One of the more frequent claims of antivaccine activists often comes in the form of a disingenuous question. Well, maybe it’s not entirely disingenuous, given that many antivaccinationists seem to believe premise behind it. The question usually takes a form something like, “If your child is vaccinated, why are you worried about my children? They don’t pose any danger to you.” Of course, the premise behind that question is, ironically, one that conflicts with many of the beliefs behind antivaccinationism, in particular the belief that vaccines are ineffective. Yet, the premise behind this question is that vaccines are so effective that there’s no reason for the parents of a vaccinated child to be concerned if that child comes in contact with another child with a vaccine-preventable disease. Of course, no one ever accused antivaccine activists of being consistent in their beliefs.

Of course, another claim that antivaccinationists like to make is that it isn’t the unvaccinated who are causing outbreaks, but the vaccinated. To make this argument, they like to point out that most of the infected in an outbreak are vaccinated, which is, of course, not uncommonly true. This is, of course, a profoundly mathematically ignorant line of argument because it neglects how small the number of unvaccinated children usually are relative to the vaccinated. Raw numbers mean little. What really needs to be examined is the relative risk of infection of the unvaccinated compared to the vaccinated during an outbreak, and, depending on how effective the vaccine is, that relative risk is usually rather high. For instance, for pertussis, being unvaccinated is associated with a 23-fold increased risk of infection.

The fact is, not vaccinating children endangers them, and just this week yet another study was published that finds yet the same thing again. However, given how often antivaccine loons keep repeating their misinformation that their choice doesn’t just endanger their children but everyone’s children, it’s always good to see a new review in a high impact journal like JAMA confirming just that. This time, it’s a systematic review of the evidence for measles and pertussis by Phadke et al entitled Association Between Vaccine Refusal and Vaccine-Preventable Diseases in the United States: A Review of Measles and Pertussis. The senior author was Saad B. Omer, MBBS, MPH, PhD at Emory University. I would have discussed this one yesterday had I not, as I mentioned yesterday, crashed hard on the couch the evening before.

Basically, noting that vaccine refusal has been associated with outbreaks of invasive Haemophilus influenzae type b disease (Hib), varicella, pneumococcal disease, measles, and pertussis and that over the past 20 years, rates of nonmedical exemptions have steadily increased, the authors reviewed the existing medical literature to characterize the relationship between vaccine refusal and the epidemiology of measles and pertussis, vaccine-preventable diseases with recent outbreaks in the United States. They chose their time periods thusly: since measles was declared eliminated in the United States 16 years ago and since pertussis reached its lowest point of its incidence (after 1977). Concentrating on studies that examined risk of disease in the unvaccinated and vaccinated, they also looked at vaccine delay and exemptions, including medical and non-medical (i.e., philosophic or religious) exemptions in order to determine how vaccine refusal affects risk of disease in both the unvaccinated and the vaccinated. As a result, they were able to estimate, for example, that over half of the cases in US measles outbreaks are unvaccinated, often intentionally.

In their search, the authors identified 18 published measles studies (9 annual summaries and 9 outbreak reports). These studies described 1,416 measles cases ranging in age from 2 weeks to 84 years of age, with 178 of them younger than 12 months. Of these cases, a total of 199 cases (14%) were people with a history of being vaccinated against measles, while more than half of the total measles victims 804 (nearly 57%) had no history of measles vaccination. There were 970 measles cases with detailed vaccination data, of which 574 were unvaccinated, and, of these, 405 (71%) had nonmedical exemptions, making up 42% of the total number of cases). One particularly pertinent observation is how the unvaccinated predominate among cases early in the outbreak:

The outbreaks evaluated in the cumulative epidemic curve included cases that occurred up to 5 generations of spread after the index case, with the latest related case occurring 12 weeks after identification of the index case. When viewed by week of outbreak, unvaccinated individuals constituted a larger fraction of the total measles cases per week in the earliest weeks of an outbreak (eg, earlier generations).

So basically, most of the measles cases were in the unvaccinated, and the majority of the unvaccinated were old enough to receive the vaccine and without any medical contraindication to being vaccinated. Their parents had refused the vaccine for nonmedical reasons. Yes, being antivaccine causes harm, and existing studies allowed the authors to estimate how much these vaccine refuseniks increase the risk in the whole population.

Reviewing the relative risk of measles in unvaccinated children, the authors found studies demonstrating that the unvaccinated were anywhere from 22- to 35-fold more likely to contract the measles during an outbreak. Worse, higher rates of vaccine exemption in a community were associated with greater measles incidence in that community, among both the exempt and nonexempt population. Curious, I went back to look up the article cited by Phadke et al, which used mathematical modeling to estimate that, depending on assumptions of the model about the degree of mixing between exemptors and nonexemptors, “an increase or decrease in the number of exemptors would affect the incidence of measles in nonexempt populations. If the number of exemptors doubled, the incidence of measles infection in nonexempt individuals would increase by 5.5%, 18.6%, and 30.8%, respectively, for intergroup mixing ratios of 20%, 40%, and 60%.”

So, yes, basically this tells us what we already know, namely that an increased proportion of unvaccinated children does degrade herd immunity and does increase the risk of disease in the vaccinated. Remember, no vaccine is 100% effective. The MMR is very effective against measles, over 90%, but not 100%. Yes, the vaccinated can still be infected; it’s just that they’re much less likely to be.

As far as pertussis goes, the numbers aren’t good either for the unvaccinated. The authors identified 32 reports of nonoverlapping pertussis outbreaks covering 10,609 cases among individuals ranging in age from 10 days to 87 years. The five largest statewide pertussis outbreaks had substantial portions of vaccinated or undervaccinated. Part of the problem that complicates the pertussis picture is, of course, the problem of waning immunity, but it’s clear with pertussis as well that being unvaccinated carries with it a substantial increased risk of developing the disease:

Three studies evaluated the individual risk of pertussis associated with vaccine refusal—1 retrospective cohort study used Colorado pertussis surveillance and immunization data from 1987-1998 and determined that those with exemptions were 5.9 times more likely to acquire pertussis compared with fully vaccinated individuals. A different case-control study analyzed pertussis cases from 1996-2007 within a large managed care organization and computed a nearly 20-fold increased risk of pertussis among individuals with exemptions—11% of the pertussis cases in that cohort were attributed to vaccine refusal. Another case-control study used pooled longitudinal data (2004-2010) from 8 Vaccine Safety Datalink sites and determined that even undervaccinated individuals had an increased risk of pertussis, with the risk being proportional to the number of missed doses of DTaP.

As is the case with measles, high rates of vaccine exemption in a community or state are associated with an increased risk of pertussis in that community or state compared to communities or states without high rates of exemptions. Worse, as was the case with measles, the risk of being infected with pertussis is higher even among the appropriately vaccinated. The authors also noted that the geospatial association between clusters of vaccine refusers and pertussis cases can’t be explained by waning immunity for the simple reason that there shouldn’t be geographic heterogeneity in the duration of protection offered by vaccines against pertussis.

Overall, the authors concluded that vaccine refusal is associated with an increased risk of vaccine among both the unvaccinated and vaccinated and that, although waning immunity to pertussis is an issue in pertussis outbreaks (as I’ve discussed before), there is still a significant contribution in some populations due to vaccine refusal.

The authors observed:

This review has broad implications for vaccine practice and policy. For instance, fundamental to the strength and legitimacy of justifications to override parental decisions to refuse a vaccine for their child is a clear demonstration that the risks and harms to the child of remaining unimmunized are substantial. Similarly, central to any justification to restrict individual freedom by mandating vaccines to prevent harm to others is an understanding of the nature and magnitude of these risks and harms. However, the risks of vaccine refusal remain imperfectly defined, and the association between vaccine refusal and vaccine-preventable diseases may be both population- and disease-specific. Vaccine refusal–specific strategies to optimize vaccine uptake could include state or school-level enforcement of vaccine mandates, or increasing the difficulty with which vaccine exemptions can be obtained.

Exactly. Depending on the vaccine and disease, the most potent one-two punch argument used by antivaccine activists, one that is often heard sympathetically among people with ideologies that take a dim view of the government and government regulations, is shown to be false. I’m referring, of course, to the claim that parents’ freedom and right to raise their children as they see fit shouldn’t be limited by vaccine mandates because their unvaccinated children are harming no one. For pertussis and particularly for measles, at least, this is clearly not true.

As is often the case with major articles like this, there was an accompanying editorial, in this case by Matthew Davis at the University of Michigan. Davis first notes that, in the case of pertussis, waning immunity and vaccine refusal are different challenges, but they are related. The reason is that nonmedical exemptions for childhood vaccination decrease overall community immunity and thus increase the risk of infection for children with waning immunity or, in the case of the children of vaccine refusers, no immunity at all. Outbreaks then occur, and these outbreaks provide “examples” that antivaccine activists can point to claim that the benefits of vaccination are being oversold and therefore not important for their children.

Davis also notes:

An important priority is to ensure high reliability in US vaccination efforts. Current US vaccination efforts are not optimally effective, as measured by outbreaks of vaccine-preventable diseases and vaccination coverage rates that fail to reach target levels. Currently, no single entity is accountable for monitoring and coordinating the multiple stakeholders with interests in maximizing vaccination rates. These multiple stakeholders include parents, physician practices, private insurance, public health institutions, community pharmacies, and government agencies. Given the public health importance of effective vaccination, a more reliable system is needed.

