White Coat Underground

Being a physician and a father, I keep an eye out for news about childhood vaccinations. I’ve always been concerned about local statutes that allow kids to be admitted to school unvaccinated, especially when all that is required is an affirmation or a letter from a doctor or religious figure. This not only endangers these individual children but also others. As the rates of vaccination drop vaccine-preventable diseases regain a foothold. Children and adults who are either ineligible for vaccination or in whom vaccination was not completely effective can become ill. Parents can, of course, do nearly whatever they want, even when it borders on abusive, as vaccine refusal does, but they should not have the right to endanger others.

This is why I was heartened to see this piece out of Pittsburgh. The three Jewish day schools in the area decided to mandate strict vaccination policies for their students. Private schools have often provided a refuge for anti-vaccination parents, and probably always will, but at least one set of schools won’t tolerate such narishkeit. According to the The Jewish Chronicle:

The new standards were set forth in a letter from the physicians to area Jewish schools last spring. They proposed that vaccination — with certain medical exceptions — should be mandated by Jewish schools as “an active step toward … fulfilling the mitzvah to preserve health.”

Physicians took action and helped the community make a change for the better. The local religious authorities then took on the issue and decided that from a religious perspective, vaccination, given the evidence, is also an individual and community obligation. They based this not just on scripture but on the scientific data presented and on fact that vaccinations rates in a community as a whole go up when schools mandate vaccination. The decision is especially heartening given the news of the mumps outbreak in an Orthodox Jewish community in New York.

Of course, not everyone thinks this is a good idea. Private schools can mandate just about whatever they wish. Jewish day schools often forbid families from having students’ birthday parties on weekends. This “infringement” on the rights of the family is possible because the parents consent to following certain behaviors in order to be a part of the educational community. Parents who consent to send their children to these schools consent to the rules, and if they don’t want to vaccinate, they can go somewhere else. That’s not good enough for anti-vaccine activists like Barbara Loe Fisher.

The Pittsburgh Jewish educational community seems to know something about the anti-vaccination movement—they will require parents seeking vaccine exemptions to get a medical certification from their primary care physician, not just some random anti-vaccination doctor they find on the internet. This is of course a disaster for the anti-vaccination crowd since they count on friendly doctors and ministers to rubber-stamp vaccine refusal letters. Fisher recognized the problem immediately:

Because it’s hard for a family to find a physician to provide a medical exemption, Loe Fisher said, many must rely on the religious or philosophical exemption, available in almost all states, to avoid vaccination. She is not in favor of a private school refusing to accept those exemptions which are provided for by state law. “It is questionable for a school to narrow those exemptions and not allow a parent who believes a child is at risk to take an exemption,” Loe Fisher said.

I wonder why it’s so hard to find a doctor to provide a vaccine excuse? Perhaps because doctors know a bit more about public health than “a parent who believes a child is at risk”? This is a private school and if they want to mandate improved public health measures above and beyond the inadequate state rules, why should Fisher care?

I imagine she cares because every time public health wins, she loses. Her not-so-firm grip on medical reality is threatened by forces trying to save our kids. Her whole freedom to choose shtick is threatened by a couple of small parochial schools. After all, I’m sure she’s in favor of parochial schools being allowed to accept broader vaccine exemptions without interference. But when they want to make their kids healthier, her twisted world-view cannot accommodate the irony.

Sweet, delicious irony.

Comments

#1 Calli Arcale
January 2, 2010

So, does Fisher not understand the difference between “public” and “private”? Private schools are not beholden to the same rules as public schools are. There are certain standards that must be met, particularly if they receive state or federal funding, but otherwise, they can make whatever rules they like as long as they don’t break any laws. It is not illegal to grow a spine and require a *REAL* medical exemption rather than a fradulent “I barely know the patient exists” exemption. And a religious exemption? It’s a religious *school*. If the religion of the school (as practiced by the school) declares it a duty to get vaccinated, then it would make no sense for them to offer a religious or philosophical exemption.

I think a fair argument could be made here that she is the one attempting to infringe on religious freedom here. Not that she’d mind that; she’s not really about religious freedom. She’s about interfering with vaccines, plain and simple.
#2 Denice Walter
January 2, 2010

1.I am familiar with these Orthodox communities(there are also a few much smaller ones in northern NJ):the NY state ones- Kiryas Yoel is near a huge designer outlet- and Monsey and New Square are close to a popular shopping/ restaurant area,bordering my county.In short,they do not live out in the middle-of-nowhere -it’s NYC and metro/suburban NYS,an area of high population density.2.About Loe Fisher(of *Virginia*): she is also involved in the various efforts to institute a “philosophical exemption” law in NJ with Kuo Habukus(of whom Orac wrote).She keeps turning up like a bad penny (or like Tenpenny)- which is my point: there are a few activists/organizers and “professionals” who tout the same “data” and “evidence” in an infinite loop.
#3 mxh
January 2, 2010

Too bad most states are trending the other way. We’re looking for daycare and live in a city with lots of health idiots who don’t vaccinate, and by law none of them can refuse kids who aren’t vaccinated (they can’t even tell us if they currently have any kids who aren’t vaccinated).
#4 Tony P
January 2, 2010

Ok, my primary education happened beginning in 1970 in Catholic schools here in Rhode Island.

