"Vaccine exceptionalism": With friends like these, who needs enemies?

There’s an old saying that basically asks the question, “With friends like these, who needs enemies? or, as Voltaire (or Marshal Villars, depending on the account) said, “May God defend me from my friends: I can defend myself from my enemies.” The point, of course, is that friends or allies can sometimes be as infuriating as enemies, if not more so.

Such is the case with Alice Dreger, author of Galileo’s Middle Finger, a book dedicated to describing how activists can undermine science in favor of ideology. I’ve written about her twice that I can recall, although both in the context of a particularly infuriating article she wrote about vaccines a year ago, What if not all parents who question vaccines are foolish and anti-science? in which she asserted that it is not completely unreasonable for parents to ask about safety concerns. Of course, when it comes to vaccine-averse parents who have not yet gone completely over to the antivaccine side, no responsible pro-vaccine advocate claims otherwise. Unfortunately, to Dreger, those of us in the trenches battling antivaccine pseudoscientific claims that pop up like Whac-A-Mole, are apparently nasty, self-righteous fanatics. To call her chastising us for offenses, real, exaggerated, and imagined, that supposedly "fuel" antivaccine sentiments unhelpful is putting it mildly.

In terms of such unhelpful and self-righteous chastisement, Dreger’s 2015 article drew my attention mainly because she took a swipe at yours truly over a post I had written years before. (The Internet never forgets, and blog posts don't either.) Of course, as I pointed out, the implication of the article that pro-vaccine advocates are frenzied, self-righteous zealots who are incorrect (and disrespectful to parents, to boot) when we point out that most fears of vaccines are rooted in pseudoscience was, for the most part, baseless. I took the opportunity to discuss how Dreger missed my point in that to someone who is not knowledgeable enough to recognize the pseudoscience underlying antivaccine fears, the irrational pseudoscientific arguments promoted by the antivaccine movement can seem quite compelling. Moreover, they’ve seeped into the very zeitgeist, such that young parents would be hard-pressed not to encounter them. Again, if you mistakenly believe antivaccine misinformation, it is rational, based on what you know, to start to fear vaccines. It’s concept I’ve referred to as “misinformed consent” not to vaccinate. If you start to believe the misinformation of the antivaccine movement claiming that vaccines are dangerous and that they don’t work that well, then of course you’re going to start to become worried and fearful! That’s what we’re fighting, the misinformation that poisons the decision-making process of these parents who are vaccine-averse!

Unfortunately, Dreger is at it again in a post from yesterday on her personal blog entitled Beyond Vaccine Exceptionalism, in which she basically used a debate between physicist Robert David Grimes and antivaccine quack Andrew Wakefield on Irish radio as a starting point for a discussion about what to do when faced with the situation Grimes faced: To debate (or not) an antivaccine quack. Not surprisingly, the context of the interview was that Wakefield was making the rounds to promote his movie VAXXED, which recounts the manufactroversy known as the “CDC whistleblower” and basically falsely claims that the CDC is covering up slam-dunk evidence that vaccines, particularly the MMR vaccine, cause autism. So far, so good. There’s nothing really objectionable in her discussion. It didn't take long for that to change.

Indeed, Dreger does what she does so infuriatingly and what I took her to task for a year ago. She basically starts spouting conspiracy theories, while expressing dismay that pro-science advocates call them conspiracy theories:

Many ordinary citizens and patients know—and are right to think about—the fact that vaccines are pushed in and by a medical industrial complex that is, particularly in the United States, rife with financial conflicts of interest, overtreatment, and iatrogenic harm from practices adopted without sufficient evidence.

Vaccines are produced and marketed by the same pharmaceutical companies that have been found, again and again, to engage in unethical and also illegal practices in pursuit of profits. And the fact is that many leaders in medicine, if not also in public health, have had deeply problematic relationships with big pharma; even the New England Journal of Medicine’s editors have lately been telling people to stop worrying their pretty little heads about conflict of interest disclosures and data transparency.

Vaccine exceptionalism—the attitude among many science and public health advocates, that approved and recommended vaccines are never to be questioned or doubted—is historically and politically naïve. Vaccine exceptionalism also ultimately feeds anti-vaccine campaigns by contributing to the sense among vaccine-worried parents that the “pro-vaccine” campaign isn’t really thoughtful or scientific.

You know, Dreger sounds just like Jill Stein, the Green Party candidate for president. She's basically blowing the antivaccine dog whistle as Stein about pharma "corruption" in the context of discussing "trust" of the public in the system that recommends specific immunizations. Of course, As I pointed out when discussing Jill Stein, the FDA and CDC actually go to great lengths to minimize conflict of interests on the relevant committees making decisions about which vaccines are approved and included in the recommended schedule.

How many blatantly obvious straw men are in the passage above, let me count? No, on second thought, let me not. I’ll simply point out one straw men so massive that, were it to catch fire, it could be seen from the International Space Station. I’m referring to Dreger’s claim that pro-vaccine advocates seriously argue that “approved and recommended vaccines are never to be questioned or doubted.” I’m sorry. Even though I consider Dreger to be more or less on “our side” when it comes to vaccines, her penchant for echoing antivaccine anti-pharma tropes notwithstanding, the adage from Voltaire about needing to be saved from my friends comes to mind. Also, when a friend says something this mind-numbingly dumb (and, make no mistake, this is one mind-numbingly dumb massive straw man), I’m not one to hold fire, particularly given that this is by no means the first time Dreger's said something like this.

In any case, Dreger’s rhetoric here is of a type that I could easily find on any of a number of antivaccine crank blogs and websites, such as Age of Autism, NaturalNews.com, Mercola,com, and the like, often with verbiage that wouldn't be the least bit out of place on those wretched hives of scum and antivaccine quackery. (Oh, wait. Was I too...strident?) Indeed, “vaccine exceptionalism,” as Dreger put it, is a variant on a frequently used trope in the deepest, darkest antivaccine corners of the Internet that misrepresents pro-vaccine arguments as stating that vaccines are such an unalloyed good that they must never, ever, ever be questioned. Another variant of this same trope is to liken vaccines to a religion, in which questioning their safety and efficacy is portrayed as "heresy." (After all, what does Dreger mean to imply by stating that vaccines “are never to be questioned” if not to implicitly liken support of vaccines to religion? It’s not as though such language is particularly subtle. At the very least, she's implying support for vaccines is based primarily on ideology.) Indeed, I’ve even seen antivaccine activist Kim Stagliano coin a term, “Vaccinianity,” which Ginger Taylor went on to define thusly:

Vaccinianity – (Vax.e.an.eh.te) n. The worship of Vaccination. The belief that Vaccine is inherently Good and therefore cannot cause damage. If damage does occur, it is not because Vaccine was bad, but because the injured party was a poor receptacle for the inherently Good Vaccine. (ie. hanna poling was hurt when she came into contact with Vaccine, not because the Vaccine was harmful, but because her DNA was not to par or because her mitochondrial disorder was to blame.) Vaccine is presumed to have rights that supersede the rights of the individual, while the human person’s rights must defer to Vaccine.

It’s such a silly and transparent term that I gave Stagliano and Taylor some friendly advice about coining such words. Not surprisingly, they didn’t take it. Still, I’d offer similar friendly advice to Dreger, as her rhetoric in her post is inching very, very close to using a term like “vaccinianity” to describe vaccine supporters. At the very least, she is by comparison painting the parents that she sympathizes with (and herself) as being oh-so-reasonable in comparison to what she characterizes as self-righteous, unthinking vaccine zealots with contempt for parents. Basically, it's a great way to feel good about yourself to portray yourself as eminently reasonable and empathetic and those with whom you disagree as radical, unthinking ideologues.

Dreger's portrayal is basically a convenient caricature. It turns out that very few pro-vaccine advocates are like that, although you can sometimes encounter those few online. Heck, even the pediatricians who decide to stop caring for children of parents who won’t vaccinate torture themselves over the decision. In fact, as I discussed just this month, public health advocates go through a great deal of effort to figure out what is behind vaccine hesitancy and how best to deal with it. If you look at actual research, too, contrary to Dreger’s dogmatic rejection of the claim that parents are afraid of vaccines not because of pseudoscience, they actually do express a lot of pseudoscientific reasons. Granted, some of the reasons might be considered to be not based in pseudoscience, such as concerns about vaccine efficacy, stress from watching their child receive multiple vaccines, ideology, and religion, many of the reasons parents give health care providers for being reluctant to or refusing to vaccinate are rooted in rank pseudoscience of the sort Wakefield is peddling in VAXXED and has been peddling for 18 years: fear that vaccines cause autism, concerns about “toxins” in vaccines, worries about “too many, too soon” and “overwhelming the child’s immune system,” and the belief that “naturally acquired immunity” is so much more preferable than vaccine-induced immunity.

