Massive measles outbreaks in Europe: A harbinger of things to come in the US?

If any of you are bloggers out there who like to write about studies, have you ever decided that you wanted to write about a study and discovered as you started writing that your university doesn't have access to the journal? Yeah, that happened to me last night. I had wanted to move on from writing about antivaccine nonsense, as it seems that that's all I've been writing about for the last several days (probably because it almost is), but I couldn't because I couldn't count on someone getting me a copy soon enough to be able to write about it last night. So until I get a hold of the paper vaccines it is again, because I saw an article that reminded me very much of just the sort of thing antivaxers could bring upon us if we let them.

Remember yesterday when I wrote about Kent Heckenlively's unbelievably brain dead proposal for a five year moratorium on childhood vaccines. Yes, it is exactly as ignorant and idiotic as it sounds. As I thought about it more, I was reminded of another post that I had written back in March, about a massive measles outbreak in Romania that at the time had infected 3,400 and resulted in the deaths of at least 17. Then it occurred to me. Wht's happening in Romania now would be a mild harbinger of things to come if antivaxers ever managed to see their vision of stopping or even significantly decreasing the use of childhood vaccines.

That's why it's worth an update, and unfortunately I saw one yesterday that tells me the measles outbreak in Romania is as bad as ever. But it goes beyond just Romania. Behold the horror:

Thirty-five people have died in the past year from measles outbreaks across Europe, the World Health Organization has warned.

It described the deaths - which can be prevented with vaccination - as an "unacceptable tragedy".

A six-year-old boy in Italy was the latest to die from the infection. More than 3,300 measles cases have been recorded in the country.

The most fatalities - 31 - have been in Romania.

But there have also been deaths in Germany and Portugal since June 2016.

Dr Zsuzsanna Jakab, the WHO regional director for Europe, said: "Every death or disability caused by this vaccine-preventable disease is an unacceptable tragedy.

"We are very concerned that although a safe, effective and affordable vaccine is available, measles remains a leading cause of death among children worldwide, and unfortunately Europe is not spared.

It is criminal that a vaccine-preventable disease like the measles is a major cause of death in children in developed nations. We have Andrew Wakefield to "thank" for this. Death and disease in Europe and all over the world are his legacies and will remain his legacies. He is to blame for this.

The Italian child who died was a six year old boy suffering from leukemia who reportedly caught the measles from an older sibling whom the parents had decided not to vaccinate even though their son with leukemia had a compromised immune system and couldn't be vaccinated himself. If that's not a case of child neglect, I have a hard time envisioning what is. In essence, the parents' negligence resulted in the death of their child with leukemia.

As I noted when I wrote about the Romanian measles outbreak, the antivaccine movement is very active there, complete with the usual conspiracy theories, such as the belief that the US purposefully infected people with HIV using polio vaccines and a direct link between vaccines and widespread HIV in Romanian orphanages. As in the US, in Europe a lot of this is driven by social media, where conspiracy theories about big pharma, national governments, the European Union, and Western governments combine with the usual fear mongering using dubious testimonials and bogus scientific studies.

In the face of this, many countries in Europe still do not have mandatory vaccinations, as a survey from 2010 reported:

In total 15 countries do not have any mandatory vaccinations; the remaining 14 have at least one mandatory vaccination included in their programme. Vaccination against polio is mandatory for both children and adults in 12 countries; diphtheria and tetanus vaccination in 11 countries and hepatitis B vaccination in 10 countries. For eight of the 15 vaccines considered, some coun- tries have a mixed strategy of recommended and mandatory vaccinations.

Until recently, these strategies worked reasonably well, and vaccine compliance was high. However, in the wake of this outbreak, EU public health officials have been playing catchup with vaccination campaigns. Progress has been hard-won:

The Region has been progressing towards measles elimination. A total of 37 countries have interrupted endemic transmission, according to the assessment of the Regional Verification Commission for Measles and Rubella Elimination based on 2015 reporting. However, remaining pockets of low immunization coverage allow the highly contagious virus to spread among those who choose not to vaccinate, do not have equitable access to vaccines or cannot be protected through vaccination due to underlying health conditions.

In addition, multiple countries are taking action to increase vaccine uptake beside education programs. For example, Germany has made moves to tighten its vaccine requirements:

Parents in Germany who fail to seek medical advice on vaccinating their children could face fines of up to €2,500 (£2,175; $2,800).

Health Minister Hermann Gröhe said it was necessary to tighten the law because of a measles epidemic.

A mother of three died of measles in the city of Essen this week.

The government wants kindergartens to report any parents who cannot prove they have had a medical consultation.

However, Germany is not yet making it an offence to refuse vaccinations - unlike Italy.

What's Italy doing? In Italy, there have been three times more measles cases this year already than there were in all of 2016. So in response, in May Italy made 12 vaccinations compulsory for children, including:

  • polio
  • diphtheria
  • tetanus
  • hepatitis B
  • haemophilus influenzae B
  • meningitis B
  • meningitis C
  • measles
  • mumps
  • rubella
  • whooping cough
  • chickenpox

Parents of children who aren't fully vaccinated according to schedule by age 6 could face a fine. It's not clear what they will do beyond that, but it's a strong statement.

Meanwhile, in France, distrust of vaccines is very high. A recent survey indicated that only 69% of respondents trust vaccines, with only 52% believing that vaccines have more benefits than risks. Worse, the distrust is higher among the young.

In response to low vaccination uptake, the French government has mandated that, as early as next year early childhood vaccines that are unanimously recommended by French health authorities will become mandatory. Currently, only three childhood vaccines are mandatory (diphtheria, tetanus and poliomyelitis), while eight others are only recommended. All will become mandatory now, although it's not yet clear what the penalty will be for noncompliance. In Slovenia, mandatory vaccination policy, complete with fines, has worked to bring compliance up to 95%.

I've always been ambivalent about punitive measures like fines to enforce mandatory vaccination, but I suspect that's because school vaccine mandates, in which children must be up-to-date on the CDC-recommended schedule before they can enter school and the only penalty is that unvaccinated and undervaccinated can't attend school, have generally worked very well and, thus far, nonmedical exemptions based on personal belief has have not (yet) reached the levels that could produce a catastrophe such as what Europe is currently experiencing—you know, the sort of thing people like Kent Heckenlively are working to produce.

Truth be told, I'm still ambivalent about methods more stringent than laws like SB 277, which eliminate personal belief exemptions to school mandates. I hope things don't get so bad that that begins to change.

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In Germany, we have mandatory public schools, no home schooling allowed. Non compliance is penalized with fines, and in extreme cases, the police takes the children to school. So school vaccine mandates wouldn't work here, simply because it's not an option to leave the unvaccinated kids out of school.

Massive measles outbreaks in Europe: A harbinger of things to come in the US

Almost certainly, I'd say. We, here in Canada, must expect the same. Our vaccination rates are way too low. See http://ottawacitizen.com/health/family-child/canadian-vaccination-rates…. It is not clear but I'd guess the data are from 2013 or 2014.

At the moment, I expect the no vaccination, no school should work here if vigorously enforced but I really don't have much of a problem with fines or other legal sanctions since failure to adequately vaccinate one's children looks a lot like child abuse to me.

By jrkrideau (not verified) on 12 Jul 2017 #permalink

Correction the immunization figures are probably from the Childhood National Immunization Coverage Survey in 2015

By jrkrideau (not verified) on 12 Jul 2017 #permalink

Prominent people and celebs need to go public with the vaccination of their own offspring and shout it from FB and twitter, et al. In this age of distrust and malign of experts, we are going to have to resort to other methods.

By darwinslapdog (not verified) on 12 Jul 2017 #permalink

I also have mixed feelings about criminalizing non-vaccinating. Among other things, I wonder if enforcement would be consistent. And as you point out, school mandates are very effective.

The point above about German schooling was important.

That said, sometimes I question whether the U.S. hesitation is the result of bias, because the parents who don't vaccinate are middle class. In a new book called Blaming Mothers Prof. Linda Fentiman contrasted our approach here to the harsh penalties for actions that put children at risk more typical of poor mothers, that are penalized harshly - like taking drugs in pregnancy.

By Dorit Reiss (not verified) on 12 Jul 2017 #permalink

One of the reasons for the surge in measles cases in Italy is that the anti-immigrant, populist Five-Star movement has apparently been disseminating antivaccine misinformation.

@Cthulhu-I don't know what to think about that. I think homeschooling should be an option, yet at the same time many of the homeschooling families in the states are doing it for the wrong reason-i.e., because they are religious nutcases and they don't want their children to be taught about evolution or other things that "go against their religious beliefs".

So I suppose I can see both sides of the argument. I don't approve of parents homeschooling their kids to prevent them from learning about things that "go against their religion" (e.g., evolution), but at the same time, religious objections to the public school curriculum are only one reason why people in the states choose to homeschool.

For example, some parents of special needs kids choose to homeschool because they don't feel public school can meet their child's needs.

@Dorit, a fine does not necessarily mean criminalization. There are plenty of civil legal issues that result in fines (eg, in my township, if you let your lawn get too long and don't correct it, the city will mow it and fine you the cost of having it mowed).

The funniest comment I've seen on stories about the push for more mandatory vaccines is that it's "un-American." Because, as we all know, Europe is super concerned about how American it is.

@Dorit Reiss-I actually do support criminalizing vaccine refusal, and I think that a very strong case could be made that parents who refuse to vaccinate are neglecting their child and therefore can be held criminally liable for child neglect.

The fact that refusal to vaccinate also endangers those exposed to the unvaccinated child obviously significantly strengthens the case for criminalizing vaccine refusal, but even without that you can make the case that simply by endangering the unvaccinated child's health, vaccine refusal amounts to criminal child neglect.

For example, tetanus is one of the few VPDs that is not communicable, but shouldn't parents still have to vaccinate their children against it? Wouldn't it essentially be negligent homicide if a parent refused to vaccinate their child against tetanus and then their child later died of tetanus? (of course, the tetanus vaccine is combined with diphtheria and pertussis vaccines, and those diseases are communicable but I think you can still see my point)

At the same time, it is important to remember that a law requiring parents to get their children vaccinated would be enforced and that the enforcement of such a law might be unpopular. For example, even if the maximum penalty for failure to vaccinate was a fine, if the parent refused to pay the fine, they would presumably face jail time, and I would imagine that a significant number of people, even people who are pro-vaccine, would object strongly to a parent being jailed for refusing to vaccine (regardless of the fact that they technically would be being jailed for failing to pay the fine for not vaccinating).

Obviously it is a very difficult issue and legitimate arguments could be made for and against criminalizing vaccine refusal. I personally support criminalizing it, but I totally understand the concerns, too.

Another thing to remember is that European don't have the same expectation of "liberty" that Americans do. For example, there isn't even freedom of speech in Europe like there is in the U.S.-for example, hate speech and Holocaust denial are illegal in most, if not all, European countries.

The idea of criminalizing "hate speech" would be unthinkable in the U.S., but it is accepted in Europe.

Another example is how homeschooling is illegal in some European countries (e.g., Germany), and where it is legal, it is generally subject to more restrictions than in the U.S.

My point is that Europeans have a different view of what "freedom" means, and therefore would probably be less averse to being compelled by law to vaccinate their children than Americans would be.

There are some errors and not-updated-news in this article:

- the 6 years old boy with leukemia dead in Italy wasn't infected by an unvaccinated brother. This was the preliminary information but later the physician that followed the case clearly stated that the two brothers take measles AFTER the deceased boy;
- the number of mandatory vaccines in Italy are lowered from 12 to 10 plus 4 strongly reccomended. The 2 "demoted" are meningitis B and C, now strongly reccomended with rotavirus and pneumococcus;
- even in Italy we are speaking of mandatiry vaccination related to school. The vaccines are not mandatory on their own, they are needed to enter a state nursery. From 6 year, when children start compulsory education, their parents must pay a fine every year if their are not in compliance with the vaccination schedule;
- the law must be approved by upper and lower chamber in two months (till 7th August) otherwise it expires.

By Ander Elessedil (not verified) on 12 Jul 2017 #permalink

Won't be long before the death-worshipping AVers start blabbing about how it's "only" 35 deaths from measles and those deaths would have been preventable with Vitamin A and a paleo diet of some other stupid holistic bullsh*t.

By Chris Hickie (not verified) on 12 Jul 2017 #permalink

the 6 years old boy with leukemia dead in Italy wasn’t infected by an unvaccinated brother. This was the preliminary information but later the physician that followed the case clearly

Thanks for the update. Unfortunately I could only go with what I could find in some English language reports and Google-translated Italian news reports, and I didn't look that hard for updates because the articles I found on this unfortunate boy were less than three weeks old. This news would still not absolve the mother of responsibility for not vaccinating her children, particularly when one of her children had leukemia and couldn't be vaccinated.

I agree that carrots would be preferable to sticks here, but from what I understand, things in Europe have gotten bad enough that sticks have become necessary there. Keep in mind that because of the Schengen treaty, anyone with a passport from a member country (which includes all EU countries except possibly the UK and Ireland, plus Norway and Switzerland) can freely travel to any other member country the same way Americans can travel freely between states or Canadians can travel freely between provinces. That's mostly a good thing, but one of the downsides is that infectious diseases are more easily spread across European national borders.

By Eric Lund (not verified) on 12 Jul 2017 #permalink

I wonder how many Europeans are going to blame the measles outbreak on immigrants? SIGH.

What would the anti-vaxxers be saying if the measles outbreak in Europe approached what India sees every year. India sees thousands of deaths from measles each year and has started a large vaccination program. In 2000, India had over 200,000 deaths from measles but because of vaccination programs that number dropped to only 50,000 in 2015.

Vaccination education, access to, and requirement to vaccinate is not just a national, regional issue but an issue that is world wide. A few idiots should not be allowed to cause the deaths of thousands of children and adults around the world.

@Orac

This is an article in Italian
http://milano.repubblica.it/cronaca/2017/06/23/news/morbillo_vaccini_ba…
Obviously I don't want to absolve the parents, only to be fair. Anti-vaxxer are known to utilize every error to spread falsehoods and to blame anyone that disagrees with them

@Johanna

In Italy, many, many, many, many. I have discussed with countless anti-vaxxer (or rather, pro-disease) in this weeks. Many of them blame immigrants or accuse the govern to put mandatory vaccines to cover its "laziness" on immigration.

By Ander Elessedil (not verified) on 12 Jul 2017 #permalink

I wonder how many Europeans are going to blame the measles outbreak on immigrants?

Technically, Andrew Wakefield is an immigrant to the US. But since he has taken concrete actions that had the effect of promoting the outbreak, his share of the blame is independent of his immigrant status.

But sadly, haters will hate, so I am not surprised that people blame immigrants (especially from Africa and the Middle East) for measles outbreaks. Whether or not there is any merit to the claim.

By Eric Lund (not verified) on 12 Jul 2017 #permalink

Chris Hickie@13 -- I've already been informed by two antivaxxers that all of the European measles deaths were really due to malnourishment or an underlying medical condition.

By shay simmons (not verified) on 12 Jul 2017 #permalink

"Won’t be long before the death-worshipping AVers start blabbing about how it’s “only” 35 deaths from measles and those deaths would have been preventable with Vitamin A and a paleo diet of some other stupid holistic bullsh*t."