I don’t recall there being any resistance to vaccinations back then. We even got our polio vaccinations at the school itself. I believe it was 1972 or 1973 when that happened.

Going forward to my first year in a state college, we were required to have all our vaccinations up to date. It just makes sense to me.

From the data I’ve seen I see no causal connection between the preservatives or the vaccines themselves causing any of the autism related spectrum. In fact new data is emerging where they’re finding the specific genes that have mutated to cause said affectation.

If I ever have kids you can damn well bet they’ll get their MMR, tetanus, and other vaccines and boosters.
#5 Dan
January 2, 2010

Thank you for this, Pal. You and Orac talk a lot about the forces of stupid in public health, so it’s heartening to see a story where good sense wins out once in a while.
#6 Kristen
January 2, 2010

This is great news for this school and the surrounding community.

My son is in a special education class at a public school in Virginia. There is a five-year-old boy in his class with a mitochondrial disorder. His mother wanted to get him vaccinated but the doctors told her it wasn’t safe.

She shouldn’t have to worry (but she does) that someone in his class might make him deathly ill because their parents refused vaccines. These are the children these idiotic people are endangering. That they are putting their own children in harms way is bad enough but they will eventually kill some of these fragile children who count on “herd immunity”. The ones who can’t fight the disease when they contract it.

These people need to get off their pulpit, unplug their ears, get their heads out of their asses and stop ignoring the truth!
#7 TheDissenter
January 2, 2010

Sheesh, yet more lazy medical thinking. Why do people think that vaccines are so useful? Where is the evidence? Please point me to it! There isn’t any other than statistical extrapolation. Vaccines aren’t rigorously tested and the manufacturers are exempt from liability from adverse events. Would you drive a car made by a manufacturer that was exempt from liability? I thought not…

Why do medical people look at vaccines as if they were all the same and thus must all be safe and effective? Every single one is different and use different ingredients and different adjuvants at different doses so one cannot say anything in general about vaccines. If they are all so safe, then why has the government paid out hundred of millions of dollars in vaccination adverse event payments? To say vaccinations are safe or are unsafe is just folly, since they haven’t been tested for safety or effectiveness. Oops! Guess we don’t need any science-based evidence when it comes to pharmas #1 income producer.
#8 mxh
January 2, 2010

Wow, dissenter, way to throw every single, thoroughly beaten-down anti-vaccine talking point in one paragraph. Try to think for yourself, for once, rather than just repeating what some celebrities tell you (your kid’s health is at stake here, after all).
#9 Chris
January 2, 2010

TheDissenter, here is some information I got from a census document (page 9):
http://www.census.gov/prod/99pubs/99statab/sec31.pdf

I cut and pasted the information on measles rates, please tell us what happened between 1960 and 1970.

Year…. Rate per 100000 of population who got measles

1912 . . . 310.0
1920 . . . 480.5
1925 . . . 194.3
1930 . . . 340.8
1935 . . . 584.6
1940 . . . 220.7
1945 . . . 110.2
1950 . . . 210.1
1955 . . . 337.9
1960 . . . 245.4
1965 . . . 135.1
1970 . . . . 23.2
1975 . . . . 11.3
1980 . . . . . 5.9
1985 . . . . . 1.2
1990 . . . . .11.2
1991 . . . . . .3.8
1992 . . . . . .0.9
1993 . . . . . .0.1
1994 . . . . . .0.4
1995 . . . . . .0.1
1996 . . . . . .0.2
1997 . . . . . 0.1
#10 E
January 2, 2010

Interesting. When I first read about the case in the Hudson Valley I had wondered whether the parents were truthfully part of the religious community mentioned. I felt bad but I personally know a woman in that area who told me she lied in the same manner to get her own children exempt – and she has five!

When talking about schooling outside the public school system, and how the health freedom gang has infiltrated it, don’t forget about the free-schools*. Along with that is the home-school circuit (that’s the one the woman I know is on). Sometimes the appeal of these schools can be driven by an ulterior motive.

Having worked throughout the entire Hudson Valley it came as no surprise that any kind outbreak happened there. The way I see it: The multi-generational fanatics have taken *~ hippiedom ~* (Woodstock being ground zero) to all new heights and have caused it to stretch in all directions.