The airline and nuclear power industries have established a culture that values consistent and standardized practices to promote highly reliable performance. In the United States, efforts to achieve complete vaccination rates in the population do not follow the standards established by these industries. By standardizing procedures and continuously evaluating the effectiveness of new initiatives to increase vaccination rates, it may be possible to reduce exemptions and waning immunity and achieve more complete vaccination of children and adults.

Exactly. Davis almost drolly notes at the end that “without a centralized infrastructure focused on the goal of maximizing community immunity, high-reliability vaccine coverage remains challenging in the United States.” That’s an understatement. The infrastructure in this country for tracking vaccination rates could use considerable improvement. It’s a patchwork of state systems, some of which do a good job, some of which do not. In some states school-level vaccination rates are reported; in others not. Unfortunately, because it is states that are responsible for setting vaccine requirements, this is not a situation likely to be improved much any time soon.

Still, the take home message of this review article needs to be repeated over and over again. Despite what antivaccine parents claim, their choice not to vaccinated does impact more than just their children and themselves. It impacts the entire community in which they live negatively, even the vaccinated.

Comments

  1. #1 Dorit Reiss
    March 17, 2016

    A few things. First, I read the query from anti-vaccine activists more as a gotcha, as a way to emphasize that vaccines don’t work: the only reason one is worried about non-vaccination is because deep down the vaccinated know their vaccines don’t work and their kids are still at risk. I could be wrong.

    Second, not only, as you pointed out, are vaccines first and foremost a state issue, but I am not sure how Davis envisions such a coordinated infrastructure, given the stakeholders. Nuclear and Airpower don’t have to contend with decision making by many, many diverse and diffuse individuals to achieve safety, but on an industry: while the industry concentration makes it more likely to put pressure on the regulators and achieve favorable regulations, absent counter pressures, it’s also easier to get industry in line, because there are less actors and a more institutionalized, rationalized (though not always rational or well functioning) decision making process.

    I would add that diffusion at the federal level – division of functions between CDC and FDA – actually should also increase accountability, since neither agency has complete control of the issue, even as it increases coordination problems.

  2. #2 AndiG
    March 17, 2016

    Long time lurker, first time commenter…

    Thank you for this post. A while back, I got stuck debating vaccines with my cousin who is anti-vaccine. Typically, I try to avoid these types of debates with family since they’re often unproductive and cause too much anxiety for everyone involved…but alas I can’t always keep my mouth shut. Anyway, at one point she made the comment you quote at the beginning of this post – that if vaccines are so great, then her not vaccinating her kids shouldn’t worry me. When I tried to point out the flaws in that argument, she interrupted me and replied something along the lines of “Oh, you’re one of those people who believe in herd immunity.” And frankly, I was dumbfounded. I mean, it’s not a matter of belief. Or choice. That’s not how science/herd immunity works. But, it becomes much more difficult to argue about these sorts of things when the other person’s whole concept and position on the issue is based on a belief or faith. It’s like a trump card.

    Needless to say, it was around that time that we both threw up our hands and agreed we were getting nowhere.

    I’ve read a decent amount of anti-vaccine challenges to herd immunity – such as the idea that good hygiene and not vaccination is the reason we don’t catch as many diseases anymore. And I’ve found many in depth rebuttals to these challenges. But I haven’t come across much of anything that addresses the out right denial that herd immunity is a thing.

  3. #3 MI Dawn
    March 17, 2016

    I remain amazed at the number of people who refuse vaccines for themselves and their children, stuffing all sorts of supplements down their throats but saying they don’t trust “Big Pharma”. I SO want to ask who they think makes their supplements….

  4. #4 Helianthus
    March 17, 2016

    @ AndiG

    And frankly, I was dumbfounded.

    Welcome to the club 🙂
    And welcome around.

    The worse part (sort of) about rejection of the idea of herd immunity is that, at its basis, the concept of herd immunity does not arise from the existence of vaccines, but from the existence of a personal immune system and of contagious diseases. Both things most layman people have a chance (or malchance) to verify by themselves.

    Contagious diseases just means that there are illnesses which can jump from one sick person to another one.
    Disease immunity just means that you will usually only catch this disease once. If you survive, you will not catch it again.
    Herd immunity is just the logical extension of the two previous facts. If you are sick but surrounded by people who are immune to your disease, it’s very unlikely that you will pass it on onto someone else.

    The rejection of this causative chain is, indeed, dumbfounding.

  5. #5 Todd W.
    http://www.harpocratesspeaks.com
    March 17, 2016

    @Helianthus

    The worse part (sort of) about rejection of the idea of herd immunity is that, at its basis, the concept of herd immunity does not arise from the existence of vaccines, but from the existence of a personal immune system and of contagious diseases. Both things most layman people have a chance (or malchance) to verify by themselves.

    Ah, but anti-vaccine types have an answer to that. You see, herd immunity, they say, only refers to “natural” immunity gained through infection. Since vaccines, in their minds, do not provide immunity, it therefore cannot contribute to herd immunity.

  6. #6 Science Mom
    http://justthevax.blogspot.com/
    March 17, 2016

    Ah, but anti-vaccine types have an answer to that. You see, herd immunity, they say, only refers to “natural” immunity gained through infection. Since vaccines, in their minds, do not provide immunity, it therefore cannot contribute to herd immunity.

    And they never acknowledge the continuing susceptible cohort that enters the herd. They just hand-wave that one away with a Steiner-esque excuse that infections are good for you.

  7. #7 Denice Walter
    March 17, 2016

    @ AndiG:

    It’s important to speak up when something bothers you that much- whether it’s about vaccines or any other topic:
    isn’t your opinion as weighty or meaningful as anyone else’s?

    If you always stand back, you won’t learn how to be comfortable holding your own and expressing what you believe. It’s a good exercise although not always the easiest- at least, not at first.

    Of course, you may not want a drawn out ( hopefully only) verbal brawl ensuing with people with whom you interact regularly but there are ways to be politely and quietly expressive that don’t engender battles. For example, when someone is discussing the political opposition, whether they know where I stand or not, I usually say something like, “Well, I don’t agree” or “I wouldn’t vote for him/ her”. I make an effort to be not challenging and don’t always go into great detail but I never apologise for my position.

    I think that what I describe might be more suited when we’re discussing data rather than politics although both are rife with nearly religious fervor. At any rate, being able to express what you truly believe publicly is not something that is easily accomplished but it is learnable. It will make you feel better about yourself- writing and reading material like RI is also a training method. Have fun.

  8. #8 Helianthus
    March 17, 2016

    @ Todd W.

    Oh, yes, this is the typical answer and it provides an easy way out.

    I’m wondering how much of this position is a strawman (“herd immunity” is narrowly redefined as “vaccine-induced immunity”) and how much it is outright germ denialism.

  9. #9 Brian Bruce
    United States
    March 17, 2016

    “Dr. Omer is a Professor of Global Health, Epidemiology, & Pediatrics at Emory University, Schools of Public Health and Medicine. He is also a faculty member at the Emory Vaccine Center. He has conducted multiple studies – including vaccine trials – in Guatemala, Uganda, Ethiopia, India, Pakistan, Bangladesh, South Africa, and the United States. Dr. Omer’s research portfolio includes clinical and field trials to estimate efficacy and/or immunogenicity of influenza, polio, measles and pneumococcal vaccines; studies on the impact of spatial clustering of vaccine refusers; and clinical trials to evaluate drug regimens to reduce mother-to-child transmission of HIV in Africa. He has conducted several studies to evaluate the roles of schools, parents, health care providers, and state-level legislation in relation to immunization coverage and disease incidence. Dr. Omer has published widely in peer reviewed journals including the New England Journal of Medicine, JAMA, the Lancet, British Medical Journal, Pediatrics, American Journal of Public Health, and American Journal of Epidemiology.”

    I don’t know…it doesn’t say anything about him doing Google research, so how much of an expert could he be? 🙂

    On a more serious note, I am also dumbfounded by those who deny herd immunity. It’s not like it’s a complicated medical theory, it’s basic probability! The fewer times you are exposed to a disease, the less likely it is you’ll catch it. While we typically talk about it in terms of contagious diseases, it applies to all vectors, and it’s because of this very concept that we, for example, clean up our water supplies, control mosquito populations, and, yes, get vaccinated. Herd immunity deniers are barely above flat-earthers, IMO.

  10. #10 Darthhellokitty
    March 17, 2016

    I have an immune disorder – basically I have almost no immune system at all, and I have to supplement it with weekly infusions of human immunoglobulin. Many vaccines don’t “take” on me. I got chicken pox twice, and if I’m exposed I’ll probably get it again.

    I have to go to work to support myself like anyone else.

    I depend on as many people as possible being vaccinated!

