SUPPORT YOUR PEDIATRICIAN, CONDEMN THEIR UNION
By Mark Blaxill
Everybody hates baseball’s new all-time home run king, Barry Bonds, for doing steroids, except of course in San Francisco where he’s a hero. But even in the Bay area, everyone knows that it’s the player’s union that stands in the way of the rigorous drug testing that will take drugs out of baseball. In most national polls, the approval rating for Congress is now down well below 30%, but in local elections voters still re-elect their own Congressman 98% of the time. Lots of people love to criticize lawyers as a group, but when you get into trouble your own lawyer is your best friend. In short, when professional people do their work well, it’s not hard to support the professional you know well even when their official representatives behave badly.
The American Academy of Pediatrics (AAP) is the union of American pediatricians. Their job is to defend the commercial interests and reputations of their constituents regardless of what the larger social interest might be. One activity of the AAP is to lobby the Federal Government to spend more money to help pediatricians to make more money.
Even when they make the case for things like expanded health insurance coverage for children, they’re also making the case for their members. Along the way, they make sure they make a case for things like: “Providing appropriate physician payment within Medicaid and SCHIP to ensure children receive access to care.”
The AAP also has a journal named Pediatrics, a publication that they claim is “intended to encompass the needs of the whole child in his physiologic, mental, emotional, and social structure.” In practice, the journal serves the agenda of the practicing pediatrician, often publishing shoddy science if it furthers the policy interests of the Academy. The stunning failure of Pediatrics to face the facts regarding the autism crisis is one of the sad byproducts of a tragic situation in which so few medical leaders have found a moral compass to guide their choices.
If you want to cut to the chase and find the commercial life blood of the pediatric profession you don’t need to look much further than the pages of the AAP’s web-site where the childhood immunization program is featured under nearly every tab. You can’t underestimate the importance of the childhood immunization program to the business of the practicing pediatrician. The reason goes right to the heart of the economic tension between customers and suppliers in our upside down health care system.
By and large, we’re all better off if we aren’t spending a lot of time in the health care system. If we’re sick we often appreciate the valuable care we receive from skilled professionals, but it’s not like buying new clothes or a car: if we’re using the doctors’ services too much, that doesn’t mean we’re having much fun in the process. By and large, doctors want us to be healthy too. But if we were all healthy all the time, we wouldn’t need to spend much time seeing doctors and there would be less economic need for their services. So doctors have incentives to give us reasons to come visit them. The practice of pediatrics is no different.
The most powerful economic friend that pediatricians have has become enshrined in law and ritual unlike any other medical practice in history. It is a 20th century invention known as the well child visit. While most parents learn to love and appreciate their pediatrician (notwithstanding the occasional sour experience), the main reason they go to see them is the well child visit. It’s a ritual with which eager and conscientious mothers, driven to do the best for their babies, have all learned to comply. And although there are a few side rituals performed during these brief encounters (only 16 minutes is spent on average with the pediatrician), there is little medical reason to conduct them except to perform a single service: the delivery of required childhood immunizations.
Pediatricians like to complain that “we don’t make money on vaccines; in fact we lose money.” If you ever hear that complaint from your doctor, tell them either to stop whining or go back to get their MBA. The hard fact is that a major chunk of a pediatrician’s annual income of about $140,000 comes from the well child visit. I’ve made numerous attempts to estimate the actual percentage, but it’s hard to do without access to private financial data and I’ve been unable to find any published estimates. Suffice it to say, if you hang around a pediatrician’s office on any given day and take a poll of the parents in the waiting room, a large percentage of them are there waiting to get their children vaccinated.
Make no mistake; the driving force behind the economic livelihood of a modern pediatrician is the childhood immunization program. Put another way, if you reduced the size of the childhood vaccine program by half, pediatricians would see a drastic decline in office visits and a lot of pediatricians would go out of business. It’s not hard to imagine then why the AAP is all over immunization policy and Pediatrics is all over the science that surrounds it.
Which brings us to the latest skirmish in the child health wars: the Eli Stone episode. It’s not unlike the recent non-fiction episode on Capitol Hill when congressmen working on behalf of Eli Lilly mysteriously intervened to exempt the manufacturer of thimerosal from liability in an otherwise unrelated Homeland Security bill. In a similar fashion, the AAP’s call for banning the Eli Stone episode steps over the line and has caused even disinterested people to wonder, what do these people think they’re doing? It’s one thing to promote vigorous debate in a democracy and everyone has a right to defend their interests and beliefs. But it’s quite another thing to ask for, no, demand censorship. That’s a demand that insults the intelligence of every American and puts the economic interests of a few over the rights of citizens to participate in the free exchange of ideas.
