Quoth Katie Tietje: Stop being mean to non-vaccinators!

freedomofspeech

Here we are, into a new week, and the Disneyland measles outbreak continues to grow, the total number of cases now having topped 100 and the disease attributed to someone visiting Disneyland now having reached my state. More than ever, given the high proportion of victims who weren't vaccinated, antivaccinationists are feeling the heat. Rober, "Dr. Bob" Sears, MD might have been the most petulant one trying to downplay the seriousness of measles and then letting out a whole bunch of antivaccine dog whistles to his patients to let them know that, despite his assertion that the measles vaccine works, he's still one of them.

Now others are getting in on the act. Maybe they're envious at how much attention Dr. Bob has been getting (although the attention he's been "enjoying" has been almost universally negative, given that supporters of science-based medicine recognize it for the disingenuous BS that it is and antivaccinationists can't be too pleased by some of Dr. Bob's positive assertions with respect to vaccines even as they recognize his antivaccine dog whistles about "freedom to choose" and how antivaccinationists shouldn't be "ostracized").

Enter Katie Tietje, known by her nom de blog as Modern Alternative Mama, and a deliciously schadenfreude-inducing whine entitled Enough is Enough with Blaming “Anti-Vaxxers.”

No. No it's not.

But let's listen for a moment to what Teitje has to say. After starting out with a boisterious, "All right, I've had it!" and complaining about articles in the mainstream media "dripping with hate and anger towards families that don't vaccinate," she lashes out thusly:

There is bullying, nastiness, insanity from every corner. We’re at the peak now. And it’s affecting people in their everyday lives. More and more are having to read tirades in their Facebook newsfeeds about how stupid “anti-vaxxers” are, or endure personal berating over their family’s choices. Some are encouraging people to find out which children in their child’s classroom aren’t vaccinated so they can ostracize them. Some are refusing to allow unvaccinated children into church nurseries, playgroups, and more. Perfectly healthy children, who happen to not have been vaccinated.

I’ve even been told that some of my readers have been messaged by trolls and harassed, simply for participating in some of the threads on my Facebook page! That’s just going too far.

"Messaged by trolls" on Facebook? Oh, the horror! Ever hear of the "block" function? It works quite well—better of Facebook than, for instance, on Twitter, and if you report a troll on Facebook you're more likely to get him or her banned from Facebook, either temporarily or permanently. "Endure personal berating"? Those horrific bullies! What's next, the comfy chair? Here's the thing: The "personal choices" of Tietje and her fellow antivaccinationists not only endanger others but do indeed contribute to outbreaks like the still growing one linked to Disneyland that we continue to follow with alarm. If I ran a church nursery, a playgroup, or any other function where large numbers of children congregate, for whatever reason, I'd start banning unvaccinated children too. In fact, it'd be my general policy because it's the responsible policy. Personally, I see this as a good thing that this measles outbreak is getting the attention of organizations that didn't previously require childhood vaccinations are starting to wake up. Similarly, if I were a parent of young children I would not let Tietje's kids play with mine. Yes, they might be "perfectly healthy"—now. However, by not being vaccinated they are at a much higher risk for contracting the measles. More importantly, they could contract it and seem to be completely asymptomatic but infectious. (That's the reason for quarantines, by the way, and even though measles is one of the most infectious diseases there is, people can't seem to get that.)

o, my dear Ms. Tietje, I'm oh-so-sorry that your "personal choices" have consequences. You seem to think that they should not, which is an unrealistic, childish standard that we apply to virtually no other choice that impacts others. By her "logic," someone making the "personal choice" to drink alcohol and then drive shouldn't be ostracized. But wait, she would say. Those people are a danger to everyone on the road. And so they are. It's an immediate danger of crashing into other cars and causing death and injury. The choice to leave your child unvaccinated poses a much less obvious danger, but it's a danger nonetheless. Moreover, it helps degrade the herd immunity that keeps infectious diseases outbreaks from spreading.

All of this leads to a call to arms from Tietje:

Families who believe in vaccine choice, it’s time to stand up. I know it’s hard, with all the hate. But if we sit silently and let them rage and fight, they’ll strip our rights. Yes, it’s easier to be quiet and hope people don’t know who we are, so that we don’t have to deal with the brunt of the anger directly. If we are silent, they win. And they cannot win. They are wrong. They are wrong to bully people into their way of thinking. They are wrong to try to force their will on others. And they won’t do it, if I have anything to say about it.

You know, when I read something like this, I often find it hard to tell how much of this "hate" is real and how much is simply people like Tietje not liking criticism for her "personal choice" and having a hard time accepting responsibility for their choices. From my perspective, I've yet to see an article or story in the mainstream media that I'd characterize as "hateful." I've seen op-eds criticizing antivaccinationists for facilitating outbreaks by contributing to pockets of low vaccine uptake that degrade herd immunity to the point where outbreaks are possible in those pockets. I've seen antivaccinationists characterized as misguided and wrong (which is true). However, I haven't seen anything that I'd characterize as "hate" or "bullying."

Of course, Tietje is not likely to succeed in getting too many more parents to speak up and identify themselves as non-vaccinators. As we all know (and as Dr. Bob himself teaches antivaccinationists), being a non-vaccinator involves "hiding in the herd" and relying on herd immunity to protect one's child. That doesn't work if others know, both because more might try to hide in the herd and other parents might understandably react the way that Tietje is complaining about right now! If you "out" yourself as a non-vaccinating parent, you can't easily hide in the herd any more—at least not as easily and certainly not in the middle of an outbreak, when awareness of the measles is at, as Tietje might put it, a "fever pitch."

Next up, Tietje tries to demonstrate that it isn't the unvaccinated who are to blame:

In the Disneyland situation:

  • There are around 70 confirmed cases currently
  • 5 of them were fully vaccinated
  • 37 were not vaccinated
  • There are no records available for at least 30 cases (so we don’t know their vaccination status)
  • We don’t know the vaccination status of “patient zero” (the first person to have measles in this outbreak)

We can’t make the leap, from what we do know, that this was “caused by unvaccinated people.” We simply can’t. That is just an easy scapegoat. If fits their agenda — to stir up hate and anger towards people who make alternative vaccination decisions, in order to try to strip exemptions and peoples’ rights. (No, nobody has the right to force medical care of any sort on anyone else. Period.)

Yes, Tietje's post was written a few days ago, when the total was 70. It's 100 now. Funny, however, that her own figures largely demolish her own argument. As even Dr. Bob himself recognizes, in many outbreaks more vaccinated children than unvaccinated children fall victim to the disease because vaccines are not 100% effective and there are a lot more vaccinated than unvaccinated children. However, when you correct for that difference and calculate the risk of catching a disease in an outbreak, the unvaccinated are always at much, much, higher risk. Indeed, 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, although it's usually more like a 20-fold differential—still substantial. By Tietje's own estimate, at least half of the measles cases to that point were unvaccinated, which points to an enormously increased risk of contracting the measles among the unvaccinated.

Of course, the next tactic Tietje moves on to is the same one that Dr. Bob used, essentially a variant of what I like to call argumentum ad Brady Bunchium, namely the claim that measles just isn't so bad. For those who don't remember, argumentum ad Brady Bunchium is a term I coined four years ago based on how frequently antivaccinationists appeal to an old episode of the Brady Bunch in which all the kids contract the measles and the family treats it as just a normal part of growing up. In fact, the kids are portrayed as not very sick and happily playing Monopoly, glad not to have to go to school for a week. It's a mischaracterization of measles, which is not a benign disease.

Tietje then rattles off a bunch of figures about the measles vaccine and measles, harping on how the last measles death was in 2005 and there have been only 15 measles deaths since 1992. Yes, and we'd like to keep it that way; actually we'd like that number to be zero, because zero is achievable, but people like Tietje are, through their ignorance, fear mongering, and belief in "personal choice" above all, sure are doing their best to make that impossible. No, they don't believe they're doing that, but that is the end result of their actions.

Finally, Tietje concludes with a call to action. The first is a request for people to sign a highly misguided Change.org petition entitled Stop allowing the violation of our children's human rights through mandatory and forced vaccinations with or without parental consent. Of course, in this country no one is "forcing" vaccinations. Parents can refuse vaccination. They simply pay a price of not being able to get their kids into public schools, although in most states nonvaccinating parents don't even pay that price because of easily obtained religious and personal belief exemptions.

One other thing by Tietje stands out:

Third, speak up. If people are being rude, call them out. Be respectful, but say something. “We all make different medical decisions for our children. The evidence is not clear cut. Being rude isn’t going to change anyone’s mind, and I’m asking you to stop talking to others like this.” I suggest deleting and banning anyone who can’t remain civil. If you’re ready, share some information on your personal Facebook profile, or talk to friends in person. Remain calm and let everyone know how hurtful and harmful this sort of negative attitude is.

To which I would respond: Those supporting science-based medicine should also speak up. Remain civil. Tell parents like Tietje (politely) that the evidence actually is clear cut. Vaccines are very safe, and measles is not. As for "hurtful or harmful negative attitudes," realize that concern trolling is a powerful weapon. As a pro-science advocate, to a person like Tietje you can never, ever be sufficiently civil. You will always be accused of being incivil, mean, nasty, and unfair by antivaccinationists, no matter how polite and civil you are. The reason is that antivaccinationists hate the message; so the messenger can never be civil enough. Also, accusing someone of "incivility" is a powerful means of shutting them up, particularly in face-to-face social situations, as opposed to online debates. Nobody likes being portrayed as a meanie, and most will usually back off.

Finally, Tietje calls for censorship by taking advantage of Facebook's automated banning policies:

Fourth, report hate pages. There are a number of different ones on Facebook. “Anti-Vax Wall of Shame.” “Things Anti-Vaxxers Say.” “Banned by Modern Alternative Mama.” There are many others. Report them for hate speech. Their entire purpose is to take screenshots from groups where they troll and mock the people — some of you may recognize your own comments being mocked on those pages!

Sorry, but mocking stupid things said by antivaccinationists does not equal hate speech. It just doesn't. Tietje seems to think, as many antivaccinationists do, that freedom of speech should equal freedom from consequences due to that speech. It's a profoundly immature attitude that says, "I can say anything I want, and you can't criticize me because freedom of speech." Sorry, but it just doesn't work that way.

Sadly, Tietje is not the only one spouting nonsense like this, but I am out of time and energy, other than to note that The Onion nailed the attitude of Tietje and her ilk perfectly in a post entitled I Don’t Vaccinate My Child Because It’s My Right To Decide What Eliminated Diseases Come Roaring Back.

But, then, I suppose Tietje would consider The Onion too mean.

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It's rather amusing to see the cries of "Bullies!", "Censorship!" or "Haters!" from the AV side.

My kids' school arranges playgroups so there aren't the common cliques formed at that age - and the parents bring home a gaggle of kids once a month or so to play at their house.

I made it abundantly clear that I would only allow children over who had been fully vaccinated.

I think it's hysterical that Tietje cries about freedom of speech, etc, when she's one of the most ban-heavy page admins on Facebook. A whiff of dissent and WHAMO - banned.

Yes, please do stand up and scream your anti-vaccine nonsense as loud as you can. This will make it easier for your neighbors to know who is to blame for this measles outbreak.

By Chris Hickie (not verified) on 27 Jan 2015 #permalink

OT

"Freedom of speech doesn't mean freedom from consequences"

Ouch, hitting a bit too close to home. The elites in my country are busy revisiting the meaning of the first part, but have trouble including the second part in the debate. We French are sort of very confused right now. Well, more than usual.

