Standards of Evidence for Lawyers and Doctors
Nothing makes the anti-vaccine crowd angrier than news reports of deaths from a preventable disease. They are angry because in the starkest terms, a death happens that could have been prevented by vaccination. In this case measles. From the anti-vaccination playbook, they will argue the person didn’t die of measles, but of pneumonia, or medical mismanagement, anything but measles.
This week, the Center for Disease Control (CDC ) reported that two people in Lancaster County, Pennsylvania, had died with measles. The report was generated from the Pennsylvania Department of Health (DOH). They stated they reported the deaths to the CDC, after “the epidemiology team thoroughly investigated and verified both individuals tested positive for measles. The information was not reported to the public until the results of the epidemiological investigations were confirmed.”
One of the deaths was an infant, who died in childbirth. The coroner reported the infant died with a ruptured spleen. Because he didn’t say it was measles immediately, the anti-vaccine crowd roared that this was deliberate misinformation.
Spleens and Measles
How can a child die from a ruptured spleen if they have measles?
The expert for that would be Dr. Paul Offit, a pediatric infectious-disease physician at Children’s Hospital of Philadelphia, director of CHOP’s Vaccine Education Center, and the Maurice R. Hilleman Professor of Vaccinology. He stated that measles can involve lymphoid tissue and produce splenic enlargement. An enlarged spleen is more vulnerable to rupture, especially during childbirth. Measles doesn’t just kill from its infection. It can kill from pneumonia, neurologic damage, and apparently a ruptured spleen.
Aaron Siri (an anti-vaccination attorney) and Robert F. Kennedy Jr. seized on the Lancaster County coroner’s comments and immediately treated uncertainty as exoneration.
I reported the infant death when Pennsylvania announced it, and even discussed Dr Offit’s mechanism involving the spleen.
Kennedy and Siri then opened the anti-vaccine playbook. Accusing Governor Shapiro of playing politics with measles. The evidence for measles was properly reported to the CDC. They dismissed the DOH findings, and based their “case” on the lack of a corner, stating it was “measles.”
The coroner gave the proximate cause of death - a ruptured spleen. He did not provide the secondary issue, measles from an unvaccinated mother.
Our hearts go out to the mother, who, had she been vaccinated, would have passed that immunity through the placenta. That does not answer whether measles contributed to the conditions that led to that rupture.
That is the revealing part of this story. It is not simply a disagreement over one infant’s death. It is a difference in how we look at the world. In medicine, we look at evidence (lab tests, etc). But in the world of anti-vaccine lawyers, they use rhetoric. They have the answer they want, and will fight to prove it. In medicine, we know we can be wrong, but when we make a statement, we at least have laboratory tests for receipts.
The coroner emphasized that the spleen was not enlarged at autopsy. But once a spleen has ruptured and hemorrhaged, gross size after the event does not necessarily tell us what the organ was like beforehand. More importantly, Paul Offit was not inventing a novel explanation. He is a pediatric infectious-disease physician and vaccinologist who has seen measles-associated splenic involvement before.
What we have here is a clinical history of measles followed by splenic rupture, a pattern that is not unprecedented. What we do not have, at least publicly, is evidence of a traumatic birth that otherwise explains the rupture.
For medicine to blame measles, it requires virology, pathology, epidemiology and a causal chain.
For lawyers to exonerate measles requires a lawyer, a microphone and a hunch.
A revealing corollary is how quickly some anti-vaccine communities embrace causation in the opposite direction. When someone who was vaccinated dies unexpectedly, temporal association alone is often treated as compelling evidence that the vaccine caused the death—sometimes before an autopsy, toxicology, medical history, or any plausible causal mechanism is known. Yet when an unvaccinated person dies during a laboratory-confirmed vaccine-preventable infection, suddenly the standard becomes: prove every link in the causal chain beyond doubt.
Dr. Offit offered a great anecdote of a doctor standing in one of many lines during the 1960’s Salk polio vaccination drives with his 9-yo child. Sadly, the vaccination center ran out of vaccine and so they went home that night hoping to get the vaccine the next day.
Worse, the child died that night. Not due to polio or some other kind of disease, and it was without warning.
As the parent explained, despite being a trained scientist, it would have been nigh *IMPOSSIBLE* for them not to associate the injection with the death, had one preceded the other. That’s human.
We forget at our peril the charlatans that preceded RFK Jr. advocating Bull semen injections into the spines of children afflicted by polio. When science doesn’t provide proven answers quickly enough, opportunists move in quickly to separate desperate parents from their money.
That’s not to say that vaccines are without risk (see polio oral, for example), but on balance the risks vs. benefits are usually very clear.