The unofficial vaccine educators: are CDC funded non-profits sufficiently independent?
BMJ 2017; 359 doi: https://doi.org/10.1136/bmj.j5104 (Published 07 November 2017) Cite this as: BMJ 2017;359:j5104
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Rational doubt cannot be raised about the measles vaccine
Miller writes below that “our organization has found that it has not been proven that the MMR vaccine results in less death or permanent disability than what is expected from measles.” This is an absurd comparison, as the reason that so few people die or get seriously injured from measles is that most of the population is vaccinated. According to the WHO, measles vaccines have saved millions of lives. It is one of the best interventions ever introduced in healthcare. Miller’s other arguments against the measles vaccine are similarly spurious and for the same reason.
According to a study in Science from 2015, with coefficients of determination close to one, i.e. almost perfect correlation, measles infection increases the risk of dying from other infections (1). This risk is not only related to the time of the infection but persists for the next 2-3 years. The mechanism behind it is that measles causes immunosuppression, likely via depletion of B and T lymphocytes. This may explain Aaby’s findings (2) that vaccination against measles decreases total mortality much more than predicted by its specific effect against measles because the vaccination does not lead to this harmful immunosuppression.
The most successful vaccines, to some extent, are victims of their own success. They have beaten so many infectious foes into oblivion that hardly any practising doctors, let alone new parents, remember how terrible those diseases once were. We have not only eliminated smallpox, diphtheria, polio and measles, we have also eliminated the memory of these diseases. This is tragic. The usefulness of some vaccines can surely be discussed, and I have, for example, never received a flu shot, but the measles vaccine is not among those where rational doubt can be raised.
1 Mina MJ, Metcalf CJ, de Swart RL, et al. Long-term measles-induced immunomodulation increases overall childhood infectious disease mortality. Science 2015;348:694-9.
2 Benn CS, Fisker AB, Aaby P (eds.). Bandim Health Project, 1978-2018. Forty years of contradicting conventional wisdom. Contact: bandim@ssi.dk. All publications are available at https://www.bandim.org/publications.aspx.
Competing interests: No competing interests
Dear Editor,
We commend Doshi on citing “insufficient evidence” for a benefit from mandatory influenza vaccination in healthcare workers and exposing conflicts of interest. [1] In the same vein, our organization has found that it has not been proven that the MMR vaccine results in less death or permanent disability than what is expected from measles.[2] The risk of dying or suffering permanent injury from measles in the United States was very small, even before the measles vaccine was introduced in 1963. Therefore, vaccine safety studies must show that the risk of dying or suffering permanent injury from the MMR vaccine is even smaller.
In the late 1950s and early 1960s, right before the measles mass vaccination program was introduced, the chance of dying from measles was 1 in 10,000 or 0.01%.[3] However, the public is generally unaware of this figure as the CDC publishes case-fatality rates based on the number of reported cases only. Since it is estimated that nearly 90% of measles cases are benign and therefore not reported to the CDC, the widely publicized measles case-fatality rate is 10 times higher than what is actually found in the general population.
Furthermore, a large 2004 Danish epidemiological study published in JAMA found that the risk of febrile seizures after MMR vaccination is 1 in 640[4] —a five-fold higher risk of febrile seizure than the risk of seizure from measles.[5] Vestergaard et al. studied the association between MMR and seizures in about 537,000 Danish children 0 to 14 days following MMR vaccination and found 1.56 MMR-related febrile seizure cases per 1,000 vaccinated children aged 15 to 17 months (95% CI, 1.44 to 1.68). Vestergaard’s results are based on 973 febrile seizures within two weeks of MMR vaccination, a robust database containing about 18,000 febrile seizures, and a nonvaccinated control group of about 98,000 children. Applying the 1 in 640 risk of febrile seizure to the 3.64 million U.S. children (91% vaccination rate applied to 4 million children[6]) vaccinated with MMR every year results in about 5,700 annual MMR-related seizures.
