Respectful Insolence

Paying the price of vaccine refusal

I’ve warned time and time again what the price will be if the Jenny McCarthy and her fellow arrogantly ignorant band of vaccine “skeptics” continue to get more and more traction. So have many others. It is true that, for the moment, vaccination rates overall remain high in the U.S., but there are numerous troubling signs that the propaganda being spread by Generation Rescue and the anti-vaccine movement is having an effect, with outbreaks of vaccine-preventble diseases popping up in areas with high levels of “philosophical” exemptions. In such areas, vaccination rates can easily fall well below the levels needed for herd immunity. However, fortunately, we have thus far avoided widespread outbreaks. I fear our luck will not hold out much longer. If you want to see what may be in our future, all you have to do is to look to the U.K., which is several years ahead of us on the road to a vaccine-free society where once vanquished diseases are endemic again.

Minnesota, unfortunately, has gotten a taste of what I fear to be the future. This story, published in City Pages, shows just where the anti-vaccine movement is leading us. It tells the story of Julieanna Metcalf, who contracted a disease that she would likely not have contracted were it not for the dimunition of herd immunity resulting from an unholy confluence of the anti-vaccine movement and a shortage of a vaccine. Here is what happened after a couple of days of what at first seemed to be a common viral illness of childhood:

Early the next morning, Flint awoke with a start: Julieanna was screaming–a shrill, sharp wail. Flint held Julie close, and the baby relaxed and dropped immediately to sleep. Flint shifted the little girl away from her body, and Julieanna awoke and screamed again. Flint pulled her close and the baby instantly fell back to sleep. Flint held Julieanna for hours. When the baby’s temperature soared to 104 degrees, Flint called the doctor and made an appointment.

She put Julieanna in a bath to cool her. The little girl slumped against the back of the tub, as if she’d forgotten how to sit up on her own. Flint ran cold water over Julie’s hair. The little girl held her head ramrod straight and her neck stiff. Her blue eyes veered left to meet Flint’s, and the mother read an expression of terror in her baby’s eyes. Flint pulled her daughter out of the tub, toweled her off, and rushed to the emergency room at Ridgeview Medical Center in Waconia.

The doctors admitted Julieanna for severe dehydration. They administered an IV, gave her a battery of tests to rule out pneumonia and bacterial infections, and kept her overnight. The physicians prodded and poked, but Julieanna hardly whimpered.

Flint stayed up all night, lying beside her baby on the hospital bed.

When Dr. Wuerger checked in the next morning, she knew that something was terribly wrong–she had never seen Julieanna so groggy and unresponsive. Wuerger called for a spinal tap.

The E.R. doc pierced Julieanna’s spine with a long needle. The baby was so out of it that she could barely muster a soft moan in response. Flint had never seen her little girl so lethargic, and the sight of it scared her. She cried as the doctor withdrew the spinal fluid: a thick, yellow smear of pus.

“Brendalee, it doesn’t look good,” he said. “It’s supposed to come out clear.”

If there’s one thing I know about pediatrics (or medicine) it’s that pus in the cerebrospinal fluid is a very, very bad thing. In fact, it’s a horrible thing that can easily kill. What Julieanna had was Haemophilus influenza type B–Hib. Hib was the scourge of the pediatrics wards a mere 20 years ago. Indeed, one of the most disturbing memories I have from my pediatrics rotation in medical school during the mid-1980s was a baby in the pediatric intensive care unit deathly ill with Hib. To this day, I don’t know if the girl lived or died. All I know is that she was still alive when I left the rotation to move on and that she had been on a ventilator and constantly kept threatening to die during the week or so I was part of the team taking care of her. I remember her parents, one of whom was always by her bed.

Hib is one of the greatest success stories in the history of vaccination and a very recent one. As pediatrician Dr. John Snyder informs us, as recently as 1987, Hib caused invasive disease in 1 in 200 children under the age of 5. Of these, one half to two-thirds developed meningitis like Julieanna, with a mortality rate of 5% and rate of permanent brain damage of 30%. It is a nasty, nasty bug, and a vaccine against it only went into widespread use in the late 1980s/early 1990s. Now, thanks to the Hib vaccine, there have been generations of pediatricians who have never seen a case of Hib meningitis. Indeed, if your pediatrician trained after 1991, it’s quite possible that he’s never seen a case. By 2006, the incidence of Hib has been cut by 99%. As Dr. Snyder put it, “within a short period of time, the very nature of pediatric medicine seemed changed forever.”

Thanks to the anti-vaccine movement, the nature of pediatrics may soon be changing back to the bad old days, and, for the moment, the epicenter appears to be Minnesota. Indeed, this article gives a good overview of the history of the recent anti-vaccine movement. It’s not without its stumbles. For instance, the reporter mistakenly repeats the mercury militia talking point that the symptoms of autism are uncannily similar to the symptoms of autism (they aren’t), but overall the article is a stronger effort than the usual “tell both sides” rule of journalism allows. Most importantly, it puts a human face on the cost of not vaccinating against deadly diseases like Hib.

There was a confounding factor in the form of a vaccine shortage that made it unclear whether decreasing rates of Hib vaccination were due to vaccine refusers or the vaccine shortage or both. As a result of a contamination problem at Merck, its Hib vaccine had had to be pulled from the shelves in early 2008. The CDC and AAP altered vaccination recommendation to keep infants as protected as possible by recommending skipping the booster at 12-15 months. Minnesota health officials investigated:

To solve the mystery, Bahta and her colleagues at the state health department investigated each of the Minnesota cases, searching for a common link. Did the families know one another, and had the children contracted the disease from each other? Or did they know someone in common who carried the disease and spread it from one child to the next? No, Bahta and her team found out, the five families lived miles apart in different counties, had never met, and knew no one in common. So were more children carrying Hib this year? No, the health department swabbed the throats of 1,600 kids and found no difference.

In fact, the only places in the country where Hib had gone up were Minnesota and Pennsylvania, where six children got sick and three died. The national rate hadn’t changed a bit.

Still, the CDC took the Hib cases as an opportunity to push vaccines. “The increase highlights the need to ensure that all children complete the primary Hib immunization series,” one CDC statement read.

In recent years, outbreaks of infectious diseases once thought to be eradicated in the West have popped up in several unvaccinated communities in Minnesota. In 1996, several children belonging to Christ’s Household of Faith in St. Paul got the measles. In 2005, a polio outbreak hit an unvaccinated Amish community in central Minnesota.

As I’ve written about before, in the most recent outbreak in Minnesota most of the victims were completely unvaccinated. Julieanna was the exception:

The worst was over, and slowly, Julieanna began to recover. As a result of the illness, she’d forgotten everything she’d ever learned: how to swallow, crawl, walk, and talk. Her days filled up with therapy appointments. The doctors did more tests and discovered that she had hypogammaglobulinemia, a rare immune deficiency disorder. Julieanna’s body lacked four antibodies needed to fight infectious diseases, the immunologist explained. Even though she’d been vaccinated, the immune deficiency made her vulnerable to contracting Hib. Julieanna was likely to face recurrent infections for the rest of her life.

In other words, Julieanna was one of the children who relies on herd immunity because she has an immune deficiency that kept the vaccine from being effective in her. Although it can’t be proven for sure that the antivaccine movement is directly responsible for Julieanna’s illness, there’s no doubt that the ongoing erosion of herd immunity in pockets of vaccine resistance will, if not checked, result in more Julieanna’s, some of whom my suffer even worse than severe illness and brain damage. There will be more pus on the brain in children. Or so I (and many others) fear.

For example, Dr. Paul Offit puts it in a chilling way:

“All you have to do is drop your guard a little bit, and these diseases come back,” says Paul Offit, chief of Infectious Diseases and director of the Vaccine Education Center at Children’s Hospital of Philadelphia. A prominent vaccine advocate and co-inventor and patent-holder of the rotavirus vaccine, Offit is disturbed by the trend of refusing vaccines. “I used to say this will change when children start to die. Now I’m starting to say, this will change when enough children die.”

He’s probably right. My only question is: How much will be “enough”? I fear that in the next few years, as people like Jenny McCarthy, enabled by Oprah Winfrey and aided by anti-vaccine apologist pediatricians like Dr. Bob Sears and Dr. Jay Gordon, and the rest of the anti-vaccine movement spread misinformation, we will soon find out.

Comments

  1. #1 Darjeeling
    June 4, 2009

    Orac, there’s a typo halfway down in the paragraph beginning “Thanks to the anti-vaccine movement…”: the symptoms of autism are uncannily similar to the symptoms of autism

  2. #2 Bryan
    June 4, 2009

    The sad part is that once parents get their heads back on straight (yes, I am an optimist) its doubtful that the people responsible for the anti-vax hoax will be held accountable for the thousands of injured and dead they’ll leave in their wake.

  3. #3 LovleAnjel
    June 4, 2009

    “its doubtful that the people responsible for the anti-vax hoax will be held accountable for the thousands of injured and dead they’ll leave in their wake.”

    Yes, because, you know, they MEANT well. Apparently people keep forgetting what makes up the road to hell.

  4. #4 carykoh
    June 4, 2009

    As a fairly young ED doc, I can tell you, H.Flu was the bane of our existence when I was training. Not only is it a particularly nasty cause of meningitis, leaving the survivors deaf or disabled in some fashion, but epiglottitis and periorbital cellulitis were common place and none too pretty prior to the vaccination. I particularly dreaded epiglottitis. Fortunately, I bet I haven’t seen a case of pediatric H.Flu in 10 years, not one. This is one disease that people can still probably remember, and once invasive, is never benign. Let’s see the anti-vax crowd defend that one.

  5. #5 JD
    June 4, 2009

    Maybe they can extend the philosophy of Autism One to the feline community so that every family with a cat can enjoy the benefits of a coronavirus.

  6. #6 CD
    June 4, 2009

    It’s terrible to see these diseases coming back. I’m a lawyer and have recently been thinking about potential liability of anti-vaxxers, especially celebrities like Jenny McCarthy (and Oprah, who gives her a platform). I wouldn’t be surprised to see lawsuits start emerging against people who encourage others not to vaccinate their children. It would probably take a very particular kind of case (known infection source and parent who admitted to not vaccinating because she heard not to from X celebrity), but I don’t think it’s outside the realm of possibility. Perhaps that will make some folks think twice before spouting non-sense.

    I wrote a blog post about it yesterday as a matter of fact. It’s mostly just questions, but I haven’t seen a legal angle like this yet, so perhaps it’s important to begin thinking about it.

  7. #7 Lobster
    June 4, 2009

    We live in a blessed time, where people have the luxury of doing extremely dangerous things, where people can engage in magical thinking, and most of the time they do not suffer any consequences for it.

    Most of the time.

  8. #8 Jay Gordon, MD, FAAP
    June 4, 2009

    A terrible case, incredibly poor medical care and more cherry picking by you, Orac.

    Incredibly rare diseases occur even in the presence of excellent herd immunity. This child’s case is being exploited by feeble journalists and others. I would expect better from you.

    Jay

  9. #9 Pat
    June 4, 2009

    The people responsible are the people who made the decision not to have their children vaccinated. There are always people around promoting this or that course of action for good health. Sometimes they are doctors and sometimes they are wrong. We are all responsible for our own health decisions and parents are responsible for those decisions which apply to their children. No one forced them to forego vaccinations.

  10. #10 Matt Penfold
    June 4, 2009

    Here in Wales we are facing an increasing incidence of measles. So far in the part of Wales I live we had over 120 cases in the last month, with over 25 hospitalisations. Public health officials are on record that in every single hospitalisation the child had not had a vaccine, or had only the first vaccine. Thankfully the media is being fairly responsible and giving airtime to doctors making the case for vaccination whilst pretty much ignoring spokespersons from anti-vax organisations. There also reports that MMR uptake in rising, and parents who previously refused to have their kids vaccinated are changing the minds when they see kids in the same school in hospital.

    Like CD, I have wondered about the possibility of legal action against anti-vaxxers, but in regards the NHS recovering the costs of treating diseases that were very uncommon a few years ago. Wales went 10 years without a single reported case of measles.

  11. #11 Jay Gordon, MD, FAAP
    June 4, 2009

    By the way, the HIB vaccine was a great creation and it did change pediatric care. When I first began practicing, I used to see HIB meningitis every year and now I haven’t seen it for over 25 years.

    Take anti-malarial medicine every day in high risk areas but not every day in low risk areas. Unequivocally recommend vaccinations when risk is high but consider possible side effects of vaccines and all other medical interventions when risk is low. Consider public health and an individual child’s health.

    There is not just one correct answer nor one correct interpretation of the science involved.

    Best,

    Jay

  12. #12 carykoh
    June 4, 2009

    I think Orac made it pretty clear this was just a case that illustrates what will happen if herd immunity wanes. I can tell you, without reservation, that if immunity wanes, this will in fact become common place. As a pediatrician, I’m sure you recall many cases of epiglottitis, periorbital cellulitis, H.Flu meningitis, all gone now since the introduction of the vaccine. Dr. Jay, would you prefer to go back to that? I also think the post is making the point that not immunizing not only affects ‘your child’ but many others, esp those immunosuppressed, an increasing segment of our society. If you have some proof that H.Flu incidence has not been affected by immunization, or that it is a benign disease, I would appreciate the proof of that.

  13. #13 Dave
    June 4, 2009

    And, as a non-medical-professional person, could someone explain to me why this particular case demonstrates “incredibly poor medical care”? What should have been done? Did someone commit malpractice here?

  14. #14 Tyro
    June 4, 2009

    The tragic irony of anti-vax and other crazy woo is that most of the people who don’t immunize their children won’t see the consequences. These diseases are rare so for 99 our of 100 families who don’t immunize, their children will come out fine which will “prove” to them that they were right.

    We both know that anecdotes aren’t proof that anyone’s right or wrong but I’m glad you’re sharing them anyway. We need the intellectual appreciation of the problem but the personal, emotional touch is important too. Keep on putting a human face to the problem that Jenny & Oprah are causing!

  15. #15 Danimal
    June 4, 2009

    Dr. Jay Gordon “A terrible case, incredibly poor medical care and more cherry picking by you, Orac.”
    I not sure what you mean here. My understanding of cherry picking from wikipedia:
    “Cherry picking is the act of pointing at individual cases or data that seem to confirm a particular position, while ignoring a significant portion of related cases or data that may contradict that position.”
    So what is you (Dr. Gordon) think that Orac is ignoring, that contradicts his position?

  16. #16 FreeSpeaker
    June 4, 2009

    CD: I believe that several years back, a financial advising radio talk show host was successfully sued for advice that he gave to people. Perhaps this might be an avenue for you to explore.

  17. #17 techskeptic
    June 4, 2009

    Jeez, Dr. Jay. I watched you say specifically “There is no evidence that vaccines cause Autism”. I thought “good for you!”. Then shortly on that show (I think it was The Doctors), you said something to the effect of “But I plead with you [the parents of multiple autistic children] to delay the vaccination of you next child”.

    She responded “we did that with the last one”. No response from you, of course.

    Now here you are with this completely ridiculous sentence:

    “Incredibly rare diseases occur even in the presence of excellent herd immunity.”

    That article was about HiB. Did you even bother to ask yourself whyHiB is rare? The point of the post was that HiB is a horrible disease and is rare now. Your efforts and that idiot client of yours are currently making this a thing of the present, instead of a thing of the past. Thanks buddy, I’ll be sure to give you a ring next time there is a pertussis outbreak around here like we just experienced.

    What exactly was horrible about the medical care this child got? What would the esteemed Dr. Jay Gordon have done differently?

    Its not the vaccines Dr. Gordon. You are causing harm. I have no idea how you live with yourself.