  11. #11 Chris Hickie
    March 17, 2016

    Anti-vaccinationism is close to achieving an antipode of herd immunity–call it herd impunity. Essentially they reached it in California, with the results being the 2010 and 2014 pertussis outbreaks (in which 14 infants too young to be fully vaccinated died from whooping cough) and the 2015 Disneyland measles outbreak. For, no matter what you debate them with, they respond with bad math and this insane belief system in which they and their children are somehow above and beyond the reach of infectious diseases.

    And then they have a hissy fit when legislation is passed to protect them along with everyone else (for whom they selfishly care not a whit and never will).

    This is why I consider dyed-in-the-wool anti-vaccinationists like Bob Sears, Jay Gordon, Jack Wolfson, BL Fisher, and the NVIC to be pure, unadulterated scum.

  12. #12 Delphine
    dark roast
    March 17, 2016

    As is often the case with major articles like this, there was an accompanying editorial, in this case by Matthew Davis at the University of Michigan. Davis first notes that, in the case of pertussis, waning immunity and vaccine refusal are different challenges, but they are related. The reason is that nonmedical exemptions for childhood vaccination decrease overall community immunity and thus increase the risk of infection for children with waning immunity or, in the case of the children of vaccine refusers, no immunity at all. Outbreaks then occur, and these outbreaks provide “examples” that antivaccine activists can point to claim that the benefits of vaccination are being oversold and therefore not important for their children.

    That’s a critical point needing emphasis for the “it’s mostly adults who are responsible (especially for whooping cough)” brigade.

    I had a discussion a few years ago with a delayed/select woman, a mother of small children, who informed me that her decision was based on “I breastfeed for the first two years, and we don’t do daycare, and we eat nutritiously and mostly organic” (privilege/status) and “How many adults are up to date? They’re the ones who are the problem, not my kids.”

    In the same breath, she informed me that she hadn’t received a Tdap booster in many years but that it was recommended to her during her two pregnancies. She declined both times.

  13. #13 Delphine
    March 17, 2016

    For, no matter what you debate them with, they respond with bad math

    Yes, the inability to distinguish rate from whole numbers crops up with depressing regularity. It’s like math stopped for them around age 9.

  14. #14 shay simmons
    March 17, 2016

    For, no matter what you debate them with, they respond with bad math

    Or their own screwy brand of “logic.” The most mind-bogglinganti-vaxxer response I’ve seen was to a related article on Forbes and came from someone signing herself Warrior Mom (sounds familiar*) who smugly wrote that because the author didn’t study *people* but only studies, it was worthless.

    I’m still trying to fathom that one.

    (*I swear if I ever run into one of those so-called warrior moms in the flesh I’m going to invite her into the pit for a round of pugil sticks. Warrior, my aunt Fanny).

  15. #15 brian
    March 17, 2016

    Two of the authors of the JAMA paper (Bednarczyk and Omer) argued at the most recent meeting of the Infectious Diseases Society of America that a sustained 2% drop from present levels of measles immunization will mean that in the US “no age group would reach the 92% herd immunity threshold.” That would have serious consequences.

    As vaccination makes preventable illness rarer, for some diseases, it also increases the expected severity of each case. Because estimates of case risks rely on data for severity generated during a pre-vaccine era they underestimate negative outcomes in the modern post-vaccine epidemiological landscape. Physicians and parents should understand when making decisions about their children’s health and safety that remaining unvaccinated in a predominantly vaccine-protected community exposes their children to the most severe possible outcomes for many preventable diseases.

    http://www.ncbi.nlm.nih.gov/pubmed/25981883

    Fefferman and Naumova show that the risk that an unvaccinated precious snowflake will experience serious adverse events or die from measles actually peaks at vaccination levels that are just below that required to eliminate the disease: only slightly below present vaccination levels—as Bednarczyk forecasts.

  16. #16 AndiG
    March 17, 2016

    @ Helianthus #4

    Thank you for the welcome!

    And yep! Which is why it’s helpful to read articles like Orac’s that help to explain these concepts and the rationale / science behind them. I’m always working on ways to better communicate this type of stuff so that I am less tongue-tied in those dumbfounding situations.

    @ Denice Walter #7

    Oh I most definitely agree with you about speaking up and usually my approach is similar to yours. I dislike being silent or passive, especially in cases where I strongly disagree – in fact, I have a bit of a reputation for not keeping my opinion to myself.

    But there is some nuance to it, particularly when the discussion moves away from stating your opinion into the murkier world of two people trying to convince each other the other is wrong.

    In the case of my cousin, the whole debate kind of came out of nowhere when she started talking about refusing the hep B vaccine when her baby was born b/c it’s a sexually transmitted disease (to paint the full picture, she was telling me her baby’s birth story while I was sitting in her living room holding the sleeping newborn). Oof. From there, she was on a mission to educate me about vaccines. And though I wanted to challenge her assertions (supported by random statistics and studies I had no way of rebutting in the moment), I wanted to do so with accurate information and helpful resources. I’ve actually considered keeping a notecard with credible numbers and resources with me when I go to family gatherings so I have a quick reference and don’t misrepresent data. I can usually hold my own with logic-based arguments, but since my background isn’t in the sciences, I’m much more comfortable debating hard facts/numbers with hard facts/numbers that I can verify.

    Researching this stuff is fun for me 🙂 and respectfully navigating the conflicting opinions of those I love is…not fun…but at least keeps things interesting.

  17. #17 Delphine
    March 17, 2016

    (*I swear if I ever run into one of those so-called warrior moms in the flesh I’m going to invite her into the pit for a round of pugil sticks. Warrior, my aunt Fanny).

    You will beat your own self senseless listening to her CrossFit blather.

  18. #18 Denice Walter
    March 17, 2016

    @ AndiG:

    That’s great!

    You’ve come to the right place ( and SBM blog amongst others like Todd’s, Just the Vax, Liz’s, Raptor and LBRB) if you want to fill up note cards.

  19. #19 Eric Lund
    March 17, 2016

    the claim that parents’ freedom and right to raise their children as they see fit shouldn’t be limited by vaccine mandates because their unvaccinated children are harming no one

    The claim conveniently ignores the existence of people who either cannot or should not be vaccinated: people with suppressed immune systems, people with allergies to some component of the vaccine, and children who have not yet reached the age where they would normally get the vaccine. Such people are protected only by herd immunity, and the refusal of the anti-vaxers to vaccinate their kids endangers the former group.

    As for the argument that “if your kids are vaccinated, why should you care?”: Leaving aside the issue that vaccines are never 100% effective, just because my kids[1] are not in the “cannot or should not vaccinate” category doesn’t mean that they always will be, or that I don’t know other people’s kids who may be in that category[2]. If the person attempting to debate you on this issue is of a religious persuasion, a mention of “doing unto the least of these” may be in order.

    [1]I don’t have kids, but the argument still holds: I know people who do have kids, and there is a nonzero probability that I won’t always be childless.

    [2]I am neither a medical professional nor a school official. So other than obvious cases of “too young to vaccinate”, it’s none of my business whether somebody else’s kids are in the “cannot or should not vaccinate” category. Therefore, just because I don’t know anybody to be in this category doesn’t mean I don’t know anybody in this category.

  20. #20 Gray Squirrel
    March 17, 2016

    AndiG-

    Stick around, you’ll find plenty of solid information in this blog.

    One thing you might try is “statistics education via fun facts & games.” By which I mean, come up with innocent-sounding fun items that can help teach your cousin about statistics, and that are easy to demonstrate with ordinary arithmetic.

    There’s an example having to do with the number of people on an airplane who have the same birthday. I don’t recall it offhand but someone here might. The way it works is, an uninformed person is likely to seriously underestimate the probability that someone else on their flight has the same birthday as themselves. The actual probability is much higher, and the math it takes to demonstrate this is simple enough that most people can follow it.

    The key here is to come up with stuff that’s interesting and fun, but doesn’t appear to have anything to do with vaccination or public health. And when you’re doing this, don’t even mention vaccination or public health in the same visit. Just stick to the fun & games, and count on the fact that the information will sink in.

    —-

    Something I’ve found can work with people who have a strong personal stake in valuing their intelligence: “Oh, you’re too smart to let those dumb bunnies tell you what to think!”

    —-

    Re. marginal herd immunity levels:

    To put this bluntly, if Trump becomes our next President, his outspoken anti-vaccine views may be sufficient to tip the balance and bring on some large outbreaks. These he will blame on Muslims & Mexicans, rather than on the popularity of anti-vaccine views that he himself promotes. That in turn has potential for stirring up outbreaks of hate crimes.

    We all have a stake in preventing those outcomes. If that means compromising a little on your preferred general election ticket, so be it.

  21. #21 Peggy Cihocki
    March 17, 2016

    I know from experience that anti vaccination loons think that herd immunity means that everyone else’s vaccines have to work in order for mine to work. The idiots they listen to must tell them that, because I’ve heard it from more than one anti-vaxxer. There are even memes to that effect that they love to use. The stupid, it hurts.

  22. #22 Rich Bly
    Ocean Shores
    March 17, 2016

    In many ways the battle between vaccinating and not is a PR battle. Unfortunately, by its very nature science doesn’t translate well to the masses. The term herd immunity may have connotations for many of cattle or other herd animals. In their mind they are not animals.

    Possibly a better term might be community immunity or something similar.

  23. #23 Orac
    March 17, 2016

    “Community immunity” is the term used in the accompanying editorial.

