If any of you are bloggers out there who like to write about studies, have you ever decided that you wanted to write about a study and discovered as you started writing that your university doesn’t have access to the journal? Yeah, that happened to me last night. I had wanted to move on from writing about antivaccine nonsense, as it seems that that’s all I’ve been writing about for the last several days (probably because it almost is), but I couldn’t because I couldn’t count on someone getting me a copy soon enough to be able to write about it last night. So until I get a hold of the paper vaccines it is again, because I saw an article that reminded me very much of just the sort of thing antivaxers could bring upon us if we let them.

Remember yesterday when I wrote about Kent Heckenlively’s unbelievably brain dead proposal for a five year moratorium on childhood vaccines. Yes, it is exactly as ignorant and idiotic as it sounds. As I thought about it more, I was reminded of another post that I had written back in March, about a massive measles outbreak in Romania that at the time had infected 3,400 and resulted in the deaths of at least 17. Then it occurred to me. Wht’s happening in Romania now would be a mild harbinger of things to come if antivaxers ever managed to see their vision of stopping or even significantly decreasing the use of childhood vaccines.

That’s why it’s worth an update, and unfortunately I saw one yesterday that tells me the measles outbreak in Romania is as bad as ever. But it goes beyond just Romania. Behold the horror:

Thirty-five people have died in the past year from measles outbreaks across Europe, the World Health Organization has warned.

It described the deaths – which can be prevented with vaccination – as an “unacceptable tragedy”.

A six-year-old boy in Italy was the latest to die from the infection. More than 3,300 measles cases have been recorded in the country.

The most fatalities – 31 – have been in Romania.

But there have also been deaths in Germany and Portugal since June 2016.

Dr Zsuzsanna Jakab, the WHO regional director for Europe, said: “Every death or disability caused by this vaccine-preventable disease is an unacceptable tragedy.

“We are very concerned that although a safe, effective and affordable vaccine is available, measles remains a leading cause of death among children worldwide, and unfortunately Europe is not spared.

It is criminal that a vaccine-preventable disease like the measles is a major cause of death in children in developed nations. We have Andrew Wakefield to “thank” for this. Death and disease in Europe and all over the world are his legacies and will remain his legacies. He is to blame for this.

The Italian child who died was a six year old boy suffering from leukemia who reportedly caught the measles from an older sibling whom the parents had decided not to vaccinate even though their son with leukemia had a compromised immune system and couldn’t be vaccinated himself. If that’s not a case of child neglect, I have a hard time envisioning what is. In essence, the parents’ negligence resulted in the death of their child with leukemia.

As I noted when I wrote about the Romanian measles outbreak, the antivaccine movement is very active there, complete with the usual conspiracy theories, such as the belief that the US purposefully infected people with HIV using polio vaccines and a direct link between vaccines and widespread HIV in Romanian orphanages. As in the US, in Europe a lot of this is driven by social media, where conspiracy theories about big pharma, national governments, the European Union, and Western governments combine with the usual fear mongering using dubious testimonials and bogus scientific studies.

In the face of this, many countries in Europe still do not have mandatory vaccinations, as a survey from 2010 reported:

In total 15 countries do not have any mandatory vaccinations; the remaining 14 have at least one mandatory vaccination included in their programme. Vaccination against polio is mandatory for both children and adults in 12 countries; diphtheria and tetanus vaccination in 11 countries and hepatitis B vaccination in 10 countries. For eight of the 15 vaccines considered, some coun- tries have a mixed strategy of recommended and mandatory vaccinations.

Until recently, these strategies worked reasonably well, and vaccine compliance was high. However, in the wake of this outbreak, EU public health officials have been playing catchup with vaccination campaigns. Progress has been hard-won:

The Region has been progressing towards measles elimination. A total of 37 countries have interrupted endemic transmission, according to the assessment of the Regional Verification Commission for Measles and Rubella Elimination based on 2015 reporting. However, remaining pockets of low immunization coverage allow the highly contagious virus to spread among those who choose not to vaccinate, do not have equitable access to vaccines or cannot be protected through vaccination due to underlying health conditions.

In addition, multiple countries are taking action to increase vaccine uptake beside education programs. For example, Germany has made moves to tighten its vaccine requirements:

Parents in Germany who fail to seek medical advice on vaccinating their children could face fines of up to €2,500 (£2,175; $2,800).

Health Minister Hermann Gröhe said it was necessary to tighten the law because of a measles epidemic.

A mother of three died of measles in the city of Essen this week.

The government wants kindergartens to report any parents who cannot prove they have had a medical consultation.

However, Germany is not yet making it an offence to refuse vaccinations – unlike Italy.

What’s Italy doing? In Italy, there have been three times more measles cases this year already than there were in all of 2016. So in response, in May Italy made 12 vaccinations compulsory for children, including:

  • polio
  • diphtheria
  • tetanus
  • hepatitis B
  • haemophilus influenzae B
  • meningitis B
  • meningitis C
  • measles
  • mumps
  • rubella
  • whooping cough
  • chickenpox

Parents of children who aren’t fully vaccinated according to schedule by age 6 could face a fine. It’s not clear what they will do beyond that, but it’s a strong statement.