NWO Reporter Ginny Whatshername will show up and misinform us about Vitamin A and measles. So, before anyone goes believing her bullsh*t, let's recap:

Vitamin A is essential for eyesight because it helps in the development of the optic nerve and specialized cells for vision. The reason it seems that kids who get Vitamin A supplements do better with measles is because that supplementation also helped their overall health status. Getting Vitamin A supplements do not guarantee better outcomes from measles, just that the child will be able to see themselves go through measles.

In essence:
- Best: Vitamin A and MMR vaccine
- Better: Vitamin A and MMR vaccine
- Good: Vitamin A or MMR vaccine
- Poor: Vitamin A no MMR, or MMR and no Vitamin A
- Bad: Neither Vitamin A nor MMR
- Worse: Misinterpreting the science and scaring parents away from vaccinating their children.

Shay Simmons @20 -- And then the AVers insinuate (or flat out state) the deceased deserved to die from that disease because they were "weak" or didn't do some quack supplement.

Ren @ 21: The development of a genetically modified banana rich in vitamin A will cause conniptions in AVers who will then have to decided if their howling on Vitamin A means they are endorsing GMOs. (and the funding for this came from the Gates Foundation, to boot). http://www.newsweek.com/scientists-orange-bananas-vitamin-uganda-633136

By Chris Hickie (not verified) on 12 Jul 2017 #permalink

@Chris Hickie: You mean they'll "go bananas" over that?

And then the AVers insinuate (or flat out state) the deceased deserved to die from that disease because they were “weak”

Yep. Eugenics at its finest.

By shay simmons (not verified) on 12 Jul 2017 #permalink

Technically, Andrew Wakefield is an immigrant to the US.

Holder of a Green Card, last I checked. I'm not sure what's "technical" about that.

But since he has taken concrete actions that had the effect of promoting the outbreak, his share of the blame is independent of his immigrant status.

What's called for here is a proper Crime of Moral Turpitude.

But sadly, haters will hate, so I am not surprised that people blame immigrants (especially from Africa and the Middle East) for measles outbreaks.

It was the Wetbacks for Disneyland.

Excellent post. Yours too, Ren. Nice to see you.

One death is too many and anti-vaxxers should know that. ("death-worshipping AVers start blabbing"--doesn't sound like the comments of a smart doctor, does it?)

Why do parents hesitate about vaccines? Coercion, misinformation and fear. Not necessarily in that order.

Calmly informing creates a better atmosphere for vaccination. The easy answer--for me,but probably not for you--would be to vaccinate every single three-year-old child with the MMR. This would create complete herd immunity protecting everyone from newborns to adults. It would obviate any discussion of "vulnerable developmental ages" which may be promulgated by people like me. Dorit, I agree that the answer is not criminalization but education instead.

By Jay Gordon, MD, FAAP (not verified) on 12 Jul 2017 #permalink

Who let the village idiot in?

By Chris Hickie (not verified) on 12 Jul 2017 #permalink

The easy answer–for me,but probably not for you–would be to vaccinate every single three-year-old child with the MMR. This would create complete herd immunity protecting everyone from newborns to adults.

I would dearly love to see the explicit calculation underlying this assertion. You've just asserted eradication.

The easy answer–for me,but probably not for you–would be to vaccinate every single three-year-old child with the MMR.

Any "easy answer" from Jay Gordon will be the wrong answer, including not testing a child with failure to thrive born to an HIV+ mother for HIV, contributing to said child's death later. That's an answer even a 2nd year medical student knows.

By Chris Hickie (not verified) on 12 Jul 2017 #permalink

Narad, yes, eradication. Why not?

By Jay Gordon, MD, FAAP (not verified) on 12 Jul 2017 #permalink

Unfortunately, what it will take is what it always takes to get Americans to wake up: when their own loved ones start dying from vaccine-preventable diseases.

Narad, yes, eradication. Why not?

As I said, show me the calculation that spits out age 3 as the magic number. I presume that you at least are alleging a compartmental model rather than, say, just begging the question in a really dumb fashion.

@Jay Gordon

The easy answer–for me,but probably not for you–would be to vaccinate every single three-year-old child with the MMR.

You've started administering the MMR? When did that happen?

I'm not sure why Jay Gordon advocates all kids skipping their first scheduled dose of MMR as a means of "eradicating" measles. Or why he espouses universal vaccination later on, when he knows it is not medically appropriate for a minority of children to be vaccinated (i.e. due to serious allergies, immune deficiency or cancer treatment).

Jay: "Why do parents hesitate about vaccines? Coercion, misinformation and fear."

Dang it, Orac has to install a warning system to protect our precious irony meters from exploding.

Here's Jay not long ago explaining why measles doesn't concern him:

"If somebody with measles walked into Dr. Gordon's office, 90 percent of the unvaccinated people who come in contact with them would get measles. I asked Dr. Gordon to explain how that type of contagion isn't a risk.

"You just said it, they'd get measles," Dr. Gordon replied. "Not meningitis, not the plague, not Ebola, they'd get measles. Measles is almost an always a benign childhood illness."

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

So one must ask: was Jay full of it then in his blithe comments about measles, or is he full of it now in his professed concern for "eradication" (the two possibilities are not mutually exclusive)?

By Dangerous Bacon (not verified) on 13 Jul 2017 #permalink

@Jay Gordon,

"Why do parents hesitate about vaccines? Coercion, misinformation and fear. Not necessarily in that order."

You and your antivax buddies are providing plenty of fear and misinformation. Coercion works both ways. The state sees the benefit to boost herd immunity and school mandates help that. Medical professionals that either ignore the evidence in favor of vaccines or pander to the fear do their own coercion.

Gordon publicly admits he almost failed out of medical school. Gordon refused to consider that patient of his born to an HIV+ mom (who herself was a very public HIV denialist) might have HIV, despite the child becoming increasingly ill and undernourished (and the child died of complications of HIV/AIDS). Gordon kowtows to anti-vax Hollywood celebrities who don't have a single working neuron between their ears--all to get his mug on TV and in print. Gordon made a horrible anti-vaccine DVD full of some of the dumbest bullsh*t I've ever read that he still sells for profit. Gordon has gone on TV during measles outbreaks in SoCal to tell parents not to vaccinate and that measles is not a serious illness. Gordon wrote a book on "preventing autism" so poorly proof read that the bibliographies for entire chapters are missing. .

The inescapable conclusion is Jay Gordon a publicity-seeking, money-grubbing, anti-vaccine quack.

Why we even debate him on here is beyond me.

By Chris Hickie (not verified) on 13 Jul 2017 #permalink

I had forgotten how much I miss all of you.

Yes, LW, I give the MMR vaccine. Far more than I used to because I can't find a strong case against giving it at age three years and above. Under that age, I'm less comfortable for but without EBM to back me up.

Hi Mike. Are you new here? I haven't been regular enough, I guess. No, no fear, just logic: Doing things in medicine six-at-a-time never has made sense to me.

Again, Bacon, I opened this little office in 1984 and have never had a case of measles in my practice. But I'm just fine with giving that vaccine (later) because there's a lot more measles in Europe and elsewhere.

Have a great day all!

By Jay Gordon, MD, FAAP (not verified) on 13 Jul 2017 #permalink

Two minutes ago, I got back titers I drew for a college-bound boy.

As I see about half (half!) the time, his measles and rubella titers are still protective and his mumps IgG is not. He has had one MMR and we'll give him the second now. Putting those three vaccines together was a scientifically unsound idea supported by no evidence-based-medicine.

By Jay Gordon, MD, FAAP (not verified) on 13 Jul 2017 #permalink

Awww...
Dr Jay misses us!

We should make a greater effort to let him feel at home here.

By Denice Walter (not verified) on 13 Jul 2017 #permalink

Ah, Dr. Jay Gordon. I can't say I've missed you. Baby Ren is almost here, and you'll be sad to know we've decided against breastfeeding. After all, we've heard of babies dying of SIDS right after being breastfed, so there's something there that La Leche and others are not telling us. Yeah, it's a dumb decision given all the evidence for breastfeeding, but I'm trying to see the world from the eyes of the antivaxxers you so passionately support and encourage.

I joke, of course. We're breastfeeding that little Ren so they can have all the advantages of Deanna's recent MMR and Dtap vaccinations. (MMR a year ago and Dtap a couple of months ago.)

"Putting those three vaccines together was a scientifically unsound idea supported by no evidence-based-medicine."

Is this your opinion, or are you basing it on "evidence-based-medicine"? Because it is my understanding -- and anyone feel free to correct me -- that the MMR was combined so that parents wouldn't delay or miss the vaccination schedule due to having to get one shot at a time, and the evidence is clear that the combined vaccine is highly effective, similar to the individual vaccines they used to give. I think it was in the UK (was it?) that they saw that children were more likely to be caught up with their vaccines if they got the MMR versus the individual vaccines?

Yeah, there is more and more evidence that the immunity against mumps wanes, but you have to understand why that is. First, because the vaccine is so good, there are not as many cases to "boost" immunity and keep you immune. Second, there is some evidence that even without titers you are still immune because the memory cells are still around to produce antibodies if challenged. Given all that, I know that CDC and others are looking at recommending a third MMR sometime in adolescence and certainly before college.

So can you tell us the evidence for the MMR to be a "scientifically unsound" idea? I'd love to hear it.

@ Ren:

A Baby Ren!
Best wishes!

By Denice Walter (not verified) on 13 Jul 2017 #permalink

Ren! Congratulations on the impending larger family. Obviously, I know you in a limited context, but I'd guess you'll be a great dad. (You had me for second on the breastfeeding . . . Good one!)

Remember the problems getting the right ratios of types 1, 2 and 3 in the oral polio vaccine?

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3782271/

I think the same might be true of MMR. I have not seen any evidence supporting this thought, but I'm also unaware of any studies done. Yes, maybe there's better compliance with one needle instead of three and that's pretty valuable, I agree. But perhaps we'd have a better "take" if the three were given separately. It would also allow selective booster for those with one or two waning titers.

I do agree that protection may still be present even with low titers and I have long wondered if the same is true of the rapidly-waning pertussis titers from the DTaP or Tdap: I see far less pertussis than I used to even though that vaccine is labeled quite suboptimal in it's creation of long-lasting "protection" compared to the old DPT. What are your thoughts on that?

By Jay Gordon, MD, FAAP (not verified) on 13 Jul 2017 #permalink

@Jay Gordon - I'm glad to see you back. I enjoy your posts and appreciate your reasoned and compassionate approach to parents who choose to delay or skip vaccines.

I was recently informed on a different thread that despite holding the opinion that vaccines work, being vaccinated myself and having vaccinating my own children, I am actually 'anti-ax to the core'. Seems an oxymoron to me but clearly any expression of disagreement with a policy designed to increase vaccination rates is sufficient to garner that particular epithet on this site.

By Beth Clarkson (not verified) on 13 Jul 2017 #permalink

whoops, I meant anti-vax not anti-ax in the previous post.

By Beth Clarkson (not verified) on 13 Jul 2017 #permalink

Oral polio is not the same as the MMR. I think it has to do with how the body deals with the vaccine since it's ingested. (Again, anyone feel free to correct me.) So we're probably comparing apples to oranges.

I'm at school working on the dissertation right now, but I'll look up the rationale for the triple combined MMR as well as any studies they did.

Acellular pertussis vaccine is always going to be less optimal in creating an immune response than the full-on cellular vaccine of old. But "Vaccine Roulette" in the 1980's ruined it for all of us. It gave us the vaccine court, but, man, did it really have to go down like that?

@Dr. Jay - the US managed to go from over 92,000 cases of measles in the early 1990s to zero domestic cases in less than 8 years.

For a disease as infectious as measles, that's an outright miracle.

I find you lack a real rationale to question the MMR to be particular disturbing, in light of your reluctance to be an advocate for vaccines with your patients.

Lawrence, I advocate for vaccines for my patients. I readily admit that I also strongly advocate for parental participation in vaccine decision-making.

Ren, it might be apples and apples in the immune system's response to a live virus vaccine.

And in between the old DPT and the quite wimpy DTaP we should have found--and will find--a better answer.

By Jay Gordon, MD, FAAP (not verified) on 13 Jul 2017 #permalink

@Beth Clarkson #44:

I was recently informed on a different thread that despite holding the opinion that vaccines work, being vaccinated myself and having vaccinating my own children, I am actually ‘anti-[v]ax to the core’.

And why were you accused of that? Because you have used arguments that were disingenuous, dishonest, and anti-vaccine.
As I said in my response to you.
"You have argued for parental choice while ignoring that those choices can severely negatively impact others, downplayed the risks of the deliberately unvaccinated passing infections on to others, and downplayed the effectiveness of vaccination as a preventer of diseases. All antivaccine tropes and tactics."
If you don't want to be called antivaccine, don't act like one.

By Julian Frost (not verified) on 13 Jul 2017 #permalink

@Ren (# 43)-The OPV is no longer used in the U.S., and hasn't been since 2000, and because the OPV can rarely cause vaccine-derived polio, there is a shift being made away from using the OPV and toward using only the IPV worldwide. The OPV is still used in some developing countries, but I would guess that in 5 years, as we get closer to eradicating Polio, a switch to using only the IPV will occur everywhere.

@Jay Gordon (#42)-It has been repeatedly shown that vaccinated patients who contract a VPD anyway are less likely to suffer complications and are more likely to have a mild course of illness. For example several studies have found that vaccinated men who contract mumps are less likely to develop orchitis than unvaccinated men who contract mumps. At least one study also found that the risk of hospitalization due to complications of mumps and the risk of mumps meningitis was also reduced in vaccinated mumps patients compared with unvaccinated mumps patients.

The same is true of pertussis-vaccinated pertussis patients tend to have less severe illness than unvaccinated pertussis patients-so yes, even low titers probably confer some level of protection.

Why am I in moderation?

Julian, you're wrong.

Nice to see you too, Beth.

As the imperfect parallel goes, if you advocate for safer cars and safer use of cars are you anti-car? (Go ahead, y'all, hit that one as hard as you like, it'll remain standing)

I give vaccines every day, have gotten vaccines as recently as this flu season and also got Hep A and Typhoid shots for my medical work in Nepal and Ethiopia and I believe vaccines work. But there's only one label that works for simplicity: antivax!

By Jay Gordon, MD, FAAP (not verified) on 13 Jul 2017 #permalink

@Ren (# 43)-The OPV is no longer used in the U.S., and hasn’t been since 2000, and because the OPV can rarely cause vaccine-derived polio, there is a shift being made away from using the OPV and toward using only the IPV worldwide. The OPV is still used in some developing countries, but I would guess that in 5 years, as we get closer to eradicating Polio, a switch to using only the IPV will occur everywhere.

@Jay Gordon (#42)-It has been repeatedly shown that vaccinated patients who contract a VPD anyway are less likely to suffer complications and are more likely to have a mild course of illness. For example several studies have found that vaccinated men who contract mumps are less likely to develop orchitis than unvaccinated men who contract mumps. At least one study also found that the risk of hospitalization due to complications of mumps and the risk of mumps meningitis was also reduced in vaccinated mumps patients compared with unvaccinated mumps patients.

