Rules of Debate

Spin Circles (illusion)Debating is an ancient art covered by certain procedural rules - but also subject to logical scrutiny to determine whether an argument is valid, or whether it falls into the category of "fallacy". When an argument is not sustainable logically, the debater may resort to using a fallacious argument in order to win.

How does it happen that the question of whether to give a vaccination now or in a few months has been twisted into an issue of whether the parent is "pro" or "anti" vaccine?

The real issue is one of parental choice as to which vaccines and in what order do the parents, in conjunction with their physician, choose to have these vaccines administered.

"Are you pro- or anti- vaccine" is a very different question than "Do you choose to immunize your child against diphtheria, tetanus, whooping cough, measles, mumps, German measles... hepatitis B, ...?"

I have no desire to vituperate against vaccination. Smallpox was a dreadful disease which has pretty much been eradicated. Tetanus is an illness that nobody should have to die of. And diphtheria was a well-known killer of toddlers, creating a membrane in their throats that essentially strangled them. Hemophilus influenza meningitis, pneumococcal meningitis, Neisseria meningitides meningitis - these all caused life-long neurologic damage, even if they did not actually kill those who were infected. Vaccination has largely eradicated these dreadful diseases.

On the other hand, chicken pox is a pretty much innocuous childhood disease - albeit potentially fatal to someone whose immune system has been compromised by drugs given to suppress tumor growth or inflammation, since these drugs also suppress the immune system. Chicken pox pretty much stays with us, whether we vaccinate against it or not, reappearing later in life, under conditions of significant stress, in the form of Shingles.

There does not appear to be any logical reason to require the multitude of vaccinations that our children receive, at the time they receive them, other than that we can vaccinate against many infectious diseases, therefore we should vaccinate.

The flu is something that comes around every year, and mutates with great abandon. Our track record in predicting which exact variety is going to be in play in any given year is not very good. To my mind, it is not worth the annual dose of thimerosal (mercury) preservative which is given with every flu shot.

For a deductive argument to be a good one (to be "valid") it must be absolutely impossible for its premises to be true while its conclusion is false.

This is a classic example of a valid argument:

Notice that you cannot logically conclude, from this argument, that therefore Martha Grout, a woman, is immortal, unless you change the premise of the argument to "all human beings are mortal" and the statement to "Martha Grout is a woman". Then the conclusion becomes valid.

The following is an example of an invalid deductive argument.

The premise of the above argument would appear to be true. As of 1960, before the introduction of the measles vaccine, rates of measles had declined to near zero. There were no vaccinated individuals before 1963. After 1963 the rate of measles infection and death dropped some more.

The second part of the argument is true, according to CDC figures.[1]

Where the logic falls down is in the conclusion. For a logical argument to be valid, its conclusion must come logically from its premise. And the conclusion that all children should be vaccinated against measles - and multiple other infectious diseases, some of which are hardly ever fatal or even dangerous - does not follow from the premise.

Measles mortality rates

Downloaded on 10-11-15 from http://www.greenmedinfo.com/blog/every-last-one-how-force-total-vaccine-compliance-controlling-conversation-and

Downloaded on 10-11-15 from http://www.greenmedinfo.com/blog/every-last-one-how-force-total-vaccine-compliance-controlling-conversation-and

The standard for inductive arguments is less rigorous - the conclusions, where not necessarily proven, at least make sense to the reasoning mind. The above argument also fails this test.

A somewhat more convincing argument is found in an article from Harpocrates Speaks, posted in 2014 and entitled Pre-Vaccine Declines in Measles Mortality.

There is, of course, a sub-argument embedded but not stated in the above.

The arguments are somewhat murky and difficult to pin down to a logical succession of rational statements. We sometimes call this "spinning" the debate or "reframing" the premise.

The stated conclusion of that blog post is "if you never get infected with it, you can’t die from it".

The argument necessary to reach this conclusion is based on the (in the article unstated) premise that the measles vaccine is 100% effective in preventing infection with measles.

