Another antivaccine-sympathetic pediatrician "reassures" his patients about the southern California measles outbreak

Gordon and Sears have behaved inexcusably as pediatricians. The sad shame is that children are being hurt by the harm they have done to vaccine rates in the US. That these two still spew anti-vaccine stupidity while measles rages in their backyard speaks volumes of their gross ignorance and incompetence.

"No measles in his office"?

Could be due to parents leaving the practice after their children got sick. They were forced to find quality care elsewhere.

Or he's lying.

@Mike - I do wonder how Dr. Jay would react if an infected child did show up in his waiting room, knowing that most, if not all of his other patients were unvaccinated & present (given Measles' degree of contagiousness) - he could certainly end up with a real problem on his hands....wonder if the parents' would up and sue him for negligence at that point.

See, for me my favorite part is when the doctor is like "psh, it sounds crazy to say 'ten times as much measles' but you know, thanks to herd immunity from vaccinations, measles has all but been wiped out! So there haven't been very many outbreaks in the past decade, you know, until people stopped vaccinating their kids because of some hocus-pocus. I mean, hey, I know all the anti-vaccine stuff is nonsense, let me be clear! I'm as surprised as anyone that my patients don't have measles!"

It would be wonderful if we could ensure that everyone graduating from med school actually understood how to evaluate scientific evidence. There are finally seismic shifts going on in the undergrad "pre-health" curriculum that may move toward this goal -- we'll see.

Meanwhile, we have these hacks who somehow memorized their way through orgo, probably with zero understanding, giving out dangerous advice. Dreadful.

Incidentally, when I use the term "pre-health" with my colleagues, I often cough weakly, look miserable, and croak out "I'm .... pre-health!". Then again, I'm class clown of the science faculty ...

"The measles outbreak of 2014 does not pose a risk to your healthy child. Best, Jay"

If a parent heeds this advice, doesn't get their child vaccinated and he comes down with measles, suffering significant/permanent harm), would that pose a risk to Jay Gordon?

Best, DB.

DB: potentially, yes, legally speaking.

Sorry for the plug: http://www.skepticalraptor.com/skepticalraptorblog.php/anti-vaccine-cla…

If it is inevitable that a future measles case will expose other kids in a doctor's office...is it wrong for me to hope that the exposures take place in Dr. Jay's office?

During the 2008 San Diego measles outbreak, the index case who was one of Dr. Bob's patients, managed to expose patients in two other physicians' offices.

DB @6 -- If that actually happened, I would really hate to be the insurance company lawyer stuck with the case.

Come to think of it -- litigation has replaced actual rational regulation for many purposes in this country. Do you suppose that Dr. Bob and Dr. Jay's malpractice carriers are aware of the terrible advice they're giving? Do malpractice policies generally contain language that says something like "If you deliberately give advice that is outside of the standard of care, and harm befalls a patient because of it, we hope you're nice and rich, because we'll wash our hands of it."

To clarify - a patient receiving personal advice can just sue for malpractice. But anyone else - relying on this general letter, relatives of patients and do on - might also have claims.

“The measles outbreak of 2014 does not pose a risk to your healthy child. Best, Jay”

If a child did get measles, what's the betting it would be "blame the victim time" again... e.g. "Well, you say your child was healthy, but really he should have been getting more of those Vitamin A supplements than he got - what do you expect?"

There are 21 reported cases in Orange County. I’m not aware of the number of cases in our immediate area.

What does Dr. Gordon consider "our immediate area"? As California counties go, Orange County is one of the more geographically compact.

palindrom @5: The term "pre-health" deserves every bit of the mocking you are giving it, and then some. What, exactly, was wrong with the term "pre-med"? (Especially where you are--some kids aspire to be nurses or pharmacists, but I don't think you see very many of them.)

One consideration (that makes me cringe) is that many of the non-vaccinators that inhabit the waiting rooms of Sears and Gordon probably deeply distrust all other physicians. I suspect they are so wedded to their belief in Dr. Jay or Dr. Bob that even if their non-vaccinated child (and I wish this on no one) contracted measles, I am not sure they would want to be seen at “ratting out” their pediatrician—after all, how could they (with all their “research”) and Dr. Jay/Bob (with all their “expertise”) have been wrong about this? I also worry that a lot of these non-vaccinating parents would not have a normal threshold for bringing their ill child to see a physician, even if the child were critically ill (because, after all, Sears and Gordon have told them measles is no big deal and a lot of these people truly believe that which does not kill you only makes you stronger and if it kills you then you weren't fit to live). This lot that vocally sticks up for Sears and Gordon is deeply disturbed and deeply disturbing—and I think normal, rational people who do vaccinate their children just can’t believe such horrible parents exist in the US in the year 2014.

Good observation Eric. Orange County is 948 square miles (I thought it was bigger). For comparison, Pima County, Arizona, where it’s 2008 measles outbreak with 21 cases caused the county health department to declare a medical emergency, is 9,148 miles—almost 10 times the size of OC. Measles in OC definitely (for the worse) plays in a smaller backyard.

Eric -- Exactly right (Eric and I actually know each other in real life).

We do get the occasional wannabe dentist or vet, but you're right -- essentially every "pre-health" student is, in reality, pre-med.

Nursing? Fuggedhaboudit!

