Who knew? My state's vaccine personal belief exemption rate stinks!

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One aspect of my life that's kind of strange is how I've basically ended up back where I started. I was born and raised in southeast Michigan (born in the city of Detroit, actually, although my parents moved to the suburbs when I was 10). After going to college and medical school at the University of Michigan, I matched at a residency in Cleveland (regular readers know that it was Case Western Reserve University), and then did a fellowship in surgical oncology at the University of Chicago. Finally, I ended up taking my first "real" (i.e., faculty) job at the Cancer Institute of New Jersey (now the Rutgers Cancer Institute of New Jersey), where I remained for eight and a half years. Here's the weird part. After 20 years away from southeast Michigan, seven years ago I had the opportunity to return, and return I did.

One thing I noticed returning is just how politically conservative the state had become. There's a huge Tea Party contingent, and unfortunately my state senator is among the wingnuttiest of the wingnuts. I sometimes joke that if it weren't for Detroit and its surrounding suburbs and exurbs, Michigan would be largely indistinguishable from Alabama, particularly the western part of the Lower Peninsula. On the other hand, at least when I moved back, based on my then stereotypical view that antivaccinationists were primarily crunchy, New Agey people who leaned left politically, I figured that Michigan, at least, would not be as full of antivaccine loons as New Jersey was. And so it seemed at first.

No more. Or I was wrong. Or both.

In fact, we have a real problem here in Michigan:

Michigan is at risk.

That's the warning from public health experts as more and more schoolchildren are not getting basic vaccinations to protect them -- and all of us -- from preventable disease.

Michigan makes it easy to avoid immunization and after years of increasing public concerns over side effects and government intervention, the rate of those going unvaccinated is dangerously high.

Nearly 45 percent of Michigan residents now live in counties at risk of disease outbreaks, according to an MLive analysis of state data.

The risk is not just theoretical. It is very real.

A recent outbreak in Traverse City shut down a 1,200-student charter school for a week, infected students at 14 other school buildings in the region, and has sickened dozens of people and forced hundreds into quarantine.

Traverse City is a lovely medium-sized city in the northern Lower Peninsula on Lake Michigan's Grand Traverse Bay. It's a big tourist destination in the state where I've stayed before. Now it's the site of a substantial pertussis outbreak. Why? Do you really have to ask? Yes, it's low vaccine uptake, as the story explains:

But Grand Traverse County has an undervaccination rate six times the national average. And nearly 1 in 5 of the kindergarteners (17 percent) at the charter school, Grand Traverse Academy, had parents who signed waivers exempting the children from required vaccinations.

This is not just a problem in Traverse City and environs, but in several other counties in Michigan, as shown in this searchable map and database listing vaccine exemption rates for different counties and communities. It lets you search kindergarten, sixth grade, and transfers, either individually or in a combination. Although it looked as though most of our schools were somewhere near the statewide average of 5.9% exemptions, I was a bit disturbed to see that more schools than I'd like to see in the school district where I live had exemption rates greater than 10%. In actuality, I was disturbed to see that the exemption rate was higher than zero in most schools.

It's getting worse than just pertussis, though. At least, there's a very worrisome recent development. Pertussis, you see, can produce outbreaks in even vaccinated populations because of complex issues of waning immunity that can leave adolescents at risk even though the acellular pertussis vaccine generally does work well. In any case, epidemics and outbreaks of pertussis are much, much smaller than they were pre-vaccine because, well, the vaccine does work.

Pertussis outbreaks are just one bellweather of impending disaster when vaccination rates fall. What is the other disease that is always lurking, always poised to come roaring back if herd immunity is compromised? Yes, you guessed it. The measles is back, too:

Last week, the other shoe dropped in Grand Traverse: Two residents were diagnosed with measles, the most contagious disease known to man and one that can have serious complications.

It happened in Traverse City. It could easily happen in communities throughout Michigan.

Exactly. It very easily could. It's been 24 years since anyone died of the measles in this state, an 11-year-old girl named Tammy Bowman who died of the measles in 1990. It was in the middle of an outbreak in Wayland. A high school sports team had traveled to a competition in northern Michigan and brought back measles, which quickly spread among other teens. The Allegan County Health Department ended up pulling the records of older students and setting up a clinic to administer vaccinations to any who had no record of being immunized. It's unclear that whether the girl had had her measles vaccine. The parents say that she had before entering a Head Start program, but there was no record of vaccination. The parents said that vaccination records were lost in a basement flood; so they signed a waiver to get their girls in school. In any case, Tammy developed measles before she could be vaccinated, and ultimately died. It was ugly; she developed a secondary pneumonia, was transported to Children's Hospital of Michigan in Detroit, and was placed on ECMO for several days. The doctors at Children's couldn't save her.

It was part of a national outbreak that occurred between 1989 and 1991 that resulted in 55,000 cases of the measles, 11,000 hospitalizations, and 123 deaths from a disease that antivaccine activists will claim is not dangerous.

The evidence is clear. Even though outbreaks can occur in vaccinated populations, that is not, as antivaccinationists would have you believe, proof that vaccines don't work. The reasons are (1) no vaccine provides perfect protection and (2) simple math. Even though it might appear that equal numbers of vaccinated (or even more) vaccinated children catch the disease, when you take into account the percentage of the population that's vaccinated versus unvaccinated and calculate relative risks, it's very clear that the unvaccinated are at much higher risk of catching the disease. For example, children not vaccinated against pertussis are at a 23-fold higher risk of catching pertussis. During an outbreak, children not vaccinated against the measles are also at a greatly increased risk of developing the measles, in the same ballpark as for pertussis. At the extreme end, in a measles outbreak in the Netherlands in 2000, it was estimated that unvaccinated children were over 200-fold more likely to catch the measles than vaccinated children.

Depressingly:

Michigan has one of the highest vaccine-waiver rates for kindergartners in the country, three times the national median, according to the Centers for Disease Control and Prevention. And the number of kindergartners getting vaccine waivers is growing. In five years, it's increased 23 percent, the CDC says.

This is, of course, a recipe for impending disaster. Remember when I said that when the outbreaks begin, they'll start in California? Maybe I was wrong. Maybe they'll start in Michigan. Or in California and Michigan. Actually, they've already begun in California and Michigan, all because of how lax both states are when it comes to granting philosophical waivers for school vaccine requirements. Herd immunity matters, again contrary to what antivaccinationists want you to think.

This lets parents like this opt out and thereby increase the danger of outbreaks:

Among those questioning the conventional wisdom on vaccines is Marcel Lenz, a Traverse City resident who is father of children ages 4 and 2.

Lenz, who has a doctorate in horticulture, said he had a "falling out with Western medicine" and is persuaded by the arguments of alternative-health advocates who say vaccines are potentially harmful.

"I haven't seen the studies that convince me that vaccines are safe and effective," Lenz said, adding that it is his belief that diseases such as polio already were already on the wane before the vaccines were introduced.

Based on his reading, he said, "the probability of getting one of these diseases is low, and even if you do get something, it's probably not going to be that severe."

By contrast, he said, "every vaccine has components in it that are toxic that you don't want in the bloodstream."

"There are pros and cons to everything," Lenz said, "and I just don't trust vaccines."

Parents signing vaccination waivers say it's their right to opt out.

"I don't believe you can drug your way to good health," said Sue Waltman of St. Clair Shores, who founded Michigan Opposing Mandatory Vaccines in 1994.

This is a toxic stew of ignorance. "I haven't seen the studies that convince me vaccines are safe and effective"? Did Lenz bother to look? I highly doubt it, or if he did he didn't understand what he found or instead found his way to antivaccine websites that confirmed his pre-existing bias against "Western medicine." The evidence that vaccines are both safe and effective is so massive and overwhelming that Lenz's failure to see it demonstrates that he is not equipped to evaluate scientific evidence, as does his spouting of antivaccine fallacies straight from the pages of many websites we know and don't love, fallacies such as: the fallacious claim that diseases like polio were on the wane before vaccines due to better sanitation; the toxins gambit; and the like. It's the same sort of misinformation that our very own home grown antivaccine activist Mary Tocco regularly spouts.

Come to think of it, I took MLive.com to task for giving Mary Tocco a platform back in August. I wonder if the backlash, much deserved, against MLive.com's supplying such an antivaccine crank with statewide platform had anything to do with this story.

This story is definitely a major improvement, but it does fall a bit too much for the "tell both sides" fallacy of pseudoscience. On the one hand, there's Paul Offit and a local pediatrician named Allan LaReau discussing the actual science showing vaccines to be safe and effective. On the other side, there's an antivaccine parent Marcel Lenz, whose inclusion can sort of be justified as a way of showing how parents are deceived by antivaccine pseudoscience (although that's not really how MLive used him) and an antivaccine activist crank named Sue Waltman who's been at it for 20 years with her organization Moms Opposing Mandatory Vaccines which is chock full of antivaccine pseudoscience and misinformation and cites a veritable panoply of antivaccine websites as resources for "research," including Mercola.com and Barbara Loe Fisher's Orwellian named National Vaccine Information Center. It even contains a direct link to the form that a parent has to sign to obtain a philosophical exemption for her child. It's very simple, perhaps even simpler than the California form.

The article makes a good point near the end, quoting Mark A. Largent, associate dean of Lyman Briggs College at Michigan State University and author of the 2012 book Vaccine: The Debate in Modern America:

While there are some parents who are anti-vaccine, "the bigger chunk are vaccine anxious," Largent said.

"We don't want the vaccine anxious to find refuge in anti-vaxers. We want to help parents feel the authorities are speaking to them, not at them," Largent said.

