Respectful Insolence

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 Chris Hickie
    March 28, 2014

    If a dentist told me not to brush my children’s teeth, I would find a new dentist. If a pulmonologist told me smoking isn’t dangerous to my health, I would look for a new pulmonologist (I have asthma–and any pulmonologist who would give advice that would fly in the face of all the research on tobacco use shouldn’t be trusted to understand something more complex like asthma).

    Yet, here is Dr. Bob, whose well-documented vaccine advice given to his own patients is completely contrary to all AAP/CDC vaccine guidelines. If Sears can’t/won’t get vaccines right, why should I trust him to know what to do if my child is acutely ill? The difference with Sears, however, is that he has decided the whole world needs to know his views on vaccines–hence his books, facebook page, many interviews, articles and webinars. This has made him direct threat to public health as he convinces parents not to vaccinate. I have seen this as a pediatrician since the early 2000′s, and it continues today every time a parent won’t fully vaccinate based on what Sears has said/written.

    The 2010 California whooping cough outbreak resulted in the deaths of 10 infants too young to receive pertussis vaccine. Scientific analysis showed that areas with high non-medical exemption rates for pertussis vaccine were 2.5 times more likely to be within an outbreak area. I have no doubt that the same correlation will be seen for measles outbreaks in California circa 2014. Sears owns these measles cases in electively non-vaccinated children in Orange County. I do not wish any more more cases to occur, but if any are children of parents who took his advice, I hope they will speak up about how medically dangerous Dr. Bob truly is.

  2. #2 Dorit Reiss
    March 28, 2014

    He thinks this makes it better?

  3. #3 Denice Walter
    March 28, 2014

    I came across an enlightening map yesterday
    ( graphics.latimes.com/us-map-autism-rates-state), which may help put the new figures in perspective:
    we might ask, first of all, what could cause such a rapid ‘increase’ and why is it so d-amned spotty? It appears that rates vary widely ( from 0% to over 1%; in 2012). There is no autism in Wyoming but plenty in Oregon.

    If it’s NOT diagnostic substitution or increased awareness, why would a condition proliferate along lines that, given a cursory glance, seem to correlate with money? The highest rates are recorded in the NE and the West coast-: which are probably more educated and affluent areas. HOWEVER rates appear lower in the South and Midwest: i suppose that there is very little toxic contamination in those places.

    Dr Insel is mentioned in AoA’s harangue as believing that there may indeed be an increase:
    sure, if more older people have children as well as those in STEM occupations, I could certainly imagine that as an added contributor alongside diagnostic substitution and increased awareness.

    The Canary Party, AoA and TMR would argue that genetics aren’t that important – it’s toxins. Whilst the Mercury Mafia ( Jake & friends, the Geiers, Hooker, Barry, Bolen et al) would focus on mercury. How can a toxin hypothesis reconcile with a map like that?

    Purely as speculation, that map almost looks like it could predict elections. Liberalism causes autism?

  4. #4 Sarah A
    March 28, 2014

    In a lot of ways, Dr. Bob p!sses me off even worse than true believers like Jenny McCarthy et al. It’s clear from his constant prevarications that he knows d@mn well the vaccine is safe, but he’s making a killing indulging worried parents instead of educating them. Now his gravy train has hit a speed bump (I know I’m mixing my metaphors terribly) and all he can do is whine about the fact that people expect him, a doctor, to actually give medical advice instead of just handing parents a sheet of scary-sounding technical jargon they don’t understand and telling them to try and figure it out for themselves.

  5. #5 Denice Walter
    March 28, 2014

    @ Sarah A:

    Right- mixed metaphor but GREAT IMAGE!

  6. #6 Shay
    March 28, 2014

    HOWEVER rates appear lower in the South and Midwest: i suppose that there is very little toxic contamination in those places.

    I wonder if the low autism rates in the South and Midwest have anything to do with rural poverty and lack of access to medical care. If the only healthcare you can afford is what’s offered by the local health department (well baby visits and immunizations), a developmental problem with your baby might very well be missed.

  7. #7 Shay
    March 28, 2014

    Sorry, forgot to add this — speaking as a resident of the rural Midwest, agricultural areas are incredibly toxic. There are 137 registered hazmat sites in our county and they’re all for fertilizer and other ag chemicals.

  8. #8 Shay
    March 28, 2014

    Oh hell. Third time’s the charm.

    They’re MOSTLY for fertilizer and other ag chemicals. We do have two hospitals and a university here.

  9. #9 Todd W.
    http://www.harpocratesspeaks.com
    March 28, 2014

    Just a reminder for Dr. Bob, in 2008, although the index case in the measles outbreak that year was not in his waiting room, the child was his patient, as reported on This American Life, episode 370. The episode includes the story of one infant who had to be quarantined for 3 weeks, causing significant hardship for the mother and father, who both worked full time. It also recounts how the outbreak led to health officials having to waste time and money tracking down over 900 people who came into contact with those who were infected with measles. So, essentially, Dr. Bob, by taking the irresponsible stance of not urging people to get vaccinated, is promoting the waste of taxpayer money, in addition to putting the community at risk.

  10. #10 Orac
    March 28, 2014

    If a dentist told me not to brush my children’s teeth, I would find a new dentist. If a pulmonologist told me smoking isn’t dangerous to my health, I would look for a new pulmonologist (I have asthma–and any pulmonologist who would give advice that would fly in the face of all the research on tobacco use shouldn’t be trusted to understand something more complex like asthma).

    Yet, here is Dr. Bob, whose well-documented vaccine advice given to his own patients is completely contrary to all AAP/CDC vaccine guidelines.

    Yup. It’s like an oncologist not recommending chemotherapy along with surgery for stage III triple negative breast cancer—outside the standard of care.

  11. #11 Todd W.
    http://www.harpocratesspeaks.com
    March 28, 2014

    Dr. Bob also seems to have forgotten what the AAP, of which he is a fellow, recommends with regard to vaccinations: get them on schedule (barring valid medical contraindications).

  12. #12 matt
    United States
    March 28, 2014

    What do Dr Bob and his unvaccinate patients say when one of them gets diagnosed with autism? Do they deny that it is actually autism? Or do they just blame “toxins”?

  13. #13 Denice Walter
    March 28, 2014

    But you see that’s why some of his clients LIKE Dr Bob: he’s not one of those everyday, regular, standard-of-care doctors- he’s something SPECIAL – just like them and their oh-so-perfect, unique progeny.

    It’s more creative medical care that way: the rules are boring so let’s make our own rules and a newer, trendier schedule that is more amenable to our highly evolved tastes and requirements. ANY old doctor can follow a schedule.

  14. #14 Dorit
    March 28, 2014

    He’s not bothering to jump in and correct the anti-vaccine claims in response to his initial post, either.

  15. #15 Dorit
    March 28, 2014

    I’m really wondering if what he says goes far enough to be negligent misrepresentation. For example, this statement “But for most, it’s a harmless disease.” is pretty close. As is the reference to the inserts without addressing frequencies or causation.

  16. #16 Indigo_Fire
    March 28, 2014

    @Denice #3

    The web url you posted goes to a blank page (maybe it’s only visible to subscribers?) so I can’t take a look at it, but I wonder if part of the regional variation may also be due to families moving to regions that have better services.

    For example, I would imagine a family in rural Wyoming (well, practically the whole state is rural) might have more problems finding services for their autistic children than one that lives in a more urban or suburban area and so they may feel the need to move to where those services are more readily available. Hence the low levels of autistic individuals in the state.

    I’m a little unsure of the methodology of the study, but it seems that they’re just looking at the overall numbers of autistic children in each state, and not what state those diagnoses originated in (which is what would be needed to answer my question).

  17. #17 janerella
    March 28, 2014

    Perhaps we could renovate some of our old asylums pop all those “not quite right” toddlers and children back into them and bring the autism rate back down again.
    http://www.abc.net.au/news/2013-07-05/hospital-feature—lucy-martin/4802138
    From an ex nurse who used to work at the above decommissioned asylum ( a 5 minute drive from where I live)
    “As a young 17-year-old I could really see no reason why they had to be locked away.
    “We had a children’s ward with children as young as two, three, and four-years-old and some of them never ever left the institution, they stayed here their whole lives

    “I think that was probably one of the most horrendous things, the fact that children were incarcerated for no other reason than they had birth defects and all sorts of other mental illnesses.”

  18. #18 janerella
    March 28, 2014

    And we are talking the mid-60′s here, not the 18 or 1900′s.

  19. #19 Denice Walter
    March 28, 2014

    @ Indigo_Fire:

    I don’t subscribe to anything,
    That url came up with the map: I found the map by searching for ‘autism rates map us’ or something similar and I added ’2012′ after that date showed up with a map. Sometimes graphics reveal what language might conceal ( e.g. look at Orac’s map of SoCal above). I do know about regional variation which is what spurred my quest.

    Of course, people do move to locales which have better services but I don’t think that that would be enough to move big numbers- altho’ it is part of the story. The trends may reflect better surveillance and awareness in particular places that spend more money on education, medical and social services. I wouldn’t be at all surprised if another contributor would refelct the tendency of more educated, affluent people in places like these to have children at a later age ( thus, more *de novo* variation) and perhaps, maybe, POSSIBLY even a small effect from people in STEM careers ( genetic variation) having children at a higher rate than previously. Of course I’m speculating but I can assure you, it’s not purely idle but based upon other things we know ( genetic influence, age, social clas, screening etc)

  20. #20 Vincent Iannelli, MD
    March 28, 2014

    “Finally, some love to blame me for the outbreak. ”

    Dr. Bob’s original alternative vaccine schedule said to separate out the MMR components and to not get the measles shot until the child was 3 years old. Not sure when he made the switch.

    Anyway, more than the folks who follow the alternative schedule are the ones who use his book, made up schedule, and Dr. Bob himself to justify not vaccinating their children at all.

    He is right that he doesn’t deserve ‘some’ blame for these outbreaks. Many think he deserves a whole lot of blame.

  21. #21 Chris Hickie
    March 28, 2014

    Well, here’s strong evidence Dr. Bob’s to blame for the measele, directly in line with what you noted above, Orac (from a post just now to his latest facebook blathering):

    misled parent’s name redacted: As a parent who takes her children to Dr Bob… I can say I trust his opinion 110% with the care of my children’s health… When the measles outbreak occurred not only was one of the initial 7 in my town but one of the 21 was at my kids school. Dr Bob and his staff were calm well informed and compassionate. I normally do not write on these sort of forums but I feel strongly about speaking about Dr Bob as a patient with so many people saying horrible things that do not know him!!! Dr Bob is a brilliant Dr who cares for all of his patients and their families deeply! He also attacks illness differently and chooses to share with others instead of keeping it within just his practice. He is intuitive, thoughtful, compassionate, well educated, and my children adore him! Dr Bob

  22. #22 Science Mom
    http://justthevax.blogspot.com/
    March 28, 2014

    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.

    What a load. His “Vaccine Book” “selective schedule” doesn’t even have MMR or the separate jabs and his “alternative schedule” has separate jabs, mumps at one year, rubella at two years and measles at three years. When Merck pulled the separate jabs he threw a hissy fit and told people not to get the first MMR until 4 years old and then pull titres. He has been recommending against a second MMR but of course he’s sent that down the memory hole.

    Death isn’t the only awful endpoint of measles. He doesn’t mention how 7 of the 21 measles cases thus far have resulted in hospitalisation or how Orange County has more than twice the number of cases as any other California county or that Orange County hasn’t had this many cases in decades. Damn straight he is largely to blame but I am enjoying watching his sorry arse squirm trying to weasel away from any responsibility.

    The man is a scientifically-illiterate, medically-negligent gobshite.

  23. #23 Chris Hickie
    March 28, 2014

    SM- A screen shot of his schedules might help refresh his memory (translation: I don’t know where I put my copies of his “book” (and whenever I have to look at it I want to throw it in the trash).

  24. #24 Renate
    March 28, 2014

    He also attacks illness differently and chooses to share with others instead of keeping it within just his practice.

    Would that mean, making other children ill as well?

  25. #25 Chris Hickie
    March 28, 2014

    Renate-maybe he thinks he can chase down Morbilliviruses with a fly swatter or a can of Lysol.

  26. #26 Broken Link
    March 28, 2014

    We have our own little local outbreak of measles. And predictibly, it was an unvaccinated child who brought it back from the Phillipines. Also, predictably, there were the usual antivax loons writing letters to the paper describing how they didn’t need the vaccine. And then this one, which I though was very good:

    http://www.ottawacitizen.com/health/Measles+issue+serious/9671825/story.html

  27. #27 palindrom
    March 28, 2014

    I’m wondering — is there any mechanism by which a member in good standing of the American Academy of Pediatrics can issue a complaint against another member? Or is it just assumed that anyone who got through medical training automatically has mad doctor-fu forever, provided they fulfill the continuing ed requirements?

