Respectful Insolence

i-e7a12c3d2598161273c9ed31d61fe694-ClassicInsolence.jpgAs I mentioned on Friday, I’m in Chicago right now attending the American College of Surgeons annual meeting, where I was until last evening. Unfortunately, I got back too late and was too tired to lay down some fresh Insolence, Respectful or otherwise. Fear not, though. I’ll get to it. In the meantime, here’s a blast from the past from the past. This post first reared its ugly head almost exactly three years ago; so if you haven’t been reading at least three years, it’s new to you.

By the way, even though this post is three years old, the problem described in it has only gotten worse in the interim.

I’m with Kevin, M.D. on this one. Not giving required vaccinations is akin to child neglect:

CHICAGO – State laws that make it easy for children to skip school-required vaccinations may be contributing to whooping cough outbreaks around the country, a study suggests.

All states allow children to be exempted from school immunization requirements for medical reasons — because they might have a bad reaction, for example, or have weak immune systems — and 48 states allow exemptions for personal or religious beliefs.

To get non-medical exemptions, some states require documentation, notarized paperwork and even visits to a local health department. In other states, parents merely have to sign an exemption letter.

Compared with stricter states, those with easy exemption policies had about 50 percent more whooping cough cases, according to the study. Also, about 50 percent more people got whooping cough in states that allowed personal-belief exemptions, compared with those allowing only religious exemptions, the study found.

Here’s the study:

Nonmedical Exemptions to School Immunization Requirements: Secular Trends and Association of State Policies With Pertussis Incidence

Saad B. Omer, MBBS, MPH; William K. Y. Pan, DrPH, MS, MPH; Neal A. Halsey, MD; Shannon Stokley, MPH; Lawrence H. Moulton, PhD; Ann Marie Navar, MHS; Mathew Pierce, JD, MPH; Daniel A. Salmon, PhD, MPH

JAMA. 2006;296:1757-1763.

Context: School immunization requirements have played a major role in controlling vaccine-preventable diseases in the United States. Most states offer nonmedical exemptions to school requirements (religious or personal belief). Exemptors are at increased risk of acquiring and transmitting disease. The role of exemption policies may be especially important for pertussis, which is endemic in the United States.

Objective: To determine if (1) the rates of nonmedical exemptions differ and have been increasing in states that offer only religious vs personal belief exemptions; (2) the rates of nonmedical exemptions differ and have been increasing in states that have easy vs medium and easy vs difficult processes for obtaining exemptions; and (3) pertussis incidence is associated with policies of granting personal belief exemptions, ease of obtaining exemptions, and acceptance of parental signature as sufficient proof of compliance with school immunization requirements.

Design, Setting, and Participants: We analyzed 1991 through 2004 state-level rates of nonmedical exemptions at school entry and 1986 through 2004 pertussis incidence data for individuals aged 18 years or younger.

Main Outcome Measures: State-level exemption rates and pertussis incidence.

Results: From 2001 through 2004, states that permitted personal belief exemptions had higher nonmedical exemption rates than states that offered only religious exemptions, and states that easily granted exemptions had higher nonmedical exemption rates in 2002 through 2003 compared with states with medium and difficult exemption processes. The mean exemption rate increased an average of 6% per year, from 0.99% in 1991 to 2.54% in 2004, among states that offered personal belief exemptions. In states that easily granted exemptions, the rate increased 5% per year, from 1.26% in 1991 to 2.51% in 2004. No statistically significant change was seen in states that offered only religious exemptions or that had medium and difficult exemption processes. In multivariate analyses adjusting for demographics, easier granting of exemptions (incidence rate ratio = 1.53; 95% confidence interval, 1.10-2.14) and availability of personal belief exemptions (incidence rate ratio = 1.48; 95% confidence interval, 1.03-2.13) were associated with increased pertussis incidence.

Conclusions: Permitting personal belief exemptions and easily granting exemptions are associated with higher and increasing nonmedical US exemption rates. State policies granting personal belief exemptions and states that easily grant exemptions are associated with increased pertussis incidence. States should examine their exemption policies to ensure control of pertussis and other vaccine-preventable diseases.

