Before I get into the topic at hand, I want to explain why there was no post yesterday. Some of you on Facebook might have seen my post about why, but basically, we lost power last night. We’re still without power. In fact, the only reason I can write this is because I’m staying at my parents’ house tonight. No, it wasn’t weather. Rather, basically a nearby substation caught fire. Michigan infrastructure is great, and I really need to get a generator.

It also reminds me how much I wouldn’t mind living in California. For one thing, it’s a beautiful state. Even better, California was willing to do something to protect children that only two other states in the union do. In 2015, California passed SB 277, a law that eliminated nonmedical exemptions to school vaccine mandates. The law was passed in the wake of the Disneyland measles outbreak, which started during the Christmas holidays in 2014 and ultimately spread to several states, Mexico, and Canada, facilitated by unvaccinated children. After that outbreak, California legislators, led by Senators Richard Pan and Ben Allen, the bill’s co-authors, actually did something that required a lot of guts. They passed SB 277, meaning that, as of the 2016-2017 school year, personal believe exemptions (PBEs) to school vaccine mandates are no more in California. Even better, SB 277 works. Percentages of students claiming PBEs plummeted in just the first year.

Unfortunately, all is not perfect with SB 277. For one thing, I predicted that parents, stymied by SB 277 when they try to claim a PBE, would shift to trying to find antivaccine-friendly physicians and other health care professionals allowed to sign letters supporting medical exemptions to school vaccine mandates who were willing to—shall we say?—expand the spectrum of medically indicated reasons not to vaccinate. Indeed, this is the weakest aspect of the law. Any doctor can write a letter supporting a PBE, and a cottage industry of doing just that and selling PBEs has sprung up in the state, with that antivaccine dog whistler “Dr. Bob” Sears leading the way with “how-to” lectures. It was noted before as a reason for concern in otherwise good news about how well SB 277 was working. I am, of course, referring to exactly what I predicted, that parents not wanting to vaccinate would start finding ways to get medical exemptions now that PBEs are no longer available to them.

Basically, the number of children with medical exemptions tripled:

Even with a new law that has boosted kindergarten vaccination rates to record highs, hundreds of schools across California still have so many children lacking full immunization that they pose an increased risk of disease outbreaks, according to a Times analysis of state data.

At nearly 750 schools, 90% or fewer kindergartners had been fully vaccinated last year, the analysis found. Experts say the rate should be at least 95% to prevent the spread of highly contagious diseases such as measles.

California’s tougher inoculation law, known as SB 277, was approved in 2015 after a measles outbreak that originated at Disneyland. The law bars parents from citing religious or personal beliefs to excuse their children from immunizations, but some who already had such exemptions were allowed to keep them.

The rest of the unvaccinated children need a form signed by their doctor saying they had a medical reason not to get their shots.

In the school year that began last fall, the law’s first year, the number of kindergartners in California with medical exemptions tripled, the analysis found.

The result is that, even as the statewide percentage of kindergarteners who had received all their vaccines has increased from 90.2% in the 2013-2014 school year to 95.6% in the 2016-2017 school year, the number of children with medical exemptions has increased from 991 to 2,850 during the same period.

No here’s the thing. As discussed in the article, the percentage of children with legitimate reasons for not being vaccinated shouldn’t be more than 3% at most. These would be children with accepted, evidence-based medical reasons for not tolerating vaccines, such as a gelatin allergy or because they’re immunosuppressed, either due to disease or undergoing chemotherapy. You might ask: So what if less than 3,000 kindergarteners in the state have medical exemptions? If those children were evenly distributed, it might not be such a big deal. However, as we know, families that are vaccine-averse tend to cluster, and that’s what appears to be happening here:

But the Times analysis found that at 58 schools, 10% or more kindergartners had medical exemptions last fall. The rate topped 20% at seven schools.

“That’s just totally wrong,” said Dr. James Cherry, a UCLA research professor and senior editor of the “Textbook of Pediatric Infectious Diseases.” “This idea of 20% having medical exemptions is nonsense, and certain doctors buy into that, but it’s wrong.”

Experts say some parents who are hesitant about vaccines may be asking doctors to vouch that their children have medical reasons to avoid them or get them later than when they’re required by law.

There’s no “may be” about it. If you pay attention to antivaccine groups, websites, Facebook pages, and the like it’s not hard to find that doctors are writing letters supporting medical exemptions based on the flimsiest of reasons. Indeed, a parent sent me an example of Dr. Bob Sears basically providing a letter supporting medical exemptions based on filling out an online form and paying a fee of $180 a child. Meanwhile, there’s been a bit of a gold rush of woo-friendly antivaccine-leaning (or at least -sympathetic) doctors seeking to profit by selling medical exemption letters. Dr. Tara Zandvliet, for example, charges $120 a child for such a letter and advertises reasons that are not evidence-based, such as:

Hyper immune conditions
Including, but not limited to:
Asthma
Allergies to food, bee stings, medicines that include hives/swelling/wheezing (hay fever does not count)
Eczema
Hives

Autoimmune Conditions
Including, but not limited to:
Celiac
Crohn’s
Ulcerative Colitis
Lupus
Sjogrens
Scleroderma
Mixed connective tissue
Hashimoto or Graves thyroid (not regular low thyroid)
Psoriasis
Vitiligo
Vasculitis
Antiphospholipid antibody
Multiple Sclerosis
Rheumatoid arthritis (not old age or overuse arthritis)
Wegeners
Type 1 diabetes (child type)
Eosinophilic esophagitis

Let’s just put it this way. None of the above conditions is a contraindication to vaccination. Indeed, the list of true contraindications to vaccination is brief, and very little of what’s on Dr. Zandvliet’s list is on that list. I suppose I should give Dr. Zandvliet credit for one thing. At the end of the list, it does say that autism, autism spectrum disorder, and behavioral issues are “not sufficient to meet medical exemption requirements.”

