Respectful Insolence

Here we go again.

Having been in the blogging biz for nearly seven years and developed a special interest in the anti-vaccine movement, I think I’ve been at this long enough to make some observations with at least a little authority. One thing that I’ve noticed is a very consistent pattern in which, every time a new study or report released that either fails to find evidence that vaccines cause autism or significant harm or that even concludes that vaccines do not cause autism, the anti-vaccine movement is right there, ready to attack it with pseudoscience, misinformation, and exaggerations of the study’s or report’s shortcomings. Indeed, outside of anthropogenic global warming (AGW) denialists, I can’t think of another group of science or medicine denialists besides anti-vaccine loons who have such an efficient “rapid response team.” Inevitably, any time a major study or report is released exonerating vaccines, it’s a sure bet that within 24 hours one of the major anti-vaccine groups will have a press release ready or that wandering home of happy anti-vaccine sycophants, toadies, and lackies, Age of Autism, will have pseudoscience-laden pseudo-rebuttal.

This time around, it’s a major report by the Institute of Medicine (IOM), entitled Adverse Effects of Vaccines: Evidence and Causality. This 667 page report is the result of a long effort by an IOM committee of 16 charged with examining the evidence linking adverse events with vaccines. The overall conclusion was–surprise! surprise!–that vaccines are safe. Before I dig into the results a bit more, here’s how the report came about:

The Health Resources and Services Administration (HRSA), the agency within the Department of Health and Human Services that administers VICP, can use evidence that demonstrates a causal link between an adverse event and a vaccine to streamline the claim process. As such, HRSA asked the Institute of Medicine (IOM) to review a list of adverse events associated with vaccines covered by VICP and to evaluate the scientific evidence about the event–vaccine relationship. The vaccines covered by VICP include all vaccines recommended by the Centers for Disease Control and Prevention (CDC) for routine administration in children. Adults who experience an adverse event following one of these childhood vaccines also are covered by the program. HRSA asked the IOM to review 8 of the 12 covered vaccines. These eight are the varicella zoster vaccine (used against chickenpox); the influenza vaccines (except for the H1N1 influenza vaccine distributed in 2009); the hepatitis B vaccine; the human papillomavirus (HPV) vaccine; the measles, mumps, and rubella (MMR) vaccine; the hepatitis A vaccine; the meningococcal vaccines, and tetanus- containing vaccines that do not carry the whole-cell pertussis component.

The adverse events selected by HRSA for IOM review are ones for which people have submitted claims–successful or not–to VICP. The committee appointed to this study was not asked to assess the benefits or effectiveness of vaccines but only the risk of specific adverse events. Its conclusions reflect the best evidence available at the time.

The VICP, as regular readers of this blog probably remember, is the Vaccine Injury Compensation Program. In this program, claims of vaccine injury are adjudicated in an expedited manner in a special court known as the Vaccine Court. The Autism Omnibus was decided through the VICP and the Vaccine Court over two years ago. As I’ve explained before as well, the Vaccine Court uses less rigorous scientific standards than normal courts, and there are certain injuries known as “table injuries” that are almost automatically assumed to be due to vaccines. In any case, I consider it important that the committee didn’t even consider efficacy, because this provides an estimate of just the known risks. Doing this was somewhat risky, because risks discussed outside the context of the benefits of vaccines can give a distorted picture of the true risk-benefit ratio. On the other hand, by focusing like the proverbial cliched laser on just adverse events, the committee could provide an estimate of the true absolute risk of each adverse event.

Obviously, I haven’t read the entire 667 page report. It was only released yesterday; I doubt even the anti-vaccine groups who are even now poring over each page looking for weaknesses to attack have read the entire report yet. However, the executive summary provides sufficient information for a “first pass” analysis of its findings, which assign each relationship (between a vaccine and a specific adverse event) to one of four categories:

  • convincingly supports a causal relationship;
  • favors acceptance of a causal relationship;
  • favors rejection of a causal relationship; or
  • is inadequate to accept or reject a causal relationship.

The methodology the committee used to assess the weight of evidence involved examining the weight of epidemiological evidence linking the adverse event to the specific vaccine in question, the weight of mechanistic evidence (one could view this criterion as asking, “Is there biological plausibility linking this particular adverse event with this particular vaccine?”), and the results of its causality assessment. How the committee went about its work, weighted each form of evidence, and came to its conclusions is summarized in this figure:

i-36aa09220755f93073beb139f85da4c6-Method-thumb-450x300-68709.jpg

And:

i-d17913a58133813961e7bfe1021d7154-assessment-thumb-450x324-68712.jpg

So, let’s summarize the results of the report and what the committee concluded. First, here are the adverse events for which the committee concluded that the evidence convincingly supports a causal relationship, which were well-summarized in this article:

  • Fever-triggered seizures, which seldom cause long-term consequences, from the measles-mumps-rubella, or MMR, vaccine.
  • MMR also can cause a rare form of brain inflammation in some people with immune problems.
  • The varicella vaccine against chickenpox sometimes triggers that viral infection, resulting in widespread chickenpox or a painful relative called shingles. It also occasionally can lead to pneumonia, hepatitis or meningitis.
  • Six vaccines — MMR and the chickenpox, hepatitis B, meningococcal and tetanus-containing vaccines — can cause severe allergic reactions known as anaphylaxis.
  • Vaccines in general sometimes trigger fainting or a type of shoulder inflammation.

The adverse reactions for which the existing evidence favors acceptance include HPV vaccine and anaphylaxis (severe allergic reaction), MMR vaccine and transient arthralgia (joint pain) in female adults, MMR vaccine and transient arthralgia in children, and certain trivalent influenza vaccines used in Canada and a mild and temporary oculorespiratory syndrome. One of these conclusions (the relationship between anaphylaxis and the HPV vaccine) was only based on mechanistic evidence.

More interestingly, what will likely result in great unhappiness among the anti-vaccine movement were the relations for which the evidence, according to the committee, favors rejection. These include claimed correlations between MMR vaccine and type 1 diabetes, DTaP vaccine and type 1 diabetes, MMR vaccine and autism, inactivated influenza vaccine and asthma exacerbation or reactive airway disease episodes, and inactivated influenza vaccine and Bell’s palsy. Let me repeat that again: The evidence does not support the claim that the MMR vaccine causes autism, just as it doesn’t support any relationship between vaccines and autism.

Finally, the committee concluded that for the vast majority of the proposed causal relationship pairs there isn’t enough evidence to accept them or reject them. This shouldn’t be construed to mean, however, that there is a high probability that vaccines cause these adverse reactions. The reasons that the committee concluded that there was “insufficient evidence” is because many of these particular adverse reactions were so uncommon that it is not possible to make a conclusion regarding whether or not the vaccine is causally associated. Indeed, listen to the chair of the committee, Dr. Ellen Wright Clayton:

Not surprisingly, the vast majority of their decisions — 133 — fell into the inadequate category, including many concerns associated with the HPV vaccine. But that doesn’t mean that the data is simply inconclusive, says Clayton. In fact, that category is quite diverse, encompassing cases in which studies show both a potential connection or no connection between vaccines and an adverse event; it also includes cases in which the information simply doesn’t exist — yet –to make a sound scientific conclusion. That’s the case with HPV, which hasn’t been used long enough in enough people to generate robust data on many of the potential side effects, such as neurological conditions that have been linked to the vaccine in some.

In another article, Clayton points out: “We looked at more than a thousand peer-reviewed articles, and we didn’t see many adverse effects caused by vaccines. That’s pretty remarkable.”

And so it is, although no doubt vaccine denialists won’t see it that way.

It should also be noted that all of these complications, even the ones for which the committee considered the evidence to be such that it convincingly supported a causal relationship are very uncommon–rare, even. Indeed, as Dr. Clayton put it, “Despite looking very hard, it was really hard to find that vaccines cause injuries and the injuries they do cause are generally pretty mild and self-contained.”

Which is pretty much what we’ve known all along.

Another thing that’s important about this study is that it is strong evidence that, contrary to the claims of the anti-vaccine movement, adverse reactions to vaccines are not hidden; they are not swept under the rug. In fact, the government and the IOM have gone to great lengths to look for adverse events and to try to correlate them to specific vaccines. Before this report was ever conceived, real scientists and real doctors spent lots and lots of money and effort to study vaccines, autism, and whether there is a relationship between the two, even after the weight of the evidence strongly suggested that there is not. They’ve also studied virtually every adverse event you can imagine. Synthesizing the estimates of risk derived from the scientific literature from hundreds upon hundreds of papers, the committee concluded that adverse reactions are rare and that adverse reactions commonly claimed by the anti-vaccine movement (autism, type I diabetes) are not supported by the data.

In any rational, reasonable world, this report would be highly reassuring, and to most parents I hope it will be. I’m also under no illusions that it will persuade the anti-vaccine movement in any way. Indeed, the anti-vaccine group SafeMinds was the first off the mark with a press release (shilled for by, of course, the anti-vaccine propaganda blog Age of Autism. Naturally, SafeMinds tries to take the part of the report that concludes that insufficient evidence exists to confirm or deny a causal relationship between specific vaccines and specific adverse events and spin it to mean that the safety of vaccines is not known. Not surprisingly, there’s the requisite conspiracy-mongering, where SafeMinds accuses the government of a conflict of interest by pointing out that:

The IOM report took two years to produce, mostly behind closed doors, and was paid for by the Department of Health and Human Services, the government agency which is also a defendant against the vaccine-injured in the government’s vaccine court.

SafeMinds then provides yet another example of Orwellian spin:

The report investigated 158 potential adverse outcomes from vaccines. Of these, 135 or 85% were found to have inadequate research to accept or reject a causal association. Of the 23 outcomes where the research was deemed adequate, 18 or 78% were found supportive of harm. Vaccines were cleared of safety concerns for just five of the outcomes considered. “These statistics are hardly reassuring to parents who are now asked to give their young children over 32 vaccinations,” noted Sallie Bernard, President of SafeMinds.

Predictably (at least, I predicted it), SafeMinds goes for raw numbers and tries to make it seem as though because there was inadequate evidence to accept or reject a causal relationship between these adverse events and vaccines that there is real uncertainty about the safety of vaccines. Of course, SafeMinds’ flack fails to mention that the reason there is inadequate evidence is because these adverse reactions are so rare that there are just too few of them to make any definitive conclusions about causality with respect to vaccines. It would take enormous studies with huge numbers of subjects to have any hope of teasing out causality, and even then the events might be too rare to make any definitive conclusions.

All of this, to SafeMinds, is not surprisingly a call for “more research”:

SafeMinds calls on Congress and the Administration to institute a rigorous science program on vaccine safety. This program would include the establishment of an independent Vaccine Safety Agency (similar to the National Transportation Safety Board), the launch of a study comparing health outcomes between vaccinated and unvaccinated children, the inclusion of vaccines as an exposure variable in the National Children’s Study and mandatory reporting by physicians to the Vaccine Adverse Event Reporting System.

I’ve already explained why the whole “vaxed versus unvaxed” study is highly unlikely to be particularly informative. Basically, SafeMinds is spinning the report into one massive appeal to ignorance, arguing that, if we don’t have adequate evidence to make a conclusion regarding whether vaccines cause these very rare events, then vaccines must not be safe and we have to “do more research.” It’s a highly predictable response, given the history of the anti-vaccine movement in doing exactly the same thing with previous studies. No matter how much research fails to find evidence of a link between vaccines and autism, anti-vaccinationists call for “more research.” When the MMR vaccine and then later thimerosal in vaccines were exonerated as causes of autism, the anti-vaccine movement turned almost on a dime and started blaming other ingredients (the “toxins gambit,” a favorite distortion also sometimes known as “Green Our Vaccines“) and the vaccine schedule as a whole (the “too many too soon” gambit), neither of which has good scientific evidence to support it. The implication of these latest tactics ends up being a call for testing, in essence, each vaccine ingredient and combination of vaccines independently, which is logistically incredibly expensive to the point of being virtually impossible) and doing their holy grail of a study, the “vaxed versus unvaxed” study, which, because it would be utterly unethical to do as a randomized clinical trial or even as a prospective study, would have to be retrospective and thus prone to the typical confounding factors all retrospective studies are prone to.

