Respectful Insolence

Dr. Jay Gordon: Get away from my alma mater!

I’m pretty sure that I’ve mentioned this before at least a couple of times, but I am an alumnus of the University of Michigan twice over. I completed a B.S. in Chemistry with Honors there and then I stayed on to do obtain my M.D. Several of my longtime friendships were forged or solidified during those years. Consequently, I still care about the place. That’s why it distresses me when I see my alma mater shoots itself in the foot. Now, I’ll grant you that what I’m about to discuss probably doesn’t bother me as much as the plight of the Michigan Wolverines bothers me, given that never before in my life (at least not since I was old enough to pay attention), have the Wolverines sucked so hard for an entire season. Given that level of utter hopeless suckitude, though, I consider it even more important that my alma mater not provide any more ammunition to those who would enjoy making fun of it. It doesn’t matter to me that I never went to law school at Michigan; it’s all part of the same campus to me, and it’s bad enough that Ann Coulter attended law school there at almost the same time I was attending medical school there. She was even an editor of the Michigan Law Review.

Speaking of the Michigan Law Review, this time around the embarrassment comes in the form of an article in that august journal by a person who has previously been a subject of posts by me and others. I’m referring to Dr. Jay Gordon, who has been–correctly, I believe–labeled as being, if not fully anti-vaccine, at least a prominent and major apologist for the anti-vaccine movement. Unfortunately, because he is the pediatrician taking care of Jenny McCarthy’s son Evan, he has gained even greater prominence in the antivaccine movement than ever, to the point where he gave a speech last summer to the antivaccine “Green Our Vaccines” march on Washington and where he is regularly called up by TV producers to give a false “balance” whenever a discussion of vaccines and/or autism comes up. He also wrote the foreword to Jenny McCarthy’s latest paean to autism quackery and attack on vaccines as the cause of autism in which he blithely repeated some of the worst distortions of the antivaccine movement. Unfortunately, Dr. Gordon lacks the intestinal fortitude to stop the piteous denials any time he is called out for his parroting of antivaccine pseudsocience and to embrace his inner antivaccinationist. Then, at least, we wouldn’t be treated to the spectacle of his simultaneously claiming he is “pro-safe vaccine, not anti-vaccine” while at the same time saying he “doesn’t give a lot of vaccines” and admitting that parents have actually had to persuade him to vaccinate.

So what was the topic of the Michigan Law Review article that Dr. Gordon was apparently asked to pen? It’s actually an interesting question from a legal, political and civil rights standpoint, specifically: Whether or not parents should be held legally liable for refusing to vaccinate their children. Not surprisingly, Dr. Gordon takes the “no” position. Unfortunately, as we’ve come to expect of Dr. Gordon, in doing so he uses a number of highly dubious arguments. However, more interesting to me, having had a nearly four year history sparring online with him off and on, was the seemingly “kinder and gentler” antivaccine stance that he took in this article. What I rapidly realized, though, was that underneath that seemingly “kinder and gentler” demeanor was the same old apologist for die-hard antivaccinationists.

But first, let’s take a look at the debate. The symposium published in First Impressions (the online companion to the Michigan Law Review) is entitled Liability for Exercising Personal Belief Exemptions from Vaccination, and it contained the following articles:

  1. Choices Should Have Consequences: Failure to Vaccinate, Harm to Others, and Civil Liability by Douglas S. Diekema.
  2. Parents Should Not be Legally Liable for Refusing to Vaccinate their Children by Dr. Jay Gordon.
  3. Unintended Consequences: The Primacy of Public Trust in Vaccination by Jason L. Schwartz.
  4. Challenging Personal Belief Immunization Exemptions: Considering Legal Responses by Alexandra Stewart.
  5. Gambling with the Health of Others by Stephen P. Teret and John S. Vernick.
  6. The Problem of Vaccination Noncompliance: Public Health Goals and the Limitations of Tort Law by Daniel B. Rubin and Sophie Kasimow

There were actually a number of fascinating issues raised here. Although it’s obvious that universal vaccination is a public health policy good, given that the higher percentage of vaccinated children, the greater the herd immunity, there is always the nagging question of how far the state should go to mandate vaccination in a free society; i.e., how much coercion is acceptable to bring about maximal levels of vaccination? In other words, what is the proper balance between the needs of society as a whole and the rights of the individual? The next interesting legal and moral question is whether parents who refuse to vaccinate should be held liable for injuries to other children if their unvaccinated child passes on an infectious disease.

Before I go on, I’ll let you know what my views are on these two issues. Personally, I tend to believe that it is entirely reasonable to require vaccination as a precondition for school or day care and that exemptions should be primarily medical in nature. I grudgingly allow that the freedom of religion guaranteed in the First Amendment probably requires religious exemptions (although I do not understand why religion should be given such a privileged place in society that it should be allowed to be used as an excuse by parents to endanger public health), I am far less convinced that philosophical exemptions should be mandated.

I realize many may disagree with this position, but I would hope that our disagreements would be based on (1) the best science regarding the benefits and risks of vaccination and (2) honest beliefs regarding the proper balance between public health concerns and individual liberty. Clearly, this is an area of debate. I also tend to believe that if parents refuse to vaccinate their child and that child passes an infectious disease to another child, then those parents should be potentially legally liable. Indeed, Douglas Diekema argues this position very well, and I would think that, given how much antivaccinationists like to cloak themselves in the mantle of individual liberty and responsibility for their children, they would agree that they should be held liable for any adverse consequences of their decision not to vaccinate. After all, that would only go along with their mantra of personal freedom and responsibility. Oddly enough, though, they don’t seem to see it that way.

Unfortunately, Dr. Gordon does not meet at least condition #1 above. He does not base his arguments on the best science–or much of any science at all, actually.

The first thing I noticed when I read Dr. Gordon’s article is that this is a very different Dr. Gordon than I’m used to seeing. His most noticeable new trait is that gone are the claims that vaccines cause autism. Indeed, Dr. Gordon didn’t even mention mercury or autism once in his entire article! If I believed in miracles, I would write to the Pope and demand that the Church investigate this Michigan Law Review article as being every bit the equal of a divine healing at Lourdes, given Dr. Jay’s history! In order to emphasize the amazing change in Dr. Gordon’s demeanor towards vaccine, let’s take a little trip down memory lane, shall we? Let’s review briefly what Dr. Gordon really thinks about vaccines:

  1. “Vaccines can cause autism.” (from the Foreword to Mother Warriors: A Nation of Parents Healing Autism Against All Odds by Jenny McCarthy.)
  2. “Yes, most vaccines have much less mercury, but wait until the evidence against aluminum in vaccines becomes common knowledge. The body of research regarding aluminum’s harm to human cells already contains hundreds of articles.” (from the Foreword to Mother Warriors: A Nation of Parents Healing Autism Against All Odds by Jenny McCarthy.)
  3. “We can only guess what harm we might be causing to babies with the huge overdoses of aluminum.” (from the Foreword to Mother Warriors: A Nation of Parents Healing Autism Against All Odds by Jenny McCarthy.)
  4. “The official position of the American Academy of Pediatrics may be the same as my personal position, but they are far too involved with the pharmaceutical industry to actually do anything but pay lip service to an open discussion. The CDC and the AAP are filled with doctors whose research, speaking engagements, and travel are often funded by the manufacturers of vaccines. Many of these same doctors are paid consultants, and some later go to work full-time for the pharmaceutical industry.” (from the Foreword to Mother Warriors: A Nation of Parents Healing Autism Against All Odds by Jenny McCarthy.)
  5. “We doctors need to stop deceiving our patients into thinking that immunizations are “free.” Every medical intervention costs the body something, and we have a legal and moral obligation to tell parents.” (from the Foreword to Mother Warriors: A Nation of Parents Healing Autism Against All Odds by Jenny McCarthy.)
  6. “I think the immune system, like every other system of the body, matures slowly, and that it can better tolerate viral infection at older ages and better tolerate one virus at a time. The other thing is that vaccines all contain other ingredients. They contain aluminum, they contain tiny bits of formalin [an aqueous solution of formaldahyde]. So I recommend waiting as long as parents are comfortable, and vaccinating very, very slowly.” (Interview with Cookie Magazine.)
  7. “I don’t give a lot of vaccines.” (from An Open Letter on Vaccines, deconstructed by Steve Novella on SBM.)
  8. “In 1980 I abandoned the recommended vaccine schedule. I received dozens and dozens of phone calls from moms and dads reporting that their child had received shots a couple of days ago and they were acting “a little different.” They couldn’t quite put their finger on it but their child was just not acting quite the same as before I gave the shots. They’d ask if this was okay…was it normal? Initially, as I was trained to do, I replied ‘yes.’ After dozens and dozens and dozens of phone calls, I decided that I had better listen to these moms a lot more.” (from An Open Letter on Vaccines, deconstructed by Steve Novella on SBM.)
  9. “I gave a half dozen vaccines today. I gave some reluctantly but respected parents’ wishes to vaccinate.” (Link.)
  10. “I think that the public health benefits to vaccinating are grossly overstated. I think that if we spent as much time telling people to breastfeed or to quit eating cheese and ice cream, we’d save more lives than we save with the polio vaccine.” (Interview with Cookie Magazine.)

