We already knew Donald Trump didn't understand medicine. He once again parroted the tired falsehood that autism and vaccines have anything to do with each other. They don't. He added insult to injury by also repeating the tired falsehood that "autism has become an epidemic." Not only is that untrue, it's offensive to the millions of autistic individuals living rich lives and the families and friends who love them. But sweeping inaccurate statements and being offensive are nothing new for Trump.
What I found far more disturbing were the contributions of the only two people on stage for last night's CNN Republican debate who actually have medical licenses (as opposed to the one man who thinks he does). Ben Carson, a neurosurgeon, and Rand Paul, an ophthalmologist, weighed in on vaccines when the moderator asked Carson whether Trump should stop beating his autism-vaccines drum. (Yes, he should.)
Carson correctly responded that "We have extremely well documented proof that there's no autism associated with vaccinations." Anyone can see a summary of more than two dozen of these studies at the American Academy of Pediatrics (AAP) website. The problem is that he didn't stop there.
"Vaccines are very important, certain ones — the ones that would prevent death or crippling," he said. "There are others, a multitude of vaccines that don't fit in that category, and there should be some discretion in those cases."
The problem is, our country doesn't make or recommend vaccines for children that aren't important, that don't prevent death. So, I have a question for Dr. Carson. Below are the vaccines recommended through age 18. I'd like to know which one of these we should "use discretion" with. Which ones are not important enough to administer?
Let's review the vaccines on the CDC childhood schedule from birth to age 18:
- Hepatitis B — Prevents a chronic infection which can lead to liver cancer. And kill you.
- Rotavirus — Prevents a gastrointestinal virus which kills nearly a half million children across the world annually. Death is rare in the U.S. Instead, your child will spend a week in the hospital, miserable, crying, with severe diarrhea, while you look on helplessly.
- DTaP — Prevents diphtheria, which killed a child in Spain last year; prevents tetanus, which kills 1 in 8 who get it; prevents pertussis (whooping cough), which killed 10 babies in California in the 2010 epidemic. (Babies under 3 months old are most likely to die from pertussis.)
- Hib — Prevents Haemophilus influenzae type b, a type of meningitis which killed 1,000 U.S. children a year before the vaccine.
- Pneumococcal — Prevents pneumonia and meningitis. Which kills 1 in 15 children who get it.
- Inactivated polio vaccine — Prevents polio. Which can paralyze you. Or kill you.
- Influenza — Prevents the flu. Which kills children every year. It killed healthy 3-year-old Emily Lastinger. And 13-year-old Brittney Peters. And 9-year-old Brandon Gonzales.
- MMR — Prevents measles, which can cause brain damage and killed 123 children during the 1989-90 epidemic in the U.S.; prevents mumps, which rarely kills (though it can) but can cause deafness and infertility; prevents rubella, which can cause miscarriage, stillbirth, birth defects... and autism.
- Hepatitis A — Prevents hepatitis, which, yes, rarely, can kill you.
- Varicella — Prevents chickenpox, which killed about 100 children a year before the vaccine. It also killed this girl's father.
- Meningococcal — Prevents meningitis, which maims and kills children and teens. It killed Texas A&M student Nicolis Williams.
- HPV — Prevents human papillomavirus, which can lead to cervical, vaginal, vulval, anal, penile and throat and neck cancers. Which can kill you.
That's it. Those are the only vaccines that the CDC recommends families give their child, barring any medical contraindications. Which ones should we stop administering, Ben Carson?
But he still wasn't done. He had to address Trump's other nonsense when Trump claimed "I am totally in favor of vaccines, but I want smaller doses over a longer period of time." Vaccines are very precisely manufactured to include only what is absolutely necessary to induce enough of an immune response that the body can protect itself against those diseases. So a smaller dose wouldn't protect a child. It would stick a child with a needle for no reason at all. And spreading out vaccines? That just increases the risks to the children, including leaving them more susceptible to the diseases for a longer period of time. Trump is not "totally in favor of vaccines" if he doesn't want children protected from the diseases above as early as possible.
But Carson's pandering response was worse: "But it is true that we are probably giving way too many in too short a period of time, and a lot of pediatricians now recognize that and, I think, are cutting down on the number and the proximity in which those are done." Again, the CDC schedule is calibrated to give children the most protection from the most diseases as early and safely as possible. And that second part? That's flat out false.
The only pediatricians who promote delaying vaccines are the irresponsible ones who would leave children more vulnerable to disease for longer. The policy statements of the AAP make it very clear that the largest organization of pediatricians in the U.S. supports the CDC schedule, does not support any delayed schedule, and wants to help pediatricians in ensuring that all the children in their practice are fully protected.
So the only thing "a lot of pediatricians" recognize is that low immunization rates can cause serious outbreaks like the Disneyland measles outbreak last year. Any responsible pediatrician is encouraging parents to follow the CDC recommended schedule.
Finally it was time for Paul to jump in: “I’m all for vaccines, but I’m also for freedom," he said. “Even if the science doesn’t say bunching them up is a problem, I ought to have the right to say I want to spread them out.”
I'm for freedom too, Rand Paul. I'm for freedom from disease. I'm in favor of ensuring that my child and those in my community don't get sick from measles and die because fear has led others in the community not to vaccinate their children. As former Supreme Court Justice Oliver Wendell Holmes once said, "The right to swing my fist ends where the other man's nose begins." And the problem when someone else spreads out vaccines and gets sick in the interim is that that person can spread the disease to others. As the libertarian magazine Reason noted on this issue, the right to make up your own schedule becomes problematic when your child is "swinging their microbes at other people."
Perhaps it's too much to ask for presidential candidates to understand even basic medical concepts, such as vaccines. But at the very least, we should expect the two men who have practiced medicine to understand them. If they don't understand the subject matter they've made careers out of, what confidence does that offer for their leadership of a nation?
And for what I wish were the last time. Vaccines don't cause autism. They just don't.
My book, The Informed Parent, with co-author Emily Willingham, is available for pre-order. Find me on Twitter here.
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