  18. #18 techskeptic
    June 4, 2009

    “There is not just one correct answer nor one correct interpretation of the science involved.”

    “Incredibly rare diseases occur even in the presence of excellent herd immunity.”

    I just realized what you gift is Dr. Jay. You can say technically correct things but then use them in the most bizarre ways to come to wrong and harmful conclusions.

    Good for you.

  19. #19 Pieter B
    June 4, 2009

    I thought the CityPages article was very well done, with just the exception you noted and one that brought me up short, a reference to “thimerosal-based vaccines.” It had balance, but not what a journalist friend calls “false fairness.”

  20. #20 Sunlight is the best antiseptic
    June 4, 2009

    Jay,
    Quick! Close the door the horse got out!!

    It seems the only way to get a low risk environment is for people to get vaccinated, nice logic. Exactly how does your strategy affect the immunosuppressed? Natural selection will out I suppose.

  21. #21 spudbeach
    June 4, 2009

    “Dr.” Jay Gordon:

    This child’s case is being exploited by feeble journalists and others.

    DIAF.

    The only reason this is even notable at all is because now it’s rare. My ex graduated FP residency in 1993. During residency, there was about one spinal tap for suspected meningitis per week. Since graduating, she hasn’t done a single one. The only difference from 1992 to 1995 was the HiB vaccine.

    Nothing in medicine is perfect. Hell, there is a risk to every single doctor visit — the car ride there! If you insist on absolute absence of risk, then absolutely nothing will be done, and we’ll be back to a life expectancy of 40 years at birth. Pig headed people like you who insist on perfection before intervention are part of the problem, not the solution.

  22. #22 Lynsey
    June 4, 2009

    Dr Jay Gordon, as a lay person from a certain demograph of the UK I’m culturally predisposed to be suspicious of what I see as possible self-promotion and therefore am unable to feel safe in my ability to evaluate the evidence you give here. I will continue to read Orac’s opinions as they lack punditry and are expressed with caution. I hope your site gets the traffic you want it to and you reach whatever audience you think you are here to speak to.

    Have a good day.

  23. #23 Vascular Technologist (i get lots of quack questions because I'm not the doctor)
    June 4, 2009

    Dr. Jay says, “By the way, the HIB vaccine was a great creation and it did change pediatric care. When I first began practicing, I used to see HIB meningitis every year and now I haven’t seen it for over 25 years.” What a weasel is Dr. Jay.

    HiB is one of the vaccines foremost in the gunsights of the anti-vax madpeople. Techskeptic and others have already pointed out the ridiculous logical fallacy in Dr. Gordon’s crude cost-benefit arguments about rare diseases, because he (dis)misses the key point that HiB vaccination has been so successful as to make HiB meningitis such a rare disease today.

    His friends at AofA and HuffPost are delighted with his sophist arguments about HiB, though they wish he would be more denunciatory of Dr. Paul Offit’s supposed lack of ethics. But, then there’s that little matter of JG’s lack of integrity in attacking Dr. Rahul Parikh’ medical ethics. Apparently that requires a little defensive work, http://www.ageofautism.com/2009/04/pediatrician-violates-hipaa-in-effort-to-bully-parents-into-vaccination-compliance.html

    Perhaps the webmaster or Orac should confirm that this is the real Dr. Jay and not some impostor. It could be that other Dr. J … the one who could dribble and dunk.

  24. #24 Vascular Technologist (i get lots of quack questions because I'm not the doctor)
    June 4, 2009

    Dr. Jay says, “By the way, the HIB vaccine was a great creation and it did change pediatric care. When I first began practicing, I used to see HIB meningitis every year and now I haven’t seen it for over 25 years.” What a weasel is Dr. Jay.

    HiB is one of the vaccines foremost in the gunsights of the anti-vax madpeople. Techskeptic and others have already pointed out the ridiculous logical fallacy in Dr. Gordon’s crude cost-benefit arguments about rare diseases, because he (dis)misses the key point that HiB vaccination has been so successful as to make HiB meningitis such a rare disease today.

    His friends at AofA and HuffPost are delighted with his sophist arguments about HiB, though they wish he would be more denunciatory of Dr. Paul Offit’s supposed lack of ethics. But, then there’s that little matter of JG’s lack of integrity in attacking Dr. Rahul Parikh’ medical ethics. Apparently that requires a little defensive work, http://www.ageofautism.com/2009/04/pediatrician-violates-hipaa-in-effort-to-bully-parents-into-vaccination-compliance.html

    Perhaps the webmaster or Orac should confirm that this is the real Dr. Jay and not some impostor. It could be that other Dr. J … the one who could dribble and dunk.

  25. #25 Vascular Technologist (i get lots of quack questions because I'm not the doctor)
    June 4, 2009

    Dr. Jay says, “By the way, the HIB vaccine was a great creation and it did change pediatric care. When I first began practicing, I used to see HIB meningitis every year and now I haven’t seen it for over 25 years.” What a weasel is Dr. Jay.

    HiB is one of the vaccines foremost in the gunsights of the anti-vax madpeople. Techskeptic and others have already pointed out the ridiculous logical fallacy in Dr. Gordon’s crude cost-benefit arguments about rare diseases, because he (dis)misses the key point that HiB vaccination has been so successful as to make HiB meningitis such a rare disease today.

    His friends at AofA and HuffPost are delighted with his sophist arguments about HiB, though they wish he would be more denunciatory of Dr. Paul Offit’s supposed lack of ethics. But, then there’s that little matter of JG’s lack of integrity in attacking Dr. Rahul Parikh’ medical ethics. Apparently that requires a little defensive work, http://www.ageofautism.com/2009/04/pediatrician-violates-hipaa-in-effort-to-bully-parents-into-vaccination-compliance.html

    Perhaps the webmaster or Orac should confirm that this is the real Dr. Jay and not some impostor. It could be that other Dr. J … the one who could dribble and dunk.

  26. #26 Vascular Technologist (i get lots of quack questions because I'm not the doctor)
    June 4, 2009

    Dr. Jay says, “By the way, the HIB vaccine was a great creation and it did change pediatric care. When I first began practicing, I used to see HIB meningitis every year and now I haven’t seen it for over 25 years.” What a weasel is Dr. Jay.

    HiB is one of the vaccines foremost in the gunsights of the anti-vax madpeople. Techskeptic and others have already pointed out the ridiculous logical fallacy in Dr. Gordon’s crude cost-benefit arguments about rare diseases, because he (dis)misses the key point that HiB vaccination has been so successful as to make HiB meningitis such a rare disease today.

    His friends at AofA and HuffPost are delighted with his sophist arguments about HiB, though they wish he would be more denunciatory of Dr. Paul Offit’s supposed lack of ethics. But, then there’s that little matter of JG’s lack of integrity in attacking Dr. Rahul Parikh’ medical ethics. Apparently that requires a little defensive work, http://www.ageofautism.com/2009/04/pediatrician-violates-hipaa-in-effort-to-bully-parents-into-vaccination-compliance.html

    Perhaps the webmaster or Orac should confirm that this is the real Dr. Jay and not some impostor. It could be that other Dr. J … the one who could dribble and dunk.

  27. #27 Vascular Technologist (i get lots of quack questions because I'm not the doctor)
    June 4, 2009

    Dr. Jay says, “By the way, the HIB vaccine was a great creation and it did change pediatric care. When I first began practicing, I used to see HIB meningitis every year and now I haven’t seen it for over 25 years.” What a weasel is Dr. Jay.

    HiB is one of the vaccines foremost in the gunsights of the anti-vax madpeople. Techskeptic and others have already pointed out the ridiculous logical fallacy in Dr. Gordon’s crude cost-benefit arguments about rare diseases, because he (dis)misses the key point that HiB vaccination has been so successful as to make HiB meningitis such a rare disease today.

    His friends at AofA and HuffPost are delighted with his sophist arguments about HiB, though they wish he would be more denunciatory of Dr. Paul Offit’s supposed lack of ethics. But, then there’s that little matter of JG’s lack of integrity in attacking Dr. Rahul Parikh’ medical ethics. Apparently that requires a little defensive work, http://www.ageofautism.com/2009/04/pediatrician-violates-hipaa-in-effort-to-bully-parents-into-vaccination-compliance.html

    Perhaps the webmaster or Orac should confirm that this is the real Dr. Jay and not some impostor. It could be that other Dr. J … the one who could dribble and dunk.

  28. #28 Vascular Technologist (i get lots of quack questions because I'm not the doctor)
    June 4, 2009

    Dr. Jay says, “By the way, the HIB vaccine was a great creation and it did change pediatric care. When I first began practicing, I used to see HIB meningitis every year and now I haven’t seen it for over 25 years.” What a weasel is Dr. Jay.

    HiB is one of the vaccines foremost in the gunsights of the anti-vax madpeople. Techskeptic and others have already pointed out the ridiculous logical fallacy in Dr. Gordon’s crude cost-benefit arguments about rare diseases, because he (dis)misses the key point that HiB vaccination has been so successful as to make HiB meningitis such a rare disease today.

    His friends at AofA and HuffPost are delighted with his sophist arguments about HiB, though they wish he would be more denunciatory of Dr. Paul Offit’s supposed lack of ethics. But, then there’s that little matter of JG’s lack of integrity in attacking Dr. Rahul Parikh’ medical ethics. Apparently that requires a little defensive work, http://www.ageofautism.com/2009/04/pediatrician-violates-hipaa-in-effort-to-bully-parents-into-vaccination-compliance.html

    Perhaps the webmaster or Orac should confirm that this is the real Dr. Jay and not some impostor. It could be that other Dr. J … the one who could dribble and dunk.

  29. #29 Vascular Technologist (i get lots of quack questions because I'm not the doctor)
    June 4, 2009

    Dr. Jay says, “By the way, the HIB vaccine was a great creation and it did change pediatric care. When I first began practicing, I used to see HIB meningitis every year and now I haven’t seen it for over 25 years.” What a weasel is Dr. Jay.

    HiB is one of the vaccines foremost in the gunsights of the anti-vax madpeople. Techskeptic and others have already pointed out the ridiculous logical fallacy in Dr. Gordon’s crude cost-benefit arguments about rare diseases, because he (dis)misses the key point that HiB vaccination has been so successful as to make HiB meningitis such a rare disease today.

    His friends at AofA and HuffPost are delighted with his sophist arguments about HiB, though they wish he would be more denunciatory of Dr. Paul Offit’s supposed lack of ethics. But, then there’s that little matter of JG’s lack of integrity in attacking Dr. Rahul Parikh’ medical ethics. Apparently that requires a little defensive work, http://www.ageofautism.com/2009/04/pediatrician-violates-hipaa-in-effort-to-bully-parents-into-vaccination-compliance.html

    Perhaps the webmaster or Orac should confirm that this is the real Dr. Jay and not some impostor. It could be that other Dr. J … the one who could dribble and dunk.

  30. #30 Vascular Technologist (i get lots of quack questions because I'm not the doctor)
    June 4, 2009

    Dr. Jay says, “By the way, the HIB vaccine was a great creation and it did change pediatric care. When I first began practicing, I used to see HIB meningitis every year and now I haven’t seen it for over 25 years.” What a weasel is Dr. Jay.

    HiB is one of the vaccines foremost in the gunsights of the anti-vax madpeople. Techskeptic and others have already pointed out the ridiculous logical fallacy in Dr. Gordon’s crude cost-benefit arguments about rare diseases, because he (dis)misses the key point that HiB vaccination has been so successful as to make HiB meningitis such a rare disease today.

    His friends at AofA and HuffPost are delighted with his sophist arguments about HiB, though they wish he would be more denunciatory of Dr. Paul Offit’s supposed lack of ethics. But, then there’s that little matter of JG’s lack of integrity in attacking Dr. Rahul Parikh’ medical ethics. Apparently that requires a little defensive work, http://www.ageofautism.com/2009/04/pediatrician-violates-hipaa-in-effort-to-bully-parents-into-vaccination-compliance.html

    Perhaps the webmaster or Orac should confirm that this is the real Dr. Jay and not some impostor. It could be that other Dr. J … the one who could dribble and dunk.

  31. #31 Vascular Technologist (i get lots of quack questions because I'm not the doctor)
    June 4, 2009

    Dr. Jay says, “By the way, the HIB vaccine was a great creation and it did change pediatric care. When I first began practicing, I used to see HIB meningitis every year and now I haven’t seen it for over 25 years.” What a weasel is Dr. Jay.

    HiB is one of the vaccines foremost in the gunsights of the anti-vax madpeople. Techskeptic and others have already pointed out the ridiculous logical fallacy in Dr. Gordon’s crude cost-benefit arguments about rare diseases, because he (dis)misses the key point that HiB vaccination has been so successful as to make HiB meningitis such a rare disease today.

    His friends at AofA and HuffPost are delighted with his sophist arguments about HiB, though they wish he would be more denunciatory of Dr. Paul Offit’s supposed lack of ethics. But, then there’s that little matter of JG’s lack of integrity in attacking Dr. Rahul Parikh’ medical ethics. Apparently that requires a little defensive work, http://www.ageofautism.com/2009/04/pediatrician-violates-hipaa-in-effort-to-bully-parents-into-vaccination-compliance.html

    Perhaps the webmaster or Orac should confirm that this is the real Dr. Jay and not some impostor. It could be that other Dr. J … the one who could dribble and dunk.

  32. #32 Vascular Technologist (i get lots of quack questions because I'm not the doctor)
    June 4, 2009

    Dr. Jay says, “By the way, the HIB vaccine was a great creation and it did change pediatric care. When I first began practicing, I used to see HIB meningitis every year and now I haven’t seen it for over 25 years.” What a weasel is Dr. Jay.

    HiB is one of the vaccines foremost in the gunsights of the anti-vax madpeople. Techskeptic and others have already pointed out the ridiculous logical fallacy in Dr. Gordon’s crude cost-benefit arguments about rare diseases, because he (dis)misses the key point that HiB vaccination has been so successful as to make HiB meningitis such a rare disease today.

    His friends at AofA and HuffPost are delighted with his sophist arguments about HiB, though they wish he would be more denunciatory of Dr. Paul Offit’s supposed lack of ethics. But, then there’s that little matter of JG’s lack of integrity in attacking Dr. Rahul Parikh’ medical ethics. Apparently that requires a little defensive work, http://www.ageofautism.com/2009/04/pediatrician-violates-hipaa-in-effort-to-bully-parents-into-vaccination-compliance.html

    Perhaps the webmaster or Orac should confirm that this is the real Dr. Jay and not some impostor. It could be that other Dr. J … the one who could dribble and dunk.

  33. #33 Vascular Technologist (i get lots of quack questions because I'm not the doctor)
    June 4, 2009

    Dr. Jay says, “By the way, the HIB vaccine was a great creation and it did change pediatric care. When I first began practicing, I used to see HIB meningitis every year and now I haven’t seen it for over 25 years.” What a weasel is Dr. Jay.

    HiB is one of the vaccines foremost in the gunsights of the anti-vax madpeople. Techskeptic and others have already pointed out the ridiculous logical fallacy in Dr. Gordon’s crude cost-benefit arguments about rare diseases, because he (dis)misses the key point that HiB vaccination has been so successful as to make HiB meningitis such a rare disease today.

    His friends at AofA and HuffPost are delighted with his sophist arguments about HiB, though they wish he would be more denunciatory of Dr. Paul Offit’s supposed lack of ethics. But, then there’s that little matter of JG’s lack of integrity in attacking Dr. Rahul Parikh’ medical ethics. Apparently that requires a little defensive work, http://www.ageofautism.com/2009/04/pediatrician-violates-hipaa-in-effort-to-bully-parents-into-vaccination-compliance.html

    Perhaps the webmaster or Orac should confirm that this is the real Dr. Jay and not some impostor. It could be that other Dr. J … the one who could dribble and dunk.

