August 23, 2016
If you listen to the mainstream media, you might be under the impression that United States parents are sharply divided between those who believe all children should be vaccinated according the CDC-recommended schedule and those who believe no children should receive any vaccine ever — and that virtually all pediatricians are firmly in the first camp.
The reality, like most realities, is far more nuanced with the majority of parents falling in a category that I’ve been known to call “wishy-washy”: Approximately one-third of all parents of young children in the United States believe that vaccines cause autism, and three-quarters think that parents should have the final say on whether to vaccinate their children or not. Approximately 40% have denied or delayed at least one vaccine for their children, and as of July 2015, uptake for all three doses of the HPV vaccine, which has been on the CDC-recommended schedule for girls 11 and up since 2006, is quite low at 40% for girls and 22% for boys (who were recently added to the recommended list), all while the number of so-called personal belief vaccine exemptions remains at about 1.8%. Even California, considered the hotbed of vaccine exemptions and which recently passed a law rescinding personal belief exemptions that was triggered by an outbreak of 149 cases of measles originating at Disneyland (despite the fact that the majority of cases were in adults, not unvaccinated children) only had an exemption rate of 2.8% of kindergarteners before the law was passed. And California’s personal belief exemption, unlike those in many other states, didn’t require parents to refrain from all vaccines in order to qualify. That means that parents had exemptions in place if they wanted to avoid so much as a single vaccine on the California schedule (which contains fewer doses of fewer vaccines than the CDC-recommended schedule).
Obviously, though a huge chunk of the parent population is “concerned” about childhood vaccines, the majority do not hold extreme views on vaccines. They just want to do their best to keep their children healthy – and that can be a tall order these days when over 50% of the child population has one or more chronic illnesses, most of which were far rarer a few decades ago. That’s why I was delighted to be provided an advanced copy of The Vaccine-Friendly Plan: Dr. Paul’s Safe and Effective Approach to Immunity and Health – from Pregnancy Through Your Child’s Teen Years, by Paul Thomas, M.D., and Jennifer Margulis, Ph.D.
I knew from encounters with the authors that both consider themselves “pro-vaccine,” believing that vaccines have been shown to effectively reduce cases of acute infectious disease, but they are also scrupulously conscientious about understanding the real risks vs. benefits, rather than the advertised benefits, and are more than willing to dig up and read the scientific evidence for themselves. I hoped that their book would be a necessary game-changer for the “wishy-washy” majority of parents, supplying them with accurate and empowering information that lowers fear of infectious disease and increases faith in their own judgment, thus providing the bravery to buck an increasingly hostile mainstream medical climate and ultimately resulting in a healthier child population.
Dr. Paul, as Dr. Thomas calls himself throughout the book, is obviously a caring and passionate human being and pediatrician. His parents were missionaries, and he grew up in Zimbabwe, Africa where a close childhood friend died of measles when he was growing up. That’s the sort of experience that understandably makes for zealous doctors, eager to vaccinate their patients against everything under the sun. Fortunately for the world, however, Dr. Paul is not a doctor who is afraid to incorporate new evidence into his worldview. It is clear from the get-go that Dr. Paul is more concerned with the health and well-being of his small patients than adhering to some arbitrarily determined “ideal.” Maybe as the father of 10 children, three of whom were adopted from Africa when their parents died, he understands better than most that one size rarely “fits all.”
The book’s subtitle describes the content of the book rather well. After an excellent and passionate chapter on the overarching problem in most childhood chronic health conditions — toxicity — Dr. Paul and Jennifer (as Margulis is referred to in the book) start with pregnancy and give specific recommendations and strategies for maximizing children’s health in every phase until adulthood. As a passionate children’s health advocate myself, I can attest that they have done a great deal of homework, and I can heartily agree with the vast majority of their suggestions, especially those involving pregnancy and birth practices. It is important to keep toxicity low by eating a whole foods-based organic diet and minimizing interventions wherever possible, including unnecessary ultrasounds (and most are unnecessary), medications in pregnancy and labor, acetaminophen use, and vaccines in pregnancy. I was glad to see Dr. Paul emphasize that, for the most part, vaccines have not been tested in pregnant women, and no studies have been done on the long-term effects on children’s health, while pointing out that they provoke inflammatory responses similar to those that are known to put children at risk of neurodevelopmental problems later in life.