Do we who support vaccines based on science refute, sometimes vociferously, antivaccine pseudoscience? Of course we do! And there’s a lot of pseudoscience to refute. Do we claim that vaccines “are never to be questioned”? Of course not! Dreger seems to be confusing statements made quite correctly by pro-vaccine advocates that there is no scientific controversy over whether vaccines cause autism (as far as a mountain of research can tell, they don’t) and whether vaccines in the current schedule are safe (an even bigger mountain of research concludes that they are) with a religious dogma that vaccines “are never to be questioned.” The two are not the same thing, and conflating them so blatantly is most definitely not helpful. Or perhaps she is conflating our strong rejection of “questioning” that is based on pseudoscience with claiming that vaccines “are not to be questioned.” These are not the same thing either. She also appears to be confusing criticism directed at the leaders of the antivaccine movement, who are so far down the rabbit hole of antivaccine pseudoscience that the chances of pulling them out to the light of science are vanishingly small with how we deal with the true vaccine fence sitters, the parents Dreger keeps describing who have doubts about vaccines because vaccination is a medical procedure and they might have heard worrisome things about it or because, as she did, they feel a primal urge to protect their child when he is being stuck with more than one needle. I’ve discussed how I think these parents should be dealt with, and none of what I discuss involves insulting them, labeling them as stupid, or hectoring them, as Dreger seems to think it does. In contrast, it does involve recognizing that parents have fears based on what they have heard living in society.

Next up, Dreger engages in what I’ve liked to refer to since the very earliest days of this blog as the “pharma shill gambit,” which is basically a form of poisoning the well and discrediting someone with whom you disagree by attacking the person, while oh-so-piously signaling her own virtue:

I care very much about vaccine public health programs and creating herd immunity for dangerous diseases. That’s why I cringe when I look at how the HPV and chickenpox vaccines came to be mandated in various states in the U.S.—namely through the purchase by pharma of Republican and Democratic politicians. That’s why I object to “ethicists” like Art Caplan taking money from vaccine makers and not revealing those payments while publishing essays arguing “it’s unethical not to be vaccinated” in the medical literature and the mainstream press. I really hate that our Centers for Disease Control, which set out vaccine public health policy, have a Foundation that explicitly takes money from vaccine makers, calling them “our partners.”

One notes that, unlike the case for some of her claims, Dreger doesn’t link to articles showing that Caplan took money from vaccine manufacturers and didn’t reveal the payments. One wonders if she knows that Caplan spent nine months in the hospital as a child with polio in 1957 and that that experience was formative:

Being forced for months in 1957 to live in a polio ward where secrets were the order of the day was, as Caplan relates, even more distressing.

"In the hospital, there were plenty of injustices," he says. "And I remember being very puzzled that the doctors wouldn't tell us the truth about the kids who were dying, even though every one knew they were. ... They wouldn't even acknowledge it when the child died overnight in the bed next to you. Even at the age of 7, I was pretty sure that wasn't the way to deal with seriously ill people."

Caplan was one of the lucky ones. He experienced a cure that was stunningly sudden, and utterly mysterious.

But his experiences in the polio ward, both the anger and the cure, were in his view what generated his lifelong interest in science and medical ethics.

Could that experience, perhaps, and not any interaction with pharmaceutical companies, be the reason why Caplan is pro-vaccine (well, that, and the overwhelming science that supports the current vaccine schedule)? I’d be willing to bet that it did. In any case, I looked for documentation of Dreger’s claim and had a really hard time finding it. (Apparently my Google-Fu was not strong last night.) Even antivaccine websites didn’t seem to have it. The most I could find was a Twitter exchange between Dreger and Caplan in 2012 in which she behaved rather...poorly. In fact, in light of her having painted pro-vaccine advocates as hopless zealots, I find this exchange to be quite...illuminating. All Dreger seems able to come up with is an observation that a drug company funded a conference his Center for Vaccine Ethics & Policy held. Of course, Dreger probably doesn’t accept that unrestricted educational grants, which pharmaceutical companies not infrequently provide to support medical conferences are just that: Unrestricted. Dreger tries desperately to make it sound as though the pharmaceutical company paid Caplan personally. In this I couldn't help but hear an echo of US Right To Know's campaign against Kevin Folta.

Dreger than finishes with a little rant that would have been right at home on Age of Autism, The Thinking Moms’ Revolution, or even NaturalNews.com (as long as it was one of Mike Adams’ minions who wrote it, not Adams himself). On the other hand, Adams would approve of the bit about “profiteers” and people being “screwed over” by the “medical-industrial” system:

It’s time to recognize our responsibility to public health by recognizing that Wakefield’s side is not the only one to have effectively unmanaged and undisclosed financial conflicts of interest. Many of the people who are suspicious of vaccines, especially in the U.S., are not stupid. They know about how they and their loved ones have been screwed over by the medical industrial system that insists they need so many ineffective and unsafe drugs and screenings that do not actually help anyone but the profiteers in industry and pseudo-nonprofits, like our “non-profit” hospitals and some well-known “non-profit” cancer-fight organizations.

If we don't understand Wakefield as a symptom of legitimate suspicion among patients and parents, we will keep giving him fertile ground. It’s time we do something not only about Wakefield, but about the system of medical “science” that is causing the suspicion perpetuating his lies.

This is an argument that, while it has a grain of truth at its core, ends up blaming the pro-vaccine side for everything. If only “we” wouldn’t permit conflicts of interest, if only “we” would reign in the “profiteers” of the pharmaceutical industry, if only “we” would “fix” our medical system to Dreger’s satisfaction, there wouldn’t be any antivaccinationists. (Or at least there would be far fewer of them.) Would that were true! As we know, however, from previous experience with the antivaccine movement, if evidence shows that one of their concerns are unfounded, they seamlessly shift to another pseudoscientific concern about vaccines. If it wasn’t the MMR, it was the mercury in the thimerosal preservative that used to be in many childhood vaccines! If it’s not the thimerosal, it’s the “toxins.” If it’s not the toxins, then it’s “too many, too soon.” No matter what they say it’s about, it always ends up being about the vaccines. That’s why I bet that believing such a simplistic view of vaccine hesitancy and antivaccine parents, in which we could win them over if only we would make medicine as perfect as possible with respect to conflicts of interest and its basis in good science, sure does make one feel good about oneself. None of this is to say that we shouldn’t work to make medicine and medical science more transparent, but it is to say that Dreger has a touching faith in antivaccine parents that doing so will change their mind.

Reading Dreger’s assessment, I couldn’t help but remember how earlier in her post she accused the near-nonexistent members of the pro-vaccine community who, according to her, believe in “vaccine exceptionalism” of being “naïve.” Then, I couldn’t help but go on to think: Pot. Kettle. Black. For how naïve is it to believe that, if only we “fixed” the medical system and the pharmaceutical industry to whatever standards of perfect moral purity to which Dreger thinks we should aspire, parents who are suspicious of vaccines or antivaccine would be much less likely to be so?

Now that’s painfully naïve.

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By Irène Delse (not verified) on 24 Aug 2016 #permalink

Exactly, Irene. Drug companies need to continually make new drugs, and developing ones that actually work is a better business model than "Let's go through the motions and cost of research then just cram the useless results down the sheeple's throats through lobbying, advertising, shill paying and general moustache-twirling.".

By Can't remember… (not verified) on 25 Aug 2016 #permalink

1. I hope Art Caplan directly addresses what Dreger claims about him in her blog. I'm sure it will come down as you suspect, Orac--but her rather insulting claims need a direct refutation from him.

2. Gotta love it when people cite "profit" as a disqualifier. As if Dreger writes for free, Wakefield cons for free, and all the other anti-vaxxers out there sell their untested, unregulated supplements for free.

3. The medical system we have (that in which I practice as an MD using the best science we have to drive clinical practice) is the best system we have for our patients. Is it perfect? No, of course not, but it's continually striving to be better based on continued research. But for someone like Dreger to imply that making a living physician creates an inherent profit-driven COI that renders me unqualified to criticize a Wakefield is ludicrous. There's no way I'm putting on sackcloth and ashes while flagellating myself to be "worthy" for an "ally" like Dreger.

4. Does Dreger not realize that ACIP voted down nasal flu vaccine (LAIV) for this coming flu season based on efficacy data for the last 3 years? That's not "vaccine exceptionalism"--that's clinical science in action that put data over "Big Pharma".

By Chris Hickie (not verified) on 25 Aug 2016 #permalink

Anti-vaccine parents who reject vaccines because of some unethical behavior at times by pharma companies are the equivalent to people who might reject the science behind the internal combustion engine because they of some unethical behavior at times by oil companies.

It is denialsm pure and simple.