The IOM report is yet another indication that serious vaccine reactions are rare and that in general most adverse reactions to vaccines are mild in nature. That is not to say that they are nonexistent, but they are much less frequent and much less severe than the impression that is intentionally promoted by anti-vaccine activists. These conclusions should reassure most people who are willing to listen, but groups like SafeMinds are anything but willing to listen. The bottom line is that anti-vaccine beliefs are not based on evidence or data, no matter how much anti-vaccine believers try to distort scientific data or do bad science themselves (like Mark and David Geier or Andrew Wakefield) to represent their fear and loathing of vaccines as being “evidence-based.” No matter how many scientific studies, systematic reviews of the literature, meta-analyses, and other evidence exonerate individual vaccines or vaccines as a whole as a cause for autism and the other conditions, the anti-vaccine movement will not be swayed. Because to groups like SafeMinds, Generation Rescue, the National Vaccine Information Center, and others, it’s first and foremost about the vaccines. It’s always about the vaccines. It always will be about the vaccines.

Comments

  1. #1 Todd W.
    August 26, 2011

    Darn it! I knew I should’ve written about this last night! Scooped again. Curse your blinking lights, Orac!

    At any rate, I could see several different ways the anti-vaccine movement could spin this. As you already mentioned, cherry picking the bits that make it seem like almost nothing is known about vaccines. This would purport to discredit vaccines in general. They could try to find flaws to discredit the report. They could cherry pick bits about adverse events for which a causal connection was found and exaggerate the real risk of these events.

    In short, much like fundamentalist religious types do with their holy texts, I could see anti-vaxers picking the bits that have the semblance of supporting their fear-mongering while at the same time disavowing the study as hopelessly flawed when it is pointed out that it does not, in fact, support their ideology. Compartmentalized thinking.

  2. #2 Lawrence
    August 26, 2011

    If only a very few instances of “adverse reaction” are available, I can imagine that it would be difficult to draw an affirmative (or negative) confirmation – since it wouldn’t constitute a large enough sample.

    And given that millions upon millions of doses of vaccines are administered every year, this review confirms that adverse events are uncommon to rare, with the most adverse reactions being extremely rare – when compared to the known statistical adverse reactions to the actual diseases (not the mention the disease symptoms themselves) that the vaccines prevent, it makes a very compelling, if not iron-clad argument for the overall safety and efficacy of the vaccine program.

  3. #3 Ted
    August 26, 2011

    well, the antivaxxers are out there.
    A of A is doing the same old, same old. Why it MUST be a government conspiracy! Let’s go on Fox again and warn all the people. Then again, the trolls will say “You’re using SCIENCE And LOGIC. And DATA. Whyyy, that’s so UNFAIR!” I’ll try not to get into a battle of wits with unarmed people.
    They also present pretzel logic so ludicrous I will not insult the readers/contributors of this blog by repeating it- let’s just say they still believe in the “correlation (no matter how slight) is causation” argument.
    The IOM is a very unassailable force. Their efforts have been the focal point for the patient safety/quality outcome movement, which have saved countless lives. For the anti-vaxxers to assail this group is sad, yet expectedly typical.

  4. #4 Denice Walter
    August 26, 2011

    We know what the anti-vax die-hards think: their major task involves ramping up fear in order to pull in more reasonable fence-sitters. Their messages about this analysis, in all of their burningly stupid glory expressed in purple prose, will be broadcast and twittered all over the internet, boiled down to short emotional outbursts that fan the flames of worry and fear. Since being logical and benefitting from instruction and *listening* patiently are rather difficult when you are terrified, usually reasonable folks might be inveigled into making stupid decisions- i.e. *not* vaccinating. Most of the idiots I survey trade on fear as a tool of persuasion and as a sales technique. They have little else in their arsenal since reason and logic are, for all practical purposes, nearly non-existent there.

    Today Mike Adams “prepares” us for the hurricane that will land in the NY area on Sunday: he goes over what you should do, hawks his course on “preparedness”, and then tells us not to fear. After inciting fear. I did a little thought experiment asking if I could I think like a fear mongerer. I listened to all of the weather reports and conjured up this scenario: following another earthquake, the hurricane will gather tsunami-like strength as it passes over the extremely warm waters of the Jersey shore; when it reaches NYC, after flooding the canyons of Wall St., it shall lap upon the great black cliffs on the west side of the fjord ( a/k/a the Hudson River) carrying off those who reside nearby- including me- out across the Sea of Darkness ( a/k/a the Atlantic) from whence some of them came ( a/k/a Europe and Africa). OMFG, I’m going to Ireland!

    How likely is that? Probably about as likely as a child “getting” autism from a vaccine.

    How do we combat fear- especially unrealistic trumped up fear? By pointing out its absurdity and its revealing its *purposes*: amongst them spreading the fame (or infamy, if you will) and influence of pseudo-scientists who attack what they are unable to comprehend because they never did the hard work to study legitimately in the first place. They can be brief because they know little. We can’t.

  5. #5 Reuben
    August 26, 2011

    Even if studies are done to the specifications of the anti-vaccine establishment, they will manage to point out to “weaknesses”, “conflicts of interest”, and “errors” when those studies show there is no link. They won’t be happy. They’re fundamentalists in that respect. Without vaccines to bash, what do they have? They’d be empty and scattered with nothing to unite them.

    An enormous punch to the gut would be if there is ever an “autism gene” discovered. THAT will get them all sorts of riled up because no one likes to be told that there is something intrinsically wrong with them, myself included. We like to blame everything on the outside world, on things we cannot control. Obese? It’s because my parents never taught me to eat right. Diabetic? It’s because I’m a minority or because I ate too much candy as a child. Lung cancer? It’s because no one warned me about smoking/asbestos/living with a smoker. Blah, blah, blah.

    This is why it upsets me like nothing else when I hear rumors that the local school board wants to do away with the science fair. It’s bad enough that the kids get only one science class a year in High School. Their critical thinking skills go down the drain. I mean, anyone with basic science knowledge would understand the concepts of these studies once explained to them IN A 600+ DOCUMENT!

    And, Todd, the only way you’ll out-scoop Orac is to design your own box of blinking lights with better processors. I recommend the sandy bridge Intel kind.

  6. #6 augustine
    August 26, 2011

    @Rueben

    An enormous punch to the gut would be if there is ever an “autism gene” discovered. THAT will get them all sorts of riled up because no one likes to be told that there is something intrinsically wrong with them, myself included.

    The “autism gene”? LOL! Good luck on that one. But billions of dollars wouldn’t keep a scientist from looking for it would it?

    Unbeknownst to you it is pretty clear that autism, like cancer, is not a single gene disorder.

    We like to blame everything on the outside world, on things we cannot control. Obese? It’s because my parents never taught me to eat right. Diabetic? It’s because I’m a minority or because I ate too much candy as a child. Lung cancer? It’s because no one warned me about smoking/asbestos/living with a smoker. Blah, blah, blah

    Yeh? Obese? It’s the Obesity gene. Diabetic? It’s the diabetic gene. Lung cancer? It’s the lung cancer gene.

    It’s all in the genes. It’s the genetic deterministic fallacy.

  7. #7 augustine
    August 26, 2011

    “There is no link between vaccines and healthy children”.

    Just ask some of the posters on here.

  8. #8 Vincent Iannelli, MD
    August 26, 2011

    That anti-vaccine folks would find ways to downplay the report shouldn’t be surprising.

    What is a little surprising to me is that their is absolutely no coverage of the study on any of the morning news shows. The Today Show has had Wakefield and Jenny McCarthy on. With all of the parents these news shows have influenced in the past, they can’t get a non-celebrity expert on to discuss this report?

  9. #9 Mephistopheles O'Brien
    August 26, 2011

    Augustine,

    If you’ll go back and re-read Reuben’s message, I think you’ll find that he in no way claimed that obesity, diabetes, or lung cancer are caused by “an X gene”, where X is the disease being described.

    It is my understanding, though, that you’re right on your first point – that autism is not a single gene disorder.

  10. #10 Jesse
    August 26, 2011

    It would be nice if they would list what incidence rate each effect can be ruled out above. Many of the examples may be ‘inconclusive’ for ANY link, but i’m sure they have the data to say. “Evidence to reject incidence rates at 1:10e7 or above, inconclusive evidence for less than 1e10^7″.

    That would provide a much more usefull risk assesment for numerate people who do not otherwise follow the whole issue closly.

  11. #11 anarchic teapot
    August 26, 2011

    I picked the wrong day to come back online after a much-needed breather. Antivaxers, creationists and climate-change denialists – three heads of the Cerberus of Wilful Stupidity – all at once. If anyone wants me, I’ll be down the pub.

    Thanks for all the links in the article, Orac. It’s all going into the personal reading list.

  12. #12 lilady
    August 26, 2011

    It seems that AofA is on top of all these reports…they must have a central diary that the editors plug into…to alert their constituency to “mark the date” when reports are scheduled to be release. They also flood their website with incendiary articles about what they can expect from the reports…laced liberally with the same tired arguments about government conspiracies, the international cabal of Big Pharma and the unscrupulous researchers.

    I suspect that they have a data base of thousands of paragraphs written and entered into the database by their “senior science editors” (Blaxill and Olmstead) to be used by them, once the report actually comes out. They have no need to really analyze the report…they only need to insert the numbers and percentages. The data base is also used for training purposes for their “senior science editors in training” (Stagliano, Wright and Boy Wonder Cub Reporter Jake Crosby) as well as “guest science editors”…the rogue’s gallery of pseudoscience journalism.

    I kinda got the first hint of how AoA was going to “analyze and report” on the IOM Study, while “slumming” yesterday at their website, with this headline:

    “Drug-addled IOM throws another bucket of whitewash over vaccine dangers”

  13. #13 rob
    August 26, 2011

    i used well known bible numerology techniques to look for messages hidden in the 667 page report.

    all i could find is:
    “paul is dead”
    “in the dead of the night, love bites”

    and

    “hello, Luka … Congratulations. You have just discovered the secret message. please send your answer to old pink, care of the funny farm, chalfont…
    -Roger! Carolyne’s on the phone!
    -okay”

  14. #14 Reuben
    August 26, 2011

    What is a little surprising to me is that their is absolutely no coverage of the study on any of the morning news shows.

    That’s because it’s not sensational enough. The viewing public craves and demands blood, gore, controversy, intrigue… conspiracies.

    Real science is dull. PCR tests take too long to fit into a 1-hour detective show. Case-control studies can only, truly give you the odds of exposure given that you have a condition. They can’t give you a definitive reason why you have the condition. Cohort studies take too damn long.

    I say that any future IOM reports should be in the form of a novel co-authored by Tom Clancy or Stephen King and made into a movie by Spielberg or Christopher Nolan. This science stuff is for the pointdexters.

    (Perhaps that’s why Auggie doesn’t bother with it.)

  15. #15 Scott Cunningham
    August 26, 2011

    My metaphorical money is on ad hominem and genetic fallacy attacks. AoA and friends will leap on the government associations (and Universities! Why are scientific studies always associated with Universities?!) and try to argue it can’t be credible because of author affiliations.

    Best of all, this angle will let them skip reading past page 3.

  16. #16 BKsea
    August 26, 2011

    I just read another blog post that seems like the perfect analogy for the anti-vaxxers, climate change denialists, etc. Apparently in South Korea, people are convinced that you can die if you fall asleep in a sealed room with a fan running. They have invented all sorts of sciency sounding rationales and the government has made efforts to enforce automatic shutoff devices on fans just in case. Every anti-vaxxer should be forced to read this story. Then, they need to be told “the anti-fanners are no different from the anti-vaxxers.”

    http://bravenewclimate.com/2011/08/26/risk-fans-fission/#more-4949

  17. #17 augustine
    August 26, 2011

    BKsea

    Apparently in South Korea, people are convinced that you can die if you fall asleep in a sealed room with a fan running. They have invented all sorts of sciency sounding rationales and the government has made efforts to enforce automatic shutoff devices on fans just in case.

    If it causes convulsive febrile seizures and brain damage by falling asleep in a sealed room with fans running, then the government should warn people and and not force or coerce them to do it.

  18. #18 augustine
    August 26, 2011

    “Yet another bad day for the anti-vaccine movement 2011.”

    Not really.

