a steady decline in under-5

33

Munyoro et al. Impact of Nationwide Measles Vaccination Campaign among Children Aged 9 Months to 14 Years, Zimbabwe, 1998–2001; J Infect Dis. (2003) 187 (Supplement 1): S91-S96 http://www.journals.uchicago.edu/doi/ full/10.1086/368116

Africa

© 2011 Greg Beattie. Sources: Inter-agency Group for Child Mortality Estimation (UNICEF, WHO, World Bank, UNPD, universities and research institutions) Vaccine coverage from WHO.

Figure 7. Child mortality, Africa

mortality rate, of around 1.8% per year, since 195034. Figure 7 shows this decline from 1960 onward35. It also shows the infant mortality rate36. Both are plotted as averages of all countries in the WHO region of Africa. This graph may appear more complex but it is not difficult to read. The two thick lines running horizontally through the graph are the infant (the lower dashed line) and under-5 (the upper solid line) mortality rates per 1000 from 1960 to 2009. The handful of finer lines which commence in 1980, at a low point, and shoot upward over the following decade, represent the introduction of the vari-

34

Garenne & Gakusi. Health transitions in sub-Saharan Africa: overview of mortality trends in children under five years old (1950-2000); Bull WHO June 2006, 84(6) p472 http://www.who.int/bulletin/volumes/84/6/470.pdf

35

If you perform a ‘google’ search for ‘infant mortality rate’ or ‘under-5 mortality rate’ you will locate a google service that provides most of this data. It is downloadable in spreadsheet form by clicking on the ‘More info’ link. Vaccine coverage data is available from the WHO website http://www.childinfo.org/files/Immunization_ Summary_2008_r6.pdf

36

Infant mortality rate is “under-1 year of age” mortality rate.

India

© 2011 Greg Beattie. Sources: Inter-agency Group for Child Mortality Estimation (UNICEF, WHO, World Bank, UNPD, universities and research institutions) Vaccine coverage from WHO.

Figure 8. Child mortality, India

ous vaccines. The vertical scale on the right side of the graph shows the rate at which children were vaccinated with each of these shots. The primary purpose of this graph (as well as that in Figure 8) is to deliver the real good-news. We see a slowly but steadily-improving situation. Death rates for infants and young children are declining. I decided to add the extra lines (for vaccines) to illustrate that they appear to have had no impact on the declining childhood mortality rates; at least, not a positive impact. If they were as useful as we have been led to believe, these vaccines (covering seven illnesses) would surely have resulted in a sharp downward deviation from the established mortality trends. As we can see, this did not occur. In Africa, the vaccines were introduced at the start of the 1980s and, within a decade, reached more than half the children. The only effect observable in the mortality rates, is a slowing of the downward trend. In other words, if anything were to be drawn from this, it would be that the introduction of the vaccines was counter-productive. One could argue that the later increase in vaccine coverage (after the year 2000) was followed by a return to the same decline observed prior to the vaccines. However, that does not line up. The return to the prior decline predates it, by around five years.

With both interpretations we are splitting hairs. Since we are discussing an intervention that has been marketed as a modern miracle, we should see a marked effect on the trend. We don’t. The WHO region of Africa (also referred to as sub-Saharan Africa) is where a substantial portion of the world’s poor-health burden is thought to exist. The country that is believed to share the majority of worldwide child mortality burden with sub-Saharan Africa is India, in the WHO south-east Asia region. Together, the African and South-east Asian regions were thought in 1999 to bear 85% of the world’s measles deaths37. Figure 8 shows India’s declining infant and under-5 mortality rates, over the past 50 years. Again, the introduction of various vaccines is also shown. And again, vaccines do not appear to have contributed. Mortality rates simply continued their steady decline. We commenced mass vaccination (for seven illnesses) from the late 1980s but there was no visible impact on the child mortality trends. In a nutshell, what happened in the developed world is still happening in the yet-to-finish-developing world, only it started later, and is taking longer. The processes of providing clean water, good nourishment, adequate housing, education and employment, freedom from poverty, as well as proper care of the sick, have been on-going in poor countries.

Enter the Millennium Development Goals (MDGs) In the year 2000, a UN summit was held at which 189 world leaders made a commitment to end poverty by 2015. To achieve this, a set of eight goals were developed, as follows: 1. Eradicate extreme poverty and hunger 2. Achieve universal primary education 3. Promote gender equality and empower women 4. Reduce child mortality 5. Improve maternal health 6. Combat HIV/AIDS, malaria and other diseases 7. Ensure environmental sustainability 8. Develop a Global Partnership for Development

37

MMWR: 1999 / 48(49);1124-1130 http://www.cdc.gov/mmwr/preview/mmwrhtml/ mm4849a3.htm

These are known collectively as the Millennium Development Goals (MDGs). They represent probably the most ambitious, as well as the most supported, international cooperative effort to combat disadvantage, and promote equity among the world’s impoverished. You will notice vaccination does not figure visibly on the agenda. It is there, however. Goal No. 4 has one target, namely: Reduce by two thirds the mortality rate among children under five. This target is to be monitored by three indicators:

So, the measles vaccination rate of 1-year-old children was mentioned as an indicator of achievement for the MDG4 target. I guess we can draw a long bow, and forgive the team at the Measles Initiative for extrapolating this to a worldwide declaration that measles deaths have plummeted. Then again, it would be a very long bow. As can be seen, the MDGs are quite interdependent. For example, removing poverty indirectly leads to improvements in nutrition, greater access to education and clean water, reduced childhood mortality, and progress toward other goals. Reducing poverty is the primary goal, as well as the key theme, of the MDGs.

Proportion of people living on less than $1.25 a day, 1990 and 2005 (Percentage) Sub-Saharan Africa

51 Southern Asia

58

49 39

Southern Asia, excluding India

45

31 CIS, Asia

6

19 South Eastern Asia

39 19

Eastern Asia

60 16

Latin America & the Caribbean

11

8

1990 2005

Western Asia

2

2015 Target

6 Northern Africa

5

3 Transition countries of South-Eastern Europe

0.1 1

CIS, Europe

2 0.3

Developing Regions

46 27

0

10

20

30

40

50

60

Figure 9. Proportion of people living on less than $1.25 a day 1990 and 2005 (Percentage)

70

“Ill-health pushes people into the poverty trap. Poverty is a major factor determining ill-health, as well as being both a cause and an outcome of ill-health.” 38 MDG1 has three targets:

women and young people The latest UN reports suggest considerable progress has been made as indicated in Figures 9 and 10.39 The good-news is that progress is being made toward the achievement of these goals. This means we can expect improvements in health prospects. Despite the negative impact of the recent global financial crisis, most developing countries have enjoyed improvement in poverty-related and other goals. As these represent the major determinants of health, we are seeing Headcount index of poverty (% below poverty line) corresponding improve70 ments in each country’s $2 per day health transition. 60 I would have loved to go back further in time with the preceding graphs (figures 7 and 8), but unfortunately I was not able to locate the data. I did uncover one graph in an issue of the Bulletin of the WHO, showing the under-5 mortality rate in sub-Saharan Africa to be an estimated 350 in 195040. It subsequently dropped to around 175

$2 per day (less China)

50

$1.25 per day 40 $1.25 per day (less China)

30 20 10 0 1980

1985

1990

1995

2000

2005

2010

Source: http://siteresources.worldbank.org/INTPOVCALNET/ Resources/Global_Poverty_Update_2012_02-29-12.pdf

Figure 10. Poverty rates for the developing world 1981—2008

38

African Regional Health Report 2006; World Health Organisation, p xiv

39

http://en.wikipedia.org/wiki/Millennium_Development_Goals

40

Garenne & Gakusi. Health transitions in sub-Saharan Africa: overview of mortality trends in children under five years old (1950-2000); Bull WHO June 2006, 84(6) p472 http://www.who.int/bulletin/volumes/84/6/470.pdf

by 1980, before vaccines figured. It continued dropping, though slower, to 129 by 200841. Do you see something familiar? Just like the graphs presented in the previous chapter, we see a death rate declining consistently over a long period of time. As our graphs here commence in 1960, and the trend was downward from the outset, it is reasonable to conclude that the decline was already in place. That is, if we go back further in time, the deaths were probably higher, just as in our Chapter One graphs from the developed world. Like before, we are probably looking at a substantial and constant decline in deaths, over many years. Once more, vaccines have arrived in the final moments, and are preparing to take the credit. The decline represents a substantial health transition, and a lot of lives saved, across the board. When cause-of-death data improves, or at least some genuine effort is made to establish credible estimates of measles deaths, it will undoubtedly be found they are dropping as well. Why wouldn’t they? This is good news, and all praise needs to be directed at the architects and supporters of the international activities that are helping to achieve improvements in the real determinants of health. In the midst of all the hype, I trust we will not swallow attempts to give the credit to vaccines... again. I am not confident, however. I feel this is simply history repeating itself. Deaths from infectious disease will reach an acceptable “low” in developing countries, at some point in time. And although this will probably be due to a range of improvements in poverty, sanitation, nutrition and education, I feel vaccines will be given the credit. To support the claim, numerous pieces of evidence will be paraded, such as:

Measles Deaths In Africa Plunge By 91% We need to purge these pieces of “evidence” if we are to have rational discussion. The public have a right to know that these reports are based on fabricated figures. Otherwise, the relative importance of vaccines in future health policy will be further exaggerated. Once more, an error needs to be corrected, regardless of how much the concrete has already set around it. This time, it needs to be corrected in such a way that everyone hears about it.

41

UNICEF; http://www.childinfo.org/mortality.html

Chapter THREE

THE REALITY “Circumstantial evidence is a very tricky thing,” answered Holmes thoughtfully. “It may seem to point very straight to one thing, but if you shift your own point of view a little, you may find it pointing in an equally uncompromising manner to something entirely different.”Sir Arthur Conan Doyle (Sherlock Holmes) In this chapter, we will take a closer look at the fundamental claim of value. Obviously, this is not the first time this has been carried out. However, in the past, we have always done so from within a belief-cloud, one which we now know was fundamentally flawed. In looking critically at the evidence, we have always started out with the unspoken assumption that we were investigating a hero from our past. Hopefully, after reading Chapter One, we are now in a position to evaluate the claim from a more objective viewpoint. To start, a quote from the Australian Institute of Health and Welfare (AIHW) tells us where the most compelling evidence of value is to be found 42: Many communicable diseases are regarded as vaccine-preventable diseases (VPD) in that effective vaccines are now available for their population control and prevention. The decline in the incidence of various VPDs proves the effectiveness of disease prevention through vaccination. Even more striking is the reduction in the number of deaths from these diseases since the pre-vaccination period. Two fundamental indicators are named above for measuring effectiveness. The first is incidence. In the following chapter, we will discover that we do not have robust incidence data. Instead, we have notifications, which are substantially different. Nonetheless, we will examine them. The second, described as the more striking of the two, is the death rate. We know from Chapter One that this is perhaps not as striking as commonly thought. I will show in the current chapter that notifications are often the kinder of the

42

Australian Institute of Health and Welfare 2006. Australia’s health 2006. p115

two, when it comes to support for vaccines... that is, at first glance. In the subsequent chapters, I will clarify some terms. Some questions that are rarely given importance in the debate, yet which I feel are pivotal, need to be considered, such as: What is benefit? How do we measure it? What data is used and where does it come from? But first, we will examine the claimed “striking” reduction in deaths.

Mortality trends I obtained data directly from the AIHW, to examine their claim. They kindly supplied me with several digital workbooks43, containing data on death rates for various conditions, and covering the period from 1907 onward (some did not go back so far). [Please note: polio and meningitis will be dealt with in subsequent chapters. In the current chapter, we will focus on diphtheria, whooping cough, measles and tetanus in some detail, while touching on other illnesses.] In Chapter One, we saw the impact of vaccines from an historical perspective. In the case of diphtheria, we were able to assess the impact of the vaccine, to some extent, by comparing the before and after. With measles and whooping cough, this was difficult (impossible, in the case of measles), as the illnesses had declined to such an extent that the before took up almost all of the landscape. In this chapter, we will zoom in on the period surrounding the introduction of each vaccine. If the vaccines were instrumental in lowering death rates, we expect to see it clearly in these graphs. If we simply observe a continuation of a longestablished trend, we can conclude vaccination was of little, or no consequence. Remember, we are looking at a blown-up portion of the tail end of the decline. For example, the death rate from measles per 100,000 population was 170 for the five years ending 1875 whereas it had reduced to less than one immediately prior to the vaccine’s introduction. That equates roughly to a 99.5% drop. I plotted the following graphs on a year by year basis so you will notice more fluctuations than in the earlier graphs. The fluctuations appear because the illnesses generally went through cycles of 3-4 years; these were smoothed out in the graphs of Chapter One, as they were quinquennial (5-yearly) plots. I also confined the following graphs to under-5 year olds. There are a few reasons I did this. First, these illnesses chiefly affected that age group (death rates were much higher in under-5s than in all other ages). Second, this was the group on which our vaccination efforts were focussed. Finally, I intend to make some comparisons with other infectious illnesses. Some of these (e.g. pneumonia and

43

Australian Institute of Health and Welfare (AIHW) 2010. GRIM (General Record of Incidence of Mortality) Books. AIHW: Canberra; Original author Dr Paul Jelfs, updated by Karen Bishop

Measles (under 5 years) - Australia

© 2011 Greg Beattie. Sources: Australian Institute of Health and Welfare (AIHW) 2010. GRIM (General Record of Incidence of Mortality) Books; Original author Dr Paul Jelfs, updated by Karen Bishop.

Figure 11. Measles, Australia 1950—1990 (under 5 years)

influenza) have significant impact in the very young and the very old. By restricting our focus to the young, we are able to compare the data meaningfully. Let us have a look at the graphs now, starting with measles44. If we peruse the death-rate for measles in Figure 11, we see the trend seems to be relatively horizontal during the 1960s, before declining to a lower level for the following decade. Is this the striking reduction in deaths that we are looking for? I guess it is possible, although it may simply be the tail end of the long established decline we saw in Chapter One. Why don’t we take a closer look? At the risk of drowning the discussion in data, I will present a couple more graphs, illustrating the same trend occurring in all other deaths at around the same time—suggesting, therefore, that it had little if anything to do with the introduction of measles vaccine. First, Figure 12 shows the same period for All Infectious and Parasitic Diseases. Here we see the same trend, only more impressive. The shaded portion shows an

44

Remember, death rates were higher in this age group than in the rest of the population. For example, in 1969 the death rate in under-5s was 2.1 whereas in “all ages” it was 0.2 per 100,000.

All infectious and parasitic disease (under 5 years) - Australia

© 2011 Greg Beattie. Sources: Australian Institute of Health and Welfare (AIHW) 2010. GRIM (General Record of Incidence of Mortality) Books; Original author Dr Paul Jelfs, updated by Karen Bishop.

Figure 12. All infectious and parasitic diseases, Australia 1950—1990 (under 5 years)

All diseases of the respiratory system (under 5 years) - Australia

© 2011 Greg Beattie. Sources: Australian Institute of Health and Welfare (AIHW) 2010. GRIM (General Record of Incidence of Mortality) Books; Original author Dr Paul Jelfs, updated by Karen Bishop.

Figure 13. All diseases of the respiratory system, Australia 1950—1990 (under 5 years)

accelerated decline during the early 1970s, representing a decrease in the death rate of around 20, compared with the drop of less than one for measles. I need to make it clear that there were no other vaccines introduced around that time that could account for this. Rubella for schoolgirls was available, but clearly outside this age group, and the Sabin polio vaccine could not account for it, as the polio death rate in this group had already reached zero by the mid-1960s. Measles is considered an infection of the respiratory system. So, in Figure 13 we will look at deaths from All Diseases of the Respiratory System. Here we see the same trend, but even more impressive. Once again, the shaded area covers the decade following the measles vaccine. It shows a very clear decrease of about 40 deaths per 100,000, compared with less than one for measles over the same period. However, the drop in both All infectious and All respiratory deaths, although more than 20 and 40 times greater than that seen in measles, is dwarfed by the drop in deaths from All causes, seen in Figure 14. Again, same trend, but this time a decrease of over 200, compared with less than one in measles. Obviously, this trend could not have been brought about by measles vaccine. Childhood mortality appears to have gone through a stagnant period during the 1960s, followed by a downward trend during the early 1970s, and it appears that measles deaths were part of this. We are left with no grounds for a conclusion that measles vaccine made any contribution to this.

Whooping cough, diphtheria and tetanus We will examine whooping cough, diphtheria, and tetanus together, as routine infant vaccination for each commenced in 195345,46, with the licensure of DTP vaccine. Also, in each case, there was an earlier vaccine in use 47. It seems sensible

45

Gidding HF, Burgess MA, Kempe AE. A short history of vaccination in Australia; Medical Journal of Australia 174(1):37-40. http://www.ncbi.nlm.nih.gov/ pubmed/11219791

46

“The first commercial vaccines were developed 60 years ago in the 1930s, and effective vaccines were widely used in the 1940s and 1950s.” Margaret Burgess and Jill Forrest. PERTUSSIS AND THE ACELLULAR VACCINES; CDI Vol 20 No.8 p192 April 15, 1996 http://www.health.gov.au/internet/main/publishing.nsf/ Content/1996%20issues-1/$FILE/cdi2008.pdf

47

When did use of the earlier vaccine start? It was difficult to find non-conflicting information on this. With whooping cough, an Australian doctor who worked towards introducing the earlier vaccine said he first heard of it in 1940 when it was undergoing trials in the USA. He said it took some persuading of Australian officials and was further delayed by World War II, but by 1950 its use had become widespread. Dr Donald Hamilton. Pertussis: the way it was; Communicable Diseases Intelligence, Volume 22, Issue number 7 - 9 July 1998

All causes (under 5 years) - Australia

© 2011 Greg Beattie. Sources: Australian Institute of Health and Welfare (AIHW) 2010. GRIM (General Record of Incidence of Mortality) Books; Original author Dr Paul Jelfs, updated by Karen Bishop.

Figure 14. All causes, Australia 1950—1990 (under 5 years)

Whooping Cough (under 5 years) - Australia

© 2011 Greg Beattie. Sources: Australian Institute of Health and Welfare (AIHW) 2010. GRIM (General Record of Incidence of Mortality) Books; Original author Dr Paul Jelfs, updated by Karen Bishop.