Each chapter contains a number of nuggets of very helpful information for getting through some of the most trying times in the lives of parents and their children. Examples include when to cut a baby’s umbilical cord, how to recognize when a fever is a problem and when it isn’t, what to do about ear infections, how to keep your child safe around water, and how to talk to your teen about sex or depression. My personal favorite is from the “Questions Parents Ask Me Most” section in the toddler chapter. Dr. Paul explains a phenomenon that my daughter experienced when she was three years old, but I have never seen discussed anywhere else, not even by the doctors my daughter saw. It’s called a “pulled elbow” or “nursemaid’s elbow,” and it results from a dislocated radial head. Dr. Paul describes the exact maneuver the pediatric resident used on my daughter in the emergency room and the very same “miraculous” result that we saw.
The most important part of the book from an overall public health standpoint, however, is the treatment of vaccines. Despite Dr. Paul’s history in Zimbabwe, he doesn’t pretend vaccines are the unquestioned uniform good that we are told they are by the mainstream media, the CDC, and their rabid army of “science bloggers” and so-called skeptics, many of whom are paid to promote vaccines. He makes the good point that vaccines have, at least in some cases, greatly reduced the incidence of acute infectious disease. And we have never argued with that. Mortality rates had dropped significantly for virtually every disease for which there is a vaccine before the vaccines were licensed, but the overall rate of disease itself? Not always. For instance, in the United States before the measles vaccine, there were approximately 3-4 million cases of measles a year. We do not even approach that level these days, even if all the babies who sport a fever and a rash and test positive for measles soon after they receive the vaccine are counted. Chances are very, very good that the vaccine has a lot to do with that. Though, as those rabid “science bloggers” love to say, correlation does not equal causation.
Dr. Paul does not question whether or not reducing or eliminating the incidence of infectious disease is in fact the good thing it appears to be. He talks about the possibility that children are “too clean” today, not giving the immune system enough challenges to work as well as it could, but doesn’t bring that point all the way home to the likelihood that successfully battling an acute viral illness or two could be the very best tune-up a sluggish or imbalanced immune system could receive.
But, with that said, Dr. Paul makes it clear that he has heard enough eerily similar stories from parents – who have absolutely no reason to lie to their children’s pediatrician – about horrible reactions to rounds of vaccines and the usual subsequent autism diagnosis to make him seriously question the wisdom of the current shoot-‘em-up, one-size-fits-all vaccine program. In addition, he and Jennifer make a justifiably big deal about the amount of aluminum that a child would receive if she received every dose on the entire CDC-recommended schedule, which is a very, very good thing because all that injected aluminum into tiny babies is a very, very bad thing.
The authors make a very good case for dumping the hepatitis B vaccine for infants for all but the minuscule number of children born to mothers infected with hepatitis B. (Personally, I think they could take this argument even further, and I hope to take up the topic in a future blog, but it is crystal clear from the discussion that there is no good reason for taking the risk of injecting the average infant with this completely unnecessary vaccine.) The scientific discussion is a little less rigorous for the HPV vaccine (partly because much of the science on adverse events is hidden), but this is one case where it is obvious that Dr. Paul is a pediatrician who can change his mind. He talks about the delicious Merck-funded dinner where he was “educated” about Gardasil and the fabulous benefits it would offer to young girls: No genital warts! And no cervical cancer way down the road! (Maybe . . . that is yet to be determined. Cervical cancer from HPV generally grows very slowly, and is often diagnosed decades after the initial infection which can usually be detected by Pap tests and treated long before it has led to cancer.) Unfortunately, what the glowing presentation left out were all the adverse events caused by the vaccine, adverse events that have led to devastating conditions for many of the previously healthy young people who have been unlucky enough to receive it. Having watched a number of young people react very badly and listened to others’ reports of similar reactions, he has decided it is simply an unsafe vaccine and no longer recommends it to any of his patients. The end result of all the vaccine discussion is a stripped down version of the vaccine schedule that he recommends to the families in his practice and which he feels balances the need to protect children from potentially deadly illness and potentially deadly vaccine reactions, but he makes it clear that families in his practice are free to vaccinate as they wish.
