SB 277

personal belief exemption

Quackery

antivaccine

Bob Sears

medical exemption

A. I am glad California passed this law, which has now been upheld by five different trial courts, three federal, two states, but I do want to add a hat tip to Michigan's for its rule change, a very effective and good step, too. Which was also upheld by a federal court.

B. Not only does that listcof conditions not qualify for exemptions, but children with asthma, diabetes and other conditions need vaccines more. They're at higher risk from at least certain diseases.

This really fails the patients, the kids.

Journey is also a Waldork school:
journeyschool(dot)net/
"A Proud Member of the Alliance for Public Waldorf Education"

That makes it 6 of the ten.
An education system based on 19th century spiritualism is anti-science? Who'da' thunk. Just dance your disease away through improved karma.
Figures.

If vaccination exemptions are disproportionately being granted by relatively few docs, those practitioners need to be looked at.

The California Medical Board could audit the medical exemptions granted by the physicians who do this the most - say, the top 5 or 10%.

I suspect that in that event, the granting of medical exemptions would drop considerably, because they wouldn't stand up to evidence-based scrutiny.

A big contributor to this rise in medical exemptions is the recently formed (2016) California-based anti-vaccine group calling itself "Physicians for Informed Consent", which has a lot of California physicians as prominent/founding members (but also has a lot other anti-vaccine wretched scummy quack doctors as well--https://physiciansforinformedconsent.org/). You can bet the ranch that this repulsive cluster of pro-disease physicians is sharing their tip among themselves regarding how best to skirt the law on writing a medical exemption and not get caught while also making a lot of money off gulled families.

This is what happens when state medical board completely and utterly failed to protect the public health back when the first prominent anti-vaccine doctors like Sears and Gordon first starting growing in the petri dish of American culture. They've now created colonies of anti-vax physicians across the US who are emboldened by the lack of any response to their public-health-endangering actions.

A third student has been diagnosed at a Steiner school in Perth http://www.abc.net.au/news/2017-08-18/third-case-of-measles-at-perth-wa…. About 50% of the 400 students at the school are unvaccinated. The measles outbreak precipitated the 'resignation' of the principal, a prominent anti-vaxxer who once stood for Parliament. Even so, a clinic organised at the school this week vaccinated 19 students.

This illustrates the problems that arise if you permit educations based on early 20th Century white nationalist spiritualism.

@ Dangerous Bacon: Agreed (very much). Almost certainly these schools with ridiculously high medical exemption rates have at most a few physicians penning these exemptions (like Sears, Gordon or one of their greedy uncaring cronies). I don't know who has the initial authority, however, to audit those exemptions to determine the physicians writing them, since I think medical board almost always only take action when presented with specific complaints against a physician.

BTW, "Jay Gordon, MD, FAAP", since you are reading this--are you a member of Physicians For Informed Consent?", and if so, why didn't you consent to putting your name out there like Dr. Bob did?

So, according to anti-vaxxers, pediatricians are in it for the "vaccine bonuses", yet anti-vax doctors are charging $120-$180 for a medical exemption letter?

I was curious and looked up the elementary school that my children attend. I found vaccine rates for 2013-2014 (couldn't find anything more recent), and surprisingly it was 100%. Not even a medical exemption. This is in upstate New York.

The California Medical Board could audit the medical exemptions granted by the physicians who do this the most – say, the top 5 or 10%.

I suspect a much smaller fraction will suffice, which is fortunate because I doubt the California Medical Board has the resources to audit that many doctors in such a short time frame. My guess is that the top 0.1 to 0.5% will catch most of the egregious offenders and put the fear of $DEITY into the rest.

@Angela: Projection is a regular thing among anti-vaxers, and alt-med types generally. They accuse science- and evidence-based practitioners of being in it for the money while profiting handsomely from selling their own dubious services, whether it's medical exemption letters or supplements.

Think about it. If it takes five minutes to sign a medical exemption letter, that physician is grossing $1440 to $2160 per hour. Nice work if you can get it. But they don't want the rubes to realize that they are running a racket, and one of the most effective ways to do that is to claim the competition are running a racket.

Off-topic, but AoA is dead?

If the California BOM would just nail Sears and Gordon's hides to the wall for their dangerous practices . . . malpractice in my opinion . . . then other antivax physicians would quickly fall in line.

It would also help of the AAP would grow a spine and take Gordon off the FAAP, and Sears too if he has it, and publicly declare why.

Narad: I don't think so. I checked their FB page, there are posts only a few hours old and they're pulling the usual BS.

It sounds like someone forgot to pay for their domain name, so their main webpage was down. They claim to be back up; I haven't checked into it.

Narad, the Age of Autism website was registered by Dan Olmsted, who died in January 2017 (he either committed suicide or accidentally OD on prescription medications).

Kim Rossi (formerly Stagliano -- they divorced recently) is now running the show. Evidently she didn't know that the domain was due to expire earlier this week, so the site briefly was out of business.

Rossi re-registered the site; it's back up for me in Chrome but not in Safari.

Back on topic: there's a woman who is running a GoFundMe to get medical exemptions.

The GoFundMe started August 6, and she’s raised $170.00 of the requested $400.00

I am a returning back to College. My daughter and son were accepted into their Daycare Facility . I am asking for All your help. They start daycare on August 22. That is if I get an exemption! We have an appointment in Santa Rosa this Saturday. However the cost are $370 per child.
Having my kids vaccine free it huge for them and vital to their long term health.

Any support will be so appreciated, and we willforever grateful!
Blessings
Update #2
Okay, so I found a doctor in Sacramento that can see us next week!! It's about two hours without traffic. Yes, and will charge $200 a child. That is huge because the last Doctor wanted $370 a child.

Sigh.

I clicked on Sunridge and who would've thunk it but it's in Sebastopol!**

I was there just a few weeks ago and it is extremely woo-fraught. Woo beyond your wildest dreams (But fun to visit as it has a cool new venue for local products, the Barlow, a main street of altie-ness and farmer's market/drum circle) . I imagine that the rest of the Sonoma-Marin-Mendocino triangle has similar isolated school figures.

-btw- I noticed the AoA absence but figured it would be back soon because they're a registered charity.

** it's the hippie town Draconis used to carp about.

@#14

Wow. If medical exemptions are vital to their long term health, she should easily be able to get one from any doctor. $200 for signing a form. What a racket.

Also, don't most of these doctors who do this not take insurance? I know Dr. Sears doesn't. Does that mean that they make more money from their patients? I really don't know.

LOL. SB277 was to "protect children"--sure. That took real guts to facilitate such a boon for the pharmaceutical industry. If not for those upstart parents, doctors and other medical providers who insist on informed consent to medical treatment, we could have blissful medical tyranny by now.

If this resistance keeps up, Dorit may have to--reluctantly--recommend that vaccination be done at gunpoint. It's not easy, but it can be done. For the greater good, of course--certainly not to keep the population sick, weak and obedient--only psychopaths running the show would want that.

Maybe if we implemented a mandatory school chant, it would help with the indoctrination: "Vaccines are safe and effective and saved the world. Vaccines are safe and effective and saved the world..." They could end it with a Bellamy salute and a resolute "Heil AMA!"

Orac writes,

At the end of the list, it does say that autism, autism spectrum disorder, and behavioral issues are “not sufficient to meet medical exemption requirements.”

MJD says,

If the autism spectrum disorder (ASD) rate continues to rise does Dr. Zandvliet’s have a tiger by the tail?

Although, the CDC is hinting at a possible plateau in autism prevalence.

https://spectrumnews.org/news/u-s-stats-show-autism-rate-reaching-possi…

Within the autism spectrum, a proteomic investigation of B-Lymphocytes in vaccinated vs. unvaccinated individuals may provide science-based evidence for the incidence of allergy-induced regressive autism.

@ Orac's minions,

Does physician bashing increase consumer confidence in vaccines?

Silly NWO

Also, don’t most of these doctors who do this not take insurance? I know Dr. Sears doesn’t. Does that mean that they make more money from their patients?.

Yes, for two reasons. One is that most insurance companies negotiate lower rates for procedures. On a typical bill for medical services you will see a quoted rate, and an adjustment which brings that price down to the insurance company's negotiated rate. The result is that people covered by insurance pay less, even when they have not yet used the deductible, than those who don't.

The other, of course, is that by not accepting insurance, these practices can charge for things that insurance companies would not allow, such as a fee for providing a medical exemption letter. I have no way of knowing this for sure, but I suspect those doctors who provide such letters to patients who legitimately need medical exemptions do not charge separately for the letter (any fee would be included in the office visit charge).

Just out of curiosity, how prevalent is vitiligo in the general population, and have any of the pediatricians here ever had a patient with it? (I don't need or want specifics, just a yes or no.) I thought it was super-rare.

Antiphospholipid antibody,Wegeners, Sjogrens,Eosinophilic esophagitis, ulcerative colitis and mixed connective tissue also all sound made up. Anyone know if they are real?

NWO: Go screw yourself, Trumpette. I've had it up to here with stupid people for the month. You contribute nothing here, and there are several thousand rocks more intelligent than you. Go home to Stormfront or go cry to Mike Adams.

Eosinophilic esophagitis is real. I believe the rest are as well.

PGP: Vitiligo occurs in 1-2% of the population. It's not really rare, but the severity varies, and when it occurs in light skinned folks it's easy to miss/conceal. I've met any number of people who have it.

All of the other diseases you mentioned are real. Some are more common than others. Sjogrens and UC are fairly common, the others more rare.

Angela: there are any number of doctors who refuse to take insurance. They do quite well; they can charge what the market will bear, and some patients will go out of their way to pay it if they think they're getting something for the money. We see this a lot in boutique medicine.

By refusing insurance, many physicians can avoid paying for the regulatory infrastructure that comes with Medicare and Medicaid. But you end up cherry picking your patients, and if you don't find a niche to indulge you may not bring in enough patients to keep the practice open.

MJD: News flash. ASD rates really aren't rising. Orac has already discussed this: http://scienceblogs.com/insolence/2017/01/25/another-reminder-that-ther…

Liz Ditz and Panacea: Ah, thank you. Once again I conflated the source with the information. (Usually, if it's a bad source offering information, one has to assume the information is false. But it looks like the stopped clock may be right in this one instance.)

Panacea: That's very interesting. I assumed vitiligo was much more obvious. (Although I suspect Micheal Jackson was still lying about his.)

Panacea (#23) writes,

MJD: News flash. ASD rates really aren’t rising. Orac has already discussed this:

http://scienceblogs.com/insolence/2017/01/25/another-reminder-that-ther…

MJD says,

I recall that I made four (4) comments in that interesting post and two (2) made it through the automoderator (i.e., Orac).

Understand that I often have to work twice as hard as Orac's minions to express some of my thoughts and opinions here at RI. :-(

@ Orac,

As the moderator, is deleting well-intended comments difficult?

PGP@24: You were correct that the information is false. The problem isn't that Dr. Zandvliet listed a bunch of nonexistent diseases; as other posters have noted, they are real. The problem is that none of these conditions is actually grounds for a medical vaccine exemption.

I'll confess that it would be easy to slip a bogus condition into that list, however--I'm not a medical expert, either. It would be like me giving you the following list: proton, neutron, electron, klystron, lepton, hadron, baryon, meson, fermion, boson, photon, phonon, gluon, graviton, deuteron, parton, anyon. All of them are terms used in physics. One of them is not like the others. If I didn't tell you that, would you have known?

PGP: It's usually pretty obvious in the African American, African, Indian and other dark skinned populations, especially if it's on the hands. It might not be as obvious in caucasians, especially if the affect sites are very small and easily concealed.

I absolutely believe Michael Jackson had vitiligo. It was confirmed on autopsy, and they found medications used to treat it in his house after he died. http://www.autopsyfiles.org/reports/Celebs/jackson,%20michael_report.pdf

But as Eric pointed out: not one of these conditions is a contraindication to vaccination. If anything, some of these folks need to be vaccinated even more, to protect them from serious illnesses that can complicate their chronic conditions.

@Eric Lund:
I would have known, but then again, I took a physics minor in University and have an amateur radio licence, so I actually know what the terms mean.

(For the record, the one not like the others is klystron, which is a form of vacuum tube that used to be used in high frequency radio and microwave amplifiers. All the others are particles or quasi-particles in physical phenomena.)

@ Denice
Yes, it's no surprise the worst school is in Sonoma County, but also no surprise that overall that Orange and San Diego counties are worse. We really need to kill the "it's all those granola crunchers" stereotype. I wonder if/how the AVs turn toward Trumpism has affected new parents who might be drawn into anti-vax... maybe slightly decreasing the numbers in NoCal while increasing them in SoCal??

@ Liz
Maybe some intrepid soul could uncover the identities of the docs selling medical exemptions in Santa Rosa and Sacramento. There are obviously more people involved than Jay and Bob, and the focus on those two here makes the phenomenon seem smaller than it is (among other things).

I wonder if/how the AVs turn toward Trumpism...

Are they? I mean, sure, Jake is a real Trump fanboi, but are any of the others really in the Trump camp? They like what he says about vaccines, but I haven't noticed them lining up on other issues beyond what I'd expect from normal distribution, and haven't noticed them being particularly vocal about it.

@ sadmar:

That's possible.

re doctors who give exemptions etc

The Vaccine Machine Facebook page has featured parents searching for 'friendly' doctors for spacing out vaccines or avoiding vaccination altogether-
e.g. questions like:
" I live in Washington, does anyone know a vaccine friendly doctor before school starts? I can drive an hour or so"

The website enabled this so why not exemptions?
( I haven't been watching them so much as of late)

@ Johnny:

I occasionally hear n AV applaud the Donald on sites I watch but not so many

ooh...to have snatched AoA's site and linked it to the CDC....

@Eric Lund #20--the disgusting irony is that pediatricians like Gordon and Sears decry the non-existent profits I make on vaccines while charging their cash-only-up-front patient several times what I get from insurance for the same visit. They are the worst type of opportunistic carpetbaggers.

@PGP

I've found PubMed Health to be a good source for info on drugs & diseases.
https://www.ncbi.nlm.nih.gov/pubmedhealth/

I look stuff up for a living, and I've used PubMed Health any number of times to get background material.

Hey, we tried.

Definitely not for a lack of trying.

I don’t think exemptions have “soared.” There are more than last year. But, as you note, vaccination rates really have soared. SB 277 has accomplished what everyone hoped it would. It has also generated much more conversation about vaccines leading many vaccine-hesitant families to begin giving vaccines. I know this last part from personal experience in my practice.

99.5% of kindergartners do not have medical exemptions. Yes, there is clustering. It is a family’s privilege to present a case for a medical exemption and a doctor’s legal right to grant that exemption.

Both the spirit of the law and the letter of law allow for latitude in medical exemptions. Certainly advertising the sale of these papers is very questionable behavior, but private conversations and case-by-case exemptions are what the law demands. Your opinion is interesting, Orac, but it’s not what the law says. I always enjoy getting your take on this topic, though. The law, however, does not give a “rat’s posterior” about your opinion. In my practice, medical exemptions are discussed and granted only to families within the practice. No one new is allowed to make a “vaccine consultation” appointment.

Dorit, I would agree that children with respiratory issues, cardiac issues and some other medical conditions actually are at higher risk.

Dangerous Bacon, read the law.

Dr. Hickie, I have not joined Physicians for Informed Consent. They and I do not agree on some points in the discussion. I’m not a big “joiner” anyway. I notice that you still haven’t joined the largest voice for pediatric health in the world, the AAP. You’re not a joiner either?

Eric Lund, the law makes no provisions for auditing a legal medical practice. The Board isn’t very interested in doing that either. Yes, Eric, I gross $2160 every hour scrawling my signature on medical exemptions. Cool beans.

Panacea, good to see your moderate take on the action needed to reign in exemptions.

Liz, it’s wrong to give medical exemptions to children you don’t know.

PoliticalGP—Yes, most of us have seen vitiligo. And, yes, it is rare in pediatrics. All of those diseases are real.

Sadmar, no, there are no other docs. Just Bob and me. Or that’s what you might believe if you read nothing but RI.

Dr. Hickie, again! Call me and I’ll explain how—when one buys a product for $20 and sells it for $40—one can make at least a small profit on vaccines.

Friday afternoon. My 3:30 patient canceled. I have used the time productively.

Have a wonderful weekend!!

Jay

ooh…to have snatched AoA’s site and linked it to the CDC….

I suspect that this wouldn't have been possible. I'm not going to try to check the routine using this tablet, but I think there's a grace period of around 60 days before a domain is fully relinquished.

Hmm. Isn't writing a medical exemption in a case that does not warrant it medical malpractice?

Also, I saw an article quoting you about alternative medicine and cancer therapy on CNN, Orac. kudos!

Very dodgy there, Jay (#36), I'm sure your patients swear by you. Too bad that it's supposedly your job to help protect your patients from your other patients: the ones that truly need medical exemptions desperately need the ones that don't to be vaccinated!... as Orac says, providing less than the standard of care is not ethical.

# 5 Chris Preston

Measles in Perth?

I live only about 85km from Perth. How did I miss that news?

Oh, “Perth, Western Australia”. My Perth is Perth Ontario Canada. I can calm down again.

Johnny: Are they? I mean, sure, Jake is a real Trump fanboi, but are any of the others really in the Trump camp?

Kent Heckenlively sure is, and before he passed, Olmsted seemed to be supportive of Trump.

EL:The problem is that none of these conditions is actually grounds for a medical vaccine exemption.

Well, I figured that. But given that antivaccine 'physicians' are,as Chris Hickie says, 'a bunch of opportunistic carpetbaggers,' I really wouldn't put it past them to invent some diseases, like Wakefield did.
I thought the anyon was the one you'd made up, not being acquainted with much physics.I recognized some of them, though.

Panacea: Very interesting. I didn't take more than a passing interest in MJ, since I was born well after his heyday. (Though, why did his nose fall off?) But, yeah, vitiligo is a very odd and interesting condition.

Jay:Yes, most of us have seen vitiligo. And, yes, it is rare in pediatrics. All of those diseases are real.

Please don't speak for the others, who unlike you, actually practice medicine. I was asking them, because Dr. Hickie and Panacea are HONEST, and you don't have more then a passing interest in the truth, if that. You lie to your patients, you lie to us, and you're a disgusting two-faced hypocrite. I hope you at least got a good price on your soul.

Letter and spirit of the law? Oh, come on, Jay. You're equivocating. Finding a loop hole in the law doesn't make what you're doing right, safe, or smart.

You couldn't pay me to join any medical organization that would accept you and your medically incompetent, anti-vaccine views and schedules, Jay, which are antithetical to being a pediatrician.

So basically, the main docs who profit from vaccines are the anti-vaccine ones. This time, they are selling exemptions, not supplements. It does make me wonder why Dr. Sears fought against this law. Maybe he didn't realize what a boon it would be to his income?

Yvette @#44: It was a win/win situation for him. The only thing that matters to medical whores like Sears (and Jay Gordon?) is the publicity, which generates income. Sick kids are higher-profit revenue units for them.

@ Yvette #44 and Opus #45
To be loved by anti-vax, they had to show they had doubts about vaccines and the way to show this, is to protest SB-277. If they wouldn't have protested, the anti-vax would have thought they weren't on their side at all. So to show their true colors, they had to protest SB-277, probably knowing this would be a lost cause, so it would only be good for their profits. By protesting, they advertised they were on the 'right' side (for the anti-vax people) and showed they were sympathic to them and thus would have some extra profit by selling medical exemptions and it would bring the right patients. An ill patient with a vaccine preventable disease would bring more income.

"My 3:30 patient canceled."

Hopefully for the right reason, but probably not.

PgPig (#41) writes,

Dr. Hickie and Panacea are HONEST.

MJD says,

Yes they are, their HONEST-to-goodness minion's of Orac.

@ Jay Gordon,

Thanks for bringing a healthy balance to this scienceblog.

Jay Gordon: "Both the spirit of the law (SB277) and the letter of law allow for latitude in medical exemptions."

I do not see anything in the text of SB277 that refers to "latitude" available to physicians that would explain the clustering of medical exemptions in certain schools. The actual pertinent language in the law:

"SEC. 5. Section 120370 of the Health and Safety Code is amended to read:

120370. (a) If the parent or guardian files with the governing authority a written statement by a licensed physician to the effect that the physical condition of the child is such, or medical circumstances relating to the child are such, that immunization is not considered safe, indicating the specific nature and probable duration of the medical condition or circumstances, including, but not limited to, family medical history, for which the physician does not recommend immunization, that child shall be exempt from the requirements of Chapter 1 (commencing with Section 120325, but excluding Section 120380) and Sections 120400, 120405, 120410, and 120415 to the extent indicated by the physician’s statement."

The obvious intent of the law is that there needs to be solid medical justification for vaccine exemptions. Bob Sears is already facing potential sanction over one such exemption. As Jay professes joy over increased vaccination rates in California secondary to the law, one would think he'd welcome audits of exemption-profuse physicians aimed at increasing vaccination rates still further, especially in schools where unprotected children congregate. He could even voluntarily disclose what percentage of school-aged children in his practice he's granted medical exemptions to, as an example to his fellow pediatricians (whether or not they're FAAPs).

But don't hold your breath waiting for that to happen.

@ PgPig (#41),

Did you notice in comment #36 from Jay Gordon, MD, FAAP that he referred to you as "PoliticalGP"?

This dedicated and well-respected pediatrician continues to be professional under very difficult circumstances.

Understand PoliticalGP, you'll always be PgPig to me.

MJD: Shut up, you wouldn't know science if it bit you. You know nothing about anything including how to write. Please stop killing trees with your drivel.And making fun of my chosen nym only makes you look stupider, especially since I told you why I use that name and that it has nothing to do with pigs. Why don't you just GO away. Maybe spend some time with your son? Oh, I forgot, the restraining order.

As far as politeness goes, "Dr" Jay''s business depends on him pretending to be polite and nice and hardly ever telling the truth. Most call girls are polite too, for the same reason.

Doltnik: Also, from now on, I'll be calling you by a nickname, until you grow up. Sheesh, I'm younger than you, and I already am certain that I'm the grownup in these exchanges. What happened, were you jammed in a freezer at twelve?

"This dedicated and well-respected pediatrician" who recommends homeopathy and advises against the Gardasil vaccine.

Nobody but a fellow idiot respects a pediatrician who is that kind of idiot

"Dr. Hickie, again! Call me and I’ll explain how—when one buys a product for $20 and sells it for $40—one can make at least a small profit on vaccines."

Wow, Gordon...you have no overhead? No administrative costs? No staff salaries?

PgPig (#51) writes,

And making fun of my chosen nym only makes you look stupider.

MJD says,

It's nothing personal, a nym that's eighteen (18) letters long (i.e., Politicalguineapig) is most preferably abbreviated.

I thought of shortening your nym to ppig but decide against that because it reminded me to much of Porky Pig.

https://www.youtube.com/watch?v=pg7HvF3a_Iw

Moving forward, if you politely ask me to stop using PgPig I will abide, and with great effort, type out your horrendous nym grudgingly.

MJD re #48: says the man who plagiarizes his "work."

Doltnik:It’s nothing personal.

Uh-huh. The others use PG or PGP, but you deliberately went for the most offensive abbreviation you could think of. Suure it's not personal.

And my 'nym is not horrendous, fyouverymuch.

There have been others on this board who use longer nyms-heck, your name is pretty long. Imagine a big middle finger right here.

Panacea (#56) writes,

...says the man who plagiarizes his “work.”

MJD says,

How can I plagiarize my "work"?

Did you mean plagiarize someone else's work?

I'd like to get back on the topic.

Orac writes,

What really needs to happen is for the culture in California to change.

MJD says,

You just antagonized ~39.25 million people.

I was just arguing with that quack Dr. Zandvliet’s! I was calling to find a pediatrician office that does not allow parents to slow vaccinations or refuse them.

She told me healthCare is a risk vs risk system and that I am obviously not Science or evidence based.

I think I found like likely sources for most of the vaccine exemptions, courtesy of an anti-vax chiropractor named Tim O'Shea: http://www.thedoctorwithin.com/vaccines/doctors-who-may-sign-vaccine-ex…

I will wager that a good number of these anti-vax, money-hunger quack MDs like close to these clusters of high non-medical exemptions.

I've been watching the MSNBC poll about vaccines ( linked by AoA Facebook)-
it says.
" Vaccines are....
and the choices are science, parental choice, dangerous
( my paraphrases)
the current results are not good but better than a few days ago

Take a look.
( it should be noted that MSNBC hosts are not anti-vax- quite the contrary)

On the vaccine exemptions template:

I thoroughly evaluated the past and current medical history and family history of this patient. It is my opinion that he be exempt from all vaccinations, including measles, mumps, rubella, chicken pox, polio, Hib, hepatitis B, diphtheria, tetanus, and pertussis, for the rest of childhood (through ( DATE– 2030..?) for the following reasons:
Family history of
...
psychiatric disorders

There, every rabid antivaxxer has a built-in exemption!

Re: PgPig

OgLing: is five letters, seven keystrokes since you need to hit shift twice.

PGP is three letters and four or five keystrokes, depending on whether thou hold down the shift of use caps-lock.

pgp is the letters, three keystrokes.

Just FYI, MJD.

Autocorrect helped me out...

PgPig is five letters, seven keystrokes since you need to hit shift twice.

PGP is three letters and four or five keystrokes, depending on whether you hold down the shift of use caps-lock.

pgp is the letters, three keystrokes.

Just FYI, MJD.

(I did like the substitution of thou for you, but it really should have substituted holdest for hold in that case)

Chris Hickie: Here are GoogleEarth pins of that list. Will be interesting to see how those locations match up with next outbreak. https://www.dropbox.com/s/xikywsvqitzmk13/VaxExemptionDrs%20RI.kmz?dl=0

LW (#63) writes,

pgp is the letters, three keystrokes.

MJD says,

Very good LW, thank you!

LW is two letters and three or four keystrokes, depending on whether you hold down the shift key or press the cap-lock twice.

In the future, please consider practicing what you preach and save us one or two unnecessary keystrokes by using lw. :-)

@ Panacea,

Have I just plagiarized lw?

@ Chris Hickie

I know the general areas where some of the docs on that list are, and of those most but not all are near 'traditional' clusters or problem schools. There are also a couple areas where you might expect some to be by stereotype, but none are listed: e.g. Berkeley area and Marin County (but then the most awful schools aren't in those areas either...) Do you think this list is fairly comprehensive for CA, or just the tip of the iceberg? I don't know how to interpret the number of docs listed, that is, whether to be depressed there are that many, happy there are only that many, or both...

"I think I found like likely sources for most of the vaccine exemptions, courtesy of an anti-vax chiropractor named Tim O’Shea"

O'Shea is the author of the antivax classic "The Sanctity of Human Blood: Vaccination Is Not Immunization", which is in at least its 12th edition. Apparently the crazy needs to be updated at frequent intervals.

(it should be noted that the most recent edition is called simply "Vaccination Is Not Immunization". Maybe the "sanctity of human blood" angle made O'Shea sound a little too much like Colonel Jack D. Ripper in "Dr. Strangelove").

LW: I think MJD just likes being offensive.

“sanctity of human blood”
O'Shea comes close to Renfield (channeling Leviticus), "The blood is the life!".
This whole blood-sanctity tradition of magical thinking is never far away from "maintaining the purity of the bloodline".

Dangerous Bacon:it should be noted that the most recent edition is called simply “Vaccination Is Not Immunization”. Maybe the “sanctity of human blood” angle made O’Shea sound a little too much like Colonel Jack D. Ripper in “Dr. Strangelove”

It's funny that so many people reference Dr. Strangelove, and yet, the point of the film flew past them and went to Mars.

To Eric Lund. Re: Comment #26. A clingon is a tiny particle of styrofoam found in stuffed toys, which, when released, adheres to almost anything.

I think MJD just likes being offensive.

Jeezums, with all the eclipse hype, I totally forgot about Irony Day.

@ Sadmar: Without seeing who is writing the exemptions, it would be hard to know if the list from O'Shea's web site is comprehensive or not. Most of those doctors on his list are "cash-only" (such as Jay Gordon, see my earlier post linking to his exorbitant "vaccine consult" visit pricing). As such parents who can afford these disease-promoting quacks probably have the means to easily travel for these exemptions. I agree it's depressing, especially with the clustering of exemptions, since I saw firsthand practicing in Tucson that pertussis outbreaks in a nearby local school district centered on the two schools with the worst vaccination rates in the district (60-70%) and not the schools with the 95%+ immunization rates.

@Dangerous Bacon: O'Shea seems an especially crazy chiroquacktor given all the paranoia and insanity on his "doctor within" web site, which I could only stomach for a few minutes. Further evidence that chiropractic is utter quackery.

MJD: Well, you just proved you don't know the first thing about APA or academic honesty. You can indeed self plagiarize, although you know full well that's not what I meant.

Orac may have antagonized a few anti vaxxers and quacks but they don't amount to millions of people.

O’Shea seems an especially crazy chiroquacktor

Considering that The Sanctity of Human Blood is in its 14h edition, I'd think that's a given.

SB 277 works. Period. No wonder antivaxers hate it.

oracknows — Thu, 13 Apr 2017 06:20:34 +0000

SB 277 works. Period. No wonder antivaxers hate it.

The Disneyland measles outbreak began over the Christmas holidays of 2014 and continued for several months into 2015, ultimately spanning eight states and two additional countries (Canada and Mexico). It also represented a seismic shift in the battle to contain the malign influence of the antivaccine movement in that the outbreak centered the Magic Kingdom made it possible for California legislators to do something that would definitely not have been possible before the outbreak: Pass a law outlawing "personal belief exemptions" (a.k.a. nonmedical exemptions) to school vaccine requirements. Indeed, given that, prior to the outbreak, only two states (Mississippi and West Virginia) allowed only medical exemptions and the other 48 states allowed some combination of religious or personal belief exemptions (PBEs, or, as I like to call them, "I don't wanna" exemptions), California was the last state I would have imagined passing a law to become like Mississippi or West Virginia. Happily, I was in error. Co-sponsored by Senators Richard Pan and Ben Allen, SB 277 was approved by the California legislature in June 2015 and signed into law by Governor Jerry Brown on June 30, 2015. The new law took full effect in the 2016-2017 school year; i.e., this school year.

The bill (and later law) itself mobilized the antivaccine movement in a way I don't recall ever having seen it mobilized before. Indeed, there's a reason why Andrew Wakefield and Del Bigtree bookended their antivaccine propaganda film VAXXED with reports of the Disneyland measles outbreak. It was such a major event in their world view and, given that California is the most populous state in the union, looked to be a profound threat to what they call "freedom" and "parental choice" (conveniently leaving out the rights of the child). Indeed, one could argue that, without SB 277, there very well might not have been a VAXXED, which has been unfortunately influential.

Not suprisingly, SB 277 was a topic of extensive blogging here all through the battle to pass it in 2015 and beyond, when I described how antivaccine-sympathetic pediatricians and other quacks were advertising medical exemptions to school vaccine requirements (which are, of course, still allowed—have to be allowed) as basically being for sale.

When last I looked at the topic a little more than a year ago, preliminary data were suggesting that SB 277 was beginning to have its intended effect. PBEs were declining and vaccine uptake was increasing, both good things. Yesterday, it was pointed out to me that the California Department of Public Health has published the most recent vaccine uptake rates for kindergarten for 2016-2017. The news is good. Vaccinate California provided the "money shot" graph:

What happened when California passed a law to eliminate Personal Belief Exemptions to vaccines? This! CA DPH released analysis just now. pic.twitter.com/OFigphuhIG

— Vaccinate California (@VaccinateCal) April 12, 2017

Notice the trends. PBEs had been increasing inexorably beginning around 1996, with few blips in the upward trend, increasing to nearly four-fold over the course of approximately 18 years. Those of you who haven't been following vaccine issues (or this blog) for very long might ask: What was AB 2109? Basically, it was the precursor to SB 277. A few years ago, alarmed at the steady upward march of PBE rates, the California legislature passed AB 2109, a law that required parents seeking PBEs to undergo counseling by a pediatrician, advanced practice nurse, or other enumerated health care provider over the risks of foregoing vaccines. The resistance to AB 2109 was almost as fierce as the resistance to SB 277, even though it was a much less stringent law. Indeed, AB 2109 first showed me that Rob Schneider was antivaccine, because that's when he came out in a big way. Unfortunately, Governor Brown eliminated most of the bill's impact by adding a signing statement instructing the California Department of Public Health to make an exception for religious exemptions and waive the requirement that parents seeking them undergo counseling. It was almost certainly an illegal instruction, given that it directly contradicted the language of the law as passed.

Even so, as you can see from the graph, for the first time in nearly 20 years, there was a significant dip in the rate of PBEs. This observation is consistent with what we've seen here in Michigan after the Michigan Department of Health and Human Services imposed a regulation that was very much like AB 2109, only more stringent in that it isn't just any doctor in Michigan who can provide the required counseling to parents seeking PBEs. No, here in Michigan, the MDHHS requires that parents actually visit a state or county health department office for standardized counseling. And it works, even better than AB 2109 did in California. Unfortunately, antivaxers in my state have successfully lobbied the legislature to have a bill introduced that would not only overturn the rule requiring counseling but would prevent health officers in our state from barring unvaccinated children from school in the event of an outbreak. Truly, the stupidity of our legislature astounds even me sometimes.

That dip after AB 2109, though, is nothing compared to the dramatic decline in PBEs among kindergarteners. Basically, in a bit more than one year, PBEs fell to levels not seen since the early 1990s. Yes, there was an uptick in medical exemptions, no doubt due to the machinations of Dr. Bob Sears and all the other antivaccine and antivaccine-sympathetic pediatricians and practitioners who saw a chance to profit in a way that aligns with their antivaccine ideology, but that increase is overwhelmed by the rapid decline in PBEs. This is a very good thing indeed. It's hard not to conclude from these data that eliminating PBEs works—and works very well.

If that doesn't convince you, check out this graph from the report itself. It shows that the percentage of kindergarteners with all their required vaccines climbed from 90.2% in the 2013-2014 school year to 95.6% in the 2016-2017 school year:

Perusing the data in the report a bit more, I see that the good news just keeps on coming. For instance, here's another way of showing that the percentage of children with all their required vaccines is increasing not just overall, but for individual vaccines:

And:

Of course, overall statewide vaccine uptake is important, but arguably what is even more important are the areas with the lowest vaccine uptake. The reason, of course, is that these areas provide the raw material for outbreaks of vaccine-preventable diseases through degradation of herd immunity to the point where outbreaks become possible. That's why these maps of county-wide vaccine uptake should be music to the ears of pro-science, pro-vaccine advocates. For instance, here are maps indicating total vaccine uptake (i.e., the percentage of kindergarteners who had all the required vaccines), with dramatic increases in the percentage who've had all vaccines and decreases in the numbers of students with PBEs. Basically, this graph, as the first one does, suggests that both AB 2109 and now SB 277 worked:

And here's a map indicating the percentage of kindergarteners with two or more doses of MMR:

Notice how, in both maps, multiple counties have increased their vaccine uptake out of the "red zone," which represents levels of vaccine uptake where herd immunity is likely to be degraded.

Per the report:

Of 562,924 kindergarteners whose schools reported their status, 537,991 (95.6%) had received all required immunizations, an increase from the previous school year of 2.8 percentage points (Table 1) and an increase over two school years of 5.2 percentage points (Figures 1, 6). Compared to the 2015-2016 school year, the percentage of students with all required immunizations increased in 50 (86%) of 58 counties (Table 5). For counties reporting at least 25 students, the highest rates were reported in Tulare (98.5%) and San Benito (98.1%) Counties (Tables 3-5). In 2016-2017, 9 (16%) of 58 counties in California have rates of kindergarteners with all required vaccines that are below 90%, compared to 20 (34%) counties in 2015-2016 (Tables 4 and 5, Figure 9).

As in past years, a higher proportion of students in public compared to private schools were reported as having had all required immunizations (95.9% vs. 91.6%; difference of 4.3 percentage points) (Table 1, Figures 7and 8). However, this gap is smaller in 2016-2017 than it was in 2015-2016 (93.2% vs. 88.2%; difference of 5.0 percentage points), as the one-year increase by 2.7 percentage points in public schools was not as large as the increase by 3.4 percentage points in private schools.

And:

When comparing the 2016-2017 school year to 2015-2016, the proportion of students reported to enter kindergarten in California after receiving all required immunizations increased by 2.8 percentage points to 95.6%, following an increase by 2.4 percentage points between the 2014-2015 and 2015-2016 school years. The 2016-2017 rate of 95.6% is the highest reported to CDPH since varicella vaccine became the most recent addition to the immunizations required for kindergarteners, which began in the 2001-2002 school year.

The CDPH report contains a wealth of information on vaccine uptake, PBEs, and permanent medical exemptions (PMEs). As I documented in 2015 and 2016, antivaccine activists are doing their damnedest to abuse PMEs. For instance, I note an interesting observation in Marin County, PMEs increased from 0.2% in 2015-2016 school year to 2.1% in the 2016-2017 school year, whopping ten-fold increase. In Orange County, another hotbed of antivaccine activity, PMEs increased from 0.2% to 0.8%, a four-fold increase. Interestingly, by comparison, in San Francisco County, during the PME rate only increased from 0.2% to 0.5%. By way of comparison, in Los Angeles County, PMEs increased from 0.1% to 0.4%.

In an ideal world, there would be no PBEs, no exemptions to school vaccine mandates based on anything other than medical indications. Of course, this is not an ideal world. Fortunately, measures that make PBEs difficult to obtain, such as AB 2109 in California and my state's policy to require that parents who wish to obtain a PBE must go to a state or county health office for counseling on the risks of not vaccinating, also work to increase vaccine uptake. They don't work as well as eliminating all nonmedical exemptions to school vaccine requirements, but they work and thus are reasonable alternatives to banning nonmedical exemptions in states where it is just politically impossible to do something as radical as SB 277.

Unfortunately, as my own state of Michigan and the state of Texas show, there will be pushback against such efforts. Even worse, somehow over the last several years antivaccine beliefs have been embraced by a segment of the right that lumps antivaccine beliefs as part of "freedom" and "parental rights," resulting in a dangerous politicization of what was once a bipartisan issue. I fear that California might be the last state to take a step like SB 277 for the foreseeable future. However, all is not lost. Many states are looking into tightening up the requirements for nonmedical exemptions, which is almost as good. From a scientific viewpoint, both work, but eliminating nonmedical exemptions work the best. However, given the current political situation, the best that can likely be expected is for some states to tighten up their PBE requirements.

oracknows Thu, 04/13/2017 - 02:20

Tags

Skepticism/Critical Thinking

antivaccine

vaccine

https://www.cdc.gov/media/releases/2016/p0331-children-autism.html

It disgusts me to see how our politicians put the public at risk to pander to loons for their votes.

Those maps look like California drought maps.

Vaccines are greening the state, and antivax influence is starting to dry up. :)

Note that some of the increase in PMEs is likely for people with legitimate medical reasons that in the past got a PBE because it was easier.

Most is likely abuse, I agree.

It will take a few years, but this is an improvement.

Also note that the law has so far been challenged four times in the courts, and upheld.

Although some "red zones" still exist, the elimination of large blocks of them will serve as a firewall for outbreaks. In other words, there is less clustering. California also provides a natural crossover study which other states should take note of before passing foolish loosening of vaccine requirements.

Orac, I just came across your blog just now when I searched for information about Ty Bollinger. My search led me to your story from April 2016 about a young woman with cancer and how she was influenced by Bollinger's video series "The Truth About Cancer." In that post, you said, "In retrospect, I’m now regretting that I didn’t expose myself to the series when it was available for free, the better to write a series of blog posts taking it down...."

Well, he has a new video series that is available free starting this month, and it's highly relevant to this post: "The Truth About Vaccines." I hope you will consider taking this new series down while it's free, maybe as each new "episode" is released. A dear friend has already shared this new nonsense on social media.

That Vaccinate California graph of PBE's has one glaring time point omitted--the publication of Bob Sears's "Vaccine Book" in 2007 which is right when the rate of PBE's really started to climb.

It's no surprise that Orange County (where Sears practices) had not one, but two measles outbreaks within 9 months of each other in 2014-2015, the first being a 21-case outbreak in March of 2014 and then the "Disneyland" outbreak in late 2014-2015. If you look at the CADPH for Orange County vaccination rates in grade K, you will see that PBEs accelerated dramatically in OC starting in 2007 through 2013. I assert Sears is directly causative for those two outbreaks and the shame is that he will never pay any price for it.

You could always Tweet that suggestion to Vaccinate California... :-)

Since I've been on a Facebook hiatus for the last few months, what is the latest with the lawsuits?

It was a complete boondoggle last year, has anything of any substance happened since?

Let's be truthful, America has the greatest system of education in the known universe.

Give your child the recommended vaccines, and they are granted a public education (e.g., SB-277).

Thank goodness for special education programs if a child gets vaccine injured, everyone deserves a chance.

My son told me the other day that special education was great for him and that he enjoyed learning but the bullying was terrible (i.e., students and classmates).

Is there legislation in America to STOP the bullying?

Q. What's the difference between respectful insolence and bullying.

Eyeballing the maps, I see a couple of counties that have backslid: one on the NV border just south of the elbow went from green to red, and one in (I think) the northern Central Valley went from yellow to red. Small number statistics is likely in play in the former case; I'm less sure about the latter. Could somebody more knowledgeable about California than I give details?

OTOH, it's a good thing that several counties flipped all the way from red to green, and several of the woo hotbeds along the coast have shown improvement.

Excellent, but not quite the whole story; my antivaccine friend is homeschooling her kids to avoid the mandate, and she is not alone. I am sure that, as a whole, more kids are being vaccinated, but unfortunately people like my friend will still contribute to pockets of VPD vulnerability.

CA DPH released analysis just now. pic.twitter.com/OFigphuhIG

Somebody should've proofread those y-axis labels.

Thinking about it. Isn't the increasing vaccine uptake a perfect time for antivaxxers to prove their contention that vaccines cause autism? Surely the diagnoses of ASD will go up now in perfect sync.....or will they? Please imagine suspenseful music at this point.

Although the absolute numbers are small, PME sharply increased in one year. Interesting that.

Isn’t the increasing vaccine uptake a perfect time for antivaxxers to prove their contention that vaccines cause autism? Surely the diagnoses of ASD will go up now in perfect sync…..or will they?

Diagnosis of autism has been increasing for a number of years now, so that trend need only continue for the anti-vax crowd to say, "Look! Autism cases increased with increasing vaccine uptake!" That this is a classic post hoc ergo propter hoc fallacy is of no importance, because the anti-vax crowd are not arguing logically. They will simply alter their arguments as needed, the way they changed their claim from mercury to generic "toxins" after thimerosal was eliminated from childhood vaccines.

@10 (Eric Lund)

You're correct that "small number statistics" may explain the green-to-red shift in liberal Alpine County: There are only about 1,100 people in the county--and so few children affected by SB277. The more modest change that you mentioned occurred in conservative Sutter County, which has about as many children in kindergarten as there are people in Alpine County.

FWIW, Alpine County voted for Kerry and Obama--and rejected the same-sex marriage ban (Proposition 8) that was supported by most California counties except those on the coast. (The only other similarly-liberal interior California counties were Yolo (which is adjacent to conservative Sutter County--but which is dominated by a University of California campus) and Mono County, which--like Alpine, its neighbor to the north--is home to ski resorts and relies on tourism. Sutter County is pretty much the opposite: the last Democratic presidential candidate to carry Sutter County was FDR, county voters overwhelmingly supported Proposition 8, etc. Make of that liberal vs. conservative split and vaccine hesitancy what you will.

@Eric Lund #15:

Diagnosis of autism has been increasing for a number of years now, so that trend need only continue for the anti-vax crowd to say, “Look! Autism cases increased with increasing vaccine uptake!”

True, but is also went up when vaccine rates were falling and PBE rates were rising, so if they try that argument we can shoot it down.

I notice that our hippie-ish/ yuppie-ish friends in NW coastal ( Humboldt, Mendocino, Sonoma, Marin) are sticking to their (metaphorical) guns and staying off the vax, altho' there is some improvement in the last map. I am pleasantly surprised.

What's next? Buying GMOs? Will wonders ever cease?

@ Julian Frost (#17)

CDC estimates 1 in 68 school-aged children have autism; no change from previous estimate. However, it is too soon to know whether ASD prevalence in the United States might be starting to stabilize. CDC will continue tracking ASD prevalence to better understand changes over time.

I believe my hypothesis is meaningful and Orac will be eating crow in the next decade. :-)

In other news...

Since I mentioned hippies....

Mercola ( today) touts the medical effects of patchouli and - silly me- I thought that it was only useful in order to repel conservatives in bars.

The California map is a little misleading in terms of the actual populations of the counties that are in red. Most of those red counties are in the least populated northeast and far north.

The extreme case is Alpine County with a population of 1110 in an area of 739 square miles, meaning it has a population density of just over 1 person per square mile. That's because a lot of it is in the high Sierras. At the other end of the red county scale, Humboldt County has 135,727 people in 3573 square miles (about 40 people per square mile).

In other words, those red counties do not represent a whole lot of people. If you total the populations of all the red counties, you get 545,737 out of a state population of about 39,000,000, which means that 98.6 percent of California's population lives in counties that are greens and yellows.

By the way, supporters of Donald Trump presented maps showing counties won by Trump vs Clinton. Trump took a large fraction of the land area and a large fraction of the total counties. More careful analysts pointed out that there are lots of rural counties with small populations. The vaccination maps are analogous. For example, Alameda County has a population that is three times the level of all the red counties combined, and it is just one county.

Last fall, a few weeks after the start of the school year, I spoke to a public health staffer from the Los Angeles Unified School District. I was told that they were getting good compliance with the new law and hadn't heard a lot of complaints. At the time, I guessed that the truly loony parents had either bought their kids a medical exemption or opted for home schooling. The graphs suggest that it may be some of both, with the paid medical exemptions the largest part. After all, if you can get the exemption by making one visit to a friendly doctor, you save yourself a huge amount of work for the coming years.

What's interesting is the relatively low level of protest and publicity over the new law. Sure we had a couple of public protests, but they were comparatively small in size (perhaps a few hundred people in the Los Angeles area) and few in number. The late night television news dutifully covered the largest protest but that pretty much ended the discussion. If you looked carefully at the news coverage, it became obvious that the numbers of the protestors were swelled by the presence of large numbers of children -- in other words, the number of voting adults was comparatively small for all of the protests combined.

