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Steve Novella vs. Julian Whitaker on vaccines at FreedomFest

Steve Novella vs. Julian Whitaker on vaccines at FreedomFest

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Posted in: Neuroscience/Mental Health, Politics and Regulation, Vaccines

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454 thoughts on “Steve Novella vs. Julian Whitaker on vaccines at FreedomFest

  1. daedalus2u says:

    pd, I am not saying it is not meaningful, but the most relevant timing is in utero, first trimester, when the brain cells that are forming neurons are differentiating. Once cells have differentiated, they can’t go back.

    What is more important than “timing” is the physiological state the organism is in and what it is trying to do. The physiological state is what changes over time, it is not “time” per se that is important.

    The most sensitive time is first trimester (probably while the O2 partial pressure is still very low, ~18 mm Hg), the next most sensitive time is the 2nd and 3rd trimesters when the O2 level is higher (~60 mm) but still much below the post-natal level (~140).

    http://www.ncbi.nlm.nih.gov/pubmed/19926662

    O2 levels have very large effects on transcription and differentiation, with many transcription factors directly (HIF-alpha) or indirectly via ROS, synthesis via P450 hemes, redox effects on thiols, or metallization status of zinc finger proteins.

    http://www.ncbi.nlm.nih.gov/pubmed/16234296

    Comparing in utero effects to post natal effects is simply not appropriate. They are extremely different physiological states.

  2. daedalus2u says:

    pd, microglia are not neurons. The morphology of minicolumns is due to neurons, and the location and orientation of axons. Do you have a reference that says that the neuroanatomy of neurons (location and orientation of axons) can change in the early post-natal period due to immune system activation?

    For neuroanatomy of someone who is NT to change to that of someone with an ASD, that is what has to happen. There needs to be a change in the number, location, orientation and branching of neurons. That is an extraordinary claim, and you have presented no references that suggest that it happens or that it can happen.

    The neuroanatomy instantiated by neurons with their axons is 3-dimensional. For that neuroanatomy to change substantially (from an NT-type to an ASD-type) requires for axons to pass through each other. As far as I know, no one has suggested that such a thing ever happens, that two axons can migrate and traverse through each other while maintaining continuity.

    I think you are conflating morphology of microglia changing with morphology of neurons changing. I think the references you cite that are relating to microglia affecting development in the context of neuron proliferation are referring to neuron proliferation in utero, not in the post-natal period. Neuron proliferation occurs before axon growth. I am not aware of any reference that says neurons can divide after sprouting axons and that the axons remain connected in the daughter cells. This is what would have to happen for post-natal exposure to produce the ASD-type neuroanatomy.

    Changes in behavior can be mediated by things that are not changes in neuroanatomy. Observing immune mediated changes in behavior does not suggest that immune mediated changes in behavior are mediated by changes in neuroanatomy.

    I presume you have seen my blog post on Fever Therapy. That discusses transient immune mediated changes in behaviors of people with autism, which are not mediated through changes in neuroanatomy. I discuss that in the context of transient changes in levels of nitric oxide, but there are mechanisms that regulate the levels of nitric oxide and those can be perturbed long term through a large variety of mechanisms.

  3. passionlessDrone says:

    @daedulus2u –

    The morphology of minicolumns is due to neurons, and the location and orientation of axons.

    I get the minicolumn argument. But minicolumns aren’t the only thing abnormal in the autism brain. I am not saying, by any means, that postnatal vaccination could alter minicolumn structure or formation. Does that help alleviate any of your concerns?

    There needs to be a change in the number, location, orientation and branching of neurons. That is an extraordinary claim, and you have presented no references that suggest that it happens or that it can happen.

    The microglia are responsible for synaptic pruning of the neurons. I listed my references to this effect in my first posting:

    Microglia sculpt postnatal neural circuits in an activity and complement-dependent manner [PMID: 22632727]
    Synaptic pruning by microglia is necessary for normal brain development [PMID: 21778362]
    A role for microglia in synaptic plasticity? [PMID: 21655446]
    Resting microglia directly monitor the functional state of synapses in vivo and determine the fate of ischemic terminals [PMID: 19339593]

    Here is part of the abstract from Synaptic pruning by microglia is necessary for normal brain development

    Here, we show that microglia actively engulf synaptic material and play a major role in synaptic pruning during postnatal development in mice. These findings link microglia surveillance to synaptic maturation and suggest that deficits in microglia function may contribute to synaptic abnormalities seen in some neurodevelopmental disorders.

    This was published in Science.

    Or this:

    We show that microglia engulf presynaptic inputs during peak retinogeniculate pruning and that engulfment is dependent upon neural activity and the microglia-specific phagocytic signaling pathway, complement receptor 3(CR3)/C3. Furthermore, disrupting microglia-specific CR3/C3 signaling resulted in sustained deficits in synaptic connectivity. These results define a role for microglia during postnatal development and identify underlying mechanisms by which microglia engulf and remodel developing synapses.

    published in Neuron. Problems in connectivity within the autism brain are talked about all the time, right? Well, one way to get there is to keep the microglia from performing their task, which, it turns out, they perform in a resting state.

    Now look back on the Harry Jean paper I submitted above; it tells us that gentle disturbances during development can persistently change microglial population and morphology, and the effect can be long lasting; especially if it occurs during critical windows of development. Then, consider the autism / microglia studies I also posted above, showing abnormal population, morphology, and spatial patterning of microglia in the autism brain. Microglia react upon peripheral immune challenge; the data indicates (see Jean) that there are timeframes where microglia can be programmed towards a persistent change.

    I think you are conflating morphology of microglia changing with morphology of neurons changing.

    No. I don’t think you’ve read the references regarding microglial participation in synaptic maintenance.

    This is what would have to happen for post-natal exposure to produce the ASD-type neuroanatomy.

    I keep saying this, but I don’t seem to be getting through. I don’t know why, because you’re smart enough to understand it. We don’t have to be causing everything abnormal in a neurodevelopmental disorder in order to be doing something. I’m not here to contest the prenatal environment as critical. There seems to be wide agreement that low penetrance effects are involved with autism; very rarely do we see ‘one thing’ as a huge risk factor; what I’m arguing isn’t any different than that.

    Changes in behavior can be mediated by things that are not changes in neuroanatomy. Observing immune mediated changes in behavior does not suggest that immune mediated changes in behavior are mediated by changes in neuroanatomy.

    No argument here. Have I suggested this in some way? If I have, I apologize. I get that there are some things that can be changed, and some that probably can’t be.

    I presume you have seen my blog post on Fever Therapy. That discusses transient immune mediated changes in behaviors of people with autism, which are not mediated through changes in neuroanatomy. I discuss that in the context of transient changes in levels of nitric oxide, but there are mechanisms that regulate the levels of nitric oxide and those can be perturbed long term through a large variety of mechanisms.

    I saw it a long time ago. Unfortunately, it quickly eclipsed my ability to follow. Take a look at the latest Patterson paper I posted in my original post here. Albeit with all of the caveats of an animal model, the authors invoked a prenatal immune response, observed stereotypical behaviors, and then replaced the immune system via bone marrow transplants and observed behavior normalization; but it wasn’t transient, it was persistent. Replacing an immune system predisposed to inflammation with one that wasn’t amelioration behaviors for good. You might find it of interest.

    - pD

  4. Scott says:

    The number of layers pD is having to add to his supposed hypothesis, simply to keep it from instantly failing spectacularly (not even giving it any credence; just keeping it away from 1+1=banana territory), seriously remind me of epicycles.

  5. daedalus2u says:

    pd, if an immune system stimulation can’t change the NT pattern of minicolumn neuroanatomy to the ASD pattern of neuroanatomy, then an immune system stimulation can’t cause autism if that immune system stimulation occurs after minicolumn neuroanatomy has occurred.

    If you already have autism, then an immune system stimulation could well modify it. But so what? We are talking about autism causation here.

    If you have an idea about what could change the NT pattern of minicolumn neuroanatomy to the ASD pattern of minicolumn neuroanatomy after that anatomy has been formed, that might be something to consider as a cause of autism, but immune system stimulation isn’t it. We are not talking differential pruning. Differential pruning is not going to change neuroanatomy because neurons that are already connected can’t move relative to each other via differential pruning.

    Barring something extraordinary which changes the minicolumn neuroanatomy after it has formed (and which has never been observed and is very likely not possible without either magic or Mr. Scott’s transporter), the most likely cause of autism is something that happens before or during the formation of that minicolumn neuroanatomy. That is during the first trimester in utero. That is when all known causes have their effects. Those causes include maternal stress, maternal folate deficiency, maternal stress, maternal valproate exposure, maternal thalidomide exposure, maternal infection with rubella, gene copy number variations in the fetus.

  6. papertrail says:

    pD, thank you for the apology; I accept. I was probably developing a tone too.

    I think I understand the passion behind your investigation. I saw your blog and see that you have an autistic son, and can appreciate that you believe you are on to something as to a potential cause of autism. It must be frustrating that others seem to be closing the door on the notion that vaccines are causing autism, even Patterson whose research is so close to what you’re investigating.

    And I can see where you’re coming from when you see everyone seems to be leaping from “bullet-proof” mmr and thimerosal studies to: therefore *vaccines* don’t cause autism. It’s not just Dr. Gorski or Dr. Hall, but Dr. Offit, and so many many others, including those who play a large role in autism research. And then to see even Dr. Patterson dismissing your idea with that same leap, that would be frustrating. And, I see that the IACC also seems to be set that the research shows vaccines don’t autism and are looking at other avenues.

