I've been writing about the antivaccine movement for a long time. The reasons are many, but they boil down to a handful. First of all, it interests me. It interests me as an example of pseudoscience and quackery, how it spreads, and how antiscience cranks attack science. More importantly, it's dangerous. The antivaccine movement is a threat to public health, which is why it's important to study its origins, the methods its members use to attack vaccines, the misinformation it spreads, and how it spreads that misinformation. As a result, I've been consistently vilified and attacked by antivaccine cranks, starting with J.B. Handley and most recently finishing up with a hilariously inept attempt at a slime job by our conspiratorial-minded young epidemiologist wannabe Jake Crosby, who seems to think he's capable of making me squirm. Well, perhaps he is—in disgust and desire to hie myself out of his presence as fast as possible—but when it comes to "proving me wrong," well, not so much. Still, it is amusing to see that everybody's favorite over-the-top homeopath Dana Ullman made an appearance to congratulate Jake. (Hint to Jake: When Dana Ullman thinks you've done a good job, you really do need to take a long, hard look at yourself and ask yourself if maybe—just maybe—you've taken the wrong path.) Perhaps the most hilarious thing of all was a comment by someone by the 'nym of Otto who in response to the part where I asked Jake if he had ever published in the biomedical literature before responded:
JAKE, you are published at AoA all the time... that is a few steps above most medical publications.
Yes, that's right. Let that soak into your brain for a moment, and try not to laugh too hard. I failed. Fortunately, to distract me from Jake's silliness, I came across a real publication that caught my eye because it simultaneously suggests why the antivaccine movement is so dangerous while suggesting why it is so important to counter the misinformation, pseudoscience, and lies promoted by antivaccinationists. Basically, it's a study of factors that affect parents who decide not to vaccinate and how they come to their decisions. Specifically, it's about the effect of social networks on vaccination decisions, both pro and con. It's a study that made the news in reports in TIME and U.S. News and World Report. The study itself, by an anthropologist Emily K. Brunson, was published online in Pediatrics and is entitled The Impact of Social Networks on Parents’ Vaccination Decisions. It consists of a survey of around US-born, first-time parents with children aged ≤18 months in King County, Washington. To give you an idea what sort of environment this county is, it's worthwhile to look at this news report:
At her son’s preschool near Seattle, Robin Haight is a foot soldier in the vaccine wars. She arranged for a pediatrician to speak about vaccines at the home of a school parent. She put up posters — she calls them “gentle propaganda” — that touted the importance of immunization in stopping the spread of disease. Her husband helped create a spreadsheet to track which children at the school are missing which vaccinations.
Some parents have said that Haight’s provaccination message has no place at preschool, that it’s disrespectful and patronizing, that the decision to vaccinate a child is nobody else’s business. One mother got so emotional that she broke out in hives. But Haight thinks a conversation is critical, and the latest research published in the journal Pediatrics backs her up.
“I’m just trying to let people know that if you don’t vaccinate your children, it might affect other children’s health,” says Haight. “It directly affects a community of young children. How do we not talk about this?”
The problem to be overcome, however, is described in this study. As I read it, I was thinking that an anthropologist is the perfect person to look at the social groups that shape vaccination decisions. In this case, Brunson surveyed 126 parents who followed the nationally recommended childhood vaccination schedule from the CDC (referred to as "conformers," which I really didn't like) and 70 others who either delayed vaccination (28), partially vaccinated (37), or didn't vaccinate at all (5) (all of them referred to as "noncomformers," which I also didn't like). 95% of both groups reported consulting their "people network" for advice and insight into vaccination decisions, and around 90% of each group included a physician in the top five members of their decision-making network. However, as you might expect, what those "people networks" told them was very different. Basically, 73% of "nonconformers'" friends and relatives advised them to disregard the CDC vaccination schedule, while only 13% of "conformers'" friends and relatives advised them similarly.
Now here's why this is so important. The significance of what the conformers' and nonconformers' friends and relatives far outstripped any other factor studied. It "blew any other variable out of the water," as Dr. Brunson put it, or, as she put it in her paper:
This is important to note because of all of the variables consideredin this study, the percent of network members recommending nonconformity was the most important in terms of predicting parents’ vaccination decisions. Considered by itself, this variable was more predictive of parents’ vaccination decisions than any demographic or general characteristic of parents or their networks. It was also more predictive than the percent of parents’ source networks recommending nonconformity and even parents’ own perceptions of vaccination. This strongly implies that for interventions aimed at promoting vaccine acceptance to be successful, they must take a broad approach, one that is capable of influencing not only parents but the people parents might discuss their vaccination decisions with. In other words, interventions targeted only at parents or interventions aimed primarily at improving communication between parents and their children’s health care providers will likely be inadequate because they fail to consider the broader impact of parents’ people networks.
The end result was that parents whose networks mostly recommended not follwing CDC immunization guidelines were more than 1,500 times more likely not to adhere to the CDC vaccination schedule compared to other parents. Even having between 26% and 50% of people in their social networks resulted in parents who were 31 times more likely not to vaccinated as recommended. In other words, it matters with whom young parents associate. It matters what their social networks believe. It matters a lot. Just look at King County, where there is a strong antivaccine sentiment to the point that what should be noncontroversial pro-vaccination messages result in strong pushback and one parent breaking out in hives because she's so upset. In such a social network, even fairly pro-vaccine parents might start to change their minds. At least, it would take considerable fortitude for them to stand their ground.
Antivaccinationists know this. They know that the way to persuade parents not to vaccinated is to create social networks in which like-minded parents, friends, and relatives congregate and reinforce each others' beliefs that vaccines are evil. That's why they go so far to create such networks online. What is the "Thinking Moms' Revolution" (or, as I like to call it—more accurately, I might add—The "un-Thinking Moms' Revolution") but a self-reinforcing echo chamber in which antivaccine moms tell each other how brilliant they are, how superior they are to the moms who vaccinate (the call themselves, without a trace of irony, "Thinkers"), and to encourage each other to greater heights of antivaccine lunacy and quackery.
Of course, this survey isn't without its problems. Dr. Brunson alludes to a central question about her results in an interview, in which she points out that this is a "chicken-and-egg" issue:
Experts said it's not certain that the advice actually steered parents in an anti-vaccine direction: Parents who were already prone to shunning vaccines may have turned to like-minded people for reinforcement.
"It's the chicken-and-egg question," said researcher Emily Brunson, an assistant professor of anthropology at Texas State University, in San Marcos. "The answer is, we don't know which came first."
I rather suspect that there is a lot of truth to this, although I also rather suspect that anyone who is on the fence can be highly influenced by antivaccine parents and relatives. Again, antivaccinationists know this. They also know that parents who are vaccine-averse need seemingly reputable sources of information to to help them justify their decision. Indeed, in this study, parents who didn't follow CDC guidelines were more likely to have extensive "source networks" that included books, blogs, websites, and magazine articles to which they turned for vaccine-realted information. Not surprisingly, 59% of these sources recommend ignoring CDC guidelines and promote the scientifically discredited notion that vaccines cause autism.
In a way, the results of this study are a bit of a "Well, duh!" result. At least, it's a "Well, duh!" result that social networks would be important in influencing the decisions of new parents to follow the CDC vaccination schedule. What is a bit surprising is how strong the effect was in this model. Moreover, from a practical standpoint, it doesn't much matter whether the reason for this result is that antivaccine-sympathetic social networks can change parents' minds or that anti-vaccine-leaning parents seek out anti-vaccine leaning social networks for reinforcement of their decisions. The point is that it's much, much harder to influence parents by just trying to influence parents. The message has to go beyond that and reach everyone. It's not enough to concentrate just on parents. It's not enough to concentrate on pediatricians. The approach has to be broad-based and comprehensive, because prevailing beliefs in social networks can trump all those sophisticated campaigns to promote the benefits of vaccination.
Places like King County show what can happen when the prevailing culture becomes too permeated with antivaccine beliefs.
This is horrible. I'm really glad this study got done.
Also, I am in so much pain right now, and my PCP who happened to be on call tonight told the answering service lady to tell me to go to the ER. And I can't bc if I wake my husband to drive me there, he will never have the resources to cope with our high-maintenance kid tomorrow. And the lady hung up on me after a terse "I hope you feel better ma'am." With am I supposed to do??? I would metaphorically kill just to have someone talk to me for five minutes; I just want someone to take another look at my back, it's not like I'm yelling for dilaudid or something-- in fact, I would metaphorically kill for some freaking toradol. But what I will not do is bankrupt my family, which is what I am afraid will happen if I go to the ER. But we can't have universal health care in this country because FREE MARKET AMIRITE???
