Kate Tietje, at Modern Alternative Mama wants to thank the trolls.

She is referring to the response to her recent article, 15 Things We Need to Stop Saying in the Vaccine Debate.

It’s become common on the internet recently for Article A, “An Odd Number of Reasons why Celery is the Great Satan” to inflame someone to write counter-Article B, “No, Celery is not the Great Satan.” Then everyone who already knew how they felt about celery gets to read the one they agree with in comfort, and reads just enough of the opposition to get their blood boiling, or even safer, reads just the headline.

But Kate doesn’t want any of that; she wants to move the rhetoric forward. She wants to clear the air and I’m all for it. Let’s have The Vaccine Debate. Neither of us has an unfair advantage, neither of us has a motive; we’re both just parents who want to do what’s best for their child.

So Kate (and this is not rhetorical), let’s talk. I’m not going to troll you. I’m going to rigorously disagree with you. If you don’t acknowledge that difference then you can stop reading now. If however, you stick with me, both of us might actually learn something, or come to an understanding, or find some common ground. There might be a few swears because I think they’re funny, but I promise, I’ll keep it civil.

Let’s set some ground rules before we start:

1. Whenever I make an assertion of fact, I will back it up with a link proving it. I’d ask you to do the same in response. Throughout your entire article, there is not a single external link. Nothing to support what you are saying other than the weight of your conviction. We can’t have The Vaccine Debate that way. If we did, it would degenerate into “Yes it is!” “No it’s not!” and we would completely waste our time.

2. After you’ve considered my arguments, whatever response you’d like to make from your platform, I’ll give it my full, fair attention and a reply. And so on until we are sick of each other or everyone in the world agrees with one of us.

Let’s get started. From your article:

The vaccine debate is real. And it’s rough. I, for one, am sick of it. (The ‘rough’ part.) I want all parents to have access to important information on vaccines. I want all parents to know that they have a choice. I want all parents to feel confident with their decision and not be shamed, whether they choose all, some, or no vaccines. It’s your choice. And no one else’s.

We’re off to a great start, because I agree with all of this. I also feel strongly that parents, not should, but MUST have the right to choose whether or not to vaccinate their children. There are consequences to choosing not to vaccinate, but we’ll discuss that later. Of course, I don’t know of anyone who is putting forth mandatory vaccination laws (other than perhaps in true public health emergencies) so it’s unfair to claim that you are for parental choice and imply that we are not.

Unfortunately, a lot of harsh things are said when people are arguing about vaccines. And it’s not okay anymore. You guys hear me? I’m declaring that over. Right now. Everyone is free to ask questions, share information, and debate respectfully, but no more rudeness. No more shame. Over!! #1: “You don’t love your children if you don’t vaccinate.” #2: “Shame on you.”

Let me be the first to apologize, Kate. With all sincerity, if people who disagree with you are rude or harsh when they discuss vaccines, that’s not productive. Please chalk it up to argumentative human nature and I will agree to call it out when I see it happen. If people have said those things to you, they are wrong and they do no credit to our efforts.

#3: “You’re putting your child at risk.” There is no way to eliminate all risk. Choosing to vaccinate is a risk (an immediate one). Choosing not to vaccinate is a risk (a future one). Getting out of bed in the morning is a risk. Anything at all places your child at risk.

Just because there is no way to eliminate all risk does not mean you should not reduce risks where you can. If it did, you would have just talked us all out of using car seats, which I assume you use. Trading a risk for a risk only seems like a wash if you don’t use any numbers. From 2006 to 2014, there were 1.98 billion doses of vaccines given in the United States and 2,566 people claimed vaccine injury. Only 1,440 were found injured, and even if we give each injured petitioner the benefit of the doubt, this is still a risk of .0000013, that’s roughly the same risk as getting hit by lightning in a given year. So let’s compare that to the risk of disease. Even TODAY with the majority of people receiving vaccinations, the risk of a child being hospitalized for vaccine preventable disease is 1 in 600, .0016. You aren’t trading immediate risk for future risk; you’re trading an extremely low risk for much a higher risk.

When I was growing up, my friend’s father was a truck driver. He used to never wear his seatbelt, and he said it was safer not to. He would tell a story about a man who he saw get thrown through the windshield of his car and land safely away instead of being crushed in the collision. Obviously, the extremely rare cases where seatbelts cause harm (rather than prevent it) do not make them unsafe.

