Another thing I've seen from those who think vaccines are not useful is that vaccines are unnecessary, because large doses of vitamins are cheap and adequate to treat or prevent the relevant diseases. Especially vitamin C, which somehow got a reputation as a disease-busting super-drug. So today I'll be looking at one study that I've seen cited on multiple articles, as well as a couple other related studies.
A. Ascorbic Acid (Vitamin C) Treatment of Whooping Cough1
Interestingly, Ormerod and Unkauf start off their paper by saying that vaccination so far was the only thing that seemed effective against whooping cough:
"While some protection has been afforded against it by vaccination, treatment of the active disease has not progressed as has treatment of other infectious diseases such as scarlet fever and diphtheria. Madsen reports that, of 1842 vaccinated children, about 25% escaped infection, while of 446 non-vaccinated children less than 2% escaped."
But for those who caught the disease anyway somehow, it'd be very helpful to have a way to treat it, to remove its status as a scary childhood disease:
"In the years 1932-34 there were 45,755 cases of whooping cough reported to the Dominion Bureau of Vital Statistics, with 1982 deaths. Of the fatal cases over 50% occur in the first year of life."
Others had studied the effects of ascorbic acid (vitamin C) on other things, like seeing if it could inactivate diphtheria toxin or inhibiting bacteria directly, but it wasn't clear that its effects weren't only due to its acidity. Even if it can inhibit bacteria in culture, anyway, doesn't mean it can do so in the human body.
Some thought they observed cases of scurvy in pertussis or pneumonia patients, and hypothesized that the body might use vitamin C as a defense mechanism somehow, thus using up its stores. And children seemed to need more than adults. So Ormerod and Unkauf decided to test ascorbic acid's effectiveness in treating whooping cough.
It's actually not so much a study as a series of case reports, since there was no control group. The authors treated pertussis patients with a synthetic form of vitamin C, sold by Roche. All but two of the patients were seven or under; one was 12, and the last was 22. The children all had the characteristic whoop from under a week up to 6 weeks, and starting at various points in the disease, the authors gave them between 125 and 500 mg vitamin C daily. It didn't seem very standardized. Their coughs all disappeared in from 3 days up to 15 days.
Ormerod and Unkauf admit that the data isn't robust enough for good conclusions, but claim that vitamin C seemed to reduce the duration from weeks to days. They don't have any controls though, so it's not really known how the patients would have done without the treatment. Is this study worth anything?
B. Pertussis Endotoxin in the Treatment of Whooping-Cough2
As a comparison, let's look at another study done around the same time, using a treatment that everyone has pretty much discarded as worthless (and had even been discredited at the time, in 1936): vaccine therapy. This is the idea of inducing a better immune response against pathogens currently infecting a person, so the body can better fight it off, rather than producing immunity before an infection is present.
In this study, Thompson wanted to try to induce an immune response against bacterial toxins produced in whooping cough patients by injecting purified toxin. Others had tried this, but the studies weren't done well, so it was hard to tell if there was really an effect.
Thompson used a procedure similar to Krueger's (076) for producing the toxin. He found that it had little effect when injected into rodents, but it often produced an allergy-like reddening in children. Possibly an immune reaction. In whooping cough patients, it seemed to exacerbate the symptoms sometimes, which doesn't seem surprising. So he tried to use lower doses to avoid this reaction.
He studied a group of 403 children admitted to the hospital with whooping cough. He gave 132 of them daily injections with the toxin, and the others were controls. Some of the controls even got placebo in the form of saline injections. The children received some other treatments too, seemingly to treat symptoms.
But even so, it was tough to compare the two groups, because there weren't specific endpoints. It didn't seem like severity was different, but maybe the duration was shorter, like the treatment accelerated the disease process, making it end sooner.
Possibly there was an effect in those treated early in their infection, shortening the case and reducing severity. But Thompson tried to replicate the result in another 71 patients, treating them early, and again it seemed to reduce the duration but not severity. So of questionable use overall.
