Dr. Robert Sears has to be one of the most irresponsible pediatricians on the face of the earth, if not the most irresponsible. Many of you might recall that a little more than a week ago “Dr. Bob” posted a borderline unhinged rant on Facebook aimed at his own patients, who, quite reasonably, were calling him about the measles outbreak going on in southern California right now and asking him about the measles vaccine. It was entitled Measles Epidemic . . . NOT!, and his response boiled down to, in essence, “get the vaccine if you’re worried, but there’s no real reason to worry.” He also downplayed the significance of the measles outbreak in a fashion completely unbecoming a pediatrician (or physician of any kind).

Apparently, Dr. Bob is feeling the heat over his irresponsibility and his passing the buck when it comes to physician responsibility, in which he basically says, “Hey, don’t blame me. Get the vaccine if you want it. I won’t stop you.” It’s obvious, because he felt obligated to post a followup entitled Orange County Measles Epidemic . . . Not (yet, anyway)! It so demanded a heapin’ helpin’ of not-so-Respectful Insolence that I decided to forego (for the moment) commenting on the latest CDC figures on autism, which (as usual) are causing a huge stir in the antivaccine crankosophere. Besides, the new autism figures might be better suited to a—shall we say?—more analytical post at my not-so-secret other blog location early next week.

In the meantime we have Dr. Bob. Just like last time, I’m going to post the whole thing, so that you can see it in all its cranky glory (also, I want a record in case it disappears down the ol’ memory hole):

Wow. Who would have thought that a few simple sentences in my last post would cause such an uproar? If you missed it, check it out below. All it says is “don’t panic. If your child hasn’t had a measles vaccine, you can get one now. If you don’t feel comfortable with it, don’t panic, because there are only seven cases (at the time).” That’s it.

But it’s interesting what people took from it:

Some people seem to believe the post advises people to not get the vaccine, which the post clearly doesn’t say. The post says get the vaccine, or don’t – it’s up to you. I guess what the vaccine militants wanted me to say, instead, is that every single person, without fail, should get the vaccine no matter what. Some have attacked me for starting a measles outbreak seven years ago in my waiting room, which is false because no one with measles has ever even been inside my office (except for one child about 15 years ago who came down with a live measles infection from the vaccine, which is pretty rare but known to happen); so much for journalistic integrity for whoever wrote that (to be fair, most journalists do have integrity).

Some took my post to say that the MMR vaccine causes autism. WTF? The post doesn’t even include the “A” word.

Oh, and some thought my post said measles is harmless. My post didn’t even comment on the severity of the disease at all. Of course measles is sometimes harmless. It’s a tough disease. It’s no fun at all. The measles chapter in the book makes that very, very clear. My mistake though – I didn’t reiterate that in the post. So, for the record, measles CAN be very serious. It RARELY causes severe complications though. Almost everyone who catches measles here in the U.S. will be fine. You’ll be sick for a week, need to be quarantined, then you’ll be fine. IF your case is typical. BUT, in a small percentage of cases, even in the U.S. where we don’t have Vitamin A deficiency and protein malnutrition, complications can occur. About 1 in 1000 may die from it (studies vary – some say 1 in 3000, some say 3 in 1000). We haven’t had a measles death in the U.S. in over 10 years. But you know what? We will someday. May be this year. May be next. May even be here in the O.C. Every death from a vaccine-preventable disease is tragic. I’ve never said otherwise. So, just to make a few of you pro-vaccine militants happy, there you go. Measles can be bad. In developing countries with malnourished children, it’s even worse. But for most, it’s a harmless disease. Old pediatric textbooks call measles a harmless and routine disease of childhood. IN DEVELOPED, WELL-NOURISHED COUNTRIES, for most people, that’s true. But not for all.

Finally, some love to blame me for the outbreak. As if people aren’t getting the MMR vaccine because of me. In the measles chapter of the book, AND in my alternative vaccine schedule, the MMR vaccine is very clearly listed at 1 year and 5 years. I very clearly recommend the vaccine in the book. The post was simple – there’s a small outbreak, don’t panic. Get the vaccine or don’t. Up to you. Perhaps I should have said, “It’s really NOT up to you. It’s your social responsibility to get your children fully vaccinated so you don’t infect others. That way, NO ONE would ever need to have measles.” Keep reading – more on this later.

So, now we have about 21 cases in Orange County. We all knew it wouldn’t stop at seven. In my last post I gave a heads up that we’d see more. I thought maybe a few more, and didn’t think it would jump to 21. But it did. 5 cases are children, all unvaccinated. 5 are healthcare workers exposed to patients. They were vaccinated when younger, but the vaccine had worn off. As for the other 11 cases, I don’t know. Those details weren’t disclosed. But they are adults, according to the public health department notice. The outbreak won’t die out until everyone who’s been exposed either gets infected (which will be a very small few) or doesn’t, because they’ve been immunized or their immune system fights it off. Most outbreaks nationwide are restricted to a small number. The largest outbreaks from last year (58 in New York and 20 in Texas) occurred because the exposures were in large groups of unvaccinated people. Here in the O.C., almost everyone is vaccinated, so we are unlikely to see such a large outbreak. But it WILL extend a bit more. Who knows what the final number will be? But in the absence of a large unvaccinated group, it isn’t likely to spread much more than it has now. IF it hits a particular school or group where many are not vaccinated, it will likely spread through that group.

Finally, a message to those who chose to not get the MMR vaccine. I would still say don’t panic. The chance that your child will be caught up in this small outbreak is still very low. I understand your reasons for not wanting the vaccine. Every parent is required to read the CDC-mandated list of side effects to every vaccine before it is given. And the list of side effects to the MMR vaccine is quite daunting, and would scare any parent. You’ve probably read this list and opted out of the vaccines. The CDC handout tones it down a bit, but the MMR vaccine product insert doesn’t. And that’s what is spelled out in the measles chapter of the book. I simply list the side effects as described in the vaccine product insert. So, if any mandatory vaccine militants are going to be mad at me for that, then what you are really saying is that parents should NOT receive informed consent about this medical treatment. They should NOT be informed of the risks of a vaccine; they should just be reassured that the risks are small, they don’t need to worry their pretty little heads about the details, and just go ahead with the vaccine. If that’s how you feel, then you are justified in being angry with me. For the rest of you who like to follow proper medical procedure and medical ethics, you provide informed consent for vaccinations. Allow the parents to be involved in this decision. Some will decide NOT to vaccinate; this puts their child at a small risk of disease, and it poses a risk of their child spreading the disease to other unvaccinated or too-young-to-be-vaccinated or those-who-got-vaccinated-but-it-didn’t work (I don’t think that was grammatically correct), but parents have that right to make that decision.

If we could guarantee that every single dose of MMR vaccine would be harmless to every child who received it, then we could be justified in making the vaccine mandatory. Since that’s not the case, we must allow parents to decide. Bottom line: if your child has had one vaccine, then there is a 95% likelihood that he or she is protected. If two doses, it’s about 98 to 99%. So, you’re in good shape. You likely have nothing to worry about. Unfortunately, as we’ve seen in this outbreak, some adults will lose their immunity, and may catch the disease. If you decided to not get the vaccine yet, then you have a decision to make. Read all the pros and cons. Understand the side effects of the vaccine as well as the disease. Consider the importance of public health protection. If you were planning to have your child get the vaccine at some point anyway, but you were waiting until an older age, maybe now’s a good time to consider it. But the outbreak is still small enough where you don’t have to rush into it. If you decide against the vaccine, the disease risk is still acceptably low. Stay tuned.

And, on a completely unrelated note, the CDC just released new autism rates: 1 in 68 kids, and 1 in 42 boys. I still have to process this, and will blog next week. But don’t worry: it’s not a REAL rise. It’s just a pretend rise. Or, it’s not rising at all – it’s ALWAYS been 1 in 42 boys, right?

Actually, Dr. Bob is only half right about this being “completely unrelated.” Yes, the measles vaccine is completely unrelated to autism prevalence. However, autism prevalence rates are anything but unrelated to measles outbreaks. It is the unfounded fear that vaccines in general, but the MMR vaccine in particular, are a major cause of the “autism epidemic” that feeds the antivaccine movement and leads to pockets of low MMR uptake, which in turn lead to susceptibility to outbreaks very much like what we are seeing in southern California right now. So Dr. Bob doubles down on his previous idiocy about the MMR vaccine and measles outbreaks. He even admits part of the reason why, blithely saying that he only expected a “few more” cases and is shocked that it’s actually higher. So he frantically tried to downplay the severity by trying to minimize the impact of unvaccinated children on outbreaks, hence is “IF” gambit, in which he admits that “IF” measles finds its way into one of the schools with low MMR uptake then an outbreak can happen there. Once again, he conflates the overall high uptake in Orange County with no need to worry about outbreaks because of herd immunity, dismissing the pockets of low uptake as being, in essence, not important.

Unfortunately for Dr. Bob (and everyone else living in Orange County), there are a lot of schools in Orange County with low vaccine uptake, below the level necessary for herd immunity. Just take a look at this news report from 2009, which reports that in south Orange County, 16 of the 38 elementary schools in the Capistrano Unified School District had high enough exemption rates to be at risk. In nearby Saddleback Valley Unified School District, a quarter of the elementary schools have similarly high exemption rates.