Regarding her thoughts about giving Wakefield "fertile ground":

1. Wakefield has no fertile ground in the UK. He realized this and left for the US.

2. Wakefield has found huge piles of fertile ground in the US. Outside of those of us working as individuals against anti-vaccinationists, no large medical groups in the US (such as the AMA, AAFP, AAP, etc) have spoken out against Wakefield. To me this is especially critical since he can't be stripped of his medical license in the US. I could be incredibly naive on this, but I do believe that if people saw denouncements of Wakefield by US medical groups appearing at the top of internet search engines, he would lose his fertile ground in the US.

By Chris Hickie (not verified) on 25 Aug 2016 #permalink

Dreger sounds a lot like Jill Stein on vaccines - suggesting that it's reasonable to buy into antivax arguments because, ya know, Corporate Influence.

The same argument is a staple of anti-GMOers. I was just involved in an online exchange with an otherwise sane-appearing poster objecting to the prospect of genetically modified mosquito release in south Florida. He had to slam Monsanto (though Monsanto has nothing to do with the project and might lose money if fewer chemicals are sprayed) and repeat the meme that farmers "must" buy Monsanto seeds.

This sort of thinking is not reasonable - it's lazy, sloppy, frequently wrong and destructive to good public policy.

By Dangerous Bacon (not verified) on 25 Aug 2016 #permalink

Jill Stein immediately came to my mind as well, DB, as did the similarities with a lot of GMOspeak. What’s frustrating to me is that “BigPharma” tends to dig its own grave with the mind-numbing bombardment of largely lifestyle drugs on TV that perpetuate its money-grubbing image.

By darwinslapdog (not verified) on 25 Aug 2016 #permalink

It's annoying that people bring up the "vaccines must never be questioned" trope. The pertussis vaccine was modified because of safety concerns, yes? And as Chris Hickie points out, the nasal spray was not recommended (a decision that REALLY depresses me, as the mother of a three-year-old needlephobe), hardly the actions of mindless slaves of Big Pharma.

But then, pretty much all of the arguments are the same old, same old tiresome round of lies, half-truths, and irrelevancies. Orac must get tired of the repetition.

By Heidi_storage (not verified) on 25 Aug 2016 #permalink

Heidi @8 -- Orac never gets tired, because fatigue is impossible for a plexiglas box of blinky lights!

Seriously, though, for sheer stamina, the actual man behind the curtain is pretty hard to beat.

By palindrom (not verified) on 25 Aug 2016 #permalink

What’s frustrating to me is that “BigPharma” tends to dig its own grave with the mind-numbing bombardment of largely lifestyle drugs on TV that perpetuate its money-grubbing image.

This and the price-hike scandals and the direct-to-consumer adverts. But vaccines are a whole other animal. I'm fine with being critical of Pharma practices and vigilant about vaccine safety but you don't paint everything with the same brush as Dreger has.

By Science Mom (not verified) on 25 Aug 2016 #permalink

Aw, I really like Dreger's book. Seeing this somehow dulls even that past enjoyment.

By historiography (not verified) on 25 Aug 2016 #permalink

Okay, this really irks me:
Vaccinianity – (Vax.e.an.eh.te)
NO! That would be vax.in.e.an.eh.te!!! They missed a syllable. /rant

Of course "vaccinanity" is a portmanteau of "vaccine" and "inanity". So my first thought was that inanity is very much in the eye of the beholder, and an equally plausible definition would apply to Stagliano et al.

Then I followed the link to Orac's advice on the subject (the post was written in 2008, before I was a regular RI reader). Yikes. It's not full Godwin, because Stagliano et al. can legitimately claim ignorance (as I do about my first reaction), but it's dangerously close to the line.

By Eric Lund (not verified) on 25 Aug 2016 #permalink

“if it didn’t have any effect on the results, why would big for-profit companies donate money to this and that research institution? Of course they want return on investment!”

Of course the pharma companies want return on investment. That's how corporations are expected to behave. And of course their donations influence the direction of research. They want to find out whether the potential wonder drug the folks in the lab have cooked up really is a wonder drug. But for every new drug that wins FDA approval, there are many that do not. Mammals are complicated biochemical systems, and things don't always work the way they do in simplified laboratory experiments.

It's like venture capital. The overwhelming majority of startups fail, so VC investors hope the profits from the successful startups cover the losses from the failures. People I know who play the VC game tell me that a VC investor is considered successful if one out of ten of his investments pays off. I have no reason to think the ratio of actual to potential new drugs is significantly different.

By Eric Lund (not verified) on 25 Aug 2016 #permalink

Vaccinianity frenemies unite!

Even on the vaccines cause sutism issue the never to be questioned claim is wrong, I think, in the sense that I expect many of us will understand and be willing to explain patiently to a new parent concerned about that claim, to someone with real questions whether vaccines cause autism.

It's not questioning vaccines that's the issue. Parents should question. It's those few that repeatedly reject well supported scientific answers.

By Dorit Reiss (not verified) on 25 Aug 2016 #permalink

Dorit Reiss says (#15),

It’s not questioning vaccines that’s the issue. Parents should question. It’s those few that repeatedly reject well supported scientific answers.

MJD says,

I'm a parent who has questioned the safety of some vaccines and have expressed my concerns through articles, citizen petitions, and books.

I support scientific answers with respect to vaccines but am still labelled an American Loon/Antivaccinationist, etc...

Hell, even the Catholic Church I attended in Grade School has a sign that reads "Get Vaccinated".

@ Dorit Reiss,

When you say "Parents should question" what does that imply?

By Michael J. dochniak (not verified) on 25 Aug 2016 #permalink

Before giving their children vaccines, it's appropriate for parents to raise any doubts, questions and concerns they have and get answers to them.

By Dorit Reiss (not verified) on 25 Aug 2016 #permalink

In reply to by Michael J. dochniak (not verified)

I'm not even sure that her basic contention is true - the claim that it's conflicts of interests that creates suspicion and concern in new parents, rather the fact that internet searches for vaccines generate a lot of anti-vaccine sources aiming to cause doubt and fear.

By Dorit Reiss (not verified) on 25 Aug 2016 #permalink

if it didn’t have any effect on the results, why would big for-profit companies donate money to this and that research institution? Of course they want return on investment!

There's another way of looking at big pharma financing public research: outsourcing. It's much easier (and less expensive) for them to finance a project with an already established independant lab than to do it on their own. If there's a molecule involved, the independent lab can also be overjoyed to have it (and often, the company gives the compound for free, and the lab does the research for free). In my field, the protease under study had exactly zero specific inhibitor on the market. To study it pharmacologically, we must have a collaboration with a company who has developped one. Other times, the compound is prohibitively expensive for a fundamental research lab, and the company gives it to the lab. So both sides are winners. It also creates data from more than 1 source (since if a paper gets published, the independant lab gets the credit and most authors, with 1 or 2 company authors dropped in there too.

In the past I have been " willing to explain patiently to a new parent concerned about that claim, to someone with real questions whether vaccines cause autism.". Now, as noted by prominent vaccine researcher Dr. Gregory Poland in an article in this month's Pediatric News ( http://www.pediatricnews.com/?id=7791&tx_ttnews[tt_news]=521265&cHash=1… )

“Patients come in with a 2-inch thick stack of Google searches,” he said. “We need to have time to talk through this with people.” Now, he said, there’s an ICD-10 code for vaccine counseling, which can be used to address the concerns and questions families bring to a clinic visit.

I agree with what Dr. Poland says, but Dr. Poland almost certainly does not see these situation regularly (if at all given his clinical status), nor deal with getting reimbursed for new ICD-10 codes like this for counseling, which rarely happens thanks to the miserliness of insurance companies (you can bill for everything you do--you rarely paid for counseling). What Dr. Poland has correctly described, however, is that most parents have already decided on whether they are going to vaccinate before their first office visit with the pediatrician, as has been noted in a recent AAP NCE abstract noting that "72% (120) of surveyed parents reported deciding on their vaccine preferences for their newborn before conception" ( https://aap.confex.com/aap/2015/webprogrampreliminary/Paper32305.html ). I will state that having someone come in with their google search, or a book by Dr. Bob, Dr. Jay or now yet another anti-vax FAAP pediatician Dr. Paul Thomas with his new book co-authored by anti vaccine "journalist" Jennifer Margulis) is an ominous sign with an extremely high negative predictive value for any chance at convincing the parents to vaccinate either on schedule or at all. In other words, the battle has been lost by that point, which agrees with my last 10 years of clinical experience during which I've given up trying to convince vaccine refusers/doubters.