  24. #24 Rich Bly
    Ocean Shores
    March 17, 2016

    Thanks Orac.

    I don’t have easy access to the editorial.

  25. #25 Orac
    March 17, 2016

    Yeah, when they consider an article important enough to be made open to the public, they should do the same thing with the accompanying editorial.

  26. #26 Eric Lund
    March 17, 2016

    There’s an example having to do with the number of people on an airplane who have the same birthday. I don’t recall it offhand but someone here might.

    I haven’t heard a version specifically about airplanes, but yes, the math is simple and straightforward. Calculate the probability that there are no common birthdays among a group of N people. (I will neglect leap days in what follows.) Assume that all birthdays are equally likely. The first person can be born on any day of the year. The second person has a 364/365 probability of having a different birthday. Multiply by the probability that the third person has a different birthday from the first two, which is 363/365. You should be able to see that the Kth person has a (366-K)/365 probability of having a distinct birthday from the previous K-1 people, so keep on multiplying factors like that. The probability P that N people will have N different birthdays is therefore P = (365)! / [365^N * (365 – N)!]. It turns out that for N = 23, P drops below 0.5, meaning that a random group of 23 or more people is more likely than not to have at least two people who share a birthday. These days, it’s rare to have a flight (even a commuter flight) with fewer than 23 passengers aboard.

  27. #27 Kiiri
    March 17, 2016

    Personally the thing that bothers me is the argument that parents ‘own’ the children. They aren’t property. I have come across this several times and it really rubs my fur the wrong way. In my view, when you have a child you are consciously choosing to do the best you can for that tiny human life. You are choosing to feed them properly, to educate them, and to protect them to the best of your ability. It should not include the right to expose them to needless risk by refusing a safe medical intervention like vaccines. The risk of injury is low, and the benefit is great, both in terms of preventing illness and death but alleviating suffering. I also hate the argument anti-vaxxers use against the Hep B shot. It is not only spread by sexual contact and if acquired as a child in particular can be devastating. There is no cure, and it can lead to liver damage severe enough to result in death. Anyone arguing that they ‘own’ their children I just find completely distasteful. Should they be allowed to work the child? Should the be allowed severe physical punishment? Should they be allowed to sell a child into marriage at a young age? You don’t own your children period. You guide them, you nurture them, you protect them. And that means vaccinate them. End of rant.

  28. #28 Todd W.
    http://www.harpocratesspeaks.com
    March 17, 2016

    @AndiG

    I hope Orac will indulge me putting in a shameless plug for a page I put together a number of years ago that addresses a lot of anti-vaccine myths. It’s not exhaustive, and there are other blogs and pages (as Denice notes) that have more info, but it’s a good primer: http://antiantivax.flurf.net/ (aka The Truth About the Evils of Vaccination).

  29. #29 AndiG
    March 17, 2016

    @Todd W.

    Awesome! Thanks for the link. I haven’t seen this one yet.

    I regularly read a slew of skeptical blogs and other pages (some of which Denice already noted), but I am always happy to learn about more.

  30. #30 Denice Walter
    March 17, 2016

    In other anti-vax news…

    AoA welcomes a new contributor, commenter LInda1, who presents an allegory ( perhaps it’s more of a roman a clef due to its length) that drones on and on about how wily plumbers find a way to guarantee additiona; work for themselves ( with governmental enablement) by *drilling* holes in pipes to prevent leaks ( Oh right! just like vaccines which prevent disease really cause disease- in their fevered imaginations, at least).

    As someone who enjoys language and likes to play around with its peculiarities, I find the characters’ names ( for politicians, television presenters, doctors) she creates just embarrassingly simple and amazingly inept
    .
    Seriously, this article gives Stagliano’s parodies/ satires/ jokes a run for their money. Not that they’re worth money.

  31. #31 THS
    March 17, 2016

    Community Immunity is a good term. But, not a joke, unfortunately, there are people who all, like, communism (Gubment; sochalism) in response to community anything. These types often are anti-vaccination.

  32. #32 Chris
    March 17, 2016

    I often tell those who do not vax that they should thank their responsible neighbors who vaccinate. Those who keep the level of immunity high in their area are protecting the anti-vaxxers family from many nasty diseases.

  33. #33 Diane
    Palacios, TX
    March 17, 2016

    I hear it under various terms…”health freedom”, ‘big government”, “who knows better for the children” blah blah blah. Where do I hear it? from very conservative Christians. Raw milk? why should the government stop me from making me (and my family) sick? This is not from a Libertarian point of view, either. I’m slammed from all sides – liberal, conservative, etc. People are actually *afraid* of sharing pages on FB (i.e. Light for Riley, he died of whooping cough in AU) because their friends are anti-vax. It is (to me) a matter…does it work? does it not work? but evidently that makes too much sense. Drives me crazy!

  34. #34 Denice Walter
    March 17, 2016

    @ Diane:

    I believe that you live in Woo-topia:

    obviously, Dr Burzynski ( Houston), Wakefield and Krigsman ( Austin), Mike Adams/ Natural News ( Austin/ Cedar Creek), Gary Null/ The Villa Health Resort ( Mineola), Jake Crosby
    ( anti–vax grad student, Austin), Alex Jones, all around crank ( Austin), Thinking Mom Thalia Michelle Seggelink ( anti-vax, legal weed activist) and many more.

    At least two of them ( Adams and Null) re-located because of health freedom friendly laws. Andy went wherever someone would pay him after being struck off.

  35. #35 sadmar
    March 17, 2016

    Inherent in Rich Bly’s #22 point that PR matters: the tide of “the battle between vaccinating and not” that determines whether uptake rates threaten community immunity is decided by parents who can be persuaded one way or the other. The sorts of ideologues who will reject anything ‘community’ are beyond reach. So are anti-vaxers, by which I mean people for whom antivax ideology is a form of identity, to the point where they express passionate advocacy for it in public forums. The questions, then, are: 1) how many likely vax-refusers are NOT hard-core true-beiievers, 2) what exactly do these folks think and why, 3) what are the key factors in their decision-making, and 4) what constitutes effective counters to those tendencies. For pretty much any social phenomenon defined by behavior, the population that engages in that behavior can be mapped in concentric circles of commitment that both lessen and change moving away from the center. The hundreds of thousand of primary voters who pull the level for The Donald are not necessarily just watered-down versions of the wing-nuts who spend half-days Tweeting fealty to The Donald. And for even those who might be at different degrees along similar lines from the ‘core’, the watered-down-ness matters, as the remainder of their world-views may contain any number of contrary impulses that could be activated with the right sort of encouragement.

    I submit that while we may know a lot about anti-vax ideology, we know very little about the wider terrain of beliefs held by potential vax-refusers. Focusing on the former is both needlesly discouraging and likely to send efforts to improve vax uptakes down a variety of dead ends.

  36. #36 Chris Preston
    Australia
    March 17, 2016

    I was last night reading some old newspapers regarding the doings of my ancestors and came across the following death notice in a newspaper of not all that long ago:

    “On the 22nd February at Killanne Rectory, Enniscorthy, of whooping cough, Honoria Louisa, fourth daughter of, and, on Feb 28., Elizabeth Mabel, youngest child of the Rev. J. S. Cooper.”

    It is important to note that the two girls were aged 11 and 8.

    Medicine has come a long way since the 1870s, but it still highlights the fact that pertussis is no walk in the park for older children either.

  37. #37 Lesley
    Rural Missouri
    March 18, 2016

    I was struck by sadmar’s comment on post #35:
    “I submit that while we may know a lot about anti-vax ideology, we know very little about the wider terrain of beliefs held by potential vax-refusers.”

    I went down a very “vax-skeptical” path in my 20s and 30s. It ended quickly when I became pregnant with my twins and began to research.

    I can give some insight into how I became skeptical and how close I was to beIng an anti-vaxer.

    In the early 2000s, I began work as a teacher’s aide is special education. I became very immersed in the community of people with children who had special needs.

    One child had autism. This was around 2002 or so. His parents related to me that he had high fevers at the time of his MMR shot and then his signs of autism began. They strongly felt that the shot caused his autism.

    Later, in 2005 or so, I began working for a close friend and her teenage son with severe autism. She related the same experience. For her it was heartbreaking to think she might have caused his autism and she was very angry. We were both in graduate school (although not hard science — she in communication disorders and me in English) and very much believed we were intelligent, informed people. Our theories made sense. There was logic to them. Her son had been so sick after the MMR that he was hospitalized. Why wouldn’t the two be related?
    In this same time, out of the probably hundred families I came into contact with, I met two more who had vaccine stories. One was an allergic reaction to a vaccine that sent a child into life-threatening seizures and she suffered brain damage. The child was now my age and severely impaired. The other was from a coworker who had a baby die of SIDS the night after he was vaccinated.

    My long-winded point is that confirmation bias is a real thing. I felt at a gut-level that all of these painful stories couldn’t be coincidences. it took much reading for me to get over the fact that my experiences and my friends’ experiences are not science.

