[back] Dr. Samuel Katz
Thursday, October 14, 1999
(This is an unedited, uncorrected transcript.)
TED KOPPEL Earlier this week, the worlds
population passed the six billion mark. What is so staggering about that number is that
most of the growth has happened during this century. There were only about 1.6 billion
people as the 20th century dawned. And when you consider how ruthlessly efficient we have
been at killing one another, Mao in China, Stalin in the Soviet Union, Hitler throughout
Europe, Pol Pot in Cambodia, well, you have to ask yourself, how in heavens name we
end this century with so many more people than we had at the beginning? More and better
food? Thats certainly one answer. Hugely improved medical care has to be another.
JOHN DONVAN Over the past year, just what message have we all been receiving about the safety of childhood vaccinations? In the winter we heard on ABC:
Unidentified Woman #1 Ronnys doctor thinks the vaccination could have triggered his illness.
DONVAN In the summer on NBC:
Unidentified Man #1: These cases are extraordinarily rare. And oftentimes, its impossible to clearly identify that the vaccine is the culprit.
DONVAN This fall, CBS:
Unidentified Woman #2 Mary Elizabeth Haggerty suffered a 45-minute-long seizure shortly after receiving a DTP shot when she was 17 months old. She never recovered.
DONVAN And also this fall, CNN:
Dr. JON ABRAMSON (American Academy of Pediatrics) We cant let down our guard as far as making sure that all our children are vaccinated.
DONVAN In short, it is a conflicting message. Vaccines, say the experts, are why diseases like polio, small pox, and diphtheria no longer scare Americans. There is no evidence, says the medical establishment, that theyre causing any harm. But welling up from the public, from parents, spreading by word of mouth and passed along of course on the Internet are those frightening anecdotes of vaccinations that do harm.
Unidentified Woman #3 He was growing up really fine until he got that shot.
Unidentified Man #2 Theres just an incredible sense of frustration in the family. You know, autism faces you 24 hours a day.
Unidentified Woman #4 Theres three of us walking distance with autistic children.
Unidentified Woman #5 It scares me.
DONVAN Right now, word of mouth says one vaccination may actually be causing autism. The suspect is MMR, the vaccination against measles, mumps, and rubella. The fear just will not die, even though the one study that looked into it, published in the respected journal The Lancet last June, says there is no evidence that autism rates are increasing because of MMR. But its as though nobody read the report. Six weeks after The Lancet study, Congress held hearings into the safety of MMR. And the news media kept raising the question of whether there is a link.
Weve seen this happen before, a refusal by nonexperts, parents or patients, to trust the word of people who are supposed to be the experts. Gulf War syndrome, silicone breast implants, these were cases where the doctors and researchers tried and failed to establish cause and effect. And when that happened, the public suspected the experts just hadnt tried hard enough. It is the power of the anecdote, the old cliche, when you see the faces of the kids who have become sick after a vaccination, that a picture is worth 1,000 words.
But do not dismiss what an anecdote may be trying to tell you, says Barbara Fisher, who believes her son suffered brain damage from a vaccination in 1982.
Ms. BARBARA FISHER You know, the corner stone of medicine has always been anecdotal evidence. That is the first warning sign that something that there may be a cause-and-effect relationship between something that a physician does and something adverse that happens.
Unidentified Woman #6 National Vaccine Information Center.
DONVAN Fisher heads a Virginia-based movement that has challenged the safety of vaccines and publishes a consumers guide for parents. The operation has a bit of a David and Goliath complex. Fisher feels that her work has been distorted, ridiculed, and demonized by certain members of the medical establishment who, she says, try to dismiss her as an overemotional mom. But Fisher is not above a little demonizing either. She believes there are people with bad intentions.
Ms. FISHER Because I think those who have a vested interest
DONVAN Who are they?
Ms. FISHER in maintaining the status quo.
DONVAN Who would who would want to maintain the status quo if kids are at risk?
Ms. FISHER I think that certainly the vaccine manufacturers who are in the business of making and selling vaccines, and whose obligations to their stockholders, frankly, is the bottom line.
