Sometimes it’s not easy being a pro-vaxxer

Despite the fact that vaccines have saved uncountable lives and virtually wiped out smallpox, polio, tetanus and rabies, vaccine risks exist. When those risks result in death, people lose trust in all vaccines.

image: Skeptical Raptor

Look at what happened in the Philippines. In 2015 they purchased three million doses of a new dengue vaccine.

Dengue is not as deadly as it might seem. Three-quarters of people infected by the mosquito-borne virus don’t notice anything. The remainder fall into three groups – symptoms similar to the common cold; or a fever accompanied by headache, pain behind the eyes, aching joints and bones that sometimes leads to internal bleeding; or the most deadly, dengue hemorrhagic fever and dengue shock syndrome where plasma seeps out of capillaries, liquid pools around organs, massive internal bleeding ensues. The brain, kidneys and liver begin to fail (Scientific American, April, 2018).

In the Philippines with a population of 105,000, dengue kills an average of 750 people a year. Any death is one too many but that number doesn’t even put dengue-deaths in the top ten list of killers. Of infectious diseases, many more die from pneumonia and tuberculosis.

The dengue vaccine wasn’t cheap. Made by the pharmaceutical company Sanofi Pasteur, Dengvaxia cost more than the entire national vaccination program for 2015, which covered pneumonia, tuberculosis, polio, diphtheria, tetanus, pertussis, measles, mumps and rubella. And it would reach less than one percent of the population.

Some wondered if the vaccine Dengvaxia had been oversold to the Philippine government in a panic mode.

Here’s where the nightmare for pro-vaxxers comes in.

Internist Antonio Dans and paediatrician Leonila Dans at the University of the Philippines Manila College of Medicine discovered some startling results: young children who were vaccinated were more like likely to suffer from dengue that those who weren’t vaccinated.

They found this out by studying publications by the makers of the vaccine, Sanofi Pasteur. While it worked for older children, for younger ones, the vaccine made things worse.

The two Dans warned the Philippine secretary of health in 2016 of their findings but in the meantime, the World Health Organization said that there was no problem.

“It was either believe us or believe the WHO,” said Antonio Dans. “If I were them, I’d believe the WHO. I mean, who were we? We were just teachers in a small medical school.”

The Philippine secretary of health responded with her own warning: doctors who engaged in “misinformation” on the vaccine would be responsible for every death from dengue that could have been prevented.

Then Eva Harris, a dengue expert at the University of California, Berkeley, found strong evidence in 2017 to support the Dans:

Harris’s evidence made the world take notice. Now Sanofi Pasteur and the WHO don’t recommend Dengvaxia for young children who have not been previously infected.

The reasons why Dengvaxia makes matters worse for children who have not been infected and better for those who have is puzzling. There are a few theories but it’s debatable.

The confusion has led to lack of confidence in vaccinations. In 2015, 93 per cent of Filipinos strongly agreed that vaccines are important.  In 2018, less than a third thought so.

Now, Filipinos suspicious of vaccines aren’t getting kids vaccinated and several outbreaks of measles have occurred.

Vaccines save lives but in a rush to save lives at any cost, the rollout of Dengvaxia was too soon and the cost was a loss of confidence of all vaccines.

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When am I dead?

When I’m dead I won’t be writing these columns. But other than that, indication of my demise might not be certain. The problem is that our definitions of death vary according to legal, cultural, religious and philosophical perspectives.

  image: slideserve.com

There was some dispute about whether Taquisha McKitty of Brampton was dead. Doctors said she was but her parents disagreed. She went into cardiac arrest following a drug overdose and was declared neurologically dead. A death certificate was issued.

McKitty’s father said: “My daughter is not dead -she shows that every day.” He maintains that his daughter shows signs of life: squeezing the hands of loved ones and even shedding tears.

Whether she was living was finally decided through a court decision. A judge ruled that McKitty was, in fact, dead.

Keeping someone alive with life support is not an issue. Canadians are kept alive with pacemakers, kidney dialysis, mechanical hearts and lungs while awaiting transplants. The issue is whether we should maintain one’s bodily functions when they are dead.

McKitty’s family might disagree with my last sentence. If they believe that bodily functions define life, then the squeezing of hands indicates that Taquisha was alive.