The same is true of pertussis-vaccinated pertussis patients tend to have less severe illness than unvaccinated pertussis patients-so yes, even low titers probably confer some level of protection.

BTW, an identical comment is in moderation at the moment because I misspelled my email address-so if you see an identical comment above at some point, that's why.

@Jay Gordon (# 50)-You are described as anti-vax because, even though there is ample evidence that the recommended vaccine schedule is safe, you say things like:
"I am very much opposed to the routine vaccination schedule in the U.S. There are too many vaccines given too early in a child’s life and not enough information given to parents"

And you also have said things like:

"I don’t give a lot of vaccines.

I still give DPT vaccinations to some children, chicken pox shots to kids who haven’t been able to acquire natural immunity by age ten years or so, and I give polio vaccines very infrequently. The polio vaccines are given for what I call “emotional” reasons because my exposition of the “numbers” (2000 cases of polio out of six or seven billion people) doesn’t counteract the very strong memory of a beloved aunt or uncle who had polio in fifties or sixties."

I call that anti-vax. Just because you aren't totally crazy like Suzanne Humphries doesn't mean you aren't anti-vax.

@Jay Gordon-I also view you as anti-vaccine because you have used the "toxins gambit", for example, when you said:

"I think the immune system, like every other system of the body, matures slowly, and that it can better tolerate viral infection at older ages and better tolerate one virus at a time. The other thing is that vaccines all contain other ingredients. They contain aluminum, they contain tiny bits of formalin [an aqueous solution of formaldahyde]. So I recommend waiting as long as parents are comfortable, and vaccinating very, very slowly. I also ask parents to wait at least six months before the first vaccine. I prefer to wait a year."

In case you were unaware, Dr. Gordon, the amount of aluminum infants get from vaccines is far less than what they get through their diet. infants receive about 4.4 milligrams* of aluminum in the first six months of life from vaccines, compared with 38 milligrams of aluminum from formula (breastfed infants would get about 7 milligrams during the same period of time).

Also, this statement, about the MMR:
"It’s a live-virus vaccine. A live-virus vaccine, in order to work, creates a little bit of an infection. And when you get measles, you get it through your nose and your throat, [which triggers a very specific immune response.] When we inject measles, we are bypassing that system and going right into the bloodstream. And we’re finding that yes, there can be some impact on the intestinal tract and to the brain from the measles vaccine. And it’s a vaccine of almost no benefit to American children, one by one. Now, in terms of public health, I don’t want to be the guy who said, “Boy, this vaccine stinks.” It doesn’t stink. It works very, very well. The reason we don’t have measles in America is because the vaccine works great. But sit down, please. Let’s talk about the fact that your cousin and your other cousin both have autism. Or that your son has some questionable neurological issues, he seems to be speaking or walking a little later. I don’t want to mess with him."

And this statement:
"I think that the public health benefits to vaccinating are grossly overstated. I think that if we spent as much time telling people to breastfeed or to quit eating cheese and ice cream, we’d save more lives than we save with the polio vaccine."

are both false, misleading, and yes, anti-vaccine.

@Jay Gordon #50: how exactly am I wrong?

As the imperfect parallel goes, if you advocate for safer cars and safer use of cars are you anti-car?

Did you even read what Beth wrote on the other thread? She was not advocating for safer vaccines at all. She was using arguments that were disingenuous and wrong, and that had been refuted before.

By Julian Frost (not verified) on 13 Jul 2017 #permalink

@Julian Frost (#54)-I think Dr. Gordon is more anti-vaccine than Beth is, at least based on what I've seen of his writings. He clearly thinks that there is some link between vaccines and autism and openly states that he views the recommended vaccine schedule is unsafe-I haven't seen Beth say that (though as you noted she does talk like an anti-vaxxer).

With Dr. Gordon, I think (based on what I've seen of his writings) that he both underestimates the danger of VPDs and believes that vaccinations carry far more risk than they actually do, whereas with Beth it may just be that underestimates the danger of VPDs. I haven't ever heard her talking about vaccines potentially causing autism or any nonsense like that, whereas (as I pointed out above, quoting his past statements), Dr. Gordon has.

I just read a news article about the 16 most deadly viruses in the world. Guess what one of them was? Yep measles. Worldwide an estimated average of 364 people (mainly children) die every day from measles: that is 132860 people per year. Those numbers are only deaths directly from measles and doesn't count disabilities or deaths from being compromised by measles.

Some argue in this country that measles is not a big deal, the numbers above show that is an unfounded argument. We safer because of vaccines and a good medical community. Take either one of those away and we will be like much of the rest of the world where measles is a big issue.

@Rich Bly-I doubt that deaths from SSPE were counted, either, since SSPE has a delayed onset (it develops on average 7-10 years after contracting measles), and because SSPE victims die slowly, with their neurological function deteriorating over months or years.

Also, SSPE is probably significantly underdiagnosed and underreported in the developing world, where measles (and thus SSPE) is most common.

Yes, SSPE is fairly rare (although it is more common than had been previously thought, with recent research indicating that about 1 in 600 infants who contract measles later develop SSPE), but it is always fatal, so it should always be mentioned when measles is discussed.

@Dr. Jay - absolutely not. Pointing, specifically, where cars can be made safer & carefully articulating the benefits of the change and process by which the changes will be made is a great way to see that change through.

Anti-vaxers merely wave their hands & say "make safer vaccines" without being able to articulate why current vaccines aren't safe & why the changes they advocate will lead to something which is safer.

Wouldn't you agree?

Dr. Gordon thinks that delaying vaccines makes them safer, when, ironically, it appears that the reverse may true-a few years ago a study came out that found that giving the first MMR dose after 15 months of age doubles the risk of a febrile seizure after vaccination (keep in mind, the risk of febrile seizures following vaccination was very low no matter when the vaccine was given, but it was lowest if the vaccine was given on time).

http://www.medscape.com/viewarticle/825333

Therefore, it appears that the best way to make vaccines safer is to make sure that they are given on time.

Using a 5/1000 death rate as an average for measles cases worldwide (it varies by region), there are approximately 26,570,000 cases of measles per year worldwide. Take 26,570,000 and divide 600, we get about 44,300 deaths from SSPE per year worldwide. That seems to a fairly large number to me.

And in between the old DPT and the quite wimpy DTaP we should have found–and will find–a better answer.

"We," Jay? I'm still waiting for the demonstration of how you came to your brilliant plan for measles vaccination with The Magic Number.

This is epidemiology, not proctology.

^ "measles vaccination eradication"

Jonas, the OPV was one of the best vaccines every invented and I think we lost that one because of lawyers not doctors. The IPV is extremely effective, though.

The quotes above show that I am capable of saying stupid things often enough so that I wish I could scrub the internet.

I also take some small amount of pride in changing my opinions and practice based on science and thinking harder. Not good enough for anyone here, but keep plugging away. (Perseverating, that is.)

By Jay Gordon, MD, FAAP (not verified) on 13 Jul 2017 #permalink

@Dr. Jay - I appreciate the insight into your mindset, because most anti-vaxers are, quite frankly, raving lunatics.

I also find most anti-vax "administrators" like Wakefield & Bigtree, are opportunistic conmen.

You've done a good job, if you can call it that, straddling the fence - but I will continue to point out that "asking questions" without actually provide concrete, rational & science-based solutions, isn't doing much at all.

Jonas, the OPV was one of the best vaccines every invented and I think we lost that one because of lawyers not doctors.

Are you insane? Do you not understand the polio eradication end game? Oh, wait . . . eradication.

LW @34: If it's true that Dr Jay didn't vaccinate any of his patients against rubella back in 2010 I really, really hope he contacts all of them now so that they know they haven't been vaccinated against rubella and the girls/women at least can get vaccinated before they get rubella while pregnant.

By JustaTech (not verified) on 13 Jul 2017 #permalink

Jay Gordon: "I advocate for vaccines for my patients."

Another example of Jay talking out both sides of his mouth.

All you have to do is visit his website to find that he tells his patients something quite different. For example: Jay's site still has his recommendations against both rotavirus and hepatitis B vaccination (regarding the latter, he's still repeating the canard that it "possibly" causes autoimmune disease). And under the heading of whether one's children should get whooping cough vaccine:

"The short answer is no, they don’t have to get these shots but the illness so nasty and the media barrage will be relentless. There will be no break in the frightening tone of news stories and official reports."

In other words, it's the nasty news media pressuring parents into getting their kids vaccinated, but no you don't have to, even though the disease is "so nasty". What utter nonsensical fence-straddling. Jay apparently doesn't care if his patients suffer unnecessarily as long as their parents are made to feel in control.

Jay wants to sell us on the idea that he's ever so reformed and improved. His statements on his own website and elsewhere contradict him.*

*any bets on whether Jay will respond that gee, he just hasn't time to get his website updated? Some of that antivax stuff has been on there since 2010.

By Dangerous Bacon (not verified) on 13 Jul 2017 #permalink

@Jay Gordon (#65) Well, this statement-
“I am very much opposed to the routine vaccination schedule in the U.S. There are too many vaccines given too early in a child’s life and not enough information given to parents”

is still on your website as of today. So, if you have "changed your opinion", as you claimed above, and you are no longer rejecting the scientific consensus, now might be a good time to remove that from your website-and you should remove the part where you accuse "vaccine proponents" of lying, while you're at it.

Of course, I highly doubt that you've really changed your views all that much-I strongly suspect that you still stand by the statement I quoted in this comment, since it's still on your website, even though you claim that you wish you could "scrub the internet" of some of your other misleading/inaccurate statements.

@Dangerous Bacon-Thanks for pointing that out-I took a quick look at his website and found some other anti-vax statements, but I didn't see those.

@Jay Gordon-Since you seem to be one of those anti-vaxxers who falls into the "too many, too soon" camp, you should take a look at the study cited below.
DeStefano, Frank, Cristofer S. Price, and Eric S. Weintraub. "Increasing exposure to antibody-stimulating proteins and polysaccharides in vaccines is not associated with risk of autism." The Journal of pediatrics 163.2 (2013): 561-567.

Jonas, I like my camp. My dislike for the schedule is one thing I would not scrub. I'm not sure I trust DeStefano.

Dangerous Bacon, you misquote my quote within one millimeter of typing it! The disease is "nasty" not the media. I hate pertussis. I wish we had a better vaccine. In the meantime, I use the one we've got.

And, Lawrence and Bacon (great name for a law firm!) you're right, I easily, if uncomfortably, straddle the fence. Stated really nicely, I can act as a liaison to hesitant parents who need more information and more patience about vaccinating.

By Jay Gordon, MD, FAAP (not verified) on 13 Jul 2017 #permalink

Maybe the reason we don't have the safer vaccines that Jay Gordon calls for is that the people who might have developed them have been too busy proving over and over and over and over and over and over and over again (plus many more overs) that vaccines do not cause the harms that certain pediatricians claim they do, based on no evidence worth presenting.

LW, no.

Different researchers as far as I know. Those are academics and the R&D guys are a different group. By the way, there is no medical intervention as large as vaccination without some adverse effects. Neither medical interventions nor surgical procedures.

By Jay Gordon, MD, FAAP (not verified) on 13 Jul 2017 #permalink

Jay: learn to read for comprehension. I quoted you correctly.

Hopefully you are more careful when scanning medical records.

By Dangerous Bacon (not verified) on 13 Jul 2017 #permalink

Quit prancing around, Jay. I've asked you two very specific questions.

It wouldn't surprise me if Jay writes bogus medical exemptions for anti-vax parents who, thanks to SB77, can't get "personal belief" exemptions for their children anymore.

Personally, I think California should follow West Virginia's lead-in WV, all medical exemptions are reviewed by a state health official to make sure that they are legit.

Apology, Narad. I misunderstood your question.

No, I have no magic number. I just prefer giving the MMR over age three years. My point was that we could achieve eradication with universal, or near universal measles vaccination. Starting at age one, two or three years. I prefer three. Not a magic number. Sorry for the evasion.

By Jay Gordon, MD, FAAP (not verified) on 13 Jul 2017 #permalink

@Jay Gordon (#72)-Your "camp" basically advocates leaving children susceptible to more diseases for a longer period of time-again, there are no benefits to delaying vaccines-none whatsoever.

As a pediatrician, you should do all you can to reassure vaccine-hesitant parents, and, if needed, gently pressure them into doing the right thing for their child. Instead, you go along with, or even feed into, their fears.

How would you feel if someone contracted a VPD from one of your unvaccinated/undervaccinated patients, and suffered serious complications from, or died of it?

Jay, why, exactly, do you feel the need to delay the MMR vaccine until age 3? You know that there's zero evidence indicating that giving it at the recommended time is unsafe, and, as I pointed out above, for whatever reason, the risk of a febrile seizure after vaccination is actually higher if the first dose of the MMR is delayed beyond 15 months.

Do you still think that vaccinations cause adverse neurodevelopmental outcomes, despite study after study indicating that they do not?

Jonas, I'd feel terrible. Obviously. The risk of that happening is miniscule. To the best of my knowledge, it has not happened in the nearly-forty years I've practiced.

My unsupported thesis is that there are risks to vaccinating and obviously risks to not vaccinating. And I rely on (Dreaded "E" word coming") experience to guide me in caring for each family while strongly considering public health.

In the community I serve, my persistent impression is that more vaccines are given when the schedule is modified. The delay creates the small risk you've alluded to.

By Jay Gordon, MD, FAAP (not verified) on 13 Jul 2017 #permalink

My point was that we could achieve eradication with universal, or near universal measles vaccination.

Clap, clap, clappity clap. Perhaps you somehow have failed to notice that this not accomplished through mere glibness.

Sorry for the evasion.

I sorely doubt it. Now, how's about that whole polio eradication thingamabob?

Narad, you're not making sense. Nothing glib about this. It's a serious topic. If eradication is your goal, pick the strategy that gets even "reluctant" families vaccinated. You may choose the legislative route. I choose another.
Polio is nearly eradicated; What is your point there?

By Jay Gordon, MD, FAAP (not verified) on 13 Jul 2017 #permalink

Jay, one strategy that could get "even “reluctant” families vaccinated" would be to abolish all non-medical exemptions to vaccination (most families cannot homeschool), or even to impose a penalty on parents who don't vaccinate, as Italy has done.

I know you will vehemently disagree, and if I recall correctly you testified against SB77, but I have to point out that that is a much better and safer strategy than the "slow vaxxing" you advocate.

Also, you said above that you're "not sure" you trust DeStefano"...please, please don't tell me that you believe the "CDC whistleblower" conspiracy theorist nonsense...

@Jay (#83) "Polio is nearly eradicated; What is your point there?"
I believe Narad's point is that, if the OPV is not eventually phased out everywhere and replaced with the IPV, Polio eradication is *impossible*, because the OPV can in rare cases cause vaccine-derived polio.

I believe Narad’s point is that, if the OPV is not eventually phased out everywhere and replaced with the IPV, Polio eradication is *impossible*, because the OPV can in rare cases cause vaccine-derived polio.

But that's "because of lawyers." Honest to G-d, I don't know why I was even bothering. Jay's performance seems to have been either pure bad faith or absolute buffoonery.

Coercion, misinformation, fear.

