Evil Needle

I dunno. I’m not much of a blogger.

But if ever there was an issue that I can’t keep mum about, this would be it. If I were told to just forever hold my peace, I simply, will not be at peace. In fact, I would burn and blister from within with the fury of a thousand suns!

While I’m generally a non-confrontational person who would be more than happy to agree to disagree on most topics, this particular issue has been weighing heavily on my heart. It is a burden I simply have to bear. And believe me, I have done my fair share of bearing (through gritted teeth) but I simply cannot tolerate this no longer; I need to say my piece.

About what, you may ask?

Well, the Anti Vaxxer community of course!

Although it is my professional opinion that Anti-Vaxxers are the scourge of the Earth, I will now go out my way to try explain myself. Sure, I may not be the utmost authority on this issue, neither is it my responsibility to re-educate the masses. But we are coming close to a crisis point, and if we don’t do something about this epidermic (of a behavioural disease), we risk crossing the point-of-no-return. Besides, being a legit medical practitioner, I guess I do have a say on this issue, if not much at all.

*Before proceeding, I would advise that one, at the very least, is aware of who Andrew Wakefield is and what he stands for. If you have no idea who this guy is, a quick Google search should fix that. Do that before proceeding to read the rest of this piece. (If anyone besides my wife should read it at all)

I would also like to do anyone who reads this a favour, by not parroting the many things that have already been said by many published scholastic articles regarding this issue. Instead, I will like to offer a fresh perspective on this issue by meeting my would-be debaters at a halfway point; let’s just cut the crap about Andrew Wakefield and begin with the (hypothetical) assumption that…

YES! I BELIEVE THAT VACCINES CAN CAUSE AUTISM!!!

Caught your attention now, haven’t I?

Now that we’ve gotten that out of the way (and off my chest. Phew!), let’s begin.

You see, the problem I find with most arguments online between the Pro-Vaccines and the Anti-Vaxxers are that they are stuck in a limbo, arguing into eternity about whether vaccines can or cannot cause autism. In the wake of the Wakefield Controversy (see what I did there?), The Anti-Vaxxer would support their claims by sharing pro Andrew Wakefield articles… maybe they share a few scholastic articles (few are peer reviewed or have strong evidence score), some share videos on youtube and articles from naturopathic websites or tabloid opinion pieces, but most would share their personal anecdotal experiences or hearsays of what happened to their aunt’s thrice-removed cousin’s grandpa’s nephew (or something to that extend). The Pro-Vaccines drop scores and scores of links to published scientific papers (many are published after Wakefield’s) that show no link between the MMR vaccine and Autism, articles disproving Andrew Wakefield’s findings, evidence to suggest it (the Wakefield paper) was fraudulent, even to pages that announce that the controversial Lancet article has been retracted, to no avail.

I would like to attempt this argument in a different way. Let’s start by assuming that I believe everything the Anti-Vaxxers are saying about the Evil-Needle. Let’s just assume that VACCINES DO CAUSE AUTISM.

What now? Do we throw out all the vaccines into the fiery depths of hell? Admit defeat and go back to live on trees?

No, we move on to the next part of the argument; If vaccines do cause Autism, should we or should we not still vaccinate? The argument now moves to the pros and cons of the Evil-Needle (I imagine myself saying this in an evil scientist supervillain voice, what? You guys never heard of one?) i.e. risk vs benefit. Does the risk outweigh the benefit? Or is it the other way around?

At this point, I imagine closed minded Anti-Vaxxers would go “No way! There is absolutely no benefit at all. The Evil-Needle is all risk, and no benefit!!!”

This almost reminds me of a scene in Batman v Superman: Dawn of Justice, where Batfleck goes…
“If there is even a one percent chance that he is our enemy, then we have to take it as an absolute certainty!”

Except I would like to think some Anti-Vaxxers are not beyond saving. Maybe if you would open you mind to what I have to say, to have a dialog instead… then I won’t have to resort to screaming the phrase “Please, save Martha!!!”

(OK, I promise, that would be the last of any Batman v Superman reference. Let’s get serious!)

Ahem! Ahem!

So, I recently had to argue with a fellow doctor on Facebook. He was a Consultant Nephrologist, and he was an Anti-Vaxxer. Can you believe that? Can you believe that I tried to argue with someone on Facebook? I mean, who has ever won an argument of Facebook anyway? What an utter waste of time, right? Except it wasn’t. Arguing with him gave me some insight into the mind of an anti-vaxxer. It helped me understand them a little more.

Basically, he was arguing with someone else in a closed Doctors-only Facebook thread/group, and what especially irked me was this phrase where he said:
“I rather my son contract measles or chickenpox and the small risk of complications than risk autism or other neuropsychiatric complications from vaccines…”

For which I had to snarkily respond by saying:
“… Yeah sure, small inconvenience for you, right? While your kid contracts the mild form of the illness, he also helps propagate a disease that should have already been eliminated, and some random 6-month-old infant somewhere gets to die and early death.”