Measles surveillance in the 1980s and 1990s revealed that there are 3 to 3.5 times more measles seizures than measles deaths.[5] Therefore, because the measles case-fatality rate is 1 in 10,000, the seizure rate from measles is 3 to 3.5 in 10,000 (mean 1 in 3,100). Although 1.56 MMR-related febrile seizures in 1,000 (about 1 in 640) is a small risk, it is five-fold higher than the 1 in 3,100 risk of seizures from measles.[5] In addition, a significant portion of febrile seizures have permanent sequelae. A large 2007 epidemiological study found that 5% of febrile seizures result in epilepsy.[7]
A query of the Vaccine Adverse Event Reporting System (VAERS) for symptoms involving seizures and convulsions from all measles vaccines (for U.S. children age 6 months to 2 years, between 2011 and 2015) results in about 90 seizure reports per year.[8] This is only 1.6% of the about 5,700 expected MMR-related seizures based on Vestergaard’s findings. Other serious vaccine adverse events after MMR, including deaths, may similarly be underreported.
As with mandatory influenza vaccination, there is insufficient evidence that mandatory measles vaccination results in a net public health benefit.
Sincerely,
Shira Miller, M.D.
President, Physicians for Informed Consent
References:
1. Doshi P. The unofficial vaccine educators: are CDC funded non-profits sufficiently independent? BMJ 2017; 359:j5104. http://www.bmj.com/content/359/bmj.j5104.
2. Physicians for Informed Consent. Measles – Vaccine Risk Statement (VRS). Oct 2017. https://www.physiciansforinformedconsent.org/measles/vrs.
3. Physicians for Informed Consent. Measles – Disease Information Statement (DIS). Oct 2017. https://www.physiciansforinformedconsent.org/measles/dis.
4. Vestergaard M, Hviid A, Madsen KM, Wohlfahrt J, Thorsen P, Schendel D, et al. MMR vaccination and febrile seizures: evaluation of susceptible subgroups and long-term prognosis. JAMA 2004;292(3):351-357. https://www.ncbi.nlm.nih.gov/pubmed/15265850.
5. Centers for Disease Control. Epidemiology and prevention of vaccine-preventable diseases. 13th ed. Hamborsky J, Kroger A, Wolfe S, editors. Washington D.C.: Public Health Foundation; 2015. 209-15. https://www.cdc.gov/vaccines/pubs/pinkbook/meas.html.
6. Centers for Disease Control. Epidemiology and prevention of vaccine-preventable diseases. 13th ed. Hamborsky J, Kroger A, Wolfe S, editors. Washington D.C.: Public Health Foundation; 2015. Appendix E-8. https://www.cdc.gov/vaccines/pubs/pinkbook/downloads/appendices/appdx-fu....
7. Vestergaard M, Pedersen C, Sidenius P, Olsen J, Christensen J. The long-term risk of epilepsy after febrile seizures in susceptible subgroups. Am J Epidemiol. 2007 Apr 15;165(8):911-18. https://doi.org/10.1093/aje/kwk086.
8. CDC wonder: about the Vaccine Adverse Event Reporting System (VAERS). Atlanta: Centers for Disease Control and Prevention [cited 2017 Nov 14]. https://wonder.cdc.gov/vaers.html.
Competing interests: No competing interests
Peter Doshi has scratched the surface with his investigation of “the semi-transparent world of vaccine advocacy organisations”.
There is much more to do, including examination of political involvement in vaccine advocacy and promotion, particularly in light of governments around the world implementing compulsory and coercive vaccination policies. Who is influencing the politicians and political parties?