  34. #34 Vascular Technologist (i get lots of quack questions because I'm not the doctor)
    June 4, 2009

    Dr. Jay says, “By the way, the HIB vaccine was a great creation and it did change pediatric care. When I first began practicing, I used to see HIB meningitis every year and now I haven’t seen it for over 25 years.” What a weasel is Dr. Jay.

    HiB is one of the vaccines foremost in the gunsights of the anti-vax madpeople. Techskeptic and others have already pointed out the ridiculous logical fallacy in Dr. Gordon’s crude cost-benefit arguments about rare diseases, because he (dis)misses the key point that HiB vaccination has been so successful as to make HiB meningitis such a rare disease today.

    His friends at AofA and HuffPost are delighted with his sophist arguments about HiB, though they wish he would be more denunciatory of Dr. Paul Offit’s supposed lack of ethics. But, then there’s that little matter of JG’s lack of integrity in attacking Dr. Rahul Parikh’ medical ethics. Apparently that requires a little defensive work, http://www.ageofautism.com/2009/04/pediatrician-violates-hipaa-in-effort-to-bully-parents-into-vaccination-compliance.html

    Perhaps the webmaster or Orac should confirm that this is the real Dr. Jay and not some impostor. It could be that other Dr. J … the one who could dribble and dunk.

  35. #35 Vascular Technologist (i get lots of quack questions because I'm not the doctor)
    June 4, 2009

    Dr. Jay says, “By the way, the HIB vaccine was a great creation and it did change pediatric care. When I first began practicing, I used to see HIB meningitis every year and now I haven’t seen it for over 25 years.” What a weasel is Dr. Jay.

    HiB is one of the vaccines foremost in the gunsights of the anti-vax madpeople. Techskeptic and others have already pointed out the ridiculous logical fallacy in Dr. Gordon’s crude cost-benefit arguments about rare diseases, because he (dis)misses the key point that HiB vaccination has been so successful as to make HiB meningitis such a rare disease today.

    His friends at AofA and HuffPost are delighted with his sophist arguments about HiB, though they wish he would be more denunciatory of Dr. Paul Offit’s supposed lack of ethics. But, then there’s that little matter of JG’s lack of integrity in attacking Dr. Rahul Parikh’ medical ethics. Apparently that requires a little defensive work, http://www.ageofautism.com/2009/04/pediatrician-violates-hipaa-in-effort-to-bully-parents-into-vaccination-compliance.html

    Perhaps the webmaster or Orac should confirm that this is the real Dr. Jay and not some impostor. It could be that other Dr. J … the one who could dribble and dunk.

  36. #36 Vascular Technologist (i get lots of quack questions because I'm not the doctor)
    June 4, 2009

    Dr. Jay says, “By the way, the HIB vaccine was a great creation and it did change pediatric care. When I first began practicing, I used to see HIB meningitis every year and now I haven’t seen it for over 25 years.” What a weasel is Dr. Jay.

    HiB is one of the vaccines foremost in the gunsights of the anti-vax madpeople. Techskeptic and others have already pointed out the ridiculous logical fallacy in Dr. Gordon’s crude cost-benefit arguments about rare diseases, because he (dis)misses the key point that HiB vaccination has been so successful as to make HiB meningitis such a rare disease today.

    His friends at AofA and HuffPost are delighted with his sophist arguments about HiB, though they wish he would be more denunciatory of Dr. Paul Offit’s supposed lack of ethics. But, then there’s that little matter of JG’s lack of integrity in attacking Dr. Rahul Parikh’ medical ethics. Apparently that requires a little defensive work, http://www.ageofautism.com/2009/04/pediatrician-violates-hipaa-in-effort-to-bully-parents-into-vaccination-compliance.html

    Perhaps the webmaster or Orac should confirm that this is the real Dr. Jay and not some impostor. It could be that other Dr. J … the one who could dribble and dunk.

  37. #37 Vascular Technologist (i get lots of quack questions because I'm not the doctor)
    June 4, 2009

    Dr. Jay says, “By the way, the HIB vaccine was a great creation and it did change pediatric care. When I first began practicing, I used to see HIB meningitis every year and now I haven’t seen it for over 25 years.” What a weasel is Dr. Jay.

    HiB is one of the vaccines foremost in the gunsights of the anti-vax madpeople. Techskeptic and others have already pointed out the ridiculous logical fallacy in Dr. Gordon’s crude cost-benefit arguments about rare diseases, because he (dis)misses the key point that HiB vaccination has been so successful as to make HiB meningitis such a rare disease today.

    His friends at AofA and HuffPost are delighted with his sophist arguments about HiB, though they wish he would be more denunciatory of Dr. Paul Offit’s supposed lack of ethics. But, then there’s that little matter of JG’s lack of integrity in attacking Dr. Rahul Parikh’ medical ethics. Apparently that requires a little defensive work, http://www.ageofautism.com/2009/04/pediatrician-violates-hipaa-in-effort-to-bully-parents-into-vaccination-compliance.html

    Perhaps the webmaster or Orac should confirm that this is the real Dr. Jay and not some impostor. It could be that other Dr. J … the one who could dribble and dunk.

  38. #38 Natalie
    June 4, 2009

    I must say I’m honestly surprised and impressed with City Pages here. I’m a lifelong Minneapolitan (or whatever we’re called) and I’ve been reading CP since high school. Their local political, food, and arts coverage is good (note that the politics is decidedly left), but their medical coverage is spotty at best. They tend to fall into the same traps most journalists do: fallacious ideas of balance, confusing correlation and causation, not understanding the difference between the rate of a disease and the reported rate of the disease, and so on. Probably the only difference is that their political slant makes them more willing to be sensationalist and pin blame on the “Big Pharma”.

    When I saw the cover yesterday before I read the article I assumed this was going to be more of the same. Good for them.

  39. #39 HCN
    June 4, 2009

    I am presently reading this article by a ScienceBasedMedicine blogger, Dr. Harriet Hall (who also has an autobiography that is a good read, “Women Aren’t Supposed to Fly”):
    http://www.skeptic.com/eskeptic/09-06-03

    She has this interesting bit about Dr. Jay: “On one talk show, a pregnant mother with several autistic children tried to tell Gordon that her child who had the worst autism was the one who had not been vaccinated. He not only refused to listen to what she was saying but tried to drown her out, loudly insisting she mustn’t vaccinate the new baby.”

    Obviously, Dr. Jay does not believe in listening to women, or possibly even patients. This would be the type of doctor to avoid.

  40. #40 techskeptic
    June 4, 2009

    Take anti-malarial medicine every day in high risk areas but not every day in low risk areas.

    Even this seems wrong to me (but I am not a doctor and I would like to learn the reality here). When I went to Thailand and India, I was supposed to take mefloquin (I did not suffer any side effects). As I recall it was supposed to be taken once a week. (a fellow traveler didn’t realize the frequency and took his every day! talk about the shakes)

    Presumably that is the frenquency an adult needs to take the drug to be able to keep the drug in enough concentration in the blood to be effective.

    By Dr. Jay’s theory, when I was in the cities it would be OK for me to take it once every 2 weeks or less.

    But then I would expect the concentration of the drug to be too low to be effective if I got a mosquito bite. So, does concentration of the drug matter or not? If it does matter, how can the doctorly advice he gave be correct?

    too bad there isn’t a prophylactic for Giardia…. :/

  41. #41 techskeptic
    June 4, 2009

    HCN, That was the exact episode I was talking about above!

  42. #42 HCN
    June 4, 2009

    techskeptic, are you saying that there are gaps in Dr. Jay’s knowledge of medicine? Dr. Jay, when was the last time you got CME credits?

  43. #43 CD
    June 4, 2009

    FreeSpeaker – that sounds very interesting. I hadn’t thought about comparing this issue to bad financial advice, but it seems very similar. I will look into that. Thanks!

    Matt Penfold – another interesting point. The government definitely has to pay quite a bit for increased health care when things like this happen. Of course, here in the US we spend millions of dollars every year on health care for people affected by cigarette smoking and cases against tobacco companies to recoup that money have been less than successful. From a governmental standpoint the wisest course is probably just to mandate vaccines for everyone (excepting of course people who medically can’t have them due to allergies, etc) with no religious refusal or anything similar.

  44. #44 Kimbo Jones
    June 4, 2009

    techskeptic, re: malaria meds. I’m given to understand (and someone correct me if I’m wrong) that the dose is related to whether the drug is being given as a treatment or as a prophylactic. As a treatment, people take higher concentrations daily. As a prophylactic, people take lower concentrations weekly. I’m guessing because it takes much more to kill an established bug than to prevent one. So, I’m pretty sure it’s unrelated to relative “risk” in the area the person is going to. Although, people who are staying in high risk areas for a long period of time (as opposed to a short vacation) may have special regimens that I haven’t considered.

  45. #45 techskeptic
    June 4, 2009

    Kimbo,

    I meant it as prophylactic, and Dr. Gordons sentence implied he meant it as a prophylactic. But who knows what he means when he continues to say one thing and then mean another.

    I think we agree, but it would be nice if we had an infectious diseases doc here who could be more definitive.

  46. #46 Matthew Cline
    June 4, 2009

    The doctors did more tests and discovered that she had hypogammaglobulinemia, a rare immune deficiency disorder.

    So will the anti-vaxxers say that she would have gotten some potentially deadly communicable disease anyways?

    Even though she’d been vaccinated, the immune deficiency made her vulnerable to contracting Hib.

    “Aha!” says the anti-vaxxer. “She got vaccinated and caught it anyways, so what’s the point of vaccination?”

  47. #47 Terrie
    June 4, 2009

    Unequivocally recommend vaccinations when risk is high but consider possible side effects of vaccines and all other medical interventions when risk is low.

    Don’t we do that already? I mean, I’ve never had a doctor recommend a rabies, typhoid or yellow fever vaccine to me. We discontinued cholera vaccines in this country because there’s not much risk here and the vaccine is only effective in the short-term.

  48. #48 Alison Cummins
    June 4, 2009

    “Take anti-malarial medicine every day in high risk areas but not every day in low risk areas.”

    That sounds like a recipe for creating resistant strains of malaria.

    As someone who has lived in a malaria-endemic area, I don’t know anyone who followed Dr. Jay’s recommendation. There were two regimes for permanent residents I was familiar with:

    1) In the rainy season, take prophylactic antimalarials; in the dry season, don’t. In either case, treat when you get malaria.
    2) Don’t bother with the prophylactics. Just treat when you get ill.

    The regime for tourists that I am familiar with is:
    3) Take prophylactic antimalarials. Getting sick with malaria will totally ruin your vacation.

    I don’t know anyone who deliberately followed a regime of prophylaxis with ineffective doses.

    Some antimalarials are nasty with obvious short and long term side effects. I don’t know of any currently available vaccine that has a cost profile similar to antimalarials.

  49. #49 Alison Cummins
    June 4, 2009

    “Take anti-malarial medicine every day in high risk areas but not every day in low risk areas.”

    That sounds like a recipe for creating resistant strains of malaria.

    As someone who has lived in a malaria-endemic area, I don’t know anyone who followed Dr. Jay’s recommendation. There were two regimes for permanent residents I was familiar with:

    1) In the rainy season, take prophylactic antimalarials; in the dry season, don’t. In either case, treat when you get malaria.
    2) Don’t bother with the prophylactics. Just treat when you get ill.

    The regime for tourists that I am familiar with is:
    3) Take prophylactic antimalarials. Getting sick with malaria will totally ruin your vacation.

    I don’t know anyone who deliberately followed a regime of prophylaxis with ineffective doses.

    Some antimalarials are nasty with obvious short and long term side effects. I don’t know of any currently available vaccine that has a cost profile similar to antimalarials.

  50. #50 Alison Cummins
    June 4, 2009

    “Take anti-malarial medicine every day in high risk areas but not every day in low risk areas.”

    That sounds like a recipe for creating resistant strains of malaria.

    As someone who has lived in a malaria-endemic area, I don’t know anyone who followed Dr. Jay’s recommendation. There were two regimes for permanent residents I was familiar with:

    1) In the rainy season, take prophylactic antimalarials; in the dry season, don’t. In either case, treat when you get malaria.
    2) Don’t bother with the prophylactics. Just treat when you get ill.

    The regime for tourists that I am familiar with is:
    3) Take prophylactic antimalarials. Getting sick with malaria will totally ruin your vacation.

    I don’t know anyone who deliberately followed a regime of prophylaxis with ineffective doses.

    Some antimalarials are nasty with obvious short and long term side effects. I don’t know of any currently available vaccine that has a cost profile similar to antimalarials.

  51. #51 Alison Cummins
    June 4, 2009

    (Sorry. Look, I do read the error messages. I got two different ones both instructing me to “try again later.” Which I did. The third time I got one telling me that my comment had probably posted and I should check. Which I also did.)

  52. #52 Orac
    June 4, 2009

    Dr. Jay opines:

    There is not just one correct answer nor one correct interpretation of the science involved.

    Straw man argument, Dr. Jay. No one ever said there must be one correct answer or interpretation. However, the existence of more than one acceptable answer or interpretation does not preclude the possibility of wrong answers and wrong interpretations, which is what the anti-vaccine movement routinely comes to. Ditto you.

    Want to show us your answers and interpretations are “correct” (or at least acceptable)? Stop whining and show us the scientific and clinical evidence to support your viewpoint. Show us how your case is superior (or at least equal) to the case made for the scientific consensus.

    But you don’t do that. Instead you whine about how awfully mean we skeptics and scientists all are to you. Dude, you couldn’t possibly be a scientist. Reviewers and colleagues are incredibly harsh judging a scientist’s work–far harsher than I’ve ever been to you. You need a thick skin to be a scientist. In any case, the way a scientist convinces reviewers, critics, and hostile colleagues is with evidence and the force of his reason in his arguments, not by whining about how there are “multiple correct answers” and appealing to other ways of knowing.

    That’s the difference. Scientists revel and thrive in the free-for-all intellectual death match between competing ideas. They know how to refute criticism. You just want everyone to take you seriously without giving them a reason to do so.

  53. #53 James Sweet
    June 4, 2009

    “Vaccinate when risk is high, but don’t vaccinate when risk is low” is only valid reasoning for diseases that are not usually spread by human-to-human contact (e.g. Malaria, genius). For vaccines that are spread from human-to-human, if you stop vaccinating when risk is low then you will be in a constant cycle of fluctuating risk, and that sucks ass.

    One thing I have said before to people who start to employ the “hide in the herd” rationale is this: Do it for your grandkids. I mean, maybe Hib can never be wiped out, but some of these diseases could be. And once a disease is extinct in the wild, then nobody needs to get vaccinated anymore. If you are really concerned about the occasional side-effects from vaccines, then you should get as many people to vaccinate as possible so that these diseases can be eliminated and then nobody will have to get vaccinated for them.

  54. #54 K
    June 4, 2009

    This child’s case is being exploited by feeble journalists and others. I would expect better from you.

    Jay

    Did I miss something? Didn’t this mother go before congressional staffers so they could hear from a parent who feels vaccines are important? Are you saying this mother is also exploiting her own child for the cause of science? What rubbish.

    She’s sharing her story because she has seen what a vaccine preventable disease can do to a vulnerable child.

    Anyway, please explain how this is different from you trotting out the Poling child or the others we hear about from the anti-vax crowd? The Polings took their child on Larry King, even. And you called the City Pages journalists feeble. Ha.