You had to look hard (or read this blog) to get any news about the lawsuits and their inevitable failures.

Thanks to Brian @16 who mentions much of what I said in my (slightly) later post. I was typing my comment when yours went up.

We might also consider a longer perspective. Before the measles vaccine, an estimated four million children got measles each year (averaging cyclic variations etc) resulting in thousands of severe cases, hospitalizations, and numerous deaths. At this point, if a few dozen children in Mendocino get measles, the outbreak won't spread to tens of thousands in the more populated regions.

Yep, more children needlessly poisoned to protect an iatrogenic federal program.

What this post is discussing is the "Kindergarten Summary Report"; the finest level of detail is at the county level. At some point in the future, the state will release an xls file for kinder at the individual school level, and the child care and 7th grade xls files.

The child care file is interesting but excludes all facilities with fewer than 10 enrollees. It also only gives a snapshot of the immunization status at one point in time (typically, September) and since babies' immunization status changes so much in the first 18 months, it's a bit confusing. It reports on vaccination status for DTAP, Polio, MMR, HIB, HepB, and Varicella.

The 7th grade xls file probably will only record Up to Date, PME, and Overdue (the only thing that is due is the Tdap booster).

So the really interesting one will be the kinder entry xls file by school. It will be interesting to see the change both in enrollment and vaccine coverage in the schools that last year had low vaccine uptake. (BTW last year, the reporting was on number of students who were up to date on DTAP, Polio, MMR, HepB, and Varicella. HIB is not required for kindergarten entry, as it is for child care.)

There were a lot of schools that had a high number of "conditional entrants" -- students who were not up to date for age, but had a plan to become up to date. In the summer of 2015, there was an administrative ruling that put more pressure on schools to follow up on conditional entrants.

@MJD: even if in the highly unlikely event your claims were proven to be "right", Orac would not be eating crow. Since he actually understands science, he would simply accept it.

And you would not actually be right. You'd be lucky, as in a lucky guess. Because that's what your claims amount to.

I thought MJD's latest theory is that everything is a conspiracy from the patent office.

No,his latest theory is that any one who disagrees with him online is a bully.

After MJD has eaten his share will there be any crows left?

Can I use a personal belief exemption to not pay taxes? I'm asking for a friend.

@#28: No. The IRS has put the banhammer on that a multitude of times.

Awaiting the "massive outbreak" of autism in California.........Surely, it's coming soon.... surely it is... any day now

Duh. Of course SB 277 works to some degree--it's coercion. Parents must either home school, or allow their children to be injected with every vaccine the State tells them to.

It used to be a few...now it's dozens...and some day it could be hundreds. If the pace of coercive legislation and vaccine propaganda keeps up with product development...and if passivity and blind obedience rises with it...we can all look forward to the utopia Ira Levin described in This Perfect Day. That last "if" is the only one that's not a given. :)

Duh. Of course SB 277 works to some degree–it’s coercion. Parents must either home school, or allow their children to be injected with every vaccine the State tells them to.

Oh, dear, Ginny, isn't mandatory indoctrination public schooling part of the New World Order agenda?

Go back to the trite, dour, unremittingly repetitive "fine art."

That’s why these maps of county-wide vaccine uptake should be music to the ears of pro-science, pro-vaccine advocates.

And now I wish someone with an actual synesthesia described how they sound like...

Duh. Of course SB 277 works to some degree–it’s coercion.

By that logic, jail for failing to pay taxes and fines for traffic violations are also coercion.

It used to be a few…now it’s dozens…and some day it could be hundreds.

Yes, in the same way that a meteor large enough to wipe out humanity could hit the Earth in the next decade.

#33 TSoL -
Maybe Mike "The DeRanger" Adams can use his maths and science skillz, honed to delusional perfection with his “Elemonics” breakthrough, to transform the county data to musical chords which will undoubtedly be discordant from those counties with high vaccine uptake and soothing and angelic from those counties with low vaccine uptake rates.

It's amazing what you can produce when you are certifiably insane...

Saying SB 277 'works' is like saying armed robbery 'works,' or extortion 'works.'

"Turn over your children for 58 injections, or we'll take their education." Or,

"That's a nice public education your children have there...sure would be a shame if they lost it. The price to keep it is only 58 injections--paid in advance."

Parent: "Once my children take the 58 injections, that'll be all, right? We'll be paid in full?"

State: "Hehehe. Sure...until the price goes up. And it will. We'll be back for more."

I expect most people do realize the difference between regulation by the state and crime. A better example here would be the laws requiring that people take epilepsy medicine before they can have a driver's license. Like those drivers, parents here have a choice. They can choose not to protect their children. In that case, the state limits their ability to send the children to school.

Like the driver, it's not an easy price to pay, but like the driver, they can choose. If they choose not to protect their child, they are imposing a risk on others. The state limits that risk.

Is it a constrained choice? Of course. As most choices are; as the choice of a parent with an immune compromised child and a school with low rates of vaccinating would be.

But there's still a big difference between restrictions created according to the legal procedures for passing laws and regulations, and aimed to protect others, and armed robbery - unless you believe the state has no authority to regulate to protect.

No, that's not a better example. The most common requirement of the State for people with epilepsy is that they be seizure free for a specific period of time and submit a physician's evaluation of their ability to drive safely. With SB 277, healthy children are being required to submit to ongoing medical treatment that may not be appropriate or necessary for them at all, and is known to have the potential to cause grievous harm, including lifelong disability and death.

The only reason a vaccine would not be appropriate is if a child had a medical condition that goes against it - and medical exemptions were left unchanged. So no.

As to risk - to remind you, the children are at much higher risk if they contract a disease they could be vaccinated against. The risk of vaccinating is an order of magnitude smaller. And, like the seizing driver, they risk others.

There is considerable dispute within the medical and scientific community about the safety and efficacy of vaccines, and there has been since vaccines were first used. Trying to create the impression that all such disputes are not credible, and suppressing them in the media and in academia, are deceptive propaganda techniques that are becoming increasingly transparent.

Our bodies do not belong to the community, nor to the government. All medical treatments carry risks. The right to informed and voluntary consent to medical treatment has been recognized as a fundamental human right for decades.

"Trust us, we're the government" and "trust us, we're doctors" are steadily losing their persuasive appeal--for good reason.

@NWOR - so, how many injections spread over how many years?

0 - 6 years is quite a long time for to get the required vaccinations...it isn't like kids get them all at once.

And then there are the vaccines that aren't required - like the Flu or HPV (which isn't even given until early teens).

And parents always have a choice. They can choose not the vaccinate their children, and every choice has consequences - anti-vaxers just don't like the fact that they are being held accountable for those choices.

NWOR Troll: I'm confused. First anti vaxxers complain about combined vaccines and demand single vaccines. But we combine them to reduce the number of shots. Then you complaint about the number of shots, when what you complain about in combined vaccines reduces the shots.

So which is it? Combined vaccines or the number of shots you object to?

You can drop the whine about "coercion." A society with rights is also a society with responsibilities.

We're responsible to pay taxes to support our government and our communities.

We're responsible to obey laws that provide for the safety and welfare not only of the community as a whole, but of ourselves.

That's includes obeying traffic laws. It also includes getting vaccinated if you want to attend a public school. Your rights stop at my nose. You do not get to put my children at risk because you're a colossally selfish, self centered moron.

If you refuse to vaccinate your children, it is YOU who is depriving your children of a public education, not the government, not society as a whole. YOU. You make your bed, you lie in it.

Of course, you probably don't mind that your children will grow up to be as ignorant as yourself. Heaven forbid they should actually be exposed to real science and learn how to think.

Also, public school systems have to take into account the safety and health of all of their students....which is why vaccine mandates have existed for decades or longer.

The first mandate for inoculation was passed in 1792 by the Commonwealth of Virginia - which included steep fines for anyone who was not inoculated against Smallpox.

The US Supreme Court has consistently ruled for more than 110 years that vaccine mandates are Constitutional.

Keep tilting at windmills (and unbuckle that seat belt while you're at it -show the man!)

For all you AVers out there, I have a simple analogy that you may be able to stretch your minds to understand.

You decide that you want to go bungee jumping but are scared off because the bungee cord might break once in a million jumps. One in a million is pretty good odds that nothing will happen. Vaccines have even better odds of no major adverse event happening.

I just had (for travel reasons) a booster flu shot and I had an adverse reaction, there was a blood spot on the band aide. I am so afraid now of the flu vaccine that I will get again in September or October.

There is considerable dispute within the medical and scientific community about the safety and efficacy of vaccines.

No there isn't, and this claim is tedious.

Trying to create the impression that all such disputes are not credible, and suppressing them in the media and in academia, are deceptive propaganda techniques that are becoming increasingly transparent.

Very well. Show us your evidence.
Show us good quality evidence that vaccines are less effective than commonly claimed. Show us your proof that they cause more negative side effects than are commonly claimed. Show us that the diseases are less dangerous and that vaccinating for them is unnecessary.
If you can, that is.

There is considerable dispute within the medical and scientific community about the safety and efficacy of vaccines, and there has been since vaccines were first used.

Quoth the fan of Jon Rappoport, "Investigative Reporter."

A few crazy people shouting through megaphones don't constitute a "dispute."

Neither does a few crazy people typing on ALL CAPS on the Internet.

The misuse of "efficacy" was a nice touch, though.

Isn't nice how NWO also completely fails to note that the reason that we don't have to vaccinate against smallpox anymore is because vaccination eliminated the disease?
We could stop vaccinating against polio soon too, if not for a lot of religious and geo-political BS.

No, it died out of its own accord or something. SRSLY: just search the pseudonym and "smallpox."

Also, NWA Troll seems to be geographically confused. She does not live in California.

To wit.

Narad: WHAT? Dude, what in the what?
Oh for fox sake.
There are books about it. Lots of books, by lots of different people. Heck, some of the people in charge are still alive to ask!
That's like the guy who told Buzz Aldrin he didn't land on the moon.

It does help estimate NWO's age, though.

Man, and the pox viruses are so interesting. All big and species specific. There's even one for caterpillars that makes them go nuts and then liquefies their insides.

It’s amazing what you can produce when you are certifiably insane…

Hey now, don't go blaming the differently-rational for the existence of Mike Adams. You sane ones must take ownership of him and his con-jobs.

Robster: So, are you another sock, or just brain damaged? I thought the whole moon landing thing was settled. The only people who think it was a hoax think the Sun orbits the Earth.

One side effect of posting this link
http://lizditz.typepad.com/i_speak_of_dreams/2017/02/the-fendlesworth-m…
is that not only does that link climb in the Google rankings when people search for Travis J. Schwochert of 239 S Church St Endeavor, WI, but comments, such as this, that have the link also rate higher in the Google rankings.

It would be a good way to let anyone searching for Captain Sock Puppet to know that he's so brain dead (possibly from drinking, but other reasons are possible) that he's also a moon landing denier and a JFK conspiracy loon, as well as an anti-vac idiot.

F off Travis.

Robster FCD, lets sock your anal cavity on the tip of a Nike X and see how far we can send you puppet.

The mooning landing happened, I've met a number of people who were of the launch teams.

TRACERT my IP, you might find I'm closer than you think. I'm in your computer, touching your stuff.

I thought the whole moon landing thing was settled.

Mehh.
https://www.youtube.com/watch?v=ks7GSmUnV3A

Such a poorly faked video

Is Bertrand Russell braindead too?

Logical atomism wasn't the brightest idea. Oh, and I've already mentioned the ultimate failure of the Principia. Maybe you should get a vintage Farrah Fawcett poster instead, Travis.

Hey Johnny, Is Bertrand Russell braindead too?

I think it's safe to say that his brain works just as well as yours these days, Travis.

Robster, FCD has not posted since 2008. It is another sock puppet.

So Travis Schwochert from Endeavor, Wisconsin how is that job hunting going? Kind of troublesome that your annoying sock puppets are so easy to find. Go away.

I won't go away until Orac removes all of your psychopathic doxxing.

You brought all upon yourself. The blame is all yours. All you have to do is to stop posting with stolen credentials. Just stop. Go away.

Get professional help.

I tell ya. I spend just one evening away from the computer, and this happens...

I won’t go away until Orac removes all of your psychopathic doxxing.

You keep using that word. I do not think it means what you think it means.

"Psychopathic" would be screen capping this thread, with your flat-out admissions of guilt, and sending them off to
James.Schwochert@somestate.somewhere

Nobody has done that as far as we know.

You brought all upon yourself. The blame is all yours. All you have to do is to stop posting with stolen credentials.

Do you speak for Orac Chris?

You’re a fμcking psychopath Johnny. You sit on your perch all day until waiting for comments critical of vaccines. They you pounce with your psychopathic ridicule.

Heh, says the boy who won't stop stalking and makes pathetic attempts at doxxing me.

Travis, since you suffer from multiple nyms, I would suggest check in at the nearest mental health facility. I sure they would give some meds that would make you feel a lot better. They could add some aluminum to the meds. I am not sure but I bet WI has remedial training for people like you.

This is bullshit Orac. I am the only Travis J. Schwochert on the planet.

All of my comments were transient and have been removed. This falls into the prank category. I intentionally give myself away. What Johnny does is intentionally and permanently linking my name with the most psychopathic slurs that he can imagine.

Since you identified yourself, I thought I'd tack an addendum to your 'nym identifying you.

And, boo-hoo. For close to six months now (I checked), your "pranks" have annoyed my regular commenters, a few of whom have been following my blog for over a decade. You've even impersonated them and even forced a few of them to start posting under a different e-mail address so that they could still comment after I blocked the old one you had co-opted for sock puppets. You've wasted untold hours of my time dealing with your sock puppets over that time. I know you've done this at one other blog (at least) that I know of. Consequently, I have zero sympathy for you whatsoever. You made your bed. Lie in it.

To be honest, I've been too nice. Over the last month or so I've been deleting everything you post as soon as I realize it's you, either on my own or from one of my readers. That's been doing you a favor, because in essence I've been erasing the evidence, and since I started doing that there remain nothing other than posts by frustrated readers saying things like, "Fuck off, Travis" (which you really, really should do, by the way). In the future, I think I'll leave a few of your "pranks" up, so that anyone who happens upon the thread understands what a childish annoyance you are.

Heh, says the boy who won’t stop stalking and makes pathetic attempts at doxxing me.

Well, all he has to do is ask Jake who you are, "Emily". I think Travis and Jake would make one heck of a team.

I really don't get the fixation on Russell, unless it's some sort of mental truck stop that was never departed. Travis J. Schwochert seems to consider invocations to be insignia of SMURT, and teh NWOR does as well, just upside-down.

I know right? We all must be Emily or Dorit.

testing, 1, 2 (a comment of mine seem lost in the ether)...

We must all be Emily or Dorit.

Wait, I thought that you were Bonnie Offit--unless that was Matt.

“Psychopathic” would be screen capping this thread, with your flat-out admissions of guilt, and sending them off to
James.Schwochert@somestate.somewhere

Even without a history of starting fires and general petty crimes?

I'm Spartacus!

@Johnny #59:

Brilliant!

Wait, I thought that you were Bonnie Offit–unless that was Matt.

That's Matt. I seem to be any other number of bloggers/commentors who provoke the ire of numpties like Travis and Jake.

In the future, I think I’ll leave a few of your “pranks” up, so that anyone who happens upon the thread understands what a childish annoyance you are.

Please do and I'll add some of his "pranks" that he's left on my blog, with his name of course.

What Johnny does is intentionally and permanently linking my name with the most psychopathic slurs that he can imagine.

Again, you keep using that word.

I maintain that I've not posted anything about you that isn't, in fact, true. However, I am human, and could have made a mistake. If you can point to a factual error I've made, I'll correct it.

Also, yes, I do ridicule stupid anti-vax statements from stupid anti-vax idiots such as yourself. Others are better at slapping them down with science, but I like to help when and where I can. It's nice to see that my modest efforts have had some small effect.

Michael J. Dochniak Dear Mr. Dochniak,
It's hard to tell if this comment is sarcasm or not

"Let’s be truthful, America has the greatest system of education in the known universe. "

As a internet search can not find any list by any organization that has the US education system near the top of the list. The US is way down on all these lists. Minnesota may have a better one than the US as it is a pretty rational state.

I hope that your son's school has or gets a strong anti bullying policy.
Thank you orca for the fascinating post
All the best

Measles outbreaks and the debate over how far we should go requiring vaccination

oracknows — Thu, 06 Oct 2016 02:11:34 +0000

Measles outbreaks and the debate over how far we should go requiring vaccination

Whenever we discuss vaccines and vaccine hesitancy, thanks to Andrew Wakefield the one vaccine that almost always comes up is the MMR, which is the combined measles-mumps-rubella vaccine. In 1998, Wakefield published a case series of cherry-picked patients in which he strongly inferred that the MMR vaccine was associated with autism and “autistic enterocolitis.” Of course, even the way Wakefield spun it, this wasn’t enough evidence to link the MMR vaccine to autism, which is no doubt why Wakefield never explicitly said that it did in the paper describing his case series. My guess has always been that the peer reviewers wouldn’t let him. However, outside of the scientific literature, unconstrained by peer reviewers, Wakefield was not nearly so shy about explicitly linking the MMR to autism. As a result, MMR uptake plummeted in the UK, and measles returned to become endemic again, after having been declared eliminated before. We now know Wakefield is a fraud, thanks to Brian Deer’s excellent investigative work, but the damage was done, and MMR uptake still hasn’t returned to pre-scare levels.

Unfortunately, measles is still in the news, even in the US, where the predominant mode of antivaccine fear mongering has not been about MMR, at least not the way it was in the UK in the wake of Wakefield’s case series. Most recently, there was what has become known as the Disneyland measles outbreak, in which an outbreak centered at Disneyland resulted in mini-outbreaks throughout the country. And, yes, the unvaccinated played a major role.

Not as well known are some previous measles outbreaks. One of these occurred in Ohio in 2014 and was traced to unvaccinated Amish men who traveled to the Phillippines, where measles is endemic. In fact, it’s bad there. with the World Health Organization having confirmed 21,403 cases of measles and 110 measles-associated deaths. This brings us to a study that appeared today in The New England Journal of Medicine (NEJM) that examined this particular outbreak, A Measles Outbreak in an Underimmunized Amish Community in Ohio. It’s more of a narrative than a study in that it’s a descriptive study of what happened, including the efforts used to contain the outbreak once it was identified, noting in the introduction:

When measles outbreaks occur in a region in which measles has been eliminated, they occur in clusters of unvaccinated persons, including those in religious communities. The Amish, a Christian sect descended from the Swiss Anabaptists, practice group solidarity and rejection of modern conveniences. Although the Amish Church does not specifically prohibit vaccination, the personal and cultural beliefs of the Amish limit participation in preventive health care, which results in low immunization rates16-19 and an increased risk of vaccine-preventable diseases. During measles outbreaks, the infection can spread unchecked among community members, which subsequently places susceptible persons in the general population at risk. Such outbreaks afford a unique opportunity to measure the ways in which high baseline immunity in a population and targeted public health responses contribute to the prevention of measles epidemics.

During the outbreak, which lasted from March to July 2014, there were 573 suspected cases of measles investigated, of which 190 (33%) were ruled out, which resulted in 383 confirmed cases. The authors note that this outbreak occurred in one of the largest Amish settlements in the US, with over 32,000 people. It was centered in Holmes County but quickly spread to neighboring counties. The overall age distribution showed that 26% of the cases occurred among children from 5-17 years of age and 48% among young adults 18-39 years of age—at least until the halfway point of the outbreak. After that, the rates changed to 52% and 25%, respectively. Early on in the outbreak, the transmission setting for 38% of the cases was church, and for 48% was home; later in the outbreak, these rates changed to 5% and 90%, respectively. Public places where lots of people gather are fantastic incubators to get an outbreak started.

Here’s where vaccination status comes in:

Before the outbreak, 340 case patients (89%) were unvaccinated As part of the public health response, 106 case patients (28%) received the MMR vaccine; of these, 16 (15%) received the vaccine before assumed exposure. No case patients received immune globulin as prophylaxis after exposure.

In 2014 in the general population in Ohio, vaccination coverage with at least one dose or at least two doses of MMR among young children and adolescents was 95.6% and 88.2%, respectively, and coverage with at least two doses of MMR among children in kindergarten was 91.9%.33 On the basis of data collected from the affected households, coverage with at least a single dose of MMR vaccine in this community was estimated to be at least 14% before the outbreak.

And there’s why the outbreak was able to spread so fast. MMR uptake among this Amish community was far below what was required to provide herd immunity. The exact percentage vaccinated necessary to maintain herd immunity depends on several factors. It’s not necessary to go into them here, but suffice to say that for a disease as highly contagious as measles in general vaccine uptake greater than 90% of the population is needed. Thus, this outbreak demonstrates how, in a state where vaccine uptake is very high there can still be a large outbreak. All it takes is a pocket of people with low vaccine uptake, like the Amish in Ohio. This is illustrated in a video that accompanies the article that’s well worth watching.

The article also details the public health response. This included containment interventions conducted according to CDC guidelines. These included enhanced surveillance, meetings with bishops and local health department personnel to encourage reporting, to emphasize the importance of vaccination, and to inform patients about the availability of testing. News of the outbreak spread rapidly through word-of-mouth, as well as by stories in the local Amish newspapers. Alerts were sent to health care providers. The ~~jack-booted thugs from the CDC~~ public health advisors from the CDC (sorry, dealing with antivaccine loons for so long sometimes causes me to lapse into their jargon) assisted local health officials in their investigation, and door-to-door case finding was conducted in areas where underreporting was suspected.

There there was a mass vaccination campaign:

During 120 free vaccination clinic sessions, 12,229 doses of MMR vaccine were administered to 10,644 persons; 6461 of the persons who received at least one dose (61%) were 5 to 39 years of age (Table 3 and Figure 3FIGURE 3). Case patients were isolated until they were no longer infectious (4 days after the onset of rash), and nonimmune persons who were exposed to measles were voluntarily quarantined at home and followed for the development of symptoms until beyond the maximum incubation period (21 days). The church-related entity that organized the charitable work in the Philippines adopted pretravel immunization measures for subsequent volunteers.

These are the sorts of things public health officials have to do once an outbreak starts. Preventing an outbreak is, obviously, far more desirable. One notes that persuading the population to vaccinate, even in the case of an outbreak. Fortunately, this time around the community involved was less resistant to vaccination than during past outbreaks and was very cooperative:

A few notable features of the outbreak revealed important characteristics of the affected community. First, the degree of opposition to immunization was less strenuous than it was in previous outbreaks among the Amish, in which vaccination was refused. In addition, infectious and exposed persons were willing to limit attendance at church gatherings, weddings, and other events, which may explain the changes in age distribution and exposure setting during the outbreak; initial transmission seemed to occur more often among adults, whereas subsequent transmission occurred more often among younger age groups once measles was introduced into households. Second, the rate of hospitalization due to measles was lower among the Amish (approximately 3%) than in the general U.S. population (approximately 20%), which may reflect differences in health-seeking behavior and the cost of medical care, because the Amish tend to be uninsured. Third, measles attack rates were 1.5 to 1.9 times as high among persons younger than 40 years of age as among those 40 to 54 years of age, which suggests that older age groups had previous natural immunity; this finding is consistent with reported measles outbreaks in Ohio in the late 1980s. The fact that no case patients were 55 years of age or older supports the statement in official recommendations that persons born before 1957 have presumptive evidence of measles immunity. Fourth, although we had expected lower attack rates among children younger than 1 year of age because of transfer of maternal antibodies, unvaccinated mothers had a high probability of remaining susceptible through early adulthood because of the low background incidence of measles in an area in which measles has been eliminated, which therefore diminished any potential transfer of protective antibodies to their neonates.

In other words, when measles isn’t around in the population, you can’t count on maternal antibodies transferred to the baby protecting against measles. All of this brings us to the conclusion:

This evaluation illustrates the way in which a clustering of persons who do not routinely vaccinate against measles can result in an accumulation of susceptible persons and can subsequently create a niche of sustained measles transmission. Since the outbreak, local health departments have continued to promote and offer vaccination. Although acceptance of vaccination among some of the Amish has generally improved, the demand for immunization has varied by county, and efforts to ascertain and to improve coverage in this and other Amish communities are needed. We highlight the importance of early recognition of measles and suggest that prompt initiation of control measures ahead of the epidemic curve may be key to limiting the spread of measles. Effective strategies rely on community commitment through engagement of local leaders, isolation of infectious persons, quarantine of those exposed, and vaccination of susceptible persons. The single best means of containment of measles, however, is maintenance of high initial levels of measles immunity in the population.

Let’s repeat that again: The best means of containment of measles is the maintenance of high initial levels of measles immunity in the population—through vaccination.

The question then becomes: How to maintain that high level of vaccination. To this end, there was also a Perspective article by James Colgrove, PhD, MPH entitled Vaccine Refusal Revisited — The Limits of Public Health Persuasion and Coercion. This is an article that explicitly addresses the difficult issues around how far the government should go to require vaccination. Colgrove starts his article that coercion as a strategy in public health goes way back, citing examples from the 19th century of compulsory smallpox vaccination laws that covered both children and adults. These laws included penalties that ranged from exclusion from school for unvaccinated children and fines or quarantine for adults who refused vaccination. These laws worked, too, and, contrary to what you will hear from antivaccinationists, their constitutionality was consistently upheld in numerous court challenges that ultimately made it to the Supreme Court, where the 1905 Supreme Court case of Jacobson v. Massachusetts also affirmed their constitutionality.

As time went on, persuasion became as important, if not more so, than coercion:

The use of coercion has always raised concerns about state intrusions on individual liberty and the scope of parental control over child-rearing. Compulsory vaccination laws in the 19th century typically contained no explicit opt-out provisions. Today, all states offer medical exemptions, and almost all offer religious or philosophical exemptions. Nevertheless, even a law with an opt-out provision may exert a coercive effect, to the extent that the availability of the exemption may be limited and conditional and the consequence of the law is to make the choice to withhold vaccination more difficult (if only marginally so) for the parent. These laws continue to be the target of antivaccination activism.

That’s an understatement. Fast forward 110 years, to when SB 277 was passed in California. Passed in the wake of the Disneyland measles outbreak, it’s a law that fully took effect this school year and eliminated non-medical exemptions to school vaccine requirements. Given how easy nonmedical exemptions were to obtain in California, it was a not unreasonable measure to take. Unfortunately, although other states have tried to pass similar laws since, no other state has succeeded. In any case, resistance to SB 277 has been fierce, with demonstrations, but also disturbingly lots of Nazi imagery comparing the law to the Holocaust and the unvaccinated to Jews, complete with some even making badges patterned after the yellow Star of David badges Jews were forced to wear to identify themselves in the Third Reich and conquered territories.

Colgrove points out that today public health officials are working on both persuasion and coercive approaches, but mostly persuasion. He notes that social scientists are working to develop a much more nuanced understanding of the phenomenon of vaccine hesitancy, which actually encompasses a wide range of behaviors that range from reluctance to vaccinate to suspicion of some vaccines but not others to wanting to delay vaccines to full-out antivaccine wingnuts like the crew at Age of Autism or The ~~Drinking~~ Thinking Moms’ Revolution. Of course, one thing that I tend to think that social scientists do too much of is trying to craft strategies to reach antivaccinationists. Don’t get me wrong. Reaching the vaccine-hesitant is important. Many, if not most, of them can be reached with the right message. Trying to reach the hard core antivaccine wingnuts is what I like to call a long run for a short slide, a lot of effort for not much chance of a return.

Where I do agree with Colgrove is that neither coercion nor persuasion is sufficient. Noting that even the best-crafted persuasive appeals can’t achieve the near-universal vaccine uptake needed to protect the population against a disease as contagious as measles, he concludes:

Both persuasion and coercion are necessary, and neither is sufficient. Laws serve as a critical safety net as well as a powerful symbolic statement of proimmunization social norms. Education and persuasion are needed to maintain public understanding of the value of vaccines and trust in health professionals, both of which are essential to securing compliance with laws. The melding of the two approaches — along with ensuring a stable, accessible, and affordable supply of vaccines for everyone who needs them — is the central challenge for vaccine policymakers. As has been the case since the 19th century, effectiveness, efficiency, ethics, and political acceptability all need to be balanced in a careful calculus.

Figuring out what the proper balance is and how to achieve that calculus is more difficult now than it was in the 19th century or even the 20th century. Thanks to the Internet and social media, antivaccine forces, which were relegated to using pamphlets and speeches, can reach millions or billions. They can forge like-minded virtual communities of individuals imbibing the same self-reinforcing misinformation, immune to correction. That is the unique challenge of the 21st century in maintaining high vaccine uptake.

oracknows Wed, 10/05/2016 - 22:11

Tags

Bioethics

school vaccine mandate

vaccine

Bioethics

Defending Dr. Bob Sears: On the affinity between "integrative medicine" and antivaccine views

oracknows — Tue, 27 Sep 2016 06:15:40 +0000

Defending Dr. Bob Sears: On the affinity between "integrative medicine" and antivaccine views

It’s been nearly three weeks since we learned that the Medical Board of California had initiated disciplinary proceedings against the most famous antivaccine physician not named Andrew Wakefield. I’m referring, of course, to “Dr. Bob” Sears, author of The Vaccine Book: Making the Right Decision for Your Child and creator of an “alternate” vaccine schedule that “spreads out the vaccines.” Unfortunately, it’s a book that’s been very influential, in particular promoting the idea of “too many too soon” and claiming that delaying vaccines will reduce a child’s risk of autism. Basically, the medical board accused Sears of failing to live up to the standard of care in two instances with one patient: Not doing a detailed neurological examination when she presented to him with history of headache two weeks after having been supposedly hit on the head with a hammer by her father and writing a letter supporting a medical exemption to school vaccine mandates based on a rationale that was not based in science and not accepted as the standard of care. Since then, antivaccine activists have rallied around Sears and portrayed the impending disciplinary hearings against him as “persecution.”

Of course, “Dr. Bob” has a long history of pandering to the antivaccine movement, a history I’ve documented extensively right here on this very blog. For example, he’s likened SB 277, the new California law that eliminates nonmedical exemptions to school vaccine mandates, to the Holocaust, basically going full Godwin on it and letting his antivaccine freak flag fly. I was also surprised that the Medical Board of California didn’t actually look at Dr. Sears for his more blatant selling of medical exemptions, including exemptions based on an online form.

So it amuses me to see the latest volley fired to defend Dr. Bob from the nefarious depredations of the evil Medical Board of California. It comes from Jennifer Margulis, PhD, who claims that long history of antivaccine posturing. If you don’t believe me, just check out her website, which is chock full of posts “standing with Sears” and promoting Andrew Wakefield’s antivaccine conspiracy propaganda piece VAXXED. So, not surprisingly, her defense of Dr. Bob invokes the views of some rather dubious physicians. First, she begins by quoting the charges against Dr. Bob, where the board points out that the “standard of care requires that a physician evaluating a patient for possible reaction to vaccines obtain a detailed history of the vaccines previously received as well as the reaction/reactions that occurred” and that, based on that information, “the physician should provide an evidence-based recommendation for future immunizations.” This is, of course, perfectly true, and it’s pretty darned obvious that if the the board’s list of charges are correct Dr. Bob failed in that.

Not according to Margulis:

But, say several doctors and supporters of Sears, according to the Medical Board’s own documentation, this is exactly what Sears did.

When Sears saw the toddler for the first time on April 3, 2014, he was told by the boy’s mother that her son had had two concerning vaccine reactions.

The boy “shut down stools and urine for 24 hours with 2 month vaccines and [was] limp ‘like a ragdoll’ lasting 24 hours and not himself for a week after 3 month vaccines.” In a letter dated April 13, 2014, excusing J.G. from future vaccines, says Sears indicated that “the patient’s kidneys and intestines shut down after prior vaccination and that at three months the patient suffered what appears to be a severe encephalitis reaction for 24 hours, starting approximately ten minutes after his vaccines, with lethargy, limpness, and poor responsiveness.”

“Based on the symptoms the child suffered after previous vaccinations (as described by the mom in the accusation), I would say Dr. Sears was being grossly conscientious,” asserts Shira Miller, M.D., a Los Angeles physician who is board certified in internal medicine and has been practicing medicine for 14 years via e-mail.

I dealt with that claim before the second time I discussed Dr. Bob’s impending disciplinary proceedings before the board. To summarize, when confronted with a new patient whose mother claims she had a serious vaccine reaction such as what was described in the records, a competent and responsible pedaitrician would look into exactly what vaccines the child had before the alleged reaction and, if possible, obtain the patient’s medical records to see exactly what form the alleged reaction took. Heck, a truly “grossly conscientious” pediatrician would have picked up the telephone and given the pediatrician who cared for the patient at the time of the claimed reaction a quick phone call. After all, if the reaction were as dramatic as claimed, most likely the pediatrician would remember it and would have reported it to the VAERS database. From the documentation available, we know that Dr. Bob did none of these things. He just wrote a letter of support for a vaccine exemption because the mother wanted one, requesting exemption for all vaccines. Even if the child did have a truly serious reaction to a vaccine, that doesn’t necessarily mean she should have been exempted from all vaccines. It might, but it might not. Dr. Bob didn’t even try to figure it out.

I had never heard of Dr. Shira Miller before; so I did a quickie Google search, which brought up her website. I expected a family practitioner, but what I got was an “anti-aging” doctor who runs the Integrative Center for Health and Wellness. She appears to specialize in menopause, particularly “bioidentical” hormones, “anti-aging” medicine, and, of course, “holistic” medicine. Her profile states that she has practiced “integrative, functional, alternative, holistic, nutritional, wellness, age management, and anti-aging medicine since 2006.” Of course, functional medicine is pseudoscience involving making it up as you go along.

Next up:

Deborah Gordon, M.D., an Ashland, Oregon, family physician who has been practicing medicine for 30 years, including five years in California, agrees. Gordon says the kind of reaction described by J.G.’s mother was “absolutely cause for concern.” A three-month-old baby who remains limp for 24 hours immediately after being vaccinated, Gordon says, is suffering from a neurological insult.

“That shrieking cry or high fever isn’t because the spot of the vaccine still hurts,” Gordon points out. “It is because an inflammatory reaction is going on in the child’s system, including in the brain.”

Um, no. A three year old remaining limp for 24 hours after being vaccinated, if that is indeed what happened, does not necessarily suffer from a neurologic insult. The differential diagnosis is much longer than that, but Dr. Gordon zeroes on on the one thing she can think of as a cause. I checked out Dr. Gordon’s website as well. She’s big into diet to treat disease, which is not a bad thing, if her approach is evidence-based, but somehow I doubt it is, even without delving far into her website. Why? Because she embraces homeopathy, working with a naturopath to provide homeopathic care to Ashland, OR. From my perspective, any physician who embraces the quackery that is homeopathy automatically forfeits pretty much all credibility in any other medical area. After all, if Dr. Gordon’s mind is so “open” that she can administer homeopathic remedies, I have to wonder how “open” it is to other forms of pseudoscience—almost certainly very. No wonder she thinks that Dr. Bob acted responsibly.

I could go on and on, but let’s see who else “stands with Sears”:

Robert Rowen, MD: Another “integrative physician” who offers ozone therapy to his patients and even claims that ozone therapy cures Ebola. That reminded me. I’ve blogged about Dr. Rowen’s Ebola quackery twice before. This is a guy who went to Sierra Leone in 2014 at the height of the Ebola outbreak to offer ozone therapy to Ebola patients.
Tina Kimmel, PhD, who is represented as having “a master’s in public health from the University of California at Berkeley and who worked for the Immunization Branch of the California Department of Public Health for six years: A woman who wrote an execrably bad study claiming that pertussis vaccine predisposes children to asthma and has appeared on Gary Null’s show. Hilariously, even though she is not a physician, she pontificates that “I have not seen any evidence that he committed negligence.”
Cammy Benton, MD: Another “integrative” physician practicing “functional medicine.”
Lonna Larsh, MD: More “functional” medicine.

Basically, they all repeat the same tropes that I’ve discussed before, claiming that what Sears did was not gross negligence because they basically believe whatever they’re told by parents. I’m rather surprised Margulis couldn’t scare up an actual pediatrician or two to “stand with Sears.” After all, there are antivaccine-friendly pediatricians out there like Dr. Bob. I mean, wasn’t Dr. Jay Gordon available? Of course, the reason why the tropes are the same is because there’s been a set of talking points that’s solidified since the charges against Sears were first made public and after antivaccine blogger Levi Quackenboss first enumerated them a few days later.

Of course, one of the reasons Margulis’ article caught my attention is not because a lot of antivaccine docs are disturbed by the Medical Board of California actually doing its job and trying to put a stop to Dr. Bob, who is, as far as I am concerned, a menace to public health in California. Rather, it’s to show the affinity between “integrative medicine” and antivaccine views. There isn’t a single mainstream physician—especially a mainstream pediatrician—defending Dr. Sears’ behavior. It’s all “integrative” physicians practicing woo like functional medicine, homeopathy, and a whole lot of other dubious medicine. They’re the only ones defending Dr. Sears. That’s just another thing that should disturb you about “integrative medicine.” The proponents of integrative medicine sitting in their ivory towers of academia will swear up and down that integrative medicine is not antivaccine, but damned if a survey on the ground doesn’t suggest otherwise.

oracknows Tue, 09/27/2016 - 02:15

The Medical Board of California initiates disciplinary action against antivaccine "hero" Dr. Bob Sears. It's about time.

oracknows — Fri, 09 Sep 2016 01:00:58 +0000

The Medical Board of California initiates disciplinary action against antivaccine "hero" Dr. Bob Sears. It's about time.

After all the bad news that I’ve been blogging about, it’s a pleasure for me to end the week with a bit of very good news, very good news indeed. That news came in the form of an article published in the Orange County Register with the glorious title Dr. Bob Sears faces medical board discipline in recommendation not to vaccinate.

Behold:

Dr. Bob Sears, the Capistrano Beach pediatrician who is an outspoken critic of mandatory vaccination laws, faces possible state Medical Board discipline after he recommended that a 2-year-old patient forgo immunizations, according to legal documents made public Thursday.
The board accuses Sears of committing “gross negligence” in 2014 when he wrote a letter excusing the toddler from future vaccinations after the child’s mother described an adverse reaction as an infant.

The documents say Sears failed to obtain a detailed medical history documenting the unidentified boy’s prior vaccines and reactions, which was necessary for making an evidence-based decision. Sears’ recommendation left the patient and “his future contacts at risk for preventable and communicable diseases,” the documents say.

Sears declined to comment Thursday.

If the board finds Sears negligent, he could face discipline ranging from a public reprimand to revocation of his medical license.

My first thought when I saw this story was: Excellent. It’s about time! Personally, like some of you, I consider Dr. Bob to be an antivaccine quack. That is my opinion, but it is one that I can give quite a few evidence-based reasons for and have been doing for years now. Given Dr. Bob’s history of opposing SB 277, the new California law that eliminated nonmedical exemptions to school vaccine mandates and his willingness to give paid seminars teaching parents to avoid the requirements of SB 277 and even outright selling nonmedical exemptions, I consider him a menace to public health, particularly that of children in California and beyond. Physicians who betray public health and the health of their patients by not only failing to vaccinate but actively seeking to subvert SB 277 (not oppose, which is Sears' constitutional right, but to actively subvert it now that it's passed by writing what I consider to be dubious medical exemptions based on bogus antivaccine pseudoscience), a law designed to maintain high rates of vaccination, do not deserve their medical licenses, as they are not practicing anywhere near according to the standard of care. I thus view the Medical Board of California’s action with strong approval, strong approval indeed.

That is my opinion of Dr. Bob and what he deserves. Now the Medical Board of California is actually acting against him.

When I read this story, I also couldn't help but wonder initially if this action was over an incident that a reader reported to me, complete with letters signed by Dr. Sears recommending exemptions from school vaccine mandates based on what I considered to be bogus medical reasons based on the mother filling out an online application and paying a fee. It rapidly became clear that it wasn't when the news story stated that the incident resulting in this complaint occurred in 2014. The legal filing by the State of California tells the tale, the tale being about a young boy named J.G. (for purposes of court hearings):

On April 3, 2014, two-year-old J.G. presented to Respondent for the first time. He was seen by Respondent for what medical records describe as a “two year.” The visit of this date includes a summary of the patient’s history with a brief description of J.G.’s prior vaccination reaction, as described by the patient’s mother. Her description included, “shut down stools and urine” for 24 hours with 2 month vaccines and limp “like a ragdoll” lasting 24 hours and not himself for up to a week after 3 month vaccines.

Respondent wrote a letter dated April 13, 2014 excusing patient J.G. from all future vaccinations. The letter indicates that the patient’s kidneys and intestines shut down after prior vaccinations and that at three months the patient suffered what appears to be a severe encephalitis reaction for 24 hours starting approximately ten minutes after his vaccines, with lethargy.

The letter dated April 13, 2014 was not maintained in patient J.G.’s medical chart in Respondent’s office.

There’s more, including other visits to Dr. Bob. I wonder what Dr. Bob’s antivaccine fans would think if they learned that he actually administered the dreaded Tamiflu to J.G. later (January 2015) for a case of what appeared to be influenza. Be that as it may, Dr. Bob also saw the child in June 2014 for headache with a history of being hit on the head with a hammer by Dad two weeks prior to visit. According to the Board, there was also a mention of a split lip prior to the hammer incident. However, the physicial examination indicated “no residual marks now.” The Board also noted that no additional physical examination, including the all-important neurological examination (in cases of head trauma), was performed and no assessment with plans recorded. I used to do trauma, including pediatric trauma, and I know that this is a grossly inadequate evaluation for what might be a concussion, based on symptoms and timing, after having been hit in the head with a blunt object. One also has to wonder if child protective services was involved somehow or whether Dr. Bob reported the incident as possible child abuse, as the law requires a pediatrician to do when he suspects possible child abuse. I suspect that most pediatricians, upon seeing a child reportedly hit on the head with a hammer by his father, even if it was reportedly accidental, would report the incident, particularly if there were reports or signs of other injuries, like the split lip.

[Note: Since I posted this, it's been pointed out to me by commenters that the reference to "An Emergency Response Notice of Referral Disposition" in the complaint likely indicates that Dr. Bob did think enough of the story to report the incident, as it is also mentioned that it also had a notation of "Allegations cannot be substantiated—case closed." Of course, that Dr. Bob believed the story enough to have reported it makes his failure to do a proper neurological examination all the more egregious a failure.]

Be that as it may, the bottom line is that Dr. Bob did see J.G. a few times for various medical issues. One of those issues was how he dealt with the child's head injury. The other issue that drew the attention of the board was this:

The standard of care requires that a physician evaluating a patient for a possible reaction to vaccines obtain a detailed history of the vaccines previously received as well as the reaction/reactions that occurred. Based on that information, the physician should provide evidence-based recommendations for future immunizations.

Respondent was grossly negligent and departed from the standard of care in that he did not obtain the basic information necessary for decision making proior to determining to exclude the possibility of future vaccines, leaving both patient J.G, the patient’s mother, and his future contacts at risk for preventable and communicable diseases.

Based on Dr. Bob’s granting of the medical exemption to vaccinations for J.G. and his failure to do a neurological examination of the child when he presented with persistent headaches after head trauma, the Board listed the first cause for disciplining Dr. Bob as gross negligence. The second cause for discipline was repeated negligent acts, given that there were two instances of gross negligence included in the complaint. The third cause for discipline was failure to maintain adequate and accurate medical records.

The complaint calls for:

Revoking or suspending Physician’s and Surgeon’s Certificate Number A60936 issued to Robert Sears, MD;

Revoking, suspending, or denying approval of his authority to supervise physician assistants, pursuant to section 3527 of the Code;

If placed on probation, ordering him to pay the Board the costs of probation monitoring;

Taking such other and further action as deemed necessary and proper.

The complaint is dated September 2, the Friday before the Labor Day weekend. Not surprisingly, now that the Board's complaint is public, the merry band of antivaccine loons at Age of Autism is up in arms, and other antivaccine sites are, predictably, referring to the Board's disciplinary action as a "witch hunt."

When I saw the news story, I must admit that I was surprised. This incident occurred before the passage of SB 277. Why did Dr. Bob write a letter supporting a medical exemption to school vaccine requirements for J.G.? He didn’t need to. The mother could have just gotten a personal belief exemption. So why did Dr. Bob do it? Why did the mother ask him for an exemption? Didn't she know about personal belief exemptions? At this time, I just don't know. The other issue that puzzles me is why the board chose this case. True, it’s pretty egregious not to have examined J.G. properly when his mother brought him in with persistent headache after head trauma. (Very sloppy doctoring there, Dr. Bob.) It’s also pretty questionable to have written a letter supporting a medical exemption based on J.G.'s history and such dubious reasoning. As bad as these lapses were, normally a state medical board would probably not bother with them, as underfunded and outmanned as they usually are. Yet California is going after him. Like Steve Novella and Reuben, I definitely approve of the Board's willingness to take this risk.

I suspect that the Board wants to make an example out of Dr. Bob, which to me is also a good thing. He's a high profile antivaccine doctor whose Vaccine Book is widely read by parents and supports an "alternate vaccine schedule" that is based on fear mongering rather than science, and lately he's been opining on how the measles isn't that bad while laying down a lot of other antivaccine misinformation. If the Board is successful it will make other antivaccine docs think twice about writing exemption letters based on a questionable history of vaccine reaction and non-evidence-based reasons. It's also risky, too. Dr. Sears has become an instant martyr to the cause among antivaccine activists, and his family's celebrity will make it easy for him to grab the limelight and portray himself as wrongly "persecuted" for his "vaccine safety" views. That makes the Board's action a high-risk strategy to send a message. If it loses, Dr. Bob and those who want to sell medical exemptions to circumvent SB 277 will be emboldened.

I only hope that the Board has the opportunity to add to Dr. Sears’ charges. After all, his selling bogus medical exemptions after the passage of SB 277 using an online form is far more egregious than the incident that the Board is going after Sears for. I suspect that, given Sears’ history, there’s a lot more to be found. I really hope that the father who sent me the letters that Dr. Bob Sears generated based on an Internet form has contacted the Medical Board of California. Now would most definitely be an excellent time to do so.