Meanwhile, in France, distrust of vaccines is very high. A recent survey indicated that only 69% of respondents trust vaccines, with only 52% believing that vaccines have more benefits than risks. Worse, the distrust is higher among the young.

In response to low vaccination uptake, the French government has mandated that, as early as next year early childhood vaccines that are unanimously recommended by French health authorities will become mandatory. Currently, only three childhood vaccines are mandatory (diphtheria, tetanus and poliomyelitis), while eight others are only recommended. All will become mandatory now, although it’s not yet clear what the penalty will be for noncompliance. In Slovenia, mandatory vaccination policy, complete with fines, has worked to bring compliance up to 95%.

I’ve always been ambivalent about punitive measures like fines to enforce mandatory vaccination, but I suspect that’s because school vaccine mandates, in which children must be up-to-date on the CDC-recommended schedule before they can enter school and the only penalty is that unvaccinated and undervaccinated can’t attend school, have generally worked very well and, thus far, nonmedical exemptions based on personal belief has have not (yet) reached the levels that could produce a catastrophe such as what Europe is currently experiencing—you know, the sort of thing people like Kent Heckenlively are working to produce.

Truth be told, I’m still ambivalent about methods more stringent than laws like SB 277, which eliminate personal belief exemptions to school mandates. I hope things don’t get so bad that that begins to change.

Comments

  1. #1 Jay Gordon, MD, FAAP
    July 21, 2017

    Heinlein was friends w LRH?? That’s disappointing. I didn’t know that.

    Panacea, I did not abandon everything, Just began thinking harder and realizing that medicine and science are not monolithic nor unchanging. The old cliche’ about “X percent of what we know now will be wrong in three years” is true as true can be. You kinda’ know nothing about what I really do in my practice: I am an asset to public health.

    It takes a lot of courage to use one’s real name out here. I am wrong to ask that of everyone (anyone??) here at RI. All hat and no cattle?

  2. #2 Chris Hickie
    July 21, 2017

    If Gordon uses a ‘nym I suggest “legend in his own mind”.

  3. #3 Jay Gordon, MD, FAAP
    July 21, 2017

    Chris, I love that pseudonym. Probably couldn’t have picked a better one myself.

  4. #4 Panacea
    July 21, 2017

    Well, Jay, what ever gets you through the day I suppose. I’ve said my piece, and watching you delude yourself is getting tedious, so I think it’s time to wrap this thread up.

    But one final thought. No medicine is not a monolith. I can point to plenty of things that have changed in my over 30 years in this profession, mostly for the better. But here’s the thing . . . they changed on the basis of medical evidence, not the wild a** guesses and wishful thinking of a self deluded, egotistical jacka**.

    That is all.

  5. #5 Jay
    July 22, 2017

    “It takes a lot of courage to use one’s real name out here. I am wrong to ask that of everyone (anyone??) here at RI. ”

    Courage? The Anti Vax side contains large amount of deranged lunatics led by cold blooded sociopaths, I applaud Orac’s bravery in his public confronting of them, but I’m in a different situation with a child to think of.

    So yes you are very wrong to ask that of anyone on RI, which you should well know after witnessing the lunacy on AoA.

    People often miss the point of RI, for me and many it is to get the best science based arguments for discussions elsewhere*, where mostly I do use my real nym.

    *Also some of the best snark on the interwebs 😉

  6. #6 shay simmons
    July 22, 2017

    Keep dodging, Gordon.

  7. #7 Narad
    July 22, 2017

    If Gordon uses a ‘nym I suggest “legend in his own mind”.

    Well, Timothy Leary’s dead.

  8. #8 JayGordon, MD, FAAP
    July 22, 2017

    Shay, sorry, is there a question outstanding? Happy to answer if you’ll please clarify.

  9. #9 Narad
    July 22, 2017

    is there a question outstanding?

    Such as the actual reason for your arbitrary choice of age 3 for MMR? No, I guess not.

  10. #10 Narad
    July 22, 2017

    Narad—Yes, Shakespeare, Vonnegut, Heinlein. Right?

    Jesus Fυcking Christ. You haven’t had much exposure to, y’know, actual literature, have you? Go read this, or this, or even fυcking Melville.

  11. #11 Narad
    July 22, 2017

    Here. Heinlein should have stuck to juvenalia.

  12. #12 cloudskimmer
    July 22, 2017

    Gordon is simply wrong about high vaccination rates in “his neck of the woods” (it’s hard to think of Santa Monica that way.) In fact, prior to SB277, vaccination rates were below herd immunity rates at Santa Monica High School and at least two of their middle schools. Crossroads School was far worse with 50% unvaccinated, according to the Santa Monica Daily Press. At least some of this travesty is due to vaccine-averse physicians like Gordon. I continue to be appalled by his callous indifference to the many senior citizens in Santa Monica. He neither knows nor cares if any of them dies or becomes seriously ill due to exposure to one of his diseased patients. It’s easy to be blasé when you ignore the facts of disease transmission. The disease outbreak at Santa Monica High School’s child care center was kept in check by immediately closing that facility, but perhaps he advocates chicken-pox parties to ensure his patients get their immunity naturally. Does he think it’s better to have a small chance of developing a serious side effect from experiencing the illness instead of an infinitesimal chance that results from vaccination? Mathematical literacy obviously isn’t his strong point, nor is caring about anyone in his vicinity that isn’t one of his patients.

