Whooping Cough Reemergence Traced Back to Vaccine Failure and Flawed Assumptions

by Dr. Mercola

The pertussis (whooping cough) vaccine is included as a component in “combination” shots that include tetanus and diphtheria (DPT, DTaP, Tdap) and some pertussis-containing shots now also include polio, hepatitis B and/or Haemophilus Influenza B (Hib). Whole cell pertussis vaccines in DPT, used in the U.S. from 1949 until the late ‘90s, were estimated to be between 30 and 85 percent effective, depending upon the type of DPT and vaccine manufacturer, with protection lasting only two to five years. [1]

The DPT vaccine was highly reactive and carried a high risk of serious allergic reactions and brain inflammation leading to permanent brain damage, as detailed in the groundbreaking 1985 book DPT: A Shot in the Dark, co-authored by Barbara Loe Fisher, cofounder of the National Vaccine Information Center.

DTaP shots — which contain the less reactive acellular pertussis vaccine licensed for infants in the United States in 1996 — are given five times to children under age 6, with additional Tdap booster doses recommended for teenagers and adults. Since the late 1980s, CDC data shows that kindergarten children in the U.S. have maintained a high vaccination rate with four to five DPT shots and, today, more than 94 percent of kindergarten children have had four to five acellular DTaP vaccines.

Very high pertussis vaccination rates in the U.S. and many other countries for the past several decades should be more than sufficient to achieve vaccine-acquired herd immunity, if the theory of vaccine-acquired herd immunity is correct. [2] Yet, despite high vaccine coverage, statistics show reported whooping cough cases continue to rise. So, what’s really going on?

Studies Show Pertussis Vaccine Doesn’t Work

Scientific findings suggest whooping cough vaccines — both whole cell and acellular — fail to provide adequate protection against infection and the transmission of infection. There are indications that subclinical and undiagnosed pertussis infections have been occurring since the early 1980s among both vaccinated and unvaccinated persons.

Now, a recently published scientific study [3,4] confirms the acellular whooping cough vaccine does not work as expected — and that the continued circulation of the disease can be traced back to the vaccine itself. Unfortunately, the study authors still maintain the false notion that the older, more toxic whole cell pertussis vaccines were more effective at preventing the spread of whooping cough than the current acellular versions. According to the authors:

Fundamental aspects of pertussis epidemiology and immunology were left unexplained following the introduction of wP [whole cell] vaccines in the 1950s. The wP vaccines worked: disease rates plummeted, mortality fell, and the pertussis problem appeared largely solved. The fact that we did not know then, and still do not know now, how wP vaccines did this was inconvenient and has remained problematic …

Had carriage studies been conducted … then this might have provided supportive evidence that infections were being blocked. But carriage studies were not done. Rather, it was assumed that because wP vaccines appeared to confer herd immunity, they therefore blocked carriage. In hindsight and in light of subsequent evidence, that assumption was probably correct.

It was subsequently assumed that aP [acellular] vaccines, most of which include combinations of adhesion protein antigens … that enable B. pertussis to bind to respiratory epithelium, would also block carriage. But, while logical, that assumption appears to have been incorrect.

Whooping Cough Resurgence Traced Back to Vaccine Failure and Flawed Assumptions

In a nutshell, the authors of the new pertussis study blame the apparent global resurgence of whooping cough cases on the failure of acellular pertussis vaccines, which were licensed for infants in the U.S. in 1996 after parents in Japan in the 1970s, and parents in the U.S. in the early 1980s, lobbied for a purified pertussis vaccine to cut down on the numbers of children being brain damaged and dying from DPT shots.

The authors allege that acellular pertussis vaccines, which demonstrated superior safety and effectiveness in prelicensure clinical trials conducted in the 1990s, do not work the way older whole cell pertussis vaccines did, and that it is this difference that is causing reported cases of whooping cough to increase. In 2014, there were more than 32,000 reported cases of whooping cough in the U.S., most of which occurred in vaccinated populations.

However, evidence shows pertussis deaths dropped by 75 percent between 1922 and 1948, a year before the introduction of DPT in 1949. In 1948, the mortality rate was less than 1 pertussis death per 100,000, and this rate has not been surpassed since. [5,6] So, the plummeting disease and mortality rates noted in the recently featured pertussis review were not the direct result of the whooping cough vaccine.