    What a ridiculous and completely-without-merit attack on Orac.

  55. #55 Alan Kellogg
    June 4, 2009

    Orac,

    The SkepDoc has an article on the anti-vax scare in the June 4th eSkeptic. Would you like a copy?

  56. #56 Alan Kellogg
    June 4, 2009

    Update: As is usual with me, I found an online copy of the article after posting the comment above.

  57. #57 Ty-bo
    June 4, 2009

    Not to be picky, but I really can’t get this phrase:

    “(for instance, the reporter mistakenly repeats the mercury militia talking point that the symptoms of autism are uncannily similar to the symptoms of autism (they aren’t)” [emphasis mine]

    Could someone explain, or is this an error and I just can’t recognize how it is supposed to read?

  58. #58 techskeptic
    June 4, 2009

    Its an error. I suspect he meant to say something like:

    symptoms of mercury poisoning are uncannily like symptoms of autism (they aren’t).

    The first comment pointed it out also.

  59. #59 Agoraphobic Kleptomaniac
    June 4, 2009

    Incredibly rare diseases occur even in the presence of excellent herd immunity. This child’s case is being exploited by feeble journalists and others.

    Hey, Jay, you seem to have “cherry picked” ORAC’s points to make him say something he’s not. The post wasn’t about how this girl got Hib from a lack of herd immunity, as he says in an entire paragraph…

    Although it can’t be proven for sure that the antivaccine movement is directly responsible for Julieanna’s illness, there’s no doubt that the ongoing erosion of herd immunity in pockets of vaccine resistance will, if not checked, result in more Julieanna’s, some of whom my suffer even worse than severe illness and brain damage. There will be more pus on the brain in children. Or so I (and many others) fear.

    So, this horrible disease could hit more kids if herd immunity isn’t maintained.

    You totally ignore this statement from the story:

    In recent years, outbreaks of infectious diseases once thought to be eradicated in the West have popped up in several unvaccinated communities in Minnesota. In 1996, several children belonging to Christ’s Household of Faith in St. Paul got the measles. In 2005, a polio outbreak hit an unvaccinated Amish community in central Minnesota.

    Care to address this, and therefore, the larger focus of this post?

    I have a feeling you won’t…

  60. #60 Donna B.
    June 4, 2009

    My daughter was diagnosed with meningitis at age 3 weeks in late 1981. It was the prompt response from my excellent pediatrician when I called to ask the proper dose of Tylenol for a fever in a child so young that saved my baby’s life and possibly the life of friend’s child a year later.

    Thank goodness, I had enough sense to call! I was otherwise young and stupid. The doc’s response was “Go to the ER now, I’ll meet you there.” We walked into the ER and by the time we were half registered, the baby was whisked away for a spinal tap.

    I got a layman’s crash course in germs, meningitis, antibiotics, as well as being scared out of my mind.

    My daughter, after aggressive and early treatment, recovered without any problems. A year later, a friend called to cancel a lunch date because her 6 month old was fussy and running a fever. Because I immediately thought meningitis, I told her she should call her doctor right away. Sure, in some ways I was over-reacting.

    It turned out that in the 2 hours it took her to get to her doctor’s office, the baby was so lethargic, the doc called an ambulance to get her to the hospital.

    Meningitis is scary as hell, folks. Because we don’t see it too often now might make the symptoms less likely to be recognized quickly.

  61. #61 Parental Choice
    June 4, 2009

    Quoting Dr. (Pr)Offit = immediate FAIL (along with a whole bunch of LOL’s)

    Just keeping things real.

  62. #62 D. C. Sessions
    June 4, 2009

    Unequivocally recommend vaccinations when risk is high but consider possible side effects of vaccines and all other medical interventions when risk is low. Consider public health and an individual child’s health.

    The control algorithm you have described requires a setpoint, a level of disease prevalence that separates “low risk” from “high risk” and invokes measures against the disease.

    So, please, do tell us what you consider the optimal prevalence for the following diseases:

    * measles
    * polio
    * mumps
    * rubella
    * pertussis
    * HIB
    * hepatitis B
    * diptheria
    * seasonal influenza
    * pneumoccal disease

    I’d also like to know where you would have drawn the line on smallpox. What prevalence for it would have been low enough to stop the effort to eradicate it?

  63. #63 Donna B.
    June 4, 2009

    Are there plans to fix ScienceBlogs comment submission problem any time soon?

  64. #64 xen
    June 4, 2009

    By the way, the HIB vaccine was a great creation and it did change pediatric care. When I first began practicing, I used to see HIB meningitis every year and now I haven’t seen it for over 25 years.

    I’d imagine no one here is disputing this.

    *re-reads comments*
    Nope, no one.

    Hey! how about you go share this very very true statement with the pro-disease crowd, who might have an axe to grind with you there!

    It might be a worthwhile piece of news to them – and I know you’ve mentioned to them you are pro-vaccine, but it never hurts to add another example of where they are wrong and enlighten them! :)

    This child’s case is being exploited by feeble journalists and others. I would expect better from you.
    Jay

    While you’re speaking truth to the crusaders, how about you mention how all they’re anecdotal cases with their own children are also examples of ‘exploitation’.

    Lets see how that one flies.
    You’re not afraid of ruffling some feathers right?
    Speak truth to crowd doc, it will make you feel good eh?

  65. #65 MI Dawn
    June 4, 2009

    @Parental Choice: At least Dr Offit states his conflicts of interest (which don’t exist as he no longer owns the patent) unlike Dr Wakefield when he wrote his paper, and all the other docs who sell supplements, treatments, and chelation for costs FAR above their true costs. Give me an honest man who admits the COI over the liar.

  66. #66 Prometheus
    June 4, 2009

    “Dr. Jay” advises:

    ” Unequivocally recommend vaccinations when risk is high but consider possible side effects of vaccines and all other medical interventions when risk is low.”

    The circular reasoning is hidden in this one – let me tease it out for you.

    Vaccines – like the HiB vaccine – reduce (do not eliminate) the risk of getting the disease and/or carrying it to others.

    Once enough of the population is vaccinated, the risk of the disease starts to drop, even for people who are unvaccinated, because there are fewer people who can carry it.

    This population immunity protects the people who cannot take vaccines (because they are too young or have medical problems) or for whom the vaccines don’t work (immune system problems, like the girl in the story).

    Ergo, what causes a LOW risk of a vaccine-preventable disease is a HIGH level of vaccination. If the vaccination level goes DOWN, the risk goes UP.

    This means that Dr. Jay’s sage advice is exactly wrong. The way to keep the risk of HiB low is to vaccinate even if the current risk is LOW.

    That’s how you keep the risk from becoming HIGH.

    Now, I’m sure that one of Dr. Jay’s “alternative ways of knowing” has informed him that he is responsible for the child in front of him, not the larger community. Perhaps a lot of people think he’s correct. However, if this sort of “devil take the hindmost” approach to vaccination becomes widespread, Dr. Jay will get to see a lot of those old vaccine-preventable killers come back.

    I’m sure that Dr. Jay doesn’t see this as his fault – he’s simply advising parents to play the game in the way that minimizes the risk to their child. It’s not like he’s saying that nobody should vaccinate. In fact, he’s counting on all the rest of us dutifully getting our kids vaccinated – exposing our children to the exceedingly low but non-zero risk that he advises his boutique clientele to avoid.

    I doubt that any of this has ever occurred to Dr. Jay. I doubt that he’s ever given a thought to the idea that encouraging people with healthy children to forgo vaccines increases the risk that a child with a weak immune system may be disabled or die from a vaccine-preventable disease.

    It’s sad and puzzling that Dr. Jay – who admits that the HiB vaccine was “a great creation” – isn’t able to see that the only way to keep HiB meningitis rare is to keep a high level of vaccination. That would include his patients, as well.

    Get a clue, Dr. Jay.

    Prometheus

  67. #67 Parental Choice
    June 4, 2009

    “Give me an honest man who admits the COI over the liar”.

    Again, LOL! Dr. (Pr) Offit does not equal an honest man. Unless and until he injects his own buttocks with 100,000 vaccines, he will be considered a utter disgraceful lying sack of shite.

  68. #68 Another lurker
    June 4, 2009

    Unless and until he injects his own buttocks with 100,000 vaccines, he will be considered a utter disgraceful lying sack of shite.

    Sweet Jeebus, you’re an unbalanced, possibly evil person. This comment is so full of vitriolic fail it’s absurd.

  69. #69 HCN
    June 4, 2009

    Parental Choice = Parasitic Choice = Clueless Troll (defined as one who makes silly statements in the form of insults and does not bother to back anything up with real evidence)

  70. #70 ababa
    June 4, 2009

    At least Parental Choice finally decided to choose a pseudonym and stick with it. Last time he brought up the 100,000 vaccine nonsense he was changing it with every post.

    Why would injecting 100,000 vaccines make him honest? He stated that the body can withstand many, many more times the immune challenges of a single vaccine but I just don’t get this 100,000 vaccine thing. And must he personally stick himself with 100,000 injections for it to make it true? Have you translated what he said into your small minded world like you do every other piece of information on the subject?

    If you want honest, then don’t go visit any of the anti-vax sites. There’s none to be found there. They are too busy selling books, “treatments” and “cures” and deleting anything that doesn’t follow the party line to worry about honesty.

  71. #71 Dedj
    June 4, 2009

    “he will be considered a utter disgraceful lying sack of shite. ”

    Except by anyone who actually counts.

    Tell me, under what criteria should untrained, unqualified, irrelevantly experienced people get to hold judgement over widely recognised experts like Offitt and expect to be taken seriously?

    I’ve been asking people like Jake Crosby this time and again. If the leading lights of the vaccine skeptic cannot answer, why we should even take their ‘opinions’ as having anymore value than our own?

  72. #72 claw
    June 4, 2009

    up near the top CD mentioned potential future legal ramifications for schills and crusaders like Jenny and Oprah. Alas they must have talked to a lawyer before going of Larry King because both her and her butt-talking boyfriend said “now we’re not telling people to skip the important vaccines…”
    if i were King i would have called them on that bs, you can’t jump up and down and parade through the streets screaming “argh! vaccines bad!” and then expect people to not want to risk their children’s health to “Big Pharma’s greed.” Jim and Jenny were just covering their butts there.

  73. #73 Chris
    June 4, 2009

    ababa:

    If you want honest, then don’t go visit any of the anti-vax sites. There’s none to be found there. They are too busy selling books, “treatments” and “cures” and deleting anything that doesn’t follow the party line to worry about honesty.

    Hence the name they were given by an Aussie Skeptic:
    Anti-vaccination Liars

  74. #74 Bridget McKinney
    June 4, 2009

    What a tragic story.

    When my daughter was getting her first vaccines 6 years ago, I remember wondering about some of the vaccines and questioning the safety of giving so many to babies. I got her vaccinated anyway because there are good reasons for it and I assumed that the doctor knew what she was doing (I wasn’t skeptical/scared to the point of denying the physician). I’m so glad that I made the right choice.

    I’m a generally intelligent, educated, and informed person, and even I felt a little bit of that nameless, shapeless fear that Jenny McCarthy and others are spreading around. It’s so effective because even generally informed people often don’t really *know* any better. I think it becomes especially effective in influencing younger parents–I was 20 at the time, and although my grandfather had polio as a boy, I’ve never seen or heard of anyone my age getting sick with anything serious. Our lack of experience and the sheltered life many of us have lived make it easy to believe that it will never happen to us or that it simply isn’t a problem anymore.

    The information that I’ve learned through reading this blog and a couple others has made me feel completely justified in vaccinating my child, as well as a little sad that the fear-mongering tactics of the anti-vaccine movement were able to make me question that decision.

    Thank you, Orac, for collecting these stories and all the other useful and interesting stuff that I read here.

  75. #75 Bridget McKinney
    June 4, 2009

    Note: I know Jenny McCarthy hadn’t hijacked the bandwagon yet in 2003, but there was still enough anti-vaccine nonsense that I felt like I should “question” vaccinations. You know. If I was a good parent and stuff, right? What a load. I’m just glad I didn’t completely fall for it, and I’m glad I’m now able to rest easy knowing that I made the right choice for my daughter–and our community.

  76. #76 Matthew Cline
    June 4, 2009

    Why would injecting 100,000 vaccines make him honest?

    I think that Offit calculated that a baby’s immune system could handle the antigen load of 100,000 vaccines every day, and lots of anti-vaxxers have criticized him for claiming this as a fact without first experimentally validating it. They miss the point that, even if modern immunology is off by a factor of 10,000 that a baby could still handle the antigen load of 10 vaccines per day, and if it’s off by more than a factor of 10,000 it would be pretty bloody obvious.

  77. #77 Cat
    June 4, 2009

    Dave wrote: “And, as a non-medical-professional person, could someone explain to me why this particular case demonstrates “incredibly poor medical care”? What should have been done? Did someone commit malpractice here?”

    Also a non-medical person, and also curious.

    The quotes from the story indicate that the child had a stiff neck in the bath and a high fever. The fact that they didn’t do a lumbar puncture until the next day may be the issue.

    I went to the ER once with a fever of 103F and stiff muscles everywhere and they did a spinal tap on me immediately. I didn’t have meningitis, though, I had Lyme and a bulls-eye rash to prove it. (Which begs the question why almost nobody does a complete physical exam anymore? They relied on me to tell them what my symptoms were. I found the rash by accident the next day after being discharged from the ER with no diagnosis.)

  78. #78 kitty
    June 4, 2009

    “Maybe they can extend the philosophy of Autism One to the feline community so that every family with a cat can enjoy the benefits of a coronavirus.”

    This is off topic, but cats and especially corona virus are really bad examples because a) routine vaccination against FIP is not recommended except in very specific cases like in catteries and not even there b) the existing FIP vaccine is controversial with conflicting studies about effectiveness and some studies showing it may sensitize cats rather than protect them. Plus vaccines in cats carry special risk that humans don’t have – VAS – which is why they are now recommended less often.

    Now if you were to choose Rabis instead of corona virus, this would’ve been a whole lot better example.

    Again it is completely off topic as cats are very very different from humans with regards to vaccines. With human you have absolutely no evidence of any link with autism and plenty of evidence that vaccines are safe. With cats, VAS is a real consideration.

  79. #79 Jay Gordon, MD, FAAP
    June 5, 2009

    In the absence of facts and real wit, I guess the only thing you can do is resort to name-calling. I spend my day with four-year-olds who try to hurt me by calling me a poopoohead. I feel at home among your similar attitudes

    A child with the signs and symptoms this baby had should have received completely different medical care: An immediate lumbar puncture and antibiotic and antiviral medication. According the accounts of this case, treatment was delayed by at least 24 hours and maybe more. Most likely, the delay cost her her life. To answer your question, Dave, yes, this is malpractice.

    Carykoh, the HIB vaccine has virtually eliminated HIB disease. With whom are you arguing? And, no, I do not want to return to the pre-HIB vaccine days.

    On the TV show some of you refer to, there was pretty general agreement that the family’s eight child should not be vaccinated. Read the transcript and you’ll see that I was not the only one reluctant to apply the routine immunization schedule to a family with four children with autism. Techskeptic, use your real name and I’d guess your insults and false bravado would diminish. You’re not saying anything terribly smart here.

    Spudbeach, same to you sir or madam: No one expects perfection in any medical intervention. We just have to try harder to get this immunization issue into better shape. We give too many shots far to early in a child’s life in combinations never proven safe. Look it up.

    Lynsey, I’m here to listen, learn and answer. I don’t need to promote myself. And I sure as heck am not promoting my agenda and winning kudos on this website!