  13. #13 Dangerous Bacon
    July 22, 2017

    Jay Gordon: “Yes, universal correct handwashing in a hospital would be a novel occurrence.”

    I see poor Jay has suffered a breakdown in comprehension.

    I hate to have to explain this in words of few syllables, but my point was that strict handwashing guidelines have been established in health care settings to PREVENT transmission of disease from caregivers to patients. Your grudging support for measles vaccination in the EVENT of an outbreak of measles is akin to endorsing handwashing ONLY after there are outbreaks of disease related to the lack of it.

    I’d have expected a FAAP like you to have picked up on this incongruity (or stupidity, to use a more appropriate and less polysyllabic word), but apologies for having expected too much of you.

  14. #14 Jay Gordon, MD, FAAP
    July 22, 2017

    Bacon–I never said you were unintelligent. Just a wee bit dense and you repeat yourself a little too much. I give measles vaccines to prevent the disease. Just as you would. And just as we encourage hand washing. You do know that hand washing has been shown to be completely inadequate in most hospitals until there’s either an outbreak or a “campaign.” Do you practice medicine?

    Cloud skimmer–There was no outbreak at the daycare center. There was one case. That’s one case. That child was contagious, probably exposed lots of others and they still didn’t get sick .Do you practice medicine?

    Narad–The Heinlein-Shakespeare comments were written in a facetious vein.

    I choose three years because I believe that developmental normalcy is more obvious.

    The reason I ask about whether or not you practice medicine is that it’s hard for you to comprehend what that means until you do it.

    Bacon, you’re turning into a bit of nasty person. And we all know how I feel about nastiness. 🙂

  15. #15 shay simmons
    July 22, 2017

    And Gordon is still weaseling.

  16. #16 Se Habla Espol
    July 22, 2017

    There was no outbreak at the daycare center. There was one case.

    Do you know what the word “outbreak” means in medicine? You should look it up: even Wikipedia knows what it means.

  17. #17 Politicalguineapig
    July 22, 2017

    A play I saw last night:
    “No one finishes Moby Dick.”
    I kind of soured on Russian authors after being assigned Turgenev. I swear, Russian books are actually disguised neutron stars.

    Shay: Has he ever not weaseled? I dunno if Dr. Jay actually knows how to be honest. I am kinda amused by his pot calling the kettle comment above.

  18. #18 JP
    July 22, 2017

    I kind of soured on Russian authors after being assigned Turgenev. I swear, Russian books are actually disguised neutron stars.

    There’s a huge variety within Russian literature; it’s not all Tolstoy and Dostoevsky.

    Personally, I hate Tolstoy for a lot of reasons, personal and literary; part of this might have to do with the fact that the first bit of Tolstoy I was assigned was The Kreutzer Sonata, which is an absolute prudish misogynistic dumpster fire. I got so mad at it that I literally threw it against the wall as an undergrad.

    I love Dostoevsky, although Demons (it’s been translated a few times and also goes under the title The Possessed) probably isn’t where I’d start. It’s actually the last of his novels that I read, I think, and I didn’t get around to it until grad school. (Hey, you try being faced with the Russian canon.) The Brothers Karamozov is definitely my personal favorite, and I’d recommend it to anybody.

    Yeah, Dostoevsky is still long, for the most part, but at least he had an excuse; he was a broke epileptic who wrote in installments for “thick journals” and was paid accordingly. Tolstoy just couldn’t be arsed to solicit the services of a decent editor, though he certainly could have afforded one.

    Generally, though, I’m a bigger fan of 20th century Russian literature. Check out Sologub and Zamyatin (his novel We is an absolutely classic and first rate sci-fi totalitarian dystopia, and it’s also the first novel I ever read in Russian.) Bulgakov is great. Chekhov, although you could definitely call him part of “the long nineteenth century.”

    Not to mention the Symbolist and Acmeist poets. (Blok, Gippius, Akhamatova, Mandelstam, and so on and so on.) I imagine that poetry is more enjoyable in the original, but there are a lot of really good translations of the major poets like Mandelstam. (Which are the best is a matter of taste, as long as we’re dealing with quality translations.)

    Moscow to the End of the Line (Moskva-Petushki in the original) is defs worth a read. I read it during my first summer in St. Petersburg.

    Of course, I could go on and on. (And that’s only Russian literature; there’s Polish, too…)

    🙂

  19. #19 herr doktor bimler
    July 22, 2017

    Bulgakov is great.
    Anyone who has not read “Master and Margarita” should stop what they’re doing and go and read it NOW.