Dorit: The 2008 measles outbreak in San Diego, caused by Dr. Bob's deliberately non-vaccinated patient cost the San Diego and California State Health Departments almost $ 125, 000 to investigate and contain:

http://pediatrics.aappublications.org/content/125/4/747.full.pdf

Other costs, including economic losses for parents "babysitting" their deliberately non-vaccinated children who were quarantined at home, and the cost of hospitalization for the infant who was too young to be vaccinated, added an additional $ 50,000 as a result of the 12 case outbreak.

Wouldn't it be difficult for the County and State Health Departments and the parents of the 11 MMR vaccine eligible children to attempt to recover monetary losses...in light of the "out" permitted by State law in the form of PBEs?

Last year Dr. Jay had a radio interview available on his website, where he discussed his consultation with his attorney, during the campaign to pass California AB 2109...because Dr. Jay did not want to comply with the provisions of that law which required him to provide reliable information to his patients' parents about vaccines and the consequences of not vaccinating...because, you know, Dr. Jay has his own belief system about vaccines.

Dr. Gordon said that he “reluctantly” vaccinates apparently only when parents badger him to give CDC-recommended vaccines to their children

Not to mention also recommended by the AAP, of which Dr. Jay is a fellow.

Also amusing was Jay's recent twitter feed, in which he, once again, gets "incidence" totally wrong.

You miss the point, Lilady,
When there are no vaccines, there will be no need to investigate outbreaks, or isolate patients, because there will be to many of them, so saving money.
;)

Lilady, there is a legal problem for the county to recoup those costs: there is a doctrine that bars public authorities from recovering costs of providing public services (The Free Public Services Doctrine). There are potential counters - specifically, nuisance torts - but it's hard without a statute.

For what it's worth, we're working on addressing this problem.

The parents are a different issue - as I said elsewhere, I think they would have a viable claim.

Thank you for drawing more attention to this irresponsible letter from Dr. Gordon. I don't know what bothers me more - that Dr. Jay is arrogant enough to admit he doesn't value medical research, knowing that people will still follow his poor advice, or that he makes parents feel their choice to vaccinate is unwarranted. There are likely parents in his practice who just don't know any better and who take him at his word. If he assures them that there is no risk than that is what they are lead to believe. But they deserve to know more - there are very real risks and those risks will increase if they live in communities where there are outbreaks and other people who are taking the advice of Dr. Gordon and remaining unvaccinated. He himself was surprised that he hasn't seen a case, but sadly I think it's only a matter of time. Then he'll just be saying "See, they lived. Don't know what all the big fuss is about. Measles is benign for a healthy child." Yet, how will that child feel? Given the choice the child would probably prefer not to suffer if it could have been avoided with a simple (and safe) vaccine. That is why I'm hoping we can make a statement by Tweeting with the #NoWayDrJay hashtag. It's not just about getting directing attention on Dr. Jay, but in doing our part to dispensing accurate info about the risk of measles and the importance of vaccination.

Sorry, I didn't directly address your point about exemptions - read too fast. Not necessarily. It would be more of an issue for public authorities, but they are already going to face difficulties. School exemptions do not necessarily absolve someone from tort liability: the fact that not immunizing is legal does not make it reasonable, and my argument is that exemptions were not adopted for this purpose: when the state is allowing parents to send their children to school unimmunized, it is not allowing them to roll the costs of their actions on others.

Is that clear?

Of course, if we do pass a statute creating liability - which I think is the best solution - it can simply say PBEs are not a defense.

We recovered costs for a hepatitis A outbreak for investigation/containment/special large clinics to administer immune globulin shots, to restaurant patrons who were exposed to a dirty food handler; not in court though...assessment of fines determined at a Commissioner's hearing.

Last comment: part of the problem is that tort liability is after the fact. Money paid won't make harms go away, and as Christine highlighted, better to prevent the suffering.

Dorit: I was thinking about a lawsuit on behalf of a young infant or an older child who has a valid medical contraindication for receiving MMR vaccine....not on behalf of a child whose parents opted out with a PBE.

I personally miss Dr Jay's visits to RI: I think that he might be a lot of fun at cocktail parties.

If ONLY he came over to the Dark S..I mean a SB vaccine schedule.. He seemed to appreciate RI's ladies. I'll bet that he would become fast friends with Dr Chris and he'd just adore Dorit.
Dr Jay, Dr Jay! There is so much for you here-
I had such hopes for him. I usually have such good results talking men into trying new things...
I'm not accustomed to failure on such a grand level...Alas!

A little question I semi-buried in a comment above:

Does anyone know if medical malpractice insurance policies include language that specifically excludes coverage if the physician has knowingly disregarded the standard of care?

@Lilady 26: I thought you meant that a PBE given to the unvaccinated child who passed measles on to another might preclude suit. So, just to clarify, you have in mind a suit by a child with a medical contraindication, harmed by measles, against someone like Dr. Jay or Dr. Bob? Or against someone else?

@palindrom 28: I'll ask one of my colleagues with expertise on this later - I'm not sure. Some liability insurance policies exclude intentional torts, but I don't know if this would qualify as one rather than as recklessness, and I'm not sure that's universal. Anyway, I'm going into two hours of teaching now, but will ask later today, if nobody else addresses it first.

Here is why it might not be an intentional tort: because the choice is conscious, but the physician might still believe they are doing the right thing, even if it is not the standard of care. Basically, deviating from the standard of care is negligence. This might rise up to recklessness.