Guess where Dr. Bob practices? You’ve got it: Capistrano Beach. At the time, I said: When the outbreaks begin, they’ll start in California. And so they are: Right near where Dr. Bob practices. Of course, correlation does not equal causation, but there’s no doubt that Dr. Bob’s antivaccine views fit in very nicely with the views of his affluent clientele. They come to him because he is sympathetic to vaccine-averse parents, and in turn Dr. Bob’s vaccine-averse clientele likely reinforces his tendency to cater to their views, thus amplifying them. In fact, if you want to see the scope of the problem in southern California, take a gander at this handy-dandy Google map included with the news story. Worse, vaccine exemptions are on the rise in California.

So, basically, Dr. Bob’s message is: Don’t worry, be happy, and if you’re worrying and not happy get the vaccine. Just don’t bother me about it anymore. Oh, and you nasty pro-science vaccine supporters out there are big meanies for pointing out that Dr. Bob is irresponsible. Oh, no, he says. He’s giving “informed consent,” such that it’s worth repeating the paragraph:

So, if any mandatory vaccine militants are going to be mad at me for that, then what you are really saying is that parents should NOT receive informed consent about this medical treatment. They should NOT be informed of the risks of a vaccine; they should just be reassured that the risks are small, they don’t need to worry their pretty little heads about the details, and just go ahead with the vaccine. If that’s how you feel, then you are justified in being angry with me. For the rest of you who like to follow proper medical procedure and medical ethics, you provide informed consent for vaccinations. Allow the parents to be involved in this decision. Some will decide NOT to vaccinate; this puts their child at a small risk of disease, and it poses a risk of their child spreading the disease to other unvaccinated or too-young-to-be-vaccinated or those-who-got-vaccinated-but-it-didn’t work (I don’t think that was grammatically correct), but parents have that right to make that decision.

Of course, my issue with Dr. Bob derives from how he actually doesn’t give proper informed consent. Instead, he gives what I like to refer to as antivaccine “misinformed consent” that massively exaggerates the risks of vaccines and downplays the risks of the measles. Always. He’s built his entire public career out of developing an “alternative” vaccine schedule that is not based in any science or clinical evidence, all based on overestimating the risks of vaccines and underestimating the risks of the diseases vaccinated against. Get a load of the fetid pile of dingos’ kidneys Dr. Bob lays down about measles not being that bad in which he says that “only” somewhere between 1 in 3,000 or 3 in 1,000 people will die of the disease. One wonders what level of death and disability would be sufficient to be a cause for concern to Dr. Bob! It doesn’t seem to concern him in the least that “someday” we’ll have another measles death in the U.S., at a time that he describes as, “Maybe this year. Maybe next. May even be here in the O.C.” Sure, Dr. Bob says at the end that “measles can be bad” and that “every death from a vaccine-preventable disease is tragic,” but his entire petulant, dismissive attitude to the severity of the measles and parents’ justifiable concern about a measles outbreak happening in Dr. Bob’s own backyard, which he couples that with a statement that in developing countries it’s worse and that “almost everyone who catches measles here in the U.S. will be fine,” tell another story. I don’t know about you, but a disease that can kill as many as 3 per 1,000 of the people who get it is a pretty concerning disease to me. One notes that Dr. Bob also fails to mention that perhaps 1 in 20 children who get the measles will develop pneumonia and that 1 in 1,000 or so will develop encephalitis, while if a pregnant woman catches the measles it can lead to miscarriage, premature birth, or a low-birth-weight baby.

Dr. Bob whines that he was mischaracterized. I don’t think so. In fact, Dr. Bob clearly says, “The post says get the vaccine, or don’t – it’s up to you.” All of which is a cop-out, particularly when Dr. Bob fails to put things into the appropriate context. His claim that he “recommends the vaccine” at age one and five doesn’t get him off the hook, as his “alternative” schedule leaves children at riks for a much longer period of time than the CDC schedule. So instead Dr. Bob whines that the “vaccine militants” wanted him to say that “every single person, without fail, should get the vaccine no matter what.” Not quite. We just want him to do what a responsible physician would do and urge people to get the vaccine, unless there are medical contraindications to it. Not “no matter what.”

Looking at the brain dead comments after Dr. Bob’s post, congratulating him for a “great post” and saying how “we all had the measles when we were kids, and we’re fine,” it’s half tempting to say that Dr. Bob’s patients and fans and he deserve each other. Unfortunately, the parents of Dr. Bob’s patients, under his influence, through their failure to do the medically responsible thing both for their own children and for society, endanger us all—starting in southern California. As Paul Offit reminded us yesterday, we seem to have forgotten just how bad the measles can be. After an excellent run of no deaths from measles that really doesn’t need to end and could go on for the foreseeable future if not for pockets of antivaccine sentiment leading to low MMR uptake, Dr. Bob, while sanctimoniously preaching “informed consent” and “parental rights” is contributing to our one day soon once again seeing children dying from the measles. Meanwhile, he shrugs his shoulders, denies responsibility, and says, “Hey, don’t blame me. We’ll always have the measles, and children sometimes die from it.”

Comments

  1. #1 Julian Frost
    April 3, 2014

    Wait, what? Sears declared autism

    the most devastating medical emergency of our century

    ?
    Bob can find a fire and die in it. When I was in primary School, I attended the funeral of a child who died of cancer. A few years ago, I attended the funeral of an 18 year old girl. She had had diabetes and health problems. How many children have died of autism?
    In addition, his comments are just the type of “autism is a tragedy” bull$h!t that makes things worse.

  2. #2 herr doktor bimler
    April 3, 2014

    How many children have died of autism?
    Depends if you include the ones murdered by parents supported by anti-autism groups.

  3. #3 dingo199
    April 3, 2014

    Re: Risks of measles..
    My 2 cents worth.

    In quantifying risks, it makes sense to determine those at risk in the first place. Generalising risks to an entire country’s population is utterly meaningless.

    Example: “There is a 1 in 10 million chance you will die in a plane crash.”
    Well, no. Firstly not everyone flies in planes – there may well be vast numbers of the populace who will never do so. Their risk is zero. So you redefine the risk as “1 in 6 million chance you will die in a plane crash, if you fly in planes”. That is more sensible, and meaningful.
    But you can go further. You can determine the risks “per plane trip”, and quantify the risks so as to say “1 in a million chance of dying in a plane crash if you are a frequent flyer (more than 10 times per year)”, or compare known risks with various airline carriers (Aeroflot versus Quantas eg)

    So for an infectious disease like measles, you could define the denominators thusly:
    1. Exclude everyone who has had measles and everyone over the age of 40. That more than halves the denominator.
    2. Refine risk according to geography/demography/whatever else.
    3. Factor in relative risks for subgroups – eg vaccinated versus unvaccinated.
    4. Maybe even determine herd immunity thresholds in certain areas, and factor that in somehow.
    5. Determine likelihood of exposure according to lifestyle/socialising/schooling etc; Do they mix with numerous strangers on a daily basis, or go to anthroposophic schools, where do they take their holidays etc?

  4. #4 dingo199
    April 3, 2014

    Another analogy springs to mind.

    “I calculate the risk of my dying from a gunshot wound is only 1 in 10 million. So me and my little drug gang are perfectly safe from harm going down to to LA County and muscling into the 18th Street gang’s territory.”

  5. #5 ann
    April 3, 2014

    Like I said, I was under the impression that this was the norm

    I am shocked beyond expression that you used “like” and not “as” there.

    Not that it isn’t a perfectly acceptable colloquial usage. In fact, I almost invariably do it, too.

    But if someone calls it to my attention, I’m still always shocked..

  6. #6 ann
    April 3, 2014

    That looks snottier than I intended, I’m sorry.

    I meant it respectfully, and even admiringly. I envy your way with words.

  7. #7 skeptiquette
    April 3, 2014

    Ann,

    I’m sure there is a way to calculate it. But you need data first.

    You can look at the relative risks of measles and the measles vaccine at the link lilady posted, and then decide if — from the average person’s perspective — it’s worth taking the statistically unknowable risk of getting measles.

    I may be misreading what you wrote, but these two sentences seem to contradict themselves. In the first sentence you say that you are “sure” there is a way to calculate and then you say that it is “unknowable”

    I agree with DIngo’s comment. The more you can personalize the risk, obviously the better. I was suggesting otherwise, because of conventionality.

    I guess the bottom line for me as that if you are assessing the risk of two different events happening (contracting measles and then experiencing an uncommon sequela) the only way to do this is to multiply the two probabilities to come to the final probability or risk. This part is not debatable.

    If you say it is not worth establishing a risk or probability for catching measles and we should consider this probability “1” then that is your opinion and I respect that.

    I am just trying to think of this from a different perspective. A perspective that probably wouldn’t accept the above assumption that the risk for contracting measles is 1.

    To me, being straightforward and non-assuming would potentially garner more respect and allow a more informed discussion of risk to develop, which could translate into a higher vaccine uptake. I may be 100% wrong about that assumption, though!

  8. #8 skeptiquette
    April 3, 2014

    Geez Ann, you’re such a Twit!

    Just kidding, I really like your tone and contribution it is light-hearted and enjoyable.

    You must be very approachable and easy to get along with in person!

  9. #9 ann
    April 3, 2014

    @skeptiquette, #208

    Really?

    No one’s ever said that to me before. (Called me a twit, I mean. I don’t know about the other stuff. I don’t find myself easy to get along with, but people who get along with me do.)

    #207 —

    The apparent contradiction resolves itself if you bear in mind that you — meaning “you, skeptiquette” — don’t have access to the data you’d need to calculate those relative risks or the statistical know-how to calculate them.

    IOW: It’s the difference between “it can be done” and “anyone can do it.”

  10. #10 skeptiquette
    April 3, 2014

    I was going to call you a “snot” but I decided on Twit.

    it was just in response to the pedantic statement to Narad and the subsequent re-qualification.