  20. #20 JP
    July 22, 2017

    Oh, and I somehow forgot to mention Olga Sedakova and Elena Shvarts, both of whom exist in English translation, probably because (ouch) I used to write on them.

    Actually, I think my own translations of Shvarts are pretty top-notch (Sedakova not so much), but the publishing rights situation has gotten complicated since her death. My advisor offered to help me get rights like five or six years ago – Lena was a personal friend of his – but for one reason or another, he never came through on that.

  21. #21 Politicalguineapig
    July 23, 2017

    JP: What do you think of Arkady Strugatskii (or Strugatsky?) I am very interested in Russian science fiction. One of my facebook friends was recommending a pair of Russian fantasy authors (married couple) only I can’t for the life of me remember the name or the title, other than it might have been something about a map? And it was like swords and sorcery?

  22. #22 Politicalguineapig
    July 23, 2017

    Also, I did enjoy the few chapters that I read of Night Watch.

  23. #23 Politicalguineapig
    July 23, 2017

    So, Russian names give the library system hiccups 🙂

  24. #24 JP
    July 23, 2017

    What do you think of Arkady Strugatskii (or Strugatsky?)

    Holy crap! I love the Strugatsky* brothers! A professor who later ended up on my committee hipped me to them; I seem to recall that she was writing an article about them, but I’m not coming up with anything.

    One of my facebook friends was recommending a pair of Russian fantasy authors (married couple) only I can’t for the life of me remember the name or the title, other than it might have been something about a map? And it was like swords and sorcery?

    Definitely reads a bell, but somehow I haven’t come across them personally. Could it be Maryna and Serhiy Dyachenko? (Technically they’re Russophone Ukrainians, though, FWIW.)

    Also, I did enjoy the few chapters that I read of Night Watch.

    I saw the movie a long time ago (during the summer Russian program at Middlebury, I think?) and it was just okay. Maybe I should give the book a go.

    So, Russian names give the library system hiccups

    Yep. The professor who taught the grad student intro seminar thingy in my first year of grad school once told a mildly amusing story about how, when she was in (college? grad school?) she was really big into Leskov (definitely a worthwhile author) and wanted to start researching him, she was going through the card catalog and shocked to find very little on him. Turns out that a lot of the sources spelled his name Лѣсков (using the pre-Revolutionary orthography) rather than Лесков.

    BTW, if you want to read some great Polish sci-fi, try Stanisław Lem’s Solaris. I also highly, highly recommend Tarkovsky’s film based on it (along with pretty much everything Tarkovsky ever did), but not the garbage movie with George Clooney from the 2000s.

    *I include the Strugatsky brothers in the group of authors (along with, for instance, Tolstoy) with names that have long been transliterated into English a certain way and are thus “grandfathered in” and excepted from the Library of Congress transliteration system which I am otherwise so uptight about.

  25. #25 herr doktor bimler
    July 23, 2017

    along with pretty much everything Tarkovsky ever did

    Watch “Stalker” and you get a Strugatsky novel filtered through Tarkovsky’s aesthetic! It’s a two-fer!
    The scary thing is that Tarkovsky did not have to construct any sets of “post-apocalyptic wasteland filled with crumbling alien artefacts filled with random lethality but no apparent purpose”, he could film everything on location.

  26. #26 Dangerous Bacon
    July 23, 2017

    Jay: “Bacon, you’re turning into a bit of nasty person. And we all know how I feel about nastiness.”

    Yes. You practice it (name-calling and shill accusations for example) then chastise others for perceived lack of decorum, mainly to try to distract from your evading questions and changing the subject.

  27. #27 Panacea
    July 23, 2017

    You know, usually when I say I’m done with a topic, I mean it and I’m done. But then I clicked on the comments here and read something and realized, I wasn’t quite done yet.

    Jay said, “You do know that hand washing has been shown to be completely inadequate in most hospitals until there’s either an outbreak or a “campaign.” Do you practice medicine?

    Wrong. Wrong, wrong, wrong. Yes, it is true most people don’t do a good job washing their hands. It’s been shown again and again washing or simply gelling in and out greatly reduces nosocomial infection rates.

    http://www.bmj.com/content/325/7360/362.short

    But when half wits don’t wash their hands, others begin to model their behavior on the half wits.
    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2901948/

    To disastrous results: http://www.sciencedirect.com/science/article/pii/S0196655315009451

    Then Jay said, “The reason I ask about whether or not you practice medicine is that it’s hard for you to comprehend what that means until you do it. ”

    I just finished my pediatrics rotation for my FNP program. I spent 4 weeks, Monday through Friday, in a very busy pediatrics practice in an underserved community. My preceptor was a PNP, but I was fortunate to get to spend a lot of time with the pediatricians in the practice as well, including doing hospital rounds several times.

    One of the pediatricians loves to teach, and he’d quiz me like a medical student or a first year resident. I loved it, even though half the time I didn’t know the answers to his questions. But I know them now.

