The Jenny McCarthy video (although it actually becomes the J.B Handley yells at the good looking doctor

Transcription

1 Understanding Vaccines/Immunization Homework 3 pt Sp 2011 Due at Friday 04/29/11 at 3 PM Please staple. You can slide your assignment under my office door if you want. I will not accept or grade ed assignments.) CHM 109 started with a consideration (George Washington, R.I.P.) of the importance of using the scientific method to make medical decisions. The phrase evidence based medicine is sometimes used to describe this approach. This assignment revisits that notion on a topic that I hope is of some importance to you: vaccine use. Completion of this assignment requires you to view one video (4 min) and read two articles about immunization/vaccine use. One of the articles is an editorial that deals with vaccination in health workers. The video deals with the contention that some vaccines cause health problems. The other article is a review from the scientific literature strongly supporting the case that MMR vaccine and thimerosal containing vaccines are not linked to autism. If you can integrate the ideas and emotions in this discussion you may begin to understand the hostility that some of our fellow citizens display toward immunization. Perhaps some of you will be able to help these fellow citizens make better informed health care decisions using the information from this assignment. Background Viewing Please view the following short video (link below) to get a feel for emotions sometimes associated with the topic. Ms. McCarthy gave birth to a child who was later diagnosed with autism. She has become a public advocate for children with autism and their parents. That in itself is certainly to be lauded. She has also made assertions about cause and treatment of autism that do not appear to be supported by science. It is extremely difficult not to be sympathetic with the difficulties in raising an autistic child. However, we have already considered some of the hazards associated with making important medical decisions that are not based on science. Added to this is the wealth of data supporting the massive benefit vaccines have had on public health in the United States. (For example, see: The point is, if someone tells you not to do something for your child (see other McCarthy videos for details) which has been shown to have some very substantial health benefits, you want to be sure they (and therefore, you) are correct. video): The Jenny McCarthy video (although it actually becomes the J.B Handley yells at the good looking doctor Final comments going into the assignment. 1) You should know by this stage in the course that science is not authoritarian. That is, Jenny McCarthy is not wrong because she is an actress, and the doctors are not right because they are doctors. (Sign up here to have Galen treat your hemorrhage!!!) Rigorous scientific analysis of the data gives us the best idea of what is right for solving a problem associated with the natural world. Let s go into this discussion assuming that autism is somehow connected to the natural world. 2) You should hopefully know by this stage in your life that the one that yells the loudest is not necessarily the one who is right. Likewise, the one that gets the most applause is not necessarily right, either. Hopefully, by the time you complete this assignment you will be able to make better informed decisions about vaccination. The reason for this, is you will have gotten a start on what Mr. Handley suggested doing: Read the science! and not just taking Mr. Handley s word for what the science says. Background Reading 1. New York Times editorial from April 14, 2010: They Should Know Better You can access this editorial through the Lexis-Nexis Academic electronic database available through the USC Upstate 1

2 Library web site. Recall that you can access the various databases by clicking on the letters below Database & E- resources Index on the library s home page. I found the article by using the Easy Search mode (I believe that is the default setting.). I entered flu vaccine health care workers and limited the search to Major World Publications under the By Source Type bar. When I did the search it came up as the third hit. (Clearly as time passes, it go further down the first list.) Read this editorial. It shouldn t take more than a few minutes. 2. From the Journal for Specialists in Pediatric Nursing 14 (3): (2009) read Autism and Vaccination-The Current Evidence by L. Miller and J. Reynolds. You can access this through CINAHL or directly through TD-Net (the journal finder). The articles in this journal are peer-reviewed. (Do you now what that means? It is important!) Read this article (It will take more than a few minutes.) and have paper and pencil handy so you can take notes as you read. Additional comment: While some of your professors might not be very fond of Wikipedia, I have found it to be quite useful when used in the proper context. It is often a good way to get a quick introduction to a topic, and there are a few areas here where it could be handy. If you need to cite works other than the ones I have identified, you are welcome to do that. Just be sure to identify the source. The citation format is not important, as long as I can find the source. Write out all answers by hand. Do not use computer/word processor/cut and paste/etc. While you will be using information from the materials below, you are not allowed to quote their words directly (except as noted for specific questions). You are welcome to restate information, using your own language, when needed. If you need to give numbers or other data (example: 62%), it is permissible to copy that directly. Turn in pages 3-10, stapled together 2