    Blaming a vaccination for pain and suffering is a human thing to do when there is nothing else to blame. I think the anti-Vax people have an advantage in that they are sympathetic to the pain of people who believe their children were hurt or killed by vaccines. If the pro vax people are going to have a shot at saving lives, we are going to have to be sympathetic and understand the pain behind these stances.

    Vaccinations are a painful subject between my friend and me. She feels her child’s future was sacrificed so that people like me could know the dangers and that I invalidate all of her painful experiences by choosing to ignore her story.

    Science can’t compete with gut- level anguish like that.

  38. #38 Murmur
    UK-ia
    March 18, 2016

    Kiiri #27

    Fortunately over here we have a legal concept called “inherent jurisdiction”, which means that ultimately the high court can decide what is in a child’s interests when the parents are being incompetent numpties…Just this week (can’t find a link – sorry) there was a ruling that some bairns should be vaccinated despite their mother’s objections.

    And as for Hep B being “sexually transmitted”, is that why the NHS insists that all clinical staff are vaccinated against it? Or might there be other means of transmission?

  39. #39 Murmur
    UK-ia
    March 18, 2016

    Aaaah, found a link to that story – not a completely straight forward anti-vax one…

    http://www.theguardian.com/uk-news/2016/mar/17/court-rules-four-children-must-have-vaccines-after-mother-objects

  40. #41 Helianthus
    March 18, 2016

    @ Murmur

    And as for Hep B being “sexually transmitted”, is that why the NHS insists that all clinical staff are vaccinated against it? Or might there be other means of transmission?

    The way you write it, I’m suddenly interested to hear about your experience with UK clinical staff 🙂

    Like other hepatitis viruses, HepB could also be transmitted by blood-to-blood contact. Hence some good basis for strongly recommending the vaccine for people working with biological fluids and/or medical needles, from hospital staff to medical labs.
    It’s the same deal with HIV, except that there is no anti-HIV vaccine (yet). Regularly, unlucky nurses fumble while recapping a soiled needle and prick themselves, and sometimes end up getting infected. It’s actually easier to catch an hepatitis than AIDS, as the hep viruses are more infectious. More reasons to get the vaccine.

    There are also been cases of HepB transmission between family members, or between kindergarten toddlers, trough saliva. Enough for the CDC to support HepB vaccine for newborns.
    Well, that, and it has been found by the CDC that, in order to decrease the transmission of HepB, it’s easier to vaccinate toddlers than to expect teenagers to avoid taking risks…

  41. […] I wrote about a systematic review of the medical literature regarding measles and pertussis outbreaks that demonstrated quite convincingly that, for these two […]

  42. #43 Alia
    March 18, 2016

    Just yesterday, a story was making rounds over here in Poland. Some parents decided that “natural” immunity would be better for their 18-month old so they took the kid to one of those chickenpox-parties. The poor child died.

  43. #44 Delphine
    March 18, 2016

    My husband didn’t catch chicken pox until he was a teenager, despite repeated exposure. This was pre-vaccine. He had chicken pox everywhere. If you know what I mean. And I think that you do.

  44. #45 Julian Frost
    South Africa
    March 18, 2016

    Only too well, Delphine. I caught chicken pox in Standard 5. I remember being on my hands and knees, naked, while my mother dabbed calamine lotion on my spots.

  45. #46 JustaTech
    March 18, 2016

    Murmur @38: Or you can catch HepB when a health care worker with an addiction problem goes around swapping syringes to steal drugs.
    There was a guy in Colorado who got caught this week doing that and now several hundred people who might have been treated by him have to get tested for HIV, HepB and HepC.

  46. #47 Narad
    March 18, 2016

    Just yesterday, a story was making rounds over here in Poland.

    Not-very-good G—le Translate account here.

  47. #48 Narad
    March 18, 2016

    ^ Blockquote fail, I hope, is obvious.

  48. #49 Narad
    March 18, 2016
    He had chicken pox everywhere. If you know what I mean. And I think that you do.

    Only too well, Delphine. I caught chicken pox in Standard 5. I remember being on my hands and knees, naked, while my mother dabbed calamine lotion on my spots.

    Back when I was little, my dad’s aunt’s son (I’ll never figure out the nomenclature of cousins) – who had Down syndrome – maybe seven years’ my senior, was staying with us and came down with a bad case. I vividly remember a similar scene.

  49. #50 Darthhellokitty
    March 18, 2016

    I’ve had it twice, once around six and once around 14. It sucked both times.

  50. #51 shay simmons
    March 19, 2016

    Oh, but that’s impossible, kitty! Everyone knows that catching this harmless disease naturally gives you lifelong immunity!

    (//snark//).

  51. #52 Murmur
    UK-ia
    March 19, 2016

    Heianthus and JustaTech – for the avoidance of doubt I was being sarcastic about the other means of transmission of Hep B…And for the best part of 30 years I was a NHS clinician…And a non-responder to Hep B vaccination, as they eventually decided after 3 full courses and boosters.

    Oh, the perils of a text-based medium.

  52. #53 Still Shaking Mama
    United States
    March 19, 2016

    I am formerly vaccine-hesitant, surrounded by many “true-believer” anti-vax friends. After we very nearly lost our 3yo to pneumococcal pneumonia in August 2014*, it was interesting to see my friends’ reactions to the diagnosis. For most, they seemed to be visibly shaken, when hearing the news. One family of 7 who’d been behind got all their kids caught up. One countered with the anecdote of how her 8 kids got chicken pox from their private school and that “many” of the other students who got it had been vaccinated. One seemed to be shaken in her anti-vax stance, and we had a few conversations about vaccines. But as things calmed down and our son got better, most of my friends returned to their anti-vax beliefs.

    I sometimes wonder if it would’ve made a difference for these parents if our son had died? I hate to think that for most parents, that’s what it would take. After reading the recent case about the 18mo boy who died of meningitis, not even that seemed to be enough.

    *If you read the Introduction of Seth Mnookin’s “Panic Virus,” that is very similar to our experience with our son. 3yo underimmunized healthy boy, very sudden onset, critical condition in ICU (9 days for our son), same dumb-struck, guilt-ridden parents. I read that book a couple of months after our son was sick and couldn’t believe the parallels. It was a nightmare – especially when I learned it could’ve been avoided.

  53. #54 Still Shaking Mama
    March 19, 2016

    One more thing … and this may sound strange. But I vividly remember, on hearing “Pneumococcal Pneumonia” feeling total shock that the illness — the bacteria itself — was, well, real. I would compare it to hearing stories when you were a child about a scary monster and then growing up and thinking it was just a made-up story. And then seeing the monster face to face.

  54. #55 Delphine
    March 19, 2016

    I sometimes wonder if it would’ve made a difference for these parents if our son had died?

    For the true believers, I don’t think so. For the fence-sitters, yes/maybe. It’s been said many times that vaccines are a victim of their success. My mother lined up for a few hours to get her polio shot when it became available. Nobody was refusing it – they were all sh!t scared of polio, because everyone knew a family who had been affected. But it can be relatively easy to dismiss vaccines if you’re willing to dismiss or revise history.

    My daughter sees a pediatrician who hails from Kolkata. He is an older man who walks with a pronounced limp. It’s right there in front of us sometimes, if we’re willing to look. Like the measles scar on my uncle’s face, or all of the little headstones in the graveyard up the road.

    One countered with the anecdote of how her 8 kids got chicken pox from their private school and that “many” of the other students who got it had been vaccinated.

    I hope this person is no longer your friend.

    I’m glad your boy is fine. His illness must have been truly terrifying for everyone involved. 🙁

  55. #56 Delphine
    March 19, 2016

    Thanks, Narad. I went looking for info and didn’t find anything, so thanks for the link.

  56. #57 Alia
    March 19, 2016

    I had chicken pox when I was 22. It was a nightmare. Fortunately, my mother (a retired nurse) was able to move in with me, because I simply do not remember the first week very well – I had high fever and constant headache. Once I learn that headache was a typical side effect of antiviral medication, strangely enough it cheered me up – I was scared stiff of viral meningitis, which is a possible complication of chicken pox. I got better after three weeks, but I will bear a few scars on my face until the end of my life. Not that I notice them much nowadays, you get used to such things.
    A friend of mine has caught chicken pox just recently. She was vaccinated but it seems that the vaccine does not work very well in adults. But it seems that in her case it’s not that bad, so perhaps the vaccine helped.

    @Delphine – my mother-in-law also remebers how her mother took her to get polio vaccine. This was 1959, when late Hilary Koprowski arranged for 9 million vaccine doses to be sent to Poland.

  57. #58 JP
    March 19, 2016

    Back when I was little, my dad’s aunt’s son (I’ll never figure out the nomenclature of cousins) – who had Down syndrome – maybe seven years’ my senior, was staying with us and came down with a bad case. I vividly remember a similar scene.

    I also managed to get it twice, like a commenter above, once a few spots as a baby, the second time much more severe. It was no fun, to put it mildly, and I still remember it quite vividly.

    Not quite as bad as the time I got ambushed by yellow jackets while picking cherries as a three-year-old, though. I remember that well, too; pain probably has something to do with it. The first thing I thought was “oh no, nettles,” having encountered them before, and the next thing I was screaming bloody murder. My aunt came running out thinking I’d broken my leg.