Note that Jenny McCarthy’s book, for which Dr. Gordon wrote the Foreword, was published in September 2008. In fact, none of these are old quotes by Dr. Gordon. Also note that Dr. Gordon has been palling around with some of the most rabid antivaccinationists out there and has become much in demand as a speaker on the antivaccine circuit and a guest on TV shows. That’s because it’s clear that Dr. Gordon believes vaccines do great harm, and he’s good for the “vaccine skeptic” viewpoint. He believes that vaccines are chock full of nasty “toxins” and that they cause autism. He long ago abandoned the conventional vaccination schedule and now is a “brave maverick doctor” who goes his own way. No meekly following along with the herd of pediatricians in thrall to the CDC and AAP, he! No reliance on large epidemiological studies showing no link between either mercury in vaccines and autism or vaccines themselves and autism! Moreover, he views pro-vaccine advocates as being hopelessly in the thrall of big pharma. He’s said so time and time again.

So what does he say about vaccination for this article for the Michigan Law Review? As I said before, we see a “kinder, gentler” Dr. Gordon:

Over many years, seeing thousands of children, my point of view about childhood vaccines has changed. I believe that parents have the right to decide when and how their children receive vaccinations and also have the right to decline any or all vaccines. Like many medical interventions, vaccines have risks and benefits, and parents may elect nonvaccination as the better choice for an individual child. The societal ramifications are significant and should certainly be a part of any discussion. 

So far, this is nothing different from what Dr. Gordon’s been saying all along, albeit couched in less inflammatory language and cleverly framed as an issue of individual freedom. What has changed is that Dr. Gordon now admits that societal ramifications are important and that they should be part of any discussion. Quite frankly, in all my years sparring with him, I do not recall his ever admitting that societal ramifications mattered one whit. Perhaps this is the beginning of a change in Dr. Gordon.

Or not:

When children or babies who have been in contact with other children (or adults) contract most illnesses, there is no feasible way to know from whom they got the disease. Whether one is talking about a routine winter viral illness, chickenpox, or whooping cough, the contagion could have come from a child with overt disease signs and symptoms, an asymptomatic carrier, or another, perhaps mutual, contact. Vaccines are not 100% effective, so that even a fully vaccinated child can contract an illness or carry that illness and give it to another child. Blaming a specific individual–let alone suing one–because your child gets sick has no credible medical basis.

As Autism News Beat points out, this is easily demonstrably false. He used the example of the recent San Diego outbreak of measles, where it was quite feasible to trace the outbreak to a single unimmunized seven-year-old who caught the disease while on vacation in Switzerland. In fact, it was possible even to determine with a high degree of probability when and where this child infected other children with his particular strain of measles. Apparently the disciplines of molecular diagnostics and forensics are too new for Dr. Gordon to be aware of them. But it’s even worse than that. He seems completely oblivious that such techniques are applied to outbreaks all the time to identify the strains of bacteria or virus that are responsible for an outbreak. It’s done all the time in the case of outbreaks of food contamination: The specific strain of E. coli or Salmonella is routinely traced back to the manufacturer all the way back through the chain of distribution, starting at the product purchased and following the infection back to through the chain of distribution to the manufacturer. The concept is the same for tracing the source of an outbreak. It beggars the imagination that Dr. Gordon could be so oblivious to these simple facts. Of course, he’s more interested in demonizing vaccines than in being scientifically accurate.

Same as it ever was.

He’s just become subtler about it:

There are many valid reasons to support vaccination, but they don’t support removing the right to refuse vaccinations. There are also situations–medical and personal–which justify waiving all or some childhood vaccines, but these are not good reasons to abandon vaccines altogether.

There you go again, Dr. Jay, with the fallacy of the false dilemma. No, it is not a matter of either abandoning vaccinations altogether versus total support. It’s not a choice between supporting vaccination or abandoning vaccines altogether. But, again, Dr. Gordon’s false dilemma is even more false than that, given that it doesn’t require abandoning vaccination altogether to endanger public health. Just having the vaccination rate drop significantly below the rate necessary for herd immunity (approximately 90% for most vaccines) will do. At that point, outbreaks become increasingly more likely, as our British friends have discovered. Indeed, that’s the reasons measles is now endemic again in the U.K. after having been declared eradicated a mere 15 years ago. It was the antivaccine movement spurred on by the dubious “findings” of the “research” of Andrew Wakefield that scared U.K. parents into not vaccinating, with MMR uptake rates falling below 80% in some areas. The results were predictable, and they came true.

Dr. Gordon also goes on to pull out the false equivalency argument:

Parents who vaccinate their children base their decisions on the advice they receive from their pediatricians and the other knowledge they have gathered. Parents who choose to waive vaccinations do so for similarly valid reasons.

Very clever, Dr. Jay. Unfortunately, Dr. Gordon neglects to mention that there are antivaccine groups out there dedicated to feeding an unrelenting stream of propaganda based on dubious or no science demonizing vaccines to parents, aided and abetted by certain pediatricians who write articles for law reviews. I do admire Dr. Gordon’s chutzpah for making the not-so-subtle implication that his advice based on his own easily fooled “personal clinical observations,” is the equivalent of science-based recommendations about vaccinations that make up the standard of care. I’ll give him a hint.

They aren’t.

But Dr. Gordon’s not finished yet with the false dilemmas:

Adverse outcomes can occur from both vaccination and nonvaccination. Vaccines work very well at creating immunity to illnesses, so there are very few situations that would likely lead to transmission of an illness from an unvaccinated child to a vaccinated child. The obvious exceptions would be infants too young to have received a full complement of shots and immuno-compromised children. Parents must protect these two groups of children by keeping them away from too many other children. Period. Newborns and young babies are at risk any time they are in public. We can only vaccinate against a very small minority of contagious illnesses; it is unwise to bring your newborn into preschool when you pick up your toddler, and equally risky to attend older children’s birthday parties with this baby. Further, parents of children taking high dose steroids for asthma or receiving immunosuppressive medicine for other diseases are strongly cautioned by their doctors to avoid the potential dangers I have described.

Although I am highly gratified that Dr. Gordon has finally–finally!–proclaimed the efficacy of vaccination in preventing infectious disease and has even gone as far as advising that unvaccinated (or undervaccinated) children should be kept away from the unvaccinated, I reluctantly have to point out that the vaccinated can be infected by the unvaccinated. The reason, of course, is that no vaccine is 100% effective, as much as we would wish that it was. Indeed, if vaccines were 100% effective, then herd immunity wouldn’t be so important, and whether Dr. Gordon encourages credulous woo-friendly parents not to vaccinate or not would matter much less. Unfortunately, his blandishments do matter. Vaccinated children whose vaccination didn’t “take” are vulnerable to infection. They’re not as likely to be infected, but they can be. In fact, Dr. Gordon even admitted as much by including babies who have not yet received their full series of booster shots in with the children who are vulnerable! In any case, Dr. Gordon can’t seem to make up his mind if vaccines are 100% effective (in which case herd immunity is much less of an issue) or if they are so ineffective and potentially dangerous that parents are right to refuse them. Perhaps he somehow believes both.

Dr. Gordon goes on to question the efficacy of the influenza and varicella zoster (chickenpox) vaccines. Note how he chooses vaccines that are a bit more controversial and for which the evidence supporting universal vaccination is not quite as overwhelming as for other vaccines. The reason is transparent, at least to me. By going after the “weaker” vaccines in the vaccine schedule, Dr. Gordon hopes to convince readers that there is a similar level of doubt about the entire vaccine schedule, a level of doubt so high that it is not unreasonable for parents to refuse to vaccinate based on the beliefs that vaccines are not that efficacious in preventing disease and that they carry unacceptable risks. Everything in Dr. Gordon’s editorial is designed to cast the efficacy and risks of vaccines in the worst possible light. Then he plays the “victim” card, whining that parents who refuse to vaccinate have been unfairly “vilified”:

In the absence of facts, doctors and others are trying to frighten people into vaccinating or not vaccinating. That fear includes the notions that unvaccinated children pose a great threat to others and that parents of these children are not being responsible. In fact, these parents are choosing what they consider to be the safest course of action for their children and pose very little, if any, danger to other children and adults.

I find this particulary ironic, given that Dr. Gordon and the mother of one of his patients, Jenny McCarthy, have been two of the most prominent of those frightening people into not vaccinating their children. Dr. Gordon appears oblivious to any responsibility he might bear for appearing on TV shows arguing that vaccines cause autism or credulously repeating the exaggeration and misinformation spread by Jenny McCarthy, J.B. Handley, and the rest of the antivaccine movement about formaldehyde, aluminum, and other allegedly horrible “toxins” in vaccines that are not toxic at the levels present in vaccines. He himself has joined in spreading fear–fear of vaccines–by demonizing vaccines every opportunity he gets, including this law review article. Indeed, he takes it to a level I haven’t seen before:

Some medical interventions are not controversial, and some prompt only mild controversy. For example, if a child has acute lymphocytic leukemia, the cure rate with conventional medical care approaches ninety percent, and very few doctors or parents will argue against the standard treatments offered in spite of their known complications and adverse reactions. But vaccines are presently controversial, and purported truths about safety and efficacy are challenged daily by lay people and physicians. 