What I don't need (and clinically is unlikely to work) is Dr. Poland's "time to talk through this with people". What I do need are online sources of information trusted by parents that are actively discrediting and denouncing anti-vaccine physicians and groups--directly by name and with using the very solid science that exists for vaccines. *That* is where the problem is--parents who are scared out of vaccinating are getting their information from the vast anti-vaccine echo chambers of the internet. I am tired of the large US medical academies hoping anti-vaccinationists go away through ignorance (as Dr. Poland posited would happen in his 2011 article "MMR Vaccine and Autism: Vaccine Nihilism and Postmodern Science". ). Anti-vaccinationists are not going away. They are growing stronger, including increasingly mediagenic physicians, who--whether they know better or not--are actively damaging public health infrastructure as well as putting individuals at risk by lowering vaccination rates. Optimistic inaction by groups like the AAP is no longer an option and is unethical as well as we are then relying on further Disneyland-type vaccine-preventable infectious disease outbreaks to do the work we should have been doing these last 10+ years.

By Chris Hickie (not verified) on 25 Aug 2016 #permalink

Doritt Reiss says (#18),

Before giving their children vaccines, it’s appropriate for parents to raise any doubts, questions and concerns they have and get answers to them.

MJD says,

It’s appropriate for parents to raise any doubts, questions and concerns they have, and get answers to them, before accepting or rejecting vaccines for their children.

By Michael J. Dochniak (not verified) on 25 Aug 2016 #permalink

I rolled my eyes when I read Dreger's piece for several reasons. First, I keep wondering why physicists and engineers get trotted out for all science questions, especially biology. I like DRG--but I am getting tired of this.

And anyone giving Wakefield air time. Ugh.

And then her squishy straws. Sigh.

Ok, I get it. You dislike pharma. I keep asking people who tell me this to explain the alternatives to me. I'm open--tell me how you produce future vaccines and other medications without pharma. How do you do quality control? How do you do distribution?

Is this what we can do with all those extra postdocs? Is that what people think we can do?

But let's say they want government to do this. They do realized that gubmint is also a bogeyman to anti-vaxxers, right?

Tell me how this happens in some other framework. I really want to know.

By Mary Mangan (m… (not verified) on 25 Aug 2016 #permalink

It's frustrating when people like Dreger accuse vaccine advocates of being dogmatic while completely ignoring the last 20+ years of antivax history. For years, antivaxxers said frog and public health organizations jumped: the formation of the NVICP, the removal of thimiserol from childhood vaccines, and millions of dollars and man-hours worth of research were all done in a fruitless attempt to reassure the public that vaccines were safe. Not only did this appeasement strategy not work, in many cases it actually backfired: the removal of thimiserol only reinforced the notion that it was dangerous, antivaxxers routinely point to NVICP pay-outs as evidence that vaccines are unsafe, etc. Doctors, scientists, and public health organizations have only fairly recently begun taking a harder line, after it's become abundantly clear that antivaxxers aren't amenable to reason and pandering to them only puts more people at risk.

Allow me to conclude with the obligatory xkcd cartoon.

Yeah, Dreger's thing seems to be to ask pro-vaccine advocates if they've stopped beating their wives. We can't win for losing with her. Basically, her whole shtick seems to boil down to claiming the moral high ground because she is "not an ideologue" and can actually "see the parents' side," while finger wagging at skeptics and scientists trying to combat antivaccine misinformation that it's all our faults for not reforming medicine and pharma to the degree she thinks we should as fast as she thinks we should. It's very self-righteous, not to mention self-aggrandizing. It's also annoying as hell, because it is often skeptics (such as Ben Goldacre) who are most active in combatting the excesses of big pharma.

She's also incredibly naive if she thinks that, even if pharma were reformed to her standards, that there wouldn't be "fertile ground" for antivax views. That's because pharma conspiracy theories are not the reason most parents who refuse to vaccinate make that decision. Usually, they come in later, as the parents go further down the rabbit hole.

I’m a parent who has questioned the safety of some vaccines and have expressed my concerns through articles, citizen petitions, and books.

I support scientific answers with respect to vaccines but am still labelled an American Loon/Antivaccinationist, etc…

You were not labeled an American Loon because you "expressed [your] concerns through articles, citizen petitions, and books".

You are an American Loon because you continue to have no evidence to support your silly ideas, and refuse all efforts made to explain to you the errors of your ways.
http://americanloons.blogspot.com/2013/07/628-michael-j-dochniak-denise…

Even after your book was gutted like a trout, you still persist in your silly fantasies.

https://web.archive.org/web/20120222133407/http://photoninthedarkness.c…

This link goes to a gone, but not forgotten, blog, and is part 2 of the deconstruction of MjD's book. Parts 1 & 3 are linked to on the archived page, but part 2 gets to the core of the matter.

So she hasn't completely joined the dark side?

There are even FDA employees that go full antivaxx, like this guy: There is a great deal of evidence to prove that immunization of children does more harm than good.” – Dr. J. Anthony Morris, Former Chief Vaccine Control Officer and Research Virologist U.S. FDA

Perhaps we should get Cadbury to make chocolates that look like little syringes for the people in limbo.

And if that fails we can have a duel with light-sabers.

By Ted Striker (not verified) on 25 Aug 2016 #permalink

So she hasn’t completely joined the dark side?

After some casual reading, I'm not sure that Dreger has any "sides" other than Dreger's. It seems to be identity politics wrung to a lone participant.

parents who are scared out of vaccinating are getting their information from the vast anti-vaccine echo chambers of the internet

Agreed that this is the fundamental problem. One of the biggest problems with Facebook (not that they initiated the trend, but they certainly accelerated it) is that it encourages users to seek out like-minded users and information sources that support their pre-decided point of view. Anti-vaccine activists have exploited this feature (not bug!) quite adeptly.

One of the many reasons I don't do Facebook is that I don't want to know how many of my high school classmates have become right-wing nut jobs (I am of the generation that came of age during Reagan's presidency; I knew that at least some already were right-wing nut jobs by the time we graduated). That extends to other facets as well: how many are anti-vaxers, how many are into such blatantly obvious medical nonsense as homeopathy or touch therapy, how many are gold bugs, etc. They can get all their information on the relevant topic from fellow Republicans, anti-vaxers, alt-med types, lunatic economists, or whatever, without consulting people who actually know anything about the topic in question.

By Eric Lund (not verified) on 25 Aug 2016 #permalink

This is a keeper, though:

"As Trust No One books go, Galileo’s Middle Finger isn’t top-shelf. It’s not nearly as gripping, for instance, as Sharyl Attkisson’s Stonewalled."

^ Eh, borked the italics.

Science Mom @10: There's also this huge misconception that the researchers who work for pharma making vaccines and drugs and stuff are the same people who make the advertising campaigns and set the prices. No. That's marketing and sales, not R&D, or quality, or manufacturing.
That's like screaming at a tomato picker because the price of pizza sauce went up.

By JustaTech (not verified) on 25 Aug 2016 #permalink

That’s like screaming at a tomato picker because the price of pizza sauce went up.

Yup, spot on.

By Science Mom (not verified) on 25 Aug 2016 #permalink

If we take this as a debate between Orac and Dreger, imho both parties are employing the same double-standard, in that both are writing polemics with the effect of telling the other 'Don't be so polemic!'. Dreger certainly overstates and over-generalizes. However, the best response to someone playing 'devil's advocate' is not to pick at the details that are wrong, but to ask 'to what extent or in what way might any of these these critiques have elements of truth it would be productive to consider?'.

The difference between Stein and Dreger is that Stein is disingenuously raising suspicion of 'Big Pharma' regarding vaccines to justify a problematic platform plank on vaccination policy, while Dreger is calling for better behavior in general on the part of pharmaceutical companies, and for more criticism of the pharmas by 'pro-science' advocates to pressure them to better behavior in general.

Where Drager loses her way is failing to clearly name the problem she sees: The bad acts of pharma companies – acts which have nothing to do with the production and distribution of vaccines like the MMR – create an understandable suspicion of 'Big Pharma' that rubs off on the issue of vaccines, and helps "feed" antivaccine campaigns.

I submit then that the best response to her critique is to filter out the hyperbole wrapping that central claim, and ask ourselves:
1) What role does suspicion of 'Big Pharma' have in "feeding an antivaccine claims"? How much fuel does it provide? Where and how?
2) What, if anything, should pro-vax advocates do to reduce/counter this 'feeding'?

Dreger's attempt to state the broad point I've identified – referring to "Wakefield as a symptom of legitimate suspicion among patients and parents" – employs language way too open to confusion and,conflation. You could read it as suggesting vaccine-suspicion is legitimate, which Dreger pretty clearly does not believe. And you could read it as saying this 'condition' of "legitimate suspicion" is a direct and primary cause of the "symptom" of Wakefield, rather than merely a contributing component of a fairy complex causal puzzle which includes not only multiple moving parts, but multiple steps and paths.

What I'm arguing is that if we didn't treat Dreger with hostile dismissive rebuttal, but looked instead at 'how or in what way this sort of critique might be valid' we'd be able to get a better handle on those different parts, paths and steps. Unfortunately, too much of the discussion in this thread just reproduces and reinforces the confusion/conflation mucking up her argument.