Figure 15. Whooping Cough, Australia 1920—1970 (under 5 years)

to centre each of the following graphs around 1945 to allow for the influence of these earlier vaccines. In Figure 15, we can see an apparent smoothing of activity in whooping cough mortality from around 1944. This could simply be the tail end of the decline from Chapter One, or it could be the impact of the vaccine that was in use at the close of the 1940s. As with the earlier example, I decided to check by comparing with other diseases. We will see shortly, that the same trend occurred in all other deaths as well. But first, a look at diphtheria and tetanus. We see a similar trend in the case of diphtheria (Figure 16). It was difficult to find good information on the use of the earlier vaccine48, although it was clear that the legacy of the Bundaberg tragedy49 delayed public acceptance of this. One interpretation of the downward trend during the 1940s could be that it was the result of use of the earlier vaccine. On the other hand, we could simply be observing the tail-end of the decline, destined to occur regardless of the vaccine. We will discuss this further shortly, after looking at tetanus (Figure 17). Once again, we see that the major portion of the decline in tetanus deaths occurred well before the vaccine was available. The graph in Figure 17 extends ten years earlier and ten years later than those preceding it, simply to demonstrate this50. The graph is still centred around 1945. It shows a drop from the 1950s, equivalent to roughly one death per 100,000. If we combine the reduction in deaths between 1940 and 1955 from the three illnesses with vaccines, we arrive at an estimated:

That gives us a total of around 56 deaths per 100,000. By comparison, we see in Figure 18 that the same downward trend occurred in All infectious diseases (see shaded portion), corresponding to a decrease of around 150 deaths per 100,000 for the same period—almost three times that of the three illnesses with vaccines.

48

School-based vaccination programs were reported to have been conducted with the earlier vaccine from about 1938. These obviously targeted the over-5 years age group. In later years pre-school children were reportedly included. In 1951 the state of Queensland bragged that it had the highest coverage in the country, with Brisbane recording 86% of 1-14 year-olds vaccinated. Year Book Queensland, 1951 p103 http://www.abs.gov.au/AUSSTATS/[email protected]/DetailsPage/1301.31951

49

Please read “Vaccination – a Parent’s Dilemma” for a detailed account of the Bundaberg tragedy. http://vaccinationdilemma.com

50

A graph covering “all ages” can be found in Chapter One

Diphtheria (under 5 years) - Australia

© 2011 Greg Beattie. Sources: Australian Institute of Health and Welfare (AIHW) 2010. GRIM (General Record of Incidence of Mortality) Books; Original author Dr Paul Jelfs, updated by Karen Bishop.

Figure 16. Diphtheria, Australia 1920—1970 (under 5 years)

Tetanus (under 5 years) - Australia

© 2011 Greg Beattie. Sources: Australian Institute of Health and Welfare (AIHW) 2010. GRIM (General Record of Incidence of Mortality) Books; Original author Dr Paul Jelfs, updated by Karen Bishop.

Figure 17. Tetanus, Australia 1910—1980 (under 5 years)

All infectious and parasitic disease (under 5 years) - Australia

© 2011 Greg Beattie. Sources: Australian Institute of Health and Welfare (AIHW) 2010. GRIM (General Record of Incidence of Mortality) Books; Original author Dr Paul Jelfs, updated by Karen Bishop.

Figure 18. All infectious and parasitic diseases, Australia 1920—1970 (under 5 years).

Finally, we see the same trend in deaths from All causes (Figure 19). This graph shows a drop of around 500 deaths per 100,000 for the same period. This is almost ten times the combined decrease from whooping cough, diphtheria and tetanus. Once again, same trend—a level line during the 1930s and a return to the previous decline some time during the 1940s. In fact, the same trend can even be observed with measles in Figure 20, more than 20 years before the arrival of measles vaccine! Clearly, the reductions in whooping cough, diphtheria, and tetanus, were part of a wider trend. Although this observation does not prove a lack of benefit from vaccines, it does establish that they were probably not the important factor in that decline. Indeed, it would be difficult to persuade a discerning public that vaccines led to a decrease in these three illnesses, when a similar fall was seen in all others.

Diphtheria compared with ‘non-diphtheria’ illness Probably the most perceptible temporal association between vaccine and decline in deaths, among the three illnesses, is that seen in diphtheria. However, we find that upper respiratory infections not caused by diphtheria declined just as

All causes (under 5 years) - Australia

© 2011 Greg Beattie. Sources: Australian Institute of Health and Welfare (AIHW) 2010. GRIM (General Record of Incidence of Mortality) Books; Original author Dr Paul Jelfs, updated by Karen Bishop.

Figure 19. All causes, Australia 1920—1970 (under 5 years)

Measles (under 5 years) - Australia

© 2011 Greg Beattie. Sources: Australian Institute of Health and Welfare (AIHW) 2010. GRIM (General Record of Incidence of Mortality) Books; Original author Dr Paul Jelfs, updated by Karen Bishop.

Figure 20. Measles, Australia 1920—1970 (under 5 years)

dramatically at the same time, as evidenced by the extract below, from a recent paediatric textbook51: Bacterial Tracheitis. Infection of the upper respiratory tract (URT) by bacteria other than diphtheria was common through the early 1900s. For reasons that are unclear, reports and literature on nondiphtheritic infections of the URT disappeared over the next half century. So, it was well known that just as diphtheria declined so too did other diphtherialike illness. In fact, it disappeared from the medical literature, at the same time as diphtheria itself disappeared... but there was no vaccine, and no fanfare.

What caused these trends? Allow me to recapitulate what we have seen so far from these graphs. In each of the illnesses, as well as deaths from All causes, there was a fairly level line throughout the 1930s—meaning no improvement—followed by a return to normal decline, during the 1940s. It is worthwhile exploring the possible explanations for this. The introduction of penicillin is often put forward as something which changed the course of mortality, and it may well have played a part in the decline we see here. However, it could be argued the decline in the 1940s was simply a return to the trend prior to the 1930s. In addition, it does not explain the levelling during the 1930s. All of these observations are perhaps best explained by an event which became known in Australia’s history as the Great Depression. Beginning with the Wall Street collapse of 1929, and affecting most nations of the world, Australia was thought to have been one of the hardest hit. The Great Depression had a devastating effect on our economy, with unemployment reaching 28%, families being forced out of homes and into shacks on the outskirts of town, and severe rationing of food. Australia had barely begun to claw its way out by the time World War II arrived. The Great Depression is a plausible explanation for the trend we see in mortality for all the causes we examined above, including the three illnesses with vaccine: the stagnation during the 1930s, and the subsequent return to decline during the 1940s. It is perhaps a more plausible explanation than that which ascribes credit to vaccines.

Why are we told something quite different? In Chapter One, we saw that each of the illnesses went through a long, and substantial, decline in mortality before their respective vaccines arrived. I

51

Rudolph’s Fundamentals of Pediatrics: Third Edition 2002 by Abraham Rudolph, Robert Kamei, and Kim Overby, p338

promised we would examine the tail-end of this decline, in order to assess the contribution that vaccination may have made to it. We have now done this, and we have seen that the decline occurred in all infectious diseases, and that the vaccines probably contributed little or nothing to it. The question is, why do we feel surprised by this? And the answer is: because our experts have consistently told us something quite different. One of Australia’s most influential spokespersons on the benefit of vaccines is Dr Brian Feery. He says52: Vaccination has been the most successful medical procedure ever introduced. It has saved more lives than any other intervention, and it has prevented more disability. Now, this is a remarkable claim: that vaccination has been the most successful medical procedure ever! Another example—our expert from the radio broadcast in Chapter One, Dr Margaret Burgess, writes about the period from 1935-2000, as follows53: In fact, over this time vaccinations for diphtheria, pertussis, and tetanus have saved a total of at least 70,000 Australian lives and prevented untold morbidity. Note, the claim of “at least 70,000 Australian lives” is not referred to as an estimate, but a fact. You may be wondering how Burgess arrived at such a conclusion, given our examination of the data above. I also initially wondered about this, but after a few calculations, it became obvious. First of all, if we follow the footnote to her article, we will find she used the same data source as we have used throughout this book. The difference was in her interpretation: she decided to give the entire credit for the tail-end of the decline to vaccination. In the article, she presented a table of data covering only this period (remember the smaller pictures?), and decided that any subsequent decrease in deaths after vaccines were introduced, must have been the result of them.

52

These are the opening lines of an address titled “One Hundred Years of Vaccination” by Feery at the NSW Public Health Network conference in 1996. Reproduced in NSW Public Health Bulletin: Vol 8 Nos 8-9 Aug-Sept, 1997. http:// www.publish.csiro.au/?act=view_file&file_id=NB97025.pdf . Feery was an expert witness at my Human Rights Commission hearing, conducted in the same year that the above address was delivered. Vaccination – a Parent’s Dilemma; Part 2. http://vaccinationdilemma.com

53

Burgess M. Immunisation: a Public Health Success; NSW Public Health Bulletin Vol 14 Nos 1-2 Jan-Feb, 2003 http://www.health.nsw.gov.au/pubs/2003/pdf/phb_ hepb_immu.pdf

That decrease amounted to a total of roughly 70,000 lives spared from these three illnesses, across all age groups. Burgess assumed that without vaccines, the number of people dying of these illnesses would have accrued at the prevaccination level. Is this a reasonable assumption? Let us put the figure against another illness, where no vaccine was used—pneumonia. Over the same time period, the decline in pneumonia deaths meant a saving of more than 330,000 lives—without a vaccine! That’s four times as many as the total of the other three illnesses. The overall drop in pneumonia deaths was 89%, but in the under-5 age group it was 99%54. And remember, no vaccine! In fact, if we look at All infectious and parasitic diseases over the same period we find the decline totals 687,000 Australian lives saved—almost ten times the saving in diphtheria, whooping cough, and tetanus combined. And this overall decline was 93% across all ages, and 99% in the under-5 age group55. And there is more. We have only looked at the 65 year period since 1935 (as Burgess did). If we compare that with the prior 65 years (before the vaccines), we find that the earlier decline in diphtheria, whooping cough, and tetanus, also equated to roughly 70,000 lives saved. But since the average population for this period was only one third that of the later period, the actual decrease in death rate was three times greater! A very impressive number of lives saved, without vaccines. In summary, the rate of decline in diphtheria, whooping cough, and tetanus during 1935-2000:

Given these, it is simply not reasonable to apportion full credit for this decline to the vaccines. Surely, it is wishful to credit them with any significant role in the decline. I would go further and say that I find it disturbing that a highly educated and influential spokesperson on this subject, with unfettered access to the information, would conclude as Burgess did, without some explanation. I find it even more disturbing that this conclusion is accepted without challenge from her

54

Average death rate for total population dropped from 109 for the decade 1926-1935 down to 12 for the decade 1991-2000. In the under-5 group it dropped from 167 down to 1.8. Source: Australian Institute of Health and Welfare (AIHW) 2010. GRIM (General Record of Incidence of Mortality) Books. AIHW: Canberra; Original author Dr Paul Jelfs, updated by Karen Bishop

55

Average death rate for total population dropped from 108 for the decade 1926-1935 down to 7.5 for the decade 1991-2000. In the under-5 group it dropped from 313 down to 2.6. Source: Ibid

Diphtheria, 1917–2005

© 2007 Commonwealth of Australia. Source: Brotherton J, Wang H, Schaffer A, Quinn H, Menzies R, Hull B, et al. Vaccine Preventable Diseases and Vaccination Coverage in Australia, 2003 to 2005. Commun Dis Intell 2007; 31 (Suppl): S112-S116.

Figure 21. Diphtheria notifications, Australia 1917—2005

Measles, 1917–2005

© 2007 Commonwealth of Australia. Source: Brotherton J, Wang H, Schaffer A, Quinn H, Menzies R, Hull B, et al. Vaccine Preventable Diseases and Vaccination Coverage in Australia, 2003 to 2005. Commun Dis Intell 2007; 31 (Suppl): S112-S116.

Figure 22. Measles notifications, Australia 1917—2005

peers, and published in the scientific literature. No one raised an eyebrow about the claim, nor questioned the death data used. I will leave you to ponder why.

Incidence Now, we come to the second set of data which allegedly proves the value of vaccines, according to AIHW—that is, incidence. This is the number of fresh cases of an illness in a given time period. However, as will be explained in the following chapter, we do not routinely collect such data. But we have something else, which we call notifications. These are a subset of the real incidence figures, and it is this data that AIHW are referring to when they use the term “incidence”. With permission, I have reproduced the following historical charts 56 of notification rates. As suggested earlier, they seem to offer some support to the case for vaccines. Here, we will examine the graphs. In the following chapter, we will examine disturbing revelations concerning the origin, and nature of the data. In the case of diphtheria (Figure 21), we are at least given a fairly complete graph to peruse. We will see shortly that for many of the other illnesses, data was unavailable for extended periods, either not collected, or collected in some states at some times and in other states at other times. In this graph, there appears to be a correlation between use of the vaccine and a drop in notifications. Please note that the graph commences in 1917, unlike our graph of death rates from Chapter One (Figure 2) which commenced roughly 50 years earlier. The graph in Figure 21 actually coincides (time-wise) with the right hand half of ours from Chapter One. It follows the same trend as the right hand half of our earlier graph as well. It is, in fact, an example of a smaller picture as discussed in Chapter One, where we present a graph which commences just prior to the vaccine’s introduction. This makes the vaccine look impressive, whilst hiding the fact that it was actually the tail end of an already significantly declining illness. This is not to suggest that the earlier data was hidden deliberately. Notifications have only been collected nationally since 1917, so the graphs are necessarily limited by that. In addition, we can see that by the time DTP vaccine was introduced in 1953, disease notifications had almost reached zero. There was a diphtheria vaccine in

56

Communicable Diseases Intelligence Volume 31 - Supplement - June 2007, Appendix 1. Historical charts of notifications of vaccine preventable diseases; Australian Government Department of Health and Ageing; Julia Brotherton et al. Copyright Commonwealth of Australia, reproduced with permission.

Pertussis, 1917–2005

© 2007 Commonwealth of Australia. Source: Brotherton J, Wang H, Schaffer A, Quinn H, Menzies R, Hull B, et al. Vaccine Preventable Diseases and Vaccination Coverage in Australia, 2003 to 2005. Commun Dis Intell 2007; 31 (Suppl): S112-S116.

Figure 23. Whooping Cough notifications, Australia 1917—2005

use prior to DTP. Public health experts date its widespread use from the 1940s onward57,58. In the case of measles (Figure 22), we immediately see that 40 years of data is missing surrounding the introduction of the vaccine. Notifications were not compiled nationally from 1949 to the mid-1980s59, when the National Campaign Against Measles began. Even the data prior to 1949 is scanty. Measles was not a notifiable illness in most states. In fact, the data used in this graph is all from

57

Notifiable Diseases Surveillance, 1917 to 1991; Communicable Diseases Intelligence Bulletin Vol 17 No.11 p226; Robert Hall, Department of Health, Housing, Local Government and Community Services, Canberra

58

NSW Public Health Bulletin Vol. 14 No. 1–2 p5; Margaret Burgess, National Centre for Immunisation Research and Surveillance of Vaccine Preventable Diseases, University of Sydney and The Children’s Hospital at Westmead

59

Notifiable Diseases Surveillance, 1917 to 1991; Communicable Diseases Intelligence Bulletin Vol 17 No.11 p226; Robert Hall, Department of Health, Housing, Local Government and Community Services, Canberra

South Australia up to 1929, when the then Federal Capital Territory started submitting reports. North Australia (as it was called at the time) joined them in 1931 and Western Australia in 1940. New South Wales, Queensland, Tasmania, and Victoria do not contribute to this graph until the late 1980s60. This is not a criticism of vaccination. It is however concerning that an indicator thought to be fundamental in proving the value of vaccination has been so poorly and non-uniformly collected and collated. With whooping cough (Figure 23), we see a 30 year gap where data was not compiled nationally. Prior to this, it came predominantly from one state (SA). In fact, examination of the raw data reveals it was not until 1982 in NSW, 1983 in NT, 1989 in Tasmania, and 1990 in Queensland that the illness was even notifiable. Also, as indicated earlier in the chapter, widespread use of the earlier vaccine probably did not occur until 1950—rather than 1942 as indicated on the graph. Shortly, I will return to whooping cough and discuss data from South Australia (the only state that routinely collected it).

Tetanus, 1917–2005

© 2007 Commonwealth of Australia. Source: Brotherton J, Wang H, Schaffer A, Quinn H, Menzies R, Hull B, et al. Vaccine Preventable Diseases and Vaccination Coverage in Australia, 2003 to 2005. Commun Dis Intell 2007; 31 (Suppl): S112-S116.

Figure 24. Tetanus notifications, Australia 1917—2005

60

Data compiled by Robert Hall for above report. Available at http://www.health.gov. au/internet/main/publishing.nsf/Content/cda-pubs-annlrpt-oz_dis19_91.htm

For tetanus (Figure 24) there appears to be an increasing trend in notifications right up to the licensure of DPT, followed by a steep decline. This raises a concern. When we compare this to our Chapter One mortality graph for all ages (Figure 6), we see there is no such upward trend in mortality rates: why do we see it in notifications? A quick look at the data reveals an explanation. First, for the period up to 1944, tetanus was notifiable only in Victoria, and not in the other States. By 1954, it was notifiable in six, but these did not include NSW, which was by far the most populous State. The rates themselves are correct, as only the populations of the participating States were used to calculate them. However, my concern is that there was ambivalence at the upper echelons of public health bureaucracy from the outset about tetanus being notifiable. What effect did this have on doctors? That is, how much importance did doctors place in reporting the illness? We see the notification rate was down to a low 1 per 100,000 prior to the start of DTP vaccine. The mortality rate in the most vulnerable age group (under-5) had dropped to the same level. Tetanus was quite possibly seen as a disease of little public health concern, which could explain the ambivalence regarding its status as a notifiable disease.

Tetanus, Victoria

© 2011 Greg Beattie. Source: Data compiled by Robert Hall for Notifiable Disease Surveillance, 1917-1991; Communicable Diseases Intelligence Bulletin Vol 19, No 11.

Figure 25. Tetanus notifications, Victoria 1917—2005

Typhoid Fever

© 2011 Greg Beattie. Source: Data compiled by Robert Hall for Notifiable Disease Surveillance, 1917-1991; Communicable Diseases Intelligence Bulletin Vol 19, No 11.

Figure 26. Typhoid Fever notifications, Australia 1917—1991

Scarlet Fever

© 2011 Greg Beattie. Source: Data compiled by Robert Hall for Notifiable Disease Surveillance, 1917-1991; Communicable Diseases Intelligence Bulletin Vol 19, No 11.

Figure 27. Scarlet Fever notifications, Australia 1917—1991

Even more concerning, if we re-plot the graph using data from the one State which did consistently collect it (Victoria, starting in 1922), we see quite a different trend (Figure 25; once again, plotted from the same raw data). I will present two more graphs, as I did in Chapter One, for typhoid fever (Figure 26) and scarlet fever (Figure 27). As we do not have vaccine programs for these illnesses, their graphs did not appear in the publication that the others did. However, I have plotted them from the same source of raw data, and present them here for comparison. Both diseases were uniformly notifiable in all States. The publication from which the first four notification graphs were taken included several more diseases, two of which (Polio and Hib) will be presented and discussed in subsequent chapters. Hepatitis A is presented in Figure 28 merely for comparison. There was no vaccine for Hepatitis A in use in Australia prior to the year 2000; after that, one was introduced selectively. The graph is presented here to demonstrate that notifications may decline dramatically, then resurge and decline again, all without a vaccine. Now that we have seen the evidence, it is time to move on to a discussion of the relative merits of the two types of data used. Which is most appropriate (notifications or deaths) for our purpose? How credible is each? I have decided to separate this discussion into its own chapter, as it covers some fundamental and disturbing elements of the vaccination conundrum.