If it's intentional, there may not be insurance - here is an article that suggests there is coverage for some intentional torts, but none of the exceptions in it seem on point: http://www.hblj.org/sites/default/files/respondr/French-10-30-2011.pdf

What frustrates me about Dr. Gordon is that his influence goes well beyond the unvaccinated patients that visit his office in California.

I live half a continent away and I know of many “attachment minded” local parents that look to him as an authority on all things parenting and trust him instead of the advice from their own child's paediatrician. He is constantly referred to in vaccine discussions in groups that I’m in as a reliable source of information on vaccines for worried parents, despite his own admission that his opinions aren’t supported by scientific evidence.

So thanks for taking on Dr. Gordon’s misinformation once again. At least now when someone points to this letter as an example of why we shouldn’t worry about the Measles cases going around my part of Canada (and they will), I can send them to this post.

@ Denice Walter: Dr. Jay *used to* try to woo me, with an offer of sharing and half-bottle of wine at a bistro; then he upped the ante with an offer to share a whole bottle of wine. For some *reason*, he didn't like me anymore//sigh//sarcasm. Was it something I said?

About 8 months ago he put me on probation on RI; shortly thereafter he banned me on RI.

Dorit I would sue the parent of child with a PBE who infected and harmed my child. If I could determine that the child was a patient of Dr. Jay's, I'd sue him as well.

IIRC, I had a discussion with another poster on your/Mary Holland's online debate, about suing the parents. No amount of damages could ever compensate me or my child who was harmed by a non-vaccinated child. I'd seek a judgment and would seek an appeal to a higher court, if necessary, and would pursue those parents to the ends of the earth...liens on their home and liens on their income.

@Lilady #33:
A. See above about why PBEs won't bar.
B. Tort liability generally does not make the harm go away. At the end of the day, money doesn't make up for death or disability. It can protect the injured families from having horrible financial consequences on top of the other harms to them.

money doesn’t make up for death or disability

I intend to sue for the intentional killing of Osama bin Laden, Saddam Hussein, and Muammar Gaddafi. One might argue that I have no standing since I am currently sitting, but I feel that only money can help the emotional trauma I experienced over their deaths.

The new California kindergarten uptake rates have just come out. I looked at the data for just Orange County, where Dr. Jay has his practice. There are a total of 42,781 children enrolled in kindergarten (public and private, in schools having more than 10 students in the kindergarten class). Of those, 3,795 lack 2 doses of MMR (the requirement for school entry). Of those 3,795, some subset may have had one dose -- the data doesn't tell us that, just the number lacking 2 doses. That's 8.9% -- not great, but as I said before, may include a large cohort that have had one dose, but not the required two.

Orange County has a total of 1,545 students with personal belief exemptions, or 3.6%. That might be a better number to work with in estimating the number of kindergarteners with 0 doses of MMR.

"Measles is unlikely to be spread by a brief encounter or sharing a BART train."

Tell that to my sister, who contracted measles in 1990. We couldn't figure out where she pickec it up since no one else in her school or family had it. (This was before the recommended 2nd dose of measles vaccine, both my sister and I only had one dose at 1 year of age; I was given a booster as soon as she was diagnosed even though it had been over a week and likely too late to make a difference - I never did get the measles, just a fever from the shot).

Liz @37:
Dr Jay is in LA county (Santa Monica).

Dr Bob is in Orange County (San Juan Capistrano).

#38 In very rare circumstances, there is a possibility of shedding from the vaccine.
Case of vaccine-associated measles five weeks post-immunisation, British Columbia, Canada, October 2013
http://www.eurosurveillance.or/ViewArticle.aspx?ArticleId=20649

www.eurosurveillance.org/ViewArticle.aspx?ArticleId=20649

The new California kindergarten uptake rates have just come out. I looked at the data for just Orange County

Where are they? I got so frustrated trying to find county-level data last night that I wrote to CDPH.

Narad, when I looked for the summary reports, the links for the new ones were listed but not live:
http://www.cdph.ca.gov/programs/immunize/pages/immunizationlevels.aspx
I suppose one could download the excel files and add up the counties one at a time, but I think I'll just wait for the state to do the work.

A. See above about why PBEs won’t bar.

Still have to show negligence, which seems like it would boil down to demonstrating knowledge of exposure of the unvaccinated child.

D'oh -- Bob, Jay -- hard to keep them straight. Stand by.

The California data comes as one big ol' Exel file -- last year I had to copy & paste it to a new file in order to massage the data. This one wasn't locked.

I want to do more fine-grained work anyway -- on a rough pass last night the schools with the highest number of students sans MMR were charter schools that serve homeschooling students. Some of those kids may never be in the same room together, and typically are spread over >2 counties.

Dr Jay is in LA county (Santa Monica).

Thanks for that info. That partly explains why Dr. Gordon can be so nonchalant about a measles outbreak in Orange County. LA County is much bigger, both geographically (it extends from Long Beach north to Palmcaster, a distance of 60-70 miles) and population-wise, than Orange County. Although given the notorious amount of commuting that many Californians do, I wouldn't be as nonchalant. There are probably some offices where people who live in Irvine work alongside people who live in Palmcaster, or at least day care centers with kids from both areas.

Epidemiology is a complex science. It's not as simple as the ratio of those infected with measles as compared to the total population of California.

