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Today's Sun carries opposing views on the controversy surrounding vaccination and autism, one from Dr. Virginia Keane, the head of the Maryland chapter of the American Academy of Pediatrics and the other from Alison Hamilton, the co-coordinator of the Maryland/DC chapter of Talk about Curing Autism. Both came in response to a Sun editorial on the topic. To put it in a nutshell, the Keane says the purported link between vaccines and autism has been debunked and parents are putting their kids at risk by withholding immunization, and Hamilton says there isn't any good science on the issue.

In her letter, Keane also addressed the issue of the economics of vaccination, which had to be cut for space in the print edition. (Hamilton's letter was also cut for space, but less so.) I'll paste the full letters below the jump.

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"Vaccination is safe Recent articles in the SUN, on whooping cough and primary care, highlight the Sun Paper's attention to local and national health issues but fail to communicate the state of affairs where these two critical issues, vaccines and primary care, overlap.

"We are at the precipice of a crisis when it comes to vaccines. Celebrities spread false accusations of vaccine danger, perpetuating the myth of a causal link between vaccines and autism. When science does not support their statements, they accuse the pediatric physician community of being in the pocket of the vaccine companies, accepting large grants and small gifts in exchange for our continued support of vaccines. They falsely claim we make large profits in our practices from the sale of vaccines, and that this alone would cause us to turn our backs on all that is true, safe and ethical. They falsely claim that we would continue to give vaccines even if we knew they were dangerous. Suddenly we, the protectors of children, are accused of knowingly causing them harm!

"In some communities this false rhetoric has convinced large numbers of parents to refuse vaccines. When 15 percent of the population is unvaccinated, there is loss of herd immunity — protection of the group as a result of there being only a small number of susceptible individuals. In several Western states there are large geographic areas where 20 percent to 35 percent of children are unvaccinated due to parental refusal! Some states, such as our neighbor West Virginia, have solved this problem by passing "no exception" legislation, requiring every child to be vaccinated for public health reasons.

"Fortunately, we are not yet seeing high refusal rates here in Maryland, but the rates are climbing.

"Unvaccinated children get preventable diseases. This spring there was a mini outbreak of measles in Montgomery County, all in unvaccinated people. An article in the journal Pediatrics finds the risk of pertussis (whooping cough) is 23 times higher in children who are unvaccinated compared to those who are vaccinated. IIf vaccine refusals increase, we will see thousands of cases of preventable diseases, and hundreds of deaths from preventable diseases.

"Vaccine refusal is not the only threat to vaccine coverage.

"A business model for vaccine compensation developed by the national American Academy of Pediatrics states that for financial sustainability physicians should be paid the cost of the vaccine plus 17-20% to cover overhead. Despite this some insurers continue to use the formula of paying the median community cost, with no compensation for overhead, which by definition means fifty percent of providers will be paid LESS THAN THE COST OF THE VACCINE, and all will be paid less than their total cost. This is supposed to incent physicians to find lower cost distributors, but what it really does is just drive down the median compensation. No shop owner could continue to sell an item for which he was compensated below cost. Some pediatricians are now saying they can no longer afford to provide vaccines. They are referring to the local health department. The local health departments do not have the infrastructure to provide vaccines to a large volume of patients.

"Thus, we face a crisis.

"All of this is happening as we approach the most vaccine intensive fall we have ever had. This is the first year that universal influenza vaccination of children birth to eighteen is recommended by the CDC. Physicians who provide childhood immunizations are struggling with how much vaccine to order so they have enough but do not have any left over, and how they are going to get every patient into the office for a vaccine in a six week period, while carrying on their practices. There is also a very good chance that we will be giving two waves of flu vaccine: one for the new H1N1, and the other for the seasonal strains. A double dilemma.

"Primary care physicians are the vaccine distribution system. If we can't do the job, or can't afford to do the job, there is no substitute system It's time for policy makers, legislators and the public to recognize that the vaccine distribution system is at risk and take steps to assure that primary care physicians can continue to vaccinate Maryland's citizens. Vaccines are safe and vaccines save lives. Let's make sure primary care physicians can give them and you can get them."

Virginia Keane, M.D., Baltimore
The writer is president of the Maryland chapter of the American Academy of Pediatrics

Risks can't be dismissed

"Your editorial, 'A Dangerous Denial' (June 1), was objectionable in many ways. Characterizing the vaccine-autism issue as "a suspicion that has been thoroughly investigated and authoritatively debunked" is both wrong and irresponsible. None of the 19 shots most American children receive in their first six months has been studied for its relationship to autism. How is that a thorough investigation? Thimerosal, the preservative still found in the vaccine supply, also has not been proven a safe ingredient. The majority of the studies that have been done — and are used by pundits and public health officials to support their case that vaccines do not cause autism — are rife with conflicts of interest, including contributing authors who received funding from vaccine manufacturers.

"The language used in the editorial mischaracterizes the parents at the center of this debate and borders on obnoxious. The 'odd beliefs' you describe don't seem so outlandish to Dr. Bernardine Healy, former director of the NIH, who said the government has been 'too quick to dismiss the concerns of these families without studying the population that got sick. I think public health officials have been too quick to dismiss the hypothesis as irrational without sufficient studies of causation.'

"Worse, you dismiss the parents' concerns with language like 'odd,' and 'strange,' treating them more like cult members than people whose concerns are founded on legitimate, painful experience. Condescending tone aside, the implication that these parents are anti-vaccine is an over-generalization. Along with many other parents who believe the current vaccine schedule played a role in our children's regression into autism, I believe that immunizations should be delivered at a pace that makes sense for children's developing systems and not at a rate that is merely convenient for health insurers. If the vaccine-autism link had been 'authoritatively debunked,' surely there would have been no reason to compensate the family of Hannah Poling, the child referenced in your editorial.

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"Dr. Healy is right: This problem demands further study, and not only by the scientific community. There is a story here. It is regrettable that no journalist at The Sun has chosen to apply any reporting skill to this issue. The conflicts of interest alone should have attracted the interest of reporters, who seem to prefer party-line quotes to probing questions. These families deserve better."

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Alison Hamilton, Crofton
The writer is co-coordinator of the Maryland/DC chapter of Talk About Curing Autism

(Baltimore Sun photo by Christopher T. Assaf)

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