Although one can quibble about its methodology, the results of this study, in which lax vaccination polices tend to correlate with higher rates of pertussis on a state-by-state basis, should come as no real surprise. The effectiveness of the pertussis vaccine depends upon herd immunity, where high levels of vaccination keep an infectious disease from spreading among the few unvaccinated and those in whom the vaccine is not offering adequate protection. (No vaccine is 100% effective; so there will always some percentage of even a vaccinated population that is susceptible to the disease vaccinated against. Antivaxers often distort, exaggerate, or misrepresent this fact to question whether vaccinations are efficacious at all.) As I’ve pointed out before, in places like Boulder, Colorado, where wealthy alties have refused to vaccinate their children in droves, pertussis has returned with a vengeance. And we may be seeing the same thing here, as the study found:

Children with nonmedical exemptions are at increased risk of disease and they increase community risk of disease transmission. From 1985 through 1992, exemptors in all states were 35 times more likely to contract measles than nonexempt children. In Colorado, exemptors were 22 times more likely to have had measles and 5.9 times more likely to have had pertussis than vaccinated children. Moreover, the incidence of measles and pertussis in nonexempt children in a county was associated with the frequency of exemptors in that county.

That’s an incredible difference.

Because the rates of once-feared diseases like pertussis have fallen so low, thanks to vaccinations, people have forgotten how horrible these diseases could be. For an example of just how warped this thinking can become, I was made aware of a discussion on Mothering.com. In this discussion, a mother by the ‘nym of Momtezuma Tuatara is practically ebullient at reports from New Zealand claiming that the vaccine is a “dud,” when in fact that is not what the reports claim. For example, this 2004 report states about the latest epidemic of pertussis there:

Vaccination information was recorded for 2181 (62.5%) cases. A total of 34 cases had received all five doses of vaccine, 146 had received four doses and 285 were in receipt of three vaccine doses. Across all age groups, the proportion of cases vaccinated was 49.4% (1725/3489). Surveillance data show that only 47.5% (47/99) of those aged 4 months or less, had received the vaccines for which they were eligible (see Table 13).

In other words, the vast majority of the cases had not received all of the recommended doses of the vaccine, and it was noted that more adults were coming down with the disease:

The immunity provided by vaccination does not last through adulthood and is not 100% effective. Therefore it is important that children are immunised on time according to the immunisation schedule. The 2004 epidemic has highlighted the need for a strategy to control the persisting pool of infection in the adult population.

But in the woo world of antivaccination zealots, this sort of data is “validation” of their belief that vaccines don’t work:

I like seeing my ideas confirmed and that is that despite these vaccinations, all the diseases come and go as they please in frequency.

Of course, in this world, “natural” immunity is assumed without question to be better than any immunity induced by vaccine:

So I think that not only is the vaccine far less effective than widely claimed/considered, what we are seeing is the long-term result of replacing natural immunity with vaccine immunity, with a much larger percentage of adults and older children being non-immune and capable of transmitting the infection (which is often subclinical or milder in these age groups as compared to in the younger age groups in which it “prefers” to occur, and who more often exhibit clinical symptoms).

I also think there may be some maternal immunity which has been lost with the loss of widespread natural immunity, which also leaves infants more vulnerable to infection. JMO.

And:

Natural immunity to Pertussis is undoubtedly superior to anything produced by the vaccine. The aluminum in the killed vaccine stimulates an antibody response but not a cell-mediated response. Natural infection stimulates the entire immune system.

There it is again, the faith in the “natural” as being inherently and automatically superior to anything conventional medicine can do, which is viewed as “unnatural.” And, as is the case in alternative cancer therapies, for example, this belief in “natural immunity” leads to irresponsible and potentially dangerous practices. In the case of chickenpox, for example, some parents are holding “pox parties“:

It sounds like a plot line from The Simpsons. In fact, it is a plot line from The Simpsons. Who else but America’s favorite dunderhead, Homer Simpson, would do such a thing?

Surprisingly, pox parties are popping up in neighborhoods in several U.S. cities. On Internet bulletin boards and blogs, rumors spread that the chickenpox vaccine is somehow unsafe or ineffective. Parents worried by these rumors join email rings. When one of these parents’ children gets chickenpox, the parents invite others in the community to a pox party…

A “natural mothering” web site gives a recipe for spreading varicella zoster virus — the chickenpox germ. It advises parents to pass a whistle from the infected child to other children.