Hepatitis A, 1952–2005

© 2007 Commonwealth of Australia. Source: Brotherton J, Wang H, Schaffer A, Quinn H, Menzies R, Hull B, et al. Vaccine Preventable Diseases and Vaccination Coverage in Australia, 2003 to 2005. Commun Dis Intell 2007; 31 (Suppl): S112-S116.

Figure 28. Hepatitis A notifications, Australia 1952—2005

Chapter FOUR

THE DATA It is a capital mistake to theorize before one has data. Insensibly one begins to twist facts to suit theories, instead of theories to suit facts. Sir Arthur Conan Doyle (Sherlock Holmes) We have used two distinct sets of data in this book to assess the value of our vaccination programs—deaths and notifications. As indicated at the close of the previous chapter, there are some disturbing aspects to the use of notifications for this purpose, so we will start from there. First, we must discuss “incidence”, which is the number of fresh cases of an illness in a population, at a particular time. Obviously, we will want to examine this year-by-year if we wish to assess the impact of a vaccine. The problem is, we can’t. We do not have incidence data, because it was not routinely collected. This may surprise us, but it is true. The incidence of whooping cough, measles, diphtheria, polio, and others in our communities, is not known—neither before, nor after vaccines were introduced. We may attempt to estimate it, but we cannot measure it because, unlike mortality data, incidence is not recorded. This will become clearer as we progress through the chapter. However, to begin with, we must acknowledge that not all cases of illness are even seen by a doctor. Many stay at home, perhaps have some time off school or work, get some rest, and eventually are well again. Some visit non-medical health services or choose to self-care. The proportion of cases that actually visit a medical practitioner is unknown, and probably changes from time to time. Even where cases do visit a doctor, there is little governance in place to ensure that they are reported. In the USA, it is officially estimated that only 1-2% of adult whooping cough cases end up being reported to the national surveillance system61.

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Kretsinger K et al. Preventing Tetanus, Diphtheria, and Pertussis Among Adults: Use of Tetanus Toxoid, Reduced Diphtheria Toxoid and Acellular Pertussis Vaccine; MMWR Dec 15, 2006 / 55(RR17);1-33 http://www.cdc.gov/mmwr/preview/ mmwrhtml/rr5517a1.htm

And... speaking of surveillance systems leads us directly to “notifications”. Let me explain. When an illness is of public health concern, meaning that we want to track its occurrence, we place it on the notifiable diseases register. Doctors, and sometimes others, are given a copy of this register and are asked to report all cases they see. The register itself changes frequently as diseases often become notifiable for a period, then are deemed not notifiable and taken off, and subsequently put back on. We saw examples of this in chapter three. The purpose of the register is simple. If we have a public health crisis, such as an outbreak of food poisoning in a particular area, we are able to efficiently notice it, track it, and coordinate a response. This is known as disease surveillance, and is an important public health tool. A problem arises however when someone, 30 or so years down the track, decides to use the data from this activity to demonstrate the impact of a vaccine. I will explain why this can become a problem.

Notifications... why they fail the validity test Refer to the notification graphs we viewed in the previous chapter—particularly measles and whooping cough (Figures 22 & 23). We are immediately drawn to the significant amount of missing data in the graphs. This is because illnesses were sometimes notifiable, and sometimes not, as mentioned earlier. Often an illness would be notifiable in one Australian State, but not in neighbouring States. This situation might go on for decades, then subsequently reverse. Such was the haphazard nature of this system. This is not a criticism of the system. Remember, surveillance is a public health tool enabling timely response to potential threats. Over the years, the public health importance of an illness may fluctuate, the response options may vary, and case definitions may change. None of these are of concern if the system is simply being used to allow quick responses to crises. But they are indeed of great concern to the public if the data is used in the future as a tool for assessing the impact of vaccines, or any other intervention. At this point, some may be thinking... since it is there, surely it could be of some use. After all, missing data alone does not mean the whole data set is unusable. We all know that survey data often covers a very small proportion of the population, yet is still useful. Yes, survey data is useful. This is because surveys are designed to ensure that the collected data, though small, is representative and valid, or can be adjusted to make it so. In the case of notifications, it is impossible to know whether the data is valid. Some of the influences to which it is subjected are simply unquantifiable. Two major issues here are participation and bias.

Participation How many doctors participate faithfully in this system? Do they dutifully send in their notification reports, or is the opposite true? We have no way of knowing the answer for sure, however, studies suggest that it is sometimes common and sometimes rare for doctors to participate. In the USA, there are State and local laws requiring medical providers to report notifiable illness. However, a review of the years 1970-1999 found that participation varied from 9% to 99%62. Another review of measles reporting during the 1980s and 1990s in the USA, found rates varied from 3% to 58%63. Researchers studying 13 developing countries found that only 2 to 5 per cent of tetanus cases, and 1 to 26 per cent of polio cases, were reported. Overall participation, when it came to the illnesses for which we vaccinate, was thought to be less than 10%64. In another round-up of estimates65, physician reports (mandated by law) were compared with discharge records of 11 hospitals in Washington, and found to come up short. Only 35% were reported, in comparison with the hospital records. In the Netherlands, only 3% of measles cases seen by the health system were reported, and in the Eastern Mediterranean, 45% of hospitalised tetanus cases were reported. Almost 30 years ago, a researcher from Glasgow cautioned against using notifications. He described them as “unreliable and fallacious”, and pointed out that half of west Scotland’s whooping cough notifications came from only 12% of the doctors, and just over one-third came from a mere 2%.66 The big question here is... what influences their participation? We have no way of knowing for sure, but it would be reasonable to propose that publicity, news, and local knowledge play a role. That is, in any given community, if there is little interest surrounding an illness, it follows that doctors will less likely suspect that

62

Doyle et al. Completeness of Notifiable Infectious Disease Reporting in the United States: An Analytical Literature Review; AM. J. Epidemiol.(2002) 155 (9): 866-874 http://aje.oxfordjournals.org/content/155/9/866.full

63

Rafael Harpaz. Completeness of Measles Case Reporting: Review of Estimates for

64

Galazka AM, Robertson SE. Global Epidemiology of Infectious Diseases, WHO 2004 p65 http://whqlibdoc.who.int/publications/2004/9241592303.pdf

65

Weekly Epidemiological Record, 57, 361-368 1982 WHO http://whqlibdoc.who.int/ wer/WHO_WER_1982/WER1982_57_361-368%20(N%C2%B047).pdf

66

Stewart GT. RE: “WHOOPING COUGH AND WHOOPING COUGH VACCINE: THE RISKS AND BENEFITS DEBATE” Am. J. Epidemiol. (1984) 119(1): 135-137 http://aje.oxfordjournals.org/content/119/1/135.full.pdf+html

illness in patients, especially where the diagnosis is not clear. On top of this, they may be less likely to report the illness, even when they do suspect it. Conversely, if media reports, departmental warnings, or other sources indicate a possible outbreak, doctors might be more ready to suspect the illness, and report it. These warnings or briefings may have a significant effect on reporting behaviour, or they may not. They might lead to an increase in participation, from say 30% to 60%. Or they may raise it from 10% to 80%. Who knows? We have no way of adjusting the data to allow for this possibility. In fact, we would not even know that it occurred. All we would see is a two or eight-fold increase in the numbers. A research team in 1993 lamented the low reporting rates during a well publicised outbreak in New York67, as follows: During the largest measles outbreak in New York City in the past decade, the reporting efficiency of measles cases from the 12 study hospitals to the department of health was estimated to be only 45%. Since this outbreak was the subject of substantial publicity, the awareness of physicians and other medical personnel should have been high. Publicity may be expected to increase the participation rate but, as we note above, it may not always have the desired effect. Once again, we are looking at an unquantifiable yet potentially significant influence. In science, data that is compromised in this way is low on the scale of usefulness. Then, as explained earlier, notifications were never intended to be used for this purpose; that is, assessing the impact of a vaccine. That is why safeguards were never built into the system to deal with these issues. It may surprise us, but in fact we did not, at any stage in our past, say: OK. We’re going to start developing some vaccines soon, so let’s start a decent monitoring system. That way, in the future, we’ll be able to make meaningful before-and-after assessments. No one did that. That is why we have no comprehensive incidence data. We did not consider it important enough to invest our time and energy in collecting it. As for the two terms—incidence and notifications—it is clear they are not interchangeable. Despite this, many of us (including public health authorities) habitually use the term incidence when we actually mean notifications. In doing so, we inadvertently bestow notifications with an undeserved measure of authenticity.

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Davis et al. Reporting Efficiency during a Measles Outbreak in New York City, 1991; Am J of Pub Health July 1993, Vol. 83, No. 7 pp1011-1015 http://ajph. aphapublications.org/cgi/reprint/83/7/1011

Some may feel that a small scientific sin has been committed with all this. In our desire for data which we neglected to collect, we took notifications from the closet, dusted them off, and relabelled them “incidence”. But wait, there’s more.

Diagnosis bias Diagnosing an illness correctly is not as straightforward as many think. Two patients with similar symptoms are frequently given different diagnoses, and therefore reported as having different illnesses (that is, if they are reported at all). These days, a good part of the diagnosing is done by laboratory tests—looking for microbes. With some, such as Hib disease, a laboratory test is virtually the sole criterion. Throughout the majority of the 20th century, however, this was not the case. Doctors had to examine a patient’s symptoms, and history, then make a call as to which illness it was. This was sometimes an easy call if the patient was a “textbook” case, displaying a classic clinical picture. Often, however, it was not so easy and judgement became a major factor in the decision. Consider whooping cough. The patient presents with a cough which may show signs of “whooping”. When this occurs a doctor has to decide whether it is cold, croup, whooping cough, bronchitis or something else. Should they decide whooping cough, they will need to follow it up with a notification to the health department, if the illness is notifiable at the time. You can imagine, if the doctor is aware of whooping cough “going around”, he/she will be more likely to consider it to be the problem. On the converse, if there is no current alert for whooping cough, a doctor is less likely to suspect that they have a case on their hands. There is also the question of faith. Recall the belief from Chapter One? Imagine a child with the symptoms described above being brought to a doctor’s clinic. The doctor remembers previously vaccinating the child, according to the schedule. The doctor has to make this call: is it whooping cough, or is it more likely to be something else? Now, we’ll go one step further. Imagine we are in the 1950s, and about to start mass vaccination with the new vaccine for whooping cough. Public announcements have been made, brochures have been distributed, and doctors have received their briefing on how to advise parents. Then they begin using the vaccine. All the while, they give the appropriate assurances to parents that the needle will prevent their child from developing whooping cough. Now, when children are subsequently brought in with an illness resembling whooping cough, there is a whole new landscape for the doctor. Number one, he has his own internal faith in the vaccine—partly because he grew up on the belief, and partly because his profession taught him it will protect. Number two, he gave his own assurance to the parent that the vaccine would protect against whooping cough.

To say to himself “I think this child has whooping cough”, would go against the grain of his own faith. To say to the parent “I think your child has whooping cough”, would draw an awkward question: “But didn’t you tell me...?” Vaccine supporters sometimes dismiss this notion. Frequently, these people are actively using notification figures to demonstrate the value of vaccines. They maintain that the business of diagnosis is straightforward, and that the vaccination status of a patient would never be used as an aid in diagnosing. To set the record straight, I will demonstrate that this bias is real and documented. The only thing not known is its extent. It is seldom discussed and rarely acknowledged, but it does exist. We will start with a quote from a highly respected article on whooping cough published in Reviews of Infectious Diseases in 1987. It comments on the bias, as follows:68 It must be difficult for a physician to escape such a bias, in particular if he or she was responsible for the vaccination; a total avoidance of the bias would imply no faith in the protective properties of the vaccine. ...Given the widely recognised difficulties in diagnosing pertussis, it is likely that this bias has affected many studies. Prior to writing A Parent’s Dilemma 14 years ago, I wandered into my local hospital staff library to read up on how doctors are taught to diagnose the illnesses. I picked up a textbook—“Current Pediatric Diagnosis and Treatment, University of Colorado School of Medicine”—and looked for the section headed “Essentials of diagnosis”, for each of the illnesses. I found the following: “no prior mumps vaccine” … meaning if you have a patient with mumps-like symptoms, first check to see if they’ve been vaccinated. If they have, you can almost rule mumps out “history of rubella vaccination usually absent” “no history of immunisation” “in a non-immunised child” “in an unimmunised patient” I’ll be honest. I had little doubt that this influence would exist in the minds of doctors performing diagnoses, but I had no idea it would be documented in

68

Fine & Clarkeson. Reflections on the Efficacy of Pertussis Vaccines; Rev Inf Dis: Vol 9 No. 5, Sept/Oct 1987 p873 http://cid.oxfordjournals.org/content/9/5/866.full. pdf+html

textbooks! Another one, “Rudolph’s Fundamentals of Pediatrics”, from which I quoted earlier, states 69: Although a thorough medical history is important to all areas of pediatric medicine, nowhere is it more essential than in the approach to an ill child with a possible infectious disease. Historical points unique to infectious diseases include questions regarding immunisation history, previous antibiotic use, and recent contacts and exposures to infectious diseases. [emphasis mine] In relation to diagnosing bacterial tracheitis, the same textbook suggests that as well as performing a thorough history and examination70: The immunisation record should also be reviewed, with special attention paid to Hib and diphtheria vaccines. Another paediatrics textbook states, regarding measles71 and rubella72: Diagnosis is based on clinical findings, exposure, and immunization history, as well as positive serology. ...It is important to obtain an immunization and contact history about any child who presents with a nonspecific viral exanthem. With tetanus, a quick search uncovered three separate texts: The diagnosis of tetanus is based on clinical findings. Wound and cerebrospinal fluid cultures should be taken, but the bacterium is often not isolated. Tetanus is unlikely if the patient has a history of immunization or a serum antitoxin level of 0.01 units/mL or greater.73 There are no laboratory findings characteristic of tetanus. The diagnosis is entirely clinical and does not depend on bacteriologic confirmation. Clues to the diagnosis include a wound or recent history of a wound, no clear history of tetanus toxoid immunization, headache, low-grade fever, irritability, and restlessness.74

69

Rudolph’s Fundamentals of Pediatrics: Third Edition by Abraham Rudolph, Robert Kamei, and Kim Overby (Feb 14, 2002) p289

70

Ibid p340

71

Pediatrics for Medical Students by Daniel Bernstein and Steven P. Shelov (Dec 13, 2002) p183

72

Ibid p184

73

Orthopaedics by Robert H. Fitzgerald MD, Herbert Kaufer MD, Arthur L. Malkani MD, and Mosby (Jan 15, 2002) p245

74

Neuromuscular Junction Disorders: Diagnosis and Treatment by Matthew N. Meriggioli (Oct 21, 2003) p223

A definite history of immunization would argue against a diagnosis of tetanus, although tetanus has been reported in patients with conventionally ‘protective’ levels of antibody.75 As an illustration of the extent to which this bias may affect judgement, the last example attempts to remind doctors that the immunisation history should not completely exclude tetanus as a possible diagnosis. An example using whooping cough follows76: If tracheal compression elicits a paroxysm of coughing and if, by history, there has been an exposure and no pertussis immunization, the physician has all that is necessary for a tentative clinical diagnosis. The online consultancy site www.wrongdiagnosis.com says77: A diagnosis of the whooping cough is generally made from information obtained by taking a thorough health history, including symptoms and vaccination history, and performing a physical exam. Misdiagnosing whooping cough is possible because the symptoms, especially early symptoms, can be vague and similar to symptoms of other diseases. These include upper respiratory infection, cold, bronchitis, pneumonia, and influenza. My question is... is it any wonder notifications of an illness have often gone down after a vaccination campaign? The wonder is that there are examples where they have not. Many authors have confirmed there is a tendency to over-report an illness in patients who have not been vaccinated, and under-report it in those who have. Naturally, with guidelines such as these, when a vaccine is introduced and given to large numbers of people, we expect to see a reduction in notifications for that illness, whether the vaccine worked or not. The practice of using the vaccination status of a patient as an aid in diagnosis is as old as the hills, as evidenced by the following quotes, starting with none other than Osler’s “Modern Medicine”, which listed the first thing to consider when differentiating smallpox from chickenpox, as78: The vaccinal condition of the patient.

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Manson’s Tropical Diseases: Expert Consult Basic by Gordon C. Cook MD DSc FRCP(Lond) FRCP(Edin) FRACP FLS and Alimuddin Zumla BSc.MBChB.MSc. PhD.FRCP(Lond).FRCP(Edin).FRCPath(UK) (Dec 10, 2008) p1115

76

Practice of Pediatrics, Volume 3. Vincent C. Kelley; Harper & Row 1983, Chapter 74 p9

77

http://www.wrongdiagnosis.com/w/whooping_cough/misdiag.htm

78

William Osler MD quoting WT Councilman MD; Modern Medicine, Volume 1 p853 Quoted in “The Facts Against Compulsory Vaccination” by R.B. Anderson http:// www.vaclib.org/books/archive1/facts/facts_sm.htm p79

One more example of the influence that vaccination status had on the diagnosis of smallpox, can be found in the following, from the “Illinois Medical Journal” in 192379: In examining a case of suspected smallpox, close observation is of the utmost importance. If the patient shows evidence of a typical vaccination scar of comparatively recent date, variola* may be almost absolutely ruled out. (* smallpox was commonly referred to as “variola”) Ultimately, diagnoses are made by medical people who are immersed in a belief that vaccines protect. This preconception is likely to influence their decisions at some level. If we do not control or make adjustments for this influence, we are faced with the prospect of contaminated data, and invalid conclusions. Obviously, this influence would also have the potential to affect cause-of-death data, although cause-of-death is determined after a much greater level of scrutiny than would be normal for a simple notification. I believe notification figures are of little use in assessing the real impact of vaccination campaigns. Considering the unquantifiable influences which may affect notifications—prompting due to health scares, prompting due to vaccine introduction, prompting due to lowered vaccination rates—together with diagnostic bias, is it not surprising they sometimes produce trends that fluctuate wildly, while more stable indicators, such as deaths, remain steady? To draw conclusions from such data is, in my opinion, scientifically unsound. To rest our whole case on it is worse. I decided none-the-less to include notification graphs in this book, for the sole reason that many use them to demonstrate that we have useful vaccines. After reading the above and viewing the graphs, I trust you will be in a better position to make up your own mind about that.