By Helianthus (not verified) on 27 Jan 2015 #permalink

I'll be mean to anybody who through stupid and irresponsible actions puts their kids, my kids and other people at risk of contracting serious and harmful diseases. They deserve nothing but scorn.

I hope Disney's time in the spotlight motivates them to lobby at state and federal level to for vaccination legislation - legislation that allows the state to prosecute neglectful parents and removes religious or philosophical opt outs for a public health issue.

I really do feel for Katie and her fellow antivaxers.

Being mocked or berated on Facebook is ever so much worse than children having to be hospitalized to treat their measles-related complications.

By Dangerous Bacon (not verified) on 27 Jan 2015 #permalink

Time to de-lurk...

The use of the ban hammer by anti-vaxers and other alt med types, while they scream about freedom of speech, is all too common: my alter ego is blocked from the FB pages of several UK alt med and anti-vax types purely for asking a few pertinent questions (I tried very hard to be polite but a bit of sarcasm might have slipped in).

Now, if only there was a term for such behaviour...

I posted a comment on Katie's post Orac references above a few days ago. Here is is, days later, still in moderation. I was polite, but obviously not anti-vax enough in outlook for Katie.

I'll post it here because I'm willing to bet she'll never approve it on her blog.

OK. I just have a few questions for you. “ONLY” 500 or so deaths from measles. Isn’t 1 death too many when we could prevent them entirely? Personally, I believe it is. I would LOVE for this generation to eradicate measles the way we were able to eradicate smallpox. And then we no longer have to vaccinate for it. Isn’t that what we want? To decrease vaccinations? Measles has no animal vector, so if we get rid of it in humans, it’s gone forever.

I will carry a smallpox vaccine scar to my death. None of my children – or even my younger siblings – ever had to get it because we eliminated it. I’d really love for no more measles.

And no, I didn't use this name. I used another name, perfectly legitimate email address and all.

Their idea of "free speech" is rather transparently the freedom to say whatever they like whilst silencing all those who disagree with them. It's the same notion of "free speech" that exists in North Korea.

It gets worse: Eventually someone's going to go blind from measles. That could mean malpractice suits.

By Gray Falcon (not verified) on 27 Jan 2015 #permalink

Grey Falcon @10 --

Eventually someone’s going to go blind from measles.

Or worse.

But malpractice suits against whom? If a parent refused vaccination for a child against medical advice, they'd have no case. Then again, we all know of a few pediatricians who would be open to lawsuits on this matter, which if it were to occur would at least be a silver lining.

By palindrom (not verified) on 27 Jan 2015 #permalink

We're talking about someone who, two days after her child showed signs of a badly injured arm, first chose a chiro over a real Dr. Another 5 days passed before a real Dr diagnosed the broken arm. A Week Later. Screenshots of the saga are halfway down this article

By janerella (not verified) on 27 Jan 2015 #permalink

The scary thing about that Onion article is that you actually hear those statements (It's my right. It's my choice. It's my child et cetera and ad nauseum) from parents like Tietje.

I have seen very harsh language aimed at anti vaxers that I'm sure would be seen as abuse, like calling them murderers or wishing harm on unvaccinated kids.

That said, it seems that abuse or attack here more often than not does mean criticism of choice - just like "discrimination" means treating them differently based on a real difference. And they completely ignore the behavior of their side.

@palindrom: see - http://shotofprevention.com/2014/04/18/the-cost-of-vaccine-misinformati…

And more about doctors: http://papers.ssrn.com/sol3/papers.cfm?abstract_id=2495971

(Sorry for the self reference).

By Dorit Reiss (not verified) on 27 Jan 2015 #permalink

Dr. Jay Gordon, MD, FAAP, got on twitter yesterday to self congratulate himself that one parent decided to vaccinate their child due to something he said on the radio. In other words, he did his job. Hooray for him.

After some back-and-forth with Seth Mnooking, Dr. Vince Ianelli, and others, an actress decided to jump into the Twitter discussion and defend Dr. Jay for not "bullying". I asked her what she meant by bullying, but I think we all know the answer. If a parent says that they don't want to vaccinate, and he acquiesces, that's not bullying. If he were to explain to them that vaccines are far more beneficial and far less dangerous than antivaxxer groups and people make it out to be, then that would be bullying.
If your feelings are so frail that someone pointing out reality to you in any tone hurts you or makes you feel like your world is coming apart, get yourself some help. Your kids need a parent with a backbone.
*Drops Mic*

Though the comments I referred to above were generally by specific commentators, not in articles or blog posts. I can't think of an article or post that went there - can anyone?

By Dorit Reiss (not verified) on 27 Jan 2015 #permalink

That could mean malpractice suits.

As palindrom says, that would only be the case if you could prove that (1) a parent followed a doctor's advice to not vaccinate the kid and (2) that recommendation was not based on a specific medical contraindication. If the parents ignored medical advice to vaccinate, then the charge would be reckless endangerment. Unfortunately (IANAL), you would have to make it a civil case, because there is enough misinformation accessible via the University of Google for parents with competent lawyers to raise reasonable doubts in a jury's mind. (Of course it would be a criminal charge in a perfect world, but we don't live in that world.)

By Eric Lund (not verified) on 27 Jan 2015 #permalink

I recommend checking out her blog. Tietje is a one-woman tsunami of BS. There seems to be no woo she doesn't push. A truly harmful person! BTW I've chosen to drive on the left side of the road (in the US) from now on. It's my personal choice and no one has the right to restrict my freedom to choose where to drive. Besides, millions of people do it in the UK and they're just fine.

@eric Lund: the question in suing a parent for failure to vaccinate will be whether there is a duty to act. There are arguments for it, but it's far from obvious (this is the über short version). It would be ideal if states passed relevant statutes.

By Dorit Reiss (not verified) on 27 Jan 2015 #permalink

In other news, Jake has a new post up, accusing Mr Fraudytrousers of being a money-grubbing bag of sh1t. (I paraphrase).

I'm surprised it took him so long to work that one out.

By Rebecca Fisher (not verified) on 27 Jan 2015 #permalink

Orac says,

"If I ran a church nursery, a playgroup, or any other function where large numbers of children congregate, for whatever reason, I’d start banning unvaccinated children too."

MjD says,

My fully-vaccinated autistic son (4 years old) was not allowed in the church nursery because of behaviors.

Simply put he is a victim of medical science in that the autistic behaviors were caused by atypical immunity after vaccinations (i.e., allergy-induced regressive autism).

It's apparent that In Regressive Autism, with respect to vaccines, sometimes your damned if you do and damned if you don't.

Banning children because of their vaccine status (Orac-ian reflex), it's terribly simplistic and uncivilized.

By Michael J. Dochniak (not verified) on 27 Jan 2015 #permalink

I just posted the following on her site:

"All right, I’ve had it!

I simply can’t believe that you are surprised at the backlash you are getting. A preventable, highly contagious disease is spreading because of people like you who think your right to eschew good medical science outweighs the reactions you deserve because of the consequences of your choices.

Orac at Respectful Insolence has a very thorough response to your post here, perhaps some of your readers would like to see it: http://scienceblogs.com/insolence/2015/01/27/quoth-katie-tietje-pro-vax…

By the way I love how you switch topics about deaths from preventable disease to those caused by medical errors. Yes, the latter is a huge problem that must be remedied, but that doesn’t negate the importance of preventing the former. And we have an easy way to prevent most, if not all, of those deaths from disease. I’d love to see some numbers for deaths from “alternative” therapies. One such death just occurred, with another likely hot on it’s heels. http://scienceblogs.com/insolence/2015/01/20/a-tale-of-two-unnecessaril… What are you doing to prevent such unnecessary, tragic deaths?

I am not optimistic that you will post this comment. But I hope you will allow it to show that you aren’t trying to hide science-based comments on your site."

Do you think she'll allow it? I noticed the only comments there were supportive. I haven't read the comments here yet, but I hope others have posted too.

By Lynn Wilhelm (not verified) on 27 Jan 2015 #permalink

Eric Lund @17 -- Dorit linked a discussion of the liability issues above, @14.

IANAL, but SIAL. ("She is ... ")

By palindrom (not verified) on 27 Jan 2015 #permalink

@ Rebecca Fisher:

Oh I know.
Even more hilariously. as I noted earlier, he is opening up comments @ ET.
Perhaps he got some editorial power or else....
the minions will frolic unencumbered.

By Denice Walter (not verified) on 27 Jan 2015 #permalink

Because, you know, being treated badly because you make dumb choices is exactly like being oppressed for the color of your skin, your religion, your sexual orientation, etc.

Arresting people for stealing is discrimination against thieves, don't you know?

By Young CC Prof (not verified) on 27 Jan 2015 #permalink

Tietje's numbers could lead some folks to mistakenly think only 70 children were exposed, and therefore conclude that the vaccine is not very effective. However, what is not stated is how many 100's or 1000's of children were exposed, but didn't get the disease because they are vaccinated.

@ imr90
Cyclists in the Netherlands do this all the time. That's why I hate them, though my bike is my only mean of transport.

A. Not a lawyer. Legal academic, though.

B. @Young CC Prof: exactly. What people don't realize is that discrimination means treating like cases alike, distinguishing on an illegitimate basis. Not every different treatment is discrimination.

Unvaccinated children are different in a meaningful way because of a choice: they are intentionally left at higher risk of disease (that may not be what the parents are trying to do, but that's the meaning of the choice). That's a reason to treat them different.

By Dorit Reiss (not verified) on 27 Jan 2015 #permalink

So Orac recommends we 'remain civil' why? These people are rude, awful, and never learned manners or civility. They deserve all the rudeness they get.
And why not work on bribing the kids? If the vaccinated kids get a well lit waiting room, with movies, coloring books and toys, and the unvaxxed kids get a small dim waiting room, and get shoved out at the first opportunity, the kids might come to see vaccinations as a good thing, and pressure their parents into getting them the shots. Another thing that might work is for, at the first mention of "i'm not vaccinating,' the doctor just gives the parents a first aid kit and a stethoscope, and doesn't say another word for the rest of the appointment.

By Politicalguineapig (not verified) on 27 Jan 2015 #permalink

Renate: "Cyclists in the Netherlands do this all the time."

It was a real shock the last time we were there that motor scooters were in the bike lanes! At least in Amsterdam.

Marc Siegel M.D. has a generally good op-ed piece in the today's Wall St. Journal about how parents should fear measles and not the vaccine.

Unfortunately, he commits a major goof of omission by mentioning VAERS data showing 688 deaths associated with measles vaccine since 1990 (this is supposed to show a low complication rate since 10 million doses of vaccine were given over the stated time period), without any explanation of the unconfirmed and often dubious nature of VAERS reports.

If I was a parents concerned about the vaccine I'd read that and think whoa, 688 deaths?

By Dangerous Bacon (not verified) on 27 Jan 2015 #permalink

What's telling is how perfectly pretty much every point she makes dovetails with stuff that Dr. Bob's posts on FB.

IMHO, the calls for civility, and the denigration of 'bullies' (note the word choice) are only partly group cohesion practice. In truth, I'd guess any guff she gets is water running off a duck's back to Kate (quack!). I think this is a rhetorical strategy to establish comparative Ethos and Pathos for fence-sitting mom's who drop in looking for guidance. It's an appeal to the self-identity of 'nurturing mom' that has nothing to do with vaccines. Are the bullies ever right?

So, note MAM's address and tone. She's not speaking in 'nice' to pro-vaxers. She's being being verbally aggressive, urging moms to get mad about being bullied over the silly little measles. But based on the other AV discourse I've run into in checking stuff about the Disneyland outbreak, I think she's running a kind of standard-talking-point-for-this approach, and it's actually quite clever...