  28. #28 Dorit
    March 28, 2014

    I think anyone can file a complaint against a doctor with a disciplinary board, but it will probably be treated differently based on the identity of the complainer. I don’t know how a complaint by a doctor would be treated, or if there would be any social or other costs from breaking ranks.

  29. #29 LIz Ditz
    March 28, 2014

    Vince Iannelli wrote

    “Dr. Bob’s original alternative vaccine schedule said to separate out the MMR components and to not get the measles shot until the child was 3 years old. Not sure when he made the switch.”

    Probably when the individual vaccines ceased to be manufactured, sometime after 2006 IIRC.

  30. #30 Eric Lund
    March 28, 2014

    Renate @24: Yes, I wonder whether he’s using “share” the way Tom Lehrer did.

  31. #31 Dorit
    March 28, 2014

    From the CA Medical Board’s site:
    “I have heard that Dr. X is prescribing large amounts of pain medication to people who are addicted to this medication. Will the Board investigate Dr. X?

    This concern can be investigated by the Board. However, to investigate a physician’s care/treatment, the Board needs information on a patient or patients. The Board can’t assess the “quality” of care without focusing on a particular patient, as the Board has no authority to audit or review a physician’s medical records without patient consent (or a subpoena which needs to be specific to a patient). If you have any information which you think would be helpful or if you know of any patients who are willing to cooperate with our investigation, please feel free to contact the Board at 800-633-2322 or file a complaint with the Board.

    Back to Top

    Can I file a complaint without giving my name?

    A complaint can be filed anonymously; however, the Board has a difficult time investigating these complaints. If the Board is unable to obtain documentation or evidence of the complaint allegations, the complaint may not be able to be pursued. The Board does accept complaints from individuals who wish to designate themselves as “confidential informants.” A “code name” can be used which would allow investigative personnel to discuss the allegations with the “complainant” without disclosing the individual’s name. But, again, if medical records are required, the patient’s name will have to be disclosed to the physician.”

    http://www.mbc.ca.gov/Consumers/Complaints/Complaints_FAQ/Complaint_Process_FAQ.aspx#7

    So anyone can file, but you’d need a patient’s name and agreement to provide records for many things. Not sure how public utterances would be treated.

  32. #32 Dorit
    March 28, 2014

    One more paragraph from that site:

    “As a licensed physician, am I required to report another physician to the Board if I am concerned that the physician may be physically or mentally impaired?

    There is no mandatory reporting requirement in the Medical Practice Act to report a colleague for possible impairment. However, as the Board’s mission is to provide patient protection, the Board clearly is concerned about physicians who potentially present a danger to their patients. Reporting an impaired colleague to the Medical Board will allow the Board to ensure adequate protections are in place so the public will not be harmed by a colleague who requires assistance. The sources of complaint information are kept confidential by the Board.”

  33. #33 Chris Hickie
    March 28, 2014

    Palindrom@ #27-I’ve been writing the AAP on this for years, first as an FAAP deeply troubled by Sears (and Gordon, too) and now no longer as an FAAP as I can’t bring myself to belong to any pediatric group that allows Sears and Gordon to be members. I never got a single response from the AAP until I stopped paying dues. You can read about it here: http://www.stopsearsandgordon.org. When I finally did get to talk to their PR director and then their current president Dr. Block in 2012, they told me they would not do anything against Sears or Gordon out of fear of being sued for libel.

    Pathetic.

  34. #34 palindrom
    March 28, 2014

    Sorry, I really wasn’t clear (@27). What I was wondering is whether a pediatrician can get another pediatrician drummed out of the FAAP. Because the Good Doctor does not seem to be much of a jolly good fellow.

  35. #35 palindrom
    March 28, 2014

    Gaack. I mean, drummed out of the AAP (not FAAP, because “F” is for “Fellow”).

  36. #36 palindrom
    March 28, 2014

    Chris @33 — Our messages crossed in the mail, as it were.

    Good for you! And thanks for all the good work you do, so close to Andrew Weil’s desert redoubt.

    Speaking of U. of A., our local cancer center (far from Arizona) is as of yet quackademia-free, thank heavens. I sent the link to Orac’s recent post about U of A to our local cancer center’s director, who replied graciously and said he would read it with interest. Sometimes it’s nice to have “Professor” in front of your name.

  37. #38 Karen Ernst
    www.voicesforvaccines.org
    March 28, 2014

    Dr. Bob seems to have forgotten that is his first job as a pediatrician is to protect children–not to sell his book or promote future blog posts. Not to bring aggrandizement to his name and his brand. He besmirches the very idea of a responsible doctor.

  38. #39 herr doktor bimler
    March 28, 2014

    If a dentist told me not to brush my children’s teeth, I would find a new dentist.
    I would also wonder how much that dentist’s opinions had been swayed by the prospect of increasing his income stream.

    Dr Bob is a brilliant Dr who cares for all of his patients and their families deeply!
    Deeply, and regularly, and lucratively.

  39. #40 Kelsey
    March 28, 2014

    OT, (but is the regulation of quackery really off topic here?). Make sure all beverages are swallowed and in their upright and locked positions. I nearly needed a new keyboard after this.

    http://www.independent.co.uk/news/world/americas/homeopathy-product-recalled-over-fears-it-may-contain-actual-medicine-9217206.html

  40. #41 Vincent Iannelli, MD, FAAP
    March 28, 2014

    “What I was wondering is whether a pediatrician can get another pediatrician drummed out of the FAAP.”

    There has been talk and I think even a resolution put forth to get both Dr. Bob and Dr. Jay out of the AAP. I don’t think that the AAP’s lawyers liked the idea.

  41. #42 ann
    March 28, 2014

    I came across an enlightening map yesterday
    ( graphics.latimes.com/us-map-autism-rates-state), which may help put the new figures in perspective:
    we might ask, first of all, what could cause such a rapid ‘increase’ and why is it so d-amned spotty? It appears that rates vary widely ( from 0% to over 1%; in 2012). There is no autism in Wyoming but plenty in Oregon.

    If it’s NOT diagnostic substitution or increased awareness, why would a condition proliferate along lines that, given a cursory glance, seem to correlate with money?

    Maybe it’s higher in states that have better-funded (or just better) special-education programs (and/or other services) for people with autism.

  42. #43 Todd W.
    http://www.harpocratesspeaks.com
    March 28, 2014

    @ann

    Maybe it’s higher in states that have better-funded (or just better) special-education programs (and/or other services) for people with autism.

    Like NJ. IIRC, a number of years ago they saw a big increase in prevalence when they started doing more aggressive screening and started offering better support and services than other nearby states.

  43. #44 Jeff1971
    March 28, 2014

    Great quote about Mr Wakefield from Brian Deer this week (thought he’d deserted us)

    http://www.medicalnewstoday.com/articles/274619.php

    “I don’t believe he is convinced of the validity of his claims at all, and today he does not even seem clear about what they are. I think he is a sociopath who is incapable of comprehending, much less acknowledging, the nature of his misconduct. For more than a decade he has been wholly dependent for his livelihood on the parents of children with various kinds of disabilities and challenges. He has nowhere else to go but to do whatever it takes to ensure that they keep giving him money.”

  44. #45 John C Key MD
    Texas
    March 28, 2014

    I’m a pro-vaccine doc, but after all, it’s just measles. Those of us of a certain age faithfully recorded “UCHD”–usual childhood diseases–when writing our medical histories. Measles, mumps, chicken pox–everybody had it.

    I am a pro-vaccine guy, but we are just talking measles here. It isn’t smallpox or polio.

  45. #46 thor
    March 28, 2014

    Just basic searching for relative risk states death from measles (not including mumps or rubella) 1-3/1000, “severe reaction” (not death) of the MMR vaccine <1/1million. Looks like pulling up my sleave is the better option.

  46. #47 anon
    March 28, 2014

    Measles notifications and deaths in England and Wales, 1940-2013
    http://www.hpa.org.uk/web/HPAweb&HPAwebStandard/HPAweb_C/1195733835814

  47. #48 Science Mom
    http://justthevax.blogspot.com/
    March 28, 2014

    @ John C Key, if that wasn’t sarcasm would you please let me know?

  48. #49 Dangerous Bacon
    March 28, 2014

    “I’m a pro-vaccine doc, but after all, it’s just measles.”

    “About 30% of measles cases develop one or more complications, including

    “Pneumonia, which is the complication that is most often the cause of death in young children.
    Ear infections occur in about 1 in 10 measles cases and permanent loss of hearing can result…
    These complications are more common among children under 5 years of age and adults over 20 years old.”

    “Even in previously healthy children, measles can be a serious illness requiring hospitalization. As many as 1 out of every 20 children with measles gets pneumonia, and about 1 child in every 1,000 who get measles will develop encephalitis. (This is an inflammation of the brain that can lead to convulsions, and can leave the child deaf or mentally retarded.) For every 1,000 children who get measles, 1 or 2 will die from it. Measles also can make a pregnant woman have a miscarriage, give birth prematurely, or have a low-birth-weight baby.”

    “In developing countries, where malnutrition and vitamin A deficiency are common, measles has been known to kill as many as one out of four people. It is the leading cause of blindness among African children. It is estimated that in 2008 there were 164,000 measles deaths worldwide.”

    http://www.cdc.gov/measles/about/complications.html

    But it’s “just measles”.

  49. #50 Dangerous Bacon
    March 28, 2014

    Dr. Key’s avowed pro-vaccine stance is welcome. But it’s puzzling to hear him say “it’s just measles” – and in comments on another blog regarding influenza vaccine say “After all, folks, it’s just the flu.”

    http://www.kevinmd.com/blog/2014/01/refusing-flu-shot-respecting-patients-choose.html

  50. #51 Mephistopheles O'Brien
    March 28, 2014

    John C Key MD – You’re correct, measles is not smallpox, polio, rabies, or ebola. However, it does kill ~1 of 1000 children who catch it, and can produce serious and lasting effects in a larger number. It is also, as I understand, a distinctly miserable experience.

    At what level of death and other effects does it stop being “just”? Seriously, I’m interested.

  51. #52 Krebiozen
    March 28, 2014

    John C Key MD,

    Measles, mumps, chicken pox–everybody had it.
    I am a pro-vaccine guy, but we are just talking measles here. It isn’t smallpox or polio.

    Back in Victorian times doctors would assure their patients that almost all parents lost a few children to infectious diseases. What was acceptable then isn’t now. Times have changed, UCHDs are no longer “usual” and human life has become a bit more valuable; in the developed world anyway.

  52. #53 AC
    March 28, 2014

    Hey guys, sorry, slightly OT, but would really appreciate your expertise in this area!
    An old schoolmate of mine has a 6 month old son. She began posting anti-vaxx blog links on facebook. I challenged them, and I wrote her a private message to apologize and say I hope she wasn’t offended, because my comments were directed toward the author of the blog and not her, for posting the link. She confided in me that her son had experienced a vaccine reaction, and she was trying to do her best to research, because she was terrified of giving him his next scheduled round of shots. She explained her story and sent me photos of the rashes, and I feel a lot of sympathy for her, and totally understand why she is questioning this. I’m directing her towards reliable links and such, but we can’t really find an answer. A dermatologist told her it was “baby eczema”, and her family doctor brushed it off as a coincidence. I’m not even convinced it was a coincidence, and her doctor’s attitude may be the reason this little guy doesn’t get his full set of vaccinations.
    So, I’m asking how I can guide her to feel confident in continuing with his proper vaccination schedule without fear in further harming her child? He is her first born, and she feels a lot of shame and fear that she made a bad call in getting him vaccinated – and I am trying to reassure her she did the best possible thing for her son!
    Here is her description:

    “Honestly, his shots up until 4 months are done. After the 3 he got at 4 months he had a bad skin reaction that is still all over his body. He didn’t have it before. But since then I have been reading a lot more about it. Only my family knows about it.”

    “Ya, I told the doc.. And of course he said the shot had nothing to do with it even though it appeared the next day and got much worse over the course of 2 weeks after till we saw a dermatologist that told us it’s baby eczema.. But it’s still there. It’s not as bad but if I don’t put cream on him it gets terrible within a day or 2. It wasn’t there before. And honestly I know it was from the shot because it started from exactly where the shots were administered. So it’s hard for me to believe what the doctor tells me when logic tells me something completely different. An if he had this bad of a reaction to the last one(which was 2 months ago) the next one he is supposed to get now apparently has mercury in it. I don’t think it’s right to give them the shots for all these different things at once. Their bodies can’t handle it like it could if they were just a little older or had each one separately. I just don’t feel comfortable giving him another one just yet.”