“It is absolute lunacy,” UCLA infectious disease specialist Peter Katona, MD, tells WebMD.

Adults who get chickenpox for the first time get a much more serious disease than do children. But even for children, chickenpox isn’t a walk in the park. And every once in a while, a child gets a very serious form of the disease. One in 50,000 kids gets a brain infection that causes retardation or death. And itchy chickenpox blisters can get infected with dangerous bacteria.

“Imagine losing a child because you were dumb enough to bring him to a pox party,” Gershon says.

Indeed. Back in the days before the availability of the chickenpox vaccine, pox parties were not quite as irrational as they sound now because there was no other way to achieve immunity to the varicella virus. Considering them in context of the times, they were somewhat understandable. Even so, that doesn’t mean they were a good idea, even then. Parents were still taking a chance, as fellow SBer Tara Smith pointed out several months ago:

Additionally, the wild virus just ain’t as benign as we’d like to think. It can cause severe pneumonia or encephalitis. Additionally, I mentioned here that deadly infections with the group A streptococcus are becoming more common. Guess what’s a major risk factor for these infections? Yep–chicken pox. Check out, for example, this manuscript on invasive group A strep disease in Alberta, Canada, which notes that “varicella virus infection preceded invasive GAS disease in 25% of children 8 years of age and under.” It has the potential to be much more than just an inconvenient itch.

And, I would add, in children with compromised immune systems, varicella infection can be deadly. Yes, the vast majority of children who get chickenpox recover uneventfully, but a number of these can suffer serious complications. Overall, the vaccine has minimal risk, and it prevents disease in children and the later development of shingles in adults.

This attitude that “natural immunity” is inherently “better” than permeates antivax websites. For example:

Exchange your faith in: Natural immunity only comes after a disease.
With faith in: Natural immunity comes with Health, a ‘clean blood stream that is well nurished’.

Exchange your faith in: Disease is dangerous.
With faith in: Healing activity (typically called disease symptoms) is a process that is natural, beneficial, and far safer than generally recognized.

Personally, I think I’ll keep my view that vaccine preventable diseases like polio or pertussis are dangerous, thank you very much. One has to wonder, of course, if diseases aren’t “dangerous,” then why bother to try to prevent or treat them? That does seem to be the attitude behind a lot of this antivaccination lunacy. After all, those nasty symptoms that can result in paralysis in polio, for example, are nothing more than manifestiations of “healing activity.” Apparently it’s better to let your child suffer the horrendous symptoms of pertussis, with the risk of the need for hospitalization and even the possibility of death. And, make no mistake, pertussis can be a horrible disease, complicated by pneumonia and occasionally death.

Although antivaccination mania goes back a long time, I wonder if this this extreme faith in the natural and belief that the symptoms of disease are a healing crisis” whose symptoms shouldn’t be interfered with may be traceable, at least in modern times, back to Ryke Geerd Hamer, a German physician who developed a concept that diseases, especially cancers, aren’t dangerous in and of themselves but rather are manifestations of a mental conflict. Indeed, he formulated what became known as German New Medicine, complete with various “rules” and “laws” (in fact, total woo) based on this concepts, such as the First Biological Law: The Iron Rule of Cancer. The bottom line from Dr. Hamer’s and other altie doctors for antivaxers is that disease isn’t really as dangerous as doctors tell you that it is, that vaccines are an unnatural assault on the immune system, and that disease is due more to internal factors (such as mental stress or a tragedy) than it is to bacteria or viruses. Of course, Dr. Hamer didn’t originate such concepts himself, but he popularized them, at least in Europe.

The results of this study suggest that, the easier it is to get an exemption from vaccination for schools, the more an infectious disease like pertussis can spread and the more herd immunity can be compromised, thus endangering even the vaccinated. Worse, it is clear that attitudes such as those expressed on the Mothering.com forums and by utter loons like Dawn Winkler (there’s just no other word that describes her), the Libertarian candidate for Governor of Colorado, are on the increase. Yes, I’m very afraid that it will take a huge and deadly resurgence of vaccine-preventable diseases to remind people of the reasons that these vaccinations were developed in the first place. It wasn’t to “enrich the pharmaceutical companies.” It wasn’t to enrich doctors. It wasn’t because conventional medicine want’s to inject “filth” into your children. It was to protect children from epidemic diseases that caused incredible suffering and death until as recently as a few decades ago. And these diseases never went away, either. They are still there, waiting to return.