Jay, you forgot privilege, ignorance, and sticking it to the man.

@Jay (#81)
"The risk of that happening is miniscule"
Sadly, I think that the risk of that happening is quite a bit higher than you think.

"there are risks to vaccinating and obviously risks to not vaccinating."

Of course-every medical intervention has possible adverse effects and carries some degree of risk, but the benefits of vaccination outweigh the risks of vaccination, and vaccines are very safe compared to most other medical interventions.

The vaccines that have the "worst" safety profiles are not even on the routine vaccination schedule here (e.g.,, the Yellow fever vaccine, which can in very rare cases cause vaccine associated viscerotropic disease).

Dr. Jay: One death is too many.
That's a new tune. I'm actually surprised you haven't lost a lot more patients, considering your cavalier approach to health.

By Politicalguineapig (not verified) on 13 Jul 2017 #permalink

Jay, while you're horsesh*ttng all over the the joint, if you take away nothing else from this revolting debasement, let it be how to spell "minuscule."

^ Understanding the meaning of the word, viz., what you actually just asserted, would also help.

TIA. HTH. I'll stop there for the time being.

I'm trying to remember something. Was it Dr Gordon, or was it some other physician who was suggesting that his patients skip MMR, but for their parents not to spread that around? I remember somebody doing that, but I can't remember who it was. If anyone knows, it might help me.

The reason I remember this now is that, as Dr Gordon admits, he has no evidence behind his stated clinical practice of giving MMR at age 3. But, what he does know, is that publicising such practices, along with various others among his pronouncements, is a marketing tool, by which he can make more money.

Since we know that children are vulnerable to measles before age 3, essentially he's offering the patients a somewhat lower-risk opportunity to free ride on herd immunity. Essentially operating parasitically on the behavior of others.

And, as for his talk about taking vaccination decisions in consultation with parents: again the same story. A marketing angle, which particularly enables him to feel good about himself. "What a great guy I am to work with the families."

Of course, if an aircraft pilot came on the public address system to consult the passengers about how to fly the plane, or what route they'd like him to take, quite some number of them would be on their cellphones demanding that the plane return to the terminal and the pilot take a breath test.

By Brian Deer (not verified) on 13 Jul 2017 #permalink

If it wasn't Gordon, it may well have been Bob Sears. I recall the phrase "hide in the herd" associated with that advice.

Being in a civilized country, it probably doesn't occur to you that the various schemes to spread out the vaccination schedule increase the number of office visits the patient('s parent) is charged for.

By Se Habla Espol (not verified) on 13 Jul 2017 #permalink

Also, Dr. Gordon, I don't know if anyone's ever explained this to you, but your responsibility ISN'T to do whatever the parents say. They aren't your customers, and they aren't always right. I really have to wonder what you do in cases of child abuse, since you seem to believe that parents can do whatever they want.

By Politicalguineapig (not verified) on 14 Jul 2017 #permalink

My list of links to Jay Gordon's greatest hits is out of date, so it took me a while to track down the place where he said that measles has lived in relative symbiosis with hominids for millions of years. I started scrolling through and stumbled across his immortal defense of measles as an agent of eugenics:

The debate [about the benefits of getting the disease, using low versus high dose vaccines and the dangers of adult measles] was heated and the vaccine remains unquestioned because one can’t have a public debate of losing “weaker” humans to measles to benefit stronger humans. If individual parents evaluate the risks and benefits of measles vaccination for their child and choose not to vaccinate, that’s a supportable decision.

The best part about the "supportable decision" is that, in context, either the parents are setting up a trial by ordeal which will kill the child if it is weaker, if they are using the child as a weapon to kill off the weaker among their neighbors.

The symbiosis comment is comment 67 on that same page.

From CBS news article "Doctor explains why he lets kids avoid the measles vaccine" (http://www.cbsnews.com/news/doctor-explains-why-he-lets-kids-avoid-the-…) wherein Jay Gordon, MD, FAAP hogs the limelight to justify his own execrable existence as a promoter of infectious disease spread:

"This measles outbreak does not pose a great risk to a healthy child," said Dr. Gordon. "And quite frankly I don't think it poses any risk to a healthy child." ...."You just said it, they'd get measles," Dr. Gordon replied. "Not meningitis, not the plague, not Ebola, they'd get measles. Measles is almost an always a benign childhood illness."

Thanks for being so clear, Jay. You think measles is a walk in the park and the vaccine is not necessary.

Compare and contrast the sheer idiocy of Gordon's babble to the following information regarding (1) the current measles outbreak in Romania (now at > 3,000 cases) and (2) the 1989-90 measles outbreak in Southern California with "with 16,400 reported cases, 3,390 hospital admissions, and 75 deaths. More than half of the patients were younger than 5 years; the highest incidence was among infants younger than 12 months":

1. A measles outbreak in Romania has killed 17 children and infected thousands more since September due to poverty and an anti-vaccination movement.

Romanian health minister Florian Bodog said that none of the children who died from the highly contagious virus had been vaccinated, adding that the last victim was a one-year-old girl from the northern city of Satu Mare. (from a March 12, 2017 article titled "Measles outbreak kills 17 unvaccinated children in Romania" (https://www.rte.ie/news/2017/0312/859093-measles/)

2. During the course of this epidemic [in California, 1989-90], two outbreaks had exceptionally high case-fatality rates. The first of these was an outbreak of 61 cases among Samoan children in Los Angeles and Orange counties in the winter and early spring of 1989. Transmission occurred primarily within and among extended families and at church gatherings. None of the patients old enough to have received measles vaccine had been immunized. Pneumonia developed in 24 (40%) of these children, and 6 (10%) died. Case-fatality rates by age group were 10% for infants younger than 12 months (1 of 10 patients) and 17% for patients aged 1 to 4 years (5 of 29 patients). All 22 patients aged 5 years and older survived. (From: (Dales LG, Kizer KW, Rutherford GW, Pertowski CA, Waterman SH, Woodford G: Measles epidemic from failure to immunize. West j Med 1993; 159:455-464, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1022280/pdf/westjmed00074-…))

Jay Gordon--you are a reprehensible excuse for a pediatrician. You ignore current measles outbreaks and as well as one you must have weathered in California, since you've had a California license since 1978. Your claim to base your decisions on "experience" is laughable, given you clearly learned nothing from the 1989-90 California measles outbreak. To claim that measles is not a threat to child while practicing pediatrics is a slap in the face to real pediatricians. You coming here to feign any semblance of competency or knowledge is laughable. I wouldn't let you care for Sea Monkeys, let alone any child.

By Chris Hickie (not verified) on 14 Jul 2017 #permalink

@ Brian Dear/Se Habla Espanol:

It was Bob Sears who made the comment you seek (but interestingly only in the first edition of his "Vaccine Book"--apparently he took enough of a beating on it to remove from version 2. Here is the quote:

"Since the fatality or complication rates for these childhood diseases are fairly low, I don't have much ammunition with which to try to change these parents' minds. I do point out that mumps can be serious when their kids grow up, and rubella may be an issue for their older daughters someday, and I urge them to do blood testing (see page 227) to determine the need for these shots later on. I also warn them not to share their fears with their neighbors, because if too many people avoid the MMR, we'll likely see the diseases increase significantly." (p 97, 1st edition, 2007)

Note how Sears, like Gordon, doesn't think measles poses any threat to his patients (as he doesn't even mention it in his reasoning for why parents might still consider giving the MMR vaccine to their child). Apparently Sears has no "ammunition" regarding the seriousness of measles. "Dr. Bob" may not have been in SoCal during the 1989-90 measles outbreak there where there were over 16,000 cases with 3,390 hospital admissions and 75 deaths, but his dad William Sears was--though either that didn't impress the original "Dr. Sears" or he forgot about it all by the time Bob penned his first anti-vaccine book.

By Chris Hickie (not verified) on 14 Jul 2017 #permalink

Brian Deer: "...if an aircraft pilot came on the public address system to consult the passengers about how to fly the plane, or what route they’d like him to take, quite some number of them would be on their cellphones demanding that the plane return to the terminal and the pilot take a breath test."

Jay's mantra (headlined on his website) is "no one knows your child better than you do". In Jay's case, that isn't just a sop to parental "empowerment", it's an admission that he caters to potentially destructive parental beliefs while knowing that they aren't medically justifiable.

Maybe someday Jay will learn that there's no honor in "straddling the fence" between evidence-based medicine and the looniest of quackery. I'll be more optimistic if I ever see Jay state not just on RI, but in media interviews and on his website that he's mellowed his opposition to vaccines and more frequently encourages their use, in contrast to his previous overwhelming disdain for them.

By Dangerous Bacon (not verified) on 14 Jul 2017 #permalink

You don't think; You just talk.

By Jay Gordon, MD, FAAP (not verified) on 14 Jul 2017 #permalink

Dr Hickie, please recheck my 'nym.

By Se Habla Espol (not verified) on 14 Jul 2017 #permalink

This is epidemiology, not proctology.

If there is a compilation of Narad's greatest hits, this one belongs there.

By MilitantAgnostic (not verified) on 14 Jul 2017 #permalink

My irritation with Dr. Gordon is that his reasons extend to his patients... and no one else. If one of them transmits a vaccine preventable disease to another child, or to parents or grandparents, he doesn't know and he doesn't care. The fact that he and his victims live in a community, and a crowded one at that, is irrelevant. Its like the rationale for breaking the law because one is unlikely to get caught. I hope he has empathy for his patients; it's obvious that he has none for anyone else.

By cloudskimmer (not verified) on 14 Jul 2017 #permalink

I just tried to access another thread on RI and got this error message:

"Your access to this service has been temporarily limited. Please try again in a few minutes. (HTTP response code 503)"

"Reason: Exceeded the maximum number of page requests per minute for humans."

I swear, this site just keeps getting weirder. I remain in Comment Moderation Hell because of a long-departed sock puppet-master who apparently never impersonated me, Jay Gordon seems to be posting while drunk, and now I'm unable to access threads because I'm a human being. Perhaps I could impersonate a Labrador retriever. Say, is that a hot dog in your pocket, and could I get a belly rub?

By Dangerous Bacon (not verified) on 14 Jul 2017 #permalink

You don’t think; You just talk.

Meaningless from someone who can't/won't learn.

By Chris Hickie (not verified) on 15 Jul 2017 #permalink

Dangerous Bacon@103,

15 times out of 12, I also get the same message and what is surprising is that I just got Internet (at my new address) last Thursday night and didn't get to visit here before sometime around midnight last night.

Alain

I'm also getting that error message.

By Julian Frost (not verified) on 15 Jul 2017 #permalink

Dr. Gordon, I work for a state Department of Family Services. I know for a fact that parents don't always know what's best.

By Gray Falcon (not verified) on 15 Jul 2017 #permalink

I am getting the weird message about no access allowed, and have been since last night at 10 eastern.

I've been getting it with Chrome on my Note 5, but Safari on my iPad seems OK.

By squirrelelite (not verified) on 15 Jul 2017 #permalink

If you get the message, clear your browsing data. That seems to help.

By Julian Frost (not verified) on 16 Jul 2017 #permalink

What would help even more is a competent set of IT monkeys. The "Current ye@r *" crap is back on my phone, as well.

@Jay Gordon

Not new here just don't post very often as the other posters capture my thoughts most admirably.

Your insistence that 3 years is the age at which MMR is administered seems quite arbitrary and dangerous. No credible evidence exists to delay the vaccine and that leaves the most vulnerable exposed for 2 extra years. Inexcusable.

MikeMa: Yes, 3 years is a little arbitrary. But it is not dangerous.

Gray Falcon: I'm afraid I agree with you. There are parents' decisions with which I must disagree. But, they still must participate in all medical discussions.

By Jay Gordon, MD, FAAP (not verified) on 17 Jul 2017 #permalink

MikeMa: Yes, 3 years is a little arbitrary. But it is not dangerous.

Tripling the window of opportunity for infection isn't dangerous?

By shay simmons (not verified) on 17 Jul 2017 #permalink

"Dr" Jay: There are parents’ decisions with which I must disagree.

You don't though. Instead of applying your expertise, you indulge the patient's parents, and actively work to steer people outside your practice wrong. You basically lie to every single parent in your practice. You are not in retail and the customer is not always right. And this is something you consistently pretend not to understand. Ever wonder why they call doctor's appointments 'consultations?'

Also, you are a mandated reporter. I am certain you have encountered at least ten or more cases of child abuse. I am equally certain that you never reported any of these and in fact covered them up since you side with the parents.

By Politicalguineapig (not verified) on 17 Jul 2017 #permalink

PGP: Ah . . . I can't go along with the false equivalency. I think we agree that Jay is a deplorable person who shouldn't be practicing medicine because of his truly awful and dangerous advice, and enabling behaviors in regards to vaccinations.

That doesn't mean I think he ignores actual child abuse.

Dr.Gordon:
As a paediatrician, you should know that measles infection in infancy increases the risk of subsequent SSPE by 2 - 4 times.

Evidence was provided that the true incidence of SSPE is approximately 4–11 cases per 100 000 cases of measles, although with measles infection acquired very early in life the risk may be higher (18 per 100 000 cases).

Why then do you insist on delaying the measles vaccine to age 3? Do you inform the parents of this increased risk?
http://www.who.int/vaccine_safety/committee/topics/measles_sspe/Jan_200…

Not to mention there is an increased association with febrile seizures when you delay the MMR past the age of 2.

"In year 2, delaying MMR vaccine past 15 months of age results in a higher risk of seizures. The strength of the association is doubled with MMRV vaccine. These findings suggest that on-time vaccination is as safe with regard to seizures as delayed vaccination in the first year of life, and that delayed vaccination in the second year of life is associated with more postvaccination seizures than on-time vaccination."

This explains why the pediatrician's office where I just finished a clinic rotation didn't get too worked up with parents if the first MMR was at 15 months rather than 12, but did get worked up if they hadn't had it by 18-24 months.

By delaying the first MMR to age 3, there is a much higher chance of febrile seizures, which are dramatic and frightening to parents.

http://pediatrics.aappublications.org/content/early/2014/05/14/peds.201…

@Panacea-I already mentioned both the increased risk of SSPE in infants and the increased risk of febrile seizures when the MMR vaccine was delayed, and Dr. Gordon pretty much ignored it.

He also claimed in an above comment that he thinks that the risk of one of his patients, or someone exposed to one of his patients, suffering a severe complication from or dying of a VPD is "minuscule", so he obviously doesn't understand the potential severity of VPDs.

Panacea: That doesn’t mean I think he ignores actual child abuse.

I'm not so sure. Remember all those "cures' Mccarthy was putting her son through? Or that Jay advises parents of children with autism to look for cures, many of which range from unpleasant to lethal? I frankly think the man will say and do anything if there's money in it for him. We've already established that his ethics are for sale to the highest bidder.

(Also, does Jay ONLY see infants? That seems kind of odd, because my siblings had the same doctor throughout their childhood. I was with my parents when they moved states, but I had the same doctor up until puberty. I assumed this was standard practice.)

By Politicalguineapig (not verified) on 18 Jul 2017 #permalink

Shay, it’s an extremely small window. Tripling it still keeps it a very small window.