#4: “You’re putting MY child at risk. You should vaccinate to protect babies/elderly/immunocompromised.” This is really two separate arguments. First, if you believe that not vaccinating places your vaccinated child at risk, then why do you trust vaccines? If they work, then you don’t have anything to fear. Second, babies, the elderly, and immunocompromised people are at risk (potentially) from anyone who is sick… It’s up to the parents of those people (or the people themselves) to protect them, not ask everyone around them to do it.

Vaccines are not a magic bullet. They are very effective, reducing the risk of infection by 35 times compared to those unvaccinated. But biology is a complex system, and only 85-95% of people who receive vaccines are protected by them. I have a 1 week old son at home right now. You’re telling me that it is my responsibility to keep him safely at home away from anyone who might be sick? That’s literally an impossible task, so yes, I expect that when I’m in the grocery store the man next to my child isn’t communicably sick. How would I even know if I interacted with someone at work who was not visibly sick and then brought it home? Believe me, if you showed me data that vaccines had high rates of injury it might be a different story. But given the statistics above, isn’t it the unvaccinated who are actually asking everyone around them to protect them through group immunity? As long as enough of us are vaccinated, it becomes increasingly less likely that a sick person will meet an unvaccinated one.

#5: “Mothers in third world countries would be grateful to have vaccines.”

I’m sorry, I just don’t think this is a good argument for or against vaccination. Comparing our lives to people of the third world is such a nebulous and difficult task; this only confuses the issue. With your permission, we’ll call this one a draw.

#6: “You just don’t really understand science or you would vaccinate.” This is so unnecessary. It’s an elitist point of view. The only way that a person would opt out or disagree is if they’re too stupid to get it? No.

Understanding science and being stupid are two very different things. Science is difficult and often not straightforward, and don’t even get me started on statistics. But it’s not elitist to say “The scientific consensus is that vaccines are not harmful.” It’s just accurate.

There are parents on both sides who might have made a choice because they didn’t look into the facts much — maybe their friend or their doctor told them to, so they just went along with it. But there are lots of people who’ve done incredible amounts of research and have come to a careful conclusion. Saying that their research “doesn’t count” because they don’t have a science background is just insulting — and wrong. People are smart enough to do their own research.

You’re right. A scientific background is not required to understand the issues at play in vaccination. However, when people ignore or dismiss the information that is available to them, or disregard the credentials of the people they get information from, is that really doing good research? Googling “Are vaccines safe?” then disregarding the first 6 results while you look for the one that supports your existing beliefs is not research, good or not.

(Plus, there are lots of doctors and other medical professionals who question vaccines or don’t vaccinate! And they clearly understand the science.) #7: “You should listen to what doctors tell you; they went to medical school and you didn’t” This is an extension of the last point. Having been to medical school doesn’t make you an expert on vaccines (the average pediatrician or family-practice doctor — the doctors most people are getting their advice from — get only a few hours of education on vaccines).

I had to put the end of 6 next to 7 because you went immediately from praising doctors that are opposed to vaccines for their understanding of science to claiming that doctors who recommend vaccination are not knowledgeable. This is a double standard. It would be fair to say many doctors are more knowledgeable than the lay person due to their extensive training, including more than a few hours training on vaccinations. However, they are also not correct simply by virtue of being a doctor.



#8: “Just walk through a graveyard and see all the babies that died 100 years ago because we didn’t have vaccines.” This is not a factual argument. It’s fear-based, and it’s not even accurate. Many of those babies died because we didn’t have access to basic medical care. … There are a whole bunch of reasons why babies died more frequently 100 years ago, most of which are not related to vaccines. (In fact, death rates for most diseases had fallen by more than 99% before the introduction of vaccines.)

Of course children died for many reasons other than vaccine preventable disease. This is not a good argument, because as you said, medical care has advanced greatly, and trying to determine the difference between the causes of death from very old records is futile. However, it’s inaccurate to claim disease rates fell by 99% prior to the introduction of vaccines. The measles vaccine was introduced in 1963. By 1968, infections and deaths had fallen by 90%. There was certainly some reduction due to better cleanliness and medical care, but it was a slow, gradual decline. With each vaccine introduced, we see a separate rapid decline in infections in the years immediately following it’s release, and nearly every vaccine has been over 90% effective at reducing cases. If cleanliness was at the heart of disease prevention, why did Varicella(chicken pox) only rapidly decline after the vaccine was introduced in the 1990’s?

#9: “My family member died of/was disabled by __________. They would have loved to have vaccines!” Any death or disability is tragic. Absolutely. But. There’s no guarantee that vaccines would have prevented the death or injury. Vaccines themselves don’t come without risks (yes, people can and do die from vaccination, too).