Wow. Just wow. Did Dr. Gordon actually just compare vaccines to chemotherapy for ALL? I believe he just did, even though any level of risk from vaccines is many orders of magnitude below those that chemotherapy poses. He also falsely labels vaccines as “controversial.” They are not, at least not among science-based physicians. The “controversy,” such as it is, is in reality what is commonly termed a “manufactroversy,” in other words, a controversy manufactured where none existed before, at least among scientists. Dr. Gordon is desperate to paint the manufactroversy about vaccines as a real scientific controversy. Of course, he’s a bit hamstrung in that he seems unable or unwilling in this particular venue to let his freak flag fly and come right out and say that he believes vaccines cause autism, neurodevelopmental disorders, and a variety of immune disorders, such as asthma, as he has in other venues. What he does do is to point out the “CYA” language in the package inserts of vaccines and try to “jazz it up” as evidence that vaccines are very, very dangerous. He then returns to his favorite technique in this article, the false dichotomy:

The list of side effects from adverse reactions to vaccines, in a Physicians’ Desk Reference “warning” section, given out of context, would probably frighten many parents out of vaccinating at all. There are thirty or more items on that list. Similarly, the list of symptoms and complications of the illnesses against which we vaccinate could scare parents into giving every shot available as soon as possible.

Pediatricians and other physicians use the latter option on a daily basis.I share my colleagues’ disdain for scare tactics from the “antivaccine” camp, but I object equally to doctors using fear and misinformation to try to convince parents (and legislators) that vaccines are risk free. Both sides are distorting the truth for their own purposes. Childhood illnesses are part of the first decade of life; immunity is acquired, and the consequences are almost always minor.

I suppose that’s why the “harmless” measles is the leading cause of preventable mortality worldwide, killing around 200,000 children a year worldwide. Of course, it was much worse before mass vaccination programs. Ten years ago, measles killed around 900,000 children a year. And why has the mortality fallen so much? The reason is mass vaccination programs spearheaded by WHO.

My irony meter also just about exploded at Dr. Gordon’s “disdain” for the scare tactics from the antivaccine camp (note his use of quotation marks!) given that he himself loves to engage in many of the exact same scare tactics of the antivaccine fringe that he now says he deplores, be they the “formaldehyde” gambit, the “toxins” gambit, or fear mongering about mercury. The hypocrisy and use of the logical fallacy of the false dichotomy are astounding, even by Dr. Gordon’s usual standards.

So much for the “kinder, gentler” Dr. Jay, I guess.

I’m very, very disappointed in the editorial staff of the Michigan Law Review, including Editor-in-Chief Adrienne Fowler, and Managing Editor Stefan Atkinson, for having fallen for Dr. Gordon’s portrayal of himself as some sort of expert on issues related to vaccination, be they medical or legal. He is an expert on neither immunology, vaccination, nor the law. As an alumnus of the University of Michigan, albeit not the Law School, I’m very unhappy to see such a self-inflicted black eye. The reason is simple, and I’m going to use a saying that I have permission to steal blatantly from a couple of online acquaintances: Relying on Dr. Jay Gordon for legal acumen and advice is akin to appointing Judge Judy to the Supreme Court. It’s bad enough that the line between news and entertainment has all but disappeared. There are two exceptions, of course. Judge Judy is actually a retired judge; Dr. Gordon has no experience in the legal profession. In addition, Judge Judy, while chaff entertainment, does not have a reputation for being spectacularly wrong so often. Dr. Gordon, as shown above, does.

That is why I, as a disheartened alumnus of the University of Michigan, urge any other fellow alumni of U. of M., or anyone concerned with medical and legal accuracy and the application of science-based medicine to the issue of mandatory vaccination, to write to Ms. Fowler (aefowler@umich.edu) and Mr. Atkinson (stefanat@umich.edu) to voice a strong complaint over their having published the misinformation and exaggerations of a pediatrician known to be an apologist for the antivaccine movement. The issue of legal liability for parents who refuse to vaccinate is a contentious and fascinating issue that is ill-served by the self-serving and misinformed posturing of someone like Dr. Gordon. Indeed, reading all the articles in this rather interesting issue, it is clear to me that the debate is actually far more informative without Dr. Gordon’s contribution, such as it is.

Comments

  1. #1 Blake Stacey
    February 2, 2009

    I grudgingly allow that the freedom of religion guaranteed in the First Amendment probably requires religious exemptions (although I do not understand why religion should be given such a privileged place in society that it should be allowed to be used as an excuse by parents to endanger public health), I am far less convinced that philosophical exemptions should be mandated.

    That’s certainly food for thought. At some point, it might appear, the First Amendment — if read in that fashion — becomes a public health hazard!

    To phrase the matter somewhat less provocatively: how does religious belief, seemingly alone among character traits, exempt the individual from laws passed for a secular purpose?

  2. #2 daedalus2u
    February 2, 2009

    If I understand what Dr. Gordon is saying, he is saying that his recommendation to not vaccinate is on an equal standing as the “standard of care” recommendation to follow the standard vaccination schedule, and that parents who follow his recommendation are not to blame.

    I guess that makes Dr Gordon to blame if one of his unvaccinated patients is infected or infects someone else.

    It seems to me he is setting himself up for some legal liability himself. If harm comes from following a recommendation to follow the standard schedule and the harmed party can sue the professional making the recommendation, then presumably if harm comes from following a recommendation to not follow the standard schedule the same thing applies.

  3. #3 Interrobang
    February 2, 2009

    The chicken pox vaccine is only “controversial” if you’ve never known anybody who’s had shingles. Sheesh.

    Three members of my family have had it, and ever since then, I’ve been wishing like crazy that the chicken pox vaccine had existed when I was little. (Notwithstanding that chicken pox, even if you do just get the mild version of it, is a miserable, shitty disease that I wouldn’t wish on my worst enemy, let alone a defenceless little kid…)

  4. #4 Calli Arcale
    February 2, 2009

    Blake Stacey: it’s a complicated question, why the “establishment clause” causes our government to bend over backwards to avoid inconveniencing a religion. The idea is that if a law is passed which presents a specific hardship for members of a particular religion, then the government has passed a law which makes it more difficult to practice that religion than it is to practice other ones. This could be construed as religious favoritism, which violates the spirit of the establishment clause.

    This may seem far-fetched, and many of the supposed infringements upon a religion are tenuous indeed, but there is actually a legitimate concern behind this — historically, laws have been *deliberately* passed which, while secular in word, are written in such a way as to harass a particular religion. That has been very rare in this country, because the Constitution forbids it, but laws have been used in such a manner for other purposes. Consider Jim Crow laws, which targeted blacks. And consider other countries, lacking an establishment clause, which have for centuries passed laws to deliberately suppress specific religions while pretending to have the moral high ground of not harassing another religion.

    Obviously this can lead to absurd results, one of which is a specific form of political correctness. But I think that it would be a mistake to totally discard the idea. While we do not even think of, for instance, passing a law forbidding students from bringing in their own lunches even on days when pork is served, in order to force Jews and Muslims out of public school, history tells us that someone else would. It’s a delicate balance to maintain, but I think it’s healthy that we as a society continue to have discussions like this, about what should get religious exemptions and what should not, because there is still great value in the establishment clause of the Constitution.

  5. #5 Mu
    February 2, 2009

    I can see why the prospect of irresponsible parents being sued would scare Dr. Jay. Many states have common liability for a verdict, so if one of his patients would be allocated 90% of the guilt, and he’s only held liable for 10% for his “bad advice” he’s still stuck with the hole bill if the parents can’t pay (which is why many lawsuits have odd defendants; not only the maker of a bad product (might be small) but also the distributor (bigger) and Walmart (real big) get sued for minimal percentages).

  6. #6 LB
    February 2, 2009

    Will be interesting to see what response you get from the editors. What sets legal academic journals apart from journals in just about every other field is that they’re (mostly) student-edited, so the people you’ve emailed are probably third year law students, sitting in class right now. Although they’re probably sitting in class with their email program open on their laptops, so that could mean that a response is more likely. :)

  7. #7 Anonymous
    February 2, 2009

    http://www.wsbt.com/news/local/38785417.html

    Community shocked by suspected meningitis death

  8. #8 Prometheus
    February 2, 2009

    Interrobang mused:


    “The chicken pox vaccine is only “controversial” if you’ve never known anybody who’s had shingles. Sheesh. Three members of my family have had it, and ever since then, I’ve been wishing like crazy that the chicken pox vaccine had existed when I was little.”

    Take heart, Interrobang – the same vaccines that little kids get to prevent chicken pox can (apparently) greatly reduce the risk of getting “shingles”. Studies suggest that by “boosting” your “lifelong” immunity to herpes zoster as an adult, you reduce the chance of having shingles.

    On the topic of the post, the Establishment Clause has been cited a number of times when religions have wanted to protect practices that are illegal, such as the use of peyote (a DEA class I substance) or marijuana in religious worship.

    So far as I know, no religion has tried to get approval for a practice that has been shown to harm uninvolved third parties (e.g. sacrifice of the first born, ala Baalism). It would be interesting to see it argued that way.

    Prometheus

  9. #9 Nancy Tranzow
    February 2, 2009

    One needs to do only a brief study of the concept of Herd Immunity to understand why the vaccination of children is incredibly important for the health of the population.When you do not vaccinate your child, you are putting at risk, the entire population of suseptible people, to infectious and deadly diseases. There is no definitive SCIENTIFIC studies that show autism is linked to vaccination. I understand the fear of harming your child but it is much more harmful to allow their immune system to be vulnerable to the many contagious diseases that exist.

    In an era where international travel is quick and dirty, so is the transport of dangerous pathogens. We do not live isolated and while people are lulled into a false sense of security and believe that because we haven’t had outbreaks of childhood disease that somehow it won’t happen, they are mistaken.
    When I vaccinated my 3 sons, I vaccinated them for themselves, other children, the immunosuppressed, the elderly and and any other vulnerable members of our population .

