In the first installment of this series debunking the book “Turtles All the Way Down” (written by “Anonymous”, and edited by Children’s Health Defense lawyer Mary Holland and Children’s Health Defense Publisher Liaison Zoey O’Toole), I examined and debunked the first chapter of the book. As I said then, because this is a fairly long book, I’ll be spreading my posts out over 10 more reasonably digestible pieces. This is the next installment in the series – debunking Chapter 2 – which is supposedly concerned with “The Science of Adverse Events”. As in the previous installment, I will present quotes or paraphrases of statements from the chapter with their associated debunks, and answers to the questions at the end of each chapter. Statements that are repetitive will be addressed only once or twice even though they might appear several times within the chapter.

1.    At present, officially sanctioned medical science knows very little about the harmful effects of vaccines. It cannot, and does not, anticipate which children will be injured by vaccination.

This is partially true in that there is no Star Trek style “medical tricorder” yet invented that can be waved over everyone’s immune system ahead of time to determine which minority of people can be anticipated to have a vaccine associated adverse event. I’m sure Children’s Health Defense would love to have such a tool, but then still be hostile towards vaccines – it’s their brand. Due to financial reasons, they can’t say anything else.

The collective knowledge, though, of vaccine side effects, is quite large – a search of vaccine side effects on Pubmed alone (this is just one database) reveals more than 54 000 entries. Again, vaccine safety surveillance, or pharmacovigilance, is always active after the release of a new vaccine. The claims linking ingredients such as thiomersal in immunizations with autism and sudden infant death syndrome have been thoroughly, thoroughly debunked, and yet the authors still bring this up.

They next go on to criticize the 2011 Institute of Medicine report, whose role was to investigate several vaccine side effects, but they are very upset that the report in general spoke to the safety of vaccines. If an immunization creates more benefit than risk, then according to even the author’s own exhortations, this is one part of following the science and then accepting that immunization into the mainstream.

It escapes the author’s thinking that we can be simultaneously supportive of effective and safe vaccines, while also being supportive of the rare patient who developed vaccine-derived polio, or the teenager who developed myocarditis (who will need the care of a cardiologist). The risk of paralysis (severe polio disease), although small, multiplied across the entire world population who received the polio vaccine, means that a massive number of people are free of the devastating disease of paralytic polio.

If the authors actually cared about helping those with a vaccine associated adverse event or figuring out the mechanism of a rare adverse event – they would fund studies to this effect. For example, here’s an article about a well done vaccine adverse event study on COVID-19 vaccine associated postural orthostatic tachycardia. The study was supported by grants from the National Institutes of Health; Doris Duke Charitable Foundation; American Heart Association; the American Society of Nuclear Cardiology; the Smidt Heart Institute (A.C.K.); and the Burns & Allen Chair in Cardiology Research (P.-S.C.), Cedars-Sinai Medical Center.

What they do instead, is fund narrative articles full of biologically nonsensical information that is relatively free of scientific reasoning. Which antivax strategy was used here? Flood the zone with information, with complete disregard as to whether or not it is correct. Robert F Kennedy Jr or Steve Kirsch are most definitely not coming to your aid if you get a vaccine associated adverse event – your physician will do that. Someone like me is going to treat vaccine associated myocarditis, not Del Bigtree. The moral high ground would be to come up with the better research project (perhaps even figure out more genetic predictors of vaccine side effects), but there is clearly no effort on the part of this group to do so.

2.    Scientific research into the mechanisms underlying side effects of vaccines should investigate, among other things, (1) the effects that vaccine ingredients (like aluminum adjuvants) have on the body; (2) the biochemical interactions between vaccine components; (3) the biochemical interactions among multiple vaccines administered at the same time; (4) genetic characteristics that may increase vulnerability to vaccine injury; and (5) permanent or transient health conditions that may increase susceptibility to injury.

There have been attempts to do all these things. The antivax strategy used here, is to be disappointed that these research problems are not thoroughly researched to perfection (No True Scotsman Fallacy).

(1) The effects that vaccine ingredients (like aluminum adjuvants) have on the body:

Many adjuvants have come and gone, and those that were retired left the scene due to too many unfavorable symptoms. The modern research into adjuvants actually stretches back many decades at least, something that is ignored in the book.