  19. #19 lilady
    August 26, 2011

    I was tempted yesterday to go o/t about immunizations with an anecdotal story about the discussion hubby and I had with our doctor yesterday when we got our seasonal flu vaccine. I mulled it over in my mind thinking what are the chances that Orac would devote a blog to this latest IOM report and discuss the anti-vax “take” on the report. P.S. I came to the conclusion that Orac would blog about it…he never “disappoints”.

    So here it is. Our family doctor reports that many of the pediatricians and family medicine practitioners who have privileges at the 600 bed tertiary care university affiliated hospital where he has privileges, are now telling “hard-core” anti-vax parents to take their child(ren) to another physician. These practitioners are telling parents that they want to care for their child(ren), but are hampered by the unreasonableness of their pseudoscience knowledge of preventive care. It is not patient abandonment…it provides parents the opportunity to find another health care provider who believes in the pseudoscience.

    I have also checked the website of this 600 bed hospital where the majority of our family’s doctors are affiliated and nary a mention of CAM or Integrative Medicine. I consider myself fortunate to have primary care and specialist docs who are based in science-based medicine. I’m also immeasurably pleased that the caring competent docs who provide care to infants and kids have taken a stand about the bogus vaccine related injuries “theories”.

  20. #20 augustine
    August 26, 2011

    I was tempted yesterday to go o/t about immunizations with an anecdotal story about the discussion hubby and I had with our doctor yesterday when we got our seasonal flu vaccine.

    Thought you might want to know what the literature says about this practice.

    http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD004876.pub3/abstract

    Main results

    We included 75 studies. Overall we identified 100 data sets. We identified one RCT assessing efficacy and effectiveness. Although this seemed to show an effect against influenza symptoms it was underpowered to detect any effect on complications (1348 participants). The remainder of our evidence base included non-RCTs. Due to the general low quality of non-RCTs and the likely presence of biases, which make interpretation of these data difficult and any firm conclusions potentially misleading, we were unable to reach clear conclusions about the effects of the vaccines in the elderly.

    Authors’ conclusions

    “The available evidence is of poor quality and provides no guidance regarding the safety, efficacy or effectiveness of influenza vaccines for people aged 65 years or older. To resolve the uncertainty, an adequately powered publicly-funded randomised, placebo-controlled trial run over several seasons should be undertaken.”

    http://www.washingtonpost.com/wp-dyn/content/article/2005/10/22/AR2005102200042.html

    To promote vaccine use, many in the public health community have overstated the risk of flu-related death and the effectiveness of the vaccine in preventing it. While the flu vaccine may have some important benefit (less flu-related illness), we really do not know whether it reduces the risk of death. For younger individuals — for whom the chance of flu-related death is extremely small — any death-protection benefit can only be very modest (and it is unlikely we will ever reliably know whether it even exists). However, we do know that the vaccine reduces the risk of being sick and time lost from work. But because the effect is small, individuals will have to judge for themselves whether it’s worth the bother.

  21. #21 Gray Falcon
    August 26, 2011

    Augustine, you don’t get to make comments until you understand the concept of relative risk. For example, do you have a number for the people killed by the measles vaccine?

  22. #22 Science Mom
    August 26, 2011

    @ lilady, I have to admit that I’m uncomfortable with physicians dismissing patients for anti-vaccinationism. I can certainly see the argument for doing so, but it is a short-term, self-defeating tactic. First, it is the children who are ultimately “punished” for their dumbass parents’ choices. Secondly, the tact is more apt to push the clients to naturopaths or chiropractors for primary care and then the children suffer there too. Lastly, it is a slippery slope for then parents who have been sucked in by the bullshit arguments and just want to slow down a bit are thrown under that bus when a little compassion, understanding and willingness to discuss the matter and present a more “palatable” schedule would benefit all involved.

    There are better, long-term solutions to encourage responsible vaccine uptake based upon valid information-sharing and improving doctor-patient relationships. Such a heavy-handed tactic may cause the reverse.

  23. #23 augustine
    August 26, 2011

    For example, do you have a number for the people killed by the measles vaccine?

    That number would be called the absolute number. Maybe tis you who has the concept misunderstanding.

    Augustine, you don’t get to make comments until you understand the concept of relative risk.

    Or what? Or you won’t respond to my posts anymore? I don’t think you have any authority here.

  24. #24 Agashem
    August 26, 2011

    *sigh* I wish I could stay home and watch the fireworks but I have a previous engagement. I will be reading tomorrow with delight while Ughustine continues to annoy and gets batted around by the rest of the commenters. Good start to a Saturday, I say…..

  25. #25 Krebiozen
    August 26, 2011

    If it causes convulsive febrile seizures and brain damage by falling asleep in a sealed room with fans running, then the government should warn people and and not force or coerce them to do it.

    Fans are probably far more dangerous than vaccines:

    The types of injury were scalp lacerations, compound depressed fractures and multiple intracranial haemorrhages. Two patients had the complication of wound infection, and one of these patients developed cerebral spinal fluid leak. One patient died from severe head injuries.

    http://www.ncbi.nlm.nih.gov/pubmed/16024308

    Also see:
    http://www.ncbi.nlm.nih.gov/pubmed/10065123

    I’m surprised but happy to find out Augustine has a hubby…

  26. #26 Th1Th2
    August 26, 2011

    It’s always about the vaccines. It always will be about the vaccines.

    Of course Orac, it’s your job as an infection promoter.

  27. #27 herr doktor bimler
    August 26, 2011
  28. #28 lilady
    August 26, 2011

    @ Science Mom: Yes, I understand your concerns…(still ignoring filthy mouthed ignorant boring troll).

    There is no policy prohibiting discharge of pediatric patients whose parents are “hard core” anti-vaxers. Notice how I used that terminology “hard core”. There are position papers however on the AAP site that encourage pediatricians “to work” with parents who have objections about immunizations. Of course, pediatricians work intently with parents by counseling them, providing accurate information, considering “staggering” of multiple vaccines at two week intervals (the so-called alternative vaccine schedule) available at the AAP Red Book and contained in the CDC Pink Book). There are also “sample” (CYA) forms available for downloading at the AAP website for pediatricians to give to parents who decline any individual, combination or all of the Recommended Childhood Vaccines.

    Again, I refer you to my posting above and the use of “hard core” anti-vax parents. If a physician (pediatrician or family practice doctor) has employed all the techniques to have the parents understand the value of vaccines for their child(ren) and for the community at large and determines that parents are adamantly “hard core” anti-vaxers, then the physician may decide that they will dismiss the young patient from the practice.

    Physicians have to make decisions “for the greater good” of the other children they provide care to…kids who have certain immuno-compromising conditions and infants who are too young to be fully immunized against potentially lethal diseases such as pertussis or measles or invasive HIB disease. You wouldn’t want to have an older child whose parents are “hard core” anti-vaxers with a child who is unimmunized against measles showing up in your waiting room during a measles outbreak, would you?

    Pediatricians and Family Practice Physicians must make a decision about discharging a young patient before the potential exposure to other vulnerable patients in their care, so that it is not considered patient abandonment.

    Please don’t confuse the immunization program to provide timely and complete immunizations before children are exposed with legal actions that are taken by pediatricians and public health officials against “anti-vax” parents who refuse immunization and prophylaxis after exposure to maternal hepatitis B virus at birth. Physicians and public health officials are duty-bound to report anti-vax parents to child protective services once the child has been exposed to hepatitis B.

    There is an interesting website that discusses steps that pediatricians should take to discharge a patient whose parents are “hard core” anti-vax:

    AAP: Dismissing Patients over Refusal to Vaccinate Okay, Doc Says
    By Emily P. Walker, Washington Correspondent, MedPage Today
    Published: October 21, 2009

    WASHINGTON — If parents refuse to vaccinate their children, it’s ethical and legal to dismiss the child as a patient, a pediatrician told attendees of the American Academy of Pediatrics meeting here.

    “In the middle of treatment, you can’t just say, I’m done,” Gary Marshall, MD, of the University of Louisville (Ky.) School of Medicine, said during a session that addressed parental concerns about vaccinations and how pediatricians can respond.

    But if it becomes obvious that you and the family will never see eye to eye on a specific issue, there’s no reason not to “fire” them, providing you follow the steps necessary to avoid charges of abandonment. Those include providing written notice that you will no longer treat their children and giving them a set time frame — at least 30 days — to find another physician.

    (apologies for not linking the full article)

  29. #29 lilady
    August 26, 2011

    Rule # 14: Ignore Thingy who has a pathological distrust of medicine and science and is delusional as well. (He/she/It brags about taking down Orac’s blog and resides in its own reality)

  30. #30 Lawrence
    August 26, 2011

    Ignore the trolls….

  31. #31 Alison
    August 26, 2011

    I’m all for doctors refusing to take patients who will expose them, their staff, and their other patients to potentially devastating preventable disease. It’s just another kind of quarantine to help limit the spread of illness among the general population.

  32. #32 Narad
    August 26, 2011

    I will be reading tomorrow with delight while Ughustine continues to annoy

    Eh, he appears to be trying straight-up feebleness at this point to attract bites.

  33. #33 Mephistopheles O'Brien
    August 26, 2011

    I’m still waiting for a coherent explanation why a killed vaccine (which can’t reproduce) or a vaccine made by recombinant DNA techniques (so no actual pathogen is present) can cause an infection, or why it’s barbaric to cause an infection that won’t (most of the time) create symptoms (up to and including death) to avoid one that (most of the time) does.

  34. #34 Sharon
    August 26, 2011

    I’m with Lawrence, ignore the trolls.

    @science mom, You make good points about the risk of Drs driving parents into the waiting arms of homeopaths and other quacks by refusing to treat children who are not immunised. BUt I wonder about the duty of care to the other patients in the waiting room? Didnt we see infection spread in a certain Drs waiting room in the not too distant past? If I am a Dr (which I am not) and I have elderly, young and immune compromised patients in my waiting area then I risk their safety. Or do we have a separate area for families who do not vax? Can you imagine the howls of protest? I think it’s a very complex issue, and I can understand both sides of the treat/don’t treat argument.

  35. #35 Narad
    August 26, 2011

    I’m all for doctors refusing to take patients who will expose them, their staff, and their other patients to potentially devastating preventable disease.

    I wouldn’t discount the element of “hard-core” antivaxxers, as lilady described them, just being so querulously filled with their own ersatz medical ideas as to make it impossible to establish a useful doctor-patient relationship.

  36. #36 lilady
    August 26, 2011

    I expanded on my post…about AAP policy…held in moderation though.

  37. #37 Lawrence
    August 26, 2011

    Sharon – I believe that was one of the vectors of infection for the San Diego outbreak (Dr’s waiting room).

  38. #38 Reuben
    August 26, 2011

    Augustine. Th1Th2. All we need now is Wide World of Sports and a Blimp!

    Good hunting, everyone. I have a weekend to enjoy.

  39. #39 Gopiballava
    August 26, 2011

    Bwahaha!

    So many hours wasted discussing with a troll who doesn’t understand that absolute numbers are, quite frequently, used to calculate relative numbers. It’s actually quite sad when you think about it.

  40. #40 ken
    August 26, 2011

    Don’t blame those unvaccinated for the outbreak- here are two links which
    point to the possibilty of another strain of pertussis unfortunately. My sister in
    CA found these links in her research- her infant caught it even though the whole family was recently immunized.
    1) http://www.cidd.psu.edu/research/synopses/acellular-vaccine-enhancement-b.-parapertussis
    2) http://t.co/nERyQg8

  41. #41 lilady
    August 26, 2011

    (My other comments are still in moderation)

    Here are two cases of measles contracted in the Emergency Room during the recent measles outbreak in Minneapolis, as reported in the MMWR:

    Notes from the Field: Measles Outbreak — Hennepin County, Minnesota, February–March 2011
    Weekly
    April 8, 2011 / 60(13);421

    The patients included children aged 4 months–4 years and one adult aged 51 years; seven of the 13 were of Somali decent. Eight patients were hospitalized. Vaccination status was known for 11 patients: five were too young to have been vaccinated, and six (all of Somali descent) had not been vaccinated because of parental concerns about the safety of the measles, mumps, and rubella (MMR) vaccine. The most recent rash onset was March 28. An additional, unrelated case of measles was confirmed in a Hennepin County resident aged 34 years who was exposed in Orlando, Florida, sometime during March 1–10.

