Holford Watch: Patrick Holford, nutritionism and bad science

Former Visiting Professor Patrick Holford is still Head of Science and Education at Biocare. We look at Holford’s advice in “Vaccinations: what every parent needs to know” in 100%health Newsletter, No. 46, July 2008, pp. 5-8.^[a] We focus on his recommendation for whooping cough vaccination.

whooping cough (pertussis)

Dr Gordon Stewart, one of Britain’s experts in this area,^[b] claims that whooping cough is no longer a serious threat to the life and health of our children.^[c] But the vaccine may be dangerous for some. According to Dr Richard Halvorsen, author of The Truth about Vaccines and a GP who runs a private clinic (www.babyjabs.com) that offers a choide of baby vaccines, there is some research to suggest that in rare and isolated cases, the whooping cough vaccination is linked to cot death.^[1]

Furthermore, a study published in the British Medical Journal indicated that the vaccine may not even be that effective as school age children still had symptoms of whooping cough, despite 86% of them being immunised as infants.^[2]

VIEW: This vaccine appears to have a questionable level of effectiveness, but as it’s part of the 5-in-1, your baby can’t avoid it. However, as previously recommmended, aim to wait until your child is at least four months old before immunising.

Holford provides a summary table for vaccinations and his recommendations. He lists pertussis (whooping cough) as No need to vaccinate.

It is not unusual for Holford to makes mistake when citing references (JKN’d). As per Holford’s account of Hannah Poling and his advice about diet and vitamin A as a prophylactic for preventable childhood illnesses, he omits pertinent facts from the research literature to which he refers. Holford makes implausible recommendations to his audience of confused and concerned parents in the guise of being an honest broker.^[d]

Holford refers to research that allegedly links whooping cough vaccination and cot death. However, he neglects to mention that the letter that he cites is a discussion of vaccination policy for “premature babies who may be at increased risk of apnoea and bradycardia“.^[1] Drs Smith and Elias-Jones report life-threatening apnoea after immunisation in 27 week gestation twins, after their first set of immunisations at 62 days (DTP, Hib, meningitis C and polio). It isn’t stated explicitly, but it seems as if the babies received DTwP for their first immunisation set. The authors state that the second set was delivered 4 weeks later and that they used acellular pertussis: neither of the babies had any reaction. The authors summarise then current opinion that supported post-immunisation monitoring rather than postponement of immunisation. Smith and Elias-Jones note:

Studies have implicated the whole cell pertussis component with significantly more reactions and raised C reactive protein after immunisation with DTwP than after separate diphtheria, Hib, and tetanus toxoid vaccines alone.^[3],[4],[5]

Many suggest immunisation with acellular pertussis, as inpatients with 48 hour monitoring.^[6] However, the evidence from one Australian study implies that the risk of future reaction is very low.

Smith and Elias-Jones do not explicitly state whether the premature twins received the older DTP vaccine or the 5 in 1 that was introduced in the UK from October 2004. The newer DTaP vaccine is associated with fewer adverse reactogenic effects.^[7] Further, although it seems more likely that it was the whole cell pertussis component that may have contributed to the respiratory arrest in this case, it is inappropriate for Holford to assume that it was or to use this reference in the unnuanced way that he has.

Holford is disingenuous to suggest that in “rare and isolated cases, the whooping cough vaccination is linked to cot death” when he neglects to mention that:

• the reference he cites in support of this is discussing immunisation for premature babies who may be at increased risk of apnoea and bradycardia
• the whooping cough vaccination was not the only one given in the case that Smith and Elias-Jones discuss
• the authors support post-immunisation monitoring rather than postponed immunisations
• the UK currently uses a different vaccine.

Holford uses the Harnden et al study^[2] to support his claim that the “vaccine may not even be that effective as school age children still had symptoms of whooping cough” despite a high rate of immunisation. However, the authors report some benefit:

Most of the children in our study had received a full set of primary immunisations. Although immunisation failed to protect them against pertussis, it did result in attenuated clinical features…

Holford also neglects to mention that the study involved 179 children recruited over 3.5 years from 18 practices: all of the children had a cough that had persisted for longer than 14 days and 172 were willing to give a blood sample (there are some interesting observations about the cohort in the Rapid Responses up to 31 July 2006). So, as nobody would argue that a vaccination will protect 100% of the children who receive it, it is difficult to understand why Holford thinks that the rate of whooping cough in a subset of children with a persistent cough is evidence for the “questionable level of effectiveness” of whooping cough vaccines and it follows that vaccination is unnecessary.