I answered this in my previous responses. Vaccination would have reduced the likelihood that people in the past would have contracted the disease. The lack of a guarantee does not make reducing risks any less worthwhile.

#10: “Parents who don’t vaccinate are just listening to that debunked 1998 study or Jenny McCarthy.” For the record — the 1998 study was on bowel disease in children with autism and had nothing to do with vaccines. … They did not say that the MMR caused autism. Ever. And the original results have been replicated…more than 25 times. (A bunch of us in the vaccine choice movement have actually spoken to Dr. Wakefield…myself included. Trust me, that’s not what the study was about.)

I don’t need to take your word for it. I can read the report myself. And you’re right, the report concluded they “did not prove an association between the MMR vaccine and the syndrome described (autism).” Wakefield manipulated and falsified data to imply that it MIGHT, and then suggested that further study was needed. But if further study was what he called for in the report, his actions showed otherwise, as he immediately went to the media to report his conclusions as fact. So has the study been replicated? Yes. It’s been repeatedly replicated and shown that there was no association between MMR and Autism.

As for Jenny McCarthy, I know her son has autism. I know she believes it was caused by vaccines. … This is just a dismissive saying, it’s clearly wrong, and it’s said to shut down the discussion.

I agree. Let’s not talk about Jenny McCarthy, or even Wakefield for that matter. Neither has contributed anything of substance to this debate and the facts stand for themselves. The case for or against vaccines will be made without either of these figureheads obfuscating.

#11: “The CDC/AAP/etc. wouldn’t recommend it if it wasn’t safe.” Eh…I’m just going to mention smoking and cocaine. The medical establishment used to recommend those, too, and we now know they are harmful. Sometimes, the medical establishment is wrong. Maybe they mean well, maybe they are making a recommendation based on how they interpret the available evidence, but our understanding of these issues evolves constantly. Just because they currently recommend it doesn’t make it right.

The medical establishment, to my knowledge, has never recommended smoking or cocaine use. But I can’t prove a negative, so I’ll ask you to provide evidence it did. Not a lone doctor, not an ad for cigarettes, you said the establishment, so I’m looking for a medical body recommending smoking.

In any case, yes, the medical establishment is sometimes wrong. It’s happened in the past, and it may happen again in the future. But we are talking about thousands of professionals who have the best training available, spend all day working in the field, and have the best access to all information on the topic, coming to an agreement. When they make a recommendation, it generally represents the best available interpretation. And while updated constantly, it does not change constantly. So while, yes, doctors are not always right, short of jumping 20 years forward and finding the compelling (but yet undiscovered) data that shows it, I don’t know how a parent can justify ignoring their recommendations.

#12: “Vaccines are the only way to protect your children; without them they WILL die, become deaf, become sterile, etc.” … You need to know that whether or not you vaccinate your children, they could get sick. If they’re vaccinated, they could be injured by vaccines. There are no guarantees. These dire outcomes are rare, but they are possible. … Most people won’t go deaf from mumps or measles. 1 in 10,000 or fewer (of cases). And fewer than 1 in 10,000 typically die. To say it “will” happen is absolutely false.

I have to give you this one. I don’t feel like it’s really a fair point, since I’ve never heard anyone actually say it, but I’ll give you the benefit of the doubt. There are plenty of uninformed people who are pro-vaccine. I wouldn’t put it past one of them to be a hyperbolic dick. So it’s settled. Children will not ALWAYS become disabled or die without protection from vaccines.

#13: “You have to vaccinate to go to school.” You do not have to vaccinate to go to school. 48 states (all except MS and WV) offer religious exemptions. About 20 states also offer philosophical exemptions. All 50 offer medical exemptions, but they’re harder to get in some states than others. Most of the time, all you need to do is sign a waiver and your child can attempt public school without some or all vaccines.

No, you don’t have to vaccinate to go to school, but that may be changing. As increasing numbers of children are reporting for school unvaccinated and outbreaks of vaccine preventable diseases increase in size, states may very well make it more difficult for parent’s to get an exemption. And for reasons we’ve already discussed, given the extremely low risk of injury from vaccination, setting reasonable standards for the health and safety of all children does not strike me as particularly insidious. Parents have a choice whether or not to vaccinate, but that choice may have consequences, like schooling outside of the public system. I might feel bad about it if vaccines were shown to be anything other than extremely safe.