The authors allege that, while both acellular and whole cell pertussis vaccines may inhibit symptomatic disease (the actual coughing fits), the older whole cell vaccines to a large degree also appeared to block the spread of infection, while acellular vaccines do not as efficiently prevent disease transmission.

However, when you take a much closer look at this assumption — that only acellular vaccines produce asymptomatic carriers capable of spreading the disease while whole cell vaccines are incapable of doing the same thing — the scientific evidence demonstrates that the assumption is incorrect.

The paper’s authors cite evidence that pertussis transmission “readily occurs” between infected animals vaccinated with an acellular pertussis vaccine and nearby uninfected and unvaccinated animals. As noted in the paper:

Disease among infants <3 months old (i.e. too young to have been vaccinated) increased sharply in the late 1970s, coincident with declines in wP coverage rates. As wP coverage improved in the 1980s, pertussis incidence fell, including among young infants. Surprisingly, though, the infant rates stabilized in the 100–200 cases/100,000 infants/year range, even as disease among older age groups fell almost to zero.

Since those infants are unlikely to be their own reservoir for infection, a more plausible explanation was transmission from a sustained pool of asymptomatic older individuals in the population. This also emphasizes that even very high rates of wP vaccination may fail to completely interrupt pertussis transmission.

However, a seminal 2014 infant baboon study published in PNAS gave strong evidence that both whole cell and acelullar vaccines are incapable of preventing infection or transmission of infection. The scientists found that whether baboons were vaccinated with whole cell or acellular vaccines, they were all capable of being infected, sometimes asymptomatically, and transmitting infection to other baboons.

The only difference was that baboons that had previously recovered from pertussis, or had been given whole cell pertussis vaccine, were infectious for a shorter period of time than those vaccinated with acellular vaccines. [7]

Both Pertussis Vaccines Have Been Proven Ineffective

While the admission that acellular pertussis vaccines don’t work may be shocking to some, it is important to point out that this paper seriously minimizes the evidence for the ineffectiveness of whole cell pertussis vaccines.

As detailed in Fisher’s fully referenced 2016 article, “Pertussis Microbe Outsmarts the Vaccines as Experts Argue About Why,” [8] scientific evidence dating back decades shows that the whole cell pertussis vaccine in DPT shots ALSO failed to prevent infection and transmission of infection that could be spread to vaccinated persons by carriers who were asymptomatic or had few symptoms. [9]

This article, published on Mercola.com, was the first in-depth analysis written for the lay public to make this important point. The B. pertussis organism actually began evolving to evade whole cell pertussis vaccine soon after DPT was introduced in 1949, developing new strains that produce more pertussis toxin to suppress the human immune system and cause more serious disease. Today, the pertussis strains included in the vaccine no longer match the pertussis strains causing the disease.

Evidence also shows that subclinical, asymptomatic pertussis capable of being transmitted to vaccinated and unvaccinated alike has been circulating for several decades — regardless of which vaccine has been in use.

Doctors assume that when children and adults have been vaccinated and present with mild respiratory symptoms, they do not have whooping cough, and so cases of pertussis have been systematically underdiagnosed in vaccinated persons for decades. By perpetuating the myth that whole cell pertussis vaccine did in fact work, it opens the door for those who want to simply reintroduce the older, more toxic whole cell pertussis vaccine for infants and children. As noted by Fisher in 2016:

When there are a lot of people with silent asymptomatic pertussis infections, it is impossible to know who is a carrier and who is not, which means that reported cases of pertussis are just the tip of a very big iceberg. It also means that articles blaming whooping cough cases on unvaccinated or partially vaccinated children are nothing more than wishful thinking and scapegoating.

Bottom Line: Both natural and vaccine-acquired immunity is temporary and while vaccination may prevent clinical symptoms, it does not block infection, carriage or transmission. If vaccinated people can get silently infected and transmit infection without showing any symptoms — even after getting four to six pertussis shots — then pertussis vaccine acquired “herd immunity” is an illusion and always has been.

In other words, the whole cell pertussis vaccine was no more effective than the acellular pertussis in blocking infection and transmission of infection. So, while the featured paper offers some important admissions, it doesn’t go far enough.