    Dr. Parikh wrote an article I did not like at all and I commented on it. When I realized that I had resorted to insults questioning his ethics, I apologized. Disagreements are no justification for insults and ad hominem attacks. I erred.

    HCN, I was on that show. You are mischaracterizing my appearance and the tone of my interaction with the mother and the other doctors. You are wrong. I got my most recent CME credits last week, HCN. And you?

    Terrie, the point of the HIB vaccine? It protects against invasive disease and creates herd immunity. You know that. I support a parent’s right to choose whether the possible risks of that vaccine are reason enough to defer or delay the shots. I do not recommend abandoning the HIB vaccine program.

    Orac, you’re the one who’s whining. No, of course you’re not: It’s your website and when you opine and insult and caterwaul, you’re merely writing. I’m the only one whining here, right? The reason to take me seriously? I have more experience in the clinical practice of pediatrics than anyone else posting here. That’s not a reason to accept everything I say without doubt and criticism but it is a very good reason to take me seriously. I have very thick skin, by the way.

    And why, James Sweet, did we stop giving the small pox vaccine? And why do we use the yellow fever vaccine and many others so selectively? Because the risk of the diseases is very small and the vaccines carry significant risk. Genius.

    The girl did not get HIB from a lack of herd immunity. She got it because even in the presence of herd immunity diseases continue to occur. Rarely. Stating that herd immunity eliminates these diseases is incorrect.

    The “polio epidemic” in Minnesota has been debunked and you know it. These children did not have polio, they had polio antibody detected in their blood. Probably a result of exposure to a recent recipient of the oral polio vaccine. Stop that.

    Donna, good medicine saved your child’s life. 28 years later, I still recall that type of winter and have no desire to eliminate HIB vaccination.

    Dr. Offit denied COI for quite a while. I was there. He has been forced to disclose and he does. Good for him. We still have no idea how much he really profited from the approval and promotion of his Rotavirus vaccine. Two million dollars? Ten million? More??

    Prometheus, eradiation or near eradication of a disease can lead to decreased use of a vaccine. At the very least, it must cause a parent and a good doctor to consider the possible risks of vaccinating versus not vaccinating.

    My Best Wishes to You All,

    Jay

  80. #80 Jay Gordon, MD, FAAP
    June 5, 2009

    NEUROLOGY 2004;63:838-842
    © 2004 American Academy of Neurology
    Recombinant hepatitis B vaccine and the risk of multiple sclerosis

    A prospective study

    Miguel A. Hernán, MD, DrPH, Susan S. Jick, DSc, Michael J. Olek, DO and Hershel Jick, MD
    From the Department of Epidemiology (Dr. Hernán), Harvard School of Public Health, Boston; Boston Collaborative Drug Surveillance Program (Drs. Susan S. Jick and Hershel Jick), Boston University, Lexington, MA; and Department of Neurology (Dr. Olek), College of Medicine, University of California, Irvine.

    Address correspondence and reprint requests to Dr. Miguel Hernán, Department of Epidemiology, Harvard School of Public Health, 677 Huntington Avenue, Boston, MA 02115; e-mail: miguel_hernan@post.harvard.edu

    Background: A potential link between the recombinant hepatitis B vaccine and an increased risk of multiple sclerosis (MS) has been evaluated in several studies, but some of them have substantial methodologic limitations.

    Methods: The authors conducted a nested case-control study within the General Practice Research Database (GPRD) in the United Kingdom. The authors identified patients who had a first MS diagnosis recorded in the GPRD between January 1993 and December 2000. Cases were patients with a diagnosis of MS confirmed through examination of medical records, and with at least 3 years of continuous recording in the GPRD before their date of first symptoms (index date). Up to 10 controls per case were randomly selected, matched on age, sex, practice, and date of joining the practice. Information on receipt of immunizations was obtained from the computer records.

    Results: The analyses include 163 cases of MS and 1,604 controls. The OR of MS for vaccination within 3 years before the index date compared to no vaccination was 3.1 (95% CI 1.5, 6.3). No increased risk of MS was associated with tetanus and influenza vaccinations.

    Conclusions: These findings are consistent with the hypothesis that immunization with the recombinant hepatitis B vaccine is associated with an increased risk of MS, and challenge the idea that the relation between hepatitis B vaccination and risk of MS is well understood.

    Received March 31, 2004. Accepted in final form May 8, 2004.

    See also page 772

  81. #81 Jay Gordon, MD, FAAP
    June 5, 2009

    And my next question is, shouldn’t the Dartmouth and Boston Children’s experience give one pause when reading the new pertussis study out of Kaiser?

    Jay

    http://tinyurl.com/dnl78m

  82. #82 Jay Gordon, MD, FAAP
    June 5, 2009

    I omitted a crucial question from the J. Neurology post above. I had said that I wanted to learn from the epidemiologists here. I have always interpreted the MS/HBV study as concluding that patients with MS were three times more likely to have received the hepatitis B vaccine than controls without MS. Is this a correct interpretation?

    Thanks.

    Jay

  83. #83 Robert S.
    June 5, 2009

    Most likely, the delay cost her her life

    Reading comprehension fail.

  84. #84 skeptiquette
    June 5, 2009

    Hi Dr. Jay,

    If you haven’t noticed already, this site is generally devoid of science(not always, just most of the time)and rational discussion of controversial issues. I just wrote a short piece and posted on the Dr. Sears thread. the post contains actual current science related to the fields of immunology, genetics, and toxicology. Just wanted to let you know, in case you wanted to engage in a potentially intriguing discussion.

    Have a good night.

    skeptiquette

  85. #85 DebinOz
    June 5, 2009

    Dr Jay,

    The study you cited has been criticised at length:

    The following is from:

    http://www.ncirs.usyd.edu.au/facts/f-hepb.html

    “Are there studies that suggest a link between Hepatitis B vaccine and MS?

    Despite many studies and expert reviews over the last decade that have found no association between hepatitis B vaccine and MS, the question of a link has been raised again by a study published in 2004 by Hernán and colleagues.
    This study was performed by looking back at the medical records of adult patients in the UK who were immunised against hepatitis B by GPs. The authors based their results on a small number of MS patients (11) who had previously received the hepatitis vaccine, and suggest that there may be an increased risk of developing MS in the 2nd and 3rd years after receiving the vaccine. However there are numerous misgivings that are important to understand regarding this study.

    The following points are important to put the study in context:

    1) The study relied on accurate recording of all immunisation records and disease symptoms by GPs. However, given the few patients involved, even a minimal difference in the way the information was recorded could alter the results

    2) In the UK hepatitis B vaccine is only targeted toward adults at high risk of getting hepatitis B. Therefore the persons who received the vaccine in this study are not representative of the general population and this may have skewed the results. Also, health workers in the study may have received their hepatitis B immunisation in the workplace, rendering information from the GPs incomplete and possibly affecting the study results.

    3) Although there were 713 cases of MS in the database, only 11 were selected in the final analysis – this may have biased the results

    4) Information on the number hepatitis B vaccine doses given, and the time over which they were given is missing and means that interpretations regarding the effect of the timing and dosing of vaccine cannot be accurately made, and

    5) An association between receiving hepatitis B vaccine more than 1 year prior to the onset of MS seems unlikely given that viruses that may trigger the onset of MS are thought to have an affect within weeks.

    An editorial accompanying this study stated that the “data presented do not provide proof of association sufficient to implement policy changes. The indisputable benefit that the HBV provides against infection must be weighed against any uncommon risks that remain disputed.” The World Health Organization (WHO) has made a statement that “the findings do not provide convincing support for the hypothesis that immunisation with recombinant hepatitis B vaccine is associated with an increased risk of multiple sclerosis.” Because of the methodological problems of the Hernán study, and the fact that it is in contrast to many other studies, experts consider that the findings do not provide convincing evidence of an association between hepatitis B vaccine and MS.”

    I am an epidemiologist, and if you really want to learn from us, you need to be able to put one study into perspective compared with the rest of the studies, and to notice the methodological flaws from any study.

  86. #86 Orac
    June 5, 2009

    On the TV show some of you refer to, there was pretty general agreement that the family’s eight child should not be vaccinated. Read the transcript and you’ll see that I was not the only one reluctant to apply the routine immunization schedule to a family with four children with autism.

    Dr. Jay, not quite:

    http://scienceblogs.com/insolence/2008/12/run_dont_walk_from_these_doctors.php

  87. #87 techskeptic
    June 5, 2009

    “Techskeptic, use your real name and I’d guess your insults and false bravado would diminish. You’re not saying anything terribly smart here.”

    If i legally changed my name to TechSkeptic would my arguments and questions all of a sudden become more relevant to you?

    That has got to be the dumbest reason I have ever heard to not answer questions from someone.

  88. #88 D. C. Sessions
    June 5, 2009

    The girl did not get HIB from a lack of herd immunity. She got it because even in the presence of herd immunity diseases continue to occur. Rarely. Stating that herd immunity eliminates these diseases is incorrect.

    So how often does smallpox occur, despite herd immunity?

  89. #89 DebinOz
    June 5, 2009

    Dr Jay makes a reference to a Kaiser study on pertussis, as if to prove a point.

    Call me a simpleton, but from what I have read, this study found that unvaccinated children were 23 times more likely to get pertussis than vaccinated kids!:

    http://www.oregonlive.com/news/index.ssf/2009/05/unvaccinated_kids_23_times_as.html

  90. #90 Orac
    June 5, 2009

    It also corrected for the differential tendency to order pertussis tests (culture, rapid test) in unvaccinated children with bad coughs and concluded that that effect was relatively small compared to the nearly 23-fold increased incidence of pertussis in unvaccinated children:

    http://scienceblogs.com/insolence/2009/05/one_more_time_vaccine_refusal_endangers.php

  91. #91 Heather
    June 5, 2009

    There is nothing inherently wrong with questioning the status quo, and determing where the exceptions are. Researchers are doing that every day. But responsible ones aren’t thoughtfully, thoroughly, painstakingly looking for answers while concurrently publicly stoking the fears and suspicions of parents of young children for personal reasons (business/money, fame, ego, ??).

    There is a difference between being sensitive to parents of children with no known or suspected risk factors who are worried that there is danger associated with vaccines or the vaccination schedule, and actually suggesting to parents that the risks of such dangers might actually outweigh the benefits of vaccination.

    Given the overwhelming scientific evidence that vaccines and the vaccination schedule are safe, I cannot understand how a responsible physician would use the media to do anything other than to get that message out.

  92. #92 K
    June 5, 2009

    And why, James Sweet, did we stop giving the small pox vaccine? And why do we use the yellow fever vaccine and many others so selectively? Because the risk of the diseases is very small and the vaccines carry significant risk. Genius.

    I understand why the risk of yellow fever is small in some areas. Why is the risk of smallpox so small? I thought it was because the use of the vaccine resulted in eradication of the disease. Is that wrong? Please clarify.

    The girl did not get HIB from a lack of herd immunity. She got it because even in the presence of herd immunity diseases continue to occur. Rarely. Stating that herd immunity eliminates these diseases is incorrect.

    I don’t think we can say that without some reservation. Children need to receive the complete primary series of 3 doses of Hib vaccine for protection. Health officials in MN found that children who had completed the primary series of three doses dropped off with as many as 18% fewer kids getting the third dose compared with the rates for receiving the first two doses. This will result in a possible loss of herd immunity. http://health.minnesota.gov/news/pressrel/2009/hib012309.html

    I am also looking forward to a response that explains “judicious” use of Hib vaccine, how you determine that and therefore who gets vaccinated and who doesn’t. I’m very interested! Thanks!

  93. #93 HCN
    June 5, 2009

    Dr. Jay said “HCN, I was on that show. You are mischaracterizing my appearance and the tone of my interaction with the mother and the other doctors. You are wrong. I got my most recent CME credits last week, HCN. And you?”

    Dude, reading comprehension fail! I was quoting Dr. Hall’s article (I don’t watch daytime TV, nor any talk shows).

    So did you get those CME credits from some faux conference that doubles a DAN! training? Like the ones that nurses get that give them instruction in therapeutic touch, as noted in http://hollywoodrealitycheck.com/?p=962 . Because it has been shown over and over on this blog your very severe lapses in basic immunity and disease prevention knowledge.

  94. #94 Pablo
    June 5, 2009

    Dr. Gordon, as a Fellow of the AAP, what is your opinion on the implication by Jenny McCarthy’s beau, among others, that the AAP has an agenda aligned with “Big Pharma” (presumably profit motivated), as opposed to providing the best health care possible for our nation’s young people? As an AAP member, shouldn’t such an accusation be an affront to your professional ethics and your oath as a doctor?

    Or does your conscience get in the way, knowing that you are in no position to contradict the claim. How are the sales of that DVD coming along?

    Meanwhile, my son’s pediatrician does not have a book out, or DVD, or even a website. Too bad he gets tarnished with the same brush as you.

  95. #95 Chris
    June 5, 2009

    Jay,
    Not sure of your algorithm for deciding who gets vaccinated and who doesn’t? For gauging whether the current community risk is high or low? How long to delay the vaccine schedule? Which vaccines are good, which ones are bad? What is the safest combination? I’m convinced you don’t know either. How could you know? You can’t prove your initial premise; you can’t even prove a problem exists. Please don’t respond with “You can’t prove a problem doesn’t exist”….You know, (I hope), that I can’t prove a negative. However, do you really think that reasonable people would disagree with you if you could prove your case? C’mon. What you do is a bunch of double-talk, really nothing to it, pulling stuff out of thin air and elsewhere. Trying to figure out the anti-vaccine point is like herding cats.

    You mentioned malpractice…I agree, not thinking of meningitis was a mistake. However consciously providing inappropriate care to your patients and your community, based on an unsupported theory that makes you money on the side is reprehensible. As the number of vaccine preventable disease cases increase, you will eventually be held to the standard expected of a physician. (I mean, after all, you have put yourself out there as a medical expert on vaccines.) The forum, however, won’t be on a blog or in your clinic preaching to your choir, or on this blog disingenuously saying your trying to learn, the forum will be in a court of law testifying to a jury. Don’t worry; no one will call you a poopoohead. In fact, they/we will demand a clear…a very clear… explanation as to what the proven risks of vaccines are that effectively justify people being hurt and killed and effectively balance the draining of public health resources. It won’t be enough to just say you know. The discussion won’t end until you either prove your case or disgracefully admit you can’t.

    Get your thoughts together, you may be asked to support, (specifically), your dangerous advice. Karma is a bitch.

  96. #96 Terrie
    June 5, 2009

    Jay, your answer has nothing to do with my statement. Again, we do not recommend that people get vaccines for diseases that are low risk to appear and spread in the United States. We have eliminated previously offered vaccines where the benefits were too small to justify continuing (cholera), despite the fact that Wyath produced the vaccine and was likely making money off it. IF the claim that our vaccine schedule is driven by profit margins is true, why aren’t rabies vaccines part of childhood shots? After all, it would seem the perfect vaccine to push. Rabies is a horrific disease, is prevalent even in the United States and children are especially high risk because they are more likely to ignorantly handle wild or stray animals and less likely to report a minor bite or scratch.

    In what way is the medical field not following your idea that unneccesary vaccines should not be given?

  97. #97 Dianne
    June 5, 2009

    And why, James Sweet, did we stop giving the small pox vaccine? And why do we use the yellow fever vaccine and many others so selectively? Because the risk of the diseases is very small and the vaccines carry significant risk.

    The small pox vaccine is no longer routinely given* because the disease no longer exists in the wild–thanks to vaccination. If more people had followed your advise we’d still be giving it.

    *It is still sometimes recommended for people in health care because of the risk of bioterrorism exposures.