ADDENDUM: I’m sure the antivaxers will pull the “pharma shill” gambit on this particular study, because two of the researchers reported support from pharmaceutical companies. Just wait. Never mind that one of the two isn’t completely convinced that lax vaccination policies are associated with higher pertussis rates.

Comments

  1. #1 Dianne
    October 15, 2009

    Never mind that one of the two isn’t completely convinced that lax vaccination policies are associated with higher pertussis rates.

    Does he receive support from a company that makes acyclovir or valacyclovir? (Asked to demonstrate that the pharma shill gambit can be a tricky one. Especially when considering a no-profit item like a vaccine.)

  2. #2 Ah
    October 15, 2009

    I am firmly pro vaccination and my daughter has had all the recommended shots. But here in the uk the nhs don’t include the chicken pox vaccince in the schedule. Not because of any doubts over efficacy but because they think it isn’t cost effective. They argue that it is cheaper to treat chicken pox than to vaccinate. So we still do chicken pox parties!

  3. #3 Sid Offit
    October 15, 2009

    @ORAC

    Your archives must be terribly depleted if you have to dredge up this piece of garbage to fill space

    —————————————-
    Complexity of procedures for obtaining exemptions was measured in 1998 and changes could have occurred over time.
    —————————————–

    So they didn’t even have data pertaining to the time-frame in which the “study” took place

    —————————————–

    And you do realize some states push vaccines more aggresivly than others. Perhaps those with “loose” policies compensated with more proactive outreach efforts. Additionally each state has different reporting methods. In epidemiology these are called c-o-n-f-o-u-n-d-i-n-g variables.

    —————————————–
    The so-called difficulties may be differences without distinction e.g.,

    whether a form was permissible vs a letter written by the parent;

    As you know exemptors are generally “well-educated parents who tend to be skeptical of mainstream beliefs”. And they’re also capable of composing a letter
    ————————–
    Finally the herd nonsense is particularly irrelevant here since there may be as many as 150,000 – 500,000 cases of pertussis per year

    The rate recently peaked to 25,616 cases (8.7 cases per 100,000 people per year) reported to the Centers for Disease Control and Prevention (CDC) in 2005 and 15,632 (5.2 per 100,000) reported in 2006. The CDC estimates that 5-10% of all cases of pertussis are recognized and reported.

  4. #4 Liz Ditz
    October 15, 2009

    Current pertussis outbreaks:

    Van Wert County, Ohio

    http://timesbulletin.com/main.asp?SectionID=2&SubSectionID=4&ArticleID=154987

    Moville, Iowa

    http://www.siouxcityjournal.com/news/local/article_6f3b4433-480f-59f0-a747-add970cf085f.html

    Genesee County, Michegan

    http://www.connectmidmichigan.com/news/story.aspx?id=354972

    North Carolina

    http://www.wxii12.com/health/21111513/detail.html

    It’s not clear from these news reports if the vaccination rates are low, or if the outbreak is concentrated among children whose vaccine immunity has waned.

  5. #5 JThompson
    October 15, 2009

    Every time I hear the phrase “natural immunity” I want to throttle the hell out of someone while screaming “What other kind is there?!”. Force fields? Repulsor shields? Nanobots? Or is it less sciencey and more supernatural? Anti-viral fetishes, charms, and potions, perhaps?

    @Sid Offit:

    As you know exemptors are generally “well-educated parents who tend to be skeptical of mainstream beliefs”.

    I’m considered well educated too, and I’m about as skeptical as a person can get, but I’m not going to start screaming in panic and covering my face every time a jet flies over because Google brings up hits for Chemtrail silliness. If you think “skeptical” means “Believing what known cranks have to say and refusing to acknowledge contradictory evidence.” then the word doesn’t mean what you think it does. I think “credulous” is more like the word you’re looking for. “Bloody Silly New Age Wanker” also works.