The issue, as I've observed repeatedly here, is that 'Big Pharma' does not exist. The term evokes a monolithic pharmaceutical industry, in which all values, principles, actions etc. are shared in every manifestation. In reality there are 'big pharmas' plural – a number of large corporations that dominate the industry, but have many differing interests which lead to some important differences in values, principles, actions etc. Moroever, typical of large corporations in general, the big pharmas are composed of many different divisions, broken down both by product lines and job functions – each of which may play different roles in the corporate structure – thus expressing the larger corporate interest in different and sometimes contradicting ways, again leading to important differences in values, principles, actions etc.

Which is to say that suspicion of, say the MMR, is a composition/division fallacy, in which the bad acts of some divisions of some pharmaceutical firms are taken to characterize the whole, which is then taken to characterize every part of the whole. Thus, for example, the 'bad apple' of Mylan's predatory pricing of EpiPens doesn't mean there are worms in Merck's medical scrutiny of the safety of the MMR.

Any attempt at discussing the pharmaceutical as a whole is almost certain to be falacious in terms of some of its parts, and will ultimately fail to support vaccination practice. The argument must address the specifics of the manufacture and distribution of the vaccine in question.

Here, it seems to me, Dreger fails spectacularly in saying: "vaccines are pushed in and by a medical industrial complex that is, particularly in the United States, rife with financial conflicts of interest, overtreatment, and iatrogenic harm from practices adopted without sufficient evidence," since, as far as i know, standard vaccines aren't "pushed" by their manufacturers to any significant degree. Where the pharmas do "push", and where bad acts most often follow, are new proprietary medications in a few extremely profitable market segments: e.g. meds for BP, heart disease, asthma, stomach acid, and psych issues.

The flipside of this coin is seen in comments 1, 2, 3, 14, 20 and 24, which attempt to justify the actions of pharmaceutical firms sui generis. This both reproduces the harmful myth of monolithic 'Big Pharma' and is doomed to failure since the pharmas do, in fact, act like disgusting greed-head assholes on a fairly regular basis. For example, Eric guesses that the profits on successful products are balanced to some level of reasonableness by the losses on failed products. They're not. According to BBC business reporter Richard Anderson:

Drug companies justify the high prices they charge by arguing that their research and development (R&D) costs are huge. On average, only three in 10 drugs launched are profitable, with one of those going on to be a blockbuster with $1bn-plus revenues a year. Many more do not even make it to market. But drug companies spend far more on marketing drugs - in some cases twice as much - than on developing them. And besides, profit margins take into account R&D costs. (http://www.bbc.com/news/business-28212223)

Anderson notes that in the previous fiscal year, Novartis spent $9.9bn on R&D, $14.6bn on Sales and Marketing, and turned a 16% profit; GSK spent $5.3n on R&D, $9.9bn on Sales and Marketing, and turned a 21% profit; AbbVie spent $2.9bn on R&D, $4.3bn on Sales and Marketing, and turned a 22% profit; and Pfizer spent $6.6bn on R&D, $11.4bn on Sales and Marketing, and turned a 43% profit. The pharmaceutical industry has the highest profit margin of any industrial sector. {Oh, btw, MMR maker Merck spent $7.5bn on R&D, $9.5bn on Sales and Marketing, and turned a 10% profit.)

Props to Science Mom #10 for making the essential point "vaccines are a whole other animal" (well, actually 'standard vaccines,' since new proprietary specialized vaccines can fall into dark-side practices) and to JustaTech #34 for the excellent pizza analogy (although it would be better stated as "screaming at the chef who came up with the dough recipe because the kitchen manager does nothing about cooks spitting in the sauce".)

Prof. Reiss #19 raises the question of whether suspicions of Big Pharma play a significant role in the creation of doubt and fear about vaccines in new parents. Orac #27 suggests (quite rightly imho) that even if all pharmas were ethically spotless, the seeds of vaccine fear of vaccines would still find plenty of fertile ground.

But both Prof. Reiss and Orac fall victim to Dreger's hyperbole, and overstate her overstatements. She doesn't actually "claim that it’s conflicts of interests that creates suspicion and concern in new parents". it's not either/or. Similarly, when Orac asserts "Pharma conspiracy theories are not the reason most parents who refuse to vaccinate make that decision. Usually, they come in later, as the parents go further down the rabbit hole" the exceptions to the 'most' and 'usually' can still be important, especially since framing the issue as "conspiracy theories' rather than 'understandable suspicion' begs the question. It's entirely possible that an understandable suspicion of the pharmaceutical industry is the precondition that tilts the scales in some concerned new/expecting/prospective parents' decision to read an email or social media post questioning 'vaccine safety' instead of just deleting or passing over it in the too-full in-box, which then leads to he Google search spitting out more sources reaffirming doubt and fear.

A key point here is that what we need to understand is not so much Dreger's "why so many people are susceptible to false claims about vaccines", but how generally reasonable people reach levels of fear and doubt sufficient to withhold their children from scheduled innoculations. This is a process, that occurs over time, and in many if not most case is not univocal. That is, at some point before a vax/don't vax decision is made, the parent will likely encounter some pro-vax argument, and some critique of anti-vax arguments.

Thus, when Dreger writes "Vaccine exceptionalism feeds anti-vaccine campaigns by contributing to the sense among vaccine-worried parents that the “pro-vaccine” campaign isn’t really thoughtful or scientific," pro-vaxers would do well to take this as a badly phrased prod to examine how their credibility with the as-yet-merely-worried is affecting by their treatment of 'Big Pharma suspicions'.

For example, I can imagine 'suspicious, concerned, but undecided' readers being very put off by the last two sentences of Orac's #27. There is no apparent empathy, no apparent room for their suspicions or indecision. The first is inferentially characterized as "conspiracy theory' and the second as 'already gone down the rabbit hole.' Orac is not a 'vaccine exceptionilst' of course, but if what those sentences read like isn't 'vaccine exceptionalism', it's close enough that it may not make a difference to such readers – who are exactly the 'vax hesitant' people we need to reach.

I’m not sure that Dreger has any “sides” other than Dreger’s. It seems to be identity politics wrung to a lone participant.

Via Narad's link:
Instead, they published a piece of pure inanity by a professor of bioethics, Alice Dreger

I find myself wondering, not for the first time, what *is* this academic speciality of "bioethics"? It's not like there are absolute values, to be constructed from first principles through the magical powers of philosophy. If you want to know whether transplants or reproductive techniques (say) meet the moral standards of one's society, hire a pollster. If you want to convince the majority to accept some technique that they currently oppose, hire a propagandist.

If Professor Drager's career is built on taking a responsibility of every citizen (making ethical judgements) and transforming it into an academic speciality reserved for the elite, I don't know where she gets off, complaining that vaccines are disenfranchising parents.

By Herr Doktor Bimler (not verified) on 25 Aug 2016 #permalink

This expert in bioethics has no problems with publishing a book (Galileo's Middle Finger) with a grossly misleading title.

For all sadmar's tergiversations (he seems to be competing with Dreger in this), I can't help thinking that Orac #27 and the xkcd #26 have hit several nails on the head.

By Peter Dugdale (not verified) on 25 Aug 2016 #permalink

@Dorit #19 - While I can't speak for parents today, when I was researching the issue back in the late 90's (prior to Wakefield's study being published), the reason we ended up declining the Hep B shot for our newborn son was due to the fact that conflict of interests that existed at that time for members of the CDC committee that made vaccine recommendations. Nearly all members of that committee had filed waivers regarding a conflict of interest in order to sit on the committee. This would have been back in late 98 or early 99.

Most parents of young children aren't able to devote the time and resources necessary to study the scientific evidence. They depend on other sources to assess the evidence and make recommendations. If they don't trust the people making that recommendation - whether due to perceived conflicts of interest or for other reasons - they won't accept their assessments.

By Beth Clarkson (not verified) on 26 Aug 2016 #permalink

@Beth #40: you must actually be a pretty unusual parents. Most parents I talk to ask whether this is an important disease to prevent, what are the risks of the vaccine, why should my baby get it, and so forth - and that's what they look up. The recommendation process comes up, if at all, late in the discussion, and most are unlikely to have even heard of ACIP.

By Dorit Reiss (not verified) on 27 Aug 2016 #permalink

In reply to by Beth Clarkson (not verified)

@Beth Clarkson:

he reason we ended up declining the Hep B shot for our newborn son was due to the fact that conflict of interests that existed at that time for members of the CDC committee that made vaccine recommendations. Nearly all members of that committee had filed waivers regarding a conflict of interest in order to sit on the committee. This would have been back in late 98 or early 99.

I'm going to have to say, "citation needed".

