Anti-vaxxers are to blame for a new epidemic of measles in the U.S.

Measles is now spreading outward from Disneyland in California, in the worst outbreak in years. The epidemic is fueled by growing enclaves of unvaccinated people. 

The CDC reports that in just the past month, 84 people from 14 states contracted measles, a number that is certainly an under-estimate, because the CDC doesn’t record every case. California alone has 59 confirmed cases, most of them linked to an initial exposure in Disneyland. A majority of people who have gotten sick were not vaccinated.

For years, scientists (including me) have warned that the anti-vaccination movement was going to cause epidemics of disease. Two years ago I wrote that the anti-vaccine movement had caused the worst whooping cough epidemic in 70 years. And now it’s happening with measles.

Finally, though, the public seems to be pushing back. Parents are starting to wake up to the danger that the anti-vax movement represents to their children and themselves. 

What's sad about this – tragic, really – is that we eliminated measles from the U.S. in the year 2000, thanks to the measles vaccine. As this CDC graph shows, we've had fewer than 100 cases every year since. 

But we had 644 cases in 27 states in 2014, the most in 20 years. And 2015 is already on track to be worse. Measles may become endemic in the U.S, circulating continually, thanks to the increasing numbers of unvaccinated people. Until now, each outbreak was caused by someone traveling from abroad and bringing measles to us. The anti-vaccine movement has turned this public health victory into defeat.

Anti-vaxxers have been relentless in the efforts to spread misinformation. Despite overwhelming scientific evidence that vaccines are beneficial, they endlessly repeat a variety false claims, such as

• Vaccines cause autism. They don’t.
• The preservative thimerosal in vaccines causes autism. It doesn’t.
• Natural immunity is all you need. It isn’t. Measles infects 90% of people exposed to it unless they are vaccinated.
• A healthy lifestyle will protect you from measles. It won’t.

Now, finally, some parents are pushing back. Parents and schools in California, where the epidemic began, are concerned that their children will be exposed to measles from unvaccinated children in schools. And the schools are starting to do something they should have done long ago: send the unvaccinated kids home.

The problem arises from California’s vaccine exemption policy: although public schools require kids to be vaccinated, parents can exempt their kids simply by saying they have a personal objection to vaccination. It’s not just California: only two states, Mississippi and West Virginia, don’t allow parents to claim a philosophical or religious exemption to vaccines  And Colorado has the worst rate of vaccination, at just 82%, primarily due to parents claiming a “philosophical” exemption.

These parents are the anti-vaxxers. Thanks to them, we now have large pockets of unvaccinated children through whom epidemics can spread further an faster than we’ve seen in decades. The CDC reports that in 2014, 79% of measles cases in the U.S. involving unvaccinated people were the result of personal belief exemptions.

Anti-vaxxers don't recognize the threat their behavior poses to others, especially to children whose immune systems aren’t functioning properly. CNN reported this week on the case of Rhett Krawitt, a 6-year-old California boy who has gone through 4 years of chemotherapy for childhood leukemia. His leukemia is in remission and he’s back in school, but the treatment wiped out his immunity, and he’s still not ready to get vaccinated. If Rhett gets measles, he might not survive. His father Carl wrote to school district officials to ask them to ban unvaccinated children from school.

Krawitt expects the schools to deny his request.

Meanwhile, the parents who refuse to vaccinate their kids aren’t budging. The New York Times reported on one mother, Crystal McDonald, who refused to vaccinate any of her four children, after “researching the issue” by reading anti-vaccine websites. When their high school sent her daughter home for two weeks, the daughter asked if she could get the measles shot so she could return. As quoted in the Times, McDonald told her daughter “I said ‘No, absolutely not.’ I said I’d rather you miss an entire semester than you get the shot.’”

Where does this breathtaking science denialism come from? It’s been building for years, as I and many others have written. The wave began with a 1998 paper published in The Lancet by Andrew Wakefield, claiming that the MMR vaccine was linked to autism. Wakefield’s work was later shown to be fraudulent, and his claims about the vaccine "dishonest and irresponsible." After lengthy investigations, the paper was retracted and Wakefield lost his medical license. Despite this very public repudiation, Wakefield has stuck to his claims, though, and has spent much of the past 15 years speaking (or perhaps “preaching” would be a better term) to anti-vaccine groups, to whom he is a kind of folk hero.