    The investigation determined that the index patient was a U.S.-born child of Somali descent, aged 30 months, who developed a rash February 15, 14 days after returning from a trip to Kenya. The patient attended a drop-in child care center 1 day before rash onset; measles developed in three contacts at the center and in one household contact. Secondary and tertiary exposures occurred in two congregate living facilities for homeless persons (four patients), an emergency department (two patients), and households (two patients). A virus isolate from the index patient was genotyped at CDC as B3, which is endemic in sub-Saharan Africa.

  42. #42 augustine
    August 26, 2011

    Oh no, Lilady, not the measles. Surely all of those patients you cited must have died. And what happened to the effectiveness of the vaccine? How many infected were vaccinated? The ones’ who didn’t vaccinate assumed the risk of a childhood illness did they not? Maybe the ones who were in psychological distress were the one’s who got the shot and found out that it didn’t work for them.

    Does your report say anything about confounders such as nutritional status? You do know what confounders are don’t you?

  43. #43 Chris
    August 26, 2011

    ken, that is a much milder disease. It does not produce the severe symptoms in humans. Your fist link is on mice, and the second one looks like a questionable news source.

    Ask your sister if the ten or so infants that died there last year died from pertussis or parapertussis, with supporting documentation from the California Department of Public Health.

    Even so, your little bit of information is still not anything that shows the DTaP and Tdap vaccines are dangerous, and contradicts the IOM report that this article is about. Because just because neither vaccine protects against a different more milder but similar disease, does not mean the vaccine is worthless.

    By the way, I found the paper you posted while doing a PubMed search. But I also found this more recent and relevant paper, Real-time PCR-based detection of Bordetella pertussis and Bordetella parapertussis in an Irish paediatric population.. Here is what was in the abstract:

    Among 1324 patients, 76 (5.7 %) were B. pertussis culture positive and 145 (10.95 %) were B. pertussis PCR positive. Of the B. pertussis PCR-positive patients, 117 (81 %) were aged 6 months or less. A total of 1548 samples were examined, of which 87 (5.6 %) were culture positive for B. pertussis and 169 (10.92 %) were B. pertussis PCR positive. All culture-positive samples were PCR positive. Seven specimens (0.5 %) were B. parapertussis culture positive and 10 (0.8 %) were B. parapertussis PCR positive, with all culture-positive samples yielding PCR-positive results.

    Now let’s review:

    Pertussis: 76 (5.7 %) were B. pertussis culture positive and 145 (10.95 %) were B. pertussis PCR positive

    Parapertussis: Seven specimens (0.5 %) were B. parapertussis culture positive and 10 (0.8 %) were B. parapertussis PCR positive

    So there were ten times as many cases of pertussis causing concern than parapertussis. And PCR seems to catch more infections than culture.

    It continues, with:

    A review of patient laboratory records showed that of the 1324 patients tested for pertussis 555 (42 %) had samples referred for respiratory syncytial virus (RSV) testing and 165 (30 %) were positive, as compared to 19.4 % of the total 5719 patients tested for RSV in this period.

    Oooh, it looks like there was another problem found! A virus! It concludes with:

    The incidence of infection with B. parapertussis is low while the incidence of RSV infection in infants suspected of having pertussis is high, with a similar age distribution to B. pertussis infection.

    Fortunately, there is a vaccine for RSV. Unfortunately, it is very expensive. Plus the data shows there it is a higher priority than parapertussis.

    So, ken, do you have similar data showing that the illness in California affecting babies is actually parapertusssi?

  44. #44 Chris
    August 27, 2011

    ken, my comment went into moderation. But you actually need to show that the health department in California has identified parapertussis, a much milder disease, to be the culprit. Neither of your links are from any health department, much less the one where your sister lives.

    And it really does not diminish the results of the IOM report by saying the DTaP and Tdap vaccines do not prevent a similar milder disease. It is akin to thinking that the HPV vaccine is worthless because it does not prevent plantar warts (another human papillomavirus). Or that plantar warts are a cause of cervical cancer!

  45. #45 Matthew Cline
    August 27, 2011

    @Reuben:

    Even if studies are done to the specifications of the anti-vaccine establishment, they will manage to point out to “weaknesses”, “conflicts of interest”, and “errors” when those studies show there is no link.

    I wish I could remember the names involved, but there a while ago there was a study to see if there was correlation between use of Thiomersal containing pediatric vaccines and any neurological/cognitive problems (not just autism). They included one of the “vaccines cause autism” people in the group which designed the study, and she approved the study design before it was set into action. However, once the study found no correlations except for a mild one with muscular tics this same person heavily criticized the study.

  46. #46 Bill Minuke
    August 27, 2011

    Let’s go back to the bad old days when, for instance, there were 60,000 cases of polio in a year and 3000 deaths.
    (http://kidshealth.org/parent/infections/bacterial_viral/polio.html)

    Antivaxers aren’t advocating for safety, they’re advocating for death and suffering on a massive scale.

  47. #47 lilady
    August 27, 2011

    @ ken: As Chris stated neither of the two articles make any reference to serious illness or deaths that are linked to the B. parapertussis bacterium. The deaths of 10 infants in California were all caused by the B. pertussis bacterium as confirmed by laboratory testing. Many cases of B. parapertussis are asymptomatic and the only pertussis bacteria that produces a toxin is B. pertussis.

    The second article you linked to contains many “conspiracies” about Big Pharma and researchers:

    “Mooi, the scientist who has been studying the bacterial mutations, said his research has been ignored by those who influence public policy on pertussis in the U.S. and beyond in part because they rely on vaccine makers to fund their meetings and research.

    There is little incentive for pharmaceutical companies to pursue a new vaccine because it would cost billions, he said. The circulation of a more virulent strain of pertussis could mean a new vaccine should be created.”

    “* Public officials around the world rely heavily on two groups of pertussis experts when setting vaccine policy relating to the disease. Both groups, and many of their members, receive money from the two leading manufacturers of pertussis vaccine.”

    It seem that you are getting information from “other” sources which plug into conspiracy theories about government and vaccine manufcturers and that take pot shots at doctors and researchers.

    I suggest you read the CDC Pink Book/Pertussis chapter for information about the incidence and prevalence of the disease, the development of the whole cell pertussis vaccine and the development of the acellular vaccine. For a variety of reasons vaccines against B. pertussis diphtheria and tetanus do not confer lifelong immunity….they require 10 year booster shots. Starting in October, 2010 it is now recommended that adolescents/teens ages 11-18 receive one dose of Tdap vaccine…preferably between ages 11-12. Adults should also get the Tdap vaccine rather than the double antigen Td vaccine so that infants who are not immunized do not contract pertussis from an older relative or friend.

  48. #48 Narad
    August 27, 2011

    They included one of the “vaccines cause autism” people in the group which designed the study, and she approved the study design before it was set into action. However, once the study found no correlations except for a mild one with muscular tics this same person heavily criticized the study.

    I suspect that you’re thinking of Sallie Bernard.

  49. #49 Matthew Cline
    August 27, 2011

    @Narad:

    Yes, that’s exactly who I was thinking of. Thanks.

  50. #50 lilady
    August 27, 2011

    @ Matthew Cline and Narad: Dang…you guys are good. I am in awe of your superior research skills…Thanks for the great link to Orac’s blog about Sallie Bernard.

  51. #51 augustine
    August 27, 2011

    Bill Minuke

    Antivaxers aren’t advocating for safety, they’re advocating for death and suffering on a massive scale.

    That, Science Bloggers, is called a logical fallacy. Who wants to defend Bill Minuke’s intellect and critical thinking skills?

    Is this how your average blogger actually thinks?

    http://www.nizkor.org/features/fallacies/straw-man.html

    This sort of “reasoning” is fallacious because attacking a distorted version of a position simply does not constitute an attack on the position itself. One might as well expect an attack on a poor drawing of a person to hurt the person.
    Examples of Straw Man

    Prof. Jones: “The university just cut our yearly budget by $10,000.”
    Prof. Smith: “What are we going to do?”
    Prof. Brown: “I think we should eliminate one of the teaching assistant positions. That would take care of it.”
    Prof. Jones: “We could reduce our scheduled raises instead.”
    Prof. Brown: ” I can’t understand why you want to bleed us dry like that, Jones.”

    “Senator Jones says that we should not fund the attack submarine program. I disagree entirely. I can’t understand why he wants to leave us defenseless like that.”

    Bill and Jill are arguing about cleaning out their closets:
    Jill: “We should clean out the closets. They are getting a bit messy.”
    Bill: “Why, we just went through those closets last year. Do we have to clean them out everyday?”
    Jill: “I never said anything about cleaning them out every day. You just want too keep all your junk forever, which is just ridiculous.”

  52. #52 augustine
    August 27, 2011

    @ Matthew Cline and Narad: Dang…you guys are good. I am in awe of your superior research skills

    Lilady, it’s called GOOGLE. As in Google University. You’ve been to that campus before.

  53. #53 Science Mom
    August 27, 2011

    You make good points about the risk of Drs driving parents into the waiting arms of homeopaths and other quacks by refusing to treat children who are not immunised. BUt I wonder about the duty of care to the other patients in the waiting room? Didnt we see infection spread in a certain Drs waiting room in the not too distant past?

    That is an absolutely valid point and one of the reasons why I can understand dismissing anti-vaxxers. However, some doctors will have patients wait outside the building until an examining room can be cleared when an infectious disease is suspected. Proper disease control measures can be implemented to prevent exposure as well.

    I wouldn’t discount the element of “hard-core” antivaxxers, as lilady described them, just being so querulously filled with their own ersatz medical ideas as to make it impossible to establish a useful doctor-patient relationship.

    You are quite right as well and there are often other issues that prevent a meaningful relationship from being established with the woo-worshipping parents and a valid reason for dismissing them. For simply not following the CDC schedule though, I strongly disagree with with dismissal from the practice.

  54. #54 Th1Th2
    August 27, 2011

    Mephistopheles,

    I’m still waiting for a coherent explanation why a killed vaccine (which can’t reproduce) or a vaccine made by recombinant DNA techniques (so no actual pathogen is present) can cause an infection,[...]

    Surprise surprise. A germ denialist asking a question. Easy. ALL vaccines contain PAMPs. It is a MUST. Geez. Don’t give it and you’ll have no infection. Killed, inactivated, fragmented, subunit and rDNA vaccines cause nontransmissible infection.

    [...] or why it’s barbaric to cause an infection that won’t (most of the time) create symptoms (up to and including death) to avoid one that (most of the time) does.

    Why is it not barbaric to avoid infection promoters? You tell me.

  55. #55 Lawrence
    August 27, 2011

    Ignore the trolls.

  56. #56 Science Mom
    August 27, 2011

    There is no policy prohibiting discharge of pediatric patients whose parents are “hard core” anti-vaxers. Notice how I used that terminology “hard core”.

    Yes, I am aware of the AAP policy about patient dismissal and vaccines. If that is the only issue though, I still think it is the children that are ultimately punished and there are infection control measures that can be implemented to avoid transmission. I am also aware of physicians using this policy to dismiss selective/delayed vaxxers from their practices as well and that is even more counter-productive. And guess what? These children still get to go to school with everyone else so you aren’t exactly preventing much of anything.

  57. #57 lilady
    August 27, 2011

    (Still ignoring ignorant filthy-mouthed troll and delusional troll)

    @ Chris: I see your comments at #43 above (out of moderation) which describes the incidence of confirmed B. pertussis versus incidence of B. parapertussis researched during a study in Ireland. Just a tiny clarification however, there is no vaccine available yet for RSV. Prophylaxis against RSV is provided to infants with a monoclonal antibody ((Palivuzumab) given monthly during the RSV “season” (November-March usually) in the pediatrician’s office through an IM injection, for certain “at risk” babies (born very prematurely or with congenital cyanotic/complicated heart abnormalities, abnormalities of the airway and neuromuscular diseases that impair the ability to handle respiratory secretions). RSV is the most common cause of bronchiolitis and pneumonia in children under one year of age and in some cases of infection can result in hospitalization and mechanical ventilation.

    @ Science Mom: My “missing” comments are out of “moderation” and appear at #28 above. I think they reflect the position of the AAP and the efforts made by pediatricians to educate recalcitrant parents about immunizations. The decision to discharge a young patient from care is not frivolous and not abandonment and is only implemented with “hard core” anti-vax parents. Why should such parents have the “rider” effect (riding in/benefiting from herd immunity and protecting their unimmunized children) with the resulting effect of putting other children at risk?