I'm also expecting all manner of conspiracy theories to flow once the antivaccine movement latches on to this news. Believe it or not, I had nothing to do with this. I will be honest, though. I wish I had.

oracknows Thu, 09/08/2016 - 21:00

Tags

autism

Medical Board of California

quackery

http://scienceblogs.com/insolence/2016/07/29/after-sb-277-online-medica…

This is rather puzzling. Well, it's not at all puzzling that the medical care given by Sears is grossly negligent, but, rather, that there is much worse out there Sears has done (and been reported for) that's received absolutely no response from the California Medical Board. It is worth noting that in the "Parties" section of the Complaint report the sole Complainant as Kimberly Kirchmeyer who "brings this accusation solely in her official capacity as the Executive Director of the Medical Board of California". She was appointed to this position in 2/2014 after having been an interim director for ~ 8 months and having been with the Medical Board since 1999 ( http://www.mbc.ca.gov/About_Us/Media_Room/2014/news_releases_20140212_d… ) . So this complaint against Sears didn't come from a parent or physician, nor did it come from someone brand new to the Medical Board.

Al Capone was brought down by tax evasion. My concern is this complaint against Sears reads more like trying to jail him for jaywalking, rather than going after him for something more egregious such as what you reported in late July where Sears had been reported for giving an exemption without even examining the patient. Also, Art Kaplan laid out last year other reasons previously used by the California Medical Board with other physicians as to why Sears should lose his license ( https://www.washingtonpost.com/opinions/revoke-the-license-of-any-docto… ). As you do, I would also like to see more complaints brought against Sears for the grossly negligent care he's given his patients (he freely admitted half his patients are completely unvaccinated to the LA Times in 2014) and the many parents he has scared out of vaccinating nationwide with his books and social media presence. I worry the Medical Board has already zeroed in on what it wants.

Perhaps the true goal of this complaint is directed at those wanting to hand out vaccine exemptions in California like candy--a strong warning that they had better be prepared to document and defend the exemptions they write. The case you wrote on in late July about Sears not examining a patient might not truly worry the exemption-writing carpetbaggers too much (as in they would always examine the patient), but the idea they might actually have to provide evidence-based recommendations concerning future vaccinations in their notes (gasp!).

I wonder why this case and not the one you mentioned - with no physical exam before exemption - as well. And why was a complain brought, if the mother wanted the exemption?

There are some strange things about this story, though it may just be because it's a complaint, reflecting a very simplified and aggregated version.

At least they're looking at his behavior. He has, as you point out, acted in concerning ways for a while now.

I would wonder if this set of (alleged) violations was selected to set a bar for the future. If this action isn't successful, the can be brought up a little next time.

Welcome news, and hopefully this will lead to more kids being protected from Sears' self-serving and inadequate care.

I expect, though, that the broader Sears family will bring their celebrity and money to bear on this case, whipping up their fan base into a frothy frenzy.

I have a suspicion that Child Protective Services is somehow involved in this, and also perhaps custody battle. The stuff about being hit with a hammer and the split lip- I think CPS was involved and I wonder if they contacted the board regarding the negligent care.

Speaking of the fan base, AoA has a protest article already up describing the charges (but somehow failing to mention the part about lack of a neurologic exam for the child Daddy supposedly hit with the hammer). AoA's typically nuanced conclusion:

"You will vaccinate with no question of your health status, religious beliefs or personal stance. This is communism. The government controls you."

Darn right. You know who really runs the California Medical Board? Putin!!!

And...introducing the newest member of the antivaxx cult's martyr club. Sears will now join the likes of Wakefield and other victims of the BIG pHARMa Conspiracy.

"Be that as it may, Dr. Bob also saw the child in June 2014 for headache with a history of being hit on the head with a hammer by Dad two weeks prior to visit."

As other issues have already been addressed, my question is this: In what situation would the incident described above NOT be a mandatory report to CPS? A toddler hit in the head with a hammer by his father. The split lip noted prior to this incident can be passed off on the clumsiness of toddlerhood. My own daughter managed several black eyes from falling on her little face in the first couple years. We never hit her in the head with a hammer. This is not a normal childhood injury. And the second injury that could signal abuse. Why was this not reported by a mandatory reporter to be looked into?

IANAD, but wouldn't it be worrisome enough to justify at least a call to the doctor, if not a trip to the emergency room, if a baby produced no urine for 24 hours? Or was limp as a rag doll for a day? There should have been records of these events if they really occurred but it sounds like there weren't and Sears just took the mother 's word for it.

Interesting. Dr. Kirchmeyer may be bringing the complaint, but the issue had to come to her attention somehow. I have to wonder how that was, in order for her to know who the child was and obtain the medical records, but hate to speculate.

I bet that becomes an issue in the defense, though.

As a strategy to set up future action against Sears this is pretty good. It focuses on conduct prior to SB277 to show his negligence or gross negligence and if found true, his conduct subsequent to SB277 gets aggravated treatment if subject to medical board action. I suspect a suspended license rather than revocation is what the board is after. Once the license gets reinstated the board can control his conduct via terms of probation which he agrees to in exchange for the reinstatement. If he persists in negligent practice in the future the prior findings seal his fate.

Maybe the medical exemption had to do with parental conflict or a divorce and it's the other parent that brought the complaint. Pure speculation on my part.

@Paul #9: in the minds of AVers, they are martyred every time they are criticized, even in the slightest. The hard-core AVers flooding the OC Register comments section in his support feel Sears has been martyred many times already. They would follow him of a cliff. My hope is that Sears is professionally disciplined severely enough to show new parents that he is not a doctor deserving of trust. Ideally he gets "struck off" like Wakefield did in the UK. Then Sears can paint "VAXXED" on the side of his Lamborghini and follow Wakefield's bus around the US.

Ami@#10 -- yeah, my radar went off when I read that, too.

As PCD and Ami have mentioned above, my suspicion is that the real issue here isn't the vaccine exemption but the failure to report child abuse to the authorities. The claim that J.G. had been hit on the head with a hammer should have raised eyebrows at the time. It also suggests that the father wasn't the one to file the complaint, unless the mother is the abusive parent who is falsely blaming the father for the abuse (crazy spouses and ex-spouses have been known to do this). The mother got the vaccine exemption she wanted, so it's unlikely that she's the complainant. That leaves CPS as the only organization that would have standing here.

@Eric -- and as a pediatrician, Sears is of course a mandated reporter.

Meanwhile, Patty Bolen is merely fixating on HBOT and "ozone therapy." Not leadership material.

The claim that J.G. had been hit on the head with a hammer should have raised eyebrows at the time. It also suggests that the father wasn’t the one to file the complaint, unless the mother is the abusive parent who is falsely blaming the father for the abuse....

I think you're getting way ahead of yourself here. (Also note that "standing" isn't required to register a complaint with the
Medical Board of California.)

I hate to take pleasure in another human being's misfortune, however richly deserved, but it's deeply satisfying to see Dr. Bob (potentially) brought down by his own greed and hubris in true comic book super-villian fashion.

Her description included, “shut down stools and urine” for 24 hours with 2 month vaccines and limp “like a ragdoll” lasting 24 hours and not himself for up to a week after 3 month vaccines.

This is so typical of the "vaccine injury" stories we see all the time that sometimes I wonder if they're read from a script. The parent describes what sounds like a pretty run-of-the-mill post-vax malaise which a) apparently wasn't severe enough to take the kid to a doctor, since there's no medical record, and b) didn't stop the parent from taking the kid back in for more shots a month later, but which now, years later and under the influence of the anti-vax movement, has morphed into vaccine-induced encephalitis and multiple organ failure. I mean, I get that even a mild vaccine reaction can be scary for a new parent, but in all the research they claim they've done they somehow missed the fact that vaccines work by inducing an immune response and that mild flu-like symptoms are a totally normal part of that? So much so, in fact, that I've often wondered if there's any correlation between mild vaccine reactions and efficacy.

“State Medical Board’s Balls Finally Drop” – every pediatrics newsletter. Fingers crossed.

FYI, Dr. Bob has appealed to his fans.

Last week you mentioned Sears when you reported on the AAP getting tougher on vaccine exemptions, which analyzed the American Academy of Pediatrics (AAP) position paper on vaccine hesitancy and refusal. Near the end of the your article you state:

One thing that’s missing from the AAP statement is a discussion of pediatricians who promote antivaccine misinformation, such as “Dr. Bob” Sears, who not only promotes antivaccine pseudoscience but is basically selling highly dubious medical exemptions online to help parents get around SB 277. The AAP needs to come out forcefully to condemn such physicians in no uncertain terms and then to take action to show that their words are more than just words. That action would be to expel such pediatricians from their organization.

It's no surprise I, too, want FAAP Sears (along with fellow FAAPs Jay Gordon and (most recently) Paul Thomas) expelled from the AAP for their anti-vaccinationism. Well, that AAP position paper has a comments section, and I submitted this comment.

Here is the AAP's response from Mark Neuman, MD, MPH, an assistant editor at Pediatrics and also an associate professor in pediatric emergency medicine at Boston Children's Hospital:

Dear Dr. Hickie.

Thank you for your comment submission to Pediatrics.

We cannot post the comment as written, but would consider re-reviewing if you tone down the rhetoric. Specifically, would help if you could broaden the scope to address anti-vaccine pediatricians (rather than solely addressing Dr. Sears).

If you would like to submit a new version, we would be happy to review it again. This link provides the author instructions: http://www.aappublications.org/content/pediatrics-author-guidelines#rea…

Please note: Resubmission of your comment should again be done online, not as a reply to this email.

Sincerely,

Mark Neuman MD MPH
Assistant Editor, Pediatrics

Given what I've stated is fact regarding Sears, I'm not sure what rhetoric needs toning down. Again, just how damned dangerous does Sears have to be before the AAP will address him (even now he is rallying his Luddite minions on his Facebook page by posting on this Medical Board Complaint)? Can Sears only be criticized once by the AAP and then only not directly by the AAP but via the Offit/Moser paper from 2009? I'm glad to see the Medical Board of California is now seriously taking Sears to task, but the AAP still is full of AAPathy with respect to combatting anti-vaccinationism, which is a damn shame.

Well, they did say "broaden it"--maybe start by saying "anti-vaccine physicians such as Dr. Bob Sears" instead of just naming him. The only toning down I can think of offhand would be that they may be unhappy about the word "disgraceful." How would "clear" or "major deviation from the standard of medical care" do? And maybe "This disregard for public health was borne out..." instead of "this is a disgraceful disregard..."

What is particularly troubling about the complaint is the suggestion that treatment must be tailored not just for the best interests of the patient, but for the best interests of the patient's 'future contacts'--i.e., others.

The vaccine exemption is not the least bit concerning. The parent reported the previous adverse vaccine reactions, and apparently wanted the exemption, having decided not to consent to further vaccinations.

It's interesting that a doctor with such a moderately 'noncompliant' stance regarding vaccine doctrine would be targeted. It wouldn't be surprising to learn that the underlying impetus is a contentious divorce or custody battle.

His appeals to his fan base will no doubt frame this as persecution due to his anti vaccine stance.
This is not a vaccination issue.
One (very) simple version of events is that, he can give a medical exemption if he follows a certain process.
He didn't do so.

If he prescribed medicine x to someone under 10 years old and the protocol said "not to be given to under 10s" then the resulting consequence should be the same.

Also note that “standing” isn’t required to register a complaint with the
Medical Board of California.

Maybe "standing" isn't the right word (IANAL, nor am I a resident of California). But because of HIPAA, there aren't many people who could legally have known enough about J.G.'s medical history to file this complaint. The parents or legal guardians, of course. If J.G. were later seen by another physician, this physician would have a legitimate need to know the medical history--there isn't enough information to determine whether this other physician, if he exists, was the guy who called CPS's attention to the case or whether he was brought in by CPS (in the latter case, the doctor would have known to look for such things). Alternatively, there might be a whistleblower in Dr. Bob's office. The CPS case manager (whatever the correct title is) would have legitimate reason to know. The other possibility is that if there is a custody battle in progress and a legal representative for the child has been appointed, this representative might be considered a guardian for HIPAA purposes.

The point is that the complainant has to have known of J.G.'s previously being a patient of Dr. Bob, and that the complainant must have had some reason to look at the details of that relationship. There is no upside for either parent to have done this, unless one is defending against the other's false accusations of child abuse: it is generally known that convicted child abusers are regarded by other prison inmates as the lowest of the low and are treated accordingly. A whistleblower would probably complain about other cases, not just J.G.'s. That leaves either CPS or a custody battle, and if CPS were not involved prior to the custody battle, they almost certainly are now.

You misrepresent information so effortlessly, it is really something to behold. You make baseless claims but then include a link which is supposed to give the appearance of substantiating your claim. Example, you cite yourself (what a surprise!) in your claim "Given Dr. Bob’s history of ... and even outright selling nonmedical exemptions". Well I read your blog entry you cite, and nowhere in it do you provide ANY shred of evidence that Dr. Sears or anyone else is "selling nonmedical exemptions".

So shame on you.

As for this current "scandal", is it or is not not within the medical doctor's discretion whether or not to grant a medical exemption? While Pan and Allen were pushing for SB277 they argued repeatedly, in order to assuage concerns from lawmakers and opponents of the bill, that yes, indeed, doctors will be able to use their own medical judgement when deciding whether or not to grant medical exemptions in order to protect children who may be at an increased risk of injury from vaccination. But then what happened once this bill was passed? In some counties the health agencies decided they would scrutinize all medical exemptions, as if they have the expertise and the right to do so.

And what is happening now? Even you admit that the Medical Board is likely trying to make an example of Dr. Sears. Like others who have come before him, Dr. Sears in this case is only guilty of one thing...listening to a parent who is trying to protect their child.

David Foster @29: You seem to be under the impression that there are no standards in medicine. Yes, Dr. Sears was allowed to make a vaccine exemption, but only after taking a fully history. He did not do that, so his vaccine exemption is in error.

When a patient presents with head pain and a history of injury to the head, the standard of medical care says that the doctor performs a neurological exam. Dr. Sears failed to do that in the case of this patient.
Dr. Sears is in trouble with the board for doing his job wrong.

Frankly, any pediatrician who fails to do basic checks on a child with a head injury inflicted by a parent is in dereliction of their oaths as a doctor and a mandated reporter.

David Foster @29: "Doctor Bob" clearly should have examined contemporaneous records rather than rely on parental report. If the Wakefield debacle isn't enough to convince you, consider the discrepancy between parental report and medical records in this case:

BS Hooker said this of his son in "Vaxxed: “Two weeks after his 15 month vaccines, then he lost all language. He lost all eye contact. You would pick him up and he would just hang limp.” However, the public documents from Hooker’s failed suit in “Vaccine Court” stand in marked contrast: the records and make it clear that nineteen days following receipt of those vaccines the Hookers took their child to the pediatrician because of concern that the scheduled surgical placement of "ear tubes" might have to be delayed because the Hookers suspected that he had an ear infection. They did not mention that he had "lost all contact” or “lost all language” or that “he would just hang limp.” The medical records clearly note that other than low-grade fever and symptoms of a cold, “no other recent symptoms were noted.” No other symptoms, such as no signs that "he would just hang limp," etc.

Should "Doctor Bob" grant Hooker's son a life-long medical exemption from vaccination based on what he says and perhaps mistakenly believes?

Mr. Foster, the report said the child had been hit by a hammer by the father. That is very serious, and should have been followed up.

You do understand that hitting a toddler with a hammer is not healthy for the child. It is right up there with making sure the kid gets chicken pox and other vaccine preventable diseases.

Let me get this right....You want to get rid of a doctor because he is looking out for the best interest of his patient.... a patient that had a bad reaction to a vaccine... and you assholes want to give the kid a vaccine again??? WTF is wrong with you people. You're a bunch of sick, satanic assholes.

No. I can't speak for others, but before a doctor decides a child doesn't get protected from disease, I want him to actually have a basis.

A diagnosis of encephalitis based on nothing, no tests or records, isn't such a basis, nor are the other claims by the mother.

I would also like a doctor faced with a two year old whose dad took a hammer to his head, according to the mom, to test and make sure the child is okay.

When a doctor fails a child multiple times like this, I'm glad to see the board step up.

Let's put aside the vaccine exemption for a moment. You have no criticism for a doctor that apparently doesn't check up on a two year old that, he heard, got a hammer to the head?

I wonder how many people on the California Board of Medicine have ties to Merck?

I wonder how many people on the California Board of Medicine have ties to Merck?

Why don't you check?

^ Here, given that there's no such thing as the "California Board of Medicine," I'll help get you started: Correlate this with this.

I haven't looked, so there's no telling from my perspective.

My hypotheses: Dad never hit J. G. with hammer. Sears didn't order a neuro exam or file a CPS report because it there was no evidence J. G. had been struck with a blunt object and suffered a concussion, and he did not believe Mom's story. Dad is the source for the Board. He's suing for custody of J. G., Dr. Bob has been supporting Mom in the litigation, and Dad wants him discredited (probably with good justification).

Rationale:
1) A two-year-old struck in the head with a hammer would more likely be dead than suffering a headache.
2) The complaint reads "leaving both patient J.G, the patient’s mother, and his future contacts at risk for preventable and communicable diseases." The absence of Dad from this language suggests Dad is no longer in contact with J. G., Mom currently having sole custody.
3) The complaint notes Sears first saw J. G. for a "two year", 10 days before he drafted the letter supporting the medical exemption. Thus Dr. Bob was not the physician who administered the immunizations, and would have noted any reactions. This suggests Mom went exemption-shopping when she couldn't get what she wanted from J. G.'s previous pediatrician, who may have known there was no serious adverse reaction to report. The doctor switch may also have been related to the parents' separation and custody struggle, i.e. Dad wanted the kid to see the legit doctor.

Analysis: If I'm right, and Sears has to defend himself on the 'hammer' thing by saying he didn't believe Mom's crazy account of J. G.'s headache, he's screwed on taking Mom's word for J. G.'s 'adverse vaccine reactions' and approving a medical exemption w/o getting medical documentation of what vaccines J.G. had received and his reactions to them.

Since the link above now returns a 404 error, here's the exact language from the complaint about the hammer:

On June 23, 2014, patient J.G. presented to Respondent with a chief complaint of headache with a history of patient being "hit on head with hammer" by Dad two weeks prior to the visit. A mention is made of a split lip prior to hammer incident without any additional history. A physical examination indicates, "no residual marks now." No additional physical exam including neurological testing, was performed and no assessment with plans was recorded...
Respondent departed from the standard of care by failing to conduct neurological testing as part of the physical examination of patient J.G. on June 23, 2014, when he presented to Respondent with complaints of headache, following head trauma...
Respondent failed to maintain adequate and accurate records related to the care and treatment of patient J.G. Specifically, he failed to document an adequate physical examination of the patient on his visit of April 23, 2014, and merely wrote, "no residual marks."

A two-year-old struck in the head with a hammer would more likely be dead than suffering a headache.

Your rationale falls apart right there, because this is not true. You seem to be assuming that the dad swung the hammer with all his might, when it is rare for a parent to do something like that unless it's one of those rare parents who is striking with lethal intent. More commonly, such injuries are due to the adult wanting to "teach the kid a lesson."

Finally, even if Sears didn't believe the story, the very fact that the mother reported it absolutely mandates a careful neurologic examination of the child, which Dr. Bob did not do. Now, maybe he did do it and didn't document it, but in medical law if it isn't documented it wasn't done.

Also, it is very risky for a mandated reporter, like a pediatrician, to dismiss a story stating that a child was hit in the head with a hammer that has even a germ of credibility. If a mandated reporter turns out to be wrong in not believing the story, he would be putting himself in grave legal jeopardy. It's far safer to let CPS look into it.

I do agree, though, that it is very likely that there very likely is divorce and/or child custody litigation going on, with Dr. Bob being the preferred pediatrician of the mother. Also, your speculation that the mother switched doctors because the original pediatrician wouldn't go along wither her desire not to vaccinate and picked Dr. Bob instead is plausible.

You seem to be assuming that the dad swung the hammer with all his might

I'm just coming to from another wretched postprandial nap-like experience, but in the complaint, is this anything more than "some sort of hammery object held by father somehow came into contact with child's head"?

Lower case brian is making a lot more sense than capitalized Brian.

Good thing I saved the PDF, as the Medical Board appears to have removed the complaint from its website.

It's all very vague. At the visit the chief complaint is reported as headache, with a history of being "hit on head with hammer" by Dad two weeks prior to visit. That's all the description.

@Eric Lund:

Omitting the prison talk:

The point is that the complainant has to have known of J.G.’s previously being a patient of Dr. Bob, and that the complainant must have had some reason to look at the details of that relationship.

Yah, OK, but I don't know what sort of investigatory powers the MBC has, and it could have been a next friend, etc. It just strikes me as quite premature to be playing Professor Plum with a candlestick in the billiard room.

Prof. Reiss:

Dr. Bob did put "An Emergency Response Notice of Referral Disposition dated June 25, 2014 with "Allegations cannot be substantiated - case closed" outcome" iin J. G.'s chart.

So the question for 'Brian' should probably be, 'You have no criticism for a doctor so credulous or unethical that when his client explained her two-year-old's routine headache as the result of being hit "on head with hammer" by Dad, despite physical evidence that this allegation was a fabulation, he wrote that this actually occurred in his records anyway?"

I don't a good basis here to be confident it isn't true, and I don't see the doctors, who actually have expertise in this, saying that.

As Narad pointed out, I don't know that we have enough to reach any conclusions on who complained. I think he made a strong point on that.

"Don't see."

Well, rats.

My sister from CA is visiting next week, and my plan was to recruit her in my quest to get a vaccine exemption for my neighbors dog (I was going to use her mailing address).

Now I'll need to wait and try after Sears (hopefully doesn't) "survives".

Brian: "…. a patient that had a bad reaction to a vaccine"

How do you know that? That paperwork seems to not exist. Quoting from the quoted part in the article:

"The documents say Sears failed to obtain a detailed medical history documenting the unidentified boy’s prior vaccines and reactions, ..."

and: "Respondent for what medical records describe as a “two year.” The visit of this date includes a summary of the patient’s history with a brief description of J.G.’s prior vaccination reaction, as described by the patient’s mother."

Apparently there were no medical records of that dire reaction. If anything Sears is being disciplined for very lousy record keeping, especially of a child with severe neurological impacts.

Those records are extremely important if that child needs special education supports and to qualify for disability services. My son's seizures and developmental history have been well documented, which have been crucial in getting him the services he needs.

It is almost a criminal act if Dr. Sears lazy record keeping prevents that child getting services (which are not easy to apply for).

@ Orac #40:

I ran all the scenarios I could imagine of “some sort of hammery object held by father somehow came into contact with child’s head” through my head, and didn't come up with anything plausible. I can't imagine an adult wanting to “teach the kid a lesson” doing so with a hammer, as the it would take a fine touch to separate punitive force from seriously injurious force, and so many less dangerous 'educational instruments' would be available.

So, yeah, if a parent waits two weeks after a concussion to take a toddler to a doctor, and then the kid shows no evidence whatsoever of his headache having been caused by blunt force trauma, I think a mandated reporter might conclude Mom's story didn't have even a germ of credibility. Or, more to the point of AV wacky, since Dr. Bob actually listened to Mom's explanation, he may have recognized verbal and non-verbal cues indicating the story was, uhhh, the ravings of a nut-job, or something like that...

Ah, but he did place "An Emergency Response Notice of Referral Disposition" in the chart. When I first read the complaint, I wasn't clear on what that meant and it was late and I was tired, but it now looks to me as though he did file a report to CPS and that the allegations could not be substantiated. (I might even go back and make a note to that effect in the post itself.) My interpretation now is that Dr. Bob did think enough of the story to report it to CPS, which makes his failure to do a good neurological examination on JG just as egregious as I described it and just as much sloppy doctoring as I described it.

Two weeks is long enough for a bump on the head to subside, and you don't have to have a fracture to have a significant closed head injury, such as a concussion or subarachnoid hemorrhage.

@ Chris #49

Dr. Bob wasn't J. G.'s pediatrician when J. G. got the shots, so that's not his record-keeping problem. I read the complaint as asserting Sears issued the medical exemption solely on Mom's account, without obtaining J. G.'s records from J. G.'s prior pediatrician. My hypothesis would be that Dr. Bob didn't request the records because he suspected Mom's descriptions of "shut down stools and urine" for 24 hours after 2 month vaccines and limp "like a ragdoll" for 24 hours after 3 month vaccines were fabula the records would not support, and knowing what the records would say he could not write the exemption letter Mom desired (and was paying cash for...).

Good thing I saved the PDF, as the Medical Board appears to have removed the complaint from its website.

It's still there, wrapped in a crappy interface: In my case, enter license number 60936 here, click on the row itself, and rename 'document.aspx' to 'something.pdf'.

^ "downloaded 'document.aspx'." YMMV.

@Orac

It looks like the full complaint is still available. When I went to the Medical Board of California, clicked on Public Documents, and then Enforcement Public Document Search, I was able to find the complaint by searching on Dr. Sears' name.

Better to go after Sears for this shoddy medical care than the egregious web exemptions. Why?

Watch out Jay Gordon.

@ Orac and Prof. Reiss:

My hypotheses are just that, not conclusions made with any confidence. I certainly don't dismiss the possibility that the presentation of J. G. and Mom's story did warrant a neuro exam, or that someone other than Dad contacted the Board.

As for the "Emergency Response Notice of Referral Disposition”, I'd guess Sears felt obligated to file something regardless of how credible he found Mom's tale. Since that notice is dated 6/25/14 and the office visit was two days prior, I'd guess Dr. Bob was able to to make enough inquiries with J. G., Mom, and maybe third parties such that, along with his physical exam of J. G., allowed him to rule out significant closed head injury and conclude "Allegations cannot be substantiated", to put it mildly. Regardless, I'd think he failed his de facto (if not de jure) responsibility by failing to document how and why he concluded the "allegations cannot be substantiated" beyond the initial note of "no residual marks now." My hypothesis (just a guess, now) would be that he chose not to explain because it would have looked bad for Mom, who he was attempting to 'serve' and cultivate as an ongoing cash-paying client.

@Madison MD #56: Somehow in 2006 Gordon escaped losing his license when he failed to test a child for HIV who had an HIV-positive mother as well as the patient herself having failure to thrive and a persistent cough. The child died shortly thereafter. You can read about it here: https://en.wikipedia.org/wiki/Eliza_Jane_Scovill?wprov=sfla1 .

Its shameful that apparently nothing happened to Gordon over this.

Before my head explodes, does anyone know offhand whether § 2227(b) of the California Business & Professions Code is necessary for making the document public? (Yah, yah, I just wanted to write it down before I forgot.)

I OCRed the Sears complaint so you don't have to search the Board site for it, and can cut-and-paste:
https://www.dropbox.com/s/g5our6u2lh5aeh8/sears_complaint.rtf?dl=0

sadmar: "Dr. Bob wasn’t J. G.’s pediatrician when J. G. got the shots, so that’s not his record-keeping problem. I read the complaint as asserting Sears issued the medical exemption solely on Mom’s account, without obtaining J. G.’s records from J. G.’s prior pediatrician"

This is where it is a problem. The follow up physician needs to get the records from the previous physician. This has been easily done for both of my son's neurologists and cardiologists to our family physician.

If Dr. Sears could not get those records, he needed to record that. As it is.. a letter he wrote in 2014 is missing. He has failed to keep on top of basic record keeping. Very important record keeping.

This may be because he hired a totally incompetent office manager. But even if he hired the best one, they cannot work unless he directs them to contact the previous doctor.

By the way, I was given copies of much of this paper work. Which I kept. It has been scanned and converted to easily transferred PDFs. While I can fault the mother for not keeping stuff... she should have been able to get records from the medical clinics. Something I have also done from two different medical entities at the request of the Mayo Clinic prior to my son's open heart surgery.

Seriously, I know the drill.

Those records are important. It is why the Mayo Clinic sent a fellow pretty much running across Rochester, MN to St. Mary's Hospital to stop the cardiac MRI my son just as he was finished getting prepped. Apparently they had just reviewed the cardiac MRI from our local university hospital and deemed it sufficient.

Sending them those medical records by the most expensive registered mail available was worth it to save both the health insurance company several thousands of dollars and my son from spending any more time in one of those very noisy claustrophobic machines. I have some very special comments on the Mayo Clinic policy of "waiting until the lasts minute" to deal with previous medical records. (I decided to walk the halls of that rather historic hospital while son was getting prepped, and then I got a frantic call on my phone, so I returned to the MRI waiting area to speak to a very out of breath medical fellow... who told me that my son who was prepped/gowned and ready to go did not have to get that particular MRI).

Did anyone mention that Sears was getting trouble mostly because of his crappy records management? Only someone who has never had any complicated medical issues would think that is trivial. It is not.

And now, here's what happens when a state medical board abdicates it's sworn duty (despite 38 complaints against this quack): Jack Wolfson, DO, FACC is now making a movie to presumably show how amazing he was back last year when he said children need to get measles, mumps and chicken pox and also said that he wouldn't feel bad if his unvaccinated child gave a fatal VPD to an immune compromised child.
https://www.facebook.com/creativedoorway/photos/a.360170897472953.10737….

The local CBS radio news station had a brief story on the Sears investigation this evening (Friday), including mentioning him by name. They didn't provide a response from either Sears or his representative. I would guess that this is the first time that most listeners have ever heard of him.

Competent Medical Professionals never said that patients won't die from vaccines, they likely will. We have merely stated that by receiving the vaccine we are reducing the risk of death at least ten-fold. The state medical board California Medical Board did their job and it made national news. However, in reference to other state medical boards such as Missouri, the past is prologue http://dx.doi.org/10.4172/2375-4273.1000155 - a history of repeatedly misrepresenting evidence.

Just clarify for those commenting about Dr. Sears giving an ME with just an online questionnaire and a fee without an exam is completely false.

And you would know this exactly...how?

Before you answer, read this:

"Did anyone mention that Sears was getting trouble mostly because of his crappy records management?"

For the medical professionals in the house -- would Sears' casual attitude towards records keeping be due in part to his not accepting insurance? I can't see any insurance carrier putting up with a practitioner who didn't dot all the i's and cross all the t's.

@ Shay #67--not necessarily. Sears probably takes cash-only so he doesn't have to deal with the hassles of getting paid by insurance companies (and it is a hassle). It also gives him a faux air of "I'm too good for insurance companies" that a lot of "holistic" quack doctors have (though depending on what "therapies" they offer, insurances might not credential them anyhow. Also, as I've said, Sears may not even carry medical malpractice insurance (which insurances require but the State of California does not) which would save him 20-30K a year. But as a licensed physician, regardless of his practice model, Sears is required to keep adequate patient notes and also be competent in his skills--that is what has him in hot water right now. Also of interest (to me at least) is that the pictures of Sears in the last few years in his office show lots of paper charts--indicative to me that he isn't even technologically adept enough to go to electronic records--but hey, what do you expect from a doctor who practices like vaccines don't matter?

Dr Hickie -- thanks. My experience was in public health, and I didn't work on the clinical side.

For the medical professionals in the house — would Sears’ casual attitude towards records keeping be due in part to his not accepting insurance? I can’t see any insurance carrier putting up with a practitioner who didn’t dot all the i’s and cross all the t’s.

I think it could indeed be in part due to his not accepting insurance. For one thing, insurance companies will require CPT codes and now ICD-10 codes for billing, and those have to be documented. An EMR makes that easier. Basically, Sears' record-keeping strikes me as very, very old school, back from the 1970s, before managed care and before DRGs, when scribbled notes without a lot of detail could be adequate. In 2016, such record keeping won't fly any more. It's considered grossly inadequate.

#64 Brett Snodgrass
Everytime you post, I see dead people. Why is that?

Isn't it odd to use a photo of a dead guy as your avatar?

One thing I'm unclear about is how Sears didn't see this coming 10 miles away. Did he think the medical board would never act? I seem to recall that he wrote somewhere (can't remember where) that he had insiders in the CA medical board telling him he was safe from discipline. What changed?

I mean, he must be provoking the ire of other physicians than Chris Hickie. If I practiced in OC and he gave one of my patients a med exemption for flimsy or fabricated reasons, I would discharge the family from my practice and report him to the medical board.

#71

Isn’t it odd to use a photo of a dead guy as your avatar?

I use a picture of a (now) dead cat as my avatar.

@Shay Simmons #69, I was military and we never dealt with insurance companies, but we had to keep accurate records.
Detailed as possible, if it wasn't documented, it never happened kind of documentation and an error in documentation may well be the difference between a service member receiving a VA disability rating and not receiving one that they earned the hard way.
Now, we didn't have ICD codes to contend with or CPT codes, especially in the field and field clinics (such as a battalion aid station), but we were required to utilize standardized terminology, standardized drug names and a baseline physiological measurement of "WNL" didn't mean Within Normal Limits, it meant "We Never Looked" and was actionable on a disciplinary level.
I'd feel badly enough to fail so badly as to be castigated by the physician, I'd feel far worse if our patient's care suffered or worse, a patient got screwed out of his deserved VA care and disability.

Interestingly, when that was explained to even our lowest Private, fresh out of Fort Sam, they instantly grasped the importance of those records.
Guess who became the resident medical encyclopedia and dictionary? I didn't have a problem with that, as that turned into training sessions.
Which were then documented, satisfying command that no matter where we were, we were training.

As for neurological examination after a blunt trauma to the head, we had a soldier fall from the back of a 5 ton cargo truck (we use the trucks to carry either cargo or personnel, but both should never be carried at the same time for safet reasons). Several days later, he complained of blurring vision, all sign of his fall already being healed. While we were examining him, his speech began to slur.
We arranged immediate evacuation to a local civilian medical center with significant diffuse edema of his brain and a modest bleed. He arrived at the local trauma center unconscious, unresponsive to painful stimuli.
After treatment, he returned to duty uneventfully, several months later.
Had we did the Bob Sears number, he'd have expired.
His prior complaint before the blurring vision? Headaches, which weren't reported to us at the time, but cropped up during the history.

#73 Is the photo taken from the obits page of an online paper?
Most people photos I've seen are understood to be the poster.

I have the impression that Brett is using it to imply a gravitas that he may feel is lacking in his own photo. But perhaps Brett could explain better...

Dr. Hickie,

That Wolfson film is no more a documentary than any of Eric Merola's informercials for Burzynski.

I spent some time at the production company Creative Doorway's website. They're a branding outfit that churns out marketing films for clients, from storyboard to final print. So essentially "The Drs. Wolfson" (a brand they've set up with dozens of products to sell) commissioned this production house to make a commercial for their brand.

At least the company is honest about they do:

"Creative Doorway is a creative marketing company that specializes in innovative brand image fabrication. With a skilled team designed to devise the ideal package for company and or personal branding uniqueness."

Unlike Merola, Wakefield and many others, they admit this is nothing more than a commercial.

The same company is also doing a marketing film for a stem cell clinic.

I doubt if "Wide Awake" will be an Academy Award nominee next year.

Wiz, I was military too. If it wasn't written down, it didn't happen.

#75

#73 Is the photo taken from the obits page of an online paper?
Most people photos I’ve seen are understood to be the poster.
I have the impression that Brett is using it to imply a gravitas that he may feel is lacking in his own photo. But perhaps Brett could explain better…

You may assume that. I don't. But I also don't make assumptions about people's character based on their avatars.

Hmm. Perhaps Bob Sears could have saved that child from abuse if he had reported the incidents, but he did save some face by exempting a child from aluminum poisoning and a possible cytokine storm.

So all in all, Bob Sears is aboutpar for the course.

Even with a full diagnostic up and notification to authorities, "saving" a kid from abuse can be a complete fantasy regardless.

TOTALLY off topic and I'm sorry. I'm writing a paper and because of a username fluke I can't get in to my university library database. Can someone with a JAMA account download this article for me?

If you reply that you've got it I'll figure out how to get you my email.

Thinking and Depression
I. Idiosyncratic Content and Cognitive Distortions
AARON T. BECK, MD
Arch Gen Psychiatry. 1963;9(4):324-333. doi:10.1001/archpsyc.1963.01720160014002

PS: I'm a mandatory reporter and small child + head + hammer + intimations of purposeful nature of injury? Report!

Sadmar #50:

"I ran all the scenarios I could imagine of “some sort of hammery object held by father somehow came into contact with child’s head” through my head, and didn’t come up with anything plausible."

Beware the argument from personal incredulity. Because one person can't imagine a particular scenario doesn't mean reality can't make it happen. People are weird. Some of them are clumsy. Some of them are evil. And then there are those who are evil but manage to persuade themselves that they're doing good.

I ran all the scenarios I could imagine of “some sort of hammery object held by father somehow came into contact with child’s head” through my head, and didn’t come up with anything plausible.

That's nice. Have you done trauma before? Would you like to hear some of my old war stories from back when I was a resident and my early years as an attending, about the crazy ways people got injured or escaped serious injury? It could well be that the story about the hammer was the mother lying, but it could also be that the story happened as related. When it's a child and you're the mandated reporter, you have to err on the side of believing the story.

Seriously, though. The argument from personal incredulity is a major logical fallacy, particularly when you don't have the background to know what is and isn't possible or likely.

Despite the alarming title, here's a good (and relevant) op-ed from a pediatric specialist:

http://www.dispatch.com/content/stories/science/2016/09/11/pediatric-re…

@DB #84, I am onboard with the good doctor for testing the Zika virus vaccine as well.
This area is lousy with aedes aegypti, the heat index today will be 105 and there's a storm drainage "bayou" full of stagnant water behind my garage. It's quite probable that the virus will become endemic here soon.
Annoyingly, that specific species of mosquito seems to find me irresistible, regardless of what precautions I've taken.
While, Zika infection wouldn't be much of a hazard to me, it'd be nice to help render others immune via testing any candidate vaccine.

I also don’t make assumptions about people’s character based on their avatars.

The presence of a Gravatar is a bit telling, though, as the f*cking thing will record your traffic on any Gravatar-enabled site whether or not you've signed up, last I checked.

I just block it entirely.

@Vicki #25 (regarding my comment @ #24): Having revised my comment to (hopefully) meet AAP suggestions, I now find that the ability to submit comments for the "Countering Vaccine Hesitancy" ( at http://pediatrics.aappublications.org/content/early/2016/08/25/peds.201… ) is not allowed (checked across 2 computers and 3 web browsers).

I do hope they haven't squelched discussion on this.

Sadmar:

I ran all the scenarios I could imagine of “some sort of hammery object held by father somehow came into contact with child’s head” through my head, and didn’t come up with anything plausible.

The first thought that I came up with is this: father's doing some home repair, child happens to be in the area, father loses his grip on the hammer while on the upswing, hammer arcs across the room and delivers a glancing blow to the child's head.

Now, it's *plausible* that in such a scenario, if this is how it was presented to Dr Sears, that Sears thought it clearly didn't require reporting as it wasn't intentional. But he would be wrong, because he can't assume it was intentional, and because there's an implication of negligence. You probably shouldn't be swinging hammers around small children, after all, even when your only intended target is a nail, and CPS would, at minimum, give him a lecture to that effect.

Less pleasant scenario that next popped into my head: father was angry at child, and gave a swat with the hand that was holding the hammer, intending to inflict pain but not maim. Or, it may not have been an ordinary hammer. Perhaps it was a plastic toy hammer. Not all hammers are lethal weapons. I could see that as well -- father gets upset after tripping over child's toys, and in a rage throws a toy at the child. Toy happens to be a lightweight plastic toy hammer. Again, still deserves followup.

I don't know much about this doctor, but the vaccine rabid folk in the comments is what sounds crazy. Parents have had the right to choose to opt out for personal beliefs for decades and the sky wasn't falling. It's a shame to see the witch hunt nature this subject has taken on. It's got to be more complicated than black & white stance purported and to not welcome thoughtful conversation about possibilities on both sides seems like dictator science. Scientific "fact" always evolves and medical practice is just that.

Ah, it's a witch hunt because doctor failed to keep accurate and detailed medical records about a child's blow to the head with a hammer!

As for rights, when the exercise of your rights endangers the fundamental and inalienable right to life of another, controversy ensues and government must needs become involved, lest lawless action then follow.
Under our current understanding of our Constitution and rights, we have the right to keep and bear arms. But, we do not have the right to carelessly shoot in the direction of a neighbor's home.
Meanwhile, one parent not vaccinating endangers children on chemotherapy, those with immune deficiencies and those too young to be immunized, they're shooting in the direction of neighbor's homes. All, while whining about their rights, to hell with the right to life that is inalienable of others. Now, your homework, look up the word inalienable.

#88, How about this as a plausible scenario (purely speculative of cause):

Maybe the hammer in question isn't one you'll find in a toolbox, but rather the type of hammer (wooden mallet) you could find in a kids room. Like this one: http://i.imgur.com/RnYk0xk.jpg

If that's the case, then it wouldn't be out-of-place in a kids room. And I could imagine at least one way the father could accidentally drop it onto the kid. (father takes something of a shelf with kids toys, he doesn't notice the hammer, and accidentally drags it off the shelf and it ends up hitting the kid)

Parents have had the right to choose to opt out for personal beliefs for decades and the sky wasn’t falling. It’s a shame to see the witch hunt nature this subject has taken on.

Oh for crying out loud; this isn't a "witch hunt" and it's not about vaccine exemptions. Did you even bother to read the post and look at the supporting materials? Bob Sears grossly mishandled at least one case and I have no doubt many more will be found. It's about medical negligence not your stupid "choice" whingeing.

@Joan Friedman

It’s got to be more complicated than black & white stance purported and to not welcome thoughtful conversation about possibilities on both sides seems like dictator science.

I welcome thoughtful conversation. So, let's talk. First, have you read the entire complaint against Dr. Sears? If so, are there any parts of it where you find his behavior and actions do not warrant concern or action by the board? Why do you believe so? If you have not read the complaint, why are you castigating people for their criticism of Dr. Sears without knowing the details?

Extraordinary gall displayed here by Orac.
Gorski should be the last person allowed to pass judgment on another Dr.

http://www.truthwiki.org/orac-david-h-gorski/

http://www.ageofautism.com/2010/06/david-gorskis-financial-pharma-ties-…

Those in glasshouses.

@Peter Harris, people in grass houses shouldn't smoke bones.
http://rationalwiki.org/wiki/David_Gorski
http://rationalwiki.org/wiki/Age_of_Autism

To use the more generous Wiki out there. There's another one who's far more scathing of AoA.

Here's hoping that next the California Medical Board closely scrutinizes Dr. Jay's medical exemptions to see whether they meet the standard of care.

Trolls who live under bridges should rely on conspiracy websites and blatantly biased sources, if they don't want to get laughed at....

Trolls who live under bridges shouldn't rely on conspiracy websites and blatantly biased sources, if they don't want to get laughed at....

Argh....we need a preview pane.

@Lawrence, I hate when I get up in the morning and find someone scrambled my keycaps!
Worse, when they scramble my fingers... ;)

OK, I'm not worth much before my third cup of coffee. :/

@Peter Harris, around here, Age of Autism is known as the "Clown Blog" and with good reason. Relying on it as a source will just get you laughed at.

@Julian Frost, but nowhere laughed at as hard as as when one uses whale dot to as a reference. :D

Those leave me full of mirth for days.

Awwww....c'mon, guys! You're being mean and keeping Peter Harris from quoting his favorite reading materials! I bet you frown on articles from Natural News, too! Meanies!

I still think it's hysterical that Peter won't engage with ME. But that just shows he's a coward who wants to boast about his credentials but can't face people with those as good or better than his.

@ Peter Harris, impressive sources what? No whale.to? I have no doubt the quality of your "research" is reflected in your "practice".

"vaccine rabid folk"

"thoughtful conversation"

Sorry Joan, these phrases are mutually exclusive. You need to up your game when it comes to concern trolling.

Those in glasshouses.
...are probably using them to grow whacky-bacy.

...around here, Age of Autism is known as the “Clown Blog” and with good reason. Relying on it as a source will just get you laughed at.

Not to mention truthwiki.

"Julian Frost

Gauteng East Rand
September 13, 2016
@Peter Harris, around here, Age of Autism is known as the “Clown Blog” and with good reason. Relying on it as a source will just get you laughed at."

roflmfao.

Hey Julian, this could be the funniest piece of sanctimonious hypocrisy I've heard in a long time.
Next time you shoot yourself in the foot, best you use an air rifle.

And to the other head wobblers here, if the accusations in those links were wrong, then it wouldn't be difficult to refute them, right?
So attacking me, because I posted those links, is no defence of the accusations in those links.

As i said before, there are not many sharp tools in the shed.

Burzinski's lawyer is going to be representing Sears. He wrote a press release about the case.

http://rickjaffeesq.com/2016/09/13/press-release-re-dr-bob-sears-case-c…

“I represent Dr. Bob Sears in the California Medical Board’s case against him for writing a medical exemption from vaccination.

We take the board’s accusation seriously. But this case is very clear: this child had two unusual and severe vaccine reactions and his situation warranted a medical exemption. To continue vaccination could have put the child at risk of further harm.

All physicians have an ethical duty to do no harm to a patient. This is no less true when a child suffers serious side effects from any medical intervention.

We anticipate this case will do much to further public education on the importance of recognizing severe vaccine reactions and providing informed consent for medical care. ”

Rick Jaffe

let the education process begin! community support appreciated.
rj"

Pete, my boy: most of the links you posted have already been refuted on this very blog. It appears that you just aren't smart enough to pick up on that.

Speaking of self- inflicted wounds, your performance here reminds me of my favorite Molly Ivins quote: "We have all seen a man trip over his pecker. But it is truly rare to see one stomp it into the dirt."

And to the other head wobblers here, if the accusations in those links were wrong, then it wouldn’t be difficult to refute them, right?

They are wrong and have been refuted. Why don't you put that massive intellect of yours to good use and do a search using the box at the top of the page instead of vomiting up the detritus of Age of Arṡeholes and Mikey Adams. It's not like they don't have an axe to grind or something.

“I represent Dr. Bob Sears in the California Medical Board’s case against him for writing a medical exemption from vaccination."

Well he's not off to a good start if he thinks it's about writing a medical exemption. Unless he's just appealing to Sears' fan base.

"Pete, my boy: most of the links you posted have already been refuted on this very blog"

Most??

“We have all seen a man trip over his pecker."

With all the contortionists around here, and their disjointed replies, perhaps you better take your "pecker" out of your mouth . . . before you speak.

With all the contortionists around here, and their disjointed replies, perhaps you better take your “pecker” out of your mouth . . . before you speak.

Sez the crank who uses AoA and Mikey Adams for sources. How about news accounts? Court documents? Anything reliable instead of your flaccid insults?

@Science Mom
Judging by your frustration, which is on display for all to see, perhaps "flaccid" is all you can get.

Hey Julian, this could be the funniest piece of sanctimonious hypocrisy I’ve heard in a long time.