GuineaPig—Your post is insulting and unintelligent all at once. Unfortunately, I have had to interact with child abuse agencies many times. Yes, I see my patients through the end of their college years (!)

Panacea—Thank you for your . . . mixed review. I guess it was the best I could hope for. I have never seen a febrile seizure after giving the MMR. I do know those data though.

TBruce—I opened my office in 1984. We have not had a single case of measles. I give that vaccine every day to attempt to keep it a very rare illness in America (and elsewhere, I hope.) I did not always feel that way.

Jonas—How long have you been in practice?

By Jay Gordon, MD, FAAP (not verified) on 18 Jul 2017 #permalink

Jay: I've been a nurse for 32 years. I've never seen a case of measles. Why do you think that is?

Oh, yeah. Because we VACCINATE for it. Most of us on schedule, which creates that thing called herd immunity. You remember herd immunity, don't you? From med school? Because I sure as hell remember it from nursing school all those years ago.

Now let's try for a hard one. Why is it that Southern California had a measles outbreak in the not too distant past, in your neck of the woods?

Because we are losing herd immunity due to the stupid advice you give on delaying vaccines, the enabling of parents who want to refuse vaccination altogether for incorrect, false, or fraudulent reasons, and FFS for your testifying against a bill that will fix the very problem you have helped to create.

There's nothing mixed about my review, sir. I'm simply confining myself to what I know about you based on your own words and actions in public. It's called intellectual honesty. You might try it someday.

Jonas: Whups. I should have scrolled up and seen your post before I responded to Jay (Sorry Orac, I know you don't like people to create a string of posts, and would rather see it all in one).

From my reading I thought you were just addressing SSPE. My apologies.

Though . . . it did provoke a response of sorts ;)

The sad thing is, I think he does understand it. I just don't think he cares because he's made a lot of money selling misinformation on vaccination and the vaccine schedule.

It's like the old Upton Sinclair line: It is difficult to get a man to understand something, when his salary depends upon his not understanding it.

Panacea, we have not had a measles outbreak in my "neck of the woods."

I do not sell misinformation; I give that away for free. It's the information that I charge for.

By Jay Gordon, MD, FAAP (not verified) on 18 Jul 2017 #permalink

Jay: really? Santa Monica is not in your neck of the woods? Isn't that where you practice?

http://www.latimes.com/local/lanow/la-me-ln-measles-santa-monica-infant…

But, at least I got you to admit you pass around misinformation. Of course, that you claim to give it away for free (I believe you do charge for it, your books being QED) really doesn't make you look any better.

I do not sell misinformation; I give that away for free.

That's certainly an odd way to characterize one's own comments.

Jay: "I do not sell misinformation; I give that away for free."

Don't the parents who visit your office get ticked off when they find out they're paying for bad advice that others get as freebies?

By Dangerous Bacon (not verified) on 18 Jul 2017 #permalink

I do not sell misinformation; I give that away for free. It’s the information that I charge for.

Blatant lie, Gordon. You continue making money off your misinformation. Your "Vaccinations?" DVD is still for sale on Amazon (with some of the most unintelligent anti-vax nonsense I've ever seen), and your "Preventing Autism" book still sells on Amazon, as well (where you advocate for vaccine delays and play the "I just know there's a link between autism and vaccines because I *feel* it" game).

Why don't you go surf with Sears off the CA coast? That way neither of you can screw up pediatric/public health any more than you two reprobates already have.

By Chris Hickie (not verified) on 18 Jul 2017 #permalink

Shay, it’s an extremely small window. Tripling it still keeps it a very small window.

It's three fucking years.

Has it dawned on you why you haven't seen a case of measles over 30 years?

By shay simmons (not verified) on 18 Jul 2017 #permalink

Panacea! There was one baby in daycare with measles and, amazingly, among many other unvaccinated babies, zero spread. Zero. There was zero (zero!) spread of measles at any school.

Narad, Bacon, Chris--Why I expected you three to have a sense humor is beyond me.

Chris--I must repeat, I lost thousands of dollars on that DVD, the book--poorly titled!--also lost money. I have a successful pediatric practice. Thank Dog. I do love surfing and the waves have been incredible the past few weeks. Have never surfed with Bob though . . .

By Jay Gordon, MD, FAAP (not verified) on 18 Jul 2017 #permalink

There was one baby in daycare with measles and, amazingly, among many other unvaccinated babies, zero spread. Zero. There was zero (zero!) spread of measles at any school.

Is this extraordinary event documented anywhere?

LW: No. Because there WERE other cases. A high school coach. Patients in the Orthodox Jewish community. That the unvaccinated infants didn't get measles is not due to anything other than plain old good luck. They probably weren't actually exposed, given how contagious and infectious measles is.

All that happened in his neck of the woods, in an area with very low vaccine uptake due in part to his enabling of anti-vax sentiments.

You can dodge and weave all you want, Jay. Sooner or later, you're going to be called to account for what you've been doing, and you're going to go down in history as a total nut job.

Nice legacy you're leaving for yourself, and your kids.

Dr. Gordon: Unfortunately, I have had to interact with child abuse agencies many times.

Whatever helps you sleep at night. Do you also prescribe Lupron? Or suggest your patients treat their children with bleach? It's just that you seem to operate on the assumption that the parents are always right and cheerfully indulge them.
And if you don't want people to come away with the impression that your ethics are up for sale- well, maybe you should consider not having a practice that only takes cash. Or that you have a site that basically screams 'give me money!'
On that note, how's your pal Wakefield?

Huh, I was under the impression that most patients could only afford your services for a year or so, unless they were celebrities.

By Politicalguineapig (not verified) on 18 Jul 2017 #permalink

Why does Doctor Gordon even comment here? Every time he does, he is called out and made to look a fool. I am reminded of the very crude joke with the punchline "You're not really here for the hunting, are you?"

By Julian Frost (not verified) on 18 Jul 2017 #permalink

and you’re going to go down in history as a total nut job.

It's not clear that history will be that kind to him.

By Se Habla Espol (not verified) on 18 Jul 2017 #permalink

Back to the OT, Jake has a deeply nasty post up blaming immigrants, and likening fear of measles to fear of Islamic fundamentalism.

By Rebecca Fisher (not verified) on 19 Jul 2017 #permalink

I must repeat, I lost thousands of dollars on that DVD, the book–poorly titled!–also lost money. I have a successful pediatric practice

Oh, I get it---you purposefully set out to lose money on your quests to disseminate misinformation...yeah, that's the ticket.

And how can you have a successful pediatric practice when you hardly vaccinate, since the rest of us pediatricians are supposedly rolling in the dough from all the vaccinations we give?

Gordon--your unwelcome, annoying appearances hear reek of nonsensical one-uppers and non sequiturs. Nothing we tell you penetrates even the first micrometer of your cortex, and it never will.

Gordon's appearances on RI used to make me think of the "Black Knight" scene from Monty Python and the Holy Grail(https://www.youtube.com/watch?v=dhRUe-gz690) but I think he's much more akin to Kristen Wiig's character "Penelope" from Saturday Night Live who just makes up stuff in lame attempts of one upmanship that have no observable purpose (http://www.nbc.com/saturday-night-live/video/penelope-thanksgiving/n129…). Orac has metaphorically skewered/diced/sliced/roasted Gordon many times over on RI, but Gordon just keeps coming back for more.

By Chris Hickie (not verified) on 19 Jul 2017 #permalink

@Rebecca Fisher-Well, there is *one* immigrant who actually is responsible for the spread of measles....he's British.

Julian: I don't know why he keeps coming back for more. But it's a rare occasion that I can directly tell someone who's doing so much public damage what I truly think of them (the occasional politician here at home), so he's welcome to keep coming back for more as far as I'm concerned.

Some people are just masochistic that way, I guess.

@Jonas, "Well, there is *one* immigrant who actually is responsible for the spread of measles….he’s British."

Damned right. And I am quite sure Jakey will not be laying any blame in that direction. I guess we can add xenophobia to Jake's list of 'issues'.

Panacea—Thank you for that welcoming comment in your last post

Shay—The possibility of contracting measles during that two year window (not three years) between the recommended age one year and my recommendation of age three years is too small to measure.

LW—Yes, the lack of spread in any classroom is documented. The coach was not at the school, by the way.

Panacea—A legacy? You seem to be just a nameless person repeating your insults. We had no measles in my neighborhood or in my practice or in any schools where I care for children. Zero. I’ll live (and die) with this legacy.

GuineaPig—You know better than that. No, I do not support the use of Lupron. Nor bleach. Your hyperbole is unpleasant and serves no purpose here. I run a business. We take credit cards and checks too. I have chosen to practice in a way that insurance companies do like: I schedule one child each hour for check-ups. Not as profitable as the 10-12 minute visits many of my colleagues schedule. But it works very well for me and the families I care for. For a long time. Wakefield is not my “pal.” He’s also not the demon you paint him to be.

Julian—Clever old joke. I come here to learn and interact. The perseveration and lack of common sense bothers me sometimes. But I come here because I enjoy it. You?

Dr. Hickie—You’re a bitter person. And, hell no, I did not set out to lose money on the DVD or the books. I intended to make money. That didn't work out at all. I was, and remain disappointed! Your posts are reasonably literate and make you sound somewhat intelligent. Then you trail off into sad, bitter, almost incoherent ranting. Pick one.

By Jay Gordon, MD, FAAP (not verified) on 19 Jul 2017 #permalink

TYPO: "Insurance companies do not like"

By Jay Gordon, MD, FAAP (not verified) on 19 Jul 2017 #permalink

And once your neighborhood reaches "critical mass" of little ones that are unprotected what do you think will keep the measles out and away from your patients?

Or would your risk calculation change then, or would you still insist on your current schedule when the outbreak eventually shows up as they always do?

Jay Gordon,

Wakefield is every bit the demon we all portray to be.
He used unethical methods to gather data.
He crapped all over the data he got.
He accepted money from lawyers intent on making a killing on the existing MMR while he had his own measles vaccine ready to market.
He lied about autism.
His whole life since defrocking has been dedicated to reducing the uptake of the measles vaccine and thereby increasing the risk of death and infection for millions of kids worldwide. Including in Santa Monica.

Julian—Clever old joke. I come here to learn and interact.

But you don't appear to have learnt anything while here.

The perseveration and lack of common sense bothers me sometimes.

Can you give examples of this supposed "lack of common sense"? I mean, apart from your own.

But I come here because I enjoy it. You?

Same here. Also, reading Orac's posts has taught me a great deal about antivaxxers, bad arguments, and how to recognise and refute the latter.

By Julian Frost (not verified) on 19 Jul 2017 #permalink

KayMarie--My neighborhood has an extremely high MMR vaccination rate.

MikeMa--OK, I guess you're not going to be convinced. By the way, I did not support him or anyone else going into an area with a measles outbreak--Minnesota--and discouraging measles vaccination.

Julian--You don't know what I've learned. Ask Orac. There are so many other medical topics Orac covers and I tend to like them all. And the anti-antivax pieces make me think harder. What would make you think harder?

By Jay Gordon, MD, FAAP (not verified) on 19 Jul 2017 #permalink

Dear Rebecca Fisher@136,

He's just getting started. Wait till he get a backhoe or something bigger.

Al

I can vouch that Dr Jay indeed did appear to change his mind a little about vaccination right here on RI publicly although I can't recall exactly how or where but perhaps Eric, Ren or another minion can fill us in.

By Denice Walter (not verified) on 19 Jul 2017 #permalink

re Jake

OMFG! is he TOTALLY off his rocker?
see commenters as well

In other anti-vax news...

@ AoA:

There appears to be a new anti-vax writer from Connecticut..
oh no, wait, it's only Kim with a new nym/ name ( explained at her twitter account.... D I V O R. C E....)

@ prn.fm

In case you ever wondered if Wikip--- was informing people:
the hoary old woo-slinger discussed how he was BANNED from speaking about vaccines at a Berkeley station because the station management looked at Wikip--- 's entry about him
*Et voila!*
the show he was supposed to be on was told he was not allowed to speak and it was kept off the air ( last year I think during the protest against the new CA law)

He says he'll sue Wikip--- ( according to quackwatch he already did that and the case was thrown out)

By Denice Walter (not verified) on 19 Jul 2017 #permalink

Jay Gordon,
"I guess you’re not going to be convinced."

Of what?

Denice, yes. I give more vaccines than before my RI education. When one has such formidable teachers (and occasional adversaries) as Orac, one has to limit the number of stupid things that come out his mouth or off his keyboard. I still think that the current vaccine schedule lacks more than few shreds of science and continue to be stunned at the number of otherwise scientific people who buy into it. But I just can't make a strong case against one vaccine at a time.

By Jay Gordon, MD, FAAP (not verified) on 19 Jul 2017 #permalink

Jay: Ooooohhhh. The old "who are you?" defense.

I'm much happier being one of the anonymous masses than a publicly known figure who gives bad advice. You seem to have taken the view of "If I can't be famous, I'll be infamous."

Reputation matters. Yours has taken more than a few dings.

The measles cases in Southern California haven't taught you a damn thing . . . and they should have.

The number of measles cases in this country, EVERYWHERE in this country should be ZERO. It's not. You enable behaviors that have led it to be greater than zero.

You don't get to wash your hands of this because you personally haven't had any measles cases.

So you give more vaccines than you used to eh?

When you publicly disavow your past behaviors on national news, I'll believe you've changed. Until then, not a chance.

Narad, Bacon, Chris–Why I expected you three to have a sense humor is beyond me.

1. It's not even humorous to start with.
2. It was, however, an attempt to deflect.

These items share the trait colloquially referred to as "brain dead."

Reputation matters. Yours has taken more than a few dings.

I'd say that Jay's recent performance falls more into the crash-and-burn category. I can recall when he was categorized as "almost likable" in these parts, but this latest shіtrain is the end of story as far as I'm concerned.

Narad, you've broken my heart.

Panacea, have the courage to attach a name and credentials to your opinions. It'll feel OK

By Jay Gordon, MD, FAAP (not verified) on 19 Jul 2017 #permalink

@ Alain:

Ha ha.

Personally I am waiting to read his dissertation.

By Denice Walter (not verified) on 19 Jul 2017 #permalink

Jay: Hahahahaha. So you deflect again, because you think you're brave that you use your name and credentials?

Utter nonsense. You should review this history of publishing under pseudonyms. There's nothing wrong with it. Your issue is you have no real answer to what I've said to you, rather than the 'nym under which I've said it. So you attack my anonymity.

So, you want to actually do some logical thinking, and come up with a real answer to what I've said to you?

Can you really come up with a logically consistent, rational reason for why you enable anti-vax parents to disrupt herd immunity? "I feel" is not an answer. This is science. What EVIDENCE do you have that makes your position tenable?

And you know, simply admitting that you've been wrong all this time doesn't make you weak. It would actually improve your standing in the medical community for you to do so, if it's sincere and you change your behavior.

Dear Denice Walter,

Personally I am waiting to read his dissertation.

You'll read mine before his :D

Al

Dr Jay: Actually, that's 730 days, 17,520 hrs of chances to get measles.
Dr Jay: No, I do not support the use of Lupron. Nor bleach.