Others could argue that breath itself is life. If so, breathing is an indication of life. Genesis 2:7 says: “The LORD God formed the man from the dust of the ground and breathed into his nostrils the breath of life, and the man became a living being.”

Still others believe that the soul, the essence of life, resides in the heart. The ancient Egyptians thought that the heart was vital. During mummification, they discarded the brain by removing it through the nose but kept the heart. They likely believed that as long as the heart is pumping, a person is alive.

In Western culture, the brain defines life because it’s the seat of the mind. Some philosophers suggest that it’s the mind that defines life. They argue that since the mind resides in the brain, and because the brain is a (biological) machine, the mind could reside in any machine. If complex computer could be built, the mind could continue to live in a solid state environment without a body.

The Japanese would disagree. They see the body and mind as a single unit so that the mind is not independent of the brain. To be alive is to experience bodily sensations and desires as well as cerebral thoughts.

The judge in McKitty’s case ruled that the brain is central in determining death. If the brain is dead, so is the mind. This opinion coincides with doctors’ assessments. Dr. Sonny Dhanani, a pediatric critical care physician in Ottawa, concludes:

“When brain death occurs, there is no blood and oxygen going to it. The brain ceases all function. There are no functions left to be lost. This means there is the irreversible loss of any ability to have thoughts or feelings or memories (Globe and Mail, July 6, 2018).”

I won’t know when I’m dead and given the definitions of life, maybe no one else will be sure any time soon.

Legalize heroin and save lives

Legal opiates are being use to adulterate illegal ones with tragic consequences. More than 800 British Columbians were killed in fentanyl-related overdoses last year. Many of them were ordinary Canadians you might find living next door. One of them was my nephew who died a few years ago.

Calgary Herald

Calgary Herald

They injected what they thought was heroin, or some other illegal drug. If they had injected legal heroin, of known purity and strength, they would still be alive. I’m not naive; they would still be addicted but their quest for bliss would not have ended in death.

It’s a question of harm prevention. Legalization of heroin may seem like a radical idea but not long ago so did giving drug addicts clean needles and a safe place to inject.

Like the prohibition of alcohol, the prohibition of drugs has been a dismal failure. Prohibition simply pushes the drug trade underground. When a trade is unregulated, who knows what junk users will end up taking? Drug manufacturers don’t intend to kill users: it’s bad for business to kill your customers. They just want to maximize profits.

Fentanyl is perfectly legal. It’s prescribed by doctors for controlling pain. Fentanyl is just one the opium family. It turns out that all of them are addictive.

A brief history of legal opiates is a guide to the intersection of illegal ones. Opium from Persian poppies has been used for pain control since the fourth century. Researchers discovered the active components of opium -morphine, codeine and theobain- in the 1800s. In an attempt to find a non-additive painkiller, heroin was derived from morphine. The manufacturer of heroin, Bayer, pulled it from shelves in 1913 once it was found to be addictive.

In the quest for a non-addictive pain killer, Perdue Canada filed a patent in 1992 for OxyContin, a pill that would treat pain “without unacceptable side effects (Globe and Mail, Dec. 30, 2016).” Perdue encouraged doctors to prescribe the pill and soon it was a blockbuster hit with billions of dollars being made.

But OxyContin turned out to have terrible side effects and thousands of were hooked. Canadians consume more prescription opiates on a per-capita basis than any other country in the world according to a United Nations report.

As in all opiates, those hooked on OxyContin become habituated so that they needed more pills to control pain. Purdue attempted to control the problem with the replacement OxyNEO in 2012, a tamper-resistant alternative that is difficult to crush, snort or inject. And that same year, the provinces stopped paying for both opiates.

Both factors drove addicts to the streets to find a fix. Illegal drug manufacturers care not how their clients get hooked, whether it be from the pursuit of bliss or the relief of pain.

Fentanyl is now the universal opiate. Manufactured in China in concentrated form, it can be ordered on the internet and sent through the mail. From there, it is pressed into pills to mimic OxyContin and other opiates.

Making fentanyl illegal is not the solution. Drug abuse is a medical problem, not a criminal one. All opiates should be legalized and safe doses prescribed. Education, as in tobacco and alcohol abuse, is the only solution.