It’s not just Wakefield, though. Anti-vaccine messages have been broadcast aggressively by the group Generation Rescue, led by former Playboy playmate and MTV host Jenny McCarthy, and by Age of Autism, a group dedicated to the proposition that vaccines cause autism. (Age of Autism is doing it again right now.) And just last summer, Robert F. Kennedy Jr. published a new book further promoting the long-discredited claim that thimerosal causes autism. 

Most of the anti-vax crowd have no scientific training or expertise, which might explain (but doesn't excuse) their complete ignorance of the science. Over the past 15 years, dozens of studies involving hundreds of thousands of people have shown convincingly that neither vaccines nor any of the ingredients in them are linked to autism. Vaccines are not only safe, but they are perhaps the greatest public health success in the history of civilization.

Measles, though, is dangerous. The CDC’s Anne Schuchat had a message for parents this week:

“I want to make sure that parents who think that measles is gone and haven't made sure that they or their children are vaccinated are aware that measles is still around and it can be serious. And that MMR vaccine is safe and effective and highly recommended.”

Make no mistake, measles is a very dangerous infection. In the current outbreak, 25% of victims have ended up in the hospital. And it is extremely infectious: the CDC’s Schuchat explained that 

“You can catch it [measles] just by being in the same room as a person with measles even if that person left the room because the virus can hang around for a couple of hours.”

Perhaps the Disneyland epidemic, which has now spread to 14 states, will finally convince parents, schools, and state legislatures that they need to insist that children get vaccinated before going to school. Perhaps it will also convince parents to stop listening to nonsense, and choose wisely by getting their children vaccinated against measles. We won this battle before, and we can win it again.

At the movies: popcorn and anti-vaccine fearmongering

The anti-vaccinationists have launched a new campaign this holiday season to spread cheer – oops, I mean fear – to moviegoers everywhere. Yes, the folks at SafeMinds and Age of Autism have produced an advertisement that they are trying to place in AMC theaters across the country. In fact, they almost succeeded, but quick action by skeptical science bloggers at SkepChick, Respectful Insolence, and their readerships convinced AMC to cancel the ad – for now.

The ad that SafeMinds is trying to run is intended to scare people away from getting their flu vaccine, just as flu season is beginning. The vaccine this year will protect you against both the new “swine” flu, called H1N1, and the previous flu strain, H3N2. Early data from the CDC makes it clear that both strains are still around, with H3N2 showing up somewhat more frequently so far this fall. The vaccine not only protects you, but also your family, your colleagues, and the many other people you might come into contact with each day while at work, shopping, or elsewhere.

Why try to scare people? Well, the people behind SafeMinds and Age of Autism believe that the preservative thimerosal, which is used in some but not all flu vaccines, causes autism. This theory has been thoroughly investigated over the past 10 years, and just as thoroughly discredited. In fact, it never had any positive evidence to support it in the first place, but it has been promoted aggressively by a journalist, David Kirby, who made his fortune off a book based on the thimerosal-autism hypothesis. (I’m not providing a link – Kirby has already made far too much money off this bogus claim, and I don’t want to give him the web traffic.)

Thimerosal was introduced into vaccines in the 1930s, and it is a very effective means to prevent the growth of bacteria without affecting the potency of the vaccine itself. In over 60 years and hundreds of millions of doses, it has proven to be quite benign. Nonetheless, it contains a form of mercury called ethylmercury, which anti-vaccinationists claim causes autism and other neurological disorders.

The claim that thimerosal causes autism was the central question of a large, multi-year Autism Omnibus trial, which ruled definitively last year that thimerosal does not cause autism. I wrote about that ruling at some length back in March, and I won’t repeat it here, except to quote again from the Special Master’s decision:

“The numerous medical studies concerning the issue of whether thimerosal causes autism, performed by medical scientists worldwide, have come down strongly against the petitioners’ contentions. Considering all of the evidence, I find that the petitioners have failed to demonstrate that thimerosal-containing vaccines can contribute to the causation of autism.”