The problem, of course, is SB 277’s greatest weakness; it is incredibly broad in the range of reasons physicians may give to justify requesting a medical exemption. Dr. Bob himself bragged about that:

The guidelines for providing medical exemptions are extremely broad in the new California law. Parents, physicians, legal experts, and some legislators fought to have the term “contraindication” removed from the guidelines, and succeeded. This means that is it up to the personal judgement of each physician and patient to work together to determine if a child qualifies for a medical exemption. The California bill declares that an exemption can be granted if “the physical condition of the child is such, or medical circumstances relating to the child are such, that immunization is not considered safe, indicating the specific nature and probable duration of the medical condition or circumstances including, but not limited to, family history, for which the physician does not recommend immunization . . .”

Not surprisingly, the areas where these nonmedical exemption rates are highest are all where most of the woo-friendly doctors are:

Statewide, private and charter schools account for the majority of schools where 90% or fewer kindergartners had received all their shots, the Times analysis found. The analysis included 6,500 schools with 20 or more kindergartners — the state did not provide data on schools with fewer than 20 kindergartners.

A third of the schools with low vaccination rates were in Los Angeles County, followed by San Diego and Orange, the analysis found.

Many school administrators said they did not want to comment on decisions made by parents. Others could not be reached for comment or were out of the office for summer vacation.

The report names the ten schools with the highest percentage of medical exemptions. Not surprisingly, four out of the ten are Waldorf Schools (or, as I like to call them, outbreak centers) and the rest are charter schools or Christian schools. The percentage of medical exemptions among these schools range from 19% to 40(!)% Oh, wait. Sunridge Charter School advertises itself as using a Waldorf curriculum. Make that half the schools at germ central are Waldorf schools. .

It’s good that, overall, even the 2,850 kindergarteners with medical exemptions represent only 0.5% of kindergarteners, but the numbers show that they are clustered in such a way that make outbreaks more likely.

So what can be done? Unfortunately, basically the only check on the issuance of letters by doctors supporting medical exemptions based on dubious reasons is the state medical board. Given how overtaxed most state medical boards, including California’s, is, it’s hard to imagine the Medical Board of California doing much to crack down on the sale of medical exemptions. On the other hand, as I noted last year, the board has actually gone after Dr. Sears for, in part, writing a letter supporting a medical exemption based on medically unsupported reasoning. It’s for something he did in 2014, though, which is before SB 277, and I haven’t heard any updates in the year since I learned of this action. I wonder what’s going on.

Despite this problem, the passage of SB 277 remains a major victory in the struggle to protect children from the ravages of infectious disease. It still remains the single biggest defeat in my memory for the antivaccine movement, which marshaled pretty much everything it had to defeat it and still came up short. Unfortunately, it is not perfect. It’s politics. Compromises had to be made to pass it. It is a beginning, not an end, and part of what needs to be done now is to keep an eye on its implementation.

What really needs to happen is for the culture in California to change. SB 277 might be able to accomplish that in the long term.

Comments

  1. #1 Dorit Reiss
    August 18, 2017

    A. I am glad California passed this law, which has now been upheld by five different trial courts, three federal, two states, but I do want to add a hat tip to Michigan’s for its rule change, a very effective and good step, too. Which was also upheld by a federal court.

    B. Not only does that listcof conditions not qualify for exemptions, but children with asthma, diabetes and other conditions need vaccines more. They’re at higher risk from at least certain diseases.

    This really fails the patients, the kids.

  2. #2 Reality
    August 18, 2017

    Journey is also a Waldork school:
    journeyschool(dot)net/
    “A Proud Member of the Alliance for Public Waldorf Education”

    That makes it 6 of the ten.
    An education system based on 19th century spiritualism is anti-science? Who’da’ thunk. Just dance your disease away through improved karma.
    Figures.

  3. #3 Dangerous Bacon
    August 18, 2017

    If vaccination exemptions are disproportionately being granted by relatively few docs, those practitioners need to be looked at.

    The California Medical Board could audit the medical exemptions granted by the physicians who do this the most – say, the top 5 or 10%.

    I suspect that in that event, the granting of medical exemptions would drop considerably, because they wouldn’t stand up to evidence-based scrutiny.

  4. #4 Chris Hickie
    August 18, 2017

    A big contributor to this rise in medical exemptions is the recently formed (2016) California-based anti-vaccine group calling itself “Physicians for Informed Consent”, which has a lot of California physicians as prominent/founding members (but also has a lot other anti-vaccine wretched scummy quack doctors as well–https://physiciansforinformedconsent.org/). You can bet the ranch that this repulsive cluster of pro-disease physicians is sharing their tip among themselves regarding how best to skirt the law on writing a medical exemption and not get caught while also making a lot of money off gulled families.

    This is what happens when state medical board completely and utterly failed to protect the public health back when the first prominent anti-vaccine doctors like Sears and Gordon first starting growing in the petri dish of American culture. They’ve now created colonies of anti-vax physicians across the US who are emboldened by the lack of any response to their public-health-endangering actions.