    I think I was on antihistamines or something, because the actual recovery is much more vague in my memory, although I remember lying stiff and miserable on the living room floor watching rented cartoons. Aquaman in particular sticks out in my mind.

  58. #59 Denice Walter
    March 19, 2016

    “( I’ll never figure out the nomenclature of cousins)”

    Your father’s aunt’s ( your great aunt’s) child is his first cousin and your first cousin, once removed.
    I have cousins by the dozens: first, first once removed, twice removed,second cousins etc etc. on both sides of the Atlantic. A few relatives keep records/ looked up ancestors.

  59. #60 JP
    March 19, 2016

    Isn’t a first cousin once removed the same as a second cousin? In my family, we just used the “first, second, third, fourth,” nomenclature.

    I also have boatloads of cousins. I even have one cousin (third or fourth) who was rumored to be a “kissing cousin” of mine when we were teenagers. (Not true, we just liked going off together while camping to get away from the younger kids. And we got along really well. Such things are not entirely unheard of in big families, though, I’ve heard.)

  60. #61 LW
    March 19, 2016

    “Isn’t a first cousin once removed the same as a second cousin?”

    No. Your first (second, third, etc.) cousin is of the same generation as you. Once removed means one generation up or down, twice removed means two generations up or down, and so on.

    Thus, if we start with the common ancestor of the people in question (Narad’s great-grandparents and his dad’s aunt’s parents), the first generation down is siblings (Narad’s grandparent and his dad’s aunt). Those in the first generation below siblings are first cousins (Narad’s dad and his dad’s aunt’s son). Since Narad is one generation below his dad, his dad’s aunt’s son is his first cousin once removed. If his dad’s aunt’s son had a child, that child would be Narad’s second cousin.

  61. #62 JP
    March 19, 2016

    Whew! Seems like an appropriate place to leave this song.

  62. #63 LW
    March 19, 2016

    When I was working in a law office, we had a case where a woman in her nineties died with no known heirs. We hired a private investigator to track down her heirs based on census records, gravestones, and so on, and I was responsible for drawing out the family tree so we could figure out who was entitled to what. We ended up with over a hundred heirs.

    Some of the heirs told me that the best thing they got out of the estate was that family tree.

    It’s a small world. One of the heirs found she lived down the block from her fifth cousin twice removed. Another heir was the mother of someone I went to school with.

  63. #64 Narad
    March 19, 2016

    Thus, if we start with the common ancestor of the people in question (Narad’s great-grandparents and his dad’s aunt’s parents), the first generation down is siblings (Narad’s grandparent and his dad’s aunt). Those in the first generation below siblings are first cousins (Narad’s dad and his dad’s aunt’s son). Since Narad is one generation below his dad, his dad’s aunt’s son is his first cousin once removed. If his dad’s aunt’s son had a child, that child would be Narad’s second cousin.

    OK. So the children of my dad’s cousin are my second cousins? And my first cousin’s children are also (in addition to the older cousin that started all this) my first cousins once removed, i.e., the delta-removed is an absolute value?

  64. #65 LW
    March 19, 2016

    “the children of my dad’s cousin are my second cousins?” Yes, that’s correct.

    “And my first cousin’s children are also (in addition to the older cousin that started all this) my first cousins once removed” Yes, also correct. The “once-removed” goes either up or down. The relationship is symmetric.

  65. #66 Johnny
    127.0.0.1
    March 19, 2016

    This video helped me understand the ‘removed’ cousins. it’s about 4 min long

  66. #67 palindrom
    March 19, 2016

    My sisters married men who were cousins of each other (not us). They both had children, and their children are both first and second cousins. All of them are long grown up, and fortunately none of them took a fancy to each other …

  67. #68 LW
    March 19, 2016

    My mother’s parents were second cousins once removed, making my siblings my fourth cousins once removed…

  68. #69 Narad
    March 19, 2016

    The “once-removed” goes either up or down. The relationship is symmetric.

    Thanks. Trying to reason from first principles just plain never imprinted. (My parent’s vocabulary seemed to stop time – everybody was cousin this or uncle that, except for my mom’s great aunt, who was “great aunt something-or-another.”* I take it that she was just my great-great aunt.)

    Two specific reckoning points are much more helpful.

    * I’ll save the story of the one visit for another time.

  69. #70 Narad
    March 19, 2016

    My mother’s parents were second cousins once removed, making my siblings my fourth cousins once removed…

    Is it possible for one person to fall into more than one cousin-classification bin?

  70. #71 palindrom
    March 19, 2016

    Is it possible for one person to fall into more than one cousin-classification bin?

    Narad — See my comment #67. Or was that not your meaning?

  71. #72 herr doktor bimler
    March 20, 2016

    “the children of my dad’s cousin are my second cousins?”

    The prefix part of the nomenclature works back to the closest common ancestor, while the suffix part is the difference in generational terms. I think

    Is it possible for one person to fall into more than one cousin-classification bin?

    So if someone is (a) a second cousin, once removed, and (b) a first cousin, twice removed, which takes precedence?

    This is why I hate object-oriented programming.

  72. #73 Narad
    March 20, 2016

    Narad — See my comment #67. Or was that not your meaning?

    Oh, no, that clarifies things, thank you. I had reached the point of imagining some sort of graph-theoretic result, but I was so tired Thursday night that I (couch-?) locked on prime gaps until my head finally followed suit, which may still be coloring my confusion.

  73. #74 Narad
    March 20, 2016

    So if someone is (a) a second cousin, once removed, and (b) a first cousin, twice removed, which takes precedence?

    I’m guessing depth-first vs. breadth-first.

    This is why I hate object-oriented programming.

    This is where one finds the bestest language of them all. (As I pay little attention to programming languages these day, I don’t know whether T’s charming – and APL-like – mapq survives in some native form.)

  74. #75 JSmith
    Waterloo, Canada
    March 20, 2016

    I am so sick of the smug arrogance of medical science types. If you look through the history of scientific discovery and advancements, you find so many example of these bogus belief systems being overturned by new data, and better theories. Sure, vaccines provide some benefits. But these are collective benefits to all, which might will come at extreme, terrible cost to certain specific individuals. As a child, and as an adult, I took all the vaccines and shots that were on offer. But I recall vividly how awful these things made me feel. Every year, public health authorities would offer flu shots. I would get them. And I would get an awful flu. Sure, an unscientific sample of one. Crumby t-statistic, I know. And then I was due for some foreign travel, so I paid 100 bucks out of pocket, and got the Twinrix vaccine for Hep. A and B, and I damn near died. I remember just getting so sick – which may actually have had nothing to do with actually getting the vaccine – I lived in a stinking, overpopulated big city. RIde the subway, and you are eating the air of every coughing slag on the car. So it’s entirely possible that these awful flu’s and colds I would get were not even related to the vaccines. But they sure felt like it.

    See, we actually know not enough about how most of these vaccines actually work. And in the 1990’s, I have learned, the egg-based vaccines turned out to actually be known to have very severe side-effects for *some* people. Perhaps I was one. By late 1990’s, I just decoupled completely from all this vaccine and flu-shot pseudo-science – which I honest believe some of it actually is. I am a very scientifically oriented person, with a serious focus on what is true and what is false – and especially on what is unproven. And I can say, having not had *any* flu-shots, or vaccines, has been better. We avoid interaction with medical agents at all costs, and are in seriously better health as a direct result. Since we live in Ontario, Canada, avoiding doctors and the witches brew they pedal, is not difficult, as our socialist medical model uses a “denial of service” strategy to reduce the growth rate of health care costs. So avoiding doctors here is real easy.

    See, many (not all, but *many*) modern drugs are just plain bad medicine. The doctors didn’t even know about chiral molecules until the thalidomide tragedy happened. Most doctors, many medical scientists, and virtually all public-health officials are the worst kind of extreme-arrogant people. They craft their particular world-views, and then are completely unwilling to listen to alternate views – especially the views of sick people. So basically, unless you are carried, bleeding, into an Emergency Room, you generaly better off avoiding doctors (and their questionable, possibly toxic medicines).

    I disagreed with this view when I was young. I was all gung-ho; “Science can fix anything!” kind of fellow. That is just wrong. I now realize that often the best course of action is to follow rule number one – first do no harm. And that rule is violated by just about every med-tech and white-coat I ever had the misfortune to have to have dealings with.

    Seriously, if you are a real scientist, you must know just how crappy, and unscientific pretty much the entire history of medical service delivery has been. We think it is so much better now, but please hear me on this – *It is NOT*. The whole business is not much improved from the beliefs like “malaria” comes from “bad air”, and bleeding sick people with leeches can help them heal faster.

    Sure, some vaccines for some people will confer a temporary immune response – maybe. And maybe not. But these widespread innoculation campaigns may have other “side effects”. Like increased chance of autism? Not likely, but maybe. Something is certainly wrong. Talk to any teacher now – these “special needs” kids – kids with real problems – are *everywhere*, and their numbers appear to be increasing. There is something signficant happening at the societal margin. I talk with a lot of people about what they do, and how things are going. Ask any LEO (police or law enforcement person), and query their view. Something is going wrong, at the collective level, and it is not just in the USA. It is being noticed in Canada and Japan. Increasing numbers of young people are turning up in these “special needs” categories – or showing evidence of serious behaviour problems.