Adjuvants have been around for a very long time and probably date back to at least the 1800s, when a scientist discovered that certain killed bacteria, when given to patients, can cure certain limited types of cancer. It was after this that the usefulness of adjuvants in enhancing immunity with vaccination was discovered, which is where aluminum compounds come into the picture.

Aluminum is never present in a vaccine as the base metal – no aluminum filings are being injected. It is aluminum chemically reacted with something else like hydroxide. This is actually the oldest and most well studied adjuvant, and in many ways, is the standard against which prospective new adjuvants are judged.

However, the lack of a precise set of mechanisms showing how the aluminum actually exerts its action is a legitimate knowledge gap. Some ideas have been proposed, such as the sensing of aluminum salts by special receptors inside the cells. One very fascinating discovery is that surgical removal of the area of skin containing the adjuvant after vaccination actually does not impede the subsequent immune response, meaning the actual aluminum isn’t behaving like a slow release mixture of the bacteria/virus being vaccinated against (like what is done with some of our oral medications).

Before someone misinterprets what I say as “take out all the aluminum because it’s not needed”, I remind the audience that certain types of vaccines do not produce a meaningful response unless an adjuvant is added (we wouldn’t want to waste an injection). Side effects of this oldest adjuvant do exist, but the book glosses over the fact that more than 3 billion vaccine doses have been given, with side effects attributable to this adjuvant being a tiny fraction of that total (approximately 130 cases).

(2) The biochemical interactions between vaccine components:

It was not originally apparent that it was feasible to mix diphtheria, pertussis, and tetanus into one vaccination. Chemists and vaccine researchers had to do separate projects to figure this out. At the most basic level, vaccine active ingredients must be put in a container with other items (like sugar, salt, water, and acidity modifying agents) such that it has a usable shelf life. It would not be acceptable for eggs to come to you, the grocery shopper, already cooked – that means the proteins have changed their shape and have become solid egg protein. The same goes with vaccines – you need the active ingredients to stay chemically stable in their containers until they reach the user.

There is quite a bit of research studying vaccine interactions that is completely ignored by the authors. In just this one study, the investigators learned not to conjugate (meaning chemically stuck together) pneumococcal vaccine to tetanus because it could cause weakened immunity to pneumococcal vaccine when given with another vaccine also conjugated to tetanus toxoid. This is one of the big reasons why the modern iteration of the PCV13 (pneumoccal vaccine) is conjugated to a diphtheria protein, rather than the tetanus toxoid.

Biochemical interactions between multiple vaccines have to be studied in order to make multi-vaccine doses (D-T-aP refers to three vaccines for example). You can’t have one vaccine degrade the other, otherwise they couldn’t be mixed together. Chemists literally had to figure out all the interactions before they could decide which vaccines could be mixed and which vaccines needed to sit in separate containers before giving to a person. There are many studies directly addressing this, for example: one group tried mixing the strep pneumoniae vaccine with a group C meningitis vaccine; the group realized that this mixture produced weaker immunity than just doing a meningitis vaccine by itself. This mixture never got FDA approval thanks to studies like these.

In other vaccines, you will see addition of salts and buffers. The addition of certain salts is to make sure the vaccine is about the same saltiness as the human body (everyone’s probably seen what happens to your fingers when submerged in the ocean for too long). The buffer is to make sure the vaccine is the same acidity as your body – you wouldn’t want to mix something that is a lot more acidic or basic than your body, into your arm. The interactions between salts and buffers is extremely well established chemistry lab science. Failure to read this science on the part of the authors is not sufficient evidence to say the science did not happen.

(3) The biochemical interactions among multiple vaccines administered at the same time:

This is a thinly veiled reiteration of the old antivax talking point of demanding a randomized placebo controlled trial of the entire vaccine schedule. Would the antivax community suddenly be satisfied if such a trial actually happened? Absolutely not, because they will find something else to be upset about.

In addition, the biochemical interactions between multiple vaccines administered at the same time has been studied for a very long time both in RCTs and post-marketing surveillance and pharmacovigilance of children receiving their country’s standard vaccine schedule.

There are also multiple issues with demanding such a trial. First, based upon the clinical trials that are already available, the number of adverse events will be very small, necessitating a very, very large trial. Next, making randomized controlled trials that big necessarily involves preventing large numbers of children from receiving vaccinations against real, health endangering, and sometimes deadly, vaccine preventable diseases, which is clearly unethical (this book generally glosses over all vaccine benefits).