There is an address to pro-vaxers in the subject, and it amounts to, 'Please, Brer Bear don't be mean to me. Ri me with your science, but please don't throw me into the bully briars! Anything but that!" That is, what I think she wants is even more snark and condemnation to circulate on the web, so all those undecided newbies can see just what kind of arrogant jerks stand against the Right to Chose, Mom and apple pie.

Really, could any post be wearing more of a sign screaming "FLAME ME!"? I have to wonder if Dawn's most is in permanent moderation because it's too civil/reasonable/humane. Tietje may censor "nastiness and hate" from her threads, as noted quickly at the end of her post. But look at MOM's calls to action. 'Complain!' she says: "let everyone know how hurtful and harmful this sort of negative attitude is." Report the Hate Speech! And those dovetail with signing petitions, writing to polticians, and sharing the anti-vax with everyone and anyone. The complaints build to the 'positive' anti-vax activism, and thus the strategy depends on there being stuff to complain about, the more barbed the better.

So, yeah, I'm thinking 'don't take the bait!' Don't give all the AVs spreading the 'bully!' trope any more ammunition. Do the 'good skeptic' thing, 'don't be a dick' — in fact be extra polite, non-judgmental, let the science and the facts do most of the ripping, and express your personal take as 'Gosh, I'm just so worried about all the vulnerable kids that could die from VPDs." Not, 'you stupid lying ho, measles are really dangerous, tell the truth!' But, 'I'm sorry. i know most people don't understand how serious measles is, but it is really bad.'

Of course, "mocking stupid things said by anti-vaccinationists does not equal hate speech" and in once sense MAM and the rest deserve all lot of the sharply-worded critiques they get. But while their position on vaccines may be dumb, their rhetorical strategy is anything but stupid. Consciously or not, it's cleverly Machiavellian.

Orac is dead on in saying, 'as a pro-science advocate, you will always be accused of being incivil, mean, nasty, and unfair by AVs, no matter how polite and civil you are'. And he right that 'concern trolling' is a powerful weapon in IRL coversations, where don't like being viewed as bullies, and may well back off the critique altogether. But that is not the dynamic online. Almost nobody backs off in text exchanges. Face-to-face, I'm super-sensitive and emotionally devoted to conflict-avoidance. 'sadmar' quite obviously, is not, at least most of the time.

One big difference is that face-to-face interactions are personal and private, and online exchanges are public. We write in awareness of a larger audience observing us — one reason we go on counter-offensives when we feel attacked. But the audience, at least the audience we really care about here, is not stupid. If we do indeed get labeled as unfair nasty bullies when we are civil and respectful, that may play with the choir, but it will backfire with the noob undecideds, 'Hey! Who you kidding? That post wasn't mean. It was just thoughtful!'

I would cite Dr. David Gorski's 1/26/15 post on SBM about parental rights and the death of Makayla Sault as an overall model of taking a tone that is not just civil, but even sympathetic to the persons engaged in pseudo-science without backing off one iota from the hard facts of the wrongness of the medical science. It also goes deeply into a human concern for the victims that shows sympathy for them, and will, I'm sure, establish credibility for Dr. Gorski with any readers 'in-the-middle', as sincere civility-and-caring is simply more trustworthy than 'arrogant-seeming' trash talk.

There are 2 kinds of motor scooters, the ones one can drive without a helmet and that are supposed to go only 25 kmh (most go faster) and the ones one need to wear a helmet on, which have a maximumspeed of 40 kmh. The first are allowed on bike lanes, the others are sometimes allowed on bike lanes and sometimes not. In Amsterdam they want all motor scooters on the road and not on the bike lanes.

@PGP

Bribing the kids... you mean like Andy Wakefield did?

One way to understand MAM audience and their ideology is that they can read" "No, nobody has the right to force medical care of any sort on anyone else.</b" (emphasis original), without seeing any sense of contradiction. Anti-vaxers are forcing medical care decisions on their children, and they are the only ones doing so. Physicians are only making recommendations. Individuals or organizations who make the un-vaccinated stay away are creating consequences for medical decisions, not forcing them to be made. AVs can (and do) keep kids inside and home-school.

The only way MAM's statement makes sense is if children are excluded from "anyone else." They are not individual human beings. but mere extensions of their parents. It might just be 'My kid is my property,' but it smells of something even deeper: a shared identity, 'My kid is a part of me. We are but a single body, with the apparent separation of physical space a mere illusion hiding a metaphysical unity of being.'

Thus from our POV MOM's bold-face may be blazingly stupid, but to counter it effectively, we need to step into the head-space of an intelligent and articulate person who could write that and ask, 'What do I have to believe in order to think that way? From what sort of view of world could such a statement follow?' Then figure out a (civil and polite, natch) strategy to counter the philosophical/theological root. You know, treat the disease holistically, not just the symptom. :-)

This "vaccine strain" measles vs wild measles angle the anti-vaxers are trying to spin is pretty hilarious. It even popped up on AoA yesterday.

"1. Has there been any laboratory confirmation of even one case of the supposed measles related to Disneyland? If yes, was the confirmed case tested to determine whether it was wild-type measles or vaccine-strain measles? If not, why not? These are important questions to ask. Is it measles or not? If yes, what kind, because if it's vaccine-strain measles, then that means it is the vaccinated who are contagious and spreading measles resulting in what the media likes to label "outbreaks" to create panic (strange how they've completely missed the Autism outbreak going on for the past 25 years). It would be what one might call vaccine fallout. People who receive live-virus vaccines, such as the MMR, can then shed that live virus, for up to many weeks...and can infect others. Multiply that in your head by all of the people who receive not only the MMR live-virus vaccine, but many others. Other live-virus vaccines include the nasal flu vaccine, shingles vaccine, rotavirus vaccine, chicken pox vaccine, and yellow fever vaccine.

Thus, it is often the vaccinated who are spreading disease, despite what the media tell you, media that are heavily supported and influenced by pharmaceutical advertising dollars. Why aren't those who receive live-virus vaccines, and the DTaP and TDaP vaccines, quarantined in their homes until it can be confirmed that they are no longer contagious with the diseases against which they were vaccinated? Why are they being allowed into schools, hospitals, grocery stores, and the like?"

http://www.ageofautism.com/2015/01/disney-measles-and-the-fantasyland-o…

The stupid. It burns!

@janerella:

We’re talking about someone who, two days after her child showed signs of a badly injured arm, first chose a chiro over a real Dr. Another 5 days passed before a real Dr diagnosed the broken arm. A Week Later.

As I've mentioned before, this appears to be based on a misreading.

the cries of “Bullies!”
I watched a documentary about Noam Chomsky in which one of Chomsky's intellectual adversaries complains that he is a bully. This seemed to be a term of art, meaning "Spoils perfectly good arguments by dragging in facts".

By herr doktor bimler (not verified) on 27 Jan 2015 #permalink

The choice to leave your child unvaccinated poses a much less obvious danger, but it’s a danger nonetheless.

Not sure how doing nothing (not vaccinating) can be dangerous.

By Sid Offit (not verified) on 27 Jan 2015 #permalink

Not sure how doing nothing (not vaccinating) can be dangerous.

Keep telling yourselves that Sid so you can delude yourselves into believing that these outbreaks aren't your fault.

By Science Mom (not verified) on 27 Jan 2015 #permalink

Johanna: Slightly more ethical than that. Think of airplanes. Vaccinated patients and their parents get 'first class' regardless of economic status, unvaccinated patients regardless of economic status get the economy, no-frills, lightbulbs perpetually on the fritz room. It isn't a direct bribe, but people will do a lot to get a slightly more pleasant experience. Parents who chose not to vaccinate are very susceptible to pressure from their kids.

Sid: The very, very short answer is that doing nothing is dangerous because viruses are doing things. They're hitching rides in people, they're sitting in the soil, they're having parties on rusty nails and in puddles. Of course, this probably wouldn't be clear enough for you if it was written in ten foot high letters, but I thought I'd give it a shot.

By Politicalguineapig (not verified) on 27 Jan 2015 #permalink

Mr. Schecter (who is not related to a highly qualified pediatrician): "Not sure how doing nothing (not vaccinating) can be dangerous."

How many red lights did you not stop for? Or what has happened when you refuse to move from the doorway during a fire drill?

Sid - If you choose to do no maintenance to your house and yard, does that increase or decrease the danger to you and your neighbors from, say, vermin infestation or fire? Does it hurt or help your neigbors' property values?

By Mephistopheles… (not verified) on 27 Jan 2015 #permalink

Being treated with civility is something you get by adhering to the social contract--do onto others, yadda, yadda. So is accepting rule of law.

You really, really don't want to vaccinate your kids? Fine. Just completely remove yourself from society so that you can't harm anyone, and while I feel bad for your kid, most of my concerns are addressed. Go churn butter, shit in the woods, cool with me. Otherwise, you're acting as a free rider on the rest of us. And if hearing that hurts your feelings, well, there's the trailhead. Pack an extra sweater, you're gonna need it.

@Politicalguineapig

"doing nothing is dangerous because viruses are doing things."

Oh, so the measles is the danger. For once I agree with you.

By Sid Offit (not verified) on 27 Jan 2015 #permalink

Thanks Annie @37 - there was no bad argument left unused down your link. Vast and lengthy entertainment.
"It was not ever, is not today, and will not be tomorrow my child's job to protect your child, in any way, shape, or form."
I'm teaching kids the dangers of obeying speed limits - don't be sheeple!! You could get rear-ended.

PGP:

You are arguing with the exact opposite of what Orac said, which includes

As a pro-science advocate, to a person like Tietje you can never, ever be sufficiently civil. You will always be accused of being incivil, mean, nasty, and unfair by antivaccinationists, no matter how polite and civil you are. The reason is that antivaccinationists hate the message; so the messenger can never be civil enough.

"Oh, so the measles is the danger. For once I agree with you."

So go vaccinate your kids, you worthless scum-sucking dog.

As a member of some of those "hate groups" on facebook, I can honestly say that the vast majority of us are not trolls. We simply state facts, and/or ask questions (generally, members found spouting hate/threats/personal attacks are removed) and act civil. The reason for the screenshots: we often take shots of our posts because MAM will remove the post then block the commenter to make sure her flock doesn't get to read the comment. She does her best to crush any attempts at open dialogue (right from the Food Babe play book).

Hey...let's not needlessly malign dogs.

I dislike this woman immensely and have never met her. I have heard a lot of screaming on the FB lately about 'bullying'. Bullying now seems to be well I posted something and you commented with science and facts (politely) which contradicted my post and now your a bully. You can't win with these people. I try to be scrupulously polite, particularly when online as the written word does not have the nuance of face to face contact, but a lot of anti-vaxxers make that so very, very hard to do. Lately some of the mainstream mommy bloggers (such as Baby Sideburns) have posted positively about vaccinating and have called out the anti-vax contingent. (sorry I don't have the link) This will probably result in fallout for them unfortunately as the anti-vax troll contingent is strong, though they scream bloody murder about even polite disagreement on their own pages they are often downright nasty to critics. I am myself on FB, I post pro-science articles and comments. People who are offended are free of course to unfriend me.

Delphine: true. Replace the word "dog" with the word "wanker."

Renate @27 -- The great humorous blogger "Bike Snob NYC" has a term for wrong-way cyclists -- "Bike Salmon", the idea being that they're like salmon swimming upstream to spawn.

By palindrom (not verified) on 27 Jan 2015 #permalink

Mephistopheles @45. Please. In an effort toward gender neutrality, we should all adopt the term "verpersons", since many rats and so on happen to be female.