Not surprisingly, the AAP’s journal has leaped into the fray, rushing into publication yet another bizarre study claiming to show that ethyl mercury is really not the least bit dangerous for children, and it’s far safer for them than methyl mercury. All because it leaves the blood quicker than methyl mercury (where does it go?) and because a few parts per billion of ethyl mercury can be detected in stool and must therefore all be excreted (how could they possibly know?).
Stay tuned for more than you ever wanted to know about mercury levels in baby’s bowel movements. But this whole episode brings me back to an experience some of us had with Pediatrics nearly five years ago. In the immortal words of Yogi Berra, this feels “like déjà vu all over again.”
Back in the summer of 2003, when analysts from the Statens Serum Institut in Denmark (themselves a vaccine manufacturer) published three variants of basically the same study in three different journals within weeks of each other (an unethical scientific practice in itself, technically known as “duplicate publication”), by far the lowest quality study came out in Pediatrics. Sallie Bernard, Lyn Redwood and I were working together on a rebuttal press release and one point we wanted to make was that there was a financial conflict of interest on the part of Pediatrics due to the fact that some of its top advertisers were vaccine manufacturers. This was not a great secret (nor was it a point we featured prominently), since Pediatrics actively promoted the prestige of its advertisers on its web-site and provided a list of top 10 advertisers for all to see.
When we sent out our press release on September 1st, criticizing the study and the journal’s decision to publish it, we included a link to the list of Pediatrics advertisers. Within hours of releasing it, we began to get questions back saying, “where’s the page?” When people clicked on the link we provided, they came up with nothing. “Nonsense”, we thought and went back to correct the url. Much to our amazement, within the short time between finding the link and our press release going out, the entire page had been taken down (and remains down to this day). Unfortunately, neither of us had saved the page itself, only the now-dead link. Sadly, the proof point had vanished, or so we thought.
Three years later, when I told this story to a close friend of mine, he taught me a trick about finding archives of web pages. There’s a thing, he said, called the “Wayback Machine” that preserves copies of old web pages, even dead links, going way back in history. It’s not perfect and it misses many things, but I hoped that I would get lucky and find the missing page. Sure enough, when I searched for it I found that the August 4, 2003 advertiser list was still there in all its glory, while the next version on September 25 had no listings at all. [For a version of the August 4 page, click HERE ] In black and white on the list of Pediatrics’ most active advertisers were:
• Pasteur Merieux Connaught (now part of Sanofi-Aventis) one of the original manufacturers of the thimerosal-containing DPT vaccine;
• North American Vaccine (a subsidiary of Baxter International) manufacturer of a thimerosal-containing DTaP vaccine; and
• Glaxo Wellcome, by then part of GlaxoSmithKline, manufacturer of a thimerosal-containing hepatitis B vaccine.
If you believe that you get the news the advertisers pay for, it’s not a big step to worrying about advertiser influence on science as well. I guess Pediatrics didn’t want people drawing inconvenient inferences about their objectivity and so they decided to cover their tracks. Is it any surprise that, five years later, they’ve asked ABC to censor a story line in a fictional TV show?
So when the AAP takes an official position, don’t be fooled into thinking that they’re doing anything else except defending the economics interests of their members. Don’t expect them to like it when anyone takes shots at the goose that laid the golden egg: the childhood immunization program. And don’t get too upset about it. That’s the way the world works. Unions exist to protect the income of dues-paying members.
But it’s time to start asking some tougher questions, when AAP “calls for the cancellation” of the Eli Stone episode and accuses ABC of “reckless irresponsibility.”
In the midst of an explosion of chronic childhood illness in America: What’s going on?
In the midst of a national emergency in autism: Why are so many children sick?
And when parents and children so desperately need help from the front line of medical care: what has the AAP done beyond serving the narrow interests of its members?
Perhaps its time for the rank-and-file pediatricians to stand up and start taking their union back.
I would love to know which vaccines if any that pediatricians now give to their own children and at what intervals they give them.
The current vaccine schedule is insane and I bet pediatricians who are after all college educated and intelligent,must suspect that something is wrong with this picture: healthy children becoming unhealthy after being vaccinated.
Posted by: Richard | February 03, 2008 at 12:53 AM
Responding to getitright's post, from the study -
"Buller added that the findings have great potential for use in developing drugs that target immunological and inflammatory disorders, including a type of heart disease called atherosclerosis (sometimes referred to as hardening of the arteries), inflammatory bowel diseases (such as Crohn's disease and ulcerative colitis) and rheumatoid arthritis."