Again, failure to read any of this science on the part of the authors is not sufficient evidence to say the science did not happen.

(4) Genetic characteristics that may increase vulnerability to vaccine injury:

Genetic characteristics that may increase the potential for vaccine related adverse events have been studied but could use additional study, for sure. For example – Dravet syndrome is a problem with your body’s ion channels, that may cause you to have a seizure with a fever (after a vaccination). An ion channel is responsible for maintaining the electricity that allows your body to function. When the ion channel functions too slowly or too quickly, disorders like Dravet syndrome can occur. This is however, nobody’s fault. It is not something you can catch by going to Starbucks. It is also easily treatable by a trained pediatric neurologist.

Compare that to the conditions that vaccine preventable diseases sometimes cause that absolutely, definitely have no cure such as subacute sclerosing panencephalitis after measles or deafness after congenital cytomegalovirus. Even if Dravet syndrome is diagnosed – that would mean the patient is still subject to febrile seizures with the actual disease. So, I hope a discussion is completed in regards to whether or not the family actually wants a child diagnosed with Dravet syndrome to gamble with the actual disease and all its complications.

The vast majority of people with inherited congenital problems still deserve vaccination, such as people with Turner syndrome, prematurity, or congenital diaphragmatic hernia. In fact, these patients at times need classical vaccinations more urgently than the general population because they may be more liable to become seriously ill.

(5) Permanent or transient health conditions that may increase susceptibility to injury:

What are some of those conditions? I invite the reader to view the published vaccine inserts that list conditions that count as generally accepted medical precautions or contraindications to receipt of certain vaccines. For example, certain immunodeficiencies mean the patient may not receive live vaccines (e.g. certain types of cancer patients). Encephalopathy after pertussis vaccine is a reason to not receive further doses of that vaccine. Again the author pretends that this part of vaccine science didn’t get researched, but in reality, they just failed to read about it.

Note the lack of quantifiable contributions of the authors to actually advance the research, despite their strong exhortations that it be done. The statement that “there is no scientific foundation” in this particular subject is then, objectively wrong, as I’ve shown several times above. A productive way of spending their time would be to fund publishable research into vaccine side effects that is successful in peer review amongst the scientific community. The authors don’t do that.

3.    The lack of solid science illuminating the mechanics of vaccination side effects has another important downside: It allows researchers conducting clinical trials to arbitrarily decide whether a particular adverse event observed in the trial is related to the vaccine or not.

This is an intentional distortion of what actually happens. While it is true that determining whether an adverse event is due to a vaccine is sometimes subjective, it is the knowledge of medicine of the person making the determination that helps create the determination. There are no people who make adverse event determinations based upon a whim or the side of the bed their cat woke up on. Some events are clearly unrelated, such as car accidents and gunshots.

The United States Vaccine Adverse Event Reporting System and the UK Yellow Card scheme are designed to allow as many reports as possible, but due to the subjective nature of the system, further analysis via a more robust database is needed, such as the Vaccine Safety Datalink. I will go through how pediatric cardiologists determine the presence of a now very famous vaccine adverse event – COVID19 mRNA vaccine associated vaccine myocarditis.

The cardiologist first determines the time course of events/symptoms. Next, they do an EKG, troponin, echocardiogram, and blood testing to determine if any other infections have recently occurred (because viral infections always place people at risk of myocarditis). Then, the definitive test for diagnosing myocarditis is cardiac MRI. Once all the tests have resulted, and no infection is found, the diagnosis of vaccine related myocarditis is established. Note that it took until 2023 for us to have some research delineating exactly why this happens. Some side effects are definitely more subjective than others, but the overall determination is definitely not made on a whim.

Remember, Children’s Health Defense wants the side effect count as high as possible so they can continue to malign vaccines. There is no situation in which they would accept a vaccine as safe, which would degrade their messaging. They actually care little about the actual healthcare of children. If the reader follows the posts on this website for a few years, it becomes evident that this is not only my opinion – CHD always finds something new to complain about in regards to immunizations.

