A new documentary, “The Greater Good,” has just been released. I don’t think it contributes to a rational debate about vaccines.
I recognize it’s a huge decision for any parent as to what medical care to provide or allow for their children – and I’m not a parent and don’t have to make that decision. I also agree that vaccine safety is an important and serious issue – it needs to be monitored on a strictly scientific basis.
Having said that, the film disturbed me. It describes itself as providing an “opportunity to have a rational and scientific discussion” about vaccines. I don’t think it does that. I’m an experienced filmmaker and am familiar with the techniques used. All the stories, and the stories with emotional impact, are about parents who are convinced that their children have been harmed by vaccines. Every now and then a proponent of vaccination pops up – his bites are often selected in a way that shows him in a bad light, sometimes by juxtaposing them with something particularly emotional. It’s a familiar technique – you load the emotional weight of the story entirely on one side, and then allow a contrasting speaker to be the fall-guy. So in these terms, the film doesn’t contribute to rational debate – it makes the full use of emotional manipulation to make a tendentious case.
Secondly, I have many questions and problems with the content. The film focuses almost entirely on the purported problems with vaccines, and there’s very little mention of the positive outcomes of vaccination – namely the elimination or near elimination of a whole range of diseases in most of the developed world – things like diphtheria, measles, polio and smallpox – diseases that used to kill millions. And entirely left out of the picture are the extraordinary, and much-under-reported immunization campaigns in the developing world – take polio for example: UNICEF: “The number of polio cases reported annually has decreased by over 99% – from 350,000 in 1988 to 1,606 cases in 2009. This rapid success has been achieved through a global campaign to immunize to children through mass campaigns, known as National Immunization Days (NIDs)…. Since the GPEI’s momentous launch, nearly five million children, who otherwise would have been paralyzed and incapacitated by polio, are walking, able and symptoms-free
Huge measles vaccination campaigns in humanitarian disasters also greatly improve protection against death and disease for vulnerable children. Overall, worldwide under-five child mortality has actually fallen – to 9.7 million in 2007 from 12.7 million in 1990(according to UNICEF), despite an increase in overall world population. This has been accompanied by a vast increase in the number of children being immunized (5% of children immunized for 6 major diseases 1974, 80% immunized in 2008 :Gates Foundation: http://www.gatesfoundation.org/livingproofproject/Documents/progress-towards-immunization.pdf), which doesn’t prove causation and is probably because of multiple factors, but given the numbers of children vulnerable to vaccine-preventable deaths, it’s certainly suggestive.
If the film wants to claim that it’s taking a balanced approach, why didn’t it have emotional, positive stories about families who have been saved by vaccines, people talking about former times when everyone was afraid of catching polio and smallpox – maybe talking with some of the last survivors of diseases that have been eliminated, commenting on the vast improvements in health brought about by immunization?
At the end of the day, the only way to know if vaccines are safe and effective is through properly controlled scientific studies. Anecdotes, while intensely moving, do not constitute scientific evidence. The alternative is to reject the scientific approach and say that anecdotes do constitute reliable evidence – in which case we would need to abandon about 500 years of scientific progress – and live in a world where, basically, one person’s word has to be seen as reliable as anyone else’s, without any systematic means to distinguish between them.
But if we are to remain on the scientific model, the fact is that evidence is very much against what is alleged in the film. The evidence for a link between vaccines and autism has been comprehensively refuted in scientific studies and, as the film itself admits, the US class action suit about it was dismissed on account of a total lack of evidence for it. The research by the British doctor who started the scare about autism and the MMR vaccine has also been thoroughly discredited, and his findings, based on a tiny study for which he was paid by a group of lawyers, completely refuted. And yet, mystifyingly, the film seems to still imply that there is a link. I think that is the height of irresponsibility.
The person from the National Vaccine Information Center was featured very prominently in the film. The title of the group seems to imply that it is a federal body – it isn’t, it’s a private lobbying group. I have been unable to find out if Barbara Loe Fischer has any medical training – although I’d assume she would have some initials after her name (ie MD) if she was. I noted some factual inaccuracies about what she said – including the claim that only 1200 children had been tested with the HPV vaccine (over 20,000 people were included in studies, see CDC report below, which also provides evidence that appears to contradict the claims made in the film about the effects of the HPV vaccine). She also made the inflammatory claim that because there are very low risks associated with immunization, we are “sacrificing” children by having a policy of vaccination: this invites the obvious reply that, for the sake of argument, if this is the case we are clearly “sacrificing” the far greater numbers of children who will die or be impaired if we fail to immunize.