It continues to amaze me that the sole mission and perspective of this brand of medicine including its multiple torchbearers, whether they consciously know it or not, seems to be to approach everything backwards. Instead of evaluating the current state of health of the many denizens and coming up with a solution for making for a better state of health in the first instance, the focus seems to be geared towards a money making sceanrio for Big Pharma by way of coming up with a drug to supposedly combat the problem. Does this sound like a familiar strategy to anyone?
They do not seem to care about the prevention of disease in the first instance, compassion for the suffering of the multitude seems to be of no concern in the mangled thought process of this brand of researchers that belong to this brand of medicine. Whatever happened to the dictum "first do no harm?" Did it happen to fall by the wayside in this unending quest for money? Are human beings nothing but guinea pigs to try drugs on to see how they perform in the drug trials? Whatever happened to morality as we knew it? It seems to have disappeared into nothingness, into oblivion.
Posted by: Backwards | February 02, 2008 at 08:18 PM
New study about the various poxviruses. Can be seen at http://www.slu.edu/x20432.xml -- some of what it says is below.
And does anyone know (one wonders) what happens when several diseases are introduced all at once?
"Normally when a virus enters the bloodstream, the immune system responds by producing a substance called interferon-gamma, which assists the development of the immune response which is responsible for ridding the body of the virus.
"Poxviruses, however, all come encoded with a potent weapon which help them to evade the immune system. The weapon is called 'interferon-gamma binding protein.'
"The protein, as its name implies, literally binds to interferon-gamma and immobilizes it, preventing it from marshaling the immune system’s defenses. The poxvirus is then able to replicate and cause immense damage."
Posted by: getitright | February 02, 2008 at 06:49 PM
One of the most worrisome aspects of this entire vaccination gambit, in my opinion, is the issue of combining antigens in the body and whether or not it is wise to do so. And one of the most alarming studies I have come upon (and I brought it to the attention of the IOM in 1993 for all the good it did) was a 1986 "Science" article. The abstract will follow, but what they found was when two 100% avirulent herpes viruses were injected in the footpads of mice, the viruses recombined to form a lethal virus that killed 62% of the mice. The "experts" do not seem to be concerned about this question at all. We should be.
Two avirulent herpes simplex viruses generate lethal recombinants in vivo.
Javier,-R-T; Sedarati,-F; Stevens,-J-G
Science. 1986 Nov 7; 234(4777): 746-8.
While it is widely appreciated that infection with a virulent virus can produce disease in an animal, the ability of a mixture of avirulent viruses to produce disease by means of complementation or recombination in vivo has not been established. In this study, two weakly neuroinvasive herpes simplex virus type 1 (HSV-1) strains were simultaneously inoculated onto the footpads of mice. Many (62%) of the animals that received a 1:1 mixture of the viruses died, whereas the animals that received a similar or 100-fold higher dose of each agent alone survived. Of fourteen viruses isolated from the brains of ten mice that died after receiving the mixture of the two weakly neuroinvasive viruses, eleven were recombinants; three of these recombinants were lethal when reapplied to the footpads of mice. These results show that two avirulent HSV-1 variants may interact in vivo to produce virulent recombinants and a lethal infection. They also suggest that different genetic lesions account for the weakly neuroinvasive character of the HSV-1 strains ANG and KOS after footpad inoculation.
Posted by: Sandy Gottstein | February 02, 2008 at 12:41 PM
"They look forward to the day of more and more combined vaccines - 4, 5, 6 diseases all in one injection."
As a parent in the process of healing her very sick child for some years now, I find, getting closer to the immune system issues, that the viruses/ bacteria we are having to treat are those that are from the combination vaccines such as the DTaP and the MMR.
These combo vaccines need to be removed from the vaccine schedule as well. Andrew Wakefield is absolutely right. The combination vaccines, especially the MMR with live viruses, confuse the immune system rendering it incapable of knowing which virus it should mount an appropriate response against. Thus, the vaccine cannot do the job it was intended to do since the immune system cannot recognize each one independently, beleaguered as it is by the onslaught of the slew of vaccines that came before it. It is therefore, not surprising that the MMR has become the death knell of so many children on the autism spectrum. Not having had a prior problem with the MMR (assuming there will now be "research" to support that truth) does not mean that it is not a problem today. Everything needs to be looked at in the context of the larger picture.