By palindrom (not verified) on 27 Jan 2015 #permalink

palindrom @56 - I'm not sure I'm willing to grant rats and so on personhood, however I will agree to the term "verbeings".

By Mephistopheles… (not verified) on 27 Jan 2015 #permalink

Shay @50 - How do you expect anyone to understand your position if you keep sugar coating it like that?

By Mephistopheles… (not verified) on 27 Jan 2015 #permalink

a term for courageous contrarian thinkers wrong-way cyclists — “Bike Salmon”

Alternatively, "Organ Donors".

By herr doktor bimler (not verified) on 27 Jan 2015 #permalink

“1. Has there been any laboratory confirmation of even one case of the supposed measles related to Disneyland? If yes, was the confirmed case tested to determine whether it was wild-type measles or vaccine-strain measles? If not, why not? These are important questions to ask"

It's as if the author is too busy asking these Important Questions to stop and read the answers. Indeed, the author must work quite hard to avoid the available information.

By herr doktor bimler (not verified) on 27 Jan 2015 #permalink

In a weird way, I find it kind of encouraging that antivaxers seem to be falling back on the "health freedom" arguments more and more lately. MAM can make vague statements like "the evidence isn't clear-cut" all she wants; anyone who's not already antivax is going to realize that if the science was on her side she'd be citing it, not falling back on "It's my child to put at risk if I want to, and you're all meanie heads."

Keep telling yourselves that Sid so you can delude yourselves into believing that these outbreaks aren’t your fault.

And that he's actually a publisher and that his child-rearing books are soon to appear.

Same woman that left her child with a broken arm for more than a week before taking the child to the doctor. Oh yes! I would totally trust her medical advice on vaccines. She is evil incarnate, to me as a mother.

It’s as if the author is too busy asking these Important Questions to stop and read the answers. Indeed, the author must work quite hard to avoid the available information.

Vincent Ianelli popped into the comments to lay this on them. Hayes's response is dumbfounding:

"So it seems the WHO was previously very well aware that travellers, infected with measles genotype B3, were permitted to travel to other countries and presumably spread measles infections, without any kind of official sanctions or controls. Some infected persons who visited Disney World were vaccinated against measles, but still contracted the disease. We are all entitled to ask WHY!"

^ Oh, wait, that was Jenny Allen's response, making it par for the course rather than dumbfounding.

^^ Alllan

I will agree to the term “verbeings”.

The barbarous habit of verbing nouns is bad enough without verbeing them as well.

By herr doktor bimler (not verified) on 27 Jan 2015 #permalink

@palindrom:

" Eventually someone’s going to go blind from measles.

Or worse.

But malpractice suits against whom? If a parent refused vaccination for a child against medical advice, they’d have no case. Then again, we all know of a few pediatricians who would be open to lawsuits on this matter, which if it were to occur would at least be a silver lining."

That wouldn't be the case if the child had been vaccinated, got measles due to an unvaccinated child in his classroom, and died. Then the parents of the non-vaccinated child would be open to a wrongful death suit . . . and if the pediatrician were an anti-vaxer, malpractice could be an issue.

I pray it doesn't happen. But I fear eventually it might.

Orac, did you see Jay Gordon on the CBS Evening News a few minutes ago (6:45 EST)? I just did.

The reporter had asked him didn't he think it was serious that if one child with measles came into his office that 92% of his patients in the waiting room would get it? The guy actually had the unmitigated gall to say that measles is not coming back in this country.

He signs a large percentage of the parental exemption forms for vaccination in California.

How can the Medical Board continue to ignore this? I know that physicians practice independently . . . but where are the limits???

http://www.cbsnews.com/news/doctor-explains-why-he-lets-kids-avoid-the-…

Dr. Jay, I know you read and comment here sometimes. If you're reading this, please accept the scorn of my mother-in-law, who cared for many kids with measles at a large children's hospital prior to the advent of the single dose. Most recovered. But some went deaf, some went blind, some got pneumonia, some ended up with brain damage. Some didn't survive. What a short memory you have, sir.

Just today I had lunch with a scientist who is deaf in one ear because of childhood measles (her childhood pre-dated the vaccine). She's pretty exercised about this whole thing, and with good reason, I'd say.

By palindrom (not verified) on 27 Jan 2015 #permalink

Vicki: No, my general argument is that we don't need to bother to be civil to anti-vaxxers. Be rude, be insulting, be dismissive, make 'em cry. Most of them were on the tip top of the totem pole in life before they had kids. In high school they were the nasty mean girls and the jocks who never developed empathy. A little shunning and a few verbal smackdowns would be good for most of them.

Palindrom, Gray Falcon: I would hope that if a child from an anti-vax family went blind from measles that they would be fostered out to relatives or understanding people. Anti-vax people absolutely hate disabled people, and a disabled child would be in danger until they managed to gain independence.

By Politicalguineapig (not verified) on 27 Jan 2015 #permalink

Newest link spreading around anti-vax circles:

http://www.fredericksburg.com/news/v...58ac38525.html

"The case is not thought to be related to an outbreak of measles in California. Health officials say the patient has no travel history to California or any places with measles outbreaks. The symptoms began after the child received the measles vaccine."

"Health Commissioner Leana Wen says the department is treating this as a suspected case of measles as a precaution and is conducting tests to learn more. Wen says it’s possible the patient had a reaction to the vaccine."

And this will be used to somehow trump the hundreds of cases of measles that have occurred in the US over the past 2 years due to unvaccinated travelers importing measles from overseas.

Even if it turns out not to be true.

On the subject of Jake, it looks like he has next to no friends left. It has been humbling for him to learn that all his heroes had feet of clay. If only someone had told him this before he hitched his wagon to the movement.

Politicalguineapig there is no need to be rude or insulting. The anti-vaxers are never going to be convinced and it is the people who are unsure and looking for information that need to be convinced. Remaining polite and demolishing the arguments with the facts is by far the best way.

A little bit of sarcasm is good, but only a little bit. You hear that Murmur? How many times have you been told?

A few things...

re 'bullies'- see AoA/ contributors: Jameson has a post 2013 ( re-posted in late September 2014) about how to deal with vaccine bullies. ( i.e. SB people). A classic.

anti-vaxxers are habituated to the 'vaccinated people cause the spread of measles' meme recently- which includes 'shedding' and 'vaccine failure'- both are big at PRN. Also, maybe the illness reported isn't REALLY measles ( or flu) because they didn't do labs. Don't trust CDC figures.

For the un-initiated, Sid's site is The Vaccine Machine Facebook where nearly 50K friends meet and discuss ways to avoid vaccinating their children. All with engagingly clever graphics. Right.

By Denice Walter (not verified) on 27 Jan 2015 #permalink

@ ChrisP:

A few years ago, I asked him whether it was more likely that there was a massive, worldwide conspiracy and cover-up involving thousands over decades or just one miserable cheating, data-fixing fraudster. I told him that his extreme beliefs might limit his career options.

So did other minions.

It didn't work.

Ha ha ha. Usually I have nearly endless sympathy for students but Jake shows me my limit.

By Denice Walter (not verified) on 27 Jan 2015 #permalink

I don't know whether to be enraged or relieved that he's finally admitting some things.

Apologies if this particular interview has already been posted:
http://www.nbcnews.com/health/kids-health/demand-measles-vaccine-sends-…

Obviously he's skirting blame, but at least people are being vaccinated and he said "I really do believe vaccines work...I really do believe that vaccines are not dangerous."

Then I remember all the BS and I get mad.

THIS DIDN'T HAVE TO HAPPEN.

By Frequent Lurker (not verified) on 27 Jan 2015 #permalink

On the subject of Jake, it looks like he has next to no friends left. It has been humbling for him to learn that all his heroes had feet of clay. If only someone had told him this before he hitched his wagon to the movement.

Well, he can still appeal to the real lunatic fringe like White Rose, Barry, and John Best. They, at least, will continue to read his blog although he burned his bridges to the (relatively) saner creatures under his rock..

Obviously he’s skirting blame, but at least people are being vaccinated and he said “I really do believe vaccines work…I really do believe that vaccines are not dangerous.”

It is almost as if the sheer size of the Disneyland outbreak in his backyard has made Dr Jay recognise his role in allowing it to occur and now he is trying to deflect by carrying on about how many vaccinations against measles he has given recently.

So much so that he has given more MMR vaccinations in the past 10 days than in the previous 12 months.

Bugger. Quote fail again. Can't we have an edit window?

@Politicalguineapig

You're a sick piece of work - as are most vaccine extremists. Thanks sharing the ugliness and hate behind your twisted ideology

By Sid Offit (not verified) on 27 Jan 2015 #permalink

ChrisP: The anti-vaxers are never going to be convinced and it is the people who are unsure and looking for information that need to be convinced. Remaining polite and demolishing the arguments with the facts is by far the best way.

The thing is, there are no fence sitters anymore, and those have always largely been imaginary. The only thing that will get them isn't argument, it's a carrot and stick- like being shown to a dim, cold waiting room while other people get to go to the nice waiting room and get newspapers and maybe even treats. Or finding out that they don't get the tax deduction for the kids if they don't vaccinate. Not vaccinating has been consequence free for too long.

By Politicalguineapig (not verified) on 27 Jan 2015 #permalink

And you Offal?

Do you deny that you are an anti-vaccine extremist?

pro-choice baglady- you can have as much vaccine as they can pump into you and I am fine with it

By Sid offif (not verified) on 27 Jan 2015 #permalink

Sid Offitt: Says the guy who would drop his kids off in a cornfield if they became disabled. Says the guy who supports people who poison their autistic children with bleach and who mocks people who've lost children or had children injured due to diseases that could have been prevented. Says the guy who mocks someone who's saved millions of children from rotavirus. My "ideology" is that I don't like hearing or seeing kids dying and that autistic people should be allowed to grow up in safe environments and given all the help they need. I guess you're fine with kids dying?

By Politicalguineapig (not verified) on 27 Jan 2015 #permalink

Tietje means titty in Dutch. Is that relevant? Just asking.

Helianthus #3

France
January 27, 2015
OT

“Freedom of speech doesn’t mean freedom from consequences”

Ouch, hitting a bit too close to home. The elites in my country are busy revisiting the meaning of the first part, but have trouble including the second part in the debate. We French are sort of very confused right now. Well, more than usual.

I immediately thought of that when I read the word "consequences". Perhaps a better word would be just "criticism", or even "mockery", or add a "...necessarily mean freedom from consequences". But in any case, if the "consequence" is a crime, then not only the person saying the speech is supposed to be "free" from it, but anyone else too. IOW, crime is not justified, on anyone, whether it happens to be a consequence of said person's doing or saying, or not.

You keep saying the same things.

And then more things like:

Tietje means titty in Dutch. Is that relevant? Just asking
and
So go vaccinate your kids, you worthless scum-sucking dog

Sad.

Vaccination rates are very high but measles will occur randomly and in clusters if you go to Disneyland at Christmas time. Influenza will also cluster at Disneyland as will every illness you can imagine.

Vaccination rates of 90-95% won't stop Mickey. 100% with a 10% failure rate won't prevent random outbreaks either, by the way.

This outbreak will stop very soon. Disagree, "scientists?"

By Jay Gordon, MD, FAAP (not verified) on 27 Jan 2015 #permalink

Delphine--You have me confused with someone who doesn't vaccinate and who doesn't adjust to new problems.

My best to your good old mother-in-law. We older docs also talk about diseases that were around "when giants like us walked the wards."

By Jay Gordon, MD, FAAP (not verified) on 27 Jan 2015 #permalink

Sad.