    I have one word for the experience: Humbling.

    As I’ve said, I’ve been a nurse for quite a long time. I’m pretty good at my job. I thought I already knew a lot when I decided to go for NP, and I do . . . but not half as much as I thought I did.

    And it IS different when I’m the one making the call on the diagnosis and the plan of care. It’s NOT as easy as it looks. I got a lot of ear diagnoses wrong because I have a hard time distinguishing the normal vascular color of a crying child from inflammation, and thought I saw otitis media when I didn’t. If it had been up to me, I would have been prescribing a lot of unnecessary amoxicillin, and that people do that is why we have antibiotic resistance in this country.

    I was a lot better at it by the end of my four weeks. But nothing makes me feel sicker to my stomach than the idea of getting a diagnosis wrong, and either not prescribing the right plan of care (which might just be to watch and wait) or prescribing the wrong one (and making the problem worse).

    You seem to have forgotten that, Jay. And I know that, because if you took the medical literature seriously . . . like my PNP preceptor and the pediatricians in her practice do . . . you wouldn’t be doing what you’re doing when it comes to vaccination.

    You need a reminder on what it means to be humble. Unfortunately, it likely would have to come at the expense of a child, so I pray it comes about some other way.

  28. #28 Politicalguineapig
    July 23, 2017

    JP: Yes, it’s the Dyachenkos. Thank you.

    I didn’t know the Strugatskiis were brothers, I thought it was another married couple. I currently own Roadside Picnic and will be getting Hard to be a God, and reading it this time. (I’ve been having some trouble with attention span lately, so some books are going unread.)
    I actually own the book of Solaris and some of Lem’s other work. Didn’t he write Memoirs Found In a Bathtub?

  29. #29 Jay Gordon, MD, FAAP
    July 23, 2017

    Panacea–Wonderful that you’re learning pediatric practice. Yes, after nearly forty years, I find something humbling in almost every office day. Keep learning, Panacea.

    You misunderstood my comment about hand washing: Not that hand washing doesn’t work, but that we know that most docs don’t wash adequately.

    By the way, Amox no longer works for otitis media and, yes, by the 20,000th ear (I’m past a quarter million and it’s not always a clear call) you look at you’ll be a lot better at diagnosing OM. Standard of care, however, pretty much mandates “watchful waiting” rather than antibiotic treatment during the first 72 hours. This, of course, varies from child to child depending on age and other factors.

    You seem smart. Know that I take medical literature very seriously. I believe that I have read much, much more than you have over the past four decades and continue to focus on pediatrics. My practice is incredibly fulfilling and I enjoy going to work every single day. Assumptions made in this little corner of the internet by the above perseverating detractors don’t really dent my enjoyment. I learn here.

  30. #30 Gilbert
    July 23, 2017

    Watch “Stalker”

    Even better, play Stalker. I recommend the free Lost Alpha {sort of The Shadow of Chernobyl} (run it on 64 bit systems for no crashes).

    http://www.moddb.com/mods/lost-alpha/news/stalker-lost-alpha-developers-cut

  31. #31 Dangerous Bacon
    July 23, 2017

    Jay: “Amox no longer works for otitis media…I take medical literature very seriously.”

    Not too seriously, or you wouldn’t have missed the current guidelines for otitis media treatment according to the American Academy of Pediatrics and the American Academy of Family Physicians::

    “Antibiotics should be prescribed for bilateral or unilateral AOM in children aged at least 6 months with severe signs or symptoms (moderate or severe otalgia or otalgia for 48 hours or longer or temperature 39°C or higher) and for nonsevere, bilateral AOM in children aged 6-23 months
    On the basis of joint decision-making with the parents, unilateral, nonsevere AOM in children aged 6-23 months or nonsevere AOM in older children may be managed either with antibiotics or with close follow-up and withholding antibiotics unless the child worsens or does not improve within 48-72 hours of symptom onset
    Amoxicillin is the antibiotic of choice unless the child received it within 30 days, has concurrent purulent conjunctivitis, or is allergic to penicillin; in these cases, clinicians should prescribe an antibiotic with additional beta-lactamase coverage.”

    http://emedicine.medscape.com/article/994656-guidelines?pa=QoqkkOUR5xUsn0%2F59tB9rP2PpCZBLN069Eu8vSHiUl1Hfu%2BRo7T2Kv5KwUhKXvL20BX5MrT8PvnSN5EwZA9ZydRNZ1wOcAGVEOAmcrMialo%3D

    It’s not surprising that Jay ignores AAP guidelines for otitis media treatment, seeing as he similarly ignores AAP guidelines for vaccination.

    “perseverating detractors” – Nasty, Jay, nasty. Surely you’re better than this.

  32. #32 Politicalguineapig
    July 23, 2017

    JP: I did manage to win out against the library system 🙂 Librarians rule.

  33. #33 Panacea
    July 23, 2017

    Nuts. DB beat me to it.

  34. #34 Michael J. Dochniak
    Minnesota
    July 23, 2017

    Jay Gordon (#29) writes,

    I learn here.

