MD, PhD, FMedSci, FSB, FRCP, FRCPEd

The fact that some alternative medicine (the authors use the abbreviation ‘CAM’) practitioners recommend against vaccination is well-known and often-documented. Specifically implicated are:

As a result, children consulting homeopaths, naturopaths or chiropractors are less likely to receive vaccines and more likely to get vaccine-preventable diseases. These effects have been noted for several childhood infections but little is known about how child CAM-usage affects influenza vaccination.

A new nationally representative study fills this gap; it analysed ∼9000 children from the Child Complementary and Alternative Medicine File of the 2012 National Health Interview Survey. Adjusting for health services use factors, it examined influenza vaccination odds by ever using major CAM domains: (1) alternative medical systems (AMS; eg, acupuncture); (2) biologically-based therapies, excluding multivitamins/multi-minerals (eg, herbal supplements); (3) multi-vitamins/multi-minerals; (4) manipulative and body-based therapies (MBBT; eg, chiropractic manipulation); and (5) mind-body therapies (eg, yoga).

Influenza vaccination uptake was lower among children ever (versus never) using AMS (33% vs 43%; P = .008) or MBBT (35% vs 43%; P = .002) but higher by using multivitamins/multiminerals (45% vs 39%; P < .001). In multivariate analyses, multivitamin/multimineral use lost significance, but children ever (versus never) using any AMS or MBBT had lower uptake (respective odds ratios: 0.61 [95% confidence interval: 0.44-0.85]; and 0.74 [0.58-0.94]).

The authors concluded that children who have ever used certain CAM domains that may require contact with vaccine-hesitant CAM practitioners are vulnerable to lower annual uptake of influenza vaccination. Opportunity exists for US public health, policy, and medical professionals to improve child health by better engaging parents of children using particular domains of CAM and CAM practitioners advising them.

There is hardly any need to point out that CAM-use is associated with low vaccination-uptake. We have discussed this on my blog ad nauseam – see for instance here, here, here and here. Too many CAM practitioners have an irrational view of vaccinations and advise against their patients against them. Anyone who needs more information might find it right here by searching this blog. Anyone claiming that this is all my exaggeration might look at these papers, for instance, which have nothing to do with me (there are plenty more for those who are willing to conduct a Medline search):

  • Lehrke P, Nuebling M, Hofmann F, Stoessel U. Attitudes of homeopathic physicians towards vaccination. Vaccine. 2001;19:4859–4864. doi: 10.1016/S0264-410X(01)00180-3. [PubMed]
  • Halper J, Berger LR. Naturopaths and childhood immunizations: Heterodoxy among the unorthodox. Pediatrics. 1981;68:407–410. [PubMed]
  • Colley F, Haas M. Attitudes on immunization: A survey of American chiropractors. Journal of Manipulative and Physiological Therapeutics. 1994;17:584–590. [PubMed]

One could, of course, argue about the value of influenza vaccination for kids, but the more important point is that CAM practitioners tend to be against ANY immunisation. And the even bigger point is that many of them issue advice that is against conventional treatments of proven efficacy.

In a previous post I asked the question ‘Alternative medicine for kids: when is it child-abuse?’ I think that evidence like the one reported here renders this question all the more acute.

31 Responses to Use of alternative medicine is associated with low vaccination rates

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  • Dr Ernst: your introduction reads like an indictment:

    ‘The fact that some alternative medicine (the authors use the abbreviation ‘CAM’) practitioners recommend against vaccination is well-known and often-documented. Specifically implicated are:

    Physicians practising integrative medicine
    Doctors of anthroposophical medicine
    Naturopaths
    Homeopaths
    Chiropractors’

    ‘Fact’, ‘well-known’, ‘often documented’, ‘specifically implicated’, ‘recommend against’.

    No Dr. Ernst, your reasoning from ‘some alternative medicine practitioners’ to a list of CAM practitioners’ is erroneous induction.

    Dr. Ernst, the vast majority of CAM practitioners (not followers, publishers etc) provide their patients with information to enable them to make their own informed decisions about their healthcare choices.

    Medical doctors are more direct in their advice to patients to take the immunizations, and some may point out the low risk of adverse responses.

    I have more to comment on this topic, but I would first like you to provide your estimate of the proportion of CAM practitioners on a global basis or, if you prefer to rather to focus on the UK (I would), who advise against immunizations.
    (A breakdown according to each CAM specialty that you listed would be interesting)

    • “… the vast majority of CAM practitioners (not followers, publishers etc) provide their patients with information to enable them to make their own informed decisions about their healthcare choices.”