Nice cherry-picking, Jay.

Vaccination rates are very high but measles will occur randomly and in clusters if you go to Disneyland at Christmas time

Spontaneous generation, Jay? What do you suppose that "in clusters" means here? Clusters of what?

@75 Yes, Chris, I know, but you know how much I like my sarcasm and dramatic irony.

Vaccination rates are very high but measles will occur randomly and in clusters if you go to Disneyland at Christmas time.

What rubbish Jay Gordon. As a pediatrician you should know better.

Two doses of vaccine are 99% effective at stopping measles infection. More than 80% of the patients where vaccination status has been reported had received no vaccines for measles. Your patients Jay?

I wonder what the people who's children ended up in hospital now think of their decision not to vaccinate? And what do they think of their doctor that aided them in making their decision?

Slightly OT:

Where do anti-vax types stand on TB?

Curious as I have just been reading about a new strategy here in the UK to try to deal with the rise in incidence of TB...

Or is TB another inconsequential disease, which is "natural"?

This outbreak will stop very soon. Disagree, “scientists?”

Perhaps you'd like to get your act together enough to define "very soon" before turning on the scare quotes, "doctor."

@ Gordon

You have me confused with someone who doesn’t vaccinate and who doesn’t adjust to new problems.

Excuse me? New problems? Measles was deemed eradicated in the US in 2000, but has been on the rise for the past 5 years.
You are adjusting to new problems like the guy who stirs himself to close the stable doors after the horses escaped.

Oh, sure you vaccinate. Once every other months, when parents keep insisting.
If you were vaccinating a bit more, and on schedule, not one year after, maybe less people would have to spend a few days in the hospital.

We older docs also talk about diseases that were around “when giants like us walked the wards.”

"that were around". Well, measles was around, and now it's back. To echo Joseph Welch, have you no sense of decency, sir?

It's your problem, isn't it? You are all talk and no action.

And in term of moral backbone, you are certainly no giant. More like pygmy-sized.

By Helianthus (not verified) on 27 Jan 2015 #permalink

Perhaps you’d like to get your act together enough to define “very soon” before turning on the scare quotes, “doctor.”

Seconded.
These threads on vaccination have seen plenty of clowns telling us that we worry too much over "benign" contagious diseases, that it's just a few cases.

Well, this outbreak in the US has recently reached the 3-digit-number level in numbers of cases.
To use another quote, a number of us must feel like Malcolm in Jurassic Park when the T-Rex shows up. "Gosh I'm tired of being right".

By Helianthus (not verified) on 27 Jan 2015 #permalink

I imagine there's some possibility that Jay was confusing this with his own signature outbreak, which amounted to 12 cases and 2 generations of transmission.

It would kind of stink if duration turned out to be related to outbreak size or, heaven help us, effective R.

@Politicalguineapig #71 - You seem to be spectacularly missing the point of science vs anti-science. Being pro science means not making broad statements for which there is no evidence. Anti-vax mothers may be stupid or badly educated, otherwise they wouldn't think they way they do. But to allege that anti-vaxers were bullies at school and hate disabled people? Really? Citation please.
Please don't post stuff like this, it just plays into the hands of the anti-vax crowd, or are you in fact an Agent Provocateur?

Vaccination rates are very high but measles will occur randomly and in clusters if you go to Disneyland at Christmas time. Influenza will also cluster at Disneyland as will every illness you can imagine.

Really really? And when was the last time a measles outbreak emanated from Disneyland? The mental gymnastics you are performing would be positively delightful if your flaccid deference to parents' wishes rather than acting like a physician wasn't the way you performed* medicine.

Vaccination rates of 90-95% won’t stop Mickey. 100% with a 10% failure rate won’t prevent random outbreaks either, by the way.

I see that you also slept through any epi you may have had in doctor school. Yes, vaccine rates of above 90% and evenly distributed will stop measles (or Mickey you smug, pompous, callous asshat). Primary vaccine failure for 2 doses isn't 10% either. Learn how to parse reports.

This outbreak will stop very soon. Disagree, “scientists?”

Says the "doctor" who is too unethical and/or really that dumb to provide factual information on measles outbreaks instead of fuelling them.

By Science Mom (not verified) on 28 Jan 2015 #permalink

Vaccination rates are very high but measles will occur randomly and in clusters

Just like smallpox does!

Oh. I see.

By palindrom (not verified) on 28 Jan 2015 #permalink

Oh yes, forgot my footnote...
*performed was intentional to illustrate "Dr. Gordon's" practise of medicine is more performance art than medicine.

By Science Mom (not verified) on 28 Jan 2015 #permalink

@Jay Gordon, MD, FAAP

Congratulations, Dr. Gordon, for doing your damn job and giving vaccinations. The fact that you have given more in the last ten days than all of last years does not speak well, though, to your professional credibility. I'm curious, Jay, how many of those people flooding your office were on-time vaccinations vs. people who delayed vaccination after you "counseled" them about the risks of vaccinations. How many unvaccinated teens were coming to see you, Jay?

As for the outbreak ending "very soon", I doubt it. I mean, it might, what with outbreak control measures going into place to stop something that never should have happened in the first place, but the way anti-vaccine types tend to cluster, I fear we'll see 150 cases or even 200+ before this thing's over. But, hey, getting up to 1/6 of last year's record-setting total in just the first month of the year is no biggie, right?

Oh, and as an aside, is 100+ cases enough for you to actually agree that this is an outbreak? Because you tend to pooh-pooh that term when we get more than the expected number of cases (which would be zero, Jay).

@Narad

Wasn't that 2008 outbreak due to one of Dr. Bob's patients, not Dr. Jay?

@Todd - I believe, yes, it was Dr. Bob, not Dr. Jay.

And to talk about the effectiveness of the vaccine - given the overall infectious profile of measles and the "landscape" at Disneyland, just imagine how large it might have been without vaccinations - you might see thousands of cases.

Dr. Jay,

We engaged a couple of years ago on this blog, on a similar topic. I relayed that when I was a new mother with a baby who simply would not sleep for longer than 3 hours at a time for 9 months, I found your site. What you wrote about infant sleep, it gave me permission in a way to ignore the advice to let her cry, which never felt right to either my husband or me. And I thanked you for that, and like most things, it passed and it's now 10 AM and that now-3.5 year old has been sleeping fairly soundly since 9 PM (she has a cold).

The thing is, you once recommended to delay MMR until age 4. Now, you recommend age 3. Yet you provide no scientific rationale for this recommendation. And here's the thing: where I live, not long ago, we had a measles outbreak. My daughter and I were in the same small walk-in clinic the same afternoon after unvaccinated patient zero was there. We self-reported to our public health department. I am fully immunized and my daughter had her first MMR at 15 months, and fortunately, neither of us contracted measles. But what if I had waited until she was 4, or 3, or whatever your current mindset is on age? What then?

As for my mother-in-law, she married (obviously) my father-in-law, who as it turned out, was sterile. Guess why? My husband and his twin are adopted. She didn't just learn from practice, she and my father-in-law lived with an unfortunate outcome of a childhood illness.

I think you are a deeply conflicted man, Dr. Jay.

Dan Olmsted ( AoA) offers the medical establishment advice:

"cut back on superfluous vaccines...
promote the ones that actually address serious circulating microbes....
unbundle the m, the m, and the r...
admit that the current schedule *in toto* causes....."
well, just about everything.
And stop blaming Andy and Jenny.

Two other entertaining articles today as well there.

AND Jake has unlocked the commentary box @ ET.

I must depart as I am expected elsewhere.
Oh crap. I might miss Dr Jay.

By Denice Walter (not verified) on 28 Jan 2015 #permalink

THIS DIDN’T HAVE TO HAPPEN.

This is my response when people point out that "it's only 80 cases!"

It should be zero, dammit.

Dr Jay -- you have a problem with me advising someone to vaccinate their children? Stick it where the sun don't shine.

Hate speech. She thinks someone disagreeing with her or snarking her is hate speech.

Oh, the irony of her posting this at the 70th anniversary of the liberation of Auschwitz!

By NH Primary Car… (not verified) on 28 Jan 2015 #permalink

Now, now, shay. Tone, and all that. /snark

By palindrom (not verified) on 28 Jan 2015 #permalink

Just for funsies, lets do some math using MAM's numbers (if anyone has updated figures, feel free to update me)

37 unvaccinated casses
5 vaccinated case (I knw all these cases weren't "fully vaccinated" as she claims, but just for the sake of argument)
total: 42 confirmed measles cases where we know the individual's vaccination status

Since we know that about 90% of susceptible individuals exposed to the virus will develop measles, we can calculated that 37/9*10 = 41 unvaccinated individuals were exposed to the measles virus.

According to the CDC's numbers for 2010, about 90% of Americans, on average, are vaccinated against the measles, meaning that, for every 1 unvaccinated person exposed, we can assume that 9 vaccinated people were exposed. 41*9 = 396. Out of those 369 who were exposed, only 5 developed measles, meaning that vaccinated individuals had a 5/396*100 = 1.3% chance of developing measles, compared to a 90% chance for unvaccinated individuals who've never had the disease.

My understanding is that when calculating vaccine efficacy, you don't just take the % of vaccinated individuals who developed the disease; you have to correct for the % who would have gotten the disease if they hadn't been vaccinated. That would be 396 *0.9 = 356.4. So the vaccine efficacy is 100% - (5/356.4*100) = 98.6%, which agrees well with the known efficacy rate.

Now I just need to distill that into a couple of lines I can copy-paste to every "Disney measles outbreak" article I can find. After my molecular biology exam this afternoon :)

Wasn’t that 2008 outbreak due to one of Dr. Bob’s patients, not Dr. Jay?

Sure enough.

All those video clips of Jay make the medical board complaint go much easier.

By Chris HIckie (not verified) on 28 Jan 2015 #permalink

Mike what got was "You must log in to continue." Sorry.

Yup, they're wetting their panties over this story:

"Looks like the Baltimore case is confirmed to be measles.

Its real!!

"The child had been vaccinated against measles. According to Baltimore Health Commissioner Dr. Leana Wen, the measles symptoms actually began not long after the baby was given his MMR vaccine, a shot that contains a mixture of live attenuated viruses of the three diseases it aims to prevent: Measles, mumps and rubella.

Wen said that the Health Department, the Maryland Department of Health and Mental Hygiene, and the CDC are treating the child’s symptoms as though they are from wild-caught measles out of an abundance of caution. Dr. Wen said that the other possibility is that it is from the measles vaccine.

The child tested positive for the measles virus at the Johns Hopkins Hospital Emergency Department.

Read more at http://www.inquisitr.com/1789056/baltimore-health-officials-report-12-m…"

Progjohn: The whole friggin POINT of the anti-vax movement is that children are better off dead than disabled. There are many cases where anti-vax parents have attempted dangerous cures on their offspring or just outright killed them.

Here are some examples:

http://www.nbcnews.com/id/9074208/ns/health-mental_health/t/boy-autism-…

http://www.sciencebasedmedicine.org/the-murder-of-autistic-teen-alex-sp…

http://leftbrainrightbrain.co.uk/category/science/extreme-biomed/mms/

You can also use the search bar on this site to search for 'Greg's' comments. He kept asserting that all autistic people were 'head-banging, diaper-wearing, non-verbal' people who would keep being so until the end of time. He denied that progress was ever possible (which is a common mindset among the "Thinking Mums" and AOA group.) and was very nasty to every commenter who dared to call him on it, including some who were autistic themselves. As for the prom kings and queen comments, just do some reading on TMR and AOA and tell me that their postings don't reek of mean girl.