Peter Doshi refers to the vaccine advocacy organisation Every Child By Two (ECBT), which has political patronage, being founded in 1991 by Former First Lady of the US Rosalynn Carter and Former First Lady of Arkansas Betty Bumpers, apparently in response to a measles epidemic in the US. According to the ECBT website, "Carter and Bumpers have been working on immunizations since their husbands were [Democrat] governors in the early 70s and have been credited with the passage of laws mandating school-age vaccination requirements in every state during the Carter Administration."[1]
As Peter Doshi notes in his article, "ECBT's website does not disclose its funding sources, and it refused to answer The BMJ's queries about how much it receives from vaccine manufacturers". I similarly received the brush-off from Rich Greenaway, ECBT's Director of Operations and Special Projects, when I wrote requesting transparency for funding of ECBT in May this year. I subsequently tried contacting The Carter Center, another 'non-government, not-for-profit organisation', founded by Jimmy and Rosalynn Carter[2], to try and obtain transparency and accountability for the ECBT organisation founded by Mrs Carter, but was again fobbed off, back to ECBT.
People such as myself, independent citizens trying to obtain transparency and accountability for vaccination policy, are well-used to getting the run-around...
As Miri Sloboda suggests in her rapid response, "in order to get to the truth of any matter, it is always prudent to 'follow the money'", but this is difficult when vested interests are determined to maintain a veil of secrecy.
The ECBT website notes "in 2000, ECBT was instrumental in working with the Clinton Administration to pass a mandate requiring federal agencies serving children to assess their immunization records". [3]
The Clintons are another pair of powerful Democrats wielding influence over international vaccination policy via their 'non-government, not-for-profit' Clinton Foundation and its program “accelerating the rollout of new vaccines”[4]. Donors for the Clinton Foundation include the Bill & Melinda Gates Foundation, a major player in global vaccine product promotion.[5] Donor information on the Clinton Foundation website indicates the Bill and Melinda Gates Foundation has donated '"Greater than $25,000,000" to the Clinton Foundation.[6]
The Democrats were again to the fore with SB277 in California, a vaccine bill initiated by Democrat Senator Richard Pan, and pushed for by ECBT, as noted by Peter Doshi. The resulting law removed the personal belief exemption that had previously allowed families to defer or decline mandated childhood vaccination, yet another brick in the wall building community compliance to the pharmaceutical industry’s growing vaccine product agenda. Incidentally, Richard Pan is a beneficiary of the pharmaceutical industry’s largesse, receiving US$95,150 in 2013/2014.[7]
The Republicans helped kick start the vaccine industry’s global growth project in the US in the 1980s with the establishment of the National Vaccine Injury Compensation Program, a “no-fault alternative to the traditional legal system for resolving vaccine injury petitions”[8], which essentially provides protection from liability for vaccine manufacturers.
Republican Ronald Reagan was the US president at the time. An article published in the New York Times in November 1986 about Reagan’s signing of a health bill on “drug exports and payment for vaccine injuries”, notes Reagan’s action in this matter “came after heavy lobbying in favor of the bill by a broad-based coalition including drug companies, physicians and groups representing children and the elderly”. The New York Times reports a California Democrat, Henry A Waxman, drafted the portion of the bill relating to vaccines.[9]
According to international market reports, the vaccines market is increasing from US$5.7 billion in 2002 to nearly US$50 billion by 2022[10], i.e. a more than eight-fold increase.
With the emerging global push for compulsory vaccination, there is much more work to do investigating the history of the broad and often sinister web that promotes and protects the burgeoning global vaccine product market.
References:
1. About us. Every Child By Two website. http://vaccinateyourbaby.org/about.cfm
2. The Carter Centre: https://www.cartercenter.org/about/leadership/founders.html
3. About us. Every Child By Two website.
4. Clinton Health Access Initiative – Accelerating the Rollout of New Vaccines: https://www.clintonfoundation.org/our-work/clinton-health-access-initiat...
5. See for example Bill & Melinda Gates Foundation Announces $750 Million Gift to Speed Delivery of Life-Saving Vaccines: https://www.gatesfoundation.org/Media-Center/Press-Releases/1999/11/Glob...