  10. #10 Patrick
    February 2, 2009

    Roflmao … “Period.”

    Jay you’re ignorant, there can’t only be one solution to protection of immunocompromised children. Yet you write this as if you are “The” ultimate authority. Your Not, and to use your own phrase, Period.

  11. #11 Scott
    February 2, 2009

    I also seem to recall that parents whose children die due to the use of exorcism instead of medicine have tried the First Amendment defense, and failed. I’d argue that it’s pretty nearly a direct precedent; if anything not vaccinating is less protected because it causes harm to others who don’t share the belief.

    I can’t find the cites, though…

  12. #12 Dawn
    February 2, 2009

    Oh Orac, so you read Jenny’s new book? And you weren’t moved to tears? I forgot, you don’t have any feelings. You are a cold individual who ACTUALLY MAKES A VERY GOOD LIVING WHEN PEOPLE ARE DYING (cancer “specialist” right?). Am I wrong?

  13. #13 nm
    February 2, 2009

    C’mon Blake we all know the real constitutional source of damage to the public health is the 2nd ammendment.

  14. #14 D. C. Sessions
    February 2, 2009

    While we do not even think of, for instance, passing a law forbidding students from bringing in their own lunches even on days when pork is served, in order to force Jews and Muslims out of public school, history tells us that someone else would.

    No need to be hypothetical here: French schools have instituted bans on head scarves for precisely that reason: as a “wedge” against Muslim families, who have to choose between having their daughters go to school dressed immodestly or not go to school at all, and being subject to legal sanctions.

    It’s one way of getting rid of undesired minorities, after all.

  15. #15 Joseph C.
    February 2, 2009

    You are a cold individual who ACTUALLY MAKES A VERY GOOD LIVING WHEN PEOPLE ARE DYING (cancer “specialist” right?). Am I wrong?

    His surgeries have also managed to cure a few patients. This is a legitimate service and a legitimate occupation in any non-crazy, non-stupid world.

  16. #16 DT35
    February 2, 2009

    Michigan has joint and several liability in malpractice actions, as described in Mu’s comment above, and a creative plaintiff’s attorney would be happy to argue that Dr. Jay’s contribution to the U-M law review should be construed as doing business in the state, thus subjecting him to the provisions of Michigan law.

    I was editor of the law review at my school (not U-M), and in my day, most articles for a themed issue like this had to be solicited. It does not speak well of the judgment of the editorial staff that the under-qualified Pediatrician to the Stars was selected as the best contributor they could get to offer a medical perspective.

  17. #17 Chris
    February 2, 2009

    Dawn said “PEOPLE ARE DYING”

    And more children will die from Hib, pertussis and measles if Jenny McCarthy has her way.

  18. #18 The ignorance here is amazing
    February 2, 2009

    “The chicken pox vaccine is only “controversial” if you’ve never known anybody who’s had shingles. Sheesh”.

    The shingles problem has been growing exponentially because of the introduction of the chicken pox vaccine. I’d try to explain why to you but something tells me you wouldn’t understand…. Orac, you have some brilliant posters here… you must be so proud.

  19. #19 Karl Withakay
    February 2, 2009

    There are limits to the first amendment rights of free speech and freedom of religion.

    You can’t sacrifice your first born or your neighbor to the god of your choice, and you can’t yell “fire” in a crowded building when you know there’s no fire.

    The is a point where your religious beliefs cannot be allowed to endanger the lives or welfare of others.

    There is also a point, where sufficient evidence has been presented to you as proof that there is no fire, or even smoke, that you should not be allowed to continue to yell fire in a crowded building even though you still personally believe there is a fire.

    I’m sure someone will respond with a slippery slope argument.

  20. #20 HCN
    February 2, 2009

    The nameless one said “The shingles problem has been growing exponentially because of the introduction of the chicken pox vaccine.”

    Documentation please?

  21. #21 RJ
    February 2, 2009

    Yes, I too would like to read up about the shingles outbreaks…considering it typically affect older individuals and the vaccine has not been in use for that long.

    Yes, documentation should clear this up.

    Thanks in advance.

  22. #22 RJ
    February 2, 2009

    Wow, I guess I must be REALLY ignorant, because I just don’t get it.

    How are people, mostly over 50, getting shingles outbreaks (that are supposedly increasing exponentially) when the vaccine was first introduced in March of 1995?

    Any time now…we’re waiting on this explanation.

    Any time now…….

  23. #23 HCN
    February 2, 2009

    RJ said “How are people, mostly over 50, getting shingles outbreaks”

    And the “mostly over 50″ are also called the Baby Boomers. They are called that because of the exponential increase of births after World War II.

  24. #24 samantha2
    February 2, 2009

    It’s been a while since law school (esp since I haven’t practiced law in a while), but if I remember correctly, the duty of a doctor to third parties is usually very limited.
    However, there are some cases where third-parties have been allowed to sue doctors that may be on point – in some STD cases where the doctor didn’t tell the patient that they had an STD, leading them to unknowingly infect their partners, the infected partner was allowed to sue in some jurisdictions. There are some non-STD communicable disease cases that take the same line (that the public interest in protecting the populace against infectious diseases requires a doctor to warn patients of the risks they pose to others; if they fail to do this, third-parties can sometimes sue). However, in ordinary circumstances, as long as the doctor warns the patient of the potential consequences, the doctor can’t be sued by third parties if the patient chooses to disregard them.
    States differ a lot on this stuff, though.

    I think it’s a no-brainer that a vaccinated (or unvaccinated for solid medical reason) child who catches a vaccine-preventable illness from a child who wasn’t vaccinated (and for no good medical reason) should be allowed to sue. In civil cases, the duty of care is judged by the reasonable-person standard, and reasonably prudent people vaccinate their children!

    Does anyone know if there have been any cases on this? I imagine that if there were one, the anti-vaccine crowd would jump all over it (like the Perth group did in the case of the guy infecting women with HIV in Australia). It would be great if they got the same slap-on-the-back-of-the-head that the AIDS denialists did! Unfortunately, I’m none too confident in the ability of jurists to recognize garbage science and unqualified experts when they see them. Your average judge (like your average lawyer, and well, your average American) is woefully undereducated in the sciences. Occasionally they do well – Dover comes to mind.

    Again, it’s been a while since law school!

  25. #25 Prudence
    February 2, 2009

    Oh hey, Crazy Dawn’s back, everybody!

  26. #26 RJ
    February 2, 2009

    ” I’d try to explain why to you but something tells me you wouldn’t understand”

    Oh, please try! Please oh knowledgeable one! I beg of you!
    Enlighten us. Be our guide in these dark, shingle-infested times! Spare us of this pox that plagues our house!

  27. #27 Prudence
    February 2, 2009

    “No need to be hypothetical here: French schools have instituted bans on head scarves for precisely that reason: as a “wedge” against Muslim families, who have to choose between having their daughters go to school dressed immodestly or not go to school at all, and being subject to legal sanctions.

    It’s one way of getting rid of undesired minorities, after all.”

    DC, ALL religious regalia is banned in French schools. Are they trying to drive a wedge with the Christians, the Jews and the Sikhs too? There are plenty of private and religious French schools that skirt the law too. I lived across from a Yeshiva in the Marais and everyone wore their yarmulkes to school.

  28. #28 SC
    February 2, 2009

    Outrageous. I’m tired of this “This has been an interesting discussion; thanks for giving me food for thought [What I really mean is I’ll continue to be clueless about the scientific evidence concerning vaccines and science in general and will spew my baseless speculation to an unsuspecting public while turning up here from time to time to offer evidence of my continued willful ignorance]” routine. The first time he showed up here I called him shameless, which I later regretted. No longer – he’s proven my initial characterization to be entirely accurate.

    let his freak flag fly

    Sheesh. Thanks for tainting that song for me until I’m able to forget any association with this antivaccination stooge.

  29. #29 Enkidu
    February 2, 2009

    About chicken pox vaccine and shingles… I’ve heard this too. I found this on pubmed:
    http://www.journals.uchicago.edu/doi/abs/10.1086/591975?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%3dncbi.nlm.nih.gov

    The theory is that since contact with circulating VZV is down due to the vaccine, reactivation of latent VZV is up (ie shingles)… occassional contact with VZV somehow keeps it latent, as Prometheus stated above.

  30. #31 HCN
    February 2, 2009

    I saw that, but since you cannot look at the whole paper I would like clarification of this statment: “there has been a significant increase in HZHDs and associated charges, disproportionately among older adults.”

    1) Since shingles is more common in older adults, why is that disportionate?

    2) Did the percentage increase among those older than 50? Because this statement “and by 2004 the overall rate was 2.5 HZHDs (95% confidence interval, 2.38–2.62) per 10,000 US population,”, seems to suggest the entire population.

    3) Since the baby boomers are getting older, was that taken into account.

    I also did some looking about, and found:
    Epidemiol Infect. 2007 Aug;135(6):908-13. Epub 2007 Feb 12. Links

    Comment in:
    Epidemiol Infect. 2008 Apr;136(4):449;
    Secular trends in the epidemiology of shingles in Alberta…. which says that “The increased rate of shingles in Alberta began before varicella vaccine was licensed or publicly funded in Alberta, and thus cannot be attributed to vaccination.”

    Which leads me to believe it was more of an aging population.