    MJD says,

    Your a good man Charlie Brown!

  35. #35 herr doktor bimler
    July 23, 2017

    Another good movie adaptation of a Strugatsky novel:
    https://en.wikipedia.org/wiki/Hard_to_Be_a_God_(2013_film)

    Has themes of religion and suppression of knowledge in the context of authoritatian politics — very timely! — in a medieval milieu, so lots of monochromatic mud and squalor.

  36. #36 Narad
    July 23, 2017

    Yes, after nearly forty years, I find something humbling in almost every office day.

    In that case, you should have a surplus of apropos examples to share with the commentariat.

  37. #37 Narad
    July 23, 2017

    You seem smart.

    *Snort*

  38. #38 Politicalguineapig
    July 23, 2017

    HDB: I have Hard to be a god bookmarked on my netflix que.

  39. #39 Chemmomo
    Late to the conversation
    July 24, 2017

    Jay Gordon #180

    KayMarie–If there were more cases–an outbreak– of measles nearby I would encourage measles vaccination for those without it

    But you didn’t! In 2015, You didn’t! http://www.cbsnews.com/news/doctor-explains-why-he-lets-kids-avoid-the-measles-vaccine/
    You mocked the outbreak! (SBM link with tweet in evidence) http://www.cbsnews.com/news/doctor-explains-why-he-lets-kids-avoid-the-measles-vaccine/

    How am I supposed to believe you’ve changed since two years ago?

  40. #41 JP
    July 24, 2017

    (I’ve been having some trouble with attention span lately, so some books are going unread.)

    Oh, I definitely know the feeling. When I do read an actual book, I do it very piecemeal and it takes me a lot longer than it used to.

    I actually own the book of Solaris and some of Lem’s other work. Didn’t he write Memoirs Found In a Bathtub?

    Yep.

    I did manage to win out against the library system 🙂 Librarians rule.

    Noice!

  41. #42 Alain
    July 24, 2017

    Panacea@27,

    Amen and Amen 🙂

    Alain

  42. #43 Dingo199
    July 24, 2017

    @Jay

    ..by the 20,000th ear (I’m past a quarter million and it’s not always a clear call)

    Jay, if you worked for 35 years, 330 days a year, that would come to over 21 ears a day. Are you telling us you still look into the ears of 11 kids every day? You must be an otitis expert indeed.

    So maybe Eliza-Jane Scoville should have got more than a cursory ear exam from you in the days leading up to her death from AIDS? Or was that Philip who boobed on that one? Maybe if she had got pneumovax and HiB vax, then she wouldn’t have got the “otitis” in the first place?

    Today I look after several kids and young adults with HIV infection. They are all well, and thriving.
    I hope you reflect from time to time on how good the outcome from HIV can be – as long as it is tested for and treated in a timely fashion.

  43. #44 Panacea
    July 24, 2017

    Dingo: on this I’ll defend Jay.

    I looked into every kid’s ears. I saw on average 10 patients a day. My preceptor saw on average 20. The pediatricians saw on average 30. From what I could observe with each of them, they looked in the ears of every kid, whether they needed it or not.

    I have no doubt Jay’s being truthful when he says he’s seen that many ear, and my preceptor told me I won’t really feel comfortable until I’ve looked in a thousand ears. I looked in about 200 during my rotation.

  44. #45 Jay Gordon, MD, FAAP
    July 24, 2017

    Dangerous Bacon—If Amox “cures” an ear infection, then no Rx would also have worked. You don’t have to know this; I do.

    Dingo199—Yes, 11 kids a day for certain.

    HIV+ pregnant women should receive appropriate medication and their children should all be tested. For better or worse, the legal issue is still unresolved regarding this care and testing. As it was 15 years ago.

    https://www.hivlawandpolicy.org/sites/www.hivlawandpolicy.org/files/With%20Child,%20Without%20Rights_%20Restoring%20a%20Pregnant%20Woman’s%20Right%20to%20Refuse%20Medical%20Treatment%20through%20the%20HIV%20Lens%20(Ulrich).pdf

    Panacea—If Orac is comfortable giving you my email address, I’d be happy to continue this discussion privately.

  45. #46 Panacea
    July 24, 2017

    Thanks, Jay but I’ll have to pass. I really shouldn’t even be commenting here as much as I have been lately. I’m supposed to be studying for my final exam, but I can only process so much at a time. I take short breaks to reset my mind, and this is one of them.

    Remember what I said earlier in this discussion about intellectual honesty? My last post was an example of what I mean by that. I’ll continue to criticize you for your position on vaccination because it’s unsupported scientifically and wrong by the evidence we do have.

    But while wrong is wrong, right is also right, and I can’t and won’t criticize you when you say something I know to be correct, or fail to say something when someone else says something that’s incorrect on this or any other subject.

    Intellectual honesty.