  5. #5 Chris Preston
    August 18, 2017

    A third student has been diagnosed at a Steiner school in Perth http://www.abc.net.au/news/2017-08-18/third-case-of-measles-at-perth-waldorf-school/8822014. About 50% of the 400 students at the school are unvaccinated. The measles outbreak precipitated the ‘resignation’ of the principal, a prominent anti-vaxxer who once stood for Parliament. Even so, a clinic organised at the school this week vaccinated 19 students.

    This illustrates the problems that arise if you permit educations based on early 20th Century white nationalist spiritualism.

  6. #6 Chris Hickie
    August 18, 2017

    @ Dangerous Bacon: Agreed (very much). Almost certainly these schools with ridiculously high medical exemption rates have at most a few physicians penning these exemptions (like Sears, Gordon or one of their greedy uncaring cronies). I don’t know who has the initial authority, however, to audit those exemptions to determine the physicians writing them, since I think medical board almost always only take action when presented with specific complaints against a physician.

    BTW, “Jay Gordon, MD, FAAP”, since you are reading this–are you a member of Physicians For Informed Consent?”, and if so, why didn’t you consent to putting your name out there like Dr. Bob did?

  7. #7 Angela
    August 18, 2017

    So, according to anti-vaxxers, pediatricians are in it for the “vaccine bonuses”, yet anti-vax doctors are charging $120-$180 for a medical exemption letter?

    I was curious and looked up the elementary school that my children attend. I found vaccine rates for 2013-2014 (couldn’t find anything more recent), and surprisingly it was 100%. Not even a medical exemption. This is in upstate New York.

  8. #8 Eric Lund
    August 18, 2017

    The California Medical Board could audit the medical exemptions granted by the physicians who do this the most – say, the top 5 or 10%.

    I suspect a much smaller fraction will suffice, which is fortunate because I doubt the California Medical Board has the resources to audit that many doctors in such a short time frame. My guess is that the top 0.1 to 0.5% will catch most of the egregious offenders and put the fear of $DEITY into the rest.

  9. #9 Eric Lund
    August 18, 2017

    @Angela: Projection is a regular thing among anti-vaxers, and alt-med types generally. They accuse science- and evidence-based practitioners of being in it for the money while profiting handsomely from selling their own dubious services, whether it’s medical exemption letters or supplements.

    Think about it. If it takes five minutes to sign a medical exemption letter, that physician is grossing $1440 to $2160 per hour. Nice work if you can get it. But they don’t want the rubes to realize that they are running a racket, and one of the most effective ways to do that is to claim the competition are running a racket.

  10. #10 Narad
    August 18, 2017

    Off-topic, but AoA is dead?

  11. #11 Panacea
    August 18, 2017

    If the California BOM would just nail Sears and Gordon’s hides to the wall for their dangerous practices . . . malpractice in my opinion . . . then other antivax physicians would quickly fall in line.

    It would also help of the AAP would grow a spine and take Gordon off the FAAP, and Sears too if he has it, and publicly declare why.

  12. #12 Panacea
    August 18, 2017

    Narad: I don’t think so. I checked their FB page, there are posts only a few hours old and they’re pulling the usual BS.

    It sounds like someone forgot to pay for their domain name, so their main webpage was down. They claim to be back up; I haven’t checked into it.

  13. #13 Liz Ditz
    Great State of California
    August 18, 2017

    Narad, the Age of Autism website was registered by Dan Olmsted, who died in January 2017 (he either committed suicide or accidentally OD on prescription medications).

    Kim Rossi (formerly Stagliano — they divorced recently) is now running the show. Evidently she didn’t know that the domain was due to expire earlier this week, so the site briefly was out of business.

    Rossi re-registered the site; it’s back up for me in Chrome but not in Safari.

  14. #14 Liz Ditz
    Great State of California
    August 18, 2017

    Back on topic: there’s a woman who is running a GoFundMe to get medical exemptions.

    The GoFundMe started August 6, and she’s raised $170.00 of the requested $400.00

    I am a returning back to College. My daughter and son were accepted into their Daycare Facility . I am asking for All your help. They start daycare on August 22. That is if I get an exemption!   We have an appointment in Santa Rosa this Saturday. However the cost are $370 per child. 
    Having my kids vaccine free it huge for them and vital to their long term health. 

    Any support will be so appreciated, and we willforever grateful! 
    Blessings
    Update #2
    Okay, so I found a doctor in Sacramento that can see us next week!! It’s about two hours without traffic. Yes, and will charge $200 a child. That is huge because the last Doctor wanted $370 a child.

    Sigh.

  15. #15 Denice Walter
    August 18, 2017

    I clicked on Sunridge and who would’ve thunk it but it’s in Sebastopol!**

    I was there just a few weeks ago and it is extremely woo-fraught. Woo beyond your wildest dreams (But fun to visit as it has a cool new venue for local products, the Barlow, a main street of altie-ness and farmer’s market/drum circle) . I imagine that the rest of the Sonoma-Marin-Mendocino triangle has similar isolated school figures.

    -btw- I noticed the AoA absence but figured it would be back soon because they’re a registered charity.

    ** it’s the hippie town Draconis used to carp about.

  16. #16 Angela
    August 18, 2017

    @#14

    Wow. If medical exemptions are vital to their long term health, she should easily be able to get one from any doctor. $200 for signing a form. What a racket.

    Also, don’t most of these doctors who do this not take insurance? I know Dr. Sears doesn’t. Does that mean that they make more money from their patients? I really don’t know.

  17. #17 NWO Reporter
    August 18, 2017

    LOL. SB277 was to “protect children”–sure. That took real guts to facilitate such a boon for the pharmaceutical industry. If not for those upstart parents, doctors and other medical providers who insist on informed consent to medical treatment, we could have blissful medical tyranny by now.

