Monday, May 13, 2019

Vaccines and Apologetics

I've been meaning to write about vaccines for a while now but just haven't gotten around to it. However, in the past year or so, I've heard several Christians question their safety (mostly about autism), there have been several outbreaks, and there is a proposed bill in Colorado (the state I live in) that would require kids to get vaccinated, so I thought now would be a good time to discuss them from an apologetics point of view. There are certainly more lessons to be learned, but for now I want to focus on just three lessons we can learn from the vaccination debate.




Stay Current

As a society, our knowledge is growing rapidly, especially our scientific knowledge. For this reason, it is important to reconsider our conclusions on various topics from time to time. The first time my wife was pregnant, I thoroughly researched the safety of vaccines, but that was almost 10 years ago. It is possible that new scientific discoveries have changed our understanding of the safety of vaccines since that time. People often like to quip that you can't trust science because it changes. This isn't entirely true. Scientific knowledge does change, but it almost always improves by becoming more nuanced. Very rarely does scientific knowledge completely change on a subject.

In the case of vaccines, I specifically looked to see if there was a link between any vaccine and autism. When I researched it 10 years ago, there was no published scientific data showing a link (more on this under the next heading); however, it is plausible that new scientific research has found a link between vaccines and autism, especially since newer research tends to be more specific.  Perhaps by testing specific vaccines given at specific times to specific populations of people, scientists have found that there is indeed a link.


I searched very thoroughly, and I found several scientific studies testing for a link between vaccines and autism, but none showed a relationship between the two. Even though the science on the subject has not changed and neither has my view, I'm glad I investigated it so that I will not embarrass myself and so that I can have stronger epistemic justification for my view.


Be Consistently Skeptical

As part of my investigation, I watched the documentary Vaxxed in order to understand why people think there is a link between vaccines and autism. One of the people featured in the documentary was part of a team investigating the MMR vaccine and he claims that he found a correlation between the vaccine and autism, but out of fear of losing his job, the leader of the team (DeStefano) covered it up and only published the analyses that showed no correlation. Most of the documentary is about the cover up, but it also includes several emotionally powerful stories of kids who developed autism shortly after receiving the vaccine.

The documentary is very well done and has a powerful emotional appeal, but ultimately, it should not be persuasive. At best, the producers of the documentary cast doubt on a single research study. From that same study, they present the "true" data to show there is a link; however, these analyses have not been subject to peer-review nor is the data available in enough detail to evaluate the reliability of the analyses. Just because the producers of the documentary present themselves as unbiased outsiders doesn't mean they are unbiased nor does it mean they are capable of performing the complex statistical calculations they claim to have done.


In searching the peer-reviewed scientific literature, I found 38 other studies that reported no link between autism and any vaccine. These studies were conducted by a ton of different scientists in several countries from multiple scientific disciplines using funding from all kinds of different sources so it's extremely unlikely that government or big pharma conspiracies can explain these results.


Moreover, there was not a single reputable scientific study showing a link between vaccines and autism. There have been three (two use the same data set) that found a link. The original study by Andrew Wakefield in 1998 that started the whole issue with vaccines and autism has been retracted and discredited due to methodological issues (small, biased sample). The two recent ones, funded by anti-vaxxers, also have sampling biases and weren't able to get published in a legitimate scientific journal so they were published in an open source journal (pay to publish journal). Despite all this, it's debatable whether they even show a link since they don't adjust statistical significance levels to account for multiple statistical tests (see notes in references below).


The point here is that we cannot trust someone simply because they claim to be an unbiased whistle-blower who has special knowledge. Likewise, we can't base conclusions off of the absence of evidence either (unless we have really good reasons for thinking the evidence should exist). We need to be just as skeptical of these people and claims as we are with mainstream claims. Ironically, I often see the same tactic used to support atheism. When sheltered Christians first learn about evolution, hear claims that the Bible has contradictions, or find out that there is limited non-Christian accounts of Jesus, they uncritically accept these as evidence against Christianity and leave the faith. Had they been skeptical of these objections and searched for Christian responses, they would realize these are non-issues.