Oh, and the bit about how you're unlikely to catch measles on the BART train? Seriously? Seriously?? Measles is highly highly contagious. If you're riding with someone who's been infected, and you're not vaccinated...well, I'll quote the CDC: "Almost everyone who has not had MMR vaccine will get measles if they are exposed to the measles virus."

Are we sure that this man attended medical school? Because, I'm not convinced.

Orac, I think you should give Dr. Jay's a bit more careful consideration. After all, he's right about earthquakes. There haven't been any significant earthquake fatalities in Southern California (since 1994) in just as long as there hasn't been any significant measles fatalities (1990).

According to Gordon's Inference, earthquakes are nothing to worry about. Which is no doubt one of the reasons he's located where he is.

Anon, I don't think you understand. They were not worried about the vaccine shedding, this girl actually got and active measles infection (which is required for measles virus shedding) and it was proven to be of the vaccine strain. None of her 41 susceptible contacts contracted measles, so maybe she wasn't even shedding.

Certainly no reason not to vaccinate but another very rare reaction (never say never)
Measles Inclusion-Body Encephalitis Caused by the Vaccine Strain of Measles Virus
http://www.cid.oxfordjournals.org/content/29/4/855
(Apologies-my first plane ride as a teenager ended in a crash landing- I'm OCD about rare happenings)

I'm sure Orac was bending over backwards to be fair to Jay Gordon when he referred to Jay as an "antivaccine-sympathetic pediatrician".

But really - seeing as how Jay has proudly announced he gives very few vaccines (and at least some of the time has to be talked into it by parents), continually spouts nonsensical antivax talking points and attacks his opponents using tactics of hard-core antivaxers (i.e. accusing pro-immunization advocates of being "shills"), I think it is perfectly valid to refer to Jay as an antivax pediatrician.

He's talked the talk and walked the walk long enough to give "credit" where it's due.

Jay is onto something:

Demographic research into parents who are reluctant to vaccinate their children demonstrates that they're not only wealthier and more privileged than average, but they also happen to have more kids. You don't need a degree in economics to understand, therefore, that there are benefits to being a pediatrician willing to shun scientific evidence in favor of pandering to the New Age-y pretensions of a wealthy and fecund anti-vaccination clientele.

That's from an article today at Slate about a recent Mother Jones interview with an anti-vaxx pediatrician:

http://www.slate.com/blogs/xx_factor/2014/04/01/meet_dr_stacia_kenet_la…

http://www.motherjones.com/environment/2014/03/pediatrician-believes-va…

@anon

Responds well to treatment.

@anon

MI-BEC is a rare side effect from the vaccine. You are far more likely to develop MI-BEC from 'natural' measles infection. The outbreak in France with around 25,000 cases of measles, had at least 1 report of MI-BEC, along with other reports of encephalitis.

If I were an antivax pediatrician, I wouldn't be worried so much about a lawsuit from those infected by my unvaccinated patient; I'd be worried about a lawsuit from the patient.

After all, the child is the patient not the parent. If the pediatrician who owes a duty to the child is actively discouraging the parents from vaccinating the child during an outbreak of highly infectious disease, and the child catches the disease and suffers permanent injury, I don't see why the child wouldn't have a claim for malpractice. And I believe the statute of limitations on that lawsuit is tolled until the child comes of age, so the antivax pediatrician isn't off the hook just because the parents are unwilling to sue.

@Eric Lund, #46

Heh, Palmcaster. I may have to use that next time I talk about the Palmdale/Lancaster area (which is seldom, given that it's kind of the pisshole of LA county).

I definitely agree with you that the legendary LA commute makes the transfer of microbes across large areas much more likely. As a lifelong Southern Californian, I've known my fair share of people who commuted to LA from Bakersfield (2 hrs drive north in the central valley) or Dana Point (also about 2 hrs away in south Orange County), to take just a couple of examples. In fact, I have one coworker who commutes into our Orange County office from San Francisco: he flies down for 3 or 4 days each week and then back up for the weekend.

So if Dr. Gordon actually thinks that the 60 odd miles between Santa Monica and Orange County is going to save his patients from the measles, he's a total maroon (though I guess we all already knew that).

Thx ann and Darwy.

@Eric Lund
#13

(Especially where you are–some kids aspire to be nurses or pharmacists, but I don’t think you see very many of them.)

Nursing is an undergraduate program. I don't know if you can do pre-nursing.

@DW #27
I usually have such good results talking men into trying new things…

[Takei] Oh myyyy... [/Takei]

#38 In very rare circumstances, there is a possibility of shedding from the vaccine.
Case of vaccine-associated measles five weeks post-immunisation, British Columbia, Canada, October 2013

We've already been through this. Not even the authors consider it a slam-dunk, and "very rare" doesn't quite capture it. There are two possible cases known to man, in the face of hundreds of millions of doses of LAV measles vaccine.

^ Actually, possibly three; I never did get my hands on that last paper.

After all, the child is the patient not the parent. If the pediatrician who owes a duty to the child is actively discouraging the parents from vaccinating the child during an outbreak of highly infectious disease, and the child catches the disease and suffers permanent injury, I don’t see why the child wouldn’t have a claim for malpractice.

The details vary by the state's tort law, but basically, yah (PDF).