    If this resistance keeps up, Dorit may have to–reluctantly–recommend that vaccination be done at gunpoint. It’s not easy, but it can be done. For the greater good, of course–certainly not to keep the population sick, weak and obedient–only psychopaths running the show would want that.

    Maybe if we implemented a mandatory school chant, it would help with the indoctrination: “Vaccines are safe and effective and saved the world. Vaccines are safe and effective and saved the world…” They could end it with a Bellamy salute and a resolute “Heil AMA!”

  18. #18 Michael J. Dochniak
    Minnesota
    August 18, 2017

    Orac writes,

    At the end of the list, it does say that autism, autism spectrum disorder, and behavioral issues are “not sufficient to meet medical exemption requirements.”

    MJD says,

    If the autism spectrum disorder (ASD) rate continues to rise does Dr. Zandvliet’s have a tiger by the tail?

    Although, the CDC is hinting at a possible plateau in autism prevalence.

    https://spectrumnews.org/news/u-s-stats-show-autism-rate-reaching-possible-plateau/

    Within the autism spectrum, a proteomic investigation of B-Lymphocytes in vaccinated vs. unvaccinated individuals may provide science-based evidence for the incidence of allergy-induced regressive autism.

    @ Orac’s minions,

    Does physician bashing increase consumer confidence in vaccines?

  19. #19 MikeMa
    August 18, 2017

    Silly NWO

  20. #20 Eric Lund
    August 18, 2017

    Also, don’t most of these doctors who do this not take insurance? I know Dr. Sears doesn’t. Does that mean that they make more money from their patients?.

    Yes, for two reasons. One is that most insurance companies negotiate lower rates for procedures. On a typical bill for medical services you will see a quoted rate, and an adjustment which brings that price down to the insurance company’s negotiated rate. The result is that people covered by insurance pay less, even when they have not yet used the deductible, than those who don’t.

    The other, of course, is that by not accepting insurance, these practices can charge for things that insurance companies would not allow, such as a fee for providing a medical exemption letter. I have no way of knowing this for sure, but I suspect those doctors who provide such letters to patients who legitimately need medical exemptions do not charge separately for the letter (any fee would be included in the office visit charge).

  21. #21 Politicalguineapig
    August 18, 2017

    Just out of curiosity, how prevalent is vitiligo in the general population, and have any of the pediatricians here ever had a patient with it? (I don’t need or want specifics, just a yes or no.) I thought it was super-rare.

    Antiphospholipid antibody,Wegeners, Sjogrens,Eosinophilic esophagitis, ulcerative colitis and mixed connective tissue also all sound made up. Anyone know if they are real?

    NWO: Go screw yourself, Trumpette. I’ve had it up to here with stupid people for the month. You contribute nothing here, and there are several thousand rocks more intelligent than you. Go home to Stormfront or go cry to Mike Adams.

  22. #22 Liz Ditz
    Great State of California
    August 18, 2017

    Eosinophilic esophagitis is real. I believe the rest are as well.

  23. #23 Panacea
    August 18, 2017

    PGP: Vitiligo occurs in 1-2% of the population. It’s not really rare, but the severity varies, and when it occurs in light skinned folks it’s easy to miss/conceal. I’ve met any number of people who have it.

    All of the other diseases you mentioned are real. Some are more common than others. Sjogrens and UC are fairly common, the others more rare.

    Angela: there are any number of doctors who refuse to take insurance. They do quite well; they can charge what the market will bear, and some patients will go out of their way to pay it if they think they’re getting something for the money. We see this a lot in boutique medicine.

    By refusing insurance, many physicians can avoid paying for the regulatory infrastructure that comes with Medicare and Medicaid. But you end up cherry picking your patients, and if you don’t find a niche to indulge you may not bring in enough patients to keep the practice open.

    MJD: News flash. ASD rates really aren’t rising. Orac has already discussed this: http://scienceblogs.com/insolence/2017/01/25/another-reminder-that-there-is-no-autism-epidemic/

  24. #24 Politicalguineapig
    August 18, 2017

    Liz Ditz and Panacea: Ah, thank you. Once again I conflated the source with the information. (Usually, if it’s a bad source offering information, one has to assume the information is false. But it looks like the stopped clock may be right in this one instance.)

    Panacea: That’s very interesting. I assumed vitiligo was much more obvious. (Although I suspect Micheal Jackson was still lying about his.)

  25. #25 Michael J. Dochniak
    Minnesota
    August 18, 2017

    Panacea (#23) writes,

    MJD: News flash. ASD rates really aren’t rising. Orac has already discussed this:

    http://scienceblogs.com/insolence/2017/01/25/another-reminder-that-there-is-no-autism-epidemic/

    MJD says,

    I recall that I made four (4) comments in that interesting post and two (2) made it through the automoderator (i.e., Orac).

    Understand that I often have to work twice as hard as Orac’s minions to express some of my thoughts and opinions here at RI. 🙁

    @ Orac,

    As the moderator, is deleting well-intended comments difficult?

  26. #26 Eric Lund
    August 18, 2017

    PGP@24: You were correct that the information is false. The problem isn’t that Dr. Zandvliet listed a bunch of nonexistent diseases; as other posters have noted, they are real. The problem is that none of these conditions is actually grounds for a medical vaccine exemption.

    I’ll confess that it would be easy to slip a bogus condition into that list, however–I’m not a medical expert, either. It would be like me giving you the following list: proton, neutron, electron, klystron, lepton, hadron, baryon, meson, fermion, boson, photon, phonon, gluon, graviton, deuteron, parton, anyon. All of them are terms used in physics. One of them is not like the others. If I didn’t tell you that, would you have known?