*Another woman I know observed for a day at one free-school because she was thinking about this type of education for her daughter. At one point a young boy threw-up and no adult came to help him or clean it up. When she asked about it they replied that it was natural, plus that children need to learn to take care of themselves. Ick. Needless to say the daughter doesn’t go to that school.
#11 military wife
January 2, 2010

Chris–but, measles are good for you! Or, er, they just went away because we started fluoridating the water. Or something.

And E–disgusting. I hope all the other families enjoyed it when their kids came down with the “natural” puking virus. Good heavens.
#12 Tian
January 3, 2010

I am not against vaccines. But I have been told that some vaccines originated from human diploid cells of aborted fetuses? If this is true then I would not take those vaccines. This is my own personal religous beliefs. If someone could fill me in on this, I would be willing to listen. Even if they did not contain this, I still would refuse just due to the fact that I would not want something in my body that was orginally made from this.

My first question, if this is actually true and they made a vaccine from this. Why did they do it if they knew it would cause people to refuse it. Also what is the opinion of physicians on here about my position? Do you think I have the right to do so? Would you as a physician tell me about the vaccines that did contain this link, if you were my family doc and knew my sincere religious beliefs?

I would be interested to see the opinions about this. I know if I were a family doc and knew a patient of mine had a certain religious belief and the vaccine I was going to give them contradicted that belief. I sure would tell them INFORMED CONSENT and allow them to make the call and try to offer an alternative. I think that would be the moral thing to do.
#13 Chris
January 3, 2010

Tian, rubella used to kill babies before they were born. Also during the 1960s rubella epidemic women who had rubella while pregnant had therapeutic abortions. One of those was used for the rubella vaccine.

Also, the cell line from two aborted fetuses have been used for over forty years. Just those, no more.

Also, the Vatican has made it clear that the use of those vaccines is more important than concerns over the abortions (though they do not like the concept).

More information here:
http://www.immunizationinfo.org/immunization_issues_detail.cfv?id=32
#14 WILLIE
January 3, 2010

If you have been vaccinated and your children vaccinated why do you even care about what other people do for their children. Truly it is none of your business. You do not question if men sleep with men or dogs or cats but you question everyone else’s vaccine status? Mind your own business your child is vaccinated does the acronym HIPPA mean anything to you? It is none of your business. If you are confident in this failed scientific expirement just keep vaccinating your kids and let the rest of us do what we want. I will never give my children another vaccine nor will I evertake another one it is ALL BULLSHIT
#15 Chris
January 3, 2010

Willie:

If you have been vaccinated and your children vaccinated why do you even care about what other people do for their children.

Because vaccines are not 100% effective. There is a small chance that the vaccine will not work for someone. Plus there is a subsection of people who cannot get vaccinated due to real medical reasons and need to be protected by herd immunity.

Plus some vaccines cannot be given until a certain age. The kid who went to Switzerland and came back with measles infected several babies too young for the MMR when he went to the doctor. That is why we care.

Now what we also care about is the science. What science shows that the vaccine, like the MMR is worse than the diseases it protects against (measles, mumps and rubella). Do try to answer with something other than insults and projection, like perhaps an actual scientific paper published in a real journal. Do you have something like that?
#16 WILLIE
January 3, 2010

Chris Fuck Off
You are no physician just a pharma ass wipe which I do not particularly mind, useful idiots and useful ass wipes have a place in the world. Your anecdotoal story you can stick up your queer ass ok. This 1 incident means nothing so quit vomiting it up all over the web like somebody should give a shit.This is a gay bath house story made up by you and others there is no reference, no journal publication. The lies told by the pharmaceutical companies and their minions , that would be you and ORAC, will not be forgotten my perverted friend. 23 fake journals by MERCK and we should believe anything they write or paid to have written. All you fucks belong in jail for bribery, fraud conspiracy to commit wire and mail fraud racketeering and conspiracy to commit racketeeering. Hey genius if your dumb fucking ass is on the payroll we will be looking for you too so do not get to comfortable. And if you are not a physician and assert that you are I will sue this blogg and come and get your ass for misrepresentation as that is clearly against the law and a federal offense so look that up too smart ass
#17 Chris
January 3, 2010

Again with the lame Pharma Shill Gambit. Is this what you use instead of evidence?
#18 WILLIE
January 3, 2010