This is why I've always said that I am not writing to try to change the minds of antivaccine activists. That is a lost cause. They are too far gone. The chances of changing their minds is minuscule, and it is rare indeed for leaders of the antivaccine movement, like Mary Tocco and Sue Walton in Michigan, and hard core antivaccinationists, like Marcel Lenz, to become pro-vaccine (or even no longer antivaccine). The Dunning-Kruger effect is just that strong. For the, refutation and (sometimes in carefully selected cases) mockery are appropriate. We have to go after the fence sitters, the parents who are anxious about vaccines, not sufficiently knowledgeable about science, the immune system, and infectious disease to recognize the fallacies inherent in the arguments of antivaccinationists and provide them with the knowledge and tools to recognize antivaccine rhetoric for the BS that it is.

MLive promises more, including the policies that facilitate such high personal belief (philosophical) exemptions, more detail about Traverse City, and how the wealthiest county in Michigan has one of the lowest vaccination rates. Good. MLive.com might just make up for its having featured Mary Tocco last summer.

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Poor you Orac...and lucky me. I live in a *State which permits Religious Belief Exemptions. The case law in my State is replete with parents' unsuccessful lame attempts to prove those non-vaccinating parents hold sincerely held religious beliefs.

* It must be true, because all the crank anti-vaccine websites have sample letter and hints for those parents to game the system...all unsuccessful because school district lawyers and the State Education Commissioner prevail.

You really should follow Hungary's example. All common vaccines like measles and MMR are mandatory, exemptions are only given for real medical reasons. The result is on average less than five cases and zero deaths per 100 thousand people per year, and some very frustrated antivaxxers throwing entertaining temper tantrums.

The morons who try to game the system first face very hefty fines, then child protective services get involved, who have the power to take the kid for a forced vaccination. Theoretically they can even take children away from parents permanently for repeated offenses, though the media backlash caused by butthurt freedom fighters would be enormous, so that rarely happens anymore.

My government does a lot of stupid things but in this case I wholeheartedly support them.

" it is rare indeed for leaders of the antivaccine movement, like Mary Tocco and Sue Walton in Michigan, and hard core antivaccinationists, like Marcel Lenz, to become pro-vaccine (or even no longer antivaccine)."

I'm curious - has anyone like this _ever_ renounced their fervent antivax beliefs?

By Dangerous Bacon (not verified) on 11 Dec 2014 #permalink

It's a head scratcher. We had a nice discussion on campus. Our head for infectious disease really put things in s simple statement: you can't fix stupid. All we can do is educate and follow evidence-based medicine with the end result being supportive care, trachs & ventilation, and finishing with ecmo. Sad.

At least you have some laws that one needs an exemption from. The previous Labour Government proposed a law to stop unvaccinated children from attending pre school/school unless vaccinated. T

At least in America you have laws that can be exempted. In Australia, the previous Labor government proposed a law that would have prevented children from being educated unless they were vaccinated. Alas the ultra conservative government now in place would never upset "the freedom of the individual to choose". This means that the anti vaccers have free rein to poison the school yards of Australia.

One question that keeps eating at me, since we have this supposed push to exempt families based on their religious beliefs, at what point in time did God go out and tell everyone to try and kill their kids?

Well, Orac, when it gets too cold in MI, come visit me in AZ, where vaccine exemption rates are just as awful. Thanks to AV stupidity, I've learned more about pertussis than I ever wanted and a lot of children have learned more about what it means to cough miserably for months on end. And some really unfortunate newborns too young to be vaccinated and learned what it means to go to the intensive care unit..

Anti-vaccine activists are lower than scum.

By Chris Hickie (not verified) on 11 Dec 2014 #permalink

@Zardas - can you provide a reference to the relevant legal provisions, even in Hungarian? I'm not doubting you, I'd just like to look and learn more about it.

By Dorit Reiss (not verified) on 11 Dec 2014 #permalink

@ MarkN

at what point in time did God go out and tell everyone to try and kill their kids?

Oi, careful here, that's flame bait.

The Abrahamic god did ask, well, Abraham, to sacrifice his son to Him, although He stopped Abraham at the last second.
(as an aside, Dan Simmons in Hyperion posited that Yahweh was not the only one testing if he should trust the other one)
Since the whole sadistic event was a test of Abraham's faith and acceptance to blindly follow God's will, one can read too much into it - and in other mythological events - and decide that one should trust God with his/her life and those of their children, in all situations, including sickness.

In short, religious people don't think of themselves as putting their children at risk, quite the contrary. They are doing that they think is good for their children.
They apparently didn't read the biblical sidenote about not trying God's will.

Personally, I see it as asking God to do your own work; that's reversing who is supposedly the master and who are the servants in the relationship.
God helps those who help themselves and all that. Insert the fable about the guy sending away rescue teams and waiting for God's personal intervention during a flood...

By Helianthus (not verified) on 11 Dec 2014 #permalink

There are some places in the US where they do it right. According to previous posts, there are two US states (Mississippi and West Virginia, IIRC) which only allow medical exemptions. But some states have gotten far too lax about it.

I wonder how many of these upcountry anti-vax types are afraid of disease-spreading immigrants. Clue phone for those who are in both groups: vaccination will help prevent you getting infectious disease from other people, no matter where those other people come from. But I fear that rational argument with such people is about as useful as a bicycle for a fish.

By Eric Lund (not verified) on 11 Dec 2014 #permalink

The Abrahamic god did ask, well, Abraham, to sacrifice his son to Him, although He stopped Abraham at the last second.

One of Wilfred Owen's poems tells that story, except that in the poem Abraham follows through with the sacrifice:

But the old man would not so, but slew his son,--
And half the seed of Europe, one by one.

Owen was referring to World War I, but if the anti-vax crowd have their way, it might apply equally to the results of their "success".

By Eric Lund (not verified) on 11 Dec 2014 #permalink

I’m curious – has anyone like this _ever_ renounced their fervent antivax beliefs? I seem to remember reading something a "mom" blogger wrote about six months ago relating her shunning by former friends when she woke up, smelled the coffee, and got her children vaccinated. The name escapes me, though.

Catholics, Protestants, Jewish, Muslims, and even Jehovahs', have all stated that they do not have a religious fundamental objection to fighting microbes (i.e. vaccines). If anything, have gone out of their way to keep their flocks healthy.

Do parents today love disease more than their kids?

I guess I don't get it.

Thankfully the rate of vaccine refusal where I'm at is small - but there are cases of measles and pertussis in the city. Not surprisingly, 95% are in unvaccinated folks (normally kids under the age of 15 months, which is when the first MMR is given here).

Eric Lund @12

There is a great reading of that Wilfred Owen poem done by Joan Baez with music composed by Peter Schickele (better know for PDQ Bach).

By Militant Agnostic (not verified) on 11 Dec 2014 #permalink

@ lilady:

I g---gled ( actually Binged) images of different state maps by county similar to what Orac has displayed for Michigan. Whilst I wasn't able to find a good one for New York I did come up with a 2012 pertussis rate map and wouldn't you know- those Hudson Valley hippies had high rates. Alas, they didn't give figures for Crooklyn - where I suspect more cases as well.

By Denice Walter (not verified) on 11 Dec 2014 #permalink

And I always thought that Michigan was a blue state.

By Denice Walter (not verified) on 11 Dec 2014 #permalink

MA@16: I wasn't aware of that version. The recording I have is from Benjamin Britten's War Requiem, which uses this poem in the "Offertorium" movement. To devastating effect, Britten paired the last line of Owen's poem with, "quam olim Abrahae promisisti et semini ejus" (roughly: as Thou didst promise Abraham and his seed).

By Eric Lund (not verified) on 11 Dec 2014 #permalink

From what I've seen of the states I've lived in, generally the blue is concentrated in the more urban areas and some of the college towns with the rural areas trending from red to very red.

So it doesn't surprise me that Michigan would have a lot of conservative counties.

@Denice Walter:
The irritating thing is that it basically is, if you look at things like the Presidential elections. Unfortunately, we had quite a bit of a "red wave," along with the rest of the country, in 2010, and the Teaparty people and Republicans took advantage of the census to gerrymander the state all to hell. I'm afraid we're pretty much scrrewed until the next census, at least.

MarkN @14: The Jehovah's Witnesses actually used to be anti-vaccine back in the day when they were even nuttier, and their "supplemental" magazine was called The Golden Age rather than Awake! (They were also against using aluminum cookware. F*** if I know.) I never believed in the JW stuff even as a kid, but I still had a certain lizard-brain fear of "what if they're right about Armageddon?" until I deprogrammed myself, largely by reading a bunch of their early literature. They're basically fundies now, but the founder, C. T. Russell, was into all kinds of crazy ish, like pyramidology.

On another note, I wonder how much adults keeping up with the shots helps with the situation? I think I was supposed to get booster shots back when I was 21 or 22, but for whatever reason (lack of health insurance at the time?) never got around to it. I did end up getting them back in May, when I spent a night in the ER after tripping and hitting my head extremely hard on some concrete steps. The bleeding was evidently spectacular and unstoppable and I kept repeating questions, so my friends brought me in to get checked out and stapled together. The nurses were like, "Well, you're not going anywhere for a while, so how about getting your booster shots?"

(The craziest part of that night/day was that I had the oral portion of my qualifying exams the following day. I got out of the ER at noon, I felt okay, and my exams were scheduled in a couple of hours, so I took the bus straight to the department instead of home, unable to see just how gory the back of me was. Needless to say, everyone was horrified, and I was promptly sent home. Word had already gotten through the grapevine, anyway, and my committee had just sort of assumed I'd reschedule... everyone kept asking me how I felt for several days after that, too.)

@Denise #18--the blue from pertussis?

By Chris Hickie (not verified) on 11 Dec 2014 #permalink

@Denice (May I call you Denice?)