By Julian Frost (not verified) on 26 Aug 2016 #permalink

Beyond ACIP (which recommended newborn hepatitis B vaccination in November of 1991), both the American Academy of Pediatrics and American Association of Family Practice followed suit with similar recommendations months later. Should both of those organizations been similarly ignored due to alleged "conflicts of interest"?

At what point are parents derelict in their duty to their children if they say they don't have time to read articles documenting why vaccines are necessary, but readily accept vague claims of "conflict of interest" on the part of health experts?

By Dangerous Bacon (not verified) on 26 Aug 2016 #permalink

[W]hen I was researching the issue back in the late 90’s (prior to Wakefield’s study being published) . . . . This would have been back in late 98 or early 99.

*Koff*

So anyway, I just rose from another accursed nap and checked out the latest installment of the Dachel Morning Movement at AoA.

Protip: You should probably first check whether the schools you're trotting out are private, Anne. Or have fewer than 80 students total K–6.

@42: "Beyond ACIP (which recommended newborn hepatitis B vaccination in November of 1991), both the American Academy of Pediatrics and American Association of Family Practice followed suit with similar recommendations months later. Should both of those organizations been similarly ignored due to alleged “conflicts of interest”?" I don't know. I didn't research them at that time. Are conflict of interest statements filed for the decision makers in those organizations? Is there any way of knowing if institutional bias was baked into their recommendation process?

It doesn't matter. The recommendations I was paying attention to as the parent of a newborn was ACIP. I assessed them as biased based on the documentation they had to file so that the public - meaning me - had a chance to include that in our assessment.

At what point are parents derelict in their duty to their children if they say they don’t have time to read articles documenting why vaccines are necessary, but readily accept vague claims of “conflict of interest” on the part of health experts?

Parents are entitled to assess whatever information they have available, weighing the trust they have in those individuals regarding what choices they will make. That you don't necessarily agree with their decisions is why they are entitled to make those choices. Deciding against a common preventative measure for whatever reason, including religious reasons, is NOT neglectful in a tolerant society.

By Beth Clarkson (not verified) on 26 Aug 2016 #permalink

That you don’t necessarily agree with their decisions is why they are entitled to make those choices.

Or something. Analyzing this on a vibrational level, though, it does get really tedious to point out that choices can have consequences.

Deciding against a common preventative measure for whatever reason, including religious reasons, is NOT neglectful in a tolerant society.

If there were a corresponding knob on some sort of public health machine, from zero to eleven ten, how far clockwise would you say Mary Mallon was set?

For that matter, if there's one knob, there could be all sorts. How about the squelch? That seems apropos.

Beth: "The recommendations I was paying attention to as the parent of a newborn was ACIP. I assessed them as biased based on the documentation they had to file so that the public – meaning me – had a chance to include that in our assessment."

What documentation are you talking about? And what "bias" do you believe the AAP and AAFP were guilty of?

"Deciding against a common preventative measure for whatever reason, including religious reasons, is NOT neglectful in a tolerant society."

Does your view apply only to vaccines, or are other "common preventative measures" (such as child car seats, seat belts, healthy diet and securing household cleaners and weapons) also optional in "a tolerant society"?

By Dangerous Bacon (not verified) on 27 Aug 2016 #permalink

@Beth 47: of course deciding against a common preventative measure can be neglectful.

I recommend against trying "well, I didn't think watching my toddler was in the bath was important" or "I have a religious objection to smoke detectors" as justifications if something happens.

By Dorit Reiss (not verified) on 27 Aug 2016 #permalink

@49 - The documentation I was referring to were the statements acknowledging financial conflict of interests with their membership on the ACIP committee and the waivers required for them to serve on that committee despite the conflict of interest. The bias I suspected was that due to those financial conflicts of interest, their decisions would be weighted towards approval of vaccines.

As far as my opinions on other matters, yes I think that society should be tolerant of parents with regard to dietary choices, restraint systems, etc. While it's reasonable for society to have bounds on those choices, I prefer a society that leans towards tolerance of different choices.

By Beth Clarkson (not verified) on 27 Aug 2016 #permalink

@Beth:

The recommendations I was paying attention to as the parent of a newborn was ACIP. I assessed them as biased based on the documentation they had to file so that the public – meaning me – had a chance to include that in our assessment.

That does not answer my question. Link to the specific documentation you used to make your decision. Tell us why you believed that they were biased.

Deciding against a common preventative measure for whatever reason, including religious reasons, is NOT neglectful in a tolerant society.

Yes it is. In fact, your religious argument was an especially bad one. Parents who used the power of prayer and failed to take their children to hospital have been convicted of neglect. Indeed, Orac has posted about several cases on this very blog.
"I don't wanna!" is the argument of a child.

By Julian Frost (not verified) on 27 Aug 2016 #permalink

@50 - You are correct, my statement was too absolute. Did you have any response to my point that trust in the individuals that comprise the decision making bodies is important to parents when evaluating what vaccines to give their children?

By Beth Clarkson (not verified) on 27 Aug 2016 #permalink

I see you commented as I was writing.

The documentation I was referring to were the statements acknowledging financial conflict of interests with their membership on the ACIP committee and the waivers required for them to serve on that committee despite the conflict of interest. The bias I suspected was that due to those financial conflicts of interest, their decisions would be weighted towards approval of vaccines

You'll have to be a little more specific. What were their financial conflicts of interest? Why did you think that would bias them towards vaccines?

I think that society should be tolerant of parents with regard to dietary choices, restraint systems, etc. While it’s reasonable for society to have bounds on those choices, I prefer a society that leans towards tolerance of different choices.

We are tolerant of choices to a certain extent. Nonetheless, when parental choices have the potential to harm either their children or other children, then society and the government have the right, indeed the duty, to intervene.

By Julian Frost (not verified) on 27 Aug 2016 #permalink

A link to the COI information would be useful.

And everyone had to sign one to participate is not enough evidence as even when not one person on the committee has a conflict of interest they all still have to sign the form.

So simply a COI form was filled out is not enough for me, maybe for others, but I have to sign them even when there is no conflict of interest for the project I am on or the paper I author, etc.

Of course most experts on a subject may have done a clinical trial with the company, but often it is someone in their department got money or their brother own stock or something much more indirect even if they do have a conflict to declare.

To clarify...if it wasn't clear enough.

Everyone signs a COI form

Even when one has no conflict one must file the paperwork.

So a link to the actual COI's so we can count how many and of what severity is needed. Not just you know COI's were filed because, anyone in science at all knows everyone on the committee filed a form to participate, even those with no conflict and it usually is the same damn form you just click off different things if you have one or not.

@Kay and Julien. To the best of my knowledge, information from that long ago is not posted on the CDC cite. Current information is. Last I looked, a few years ago, there were two members of the committee who had filed the paperwork necessary declaring specific conflicts of interest with firms involved in manufacturing vaccines. If you are actually interested, feel free to put the work in to confirm or disprove what I recall from my personal research nearly twenty years ago.

My point is not to defend my choice or the information I used in making it. My point is that such information is available - even if not easily accessed - for the purpose of allowing individuals such as myself to be aware of those biases and weight the opinions of the committee as we feel appropriate based on that information. It's well known that financial conflicts of interest are biasing, often in subtle rather than overt ways...that's why we have laws requiring such information to be publicly available.

By Beth Clarkson (not verified) on 27 Aug 2016 #permalink

@Richard Frost We are tolerant of choices to a certain extent. Nonetheless, when parental choices have the potential to harm either their children or other children, then society and the government have the right, indeed the duty, to intervene.

Exactly why they should outlaw vaccination!
The vaccination policy unnecessarily puts children in harms way.

By Vaccine Truther (not verified) on 27 Aug 2016 #permalink

The vaccination policy unnecessarily puts children in harms way.

What are the risks of not vaccinating compared to the risk of vaccinating? Please be specific. Thanks.

By Mephistopheles… (not verified) on 27 Aug 2016 #permalink

I prefer a society that leans towards tolerance of different choices.

Personally, I prefer a society where parents aren't allowed to kill their kids through stupid choices.

By shay simmons (not verified) on 27 Aug 2016 #permalink

@ Shay Simmons I prefer a society where parents aren’t allowed to kill their kids through stupid choices.

I know. That is why the parents should be informed that vaccination causes SIDS.

Sudden Inoculation Death Syndrome

By Vaccine Truther (not verified) on 27 Aug 2016 #permalink

Oh hi Fendelsworth.

By Science Mom (not verified) on 27 Aug 2016 #permalink

Vaccination is not a cause of SIDS. This was investigated by a team at Bristol University, including Peter Fleming, perhaps the world's foremost expert on SIDS.
http://research-information.bristol.ac.uk/en/publications/reanalyses-of…
From the abstract of the above report:

There is no increased or reduced risk of sudden infant death during the period after the vaccination.

By Julian Frost (not verified) on 27 Aug 2016 #permalink

Oh yeah? Then why is it called Sudden Inoculation Death Syndrome?