@ Brian #52--well that tells me where the northern California hive of scum and quackery that drives the anti-vaccine problems of Marin County: http://www.pediatricalternatives.com/the_doctors.html . Here you will find 4 quack-brained moronic pediatricians who don't deserve to be called pediatricians.

anon: "Case of vaccine-associated measles five weeks post-immunisation, British Columbia, Canada, October 2013"

One case report.

Two questions:

What would be better for any of your grandchildren: two MMR vaccine doses or a measles infection?

What PubMed indexed studies by reputable qualified researchers covering several hundred people (no single case reports) show the MMR vaccine is more dangerous than measles?

@ Roadstergal:

I was merely referring to my renowned abilities for convincing them to change positions,,,
in philosophical matters.
And I'm great at planning trips.

#64 They were vaccinated with the MMR.

What makes Dr. Jay particularly dangerous is that he uses language that's emotionally soothing and upbeat:

'Greetings! ... we celebrate .... use sparingly .... the media make it appear that there is imminent great danger .... but 35 cases are not frightening ... feel free .... my personal reservations ... but measles is no risk to your child. Best - Dr. Jay.'

There now, don't you feel reassured and happy? His patients and his followers sure do. For now.

That emotional tone is what sells. It makes him seem 'reasonable,' as does admitting that it's not science, it's just his opinion. Disarm the critics by conceding their main point and then plaster it over with pleasant emotions to minimise it.

Same case for Dr. Lansman in Marin California. Plenty of nice attractive emotions to offer, along with delayed jabs and (you guessed it!) homeopathy.

To paraphrase Mary Poppins, 'Just a spoonful of organic honey, makes the quackery go down: in the most delightful way!'

Here's another danger: One vax per visit per Dr. Lansman, as long as the insurance companies cover it, is a far more lucrative way to run a practice than using those annoyingly efficient government-recommended protocols. This creates an incentive for pediatricians who are newly setting up their practices, to indulge in this nonsense. When it 'works' (puts their practices in the black more quickly), the word will spread, and there will be an increasing number of practices that start doing it. Once they start, the perverse incentives make it highly unlikely they'll stop.

Side note: There are now 116 mumps cases in D.-ville.

@67: Speaking of vaccinations and homeopathy, a friend of mine was sold on homeopathy because the homeopath convinced her that the mechanism is exactly the same as vaccinations, because a tiny substance stimulates the immune system. Aghhh.

If you read Dr. Jay's patients' mommy's reviews, you'll find he doesn't take insurance/copays and his fees are very high. So whatever he charges per visit, you pay upfront, then chase your insurance company for reimbursement. So...no matter which medical insurance company the parents have...when they submit a claim for reimbursement...the reimbursement will be a lot less, because Dr. Jay is "out of network" for everyone.

Reviews are basically fine:

"He supports our choices"

"He's very knowledgeable about allopathic and homeopathic medicine"

Several reviewers shlep their kids from great distances (1-1/2 hours by car, one way), to his office and he prefers to see soon-to-be patients' mommies when they are pregnant.

@anon #66:
Firstly, we kinda figured that they were vaccinated with the MMR.
Secondly, you haven't answered Chris's question: is it safer to have the MMR, or the diseases it protects against?
Thirdly, are you the anon who showed up on justthevax and was totally pwned? I'm seeing a lot of the same general belief.

#71 Obviously- I vaccinated my children with the MMR. My brother had a mild case of the measles-even that was awful.
Don't know justthevax but will look it up.

anon, case reports? One from 1999, and one from 2013?

Let’s think about this. From this week’s CA health department review (my emphasis) http://www.cdph.ca.gov/Pages/NR14-035.aspx

The measles cases have been reported in: Alameda (1), Contra Costa (4), Los Angeles (10) Orange (21), Riverside (5), San Diego (4), San Mateo (3) and Santa Clara (1) counties.

Among these 49 cases, 11 patients had travelled outside of North or South America, including to parts of the world where outbreaks are actively occurring or where measles is widespread. Of the patients without international travel, 30 had contact with known measles cases, three had contact with international travelers and 5 are under investigation to identify potential sources.

Which one poses the bigger risk, the vaccine or the wild type measles that has been show to spread to other individuals?

Jay Gordon sniffed in snotty elitism, "If you would like the MMR vaccine, please feel free to get it."
To me this is very disturbing and highly offensive.

The only way I can interpret what he wrote is as a petulant, dismissive whine that means: 'If you are dead set on getting the vaccine, please go get it - elsewhere, but not here, since I'm not offering it to you nor recommending it.'

Note he doesn't say, 'If you would like the MMR vaccine, please let my staff know and we will be happy to provide it."

His above statement jibes with the tenor of the quote cited by Orac:
"I gave a half dozen vaccines today. I gave some reluctantly but respected parents’ wishes to vaccinate. "

"reluctantly"
"feel free to get it."

He is essentially firing his patients for wanting vaccination against one of the most contagious diseases known to man.
What a very disturbed individual this man must be.
One might even say deranged.

@ D.C #48 - Gordons Inference.
Do I detect a new Internet Adage? Has almost as nice a ring to it as Dunning-Kruger, Occam's Razor and Godwin's Law....

janerella@76:

Squeeeeee! Does this mean I might become, like, famous?

