Submitted for your approval.

The link brings you to a video by Sherri J. Tenpenny, D.O. entitled "Vaccines...the benefits...the risks...the choices". Dr. Tenpenny describes herself as board-certified in Osteopathy and Emergency Medicine. To listen to her own account of her career, it appears that she has done very little either Osteopathy or ED work for several years. Instead, at the time of the lecture in 2004, Dr. Tenpenny claims to have spent over 6000 hours researching vaccines and vaccine-preventable diseases.

It's a fascinating lecture, though a little long at 2 hours, 52 minutes. Dr. Tenpenny discusses many of the risks, many of the choices, but precious few of the benefits associated with vaccines. In fact, by the 2-hour mark it is fairly clear that Dr. Tenpenny would prefer that Americans not vaccinate their children at all.

Presented here are several classic anti-vaccination arguments: Vaccines are not solely responsible for the elimination of infectious diseases (Dr. Tenpenny argues explicitly that Smallpox would have vanished on its own without the vaccine); Vaccines are not as safe and effective as conventional doctors are willing to discuss; And the potential for harm from vaccines is in many cases greater than the risk from the relevant diseases.

It is this last point on which Flea wishes to focus, because therein lies the crux of the debate over universal vaccination programs. What one will not hear from Dr. Tenpenny is any discussion of relative risk: What's more likely, morbidity and mortality from a vaccine-preventable disease (VPD), or morbidity and mortality from vaccines?

She is pretty good at rehearsing the low numbers of reported deaths from VPD's, but rather bad at quantifying the numbers of individuals harmed by various vaccines.

For example, regarding the Hepatitis B vaccine (Dr. Tenpenny's avowed nemesis), we are told that basically only drug-abusing prostitutes get the disease, but that the vaccine causes autoimmune diseases.

Dr. Tenpenny's best discussion of VPDs centered on Diptheria, Tetanus, and Pertussis. She gives a terrific overview of all three diseases including their pathophysiology and the mechanism of action of the relevant vaccines. At great length she argues that none of these VPDs are particularly harmful, but that the DPT vaccine, caused serious complications. That DPT vaccine is no longer widely administered does not disrupt the thread of Tenpenny's argument.

Perhaps the most remarkable segment of the video comprises the few minutes Dr. Tenpenny spends on Hib. She admits that morbidity and mortality related to the diseases has largely disappeared since introduction of the vaccine. "The Bad News" about Hib, however, is that one report showing an increased rate of Type I diabetes in Finland. Furthermore, Tenpenny argues that a decrease in invasive Hib disease has led to an increase in invasive pneumococcal disease, making a pneumococcal vaccine "necessary".

And what about the hepta-valent pneumococcal vaccine (PCV-7, or Prevnar)? Dr. Tenpenny tells us only that there's a fair amount of aluminum in each vaccine and that the teratogenic and carcinogenic potential of the vaccine has never been established.

Regarding the chicken pox vaccine, Dr. Tenpenny tells us that disease is mild, everybody gets it, and that the efficacy of the vaccine is fairly lousy.

One recurrent theme in the talk deserves mention. Dr. Tenpenny goes on at length about "molecular mimicry". This is the theory that excess disease-specific antibodies with nothing to do will likely attack our own bodies, resulting in immune diseases. Indeed, we know from the pathophysiology of Rheumatic Fever that antibody cross-reactivity can give rise to disease. Dr. Tenpenny argues that since the phenomenon exists, it must exist in the case of vaccine-induced antibodies.

The doctor presents no such evidence because none exists.

One more annoying feature of the video: Dr. Tenpenny appears to speak before an audience. There is a stage festooned with flower-pots, a screen and a screen for slides. But the audience, if there is one, is silent - nary a cough or sneeze in three hours. At several junctures Dr. Tenpenny tells jokes that elicit no laughs. Flea suspects there is, in fact, no audience.

Unfortunately, there is indeed an audience in the community and they are paying rapt attention. We owe this audience a discussion of relative risks. Otherwise we might as well give talks to empty rooms ourselves.