  46. #47 Johnny
    On my way back to 127.0.0.1
    July 25, 2017

    How does Doctor Gordon Like to really treat ear infections? We don’t have to ask, we can read his web site (bolding mine)

    http://drjaygordon.com/medical-concerns/earinfections.html

    When viruses and/or bacteria manage to grow in the fluid, “acute otitis media” can be diagnosed. The traditional treatment with antibiotics has been shown to be quite ineffective and, as a matter of fact, not anymore effective than doing nothing at all during the first three to four days. Most experts now recommend pain control only during the first days of an ear infection, although I think thatsafe alternative care (homeopathy, ear drops, hot compresses, vitamin C, elderberry or echinacea) will improve the healing course.

    Speaking only for myself, I wouldn’t trust him to treat anything living, human or otherwise.

  47. #48 Vander Heiden
    July 25, 2017

    Yeah⇑

    Anyone who recommends homeopathy needs to be slapped.

    My recommendations would be not eat dairy products. The steroids 5α-pregnanedione and 5α-androstenedione increase cholesterol synthesis in the skin. This leads to clogged follicles as the sebum concentration of waxes (cholesterol) increases over the fatty acids.

    This has been proven in the lab. I have links.

  48. #49 Se Habla Espol
    July 25, 2017

    Oh, good to know. I’ll be sure that my lab doesn’t eat any dairy products.

  49. #50 Julian Frost
    July 25, 2017

    @Vander Heiden:

    I have links.

    Then why don’t you post them?

  50. #51 Vander Heiden
    July 25, 2017

    Acne, dairy and cancer: The 5α-P link
    Dermato Endocrinology

    Consequences of Use of Anabolic Androgenic Steroids
    Pediatric Clinics of North America

    A SURVEY OF THE STEROIDS IN COWS’ MILK
    Journal of Endocrinology

    The effect of the antiandrogen IIα-hydroxyprogesterone on sebum production and cholesterol concentration of sebum
    British Journal of Dermatology

    Comparative Chemistry of Sebum
    Journal of Investigative Dermatology

    SEBUM EXCRETION AND SEBUM COMPOSITION IN ADOLESCENT MEN WITH AND WITHOUT ACNE VULGARIS
    British Journal of Dermatology

    Glucocorticoids in Mammary Secretions and Blood Serum during Reproduction and Lactation and Distributions of Glucocorticoids, Progesterone, and Estrogens in Fractions of Milk
    Journal of Dairy Science

    Hormones in bovine milk and milk products: A survey
    International Dairy Journal

    You are on your own if you want to read the full texts; I cannot link those. The best one is “Comparative Chemistry of Sebum”. What causes a pore to clog is largely the ratio of sterols to fatty acids, and this can be changed depending on the hormonal state.

    Woman on birth control and body-builders know this well. I’ll assume that you are neither of those, which would probably make you a skinny male.

  51. #52 MI Dawn
    July 25, 2017

    Like Panacea, I’ll be fair to Dr Jay, even though most of the time I think he’s ridiculous.While most of his recommendations for acute otitis media are silly, warm/hot compresses can be very soothing to a child, and, depending on the ear drops, they may help with any wax buildup that add to discomfort.

    The rest of the stuff is worthless as a treatment, though most kids enjoy juice and I have one kid who has always loved elderberry tea.

  52. #53 David.
    July 25, 2017

    I was vaccinated in 1986. I got measles in 1990 during an outbreak in Poland. Mass vaccination against measles started in 1975 or 1976 in Poland.

    Shall I be skeptical towards vaccination efficacy?

    Engerix taken in 2010 caused seizures and uncontrolled legs and body movements at the moment of trying to get up from a bed. I have been blind for an undefined peroid of time and I couldn’t get up and I couldn’t move.

    Can anyone explain please what happend to me? There were no other than vaccination relevant form the health’s point of view factors. Probability of its occurence were close to 0. It wasn’t a coincidence.

  53. #54 Narad
    July 25, 2017

    Yeah⇑

    Go away, Fucklesworth.

  54. #55 Dangerous Bacon
    July 25, 2017

    It’s not that antibiotics are called for in every case of acute otitis media – certainly that’s not the case, as the AAP/AAFP guidelines make clear.

    What’s at issue is Jay’s “knowing” that a first-line antibiotic recomended in those guidelines “does not work”, a non-evidence based belief similar to his conviction that vaccines cause autism.

  55. #56 Panacea
    July 25, 2017

    It depends on whether or not there is suppuration in the otitis media. You don’t treat an *serous* effusion (clear fluid) with antibiotics. You treat pus. If the eardrum is opaque and immobile, it’s infected and then you treat.

    That’s the part that can be tricky because I know a lot of providers who will say “if there’s a serous effusion it’s going to turn into infection anyway” and will give antibiotics anyway. You have to resist that temptation because the fluid may never become infected, or may be recovering from an infection and no longer needs treatment.

    Maybe that’s why Gordon thinks antibiotics are not effective; they certainly aren’t with serous AOM.

    But when antibiotics are indicated, amoxicillin IS first line unless there is a history of allergy to penicillin or if the child has previously been treated within 30 days. If the latter, or if conjunctivitis is also present, you bump up to augmentin.