  98. #98 Chris
    June 5, 2009

    Dr. Jay, you should read this most recent article by a real infectious disease doctor:
    Herd Immunity

    (different Chris than the one above)

  99. #99 Tsu Dho Nimh
    June 5, 2009

    Dr Jay … you didn’t answer this one from D.C. Sessions. What are the optimal levels that balance high risk and low risk? How do you know this?

    The control algorithm you have described requires a setpoint, a level of disease prevalence that separates “low risk” from “high risk” and invokes measures against the disease.

    So, please, do tell us what you consider the optimal prevalence for the following diseases:

    * measles
    * polio
    * mumps
    * rubella
    * pertussis
    * HIB
    * hepatitis B
    * diptheria
    * seasonal influenza
    * pneumoccal disease

    I’d also like to know where you would have drawn the line on smallpox. What prevalence for it would have been low enough to stop the effort to eradicate it?

    Jay says … And why, James Sweet, did we stop giving the small pox vaccine? And why do we use the yellow fever vaccine and many others so selectively? Because the risk of the diseases is very small and the vaccines carry significant risk. Genius.

    We stopped giving the smallpox vaccine because universal vaccination and cordon sanataire quarantines drove the virus into extinction, country by country, hemisphere by hemisphere. After the USA stopped giving vaccines routinely to kids, they still required it for travelers leaving/coming into the US.

    Yellow fever is a very risk-free vaccine, with very high effectiveness, and given widely in places where there are … you know, monkeys that carry it and mosquitoes capable of spreading it from monkeys to people and people to people. It’s required for entry to quite a few countries where it could get a foothold if an infected person brought it in.

  100. #100 Parental Choice
    June 5, 2009

    “Tell me, under what criteria should untrained, unqualified, irrelevantly experienced people get to hold judgement over widely recognised experts like Offitt and expect to be taken seriously”?

    Well, it is pretty sad when “untrained, unqualified, irrelevantly experienced people” are able to see right through Dr. (Pr)Offit’s nonsense. You see, the title of Dr. (Pr)Offit’s article to which the 10,000/100,000 vaccinations comment comes from is entitled:

    “Addressing Parents’ Concerns: Do Multiple Vaccines Overwhelm or Weaken the Infant’s Immune System”?

    Now, everyone wants to suggest and discuss well, he meant antigens… He didn’t mean vaccines, blah, blah, blah… Well, minimally it’s good news that anyone with a heartbeat knows that injecting babies with 10,000 or 100,000 vaccines would either a) Kill a child or b) Cause serious injuries.

    The question remains why would Dr. (Pr)Offit be either intentionally misleading or completely incompetent in contributing to such a terrible article?

  101. #101 ababa
    June 5, 2009

    As you said, it’s antigens not vaccines. Antigens may be a single virus. 100,000 vaccines would be more volume than the child themselves. Injecting water in that volume would kill someone just as quickly. However, if you were able to obtain a single antigen from 100,000 different vaccines – sure no problem. A vaccine obviously has more than a single instance of an antigen, enough to obtain the desired response from the immune system.

    It’s only misleading to dummies or the intentionally obtuse. Thanks for demonstrating.

  102. #102 bozzy
    June 5, 2009

    This child’s case is being exploited by feeble journalists and others. I would expect better from you.

    Jay

    Geez, if this child is being exploited, what degree of exploitation is Jenny’s boy experiencing?

  103. #103 Dedj
    June 5, 2009

    “Well, it is pretty sad when “untrained, unqualified, irrelevantly experienced people” are able to see right through Dr. (Pr)Offit’s nonsense.”

    You were not asked what you think. You were asked why anyone should take you claim that you know more than him seriously.

    Whether you think he is talking nonsense is an opinion that has no value until you prove it to have value.

    “You see, the title of Dr. (Pr)Offit’s article to which the 10,000/100,000 vaccinations comment comes from…..Now, everyone wants to suggest and discuss well, he meant antigens… He didn’t mean vaccines, blah, blah, blah…”

    Well, he discusses what he meant in the original paper. It’s easily available online. You can get round to reading it anytime you want. If you’re thinking he means shots then you clearly haven’t read the (easily available and well written with the maths on show) original paper.

    Stop pretending that you have done so.

    “Well, minimally it’s good news that anyone with a heartbeat knows that injecting babies with 10,000 or 100,000 vaccines would either a) Kill a child or b) Cause serious injuries.”

    Unless they’re an expert who has actually studied this.

    You know, like Offitt.

    “The question remains why would Dr. (Pr)Offit be either intentionally misleading or completely incompetent in contributing to such a terrible article?”

    You have to prove that he made a false statement first.

    All we have seen so far is egotistic (ZOMG! I’m soooo brainy!) slandering devoid of any factual challange.

    Stop wasting our time here.

    You will return with either an apology for your actions, or a factual challenge.

    YOU are NOT a well recognised expert with a clearly written paper detailing mathmatically how you reached your conclusion. Offitt is.

  104. #104 Joseph
    June 5, 2009

    Thought you might relish the knowledge that our son had his first set of vaccinations (two-month appointment, first time that the vaccinations can be given, save for the Hep-B (?) that he got on his first or second night on the outside).

    Doin’ our part for the herd, even if it contains sheep. ;)

  105. #105 Joseph
    June 5, 2009

    Thought you might relish the knowledge that our son had his first set of vaccinations (two-month appointment, first time that the vaccinations can be given, save for the Hep-B (?) that he got on his first or second night on the outside).

    Doin’ our part for the herd, even if it contains sheep. ;)

  106. #106 Joseph
    June 5, 2009

    Sorry for the double-post; accidentally reloaded while the comment was submitting (and taking forever to do so, I might add).

    In the intervening time, I realized you might find our pediatrician’s office’s policy on vaccinations. Basically, it can be paraphrased as, “Although you legally have the right to not vaccinate your kid, to protect the kids here, if you do, you can’t get them seen here.” wewt. :)

  107. #107 dean
    June 5, 2009

    “Its not the vaccines Dr. Gordon. You are causing harm. I have no idea how you live with yourself.”

    As long as his website gets hits and he gets money, he doesn’t care.

  108. #108 Parental Choice
    June 5, 2009

    “It’s only misleading to dummies or the intentionally obtuse. Thanks for demonstrating”.

    Oh really? Ok, smartass… why did Dr. (Pr)Offit write or approve of the title of the article? Again the title which reads… “Addressing Parents’ Concerns: Do Multiple Vaccines Overwhelm or Weaken the Infant’s Immune System”? Basically, you are saying that he MEANT antigens… so why the confusing title? Again though… Let’s be clear that we are in agreement that 10,000 vaccines would likely KILL a baby… Why don’t you tell me what the cutoff would be between the number of vaccines (not antigens) which is safe and effective and the number of vaccines which could seriously INJURE/KILL a baby?

    Again, Dr. (Pr)Offit either intentionally misled the general population of parents and their ignorant pediatricians who hang on every word he speaks/writes or is simply a pathetic author. The problem here is… It isn’t me who falls for his crap, it’s the other 99% of the population who will listen to him and actually believe his nonsense.

  109. #109 Scott
    June 5, 2009

    Perhaps you would care to explain how you get “10,000 vaccines” out of the title? (Hint: you can’t.) Or how you can get the number “10,000” out of the paper AT ALL, except in explicit reference to antigens? (Hint: you can’t.)

    It’s really quite simple. The paper does not, and cannot in any possible way to be construed, to say ANYTHING like what you claim. The ONLY way to get to “10,000 vaccines” is to DELIBERATELY misinterpret it. So either you’re (a) lying through your teeth or (b) mindlessly parroting the lies of somebody *else* lying through their teeth, without bothering to think about them at all, much less do any cursory fact-checking.

    “Why don’t you tell me what the cutoff would be between the number of vaccines (not antigens) which is safe and effective and the number of vaccines which could seriously INJURE/KILL a baby?”

    In the paper. Read it.

  110. #110 Parental Choice
    June 5, 2009

    “Thought you might relish the knowledge that our son had his first set of vaccinations (two-month appointment, first time that the vaccinations can be given, save for the Hep-B (?) that he got on his first or second night on the outside).

    Doin’ our part for the herd, even if it contains sheep”.

    Good luck, Joseph! You know where to come when/if your child has an adverse reaction to his vaccines. Although I hope that does not happen… I also recognize that there is a darn good chance of it… Congrats on the baby!

    As for the paraphrased policy of your pediatricians office: Must be a pretty sick place there… Lots of allergies, neurological problems, autoimmune problems.

  111. #111 Scott
    June 5, 2009

    I also recognize that there is a darn good chance of it…

    As for the paraphrased policy of your pediatricians office: Must be a pretty sick place there… Lots of allergies, neurological problems, autoimmune problems.

    Care to provide any, you know, FACTS to back that up?

    (I expect the answer will be “no”, since by definition a false statement cannot be factually demonstrated.)

  112. #112 Parental Choice
    June 5, 2009

    “You were not asked what you think. You were asked why anyone should take you claim that you know more than him seriously”.

    Did I say that I know more than him? I don’t think so… I think that I said that he was a lying sack of shite. :)

  113. #113 Scott
    June 5, 2009

    Did I say that I know more than him? I don’t think so… I think that I said that he was a lying sack of shite. :)

    A meaningless, unjustified, and probably slanderous claim unless you also claim to have evidence to back it up. Which would necessarily imply a claim that you do know more (i.e. said evidence).

  114. #114 Joseph
    June 5, 2009

    “Congrats on the baby!” Thanks! He’s a real cutie. :)

    “Must be a pretty sick place there… Lots of allergies, neurological problems, autoimmune problems.” Actually, no. The only data I have to go off of is the sick vs well sections (well section is where you go for “well child” visits; “sick” is where you go otherwise). I don’t think I’ve seen anyone in the sick section, although the well section is usually pretty well-occupied. Not really a scientifically valid study, but it’s what I have to go off of.

  115. #115 ababa
    June 5, 2009

    Parental Choice bleated: Oh really? Ok, smartass…

    Yes really. Ok, dumbass…

    So he referred to “vaccines” in the title then made mention of antigens in the paper. Oh no, what ever shall we do! He simply can’t use the word “antigen” that when talking about a “vaccine”. It confuses the Simpleton.

    Injecting 10,000 doses of water (or anything) would “KILL a baby” too. The cutoff would be somewhere prior to injecting the volume equal to the size of the child. I’m sorry that you seem to be incapable of figuring out that on your own.

    I don’t see 99% of the population lining up to inject 10,000 times the recommended dose because this paper confused them. What’s your point again?

    Oh that’s right, you want to nitpick small, irrelevant details because you know you are full of crap.

  116. #116 Chris
    June 5, 2009

    Because Parasitic Choice will not or cannot read the article for comprehension. Here is the free link to it:
    http://pediatrics.aappublications.org/cgi/content/full/109/1/124

    The pertinent quotes:

    A more practical way to determine the diversity of the immune response would be to estimate the number of vaccines to which a child could respond at one time. If we assume that 1) approximately 10 ng/mL of antibody is likely to be an effective concentration of antibody per epitope (an immunologically distinct region of a protein or polysaccharide),39 2) generation of 10 ng/mL requires approximately 103 B-cells per mL,39 3) a single B-cell clone takes about 1 week to reach the 103 progeny B-cells required to secrete 10 ng/mL of antibody39 (therefore, vaccine-epitope-specific immune responses found about 1 week after immunization can be generated initially from a single B-cell clone per mL), 4) each vaccine contains approximately 100 antigens and 10 epitopes per antigen (ie, 103 epitopes), and 5) approximately 107 B cells are present per mL of circulating blood,39 then each infant would have the theoretical capacity to respond to about 10 000 vaccines at any one time (obtained by dividing 107 B cells per mL by 103 epitopes per vaccine).

    and an explanation of how many actual vaccines:

    Of course, most vaccines contain far fewer than 100 antigens (for example, the hepatitis B, diphtheria, and tetanus vaccines each contain 1 antigen), so the estimated number of vaccines to which a child could respond is conservative. But using this estimate, we would predict that if 11 vaccines were given to infants at one time, then about 0.1% of the immune system would be “used up.”

  117. #117 Prometheus
    June 5, 2009

    Reading comprehension is a skill that is not emphasized enough in schools.

    Of course, if you don’t read the material, it’s exceedingly hard to comprehend it.

    DSL Internet connection: $45 a month

    Cost to read a whale.to rant about Dr. Offit: free

    Getting your butt handed to you because you were so darn sure (and arrogant) about something that wasn’t true: Priceless.

    Prometheus

  118. #118 Parental Choice
    June 5, 2009

    “I don’t think I’ve seen anyone in the sick section, although the well section is usually pretty well-occupied. Not really a scientifically valid study, but it’s what I have to go off of”.

    LOL! Clearly a new parent. Children with neurological problems/autoimmune problems wouldn’t be directed to the “sick” section simply due to their long term medical/developmental concerns.

  119. #119 Parental Choice
    June 5, 2009

    So, Dr. (Pr)Offit sets out to try to ease the minds of parents/pediatricians by explaining to them why having multiple vaccines at one time does not affect the immune system… but in fact, he does no such thing as he doesn’t include the other factors which are in a vaccine (aluminum, etc)… So, basically what you are telling me is that this article is of no relevance whatsoever in terms of the number of vaccines that can safely be given to babies? Sounds about right. Dr. (Pr)Offit misleading people again…

    How many VACCINES (not antigens) can a baby tolerate at a given time?

  120. #120 Chris
    June 5, 2009

    Parasitic Choice ranted

    How many VACCINES (not antigens) can a baby tolerate at a given time?

    According to the article the number of antigens that would be in 10000 vaccines, and continues with:

    But using this estimate, we would predict that if 11 vaccines were given to infants at one time, then about 0.1% of the immune system would be “used up.”

    How does that compare to the level of microbes you breathe or consume per day?

  121. #121 Joseph
    June 5, 2009

    “Children with neurological problems/autoimmune problems wouldn’t be directed to the “sick” section simply due to their long term medical/developmental concerns.”

    Could be–I’m hardly a professional–but I don’t think so. Especially when it’s not yet diagonsed. But regardless, it’s the only piece of hard data that I can get my hands on, so it’s what we have to go off of.

  122. #122 D. C. Sessions
    June 5, 2009

    So either you’re (a) lying through your teeth or (b) mindlessly parroting the lies of somebody *else* lying through their teeth, without bothering to think about them at all, much less do any cursory fact-checking.

    I’m inclined to vote for Hanlon’s Razor.

  123. #123 Dedj
    June 5, 2009

    “Did I say that I know more than him? I don’t think so… I think that I said that he was a lying sack of shite. :)

    Which means you think he’s wrong, and that you know how.

    So yes, you are saying you know better than him.

    Anyway. From reading the original paper, Offitt lays out the exact calculation that derived his figure. In it, he is always referring to antigen load per vaccine. This would be obvious to you if you had actually read and comprehended the original paper.

    Offitt was clearly talking about antigen load. He did not answer the question about aluminum load etc because that wasn’t the point of the paper, nor was it the claim he was trying to address, nor could he have answered it without knowing the content of the ‘shots’.

    He does not at any point state that infants can take 10000 ‘shots’ at once. This would be utter madness as the fluid content alone would kill the average baby. The fact that this claim is so idiotic should have given you pause in attributing it to a recognised expert like Offitt.

    The most reasonable course of action would have been to assume that you – the unqualified, inexperienced, non-expert got it wrong – and that he wasn’t actually saying that.

    It’s pure arrogance of you to think that you’ve seen the obvious, yet a qualified, experienced and respected expert like Offitt hasn’t.

    You should be ashamed of yourself.