    I’m taking Dr. Offit’s online video “Coursera”, and he just talked about this topic. He covered the MMR autism claims and how they were discredited with large studies, and he covered the thimerosal claims and how they were discredited with large studies. And then he presented the too many too soon hypothesis and said something like: these studies would be very hard to do but there is one study that addresses this, and he linked us to the one I linked to above, which was pretty small. (“On-time Vaccine Receipt in the First Year Does Not Adversely Affect Neuropsychological Outcomes” Smith and Woods.) He then concluded, something like: so you see, this has been very very well studied and so there is no reason to fear vaccines causing autism. I admit it felt like a leap.

    I do suspect these experts are making this perceived leap for the reasons that I mentioned before and that daedalus2u is explaining (I’m not pretending here to know all that is being said) about why the MMR studies enable us to come to conclusiions about vaccines in general. That there is a perception of a leap may have more to do with a communication gap than a huge knowledge gap.

    No, I don’t think it’s a logical fallacy to expect experts in the field to know more than non-experts, like myself. You seem to be pulling studies from pubmed that appear to support your hypotheses, but I learned a long time ago that it’s almost impossible to see the big picture that way. It’s too easy to cherry pick, for one thing. We need experts in the field to examine each study for it’s strengths and weaknesses and conduct a systematical review in an unbiased manner. If I remember right, I think the IOM did do a systematic review of the kind of research that you’re talking about. I’d have to look that up again, but I’m pretty sure they didn’t find it compelling enough or found it too contradictory. Should we rely on just the IOM? No. Maybe additional reseach occured after that, and they aren’t infallible, but it gives us a clue as to the strength of the research on the matter, at that point.

    Best of luck. For some reason you’re making me think of Lorenzo’s Oil.

  7. passionlessDrone says:

    @papertrail –

    It must be frustrating that others seem to be closing the door on the notion that vaccines are causing autism, even Patterson whose research is so close to what you’re investigating.

    What frustrates me primarily is the hypocrisy. I don’t like being lied to. Earlier in this post I said that I was terrified about what is going to happen when, eventually, the public catches onto the reality of ‘the question has been asked and answered’. I meant it.

    That there is a perception of a leap may have more to do with a communication gap than a huge knowledge gap.

    But that’s the thing; it isn’t a perception gap, it is an orchestrated effort to massage the message from what is true, to what is comforting. In fact, you mention it below.

    If I remember right, I think the IOM did do a systematic review of the kind of research that you’re talking about. I’d have to look that up again, but I’m pretty sure they didn’t find it compelling enough or found it too contradictory.

    Check out this paper by Dr. Offit:

    In that paper, regarding the ‘too many, too soon’ area, he discusses the 2004 IOM report.

    Autism is not an immune-mediated disease. Unlike autoimmune diseases such as multiple sclerosis, there is no evidence of immune activation or inflammatory lesions in the CNS of people with autism [38].

    Reference 38 is this: McCormick MC. Immunization safety review: vaccines and autism. Institute of Medicine; Washington, DC: 2004.

    Now, here is a link to the IOM paper in question:

    http://www.nap.edu/openbook.php?isbn=030909237X&page=131

    Check out the part concerning immune activation in the CNS in autism.

    Unlike what is known about neuroimmunological disorders that affect the brain, such as multiple sclerosis and acute disseminated encephalomyelitis, there is no evidence of immune activation or an inflammatory process within the autistic brain. Neuropathological studies of autism have revealed no evidence of cerebral inflammatory lesions or microglial activation, which is a common feature in immune-mediated encephalitis (Bauman and Kemper, 1997). However, there are very few autopsy studies of brains from people with autism and this has not been fully investigated.

    Now, I guess it isn’t necessarily out of line to fail to mention what the IOM states, that there had been very, very little investigation into the question of immune activation in the CNS. [sound familiar?] At worst, we could only accuse Dr. Offit of failing to convey the nuance of the IOM report.

    BUT. The IOM report was published a full 5 years before Dr. Offit’s paper, and that is a long time in the autism research realm. In the intervening years, there were no less than four papers that showed exactly the evidence Dr. Offit claimed was missing:

    Neuroglial activation and neuroinflammation in the brain of patients with autism published in 2005.
    Glial fibrillary acidic protein is elevated in superior frontal, parietal and cerebellar cortices of autistic subjects also published in 2005.
    Elevation of tumor necrosis factor-alpha in cerebrospinal fluid of autistic children published in 2007.
    Immune transcriptome alterations in the temporal cortex of subjects with autism published in 2008.

    There are really only two things that could have happened to cause Dr. Offit to craft his statements they way he did:

    1) He was incompetent, and was unable to locate the papers I posted above, all of which clearly state they provide evidence of an ongoing immune reaction in the CNS. In this case, if he is incompetent to search pubmed, why should the rest of his text be given any credence?

    2) He knew exactly what he was doing, and decided to use a five year old reference, one that stated with clarity that the was a dearth of observations. He knew there was evidence of immune activation in the CNS of people with autism, but intentionally cherry picked an ancient reference that was more suitable towards his preferred conclusion, Thus, speculation that an exaggerated or inappropriate immune response to vaccination precipitates autism is at variance with current scientific data that address the pathogenesis of autism

    If we are wedded to the scientific method, if we intend to apply the rules that have allowed us to learn so much about the natural world, we must update our models to fit the observed reality. What you see Dr. Offit perform in this paper is the opposite of that; very selectively picking and choosing which literature to present as evidence when making his claim. I’m just some jerk on the Internet, but Dr. Offit is the goto guy the media calls when they want an expert on this debate, and yet, we have good reason to not to trust the words that come out of his mouth.

    Can you think of any legitimate reason, to use a 2004 report as a referece, one that patently states a lack of investigation, instead of repeated studies since that time? That is a lot more than a stretch. That is an intentional effort to deceive. That feeling, the knowledge that people are trying to very subtly pull the wool over our eyes, is what keeps me tugging on this chain from time to time. Try looking at some of my posts on environmental enrichment if you want to see if I have more than one trick up my sleeve.

    Here is the conclusion to Dr. Offit’s paper:

    Twenty epidemiologic studies have shown that neither thimerosal nor MMR vaccine causes autism. These studies have been performed in several countries by many different investigators who have employed a multitude of epidemiologic and statistical methods. The large size of the studied populations has afforded a level of statistical power sufficient to detect even rare associations. These studies, in concert with the biological implausibility that vaccines overwhelm a child’s immune system, have effectively dismissed the notion that vaccines cause autism.

    Does that have a familiar sound to it? If you try reading some of the animal articles I posted above, you’ll see that changing is a lot different than overwhelming. You’ll have to reach your own conclusion about whether or not there is any merit towards further investigation of the process of vaccination. My recommendation is that you keep an open mind, and don’t believe everything you read. When in doubt, ask someone if they can provide a reference to back up their claim; if they refuse to, if they can’t, then you don’t even have to worry about your expertise level when trying to evaluate it.

    Take care.

    - pD

  8. passionlessDrone says:

    Err edit:

    ….

    Check out this paper by Dr. Offit:

    Vaccines and Autism: A Tale of Shifting Hypotheses

    ….

    Note to SBM Tech Team: Preview buttons are easy to implement.

    (sorry)

  9. pmoran says:

    @pmoran,

    “I have almost single-handedly reduced the level of juvenile name-calling on this supposedly science-based forum”

    That’s not only hubris, it’s delusional.
    All you have contributed to this forum is criticism of our approach, and you have not backed it up with evidence that another approach would be more effective or even with a coherent example of what you think we “should” be doing. Please stop this useless, disruptive commenting and submit a guest post.

    Ha! I am now being accused of being delusional, and if I respond to this further insult I will be held to be making useless and disruptive comments?

    I will, however, be brief. When was the last time the demeaning “altie” was used here to refer to the persons we hope to influence with our oh-so-mature scientific deliberations? Who was the main complainant concerning such juvenile and almost certainly counterproductive practices? Or are you telling me this was an unprompted editorial decision against — among other principals of this blog — Dr Gorski’s common use of that term?

    Leave me and my person alone and I will be silent for now. Devote your energies to answering Pd’s concerns.

  10. passionlessDrone says:

    @Scott –

    If you prefer more simplistic models of neurodevelopment and neuroimmunology, I believe that Harriet Hall has a 24 page chapter that might suit your needs. If that is still too complicated, you could also just say the word ‘minicolumn’ anytime someone suggests a condition manifesting as heterogeneously as autism might have multiple low penetrance drivers.

    By the way, you were among the first on this thread to announce that “vaccinations in general” had been studied with regard to autism. Do you have any studies to support this claim? I keep waiting!

    - pD

  11. daedalus2u says:

    pd, you are cherry picking data and then confabulating it to feed your conspiracy theory. The four papers you cite don’t mention “cerebral inflammatory lesions”, which are present in disorders that are characterized by and exacerbated by neuroinflammation, including MS.

    Do vaccines cause MS? Do vaccines cause neuroinflammatory disorders?

    You might want to look at the more recent IOM report.

    http://www.iom.edu/Reports/2011/Adverse-Effects-of-Vaccines-Evidence-and-Causality.aspx

  12. Scott says:

    @ pD:

    Studies of subsets of vaccination will pick up associations with vaccination in general. For example, the Hepatitis B vaccine used to contain thimerosal; ergo if that vaccine were associated with autism even for reasons other than thimerosal the various studies looking at thimerosal vs. autism would pick it up (with some sensitivity). Your entire distinction is unfounded.

    You also grossly miss the point of the epicycle analogy. You keep having to add more and more assumptions simply to get around the fact that the immune challenges associated with vaccination are not distinctive, either in degree or in timing. The additional assumptions aren’t motivated or supported by anything other than “if I don’t make this assumption, the claim is falsified immediately.” This should be taken as a strong reason to question the claim.