DONVAN All that aside, Fishers organization is an example of lay people who have made themselves experts on complicated medical issues. They have also proved their point in a significant way. Thanks in part to their well-informed lobbying, Congress, in 1986, passed a law providing compensation for kids harmed by vaccines. The fact that in recent years, the DTP vaccine for diphtheria, tetanus, and pertussis was changed because there were concerns it could lead to brain damage, the fact that the CDC has suspended this year the rotavirus vaccine, which appeared to cause severe intestinal problems in infants.
Unidentified Woman #7 You are good. Honey, youre a good girl.
DONVAN These changes suggest that parents and doctors who question the safety of vaccines are not just being paranoid. But the greater fear of most doctors is that parents will panic and stop getting their children vaccinated; and that, they say, could be a nightmarish step backward. You dont see whooping cough, pertussis very much anymore. It used to kill 9,000 a year, before there was a vaccine. And polio, its been all but eradicated from our hemisphere since 1991, because of a vaccine.
Dr. ABRAMSON There were hospitals full of children and adults on iron lungs, which was the only way these children and adults could breathe because of polio. When you see the real disease, and its in front of you, thats when it becomes real. We have done such a good job with vaccines and eliminating diseases that people forget what happens when you stop vaccinating.
DONVAN Let me be clear about one thing. Youre coming nowhere near calling for a banning of vaccines or a boycott of vaccines by parents.
Ms. FISHER No. Absolutely not. Were simply saying youve got to take a look at this. Youve got to achieve a balance. And youve got to make the policies more humane. And youve got to always try to make the vaccines safer.
DONVAN Which any doctor will tell you is their concern, too.
Dr. ABRAMSON Safety is extremely important to me. I have three children. I have immunized them. I want to make sure these vaccines are safe.
DONVAN But the truth is, even living as we do in the most medically advanced society in history, 100 percent safety in anything still eludes us. Medicine tries all the time to achieve that mark. But, when medicine fails, when science cannot explain everything, thats when we start listening to tragic anecdotes, especially if youre the mother or the father of the child the anecdote is about. Im John Donvan for NIGHTLINE in Washington.
KOPPEL So, whats a parent to do, vaccinate or not? A variety of views when we come back.
KOPPEL Joining me now here in Washington, Dr. Samuel Katz, one of the
co-creators of the measles vaccine. He co-chairs the National Immunization Information
Network. In Coeur DAlene, Idaho, Dr. Jane Orient, an internist, whos also
executive director of the Association of American Physicians and Surgeons. And in our
Boston bureau, my old friend ABC News medical editor Dr. Timothy Johnson.
Dr. JANE ORIENT (Association of American Physicians & Surgeons) I think we should be cautious. All vaccines just like all drugs have side effects. I think we need to consider whether we should force parents to have vaccines that they believe are not in their childs best interest, particularly against diseases such as hepatitis B at which the child is at minimal risk, at least if his mother is not infected. We have sent a letter several months ago to the CDC asking for the answer to a few simple questions. When before you licensed hepatitis B vaccine for newborns, how many newborns were tested, how old were they, what ethnic groups did they belong to, what did you look for and how long did you follow them for? We have yet to get an answer to those questions.
KOPPEL Let me
Dr. ORIENT Theres a lot of questions about the safety of vaccines that have not been answered.
KOPPEL Let me just rewind the tape a little bit here and ask you whether, in fact, it is just a few vaccines that you are concerned about, or are you concerned in principle about the notion of mandatory vaccines of any kind?
Dr. ORIENT We are concerned in principle about violating the Nuremberg code which forbids subjecting patients to medical treatment without their informed consent. I think that for many vaccines the physician would certainly advise the parents to have the child vaccinated. For others there are serious questions. In every case its the physicians responsibility to weigh the risk and the benefit to the individual patient.
KOPPEL What do you think would happen, Dr. Katz, if in fact we left it up to each individual parent? I mean, there is something rather appealing about the notion that a parent should in the final analysis have the right to determine whether his or her child gets a vaccination.