Are you going to supply hard evidence, or just pile more non-sequitors on?

@Julian I think you may be expecting too much from someone who apparently thinks it's clever to suggest a woman is having trouble with her penis?

@Julie Frost.

"Are you going to supply hard evidence, or just pile more non-sequitors on?"

"supply HARD evidence" HA HA HA.

And seriously, who started with the penis gags??

The hypocrisy medal of the day goes to Julian Frost.

So, no evidence, just more insults, and accusations of hypocrisy from someone who is being a hypocrite. How metahypocritical you are, Peter.

Sticks 'n' stones folks, Sticks 'n' stones.

And seriously, who started with the penis gags??

Penis gag?
I went to jail for something like that once.

Judging by your frustration, which is on display for all to see, perhaps “flaccid” is all you can get.

So you aren't going to defend your use of the clown blog and Mikey Adams or find any legitimate sources for your ludicrous claim? Just keep trying to distract from your obvious incompetence and poor judgement?

Are you really that silly, you cannot follow the normal rules of a debate?
I put those links there for YOU to defend.
If those accusations are "Ludacris," as you claim, it should be a cinch for you and your flunkies to destroy those claims, yes?

I put those links there for YOU to defend.

That isn't how it works. YOU have to defend them.

"That isn’t how it works. YOU have to defend them."

I'm not sure what planet you reside on, but here on Earth, the sun rises in the east.

And water flows downhill.

Peter Harris: And here on Earth, the burden of proof lies on the accuser.

Oh, the grey sparrow is back with more Flim Flam.
I'm not the accuser, the people who compiled those websites are the accusers.
Have you ever heard of the phrase, "don't shoot the messenger"?

I think all the bedwetters and dribblers here have spent too much time trying to hold me accountable for those links, when they could have been spending their precious time defending their guru.

But of course, we know why.

"You can't always trust the accuracy of things you read on the internet." -Abraham Lincoln

Mr. Harris, if someone went around saying you committed horrible crimes against your patients, would you accept "I'm only saying what I heard!" as a defense?

That is barely an argument, because your guru has had more than a "someone" making claims about his wrongdoing.
If you care to Google his name, "David H. Gorski" and "criticisms," together, you will find that a lot of people are making accusations about this guy.
There is a lot of smoke, and I suspect a lot of Fire.

@Peter Harris, you said:

I’m not the accuser, the people who compiled those websites are the accusers.

But in #94, you said:

Extraordinary gall displayed here by Orac.
Gorski should be the last person allowed to pass judgment on another Dr.

In other words, you repeated the accusations as accurate, which makes you an accuser too.

Comment of mine in moderation.

So Mr Jaffe, lawyer extraordinaire, is defending a doctor who doesn't have good documentation? This should be fun. But then, he has experience with MDs who have lousy documentation and still get away with murder (yes, I think Burzynski has committed murder with his lies.) At least in this case, the little boy isn't suffering severe effects from being hit in the head with a hammer.

@Wyzd1: yeah, WNL - we never look/we never listen. As a nurse and CNM, if it wasn't documented, it wasn't done - and WNL didn't count as documentation. I've seen a lot of lousy documentation, though. Especially in the older MDs. And the special snowflake MDs who only accept cash so they don't have to show their lousy record keeping to the insurance companies.

Are you really that silly, you cannot follow the normal rules of a debate?
I put those links there for YOU to defend.
If those accusations are “Ludacris,” as you claim, it should be a cinch for you and your flunkies to destroy those claims, yes?

You really don't grasp how this works. Your sources are for you to defend. How on Earth can you expect us to defend your own use of very poor sources numpty? Those claims have no merit and the explanations why have already been discussed, again if you care to conduct a simple search.

You can be pro-vaccine without being a vaccine fanatic.

I'm pro-vaccine and my own children have had all of the AAP recommended vaccinations. We even get the yearly flu shot. But vaccine pushers who pretend that vaccines are 100% safe are cut from the same cloth as the vaccine deniers.

Vaccine's are not 100% safe! As recently as 1999, a rotavirus vaccine RotaShield was pulled from the market for a life-threatening side-effect in children. Even a vaccine that's safe enough to be on the market needs to be made correctly. There are vaccine recalls every year.

HOWEVER, choosing to not get vaccinated is far from 100% safe!!! As we've seen with recent measles and whooping cough outbreaks, not getting vaccinated poses non-trivial risks to yourself and others. Most of the vaccines currently recommended have long track records of being effective and have low (not zero but very low) risks of serious side-effects.

This is why we have the FDA and CDC! The risks of vaccines must be constantly monitored and studied to make sure the benefits provided by the vaccine outweigh the dangers. The FDA and CDC do a good job. It's impossible to be perfect and some problems can only be discovered after a sufficient number of people have been hurt to discover the signal. But the FDA and CDC are the institutions that tip the balance of probabilities strongly in favor of getting vaccinated.

That said, risks have to be individualized by person and by vaccine. I would like to see almost everyone get vaccinated with almost all of the currently recommended vaccines. But for some people with some vaccines the risks are greater than the benefits.

I'm not familiar with all of Dr. Sears' actions or stances, but I have read "The Vaccine Book: Making the Right Decision for Your Child". This book is pro-vaccine without being fanatical. Dr. Sears' book makes a far more convincing and evidence-based case for getting vaccinated than the vaccination propaganda that denies the rare, but real, risks.

Um, no. Sears book is not pro-vaccine, and it is not evidence-based. He accepts, for instance, that vaccines can cause autism, a claim for which there is no good scientific evidence and refuting which there is lots of strong evidence.

https://www.sciencebasedmedicine.org/cashing-in-on-fear-the-danger-of-d…

BTW, stop trying to post under a different 'nym. Using sock puppets is one of the very few offenses that will absolutely get you banned from the comments here. I did not approve your new comment and will not. You've picked your 'nym for this blog's discussion section. Now you're stuck with it. Attempts to post under other 'nyms will not be approved, and if you persist in generating new sock puppets you will be banned. This is your only warning, and I'm being generous. Normally I'd just ban you for even one attempt at using a sock puppet.

@YCBP-VWBAVF:

Dr. Sears’ book makes a far more convincing and evidence-based case for getting vaccinated than the vaccination propaganda that denies the rare, but real, risks.

That is a straw man argument. Nobody denies that vaccines have risks.
As for

As recently as 1999, a rotavirus vaccine RotaShield was pulled from the market for a life-threatening side-effect in children.

The side effect was intussusception, it was not life threatening and it increased the risk by 1-2 cases per 10,000 vaccinations.

Poor Bob just can't be bothered to pawn his Lamborghini for his legal defense fund--http://standwithsears.org/ . Of note, any $$$ you send him are his to do with as he pleases--in true Sears Family carpetbagging tradition. This should be funny since Sears got embroiled in a lot of financial finger pointing with where all the anti-SB277 monies went after the passage of SB277.

There is a lot of smoke, and I suspect a lot of Fire.

Actually, there's a lot of mirrors.

"I’m pro-vaccine"

Well hurrah.

"But vaccine pushers"

Too bad, it was nice while it lasted. :(

@YCBPVWBAVF

But vaccine pushers who pretend that vaccines are 100% safe are cut from the same cloth as the vaccine deniers.

Can you point out any instance of a pro-vaccine person claiming that vaccines are 100% safe? I've never seen such a claim.

HOWEVER, choosing to not get vaccinated is far from 100% safe!!! As we’ve seen with recent measles and whooping cough outbreaks, not getting vaccinated poses non-trivial risks to yourself and others. Most of the vaccines currently recommended have long track records of being effective and have low (not zero but very low) risks of serious side-effects.

Citation, please.

FYI none of my over 5,000+ patients in the last 9 years never had a parent bringing them tell me they decided to vaccinate ( as opposed to delaying vaccines or skipping them all together )their child based on what Sears had written in his horrible book.

Levi Quackenboss kindly explains how ridiculous the allegations against Dr. Sears are here ;-)

https://leviquackenboss.wordpress.com/2016/09/09/the-dr-sears-allegatio…

I realize she tried, but she did not do a very good job attacking the claims.

She did not address how the mother's descriptions become encephalitis and kidney shutdown without any supporting documentations for those serious conditions, which were not what the mother said. Or if he believed there were these conditions, where is any follow up or treatment?

She did not really give a good explanation for not conducting testing when a boy that had a hammer to the head two weeks before came in with a headache. Read the comments above on how inappropriate that is.

She seems to think she is reading something into the notes that was not there - without elaborating what - but really, her unstated diagnosis isn't in the notes, and Dr. Sears did not justify any such things.

So this explanation appears to be based on some kind of unstated belief that isn't likely to work very well as a justification of Sears' actions.

Thanks Dorit. Woo friend of mine shared the Quackenboss link on Facebook and I knew that there were loads of holes in it, and that someone could point them out.

I expect our host and the other guests can further tear it apart. I had the advantage of reading it yesterday, so had some answers ready. :-)

Levi Quackenboss kindly explains how ridiculous the allegations against Dr. Sears are

The "Tamiflu slows brain activity" bit is made all the more hilarious by the ease of finding where it was cribbed from.

It appears that Robyn has also, by implication, concluded that the patient is Japanese. (P.S.: Not actually banned.)*

* See also PMIDs 17377552, 20121561, etc.

@ "Julian Frost

Gauteng East Rand
September 14, 2016
So, no evidence, just more insults, and accusations of hypocrisy from someone who is being a hypocrite."

Tautology alert!

I see Julie, that your grammar is on a par with your medical knowledge.

@ Gray Sparrow.

"Actually, there’s a lot of mirrors."

I see.
So the world we live in, with digital platforms such as the Internet, Google and online blogs, are nothing more than mirrors huh?
Ok then.
And this "science" blog, is a beacon of supreme truth, and scientific discussion which is beyond reproach?
An island of grounded and reliable medical advice?

Ha ha ha ha

@ Science mum.

"Those claims have no merit. . ."

If that were true, then you disciples of Gorski should have no trouble in defending those accusations.
But like a true disciple - Guru relationship, the disciple slavishly follows, what ever the Guru demands, and defends the Guru, regardless how illogical that argument becomes.

I see Orac himself has been on this thread overnight, and even he has not tried to defend himself from those accusations.

One can only assume, that those accusations are true, if they cannot be challenged in a meaningful way.

@Peter Harris, if you're resorting to grammar trolling instead of addressing my points, you've lost.

Your "points"?

You don't have any points. . . Well, apart from the tapering extension atop of your cranium.

@Julian

He seems to just copy what's probably worked on him in the past. Meaning he was, most likely, trolled hard over his grammar and now runs whatever anyone says through an online grammar checker; thinking he's scoring points.

Mr. Harris, are you not familiar with the phrase "smoke and mirrors?" That's what I was referring to. That's all the accusations against ORAC amount to. A lie repeated one thousand times is still a lie, and everyone who repeats it is guilty of spreading it, you included.

There are two good reasons why we don't compare every new vaccine to saline placebos:
1) Consider watching an ad for an expensive new floor-cleaning product. Your response is likely to be "Why can't I just use a mop?" When testing something for which an established tool exists, you want to see which one actually works better in comparison.
2) Consider the development of a newer, lighter but stronger parachute. Would you test it with someone falling out of a plane against a backpack weighted like a parachute?

@ Gray sparrow.

"That’s all the accusations against ORAC amount to."

One thing is perfectly clear, to any neutral observer reading your nonsense.
You are one unctuous and feckless fool.
You would defend your guru, at any cost, regardless of his crime.

"A lie repeated one thousand times is still a lie"

Now I agree.
There is ample evidence of that around here.

@ Jay, Julie.
Calling me a troll?
Well of course, when you've got nothing intelligent left to say, and when you loose a simple debate.
Too easy huh.

Mr. Harris, if ten people publish web pages all claiming you killed all your patients, would that make it true?

Indeed. And if Harris chooses not to sue for libel, the charges must be true!

Orac

September 15, 2016
"Indeed. And if Harris chooses not to sue for libel, the charges must be true!"

My God, the quack does speak, down from up on high.
Nice twisted logic, but hey, it's normal practice around here to deflect away valid criticism, with inane and infantile drivel.
You taught your disciples well..
Would you care to respond, to the many accusations, made against you??
Take your time.

Nice twisted logic, but hey, it’s normal practice around here to deflect away valid criticism, with inane and infantile drivel.

I'm glad you agree that your logic that if I don't sue Mike Adams for libel his accusations must be true is twisted.

@Peter Harris:

[W]hen you loose a simple debate.

Better than losing a simple debate, which is what you happen to be doing. :D

@ JF
1 too many MRR vaxx JF??

Well, you must be getting desperate now.
Deleting my comments?
And I was so civil too.

Do you really have that much to hide?

Hey! Peter Harris! (waves). You keep complaining about the rest of the hordes, and ignore me and my medical education. I've submitted my bona fides to you on the other thread, and you keep ignoring me. Therefore, all I can do is conclude that you are a coward who can't stand up to a TRUE medically educated person, and use your ND as a hammer.

And, looking at the increase in typos, all I can do is conclude that Peter Harris is losing the argument.

Meaning he was, most likely, trolled hard over his grammar and now runs whatever anyone says through an online grammar checker; thinking he’s scoring points.

Umm... his complaints about grammar have been uniformly nonsensical. A simpler explanation by far is that he's an imbecile.

Peter: As an ND, what is your protocol for assessing a potential concussion or other closed head injury?

(Since that is part of the topic at hand.)

Well, surprise surprise.
My comments reemerged overnight.
Now perhaps Orac can address the allegations, but after reading more about this guy, I doubt it.
And no doubt also, he'll just use his disciples to attack me, instead of defending those accusations.

Well, surprise surprise.
My comments reemerged overnight.

Erm, you get filtered, it sits overnight until a moderator releases it. If you're dissatisfied with that delay, perhaps a moderator will next not bother releasing your comment.

And no doubt also, he’ll just use his disciples to attack me, instead of defending those accusations.

Erm, I have no idea which disciples to which you refer, but if you think that there's some sort of organized cabal here that follows Orac's expressed directives, you're as wrong as you can humanly be wrong. To judge from your previous comments, that's pretty wrong!

As for whateverinhell you blathered about, I've been offline for a few days. Some of us actually have real lives offline, otherwise, I'd likely be one of those "disciples" you claim obey Orac's every desire or something.
Still, I'm quite certain our loyal readers here will quickly dispatch whatever drivel that you submitted.

Many people would find it strange, that there are a lot of animal avatars here, particularly cats.
But no, there is an explanation for that.
It's a classic sign of pathological misanthropy.

And I see the grey sparrow, is just reinforcing my views of him, that he is one sick and twisted individual.
Who would create some argument around loose analogies, comparing cars and parachutes to the dangers and shocking side-effects of vaccines?
Well a demented mind of course.

And I see the grey sparrow, is just reinforcing my views of him, that he is one sick and twisted individual.

Heh, I used a full stop rather than a comma in the killfile entry. This was a serendipitous error on the Lowell Hubbs front.

^ While the window is still open,

It’s a classic sign provocation of pathological misanthropy yobbo frustration.

FTFY.

Too much to wish for?

Who would create some argument around loose analogies, comparing cars and parachutes to the dangers and shocking side-effects of vaccines?

What are the "dangers and shocking side effects" of vaccines, Peter? Oh, and you can't just list a number of things that may or may not be caused by vaccines. You have to supply good evidence proving that they are caused by vaccines.

Narad @176

The "Peter Harris" in that link is in the Neath area of South Wales (I checked the STD code on the phone number) rather than Australia.

So unless the "Peter Harris" throwing his weight under a couple of posts here manages to be in 2 places at opposite sides of the globe at the same time...

Mmmmm, mebbe all that magical guff on that LinkedIn page allows you to do that....

The “Peter Harris” in that link is in the Neath area of South Wales (I checked the STD code on the phone number) rather than Australia.

Ah, well. Thanks for thinking to check that.

Now perhaps Orac can address the allegations, but after reading more about this guy, I doubt it.

Muppet doesn't know how to use the search box?

@Wzrd1

Wasting your time. The only things Harris apparently knows how to do are argue by assertion and lob attempted insults.

@Todd W, well, I was seeing if he'd go to the higher level of calling me a poo-poo caca pants. ;)

@Wzrd1

"Erm, you get filtered, it sits overnight until a moderator releases."

No, not at all, they appear straightaway, unless the post is accompanied by multiple links.

"Some of us actually have real lives offline

And what would that be?
Drugging, maiming and butchering your "patients" with allopathic medicine?
And I guess, you come over here, and brag about it.

Actually, I'm a retired SF medic and am currently an information security professional.
I'd also be quite dead if it weren't for those drugs, as my aorta would've ruptured and I'd be doing that dead thing. That makes for a lousy weekend.
If my aorta further expands from dilation to aneurysm, that "butchering" would save my life, as surgery can repair the aorta now.
I'd consider that accomplishment brag worthy!

So, what do you have to offer to treat hypertension, caused by hyperthyroidism? Magic?

"Actually, I’m a retired SF medic"

I see, so you're a jar-head, fighting illegal wars, to maintain British/US hegemony over the rest of the developed world. I'm sure you proud of yourself.

"So, what do you have to offer to treat hypertension, caused by hyperthyroidism? Magic?"

I guess you had never heard of Linus Pauling, or vitamin C.
And you've never heard of "You are what you eat."
And, a famous quote from Hippocrates; "Let food be thy medicine and medicine be thy food.”

That question from you, is so typical of the allopathic mentality.
Natural/holistic medicine and Naturopathy, is all about PREVENTION.
If you come to me some years ago, I would have got you on a specific dietary plan, that would have eliminated the risk of the diseases you have mentioned.

But of course, as I said before, there's no money in preventing disease, however, there are billions of dollars to be made by treating the symptoms.

Ah, the old US/UK hegemony gambit The year 1812 being a fireworks display, to show to the world the ineffectiveness of militias.
Or something.
And vitamin C, being magical, being disgraced as a panacea by the same SOB who held the first study that was destroyed by peer review.

Lemme give you a hint, sod off now. Wank in the corner as usual.
While you're doing your usual, Google aortic aneurysm. Figure out why that's bad.
*Really* bad.

You know, the best part of you didn't run down your old man's leg, it stayed inside of the rubber!

"You know, the best part of you didn’t run down your old man’s leg, it stayed inside of the rubber!"

I split my sides. . . No not really.
But it does remind me of those American movies i used to watch in the 80s.
You clearly are living up to that phrase, Jar-head.

Erm, jarheads are Marines, I was Army.
Retired now, my personnel file stamped REF.
Retired, Extremely Flatulent.

If you're still in SF and so inclined, come by sometime.

Dorit, SF in this context is Special Forces. That said, I'd love to pop by if I'm in your neighborhood. Good company's hard to come by these days. :)
Be warned, I love to play with kids, kids love to play with me. My wife and you can just shake your heads at my silliness. ;)
Although, a fair warning is due, in a funny face making contest, I *always* win. I have a naturally funnier face than kids are issued. ;)

Alas, we're in NW Louisiana, travel for any proper distance isn't in the cards for either of us, due to various injuries and disease states. :(
Still, plenty of kids around here to play with, give a good example to, while we miss our grandkids in Pennsylvania.

So, if we're in the neighborhood, we'll schedule a time to pop by, just keep the kiddies handy to play with. Pets as well. :)
We'll bring food. Both of us love cooking and are quite good at specific dietary requirements due to faith or preference. :)
You've not lived until you've had my lamb meatballs and marinara sauce, loaded with lamb or goat until the meat falls from the bones. :)

But, things military won't be discussed. Bad memories there. I'll happily talk about my guys, just not missions and things related to them. NDA and all other forms of nightmares.
Although, we'll have to trust you on the wine selection. ;)

That sounds wonderful, and anyone who can make my kids laugh is in my good books forever. Maybe it will happen.

But don't trust me with the wine selection, unless you're happy with grape juice. I don't do alcohol. My husband has good taste, though, so he can come up with something.

@ Julian Frost.

"What are the “dangers and shocking side effects” of vaccines, Peter? Oh, and you can’t just list a number of things that may or may not be caused by vaccines. You have to supply good evidence proving that they are caused by vaccines."

I'm beginning to wonder, as to whether my description of the regulars here, as bedwetters and dribblers, is actually an understatement.
Perhaps I'll just stick with the phrase; Nuffs-nuffs.

So now you're denying that severe and chronic, long-term debilitating side-effects exist from vaccinations??

Here's your favourite organisation, that lists the many side-effects of vaccinations.
For example, I found the word "seizure," over 30 times, in relation to vaccinations.
And that's just the tip of a titanic iceberg.

https://www.cdc.gov/mmwr/preview/mmwrhtml/00046738.htm

“Erm, you get filtered, it sits overnight until a moderator releases.”

No, not at all, they appear straightaway, unless the post is accompanied by multiple links.

I see that your reading skills are as dull as ever.

Here’s your favourite organisation, that lists the many side-effects of vaccinations.
For example, I found the word “seizure,” over 30 times, in relation to vaccinations.

Yay, you're on a comprehension-failure roll.

@Narad

"I see that your reading skills are as dull as ever."

Speaking of dull, how was your weekend Narad??

@ Narad.

"Yay, you’re on a comprehension-failure roll."

Translated that means;
If I look at the CDC link, I might have to admit it is true, but seeing as though I am a Nuff-nuff, I could not read the abstract to begin with, and non-sequiturs are all i got.

“Yay, you’re on a comprehension-failure roll.”

Translated that means;
If I look at the CDC link, I might have to admit it is true, but seeing as though I am a Nuff-nuff, I could not read the abstract to begin with, and non-sequiturs are all i got.

The irony, it burns:

"Despite concerns about vaccine safety, vaccination is safer than accepting the risks for the diseases these vaccines prevent."

Even dumber is your, ah, attempting to count the number of appearances of the word "seizure," which are a combination of shooting yourself in the foot and pulling out a 20-year-old discussion of DTP.

Again, your inability to read for comprehension is just painful in its stupidity. And the killfile is back on, so do enjoy your own company.

I very nearly feel bad for someone that shoots their own foot, save that they inevitably then complain about the limp.

@ Narad.

"Again, your inability to read for comprehension is just painful in its stupidity. And the killfile is back on, so do enjoy your own company."

The week has barely started, and already Nuff-nuff Narad gets the hypocrisy/non sequitur/ad hominem award for the week.

So now you’re denying that severe and chronic, long-term debilitating side-effects exist from vaccinations??

No, you strawmanning dim bulb. I'm saying that YOU need to PROVE AND LIST those "severe and chronic, long-term debilitating side-effects exist from vaccinations".
By the way, I went through that CDC document you posted. Here are some of the phrases that caught my eye.

"side effects were reported no more frequently among vaccinees than among persons receiving a placebo"

"available data concerning these vaccinees do not indicate an association between receipt of recombinant vaccine and GBS"

"No serious side effects of currently available IPV have been documented."

"Although children with a personal or family history of seizures are at increased risk for developing idiopathic epilepsy, febrile seizures following vaccinations do not in themselves increase the probability of subsequent epilepsy or other neurologic disorders. Most convulsions following measles vaccination are simple febrile seizures, and they affect children without known risk factors."

"The administration of live measles vaccine does not increase the risk for SSPE, regardless of whether the vaccinee has had measles infection or has previously received live measles vaccine."

To repeat myself.
What are the “dangers and shocking side effects” of vaccines, Peter? Oh, and you can’t just list a number of things that may or may not be caused by vaccines. You have to supply good evidence proving that they are actually caused by vaccines.

@Julian Frost: don't bother wasting your time on Peter Harris. He's a coward who won't talk to educated women, because he's afraid we know more than he does. And you know he won't post anything that defends his whinging. He'll just call everyone names and stomp his feet. Personally, I wish he'd take his toys and go home. I'd say he's acting like a toddler,but that's an insult to toddlers.

I've always been the odd fellow who enjoys talking to people who know more than I do. How else can one learn? :)

As for Peter, yeah, no need to insult toddlers. Still, he was born ignorant and has been losing ground ever since.

Good advice is wasted on you, isn't it.
But as long as the humvee is fuelled, and Bruce Springsteen is playing in the background, then everyone can be "losing ground," for all-time.

I dunno about the hummer, I drive a 1996 Taurus. Which is now fix or repair daily.
But, whatever floats your boat full of lead,

Personally, I happen to *like* that car. Although, I have a gun and have entirely failed to locate a grease fitting...
Permanently lubricated, my ass, lubricated until failure, then the part's lifetime is over.*

*You'd have to share context of age, when one lubricated a vehicle's grease points, not sought them and not found much.
When wearing tree looking clothing, I used to hunt down such points on my military vehicle, lubricating many, many, many points.
Just like I did with my older cars.
But, hey, it's all cool. Walk, rather than ride, carry 47 pounds of body armor, primary arm reloads to 200 rounds or so, secondary arm for another half hundred rounds or so, maybe be "blessed" with 12 gauge rounds as well for breaching purposes, then add in my 50 pounds of IV fluids, treatment kits, etc.
Yeah, leaving impressions into granite surfaces, so done that.

@ JF.

"I’m saying that YOU need to PROVE AND LIST ..."

So there you have it folks, the CDC is not a reliable source regarding the dangers of vaccines.
And when somebody presents me with something from the CDC, as an argument to refute something I've stated, I'll just say that; "YOU need to PROVE AND LIST."

Nice attempted cherry picking Mr Frost.
You obviously missed the hundreds of examples of severe and debilitating side-effects as a result of vaccines.

"To repeat myself.
What are the “dangers and shocking side effects” of vaccines, Peter? "

I guess the Nuffs-nuffs around here, including Mr Frost, do not believe that death, which was mentioned over 30 times in that CDC report, is to be considered a "danger," or a "shocking side-effect."

I think some of the guys here are just hilarious.
They dig a hole for themselves, and then fill it in on themselves.

You can't make this shit up, because nobody would believe you.

Sigh. SF =/= jarheads.

Hey, Wizard -- you would get a kick out the looneytunes who has been holding forth on Disqus on how vitamin C cures everything including tetanus. She thinks I have a death wish because I prefer the Tdap.

@shay, I've been studiously ignoring the idiocy of USMC vs US Army BS.
Morons are morons.
See the bit about staying inside of the rubber.

That's a rarity for me, in the extreme, as I do try my best to keep things family safe.
But, some earn their way dearly into disrespect.

Natural/holistic medicine and Naturopathy, is all about PREVENTION.

[...]

But of course, as I said before, there’s no money in preventing disease,

Sure. nobody never made no money by "natural/holistic medicine".

If you come to me some years ago, I would have got you on a specific dietary plan, that would have eliminated the risk of the diseases you have mentioned.

Be specific.

"Be specific."

I'm hardly going to give you any advice.
You are beyond redemption.

Speaking of being specific, have you found some answers to my 2 simple questions yet?

How amusing that you have "nothing specific", at all.
Wank off elsewhere, your microscopic member isn't of interest here.
But, further proving that the best part of this individual stayed inside of the condom.

This thread reveals the secret to Peter Harris' claims that he successfully treated all his patients without any side effects. He simply refuses to acknowledge the existence of anything that contradicts him.

" He simply refuses to acknowledge the existence of anything that contradicts him."

Because nobody has put up a reasonable argument/rebuttal against what I have stated, in regards to the safety and efficacy of holistic/natural medicine.
But you and the other flunkies may try, but reason and logic will always destroy your nonsense, purely for the fact that you are completely ignorant of cellular biology and evolutionary biology.
So keep banging your head against the wall, as I say good night.

So, I just saw an interesting note that Sears has been hit with a second complaint - involving someone he mentioned during his SB277 testimony.

Unfortunately, because it isn't a child that Sears treated, I don't think it will mean much in the grand scheme of things.

Speaking of being specific, have you found some answers to my 2 simple questions yet?

I'm not one one having trouble finding the answers - you're the one who can't find them.

But this isn't the tread for this - Anything else on the subject, bring it up in the original thread.

Because nobody has put up a reasonable argument/rebuttal against what I have stated, in regards to the safety and efficacy of holistic/natural medicine.

You haven't stated anything, you just keep vomiting up words and insults.

If he were here in the US, Peter could explain to Logan Stiner's mother how safe his treatments are.
http://www.cbsnews.com/news/dietary-supplements-health-risks-consumer-r…

And he doesn't cite studies like this 1 year survey of supplement adverse event reports.

http://www.ncbi.nlm.nih.gov/pubmed/18570167

Of 275 dietary supplements calls, 41% involved symptomatic exposures; and two-thirds were rated as probably or possibly related to supplement use. Eight adverse events required hospital admission. Sympathomimetic toxicity was most common, with caffeine products accounting for 47%, and yohimbe products accounting for 18% of supplement-related symptomatic cases.

Nor does he mention the 3 or 4 million people who no longer die of smallpox worldwide every year.

Even the reference he did quote shows that public health officials like the CDC put a continual effort in finding possible adverse effects of vaccines, quantifying the risk (which is much less than the risk of the diseases themselves) and finding ways to make vaccines even safer.

In Peter's field, by contrast, the norm is to assume that someone wrote down 200 or 2000 years ago that this works so we'll just take their word for it.

I thought you were a little different, but no, you're just a bumbling muckraker like the rest of them.
For a start, I do not prescribe the "supplements" in that story.
I also looked at the links that were embedded in that story, and they too are misleading, by using the word "supplement," to describe weight loss products, and other products to make you look good. I do not consider caffeine to be a supplement.
This just shows how utterly ignorant you are, in regards to what Naturopaths do in a professional setting, and what supplements they prescribe, which are no more than high-quality vitamins/minerals.
And with the modern commercial, Broadacre intensive farm practices, along with further refining and processing of food in factories, I find minerals are more important than vitamins, when it comes to my clients diseases, and that mineral depletion is the root of many modern diseases.

One of the so-called doctors, who was featured in the story, a Dr Byers, is just like any other mainstream medical researcher. He distorts and overplays, any significance vitamins play in causing disease.
And when you read through the BS, you find this statement;
"Byers says it's still unclear why supplements could have this adverse effect, but he and other researchers hope to learn more about the association."
"Other studies Byers reviewed indicated that many other supplements had no apparent impact on cancer risk -- neither increasing nor decreasing it."

You then give me a link to; http://www.ncbi.nlm.nih.gov/pubmed/18570167

Maybe you fail to read it.

"Suspected drug-herb interactions occurred in 6 cases, including yohimbe co-ingested with buproprion (1) and methamphetamine (3), and additive anticoagulant/antiplatelet effects of NSAIDs taken with fish oils (1) and ginkgo (1). Laboratory analysis identified a pharmacologically active substance in 4 cases; supplement toxicity was ruled unlikely when analytical testing was negative in 5 cases."

So for example, the anticoagulant was a result of the NSAIDS, or the fish oil?
Would you care to answer that?

And then the conclusion was;
"CONCLUSION:
Most supplement-related adverse events were minor. Clinically significant toxic effects were most frequently reported with caffeine and yohimbe-containing products. Active surveillance of poison control center reports of dietary supplement adverse events enables rapid detection of potentially harmful products, which may facilitate regulatory oversight."

No traditional vitamins or minerals were mentioned.

And then you completely out yourself as a fool with this statement:

"In Peter’s field, by contrast, the norm is to assume that someone wrote down 200 or 2000 years ago that this works so we’ll just take their word for it."

Just like the other feckless and clueless types here, you have absolutely no understanding of Cellular Biology and Epigenetics, and how our evolutionary past, has shaped us to what we are today, developed through our reliance on the fresh, nutrient dense foods we ate, for hundreds of thousands of years, when we were hunters and gatherers.
And somehow, boneheads like yourself and others, come along and say that "science in medicine," will replace what nature provided for us over those countless years of evolution.

http://www.healthnewsreview.org/2015/04/the-study-that-never-existed-ca…

http://www.nyrnaturalnews.com/uncategorized/2015/04/another-misleading-…

OK. now i'm amused. Peter Harris is living in the past, that's why none of his patients ever die.

After all, if he can post a 20 year old CDC document thinking it has current information,(I guess he's afraid of the current MMWR just like he's afraid of me). then he's living in the past.
Let me help you out, Peter. There is this thing known as a "data" that is at the top of a MMWR. You want the most current recommendations and information. Try this one - it's much more recent than 1996:

http://www.cdc.gov/mmwr/preview/mmwrhtml/rr6002a1.htm

Ah, MI Dawn, you're also on the MMWR mailing list? :D

Pardon my double error.
I'm late for work

@PH:

I guess the Nuffs-nuffs around here, including Mr Frost, do not believe that death, which was mentioned over 30 times in that CDC report, is to be considered a “danger,” or a “shocking side-effect.”

A number of VAERS Reports mention deaths, but on closer investigation it turns out that the vaccine could not possibly have had anything to do with it.
To repeat myself again:
What are the “dangers and shocking side effects” of vaccines, Peter? Oh, and you can’t just list a number of things that may or may not be caused by vaccines. You have to supply good evidence proving that they are actually caused by vaccines.

You really are becoming quite desperate aren't you.
Banging your head, with illogical nonsense.
I prove you wrong, and you still breathlessly carry on like a toddler, who demands its dummy.
I do not consider VAERS to be inaccurate source of information, regarding the adverse affects of vaccines.
Your argument is now in the toilet, all we need now is for someone to come along and press the button.
But going by your history, you will probably do it yourself.
Just make sure you press the full button, the one with the semicircle icon.

http://www.renewamerica.com/columns/janak/080330

http://www.activistpost.com/2016/07/cdcs-vaers-data-confirm-multiple-va…

However, if you still insist that VAERS reported no deaths, then perhaps you should press the button now.

"HPV vaccine-related problems that were reported on the VAERS site included

autoimmune hemolytic anemia, idiopathic thrombocytopenic purpura, lymphadenopathy, pulmonary embolus, nausea, pancreatitis, vomiting, asthenia (weakness), chills, death, chronic fatigue, malaise, autoimmune diseases, hypersensitivity reactions (including anaphylactic/anaphylactoid reactions, bronchospasm, and urticaria), arthralgia, myalgia, acute disseminated encephalomyelitis, dizziness, Guillain-Barré syndrome, headache, motor neuron disease, paralysis, seizures, syncope (sometimes resulting in falling with injury), transverse myelitis, and deep venous thrombosis."

And then. . .

"No Guarantee of Vaccine Efficacy and Lots of Risks

Just two years after Gardisil’s introduction into the US, the Vaccine Adverse Event Reporting System (VAERS) reported the following HPV vaccine-related problems, including 32 deaths (that were more or less equally distributed following either the first, second or third inoculation)."

http://www.globalresearch.ca/big-pharmas-nefarious-control-of-health-ca…

A number of VAERS Reports mention deaths, but on closer investigation it turns out that the vaccine could not possibly have had anything to do with it.

It's rather plain that he can't be bothered to read his own source. Let's pick one of those "over 30" matches (five of the 33 are in the references):

"Rarely, immediate anaphylactic reactions (i.e., swelling of the mouth, breathing difficulty, hypotension, or shock) have been reported after receipt of preparations containing diphtheria, tetanus, and/or pertussis antigens. However, no deaths caused by anaphylaxis following DTP vaccination have been reported to CDC since the inception of vaccine-adverse-events reporting in 1978, a period during which more than 80 million doses of publicly purchased DTP vaccine were administered."

Or Table 2, which lists sudden infant death syndrome under "evidence favored rejection of a causal relationship" for DTP.

His counting routine is imbecilic.

[Only slightly off-topic]

How would one distinguish between an anti-vaxxer with poor reading skills and a failed computer program attempting to pass the Turing test? Based on the 'conversation' so far I don't think there is enough evidence to determine if we are dealing with a slightly off-center loon with minimal reasoning skills or a graduate school project in computer science/psychology.

Or, as a CS professor of mine in the 1990's was fond of saying, "It isn't ALWAYS an either/or solution." Which means that "Peter Harris" may be an attempt to pass the Turing test, designed by a slightly off-center loon with minimal reasoning skills.

Feel free to return to your non-productive discussion. Hopefully it will produce enough data to solve this mystery.

PH: "Calling me a troll?
Well of course, when you’ve got nothing intelligent left to say, and when you loose a simple debate.
Too easy huh."

Yes, too easy, when you keep scoring own goals like that. Like that study you posted showing Big Pharma being honest in their test results, like that study you posted showing vaccine safety in Cuba, I could go on.

You're a terrible troll. But that's fine, as I can see any lurking naturopaths gently weeping in shame at being represented by you. They are certainly quiet when you're about.

Any naturopaths out there that want to back Pete up? Maybe you could pop up and let us know what qualifications your naturopath course required?

How would one distinguish between an anti-vaxxer with poor reading skills and a failed computer program attempting to pass the Turing test?

Well, use of the word "attempting" is begging the question, but to the point, I've found that if Dadadodo can produce prose that comes off as more insightful than the source of its input, the input is reliably a dumb human. I've only tested this with recycling its own output, though; SciGen input could be another experiment, but I just don't have the interest these days.

But don’t trust me with the wine selection, unless you’re happy with grape juice.

There's no reason why teetotalers can't indulge in beverage pairing. Somewhat gamey meatballs in tomato sauce would call for some body and acidity* in a wine, right?

Leaving aside the Ariel option** and lassi-type entries – just because they seem too heavy – I'm willing to believe that it might be possible to create some sort of sparkling beverage that would work. Rhubarb ± pomegranate spring to mind; green mango, maybe.

This leaves body. Egg white, sugar, glycerin ... or a cucumber/squash/etc. base. The latter would muck up the glassware, though.

* Oh, wait, wine is alkaline.
** Full disclosure: I have received an autographed copy of one of Graham Kerr's cookbooks after sending a CD of his lone LP, which he did not have a copy of (and which was not easily available) at the time. I have at least three vinyl copies at the moment.

@ gaist
"Speaking of being specific, have you found some answers to my 2 simple questions yet?

I’m not one one having trouble finding the answers – you’re the one who can’t find them."

"But this isn’t the tread for this – Anything else on the subject, bring it up in the original thread."

Oh, this is a novel way of avoiding the questions.
Firstly, claiming I must answer my own question, when it's you who's defending the safety and efficacy of vaccines.

Oh, of course, that old chestnut.
Telling me to go over to the other thread, and discuss it there. But unfortunately that thread has disappeared.
Of course, there is no reason why you can't answer my 2 simple questions here on this thread.

But unfortunately that thread has disappeared.

No longer sure if he's that stupid, or just delusional.

Oh, so you found it. ha ha.
So now you need to find me some answers.
It can’t be that hard, seeing as though you have demonstrated your Internet skills.

https://youtu.be/SGD69Q9rz3M

Obviously, Peter Harris has reading comprehension issues. He says : I do not consider VAERS to be inaccurate source of information, regarding the adverse affects of vaccines.

Peter: as our beloved lilady used to say, what's that part you have to read and agree to BEFORE going into the VAERS database?

To make it easier for you, I'm attaching it to this post and bolding the relevant part.

VAERS Data

Guide to Interpreting VAERS Case Report Information
When evaluating data from VAERS, it is important to note that for any reported event, no cause-and-effect relationship has been established. Reports of all possible associations between vaccines and adverse events (possible side effects) are filed in VAERS. Therefore, VAERS collects data on any adverse event following vaccination, be it coincidental or truly caused by a vaccine. The report of an adverse event to VAERS is not documentation that a vaccine caused the event.

VAERS data contains coincidental events and those truly caused by vaccines.
More than 10 million vaccines per year are given to children less than 1 year old, usually between 2 and 6 months of age. At this age, infants are at greatest risk for certain medical adverse events, including high fevers, seizures, and sudden infant death syndrome (SIDS). Some infants will experience these medical events shortly after a vaccination by coincidence.
These coincidences make it difficult to know whether a particular adverse event resulted from a medical condition or from a vaccination. Therefore, vaccine providers are encouraged to report all adverse events following vaccination, whether or not they believe the vaccination was the cause.

Please read the following statement on the limits of VAERS data. You MUST click on the box below to access the VAERS database.
When reviewing data from VAERS, please keep in mind the following limitations:

VAERS is a passive reporting system, meaning that reports about adverse events are not automatically collected, but require a report to be filed to VAERS. VAERS reports can be submitted voluntarily by anyone, including healthcare providers, patients, or family members. Reports vary in quality and completeness. They often lack details and sometimes can have information that contains errors.

"Underreporting" is one of the main limitations of passive surveillance systems, including VAERS. The term, underreporting refers to the fact that VAERS receives reports for only a small fraction of actual adverse events. The degree of underreporting varies widely. As an example, a great many of the millions of vaccinations administered each year by injection cause soreness, but relatively few of these episodes lead to a VAERS report. Physicians and patients understand that minor side effects of vaccinations often include this kind of discomfort, as well as low fevers. On the other hand, more serious and unexpected medical events are probably more likely to be reported than minor ones, especially when they occur soon after vaccination, even if they may be coincidental and related to other causes.

A report to VAERS generally does not prove that the identified vaccine(s) caused the adverse event described. It only confirms that the reported event occurred sometime after vaccine was given. No proof that the event was caused by the vaccine is required in order for VAERS to accept the report. VAERS accepts all reports without judging whether the event was caused by the vaccine.

DISCLAIMER: Please note that VAERS staff follow-up on all serious and other selected adverse event reports to obtain additional medical, laboratory, and/or autopsy records to help understand the concern raised. However, in general coding terms in VAERS do not change based on the information received during the follow-up process. VAERS data should be used with caution as numbers and conditions do not reflect data collected during follow-up. Note that the inclusion of events in VAERS data does not imply causality.

For more information, please call the VAERS Information Line toll-free at (800) 822-7967 or e-mail to info@vaers.org.

I have read and understand the preceding statement.

So often I get accused of not reading, when in fact it's the Nuff-nuffs here, who cannot comprehend what I'm saying, even when I use simplistic terms.
I guess it's a symptom of, a lack of engaging one's prefrontal cortex, and relying on one's limbic system a little too much, when interacting with the world.

I'll make it clear for you this time, using simple monosyllabic terms.

VAERS is not accurate. It's run by the medical system, to cover up the medical systems mistakes. This is not an independent reporting system, and it's open to broad range contamination, in its collection, and formulation of data.

It's even in the text that you sent me to read!
How F%&#ING dumb can you get??!!

"VAERS is a passive reporting system, meaning that reports about adverse events are not automatically collected, but require a report to be filed to VAERS. VAERS reports can be submitted voluntarily by anyone."

And it continues . . .

"VAERS reports can be submitted voluntarily by anyone, including healthcare providers, patients, or family members. Reports vary in quality and completeness. They often lack details and sometimes can have information that contains errors."

“Underreporting” is one of the main limitations of passive surveillance systems, including VAERS. The term, underreporting refers to the fact that VAERS receives reports for only a small fraction of actual adverse events."

And no need for bolding, it jumps out at you anyway.

Now, I have real work to do, unlike PH who forgets what the pot calls the kettle.

VAERS does have its uses (though the noise generated by anti-vaxers has certainly made it less useful over the last decade).

It was initial reports in VAERS which lead investigators to take another look at the original Rotavirus vaccine. There was enough data to suss out a single additional adverse event per 100,000 doses of the vaccine, which caused the vaccine to be removed from the market.

If VAERS was good enough to find that rare of a reaction, don't you think the other anti-vax claims - like autism, diabetes and auto-immune diseases would have been easy to find?

Just another example of anti-vaxers not understanding what they are talking about, at all.

@Peter Harris: since the first part of my comment was your own words, I don't think I suffer from reading incomprehension.

Unless you had a typo in your wording:
I do not consider VAERS to be inaccurate source of information, regarding the adverse affects of vaccines.

I read exactly what you typed.

Yes, the auto-correction got it wrong, it was meant to say. "an accurate..."
But despite that, it's quite clear what I think of VAERS, and it's dodgy nature of reporting.

And then you can explain if you don't consider VAERS to be an ACCURATE source of information, why you insist on quoting it for "32 deaths" from HPV vaccines. By the way...if you bothered to LOOK at the data, you'd see some of those deaths were suicides, auto accidents and other things that are pretty hard to tie to a vaccine.

Again, doesn't really need explaining!

Deaths, as opposed to lets say, localised skin rashes, cannot be misreported, even in a dodgy system such as VAERS.
Deaths, at least need a certificate.

Nobody needs to show a death certificate to report a death to VAERS. They can report a story they read on the Internet.

More important, the question isn't if someone died, but whether the vaccine caused it. An unverified VAERS report simply doesn't show a vaccine caused a death.

Here are two examples I like to use for this.

VAERS #379570: “…patient accidentally fell in open well (granite quarry filled with water), drowned and expired. This event occurred 49 days of receiving first dose of GARDASIL.”

VAERS ID: 495494-1 -- An MMR death - "Vaccine recipient started to bleed on both hands and walked over a filled bathtub."

Just more gullible nonsense.
In the past, you will defend the VAERS
But now, you're calling into question its accuracy, just to spite me.

Ha ha ha.

As I said, dribblers and bedwetters.

If by defend you mean point out that properly used, it's useful, it certainly is.

I doubt anyone here ever claimed all VAERS reports - or deaths reports to VAERS - reflect vaccine causation, because that's simply not true and people here know better.

I certainly didn't claim that.

Using unverified VAERS reports as evidence of vaccine-caused harms or deaths is simply incorrect and improper use. That doesn't contradict the fact that properly used, VAERS can be useful.

And the Flip-flop award goes to. . .

What the VAERS website says: "I have read and understand the preceding statement."

What Peter Harris read: "I have read the preceding statement and am at liberty to misinterpret and/or distort it, to the maximum extent possible."

I’ll make it clear for you this time, using simple monosyllabic terms.
VAERS is not accurate. It’s run by the medical system, to cover up the medical systems mistakes. This is not an independent reporting system, and it’s open to broad range contamination, in its collection, and formulation of data.

Monosyllabic terms. Yes indeed.

@LW

Bon vous comprenez.

I do not consider VAERS to be inaccurate source of information, regarding the adverse affects of vaccines.

VAERS is not accurate. It’s run by the medical system, to cover up the medical systems mistakes. This is not an independent reporting system, and it’s open to broad range contamination, in its collection, and formulation of data.

One of these things is not like the other. Oh Ooops.

Like all dribblers, they need spoon feeding.

As i stated earlier.

"Yes, the auto-correction got it wrong, it was meant to say. “an accurate…”
But despite that, it’s quite clear what I think of VAERS, and it’s dodgy nature of reporting."

So even though PH considers VAERS dodgy, he still uses it to support his stance that the HPV vaccine caused 32 deaths...

Logic. I can haz it?