    Really, I was just joking around… I don’t think you are a twit or a snot.

  11. #11 ann
    April 3, 2014

    guess the bottom line for me as that if you are assessing the risk of two different events happening (contracting measles and then experiencing an uncommon sequela) the only way to do this is to multiply the two probabilities to come to the final probability or risk. This part is not debatable.

    ^^Just to make another vain attempt at pointing to the logical flaw there:

    It’s not possible to calculate the average probability of any individual contracting measles without knowing how probable it is that the people in your sample are at higher or lower risk for it, due to some, any or all of a number of circumstantial and/or natural factors.

    Same goes for the average probability of any individual having an adverse reaction to the MMR vaccine. The only difference is that the calculation’s already been made.

    I hope that helps.

  12. #12 lilady
    April 3, 2014

    Ann: Anyone who has any experience with skeptiquette and her tandem posting partner pD knows that discussions with them are exercises in futility.

    Now that Dr. Jay has recalculated the risk of exposure for contracting measles aboard a BART train and skeptiquette has volunteered her opinion, we might as well toss out the CDC Case Surveillance Manual for investigating/containing measles outbreaks:

    http://www.cdc.gov/vaccines/pubs/surv-manual/chpt07-measles.html

  13. #13 ann
    April 3, 2014

    Really, I was just joking around… I don’t think you are a twit or a snot.

    I know. I appreciated the compliment. Thank you.

    It was just in response to the pedantic statement to Narad and the subsequent re-qualification.

    However. I now advise you in the strongest possible terms to drop that shovel and slowly back away from the hole you’re digging.

    (While it’s*** more grammatically acceptable to use “like” as a conjunction than “not at all,” it’s not a characteristic choice for Narad, whose writing is typically distinguished by a very lovely and original sensitivity to exactly that kind of nicety.

    I’m not pedantic. I’m just a close reader. Grrr.)

    ***Arguably. I’d say it was wrong, personally, though I do it myself.

  14. #14 skeptiquette
    April 3, 2014

    I understand where you are coming from… I think.

    You think it is logically flawed to attempt to define the risk of contracting measles, because there are so many factors that would have to be considered and the variability could range form 0-1. Therefore any subsequent calculations using the “risk of catching measles” are also logically flawed?

    does that sum it up?

  15. #15 skeptiquette
    April 3, 2014

    Ann: Anyone who has any experience with skeptiquette and her tandem posting partner pD knows that discussions with them are exercises in futility.

    The feeling is mutual, but I get bored or am procrastinating doing something else… hence barrages of posts.

  16. #16 skeptiquette
    April 3, 2014

    I should qualify that the feeling is only mutual sometimes.

  17. #17 skeptiquette
    April 3, 2014

    But Ann, I like digging!

    Sometimes I think I could dig to China (most of you probably do as well)

  18. #18 ann
    April 3, 2014

    @#214 —

    No. I think it’s categorically illogical to persist in using means and methods to achieve a theoretically meaningful outcome that won’t and can’t result in one.

  19. #19 lilady
    April 3, 2014

    “Ann: Anyone who has any experience with skeptiquette and her tandem posting partner pD knows that discussions with them are exercises in futility.

    The feeling is mutual, but I get bored or am procrastinating doing something else… hence barrages of posts.”

    Get yourself a new hobby; this one is not a good fit.

  20. #20 ann
    April 3, 2014

    Apart from which:

    Let me ask different question:

    Is it logical to compare the risk using the simplified formula where:

    A = average risk of catching measles
    B= average risk of particular sequela from measles
    C= Average risk of getting a vaccine (either 1 or 0)
    D=Average risk of particular sequela from MMR vaccine.

    A*B= actual average risk of particular sequela from measles

    C*D=actual average risk of particular sequela from MMR vaccine.

    While I suppose it might be (in some sense) logical to conceive of it those terms, it’s not reasonable or — by my standards — ethical. Measles presently causes 122,000 deaths a year. So. Never mind that vaccination prevents them, or that universal vaccination would essentially eliminate them. It doesn’t cause them.

    No annual deaths vs. 122,000 annual deaths is therefore the pertinent relative risk, imo.

  21. #21 Narad
    April 3, 2014

    While it’s*** more grammatically acceptable to use “like” as a conjunction than “not at all,” it’s not a characteristic choice for Narad

    This is about my writing “like I said”? That wasn’t even a grammatical issue for Fowler. Anyway, I’m a selective prescriptivist; I was recently disputing some matter of attempted pedantry with a fellow who turned to Garner – whom I consider to be more or less a blight – for support and then immediately misused “compare to.”

  22. #22 Narad
    April 3, 2014

    ^ Yah, that key immediately to the left of the right shift is dying.

  23. #23 skeptiquette
    April 3, 2014

    It’s fine Ann…

    It’s just that sometimes you have to put yourself in other people’s shoes. (I know you know this)

    I am making an assumption, but I think that many parents that do not vaccinate do so because they think the relative risk of vaccinating is higher than the relative risk of catching a disease and having an uncommon reaction to the disease.

    In some (possibly many) cases this will be skewed by “personal” probabilities as Denice mentioned, where the parent has a unjustified notion of the apparent risk from the vaccine. In other cases it may be that the parents think that the possibility of catching the diseases is pretty much slim to none, thereby nullifying the disease risk to the point that the vaccine poses a greater risk.

    I would think that if we could offer a range whereby the risk of getting the disease (which would allow us to convey an accurate risk of a particular sequela) is conveyed based on finer grained data, there may be a better chance at breaking through and convincing some to change their minds.

  24. #24 skeptiquette
    April 3, 2014

    Get yourself a new hobby; this one is not a good fit.

    You are, of course, entitled to your opinion.

    What makes a good fit? Someone who toes the party line?

  25. #25 ann
    April 3, 2014

    @skeptiquette —

    I would like to live in a world in which every mentally competent adult alive grasps that if you can prevent the death and suffering of 122,000 people a year (most of whom are children younger than five) without appreciably increasing the risk that you or anyone else in the world will suffer avoidable adversity above the standing odds of same, you should.

    So as long as I have to change people’s minds about something anyway, I’d prefer to aim for that.

    It seems to me like as if that’s the more logical approach as well, both in practical terms and in terms of secondary benefit. Finer-grained data does not have an overwhelming track record as an influence on the behavior or perceived self-interest of large numbers of people.

    @Narad —

    I like them all — ie, The Chicago Manual, Strunk & White, Fowler, whatever I’m forgetting — without being wholly down with any of them. However, my grammar’s pretty touch and go. I mostly just enjoy the genre on aesthetic grounds.

    However, given those parameters and the freedom to choose, I’d probably be the least likely to reach for Fowler. I don’t feel much kinship with it, for some reason.

    But enough about me. Like you were.

  26. #26 ann
    April 3, 2014

    D’oh!

    I’m capable of starting two sentences in a row with “however,” too.

  27. #27 lilady
    April 3, 2014

    “Get yourself a new hobby; this one is not a good fit.

    You are, of course, entitled to your opinion.

    What makes a good fit? Someone who toes the party line?”

    My profession as a public health nurse clinician-epidemiologist was not a hobby, skeptiquette.

    I see your fluffy white tail going down that rabbit hole.

  28. #28 Narad
    April 3, 2014

    ie, The Chicago Manual, Strunk & White, Fowler, whatever I’m forgetting

    CMOS only began including a usage section with the disastrous 15th edition; it’s Garner. As for Strunk & White, I spend a fair amount of time splitting infinitives for authors who had this “rule” somehow placed in their heads. There’s more (although that–which is a sensible stylistic choice for technical writing).

    Fowler is interesting for its exposition but hardly the sort of thing to be followed religiously in the modern day (trying to fix fused participles can quickly lead to trouble). But when somebody advances a rule and one can observe that not even this work of prescriptivism saw a problem, the “rule” is pretty much toast.

  29. #29 Alain
    friggin Montreal this time...
    April 3, 2014

    What makes a good fit?

    I don’t know but what doesn’t make it a good fit is thinking that vaccine cause autism in the face of numerous epidemiological evidence that vaccines dont cause autism or not considering the 1000’s of cause of autism which are genetically derived. If even vaccines cause autism in a very limited subset of the US population (read Michelle Cedillo), that’s only a very few rare case of 1 in a million or something like that. You need to address the 999 other cause of autism.

    Now enjoy your vodka tonic from the firehose of vodka…

    Alain

  30. #30 Alain
    April 3, 2014

    @Skeptiquette

    Furthermore, why are you investigating the cause of autism?

    Alain

  31. #31 Chris,
    April 3, 2014

    Alain: “I don’t know but what doesn’t make it a good fit is thinking that vaccine cause autism in the face of numerous epidemiological evidence that vaccines dont cause autism or not considering the 1000′s of cause of autism which are genetically derived.”

    Also if the MMR vaccine caused autism it would have been noticed long before Wakefield came on to the scene. It had been used for at least twenty years in the USA, a much larger country than the UK.

    If there was a connection between MMR and autism it should have been noticed before 1990? Where is that documentation.

  32. #32 Alain
    April 3, 2014

    @Chris,

    Okay, vaccine don’t cause autism, even in Michelle Cedillo’s case.

    Alain

  33. #33 ann
    April 3, 2014

    As for Strunk & White, I spend a fair amount of time splitting infinitives for authors who had this “rule” somehow placed in their heads.

    Makes sense if you’re writing Latin.

    (I’m also strongly pro-split-infinitive.)