Chris you are uneducated and full of shit and there is nothing lame about that as it is the simple truth. The literature is replete with information that is beyond the scope of your inadequate education and training, which is no great feat, that suggest that vaccines are not only a failed idea but actually quite dangerous. This is why they do not do the the independent randomized prospective controlled double blind study which as you clearly do not know or cannot fathom, is the gold standard and considered level 1 evidence based medicine. You should look all of this up BEFORE coming onto a blogg and giving advice Chris. You are just another blogg bullshitter and I will not take the time to educate your dumb clearly uneducated ass. Go to bed
#19 Donna B.
January 3, 2010

Am I the only one thinking that WILLIE may be off his meds?
#20 DebinOz
January 3, 2010

Oh dear, WILLIE Wanker is actually threatening people. Call the men in white coats.
#21 reasonablehank
January 3, 2010

Willie… is that you, John? Anti-vaxxers are the kindest people IN. THE. WORLD. Oh, the LULZ.
#22 DebinOz
January 3, 2010

Is WILLIE Wanker really John Best, or just his more evil twin? Hadn’t thought of that. Must go back and compare the rants.
#23 Kristen
January 3, 2010

Willie

2:02AM-2:48AM…He has been drinking, perhaps?

My, that is more vulgarity than I hear in my teens’ music.
#24 Katharine
January 3, 2010

“You are no physician just a pharma ass wipe which I do not particularly mind, useful idiots and useful ass wipes have a place in the world. Your anecdotoal story you can stick up your queer ass ok. This 1 incident means nothing so quit vomiting it up all over the web like somebody should give a shit.This is a gay bath house story made up by you and others there is no reference, no journal publication.”

Oh, so he’s a homophobe too!

Sounds like another one of those weirdo conspiracy theorists.
#25 PalMD
January 3, 2010

He does not appear to be John Best. But still batshit insane.
#26 Fitz
January 3, 2010

“You do not question if men sleep with men or dogs or cats”

I’ve no problem with men sleeping with men, but dogs and cats are another matter entirely. The fact you equate them is pretty worrying.
#27 Chris
January 3, 2010

Aww, but it is nice when the cat comes in and snuggles and purrs in the morning (as she is begging to be fed!).
#28 mxh
January 3, 2010

@Chris

Plus some vaccines cannot be given until a certain age. The kid who went to Switzerland and came back with measles infected several babies too young for the MMR when he went to the doctor. That is why we care.

Exactly, my son will be 3 months old when he starts daycare and he wouldn’t have gotten all his vaccines by then. I don’t want him exposed to some idiot’s child who is carrying preventable diseases.
#29 Liz Ditz
January 3, 2010

Chris at @15, I think you mis-wrote:

What science shows that the vaccine, like the MMR is worse than the diseases it protects against (measles, mumps and rubella).

I think you meant to write something along the lines of

What science shows that the vaccine (such as the MMR) poses significantly fewer risks to health than the diseases it protects against (in this case, measles, mumps and rubella).
#30 Liz Ditz
January 3, 2010

OK, enough with amusing ourselves with Willie.

Congratulations to the Philadelphia Jewish day schools for coming down on the side of science and public health.

But I have a question.

I understand the anti-vaccination woo in Waldorf schools (illnesses are Karmically necessary, etc.)

I understand vaccine refusal in the extreme element of the anti-abortion communities (lots of lies about how many abortions necessary to make vaccines, etc.)

I sort of get the anti-vaccination stance of crunchy new-age mommies, trying to prove that they are taking better care of their children than any body else is taking care of their own (from the relentless lies and misinformation of people like Barbara Loe Fischer).

But what is the rationale for anti-vaccination ideology in Orthodox Jewish communities? Anybody know the history?
#31 PalMD
January 3, 2010

I don’t know that there is any real organized thing. In the recent mumps outbreak, the community had lower vax rates than the surrounding community but still over 70%. It may just be an isolation thing, not having access to the same things people living outside the community do.
#32 Chris
January 3, 2010

No, Liz, I meant exactly what I wrote. There is plenty of science that shows that the MMR is safe, what is lacking is proof from others that it is dangerous.
#33 TheDissenter
January 8, 2010

“I cut and pasted the information on measles rates, please tell us what happened between 1960 and 1970.”

Are you calling that proof? If so, I guess I see why you are so easily duped into believing this crap. Empirically observed covariation is a necessary but not sufficient condition for causality. Thought you would know that but maybe that’s too scientificky for you. Perhaps you can tell us what happened in the late 30′s when the rates dropped substantially without the ‘benefit’ of vaccines? Oops!
#34 Chris
January 8, 2010

World War II. And the drop was not as severe pronounced.
#35 Chris
January 8, 2010

Plus there were fewer children due to the depression.
#36 TheDissenter
January 8, 2010

“World War II. And the drop was not as severe pronounced.”

Good analysis. I guess then the Vietnam war accounts for the drop in the 1970′s doesn’t it?
#37 Chris
January 8, 2010

Not even close.