It seems more dribblers need to be spoon fed.

As I said earlier; in reply;

"Again, doesn’t really need explaining!

Deaths, as opposed to lets say, localised skin rashes, cannot be misreported, even in a dodgy system such as VAERS.
Deaths, at least need a certificate."

Yet Peter Harris went on to use it to make a "point" or somesuch.

@PH
Still a death after vaccination, reported to VAERS doesn't have to mean both are linked.

Oh, I see.
So you get run over by the 9:15 bus, on your way to the vaccination clinic.

Not to mention the cases in VAERS of children turning into Wonder Woman and the Incredible Hulk (the latter was removed after the individual who entered it was contacted with a request to delete that record).
https://en.wikipedia.org/wiki/Vaccine_Adverse_Event_Reporting_System#Li…

It is clear that Peter Harris is NOT a Turing test failure. Anyone able to comprehend the concept of a Turing test couldn't screw up the logic subroutines as badly as Peter's are operating.

I remember once arguing with adults the same way Peter Harris does. Then I started kindergarten and had to grow up.

Peter, you are like the Black Knight in Monty Python and the Holy Grail. Utterly defeated and oblivious to that fact. At least you have some use as a chew toy.

https://www.youtube.com/watch?v=QdxC-lNOFJo

It's gratifying to see yet another addition to the antivax literature. There's a new book out by Brett Wilcox (foreword by Kent Heckenlively) called "Jabbed: How The Vaccine Industry, Medical Establishment And Government Stick It To You And Your Family".

https://www.amazon.com/Jabbed-Vaccine-Industry-Establishment-Government…

Mr. Wilcox, who previously authored such classics as "21 Solutions To 21 Relationship Bloopers", is described in the book's Amazon blurb as "a Licensed Professional Counselor and agnotologist (one who studies culturally induced ignorance or doubt)."

Dang, I should have warned you all to double-shield your irony meters before I posted that. :(

Dammit! That's the third irony meter that's burned out this week!
You really outta warn people earlier than that. ;)

DB:
I looked up 'agnatology', and found the term was coined by Robert N. Proctor in his book of Cancer Wars: How Politics Shapes What we Know and Don't Know About Cancer. While 'culturally induced' may be in the broad definition, in practice 'agnatology' is primarily concerned with the deliberate production of ignorance" e.g. in Proctor's book "the tobacco industry's advertising campaign to manufacture doubt about the health effects of tobacco use. Under the banner of science, the industry produced research about everything except tobacco hazards to exploit public uncertainty" (Wikipedia).

Thus, no doubt Wilcox imagines himself uncovering how "The Vaccine Industry, Medical Establishment And Government"conspire to deliberately produce ignorance about the evils of immunization. So yet another form of legitimate inquiry had it's terms co-opted, hollowed-out, and refilled with hooey in the AV funhouse mirror alt-reality...

The Amazon blurb is filled with Insolence-begging hoots:

Germs are bad and vaccines are good. Period.
Questioning the dominant paradigm results in shaming, scapegoating, and in some cases tainted reputations, lost careers or worse. Such an environment is not the domain of science; rather it’s the breeding ground of tyranny and fascism.
Corporate and personal profits from the burgeoning vaccine pie depend upon the larger-than-life, myth-based vaccine paradigm. Sociopaths inject this paradigm into medical journals, medical curricula, congressional hearings, regulatory policies, White House statements, executive orders, and finally into the minds of vaccine believers.
Million dollar sociopathic propaganda campaigns ensure that vaccine believers unleash their wrath against the vaccine informed, effectively keeping The Herd immune to the truth and ready and willing to roll up their sleeves to any and all vaccines...
In spite of and in part because of the propaganda, the day is soon coming when consumer distrust of vaccine sociopaths will gut the vaccine industry. Don’t expect the sociopaths to roll over, play dead, and sacrifice their multi-billion dollar generating machine, however. Human bodies are, after all, their ATMs. The waves of coercive and mandatory vaccination laws that are rolling out demonstrate that if sociopaths are denied voluntary access to our bodies, they will take them by force. A vaccine informed public is the only thing that will have the power to stop them and to hold them accountable for their crimes.

Thankfully, Wilcox is so over-the-top with the "sociopath" CT that reasonable people will instinctively shy away from the ranting man on the soapbox. Because, unfortunately, good public health practice on vaccines is socially vulnerable to such arguments for several reasons. First, of course, the science isn't that for lay folk to grasp, and humans are hard-wired to over-credit the post hoc 'logic' in the anecdotes of perfect tots 'breaking' immediately after their shots. But it doesn't help that vaccines come from an industry well-known for documented bad behavior in other areas, and policies/procedures that are anything but transparent. It also doesn't help that 'skeptics' are so afraid the 'sheeple' will be swayed by anti-vax messaging, they repeatedly respond to anti-vax messages by asserting 'This should NOT be distributed' - Vaxxed being the prime example. While this is not 'censorship', it's still censorious enough to appear consistent with hinky repression. Especially since AVs can't mount any argument beyond smoke and mirrors or outright lies, it's far better to say "Bring it on, Del! Show me you're best stuff, and watch me knock it into Waveland Ave."

Anyway, NPD-warped AVs imagining public health advocates as "sociopaths" is pretty funny. If it breaks your irony meter, though, you must have a very old model, as this kind of think is pretty much paradigmatic within the media culture of postmodernity.

How can anyone claim that vaccines, which are known to often contain aluminum, mercury, or albumin (a protein in eggs that is a common allergen) are safe for EVERYONE? Lately it has been shown than some vaccines also contain glyphosate, the main ingredient in Monsanto's Roundup pesticide (as well as in some pesticides made by other manufacturers, since Roundup's patent has expired). While studies have been done on glyphosate's safety when SWALLOWED, no studies have been done on its safety when INJECTED. Parents have legitimate reasons to be concerned about vaccinations. Please do not accept the prevailing view so blindly. Follow the money.

Why don't we follow the money?
Vaccines aren't even properly reimbursed by insurance companies, resulting in pediatricians administering the vaccines at a loss. (I was conversing with a pediatrician just the other day on that very subject. He loses money on vaccines.)
Meanwhile, the companies making vaccines get around 2% of their income from vaccines. Some big money there, huh?
http://www.philly.com/philly/blogs/healthy_kids/The-truth-Why-pediatric…

And seriously, aluminum? One of the most plentiful metals on the earth and you claim that it's a health risk? I guess humans should never have moved to this planet!
Oh wait, humanity evolved here, with all of that nasty aluminum all over the place.

@ Sadmar

It also doesn’t help that ‘skeptics’ are so afraid the ‘sheeple’ will be swayed by anti-vax messaging,

This fear is not exactly unfounded. The spreading of lies is not without consequences.

Grab a man (or woman) in the street, tell him the gov and/or Big Pharma are covering up some messed-up product, you will get his ear.
Because we all have in our memory examples of shitty things one or the other has done. Human beings cheat, distort the truth and lie all the time, so why not about vaccines?

Wakefield article and interviews did sway a number of people in the UK and other countries. It took more than a decade to inverse the narrative in the press.
On another topic, South Africa officials were swayed by articles and advocates from the HIV denier circles.
Lies kill.

In my country a few years back, a French-German science-friendly TV channel broadcasted a documentary about the evils of aluminium in general and its presence in vaccines (never mind the quantities involved and the dubious science). People (like my parents) were swayed by this documentary.
I don't have the resources to make a counter-movie and sit my parents through it. Forcing people to watch some movie is no better than censoring them from watching another movie, anyway.
In addition, I will be losing my time with my dad, he is a true believer of the evils of Big Pharma, Monsanto and the rest. He even fell for homeopathy at some point. Whatever his idiot son of a biologist could say had no bearing on his beliefs (say a lot about my communication skills; but again, since he won't listen...).

Tell you that: come to my country, and convince some of my compatriots to accept to eat GMO food. No cheating by waiting 2 or 3 generations.
Bring some riot police armor, you may end up facing a lynch mob.

If you manage to do it, then I will believe that propaganda and culturally deep-rooted opinions could be fought with fact-based public debates.

tl;dr: while I see your point about appearing censorious is not helping, I'm afraid that debuncking lies is more complicated than just confronting the other's propaganda.
If people have made their opinion, they won't listen to your facts.

How can anyone claim that vaccines, which are known to often contain aluminum, mercury,

Oh god. It's Fendlesworth again.

@Margaret:

Have you never heard of exemptions for the egg-allergic from albumin-containing vaccines?

Although MMR is safe, and non-egg-containing versions of the flu vaccines are available.

Lately it has been shown than some vaccines also contain glyphosate, the main ingredient in Monsanto’s Roundup pesticide (as well as in some pesticides made by other manufacturers, since Roundup’s patent has expired).

When said "evidence" appears in something that's not a YouTube video, then we'll talk.

And Travis S. go eff yourself already.

flu VACCINE

Also, straw man. Nobody claims all vaccines are safe for "everyone." Medical exemptions exist for a reason.

I would like to subscribe to Narad's cocktail recipe book. I really should not be drinking.

A question for the scientists here (sent from my pbone with .o preview, please forgive any errors).

So the anti Alluminium (Al) mob get upset when Al ijected into the muscle doesn't get excreted in the urine. Chunks get phagocyted instead, so as the Al is now in a cell, could that Al not end up being excreted in the feaces instead? Anybody ever test that? Or even, as the Al used is a salt, leave the body via the sweatglands? Could you even check that?

@Sadmar and Dangerous Bacon re the Brett Wilcox book:

1. At least he's not a doctor
2. He seems parasitic in his latching onto anti-vaccinationism with is only link in his book plug being that right after he and his 15 y/o son ran across the country to protest GMOs, William Thompson then came forth (blah blah blah). That's the weakest tie-in I've seen in a while.
3. He lives in Sitka, Alaska. Rumor has it grizzlies prefer unvaccinateds because they are more "natural" and "crunchy" so if he still likes to go running, there is hope for resolution of Wilcox.

(Hey, what do you want from me, now that I've been exposed as a sociopath by the all-seeing-eye of Brett Wilcox? )

@Peter Harris

@Peter Harris Check out this photo.

@Jay

Aluminum that does not get absorbed is excreted int he feces. Al that is absorbed eventually makes its way to the blood, which carries it to other tissues, predominantly the bones and lungs. Eventually, that aluminum will get excreted in the urine and bile. More info here.

@Todd

That's a great post thanks, cleared things up quite a bit. My question's pointless as the quantity is so low, that it would just spread about with the rest of Al.

Though you did mention bile, so there is a faecal route, that might annoy those anti vaxers quoting Flarend's "In vivo absorption of aluminium-containing vaccine adjuvants using 26Al".

I would like to subscribe to Narad’s cocktail recipe book.

Try searching for "Yamuna Devi" + beverages or "sparkler," etc.

My 16 year old was due for 3 shots at his last doctor visit, all boosters but only one required before school started (WA added a second varicella to the school mandate). He has hustorically been very difficult for all medical procedures, so we were not sure how to go. His pediatrician suggested we could bring all three in, start with the required one and see how it went for the other two. I said "won't that spoil the other two if we can't use them?" She said "we'd need to use them within an hour, but don't worry about wasting them. The cost is not what matters to us, taking care of Philip is. If we have to throw them away, we will."

So, yeah. All about the money.

(We actually got three nurses in and did all three simultaneously and all he said was "ow." Victory!)

@Peter Harris (217) 9/19/2016

At the moment I'd rather enjoy my dinner than do a detailed reply, so let me offer some thoughts. Until you give us more information about what treatment methods you do and don't use, we can only presume that those include the full range of naturopathic methods including homeopathy which seems to be on every term of the curriculum at Bastyr University, for instance.

I'll have to find the comment but I remember a comment about naturopathy being about preventing disease. It's quite ironic then that you spend so much effort arguing against the most effective method of preventing diseases yet discovered which saves millions of lives ever year.

Supplements are commonly recommended by everyone from the sales person at the local health food store to naturopaths like you. Since you consistenly point out even side effects that were only incidental to the testing of vaccines, a balanced assessment of both methods must include the understanding that supplements also have side effects that have been documented up to and including death.

Since you have some process for deciding which methods are safe and effective and which ones not, perhaps you would enlighten me.

Can you name three treatment methods that have been generally abandoned by naturopathic schools and doctors in the last 10 or 20 years because they have been found to have unacceptable side effects or because better treatment methods have been found or developed?

Emma Crew: "(We actually got three nurses in and did all three simultaneously and all he said was “ow.” Victory!)"

Woot! Amazing how kids just seem to grow up a bit more each year. Actually I always get surprised at what changes, even now, and my youngest is 22 years old. (now I need to finish putting together the care package for youngest who has moved to another state... with just a few sniffles because I miss her)

Peter Harris:

I am actually in the market for some medical advice and am willing to listen to your recommendations.

My wife has multiple myeloma, stage 3. It is the IgA variety, with the kappa light chains being the culprit. She has an abnormal hyperdiploid karyotype, with multiple trisomies PLUS the P53 deletion. She is refractory twice (VdT & Rd).

What treatment would you suggest and why do you think it is appropriate for her specific situation?How will you address the P53 deletion?

Thanks in advance!

Opus, You are awesome and I am wishing your wife and you the very best.

What treatment would you suggest and why do you think it is appropriate for her specific situation?

I expect it will involve coffee enemas and juicing, because altie cancer treatments always involve coffee enemas and juicing.
Why? Who the fzzk knows?

How will you address the P53 deletion?

Dark roast, maybe?

@Opus,

Wishing your wife all the best in treatment and luck.

I don't know about the P53 deletion,but there's a P47 still in its case in one of the remaining B36 bombers on a farm in northeast Ohio. Maybe that would fill the gap.

Just kidding. I really hope she gets well.

Thanks for the best wishes. She starts a new chemo treatment next week so we have our fingers crossed.

A little light reading on the P53 gene, for those who might be interested. Only $1.99 on Kindle!

https://www.amazon.com/p53-Gene-that-Cracked-Cancer-ebook/dp/B00NB14L6Y…

While the pro-VaXXers here are derping along, the death toll of murdered Holistic doctors has reached 50!

http://truththeory.com/2016/06/26/50-holistic-doctors-have-mysteriously…

One of the latest "mysterious" deaths involved Rod Floyd, a licensed chiropractor and associate professor at Palmer College of Chiropractic!

The intrepid reporters at NumbNuts News have revealed that the killings appear connected to the use of nagalase (or nagalese)* in vaccines, which it seems is what makes them toxic, along with aborted babies, goat horns, barrels of Roundup and other Toxins.

I'm not sure what can be done, other than organizing civilian militias to guard every Holistic practitioner in the country 24/7. Anyway, that would be a start.

*"nagalese" is also defined as the language in a marital contract where one party is reminded of the obligations to the other party that are not being met.

And here I thought that "nagalese" was the language of the serpent people.

And here I thought that “nagalese” was the language of the serpent people.

More recently it would be the common language of Nagaland.

And here I thought that “nagalese” was the language of the serpent people.

It is an oblique reference to snake oil.
It's in your vaccines and chem trails! And children's ice-cream!
http://2.bp.blogspot.com/-2dtD523YhsU/VjVl5evvM4I/AAAAAAAASC4/AcVdxSVrc…

http://www2.mbc.ca.gov/BreezePDL/document.aspx?path=%5cDIDOCS%5c2016090…

Check out this lawsuit against Dr. Thomas S Powers of Open Care Medical in Santa Ana. Patients be careful

After SB 277, online medical exemptions to school vaccine mandates are now for sale

oracknows — Fri, 29 Jul 2016 07:30:49 +0000

After SB 277, online medical exemptions to school vaccine mandates are now for sale

After writing about the failure of state medical boards to discipline physicians who practice quackery and an apparent notable exception in Tennessee just yesterday, my attention was brought back to California and the topic of SB 277, the law enacted last year that, as of July 1 this year, eliminated non-medical exemptions to school vaccine mandates. As anyone who’s read this blog for more than a year knows (or anyone who’s just paid attention to the political battle to pass SB 277 lsat year in the wake of the Disneyland measles outbreak), once the battle was over and antivaccine activists lost, their attention turned immediately to finding ways to get around the law. Unfortunately, the law provided a way.

There are now three states in the US that do not allow nonmedical exemptions to school vaccine mandates: Mississippi, California, and West Virginia. Not surprisingly, just as antivaccine parents have tried to falsely claim religious exemptions in states that only Each of them has different standards for documentation of what is required to qualify for a medical exemption that fall into two categories. The most strict is West Virginia, where requests for medical exemptions are reviewed by an Immunization Officer, who determines if they are appropriate “based upon the most recent guidance from the Advisory Committee on Immunization Practices (ACIP), the American Academy of Pediatrics (AAP), and the American Academy of Family Physicians (AAFP) with respect to medical contraindications or precautions for each vaccine.” In Mississippi and, now, in California, all that is required is a letter from a physician.

You might ask: So what’s the problem with just letting any old physician write a letter supporting a medical exemption to school vaccine mandates in California? It’s a system that seems to work very well in Mississippi. Here’s the problem: California is not Mississippi. One key difference is that California is has a lot more antivaccine parents; indeed, it is arguably the epicenter of antivaccine activism in the US, which is why the resistance to SB 277 was so loud and public. It’s also why I’ve said on more than one occasion that when the outbreaks occur they’ll start in California. Another key difference is that California is chock full of antivaccine and antivaccine-sympathetic pediatricians and family doctors who have seen a lucrative business opportunity selling medical exemptions to all of these antivaccine parents. Indeed, I speculated whether this would happen right around the time SB 277 passed.

So did others:

@gorskon @MyHealthyBabies @JayGordonMDFAAP No doubt some CA doctors will profit from this. I hear Bob just ordered a new Lamborghini.

— Greg Hinson (@ackdoc) June 30, 2015

Dr. Bob, of course, is Dr. Bob Sears, the antivaccine-sympathetic pediatrician who’s’ most famous for a book full of bad advice on vaccines and, during the political battle over SB 277, prone to going full Godwin over the bill. Consistent with that, it didn’t take Dr. Bob very long at all to start giving seminars on how to get medical exemptions and avoid school vaccine mandates under SB 277. At the time, mere weeks after the passage of SB 277, Dr. Bob focused on non-evidence-based reasons for medical exemptions and ways to get around the law other than home schooling. For example, he suggested getting an Individualized Education Program (IEP) that specifies regular classroom time. IEPs are mandated by the Individuals with Disabilities Education Act (IDEA) for children with special needs. If a child receives special educations services, he must have an IEP that includes a description of how the child is doing, the child’s specific annual education goals, specific special education supports and services that the school will provide to help the child reach those goals, modifications and accommodations the school will provide to help the child make progress, and other information. To comply with federal law, SB 277 specifically stipulates that the law “does not prohibit a pupil who qualifies for an individualized education program, pursuant to federal law and Section 56026 of the Education Code, from accessing any special education and related services required by his or her individualized education program.” So Dr. Bob recommended that parents seek an IEP, even for “minimal speech delay or learning issue” when the child is 2 or 3 years old so that they have it later and will be “protected” from SB 277 for the entire child’s school career.

Less than three months ago, I learned that there was now basically a cottage industry of bogus medical exemptions, with physicians such as Dr. Tara Zandvliet, Dr. Kelly Sutton, and, of course, Dr. Bob Sears selling medical exemptions based on medical reasons not supported by science.

What I don’t talk about that much on this blog is how often people write to me about the issues I discuss on this blog. Sometimes it’s just abuse from people who don’t like my point of view on alternative medicine, vaccines, and science. Sometimes, it’s people asking for medical advice, which I really can’t give, except in general terms. Sometimes it’s people telling me their stories about encounters with quacks. Of these, reading stories of patients whose family members have chosen, for example, Gerson therapy instead of real medicine are the hardest to read and steel me to continue what I do. Sometimes people let me know about something that I might want to blog about. This was one of those times, as it was the story of a parent and Dr. Bob’s vaccine exemptions that demonstrates how bogus these exemptions are.

I won’t tell you whether this was a male or a female, and I’ve stripped all potentially identifiable information from the genuine letters generated by Dr. Bob’s office in support of medical exemptions for their children. I’m going to refer to this parent as “he” for convenience and based on the default to male pronouns in English. Basically, this story developed out of, unfortunately, divorce, where the person who wrote me is not the custodial parent. He describes himself as formerly antivaccine but now pro-vaccine, which, as described, caused a rift in the marriage to the point where his spouse left. This is, unfortunately, a story I’ve heard too many times. In any case, this person who wrote me wants the children vaccinated. His spouse, however, does not, and his spouse stymied him by getting a medical exemption from Dr. Sears. Basically, his spouse filled out an online history form, paid a fee of $180 per child, and Dr. Bob’s office spit out these two boilerplate exemption letters. Nothing about them has been altered, other than to white out the names, dates of birth, and the date of the letter. (I wouldn’t want Dr. Bob to be able to figure out who it was based on the reasons for exemption and the date issued. Let’s just say that it was within the last four months or so.) Here are the letters (click to embiggen):

Note the bogus reasons:

Family history of Autoimmune Disorders, Inflammatory Bowel Disease, Neurodevelopmental Disorders, Psychiatric Disorders.
His own current medical problems.

My reader described how he showed these letters to the children’s regular pediatrician, who was appalled. By e-mail (and, by the way, I’ve saved every e-mail), I urged him to report Dr. Bob for what, in my opinion, is highly unethical behavior and failure to meet the standard of care. After all, Dr. Bob never actually examined the patient and appears never to have verified even the medical history. Basically, he appears to have an online form that a parent can fill out and get a medical exemption for pretty much any condition. I was assured that a report to the Medical Board of California has been filed.

To be honest, given how many quacks practice in California, I’m not as optimistic as I’d like to be that anything will be done about Dr. Bob’s issuing boilerplate medical exemptions unless there are a lot of complaints. That’s the problem. The very parents who take advantage of such a “service” are the very parents least likely to complain to a state medical board about the physician providing the service. After all, such parents got what they want: an exemption from vaccinating their children. Because they are antivaccine and motivated enough to seek out such a service, they really don’t care how they got the exemption; all they care about is that they got it. Cases like this one, where one parent has become pro-vaccine and objects enough when the other parent uses a physician like Dr. Bob to obtain a medical exemption are almost certainly comparatively rare. No doubt Dr. Bob will get that new Lamborghini if he decides he wants it.

Still, I’m hopeful that publicizing this story, with the permission of my reader, will draw some attention to Dr. Bob. In the meantime, I referred my reader to people who can help find legal help if he doesn’t already have it. If ever there were a case that cried out for investigation by the Medical Board of California, this is it.

oracknows Fri, 07/29/2016 - 03:30

Tags

school vaccine mandate

https://popehat.com/2016/06/14/lawsplainer-its-not-rico-dammit/

This is truly appalling. Sears needs to lose his license immediately. He's a direct threat to public health and is practicing medicine without examining patients as well.

If there was ever a time for other pediatricians in California including those in the California chapters of the American Academy of Pediatrics. including Dr. Richard Pan, to publicly call out a pediatrician by name and demand action by the medical board of the State of California, it is now. If you California pediatricians won't speak up on this, then why the hell did you bother to even put SB277 on the books? -- signed, an Arizona pediatrician who despises Sears for what he has done to vaccination rates in my state and can't understand why you tolerate him and yours.

Personal note here. My heart hurts for the children in this story. I am a stepmother and muy daughter's father and I divorced when she was in elementary school. Co-parenting isn't easy; when parents are divided, the children suffer.

One of the lawsuits against SB277 tries to make a big issue from the counties' effort to oversee medical exemptions, under the heading of "doctor has discretion."

They seem to miss the fact that medical discretion is never unsupervised or without limits.

Part of the irony is that the opponents complain SB277 discriminates against those without means - but who are the ones who can get cash-only medical exemptions for sale? Not the ones without means.

Personally, I would complain to the Medical Board of California, as there are a number of issues that, from my perspective, could potentially put Dr. Bob's license in jeopardy. As Chris pointed out, according to this parent Dr. Bob is making medical recommendations without actually seeing and examining patients. That alone is bad enough, but he's also making recommendations that are not considered part of the standard of care and go against nationally accepted guidelines from various professional societies and the CDC. If the medical board actually had any balls, that would be enough to initiate an investigation and hearings.

This is disgusting. Dr Sears is blatantly lying. "I am the pediatrician for XX". No, you aren't, you lying sack of S***. You sent out a boilerplate letter in response to an online request? What kind of pediatrician are you? I wouldn't trust you to care for anyone or anything. They'd probably die in your care, and you'd lie to me as to what happened.

For example, he suggested getting an Individualized Education Program (IEP) that specifies regular classroom time. IEPs are mandated by the Individuals with Disabilities Education Act (IDEA) for children with special needs.

I have heard anecdotally that for several years there have been parents gaming special education requirements in order to get additional attention for their special snowflakes. You can guess where these parents fall in the socioeconomic spectrum. One side effect of SB277 will be to make this phenomenon even more pronounced.

Part of the irony is that the opponents complain SB277 discriminates against those without means – but who are the ones who can get cash-only medical exemptions for sale? Not the ones without means.

If you accept the faulty postulate that vaccines are always bad, the claim that SB277 discriminates against people without means logically follows. The sort of doctor who would offer medical exemptions for sale--Dr. Bob being a classic example--tends not to accept medical insurance, so only those parents who can afford to pay cash will use such services. It's the same kind of deal as gaming special education requirements: the parents who play that game are the ones with the spare cash available to hire compliant "experts". Poor parents don't get medical vaccine exemptions or special education plans for their children unless the kid really needs it.

To be brutally honest, the blame here falls not on antivax parents or even antivax quacks, but entirely upon the medical profession itself for its persistent failure to regulate itself consistently and effectively. Grifters and incompetents will always exist in any profession; what matters is the mechanisms for identifying and ejecting them before they do harm. And for all the fantastic advances that medicine has made in other aspects of patient care, this is one area where it remains frighteningly stuck on the wrong side of Hippocrates.

Developing more robust and effective process improvement and internal/external regulatory systems may not seem nearly as glamorous as discovering a new antibiotic or surgical procedure, but is just as critical to improving and maintaining that care; so if the health profession can't even take out its filthiest trash then where else might it be cutting on corners? Because people suffer and die when that happens.

Would this put Sears into RICO territory?

Re RICO: No.

(I apologize for the "stupid" in the language; there's no reason for you to know this, and I used that post because Popehat's analysis is great, but I realize the language can offend).

Wow - just when I think Dr. Bob can't sink any lower, he still manages to surprise me. It's been obvious since SB277 first passed that Dr. Bob intended to turn a profit by basically selling medical exemptions to anyone who was willing to pay for them, but I never imagined he'd do it without even seeing the children who are supposed to be his patients. I'd like to think that this will be the last straw that finally gets the medical board to take action against him; however, I notice that he carefully avoids stating that he actually examined the patients he's writing exemptions for, instead, he states that he "evaluated the past and present medical history and family history," which is technically true (at least, its impossible to prove that he doesn't at least read the info provided by the parents, although I personally wouldn't be surprised.) There's still the fact that his exemptions aren't based on accepted medical guidelines, but if the medical board was willing to act on that that presumably they'd have done it a long time ago.

So where does this leave us? The entire point of SB277 wasn't so much to improve over-all vaccination rates as to eliminate those pockets of low vaccine uptake that act as foci for new outbreaks. With exemptions this easy to get, it seems likely that those unvaccinated pockets will persist, which means that sooner or later there will be another measles outbreak in California, which antivaxxers will then turn around and use as evidence that vaccines aren't effective.

I looked up California's school immunization rates for the last school year (2015 - 2016), but they include personal belief exemptions (PBEs), so apparently SB277 hadn't taken effect yet. Does that mean we'll have to wait until next year to determine whether SB277 worked, and where the remaining pockets of low vaccine uptake are? And if there are still counties where less than 90% of kids are still going to school unvaccinated, what can be done about it? I'm guessing the chances of amending SB277 to require oversight similar to West Virginia's are slim to none.

Incidentally, while several counties had worrisome numbers of PBEs (over 10% in some cases), Plumas county stood out as having an unusually high number of medical exemptions - 6% (compared to < 1% for most counties; the next highest county only has 2.9%) Any Californians here who might have an idea why that might be?

@Sarah A: Yes, basically we will have to wait and see how SB277 affected rates.

There are also two lawsuits pending. As I mentioned, one of them has a large section about the effort to crack down on medical exemptions. I cover the latest in that here - it links to the original post, too: http://www.skepticalraptor.com/skepticalraptorblog.php/california-sb277…

^ That should be, "where less than 90% of kids are going to school vaccinated."

@Has #7: Arthur Kaplan spelled it out clearly (to me) last yeat that the California Medical board already had sufficient reason, power and prior example to take Sears' license, but clearly they have not. https://www.washingtonpost.com/opinions/revoke-the-license-of-any-docto…

The tide seems to be turning slightly, according to this Medscape poll:

The percentage of clinicians who see a rise in the numbers of families willing to get their children vaccinated increased again in the Medscape Vaccine Acceptance Report 2016 , published today.

Last year, when healthcare professionals were asked about vaccine acceptance over the past year in a similar Medscape survey, 42% said that overall vaccine acceptance had increased. This year, 46% believed the same. At the same time, 12% of clinicians reported that they saw less acceptance of vaccines this year.

http://www.medscape.com/viewarticle/866754

...filled out an online history form, paid a fee, and Dr. Bob’s office spit out these two boilerplate exemption letters.

Hmmmm... I wonder if I can get an exception for the neighbors dog? Anyone know where to find the portal? My Google-Fu is weak on this one.

@Sarah A #10

Both of the high counties have a pretty low number of total kids so it could just be a signal to noise kind of cluster issue rather than either a doc signing off or something causing more disease.

Might have to trend it over a few years to see if it is some odd blip or indicative of a pattern.

I know this is somewhat off topic, but are you going to be doing anything on Green candidate Jill Stein? She has apparently said "There were concerns among physicians about what the vaccination schedule meant, the toxic substances like mercury which used to be rampant in vaccines. There were real questions that needed to be addressed. I think some of them at least have been addressed. I don’t know if all of them have been addressed." and "Like any medication, they also should be — what shall we say — approved by a regulatory board that people can trust. And I think right now, that is the problem. That people do not trust a Food and Drug Administration, or even the CDC for that matter, where corporate influence and the pharmaceutical industry has a lot of influence."

Bogus food safety certificates going for $450 in Massachusetts. Isn't this what the quack MD (QMD) Sears is doing. At least one food inspector is suspended and will probably be fired (and EHS License revoked) for this.

The food store that lead to this investigation was also busted for selling Viagra; it was a butcher shop.

Can anyone explain the link between POTS and HPV-vaccines?
http://www.ncbi.nlm.nih.gov/pubmed/25882168

@James Castle #19

I'd have to get the whole paper to really comment but I did find this commentary http://www.skepticalraptor.com/skepticalraptorblog.php/hpv-vaccine-adve…

I know HPV isn't required for kindergarten, I'm not even sure it is required for middle or high school so is it even one of the vaccines mandated by sb277, and if not how is it relevant to this discussion?

http://www.skepticalraptor.com/skepticalraptorblog.php/hpv-vaccine-adve… see if that link works.

@Johnny #16:

An exception for your neighbour's dog? If you were to do that, you'd be following in a proud tradition of gifting domestic animals with uncanny human powers.

HPV is not mentioned in SB277. The diseases to be prevented are:

(a) A means for the eventual achievement of total immunization of appropriate age groups against the following childhood diseases:
(1) Diphtheria.
(2) Hepatitis B.
(3) Haemophilus influenzae type b.
(4) Measles.
(5) Mumps.
(6) Pertussis (whooping cough).
(7) Poliomyelitis.
(8) Rubella.
(9) Tetanus.
(10) Varicella (chickenpox).
(11) Any other disease deemed appropriate by the department, taking into consideration the recommendations of the Advisory Committee on Immunization Practices of the United States Department of Health and Human Services, the American Academy of Pediatrics, and the American Academy of Family Physicians.

So the POTS HPV vaccine question is irrelevant here.

I looked up California’s school immunization rates for the last school year (2015 – 2016), but they include personal belief exemptions (PBEs), so apparently SB277 hadn’t taken effect yet.

That is correct. The law went into effect July 1 2016. Some California districts start as early as mid-August. California collects data from all schools and publishes said data (at the school level) in late January or early February, so we will have to wait to see then.

Johnny, go for it.
I'd love to see someone register some nonexistent kids for Dr. Bob's exemption letter. If he issues them, he's toast, or should be. It's an old tactic but it works in situations like this. I can't afford it myself, but if someone tries it, I'll kick in the $10 that I never got around to sending Bernie (and now I'm glad I didn't).

And if there are still counties where less than 90% of kids are still going to school unvaccinated, what can be done about it?

The county data are irrelevant, really, you have to look at the very granular school data. It gets confusing there, too, because there are a lot of charter chains especially in some of the rural counties.

The other thing that changed in California is that the Department of Education got tough on reporting "conditional entry" -- kids allowed into school who aren't fully vaccinated for age, but who have a plan to vaccinate. A lot of the schools were doing a lousy job of following up to see if these students' vaccine plans were actually carried out.

Additionally there's some anecdotal evidence that people who intended to vaccinate but hadn't gotten around to it were offered PBEs by school administrators, rather than conditional entry -- but conditional entry management is more work for the schools.

@ Sarah A.

The CA county-by-county %s of PBE and PME aren't that illuminating. If you just look for the highest % of exemptions, you miss the counties that have contained vulnerable clusters: Alameda, Marin and Sonoma in NoCal, and LA, Orange and San Diego in SoCal. There are many factors at play in outbreak risk: the % of unvaxed kids in county X may mean little if they don't come in contact with one another due to geography, social patterns, etc. etc. A more indicative stat would be the %s in actual individual pre-schools and kindergardens, though that misses the home schoolers who may mix with other kids at public places.

As poor as county numbers are, the numbers that seem meaningful to me are the healthy increase in vax in Alameda (which includes Berkeley and is solid metropolitan Democrat), the only slight increase in Orange (Dr. Bob land, solid Reaganite Republican), and the actual decline in Sonoma (well-heeled granola-crunchers stereotype). But, for Sonoma for example, that only represents a raw number change of about 50 kids, so that's not exactly a reliable indicator of the effect of SB277, as too many other things could be at work in the short term.

@Johnny #16

It is evading my google fu as well, but I suspect with the online history form it probably is some system where you call the practice and get whatever you need to get a log in for their patient portal and then the form comes up there.

Might need to be that way to ensure the info coming in is on a secure server ala HIPAA

Plumas county stood out as having an unusually high number of medical exemptions – 6% (compared to < 1% for most counties;

Plumas County has <21,000 residents total. The enrollment in Plumas county public schools is somewhere between 2,100 and 2,200 kids. There are a couple of alternative medicine practices in Quincy and I think one in Portola (the two towns). One script-happy doctor & a "crunchy" parents group is all it would take to swing those relatively small numbers.

Let that be a lesson in not relying on percentages, but looking at the absolute numbers.

In the course of advocating for SB277, we found a couple of other pockets of high numbers of medical exemptions. One resolved to being a magnet school for medically fragile children; the others were probably clusters of fearful parents.

So what medical history is accepted? Just the parent's word? Do they require supporting documentation from another Dr confirming the conditions? Are naturopath reports included as valid?
Freaking appalling.

I wish someone would start a go fund me or something just to film the process of filling out the information online to show what a scam this is.

This is disgusting.

I do not believe Sears has gone to an electronic medical record, putting him in a now small minority of physicians. (http://giving.biola.edu/news/2015/nov/16/building-foundation/ ). I note this because with an EMR, you can't fake a note like you can with paper charts, and I wouldn't put it past this slimy SOB to try and fake a doctor visit for this child he didn't see.

Also, this video I cite gave me some insight as to why Sears really doesn't give a sh*t about whether you vaccinate, as he clearly has this view that "knowing God made us makes me a better doctor". Well, f*ck a duck, Dr. Bob--clearly you only went to med school to get that license and if some poor 5 week old infant died of pertussis in San Diego a few weeks ago, well that's God's problem and not yours.

What a pompous, ignorant, greedy, vile POS.

So what medical history is accepted? Just the parent’s word? Do they require supporting documentation from another Dr confirming the conditions? Are naturopath reports included as valid?

All good questions. Here's the actual text of the bill.

120370. (a) If the parent or guardian files with the governing authority a written statement by a licensed physician to the effect that the physical condition of the child is such, or medical circumstances relating to the child are such, that immunization is not considered safe, indicating the specific nature and probable duration of the medical condition or circumstances, including, but not limited to, family medical history, for which the physician does not recommend immunization, that child shall be exempt from the requirements of Chapter 1 (commencing with Section 120325, but excluding Section 120380) and Sections 120400, 120405, 120410, and 120415 to the extent indicated by the physician’s statement.

So anything a licensed physician attests to...

Dr. Bob reminds me on 2 Dutch psychiatrists, who declared healthy people to suffer from mental health problems, so they could use their falsified medical files to get income support.
They are stripped from their licenses and can't work as psychiatrists anymore.
There is still some criminal investigation going on.

Seems like that father has a good malpractice case. Judges are supposed to look at evidence and only allow scientific facts, so the case could be a simple source of money. Plus Dr Bob sears insurance company is likely to cut him off.

This practice seems to track to Robert Sears (unless he is listed in the medical liscence database as something else?)http://www.memorialcare.org/find-doctors/physician/robert-w-sears-md

The only website is part of the system and the system has medical records. I dunno if he is trying to do the meaningful use and other such modern stuff that pretty much requires having an eHR and patient portal. For a lot of practices joining a practice group usually as part of a larger health system has been the way to get in.

It is fairly odd an independent practice doesn't have even a hint of a website. Especially given he has his information to the general public stuff website.

If he has some other practice that is off the grid or legally has another name....I may have found the wrong place.

If he is taking an online medical history form as suggested by the father in the main blog post it probably is through some medical portal system. If for no other reason than I can only imagine how much it would cost to hire a programmer to create your own HIPAA compliant system. I recently did my medical history through the portal here as my PCP moved to a new position with a medical school several states over and they wanted me to do one for the new doc taking over.

Sorry system seems to have the usual electronic medical records and patient portal.

Again, Dr. Bob's practice is cash-only, as far as I know. He doesn't take insurance or Medicare; so he doesn't have to worry about meaningful use, pay for performance, etc.

I've never been able to find a web site for Sears' own practice or that run by his dad and brother (both of which operate in the same physical space but his dad's/brother's practice does take insurance. If you are a cash-only "concierge" practice (more like "merde" practice here) like Sears that doesn't take insurance you don't need an EHR, nor would any outside group (insurance carriers, medicaid, etc) be able to enforce/entice you to do so). However forms could still be sent to patients via a secure web portal (hopefully HIPAA compliant) for greater ease for parents. This portal would probably not be able to be found even with the best google fu.

There certainly are a number of business models and it could be only some portion of the practice is in,a system (and there are concierge practices that are part of a healthcare system and aren't always completely off the grid.)

Even our don't take insurance non-concierge clinics around here have much more of a web presence than the good Dr. Bob! Although none of them try to have his fame.

Either way given what little on the web exists I'm pretty sure there isn't going to be any easy way to get to whatever online system there is, it if is even a website vs an emailed fillable form and I'm not sure how much some people distinguish between did it on the computer through email and online at least some of the time.

Well, sometime in the next few weeks, I'll give them a call, and see if I can BS my way in. It'll give me time to come up with a good story, flesh out some details, and practice it a bit in my mind.

Speaking of a portal system:
The best way to do that would be to have something that has no links to it and is accessible through typing in a hyperlink only. My employer has an employee portal. You need an ID and password to access it. If Dr. Bob is doing it like that, you would need to be supplied with a log on and password.
Such a system would probably be to stop honeytrapping. Even if you got in, Johnny, I'm guessing you'd be made to jump through some hoops.

Hey, I'm retired - I have time to make a phone call, type a URL, and make up answers for a web form. The most complicated problem is going to be figuring out how to resolve the billing issues without using my real first name (in case they are reading this), and I think I have that covered. (I have no problem lying to them to get a dog an exemption, but I suspect I could get in serious trouble if I stiff them on the bill.)

I think the two biggest problems are that they might ask a question I won't be prepared for, or that they will want too much money. I don't know what questions I'll have to answer over the phone (having never had to deal with a pediatrician) or exactly how much money is too much (I'll know it when I hear it).

Any law that takes away natural rights deserves to be defeated in any way! The right to decide what to inject into your child's body is your right alone! Studies paid for and benefiting big pharma are irrelevant, in fact there are few if any studies that prove anything! The damage that could be done to a child's immune system is high whether now or in the future. As with all irrelevant laws, it's the right of all to find the loopholes just like the politicians do. If you want credible information, don't listen to the indoctrinated allopathic medical community, they benefit from MONEY and are only educated on what the medical system wants them to know! Those who chose to exempt their children have educated themselves, found out the truth and deciphered the facts to arrive at a sensible, non evasive solution... Congratulations to those intelligent parents who use the system to save their children from tyranny!

You don't have a natural right to send an unvaccinated child to school and risk others.

You don't even have a natural right to refuse to protect a child from disease by not vaccinating the child, even if your reason is misunderstanding the fact that the risk of harm from vaccine is minuscule compare to the risk of harm from disease.

This is off topic, but why do doctors suck ass at following contact precaution protocols. Our policies for things like MRSA and C. diff is that we have to gown and glove up, any equipment that goes in the room most get bleached upon exiting (i.e. my mop handle) then wash our hands when we are done. I have seen so many doctors go into these rooms without gowning up, without putting on gloves, without cleaning their stethoscopes, without washing their hands. WTF. One of these days I'm going to yell at one.

The right to decide what to inject into your child’s body is your right alone!

Might want to rethink that wording.

With Logical @44's comment, my bingo card is full! Where's my prize?

Logical, you don't own your child. You are sadly misled and I hope that your paranoia doesn't kill your child one day.

@Logical (44)

I think your right to pursue the happiness of blaming any conditions you want on vaccines is interfering with your and other childrens' right to life free protected from the threat of deadly infectious diseases.

What method would you propose for resolving that conflict?

he right to decide what to inject into your child’s body is your right alone!

https://www.youtube.com/watch?v=k9oyGK23ohE

Aren't all doctors, even concierge MDS like Sears, required to have malpractice insurance? I think that is what Henry Miller is driving at.

@ Shay #51: If you contract with health insurances, they will want proof of malpractice insurance. As Sears does not take insurances, he may not need malpractice (in California) to carry malpractice insurance ( http://www.mbc.ca.gov/Consumers/Complaints/Complaints_FAQ/Practices_and… ) . Not carrying malpractice would be rather foolish, IMHO, but he could decide not to. If he does have malpractice, there is no requirement for public disclosure as to the name of the carrier. If he has a malpractice carrier, I don't think the carrier honestly cares what he's doing as a physician until it's clear they have to settle on a malpractice case--and then they either raise your premiums or drop you.

Sears does take one insurance plan, he is a Tricare out-of-network provider, and if you search by name and city you can find his office in their directory:

https://www.uhcmilitarywest.com/uhcmw/portal/search/providerbynameresul…

Presumably if he takes TriCare he also has malpractice insurance.

I believe anyone can be an out-of-network Tricare provider simply by requesting to be so. Essentially if it's what I think it is, Tricare families pay him cash at the time of service and he gives them a claim form to submit to Tricare and they have to take whatever Tricare feels like paying for the visit. I still think he would be very foolish not to have malpractice insurance but I still think it's possible he could practice without it given his practice model.

I'm rather suspicious that Dr. Bob does not carry malpractice. First, his practice model does not require it. Second, his practice is a separate business entity from the other Sears doctors' practice at their common physical location. That would make sense for me if I were the other Sears doctors (who do take insurance) as it would protect them from liability of "Dr. Bob" were sued. Finally, I contacted the CA medical board and they told me that in California a doctor does not have to disclose if they are "going bare" (aka don't have malpractice insurance), which is unfortunate, as some states like Georgia and Florida do require doctors to disclose this (and I do think that is reasonable). So quack boy Bob could be flying by the seat of his pants right now, not vaccinating patients while telling others through his books and social media presence not to vaccinate as well as now "seeing" patients without actually seeing him. How nice.

Re. Johnny @ 41:

Find a pediatrician who can help you get your cover story together. There are doctors right here who comment frequently; maybe one of them can volunteer.

What you're doing is a "sting op," similar to what law enforcement does to spot people for further investigation (terrorism, organized crime) and to catch people for specific acts (e.g. seeking to set off a car bomb).

A few things to keep in mind:

= Have your entire cover story down pat, and rehearse answering potential questions from your target. This is where working with another pediatrician would be helpful.

= Keeping your interactions with your target in email and avoiding phone calls with them if possible, will give you time to check with whoever else you may be working with (e.g. another pediatrician) before you write back to your target.

= Never ever suggest or even mention any unlawful activity to your target, and that includes not asking leading questions. Any such activity on your part can be used by your target to argue entrapment (yes, civilians can commit entrapment, it is remarkably easy to blunder into doing it) and escape legal sanctions.

= The usual rule when going after badguys online is "observe and report only, do not interact with persons of interest." Doing a sting op obviously requires some degree of interaction, so practice ahead of time, avoid entrapment, and try to minimize the amount of stuff you have to say to your target to achieve the desired investigative outcome.

= Save all emails, take date/time-stamped screenshots of incoming & outgoing email, websites, etc. If you're going for a legal outcome (shutting down an antivax quack) you might want to forward copies of everything to an attorney. If you're going for a journalistic outcome (writing for publication to attract regulatory attention to the quack), you should still at least check with a lawyer as to what kinds of evidence preservation might be needed in case your target tries to sue you for libel. I'm not a lawyer, I can't give you legal advice.

= If your target catches on to what you're doing, it's not the end of the world, because it'll put him on notice that he's under scrutiny. You can still publish a story that ends with the target catching on and whatever else happens: it might inspire someone else to take up the challenge.

Thanks for taking this on, and may the hunt be fruitful!

So disturbing that any one person could justify their choice forced on another. Those commenting here have LOST SIGHT of the human rights violations they keep chanting for. These medical exemptions shouldn't even be a requirement. they should not exist. it is a choice of the person, not yours, to decide what is put into their bodies.

As has been addressed repeatedly, these people are not choosing for themselves. In the first place, it's their children they are choosing for - their children are not their bodies, and frankly, when I hear reference to "people have a right to decide what to inject into their bodies" when we are talking about immunizing young children, it's troubling. It's a very unhealthy frame of mind, not to be able to tell your child apart from your body.