    The thing about Strunk & White that’s charming is how unbelievably uptight it is, though:

    Vigorous writing is concise. A sentence should contain no unnecessary words, a paragraph no unnecessary sentences, for the reason that a drawing should have no unnecessary lines and a machine no unnecessary parts. This requires not that the writer make all his sentences short, or that he avoid detail and treat his subjects only in outline, but that every word tell.

    Yeah, yeah. Go tell it to Proust.

    _____________

    Honestly, I’m a cheap date wrt this subject area. As long as it’s about usage, I find just about any foolish crap diverting.

    https://www.youtube.com/watch?v=PcloWhudu8A

    I’m not too ashamed to admit it. Anonymously. On the internet.

  34. #34 ann
    April 3, 2014

    Ha.

    I didn’t check out your link until after I’d posted. I don’t disagree. But I like it anyway. It’s so uptight and so fully pre-convinced that it’s addressing hopelessly bad writers. It reads sort of like E.B. White was traumatized by the style of his classmates who bullied him at Groton. Or wherever.

    I find that appealing.

    His stepson’s really the one I don’t care to read.

  35. #35 Sarah A
    April 3, 2014

    I would think that if we could offer a range whereby the risk of getting the disease (which would allow us to convey an accurate risk of a particular sequela) is conveyed based on finer grained data, there may be a better chance at breaking through and convincing some to change their minds

    At first glance, I see two main problems with this approach, one pragmatic and one ethical. The pragmatic problem is that the data would have to be very fine grained in order to be applicable to an individual. Presumably the main places where most kids will be exposed to crowds of people would school and church/place of worship, if they attend one. So the first thing the parent trying to play the odds would need to know would be the vaccination rates for the individual school and/or church their child attends. Most schools don’t publish their vaccination rates, and I doubt any church does. The second thing the parent would need to know would be the chances of a VPD being introduced into their social circle in the first place. So they’d have to have some idea of how many of the unvaccinated people they come in contact with travel, where to, what’s endemic there, etc. Obviously its impossible to have all that info on every person you come into contact with, every person those people come into contact with, etc.

    The ethical problem is, of course, that the only reason the risk of getting a VPD in this country is so low is because the overwhelming majority do vaccinate, so if you decide not to vaccinate and rely on herd immunity, you’re acting in a way that you wouldn’t want others to act, which is generally considered unethical (explicitly stated in Kant’s categorical imperative, but implied in most ethical systems.) Of course, you could just say “F– your ethicak system, if I get the chance to mooch off everyone else, why not?” but in practice, few people do. You hardly ever see someone admitting that their reason for not vaccinating was simply that the odds worked out in their favor; their rationale is nearly always based on the misinformed idea that the vaccine is unsafe and/or ineffective.

  36. #36 Chris,
    April 3, 2014

    Sarah A: “Most schools don’t publish their vaccination rates, and I doubt any church does. ”

    Actually they do publish it for public schools at least in California. I know I downloaded that database at one time.

    “The second thing the parent would need to know would be the chances of a VPD being introduced into their social circle in the first place. So they’d have to have some idea of how many of the unvaccinated people they come in contact with travel, where to, what’s endemic there, etc. Obviously its impossible to have all that info on every person you come into contact with, every person those people come into contact with, etc. ”

    When my son was a baby and toddler I would ask the vaccination status of the children he came into contact with. This was because he had seizures as an infant and was only given the DT vaccine, plus it happened to be at a time when the county was having a pertussis outbreak. That was in the news, along with the measles epidemic that ended up killing over 120 Americans.

    I only encountered one mom/kid group where someone declared her doctor said they did not need to get vaccines. I never attended that one again for two reasons. First I did not want to put my kid at risk, and second, the attitude of that self-righteous mother was something I would avoid anyway.

  37. #37 Chris,
    April 3, 2014

    Alain: “Okay, vaccine don’t cause autism, even in Michelle Cedillo’s case.”

    The home videos shown at the Autism Omnibus proceedings pretty much proved that she was autistic before she got the MMR vaccine. And she was not born before 1990.

  38. #38 Alain
    April 3, 2014

    @Chris,

    Indeed, I remembered that.

    Alain

  39. #39 ann
    April 3, 2014

    NYC private school vaccination rates here:

    http://nymag.com/daily/intelligencer/2014/03/some-nyc-schools-show-dismal-vaccination-rates.html

    The second thing the parent would need to know would be the chances of a VPD being introduced into their social circle in the first place. So they’d have to have some idea of how many of the unvaccinated people they come in contact with travel, where to, what’s endemic there, etc. Obviously its impossible to have all that info on every person you come into contact with, every person those people come into contact with, etc.

    Agree that this would be impossible in all but very unusual circimstances, especially after the unvaccinated child was four or older. You’d have to know everything about every kid in the park, on the playground, at ballet class, soccer. and in the grocery store. Plus never go to the zoo, the movies, or the library. Or the shoe store. Or the family-style seafood restaurant where they have lollipops by the cash register.

    Unless you were raising a little unvaccinated Kaspar Hauser, it couldn’t be done.

  40. #40 herr doktor bimler
    April 3, 2014

    for the reason that a drawing should have no unnecessary lines and a machine no unnecessary parts.

    And to paraphrase Emperor Joseph II, a symphony should have no unnecessary notes.

  41. #41 Narad
    April 4, 2014

    Actually they do publish it for public schools at least in California. I know I downloaded that database at one time.

    Here; excludes schools with fewer than 10 students.

  42. #42 Chemmomo
    Narad beat me to it
    April 4, 2014

    Sarah A @235 (and Chris)
    To clarify: the California database includes private schools – parochial, Montessori, Waldorf, whatever.

    There are separate databases for day care and middle schoolers.

  43. […] given that their children are unprotected because they are unvaccinated—not just once but twice. Then we had our old pal, pediatrician to the antivaccine stars’ children Dr. Jay […]

  44. #44 Sarah A
    April 4, 2014

    @ Chris et al: I stand corrected. Do all states publish public school vaccination rates? I haven’t been able to find them for Virginia public schools, but maybe I’m just not looking in the right places.

    It still seems to me that trying to calculated the probability of any individual child getting a VPD vs having an adverse vaccine reaction is doing a lot of work to answer a question no one really seems to be asking (except Skeptiquette, of course), since antivaxers a) don’t believe the official rates of adverse events, and b) think they’re immune to disease b/c of their “healthy/natural” lifestyles.

  45. #45 Narad
    April 4, 2014

    I haven’t been able to find them for Virginia public schools, but maybe I’m just not looking in the right places.

    They’re here.

  46. #46 Sarah A
    April 4, 2014

    @Narad: Thanks – looks like my google-fu needs work. Fortunately it looks like vaccine rates are fairly high in my neck of the woods, but there are still private schools here and there with a high number of religious exemptions. Just another example of why you can’t rely on state-wide rates to determine an individual’s risk.

  47. #47 Antaeus Feldspar
    April 5, 2014
    Get yourself a new hobby; this one is not a good fit.

    You are, of course, entitled to your opinion.

    What makes a good fit? Someone who toes the party line?

    How about someone who doesn’t keep persisting with the same false assumptions after she’s received lengthy explanations of why they’re false? How about someone who doesn’t say things like “This is my syllogism that So-And-So revised”, implying that So-And-So gave their approval, when in fact what they’re presenting is EXACTLY the same syllogism they started with and was not modified at all despite So-And-So explaining why it didn’t even qualify as a syllogism, period??

    It took me a long time to catch on to your trick, SQ, but you’ve pulled it so many times that it’s obvious by now, and every time you trot it out again, it just tells us how much contempt you have for us. Namely:

    skeptiquette: Gosh, I just want to speculate on HOW vaccination might be causing autism, in the absence of any evidence that it IS doing so and a lot of evidence that it ISN’T!! I just don’t understand why that would be wrong!

    RIgular: [concise explanation of why that is wrong]

    skeptiquette: Oh, I suppose I understand that. But still, let me offer some specific speculations about how vaccinations COULD be causing autism, still ignoring the dearth of any evidence that they are doing so. Don’t those mechanisms sound kind of plausible? Don’t you think we should give them lots of attention? While paying no attention to the complete lack of evidence that anything of the sort is happening? Isn’t that the sciency thing to do?

    RIgular: [longer, but still patient explanation of why that is wrong. Why science is about finding the best and simplest explanation FOR the evidence, not about holding on to your pet belief DESPITE the evidence. Why putting the cart of “possible mechanisms” before the horse of “is it or is it not actually happening?” leads to chasing way too many false leads, not to actual progress in understanding.]

    skeptiquette: Ohhhh! I get it!! That makes so many things clear, thank you! There’s just one little part I don’t quite get, really: let’s say I have a mechanism in mind by which vaccinations could be enturbulating the immune system, and enturbulated immunity could be triggering autism. In THAT case, of course, wouldn’t it make total sense to skip over the question of “DOES it?” and go straight to “is this HOW it does it?”?

    RIgular: [extremely frustrated, extremely lengthy explanation so thorough that no one could miss the key point: IT IS WRONG to go speculating on mechanisms for a phenomenon BEFORE YOU HAVE ANY EVIDENCE THAT THE PHENOMENON HAPPENS. It is a recipe for PERPETUATING MYTHS AND LIES. It is MORALLY WRONG because it drains resources that could go to ACTUAL SCIENTIFIC STUDY, not to mention it hurts those who are FALSELY BLAMED in these fantasy scenarios.]

    [rather than answer, skeptiquette disappears. a few weeks later …]

    skeptiquette: Geee, I have all these mechanisms I’m thinking about by which vaccines could be causing autism! Let me share them with you!

