Perhaps because attachment parenting (AP) is still outside of the mainstream, AP parents tend to be interested in other alternative ideas as well. One of these ideas is selective vaccination, usually referred to as SV on the mailing lists. SV refers to the practice of skipping or delaying vaccinations that are on the recommended schedule, based on information about the dangers of vaccines. This has always struck me as a fringe idea, but I try to keep an open mind, which is why I picked up a copy of The Vaccine Guide; it was recommended as the best book on the subject by several people whose opinions I respect.
Well, if this is the best book on SV, then I needn't read any others. To bluntly summarize: Neustaedter is an intellectually dishonest charlatan who produced a shoddy polemic designed to scare parents with an apparent veneer of research over unsubstantiated conclusions. I tried to find something less combative to say, but really, sometimes it amazes me that people will fall for this sort of thing.
Neustadter argues that vaccinations are a plot by big medicine and big business who have a vested political and monetary interest in selling more vaccines. It turns out, though, that this _cui bono_ stance cuts both ways. Who benefits if you follow his advice? Homeopaths, who offer an 'alternative' to vaccination. It turns out that Neustaedter is a homeopath himself. Not that he makes any secret of this, but it does make me wary of trusting his conclusions. I don't want to take the time to debunk homeopathy yet again. That's already been done in many places. As the folks at Quackwatch put it, "Simply put: Most homeopathic research is worthless, and no homeopathic product has been proven effective for any therapeutic purpose." Other useful sites on homeopathy include the explanation from The Skeptic's Dictionary and the National Council for Reliable Health Information (see their "Position Papers" section).
While finding that Neustaedter is a homeopath did set my bullshit alarm ringing, I read the rest of the book anyhow. After all, as the old saw has it, even a blind pig finds an acorn every once in a while. Unfortunately, the acorns are thin on the ground in this book.
Here's some of what passes for intelletual rigor in this book: "A number of vaccines are commonly given simultaneously. This may create more of a burden on the system and cause a greater likelihood of adverse reactions than giving the vaccines individually. No studies have evaluated the effect on the immune system of single versus combined vaccines, but since vaccines have been shown to temporarily suppress various immune system functions, it is conceivable that combination vaccines could compound this effect." (p. 30) "May" and "could" are not science. They're speculation, and should be labeled as such. One could equally well assert that giving multiple vaccines at one time could cause them to cancel out each other's adverse side effects, and so increase vaccination safety. The two statements have exactly the same connection to the truth: that is, none at all, in advance of actual studies. Science works by advancing hypotheses and then testing them. This book is long on hypothesis, and short on tests.
Neustaedter is also guilty of a sort of reverse argument from authority. For example, he's a great proponent of the notion of "delayed reactions" from vaccines, even though every evaluation I've seen of such reactions (autism, diabetes, Epstein Barr, GBS, MS, and so on) has come out negative. One of his arguments for the existence of delayed reactions is that the Vaccine Safety Committee of the Institute of Medicine says that they don't exist. The establishment says that delayed reactions don't exist; therefore, they must exist.
Neustaedter spends many, many pages on presenting the possible adverse side-effects of vaccines. No one denies that these side-effects occur; what's missing from his discussion is any hard facts on the frequency of side effects. He also challenges the efficacy of vaccines. He's not above playing fast and loose with the facts to achieve his goal, which is to convince the reader that vaccines are dangerous and ineffective. For example, here's a quote from his chapter on polio: "A widespread outbreak of type 1 polio occurred in Oman during 1988 and 1989. A total of 118 cases occurred, primarily in children younger than 2 years old, despite a universal vaccination program and full coverage (at least 3 doses of OPV) for 87 percent of children by the age of 12 months. The high rate of paralytic polio in this population means that thousands of fully vaccinated children became infected during the outbreak." (p. 111) What's missing there? How about this quote from the very same research paper in the Lancet that he cites as a source: . "A primary series of OPV (3 doses) reduced the risk of paralysis by 91% (adjusted estimate); two doses reduced the risk by 80%." (quoted at http://www.pathguy.com/antiimmu.htm) It's tragic that 118 children got polio, of course. How much more tragic would it have been without vaccination?
In general, in fact, Neustaedter just ignores vaccination success stories. You'll search in vain. for example, for any mention in his book of the successful world-wide effort to eradicate smallpox.
Neustaedter's discussion of vaccine additives is similarly dishonest. He draws a horrible picture of the substances added to vaccines -- formalin, Thimerosal (an organic mercury compound), aluminum salts -- and implies that vaccination involves injecting poisons into your child. Yes, formalin is bad for you in large doses with long exposure. This does not imply that it is bad for you in small doses. In fact, were he a consistent defender of the homeopathic faith, it seems he'd have to maintain that it's good for you. After all, the entire materia medica of homeopathy depends on giving, in very dilute doses, the exact ingredients that cause symptoms. But this logical inconsistency seems to escape his notice.
There are many, many other points on which I could challenge this book, but this review is already long enough. On every single point where I've bothered to do the research, Neustaedter's conclusions are wrong. It would require an entire book to refute his conclusions, but I have no doubt whatsoever that writing that book would be simply a matter of reading the studies he cites and seeing what they actually say, without the intellectual blinders of homeopathy. I suppose if you've already decided not to vaccinate, or to skip or delay certain vaccinations, The Vaccine Guide might provide validation for your conclusions. The section on your legal rights to not vaccinate is well-written and contains useful information. But that's a mighty thin recommendation.
In contrast, I found Vaccinating Your Child to be a readable summary of the current issues in vaccination. The lead author is a researcher at the Centers for Disease Control, so of course she's part of The Conspiracy (as, I suppose, am I at this point), but she doesn't gloss over the risks of vaccination.
Written in January 2000, Vaccinating Your Child starts off by discussing the overall point of vaccination and the way in which the immune system reacts to vaccines. The authors review the testing process and then discuss some of the current vaccine controversies. There are also chapters on medical reasons not to vaccinate (for example, you should beware of routine vaccines in children with HIV infections) and the rights of parents.
The rest of the book is a discussion of each of the common childhood vaccines (and a few others, such as smallpox and anthrax, that are not generally available). The authors describe the diseases being vaccinated against, talk about the vaccines and their effectiveness, and warn of possible side effects.
While being overall pro-vaccine, this book does not gloss over the dangers of vaccinating. There are vignettes focusing on individual children throughout. Some of these stories are of tragedies that could have been prevented by vaccination, but others are of children who were injured or killed by adverse reactions. The authors provide solid figures on potential side effects, so each parent can judge the risks. The DTaP vaccine, for example, causes convulsions or seizures in 1 out of 14,300 children. Yes, that's a risk, and a serious one. But before this vaccine, diphtheria alone killed 13 to 15 thousand people per year in the United States. The choice seems clear to me. I personally do not want to live in a society where diphtheria is rampant. There are still reservoirs of diphtheria worldwide (for example, an epidemic in the Soviet Union killed 5000 people in the early 1990s), and with modern travel, those reservoirs are hours away from my children. If all the other children in the USA were vaccinated, and mine was not, my child would probably be safe; there would be no epidemic. But that sort of reasoning is the quintessence of selfishness. If everyone reasons that way, epidemics result. To be a part of society requires, on occasion, accepting risks. Vaccination strikes me as one of those necessary risks.
But it's not one to be undertaken blindly. Parents ought to become informed, so that they know what questions to ask of their physician, and what side effects to watch out for. Vaccinating Your Child is an excellent book in this regard, and I'd recommend it to any new parent.