There is a misconception about the blueness of any state. Most that are labeled “blue” are so because of their largest cities, whilst the rural areas are very “red”. That’s even true in Oregon and Washington, and I would guess California as well. If it weren’t for Portland, Oregon would be as red as Utah. If it weren’t for Milwaukee and Madison, Wisconsin would be as red as Kansas, and if it weren’t for Detroit, as Orac says, Detroit’s red state (fate?) would be sealed. And God help Illinois without Chicago.

Faux News and it’s radio brethren have captured the (limited) imaginations of much of the rural population.

Dorothy @26:
Hey now! I grew up in a "town" of 200 people in rural Washington state, and I have a perfectly broad imagination, thank you.

(I know what you mean, though. I can't even have much of a conversation with my brother at all, as he's not really interested in much of anything as far as I can tell, outside of his truck, his job on the railroad, and going hunting and fishing. Whatever floats yer boat, I guess...)

As a Lyman Briggs graduate, it's good to see a representative of the school supporting science against the wave of BS.

I couldn't find county statistics for New Mexico, but at least the state has removed the philosophical exemption and is trying to stop parents using the religious exemption as a thinly veiled cover.
http://www.skepticalraptor.com/skepticalraptorblog.php/mexico-removes-f…

Unfortunately, the latest statistics from 2011 still show a rise in exemptions.

By squirrelelite (not verified) on 11 Dec 2014 #permalink

Hey Orac. I got tired of reading your hateful political screeds contaminating sound medical rants and took a break for a few years, just decided to take a peek and see what's up. Gosh darn it, you had to go and make nastiness about the "Tea Party" and conservatives in general in a confused garble of conflicting haughtiness right there in the first post. I mean, I grew up in Jersey and know how easy it is for it to infect your perceptions if not your accent, and I lived in MI for a few decades, and saw how those terrible T's destroyed Detroit and Flint, so I can understand a bit how confused you are, but really, comparing Alabama and Grand Rapids is pretty delusional.

That being said, there are anti-vax folks on all sides of the political spectrum, but your map suggests the areas of the State infested with conservative values have the lowest waiver rate.

By Doc Epador (not verified) on 11 Dec 2014 #permalink

@ Dorothy:

Yes, you may call me that- practically everyone does except those required by law to refer to me exclusively as 'Great White Queen'.
AND they'd better.

By Denice Walter (not verified) on 11 Dec 2014 #permalink

@Shay and Dangerous Bacon - probably the best example I can give regarding someone who was truly antivax and has turned around is Shannon Des Roches Rosa at http://www.squidalicious.com/

Shannon has an autistic son, firmly believed it was the vaccines, didn't vaccinate her youngest child for many years. She is now a huge proponent of vaccines. Reading her blog, as her beliefs have changed over the years, is fascinating.

Although I'm not sure how deeply he was into the anti-vax part but ( Dr) James Laidler bought into the autism woo and even spoke in support of it until he saw the light. ( see Autism Watch).

By Denice Walter (not verified) on 11 Dec 2014 #permalink

@MarkN
"Do parents today love disease more than their kids?"
No, that's not why they refuse or delay their children's vaccinations. Do you really think it's possibly because they love disease more than their kids?

Even intelligent and educated young parents have a hard time grasping the levels of risk involved for vaccinations, but it doesn't take a genius to know that the more of them you are giving to your child, the higher the probability of risk becomes.

In the end, nearly all parents, whether intelligent and well educated or stupid and ignorant, have to make a decision about vaccines for their children. Since the majority of people cannot simply read and understand the scientific literature on it. If they are rejecting vaccines for other than religious reasons and they aren't reading the scientific literature, but the summaries of the studies produced for non-scientists, they are making their decision based on who they trust. If they trust anti-vaccine sites more than they trust the CDC (and clearly many do), that's a serious problem that I think should be addressed independently of vaccine laws.

Juniper Russo at Voices for Vaccines.

My fears were a product of a potentially lethal combination of maternal panic and youthful ignorance. I was afraid. I was afraid of autism, of chemicals, of pharmaceutical companies, of pills, of needles. I saw medicine as an impersonal monolith of unpronounceable words and latex gloves, of figures and averages and data. I didn’t trust it with the pearl I guarded inside my womb. I wanted my baby to be safe—and safety, it seemed, could be promised by midwives and crystals, herbs and exercises. I didn’t trust science to provide it.

Juniper is now a very vocal advocate for vaccines and science.

Megan Sandlin at Voices for Vaccines: Leaving the Anti-Vaccine Movement

I now view the anti-vaccine movement as a sort of cult, where any sort of questioning gets you kicked out, your crunchy card revoked. I was even told I couldn’t call myself a natural mother anymore, because vaccines are too unnatural. That’s fine. I just want to be the best parent I know how to be, and that means always being open to new information and admitting when I’m wrong.

Megan's story is worth reading in full.

Maranda Dynda at Voices for VaccinesI was Duped by the Anti-Vaccine Movement

My journey into the anti-vaccination scene began when I became pregnant with my one and only child. It all started when I watched the documentary The Business of Being Born and decided to pursue a home-birth midwife. After months of searching, I found one in my area who agreed to take me under her care.

At our first appointment, she asked me how I felt about vaccines. “I’m not sure what you’re asking me,” I responded, confused. She then told me about her experiences with vaccines and her seven children. She claimed her one son had a negative reaction, causing him to regress and become autistic. Now, she said, their family does not undergo any medical care except for chiropractic and homeopathics. I was fascinated, to say the least. The idea of not vaccinating was something I had never even heard of, let alone not taking your children to a doctor. But her kids seemed healthy, and she encouraged me to “do my research” on the Internet. And so I did.

Maranda Dynda is a former anti-vaccine mom turned vaccine advocate.

I don't know much about Michigan, Doc Epador, but in my state, California, the urban areas with the highest rates of vaccine refusal are very much Democratic. The rural areas with high refusals are split between the pot-growing areas (one assumes, quite liberal) and the more conservative, "the government can't tell me what to do" areas.

And I always thought that Michigan was a blue state.

Well, yes and no. State-wide it tends to vote Democratic, but if you look at the makeup of its contingent in the House of Representatives, you'll see it's heavily Republican, much, but by no means all of it, due to gerrymandering. Only five out of 14 of our Representatives in the current Congress are Democrats; the same is true of the next Congress:

http://www.politico.com/2014-election/results/map/house/michigan/#.VInT…

Four out of those five are from the Detroit area. The other covers a district around Bay City/Saginaw area.

Also, as I've pointed out time and time again over the years (something I've been consistent about over the years), contrary to the stereotype of lefty, crunchy antivaccinationists, antivaccinationism is the pseudoscience that does not skew strongly left or right.

http://scienceblogs.com/insolence/2014/06/04/the-daily-show-hilarious-s…

http://scienceblogs.com/insolence/2013/12/18/why-are-antivaccinationist…

That is why it's not surprising that several of the Michigan counties with high rates of vaccine exemptions are in solidly Republican districts. In contrast, then there's Ann Arbor (quite liberal) with its high exemption rate and Grand Rapids (quite conservative) with its low exemption rate.

"Faux News and it’s radio brethren have captured the (limited) imaginations of much of the rural population."

A sure sign of an ignorant and unimaginative person is that they write off broad swaths of the population as other and less than.

Recently the LA Times published a map of schools in the state with vaccination rates of each school. I noticed that "Waldorf" schools throughout the state have ridiculously high unvaccinated rates. Some Waldorf schools were approaching 50%.
Waldorf schools teach a quasi religion called anthroposophy and a kind of "spiritual science". The curriculum is saturated with new age groovyness.

By Mike Callahan (not verified) on 11 Dec 2014 #permalink

Orac,
I see that you other persona is becoming more deeply involved in outreach to government in order to affect regulatory development. I posted over there as well that these partisan digs that are completely unnecessary to the scientific topic will only lessen the effectiveness. You will be seen as yet another partisan trying to have things your way rather than as an objective provider of scientific information.

Your tea party rant was just that, a rant that provided no analysis of vaccine rates with partisan alignment.

Again, guess what? On this blog, I really don't care, and it's not as though I've been secretive about it, either. Read paragraph one here:

http://scienceblogs.com/insolence/2014/12/10/the-dublin-doctor-who-is-n…

This is my hobby and my personal blog. If my little political rant pisses you off, I don't care. (Note that I say this as someone who was more conservative politically than you could possibly know as recently as about 15 years ago.) In fact, Michigan is an excellent example supporting my assertion that antivaccine is the pseudoscience that knows no political boundaries. Indeed, I also can't help but note that my little political rant was to set up why I was surprised that rates of vaccine exemptions in Michigan were so high, given the generally politically conservative political leanings of huge swaths of the state, which are only outweighed by the much larger population in southeast Michigan in statewide elections.

My other, not-so-super-secret blog is another issue.

@Mike:
I don't know, I think it's personally reasonable to think about why people don't vaccinate, and ideology seems to be the driving force for a lot of people, whether it's left wing or right wing ideology.

Orac,
I am not pissed off. You have changed my thinking that anti-vaccine was based on the hippy wing of the left. It is also in the libertarian/religious wing of the right.

JP,
You are right, but that was not part of the his post. It was just a rant disconnected by analysis to the antivaccine problems.

I had a job interview at Michigan Tech once. Even though I was unemployed at the time, I was relieved I didn't get the offer and have to decide if the isolation of living in Houghton was a bearable price to pay for a tenure-track gig.

I see Houghton County is among the worst and wonder why. There's not that people up there outside of Houghton, and MTU's the biggest thing in Houghton (a town that literally had but one stoplight when I was there.) The area was settled mainly by Finns during a copper-mining boom. (MTU was originally the Michigan School of Mines). The copper ran out long ago, and the region is quite impoverished, though the Finns remain the dominant ethnicity among the locals.