  48. #48 Alain
    April 5, 2014

    Antaeus,

    You win the internet 😀

    Alain

  49. #49 Alain
    offtopic
    April 5, 2014

    I got accepted to do an internship at SAP in Montreal which, in 99% of cases, lead to a job.

    Alain

  50. #50 squirrelelite
    April 5, 2014

    Congratulations, Alain!!!!

  51. #51 squirrelelite
    April 5, 2014

    And, Antaeus, I second Alain’s comment.
    That was an excellent summary.

  52. #52 Denice Walter
    April 5, 2014

    @ Alain:

    Good for you!

    @ Antaeus:

    Agreed.

  53. #53 Brook
    April 5, 2014

    @Alain – congratulations!

  54. #54 Chris,
    April 5, 2014

    Antaeus Feldspar, that was beautiful.

  55. #55 lilady
    April 5, 2014

    Antaeus Feldspar, you nailed her…perfectly. Thanks.

  56. #56 anon
    April 5, 2014

    #247 Somehow finding this on wikipedia does not give me any confidence in the supercilious “opinions” of the poster.

    http://www.en.wikipedia.org/wiki/User:Antaeus_Feldspar
    quote-
    “Hello, my name is Antaeus Feldspar.
    I am proud to be the recipient of a WikiMedal for Janitorial Services, awarded by Topbanana.”

  57. #57 squirrelelite
    April 5, 2014

    So another Wikipedia user appreciated his contributions.
    Good for him!
    As for this blog, his comments speak for themselves as do yours.

    Personally, I find his much more persuasive.

  58. #58 Alain
    April 5, 2014

    Anon,

    Are you trying to infer that his comment does not inspire confidence based on a random wikipedia quote? I didn’t think you where this gullible.

    Alain

  59. #59 Narad
    April 5, 2014

    Somehow finding this on wikipedia does not give me any confidence in the supercilious “opinions” of the poster.

    Somehow I don’t believe that you “found” it.

  60. #60 Narad
    April 5, 2014

    And… Mazel tov, Alain!

  61. #61 anon
    April 5, 2014

    #259 And…namaste, narad!

  62. #62 anon
    April 5, 2014

    #258 Namaste, alain

  63. #63 Politicalguineapig
    April 5, 2014

    AF: It took you this long to figure out what she was up to?

    Alain: Congrats.

  64. #64 lilady
    April 5, 2014

    More replies to Bobby Kennedy on Medical News Today (I have a comment “in moderation”).

    http://www.medicalnewstoday.com/opinions/174696#post

    Notice how the blathering bullsh!tter hasn’t returned to defend himself against the multiple commenters who invited him to put or shut up, by publishing his book about Thimerosal.

  65. #65 novalox
    April 5, 2014

    @Alain

    Congrats. May you have future success.

  66. #66 sheepmilker
    April 5, 2014

    Féliciations Alain!

    I’m not really bilingual, but I think I should make the effort, especially with the election on Monday!

  67. #67 Alain
    April 5, 2014

    Thanks sheepmilker 🙂

    Re the election, perhaps I’m despairing too much because 3 out of 4 parties want to extract oil and this will create a pollution problem in the province while my party Quebec Solidaire did not consider the manifesto of my Montreal flatmate to fill out the column of revenues and really, it was a work of arts.

    Alain

  68. #68 Chemmomo
    Not quite bilingual, and with a different language
    April 5, 2014

    Alain @249
    Once again, congratulations and best wishes for future success!

  69. #69 Antaeus Feldspar
    April 5, 2014

    Alain: Congratulations! Bonne chance!

    Anon: You know, you’re not the first person to try and use that quote against me. I must say, I don’t even understand what you have in your head which makes you think it is against me. I mean, what’s supposed to be the damning part? That I once edited Wikipedia? That I did good work? That another user showed their appreciation for that good work? That I was happy to have my efforts appreciated? I really don’t understand the world you and your brethren live in, where “works hard, and earns the respect of their peers for that hard work” goes in the demerits column.

    PGP: I suspected it long before this, but I deliberately try to give people the benefit of the doubt. I would rather do that than poison every interaction that might have gone well, by pretending I “know” what someone’s hidden motives and traits are based on their zip code or shoe size or star sign or what-have-you.

  70. #70 Alain
    April 5, 2014

    Thanks you very much Chemmomo and Antaeus.

    Alain

  71. #71 MI Dawn
    April 6, 2014

    Congrats, Alain! May your internship lead to great things.

  72. #72 Alain
    April 6, 2014

    Thanks MI Dawn, I’ll know for sure if it will lead to a career on the first week of July.

    Alain

  73. #73 Chris,
    May 20, 2014

    Antaeus Feldspar: “How about someone who doesn’t keep persisting with the same false assumptions after she’s received lengthy explanations of why they’re false?”

    Skeptiquette is not terribly happy that after she posted a lengthy comment I posted a link to your depiction of her behavior. She says::

    Antaeus is not a research scientists, nor does he have any background in immunology or any real grasp of the current state of knowledge regarding immune contributions to autism.

    On top of that he got just about everything wrong in the post you linked to.

    Sorry, it is hard to take him seriously

    In the thread others were telling her that you cannot try to find our why vaccines cause autism, when it has been determined that there is no association. She just tells us that we are wrong and don’t understand the issue.

    She has not yet answered my question on whether a vaccine or a disease like measles has a bigger impact on the immune system.

  74. #74 Chris,
    May 20, 2014

    I botched the blockquote….

    First her comment about the above comment:

    Antaeus is not a research scientists, nor does he have any background in immunology or any real grasp of the current state of knowledge regarding immune contributions to autism.

    On top of that he got just about everything wrong in the post you linked to.

    Sorry, it is hard to take him seriously

    And the rest of mine: “In the thread others were telling her that you cannot try to find our why vaccines cause autism, when it has been determined that there is no association. She just tells us that we are wrong and don’t understand the issue.

    She has not yet answered my question on whether a vaccine or a disease like measles has a bigger impact on the immune system.”

  75. #75 Politicalguineapig
    May 20, 2014

    AF: Well, you can probably afford ‘benefit of the doubt.’ It’s a luxury item for me.

  76. #76 Narad
    May 20, 2014

    “Autism is multifactorial and heterogenous in its etiology, therefore modern epidemiological approaches (Cartesian reductionist) are not adequate for establishing general understandings of causation or non-causation.”

    What?

  77. #77 Alain
    May 20, 2014

    @Narad,

    I agree, on what planet she’s living?

    Alain

  78. #78 novalox
    May 21, 2014

    @Narad

    So basically, she’s saying that since there is more than one cause of autism, there is no way of understanding how to determine a cause.

    As a sheepherder once said, “What in the flock is going on with her?”

  79. #79 Chris,
    May 21, 2014

    novalox: “As a sheepherder once said, “What in the flock is going on with her?””

    I am just glad I am not the only one who can’t figure out her machinations. All I can deduce is that she makes them so convoluted in an attempt to mask her true intent: prove vaccines cause autism. Though she does it backwards, trying to claim immune responses to vaccines cause autism even though there is really no evidence vaccines are associated with autism.

    Then there is the sticky issue that the diseases seem to cause even greater immune impacts. As evidenced by my oldest kid’s multiple hospitalizations due to croup and his massive seizure due to a now vaccine preventable disease.

    By the way, there is really probably no way to find “one true cause” of autism. It is diagnosed only by a series of behavior observations. It is quite true that if you met one person with autism, you have only met one person with autism. All of the others will be completely different.

    There will be several reasons, but we can safely rule out vaccines.

    My oldest, along with having several indicators for autism (he is too old to have been diagnosed with DSM IV), has a very severe genetic heart condition that is diagnosed with an echocardiogram that actually shows a physical anomaly. There is actual physical evidence, especially after he had open heart surgery to remove the extra heart muscle tissue that could block the aortic valve.

    At the time of his genetic screen there were eighteen known genetic sequences that cause this abnormal heart muscle growth (some of them in the mitochondrial DNA). He tested negative for every single one of them. Obviously there are other genetic sequences that cause this, they have just not been found yet.

    For all we know, his heart anatomy and autistic like behaviors may be linked. But we were not going to pay the full genetic screen (over five figures) for researcher curiosity (hinted at by both the local genetic doctor and the hospital where the surgery was done). Though we did say they were welcome to more of his blood in a future study paid for with a grant.

  80. #80 Narad
    May 21, 2014

    So basically, she’s saying that since there is more than one cause of autism, there is no way of understanding how to determine a cause.

    If “Cartesian reductionism” is a problem, it seems like “cause” and “effect” ought to be as well. How epidemiology gets singled out as “not adequate for establishing general understandings” is anybody’s guess.

  81. #81 Mark
    Canada
    May 21, 2014

    Why are so many people reducing this issue to an over-simplified dichotomy of pro-vaccination/anti-vaccination?

    No one is asking the right questions. 20-50 measles cases is not an “outbreak” by any stretch. Use logic and quit perverting language.

    The risks of an adverse event from the MMR vaccine are greater than the risks of getting measles, mumps, and rubella in first-world countries. And why can’t we just get the measles vaccine without the mumps and rubella mixed in?

    And herd immunity is a joke. The MMR vaccine lasts seven years in your system (at the most), then it’s like you haven’t been vaccinated at all. When’s the last time an adult had a measles shot?

    We had a few dozen people get measles in British Columbia and Alberta this winter — 40 per cent of the kids and adults who got the measles had both vaccinations at age 1 and 5 as per the recommendations. So the vaccine isn’t even effective. And this rarely gets reported in the media because they’re afraid of sparking an “anti-vaccination” movement.