      What are the alternatives to vaccination?

      Niall

  • Greg, you opine: “…the vast majority of CAM practitioners (not followers, publishers etc) provide their patients with information to enable them to make their own informed decisions about their healthcare choices.”

    Just to be clear, do you have (and please may we see), any evidence that CAM practitioners (whom I term ‘camists’), provide their patients with the information that their modalities are regarded by mainstream medical practitioners as ‘alternative’ – because there is no plausible reproducible evidence obtained by orthodox scientific methods of the modality having any effect on any specific condition?
    In my experience, camists make claims they cannot justify. That is why their modalities are termed ‘CAM’ and we are having this discussion.
    If only professional and intellectual honesty prevailed.

    I do have one concern about Edzard’s piece. He refers to ‘Physicians practising integrative medicine’.

    ‘IM’ ,as we all know, is simply the latest in a line of trendy marketing terms used by those who intend promoting tripe, piffle, poppycock and balderdash to the gullible.

    In other contexts, ‘IM’ refers to the integration of social,mental, specialist, hospital and GP health services – which we all try to practice. Best not to use the term ‘IM’ at all unless you are referring to health fraud or make the sense clear.

    • Editorial moderation should consider that the underlying topic is the issue of bias and whether biased attitudes can extend beyond one domain into another domain.

      Dr Rawlins

      Talk about promoting poppycock and balderdash to the public, lets have a look at this topic:

      Given your use of asking questions in the negative form:
      ‘Homeopaths are ignorant, corrupt, charlatans, frauds, quacks, criminals.’
What evidence is there that they are not?

      I thought you might like to consider your use of this method of debate in relation to another group of people: Freemasons, and see how the method works for you.

      In my opinion, there is a ‘black and white’ approach to your thinking; almost every comment of yours that I have read has tried to argue that homeopathy must remain separate from conventional medicine.

      Black and white thinking reminds me of Freemason black and white checkered floors:
      “The black and white checkered floor has existed in temples since the times of ancient Egypt. More than simply decorative, the mosaic pavement bears a profound esoteric (special) meaning. Today it is one of Freemasonry’s most recognizable symbols and is the ritualistic floor of all Masonic lodges. The pavement is the area on which initiations occur and is “emblematic of human life, checkered with good and evil.”
      http://www.hamiltondistrictcmasons.org/upload/lecture_file87.pdf

      There is another area where the separation of black and white was essential to Freemasonry and that was the separation of black people and white people from belonging to the same lodges: Black people belonged to Prince Hall
      http://www.foxnews.com/story/2006/10/24/masonic-groups-in-south-struggle-with-racial-separation.html

      Apart from the separation of Masonic groups based on race, the other great divide was the exclusion of women from the fraternity of Freemasons.
      https://en.wikipedia.org/wiki/Premier_Grand_Lodge_of_England

      Lastly, the closeness of the brotherhood in terms of looking out for the brothers and the protection the ‘secrets of masonry’ the raises (excuse the pun) question: what evidence is there that freemasons have not been complicit in the cover up of crimes?
      http://www.independent.co.uk/news/uk/home-news/freemasons-hillsborough-police-coverup-ipcc-liverpool-sheffield-a7211906.html

      In summary: what evidence is there that Freemasonry is not part of the history of racism and subjugation of women? Due to the secret nature of the society, what evidence is there that Freemasons have not been involved in the commission and cover up of crimes?

  • Dr Richard Rawlins:you ask me to provide: do you have (and please may we see), any evidence that CAM practitioners (whom I term ‘camists’), provide their patients with the information

    However, you stated:
    1. ‘Homeopaths are ignorant, corrupt, charlatans, frauds, quacks, criminals.’
    What evidence is there that they are not?

    2. What evidence is there that homeopaths are not ignorant (of scientific methodology); corrupt (associated with companies selling remedies of no proven value); charlatans (shouting out and promoting the benefits of their practices and pillules); frauds (obtaining money by false pretences), quacks, (professing knowledge of medical practices of which they have no proper understanding); criminals (acting contrary to the laws of the land in which they reside)?

    Dr Rawlins: Please just name the homeopaths in the UK that are criminals (acting contrary to the laws of the land in which they reside) so that the police can take action.