  124. #124 Jay Gordon, MD, FAAP
    June 5, 2009

    Answering a few questions posed above:

    The AAP, like any other union, attempts to get the best compensation, working conditions and public regard possible for its members. Certainly most of the members and leadership are devoted to promoting optimal care for America’s children. But, this is not the sole nor primary goal of any union including the AAP.

    My DVD sales are OK but not great, thanks for asking. The information on the DVD is good enough but I think we need to promote it far better.

    Yellow fever vaccination is not risk free. Every doctor here has seen some harsh reactions to this vaccines. It must be given for certain travel destinations, though.

    Bozzy, excellent question. I think that Evan’s mother has decided that she can help many other children by making her son’s situation public. I think most of you here disagree. However, the degree of vitriol and vituperation towards someone you don’t know and whose motivations you can only guess at is excessive.

    Best,

    Jay

    Dr. Gordon, as a Fellow of the AAP, what is your opinion on the implication by Jenny McCarthy’s beau, among others, that the AAP has an agenda aligned with “Big Pharma” (presumably profit motivated), as opposed to providing the best health care possible for our nation’s young people? As an AAP member, shouldn’t such an accusation be an affront to your professional ethics and your oath as a doctor?

    Or does your conscience get in the way, knowing that you are in no position to contradict the claim. How are the sales of that DVD coming along?

    Yellow fever is a very risk-free vaccine, with very high effectiveness, and given widely in places where there are … you know, monkeys that carry it and mosquitoes capable of spreading it from monkeys to people and people to people. It’s required for entry to quite a few countries where it could get a foothold if an infected person brought it in.

    Geez, if this child is being exploited, what degree of exploitation is Jenny’s boy experiencing?

  125. #125 One GROSS mistake
    June 5, 2009

    There was NO outbreak of polio among the Amish. that is a gross distortion of the facts.

    And at least you have the decency to ACKNOWLEDGE that the shortage is probably contributing alot to the reduce herd immunity. That’s more than some of you do. Even the CDC and AAP look towards the shortage as the greater culprit.

    I would have been pulled into the this store more if the child had not been vaccinated and had not already had an immune difficiency disorder. With that, it’s VERY difficult to prove that had HIB rates been the same pre-shortage that she might not have gotten as sick. And without clear figures on Minn. vaccine uptake rate and changes, it becomes hard to say for sure that a sigficant decline made her more vulnerable.

  126. #126 D. C. Sessions
    June 5, 2009

    Jay, the tag you need is <blockquote>text</blockquote>

  127. #127 Scott
    June 5, 2009

    And at least you have the decency to ACKNOWLEDGE that the shortage is probably contributing alot to the reduce herd immunity. That’s more than some of you do. Even the CDC and AAP look towards the shortage as the greater culprit.

    You entirely miss the point. These events demonstrate what happens when vaccination rates fall, *whatever the reason.* This time, a shortage was a contributing factor. But if the antivax brigade has its way, such occurrences will become commonplace.

  128. #128 K
    June 5, 2009

    @ Jay: So it’s OK for Jenny to talk about her child and tell stories about him and his poop and whatever else in her books and online and on Larry King for the world to see, but a parent who wants the story of her child to get out so that others will see the importance of vaccinating is contributing to the exploitation of said child? Bit of a double standard, wouldn’t you say?

    Please clarify for me how you see these two things as different and specifically show me how the MN mom was worse.

    And please don’t say you meant only Orac and journalists were exploiting the child; clearly the mother wanted this story to be told.

    Oh, and I think you forgot to include something in your previous reply. I really want to hear your Hib vaccination protocol where you tell us how the US and world should determine who needs to receive the Hib vaccine and who doesn’t.
    Thanks!

  129. #129 D. C. Sessions
    June 5, 2009

    Oh, and I think you forgot to include something in your previous reply. I really want to hear your Hib vaccination protocol where you tell us how the US and world should determine who needs to receive the Hib vaccine and who doesn’t.

    Do you think he could combine that with his answer on what the correct number of HiB cases should be each year? Remember, he’s told us that if there are too few cases we should reduce vaccination rates to bring them back up to the desired level.

    Unfortunately, he hasn’t disclosed what the ideal prevalence is.

  130. #130 Scott
    June 5, 2009

    I ought to use preview more, sorry. Only “This” was supposed to be italicized.

  131. #131 Joseph
    June 5, 2009

    How many VACCINES (not antigens) can a baby tolerate at a given time?

    Water is probably what will kill you first. Let’s say a baby can only tolerate 1 liter of water, and there’s 1 mL in each vaccine. Then 1,000 vaccines would be the limit.

    If it’s a thimerosal containing vaccine, 1,000 vaccines would contain 25 milligrams of thimerosal. A guy once ingested 5 grams. Let’s say this is equivalent to 250 milligrams for a baby. So with 1,000 vaccines, the baby would be getting 10 times less than the guy, adjusted for weight. I don’t think the thimerosal would kill the baby, but the water might.

  132. #132 D. C. Sessions
    June 5, 2009

    If it’s a thimerosal containing vaccine, 1,000 vaccines would contain 25 milligrams of thimerosal. A guy once ingested 5 grams. Let’s say this is equivalent to 250 milligrams for a baby. So with 1,000 vaccines, the baby would be getting 10 times less than the guy, adjusted for weight. I don’t think the thimerosal would kill the baby, but the water might.

    Bear in mind that back in the 30s, they administered thimerosal internally for infections. Adult doses on the order of 2000 mg had no particular neurological symptoms.

    I wouldn’t worry about the water nearly so much as the number of needle sticks, by the way. A hundred is a lot of holes in a little baby.

  133. #133 AnnR
    June 5, 2009

    http://voices.washingtonpost.com/celebritology/2009/06/oprah_–_hazardous_to_your_hea.html

    If you stay on these things long enough it makes it’s way into the mainstream.

    So stick with it!

  134. #134 gaiainc
    June 5, 2009

    The simple statement “The AAP, like any other union” seriously makes me wonder if that person is a doctor or if he has a very warped sense of what a union is. Medical organizations are not unions. If they were, health care in the US might look different than what we have now.

    I’ve also come to the inescapable conclusion that if the success of the Hib, polio, and smallpox vaccines not enough to convince Dr. Gordon that vaccines should be given to all children who do not have a medical exemption, then nothing ever will be. Theoretical risks of autism do not scare me. Invasive Hib disease, measles, polio, smallpox, diptheria, tetanus, and pertussis do. Autism is not a fatal disease. All the others are. Yes, the vaccines have risks to them, but they pale to insignificance when compared to the risk of not immunizing. That is my risk/benefit analysis conclusion.

  135. #135 PharmGirl MD
    June 5, 2009

    Orac,

    Thanks for keeping on top of the importance of vaccination in public health. With the way that the medical system evolved in the US, individual medical care (“curative medicine”) and care of the public as a whole (often “preventive medicine”) diverged sharply in the early 1900’s, with the result that we take for granted things like potable water, functioning sewer systems, and freedom from deadly childhood illnesses. PBS made an excellent documentary about a formerly terrifying childhood illness — polio — which was rendered nearly non-existent by vaccines. It also relates some of the REAL side effects that can occur due to vaccine contamination — not due to a vaccine or its preservatives.

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

  136. #136 Matthew Cline
    June 5, 2009

    “Addressing Parents’ Concerns: Do Multiple Vaccines Overwhelm or Weaken the Infant’s Immune System”?

    Now, everyone wants to suggest and discuss well, he meant antigens… He didn’t mean vaccines, blah, blah, blah… Well, minimally it’s good news that anyone with a heartbeat knows that injecting babies with 10,000 or 100,000 vaccines would either a) Kill a child or b) Cause serious injuries.

    One of the concerns that parents have over the vaccine schedule is that having too many vaccines at once will overwhelm or weaken a baby’s/child’s immune system. Since what the immune system responds to is antigens, Offit talked about the ability of the baby’s/child’s immune system to handle antigens. The “toxins” in the vaccine is a separate question, so in his paper Offit only addresses antigen loads.

  137. #137 Jay Gordon, MD, FAAP
    June 5, 2009

    Pharmaceutical companies either directly or indirectly pay people to post on blogs like this. It’s illegal not to disclose if you are doing this.

    (Orac: “Aah, the Pharmashill gambit.” Baloney, Orac. It’s real and you know it!)

    Best,

    Jay

    http://tinyurl.com/crwdbe

    http://tinyurl.com/crcqoc

    http://tinyurl.com/mllnqb

    http://tinyurl.com/lpth3t

    http://tinyurl.com/d9q9hj

  138. #138 Scrabcake
    June 5, 2009

    Parental_choice, could you STFU please? Your dumb comments and their replies are disrupting my enjoyment of this thread by making me skim every post before I read it to ensure that it is stupid-free with no traces of troll-food.

  139. #139 Joseph
    June 5, 2009

    FYI, post #117

    117

    How many VACCINES (not antigens) can a baby tolerate at a given time?

    Water is probably what will kill you first. Let’s say a baby can only tolerate 1 liter of water, and there’s 1 mL in each vaccine. Then 1,000 vaccines would be the limit.

    If it’s a thimerosal containing vaccine, 1,000 vaccines would contain 25 milligrams of thimerosal. A guy once ingested 5 grams. Let’s say this is equivalent to 250 milligrams for a baby. So with 1,000 vaccines, the baby would be getting 10 times less than the guy, adjusted for weight. I don’t think the thimerosal would kill the baby, but the water might.

    Posted by: Joseph | June 5, 2009 6:55 PM”

    must be a different Joseph; it’s not me (I’m the guy with the baby). :)

  140. #140 Tsu Dho Nimh
    June 5, 2009

    Jay – You still haven’t answered DC’s question in #48. Given that you want to stop vaccinating when the risk is “low”, what prevalence do you consider acceptable, and why?

  141. #141 Joseph
    June 5, 2009

    must be a different Joseph; it’s not me (I’m the guy with the baby). :)

    Sorry, but I was here first :)

    There’s also Joseph C.

  142. #142 Jay Gordon, MD, FAAP
    June 5, 2009

    Tsu Dho, nine.

    Best,

    Jay

  143. #143 Chris
    June 5, 2009

    Dr. Jay, how did you come up with that number? And why do you think it is a good number? What are your references?

  144. #144 D. C. Sessions
    June 5, 2009

    Tsu Dho, nine.

    OK, that’s a fair answer. Historically in line with the death tolls from childhood diseases prior to vaccines, too — diphtheria took one child in ten prior to the age of ten a hundred and fifty years ago, with measles having a similar body count. One in nine would be in line with your “no vaccines” position.

    So now we can discuss the level of “acceptable risk” that you think parents should accept.

  145. #145 The Other Other Joseph
    June 6, 2009

    must be a different Joseph; it’s not me (I’m the guy with the baby). :)

    Sorry, but I was here first :)

    There’s also Joseph C.

    Right. I think I’ve found a solution to split the degeneracy. :)

  146. #146 Matthew Cline
    June 6, 2009

    If you stop vaccinating when the prevalence has reached 9%, wouldn’t the prevalence rise again, so you’d start vaccinating again, so it goes below 9% again, and so on? Wouldn’t reaching a stable point require slowly ramping down the vaccination rates as the prevalence decreases, rather than stopping completely at a certain cut-off point?

  147. #147 Chris
    June 6, 2009

    Matthew Cline

    f you stop vaccinating when the prevalence has reached 9%,

    Wait, I just saw Dr. Jay write “Tsu Dho, nine.” … is that nine, as in a a scalar number of nine who get the disease, or as you assumed 9% ? Whatever it is, I would like to see the documentation.

  148. #148 Parental Choice
    June 6, 2009

    “Could be–I’m hardly a professional–but I don’t think so. Especially when it’s not yet diagonsed. But regardless, it’s the only piece of hard data that I can get my hands on, so it’s what we have to go off of”.

    Come back to me when you’ve been a parent for over 5 years. Clearly, you are confused about the ‘sick’ area of a pediatricians office.

  149. #149 D. C. Sessions
    June 6, 2009

    If you stop vaccinating when the prevalence has reached 9%, wouldn’t the prevalence rise again, so you’d start vaccinating again, so it goes below 9% again, and so on? Wouldn’t reaching a stable point require slowly ramping down the vaccination rates as the prevalence decreases, rather than stopping completely at a certain cut-off point?

    Dr. Gordon is a true Renaissance man. His expertise in virology, epidemiology, and neurology outshines others in each of those fields, but few suspected his knowledge of control theory as well.

    Since that is something I do professionally, I am intrigued by his proposal to implement a closed-loop control protocol in a system with highly nonlinear response and a latency of years.

  150. #150 Parental Choice
    June 6, 2009

    “Since what the immune system responds to is antigens, Offit talked about the ability of the baby’s/child’s immune system to handle antigens. The “toxins” in the vaccine is a separate question, so in his paper Offit only addresses antigen loads”.

    When should we expect the paper to come out in regards to the TOXINS? Obviously that is a very big concern. So, now why don’t you go and read the press release on the paper that Dr. (Pr)Offit wrote. You can read it here:

    http://www.newswise.com/articles/view/?id=VACINE.CHP

    Pay special attention to how many times they use the word vaccines (or immunizations) is used as compared to how many times the word ‘antigen’ comes up? Keep in mind that the title of the paper (and this press release) has to do with ‘parental concerns’ regarding VACCINES. This was not a real scientific study using monkey’s and test tubes, etc… This was an article whose purpose was to ‘inform/educate’ (I use that term loosely) parents. How many parents who read that press release or whose pediatricians used the article as backup information to push vaccines on their patients… know anything about antigens, etc. etc…. Come on now.

    Let’s regroup. The main purpose of the article was to confuse parents (and peds) into believing that it was safe to inject babies with multiple VACCINES. Period. End of story. You will have to decide whether Dr. (Pr)Offit: a) intentionally misled people b) mistakenly misrepresented the information or c) is a big fat liar. Your choice. There are no other options.

  151. #151 Orac
    June 6, 2009

    Dr. Jay, your invocation of the “pharma shill” gambit annoyed me enough that it merited a response in a post:

    http://scienceblogs.com/insolence/2009/06/orac_gets_comments_dr_jay_tries_the_phar.php

  152. #152 Dedj
    June 6, 2009

    “Your choice. There are no other options. ”

    Or you can read the actual paper.

    Until you have done so and demonstrated that you have understood it, it would be best for you to shut your mouth and stop making yourself look like an idiot with an agenda.

    It is clearly laid out exactly what was meant by ‘vaccines’ in the original paper, and exactly what concern the paper was trying to address.

    But I guess you’d rather just play pedantic word games and lie through your teeth.

    Pathetic.

  153. #153 D. C. Sessions
    June 6, 2009

    If you stop vaccinating when the prevalence has reached 9%, wouldn’t the prevalence rise again, so you’d start vaccinating again, so it goes below 9% again, and so on? Wouldn’t reaching a stable point require slowly ramping down the vaccination rates as the prevalence decreases, rather than stopping completely at a certain cut-off point?

    Dr. Gordon is a true Renaissance man. His expertise in virology, epidemiology, and neurology outshines others in each of those fields, but few suspected his knowledge of control theory as well.

    Since that is something I do professionally, I am intrigued by his proposal to implement a closed-loop control protocol in a system with highly nonlinear response and a latency of years.

  154. #154 D. C. Sessions
    June 6, 2009

    Until you have done so and demonstrated that you have understood it, it would be best for you to shut your mouth and stop making yourself look like an idiot with an agenda./blockquote>

    Personally, I kind of prefer truth in advertising.