All in all, I'd rather become known for Sessions' Challenge:

Then you won’t have any trouble at all finding just ONE
example from hundreds of combinations where mass vaccination
didn’t immediately precede a major drop in the disease it
targeted for one of:

* polio
* diphtheria
* pertussis
* tetanus
* measles
* mumps
* rubella
* Hib
* HepB
* Meningococcal disease

In a country where they’ve kept reasonably complete records
for at least the ten years before and afterward. Then post
them! Win instant fame!

Think of being the first to pull this off after I’ve been
posting it since 20 July 1997. For some reason none of the
other anti-vaccination posters before you has even tried.
Strange, that — just like you they all try to change the
subject or just plain drop out of the newsgroup for a while.

And should Our Gracious Host, Orac, happen to read this and take the notion of propagating the Challenge, he is so very, very welcome to do so. With or without attribution.

Rats. Busted link: http://scienceblogs.com/denialism/2008/08/22/antivaccinationold-religio…

The author of 'Mistakes Were Made (but not by me)' needs to add a chapter for the antivaccine movement. Folks like Dr. Bob and Dr. Jay got some of that cognitive dissonance big time.

"The engine that drives self-justification, the energy that produces the need to justify our actions and decisions — especially the wrong ones — is an unpleasant feeling that Festinger called 'cognitive dissonance.'"

Why It's Hard to Admit to Being Wrong

anon: "#71 Obviously- I vaccinated my children with the MMR. My brother had a mild case of the measles-even that was awful"

Then why did you post the case reports? Why not directly answer the question?

Just admit that you would prefer the MMR over measles and stop the passive/aggressive comments where you post a link that is only tangentially related to the blog article without any verbiage to explain your reasoning.

"I’m sure Orac was bending over backwards to be fair to Jay Gordon when he referred to Jay as an “antivaccine-sympathetic pediatrician”."

Dr. Jay is a nice guy when you chat with him. From reading Dr. Bob's anti-vax rants, I'm pretty sure you can't say the same for him.

"What a very disturbed individual this man must be." 

When he used to comment here, I felt like asking, "Man, what is wrong with you?"

Now he's gone from deciding that he knows better than anyone who's ever genuinely studied vaccination to deciding that he knows better than anyone who's ever genuinely studied measles. And he feels it necessary to spam out this revelation to the parents of his defenseless patients. 

What a horrid, horrid man.  

A known case of measles has been identified on the San Juan Islands in Washington State. There were notices in the Seattle paper of loctations where the infected individual was (two restuarants over several nights) and encouraging anyone who may have had contact to get checked by their doctor. Given that the San Juan islands are a bastion of hippies, I expect that this will turn into a (hopefully) localized outbreak.

Dr. Ianelli...I've never met Dr. Jay in person, but he is a pathological liar who wouldn't know truth from fiction, if truth came up to him and slapped him upside the head.

I've had heated debates with him here on RI and the SBM blogs about his website, his "opinions" about each vaccine, his links to whale.to articles about vaccines for parents to peruse and his lies about varicella vaccine being used on a "compassionate use basis" in the United States, when the vaccine was still in clinical trials in Japan.

He's a public health menace.

Dr Ianelli: I haven't met Dr. Bob Sears in person, but I tangled with him on the Ho-Po, when he posted his opposition to the passage of California AB 2109 which requires parents to consult their child's health care provider for accurate information about vaccines, before they claim "Personal Belief Exemptions".

http://scienceblogs.com/insolence/2012/03/27/dr-bob-sears-vs-seth-mnook…

Like his older colleague, Dr. Bob is a public health menace.

Dr. Jay didn't even show up here yet. He usually swoops in all chirpy-like and sooper reasonable, is exposed to facts and leaves in a righteous wounded huff. I miss that.

Questions for Dr. Gordon.

You say there have been no deaths from measles in the US since 2003. Why?

You say you've never had a child in your office contract measles. Given that measles is highly contagious, can you explain why your unvaccinated patients have been so lucky?

What fraction of the population can remain unvaccinated to measles before heard immunity starts to break down, and measles begins to effect your patients?

What is it about your patients that privileges them to "hide in the heard"? Is it their wealth? or is it because some animals are more equal than others?

How many deaths from measles is acceptable?

If measles were eradicated from the globe, then no one would need to be vaccinated (see example smallpox). Should global eradication be a public health goal?

---------------------------
I'm so pissed off at this guy. Anyone want to start a pool about how big the epidemic becomes and how many deaths occur before Drs Jay and Bob bail out and go party line with MMR vaccinations? It didn't take long for the Texas megachurch preacher to reverse course. These two are much further down the wormhole I'm afraid.

Dr. Jay showed up at the SBM blog, got his comeuppance and just disappeared:

http://www.sciencebasedmedicine.org/autism-prevalence-now-estimated-to-…

Hey, pediatricians here, I have a medical economics question.

So Drs. Bob and Jay do not vaccinate, meaning that they don't have to keep the usual suite of vaccines on hand. How does much does that save them on practice overhead?

Liz, a while back Chris Hickie posted some comments about the costs to maintain adequate supplies of vaccines for a busy pediatrics practice. IIRC, he spends $250,000 for those vaccines. The reimbursement rate from insurance companies is not great, when you figure in the time to administer the vaccines and to document the chart's vaccines administration records.

"You say you’ve never had a child in your office contract measles. Given that measles is highly contagious, can you explain why your unvaccinated patients have been so lucky?"