Second, they are choosing to impose a risk on their child's classmates.

I've said it before and will say it again. You don't have a human right to force a risk of outbreak on other people's children in school and the community by sending an unvaccinated child to school.

You don't have a human right to refuse to protect your child from disease, either.

@Linda burt: no one is forcing you to get immunized. You have options: immunize or change jobs (for medical personnel who don't want vaccines), don't join the military. If you make that decision for your children, then you have options: homeschool or a private school that will take unimmunized children.

There is no force in any of the measures. There are consequences. You can do anything you want in this world; you just have to accept that SOME actions have consequences that you don't like. Therefore, you have to decide which actions you want to do. But no one in the US is forcing anyone to be vaccinated.

If you make that decision for your children, then you have options: homeschool or a private school that will take unimmunized children.

Let's be precise: SB 277 applies to private schools as well, although homeschooling collectives of some sort are allowed.

^ Then again, Linda didn't in fact assert that SB 277 had direct personal consequences for her at all. I have a vague sense that the demographics of the loud antivaccine brigade are trending older.

(Which is conveniently self-serving, given my long-standing suspicion that opposition to HPV vaccination has much more to do with concerns over the pool of fresh recruits than it does with sex.)

How do you explain the high infant mortality rate in Japan until they changed their policy and didnt administer vaccines until after age 2 and their IMR's dropped immediately? Please enlighten!

http://www.vaclib.org/basic/japanmor.gif

Japan infant mortality rate 4th lowest in the world!
http://www.infoplease.com/ipa/A0934744.html

I think that it is funny that the Japanese vaccinate for Japanese Encephalitis. Why don't they just call it encephalitis?

Don't Mexicans that drink Mexican Coke just call it coke?
And don't Swiss that eat Swiss Cheese just call it cheese?

Ms Mia Wallace (if you're not yet ANOTHER sockpuppet), those claims are lies.
Here is the schedule for vaccines in Japan. As is clearly visible, there are vaccines that are administered before the age of 2 years.
In fact, the only source for your claims are antivaccine websites.

How do you explain the high infant mortality rate in Japan until they changed their policy and didnt administer vaccines until after age 2 and their IMR’s dropped immediately?

It's a bit more complicated than that.
There was an issue with the MMR vaccine Japan was using in the 70's (but it's not our vaccine).
And there was unfounded fears of SIDS with the DTwP vaccine.
But then these vaccines were discontinued and not replaced, both the number of infected people and infant mortality went up.

tl;dr: the supposed drop in Japanese IMR following vaccine discontinuation is a lie.

I found a different source that said only one vaccine, the DTP, was postponed until the second year. Allegedly, this came with a concomitant decrease in IMR's.

I found a different source

I quoted mine.

The newest sock puppet: "How do you explain the high infant mortality rate in Japan until they changed their policy and didnt administer vaccines until after age 2 and their IMR’s dropped immediately? Please enlighten!"

It was a lie. The DTP was dropped, but more kids died. But they could not blame a vaccine that was not given:
http://www.ncbi.nlm.nih.gov/pubmed/15889991

Which says: "An antivaccine movement developed in Japan as a consequence of increasing numbers of adverse reactions to whole-cell pertussis vaccines in the mid-1970s. After two infants died within 24 h of the vaccination from 1974 to 1975, the Japanese government temporarily suspended vaccinations. Subsequently, the public and the government witnessed the re-emergence of whooping cough, with 41 deaths in 1979. This series of unfortunate events revealed to the public that the vaccine had, in fact, been beneficial."

I think that it is funny that the Japanese vaccinate for Japanese Encephalitis. Why don’t they just call it encephalitis?

Why don't the Germans call German measles just plain measles?

http://www.who.int/mediacentre/factsheets/fs386/en/

We Canadians call Canadian Bacon Back Bacon, and Canadian Whiskey Rye Whisky.

No Canadian disease though (except frostbite maybe).

the MMR vaccine Japan was using in the 70’s

I mispoke. The DTwP (non-)issues were in the 70's, as Chris is explaining above. For MMR, issues were around 1990-1993, most likely coming from the Mumps' Urabe strain used in the MMR vaccine.
I got confused with the start of anti-measles and rubella immunization, which was at the end of the 70's.

I will just leave here another article about Japanese vaccination: the complete withdrawal of the MMR vaccination didn't affect the rise of autism incidence.

And remember, it's racist to refer to "Norwegian scabies".

Norwegian scabies was first reported by two Norwegian researchers, hence the name. That is unfortunate.
BTW, do NOT do a GIS.

"It is error alone which needs support of the governments. Truth can stand by itself."
-Thomas Jefferson [no doubt referring to SB 277]

no doubt referring to SB 277

Suuure. Also maybe the (non-medical) exemptions are the error?

Should vaccines be compulsory?

oracknows — Tue, 26 Jul 2016 01:03:07 +0000

Should vaccines be compulsory?

As long as there have been vaccinations, there has been an antivaccine movement, and as long as there has been an antivaccine movement, there have been parents who refuse to vaccinate. In a past that encompasses the childhood of my parents, polio was paralyzing and killing children in large numbers in yearly epidemics, the fear of which led to the closure of public pools every summer. In such an environment, the new polio vaccine introduced by Jonas Salk in the mid-1950s wasn’t a hard sell. In fact, satisfying the initial demand for it was the problem, not parents refusing to vaccinate their children. Since then, more and more vaccines have been developed to protect more and more children from more and more diseases, to the point where the incidences of most vaccine-preventable diseases is so low that, unlike 60 years ago, most parents today have never seen a case or even known other parents whose child suffered from a case. Even as recently as the 1980s, Haemophilus influenza type B was a dread disease that could cause meningitis, pneumonia, sepsis, and death. Since the introduction of the the Hib vaccine a mere quarter century ago, Hib has been virtually eliminated. Most pediatricians in residency now have never seen a case.

As much of a cliche as it is to say so, unfortunately vaccination has been a victim of its own success, at least in developed countries. Parents no longer fear the diseases childhood vaccines protect against, which makes it easy for antivaccine activists to provide what I like to call “misinformed consent,” by spreading misinformation that vastly exaggerates the risk of vaccines compared to the benefit of vaccinating. Basically, parents who believe the misinformation conclude, based on a warped view of the risk-benefit ratio of vaccines, that not vaccinating is safer. Add to the mix fear mongering against the MMR based on Andrew Wakefield and his dubious 1998 case series that popularized the then-recent idea that vaccines cause autism, and it’s no wonder that parents decide that not vaccinating is safer than vaccinating. If you believe the misinformation, it’s not an entirely unreasonable conclusion. Then add to that the easy availability of “personal belief exemptions” to school vaccine mandates in many states, which include anything from religious exemptions to parents just signing a form that says they are “personally opposed” to vaccination, and it isn’t a huge surprise that vaccine uptake has fallen in some areas to the point where outbreaks can occur. It was happening in California and my own state of Michigan.

The question then becomes: What to do about it? This question always brings up hard questions about how far the state should go to encourage vaccination, and that’s what this post is about, prodded by a recent article on Slate.com advocating mandatory vaccination for all children written by two pediatrics residents, Dr. Phoebe Danziger and Dr. Rebekah Diamond. This lead me to ask the question: Should vaccines be mandatory? Basically, mandatory vaccination of the sort described by Danziger and Diamond would represent a major change in policy. In the US, the general strategy to encourage adherence to the CDC-recommended vaccination schedule does not rely on making vaccines mandatory for all children, but rather requiring certain vaccines as a precondition for enrollment in day care centers and public schools. Basically, the idea is that parents don’t have to vaccinate, but if they choose not to there will be consequences and measures taken to lessen the risk of outbreaks due to their refusal to vaccinate. You might think this is a distinction without a difference in that most children go to public schools, but in reality it is a clever compromise between individual liberty and responsibility to one’s community. Included in this compromise are nonmedical exemptions, specifically religious exemptions and so-called “personal belief exemptions,” which basically boil down to parents saying that vaccinating their children conflicts with a “strongly held personal belief.” As long as nonmedical exemptions were uncommon and the number of unvaccinated children small, there wasn’t a major problem. However, over the last couple of decades, the number of unvaccinated children has increased, and those children’s parents tend to cluster, facilitating outbreaks of vaccine-preventable diseases, particular the highly contagious ones like measles and whooping cough.

One strategy to counter this tendency, initially tried, for example, in California and Michigan , has involved keeping nonmedical personal belief exemptions but making them more difficult to obtain. In California, a law (AB 2109) was passed that required parents seeking personal belief exemptions to have a physician sign the exemption certifying that he had counseled the parents on the benefits and risks of vaccines and the dangers of not vaccinating. In Michigan, parents were required to go to a local health department office to sign their waver, which would not be permitted until they had undergone a brief state-mandated education session with a local health official educating them on, yes, the benefits and risks of vaccines and the dangers of not vaccinating. At this point, there were only two states that didn’t allow nonmedical exemptions, West Virginia and Mississippi.

Then came the Disneyland Measles outbreak a year and a half ago. In response, California passed SB 277, a law that, as of July 1, 2016, eliminated all nonmedical exemptions. The battle over SB 277 has been vociferous and reignited the argument of how far the state should go to ensure the vaccination of children. Not surprisingly, antivaccine activists painted SB 277 as incipient fascism, a horrific violation of parental rights, and “forced vaccination.” Also not suprisingly, a cottage industry of quacks and antivaccine-sympathetic physicians like Dr. Bob Sears, has sprung up to generate cookie-cutter medical exemptions not based in legitimate science. (More on that later this week.) Still, the basic compact remains in place, even in California: Parents can’t be forced to vaccinate, but if they refuse their children can’t access public schools and certain services, like day care. It’s just that exemptions to that social compact are now much harder to come by in California. Whether other states will follow California’s lead seems doubtful right now; so the current status quo appears likely to remain for the foreseeable future.

Enter Drs. Danziger and Diamond and their Slate.com article The Vaccination Double Standard, which is subtitled: “Despite years of research, there’s no good way to convince anti-vaxxers of the truth. It’s time to make vaccination mandatory for all kids.” It’s a viewpoint to which I’m sympathetic but in the end just can’t bring myself to sign on for. I’ll explain why momentarily, but first there is much in the article that does hit the proverbial nail on the head. For example, Danziger and Diamond start out with the story of a 28 week preemie who was doing well in the NICU with a caring, appropriate, but disadvantaged mother. They describe how “when we were able to reach his mother by telephone in between her work shifts, she was always loving, caring, appropriate, and eager for the day when her son, a perfect illustration of how modern medicine can impact even the tiniest baby’s chance for a long and healthy life, would be ready to come home.” Then, after they rotated off of the NICU, they later heard from their successors as NICU residents that there was a Child Protective Services (CPS) investigation underway because “CPS and the medical team were concerned his mother—young, single, and working two full-time jobs in a town hours away from the hospital while supporting two other toddlers at home—simply could not pull together the resources to be present enough at the hospital to demonstrate her competence and commitment to caring for her baby.” Danziger and Diamond compare this mother as “another example of poor, disadvantaged parents being held to impossible standards” standing in stark contrast to what they view as a case of more serious parental neglect, refusing vaccines.

They note:

We see the mother, who works double shifts at minimum wage to avoid eviction, traumatized by a CPS investigation instigated because she cannot possibly be present at a hospital bedside. We see the family whose incompletely immunized child is refused entry to a school, not because they oppose vaccines but because they lack reliable transportation and predictable time off to receive all the shots.

And then we watch parents who willingly expose their children, and society at large, to the real and specific risk of deadly diseases that should have been eradicated long ago—and we kowtow to them. These parents almost always come from privilege, and they are almost never punished for their actions. It seems to us that this reaction is at least partially—and perhaps subconsciously—informed by the fact that they are by and large white, educated, and affluent.

This is, of course, nothing that I haven’t been saying for a long time now. Parents who refuse vaccines are largely privileged, affluent, and white, although, I noted, despicable antivaccine activists like Del Bigtree, Polly Tommey, and Andrew Wakefield sure are trying to persuade disadvantaged African-Americans not to vaccinate too, apparently not caring that not vaccinating will likely impact minorities people much more seriously than their privileged white followers.

Be that as it may, our good pediatrics residents do couch their arguments in a lot of social justice, and, to a large extent, they make good points. Right now, the bulk of the most vocal antivaccine activists are in general white, educated, and affluent. Because they’re educated they’re very good at motivated reasoning, and because they’re affluent they have the resources to cluster in expensive neighborhoods and pay cash-only, antivaccine-sympathetic pediatricians like Dr. Bob Sears.

Drs Danziger and Diamond also correctly note that science is unlikely to persuade antivaccinationists that vaccines are safe, but there’s a problem. Their statements lack nuance and appear (to me at least) to incorrectly lump all antivaccinationists into one group, with all of them being equally unpersuadable. I’ve said it many times before: My message is not aimed at die hard antivaccine parents. Those are the parents Danzinger and Diamond no doubt mean when the write about science not persuading them, but there are, as I like to put it, shades of antivax. They range from the hard-core leaders of the antivaccine movement and Andrew Wakefield’s admirers to parents who are concerned because so many needles are being stuck into the most precious thing in the world to them and they saw some stuff about vaccines on the Internet—and everywhere in between. The former are, with rare exceptions, not persuadable. The latter are very much potentially persuadable.

I also agree that there is a double standard with respect to vaccines:

...we have also decided there is a limit to what parents can choose. Parents must use correct car seats and seat belts for their children; they must care for them in safe homes and provide sufficient food; they must also follow basic medical standards for their children’s health. Thus, there is ample precedent for removing the decision-making capacity from parents who are determined not to act in their child’s best interest. Take, for instance, the 2009 case of this child with leukemia who was successfully treated with chemotherapy on court order against her parents’ wishes, because they believed in “natural” treatment for cancer.

And yet, unlike any other aspect of pediatric medicine and child safety, if a parent explains that they have a personal objection to vaccination, they are allowed to deny their children proper care. It is true that some promising laws have been passed, such as California’s SB 277, which eliminates personal belief exemptions. But even these lauded policies have significant loopholes and pitfalls.

As Drs. Danziger and Diamond note with frustration:

We have spent hours explaining to CPS case-workers that it is impossible for the homeless parents of a critically ill infant to simultaneously attend medical rounds, to participate in medical decision-making for their child, and apply for public housing and employment. Then we turn around and treat a purposefully un-immunized child for a serious brain infection caused by vaccine-preventable bacterium—requiring weeks of hospitalization with intravenous antibiotics—and watch his mother continue to refuse vaccines for him or his siblings, and we can’t do anything about it.

I can see the appeal of this argument. I really can. I can see how such an argument could lead to this conclusion:

There is simply no reason vaccinations should be treated differently than any other form of medical care, and they must be protected within the same framework that has been created for child protection and against medical neglect. There are many ethically gray areas of medicine, but this is not one. Our laws must unambiguously and without loopholes reflect this, and there cannot be conflicting standards of child protection based on race, wealth, and education. By continuing to allow exceptions, we are fueling the misconception that vaccinations are an option, a choice, a subjective topic about which people can have different opinions that ought to be respected, when in fact all of the data proves they are not. Enacting a policy that is consistent with the science would provide clarity for the parents—the majority of whom are loving caretakers trying to do the right thing. We are failing our society by creating unequal standards of parenting, and worse, we are failing our children by not protecting their right to be vaccinated against deadly, preventable diseases. Competent parenting must include fully immunizing all children according to the medical standard of care.

While I sympathize with this point of view, I also have a hard time adopting this sort of a plan for the simple reason that I don’t think that Dr. Diamond and Dr. Danziger have thought their position through to its conclusion or clearly thought about what it could lead to. Let’s assume, as appears reasonable based on what they have argued, that what they mean by “make vaccines mandator” is that vaccines administered according to the recommended CDC schedule should be mandatory, barring any medical contraindication of course. If someone made them emperor of the US, have Drs. Danziger and Diamond thought about how they would go about enforcing this policy? It’s easy enough to say that “vaccines should be mandatory” and to castigate antivaccine parents for being privileged, selfish, entitled white people, but laws and policies have to be clearly written, and there has to be an enforcement mechanism, complete with some form of punishment for non-compliance.

The big question is: How far are Drs. Danziger and Diamond willing to go to enforce the “mandatory vaccination” that they liken to medical neglect? Don’t get me wrong, regular readers know that I am as pro-vaccine as anyone; I’ve spent a dozen years combatting antivaccine misinformation I’ve suffered online attacks and attempts to get me fired from my job for my trouble. So I won’t let anyone claim that I’m not sufficiently pro-vaccine. Let’s say, as would arguably be reasonable in a policy of mandatory vaccination, that parents who refuse to comply face an escalating series of consequences or punishments the longer they remain out of compliance. One could imagine, for instance, a series of escalating fines or even potentially jail time. Now, let’s imagine parents who still absolutely refuse to vaccinate. Again, how far are Drs. Danziger and Diamond willing to go? Have they really thought about this?

Again, I don’t think they have, and to illustrate that point I’ll just ask a couple of questions about what they would do in the case of parents who, despite escalating fines and the threat of jail time, still refuse to vaccinate their child. This is not such a far out scenario, either. Just look at all the parents in California talking about moving out of state, home schooling, and in general resisting SB 277. Are Drs. Danziger and Diamond, for instance, willing to allow courts to order forced vaccination and have the police enforce this order? I can’t help but note that in such a case, a lot of physicians would have ethical qualms about being the ones to oversee the administration of vaccines. Or, more relevant to their analogy, are they willing to give CPS the power to remove children from their homes solely because their parents won’t vaccinate them? This is something CPS is exceedingly reluctant to do even in the case of families refusing to treat their cancer-stricken child with standard-of-care chemotherapy and radiation, and in this case the children are perfectly happy. I won’t make the question easy for them, either. Imagine that this is the only problem that CPS finds and that otherwise CPS finds that the parents are loving, supportive, provide all other medical care, do not abuse their children, and are well off? Would they remove a child from a home like that to place him in foster care and be vaccinated? I assume they know just how overburdened the foster care system is and how hard it is to find good placements. Would it really be better to have the child in a the crappy foster care systems in some parts of this country and vaccinated rather than unvaccinated and with their family?

Perhaps Dr. Danziger and Diamond will think I exaggerate, but make no mistake. When they equate failure to vaccinate to medical neglect on par with or even worse than failing to let a child with cancer be treated with chemotherapy, almost any measure is justifiable. I would also remind them that whenever parents refuse to treat their children with cancer with chemotherapy, they make martyrs. Popular opinion rarely favors CPS. I’ve documented this time and time and time again. Consider the case of Sarah Hershberger and Cassandra Callender. Consider Makayla Sault. Consider Abraham Cherrix, whose battle to refuse chemotherapy led the Virginia State legislature to pass “Abraham’s Law,” basically permission for teens over a certain age to refuse medical treatment in favor of quackery.

Now imagine the public reaction if CPS tries to take what appear to be perfectly healthy children away from their parents because their parents don’t vaccinate. While it is true that most people support mandatory vaccination in the abstract, for a significant minority “parental rights” and “health freedom” arguments resonate among the electorate to the point that Republican politicians were pandering to them last year during the primaries, and my home state of Michigan considered a bill to re-loosen nonmedical exemption requirements. How well do you think that would go over? I think you know the answer.

No, Drs. Danziger and Diamond, for all their justified righteous anger, have not thought this through. In fact, taken from a point of view of social justice, whom do you think would be most affected by such a policy of compulsory vaccination? Hint: It won't be the affluent white antivaxers whom they rail against. They have the resources, the social media, and the ability to project a sympathetic picture of themselves that could easily turn them into "health freedom martyrs." We see it every time parents refuse to treat their child with cancer in favor of choosing "natural therapies." Although much less numerous, there are vaccine-hesitant minorities. The African-American community, in particular, has reason to be suspicious of modern medicine. I rather suspect that, as is the case for most issues, enforcement of a compulsory vaccination law would fall disproportionately on minorities and the poor, who are not as able to afford fines and legal representation.

There’s a reason why we don’t have compulsory vaccination in the US. The CDC vaccine schedule is not mandatory. However, we do have school vaccine mandates, which require that children be up-to-date on the their vaccinations before they can attend school or be placed in day care, and all but three states allow nonmedical exemptions, either religious, personal belief exemptions, o The current system of requiring vaccination before children can attend school and day care is actually a reasonable compromise between social responsibility and individual liberty, as long as nonmedical exemptions are not too freely available. In an ideal world, there would be no nonmedical exemptions, and all states would have a law like SB 277—or at least policies like Michigan that make it more difficult to obtain a nonmedical exemption and require parental education. The system we have now, for all its flaws, actually works well, producing high overall vaccination rates, even if there are pockets of vaccine uptake sufficiently low to abrogate herd immunity. Of course, could be improved if additional states would either eliminate nonmedical exemptions or make them harder to obtain. In any case, making vaccination compulsory is a bad idea if it is enforced to its logical conclusion in cases of parents who will not budge and an even worse idea if it isn’t enforced.

oracknows Mon, 07/25/2016 - 21:03

Tags

compulsory vaccination

forced vaccination

mandatory vaccination

Phoebe Day Danziger

Rebekah Diamond

school vaccine mandates

http://www.buffalolawreview.org/past_issues/63_4/Reiss.pdf

At its base, I agree with you that direct compulsion is impractical and will have undesirable consequences. It's happened before.

But I think it's worth discussing and considering other measures beyond school immunization requirements, and by laying out the problem so starkly the authors help that discussion.

At its base, I agree with you that direct compulsion is impractical....

That I would generously describe as an understatement, and raise you an "undesirable."

Over here, certain vaccines are in theory compulsory (and available free of charge). And parents face fines if they fail to vaccinate their children. I've written "in theory", because our authorities do not enforce these fines very strongly - and affluent parents can afford them easily anyway.

Where do you live Alia?

I absolutely agree. You cannot put a price on health and wellbeing. I agree wholeheartedly. I think vaccination should be just part of every day life.

The same debate happened in Scotland, where there was a proposal to put fluoride in the drinking water. The idea being to benefit kids who otherwise might not be too assiduous about cleaning their teeth. It was opposed most strongly by a certain woman, whom the media noted had no teeth left in her head. But in the end, the proposal was abandoned, because (rightly in my opinion) the state should not have the power to medicate people without their express consent.

If it helps, we discussed the options to handle non-vaccination and tried to map them on a continuum - you can see the table summarizing them starting on p. 977 of this monstrous thing:

They are probably too you the famous picture of Elian Gonzalez being dragged from his family's arms by police with machine guns. Were that image to be reproduced for the sake of vaccines, it would set back the pro-vaccine movement in a big way.

http://abcnews.go.com/International/elian-gonzalez-boy-middle-us-cuba-t…

It is not surprising that the opinions of two pediatrics residents lacks nuance. It is the voice of inexperience. I am not faulting them. They are entitled to their opinions, but I suspect they will have rethought things in 20 years or so.

It is worth having a discussion about how the irrational behavior of a few are threatening the rest of us, and how we, as a society, needs to respond to protect ourselves.

Instead of making the results of the parents negligence a simple inability to attend schools and such, make it a real financial burden. If you don't vaccinate your child, you are responsible for obtaining insurance policies that cover the care and damage caused to anyone else that your child infects. If your child dies due to your negligence, that's on you. If someone else who cannot be vaccinated becomes ill or dies due to being in contact with your unvaccinated child, then you are on the hook to pay their medical bills/funeral costs/lost income.
As you point out, the other options are morally and ethically suspect. However, it is still a public health concern, and is part of living in a society. Much like taxes, and limiting your personal freedoms for the greater good are necessary to a functional society. If they are really that opposed to vaccination, there are other nations out there that would probably have no issues with their immigrating.

On a side note, aren't school nurses qualified to administer vaccinations? If getting kids to a doctor is such a burden, set a-side a day a year for all the students to get their jab or provide proof of vaccination / proof of medical exemption. Attendance can be easily monitored and those that don't attend / cannot prove their vaccinated state get to bring home the above mentioned insurance policy application that needs to be active before the child can return to school. My guess would be that they would quickly get their children vaccinated against the very real high costs.

Other than the elimination of non-medical exemptions to school vaccination requirements, it might be more effective to make getting vaccinated easier. Make it free for everyone. Make it easily accessible so that those who are less well-off are able to get their kids vaccinated in a timely manner. It should not be a hardship to take your child to get immunized.

@Todd W.: I think that's at least in part an argument for school-based vaccine clinics, which are a very effective way to help children get vaccinated.

Of course, then the anti-vaccine people claim it's a conspiracy to get children vaccinated against the parents' will.

The authors refer to people of privilege as they make their case for compulsory vaccination. Well, anti-vaccine physicians are people of unusually high privilege, and until state medical boards and groups like the AAP, AMA and AAFP root out and censor anti-vaccine physicians, with the medical boards stripping anti-vaccine physicians of their license to practice (you all know the ones like Bob Sears, Jay Gordon, Sherri Tenpenny, Suzanne Humphries, Jack Wolfson, Eric Mercola, etc) to show the public that doctors are serious about vaccines, I do not favor making vaccine rates increase with laws like (or even stronger than ) SB277. As Brian Deer mentioned in a a comment on the Slate board yesterday, vaccine rates in the UK were brought back up (after Wakefield's fraudulent 1998 Lancet paper without passing of vaccine laws (though there were also huge oubreaks to remind people in the UK of what happens when vaccine rates fall). I still believe some of the vaccination rate recovery in the UK stems from the exposing and discipline of Wakefield. Here in the US, I cannot come up with one single anti-vaccine physician who has been disciplined in the slightest for their actions, which is shameful. How can we expect the 95-99% of parents we need vaccinating their children to decide on vaccination when there are so many anti-vaccine doctors proudly and publicly willing to tell you otherwise and who all remain in good standing as physicians due to the unwillingness of medical groups to give them the professional thrashing they so richly deserve?

I think SB277 has it exactly right: children must be vaccinated (or have documented medical contraindications) in order to enroll in day care or school. Parents who do not wish to comply can home school their children (there seems to be a substantial overlap anyway between anti-vax parents and home schoolers). Going further than that is likely to be counterproductive, given the prevalence of politicians who espouse libertarian philosophy (whether or not they actually practice what they preach).

@ Eric Lund #15--my issue is, had groups like the CA-AAP spent as much time going after anti-vaccine groups and physicians as they did lobbying for SB-277, maybe SB-277 wouldn't have been necessary. And Bob Sears has been reported to the California Medical Board, but nothing has ever happened. Now we have SB-277 following a horrendous measles outbreaks (along with 2 awful pertussis outbreaks in California in 2010 and 2014 that killed 14 infants).

On a brighter note, it appears an anti-vaccine family physician in Tennessee who caught a sh*tstorm when he went publicly anti-vaccine a few months ago is now resorting to gofundme to help pay for his defense before the state medical board (https://www.facebook.com/permalink.php?story_fbid=275374442824720&id=10…). Here's to hoping Dr. Kalb loses his license.

I wonder how many anti-vaxxers there are within the native populations of the Third World that still suffer wide-spread ravages of the diseases the vaccines prevent.

I wanna say anything between negative 3% to 0%.

Excellent article. I totally support mandatory vaccination for children attending public school/daycare, but I think the harms would outweigh the benefits if we were to hunt down all of the parents who believe it wrong to vaccinate their kids, and this post summarizes the problems nicely.

Mandated vaccination might be a step to far: but I think it's good people are calling for it. That expands the 'overton window'. In other words: mandated vaccination for school/daycare children would become a compromise, middle of the road sollution.

@Amethyst

Oh, there are anti-vaccine folks everywhere, including developing nations. What tends to happen there, however, is a more conspiratorial angle, along the lines of "It's a plot by the West to sterilize you". I'd venture to guess that they are still somewhat of a minority, but arguably they do exist.

I'm all for eliminating non-medical exemptions, stripping licenses from anti-vaccine, etc. But I've heard in other discussions people saying medical exemptions should be limited to the CDC list of contraindications for vaccines, which worries me. I recently found out my nephew, who is developmentally disabled and diabetic, no longer gets vaccines. His parents found that if he had a reaction to the vaccine, such as fever, his diabetes, already difficult to control, becomes more complicated. He is non-verbal and unable to participate in his own care. his parents uderstand the risk, especially with anti-vaccine nuts out there, but in his case, the risk-benfit analysis tips on the side of managing his blodd sugar.

There are kids who can't be vaccinated, e.g. autoimmune diseases, being treated for cancer, or, simply, who were vaccinated and the vaccine did not elicited a sufficient immunological response. These kids go shopping with their mothers, go to playgrounds, travel by air, go to birthday parties, etc. I don't know the answer; but how do we protect them? Home-schooled kids who are not vaccinated won't infect others at school; but they also go shopping with their mothers, go to playgrounds, travel on airplanes, go to birthday parties, etc. Since several diseases are contagious prior to being symptomatic, what should we do? Living in complex societies, we have rights and we have responsibilities. Unfortunately, many Americans seem to "know" their rights; but feel nothing for their responsibilities. I don't know the answer; but whatever it is, it should weigh in on protecting those children who, for whatever reason, either couldn't be vaccinated or the vaccine didn't take, it should weigh in on the side of responsibilities in a community.

Chris@16: Most health and safety regulations, at least in the US, are enacted because people died without the regulation. This phenomenon is hardly limited to vaccines--reinforced and locked cockpit doors, which would have prevented 9/11 had they been in use at the time and had been recommended several years earlier, are one of the most common examples. Most people tend not to deal with problems until they are forced to do so--this is the tendency spoofed by the SEP (Somebody Else's Problem) field in the works of Douglas Adams.

Todd@20: In the case of Pakistan, the conspiracy theorists actually have a justification. The CIA project to locate Osama bin Laden used a polio vaccination program as cover. Pakistan happens to be among the handful of countries where polio is still endemic.

Oh, there are anti-vaccine folks everywhere, including developing nations. What tends to happen there, however, is a more conspiratorial angle, along the lines of “It’s a plot by the West to sterilize you”. I’d venture to guess that they are still somewhat of a minority, but arguably they do exist.

Certainly they exist. Most recently, I wrote about them in Kenya:

http://scienceblogs.com/insolence/2014/11/13/catholic-doctors-and-pries…

http://scienceblogs.com/insolence/2015/08/12/the-kenyan-catholic-bishop…

http://scienceblogs.com/insolence/2015/03/23/no-lawrence-solomon-unicef…

Why jump to a more extreme method when data from California, Mississippi, and West Virginia demonstrate simply removing non-medical exemptions to be effective? This is by all appearances a solved problem; what we lack implementation. Drs. Danzig and Diamond's proposal actually has much higher implementation barriers.

Many people believe that some of the vaccine hesitancy in the UK exists because the smallpox vaccine was initially compulsory there. I would think that we have learned our lesson about what happens when you try to force vaccines on people.

https://www.verywell.com/history-anti-vaccine-movement-4054321

Why jump to a more extreme method when data from California, Mississippi, and West Virginia demonstrate simply removing non-medical exemptions to be effective? This is by all appearances a solved problem; what we lack implementation.

I'd go even further and say that a less radical solution than even SB 277 can be effective as well, depending on the state, namely an AB 2109- or Michigan-like solution of requiring parents who want personal belief exemptions to undergo counseling and education before they can have it. It won't stop the die-hards, but they're only around 3% or so of the population anyway.

Slightly OT, I recently had a case with the 48 YOM having low back pain. He came to the ED repeatedly, and discharged with an anti-inflammatory. When I got him, I noticed his ecg had several spams ticks as if in a-tach or some aberrant pacemaker site/AVNRT. Upon physical exam, his radial pulse was normal mid-80 and was uncontrollably shivering. No fever, no seizure, and no neuro deficits, but slight muscle weakness in legs. His past lab values all normals. We started a workup for sepsis anyway (he passed both SIRS and qSOFA criteria, slight tachypnea, but it was transient) -- we were working on gestalt or gut feeling. His CBC/CMP values again, normals. Vitals/temp also stayed normals. But, we felt he was sick and decided to admit based on slightly elevated procalcitonin. We ran an MRI on the lower back looking for osteomyelitis, no joy, but possible it's hiding in his pelvis.

Turns out he was HIV pos. He was at the point couldn't mount an effective defense, so his lab values could not get elevated. Blood cultures grew out....Hib. Obviously, a serious and life-threatening infection, bacteremia being the dx. We think we got ahead of the curve by using empirics and fluid resuscitation (even though he passed SIRS and qSOFA). He's still an admit, but on the mend.

As far as vaccines being compulsory, no. Access to vaccines being yes, of course. Surprisingly, I've worked on two patients with significant brain injury from vaccine (seeing one occurrence is about one in a million, correct?). There's enough flexibility in the timeline to maintain the evidence-based schedule, and that the benefits of vaccination greatly outweigh the risks to the individual and community health.

I could even go with allowing more exemptions if in addition to some education it came with additional financial burden. Akin to having smokers pay more for insurance have a rider that if you don't vaccinate you pay extra to cover the costs of both your potential risk for illness and your risk to spreading it to others. Even have it earmarked so the money can only be used for either vaccine preventable disease care or programs to increase vaccination among the disadvantaged like bringing back vaccination clinics in school (we had a few of those as vaccines came out so I know we know how to do those).

Fine, you can go to public schools, but have to pay extra tax into a fund that pays for remote learning systems for those days your kid will be home quarantined if there is an outbreak and would also help fund the technology for those kids who may not be able to be protected because of a medical problem when they are either too ill to go to school as even a cold would be really bad for them or also must stay away because of an outbreak.

Part of my thought is the more they work hard to increase their numbers the more money that is earmarked to cover the costs. Now it may need to be sliding scale so the more money you make the more you pay after all we can't convert the poor and disadvantaged to the cause if they can't pay for it, so yep, make it progressive and clearly transparent that each rich person pays for a poor person and if they keep up trying to spread their -ism to the poor, then they'll be paying for 2 poor people each.

FWIW, I suspect most won't mind paying more to have their special snowflake in the special programs that must be better because they cost more, but if they are subsidizing others that can't be so special and shouldn't have the same privilege...that may get them to decide the social contract the rest of us agree to isn't so bad after all.

Compulsory no, required for public school, public daycare, certain jobs (in contact with other people) etc.; yes.

If want to see a documentary that cause tears; see Gleason. It opens Friday, unfortunately the closest showing to me is 200 miles away.

I do not think vaccinations should be compulsory outside of an imminent threat, such as for instance a biowarfare attack with weaponized smallpox or something terrifying like that. Lacking such an imminent threat, we can't force it.

Yes, vaccines are for a child's good. But I don't think we can compare it to withholding food or cancer treatment. Vaccinations do not treat disease (generally speaking). They are preventative only, and the child isn't directly harmed by not getting them. We don't mandate that children eat their vegetables; we don't need to mandate that they get vaccinated. We are doing well merely encouraging it.

I am also leery of financial penalties for non-vaccination. In our system, the most obvious way of implementing them would be an increase in medical premiums. This would be unfair to people who have a medical reason not to get vaccinated, and would perpetuate the problem where those who most need insurance are least able to afford it -- because premiums are based on how likely you are to get sick. I would prefer to see single-payer health care, completely removing the financial component from the minds of caregivers. And although I know this cheeses off the antivaxxers, I'd like to see more combo vaccines. The vast majority of parents skip vaccines not because they're against them but because they forget to get it done, and because it's unpleasant for the kid. If more vaccines can be grouped into a single appointment, I believe coverage will improve. The antivaxxers will find a way to be upset no matter what, so frankly I don't see much point factoring their concerns into the decision.

Since the commentariat is multi-national, I want to ask about the case of Henri Joyeux, in France.

In France, only the vaccines against diphtheria, tetanus and polio are compulsory. According to WHO, there is NOT an infant vaccine (<12 months) for just those 3 diseases.

In the European Italy has a monovalent infant diphtheria vaccine; a monovalent infant tetanus vaccine; and a stand-alone inactivated polio vaccine (various European other countries have one or more of the monovalent vaccines as well.)

Joyeux's action is to demand (I think) that the French government make available either the monovalent vaccines, or a DT-Polio vaccines without aluminum, which he claims is a neurotoxin.

So according to French sources, Joyeux's (Google translate follows)

anti-vaccine positions have riled up the Ministry of Health in June 2015. The surgeon and oncologist appears this Friday, May 27 before the Disciplinary Division of the Council of the Order of Languedoc-Roussillon doctors in Montpellier for "discredited the profession", holding" alarmist "and based on" non-established scientific evidence. "

In June, Joyeux (who retired in 2014) was struck off the medical register.

What I want to know is, how much influence does he actually have in France?

http://www.francetvinfo.fr/sante/affaires/le-professeur-henri-joyeux-ra…

Link to Joyeux's petition, which has over a million signatures.

http://petitions.ipsn.eu/penurie-vaccin-dt-polio/index.php

The website for the not-a-documentary "Man-Made Epidemic" is talking up Joyeux's case. About the film:

interviews with leading doctors, scientists and families to find out the truth about the autism epidemic and whether or not vaccines have a role to play.

The film explores the common misconception that autism is solely genetic and looks into scientists concerns over recent years about environmental factors such as medication and pesticides which continue to leave our children with physical and neurological damage.

The film does not seem to have gotten much attention...

Lacking such an imminent threat, we can’t force it.

Many countries (I don't happen to know if the US is among them) have vaccination requirements for foreign travelers; the only exceptions are for documented medical contraindications, with the document translated into the local language as appropriate. The most common requirement is for a yellow fever vaccination to have been given in the last ten years, e.g., Brazil, which I visited in 2005 (so I would need a booster to go back there). There is no reason why a national government could not impose vaccination requirements if it doesn't have them already--it could be a condition for issuing a visa, for instance.

It wouldn't be a perfect solution, because not all countries have such a requirement, and unvaccinated kids (or adults) could pick up something while traveling abroad and bring it back. But it might cut down a bit on the spread of vaccine-preventable diseases.

Like many others, social strictures is my preferred methodology. I remember the days when getting on a bus (in the UK) meant you would stink of smoke all day long. Then smoking was confined to the upper deck (or rear of a single decker). Eventually all smoking on buses banned. Followed several years later with no smoking in public areas.
Vaccinations is harder to monitor, but increase social pressure to keep unvaxxed (but which vaxs to be affected is a far harder question) out of public areas (med exempt excepted).
Imagine going down the pub with a smoker. In the past the group was under pressure to cave to the requirements of the sole smoker. Not nowadays.
Dorect monitoring and implementation would be hard. Indirect methods can also be used. If someone catches a VPD and it can be shown that 'you' are the source, sue for the costs. Make them a social pariah the same way smokers are in public. Only those who are more hardcore will continue to be unvaxxed.

Danziger and Diamond aren't taking the public health case, so uptake rates don't really address their argument. It's a social justice argument, about the poor having an increased exposure to disease, or maybe just having to pay too much for what ought to be a societal burden, as community immunity serves the common good, not just the individual. I think what the authors are doing is trying to leverage the anti-antivax thing to backdoor what Todd suggests: free immunizations for low income families, in their schools and communities etc. If these were 'compulsory', the next logical step would be: 'these people are poor and can't get to Drs. easily, so we have to make it free and take it to them.'

Orac doesn't say if the authors address penalties at all (and I have no time to go to the source essay). But Prof. Reiss is suggesting this needn't be a binary between mandate/no-mandate, or 'punishment'/nothing.

Especially if the idea isn't to shove shots at the kids of the commited AVs, but to help the poor and perhaps clueless, nothing like jail or protective services need be involved, as we could let them have easy loopholes, since they're 'not the point'. The authors make a car-seat analogy, and I don't think CPS gets a call if parents forego that now and then (not that I know, being childless...).

Note that what they really seem to be after here is the rhetorical force of a mandate, not the material consequences.

By continuing to allow exceptions, we are fueling the misconception that vaccinations are an option, about which people can have different opinions that ought to be respected. Enacting a policy would provide clarity for the parents...

Seems to me we have a number of laws like this – that don't have much teeth, but help establish norms, just, as the authors say, clarifying 'this is wrong, don't do that'. And it seems to me these rules-without-dire-consequences-for-violation still get followed pretty well. E.g. I don't know what penalties, if any CA can impose on individuals who don't adhere to the drought-response water-use restrictions due to washing their car too often, but the cops aren't out in cruiser looking for scoflaws. But the watering restrictions definitely help...

I am very pro-vaccine. My daughters (3 and 7) are up to date with the CDC recommended vaccines. we have even enrolled our children in multiple vaccine studies with Johns Hopkins researchers developing a new vaccine for RSV.

However, I am adamantly opposed to mandatory vaccination. Government injecting vaccines at the point of a gun into kids will likely do more to lower the real vaccination rate than anything else as there will be a large backlash.

every time some says "There ought to be a law" remember that every law is enforced at the point of gun as no law is followed all of the time.

@sadmar

"Seems to me we have a number of laws like this – that don’t have much teeth, but help establish norms, just, as the authors say, clarifying ‘this is wrong, don’t do that’."

Do you want "crime" Eric Gardner was committing before he was killed in police custody? Selling black market cigarettes. Only minimal fines. so even laws with minimal penalties do get enforced physically and with deadly consequences to people.

Mike: Reductio ad absurdam. If laws with minimal penalties get enforced with deadly consequences, that's policing insanity, not a problem with the legislation. I'm sure there are cops who'd shoot African-Americans motorists after stopping them for littering. I don't think the answer would be removing all fines for chucking a bag of Burger King wrappers out the car window.

It is not Reductio ad absurdam when it is an established fact in our reality that it happens.

Now, you may want to reject reality and pretend that it does not happen, but then that is not very science based.

Would love to see your examples, Mike.

@ LIz Ditz Joyeux's action is to demand (I think) that the French government make available either the monovalent vaccines, or a DT-Polio vaccines without aluminum, which he claims is a neurotoxin.

Aluminum is a neurotoxin. This is not just some wacky idea.

"Aluminum is a neurotoxin. This is not just some wacky idea."

The wacky idea is that Aluminum could be a neurotoxin in the dosages you get from vaccines...

The ever-interesting Prof. Steve Dutch has this on one of his pages: "Prince George’s County, Maryland decided to crack down on parents who failed to get their children vaccinated. This shocking example of nanny-state bullying has been duly hyped on various libertarian and anti-vaccination sites.
So, I can expose myself and my kids to the (minuscule) risks of vaccination, then we create a disease free society and you and your kids enjoy the benefits without that nasty needle. Or, horror of horrors, having somebody tell you what to do.
There are all sorts of dark corners of the world we could send these people where they will never, ever have to face a needle. The not having somebody tell you what to do part, not so much. I'm sure the folks we bring here to replace them would eagerly line up at dawn to get their kids immunized."
This essay is here: http://www.uwgb.edu/dutchs/PSEUDOSC/ModestProp.HTM.

The wacky idea is that Aluminum could be a neurotoxin in the dosages you get from vaccines…

Is it really the concentration that matters here or are some (just not so many) neurons always sacrificed for the shot??

Especially if the idea isn’t to shove shots at the kids of the commited AVs, but to help the poor and perhaps clueless, nothing like jail or protective services need be involved, as we could let them have easy loopholes, since they’re ‘not the point’. The authors make a car-seat analogy, and I don’t think CPS gets a call if parents forego that now and then (not that I know, being childless…).

Here's the problem. Danziger and Diamond make a social justice argument, starting out contrasting the poor woman whose struggle to put food on the table for her other kids and pay the rent made it difficult for her to learn how to care for her preemie ready for discharge from the NICU to privileged antivaccine parents who choose not to protect their children from disease, with the poor mother being reported to CPS and the antivaxers facing no government action. They are, of course, understandably outraged at this disconnect. The problem is that later they make an explicit analogy between parents who refuse to vaccinate and parents who withhold chemotherapy and other effective life-saving treatment from their children with cancer, referring to them both as medical neglect. OK, you might say, but not all medical neglect is the same; so the punishments don't have to be the same. Sounds reasonable, right? For instance, withholding chemotherapy from a child with a treatable cancer almost certainly will result in the very unpleasant death of that child. That's very bad, and CPS will often ultimately intervene to take the child away, even though it will always try its best not to. Parents will be dragged before a judge and sometimes even jailed. So, you might say, failure to vaccinate is not as serious; odds are that the child will not die or even get sick unless there is an outbreak, and even then the odds are probably in a healthy child's favor, at least compared to the analogy of withholding chemotherapy from a child with cancer. So the punishment doesn't have to be the same. The problem is that, in terms of severity of medical neglect, Danziger and Diamond don't seem to make that distinction, stating:

Instead of spinning our wheels producing ineffectual research, the time has come to call vaccine refusal by another name that more accurately sums it up: medical neglect. We can continue our scholarly inquiry to find more effective ways for convincing parents that vaccines are worthwhile, but it is time to declare, unequivocally, that vaccination is a human right no child should be denied.

If this is your position, that vaccines are a human right that no child should be denied, then a "slap on the wrist" penalties and a lot of easy loopholes will not suffice. This is a declaration that the law needs to be willing to do whatever it takes, even if it means forcibly vaccinating against the parents' will, fining or throwing the parents in jail, and/or taking the children away, temporarily or permanently as the situation requires.

Here in Italy some child vaccinations are compulsory, other ones only "recommended". However, even if theoretically a child could not be enrolled in public schools unless vaccinated, in practice there is no penalty for skipping vaccinations, as it would be deemed contrary to the right to instruction, which is compulsory, too.
Now a proposal is emerging in some parts of the country to bypass this conundrum: children with no record of vaccination may not be admitted to nursery schools. These schools are not compulsory, so no risk of a conflict between health or instruction.

If there aluminum in a vaccine were dangerous, then we'd all be dead now from all the aluminum naturally in the environment. It's not exactly a rare element.

Many countries (I don’t happen to know if the US is among them) have vaccination requirements for foreign travelers....

Travelers, no; immigrants, yes.*

* With a unique exemption, it seems; I have no idea how those prongs are adjudicated: "https://www.uscis.gov/news/questions-and-answers/vaccination-requiremen…

The wacky idea is that Aluminum could be a neurotoxin in the dosages you get from vaccines…

Why is that a wacky idea?

How much intramuscular Aluminum [μg/Kg] would you say is neurotoxic?

I have not been able to find an answer to this, and I have looked.

@ GrayFalcon If there aluminum in a vaccine were dangerous, then we’d all be dead now from all the aluminum naturally in the environment. It’s not exactly a rare element.

Studies have shown that we only absorb between .01-.05% of ingested aluminum.

The people that primarily get alumunum induced neuropathy are people on heomodialysis, welders, and vaccine recipients.