    I also found this paper:
    http://pediatrics.aappublications.org/cgi/content/full/122/3/e744 … which has this paragraph: “For addressing this concern, a number of studies assessed the incidence of HZ in the United States in the pre- and postvaccine eras. Results so far are inconclusive. In a study in a health maintenance organization in Seattle, the age-adjusted incidence of HZ remained stable during 1992–2002 as the incidence of varicella decreased 65%.79 Data from 2 health maintenance organizations in Oregon and Washington for 1997–2002 showed no statistically significant increase in HZ incidence rates except among children aged 10 to 17 years (relative risk: 1.12 [95% CI: 1.05–1.18]); these increases were attributed to increased use of oral steroids.80 An analysis of incidence data from a national database81 found an overall incidence of HZ in 2000 and 2001 in the range reported before vaccine introduction.82 A study that used statewide telephone survey data during 1998–2003 in Massachusetts demonstrated an overall 90% increase in HZ, whereas varicella incidence declined 66%.83 A population-based study found a 22% increase in the incidence of HZ between 1996 and 2001.84 In interpreting these findings, it should be noted that some studies showed a rising trend in HZ incidence in the absence of a vaccination program.85–87 Because risk factors other than age and immune status for HZ are largely unknown, understanding the secular trends and separating the potential impact of the varicella vaccination program on HZ epidemiology will be challenging, especially among adults aged 60 years, the age group now recommended for zoster vaccine.88 A definitive answer may not be available in the short-term.”

    I don’t see anything that shows an “exponential” growth of shingles outside an increase in older adults.

  31. #32 SC
    February 2, 2009

    Don’t know if this has been mentioned here before, but a reminder might be worthwhile in any event. Tonight at 9:00 Eastern (Sb) time – in about an hour – PBS’ American Experience is “The Polio Wars”:

    http://www.pbs.org/wgbh/americanexperience/polio/

    (If you click on the link, beware of video playing automatically.)

  32. #33 LW
    February 2, 2009

    You are a cold individual who ACTUALLY MAKES A VERY GOOD LIVING WHEN PEOPLE ARE DYING (cancer “specialist” right?).

    That’s right. If Orac were really kind and caring and warm-hearted, he’d be making a living doing elective plastic surgery and breast implants, and letting all those cancer patients die slowly and horribly without care. All oncologists should immediately abandon their patients and go into medical specialties where nobody dies.

  33. #34 Marilyn Mann
    February 2, 2009

    “it’s bad enough that Ann Coulter attended law school there at almost the same time I was attending medical school there. She was even an editor of the Michigan Law Review.”

    Yes, she was an articles editor although she rarely showed her face in the offices of the law review. Ann and I were in the same class (1988). Her behavior was more normal in those days. She was known for being conservative, but she didn’t spew forth totally wacked-out stuff like she does now, or at least I never heard her doing so. I had lunch with her a couple times in the late 80s, have not seen her since then.

  34. #35 JKW
    February 2, 2009
  35. #36 JoshS
    February 2, 2009

    Orac wrote:

    “I grudgingly allow that the freedom of religion guaranteed in the First Amendment probably requires religious exemptions (although I do not understand why religion should be given such a privileged place in society that it should be allowed to be used as an excuse by parents to endanger public health), I am far less convinced that philosophical exemptions should be mandated.”

    I usually find you spot on, but this really troubles me, Orac. I think if you look at it again, you’ll see that it merely exacerbates the privilege that religious claims get over any other. Let me be clear – I’m a rationalist, an atheist, and I loathe the anti-vaxxers. I don’t think anyone should get an exemption except on medical grounds. I have a voodoo doll of Jenny McCarthy. . well, no I don’t, but you know what I mean.

    This is not the only sphere where claimed deference to God is given more credence than other, just as justifiable or unjustifiable, philosophical claims. I resent the idea that in order to avail myself of a right, I have to do so by proclaiming a belief in a deity – apparently my own convictions aren’t enough. Frankly, I think such favoritism toward religion – as compared to any other basis for beliefs – could be challenged on constitutional grounds. If I’m not being clear, I could provide other examples that don’t relate to potential harm to public health, if that would be helpful.

    Again, I’m four-square against vaccination exemptions, and against exemptions from other such sound laws. But there are instances where state laws give exemptions to people for other things (again, unrelated to public health or welfare like this is) based on “recognized” religions. That’s fundamentally unfair, and I don’t think it’s constitutional.

  36. #37 BB
    February 3, 2009

    @Dawn, I’m a cancer researcher (non-MD) who makes a LOUSY living trying to find new ways to treat cancer. Want to make something of it?

    As for “free societies,” what about my children’s right to be “free” of pestilence? If the Jennies and Dawns have their ways, my children will forever be at risk.

    And the Salmonella in peanut butter? By their stupid reasoning, that’s the fault of the FDA.

  37. #38 Try 'The Google'
    February 3, 2009

    “About chicken pox vaccine and shingles… I’ve heard this too. I found this on pubmed:
    http://www.journals.uchicago.edu/doi/abs/10.1086/591975?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%3dncbi.nlm.nih.gov

    The theory is that since contact with circulating VZV is down due to the vaccine, reactivation of latent VZV is up (ie shingles)… occassional contact with VZV somehow keeps it latent, as Prometheus stated above”.

    See, that wasn’t so hard now, was it? RJ, consider yourself enlightened. Interrobang, sorry about your family members who got shingles… I hear that it is MUCH worse than silly old chicken pox. HCN – LOL!

  38. #39 ababa
    February 3, 2009

    Yeah RJ, you forgot to look on “The Google”. It’s where all the smart peoples gets their learnin’

  39. #40 Liz Ditz
    February 3, 2009

    I made a resolution that I would ignore Dawn (Dawn Crim, Dawn2000K), when she showed up here and elsewhere. So I’m breaking that resolution.

    Here’s what Dawn wrote:

    I forgot, you don’t have any feelings. You are a cold individual who ACTUALLY MAKES A VERY GOOD LIVING WHEN PEOPLE ARE DYING (cancer “specialist” right?). Am I wrong?

    Yes, Orac specializes in breast cancer. And I imagine that some of his patients do indeed succumb to the disease.

    Well, people dying.

    Twenty-six days ago, a dearly-beloved friend lost his four-year battle with metastatic colon cancer. He had a number of oncologists (cancer “specialists”, in Dawn’s world) who bent all their training and efforts to defeat his disease.

    In the end, all their training and expertise bought time.

    Dawn, without the efforts of these men and women, my beloved friend would have died in 2005. He would not have seen his daughter graduate from high school. He would not have seen his older son get his life back on track, or met his older son’s fiancee, or get to experience his older son as a father.

    He would have not seen his younger son get married. He would not have seen his younger son as a father, or had the pleasure of playing with his grandson.

    Dawn, after my friend’s death, one of the most recent of my friend’s oncologists called each of my friend’s adult children to express his condolences and regret that the treatment he offered was ineffective against my friend’s disease. It meant a lot to the children, to hear from one of their father’s physicians.

    Dawn, your comments reveal an irrational anger. Once again, I urge you to seek help, for the sake of your children. Find a pastor or counselor, if you don’t trust psychologists.

  40. #41 DT35
    February 3, 2009

    So Anti-Vax Dawn’s policy is that little kids need to keep getting chicken pox with its discomforts and potential complications, so that adults can keep getting their immunity refreshed and avoid the discomforts of shingles.

    Since this childhood chicken pox/adult shingles pattern demonstrates that immunity to herpes zoster conferred by actually having chicken pox does not, in fact, last a lifetime, logic would support avoiding at least the chilhood illness through immunization.

    Speaking as one who has experienced both chicken pox and shingles, I can say that shingles was the lesser misery.

  41. #42 RJ
    February 3, 2009

    “The theory is that since contact with circulating VZV is down due to the vaccine, reactivation of latent VZV is up (ie shingles)… occassional contact with VZV somehow keeps it latent, as Prometheus stated above”.”

    So, in the mean time, we should keep allowing children to have the disease, and spread it around, as well as let the virus become latent in all infected…so that a subset of this current generation won’t get shingles if they refuse the shingles vaccine? Nice thinking! Brilliant!

    Hey, here’s another plan. Let’s go ahead and figure that some of those “exponential increases” in shingles cases are because of demographics. Then, we can figure that once this generation that never gets infected with the virus comes into their own (and those that have pass on), we can scratch another infectious viral disease off the list. No chicken pox. No shingles. Gone.

    Just out curiosity, are you going for your Master’s or Ph.D. from google?

    And to think I wasted all those years going to school. Damn!

  42. #43 passionlessDrone
    February 3, 2009

    Hi RJ –

    “Let’s go ahead and figure that some of those “exponential increases” in shingles cases are because of demographics.”

    But why should we figure this? Throwing aside the ‘exponential’ claim, the study referenced states:

    “Beginning in 2001, however, the rate of HZHDs overall began to increase, and by 2004 the overall rate was 2.5 HZHDs (95% confidence interval, 2.38–2.62) per 10,000 US population, significantly higher than any of the rates calculated during the years prior to 2002.”

    For us to attribute much increase to demographic changes, we’d have to believe that there was a meaningful change in demographics between 2001 and 2004.

    So, in the mean time, we should keep allowing children to have the disease, and spread it around, as well as let the virus become latent in all infected…so that a subset of this current generation won’t get shingles if they refuse the shingles vaccine? Nice thinking! Brilliant!

    But we all know that vaccination isn’t perfect, and will leave some individuals unprotected. As adults, these individuals will now risk get chickenpox, when the risks of serious complications and death are much greater.