    And I have not had a flu, or a cold, since I stopped getting flu shots. Not scientific, I know. But it’s been over 13 years now. Every year, I would get the flu shot, and every year, I would get a nasty flu. Once I stopped having flu virus injected into me each year, I stopped getting influenza each winter. How about that?

    I still think kids should get the basic, known vaccines, assuming there has been good, solid scientific testing for side-effects, and the production controls are adequate and audited. But so much is just plain wrong and poorly done now. Parents and patients have the right – and the responsibility – to question their medical service providers – doctors and nurse-practitioners – who should then address any questions people have, and public authorities should make sure things are being done right. That might mean tailored dosages for specific different types of people, based on their personal characteristics. The current “one size fits all” approach might be part of the problem.

    And folks who do not want to get involved with vaccines, or have their children vaccinated, should have their choice respected. There may be useful science that results from an increased occurance of some ailments.
    This sounds harsh and awful, but it might be part of the evolutionary model. Global population is at 7.4 billion, as of March, 2016. This is perhaps already too many, for our long term planetary survivial, and an increase in childhood mortality may be both beneficial and necessary for the survival of the human species. My Mathusian bias is showing, of course, but all you need to have massive die backs, are geometric growth in breeding pairs, and linear growth in available food and housing resources, to have the curves cross, and mass diebacks begin.

    It is quite possible that “vaccine hesitancy” will increase the mortality of the offspring of the mentally weak and the socially unfit, in exactly the way that a Darwinian would predict that it should, and that this trend will be very net-positive for the medium and long term future of the human species. I am perfectly serious here. The USA is one of the few modern, rich states where fecundity still is close to 2. Current figures put it at 1.9, but it has historically been over 2, until recently. (Europe averages around 1.6, as does Canada). Of course, you need a rate of 2, just to maintain population levels. India, for example, averages 2.3. The global (all-Earth) fertility rate is estimated to be roughly 2.5. In places like China and India in the 1950’s, it rose as high as 6 and 7, for a time.

    Global population of 10 to 15 billion people, which it is estimated to be at by 2100, will probably be quite unpleasant. And in all evolutionary models, and observed populations, whenever population pressure reaches levels where resource-constraint becomes evident, behaviour changes occur that seem to act to limit and reduce fertility. So, bottom line basically is vaccine avoidance might be a good thing, especially if it has a clear Darwinian aspect, in that it perhaps selectively targets the mentally weaker segments of the population, that are already overproducing children of questionable quality. Sure that sounds harsh, and one sounds like a facist for even talking about it, but it still might be a real, solid phenomenon with a clear scientific outcome.

    Over time, the even-hand of evolution, will cull the low quality off-spring of the weaker members of the species, resulting in a stronger, healthier – but somewhat smaller – herd. And clearly, that smaller herd will have better immunity to common sicknesses. This is a good result.
    So perhaps vaccine avoidance is a self-correcting problem, with both medium and long term benefits.

  75. #76 JP
    March 20, 2016

    (My parent’s vocabulary seemed to stop time – everybody was cousin this or uncle that,

    Same here. There’s one woman who was “aunt Helen” to my mom but actually my grandma’s niece, which I guess made her and my mom first cousins, and she and I first cousins once removed.

    My grandma herself was “auntie Ben” (short for Benora) to a whole gaggle of cousins.

    Then there’s my mom’s cousin Darrell, who was more of an uncle figure, who I guess would also be my first cousin once removed. He and his family lived almost next door, and my (second? third?) cousin Jake and I used to raise worms and sell them to fishermen driving through “town.” They were also good for freaking out the girl cousins, as were the crawdads we would catch when we were out camping.

  76. #77 JP
    March 20, 2016

    ^ Jake co-owns a taqueria now. He married well. His Spanish is even passable these days.

    We used to take turns hiding the local immigrant kids when INS came around.

    “No, sir, I haven’t seen Juan Pablo today. Have you checked over at the neighbors? He goes over there to play pretty often.”

  77. #78 Lazy linking
    March 20, 2016

    […] One more time: Vaccine refusal endangers everyone, not just the unvaccinated […]

  78. #79 Johnny
    127.0.0.1
    March 20, 2016

    And I have not had a flu, or a cold, since I stopped getting flu shots. Not scientific, I know. But it’s been over 13 years now. Every year, I would get the flu shot, and every year, I would get a nasty flu. Once I stopped having flu virus injected into me each year, I stopped getting influenza each winter. How about that?

    Behold, the power to raise a virus to life, just by having that virus, previously cold and well dead, injected into his person.

    Behold, the power to create a new living virus, from the dead remains of a completely different virus.

    Could this humble human have the power of the Creator?

    What else could explain how an injection of a dead flu virus could cause a cold or ‘nasty flu’? Some might say this sounds like a case of someone who, after receiving a flu shot, picked up an entirely unrelated bug that caused an upper respiratory infection. But I say ‘no’! After all, if flu shots worked, they would not only prevent Influenza, but all sniffles and sneezes.

  79. #80 Alia
    March 20, 2016

    It’s anecdata vs. anecdata but I’ve been getting my annual flu shot every autumn for the last 13 years – and no flu in all this time, while before I would get a flu every 2-3 years. The same goes for my husband. And while he mostly works from home, so not many chances to get infected, I work at a high school with 650+ students and 70+ staff, we went through flu epidemics a few years back and I was one of very few teachers who did not have to go on sick leave (while my colleague ended up with heart problems).
    Of course, I get through 2-3 colds every season, last one (started 2 weeks ago) was rather nasty and took the whole week, but still it wasn’t flu.

    I did have a very unpleasand reaction to Hep B booster shot (I did require it, checked my antibody titers beforehand and it seems I’m one of those people who have very weak reaction to this vaccine) – two days of very high fever and generally feeling like I was going down with the flu, but it resolved abruptly after just two days.

  80. #81 Julian Frost
    South Africa
    March 20, 2016

    @JSmith:

    Over time, the even-hand of evolution, will cull the low quality off-spring of the weaker members of the species, resulting in a stronger, healthier – but somewhat smaller – herd. And clearly, that smaller herd will have better immunity to common sicknesses. This is a good result.
    So perhaps vaccine avoidance is a self-correcting problem, with both medium and long term benefits.

    Achievement unlocked. You are Adolf Hitler.

  81. #82 Ellie
    On the green side of the grass
    March 20, 2016

    It has been my experience over many decades, that those who talk about “culling the herd,” generally do not believe that would ever involve themselves, but…I’ve got a little list.

  82. #83 Chris
    March 20, 2016

    “Over time, the even-hand of evolution, will cull the low quality off-spring of the weaker members of the species, resulting in a stronger, healthier – but somewhat smaller – herd. And clearly, that smaller herd will have better immunity to common sicknesses. This is a good result.”

    Behold the power of eugenics from someone who does not have a clue. Here is a hint: sickle cell anemia is one evolutionary result from built in malaria resistance.

    Oh, and here is another clue: in cultures where children hae a better chance to grow up and women are educated, the population levels stabilize and cease to grow. The countries with the highest population growth are Afghanistan and Pakistan, and the ones with pretty much no population growth are ones like Italy and Japan.

    Here is a place where you can get a clue and become less ignorant:
    http://www.gapminder.org/videos/

  83. #84 JP
    March 20, 2016

    Achievement unlocked. You are Adolf Hitler.

    I was going to say something about the Soviets vs. the Nazis, but then I thought better of it. But let me say that a good Soviet (Russian, Kyrgyz, whatever) doctor would have none of this nonsense.

    So basically, unless you are carried, bleeding, into an Emergency Room, you generaly better off avoiding doctors (and their questionable, possibly toxic medicines).

    Well, my (Korean immigrant descended) psychiatrist is just fine, thanks. He’s made some mistakes that have messed me up, but we all mess up from time to time.

    Are you going to suggest we start rounding up the “white coat” doctors next?

  84. #85 Chris
    March 20, 2016

    JSmith: “The doctors didn’t even know about chiral molecules until the thalidomide tragedy happened. Most doctors, many medical scientists, and virtually all public-health officials are the worst kind of extreme-arrogant people.”

    The USA mostly missed out on the tragedies due to thalidomide because a very strong woman from Canada. Too bad you don’t know about her.

  85. #86 Chris
    March 20, 2016

    JP: “Are you going to suggest we start rounding up the “white coat” doctors next?”

    I suspect JSmith has never had to deal with real medical issues. I am sure he/she has [sarcasm] fantastic ideas on how to adequately treat type 1 diabetes, obstructive hypertrophic cardiomyopathy, seizures from measles, Hib, etc, immune disorders and mental health issues. [end sarcasm]

  86. #87 JP
    March 20, 2016

    The USA mostly missed out on the tragedies due to thalidomide because a very strong woman from Canada. Too bad you don’t know about her.

    About 75% of Russian doctors are women, a little known fact. Tough, smart ladies over there.

  87. #88 Chris
    March 20, 2016

    This woman was an employee of the FDA, and was honored by Pres. John Kennedy for her civic service to the USA. Too bad that a Canadian like JSmith is totally clueless about her.