Vaccine manufacturers selling vaccines, medical trade groups promoting vaccines and public health officials responsible for regulating and making policy for vaccines clearly do not want to be held responsible for the failure of both DPT and DTaP/TdaP vaccines. At the same time, the failure of the whooping cough vaccine has become so obvious it cannot be swept under the rug much longer.

In that respect, this paper is a timely one, providing the perfect message for propagandists: The more toxic whole cell pertussis vaccine had a superior effectiveness compared to the less toxic acellular vaccine and should not have been replaced. But this is simply a way of trying to deflect attention away from the fact that vaccines, including pertussis vaccine, not only cause harm but also fail to work as advertised.

Public Distrust in Vaccine Safety Is Becoming a Public Relations Crisis

The study authors do recognize that by not openly and honestly addressing vaccine failures, public distrust will only continue to grow. As noted by the authors, “We are approaching a critical decision point … The resurgence of pertussis in the [acellular] vaccine era is evolving into a slow-moving global public health crisis,” and that “with the public’s trust in vaccines waning, this has also become a public relations crisis.”

At present, infant deaths associated with pertussis infection are at a 70-year high, despite the fact that uptake of pertussis vaccines is higher than ever. According to the authors, this casts “doubt on whether further increasing aP vaccine coverage can ever compensate for their fundamental limitations.” Lead author Dr. Christopher Gill, infectious disease specialist and associate professor of global health at Boston University added: [10]

This disease is back because we didn’t really understand how our immune defenses against whooping cough worked, and did not understand how the vaccines needed to work to prevent it. Instead we layered assumptions upon assumptions, and now find ourselves in the uncomfortable position of admitting that we may made [sic] some crucial errors.

They also stress the importance of making sure that any future pertussis vaccines can clearly demonstrate ability to both prevent clinical disease AND prevent the transmission of infection. But, unfortunately, by perpetuating the false idea that whole cell pertussis vaccine was able to prevent transmission, we may actually end up taking a huge step backward. As noted by Fisher: [11]

The whole cell DPT vaccine used until the late 1990s in the U.S. was an extremely reactive vaccine. DPT vaccine reactions like fever, pain and irritability were experienced by between 50 and 85 percent of children and seizures and collapse/shock reactions followed 1 in 875 DPT shots. [12,13] Brain inflammation was reported following 1 in 110,000 DPT shots with permanent brain damage after 1 in 310,000 DPT shots. [14]

The Problem With Modern Pertussis Vaccines

Shortcomings aside, the paper does make a few other points of note. In summary, they discovered that:

• Contributing factors such as detection bias, waning immunity and evolutionary shifts in the pertussis’ genome alone cannot fully explain the epidemiologic data. Importantly, vaccine refusal was one hypothesis considered as a cause behind the resurgence of whooping cough that was ultimately discounted. In other words, they agreed that reemergence of whooping cough cannot be blamed on parents who opt not to vaccinate their children. According to the authors: “[G]iven that U.S. pertussis vaccine uptake is so high on average, the impact of vaccine-refusing communities must, by definition, be small and largely limited to those communities. It is difficult to see how this could significantly affect the overall increases seen across the general population in the U.S.” Ever since the pertussis scare of summer 2010, the attacks on religious and conscientious belief exemptions have intensified and spread across the U.S., and it’s completely unwarranted. • The practice of “cocooning,” where Tdap is given to all household contacts of a newborn to prevent whooping cough in the infant does not work. As noted by the authors, “Cocooning is logical but presupposes that aP vaccines prevent asymptomatic infections. Unfortunately, several controlled trials of cocooning in the U.S. found no efficacy. These counterintuitive results conflict with expectations if aP vaccines block carriage and transmission but fit well if aP vaccines only prevent disease but have more limited ability to block infections.”

Th1 Versus Th2 Immune Responses

To understand why vaccine-induced immunity is so short-lived compared to naturally-acquired immunity, you have to understand how your immune system works. Your immune system is divided into two different parts, each of which fights disease in your body in its own way, and the second of them is further subdivided into two arms with separate immune functions:

1. The innate immune system, which is always at the ready and a first-line defense against foreign invaders 2. The adaptive immune system, which in turn consists of two separate arms Th1, commonly known as the cell mediated arm Th2, known as the humoral or antibody arm, i.e., the part of your immune system that produces antibodies

Most vaccines, including acellular pertussis vaccines, preferentially stimulate Th2 — a fact that other research suggests may compromise your immune function in the long term and increase your risk of cancer. Vaccine efficacy is determined by measuring antibodies, which is a sign of humoral immunity activity. The benefit of measuring antibodies as a means of assessing vaccine effectiveness is that it can be easily determined by drawing blood samples.