I'm curious why Finns or faculty/staff families at a technical university would be vax-anxious. Could it be the poverty? The crushing boredom? But then why is the Kenewah worse than the rest of the UP? The lake effect snow? (Over 200" /year).

Orac probably doesn't know. Traveling by car, Detroit to Washington D.C. is fewer miles than Detroit to Houghton. Detroit to Houghton is 6 hours by airplane (only the tiny slow ones go there). Weird.

Rural culture in the U.S. is not one thing, and has also changed over times. Back in the days of 'family farms', farmers were a staple of progressive politics: e.g. The Wizard of Oz being a populist allegory where the farmers (scarecrow), and industrial labor (tinman) join with W. J. Brian (cowardly lion) to free America (kansas) from the gold standard (oz, yellow brick road). IRL there was the Farm-Labor Party in Minnesota, and The Non- Partisan league in North Dakota. Anyone who's spent time in Iowa knows the phrase "West of Des Moines" — a polite term for wingnut-land. When Jesse Jackson ran for President in the 80s, he had a lot of support from farmers East of Des Moines in the caucuses.

Over the decades, though, the rise of corporate farming, the collapse of many small-farm-town economies, depopulation as independent farmers who can no longer make a go of it are forced to move to urban areas and different lines of work, and the weakness of poorly funded progressive organizers who can't come close to matching the resources of Koch-backed influence groups, all have pushed a lot of rural districts towards the Right.

I suspect that there could be a couple of ideologies feeding into the antivax movement and they don't all tend to be in the same political wing.

It is both man-made (crunchy granola left) so bad and gov't says to do it (Don't Tread on Me right) so bad.

Who posited that the political spectrum is a circle not a line and if you go far enough on the deep end from either direction you end up being more alike than the middle of the road left or right leaning folks.

@sadmar

Yeah, that area of the UP near Houghton really surprised me too. Why so much worse than the rest of the UP? As for living in Houghton, I just couldn't do it. It's too isolated, and the winters are just too brutal.

Sadmar,
I would suggest there are few other reasons for the urban rural divide. I had a career in Extension working with the family scale farmers. The political issues they mentioned the most included guns and environmental regulations, particularly a worry about fencing off streams which just happened this year in MD.

There is certainly populism in rural areas. there is distrust of big businesses. Currently the groups are squabbling over the beef checkoff, in part due to how much the Beef Board should work with packers, mostly 5 large businesses. That squabbling is so bad that the USDA is preparing to set up another Beef Checkoff so there will be two of them.

Such a joy to see this post today. Here I thought, smugly, all those west coasters not vaccinating their children, they are so far away, we are so safe. NOT. I have 'liberal' family/friends, and 'conservative'. The ideologies they match up on? Anti-vaccine, or at least question vaccines. GMO's.

My only guess about Michigan Tech area is maybe libertarianism? Yoopers are their own breed, for good or bad. They are an extremely independent bunch. And to choose Michigan Tech as your college, you have to be a pretty independent person. It's far from anywhere. I was ASTOUNDED the Kent County area was low exemptions. But there is a pattern elsewhere, with Houghton/Midland/Ann Arbor/Traverse City areas? People with money? The Mackinaw City area was a shocker too.

/sigh Great. Another thing to worry about with my children. Thank you Orac. I shared this article in hopes someone might change their minds before its too late. But looking at this, sadly I think it is too late.

Mike:

Medical science is always constrained by social, economic and political contexts. Vaccination is a Public Health issue — what individuals choose affects everyone — and Public Health is a question of public policy and therefore of government and politics. Anyone who truly cares about rising VPD outbreaks and doesn't look at the politics is being irresponsible.

Policy on vaccine exemption does not necessarily correlate to the ideological distribution among the vaccine-anxious. Remember, were talking about minorities among groups. A 'liberal' area with a 40% vax exemption rate still has 60% pro-immunization, and these folks aren't one issue voters. The representatives they elect are far more likely to support Public Health initiatives with some teeth. Even if 95% of Tea Party ideologues vax their kids, their representatives are going to back pretty much any anti-guvment measure, especially one couched in terms of religious freedom and 'family over state'.

Except, of course, that Baum did not concienve of orauthor the Wizard of Oz as a populist political allegory.

The idea that he did arose with the publication of an article by Henry Littlefield in the fall 1968 issue of the American Quarterly, but in an article pubklished 3 decades later ("The Wizard of Allegory”) admitted he created the theory simply as a device to teach his high school history students about the Populist movement, and that he never expected it to be taken seriously.

I have to say that I'm very disappointed in my fair adopted ciy, Ann Arbor. It's even more shameful considering the caliber of the medical school here, and the general level of education. Geez, what is it, the hippies?

Not that one's education level always makes a big difference, I guess. I was just at the department's little annual holiday party, and at the "grad student" table, we somehow started talking about leeches, maggots and other fun things, and someone mentioned that maggots are actually used as a medical therapy sometimes, for necrotic wounds.

One of my colleagues said that she'd rather they use maggots than "some nasty chemical that's going to give you cancer, or some kind of experimental plastic or something." Um... first of all, I'm pretty sure nobody would ever wrap a necrotic wound in plastic, and secondly, I'd rather have someone use whatever would work best to save life and limb, myself. (I said as much.) Oh, the naturalistic fallacy...

"Just a city boy
Born and raised in south Detroit
He took the midnight train goin' anywhere...
Don't stop, believin'
Hold on to the feelin'..."

I am not sure what sort of believin' Steve Perry was advocating in the song, but I doubt it was personal vaccine belief exemptions.

By CTGeneGuy (not verified) on 11 Dec 2014 #permalink

One of my colleagues said that she’d rather they use maggots than “some nasty chemical that’s going to give you cancer, or some kind of experimental plastic or something.”

Whiskey Tango Foxtrot. I would think that someone with a necrotic wound has more immediate worries than cancer. Deal with that first, please, and as you say, use whatever means works.

By Eric Lund (not verified) on 11 Dec 2014 #permalink

I've yet to come upon a single valid argument against compulsory vaccination with only exemptions based on genuine medical issues. I really don't think your religion or your philosophy justifies putting me at risk. Or at the very least if you don't get vaccinated and you get a contagious disease and spread it, anyone who catches said disease from you should have a legal claim against you. And certainly you should be subject to both wrongful death suits and criminal prosecution if anyone dies as a result of your lack of vaccination (this includes passing influenza to at risk populations due to failure to be vaccinated).

Denice,

And I always thought that Michigan was a blue state.

I know someone who was convicted, not too many years ago, of growing a few marijuana plants in Michigan (in an attempt to stop their teenaged son from going into Detroit to score weed) and got jail time. The judge said that he wished he had the power to give the death penalty instead! That's about as conservative as it gets, in that one county at least (Livingston County, should anyone care).

By Krebiozen (not verified) on 11 Dec 2014 #permalink

JP,

Geez, what is it, the hippies?

From what I know and have seen of Ann Arbor, which I love, I'd say so.

By Krebiozen (not verified) on 11 Dec 2014 #permalink

Born and raised in south Detroit

There is no such place as "south Detroit," at least no such place that locals refer to as "south Detroit."

Ah, but at least in Ann Arbor you have Zingerman's. I would probably commit a minor crime for a lifetime supply of their scones.

For a state that has a high level of science & education in it, and touted as a beacon of personal health and well-being, looks like my home state is also the pinnacle of really bad decisions on infectious disease:

http://www.kunc.org/post/colorados-personal-belief-exemption-target-new…

http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6341a1.htm

In fairness, I should correct my statements on religion in my state as they show much more responsible compliance (1% waiver) than the personal-exemption (94%). Considering I put in a lot of hours at one of the best catholic hospitals, they actually do have great people there that take community health as the highest priority. And, the children’s is really top notch. Surprising that the state sucks so much at the reality of infectious disease.

However, the Southeast, with all it’s mass of health problems, surprisingly shows pretty high compliance in taking on infectious disease. I really wouldn’t have thought that.

Parents of young children, aside from those motivated and competent to do their own research, make their choice based on who they trust. My daughter had to do this a couple of years ago, when she was pregnant. She an intelligent college-educated young parent.

She ended up giving up on learning enough about vaccines to make an educated choice. She complained to me about how the information she could both find and understand was biased and untrustworthy. She didn't feel she could understand the scientific literature in a timely manner to make her decision, not to mention she didn't want to commit that level of her time and intellectual energy to that decision.

She and her spouse finally opted to follow the recommended schedule for her daughter. She made her choice based on trusting the people on the pro-vax side more than the anti-vax side.

I suspect this is what most young parents do. Certain ideologies, such as tea-party and hippies, have strong anti-government biases. If their motivation is based in ideology, I think that it is lack of trust in authorities that correlates with opting out of vaccines.

By Beth Clarkson (not verified) on 11 Dec 2014 #permalink

@Greg H "I’ve yet to come upon a single valid argument against compulsory vaccination with only exemptions based on genuine medical issues. I really don’t think your religion or your philosophy justifies putting me at risk."

I'm opposed to making any vaccination compulsory on based on the privacy of personal health decisions. I don't have a problem with the current system of making vaccines the normal and requiring people to 'opt out' of getting them. I think there are reasonable rules currently in place with regards to requiring non-vaccinated students to stay home during an outbreak, etc. If day-cares don't want to accept non-vaccinated kids, I'm okay with that.

Making them compulsory with only medical exemptions just stomps all over personal privacy rights and the right to make personal health care decisions. In my value system, the risks - including the risks of outbreaks - are not worth the cost.

Among other costs, keep in mind that one cost of any law is people being killed in the course of enforcing the law. I just learned this principle as a result of discussions on the killing of Eric Garner for selling loosies. It applies to ALL laws.

A child's parent might be killed if they stand in the way of their child being vaccinated. I'd far rather that family was allowed to home school their child if that's how they feel about the matter and there are parents who feel that strongly about vaccinations.