The film does make some good points – we all need to be vigilant that commercial interests are separated from scientific research – and we know that the official regulatory system in the US can come under commercial pressure and is sometimes flawed. This causes concern, but if you are going to dispute the evidence supplied by the Centers for Disease Control, the National Institutes for Health and the World Health Organization, you had better be sure that your challenge is based on properly controlled, peer-reviewed and replicable scientific research.
In order to protect children most effectively, we need to carefully evaluate the scientific evidence in a responsible way, and draw reasoned conclusions from that as best we can.
It should be noted that there have been several large scale studies on the alleged link between the MMR vaccine and autism, involving hundreds of thousands of children in Denmark, and a study of 100,000 in the US. No correlation was found between the vaccine and autism.
I feel strongly that this film does not do a public service – it spreads misleading information in the guise of being a “balanced” documentary. In view of the fact that immunization has brought enormous benefits to children in the US and around the world, and that reducing or withdrawing it puts children at much increased risk, I believe strongly that people should publicize rational debate about this subject, not use misleading and emotive stories to misinform the public.
Extract from CDC report on trials for HPV, referring to safety of vaccine: http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5602a1.htm
“The quadrivalent HPV vaccine was evaluated for injection-site and systemic adverse events, new medical conditions reported during the follow-up period, and safety during pregnancy and lactation. Safety data on quadrivalent HPV vaccine are available from seven clinical trials and include 11,778 persons aged 9–26 years who received quadrivalent vaccine and 9,686 who received placebo. Detailed data were collected using vaccination report cards for 14 days following each injection of study vaccine on a subset of participants aged 9–23 years. The population with detailed safety data included 5,088 females who received quadrivalent HPV vaccine and 3,790 who received placebo (Tables 7–9) (111)…
Serious Adverse Events in All Safety Studies
Vaccine-related serious adverse events occurred in <0.1% of persons. The proportions of persons reporting a serious adverse event were similar in the vaccine and placebo groups, as were the types of serious adverse events reported. Seven persons had events that were determined to be possibly, probably, or definitely related to the vaccine or placebo. Five events occurred among quadrivalent HPV vaccine recipients and two among placebo recipients. The five in the quadrivalent HPV vaccine group included bronchospasm, gastroenteritis, headache/hypertension, vaginal hemorrhage, and injection site pain/movement impairment.
In the overall safety evaluation, 10 persons in the group that received quadrivalent HPV vaccine and seven persons in the placebo group died during the course of the trials. None of the deaths was considered to be vaccine related. Two deaths in the vaccine group and one death in the placebo group occurred within 15 days following vaccination. Seven deaths were attributed to motor-vehicle accidents (four in vaccine group and three in placebo group), three were caused by intentional overdose (nonstudy medications) or suicide (one in vaccine group and two in placebo group), two were attributed to pulmonary embolus or deep venous thrombosis (one each in vaccine and placebo group), two were attributed to sepsis, one case each attributed to cancer and arrhythmia (in vaccine group), and one case caused by asphyxia (placebo group).
New Medical History
Information was collected on new medical conditions that occurred in up to 4 years of follow-up. Overall, nine (0.08%) participants in the vaccine group and three (0.03%) participants in the placebo group had conditions potentially indicative of autoimmune disorders, including various arthritis diagnoses (nine in vaccine group and two in placebo group) and systemic lupus erythematosis (none in vaccine group and one in placebo group) (111). No statistically significant differences exist between vaccine and placebo recipients for the incidence of these conditions.”
Description of large Denmark study on the alleged link between MMR and autism:
In Denmark, Madsen et al. did the opposite kind of study, called a cohort study: you compare groups that had the exposure or not, in order to see whether there is any variation in the outcome. In this specific case, then, you take two groups of people who either had MMR or didn’t and then check later to see if the rate of autism is any different between the two groups. This study was big—very big—and included all the children born in Denmark between January 1991 and December 1998. In Denmark there is a system of unique personal identification numbers, linked to vaccination registers and information about the diagnosis of autism, which made it possible to chase up almost all the children in the study. This was a pretty impressive achievement, since there were 440,655 children who were vaccinated and 96,648 who were unvaccinated. No difference was found between vaccinated and unvaccinated children in the rates of autism or autistic spectrum disorders and no association between development of autism and age at vaccination.
Goldacre, Ben. Bad Science: Quacks, Hacks, and Big Pharma Flacks . Faber & Faber. Kindle Edition.