The anti-vax crowd will not give up, unfortunately. Rather than spending their time and effort trying to find the true causes of autism, they continue to repeat claims that have already been shown false. For example, the SafeMinds website lists 5 “key points” that are just flat-out wrong. Here are the first two:

1. “The autism epidemic that began in the late 1980’s is likely due primarily to toxins adversely affecting fetus and infants during development.” Wrong, in at least two ways. First, there is no autism “epidemic.” The best evidence today indicates that the rising rates of autism are due to a combination of factors, primarily (a) rising rates of diagnosis due to increased awareness among physicians and patients and (b) a dramatically broader medical definition of autism that was introduced in the early 1990s.
2. “Mercury is likely a major contributor to this toxin-induced autism, whether the source of the mercury is from vaccines or environmental mercury exposure.” Wrong again. This is the claim that was so thoroughly refuted in the lengthy Autism Omnibus trial, with hundreds of pages of testimony from dozens of experts, and epidemiological data from literally hundreds of thousands of people.

But data doesn’t seem to have any effect on the anti-vax zealots at Age of Autism and SafeMinds.

Because AMC refused to run their ad, Age of Autism is telling its readers to stay away from AMC theaters this holiday season. I hope they do! Why? Because these unvaccinated individuals are a genuine threat to public health. Movie theaters, and the malls in which they are located, are an ideal place for infectious diseases to spread. Without vaccines, countless thousands of people would fall ill every holiday season after mingling with other shoppers, and some would likely die. My message to the unvaccinated crowd at SafeMinds is: stay away from the rest of us.

And I encourage everyone else to get your flu shot, get your kids vaccinated, and then go see a movie at an AMC theater. Meanwhile, you can also tell them at this link that you appreciate their taking a stand against misinformation and for the benefit of public health.

Whooping cough in California: deaths caused by the anti-vaccination movement

California is suffering the worst epidemic of pertussis, or whooping cough, in 60 years, with over 5,200 cases already, the most since 1950. Nine babies have died, all of them too young to receive the vaccine. Michigan is also reporting a serious outbreak, with over 600 cases so far this year. The deaths of the infants in California are tragic, and what’s more tragic is that some of them almost certainly could have been prevented if more people had been vaccinated.

The pertussis vaccine, called DTaP (diphtheria, tetanus, and pertussis) has been responsible for a dramatic drop in whooping cough in recent decades. It isn't 100% effective, but its effectiveness relies in part on “herd immunity”: if enough people are immune to the bacteria, then even if someone gets sick, the disease cannot easily spread through the community. This is especially true for very young infants, who are too young to be vaccinated and whose immune systems are not yet strong enough to defeat the bacteria on their own.

Unfortunately, it’s not a coincidence that California is the center of the new pertussis epidemic. Vaccination rates among adults in California have been dropping in recent years, largely due to the influence of anti-vaccination zealots such as Jenny McCarthy and groups such as Age of Autism. Anti-vaccination sentiments seem to strike a chord with relatively well-educated segments of the population – the same people who favor organic food and want to use “natural” products as much as possible. Anti-vaxers appeal to this group by arguing that vaccines are unnatural, and that the body’s own immune system can be “boosted” by various natural treatments. Appealing though this may sound, it has no basis in science. California makes it easy for parents to claim exemptions from the required vaccinations for their children, and exemptions have more than doubled since 1997, according to the L.A. Times.

Among the anti-vaccinationists who deserve blame for the current pertussis outbreak is “Dr. Bob” Sears, a kindler, gentler anti-vaxer who claims (like many of them) to be in favor of vaccines, but only under his own, unscientific terms. He stated flatly in the Huffington Post (a hotbed of medical misinformation) recently that pregnant women should not get the DTaP vaccine. But as Dr. Paul Offit tells us in a tragic story, refusing the vaccine can lead directly to the death of an infant. Dr. Bob is just wrong. I should add that Sears has written two books on vaccines and autism, promoting his misguided “alternative” vaccine schedule (see this article in Pediatrics about that) and his rather naive theories about the rise in autism diagnoses.