  27. #27 Panacea
    August 18, 2017

    PGP: It’s usually pretty obvious in the African American, African, Indian and other dark skinned populations, especially if it’s on the hands. It might not be as obvious in caucasians, especially if the affect sites are very small and easily concealed.

    I absolutely believe Michael Jackson had vitiligo. It was confirmed on autopsy, and they found medications used to treat it in his house after he died. http://www.autopsyfiles.org/reports/Celebs/jackson,%20michael_report.pdf

    But as Eric pointed out: not one of these conditions is a contraindication to vaccination. If anything, some of these folks need to be vaccinated even more, to protect them from serious illnesses that can complicate their chronic conditions.

  28. #28 Jenora Feuer
    August 18, 2017

    @Eric Lund:
    I would have known, but then again, I took a physics minor in University and have an amateur radio licence, so I actually know what the terms mean.

    (For the record, the one not like the others is klystron, which is a form of vacuum tube that used to be used in high frequency radio and microwave amplifiers. All the others are particles or quasi-particles in physical phenomena.)

  29. #29 sadmar
    August 18, 2017

    @ Denice
    Yes, it’s no surprise the worst school is in Sonoma County, but also no surprise that overall that Orange and San Diego counties are worse. We really need to kill the “it’s all those granola crunchers” stereotype. I wonder if/how the AVs turn toward Trumpism has affected new parents who might be drawn into anti-vax… maybe slightly decreasing the numbers in NoCal while increasing them in SoCal??

    @ Liz
    Maybe some intrepid soul could uncover the identities of the docs selling medical exemptions in Santa Rosa and Sacramento. There are obviously more people involved than Jay and Bob, and the focus on those two here makes the phenomenon seem smaller than it is (among other things).

  30. #30 Johnny
    127.0.0.1
    August 18, 2017

    I wonder if/how the AVs turn toward Trumpism…

    Are they? I mean, sure, Jake is a real Trump fanboi, but are any of the others really in the Trump camp? They like what he says about vaccines, but I haven’t noticed them lining up on other issues beyond what I’d expect from normal distribution, and haven’t noticed them being particularly vocal about it.

  31. #31 Denice Walter
    August 18, 2017

    @ sadmar:

    That’s possible.

    re doctors who give exemptions etc

    The Vaccine Machine Facebook page has featured parents searching for ‘friendly’ doctors for spacing out vaccines or avoiding vaccination altogether-
    e.g. questions like:
    ” I live in Washington, does anyone know a vaccine friendly doctor before school starts? I can drive an hour or so”

    The website enabled this so why not exemptions?
    ( I haven’t been watching them so much as of late)

    @ Johnny:

    I occasionally hear n AV applaud the Donald on sites I watch but not so many

  32. #32 Chris Hickie
    August 18, 2017

    ooh…to have snatched AoA’s site and linked it to the CDC….

  33. #33 Chris Hickie
    August 18, 2017

    @Eric Lund #20–the disgusting irony is that pediatricians like Gordon and Sears decry the non-existent profits I make on vaccines while charging their cash-only-up-front patient several times what I get from insurance for the same visit. They are the worst type of opportunistic carpetbaggers.

  34. #34 EmJay
    August 18, 2017

    @PGP

    I’ve found PubMed Health to be a good source for info on drugs & diseases.
    https://www.ncbi.nlm.nih.gov/pubmedhealth/

    I look stuff up for a living, and I’ve used PubMed Health any number of times to get background material.

  35. #35 Lawrence
    August 18, 2017

    Hey, we tried.

    Definitely not for a lack of trying.

  36. #36 Jay Gordon, MD, FAAP
    August 18, 2017

    I don’t think exemptions have “soared.” There are more than last year. But, as you note, vaccination rates really have soared. SB 277 has accomplished what everyone hoped it would. It has also generated much more conversation about vaccines leading many vaccine-hesitant families to begin giving vaccines. I know this last part from personal experience in my practice.

    99.5% of kindergartners do not have medical exemptions. Yes, there is clustering. It is a family’s privilege to present a case for a medical exemption and a doctor’s legal right to grant that exemption.

    Both the spirit of the law and the letter of law allow for latitude in medical exemptions. Certainly advertising the sale of these papers is very questionable behavior, but private conversations and case-by-case exemptions are what the law demands. Your opinion is interesting, Orac, but it’s not what the law says. I always enjoy getting your take on this topic, though. The law, however, does not give a “rat’s posterior” about your opinion. In my practice, medical exemptions are discussed and granted only to families within the practice. No one new is allowed to make a “vaccine consultation” appointment.

    Dorit, I would agree that children with respiratory issues, cardiac issues and some other medical conditions actually are at higher risk.

    Dangerous Bacon, read the law.

    Dr. Hickie, I have not joined Physicians for Informed Consent. They and I do not agree on some points in the discussion. I’m not a big “joiner” anyway. I notice that you still haven’t joined the largest voice for pediatric health in the world, the AAP. You’re not a joiner either?

    Eric Lund, the law makes no provisions for auditing a legal medical practice. The Board isn’t very interested in doing that either. Yes, Eric, I gross $2160 every hour scrawling my signature on medical exemptions. Cool beans.

    Panacea, good to see your moderate take on the action needed to reign in exemptions.

    Liz, it’s wrong to give medical exemptions to children you don’t know.