  13. papertrail says:

    pD, since the bottom line is whether or not early vaccinations are associated with an increase in neurological disorders, have you looked at studies that examine the DTaP vaccination? I think these studies would be most revealing because the series starts at 2 and 4 mths, generally, and this would include the Hep B vaccine usually given after birth.

    Here’s a quote from a NY Times article that sums up the research on that (admitting that this is not as good as providing links to specific studies, but I don’t have time right now): “It is well established that the diphtheria and tetanus components cause no adverse neurologic effects, so some people suspect the pertussis component. However, many major studies found no causal relationship between neurologic problems and the pertussis vaccination. Studies on the newer DTaP have reported no safety concerns to date.” http://health.nytimes.com/health/guides/specialtopic/immunizations-general-overview/diphtheria,-tetanus,-and-pertussis.html

    pD said: “There are really only two things that could have happened to cause Dr. Offit to craft his statements they way he did: 1) He was incompetent… 2)He knew exactly what he was doing…

    I think a third option in pD’s assessment of why Dr. Offit would appear to be closing the door on autoimmune disorder from vaccines is that perhaps he hasn’t seen any *credible* indication that the IOM assessment was appreciably inaccurate, especially with some studies showing no evidence for a connection between certain other autoimmune disorders and vaccines.

    @Scott re: “vaccine were associated with autism even for reasons other than thimerosal the various studies looking at thimerosal vs. autism would pick it up (with some sensitivity)”

    I thought this too, but then I considered that the studies were probably (I haven’t examined each one carefully) comparing populations using thimerosal containing vaccines to populations using the same vaccines but without thimerosal, finding the same autism rates. But this wouldn’t rule out the vaccine itself (with or without thimerisal) causing both autism rates. Even if they found that both groups had the same autism rates as background rates, background rates would include vaccinated kids, as most children are vaccinated. I think this is one reason we hear vaccine critics’ cries for unnvaccinated versus vaccinated studies. And, we know why that would be impossible/wrong/massively expensive.

    It does look to me like the main argument that vaccines in general don’t cause autism comes down to the lack of plausibility and evidence that they do, as opposed to being able to look at a number of quality studies actually disputing that they do. I think that’s why we see pD pushing for recognition of the *plausibility* of his/her argument, which no one seems to be buying other than anti-vax organizations. I think pD should strive get to the heart of this dismissal, which is widespread – without resorting to conspiracy arguments or dismissing all these experts as incompetent.

  14. Chris says:

    pD, I noticed you have not answered how to protect babies in their first year from disease as an explanation for your statement:

    I am not against vaccination. Your response implies a binary decision, vaccinate or not. We have a lot more options than that, I think you understand this, but I’m not sure.

    Do tell us what those options are? It is obvious we don’t understand, so you need to clarify exactly what other ways than vaccines can protect infants from Hib, pertussis, tetanus, diphtheria, etc.

    And please tell us if you have been proactive in one other known way to protect infants from pertussis by getting a Tdap yourself to increase herd immunity in your local community. Is there a reason you won’t answer this simple question?

  15. Scott says:

    @ papertrail:

    I think you’re right; I hadn’t thought through that angle.

    Apologies to pD on that point.

  16. libby says:

    After being lampooned for months about my use of the term “bribery” in describing the dubious practice of gift giving within the medical industry, it turns out the SEC is on my side.

    Kara Brockmeyer, chief of SEC’s foreign enforcement division, had this to say about the $60 million fine assessed on Pfizer recently: “Pfizer subsidiaries in several countries had bribery so entwined in their sales culture that they offered points and bonus programs to improperly reward foreign officials who proved to be their best customers”. (Aug 11, 2012 – Toronto Star)

    The report further says the SEC claimed that since 2001 Pfizer “tried to conceal the bribes by recording them as legitimate business expenses for travel, entertainment and marketing purposes”.

  17. Right, because that has everything to do with giving a doctor a clicky-top pen.

    /biggest eye-roll ever

  18. BillyJoe says:

    SH,

    You might be an exception but, in general, doctors can easily be had (yes, even by a clicky top pen!) – especially those who think they can’t ;)
    Really, they just aren’t going to spend that sort of money for no reward.

  19. libby says:

    By the way, Pfizer is #6 on the top ten list of pharma companies bribing doctors.

    So really what we should all be looking for is the least criminal of the companies. Anybody know who is #10?

  20. daedalus2u says:

    I saw a blog post on how to tell if you are a journalist who has “sold out”, or in CIA nomenclature have been “cognitively captured”. I think the broad heuristic is valid for MDs as well.

    http://barryeisler.blogspot.com.br/2012/08/you-will-be-assimilated.html

    I think it is also valid for proponents of CAM, particularly #8.

    “8.  Here’s one you wouldn’t think a journalist [health care professional] should even need to ask (but you’d be wrong):  are there any public figures [CAM treatment modalities] you refuse to honestly, objectively, publicly criticize?  If yes… it’s worse than bad.  You’re already suborned.  You’re not even a journalist [health care professional].”

    This is why the tu quoque arguments against allopathic medicine (aka Medicine) by CAM practitioners are empty and vacuous. CAM practitioners have no intellectual integrity at all, why should they be believed or trusted about anything?

  21. lilady says:

    @ Skeptical Health:

    And how, pray tell, does Libby’s post add to the discussion of Dr. Whitaker’s debate debacle with Dr. Novella?

    We have already wasted enough time on Libby’s thread-derailing off-topic fixation.

  22. Lilady, agreed and point taken.

  23. Chris says:

    Especially since that particular derailment does not make any sense when taking into the account the costs between vaccines and treating the actual diseases. This was directed to Dr. Whitaker on his website, and he never answered the question. Perhaps libby would like to take a crack:

    If a parent decides to not vaccinate their child, and gets the waiver signed by a health care provider saying they have been told the risks, is an insurance company obliged to pay for any medical care if the child gets a disease preventable disease? Could Medi-Cal deny medical benefits to the children whose parents signed the vaccine exemption?

    In 1990 there was a measles epidemic in California, which cost Medi-Cal several millions of dollars, along with millions of dollars cost born by private health insurance companies: see Pediatric hospital admissions for measles. Lessons from the 1990 epidemic.

    So who should pay for that health freedom exemption? The parents or the health insurance company? Should their insurance premiums be increased because of the documented greater risk of illness?

    See:

    Pediatrics. 2009 Jun;123(6):1446-51.
    Parental refusal of pertussis vaccination is associated with an increased risk of pertussis infection in children.

    Am J Epidemiol. 2008 Dec 15;168(12):1389-96. Epub 2008 Oct 15.
    Geographic clustering of nonmedical exemptions to school immunization requirements and associations with geographic clustering of pertussis.

    Arch Pediatr Adolesc Med. 2005;159:1136-1144.
    Economic Evaluation of the 7-Vaccine Routine Childhood Immunization Schedule in the United States, 2001

    JAMA. 2000 Dec 27;284(24):3145-50.
    Individual and community risks of measles and pertussis associated with personal exemptions to immunization.

  24. That’s a good idea, but likely would never happen. In America, we are afforded the right to be as stupid, fat, lazy, and non-contributory as we like. Not only can we not vaccinate our children and expect other people to pay for their medical care later on, you can actually never work a day in your life, get free food, living, spending money, and healthcare, and then get free home-health (in home care) until you die. (I’m sure one of the bleeding-heart liberals here will now accuse me of not believing in global warming, or something completely unrelated because I don’t believe in infinite-length entitlement programs.) Yes, that’s right, you can contribute nothing and still get millions of dollars. Oh, and then you can still sue the doctor that is providing this care for you, at no cost to yourself.

    Rant aside, can you imagine if we made those types of rules? What if I counsel a patient that they need to lose weight, document it in the chart, and then they don’t, what if they could no longer get their CHF exacerbations, or diabetic complications, etc, paid for by the insurance systems? Or what if I give a patient a prescription, and they don’t follow it, and then they end up sick again? We’re all paying for these people’s stupidity.

    Want to hear something really bad? At our hospital, we have a 30 day “bounce back” rule. So you come in for CHF exacerbation, I treat you and send you on your way. You don’t care that much about your health, so you don’t bother with your meds or improving your lifestyle, so you get sick again and come back within 30 days. We (the hospital) dosen’t get paid for that next visit. It doesn’t matter that it’s *your* fault you got sick again, because it’s seen as a failure of the hospital to treat you appropriately. Absolutely ridiculous.

  25. ^ Oh, and a little more on those “bouncebacks.” Sometimes we have a good feeling that a patient will be a bounceback, so we’ll keep them an extra day or so to make sure they are tuned up. Their insurance may only pay for a 3 day visit, but we kept them 5 days because we want to make sure they are as good as possible before we dc them. So who eats the cost of those 2 extra days? We do. It sure as hell isn’t going ot be paid by the patient, because some people believe that expensive healthcare should just be given to them. It doesn’t matter that they’re in their room on an iPhone, because iPhones are fun to buy and health insurance isn’t. So yeah, because we fear lazy patients not taking care of themselves bouncing back to the hospital, we end up having to eat the cost of some of their care up front, which means less money taken in by the hospital, which means less hiring of staff, so now we have fewer jobs to offer, cutbacks, etc.

    It’s just a vicious cycle.

  26. weing says:

    “So you come in for CHF exacerbation, I treat you and send you on your way. You don’t care that much about your health, so you don’t bother with your meds or improving your lifestyle, so you get sick again and come back within 30 days. We (the hospital) dosen’t get paid for that next visit. It doesn’t matter that it’s *your* fault you got sick again, because it’s seen as a failure of the hospital to treat you appropriately. Absolutely ridiculous.”