    You are painting with a pretty broad brush when you show your disdain for a ‘subset of this generation who won’t get a shingles vaccine'; though I doubt you realized it. It turns out, if you have a weakened immune system, you shouldn’t get the vaccine:

    http://www.cdc.gov/vaccines/pubs/vis/downloads/vis-shingles.pdf

    A person should not get shingles vaccine who:

    1) has a weakened immune system because of – HIV/AIDS or another disease that affects the immune system
    2) treatment with drugs that affect the immune system, such as steroids
    3) cancer treatment such as radiation or chemotherapy

    The irony is, that it is precisely these individuals who are most at risk for developing shingles!

    http://www.nfid.org/pdf/factsheets/varicellaadult.pdf

    Shingles, typically affects people over 50 years of age and those whose immune systems have been weakened by HIV infection, cancers, or treatment with immunosuppressive drugs.

    In your zeal to show you clever you are and how dumb anyone else is; you have proposed a plan wherein the most vulnerable, those who cannot be vaccinated, are exposed to greater risk of developing the disease. To steal a quote: “Brilliant!”

    “Then, we can figure that once this generation that never gets infected with the virus comes into their own (and those that have pass on), we can scratch another infectious viral disease off the list. No chicken pox. No shingles. Gone. “

    It’s an admirable task (especially for things like smallpox and polio), for sure, but if that is your plan, it is long on ambition, short on working examples, and very low on payoff. Why not spend the resources on diseases that actually kill people?

    The nice part is that I’m absolutely convinced that increasing the rates of shingles is the only unanticipated side effect of our increasing vaccine schedule. So that’s a relief!

    – pD

  43. #44 Robster, FCD
    February 3, 2009

    Dawn, an appeal to emotion is useless without evidence to back up your claims. If I am moved to tears by JMc, it will be for those whose lives she has endangered by her promotion of quackery.

    passionlessDrone,

    That is why herd immunity is important. If the community has a strong baseline immunity, those high risk individuals are at less risk than if the community remains unvaccinated.

    Put simply, the vaccine, as an occasional booster, would take the place of the repeated exposure through circulating wild virus. Even with an average efficacy for the vaccine, herd immunity would be protective.

    Also, chickenpox and shingles can and do kill. Chickenpox can kill via encephalitis or hemorrhagic events. Shingles can do the same, but more likely is suicide. Pain from shingles is the third most common cause of suicide in the elderly.

    My dad has had shingles, and even with the anti herpes drugs, it was extremely painful for him. I’ll happily be getting my vaccination when that time comes.

  44. #45 D. C. Sessions
    February 3, 2009

    Why not spend the resources on diseases that actually kill people?

    Chicken pox does.

  45. #46 Prometheus
    February 3, 2009

    pD comments:


    “The irony is, that it is precisely these individuals who are most at risk for developing shingles!”


    “In your zeal to show you clever you are and how dumb anyone else is; you have proposed a plan wherein the most vulnerable, those who cannot be vaccinated, are exposed to greater risk of developing the disease.”

    pD has been informed that his immunology knowledge base is defective, yet he perseverates in his attempts to “correct” those who know more than he.

    Let me spell it out for him, slowly.

    [1] “Shingles” is a recurrence of herpes zoster virus (HZV), which most current adults first received as “chicken pox”. The virus remains dormant in our dorsal root ganglion nerve cell bodies until it is activated by a combination of “stress” (variously defined) and falling immunity.

    [2] People who already have the wild-type virus in their bodies are at risk for recurrence (“shingles”) either when their immunity naturally declines or if they experience immune suppression due to disease (e.g. cancer) or medications (e.g. cancer chemotherapeutics).

    [3] Adults can maintain their immunity by being exposed to the herpes zoster virus either by “natural” exposure (usually from children infected with the virus, but also from adults with “shingles”) or by immunization. Note – immune-compromised individuals should not be immunized with the HZV vaccine since it is a live virus.

    [4] Adults who did not have the wild-type HZV, but who were vaccinated are currently few, but they should not experience the type of “shingles” recurrence (even if their immunity is allowed to wane) that people with wild-type HZV are at risk for, since their vaccine-strain HZV has a milder phenotype.

    Thus, while we wait for the vaccine-strain HZV to displace the wild-type, adults who are not immune-compromised should get the HZV vaccine to prevent “shingles”.

    Those adults who cannot take the vaccine because of immune-compromise are at no greater risk than they would have been without the existence of the vaccine, since even on-going exposure to the wild-type virus would not protect them (hint: they’re immune-compromised).

    Eventually – if the anti-vaccination Luddites don’t get their way – herpes zoster virus will be eradicated and nobody will have to worry about getting either chicken pox or shingles. Because of the nature of the virus (its ability to remain latent in the body for a lifetime), this will take a lot longer than the eradication of smallpox.

    It is telling that people like pD want to throw up their hands and say, “See! Herpes zoster hasn’t been eradicated yet – the vaccine isn’t working!” It shows the depths of their ignorance and their true agenda.

    Prometheus

  46. #47 Prudence
    February 3, 2009

    It completely boggles my mind that someone would consider not vaccinating, even for chicken pox. My father gets shingles occasionally, it’s always very uncomfortable for him. Conversely, I didn’t contract chicken pox as a child, dengue and malaria were more likely where I grew up, so I really dreaded catching it until I was vaccinated in 2005. The anti-vaxers wouldn’t like me as case specimen, I’ve had every kind of vaccine going: yellow fever, typhoid, cholera, you name it. And I’m sure they were all chock-full of preservatives! Admittedly, I’m slightly bats, but that’s genetic.

  47. #48 RJ
    February 3, 2009

    Just a point of fact to add to the discussion,

    “For us to attribute much increase to demographic changes, we’d have to believe that there was a meaningful change in demographics between 2001 and 2004. ”

    Yes. Because of a shifting age distribution, your 10,000 person sample will include more older individuals than in previous years.

    “But we all know that vaccination isn’t perfect, and will leave some individuals unprotected. ”

    So? What are the relative percentages? To say ‘some’ will be unprotected is true, but is it significant if most are? There is a THRESHOLD necessary for continued incubation and spread of the virus. Herd immunity. Get it?

    “You are painting with a pretty broad brush when you show your disdain for a ‘subset of this generation who won’t get a shingles vaccine'”

    Disdain? Not as much as for those that continue to smoke, or refuse to exercise, or eat a poor diet, or do not visit the doctor, or take their meds….

    Yeah, they exist. And the cost you and me a lot. The difference is that, in the case of cancer and heart disease, they are not contagious.

    “In your zeal to show you clever you are and how dumb anyone else is; you have proposed a plan wherein the most vulnerable, those who cannot be vaccinated, are exposed to greater risk of developing the disease. ”

    Immune-compromised individuals do not just have issues with chicken pox. Therefore, since some vaccines are not an option, other modifications are used to avoid infection, such as behavioral changes or the use of anti-virals. They certainly should be considered, but for you to argue that keeping the infectious wild-type virus around longer, to infect any and all who are susceptible is going to keep those who are immuno-compromised at lower risk…how is that again? Somehow having the virus emerge from infected individuals is going to benefit immuno-compromised people? Wha?!?!?

    pD, you bring up some interesting perspectives for the debate, but your information is incomplete, you do not recognize other contributors to the ‘big picture’, and your logic is fatally flawed.

    It sounds to me like you are more interested in hammering away at others’ points rather than making some valuable ones of your own. Still…keep it up. You’ll learn.

  48. #49 bozzy
    February 3, 2009

    pD “Beginning in 2001, however, the rate of HZHDs overall began to increase, and by 2004 the overall rate was 2.5 HZHDs (95% confidence interval, 2.38–2.62) per 10,000 US population, significantly higher than any of the rates calculated during the years prior to 2002.”

    I don’t think these were age-adjusted rates. Survey says…XXX (notice, I skipped directly to three strikes)

  49. #50 bozzy
    February 3, 2009

    pD “Beginning in 2001, however, the rate of HZHDs overall began to increase, and by 2004 the overall rate was 2.5 HZHDs (95% confidence interval, 2.38–2.62) per 10,000 US population, significantly higher than any of the rates calculated during the years prior to 2002.”

    I don’t think these were age-adjusted rates. Survey says…XXX (notice, I skipped directly to three strikes)

  50. #51 RJ
    February 3, 2009

    I will say…in the interest of civility and progress, that debates with the likes of pD are far, far better than the nonsensical BS ramblings of most. At least pD is dealing with the particulars of the discussion and not on some tangent, citing anecdotal ‘evidence’ to make their case.

  51. #52 Enkidu
    February 3, 2009

    Prometheus: “Eventually – if the anti-vaccination Luddites don’t get their way – herpes zoster virus will be eradicated and nobody will have to worry about getting either chicken pox or shingles. Because of the nature of the virus (its ability to remain latent in the body for a lifetime), this will take a lot longer than the eradication of smallpox.”

    I tried explaining this to an anti-vaxer and they looked at me like I had 3 heads. They didn’t understand the concept of a virus “dying out” if you remove its hosts.

  52. #53 Jay Gordon
    February 4, 2009

    Parents must be informed participants in health care decisions for their children.

    Virtually every expert in pediatrics and infectious disease agrees that vaccines have done much more good than harm.

    National health care policy is not the topic of discussion. Instead, I am addressing decisions about individual children and families.

    “Science” is not the bold-faced, unequivocal deliverer of good to all: It has brought us medications with terrible side effects, surgeries later deemed unneeded, and unintended consequences which could have been avoided with more judicious melding of science and the wisdom of experience.