  58. #58 Narad
    August 27, 2011

    For simply not following the CDC schedule though, I strongly disagree with with dismissal from the practice.

    I’m mildly inclined to agree, but with the caveat that “simply” can go off the rails fast with the selective/delayed crowd. When Ms. Hoomi comes in and insists that little Kooter will be following Dr. Sears’ schedule, except that you need to order a supply of Td because aP doesn’t prevent transmission and we’re going to rely on sodium ascorbate instead and I know that he said that Merck was going to resume production of separate MMR, so you don’t exactly inspire confidence when you say that they’re not available hmmmm you know you work for me and I think I’d like some titers because two polios should be enough and you also need to study up on serotype replacement and on and on and on.

  59. #59 lilady
    August 27, 2011

    “For simply not following the CDC schedule though, I strongly disagree with with dismissal from the practice.” It doesn’t seem that Science Mom understands certain principles of disease prevention/disease transmission and certainly doesn’t understand why doctors would discharge a patient from care.

    Science Mom now ends her latest comment with this gem:

    “And guess what? These children still get to go to school with everyone else so you aren’t exactly preventing much of anything.”

    Doh, thank you for educating posters here about exposures that take place within the school setting. We were all totally unaware that liberal “philosophical exemptions” claimed by “hard core” anti-vax parents are responsible for outbreaks of vaccine-preventable diseases in the school setting…as well as the risks to infants and immune-suppressed people to acquire a disease through secondary or terciary transmission from an unimmunized school-aged child.

  60. #60 Chris
    August 27, 2011

    lilady, thank you very much for the clarification on RSV. That is the danger on going on anecdote. It was actually a mother of premie twins who told me about the cost of the RSV protection for her babies. So I was wrong.

    Still it seemed interesting that they were looking at to what exactly what bugs were causing issues. And parapertussis was low on the list.

  61. #61 Chris
    August 27, 2011

    ken, in addition to more recent studies, go back and review two older posts by Orac:
    One more time: Vaccine refusal endangers children
    and
    Pertussis returns in states with lax vaccination laws

    Read those, and then come back with some real evidence that the increase is from parapertussis.

  62. #62 Science Mom
    August 27, 2011

    @ Science Mom: My “missing” comments are out of “moderation” and appear at #28 above. I think they reflect the position of the AAP and the efforts made by pediatricians to educate recalcitrant parents about immunizations. The decision to discharge a young patient from care is not frivolous and not abandonment and is only implemented with “hard core” anti-vax parents.

    @ lilady, I was responding to your comment which came out of moderation. What about the concern of driving such parents into the care of sub-rate practitioners such as naturopaths, chiropractors or wooey physicians? Particularly in areas or HMOs where physician choices are limited. Do you think these children will receive appropriate medical care in the event of illness, whether VPD or not? And it isn’t only “hard core” anti-vax parents who are subject to this policy, it’s many parents who deign to deviate from the CDC schedule at all. If it was actually your “hard-core” anti-vaxxers that this was limited to, it would be less cringe-worthy for as Narad pointed out, “hard-core” anti-vaxxers almost always have their own ideas about healthcare and thus, difficult to establish a meaningful relationship with them.

    Why should such parents have the “rider” effect (riding in/benefiting from herd immunity and protecting their unimmunized children) with the resulting effect of putting other children at risk?

    This is a difficulty for sure, but how does dismissing them from a practice change this? These children are still out in public and still going to schools. The only difference is now they are now either receiving lousy or no medical care.

    “For simply not following the CDC schedule though, I strongly disagree with with dismissal from the practice.” It doesn’t seem that Science Mom understands certain principles of disease prevention/disease transmission and certainly doesn’t understand why doctors would discharge a patient from care.

    Oh how I wish you hadn’t gone there, as someone who had respect for your experience and formal knowledge. It seems as though not only do I have expertise in infectious disease, but also have some foresight and compassion to understand that this is not a policy that will solve the problem of vaccine compliance, something you are lacking and seem perfectly happy to commend such a knee-jerk reaction.

    “And guess what? These children still get to go to school with everyone else so you aren’t exactly preventing much of anything.”

    Doh, thank you for educating posters here about exposures that take place within the school setting. We were all totally unaware that liberal “philosophical exemptions” claimed by “hard core” anti-vax parents are responsible for outbreaks of vaccine-preventable diseases in the school setting…as well as the risks to infants and immune-suppressed people to acquire a disease through secondary or terciary transmission from an unimmunized school-aged child.

    You’re very welcome and it does bear mentioning since exemptions are a large part of the problem that dismissal from physicians’ practices does not resolve. As a public health nurse, you should know that the two primary venues for disease transmission are schools and hospitals (primarily ERs I believe). So Mr. and Mrs. Sparleigh’s precious unvaccinated snowflake is going to still go to school and will more likely end up in an urgent care or ER due to dismissal from a physician’s practice when precious becomes sick.

    It is a policy that may make sense on the surface and provide some immediate gratification but it doesn’t address the larger problem. There are flaws in vaccination policies, there are flaws in AAP recommendations; there is nothing wrong with addressing those flaws and doesn’t mean patent abandonment of a pro-vaccine position.

  63. #63 Enkidu
    August 27, 2011

    “Fortunately, there is a vaccine for RSV. Unfortunately, it is very expensive.”

    My preemie daughter was lucky enough (or unlucky, since the criteria was very low birth weight) to qualify for insurance-paid RSV antibody shots (as lilady described) for two straight winters; without insurnace they were $1200 a shot! I can’t imagine having to pay that out-of-pocket.

  64. #64 lilady
    August 27, 2011

    @ Science Mom: If I was somewhat strident in my remarks directed at you, I apologize. But, I have had experience in public health and have actually done case surveillance, provided post exposure prophylaxis for vaccine-preventable disease and sadly, have reported cases to the CDC of children left permanently disabled or who have died from vaccine-preventable diseases.

    I originally started this “thread” about physicians making a decision to discharge patients whose parents are “hard core” anti-vaxers and offered up an opinion that doctors who want to protect vulnerable patients in their practice, have every “right” to make that decision.

    When this anti-vax movement first occurred, there was some real concern about a possible link between certain vaccines and developmental disabilities. (Anyone recall the now debunked Stony Brook University medical students study of children who received prophylactic HBIG and Hep B vaccine at birth and the reported “incidence” of higher risk for developmental disabilities?) This was years before hepatitis B was added to the Recommended Childhood Vaccine Schedule. Now how many other studies (Chris has the best list that I know of), have now totally debunked any and all linkage between any and all childhood vaccines and autism…yet a small percentage of parents still persist with their “hard core” anti-vax views…joined now by others who are concerned about “patient choice”, various conspiracists and other cranks.

    I don’t agree that by taking this firm stance doctors are wrong and don’t assume that they will be forcing parents into the arms of CAM practitioners. There is a small coterie of board certified pediatricians and family medicine docs who will admit such children into their practices (Dr. Jay Gordon and others) that “hard core” anti-vax parents take their children to…where they may not have the benefit of riding in on the herd immunity.

    Let us not forgot the role of school nurses in public and parochial schools who educate parents about the need to have their children fully immunized and the potential for disease transmission when parents use a “philosophical exemption.” Each school nurse in the County where I worked in public health had a list of school children whose parents had opted for the exemption. Whenever an “index” case is reported to the health department (sometimes the school nurse reports the “case” to the health department), children whose parents have chosen a philosophical exemption are exempted (banned) from attending school…usually within hours.

    There is a heightened awareness of vaccine-preventable disease transmission in health care facilities such as emergency rooms, public clinics and doctors’ offices, yet still some exposure/transmission takes place. Doctors making the decision to discharge a patient from care after employing every technique to get children immunized is just one way to cut down on transmission rates…it also affords some protection for vulnerable infants and immune-suppressed patients. I firmly believe that not only do doctors have the right for such action…they are also practicing good medicine.

  65. #65 Dr. Harshit
    August 27, 2011

    I don’t know if any of you are from a developing country, but I’d urge the vaccine nay-sayers to come down here (India) and see for yourself what it means to be in fear of the diseases which vaccination has curbed in your country giving you the (false) sense of security to speak out against it (vaccination).

  66. #66 Chris
    August 27, 2011

    Don’t count on it, Dr. Harshit. There is one particular fellow who occasionally posts here as “Sid Offit” who really doesn’t care. His racism has been pointed out several time here.

    By the way, welcome to the blog!

  67. #67 lilady
    August 27, 2011

    @ Enkidu: I know your “wee one” is the joy of your life and here’s an example of “greedy Big Pharma” taking advantage of parents of premature babies:

    MedImmune Expands Access for Eligible Premature Infants to Receive Synagis(R) at No Cost

    Tags:monoclonal antibody respiratory syncytial virus respiratory tract infection

    Company Increases Eligibility to Its Patient Assistance Program to 400 Percent of Federal Poverty; as Many as 75 Percent of U.S. Households May Now Qualify for This Program

    GAITHERSBURG, Md., June 29 /PRNewswire/ — MedImmune today announced the expansion of the MedImmune Assistance Program for Synagis(R) (palivizumab) designed to provide the antibody at no cost to qualifying patients who lack health insurance and whose family household income falls within a certain range of the Federal Poverty Level (FPL) guidelines established by the U.S. Department of Health and Human Services (HHS). Synagis is a biologic medicine known as a monoclonal antibody administered monthly to high-risk infants to prevent serious lower respiratory tract infection caused by respiratory syncytial virus (RSV), a leading cause of viral respiratory infection among infants.

    Effective July 1, 2009, patients with household income up to 400 percent of the FPL (e.g. a household of four with an income up to $88,200), and without healthcare coverage or medical insurance, may be eligible to receive Synagis at no cost. This marks a significant expansion over the program’s previous eligibility ceiling of 250 percent of the FPL (e.g. $55,125 for that same four-member household).

    Hello to Dr. Harshit: Sid Offit a notoriously prejudiced anti-vaxer has chosen to post under that name as part of his ongoing internet harassment of Dr. Paul Offit a respected researcher and practicing pediatrician. One of Sid’s most recent postings poked fun at a young girl whose entire face was covered in smallpox pustules. I have re-dubbed Sid as Sid Offal…a more descriptive pseudonym for his incessant bigoted blather.

  68. #68 adelady
    August 27, 2011

    I’m with lilady on this one.

    Doctors’ waiting rooms must, by definition, contain a higher proportion of vulnerable people than the general population in a school or a shopping centre. A doctor pointing out that the practice has a duty of care to patients in the waiting room, not just during a consultation or a procedure, is a good explanatory device for parents with foolish fears.

    Parents who then protest that they’d not bring a ‘sick child’ to the practice need reminding, or teaching, that infectious diseases don’t show obvious, or any, symptoms at onset. There is _no_ way of knowing whether an apparently healthy child is in the first few, highly infectious, days of a transmissible illness.

  69. #69 Science Mom
    August 27, 2011

    @ Science Mom: If I was somewhat strident in my remarks directed at you, I apologize. But, I have had experience in public health and have actually done case surveillance, provided post exposure prophylaxis for vaccine-preventable disease and sadly, have reported cases to the CDC of children left permanently disabled or who have died from vaccine-preventable diseases.

    Thanks for your apology. I enjoy your posts due to your experience and expertise but please let’s not forget that there is a rich array of professionals here and not all choose to divulge their specific qualifications.

    I don’t agree that by taking this firm stance doctors are wrong and don’t assume that they will be forcing parents into the arms of CAM practitioners. There is a small coterie of board certified pediatricians and family medicine docs who will admit such children into their practices (Dr. Jay Gordon and others) that “hard core” anti-vax parents take their children to…where they may not have the benefit of riding in on the herd immunity.

    It’s not just about driving some non-compliers to CAM practitioners, that’s just part of it. Such a measure does not address the larger problem of getting parents to vaccinate, of who, sit on a spectrum of reasons for their poor decisions. By refusing to see any and all non-compliers, physicians are missing the opportunity to work with them to get their children vaccinated. The “hard-core” anti-vaxxers with profound philosophical differences are kind of fair game for dismissal, in my opinion.