Harnden et al^[2] observe that:

Our research suggests that in the United Kingdom pertussis is…endemic among younger school age children. This finding is important because secondary attack rates of pertussis in non-immunised household contacts have been estimated to be 90%.^[8] Younger children are more likely than adolescents to have a newborn sibling to whom they could transmit the infection with potentially devastating consequences.

They suggest monitoring the impact of any change from the “whole cell vaccine to an accelerated primary course of the acellular vaccine with a fourth preschool booster dose” that had happened during the course of their study.

The authors are concerned about the high rate of transmission in homes where other contacts are not immunised: they explicitly mention the consequences for newborn babies. You will recall that Holford recommends that if the vaccine is given at all, it should not be before the age of ‘at least 4 months’ although that is one of the most vulnerable and dangerous ages at which to contract whooping cough.

HolfordWatch would argue that Holford omitted to mention that Harnden et al report that children who had been immunised presented with weaker clinical features of whooping cough. Harden et al also drew attention to the importance of vaccination in order to protect very young children from become secondary cases if somebody brought the infection into the household. The authors advocated monitoring the cycle of the disease to remain aware of any changes in the natural history.

HolfordWatch would suggest that Holford is misguided to juxtapose his claims about the non-serious nature of whooping cough and the alleged dangers of the vaccine. We have no way of knowing what other readers thought when they read that “whooping cough is no longer a serious threat to the life and health of our children”. However, according to NHS Immunisations: How Serious Is Whooping Cough?:

• more than half of babies under 1 with whooping cough are hospitalised
• the majority of pertussis cases involve some degree of collapsed lung and/or pneumonia
• about 1 in every 500 die from the illness, and the risk is highest in younger babies
• half of the deaths are attributed to pneumonia
• up to 1 in 50 can suffer convulsions
• around 1 in 1000 may develop encephalopathy (brain disease).

Serious illness is less common in older children however whooping cough can still be debilitating, and it is disruptive both for them and other family members.

Harnden et al^[2] made an interesting observation that data show that “neither infection nor immunisation results in lifelong immunity” for whooping cough. They also mentioned a US study that reported a 20% incidence of whooping cough infection in adults with a persistent cough.^[9] In Feb. 2008, Dr. Nayer Khazeni adopted a public information approach to disseminating Vaccine News You Need in the San Franciso Chronicle where he advised adults to be vaccinated against whooping cough.

The new tetanus/diphtheria vaccine also vaccinates against whooping cough. This resurging infection in adults can cause cough severe enough to crack ribs or induce vomiting, and may last months.

Vaccinated adults are also less likely to bring home the illness and transmit it to very young children. Dr Dragan Djordjevic likewise included pertussis vaccine in his list of 10 Life-Saving Inoculations for Adults.

As ever, if parents have concerns about vaccination, please talk to your Health Visitor, GP or other appropriate healthcare provider. HolfordWatch is exploring the evidence that Holford cites in support of his vaccination advice and we are demonstrating that he is using it inappropriately and, in some cases, distorting it. Decisions should be taken with as much clear information as possible, the process is hindered when interpreters such as Holford omit to mention relevant information or distort the research.

Sadly, there is more to come in this series devoted to Holford’s latest vaccination advice to parents. However, we close with a quotation from Horse and Buggy Doctor, written in 1938, by Dr Arthur E. Hertzler (h/t).

In summary, let it be emphasized that the freedom from disease that the public now enjoys is the result of the regular profession. (ie, medical doctors). It is all right for those with minor ailments, or with none at all, to consort with the cultists. It is all right to do fool things if someone is standing by able to protect us from the fruits of our folly.

But, let it be emphasized, if the cultists inherited the earth the epidemic diseases would be upon us with their original pristine terribleness.