A case in point One year after A Parent’s Dilemma was published, an article appeared in the “Communicable Diseases Intelligence Bulletin”. Its four authors were from the South Australian government. It opened with the following sentence: Concurrent with the introduction of mass vaccination programmes for pertussis in the 1950s all Australian states, with the exception of South Australia, discontinued surveillance of pertussis.80

79

Archibald L. Hoyne MD. Smallpox — Its Differential Diagnosis; Illinois Medical Journal, June, 1923 Quoted in “The Facts Against Compulsory Vaccination” by R.B.Anderson http://www.vaclib.org/books/archive1/facts/facts_sm.htm p79

80

Scheil et al. Pertussis in South Australia 1893 to 1996; CDI Vol 22, No 5; 14 May 1998 pp76-80 http://www.health.gov.au/internet/main/publishing.nsf/Content/cda-

I urge you to follow the footnote (below) and locate this article on the internet. You will find a rare example of a comprehensive mortality graph for whooping cough, covering the period 1893-1996 in South Australia. You will also find one for notifications 1917-1996 in South Australia—the only collection of notification statistics available, in Australia, which covers the period of the vaccine’s introduction. The authors also discuss an example of why notification data should be interpreted with extreme caution—a surge in notifications in 1993 that was 12 times greater than the highest figure in the previous decade. After investigation, they concluded it was purely an artefact of the system, as there was no corresponding increase in deaths or hospital admissions: Thus, only the notifiable diseases register identified 1993 as significantly different compared with previous years of high activity in the past decade... Notification data are sensitive to changes in diagnostic and reporting practices. I want to return our focus briefly to the opening sentence of the article. When mass vaccination commenced, seven out of our eight states and Territories stopped counting whooping cough cases. Why? Why stop monitoring an indicator which is now claimed, by some, to be the most meaningful measure of the impact of the vaccine? Was this not an acknowledgement that notification data was never intended to be used for this purpose? Was it not also an illustration of the faith we had in the vaccine? We told doctors to not bother reporting it any more.... got a vaccine.... illness gone.... problem solved. What does all this mean for the graphs? Well, the bottom line is notification figures were not intended to be used in this way—that is, studying historical trends. Instead, they are a surveillance tool, and they facilitate quick responses to public health alerts. They are sample data only, and although sample data may be useful, we must first be satisfied that it is representative and uncontaminated. In this case, there is ample reason to believe it is neither. If the sampling method left us confident that the samples were representative of actual incidence rates, and that preconceptions had not favoured a particular outcome, we might have data that is useful for this purpose. Unfortunately, the notification system is likely to produce a data-set that is significantly influenced by reporting trends and bias.

How valid is mortality data? Cause-of-death data was used to plot most of the graphs we have seen in this book. It has been routinely collected and collated in most developed countries since around the middle of the 1800s. For each death, an underlying ‘cause’ is decided, and recorded. These decisions are to some extent subjective. They involve doctors’ judgement. However, as the deceased has often undergone many tests (both pre- and post-mortem), been examined by several health professionals (including specialists), and often been hospitalised, the diagnosis is the product of a reasonable level of scrutiny, although obviously still open to influences. The data has integrity in that it is consistently collected. That is, it is not simply a subset of the real data. This is the real data. It is meticulously coded into a classification system that provides for worldwide comparisons. The classifications have been routinely revised since the 1880s and are now governed by the WHO, enabling more countries to adopt the same system, thereby standardising collection, and making comparisons more meaningful81. A criticism of using cause of death data is worth discussing briefly: that is, it only reflects deaths. What about those who had the illness but did not die? Unfortunately, we have no reliable data for those who did not die, as has already been discussed in this chapter. Mortality is however also a useful indicator of the incidence of an illness. The relationship is quite straightforward. For each illness, we have an established “case-fatality ratio”. That is, a proportion of those who develop the disease will, fairly predictably, die from it. Although this ratio may change over longer periods of time, it is reasonably stable in the short term, in any given population. Put simply, the number of deaths is essentially the number of cases multiplied by the case-fatality ratio. For example, if an illness has a case fatality ratio of 10% and we have 100 cases this year, we can expect around 10 deaths. But if we have 500 cases next year, we can expect 50 deaths. If the number of cases goes up by a factor of 20, the deaths will likely do the same. In fact, it may be argued that death figures are more purposeful, in that they are also a measure of severity. We are often told that vaccines prevent the disease in some, and reduce its severity in others. As deaths represent a direct measurement of the ultimate outcome of the illness, it follows that they are an indicator of severity.

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For more information on the International Classification of Diseases visit http:// www.aihw.gov.au/mortality/history.cfm

Chapter FIVE

REVISITING THE PARADIGM People tend to want to follow the beaten path. The difficulty is that the beaten path doesn’t seem to be leading anywhere. Charles M. Mathias ‘Paradigm’—a set of assumptions, concepts, values, and practices that constitutes a way of viewing reality for the community that shares them, especially in an intellectual discipline82. Our paradigm tells us we are at war with an invisible enemy... constantly under attack from an army of hostile invaders. If they shoot us, we are down with an illness: that is, unless we have taken the antidote! The antidote is our only weapon in the war. We must all take up this weapon to eradicate the invaders. No, this is not a hollywood script, nor a computer game. This is how we look at the issue of acute illness, and the vaccines we produce to combat it. Perhaps we should start this discussion by looking at some terms we use, and asking some pivotal questions.

Do vaccines really work? This sounds like a simple enough question. However, it depends entirely on what we mean by “work”. I believe if we stood a medical researcher and a parent side by side, and asked what evidence would convince each that a vaccine had worked, we would receive fundamentally different answers. Let me use a chainsaw as an analogy. If we ask a group of people whether chainsaws work, we can expect a range of replies. Some will say they work 90% of the time. Others will say they never seem to work when you need them to. A small engine mechanic may be able to clarify this for us, and discuss factors which affect the figure—age, brand, operator habits etc. However, others might consider that the question is not simply do they “work”, but a wider question of benefit; that is, do they work for a purpose? An environmentalist might ask whether they work for the good of the planet. A farmer, or

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http://www.yourdictionary.com

tree lopper, may look at the question from another angle. A sawmill operator may tell us they are next to useless. Back to vaccines. Do they work? If we ask the “mechanics” in this case, the answer is: ...they work roughly 90% of the time, depending on brand, age, operator habits etc. By this, they mean vaccines produce a response in our bodies (aka antibodies) that standard medicine refers to as immunity. Although immunity is a complex and confusing concept, we can summarise the standard medical view of it as: a state of body in which a particular microbe is likely to be more efficiently dealt with, than would otherwise be expected. However, for Mums and Dads, this is not really what the question is about, is it? Like the farmer or the environmentalist, we want to know whether vaccines will work for us. Isn’t it true that our interest—our only interest here—is whether vaccines will improve our children’s health prospects? I am sure some of you will be asking... “What’s the difference? If we stop a certain microbe from hanging around in our body it follows that health prospects have improved, doesn’t it?” That may or may not be true. Just for a moment, I would like to consider the following. What if targeting specific microbes is not the best way to achieve our aims? Wait a minute. Am I questioning 100-odd years of medical research? Yes, I suppose I am. Remember, this chapter is about revisiting the paradigm. Besides, after the revelations of Chapter One, surely nothing is sacrosanct. For now, bear with me while I use another analogy—this time, plumbing83. After noticing a water leak in our garden, we dig around it and expose the problem; a patch of corrosion with six or seven small holes in a pipe that supplies water to our home. Because of the water pressure in the pipe, each hole is emitting a thin stream of water. Now, if we put a finger over one of the holes, what happens? 1. The water stops streaming from the hole our finger is covering, but 2. It streams faster from the other holes

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Some people hate analogies and some love them. I’m in the latter camp. Used correctly they can be a great tool to help us think outside the box.

We cover two holes, and the water streams even faster from the remaining four. And so on. The solution, of course, is to cover all the holes84. To a child, a finger over one of the holes may appear to work. And, from a limited perspective, it does. It stops the water coming out of one hole. However, we know it will not produce the result we want. So we call a plumber, who attends to the leak. But the plumber, without our knowledge, only patches one of the holes, and leaves the other five leaking. We subsequently notice the continued leak, and call him back. After all, he may have simply missed the other holes. He digs the pipe up again and reports, with a confident smile, that the water is definitely not leaking from the hole he patched. Therefore, his fix worked. With this he leaves and, without us knowing, adds us to his database of satisfied customers. And we are left, shaking our heads in disbelief. This sounds crazy, I know. However, in the above example, it is easy for us to see the problem. The plumber had not attended to it, even though he had congratulated himself on a job well done. It is not so easy to see the problem when we are dealing with illness. After all—we cannot see the holes. You may not see the relevance, but bear with me for I am going to use polio to illustrate this.

Paralysis We know that polio is an acute illness resulting in paralysis. Not so well-known is that this illness can occur with, or without, the polio virus. In fact, when A Parent’s Dilemma was being prepared, I discovered there were at least 23 enteroviruses associated with illness that is clinically indistinguishable from polio. The figure has no doubt grown since then. There are also certain chemical poisons, as well as bacteria that result in the same outcome. Now, imagine your child is fully vaccinated for polio, but subsequently develops the illness and is left paralysed. Would you find comfort in your doctor phoning to tell you the laboratory tests had come back, and were negative for polio virus? Probably not. Would your doctor find comfort in that news? On one level, no. But on another level, yes. Doctors are certainly not callous, but in this case, the system in which they operate defines success in much narrower terms than parents do.

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There is another solution which may not be immediately apparent. That is... turn off the water supply. In this analogy it doesn’t make immediate sense to do so. But if the pipe were carrying waste away from the house things would be different. We could stop pouring waste into it. This is essentially the approach taken by some nonmedical philosophies when dealing with much of the illness mentioned in this book.

You see, one of your doctor’s aims as a practitioner of standard medicine, was to stop the polio virus getting to your child. Vaccination was their way of covering one of the holes. When paralysis appeared, it looked as if the fix may not have worked. In the end, laboratory tests confirming it was not polio virus meant the fix did in fact work. This restored some faith in the system. And believe it or not, in a sense, you were also added to the collective database of satisfied customers. The illness was given a different name, because no polio virus was found. Same illness, and same outcome—paralysis—but not polio. In fact, with polio we (as a community) have been finding such comfort, and celebrating such successes, for around half a century now. We have been collecting all the acute paralysis cases that occur, and investigating them for evidence of polio virus. Each year we detect polio virus in less and less of them, so we announce the news that we must be eradicating polio. But what is happening with acute paralytic illness? Is it decreasing, or is it marching on, seemingly unnoticed? We will investigate this in Chapter Seven. Medical thought is so centred on the notion that MICROBE = ILLNESS that we do not even bother to check whether paralysis is reducing. Paralysis may have been the reason we originally developed a vaccine but, remarkably, it has now taken a back seat. All we are concerned with is how often polio virus is found in laboratory tests.

What eradication? So, how does this focus affect us when we are considering whether polio vaccine has been of benefit? Well, we all know of the Global Polio Eradication Initiative. After decades of intense vaccination, the dreaded illness that paralyses children is about to disappear from the face of the earth. What most of us do not realise is that that is entirely false. The illness is not about to disappear—it is a microbe that is about to disappear from the face of the earth. But from all reports, the illness that paralyses children is not going anywhere. I will discuss this in detail in Chapter Seven. For now, I simply want to point out that the leak is still there. In fact, it may surprise us but reported cases of the illness that paralyses children have actually increased in the past 15 years. The reason this is not common knowledge is because the illness sports a new name these days, as mentioned a few paragraphs back. It is now called AFP. What is AFP? Remember when the musician “Prince” changed his name to a symbol which nobody could pronounce? People began referring to him as “the artist formerly known as Prince”. Well, AFP is “the illness formerly known as polio”. Let me back track. There was something called polio. We changed its name to AFP and gave “polio” a new definition. There was no ceremony, and it did not happen overnight, but it did happen.

This all started about 50 years ago. Was it done deliberately? Yes, but I do not believe it was done deliberately to deceive. We simply began changing the rules because we found a hole we could plug. We changed the definition of polio to “polio that comes from this hole”, and started plugging the hole. There is a humorous golden rule of hunting, which seems to apply here: If you want to be sure of hitting your target, shoot first. Whatever you’re able to hit, call it the target. We have not found a way to “hit” the illness, but we found a way to hit a virus. So, what happened to all the polio that came from the many other holes? They still exist; but they had to be given new names. This has happened, and now all of them live happily, with polio, in a new syndrome named Acute Flaccid Paralysis (or AFP). I call it the illness we used to call polio because that is precisely what it is. It is the illness we are reminded of each time we are urged to have our children vaccinated for polio. And yes, the comment a few paragraphs back was correct. Reported cases of this have increased steadily over the past 15 years. This is the same 15 years that we have been announcing the steady eradication of polio. Why the different stories? Because medicine as an art is somewhat interested in its ability to reduce the occurrence of certain microbes (aka blocking certain holes). In the paradigm whose primary concept is MICROBE = ILLNESS, this focus is not out of place. It makes sense to be focussed on a virus if we accept that it is the cause of paralysis; even if it is the cause of some of it. However, if the virus is not the cause of the paralysis, or at least an important cause, there is potential for monumental failure.

Success We are proficient when it comes to killing germs. Through the use of disinfectants, antibiotics, vaccines, and other means we have managed to demonstrate our capacity to kill microbes, and control their populations. As has been noted throughout the book so far, we can no longer assume similar success in controlling illness—at least not through the use of vaccines. What if MICROBE = ILLNESS is not a useful concept? We would certainly wish we had been monitoring a less specific outcome, i.e. the illness, rather than the microbe. In the polio example above, that less specific outcome would be AFP. In fact, if we were simply monitoring AFP then it would not matter whether MICROBE = ILLNESS were a useful concept, or not. We would still be in a position to assess the real impact of the vaccine. For Mums and Dads, it is the outcome (paralysis) that is important. But Mums and Dads are not the ones calling the shots (pardon the pun). Neither are they aware that the system is totally focussed on a microbe. Their family doctor will undoubtedly be focussed on the overall health of their child, but the system that collects and analyses the statistics is not. At least, not in the case of polio. And

it is this system which reports back to us on our progress. From these reports we set policy. When we hear polio has been reduced by 90%, we celebrate, and congratulate ourselves. We think 90% fewer children are being paralysed. Wrong! When our doctors are taught that blocking a particular hole is important, they believe it and pass that belief to us. Remember, the same good-news stories are delivered to them first. Here is another example—Hib disease. What is it? Ask anyone to define the symptoms of Hib disease. They will not be able to, unless they make something up. This is because Hib disease is not an illness, in the classical sense. It is not defined by its symptoms. Instead, it is defined in terms of a microbe. More on this in Chapter Six, but for now I want to draw your attention to one thing. Our primary motivation with Hib vaccine was to fight meningitis. And we continue to market it to parents as such. However, we do not use the prevalence of meningitis as our measure when it comes to assessing performance. Instead, we monitor the occurrence of a microbe. Meanwhile, meningitis carries on in the community, attracting little interest in terms of monitoring and planning. In Chapter Six, we will discover that if we did use meningitis as our measure, the vaccine would be very difficult to market. Once again, a pipe was leaking and we placed a finger over one hole. However, while we were busy congratulating ourselves, the water continued to leak. You may not be convinced by any of this yet, but hopefully it will fall into place as you read on and into the following chapters. In each of the above two examples, what we essentially did was create a new disease and call it “water that leaks from this hole”. With this definition in place, all we needed to do was place a finger over this hole and, by definition, we were able to claim success. For myself, the disturbing aspect of our focus on MICROBE = ILLNESS is that we are content to claim this success, with little concern for the overall volume of the leak (or illness). On the other hand, illnesses such as measles and whooping cough were traditionally defined by the symptoms they produced (clinical diagnosis). However, that is now changing. In recent years, access to pathology testing has become easier. Now it is routine to have all suspected cases tested for evidence of the microbe. So... how much does confirming the microbe affect the figures? Hold on to your seat. Researchers in the UK analysed 3442 cases of notified measles when testing first started, and found only 3.7% had evidence of the measles virus85! Another

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Ramsay M et al. Surveillance of measles in England and Wales: implications of a national saliva testing programme; Bull WHO 1997: 75(6) 515-521 http:// whqlibdoc.who.int/bulletin/1997/Vol75-No6/bulletin_1997_75(6)_515-521.pdf

study in Finland found that only 0.8% had the virus86. Where does that leave our fundamental concept MICROBE = ILLNESS? We have reacted to this by changing the definitions of each illness, in order to suit our new methods of diagnosis. For example, now:

These diseases are becoming more dependent on the microbe for their identity, as time goes on. This is enabling us to report greater, albeit hollow, success. We simply establish a cover for a hole, then we redefine the illness in terms that will guarantee our success. Remember: If you want to be sure of hitting your target, shoot first. Whatever you’re able to hit, call it the target. So, the concept MICROBE = ILLNESS has increased its influence. Old diseases that used to be diagnosed by symptoms, are now diagnosed by laboratory tests. And we have new diseases (such as Hib), which are defined entirely by the existence of a microbe.

Preventing illness in the current paradigm With this in mind, we will now discuss the business of preventing illness (or covering the holes) by vaccination. The standard medical philosophy suggests we cover each potential hole with a corresponding vaccine. One problem with this is that we do not have only six holes. There are many, many different microbes, most of which have not yet been identified by science. And some that are known seem to constantly mutate into new microbes. Standard medicine says, that’s OK... we just keep plugging away at them. So, as you may have noticed in recent years, the race is on to develop and patent vaccines for as many holes as possible. As we know, vaccines are developed per microbe. In other words, we have a vaccine for the measles virus, one for the polio virus etc. They may be combined into single shots, but the theory dictates that we need a specific vaccine for each microbe. For those developing and patenting vaccines, business is looking good. The pie is huge. After all, how many microbes might there be? Almost every day, another microbe is added to the list of potential pathogens, and a new mutation of one

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Peltola H. et al. The elimination of indigenous measles, mumps and rubella from Finland by a 12-year, two-dose vaccination program; New Eng J Med, 1994:331(21) 1397-1402 http://www.nejm.org/doi/pdf/10.1056/NEJM199411243312101

already on the list is discovered. But therein lies a problem; how will we block all of the holes? Do we aim to develop a vaccine for every microbe we find? It is estimated there are probably somewhere between 10 million and one billion different species of bacteria on the planet87. Apparently, almost 5kg of our body weight is made up of bacteria, living primarily on the skin, and mucous membranes. Because they are so small, they outnumber our own cells by a factor of around ten, and in a healthy body around 15% are thought to be pathogenic (disease-causing)! That is only the bacteria. Who knows how many viruses? Seriously, this looks like a job for Superman, Spiderman, Wonder Woman—and all the rest! And, while we are busy doing this, what will happen with illness? With each new vaccine, will we be reducing illness, or will it merely spurt out faster from the unblocked holes?

Is the concept MICROBE=ILLNESS wrong? Let us ponder something which I think is of immense interest. The three main bacteria considered to be the cause of severe meningitis, colonise the bodies of healthy children all the time. And I mean all the time! In fact, it is much more common to find these bacteria colonising the noses and throats of healthy children, than it is to find them in cases of meningitis. Studies have shown that somewhere around 25% of healthy children, at any one time, will be colonised by these bacteria88. One of the three, meningococcal, is thought to colonise more than 90% of healthy children at times89. Why are these children healthy? Why don’t they go on to develop meningitis? Now, 25% of Australian children equates to hundreds of thousands: all with the microbe in their throats, and noses; 90% equates to many more, of course. Every now and then, a child will fall ill with meningitis. Sometimes, that child will be found to have one of these bacteria in their blood or cerebrospinal fluid. When this happens, we reaffirm our concept by saying MICROBE = ILLNESS. But what happened to the hundreds of thousands who did not get sick? They had the MICROBE. Where was the ILLNESS? How can we explain that? Where does it leave our fundamental concept? As will be discussed further in Chapter Seven, it is thought that, before the vaccine era, virtually everyone had the polio virus pass through their body. Yet very few became sick. Even fewer became paralysed. Why?