If specific vaccine-induced antibodies are present, the person is presumed to be immune to that infection and protected because vaccine developers and regulators have maintained that if vaccines stimulate antibody production, it is a demonstration of vaccine-acquired immunity that is protective against infection and transmission of infection.

The theory goes back to the early days when it was believed that the humoral (antibody) arm of the immune system was the most important part of stimulating immunity. There’s a problem with this theory, however.

Research reveals that individuals who, due to a genetic variation, are unable to generate antibody production, actually recover from infectious illness just as well as those able to make normal antibodies. [15] They also usually have protection in the future upon re-exposure.

This demonstrates the importance of the Th1 arm of immunity, and suggests humoral immunity may only play a secondary role in natural resistance against targeted “vaccine-preventable” diseases. This, and the fact that vaccines fail to confer lifelong immunity, suggests that having a cell mediated (Th1) response is in fact necessary to confer robust, long-lasting immunity.

Today, vaccine manufacturers are developing genetically engineered vaccines and adding novel vaccine adjuvants that hyperstimulate immune responses in an attempt to generate cell mediated immunity, not just humoral immunity.

A Timeline of Whooping Cough Failures and Science

Since 2011, I’ve reported studies showing the whooping cough vaccine is failing, and the many reasons why. Here’s a quick summary of such findings. For more information, follow the hyperlink provided for each year.

2011

A 2011 investigation found the pertussis bacteria mutated nearly 20 years prior. Newer strains, such as the strain called P3, produces more pertussis toxin and/or have evolved to become vaccine resistant. Another Bordetella organism called parapertussis — for which there is no vaccine — can also cause symptoms of whooping cough, and this too is contributing to rising rates of infection.

Canadian researchers also published evidence showing “cocooning” is grossly ineffective. They determined at least 1 million parental immunizations were needed to prevent a single infant death from whooping cough. [16]

Research published in 2012 found that 81 percent of 2010 California whooping cough cases in people under 18 occurred in those fully up to date on the whooping cough vaccine. [17] It also confirmed that acellular pertussis vaccines only stimulate a type of immunity that lasts about three years at best.

In an article published in the journal Pediatrics, Dr. James D. Cherry also revealed that estimates for pertussis vaccine efficacy [18] have been significantly inflated due to the case definitions adopted by the World Health Organization in 1991, which required laboratory confirmation and 21 days or more of paroxysmal cough.

All less severe cases were excluded. As a result of these updated case definitions, the efficacy of the vaccine Infantrix was boosted from 71 to 84 percent. A New England Journal of Medicine study [19] also reported that after the fifth dose of DTaP, the odds of acquiring whooping cough INCREASED by an average of 42 percent per year.

An infant baboon study [20] led by U.S. Food and Drug Administration researchers showed that while the pertussis vaccine in DPT and DtaP reduces serious clinical disease symptoms, it does not eliminate infection or transmission of B. pertussis whooping cough.

The study’s lead author Tod Merkel explained that when exposed to B. pertussis after recently getting vaccinated, you could be an asymptomatic carrier and infect others, adding, [21] “When you’re newly vaccinated, you are an asymptomatic carrier, which is good for you, but not for the population.” Another study [22] published in the BMJ found the Tdap booster shot is only 53 to 64 percent effective.

A British study showed that of the 20 percent of children diagnosed with whooping cough, 18 percent were fully vaccinated against it. Another study, [23] which analyzed the genomes of whooping cough bacteria, found that the “acellular vaccine antigen encoding genes are evolving at higher rates than other surface protein encoding genes,” again suggesting the disease is not being prevented with mandatory, mass vaccination programs.

2015:

Noting the reemergence of pertussis as a major public health concern despite very high vaccine uptake, a 2015 paper addressed the scientific and practical problems of developing an optimal booster vaccination schedule. According to the authors, “Our results argue that booster vaccination schedules developed based on misdiagnosis of the problem are likely to be epidemiologically ineffective and economically costly.”