#14: “Vaccines do not cause autism. End of story.” … It’s recently come out that a key study that the CDC used to “disprove” a link between vaccines and autism was falsified. Statistically significant data was omitted from the results. That data showed a 340% increase in autism among African-American boys when they received the MMR prior to 36 months of age, instead of after. One of the lead researchers, Dr. Thompson, admitted this in a public statement. … It’s also true that we’ve done very few studies on the link, the studies have been (generally) poorly designed, and that we have never done a vaccinated vs. unvaccinated study. This question is far from settled, but from the evidence we do have (scientifically and anecdotally)…we can say, yes, vaccines do cause autism.

This is very important: Vaccines do not cause autism. End of story. The study that was recently “re-evaluated” by Brian Hooker, an antivaccinationist biochemical engineer, was a case-control study. When Hooker re-evaluated it, he treated it like a cohort study, and in so doing, he was able to create the appearance of statistical relevance where there was none. The 340% increase is smoke and mirrors. Separately from this, Dr. William Thompson, one of the lead researchers seems to disagree with the original methodology of the study and wants to investigate it further, but has not been descriptive about what those problems might be. I welcome that, as I do all science that seeks to answer a question rather than prove a pet theory. But even if this study was found to be flawed in some meaningful way, there are still so many other studies that found the same results.

And I freely admit that we’ve never done a vaccinated vs non-vaccinated study. If you would like to volunteer your children to not receive a vaccine and then be exposed to measles or mumps, or polio… actually, we still couldn’t do it because that would be unethical. No doctor in the world would perform that study, which is why it has never been done. When you ask for it, you ask us to violate basic human rights. There are lots of other ways to study vaccines and their safety and effectiveness.

#15: “We were vaccinated, and we’re all fine.” The 1980s schedule and the 2014 schedule aren’t even remotely the same. Most of the vaccines in the 1980s contained quite a few more antigens and no adjuvants (aluminum). Most of them have been removed from the market (OPV polio and DTP definitely have). The schedule consisted of MMR (1 dose), DTP (5 doses), and OPV (4 doses). All in all, children received around 10 shots in their first 6 years, covering just 7 diseases. Up to 4 different diseases are addressed at just one visit (DTP + OPV). Today, vaccines contain aluminum. Children receive up to 6 shots in one visit. They receive 36 shots in their first 6 years, covering 14 different diseases. Up to 8 different diseases are addressed at one visit.

No, vaccines being safe in the 1980’s does not necessarily make them safe now. Vaccines being repeatedly shown to be safe now makes them safe now. Aluminum adjuvants have been in vaccines since the 1950’s. And although the vaccine schedule has increased it’s pace, there has been no indication that this is at all detrimental, partly because vaccines have become more effective with lower volumes, less antigen, and are easier on the immune system.

Plus, honestly? We’re not fine. Many people have autoimmune disorders. Many people are overweight. A lot of people have allergies. A lot of people have learning disabilities. A lot of people (1/3) have cancer! I don’t know about your definition of “fine,” but it’s not mine. We don’t fully know if these things are related to vaccines or not, but I’d investigate that a lot more closely before we declare they’re not related and keep vaccinating so heavily. No other country does it, and no other country has rates of these chronic illnesses quite as high as we do.

Europe’s vaccination rates have long been higher than the U.S., and our rates of chronic disease are pretty similar to every other developed nation where most people die of old age. In fact, even autism rates may not be rising, according to unconfirmed research. Vaguely asserting that so many myriad health issues MIGHT be related to vaccines simply doesn’t make a good argument. They MIGHT be related to the phases of Neptune, but I’ve yet to be shown that correlation.

I’m not here to tell you that you shouldn’t vaccinate. Any choice comes with its own set of risks. I am here to make sure that I share accurate information, including the information that isn’t easy to find. I want parents to know what’s out there before they make this very important decision.

I am here to tell you to vaccinate. Inform yourself, then choose to vaccinate. There isn’t a conceivable, credible reason not to. If there is, tell me about it, because I genuinely want to know. I have corrected your “accurate information” with accurate information, and actually spent quite a bit of time getting it, so I genuinely hope that you respond Kate. I understand you’ve had some family issues lately, so I won’t hold it against you if it takes a while. Just give me a heads up with the contact form above. Don’t worry, I’ll be here, gauntlet down, waiting, and vaccinating.

Featured Image and Vaccination Poster used under Creative Commons License from Wikimedia Commons. Smoking Poster under CC from NY Times.

All other images rights reserved.

9/10/2014 16:00 CST Edited to accurately reflect HRSA data was over an 8 year period, not a single year.