C. Vitamin C in Treatment of Whooping-cough3
Responding to both of the above studies, apparently Douglas Gairdner was dubious:
"It also seems true to say that although 'nearly every newly discovered remedy in ancient and modern times has at one time been advocated for treatment of this disease', there is not one that has been proved to have an appreciable effect on its course. Of vaccine or endotoxin therapy, lately so enthusiastically recommended, the conclusion...'that the more carefully the results are controlled the less impressive do they become' seems inescapable in light of recent reports."
Ormerod's results from North America using vitamin C showed a much shorter whooping cough duration than what was common in the UK, so Gairdner wanted to try to replicate those results. He used naturally derived ascorbic acid, donated by Roche, to avoid a possible difference in effect from the synthetic (like Ormerod used); a few younger children got the synthetic kind because it was less bulky. He tried to use doses similar to Ormerod, several hundred mg, much more than the daily requirement for normal children (about 25 mg). Control subjects were given a placebo, cod liver oil and a couple other things that were known not to affect the disease.
In total, Gairdner treated 21 children, and kept another 20 as controls. 20% of each dropped out. Cases were confirmed by culturing the bacteria and hearing the cough. All cases had been coughing for less than 3 weeks when they started treatment. He followed them by getting the mothers to record the number of coughs each day and night until they stopped coughing at night. He also weighed the children to see if the disease was impairing their growth.
In Ormerod and Unkauf's study, they started treating an average of 9 days after disease started, and it lasted an average of 14 days longer, for 23 days total.
Gairdner started treating his patients 10 days after the disease started on average (14 days for controls), and the disease lasted an average of 25 days after treatment (27 days for controls), for a total of 35 days (or 41 for controls). Apparently there was no statistically significant difference between the groups, nor for the difference in weight gained during the disease period (0.01 lb difference). Severity wasn't really measured.
So both treated and controls had much longer disease than in Ormerod's study, at least 12 days. Gairdner's conclusions:
"The assertion of Ormerod and UnKauf that the paroxysmal period of the disease is shortened 'from a matter of weeks to a matter of days' was not confirmed.""As there were no controls in the Canadian series, however, it is impossible to judge whether the natural course of the untreated disease varies in the two countries, or whether the considerable difference in the course of the disease in the present and in the Canadian series is due, for instance, to the application of a more rigorous standard of cure in the former series.""It is considered that the statement that the administration of vitamin C in whooping-cough has an effect upon the course of the disease is at present unproven."
It's possible that synthetic vitamin C worked better than naturally-derived kind, though these studies can't really be used to conclude that either. But it would be interesting.
Later studies commented on the vitamin C studies discussed:
"Gairdner has reported a failure to affect the course of whooping cough using the method of Omerod (sic), but Gairdner also failed to test for a deficiency before instituting treatment."4
"Gairdner in a controlled experiment found that the duration of illness in a group receiving vitamin C was shorter than in controls. The difference in the two groups was not a significant one, and he considered that the alleged benefits of vitamin C in whooping cough were unproven."5
The first statement, by J.B. Youmans, is slightly puzzling to me, because the original paper doesn't indicate that Ormerod and Unkauf tested for deficiency either. All just assumed that the doses they were giving were high enough to correct any deficiency. If it is a legitimate criticism, it seems to show that vitamin C would only be beneficial if there is a real deficiency.
References:
1.
Ormerod, M. J. & Unkauf, B. M. Ascorbic Acid (Vitamin C) Treatment of Whooping Cough. Can Med Assoc J 37, 134–136 (1937).
2.
Thompson, A. R. Pertussis Endotoxin in the Treatment of Whooping-Cough. The Lancet 230, 733–736 (1937).
3.
Gairdner, D. Vitamin C in Treatment of Whooping-cough. British Medical Journal 2, 742–744 (1938).
4.
Youmans, J. B. The Influence of Vitamin Deficiencies on Other Diseases. Ann Intern Med 13, 980–986 (1939).
5.
Glazebrook, A. J. & Thomson, S. The Administration of Vitamin C in a Large Institution and Its Effect on General Health and Resistance to Infection. The Journal of Hygiene 42, 1–19 (1942).