    Dr Rawlins: Please provide evidence for your statement that homeopaths are corrupt and frauds.

    Dr Rawlins: what evidence do you have that homeopaths do not provide information to their patients to make their own informed decisions?

    Dr Ernst, please read the abstract to the first link that you provided:

    Vaccinations are one of the most effective preventive procedures in modern medicine. However, earlier studies have indicated that homoeopathic physicians do not recommend or apply vaccinations as frequently as their allopathic colleagues. Few studies have been undertaken to clarify this question and most of these have not distinguished between medically and non-medically qualified homoeopathic practitioners. Therefore, misunderstandings have arisen concerning this question. In the study presented only medically qualified colleagues were included. In the course of this study, 219 medically qualified homoeopathic and 281 non-homoeopathic physicians in Germany (response rate 30.4%) returned a questionnaire about the application and recommendation of 17 different vaccinations in their practices. The answers show that the responding homoeopathic physicians do not generally refuse vaccines but rather view them with a specific hierarchy. The ‘classical’ vaccines against tetanus, diphtheria and poliomyelitis are applied to nearly the same degree as by non-homoeopathic colleagues. Vaccines against childhood diseases, risk group vaccinations and vaccinations judged as ineffective are applied and accepted with more restraint by homoeopathic physicians.
    End of quote

    Dr Ernst, this does not equate with your statement, does it?

  • The following facts exist in and anyone can look them up:
    1. Flu vaccines don’t work, there is plenty of evidence supporting this
    2. Vaccines contain dubious ingredients that people don’t want to put in there bodies
    3. Vaccines contain neurotoxins and heavy metals that have known adverse effects
    4 Mercury is the most poisonous, non-radioactive, substance on our planet. There is no safe level
    5. Vaccinated people spread disease due to shedding
    6. You cannot inject health only disease
    7. The healthiest children and adults are the unvaccinated ones, that’s why there has never been a live study comparing unvaccinated to vaccinated
    8. Doctors are offered bonuses and incentives to achieve high vaccination rates in there clinic despite their moral views, opinions, and access to opposing data.
    9. The higher the Iq people have the more they object to vaccine use

    • “The following facts exist in and anyone can look them up” This statement was followed by 9 pieces of utterly ignorant, false information. We clearly live in a post-reality era.

      Grace S: if you are going to provide readers of this blog with ‘facts’, it’s best to tell us precisely what sources of misinformation you have used to turn your bizarre notions into ‘facts’. Otherwise, we’ll just google and find your ‘facts’ are roundly debunked by people with knowledge and intelligence.

    • “The higher the Iq people have the more they object to vaccine use”
      I WOULD LOVE TO SEE EVIDENCE FOR THIS [OR YOUR OTHER CLAIMS]; NOT LEAST BECAUSE IT WOULD PUT ME IN THE LOW IQ BRACKET!!!

    • The healthiest children and adults are the unvaccinated ones,

      Please do provide evidence for this interesting statement. Also, how is this consistent with the fact that people who are vaccinated tend to die in far smaller numbers than those who are not?

    • That will be funny. Let’s reply point by point:

      1. Flu vaccines DO work although not 100%. Cite your evidence.
      2. Actually vaccines are quite well characterized. Aside that, this is a non-argument
      3. Which ones ? Cite your source. Or do you mean Mercury ? Well, that has been phased out of vaccines decades ago.
      4. Nope Grace, Mercury is NOT the most poisonous non-radioactive substance on the planet. In fact the toxicity of mercury is so low that it has been used as (non-working) treatment against syphilis.
      5. Vaccinated people do normally NOT spread disease. Unvaccinated do, that is called an epidemic.
      6. irrelevant.
      7. Nope, they are not. And there have been studies comparing unvaccinated with vaccinated people.
      8. A nice epidemic is much more profitable for the pharma industry, so your comment is wrong.
      9. The higher the IQ, the more people think they know about something which they in reality don’t. It is called the Dunning Kruger effect of which you are a prime example, Grace S.

    • Grace S: you might be interested in the real facts shown here.

      • Lovely graph, Frank. I had never seen it, but it surely makes things quite clear. It also nicely shows the quacks’ ‘hygiene’ hypothesis is vanishingly umprobable.