I would quibble with Dr. Paul on a number of points, among them his eagerness to put strep B-positive pregnant women on antibiotics in labor and the first discussion of obesity. Approximately one-third of American women test positive for strep B bacteria late in pregnancy, which means that those children as well as the children born by C-section are exposed to antibiotics right at the beginning of life when their guts should be receiving a wide variety of beneficial microbes from their mothers. This gut disruption right as life begins sets a child up for a host of negative health effects, including obesity. When the subject of obesity first comes up, Dr. Paul states baldly that if you are obese it is because of what you eat – and then goes on to explain insulin resistance and its role in making people fat. It is several chapters later before he mentions the fact that studies have shown that obese people (and mice) have an imbalance of gut bacteria that leads their bodies to metabolize food differently, and that they can gain weight if they eat exactly the same thing that thin people do. That means that if you are obese, chances are very good that it’s not because of what you eat: it’s because of a complex interplay between your genes, your gut bacteria, and the food you eat. One way to affect the outcome is to change the food you eat, but that’s not the same thing as your food causing the condition in the first place – a subtle but important difference that helps people set about finding solutions without the fat shaming that is so common – and so destructive – in our culture.
I also don’t like the fact that he mentions that MTHFR mutations and autoimmune conditions make for higher risk when vaccinating, but doesn’t suggest genetic testing for all children whose parents are considering any vaccines before the two-month visit where he recommends two shots. He also doesn’t make it clear that common immune dysregulation conditions, like asthma and allergies, are also red flags indicating that parents should be very careful with vaccines. And the authors neglect to mention the extremely important point that, although Dr. Paul’s vaccine plan is definitely safer than the CDC schedule, in many states it wouldn’t fly. Some vaccines that are considered “required” to attend school (or even day care) are left off his suggested schedule altogether or are suggested at far later times. In some states, that’s fine and a personal belief exemption can be filed for any missing vaccines as suggested by the authors. But in many states, the children would have to get “caught up” before school by receiving any “missed” vaccines or would have to get a religious exemption that would require foregoing any future vaccines, if the exemption could even be obtained in the first place.
That said, I think the overall impact of the book is going to be extremely positive. A helpful appendix at the back of the book includes a numerical analysis of all children under seven who have been Dr. Paul’s clients since birth and makes the compelling point that, among the children who have received zero vaccines and those who have been vaccinated according to Dr. Paul’s recommendations, there are zero cases of autism. Assuming a 1 in 50 autism rate, slightly lower than the 1 in 45 rate for all children reported by a National Health Interview Survey released in 2015, there should be approximately 26 cases between the two groups – if the alterations in vaccine schedule had nothing to do with the development of autism. The third group, vaccinated according to CDC recommendations, had an autism rate of 1 in 60 – very close to the true “background” rate as reported by the 2015 survey.
The bottom line: if you want healthy kids – and who doesn’t? – give at least as much thought to the vaccine schedule as Dr. Paul Thomas does. The easy way to do that is to read his book. As a TMR reader, it may not be perfect for you, but it may just be exactly what it takes to get your next-door neighbor, your pediatrician, or your second cousin to finally understand what it’s going to take to keep kids healthy in today’s world.
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Full disclosure: I consider one of the authors, Jennifer Margulis, a good friend and am mentioned in the acknowledgments section at the back of the book (just after Robert F. Kennedy, Jr.) as a medical freedom fighter and friend.