    PoliticalGP—Yes, most of us have seen vitiligo. And, yes, it is rare in pediatrics. All of those diseases are real.

    Sadmar, no, there are no other docs. Just Bob and me. Or that’s what you might believe if you read nothing but RI.

    Dr. Hickie, again! Call me and I’ll explain how—when one buys a product for $20 and sells it for $40—one can make at least a small profit on vaccines.

    Friday afternoon. My 3:30 patient canceled. I have used the time productively.

    Have a wonderful weekend!!

    Jay

  37. #37 Narad
    August 18, 2017

    ooh…to have snatched AoA’s site and linked it to the CDC….

    I suspect that this wouldn’t have been possible. I’m not going to try to check the routine using this tablet, but I think there’s a grace period of around 60 days before a domain is fully relinquished.

  38. #38 viggen
    Boulder
    August 18, 2017

    Hmm. Isn’t writing a medical exemption in a case that does not warrant it medical malpractice?

    Also, I saw an article quoting you about alternative medicine and cancer therapy on CNN, Orac. kudos!

  39. #39 viggen
    Boulder
    August 18, 2017

    Very dodgy there, Jay (#36), I’m sure your patients swear by you. Too bad that it’s supposedly your job to help protect your patients from your other patients: the ones that truly need medical exemptions desperately need the ones that don’t to be vaccinated!… as Orac says, providing less than the standard of care is not ethical.

  40. #40 jrkrideau
    At the bottom of the lake (the bottom end that is)
    August 18, 2017

    # 5 Chris Preston

    Measles in Perth?

    I live only about 85km from Perth. How did I miss that news?

    Oh, “Perth, Western Australia”. My Perth is Perth Ontario Canada. I can calm down again.

  41. #41 Politicalguineapig
    August 18, 2017

    Johnny: Are they? I mean, sure, Jake is a real Trump fanboi, but are any of the others really in the Trump camp?

    Kent Heckenlively sure is, and before he passed, Olmsted seemed to be supportive of Trump.

    EL:The problem is that none of these conditions is actually grounds for a medical vaccine exemption.

    Well, I figured that. But given that antivaccine ‘physicians’ are,as Chris Hickie says, ‘a bunch of opportunistic carpetbaggers,’ I really wouldn’t put it past them to invent some diseases, like Wakefield did.
    I thought the anyon was the one you’d made up, not being acquainted with much physics.I recognized some of them, though.

    Panacea: Very interesting. I didn’t take more than a passing interest in MJ, since I was born well after his heyday. (Though, why did his nose fall off?) But, yeah, vitiligo is a very odd and interesting condition.

    Jay:Yes, most of us have seen vitiligo. And, yes, it is rare in pediatrics. All of those diseases are real.

    Please don’t speak for the others, who unlike you, actually practice medicine. I was asking them, because Dr. Hickie and Panacea are HONEST, and you don’t have more then a passing interest in the truth, if that. You lie to your patients, you lie to us, and you’re a disgusting two-faced hypocrite. I hope you at least got a good price on your soul.

  42. #42 Panacea
    August 18, 2017

    Letter and spirit of the law? Oh, come on, Jay. You’re equivocating. Finding a loop hole in the law doesn’t make what you’re doing right, safe, or smart.

  43. #43 Chris Hickie
    August 18, 2017

    You couldn’t pay me to join any medical organization that would accept you and your medically incompetent, anti-vaccine views and schedules, Jay, which are antithetical to being a pediatrician.

  44. #44 Yvette
    August 19, 2017

    So basically, the main docs who profit from vaccines are the anti-vaccine ones. This time, they are selling exemptions, not supplements. It does make me wonder why Dr. Sears fought against this law. Maybe he didn’t realize what a boon it would be to his income?

  45. #45 Opus
    just north of the buckle on the Bible Belt
    August 19, 2017

    Yvette @#44: It was a win/win situation for him. The only thing that matters to medical whores like Sears (and Jay Gordon?) is the publicity, which generates income. Sick kids are higher-profit revenue units for them.

  46. #46 Renate
    August 19, 2017

    @ Yvette #44 and Opus #45
    To be loved by anti-vax, they had to show they had doubts about vaccines and the way to show this, is to protest SB-277. If they wouldn’t have protested, the anti-vax would have thought they weren’t on their side at all. So to show their true colors, they had to protest SB-277, probably knowing this would be a lost cause, so it would only be good for their profits. By protesting, they advertised they were on the ‘right’ side (for the anti-vax people) and showed they were sympathic to them and thus would have some extra profit by selling medical exemptions and it would bring the right patients. An ill patient with a vaccine preventable disease would bring more income.

  47. #47 rs
    August 19, 2017

    “My 3:30 patient canceled.”

    Hopefully for the right reason, but probably not.

  48. #48 Michael J. Dochniak
    Minnesota
    August 19, 2017

    PgPig (#41) writes,

    Dr. Hickie and Panacea are HONEST.

    MJD says,

    Yes they are, their HONEST-to-goodness minion’s of Orac.

    @ Jay Gordon,

    Thanks for bringing a healthy balance to this scienceblog.

  49. #49 Dangerous Bacon
    August 19, 2017

    Jay Gordon: “Both the spirit of the law (SB277) and the letter of law allow for latitude in medical exemptions.”