Coulda fooled me. But the real question is, would you be okay with the parents using that stuff.
" We take credit cards and checks too."
Yes, but the point is, medicine isn't supposed to be a business. It's a service. Again, when it comes to medicine the customers aren't always right.

Dr. Jay: Panacea, have the courage to attach a name and credentials to your opinions. It’ll feel OK.

Easy for a dude to say. Of course, the police will come anytime you snap your fingers- and they won't shoot you dead. The rest of us prefer not to have the dreck you hang around with know where our doors are. Psuedonyms are a long and honorable tradition and only a fool uses their real name online.

By Politicalguineapig (not verified) on 19 Jul 2017 #permalink

@Jay Gordon:

I still think that the current vaccine schedule lacks more than few shreds of science and continue to be stunned at the number of otherwise scientific people who buy into it.

What evidence dies it lack? What evidence would convince you that the schedule is both safe and effective?
If you can't articulate why you're unhappy, and why your modified schedule is better, maybe you're wrong.

By Julian Frost (not verified) on 19 Jul 2017 #permalink

Narad, Bacon, Chris–Why I expected you three to have a sense humor is beyond me.

Is there anything that *isn't* beyond Jay Gordon?

By Chris Hickie (not verified) on 20 Jul 2017 #permalink

@Julian Frost,
"dies" is an interesting typo. If Jay continues to second guess the science, "dies" is a likely outcome.

Shay—The possibility of contracting measles during that two year window (not three years) between the recommended age one year and my recommendation of age three years is too small to measure.

And you still haven't figured out why.

By shay simmons (not verified) on 20 Jul 2017 #permalink

Panacea—I just reviewed the history of publishing under a pseudonym. I am shocked and amazed at the courage it takes to make up a name, write nasty things about other people and sleep well at night. Thank you for pointing me in that direction. I support parents participating in all health care decisions including vaccine decisions. “Enabling” is a cliche’d word. And inaccurate.

GuineaPig—I am not OK with parents using Lupron. For better and worse, medicine is a business. I know this from trying to skip payments on my rent, electric bill and employee salaries. Bad business decisions will kill even the best medical practice. Police do not come when I “snap my fingers.” I hang around with no one, actually.

“Fool??!!” Orac uses his real name at the other place and he is far from a fool. You drift off into illogical and strange arguments after you’ve exhausted reasonable possibilities.

Julian—Hard to argue with you. Impossible, really.

Shay—Herd immunity against measles is the right answer.

Have a great day all.

By Jay Gordon, MD, FAAP (not verified) on 20 Jul 2017 #permalink

Jay: if you encourage waiting until age 3 for the first MMR, you are enabling anti vax sentiments, and playing Russian roulette with the health of children. I don't care what you think of my 'nym. You're just shifting the goal posts again to make yourself feel better about what you are doing.

I suppose I shouldn't be surprised. "The villain is never the villain in his own eyes." RAH

Herd immunity against measles is the right answer.

No. Going all smallpox on it by vaccinating everybody, and making measles extinct in the wild, and then not having to vaccinate anybody ever again is the right answer.

I dunno why you don't want that.

Panacea!!!

If you are going to quote Robert Heinlein, one of the greatest authors ever, you had better know that the rest of us know his stuff and will not tolerate a serious misquoting.

"Your enemy is never a villain in his own eyes"

You may think of me as "your enemy" (I'm not!) but I am not "the villain."

Universal MMR vaccination at age three years would create better herd immunity than we have now.

Full quote: "Your enemy is never a villain in his own eyes. Keep this in mind, it may offer a way to make him your friend. If not, you can kill him without hate."

And another: "One man's "magic" is another man's engineering."
RAH

Be well, Panacea. "You are not my enemy and I am not yours." JNG

By Jay Gordon, MD, FAAP (not verified) on 20 Jul 2017 #permalink

PGP,

only a fool uses their real name online.

Thanks for the compliment :) That said, I suggest that no one underestimate me.

Alain

I just reviewed the history of publishing under a pseudonym. I am shocked and amazed at the courage it takes to make up a name, write nasty things about other people and sleep well at night.

Maybe you should challenge Panacea to a duel.

Jay: "For those of you who do have a sense of humor:"

Actually, for us who are literate know that it is not a vaccine for measles, and nor is it either of the rotavirus vaccines that were developed in the USA years ago.

Also, Jay, are we supposed to be laughing at the Serum Institute in India? Why?

Hi Chris--The irony of an anti-diarrhea vaccine being found to cause increased diarrhea merited the chuckle. Not the Serum Institute of India which, as we all know, is the world's largest manufacturer of vaccines.

Narad--Panacea is not my enemy. We just disagree about a few things.

By Jay Gordon, MD, FAAP (not verified) on 20 Jul 2017 #permalink

Not really, Jay. That was truly pathetic, even for you.

Panacea is not my enemy.

"I am shocked and amazed at the courage it takes to make up a name, write nasty things about other people and sleep well at night."

Humor, Narad, humor.

Hey Chris, on the other hand, calling names is neither humorous nor terribly clever. (I know, I know, I do the same thing sometimes. Apologies.)

What was pathetic? You do know about the Serum Institute, right? And you know irony? What part??

By Jay Gordon, MD, FAAP (not verified) on 20 Jul 2017 #permalink

"KayMarie–My neighborhood has an extremely high MMR vaccination rate. "

And you assume it will always stay that way?

Would you change your ways if/when it does change, or if there is an outbreak?

Lots of places used to have a high vaccination rate, but don't anymore.

@MikeMa yep. One of the times I did my best proofreading AFTER hitting "Submit".
@Jay Gordon #165, very sly of you. "Julian—Hard to argue with you. Impossible, really." Instead of admitting that you can't refute my responses to you, you insinuate that I'm stubborn and impossible to reason with.

By Julian Frost (not verified) on 20 Jul 2017 #permalink

KayMarie--If there were more cases--an outbreak-- of measles nearby I would encourage measles vaccination for those without it. Just as I do when unvaccinated kids and teens travel to Europe: I always discuss the much different measles situation there and the greater likelihood of contagion.

By Jay Gordon, MD, FAAP (not verified) on 20 Jul 2017 #permalink

Jay, calling your attempt at diversion pathetic was a description, not calling someone a name. There was nothing humorous in you linking to an article about a vaccine developed recently in India.

Lots of vaccines have been known to not be as effective as desired. That is the purpose for ongoing surveillance. A recent American example would be FluMist. Older examples would be the earliest measles and rubella vaccines. This is why one needs to be specific about where and when a particular vaccine was developed and approved.

An example would be that in 1988 UK introduced three different MMR vaccines. In 1992 they removed two of them because of the too high a risk from aseptic meningitis from the Urabe mumps strain (a newer cheaper strain from Japan, never used in the USA). So even if Wakefield had figured out which MMR was used in his case series (which had one American kid who had been given the MMR vaccine introduced in 1978 in the USA), it really had no bearing on any MMR vaccine you would use here (even with the N=1 in that case series).

What your silly diversion proved is that you do not understand the issues and science, so you should definitely not be making up your own vaccine schedules.

@Jay Gordon (#180) Are you saying that, if there was an outbreak of measles in Santa Monica, you'd vaccinate your patients on time, rather than needlessly waiting until age 3?

BTW, considering the increased risk of SSPE and other complications in infants who contract measles, the appropriate thing to do in that situation would probably be to vaccinate even infants under a year old, as is recommended if infants under a year old are going to travel to a country where measles is endemic.

Jonas--You might be right.

By Jay Gordon, MD, FAAP (not verified) on 20 Jul 2017 #permalink

Jay @180: So what do you do about kids who will be around people who have traveled to Europe? Parent, grandparent, aunt, uncle, close family friend, other caregiver? Do you recommend getting them their shots as well?

By JustaTech (not verified) on 20 Jul 2017 #permalink

Jay: you're right. I misquoted Heinlien. And while I don't consider you my personal enemy, I do consider you an enemy of public health. Whatever your motives, your actions are a danger to public health.

And I haven't pulled my punches about that.

Your attempts to use humor to deflect aren't very funny. You're not half as clever as you think you are.

Narad: a duel would probably give Jay at least a fighting chance.

Alain: I didn't mean to insult anyone on this thread other then Jay. I was paraphrasing something I was taught regarding security on the 1.0 internet. That said, I imagine there are hundreds of Alains where you live, and I notice you don't use your full name. I only use my real name on email accounts and the Book o' Face. On blogs there are just too many randos around.

Jay: Rules are slightly different for Orac. His instituition and supervisors have his back. I imagine he wouldn't use his real name online if he had an unsupportive workplace. He also doesn't have kids to worry about, nor does he have to worry about his personal safety (much.)

I was referring to other antivaxxers, not your friends-if any- in real life.
You should check out Jake Crosby's blog- another pal of Wakefield's- sometime. Or swing around to Age of Autism where all your pals and fellow travellers post. Then you might understand why some of us might not want those people knowing our real names.

Johnny: That would actually be really awesome if measles went extinct. I wouldn't mind mumps and rubella following suit. Of course, if measles went bye-bye, someone wouldnt' get that sweet money, and that's what really matters.

By Politicalguineapig (not verified) on 20 Jul 2017 #permalink

PGP,

My full name is a very loosely kept secret (as evidenced by a certain travis who posted under my name at a few places including here) and there's aren't many peoples with my last name.

Still, I'm not that concerned about the weirdos on the intertoob, more so by the dangerous ones (which I met a few of them and helped put one in prison and thereafter, in a forensic psychiatric hospital) in real life.

Alain

Wait, Heinlein is "one of the greatest authors ever"? Maybe Jay finally dug an actual bit of humor out of his medulla oblongata.

Couple of points for Doctor Jay to consider:

Re use of 'nyms - I use this and other 'nyms because I started out commenting on things to do with my former professional field (MH nursing), but my employer (a large NHS trust) had some very strict rules about us not writing or saying anything which might reflect in any way on our employer and we could be disciplined up to sacking for that (FFS I got into trouble for co-writing some multi-agency care guidelines and not running them by trust corporate affairs). So it's 'nyms all the way. Dunno what rules apply in Merkinania, but I do know that medics are treated rather differently to nurses over here.

Talking of which, Wakefield "not a demon"...Do you have any idea how hard someone has to try to get struck off by the GMC? Managing to achieve that is really going some. And that's before you consider that he assaulted several children for his own ends. You should hear how a number of child and adolescent psychiatrists, paediatricians and pathologists of my acquaintance describe him (wouldn't get through the software on RI)...

Jay: "If there were more cases–an outbreak– of measles nearby I would encourage measles vaccination for those without it"

Following this line of reasoning, if there was an surge in antibiotic-resistant staph and norovirus infections at his local hospital, Jay would encourage the medical staff to wash their hands.

By Dangerous Bacon (not verified) on 21 Jul 2017 #permalink

@Dy Jay - you see humor in the "irony of an anti-diarrhea vaccine being found to cause increased diarrhea".

Not when one looks at the comparison for severe and very severe diarrhea from any cause, the rota vaccine was protective.

So maybe some kids get mild diarrhea with vaccine, instead of getting very severe diarrhea without vaccine?
That's a trade off I'd be delighted my children get.

Once again, we see that Dr Puliyel has cherrypicked results and placed his own twisted interpretation on them, switching between "intention to treat" and "as per protocol" analyses to suit his own biased antivaccine agenda.

Jay, your own biased agenda has been plain to see for a long time. Maybe you should read the original article, instead of having your views regurgitated to you by antivax intermediaries.

Justa—Travelers should get appropriate vaccines

Panacea—“Heinlein” No, I’m not a danger to public health. “Preaching to the converted” is easy. I convert.

Politicalguineapig—I don’t like the tone of antivax sites.

Narad—Yes, Shakespeare, Vonnegut, Heinlein. Right?

Murmur—If your employer suppresses Freedom of Speech, that’s wrong.

Dangerous Bacon—Yes, universal correct handwashing in a hospital would be a novel occurrence.

Dingo199—Irony. And, by their very nature, agendas are biased, Mine certainly is. Yours is not?

By Jay Gordon, MD, FAAP (not verified) on 21 Jul 2017 #permalink

Re Heinlein. He's a major figure in science fiction and space opera, but even the most rabid fan wouldn't compare him to Shakespeare.
Not to mention some of the problematic themes in his writing. Have you read "To Sail Beyond Sunset" or "Time Enough for Love"? Dude had issues.

By JustaTech (not verified) on 21 Jul 2017 #permalink

Shay—Herd immunity against measles is the right answer.

And how was that herd immunity achieved (in the days before anti-vaxxers and pandering pediatricians began making inroads against public health)?

By shay simmons (not verified) on 21 Jul 2017 #permalink

Dr. Jay: I don’t like the tone of antivax sites.

Why not? They're rude as all-get-out, just like you, and most of the posters are just as honest as you are. And most of the writers of Age of Autism are of a type you know and love.

Dr Jay:Yes, Shakespeare, Vonnegut, Heinlein. Right?

One of these things is not like the other. For the record, I think Heinlein had a FEW decent books, but a lot of his later works are sheer turds.(I will note that for a yarn that is about 100 pages long and is about interplanetary politics, Double Star is oddly haunting.)
Vonnegut is definitely a contender, but I think Arthur C Clarke and Asimov were twice the writers Heinlein was. Also, most of Heinlein's stuff is only accessible to American readers. Writers should have a universal appeal and not be blinkered by politics or the country they live in.
Heinlein also had a bad habit of writing about 'perfect' protagonists. Vonnegut, for instance, wrote about humans, as did Shakespeare.

For sheer writing skill, 'Neutron Tide' is one of my all time favorites. Yes, it's short, but the trouble Clarke takes with that set up is amazing.

Isn't norovirus airborne?

By Politicalguineapig (not verified) on 21 Jul 2017 #permalink

Alain: My main concern is that weirdos on the internet NOT become a part of my real life. I suppose Canada is safer, though. I also have a distinctive last name- which I don't use on the 'net. It gives spellcheck the fits.

By Politicalguineapig (not verified) on 21 Jul 2017 #permalink

DW: There appears to be a new anti-vax writer from Connecticut..
oh no, wait, it’s only Kim with a new nym/ name ( explained at her twitter account…. D I V O R. C E….)

That's surprising, I was under the impression that she married a doormat. I can only hope hubs got custody. Those girls deserve a break from her.

By Politicalguineapig (not verified) on 21 Jul 2017 #permalink

JustaTech—Ya’ got me. Maybe Heinlein is not in the same leagues as Bill Shakespeare.

Shay—Herd immunity against measles not only remains intact, but is actually improving in my area. (You’re welcome)

Politicalguineapig—Some AOA denizens are OK and some are not. Kinda’ like here at RI
Yes, Noro can be airborne

Alain—Hard to disagree about the weirdos

By Jay Gordon, MD, FAAP (not verified) on 21 Jul 2017 #permalink

I like Heinlien. The man won four Hugo awards and was nominated for six others (one nomination for a book he eventually won best novel on, granted). One of the nominees, Job: a Comedy of Justice, I consider the worst novel he ever wrote. Well maybe I Will Fear No Evil was. YMMV ;)

Then again, I don't use him as a moral model. He was friends with L Ron Hubbard, FFS.