  6. #6 Denice Walter
    October 15, 2009

    We (in NJ) supposedly have the *least* lax laws- anti-vaxers target us because we have the most “required vaccines and autism”(sic)- they especially revile Gov. Corzine because he mandated additional vaccines for school kids(flu, HPV).Tomorrow the NJ Coalition for Vaccination Choice(see website) will descend upon Wm.Paterson University(a state university noted for education, special education, and nursing programs) because the governor will be there to debate his challengers.They demand a “philosophical exemption” law giving parents freedom to choose…. to be promoters of preventable diseases in children and to openly and cavalierly flaunt public health measures.

  7. #7 k
    October 15, 2009

    @Orac -

    What do you think would happen if a high-
    profile pro-preventable-disease figure’s
    child (J “Voldemort” McC, one ot the
    mommy blog Loons) or pt (“Drs” Jay or
    Bob) died from swine flu?

    I don’t wish ill on anyone, least of all
    a hapless child, but might that be the
    proverbial whack with a 2×4 cluestick that
    gets the mule’s attention?

  8. #8 Denice Walter
    October 15, 2009

    @ k: Truely,it is a “2 x 4 cluestick”;however, some still might unfortunately remain clueless. In an unhappy parallel, AIDS denialists did not “wake up” when several of their own died of AIDS, notably Ms.Maggiore.

  9. k, its simple. They would claim conspiracy and say that big pharma had killed them.

  10. #10 Jay Gordon, MD, FAAP
    October 16, 2009

    Orac–

    Allowing this kind of garbage on your blog makes you look like an irresponsible jerk.

    @Orac -

    What do you think would happen if a high-
    profile pro-preventable-disease figure’s
    child (J “Voldemort” McC, one ot the
    mommy blog Loons) or pt (“Drs” Jay or
    Bob) died from swine flu?

    I don’t wish ill on anyone, least of all
    a hapless child, but might that be the
    proverbial whack with a 2×4 cluestick that
    gets the mule’s attention?

    These are the same types of people who foment violence against pro-choice doctors and you are abetting them by not banning them. This is not a First Amendment issue: When someone speaks of my death as a wake up call I object. Do something instead of harping on a single vaccine/autism issue every third post.

    Jay

  11. #11 Jennifer B. Phillips
    October 16, 2009

    Jay,it is an ugly thought, to be sure, and not one that I would have chosen to articulate, personally. However, please note that it is not in fact your hypothetical death being spoken of, but that of one of your unvaccinated patients. Offensive though that may be, the fact that children can and do die because of the choices their parents or physicians make to not vaccinate is NOT analogous to making threats on someone’s life or–worse–carrying them out a la Dr. Tiller’s tragic death.

  12. #12 Jay Gordon, MD, FAAP
    October 16, 2009

    Nice correction, Jennifer. They’re actually just speaking about the death of one of the children in my care.

    You and your friends are disgusting.

    Read the responses I wrote at Novella’s hole–at your urging. Check my records, my malpractice record and Medical Board record and hospital disciplinary record. Zero complaints or suits.

    I practice very, very carefully, with love and respect for the children and families in my care. I disagree with you and the others about a few vaccine/autism issues. Focus on someone else for a while and come back to me later. I won’t miss you and your reprehensible colleagues.

    Jay

  13. #13 Jennifer B. Phillips
    October 16, 2009

    Yes, that is what they are speaking of–but without schadenfreude as far as I can detect. No one *wants* this to happen, but it is something that we all fear, Dr. Jay. The advice you give your patients w/r/t vaccines has the potential to contribute to a public health crisis, and as a mother of two children under 10 in a community with diminishing vaccine compliance rates, I am gravely concerned. If you find that “disgusting”, I guess I’ll have to live with that.

    Focus on someone else for a while and come back to me later. I won’t miss you and your reprehensible colleagues.

    Wait, where are we? Have we all blundered into your living room by mistake? *You* have chosen to comment here and at SBM with increasing frequency in defense of your position. If you find it uncomfortable to be challenged on these views, perhaps you should duck out for a while, as I doubt any RI/SBM denizens are inclined to let you have your say without rebuttal.