  88. #89 brian
    March 20, 2016

    Chris wrote, “The USA mostly missed out on the tragedies due to thalidomide because a very strong woman from Canada.”

    Yes. Frances Kelsey was a Canadian with M.D. and Ph.D. (pharmacology) degrees from the University of Chicago. She worked for the United States Food and Drug Administration when she reviewed and withheld US approval for Richardson Merrell’s application for thalidomide, which had unfortunately already been approved in Canada. Most people who are concerned with drug safety know her name. She is a hero.

  89. #90 Dangerous Bacon
    March 20, 2016

    JS: “It is quite possible that “vaccine hesitancy” will increase the mortality of the offspring of the mentally weak and the socially unfit, in exactly the way that a Darwinian would predict that it should, and that this trend will be very net-positive for the medium and long term future of the human species.”

    This is a very typical outlook among antivaxers. They are superior beings doncha know, with fantastic native immune systems (helped by handfuls of supplement pills), and those at risk of serious infectious disease are weaklings who society is better off without.

    This attitude persists until they develop a serious illness manageable or curable by the medical science they detest. And even then they find excuses (it was really my apple cider vinegar/colloidal silver/resveratrol that saved me).

  90. #91 Narad
    March 20, 2016

    The doctors didn’t even know about chiral molecules until the thalidomide tragedy happened.

    Yes, nobody had heard of dextrose.

  91. #92 Graham
    March 20, 2016

    Anti-Vaxers seem to be the ‘canaries in the coalmine’ for the rise of a culture whose primary ‘motto’ is “This offends, make it go away.”

    Of course if they succeed, large numbers of people will ‘go away’ from the disease outbreaks that will inevitably result.

  92. #93 herr doktor bimler
    March 20, 2016

    The doctors didn’t even know about chiral molecules until the thalidomide tragedy happened.

    Dorothy Sayers’ co-author, under the pseudonym of Robert Eustace, was Dr Eustace Barton, a physician who also wrote medico-legal thrillers. Barton suggested to Sayers the scientific theme crucial to the novel’s dénouement, which concerns the difference between a naturally produced organic compound and the corresponding synthetic material, and the use of the polariscope to distinguish between them. He travelled to University College Hospital in August 1928 to consult colleagues and see a practical demonstration of the effect.[1]

  93. #94 herr doktor bimler
    March 20, 2016

    JSmith is “a very scientifically oriented person, with a serious focus on what is true and what is false – and especially on what is unproven”. And he or she is SO SICK of those scientists who think they know better than JSmith.

  94. #95 Chris
    March 20, 2016

    From the Wiki page on “chirality”: “The rotation of plane polarized light by chiral substances was first observed by Jean-Baptiste Biot in 1815,[17] and gained considerable importance in the sugar industry, analytical chemistry, and pharmaceuticals. Louis Pasteur deduced in 1848 that this phenomenon has a molecular basis.[18][19] The term chirality itself was coined by Lord Kelvin in 1894.[20]”

    So, JSmith just keeps verifying that they would not understand science if it grabbed them by shoulders and tried to shake some sense into their closed mind.

  95. #96 Delphine
    once again the fine dark roast
    March 21, 2016

    My Mathusian bias is showing, of course

    *Scooby giggle*

  96. #97 shay simmons
    March 21, 2016

    Why is it that extreme libertarians assume that they aren’t the ones who are going to be culled?

  97. #98 MarkN
    March 21, 2016

    I was gonna say at least JSmith didn’t use the all-caps in that diatribe of ranting jibberish, but fail, and showing again, you can’t fix stupid….that’s 10 minutes of my life I can’t get back. Some people understand the gen,o,p, & bio-chems with physiology….others, obviously, not so much.

  98. #99 Alain
    FYI
    March 21, 2016

    As of this morning, I resigned from my position at the brewery. They didn’t have a basic structure in place to meet my needs (I do think I need a minimal structure but how much, I don’t know) and I was overcompensating too much.

    Alain

  99. #100 JP
    March 21, 2016

    @Alain:

    I know how you feel, sort of. Being on fellowship historically was actually not great for me, especially what with having an almost entirely absentee advisor. At least when I was teaching Russian I had a regular schedule.

    Things are a little better now that he has tenure. He was only a week late getting back to me on the last chunk of writing I turned in, and I have regular (every two or three weeks) deadlines for turning in writing, and we have actually met about my writing twice so far. (Good reviews.)

    So that’s better for the moment, at least.

  100. #101 JustaTech
    March 21, 2016

    brian @89: I have a picture of Frances Kelsey on the wall of my cube, to remind my of costs, benefits, and the duty to the greater good.

  101. #102 JerryA
    March 21, 2016

    While I know Orac doesn’t like corrections, this one bugged me:
    “Overall, the authors concluded that vaccine refusal is associated with an increased risk of vaccine among both the unvaccinated and vaccinated…” should be ‘increased risk of disease’, right?
    JSmith- You need to take classes in basic biology, statistics, and logic before you can rise to the level of dunce. In the meantime, you’re not fooling anyone with your nonsense.

  102. #103 Sara
    March 23, 2016

    Longtime lurker.
    I’m really surprised it took so long to see responses to the original JP eugenics, etc. diatribe. I was beginning to fear that no one wanted to take it on. That’s got to be one of the scariest posts I’ve ever seen here–almost worse than the 24K woo that can easily be dispatched because it’s such an easy target. And then there was the usual passive-aggressive humble-brag about his/her background to establish some kind of scholarly bona fides for it

    I am definitely saving this thread for future reading. Chilling that an earnest and evidently sincere survival-of-the-fittest rant popped up here. Rather like an argument that it’s good for older people not to live longer and better–it saves on the end-of-life Medicare and insurance costs for everyone else, you know…..

  103. #104 Sara
    March 23, 2016

    Sorry, meant the JSmith rant….

  104. #105 elsworthy
    March 23, 2016

    Sara @#104: It’s a “drown them with my words” troll; it hits sites where vaccines are mentioned and vomits the same 10 paragraphs into any comment system that will allow it. It probably will not come back to answer any commentary directed towards it.

    I always assume people with super-excellent! immune systems will end up dying from things like ‘flu, since it’s the body’s reaction to the virus that causes the problems. My own (super-excellent!) immune system has a wee issue with telling the difference between diseases and harmless but important body parts, so I always get the ‘flu shot.

    I have multiple respiratory infections every year, but I’ve avoided ‘flu and pneumonia so far. I’m fairly certain that if I did get ‘flu, my lungs would secede, due to hostile workplace conditions. That’s what a really strong immune system will get you.

  105. #106 Hydra viridis
    Italy
    March 24, 2016

    @JSmith: Over time, the even-hand of evolution, will cull the low quality off-spring of the weaker members of the species, resulting in a stronger, healthier – but somewhat smaller – herd. And clearly, that smaller herd will have better immunity to common sicknesses. This is a good result.
    So perhaps vaccine avoidance is a self-correcting problem, with both medium and long term benefits.

    Evolution is a natural process that selects individuals before the age of reproduction, so there is no selection of stronger individuals in the population if the disease, even deadly, occurs at any age or (like cancer for example) after the age of reproduction.
    Having said that your point of view seems not so far from from what was widely practiced in ancient Greece in the case of congenital deformity: “As to the exposure of children, let there be a law that no deformed child shall live”

    http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2672651/

  106. #107 Amethyst
    The Crystal Gem
    March 24, 2016

    Over time, the even-hand of evolution, will cull the low quality off-spring of the weaker members of the species, resulting in a stronger, healthier – but somewhat smaller – herd. And clearly, that smaller herd will have better immunity to common sicknesses. This is a good result.

    Charles Darwin said something (sadly I forget the exact quote – I think it is in ‘Origins’) that humanity’s tendency towards seemingly defy evolution and natural selection by caring for the members of our species that would not survive on their own (i.e the handicapped etc.) is one of our better qualities and I very much agree with him on that.

    You’re despicable..

  107. #108 Blues
    March 24, 2016

    How about a ray of sunshine on this topic?

    A friend posted a photo o her 3 month old, band aids on legs. She had received 1 oral and 4 injected vaccines that day.

    A friend of hers asked “Why so many at one?”

    Her reply was, “Lots of diseases. Gotta keep my girl safe.”

  108. […] unvaccinated due to the religious or ‘philosophical’ objections of their parents, an outbreak of these diseases can easily spread. As Orac writes, “Despite what antivaccine parents claim, their choice not to vaccinate does […]

  109. #111 Narad
    April 4, 2016

    Yeah, when they consider an article important enough to be made open to the public, they should do the same thing with the accompanying editorial.

    Well, the original paper’s now paywalled as well. Yay, marketing department?

  110. #112 Graham
    April 5, 2016

    We’ve just had a very interesting case in Australia where a self described “healthy, fit, organic woman” who refused vaccination passed Whooping Cough onto her newborn daughter, thanfully the child survived and is now going to get her child vaccinated. Why the hell did it have to come to this?

    For the full story see:

    http://www.msn.com/en-au/news/australia/healthy-fit-organic-woman-who-refused-whooping-cough-booster-becomes-newest-advocate-for-immunisation/ar-BBrmQlM?li=AAgfYrC

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