So, like, this pain-and-Motrin induced rant is a roundabout way of saying that we believers in science-based medicine can often TRULY, DEEPLY empathize with where the alt-med believers and the antivaxxers are coming from, in that we have all at one point or another felt let down by "The System." I GET IT. I really do. I woke up just now in the middle of the freaking night in as close to a 10/10 pain as I have ever experienced, and this after 3 wks of PT, and I have no one to talk to and no one I can call, and my dr's office after-hours service hangs up on me. I am so mad, I was so full of despair that I cried for like a half hour.
But through all this, even through all this, I would NEVER even consider doing something that the CDC says puts OTHER PEOPLE at risk.
Seriously people. Vaccinate your kids.
Oh Melissa, I really feel for you right now. Just like the vaccination issue, your problem is compounded by the fact that any form of social contract that once existed in your country has been replaced with the "Charter of Me and Mine".
It's a short term, shortsighted position that refuses to think of the future, think for other people, and think "What if I'm wrong?".
When "mommy intuition" and echo-chambers combine to produce statements like "the decision to vaccinate is personal" then that society is in danger.
When science-deniers have warped. curricula and discourse to the point where people can claim "I don't believe in science", or (an old SBM favourite) "I eat a chemical-free diet" without irony then, once again, that society is in danger.
When people cannot see how universal access to healthcare would impove all the metrics of success and stability, then that's such a sad indictment of a nation.
I wish I could email the various forms of relief, because I know only too well how mentally and physically devastating chronic pain is.
The bright spot in this was the answer, on 'Are You Smarter than a Foetus?", to "Have you been published, Jake?"
"JAKE, you are published at AoA all the time… that is a few steps above most medical publications"
It's tragically funny and depressing all at once.
You'd think peer-pressure is an issue! It is certainly hard to talk to parents from within social media forums aimed at opposing vaccines, or raising "concerns".
A pity the paper is pay-walled.
FWIW, there is a smaller survey done recently in New Zealand of parents who delay infant immunisation, looking at “parents’ decisions and reasons for delaying the primary course of immunisations” and to test what “messages to encourage and support parents to immunise their infants on time” might be effective. I’ve introduced it in my latest post and might return if there is demand (it's a fairly long document for me to work through).
One thing they mention is that a key driving force to motivate parents is caring for their child (no surprise there). They test some messages they might offer parents - it seems to me that empathy with a want to do well for their child is one that matters. (There may be differences compared to areas with higher non-vaccination rates, etc: our vaccination rates are ~87% fully-vaccinated and ~4% not vaccinated.)
In Ireland newborns receive various "milestone" checks by community nurses to ensure they're developing properly, identifying issues etc. Parents also receive a vaccination book which gets stamped so they know when kids got what jabs and there are reminders posted out when it's time to receive them.
Does the US have a similar system? It would seem to be a good idea to do this and take the opportunity to impress on parents the importance of vaccination and allay any fears. It would also be a good idea to followup when there is no record of vaccination and offer an appointment to discover why.
I have been a skeptic reader of this site for some time and have learned a good deal about how to talk common sense to less scientifically minded associates .
Here in the UK ,we have an escalating measles outbreak,
at present centered in South Wales .
The headlines for days have been of queues at vaccine centres and health staff giving up their free time to help .
Since your post was about how to influence parents ,this is one very effective but sadly drastic way .
Journalists are scrabbling to salvage their reputations if they once supported Wakefield .In the case of The Sunday Times
which was instrumental in blowing the whistle on him ,
they are rightly taking the high moral ground and using it to inform about responsible citizenship and herd imunity .
I am doing my bit by informing other grandparents in our circle
about your blog and convincing and true scientific evidence to help guide their offspring .
@Adam - there are standard "well-child" visits that are encouraged by pediatricians, usually at the same time that various vaccines are scheduled to be given as well. It is the opportunity for the doctor to examine the child, talk to the parents about milestones, vaccine administration, etc - for some reason, the anti-vax groups seem to ignore the relationship between parents and doctors - our Pediatrician is very much in synch with my wife and I, knows our sons very well and is very proactive in working with us on any issues that come up.
Maybe if the people at AoA would stop vilifying doctors and instead encourage parents to develop good personal relationships with them, a lot of these misconceptions & issues would be resolved.....it's a pipedream, I know....
Just to tack on to what Lawrence said, there are also vaccination books/sheets that parents can bring with them to keep a record of which vaccines were received and when.
On a side note, I've had a wonderful influx of requests for my disease cards (details here - they're free!) from a number of public health nurses in one state. Would be awesome to get a wider spread. [/shameless plug]
All most parents hear is vague murmurs and whispers that there are "problems" with the vaccine schedule or that they heard once, years ago, that getting vaccines leads to autism. They don't know anything else, they have no idea that the guy that wrote that paper has been utterly discredited, they heard one part of the story, it lodged in their brain and now they find some book about delaying or whatever and they think "oh, a doc says this is safe" and go with it.
They are the OPPOSITE of thinkers.
I will continue to assert it is the miserable presence of two anti-vaccine pediatricians, Robert Sears and Jay Gordon--who promote their anti-vaccine lies and rhetoric using their MD/FAAP monikers-- that have helped to create a perceived linkage to on-the-fence parents between groups like the NVIC and pediatricians/AAP . As a pediatrician, I find this deplorable and continue to see daily in my office the undesirable results of this linkage when parents refuse and delay/skip vaccines
-Chris Hickie, MD, PhD
@allieP - yes, it is in the interest of groups like AoA & Generation Rescue to vilify real doctors, so their supporters will be distrustful & only listen to their own propaganda. These groups don't want parents to think for themselves - quite the opposite, that they should only listen to what gets printed by the Stag's & Olmsted's of the world.....
I have no problem with parents wanting to become more educated - and they should take medical decisions very seriously - but that doesn't mean to base those decisions on junk science and myths about vaccines - it means do real research & have in-depth conversations with their chosen pediatricians....
The truth about anti-vaccine parents at last!!
Lawrence mentions 'vilifying doctors'-
I have found that this is a simple way of recognising full-tilt alt media hype: if the site/ broadcast tells you not to trust doctors, that they "don't know everything", that they are greedy, in the pay of BigPharma, etc, run, don't walk away.
Obviously we hear that all the time - doctors don't know how nutrition or vitamin C can be used against cancer ( prn), doctors don't understand vaccine population studies (Jake).
Doctors are "@sshats"- Alison MacNeil.
AoA and TMR are certainly anti-doctor as are less diversified woo-spreaders like Natural News and PRN.
I was 'pleased' to play Sunday night's "Talkback" tape ( PRN) wherein I was informed that the show's host "counselled" 2 people with severe depression and was able to transform their lives easily in a few weeks : 20 years of psychologists, psychiatrists and meds did nothing for this woman but he did. And she also lost 40 lbs! Nutritionists and woo-meisters believe that they can treat patients by recommending diets, supplements and exercise - in this case 2g daily of tryptophan ( he probably meant 5-htp) will do the trick for depression.
So the faithful loyalists listen to/ read about their gurus' exploits and follow ensuite. Sites like TMR are rife with medical advice about "recovering" lost children - and I don't mean calling the police and getting a search going-
but using woo to reclaim that perfect being who was secreted away by the machinations of the evil faer... I mean DOCTORS.
As I mentioned previously, I venture that these beliefs allow a parent to cast blame elsewhere and simultaneously restore self-esteem because at some level they must believe that having a child with an ASD is a stigma. They find solidarity with others who feel the same and they prop each other up with praise.
I would also venture that particular people are more vulnerable to these ploys: those who perhaps feel badly about their own selves and view doctors as privileged without merit.
I would ask the faithful: your leaders ask you not trust doctors but to trust them instead?
What makes them MORE trustworthy?
MORE diversified woo spreaders....
Conventional medicine often over asserts its quality, expertise and authority.
In an increasingly dysfunctional society, educated parents are likely to specialize
prn please give examples of how conventional medicine "over asserts its quality, expertise and authority."
The statement about Jake's publication record isn't all that wrong - he sure is more known for his "knowledge" about autism and its causes than 99% of the MDs working in the field. And 90% of the public probably don't get the difference between peer reviewed scientific literature and blog posts. And it's those 90% that Jake is trying to convince of the correctness of his point of view, not the 0.1% that are actually familiar with the state of the art of autism research, or the 9.9% that are willing to look it up.
AND -btw- today's TMR:
Ms Blaze tells readers how to 'spread the joy' even more.
Facebook is only the first step.
and "farm out" parts of their assessments to others. Conventional medicine is getting nailed on its errors and arrogance. When conventional medicine blows off the educated classes with drivel, like in the nutrition wars, the educated populii become skeptical and hesitant as conventional medicine's expertise and derived authority shrivel.
You folks want to be listened to, and heeded reflexively? You need to improve on your error rate, like in nutrition, ***a lot***. The vitamin C and D stories alone discredit conventional medicine, much less the whole dietetics wreckage.
It is rational behavior to hesitate until broad questions are resolved. Cramming it down will breed more resistance. Did you read the parable of the Wind and the Sun? You have to sell quality and desire. Basic fear tactics, even if the claimed risk - benefits are correct, have worn out their welcome.