By Beth Clarkson (not verified) on 11 Dec 2014 #permalink

Orac: "There is no such place as "south Detroit""

At least it sounds more real than the neighborhood that Paper Lace sang about in "The Night Chicago Died":

"Daddy was a cop
On the east side of Chicago"

Daddy must've been a _very_ good swimmer.

By Dangerous Bacon (not verified) on 11 Dec 2014 #permalink

Michigan needs at law like WA state enacted in 2011. For the 2010-11 school year, nine counties had exemption rate of 10+ % and 15 counties, including the most populous county (King) had rates in the 5-9.9% range. The law was enacted that year and now, for 2013-14 school year, it has changed dramatically. Now, we have four counties with higher than 10% exemption rate and 14 counties with 6-10% exemptions. Both the most populous counties lowered exemption rates. Only one county, Ferry, increased exemption rates.

I call this a success.

http://www.doh.wa.gov/DataandStatisticalReports/Immunization/SchoolRepo…

My own county saw a decrease from having 10+% exemption rates to now being in the 5-10% range. We still have a great deal of work to do to make these rates decrease even more, but this is a start!!

Except that what authors think they're doing, or say about it later, is completely irrelevant to what the creative work actually means. The question is not what Baum intended. It's not even whether most contemporary readers saw only a childrens' story free of any subtext. The question is whether the text itself does in fact function as an allegory of Gilded Age politics.

Dorothy is from Kansas. Her Aunt and Uncle are dirt poor farmers. A scarecrow is a symbolic farmer, warding off predators. Industrial workers were men made to act as machines. W. J. Bryan did talk big and act soft. Dorothy must travel to a big city on a path of yellow bricks fraught with dangers. The wizard is a fraud who scares citizens into submission. The magic shoes are silver.

To argue these things have no meaning is to bury your head in the sand.

I've read various attacks on 'the Littlefield thesis' published mostly by (conservative) regional historians, and they're utterly unpersuasive. No allegory (intentional or accidental) is ever pure, and the many elements of WoO that deviate from a pure progressive line are just what one would expect in any popular text. Articulating the pure party line has no dramatic tension, and even intentional propagandists know they usually have to grant a certain credibility to the other side before cutting it down.

I remember one article said Oz references the White City, as if that somehow undermines any populist/progressive subtext of the story. But the Columbian Exposition was marked by the tension between the Arnoldian ambitions of Olmsted in the grandeur of the White City, and the more commericalized debauchery of the Midway — both seductive and spectacular, though at the same time the authoritarian implications of the former and the licentiousness of the latter also appeared quite frightening to rural Americans rooted in the Jeffersonian ideal of simple things and make-for-yourself and not yet ready for the power shifts brought by modernity and industrialization. Oz is both White City and Midway. It seduces, like any gleaming metropolis, but dangers lurk within, and there's no place like home.

The populist movement in the agricultural Midwest is well established historical fact. The easiest way to reference the politics involved in terms contemporary readers can understand is via the Wizard of Oz, noting how Hollywood changed the slippers from silver to ruby.

There is no such place as “south Detroit,” at least no such place that locals refer to as “south Detroit.”

They call it Windsor, don't they?

By Bill Price (not verified) on 11 Dec 2014 #permalink

Ah, but at least in Ann Arbor you have Zingerman’s. I would probably commit a minor crime for a lifetime supply of their scones.

Zingerman's is without a doubt the best deli I have been to on four continents. Now I'm hungry.

By Krebiozen (not verified) on 11 Dec 2014 #permalink

Zingerman’s is without a doubt the best deli I have been to on four continents.

Even Obama agrees! My friend Bess served him his Reuben. Honest to God.

Four continents?
BUT Krebiozen, I didn't know that they had delis in India.

By Denice Walter (not verified) on 11 Dec 2014 #permalink

Those of you wondering about Houghton County: there's a lot of Houghton County that ain't Houghton, or Michigan Tech. There are people up in Calumet who haven't ever been over the bridge, and I'm talking about the lift bridge between Houghton and Hancock, not the Mackinac Bridge. And in those areas there are a lot of very conservative, anti government people, who I think tend to see vaccinations as part of that government. And it wouldn't surprise me if religion plays a role too. I'm not sure exactly how the Apostolic Lutherans view vaccination, though. Have to check up on that.

@Denice Walter

I didn’t know that they had delis in India.

I've been hearing about a new one there for years.

By Mephistopheles… (not verified) on 11 Dec 2014 #permalink

Mostly OT, but amusing. This is what Skyhorse's site is returning.

Denice,

BUT Krebiozen, I didn’t know that they had delis in India.

I reckon you can find literally anything in India, if you have enough dosh, even a deli, though to be honest I didn't visit this one. I did find a place called Nirula's in New Delhi, which served excellent vegetarian pizzas - after a few weeks I started to tire of curry, and developed an intense craving for pizza. I also found pizza on the menu in a hotel in a wonderful little town in the Thar Desert called Jaisalmer, but it turned out to be a chapati covered in luminous red tomato ketchup, sprinked with crumbled paneer and grilled, not really what I hoped for.

By Krebiozen (not verified) on 11 Dec 2014 #permalink

M.O'B.,

I’ve been hearing about a new one there for years.

Groan. Seriously, New Delhi is beautiful, designed by the Brits, with wide roads and parks, with a series of concentric circular roads around the center. I preferred Old Delhi, a couple of miles away: crowded, smelly, narrow streets, an elephant, perpetual traffic jams and hotel rooms a tenth of the price of those in New Delhi.

We had three collisions in an auto-rickshaw ("Indian helicopter") on the journey from Old to New Delhi, taking out two cyclists and denting another auto-rickshaw. It would have been terrifying if the traffic had allowed us to pick up any speed.

Pardon my nostalgia.,I'm suffering from itchy feet.

By Krebiozen (not verified) on 11 Dec 2014 #permalink

I also found pizza on the menu in a hotel in a wonderful little town in the Thar Desert called Jaisalmer, but it turned out to be a chapati covered in luminous red tomato ketchup, sprinked with crumbled paneer and grilled, not really what I hoped for.

This used to happen to me all the time in Russia. There's a general notion of what pizza is there, and it's weirdly sort of popular, but it's not pizza. The crust is "meh," they use ketchup instead of tomato sauce, and they put really stupid things on it, like mayonnaise and corn. (Granted, in Russia people put mayonnaise on everything. I once tired of this and decided to buy ingredients to make pizza myself. Some friends were over while I was cooking, and one of them asked me when I was going to put the mayonnaise on. "No, see. That's the whole point. I'm not.

The crust is “meh,” they use ketchup instead of tomato sauce, and they put really stupid things on it, like mayonnaise and corn. (Granted, in Russia people put mayonnaise on everything. I once tired of this and decided to buy ingredients to make pizza myself.

The Japanese love to put mayo on everything as well (though it is subtlety different in flavour from north american mayo). I used to fight it, and attempt to stay clear of it ... but now crave it when not there. Looking forward to my prosciutto, corn, mayo pizza next month ^^

By stewartt1982 (not verified) on 11 Dec 2014 #permalink

@ stewartt1982:

I occasionally visit a Japanese bakery that presents its own take on French and Italian pastry- which is not bad but also not the real deal. Their version of bread seems less inviting.

By Denice Walter (not verified) on 11 Dec 2014 #permalink

I’ve been hearing about a new one there for years.
I do hope that some entrepreneur has started a Deli Lama up in Darjeeling to cater to the Tibetan ex-pats.

By herr doktor bimler (not verified) on 11 Dec 2014 #permalink

@Orac...that's because you didn't grow up in the northern 'burbs like I did. South Detroit - in our lingo, anyway (for those of us who lived straight up Woodward but north of 12 Mile Rd) - was the area over by City Airport. NOT the place you wanted to be at night. (And yes, my first job working after graduating as a RN from U-M WAS in that area. I started at Old St Joe's).

As an added note...I'll be home for Christmas. Which means, given this map, that I'll be making damn sure that all my friends and family are up to date on their vaccines. I'm sure my parents are. Not so sure about my nieces and nephew..nor my Ohio cousins who now have young children. However, medical genes run dominent in that side of the family so there are very few anti-vax members.

(last comment before bedtime... and before Sciblogs decides I've commented too often). I love reading the comments of the Minions. Where else can you discuss vaccine refusal, delis around the world, and Steve Perry songs all in one thread?

@stewartt1982:
To be fair, I don't mind mayonnaise on Russian food at all. I really dig Russian food in general, but one does miss things like pizza, and the lame Russian imitations only make it worse...

Myself and a couple of ex-pat friends used to go to the one blessed Carls Jr.'s in St. Petersburg for cheeseburgers and beers, in fact. And I have to admit that I've been known to visit McDonald's on rare occasions while abroad in Russia and various points in Eastern Europe. I mean, they have free Wifi, clean bathrooms, and french fries.

I have to admit that I’ve been known to visit McDonald’s on rare occasions while abroad in Russia

Teremok for me.

By herr doktor bimler (not verified) on 11 Dec 2014 #permalink

I enjoyed taking my son into Макдональдс when we were there.
He had no idea.

Some of us Hippies in Ann Arbor are staunch anti-anti-vax people. But, as the continuing need for posts on this blog prove, it's not an easy thing to convince everybody, particularly given the amount of writing going on for the other $ide.
Thanks for Voices for Vaccines quotes, Llz. The "I was afraid" one was outstanding - explaining it in ways I couldn't have done.