    Oh, and nice job with curbing the name calling, by the way.

  14. #14 Orac
    October 16, 2009

    @10 (Dr. Jay)

    Yes, it’s an ugly thought, but you misunderstand. No one threatened your death or made light of it. Rather, you were asked whether the death of a high profile unvaccinated child, either celebrity or a child in your practice, would finally get your attention and suggest to you that your “alternative” vaccination schedule is not safe.

    It’s a harsh, but legitimate, question. I wouldn’t have phrased it the same way, but I think you’re overreacting. No one threatened you. No one threatened or made light of the death of a child in your practice.

  15. #15 daedalus2u
    October 16, 2009

    It was a legitimate question, and one that Dr Jay didn’t want to answer. He didn’t want to answer because his answer would be no, the death of an unvaccinated child in his care from a vaccine preventable disease would not cause him to change his practices.

    I know why that is. It is because the narcissistic injury he would inflict upon himself by admitting he was wrong is much more painful to him than the death of a child in his care.

    Sorry to be so harsh Dr Jay. Your contrived “logic” may be enough to fool yourself and your clients (not really patients because you put your narcissism ahead of their welfare), it is not enough to fool us.

  16. #16 Andrew
    October 16, 2009

    Poor “Dr. ” Jay. He accuses thousands of other doctors of being corrupt, but asking him if anything, even the death of a patient, would cause him to change his closed, locked, and lost-key mind, is “disgusting”.

  17. #17 Chris
    October 16, 2009

    Remember a “high profile” child under Dr. Jay’s care did die. Though, truthfully, he was not completely informed of her medical history and there was no way he could have properly interfere with the mother’s decision.

    Unfortunately that child’s death did not sway the belief of her mother, who passed away for essentially the same reason just after Christmas this past year.

    Because of this, Dr. Jay is no longer an HIV/AIDS denialist. One would hope that he would come to the realization that his anti-vax attitudes are dangerous if someone in his practice did come to harm. But considering how he downplays the increase of measles in the USA last year, I doubt he will change his mind.

  18. #18 Faithful Reader
    October 16, 2009

    I went to my dr about a month ago and asked for a tetanus booster because the puppies at the barn had scratched me while we were playing. She gave me the whole DTP, saying that pertussis was indeed on the rise.

    Genessee County in MI may have a high rate because it is pretty poverty-stricken– that’s where Flint is, one of the auto industry’s former hometowns.

  19. #19 Caro
    October 16, 2009

    I’m just going to add a personal testimonial, the kind of which the woomeisters and quacks seem to enjoy so much except I’m going to say something they don’t like.

    Pertussis fucking sucks! Please remember to get your boosters!

    Love,

    Caro
    Who was never told about the need for a booster vaccine and got pertussis at age 18 and now will be asthmatic for the rest of her life as a result -_-

  20. #20 Pablo
    October 16, 2009

    I went to my dr about a month ago and asked for a tetanus booster because the puppies at the barn had scratched me while we were playing. She gave me the whole DTP, saying that pertussis was indeed on the rise.

    I _think_ the adult version is TDaP, whereas the child’s version is DTaP. That’s my impression from my recent visit to the doctor.

    I actually went in specifically to get the Pertussis booster. I have an 11 mo old, and want to minimize any chance that he gets it. He has his shots, but as we know, pertussis is one of the harder ones, so our household is going to do everything we can.

  21. #21 Todd W.
    October 16, 2009

    @Pablo

    Yes, the adult booster that contains the pertussis vaccine is the Tdap. Children’s vaccine is DTaP.

    I was just looking at the CDC web site and Ask the Experts. One of the things that people probably don’t know is that even if you have had pertussis at some time in your life, reinfection later on is possible, which is why the adult booster is recommended.

    And, yeah, pertussis is nasty, nasty, nasty.

  22. #22 the bug guy
    October 16, 2009

    I had the TDaP booster last month. In my current line of work handling hazardous waste, I really want my tetanus immunization up to date.

  23. #23 Todd W.
    October 16, 2009

    @the bug guy

    I got my booster a few years ago, since at the time I was doing both carpentry and some gardening, both of which are just faboo ways of getting tetanus.