6. Contributor and Grantor Information, Clinton Foundation: https://www.clintonfoundation.org/contributors
7. Drug companies donated millions to California lawmakers before vaccine debate. The Sacramento Bee, 18 June 2015: http://www.sacbee.com/news/politics-government/capitol-alert/article2491...
8. National Vaccine Injury Compensation Program website: https://www.hrsa.gov/vaccine-compensation/index.html
9. Reagan signs bill on drug exports and payment for vaccine injuries. The New York Times, 15 November 1986: http://www.nytimes.com/1986/11/15/us/reagan-signs-bill-on-drug-exports-a...
10. A recent vaccines market report notes the global vaccines market is expected to reach US$49.27 billion by 2022 from US$34.30 billion in 2017. A FierceVaccines report published in 2012 notes ten years previously, the vaccine market sat at US$5.7 billion, now [2012], that market has soared to US$27 billion. So it seems from 2002 to 2022 the vaccines market will increase from US$5.7 billion to US$49.27 billion.
MarketsAnd Markets Press Release: Vaccine Market worth 49.27 Billion USD by 2022 (undated): http://www.marketsandmarkets.com/PressReleases/vaccine-technologies.asp
FiercePharma report 20 Top-selling Vaccines – H1 2012, 25 September 2012: http://www.fiercepharma.com/vaccines/20-top-selling-vaccines-h1-2012
Competing interests: No competing interests
In using the phrase "nurturing anti-vaccine conspiracists" Alain Braillon [1] seems to be referencing comments in conversations that have taken place outside these columns. Speaking as someone who has been vociferous on these matters here and elsewhere, and without type-casting, what I am is "anti-vaccine lobby" - to the hilt. And what I at least am trying to call for, in a rather old-fashioned way, is something like reason and order. There are huge problems which emerge from this aggressive, totalitarian culture of assertion and denial. The culture which consistently denies criticism or contrary evidence simply loses the claim to be objective science by the way it conducts itself.
This would certainly have to change if any trust was to be restored. It is also intolerable if children are regarded by an industry as a captive market for the ever growing number of products it develops, jockeying for each to be added to the schedule as it is licensed.
[1] Alain Braillon, "Who is nurturing anti-vaccine conspiracists?", BMJ Rapid Responses 12 November 2017 http://www.bmj.com/content/359/bmj.j5104/rr-8
Competing interests: No competing interests
Doshi must be commended for his report, a beacon for investigative medical journalism, showing vaccine advocacy groups have serious financial and professional conflicts of interest.(1) He must not be shamed for nurturing anti-vaccine conspiracists because vaccine advocacy groups are those responsible for the state of affair.
First, vaccine advocacy groups should not have conflicts of interest and, even disclosing them cannot dissolve them.
Second, claims from vaccine advocates are out of control and some medical journals look like tabloids: one published an unbalanced pledge for Human Papillomavirus (HPV) vaccination on the behalf of the NCI of Milan claiming “good information is warranted in order to improve adherence to vaccination” but stated “vaccines against HPV represent the first vaccine against cancer” and presented the vaccine as a panacea despite it must be combined with screening, the cornerstone for prevention.(2) The editor was personally happy with this despite I stressed: a) Maupas published the results of the first vaccination against hepatitis B in humans in 1976 and two decades were necessary for cohort studies to show a halved risk of hepatocellular carcinoma after vaccination;(3,4) b) the NCI of Milan is not used to issue position statements and nothing about this one on its website; d) main author’s conflicts of interest (consulting/advisory role for several companies) were not mentioned.
In France, in 1994 hype for systematic vaccination of children against hepatitis B had devastating consequences: in 2006, the percentage of 1-year-old children immunized was 29 vs 86% in Germany and even in 2009 publications cried wolf.(5)
1 Doshi P. The unofficial vaccine educators: are CDC funded non-profits sufficiently independent? BMJ 2017;359:j5104.
2 Bogani G, Lorusso D, Raspagliesi F.Vaccine. Safety and effectiveness of Human Papillomavirus (HPV) vaccination: NCI of Milan position statement. Vaccine 2017;18;35:5227.