By Politicalguineapig (not verified) on 28 Jan 2015 #permalink

Dr. Jay is quoted as stating on that TV interview...

"Measles is almost always a benign childhood disease"

What about the infants too young to be vaccinated and the children for whom measles is NOT a benign childhood disease?

http://www.npr.org/blogs/health/2015/01/27/381888697/to-protect-his-son…

My heart aches for that little boy and for his parents. Scroll down to see the reactions of some non vaccinating parents when they were told how their choices could lead to a life-threatening illness for the youngster.

Unfortunately the article is rather vague about what symptoms the baby is experiencing and exactly how long after the shot. Fever and a measles-like rash are known adverse events associated with the measles vaccine, but that is definitely not the same thing as actually getting the measles. And the vaccine takes two weeks to "kick in," so she could have contracted wild-type measles within that time frame.

Oops, my bad, I overlooked the part where she tested positive for the measles virus. I guess we'll have to wait for the outcome of the tests to determine the strain. What do you wanna bet antivaxers will continue to flog the story even if it turns out to be a wild type strain?

So, I posted this on Katie's blog - it's still 'awaiting moderation'. Which is her way of saying it's never going to appear.
People are not being mean to you.
But it’s obvious that you neither understand nor care about how your lack of action in not having yourself or your children vaccinated will eventually lead to these diseases resurfacing. Nor do you care that your very selfish actions put many people at risk: The newborn, the immuno-compromised, cancer patients, the elderly.
You recycle lies and deserve to be called out on them.
You cherry pick statistics.
You have nothing but the occasional questionable anecdote to back up your suppositions.
You are lying and getting others to support your lies.
I suggest that you of the anti-vax-oh-measles-&-polio-&-smallpox-&-mumps-weren’t-so-bad brigade you should take a look at this
http://www.scibabe.com/antivaxxers/

@politicalguineapig #84 "The thing is, there are no fence sitters anymore"

This. So frickin' this.

@Lilady

Just read that NPR piece on Rhett Krawitt and wept. He's spent the majority of his 6 years on this goddamned earth fighting leukemia and now, his parents have to fight the system -- over what? Look at how proud that little boy is, standing next to his grade one class.

If there is ANYTHING I could do for him, if my child was in his class, you bet I would.

Considering that my family housed refugees from a communist country where free speech was limited and saying something against the government there could land you in "reeducation camps", I'd say katie's whine about so-called "bullying" is a whole lot of horse crap.

Let her try whining where those refugees lived, I'd say she'd be changing her tune quick.

As of yesterday we have a confirmed measles case in our state -- waiting to hear if it's connected to the Disneyland outbreak.

@ Sarah A the time frame from vaccination (2 Jan) to hospital admittance (~20 Jan) is certainly in the time frame that it could be a vaccine reaction. However, it's prudent to take the precautions they are in light of events.

By Science Mom (not verified) on 28 Jan 2015 #permalink

@ ProgJohn:

I wish that PGP would be more careful with her language-
I give her the benefit of the doubt in that ( I think) that she is using hyperbole and isn't careful to express this- I hope that it's merely linguistic on her part because otherwise she shows her support for SBM .

Other minions have spoken to her about this already.

Things like this take time and patience.

By Denice Walter (not verified) on 28 Jan 2015 #permalink

Yup, they’re wetting their panties over this story

Leaving aside the sketchiness of the news reports (there's a difference between measles disease and postimmunization fever and rash), one is left with the problem that possible cases of transmission can be counted on one hand (see here and following).

Here's an awful story I just learned....

I know a young woman, an immigrant who sought her fortunes here - she seems hardworking and enthusiastic but has a poignant quality about her about which I wondered.

She told me that she is a widow- her husband worked delivering furniture and suddenly became ill and died a few days later. He had meningitis and, although he was young, he wasn't vaccinated against it because of his national origins. So he died in his twenties 5 years ago.

She's managed to improve her lot since then through education, employment and buying a small home but she knows about tragedy whilst still young.

By Denice Walter (not verified) on 28 Jan 2015 #permalink

You know how many "measles after the MMR" cases public health investigates each year? Tons. Physicians haven't seen measles, so a kid comes in with fifth disease or some other rash, the parents mention the MMR shot, and the health department gets called in. It wouldn't surprise me if the case in Baltimore was publicized more because of the current situation than because it really needed to.
See, if we had kept measles eliminated (not eradicated, btw), we could really devote our time and effort to looking for better vaccines. Heck, if we eradicated measles, that would be one less vaccine to use... For the rest of time.

OT: Looks like Sherri Tenpenny has officially cancelled her Australian tour, claiming it was cancelled "for reasons of safety and security". As lots of people in the comments pointed out, however, the bomb and death threats were coming from her supporters who were angry the venues were canceling!

https://www.facebook.com/vaccineinfo/posts/10152993156565891

"This “vaccine strain” measles vs wild measles angle the anti-vaxers are trying to spin is pretty hilarious. It even popped up on AoA yesterday. "

I answered that one for them. The CDC posted the strain type for 9 cases in the Disneyland outbreak. It matches the WILD type strain from the Philippines. I'll have to see if my comment got through on AOA...

By Vincent Iannelli, MD (not verified) on 28 Jan 2015 #permalink

I’ll have to see if my comment got through on AOA…

It did.

The opposite of bullying is probably pandering. The problem with Bob and Jay and other 'vaccine friendly' pediatricians is that they can only think in extremes.

bully - use superior strength or influence to intimidate (someone), typically to force him or her to do what one wants

pander - gratify or indulge

Forcing a parent to get vaccines when they are scared to death is not good. But even those of us who are strong advocates for vaccines and avoiding vaccine-preventable diseases don't do that. Allowing parents to make a decision to keep their kids unvaccinated and unprotected based on misinformation and propaganda is hardly good either.

In between those extremes, the great majority of pediatricians educate parents about the safety, efficacy, and necessity of vaccines. And we don't wait until their is an outbreak to do it.

Get Educated. Get Vaccinated. Stop the Outbreaks.

By Vincent Iannelli, MD (not verified) on 28 Jan 2015 #permalink

@ Science Mom - Thanks for the dates; I wasn't able to load comments the first time I looked at the article. I wasn't doubting that she was in the window for an adverse reaction so much as wondering if she was still in 2 week period before the shot takes effect - if so, she could have gotten the measles before she was protected (like all those people who swear up and down that the flu shot gave them the flu.) Eighteen days is pushing it, though. Its not good news either way: if she has wild-type measles, then there will likely be more cases in Boston. If its vaccine related, that wilI decrease confidence in the vaccine just when its needed most, plus there's a possibility that the entire batch that vial came from was improperly inactivated. I hope the test results will be reported when they come in.

"This outbreak will stop very soon. Disagree, “scientists?”"

@Dr. Gordon. Shame on you. SHAME ON YOU!

That's not the FLIPPIN' Point. The point is to prevent suffering and unnecessary complications. It's the first level of prevention.

There is ZERO evidence that vaccines cause children any harm, and tons of evidence for their safety and efficacy. There is NO GOOD excuse for denying anyone access to vaccines.

I seldom wish ill on anyone. But I really do hope someone sues you for malpractice. But that's what you're doing. It's malpractice. You are just too insufferable for words.

I also wish the American Academy of Pediatrics would publicly denounce you and strip you of your FAAP status. You are not worthy of it.

plus there’s a possibility that the entire batch that vial came from was improperly inactivated

Edmonston-Enders isn't inactivated during manufacture, it's attenuated from the get-go.

@ sadasd #127

PGP #84 “The thing is, there are no fence sitters anymore” This. So frickin’ this.

The Internet's not real life.There are only a few fence-sitters posting on the Web about vaccines compared to the pro-vaxers and anti-vaxers, but you'll find them if you look in the right places, and a lot more are undoubtedly lurking. But, more importantly, regular people are busy with all kinds of stuff and everyday worries, and whatever time they may spend online is likely entertainment/diversion. I would like to see a sociological study on parents who don't follow vax recommendations broken down into:
1) delayed scheduling
2) just not taking the kid in for the shots
3) filing for vax exemptions
to see what information sources influenced their decisions, and how. (This would not yield itself to survey research well, better to do focus groups and go for depth...)

My first hypothesis would be that only group 3 would show any significant % ever having visited an anti-vax website. My second hypothesis would be that for all three groups word-of-mouth from friends and family would be the most salient source of information and opinion. My third hypothesis would be that for the majority of groups 1 and 2, the issues remain indecisive. That is, they haven't looked into the question all that deeply themselves, and in the face of conflicting opinions they just don't act. That is, the default for medical issues of all sorts is 'NOT going to the doctor unless there's a good reason.'

Thus, my cumulative hypothesis is that the dip in vax rates over recent years is more due to fence-sitters never getting off the fence than to true-believers in vaccines=harm.

This is basic old-school communication sociology theory, what Lazarsfeld and Katz labeled "two-step flow." It's hardly a consensus model in the field, though it remains well-respected. The idea is that i any local community, most people don't pay that much direct attention to sources of information and persuasion. They don't read or watch the news that much, don't even see that much advertising, don't pay that much attention to what they do see, etc. They do, however, listen to their friends, neighbors and family. So in any of these local communities there will be a small number of what Lazarsfeld and Katz called "opinion leaders": folks who DO attend to public discourses, form opinions about subjects, and then in turn influence all those other folks who aren't paying direct attention. Thus the two-steps of the flow are from the media—>the opinion leaders, and from the opinion leaders—>masses.

For Lazarsfeld and Katz, this was how any communication agenda got it's business done, whether it was electing a political candidate, or selling a particular brand of dishwashing liquid. Target the opinion leaders, the masses will follow. Now, we might think the Internet would change that, but Internet use seems highly selective. Again, there's no evidence people people frequent websites outside of their narrow personal range of hobbies/entertainment/professional afaik.

In the case of 'the vaccine controversy' the pro-vax side faces a disadvantage in that every fence-sitter who comes down on the side of taking the kids in for the MMR has reached a resolution point and is out of the discussion, while those that remain on the fence are still in it.
Q: 'Did you take your kids in for their shots?'
A: 'No. Not yet anyway.'
Q: 'Why not?"
A: 'I just keep hearing all these bad things about vaccines.'
Q: 'Do you think they're true? Do you think vaccines are really dangerous?'
A. 'I just don't know. I'm not sure. You know, unless I'm really comfortable that it's OK... better safe than sorry, I guess...'

In the absence of definitive sociological research to the contrary, the best campaign strategy for raising vax rates is:
a) assume plenty of parents are still on the fence
b) assume the alienation of any fence-sitter will knock five more off the fence in the same direction
c) figure out what appeals are effective for getting the opinion-leader fence-sitters to come down on your side
d) employ those those appeals tactically, whether they appeal to you or not.

If you want to see how real pros do it:
http://tinyurl.com/oj7bhnl
This. So totally this. I gotta remember to put that link in every comment on vax/VPD issues. Stories, real people, identified by name, lots of pictures, ending with a conversion narrative. That is how it's done.

@sadmar @PGP
Anecdote is not the singular of data, but I don't think the categories always that easy to pin down.

I know some people who don't vaccinate because they pretty much avoid all medications unless the need is dire. They also don't take Tylenol, aspirin, etc. They don't seem to think the vaccines will hurt their kids in any way, they just don't think they are necessary. They have bought in to the some diseases aren't so bad thing, and I think they are aware how much herd immunity helps them, but, yeah. Many people have tried and failed to get them to change their minds.