Love Your Neighbor

Jesus sacrificed His life to save ours. As Christians, we are called to be like Christ. Not only are we to love our neighbors as ourselves (Mark 12:30), but we are to consider others as more important than ourselves (Philippians 2:3). Vaccines are a simple measure that improves quality of life and prevents death. Unfortunately, not everyone can get them. Infants, elderly, those who are allergic to some of the ingredients, cancer patients, and others are sometimes unable to receive vaccines. Thankfully, they can receive protection from illnesses when others get vaccinated. This is because when a greater number of people get vaccinated, fewer people will contract the disease and the few vaccinated people who get the disease will spread it to fewer people since they'll have it for a shorter period of time.

Getting vaccinated is a simple and effective way to love your neighbor by decreasing the chances they will get sick. Yes, there are some risks. Here's the CDC's list of possible side-effects, most of which are rare and minor, although there a few major ones (on a side note, why are these major risks accepted by the scientific community but the link with autism isn't? 🤔) The risks associated with vaccines are smaller than the risk of not getting them, but if you're still not willing to get them for yourself or children, please consider doing it for the sake of others. Nobody is asking you to lay down your life or your kids' lives for others, but to simply take a small risk.


Conclusion

There is a lot of information in our world and very little time for us to really learn about and understand it all. Thankfully, we don't have to because we have experts who spend their lives studying topics in great depth. It is possible that the experts are wrong, but unless we have advanced knowledge in an area and very good reasons for rejecting what the experts say, it's probably best that we stick with the experts. If we, as non-experts, disagree with experts, we are likely the ones getting something wrong, not them.

Additionally, rejecting expert views calls into question our credibility and intelligence so that our ability to preach the gospel is greatly diminished. Again, this is worth doing, but only if we have strong reasons for doing so. In regards to vaccines, most people just aren't knowledgeable enough in the science and statistical methods used in order to take a rational stand against the experts.


Reasons to Believe (RTB), which is a ministry that focuses on science, has done some excellent work on this subject as well. Here's a couple of their articles and videos, which echo what I've said and goes into more detail in some ways. Here's their article on how vaccines are a way to love your neighbor, an article on vaccine safety, a video on vaccines from a Christian worldview, and a final video below by one of the RTB scholars, AJ Roberts who has done scientific work on vaccines.




The young-earth creationist ministry, Answers in Genesis, has also made favorable statements about vaccines in articles here and here. Likewise, the Discovery Institute, the other major ministry that focuses on science, has made favorable comments about vaccines here and here. My hope is not that people will get vaccinated, which is good for society, but that Christians will come to see that vaccines work because of our God-given design, and therefore, become proponents for them.


References

This first set of articles are all the ones that found no link between the MMR vaccine or those containing thimerosal and autism.


Andrews N, Miller E, Grant A, Stowe J, Osborne V, Taylor B. Thimerosal exposure in infants and developmental disorders: a retrospective cohort study in the United Kingdom does not support a causal association. Pediatrics. 2004;114:584-591.
Davis RL, Kramarz P, Bohlke K, et al. Measles-mumps-rubella and other measles-containing vaccines do not increase the risk for inflammatory bowel disease: a case control study from the Vaccine Safety Datalink project. Arch Pediatr Adolesc Med. 2001;155:354-59
Demicheli, Vittorio, Tom Jefferson, Alessandro Rivetti, and Deirdre Price. "Vaccines for measles, mumps and rubella in children." Cochrane Database Syst Rev 4, no. 4 (2005).
DeStefano, Frank, Tanya Karapurkar Bhasin, William W. Thompson, Marshalyn Yeargin-Allsopp, and Coleen Boyle. "Age at first measles-mumps-rubella vaccination in children with autism and school-matched control subjects: a population-based study in metropolitan Atlanta." Pediatrics 113, no. 2 (2004): 259-266. This is the article that is challenged in the documentary Vaxxed , yet there is no actual published evidence that the data were wrong. Even if we toss this one out, there are still all these other articles.
DeStefano F, Chen RT. Negative association between MMR and autism. Lancet. 1999;353:1986-1987.
DeStefano, F., & Shimabukuro, T. T. (2019). The MMR Vaccine and Autism. Annual review of virology6.