I know at my house we now scratch and sniff every medical situation - automatic "yes sir" isn't happening. If "Urfkd auto sales" delivers a Yugo 3/4 of the time customers specify a particular Lexus model, don't surprised when they spend a lot of time on contracts and delivery verifications, or just shop down the street.
IIRC there has been at least one pertussis outbreak in Washington state in the last 12 months. My recollection is that the outbreak occurred in Skagit County, which is two counties north of King County, but it would be easy for such an outbreak to spread to the Seattle area (some people commute to Seattle from Skagit County).
The conformer/nonconformer frame also struck me as being off. There could be some people in the "nonconformer" group who have understandable reasons for not adhering to the vaccination schedule: medical contraindications, or not having enough money to pay for doctor visits in a timely fashion. A suitably designed study would avoid including children in those two categories, but I don't know if this was actually done in this study.
@prn: Alt-med also frequently over-asserts its quality, expertise, and authority. There may be good reasons for being skeptical about what your doctor tells you, but this isn't one of them.
Did anyone else notice the amount of comments on Jake's piece where people wrote that they didn't watch but still trust Jake that he "won" the "debate"? Or the number of comments where all they had against Dr. G was his looks, his mannerisms, or his speaking skills? Very few commented on the substance while most just launched vilifying attacks.
We need to be careful not to fall into that trap, not to play their game. Dana is wrong not because he's an ignorant fool when it comes to physics and chemistry, but because his understanding of physics and chemistry is wrong. Likewise with Jake. He's not wrong because he's creepy or because he yells when he speaks. He's wrong because he doesn't understand basic scientific and journalistic principles.
It's the same when someone who is on the fence about vaccines approaches us. We can't just say "they're nuts, don't trust them" even if the anti-vaccine people display nut-like behavior. We need to say "they're wrong, and here's why," even if a full-on dissertation follows.
What's wrong with using "compliant" vs. "noncompliant"? I thought that was standard medical terminology. Being a nonconformist makes you sound all romantic like Jack Kerouac or something.
I was born and raised in King County, and this mindset wasn't there when I was a kid in the 60's. It's the flood of weirdoes from California and the Midwest (only about 40% of the population is native) that brought a lot of the woo--its probably even worse in Portland where naturopathy has a school and is totally licensed, and where insurance has to pay for acupuncture.
Thanks, Eric. For many people the situation is chunkier than any specific answer. My point is that major failures in one area, like nutrition, have blow back in general perceptions of medical credibility that broadly undermine automatic acceptance and alacrity far more broadly.
Or the number of comments where all they had against Dr. G was his looks, his mannerisms, or his speaking skills?
Yes, I did notice that, as well as the general lack of interest in the substance of the debate. Unfortunately that is the mindset you get when you believe your 'side" is in possession of an Absolute Truth and anyone who questions it is the enemy .
And I do have some sympathy for Jake, who clearly does not realize how cynically he's being manipulated by the older people in the antivax movement. How could he? He's been living in a bubble for most of his life. His parents subjected to him to a lot of quack treatments and let him believe that he's "toxic" (which he seems hell-bent on turning into a self-fulfilling prophecy.) He got an expensive education that's been wasted on him, as he's rapidly making himself unemployable with his unethical and self-orienting behaviour. His judgment is so skewed that he can't even recognize what a despicable bottom-feeder Patrick "please call me Tim" Bolen is. If Jake doesn't turn it around soon he's going to be trapped down the rabbit hole with these people for the rest of his life. I wouldn't wish that on anybody.
When conventional medicine blows off the educated classes with drivel, like in the nutrition wars, the educated populii become skeptical and hesitant as conventional medicine’s expertise and derived authority shrivel.
What drivel and what "nutrition wars" are you referring to specifically? Perhaps you could identify the "drivel" in conventional dietary advice, such as the USDA Dietary Guidelines for Americans along with citations to back up your assertions. I have done a lot of reading in this area, and I still find the maxim, "eat, not too much, mainly plants" to be the best dietary advice around. I know that UK recommendations are to eat more fiber, less fat, more fruit and vegetables and to avoid being overweight, and US recommendations appear to be much the same. Is this drivel?
If you look at the EPIC prospective study of diet, the association between diet and most diseases (except for the effects of obesity) is surprisingly weak. Colon cancer is associated with less fiber and fish, and more red and processed meats. Breast, ovarian and prostate cancers do not appear to be associated with fruit and vegetable consumption at all. Gastric cancer is reduced by fruit but not vegetable consumption. That isn't what you would expect to see if the CAM dietary gurus (with their often contradictory recommendations) are correct.
You folks want to be listened to, and heeded reflexively? You need to improve on your error rate, like in nutrition, ***a lot***. The vitamin C and D stories alone discredit conventional medicine, much less the whole dietetics wreckage.
Again, what "vitamin C and D stories" are you referring to? Where are the citations to back this up? Low vitamin C levels are correlated with poor health outcomes (magnesium too), but it is far from certain that there is a causative relationship, as increased fruit and vegetable consumption is also linked to many potentially confounding factors. It really isn't as simple as you seem to believe.
As for vitamin D, the Institute of Medicine carried out an exhaustive study of the evidence a couple of years ago and concluded:
From this committee’s perspective, a considerable over-estimation of the levels of vitamin D deficiency in the North American population now exists due to the use by some of cut-points for serum 25OHD levels that greatly exceed the levels identified in this report as consistent with the available data. [...] At this time, the scientific data available indicate a key role for calcium and vitamin D in skeletal health and provide a sound basis for DRIs. The data do not, however, provide compelling evidence that either nutrient is causally related to extra-skeletal health outcomes or that intakes greater than those established in the DRI process have benefits for health.
I don't know what you mean by "the whole dietetics wreckage"; are you suggesting that nutritionists know better than dieticians? Perhaps you would care to explain.
I'm curious, prn: exactly what vitamin C and D stories discredit conventional medicine? What major failures in the area of nutrition undermine the medical crediblity of science based practicioners?
As I said in the other thread: Citation needed.
the educated populii become skeptical
No, I believe the word you're looking for is "cynical". If only they would be skeptical, that would be a great thing. What you're describing, though, is close-minded distrust, not open-minded inquiry.
I certainly do notice the type of criticism the illustrious Dr G recieved ( also above- see my 'doctors know nothing' ). re "looks"- developmental psychologists might attribute this sort of superficial criticism to developmental level- kids look at the outside first and consider internal abilities,values and motivations much later on.
But I digress- sure, they want to discount his message so they dismiss the envelop first**- it's a way of getting people to NOT listen to him. A pre-emptive strike if you will.
Woo-folk can be very appearance oriented - like anyone- but there may be an ulterior motive: they often sell health and youth at all costs. And there is a deeper reason- perhaps the surface is all there is.
You'll notice Andy's new look: some of those I survey ( see facebook posing) fancy themselves to be matinee idols- they understand their audience's needs and most frequent depth of processing.
Fascinate them with a bright, shiny object, perhaps they'll forget what it has wrought.
Actually I have learned that when you counsel people there is a possibility that your own appearance will be thoroughly scrutinised and judged. I try to maintain a professional wardrobe and even make efforts when I encounter someone new: I put my hair up instead of allowing it to follow its own natural dictates..
** I have no problem WHATSOEVER with his appearance or demeanor and I DO know something about men - ahem!-.
-btw- you are so hot you need to cover up!
The idea that there is a "war" between alt med and real science keeps popping up in alt med discourse; the idea that they are engaged in a mighty struggle with mainstream medicine for scientific "truth". In their minds this fight puts them on equal footing with real science. In reality their war is pretty much one sided, as prn so eloquently illustrated.
I've posted before...and I'll post it again.
We need to reach (expectant) parents before they get involved in the nonsense that proliferates on the internet, by providing them with all the VISs for the Recommended Childhood Vaccines; easily accomplished for patients who receive care through HMOs...where there is a seamless transition from OB care to Pediatric care.
There are more than 600 confirmed cases of measles YTD in Wales (population 3 million). If we were to extrapolate those confirmed cases of measles to the United States (population 314 million), we would be looking at 6,000 cases of measles, YTD. The "worst year" recently, in terms of public health, was the 222 confirmed cases reported for the United States for the 2011 calendar year.
Could the *problem* be that the U.K. does not have vaccine mandates for entry into day care and public schools?
Could the *problem* be that the U.K. public health system charged with investigating and containment of single cases, clusters and outbreaks of V-P-Ds are ill-equipped (or underfunded), to act quickly to protect the vulnerable from contracting measles?
That is exactly the atmosphere exuded at places like PRN ** and Natural News.
There is a war on for the public's hearts and minds and alt med is balanced on the cusp of victory, riding a ever-mounting tsunami of paradigm change as SBM deservedly drowns under the cleansing *nouvelle vague* of transformation.,
( Forgive me: I left out references to the rising phoenix, Shiva, the Apocalypse and Ragnarok... short on time.)