Native Yooper, BS chemistry, Da Tech, eh?, MS The University of Michigan, now in Missouri. If you live there long enough, you adapt to the weather (humans are amazing that way). I actually prefer snow that stays around to ski on and play in to our slush-for-a-day stuff.
There is a strong go it alone mentality in the UP. My uncle built a log house, raised a family an didn't get an electric stove until about 1965. They don't trust banks, big business or liberal college people-engineers are OK. Hunting out of season is smart because the woods aren't safe when those trolls (downstaters) are around.
Ann Arbor was a shock. The woo-merchants around the Peoples Food Coop cater to the parents of the Waldorf school kids. But Hill auditorium and Zingerman's were worth it all.
(I think I was your advanced organic lab TA, Orac).

@Herr Doktor:
Teremok is great. There's nothing like bad American food when you're hungover, though. Plus Putin hates McD's now, and, well, I hate Putin.

The 200 fold increase in risk in that epidemic in the Netherlands in 1999-2000 was in our own biblebelt. I have only statistics on voting district level but they closely follow each other.
The districts with the highest level of fundamentalist believers (15%-35%) have the lowest vaccination rates (90% or less, at about 90% of the percentage fundamentalists) of as god is supposed to help them not man. The number of deaths (as a percentage of the population) are highest in those districts.

By who cares (not verified) on 12 Dec 2014 #permalink

@JP
fair enough, I think the difference between Japanese and Russian pizza is that 1) normally made quite well (even if they used mayonnaise as a topping), with no icky ketchup sauce 2) There will be non-mayonnaise topped pizza that you may order. So it ends up being a normal, north american pizza with a few slight changes.

I think almost everyone goes in search of comfort food from back home when they live abroad at some point. My English colleagues were tickled pink when we found a proper curry place just outside Mito ... wish I could get poutine or rappie pie abroad.

@Denice Walter
I know what you mean, I like Japanese bakeries but for the most part they are presenting a Japanese interpretation of bread (in my experience, sweet, soft and somewhat chewy) ... or just odd things such a bun stuffed with a hotdog, fried potatoes, sealed in with eggsalad and melted cheese.

I think my favourite Japanese bakery good is Korokke Pan (croquette bread). A nice bun with a deep fried croquette covered in tonkatsu sauce baked inside. Bad for the heart but comforting when you are stuck in the control room on shift all day.

By stewartt1982 (not verified) on 12 Dec 2014 #permalink

@BethH:

Your argument is unavailing to me because it completely ignores the communal aspect of these things. Your personal privacy always takes second place to the harm you can cause others. The old definition of liberty comes to mind: "Your right to swing your arm ends at my face". Similarly your right to control your own healthcare decisions ends when you put me (read: any third parties) at risk. Your choice not to vaccinate yourself/your kids puts me at risk of communicable diseases. That is precisely why you have no right to insist on your "privacy" or "religion" or "philosophy" as a defense, all of those rights only extend so far as to not cause harm to others. Not vaccinating is pretty likely to cause harm to others (especially for still endemic diseases like influenza). Therefore, I fail to see how your "privacy" is a valid concern in this specific case.

I often read this blog, although I don't really comment, as I never feel like I have anything to add or that I'm not qualified enough on the subject. But I will say this: I'm not in any way surprised that Grand Traverse Academy is having outbreak issues. The founder, Steve Ingersoll, is a medical nut. As far as I know, he's currently under investigation for tax fraud, but he's also very antivaccinationist. You see, he was my boss for a period of time in the early 2000s. (Not at one of his charter schools. It was another one of his medical thingies that claimed to cure autism by IVL.) As much as I hate to say it now, my job back then was to run the sensory chair and find anti-vaccination "information" to pass on to parents. My only defense for myself is that I was young, my only credentials were that I was good with autistic children, and I was working my way through community college. But that office was saturated with anti-vaccine ideas and pseudo-science. I'm ashamed to admit that I was suckered into it for a while.

The charter schools that Ingersoll ran are trying to distance themselves from him now because of the scandal, but I wonder if that will change their anti-vaccine attitude.

By littleredlemon (not verified) on 12 Dec 2014 #permalink

Not vaccinating is pretty likely to cause harm to others (especially for still endemic diseases like influenza).

In teh news today: the current California pertussis is now officially the worst outbreak in 7 decades with almost 10,000 cases of infection. One contributing factor has been the failure of pregnant women to embrace the CDC's recommendation that they be vaccinated against pertussis during their pregnancy (compliane is at about 20%).

@ stewartt1982:

Right, the bread is not much. One of my gentlemen likes the hotdog thing. I absolutely adore green tea sponge cake.

Japanese/ Korean/ Chinese bakeries also do their own versions of strawberry shortcake or what they call 'French cake' or 'layer cake'- not the original but interesting and far lower in calories and fat content.

By Denice Walter (not verified) on 12 Dec 2014 #permalink

"Your argument is unavailing to me because it completely ignores the communal aspect of these things. Your personal privacy always takes second place to the harm you can cause others. The old definition of liberty comes to mind: “Your right to swing your arm ends at my face”. "

You're entitle to place a different value on personal freedom and privacy. The whole point of civil discourse is about arriving at compromises that the majority are willing to live with. However, with regard to your quote about freedom, I see this issue differently. Your right to a reduced risk of VPD ends where my body begins. I don't like the idea that society gets to dictate what goes into my (or my children's) body against my will. It's one thing to make vaccination the default while still allowing people to opt out. It's another to make is compulsory for everyone.

Consider this scenario: assume an ebola vaccine is developed with a very low but non-zero risk of harm due to the vaccination. Does the government have the right to insist everyone be vaccinated with it? Or should citizens be allowed to decide for themselves whether they prefer the risk of the vaccine or the risk of getting the disease?

By Beth Clarkson (not verified) on 12 Dec 2014 #permalink

That hypothetical Ebola vaccine--are we in Seattle or in Monrovia? No government outside west Africa would mandate an Ebola vaccine right now, because the risk of infection elsewhere is so low. Furthermore, I suspect you knew that when you picked that hypothetical.

Legally in the U.S. and I think ethically as well, the government does have the right to mandate vaccination: that was established with smallpox vaccines, because yes there's some risk from the vaccine, but the risk of not being vaccinated is much greater.

If you want to avoid vaccines against diseases that could kill children because of vague ideas about "privacy," you have the ethical obligation to avoid children. Or at least any child whose parents haven't specifically given informed consent to you exposing their child to that disease. That means staying away from places that children might be, such as airports, buses, supermarkets, movie theaters, restaurants, and sidewalks. Not just "during an outbreak," because every outbreak has a starting point, and you don't have the right to infect other people because you're one of the first people to get sick. I can't tell, if a random stranger on the bus coughs, whether that's because of something in their throat, a seasonal allergy, or an infectious disease.

Vicki,

I don't avoid vaccines. In fact, mine are up-to-date. I just don't think they should be forced on people against their will. That's a personal value, not a scientific conclusion.

There is an argument for allowing people to choose between vaccination or losing some amount of freedom of moment during an outbreak of a disease like smallpox or ebola. But restricting freedom of movement of the unvaccinated in the absence of an outbreak is not reasonable IMO.

Lets keep the hypothetical to U.S.A. rather than Monrovia, because I am familiar with the U.S. constitution, but not the government of Monrovia. You cannot discuss promotion of vaccination by law without taking into consideration the political climate and the currently recognized rights of individuals.

However, feel free to discuss under what circumstances you think it would be appropriate to mandate an ebola vaccine for citizens unwilling to get it and what you think an appropriate response would be for those who refuse.

By Beth Clarkson (not verified) on 12 Dec 2014 #permalink

The anti-vaccination vocal push is strong here too - Southwest Michigan region, Grand Rapids to Lake Michigan and Southward. It is driven primarily by two groups: the vapid anti-vaccination people who would say what they do no matter what, and the tea-baggers with a "vaccination is just another gubbmint push at individual liberties".
There is also an extremely vocal loon from near Grand Rapids who, well, I'm not sure how to categorize. He posts long rants about the "dangers of the vaccines in the United States" and how they are "unethical" and "linked to autism and other mental illnesses" (his words), but states that there are safer versions in other countries and that people should do has he and his wife did and take their children to other countries to be vaccinated. No specific information given on that. (He also goes on about cancer and cell phones and a variety of other crap.)

One thing I did find interesting about the data on vaccination rates here: several Amish areas in northern michigan had low vaccination rates - lower than Amish communities in Ohio and Indiana. I find that odd.

my wife works in the administrative offices at a prestigious university ,and is astonished at the amount of woo belief among the highly educated (most people in the office are Phds) co-workers. Fad diets, ultra vegan lifestyle, alternative healing etc. Wouldn't be at all surprised if anti-vax was in there too.

Yeah, I can attest to that. There's a certain amount of woo present among certain people in my department, but I think anti-vax views are pretty extreme even for them.

BTW, an "ultra vegan" lifestyle isn't necessarily woo. I'm not a vegan, but I was a vegetarian for 8 years or so, until I started traveling around Russia and Eastern Europe. (It just isn't really feasible over there, so I ended up "falling off the wagon" altogether.) A lot of people are vegan or vegetarian purely for ethical reasons. Heck, some are even just animal lovers and don't want to eat or wear animals.

While the religious opponents seem to make the news, the woo believing blue staters are numerically the problem. California and Oregon have terrible exemption rates.

Whoo boy, that's a bad article you cited there. And I'm not the one trying to link this to a red-state/blue-state divide. I consistently point out that antivaccinationism is the quackery that crosses ideological boundaries and that more recent evidence fails to find much difference in the prevalence of antivaccine views between liberals and conservatives.

http://scienceblogs.com/insolence/2011/05/09/motivated-reasoning-and-th…

http://scienceblogs.com/insolence/2014/06/04/the-daily-show-hilarious-s…

http://scienceblogs.com/insolence/2013/12/18/why-are-antivaccinationist…

Red states might appear to be solidly pro-vaccine, but when you take a more granular look at the data, as these stories about Michigan did, you'll find much less correlation between political alignment and vaccine exemption rates. In Michigan, for instance, the solid Republican part has several pockets of antivaccine sentiment (or at least high exemption rates), and so do a couple of liberal bastions like Ann Arbor. Detroit, the most solidly Democratic part of the state, has relatively low vaccine exemption rates.