But really Jay. You abandoned everything you were taught in medical school to "buck" the system, sell a few books and DVDs, and get a lot of media attention. You claim you lost money on the DVDs at least, but apparently the attention and adoration of anti vax parents is enough for you.

That you ignore the consequences and pretend they don't exist doesn't absolve you of anything. You are a danger to the public.

As for 'nyms: One of the reasons I went to using Panacea as my 'nym is because the one I used before this (for 20 years before this one) got outed on the comment boards of my local news paper about 10 years ago. The local conservative nut jobs (as opposed to the rational conservatives who could defend their POV using logic and reason rather than ad hominem attacks) didn't like me any better than you do, Jay. One of them tried to cause problems for me at work.

That didn't work because the administration of my college didn't care and supported my academic freedom. But I don't need the kind of harassment Orac got . . . so anonymous it has to be. If we lived in a better world it wouldn't be necessary. But . . . there it is.

"Some AOA denizens are OK "

Citation needed :p

Actually, name some names, have not seen any evidence of OKness.

Heinlein was friends w LRH?? That's disappointing. I didn't know that.

Panacea, I did not abandon everything, Just began thinking harder and realizing that medicine and science are not monolithic nor unchanging. The old cliche' about "X percent of what we know now will be wrong in three years" is true as true can be. You kinda' know nothing about what I really do in my practice: I am an asset to public health.

It takes a lot of courage to use one's real name out here. I am wrong to ask that of everyone (anyone??) here at RI. All hat and no cattle?

By Jay Gordon, MD, FAAP (not verified) on 21 Jul 2017 #permalink

If Gordon uses a 'nym I suggest "legend in his own mind".

By Chris Hickie (not verified) on 21 Jul 2017 #permalink

Chris, I love that pseudonym. Probably couldn't have picked a better one myself.

By Jay Gordon, MD, FAAP (not verified) on 21 Jul 2017 #permalink

Well, Jay, what ever gets you through the day I suppose. I've said my piece, and watching you delude yourself is getting tedious, so I think it's time to wrap this thread up.

But one final thought. No medicine is not a monolith. I can point to plenty of things that have changed in my over 30 years in this profession, mostly for the better. But here's the thing . . . they changed on the basis of medical evidence, not the wild a** guesses and wishful thinking of a self deluded, egotistical jacka**.

That is all.

"It takes a lot of courage to use one’s real name out here. I am wrong to ask that of everyone (anyone??) here at RI. "

Courage? The Anti Vax side contains large amount of deranged lunatics led by cold blooded sociopaths, I applaud Orac's bravery in his public confronting of them, but I'm in a different situation with a child to think of.

So yes you are very wrong to ask that of anyone on RI, which you should well know after witnessing the lunacy on AoA.

People often miss the point of RI, for me and many it is to get the best science based arguments for discussions elsewhere*, where mostly I do use my real nym.

*Also some of the best snark on the interwebs ;)

Keep dodging, Gordon.

By shay simmons (not verified) on 22 Jul 2017 #permalink

If Gordon uses a ‘nym I suggest “legend in his own mind”.

Well, Timothy Leary's dead.

Shay, sorry, is there a question outstanding? Happy to answer if you'll please clarify.

By JayGordon, MD, FAAP (not verified) on 22 Jul 2017 #permalink

is there a question outstanding?

Such as the actual reason for your arbitrary choice of age 3 for MMR? No, I guess not.

Narad—Yes, Shakespeare, Vonnegut, Heinlein. Right?

Jesus Fυcking Christ. You haven't had much exposure to, y'know, actual literature, have you? Go read this, or this, or even fυcking Melville.

Here. Heinlein should have stuck to juvenalia.

Gordon is simply wrong about high vaccination rates in "his neck of the woods" (it's hard to think of Santa Monica that way.) In fact, prior to SB277, vaccination rates were below herd immunity rates at Santa Monica High School and at least two of their middle schools. Crossroads School was far worse with 50% unvaccinated, according to the Santa Monica Daily Press. At least some of this travesty is due to vaccine-averse physicians like Gordon. I continue to be appalled by his callous indifference to the many senior citizens in Santa Monica. He neither knows nor cares if any of them dies or becomes seriously ill due to exposure to one of his diseased patients. It's easy to be blasé when you ignore the facts of disease transmission. The disease outbreak at Santa Monica High School's child care center was kept in check by immediately closing that facility, but perhaps he advocates chicken-pox parties to ensure his patients get their immunity naturally. Does he think it's better to have a small chance of developing a serious side effect from experiencing the illness instead of an infinitesimal chance that results from vaccination? Mathematical literacy obviously isn't his strong point, nor is caring about anyone in his vicinity that isn't one of his patients.

By cloudskimmer (not verified) on 22 Jul 2017 #permalink

Jay Gordon: "Yes, universal correct handwashing in a hospital would be a novel occurrence."

I see poor Jay has suffered a breakdown in comprehension.

I hate to have to explain this in words of few syllables, but my point was that strict handwashing guidelines have been established in health care settings to PREVENT transmission of disease from caregivers to patients. Your grudging support for measles vaccination in the EVENT of an outbreak of measles is akin to endorsing handwashing ONLY after there are outbreaks of disease related to the lack of it.

I'd have expected a FAAP like you to have picked up on this incongruity (or stupidity, to use a more appropriate and less polysyllabic word), but apologies for having expected too much of you.

By Dangerous Bacon (not verified) on 22 Jul 2017 #permalink

Bacon--I never said you were unintelligent. Just a wee bit dense and you repeat yourself a little too much. I give measles vaccines to prevent the disease. Just as you would. And just as we encourage hand washing. You do know that hand washing has been shown to be completely inadequate in most hospitals until there's either an outbreak or a "campaign." Do you practice medicine?

Cloud skimmer--There was no outbreak at the daycare center. There was one case. That's one case. That child was contagious, probably exposed lots of others and they still didn't get sick .Do you practice medicine?

Narad--The Heinlein-Shakespeare comments were written in a facetious vein.

I choose three years because I believe that developmental normalcy is more obvious.

The reason I ask about whether or not you practice medicine is that it's hard for you to comprehend what that means until you do it.

Bacon, you're turning into a bit of nasty person. And we all know how I feel about nastiness. :-)

By Jay Gordon, MD, FAAP (not verified) on 22 Jul 2017 #permalink

And Gordon is still weaseling.

By shay simmons (not verified) on 22 Jul 2017 #permalink

There was no outbreak at the daycare center. There was one case.

Do you know what the word "outbreak" means in medicine? You should look it up: even Wikipedia knows what it means.

By Se Habla Espol (not verified) on 22 Jul 2017 #permalink

A play I saw last night:
"No one finishes Moby Dick."
I kind of soured on Russian authors after being assigned Turgenev. I swear, Russian books are actually disguised neutron stars.

Shay: Has he ever not weaseled? I dunno if Dr. Jay actually knows how to be honest. I am kinda amused by his pot calling the kettle comment above.

By Politicalguineapig (not verified) on 22 Jul 2017 #permalink

I kind of soured on Russian authors after being assigned Turgenev. I swear, Russian books are actually disguised neutron stars.

There's a huge variety within Russian literature; it's not all Tolstoy and Dostoevsky.

Personally, I hate Tolstoy for a lot of reasons, personal and literary; part of this might have to do with the fact that the first bit of Tolstoy I was assigned was The Kreutzer Sonata, which is an absolute prudish misogynistic dumpster fire. I got so mad at it that I literally threw it against the wall as an undergrad.

I love Dostoevsky, although Demons (it's been translated a few times and also goes under the title The Possessed) probably isn't where I'd start. It's actually the last of his novels that I read, I think, and I didn't get around to it until grad school. (Hey, you try being faced with the Russian canon.) The Brothers Karamozov is definitely my personal favorite, and I'd recommend it to anybody.

Yeah, Dostoevsky is still long, for the most part, but at least he had an excuse; he was a broke epileptic who wrote in installments for "thick journals" and was paid accordingly. Tolstoy just couldn't be arsed to solicit the services of a decent editor, though he certainly could have afforded one.

Generally, though, I'm a bigger fan of 20th century Russian literature. Check out Sologub and Zamyatin (his novel We is an absolutely classic and first rate sci-fi totalitarian dystopia, and it's also the first novel I ever read in Russian.) Bulgakov is great. Chekhov, although you could definitely call him part of "the long nineteenth century."

Not to mention the Symbolist and Acmeist poets. (Blok, Gippius, Akhamatova, Mandelstam, and so on and so on.) I imagine that poetry is more enjoyable in the original, but there are a lot of really good translations of the major poets like Mandelstam. (Which are the best is a matter of taste, as long as we're dealing with quality translations.)

Moscow to the End of the Line (Moskva-Petushki in the original) is defs worth a read. I read it during my first summer in St. Petersburg.

Of course, I could go on and on. (And that's only Russian literature; there's Polish, too...)

:-)

Bulgakov is great.
Anyone who has not read "Master and Margarita" should stop what they're doing and go and read it NOW.

By herr doktor bimler (not verified) on 22 Jul 2017 #permalink

Oh, and I somehow forgot to mention Olga Sedakova and Elena Shvarts, both of whom exist in English translation, probably because (ouch) I used to write on them.

Actually, I think my own translations of Shvarts are pretty top-notch (Sedakova not so much), but the publishing rights situation has gotten complicated since her death. My advisor offered to help me get rights like five or six years ago - Lena was a personal friend of his - but for one reason or another, he never came through on that.

JP: What do you think of Arkady Strugatskii (or Strugatsky?) I am very interested in Russian science fiction. One of my facebook friends was recommending a pair of Russian fantasy authors (married couple) only I can't for the life of me remember the name or the title, other than it might have been something about a map? And it was like swords and sorcery?

By Politicalguineapig (not verified) on 22 Jul 2017 #permalink

Also, I did enjoy the few chapters that I read of Night Watch.

By Politicalguineapig (not verified) on 22 Jul 2017 #permalink

So, Russian names give the library system hiccups :)

By Politicalguineapig (not verified) on 22 Jul 2017 #permalink

What do you think of Arkady Strugatskii (or Strugatsky?)

Holy crap! I love the Strugatsky* brothers! A professor who later ended up on my committee hipped me to them; I seem to recall that she was writing an article about them, but I'm not coming up with anything.

One of my facebook friends was recommending a pair of Russian fantasy authors (married couple) only I can’t for the life of me remember the name or the title, other than it might have been something about a map? And it was like swords and sorcery?

Definitely reads a bell, but somehow I haven't come across them personally. Could it be Maryna and Serhiy Dyachenko? (Technically they're Russophone Ukrainians, though, FWIW.)

Also, I did enjoy the few chapters that I read of Night Watch.

I saw the movie a long time ago (during the summer Russian program at Middlebury, I think?) and it was just okay. Maybe I should give the book a go.

So, Russian names give the library system hiccups

Yep. The professor who taught the grad student intro seminar thingy in my first year of grad school once told a mildly amusing story about how, when she was in (college? grad school?) she was really big into Leskov (definitely a worthwhile author) and wanted to start researching him, she was going through the card catalog and shocked to find very little on him. Turns out that a lot of the sources spelled his name Лѣсков (using the pre-Revolutionary orthography) rather than Лесков.

BTW, if you want to read some great Polish sci-fi, try Stanisław Lem's Solaris. I also highly, highly recommend Tarkovsky's film based on it (along with pretty much everything Tarkovsky ever did), but not the garbage movie with George Clooney from the 2000s.

*I include the Strugatsky brothers in the group of authors (along with, for instance, Tolstoy) with names that have long been transliterated into English a certain way and are thus "grandfathered in" and excepted from the Library of Congress transliteration system which I am otherwise so uptight about.

along with pretty much everything Tarkovsky ever did

Watch "Stalker" and you get a Strugatsky novel filtered through Tarkovsky's aesthetic! It's a two-fer!
The scary thing is that Tarkovsky did not have to construct any sets of "post-apocalyptic wasteland filled with crumbling alien artefacts filled with random lethality but no apparent purpose", he could film everything on location.

By herr doktor bimler (not verified) on 22 Jul 2017 #permalink

Jay: "Bacon, you’re turning into a bit of nasty person. And we all know how I feel about nastiness."

Yes. You practice it (name-calling and shill accusations for example) then chastise others for perceived lack of decorum, mainly to try to distract from your evading questions and changing the subject.

By Dangerous Bacon (not verified) on 23 Jul 2017 #permalink

You know, usually when I say I'm done with a topic, I mean it and I'm done. But then I clicked on the comments here and read something and realized, I wasn't quite done yet.

Jay said, "You do know that hand washing has been shown to be completely inadequate in most hospitals until there’s either an outbreak or a “campaign.” Do you practice medicine?

Wrong. Wrong, wrong, wrong. Yes, it is true most people don't do a good job washing their hands. It's been shown again and again washing or simply gelling in and out greatly reduces nosocomial infection rates.

http://www.bmj.com/content/325/7360/362.short

But when half wits don't wash their hands, others begin to model their behavior on the half wits.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2901948/

To disastrous results: http://www.sciencedirect.com/science/article/pii/S0196655315009451

Then Jay said, "The reason I ask about whether or not you practice medicine is that it’s hard for you to comprehend what that means until you do it. "

I just finished my pediatrics rotation for my FNP program. I spent 4 weeks, Monday through Friday, in a very busy pediatrics practice in an underserved community. My preceptor was a PNP, but I was fortunate to get to spend a lot of time with the pediatricians in the practice as well, including doing hospital rounds several times.

One of the pediatricians loves to teach, and he'd quiz me like a medical student or a first year resident. I loved it, even though half the time I didn't know the answers to his questions. But I know them now.

I have one word for the experience: Humbling.

As I've said, I've been a nurse for quite a long time. I'm pretty good at my job. I thought I already knew a lot when I decided to go for NP, and I do . . . but not half as much as I thought I did.

And it IS different when I'm the one making the call on the diagnosis and the plan of care. It's NOT as easy as it looks. I got a lot of ear diagnoses wrong because I have a hard time distinguishing the normal vascular color of a crying child from inflammation, and thought I saw otitis media when I didn't. If it had been up to me, I would have been prescribing a lot of unnecessary amoxicillin, and that people do that is why we have antibiotic resistance in this country.

I was a lot better at it by the end of my four weeks. But nothing makes me feel sicker to my stomach than the idea of getting a diagnosis wrong, and either not prescribing the right plan of care (which might just be to watch and wait) or prescribing the wrong one (and making the problem worse).

You seem to have forgotten that, Jay. And I know that, because if you took the medical literature seriously . . . like my PNP preceptor and the pediatricians in her practice do . . . you wouldn't be doing what you're doing when it comes to vaccination.

You need a reminder on what it means to be humble. Unfortunately, it likely would have to come at the expense of a child, so I pray it comes about some other way.

JP: Yes, it's the Dyachenkos. Thank you.

I didn't know the Strugatskiis were brothers, I thought it was another married couple. I currently own Roadside Picnic and will be getting Hard to be a God, and reading it this time. (I've been having some trouble with attention span lately, so some books are going unread.)
I actually own the book of Solaris and some of Lem's other work. Didn't he write Memoirs Found In a Bathtub?