For which he replies: “Well if I know there’s a risk of autism with the vaccine, I certainly am not going to allow my son to be exposed to that risk…”

Blah blah blah… If there is even 1 percent chance that Vaccines are Evil, then we have to take it as an ABSOLUTE CERTAINTY that the Needle is Evil!!!

(Oops! I did it again)

We went on for a while. This intellectual game of fencing. But because I took too long to respond at times (after all, I’m a busy GP who has to see, sometimes, up to 50 patients in a day) the thread got cold. And I’m not that rude to go reopen old threads like some people (Internet Ethics 101 anyone?) so... Yeah. We left it at that.

But that was when I realised that that was the Anti-Vaxxers main concern! They have felt that if there were any risk at all, then the vaccine was not worth it. And that is where they’re wrong!

Back to my argument. Assume that vaccines do cause autism. What would you attribute the risk to be? 1 in 10,000? 1 in 1000?  A 1 percent chance?

Of course, real world scientists have proven no link between vaccines and autism. But let’s imagine a hypothetical situation here where vaccines did cause autism. In fact, let’s go further and assume that ALL AUTISM CASES IN THE WORLD WERE CAUSED BY VACCINE AND VACCINE ALONE. How’s about that, huh? Sounds absurd, but if we’re having a dialog with anti-vaxxers anyway, let’s dial up the crazy all the way there.

Okay. So, we take that one CRAZY assumption, what numbers would we arrive at?

Walk with me here, guys. Let’s ask Google…

What’s the current world population?
The current world population is estimated to be 7.6 billion people.

What’s the worldwide incidence rate of autism?
A 2012 review of global prevalence estimates of autism spectrum disorders found a median of 62 cases per 10,000 people

Ok, It’s 2018, but let’s just take that amount and dial it up a little to say, 65. 65 cases per 10,000 people. 65 per 10,000 in a world full of people (that’s 7.6 billion people like we counted earlier) should give us
0.0065 x 7,600,000,000 = 49,400,000 about 50 million people in the world now living with autism

What percentage of the world is vaccinated?
As of March 2018, it is said that about 85 percent of the world's children receive vaccines that protect them against tuberculosis, polio, diphtheria, tetanus, pertussis, and measles.

85% of 7.6 billion?
0.85 x 7,600,000,000 = 6,460,000,000
That’s about 6.5billion people in the world who has received the Evil-Needle

So, if we take all these crazy assumptions, and feed it into the MultiVac (old Asimov joke, I bet nobody is getting this but heck), what do we get?

Well, let’s see, if all 50 million cases of Austism in the world right now is caused by vaccination (and vaccination alone. No confounding factors whatsoever. I know! Crazy right?), then likelihood of getting autism from the Needle is 50 million in 6.5 billion. Okay, let’s work with that.

50,000,000 out of 6,500,000,000. That’s 0.76923077%

This means that there would be a 0.77% chance that he is our enemy vaccine can cause Autism. Or in other words 7.7 in every 1000 child receiving the vaccine would become autistic.

(Now don’t shit your pants, this is a crazy overestimation on top of a hypothetical assumption that all autism cases were caused by vaccine ok? So, chill out)

So, we’ve done the maths. What does this all means? Well, it means that, in the worst-case scenario, about 7 to 8 in every 1000 child who gets vaccinated might develop autism. The worst-case scenario.

Does that seem like a risk too much to bear? Well, to some, I’m sure it is. It’s not even 1 percent, but I’m sure that’s big enough a risk to scare some people. Should we then abandon the practise of vaccination altogether? Discard all the MMR vaccines into the Big Bin of Oblivion?

Maybe. Maybe not.

But we’re talking about risk versus benefit here, right?

What’s the benefit of vaccine?

The prevention of easily preventable diseases, right?

Let’s talk about Measles.

What is Measles?
Well, it’s viral infection, caused by the Measles Virus. Simple enough.
It usually presents with a bout of fever (high grade, usually greater than 40* Celsius), a sore throat, cough, runny nose, and inflamed eyes. Symptoms typically lasts only 7-10 days. Doesn’t sound too bad right? But here is where it gets interesting. It’s got a complication rate of 30%, which may include diarrhea, sepsis, pneumonia, blindness, meningitis or even encephalitis (inflammation in the brain, may even lead to permanent brain damage). Some of these complications, yes, you’ve guessed it, can lead to death. But so what, right? The death rates can’t be that high, right? Well, guess again!

“In populations with high levels of malnutrition and a lack of adequate healthcare, mortality can be as high as 10%. In cases with complications, the rate may rise to 20–30%”

10-30% death rate.