Here, the four hypotheses presented for the rise in prevalence were: insufficient vaccine coverage; frequent primary vaccine failure; waning of vaccine-derived protection and vaccine “leakiness” (when a vaccinated individual somehow becomes infected upon exposure). Significant variations were noted in the proposed booster schedule depending on which of these scenarios were chosen as the basis for the algorithm.

2016

A U.S. Centers for Disease Control and Prevention (CDC) [24] report highlighted the transmission of whooping cough among vaccinated children. The outbreak occurred at a Tallahassee, Florida, preschool in 2013. Twenty-six students between the ages of 1 and 5 contracted whooping cough, as did two staff and 11 family members.

The majority of the students were fully vaccinated against whooping cough according to the CDC’s recommended schedule. In one particular classroom in which all students had received the pertussis vaccine, 50 percent still developed whopping cough. According to the authors:

This outbreak raises concerns about vaccine effectiveness in this preschool age group and reinforces the idea that recent pertussis vaccination should not dissuade physicians from diagnosing, testing or treating persons with compatible illness for pertussis … Reports of genetic changes in circulating B. pertussis have raised concern that this organism could be adapting to vaccine-induced immunity …

Questions Abound

The new pertussis study authors attempted to answer a number of pressing and unresolved questions about the whooping cough vaccine in their paper, such as:

Why is whooping cough increasing in the U.S. despite record rates of pertussis vaccine uptake?

Why has vaccinating household contacts of newborns (so-called “cocooning”) failed to prevent pertussis among infants?

Does B. pertussis exist in an asymptomatic infection state?

Can pertussis be transmitted from asymptomatic individuals?

Do pertussis vaccines interfere with transmission processes and, if so, how?

All of these questions have been raised in the past, and a number of scientific studies have offered compelling clues to their answers. Unfortunately, concerns have been largely swept under the proverbial rug, and the “solution” has been to simply add booster shots. Based on the conclusions in this new paper, the real problem — the fact that the B. pertussis bacteria have evolved to survive vaccine pressure and will continue to do so as long as we insist on mass-vaccinations — may well continue to be ignored.

How Great a Concern Is Whooping Cough?

Whooping cough can indeed be serious, especially for newborns and babies whose tiny airways can become clogged with the sticky mucus produced by the toxins in B. pertussis bacteria. That said, the vast majority of children and adults get through a bout with whooping cough without complications, and it’s important for them to get proper nutrition, hydration and rest to support the healing process that sometimes can take as long as two to three months before coughing ends.

For a list of natural remedies that can help someone with whooping cough move more comfortably through the healing process, please see “Whooping Cough Vaccine Not as Effective as Thought.” Similarly, while some children and adults get pertussis-containing vaccines and experience no complications, others suffer serious reactions and injuries, or have died after getting vaccinated.

It is well known, for instance, that whole cell and acellular pertussis vaccine in DPT and DTaP/Tdap vaccines may cause brain inflammation and permanent brain damage in both children and adults.

If you want to learn more about vaccines, consider picking up a copy of Neil Z. Miller’s book, “Miller’s Review of Critical Vaccine Studies: 400 Important Scientific Papers Summarized for Parents and Researchers” — a book written in response to the common refrain that ‘there are no studies showing vaccines are unsafe or ineffective.’ In it, he reviews the concerns about vaccine safety and efficacy raised by 400 peer-reviewed published studies.

Protect Your Right to Informed Consent and Defend Vaccine Exemptions

With all the uncertainty surrounding the safety and efficacy of vaccines, it’s critical to protect your right to make independent health choices and exercise voluntary informed consent to vaccination. It is urgent that everyone in America stand up and fight to protect and expand vaccine informed consent protections in state public health and employment laws. The best way to do this is to get personally involved with your state legislators and educating the leaders in your community.

THINK GLOBALLY, ACT LOCALLY.

National vaccine policy recommendations are made at the federal level but vaccine laws are made at the state level. It is at the state level where your action to protect your vaccine choice rights can have the greatest impact.

It is critical for EVERYONE to get involved now in standing up for the legal right to make voluntary vaccine choices in America because those choices are being threatened by lobbyists representing drug companies, medical trade associations, and public health officials, who are trying to persuade legislators to strip all vaccine exemptions from public health laws.

Signing up for NVIC’s free Advocacy Portal at www.NVICAdvocacy.org gives you immediate, easy access to your own state legislators on your smart phone or computer so you can make your voice heard. You will be kept up-to-date on the latest state bills threatening your vaccine choice rights and get practical, useful information to help you become an effective vaccine choice advocate in your own community.