    I have a slightly different take on this. These patients are victims of the advertising industry and the corporations that pay for the continuous bombardment with advertising to consume foods and drinks that will throw them into CHF. This advertising is very effective. They spend billions on it. Much more than advertising to MDs. How are we supposed to effect changes in patients’ lifestyles in the face of that tsunami?

  27. daedalus2u says:

    weing, that is an excellent argument for single payer universal health care. If the “problem” is caused by free speech and a free market, shouldn’t those who benefit from the free market be taxed to pay for it?

  28. This is only my opinion, but I’m a firm believer that we are all responsible for ourselves. Sure, a Range Rover looks sexy in commercials, and I lust after them, but no way am I going to go buy a hundred thousand dollar vehicle. If I bought one, and couldn’t afford it, should I then ask the population and/or government to pay for it for me? Hey, it’s not *my* fault I bought a vehicle I couldn’t afford, I was tricked by advertising. (sarcasm)

    I think the exact same applies to health. You have the right to eat whatever garbage you want, to never exercise a day in your life, and whatever else, but why should other people pay for your self abuse? It’s not the fault of advertisers. To me, that is just a really bad excuse. Why are we so scared to blame the individual who actually puts those french fries in their mouth, and washes it down with a sugary coke?

    @daedalus2u, are you being sarcastic? I hope so.

    As how to change lifestyles, I don’t know. It is so much easier being lazy than it is to be healthy. It takes no effort to sit on a couch and eat all day long, but it takes effort to cook a healthy meal and then go exercise. Let’s make commercials that shows gigantic fat people in hospital beds with oxygen masks hooked up, and then show them having to go to the cath lab, and then a funeral, and then a picture of their big heart and sclerotic coronaries.

    Sincerely, I do not blame advertisers or a free market. I blame the individual.

  29. * I also realize every one of us is going to have a different belief.

  30. BillyJoe says:

    SH: “I do not blame advertisers or a free market. I blame the individual.”

    You don’t blame the power brokers such as the advertisers and those who promote a free market, you blame the often poor, often poorly educated, often confused individual, the very person you were presumably trained to help?

    I actually have no time for this point of view. Forget your own private brand of politics. If there is anything that a doctor should be ‘for’ it is the individual patient in front of him. With all his faults. It seems to me that it is just easy to treat patients who are perfect. The real challenge is with the people who you conveniently dismiss as not worth treating.

    As for the “bounceback” patient, the real culprits are the powerful insurance companies who find anyway they can to avoid payment. Those patients don’t want to be sick. They don’t want to be in hospital. Some just can’t help themselves. And some – like end stage cardiac failure patients – are maybe just a little sicker than those who don’t bounce back.

  31. @BillyJoe, thank you for sharing your point of view on the lack of compliance in hospitalized patients. I find it very informative, especially considering you’ve never spent a day in a hospital (as a healthcare provider) in your entire life.

    The mere fact that you called “Joe Plumber” as “the often poor, often poorly educated, often confused individual” is telling. When can we stop acting as if nothing is the individuals fault, and let them begin to take responsibilities for their own actions?

    This has nothing to do with a doctor-patient relationship. This has to do with an individual not caring or otherwise looking out for themselves. Many patients simply don’t give a damn about their health, and don’t care to take pills as prescribed, and don’t care to put forth any effort to improve their own quality of life. I’m sorry, but I simply don’t believe we should coddle every individual, pat them on the back, and say “Hey! It’s not *YOUR* fault! It’s society that makes you drink a 12-pack of Coke and eat fast food every day!”

    I whole-heartedly agree about who is to blame for the bounceback payments. In the USA, which entity do you think controls the insurance company that lead the way for such ridiculous plans?

  32. libby says:

    @Skeptical Health:

    You state: “This (patient’s condition) has to do with an individual not caring or otherwise looking out for themselves.”

    This is of course a gross generalization of a complex issue. Your view would be accurate if responsible people didn’t get seriously sick, but they do all the time.

    It is true that people are susceptible to clever advertising and marketing and suffer from their inability to analyse properly the likely consequences of their actions. However I notice that you also berate me for questioning the motivation behind drug companies who bribe doctors, conceal safety information from gov’t regulatory agencies via the legal system, fudge figures, and heavily lobby gov’ts to carve out favourable market rules for themselves (check into the Sunshine in Litigation Act that doctors here refuse to endorse).

    You can’t have it both ways.

    You can’t vilify me for thinking, criticise your patients for not, and then claim consistency.

    Then again, if you are not really a doctor but an imposter, never mind what I’ve said.

  33. @libby, in no way am I referring to all patients. I am referring to a select few: those with self-induced chronic disease who refuse to make lifestyle changes and/or take their prescribed medications appropriately.

    I don’t see where the rest of your post follows.

  34. weing says:

    @SH,
    Are you sure you’re not burning out? Sounds like you need a vacation.

  35. weing says:

    “(check into the Sunshine in Litigation Act that doctors here refuse to endorse)”
    Huh? I think you mean the Physician Payment Sunshine Act. That happens to be the law. Whether we endorse it or not. One thing I dislike more than corporations trying to control our lives is the criminals in Congress passing laws to regulate how we work.

  36. Chris says:

    libby, so if a parent declines vaccines for their child and then the child is hospitalized for measles, or some other vaccine preventable disease: who should pick up the bill? Should the insurance company decline payment? Or should they require higher premiums because the parents declined preventative measures, much like home owners insurance companies do to those who smoke?

  37. libby says:

    @ SH:

    You state: “in no way am I referring to all patients. I am referring to a select few”. You in fact referred to “many patients” in your previous post (5:51pm).

    Nevertheless you are mixing two concepts: responsibility and obedience. You don’t seem to want patients to think as much as you want obedience and silence.

    This is all a moot point for me because I have no interest in conventional medicine. I don’t use it because I don’t need it. Don’t smoke. Don’t drink. Exercise every day. Don’t take drugs, including the pharma variety. And I don’t eat the garbage that is passed off as food from crappy outlets.

    On the other hand I don’t believe in a health system that is tied to the free market. I have worked in the private sector and this structure promotes corruption, theft, opportunism, fraud, concealment, in general a highly unethical system. Not a serious problem when buying a computer but creates all sorts of issues when there is a heavy reliance on the private sector within the medical field.

  38. weing says:

    “I have worked in the private sector and this structure promotes corruption, theft, opportunism, fraud, concealment, in general a highly unethical system.”
    If you add incompetence to that you have the public sector.

  39. libby says:

    For those of you being subjected to misinformation by a doctor on this board, the Sunshine in Litigation Act has nothing to do with the Physician Payment Sunshine Act. In fact the SLA is not about physicians at all but about corporations. It limits corporations, including drug companies, from applying for court sanction to conceal safety information from public scrutiny.

    At present, this questionable practice allows drug companies to legally conceal from the public (including government regulatory bodies) payments to victims as well as the court proceedings themselves. The company can continue to market the offending product with legal impunity.

    I myself had been prescribed a drug that had, months previously, been known by the company to cause serious reactions including death, and indemnity payments had already been made to victims. The safety concerns about the drug had been legally protected making information about it unavailable to the public.

    All this seems a far cry from the Physician’s Oath.

  40. weing says:

    Thanks for clarifying.

  41. libby says:

    Reality Check:

    It’s time to expose a couple of impostors on this board:

    weing is not a doctor. His level of comprehension would never get him through med school.

    That leaves Skeptical Health:

    He/She had me believing for a while but then some cracks started to appear. The first was that all doctors on this board use their real names. Visitors can then check to see their profile, and they do all check out. The clincher however was the 2 free days at the hospital. What was it now: “we’ll keep them an extra day or so to make sure they are tuned up. Their insurance may only pay for a 3 day visit, but we kept them 5 days because we want to make sure they are as good as possible before we dc them”

    A free 2 day tune up???? Not a chance. Those 2 extra free-bee days you wax about would be the decision of the hospital admin, not a doctor. In reality any bill not paid by the HMO would be sent directly to the patient. Now some patients can’t pay, the homeless for example, but that’s another story. That’s not the case here. These people you talk of have insurance. They can pay their bills.

    Time to fess up you two. As for SH, tell me what hospital you work out of and I’ll check into the 2 day vacation plan they offer (HAHAHA).

  42. BillyJoe says:

    libby,

    “I have no interest in conventional medicine. I don’t use it because I don’t need it. Don’t smoke. Don’t drink. Exercise every day. Don’t take drugs, including the pharma variety. ”

    I identify with your last four sentences, but not your first. I am intensely interested in conventional medicine (though mainly through the medical adversity of family and friends).
    However, your above quote seems incompatible with the following quote from your very next post:

    “I myself had been prescribed a drug that had, months previously, been known by the company to cause serious reactions including death”

  43. BillyJoe says:

    SH,

    It’s just that I think all professionals need to ba able to separate their ideological, political, and religious outlooks from their professional outlook. For a doctor, I believe this means doing the best for the individual person in front of you no matter what the circumstances. Because without you, he has nothing and no one to rely on. Especially not insurance companies or politicians.

  44. Chris says:

    So, libby, is it okay for an insurance company to insist in higher premiums when parents skip preventative measures like vaccines? Or should they just insist that that the parents pay for hospital costs themselves if their child gets a vaccine preventable disease?

    What about the costs if their child infects someone else’s baby or an immune compromised person? Much like the three babies infected in San Diego during a 2008 measles outbreak caused by an unvaccinated child.