    I gently told her it’s not an issue in regards to the amount of vaccines, and that she could easily ask for a Thimerosal-free vaccine. She seemed to be relieved :) I asked her if her or anyone in her family had a history of vaccine reactions, or an egg allergy..

    “I didn’t. But when my brother was a baby he was literally sick all the time. He almost died when he was about 2″

    “Honestly, I really appreciate you talking to me about this. It’s been something on my mind since he was 6 weeks old. I keep going back and forth with it. So much shit out there it’s making my head spin. And the shots that he receives here are same as US. Even more reason why I’m scared.. If it was from canada I would honestly feel better about it. Lol maybe I should find a different pediatrition…”

    “And I don’t know about egg allergy. I will ask the doc. I ate a lot of eggs while preggers though.. Don’t know if that would make it better or worse.”

    “The one that gave him the reaction was the combo of DTAP, Hib, HBV,OPV, PCV”

    Which was 2 1/2 months ago, and he still has the rash. It is quite extensive, but somewhat mild. She says cream helps..

    Posting this with her permission. Any input greatly appreciated! You will help get a sweet little baby vaccinated :) They live in Dubai, and she just found a female Canadian pediatrician she is going to try to get an appointment with, which sounds promising.

  53. #54 Krebiozen
    March 28, 2014

    anon #47,
    Thanks for the link to UK measles statistics, though I’m not sure why you posted it. Is there any particular point you wanted to make about the dramatic decline in measles cases and deaths since the vaccine was introduced? If the point you wanted to make was that the fatality rate is apparently lower than usually stated, you need to consider how many of those cases had been vaccinated and had a much milder case of measles as a result. Remember the vaccine is only 99% effective. Also, that chart doesn’t include those with serious complications such as pneumonia and encephalitis which can lead to permanent disabilities.

    I don’t get this minimizing of the seriousness of measles. It’s like arguing that drunk driving isn’t so bad, because of improvements in car safety in collisions, and advances in medical technology in saving the lives of people injured as a result. Back in my day many people habitually drove after drinking too much alcohol, but that doesn’t make it OK today any more than complacency about measles is OK.

  54. #55 Krebiozen
    March 28, 2014

    AC,
    I suggest your friend gets her child’s serum zinc checked. His symptoms sound very like acrodermatitis enteropathica, which is a congenital inability to absorb zinc. Synptoms often appear shortly after breast feeding is stopped. It’s a long shot but worth checking, just in case.

  55. #56 Krebiozen
    March 28, 2014

    I hasten to add, it’s incurable but easily treated with megadoses of zinc supplements.

  56. #57 thor
    March 28, 2014

    AC,
    A lot is going on in your post. We do not know what the rash looks like, what treatment has been tried..etc. I feel you can probably discount the shot as a cause since the time frame does not fit. The rash has been occuring way past when an allergic reaction should have aleviated. Something to suggest is see if she has access to dermatologist via telemedicine. I am from a small town hospital and we use it often with our distant specialists.

  57. #58 Yodelady
    March 28, 2014

    @Denice Walter
    The LA Times graphic says the data comes from the U.S. Department of Education. There’s a journal article on the USDE’s autism data here: http://pediatrics.aappublications.org/content/116/1/e120.full

    It says, “The assessment criteria for autism (and the other IDEA-qualifying categories) are based on legislation passed by the individual state legislatures, as interpreted by the state education departments and local school districts.”

    So It seems to me the map could have a lot to do with how the state and/or the locality defines autism and not necessarily with autism itself. The journal article also says the USDE’s data show a lot of teens being newly diagnosed with autism, which seems odd, but might make sense if new legislative definitions of autism are being applied retroactively.

  58. #59 lilady
    March 28, 2014

    I found Dr. Bob’s alternative vaccine schedule from 2008.

    Yup, first single antigen measles vaccine at three years of age:

    http://childrenshealthchoices.org/sears.html

  59. #60 AC
    March 28, 2014

    Thank you so much, Krebiozen! I will pass on the info. Much appreciated.

    thor – Sorry, I know there is. It was diagnosed by a dermatologist as “baby ezcema”. Does within 24 hours of the shot not sound like a reaction? She said it appeared the next day..

  60. #61 AC
    March 28, 2014

    Also, we are having a more impressive measles outbreak – up to 228 cases.

    http://www.cbc.ca/news/health/b-c-measles-outbreak-reveals-vulnerability-of-unvaccinated-children-1.2585457

  61. #62 Shay
    March 28, 2014

    I’m a pro-vaccine doc, but after all, it’s just measles.

    I’ll pass that comment along to my youngest brother, who is deaf as a result of “just” having contracted measles as a child.

  62. #63 The Grouchybeast
    March 28, 2014

    there’s no doubt that Dr. Bob’s antivaccine views fit in very nicely with the views of his affluent clientele

    Back when Tom Lehrer talked about a doctor specializing in ‘diseases of the rich’, I bet he never thought one of those would turn out to be measles.

  63. #64 thor
    March 28, 2014

    AC,
    I agree that the timing of the shot seems suspect but so does everything the child inhaled and ingested that day and the day prior which could cause an allergic reaction (if thats what it is). If it was the vaccinations then the rash should have resolved in the next 5-14 days per UpToDate.

  64. #65 Chris,
    March 28, 2014

    So, anon, you have failed to answer a question, why is that? Please tell is you would rather a grandchild get the PCV13 or Hib vaccine or get bacterial meningitis?

    Now tell is if you would rather a grandchild had the MMR vaccine or a measles infection? Which is better, provide evidence to support your answer.

    Stop the diversionary tactics: answer the questions.

  65. #66 AC
    March 28, 2014

    thor – thanks for your input. Is it at all possible that the shot could have instigated some immune response that also triggered antibodies to potentially trigger the ezcema? (sorry, horrible wording)

    She is most worried that with his next shots, his reaction will be even more severe. She is logical enough to realize that a rash is better than a vaccine-preventable disease. She’s just scared of the possibilities now that she’s had a taste of a vaccine reaction (in her mind). If I was able to confirm to her that this was a vaccine reaction, but that it won’t get worse, I think she would feel more at ease with proceeding.

    I’ll let her know that if it was an allergy due to the vaccinations it should have resolved by now (which makes sense of course).

  66. #67 thor
    March 28, 2014

    AC,
    Unfortunately we go back to the question of what has been tried and tested up to this point. If the 2.5 months is accurate then hopefully antihistamines and corticosteroids have been tried, topical steroids for the possible eczema…etc. There are too many ifs and what ifs. What she could do is get the next series on schedule with the new pediatrician, express her concerns about an allergic reaction and then would monitor the child for such a thing and be ready to stop any adverse event.

  67. #68 Bob G
    Los Angeles
    March 28, 2014

    Interesting change (I hope) in the way the local news is handling measles. A few months ago, there was a case of measles in Ventura County, a little north of Los Angeles. The local CBS television station covered the story by first interviewing a public health doctor in Ventura, and then going directly to a vaccine-averse parent and to Dr Jay Gordon. In that two and a half minute story, the anti-vaccine part was given about half of the time.

    This week, there was a story about the Orange County outbreak on the same station. It was completely different. The story announced that there is an outbreak of measles, showed a picture of a child with a bad rash, mentioned that 7 of 21 affected people had been hospitalized, and did not mention the anti-vaccine types at all. There was no mention of Dr Sears, much less a visit to his office, and the story did not go into vaccine avoidance as a way of life among a few people.

    I don’t know whether the change in tone was just a coincidence — maybe the station had a different writing crew on deck this time around — or had something to do with a bit of pushback against the last story they did. We’ll get a better idea if and when they have to do another measles outbreak story.

  68. #69 jonmc
    March 28, 2014

    Here is the corrected address for the atate autism map
    http://graphics.latimes.com/usmap-autism-rates-state/

  69. #70 lilady
    March 28, 2014

    The roving RI Regulars managed to post some comments about the Ventura measles case. Dr. Jay, who isn’t shy about commenting on TV or in print media, got his comeuppance:

    http://losangeles.cbslocal.com/2013/07/19/1-confirmed-case-of-measles-in-ventura-county/

  70. #71 Narad
    March 28, 2014

    Maybe it’s higher in states that have better-funded (or just better) special-education programs (and/or other services) for people with autism.

    Like NJ. IIRC, a number of years ago they saw a big increase in prevalence when they started doing more aggressive screening and started offering better support and services than other nearby states.

    The last time I checked, this looked like a pretty strong signal between Utah (which had below-par uptake) and New Jersey.

  71. #72 Narad
    March 28, 2014

    ^ Another attempted double-blockquote to the mass grave.

  72. #73 Narad
    March 28, 2014

    Measles notifications and deaths in England and Wales, 1940-2013

    So, your point is that in the prevaccine era, the UK had worse mortality than the U.S.?

  73. #74 Vicki
    March 28, 2014

    As a side note, county lines aren’t magic. . “Everyone in the county is vaccinated” doesn’t protect your child if they and a third of their classmates aren’t. If there are several cases of measles near you, and a lot of unvaccinated children in your social group, your kid’s daycare, and your older kid’s grade school, you can’t meaningfully average that with some other area that happens to be in the same county (or state, or planet) to get a more reassuring vaccination coverage.

  74. #75 palindrom
    March 28, 2014

    I’m a pro-vaccine doc, but after all, it’s just measles.

    Oy. I need a drink.

    Then I need to go revise my pre-med course to make it much, much harder.

  75. #76 roninsheep
    the lab
    March 29, 2014

    Denice (#3)
    I suspect this is the map you were looking at:
    http://graphics.latimes.com/usmap-autism-rates-state/
    (not us-map but usmap)

    After looking at this map, I was immediately struck by the similarities to this map:
    http://www.motherjones.com/files/vaccine_rateBystate-UPD-01.png

    That isn’t vaccinations by state, that’s the number of non-medical vaccine exemptions by state… which… looks like states with higher non-medical vaccination exemptions ALSO have higher autism…

  76. #77 Narad
    March 29, 2014

    looks like states with higher non-medical vaccination exemptions ALSO have higher autism…

    I’m not really seeing it. Then again, I was going to plot it, but I’ll be damned if I can find a breakout of the autism information by state in the NCES “Common Core of Data.”

  77. #78 Darwy
    Røde grøde med fløde
    March 29, 2014

    @Dr Key

    “It’s just measles”

    Yeah, ‘just measles’, which ‘just’ used to kill children, or ‘just’ leave some deafened, ‘just’ leave others blinded, ‘just’ used to cause miscarriages…

    That’s ‘just’ a small part of measles.

  78. #79 janerella
    March 29, 2014

    And anyway, they’re “just children”. Take a leaf out of the good ol’ days and just have some more. Many more….. http://www.findagrave.com/cgi-bin/fg.cgi?page=pv&GRid=22644320

  79. #80 Lurker
    March 29, 2014

    There was something in the Beeb the other day about a new finding that’s either just been published or will be soon, to the effect that signs of abnormal brain development that correlate with early childhood autism diagnoses, are detectable in fetuses.

    Prediction: the anti-vaxx loons will start to claim that a) the fetal abnormality is due to ‘toxins’ of whatever kind (unspecified) and/or b) the fetal abnormality confers a ‘susceptibility’ that can subsequently be ‘triggered’ into autism by exposure to the same (unspecified) toxins (or vaccines).

  80. #81 The Very Reverend Battleaxe of Knowledge
    March 29, 2014

    Re Bob G’s observation at #68 about the changing tone in reports about measles outbreaks: It looks like some plague monkey passing through Sea-Tac airport could have exposed any number of people to measles, and the reports on the local news channels have all been completely science-based. Maybe the antivaxxers won’t come out of the woodwork until there’s an actual outbreak, but it’s something.

  81. #82 The Very Reverend Battleaxe of Knowledge
    March 29, 2014
  82. #83 The Very Reverend Battleaxe of Knowledge
    March 29, 2014

    P.S.: I just noticed the health department report was from January; why it took till the end of March to make it to the TV news, I don’t know….

  83. #84 Chris Hickie
    March 29, 2014

    Bob G (#68) and The Very Reverend (#81)–That change in tone is encouraging. I hope it sticks…but I wish they would show they are completely up on things by putting a harsh spotligh on Sears and Gordon. Every media post I see about measles I will write the author and/or post in the comments about how it’s no coincidence that the two most vocally anti-vaccine pediatricians in the US live in the LA Metro Area. Sadly, there has not been anyone interested in covering that angle.