Here is a study that shows intramuscular Al(OH)₃ in amounts proportional to human vaccine exposure causes motor deficits: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2819810/

Eric Lund @34: Except that in a lot of places where immunization records are required to travel between countries, it is just as easy to get a fake record as a real vaccination. I have friends who did that because they did not trust (or see the need for) a yellow fever vaccination in two countries that don't have yellow fever.

So that's not a perfect solution either.

@#52: A study by Christopher Shaw? Bwahahahaha! He's basically perfected the dark art of doing injecting vaccines or vaccine ingredients into mice and then using dubious, unblinded behavioral tests to "prove" how evil the vaccine ingredient is.

Thanks for the chuckle!

The Shaw studies are the only ones that have been published.

ORAC. I hope you buy an Aluminum saucepan and make marinara sauce in it twice a week.

And bake some French-style bread with double acting baking powder while you are at it.

How about a very simple carrot and stick: Parents who vaccinate get it on their records, and consequently, in every non-emergency, the whole family gets priority service in medical, dental and eye-care, plus discounts. Parents who do not vaccinate, get lower standards of service and longer wait times.
In some communities, like say, Orange County, have a two tiered service for vaccines: regular folks get the discount, wealthy suburbanites get 'the premium vaccines' (really, just regular vaccines at a new price. Worked for bottled water.) One of the quickest ways to make something valuable is to announce a scarcity; if vaccines are suddenly hard to find in anti-vax communities, they will become more valuable.

PB just loves him some anti-vax talking points....

If there aluminum in a vaccine were dangerous, then we’d all be dead now from all the aluminum naturally in the environment.

Plants sure have a problem with it, Gray Falcon #48:

Aluminum (Al) toxicity is a major constraint for crop production in acidic soil worldwide...

To develop high tolerance against Al stress is the major goal of plant sciences. This review examines our current understanding of the Al signaling with the physiological, genetic and molecular approaches to improve the crop performance under the Al toxicity.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2710549/

But we're not potted plants like Ollie North's lawer or anything.

"I hope you buy an Aluminum saucepan and make marinara sauce in it twice a week"

We have some aluminum cookware. Apparently it causes limericks.

Here is study without Shaw: http://pubs.rsc.org/is/content/articlelanding/2015/nr/c5nr03598h#!divAb…

They basically gave rats alzheimers by ingecting them with Al₂O₃.

Here are the micrographs of the brain slices, with Al elucidated with the Morin Stain: http://pubs.rsc.org/services/images/RSCpubs.ePlatform.Service.FreeConte…

Basically Aluminum accumulates in the brain and makes people dumb and forgetful. Aluminum should be avoided.

Oh, no! It is the Aluminati coming to spread fear and loathing about the most abundant metal element on this planet's crust!

PB: "How much intramuscular Aluminum [μg/Kg] would you say is neurotoxic?"

So you never fell and scraped your knee in dirt, which is composed of minerals containing aluminum. Lots and lots of nanoscale alumina in that dirt... and not in mice, but any kid who was allowed to play outside.

I would place a bet that the tetanus spores in the soil are more dangerous than the aluminum.

I hope you buy an Aluminum saucepan and make marinara sauce in it twice a week.

And bake some French-style bread with double acting baking powder while you are at it.

Yes, I use aluminum pans. I inherited them from my mother. Also, a wonderful aluminum citrus press for making fresh orange juice.

But, no, I don't use baking powder of any kind when making French bread. I use yeast as the recipes call for. I use my double acting backing power in cakes and biscuits. I make very good biscuits.

Darn. Block quote fail.

@Meg I use my double acting backing power in cakes and biscuits.

I am sure that your Aluminized "autism biscuits" are wonderful Meg.

@60

I've been known to be dumb and forgetful sometimes. You don't think... it wasn't my childhood vaccination series, was it??? I SHOULD SUE.

I'd love it if we could get an SB277-style law passed on a federal level. While I'm wishing, I'd also like Wakefield to shut his cavernous maw permanently, David Wolfe to take up a life of ascetic monasticism on a mountaintop somewhere, and Crystal Pepsi to come back...

Looks like the Governor of New Jersey forgot to take his mumps vaccine: http://media.salon.com/2015/04/chris_christie18.jpg

@PuppyBoners I'm from Poland.
As for other proposals put here, we had immunisations at school. There would be a day when the whole class would go to the nurse's room, there was the school nurse and some doctor invited for the event, and we would get our vaccines (I remember oral polio vaccine in primary school very well and then rubella). And then in high school we had Mantoux skin tests - TB was still a problem here at that time.
Nowadays it's probably different. Don't know about primary schools but in high schools there are certainly no vaccines given - the school nurse only checks such things as blood pressure, weight, does basic eyesight tests, etc.

Studies have shown that we only absorb between .01-.05% of ingested aluminum.

Source?
Speaking for myself, I eat everyday. OTOH, even as a toddler, I received, at the worst, one vaccine every other week, if not every other year.
(exception: special mention for my military period, 3 multishots in one day; if it was to brainwash us and make us compliant, it didn't work well, especially compared to our drill sergeants)

The people that primarily get alumunum induced neuropathy are people on heomodialysis, welders, and vaccine recipients.

Again, I have this feeling that people on heomodialysis or welders get enough weekly exposure to aluminium that they don't have to worry about the one coming with the occasional vaccine.

tl;dr: alu toxicity may well be an issue, but I suspect that vaccines are not the main source. Especially for adults.

@69 I have failing kidneys. I can't even use my favorite antacid because it's made from aluminum. I understand that my kidneys no longer eliminate the metals they should. However, you can be sure if there was a vaccine I needed, that would protect me from a potentially dangerous VPD, and it had some aluminum in it, I wouldn't hesitate for a moment (with professional advice, of course).

Here in Oz there's a financial incentive. There is a tax refund given to parents depending on the age of your kids (and there's an income component but it's complicated) and there's reimbursement for childcare. If your kids aren't up to date on their vaccines and you don't have a good medical excuse, you get nothing.

So the only people who can afford not to vaccinate are the pampered stay at home mums.

I'd like to see a system where every family who slips behind gets a phone call from the mother and child health nurse to schedule a checkup. If the appointment was for either vaccination or a counseling session to explain exactly why it's recommended, at least there wouldn't be parents forgetting about it or letting it slip.

A nurse visit for a vaccine is free so there's no access issue. They have centrally located mass-vaccine days or you can schedule an appointment with your own clinic or the mother and baby clinic.

We also still have school vaccine day for kids at certain grade levels. They get sent home with a consent card and information including the website for a documentary explaining why it's done.

We used to have the dentist van come around every 2 years for a checkup too. If anyone needed any work done they would generally send home a note explaining and schedule a follow-up appointment. I think it's still happening in the country. Kids' dental is free so it's a great opportunity.

But with all the awesome stuff we get, there are still so many people insisting on private schools, private healthcare, private decision-making. There's this sense of not wanting to do what the hoi polloi are expected to do, of assuming that the baseline isn't really good enough, even though it's proven to be awesome. The theosophist schools are the usual disease vectors in Australia.

Medscape has an article about vaccine acceptance.

Medscape Vaccine Acceptance Report 2016

Susan B. Yox, RN, EdD; Laura A. Stokowski, RN, MS | July 27, 2016

Does the Democrat Party Platform include anything on making vaccines compulsory?
Will Hillary be addressing this in her speech this week?

If not, why not?

I’d love it if we could get an SB277-style law passed on a federal level.

I know it's only a wish, but it will never happen. Vaccine policy is set at the state level. What I wish is that every single state have a medical-exemptions only policy, with maybe a personal exemption that requires taking and passing a comprehensive course on the immune system, the burdens of the diseases we vaccinate against, and vaccine manufacture.

Liz - that's a great idea.

And yes, getting anything done on the Federal Level (outside of the military) would be legally impossible, based on all of the various case law which has been built up over the last two hundred years.

It is very much a state-level affair (and even NYC was slapped down by a judge when they tried to do something on their own with a Flu vaccine mandate at the local level).

The issue with having school nurses give vaccines is that not all schools have nurses anymore. It's a budget thing, although it's not just a poor-community thing. In Seattle a child was not allowed to go to school because his school did not have a nurse and none of the teachers were willing to administer his EpiPen if he needed it. The only way he could go to school was if one of his parents was there. All day.

So until there actually are nurses in schools again, we can't use that as a way to make it easy to get vaccinated (which is too bad).

Just wondering if anyone knows what penalties parents face for not using seat belts and car seats for their children? If the penalty for non-vaccination was of the same order of magnitude, then you might get compliance from on-the-fence parents.

Broken Link @77: It depends on the state, but generally it's a ticket, just like for adults not wearing seatbelts or talking on phones. I think it depends on the state if it is a primary violation (something you can get pulled over for) or a secondary violation (they can't pull you over for that, but if they pull you over for speeding they can get you on seatbelts/carseast/etc).

SN
SN @73

Does the Democrat Party Platform include anything on making vaccines compulsory?

I fail to see what the relevance of the platform of a fringe political party dedicated to horse draw conveyances is to the topic at hand.

FYI, it appears that vaccinationcouncil.org and some of its clones have lapsed on their domain renewal. It would be interesting if the site fell into the right hands...

The problem with "you either get yourself/your children vaccinated or you have to buy this insurance" is that either it's another penalty that is a lot more onerous for poor parents than rich ones (both because something like $500/year is anything from impossible to trivial depending on your income, and because of the increasing tendency to throw people in jail if they can't pay fines); it's unenforceable, because what do you do if someone refuses to buy the insurance?; or it's mandatory vaccination for the poor, and optional for people who can afford the insurance.

Politicalguineapig: I am dubious of any policy that requires people to show their medical records, both for reasons of privacy and because paperwork gets lost, and it's not always the fault of the person whose paperwork it is. There are chunks of my medical history that I remember parts of, and my mother may remember other parts, but the doctors retired without us getting the records. (One of those was a doctor I had seen relatively recently; I found out she had retired because a friend called her to make an appointment and was told something like "Dr. Villanueva is retiring soon and isn't making any more appointments.") And then there's the eye doctor who somehow lost several years of my records when he moved from one practice to another....

"I’d love it if we could get an SB277-style law passed on a federal level. ..."

And I'd love it if they would roll back the decision to disallow lawsuits against vaccine manufacturers because of severe, permanent damage or deaths as a result of their obscene chemical injection mandate.

And I’d love it if they would roll back the decision to disallow lawsuits against vaccine manufacturers because of severe, permanent damage or deaths as a result of their obscene chemical injection mandate.

So do I, in my less charitable moments. Could you lay out your specific arguments in favor of a lottery system with extremely high priced tickets in this realm?

@ Narad #83

Lol fierce logic combined with a florid writing style. Makes me rather relieved that you are in the states and not against me in a pub argument :)

Orac and all those that support the violation of fundamental human rights should be in fucking jail.

You don't have a fundamental human right to refuse to protect your child from disease. A child is a human being and deserves the protection.

I would also recommend reading the article before commenting.

Yeah, I have to wonder if someone posted this to an antivax list.

It is rather obvious, though, that those who protest the loudest about "natural rights" and claim that it is the parents' "absolute right" to determine what goes into their child's body don't give a damn about the child and his rights as an autonomous being. It's all about the parent, pure narcissism.

Apparently "jay" wants to cast Orac in his new pornographic film.

I live in a country where vaccines are mandatory, bar medical exemptions. Technically, if someone would refuse vaccines, it could end up by a court order enforced by police but the system is that if parents refuse, they're send to a district Public Health Office which has a designated person to explain vaccination to refuseniks of all colours. I hear that at the end, most of the parents are persuaded, one way or another, to vaccinate and if they persist, the child's paediatrician is informed to keep an eye on the child. I am not aware of any court ordered vaccination, I guess I would notice the kerfuffle because I vaguely follow the local loony scene but I might have missed it entirely.
And, well, it sorta works.

My apologies to Jay - I meant jason.

@ Orac #46

I take the point that Danziger and Diamond's argument could be extended into justification for harsh penalties including incarceration and stewardship. But, back to the car-seat analogy, that too is a form of neglect, but draconian punishments don't follow. In fact, any number of existing laws that could be used to toss parents in stir or take their kids away are only rarely enforced, usually only in extreme cases.

I could argue that D&D are engaging in polemic – employing some harsh rhetoric in an attempt to stir the pot and establish a hard-line position as an opening gambit in an inevitable bargaining exchange that could only result in a moderated much weaker policy, but one they'd be content with. I think your point would be that this is bad strategy: not that the harsh penalties would ever be instituted, but that the fear they could be implemented is so easily activated that the counter-pressure would likely scuttle any effort at policy reform at all. That's a fair concern.

I hadn't read the full text on Slate before, and in total it comes off as more hard-core than the quotes you pulled. By the time they get to the conclusion that seems to emphasize the rhetorical force of mandates over material enforcement, they've made enough statements about the failure of persuasion, and enough references to actual severe policing that the distinction might not even register, much less carry any weight. On the whole it's a pretty confused piece that could have used a good editor. But just because D&D may be off-the-rails doesn't mean we need to abandon the discussion of vaccination mandates. We can look at the issue, and see if we can come up with a more specific policy proposal that addresses the concerns you've raised in #46.

Why go beyond SB277? Buried in D&Ds essay is an issue with SB277 that only Vicki seems to have really picked up on;

We see the family whose incompletely immunized child is refused entry to a school, not because they oppose vaccines but because they lack reliable transportation and predictable time off to receive all the shots.

The LAST people we ought to be keeping out of school are the children of poor parents who may delay vaccination for economic reasons, and/or may be vax-hesitant by virtue of being poorly informed. They can't buy PMEs from Dr. Bob; can't home school, can't buy more insurance, etc. etc. That's the 'social justice' argument for mandates: in practice 'your kids must be immunized, or else they can't go to school' discriminates against the already educationally-disadvantaged poor, and a mandate would likely have be accomanied by free immunizations administered in schools to pass muster under the Equal Protection Clause. True, a mandate might not be the only means of achieving this end, but it's worth discussing on that point among other possible merits.

I looked at Prof. Reiss's 'continuum of options to handle non-vaccination' and it's strikes me that what's missing is a continuum of enforcement methods and steps to go with "criminal sanctions for non-vaccination". Back to the car-seat analogy, and JustaTech noting first violations just yield a ticket, not a report to CPS. But unlike carrying a kid w/o a car seat, non-vaccination is not a criminal act, but a condition demanding action-to-remedy. When citizens are in non-compliance with a law, the penalties they face are based on how long they remain so after receiving notification.

Drive with a broken tail-light in CA, you get a fix-it ticket with a conditional fine revoked if you take the car to the Police Station and show an officer the repair within X-number of days. After that, you're levied the rather nasty fine, and after a while, if you don't comply, they suspend your DL, and so on*. With some creative thinking, we could propose specific enforcement measures for a vaccine mandate that would be eminently fair, reasonable, non-draconian, and stop well short of either incarceration or loss of custody, except perhaps for only the most ridiculously egregious instances... (and maybe not even that).
_________
* So I was driving back from an errand, just a few block from home, and unbeknownst to me my tail-light fuse had blown somehow during the day. It was just getting dark, and sure enough, just as I turned on my lights, I passed a police cruiser, got pulled over for no tail-lights, and was issued a fix-it ticket. I replaced the fuse as soon as I pulled into my driveway, checked that everything worked... and then forgot about it and didn't get to the PD on time. Then once I got the clearance note from the city police, I forgot to mail it to the County Court on time. Then I sent in the late payment fee and the copy of the ticket slipped out of the envelope somewhere along the way, so they sent it back. By the time I got that notice, my license had been suspended. I had an acquaintance drive me down the 30+ miles to the traffic court to try to straighten things out in person, but the line was so long I didn't get to the front before the window closed. Then I couldn't get another ride, and then... and THEN.... I finally got it straightened out before my license got permanently revoked, but it wasn't cheap. Anyway, I did learn something about mandates enforced with less than a slap-on-the-wrist at first, but that can lead to digging yourself steadily into a deeper and deeper hole via non-compliance.

The day that I am compelled to take a thimerosal shot for the flu is the day that I start flogging health officials.

I'll take vaccines for the scary diseases only. I don't need a vaccine for archaic wimpy diseases like: influenza, mumps, measles, ect...

Annabel Lee: "I don’t need a vaccine for archaic wimpy diseases like: influenza, mumps, measles, ect…"

So influenza is wimpy because it "only" kills an average of a hundred American kids per year? Is measles "wimpy" because it puts "only" one out of ten cases in the hospital and "only" kills about one out of a thousand cases?

Or is the is the only thing that is "wimpy" is your grasp of reality?

Toldja.

Not as wimpy as you Chris.

And here I thought "whimpy" was spelt with an "h".

Sorry, up way past my bedtime.

My impression of Chris:

"I need a measles vaccine to keep the measles away because I am so wimpy. My immune system is like Freddy Mercury with AIDS."

Annabel Lee is using a P.R.A.T.T. I haven't written down on my list.

I’ll take vaccines for the scary diseases only. I don’t need a vaccine for archaic wimpy diseases like: influenza, mumps, measles

All the disease we vaccinate against can kill, and have negative sequelae far more severe and far more likely to occur than vaccine adverse reactions.

Whatever. I would take influenza, mumps, and measles over autism, guilaine-barré, and POTS!

Two P.R.A.T.T.s in one. Miscalculating the risks of vaccines comparative to the diseases and blaming vaccines for things they don't cause.
Vaccines do not cause autism. A meta-analysis comprising over 14.5 million subjects looked at the question. No link.
Guillaine-Barre was 17 times more common in people who got the flu than people who were vaccinated.
What is your evidence that POTS is caused by vaccination?

Here is one: http://www.ncbi.nlm.nih.gov/pubmed/25990003

They have even come up with the phrase: Human papillomavirus vaccination syndrome

Published in "Clinical Rheumatology".
Title: Hypothesis: Human papillomavirus vaccination syndrome--small fiber neuropathy and dysautonomia could be its underlying pathogenesis.
The very first word is Hypothesis. That's not evidence.
Below the abstract is the Comment in section. And one of the articles mentioned under this subheading is:
Proposed HPV vaccination syndrome is unsubstantiated.
Extremely weak tea, and nowhere near proof.

They have even come up with the phrase: Human papillomaaluminovirus vaccination syndrome

FTFY.

This one is better: http://www.ncbi.nlm.nih.gov/pubmed/25882168

Orthostatic intolerance and postural tachycardia syndrome as suspected adverse effects of vaccination against human papilloma virus

SUSPECTED Adverse Event, not proven adverse event.

RESULTS:
35 women aged 23.3 ± 7.1 years participated.

A sample size of 35 is not nearly large enough.
Again, this is a case of "might be", not "is", with strong emphasis on "might".

One has to wonder why the HPV vaccine is so very different from others that there are such weird side effects postulated (with no logical mechanism to be found).

Oh yes - it involves POINTY NEEDLES being INSERTED into INNOCENT YOUNG WOMEN to facilitate PROMISCUOUS BEHAVIOR.

That's enough for me! (and apparently for our latest sock puppet/troll as well).

Only anti-vaxers (and nuts) could lose their minds over something that prevents cancer.....

Annabel: Vaccines work through the immune system. If we didn't believe in our immune systems, we wouldn't vaccinate. I highly recommend getting the basic facts right before commenting on a subject.

@Gray Fuckon

Yes, I know how they work. They do, like all drugs, carry toxicological risks. Scientists have been hunting for the "autism factor" for years now.

@Julian Frost

OK, there may not be sufficient proof that Gardasil causes POTS, but can you prove that HPV can cause cancer?

Yes, I can.

My mother has HPV-derived Cervical Cancer.

Anecdotal!

YMIAW

Scientists have been hunting for the “autism factor” for years now.

With a singular lack of success.

Vaccines are not associated with autism: An evidence-based meta-analysis of case-control and cohort studies
Vaccine, Volume 32, Issue 29, Pages 3623-3629
Luke E. Taylor, Amy L. Swerdfeger, Guy D. Eslick

http://www.ncbi.nlm.nih.gov/pubmed/24814559

@Ditzy Liz

With a singular lack of success.

There is no lack of successful associations:
http://www.ncbi.nlm.nih.gov/pubmed/18482737
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3878266/

You can find plenty on this blog about why the Geiers are not a good source - their work is generally bad - but here is a good summary that can shorten the process:

https://leftbrainrightbrain.co.uk/2013/10/20/looking-back-at-two-decade…

Not all studies are equal. Bad studies do not support a claim.

And another: http://www.ncbi.nlm.nih.gov/pubmed/16807526

Whatever. I would take influenza, mumps, and measles over autism, guilaine-barré, and POTS!

Pretty stupid trade-off considering none of those vaccines cause Autism and POTS [sic] and influenza vaccines raise the risk of GSB only slightly.

It's not anecdotal:

http://www.cancer.gov/about-cancer/causes-prevention/risk/infectious-ag…

There is no lack of successful associations:

Now I'm going to take a wild guess that Annabel doesn't know how to parse studies else she never would have invoked the Geiers.

If she's quoting the Geiers - well, that explains a lot.

Better than quoting Swerdfeger and Eslick!

As was done on post #112

Swerdfeger likes to feg swerds, that is where her name came from.

And Eslick likes to lick esses.

Annabel Lee is a pretty poor excuse for a troll. She's probably been relegated to a culvert.

And Lee is infested with fleas.

Do you see the immaturity you display with your childish insults and vacuous references? At least try to demonstrate that you're a competent and intelligent adult.

else she never would have invoked the Geiers.

Our nym-shifting aluminium-Concerned visitor (Phoebe C. / James Castle / PuppyBoners et al) knows perfectly well the opprobrium and contempt associated with the Geiers, from previous visits. I imagine that he or she is linking to their career of grifting mainly as a wink to the audience.

Lots of anagrams for Annabel Lee -- I like Lean Baleen (whale)

http://wordsmith.org/anagram/anagram.cgi?anagram=Annabel+Lee&t=1000&a=n

"Oh Mr Dork Terrible" is an anagram for "Herr Doktor Bimler"

None of the anagrams for "anagram" are particularly satisfying.

Who let the preschoolers out to play in the comments?

I got my MMR today. Outside of a bit of soreness, no side effects.

Less than three weeks after my one year old got his, he started walking.

He's been trying to get into places and things that can hurt him since. Well, before too, but since then he's better at it.

Herr Docktor: there was a Doctor Who novel called "Managra". They were playing around with the tendency of many Dr Who villains to have anagrammatic names. ;-)

@MI Dawn I got my MMR today

Well, enjoy your last week of almost normal intelligence before plummeting into the 5th quintile.

It seems Annabel Lee is three years old. One who actually thinks the MMR contains thimerosal. What kind of bargain basement troll was sent here. Let's send it back,

@Chris

I never said that the "MMR contains thimerosal".

The MMR is autismogenic in manners that have yet to be elucidated.

The MMR is autismogenic in manners that have yet to be elucidated.

Cart before horse? Please do elaborate.

@ rs

I'm afraid the opposite demonstration has already been done.

Successfully garnering attention under its initial 'nym, and then scuttling its reputation by going into an hurricane of sockpupetting.... I'm left to wonder if our troll is really that stupid or in need of psychiatric help.

@ Science Mom

Please do elaborate.

Let's not. 'Tis a silly place anyway.

The MMR is autismogenic in manners that have yet to be elucidated.

Leaving aside the strange Emily Post reference, "autismogenic" may well be the most comically abysmal attempt a coining a neologism that I've ever seen. It's Greek! It's English! Let's make Greconglish!

Oh, and presuming this was from "Annabel Lee," it's killfiled, so don't bother.

^ "at coining"

Successfully garnering attention under its initial ‘nym

Fendlesworth has been reduced to necromancing in a further bid for attention at AoA, by the way.

The MMR is autismogenic in manners that have yet to be elucidated.

I mentioned a meta-analysis comprising over 14.5 million subjects that looked at the question and found no link. If MMR was autismogenic even in some way that has yet to be discovered, that study would have found it.
MMR is not autismogenic.

I got my MMR today. Outside of a bit of soreness, no side effects.

Now here is a thought that has been plaguing my mind. If MMR is so autismogenic, then there must loads of cases of MMR causing immediate onset of severe Autism, in adults!?!

I mean there's an epidemic out there!!! There must be loads of cases!!!!!

@Narad

This is not my neologism. This is from Dr. Lyons-Weiler:
https://jameslyonsweiler.com/2016/01/19/hey-california-there-is-much-mo…

It’s Greek! It’s English! Let’s make Greconglish!
If Autism had a Greek name then I'd use that. But obviously, the Greeks didn't have vaccines so the didn't have a word for Autism.

Have you ever heard of a Hybrid Word Narad? There are dozens that come from two different languages: https://en.wikipedia.org/wiki/Hybrid_word

Such a douchebag Narad.

Such a douchebag Narad.

"Douche" is a French / Italian root, "bag" is Old Norse, HOW CAN YOU COMBINE THEM!?

@Jay

Just wait Jay.

MI Dawn will stop making eye-contact any day now. It takes a while for the Autism to manifest itself after an MMR.

I has to cause a gut-pathology first, as first described by Dr. Wakefield.

If Autism had a Greek name then I’d use that. But obviously, the Greeks didn’t have vaccines so the didn’t don't* have a word for Autism.

* fixed that for you.

Approximately 13 million speakers of Greek are about to prove you wrong...

αυτισμός

@Annabel Lee: does pointing at you and laughing hysterically count as stopping eye contact?

At my age, and after the number of MMRs I've had in my life (along with mumps and measles - you know, those "minor" diseases that are supposed to give you life-long immunity), I'm not too worried about a vaccine.

And, it's a good thing you a)aren't my child and b)within arms' reach. You'd have been punished for your nasty remarks about those with autism or mental disabilities. What a little nasty critter you are. And a lousy troll.

(and, by the way...I hope you are a relative to Edgar Allen with that 'nym.)

No Annabel, as people are starting to get to grips with the idea that Autism starts in the womb, way before MMR, the idea that MMR could cause formation of disorganization in the neocortex after birth, just looks ridiculous.

http://www.ncbi.nlm.nih.gov/pubmed/24670167

Mr. (not a Doctor) Wakefield:
1) Failed to declare that he had been hired to find evidence that MMR caused autism;
2) Withheld the fact that the 12 children he saw were referred to him by the solicitors looking to build a case that vaccines cause autism, they didn't come in off the street;
3) Never disclosed that he was working on a single measles vaccine;
4) Tried to set up a company to sell "test kits" for "MMR induced autism";
5) Committed multiple ethical violations, and;
6) When the data he gained from testing those autistic children failed to support his hypothesis, lied, distorted and misrepresented it.
If you are relying on the "case report" of not a Doctor Wakefield, you have nothing.

@ Annabel Lee #109

Yes, I know how they work. They do, like all drugs, carry toxicological risks. Scientists have been hunting for the “autism factor” for years now.

Hum, yes, and since they didn't find a convincing association, they decided to look elsewhere. I keep tracks of autism research for my job ; there are a lot of hypothesis more convincing than vaccines nowadays.
For example, age / weight of the parents, antidepressants / paracetamol / sodium valproate taken in utero, exposure in utero to flu / pesticides (although not specifically glysophate and in much more nuanced terms than Seneff and Lyons-Weiler)...

Notice the absence of MI Dawn only one day after the MMR?

Someone should call for help.

“Douche” is a French / Italian root, “bag” is Old Norse, HOW CAN YOU COMBINE THEM!?

No. "Autismogenic" is incompetent from any angle. The attempted interfix 'o' merely creates a new morpheme with an extra syllable, "autismo." Simple euphony should be enough to tell one that something has gone horribly wrong with their coinage.

"Austistogenic" avoids that problem, but it's still abysmally stupid.

Wonky wording aside., I would still like Annabel to clarify this:

The MMR is autismogenic in manners that have yet to be elucidated.

Maybe she should call for help.

"She"? <Janis>C'mon man, get it together.</Janis>.

Is there an antidote for the MMR?

“She”? C’mon man, get it together..

All right all right, just going along with his chosen 'nym.

Oh, Annabel, it's so sweet you're worried about me. However, it's just that my off-line life has been quite busy so I haven't been on line as much as my norm. I'm feeling quite well. My only issues at the moment have to do with construction, not health.

@Annabel Lee

I has to cause a gut-pathology first, as first described by Dr. Wakefield.

Actually, Dr. Wakefield failed to find any connection between MMR and his alleged gut pathology. To quote from his 1998 (retracted) study:

We did not prove an association between measles, mumps, and rubella vaccine and the syndrome described.

He did not even prove an association, let alone any kind of causal connection.

Newest sock puppet: "Is there an antidote for the MMR?"

For what effects? Provide the PubMed citation, obviously nothing by Wakefield because he did not really find anything.

"Is there an antidote for the MMR?" Well, if you have your bone marrow obliterated then that generally removes your immunological memory, including to vaccines like MMR, so I guess sort of?

@JustaTech

I suppose a sufficiently high dose of measles virus itself could counteract the MMR, if there were enough virions to evade the immune response long enough to set up shop and wipe out the immune memory. But then, if you were bombarded with that much measles virus, you'd have much greater things to worry about than whether the MMR causes some delusional illness.

CDC - DOCTOR PRESCRIBED RX ARE NOW THE LEADING CAUSE OF ACCIDENTAL DEATH IN THE U.S.A.

CDC - 1.9 MILLION AMERICANS ARE ADDICTED TO PRESCRIPTION PAIN "RELIEVERS".

Pharmaceutical Prescription Opioid overdose deaths
are now the leading cause of accidental death in the US, with 18,893 overdoses in 2014.

How can we call the skeptics of Big Pharm "quacks"? The very industry we seek to advocate is directly responsible for the greatest drug epidemic in United States history.

@William Godfrey:

Pharmaceutical Prescription Opioid overdose deaths
are now the leading cause of accidental death in the US, with 18,893 overdoses in 2014.

Citation Needed.

How can we call the skeptics of Big Pharm “quacks”? The very industry we seek to advocate is directly responsible for the greatest drug epidemic in United States history.

Leaving aside the incorrect wording of your sentence, it is physicians responsible for Rx opioid use. While pharma does engage in dodgy practices, what exactly is your complaint re: vaccines?

William Godfrey seems to have forgotten about deaths in car crashes. Or are those not accidents?

Rob Schneider cries "FREEDOM!" to refuse vaccination

oracknows — Wed, 06 Jul 2016 01:52:39 +0000

Rob Schneider cries "FREEDOM!" to refuse vaccination

This weekend was the 4th of July, Independence Day. It’s the most patriotic holiday of all, at least for Americans. We celebrated it in the usual way, with parades, fireworks, the odd lost digit or two, and barbecues. Unfortunately, there’s another thing that the 4th of July inevitably brings on as well, and that’s the invocation of liberty to support dubious causes. Given what happened last year around this time in California, regular readers probably have an idea where I’m going with this. Yes, I’m referring to antivaccine activists invoking “rights” and “freedom” to justify their refusal to vaccinate their children. The invocation of “parental rights” and “health freedom” are the ultimate dog whistle for antivaccinationists, wherein patriotic ideas like “freedom” are co-opted in the cause of not vaccinating. Dr. Bob Sears excels in this; he’s not even subtle about it. Conservative politicians with a propensity for antivaccine views, like Rand Paul or my very own state senator, also like to conflate “freedom” in general with the “freedom” not to vaccinate. That’s leaving aside even the most loony antivaccine politician of all, Donald Trump.In California, as SB 277 took effect on July 1 and eliminated non-medical exemptions in California, antivaccinationists lost it even more than they usually lose it.

So whose turn is it this time to use the 4th of July as an excuse to spew antivaccine nonsense and try to repackage it as “freedom”? This year, I’m afraid it’s very disappointing. Seriously, antivaccinationists really do need to find a higher quality celebrity to represent them. Yes, this year they got Robert DeNiro, but his handlers are clearly desperately trying to keep him from publicly spouting too much antivaccine nonsense, and he hasn’t been much heard from since he let it be known that he wanted to make a “vaccine documentary” with Harvey Weinberg. So I guess when the 4th of July rolled around, all they could count on was Rob Schneider.

Yes, that Rob Schneider.

This time around, Schneider wrote something (or someone wrote it for him) for The Vaccine Reaction, a blog published by Barbara Loe Fisher’s Orwellian-named National Vaccine Information Center (NVIC). Blowing that antivaccine dog whistle loud and proud on the 4th of July, Schneider entitled his post We Must Protect Our Vaccination Informed Consent Rights, and, yes, SB 277 seems to be the inciting factor.

But first, experience this introduction:

The most basic of all human rights is the ability to have control over your own body and be able to exercise informed consent when making medical decisions that can harm you or your child.

There is a concerted effort by the pharmaceutical industry, medical trade groups and their lobbyists and our paid elected representatives in state and federal government to persuade legislators to abolish rights that individuals and parents have in making informed choices about what is best for their health and their children’s health.

In 1986, Congress passed the National Childhood Vaccine Injury Act and declared that government licensed and recommended vaccines are “unavoidably unsafe.” In 2011, the U.S. Supreme Court said the same thing when they shielded vaccine manufacturers from vaccine injury lawsuits: vaccines are “unavoidably unsafe.” Their words.

Um no. Not quite. Clearly, Schneider’s conflating two different things, the National Childhood Vaccine Injury Act that formed the National Vaccine Injury Compensation Program (VICP) and a legal decision from five years ago, Bruesewitz v. Wyeth. The NCVIA never actually uses the term “unavoidably unsafe.” Rather, it states:

...[n]o vaccine manufacturer shall be liable in a civil action for damages arising from a vaccine-related injury or death associated with the administration of a vaccine after October 1, 1988, if the injury or death resulted from side-effects that were unavoidable even though the vaccine was properly prepared and was accompanied by proper directions and warnings.

Schneider seems to be taking a common antivaccine trope in the wake of Bruesewitz v. Wyeth and, as is his usual habit, not thinking clearly about it; that is, ife he can even think at all. First of all, as Dorit Reiss explains, even if the NVCIA did characterize vaccines as “unavoidably unsafe,” that doesn’t mean they are dangerous or, just as importantly, defective. To be defective, a product has to be unreasonably dangerous, either because it was poorly made or designed or because consumers weren’t aware of its dangers.

There is such a thing as an “unavoidably unsafe” product, as Reiss explains:

There are some products which, in the present state of human knowledge, are quite incapable of being made safe for their intended and ordinary use. These are especially common in the field of drugs. An outstanding example is the vaccine for the Pasteur treatment of rabies, which not uncommonly leads to very serious and damaging consequences when it is injected. Since the disease itself invariably leads to a dreadful death, both the marketing and the use of the vaccine are fully justified, notwithstanding the unavoidable high degree of risk which they involve. Such a product, properly prepared, and accompanied by proper directions and warning, is not defective, nor is it unreasonably dangerous.”

The last sentence is the important one: A vaccine whose benefits outweigh its risks is not unreasonably dangerous or defective – even if the risks are as frightening as those attributed to the Pasteur vaccine, let alone modern vaccines, with their much lower risks.

In other words, an “unavoidably unsafe” product is not a dangerous product. It’s a product with risks, even when properly used, but where the benefits of its use outweigh the risks. This is, of course, true for vaccines, whose risks are very, very low indeed. As for Bruesewitz v. Wyeth, I discussed the case in detail when its ruling was first announced, which is when antivaccine activists latched on to the term “unavoidably unsafe,” and Dorit Reiss discussed it in even more detail a couple of years ago. It was a ruling that the NVCIA preempts claims that a vaccine manufacturer should have sold a safer formulation of a vaccine.

But I’ve spent more time discussing this point that I had planned. What stands out in particular is the dog whistling going on here. Notice how Schneider claims to be standing up for the right to “informed” consent, when in fact nothing in SB 277 invalidates informed consent. Parents can still refuse to vaccinated, but there is a consequence. Their children can’t access services where the presence of unvaccinated children endangers everyone by degrading herd immunity and facilitating outbreaks of vaccine-preventable disease. In reality, what antivaccinationists want is not informed consent, but what I used to like to call “misinformed consent,” because what antivaccinationists want to use as the basis for informed consent are misinformation and pseudoscience that vastly exaggerate the risks of vaccines and vastly underestimate the benefits. I say I used to like to call it that because these days I think I prefer calling it “misinformed refusal,” to contrast it better with true informed consent. Maybe I’ll start doing that, because “misinformed refusal” of vaccines is exactly what people like Rob Schneider are promoting, while invoking freedom:

All pharmaceutical products, like prescription drugs and vaccines, carry a risk of permanent injury or death. No drug or vaccine is 100% safe or effective 100% of the time. It is also true that, as individuals, we do not all respond the same way to drugs and vaccines.

When there is a risk of permanent injury or death from any drug or vaccine, we must have a choice. If choice is taken away and people are forced to use any drug or vaccine licensed and mandated by our government, then we are no longer a free people but live in state sponsored medical tyranny.

I’m just waiting for Schneider to paint his face half blue, as Mel Gibson did playing William Wallace in Braveheart, and start yelling “FREEDOM!” imagining himself meeting William Wallace’s fate as a martyr for freedom.

Not surprisingly, this being Rob Schneider and all, his next move is to repeat common, easily refuted antivaccine tropes. For instance, he rants about how THREE BILLION DOLLARS have been paid out to children and their parents under the VICP since 1988. Whenever I see an antivaccine activist capitalizing “THREE BILLION DOLLARS” I can’t help but think of Doctor Evil in the Austin Powers movies demanding for his ransom one...MILLION DOLLARS! (Muahahahahaha!) It’s basically a rehash of the misinformation Schneider laid down three years ago about the Vaccine Court. For instance, he claims that most parents don’t know the deadlines for applying to Vaccine Court for compensation, without actually citing any data that this is true, and points out that 2/3 of claims are rejected. Of course, given how many people believe that vaccines cause autism and conditions that they don’t cause, labeling such conditions “vaccine injury,” it strikes me as pretty good if the VICP compensates 1/3 of complainants, assuming that Rob Schneider’s figures are correct, which is something I never assume. For example, one wonders what the percentage of complainants compensated is if you leave out the 5,000 cases of the autism omnibus, whose claims that vaccines cause autism were rejected based on test cases.

Much of the rest of the post is a “greatest hits” of the antivaccine movement. For instance, Schneider claims that Congress and the Supreme Court gave vaccine manufacturers COMPLETE IMMUNITY from product liability and personal injury suits when in fact that is not true. If a complainant is not compensated by the Vaccine Court, that complainant can then access the regular courts. All the VICP does is to require that the first step be the Vaccine Court, which uses a loosened standard of evidence for determining vaccine injury and even pays the court costs of complainants. The only reason antivaccinationists hate the Vaccine Court is because unscrupulous lawyers preferring to gamble on the chance to get big payouts from the regular courts rather than accepting the certainty of being paid much less by the Vaccine Court have convinced them that they could be compensates so much more if the Vaccine Court didn’t exist. In reality, these lawyers do not have the best interests of the truly vaccine-injured (as opposed to those whose parents only think they’ve been vaccine-injured) at heart at all. It is far better for such parents to have a higher probability of payout and have their court costs covered even if they lose than it is for them to gamble on big payouts with the vast majority of them receiving nothing at all.

Others are there, too, such as the claim that vaccines cause all sorts of horrible problems, that children receive more vaccines than any other generations, and how it was “media hysteria” over the Disneyland measles outbreak last year that lead to SB 277, making the claim that only “2.5% of children attending kindergarten in California had a personal belief exemption on file but those children will be blocked from getting a school education starting in the fall.”

Or you could look at it this way, the way a study in February looked at it:

The percentage of fully vaccinated kindergartners entering the state’s schools in 2015-2016 was the highest in a decade: 92.9%, up from 90.4% last year. State health officials say the measles outbreak at Disneyland a year ago might have scared a few parents off the vaccination fence, but SB 277, combined with another bill from 2012 that required parents to talk to a pediatrician before obtaining an exemption, had more to do with it.

That could be the difference between effective herd immunity and ineffective herd immunity.

After all that, Schneider concludes:

Now there is a concerted effort by public health officials to mandate vaccines for adults, too. Health care workers are being fired if they don’t get an annual flu shot, which CDC admits is a vaccine that doesn’t work half the time!

With hundreds of new vaccines being developed by industry and government, it is very important that we protect our legal right to exercise informed consent to vaccination for ourselves and our children because our civil rights also are being threatened if vaccination is tied to our ability to get an education, a job or medical care.

First off, no one is tying vaccination to our ability to receive medical care; that’s just not going to happen. As for tying vaccination to our ability to get a job, yes, that can happen, but only in health care fields involving direct patient contact, which is as it should be.

Of course, Schneider views this all as a huge conspiracy between industry and government to “force” vaccination when in reality it is nothing of the sort. It’s an effort to keep vaccination rates above the threshold of herd immunity in the face of antivaccinationists like Rob Schneider.

oracknows Tue, 07/05/2016 - 21:52

Tags

school vaccine mandate

https://www.youtube.com/watch?v=ZxYA6duF-9E

Interestingly enough, I take various medications that could, trivially, kill those not requiring those medication.
By the antivax standard, those medications and my aorta shoud burst.
I'm also a childhood smallpox vaccine recipient, in adult life, receiving it yet again, several times. As it's the most risk full vaccine on the planet, I'm still cool with it.
Seriously, when a disease kills more than a third of its victims, yeah, the modest, but currently unacceptable risk is worth the effort.
Today, smallpox is extinct.
My honest, last dying wish, preferred long before I even get old, is, polio, measles and German Measles are all rendered extinct, along with diphtheria. I have modest hopes.

To the antivaxers, some of which threatened me, a singular member even managed to both dox me and threaten my entire family, as I responded then, as now, go for it.
If I'm feeling charitable, I'll use a firearm, as that's utterly unlikey a black hole shining like new money, let's suffice it to say, as back then that I did relate, it'd be edged weapons only and you'll depart in two body bags.

Yeah, there's a side of myself that I honestly loathe, but was treasured by the military enough to hold up a retirement for half a year.

I always wonder when I read about "medical FREEEEEEDOM!", would the advocates stand by my side if I decided to inject myself with, for example, a bubonic plague or some other highly contagious and lethal disease and then spend time with them and their children.

I mean it is my body and I should have complete freedom to do with it as I wish.

One more area where we may see - are already seeing - school immunization requirements tied to job is daycare or school workers. To remind you, in 2015 California also passed SB792 which requires daycare workers to receive certain immunizations - and appropriately so, for people working with young children.

I think what's common to health care and daycare workers are three things, and it's the combination of them that makes immunization mandates justified:
A. These are service professions, where you go in choosing to make your job serving and taking care of the interests of another. It's therefore appropriate to expect you to take precautions to do so.

B. These are professions where you work with vulnerable populations - sick people or young children.

C. These are already heavily regulated professions - you go in knowing your conduct, and to some degree personal conduct, will be subject to very intensive and intrusive regulation.

This fall, Rob Schnider is.... an anti-vaxer!

Derp-de-derp-de-derpity-derp!

About the 90-92% vaccine coverage:

That could be the difference between effective herd immunity and ineffective herd immunity.

Especially if most of these unvaccinated 10% are congregating around the same places, like a school. You could have a 95% coverage at the state level and only 80% in your own neighborhood.

Freedom. The thing that ensures we can't control infectious diseases or gun violence. The thing that ensures women can't upset us by wanting to control their own bodies. Oh yes.

Narad will probably correct me if I'm wrong, but I believe that Bruesewitz expressly rejected the claim that vaccines are "unavoidably unsafe". Also, that if a claimant is rejected, their options are to accept the ruling, or appeal based on administrative reasons (i.e., the Special Master made a mistake), not that they can take their claim to the civil courts and sue directly.

However, manufacturing defect and labeling defect claims are still wide open for people to pursue in civil court.

The majority in Bruesewitz found that Congress was not referring to the unavoidably unsafe classification when it wrote the National Childhood Vaccine Injury Act, you are right.

I addressed that in the post Orac cited from - http://www.redwineandapplesauce.com/2014/07/17/guest-post-vaccines-and-…

And you're also right about the result of Breusewitz. Petitioners unhappy with the NVICP result can no longer go to the regular courts with design defect claims, but they can with manufacturing or warning defect claims.

Actually, Dorit could probably clarify. IANAL, as everyone knows, which is why I probably should have shortened the Bruesewitz section. After all, the overall point is that "unavoidably unsafe" doesn't mean what Rob Schneider and other antivaxers think it does when they use it to scare parents. And I do think you're right, neither the NCVIA nor Bruesewitz, I think, actually uses the term "unavoidably unsafe."

@Orac

"the overall point is that “unavoidably unsafe” doesn’t mean what Rob Schneider and other antivaxers think it does"

True. IIRC, the Bruesewitz ruling said that the "unavoidably unsafe" language does not apply, but even if it did, the benefits of vaccines still outweigh the risks, and so they are not unreasonably risky.

No one is being forced to be vaccinated. Even the healthcare and daycare workers. Don't like it? Get into a different profession. You're not going to be kidnapped, whisked away, and have a needle thrust into your arm.

Healthcare workers who are against vaccination are already suspect in my mind.

Also, I really wouldn't want to send my kids (especially a baby) to a daycare where the staff weren't up to date on their vaccines.

Rob Schneider makes wasteoids appear intelligent. I invite Mr. Schneider to visit Eloy, AZ, where employees of a detention center are even now showing the consequences of "vaccine freedom" with regards to a measles outbreak (starting late May) in this facility that is up to 22 cases-- thanks to employee refusal to vaccinate (with subsequent media notification with each new case about places in Casa Grande and Phoenix where the newly infected staff member visited whilst contagious with measles.

From a recent news article when the case count reached 22 ( https://www.azpm.org/p/top-news/2016/6/30/91124-measles-at-eloy-detenti… ):

When measles cases started surfacing at the Eloy detention center in the spring, Pinal County health officials made two requests, Health Director Thomas Schryer said.
"One was for the inmates or detainees to become vaccinated," Schryer said. "They all agreed to do that so they are immune and are not passing the disease amongst each other.

"The other was for the staff to either be vaccinated or provide proof of immunity," he said. "However probably about 40 percent of the staff have not done that, and what we’re seeing today and the reason we’re seeing cases out of that facility is because the staff are passing measles amongst each other, and unfortunately they’re going out into the community, so we expect to see more cases from those exposures."

He said workers are refusing vaccination requests and employers are trying to convince them otherwise.

This is what happens, Mr. Schneider, when people are "free" to refuse vaccines without consequences--they put are communities at grave risk, which is especially worrisome given that hundreds of Arizona schools are not at herd immunity levels for measles (AZ had the worst MMR rate for children in the US in 2015 per the annual CDC survey).