Updates

July 22: Stifled Mind on Vaccination and asthma shown to be unlinked.
Epiwonk on Childhood vaccination is not associated with asthma. Epiwonk concludes:

A recent systematic literature review of high-quality studies that directly compared vaccinated and unvaccinated children, validated vaccination status by medical charts, and used preset criteria to define asthma found no association between childhood vaccination and asthma.

References

[1] Smith RK, Elias-Jones AC. Risk of life threatening apnoea after immunisation. Arch Dis Child. 2005 Apr;90(4):436-7.
[2] Harnden A, Grant C, Harrison T, Perera R, Brueggemann AB, Mayon-White R, Mant D. Whooping cough in school age children with persistent cough: prospective cohort study in primary care. BMJ. 2006 Jul 22;333(7560):174-7.
[3] Pourcyrous M, Korones SB, Crouse D, Bada HS. Interleukin-6, C-reactive protein, and abnormal cardiorespiratory responses to immunization in premature infants. Pediatrics. 1998 Mar;101(3):E3.
[4] Howson CP, Fineberg HV. Adverse events following pertussis and rubella vaccines. Summary of a report of the Institute of Medicine. JAMA. 1992 Jan 15;267(3):392-6
[5] Munoz A, Salvador A, Brodsky NL, Arbeter AM, Porat R. Antibody response of low birth weight infants to Haemophilus influenzae type b polyribosylribitol phosphate-outer membrane protein conjugate vaccine. Pediatrics. 1995 Aug;96(2 Pt 1):216-9
[6] Andrews RM, Kempe AE, Sinn KK, Herceg A. Vaccinating children with a history of serious reactions after vaccination or of egg allergy. Med J Aust. 1998 May 18;168(10):491-4.
[7] Jefferson T, Rudin M, DiPietrantonj C. Systematic review of the effects of pertussis vaccines in children. Vaccine. 2003 May 16;21(17-18):2003-14.
[8] Lambet HJ. Epidemiology of a small pertussis outbreak in Kent County, Michigan. Public Health Rep 1965;80: 365-9.
[9] Wright SW, Edwards KM, Decker MD, Zeldin MH. Pertussis infection in adults with persistent cough. JAMA. 1995 Apr 5;273(13):1044-6.

Notes

[a] Holford thanks Melody Mackeown of Natural Nutrition for “all her excellent research”. However, it is unknown whether Holford’s errors are attributable to Mackeown’s work or his use of it.
[b] Brian Deer discusses Professor Gordon Stewart and his role in the claims relating to pertussis vaccination in the 1970s.
[c] William Hoyt Jnr provides a readable and detailed description of whooping cough alongside a summary of the history of it and the vaccine programme in various countries during the twentieth century: Anti-Vaccination Fever: The Shot Hurt Around the World. Hoyt provides an overview of some of the important literature and summarises the impact of vaccination alarms and the return of epidemics of whooping cough in several countries.
Dr Doug Jenkinson has a special interest in whooping cough. He monitors the illness and provides statistics for it; he maintains Whooping Cough Information. In a 31 July 2006 Rapid Response he disclosed that he has a “website on whooping cough that charges a fee for personal advice. The fees have so far never covered the site expenses”.
Google search for whooping cough for first quarter of 2008 returns several stories about a rapid increase in the number of cases in the UK. Both the Daily Telegraph and Daily Mail report substantial increases.
[d] Holford creates confusion, mistrust and uncertainty. He then concludes with this recommendation:

Only you can decide in the face of conflicting and often confusing information when, and if, to vaccinate your children. My advice is don’t be bullied. Ask your health practitioner for clear answers to your questions, and if you’re not satisfied, ask to see an immunologist. [pg.8. My emphasis.]

There is little reason to think that an immunologist would provide different answers to those from your GP unless there are already contraindications that a GP knows about and is already taking into account. There is probably a long lead-time for a non-urgent referral on this matter and in the interim that might disrupt a child’s vaccination schedule. Such recommendations are disingenuous and seem to be made only to create discord and distrust rather than discourse.

BPSDB