  84. #85 palindrom
    March 29, 2014

    The Very Reverend, Chris H — The Sea-Tac airport notification reads as if it were transcribed pretty much verbatim from a public-health dept press release – no empty-headed cub reporter went out there to get “both sides” (scare quotes very much intentional).

    If so, it’s not surprising that it’s actually rational.

  85. #86 Dorit Reiss
    March 29, 2014

    Dr. Sears Sr, seems a lot more supportive of the schedule. http://m.parenting.com/entry/view/id/10791

  86. #87 MI Dawn
    March 29, 2014

    So Dr Key posted and ran away, like another Brave Sir Robin.

    @Dr Key: it’s too bad you never met my grandfather, also a doctor who had to record UCHD on his records. Unlike you, apparently, he was well aware of the dangers of measles, and as soon as the vaccines were available, insisted that his patients obtain them if they could. He also insisted that all of his grandchldren, whether we’d had the disease(s) or not, get the MMR, and all other vaccines as they became available. Having seen children die, hospitalized, become deaf or blind – he never thought ANY childhood disease was “mostly harmless”.

  87. #88 Chris Hickie
    March 29, 2014

    You left about the best part about the traveler at Sea-Tac:

    Local public health officials have confirmed a measles infection in a traveler who was at Sea-Tac airport during the contagious period, according to as news release from Public Health – Seattle The traveler is a resident of California and was likely exposed to the measles while overseas (http://www.tukwilareporter.com/news/252938871.html).

    Of course, now that measles is almost endemic in California, can they be certain this person from California didn’t g contract measles in California and then bring it overseas?

  88. #89 Lawrence
    March 29, 2014

    Measles was worse, because it was ubiquitous – everyone got it, as opposed to other diseases which aren’t nearly as contagious…..

  89. #90 Denice Walter
    March 29, 2014

    I deliberately brought that particular map to readers’ attention because, for me, it represents a way to get anti-vaxxers to question their own quasi-religious beliefs about the causation of autism.

    If autism is caused by vaccination -( variant creda: caused by vaccination in susceptible children, caused by toxins in vaccines, caused by amount of vaccinations or critical period when administrered i.e. too many/ too soon)- why would THAT particular pattern arise UNLESS if that pattern also reflected vaccination rates. BUT it doesn’t.

    It may illustrate how different ways of defining, investigating and counting autism affect *rate*.

    If you peruse AoA, you’ll be familar with the mantra-
    ’1 in 10 000, 1 in 500, 1 in 100, 1 in 88, 1 in 50′ ( not a parphrase, but you get the gist):
    in other words, they think of autism as a stable condition that is caused by something – both of which increased-
    more vaccines = more autism.

    In the real world we know that diagnosis is not a black-and-white situation, e.g. how do we define high bp?
    The answer depends on when we define it- it changes- amongst other issues like qualiifiers ( borderline high etc).This situation is even more apparent when we describe conditions which are not purely physical.

    We might ask them about what could cause such variability if it is truely based on vaccination? Do the susceptible cluster around centres of trade? Are rural children somehow protected from the harm vaccines inflict?

    If social attitudes are not a factor, we might ask them why we no longer have so many institutes for kids with developmental conditions as we did all over the ‘western’ world 50 years ago. Did we cure those conditions in today’s youngsters?

  90. #91 lilady
    March 29, 2014

    Interesting points that Denice raises about developmental centers.

    Have you all seen one of the latest sponsors of AoA? AoA is taking money for ad space for VOR (Voices of the Retarded) which is a “front” organization for union employees at developmental centers. Every bit of their political activities are to fight the closure of developmental centers and other institutions where the developmentally disabled are warehoused.
    New York State ARC’s President Marc Brand lauds the closure of these warehouses…it’s been 40 years since the Willowbrook Consent Decree to deinstitutionalize that human warehouse. Scroll down to see the dissenting comment from Tammie Hopp representing VOR. Hopp is the Executive Director of VOR and the Director of Government Affairs at VOR.

    “What about the families of the affected residents who will be displaced from their homes? Doesn’t their opinion matter more than self-advocates and parents of individuals whose choices have been honored and are not, as individuals, directly impacted by these closures. I’d like to hear what affected residents and their families think and find it perplexing, frankly, that their voices were not featured as part of this announcement. http://www.vor.net

  91. #92 lilady
    March 29, 2014

    ^ Marc Brandt President of NYARC Press Release about Institution closures and the comment by VOR President Tamie Hopp, here:

    http://blog.nysarc.org/2013/07/29/politics-as-it-happens-state-to-close-4-remaining-developmental-centers/

  92. #93 Narad
    March 29, 2014

    You left about the best part about the traveler at Sea-Tac

    Those appear to be two different notifications.

  93. #94 Dangerous Bacon
    March 29, 2014

    “City health officials are investigating two cases of deafness that could be tied to the mumps outbreak that started at Ohio State University but has spread beyond campus to sicken at least 103 people.”

    “At the same time, three or four men sickened in the outbreak have complained of swollen testicles, another rare complication of mumps and one that can lead to sterility. Health officials also are investigating those cases.

    http://www.dispatch.com/content/stories/local/2014/03/28/103-mumps-cases-tied-to-outbreak.html

    But it’s “just mumps”.

  94. #95 Julian Frost
    Gauteng East Rand
    March 29, 2014

    Some good news for everyone. India has gone three years now without a new case of polio, and so the WHO has certified the country as polio-free.

  95. #96 Spectator
    March 29, 2014

    #94

    The Daschel crowd has the answer: Those people have inferior genes, so Nature is attempting to remove them from the gene pool.
    If nature doesn’t doesn’t finish the job, do alties conclude it needs a little help?

  96. #97 Zoe
    March 29, 2014

    Thanks for keeping us updated.

  97. #98 Narad
    March 29, 2014

    Maybe it’s higher in states that have better-funded (or just better) special-education programs (and/or other services) for people with autism.

    Per SFARI, from 2011:

    “Data collected by the Centers for Disease Control and Prevention shows the highest autism prevalence in states with the best autism health and support services, such as Arizona (121 cases per 10,000 people), Missouri (121) and New Jersey (106). In contrast, areas with fewer services have lower rates, such as Alabama (60), Arkansas (69) and Florida (42).”

  98. #99 Narad
    March 29, 2014

    Per a pro-Sears (and pro-Schecter) commenter on Dr. Bob’s latest epistle:

    “From Dr. Jay Gordon’s email he sent to his patients regarding measles the other day:

    “‘The media, as they often do, are covering this story quite heavily and the headlines make it appear that there is imminent great danger. In fact, the last fatality from measles in the USA was eleven years ago in 2003. Headlines speak of “ten times more measles in 2014.” The newspaper articles often don’t mention that California had very few cases of measles in the past five years so the 35 cases reported among 38,000,000 Californians is not a frighteningly large numerical jump. There have been about 80 cases of measles in the United States this year. All of these cases began with importation by travelers and then spread to close contacts. Measles is unlikely to be spread by a brief encounter or sharing a BART train.‘”

  99. #100 ann
    March 29, 2014

    Per SFARI, from 2011:

    “Data collected by the Centers for Disease Control and Prevention shows the highest autism prevalence in states with the best autism health and support services, such as Arizona (121 cases per 10,000 people), Missouri (121) and New Jersey (106). In contrast, areas with fewer services have lower rates, such as Alabama (60), Arkansas (69) and Florida (42).”

    Thanks so much for doing the work I didn’t have time to do.

    Interesting.

    I’ve always thought the mandatory reporting requirement in the IDEA act was sufficient to explain the increased prevalence of autism in the ’90s all by itself.

    But it’s probably a combination of factors.

    ,

    “Measles is unlikely to be spread by a brief encounter or sharing a BART train.‘”

    Frightening and sad.

  100. #101 Narad
    March 29, 2014

    Thanks so much for doing the work I didn’t have time to do.

    Oh, I didn’t do any work; it just fell out while I was looking for global prevalence data (somebody at AoA speculated that it was correlated with “freedom of speech”). I was too damned lazy to so much as look up my own Utah–New Jersey comparison from a while back.

  101. #102 Chemmomo
    Glad I'm not in Ohio
    March 29, 2014

    Re #94
    I wish I could bombard both Jenny McCarthy and Andrew Wakefield with links to that Columbus Dispatch article and a note saying “This is your fault.”

    Jenny, you wanted the diseases to come back? Guess what? They’re here.

    Be careful what you wish for.

  102. #103 Matt Carey
    March 29, 2014

    “Dr. Robert Sears has to be one of the most irresponsible pediatricians on the face of the earth, if not the most irresponsible.”

    I recall the old list of DAN doctors, at least 10% of whom were in trouble. I distinctly recall one who was not allowed to be alone in a room with young children. Yes, it’s what you think.
    So, Dr. Sears is bad, but there are worse.

  103. #104 Chemmomo
    Unfortunately wiIthin 2 hours' drive of Dr Bob Sears' office
    March 29, 2014

    Again re the article from #94 (Dangerous Bacon, Columbus Dispatch in case someone comes out of moderation)
    My emphasis:

    The university is working with the city to provide vaccine to students who have never been vaccinated or never received a booster shot.

    Why is that line even in there? Why aren’t they vaccinated?

    Yes, I’m angry. This should not be happening in 21st century America.

  104. #105 Narad
    March 29, 2014

    I wish I could bombard both Jenny McCarthy and Andrew Wakefield with links to that Columbus Dispatch article and a note saying “This is your fault.”

    As with Gerg, the response would merely be to point to other mumps epidemics without an index case and then blame it on the vaccine. (As it turns out, the first Fordham case was vaccinated.)

  105. #106 Narad
    March 29, 2014

    Why is that line even in there? Why aren’t they vaccinated?

    Not required for attendance in the Buckeye State.

  106. #107 Narad
    March 29, 2014

    ^ “for college attendance”

  107. #108 Chemmomo
    Glad I'm not in Ohio
    March 29, 2014

    Not required for attendance in the Buckeye State.

    .
    See my location.

    I was a graduate student in both CA and NJ, and while in NJ lived off campus but the university didn’t care! They required that my vaccinations were up to date.

    What’s wrong with Ohio? Did science go out the window after the Wright brothers and Neil Armstrong died?

  108. #109 Denice Walter
    March 29, 2014

    More hilarity I didn’t have time to communicate earlier:

    from Jeff Hays via Toni Bark via Gary Null ( gleaned from Friday’s broadcast tape @ PRN 28 minutes in)-
    it seems that Hays met a woman attending a robotics conference in Santa Clara who spoke about her colleagues creating a bot to scan social media and intervene whenever a conversation about AJW’s work and anti-vax started up. These bots- masquerading as people- provided contrary information to STIFLE conversation and debate amongst the moms to STOP their Thinking-
    OH, the humanity!
    Or is it: OH, the lack of humanity!

    I believe that Hays creates anti-SBM films ( “Doctored”). Bark is an Illinois altie doctor who has become an anti-vax darling of late. Null advised followers to post his anti-vaccine articles and films on social media to counter those amoral, pharma funded, soulless bots.

    So perhaps we should now refer to ourselves as -
    shills, minions and bots.

  109. #110 Narad
    March 29, 2014

    from Jeff Hays via Toni Bark via Gary Null

    Ah, yes, Toni Bark.

  110. #111 Narad
    March 29, 2014

    it seems that Hays met a woman attending a robotics conference in Santa Clara who spoke about her colleagues creating a bot to scan social media and intervene whenever a conversation about AJW’s work and anti-vax started up

    Tenpenny’s on it.

  111. #112 Chris Hickie
    March 30, 2014

    Could we all be boxes of blinky lights?

  112. #113 Narad
    March 30, 2014

    Paging lilady. (It’s necessary for nonsubscribers to dump all of their cookies on every revisit.)

  113. #114 Narad
    March 30, 2014

    ^ “Their cookies” being those from newsday.com.

  114. #115 herr doktor bimler
    March 30, 2014

    What in the name of Beelzebub is that Newsday columnist on about, Narad? The column begins as if heading towards a coherent point but then veers off into “1. Einstein 2 Mozart 3. Daryl Hannah”. I found myself exclaiming “Gorbachev Sings Tractors: Turnip! Buttocks!” in response.

  115. #116 Rebecca Fisher
    March 30, 2014

    @hdk – Where can I buy that album?

  116. #117 Scottynuke
    March 30, 2014

    @Rebecca — I don’t know that the Bloom County Players ever put that on vinyl. Oliver Wendell Jones still hasn’t lived that mistranslation down. :)

  117. #118 Andy
    March 30, 2014

    I regularly see references (such as that from Dr Bob) claiming old medical texts described various childhood illnesses as harmless and routine. Was this universally true at some point and if so, when did it change? I assume that authors of medical texts must have recognised these diseases as worthy of vaccine development at some point – or do modern texts still dismiss them? Or is it a fact, as appears to be the implication, that these previously harmless diseases were only described as dangerous after the legendary Big Farmer developed a vaccine?