  24. #24 Kismet
    October 16, 2009

    Jay your call for censorship is ghastly yet expected. What crazy, demented world it would be if a harmles “what if” question couldn’t be asked on the internetz.

  25. #25 sikiş
    October 17, 2009

    Jay your call for censorship is ghastly yet expected.

  26. #26 somewhereingreece
    October 17, 2009

    Long time fan, first time commenting.

    What these statistics illustrate, aside from the fact that missing vaccines is asking for trouble AND dangerous to public health, is the lack of quality control when it comes to who becomes a parent.

    How else can one interpret higher vaccination rates in states where they demand notarizing etc other than “I am so worried about all the eeevil toxins and metals and normal saline in the vaccine but I can’t be bothered to go through the bureaucratic procedures to protect my innocent child”? I work in a paediatric hospital and I encounter this sort of stupidity all the time, but it never fails to amaze me.

  27. #27 ebohlman
    October 17, 2009

    somewhereingreece: I think what you’re running into is a variant of “no cost virtue” in which people will stick to their principles as long as it doesn’t require any effort on their part. The classic example is the heterosexual who argues that asking gay people to abstain from sex isn’t asking any more of them than it is for him (or the non-smoker who gives up smoking for Lent).

    It’s also possible that the main effect of the notarization requirement is on fence-sitters; its existence may lead to a little voice in the back of the head saying that there must be a good reason for it. Finally, some people will hold an abstract position but aren’t motivated to take concrete action based on it.

  28. #28 somewhereingreece
    October 18, 2009

    @ebohlman: A year ago I would probably agree with you on this, but I have had too many children brought in at 3 in the morning with fractures and pulled elbows from the previous day (or more) that the parents only bothered to address because the kids were crying and wouldn’t let them sleep. One Saturday morning we had 24 children in the orthopaedic ER before we got one who was hurt on the same Saturday, as opposed to the past few days.

    My gripe is with greek parents mostly. I have worked in England and there the parents were, for starters, sane.

  29. #29 Maronan
    October 18, 2009

    Natural immunity comes with Health, a ‘clean blood stream that is well nurished’.

    I don’t see why this is so controversial. Obviously, all you need is Health, and if you can’t find a Potion of Health, you just need to make sure you have enough hitpoints!

    Actually, it’s surprising how many altie beliefs would be validated if someone were to discover a hitpoint meter floating above our heads.

  30. #30 El Guerrero del Interfaz
    October 19, 2009

    Well, here in Spain, refusing to get your child vaccinated will eventually lead to losing their custody (except for *medical* exemptions of course).

    If you don’t vaccinates your kids, they cannot go to school. And if your kids don’t go to school, you lose custody. Besides, if the kid gets near any responsible doctor, he can get them vaccinated without the parents’ consent with minimal judicial intervention. Just like Jehovah Witnesses fathers cannot forbid blood transfusions for their kids.

    Some can see that as a limitation of their freedom. I don’t and I’m of the kind who felt a lack of freedom in the US. But if you live in a civilized society, you cannot behave like a salvage.

  31. #31 barbie123
    October 19, 2009

    “I won’t miss you and your reprehensible colleagues.”
    “You and your friends are disgusting.” “Harping.” “Garbage.” “Irresponsible jerk.”

    There is an axiom in law: if you don’t have good facts, pound the law; if you don’t have good law, pound the facts; and if you have neither, pound your opponent. . . hmmmmm. . .

    sounds like Dr. Jay is running out of facts. . .and science. . .

  32. #32 Enkidu
    October 19, 2009

    I got my TDaP booster two weeks ago. Holy sore arm Batman. But in three days it was all better, and now I am better protected, as is my 20 month old daughter.

  33. #33 Pablo
    October 19, 2009

    I got my TDaP booster two weeks ago. Holy sore arm Batman. But in three days it was all better

    That’s about how long my sore arm lasted, too.

    It was far longer than I’ve ever had with a flu shot, that’s for sure.