    I do not see anything in the text of SB277 that refers to “latitude” available to physicians that would explain the clustering of medical exemptions in certain schools. The actual pertinent language in the law:

    “SEC. 5. Section 120370 of the Health and Safety Code is amended to read:

    120370. (a) If the parent or guardian files with the governing authority a written statement by a licensed physician to the effect that the physical condition of the child is such, or medical circumstances relating to the child are such, that immunization is not considered safe, indicating the specific nature and probable duration of the medical condition or circumstances, including, but not limited to, family medical history, for which the physician does not recommend immunization, that child shall be exempt from the requirements of Chapter 1 (commencing with Section 120325, but excluding Section 120380) and Sections 120400, 120405, 120410, and 120415 to the extent indicated by the physician’s statement.”

    The obvious intent of the law is that there needs to be solid medical justification for vaccine exemptions. Bob Sears is already facing potential sanction over one such exemption. As Jay professes joy over increased vaccination rates in California secondary to the law, one would think he’d welcome audits of exemption-profuse physicians aimed at increasing vaccination rates still further, especially in schools where unprotected children congregate. He could even voluntarily disclose what percentage of school-aged children in his practice he’s granted medical exemptions to, as an example to his fellow pediatricians (whether or not they’re FAAPs).

    But don’t hold your breath waiting for that to happen.

  50. #50 Michael J. Dochniak
    Minnesota
    August 19, 2017

    @ PgPig (#41),

    Did you notice in comment #36 from Jay Gordon, MD, FAAP that he referred to you as “PoliticalGP”?

    This dedicated and well-respected pediatrician continues to be professional under very difficult circumstances.

    Understand PoliticalGP, you’ll always be PgPig to me.

  51. #51 Politicalguineapig
    August 19, 2017

    MJD: Shut up, you wouldn’t know science if it bit you. You know nothing about anything including how to write. Please stop killing trees with your drivel.And making fun of my chosen nym only makes you look stupider, especially since I told you why I use that name and that it has nothing to do with pigs. Why don’t you just GO away. Maybe spend some time with your son? Oh, I forgot, the restraining order.

    As far as politeness goes, “Dr” Jay”s business depends on him pretending to be polite and nice and hardly ever telling the truth. Most call girls are polite too, for the same reason.

  52. #52 Politicalguineapig
    August 19, 2017

    Doltnik: Also, from now on, I’ll be calling you by a nickname, until you grow up. Sheesh, I’m younger than you, and I already am certain that I’m the grownup in these exchanges. What happened, were you jammed in a freezer at twelve?

  53. #53 shay simmons
    August 19, 2017

    “This dedicated and well-respected pediatrician” who recommends homeopathy and advises against the Gardasil vaccine.

    Nobody but a fellow idiot respects a pediatrician who is that kind of idiot

  54. #54 shay simmons
    August 19, 2017

    “Dr. Hickie, again! Call me and I’ll explain how—when one buys a product for $20 and sells it for $40—one can make at least a small profit on vaccines.”

    Wow, Gordon…you have no overhead? No administrative costs? No staff salaries?

  55. #55 Michael J. Dochniak
    Minnesota
    August 19, 2017

    PgPig (#51) writes,

    And making fun of my chosen nym only makes you look stupider.

    MJD says,

    It’s nothing personal, a nym that’s eighteen (18) letters long (i.e., Politicalguineapig) is most preferably abbreviated.

    I thought of shortening your nym to ppig but decide against that because it reminded me to much of Porky Pig.

    https://www.youtube.com/watch?v=pg7HvF3a_Iw

    Moving forward, if you politely ask me to stop using PgPig I will abide, and with great effort, type out your horrendous nym grudgingly.

  56. #56 Panacea
    August 19, 2017

    MJD re #48: says the man who plagiarizes his “work.”

  57. #57 Politicalguineapig
    August 19, 2017

    Doltnik:It’s nothing personal.

    Uh-huh. The others use PG or PGP, but you deliberately went for the most offensive abbreviation you could think of. Suure it’s not personal.

    And my ‘nym is not horrendous, fyouverymuch.

    There have been others on this board who use longer nyms-heck, your name is pretty long. Imagine a big middle finger right here.

  58. #58 Michael J. Dochniak
    Minnesota
    August 19, 2017

    Panacea (#56) writes,

    …says the man who plagiarizes his “work.”

    MJD says,

    How can I plagiarize my “work”?

    Did you mean plagiarize someone else’s work?

    I’d like to get back on the topic.

    Orac writes,

    What really needs to happen is for the culture in California to change.

    MJD says,

    You just antagonized ~39.25 million people.

  59. #59 Adam
    San Diego
    August 19, 2017

    I was just arguing with that quack Dr. Zandvliet’s! I was calling to find a pediatrician office that does not allow parents to slow vaccinations or refuse them.

    She told me healthCare is a risk vs risk system and that I am obviously not Science or evidence based.

  60. #60 Chris Hickie
    August 20, 2017

    I think I found like likely sources for most of the vaccine exemptions, courtesy of an anti-vax chiropractor named Tim O’Shea: http://www.thedoctorwithin.com/vaccines/doctors-who-may-sign-vaccine-exemptions/

    I will wager that a good number of these anti-vax, money-hunger quack MDs like close to these clusters of high non-medical exemptions.

  61. #61 Denice Walter
    August 20, 2017

    I’ve been watching the MSNBC poll about vaccines ( linked by AoA Facebook)-
    it says.
    ” Vaccines are….
    and the choices are science, parental choice, dangerous
    ( my paraphrases)
    the current results are not good but better than a few days ago

    Take a look.
    ( it should be noted that MSNBC hosts are not anti-vax- quite the contrary)

  62. #62 LW
    August 20, 2017

    On the vaccine exemptions template:

    I thoroughly evaluated the past and current medical history and family history of this patient. It is my opinion that he be exempt from all vaccinations, including measles, mumps, rubella, chicken pox, polio, Hib, hepatitis B, diphtheria, tetanus, and pertussis, for the rest of childhood (through ( DATE– 2030..?) for the following reasons:
    Family history of

    psychiatric disorders

    There, every rabid antivaxxer has a built-in exemption!