  118. #119 palindrom
    March 30, 2014

    Narad @110 — This gives the term “barking mad” a new potency.

    Somebody had to say it! OK, maybe not.

  119. #120 lilady
    March 30, 2014

    @ Narad: Sometimes I do take a night off.

    I just received an email notification that my reply to RFK Jr. got through on Medical News Today.

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

    Let’s all get behind Bobby Kennedy to urge him to publish that book. He threatened he would publish that “explosive” heavily researched book on the Simpsonwood Conference, if the Congressional Government Oversight and Reform Committee, chaired by Darrell Issa, with an agenda to investigate the CDC and the hidden effects of Thimerosal was not scheduled. The Hearing is “indefinitely postponed”. What is Bobby Kennedy waiting for?

  120. #121 Dangerous Bacon
    March 30, 2014

    Editorial page cartoon on the mumps outbreak in central Ohio:

    http://editorialcartoonists.com/cartoon/display.cfm/131191/

    I’m picturing the two adults in the cartoon as Bob Sears and Jay Gordon.

  121. #122 squirrelelite
    March 30, 2014

    @Narad 110,
    J Stone also had a comment removed!

  122. #123 Denice Walter
    March 30, 2014

    A few thoughts:

    Narad’s link to Tenpenny’s link to Hays’ was read verbatim
    ( with the name of the woman redacted) by the Nullmacher.

    You have no idea how stalwartly I resisted the urge to write: Bark(ing). Until now.

    Bark has ties to Oprah’s show and PRN..

    Wasn’t Seth Kalichman funded to do something similar? W/O bots.

    re Jeff Hays’ piece:

    the comments are rather precious.

    Note that all of the prinicpals in this game of spread-the-merde are:
    - providers of alt med treatments, supplements and/or information. Two anti-vax doctors, a woo-meister/ film maker and an anti-SBM filmmaker. No COIs there.

    And-altho’ I do not post comments on articles about vaccines- I do somewhat resent being associated with ‘bots’-
    I’m a lifesized android with realistic skin and hair who has the ability to ambulate and make decisions based upon prior experience. And enage in conversation in a few European languages. You’d never know if you met me live.

    Seriously. Calling us “pharma shlls”is one thing but “bots”?

  123. #124 lilady
    March 30, 2014

    I’m insulted that my efforts have been classified as the work of a bot.

    From CBS TV News, yesterday’s interview with Dr. Anthony Fauci about the mumps and measles outbreaks:

    http://www.cbsnews.com/videos/how-do-measles-outbreaks-happen-in-the-us-anymore/

  124. #125 ann
    March 30, 2014

    I regularly see references (such as that from Dr Bob) claiming old medical texts described various childhood illnesses as harmless and routine.

    Even if they did, I’m not sure why it should matter. I mean, old medical texts also frequently described (and illustrated) female reproductive anatomy without mentioning or depicting the clitoris. But that doesn’t mean it wasn’t there.

    I’m sure there are other examples.

  125. #126 Dangerous Bacon
    March 30, 2014

    Sherri Tenpenny is listed as the “emeritus President” of the Alliance for Natural Health, a woo promotion outfit.

    Check out who the chairman and medical director of ANH is – Jeanne Drisko, the U. of Kansas vitamin C disciple who’s been profiled here.

    http://www.anh-usa.org/main-menu/about/leadership/

    You’d think that someone who wants to be viewed as a serious scientist would avoid associating with any organization that has Sherri Tenpenny as one of its leaders.

    Guess not.

  126. #127 Narad
    March 30, 2014

    J Stone also had a comment removed!

    Nearly the entirety of the deleted comment is what appears in the pop-up balloon:

    “It is a great shame (an active shame) that the authors do not respond. Is it inability? Is it arrogance?”

    Complete failure to understand what postpublication review is about, in particular that it’s not John Stone.

  127. #128 herr doktor bimler
    March 30, 2014

    You’d think that someone who wants to be viewed as a serious scientist would avoid associating with any organization that has Sherri Tenpenny as one of its leaders.

    So many American Loons, so few Encyclopedists.

  128. #129 squirrelelite
    March 30, 2014

    Thanks, Narad.
    I thought the actual comments posted were somewhat informative as a discussion of the pro’s and con’s and limitations of what is or should be a global first level surveillance system, somewhat equivalent to VAERS.

    I guess John Stone thinks it’s just another blog post.

  129. #130 Narad
    March 30, 2014

    I thought the actual comments posted were somewhat informative as a discussion of the pro’s and con’s and limitations of what is or should be a global first level surveillance system, somewhat equivalent to VAERS.

    They were within the boundaries of the PubMed Commons guidelines, but Puliyel is an antivax darling who believes that polio vaccination causes AFP.

  130. #131 Denice Walter
    March 30, 2014

    Alright, above we illustrated how someone ( Hays) said something ridiculous ( ‘SBM iz bots’) and where it was quoted ( Tenpenny, Bark, Null).

    Now there are currently at least TWO comments @ AoA (Jameson’s post, today) talking about SB bots.Pretty quick.

    We are poor little bots wot have gone astray..
    Nya, Nya, Nya…

  131. #132 lilady
    March 30, 2014

    @ Denice Walter: That’s so funny…coming from AoA, home of the Dachel bot who carpet bombs each and every article and blog that she receives in her news feed.

  132. #133 squirrelelite
    March 30, 2014

    Thanks again, Narad.
    I hadn’t heard of him, but his comments were definitely pushing in that direction.

  133. #134 Mark McA
    March 30, 2014

    This is his most revealing line, IMHO:

    “If we could guarantee that every single dose of MMR vaccine would be harmless to every child who received it…”

    Which is of course impossible for *anything* and a pathetic straw man. That he then emphasises the ‘low odds’ of death from measles but doesn’t even mention the FAR-lower odds of vaccine reaction is just disgusting.

    He’s a disgrace to the medical profession.

  134. #135 Delphine
    with your mercury mouth in the missionary times
    March 30, 2014

    @Lilady

    …wait, Bobby Kennedy Jr. is threatening to write an expose (can’t find my accent aigu, sorry) on vaccines?

    PLEASE BOBBY DON’T DO IT!!! PLEASE, NOT A BOOK!! PLEASE, FOR THE LOVE OF ALL THINGS HOLY AND SACRED, PLEASE, I BEG YOU, PLEASE, PLEASE, PLEASE, PLEASE DO NOT WRITE A BOOK!!!11!!

    …he will force us to read it in the comfy chair…

  135. #136 lilady
    March 31, 2014

    @ Delphine: Bobby Kennedy’s book is already written. According to Jake Crosby, Kennedy paid $100,000 for the research and Kennedy paid an additional $100,000 for editing and publishing.

    See Orac’s post about “the book”, here:

    http://scienceblogs.com/insolence/2013/06/12/why-wont-you-call-me-rfk-jr/

  136. #137 Delphine
    March 31, 2014

    Holy shit. Either I read that piece way back when and don’t remember it, or Orac lives in my head. The comfy chair!!! Confess, confess, etc. etc. etc……………

    I’m going with the former.

    I have to read this book. My loathing of Bobby Jr. knows no bounds. What a disgrace he is to the legacy of his old man.

  137. #138 Narad
    March 31, 2014

    We are poor little bots wot have gone astray..

    I still have an uncorrected proof sheet of some ad copy that the Service Center sent over.

  138. #139 Helianthus
    March 31, 2014

    @ Andy

    I regularly see references (such as that from Dr Bob) claiming old medical texts described various childhood illnesses as harmless and routine

    Some old medical texts could have described usual childhood illnesses as routine (as in, every child will get them) and mostly harmless (emphasis on the “mostly” – quite different as “totally”).
    But context is important:

    1 – compared to diseases which were as prevalent and also more debilitating, like polio, smallpox, or whooping cough, measles doesn’t seem as dangerous
    (unless you are the unlucky one in a few hundreds to develop long-lasting complications)
    In short, next to the black plague or Ebola, everything else could be described as mostly harmless.

    2 – if these old medical textbooks we are talking of were for educating parents rather than solely for physician reading, I suspect the potential seriousness of childhood illnesses was toned down, as to avoid a rush of contagious children in hospital. The standard of care for measles, mumps and a few others was (and I believe, still is) to keep the child home.
    In short, these illnesses are routine and harmless in the sense “watch over your child and hope for the best; most children will survive it; and once it’s over, most of them won’t have it again”.
    That’s not the same as saying everybody will be lucky and get over them without sequelae.

    My mom is the sole survivor of 5 siblings. I guess her parents wouldn’t have considered deafness or scars in annoying places a serious complication, compared to more life-threatening alternatives… Yet, it is not trivial.

  139. #140 lilady
    March 31, 2014

    @ Andy: I actually remember having measles when I was 14 y.o. My 15 y.o. sister contracted measles, then infected me and I then infected my 20 y.o. brother (2 days before he was supposed to be inducted into the Marine Corps and board a train for Parris Island for basic training, my sister broke out in the rash). My brother was quite upset, when he had to call the Marine recruiter…three times…to delay his induction and departure. My mother convinced him to make those calls, and warned him that the entire train would have been quarantined and for the duration of his enlistment his name would be “Measles”.

    An older cousin contracted measles and was left with lifelong neurological sequelae from measles encephalitis and a childhood chum died from polio, before vaccines were developed to prevent these childhood diseases.

  140. #141 ann
    March 31, 2014

    I remember having chicken pox and rubella, both of which were hellish, and even mildly traumatic. I’m not sure how old I was. Younger than three, though. The hellishness was very memorable.

    On the other hand, I do not have any specific memories of being vaccinated, although I’m told I had an allergic reaction to the pertussis vaccine.

    Anecdotal, granted.

    My loathing of Bobby Jr. knows no bounds. What a disgrace he is to the legacy of his old man.

    He’s not admirable. But probably more to be pitied than censured, in human terms, I try to remind myself.

  141. #142 Denice Walter
    March 31, 2014

    “with your mercury mouth in the missionary times”

    Interpretation of lyrics:
    A song writer marries a beautiful model from Delaware who- unfortunately has a mouthful of amalgam fillings- they settle down in the country and have a pile of babies.
    BUT the babies all come down with autism and the parents have to give stop working to stay home and take care of them and the whole family is destroyed. That’s why she has such sad eyes; she later starts a blog about vaccine injury.

    ( -btw- I’m JOKING-the kids are alright; the songwriter went on; there is no “Sara Sez” blog)

  142. #143 JGC
    March 31, 2014

    The chance that your child will be caught up in this small outbreak is still very low.

    And it’s always a good idea to gamble with your child’s health…

  143. #144 Shay
    March 31, 2014

    My mother convinced him to make those calls, and warned him that the entire train would have been quarantined and for the duration of his enlistment his name would be “Measles”.

    Or worse.

  144. #145 Mephistopheles O'Brien
    March 31, 2014

    And it’s always a good idea to gamble with your child’s health…

    The antivaccine cohort say the same thing, but with the meaning reversed (i.e. by immunizing you are gambling with your child’s health).

    Of course, in a literal sense both are true. If you vaccinate you are laying one bet; if you don’t, you’re laying another. The odds aren’t even close between the two bets, but you have to play.

  145. #146 LIz Ditz
    Action Alert
    March 31, 2014

    Any of y’all on twitter?

    As mentioned above, Jay Gordon MD FAAP who practices in Orange County, California, where there is a measles outbreak, has sent a letter to his patients telling them “The measles outbreak of 2014 does not pose a risk to your healthy child. Best, Jay”

    Jay gives the MMR vaccine “sparingly”.

    If you want to tell the world what you think of Jay’s promotion of vaccine preventable disease, use the hashtag #NoWayDrJay and you can link back to the post at Shot of Prevention

    http://shotofprevention.com/2014/03/31/say-nowaydrjay-dont-bring-measles-back/

    There’s an ongoing discussion at the Vaccinate Your Baby Facebook page

    https://www.facebook.com/VaccinateYourBaby/posts/864613233564341?stream_ref=10

  146. #147 skeptiquette
    March 31, 2014

    MOB,

    I think this is closer to how the actual thinking goes, but maybe a little off.

    If it is just a risk eqn then the risk posed by the actual pathogen is highly dependent on vaccine uptake in the community. With high uptake the chance (1/x) of getting the disease is very very low.

    Let’s think about it this way, because this is how it is probably played out in peoples’ minds.

    The risk of getting measles = ??

