UPDATE: On the same day (August 20) that Kennedy taped a segment on the Dr. Oz show, he was interviewed on Good Day New York (a Fox affiliate), and the Leonard Lopate radio show. Lopate was very skeptical of Kennedy's claims and challenged him with good questions. *** I was at the Baltimore aquarium with my wife and kids a few weeks ago when Robert Kennedy Jr. called me on my cell phone to vent about the media's deep reluctance to take his newly published book seriously. At the time, even the Huffington Post was giving him the back of the hand. This was a familiar story, one I had recently chronicled. But what struck me about Kennedy's call was the timing: He was getting married the next day to Cheryl Hines. I told him to forget about Thimerosal for a day and focus on his wedding. I mention this anecdote to illustrate Kennedy's persistence. Call him a zealot, call him anti-science, call him what you will, but he is pressing on with his lonely campaign to rid all vaccines of Thimerosal, a mercury-based vaccine preservative long discontinued in U.S. pediatric vaccines but still used in a few flu vaccines. He has many friends in politics and media, but as I noted in my Washington Post magazine piece, he's been repeatedly spurned on the thimerosal issue. He did recently get some airtime at CNN and today, he is taping a segment on the Dr. Oz show. Joining Kennedy on the show will be Mark Hyman, a medical doctor (he operates The UltraWellness center) and best-selling author who has embraced the thimerosal issue with nearly as much gusto as Kennedy. Earlier in the year, Hyman's health advisory role with the Clintons's was written about in the New York Times. Hyman collaborated closely with Kennedy on his just-published Thimerosal book. I'll be curious to hear Dr. Oz's interview with Kennedy and Hyman. Meanwhile, if you'd like to learn what Hyman thinks about Kennedy's critics and the science and health authorities that have pronounced Thimerosal to be a safe vaccine ingredient, below is the recent email exchange between us.KK:
Since my Washington Post magazine profile of Robert Kennedy Jr. was published last month, he's been heavily criticized in Time, Slate, the Daily Beast, among other outlets. I'm assuming you've read all the pieces. The sentiments range from bafflement to anger. All the writers argue that his crusade against Thimerosal is terribly misguided and not based on science. You worked closely with Mr. Kennedy on the book and obviously feel different. Do you think respected mainstream science journalists, such as Laura Helmuth at Slate and Jeffrey Kluger at Time, are wrong? if so, what are they--and so many others--getting wrong?
MH: What was most stunning about the articles was that none of the journalists had actually read the book, or read the scientific papers that the book was based on. It wasn’t even available when they wrote those articles. There were over 500 peer reviewed papers referenced the book. Instead they relied on what they believed was or was not in the book. They claimed that it was anti-vaccine and anti-science. In fact, challenging existing or new hypotheses is the very essence of science. To declare “case closed” on a scientific question, as they have done, is the antithesis of scientific discourse. The book attempts to soberly review an imperfect literature on a very controversial subject. And asks a very simple question, which was not addressed in their reviews [Hyman's emphasis]: Should we inject a known neurotoxin in vaccines into pregnant women and children? Even if there were only weak evidence of harm, the rule of reasonableness and the precautionary principle suggests that we should remove mercury from vaccines, especially in light of the effectiveness of alternatives. It has already been removed from childhood vaccines used in the United States and remains primarily in flu vaccines. Jeffrey Kluger dismisses ethylmercury as non-toxic and the dose insignificant. He states that, “the quantity of ethylmercury that was once in vaccines was so small that it was actually within acceptable limits for the more toxic, methyl form—but it wasn’t even in that methyl form to begin with.” This is wrong. The dose of Thimerosal (50 percent ethylmercury) is 25 mcg per vaccine. If the flu vaccine were given to a baby, it would have to weigh 225 pounds for the dose to be safe at the EPA threshold of 0.1 microgram/kilogram per dose. And in fact, an Institute of Medicine review of the evidence, concludes that while there is limited research, “ethylmercury should be considered equipotent to methylmercury as a developmental neurotoxin. This conclusion is clearly public health protective.” It is absurd to think that the FDA recently banned trans fats and banned the use of mercury in topical preparations like Mercuochrome, but allows it to be injected into pregnant women and children. Russell Saunders in his piece in The Daily Beast “Robert F. Kennedy Jr.’s Twisted Anti-Vaxx History” states that, “despite multiple studies showing no link between vaccines and autism, RFK Jr. continues to use his position to spread that lie.” Clearly he never read the book. First it is pro-vaccine, not anti-vaccine. The first chapter clearly lays out the strategy to increase not limit vaccinations. Second the book does not discuss autism and Thimerosal. It is hard to take criticism seriously by someone who has not read the book, nor who understands its intent, which is simple. It is this [Hyman's emphasis]: Thimerosal is 50 percent mercury. Mercury is a neurotoxin. Is it a good idea to inject into pregnant women and children when alternatives exist? Probably not! Do we need more evidence that is it potentially harmful? Probably not!KK:
There is a small, vocal minority of the autism community that associates vaccines--specifically Thimerosal--with autism and other disorders. According to the CDC:
a scientific review by the Institute of Medicine (IOM) concluded that 'the evidence favors rejection of a causal relationship between thimerosal–containing vaccines and autism.' CDC supports the IOM conclusion that there is no relationship between vaccines containing thimerosal and autism rates in children.