4.    There is never any mention of the fact that no attempt was made to establish whether or not a causal link exists.

The allegation here is that initial reports of possible vaccine related adverse events use the terminology “condition X was reported following use of the vaccine” and emphasize that “a causal association could not be established”, therefore the vaccine researchers don’t actually care to research vaccine side effects. This is an intentional distortion of what we do.

When initial reports of adverse events come in, investigators do not have enough information, based upon the reports alone, to determine if the adverse event was caused by the vaccine. One of the reasons is that many of the adverse events also occur in the absence of a vaccine. After reports are made, in the United States, the CDC needs to follow up, call physicians, and sometimes get additional medical testing to figure out what really happened.

The reports must be collated, verified (no reports of turning into The Incredible Hulk can be used), and other investigators must start working on potential vaccine adverse event mechanisms before a valid side effect or adverse event can be established. The rates of a particular adverse event are also compared to the rates of those events in the general population – the “background rate” – to see if they’re occurring at a higher rate among those who are vaccinated. This can take a long time. To make statement #4 with a straight face requires ignoring all of this willingly.

5.    If our child experienced a health problem following vaccination, what medical tests are at your disposal to decide whether the condition was actually caused by the vaccine?

In every vaccine out there, the overall risk to all age groups for which it is targeted is far outstripped by the benefits, otherwise no national health agency would approve the vaccine. They have certainly been instances when rare side effects only became apparent after approval and further pharmacovigilance review, such as myocarditis after the mRNA COVID-19 vaccines and intussusception after the RotaShield® vaccine.

The selection of tests may not necessarily be good enough to formally diagnose every observed side effect that has ever been recorded, but myocarditis is efficiently diagnosed by cardiac MRI and intussusception is efficiently diagnosed by ultrasound. There are actually many more tests for different types of possible adverse events than this book is giving the medical community credit for – and authors ignore that on purpose.

However, many side effects and adverse events that occur following vaccination also occur in the absence of a vaccine – both myocarditis and intussusception, for example, have other causes. Part of determining whether a particular health issue following vaccination was caused by the vaccine involves ruling out other possible causes. However, there are specific adverse events that have been determined to be related to specific vaccines and if they occur within a certain time following the vaccine it can be assumed that they are caused by the vaccine.

6. We fear that our child could be adversely affected by a particular vaccine. What medical tests can you perform in order to determine whether or not she is at high risk of being injured by that vaccine?

The author is sort of correct in the second part of this question in that there is no Star-Trek style medical tricorder that can scan a baby ahead of time, to predict every possible vaccine side effect. However, this discussion should always be accompanied by the risks of the disease that the vaccine is trying to prevent. While the ability to predict vaccine side effects ahead of time, for an individual patient, is limited, the risks versus the benefits are very, very well known.

Willful misrepresentation

Overall, the authors in this chapter attempted to make a case that the toolbox for diagnosing vaccine related adverse events is an empty toolbox, and full of missing links. If the speakers wanted to go to Home Depot and take a picture of an empty toolbox, and claim this is the toolbox used by a professional car mechanic, this would be clear evidence of misrepresentation. This is exactly how this chapter reads to someone who is actually trained on pediatric vaccines. It shouldn’t require a medical degree for the reader to appreciate that the Home Depot scam I invented is not reflective of reality. One can give the impression that vaccine science is full of missing links very easily – if one fails to read all the links that were provided even in the sources that the authors cited. This whole chapter, is therefore, a great example of the authors simply putting their heads in the sand.

The complete series

Posted by Frank Han

Frank Han, M.D. is an academic board certified pediatrician/ pediatric cardiologist. He splits his time between cardiac imaging (Nuclear, CT, MRI, and echocardiography), inpatient cardiology, and outpatient cardiology. He primarily cares for cardiology patients of all ages with congenital heart disease, and is dedicated to educating pediatric residents and medical students. Dr. Han first became aware of and interested in the incursion of pseudoscience into his chosen profession while completing his pediatric residency at Connecticut Children's Medical Center and saw it explode during the COVID pandemic. He has since focused his efforts on spreading the joy of science literacy and teaching patients how to take charge of their own health while navigating the tricky online world of medical information. Dr. Han has no conflicts of interest to disclose and no ties to the pharmaceutical industry. He can be found on Twitter as @Han_francis. The comments expressed by Dr. Han are his own and do not necessarily represent the views or opinions of OSF Medical Center, or the University of Illinois College of Medicine.