Unfortunately, we know that this is not the case. There have been documented cases of measles transmitted by immunized individuals.[2], [3] Thus, the whole argument falls into question.

A very well written article from GreenMedInfo.com appeared in my Inbox. The title of the article is: Every Last One - How to Force Total Vaccine Compliance by Controlling the Conversation and Eliminating Choice.

I too am not convinced that the debate is about vaccination. My point is that the debate has been skewed. 90% vaccination rate is pretty impressive, in terms of public health campaigns.

I agree with the GreenMedInfo article that the issue is much more a matter of freedom of choice. Our country, the United States of America, was built upon freedom of choice. If our freedom of choice is taken away, then it's really not the "One Nation Indivisible Under God" that I have always understood it to be.

I am not necessarily relating the number of vaccinations to the increasing incidence of "mental illness" in our children. Although the idea that 1 in 6 children being diagnosed with mental illness is appalling, we need to keep In mind the concept of total toxic load. Our children are also exposed to chemical preservatives and flavorings introduced into their food, pesticides and herbicides incorporated into their food, a multitude of volatile organic compounds from construction materials, furniture, bedding, clothing - there is no shortage of exposure to chemicals which are neither found in nature nor necessary for life. Vaccines and their additives and adjuvants are just part of the total toxic load.

According to the CDC National Immunization Program Printable Record for 2015 Recommended Childhood Immunization Schedule , a child born January 1st of 2009 should receive 16 vaccines by the age of six months, 24 by the age of 15 months. By the age of 6 years, a fully vaccinated child would have received a grand total of at least 38 vaccinations. Some make the count as high as 49 doses of vaccine. This would include an annual flu shot, most of which contain a thimerosal - mercury - preservative, starting at age 6 months, another contributor to the total toxic load. Mercury is highly toxic to the nervous system.

My point is that (a) that's a lot of vaccines for diseases some of which are not lethal, and (b) somewhere along the line the issue of freedom of choice has been corrupted. Who wouldn't want to vaccinate their child against tetanus or diphtheria? And who decided that chicken pox is a lethal disease?

And yet, things that seem like reasonable contraindications to vaccination at any given time are discounted, and not allowed to be listed as a "medical" exemption. The CDC has even published a document outlining conditions "mistakenly thought to be contraindications to vaccination", even by trained medical personnel like physicians.

From the CDC website we read: "Among the most common conditions mistakenly considered to be contraindications are diarrhea, minor upper respiratory tract illnesses (including otitis media) with or without fever, mild to moderate local reactions to a previous dose of vaccine, current antimicrobial therapy, and being in the convalescent phase of an acute illness." On the face of it, these conditions seem innocuous. However, how many parents have seen significant deterioration in a child with one of these "innocuous" conditions after receiving the 12-month or 16-month series of immunizations?

So apparently an immune system already under stress because of current illness is not a contraindication to deliberately inducing further stress on that immune system? I fail to see the logic.

If my child developed a seizure after previous vaccination, I would be reluctant to administer that particular vaccine again. Of course, if the child received four or five vaccines in one day, it becomes much more difficult to figure out which one caused the seizure - or whether it was simply an overload of the immune system. I might choose to do the vaccines one at a time, so as to lighten up on the immune system.

If a household member has a deficient immune system - perhaps a sibling with leukemia on immunosuppressants - that is also not considered a contraindication to vaccination of the healthy sibling. Tell that one to the mother whose with leukemia just died of disseminated chicken pox, acquired from a sibling or cousin who was recently vaccinated against varicella.

There is also a chart which lists the absolute contraindications to vaccination. These include only a few conditions - severe anaphylactic reaction after previous vaccination, severe immunodeficiency, coma or multiple seizures (not just one) after previous vaccination, collapse or shock after previous vaccination. It's a pretty small list. Most children would not qualify for medical exemption. There is no mention of even a possible contraindication if a child had an older sibling (or two) who developed regressive autism, developmental delay, speech delay, or cognitive impairment after vaccination.

There are plenty of reasons for parents to choose to vaccinate, and some reasons for them to choose not to vaccinate. The point is the word "choice".