** and possibly, by prn.
"Or the number of comments where all they had against Dr. G was his looks, his mannerisms, or his speaking skills? "
Par for the course for AoA. For a supposedly disability-centric blog, they do a lot of making fun of people for being different.
Jake could put up a video of 10 minutes of static and say he was criticizing Dr. G, Paul Offit, or anyone else they hate and the comments would say "good job!"
"Jake could put up a video of 10 minutes of static and say he was criticizing Dr. G, Paul Offit, or anyone else they hate and the comments would say “good job!”"
Well, Andy's latest video asking for a public debate was as close to 16m22s of static as it gets. But I did watch it. I had a bit of a chuckle when he turns to the camera to challenge (at 13m35s) Dr. David Salisbury to a public debate. Scripted much?
I almost heard Professor Elemental ask for his fighting trousers.
Dr. Hickie, how about starting a petition to not listen to Dr. Sears and Dr. Gordon?
LOL, I am right there with you on the looks issue, Denice Walter! Nerdy is the pinnacle of male beauty in my opinion (as our esteemed host can probably attest, having met me and my spouse at CSIcon in November).
I was once hired to draw several "stereotypical" humans of Attractive, Average, and Below Average attributes-- let's just say I required a lot of art direction on the subject, because my tastes are so skewed! :D Personally, I wouldn't give the "stereotypically Attractive" male drawing a second look!
But yes, lest we all forget (unlikely!), it is *always* the quality of the evidence that matters, and never the looks of the person putting forth the argument.
elburto, you are so wonderful and awesome. :) Thanks so much for the words of comfort! Going to an emergency PT appointment this morning helped immensely, and I was lucky my spouse was able to drive me to and from. You phrased so beautifully everything that is wrong with American healthcare... I really hope you are writing a book, because you're like the Christopher Hitchens of RI commenters!!!
On the subject of peer pressure and mommy networks, I would add that there is a TREMENDOUS amount of negative scrutiny on mothers these days. When I was a new mom, I felt like EVERY time we were out in public, everything my child and I did was being scrutinized and judged by the people around us. Now, granted, I am prone to anxiety, but even looking past that, my experience does not seem entirely out of line with that befalling many, many other new mothers.
Now, I was one of the lucky ones. I had my online support networks at RI and Ben Goldacre's forums. I was, at the very least, confident in the *medical* decisions I had made and continue to make for my child. But I can so easily imagine being a new mother in a woo-heavy community, and how easy it would be just to get drawn into the antivax life, even for the simple reason of avoiding the censure and negative judgement of the friends you've made.
Parenting is ridiculously hard without a support network. I really think that the relative lack of a social support system for parents and children (compared to, say, France, where decent daycare is widely available and affordable, and women aren't as OMGJUDGED for working after childbirth!) is something US society is going to *have* to address, sooner rather than later I hope.
Dr. Hickie, I've seen you, indeed, have a petition running on for pediatric doctors but can we sign it?
" I had a bit of a chuckle when he turns to the camera to challenge (at 13m35s) Dr. David Salisbury to a public debate."
He specifically names David Salisbury?
Previously he stated:
The more light that shone on this subject by way of informed, balanced debate, the better. I am offering to debate any serious challenger on MMR vaccine safety and the role of MMR in autism, live, in public, and televised.
Mike Fitzpatrick offered to take him up on this offer.
Mike Fitzpatrick has challenged Mr. Wakefield in the past, but Mr. Wakefield demured.
Mike Fitzpatrick has actively challenged Mr. Wakefield's poor science since the early days of the scare. He is a GP in London. He has written at least one book on autism. He's an autism parent. He is certainly a "serious challenger".
In other words, having been called on a bluff, Andrew Wakefield is moving the goalposts. A brave Sir Robin act.
"Mister Wakefield ran away!" "NO!" "Bravely ran away, away!" I didn't!"
When science reared it's ugly head
He bravely turned his tail and fled.
Yes Brave Sir Fakefield turned about
He gallantly chickened out.
"He specifically names David Salisbury?"
Yep. At 13m35s, he looks away from the person he's talking to off screen and looks directly at the camera:
"And, specifically, Dr. David Salisbury, I would like to debate you. Because I believe you are at the heart of this matter. I believe the decisions taken by you and your committee... lie at the heart of this matter. There are many things that I would like to debate with you."
Of course, he has to check with his lawyers.
When I first watched the video, it stopped at about minute 13. Right at the start of his call for a debate.
Blameshifting. Andrew Wakefield has done this for years.
It could be a long debate.
"You are Andrew Wakefield?"
"Let me check with my lawyers about how to answer that"
and so on.
the educated populii become skeptical
No, I believe the word you’re looking for is “cynical”.
If I were prn I would be looking for a word better than 'populii'. The attempt to pluralise a second-declension genitive by tacking on another 'i' makes my head hurt.
This press release just floated across my desk.
SPRINGFIELD –The Illinois Department of Public Health (IDPH) is reporting the highest number of pertussis (whooping cough) cases in Illinois since 1950. Preliminary numbers show 2,026 cases of pertussis in Illinois residents in 2012. During National Infant Immunization Week, April 20-27, 2013, the Department urges parents to make sure their children have received all 14 recommended vaccinations, which includes pertussis, before age two.
“The record number of pertussis cases is the perfect example of the importance of continued immunization,” said Illinois Department of Public Health Director Dr. LaMar Hasbrouck. “Vaccines have reduced and, in some cases, eliminated many diseases that killed or severely disabled people just a few generations ago. If we continue vaccinating, we can further reduce or possibly eliminate additional vaccine-preventable diseases like pertussis.”
One example of the impact vaccines can have is the eradication of smallpox worldwide. Children no longer need smallpox shots because the disease no longer exists. Another example is the elimination of polio in the United States. Polio once caused death and paralysis across the country, but today, thanks to vaccination, there are no reports of polio in the U.S.
However, there are other vaccine-preventable diseases still circulating in the U.S. and around the world, so continued vaccination is necessary to protect everyone from potential outbreaks. Even diseases that are rare in the U.S. can be brought into the country, putting unvaccinated children at risk.
"Let me check with my lawyers about how to answer that"
Yeah, Andy would be all like, "You are oppressing me!"
Dr. Salisbury would look at him with a confused look. "Me? What am I doing?" he'd ask.
"Oppressing you how, dear chap?"
Wakefield would then consult with his lawyers. One would give him a flawed definition of "oppressed," another would suggest that Wakefield say he's actually not Wakefield but Jesus Christ and Gandhi all rolled into one. That way, if he is Gandhi, then he can rightfully say that the British are his oppressors. So Andy goes with that.
"Dr. Salisbury doesn't seem to notice that I am Jesus Christ and Gandhi rolled into one," Andy says with a proud tone and a swollen chest. The audience gasps. JB Handley would stand up and cheer, but he would be the only one. He'd then look around and feel a little bit embarrassed. JB would give one more "hooray" in a soft, silent voice before sitting down.
"Mister Wakefield," Dr. Salisbury would say, "we are here to debate the merits of your paper to the Lancet and your statements hence whereby you asserted that the triple vaccine, the MMR vaccine, was dangerous, and that the single jab would be the way to go."
"Yeah, so?" Andy would reply.
"So can we debate that or make a mockery of this debate?"
Andy would then clear his throat and answer, "Sure, let's, uh, debate." He would look over to his lawyers. One of them would nod in agreement. "Yes, let's do this."
Piers Morgan, who would be moderating this theoretical debate, would begin by instructing them that they each have one minute to make an introductory statement. Of course, Piers was not my first choice for this theoretical debate. I'd much rather have that guy from the British version of "Whose Line Is It Anyway?" but I can't remember his name. I keep seeing Greg Proops in my head, but I know Greg... He's not British.
Anyway, Dr. Salisbury would go first, and he would state nothing but facts, reading from notes carefully prepared and backed up by evidence. Then it would be Andy's turn. "I'd like to begin by saying that I am being oppressed..." At that moment, the whole audience, with the exception of JB Handley and some lackeys from Generation Rescue, would collectively groan in frustration. Jake would applaud slowly, like they do in the 80's movies, only that no one would join him. "I have been openly blamed for the current measles outbreak in Wales and not given the opportunity to rebut those accusations. Did I state that the MMR vaccine was dangerous?" He would then take a long pause, look over at his lawyers, and then clear his throat. For this debate, by the way, the lawyers would be wearing black robes and funny white wigs. "Yeah, okay, I did," he'd say. "But you all misunderstood me. I meant that it was more dangerous than the single jab vaccines, because, as my right honorable friend JB Handley has instructed me, all vaccines are dangerous." JB would be seen nodding as if to say, "Yes, Andrew. Yes. The check is in the mail."