Also, when national vaccine issues come up, you will have the up-to-date information and call to action items you need at your fingertips. So please, as your first step, sign up for the NVIC Advocacy Portal.

Share Your Story With the Media and People You Know

If you or a family member has suffered a serious vaccine reaction, injury, or death, please talk about it. If we don’t share information and experiences with one another, everybody feels alone and afraid to speak up. Write a letter to the editor if you have a different perspective on a vaccine story that appears in your local newspaper. Make a call in to a radio talk show that is only presenting one side of the vaccine story.

I must be frank with you; you have to be brave because you might be strongly criticized for daring to talk about the “other side” of the vaccine story. Be prepared for it and have the courage to not back down. Only by sharing our perspective and what we know to be true about vaccination, will the public conversation about vaccination open up so people are not afraid to talk about it.

We cannot allow the drug companies and medical trade associations funded by drug companies or public health officials promoting forced use of a growing list of vaccines to dominate the conversation about vaccination.

The vaccine injured cannot be swept under the carpet and treated like nothing more than “statistically acceptable collateral damage” of national one-size-fits-all mandatory vaccination policies that put way too many people at risk for injury and death. We shouldn’t be treating people like guinea pigs instead of human beings.

Connect With Your Doctor or Find a New One That Will Listen and Care

If your pediatrician or doctor refuses to provide medical care to you or your child unless you agree to get vaccines you don’t want, I strongly encourage you to have the courage to find another doctor. Harassment, intimidation, and refusal of medical care is becoming the modus operandi of the medical establishment in an effort to stop the change in attitude of many parents about vaccinations after they become truly educated about health and vaccination. However, there is hope.

At least 15 percent of young doctors recently polled admit that they’re starting to adopt a more individualized approach to vaccinations in direct response to the vaccine safety concerns of parents.

It is good news that there is a growing number of smart young doctors, who prefer to work as partners with parents in making personalized vaccine decisions for children, including delaying vaccinations or giving children fewer vaccines on the same day or continuing to provide medical care for those families, who decline use of one or more vaccines.

So take the time to locate a doctor, who treats you with compassion and respect, and is willing to work with you to do what is right for your child.

Read the full article at Mercola.com.



References

Leaving a lucrative career as a nephrologist (kidney doctor), Dr. Suzanne Humphries is now free to actually help cure people.

In this autobiography she explains why good doctors are constrained within the current corrupt medical system from practicing real, ethical medicine.

One of the sane voices when it comes to examining the science behind modern-day vaccines, no pro-vaccine extremist doctors have ever dared to debate her in public.

Medical Doctors Opposed to Forced Vaccinations – Should Their Views be Silenced?

One of the biggest myths being propagated in the compliant mainstream media today is that doctors are either pro-vaccine or anti-vaccine, and that the anti-vaccine doctors are all “quacks.”

However, nothing could be further from the truth in the vaccine debate. Doctors are not unified at all on their positions regarding “the science” of vaccines, nor are they unified in the position of removing informed consent to a medical procedure like vaccines.

The two most extreme positions are those doctors who are 100% against vaccines and do not administer them at all, and those doctors that believe that ALL vaccines are safe and effective for ALL people, ALL the time, by force if necessary.

Very few doctors fall into either of these two extremist positions, and yet it is the extreme pro-vaccine position that is presented by the U.S. Government and mainstream media as being the dominant position of the medical field.

In between these two extreme views, however, is where the vast majority of doctors practicing today would probably categorize their position. Many doctors who consider themselves “pro-vaccine,” for example, do not believe that every single vaccine is appropriate for every single individual.

Many doctors recommend a “delayed” vaccine schedule for some patients, and not always the recommended one-size-fits-all CDC childhood schedule. Other doctors choose to recommend vaccines based on the actual science and merit of each vaccine, recommending some, while determining that others are not worth the risk for children, such as the suspect seasonal flu shot.

These doctors who do not hold extreme positions would be opposed to government-mandated vaccinations and the removal of all parental exemptions.

In this article, I am going to summarize the many doctors today who do not take the most extremist pro-vaccine position, which is probably not held by very many doctors at all, in spite of what the pharmaceutical industry, the federal government, and the mainstream media would like the public to believe.