    I have no idea how to determine this, hoping someone can help… I would think that it would be something like 1 in a hundred thousand (maybe one in a million), even if you are unvaccinated.

    the risk of serious complication is 1/1000, right?

    so that makes the risk of serious complication from measles at:

    1E-5 x 1E-3 =1 E -8 so, .00000001 x100 = .000001%

    Whereas the chance of getting a vaccine is 1 (or 0.)

    and the risk of a serious complication is 1 in a million (?please fix these risks if I am way off)
    so we have:

    1 x .000001 =.000001 x 100 = .0001 % chance

    This equates to a 100 time greater chance of having a serious complication from a vaccine given the current high uptake of vaccine.

    Does this make sense? it’s always something I have thought but never thrown out to the pack.

  147. #148 lilady
    March 31, 2014

    Skeptiquette: The risk of contracting measles for an unvaccinated child varies, dependent on where you were exposed and the length of time you were exposed.

    If you are outdoors when the exposure takes place, for a minute or two, the risk is minimal. If you are in a doctor’s indoor waiting room, the risk is high. (Once it is determined that a suspect case of measles was in an enclosed indoor area such as a doctor’s waiting room or hospital treatment room, that area must be evacuated, the door must be closed and the room should not be opened for at least two hours).

    Here from the Australian National Centre for Immunization Research & Surveillance, a guide for parents to make a decision regarding the protective value measles vaccination-vs-the risk of mild, moderate or severe adverse events. The evidence for measles vaccination is overwhelmingly positive. Feel free to use this link to throw out to the pack.

    http://www.ncirs.edu.au/immunisation/education/mmr-decision/measles.php

  148. #149 Narad
    March 31, 2014

    I have no idea how to determine this, hoping someone can help…

    The trick is that measles outbreaks require a critical mass in the susceptible population in order to be sustained, so very fine-grained data are necessary. It’s a lot easier to do with influenza, which is a yearly epidemic.

    I’ve done this calculation elsewhere, so apologies to those who have seen it, but if you have a 5% chance of getting the flu when unvaccinated, it comes out to 13.5 years from one bout until you have even odds of catching it again. If one makes the very simplistic assumption that vaccination halves that risk every year, that window becomes 27.4 years.

    Let’s say the attributable risk of Guillain-Barré is 1.03 per million doses. The time to having 50–50 odds with an annual flu shot is 672,958 years.

  149. #150 Narad
    March 31, 2014

    ^ No, I screwed up: it’s 533,190 years.

  150. #151 Mephistopheles O'Brien
    March 31, 2014

    @Skeptiquette,

    The risk of getting measles = ??

    The risk of getting measles depends on whether you are immune, whether those around you are immune, and whether you encounter someone who is carrying/infected with the disease. This is a fairly complicated calculation, best worked out in retrospect.

    the risk of serious complication is 1/1000, right?

    Per the CDC, the risk of death for children is about 1/1000. About 1/20 get pneumonia, 1/1000 get enceyphalitis. Pregnant women who are exposed to measles can experience miscarriages, low birth weight babies, or premature birth.

    In my quick look at the CDC site, I did not find a rate for serious complications (at least, as serious as pneumonia, encephalitis, or death. There were some numbers for rash, fever, and febrile seizures (seizures associated with fevers).

    I would agree – if enough of your neighbors take the risks to protect your and your children, the chance of your and yours catching measles is fairly small. After all, millions of people live in California, only 20 or so have caught measles this year. Of course, if enough people do the math and determine that as long as everyone else gets vaccinated I can get the benefit of them taking the risks, then the overall vaccination rate drops, and you lose.

  151. #152 Mephistopheles O'Brien
    March 31, 2014

    Sorry, in my comment above I left out that I was unable to find rates for serious complications for the vaccine, besides rashes, fevers, and febrile seizures.

  152. #153 Narad
    March 31, 2014

    After all, millions of people live in California, only 20 or so have caught measles this year.

    Forty-nine as of 29 March, 21 in Orange County.

  153. #154 Krebiozen
    March 31, 2014

    skeptiquette,
    I have mentioned here before that the smallpox vaccine in the 50s to the 70s carried substantial risks, it sickened many and caused several deaths every year in the UK (PDF). A Professor Dick argued in the BMJ in 1971 that it was time to end routine vaccination:

    Between 1951 and 1970 there were about 100 deaths from smallpox vaccination in England and Wales, about half of them from neurological complications; one can only guess at the number of individuals with residual brain damage attributable to vaccination.

    There were only 37 deaths from smallpox itself over the same period, but this was still considered an acceptable price to pay to prevent the return of smallpox, though I don’t suppose this was much consolation to those that lost loved ones to vaccine reactions. I’m sure you see the relevance to your question about the relative risk of the vaccine adverse events and of catching the disease and suffering complications.

    Even if someone decides to hide their child in the herd, and rely on other people getting their children vaccinated (there are less polite ways of putting it), they will probably find they have raised an adult who is not immune to measles. This is not an enviable state to be in, given the higher rate of complications in older measles victims. A fit, healthy young colleague of mine went down with chicken pox and it laid him out for months, so I dread to think what measles could do. If these non-immune people ever want to work on healthcare (in the US at least), travel abroad, work with immigrants or otherwise put themselves at a greater risk of exposure to the virus, they will need to get the MMR anyway. I certainly wouldn’t feel comfortable knowing I had no immunity to a disease like measles. Why not just get the vaccine in the first place? I don’t think those who avoid it have properly thought it through.

  154. #155 Mephistopheles O'Brien
    March 31, 2014

    Narad – I stand corrected. Of course, California = Orange County for small enough values of California.

  155. #156 ann
    March 31, 2014

    @MOB

    Maybe I’m confused about which risks you’re missing. But there’s a pretty comprehensive comparison of the relative risks at lilady’s link above.

    They’re much higher for measles, across the board.

    So much so that if you don’t have any way of ascertaining that the risk of your unvaccinated child crossing paths with another while indoors is lower than 26 in a million, you’re taking a bigger risk by not vaccinating.

    Plus, while the 1-in-100,000 odds of (nearly always lethal) subacute sclerosing panencephalitis that go with measles doubtless sound very remote to everybody, the good fortune of the other 99,999 kids probably isn’t exactly a source of comfort to contemplate when yours is the one.

    There are limits to what kind of possibilities statistical risks can realistically or accurately convey.

  156. #157 lilady
    March 31, 2014

    As I’ve stated before, my daughter born 1970, was part of the last birth cohort that received the smallpox vaccine in 1971; thereafter the vaccine was removed from the childhood schedule.

    I remember some awful deaths which occurred in the U.K. because of smallpox exposure in a laboratory:

    http://en.wikipedia.org/wiki/Janet_Parker

    I volunteered and received Dryvax smallpox vaccine as part of the bio terrorism investigation/containment team in my County:

    http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1069029/

  157. #158 LW
    April 1, 2014

    “A Professor Dick argued in the BMJ in 1971 that it was time to end routine vaccination”

    And the way to do that was to eradicate smallpox as a disease in the wild. If antivaxxers really cared about all children, and not just their special snowflakes, they’d be devoting all that energy to demanding the eradication of measles, mumps, and rubella, instead of vilifying and threatening the experts who are struggling to keep those diseases at bay.

  158. […] same measles outbreak that “inspired” Dr. Jay to write his note to his parents. In the second Facebook rant, he used a very similar technique to that of Dr. Jay to downplay the severity of the outbreak by […]

  159. #160 Brook
    April 1, 2014

    I’m that one in a million who got Guillain-Barré from the flu vaccine. Wish my luck extended to lottery tickets. Doesn’t change the reality that vaccines are far safer than the diseases they prevent. I don’t get the flu vaccine, but I make sure those around me do.

  160. #161 Denice Walter
    April 1, 2014

    Becase people often rely upon their own *personal* sets of probabilities, here’s what I imagine is going on:

    to a science based person, wno learns about a 1 per million risk of an adverse vaccine effect and 1 in a thousand risk of death from a VPD plus a risk of more than 1 in a thousand of serious complications, the choice is not difficult.

    Suppose however that another person believes what they read in AoA:
    the risk of death/ complications from illness remains the same- altho’ it may be de-emphasised by anti-vax writers-
    BUT the risk of adverse events from a vaccine is re-named *vaccine injury* -autism- and is estimated at less than one in a hundred ( 1 in 50/1 in 68).Their choice is also obvious- although it is based on myth and rumour.

    A year or two ago, Jon Brock ( Cracking the Enigma) quoted a UK- based focus group study wherein parents were more likely to trust vaccine informationt that came from other parents than that which come from official sources.

    AoA and TMR testify first and foremost as parents warning others about the perils of vaccination.

  161. #162 dingo199
    April 1, 2014

    Lilady, the “MMR decision aid” you cited is incomplete, and incorrect.

    It should contrast the illnesses of mumps and rubella, along with measles (if it is going to compare disease complications with those from the MMR).

    Also it is wrong to includes as “YELLOW” the MMR symptoms of “high fever, irritability and swelling of salivary glands”

    With the diseases, virtually ALL will get them, but they aren’t even considered in the disease chart. I’d not include them in the vaccine chart at all, frankly. It makes it seem as though these are significantly nasty reactions to the vaccine and that those with measles do not get them (when in fact high fever and irritability are near universal)

  162. #163 Mephistopheles O'Brien
    April 1, 2014

    Ann,

    My original comment was inspired by a few people who have said in other threads that, in effect, getting a vaccination was like playing Russian roulette. This lead to discussions on whether risks taken by inaction (i.e. not vaccinating) are preferable to the risks taken by action, as well as multiple discussions on relative risk. Some of these people dismiss the risks of the disease itself as minor.

    Indeed, some have also argued (as apparently Dr. Sears has) that as long as the risk catching and dying (or, in some cases, having serious complication) from a disease is no higher than the risks of complications from the vaccine, then they are perfectly justified in not vaccinating. They calculate based on current incidence in highly developed countries. After all, if my lifetime risk of exposure to measles is, say, 1 in 26 million, then my risk of death is 3 in 26 billion, which is easily ignorable in the grand scheme of things.

    Naturally, the more people who act on those calculations the higher the risk of catching the disease.

  163. […] their blog they have a guest post from none other than Dr. Bob Sears, a man responsible for spreading misinformation about vaccines endangering his patients and more. One of Dr. Sears’ patients was found to be the cause of a […]

  164. #165 dingo199
    April 1, 2014

    I got a smallpox vaccine about 8 or 9 years ago (work requirement).
    My family were considering making me sleep in the shed until the scab had fully healed, so they didn’t get it from secondary transmission.

  165. #166 LW
    April 1, 2014

    You know, there are lots of other “one-in-a-million” risks that we take without even thinking about it. What are the risks of being killed or injured in a car accident if you drive to work every day, as I do? What are the risks of a slip-and-fall in the bathtub? What are the risks of being struck by lightning if you go outside during a storm (to look for the tornado, of course)?

    If we didn’t do anything that had greater than a one-in-a-million chance of causing us even the slightest injury, we’d spend our whole lives cowering in bed.

  166. #167 TBuce
    April 1, 2014

    If we didn’t do anything that had greater than a one-in-a-million chance of causing us even the slightest injury, we’d spend our whole lives cowering in bed.

    But then you would have a greater than one-in-a-million (much greater,actually) chance of dying of a pulmonary embolism.

    You can’t win!

  167. #168 lilady
    April 1, 2014

    dingo199, when I received my smallpox vaccine, during the summertime I wore long sleeved shirts and long sleeved pajamas with just a small bandage covering the site. My tops were laundered separately.

    When I visited my son in his group home, I wore a large occlusive bandage beneath the long-sleeved shirt.

    I heard about military staff infected close family members and some self-innoculation in the eye, caused by not following strict protocols.

    I just replied to a dumb comment on the SOP blog about the one in one thousand deaths caused by measles:

    http://shotofprevention.com/2014/03/31/say-nowaydrjay-dont-bring-measles-back/

  168. #169 skeptiquette
    April 2, 2014

    First, I do understand that there are a lot of factors that go in to understanding the risk of contracting measles, but we should be able to arrive at a general risk in numerical form, right?

    There are always “personal” sets of probabilities, but I am trying to get away from that here.

    For example, we can generalize the risk of getting in a car accident to the US population, despite the fact that there are situations were a personal probability may be much more accurate. An example of this would be someone that drives during certain hours, or has a car that hasn’t been serviced properly, etc. This person would probably have a higher (or lower) risk than the general risk that is conveyed. Likewise, with contracting measles, a person living in a hub city or one that lives in a highly unvaccinated community would have a different risk of contracting measles than the general risk.

    What is the most objective way to look at it?