I also know a family with an autistic son (who got the usual childhood vaccinations) about the same age as my autistic son. They were in school together, the parents are fierce advocates for their son, getting the school's ASD program up and running, they love their kid. And their younger son was (is?) not vaccinated at the height of the autism-MMR scare because they were afraid he might also end up on the spectrum. Caring for one ASD kid is exhausting, I can understand hoping to avoid caring for two, but they are among the furthest I know from thinking their kid is broken.

(And I'm basically a recluse, so if *I* know this many folks who don't fit the "anti-vaxxer" mold, I can't begin to imagine how many there must be. They just don't scream on the Internet.)

By Emma Crew (not verified) on 28 Jan 2015 #permalink

Edmonston-Enders isn’t inactivated during manufacture, it’s attenuated from the get-go.

Good grief, where did that answer even have to come from?

By Science Mom (not verified) on 28 Jan 2015 #permalink

My heart aches for that little boy and for his parents. Scroll down to see the reactions of some non vaccinating parents when they were told how their choices could lead to a life-threatening illness for the youngster.

I did as instructed and scrolled down to read soem of the comments. Good grief the stupid is strong.

Some of my "favorite" parts:

In the early 1900s, other treatments were being successfully used to treat measles. In 1919 Dr. Drummond commented that cinnamon oil was an effective prophylactic against measles or that it made measles milder.

"It has been my practice, when I meet with a case of measles in a family, to prescribe a course of cinnamon for all unprotected members of the family. In the majority of cases the person so treated [with cinnamon] escaped the disease [measles] altogether, or else had it in very mild form. [20]"

And:

"And was the measles incidence declining before 1963 anyway? Looking at the measles incidence data, the trend line shows that incidence was on the decline. In fact, if that trend line held, measles incidence would have hit zero by around the year 2000. This is actually the year when the CDC declared measles had been eliminated from the United States."

Panacea @ 143 --

There is ZERO evidence that vaccines cause children any harm,

That's almost true, but not quite. On rare occasions, children suffer ill effects from vaccines ranging from the trivial to (very rarely) rather severe problems. But these effects are rare, so that the overall risk from vaccination is much less than that from the disease.

I think it's best to be scrupulously honest, because any kind of dishonesty, or exaggeration, just hands ammunition to the crazies we're all up against.

By palindrom (not verified) on 28 Jan 2015 #permalink

"Officials: Up to 1K possibly exposed to measles in Arizona"

http://www.azcentral.com/story/news/local/arizona/2015/01/28/arizona-me…

"Health officials believe the Phoenix-area woman recently diagnosed with measles may have exposed as many as 195 children to the disease at the Phoenix Children's East Valley Center between Jan. 20 and 21.

Maricopa County officials were in the process of contacting the children's families Tuesday. A hospital official told 12 News that the woman was not an employee and that it was not known why she was at the facility."

Edmonston-Enders isn’t inactivated during manufacture, it’s attenuated from the get-go.

Doh! (forehead smack) I knew that. Internet and studying for exams don't mix (its probably not great for my exam grades either, but obviously that's a secondary consideration.)

I posted my earlier comment on the math to MAM's article and, to her credit (and, frankly, my surprise) she actually let it through. There are actually quite a few pro-vax comments on there now, if anyone else wants to join the party.

Emma: Have you considered that they're just acting nice to fool everyone? Because while a few anti-vaxxers might be nice people, most of them are two-faced.

By Politicalguineapig (not verified) on 28 Jan 2015 #permalink

5 confirmed measles cases in Alameda County, 4 linked to Disneyland, 30 babies under quarantine. As the SJ Mercury News reports, non-vax in Alameda county cuts across class lines:

the reasons so many kindergartners don't have up-to-date vaccinations is as diverse as the students themselves: While many lower-income parents struggle to get their kids to the doctor or deliver the paperwork, some higher-income parents are refusing to get their children immunized over concerns the shots lead to autism and other illnesses.

I'd guess folks in the East Bay who could afford a holiday trip to Disneyland – or whose kids have hung with those who could – aren't on the low-income side. but they're obviously threatening the poor kids. There are also two confirmed cases in Santa Clara county, where the infected kid was taken out shopping: to a Costco, a WalMart and a Dave and Buster's. The D&B is in a big lower-end shopping mall (Burlington Coat Factory, Marshall's) right across the hall from a 20 screen cineplex. Wouldn't it be fun to take out the kids for Pretzel Dogs, Fries and a screening of Big Hero?

AND, AND, AND...
A WaPo article from this Monday suggests the Disneyland outbreak is making it easier for Dr.s to nudge fence-sitters off the fence if they haven't already jumped:

Much of the scrutiny in the Disney measles outbreak has fallen on an entrenched anti-vaccination movement in places such as Orange County, Calif. These “anti-vaxxers” are viewed as dead-set against vaccinations. But doctors believe the current outbreak could change the minds of a less-known but even larger group: parents who remain on the fence about the shots. These “vaccine-hesitant” parents have some doubt about vaccinations, leading them to question or skip some shots, stagger their delivery or delay them beyond the recommended schedule. An estimated 5 to 11 percent of U.S. parents have skipped at least one vaccination or delayed a shot, according to studies. That compares to only 1 to 3 percent of parents who object to all vaccinations.

So, be nice. And this: http://tinyurl.com/oj7bhnl

@lilady

Yes you're right! Accidentally wrote Tenpenny instead of Humphries.

Annie, it's hard to keep these anti-vaccine doctors and their unique arguments against vaccines straight.

Your accident gave me the opportunity to reread Orac's post. :-)

these anti-vaccine doctors and their unique arguments against vaccines

Oh no, sarcasm is infectious! If only there were a vaccine against it!

By herr doktor bimler (not verified) on 28 Jan 2015 #permalink

While I may be incredibly optimistic, this could just be the beginning of the end for the modern anti-vax movement (as we know it today) - now that a real VPD outbreak of substantial size has occurred, right in the heart of anti-vax country, in a place like Disneyland, they (the anti-vax folks) will be hard-pressed to come up with a response to all of the scrutiny they are currently receiving that won't make them look like a bunch of lunatics.

Politicians aren't going to want to be associated with pro-disease people at a time like this - so I would expect that the current crop of bills to tighten vaccine mandates will be much more likely to pass (and attempts to loosen them should fail miserably).

Now that disease is knocking on peoples' doors - it could get quite interesting....

Lawrence @ 160, The anti-vaxx contingent is trying right now to get a philosophical (ginned up as religious) vaccine exemption through the Mississippi legislature. Probably not very strategic timing in the midst of another measles outbreak.

By Science Mom (not verified) on 29 Jan 2015 #permalink

The Mississippi Health Department merely needs to point to California....

Mrs. Tietje posted that there were no documented cases of one person being identified as the individual who passed along a disease to another. This was in the thread "stop blaming anti-vaxxers.". I respectfully mentioned Mary Mallon (aka Typhoid Mary). She removed my comment and has apparently banned me from her page. I said nothing in a critical tone.

By Sue Branson (not verified) on 29 Jan 2015 #permalink

Mrs. Tietje posted that there were no documented cases of one person being identified as the individual who passed along a disease to another.

I don't know why she even thinks this is somehow a smoking gun. The index case(s) could have come and gone before they were even symptomatic. It doesn't somehow negate the fact that the majority of infected are unvaccinated and index cases for every outbreak isn't always identified. The fact remains that it's wild-type measles strain B3 which has been circulating in the Phillipines.

By Science Mom (not verified) on 29 Jan 2015 #permalink

Ms. Branson: "She removed my comment and has apparently banned me from her page. I said nothing in a critical tone."

The funny thing is that she wrote:

Fourth, report hate pages. There are a number of different ones on Facebook. “Anti-Vax Wall of Shame.” “Things Anti-Vaxxers Say.” “Banned by Modern Alternative Mama.”

So, yeah, the page created by those who were banned by her are automatically "haters." Oh, the irony.

@Sue Branson

Wasn't she asking for just ONE (sic) proven case of an unvaccinated child getting infected, passing measles along to another child and that child dying? I guess she hasn't searched very hard. Otherwise, she might have come across Micah and Natalie, both of whom were infected as infants by unvaccinated children and both of whom developed SSPE and died.

@palindrom

Fair enough. Good point.

@ Todd W.

I don't believe Ms. Tietje searches for facts. It seems that she only looks for items that support her views. When facts are presented, she calls it "hate speech" or "trolling." I find it infuriating when folks with no scientific credentials tell people, "Educate yourselves." The problem with that it that if you're untrained, you have no way of determining what information is credible and what is just woo.

By Sue Branson (not verified) on 29 Jan 2015 #permalink

@PGP
Over a decade with no slips is pretty long to hold up such a facade and their kid is visibly content, so I'm pretty convinced they're genuine, but whatever, I'm just some stranger on the Internet.

By Emma Crew (not verified) on 29 Jan 2015 #permalink

It's difficult to identify the index case when the exposures take place in a large public place.

Smaller outbreaks in a small community (such as schools) are usually identified...but their names are never disclosed to the public.

Here's Dr. Bob Sears' deliberately non vaccinated patient who was the index case for the 2008 San Diego Measles outbreak:

http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5708a3.htm

Update on the Baltimore measles case:

"BALTIMORE - A one-year-old girl whom health officials were investigating for a possible case of measles does not have the virus.

The Baltimore City Health Department said Thursday the tests for the disease came back negative."

But then it says:

"On Jan. 21, the girl was taken to MedStar Good Samaritan Hospital’s Emergency Department with a fever, rash, runny nose, cough and watery eyes, which are symptoms of measles. The patient was then taken to Johns Hopkins Hospital's emergency room where they ran lab work, which tested positive for the measles virus."

http://www.abc2news.com/news/health/baltimore-health-officials-one-year…

Interesting that she tested positive initially and then negative.

Interesting that she tested positive initially and then negative.

Different tests according to the news report. Possibly serum test versus PCR. I am not up on how they test for measles in the US, but tests can vary from place to place.

The fact that it is not measles won't stop the anti-vax mob claiming it as an example of a patient getting measles from the vaccine and shedding the virus, etc. etc.

"The fact that it is not measles won’t stop the anti-vax mob claiming it as an example of a patient getting measles from the vaccine and shedding the virus, etc. etc."

Pretty much. Some responses from mothering :

"In that article they say she tested positive for measles, but since feh was vaccinated, they are claiming a vaccine reaction? What? That makes no sense at all."

"Yeah, as I suspected, that case would be categorized as one off... basically they are saying THE John Hopkins hospital lab is a joke, but then admitting the child suffered a reaction that seems likely measles. Go figure."

"One off? are we sure? Did she spread her "reaction" ?

Remember Mary? well for those who don't - here it is again

http://news.sciencemag.org/health/20...ent-first-time"

If your vaccines work why are you so concerned with my child not being vaccinated?

If your vaccines work why are you so concerned with my child not being vaccinated?

Oh, look, it's the dumbest antivaccine trope of all time.

@Ashley - there are several reasons. For one thing, hard as it may be for you to understand, some people do care about the health and welfare of all children, not just their own. Secondly, there is a small but significant population of people who can't be vaccinated: babies under 12 months, the immunocompromised, etc. Lastly, although the measles vaccine is one of the most effective at 98 - 99% for two doses, that's still 1 or 2 chances in 100 that you can get it if your exposed to someone who's sick - small but certainly not trivial. The more the virus circulates among the unvaccinated (who have made up the bulk of this outbreak), the more chances it has to cause breakthrough infections or even develop resistance to the vaccine. In short, antivaxers' "personal healthcare decisions" don't just affect themselves or even just their own children, they impact everyone.