    Instead of herd immunity, let’s talk about the problems of herd stupidity. Even the most educated people gobble up whatever they read in the papers as Truth. No one knows how to think …

    And here’s the latest bit of insanity:
    http://kfor.com/2014/05/19/new-study-encourages-early-vaccination-for-measles/

    The risk of seizures from the MMR increases as children get older. But what is the vaccine doing to children at age 1? There is no research on this. I personally know (and have heard of) many children who got febrile seizures within 48 hours of getting the MMR shot.

    Why can’t modern medicine create something that actually works with no side effects? The whole health care industry needs to be constantly questioned. The best heath care professionals know we know nothing, and unless you’re bleeding out of your neck, or have a broken leg, the system is clueless more often than not.

  82. #82 Lawrence
    May 21, 2014

    @Mark – actually, you have no idea what the medical definition of an “outbreak” is, do you?

    As to the longevity of the vaccine immunity – I had my titres tested a few weeks ago & guess what, almost 40 years after getting vaccinated and I am still well above the levels necessary for being immune.

    And your comments about herd immunity show, again, that you have no idea about the actual concept or how easy it is to both calculate and prove….the outright stupidity of the anti-vax militia never fails to surprise me, even after all there years.

  83. #83 LW
    May 21, 2014

    @Mark, do you know why measles was called a childhood disease?

    Because it is so contagious that pretty much everybody who is exposed but not immune catches it and becomes immune. In the days before the vaccine, that meant that pretty much every adult had had it so only children could catch it. 

    If, as you claim, the immunity from the vaccine wears off in seven years “at most”, then most adults would not be immune and as soon as measles was introduced — say by someone walking through an airport shedding measles virus, as happened last year in America — we would not see outbreaks of ten or twenty; we would see epidemics of ten or twenty million.

    We don’t, so you’re wrong.

  84. #84 Mark
    Canada
    May 21, 2014

    Thanks for the comments, Lawrence.

    I’m curious: did you have your titre tests BEFORE you got vaccinated? I know many people who are naturally immune to chicken pox, measles, etc. who have never been vaccinated or contracted these diseases — their titres all show full immunity.

    Your extremism is not surprising, and your presumptive ad hominem characterization and gross over-simplification of me as “anti-vax militia” fits nicely within your mindset. In addition, your comments are quite bizarre.

    “Medical” definition? What are you talking about? An “outbreak” is not 50 people. And I don’t care whether medicine “defines” it as such or not. The Nazis defined Jews a certain way too. See the flawed logic and the perversion of language?

    And I wish you would have read my entire post, but someone with your extreme, parochial views most likely doesn’t want any facts.

    Here are three excellent articles from THE NATIONAL POST that address the measles issue. Hope you read them and learn something.

    http://business.financialpost.com/2014/04/16/lawrence-solomon-the-untold-story-of-measles/

    http://business.financialpost.com/2014/05/01/lawrence-solomon-vaccines-cant-prevent-measles-outbreaks/

    http://business.financialpost.com/2014/05/08/lawrence-solomon-vaccinomics-personal-vaccines/

  85. #85 Julian Frost
    May 21, 2014

    @Mark:

    20-50 measles cases is not an “outbreak” by any stretch.

    Definition of “Outbreak”: A disease outbreak is the occurrence of cases of disease in excess of what would normally be expected in a defined community, geographical area or season. So if normally a defined community, geographical area or season had just 5 measles cases, 20-50 cases would be an outbreak.

    The risks of an adverse event from the MMR vaccine are greater than the risks of getting measles, mumps, and rubella in first-world countries.

    Wrong. From Wikipedia:

    Complications with measles are relatively common, ranging from…diarrhea to…pneumonia (either direct viral or secondary bacterial), otitis media, acute encephalitis and SSPE, and corneal ulceration…
    Between 1987 and 2000, the case fatality rate across the United States was 3 measles-attributable deaths per 1000 cases, or 0.3%”

    For mumps, Wikipedia says the risks are:
    30% for testicular infection in adolescent and adult males (half of these result in testicular atrophy); 27% for spontaneous abortion in the first trimester; 5% for Oophoritis in adolescent and adult females; 10% for meningitis; 4% for pancreatitis.
    Rubella can cause brain infections, bleeding problems and congenital rubella syndrome.
    Contrast these with MMR:

    10% of children develop fever, malaise and a rash 5–21 days after the first vaccination; 3% develop temporary joint pain.

    And herd immunity is a joke. The MMR vaccine lasts seven years in your system (at the most), then it’s like you haven’t been vaccinated at all.

    Really? Well, it’s very strange then that in the most recent outbreaks, people who had received the two doses of vaccine more than 7 years ago weren’t affected.
    Or maybe you’re talking horse apples.

    We had a few dozen people get measles in British Columbia and Alberta this winter — 40 per cent of the kids and adults who got the measles had both vaccinations at age 1 and 5 as per the recommendations. So the vaccine isn’t even effective.

    Assuming that you’re telling the truth, since vaccination rates are typically at 80% or higher, that means the unvaccinated were 6 times more likely to get the disease.
    Here’s the calculation. 1000 people, 800 vaccinated and 200 unvaccinated. 100 measles cases. 40 in the vaccinated, 60 in the unvaccinated. 1 in 20 vaccinated people got the disease (40/800), while 3 in 10 unvaccinated did (60/200).

    The risk of seizures from the MMR increases as children get older. But what is the vaccine doing to children at age 1? There is no research on this. I personally know (and have heard of) many children who got febrile seizures within 48 hours of getting the MMR shot.

    The rate of febrile seizures is 9 in 10,000. Methinks that thou art exaggerating.

    Why can’t modern medicine create something that actually works with no side effects?

    Gee, I dunno. Maybe the fact that human physiology is incredibly complex, comprising of multiple systems, each comprised of multiple organs, each comprised of multiple tissue types, each having a possible different reaction to a substance?

    The best heath care professionals know we know nothing, and unless you’re bleeding out of your neck, or have a broken leg, the system is clueless more often than not.

    In 1650, your odds of reaching 18 were 1 in 3. Childhood diseases, malaria and dysentery were huge killers. Cancer and diabetes were virtual certain death sentences. If you had a limb severely injured, it would almost certainly have to be amputated. Today, none of this is the case. Medicine is a lot less “clueless” than you ignorantly think.

  86. #86 Mark
    May 21, 2014

    Thanks for the feedback, LW.

    Did you know that when a child gets measles in a country with good nutrition, sanitation, and health care in a first-world country, in all likelihood they won’t die?

    And did you know that once a child gets measles, they are 100 per cent immune for the rest of their life?

    And did you know that the vaccine is at best 70 per cent effective, but opens children up to a whole host of adverse events that aren’t properly tracked or reported?

    And did you know that the first measles vaccine recommended for one-year-old children is 95% effective? So why the second shot? And why no titre test for these diseases for children BEFORE they get the vaccine?

    And did you know that in these recent “outbreaks”, one-quarter to one-third of those that got measles HAVE been vaccinated?

    Read the articles I just posted links to in my last transmission.

  87. #87 Julian Frost
    Gauteng East Rand
    May 21, 2014

    Mark, Lawrence Solomon is a writer on the environment and the founder and executive director of Energy Probe, a Canadian non-governmental environmental policy organization and fossil fuel lobbyist group. In other words, not an epidemologist, not someone with a medical qualification, just a global warming denialist.

  88. #88 Julian Frost
    May 21, 2014

    Mark, you are lying.

    The vaccine is at best 70 per cent effective, but opens children up to a whole host of adverse events that aren’t properly tracked or reported?

    Look up VAERS. Look up the Vaccine Safety Datalink. Anybody, even a parent, can submit a report to VAERS. ANY adverse events that are reported are investigated.

    And did you know that in these recent “outbreaks”, one-quarter to one-third of those that got measles HAVE been vaccinated?

    So because the vaccine isn’t 100% effective it’s useless? Is that what you’re saying? As I showed in a previous comment, the vaccination rate means that the unvaccinated are far more likely to fall victim to the disease.

  89. #89 Mark
    May 21, 2014

    Thanks for all your comments, Julian.

    So sorry you didn’t take the time to read the articles written by a journalist citing the work of Dr. Gregory Poland, “one of the world’s most admired, most advanced thinkers in the field of vaccinology”.

    You google a journalist’s name and that’s your response?

    I’m due back on the Planet Earth.

  90. #90 Lawrence
    May 21, 2014

    @Mark – “transmission” from inside your tin-foil HQ, perhaps?

    And if Lawrence Solomon (again, as Julian pointed out, isn’t an infectious disease specialist) was actually correct, we’d be seeing hundreds of thousands of measles cases – not the small outbreaks we see today (invariably caused by an unvaccinated individual). Measles is one of the most infectious diseases on the planet – so if the vaccine wasn’t effective, again, we’d be seeing tens of thousands of cases….but hey, we don’t do we?

    As to my titres – I had them taken before I got re-vaccinated (my TdaP was all I needed) – no need to get another shot if I didn’t need it.

    Three doses of the MMR was found to be most effective at granting full immunity – and given that the overall rate of side-effects is so low, it was a no-brainer recommendation (supported by sound science).

    Got anything else you’d like to say?

  91. #91 Lawrence
    May 21, 2014

    And here is an interesting take on Dr. Polland – I guess the anti-vax groups don’t like him very much:

    http://anthraxvaccine.blogspot.com/2013/01/flu-vaccine-pusher-greg-poland-says.html

  92. #92 Julian Frost
    Gauteng East Rand
    May 21, 2014

    You google a journalist’s name and that’s your response?