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http://www.wisegeek.com/how-many-species-of-bacteria-are-there.htm

88

Kenneth Todar, Todars Online Textbook of Bacteriology http://www. textbookofbacteriology.net/normalflora.html

89

Ibid. Also Wikipedia http://en.wikipedia.org/wiki/Neisseria

Both of these issues will be covered in more detail in the coming chapters. The paradigm will be further challenged as we proceed. It has become so enmeshed in our thinking that it determines not only the way we think of and react to illness, but also the way we define it, and hence the way we measure our success in preventing it. The concept MICROBE = ILLNESS is perhaps a long way from reality. And I guess it is just as well, or we could not have survived as a race. If microbes could routinely overpower our cells we would have lost the war, long ago. Remember, there are still no vaccines for more than 99% of pathogenic microbes. The relationship between microbe and illness is complex, and poorly understood90. Simplifying it to MICROBE = ILLNESS does not assist us to make sense of our circumstances. Yet we parents receive, and believe, this simplified version. Once we see that it can take hundreds of thousands, if not millions, of contacts between MICROBES and humans before one ILLNESS is observed, we begin to appreciate things are not as we thought. Now, here is the killer. The whole business of vaccination depends on the legitimacy of MICROBE = ILLNESS. It must be on the button. If it is not, we will find vaccines are of little or no benefit, when assessed in real terms. In a nutshell, we will find precisely what we saw, when we perused data in the first three chapters.

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Casadevall A and Pirofski L. Host-Pathogen Interactions: Basic Concepts of Microbial Commensalism, Colonization, Infection, and Disease; Infection and Immunity, Dec 2000; 68(12) 6511-6518 http://iai.asm.org/cgi/content/full/68/12/6511

Chapter SIX

INVENTING NEW DISEASES Whether you can observe a thing or not depends on the theory which you use. It is the theory which decides what can be observed. Albert Einstein This chapter discusses one of the modern success claims—Hib vaccine. “Hib” is Haemophilus influenzae type ‘b’. It is a microbe. The vaccine for this microbe was introduced to Australia in 1992-93, and marketed with gusto. Its success has been reported as nothing short of miraculous. Once again, we will examine the evidence and see, for ourselves, whether such a claim is warranted. In order to do this, we will need to distinguish between two methods of diagnosis: “clinical” and “laboratory”.

Clinical vs laboratory diagnosis Let us consider whooping cough. Clinical whooping cough is defined by the World Health Organisation as follows: A person with a cough lasting at least two weeks with at least one of the following symptoms: 1.Paroxysms (i.e. fits) of coughing 2.Inspiratory whooping 3. Post-tussive vomiting (i.e. vomiting immediately after coughing) without other apparent cause Laboratory-confirmed whooping cough is the same as above, but with one added requirement—laboratory tests must show evidence of the microbe Bordetella pertussis. Put simply, a clinical diagnosis is a doctor’s conclusion after examining us. It takes into account the history, and the symptoms (cough, loss of breath, vomiting and other features of the illness). A laboratory diagnosis is the result of sending a swab to a laboratory, to be examined for evidence of microbes. Illnesses used to be diagnosed clinically, and only clinically. That is, doctors would decide which illness by examining physical manifestations and history. They were, and no doubt still are, very good at this.

From around the middle of the 20th century, a change slowly started to take place. Laboratories became more widely available, and doctors were able to request testing to help determine which microbe their patient had. This was seen as an important improvement, because it had been known for a long time that certain microbes were found, and presumed associated, with certain illnesses. For example, measles patients tended to have rubeola virus in them (which I have been referring to as the measles virus). So, it appeared to make sense to test for the presence of this microbe, if measles was suspected. It soon became an aid in the art of diagnosis. For some diseases, as time went on, testing became a required part of the diagnosis. For example, at the close of the 1950s, the rules for polio were changed (as will be discussed in the following chapter). With the new rules, a doctor could not make a diagnosis of polio unless there was a positive laboratory test. For most illnesses, the rules changed slowly. Clinical diagnosis was still the mainstay for whooping cough, measles, mumps, and rubella until toward the end of the century. In fact, prior to writing A Parent’s Dilemma, most cases of these were still diagnosed clinically; that is, without ordering laboratory tests. By the time the book had been published a fairly major shift was underway. The introduction of quick and inexpensive laboratory techniques during the 1990s meant that laboratory testing was finally to become a routine procedure. This has meant a shift in paradigm. Our older concept of “illness” slowly changed, in order to neatly fuse with our new capacity to detect microbes. In other words, laboratory evidence of the microbe slowly became an essential part of the definition for each of the diseases. Now, when clinical whooping cough occurs, we will routinely test for the microbe known as B. pertussis. If tests are negative for this, but positive for some other microbe, we simply diagnose it as a different illness. Similarly, if a child has testing done for an illness that was at first thought to be something else, and it comes up positive for B. pertussis, the diagnosis is changed, and the disease is reported as whooping cough. As mentioned in the previous chapter, if a child exhibits clinical polio, but tests are negative for the virus, the disease is not reported as polio. The point of all this is simple, although perhaps a little difficult to grasp at first. We no longer think in terms of illness. Instead, we think in terms of microbe. Our efforts to prevent ill-health are now centred on the notion MICROBE = ILLNESS. When we come to Hib disease, we find we are in a little deeper, because the illness actually owes its entire existence to the microbe. If it turns out MICROBE does not equal ILLNESS... then Hib disease is nothing more than an abstraction.

So, what exactly is Hib disease? Is it meningitis? Yes and no. Is it epiglottitis? Yes and no. Is it septicaemia, or pneumonia, or cellulitis, arthritis, middle ear infection, osteomyelitis, conjunctivitis, or respiratory infection? All... yes and no. A WHO fact sheet tells us 91: Unlike measles, polio or diphtheria, Hib does not cause a specific illness with which it, alone, can be identified. The most deadly forms of Hib infection include pneumonia and meningitis, but those diseases can have other causes, and can look the same whether caused by Hib or some other agent. More rarely, Hib is responsible for other life-threatening complications in young children, such as septic arthritis, an inflammation of the joints, and septicaemia, or blood poisoning, both of which also can have other causes. And it may lead to epiglottitis (a life-threatening inflammation of the flexible cartilage that covers the gap in the vocal cords during swallowing). So the short answer is: Hib disease is any illness where Hib microbe is found in laboratory tests. It can be any of a great variety of illnesses, including those mentioned above. But that does not mean all cases of meningitis, or epiglottitis, or middle ear infection etc, are Hib disease—only those cases where the Hib microbe is found in laboratory tests. If other microbes are found instead, the illness is given a different name. If no bacteria are found, it gets another name again.

In practice Twenty years ago, standard medical thought was that the vast majority of severe meningitis was caused by three types of microbe: 1. Haemophilus Influenzae type b (Hib) 2. Neisseria meningitidis (Meningococcal) 3. Streptococcus pneumoniae (Pneumococcal) Of these, Hib was thought to be the biggest culprit. This led to the assumption that developing a vaccine for it (and eventually all three) would virtually rid us of severe meningitis. Even more good news, at least in theory, was that we would also be ridding ourselves of the bulk of septicaemia, pneumonia, epiglottitis, and others in the process. Why? Because these same three microbes were thought to be responsible, in large part, for those illnesses as well. So, we invented three new diseases, each named and defined according to the above three microbes: Hib disease, meningococcal disease, and pneumococcal disease. We then went about targeting these microbes.

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WHO Media Centre; Fact sheet No 294, Dec 2005 http://www.who.int/mediacentre/ factsheets/fs294/en/index.html

Meningitis (all ages) – Australia

© 2011 Greg Beattie. Sources: Australian Institute of Health and Welfare (AIHW) 2010. GRIM (General Record of Incidence of Mortality) Books; Original author Dr Paul Jelfs, updated by Karen Bishop.

Figure 29. Meningitis, Australia 1907—2007 (all ages)

Our first weapon was Hib vaccine, introduced to Australia in 1992-93. Now 18 years down the track, we are in a position to examine some before and after data to assess its impact.

Meningitis As outlined earlier, prior to 1993 Hib was considered the most common “cause” of severe bacterial meningitis. Hib vaccine was therefore ushered in with a promise to combat it. Data for the following graphs was kindly supplied by the Australian Institute of Health and Welfare (AIHW) 92. As in Chapter One, we will first put the vaccine effort into historical perspective, by examining the death rate over time, from 1907 until 2007 (Figure 29). As with the vaccines discussed in Chapter One, we see that this vaccine arrived much too late to play a significant role in the overall saving of lives that occurred during the past 100 years. In fact, Hib was the first of three vaccines targeting meningitis in children. Pneumococcal vaccination commenced in 2001, for “high

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Australian Institute of Health and Welfare (AIHW) 2010. GRIM (General Record of Incidence of Mortality) Books. AIHW: Canberra; Original author Dr Paul Jelfs, updated by Karen Bishop

Meningitis (all ages) – Australia

© 2011 Greg Beattie. Sources: Australian Institute of Health and Welfare (AIHW) 2010. GRIM (General Record of Incidence of Mortality) Books; Original author Dr Paul Jelfs, updated by Karen Bishop.

Figure 30. Meningitis, Australia 1960—2007 (all ages)

risk” children, and was introduced into the national schedule for all children in 2005. An earlier pneumococcal vaccine was available from 1983, and a funded program to supply it for Indigenous adults aged over 50, commenced in 1999. In addition to these, a meningococcal vaccine was added to the national schedule for babies, in 200393. The graph in Figure 30 zooms in on the period from 1960 onward, allowing us to examine the before and after effect of the introduction of Hib vaccine to the national schedule, in 1993. An earlier vaccine was in use in 1992, but was not recommended for children under 18 months of age. It is perhaps inappropriate to study the “all ages” population when, as with the illnesses in Chapter Three, severe meningitis primarily affected the very young. With this in mind, we will again focus on the under-5 age group (Figure 31). As can be seen, there has been a slow but consistent downward trend in death rates over the almost 50-year period. It would appear that Hib vaccine, from

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Australian Immunisation Handbook 9th edition: 2008 Australian Government, Department of Health and Aging

Meningitis (under 5 years) – Australia

© 2011 Greg Beattie. Sources: Australian Institute of Health and Welfare (AIHW) 2010. GRIM (General Record of Incidence of Mortality) Books; Original author Dr Paul Jelfs, updated by Karen Bishop.

Figure 31. Meningitis, Australia 1960—2007 (under 5 years)

Pneumonia (under 5 years) – Australia

© 2011 Greg Beattie. Sources: Australian Institute of Health and Welfare (AIHW) 2010. GRIM (General Record of Incidence of Mortality) Books; Original author Dr Paul Jelfs, updated by Karen Bishop.

Figure 32. Pneumonia, Australia 1907—2007 (under 5 years)

Septicaemia (under 5 years) – Australia

© 2011 Greg Beattie. Sources: Australian Institute of Health and Welfare (AIHW) 2010. GRIM (General Record of Incidence of Mortality) Books; Original author Dr Paul Jelfs, updated by Karen Bishop.

Figure 33. Septicaemia, Australia 1907—2007 (under 5 years)

Pneumonia (under 5 years) – Australia

© 2011 Greg Beattie. Sources: Australian Institute of Health and Welfare (AIHW) 2010. GRIM (General Record of Incidence of Mortality) Books; Original author Dr Paul Jelfs, updated by Karen Bishop.

Figure 34. Pneumonia, Australia 1980—2007 (under 5 years)

1993 on, had no visible effect on this. The subsequent vaccines in 2001, 2003, and 2005 were too recent to tell (and perhaps too late to be of material value).

Pneumonia and septicaemia Other illnesses which Hib vaccine was claimed to address include pneumonia and septicaemia. The graphs in Figures 32 and 33 first place the vaccine into historical perspective. Once again, we zoom in on each to assess any impact that may be attributed to the vaccine (Figures 34 and 35). This time we will start from 1980, to avoid the obvious drops that occurred immediately prior. As we can see, the vaccine produced no observable positive influence for either of these two. In the case of pneumonia, the decline appears to have slowed since the introduction of the vaccine. With septicaemia, it even reversed. There is another illness—epiglottitis—generally considered to be a member of this group (that is, the major illnesses targeted by Hib vaccine). It is characterised by inflammation of the epiglottis, a small flap of cartilage attached to the base of the tongue. The reason I have not provided graphs for this illness, is that the AIHW were not able to provide data for it. Another indicator which can be used to assess vaccine effectiveness is hospitalisation data. I was initially tempted to include graphs of hospitalisations however such data was not collected by the AIHW prior to 1993-9494, making it impossible to carry out before-and-after comparisons. For those interested, data from that time onward is available for interactive querying, from the AIHW website95.

Back to notifications So, what is the “overwhelming success” that has been reported with Hib vaccine? I will show you. The graph in Figure 36, reproduced with permission, shows notification rates for Hib disease. It is this image of falling rates that is used to demonstrate the success. We see an impressive drop in notifications, over a five year period. But hold on.... why only five years? What happened to the years prior to 1991? The answer is simple. There is no prior data. Remember, this is a new disease. Hib disease was not notifiable until 1991. Thereafter, the figures merely represent the rate of detection of Hib bacteria in specimens from “normally sterile sites”, in sick people referred by doctors and hospitals.

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Personal communication – Head, Hospital Data Unit, Australian Institute of Health and Welfare

95

http://www.aihw.gov.au/hospitals/datacubes/datacube_pdx.cfm

Septicaemia (under 5 years) – Australia

© 2011 Greg Beattie. Sources: Australian Institute of Health and Welfare (AIHW) 2010. GRIM (General Record of Incidence of Mortality) Books; Original author Dr Paul Jelfs, updated by Karen Bishop.

Figure 35. Septicaemia, Australia 1980—2007 (under 5 years)

Haemophilus influenzae type b disease, 1991–2005

© 2007 Commonwealth of Australia. Source: Brotherton J, Wang H, Schaffer A, Quinn H, Menzies R, Hull B, et al. Vaccine Preventable Diseases and Vaccination Coverage in Australia, 2003 to 2005. Commun Dis Intell 2007; 31 (Suppl): S112-S116.

Figure 36. Hib notifications, Australia 1991—2005

In Chapter Five we discussed the paradigm, using the analogy of a leaking pipe in the garden. We dug around the pipe and found several pin-holes, with water streaming from them. We found that covering one of the holes did not fix the leak. In fact, it simply made the water stream faster from the other holes. Remember the jubilant plumber who “fixed” just one hole? When we rang and told him the water was still leaking, he returned and reported triumphantly that it was definitely not leaking from the hole he had “fixed”. We have a similar story here. We invented a new disease—one defined in such a way that we could demonstrate our ability to control the microbe. The graph in Figure 36 demonstrates that ability. We have been declaring, for more than a decade, that water is not leaking from the “Hib” hole (our invention). How do we know the analogy fits in this case? Quite simply, because the preceding graphs demonstrate that no observable impact was made on the leak. Our paradigm states MICROBE = ILLNESS. We found the MICROBE (or at least the biggest culprit) and “fixed” it. We should see a major impact on the illness, but we don’t. Where does that leave our paradigm? Once again, had we been monitoring the illness instead of the microbe, it would not matter whether the paradigm were correct. While we continue to centre our thoughts on microbes, even measuring our success by them, we are engaging in little more than the academic pursuit of a theoretical villain. There will no doubt be those who feel science has irrefutably established that Hib causes meningitis. I will say two things to that. First: even if that is true, what does it matter? The same “science” has made no visible impact on illness as a whole. Second: nothing is irrefutable, especially after the revelations of Chapter One. As with the other illnesses we have discussed in this book, the microbe may be present in some cases, but we know it does not even appear in other cases. The results we see in the meningitis graphs above are illuminating in this sense. The bottom line is this: if we take the major cause of meningitis and “fix” it, we should see clear evidence of this in our most legitimate indicator. Yes? If that does not happen, we must go back to the drawing board. The microbe is obviously not important to Mums and Dads (the public). It is important only to those engaged in its pursuit. Mums and Dads are more concerned whether the illness (meningitis) is still plaguing their children, and if it is, what can be done to prevent it or reduce its severity. A few pages back, we discussed the increasing trend of naming new diseases after a microbe, or at least defining them in terms of a microbe. It is interesting to consider why we might be doing this. All in all, we have enjoyed great success in manipulating microbes. We use various chemicals to kill bacteria and we have learned how to control their numbers in other (environmental) ways. Even inside our bodies, we have learned to control them, to an extent, through the use of antibiotics and vaccines.

But we have not enjoyed the same success in controlling illness. All of the illnesses in this book are examples of this. In each case, we introduced a procedure which should have produced remarkable results, but failed to do so. What have we done to address this apparent anomaly? In the examples of measles and whooping cough, we added more doses of vaccine to the schedule (and covered more of the population). But that was not all we did. We also re-invented the illnesses—defined them in terms of the microbe. Given that we have done both of these things, we are left with an interesting question. If we should observe a subsequent decline in reports of the illness, which of the methods do we award credit to? The increased vaccination effort, the change in definition, or both? How do we know how much, if any, of the credit might belong to vaccination, if we are not controlling the influence of the other method? Inventing new diseases is the direction standard medicine is taking, regardless. The MICROBE graph (Figure 36) reports our achievement in reducing detections of Hib microbe. The graphs above it, report the lack of achievement with actual illness, regardless of whether the microbe was found. Remember, if you want to be sure of hitting your target, shoot first. Then call whatever you were able to hit, the target. As a closing thought, I draw your attention to a letter published in 2008 in the Bulletin of the World Health Organisation96. In the letter, two high profile Indian paediatricians discuss the merits of pneumoccocal vaccine, and point out that although the vaccine may have an effect on “vaccine-serotype bacteraemic” pneumonia, it does not reduce clinical pneumonia. In other words, regardless of what is reported about the vaccine’s effectiveness against a microbe, it does not reduce actual illness.

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Sona Chowdhary, Jacob Puliyel. Incidence of pneumonia is not reduced by pneumococcal conjugate vaccine; Bull WHO vol.86 no.10 Oct 2008 http://www.scielosp.org/scielo.php?pid=S0042-96862008001000021&script=sci_ arttext

Chapter SEVEN

THE PECULIAR STORY OF POLIO I know that most men, including those at ease with problems of the greatest complexity, can seldom accept even the simplest and most obvious truth if it be such as would oblige them to admit the falsity of conclusions which they have delighted in explaining to colleagues, which they have proudly taught to others, and which they have woven, thread by thread, into the fabric of their lives. Tolstoy Despite having been mentioned frequently in this book, I feel polio deserves a separate chapter so that concepts which have been outlined earlier can be fully discussed. The illness has a truly peculiar history, for the following reasons: 1. Of all the people “infected” with polio virus, very few became sick, and even fewer experienced paralysis 97 2. Polio is not polio any more. We have changed its definition, so that most of what we called polio 50 years ago, has a different name today 3. Without knowing it, we caused a significant amount of the polio we had in the 1900s, through vaccinations and other unnecessary injections and medical procedures.