Using her numbers:
There are around 70 confirmed cases currently
5 of them were fully vaccinated
37 were not vaccinated
There are no records available for at least 30 cases (so we don’t know their vaccination status)

Out of 72 cases:
7% were vaccinated
51% were not vaccinated
42% were unknown.

If you exclude the unknowns, then
12% were vaccinated
88% were unvaccinated.
Or Unvaccinated kids were 7.4 times more likely to get measles than the vaccinated kids.

What we have here is a failure to appreciate simple mathematics.

Ashley: "If your vaccines work why are you so concerned with my child not being vaccinated?"

How well is a baby protected if they can't get an MMR until after their first birthday?

And why would you want to risk your child getting measles, mumps and rubella?

Ashley

If your vaccines work why are you so concerned with my child not being vaccinated?

Even if you personally don’t care about other people’s children, do you think this is a good use of resources?
http://www.nytimes.com/2015/01/30/us/measles-outbreak-has-arizona-track…

Arizona health officials on Thursday were tracking more than 1,000 people, including at least 195 children, who might have been exposed to measles as part of an outbreak that began at Disneyland in Southern California and has grown to 67 cases in seven states.

Or would you prefer to just take your chances and hope your unvaccinated children don’t encounter anyone who is contagious?

If your vaccines work why are you so concerned with my child not being vaccinated?

If your child is well fed, why are you so concerned about me starving my child?

If your child is being brought up successfully without corporal punishment, why are you so concerned that I discipline my child with a baseball bat?

Shall I go on?

@ Lawrence #160
"this could just be the beginning of the end for the modern anti-vax movement (as we know it today)"

That's the way I see it, with the mainstream media now descending on various anti-vaxers like a pack of hungry dingos. They don't get that far ahead of public opinion. I wouldn't expect too much on the legislative front as "parental rights" and "anti-government" are too dear to the hearts of the GOP, but perhaps the outcry will keep the Mississippi thing from passing when it otherwise would have. But it's Mississippi, so I wouldn't make book on it.

Anyway, especially in the grid-lock era, it isn't so much legislation that changes things, but court cases. As I posted in another thread, Australia Broadcasting radio had this in a report the other day.

REPORTER: Health care lawyer Nick Diamond co-authored a paper discussing whether non-vaccinating parents should be able to be sued and he does see it as an issue of negligence.
NICK DIAMOND: This particularly situation, it was a hypothetical at the time and very real now, is what happens when you have a child get sick due to another child who wasn't vaccinated based on their parent's choice, and whether those parents who didn't have their child vaccinated could be held liable. In the case that we tried to make out in the paper was that it's not really a slam dunk in terms of suing for negligence but there is a pretty strong case...
REPORTER: In a poll run by one television network, a majority of respondents said people should be able to sue parents who don't vaccinate their children.

Maybe not just people, but insurance companies forced to bear the costs of the measles outbreak (established by the Aussies as already much more than we spent on ebola), and maybe not just sue the parents but the doctors when enabled the whole thing? That'd get 'er done, don't you think?

@ashley - why do you care if I drive drunk? Or the auto body shop stores their solvents in containers that leak into the streams feeding a public reservoir?

At least we know you aren't using a religion as an excuse not to vaccinate.

Like others, I left a civil, sincere comment on Tietje's website, and it has been awaiting moderation for several days. I quick Google search confirmed that Tietje has a habit of censoring critics through indefinite limbo. Here is my comment:

From a moral standpoint, I don’t think it’s accurate to say that it’s not your job to protect other people. I’m not comfortable with forcing parents to vaccinate their children, but certainly parents who choose not to vaccinate have a moral obligation to 1) limit an unvaccinated child’s contact with potentially sick individuals and 2) limit a potentially sick child’s contact with the general public.

You mentioned several times that the measles doesn’t concern you because a healthy child is unlikely to have a severe reaction; however you can’t guarantee that everyone your child comes into contact with when contagious will have the same results. This applies to everyone who may be contagious, but it is especially applicable to unvaccinated to children, who are more likely to catch a disease.

Additionally, I think you are overlooking potential legal implications. If you recall from the recent ebola cases, exposed and sick individuals were quarantined. Since society can no longer rely on herd immunity for a lot of diseases there is likely to be an increase in disease that were common a hundred years ago, and public health laws are likely to change in response. There are also laws in place requiring people with STIs to inform sexual partners of diseases. People who don’t inform a partner can be charged with crimes and held liable under tort. It’s likely that public health and tort law will change, as well.

Even if you personally don’t care about other people’s children, do you think this is a good use of resources?

To wit. The Dr. Bob case came with a price tag of $10,376 per case.

Of course, (likely) hit-and-run Ashley can simply state that this proves her "point."

@Joe #181 - It's even worse than you think; once you take vaccination rates into account, the unvaccinated are 69 times more likely to get the measles (90% chance vs 1.3% - see my comment at 115.)

I gave up reading all the comments. When I heard about the outbreak in Disneyland, I felt sick to my stomach. My son was born with kidney failure. He spent 4 years on dialysis so he was able to have all of his vaccines up until age 5 when he got his transplant. When you are on dialysis your body is less likely to respond to the vaccine though. He had a kidney transplant at age 5 and has not been able to have any live vaccines since then. He's now almost 23 years old. MOST people know that vaccines are not 100% effective, just like everything else in the world. If my son were to get measles (or many other diseases), he could become much more sick than other kids/adults. He would mostly likely end up in the hospital and he could die. The reason the Disneyland outbreak made me so sick was that I know so many children who have received Make A Wish trips to either Disneyland or Disney World. Many of these kids have suppressed immune systems. Imagine a child with a transplant, there on their dream trip, having struggled for their lives, and STILL struggling for their lives (transplant is NOT a cure), and they get sick...and they die. How about a child with cancer or lupus or any number of life threatening or terminal conditions? What if this were your child? And then you see how far this has spread. So maybe my child didn't go anywhere near Disneyland, but someone at their school did.... or a family member of the person at that school or who knows!!! Measles is the most contagious preventable disease that we know. Yes there are risks of getting a vaccine, just like there is a risk of getting in a car or crossing the street. Even walking on the side walk, or turning on the microwave or the stove, or taking a bath! The risk of a severe reaction to a vaccine is so tiny compared to the risk of the disease. Yes, if your child is the one with the severe reaction, you are going to cry and scream and tell everyone to avoid vaccines at all costs, but what if your child was the one to get the disease? What if your child because disabled due to it? What if your child died? Maybe your child was ok, but they passed it on to baby brother or grandma who did not have the strength to fight it? I'm holding my breath and praying that I will not read about the first child dying due to complications from measles. Sometimes I wish I could go back in time when people cared about their neighbors. It wasn't all about "me and mine." I want to protect my kids, but I also care what happens to other people's kids. Both of my sons have autism. They showed signs long before they got the MMR vaccine. I wish the anti-vaxers could see what I've seen with my son spending so much time in the hospital. Hearing nurses and doctors yelling that a child was coding. Finding out that a child who came in with a "cold" died. Listening to a friend talk about giving her child one last kiss before closing his casket. If you are afraid of toxins, then you better find another planet to live on. It's too late for you to avoid them on earth.

Not sure how doing nothing (not vaccinating) can be dangerous.

Yeah, just like not wearing a seat belt (a form of doing nothing) isn't dangerous.

Not securing your firearms with trigger locks when you've got 6 year-olds wandering unsupervised (another form of doing nothing) isn't dangerous.

Not wearing eye protection or a hard hat another form of doing nothing) when working construction isn't dangerous.

Not wearing a life preserver when boating isn't dangerous.

Not installing and maintaining smoke and CO2 detectors in your home isn't dangerous.

Shall we continue?

Simpler than that: a person can die of thirst in a week by "doing nothing," because eating and drinking are doing something. No need for firearms, boats, construction sites, automobiles, or even a fire.

This outbreak will stop very soon. Disagree, “scientists?”

Trivia, anyone? CDPH, January 31:

"91 confirmed measles cases ... Of these, 58 have some identified epi-linkage to Disneyland.... 18 cases are secondary or tertiary cases...."

Today:*

"92 confirmed measles cases ... Of these, 59 have been indentified epi-linkage to Disneyland.... 19 cases are secondary or tertiary cases...."

If No. 19 is tertiary, "very soon" just got that much less so, Dr. Scare Quotes.

* Not yet crawled.

Not sure how doing nothing (not vaccinating) can be dangerous.

Amusingly, the Breitbart item mentioned elsewhere contains this note to Bob:

"Playing footsie with this misguided movement is a good way to lose everyone else, shifting the debate over individual rights onto such unfavorable terrain that those who can speak eloquently and reasonably about such rights find themselves without an audience. Even the ardent libertarian should concede their [sic] must be some rules, and when children are packed into school environments where disease can spread like wildfire, sensible vaccination procedures should be among them."

@Courtney It shouldn't surprise me that Kate Tietje, once again, blames everyone/anyone for something that she is uncomfortable with in her life. I try hard to stay away from her train wreck of a blog and I refuse to look at her FB page because my head explodes from the ignorance on her page/blog. I've typed her comments before only to delete them because I know she doesn't understand sarcasm and she definitely won't post anything from someone as Pro-Vaccine as I am. If she ever posted a statistic that came from a credible source or wasn't a guestimate I'd probably drop dead from shock.

I couldn't agree with your censored comment to Tietje more. The fact that she isn't a medical professional and her site is for "informational" purposes only makes her an even more deadly contributor the the anti-vax conspiracy theory. I couldn't live with myself if I advised a young mother not to vaccinate and then something happened and they caught measles. This is a critical time right now with several outbreaks of a disease that will kill children. Her disregard for anyone shocks me. There is no personal responsibility in that woman at all. Her first child was delivered in a hospital and he has sensory issues. Hospitals fault. Her feelings are hurt. All Pro-Vaxer's fault. If one of her children contracts the measles, our fault again. She truly believes that letting someone get the flu as opposed to taking the vaccine is BETTER!!!!! Truth be told? I bet she and her family would be first in line for an Ebola vaccine if it is ever invented and we have a serious threat here. Just sayin'

Aside from venting, I guess my point is she is the worst kind of anti-vaxer because she has a substantial following of young, scared parents who feed into the conspiracy of autism and greed. I am seriously thinking about starting a "Kate Tietje Response Blog" where I can re-blog her content with the TRUTH underneath every lie she speaks in red. (JK) Although I would find it very cathartic.

The facts are black and white to me. Not all the issues that need to be worked out, like medical exemptions and research into better and more effective vaccines, etc. However, being unable to speak to a conspiracy theorist who treats the anti-vax movement as if it were a religion, I simply don't know what to do anymore except vent here and thank all of y'all for the intelligent and thought provoking conversations.

P.S. Can you imagine being Kate Tietje's psychologist? I have a feeling her psychologist is going to need therapy when she is done. Oh, and I don't know if Tietje sees a therapist but my momma taught me if the shoe fits...

By NikkiSixx (not verified) on 04 Feb 2015 #permalink

Great post, full of excellent points. However, I do wish you had given it a better title like "Everybody Hates You: The problem with free speech arguments for anti-vaxxers". Your current title makes it seem like a pro anti-vaxx article.

By Marta Manning (not verified) on 09 Feb 2015 #permalink

This outbreak will stop very soon. Disagree, “scientists?”

2/9/15 -- first related case in Georgia.

You should rename your blog from "Scienceblog" to "whinersbitchfestblog".

By Hugo Burquois (not verified) on 10 Feb 2015 #permalink

@Hugo - oh, that's so witty! Did you stay up all night coming up with that one?

Shittiest read ever. You are all Nazis.

Wow, another witty comeback....will the wonders ever cease?