    Keep public vaccination policies intact until science shows otherwise but certainly allow parents to participate in decisions about vaccinating their children.

    Best,

    Jay

  53. #54 Jay Gordon
    February 4, 2009

    By the way, Dave, I still most definitely believe that vaccines, as they are now formulated and administered can trigger autism in susceptible children.

    Best,

    Jay

  54. #55 Orac
    February 4, 2009

    “Science” is not the bold-faced, unequivocal deliverer of good to all: It has brought us medications with terrible side effects, surgeries later deemed unneeded, and unintended consequences which could have been avoided with more judicious melding of science and the wisdom of experience.

    Uh, no. That’s dead wrong, Dr. Jay. The vast majority of such treatments were clung to tenaciously by doctors using their “wisdom of experience” as an argument that a treatment “must work” until the procedure was ripped from their hands, metaphorically speaking, by studies showing that it didn’t work. You see, Dr. Jay, as has been explained to you time and time and time again, “experience” is very easily fooled by the placebo effect, confirmation bias, confusing correlation with causation, and selective memory. You are prime evidence of that.

    I’ll give you a prime example. Back in the 1950s there was a common operation for angina pectoris called pericardial poudrage. Basically, it involved opening the chest, sprinkling sterile talcum powder on the heart, and closing. The idea was that the powder would invoke an inflammatory reaction that would lead to the ingrowth of new blood vessels and the revascularization of the heart muscle. “Experience” and “personal clinical observations” told surgeons it was very effective. Patient sure seemed to have less angina after the procedure.

    Then some nasty reductionist scientists did a study.

    Indeed, it was one of the very first and still one of the most famous randomized studies in surgical history. Guess what? There was no difference between patients who simply had their chests opened with no powder used and those who got the full powder treatment. The “wisdom” of all those surgeons who did that operation, which was popular for well over a decade, were wrong. Science proved it.

    This does not mean that personal clinical experience is not useful for many things, but it’s really not very good for determining whether a treatment works (with the exception of blindingly obvious “all-or-none” treatments like surgery for exsanguinating hemorrhage). “Personal clinical experience” is particularly bad at correctly distinguishing correlation and causation. At best, for correlations, personal clinical observations are useful as hypothesis generators. Those hypotheses must then be tested using the best science, clinical trials, and/or epidemiology, as appropriate. That’s been done for vaccines and autism. Once again, “personal clinical observations” and “wisdom” have failed.

    Finally, it’s a huge straw man to say that any of us don’t want parents to participate in decisions about vaccinating their children. However, you seem to want it both ways. You want to claim for parents the freedom to refuse vaccination. Fair enough. However, in doing so, you would have them shirk the responsibility that comes with refusing to vaccinate and to be free of any consequences that might result from their decision.

  55. #56 Orac
    February 4, 2009

    y the way, Dave, I still most definitely believe that vaccines, as they are now formulated and administered can trigger autism in susceptible children.

    You are, of course, entitled to your beliefs. You are not, however, entitled to your own facts or science. Be that as it may, science does not support your belief. I guess it doesn’t matter to you, as you have never really been able marshal any scientific arguments worth a cup of warm piss in favor of your “belief.”

  56. #57 Jay Gordon
    February 4, 2009

    I do not want parents or doctors to shirk the responsibility of deciding to either vaccinate or not vaccinate. Here’s some science for you all:

    http://query.nytimes.com/gst/fullpage.html?sec=health&res=9501E7DB1F30F931A15752C0A9619C8B63

  57. #58 Jay Gordon
    February 4, 2009

    I only wish to be entitled to my beliefs and not to my own science. But, again, science is often shown to be completely wrong months or years after being established as “the truth.”

    And, in response to the “anti-vaccinationists” who claim that they can prove that vaccines cause autism, I disagree. We do not have that proof yet.

    In response to the scientists who claim we’ve proven vaccines cannot cause autism, the very act of making that statement lessens your hold on the title of “scientist.”

    Jay

  58. #59 anonimouse
    February 4, 2009

    Jay (because I refuse to refer to you as a doctor):

    Of course nobody can prove conclusively that vaccines cannot cause autism. That’s asking someone to prove a negative.

    Considering the overwhelming effectiveness of vaccination as public health policy, the burden of proof is on those who claim that vaccines play a role in autism. To date, not only has that burden of proof not been met, there isn’t even enough credible evidence to suggest that it someday might be met.

    I am disgusted that a physician would be so cavalier as to suggest to parents that it’s “ok” to put their children at risk or contracting HiB or pertussis.

  59. #60 Dangerous Bacon
    February 4, 2009

    “jay gordon”: “But, again, science is often shown to be completely wrong months or years after being established as “the truth.””

    This is the classic altie argument: “Science was wrong about X, therefore you must honor my crazy-ass belief.”

    The way you overturn a tenet of science (or radically alter a highly successful public health program like mandatory immunization) is with good science, not using one’s little fund of bias-laden “experience”.

    Any knowledgeable physician is aware of this, which is why I still have trouble believing that the “jay gordon” posting here is actually Jay Gordon M.D., Pediatrician To The Stars. Could the real Dr. Jay possibly be so fallacy-prone and clueless?

  60. #61 Scott
    February 4, 2009

    What *has* been proven beyond any meaningful doubt is that the benefits of vaccines hugely – meaning by several orders of magnitude – outweigh their risks. INCLUDING any hypothetical link to autism.

    Therefore, “choice” and “freedom” arguments are grossly wrong-headed. Not vaccinating a child (in the absence of a specific medical contraindication) is ethically very similar to giving an infant a loaded pistol as a toy. (The difference is in degree only, not kind.) And nobody in their right mind would defend the latter as a legitimate choice. I must therefore conclude that anybody who DOES defend the former as legitimate is not in their right mind.

  61. #62 Orac
    February 4, 2009

    In response to the scientists who claim we’ve proven vaccines cannot cause autism, the very act of making that statement lessens your hold on the title of “scientist.”

    Once again, Dr. Jay, as you well know, science can never completely, absolutely, 100% prove a negative. All it can do is estimate probability and put error bars around that estimate. Many have studied whether there might be a link between mercury in vaccines or vaccines in general and autism. None of the large, well-designed epidemiological studies have found such an association. Given these results, we can safely conclude that neither mercury in vaccines nor vaccines themselves are major causes or contributors to the pathophysiology of autism. In fact, we can go beyond that and say that, given the data we have now, the odds that any possible association between mercury in vaccines or vaccines themselves and autism exists is so exceedingly low that it is undetectable using our best epidemiological, clinical trial, and experimental methods available. Given that, as far as science can be concerned, the chance that vaccines cause autism is about as close to zero as we can evaluate, which means, for all practical intents and purposes, when it comes to deciding health care and public policy it is zero.

    Funny you should question whether those of us who argue that this question is pretty much a dead question can claim the mantle of “scientist.” If there’s one thing about science it’s that it does change its position in the face of new evidence. If a large, well-designed study were to be done that showed a strong, plausible link between vaccines and autism, I would seriously consider changing my mind. If multiple such studies were done, such that the preponderance of evidence switched from no causation to causation, I would change my mind. You, on the other hand, have shown us time and time again that you value your own “personal clinical experience” above science and epidemiology, which means that it appears that there is no amount of scientific studies that will ever lead you to change your mind. That’s not science.

    Antivaccinationists remind me of the example of Bertrand Russell’s celestial teapot:

    http://demokat.blogspot.com/2006/11/ceslestial-teapot.html

    Quote:

    Many orthodox people speak as though it were the business of sceptics to disprove received dogmas rather than the dogmatists to prove them. This is, of course, a mistake. If I were to suggest that between Earth and Mars there is a china teapot revolving about the Sun in an elliptical orbit, nobody would be able to disprove my assertion provided I were careful to add that the teapot is too small to be revealed even by our most powerful telescopes. But if I were to go on to say that, since my assertion cannot be disproved, it is intolerable presumption on the part of human reason to doubt it, I should rightly be thought to be talking nonsense.

    Their behavior is very similar to that of the religious as described in Russell’s analogy, which is not surprising, given how much antivaccinationism has in common with religion.

  62. #63 Joseph
    February 4, 2009

    Here’s some science for you all: http://query.nytimes.com/gst/fullpage.html?sec=health&res=9501E7DB1F30F931A15752C0A9619C8B63

    Did you really just cite an article about a fake epidemic to prove a point, Dr. Jay? I don’t get it.

    In response to the scientists who claim we’ve proven vaccines cannot cause autism, the very act of making that statement lessens your hold on the title of “scientist.”

    Do you have a direct quote of a scientist who said this? I don’t believe this is common. The most they will say is “there’s no credible evidence vaccines cause autism,” which is true. A more strict wording would be “the null hypothesis cannot be rejected.”

    Similarly, it would be incorrect to say “it’s proven Reindeer can’t fly.” No such thing is proven. However, there’s no evidence Reindeer can fly.

  63. #64 Prometheus
    February 4, 2009

    So sayeth “Dr. Jay”:


    By the way, Dave, I still most definitely believe that vaccines, as they are now formulated and administered can trigger autism in susceptible children.

    That’s OK, Jay. I know of people who believe in Bigfoot and “Intelligent Design”. I even know of a few who think that most of the world’s political leaders have been replaced by reptilian aliens. Your peculiar belief is no stranger than any of those.