By Politicalguineapig (not verified) on 23 Jul 2017 #permalink

Panacea--Wonderful that you're learning pediatric practice. Yes, after nearly forty years, I find something humbling in almost every office day. Keep learning, Panacea.

You misunderstood my comment about hand washing: Not that hand washing doesn't work, but that we know that most docs don't wash adequately.

By the way, Amox no longer works for otitis media and, yes, by the 20,000th ear (I'm past a quarter million and it's not always a clear call) you look at you'll be a lot better at diagnosing OM. Standard of care, however, pretty much mandates "watchful waiting" rather than antibiotic treatment during the first 72 hours. This, of course, varies from child to child depending on age and other factors.

You seem smart. Know that I take medical literature very seriously. I believe that I have read much, much more than you have over the past four decades and continue to focus on pediatrics. My practice is incredibly fulfilling and I enjoy going to work every single day. Assumptions made in this little corner of the internet by the above perseverating detractors don't really dent my enjoyment. I learn here.

By Jay Gordon, MD, FAAP (not verified) on 23 Jul 2017 #permalink

Jay: "Amox no longer works for otitis media...I take medical literature very seriously."

Not too seriously, or you wouldn't have missed the current guidelines for otitis media treatment according to the American Academy of Pediatrics and the American Academy of Family Physicians::

"Antibiotics should be prescribed for bilateral or unilateral AOM in children aged at least 6 months with severe signs or symptoms (moderate or severe otalgia or otalgia for 48 hours or longer or temperature 39°C or higher) and for nonsevere, bilateral AOM in children aged 6-23 months
On the basis of joint decision-making with the parents, unilateral, nonsevere AOM in children aged 6-23 months or nonsevere AOM in older children may be managed either with antibiotics or with close follow-up and withholding antibiotics unless the child worsens or does not improve within 48-72 hours of symptom onset
Amoxicillin is the antibiotic of choice unless the child received it within 30 days, has concurrent purulent conjunctivitis, or is allergic to penicillin; in these cases, clinicians should prescribe an antibiotic with additional beta-lactamase coverage."

http://emedicine.medscape.com/article/994656-guidelines?pa=QoqkkOUR5xUs…

It's not surprising that Jay ignores AAP guidelines for otitis media treatment, seeing as he similarly ignores AAP guidelines for vaccination.

"perseverating detractors" - Nasty, Jay, nasty. Surely you're better than this.

By Dangerous Bacon (not verified) on 23 Jul 2017 #permalink

JP: I did manage to win out against the library system :) Librarians rule.

By Politicalguineapig (not verified) on 23 Jul 2017 #permalink

Nuts. DB beat me to it.

Jay Gordon (#29) writes,

I learn here.

MJD says,

Your a good man Charlie Brown!

By Michael J. Dochniak (not verified) on 23 Jul 2017 #permalink

Another good movie adaptation of a Strugatsky novel:
https://en.wikipedia.org/wiki/Hard_to_Be_a_God_(2013_film)

Has themes of religion and suppression of knowledge in the context of authoritatian politics -- very timely! -- in a medieval milieu, so lots of monochromatic mud and squalor.

By herr doktor bimler (not verified) on 23 Jul 2017 #permalink

Yes, after nearly forty years, I find something humbling in almost every office day.

In that case, you should have a surplus of apropos examples to share with the commentariat.

You seem smart.

*Snort*

HDB: I have Hard to be a god bookmarked on my netflix que.

By Politicalguineapig (not verified) on 23 Jul 2017 #permalink

Jay Gordon #180

KayMarie–If there were more cases–an outbreak– of measles nearby I would encourage measles vaccination for those without it

But you didn’t! In 2015, You didn’t! http://www.cbsnews.com/news/doctor-explains-why-he-lets-kids-avoid-the-…
You mocked the outbreak! (SBM link with tweet in evidence) http://www.cbsnews.com/news/doctor-explains-why-he-lets-kids-avoid-the-…

How am I supposed to believe you’ve changed since two years ago?

(I’ve been having some trouble with attention span lately, so some books are going unread.)

Oh, I definitely know the feeling. When I do read an actual book, I do it very piecemeal and it takes me a lot longer than it used to.

I actually own the book of Solaris and some of Lem’s other work. Didn’t he write Memoirs Found In a Bathtub?

Yep.

I did manage to win out against the library system ? Librarians rule.

Noice!

@Jay

..by the 20,000th ear (I’m past a quarter million and it’s not always a clear call)

Jay, if you worked for 35 years, 330 days a year, that would come to over 21 ears a day. Are you telling us you still look into the ears of 11 kids every day? You must be an otitis expert indeed.

So maybe Eliza-Jane Scoville should have got more than a cursory ear exam from you in the days leading up to her death from AIDS? Or was that Philip who boobed on that one? Maybe if she had got pneumovax and HiB vax, then she wouldn't have got the "otitis" in the first place?

Today I look after several kids and young adults with HIV infection. They are all well, and thriving.
I hope you reflect from time to time on how good the outcome from HIV can be - as long as it is tested for and treated in a timely fashion.

Dingo: on this I'll defend Jay.

I looked into every kid's ears. I saw on average 10 patients a day. My preceptor saw on average 20. The pediatricians saw on average 30. From what I could observe with each of them, they looked in the ears of every kid, whether they needed it or not.

I have no doubt Jay's being truthful when he says he's seen that many ear, and my preceptor told me I won't really feel comfortable until I've looked in a thousand ears. I looked in about 200 during my rotation.

Dangerous Bacon—If Amox “cures” an ear infection, then no Rx would also have worked. You don't have to know this; I do.

Dingo199—Yes, 11 kids a day for certain.

HIV+ pregnant women should receive appropriate medication and their children should all be tested. For better or worse, the legal issue is still unresolved regarding this care and testing. As it was 15 years ago.

https://www.hivlawandpolicy.org/sites/www.hivlawandpolicy.org/files/Wit…€™s%20Right%20to%20Refuse%20Medical%20Treatment%20through%20the%20HIV%20Lens%20(Ulrich).pdf

Panacea—If Orac is comfortable giving you my email address, I’d be happy to continue this discussion privately.

By Jay Gordon, MD, FAAP (not verified) on 24 Jul 2017 #permalink

Thanks, Jay but I'll have to pass. I really shouldn't even be commenting here as much as I have been lately. I'm supposed to be studying for my final exam, but I can only process so much at a time. I take short breaks to reset my mind, and this is one of them.

Remember what I said earlier in this discussion about intellectual honesty? My last post was an example of what I mean by that. I'll continue to criticize you for your position on vaccination because it's unsupported scientifically and wrong by the evidence we do have.

But while wrong is wrong, right is also right, and I can't and won't criticize you when you say something I know to be correct, or fail to say something when someone else says something that's incorrect on this or any other subject.

Intellectual honesty.

How does Doctor Gordon Like to really treat ear infections? We don't have to ask, we can read his web site (bolding mine)

http://drjaygordon.com/medical-concerns/earinfections.html

When viruses and/or bacteria manage to grow in the fluid, “acute otitis media” can be diagnosed. The traditional treatment with antibiotics has been shown to be quite ineffective and, as a matter of fact, not anymore effective than doing nothing at all during the first three to four days. Most experts now recommend pain control only during the first days of an ear infection, although I think thatsafe alternative care (homeopathy, ear drops, hot compresses, vitamin C, elderberry or echinacea) will improve the healing course.

Speaking only for myself, I wouldn't trust him to treat anything living, human or otherwise.

Yeah⇑

Anyone who recommends homeopathy needs to be slapped.

My recommendations would be not eat dairy products. The steroids 5α-pregnanedione and 5α-androstenedione increase cholesterol synthesis in the skin. This leads to clogged follicles as the sebum concentration of waxes (cholesterol) increases over the fatty acids.

This has been proven in the lab. I have links.

By Vander Heiden (not verified) on 24 Jul 2017 #permalink

Oh, good to know. I'll be sure that my lab doesn't eat any dairy products.

By Se Habla Espol (not verified) on 24 Jul 2017 #permalink

@Vander Heiden:

I have links.

Then why don't you post them?

By Julian Frost (not verified) on 24 Jul 2017 #permalink

Acne, dairy and cancer: The 5α-P link
Dermato Endocrinology

Consequences of Use of Anabolic Androgenic Steroids
Pediatric Clinics of North America

A SURVEY OF THE STEROIDS IN COWS' MILK
Journal of Endocrinology

The effect of the antiandrogen IIα-hydroxyprogesterone on sebum production and cholesterol concentration of sebum
British Journal of Dermatology

Comparative Chemistry of Sebum
Journal of Investigative Dermatology

SEBUM EXCRETION AND SEBUM COMPOSITION IN ADOLESCENT MEN WITH AND WITHOUT ACNE VULGARIS
British Journal of Dermatology

Glucocorticoids in Mammary Secretions and Blood Serum during Reproduction and Lactation and Distributions of Glucocorticoids, Progesterone, and Estrogens in Fractions of Milk
Journal of Dairy Science

Hormones in bovine milk and milk products: A survey
International Dairy Journal

You are on your own if you want to read the full texts; I cannot link those. The best one is "Comparative Chemistry of Sebum". What causes a pore to clog is largely the ratio of sterols to fatty acids, and this can be changed depending on the hormonal state.

Woman on birth control and body-builders know this well. I'll assume that you are neither of those, which would probably make you a skinny male.

By Vander Heiden (not verified) on 24 Jul 2017 #permalink

Like Panacea, I'll be fair to Dr Jay, even though most of the time I think he's ridiculous.While most of his recommendations for acute otitis media are silly, warm/hot compresses can be very soothing to a child, and, depending on the ear drops, they may help with any wax buildup that add to discomfort.

The rest of the stuff is worthless as a treatment, though most kids enjoy juice and I have one kid who has always loved elderberry tea.

I was vaccinated in 1986. I got measles in 1990 during an outbreak in Poland. Mass vaccination against measles started in 1975 or 1976 in Poland.

Shall I be skeptical towards vaccination efficacy?

Engerix taken in 2010 caused seizures and uncontrolled legs and body movements at the moment of trying to get up from a bed. I have been blind for an undefined peroid of time and I couldn't get up and I couldn't move.

Can anyone explain please what happend to me? There were no other than vaccination relevant form the health's point of view factors. Probability of its occurence were close to 0. It wasn't a coincidence.

Yeah⇑

Go away, Fucklesworth.

It's not that antibiotics are called for in every case of acute otitis media - certainly that's not the case, as the AAP/AAFP guidelines make clear.

What's at issue is Jay's "knowing" that a first-line antibiotic recomended in those guidelines "does not work", a non-evidence based belief similar to his conviction that vaccines cause autism.

By Dangerous Bacon (not verified) on 25 Jul 2017 #permalink

It depends on whether or not there is suppuration in the otitis media. You don't treat an *serous* effusion (clear fluid) with antibiotics. You treat pus. If the eardrum is opaque and immobile, it's infected and then you treat.

That's the part that can be tricky because I know a lot of providers who will say "if there's a serous effusion it's going to turn into infection anyway" and will give antibiotics anyway. You have to resist that temptation because the fluid may never become infected, or may be recovering from an infection and no longer needs treatment.

Maybe that's why Gordon thinks antibiotics are not effective; they certainly aren't with serous AOM.

But when antibiotics are indicated, amoxicillin IS first line unless there is a history of allergy to penicillin or if the child has previously been treated within 30 days. If the latter, or if conjunctivitis is also present, you bump up to augmentin.

Treating for pain is up to the provider, but I would always recommend Children's Tylenol or Children's ibuprofen (if six months or older), even if there is not fever. A warm compress is very helpful and feels good. Herbal remedies are a waste of time; neither effective or safe. They don't work. Xylitol gum is a good preventative but you pretty much have to chew gum all day, and you can't give it to kids under 2, and it's deadly toxic to dogs.

Analgesic ear drops are indicated for otitis externa, not media. Antibiotic ear drops are indicated only if the TM is perforated.

As for the silliness with milk and sebum: if Vander is Travis, then let me add a hearty "Go away Fucklesworth" to Narad's greeting.

If not, let me point out earwax is much more than sebum, and that the links you posted have nothing to do with anything. So yeah, go away Fucklesworth. I didn't comment on the quantum chemistry nonsense because I am neither a chemist or a physicist. I am a health care provider, and you clearly are reaching out of your a** on this subject.

I think it probably was Fendlesworth, which is a shame. He'd been away for so long and it was so nice.

I have a moment, so I'll offer my thoughts on Dr Jay's 3 year schedule.

There are about 4 million live births in the US every year in a population of about 326 million, so 1.2% of the population is too young to start the MMR series.

At the same time, we need about 90-95% "coverage" to maintain herd immunity and keep the disease from returning to endemic circulation like it did in the UK.

And Dr Jay recommends that everyone wait till age 3 to start the MMR, which would increase the unvaccinated population to 3.6%.

And the measles vaccine is 97% effective with 2 doses. So, even if we vaccinate everyone else, we have another 3% of the population vulnerable or 6.6% now.

That puts us into the grey area where herd immunity starts to break down.

And it's not a sharp black division. The bigger the unprotected population, the wider and longer outbreaks like the Disneyland incident will spread before they eventually go away.

Adding 2.4% to that unprotected population makes those outbreaks worse.

But, Dr Jay thinks we can achieve eradication even under those conditions.

And he calls the risk of someone getting infected and possibly dying from exposure (at least to one of his patients) "miniscule"!!!

Pull the other leg, Jay.

By squirrelelite (not verified) on 25 Jul 2017 #permalink

@ Orac #57: He must have been getting jealous of all the attention Jay Gordon was getting. Sad when one crank gets outshone by another crank.

@squirrellite: Not to mention all those kids left unprotected for no good reason at all. Hence my very open contempt.

He must have been getting jealous of all the attention Jay Gordon was getting. Sad when one crank gets outshone by another crank.

Travis J. Schwochert isn't so much a proper crank as a fistulotomy waiting to happen.

David,

Shall I be skeptical towards vaccination efficacy?

You could also be skeptical about why your body didn't react to the vaccine (which is also, likely a pertinent hypothesis). I got my genetic code done and looked over by a medical doctor a few years ago and at the moment, my psychiatrist is also looking at it (though neither did look from a vaccination standpoint because it look so far that I don't have any issues related to vaccination).

Al

Hi, Alain,

If you're talking about what I think you're talking about that screen only looks at a few classes of drugs, mostly used for mental health purposes. ADHD drugs, MH drugs . . . it's a great tool to determine which ones will work for you, especially for the ADHD kids. You can skip starting them on stimulants if the screening says the non-stimulants are the ones that work.

Not only drug for for taxation purpose. I had my genetic code sequenced years ago but it's only since last year I signed the paperwork so that my psychiatrist can get access. See here:

https://www.canada.ca/en/revenue-agency/services/tax/individuals/segmen…

and here:

http://www.revenuquebec.ca/en/citoyen/credits/defic_grave/default.aspx

We're covering every angles and I'm having a lot of test script from my PCP that I recently got around to submit to the local hospital to cover more angle.

The benefits are potentially important.

Alain

JP: Another twist: turns out someone in the family actually OWNS We. One of these days, we need to do a family book sorting.

By Politicalguineapig (not verified) on 27 Jul 2017 #permalink