  45. weing says:

    @BillyJoe

    It’s possible. From my limited comprehension, she was potentially damaged by zomax in the early 1980s. It was pulled from the market in 1983. I could not, however, figure out whether she was actually damaged by the drug.

  46. libby says:

    @ BillyJoe:

    To clarify, I said I don’t use it (conventional medicine), not that I never used it. English grammar is confusing on the issue of tenses as the present tense can also function as an historical present, so the confusion is understandable.

    The case of Zomax that I have already expressed here on another thread was the first sign to me that there were serious flaws within the structure of conventional medicine. This ultimately led to my complete avoidance of the industry except in extreme cases.

    As for medicine, my interests are confined to its political and social significance. I have no interest in the memorisation of drug names and their uses, nor of the protocols for their use, just as I have no interest in learning the rules of the game of cricket.

  47. libby says:

    @ Chris:

    I meant to answer you sooner but your question is not easy.

    I can only answer it personally. If I decided to not vaccinate my child for a disease that he later got and for which he had to be hospitalised, I would assume that my decision would risk the possibility of it not being covered. If I felt strongly about the danger of side effects from vaccines, then it would be a small price to pay for my convictions.

    As for your question about insurance, I am not in favour of private health insurance companies, so I’m not really the person to ask.

    As for infecting others, that’s a very hard thing to prove. Were the 3 babies already vaccinated? If so, how did they get the disease from the unvaccinated child? In fact, how is a vaccinated child in any danger from an unvaccinated one, assuming the vaccine works?

  48. BillyJoe says:

    libby:

    “I have no interest in learning the rules of the game of cricket.”

    I will forgive you. Unlike me, you are obviously not an Australian.

    “If I decided to not vaccinate my child for a disease that he later got and for which he had to be hospitalised, I would assume that my decision would risk the possibility of it not being covered. ”

    That actually doesn’t make sense. If, as you seem to believe, it is true that the risk of vaccines is greater than the risk of infection, then vaccines should not be given and therefore, if you child gets the infection you should demand that he should be covered for its treatment; whereas another child who is given the vaccine and suffers the side-effects of that vaccine should not be covered.

    “Were the 3 babies already vaccinated? If so, how did they get the disease from the unvaccinated child? In fact, how is a vaccinated child in any danger from an unvaccinated one, assuming the vaccine works?”

    The vaccine works, but it is not 100% effective. I think the figure is 95%. Therefore the 5% of vaccinated children for whom the vaccine does not work, is at risk of being infected from any other child who is infected. That risk becomes real when the percentage of unvaccinated children rises above 15%.
    (I’m nor sure if those percentages are correct)

  49. lilady says:

    @ Libby: I believe this is the San Diego Measles outbreak that Chris is referring to:

    http://www.ncbi.nlm.nih.gov/pubmed/20308208?dopt=AbstractPlus

    The young boy who was deliberately not vaccinated and who was the “index case”, was a patient of Dr. Bob Sears, who is one of the luminaries of the anti-vaccine crowd.

    Dr. Bob Sears who has an “alternative” vaccine schedule, along with Dr. Jay Gordon who tells his patients’ parents to rely on their “intuition” to determine when and if their child receives any or some of the Recommended Childhood Immunizations, both fought the implementation of California AB 2109 legislation.

    Dr. Sears, Gordon and Whitaker are deliberately misinterpreting California AB 2109…which does NOT eliminate a parents ability to opt out of vaccines and claim a “personal belief exemption” under California State Health and Education laws.

    I’m old enough to remember the death of a childhood chum from polio and the measles encephalitis that left an older cousin with permanent lifelong neurological deficits, before vaccines were developed to prevent these diseases.

    I worked as a public health nurse/clinician and I investigated individual cases and outbreaks of invasive bacterial diseases caused by S pneumoniae, Hib and meningococcal bacteria, before vaccines were developed to prevent these serious, often deadly diseases.

    Would you like to stay on topic here and comment about the subject of this thread? What are your opinions about Dr. Whitaker who knows nothing about vaccines and the diseases they prevent. What are your opinions about Dr. Whitaker who sells totally worthless vitamins and supplements that are supposed to protect kids and adults, in lieu of vaccines. Care to comment on the charts he used during his debate with Dr. Novella and why they are worthless…as well?

  50. lilady says:

    @ Billy Joe: Here from the CDC Pink Book-Measles Chapter, is the information about measles vaccine…and the recommendation for the second dose of MMR vaccine:

    http://www.cdc.gov/vaccines/pubs/pinkbook/downloads/meas.pdf

    Measles antibodies develop in
    approximately 95% of children vaccinated at 12 months
    of age and 98% of children vaccinated at 15 months of
    age. Seroconversion rates are similar for single-antigen
    measles vaccine, MMR, and MMRV. Approximately 2%–5%
    of children who receive only one dose of MMR vaccine fail
    to respond to it (i.e., primary vaccine failure). MMR vaccine
    failure may occur because of passive antibody in the
    vaccine recipient, damaged vaccine, incorrect records, or
    possibly other reasons. Most persons who fail to respond
    to the first dose will respond to a second dose. Studies
    indicate that more than 99% of persons who receive two
    doses of measles vaccine (with the first dose administered
    no earlier than the first birthday) develop serologic
    evidence of measles immunity.

  51. mousethatroared says:

    Does any one else ever wonder if Libby and SH are actually constructed personnas written to discredit the opposing sides? I mean, I don’t think I could invent a more unflattering portrait of an “allopathic” doctor or a socialist alternative medicine proponent if I tried.

    No?

    Okay, probably not. I agree.

  52. gziomek says:

    @libby

    One of your earlier points about the private sector influence on the healthcare system is exactly why some of the issues in the current system exist. You’d be hard pressed to find someone in/around healthcare that is unaware of this to some degree, though I’m sure there’s plenty of folks that are in complete denial.

    To further Bille Joe’s point, you questioned how a vaccinated child is threatened by an unvaccinated one. That isn’t the problem, as far as I know. The MMR vaccine is given at around age 1, so an unvaccinated child is a threat to a child that’s under 12 months. Hope that helps address this question.

    I apologize if my comment is irrelevant or has already been said to death.

  53. Chris says:

    libby:

    As for infecting others, that’s a very hard thing to prove. Were the 3 babies already vaccinated? If so, how did they get the disease from the unvaccinated child? In fact, how is a vaccinated child in any danger from an unvaccinated one, assuming the vaccine works?

    lilady posted the relevant link. I am surprised how many people think a child should be protected before they get a vaccine, or have completed an entire DTaP series.

    My auto insurance has informed me that they will begin legal proceedings against the uninsured driver who totaled one of our cars. In the 1990 measles epidemic cost the California public health system, Medi-Cal, several million dollars. In the future when it happens again, should the state demand to recover some of the costs?

    You see, libby, while you are going on and on and on about your little pet peeves about health care, you cannot deny that preventing the diseases is cost much less than the treatments. So until you can show that providing two MMR vaccines to each child is much more expensive than the hospitalization of one out of a hundred (and recently in Europe it was one out four) cases of measles: your rants on Big Pharma gifts is just flat out silly.

  54. @Chris,

    I thought about your question today. This is the issue: it’s not the child’s fault. So the parent is a hippie moron who doesn’t want to vaccinate their children, and the child gets sick. While I fundamentally agree that the parent is the person who should be ultimately held responsible, I don’t think that the kid should suffer if, for example, the parent cannot afford to pay for the treatment and therefore the child doesn’t receive it. I’d be fine with any sort of penalty, for example, if you don’t vaccinate your children, and your child gets sick, then the child will be treated, and any bills from hospitals, etc, can be garnished from the parent’s salary. Whatever it takes, as long as the child is indeed treated. We can’t let them suffer because their parents are idiots.

  55. libby says:

    @ BillyJoe:

    You state: “if you child gets the infection you should demand that he should be covered for its treatment; whereas another child who is given the vaccine and suffers the side-effects of that vaccine should not be covered.”

    The question applies to HMO’s, not universal health care. HMO’s make their own rules on what they cover, and by accepting private health insurance, I am also accepting that they will only pay if compelled, or if they have no legal option available to avoid it. If they decide that I am irresponsible it would then entail a long legal battle to extract payment. I would sooner pay the hospital fee.

    Deciding whether they should pay is a different story. I answered the question practically not ethically. Health insurance should cover all medical occurrences except elective treatments such as cosmetic surgery.

    The second part of your statement, not covering a child suffering side effects from a vaccination, is wrong because the population is encouraged to get vaccinations. For the medical community to not cover the victims of its procedures, especially those procedures it promotes, would be a highly unethical position.

    “The vaccine works, but it is not 100% effective. I think the figure is 95%. Therefore the 5% of vaccinated children for whom the vaccine does not work, is at risk of being infected from any other child who is infected. That risk becomes real when the percentage of unvaccinated children rises above 15%.”

    My real problem in responding to this statement is that my concern about vaccines goes much deeper. I have shown on a number of posts that corporations place considerable effort in protecting profits. Part of that is legally concealing safety concerns. The pharma industry is no different. So we have handed over the production of vaccines and other drugs to the private sector in the hopes that they will perform drastically differently than corporations in other fields. This is a pipe dream. They don’t.

    And you see on this board that no doctor openly supports legislation that will easily solve this issue. Whether this is an issue of not biting the hand that bribes you is hard to say. It could simply be that doctors prefer to deal with patients and not politics. In any case, doctors seem to be onside with the free market structure of drug production, and they also seem to be unconcerned as to the level of untrustworthiness associated with it. As I say, buying a toaster from a corporation is not the same as injecting a chemical substance into your body.