3 Maupas P, Goudeau A, Coursaget P, Drucker J, Bagros P. Immunisation against hepatitis B in man. Lancet 1976;1:1367-1370.
4 Chang MH, Chen CJ, Lai MS et al. Universal hepatitis B vaccination in Taiwan and the incidence of hepatocellular carcinoma in children. Taiwan Childhood Hepatoma Study Group. N Engl J Med 1997;336:1855-9.
5 Braillon A, Dubois G. Hepatitis B vaccine and the risk of CNS inflammatory demyelination in childhood. Neurolog 2009;72:2053.
Competing interests: No competing interests
This excellent article also tacitly throws light of the motivations of the vaccine safety movement (incorrectly labelled by detractors as “anti-vaccine”). It is important to note that groups and organisations established to explore potential dangers of vaccines receive little or no money from anywhere for doing so. With very few exceptions, nobody working within vaccine safety makes any money from their endeavours. On the contrary, doing vaccine safety work typically means spending one’s own money, in order to set up websites, print literature, organise events, and so on.
In order to get to the truth of any matter, it is always prudent to “follow the money”, and in this case, it is clear to see almost none of it goes anywhere near vaccine safety organisations. Vaccine safety groups are relatively immune to financial corruption, because they are not selling any product, and, as no wealthy individuals or groups benefit from vaccine scepticism, vaccine safety groups will not be sponsored by them. This is not to say all information presented on all vaccine safety resources represents inerrant and unblemished truth, simply to recognise the importance, when evaluating this general movement, of the almost complete lack of financial incentive for those working within it.
This article further enables us to understand both why vaccine advocacy groups may be motivated to spread inaccurate messages about vaccines, and why they benefit from the smearing or silencing of groups offering an alternative message.
I encourage everyone to read as much information as they can, from a wide variety of sources, before making a decision on any vaccine, and crucially, to investigate what financial incentives organisations or individuals may have for promoting a certain message. This includes GPs, who are financially incentivised to vaccinate a certain percentage of their patients, a fact of which very few are aware.
Miri Sloboda, founder and editor of Student and Teacher Research Initiative for Vaccine Education (STRIVE - www.strive-uk.org)
Competing interests: No competing interests
A page on the Task Force for Global Health website from 2011 to 2016 [1,2] identifies Voices for Vaccines as a Task Force for Global Health "project":
"The Task Force project, Voices For Vaccines, addresses questions about vaccines."
and Alan Hinman or Alan R Hinman as its single member of staff and director.
[1] The Task Force for Global Health: Home › Our Work › Projects › Voices For Vaccines https://web.archive.org/web/20110413075251/http://www.taskforce.org/our-...
[2] The Task Force for Global Health: Home › Immunizations and Vaccines Sector › Voices For Vaccines https://web.archive.org/web/20160606211029/http://www.taskforce.org:80/o...
Competing interests: No competing interests
I am grateful to Peter Doshi [1]. Venturing into the web-archive I have turned up one of the first existing pages for Voices for Vaccines from August 2008 where it states:-
"Voices For Vaccines is currently led by a Steering Committee [2]:
Joseph Bocchini, MD – American Academy of Pediatrics
Douglas Campos-Outcalt, MD and Jon Temte, MD – American Academy of Family Physicians
Anna DeBlois – Association of State and Territorial Health Officials
Alan R. Hinman, MD – Task Force for Child Survival and Development
Mark Kane, MD – Consultant
Frankie Milley – Meningitis Angels
Paul A. Offit, MD – Vaccine Education Center, Children’s Hospital of Philadelphia
Walter Orenstein, MD – Emory Vaccine Center
Denise Palmer and Gary Stein – Families Fighting Flu
Trish Parnell – Parents of Kids with Infectious Diseases (PKIDS)
Amy Pisani – Every Child By Two
L J Tan, PhD – American Medical Association
Deborah L. Wexler, MD – Immunization Action Coalition"
On another page it states [3]:
"Voices For Vaccines has already begun enlisting members to demonstrate the strong support that vaccines enjoy across the population. Membership is at no cost and provides a subscription to our newsletter as well as the opportunity to participate in VFV-coordinated action campaigns.