    Calculating the relative risks as a bot would (number crunching only) would seem to be the most objective.

    I thought about the risk of getting measles a bit more and came up with this very crude estimate.

    On average there are 60 cases measles/year in the US.
    There are 313 million people in the US.

    Based on data from PMID: 22543023, we can see that the attack rate (AR) on non-vaccinated individuals is about 82% vs. and attack rate of approximately 4.6% on vaccinated individuals (both those that only had 1 shot and those that had 2) On a side note, this is an interesting paper in that it indicated better protection when the vaccine was administered at or after 15 months vs. at 12 months.
    So the attack rate is roughly 18 times greater if you are unvaccinated.

    Therefore the very generalized risk of getting measles if you are unvaccinated is (60/313,000,000)*18 = .00000345.

    1/x =.00000345 so x is approx. 290,000

    Therefore, an unvaccinated individual has a risk of 1 in 290,000 of contracting measles in the US based on current incidence and vaccine uptake rates.

    Does this seem reasonable?

    To objectively convey the “general” risk, we then have to multiply 1/290000 by whatever specific risk we are trying to compare.

    The form would simply be: for vaccines 1 * (whatever risk you are looking at) vs. (1/290,000) * (whatever risk you are looking at).

    Seems to be the most objective way to look at it, I could be convinced otherwise if someone has a better argument.

    I can also imagine a table where column one is vaccine uptake rate and column two represents the risk of an unvaccinated individual contracting measles and column three then would be the specific risk from that disease that is in question. It would be interesting to see at what point (vaccine uptake rate) the risks would be equivalent.

  169. #170 Narad
    April 2, 2014

    Therefore, an unvaccinated individual has a risk of 1 in 290,000 of contracting measles in the US based on current incidence and vaccine uptake rates.

    Does this seem reasonable?

    Not really, as the quantity of interest is how likely you are of being near an outbreak, so population density is a factor. Moreover, then trying to compare with the attack rates, which are outbreak-derived, is comparing apples and oranges.

  170. #171 ann
    April 2, 2014

    @skeptiquette –

    Therefore, an unvaccinated individual has a risk of 1 in 290,000 of contracting measles in the US based on current incidence and vaccine uptake rates.

    Does this seem reasonable?

    Well….

    It’s as reasonable as a calculation based on the 100-percent unreasonable assumption that it’s possible to estimate the real statistical risk of an unvaccinated individual contracting the measles by doing some simple math with a handful of very general figures from different sources.

    Or, in a word: No.

    I’m sorry. I don’t mean to be rude. But although working with numbers has never been a personal strength, I’m relatively certain that it’s not possible to calculate the individual statistical risk of someone getting a highly contagious airborne disease without knowing more about the individual than that he or she lives in a very large country and hasn’t been vaccinated.

  171. #172 ann
    April 2, 2014

    My original comment was inspired by a few people who have said in other threads that, in effect, getting a vaccination was like playing Russian roulette.

    Despite what I just said about myself and working with numbers, I’m going to go out on a limb here with an unqualified declarative statement:

    Playing Russian roulette is riskier than getting routine vaccinations.

    This lead to discussions on whether risks taken by inaction (i.e. not vaccinating) are preferable to the risks taken by action,

    That seemed to me like it ought to be a quick, fun and interesting exercise in propositional logic, at first blush. But if thought is an action — which it is, imo — it wouldn’t be quick. (For me; above my skill level.)

    I like the concept, though.

  172. #173 AdamG
    April 2, 2014

    First, I do understand that there are a lot of factors that go in to understanding the risk of contracting measles, but we should be able to arrive at a general risk in numerical form, right?

    Why is this true?
    You seem to want to compare two magic numbers in order to…conclude something, I guess. Why do you feel entitled to simple answers to complex problems?

  173. #174 skeptiquette
    April 2, 2014

    This is curious to me… because,

    This is how risks are conveyed all of the time, for everything.

    Are you telling me it is impossible to define (even remotely or using a range) the average risk of catching measles in the united states for an unvaccinated individual?

    The same argument can be made then about an adverse vaccine reaction: If I don’t know more about the individual I can’t calculate an individual statistical risk, but we convey the average risk without considering the individual all of the time.

    I think there is a way to calculate the average risk of catching measles (both vaccinated and unvaccinated), I just don’t know the best way to go about it.

    Does somebody here know the best way of calculating this average risk?

  174. #175 Politicalguineapig
    April 2, 2014

    LW: What are the risks of being struck by lightning if you go outside during a storm (to look for the tornado, of course)?

    Er, speaking as someone who lives in a state that gets hit by tornadoes, that’d be pretty low. Right before a tornado hits, there’s sort of an eye effect where the rain etc, will stop for a bit, and then resume.

  175. #176 skeptiquette
    April 2, 2014

    Adam,
    I don’t feel entitled to a simple answer to a complex problem, that is why I am asking if anybody can guide us to the answer.

    I just think that this number is imperative if you are to objectively compare risks, why don’t you?

    What two magic numbers am I comparing?

  176. #177 JGC
    April 2, 2014

    I think there is a way to calculate the average risk of catching measles (both vaccinated and unvaccinated), I just don’t know the best way to go about it.

    With resepct to risk do we really need to know anything more than what has already been established–that unvaccinated children are between 22 and 35 times more likely to get measles than their vaccinated peers?

  177. #178 skeptiquette
    April 2, 2014

    Ann,

    In order to compare the two risks we need the average risk of catching measles if unvaccinated. Without this number you can only make a baseless claim that appeals to emotion, but this is what I am trying to shy away from. I would rather have an objective claim based on a numerical calculation of risks.

    Remember hyperbole in this arena is causing a backlash.

  178. #179 JGC
    April 2, 2014

    Just to expand on my last post, regardless of the likelihood you’ll be in an automobile accident it’s still a good idea to wear a seat belt everytime you get into a car.

  179. #180 skeptiquette
    April 2, 2014

    JGC,

    Yes you do. This number you mention would be used to refine the average risk of catching measles (like I did in my crude calculation) in the US.

    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.

    I think this is the most objective way to compare these risks. Do other agree or disagree with this?

  180. #181 Chris,
    April 2, 2014

    Actually, you might try these math models. One must tip their hat to Sir Ronald Ross for developing many of those models while trying to figure out what caused malaria. I highly recommend reading Mosquitoes, Malaria, and Man: A History of the Hostilities Since 1880 by Gordon A Harrison, it is out of print but our library system had a copy.

    In our state the chance for certain persons to get infected with measles was 100%, since they lived in the same Whatcom County house with the person who caught measles in British Columbia. They are all in isolation: Whatcom County measles cases up to four in same home.

    The problem with your simplistic reasoning is that those with similar attitudes tend to form clusters. This is exactly what happened in the following outbreaks:

    Pediatr Infect Dis J. 1993 Apr;12(4):288-92.
    High attack rates and case fatality during a measles outbreak in groups with religious exemption to vaccination.

    N Engl J Med. 2006 Aug 3;355(5):447-55.
    Implications of a 2005 measles outbreak in Indiana for sustained elimination of measles in the United States.

    Pediatrics. 2010 Apr;125(4):747-55. doi: 10.1542/peds.2009-1653. Epub 2010 Mar 22.
    Measles outbreak in a highly vaccinated population, San Diego, 2008: role of the intentionally undervaccinated.

    The latter says:

    Despite high community vaccination coverage, measles outbreaks can occur among clusters of intentionally undervaccinated children, at major cost to public health agencies, medical systems, and families. Rising rates of intentional undervaccination can undermine measles elimination.

  181. #182 Chris,
    April 2, 2014
  182. #183 skeptiquette
    April 2, 2014

    Thanks Chris,

    I will check those out.

    Despite high community vaccination coverage, measles outbreaks can occur among clusters of intentionally undervaccinated children, at major cost to public health agencies, medical systems, and families. Rising rates of intentional undervaccination can undermine measles elimination.

    I get this, and I had all of my kids vaccinated against measles, mumps and Rubella.

    I have seen the argument that I presented in the past and I didn’t see anything totally wrong with it. However, the same thing came up the few times that I have seen the argument, that is: what is the risk of catching the disease?

    nobody had a clear answer to this (of course, they were concerned parents trying to compare the risks, not mathematicians or epidemiologists)

  183. #184 skeptiquette
    April 2, 2014

    The problem with your simplistic reasoning is that those with similar attitudes tend to form clusters. This is exactly what happened in the following outbreaks:

    I know it may seem simplistic, but is there anything logically wrong with it?

    I mean, you can’t really argue with the basic form for solving the probability… this is standard math.

    What can be debated is what is “A” and how does that change based on finer grained variables such as population density, clusters of unvaccinated, etc.

  184. #185 ann
    April 2, 2014

    This is curious to me… because,

    This is how risks are conveyed all of the time, for everything.

    Are you telling me it is impossible to define (even remotely or using a range) the average risk of catching measles in the united states for an unvaccinated individual?

    No. I’m telling you that it’s impossible for you to define in a way that’s even remotely, generally valid by doing a simple calculation with four numbers you found on the internet.

    That’s not how the risks that are conveyed that way all the time are determined.

    The same argument can be made then about an adverse vaccine reaction: If I don’t know more about the individual I can’t calculate an individual statistical risk, but we convey the average risk without considering the individual all of the time.

    The average risk of an individual having an adverse vaccine reaction can’t be calculated without the person doing it knowing more about the individuals in the sample than you have access to, because: He or she would have to know that they’d been vaccinated and how they’d reacted to the vaccination. At a minimum.

    I think there is a way to calculate the average risk of catching measles (both vaccinated and unvaccinated), I just don’t know the best way to go about it.

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

    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.

    It wouldn’t and couldn’t yield a result that was meaningfully applicable either to anybody in particular or everybody in general.

    So no. It’s not logical.

    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. Though.

    That would be logical!

  185. #186 LIz Ditz
    April 2, 2014

    Bob oh Bob on what the medical response to the new autism numbers should be, at the Talk About Curing Autism blog

    http://tacanowblog.com/2014/04/02/so-autism-has-risen-another-30-in-two-years-to-1-in-68-who-cares/

    We can’t abandon science. The scientific method is important. What we NEED is for EVERYONE in the medical science community to ban together to figure this out. We need to start calling it for what it is: the most devastating medical emergency of our century. If we don’t find an answer soon, the day will come when we start screening all kids to identify the developmentally typical ones so that we can know who not to start early intervention therapy on. We must focus our research on environmental factors which cause the genetic and metabolic changes we see in autism. And we must make it stop. (2,3.)

    Meanwhile, we’ve gotten pretty darn good at treatment and offering some preventive measures. That’s where organizations like TACA and MAPS (4) really shine. But finding THE CAUSE, and bringing an end to autism – that’s what we really need.

    Dr. Bob Sears

    Pediatrician, TACA Physician Advisor, and author of The Autism Book

    “the most devastating medical emergency of our century”?

  186. #187 ann
    April 2, 2014

    The average risk of an individual having an adverse vaccine reaction can’t be calculated without the person doing it knowing more about the individuals in the sample than you have access to, because: He or she would have to know that they’d been vaccinated and how they’d reacted to the vaccination. At a minimum.

    And that it had been a reaction to the vaccine, I forgot to say. (Meaning: You’d either have to know enough about the people who had each adverse reaction — fainting — let’s say) to exclude other causes, or you’d have to know the odds of someone of the same age, gender and (etc.) fainting for any reason.)

    And so on.

    Maybe not exactly. But in some way that would be loosely analogous to the above, you’d need to know quite a bit about the people whose heads and adverse reactions you were counting.

    Or so I imagine, based on inferential logic.

    I don’t actually know what I’m talking about.

  187. #188 LIz Ditz
    April 2, 2014

    I believe this was posted today

    “Parents who oppose vaccines are not only misinformed, they’re spoiled, having grown up in a world that stands behind the berms built by the scientists and vaccine developers who came before them. If you’ve never seen measles — or polio or whooping cough or mumps — you have the luxury of believing they don’t exist.”

    http://time.com/46914/vaccine-opponents-wrong/

  188. #189 Chris,
    April 2, 2014

    skeptiquette: “I know it may seem simplistic, but is there anything logically wrong with it?”

    Yes. Since the last few outbreaks have occurred in clusters of at risk populations, you cannot ignore that factor. Which is why we have these kinds of studies: Individual and Community Risks of Measles and Pertussis Associated With Personal Exemptions to Immunization.

    Dr. Offit has often said that an unvaccinated person is safer in a community with high vaccine rates, than a vaccinated person in an area with low vaccine rates.

  189. #190 ann
    April 2, 2014

    @Liz Ditz –

    Thanks for posting.