3 SCHM 109 Vaccine Homework Based on: They Should Know Better (Note: This article is based on information from the flu season (fall/winter/spring) of ) 1.(0.05 pt) According to the CDC and RAND Corporation, what percentage of health care workers received: seasonal flu vaccine swine flu (H1N1) vaccine 2. (0.05 pt) The editorial gave two reasons why health care workers should get vaccinated. What were these? 1) 2) 3. (0.05 pt) Among the most frequently cited reasons cited by health care workers for not getting vaccinated was I don t need it. I have been struggling to understand what that statement means. In four sentences or less, try to explain below what you think workers that gave that answer actually meant. If you cannot come up with an explanation, invent something that is humorous. 4. (0.05 pt) Was there a correlation between employers policy regarding vaccination and the rate at which health care workers complied with vaccination? If yes, elaborate briefly. 3

4 Based on Autism and Vaccination-The Current Evidence, by L. Miller & J. Reynolds 5. Define the following terms (0.4 pt). Some of these terms have a somewhat different meaning in a medical than a layman s context ( attenuated would be a good case in point). While I will accept a definition from either background as long as it is reasonably accurate, I hope you will try to find definitions for some of the terms that are more appropriate for the medical context used in this paper. etiology onset rigor validation attenuated regression cohort refuting 4

5 6. (0.1 pt) What is the date of publication for the article and what are autism spectrum disorders (do the best you can regarding rewording vs. copying), and have they increased in frequency over the previous several decades? 7. (0.1 pt) When scientists make a direct assertion in their writing, they usually support that assertion with data they are presenting or by citing work and writings that other people have done. The authors make the assertion that Vaccines are a cornerstone in public health practice... How do they support this assertion? 8. (0.1 pt) Why do the authors state that some parents may be more concerned about the risks of taking a vaccine than the risks associated with not taking the vaccine? 9. (0.1 pt) Who is thought to have developed the first vaccine, and for what disease was this vaccine effective? 10. (0.05 pt) What health problem do the authors indicate was significant in the mid-1900's in the United States, and was among the most feared diseases? Name two individuals that worked on vaccine development for this disease. 5

6 11. (0.1 pt) The authors list approximately 23 different diseases for which vaccinations exist. Write the names of your favorite 8 diseases from their list in the space below. 12. (0.05 pt) Against how many diseases are pre-school children routinely vaccinated? 13. (0.1 pt) Why is it logical to immunize children relatively early in their life? 14. (0.1 pt) What is the goal of the immune system? 15. (0.05 pt) Are infant immune systems generally capable of responding to antigens by producing antibodies? yes no 16. (0.05 pt) Who plays a roll in monitoring the safety of vaccines? (In answering this question you may simply copy the appropriate words from the article.) 17. (0.05 pt) Why is it important to encourage parents to trust their instincts related to their children s health? (In answering this question you may simply copy the appropriate words from the article.) 18. (0.1 pt) What information are nurses and other healthcare providers required to record fo reach vaccine administered? (In answering this question you may simply copy the appropriate words from the article.) MMR section 19. (0.05 pt) What does MMR stand for? (In answering this question you may simply copy the appropriate words from the article.) 6

7 20. (0.1 pt) Has the MMR vaccine been effective in reducing the frequency of measles in the United States? (Indicate yes or no, and then supply some data to support your answer.) (In answering this question you may simply copy the appropriate words from the article.) The heart of this problem: 21. (0.05 pt) Twelve children were described in a 1998 publication by a British researcher & 12 coauthors. Of these children, for how many was a diagnosis of autism given? For how many of these children was link between the developmental disorder and vaccination made? What types of people made this link? 22. (0.05 pt) In 2004 how many of Wakefield s coauthors asked to formally retract the interpretation placed upon these findings...? 23. (0.05 pt) You can access Wakefield s Lancet paper by going through TDNet via the USC Upstate library (use the British version). What does it say, in what color, and roughly what size font across the first page of the article? 24. (0.05 pt) The authors cite a number of published studies that refute an association between MMR vaccine and autism. Give only the author s names part of the citation for two of these. 1) 2) 25. (0.05 pt) MMR immunization rates decreased somewhat in England (to a low of 80% in ). Was there a increase in the number of cases of measles in England between 1998 and 2008? If so, what was the number of cases in each year? Thimerosal section (This will be short.) 26. (0.1 pt) Write the structure of thimerosal in the space at right: (readily available on the www). 7