While it's true that some of the more famous antivaccine voices (such as Robert F. Kennedy, Jr. and Bill Maher) are "progressive" or "liberal," it's become very clear to me over the last couple of years that it's just not true that antivaccine beliefs are primarily held by left-leaning individuals, but antivaccinationism, at least, is clearly a bipartisan affair, and it is actually a myth that it's primarily a "liberal" or "progressive" issue.

Indeed, think back not that far. Representative Dan Burton was huge in the antivaccine movement and completely convinced that his grandson was made autistic by vaccines. Now, Darrell Issa appears to be taking up the mantle and holding antivaccine hearings.

The "health freedom" movement tends to be an amalgam of right/libertarian types (for instance, General Stubblebine and Rima Laiblow) with some crunchy lefties. Hell, right wing icon Chuck Norris is quite antivaccine these days! (Actually, he's anti-GMO, too!) And let's not forget that Donald Trump is quite antivaccine. Particularly telling to me was The Amazing Meeting two years ago, where Steve Novella went to FreedomFest, a libertarian/conservative conclave, to a vaccine "debate" with Julian Whitaker hosted by the event. Later that same day, FreedomFest held a screening of the antivaccine film The Greater Good. And who moderated the debate? Leslie Manookian, the producer and director of that very movie! Meanwhile, the Texas Republican Party inserted support for supplements and "vaccine choice" as planks in its party platform last year.

In fact, with respect to vaccines, I'm hard pressed to think of a single "liberal" politician who is rabidly antivaccine, the way Dan Burton was and Darrell Issa appears on the road to be becoming. Look at the Congressional "panel" that will be appearing at 2013 autism quackfest known as Autism One:

http://www.autismone.org/Congressional-Panel-Autismone-Conference-2013

Nary a "progressive" among them, and they're a key attraction of an antivaccine quackfest! Let's just put it this way. For all the harm that Senator Tom Harkin (a Democrat) did when he pushed for the creation of the National Center for Complementary and Alternative Medicine (something we all agree on), I have as yet to find any evidence that he is antivaccine, the way that, for example, Dan Burton was (and presumably still is, now that he's retired).

I used to believe that antivaccinationism was primarily a phenomenon of the "crunchy" left. Over the last few years, I've learned that that commonly held impression is not correct, and that I was wrong.

I don’t like the idea that society gets to dictate what goes into my (or my children’s) body against my will.

Then don't attend, or send your children to, schools that "society" pays for. Problem solved. Its not as if the gestapo are going around kicking in people's doors and dragging them screaming into the streets to get vaccinated.

@Beth Clarkson, with regard to your comments:

I see this issue differently. Your right to a reduced risk of VPD ends where my body begins.

and

restricting freedom of movement of the unvaccinated in the absence of an outbreak is not reasonable IMO.

I can't agree. The law places restrictions on us all. Think of fire codes. They protect not just the people who follow them, but everyone. If a fire does break out, it's far less likely to go out of control and consequentially everyone is safer. Think of laws about air pollution or noise by-laws. Those are restrictions that protect everyone.
A large number of recent outbreaks followed the same pattern: unvaccinated person went abroad to a country where a disease was endemic and caught it there, then came home and spread it around. You can be infectious and asymptomatic for days, even weeks. It is perfectly reasonable to place restrictions on the unvaccinated, even when an outbreak isn't underway.

By Julian Frost (not verified) on 12 Dec 2014 #permalink

What Orac describes in #107 is all too familiar to me because I follow alt media/ woo-fraught websites including the anti-vax contingent: they frequently tread the razor's edge in order to NOT alienate either end of the spectrum.

They carefully word rants ( a carefully worded rant! Fancy that!) to focus upon Nature, Spirituality, Freedom, Purity- which can all be understood in a variety of ways- gaia's natural world or g-d's green earth, the soul as Christian, heathen, Hindu or a World Spirit and freedom from government, taxes, corporations or traditional values .And pure in several senses of the word.

Adams speaks of a back-to-the-land movement that might appeal to your average crunchy folk as well as survivalists/ libertarians; Null calls his own ( in the planning stages) political party 'progressive libertarian'. Blogging Moms ( Like Jameson) might be close mouthed about their own political leanings ( right) or try to appear a-political.

By Denice Walter (not verified) on 12 Dec 2014 #permalink

@Sarah - Actually I both vaccinated my kids and homeschooled them.
My comment was in response to another comment that advocated compulsory vaccination with only medical exemptions documented by physicians.

@Julian

I agree that the law places restrictions on all of us. Whether or not the risk involved is sufficient to justify placing restrictions on the non-vaccinated is debatable. We are entitled to our respective opinions on the matter.

By Beth Clarkson (not verified) on 12 Dec 2014 #permalink

Oooooops!
I spoke too soon: Mikey rants today without regard for his audience's diverse political leanings.

By Denice Walter (not verified) on 12 Dec 2014 #permalink

rork@89:
Incidentally, I hadn't meant meant "hippies" as an insult, though I can see how it could come off that way. Some of my best friends, as they say, are hippies. You could maybe call my one myself, though I've always tended more toward the punk/goth end of the subculture, and as such, I do good-naturedly, and jokingly, rag on hippies from time to time. But I love weirdos of all stripes, especially smart ones.

i bet you can guess which kitten in this picture I identify with.

Beth Clarkson, #111, December 12, 2014:

My comment was in response to another comment that advocated compulsory vaccination with only medical exemptions documented by physicians.
We are entitled to our respective opinions on the matter.

Beth, you are (as everyone is) entitled to your own opinions. As the wise observation goes, though, you are not entitled to your own facts.
I point out that there are two situations where a physician can validly certify: 1) this kid's physiological state can't handle being vaccinated, and 2) the patient has already had the disease(s) in question, so we won't bother. When we had a measles outbreak here, schoolkids and school staff were forbidden to attend school for the duration, unless they had recorded vaccinations against, or survival of, measles.
I haven't been vaccinated against measles, mumps, or rubella: I already had survived each of them, plus chicken pox, before those vaccines were developed. Thus, my non-vaxed status is not a danger to anyone.
I certainly hope that your kids, despite being homeschooled, have developed better consciences than you have demonstrated in your comments.

By Bill Price (not verified) on 12 Dec 2014 #permalink

I don’t like the idea that society gets to dictate what goes into my (or my children’s) body against my will.

I'm not sure why you conflate control over your body with control over your children's bodies. They have very separate bodies of their own, you know.

They're "your" children not in the sense that they're your property to do with as you will, but rather "yours" in that you have the responsibility to act in their best interests until they reach the majority. The state does indeed act in loco parentis in instances where a parent is not acting in his or her child's best interest. I am in fact quite pleased, for instance, that many governments around the world have decided that Jehovah's Witnesses do not have the "right" to deny their children blood transfusions when medically necessary. I see no reason why medical neglect by non-vaccination couldn't be included in this category.

Our "society," as you say, has only been recently coming around to the idea that children have rights of their own, separate from their parents. There are a lot of rights that children don't have in our society - like freedom of religion, for example - but that they deserve to be able to exercise upon reaching adulthood. The state, then, has a moral responsibility to make sure every kid has the best shot possible at making it to the age of majority.

until they reach the majority.

Until they reach the age of majority, that is.

Lets keep the hypothetical to U.S.A. rather than Monrovia, because I am familiar with the U.S. constitution, but not the government of Monrovia. You cannot discuss promotion of vaccination by law without taking into consideration the political climate and the currently recognized rights of individuals.

I'm afraid that there is absolutely no constitutional protection for anti-vaxxers to use their spawn as infectious disease vectors.

By Science Mom (not verified) on 12 Dec 2014 #permalink

@Beth

I realize that you're not personally opposed to vaccination; I should have been clearer that I wasn't responding to you personally but to the argument you used, which is still specious when applied to vaccine requirements for public schools. That's what people typically mean by "compulsary" vaccination, at least in the U.S.

As long as I'm on the subject, though, I would like to add that your assertion, "your right to a reduced risk of VPD ends where my body begins" is completely backwards. The saying, "your right to swing your fist ends where my face begins" means that your freedom, even to the extent of control over your own body, is limited insofar as your actions have the potential to harm others. You've turned that on its head by claiming that someone else's right to not be harmed should be limited insofar as it restricts your freedom. In essence, you're saying, "your right to not have your nose broken ends where my fist begins."

@Sarah A #108

Its not as if the gestapo are going around kicking in people’s doors and dragging them screaming into the streets to get vaccinated.

It does seem that way sometimes at various places. Maybe it will work out as well as this did:

http://scienceblogs.com/insolence/2007/11/19/prince-georges-county-cour…

It is the threatful cohersion that leaves a stink and more doubt. It happens all over that it is the school's policy to attend but then the parents/kids are entered into the system with all that entails for violating 'truancy laws'. Surely, it has nothing to do with the schools around here getting a fistfull of dollars per student/day back in the day.. Often, the parents are unaware of the waver and any inquiry over them earned 'the visit' (welfare check (not the monetary kind) ).

"Isn't it really that there's no law you have to take the vaccines, but then if you're truant, that's when criminal penalties kick in?" State Attorney Glenn Ivey conceded on The Alex Jones Show that, "Yeah, there's a statute here in Maryland, it's called Child In Need of Supervision and I have used it for chronic truancy cases to pressure the parents to get their kids back in school."