  155. #155 Nico
    June 6, 2009

    I was in and out of hospital as a kid for asthma, and saw many a kid with Hib get admitted, one who’d appeared at the ER with a mild fever and was airlifted to a major trauma center a mere 4 hours later, in a coma. A few of us older patients watched from the corridor as the staff sounded extremely terrified for this boy’s life, of the speed at which the infection was moving.

    I remember the advent of the new vaccine and how the Hib infection rate dropped to almost nil.

    I can’t fathom why, of all the communicable diseases one would risk, is this one, because it moves SO fast.

  156. #156 Joseph
    June 6, 2009

    “Come back to me when you’ve been a parent for over 5 years. Clearly, you are confused about the ‘sick’ area of a pediatricians office.”

    *shrug* Could be. OTOH, I won’t be “coming back” to you; I wasn’t coming to you in the first place, and almost every comment from you has been snarky and condescending. Nein, danke.

  157. #157 Nico
    June 6, 2009

    Joseph, I think you just got hit with a variant of the “well, you’re not a parent” platitude. Now you have to have a certain number of years under your belt AS a parent.

    That ye old herd immunity saved my life because I couldn’t be vaccinated at various points due to the immunosuppresants I was on. Viva la herd, baby.

    Any pediatrician who spoke to me of anti vaxing and “acceptable infection rates” would have me running for the door. I can’t take Mr. Gordon’s blather seriously, because I just find it so utterly at odds with all known logic.

    He’ll say, well, I’m not a doctor! But I’ll spare him the breath and say anyone who still holds on to the old autism/vaccine canard and willfully thinks non vaccinating is ok, isn’t much of one either.

    I’ve seen what non-vaccinating can do. I’ve experienced it.My sister carted home chicken pox which led to one of the more severe medical panics for me, because I was on high dose prednisone then. Not exactly a benign inconvienience of a mere fever and rash for me.

  158. #158 The Other Other Joseph
    June 6, 2009

    “Joseph, I think you just got hit with a variant of the “well, you’re not a parent” platitude. Now you have to have a certain number of years under your belt AS a parent.”

    Meh, even if my interpretation of “sick” vs “well” rooms were right (and it’s likely not), the data’s still crap. I mean, I’ve only been there a handful of times. That’s an error of, what, 1/sqrt(4) = 50%? :)

    Still, it’s the only data we have, and it (for the little it’s worth) doesn’t support PC’s hypothesis. The hypothesis itself is entirely testable, though, and PC actually brings up an interesting point; has a study been done that compared pediatricians with and without such a policy in place (preventable illness, allergy, autism incidences)? There are certain to be confounding influences if a correlation is proven, but it’s still a hard data. Might also be interesting to see same data on pediatricians’ offices with such a policy as a function of time, to see how the rates change after the policy is in places. There are *definite* confounding influences there, since the policy is related to the anti-vax movement, but it’d be interesting.

  159. #159 Jay Gordon, MD, FAAP
    June 6, 2009

    Not much sense of humor in this room.

    Four. Centigrade.

    Jay

  160. #160 Jay Gordon, MD, FAAP
    June 6, 2009

    And by the way, while you nasty, inexperienced theoreticians toss insults back and forth, we working pediatricians have to deal with an extremely real epidemic of autism.

    My concern for that huge problem is far greater than my concern about your theories about measles epidemics

    None of your numbers, pharma-shilled studies and politically-influenced court decisions amount to a thimbleful of proof that vaccines don’t increase the incidence of autism.

    Until that proof is found, I will worry about the very real epidemic of spectrum disorders while you concern yourself about theories.

    Jay

  161. #161 Matthew Cline
    June 6, 2009

    Until that proof is found, …

    What sort of proof would convince you that your clinical experience has mislead you? Obviously it would have to be studies funded by neither pharmaceutical companies nor the government (which leaves the question of who would fund it), but other than that what would you require?

    And not everyone here has been insulting you. I mean, I’m pretty sure I haven’t insulted you; I apologize if I have.

  162. #162 sad
    June 6, 2009

    You entirely miss the point. These events demonstrate what happens when vaccination rates fall, *whatever the reason.*

    No, YOU miss the point. You all are leaping towards blaming non/selective vaccinating parents RIGHT now for something that is not necessarily something they are accountable for. You CANNOT separate shortage from those parents and it is wrong of you and VERY unscientific of you to do so. I don’t hear any blame towards Merck for blowing it, for creating a faulty product. I just hear the blame for parents. And THAT is wrong.

  163. #163 sad
    June 6, 2009

    You entirely miss the point. These events demonstrate what happens when vaccination rates fall, *whatever the reason.*

    No, YOU miss the point. You all are leaping towards blaming non/selective vaccinating parents RIGHT now for something that is not necessarily something they are accountable for. You CANNOT separate shortage from those parents and it is wrong of you and VERY unscientific of you to do so. I don’t hear any blame towards Merck for blowing it, for creating a faulty product. I just hear the blame for parents. And THAT is wrong.

  164. #164 isles
    June 6, 2009

    “Dr. Jay” says in comment #123:

    “Pharmaceutical companies either directly or indirectly pay people to post on blogs like this.”

    Dude, where’s my check? Apparently, I’ve been a sucker to do this for free.

    Seriously…this is the clearest indication yet that “Dr. Jay” has departed Reality Ranch.

  165. #165 Nico
    June 6, 2009

    I find kids potentially dying of HiB or other related preventable diseases of childhood rather not a laughing matter, if that puts me in the unfunny category, I still think it’s better than a pediatrician with the time to post inanities and half truths, whilst perpetuating falsehoods and making light of the situation.

    Just sayin.

    “pharmashill: for when you’ve run out of logical statements to back your tenuous position on childhood medicine.”

  166. #166 Chris
    June 6, 2009

    Dr. Jay:

    we working pediatricians have to deal with an extremely real epidemic of autism.

    What epidemic of autism?

    While emergency department personnel, infectious disease specialists and public health professionals are dealing with increases in levels of pertussis and Hib, plus measles in certain areas. I can guarantee there is a special word for your kind uttered in San Diego’s public health folks, and in all the emergency departments who have to deal with very very sick kids.

  167. #167 Richard
    June 6, 2009

    Supposed epidemic of autism vs. real epidemic of Hib?

    Yeah, get stuffed, “Doctor” Jay.

  168. #168 Brian X
    June 7, 2009

    Jay:

    You know, far be it from me to remind you that putting all those letters after your name makes you look like a pretentious git, but “FAAP” looks like a bit of a freudian slip…

  169. #169 Terrie
    June 7, 2009

    Personally, I find the dehumanizing rhetoric of the “autism” community (which consists almost entirely of people without autism) to be much more frightening than any of their scare tactics about “epidemics.” It’s only a step or two away from the old “Put them in an institution and forget about them” mentality. Now, they’re saying if you don’t “rescue” your “real” child from the “prison” of autism, you might as well stick the kid in an institution and forget about them.

  170. #170 Dr. P
    June 7, 2009

    we working pediatricians have to deal with an extremely real epidemic of autism.

    Don’t attempt to turn this into a “real working guy vs. egghead”. type of argument;its not. the facts and the opinion of the vast majority of the medical community are against you. That includes most of us working pediatricians. Those who actually look into this issue in some detail like me and many others I’ve spoken with are frankly embarrassed to have to call you one of us.

  171. #171 Rogue Medic
    June 7, 2009

    And by the way, while you nasty, inexperienced theoreticians toss insults back and forth, we working pediatricians have to deal with an extremely real epidemic of autism.

    In the ranking of the authority of research, at the bottom is expert opinion. Since you claim to be an expert, but only capable of reciting anecdotal information, that refers to you.

    Your anecdotes are misleading. Most real pediatricians ignore your attempts to harm children.

    My concern for that huge problem is far greater than my concern about your theories about measles epidemics

    In other words, I, Dr. Gordon, will continue to pretend the problem is not a problem, until it is too big a problem to ignore.

    None of your numbers, pharma-shilled studies and politically-influenced court decisions amount to a thimbleful of proof that vaccines don’t increase the incidence of autism.

    Maybe there will never be proof that vaccines do not in some slight way affect autistic patients. What is clear, is that the risk from vaccines is dramatically less than the risk of avoiding vaccines.

    That is a word Dr. Gordon should be familiar with.

    Dramatically.

    Look at me, Dr. Gordon. I, Dr. Gordon, make noise. I, Dr. Gordon, do not make sense, but I am dramatic.

    Until that proof is found, I will worry about the very real epidemic of spectrum disorders while you concern yourself about theories.

    As long as you continue to demand that research be diverted from any real causes of autism, you are spreading this epidemic as well as your peers – Honest Jenny Killer McCarthy and the rest of Generation Revenue. You, and your peers, are probably the most dangerous people your patients will ever meet.

  172. #172 Pablo
    June 8, 2009

    The AAP, like any other union, attempts to get the best compensation, working conditions and public regard possible for its members.

    You must have some bizarre definition of “union” to consider the AAP an example of one. In what way is it?

    Moreover, can you provide me with some evidence to support your assertion that it has as a goal to get the best compensation, working conditions, and public regard possible for its members?

    I have been looking around the AAP website, looking for a mission statement, but all I find are statements like

    “Dedicated to the Health of All Children” – that’s the by-line

    The closest it might come is in the mission statement:
    “The mission of the AAP is to attain optimal physical, mental, and social health and well-being for all infants, children, adolescents, and young adults. To accomplish this mission, the AAP shall support the professional needs of its members.”

    Yes, it says it will support the professional needs of its members. However, it also says it does that “to accomplish the mission” of the optimal physical, mental, and social health and well-being. Thus, maximizing doctors income at the expense of children’s health is contrary to the mission of your organization.

    However, given the nature of your response, it sounds to me like you agree with Jim Carrey’s implication that the AAP is involved in a conspiracy with the drug companies. If so, why do you so boldly advertise your association with them? If you don’t agree with it, then have you ever mentioned it to him or his girlfriend?

  173. #173 Paul Murray
    June 9, 2009

    Quoting Dr. (Pr)Offit = immediate FAIL (along with a whole bunch of LOL’s)
    Just keeping things real.

    One of life’s little lessons that can come as a surprise to reasonably bright people is that most people – the majority of people – are just plain dumb. Pigshit stupid. Most of ‘em. It still shocks me.

  174. #174 Chris
    June 9, 2009

    Paul Murray, there is a reason while I call the person you quoted “Parasitic Choice.”

  175. #175 Paul Murray
    June 9, 2009

    Wouldn’t reaching a stable point require slowly ramping down the vaccination rates as the prevalence decreases, rather than stopping completely at a certain cut-off point?

    Naah – these kinds of networks are mathematically interesting – it’s not a linear relationship, more like how crystalisation progresses in a cooling liquid.

  176. #176 Chris
    June 9, 2009

    Erg… I meant to say: Paul Murray, there is a reason why I call the person you quoted “Parasitic Choice.”

    (remember do not post late at night!… I am proficient at grammatical errors, and I seem to only find them just as I hit “Post”)

  177. #177 Paul Murray
    June 9, 2009

    And by the way, while you nasty, inexperienced theoreticians toss insults back and forth, we working pediatricians have to deal with an extremely real epidemic of autism.

    Yeah, all those ERs and hospital wards full to overflowing with kids in immediate danger of being killed by a sudden attack of autism …

    Sorry – I was thinking of whooping cough. My bad.

    Still – why the epidemic now, do you suppose, when we’ve been vaccinating for half a century?

  178. #178 Shay
    June 9, 2009

    It can’t be much of a surprise that this is happening in Minnesota. Isn’t this the state that keeps re-electing Michelle Bachmann?

  179. #179 dean
    June 9, 2009

    “And by the way, while you nasty, inexperienced theoreticians toss insults back and forth, we working pediatricians have to deal with an extremely real epidemic of autism.

    My concern for that huge problem is far greater than my concern about your theories about measles epidemics

    None of your numbers, pharma-shilled studies and politically-influenced court decisions amount to a thimbleful of proof that vaccines don’t increase the incidence of autism.

    Until that proof is found, I will worry about the very real epidemic of spectrum disorders while you concern yourself about theories.

    Jay”

    jay must be making a good living mistreating kids in order to internally justify making such stupid statements.

  180. #180 diatom
    June 30, 2009

    Pardon me, perhaps this has been addressed elsewhere, but I have to ask the obvious question, what’s up with the pharmaceutical co. adverts on this site? First it was Schering Plough, now it’s Sanofi Aventis……..

  181. #181 Scientizzle
    June 30, 2009

    The advertising for Scienceblogs is run by Seed Media Group (info here). Orac has no control over the adverts.

  182. #182 diatom
    June 30, 2009

    Interesting. So the Respectful Insolence site is “indirectly” receiving support from pharmaceutical companies via Seed Media Group.

  183. #183 Chris
    June 30, 2009

    And Orac still does not have any control over the adverts, and what he is paid by Seed pales in comparison to his real job as an oncologist/scientist at a university. Your Pharm shill gambit ploy has been noted, and will be duly ignored.

  184. #184 diatom
    June 30, 2009

    Closed minds shall ignore, as they are wont to do. What quaint phrases are used here, such as “pharma shill gambit”… To which definition of gambit do you refer? A remark intended to start a conversation or make a telling point? Or a calculated move?

    I made an observation. The lady doth protest too much, methinks. Calmez-vous.

  185. #185 dedicated lurker
    June 30, 2009

    The gambit is assuming that since Orac supports vaccination, he must be in the pay of big pharma.

    Using this logic, the Science-Based Medicine blog is in the pay of big vitamina, as their ads show up all the time there.

  186. #186 Chris
    June 30, 2009

    Actually, I “doth not protest” at all. I see you did not quite get my meaning: I was calling you an idiot.

  187. #187 Joseph
    June 30, 2009

    Interesting. So the Respectful Insolence site is “indirectly” receiving support from pharmaceutical companies via Seed Media Group.

    Considering how well web advertisements convert (not very well), and considering that web publishers are rarely even aware or have control of all the different advertisements that run on their sites, that’s really not so interesting.

    Nevertheless, if there were infomercial posts as part of the blog (like AoA has, for example) that would be different.

  188. #188 diatom
    June 30, 2009

    Chris, your subtle eloquence and astute observation are overwhelming indicators of……..

  189. #189 Chris
    June 30, 2009

    Like I care what you think. Look there is an ad with Dr. Oz on it, and another for Russian Brides on this page. What does your diatom sized brain say about that!

  190. #190 diatom
    June 30, 2009

    your rapier wit slays me

  191. #191 Fannin
    August 12, 2009

    From one of the “experts” (as opposed to the relative newcomers to vaccine denial) on the Mothering Dot Com board, today we get this opinion on Hib to a parent considering vaccinating for pertussis and Hib before putting her young baby in daycare: “It is funny! that so many moms are concerned about a bacteria which no one (including pediatricians) knew virtually nothing before they brought a vaccine for it on the market.”

    I note this because I have tended to think some of the respected oldsters of the anti-vaccine movement really truly don’t know any better. Maybe they genuinely fall into the “unskilled and unaware” category and honestly think they understand the PubMed literature better than most scientists do and much better than they do themselves. But there is no way that anyone with access to Google who has spent even the small amount of time that MDC “experts” brag about “researching” could possibly believe what this poster says here.

    I’m pretty misanthropic, but reading this is disillusioning all the same.

    If I were putting my baby in daycare much earlier than I was comfortable with (as the person starting the MDC thread is) and were trying to decide how best to protect my child from disease, and if I got a post like that from someone whose claims to expertise I trusted, then later on, when had I learned more about vaccination and realized the deceit and trickery involved in trying to get me to go along with their program, I would be enraged.

    For the sake of this woman’s child I hope she is too.

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