    Treating for pain is up to the provider, but I would always recommend Children’s Tylenol or Children’s ibuprofen (if six months or older), even if there is not fever. A warm compress is very helpful and feels good. Herbal remedies are a waste of time; neither effective or safe. They don’t work. Xylitol gum is a good preventative but you pretty much have to chew gum all day, and you can’t give it to kids under 2, and it’s deadly toxic to dogs.

    Analgesic ear drops are indicated for otitis externa, not media. Antibiotic ear drops are indicated only if the TM is perforated.

    As for the silliness with milk and sebum: if Vander is Travis, then let me add a hearty “Go away Fucklesworth” to Narad’s greeting.

    If not, let me point out earwax is much more than sebum, and that the links you posted have nothing to do with anything. So yeah, go away Fucklesworth. I didn’t comment on the quantum chemistry nonsense because I am neither a chemist or a physicist. I am a health care provider, and you clearly are reaching out of your a** on this subject.

    • #57 Orac
      July 25, 2017

      I think it probably was Fendlesworth, which is a shame. He’d been away for so long and it was so nice.

  56. #58 Narad
    July 25, 2017

    As it was 15 years ago.

    h[]tps://www.hivlawandpolicy.org/sites/www.hivlawandpolicy.org/files/With%20Child,%20Without%20Rights_%20Restoring%20a%20Pregnant%20Woman’s%20Right%20to%20Refuse%20Medical%20Treatment%20through%20the%20HIV%20Lens%20(Ulrich).pdf

    If anyone would like, y’know, a working version of Jay’s link, the paper is here. I find it to be rather a curious choice at first glance, but I’m on deadline, so whatever.

  57. #59 squirrelelite
    July 25, 2017

    I have a moment, so I’ll offer my thoughts on Dr Jay’s 3 year schedule.

    There are about 4 million live births in the US every year in a population of about 326 million, so 1.2% of the population is too young to start the MMR series.

    At the same time, we need about 90-95% “coverage” to maintain herd immunity and keep the disease from returning to endemic circulation like it did in the UK.

    And Dr Jay recommends that everyone wait till age 3 to start the MMR, which would increase the unvaccinated population to 3.6%.

    And the measles vaccine is 97% effective with 2 doses. So, even if we vaccinate everyone else, we have another 3% of the population vulnerable or 6.6% now.

    That puts us into the grey area where herd immunity starts to break down.

    And it’s not a sharp black division. The bigger the unprotected population, the wider and longer outbreaks like the Disneyland incident will spread before they eventually go away.

    Adding 2.4% to that unprotected population makes those outbreaks worse.

    But, Dr Jay thinks we can achieve eradication even under those conditions.

    And he calls the risk of someone getting infected and possibly dying from exposure (at least to one of his patients) “miniscule”!!!

    Pull the other leg, Jay.

  58. #60 Panacea
    July 25, 2017

    @ Orac #57: He must have been getting jealous of all the attention Jay Gordon was getting. Sad when one crank gets outshone by another crank.

    @squirrellite: Not to mention all those kids left unprotected for no good reason at all. Hence my very open contempt.

  59. #61 Narad
    July 25, 2017

    He must have been getting jealous of all the attention Jay Gordon was getting. Sad when one crank gets outshone by another crank.

    Travis J. Schwochert isn’t so much a proper crank as a fistulotomy waiting to happen.

  60. #62 Alain
    July 26, 2017

    David,

    Shall I be skeptical towards vaccination efficacy?

    You could also be skeptical about why your body didn’t react to the vaccine (which is also, likely a pertinent hypothesis). I got my genetic code done and looked over by a medical doctor a few years ago and at the moment, my psychiatrist is also looking at it (though neither did look from a vaccination standpoint because it look so far that I don’t have any issues related to vaccination).

    Al

  61. #63 Panacea
    July 26, 2017

    Hi, Alain,

    If you’re talking about what I think you’re talking about that screen only looks at a few classes of drugs, mostly used for mental health purposes. ADHD drugs, MH drugs . . . it’s a great tool to determine which ones will work for you, especially for the ADHD kids. You can skip starting them on stimulants if the screening says the non-stimulants are the ones that work.

  62. #64 Alain
    July 26, 2017

    Not only drug for for taxation purpose. I had my genetic code sequenced years ago but it’s only since last year I signed the paperwork so that my psychiatrist can get access. See here:

    https://www.canada.ca/en/revenue-agency/services/tax/individuals/segments/tax-credits-deductions-persons-disabilities/information-medical-practitioners/mental-functions-necessary-everyday-life.html

    and here:

    http://www.revenuquebec.ca/en/citoyen/credits/defic_grave/default.aspx

    We’re covering every angles and I’m having a lot of test script from my PCP that I recently got around to submit to the local hospital to cover more angle.

    The benefits are potentially important.

    Alain

  63. #65 Politicalguineapig
    July 27, 2017

    JP: Another twist: turns out someone in the family actually OWNS We. One of these days, we need to do a family book sorting.