DeStefano, F., Bodenstab, H. M., & Offit, P. A. (2019). Principal Controversies in Vaccine Safety in the United States. Clinical Infectious Diseases, 69(4), 726–731.
Doja, Asif, and Wendy Roberts. "Immunizations and autism: a review of the literature.” Canadian Journal of Neurological Sciences 33, no. 4 (2006): 341-346.
Dudley, M. Z., Salmon, D. A., Halsey, N. A., Orenstein, W. A., Limaye, R. J., O’Leary, S. T., & Omer, S. B. (2018). Do Vaccines Cause Autism?. In The Clinician’s Vaccine Safety Resource Guide (pp. 197-204). Springer, Cham.
Farrington, C. Paddy, Elizabeth Miller, and Brent Taylor. "MMR and autism: further evidence against a causal association." Vaccine 19, no. 27 (2001): 3632-3635.
Fombonne E, Zakarian R, Bennett A, Meng L, McLean-Heywood D. Pervasive developmental disorders in Montreal, Quebec, Canada: prevalence and links with immunizations. Pediatrics. 2006;118:E139-150.
Fombonne E, Chakrabarti S. No evidence for a new variant of measles-mumps-rubella-induced autism. Pediatrics. 2001;108:E58.
Fombonne E, Cook EH Jr. MMR and autistic enterocolitis: consistent epidemiological failure to find an association. Mol Psychiatry. 2003;8:133-134.
Heron J, Golding J. Thimerosal exposure in infants and developmental disorders: a prospective cohort study in the United Kingdom does not support a causal association. Pediatrics. 2004;114:577-583.
Hviid A, Stellfeld M, Wohlfahrt J, Melbye M. Association between thimerosal-containing vaccine and autism. JAMA. 2003;290:1763–6.
Hviid, A., Hansen, J. V., Frisch, M., & Melbye, M. (2019). Measles, Mumps, Rubella Vaccination and Autism: A Nationwide Cohort Study. Annals of internal medicine.
Honda H, Shimizu Y, Rutter M. No effect of MMR withdrawal on the incidence of autism: a total population study. J Child Psychol Psychiatry. 2005;46:572-579
Hornig, Mady, Thomas Briese, Timothy Buie, Margaret L. Bauman, Gregory Lauwers, Ulrike Siemetzki, Kimberly Hummel et al. "Lack of association between measles virus vaccine and autism with enteropathy: a case-control study." PloS one 3, no. 9 (2008): e3140.
Jain, Anjali, Jaclyn Marshall, Ami Buikema, Tim Bancroft, Jonathan P. Kelly, and Craig J. Newschaffer. "Autism occurrence by MMR vaccine status among US children with older siblings with and without autism." Jama 313, no. 15 (2015): 1534-1540.
Kaye, James A., Maria del Mar Melero-Montes, and Hershel Jick. "Mumps, measles, and rubella vaccine and the incidence of autism recorded by general practitioners: a time trend analysis." Bmj 322, no. 7284 (2001): 460-463.
Madsen, Kreesten Meldgaard, Anders Hviid, Mogens Vestergaard, Diana Schendel, Jan Wohlfahrt, Poul Thorsen, Jørn Olsen, and Mads Melbye. "A population-based study of measles, mumps, and rubella vaccination and autism." New England Journal of Medicine 347, no. 19 (2002): 1477-1482.
Madsen KM, Lauritsen MB, Pedersen CB, et al. Thimerosal and the occurrence of autism: negative ecological evidence from Danish population-based data. Pediatrics. 2003;112:604-606.
Maglione, Margaret A., Lopamudra Das, Laura Raaen, Alexandria Smith, Ramya Chari, Sydne Newberry, Roberta Shanman, Tanja Perry, Matthew Bidwell Goetz, and Courtney Gidengil. "Safety of vaccines used for routine immunization of US children: a systematic review." Pediatrics 134, no. 2 (2014): 325-337.
Mandy, William, and Meng‐Chuan Lai. "Annual research review: the role of the environment in the developmental psychopathology of autism spectrum condition." Journal of Child Psychology and Psychiatry 57, no. 3 (2016): 271-292.
Mrozek-Budzyn D, Kiełtyka A, Majewska R. Lack of association between measles-mumps-rubella vaccination and autism in children: a case-control study. Pediatr Infect Dis J. 2010;29(5):397–400
Newschaffer, Craig J., Daniele Fallin, and Nora L. Lee. "Heritable and nonheritable risk factors for autism spectrum disorders." Epidemiologic Reviews 24, no. 2 (2002): 137-153.
Parker, Sarah K., Benjamin Schwartz, James Todd, and Larry K. Pickering. "Thimerosal-containing vaccines and autistic spectrum disorder: a critical review of published original data." Pediatrics 114, no. 3 (2004): 793-804.
Peltola H, Patja A, Leinikki P, Valle M, Davidkin I, Paunio M. No evidence for measles, mumps and rubella vaccine associated inflammatory bowel disease or autism in a 14-year prospective study. Lancet. 1998;351:1327-1328.
Picciotto IH, Green PG, Delwiche L, et. al. Blood mercury concentrations in CHARGE study children with and without autism. Environ Health Perspect. 2010;118(1):161-166.
Plotkin, Stanley, Jeffrey S. Gerber, and Paul A. Offit. "Vaccines and autism: a tale of shifting hypotheses." Clinical Infectious Diseases 48, no. 4 (2009): 456-461.
Price, Cristofer S., William W. Thompson, Barbara Goodson, Eric S. Weintraub, Lisa A. Croen, Virginia L. Hinrichsen, Michael Marcy et al. "Prenatal and infant exposure to thimerosal from vaccines and immunoglobulins and risk of autism." Pediatrics (2010): peds-2010.
Price CS, Thompson WW, Goodson B, et. al. Prenatal and infant exposure to thimerosal from vaccines and immunoglobulins and risk of autism. Pediatrics. 2010;126:656-664
Richler, J., Luyster, R., Risi, S., Hsu, W. L., Dawson, G., Bernier, R., ... & Goudie-Nice, J. (2006). Is there a ‘regressive phenotype’of autism spectrum disorder associated with the measles-mumps-rubella vaccine? A CPEA study. Journal of autism and developmental disorders, 36(3), 299-316.