Everyone should have their children vaccinated. On top of that, in order to maintain herd immunity, most of us should get the pertussis booster shot if we haven’t had one in the last ten years. That’s what vaccine expert Paul Offit recommends, and I’m planning to follow his advice myself. It won’t take long, and it might save a life.

Another hero of the anti-vaccine movement bites the dust

I often wonder what motivates anti-vaccinationists. Are they in it because they truly believe they are offering valid treatments and advice? (Some of them do, I think.) Or are they just in it for baser reasons, such as money and fame?

Boyd Haley is a retired professor of chemistry from the University of Kentucky. His name has appeared several times in the Comments sections of this blog (for example, here and here), when commenters have presented him as a scientific expert supporting the claim that thimerosal in vaccines causes autism.

In his own words, Haley has said

“I have been a strong proponent of investigating thimerosal as the casual agent for autism spectrum disorders based on the biological science that shows thimerosal to be incredibly toxic, especially to infants.”

Haley also wrote

“If, indeed, the complete removal of thimerosal from vaccines was not followed in an appropriate time by a decrease in autism then this would be solid proof that thimerosal was not causal for autism.”

Thimerosal was removed from childhood vaccines in the U.S. by 2002, and the rate of autism diagnoses continued to increase, but Haley simply changed his tune and continued to claim that thimerosal causes autism. The overwhelming (and still growing) evidence against the thimerosal-autism link has apparently done nothing to change his mind.

Is Haley simply a confused chemist who fails to understand epidemiological evidence? Or does he have another agenda?

Well, he does: money.

As Los Angeles Times reporter Trine Tsouderos wrote in a two-part story this past week, Haley and his company have been marketing a chelating agent – a powerful, highly toxic chemical that removes mercury from the bloodstream – as a treatment for autism. They also claim that this chemical, called OSR#1, is a harmless dietary supplement. Haley’s company, CTI Science, is selling OSR#1 as "a toxicity free, lipid soluble antioxidant dietary supplement." The LA Times ordered 30 100-milligram capsules of OSR#1 for $60 through an online pharmacy.

The FDA has sent Haley and his company a formal warning letter telling them to stop marketing this unapproved drug as a supplement. Haley’s claim that OSR#1 is a supplement is a flimsy attempt to try to avoid regulation of this dangerous chemical as a drug, though it clearly is a drug. (Dietary supplements are unregulated in the U.S. - a topic for another day.) The FDA letter is unambiguous, stating:

“this product is a new drug, as defined by section 201(p) of the Act, 21 U.S.C. § 321(p), because it is not generally recognized as safe and effective for use under the conditions prescribed, recommended, or suggested in its labeling.”

Just to be sure, I checked the CTI website today, and the main headline is “CTI Science Introduces OSR#1.” Haley is President and CEO of the company and his former University of Kentucky holds a patent on it. There are no clinical trials or other data showing that OSR#1 is safe or effective; on the contrary, the FDA letter explains that it has several serious side effects, including diarrhea, abnormalities of the pancreas, and lymphoid hyperplasia.

This hasn’t stopped Boyd Haley and his company from marketing their drug as a treatment for autism. The anti-vaccination site Age of Autism has promoted it; indeed, the LA Times reported that

[AoA’s] managing editor, Kim Stagliano wrote of sprinkling the white powder on her three daughters' breakfast sandwiches and orange juice. "We've seen some nice 'Wows!' from OSR," she wrote.

Boyd Haley may be misguided, but he has a deep financial reason for pushing the link between thimerosal and autism: without it, his company can’t sell its product.

Will the anti-vaccinationists start to doubt Dr. Haley? Will his obvious conflict of interest, and his violation of FDA regulations, make them wonder why he’s selling them a powerful, possibly harmful chelating agent to treat their children? I hope so.

For further reading, I recommend the recent articles by Dr. Steven Novella at Neurologica and Orac’s detailed discussion at Respectful Insolence.

