An Interview with Paul Offit
by Felipe
Nogueira
Dr. Paul Offit is a pediatrician, the Chief of the
Division of Infectious Diseases of the Children's Hospital of Philadelphia, and
was the co-inventor of the rotavirus vaccine. He wrote several books about the
importance of vaccines, clarifying the risks, which is often misunderstood. For
example, the anti-vaccination movement insists that MMR vaccine causes autism.
However, that relationship was already analyzed scientifically and we know it's
wrong. In his book Do You Believe in Magic?, Offit makes a critical analysis of alternative medicine
and the use of large dose of vitamins supplements. It’s important to raise the
awareness about the vitamins supplements: it’s unregulated industry that claims
vitamins supplements prevent disease. However, several studies [1-3] say most supplements do not prevent disease and some, such as vitamin E and
beta-carotene [4], can increase the risk of
cancer and mortality. Paul Offit’s website is www.paul-offit.com
Nogueira:
Can you pinpoint when the anti-vaccination movement started?
Offit: I think it started with the first vaccine.
The smallpox vaccine was developed by Edward Jennen in 1700s. There was violent
opposition to the vaccine in the early 1800s because that vaccine was mandated.
I think the professional anti-vaccine people, like National Vaccine Information
Center, Moms Against Mercury, Safeminds, and Generation Rescue, will say they
would stop their anti-vaccine efforts if you simply make vaccines optional.
Offit: We can say with confidence that the 1976
swine flu vaccine had a risk of GBS in 1 per 100.000 who were given the
vaccine. It’s not clear that since then any vaccine causes GBS. CDC and other
groups that tried to categorize this always say that we cannot say is more
common than 1 per million. The people are left with this vague notion that
vaccine might cause GBS, but since the 1976 swine flu vaccine there is no clear
evidence that it has.
Nogueira:
If a vaccine causes a symptom, usually the disease the vaccine tries to prevent
causes the same symptom. Can you clarify?
Offit: The best example is thrombocytopenia, which
is low platelets level. There are a couple of studies and they all have been
consistent and reproducible: the measles vaccine causes thrombocytopenia in 1
per 25-30 recipients. A measles virus also causes thrombocytopenia, but it is
far more common. Another example: from 8 to 12 days after receiving chicken-pox
vaccine, one can get a mild chicken-pox rash with 5 blisters, but sometimes can
be 30 blisters. But chicken-pox natural infection can cause 300 to 500
blisters.
Nogueira:
Knowing that MMR vaccine does not cause autism, how dangerous is to widespread
information not corroborated by science?
Offit: I think once you scare people, it's hard to
unscare them; once you open the Pandora’s box, it's hard to close it. The
question was raised by Andrew Wakefield in 1998 with his publication in The Lancet,
which wasn't a study. It was a simple case series: 8 children who had received
the vaccine and developed symptoms of autism within 1 month. There are now 12
studies, looking to large number of people who did and didn't get the vaccine
to answer the question "are you at a greater risk of having autism if you
receive MMR vaccine?" The answer has been very reproducible: no. I think
people are far more compelled by anecdote than they are by statistics. If Jenny
McCarthy gets on Oprah and says "I watch my son get this vaccine, I watch
his soul leave his eyes" and she cries, that's very compelling. A
scientist on the show would say "fair question: could the vaccine cause
autism? Is this a causal effect relationship? Is this just a temporal
effect or it is a plausible effect?" This is a scientific question and it
has been answered in a scientific venue. But how do you trump the anecdote with
science? The media became critical and they're not great at it.
Nogueira: Moving into vitamins supplements, when this idea begun?
Offit: We need vitamins, no doubt it. If we don’t
get enough of it from diet, we suffer diseases like pellagra, scurvy and
rickets.[6]
But we crossed the line from certain amount is good to therefore more would be
better. That’s not true. Once you’re above the protective levels, you don’t
need to be above of it. And I think the “big push” for supplements came in
1970s with Linus Pauling, who won Nobel Prizes in Chemistry and Peace. He was a
strong voice and used to push vitamins supplements. Some of the earlier supplements
were called Linus Pauling vitamins.
Nogueira: What about the risks of taking
vitamin E?