Rutter, Michael. "Incidence of autism spectrum disorders: changes over time and their meaning." Acta paediatrica 94, no. 1 (2005): 2-15.
Schechter R, Grether JK. Continuing increases in autism reported to California’s developmental services system: Mercury in retrograde. Arch Gen Psychiatry. 2008;65:19-24.
Stehr-Green P, Tull P, Stellfeld M, Mortenson PB, Simpson D. Autism and thimerosal-containing vaccines: lack of consistent evidence for an association. Am J Prev Med. 2003;25:101-106.
Taylor LE, Swerdfeger AL, Eslick GD. Vaccines are not associated with autism: An evidence-based meta-analysis of case-control and cohort studies. Vaccine. 2014 June;32(29):3623–3629.
Taylor B, Miller E, Farrington CP, et al. Autism and measles, mumps, and rubella vaccine: no epidemiological evidence for a causal association. Lancet. 1999;353(9169):2026–2029
Tozzi AE, Bisiacchi P, Tarantino V, et. al. Neuropsychological performance 10 years after immunization in infancy with thimerosal-containing vaccines. Pediatrics. 2009;123(2):475-482.
Uchiyama, T., Kurosawa, M., & Inaba, Y. (2007). MMR-vaccine and regression in autism spectrum disorders: negative results presented from Japan. Journal of autism and developmental disorders, 37(2), 210-217.