"Voices For Vaccines is administratively housed within the Task Force for Child Survival and Development, an Atlanta-based 501(c)(3) organization."
So it is apparent that whatever steps Task Force took to make VFV look like a financially independent parent-led organisation it was a professional operation from inception.
[1] Peter Doshi, 'Voices for Vaccines', BMJ Rapid Responses 9 November 2017, http://www.bmj.com/content/359/bmj.j5104/rr-2
[2] Voices for Vaccines: Our leadership https://web.archive.org/web/20080820113513/http://www.voicesforvaccines....
[3] Voices for Vaccines: History https://web.archive.org/web/20080820113527/http://www.voicesforvaccines....
Competing interests: No competing interests
This is a brave article.
WHO and others are at present running research programs aimed at overcoming vaccine resistance.[1] I wonder if any of those involved put any thought into assessing how much efforts to force vaccine uptake is creating vaccine resistance - among people like me who have traditionally been pro vaccines and had all my children vaccinated, and what the consequence of this resistance might be. The only thing that would undo my growing resistance at this point would be evidence of a genuine collection of the data on harms that would enable me or anyone who asked my advice to balance the harms of a specific vaccine against the harms of a specific condition. I'm not prepared to accept there is someone out there who can make these judgements for me, given the track record of the authorities in tolerating a medical literature that for on-patent products is almost entirely ghost-written and tolerating a total denial of access to the data on harms in clinical trials.[2]
1 Dubé E, Laberge C, Guay, M, Bramadat P, Roy R, Bettinger J Vaccine hesitancy. Hum Vaccin Immunother. 2013; 9: 1763–1773.
2 Healy D. Pharmageddon. California University Press, Berkeley CA 2012.
Competing interests: No competing interests
Re: The unofficial vaccine educators: are CDC funded non-profits sufficiently independent?
Rational doubt will continue to be raised about the measles-containing vaccine MMR until a safety study with the statistical power to detect permanent injury from the vaccine in 1 in 10,000 vaccinated subjects is produced.
Gotzsche writes below “the reason that so few people die or get seriously injured from measles is that most of the population is vaccinated.” However, it is a documented fact that before the vaccine was introduced in the United States, measles was fatal in 1 in 10,000 cases.[1,2] Consequently, to prove the vaccine causes less permanent injury than measles infection, vaccine safety studies must have the statistical power to detect permanent injury in as little as 1 in 10,000 vaccinated children.
Gotzsche also claims “measles infection increases the risk of dying from other infections,” which “persists for the next 2-3 years.” He supports that assertion by citing a study by Mina et al. that states, “Other studies (12, 38, 39) have failed to detect long-term immunologic sequelae of measles.”[3] Furthermore, Mina et al. also caution that the results of the study “should be viewed with the caveat that the increased relative risk of mortality after intensive measles exposure was measured in children exposed before 6 months of age.”3 Because less than 5% of all measles cases occur in infants less than 1 year of age,[4] and that age group is among the most vulnerable to serious complications from measles, there is reasonable doubt about the validity of projecting the immune suppressing effects of measles on infants exposed before 6 months of age to the remaining greater than 95% of all measles cases.