  34. #34 TJ
    October 30, 2009

    First off, WTF is “Pertussis?” forgive me if I’ve never heard of it, but you people act as if this is some “common knowledge” – the definition never is mentioned anywhere that I can tell – so, from the rather inherent vague connections, I suppose I can assume it is “whooping cough,” but wouldn’t it be informative if you came out and SAID that?! This is yet more of the “Superior Doctor” attitude, where doctors assume patients know “this term” and “that term” – this has happened SO often, and it happens in legal pratice as well, and it makes me sick – i.e., “Oh, this is a ‘tort law’ issue” or “this is a ‘civil’ issue” – WTF – come down on OUR level and realize that not everyone has been through first-year med or law school.

    In essence, I feel as if I should apologize in advance, but PLEASE use common sense – I am xx years old and NEVER have heard the term “pertussis.” Maybe that makes me “less-than-informed,” but the point still stands – so many things such as these are brought to light, WITHOUT making full and clear connections to the related terms; i.e., it would have been utterly simple and incredibly informative to put “Pertussis (aka Whooping Cough)” – again, I never have heard of it, so I will go and check the Wikis, but please try and be more clear in the future. Thanks.

  35. #35 Luna_the_cat
    October 30, 2009

    Um, TJ — if you Google the word “pertussis”, the very first link that comes up is Wikipedia, and the very first sentence begins with “Pertussis, also known as the whooping cough” [bolding in the original]. It took you considerably longer to type the post above castigating people for not helping you, than it would have taken you to find this yourself.

    So my sympathy for your struggle with an unfamiliar term is a bit limited. I can understand people having some difficulty with advanced concepts and highly technical language, but you can reasonably be expected to spend a few seconds on finding basic definitions out for yourself. Expecting people to carefully feed you information that simple to find is a bit like still expecting mommy to cut your dinner into small pieces for you.

  36. #36 TJ
    October 30, 2009

    First off, WTF is “Pertussis?” forgive me if I’ve never heard of it, but you people act as if this is some “common knowledge” – the definition never is mentioned anywhere that I can tell – so, from the rather inherent vague connections, I suppose I can assume it is “whooping cough,” but wouldn’t it be informative if you came out and SAID that?! This is yet more of the “Superior Doctor” attitude, where doctors assume patients know “this term” and “that term” – this has happened SO often, and it happens in legal pratice as well, and it makes me sick – i.e., “Oh, this is a ‘tort law’ issue” or “this is a ‘civil’ issue” – WTF – come down on OUR level and realize that not everyone has been through first-year med or law school.

    In essence, I feel as if I should apologize in advance, but PLEASE use common sense – I am xx years old and NEVER have heard the term “pertussis.” Maybe that makes me “less-than-informed,” but the point still stands – so many things such as these are brought to light, WITHOUT making full and clear connections to the related terms; i.e., it would have been utterly simple and incredibly informative to put “Pertussis (aka Whooping Cough)” – again, I never have heard of it, so I will go and check the Wikis, but please try and be more clear in the future. Thanks.

  37. #37 TJ
    October 30, 2009

    First off, WTF is “Pertussis?” forgive me if I’ve never heard of it, but you people act as if this is some “common knowledge” – the definition never is mentioned anywhere that I can tell – so, from the rather inherent vague connections, I suppose I can assume it is “whooping cough,” but wouldn’t it be informative if you came out and SAID that?! This is yet more of the “Superior Doctor” attitude, where doctors assume patients know “this term” and “that term” – this has happened SO often, and it happens in legal pratice as well, and it makes me sick – i.e., “Oh, this is a ‘tort law’ issue” or “this is a ‘civil’ issue” – WTF – come down on OUR level and realize that not everyone has been through first-year med or law school.

    In essence, I feel as if I should apologize in advance, but PLEASE use common sense – I am xx years old and NEVER have heard the term “pertussis.” Maybe that makes me “less-than-informed,” but the point still stands – so many things such as these are brought to light, WITHOUT making full and clear connections to the related terms; i.e., it would have been utterly simple and incredibly informative to put “Pertussis (aka Whooping Cough)” – again, I never have heard of it, so I will go and check the Wikis, but please try and be more clear in the future. Thanks.

  38. #38 Chris
    October 30, 2009

    Your ignorance is no excuse for not knowing how to use a dictionary. Also, it might have helped if you clicked on a couple of the links (those are the words in blue).

    Here is another term you need to look up: “concern troll”

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