At this point, I'd change the channel to BBC America to watch Doctor Who, a more educational and more reality-based television program compared to the delusions of one Andrew J. Wakefield. I'd then log on to read Orac's deconstruction of the debate the next day.
That's more or less how I think it would go. But this is all conjecture at this point. Andy doesn't want a debate. He wants a circus.
@Melissa - so glad you got some help. I was reading and posting on RI after an hour of sleep earlier today, and was exhausted. When we got up the other Mrs elburto asked "Who's Melissa, and why were you talking about tying fentanyl patches to pigeons? Internet serious business?"
She thinks it's hilarious. I used to do it when I worked taking calls for the evening/weekend GP service, spend my sleepy time rambling about various symptoms and people. I once started shouting about a baby who'd cut himself shaving, and was wasting time calling for a GP home visit!
We have 214 confirmed/220 suspected measles cases here in the North-East of England with 1 in 6 requiring hospital treatment. As we're further away from London, and tend to be treated almost as a different country, there's very little press about it.
400+ cases confined to an area with a population of 200,000. It's terrifying. If the numbers here of just the confirmed cases were happening in Wales we'd be talking of about 3500 people, yet we barely getting footnotes. in articles about the outbreaks.
Clinics are giving out vaccinations, home and overseas students are being jabbed at their respective universities (lots of campuses in a small area here), and healthcare staff are being vaxed/boosted as necessary. But it's still rising by 10% a week, aided (no doubt) by the fact that schools are starting the new term.
Good old Andy Snakefield.
@ Melissa G:
Heh heh. I also have somewhat *interesting* taste myself- I'm constantly being told how "handsome" my "brother" is. Yes, we're both lovely.
I'm so sorry to hear about your injury: I hope you're already feeling better. Of late, I've been involved in "talking" two people through their post-operative blues/ pt/ work adaptions ( they're non-clients). So much of our identity is wrapped up in our 'abilities'/ 'independence' that we face major emotional repercussions when any of them change, even temporarily.
I sometimes wonder the alt med's attitude that denies SBM's efficacy also denies the reality of personal helplessness in the face of serious injury or illness?
As if to say- "If I do everything correctly- diet, exercise, meditation- nothing will ever go drastically wrong".. cancer can be cured easily with nutrition.. no mental illess will ever occur if you take supplements.. if parents just avoid doctors, vaccines and toxins, their kids will be absolutely perfect as well as asthma and autism-free.
Illness and diability are not part of the human conditionto them but imposed from WITHOUT.. the evil machinations of something or somebody. A hex or a curse perhaps.
Fortunately, as a young student I thoroughly read my Frazer as well as folklore and mythologies. I come ready-armed for combat with woo-meisters.
@37. Nice article by Mike Fitzpatrick. I was struck by his comments about reducing fear mongering on both sides. Right now I see two images:
First, the vivid descriptions given repeatedly, ad nauseum, by anti-vaxxers of doctors shooting toxins and monkey brains and antifreeze into babies with one hand, while the other hand is holding a bank deposit slip;
Second, the look on the face of my nephew, a new intern in Ohio, when he described what was by far the worst experience he had had so far in his medical journey: telling a mother of a 7 year old girl that her daughter had died of measles-caused meningitis, and listening to her sob over and over, "Why did I believe them?" (the antivaxxers) He was very angry, and devastated.
Oops, wasn't finished. Last sentence:
The first image was fear mongering. The second, not so much, though the anti vaxxers will find a way to make it so.
Here in New Zealand it would certainly help to win hearts and minds if the varicella and noro virus vaccines were on the fully funded schedule. Not only would this make it accessible for those with larger families, but it would make these vaccines appear as important as the others. The view that chicken pox in particular is a normal childhood illness is very prevalent among parents here. Only two weeks ago a mother at my Playcentre was asking if anyone knew a child with chicken pox so that she could get her children exposed.
@elburto - those statistics are very terrifying. I wonder if Andrew Wakefield believes his own lies about not being responsible.
I mean 'roto' virus, not 'noro'
I’d much rather have that guy from the British version of “Whose Line Is It Anyway?” but I can’t remember his name. I keep seeing Greg Proops in my head, but I know Greg… He’s not British.
Are you sleep-deprived again? I think you mean Clive Anderson. A good choice, since he is (or was) a lawyer himself, with a razor -sharp lightning wit.
One of the results in the 2013 Immunisation Health Report that has just come out was—cribbing from my post here!—that “86% of adults want healthcare providers to inform them of vaccines that provide extra coverage against diseases, even if these are not funded through the National Immunisation Schedule.”
That one turned out to be a self-limiting assault on the public: woo-tard wanted to raise a little bio-terror bomb, but it blew up in his hands. Your nephew isn't fear-mongering, he's just relating real life.
Yes, that's a touch harsh sounding. It's also the truth. Consider what would have happened had it spread into the community, taking down those too young, immune-compromised or otherwise not insulated by the vaccine.
Al-Queda would luurrve to get US and British vaccination rates below the herd immunity threshold; that would create misery, disfigurement and disability far beyond what a few terrorist attacks could accomplish.
Edith-- Fakefield!!!! ROFLOL!!!! And then elburto comes along with Snakefield!!! I tell you, these are making my day! AND another dramatization from Ren-- awesome, which I am thinking in capslock, only the blog hates it when I capslock as much as I feel capslocky, so **superseekritcapslock enthusiasm** at everyone!!! And a hi5 from afar to DW on our *excellent* taste in attractive nerdery!!! :D
Also, Denice, you are so right about our independence defining our identity to a great degree. In my youth I used to lift weights, plus I grew up in one of those families where women were expected to do everything and suck it up, be "nice," not a "complainer!" Pushing through pain is so deeply ingrained in me that I don't even *notice* when I'm doing it.. As a result,I have spent a lot of precious healing time effectively *undoing* my PT. Re-learning how to get out of bed, how to sit in a chair, how to put my clothes on, and worst, how to SLEEP without inflaming my nerves-- this is my life now. I have a staggering respect for people who live with chronic pain, who are profoundly disabled... just... apart from the pain entirely, the level of frustration has been monumental. AND STILL, I know I am one of the lucky ones, and yet it still sucks this badly!! Jeez!!! Talk about a newfound empathy with, like, every chronic pain sufferer on the PLANET.. Sorry for the inarticulate ramblings. I just have not the words for it.
elburto, you have me in stitches at "pigeons with fentanyl patches!" I am seriously going to injure myself laughing! :D You and your wife are so awesome. I'm so glad the internet exists for our Serious Business! I love those dreams-- love it when people sleep-talk and the wacky dreams get remembered!!!
Shay, that is an awesome press release!!!
I am saying awesome a lot. Apparently the brain really DOES release endorphins on its own, who knew???
What is NOT awesome is what Ism's nephew went through-- that poor family!!!!! That poor little girl!!! Antivax propagandists ought to be ashamed of themselves-- I seriously have no idea how they sleep at night, other than delusion making for a soft pillow.
In general, "-tard" is not appropriate. Consider that in discussions of Andrew Wakefield even more of the readership will be disabled or parents of those with disabilities.
My kid is intellectually disabled (mentally retarded). My kid has done more with his abilities in a short time than I ever will with my abiltities. Disability shouldn't be an insult.
Hi5 to Matt Carey and double-hi5 to your child!
I have a minor objection to saying that Wakefield is "discredited." That somehow sounds much too gentle, like he merely made sloppy mistakes or was incompetent (although that is bad enough.) Something along the lines of "caught red-handedly falsifying data" seems more fitting. There is a word in the back of my head that would say this more succinctly but I cannot get it to come out right now.
In flagrante delicto?
"caught red-handedly falsififying data" = "arripuit red-handedly supponamus nititio"
JGC: The decades at 200 - 400 iu of vitamin D2 were total failures by IOM. Even recently, IOM did not address a lot of non bone issues and their studies algorithm is not promising, too low and slow to address many issues in cancer, immune function and osteoporosis, especially with other nutrient issues. I half expect their vitamin D3 recommendations to crater on calcium deposition locations from magnesium and vit K2 deficiency problems in the future and still yield suboptimal results with low D3 recommendations.
20 - 30 - 40 - 60 - 80 ng/ml, which would you recommend or prefer? The best answer may depend strongly on how much vitamin K2 and magnesium are available.
Their current 4000iu UL is not even adequate for a lot of people without using a grossly inferior adequacy levels like 20 ng/ml instead of the 30-32 ng/ml versions. For many old folks intakes of 5000 iu are required not 200-400-600-800 depending on date and age. Many cancer patients, or even other "benign diseases", need 10,000iu even 20,000 iu else their calcium levels drop like a rock below normal range. Without adequate K2 and magnesium the calcium may deposit in the artery instead of the bone.
Conventional medicine has not been addressing these with known data, rather the patients initiate or do without even with cooperative doctor.
In flagrante delicto?
Conventional medicine has not been addressing these with known data, rather the patients initiate or do without even with cooperative doctor.