But, quoth Dr. Gordon, measles isn't highly contagious. Didn't you read his message? You won't catch it from casual contact or riding on the BART.

Dr. Gordon should save the taxpayers some money by sharing his reality with the epidemiologists at the CDC so they can stop all that pointless contact tracing.

LW @90: Of course, the AP had an article today that said that you *can* in fact get measles from riding the BART or even just walking past a place where someone with measeles was hours before.

Also, the outbreak in Washington state is probably going to expand. A person infected with measles attended a big concert and visited a number of tourist destinations March 28th. Given the 1-3 week latent period I have a feeling this could get big.

@ 91, Yeah, there's no doubt measles is highly contagious, Gordon's playing games with probability; Statistically you're more likely to get measles from a known index case, especially with repeated contact. That said, there is absolutely no reason that you can't get measles sitting next to someone on BART, though he uses weasel words to disparage the idea. Additionally I'd be surprised( given just how contagious it is) if it didn't get much worse before it got better. If it doesn't he can thank those parents who had their kids immunized, the hack.

Also, the University of Wisconsin-Madison has confirmed three cases of mumps. Three apparently unrelated cases.

Spring break.

The image of Jay and Silent Bob springs into my mind when thinking about these two doctors, except that Jay and Silent Bob are more entertaining....

@ Kochanski:

We'd be better off if Dr Bob were actually silent.

I just tried to post a comment on Dr Jay Gordon's website. Surprise, surprise -- comments were closed. what a turd.

I saw this, and knew I had to post it here.
http://www.cracked.com/photoplasty_861_27-classes-we-wish-they-forced-p…
Pay special attention to slides 26 and 18.

Thanks, Julian.
I liked 13 too.
I recognized Sylvia Brown and John Edward but didn't recognize the middle one on 17.

It's the Long Island Psycho Medium...

http://www.tlc.com/tv-shows/long-island-medium

Off-topic and almost certainly old news for this crowd, but just in case: you’ve seen Jenny McCarthy effort to say she’s not anti-vaccine and the response in TIME? -

http://www.suntimes.com/news/otherviews/26784527-452/jenny-mccarthy-the…

Thanks, lilady.
I think I heard of her but hadn't seen her before.

Good link, Grant.

I would guess that "reduce the schedule" really means stretch out the schedule so it takes longer before children are fully protected.
And the grey zone is her new code phrase for too many too soon. And she is pro vaccines but won't step up and say which ones are already safe enough.

I hadn't heard of Nancy Colasurdo before.
Her main specialty seems to in unfettered (by reality or science) thinking.
But, here is the blog much of the Sun Times article is pulled from:
http://unfettered50.com/health/vaccines-and-yes-gray-matter/

Where inquiring minds in US get their information:
Jenny McCarthy

Sadly.

I read it. Good slapdown of McCarthy.

Wow, you finally found something you can get mad about, and it seems to be that there are doctors who aren't fear mongering, but actually fight the fear.

This doctor is correct in how an outbreak is defined. Read this CDC article to find out. He is also completely accurate in terms of no deaths. He is also completely accurate in describing how the disease has behaved in the US, after transport.

The article clearly states: "Forty-seven of the 58 cases were associated with 12 measles clusters (defined as two or more cases linked in time or place), which included nine outbreaks (defined as three or more cases linked in time or place)."

http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6316a6.htm?s_cid=mm6316a6_w

Also, considering that 11 of the people who contracted measles actually had two doses of vaccines and the papers to prove it, this vaccine is either less effective than you might think or natural immunity is pretty good also at preventing disease. The people who didn't have papers get lumped in with the ones who know they didn't vaccinate, but chances are, they actually DID get the vaccine and just don't have papers, if 90% of the population has been vaccinated.

The problem with vaccine people is they assume that all the effectiveness is due to the vaccine and they make stupid claims like 99% effective for the rest of your life, and that's just plain not true. Well, not getting the shots is about 75% effective for the rest of your life, too, according to the most conservative estimate that I can make based on those claims. By more reasonable estimates, not getting the shots is actually 97% effective...hmm, all that vaccine effort is getting us an addition 2% of effectiveness??

By more reasonable estimates, not getting the shots is actually 97% effective

It does help to be surrounded by people who can't catch the disease. Did you factor that part in?

Strangely enough, when you compare the ratio of {vaccinated who get the disease}/{vaccinated} to the ratio of {non-vaccinated, get the disease}/{non-vaccinated}, the numbers are suddenly a bit more in favor to the vaccinated.

Well, not getting the shots is about 75% effective for the rest of your life, too, according to the most conservative estimate that I can make based on those claims.

Only because of the 90% who have vaccinated.

Ms. Ku, have you thanked your responsible neighbors who vaccinate for protecting you and your family from measles?

I suppose for Faye Ku,an ideal world would be everyone being vaccinated except her family. Then not vaccinating would be 100% effective.

What a dope.

Faye Ku,

Wow, you finally found something you can get mad about, and it seems to be that there are doctors who aren’t fear mongering, but actually fight the fear.

You mean rational fears, like catching measles and almost certainly suffering weeks of illness and a 1 in 5 chance of pneumonia? Or irrational fears like becoming autistic due to vaccines? Doctors like Jay Gordon minimize the real dangers and exaggerate the vanishingly tiny ones.

This doctor is correct in how an outbreak is defined.