The unusual complication We will look at these points in detail. To begin with, it may surprise us to learn that the polio virus is rather benign. In fact, it is thought that in the pre-vaccine era practically everyone in Australia had been “infected” at some stage, yet only

97

Burnet F. Poliomyelitis and Murray Valley encephalitis: a comparison of two neurotropic virus diseases; Med J of Aust: Feb 9, 1952 169-175

a relative handful developed paralysis . Doctors found that the condition of the body was the primary factor determining whether paralysis developed. At the second International Poliomyelitis Conference held at Copenhagen in 1951, it was submitted that98: ...the condition of the host is so important that it may determine, not only whether infection occurs, but also whether the virus is localised or becomes systemic, the extent to which it multiplies, the type of symptom produced, or whether symptoms are produced at all. This explains why, of those who did carry the virus, most experienced no symptoms whatsoever. Those who did experience symptoms often had headaches, aching necks, flu-like symptoms, and fever, but few experienced paralysis. In fact, the occurrence of paralysis was so unusual, it was considered a complication, in the same way encephalitis is considered a complication of measles99 (see Figure 37). This is part of the forgotten history of polio. The importance of this is that, during the epidemics of the 1940s and 1950s, Figure 37. Non-paralytic cases of polio children with mild symptoms were re- made up most of the numbers in the 1950s corded as having polio, whether or not (From Med J of Aust; March 3, 1951) they had paralysis. Many of the cases recorded during these earlier outbreaks suffered no paralysis. They were simply ill, and visited a doctor’s clinic at a time when polio was thought to be around. Of those who did experience paralysis, the majority recovered from it within a few weeks. A review of USA data claimed100: Prior to the early 1940s few nonparalytic cases were reported, while about one-half of the cases reported during 1945-1954 were nonparalytic. This change in reporting practice contributed to the rise seen for this 10-year period.

98

The Second International Poliomyelitis Conference; Med J of Aust: Dec 8, 1951 790-792

99

The pathogenesis of poliomyelitis; Med J of Aust: Mar 3, 1951 p343

100 Natanson N and Martin J. The epidemiology of poliomyelitis: enigmas surrounding its appearance, epidemicity, and disappearance; Am J Epid: 1979, 110(6) 672-692 http://aje.oxfordjournals.org/content/110/6/672.full.pdf+html

Today, such cases would not be recorded as polio. Why? Because we changed its definition. Polio is now an illness that involves paralysis, by definition. Additionally, the paralysis must last for at least 60 days. These changes to definition began taking place around the time of the introduction of the first polio vaccine, in the 1950s. After these changes, we no longer recorded cases that were not paralysed, or where the paralysis resolved inside 60 days. However, prior to this, such patients made up the bulk of polio numbers. What does this mean? It means we cannot meaningfully compare polio numbers before and after the definition change. But there is an even greater reason to avoid comparing them, which brings us to point number two.

Moving the goalposts off the field If we were to retrospectively analyse the paralytic cases of polio that occurred in the pre-vaccine era, we would have to change their diagnoses. Why? Because the definition has changed in another important way. Doctors now use laboratories to diagnose polio. They no longer simply say “OK. This one looks like polio.” Instead, they are required to send stool samples to a special laboratory for testing. Only when the laboratory finds polio virus may the illness be recorded as polio. Otherwise, it is recorded as something else. These laboratories were not available to doctors before the era of mass vaccination (see Figure 38). When we started using laboratories to test for the virus, we discovered that most of the cases we thought were polio did not actually have the polio virus. Some of them had other viruses, some had bacteria, and others had no detectable organisms at all. But, rather than returning to the drawing board to re-ponder the real cause of polio, we simply stopped counting these cases. They would no longer be recorded as polio. The point here is that the rules were changed. Until then, it had been assumed that everyone who suffered acute paralysis, had polio. In fact, polio was originally called infantile paralysis. We now think differently. We test for the virus, and if we do not find it, we do not call it polio. We found that there were at least 21 other enteroviruses that we can blame for illness which is clinically indistinguishable from polio101. Now, that covers only the viruses. There is also a list of bacteria fitting the same bill. In addition, the illness can occur with no

Figure 38. Use of laboratories predicted to reduce polio numbers (From Med J of Aust; July 5, 1952 p3)

101 Vaccines 2nd Ed: Plotkin and Mortimer, 1994 p 155-204

Poliomyelitis, 1917–2005

© 2007 Commonwealth of Australia. Source: Brotherton J, Wang H, Schaffer A, Quinn H, Menzies R, Hull B, et al. Vaccine Preventable Diseases and Vaccination Coverage in Australia, 2003 to 2005. Commun Dis Entell 2007; 31 (Suppl): S112-S116.

Figure 39. Polio notifications, Australia 1917—2005

Polio – Australia

© 2011 Greg Beattie. Sources: Australian Institute of Health and Welfare (AIHW) 2010. GRIM (General Record of Incidence of Mortality) Books; Original author Dr Paul Jelfs, updated by Karen Bishop.

Figure 40. Polio deaths, Australia 1922—2006

organisms detected. Perhaps this finding should have led us to rethink whether polio virus was the real cause, but it didn’t. Instead, we simply adjusted the definition of polio to “only if the polio virus is present”. Remember the plumber who covered one hole? Meanwhile, the leak continued. We used to call it all polio. Now, it is aseptic meningitis, Guillaine-Barre syndrome, cerebral palsy, encephalomyelitis, transverse myelitis, demyelination, diplegia, hemiplegia, and many others. Lots of new diseases, but of course polio figures went down. As the definition became stricter, figures dropped. They became a mere fraction of their former levels. The graph in Figure 39 is from the same government publication which presented the notification graphs we saw in Chapter Three. Those who present this graph Figure 41. New diagnostic criteria: as evidence of the value of the vaccine doctors urged to rethink polio in enthusiastically point out the dramatic vaccinated patients. (From Med J of Aust; effect after it was introduced. Now that July 28, 1956 p158) we know what really happened, we can perhaps begin to view it in a different light. As a minimum, there obviously needs to be an extra arrow, just to the left of the first one, saying “new definitions start here”. We can see a similar trend in death rates in Figure 40. As mentioned earlier, part of this moving of the goalposts occurred in unison with the introduction of the vaccine. In fact, in the very month of its introduction (July 1956), our government issued a new set of guidelines for diagnosing polio (see Figure 41), with an accompanying explanation, as follows102: The diagnosis of poliomyelitis in persons vaccinated against poliomyelitis assumes considerable importance in assessing the degree of protection afforded by the vaccine. Once immunisation commences the public mind will be as in a poliomyelitis epidemic, and such is the fear of the disease, that any illness is likely to be considered to be poliomyelitis until someone in authority says it is not.

102 Med J of Aust: July 28, 1956 p158

It is hoped that the following list of diagnostic criteria will not only help practitioners in what is often a difficult diagnosis, but may prevent unwarranted criticism of the vaccine by incorrect notification of poliomyelitis in vaccinated persons; or, more important, incorrect provisional diagnosis.[emphasis mine] Under the heading “Laboratory methods of diagnosis of poliomyelitis”, the guidelines stated: It should be emphasised that in many patients, particularly the nonparalytic type, it is not possible to make a precise diagnosis of poliomyelitis without laboratory confirmation. Even in the presence of a lower motor neuron paralysis, examination of the cerebro-spinal fluid may reveal that the condition is due to acute infective polyneuritis, in which condition as a rule there is no increase in cells. The following laboratory methods should be adopted in all cases where any doubt exists: (a) examination of the cerebro-spinal fluid, (b) isolation of poliomyelitis virus, (c) positive serological tests... (d) serological antibody tests to exclude mumps, herpes simplex and other causes of meningo-encephalitis. For those who find the above difficult to follow, I will interpret its major points. Some may think I am a touch cynical, and perhaps I am. I guess it depends on the belief-cloud we are in when we read it: If you are considering diagnosing polio in a child who has been vaccinated against it, BE VERY CAREFUL. By the time the vaccine gets out amongst the population, it will be summer—polio season—and we all know that during polio season lately, almost any illness gets recorded as polio. Remember, this can be a difficult diagnosis. We don’t want you notifying polio in children who have been vaccinated for it unless you can prove it. If you are not absolutely sure, then you must submit samples for labratory testing. This was the second step in the reshaping of polio. A short while later, a third step was added. A panel of experts was established to confirm each diagnosis. This panel, called the Poliomyelitis Surveillance Committee, gave a second and final opinion on cases that were proposed by doctors as still fitting the criteria. In other words, doctors who still believed they had a case of polio on their hands, had to refer all the evidence to this panel. As we see in Figure 42, only a fraction were accepted by the committee103 as true polio, under the new definition.

103 Poliomyelitis in Australia; Med J of Aust: Nov 4, 1967 861-862

The World Health Organisation now requires that polio virus be found in two separate stool samples, collected 24 hours apart, and within seven days of the onset of paralysis. It also requires that there be residual paralysis after 60 days. So, the new definition of polio is very strict. You may be wondering what happened to the old illness that we used to call polio... the many thousands of cases that were recorded before we changed its definition? Well, it is still with us. As mentioned earlier, I call it the illness we used to call polio, because I think that is an informative name, but its official name is Acute Flaccid Paralysis (AFP). Much of it ends up being labelled aseptic meningitis, Guillane Barre syndrome, and the various other illnesses listed a couple of pages ago, but AFP is the broad diagnostic term for the illness we used to call polio 104.

Fig 42. Doctors no longer permitted to diagnose polio after vaccine is introduced. All suspected cases to be referred to Poliomyelitis Surveillance Committee. (From From Med J of Aust; Nov 4, 1967)

In Australia 105 today, AFP is reported at a rate of around one per 100,000 children under 15. This is similar to rates in the U.K. and the Americas. Polio surveillance officials tell us this is a healthy sign, because it is expected to occur at this rate. Indeed, they tell us that if such a rate is being recorded, the illness is being faithfully reported to the surveillance system. If the rate falls below one per 100,000 we are told it is probably not being reported when found. This is referred to as the “sensitivity” of the surveillance.

104 Well, at least a part of it. Obviously AFP does not account for all the non-paralytic cases we used to call polio. 105 CDI Bulletin: Vol 20 No. 19; Sept 16, 1996 p403-405

Given the under-15 population of Australia (around 4 million), this rate equates to approximately 40 cases per year. However, as I said before, none of these are recorded as polio any more. A case can only be recorded as polio when:

All other cases are recorded as something else under the AFP umbrella.

The great eradication program The same method of eradicating polio from the developed countries is now being used in developing countries. We believe we are eradicating the illness through mass vaccination. However, a look at the evidence suggests it is being eradicated quite efficiently through re-definition. Naturally, developing countries established their laboratories later than the developed countries. Some are still doing so. The first success story was the Americas. It is claimed we eliminated polio there during a vaccination campaign, from 1986-1991. This victory is used as a gold standard for the rest of the developing world. However, a closer look reveals it was probably nothing more than moving the goalposts, again. When the program commenced, laboratories were set up 106, new methods of diagnosing the disease were established107, and doctors were re-briefed on how to distinguish true polio from all the other cases of AFP. Also, a new monitoring system was set up. Sound familiar? Subsequently, almost all cases were given a new diagnosis. We can read about it in the official report from the World Health Organisation 108. Here is an extract from the beginning of the report: In 1986, when aggressive surveillance activities for acute flaccid paralysis (AFP) were first implemented, 930 clinically confirmed poliomyelitis cases were reported in the Americas. By 1988, with improvements in laboratory technology and support, 32 of the 340 cases of AFP confirmed as poliomyelitis

106 “This increased attention to laboratory-based poliovirus surveillance was carried out through a network of eight laboratories in the hemisphere. The network became fully operational in 1989.” p225 in De Quadros et al. Eradication of poliomyelitis: progress in the Americas; Ped Inf Dis J: 10(3) 222-229 http://journals.lww.com/pidj/ Citation/1991/03000/Eradication_of_poliomyelitis__progress_in_the.11.aspx 107 “changes in the case definition for polio” was listed first in recommendations given on p223, Ibid 108 Andrus et al. Screen of cases of acute flaccid paralysis for poliomyelitis eradication: ways to improve specificity; Bulletin WHO: 70(5);591-596, 1992 http://whqlibdoc. who.int/bulletin/1992/Vol70-No5/bulletin_1992_70(5)_591-596.pdf

were determined to be associated with wild poliovirus isolation. Between January and October 1991, six109 poliomyelitis cases in the Region were found to be associated with wild poliovirus isolation. This tremendous decrease in the number of confirmed cases occurred despite a doubling in the number of reported cases of acute flaccid paralysis, from 1000 in 1985 to >2000 estimated by the end of 1991. What this means in simple terms is this: in the year we commenced the eradication campaign, 930 cases of paralytic disease were reported, and all were named polio. Five years later, at the end of the campaign, roughly 2000 cases of paralytic disease were reported—but only six of them were named polio. This has been celebrated as quite an achievement by those engaged in the pursuit of the polio virus. I do not know that it appeals as much to parents and other members of the public. Reports of paralytic illness doubled, but the definition of polio had changed so comprehensively that hardly any of it was called polio any more. The report went on to say: The challenge to eradicate the transmission of wild poliovirus from the Americas, and ultimately from the world, to a large extent depends on how well we can distinguish “true” poliomyelitis cases i.e., those caused by wild poliovirus from cases of AFP [acute flaccid paralysis] due to other causes... poliomyelitis has a wide range of clinical presentations that require skilled examiners and an extensive laboratory support system for diagnosis. Note the focus on the microbe? Remember, MICROBE = ILLNESS is the concept. It is central to standard medical thought (and now, procedure) on this issue. In the above passage, the writers are talking of eradicating the transmission of wild poliovirus. But by the time the story is reworded for press release, and finally reaches Mums and Dads, it has changed to the eradication of polio, the illness. I should explain the term “wild poliovirus”. Modern laboratories can now tell whether the virus found in a patient’s stool came from the polio vaccine, or instead was a naturally occurring (or wild) one. To be called true polio, the virus must now be a wild one. Yes, it is quite specific. In Oman, the eradication program commenced in 1990 110. A laboratory was set up to weed out the cases that had no polio virus, and the diagnosis was restricted

109 Prior to 1990 a case could be recorded without lab confirmation if it was linked to a ‘confirmed’ case, had residual paralysis after 60 days, died or was “lost to follow up”. In 1990 this was changed to lab-confirmed cases ONLY. p592 Ibid 110 Robertson et al. Poliomyelitis in Oman: acute flaccid paralysis surveillance leading to early detection and rapid response to a type 3 outbreak; Bulletin WHO: 72(6):907-914 1994 http://whqlibdoc.who.int/bulletin/1994/Vol72-No6/ bulletin_1994_72(6)_907-914.pdf

to under-15 year olds. Then came the final step—cases had to pass the scrutiny of “an expert committee composed of paediatricians, a paediatric neurologist, an epidemiologist, and a virologist”. In addition to the new rules, extra vaccination went on. The coverage of 1-year-olds with 5-doses reached 95%. The result of all this was that from January 1990 to April 1993, there were 49 cases of AFP reported in Oman, but only four of them were recorded as polio. Interestingly, all of these had been vaccinated. Two of them with four doses, one with five doses, and the other, six. The 49 cases above represent a rate of 2.1 per 100000 children under-15. This is approximately double that found in developed countries. The rate prior to the new rules was not measured. China provides an interesting example. It commenced an eradication program in 1991. A study published by WHO111 described the process as it occurred in Shandong Province. In 1991, a new campaign was launched aimed at vaccinating as many under-4-year-olds as possible. Along with this, an elaborate system for dealing with cases of AFP commenced, centred around collecting specimens and having them tested for polio virus. In 1990, only 13% of cases had laboratory specimens collected. This was increased to 50% in 1991, and then 84% in 1992. With this system, the number of confirmed cases of polio was reduced from 284 in 1990, to 25 in 1992. In reality, there were 130 cases of polio-like illness reported in 1992 but only 25 conformed to the rigorous new definition. About 20 years before this, health officials had convinced the Chinese to rename the bulk of their polio to Guillaine-Barre Syndrome. This appeared to go along without a hitch for some time, until a research team suggested giving it a separate name—Chinese Paralytic Syndrome112. This prompted an even closer look at the data, with a later study (in Hebei Province) finding that both the new disorder, and the Guillaine-Barre Syndrome, were really polio. The researchers came to their conclusion after looking at the trends in polio from 1955-1990. It was noted that, after mass vaccination started in 1971, reports of polio went down but Guillaine-Barre Syndrome increased about ten-fold 113. Again, polio was still there but wearing a different name tag.

111 Yasuo Chiba et al. Poliomyelitis surveillance in Shandong province, China 1990-92; Bulletin WHO: 72(6):915-920 1994 http://whqlibdoc.who.int/bulletin/1994/Vol72No6/bulletin_1994_72(6)_915-920.pdf 112 McKhann et al. Clinical and electrophysiological aspects of acute paralytic disease of children and young adults in northern China; The Lancet: Vol 338; Sept 7, 1991 p593-597 http://www.thelancet.com/journals/lancet/article/PII01406736%2891%2990606-P/abstract 113 Shen et al. What causes Chinese paralytic syndrome?; The Lancet: Vol 344; Oct 8, 1994 p1026 http://www.thelancet.com/journals/lancet/article/PIIS01406736(94)91688-8/fulltext

Global – Polio and Accute and Flaccid Paralysis (AFP)

© 2011 Greg Beattie. Sources: WHO for Polio and AFP data. US Census Bureau for population data.

Fig 43. Polio and AFP notifications, Global 1980—2009

Global Polio Laboratory Network Laboratories are gradually being set up all over the world. The process of redefining the illness known as polio is nearly complete. Countries that are slow to establish their laboratory facilities are urged to start the process by restricting their polio diagnoses to children under ten years old, with initial paralysis in the lower limbs only, and lasting for at least 60 days 114. The eradication phase however does not commence until the laboratories are in place, and the other redefinition steps are established. The specialised polio laboratories must comply with rigorous certification measures. Procedures, equipment standards, and training of personnel are all governed by the WHO. The Global Polio Laboratory Network was established in 1990. Five years later, there were 81 accredited laboratories in the network115. Now, there are 145.