Posted by: Our mission | February 02, 2008 at 08:57 AM
There is a book which discusses how-or-why so many pediatricians truly believe that vaccinations are a fine thing. The title of the book is "Mistakes Were Made (But Not by ME)."
Its subject is "why human decision-making predisposes us to sometimes make mistakes even worse by mechanisms of self-justification and confirmation bias - which causes us to reinforce our decisions and beliefs (even mistaken ones) ever more strongly."
Many or perhaps most pediatricians believe there was never a problem with injecting mercury into infants, children, the elderly, etc.
Likewise they believe the current schedule - (and what is it now, 25 vaccines by age 6 or something?) - is 'just fine' and not a problem.
They look forward to the day of more and more combined vaccines - 4, 5, 6 diseases all in one injection.
They wish the AAP would do *more* and not less - to 'encourage' acceptance of vaccines.
Pediatricians these days seem to do 3 things, and these are in rank order:
(1) paperwork (insurance, coding, all that);
(3) miscellaneous (everything else)
And quite a few pediatricians ridicule parents who refuse, or even defer, vaccinating. And 'discharge' those families as patients.
How much slack do pediatricians like that deserve?
Posted by: getitright | February 02, 2008 at 03:46 AM
The AAP's hysterical reaction to the showing of a fictional television shows and their accompanying demands of censorship of the fictional televison show illustrates how the AAP's all consuming self-interest trumps the needs of our children as well as as rational thought or even the First Amendment. The AAP have been checked out of the autism epidemic from the start and have been a force of irrelevance in many of our lives for some time. Interest in autism has been very low on their list of priorities. Meanwhile the AAP finds the time to issue reams of angry press releases about a TV SHOW, makes dozens of furious phone calls to ABC executives, issues a sloppy and misleading mercury study as a pre-emptive strike in "Pediatrics" and continues their dedicated work maligning parents of vaccine injured children. Another day at AAP headquarters, where they are committed to making their organization safe from the inconvenient needs of children.
Posted by: katie wright | February 01, 2008 at 09:06 PM
There is a moral choice that we need to ask everyone to make. That choice transcends their narrow economic interestst and goes to their legacy to the world.
I'm suggesting that rank and file pediatricians need to take back their union. But IF THEY DO NOT CHOOSE TO DO SO, than the question changes: how should we judge the entire profession!
As you suggest, not very well.
Posted by: Mark | February 01, 2008 at 08:52 PM
Oops! The apostrophe at the end of my link was not supposed to be part of it! Here's the link again: http://www.vaccinationnews.com/Scandals/2006/Apr_10/Scandal78.htm
Posted by: Sandy Gottstein | February 01, 2008 at 02:22 PM
For a long time, I felt Pediatricians were unwitting victims in the whole autism epidemic as well:
- CDC makes the vaccine schedule
- AAP publishes science that they rely upon to help make their decisions
I thought "You could be a well intended Pediatrician, follow all the rule, read all the science, and think you were doing the right thing."
I no longer think that. The "hall pass" that perhaps a pediatrician deserved in 2000 is undeserved in 2008. The epidemic is getting worse. The pediatric camp has no plausible explanation for what is going on. The pediatricians have some very, very smart parents who trusted them, saw their children regress right after their shots, and come back to the doctors office to explain what happened.
We had this encounter with our doctor. Up until the day we explained to him what happened, he'd been a decent guy. Then, we explained that we were sure it was the shots and he became a defensive prick, dismissed our fears as illogical, cited a lot of biased research, and looked like he wanted us out of his office as fast as possible.
The pediatricians, at least those who enable the AAP to remain reckless, are now part of the problem.
Posted by: JB Handley | February 01, 2008 at 01:37 PM
Another great analysis.
I spoke a little earlier today to Elie Ward, Director of Policy and Advocacy for the New York State Immunization Coalition. This morning, they sent out a “press release” in follow up to the Eli Stone episode.
After talking for about 20 minutes – focusing mostly on the two statements contained within the release – she told me it was obvious that I knew what I was talking about and she wasn’t against parents making an “informed” choice as a result of them doing research on the issue. (I guess that would be me?)
She was “worried that other parents who don’t know about the issue (uninformed parents) would watch the episode and base their vaccination decisions on that instead.”
I pointed out to her that the episode was correct in regards to the flu shot containing a hazardous component and since “uninformed parents” wouldn’t be getting that information from the AAP/Pediatricians, ABC was doing a great service by providing accurate information for them to make an “informed” decision.
I think I’ll send her your piece and see what (if anything) she has to say in response to your analysis.
Posted by: Kelli Ann Davis | February 01, 2008 at 01:30 PM
Another great piece, Mark. Thanks, as always.