    Yes. Put “Crank Magnetism” into the search box on this page. Falsus in unum, falsus in omnibus.

  93. #93 Lawrence
    May 21, 2014

    And I will say this for Dr. Polland – his stringent support for vaccinations in general is very refreshing & drive to continue to produce better vaccines, even better…..if it is going to take something like he is proposing to finally eliminate diseases like Measles, I’m all for it – but until such time that something can be brought to the table that can be shown to be better than what we are doing now, there is no need to change what we are doing…..

  94. #94 Lawrence
    May 21, 2014

    I also fail to find any mention from Dr. Polland that he proposes that we end the vaccination program……

  95. #95 Johnny
    127.0.0.1
    May 21, 2014

    Did you know that when a child gets measles in a country with good nutrition, sanitation, and health care in a first-world country, in all likelihood they won’t die?

    Did you know that, with about four million live births per year, if a child has a 99.999% chance of surviving measles, that we would have 40 dead babies every year?

    How many dead babies do you think we should be OK with?

  96. #96 TBruce
    May 21, 2014

    @Mark:

    Lawrence Solomon is a fool. He is notorious for cherry-picking and quote mining real scientists to fit his agenda. He boasts of founding, chairing and being “research director” of a myriad of fancy-sounding organizations that are, to put it charitably, rather obscure. He also boasts of being a “leading” environmentalist and a “best-selling” author. He is not. He doesn’t mention any degrees or post-secondary studies in any scientific or medical field. I think it’s safe to assume that he has none. He is also a vocal AGW denier, and his articles use the same sleazy tactics as his anti-vax articles.
    I could go on, but I won’t. Suffice it to say that if you use Solomon as support, you lose.

  97. #97 TBruce
    May 21, 2014

    So because the vaccine isn’t 100% effective it’s useless? Is that what you’re saying?

    That’s Lawrence Solomon’s latest dirty trick – the measles vaccine is “a failure”. Mark is just following the leader.

  98. #98 Mark
    May 21, 2014

    Thanks for running some numbers, Johnny.

    Using your un-cited numbers, more babies actually died (and many more were injured) from the MMR vaccine:
    As of March 1, 2012, there have been 898 claims filed in the federal Vaccine Injury Compensation Program (VICP) for injuries and deaths following MMR vaccination, including 56 deaths and 842 serious injuries.
    (http://www.nvic.org/vaccines-and-diseases/Measles.aspx)

    And these are based on numbers from people actually reporting adverse events. Because of the way the system is set up in the United States, the reporting system is deeply flawed with numbers that are even higher due to people not reporting, or knowing how to report. But the States is better off than Canada — Canada doesn’t even have a reporting body to go to if your child has an adverse event. This is a total travesty.

    In the meantime, keep attacking me and the reputable sources I cite to make yourself feel better …

    I wish we could have a reasonable conversation about important issues here.

  99. #99 Militant Agnostic
    May 21, 2014

    Mark writes “THE NATIONAL POST” in all caps as if it is some sort of oracle. The fact that he considers a right wing newspaper to be a super credible source is pretty good sign that he is an anti-science knee jerk contrarian. I will put hundred quatloos on him being an AGW denialist.

    Did you know that when a child gets measles in a country with good nutrition, sanitation, and health care in a first-world country, in all likelihood they won’t die?

    When some one is in head-on car crash in all likelihood they won’t die either.

  100. #100 Johnny
    127.0.0.1
    May 21, 2014

    I neglected to mention that the four million live births per year is just the good ol’ USA. I didn’t include the birth rate of all the other first-world countries, partly because that info wasn’t on the first page of google results, but mostly because, hey, I’m USAian.

  101. #101 Lawrence
    May 21, 2014

    @Mark – and that is how many claims again – over 35 years? Versus the number of people who have actually died of the Measles over the last 35 years or who would die without vaccinating….

    Oh, and no comments about Dr. Polland being one of the staunchest supports of general vaccinations?

  102. #102 TBruce
    May 21, 2014

    and the reputable sources I cite

    To quote Bender Rodriguez:

    Ha ha ha! Oh wait, you’re serious. Let me laugh even harder. HAHAHAHAHAHAHAHAHA!!

  103. #103 Johnny
    127.0.0.1
    May 21, 2014

    Well, the 99.999% I pulled out of the air as what I viewed as being in ‘all likelihood’, and the 4M births is from here –
    http://www.infoplease.com/ipa/A0005067.html
    If you have a better cite to use, please provide.

    So NVIC (an anti-vax loon site) says 56 total deaths (no cite given for that number either) from vaccine is too many, but you’re OK with 40 per year? That’s some messed up logic you got there.

  104. #104 TBruce
    May 21, 2014

    @Mark:

    Look up Subacute Sclerosing Pan-Encephalitis (SSPE). It’s rare, but it’s a horrible way for a child to die. Then carry on, if you dare.

  105. #105 Mark
    May 21, 2014

    Hey Militant Agnostic. Love the handle. And particularly love the Trek reference.

    Just to clarify (maybe you haven’t graduated high school), when you cite a journal or newspaper (or book, etc.) as a source, proper writing style is to underline, italicize, or use all capitals to note that it is the title of said source. Given the limitations of this blog, all caps was the easiest way to achieve this outcome.

    I love all the spurious assumptions being made in this forum. All quite flawed too …

    I think you’re Herbert, Militant Agnostic.

    We reach …

  106. #106 sheepmilker
    Also in Canada
    May 21, 2014

    Mark, Canada DOES have an adverse event rooting system: Canadian Adverse Events Following Immunization Surveillance System (CAEFISS). There is also an active surveillance system.

  107. #107 sheepmilker
    May 21, 2014

    ^ REPORTING system!

  108. #108 Mark
    May 21, 2014

    Nice, sheepmilker! I wish my GP knew about this. I’ll have to enlighten her.

  109. #109 Lawrence
    May 21, 2014

    Unless your GP has been living under a rock, I think you’re full of crap – since that system has been around for decades…..

  110. #110 Chris
    May 21, 2014

    Mark: “The risks of an adverse event from the MMR vaccine are greater than the risks of getting measles, mumps, and rubella in first-world countries.”

    Really? Why is that?

    Though you need to provide some actual evidence. Please post the PubMed indexed studies by reputable qualified researchers showing that the risks of the MMR are greater than measles.

    “And herd immunity is a joke. The MMR vaccine lasts seven years in your system (at the most), then it’s like you haven’t been vaccinated at all.”

    Citation needed.

    Also can you find the serious disconnect between the sentences I quoted from you? The reason you can claim a minor chance of measles injury in “first-world countries” is due to highly vaccinated populations.

    Have you thanked your responsible neighbors who help protect your family by vaccinating theirs?

    Though it may not help in Canada where in only one province (BC) there were almost twice as many cases of measles (400+) than the USA, a much larger country.

  111. #111 MI Dawn
    May 21, 2014

    Hey, Mark. You said @286: “And did you know that once a child gets measles, they are 100 per cent immune for the rest of their life?

    Tell that to my body. I *had* measles, mumps, and rubella (I’m that old, yes). I only test as immune to rubella. I’ve had several MMRs for school and college as I don’t test immune to measles or mumps. I worry that I’ll come across some numpty who doesn’t vaccinate and get one or the other. At my age, I really don’t want either.

    I, and my children had chicken pox. We are at risk for shingles now. I ended up giving my child narcotics for the pain she was in, she was so covered with pox. I’d MUCH rather have preferred the short term vaccination pain over the days of agony she was in. Unfortunately, that vaccine wasn’t available for them.

    I am, AND my children, as adults now, are all fully up to date with our vaccines. Flu shots yearly (even the kid who hates shots) voluntarily because we care about the people we interact with. Other vaccines as needed/recommended. And I’m counting the years till I can get the shingles vaccine (only a few to go…)

  112. #112 lilady
    May 21, 2014

    @ Mark:

    “We had a few dozen people get measles in British Columbia and Alberta this winter — . And this rarely gets reported in the media because they’re afraid of sparking an “anti-vaccination” movement.”

    You had more than a “few dozen people” who contracted measles in British Columbia and Alberta this past winter; there were hundreds and you have failed to provide your source for your statement “40 per cent of the kids and adults who got the measles had both vaccinations at age 1 and 5 as per the recommendations. So the vaccine isn’t even effective.”

    British Columbia and Alberta do not have regulations in place which mandate proof of vaccination with the 2-dose series of MMR vaccine for school children and for staff. Consequently, hundreds of school children and teachers were barred from attending schools during those outbreaks.

    Lawrence Solomon is a joke. He’s anti-vaccine and he cherry-picked scientific papers to use in his articles. I and many of the Respectful Insolence commenters posted comments on those three articles and Solomon removed them.

    IIRC, it was Anne Dachel, the Media Director at the clown blog Age of Autism who alerted her readership to Solomon’s articles, which evoked hundreds of responses posted by CIA Parker and Twyla.

  113. #113 TBruce
    May 21, 2014

    I wish we could have a reasonable conversation about important issues here

    Great idea! When do you start?

  114. #114 Calli Arcale
    http://fractalwonder.wordpress.com
    May 21, 2014

    MIDawn: I, too, had chickenpox. My mild case cost me a couple weeks of school, but not until after I had already passed it along to many other kids. (It’s infectious before the pox appear, of course.) One of my best friends had a horrible case. Pox in her throat even.