114 Biellik et al. Poliomyelitis case confirmation: characteristics for use by national eradication programmes; Bull WHO: 70(1); 79-84 1992 http://whqlibdoc.who.int/ bulletin/1992/Vol70-No1/bulletin_1992_70(1)_79-84.pdf 115 The Polio Lab Network Qtrly Update; Vol 1 No 1 1995, World Health Organisation http://www.who.int/immunization_monitoring/laboratory_polio_resources/en/index.html

Data for the graph in Figure 43 was obtained from WHO and the US Census Bureau116. Here we see worldwide figures illustrating the decrease in polio reports alongside an increase in AFP reports since 1996. Many critics of vaccination point to the pitfalls of using notification statistics when assessing trends in illness, and I am certainly one of these. For a reminder of those pitfalls, please read Chapter Four. Still, those who promote vaccines generally have a small collection of notification graphs to parade in support of their case. The graph in figure 43 is not one of these. Indeed supporters have a version which does not include the solid line on the right hand half of the plot area. This line represents the rise of a new set of data. The cases are labelled AFP, rather than polio. It commenced in the beginning of the 1990s worldwide, and is now considered reasonably mature, meaning that experts feel it is representative of the occurrence of actual illness. Remember, AFP is the illness we used to call polio. The dotted line starts out representing the illness we used to call polio, but as time moves on the definition of polio changes. Eventually, the line only represents the new polio, which must be laboratory-confirmed and scrutinised by expert committees. The solid line illustrates that the illness we used to call polio is still there, just as it was in 1980 before this all started. To be consistent, we must acknowledge notification data cannot prove that the vaccine was of no practical use. What we can be sure of, however, is that we fiddled with the definition in such a monumental way that we could quite reasonably expect to see polio numbers decrease, with or without a useful vaccine. I am also not suggesting there was a conspiracy to defraud. However, I do believe that the level of fiddling that occurred here speaks volumes about the underlying “science” involved. Only a cultural trance would permit us to barge through our normal scientific standards, and be content with such poor data quality. What type of plumbers are we when we leave the pipe leaking, but throw a party for the hole we covered? Polio, as it is generally known, is not being eradicated. And yet, many generous people have given their time and money to this cause in an effort to prevent paralysis, and help children enjoy better health prospects. It would be a terrible shame if these efforts were wasted because they were directed to activities that were ineffectual. I say “terrible shame” because, not only would that waste time and money, but it would displace our focus. Rather than acting on a real and

116 Reported polio http://apps.who.int/immunization_monitoring/en/globalsummary/ timeseries/tsincidencedip.htm Reported AFP http://apps.who.int/immunization_ monitoring/en/diseases/poliomyelitis/case_count.cfm Population data http://www. census.gov/ipc/www/idb/informationGateway.php

ongoing problem of paralysis, we waste our resources in pursuit of a (possibly benign) microbe. The true issue for parents remains: has real illness (the illness we used to call polio) been reduced by vaccination? The only routinely collected data we have suggests it has not.

A unique opportunity AFP and polio in developing countries has provided us with a unique opportunity to view this phenomenon. It is not the systematic redefinition of polio which is unique. After all, measles, whooping cough, and other illnesses have undergone comprehensive changes in definition as well. The unique aspect with polio is that we unwittingly recorded the change, by counting AFP cases. This enabled us to compare the rate of acute paralytic illness after mass vaccination (AFP) with the rate before it (polio). I am grateful to the architects of the new surveillance system for polio, because they actually built into it a means by which we can now, retrospectively, estimate the influence of the changes in definition. By recording cases of illness which broadly fit the diagnostic guidelines of the pre-eradication era, they have enabled us to measure this influence.

Polio in India We will briefly look at India: the second largest country in the world, and also the area currently having the hardest time with polio. We will start with a graph (Figure 44) showing trends in India alone, for reported cases of AFP and polio. We shall then review some comments from doctors and researchers in India. I will start by quoting an article 117 written by the Vice Chairman of the Indian Medical Association’s Sub-Committee on Immunisation. The article appeared in India’s national newspaper, The Hindu. It starts with: It is now being acknowledged that the National Polio Eradication Programme did not work according to plan. The failure of this magic bullet approach (repeated doses of oral polio vaccine) to solve what is essentially a water and sanitation problem was predictable. Yet, that did not mitigate the sadness its failure caused among many of us who have worked tirelessly to make it succeed. The Indian Medical Association (IMA) Sub-Committee on Immunisation debated on whether to go public with its findings about the failure of this initiative. In August 2006, it concluded that it was its duty to do so.

117 The Hindu, Sunday, Nov 19, 2006 http://www.hinduonnet.com/thehindu/ mag/2006/11/19/stories/2006111900100400.htm

India – Polio and Accute and Flaccid Paralysis (AFP)

© 2011 Greg Beattie. Sources: WHO for Polio and AFP data. US Census Bureau for population data.

Figure 44. Polio and AFP notifications, India 1980—2009

One of the issues raised in the article was: [The IMA Sub-Committee]... was alarmed by the number of vaccine induced polio cases (1,600 last year) that repeated doses of OPV were producing. More alarming were the 27,000 cases of polio-like paralysis in children in whom the polio virus was not cultured in the stools. The government was not willing to even enquire how many were left with residual paralysis in this group. There was also clear evidence that many who were already vaccinated, were getting polio paralysis, suggesting the vaccine was not efficacious. In the face of a bureaucracy that would not even acknowledge the problem, the IMA Sub-Committee was left with the unpleasant task of exposing this farce. Shortly after this, the Indian Journal of Medical Research published an editorial118 from this author, along with two other paediatricians. In it, they discuss several issues that have frustrated doctors in India regarding the polio eradication initiative, including the advice from the WHO regarding the level of polio at the outset:

118 Puliyel J et al. Indian J Med Res, January 2007, pp 1-4 http://www.icmr.nic.in/ ijmr/2007/january/editorial1.pdf

In India many who have received 10 doses of OPV have contracted poliomyelitis raising doubts about the efficacy of vaccine in some populations. Enteric infections, poor nutrition and poor sanitation are being blamed. This belated acknowledgement that public health problems cannot be solved by magic bullets alone (repeated doses of OPV) may be one of the gains from this misadventure. ...In the 1988 World Health Assembly, urged by the WHO, 160 member states committed themselves to eradicate polio by the year 2000. Polio eradication was not a public health priority for developing countries. In India polio cases had come down from 24,257 in 1988 to 4793 cases in 1994 with the help of routine immunization, well before the eradication programme started in India. In those days all cases of acute flaccid paralysis (AFP) with residual paralysis beyond 60 days were diagnosed as polio. ...WHO claims five million children have been saved from polio paralysis. It is instructive to see how this figure is arrived at. In 1988, there were 32,419 cases of paralytic poliomyelitis. The WHO arbitrarily raised this number ten-fold to 350,000 claiming incomplete reporting. In 2004 with the changed definition, only culture positive paralysis was considered polio and there were 2000 such cases. Subtracting 2000 from 350,000, the WHO calculated that 348,000 children were saved from paralysis that year. From this, we can gauge the frustration that (at least some) Indian doctors are feeling, regarding the initiative to eradicate polio. It has sparked much heated debate in the medical literature. One more point the authors made, was in relation to funding: The Pulse Plus programme began in India with a US$20 million grant. The polio eradication programme started in 1995. Soon afterwards, donor fatigue set in. The government was left to borrow US$180 million from World Bank for the programme. This pattern is the norm with international funding. To sum up, we see that polio was redefined in the developed world during the latter half of the 1900s. In the developing countries, the process is still occurring, but almost complete. It appears this redefinition may have been the major contributor to the huge drop in polio numbers, over the past 50 years. I use the term major because it also appears to me there was, in reality, more paralytic illness occurring during the period immediately following World War II, than there is now. This brings us to the third point.

Provocation Polio can be provoked by other injections. Provocation paralysis has been documented in the medical literature for more than 100 years. An editorial119 in “The Lancet” in 1992 discussed it as follows: At the beginning of this century Hochhaus noted that the affected limb at onset of paralytic poliomyelitis had commonly been the site of an injection. Sporadic reports of the phenomenon then appeared up to the 1940s.... The introduction of widespread vaccination with diphtheria and pertussis vaccines in the 1940s led to an outbreak of reports. The editorial reported on an investigation by the UK Medical Research Council, during the 1940s and 1950s. It estimated 13% of the polio back then was caused by diphtheria and whooping cough vaccine injections. It then confirmed that data from an outbreak in Oman revealed an estimate indicating that 15% of their cases had been caused by DPT injections. It suggested both were likely to be under-estimates, and concluded: …the public health message is unchanged: avoid unnecessary injections. When polio appeared again in Oman, two years later, health officials reacted by declaring a 60-day moratorium on all elective surgery, unnecessary injections and vaccinations120.

Wait... there’s more Injections of vaccines are not the only activities capable of provoking polio. Antibiotics used to be injected frequently and, for a time, a shot of penicillin was routine whenever a child had an infectious condition of practically any description. Have you ever wondered why we routinely take tablets now, instead of injecting antibiotics? A study in Romania121 revealed the sometimes devastating result of routinely injecting antibiotics. It concluded that the rate of paralytic polio could be reduced from 10.3 per year to 1.4 if they avoided injecting antibiotics into children who had recently been vaccinated for polio. All cases of polio reported from 1984-92

119 Provocation paralysis. The Lancet, 1992; 340 (8826) pp 1005-1006 120 Robertson et al. Poliomyelitis in Oman: acute flaccid paralysis surveillance leading to early detection and rapid response to a type 3 outbreak; Bulletin WHO: 72(6):907-914 1994 http://whqlibdoc.who.int/bulletin/1994/Vol72-No6/ bulletin_1994_72(6)_907-914.pdf 121 Strebel et al. INTRAMUSCULAR INJECTIONS WITHIN 30 DAYS OF IMMUNIZATION WITH ORAL POLIOVIRUS VACCINE — A RISK FACTOR FOR VACCINE-ASSOCIATED PARALYTIC POLIOMYELITIS; NEJM: Feb 23, 1995 p500 http://www.nejm.org/doi/pdf/10.1056/NEJM199502233320804

were evaluated and it was found that only 13 were naturally acquired, whereas 93 were caused by this problem122. An earlier study in India concluded123: In India, where poliovirus infection is still widespread, our findings suggest that three-quarters of cases of paralytic poliomyelitis in the past decade were caused or made more severe by unnecessary injections. Let us campaign to banish all unnecessary injections. A report 124 of an outbreak of 108 cases of polio in Yemen, in 2005, found that in 90% of victims the paralysis was precipitated by an injection in the buttock. It was mentioned that malaria was common in the area. So too were injections in the buttock of Fansidar, an anti-malarial drug. Retired Principal Research Scientist Dr Viera Scheibner concluded in 2009 after exhaustively studying the epidemiology of polio125: Not only has mass polio vaccination not eradicated paralytic poliomyelitis, it has caused a number of outbreaks of paralysis directly linked to the administered vaccines.

And more There is even more to provocation. Another medical procedure we rarely see any more—tonsillectomy. At a forum held in Parliament House Sydney in 1997, Dr Mark Donohue126 had the following to say127: Do you ever wonder why the medical profession drops a procedure? Certainly, not because they have paid their cars off. There was a problem in that we were removing tonsils from people throughout the 40s and 50s. They were taken to be extra tissue not needed by humans, but only a source of trouble. Then, during the polio epidemics

122 Samuel Sepkowitz. Letter, NEJM: Jul 6, 1995 p64 http://www.nejm.org/doi/ pdf/10.1056/NEJM199507063330115 123 Wyatt et al. Provocation Paralysis; The Lancet: Vol 341; Jan 2, 1993 p61 124 Community Health and Disease Surveillance Newsletter, Vol 14 Iss 1, Jan-Mar 2005, Ministry of Health, Sultanate of Oman 125 Scheibner V. Little known facts about poliomyelitis vaccination; Nexus Magazine Aug-Sept 2009 Vol 16, No.5 & Oct-Nov 2009 Vol 16, No 6 http:// www.nexusmagazine.com/index.php?page=shop.product_details&category_ id=196&flypage=shop.flypage&product_id=1826&option=com_ virtuemart&Itemid=44 126 http://homepage.mac.com/doctormark/Medical/ 127 Dr Mark Donohue, speaking at Parliament House, Sydney - “In the Best Interests of the Child”, April 7, 1997

it was found that people who had their tonsils removed were three to five times more likely to develop paralysis. That does not mean that they get the polio virus more frequently, simply that without the protection of the lymphatic tissue in the throat there appeared to be a quite strong association between getting the polio virus and developing an illness. There were many at that time that suggested that paralytic polio was an iatrogenic [doctor made] disease. The medical profession dropped tonsillectomy as if it was a hot potato, but I don’t know that it told many about that. Certainly, it did not tell me, in my medical school, why tonsillectomies were becoming so much less popular. I had mine removed; virtually everybody in my community did. It is one of those forgotten truths in Australian medicine, and world-wide medicine, that we removed tonsils at our own risk. We thought there was no problem. The iatrogenic part of it was that we caused thousands of cases of paralysis. We did not cause the polio, but we converted people who would have recovered from a viral illness into people with a paralytic illness. To this day I don’t think the medical profession has owned up to that problem that it caused in the Australian health community. One aspect Donohue did not mention was that the paralysis associated with tonsillectomy was the worst—known as bulbar, involving the lungs. Remember all those photos of children lined up in iron lungs? We now know how at least some of them got there. The association between trauma, or injection site, and paralysed muscles, was well documented, as evidenced in this editorial from 1995 128:

Figure 45. A relationship between tonsillectomy and Bulbar (involving the lungs) polio. (From Med J of Aust; Oct 4, 1952 p482)

128 Wright P and Karzon D. Minimising the risks associated with the prevention of poliomyelitis; New Eng J Med, Feb 23, 1995 529-530

Invasive procedures occurring during the poliomyelitis epidemic season were shown to increase the risk that paralytic poliomyelitis would affect muscles in the area of the trauma. For example, tonsillectomy and adenoidectomy increased the risk that poliomyelitis would be bulbar, and intramuscular injection increased the risk of paralysis in the injected limb. Polio has a truly bizarre history. Its redefinitions make comparisons of numbers, before and after the vaccine, utterly meaningless. The horrific iatrogenic aspect that has been acknowledged, but rarely discussed, places it as a contender for one of the greatest medical blunders of modern times. In addition, possibly no disease strikes more fear into the hearts of parents than polio. We are convinced there is nothing we can do to protect our children, except to vaccinate them. Our entire focus is now on a virus, however we have forgotten that this virus was once considered ubiquitous, and virtually benign.

Chapter EIGHT

CONCLUSION Men occasionally stumble over the truth, but most of them pick themselves up and hurry off as if nothing had happened. Winston Churchill In this book we conducted a comprehensive review of data in an attempt to assess the benefit from vaccines that have been in long term use in Australia. In the first three chapters we discovered that our foundational belief in vaccines was unsupported, and that the most robust data we have (mortality) illustrates they have contributed little, and perhaps nothing, to improvements in the illnesses they were designed to combat. We found our entire perception had been based on a flawed belief that vaccines saved us from the scourges of our past. We found that there was another set of data (notifications) which seemed to show vaccines in a more positive light. In Chapter Four we investigated this data, and discussed its use. In doing so, we uncovered some disturbing breaches of basic scientific standards. Apart from being haphazardly collected, and subjected to bias and other arbitrary influences, this data-set was pre-disposed to favour vaccines, and therefore unsuitable for assessing them. Yet this has been the predominant set used to market the vaccination program to parents. In Chapter Five and beyond we reconsidered the paradigm in which the belief flourishes, and found some key areas that did not add up. We discovered that the underlying concept behind it all (which I termed MICROBE = ILLNESS) suffered significantly under scrutiny. We also learned that when we stepped outside the paradigm to re-assess the claims of benefit, they became illusory. This was presumably an uncomfortable book for many readers. Among other things, it involved the destruction of a cherished belief. Given that this belief has been almost universally trusted, and with us all our lives, its loss will likely result in a degree of pain. The easiest way to overcome this, of course, is to walk away. Pick yourself up and hurry off, as Winston Churchill suggests in the quote above. I know that many will refuse to read past, or even into, the opening chapter, simply because it is not in accord with the consensus.

What is consensus science? When a group comes to agreement on something, the result is organised opinion. If the group is large enough or represents an institution, its organised opinions sometimes become institutionalised. When the institution involved refers to itself as “science”, its organised, institutionalised opinions can appear to be nothing short of gospel. This is consensus science, and when it speaks we listen. It tells us vaccines are the miracle of modern medicine; that they delivered us from the high death rates of more than a century ago to the low rates of today. It tells us that, like magic bullets, they came and saved us. Meanwhile the evidence, showing something quite different, sits by in silence. How long will it take before this flawed and deeply institutionalised belief is no longer taught? When will figureheads of science stand up and say this did not happen? Going a little further, when will they stand up and say: According to the most dependable data we have, we could stop vaccinating tomorrow, and the death rates would most likely not be affected. The day must surely come. When consensus science espouses views which are fundamentally flawed, and visibly unbelievable, it clearly no longer has a valid relationship with “science”. Vaccination is unlikely to stop tomorrow, even if a reasonable proportion of the community begins to feel that its value is dubious, or its risks unacceptable. There are many reputations at stake. Not just careers, but entire professions are built around researching, developing, manufacturing, distributing, administering, and marketing vaccines. But it is not just those who work in the industry. Our collective reputation is at stake. We have been telling ourselves that vaccination is safe and effective for so long now, and in such an institutionalised way, that it is a runaway train, and virtually unstoppable. We should have been more vigilant, but we weren’t.

In closing, these are some of my thoughts: Media Media reports such as “Measles deaths plunge in Africa...” (Chapter Two) are difficult to change, once they are published worldwide. All we can do is spread awareness that the situation in the publishing world is currently ripe for this. From what I can gather, it seems financial constraints have placed severe restrictions on investigative journalism in mainstream media. The press release has been king for some time now. I guess a press release from WHO, UNICEF, and certain other large authoritative bodies, is like a message from God. It is a great time to check what we read. Wherever possible, tell others how these stories have come about.

Data It is clear we need to demand objective measurements of real-world outcomes, if we are to assess the real impact of our interventions. In our enthusiasm to show vaccines in a positive light, we have violated fundamental principles of science, by:

Perhaps we cannot eliminate vaccine-bias in clinical diagnosis; at least, not while our faith in vaccines is sufficient to justify their use. Here, a less-specific measure of illness prevalence might be useful. This would allow us to monitor all alternative diagnoses for a syndrome in one place. For example, a decrease in whooping cough reports may be artefactual if not also present in a less specific indicator, such as its parent, acute respiratory illness129.

Concepts We understand that data is only as useful as the concepts that define its validity. In this case, the key concept is MICROBE = ILLNESS. After reading Chapter Five and beyond, we must question whether this concept itself is valid. Should we group diseases according to microbes, prior to measuring their prevalence? Of what practical use might that be? In Chapter Six, we saw an example of how doing so appears to obscure the real picture of illness.