No he isn't. Dr. Jay Gordon claimed that, "The CDC defines outbreak as two cases spread from the same source". That isn't true, as the CDC states on the very page you linked to, in the passage you quoted, an outbreak is "defined as three or more cases linked in time or place". It is a "cluster" that is, "defined as two or more cases linked in time or place".

Read this CDC article to find out. He is also completely accurate in terms of no deaths. He is also completely accurate in describing how the disease has behaved in the US, after transport.

He may be strictly accurate in that there have been no deaths yet, but he is still extremely irresponsible in encouraging people to believe that not vaccinating their children is a rational choice. It isn't. It is only a matter of time before the US sees another death from measles, if current trends continue.

If I told you that a drunk driver will have, on average, one fatal accident for every 3 million miles he drives, so fears of people driving under the influence of alcohol are irrational, would that be responsible of me? It's true*, but none of us would condone driving while drunk, because it unnecessarily increases the risk of death by a factor of about 25 (according to road safety figures you can look up if you wish). Not vaccinating your child against measles increases her risk of dying of measles by a factor of at least 17 (see below). I see not vaccinating as just as irresponsible as driving drunk with a child in your car.

Also, considering that 11 of the people who contracted measles actually had two doses of vaccines and the papers to prove it, this vaccine is either less effective than you might think or natural immunity is pretty good also at preventing disease.

How do you come to that conclusion? The data suggest the exact opposite.

Look at it this way:

The measles vaccine (2 doses) is at least 94% effective, and probably greater; there is no doubt about this, it has been shown in multiple studies in multiple countries. In the USA as a whole, according to the CDC, MMR uptake in children is 91%.

So, if we take 1,000 average people, 910 of them will be vaccinated, of which up to 56 will still be susceptible to measles (through primary vaccine failure) if exposed. All 90 unvaccinated people will be susceptible to measles if exposed.

So, in an average outbreak, you would expect about twice as many unvaccinated people to succumb to measles. In this outbreak 25 unvaccinated people and 11 vaccinated people succumbed to measles, which is very close to what we might expect given the high efficacy of the vaccine.

As you mention, in 18 measles cases vaccination status was unknown, which suggests to me that they were very likely unvaccinated - the vast majority of people who have been vaccinated will have a record of this in their medical records. So we are probably looking at about 40 unvaccinated cases and about 15 vaccinated cases, suggesting that the vaccination uptake in this population may have been below the national average.

Also, we know that natural immunity in the measles-naive does not protect against getting measles; almost all unvaccinated people who have not had measles will contract the disease if exposed. In the pre-vaccine era practically all children got measles.

The people who didn’t have papers get lumped in with the ones who know they didn’t vaccinate, but chances are, they actually DID get the vaccine and just don’t have papers, if 90% of the population has been vaccinated.

They weren't "lumped in" with the rest, they are clearly described separately in the CDC article. I don't think assuming that those without any documentation of vaccination are vaccinated is justified. It seems very likely to me that those without evidence of having had MMR very likely haven't had it.

The problem with vaccine people is they assume that all the effectiveness is due to the vaccine and they make stupid claims like 99% effective for the rest of your life, and that’s just plain not true.

The problem with antivaccine people is that they keep repeating misinformation, don't understand statistics and appear to have problems with basic math.

Vaccine effectiveness is measured by comparing the vaccinated with the unvaccinated. What else can effectiveness possibly be due to? All the available evidence suggests that the measles vaccine is indeed effective for life for the great majority of people. An anamnestic response can be demonstrated even in those with waning antibody levels.

Well, not getting the shots is about 75% effective for the rest of your life, too, according to the most conservative estimate that I can make based on those claims. By more reasonable estimates, not getting the shots is actually 97% effective…hmm, all that vaccine effort is getting us an addition 2% of effectiveness??

That's nonsense. How did you come up with such grossly inaccurate figures? Which people were protected from getting measles by "not getting the shots"? As I stated earlier, we know that almost everyone exposed to measles will contract it if they are unvaccinated and haven't had the disease. The effectiveness of "not getting the shots" is zero, by definition.

You don't know how many hundreds of vaccinated people were exposed to measles in these outbreaks, or how many unvaccinated were exposed, so you cannot estimate effectiveness from these numbers. You appear to have ignored the fact that the vast majority of people are vaccinated.

As I pointed out above, we know from multiple studies just how effective the vaccine is. An unvaccinated child is about 17 times more likely to suffer measles than a vaccinated child, 17 times more likely to suffer pneumonia, encephalitis or death from measles**.

* A driver with an alcohol concentration of 0.15 or greater (that's impaired reflexes, reaction time, and gross motor control, staggering and slurred speech drunk) is about 25 times more likely to be involved in a fatal car accident than a sober driver. Since the average fatal accident rate in the US is 1.27 fatalities per 100 million miles traveled, a drunk driver will have about 1 fatal accident every 3 million miles.

** If 100 unvaccinated children are exposed to measles, we can expect 100 to contract measles. If 100 fully vaccinated children are exposed to measles, we can expect up to 6 to contract measles. Assuming the probability of exposure is the same, an unvaccinated child is 100/6 = 17 times more likely to contract measles than a fully vaccinated child.

FWIW, the outbreak is now the biggest since 1996.

http://www.nbcnews.com/health/health-news/ohio-measles-outbreak-biggest…