By Vaccine Truther (not verified) on 27 Aug 2016 #permalink

@Beth Clarkson:

If you are actually interested, feel free to put the work in to confirm or disprove what I recall from my personal research nearly twenty years ago.

That's not how it works here. You make a claim, YOU stump up the evidence.
@Vaccine Liar:
The fact that you renamed SIDS from "Sudden Infant death Syndrome" does not mean vaccinations caused it, troll.

By Julian Frost (not verified) on 27 Aug 2016 #permalink

So, to summarize:

Beth Clarkson first posted that "Nearly all members of (the ACIP committee recommending newborn vaccination for hepatitis B) had filed waivers regarding a conflict of interest in order to sit on the committee." (whatever that means).

Now she tells us "Last I looked, a few years ago, there were two members of the committee who had filed the paperwork necessary declaring specific conflicts of interest with firms involved in manufacturing vaccines."

Hmm, looks like the alleged conflicts of interest have declined dramatically in Beth's telling.

"If you are actually interested, feel free to put the work in to confirm or disprove what I recall from my personal research nearly twenty years ago."

Nope. You made the allegation in all its glorious vagueness, it's up to you to document it.

"It’s well known that financial conflicts of interest are biasing, often in subtle rather than overt ways"

Personally, I don't handwave away good healthcare advice because an expert (allegedly) reported a potential conflict of interest. I don't even dismiss bad healthcare advice solely because of someone's conflict of interest, although it makes me question what they say and look into it more deeply. For instance, there's Andrew Wakefield, who concealed a glaring conflict of interest when submitting his MMR paper for publication (failing to reveal that he'd accepted a huge amount of money from a lawyers' group hoping to sue over the vaccine, and that he submitted a patent application for a competing vaccine).

I see Beth believes society should be "tolerant" towards parents' dietary choices for their kids, restraint systems in autos etc. Does that mean she's OK with children becoming sick or dying because they're fed improper foods, or flung about in car accidents and injured or killed because their parents ignored good advice (and laws) about child restraint seats or seat belts?

If that's "tolerance", I confess I'm on the side of intolerance. This doesn't necessarily mean removing kids from their parents' custody, but there should be a price for the parents to pay to discourage willful neglect and protect children.

By Dangerous Bacon (not verified) on 27 Aug 2016 #permalink

VT (aka as identity confused troll): "Then why is it called Sudden Inoculation Death Syndrome?"

Only you do that, perhaps because you made it up.

^^ In addition to the failure of the SB 277 injunction, Quackwatch has prevailed over the "American Academy of Anti-Aging Medicine" quacks Goldberg & Klatz. Must've been a rough week for Pattimmy.

I'm sure he'll be right on these stories.

@Beth Clarkson - Do you happen to live in Idaho?

It's the attempted necromancing that's truly pathetic ("go Rand" – presumably now "go Trump" – appears to the the first at AoA, as well*).

* Lagging behind NVIC commenter "Jenny M": goo[.]gl/HQBJly

^ Um, the lead-in blockquote there was supposed to be "Oh hi Fendelsworth."

@61 "Personally, I prefer a society where parents aren’t allowed to kill their kids through stupid choices."

I think that a society that allows parents to make what society might currently consider 'stupid choices' will minimize the number of children killed due to 'stupid choices'. While committees may make fewer choices later labeled 'stupid' after someone dies; when they do, it impacts far more people.

By Beth Clarkson (not verified) on 27 Aug 2016 #permalink

@66 - You seem to have mistaken my attempt at conversation for a debate challenge. I am not interested in defending my belief at that time as correct - I may have made an error in either my original research or my recollection of it. I was merely pointing out that such information is pertinent and some parents do look into it.

By Beth Clarkson (not verified) on 27 Aug 2016 #permalink

@Beth Clarkson – Do you happen to live in Idaho?

Kansas.

@Beth Clarkson:

I think that a society that allows parents to make what society might currently consider ‘stupid choices’ will minimize the number of children killed due to ‘stupid choices’

I can't agree. In fact, I would strongly argue that the opposite is true.

By Julian Frost (not verified) on 27 Aug 2016 #permalink

@75
Oh...I see.

I think that a society that allows parents to make what society might currently consider ‘stupid choices’ will minimize the number of children killed due to ‘stupid choices’

I can’t agree.

Kind of hard to go one way or the other when confronted with word salad.

I agree. Ms Clarkson's statements need lack cogency.

By Ted Striker (not verified) on 27 Aug 2016 #permalink

LOL.

By Ted Striker (not verified) on 27 Aug 2016 #permalink

@76 Okay. We can disagree on that point. Why do you feel that way?

My own opinion is based on my own subjective opinion having been a quality improvement professional for close to thirty years now. I find that optimum performance to management's goals is achieved by allowing the individuals closest to the process the ultimate decision making authority. It often seems counter-intuitive, yet that's where the highest probability of success usually lies.

By Beth Clarkson (not verified) on 27 Aug 2016 #permalink

Beth: "I am not interested in defending my belief at that time as correct – I may have made an error in either my original research or my recollection of it."

So the progression has gone from "nearly all" ACIP committee members had alleged conflicts of interest, down to two members, and now to well-I-may-have-been-wrong.

In my book, wrongfully accusing others is a form of ethical malfeasance.

By Dangerous Bacon (not verified) on 27 Aug 2016 #permalink

Guys as we are talking COI, I have a confession to make, I'm now taking Big Pharma Lucre! :O

After decades working in all sorts of industries from Charities, Nightclubs, Industrial, Marketing, Software, etc I'm now working for a pHarma distributer, that Promotes Vaccinations!!!!

Well it's a bit indirect, I work for an agency, that sub contracts me to another agency, that has been hired to upgrade the computers and peripherals of the final client.

The contract ends in two weeks, then I'm swapping servers for a Retail Giant (Big Clothing). My question is:

How long will my Big Pharma Taint last?

#78

I find that optimum performance to management’s goals is achieved by allowing the individuals closest to the process the ultimate decision making authority. It often seems counter-intuitive, yet that’s where the highest probability of success usually lies.

Oh, dear. Too much time dealing with corporate jargon does have a tendency to impair a person's ability to write in a comprehensible fashion.

I think that a society that allows parents to make what society might currently consider ‘stupid choices’ will minimize the number of children killed due to ‘stupid choices’

So, "tolerating" a few deaths here and there from, say, substituting prayer for medical treatment will minimize the number of deaths due to substituting prayer for medical treatment?

How would this, ah, process – in detail – yield "optimum performance to management’s goals"? How quickly would the benefits set in? How long would it take for them to decay to baseline?

Let me help Ms. Clarkson.

I think she was referring to the conflicts of interest prevalent in the Rotavirus vaccine approval that was investigated by the Committee on Government Reform of the House of Representatives circa 2000. It was revealed that many of ACIP's voting members had conflicts of interest that they either did not disclose fully or were waived by the CDC.

This was some time ago, and there is no doubt that the committee members are different people now; both physically and financially. Perhaps the rules of disclosure and the practice of waiving the conflicts of interest had changed in the interim between the Rotavirus Vaccine recommendations and the Hepatitis B Vaccine recommendations.

What Ms. Clarkson has to do is find documentation for the conflicts of interest of the ACIP members during the time the HepB vaccine was advised to the CDC.

I hate reading legalese and legislative transcripts, so I won't be of much help.

By Ted Striker (not verified) on 27 Aug 2016 #permalink

So anyway, I just rose from another accursed nap and checked out the latest installment of the Dachel Morning Movement at AoA.

Protip: You should probably first check whether the schools you’re trotting out are private, Anne. Or have fewer than 80 students total K–6.

I'm disturbed by the fact that, in order to read AoA, I have to turn off Ghostery and allow all sorts of trackers to track my browsing.

From the Erratically Nested Comments Are a Bug Dep't (emphasis added):

@Dorit #19 – While I can’t speak for parents today, when I was researching the issue . . . , the reason we ended up declining the Hep B shot for our newborn son was due to the fact that conflict of interests that existed at that time for members of the CDC committee that made vaccine recommendations. Nearly all members of that committee had filed waivers regarding a conflict of interest in order to sit on the committee. . . .

Most parents of young children aren’t able to devote the time and resources necessary to study the scientific evidence. They depend on other sources to assess the evidence and make recommendations. If they don’t trust the people making that recommendation – whether due to perceived conflicts of interest or for other reasons – they won’t accept their assessments.

@Beth #40: you must actually be a pretty unusual parents.

Dorit beat me to it.

Since Beth brought up the field of quality imrovement, I did a quick search and most of the top Google hits involved the healthcare industry, including this one from HRSA

QI program involves systematic activities that are organized and implemented by an organization to monitor, assess, and improve its quality of health care

I got some training on the quality improvement process about 30 years ago and, as I recall, it involves getting the people actually involved in producing the product to suggest and make incremental improvements in the design and production of the product.