Uno Y, Uchiyama T, Kurosawa M, Aleksic B, Ozaki N. The combined measles, mumps, and rubella vaccines and the total number of vaccines are not associated with development of autism spectrum disorder: the first case–control study in Asia. Vaccine. 2012;30(28):4292–4298
Verstraeten T, Davis RL, DeStefano F, et al. Study of thimerosal-containing vaccines: a two-phased study of computerized health maintenance organization databases. Pediatrics. 2003;112:1039- 1048.
Wilson, Kumanan, Ed Mills, Cory Ross, Jessie McGowan, and Alex Jadad. "Association of autistic spectrum disorder and the measles, mumps, and rubella vaccine: a systematic review of current epidemiological evidence." Archives of Pediatrics & Adolescent Medicine 157, no. 7 (2003): 628-634.
This is a non-exhaustive list of articles that investigate the psychological factors of people who think there is a link between autism and vaccines, suggesting there might be a psychological explanation for why some people think there's a link.
Betsch, C., & Sachse, K. (2013). Debunking vaccination myths: Strong risk negations can increase perceived vaccination risks. Health psychology32(2), 146.
Browne, M., Thomson, P., Rockloff, M. J., & Pennycook, G. (2015). Going against the herd: psychological and cultural factors underlying the ‘vaccination confidence gap’. PLoS One10(9), e0132562.
Gulyn, L. M., & Diaz-Asper, C. (2018). Exploring Perceptions of Blame for Autism Spectrum Disorder. Journal of Developmental and Physical Disabilities30(5), 587-600.
Hornsey, M. J., Harris, E. A., & Fielding, K. S. (2018). The psychological roots of anti-vaccination attitudes: A 24-nation investigation. Health Psychology37(4), 307.
Jolley, D., & Douglas, K. M. (2017). Prevention is better than cure: Addressing anti‐vaccine conspiracy theories. Journal of Applied Social Psychology47(8), 459-469.
Larson, H. J., Jarrett, C., Eckersberger, E., Smith, D. M., & Paterson, P. (2014). Understanding vaccine hesitancy around vaccines and vaccination from a global perspective: a systematic review of published literature, 2007–2012. Vaccine32(19), 2150-2159.
Mitra, T., Counts, S., & Pennebaker, J. W. (2016, March). Understanding anti-vaccination attitudes in social media. In Tenth International AAAI Conference on Web and Social Media.
Pluviano, S., Watt, C., Ragazzini, G., & Della Sala, S. (2019). Parents’ beliefs in misinformation about vaccines are strengthened by pro-vaccine campaigns. Cognitive processing, 1-7.
Here are the only two peer-reviewed articles that have ever shown a link between vaccines and autism. Both of them have been retracted due to methodological issues such as biased sampling or poor controls. 
Wakefield, Andrew J., Simon H. Murch, Andrew Anthony, John Linnell, D. M. Casson, Mohsin Malik, Mark Berelowitz et al. "RETRACTED: Ileal-lymphoid-nodular hyperplasia, non-specific colitis, and pervasive developmental disorder in children." (1998): 637-641. Article has since been debunked and retracted due to methodological errors. This is the original article that started the controversy.
Mawson, Anthony R., Azad Bhuiyan, Binu Jacob, and Brian D. Ray. (2017). "Pilot comparative study on the health of vaccinated and unvaccinated 6- to 12-year old U.S. children. Journal of Translational Science3(3), 1-12. Three results regarding autism and vaccines, two of them are significant at .05, but not .01. The other is significant at .01. 
Mawson, A. R., Bhuiyan, A., Jacob, B., & Ray, B. D. (2017). Preterm birth, vaccination and neurodevelopmental disorders: a cross-sectional study of 6-to 12-year-old vaccinated and unvaccinated children. J Transl Sci3(3), 1-8. These two "studies" are not published in reputable perr-reviewed journals and use a single data set. They also group all vaccinated children together, looking at neurodevelopmental disorders (not just autism) and all vaccines (not just MMR). The data comes from a "convenience sample" of homeschool children who are both more likely not to vaccinate and to have a neurodevelopmental disorder (which is why they homeschool). Here’s a more detailed response to these articles. https://sciencebasedmedicine.org/no-two-studies-purporting-to-show-that-vaccinated-children-are-sicker-than-unvaccinated-children-show-nothing-of-the-sort/ Here’s another critique of the study. https://www.snopes.com/2017/05/17/vaccine-study-autism/

Update: I was recently sent this article which appears to show a link between a different vaccine (Hep B) and autism. After reading it, it seems like a classic case of data fishing, which is when you have a large dataset and go digging for random correlations. In this case, out of 80,000 kids, they found a correlation with autism from on 9 kids who had autism and the vaccine and did no correction to control for type I error, which is they did, there would not be a significant correlation. Moreover, if we consider these results reliable, we must also accept that being a single-mother causes autism, which is what this study also reports.

Gallagher, C. M., & Goodman, M. S. (2010). Hepatitis B vaccination of male neonates and autism diagnosis, NHIS 1997–2002. Journal of Toxicology and Environmental Health, Part A, 73(24), 1665-1677.
Here are some sites that list additional studies showing no link between the MMR vaccine and autism. These are all probably listed above, but there might be a few extras that aren't.






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