Dr. SAMUEL KATZ (National Immunization Information Network) Indeed, that is the way it is done, Mr. Koppel. Physicians, pediatricians, in particular, and parents discuss vaccine programs and arrive at informed decisions about what has been determined to be the most lifesaving protective event and discovery of the 21st and 20th century. The vaccines that you already spoke of have prevented many of the infectious diseases that formally made children ill, killed some children, and left some children disabled for life.
KOPPEL What about some of the public school programs which, indeed, require that before a child can come to school that child has to have, as I mentioned at the top of the program, in some cases our kids have 12, 14, 15 different inoculations and vaccinations before they are six years old.
Dr. KATZ In the first two years of life, children get a dozen immunizations, and then several more by the time they are four or five years of age. The school entry requirements and day-care requirements are established to protect these children. Its not just an individual but a community protection and responsibility.
KOPPEL But that does undermine thethe suggestion you made a moment ago that indeed it is voluntary. Its not voluntary if I cant send my children to school if I dont do it.
Dr. KATZ You can refuse to have your child immunized. But, by and large, less than 1 percent of the US population, about .4 percent in the studies that have been done, choose not to have their children immunized. You may pay a penalty in the sense that if a disease breaks out in the school, which is one for which your child has not been immunized, she or he will be discharged from the school until the disease epidemic or outbreak has ended.
The other thing that people forget is that though we dont see these diseases in the continental US today, there were over 100,000 cases of diphtheria in Russia in the last several years. There are measles outbreaks in Brazil and even in Canada. These diseases have not disappeared. They are less than a jet plane ride away from us. And, in fact, last year, of all the measles cases that occurred in this country, they were all imported from other countries. And, indeed, it was determined by studies that if you were unimmunized you had a 35 times greater likelihood of acquiring measles than did any of the immunized children.
KOPPEL Tim Johnson, let me let me bring you in. Youve made a career here at ABC out of reassuring people all over the country. So, do a little bit of reassuring here. When when there is concern, for example, by some of these parents that their autistic children, that the autism seems to manifest itself shortly after or in concert with the giving of a certain vaccination, you can understand that they that they may jump to certain conclusions here. How justified are those conclusions?
Dr. TIM JOHNSON (ABC News Medical Editor) The issue is, and the problem is that you are talking about two things that are very common in early childhood. That is certain disease conditions. Youre talking about autism in this case and the fact that most children get vaccinated. So you have side by side two very commonly occurring events in early childhood. When it occurs in a child, that is a child that gets vaccinated and then develops autism, its very natural that a parent would put the two together. Thats an association. But the job of science is to pr prove that its true cause and effect. And the way we do that traditionally, in this case the way its been done already, is to take a look at a group of autistic children and see if theres any difference in the rate of autism among those children who were vaccinated and those who were not. And when they did that in the study referred to in the piece earlier, printed in The Lancet last June, there was no difference. That suggests that while there may be a causation that is, a coincidence in time, there is no true scientific cause and effect. Thats what we have to do for all of these kinds of problems when they arise. And every time weve tried to look at them with vaccines, we can not prove cause and effect.
KOPPEL All right, weve set the table. Well continue the discussion in just moment. Back with our guests in a moment.
KOPPEL Three guests, three doctors, Samuel Katz, Jane Orient, and ABCs Tim
Dr. ORIENT Yes, I do, because I think that the CDC is not being completely honest with people. They are saying these vaccines are safe and to save the world from hepatitis B your baby has to be vaccinated. If parents want to refuse consent, they may be threatened with having their children taken away from them. They may be treated quite quite callously when they ask, Well, why did my baby bleed to death and have liver damage at autopsy 12 hours after receiving an injection hepatitis B vaccine?
KOPPEL Let me let me let me let me stop you, because what youve said isis so outrageous if true, that it does require an immediate response. And Dr. Katz, I know youre an adviser to the CDC. So, would you respond, please?