    Of course governments are also corrupt, but they are at least accountable to some degree, and depending on the level of education of the population, potentially to a very high degree. Corporations and the private sector in no way operate under the same level of accountability, except to their stockholders.

  56. libby says:

    @Chris:

    “…..your rants on Big Pharma gifts is just flat out silly.”

    Sorry but I can’t converse with someone of limited comprehension.

    Good Luck!

  57. libby says:

    gziomek:

    “The MMR vaccine is given at around age 1″

    Well then give it to them sooner. It’s apparently safe because pharma tests show it to be.

    So what’s the delay?????

  58. mousethatroared says:

    Chris “My auto insurance has informed me that they will begin legal proceedings against the uninsured driver who totaled one of our cars. In the 1990 measles epidemic cost the California public health system, Medi-Cal, several million dollars. In the future when it happens again, should the state demand to recover some of the costs?”

    I know that you addressed this question to Libby, but I always find these questions intriguing, so I hope it’s okay that I comment.

    1. It seems like it would be much harder to prove a particular unvaccinated child was the source of an outbreak than that a particular uninsured driver was the source of a wreck. I’m assuming that in the area of an outbreak there will be children who are unvaccinated to their parent’s beliefs, but also child who are unvaccinated due to other health conditions or adults who’s immunity may have waned…can forensics prove that a particular person was the source of an outbreak?

    2. In our state driving without insurance is illegal, so there is a clear cut law setting the permitters for driving/property responsibility. In most states going unvaccinated is not illegal. If the parents of the child are following the laws regarding vaccination, it seems that it would be much harder to prove that they are not meeting their responsibilities for public health.

    3. I wonder if winning a case like that would ultimately result in winning the legal battle but loosing the PR war. It just seems like it could play very badly…big bad government vs the parent who are “just worried about the safety of vaccines.” I can’t prove that, but just seems kinda risky.

    4. Generally, I suspect making vaccine as accessible as possible and making the process for NOT vaccinating a child (who is safe to vaccinate) as boring and inconvenient as possible, in the form of paperwork, etc is going to result in better vaccination numbers and less backlash from the public. But once again, I can’t prove that. Probably there are people who study such things who might have an opinion NOT based on intuition.

  59. lilady says:

    @ Libby: The reason that the MMR is not given before 1 year of age, is explained in the Pink Book-Measles Chapter that I linked to above:

    http://www.cdc.gov/vaccines/pubs/pinkbook/downloads/meas.pdf

    BTW Libby: It is recommended by the CDC, the WHO and every other governmental entity that babies age 6 months to one year of age receive the MMR vaccine for the limited protection it provides, prior to traveling to a measles-endemic country…or if there is a widespread measles outbreak. MMR vaccines given before one year of age do not “count”….the baby will require the two-dose MMR series, after one year of age.

  60. libby says:

    @ mousethatroared

    “…socialist alternative medicine proponent…”

    ¡¡Viva la Revolución!!

  61. WilliamLawrenceUtridge says:

    Libby:

    Don’t smoke. Don’t drink. Exercise every day. Don’t take drugs, including the pharma variety. And I don’t eat the garbage that is passed off as food from crappy outlets.

    So you follow the exact guidelines that any reasonably-trained and competent doctor would give you to live a healthy life? Good for you, I’m sure your doctor would approve. Last I checked doctors don’t give out medication unless there is a need, and can’t make you take it if you don’t want to. Also:

    This ultimately led to my complete avoidance of the industry except in extreme cases.

    That’s pretty much the ideal situation for any doctor and patient – if everybody actually followed their doctor’s advice, for pretty much anyone without a congenital condition would only ever need an emergency room (naturally since vaccination is included in basic advice of any competent doctor, illness would be only low-risk, self-limiting conditions).

    Also, the distinction between a “gift” and a “bribe” – a bribe is money given to make a specific choice. A gift is non-monetary and might be given to influence someone. Portraying pens, hats, lunches and conference tats as bribes is nonsense; while a doc given free pens and samples might be more likely to prescribe one of several competing drugs, or a specific drug to a borderline-risky patient, I doubt these gifts would be enough to make them give a symptom-free patient a neuroleptic. A bribe might, pens are less likely. All those relatively low-value items are meant to sway judgement in situations where there is uncertainty, I highly doubt they’re going to make a doctor commit malpractice.

    And I know I read it somewhere on SBM, though I can’t recall where, but apparently doctors who never met with drug reps actually had worse prescribing practices than those that did – they used older medicines and failed to take up newer, often better drugs. I believe Dr. Hall originally discussed this, perhaps she can link the article. Like so many things, the situation is less than perfect and has both good and bad points. Portraying all medicine as not just flawed but evil is stupid and insulting. Portraying doctors and medicine as perfect, unbiased and flawless is prideful, unrealistic and naive. Everything in medicine is messy and imperfect, but it’s still your best bet to live a long, healthy, mostly symptom-free life. Libby, you’re damned lucky you live in a country with a public health infrastructure that protects you from infectious diseases. I doubt you’re grateful.

  62. mousethatroared says:

    WLU – “That’s pretty much the ideal situation for any doctor and patient – if everybody actually followed their doctor’s advice, for pretty much anyone without a congenital condition would only ever need an emergency room (naturally since vaccination is included in basic advice of any competent doctor, illness would be only low-risk, self-limiting conditions).”

    WLU – am I reading you right? That is an overly simplistic statement. One can live a healthy lifestyle and still get cancers, strokes, autoimmune diseases, various bacterial illnesses, viruses, abscesses, asthma, allergies, etc. Those are not all congenital and are not nescasarily self-limiting and it would be silly and impractical to handle them all in an emergency room.

    And you can’t actually follow ALL the recommendations, can you? Take drinking for instance, moderate consumption of alcohol is probably good for some things and probably bad for others.

  63. Chris says:

    libby:

    I don’t think that the kid should suffer if, for example, the parent cannot afford to pay for the treatment and therefore the child doesn’t receive it.

    Where did I say the child should not be treated? When you went off on not buying health insurance, I then asked about Medi-Cal, which is California’s health system for those with less than a certain income.

    libby:

    Sorry but I can’t converse with someone of limited comprehension.

    Yet, I am not the one who is derailing this thread with off topic comments. Nor am I the one who claimed children would not receive treatment. I actually provided citations that you did not seem to read.

    mousethatroared:

    1: Actually they can and often do find the index patient. Go up and read the link lilady posted on the 2008 San Diego measles outbreak. Go read about the other measles outbreaks. There are investigations, some are described in the book Inside the Outbreaks: The Elite Medical Detectives of the Epidemic Intelligence Service by Mark Pendergrast.

    2: I am not addressing the legality of state laws, but rules put down by private insurance companies. The options are either increasing the premiums for disregarding preventative measures or trying to gain back funds that they spent on something that could have been prevented.

    3. Winning a case? It is something that is not in place at the moment. But it is to highlight that choosing to skip prevention, can be costly later.

    4: Yes. In my state, like many other states, put in programs to make sure kids get vaccinated after the 1990 measles epidemic. The county public health department actually supplies vaccines to clinics for low income populations, and even to private medical practices. Plus the legislature now requires that a vaccine exemption form be signed by a medical professional that the risks were explained to the parent. Laws like that are now pending or active in other states, like California.

    The point is that the decision to not vaccinate carries a real risk, and that risk comes with a price tag. Not only in illness, misery and suffering: but also in real cold hard cash.

    So it is illuminating that people go and blindly follow Dr. Whitaker because he is a real doctor, but is scaremongering about disease prevention without real evidence. Most of the stuff he spouts is nonsense, especially with a graph with imaginary data that literally does not add up. And yet, he is clueless when actual evidence shows his anti-vaccine stance is both dangerous and expensive.

    And since the debate was at a libertarian conference, I really want to know who pays the bills when those decisions get costly. The insurance companies are private businesses, and would find ways to get out of paying bills if preventative measures were not followed. And then when the parents cannot afford the medical care, it turns out the tax-payers end up paying. The parents lose, the kids lose and Dr. Whitaker just pockets the cash from his online orders.

  64. Chris says:

    Sorry for closing the italics tag on the book title. It is an interesting book.

    And I am baffled why you are so keen on finding the index patient. I know there have been discussions of suing parents whose children cause illness in the vulnerable, but that is not what I mean. I am only discussing if parents who deliberately deny disease protection from their should have a financial penalty when their children do get sick.

  65. mousethatroared says:

    @Chris – Your last comment was addressed to me, right? Yes, I misunderstood you, maybe I mentally blended comments. I thought you were saying that parents of a child who goes unvaccinated should be responsible for some of the cost of the outbreak, meaning the medical care of the others sickened by the outbreak and the cost of investigating the outbreak, if their decision not to vaccinate was causative in the outbreak.

    Not that they might be responsible for the cost of their child’s care (via insurance penalty, etc).

    Yup, that difference make most (or all) of my previous comment irrelevant. (Color me embarrassed).

    Sorry about the confusion.

  66. lilady says:

    The investigation of a measles outbreak is not an easy undertaking. It requires a knowledge of immunology and epidemiology and trace-back skills. The CDC provides an outline for public health doctors and nurses to implement for measles cases/outbreaks surveillance/reporting:

    http://www.cdc.gov/vaccines/pubs/surv-manual/chpt07-measles.html

  67. daedalus2u says:

    The point of requiring a MD to sign the exemption from vaccination is to require that the parents know what precautions to take. The index case in the CA measles epidemic was someone unvaccinated who went to a country where measles is endemic. The parents should have been informed to not do that, or to get their child vaccinated first, or to keep their child quarantined afterward.