The government also has choices. They can choose to exclude unvaccinated children from school, or from public gatherings. They could even choose to put unvaccinated children into their own separate compounds, where they would not put vaccinated children at risk (although in theory vaccinated children are not at risk, since they have been vaccinated). Or they could simply choose to accept that some parents will not vaccinate their children for whatever reason, and that this is a parental choice. If the child dies of a communicable disease that might have been prevented by vaccination, the parents are making that choice. The child is generally not of an age where he/she could understand the choice - although presumably the spirit of the child chose to reside in the particular family to which he/she was born, and hence would have been aware of the possibilities, and could have opted for a different choice before birth.

Of course, that latter option only makes sense if we believe in freedom of choice and life both before birth and after death.

Let us always remember that the word "choice" needs to be accompanied by the word "informed". Let us inform ourselves, let us disseminate accurate information, and then let us make our choice, whatever that choice may be.

The choice of vaccination does not need to be all or nothing, if we can simply agree on the concept that some viral illnesses are exceptionally lethal or damaging - diphtheria, tetanus, H flu meningitis, rubella in the fetus - and others may not be nearly so lethal, then perhaps we can be logical about the whole issue, and not have to threaten to put parents in jail or keep children out of school if the parents refused some of the vaccines at certain times.

Freedom of choice is a precious gift that many people in the world do not possess. Let us not throw away that premise upon which our Nation was founded. And let us not throw freedom of choice into the grinder of expediency.

The following charts were downloaded from the CDC website on 10/11/2015.