    It is ironic that you mentioned the likes of Dr. Gordon and to that I would add Dr. Bob Sears, the latter having actual measles transmission take place to several infants and toddlers in his practice. I would mention them in a different light however since their ilk, being the worst offenders as far as vaccine education/compliance would not be at all inclined to dismiss non-compliers from their practices. So where do you think the greatest chance of transmission of VPDs is? I will also add that these “vaccine-friendly” physicians are not always geographically-available for dismissed patients and they almost always don’t take insurance.

    Let us not forgot the role of school nurses in public and parochial schools who educate parents about the need to have their children fully immunized and the potential for disease transmission when parents use a “philosophical exemption.” Each school nurse in the County where I worked in public health had a list of school children whose parents had opted for the exemption. Whenever an “index” case is reported to the health department (sometimes the school nurse reports the “case” to the health department), children whose parents have chosen a philosophical exemption are exempted (banned) from attending school…usually within hours.

    Yes, and reporting is key, yet not always done is it? Next, incubation/contagious periods are often prior to symptomalogy so exempting non-vaccinated children from school is of limited value. I’m not saying it shouldn’t be done, it should but how does booting them out of physicians’ practices address this? How about the Waldorf school that was shut down due to pertussis earlier this year? Most of the children weren’t vaccinated at all.

    There is a heightened awareness of vaccine-preventable disease transmission in health care facilities such as emergency rooms, public clinics and doctors’ offices, yet still some exposure/transmission takes place. Doctors making the decision to discharge a patient from care after employing every technique to get children immunized is just one way to cut down on transmission rates…it also affords some protection for vulnerable infants and immune-suppressed patients. I firmly believe that not only do doctors have the right for such action…they are also practicing good medicine.

    Let me first clarify that I am mainly addressing parents who wish to follow a non-CDC schedule who still get dismissed from practices or not allowed in from the get-go. I have had tremendous success getting some anti-vaxxers or extremely apprehensive ‘maybe’ vaxxers to do so with a little patience, education and a vaccine schedule that they can palate. I do not like to devise alternate schedules but it’s better than to leave them in the abyss of pseudo-science and not vaccinating at all. It would be much more desirable for physicians to do this for their patients even though it takes more time from their already hectic schedules. Why doesn’t the AAP instead hold seminars for new parents on the subject? Or the physicians schedule a consultation prior to a well-baby visit?

    As I mentioned earlier, what transmission has this policy actually prevented when the likes of Dr. Sears, who won’t dismiss non-compliant patients, even encourages them, has had VPD transmission in his waiting room? Don’t you think implementing better infection control measures, even differing ones for non-compliant patients would be more pragmatic?

  70. #70 Chris
    August 27, 2011

    lilady and Science Mom, it gets into all sorts of interesting thoughts when trying to deal with those that will not vaccinate. I wonder how one would educate a person who answers my very real concerns on protecting vulnerable children in a community with this:

    Those who vaccinate should stay in quarantine themselves for at least 30 days.

    There is always much talk about how the non-vaxers are the ones putting un-vaxable children are risk. However, those that DO vax are doing the same, by not quarantining your children after vaccinations.

    Many children get the diseases for which they have been vaccinated, including measles and chicken pox. If you truly care about the un-vaxable then you would be spreading the word to the those that ARE VACCINATING and stop putting all the fault/responsibility on the non-vaxers.

  71. #71 lilady
    August 27, 2011

    @ Chris: There is definitely a difference between a “hard core” anti-vaxer and a parent who has some reluctance about vaccines. The ones who are reluctant are the ones who are open to information and the very same ones who sit down with their child’s doctor and call the health department for information. A large portion of my working day was spent speaking to parents about vaccine and sending them information about vaccine preventable diseases.

    The pediatricians and family practice doctors in my county are always available to speak at the County Medical Society and local schools and at the County hospital to explain the value of childhood immunizations. County health department nurses and health educators always attended each and every “health fair” held in schools, shopping malls, etc. alongside the (shudders) supplement sellers.

    All “reportable” diseases are eventually reported to the local health department; physicians, laboratories, day care centers and schools are mandated to report the diseases. Yes, sometimes school nurses provide the “leads” to the health department following a phone call from a parent reporting a suspected case of measles. My State’s Health Department Law/Regulations and Education Law/Regulations mandate exclusion of all unimmunized children from school in order to contain the outbreak…which is recommended by the CDC:

    Manual for Surveillance of Vaccine Preventable Diseases-Measles Chapter

    Prevention of vaccine-preventable disease and containment of vaccine-preventable diseases just doesn’t “happen”. It takes the cooperation of the public to not put others at risk, and the joint efforts of physicians, hospitals, public health staff and schools.

    Parents of not fully immunized infants and parents of children with real medical contraindications for immunizations have enough to worry about. They put there trust in their physicians and in the child’s school to protect their kids. They shouldn’t have the added worry of their child contracting a potential deadly disease just based on the whim of a “hard core” anti-vax parent

  72. #72 Gopiballava
    August 27, 2011

    I wonder if something like, “every six month delay in the vaccine schedule adds N more kids to spread the disease” would help remind people that delaying does increase risks.

    Perhaps a one page brochure explaining herd immunity along with some numbers / diagrams explaining the risks of increasing the numbers of people who can transmit diseases?

    (Now that I think about it, I realized that I don’t actually know why vaccines are spaced in the specific way they are now – which ones could be earlier, or couldn’t, and why. I’m sure Google U can inform me…)

  73. #73 lilady
    August 28, 2011

    “I wonder if something like, “every six month delay in the vaccine schedule adds N more kids to spread the disease” would help remind people that delaying does increase risks.”

    Would this PubMed citation do? It details the extent of an outbreak caused by large pockets of school aged children returning from Romania who were unimmunized.

    Implications of a 2005 measles outbreak in Indiana for sustained elimination of measles in the United States

    (NEJM-September 14, 2006 Indexed at PubMed 16885548)

    “(Now that I think about it, I realized that I don’t actually know why vaccines are spaced in the specific way they are now – which ones could be earlier, or couldn’t, and why. I’m sure Google U can inform me…)”

    Nah, you won’t get really good information from Google U. You can however go the CDC Pink Book website and read Chapter II “General Recommendations on Immunization” to find out the answer to your questions about spacing and “earlier” than recommended schedules.

    No vaccine should be given to an infant earlier than recommended age because an infant’s immature immune system may prevent the child from getting lasting immunity. Measles vaccine should be given prior to the recommended one year of age (between ages 6 months and 1 year), during a measles outbreak or prior to travel to a foreign country where measles is endemic…but that immunization “doesn’t count” and the child will require the 2-dose series after age one.

    The spacing of a vaccine series used to be a hard and fast rule; i.e. one month=28 days spacing; less than 28 days was consider an invalid immunization. About 15 years ago, following a lot of research the ACIP (Advisory Committee on Immunization Practices) recommended that spacing two days earlier than the recommended spacing should be considered valid. Recently the ACIP recommended that 4 days earlier (24 days between shots given in a series) should be considered valid.

  74. #74 augustine
    August 28, 2011

    Dr. Harshit

    I don’t know if any of you are from a developing country…

    No, I’m not.

    but I’d urge the vaccine nay-sayers to come down here (India) and see for yourself what it means to be in fear of the diseases…

    Why must you use fear in lieu of science Dr. Harshit?

    which vaccination has curbed in your country giving you the (false) sense of security to speak out against it (vaccination).

    Can you explain why said diseases (which you didn’t name, a common hallmark of mass vaccine ideologists) have decreased in severity and/or incidence BEFORE the introduction of mass vaccination.

    Now I know your education instructors didn’t inform you of this FACT but it throws a monkey wrench into your belief system. Can you explain why they didn’t go into depth about this discussion?

    Can you also describe the nutrition, hygiene,sanitation, and socioeconomic conditions of your average patient? Could you also please explain how these conditions compare to that of the United States?

    Do you, as a Medical doctor, understand what confounders are? Do you understand how they affect scientific studies and conclusions?

  75. #75 augustine
    August 28, 2011

    Nah, you won’t get really good information from Google U. You can however go the CDC Pink Book website…

    And how would you expect the lay reader to get to that actual website? Could you actually get there by using….gasp …google?

    And could you please tell the science blogging community when the last time you took an actual relevant university related clase. Was it 1960?

    Tell us again why you are qualified to say anything scientific at all? Is it because of your nursing degree? What year did you graduate, again?

  76. #76 Chemmomo
    August 28, 2011

    A dose of reality on the topic of sick kids in the waiting room: if I can’t bring my sick kids to the doctor’s office, what is it there for?
    My own pedi’s office 40 years ago had a separate waiting room for sick kids. The one I use for my own kids does too, sort of. The problem is that it shares air with the well child side.
    Two years ago I had the unfortunate experience of exposing the entire suite to H1N1 flu. The staff knew why I was bringing my child in, and they gave me a mask for him to wear (it was tiny, and it even had Mickey, Donald, and Goofy on it) as soon as we entered.
    The problem was my kid (3.5-yo at the time) kept taking it off. I had to confirm my insurance coverage and write a check (hmm, sick kid, no cash on hand) for the copay and I didn’t have enough hands to keep the mask on him at the same time. I did not have the option of bringing along an extra adult to the office visit that day.
    The bottom line is that the responsibility for limiting the doctor’s office waiting room as a disease vector lies with the doctor’s office. If that means that some of them send away the anti-vaccine folks, well, that’s their decision. It’s still not going to eliminate the transmission of all diseases via the waiting room.

    And in case anyone cares: the child in question is now triply protected from H1N1, having had the disease itself, the vaccine when it finally came out, and again when he got last year’s flu vaccine.
    Oh, and if you’re going to tell me I shouldn’t have brought him to the doctor’s office, do you think that Urgent Care or the ER would be a better option?

  77. #77 Bill Minuke
    August 28, 2011

    Dear augustine

    I see your straw man fallacy and raise you a “No true Scottsman.”

  78. #78 lilady
    August 28, 2011

    @ chemmomo: Gosh you are making me feel ancient with you comment about 40 years ago when you were a pediatrics patient. When I, as a young mother brought my young children to the pediatrician’s office 40 and 35 years ago respectively, there was a separate waiting room for kids who were (obviously) sick to isolate them from babies who were at the office for well baby check ups. I also recall being questioned intently by the doctor’s nurse about symptoms, rashes and fevers and if those symptoms were present, being scheduled for the very last appointment of the day and told not to arrive “early”. But that was a different time then when we didn’t have groups of parents who were adamantly anti-vaccines.

    None of these screenings that take place both then and now in hospitals, clinics and private doctor’s offices are foolproof due to the prodrome asymptomatic highly infectious period of time when an infectious child could unknowingly expose others in a waiting room.

    But the debate here is whether a physician will increase the risk of transmission of a vaccine-preventable disease, by knowingly allowing a child into a waiting room who is unvaccinated due to parental “choice”, to expose babies who are not fully immunized and others kids who have medical contraindications to vaccinations?

    I support the physician, who evaluates such risks for the majority of his/her patients and tells “hard core” anti-vax parents to seek another physician to provide care to their unvaccinated child(ren).

    BTW, I had a nasty case of pertussis two years ago and was eternally gratefully that I was retired from public health and consequently did not unknowingly expose patients that I came into contact with, during the highly infectious asymptomatic prodrome period.

  79. #79 Bill Minuke
    August 28, 2011

    augustine

    It seems you’re not defending the anti-vax position, but diverting attention, calling my statement a strawman, i.e. a position that no antivaxer actually holds.

    My meaning is not that you want to cause death and suffering, I have no desire to speculate on motive, but that the antivax position will result in it.

    There has already been an uptick in deaths from pertussis ( whooping cough) attributed to a lack of vaccination as a result the anti-vax movement. As this anti-scientific movement spreads it will cause more deaths.

    And who are the victims of this lunacy? Innocent children.

  80. #80 Lawrence
    August 28, 2011

    Ignore the boring troll Bill – he’s an Objectivist contrarian who is only trying to get a rise out of us or insult Lilady (or both).

  81. #81 Reuben
    August 28, 2011

    From Sid Schecter’s pointless rant:

    Yet since routine can be defined as occurring “in the ordinary course of events,” no one in their right mind would claim that death to be ordinary outcome of the measles.