In recent years, we've seen outbreaks of measles and whooping cough, due in part to vaccine resisters. Are you concerned that this book will fuel vaccine fears?MH: I am very concerned that public confidence in vaccines has been eroded and see a very important opportunity for policy makers to reassure parents and the population that clear steps have been taken to reduce a potential risk from vaccines and thereby reestablish public trust. Most consumers and even most policy makers don’t understand that the conclusions from the IOM [Institute of Medicine], which found no correlation between Thimerosal and autism, were fundamentally flawed. First the studies looked only at autism, not at neurodevelopmental disorders in general, missing the potential to identify more subtle harm from Thimerosal. Second, population studies, by their very nature, cannot prove cause and effect, nor disprove it. They can only generate hypotheses based on associations. So to draw a conclusion that they are not linked, and to declare the need for further studies unnecessary is simply scientifically inaccurate. And the few studies observational studies that the IOM report was based on that everyone quotes as vindicating Thimerosal were deeply flawed as extensively documented in the book. Three of the IOM-accepted studies relied in whole or in part on Danish population autism statistics, which showed that autism levels increased after Thimerosal was removed from vaccines in 1992. This evidence strongly suggested that Thimerosal was not linked to autism. However, the IOM did not properly account for confounding factors in the data, such as the counting of both outpatient and inpatient cases after 1995 that expanded the number of children known to be affected, the adopted use of a broader definition of autism in 1994, and the exclusion prior to 1992 of the largest Danish clinic treating autism, which cared for 20 percent of autism cases. KK:During one of my interviews with Mr. Kennedy, he jokingly said, "Mark doesn't know this, but I'm gong to ruin his career." Are you worried that your association with his anti-thimerosal campaign will harm your reputation?MH: As a doctor my first oath is to “First Do No Harm”. In all good conscience, even in the face of a small risk, given safe and cost effective alternatives, I could not remain silent on this subject. I have treated thousands of patients sick from the harmful effects of low levels of mercury on human biology, risks well established in the medical literature, but mostly ignored in medical practice. There is no role for mercury in any form in medical products. If we are right, then we can save 137 million children a year from being injected with a known neurotoxin. If we are wrong we removed a known neurotoxin from medical use. Probably a good thing. I have never shied away from taking on tough topics, calling out the food industry for its role in the obesity epidemic, or advancing a new medical paradigm called Functional Medicine that most dismissed until now when it is being embraced by leading medical institutions such as Cleveland Clinic. Now twenty years after being ridiculed by my colleagues for suggesting that gut flora may play a role in chronic disease including autoimmunity and obesity, the research on our microbiome is one the fastest growing and more important areas of biomedical research. Scientific debate is often heated and emotional, when in fact, it should be dispassionate. This scientific question raises emotions, when it should raise curiosity and stimulate further inquiry. KK:
Critics of Mr. Kennedy correctly echo scientific bodies and medical authorities when they say the science of thimerosal is settled--that, as the World Health Organization stated in 2012, the "available evidence strongly supports the safety of the use of thimerosal" as a a vaccine preservative. The WHO further states:
Thimerosal allows millions of people worldwide to have access to life-saving vaccines and to date, no other safer and equally efficacious alternative has been identified for many vaccines.
Has the WHO gotten it wrong on thimerosal, too? How do you account for all these highly respected public health bodies coming to a conclusion very different from the one in the book put together by you and Mr. Kennedy?MH: This statement from the WHO is curious and perhaps even frighteningly uninformed. How could it be accurate that “Thimerosal allows millions of people worldwide to have access to life-saving vaccines and to date, no other safer and equally efficacious alternative has been identified for many vaccine” when Thimerosal has already been removed from all pediatric vaccines in the United States and many other countries? Arguments are made about the challenges of keeping vaccines cold in the developing world if there were no preservative or about the cost of changing from multi to single dose vials. Even if all vaccines were switched to single dose vials, obviating the need for preservatives the cost is $300 million, a fraction of the potential human and economic impact of injecting neurotoxins into children. In fact, studies show that up to 60 percent of the multi-dose vials are wasted in the developing world, making the cost per dose the same as single dose vials that don’t need preservative. As far as efficacy, the book clearly describes the science documenting the fact that Thimerosal is a weak preservative and other more effective preservatives exist. Even if all vaccines were switched to single dose vials, obviating the need for preservatives the cost is $300 million, a fraction of the potential human and economic impact of injecting neurotoxins into children.