Even (to me at least) further infuriating is that the Director of the Arizona Dept of Health Services (AZDHS) does have the power under law (http://www.azleg.state.az.us/ars/36/00136.htm , section H) to stop this outbreak but has refused to do so. It is only a matter of time if this measles outbreak (the largest since Disneyland in the US) continues before it breaks into the surrrounding communities.

@ Chris Hickie

where employees of a detention center are even now showing the consequences of “vaccine freedom”

As a side effect, the inmates must be overjoyed with the free show.

"OK, warden Johnson is looking a bit pale. The betting pool is open. How long before he calls in sick, and how long before he comes back."

"Not so tough now, eh, mate?"

De Nero is making a vaccine documentary with Harvey Weinberg?

I really hate people in the "service" industry that refuse common sense regulations - and especially those who want "religious" freedom to discriminate.....if they wanted that kind of "freedom" then perhaps they shouldn't have started a business who's sole purpose is to serve the public...then entire public.

From what I can gather, antivaccinationists support quarantine for dangerous infectious diseases. Well, many diseases are contagious while incubating prior to becoming symptomatic. We could, of course, quarantine everyone returning from abroad; but our borders are porous. In other words, not only not vaccinating ones own child puts him/her at risk; but risks other children as well if the unvaccinated child joins the chain of transmission. Since there are children who can't be vaccinated, e.g. autoimmune diseases, undergoing chemotherapy, and/or whose immune system just didn't respond sufficiently from vaccination, they have rights to.

The bottom line is that in a modern civil society, people have both rights and responsibilities. Unfortunately, Americans forget the second part "responsibilities." I find it offensive when antivaccinationist parents state publicly that their only concern is their own child. If everyone thought that way, they would rue the day they had made their statement. In addition, the antivaccinationists parents are ill-informed about the "risks" from vaccinationists, mostly mild reactions, though a few serious ones; but exponentially fewer than from the natural diseases they protect against.

Just an historical tidbit: Washington ordered variolation of all troops under his command. Smallpox killed 1/3 or more during an outbreak, leaving others blind, and recuperation time was long. Variolation had been found to reduce deaths to under 2%, closer to 1%, from the variolation. Yes, the procedure, a primitive form of inoculation, killed approximately 1% as opposed to the disease killing 1/3 or more. Most people would think Washington's decision highly responsible. The main point is that mandatory vaccination is nothing new in this country. And Washington offered the variolation to the civilian populations where his troops were and many availed themselves of it.

@14

The notion that General Washington ordered smallpox inoculation of the Continental Army in 1777 simply isn't true as Jenner wouldn't make his discovery for another 19 years.

Though it was true that he ordered the inoculation, I'm not sure how far it went from there. So, my mistake-- there is some truth to that claim.

Just an historical tidbit: Washington ordered variolation of all troops under his command.

A wise precaution. More than a century later, nearly 90% of American military deaths, and about 60% of total casualties (including wounded), in the Spanish-American War were from disease rather than battle.

"Unavoidably unsafe"?

You mean like wooden blocks, toy telephone and foam ball?

http://www.nbc.com/saturday-night-live/video/irwin-mainway/n8641

@ Chadwick Jones

Jenner showed that vaccination for smallpox worked. However, I said Washington variolated his troops. Variolation was brought to England by Lady Mary Wortley Montagu in 1717 and first used in a smallpox outbreak in 1721 in Boston. Ben Franklin initially opposed it; but later did some of the first statistical calculations, using number died and denominators of those variolated and those not, finding far fewer died who were variolated. There is a great little book, entitled "The Pox and the Convenant" about this episode in American history.

Variolation involves scratching the scab of someone with smallpox, taking the substance obtained and scratching someone who is still unaffected (in China, they powdered and inhaled it). Vaccination involved scraping the sores from an infected cow and then scratching the substance on a person. Before mouthing off, trying using Google and checking.

If your children have such wide freedom, why do you refuse to let them drink, carry guns, have sex with another person, sign up to contracts and so on?

BECAUSE CHILDREN HAVE LIMITS TO THEIR FREEDOM.

Moreover, paedophiles have THEIR adult freedom to engage with sex with your child because the rights of children to a safe and healthy life, despite being unable to enforce such rights personally are granted by society to be enforced BY that society, against the freedoms of the adult wishing to engage in practices that may be deleterious to the child.

Society has the right to vaccinate your child against the parents wishes for just the same reason as they would have the right to remove you from their life if you wished to have sex with them. EVEN IF the child claimed it was voluntary.

Because it's not YOUR child, they belong to themselves. You're responsible for their health. No more right than that.

And you don't have the right to risk them, even if you fervently believe it the best thing for them if society believes otherwise.

Don't like it? Move to a different country that will allow you.

E.g. Thailand.

At the hospital I work at, you are given a choice about getting the flu vaccine, get it or where a mask while you are at work.

I hadn't thought about the rabies vaccine for a long time, but I do remember how awful its side-effects were. So bad that sometimes parents of bitten children would rather risk rabies than the vaccine. It seems to me there must be an opportunity there to produce a purified protein derivative that would have reduced side-effects. As I recall, there were reactions caused by egg allergy because of the use of eggs in the manufacturing process. There's no necessity for a rabies vaccine to contain egg protein. Why can't they use recombinant DNA to make a viral coat protein?

@ Mark Thorson

From Wikipedia:

Rabies vaccines may be safely used in all age groups. About 35 to 45 percent of people develop a brief period of redness and pain at the injection site. About 5 to 15 percent of people may have fever, headaches, or nausea. After exposure to rabies there is no contraindication to its use. Most vaccines do not contain thimerosal. Vaccines made from nerve tissue are used in a few countries, mainly in Asia and Latin America, but are less effective and have greater side effects. Their use is thus not recommended by the World Health Organization

The human diploid cell rabies vaccine (H.D.C.V.) was started in 1967. Human diploid cell rabies vaccines are inactivated vaccines made using the attenuated Pitman-Moore L503 strain of the virus.[7] Human diploid cell rabies vaccines have been given to more than 1.5 million people as of 2006.[citation needed]

In addition to these developments, newer and less expensive purified chicken embryo cell vaccine, and purified Vero cell rabies vaccine are now available. The purified Vero cell rabies vaccine uses the attenuated Wistar strain of the rabies virus, and uses the Vero cell line as its host.

Only the vaccine made in chicken embryo cells would cause egg allergic people to react.

According to Wikipedia there is a recombinant rabies vaccines; but only used for animals.

The original Pasteur vaccine was quite nasty, involving multiple injections in the stomach muscles with lots of side-effects; but I haven't heard of many with the newer vaccines. Keep in mind that all vets and veterinary personnel, people working at zoos, game wardens, etc. get them prophylactically.

Given that except for, as I remember, 2 cases that survived full-blown rabies, if a bite is from a suspected rabid animal, any parent refusing the newer shots would be quite foolish.

The scenario/film I'd like to see: Schneider as the patient entering sugery for his bowel obstruction.

Schneider: "I'll be OK won't I doc; I don't want to get an infection or anything"
Doc: "We'll have to see. I don't wear gloves or wash my hands before surgery. Didn't they tell you?"
Schneider: "Gulp! ..Whaaat...?"
Doc: "It's against my principles. I invoke "Health Freedom" - that should accord with your views surely Rob?"
Schneider: "Err.. I'm not too sure about that."
Doc: "Oh come on, what's the worst that could happen? Maybe you get some resistant coliform bug from my dirty hands? What's that compared to my rights to operate in the way I chose, unfettered by medical constraint and infection guidelines produced by some pharma shills?"
Schneider: "But..but.."
Doc: "And I hope they told you about my being a Hep B carrier and all. I didn't want the Hep B vaccine forced on me you see when I was a student. You'll understand exactly why, of course. Let's just hope I don't nick myself while I sew up your colon, shall we?"
Schneider: "Uhhh..."
Doc: "Rob? ROB..? Mr Schneider?! Quick someone get the arrest trolley and dial for the crash team!!!"

Wow: Even Thailand vaccinates. So do most developing countries, because they remember what happened when they didn't.

And I do think you’re right, neither the NCVIA nor Bruesewitz, I think, actually uses the term “unavoidably unsafe.”

Bruesewitz does, by way of rejecting the Bruesewitzes claim that the concept applied (this would have gotten them a case-by-case analysis in state court). The reference to "Congress" is to a House report that endorses the comment k idea, but it's nowhere in the law and also rejected by the Court, I believe, but I've got at least one fractured rib at the moment, so it's hard to focus.

Angela@10:

Healthcare workers who are against vaccination are already suspect in my mind.

Ditto. I wouldn't want to be treated by anyone who puts their own neuroses before patients' health. That's not the definition of medical professional. Find a different career: it will be best for all.

Also, that if a claimant is rejected, their options are to accept the ruling, or appeal based on administrative reasons (i.e., the Special Master made a mistake), not that they can take their claim to the civil courts and sue directly.

Right; the appeals path is to the regular Court of Federal Claims (which only checks for wanton recklessness by the Special Master), then the Federal Circuit, and then the Supreme Court.

However, manufacturing defect and labeling defect claims are still wide open for people to pursue in civil court.

Realistically, labeling defect is probably off the table too, because the FDA approves it.

@Narad

Realistically, labeling defect is probably off the table too, because the FDA approves it.

True, but it's always possible for the manufacturer to become aware of some adverse reaction and fail to update their labeling. That could lead to both FDA action and open them up to a civil suit. Unlikely, but possible.

dingo199@24:

The scenario/film I’d like to see: Schneider as the patient entering sugery for his bowel obstruction [snip]

Major surgery? What, you couldn't find an adult-sized set of these?

Schneider wrote something (or someone wrote it for him) for The Vaccine Reaction

If Rob wrote that all by his lonesome, I'm Hannukah Harry. Not that he's 'too stupid' or anything, I just don't see him using language in that way. I'd guess that whoever wrote it, it's actually Fisher's voice, and she just wanted it published under a 'celebrity' byline for greater publicity, and to suggest a wider group of adherents to her line, including 'regular people' like the Scheid.

Regardless, I think it's a bit misleading to attribute the arguments to "Schneider", as that allows for them to be cast as just idiosyncratic rantings of a professional baboon. I mean, to non-AVs, the reaction would likely be, 'Rob Schneider? Who cares what he thinks?' Better, I think, to consider this post as expressing the institutional voice of NVIC. That is, I think the OP would be more on point, and more disturbing, if you did a global search and replace substituting 'NVIC' for 'Schneider' after the first blockquote.

Basically, people are selfish. Antivaxers are not unique in this manner. Americans seem to be selfish about a lot of issues. But, I digress. My point is antivaxers are selfish and want their way and don't care about others. They don't care that SB277 actually affords both sides freedoms and choices, they only care about themselves and their children. They never stop to think about society or the public.

@sadmar

You apparently haven't seen Rob Schneider's Twitter rants or his public comments about vaccines. (A number of years ago, Radio from Hell gave him a good skewering.)

I haven't seen Schneider's Twitter rants because he's blocked both of my Twitter accounts (Orac and my not-so-super-secret real name account). That means if I want to see anything by him I have to use my secret Twitter account that I've never used to post and keep for the sole purpose of seeing what those who've blocked me are saying. But only when I'm curious. I haven't checked on Schneider's Twitter rants for many a moon. :-)

@Orac

Yeah, he's blocked me, too. There are ways around such things, though.

The Mel Gibson reference is more apropos than a lot of folks might expect... Gibson's celebrity was used in a similar way back in the 90s when the vitamin/supplement organizations were freakiing out at possible regulation and rather successfully lobbied Congress to protect their billion-dollar snakeoil industry free-for-all. (Special shout-out to Sen. Harkin and Sen. Hatch for that one, ouch...)

And though it may seem tangential, I think it's important to keep in mind that all of these charlatans, whether promoting "supplements" or "organic" food or antivax views with "alternative" medical options, all share the same pedigree and historical underpinnings, and especially the same market.

If you haven't seen this yet, brace yourself... it's a real whopper: https://m.youtube.com/watch?v=IV2olDA0w8U

I'm of the same mind as has and Angela. Someone who objects to vaccinations shouldn't work in health care.

Re labeling defect: I agree with Narad that a warning defect against the manufacturer may be off the table because of FDA involvement. But a warning defect against a provider - especially one who failed to provide the VIS before vaccinating - may not be. The act revived the Learned Intermediary doctrine, which would make it hard to sue manufacturers anyway but puts more risk on the doctors.

Re labeling defect

Geez, and I'm still just on the tramadol.

Unrelated but I just noticed a friend of the blog quoted in a listicle about alternative medicine: http://www.msn.com/en-us/health/medical/9-plain-truths-about-alternativ…

I haven’t seen Schneider’s Twitter rants because he’s blocked both of my Twitter accounts (Orac and my not-so-super-secret real name account). That means if I want to see anything by him I have to use my secret Twitter account that I’ve never used to post and keep for the sole purpose of seeing what those who’ve blocked me are saying.

I'm not a Twitter user, so I have to ask: What is the logic behind this implementation of "blocking"? It's as if somebody is saying, "I'm going to write this for all the world to see, except certain specific people whom I don't want to see it." Of course there are workarounds for something like this. I've been told (but not verified for myself) that you do not actually have to be logged into a Twitter account to see tweets--that might be one workaround.

I get the idea that there might be Twitter stalkers, and something has to be done about that before it spills over into meatspace. But I don't see how saying that specific users (and only those specific users) are not allowed to read your Twitter feed is supposed to accomplish this. The ones who are determined enough to be potentially dangerous in meatspace will find workarounds.

It's to be able to block stalkers and harassers. Also, if you're not logged onto Twitter, you can see Tweets, but you can't Tweet yourself. Also, serial offenders can have their Twitter accounts taken away by Twitter.

No one said it's a perfect tool, but I really don't know what else Twitter can do other than give the ability to block problematic users. I myself have blocked users who were simply too annoying, constantly Tweeting idiocy at me. It is a good thing.

@Eric Lund

Blocking can serve a legitimate purpose, like making it so you don't see the tweets from some annoying pest that constantly mentions you (though that can be achieved with muting, as well). It can also help to keep stalkers from seeing what you're up to, though, again, minimally. You can protect your tweets so that only people you approve can see your tweets, but that's rather silly for a celebrity to do if they want to engage their fans.

When it comes to anti-vaccine people, blocking seems mainly to serve two purposes: 1) prevent any unwanted and inconvenient facts from intruding into their echo chamber, and 2) prevent science-minded people from gathering blog fodder. It's pretty effective for #1, since getting around that is a bit tedious, but blocking is as good as useless at #2.

Yep. You can protect your Twitter stream so that only people to whom you grant permission can see it, but that doesn't work so well for celebrities, and relatively few people do that.

Orac,

In case you ever write a post about a medical issue other than vaccines, you might want to consider this
cluster f.. f… failure:

“Functional MRI (fMRI) is 25 YEARS OLD, yet surprisingly its most common statistical methods have not been validated using real data. Here, we used resting-state fMRI data from 499 healthy controls to conduct 3 million task group analyses. Using this null data with different experimental designs, we estimate the incidence of significant results. In theory, we should find 5% false positives (for a significance threshold of 5%), but instead we found that the most common software packages for fMRI analysis (SPM, FSL, AFNI) can result in FALSE –POSITIVE RATES OF UP TO 70%. These results question the validity of some 40,000 fMRI studies and may have a large impact on the interpretation of neuroimaging results.”
http://www.pnas.org/content/early/2016/06/27/1602413113.short

Just a thought.

Todd: I don't do Twitter, but you seem to have taken my doubt that Schneider wrote that as relating to his opinion on vaccines, which it wasn't. I've read his previous remarks that Orachas quoted, and they fit your description of his Tweets as "rants". If anything, the post in question is more 'tame' linguistically than I'd expect Schneider to be.

The point, again, is that the sentiments Orac critiques have the backing of an organization that actually has had some clout in the past, and presents itself as the 'legitimate' voice of 'vaccine safety' concerns. In some ways, Fisher presenting her position under Schneider's byline offers her some protection as well as publicity. Schneider takes the flack, as he does here, and Fisher's free to go on acting like Ms. Responsible as she lobbies for her cause.

^ Which the f*ckwit also posted at Ethan's.

At many facilities, healthcare workers who refuse a flu vaccine have to wear a mask. However, at my local hospital (or one of them) administration decided EVERYONE gets a flu shot unless they are allergic to eggs or have a documented reason why they can't get one.

The university I'm attending is now requiring proof of MMR, varicela titers/vaccination, TDaP, and Hep B before students can participate in clinic. Meningitis vaccination for the younger students (I'm too old to need it).

I got Hep B and didn't seroconvert with after 2 series. I can't find my documentation for the second series.

If I have to get a third round, so be it. I got a TDaP booster two years ago because they wanted the Pertussis (we had a local outbreak). I'm allergic to Tetanus. A course of prednisone and diphenhydramine, and all is right with the world.

Worth it.

I wouldn’t want to be treated by anyone who puts their own neuroses before patients’ health. That’s not the definition of medical professional.

I'm going to start using the phrase Medical amateur for people like this, and CAM practitioners.

Rebecca @49: I have a childhood friend who is a nurse who expressed concern about the flu shot a few years ago on Facebook. While I was writing up a respectful pointed rebuttal, her dad posted a link to a Snopes article debunking her specific concern. And then my friend was all "Oh, you're right, now I see what a bad argument that was!" And never another word.
So people can learn and be sensible.

On the whole "fired if you don't get a flu shot": in the US, unless you have a contract (which is generally uncommon unless there is a union) you can be fired for anything that isn't a protected class. Thus, you can be fired for breathing too loud, or being left handed, or liking New Wave music. Or not getting a flu shot. It might be unreasonable, unfair or stupid, but it's legal. It's only not legal to fire someone as retaliation or for their race, religion, sex, gender, age, national origin or other protected class.

Anti-vaxxer is not a protected class.

JustaTech: I'll add a wrinkle to your point, which is that there can be challenges to such dismissals under labor law for the claim of unilateral challenges of work rules in violation of collective bargaining agreement. There were challenges to mandates on those grounds How successful such challenges are depends on the collective bargaining agreement and the arbitrator - and at any rate, they only apply to unionized workers.

But generally, I agree with you. There might be a wrinkle if the claim is religious opposition to the shot, but safety concerns are not a defense against dismissal for refusal to vaccinate.

"^ Which the f*ckwit was also posted under the f*ckwit's name at Ethan’s."

FTFY. Regardless of who posted it where, that doesn't clarify the questions of authorship and purpose. In the broader scheme of things, critique directed at Rob Scheider has no consequence for opposition to the policy agendas of antivax politicos. Fisher remains able to have at least enough legitimation in the corridors of power to "get their attention" (c.f. Chaffetz on the "CDC Whistleblower"). NVIC, not Schneider, is the voice that can make policy trouble, and when "Schneider" either voices or echoes NVIC's arguments and rhetoric, it's NVIC that needs to be countered and de-legitimated.

Um, not exactly. I think you really do attribute to the NVIC way more influence than it, in fact, has. The center of power in the antivaccine movement has shifted, and the NVIC hasn't been the main heavyweight in a long time.

It wasn't Barbara Loe Fisher who got Chaffetz's attention. It was a combination of antivaccine lawyers looking to sue vaccine manufacturers plus Del Bigtree and Andrew Wakefield. As far as I've been able to tell, Fisher had nothing to do with the Chaffetz meeting. Fisher might still be respected as the grande dame of the antivaccine movement, having been integral in starting the modern iteration of it back in the 19080s by igniting the DPT scare and contributing to the passage of the National Childhood Vaccine Injury Act of 1986, but thirty years later her influence, other than as propaganda. The reason, of course, is that the National Vaccine Injury Compensation Program and the Vaccine Court are so widely hated by antivaccine loons, and they don't forget that Barbara Loe Fisher worked with legislators to draft and pass it, which, ironically, is the only thing of value Fisher has accomplished in this realm. It's also an action she now regrets bitterly, because the Vaccine Court has never ruled that vaccines cause autism and doesn't actually compensate every wild parental claim of vaccine injury. Also, trial lawyers hate it because they seem to prefer rolling the dice for a small chance at a big payout, from which they get 30%, to a guaranteed reasonable fee for representing complainants to the Vaccine Court. That's because they're all about money, not the children.

The last time hearings were held a couple of years ago, she didn't have much to do with them, either. The Canary Party and the AoA collective hive mind did, although they did use a video narrated by Schneider as one of their propaganda tool. Oh, and Jennifer Larsen's $40,000 contribution to PACs supporting Darrell Issa's reelection.

http://scienceblogs.com/insolence/2013/09/18/the-antivaccine-movement-t…

If anything, I suspect that publishing a post by Rob Schneider, whoever actually wrote it, was nothing more than a strategy on Fisher's part to assert that she is still relevant.

@Orac,

In the picture you provided for this post, the two Warrior's behind the screaming Man are clearly looking at the camera. If Rob Schneider was in this picture he would have had this scene removed or reshot. Mr. Schneider is a talented professional both on-screen and off-screen no matter what arena he's in.

@MJD:

Mr. Schneider is a talented professional both on-screen and off-screen no matter what arena he’s in.

Um, no actually. He's only good when he's in films produced by Adam Sandler. He's also not above immature sniping, which is highly unprofessional.
When film critic Patrick Goldstein wrote a scathing review of Deuce Bigalow: European Gigolo, Schneider retaliated by mocking Goldstein for never having won a Pulitzer. The famous Roger Ebert had won a Pulitzer, and declared:

As chance would have it, I have won the Pulitzer Prize, and so I am qualified. Speaking in my official capacity as a Pulitzer Prize winner, Mr. Schneider, your movie sucks.

OK, my error on Fisher. I know Schneider's a Canary, and I had the impression they were more aligned with Fisher, but obviously I have my taxonomy of the internecine AV feuds mixed up, and can't tell the People's Front of Judea, from the Judean People's Front, or the Judean Popular People's Front. "Never mind'."

Julian: I'm not sure "good" and 'Adam Sandler movies' belong in the same sentence. Schneider's character was the most entertaining part of Stallone's Judge Dredd, but that's not saying much. I'd say Rob's career highlight is an uncredited one-liner in another futuristic Stallone flick: “He doesn’t know how to use the three seashells!”

I disagree. I think that Schneider's career highlight was definitely Saturday Night Live.

He was also on the writing staff for three years. He is actually a funny guy IMO, but you wouldn't know that from his movies.

I used to despise him until I saw his stand-up comedy. He is a better writer than actor IMO.

But this is coming from someone that hasn't seen "Deuce Bigalow" and "The Hot Chick".

He is credited with writing the screenplay for both of these, so if they suck, it is a double indictment.

@sadmar:

I’m not sure “good” and ‘Adam Sandler movies’ belong in the same sentence.

The thing is, most of them have made a lot of money, which is why he's constantly being given the opportunity to make more. I liked The Wedding Singer. It's silliness wasn't OTT and that was part of its charm.
@Travis: I didn't know about his stand-up work. I saw The Hot Chick. In my view it was amusing but forgettable. Ditto The Animal.

After SB 277, medical exemptions for sale, courtesy of Dr. Bob Sears and other antivaccine quacks

oracknows — Mon, 09 May 2016 01:13:41 +0000

After SB 277, medical exemptions for sale, courtesy of Dr. Bob Sears and other antivaccine quacks

I realize that it's a cliché to say so, but some clichés are true. Time really does fly. It's hard to believe that a year ago California—and, by proxy, the rest of the country—was in the throes of a major political war over the bill SB 277. SB 277, you will recall, was a bill introduced into the California Assembly in the wake of the Disneyland Measles outbreak in early 2015 that eliminated non-medical exemptions to school vaccine mandates beginning with the 2016-2017 school year. Ultimately, SB 277 passed and was signed into law by Governor Jerry Brown last July. It was an uncommon victory for science and public health, and already appears to be having a positive effect on vaccine uptake in kindergarten children.

Unfortunately but not unexpectedly, to say that the proposal and passage of SB 277 into law drove the antivaccine movement into even greater fits of crazy in response is to put it mildly. It became a common trope on antivaccine websites and blogs to see SB 277 compared to fascism, in particular the Holocaust. Robert F. Kennedy, Jr. and "Dr. Bob" Sears explicitly compared SB 277 to the Holocaust. Truly, the Godwin was strong in the antivaccine movement. One particularly offensive meme that went around at the time consisted of antivaccinationists suggesting that SB 277 was a major step in the direction of requiring unvaccinated children to wear a badge or armband to identify themselves, the way that the Nazis required Jews to wear badges or armbands with a yellow Star of David on them. One, Heather Barajas, even went so far as to be photographed with her children wearing such an "unvaccinated" badge and juxtapose that photo with photos of Jews from the Third Reich wearing yellow Stars of David.

The flaw in SB 277

SB 277 is generally a good law, but it's definitely not perfect. Perhaps its most glaring weakness is that all that it requires for a child to obtain a medical exemption is a letter from the child's doctor. In other words, any physician can provide a letter for parents to use to get a vaccine mandate. It's useful to look at the other two states that do not allow nonmedical exemptions to school vaccine mandates, Mississippi and West Virginia. Basically, in its acceptance of the word of basically any physician, SB 277 is similar to Mississippi law. In contrast, in West Virginia, it isn't just the word of the child's physician that matters; all requests for medical exemptions are reviewed by an Immunization Officer, who determines if they are appropriate "based upon the most recent guidance from the Advisory Committee on Immunization Practices (ACIP), the American Academy of Pediatrics (AAP), and the American Academy of Family Physicians (AAFP) with respect to medical contraindications or precautions for each vaccine."

On the surface, SB 277 would indeed seem to be a godsend to antivaccine pediatricians, who will likely see their business boom in the wake of SB 277, as parents, no longer able to get nonmedical exemptions, start looking for medical exemptions, much the way parents in states that allow religious exemptions but not personal belief exemptions, suddenly found religion and used it as a justification for not vaccinating. Resistance will flow wherever it can. I'm just happy that, in this case at least, only letters from a physician will be valid for obtaining a medical exemption; one could only imagine what would happen if letters from naturopaths and chiropractors, who, unfortunately, are licensed "health care professionals" in the state of California, were permitted. Over at my not-so-secret other blog, I predicted this would happen based on statements of antivaccine-friendly pediatricians such as Dr. Jay Gordon and Dr. Bob Sears last summer.

Now, as the 2015-2016 school year winds to a close and parents are thinking about the 2016-2017 school year, I have discovered that my predictions were correct.

A gold rush among antivaccine-sympathetic pediatricians

Over the weekend, I saw this story by Kaleigh Rogers, "California Doctors Are Advertising Ludicrous Medical Exemptions to Anti-Vaxxers", that appeared to confirm my predictions:

Dr. Tara Zandvliet, a pediatrician based in San Diego, has a pretty typical doctor's website. The design is reminiscent of a late-90s Dreamweaver template; the color palette is beige, yellow, and brown. There's an online system where you can book an appointment, a list of the services she offers and the prices, and a short bio listing her credentials.

But there's one part of the site that stands out: a page that lists qualifying conditions to obtain a medical exemption from having your child vaccinated. These conditions include things like asthma, eczema, and psoriasis, and for $120 per child, Zandvliet will offer a 40-minute consultation to decide whether or not you qualify.

Last year, California changed its laws to eliminate personal belief and religious exemptions for vaccines. These exemptions were what anti-vaxxer parents had been using to continue sending their kids to school unvaccinated. Now, in order for children to attend school (private or public) in California, they must be up to date on the required shots. No special treatment for personal beliefs. So some parents are now turning to medical exemptions to take the place of their personal belief coverage.

Unsurprised but curious, I wandered over to Dr. Zandvliet's website, screen captured her page and saved it as a web archive (in case it disappears down the old memory hole). The list of qualifying conditions for medical exemptions is long and—shall we say?—not what I would call evidence-based. Sure, there are accepted indications there, such as immunodeficiency, malignancies whose treatment causes immune suppression, and a history of severe reactions to vaccines and vaccine components. Then, however, there's a cornucopia of non-evidence-based reasons, including:

Hyper immune conditions
Including, but not limited to:
Asthma
Allergies to food, bee stings, medicines that include hives/swelling/wheezing (hay fever does not count)
Eczema
Hives

Autoimmune Conditions
Including, but not limited to:
Celiac
Crohn's
Ulcerative Colitis
Lupus
Sjogrens
Scleroderma
Mixed connective tissue
Hashimoto or Graves thyroid (not regular low thyroid)
Psoriasis
Vitiligo
Vasculitis
Antiphospholipid antibody
Multiple Sclerosis
Rheumatoid arthritis (not old age or overuse arthritis)
Wegeners
Type 1 diabetes (child type)
Eosinophilic esophagitis

Let's just put it this way. None of the above conditions is a contraindication to vaccination. Indeed, the list of true contraindications to vaccination is brief, and very little of what's on Dr. Zandvliet's list is on that list. I suppose I should give Dr. Zandvliet credit for one thing. At the end of the list, it does say that autism, autism spectrum disorder, and behavioral issues are "not sufficient to meet medical exemption requirements." Goody for her. I was kind of depressed to note that Dr. Zandvliet is double-boarded in internal medicine and pediatrics, which is very difficult to accomplish. She's also board certified in integrative medicine; of course, as I pointed out before when that board certification was first announced, it's a highly dubious board certification, to say the least.

In other words, Dr. Zandvliet's practice consists of "integrating" quackery with science- and evidence-based medicine, because that's what integrative medicine is, by definition. If you don't believe me, just check out Dr. Zandvliet's FAQ, where she does the antivaccine shuffle in which she concedes that vaccines "can save lives" but she believes in "talking to parents about the necessity of some of the less essential vaccines" and often suggests "alternative" vaccine schedules. Elsewhere, she points out how she prefers "lifestyle changes to medication," believes that "acupuncture and Chinese herbal medicine are based in science that has yet to be understood fully," and supports the "use of nutritional supplements."

Not surprisingly, Dr Zandvliet testified last year against SB 277, invoking the same sorts of overblown claims of vaccine "injury" and "health freedom" that we're used to seeing from SB 277 opponents:

She could be "Dr. Bob" or "Dr. Jay." Speaking of Dr. Bob (Dr. Bob Sears, that is), not surprisingly, he makes an appearance in the article.

Dr. Bob: A trailblazer in selling nonmedical exemptions

Shortly after the passage of SB 277, I and others were already speculating that some antivaccine doctors would see the law as an excellent chance to profit. Let’s do a brief recap, given that it’s been nearly a year.

For example, on Twitter:

@gorskon @MyHealthyBabies @JayGordonMDFAAP No doubt some CA doctors will profit from this. I hear Bob just ordered a new Lamborghini.

— Greg Hinson (@ackdoc) June 30, 2015

Meanwhile, our old friend Dr. Jay Gordon wrote:

Governor Brown signed this law because of the strong medical exemption provisions. He recognized that parents with reasonable medical objections—as opposed to personal or religious objections—must still have access to exemptions for their children.

Consult with a physician who knows your child and your family.

No one should scare you into or out of vaccinating.

Dr. Jay often plays the "false balance" card, making it seem as though pro-science vaccine advocates are desperately trying to "scare" parents into vaccinating, when it's really antivaccine activists who are trying to scare parents out of vaccinating with false claims that vaccines cause autism, diabetes, sudden infant death syndrome, asthma, and a plethora of other diseases and conditions. Be that as it may, Dr. Jay isn't really the culprit here. He's just pointing out a loophole in the law that's big enough for Dr. Bob to drive a Lamborghini through, something we discover later in Rogers' article, when she cites a Facebook post from last July by everybody's favorite antivaccine-sympathetic (if not outright antivaccine) pediatrician, Dr. Bob Sears:

The key passage reads:

The guidelines for providing medical exemptions are extremely broad in the new California law. Parents, physicians, legal experts, and some legislators fought to have the term "contraindication" removed from the guidelines, and succeeded. This means that is it up to the personal judgement of each physician and patient to work together to determine if a child qualifies for a medical exemption. The California bill declares that an exemption can be granted if "the physical condition of the child is such, or medical circumstances relating to the child are such, that immunization is not considered safe, indicating the specific nature and probable duration of the medical condition or circumstances including, but not limited to, family history, for which the physician does not recommend immunization . . ."

While it's true that Dr. Sears recommended against seeking medical exemptions "now," remember that this Facebook post was written 10 months ago, over a year before the 2016-2017 school year is to begin. His reasons for recommending against seeking medical exemptions then was purely strategic, because there is a provision in SB 277 that grandfathers in children who already had exemptions. They can continue to use those exemptions until they hit a new grade span (starting preschool, entering kindergarten, or beginning the seventh grade), at which point they'll need to be up to date on their vaccines.

I don’t feel the need to review any more of Dr. Bob’s scheming last summer. I discussed Dr. Bob’s discussions of, in essence, selling medical exemptions, all with plausible deniability when he was holding seminars and posting to Facebook. It turns out that nothing’s changed. Dr. Bob is still at it, as you will see.

The antivaccine quackery continues

If you want to see just how much Dr. Bob has aligned himself with the antivaccine, pro-quackery movement, consider this: He's still giving seminars on how to obtain medical exemptions; only now he's charging $20-$50 a pop for them. For example, this very week on May 11, if you live near Irvine, CA, you can attend a seminar in which Dr. Bob will appear with a homeopath, "Dr. Bob Sears - Mandatory vaccine laws: Are they necessary? Will they even work? What are your options? Homeopath Tania - Homeoprophylaxis for immune boosting." That's right. Dr. Bob is appearing side-by-side on stage with a practitioner of The One Quackery To Rule Them All, homeopathy. This practitioner, Tania Dilmani, offers just as much quackery on her website as you would expect from a homeopath, plus an amazing helping of self-promotion as well.

Dr. Kelly Sutton: Selling webinars telling parents how to obtain a medical exemption to school vaccine mandates, whether the exemption is appropriate or not.

Unfortunately, Dr. Bob is not alone on the medical exemption seminar circuit in California—webinar circuit, actually. Rogers cites another med-peds doc, Dr. Kelly Sutton, who is offering webinars on how to avoid the requirements of SB 277 by seeking medical exemptions to school vaccine mandates. Shockingly (that's sarcasm, obviously), Dr. Sutton practices anthroposophic medicine, one of the quackiest of quack medicines. Her website describes her approach thusly:

Dr. Sutton bases her diagnosis in part on conventional medicine: history, physical, laboratory and imaging, and subspecialist consultation when needed. Significant understanding arises from listening to aspects of an individual's biography, life purpose, the emotional context of illness and health, and understanding the level of vitality and strength of the life forces. She treats acute and chronic illness using the least toxic effective treatment for the condition. Anthroposophic remedies (low potency homeopathic preparations and herbs), diet, nutritional supplements, healthy rhythm, warmth are some of the foundational principles she employs. Anthroposophic therapies play a key role in treatment.

Yep. More homeopathy.

She bills her seminars as the "Step-by-step Program to Help Protect Your Child from the 'One Size Fits All' California Vaccine Mandate!," promising to provide the "tools and knowledge you need to protect your rights as a parent to choose the healthcare of your child" and take attendees "from cornered to confident." She offers this all for $27—but only if you take advantage of the early bird special. You can get a taste of what she's offering here. I must admit that I laughed out loud when Sutton started her webinar out by claiming that her presentation is neither antivaccine nor pro-vaccine, but rather pro-parent. This, of course, led me to ask" What about pro-child?" That's because antivaccine views seem to be always far more about the parent than the good of the child. Indeed, as I've pointed out many times before, the attitude of many antivaccine parents is that their rights matter more than that of the child and that the child is essentially their property.

Even more hilariously, Sutton tells parents to trust themselves and that no one cares more or knows more. Really? I'd say scientists and pediatricians know more than the vast majority of parents about vaccines, their indications, their benefits, and their risks. Sutton is basically massaging her marks to assure them that they're the smartest ever and no one knows more about the topic at hand than they do. The rest of the video is chock full of antivaccine misinformation and tropes, such as the "vaccines didn't save us" gambit, and the claim that Pasteur was wrong. I was also shocked at how amateurish the graphics in the webinar were, as well.

Finally, I've discussed how genetic profiling is still in its infancy, even for cancer. Even so, quacks do so love to get ahead of the science and claim to be able to use it to diagnose and treat conditions. Rogers called a number of clinics listed on Bob Sears' website posing as a patient asking about a medical exemption for her children and noted:

I also cold-called a random selection of California clinics listed on Sears's website as "vaccine friendly," and posed as a patient inquiring about medical exemptions. Most of the clinics told me it was highly unlikely my child would qualify for a medical exemption and that they would not consider it for anyone who wasn't already an established patient.

But a few offered other responses. One clinic told me new patients hoping for a medical exemption must first get DNA testing done by 23andme, "so that we have proof of a genetic predisposition." Another suggested I use the form on Zandvliet's site as a guideline before coming in for a consultation. One other suggested I attend an upcoming seminar hosted by Sears.

There is, of course, no convincing (or even suggestive) evidence that 23andme testing can reliably identify genetic predispositions to adverse vaccine reactions. Any clinic making this claim is just making it up as it goes along. I expect, however, to see a lot more of this.

What can be done?

Clearly, the great leeway granted physicians in identifying diseases and conditions upon which to base a letter supporting a medical exemption to school vaccine mandates for an individual patient is a feature, not a bug, in SB 277. It was a compromise without which the bill likely would never have become law. So the question will be: Can anything be done to prevent antivaccine-sympathetic doctors from issuing vaccine mandates to just about anyone. Ten months ago, I sarcastically predicted:

.@MyHealthyBabies I suspect @JayGordonMDFAAP's "medical criteria" for exemption under #SB277 will be "Mommy and Daddy want it."

— David Gorski (@gorskon) June 30, 2015

Clearly, doctors like Bob Sears, Tara Zandvliet, and Kelly Sutton are doing their best to make my prediction come true. What kind of push-back can they expect?

Unfortunately, there's not much that can be done. Rogers points out that the percentage of children with medical exemptions in California is below 1% and has been stable for decades. If that rate starts to rise, it could be an indicator that more doctors are offering more dubious medical exemptions. However, it could take years for such an increase to manifest itself, because many California children are still grandfathered in with their nonmedical exemptions and won't be facing a school year where they have to catch up on their shots for years. Rogers notes:

It's also not totally clear that, if a doctor did offer a medical exemption for a child because his or her grandmother has psoriasis, it would be illegal. There are no official "rules" for what qualifies a patient for a medical exemption, outside of the CDC's recommendations, and the law leaves it up to the discretion of the doctor. In general, that's a good thing, because it would be difficult to very precisely account for every possible situation when a medical exemption would make sense.

I disagree. The vast majority of these "possible situations" are not indications for medical exemptions, as the number of such indications is few and the indications are clear. West Virginia, as I pointed out above, doesn't leave it just to the physician's discretion. It double checks the reason given for a requested exemption before permitting that exemption.

Really, the only option, barring a change in the law, is the state medical board, as Rogers quotes law professor and pro-vaccine advocate Dorit Reiss discussing:

But it also opens up the possibility of medical exemptions being used to fill the role of personal belief exemptions. The only way a doctor might be subject to discipline for handing out questionable medical exemptions would be through the Medical Board of California.

"You could complain to the board and say it's a violation of the standard of care, but it's not formalized," Reiss said. "Doctors that advertise online saying they'll give medical exemptions are kind of natural targets. They kind of deserve to be closely monitored."

A spokesperson for the Medical Board told me it's not specifically monitoring who gives out medical exemptions or how many, but that just like anything else a doctor does, this decision would need to meet the board's standard of care.

Given how toothless most state medical boards are, I wouldn't hold my breath waiting for California's board to go after the Dr. Bobs of its state. Contrary to Rogers' assertion, this aspect of SB 277 is toothless and California will have to depend on the essential honesty and science-based practice of the vast majority of its pediatricians and family practice doctors. That appears to have been enough in Mississippi, but whether it will be enough in the woo-friendly, antivacine-riddled state of California remains to be seen. I'm cautiously hopeful that it will be, but I wouldn't be surprised to be wrong.

Don't get me wrong. The passage of SB 277 is a major victory in the struggle to protect children from the ravages of infectious disease and a major defeat for the antivaccine movement, which marshaled pretty much everything it had to defeat it and still came up short. But it is not perfect. It's politics. Compromises had to be made. SB 277 makes the situation in California much better than it was before with respect to child health and should serve as a model for the remaining 47 states that allow religious and personal belief exemptions. It is a beginning, not an end, and part of what needs to be done now is to keep an eye on its implementation.

oracknows Sun, 05/08/2016 - 21:13

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Who knew? Tightening up requirements for waivers for school vaccine requirements increases vaccine uptake! (Part two)

oracknows — Thu, 04 Feb 2016 05:30:34 +0000

Who knew? Tightening up requirements for waivers for school vaccine requirements increases vaccine uptake! (Part two)

Well, it's finally done.

The grants that have been taking up so much of my time are finally with the grants office and, hopefully, won't have too many errors flagged as they go through the validation process. So it's time to get back into that blogging thing again, even though I'm admittedly tired. So I'll start out slow. No Orac-ian epics today, just another rather satisfying bit of news mirroring a previous post that I did last week about how making it more difficult to obtain personal belief exemptions to school vaccine requirements works. In states where PBEs are difficult to obtain or not permitted vaccine uptake rates are high or higher.

I saw this gratifying outcome in my very own state, where as of January 1, 2015, the Michigan Department of Community Health issued a new rule that required parents seeking PBEs for their children to go to the local health department office and be educated by a local health worker about vaccines and the diseases they are intended to prevent, after which they would be required to sign the universal state form that includes an explicit statement of acknowledgement that parents understand they may be putting their own children and others at risk by refusing the shots. Initial data from 2015 suggest that this tightening of vaccine waiver rules has had an effect. Vaccine waiver rates fell from 4.6% in 2014 to 2.8% in 2015. Of course, Michigan being Michigan, there are wingnuts in our legislature who want to reverse that in the name of "freedom." Or should I say, "Freedumb!"?

California is another experiment in what happens when vaccine exemptions are made more difficult to receive, but a more extreme example. Like Michigan, California had a problem with areas where vaccine exemption rates were high and, as a consequence, were prone to outbreaks of vaccine-preventable diseases. About a year ago, there was an outbreak that got worldwide news attention centered at—where else?—Disneyland that finally spurred lawmakers to act. Introduced by Sens. Richard Pan and Ben Allen, passed by the California legislature after much controversy (and no shortage of rhetoric likening it to Nazi genocide of the Jews), and signed into law by Governor Jerry Brown in July, basically eliminates nonmedical exemptions to school vaccine mandates as of the 2016-2017 school year.

Already, it seems to be working. At least, initial numbers suggest this is the case:

California's new, more stringent law on childhood vaccinations, SB 277, doesn't fully kick in until July 1. But it started protecting the public months ago when parents heard from schools and doctors that they would no longer be able to claim a "personal belief exemption" from immunizations if they wanted to enroll their children.

The proof is in the numbers. The percentage of fully vaccinated kindergartners entering the state's schools in 2015-2016 was the highest in a decade: 92.9%, up from 90.4% last year. State health officials say the measles outbreak at Disneyland a year ago might have scared a few parents off the vaccination fence, but SB 277, combined with another bill from 2012 that required parents to talk to a pediatrician before obtaining an exemption, had more to do with it.

The law from 2012 referred to in this article is California AB 2109, a law upon which the Michigan Department of Community Medicine based its rule change on. Michigan actually improved upon it. The California law allowed parents to receive counseling from any physician and some other health care professionals, like nurse practitioners. The Michigan rule, in contrast, requires that parents receive their counseling from the health department. Thus, in California, parents seeking PBEs were free to seek out woo-friendly and anti-vaccine friendly physicians for their "counseling," while in Michigan parents seeking PBEs receive the same standardized information from a script and must sign a statement explicitly acknowledging that they are potentially endangering their children.

What these numbers suggest is that a significant part of the problem with unvaccinated children comes not from parents who are truly antivaccine (although certainly they are a major problem) but from sheer human nature. In California, for instance, it was much easier just to sign a vaccine waiver than to have one's children fully vaccinated or to sign the waiver with a promise to finish vaccinating:

The vaccination rebound validates the suspicion that the falling rates were caused in part by procrastination, not politics. Schools encouraged an increase in partially immunized students by allowing parents to sign a form promising they would finish the vaccinations, but the promise wasn't well enforced. This year, the percentage of such enrollees dropped by the same amount the overall immunization rate increased.

When one option is much easier than another, even though it's the wrong option, there will always be some who will choose the easier option. It's human nature. Rules like the one now enforced in Michigan seek to make the effort required to obtain vaccine waivers closer to the level of effort required to have one's children vaccinated, and it's working. It appears to be working in California as well. However, what will be far more interesting is to see the effect of SB 277 next year, after the law has fully kicked in and only medical exemptions are required. Already antivaccine pediatricians like Dr. Bob Sears are preparing for an influx of business to sell medical exemptions, but it's likely that the effects of this will be small. Fortunately, there aren't many pediatricians like Sears.

None of this should come as a surprise. As far back as 2006, I was discussing research that showed that ease of obtaining vaccine exemptions correlated—of course!—with increased vaccine exemption rates, which correlated with higher incidences of pertussis. Basically pertussis was returning in states with lax vaccine laws. Experience since then has validated that observation. More recently, a systematic review of studies of state vaccine exemption laws and vaccine exemption rates concluded that vaccine exemption rates have been increasing and tend to occur in clusters. It also concluded that easier state-level exemption procedures are correlated with increased exemption rates and increase the risk of vaccine-preventable diseases.

None of what is happening in Michigan and California is a surprise. Unfortunately, in today's political climate the widespread adoption of SB 277-like bans on nonmedical exemptions to school vaccine mandates is highly unlikely. This is particularly true since right wing "freedom" warriors have conflated personal freedom with "health freedom" and the freedom to refuse vaccines, even leading Presidential candidates like Donald Trump, Rand Paul (who has suspended his campaign), and Ben Carson to pander to this view. Actually, neither Trump nor Paul are pandering. They appear to really believe antivaccine views. "Freedom" and "parental rights" have become antivaccine dog whistles.

In an ideal world, PBEs would not be permitted. That's not likely to happen any time soon in the current political climate. (Witness the nastiness that happened in California as SB 277 moved towards passage.) However, the Michigan experience suggests that a smart "middle way" requiring parents to visit the health department for a counseling session and to sign a form explicitly acknowledging that they are endangering their children might do almost as much good.

oracknows Thu, 02/04/2016 - 00:30

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