In another telling admission, Ivey later said that he personally prevented his children from getting the very same vaccines that parents may go to jail for not allowing their children to receive in Prince George's County.

http://www.prisonplanet.com/articles/november2007/151107_attorney_admit…

@Tim:
That's all pretty hyperbolic, which isn't surprising, considering you're referencing the Alex Jones show.

It seems pretty simple to me: if parents want to avail themselves of schools, they need to vaccinate their kids, for their own safety and everyone else's. They also have to put clothes on their children to send them to school - it's a public place. If they're really so committed to not getting their children vaccinated, they can homeschool. This is a free country. And they can have a nudist colony in the privacy of their own home if they really want.

Of course, homeschooling young children would require a lot of effort, and at least one full time stay at home parent. If that's too much effort for anti-vaxxers, well, tough.

I mean, come on. I know people who've actually lived in a totalitarian regime, and comparing a public health measure to that kind of experience is just ludicrous. Nobody's getting shot in the back of the neck or sent to a gulag here.

orac (ref post 107)

I agree that article pushed the position (in other articles he comes done hoard on antiscience conserviatives) the other way but my point was that it is NOT a red/blue issue, some very blue areas have among the highest numerical numbers of exemptions, seemingly larger than the conserviative religious opposers.

The religious opposition is largely associated with wingnut offshoot sects tha,t while troublesome, are not the biggest issue.

Travel down the NJ turnpike and you see an enormous (expensive) anti vax billboard which has been there for some time. This is not the product of some little fundamentalist cult.

Personally, as a strongly libertarian leaning atheist, I have a lot of contempt for both the left and the right, I don't have any particular interest in defending religious nutters. But I think it's a mistake to consider this a religious issue.

Orac @103:
Kevin Rahe. I don't know whether he has a web site.
Here are a couple of his latest comments - from another article in Mlive's series, this one on why parents choose not to vaccinate.
"If the problem is the residual human DNA fragments in some vaccines combining with the vaccinee's own DNA, it may very well be that only people receiving the vaccine whose DNA closely matches the fragments of DNA from the person in whose cells the vaccine was cultured will develop Autism symptoms. But that also means that they wouldn't have developed those symptoms had the foreign DNA fragments never been introduced."

"That's all well and fine, but about 10 years ago a study was published that also concluded that there was no link between the MMR vaccine and Autism, and just a few months ago one of the researchers involved went public with an acknowledgement that they did indeed find an increased risk for Autism among a group of African American children who were vaccinated in a particular age range, but didn't report it at the time. How do we know that 10 years from now there won't be a similar revelation about the studies you refer to?"

He is far from the only loon: you'll see comments about tens of thousands of deaths caused by the polio vaccine, for example.

If DNA fragments must closely match in order to cause autism.......has anyone told the good mothers of TMR that they cause their children's autism by 'kissing it better'?

By NumberWang (not verified) on 13 Dec 2014 #permalink

@Beth Clarkson #64, #65, #(et. al.)

I think that it is lack of trust in authorities that correlates with opting out of vaccines.

Trust.

Among other costs, keep in mind that one cost of any law is people being killed in the course of enforcing the law. I just learned this principle as a result of discussions on the killing of Eric Garner for selling loosies. It applies to ALL laws.

A child’s parent might be killed if they stand in the way of their child being vaccinated.

Precisely, Beth Clarkson.

...Every law, no matter how trivial, will be enforced with violence against you. Remember those words. Against me.

https://www.youtube.com/watch?v=Jf_Sl3BlsVc

jay #121
What kind of web browser malfunction morphed Orac's #107 on your screen to say anything about religious nutters? Issa, Burton, Weldon, Posey, Stubblebine, Norris, The Donald. Church of Monopoly Capitalism, maybe. We're talkin' about the Tea Party, dude, not exactly a little fundie cult.

Skepticism 101 should lead anyone to question the assumption that head counts on the political affiliations of folks with exemptions means diddly poo. See my #52. We're talking about exemption policy. What political woo would lead anyone to think political power correlates to the rates of vaccine exemptions distributed by ideology? The map we need would show where the votes for exemption statutes come from by party affiliation and 'caucus' as revealed by votes on other issues. I could be wrong, but my bet would be that tilts waay to the right.

Peter Pomerantsev (who just wrote a book about deception and lying at the heart of the Russian political system) has a perceptive op-ed published in yesterday's New York Times.

Pomerantsev writes "Everything is P.R.," my Moscow peers would tell me. This cynicism is useful to the state: When people stopped trusting any institutions or having any values, they could easily be spun into a conspiratorial vision of the world. Thus the paradox: the gullible cynic...At the core of this strategy is the idea that there is no such thing as objective truth. This notion allows the Kremlin to replace facts with disinformation."

http://www.nytimes.com/2014/12/12/opinion/russias-ideology-there-is-no-…

Replace "Kremlin" with "Natural News" or "Age of Autism" and you see a similar strategy at work. Get your target audience to distrust and disbelieve all mainstream sources of information (government, science, educational establishments), embrace conspiracies and reject the idea that any scientific proposition can be proven (i.e. "studies are unreliable!").

But people can't stand the idea of existing in a vacuum with nothing to believe - so you can substitute your own "facts" which will then be accepted despite their ludicrousness.

We see the same paradox among alties and antivaxers that Pomerantsev has described - the gullible cynic.

By Dangerous Bacon (not verified) on 13 Dec 2014 #permalink

Dangerous Bacon:

Take a look at Dan Olmsted today @ AoA.

By Denice Walter (not verified) on 13 Dec 2014 #permalink

@Dangerous Bacon:
Mmm-hmm. The 90s saw a huge explosion of all kind of conspiracy theories, weird New Age stuff, and all other manner of nonsense in Russia. When nothing makes sense anymore, it seems to be pretty easy to believe in anything.

There was a famous TV hoax in May of 1991, the last year of the USSR's existence, on a program called "The Fifth Wheel." It's basically a bizarre hodgepodge of every logical fallacy known to man, in a very deadpan manner, leading to the conclusion that Lenin was, in fact, a mushroom. There's a brief Wikipedia article in English here. You can watch the video here. (The second part is the first video in the list to the right. The subtitles aren't perfect, and some bits were cut out, but you can sure get the gist. It's a thing of beauty.) A lot of people fell for it, which is even more amazing considering the two guys pulling it off basically start laughing at the end.

Postmodern, surrealist literature also had a bit of an explosion in the 90s, Viktor Pelevin in particular. I'm not a huge fan, but I do really like his novel Omon Ra, a take on the Soviet space program. You can find it in English.

But yeah, in such an environment, the siren call of nationalist ideology - some kind of coherent narrative, even if it's a false one - becomes pretty strong. There's even a group of fascists in Russia who essentially want to go back to 19th century "Nationalism, Orthodoxy and Autocracy." In the summer of 2012, when I was marching against Putin in Moscow, they came charging into the end point where people were gathered, knocking people down right and left, including yours truly, and generally causing chaos and trying to incite confrontation with the police. I wonder, now, if they weren't planted by the government to try to discredit the opposition. (See? Even my thinking gets conspiratorial when it comes to this stuff. Of course, when political conspiracies are actually a legitimate possibility...)

Mmm-hmm. The 90s saw a huge explosion of all kind of conspiracy theories, weird New Age stuff, and all other manner of nonsense in Russia. When nothing makes sense anymore, it seems to be pretty easy to believe in anything.

There was an article in Scientific American from the early 90s, examining the rise of pseudoscience and quackery in Russia. The authors reckoned it was a normal, predictable to the collapse of authority and the end of comforting illusions of national strength.

By herr doktor bimler (not verified) on 13 Dec 2014 #permalink

I'm rather surprised that anyone is defending GregH's call for compulsory vaccination of every man, woman, and child, apparently against everything.

I’ve yet to come upon a single valid argument against compulsory vaccination with only exemptions based on genuine medical issues.

Apparently, 70 years worth of consitutional law regarding compelling state interests and strict scrutiny is "invalid."

OT, except for the fact that we briefly touched on Russia, but I just got what might be my favorite email ever, and I feel a desperate need to share it with somebody besides the books with which I am currently holed up in my office. It's from a former student, now a rocket scientist with a Real Job:

"Hi,

I stayed up reasonably late last night reading poetry. In Russian. I blame this entirely on you."

How I love corrupting young minds. :D

I have said this a million times: if you choose not to vaccinate your child, two things need to be agreed to if your child comes down with a vaccine-preventable vaccine:

1. Your child gets no treatment. At all.

OR

2. Your insurance company is not required to cover ANY costs that are the result of your child not being vaccinated.

By Elizabeth (not verified) on 19 Dec 2014 #permalink

Elizabeth, I cannot agree with your stance about deliberately non vaccinated children, who, are innocent of any wrongdoing. I don't even agree that we should deny medical care to adults who refuse to get themselves vaccinated.

Private medical insurance and publicly funded medical insurance (Medicare and Medicaid), provide reimbursement of costs associated with other diseases and disorders, where adult patients don't following their physicians' advice to lose weight, to stop smoking, to exercise and to take prescribed medication...as well as those who indulge in downright risky behaviors, such as driving while impaired.

1. Your child gets no treatment. At all.

Utterly nonsensical, not least because it's in direct conflict with EMTALA.

OR

2. Your insurance company is not required to cover ANY costs that are the result of your child not being vaccinated.

In direct conflict with PPACA. I suggest you put aside the revenge fantasies and examine whether so much as differential pricing on individual policies or group copays would be permissible.

One thing I noticed returning is just how politically conservative the state had become. There’s a huge Tea Party contingent, and unfortunately my state senator is among the wingnuttiest of the wingnuts

In my sate, California, id is Democrats who are slightly more likely to be anti science. Dems are slightly more likely to be anti vaccine and much more likely to be anti GMO flat earthers. Four of our Dem members of congress waffled on vaccines he last election