    No, but antivaxers like yourself keep pointing at the doctored graphs of declining deaths from measles as “proof” that vaccines are not needed. You can’t have it both ways, Schecter. You just can’t.

    You should stick to posting Bible verses out of context to your followers.

  82. #82 Antaeus Feldspar
    August 28, 2011

    My meaning is not that you want to cause death and suffering, I have no desire to speculate on motive, but that the antivax position will result in it.

    Well-phrased, Bill. Just don’t be surprised that it will not convince Boring Auger, who cultivates a thorough ignorance of subjects such as probability and the meaning of words such as “hypothetical”; even in the rare case that Augie actually understood your point, he’d probably just change the subject to transsexualism, since he thinks he can “win” on that topic and cares not a fig that radically changing the subject is a tacit admission that he can’t win on the field he’s abandoning.

  83. #83 lilady
    August 28, 2011

    @ Bill and Dr. Harshit: Just ignore the “welcoming committee of one ignorant, unemployable, uneducated filthy-mouthed troll.”

  84. #84 Th1Th2
    August 28, 2011

    Bill,

    There has already been an uptick in deaths from pertussis ( whooping cough) attributed to a lack of vaccination as a result the anti-vax movement. As this anti-scientific movement spreads it will cause more deaths.

    There are more vaccinated who have the evidence of the disease than then are unvaccinated and uninfected. Obviously, you are barking up the wrong tree. All you do is fear mongering. Well, infection promoters do that all the time because they choose to remain blind and ignorant. Vaccinators still keep denying that they are the number one cause of infectious diseases. And of course, death from “pertussis” is always an iatrogenic event.

  85. #85 lilady
    August 28, 2011

    Why do I have that lingering thought that the *Delusional* Thingy Troll and Filthy Mouthed Ignorant Troll are at a minimum… “channeling” each other?

    * Waiting for Thingy to claim “victory” over Orac by shutting down his blog

    * Waiting for Thingy to describe “terminal disinfection” for containment of a suspect measles case in an Emergency Room

  86. #86 Th1Th2
    August 28, 2011

    Regarding post #70 as to why the vaccinated never quarantine themselves after inoculation (I’ll go as far as 41 days). Until somebody answers intelligently, this thread should be closed to protect the naive from the vaccinated. Of course, self-quarantining would only deter their infection promoting agenda.

  87. #87 novalox
    August 28, 2011

    Ignore willfully ignorant troll.

  88. #88 lilady
    August 28, 2011

    HOLY SH**!! Thingy posted at the same time I did:

    “Until somebody answers intelligently, this thread should be closed to protect the naive from the vaccinated.”

    Stu, where are you? Your chew toy is back!

  89. #89 Th1Th2
    August 28, 2011

    Still waiting for lilady to look for her brain.

    [Search] is your friend.

  90. #90 Science Mom
    August 28, 2011

    @ Chris, I see that someone already responded on that forum but it is worthy of a blogpost methinks. Very few vaccines actually “shed”, the transmission rate is extremely low and vaccine strain transmission requires close contact and the resultant disease is almost always extremely mild. Vaccinees also have the benefit of knowing when they were “exposed” so can avoid close contact with those who may be vulnerable to secondary transmission.

  91. #91 Th1Th2
    August 28, 2011

    Science Mom,

    You call yourself that? No wonder you’re no different than a pox party mom.

  92. #92 Gray Falcon
    August 28, 2011

    Th1Th2, do you have any evidence for either of your claims? If not, then why should we believe you and not the real world?

  93. #93 Th1Th2
    August 28, 2011

    Science Mom,

    Very few vaccines actually “shed”, the transmission rate is extremely low and vaccine strain transmission requires close contact and the resultant disease is almost always extremely mild.

    Haha. Well, all vaccines do shed. It’s part of what is called antigenic clearance. Some remain infectious and contagious like live vaccines and capable of secondary transmission let alone passing its infectious derivatives–like OPV. Also the vaccinee, following inoculation, is not prevented to mingle with close contacts, kiss baby sister nor go to school. Yup, these are a perfect recipe for an outbreak.

  94. #94 novalox
    August 28, 2011

    Continue to ignore ignorant troll

  95. #95 Chris
    August 28, 2011

    Science Mom, just checked. No one has responded to my more recent responses, but Frankie (a mother who lost her only child to meningitis) has ranted back to the clueless woman. A woman who seems to actually believe Thingy.

  96. #96 Th1Th2
    August 28, 2011

    Science Mom,

    Vaccinees also have the benefit of knowing when they were “exposed” so can avoid close contact with those who may be vulnerable to secondary transmission.

    Another haha. No, don’t assume they knew they were exposed. The only thing in their mind is that they were “protected” following vaccination so that they can do whatever they want. Yup that they are no longer susceptible. Superiority complex that is. What they didn’t know is that they were primarily infected and thus will remain infectious and contagious after inoculation.

  97. #97 Narad
    August 28, 2011

    You call yourself that? No wonder you’re no different than a pox party mom.

    I see that Th1Th2 is still a bit asshurt over not being immediately elevated to the clergy during its foray into MDC.

  98. #98 Reuben
    August 28, 2011

    Alright, I’ll feed the hiddeous, obtuse, somewhat dense troll.

    Th1Th2, what’s your area of expertise?

  99. #99 lilady
    August 28, 2011

    @ Chris: Yes, I did see Frankie’s postings and they come from the heart. I give her enormous credit for “going public” with the circumstances of her son’s death from meningococcemia and her efforts to educate parents about vaccine-preventable diseases.

    It is difficult to believe that another clueless person exists who ascribes to the same bizarre germ theories as one of our resident trolls.

    I still thing that the two trolls who post consecutively are “channeling”. (notice when they spew their venom at posters here…they never attack each other)

    Warning to Science Mom: This particular odious troll is very persistent…best to just ignore its insults and delusional behaviors.

  100. #100 W. Kevin Vicklund
    August 28, 2011

    Well, all vaccines do shed. It’s part of what is called antigenic clearance.

    Wrong. In fact, if a vaccine is shedding, that’s an indication the antigenic clearance is not happening. Antigenic clearance is the breaking down of antigens; shedding is (generally) the excretion of viable viruses and microbes.

    It’s like claiming that you made a cheeseburger because you had a bowel movement after eating a Big Mac for lunch.

  101. #101 Th1Th2
    August 28, 2011

    Narad,

    I see that Th1Th2 is still a bit asshurt over not being immediately elevated to the clergy during its foray into MDC.

    On the contrary, it was MDC who got butthurt after I exposed its infection promoting agenda. Had I known earlier that it was a pro-pox community, I should not have wasted my time over there. Don’t worry RI is also receiving that same treatment at least it’s happening in their own backyard.

  102. #102 Mephistopheles O'Brien
    August 28, 2011

    The existence of PAMPS is not synonymous with infection.

  103. #103 novalox
    August 28, 2011

    Continue to ignore delusional troll.

  104. #104 Science Mom
    August 28, 2011

    Warning to Science Mom: This particular odious troll is very persistent…best to just ignore its insults and delusional behaviors.

    Oh yes, I’m quite familiar with her and am enjoying watching her shine the light of day on her own deliciously cretinous ideas of immunology. I’m not going to dilute it nor legitimise it with direct commentary.

  105. #105 Th1Th2
    August 28, 2011

    Kevin,

    Wrong. In fact, if a vaccine is shedding, that’s an indication the antigenic clearance is not happening. Antigenic clearance is the breaking down of antigens; shedding is (generally) the excretion of viable viruses and microbes.

    Wrong. The effector function of the immune system is simple; immediate clearance of foreign nonself regardless of whether it’s live or not, contagious or not.

    It’s like claiming that you made a cheeseburger because you had a bowel movement after eating a Big Mac for lunch.

    Precisely the reason why you can make a VDPV after “eating” OPV. Of course, that doesn’t count the majority who were intentionally infected by the vaccine itself, vaccine-related poliovirus.

  106. #106 Gray Falcon
    August 28, 2011

    Th1Th2, what evidence do you have for your claims?

  107. #107 ken
    August 28, 2011

    To those bringing up vaccination schedules- I doubt there were anti-vaxers then.
    How could anyone object to this 1983 schedule?
    Is it really inadequate? I don’t know.
    DTP (2 mos.)
    OPV 2
    DTP 4
    OPV 4
    DTP 6
    MMR 15
    DTP 18
    OPV 18
    DTP 48
    OPV 48
    ______
    Total :10

  108. #108 Narad
    August 28, 2011

    On the contrary, it was MDC who got butthurt after I exposed its infection promoting agenda. Had I known earlier that it was a pro-pox community, I should not have wasted my time over there.

    That’s the first really good laugh I’ve had all day. As I recall, you were listened to and questioned in the very finest, concerned, earthy mama style possible. And then deemed to be of no interest whatever.

  109. #109 ken
    August 28, 2011

    OOPs- OPV not a good choice-discontinued in 2000.

  110. #110 Chris
    August 28, 2011

    Because, ken, in 1991 I met a woman who lost her first child from Hib as a toddler. Also, my son suffered from a seizure from another now vaccine preventable disease in 1990 and is still quite disabled.

    And there were anti-vaxers in 1983. That is about the time Barbara Loe Fisher got her start.

    Now, ken, where is that information from the California Department of Health I asked for?

  111. #111 Th1Th2
    August 28, 2011

    OOPs- OPV not a good choice-discontinued in 2000.

    It was never a good idea ever since—discontinued in 1935. They played with fire, they got burned.

  112. #112 Chris
    August 28, 2011

    Also, ken, you might want to tell the folks who started Parents of Kids with Infectious Diseases how you don’t think there is a need to prevent some of the chronic diseases the kids of the founders have. You might actually educate them on how unimportant their conditions are in your world view.

  113. #113 ken
    August 28, 2011
  114. #114 ken
    August 28, 2011
  115. #115 lilady
    August 28, 2011

    @ Ken: “Adequate” for its time, but 28 years have elapsed since then and we are protecting kids against more infectious diseases:

    Hepatitis B, Rotavirus, Invasive Hib Disease, Invasive Pneumococcal Disease, Meningococcal Disease, Varicella, Hepatitis A, HPV and Yearly Seasonal Influenza. Schedules for Recommended Childhood Vaccines are updated yearly and available at the CDC, ACIP and AAP websites.

    Pass the popcorn, Science Mom.

  116. #116 Th1Th2
    August 28, 2011

    You might actually educate them on how unimportant their conditions are in your world view.

    Somehow PKIDS got it right.

    The vaccine is injected into the blood stream.

    They asked for it. Poor kids. Yeah blame the parents.

  117. #117 Krebiozen
    August 28, 2011

    Ken,

    I don’t understand your point about the Californian pertussis figures.

    There is no mention of parapertussis there, and the ratios between vaccinated and unvaccinated people are what you would expect from a vaccine with around 80% coverage and 60% efficacy at completely preventing the disease in those who are up to date. Those who are vaccinated have much milder cases than the unvaccinated, around 95% protection against severe disease as compared to the unvaccinated.

    It requires 94% vaccine coverage to achieve herd immunity for pertussis, and vaccine coverage in California has fallen to around 80%, so the recent outbreaks are exactly what you would expect, and exactly what Mark Crislip predicted in 2009.

    If not a drop in vaccination coverage, what do you suggest is the cause of the huge increase in cases in recent years as compared to the 70s and 80s?

  118. #118 Th1Th2
    August 28, 2011

    Mark Crislip is so blind he couldn’t find the herd immunity he’s talking about between 1971 to 1980.

    Because there is none. Herd immunity does not exist. It is an imaginary security blanket. Only dumb people would believe that the emperor is wearing new clothes.

  119. #119 Chris
    August 28, 2011

    Thank you, ken. You confirmed that it is pertussis and not parapertussis that is circulating. Glad to note that you noticed that the minor infection was not the concern. I asked you to confirm that it was parapertussis that was what was spreading (and killing babies), and you opened up your mind and learned it was exactly the opposite!

    And that children should get their DTaP boosters as soon as possible and not skip any. They should have four DTaP by age 15 to 18 months, then the fifth before entering kindergarten (4 to 5), and a Tdap at age 10. That is what the chart on page 5 says if you read it like I do. Most of the ten year olds had had only five doses, not six.