Harm Clearly, we need to be open and honest about negative outcomes from vaccination. We need to not only allow unbridled research and reporting of these; we need to facilitate each. A community that ferociously pursues the likes of Dr Andrew Wakefield130, after his suggestion that further research needs to be conducted into a vaccine-autism link, is clearly a fearful community. Criticism should be the life-blood of science. We must ensure that research which simply

129 For example, if we devise a new intervention for whooping cough, and it decreases by 100 the following month, we expect “acute respiratory illness” to have dropped by 100. If not, the cases may still be occurring but wearing a different name tag, such as ‘bronchitis’. 130 Andrew Wakefield is the British researcher who was persecuted for alleged scientific misconduct after he co-authored (with 12 others) a small research paper published in the Lancet, in which it was suggested that the possibility of a vaccine-autism link warranted further investigation. The story from his side is quite different to the one you’ve heard. His supporters are many and cover all echelons of the scientific community. http://www.callous-disregard.com/

suggests we may need to be concerned, is not stifled because of our unfounded fear of returning to the days of measles-ridden corpses. As long as we hold on to the belief that vaccines were our saviours, we will be reluctant to embrace concerns that they may result in serious harm. Only when we relinquish this belief will there be more openness, and a willingness to face uncomfortable suggestions. When this happens we will find fewer rushing to silence those who express concern about injecting poison into healthy babies131.

Doctors Readers may want to blame doctors for some of the issues raised in this book. I think this is a mistake. Many health professionals will appreciate the logic in these pages. Indeed many are already aware of the situation. Others may resist. This is understandable. After all, we have fed each other for so long with consensus science. In some ways, I believe doctors have been severely let down by the system. We asked them to dispense vaccines, en masse. We also asked them to market the scheme for us. We fed them with reports of the achievements along the way (using slanted data) and urged them to continue, for over 50 years. Then, when there was a bad news story about vaccines, it was doctors who ended up in the hot seat. They were left to face unhappy and unwilling parents on one side, while on the other side, if they failed to market the vaccines effectively, they were threatened with punitive measures. Of course, doctors are likely to follow consensus science willingly, anyway. Why wouldn’t they? Like the rest of us, they have no reason to believe anything is wrong, and the data they receive looks good. In 1955, a letter from a New York doctor was published in the Journal of the American Medical Association. He described the “hoopla” with which the polio vaccine had been introduced noting that so many, including the President, wanted to jump on the bandwagon for a slice of the credit. However, things did not go well with the vaccine and, for a few years prior to rewriting the rules for diagnosing polio, reports of the illness actually increased. He claimed doctors were left holding the baby132: During all this hoopla the physicians of this country were placed in an unenviable position. By direction or innuendo every physician was conceived as a blackguard, a potential black marketeer, and a vulture waiting anxiously to prey on unsuspecting children. Everyone is entitled to his opinion, but this is a flagrant abuse of the medical profession, and

131 Please see Appendix – What’s in a shot? 132 Brescia M. Poliomyelitis vaccine; JAMA 1955: 158(7) June 18, p585

to compound this grievance not a responsible medical official or medical journal came to the defense of the physician. So-called organised medicine as embodied by the American Medical Association and for us in New York the state society were most negligent in their duty to the medical profession and specifically to their members.

What will happen if more people stop vaccinating? This is a question I am often asked. And my answer is... who knows? But after looking at all the information that has led me to write this book, I will take a stab. There are two parts to the question: 1. What will happen socially: that is, in relation to reactions, fear and politics? 2. What will happen in real terms: that is, mortality and morbidity? I will answer the second part first. Let me start by saying I do not think there is any chance of us abandoning vaccines in the near future (wholesale, communitywide). But if we did, I feel there would be little change for the public. The evidence indicates there is probably not going to be an increase in deaths, which likely means there will be no increase in morbidity. We will probably see a juggling of diagnoses. As examples, we may start seeing more polio and less Guillane Barre Syndrome (among others), more measles and less roseola infantum (among others); more whooping cough and... I’m sure you get the picture. From the available evidence, I believe there is little reason to expect an increase in death, or suffering. Remember, other illnesses declined to low levels without vaccines. In addition, if hypotheses suggesting that vaccines may lead to widespread brain injury and developmental problems (as well as many other conditions) are valid, then stopping them tomorrow could have a pronounced effect for the better. Now, to the first part of the question. What might we expect socially if more people turn away from vaccination? For example, what if vaccination rates decline to, say 50%? Socially, I think we would have a substantial problem. As mentioned many times, our deep-rooted belief in vaccines is almost universal. Many in the upper echelons of government and health bureaucracy are also intimately involved with maintaining this status quo. But there is more at stake. As mentioned earlier, we have careers, and even entire professional disciplines constructed around the research, development, and use of vaccines. For many, a drop in rates would sound a warning bell. There would undoubtedly be grim predictions of a public health calamity. As suggested in Chapter One, an image of measles-ridden corpses is probably not all that far removed from the truth, for some. We certainly need to be prepared for this social fallout if vaccine acceptance declines. We saw in Chapter Four and beyond how pliable the data can be. We have witnessed the wide variance in disease reporting rates, and the inherent,

almost inescapable vaccine-bias in diagnoses. If there is a segment of the community that believes we are headed for calamity, and that segment is collecting the data, and running the show, we can expect their grim predictions to materialise in their figures. This appears to have occurred in England, during the 1970s133, when disquiet over whooping cough vaccine led to a significant drop in the number of parents taking their children for the shot. The fallout: a cry from the health bureaucracy, accompanied by predictions of epidemics. The epidemics eventuated, but apparently on paper only. They did not appear in death rates or hospitalisation rates; only notifications. Still, that was sufficient to bring parents back around to accepting the shot. If we prepare ourselves for this by collecting data which is more valid, we will be able to demonstrate, with more integrity, the real effect of the change.

What do we do with this information? My response to the information in this book has been to put pen to paper. In doing this, I am following in the footsteps of many, without whose work I would not have stumbled upon it myself. However, I learned many years ago that a handful of people armed with facts and logic are no match for widespread dogma. At least, not before more join their ranks. When the number of people demanding change reaches a critical threshold, we can expect it. So, in closing, probably the most important question of all is... What will you do with this information?

133 This event is discussed in Chapter Five of “Vaccination – a Parent’s Dilemma” http://vaccinationdilemma.com

Appendix I

SMALLPOX Although smallpox is perhaps the poster illness of vaccination, it has not been featured in this book. This observation was raised by a friend who gave me feedback on the manuscript. I do not pretend to do the subject justice in this Appendix, but merely point out that there are well-researched pieces on smallpox vaccine bearing the same arguments raised in this book. I will mention two of them shortly. Before I do, I would like to draw your attention to a graph plotted by Roman Bystrianyk 134 (Figure 46 ) showing death rates for smallpox and scarlet fever in England and Wales, for the period 1838-1922. Here we can see the decline in smallpox, along with a similar trend for scarlet fever. Vaccination for smallpox was introduced in 1798 and made compulsory in 1853. Following this, the laws were altered in 1867 to provide for penal enforcement. Throughout this period the death-rate for scarlet fever followed the same trend as smallpox, although it had no vaccine. As with the other illnesses examined in Chapter Three, it begs the question... why would we credit a vaccine for the decline in one illness, when the same decline occurred in other illnesses without a vaccine? The largest outbreak of smallpox in England’s recorded history was the epidemic of 1871-72, which claimed more than 40,000 lives. According to Sir John Simon, Chief Medical Officer to the Privy Council, this occurred at a time when 97.5% of the people over two years of age and under 50 had been vaccinated or had smallpox before.

Two great works The value of smallpox vaccine has been examined by many authors. The first I will mention was written by one of the most important scientists of the past two centuries. “Vaccination: a delusion”, by Alfred Russel Wallace, is available in its entirety on-line135. I urge you to read it if you are interested in the question of whether vaccination was responsible for the decline in smallpox. Wallace

134 Other graphs from Mr Bystrianyk can be found at http://healthsentinel.com 135 Wallace AR. Vaccination, a delusion: its penal enforcement a crime; 1898 http:// www.whale.to/vaccine/wallace/comp.html

gives an easy to follow, but comprehensive, account of the impact of smallpox vaccination during the 1800s: ...all the statistics of small-pox mortality, whether of London; of England, Scotland, and Ireland; of the best vaccinated Continental States; of unvaccinated Leicester; or of the revaccinated Army and Navy, without any exception, prove the absolute inutility of Vaccination; and I feel confident that every unprejudiced person who will carefully read these few pages, and will verify such of my statements as seem to them most incredible, will be compelled to come to the same conclusion. Wallace was co-founder of the theory of evolution136 with Charles Darwin, and is described as “...a towering figure in the transition from old-fashioned natural history to modern biology”. Figure 47 is a copy of a graph hand-plotted by Wallace, showing death rates in London for the period 1760-1896. Smallpox (the lower, shaded area) is compared with all zymotic illnesses (middle line) including measles, fevers, whooping cough and diphtheria, as well as deaths from all causes (upper line). There is a “break” in data toward the end of the 1830s. This reflects the change in data source. The earlier figures are from the old Bills of Mortality (considered less accurate). The General Register was established in 1836. The vaccine was introduced in 1798 and slowly gained acceptance over the first 40 years of the century, after which the British government provided it free of charge. The graph (explained more completely in the book) shows that the trends in the three separate lines were the same. All death rates rose and fell together, even though smallpox was the only one with a vaccine. Another enlightening book of the time was Leicester: sanitation versus vaccination 137 by J.T Biggs, also available on-line. Biggs was a member of the Leicester Sanitary Committee for 23 years. He was also an Alderman and a Magistrate. His book is very comprehensively researched and includes the pre-Jenner history of vaccination.

136 Quammen D. The man who wasn’t Charles Darwin; National Geographic, Dec 2008 http://ngm.nationalgeographic.com/2008/12/wallace/quammen-text 137 Biggs JT. Leicester: sanitation versus vaccination (1912) http://www.whale.to/a/ biggs.html

England/Wales, Smallpox Mortality Rates

© Roman Bystrianyk, healthsentinel.com References: Record of mortality in England and Wales for 95 years as provided by the Office of National Statistics – Published 1997; Report to The Honourable Sir George Cornewall Lewis, Bart, MP, Her Majesty’s Principal Secretary of State for the Home Department, June 30, 1860, p. a4, 205; Written answer by Lord E. Percy to Parlimentary question addressed by Mr. March, M.P., to the Minister to Health on July 16th, 1923; Essay on Vaccination by Dr. Charles T. Pearce, M.D member of the Royal College of Surgeons of England

Figure 46. Smallpox mortality rates, England and Wales 1838-1922

Fig 47. London mortality rates 1760—1896

Appendix II

WHAT’S IN A SHOT? (The good, the bad, and the downright ugly) I did promise that this book would not focus on harm, but browsing the contents of a vaccine is certainly a worthwhile exercise. Let’s have a look at INFANRIX HEXA138. This is a combined shot for diphtheria, tetanus, pertussis (DTPa), hepatitis B, polio and Hib. What’s in the mix? We have the toxic excretions of some of the bacteria, plus other pieces of cellular debris there for starters, along with several viruses. Most are treated with formaldehyde139 and glutaraldehyde140, both of which are chemicals also used in the embalming process (and regarded as probable carcinogens). In the mix they are chemically attached to aluminium salts known as adjuvants141 (also known as neurotoxins).

138 INFANRIX HEXA is a product of GlaxoSmithKline http://www.gsk.com.au/ resources.ashx/vaccineproductschilddatadownloads/261/File/3964545FED7E67DD 37D2316DF4E28D00/Infanrix_Hexa_(Preservative_containing)_CMI.pdf 139 Formaldehyde is used to embalm corpses http://www.ehow.com/how_2074674_ embalm-body.html Our normal exposure to it is via the skin, eyes, lungs and gut. Via these routes it is considered a potent sensitiser and probable human carcinogen http://www.atsdr.cdc.gov/mhmi/mmg111.html 140 Similar to formaldehyde. Also used in embalming, athough less. Again, not intended to be injected into living humans. Via the usual exposure routes however... “As a strong disinfectant, glutaraldehyde is toxic and can cause severe eye, nose, throat and lung irritation, along with headaches, drowsiness and dizziness. It is a main source of occupational asthma among health care providers” - http:// en.wikipedia.org/wiki/Glutaraldehyde 141 Aluminium hydroxide and aluminium phosphate are popular ‘adjuvants’ found in this vaccine. Adjuvants are necessarily toxic as their purpose is to agitate the body’s defense system into action. Without adjuvants vaccines would not have an effect. They are known in scientific circles as vaccine’s ‘dirty little secrets’.

The final brew includes the following extras: 142

143 144 145 146 147 148

142 The sugar found in milk, meant to be converted to simple sugars in the small intestine before being absorbed (injecting it results in its excretion, unchanged) 143 Adjuvant. Implicated in a host of disorders including motor deficit, alzheimers and seizure. http://www.associatedcontent.com/article/887707/aluminum_ hydroxide_in_vaccines.html?cat=5 http://www.ncbi.nlm.nih.gov/pmc/articles/ PMC2819810/?tool=pubmed 144 Adjuvant. Similar to above. http://www.novaccine.com/vaccine-ingredients/results. asp?sc=44 145 Preservative also known as glycol ether. “According to Journal of Industrial Hygiene and Toxicology, phenoxyethanol affected brain and nervous system in animals at moderate doses. In 1990 Journal of the American College of Toxicology reported that phenoxyethanol also acts as an endocrine disruptor that also caused damage to bladder and acute pulmonary edema in animals. Early 1980s studies also suggest that phenoxyethanol can cause DNA mutations - again, only in animals. Phenoxyethanol is a scientifically proven irritant to human skin and eyes (Comparison of objective and sensory skin irritations of several cosmetic preservatives. Lee E, An S, Choi D, Moon S, Chang I. Contact Dermatitis. 2007 Mar;56(3):131-6.) and it is classified as irritant in European Union. Phenoxyethanol is also restricted for use in Japan.” http://thegreenbeautyguide. com/?p=111 http://www.inspiredliving.com/organic/a~chemicaldetection.htm 146 As stabiliser containing amino acids, mineral salts, vitamins and other substances. The tissue culture medium. 147 Used for lethal injection in execution http://www.howstuffworks.com/lethalinjection4.htm 148 Emulsifiers - low to moderate toxicity http://www.associatedcontent.com/ article/906301/toxic_chemicals_in_vaccines_polysorbate.html?cat=70

149 150

151

(another antibiotic)

The problem: we must work out whether to have this injected into our babies. Not once, but three times in the first six months of their life. Remember also— this is only one of the shots. There are others for them at several stages during their early development (including one at birth). I am going to be blunt here. I look at the decision of whether to inject this into babies, in the following way: 1. If there is no benefit to be gained, it is an act of gross stupidity 2. If there is minimal benefit, the stupidity is reduced, minimally 3. If there is great benefit, it may be a good idea When we use force, such as laws, coercion, financial incentive, and social pressure, to encourage parents to have their babies vaccinated, we run into problems. Parents who feel that the benefit has not been established to start with, are faced with the implications of aligning themselves with options 1 or 2, on the list above. Only those who are fully convinced of the benefit fall into option 3. Even then, they have to decide whether that benefit really does outweigh the prospect of harm.

149 One of the first amino acids to be isolated. “...the major inhibitory neurotransmitter in the brainstem and spinal cord, where it participates in a variety of motor and sensory functions”. “It is likely that the wealth of new information on GABA and glycine will result in an even better understanding of their potential role(s) in various neuropsychiatric disorders and in the discovery of even more effective therapeutic agents.” http://www.acnp.org/g4/gn401000008/default.htm 150 MSDS says “Slightly hazardous in case of skin contact, ... eye contact, ... ingestion, ... inhalation....Expected to be a low ingestion hazard for usual industrial handling.” http://www.sciencelab.com/msds.php?msdsId=9925025 151 “WARNING - WHEN THIS DRUG IS GIVEN INTRAMUSCULARLY AND/ OR INTRATHECALLY, IT SHOULD BE GIVEN ONLY TO HOSPITALIZED PATIENTS, SO AS TO PROVIDE CONSTANT SUPERVISION BY A PHYSICIAN... Intramuscular: Not recommended routinely because of severe pain at injection sites, particularly in infants and children.” http://www.rxlist.com/ polymyxin_b-drug.htm

Who will test this for safety? Many would not be aware of this but Australian Principal Research Scientist (now retired) Viera Scheibner Ph.D. has had an open challenge152 to vaccine supporters to demonstrate the safety of the baby vaccines schedule, by agreeing to take it themselves, in dosage adjusted to their body weight. The challenge was published in the Medical Observer more than ten years ago. To date, no-one has taken it up. I have recently implored vaccine supporters to do so through forum discussions, on the Australian Vaccination Network website. I have even offered to take the microbes that the vaccines protect us from, in an effort to encourage them to participate153, but still no takers.

152 http://www.vierascheibner.org/index.php?view=article&catid=44%3Avieraretort&id=57%3Avaccination-challenge&option=com_content&Itemid=59 153 I was not the only one willing to take the microbes. Follow the discussion here http:// avn.org.au/nocompulsoryvaccination/?p=916&cpage=2#comment-4644

About the author Greg Beattie lives in South-East Queensland. He has seven children and three grandchildren, and is a self-employed businessman. In 1996 he participated in a two-day Human Rights Commission hearing concerning the banning of two of his children from a government sponsored child care facility. The Commissioner, in his written assessment of the hearing, described Beattie’s knowledge of the medical literature as ‘almost encyclopaedic’. An account of the hearing is included in his first book “Vaccination: a Parent’s Dilemma”, published one year later. This is his second book on vaccines.

Vaccine science has become a religion Living up to the promise of its title, Fooling Ourselves reveals the fallacy of the cultural belief in vaccination, in which most of the world is immersed. Beattie exposes the shaky ground upon which vaccines as a means of disease prevention rests by presenting the data showing large declines in infectious diseases that occurred before speci c vaccines were applied, the rates of decline after vaccine application and the closely parallel rates of decline in diseases for which no vaccines were developed. Even the decline in meningitis associated deaths for Australia are shown graphically beginning in 1907. Here in the USA we must be content with estimates for Hib associated meningitis prior to 1991 when Hib became a reportable disease. The most refreshing and original revisiting of the Germ Theory of disease in print thus far is in Chapter 5, Revisiting the Paradigm. Beattie illustrates quite succinctly why speci c microbes cannot be equated to speci c diseases, revealing that our bodies are teeming with microbes, 15 percent of them pathogenic, and yet most of us, especially if we have been spared the onslaught of vaccines recommended today, remain healthy. In short, Beattie cleverly puts to rest through sheer logic the shortcomings of the microbe = disease paradigm. But one of the most valuable sections for American researchers is Chapter 7, The Peculiar Story of Polio, where we discover that the land down under had the same fate as the USA. The Salk and Sabin polio vaccine campaigns were given credit for the near eradication of polio. However, polio numbers declined due to rede ning polio as a disease of non-vaccinated children while polio in vaccinated children is today called AFP (Acute Flaccid Paralysis). Most readers will nd Beattie's original graphs from of cial data sources the most valuable aspect of Fooling Ourselves. But for many of us who have freed our minds from the vaccine paradigm, we will want to get this book into the hands of anyone we encounter who is still locked into the belief that vaccines = disease prevention. Brilliantly crafted and well-documented, Fooling Ourselves proves to the world that the vaccine paradigm is not based on sound science. Ingri Cassel and Dewey Ross Duffel -Vaccination Liberation USA