CDC National Immunization Program Printable Record for 2015 Recommended Childhood Immunization Schedule
For the best schedule for your child, consult your child’s physician or other healthcare professional. Visit http://www.cdc.gov/vaccines/schedules/index.html for additional information about vaccines and childhood immunizations.
This immunization schedule is recommended for your child, born on January 1, 2009.
Child’s Age Vaccine and Dose Protects Against Recommended Vaccination Date
At Birth
Hepatitis B
Dose 1 of 3
Hepatitis B virus (chronic inflammation of the liver, life-long complications) Jan 1, 2009
1 to 2 months
Hepatitis B
Dose 2 of 3
Hepatitis B virus (chronic inflammation of the liver, life-long complications) Jan 31, 2009 to Mar 2, 2009
2 months
(part of well-baby visit)
DTaP
Dose 1 of 5
Diphtheria, tetanus and pertussis (whooping cough) Mar 2, 2009
Hib
Dose 1 of 4
Infections of the blood, brain, joints, or lungs (pneumonia) Mar 2, 2009
Polio(IPV)
Dose 1 of 4
Polio Mar 2, 2009
Pneumococcal conjugate (PCV13)
Dose 1 of 4
Infections of the blood, brain, joints, inner ears, or lungs (pneumonia) Mar 2, 2009
Rotavirus **
Dose 1 of 3
Rotavirus diarrhea (and vomiting) Mar 2, 2009
4 months
(part of well-baby visit)
DTaP
Dose 2 of 5
Diphtheria, tetanus and pertussis (whooping cough) May 1, 2009
Hib
Dose 2 of 4
Infections of the blood, brain, joints, or lungs (pneumonia) May 1, 2009
Polio (IPV)
Dose 2 of 4
Polio May 1, 2009
Pneumococcal conjugate (PCV13)
Dose 2 of 4
Infections of the blood, brain, joints, inner ears, or lungs (pneumonia) May 1, 2009
Rotavirus **
Dose 2 of 3
Rotavirus diarrhea (and vomiting) May 1, 2009
6 months
(part of well-baby visit)
DTaP
Dose 3 of 5
Diphtheria, tetanus and pertussid (whooping cough) Jun 30, 2009
Hib
Dose 3 of 4
Infections of the blood, brain, joints, or lungs (pneumonia) Jun 30, 2009
Pneumococcal conjugate (PCV13)
Dose 3 of 4
Infections of the blood, brain, joints, inner ears, or lungs (pneumonia) Jun 30, 2009
Rotavirus **
Dose 3 of 3
Rotavirus diarrhea (and vomiting) Jun 30, 2009
6 to 18 months
Hepatitis B
Dose 3 of 3
Hepatitis B (chronic inflammation of the liver, life-long complications) Jun 30, 2009 to Jun 30, 2010
Polio (IPV)
Dose 3 of 4
Polio Jun 30, 2009 to Jun 30, 2010
6 months or older Influenza Dose 1 of 2 Flu and complications Sep 1, 2009 or later
Influenza Dose 2 of 2 Flu and complications Sep 29, 2009 or later, and one dose yearly thereafter
Quick Guide to Conditions Commonly Misperceived as Contraindications to Vaccination
Vaccine Conditions commonly misperceived as contraindications
(i.e., vaccination may be administered under these conditions)
general for all vaccines, including DTaP, pediatric DT, adult Td, adolescent-adult Tdap, IPV, MMR, Hib, hepatitis A, hepatitis B, varicella, rotavirus, PCV, TIV, LAIV, PPSV, MCV4, MPSV4, HPV, and herpes zoster
  • Mild acute illness with or without fever
  • Mild-to-moderate local reaction (i.e., swelling, redness, soreness); low-grade or moderate fever after previous dose
  • Lack of previous physical examination in well-appearing person
  • Current antimicrobial therapy1
  • Convalescent phase of illness
  • Preterm birth (hepatitis B vaccine is an exception in certain circumstances)2
  • Recent exposure to an infectious disease
  • History of penicillin allergy, other nonvaccine allergies, relatives with allergies, or receiving allergen extract immunotherapy
DTaP
  • Fever of <105°F (<40.5°C), fussiness or mild drowsiness after a previous dose of DTP/DTaP
  • Family history of seizures
  • Family history of sudden infant death syndrome
  • Family history of an adverse event after DTP or DTaP administration
  • Stable neurologic conditions (e.g., cerebral palsy, well-controlled seizures, or developmental delay)
Tdap
  • Fever of ≥105°F (≥40.5°C) for 48 hours after vaccination with a previous dose of DTP or DTaP
  • Collapse or shock-like state (i.e., hypotonic hyporesponsive episode) within 48 hours after receiving a previous dose of DTP/DTaP
  • Seizure <3 days after receiving a previous dose of DTP/DTaP
  • Persistent, inconsolable crying lasting >3 hours within 48 hours after receiving a previous dose of DTP/DTaP
  • History of extensive limb swelling after DTP/DTaP/Td that is not an arthus-type reaction
  • Stable neurologic disorder
  • History of brachial neuritis
  • Latex allergy that is not anaphylactic
  • Breastfeeding
  • Immunosuppression
IPV
  • Previous receipt of ≥1 dose of oral polio vaccine
MMR3,4
  • Positive tuberculin skin test
  • Simultaneous tuberculin skin testing5
  • Breastfeeding
  • Pregnancy of recipient’s mother or other close or household contact
  • Recipient is female of child-bearing age
  • Immunodeficient family member or household contact
  • Asymptomatic or mildly symptomatic HIV infection
  • Allergy to eggs
Hepatitis B
  • Pregnancy