    If the MD doesn’t do that, the MD can be hit with patient and public health malpractice.

    Dr Whitaker may think his magic water will prevent measles, but if it doesn’t, he better have pretty good malpractice insurance.

  68. lilady says:

    @ daedulus2u:

    I tackled Dr. Bob Sears on his Ho-Po blog, when he posted about the implementation of California AB 2109:

    http://scienceblogs.com/insolence/2012/03/27/dr-bob-sears-vs-seth-mnookin-measles-out/

    Yes, sometimes I do wallow, hip boots on, in the morass of the “science” presented by Sears, et alia :-)

  69. Chris says:

    mousethatroared:

    I thought you were saying that parents of a child who goes unvaccinated should be responsible for some of the cost of the outbreak, meaning the medical care of the others sickened by the outbreak and the cost of investigating the outbreak, if their decision not to vaccinate was causative in the outbreak.

    Definitely not my meaning. I am just going on a personal liability basis, where if you don’t protect you and your family, then you pay a price. Much like the stories of someone who gets a bill for fire protection because their community pays for private fire protection. Well, if one does not pay the bill and their house is destroyed by a fire, then you must pay for everything (this has happened in some places).

    I am just wondering if Dr. Whitaker and his followers know that there could be financial repercussions for their action (or lack of action) in disease prevention.

  70. mousethatroared says:

    WLU – the two SBM articles I remember about doctor education and pharmaceutical reps are…

    http://www.sciencebasedmedicine.org/index.php/gsk-pays-3-billion-fine/
    http://www.sciencebasedmedicine.org/index.php/a-foolish-consistency/

  71. libby says:

    WLU:

    You state: “…the distinction between a “gift” and a “bribe” – a bribe is money given to make a specific choice. A gift is non-monetary and might be given to influence someone.”

    Incorrect definitions for both words. You yourself could of course use these words in this way but no one would pay the slightest attention.

  72. lilady says:

    @ libby: Do you think you could stay on topic? Perhaps you should stop posting here, because you so obviously know nothing about immunology, epidemiology or vaccine-preventable diseases.

  73. Chris says:

    libby, who should bear the cost of an epidemic from a vaccine preventable disease? While you are going on about what are mostly now illegal bribes, especially since many vaccines are provided with public funds, there are real financial risks with diseases.

    Dr. Whitaker actually does not care, because he really does not treat children. And if he is like Dr. Jay Gordon, he does not even accept insurance payments. So your silly diversions are pointless, and show little comprehension of the issues involved. How can you even discuss them when you did not even know why some vaccines are not given until a child is a year old?

  74. WilliamLawrenceUtridge says:

    @mousethatroared

    WLU – am I reading you right? That is an overly simplistic statement. One can live a healthy lifestyle and still get cancers, strokes, autoimmune diseases, various bacterial illnesses, viruses, abscesses, asthma, allergies, etc. Those are not all congenital and are not nescasarily self-limiting and it would be silly and impractical to handle them all in an emergency room.

    Ya, it’s about as much of a characiature as Libby and SkepticalHealth’s posts but I recognize your point, my examples went too far. Really my point is that criticizing doctors for being pill-pushers, then being essentially the ideal patient by following every single recommendation a doctor would make, is kinda absurd.

    And you can’t actually follow ALL the recommendations, can you? Take drinking for instance, moderate consumption of alcohol is probably good for some things and probably bad for others.

    Yup, like all medicine, it’s complicated – and not the simple, pill-pushing, Big Pharma, bribes-and-evil narrative libby is trying to sell.

    Thanks for the links!

    @libby

    Incorrect definitions for both words. You yourself could of course use these words in this way but no one would pay the slightest attention.

    Even if you are correct, and that’s arguable, you are still claiming that doctors will put the health of their patients at risk for a couple pens and post-it notes. It’d be a laughable claim if it weren’t so insulting. There’s a difference between “unanticipated adverse effects that were noted by a company but not told to your doctor” and “your doctor deliberately gave you something he thought poisonous”. You’re letting a personal event influence your perception of an entire field of scientific endeavour and an entire industry. That’s quite obvious and understandable – humans are prone to illogical errors in judgement when it affects them personally. Doesn’t mean it’s right. I’m sorry you were injured by a medication, I’m sorry medications aren’t perfect, but that doesn’t mean science doesn’t work or we’re better off without vaccines and it doesn’t mean your charicature of science and medicine is accurate.

  75. libby says:

    WLU:

    You state: “…you are still claiming that doctors will put the health of their patients at risk for a couple pens and post-it notes. It’d be a laughable claim if it weren’t so insulting.”

    You really do piece together moronic arguments. Feel free at any time to introduce some facts into your entries.

    The AMA has already studied the situation and I have already listed it on anther thread. Doctors are susceptible to ‘gifting’ (more correctly called bribing) because A STUDY SHOWS THIS TO BE THE CASE. Doctors who claim gifting does not influence them are in fact influenced by prescribing considerably more medicines from that company, even if these drugs are more expensive for the patient.

    Stanford University Medical Center is so concerned about bribing by drug reps that they have severely curbed their presence on campus, and have refused all gifts EXCEPT small items like pens and post-it notes. What does that tell you? Well that the gifts are often substantial. Stanford is also concerned by the public perception of an improper relationship between drug company and doctor.

    The idea that this is only about pens and post-it notes is simply a lie by a sycophant of the medical establishment.

  76. libby says:

    @ lilady:

    Your posts are simply embarrassing – feeble attempts at put-downs by a feeble mind.

  77. @libby, but please provide *any* evidence that doctors receiving pens has led to worse outcomes for patients.

  78. weing says:

    @WLU,

    “I’m sorry you were injured by a medication, I’m sorry medications aren’t perfect, but that doesn’t mean science doesn’t work or we’re better off without vaccines and it doesn’t mean your charicature of science and medicine is accurate.”

    Was she actually injured by the medication? I got the impression that she was potentially injured by the medication. She has not clarified that point.

  79. WilliamLawrenceUtridge says:

    You really do piece together moronic arguments. Feel free at any time to introduce some facts into your entries.

    Right back at ya, champ.

    The AMA has already studied the situation and I have already listed it on anther thread. Doctors are susceptible to ‘gifting’ (more correctly called bribing) because A STUDY SHOWS THIS TO BE THE CASE. Doctors who claim gifting does not influence them are in fact influenced by prescribing considerably more medicines from that company, even if these drugs are more expensive for the patient.

    Did those studies indicate that doctors became more likely to give drugs to people who didn’t need them? Do the studies indicate that neuroleptics were given to diabetics, or statins to infants? There’s a difference between having to choose between two medications, and giving someone a completely unnecessary medication. There’s a difference between being convinced a borderline-high cholesterol patient might benefit from a statin and putting a depressed patient on natalizumab. In both cases the former is a judgement call, the latter is malpractice. The former is probably influenced in greater and lesser ways by phrama reps. The latter, not so much. Pharma reps are about shifting judgement calls, not blatant malpractice.

    And note that you’re citing scientific literature, which is how medicine improves itself. So yes, giving away pens and having hot pharma reps can influence doctors. Fortunately this is known, is being studied, is being publicized and people are trying to change things. I think SkepticalHealth is himself falling victim to cognitive biases and being naive, but his own comments support my own – it’s about making a choice when several appropriate options are available. It’s not about giving patients completely inappropriate medication for no reason. Insult me all you want, you’re not actually making my point go away.

    Stanford University Medical Center is so concerned about bribing by drug reps that they have severely curbed their presence on campus, and have refused all gifts EXCEPT small items like pens and post-it notes. What does that tell you? Well that the gifts are often substantial. Stanford is also concerned by the public perception of an improper relationship between drug company and doctor.

    It tells me that the medical profession recognizes the issue and is attempting to address it. Good for them. You appear to be criticizing the medical profession and academic world for trying to address a noted problem. So what’s the issue, that it’s not perfect? Nothing is perfect, but that doesn’t mean medicine is ineffective or drug companies are all powerful. Frankly, if drug companies were all powerful, they wouldn’t need to make profits, they’d just take what they wanted. Your comments are charicatures based on your own peronal history, with no reflection on the difficult calculus required to improve human health in all its complexity. You aren’t helping.

    The idea that this is only about pens and post-it notes is simply a lie by a sycophant of the medical establishment.

    The idea that doctors willfully commit malpractice based on bribes is simply a lie by someone who can’t get past their personal tragedy. The idea that the entire medical profession is corrupt and causes more harm than good is simply wrong.

  80. WilliamLawrenceUtridge says:

    @weing

    Was she actually injured by the medication? I got the impression that she was potentially injured by the medication. She has not clarified that point.

    Does it matter? The level of rhetoric and vitriol indicates personal feelings are over-riding any rational risk to benefit calculation regarding medicine. Whether she was actually harmed by a drug, or thinks she was harmed, or her children were harmed, or friends or family, this doesn’t change the fact that her emotional investment is causing a biased assessment of the situation and evidence. Reactions like this are why science and evidence need to rely on very careful methodology to minimize bias, empirical assessment, convergent lines of evidence, replication and statistics in order to figure out if a medicine, intervention or whatever is worthwhile. Not whether an emotionally salient story can be told.

    Note that I’m assuming Libby is a “she”, possibly due to “Scooter” Libby being a she, I’m not actually sure.

  81. libby says:

    WLU:

    “…the medical profession recognizes the issue (bribery) and is attempting to address it. Good for them.”

    HaHaHa. You’re such a imbecile.

    You just said there was no problem. But now it’s a problem that the medical field is trying to fix.

    So which is it? – a problem, not a problem.

    Your posts have internet junkie written all over them.