    We know that the vaccine for pertussis is not perfect, which is why herd immunity is very important. The best way to maintain herd immunity is to make sure the kids get their scheduled vaccines, and adults make sure their ten-year tetanus booster is the Tdap.

    Good job in realizing that the pertussis vaccines are important!

  120. #120 Chris
    August 28, 2011

    Oops, made an error, the Tdap is for age eleven.

    ken, just in case you are unclear why there seem to be more kids who are vaccinated who get sick, it is because there are more of them. As a case in point, check out what happened in a in a private school where half the students got pertussis… none were vaccinated.

    Did you click on the links I provided in Comment #61, dated August 27, 2011 1:18 PM? It was where Orac discusses two papers:

    Pediatrics. 2009 Jun;123(6):1446-51.
    Parental refusal of pertussis vaccination is associated with an increased risk of pertussis infection in children.
    Glanz JM, McClure DL, Magid DJ, Daley MF, France EK, Salmon DA, Hambidge SJ.

    Am J Epidemiol. 2008 Dec 15;168(12):1389-96. Epub 2008 Oct 15.
    Geographic clustering of nonmedical exemptions to school immunization requirements and associations with geographic clustering of pertussis.
    Omer SB, Enger KS, Moulton LH, Halsey NA, Stokley S, Salmon DA.

    Do you understand that they directly contradict your earlier state opinion it was parapertussis? And is relevant to Krebiozen’s reply. To help you understand this better here is some herd immunity arithmetic:

    Take 1000 people (ignoring the infants under 2 months who cannot be vaccinated, or babies under a year who can only be partially vaccinated), if 5% refuse vaccines then the numbers are:

    950 vaccinated persons (assuming full schedule)
    50 unvaccinated persons

    The pertussis vaccine is actually only 80% effective at worse, so the numbers are:

    760 protected persons
    190 vaccinated but vulnerable persons
    50 unvaccinated persons

    There is an outbreak and it gets spread to 20% of the population, then:

    760 protected persons without pertussis

    38 vaccinated persons get pertussis
    152 vaccinated persons who may still get pertussis

    10 unvaccinated persons get pertussis
    40 unvaccinated persons who may still get pertussis.

    This is how more vaccinated persons get the disease than unvaccinated. Even if the infection rate was at 100%, there would still be more of the vaccinated getting the diseases because there are more of them!

  121. #121 Chris
    August 28, 2011

    Post in moderation: ken, did you read the links in comment #61?

  122. #122 Andrew
    August 28, 2011

    >Only dumb people would believe that the emperor is wearing
    >new clothes.

    In the story of the Emperor’s New Clothes, the moment that the child pointed out the truth, everyone immediately recognized that they had been mistaken. When you speak, everyone immediately recognizes that you’re mistaken. Notice the difference?

  123. #123 LW
    August 28, 2011

    “Herd immunity does not exist. It is an imaginary security blanket.”

    I’m really quite amazed by people who think that herd immunity is imaginary. That’s like saying that exponential growth is imaginary. Before easy worldwide travel, diseases like measles used to regularly die out in isolated communities when virtually the whole population was immune, and then there’d be an epidemic when some traveller brought the disease again — but only when there were enough new susceptibles (children) to sustain it. Herd immunity is an achievable fact — it has occurred naturally in human and animal populations. It doesn’t cease to be a fact just because you don’t think it should be achieved through immunization.

  124. #124 Chris
    August 28, 2011

    LW, those are the same people who go apoplectic when they find out that imaginary numbers exist, and the design of their cars and computers are dependent on their existence.

    It is just because they don’t understand the mathematics used in electrical circuits and mechanics (differential equations, Euler’s Equation, etc). Just like they do not understand the mathematics of epidemiology.

    Because they don’t understand it, in their mind it simply does not exist.

    I don’t think they are stupid, but they just do not have the appropriate education. The problem is that they don’t know their limitations, and worse they refuse to learn.

  125. #125 The Very Reverend Battleaxe of Knowledge
    August 28, 2011

    @ LW:

    What’s amazing about Thingy is that the demonstration of herd immunity doesn’t depend on any of her misunderstood biology, back-asswards epidemiology, demented immunology, or twisted redefinitions of well-known terms. It’s simple arithmetic. She’s saying arithmetic doesn’t work!

  126. #126 W. Kevin Vicklund
    August 28, 2011

    The effector function of the immune system is simple; immediate clearance of foreign nonself regardless of whether it’s live or not, contagious or not.

    Yes, the effector function of the immune system is quite simple – it is the absorption and breaking down of antigens, thereby clearing the infected tissue of the antigen. It is not, however, the physical removal of intact antigen from the body.

    Shedding is to antigenic clearance as transplanting a tree is to running it through a woodchipper and lighting it on fire.

  127. #127 Rogo5
    August 28, 2011

    “She’s saying arithmetic doesn’t work!”

    So does that mean logarithms don’t exist, after all? Math teachers are lying to us and our children! IT’S A CONSPIRACY!

  128. #128 Th1Th2
    August 28, 2011

    LW,

    Herd immunity is an achievable fact — it has occurred naturally in human and animal populations. It doesn’t cease to be a fact just because you don’t think it should be achieved through immunization.

    That’s not called herd immunity but rather herd infection and it is quite an achievable fact thanks to infections promoters like the pro-pox party moms and vaccinators.

  129. #129 lilady
    August 29, 2011

    Please don’t feed this delusional Thingy Troll…he/she/it feeds on the derision that each of his/her/its comments elicits.

    It is amazing that this uneducated,unemployable germ phobic troll who lives in a different reality make up of an imaginary career in the health field has the colossal chutzpah to comment on any vaccine preventable diseases..in particular pertussis…after the vulgar crass comments he/she/it made about the death of an Australian infant from pertussis on this blog two months ago.

    Time to send this Thing back to its cave and stick a fork in this heartless odious Thing…it’s more than overdone.

  130. #130 Th1Th2
    August 29, 2011

    I don’t think they are stupid, but they just do not have the appropriate education. The problem is that they don’t know their limitations, and worse they refuse to learn.

    You must be referring to Jenner et al. I see.

  131. #131 lilady
    August 29, 2011

    Ignoring crass delusional troll.

  132. #132 Th1Th2
    August 29, 2011

    Rev,

    It’s simple arithmetic. She’s saying arithmetic doesn’t work!

    When did I say that? Oh please guide them.

    Here’s a simple arithmetic for you disease spreader.

    If a given group of 10 persons got inoculated with live measles virus, how many from the group were protected from primary measles infection?

  133. #133 novalox
    August 29, 2011

    Continue to ignore willfully ignorant troll

  134. #134 lilady
    August 29, 2011

    Willfully ignorant crass delusional troll is still willfully ignorant crass and delusional…Stick a fork in it.

  135. #135 Th1Th2
    August 29, 2011

    Mephistopheles,

    The existence of PAMPS is not synonymous with infection.

    Almost missed this one. If PAMPs are not synonymous with infection then natural infection and vaccination are not synonymous with immunity particularly acquired immunity. Then why the hell are you still vaccinating? Or may be you’re just poisoning the children.

  136. #136 novalox
    August 29, 2011

    Continue to ignore troll

  137. #137 Krebiozen
    August 29, 2011

    I have just been reading an article, from 1998 but still very relevant, ‘Impact of anti-vaccine movements on pertussis control: the untold story’.

    You can directly relate increases in pertussis incidence to anti-vaccine movements, or the lack of them, in various countries. The fears of permanent brain damage from the whole cell pertussis vaccine turned out to be unfounded, and were described by JAMA as “a myth”. The deaths and injuries that resulted from pertussis epidemics due to these scares were very real (my son got pertussis in the early 80s as a result of an epidemic in the UK when vaccination coverage fell to 31%).

    BTW, pertussis figures of the sort Ken linked to can be a bit misleading, as the vaccine is not as effective at completely preventing pertussis as we might hope. When you look at its efficacy at preventing whooping cough, the severe form of the disease that results in significant morbidity and mortality, the vaccine is very much more effective. In people who do contract pertussis despite vaccination, it is usually a much milder illness that is difficult to distinguish from any other common URTI without laboratory tests.

  138. #138 Th1Th2
    August 29, 2011

    Since no none wants to answer or take responsibility for #86, this thread should be closed. No takers just pretenders.

    Another bad day for vaccine apologists.

  139. #139 lilady
    August 29, 2011

    Still delusional troll persists…and still being ignored.

  140. #140 Gray Falcon
    August 29, 2011

    So, Th1Th2, you believe that if somebody makes a statement, it’s up to everyone else to prove them false. Th1Th2, you are a top-level Al-Qaeda operative. Please prove me wrong.

  141. #141 Mephistopheles O'Brien
    August 29, 2011

    If PAMPs are not synonymous with infection then natural infection and vaccination are not synonymous with immunity particularly acquired immunity.

    That does not follow logically nor is it consistent with current science.

    Sorry, lilady.

  142. #142 Chris
    August 29, 2011

    Mephistopheles O’Brien:

    Sorry, lilady.

    Please do not confuse Thingy with lilady.

  143. #143 lilady
    August 29, 2011

    (Chuckling over the last two postings) “lilady” now declares this thread is still open…(“as if” Thing troll could ever close down a thread). And, Mephistopheles O’Brien, I have no problem if you confuse me with Chris.

  144. #144 Mephistopheles O'Brien
    August 29, 2011

    My apology was not to Thingy, but to lilady who advised ignoring the troll. My apologies also go out to Lawrence, Sharon, and Novalox.

  145. #145 D. Wu
    August 29, 2011

    Hey, why doesn’t augustine respond to any of the science that Orac has gone to great lengths to discuss and dissect? Also, why is it that augustine’s logic seems tainted by libertarian rhetoric and it’s not just about the science?

  146. #146 Lawrence
    August 29, 2011

    Boring troll is an Objectivist & contrarian….ignore please.

  147. #147 Chris
    August 29, 2011

    Mephistopheles O’Brien, ah I see!

    How we know when Thingy is wrong? She has typed something in a comment box.

    It will be the end of days if she ever gets the science correct.

  148. #148 Th1Th2
    August 30, 2011

    Mephistopheles,

    That does not follow logically nor is it consistent with current science.

    No, your persistent germ denialism does not follow logically nor it is consistent with current science.

  149. #149 lilady
    August 30, 2011

    Thingy keeps insisting he/she/it smells fish and he/she/it is not wrong….I left on comment for Thingy on Menomune Vaccine (Haunted by memories of the consequences of not vaccinating) and I guess he/she/it is wrong, again.

    I smell dead troll here.

  150. #150 Mephistopheles O'Brien
    August 30, 2011

    I keep trying to respond, but can’t keep from laughing long enough. I don’t like to appear to be mocking someone, as I like the blogosphere to be polite. But with lines like Th1Th2′s…

  151. #151 Dangerous Bacon
    August 30, 2011

    Oh, dear. NaturalNews and Mike Adams, the Health Deranger have denounced the Institute of Medicine over its report verifying vaccine safety.

    Actually, NaturalNews is more than a bit confused on this matter. First, it claims that (contrary to news articles generated by the “old media”), the IOM report doesn’t vindicate vaccines at all:

    “The Institute of Medicine is suddenly in the news following the release of its vaccine “adverse events” research which found that MMR vaccines actually cause measles, seizures and anaphylactic shock. The old media predictably distorted the story and used it to deceptively announce that “vaccines are not linked to autism!”

    After this through-the-looking-glass appraisal, Adams turns around and attacks the IOM (why, it’s hard to tell, since he claims it’s supporting his agenda) for its sinister links to the “military medical complex”, global population control and other nasties, including the obligatory Holocaust reference.

    Things get even more bizarre when you find that NaturalNews has previously run a bunch of articles gleefully highlighting earlier IOM reports on medical errors, the childhood obesity epidemic and recommendations for reforms at the FDA. I suppose NaturalNews will now have to retract all those articles in the light of its discovery that the IOM is bought and paid for by sinister interests bent on world domination. After all, if you can’t trust them on vaccination, you can’t trust what they say about those other topics either.

    Right, Mikey?

  152. #152 lilady
    August 31, 2011

    @ Dangerous Bacon: It’s hard to believe that the Deranger has any sort of audience. He’s absolutely paranoid and probably O.D.ed on his supplements or another “substance”. Thanks for the link…good for a lot of chuckles.

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