So says the person who was giving unsolicited medical advice on another thread.
Just a reminder that the known data shows the MMR vaccine is safe, and does prevent measles. On the other thread you seemed to say that certain nutritional supplements could prevent measles:
If I were in Elburto’s position, I might try to whine less and take more proactive steps to find a secondary antiviral strategy. Like maybe cut down on the carbs, maybe boost my blood vitamin D over 60 ng/ml in winter, make arrangements for IV sodium ascorbate with the U Kansas protocol. Perhaps consider flavonoids, hydroxycobalamin and Zn too.
Perhaps you should apologize to elburto, and come up with actual evidence that "advice" would prevent measles.
Note that Andrew Wakefield has also changed this from a "science debate" (like that was ever really going to happen) into a policy debate. The questions he proposes posing to David Salsbury are not science at all.
I can't see where Wakefield would believe that the chances of him being allowed to "debate" Dr. Salsbury were anything but nil. But, there are many things Mr. Wakefield has stated and done that I can't believe a rational person would do.
Her in my state of NSW (Australia) the work by SAVN, of which I am an admin/elder, has always been to use a community of diverse people to counter the pseudoscience, misinformation and fearmongering of the AVN through countering the messages in their blogs and social media. We've always known it won't change the die-hards in the echo chambers, but we may actually influence those fence sitter parents.
Of course, the rest of the campaign to hold the AVN to account for what they do is also bearing fruit - we have successfully lobbied both the media and the NSW Government, resulting in the AVN becoming anathema to mainstream media and a bipartisan political party/govt agreement re these sorts of groups and their threat to the public health. It's becoming recognised that you just can't ignore them because of the insidiousness of theor message that filtrates through the decision groups of parents as Orac described above.
The current measles epidemics in Wales, recently released figures in NSW that show the local areas that have low vaccination rates and the current media focus on providing good, SBM information re VPD and vaccination is such a turnaraound from when I first started with my complaint to authorities that lead to the AVN losing their charitable fundraisng licence (albeit for a finite time). :)
As far as engaging parents to vaccinate on schedule, NSW Health has released a smartphone app (with all the promotion of same) called 'Save the Date (to Vaccinate). It's the first concerted campaign we've seen in a long time, and the result of some concerted lobbying on several fronts. Fingers crossed!
(ps sorry for the longish post).
the Institute of Medicine carried out an exhaustive study of the [vitamin D] evidence a couple of years ago and concluded
Not everybody agreed.
At this time, the scientific data available indicate a key role for calcium and vitamin D in skeletal health and provide a sound basis for DRIs. The data do not, however, provide compelling evidence that either nutrient is causally related to extra-skeletal health outcomes or that intakes greater than those established in the DRI process have benefits for health.
Let me help you translate that: "We haven't collected much relevant data for the last 60 yrs in the proposed healthy range of 30 - 80 ng/ml, and can't cite any since the dog ate my homework. Also higher corrected values are embarrassing given the IOMs previous insistence that 200 iu was more than adequate. A good time was had by all. More funded studies are needed. FOAD."
What does that mean to us personally? Colon cancer has a significant vitamin D correlation component too. Decades of chronic conditions like bone pain and immune/susceptibility issues that cleared up when I began to prod the "toxic limits" like 1200-2000 iu over several years, or when we finally made the jump to "crazy" therapeutic doses.
But still too little, too late. Our 30 ng/ml thesholds? about 5000 and 15,000 iu. Unf'g real. Thanks IOM, defund and rot.
prn, do provide the evidence that your advice will prevent measles infection.
I forgot to add - the NSW Health Campaign addresses the importance of herd immunity as well as the 'myths' re vaccination on the interwebz. It's probably the best govt campaign I've seen in years. :)
"unmasked" is in the right direction but needs to be more pejorative
You keep making assertions that are not supported by anything remotely resembling compelling evidence. I try to ignore it, but when you blunder into an area I know something about I feel compelled to respond.
Their current 4000iu UL is not even adequate for a lot of people without using a grossly inferior adequacy levels like 20 ng/ml instead of the 30-32 ng/ml versions.
What evidence do you have that 30-32 ng/ml leads to better outcomes in bone health, much less other extra-skeletal health outcomes? To quote the IOM report I mentioned above:
Some, but not all, persons are potentially at risk for inadequacy at serum 25OHD levels from 30 up to 50 nmol/L (12 to <20 ng/mL). Practically all persons are sufficient at levels of 50 nmol/L (20 ng/mL) and above. Serum concentrations of 25OHD above 75 nmol/L (30 ng/mL) are not associated with increased benefit. There may be reason for concern at serum 25OHD levels above 125 nmol/L (50 ng/mL).
As I stated above the IOM found "no compelling evidence that either nutrient [calcium and vitamin D] is causally related to extra-skeletal health outcomes or that intakes greater than those established in the DRI process have benefits for health". The extra-skeletal health outcomes they looked at included all cancers, breast cancer, colorectal cancer/colon polyps, prostate cancer, cardiovascular diseases and hypertension, diabetes (type 2) and metabolic syndrome (obesity), falls, immune response, asthma, autoimmune disease, diabetes (type 1), inflammatory bowel and Crohn’s disease, multiple sclerosis, rheumatoid arthritis, systemic lupus erythematosus, infectious diseases including tuberculosis and influenza/upper respiratory infections, neuropsychological functioning including autism, cognitive function, depression, physical performance, preeclampsia, pregnancy-induced hypertension, and other non-skeletal reproductive outcomes. That seems pretty thorough to me.
Are you seriously claiming that you know better than the 14 IOM Committee members who were scientists "with expertise in the areas of vitamin D and calcium or a related topic area, with specific expertise related to pregnancy and reproductive nutrition, pediatrics and infant nutrition, minority health and health disparities, cellular metabolism, toxicology and risk assessment, dermatology, immunology, endocrinology, skeletal health, oncology, cardiovascular health, epidemiology; nutrition monitoring, and biostatistics"?
They met eight times, held a public workshop and open sessions to gather information and receive input on the nature of the available data, maintained a website that accepted comments and data from stakeholders, conducted a review of existing data, and developed a report that included the specification of DRI values. Yet you describe their recommendations as "grossly inferior". I assume you must have some very compelling evidence to support such an assertion.
For many old folks intakes of 5000 iu are required not 200-400-600-800 depending on date and age.
That doesn't seem to be supported by the IOM review and in some cases higher levels of supplementation in the elderly were associated with poorer outcomes. For example:
A randomized but not placebo-controlled trial examined the effect of either 800 or 2,000 IU of vitamin D per day combined with enhanced or standard physiotherapy on the rate of falls and hospital re-admission following hip fracture in free-living adults with a mean age of 84 years (Bischoff-Ferrari et al., 2010). Neither of the two dosages of vitamin D reduced the rate of falls or improved strength or function compared with physiotherapy. Another study (Sanders et al., 2010) that examined the incidence of falls and fractures in elderly women treated with 500,000 IU of vitamin D annually for 3 years found a significant increase in falls and fractures in the treatment group compared with the placebo group. Notably, the increased incidence of falls was significant in the treatment group by 3 months following administration of the supplemental vitamin D. Further [...] the authors of this study concluded that levels of 65 nmol/L were not consistent with reduced rates of fall or fractures.
I would like to see some evidence for the following assertion as well.
Many cancer patients, or even other “benign diseases”, need 10,000iu even 20,000 iu else their calcium levels drop like a rock below normal range.
The study you linked to was of patients with pancreatic insufficiency, who suffer from an inability to digest and absorb fats efficiently, so of course they need to ingest vitamin D to be sure they absorb enough vitamin D to be healthy. In more than two decades of measuring serum calcium and vitamin D levels I don't recall any cancer patients whose "calcium levels drop like a rock below normal range" due to low vitamin D status. Cancer patients are much more often hypercalcemic. You might find this issue of the American Journal of Epidemiology of interest since it includes a number of articles that found no suggestion of an inverse association between vitamin D levels in the circulation and later incidence of 6 types of cancers (upper gastrointestinal, ovary, endometrial, pancreatic, kidney, and non-Hodgkin lymphoma).
I think vitamin D is overhyped, just as megadoses of most nutrients are overhyped.
Are you sleep-deprived again? I think you mean Clive Anderson. A good choice, since he is (or was) a lawyer himself, with a razor -sharp lightning wit.
Yeah. My allergies came on strong this week, and I've been taking a lot of allergy meds. Zyrtec is a hell of a drug, but it also makes me drowsy, which tends to shut down the prefrontal cortex and liven up the temporal lobes... Which only leads me to trouble.
A cartoon you might relate to, Ren.
Let me help you translate that: “We haven’t collected much relevant data for the last 60 yrs in the proposed healthy range of 30 – 80 ng/ml, and can’t cite any since the dog ate my homework. Also higher corrected values are embarrassing given the IOMs previous insistence that 200 iu was more than adequate. A good time was had by all. More funded studies are needed. FOAD.”