    “Dr. Jay” sayeth further:


    I only wish to be entitled to my beliefs and not to my own science.

    Jay, you are always “entitled” to your own beliefs. Even in the most repressive totalitarian regimes, people are “entitled” to hold their own beliefs. What you’re actually asking for is the “right” to spout nonsense without anybody calling you on it.

    Jay, please don’t confuse the US right to free speech with a non-existent “right” to not be criticized for preaching your erroneous beliefs. My critique of your “arguments” in no way infringes on your right to free speech or your “entitlement” to hold any sort of beliefs you like – even if they are silly and irresponsible.

    If you don’t want to be criticized for your beliefs, keep them to yourself. “Better to keep silent and be thought a fool than to speak and remove all doubt.”

    “Dr. Jay” endeth the lesson with:


    But, again, science is often shown to be completely wrong months or years after being established as “the truth.”

    Well, that puts us in our place, doesn’t it? After all, while “science” is often proved completely wrong, “beliefs” are never….wait a minute!

    “Dr. Jay” seems to think that his “beliefs” about autism and vaccines will never be “shown to be completely wrong” because…..well, because they’re his beliefs and he is infallible.

    Sorry, Jay, but everybody thinks that their beliefs are “right”. Your confidence in your own beliefs may be a comfort to you, but it’s not doing anything for me. How about some data to support your assertion? Without it, your “belief” that vaccines cause autism is as valid as the “belief” that extra-terrestrial aliens are infiltrating our government.

    Bottom line, Jay – “beliefs” are “often shown to be completely wrong” more often than scientific “truth” (which would be better called “facts”) for the simple reason that scientific “facts” are backed by data while “beliefs” are backed by….well, belief – the confidence of the believer that they are correct.

    Jay, you’re out of your league here. Your whining and tugging at heart strings just doesn’t work against logic and data. I certainly appreciate your willingness to put yourself through a thorough fisking every time you stop by here, but I’m concerned that you don’t seem to be learning from your mistakes.

    Your “belief” that vaccines cause autism is based on the worst possible information – personal experience. This is the same sort of information that led to bleeding being used for centuries as a cure-all. This is the sort of information that led doctors to use emetics (purging) as a treatment for most illnesses. It’s what led people to believe that communicable diseases were caused by “bad air”.

    As a society, we stepped away from reliance on “personal experience” as the sole guide to medicine over 150 years ago.

    Jay, it’s time to move into the 20th century – don’t worry about getting to the 21st century, just make it to the 20th. Step away from your “personal experience” and look at the data. You might be surprised what you can see.

    Prometheus

  64. #65 Danimal
    February 4, 2009

    Orac regarding the teapot, from link on PZ’s site:
    here is the proof.

  65. #66 khan
    February 4, 2009

    Is J G a creationist? Sounds a lot like one.

  66. #67 DT35
    February 4, 2009

    Orac, did you ever get any response from Ms. Fowler or Mr. Atkinson?

  67. #68 Dawn
    February 12, 2009

    Liz Ditz stated: “Twenty-six days ago, a dearly-beloved friend lost his four-year battle with metastatic colon cancer. He had a number of oncologists (cancer “specialists”, in Dawn’s world) who bent all their training and efforts to defeat his disease.

    In the end, all their training and expertise bought time.

    Dawn, without the efforts of these men and women, my beloved friend would have died in 2005. He would not have seen his daughter graduate from high school. He would not have seen his older son get his life back on track, or met his older son’s fiancee, or get to experience his older son as a father.

    He would have not seen his younger son get married. He would not have seen his younger son as a father, or had the pleasure of playing with his grandson.

    Dawn, after my friend’s death, one of the most recent of my friend’s oncologists called each of my friend’s adult children to express his condolences and regret that the treatment he offered was ineffective against my friend’s disease. It meant a lot to the children, to hear from one of their father’s physicians.

    Dawn, your comments reveal an irrational anger. Once again, I urge you to seek help, for the sake of your children. Find a pastor or counselor, if you don’t trust psychologists”.

    Well, Liz, I guess that it sucks to be you and your friends. I have had the pleasure of meeting several people who survived their cancer ordeal – my Dad included (20 years now cancer free!) cancer free without the aid of your pathetic, greedy, ambitious, loser, oncologists. Yes, cancer is curable and the answer doesn’t lie with the western medicine quacks!

  68. #69 eric
    February 22, 2009

    Remember 50 years ago when doctors were all over telling us how smoking was actually good for our health?

    Go ahead and believe the government.

    Go ahead and believe a committee headed by Dr Paul Offit.

    “It’s a great day for science and I’d like to think it’s also a great day for children with autism,” said Dr. Paul Offit, chief of infectious diseases at Children’s Hospital of Philadelphia and co-inventor of the rotavirus vaccine (a standard childhood immunization that does not contain thimerosal).

    The latest estimate is that Dr. Offit’s share of the Rotateq revenues is $29,000,000 to $55,000,000. I think he has a conflict of interest here.

    Selectively and slowly vaccinating our kids is the safest course of action.

    That’s not ‘anti-vac’, it’s common sense. When I was a kid I got 7 vaccinations.

    Now there are 29.

    Who is making a profit? Who is controlling the media and studies? Look for the money trail, then make your own decisions.

  69. #70 Chris
    February 22, 2009

    eric said “Remember 50 years ago when doctors were all over telling us how smoking was actually good for our health?”

    That was not true. That was just in advertisements by the tobacco company.

    And just about everything else in what you wrote is just about as truthful. You are really a clueless git.

  70. #71 Jennifer Gupta
    April 23, 2009

    What I don’t understand is when parents are choosing to make educated choices by researching different options and choosing what is best for their child, they are ridiculed. What the hell is wrong with you people? Food for thought – a few years ago, Japan stopped vaccinating children under the age of 2. Their SIDS rate went down to almost 0%. Hmmm….

    The AAP is in bed with the vaccination companies. It is disgusting and is causing harm to our children. The pharmaceutical companies knew years ago that the levels of mercury were too high and they chose to ignore it. THere was a memo found from years ago that the MERCK pharmaceutical company continued to ignore from one of it’s scientists. That is simply disgusting. Just to let you know, my daughter has received some vaccinations so I am not one of “those” parents but it is an issue that we cannot blindly trust someone else to take care of our children. My husband is also a physician, so we are not “uneducated idiots” as people like you tend to claim. Then again, our culture is so pathetic when it comes to child rearing, I don’t know why I would expect any of you to take time to really research the issue.

  71. #72 Joseph C.
    April 23, 2009

    Food for thought – a few years ago, Japan stopped vaccinating children under the age of 2. Their SIDS rate went down to almost 0%.

    What’s next? The Amish canard?

  72. #73 Scott
    April 23, 2009

    What I don’t understand is when parents are choosing to make educated choices by researching different options and choosing what is best for their child, they are ridiculed.

    It’s because their research is wrong and their “educated choice” is worst for their child. Choosing not to vaccinate is really not much different, conceptually, from calling an exorcist instead of an ambulance for a child with a fever of 105 and uncontrollable vomiting.

  73. #74 HCN
    April 23, 2009

    Jennifer Gupta repeating the lie “Japan stopped vaccinating children under the age of 2. Their SIDS rate went down to almost 0%. Hmmm….”

    That is because the babies started to die from pertussis, and since they had not been vaccinated with the DPT, it could not be blamed. From http://www.ncbi.nlm.nih.gov/pubmed/15889991? … “After two infants died within 24 h of the vaccination from 1974 to 1975, the Japanese government temporarily suspended vaccinations. Subsequently, the public and the government witnessed the re-emergence of whooping cough, with 41 deaths in 1979. This series of unfortunate events revealed to the public that the vaccine had, in fact, been beneficial.”

    By most standards of mathematics, 41 is more than 2. Also it shows how crappy your “research” is.

    You’ll be happy to know that Japan now does mandate vaccines for babies:
    http://idsc.nih.go.jp/yosoku/vacpdf/EN_05-1.pdf

  74. #75 Joseph
    April 23, 2009

    The pharmaceutical companies knew years ago that the levels of mercury were too high and they chose to ignore it. THere was a memo found from years ago that the MERCK pharmaceutical company continued to ignore from one of it’s scientists. That is simply disgusting.

    Whenever you see claims like this from anti-vaxers, I’ve learned that it’s a good idea to check the original source, analyze the original data, etc. Media reports are no good.

    I found a copy of the Merck memo: It’s here.

    This is how the memo begins:

    The regulatory control agencies in some countries, particularly Scandinavia (especially Sweden), but also UK, Japan and Switzerland, have expressed concern for thimerosal, a mercurial preservative, in vaccines.

    So it’s not like Merck secretly knew about thimerosal and wasn’t telling anyone. The potential issue of thimerosal was generally known throughout the world, but perhaps not well known and widely discussed. That took time.

    The memo also explains that while the FDA did not have this concern at the time, it permitted exclusion of thimerosal from single-dose vials if requested and qualified.

    I’d recommend reading the whole memo to those who are interested in the history of the debate. It’s basically a recommendation from a scientist who noticed there was not a lot of science at the time that would rule out hazardous effects from low doses of mercury. He basically recommends removing thimerosal from single-dose vials, based “more on perception than on any data.”

    He also makes some mistakes in his estimates. For example, he compares the cumulative exposure to thimerosal in the first 6 months of life to the daily allowance of mercury in Sweden. This is clearly not a valid comparison.

The site is currently under maintenance and will be back shortly. New comments have been disabled during this time, please check back soon.