That’s 10 to 30 percent of everyone who gets infected.

So what, right? It’s not like everyone gets infected, right?

Let’s ask Google. What was the incidence rate of Measles before the invention of the vaccine?

“In the decade before 1963 when a vaccine became available, nearly all children got measles by the time they were 15 years of age. It is estimated 3 to 4 million people in the United States were infected each year. Also, each year, among reported cases, an estimated 400 to 500 people died, 48,000 were hospitalized, and 1,000 suffered encephalitis (swelling of the brain) from measles”
https://www.cdc.gov/measles/about/history.html

What? Nearly all children? No way!

Alright, I tried searching and searching but I couldn’t get a number of what the incidence rates were like before the 1960’s. Not surprising, back then the reporting system may not be as efficient as it is now. 

“Not all cases were reported to the public health system; from 1956 to 1960, an average of 542,000 cases were reported annually.” https://academic.oup.com/jid/article/189/Supplement_1/S1/820569  
This was in the US alone!

Before the 1960’s…
“seven to eight million children are thought to have died from measles each year before the vaccine was introduced. Before the vaccine, epidemic cycles occur every 2 to 3 years, and virtually everyone experienced measles illness during childhood. Lifelong immunity is provided by natural infection”
https://en.wikipedia.org/wiki/Timeline_of_measles

Alright, I looked everywhere. The consensus seems to be that “almost” everyone got Measles. Those that survived, well, they survived! Those that didn’t, it numbered to the millions. Imagine a time when children died in the millions every year!

I input that 30% death rate into our calculations so far. Remember, this is but a hypothetical exercise…

30% death rate on everyone?

30% x 7,600,000,000 = 2,280,000,000

What’s 2.2 billion deaths? That’s about slightly less than a third of the world’s population being wiped out.
You know what? If Thanos wanted to rid the Earth of a third of its population, all he’s got to do is destroy the vaccines! Simple enough huh? Hmmm…

That’s 2.2 billion deaths, worldwide, a year!

Alright, let’s put things into perspective here…

TAKE THE BLUE PILL

We vaccinate, 7 or 8 in every 1000 (hypothetical) child who gets vaccinated might develop autism.

TAKE THE RED PILL
We don’t vaccinate, 2.2 billion people gonna die every year.
And that’s just Measles. I haven’t it touched on Mumps, and Rubella, and practically every other preventable disease in the world!
AND SEE HOW FAR DOWN THE RABBIT HOLE GOES…

Which is worse? You do the math!

I’m done. Typing this made me feel sick to the stomach and pissed off beyond social media acceptable levels. I’m not sure how some people can look at this numbers and go,

“Oh, I don’t care. I don’t wanna subject my son/daughter to the Evil Needle. I don’t care if other children gonna die. I just wanna protect my precious little spawn. You can’t force me! I know my rights! As sure as the Earth is Flat… Never!”

Pfft.

Scourge of the Earth.

- Dr Jickson Ng

Your Friendly Neighbourhood GP

The Parable of the Impatient Patient

There was once a patient who came down with a common cold. He went to see a doctor, and was told that he was simply suffering from a common cold.

The Physician said unto him "Verily I tell you, the disease will run its own course, and surely you will recover in 5 days or so."

He paid RM15 for the consultation (and some medications, for symptomatic relief) and went home to rest.

The patient woke up the next day feeling the same as he felt the day before, so he thought to himself "Maybe I should go and see another healer. Surely the first one did not treat me adequately"

Thus, he set off to see another doctor to seek a second opinion. The second doctor concurred with the first, saying that the patient was only stricken by a common cold, but because the patient insisted, started him on a course of antibiotics. The patient paid RM30 for the consultation (and the antibiotics) and gladly went home to take a rest.

However, on third day, the patient felt that he was not well enough, and thus he went to another doctor for yet another opinion. The third doctor told him that he appeared to be improving, and that he should just continue (and finish) the medicines he was prescribed. But the patient insisted that he be given more potent antibiotics, and so this doctor also gave in. The patient then paid RM60 for the consultation and antibiotics, and went home to rest.

On the fourth day, the patient was still not satisfied with the condition of his health. So this time, he went to a pharmacist and demanded for the most potent and effective medicines. He had to pay RM100 for them, but he was glad as the pharmacist had given in to all his requests (with no questions asked)

On the fifth day, the patient woke up feeling much better. He thought to himself "I have recovered! Surely it was because of the expensive drugs I bought from the pharmacy yesterday. I shall seek out the first doctor and tell him of this." And saying so he went to look for the first doctor to share the news of his recovery.

The first Physician however, rebuked him, saying "You fool! Did I not tell you that the illness would run its own course, and that you would recover in exactly five days? You had spent a total of RM205 for nothing! I tell you the truth! Repent and turn from your evil ways"

Those who have ears, let them hear.