  82. weing says:

    @WLU,
    “Does it matter? ”
    I guess for me it does. If she was actually injured, I could understand her reaction. If she was not actually injured but only potentially. Well, that’s a horse of a different color.

  83. libby says:

    WLU:

    By the way, seeing that you can’t correctly define simple words like “gift” and “bribe” that would provide little problem for an 8 year old, I notice than when you promised to talk about the evidence that countered the AMA study on bribery, you asked 2 questions and then proceeded to express more opinion.

    Are you having trouble defining the words “evidence” and “opinion” as well. You do know they are different things. Let me give you a hint. Evidence is not the rubbish that spews from your brain.

  84. libby says:

    weing (the impostor)

    Actually people died from Zomax AND it stayed on the market after that because McNeil Pharmaceuticals legally hid the information. Then again, you wouldn’t know about that, nor would you care, because you’ve never stepped inside a med school in your life.

    It’s interesting as well that no matter what time of day, you seem to be happily posting on this board, and yet, you also seem to have time for your patients. Hmm. Very interesting wouldn’t you say.

    You’re as phoney as a 3 dollar bill.

  85. libby says:

    SH:

    Tell me which hospital you work at and I’ll call them about the free 2-day room, board and medical care they offer HaHa.

    Another phoney exposed.

  86. weing says:

    @WLU,

    It’s looking more and more like the horse of a different color.

  87. libby says:

    weing (the pseudo-doctor):

    This rule applies to phoneys as well.

    When you use an expression, you should know what it means.

  88. @libby, if you go back and read, you will see that the insurance does not pay for the extra days, and the patient is billed, but the patient simply doesn’t pay. So who do you think ultimately pays for it? Please note, in no way am I saying or implying we are “giving away” free care. It is still a cost-saving measure, because we’d lose more money on a bounceback, so we take the loss up front to prevent a bigger loss later down the road.

    Every single hospital I’ve worked in works this way. Every hospitalist deals regularly with case managers who are trying to get the patients out the door in accordance with what the insurance companies will pay, but sometimes the patients need to stay longer. The insurance companies do not pay for that, and regularly the patients will not pay the bill. Where do you think the money for that comes from?

  89. PS, Why are you accusing everyone of not being a doctor? Isn’t that a rather weird thing to start doing, simply because we don’t agree with you?

  90. weing says:

    @libby,

    So, tell us about your phoney injury.

  91. mousethatroared says:

    @ WLU and Weing – The last time Libby was on this board I was curious about the “potentially injured by Zomax” claim. As I recall, Libby said she was given Zomax by a dentist and later found that the drug had a higher incidents of negative side effects and deaths that the drug company had revealed.

    But here’s the thing, The deaths from Zomax appeared to have been from allergic reactions, NOT something nebulous like, ‘people who took this drug had a higher chance of developing a particular neurological defect or cancer or asthma, etc’

    I could understand Libby’s over the top reaction if she had taken Zomax and had a severe allergic reaction, or if she had unknowingly taken a drug that had potential long term worrisome health risks without knowing it. But neither appear to be the case. It appears she took the drug for a short time, did not have an allergic reaction and now she is in the clear.

    IMO – while It’s appalling that the drug company covered up the increased risk of allergic reaction after they were aware of it, probably causing unnessary deaths, and we certainly want to do everything legally possible to prevent and or punish such shameful behavior in corporations that responsible for health a safety, Libby’s suggesting that she was ‘potentially injured by drug company corruption’ is far fetched, counter-productive and well…seems pretty unbalanced.

    Of course, I’m pretty unbalanced myself, so who am I to judge? :)

  92. weing says:

    @MTR,

    You hit the nail on the head. Oh no. Not again. I gotta start avoiding cliches like the plague.

  93. mousethatroared says:

    @WLU – “Really my point is that criticizing doctors for being pill-pushers, then being essentially the ideal patient by following every single recommendation a doctor would make, is kinda absurd.”

    Okay – I get you now. I do find these discussions particularily annoying. The alternative health folks always claim ‘I live a healthy lifestyle so I don’t get sick. Doctor are just trying to replace drugs with a healthy lifestyle.’ They are completely oblivious to the fact that a large part of medicine has always been for people who have lived reasonably healthy lifestyles and still have something go very wrong with their health.

    Surprise, surprise! if you live a healthy lifestyle and you are lucky enough to not be sick or at a high risk for an awful disease, than certainly don’t take prescription medications. If you feel well and you are not at high risk for an awful disease that required preventative medication AND your doctor is pushing you to take some trendy medication that the drug companies are pushing, TRY ANOTHER DOCTOR. It’s not rocket science folks.

  94. mousethatroared says:

    @weing – ha!-good one

  95. libby says:

    SH:

    Tell me what hospital you work at so your specious story can be checked out. What are you afraid of, besides the truth?

    @ weing:

    “So, tell us about your phoney injury.” Ah such a wit. Such a clever turn of the phrase.

    MTR:

    When you present your opponent’s argument there are some rules. One is not to fabricate quotes and assign them to the other side. It was Dr. (if you believe that) weing, your internet junkie ally, who called me brain damaged and keeps repeating his own lie. I never ever ever said I was damaged by Zomax (If you repeat a lie often enough, it becomes the truth – Goebbels).

    Secondly, you need to read the entire story about Zomax. Yes it was an allergic reaction, but that’s where your rubbish replication of the facts ends. Secret payments were made by McNeil Pharmaceuticals after concealed court proceedings took place. The drug was finally revealed to the public to be dangerous and withdrawn from the market because of these adverse reactions, because a doctor in Syracuse came close to death and soon after went public. At the time that I was prescribed the drug, indemnity payments had already been ordered by the court to its victims. McNeil kept it on the market as long as possible, delaying its recall, because it was a huge money maker. Screw the patients, we’re making money.

    Come on people. You have the internet at your fingertips. Use the damn thing.

  96. WilliamLawrenceUtridge says:

    @libby

    Evidence is not the rubbish that spews from your brain.

    Right back atcha, champ!

    To clarify – in my opinion the impact of pharmaceutical representatives and advertising is potentially problematic, but it depends on the doctor, the patient and the drug. But to make the point again, the one you’ve been dodging in your content-free, ad hominen and pedantically correct but substantively wrong responses.

    There’s an enormous difference between a doctor who is influenced to prescribe one of several drugs, all of which are potentially appropriate, and one who will prescribe a blatantly inappropriate drug out of greed. There is an enormous difference between a doctor letting their opinion be swayed without knowing about it (hi SkepticalHealth, that might be you!) and a doctor who knows what they are doing is wrong and does it anyway. Your arguments seem to imply the second half of these sentences is the more common. I would be keen to see that evidence. Calling me stupid doesn’t make that evidence appear. Also:

    This rule applies to phoneys as well.

    Are you channeling Holden Caulfield? The self-righteousness of your responses and their often belittling content do make you sound like a 17-year-old, convinced of their rightness in the world and the ease with which choices can be made. But the world isn’t black-and-white, right-and-wrong, and medicine is not simple. Shouting insults and proclaiming things simple doesn’t actually make things simple.

    @mousethatroared:

    Okay – I get you now. I do find these discussions particularily annoying. The alternative health folks always claim ‘I live a healthy lifestyle so I don’t get sick. Doctor are just trying to replace drugs with a healthy lifestyle.’ They are completely oblivious to the fact that a large part of medicine has always been for people who have lived reasonably healthy lifestyles and still have something go very wrong with their health.

    I also find such proclaimations amusing. And thanks for pointing out that my own claims were exaggerations. They’re fun when you write them, but that doesn’t mean they’re right :)

  97. libby says:

    @ WLU:

    You state: “Shouting insults and proclaiming things simple doesn’t actually make things simple.”

    HaHa. This coming from the guy who called me a Nazi. Here’s a word you might want to add to your vocabulary, ‘hypocrite’.

  98. Chris says:

    libby, which gives a doctor more potential income:

    a: Providing patients, especially children, with vaccines on the recommended schedule

    b: Treating patients when they become ill with measles, mumps, Hib, pertussis, etc?

    Be clear on how one provides more income than the other, and note these papers that I have posted earlier:

    Pediatrics. 2009 Jun;123(6):1446-51.
    Parental refusal of pertussis vaccination is associated with an increased risk of pertussis infection in children.

    Am J Epidemiol. 2008 Dec 15;168(12):1389-96. Epub 2008 Oct 15.
    Geographic clustering of nonmedical exemptions to school immunization requirements and associations with geographic clustering of pertussis.

    Arch Pediatr Adolesc Med. 2005;159:1136-1144.
    Economic Evaluation of the 7-Vaccine Routine Childhood Immunization Schedule in the United States, 2001

    JAMA. 2000 Dec 27;284(24):3145-50.
    Individual and community risks of measles and pertussis associated with personal exemptions to immunization.

    West J Med. 1996 Jul-Aug;165(1-2):20-5.
    Pediatric hospital admissions for measles. Lessons from the 1990 epidemic.

  99. mousethatroared says:

    Libby “And thanks for pointing out that my own claims were exaggerations. They’re fun when you write them, but that doesn’t mean they’re right ”

    Exaggerations of what? Your claims about your personal experience with Zomax have been very vague. I just put together what you have written (that I have read) and the news reporting on Zomax and wrote my conclusion.

    But, there were certainly people harmed by Zomax, due to shameful behavior on the drug companies part.. I don’t think anyone is disputing that.

    The vague anecdote about your personal experience is more of a distraction from that fact than anything else.

    Oh and Libby, you really should use SkepticalHealth’s policy of ignoring all my comments, or ultimately you might find yourself asking “who’s trolling who?” ;)

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