    And then shingles — oh, what fun that will be. One of my husband’s relatives had shingles, and developed Beall’s Palsy as a result. It’s been at least five years now, yet has had no improvement, so the nerve damage is very likely permanent. You can bet I’m gonna get the vaccine.

  115. #115 Chris,
    May 21, 2014

    If you are willing to pay for it yourself, you can get after age fifty at a local pharmacy. Hubby and I both got the shingles vaccine in our early fifties.

  116. #116 Militant Agnostic
    May 21, 2014

    Bachelor of Science (Mechanical Engineering) – how many post secondary calculus and statistics courses have you taken.

  117. #117 Chris,
    May 21, 2014

    Mark:

    Just to clarify (maybe you haven’t graduated high school), when you cite a journal or newspaper (or book, etc.) as a source, proper writing style is to underline, italicize, or use all capitals to note that it is the title of said source. Given the limitations of this blog, all caps was the easiest way to achieve this outcome

    Those limitations be so onerous that you are can only use the CAPs lock.

  118. #118 herr doktor bimler
    May 21, 2014

    Instead of herd immunity, let’s talk about the problems of herd stupidity. Even the most educated people gobble up whatever they read in the papers as Truth. No one knows how to think …

    WAKE UP SHEEPLE!!!!

  119. #119 LW
    May 21, 2014

    @Mark, since you addressed me directly, I will respond though many others have already responded while I was busy at work. 

    Did you know that when a child gets measles in a country with good nutrition, sanitation, and health care in a first-world country, in all likelihood they won’t die?

    In all likelihood, no. Only somewhere between 1 and 30 per 10,000. Would you be comfortable taking an action with no benefit to you and an 1/10,000 of killing you?

    On the other hand, “not dying” isn’t the only measure.  There’s also a 1/1000 chance of measles encephalitis, leading to, in many cases, blindness, deafness, or brain damage. Modern medicine can often keep people alive, but it can’t do anything about neurons killed by disease.  As a doctor once observed to me, “I can do a lot, but I can’t raise the dead.”

    And did you know that once a child gets measles, they are 100 per cent immune for the rest of their life?

    Well, first of all, I have a hard time seeing why anyone would want to get measles in order not to get it again, when they could avoid getting it at all via vaccination. Second, as others have noted, it is not true that every person who gets measles is 100% immune, just as not every person who gets the vaccine is 100% immune.
     

    And did you know that the vaccine is at best 70 per cent effective, but opens children up to a whole host of adverse events that aren’t properly tracked or reported?

    Again, if this were true, we in America would have a huge population of non-immune adults and would see epidemics every time measles was introduced, as it is several times each year.  We don’t have such epidemics, so your statement is untrue. 
     

    And did you know that the first measles vaccine recommended for one-year-old children is 95% effective? So why the second shot?

    This directly contradicts your previous point. The reason a second shot is recommended is that the first isn’t 100% effective, of course. 
     

    And why no titre test for these diseases for children BEFORE they get the vaccine?

    Because it subjects children to unnecessary pain and the parents to unnecessary expense and inconvenience. 

    And did you know that in these recent “outbreaks”, one-quarter to one-third of those that got measles HAVE been vaccinated?

    Yes, as has been explained to you and as you appear to understand, there are vaccine failures. However, since a lot more than one-quarter to one-third of population is vaccinated, that means that vaccinated people are a lot less likely to get the disease, as expected. The vaccine isn’t perfect but it is much better than nothing. 

  120. #120 Militant Agnostic
    May 21, 2014

    @LW

    I think we can be sure that Mark has never taken a post-secondary math or statistics course.

  121. #121 Science Mom
    http://justthevax.blogspot.com/
    May 21, 2014

    If Orac will release my post that’s in link jail, Mark will garner some perspective with regards to vaccine v. disease risks. We’ll see how honest he is.

  122. #122 Antaeus Feldspar
    May 21, 2014

    Mark, I’ll ask you politely to stop Gish galloping. A competent person will have no trouble Googling “Gish gallop” and understanding what has been requested of them; an honest person presenting only claims they truly believe to be sound should have no reason not to agree to that reasonable request.

    I will give you the benefit of the doubt and presume that you’ve agreed to that request: agreed to stay and discuss the claims you’ve made, rather than just speeding off to make new ones. So this is the claim of yours I want to focus on: that in recent measles outbreaks, one-quarter to one-third of the cases were in people already vaccinated, and that (you’ve left us to infer this part, but no one would think you meant anything else) this means vaccination isn’t effective.

    Do you realize that if even half the general population is vaccinated, “one-quarter to one-third of those infected had been vaccinated” is in fact very strong evidence that vaccination is effective??

    Let’s say there is a charity drive. We’ll look at the donors in that charity drive, and we’ll identify one specific group. That group represents only 3% of the donors to the charity drive. If we were told their donations represented only 3% of what was raised by the drive, we wouldn’t find that unusual at all. But if we find instead that 3% of donors contributed 60% of what was raised by the drive, obviously that tells us something quite different. They contributed a percentage of the total money that far exceeds their representation in the population.

    Now, for the sake of argument, let’s look at vaccination numbers. We’ll pretend for the sake of argument that the rate of vaccination in the general population is far lower than it actually is: we’ll pretend that only half the general population is vaccinated. We’ll also, for the sake of argument, accept your figures that “one-quarter to one-third of cases were vaccinated”, and in fact we’ll take the figure at the extreme of the range most favorable to your position, and say that a full one-third of those who contracted measles were fully vaccinated.

    If vaccination does not protect against measles as compared to non-vaccination, then how do you explain a group that is only 50% of the population – the unvaccinated – being responsible for 66.6% of the measles cases?? Clearly, the unvaccinated are “contributing” victims to the disease at a rate that outstrips their rate of representation in the population! And that’s the case even with us taking a very unrealistic figure of “50% of the general population is vaccinated”; if we take a more realistic figure such as 75% being vaccinated, the conclusion is inescapable: the minority of the population that is unvaccinated represents the majority of disease victims.

    Anyone who tries to present those figures as evidence that vaccination is not protective is, in the most charitable interpretation, deeply befuddled.

  123. #123 LW
    May 21, 2014

    @Militant Agnostic: Forget post-secondary; I am somewhat dubious about his primary-school math. He seems quite weak on simple logic as well.

  124. #124 Narad
    May 21, 2014

    And did you know that once a child gets measles, they are 100 per cent immune for the rest of their life?

    Not exactly.

  125. #125 Chris,
    May 21, 2014

    LW: “I am somewhat dubious about his primary-school math.”

    Exactly. He said: “‘We had a few dozen people get measles in British Columbia and Alberta this winter”

    Actually the numbers were in the hundreds, especially in the Fraser Valley of British Columbia.

  126. #126 Narad
    May 21, 2014

    I know many people who are naturally immune to chicken pox, measles, etc. who have never been vaccinated or contracted these diseases — their titres all show full immunity.

    Maybe it’s Maybelline.

  127. #127 LW
    May 21, 2014

    I have irrefutable proof that the measles vaccine does not last “at most seven years”. 

    Immunity from the DTaP/TDaP wears off after a while, so adults are urged to get boosters every ten years. Or, ask antivaxxers would put it, Big Pharma has convinced the CDC to boost their profit by pushing boosters. But nobody at all urges adults to get regular measles boosters.  As Mark said himself, “When’s the last time an adult had a measles shot?” Adults aren’t urged to get measles boosters except in special circumstances*.

    Why is that?  Obviously because the claim that immunity to measles from the vaccine wears off in at most seven years is so patently absurd that the CDC and Big Pharma would be laughed at if they made it. 

    * I know someone who had to get the MMR to go to work in a hospital because she lacked proof of receiving the MMR as a child.

  128. #128 Julian Frost
    Gauteng East Rand
    May 22, 2014

    I know this was said way back @298, but I can’t let it pass unchallenged.

    As of March 1, 2012, there have been 898 claims filed in the federal Vaccine Injury Compensation Program (VICP) for injuries and deaths following MMR vaccination, including 56 deaths and 842 serious injuries.

    Filed. Not conceded, not paid out. FILED.

  129. #129 Lawrence
    May 22, 2014

    Yes, less than 1000 filed out of hundreds of millions of MMR does given…..

  130. #130 Dangerous Bacon
    May 22, 2014

    Mark: ” The MMR vaccine lasts seven years in your system (at the most), then it’s like you haven’t been vaccinated at all.”

    CDC: “When this (measles) vaccine virus is given to a child it replicates only a little before it is eliminated from the body. This replication causes the body to develop an immunity that, in 95% of children, lasts for a lifetime.”

    http://www.cdc.gov/vaccines/vpd-vac/measles/vacc-in-short.htm

    Measles vaccination provides about the longest immunity of any vaccine.
    Hopefully Mark will not keep repeating the only-good-for-7-years argument in his future antivax diatribes, but don’t count on it. Antivax lies take on a life of their own.

    Mark seems to be big on citing measles as only a Third World problem. Mark does not appear concerned that anti-MMR and other antivax nonsense gets propagated abroad or to new immigrants to the U.S., and helps foster resistance to getting lifesaving vaccines (for instance, among Somalis emigrating to this country, egged on by the likes of Andrew Wakefield).

    The damage that antivaxers do is not confined to developed nations.

  131. #131 Narad
    May 22, 2014

    Filed. Not conceded, not paid out. FILED.

    Including one case of blunt-force trauma (PDF). As it happens, the attorney in this case has been disbarred.

  132. #132 Shay
    May 22, 2014

    Due to the torpor manifested by Petitioner’s Counsel, that Order threatened a ruling on the record as it existed if Petitioner did not comply,

    I love a witty judge.

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