      • @Frank Odds

        You might be interested in the real facts shown here:

        “Scientific medicine has taken credit it does not deserve for some advances in health. Most people believe that victory over the infectious diseases of the last century came with the invention of immunisations. In fact, cholera, typhoid, tetanus, diphtheria and whooping cough, etc, were in decline before vaccines for them became available – the result of better methods of sanitation, sewage disposal, and distribution of food and water.”

        http://www.vaclib.org/sites/debate/web1.html

        • @Grace S

          You call them ‘facts’, but it doesn’t look like you understand the meaning of the word.

        • I knew that this will be fun. The diseases where NOT in decline. Fewer people died due to the developments in medicine. Your death rate is confounded with the development in medicine, i.o.w. you use the *wrong* statsitics. The correct statistics is the incidence which has been correctly shown by Frank. If you do not get sick you can not die or have complications, got that ?

          Aside this, that a deadly disease can be rooted out by vaccination and NOT by sanitation is demonstrated by smallpox which went from a feared scourge to something almost unknown within 50 years. In the 19th century that is, at times when cholera etc. ravaged.

          Grace, we are scientists. We know the literature and the data, most importantly, we know how to interpret them.

          • For every drug that benefits a patient, there is a natural substance, that can produce the same effect…
            – Dr. Carl C. Pfeiffer, M.D., PhD (Hall of Fame 2004)

          • Grace, I am a scientist in cancer research. A “Hall of Fame” does not impress me one little bit. The same goes for an appeal to authority, the more if the authority *died* 30 years ago (that is medical stone age) and adhered to teachings that are soundly debunked by now.

        • @Grace S

          Your graphs are spot on. As an infectious disease specialist, when I taught medical students I routinely showed them the graph you’ll find in figure 1 here. It shows that, indeed, the biggest impacts on infectious diseases were achieved by improved sanitation: specifically by separation of drinking water from sewage effluent. Your point was taken in 2007, when the British Medical Journal ran a survey inviting readers to suggest the most important medical advance since 1840. More than 11,300 readers (I was one of them) chose the “sanitary revolution”, way ahead of all the other choices. click here for the details.

          Now, Grace, since I and a huge number of other medical and biology specialists already know perfectly well that the incidence of infectious diseases — in countries with effective sanitation — was in decline before the advent of vaccination (the Salk vaccine for polio was the first, as you can see in my link), does this not make you wonder why I and a huge number of other medical and biology specialists regard your anti-vaccination diatribe as piffle, nonsense, ignorant, ill-informed rubbish and downright idiocy?

          It’s because the death rate from infectious diseases, though much lower by the mid-20th century compared with the mid-19th, was still appallingly high. Look at the figure 1 I linked to above. by 1950, the total deaths from infections in the USA (a country with excellent sanitation) had levelled out at around 30 per 100,000 population. That equates to 45,000 infection deaths each year in the USA alone (based on 1950 population data). Maybe you, with your poisonous hatred of all things medical, regard 45,000 people as a reasonable price to be paid for avoiding the vaccination ‘hazards’ you list. And — by the way — your risk list is laughable, as Thomas Mohr already spelt out to you. But I, and physicians who deal with infections, don’t.

          The incidence of infectious diseases in the USA every decade from 1950 can be seen here. There are no data for scarlet fever or typhoid (CDC currently estimates about 400 cases of typhoid in the USA annually), but for the other four infectious disease graphed in your link the data for 1950 vs 2013 are as follows (1950 / 2013). Whooping cough 120,718 / 28,639; Diphtheria 5,796 / 0; measles 319,124 / 187; polio 2525 / 1. (The first polio number is for 1960, data were not available for 1950). Just ponder that link: for every notifiable disease listed where vaccines are available, there’s a clear downward trend in incidence. For those where no vaccine exists (e.g. gonorrhoea, rickettsia, salmonella, shigella), the incidence trend is rising! (And only a total idiot would seriously argue that sanitation improvements have had an impact in the USA since 1950).

          I could go on, but I’ll leave it to your high IQ to go figure. Recheck the graph on vaccination effects I already linked to.

          Your vaccination risk list is a piece of execrable nonsense, distilled from the fears of otherwise reasonable people who feel medicine shouldn’t interfere with nature. (You probably don’t extrapolate that feeling to motor vehicles, aviation, civil engineering, electronic technology, computing and the rest, but I guess that’s because of the vast discriminatory power of your intelligence.) You, and others who pursue an anti-vaccination line, are willingly consigning colossal numbers of people to illness and death, but you’re so bloody stupid and sanctimonious you’re not even aware of it. A sizeable proportion of those affected are the very young, who deserve better from people like you who regard themselves as enlightened. And, by the way, you’re challenging the wrong guy where infectious disease is concerned.