That's not true. The IOM review looked at several studies that gave higher doses and achieved serum levels in the range you mention. By doing a quick search for "75 nmol/l" [30 ng/ml] I found the review discusses 18 studies that looked at this level or above. For example in influenza:
In another 3-month prospective double-blind RCT (Li-Ng et al., 2009), even though 73 percent of subjects supplemented with 2,000 IU of vitamin D daily achieved a serum 25OHD level above 75 nmol/L [that's 30 ng/ml] , no benefit of supplementation was seen for either prevention of self-reported upper respiratory infections or a decrease in their severity. This evidence from RCTs in both children and adults shows no causal role for vitamin D in either reducing or preventing influenza.
Also perhaps of interest:
A recent study reported by Cauley et al. (2009) indicated that in contrast to white and American Indian women, black women and possibly Asian women appeared to be at greater risk of fracture with higher serum 25OHD levels (greater than 75 nmol/L).
I could go on, but I think you are mistaken in your belief that more vitamin D is better.
I was thinking along the lines of "caught with pants down"
that's why I used a phrase with both criminal and sexual connotations.
You're doing great work.
Jon Brock's 'Cracking the Enigma' had something about a focus group (UK) a while back that showed that parents seemed to take vaccine information from other parents more seriously than from others.
I imagine that that could work for our side as well.
Firstly, Melissa G needs to find a PCP who is more suited to her needs. But my comment to the original post is that I am glad someone is taking a scholarly look at the anti-science folks from an anthropologists viewpoint. My background is Anthropology/Archaeology, although I left academia long ago. My wife is a PCP, so I hear her perspective every day. I remember from grad school a series of lectures I attended about believers in Atlantis and magic pyramids and such, and the vectors of these beliefs are very similar to the anti-vac people of today. Of course the internet just makes it exponentially worse. As a side not, I have spent enough time in West Africa to see exactly what life without vaccines is like.
I didn't mean it that way, unfortunately there's no edit function. I will keep that in mind next time I post.
Still, light, polite, cautious adjectives for people menacing public health are not appropriate either. I'll try to come up with something that doesn't inadvertently insult a group of people unrelated to the discussion.
Spectator-- try "doucheweasles." I like that one!
Wait, you said adjectives... "Doucheweaslesque?"
Thanks Denice :)
I think engaging the parents that are genuinely seeking good, accurate info is a good thing, expecially when you counter the fallacy and misinformation to enable them to think critically (even if they don't recognise it as such).. There will always be those that fall into that small percentage of believers. But peer pressure in parents groups is a powerful thing and can be used to good advantage imo.
In our situation the AVN have unintentionally been our biggest ally in exposing them for the shrill, nasty, conspiracy-mongering fools that they are; it has enabled a lot of people to see beyond the veil of reasonable sounding 'evidence' and assertions of 'we're pro choice!' that all anti-vaxxers seem to hide behind..
And they unbeknowingly have contributed to a very small change in legislation (by exercising their legal right to challenge a govt decision) that will have long reaching effect for their beloved alternative practitioners with regards to health complaints. No longer will there have to be a complaint from a client/patient that has been adversly affected by treatment/management. Anyone will be able to lodge a complaint against any alternative health practitioner/provider, registered or not, if the issue being complained about poses an actual or potential threat to public health.
This is a huge win, and a direct result of lobbying and the resulting bipartisan approach in the NSW govt at the moment. The Legislation has been through it's first reading, two more to go and presto law.
(I did it again with a long post. Sorry all)
No worries about the long posts, Ausduck! We love hearing good news!
Also, this is RI! We're used to long! ;D
In answer to Eric (19): The groups were based on parents' decisoins not children's outcomes. As you said in your post there's an important difference between the two. It was taken into account in the research.
@Ausduck: I always share the SAVN posts on Facebook - if people are going to clutter up my feed with annoying pictures of stuff, I'm going to share useful things! They have so far helped me convince 2 friends that vaccines are not Teh Ebil the tin-foil hat wearers insist they are.
offtopic, new light hearted blog post:
@Melissa - don't laugh too hard, I don't want to be responsible for crippling you!
WRT your current pain/impairments - You may see it from the perspective that you're "lucky" because it's temporary, but that's not how I see it. If you are in the worst pain you've ever been in, then you're suffering. If you're more impaired than you've ever been, you're suffering.
If I compare my own situation I have all the medication I need to be as comfy as possible. I am making subtle, slow improvements, and I don't have to worry about how this affects anyone but me and the little missus. So I'm comfortable, I can get some sleep whenever I need to, and we don't have kids to worry about. To me, your situation is not an enviable one, because you can't minimise pain by telling yourself "It won't be forever", your body only ever lives in the present. You've gone from living on physical autopilot to having to think ahead constantly and relearn the simplest of actions, and that is exhausting. All that while parenting? Yikes. That's not luck, that's horribly hard on the mind and body.
Remember that "worst pain ever" is subjective. Having had impacted kidney stones then anything is preferable to ever going through that again*, but if there's someone out there who's managed to avoid physical pain, then one day they stub their toe on the edge of a door, then their pain and fear is not made better if I say "Ha! Try p¡ssing jagged lumps of pure misery!"
Letting off steam and being upset is fine. Trying to live up to societal pressure like "grin and bear it" or "be grateful, there are people worse off" is toxic. Keeping pain stuffed down is doubleplus ungood, and suffering is not a zero sum game, if someone gets cancer tomorrow then that won't free someone else from their pain.
So, go easy on yourself. Stick to your limits, don't overdo it for fear of being seen as "giving in" to your pain.
When that inner voice says "OMG buck up and smile Melissa, it could be worse", then flip that voice off. OK? Put a new voice module in to replace it. That one will give approphate (if somewhat corny) advice, like "You have the right to the feelings you experience" and "You can't take more than one day at a time, so don't try to", and "RIsistance is futile. We are the Borg".
*Another really great reason to not pop vitamin D3 like sweeties.
Jake thinks he knows who I am.
I know who you really are; as you're probably aware, the presentations are only open to Department faculty and other students. You have not been a student at my school for seven years. Off-campus attendance is by invitation-only. Needless to say, you are not invited.
His school? Petulant child. I don't need no stinkin' invitation.
"Petulant child" is a perfect description of Jake. A petulant, self-important, entitled man-child who has yet to grow up. Oh, and Jake: I know you peruse the comments of this blog whenever you are mentioned; so I really hope you see this.
Now, that being said, I still don't think it would be a good idea to show up at Jake's presentation for school. It would only feed the paranoia of the antivaccine movement and seemingly validate Jake's persecution complex to no good end. If Jake ever gives a public talk about vaccines and autism, that would be another matter. That's fair game. After all, I let Jake ask questions. Would Jake let me ask him questions if our positions had been reversed? Somehow, I doubt it.
In any case, having seen Jake speak publicly on video and now in person asking questions, I have a hard time imagining anyone outside of hard core antivaccinationist Jake Crosby groupies actually wanting to see Jake give a talk. For all the slime thrown at me in the comments by antivaccinationists telling me my talk sucked or that I was a lousy public speaker (the latter of which was true at one time but I've managed to make considerable progress and improvement on that front through work and practice), I'd put a video of my talk against any video of Jake giving a talk and confidently predict that 99% of non-AoA types would pick mine as the better talk.
But, hey, the AoA comments did amuse me. What's with all this obsession over my looks? I'm a somewhat frumpy middle-aged dude who was never much better than average-looking even in youth, but from the AoA comments you'd think I look like an extra from "The Walking Dead" and smell as bad. It's not about looks, anyway. It never has been. In any case, the best part of the whole thing is that my initial encounter with Jake is right there on the YouTube video. Whatever the AoAcolytes say about it, it's right there for anyone to judge if I was "condescending," "arrogant," "harsh," or "dismissive."
I understand what you're saying, Orac. I'll back off. He can do whatever he goddamn wants.
Ausduck: engaging the parents that are genuinely seeking good, accurate info is a good thing.
Except that that's like netting unicorns. Most parents aren't interested in hearing anything that contradicts their views, and can't be swayed.
Orac: About that talk..could you please put up a transcript? I read way faster than I listen, and my computer is stuck in recovery mode.
@ Alain, (#36)
Here is the link for that petition: http://www.ipetitions.com/petition/request-by-non-pediatricians-for-the…
Christine @ 83:
Thank you for the feedback, it's nice to hear SAVN is helping :)
Politicalguineapig @ 89:
I agree, the believers are a tougher nut to crack. It's not impossible though, you just have to evaluate if it's really really worth the time and energy (and your sanity).