A few comments. Many people keep saying that epidemiological studies are "bad". Perhaps I am wrong, but epidemiological studies do not have to be bad. In fact, a study which compared the vaccinated to the never-vaccinated would be an epidemiological study. It is poorly designed epidemiological studies, which do not have a proper control group, i.e., a non-intervention group, that are the problem. Granted, the most powerful epidemiolgocal study would be a long-term one in which the groups were randomized, placebo-controlled and double-blinded. That's not going to happen, even though it should have happened long ago, long before claims about safety were pronounced. But the next best thing, comparing the vaccinated to the never-vaccinated is not only necessary, but a form of an epidemiological study.
I wrote a Scandals column about the AAP a couple of years ago that I think is very relevant to this discussion, titled "Introducing the American Academy of Pediatrics’ new 'Two Wrongs Make a Right” policy!'". Here it is (if you wish to see the article with the links go to: http://www.vaccinationnews.com/Scandals/2006/Apr_10/Scandal78.htm)
"In a stunning admission, Dr. Louis Z. Cooper, former President of the American Academy of Pediatrics (AAP) and current head of its Center for Child Health Research, 'voiced concern about the effect on immunization programs in the developing world (if thimerosal was banned in the U.S.). The World Health Organization relies heavily on thimerosal to immunize millions of children in poor nations, and could face cost and logistical problems if forced to abandon it… If we banned mercury-containing vaccines by statute in the United States,’ Cooper said, ‘it would make it a lot harder to explain in other parts of the world’ why they should accept them.'
So let me get this straight, convoluted though it may be: we need to use thimerosal in the U.S. because it wouldn’t look good asking anyone else to use something that we think is bad for our children. But we apparently must ask others to use it, even if it is bad. So we must use it too.
Gee, and here I thought the FDA’s “Ostrich (what you don’t know can’t hurt you) Policy” was a tad lacking.
Granted, the AAP is not buying any of the evidence against thimerosal. Given how powerful and extensive that evidence is, for no good reason, I might add.
It makes you wonder - might their state of denial have something to do with the fact that, as just reported in the LA Times (and before that by me), the AAP has serious conflicts of interest with the very vaccine manufacturers whose products they are recommending we use? These conflicts like it or not, make any vaccine recommendations the AAP makes highly suspect. It is high time pediatricians faced up to that fact.
It would be virtually impossible for pediatricians to keep up with the literature and still have time to practice medicine, so pediatricians rely on the AAP to tell them what to do.
Regardless, is this a group to whom we want to entrust the care of our children? More important, is this a group pediatricians should be relying on?
No more excuses. It is time for our pediatricians to start questioning their recommendations."
All the best, Sandy
Posted by: Sandy Gottstein | February 01, 2008 at 01:08 PM
I would just like to add that another big motivation for the AAP is fear of admitting to terrible mistakes. Pediatricians are protected from liability for harm arising from vaccines. But if the terrible truth about vaccines is acknowledged there will be a huge public outcry, and loss of confidence in pediatricians. Plus, defending against lawsuits can be terribly expensive and time consuming even if the final outcome is that the petitioner takes nothing.
I feel sure that eventually the insanity of the current vaccine schedule will be common knowledge, and I can just imagine what future generations will say: "What? You allowed little babies to be injected 25 or 30 times with aluminum, mercuy, antifreeze, and multiple live viruses? Isn't this obviously hazardous? Weren't there any studies other than epidemiology to prove that mercury and aluminum could be safely injected into infants? Weren't there any studies comparing vaccinated and unvaccinated populations to find out whether the whole combined accumulation of these injections was having adverse effects?" The AAP can only hope to stall and suppress these questions -- and the accompanying guilt, embarassment, recriminations and potential liability.
Thanks so much for another excellent, interesting article.
Posted by: Twyla | February 01, 2008 at 11:44 AM
What an insightful post, you've given us a wealth of insight on the AAP. I join you in your call for physicians to question the motives of their union. I pray that they will begin to understand that our children are sick. While this may ultimately have an effect on their "well visit" income, the sad truth is that if they started treating our children properly, they'd have plenty of work to keep their practices busy. But will they know what to do with our kids? What are pediatricians learning in med school? So many seem skilled only in the "band-aid" approach - writing a prescription for a drug that will cover up the symptoms, but never considering what the cause of those symptoms might be. Physician training is of utmost importance and is something we need to address as a commmunity, we obviously can't count on the AAP to do it.
Posted by: Wendy Fournier | February 01, 2008 at 08:15 AM