Making money by making people sick

I’m a long-time fan of Quackwatch.org, an award-winning website built by Stephen Barrett, M.D. that covers a wide variety of questionable medical practices. I just discovered that Dr. Barrett has a sort of “Hall of Shame” page, listing some of the most egregious promoters of bad medicine and bad science. Everyone on this page has been involved with the promotion of questionable practices and products, some of them so outrageous that they’ve been the target of government enforcement actions. (Whatever conspiracy theoriest might say, the government doesn’t have the resources to go after most quacks.) Barrett helpfully tags each person with one asterisk for each enforcement action.

This is an excellent resource for anyone who might question a product that is being sold over the Internet. It’s also a good place to go if you’re skeptical about the advice offered by a self-proclaimed expert on any medical topic. Each name on Barrett’s list is linked to a more detailed page of useful facts about the person. Let’s look at what it says about Joseph Mercola, D.O., who operates a startlingly popular website dedicated to – well, let’s see.

Mercola is a major promoter of anti-vaccination myths, as I’ve written before, here and here and here. His latest anti-vax screed is an attack on Gardasil, the HPV vaccine, but I won’t discuss that today – Joseph Albietz dismantled it a few weeks ago over at Science-Based Medicine.

Mercola originally came to my attention because of his anti-vaccine activism. He maintains a special page devoted to this topic, which he states contains “vaccine news.” It should really be called “anti-vaccine news”, because that’s what it contains; it’s a font of misinformation. Essentially he claims that every vaccine is bad for you, and that vaccines are little more than a huge government-industrial conspiracy to make money for Big Pharma. Instead of getting vaccinated, he argues, you should try his all-natural treatments instead. Great idea! If everyone followed his advice, who knows how many people would die of preventable infectious diseases? I wonder if Mercola really believes his own anti-science propaganda, or if he knows it is bogus and just doesn’t care.

Regardless of whether he is sincere or not, what Mercola does really well is to promote his own products. A 2006 Business Week article pointed out that Mercola “is a master promoter, using every trick of traditional and Internet direct marketing to grow his business,” and comparing him to “the old-time snake oil salesmen of the 1800s.” That’s exactly what he is, but he uses the modern tools of internet advertising to turn his particular brand of snake oil into a very successful business.

He sells hundreds of “natural” products and makes countless claims for them, most of which are either unproven, medically vague, or irrelevant. He still sells the very same products that the FDA warned him about: he merely changed the way he advertises them. The FDA doesn’t really have any power to regulate supplements – all it can do is prevent specific claims about curing disease. Clever snake-oil salesmen like Mercola can easily circumvent the FDA with a few simple edits to their websites.

For example, Mercola was warned about a product called Chorella in both the 2005 FDA warning letter and the 2006 warning letter, but he’s still selling Chorella on his site. He claims that it will “boost your immune system”, “purify your blood and clean away toxins,” promote tissue repair, and countless other unsupported claims. All of these claims are marked with an asterisk (*), and if you scroll down you’ll find that he qualifies his claims with this:

“*These statements have not been evaluated by the Food and Drug Administration. This product is not intended to diagnose, treat, cure or prevent any disease.”

This disclaimer appears below the instructions on how to buy the product, of course.

Mercola knows how to diversify his product line, too: he even has his own brand of cookware, which he claims will help you avoid the nasty toxins that are getting into your food during cooking. What, you didn’t know? Mercola says we should throw out all of our stainless steel, aluminum, and Teflon cookware because these materials will make you sick – unlike his cookware, which he says is “made from the earth's natural minerals and water” among its many other virtues. What, and aluminum isn’t a natural mineral? This stuff is almost hilarious, but unfortunately some people believe Mercola’s wacky claims. His cookware site claims that aluminum causes Alzheimer’s disease (wrong), that Teflon causes multiple types of cancer (wrong again), that stainless steel causes narrowing of the blood vessels (wrong again), and on and on.

Oh, I see it’s dinner time. Better fry up some synthetic fish sticks in my Teflon skillet and then eat them with my stainless steel fork. Yum.