By fencesitters I mean those who haven't gone down the belief track yet. It's been my experience that there are parents out there that are confused by all the info out there, and can be drawn to the scary, scary anti vaccination message through concern for their child, but when shown how that message is scewed and not based on reality good information that is available and how public healh units utilise this information, as well as the undercurrent of consiracy theory etc that is a hallmark of these antivax groups, most reasonable people see sense. We have people in the SAVN page who have come 'from the other side' so to speak and who have now vaccinated their children. That to me is a good thing. The current state govt campaign is also a good thing, as it should not just be groups like SAVN that are promoting the vaccination message.
Elburto, your post made me feel better already! :) I haven't the eloquence nor the type-without-pain to properly express, but you are seriously amazing. Thank you!!!!! Everything you said was just exactly to the mark.
I do see my doc again tomorrow, because my PT person called the practice and said they should take another look at me.
I have seen only about one pro-science, pro-vaccine post or image on Facebook. I have seen a lot of garbage about BVO, "cleanses," and the like.
I would like to see more facts out there.
Khani, join the Facebook groups "Myths of the Antivaccination Movement" (facebook.com/MOAVM), "Jenny McCarthy Body Count" "Stop the Australian Vaccination Network (facebook.com/stopavn), "Anti vaxx Wall of shame", "GAVI Alliance" and the Dana McCaffrey memorial page. I'm a member of all of them and frequently repost their rebuttals to antivaccination lies on my own wall. A cousin of mine is a nurse who recently finished a 10 year enlistment in the Royal Army and she also reposts the stuff on my wall.
First time commenting on this blog(which I thoroughly enjoy!). But as someone born and raised in King County it doesn't surprise me that this is happening. We have had whooping cough out breaks for a few year now and I blame the counterculture theme that is common in the Puget Sound area. Alt med is also seems popular in the Seattle area compared to other areas in Washington. So I'm not too surprised by the numbers in the study.
Add COVRAC (Chillin' out, vaxxin' relaxin' all cool) to the above list.
I'm way late to the party, but 2 comments and a question:
1) Robin Haight sounds like a wonderful person. Keep up the good work, Robin!
2) I guess I must be odd, because the question of whether to vaccinate our kids or not was NOT based on talking to friends and neighbors. Why in the blazes would I ask them? My friends are all pretty educated and smart, but not about immunology.
3) Re: the study, how can you get a factor of 1500 times more likely to do something in a study of only 200 subjects?
Doctors should present all the facts about vaccines and the risks of not vaccinating to their patients. Mention vaccines' common minor adverse reactions and the rarity of truly confirmed severe reactions.
Take the time to discuss diseases and complications and herd immunity. If a parent's conclusions are not in keeping with the way you must practice medicine--in the best interests of that child and the rest of your practice--you can either continue to educate them at the next visit or ask them to see another pediatrician. You can increase the strength of your recommendations with facts and epidemiological data, not anecdotes, and win their trust so they vaccinate as you think they should according to protocols devised by experts.
And your fear of one or two pediatricians who disagree with you should shrink to absolutely zero because you have data and research on your side instead of anecdotes and speculation. And you have earned their trust by being 100% honest with.
“and the rarity of truly confirmed severe reactions.” - and that the rarer severe reactions aren’t cause-and-effect type concerns but are associations that may not be related to the vaccines.
(e.g. recent study showing Guillain–Barré syndrome unlikely to be related to vaccines.)
@Jay - you sound almost completely rational.....so why do you insist on linking to & supporting anti-vaccine nutters?
Hi fellow oracians,
I could use some assistance in winning anti-vaccine hearts and minds. I posted some pro-vaccine stuff on an anti-vaccine facebook page and now I am being challenged that the only way to "prove" the safety of vaccines would be for an adult to redo the entire schedule adjusted for weight to prove there are no toxic side effects (i.e. taking 50 mL injections of vaccines). Of course this is ridiculous (and burden of proof is on the anti-vaccine side to show that vaccines are not safe) but I cannot think of an eloquent way to refute this argument. I'm not intending to change the OP's mind but I am trying to put good information out there for the 23,000 followers of that page. Any suggestions? Thanks!
Well, there are a few problems with such an approach. 1) Adjustments are not merely a matter of weight. Physical processes are slightly different, so even adjusting for weight would not lead to equivalent results. 2) You'd need to find sufficient numbers of adults who have had no vaccines at all for the results to be valid (if, that is, you manage to address issue #1). But the need for such a study doesn't actually exist. There have been a number of studies looking at specific ingredients, effects of full- vs. partial- vs. no- vaccination, effects of antigen load, etc. There are studies looking at adverse event rates (e.g., the Vaccine Safety Datalink and the studies produced from it).
Suggest that they provide evidence that vaccines cause adverse reactions at a rate greater than the diseases they prevent.
I'd ask them if they thought the only way to prove applesauce for children is conducting an adjusted-fro-weight study where adults consume 12.5 pounds of applesauce at a sitting?
They'll probably try hard not to say "No, that's crazy, ther are other ways to assess safety". Ultimately I expect they'll wind up at "But there's no reason to think that applesauce is harmful to kids" to which you can respond "Is there any evidence--evidence, mind you, not anecdote--that the vaccine schedule is harmful to kids?
First sentence should read "only way to prove applesauce is safe for children"
@ bluedevilIRA: I "don't do Facebook", but IMO is you are trying to change the minds of the 27,000 followers of an anti-vaccine FB page...it is an exercise in futility. These people are not "fence-sitters"...they are on that site because they want confirmation and the company of their fellow anti-vaxxers.
IMO, you are playing "their game", because their latest theme is that an infant cannot handle all those antigens, adjuvants, excipients, traces of culture media and (horrors) rDNA, as well as an adult can...thus the infant becomes poisoned by those toxins.
Most of those FB subscribers are well-versed in the "art" of Gish Galloping with bogus studies that support their viewpoint.
I much prefer to post my comments directed to a wider audience, on blogs run by science journalists and on blogs in mainstream media outlets.
I've just been over to the Autism One 2013 quack fest list of speakers.
The "usual suspects" are all scheduled to speak, including Wakefield, the Geiers, Kerri Rivera and her bleach enemas and the editors at AoA. (Keynote speaker is RFK, Jr., with a special panel of the Congressmen who conducted that sham Congressional hearing on autism.
Jake Crosby has his own seminar...and you're going to love the topic he has chosen:
"Challenging the Consensus Through Effective Advocacy
This talk will answer questions about how you can become a more effective advocate. Discussions will range from tips and tricks for challenging people publicly at their own venues to tracking down the connections of those who defend the vaccine lobby but don't disclose their ties. Effective narratives for countering the vaccine lobby's talking points will also be explored."
And here, I've misinterpreted Jake's stalking behaviors, his defamatory rants and his "Six, Sixty, Six-Hundred Degrees of Separation" type of *journalism*.
re 23K followers...
could that facebook page be The Vaccie Machine?
of Robert/ Sid?
Too bad we're on the 'forbidden' list, we're missing top flight entertainment.
Maybe someone we know will 'challenge him at his own venue'
OK, why are the comment tracking options in German today?
Ah, so it's not just my computer. Feeling better :-)
Could it be our geographical location? I'm in France. I don't know if you are also in Europe or if people in North America also got the German version.
Discussions will range from tips and tricks for challenging people publicly at their own venues to tracking down the connections of those who defend the vaccine lobby but don’t disclose their ties.
Ah, so it's going to be a speculative fiction workshop! "How to Create Your Own Conspiracy Theory in 6 Easy Steps..."
I do hope there will be a video of this.
@Heliantus - I'm in Canada and still seeing German checkboxes at the bottom of my page.
I've never had comment tracking options at all on this blog until yesterday.
I'm in Montreal: I'm going to complain to the Office de la Langue Francaise that my tracking checkboxes are in German, not French! The Parti Quebecois will deal with this, rest assured!
I have even more German text lined up on my computer with the two check boxes, that I had last evening
Benachrichtige mich über nachfolgende Kommentare per E-Mail.
Benachrichtige mich über nachfolgende Kommentare per E-Mail
Thanks for the feedback everybody! Great ideas. I particularly like the applesauce analogy, and it illustrates what Todd was saying. There are far too many variables at work for it to be just a weight-adjusted calculation.
Denice, yeah it is The Vaccine Machine. I agree with lilady that I am unlikely to change a lot of their minds. Even though the majority are probably entrenched in the anti-vax movement, I'm sure among the 23,000 followers there must be some people that second guess themselves. My posts managed to get some "likes," so they can't all be diehard anti-vaxers.
Heliantus - I'm in New Zealand. (Where my blog is, see Location.)
At least, you're fighting the good fight.
Looking at that FB page, I can't help but notice that a new topic there concerns whether one should vaccinate the pets or not. "Dogs don't need vaccines for parvo' etc.
I can bet that our esteemed host will not apppreciate that.
Oh, so this is the post to mention German-language comment tracker boxes.
“Dogs don’t need vaccines for parvo’ etc.
I have no reason to believe that "Madame Ghis" doesn't continue to maintain that rabies does not exist.