          • “If vaccines are “safe and effective” as our medical practitioners and politicians constantly tell us via mainstream media outlets, then why are there already over 370 compensated cases in fiscal year 2017? Why is there a running payout total from 1988 up to now of “around $3.6 billion,” according to the US Health Resources and Services Administration?”

            And these figures are just from the USA…??

            http://www.australiannationalreview.com/whopping-vaccine-injury-payouts-fiscal-year-2017-released/

          • @Frank

            “Maybe you, with your poisonous hatred of all things medical…”

            Why do you think Grace hates all things medical? Her comments focus on vaccination, you’re jumping to a huge conclusion. How much of the rest of your comment was speculation?

          • @jm

            See this comment from Grace. I rest my case. Anti-vaxxers are characteristically anti-medicine. Sad but true.

            And my comment carefully cited evidence for what I stated (including my acknowledgement that Grace is right that infectious disease rates were tumbling pre-vaccination). “How much of the rest of your comment was speculation?” is therefore utterly unreasonable. You take a gadfly approach to comments on this blog, which I appreciate, but you’re not going to get away with this one.

          • Frank,

            I saw that comment from Grace. Your case isn’t rested – a drug isn’t inherently medicine, neither are “natural substances”. Anything can be used as medicine. It depends.

            You come to the conclusion that Grace is anti medicine. Maybe, maybe not. There’s not enough info to tell one way or the other. Your opinion (or possibly observation) is that anti-vaxxers are characteristically anti-medicine. That doesn’t mean that Grace is. Sadly, I know a bunch of anti-vaxxers. None of them are anti medicine. But just because I don’t know any anti-vaxxers that are anti medicine, doesn’t mean they aren’t out there.

            You do cite references – I wasn’t questioning that you cited references, but your conclusions. You don’t have enough info to determine whether or not Grace is anti medicine. Why should I think your other conclusions are solid? Maybe they are, maybe they aren’t. Without checking (and understanding) your references…all I have to go on is the obvious – you jumped to a conclusion about Grace without enough info.

            You posted a great comment, one that anti-vaxxers should read. Don’t dilute it or make it dismissible.

    • The higher the Iq people have the more they object to vaccine use

      I think you mean “the higher people are educated, the more they object to vaccine use”. There is some evidence for that. The problem is that this statement is a nice example of “lying by omission”. What is (almost?) always left out is that this “higher education” tends not to be one in science but in completely unrelated fields such as fashion, arts, language, media and other nonscientific or even antiscientific fields, i.e. while these people may be highly educated, it is an education that all but guarantees their lack of qualifications in this field.

    • @Grace S
      Your comment is superb and one of the best I have read so far. You have managed to take all of the hot topics of vaccines and condense them down to a short concise list, something which is needed. Everyone gets swayed by the long winded answers given to us all the time but all that is needed is a short answer that encourages people to look into these matters further for themselves.

      After studying this topic personally and professionally for over twenty years I agree 100% with everything you have said. ‘The truth is indeed out there’ you just have to want to know it.

      • in this case, perhaps you could show us the evidence to support these claims?

      • Tom. Grace’s fatuous arguments have been comprehensively eviscerated above, point by point, by professionals who know EXACTLY what they’re talking about. Perhaps, with all your “research” you can detail exactly where they’ve got it wrong. I’m sure everyone would be delighted to read your supposed refutations.

      • It is incredibly frustrating and dangerous to see there are brainwashed people like Grace,jm and Tom who naively believe lies and bogus papers from unscrupulous and fake alternative so-called health care gurus and those with no real knowledge or background in science and medicine. Many of them also strongly believe with religious conviction the BS from Gwen Paltrow and the many other con artists who make up remedies for profit.(including most Alternative to real medicine quacks). They should read some legitimate medical and history books documenting infections and other diseases in the pre vaccine era and the difference after modern health care innovations were developed. History may have to repeat itself to convince the reality deniers.

        • S. Cox

          Every medical and history book I’ve seen has warned against jumping to conclusions with limited information. There isn’t enough info to tell if Grace is just “anti-vax” or full on “anti-med”, as Frank concluded.

          And, getting medical advice from Paltrow, etc is almost as ridiculous and dangerous as getting medical advice from MDs who jump to conclusions without enough information.

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