    Maybe I’m reading too much into it. But by this…

    A deeply disturbing investigative piece in New York magazine reveals that fully 245 of the city’s private schools have vaccination rates that fall below the 95% level needed to ensure herd immunity — the protection that’s provided to the few unvaccinated members of a community because so many others are protected that a pathogen never gets a foothold. Of those schools, 127 fall below 90% and 37 fall below 70%. Nine schools fall in a dismal range of 18.4% to 41.5%. Numbers like that are the leading cause New York is suddenly suffering a measles outbreak, more than 50 years after the first vaccine against the disease was licensed.

    The anti-vaxxers all cite the same imaginary problems to support their resistance: Vaccines are linked to autism (they’re not), they cause autoimmune diseases (they don’t), they are “messing with nature,” as one pediatrician in a Marin County, Calif. practice that indulges parents who don’t want to vaccinate their kids or want to administer the shots on their own schedule, told Mother Jones Magazine. Um, OK.

    …I took the author to be suggesting that the culprits are a stuck-up, private-school-fee-paying, overly entitled and self-indulgent class of people.

    And although I didn’t run down the details on every school on the New York Magazine story list, per a once-over and some spot-checking, that appears not to be the case.

    The ones with the lowest rates that I looked at were mostly in neighborhoods characterized primarily by brutal housing projects or religious schools. (While there were also some Catholic schools in parts of the Bronx I don’t know, by “religious schools,” I mean “exceptionally religious schools” — Seventh-Day-Adventist academies, yeshivas, etc.)

    It’s probably not really the same phenomenon as in Marin County, IOW. The places like Fieldston and Horace Mann had good coverage.

    The New York story is here, if anyone wants to look into it:

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

  190. #191 ann
    April 2, 2014

    In case it needs saying:

    The reason it matters is that while it’s definitely a nightmarish public-health problem that there are children in Bed-Stuy attending schools with 31-percent vaccination rates, it’s probably not one that can be addressed by condemning their parents for being spoiled and over-accustomed to luxury.

    And it should be addressed.

  191. #192 LIz Ditz
    April 3, 2014

    Hi ann,

    I don’t live in New York City or even in New York State. I live in California.

    I can’t parse the New York data the way I can the California data, which is published annually here

    http://www.cdph.ca.gov/programs/immunize/Pages/ImmunizationLevels.aspx

    I cannot speak authoritatively overall, but as a broad-brush statement about California vaccine uptake rates: schools with indicators of low-SES (social economic status) tend to have higher levels of vaccine uptake.

    Another impressioinistic bit about the California data: vaccine refusal isn’t uniform — Hep B refusal and varicella refusal (both rquired for kinder entry) may account for a big chunk, but I’m not sure.

    Here’s another thought:some 5 year olds arrive at kindergarten up to date on the vaccines from birth to 18 months, but lacking the later booster shots.

    So they are partially protected, or event totally protected depending on the individual child’s immune response.

  192. #193 LIz Ditz
    April 3, 2014

    Another note: I haven’t yet looked at the “just private school data” but I’m willing to bet that Waldorf schools totally skew the data. In the two counties I follow closely (San Mateo and Santa Clara) for example, the Roman Catholic parochial schools (which are coded as “private” in the California registry, have >95% uptake.

  193. #194 Narad
    April 3, 2014

    I mean “exceptionally religious schools” — Seventh-Day-Adventist academies, yeshivas, etc.

    This is a recurrent issue with the Charedim, although I thought it was mostly one of delaying until the last minute. Culturally, it’s not dissimilar to the Amish, where secular education gets formally tossed early on. There’s a powerful argument that vaccination is a positive mitzvah, so this is largely an outreach effort that needs to be disseminated by the rabbonim.

    Yeshivas are notoriously bad places for low uptake, as much of the activity is sustained student–student close contact. Large families and comparative poverty don’t help much, either.

  194. #195 ann
    April 3, 2014

    There was one Waldorf school listed, for sure.

    There appeared to be a ton of Catholic schools, too. But that doesn’t mean/suggest/say any one particular thing in NYC, except that there are a ton of Catholic schools here.

  195. #196 ann
    April 3, 2014

    @Narad –

    I imagine that there are yeshivot with high uptake here. Probably in Riverdale.

  196. #197 lilady
    April 3, 2014

    Nothing has changed too dramatically since I worked as a public health nurse in a large suburban health department (catchment area 1.2 million population), where every public and private school had a school (registered) nurse on duty for every school day.

    Registration for the incoming kindergarten classes took place during late May-early June at the school building. Parents were instructed to bring their child’s immunization record to the school building (public, private, parochial) where their child would attend school. The school nurse reviewed each child’s immunization record to ascertain if it was complete (usually just missing the second MMR or varicella vaccine) and were shown the NYS Recommended Childhood Vaccine Schedule which was a requirement for school entry. Arrangements were made with one of our 7 satellite clinics or the mobile health vans operated by several of the area hospitals for the child to be brought up to date, to be in compliance. (There would be pandemonium if the schools were unaware of the number of classes that needed to be set up for the entering kindergarten class and busing schedules were not arranged).

    A few children who had moved into a school district during the summer, were registered for school in early September, with the same requirement to produce an official vaccine immunization record.

    NYS permitted kids to enter school with some missing shots and each building’s nurse had the lists of the children with missing shots in a diary, with reminders sent to the parent.

    Occasionally, a parent would receive a final notice from the school nurse, to complete their child’s immunization, or face removal from the class. The district school superintendents would inform the parent via certified mail that the child could not attend school after a certain date.

    Private and parochial schools had their own school nurse, paid for with public tax dollars…as well as school texts (non religious), psychological services, social worker services, special educators and therapists for public and parochial school kids, who had IEPS specifying those services. Busing costs were all paid by school tax receipts, as well. (And, you wonder why my school taxes are sky high).

    Yay, for school nurses who are the guardians at the gate, so that every child is fully immunized and every child who has a valid medical contraindication for receiving one or more vaccines, does not have to worry that a childhood disease will be contracted within the school setting.

  197. #198 Narad
    April 3, 2014

    “the most devastating medical emergency of our century”?

    “Ban together”? Anyway, that thing nearly merits a part VI.

    “If we don’t find an answer soon, the day will come when we start screening all kids to identify the developmentally typical ones so that we can know who not to start early intervention therapy on.”

    OK, so let’s try to take this seriously. It’s a bit tricky, since implicit in screening for “nonneurotypical” is screening for “neurotypical,” but whatever. Dr. Bob has just asserted that “the day will come” when the “neurotypical” will require special services. What to choose for this level? Let’s do the routine lifting first.

    Consider a 30% ASD increase every two years:

    2008 1:88
    2010 1:68
    2012 1:52

    Etc.; the denominator in year n after 2008 is 88√[(1/1.3)ⁿ], so in year n it’s 10^[log(88)+0.5n log(1/1.3)] and for a denominator d one has n = 2 log(d/88)/log(1/1.3).

    The denominator obviously has to be less than unity in Dr. Bob’s scenario. Let’s say the “nonneurotypical” have to outnumber the “neurotypical” by 9 to 1 for there to be a risk of “inappropriate treatment,” so d = 0.1.

    Dr. Bob’s scenario comes to pass sometime in 2059. I don’t know about you, but the outcome of the assumptions has a certain Clifford Miller feel to it for me.

  198. #199 herr doktor bimler
    April 3, 2014

    But finding THE CAUSE, and bringing an end to autism – that’s what we really need.

    So you’re looking for a SINGLE CAUSE, Bob? That could be part of the problem.

  199. #200 Narad
    April 3, 2014

    I imagine that there are yeshivot with high uptake here.

    Like I said, I was under the impression that this was the norm – more specifically, that delaying until necessary for school attendance isn’t an unusual NY frum trip. New York immunization requirements apply to private and parochial schools.

  200. #201 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.

  201. #202 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.

  202. #203 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?

  203. #204 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.”

  204. #205 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..

  205. #206 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.

  206. #207 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!

  207. #208 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!

  208. #209 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.”

  209. #210 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.

  210. #211 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.

  211. #212 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

  212. #213 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.

  213. #214 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?

  214. #215 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.

  215. #216 skeptiquette
    April 3, 2014

    I should qualify that the feeling is only mutual sometimes.

  216. #217 skeptiquette
    April 3, 2014

    But Ann, I like digging!

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

  217. #218 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.

  218. #219 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.

  219. #220 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.

  220. #221 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.”

  221. #222 Narad
    April 3, 2014

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

  222. #223 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.

  223. #224 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?

  224. #225 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.

  225. #226 ann
    April 3, 2014

    D’oh!

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

  226. #227 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.

  227. #228 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.

  228. #229 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

  229. #230 Alain
    April 3, 2014

    @Skeptiquette

    Furthermore, why are you investigating the cause of autism?

    Alain

  230. #231 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.

  231. #232 Alain
    April 3, 2014

    @Chris,

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

    Alain

  232. #233 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.

  233. #234 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.

  234. #235 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.

  235. #236 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.

  236. #237 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.

  237. #238 Alain
    April 3, 2014

    @Chris,

    Indeed, I remembered that.

    Alain

  238. #239 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.

  239. #240 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.

  240. #241 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.

  241. #242 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.

  242. […] 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 […]

  243. #244 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.

  244. #245 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.

  245. #246 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.

  246. #247 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!

  247. #248 Alain
    April 5, 2014

    Antaeus,

    You win the internet :D

    Alain

  248. #249 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

  249. #250 squirrelelite
    April 5, 2014

    Congratulations, Alain!!!!

  250. #251 squirrelelite
    April 5, 2014

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

  251. #252 Denice Walter
    April 5, 2014

    @ Alain:

    Good for you!

    @ Antaeus:

    Agreed.

  252. #253 Brook
    April 5, 2014

    @Alain – congratulations!

  253. #254 Chris,
    April 5, 2014

    Antaeus Feldspar, that was beautiful.

  254. #255 lilady
    April 5, 2014

    Antaeus Feldspar, you nailed her…perfectly. Thanks.

  255. #256 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.”

  256. #257 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.

  257. #258 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

  258. #259 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.

  259. #260 Narad
    April 5, 2014

    And… Mazel tov, Alain!

  260. #261 anon
    April 5, 2014

    #259 And…namaste, narad!

  261. #262 anon
    April 5, 2014

    #258 Namaste, alain

  262. #263 Politicalguineapig
    April 5, 2014

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

    Alain: Congrats.

  263. #264 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.

  264. #265 novalox
    April 5, 2014

    @Alain

    Congrats. May you have future success.

  265. #266 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!

  266. #267 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

  267. #268 Chemmomo
    Not quite bilingual, and with a different language
    April 5, 2014

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

  268. #269 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.

  269. #270 Alain
    April 5, 2014

    Thanks you very much Chemmomo and Antaeus.

    Alain

  270. #271 MI Dawn
    April 6, 2014

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

  271. #272 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

  272. #273 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.

  273. #274 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.”

  274. #275 Politicalguineapig
    May 20, 2014

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

  275. #276 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?

  276. #277 Alain
    May 20, 2014

    @Narad,

    I agree, on what planet she’s living?

    Alain

  277. #278 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?”

  278. #279 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.

  279. #280 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.

  280. #281 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.

  281. #282 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.

  282. #283 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.

  283. #284 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/

  284. #285 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.

  285. #286 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.

  286. #287 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.

  287. #288 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.

  288. #289 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.

  289. #290 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?

  290. #291 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

  291. #292 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.

  292. #293 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…..

  293. #294 Lawrence
    May 21, 2014

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

  294. #295 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?

  295. #296 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.

  296. #297 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.

  297. #298 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.

  298. #299 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.

  299. #300 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.

  300. #301 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?

  301. #302 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!!

  302. #303 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.

  303. #304 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.

  304. #305 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 …

  305. #306 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.

  306. #307 sheepmilker
    May 21, 2014

    ^ REPORTING system!

  307. #308 Mark
    May 21, 2014

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

  308. #309 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…..

  309. #310 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.

  310. #311 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…)

  311. #312 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.

  312. #313 TBruce
    May 21, 2014

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

    Great idea! When do you start?

  313. #314 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.

  314. #315 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.

  315. #316 Militant Agnostic
    May 21, 2014

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

  316. #317 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.

  317. #318 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!!!!

  318. #319 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. 

  319. #320 Militant Agnostic
    May 21, 2014

    @LW

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

  320. #321 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.

  321. #322 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.

  322. #323 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.

  323. #324 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.

  324. #325 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.

  325. #326 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.

  326. #327 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.

  327. #328 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.

  328. #329 Lawrence
    May 22, 2014

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

  329. #330 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.

  330. #331 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.

  331. #332 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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