Offit: What amazes me about the vitamin E story is that there
is a preparation of vitamin E that said "natural E 1000". If you look
on the back label, it said that it had 3333% of the recommend daily allowance.
You would have to eat about 1650 almonds, which are good source of vitamin E,
to get the same amount from one gel capsule. That's not a natural thing to do. And
if you take large doses of vitamin A, E or beta-carotene for prolonged period
of time, you increase your risk of cancer and heart disease and potentially
shorten your life. Those data are clear; there are twenty studies now that show
that.
Nogueira: There is an article discussing that laboratory cut-off values for
vitamin D are not evidence-based. What
can you say about it?
Offit: You’re right. Suddenly in the United States everybody has become vitamin
D deficient. Certainly, it’s not because there’s been an outbreak of rickets;
that hasn’t happened. It’s because of serum tests. I think what is considered
normal values are not validated. Because of incorrect levels, all my friends
tell me their doctors prescribed vitamin D for them. I like to think this is
fad and will pass in a few years, because we’re doing no good and potentially
some harm.
Nogueira: Do you think there is enough evidence for vitamin D
supplementation to prevent falls or fractures?
Offit: The U.S. Preventive Services Task Force (USPSTF)
had at one point supported the use of vitamin D specially to prevent
osteoporosis. The bone gets thinning in older people, so when they fall,
they’re more likely to have fractures. Postmenopausal women are more likely to
have these fractures. Then, vitamin D was recommended, since it helps to
increase the uptake of calcium in the intestinal tract. However, with more data
available, USPSTF does not recommend it anymore, since there is no clear
evidence that postmenopausal woman or older people benefit from the intake of
vitamin D or calcium.
Nogueira:
Where do you think came from this notion that vitamin supplements are natural?
Offit: I give credit to
the industry, which has been able to sell itself as natural. The nutraceutical
and dietary supplements industry sell their supplements “as all natural, it can’t
hurt you and it’s being made by old hippies”. This is not true. Pfizer and
Hoffman-LaRoche are major players in dietary supplement game. It’s an
unregulated industry with no obligation to support its claims. And, in United
States, they have enough political influence to keep the FDA away from
regulating them. Also, it’s very hard to be vitamin deficient; everything is
supplemented. For example, it’s hard to suffer from folic acid deficiency in
US, because grains, cereals, and pastas are supplemented with folic acid.
Nogueira: Your latest book is Bad
Faith. What’s all about it?
Offit: It’s about how, in the United States, people
have been able to use their faith to medically neglect their children. I think
people should not be able to use the law to medically neglect their child. For
example, 47 states have religious exemptions for vaccines. So, the book’s
message is “we should not allow people in this country to use religion to put
children in harm’s way.”
Nogueira: Have you planned a next book?
Offit: I
have a new book coming out in April. The title is Pandora’s lab. Seven Stories of Science Gone Wrong. It’s about
scientific discoveries that change the world for the worst.
Nogueira: Thanks for this thoughtful interview.
Notes/References:
1. Fortman, S., et al. 2013. “Vitamin and Mineral Supplements in the
Primary Prevention of Cardiovascular Disease and Cancer: An Updated Systematic
Review for the U.S. Preventive Services Task Force. Annals of Internal Medicine,159
(12):824-834.
2. Guallar, E., et al. 2013. “Enough is Enough. Stop Wasting Money on
Vitamin and Mineral Supplements Annals of Internal Medicine,159 (12):850-851-851
4. Bjelakovic, G., et al 2012. “Antioxidant supplements for prevention of
mortality in healthy and patients with various diseases”. The Cochorane Library, March, published online.
5. Guillain-Barré syndrome (GBS) is an autoimmune disease that attacks
nerves cells causing muscle weakness and often paralysis. According to the CDC,
approximately 3000 to 6000 people develop GBS each year in United States.
Infection by Campylobacter jenuni, influenza and other infections are risk
factors for GBS. More recently, countries with zika virus outbreak reported
increased numbers of GBS cases. For more
information, visit the following CDC page:
http://www.cdc.gov/flu/protect/vaccine/guillainbarre.htm
6. Pellagra, scurvy and rickets are caused by deficiency of niacin
(vitamin B3), vitamin C, and vitamin D respectively.
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