8 27. (0.05 pt) What element is present in thimerosal that you might expect would be dangerous to humans? 28. (0.05 pt) Have scientific studies shown there to be a link between use of thimerosal in vaccines and autism or other childhood development disorders? yes or no 29. (0.05 pt) List only the authors names for two of the citations given by Miller & Roberts to support the answer to Q# 28. 1) 2) 30. (0.1 pt) What did the U.S. Court of Federal Claims find (published 02/12/09) concerning MMR & thimerosal vaccines related to autism or ASD? extra credit (0.1 pt) What word from the article are you surprised that I did not ask you to define? Write the definition of that word. Back to the video, and summary questions. 31. Mr. Handley states: 1) that the U.S. is 34 th in under age 5 mortality rate 2) that the U.S. vaccinates for many more diseases (..., we have 36 vaccines. ) 3) the top 5 countries in under age 5 mortality (...which include countries like Finland, Norway, and Iceland... ) averaged 11 and 13 vaccines. 4) Why are their autism rates 1 in 1,000, 1 in 1,500, 1 in 2,000? (I presume these rates refer to Finland, Norway, and Iceland.) 5) It doesn t take a brain surgeon or an ER doctor to figure out there might be a correlation. (I am pretty certain he means a correlation between vaccination and autism.) (Aside: If you are not familiar with the correlation proves causation logical fallacy, please spend no more than 3 minutes looking at: ) a) (0.03 pt) Is Mr. Handley s statement above in #5 correct? For emphasis, might there be a correlation? If I understand the language correctly, he is only saying it is possible that a correlation exists. (This is a yes or no answer.) b) (0.03 pt) If there is a correlation between incidence of autism and vaccination, does that mean that vaccination in general, or a specific vaccination causes autism? (Another yes or no answer.) 8

9 c) (0.1 pt) Propose another possible correlation (or 2 or 3). That is, identify some aspect of living in Finland, Norway, and Iceland or the people living in those countries that is quantitatively different than the U.S.. (Although blondness certainly would be a valid correlation, you can t use blondness because Dr. Mr. Krueger had to suffer through way too many blond jokes back when he had hair.) While you may provide a citation, you don t have to, particularly if your correlation falls into the common knowledge category. (Example: The average European likes soccer more than the average U.S. citizen.) A funny correlation would be appreciated. d) (0.1 pt) This is a psychology, not chemistry question. Mr. Handley mentioned the U.S. ranking in under age 5 mortality, but does not appear to be asserting any correlation/causation between that and autism (or vaccination?). Why do you think Mr. Handley mentioned the U.S. being ranked 34 th in under 5 mortality? (I will grade this based on how clearly you support your logic. There is no necessarily right or wrong answer. I am more interested in how carefully you can analyze someone s attempts to influence your thought patterns.) e) (0.04 pt) Mr. Handley gives the ranking of the U.S. in under age 5 mortality, but does not give any actual mortality rates. I want you to guess the under age 5 mortality rates (deaths per 1,000) for: (You can t get this wrong, but try your best, and think about why I asked you to do this.) U.S. Finland Norway Iceland If you want to look at worldwide data (but you don t have to), there is a really neat visualization tool at a University of Washington associated web site: f) (0.1 pt) At ~ 1:00 min in the video, Ms. McCarthy asserts that flu vaccines still contain mercury. I assume she is referring to vaccines developed for use in young people. Do Miller and Reynolds comment on this topic? (Yes or no answer.) If yes, what do they say about flu vaccines recommended for children under 6, both through time and what is available today. (Hint: see p. 170.) 9

10 g) (0.1 pt) Now we get back to Mr. Handley. At ~ 1:25 Mr. Handley asserts that we (the U.S., I think) have 35 vaccines. Does this number conflict with the number of diseases that Miller and Reynolds say children are routinely vaccinated against during their infancy and preschool years. (Yes or no.) Hint: see p If yes, how many diseases do Miller and Reynolds indicate? Remembering that science is not authoritative, what are Miller and Reynold s degrees and employment affiliations? (1 st page of article.) Miller Reynolds Does their educational background, nature of their employment, and the fact their article is published in a peerreviewed journal have any influence on how much you trust their assertions on this subject? Now, the yelling at the good looking doctor part (~2:27). Instructive for its argumentative approach? My effort to transcribe Mr. Handley s comments: How many vaccines have they looked at in these studies?... It s two!... How many ingredients have they studied of 35?... It s one! You ve looked at two of 36 shots and one of 35 vaccines... Since this seems to be the climax of the discussion it would be nice to reach a definitive conclusion on the validity of Mr. Handley s discourse. However, I found myself a bit confused between shots, vaccines, and ingredients, and also the distance between the numbers 14 and 35 (or 36?). That said, do Miller and Reynolds explain why MMR and thimerosal vaccines [More than one thimerosal containing vaccine was covered in the studies described by Stehr-Green, et al., (2003) in the reference list.] were looked at for correlations to autism? Finally, state the number of vaccines (or shots, or ingredients) that you think would have to be shown not to cause autism to make Mr. Handley stop yelling at the good looking doctor. Briefly (3 sentences or less) explain your answer. (Note: I am assuming that Mr. Handley has good intentions, and I intend the question to be taken sincerely.) # of vaccines (or shots, or ingredients) 10