  63. #63 LW
    August 20, 2017

    Re: PgPig

    OgLing: is five letters, seven keystrokes since you need to hit shift twice.

    PGP is three letters and four or five keystrokes, depending on whether thou hold down the shift of use caps-lock.

    pgp is the letters, three keystrokes.

    Just FYI, MJD.

  64. #64 LW
    August 20, 2017

    Autocorrect helped me out…

    PgPig is five letters, seven keystrokes since you need to hit shift twice.

    PGP is three letters and four or five keystrokes, depending on whether you hold down the shift of use caps-lock.

    pgp is the letters, three keystrokes.

    Just FYI, MJD.

    (I did like the substitution of thou for you, but it really should have substituted holdest for hold in that case)

  65. #65 BBBlue
    California
    August 20, 2017

    Chris Hickie: Here are GoogleEarth pins of that list. Will be interesting to see how those locations match up with next outbreak. https://www.dropbox.com/s/xikywsvqitzmk13/VaxExemptionDrs%20RI.kmz?dl=0

  66. #66 Michael J. Dochniak
    Minnesota
    August 20, 2017

    LW (#63) writes,

    pgp is the letters, three keystrokes.

    MJD says,

    Very good LW, thank you!

    LW is two letters and three or four keystrokes, depending on whether you hold down the shift key or press the cap-lock twice.

    In the future, please consider practicing what you preach and save us one or two unnecessary keystrokes by using lw. 🙂

    @ Panacea,

    Have I just plagiarized lw?

  67. #67 sadmar
    August 20, 2017

    @ Chris Hickie

    I know the general areas where some of the docs on that list are, and of those most but not all are near ‘traditional’ clusters or problem schools. There are also a couple areas where you might expect some to be by stereotype, but none are listed: e.g. Berkeley area and Marin County (but then the most awful schools aren’t in those areas either…) Do you think this list is fairly comprehensive for CA, or just the tip of the iceberg? I don’t know how to interpret the number of docs listed, that is, whether to be depressed there are that many, happy there are only that many, or both…

  68. #68 Dangerous Bacon
    August 20, 2017

    “I think I found like likely sources for most of the vaccine exemptions, courtesy of an anti-vax chiropractor named Tim O’Shea”

    O’Shea is the author of the antivax classic “The Sanctity of Human Blood: Vaccination Is Not Immunization”, which is in at least its 12th edition. Apparently the crazy needs to be updated at frequent intervals.

    (it should be noted that the most recent edition is called simply “Vaccination Is Not Immunization”. Maybe the “sanctity of human blood” angle made O’Shea sound a little too much like Colonel Jack D. Ripper in “Dr. Strangelove”).

  69. #69 Politicalguineapig
    August 20, 2017

    LW: I think MJD just likes being offensive.

  70. #70 herr doktor bimler
    August 20, 2017

    “sanctity of human blood”
    O’Shea comes close to Renfield (channeling Leviticus), “The blood is the life!”.
    This whole blood-sanctity tradition of magical thinking is never far away from “maintaining the purity of the bloodline”.

  71. #71 Politicalguineapig
    August 21, 2017

    Dangerous Bacon:it should be noted that the most recent edition is called simply “Vaccination Is Not Immunization”. Maybe the “sanctity of human blood” angle made O’Shea sound a little too much like Colonel Jack D. Ripper in “Dr. Strangelove”

    It’s funny that so many people reference Dr. Strangelove, and yet, the point of the film flew past them and went to Mars.

  72. #72 DANIEL GAUTREAU
    Canada
    August 21, 2017

    To Eric Lund. Re: Comment #26. A clingon is a tiny particle of styrofoam found in stuffed toys, which, when released, adheres to almost anything.

  73. #73 Narad
    August 21, 2017

    I think MJD just likes being offensive.

    Jeezums, with all the eclipse hype, I totally forgot about Irony Day.

  74. #74 Chris Hickie
    August 21, 2017

    @ Sadmar: Without seeing who is writing the exemptions, it would be hard to know if the list from O’Shea’s web site is comprehensive or not. Most of those doctors on his list are “cash-only” (such as Jay Gordon, see my earlier post linking to his exorbitant “vaccine consult” visit pricing). As such parents who can afford these disease-promoting quacks probably have the means to easily travel for these exemptions. I agree it’s depressing, especially with the clustering of exemptions, since I saw firsthand practicing in Tucson that pertussis outbreaks in a nearby local school district centered on the two schools with the worst vaccination rates in the district (60-70%) and not the schools with the 95%+ immunization rates.

    @Dangerous Bacon: O’Shea seems an especially crazy chiroquacktor given all the paranoia and insanity on his “doctor within” web site, which I could only stomach for a few minutes. Further evidence that chiropractic is utter quackery.

  75. #75 Panacea
    August 21, 2017

    MJD: Well, you just proved you don’t know the first thing about APA or academic honesty. You can indeed self plagiarize, although you know full well that’s not what I meant.

    Orac may have antagonized a few anti vaxxers and quacks but they don’t amount to millions of people.

  76. #76 Narad
    August 21, 2017

    O’Shea seems an especially crazy chiroquacktor

    Considering that The Sanctity of Human Blood is in its 14h edition, I’d think that’s a given.