Dr. KATZ Yes, I think that is an egregious totally unreliable statement. First of all, the Nuremberg code speaks to experimentation, not to prevention and to treatment. Secondly, hepatitis B infection in infants and children leaves an incredibly high risk of chronic liver disease, of cirrhoses, of cancer of the liver. There are four of five thousand individuals a year in our country who die of the complications of hepatitis B.
KOPPEL Address address, if you would, though, what Dr. Orient said about if parents refuse, that the child would be taken away from them, because Ive never heard that.
Dr. KATZ Thats fallacious. Theres no such event ever been recorded to my knowledge, or that Ive ever heard from anyone else. Thats just not true.
KOPPEL Dr. Orient, would you like to be a little more specific there.
Dr. ORIENT I have heard of cases well, I have heard of cases of parents
Dr. KATZ Id like to hear one demonstrated.
Dr. ORIENT who were threatened in that way.
Dr. ORIENT Even after the baby had a severe adverse reaction to the first dose, they were told
KOPPEL I must tell yo u I must tell you, for a scientist to say I have heard of cases is about as unconvincing as anything I have ever heard to
Dr. ORIENT Well, Im a physician. And when a patient tells me something, I dont assume that the patient is a liar. I assume that what hes telling me is probably true.
KOPPEL Tim Johnson, have you ever heard anything like this happening? I dont want to dismiss it because, you know, strange and terrible things happen even in this country. But I also dont want to leave it hanging out there if, in fact, theres no evidence to support it.
Dr. JOHNSON No, I have not heard of any such case, nor have I ever had an impetus to look into it. You know, this kind of boils down to individual rights vs. whats best for society. And from a political point of view, this debate can be appealing. I have to say just flatly from a medical point of view, there should be no debate. That is the benefits of vaccines so clearly outweigh potential risks.
Dr. ORIENT That
Dr. JOHNSON That from a strictly medical viewpoint there should not be a debate.
KOPPEL Go ahead, Dr. Orient.
Dr. ORIENT that is notthat is not so.
KOPPEL What is not so?
Dr. ORIENT There has been no proof that the benefits outweigh the risks for the individual patient. And hepatitis B is extremely rare in babies.
Dr. JOHNSON What what...
Dr. KATZ Let me tell you about meningitis. We had 20,000 cases of meningitis a year in this country due to an organism caused tomof called Haemophilis influenza B, in children under five years of age. Until the early 1990s, when a new vaccine was introduced, a conjugated protein vaccine against the organism, Haemophilis influenza B. This last year there were less than 200 cases in children under five years of age. Thats a remarkable achievement. But those are the things that people dont put on the front pages of papers. They put on these bizarre complaints, such as Dr. Orient is raising, which have no basis in fact.
KOPPEL Tim Johnson, were were down to our last minute or so, and I think it is appropriate if you would just spend that last minute weighing and comparing the relative importance of individual rights, which of course Dr. Orient is stressing, and the rights of society as a whole, in a case like this, particularly with infectious diseases, to protect itself.
Dr. JOHNSON Its appealing on the surface to say an individual has the right to do what they want. The problem when it comes to vaccines and infectious disease is that if enough individuals start making that decision, all of a sudden you reach a point where the immunity that has been caused by the vaccine will start to disappear and all of us will be at risk. Ten years ago, when there was concern about the measles vaccine, measles vaccinations dropped by 10 percent. In a relatively short time we had an epidemic of measles. Over 55,000 cases, 120 deaths. So, what an individual does doesnt just affect that individual, but it can affect all of us. And thats why we have to be so certain that we vaccinate in our society.
KOPPEL It would have been overly optimistic to expect that we can resolve this issue tonight. But Im very grateful to the three of you for joining us Dr. Orient, thank you. Dr. Johnson and Dr. Katz.
Dr. KATZ Thank you, Ted.
KOPPEL Im deeply appreciative that you all came in. Ill have a word about our NIGHTLINE Friday night special when we come back in a moment.
KOPPEL Tomorrow on NIGHTLINE, a forgotten chapter from World War II. African-American sailors still looking for justice nearly 55 years after they were court-martialed for refusing to load ammunition aboard Navy warships. The explosion at Port Chicago, our NIGHTLINE Friday night special.
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