In addition, mortality statistics recorded in the United States between 1953 and 1973 suggest that the “increased relative risk of mortality” found by Mina et al. in young infants did not result in a significant change in absolute risk of child mortality. In 1953, 10 years before the introduction of the vaccine, about 33,500 children of age 1–14 died from a population of about 42 million (about 1 in 1,250).[5,6] By 1963, the year the vaccine was introduced, the child mortality rate had declined by 24% to 33,100 deaths from a population of 54.7 million (about 1 in 1,650).[7,8] In 1973, 10 years after the introduction of the vaccine, the child mortality rate continued to drop, but not as rapidly, declining by 16% to 26,800 deaths from a population of 52.6 million (about 1 in 1,960).[9,10] Clearly, the prevaccine decline in overall childhood mortality eclipsed the postvaccine decline. Consequently, there are reasonable doubts about the plausibility of Mina et al.’s claim that “MV infections could have been implicated in as many as half of all childhood deaths from infectious disease.”
Gotzsche concludes, “hardly any practising doctors, let alone new parents, remember how terrible those diseases once were.” However, there is an abundance of historical records describing how measles was perceived in the United States before the introduction of the mass vaccination program. Perhaps the most compelling account is that of Alexander Langmuir, chief epidemiologist of the CDC during the introduction of the measles mass vaccination program, “In the United States measles is a disease whose importance is not to be measured by total days disability or number of deaths.”
The purpose of this comment is not to determine whether a case fatality rate of 1 in 10,000 is the sign of a “benign disease,” rather, the purpose of this comment is to bring attention to the fact that measles vaccine safety studies do not have the statistical power to detect permanent injury occurring in 1 in 10,000 vaccinated children. This is an important problem that justifies reasonable doubts.
References
1. Langmuir AD, Henderson DA, Serfling RE, Sherman IL. The importance of measles as a health problem. Am J Public Health Nations Health. 1962 Feb;52(2)Suppl:3. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1522578/.
2. Barkin RM. Measles mortality: a retrospective look at the vaccine era. Am J Epidemiol. 1975 Oct;102(4):347. https://www.ncbi.nlm.nih.gov/pubmed/1180255.
3. Mina MJ, Metcalf CJ, de Swart RL, et al. Long-term measles-induced immunomodulation increases overall childhood infectious disease mortality. Science. 2015 May 8;348(6235):694-9. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4823017/.
4. Engelhardt SJ, Halsey NA, Eddins DL, Hinman AR. Measles mortality in the United States 1971-1975. Am J Public Health. 1980 Nov; 70(11): 1166-9. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1619577/.
5. U.S. Department of Health, Education, and Welfare. Vital statistics of the United States 1953, volume II—mortality data. Washington: U.S. Government Printing Office; 1955. 164 p. https://www.cdc.gov/nchs/data/vsus/VSUS_1953_2.pdf.
6. U.S. Department of Health, Education, and Welfare. Vital statistics of the United States 1953, volume I—introduction and summary tables; tables for Alaska, Hawaii, Puerto Rico, and Virgin Islands; marriage, divorce, natality, fetal mortality and infant mortality data. Washington: U.S. Government Printing Office; 1955. XXIX p. https://www.cdc.gov/nchs/data/vsus/vsus_1953_1.pdf.
7. U.S. Department of Health, Education, and Welfare. Vital statistics of the United States 1963, volume II—mortality, part A. Washington: U.S. Government Printing Office; 1965. 1-86 p. https://www.cdc.gov/nchs/data/vsus/mort63_2a.pdf.
8. U.S. Department of Health, Education, and Welfare. Vital statistics of the United States 1963, volume I—natality. Washington: U.S. Government Printing Office; 1964. 4-15 p. https://www.nber.org/vital-stats-books/nat63_1.CV.pdf.
9. U.S. Department of Health, Education, and Welfare. Vital statistics of the United States 1973, volume II—mortality, part A. Rockville, Maryland: U.S. Government Printing Office; 1977. 1-184 p. https://www.cdc.gov/nchs/data/vsus/mort73_2a.pdf.
10. U.S. Department of Health, Education, and Welfare. Vital statistics of the United States 1973, volume I—natality. Rockville, Maryland: U.S. Government Printing Office; 1977. 4-20 p. https://www.cdc.gov/nchs/data/vsus/nat73_1.pdf.
Competing interests: No competing interests