  • Autoimmune disease (e.g., systemic lupus erythematosis or rheumatoid arthritis)
Varicella
  • Pregnancy of recipient’s mother or other close or household contact
  • Immunodeficient family member or household contact6
  • Asymptomatic or mildly symptomatic HIV infection
  • Humoral immunodeficiency (e.g., agammaglobulinemia)
TIV
  • Nonsevere (e.g., contact) allergy to latex, thimerosal, or egg
  • Concurrent administration of coumadin or aminophylline
LAIV
  • Health-care providers that see patients with chronic diseases or altered immunocompetence (an exception is providers for severely immunocompromised patients requiring care in a protected environment)
  • Breastfeeding
  • Contacts of persons with chronic disease or altered immunocompetence (an exception is contacts of severely immunocompromised patients requiring care in a protected environment)
PPSV
  • History of invasive pneumococcal disease or pneumonia
HPV
  • Immunosuppression
  • Previous equivocal or abnormal Papanicolaou test
  • Known HPV infection
  • Breastfeeding
  • History of genital warts
Rotavirus
  • Prematurity
  • Immunosuppressed household contacts
  • Pregnant household contacts
Zoster
  • Therapy with low-dose methotrexate (≤0.4 mg/kg/week), azathioprine (≤3.0 mg/kg/day), or 6-mercaptopurine (≤1.5 mg/kg/day) for treatment of rheumatoid arthritis, psoriasis, polymyositis, sarcoidosis, inflammatory bowel disease, or other conditions
  • Healthcare providers of patients with chronic diseases or altered immunocompetence
  • Contacts of patients with chronic diseases or altered immunocompetence
  • Unknown or uncertain history of varicella in a U.S.-born person
Abbreviations
DT = diphtheria and tetanus toxoids; DTP = diphtheria toxoid, tetanus toxoid, and pertussis; DTaP = diphtheria and tetanus toxoids and acellular pertussis; HBsAg = hepatitis B surface antigen; Hib = Haemophilus influenzae type b; HPV = human papillomavirus; IPV = inactivated poliovirus; LAIV = live, attenuated influenza vaccine; MCV4 = quadrivalent meningococcal conjugate vaccine; MMR = measles, mumps, and rubella; MPSV4 = quadrivalent meningococcal polysaccharide vaccine; PCV = pneumococcal conjugate vaccine; PPSV = pneumococcal polysaccharide vaccine; Td = tetanus and diphtheria toxoids; Tdap = tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis; TIV = trivalent inactivated influenza vaccine.Footnotes
  1. Antibacterial drugs might interfere with Ty21a oral typhoid vaccine, and certain antiviral drugs might interfere with varicella-containing vaccines and LAIV.
  2. Hepatitis B vaccination should be deferred for infants weighing <2,000 g if the mother is documented to be HBsAg-negative at the time of the infant’s birth. Vaccination can commence at chronological age 1 month or at hospital discharge. For infants born to HBsAg-positive women, hepatitis B immune globulin and hepatitis B vaccine should be administered within 12 hours after birth, regardless of weight.
  3. MMR, LAIV, and varicella vaccines can be administered on the same day. If not administered on the same day, these vaccines should be separated by at least 28 days.
  4. HIV-infected children should receive immune globulin after exposure to measles. HIV-infected children can receive varicella and measles vaccine if CD4+ T-lymphocyte count is >15%. (Source: Adapted from American Academy of Pediatrics. Passive immunization. In: Pickering LK, ed. Red book: 2009 report of the Committee on Infectious Diseases. 28th ed. Elk Grove Village, IL: American Academy of Pediatrics; 2009.)
  5. Measles vaccination might suppress tuberculin reactivity temporarily. Measles-containing vaccine can be administered on the same day as tuberculin skin testing. If testing cannot be performed until after the day of MMR vaccination, the test should be postponed for at least 4 weeks after the vaccination. If an urgent need exists to skin test, do so with the understanding that reactivity might be reduced by the vaccine.
  6. If a vaccinee experiences a presumed vaccine-related rash 7 through 25 days after vaccination, the person should avoid direct contact with immunocompromised persons for the duration of the rash.

Reference:

  1. Szilagyi PG, Rodewald LE. Missed opportunities for immunizations: a review of the evidence. J Public Health Manag Pract 1996;2:18-25.

[1] Morbidity and Mortality Weekly Report (MMWR) – Vaccination Coverage Among Children in Kindergarten - United States, 2013-14 School Year. October 17, 2014 / 63(41);913-920

[2] Aaby P, Bukh J et al. Vaccinated children get milder measles infection: a community study from Guinea-Bissau. J Infect Dis. 1986 Nov;154(5):858-63.

[3] Rosen JB, Rota JS et al. Outbreak of measles among persons with prior evidence of immunity, New York City, 2011. Dis. 2014 May;58(9):1205-10. doi: 10.1093/cid/ciu105.

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