From that point of view, it's hard to see how Beth's individual no vote on one vaccine provided any input to change the design or production of the Hep B vaccine.

On the other hand, even the withdrawal of the Rotashield vaccine as investigated after the fact by the House as linked by Ted Striker (87) led to replacing a less safe vaccine with a safer vaccine for the same disease.

I did a quick skim of that link and the people whose conflicts were griped about were the sort of thing a good QIP needs, developing new vaccines, testing them for safety and efficacy, etc.

By squirrelelite (not verified) on 27 Aug 2016 #permalink

@Squirrelelite

Did you know that Gilbert eats squirrels?

And I quote: Tree rats, get in mah belly.

You had better watch out!

By Ted Striker (not verified) on 27 Aug 2016 #permalink

I've had a few periods in my life when I've been involved in decisions to vaccinate. As a child growing up in the 50's, I had to experience several of the diseases we can now protect against first hand. Even though I and my siblngs suffered no long term bad effects, we were worried about them and the diseases themselves were no fun.

I only had to go back 2 presidents to get to a president who was confined to a wheelchair because of polio, swimming pool closures were a regular part of the summer routine, and a person in an iron lung was a plot feature in many TV drama shows. So, when they came out, lining up in the school cafeteria to get the first polio vaccines was a no-brainer.

About 10 years before Wakefield's study was reported and Beth was doing her research, I was takng 4 kids to get their vaccinations. The wait afterwards in the immunization clinic was a reminder of the possibility of an adverse event, but the worst that we experienced was a bit of mild fever. And we were definitely glad our kids didn't have to get their immunity the hard way.

The only vaccine I've been lackadaisical about was the flu vaccine, mainly because of the way it was rolled out each year. Elderly and health care professionals need to get it right away, the rest of you can wait till whenever. I changed that about 10 years after Beth's research when I was working in the school system and had access to websites like this one. When I read how the H1N1 variant was killing children like the ones I was working around, I knew it was important to help protect them, took advantage of the school vaccination program, and have been getting my annual flu shots every year.

The last two mornings I've been babysitting my 2 month old grandson, who got 5 shots 2 days ago. Evidently my suggestions to my son paid off because the mother drug him along to share the blame! The boy was more restless than usual yesterday but back to normal today. He makes eye contact at greater distances now, calms down quickly when i pick him up and cuddle him, makes a lot of sounds, and seems to enjoy it when I read poems to him or sing along with a playlist I've made. It only took him most of a bottle and a couple songs while walking up and down the hall for him to doze off.

Definitely no lights out yet.

By squirrelelite (not verified) on 27 Aug 2016 #permalink

From that point of view, it’s hard to see how Beth’s individual no vote on one vaccine provided any input to change the design or production of the Hep B vaccine.

I thought "management's" "goal" was uptake. One way or the other, waiting for liver disease to set in seems like an awfully crappy metric for this routine:

I think that a society that allows parents to make what society might currently consider ‘stupid choices’ will minimize the number of children killed due to ‘stupid choices’. While committees may make fewer choices later labeled ‘stupid’ [or not, whatever, I guess] after someone dies; when they do, it impacts far more people.

Beth Clarkson:

My own opinion is based on my own subjective opinion having been a quality improvement professional for close to thirty years now. I find that optimum performance to management’s goals is achieved by allowing the individuals closest to the process the ultimate decision making authority. It often seems counter-intuitive, yet that’s where the highest probability of success usually lies.

Be wary of applying lessons learned in one industry to a different, more complex situation. I also work in industry (I'm an engineer) and I have to agree that in this context, giving stakeholders more direct control over the process generally pays off handsomely in the form of a better product.

But that's process improvement, where the measure of "better" is how well management's goals are being met, and we can safely assume everyone is committed to meeting those goals. That is where the analogy to making medical decisions for your children breaks down.

You assert that because the QIP work you've done shows that giving stakeholders more direct control of a process improves quality, that fewer children will die if we allow parents to make stupid choices for their children. I have to point out that this is not something where we need to make inferences from our corporate process improvement experience in order to predict the future. We can look at the actuals.

In this case, the actuals are what happens when indeed parents are given free reign to make stupid decisions for their children. You were asked if you live in Idaho; this was not a random question, but rather an oblique reference to the fact that Idaho has some of the most permissive religious shield laws in the nation -- and also an awful lot of cemeteries where headstones have birth and death dates quite close together. Child mortality is markedly higher when parents are allowed, without repercussions, to choose to substitute prayer for medical treatment, or to choose nothing at all simple because the parents can't be bothered. Now, I do think parents should be able to make medical decisions on their childrens' behalf, but we cannot give them carte blanche.

And honestly, we should not give stakeholders in the workplace carte blanche either. While in general your statement is correct in project management, one should always be on the lookout for employees with poor judgement or employees who are not interested in the process beyond the bit that they work with, or who are indeed not even particularly committed to the project's success. I remember working with one individual who was so deeply convinced of the futility of the program that he blew off critical defects merely because in *his* opinion, they didn't matter. He was very much wrong, and it cost us.

I would say those closest to the process should have maximum input into the decision making process, but not necessarily ultimate authority. Someone needs to make final decisions, and adjudicate conflicts, not just let a free-for-all gradually evolve your overall process towards something coherent.

By Calli Arcale (not verified) on 27 Aug 2016 #permalink

We can look at the actuals.

This cries out for "have a convo re" instead.

I was going to answer Beth Clarkson's challenge to me @81, but Narad @85 absolutely nailed it.

So, “tolerating” a few deaths here and there from, say, substituting prayer for medical treatment will minimize the number of deaths due to substituting prayer for medical treatment?

How would this, ah, process – in detail – yield “optimum performance to management’s goals”? How quickly would the benefits set in? How long would it take for them to decay to baseline?

Boom goes the dynamite.

By Julian Frost (not verified) on 27 Aug 2016 #permalink

#81

Beth you do realize that in this instance, the people who are closest to your childs heathcare are the doctors and scientists who recommend vaccination.

I may be a little out of the debate, but do you know that Luc Montagnier participated to the movie Vaxxed?:

Message transmitted by Professor Luc Montagnier, in response to censorship and media lynching organized against documentary Vaxxed:

"Respect scientific truth is the basis of the credibility of the institutions responsible for public health. If they fail in this respect they are seriously exposed to a loss of confidence from the public. The CDC seem to have falsified the results of their own studies that showed a correlation between the onset of autism and vaccination R0R (English MMR) in young African-American children. This falsification, revealed by one of its authors, support the conclusion that the lack of correlation, which has helped to keep vaccinations without changing the conditions. Besides the damage to young victims, this case amplifies the fear of vaccinations in the audience, thus ruining the disease prevention policies. This is what describes the film of Andrew Wakefield, medical researcher and whistleblower with courage and lucidity. "
Luc Montagnier
http://www.congressortirdelautisme.com/pourquoi-le-professeur-luc-monta…

This letter from Montagnier was published on the occasion of a conference in January 2016 in which he participated in company of anti-vaxxers, a homeopath, Natasha Campbell-McBride, Dr. Martha Herbert, DAN! doctors and other dubious persons: http://www.congressortirdelautisme.com/intervenants/

Wakefield, a courageous and lucid researcher, a whistleblower, dare to say Montagnier!

By Suzanne S. (not verified) on 28 Aug 2016 #permalink

Surprising someone so well spoken can be such an idiot.

Suzanne S.
...known as the Linus Pauling effect.

By Peter Dugdale (not verified) on 28 Aug 2016 #permalink

If needed, I’ll bring on my alternate avatar

Ahh! Democracy is two cats and a squirrel voting on who's for dinner; Liberty is one well-armed squirrel contesting the vote.

Message transmitted by Professor Luc Montagnier, in response to censorship and media lynching organized against documentary Vaxxed

The sad part is that he probably didn't even bother to try sending it by homeopathic DNA radio.

While bobcats and cougars both eat rodents and even insects, bobcats prefer rabbits and hares, while cougars go for bigger game such as deer.

Cougars are ambush predators, but it's easy to avoid Gilbert ambush regarding the subject of this blog because he doesn't bother to set one.

By squirrelelite (not verified) on 28 Aug 2016 #permalink

#58 Vaccine Truther

The vaccination policy unnecessarily puts children in harms way.

You're a idiot. I lived through the last Canadian polio epidemic and people were still getting small-pox vaccinations. Come back when you know a little history

By jrkrideau (not verified) on 28 Aug 2016 #permalink

I’m disturbed by the fact that, in order to read AoA, I have to turn off Ghostery and allow all sorts of trackers to track my browsing.

I've never had to do that, but the entire site has been effectively dead from here for over 12 hours. My understanding is that D'Olmsted is the IT tinkerer.