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Pox parties taken to the next (illegal) level

Normally, we don’t post on weekends on this particular blog, mainly because most of our readership visits during the week and we don’t have enough bloggers to cover the weekend reliably anyway. However, occasionally something happens that’s so bizarre, so worrisom that we can’t wait until Monday. I don’t even care if I’m late to the party after Tara, Mike the Mad Biologist, The Biology Files, Todd, and probably several others whom I’ve missed.

Regular readers of this blog and anyone who’s ever followed the anti-vaccine movement more than superficially have probably heard of pox parties. These are, yes, parties where parents who don’t want to vaccinate their children against chickenpox, hoping for “natural immunity,” expose their children who have never had chickenpox to children with active chickenpox in order to intentionally infect them with the disease. (Thanks, Mom and Dad, for a couple of weeks worth of misery and intense itching and a small chance of serious complications!) Although there might have been a weak rationale for such activities back before there was a vaccine for chickenpox, today pox parties are about as dumb a concept as I can think of and only make sense in the context of equally idiotic anti-vaccine pseudoscience, and apparently, as is the case with many idiotic things, has co-opted Facebook and other discussion forums as a means of getting like minded (if you can call what is behind this a “mind”) together for purposes of inflicting misery on their children. One such page even has a Quack Miranda-style warning:
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Random Flu Thoughts

I normally write the first draft of this blog the weekend before it is due, and this is no exception.  However, I am ill this weekend.  Headache, myalgias., painful cough, but only mildly ill.  The worst part is the interferon induced brain fog; my thoughts flow with all the speed of pudding and I was not appreciably better as the week progressed, although no cracks about how  you can’t any difference in my writing over baseline.

I doubt the cause of my symptoms is influenza.  According to the CDC site and Google flu trends there is little influenza activity in the US at the moment, so it is probably one of the innumerable viruses that can cause a flu-like illness.  I am also not ill enough to think I have influenza, but I could be having a modified course as I was vaccinated a month ago.  Of course, the doctor who treats herself has a fool for a patient and an idiot for a doctor. Flu season approaches, so from my interferon addled brains, flu thoughts.

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Posted in: Public Health, Science and Medicine, Vaccines

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Return of an old foe

In 2000, a panel of experts was brought together by the Centers for Disease Control and Prevention (CDC). They came to discuss whether measles was still endemic in the United States, that is whether it still existed in the general background of US infectious diseases. They concluded that measles had been eradicated in the US, and that the occasional cases imported from abroad were stopped by a wall of vaccinated Americans.

Welcome to the future. The US is in the middle of its largest measles outbreak since 1996. Most of the cases originated abroad, brought back by unvaccinated travelers, either American residents or foreign visitors. This has so far led to 12 outbreaks (that is, a cluster of three or more connected cases) mostly among the unvaccinated. Of the 139 cases who were US residents rather than foreign visitors, twelve had documentation of adequate immunization.

The surprise isn’t that a few cases should slip through the wall of vaccination, but that the wall has so many chinks in it. The number of measles cases being imported, and the falling vaccination rates of Americans may reach the point soon where we no longer need to import our measles as it will once again become endemic.

Measles isn’t just a curious disease that we learned about in medical school (“cough, coryza, conjunctivits”); it’s a serious disease that leads to pneumonia in 1 in 20 children, and brain inflammation in 1 in 1000. Outside the US, it causes hundreds of thousands of deaths yearly.

We must increase our efforts to vaccinate all US residents properly (including undocumented residents). If measles does take hold once again in the U.S., the blame will fall squarely on our health care system’s failure to deliver vaccine, and on those who for whatever reason delay or avoid vaccination altogether.

It used to be that Americans viewed public health battles with excitement, a battle against fear itself, against the fear of children choking to death from whooping cough, or becoming paralyzed by polio. Now, as we sit behind our crumbling shield of vaccination, we have become complacent. If we fail to act, our complacency will be replaced by very real fears, especially for our children.

Posted in: Vaccines

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Alternative Vaccination Schedules

Evidently the 7 billionth human is going to be born on October 31. Happy birthday and welcome to the Earth.  If you were unfortunate enough to be born into a developing country or a affluent California family, you may not receive your vaccinations, and may join one the 57 million who die each year of vaccine preventable diseases (VPD).

I totally misread the table.  It’s about 4,320,000 who die of VPD. Well, I said I was no damn good at stats.

And if you are doubly unlucky, you may be exposed to illness from an unvaccinated friend, family or health care worker before you can get your vaccines, and join the ranks of the ‘only’s.’  The ‘only’s’ are those who die of vaccine preventable diseases and are mentioned in anti-vaccine literature in a sentence like ‘VPD X is a mild illness in most children and only kills Y% of cases ’.  As I have said before the anti-vaxers do not care for whom the bell tolls.

I am no good at statistics.  I signed up for, and dropped, statistics at least 4 times in college.  Once they got past the bell shaped curve, it was one incomprehensible huh?  Part of the problem with statistical concepts such as risks, both relative and absolute, is that it is often impossible to get a feel from what they represent. For me it is like metric measurements.  I know what a 8 mile hike represents, but not an 8 kilometer hike.  Same with centigrade and liters.  I have been unable to internalize what metric means in my daily life. (more…)

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Quoth the anti-vaccine group SANE Vax: Beware HPV DNA in Gardasil!

Every so often, there’s a bit of misinformation that starts spreading around the Internet that shows up in enough places that our readers take notice and e-mail us about it. What happens is that these in essence become “requests.” We at SBM are, of course, happy to consider all requests and sometimes will actually take them on, particularly when doing so will be educational about the mission of this blog, namely discussing science-based medicine and providing much needed critical analysis to the pseudoscience that is, alas, becoming more and more common in medicine. A frequent topic of this blog is, not surprisingly, the anti-vaccine movement, which is arguably the most dangerous (to public health, at least) pseudoscience movement currently in existence. The misinformation about vaccines that anti-vaccine activists spread through websites, podcasts, radio, TV, and other media is protean, and it’s difficult to keep up with it all.

Which is probably why I hadn’t heard this bit of misinformation about the HPV vaccine from an anti-vaccine group I hadn’t heard of before (or at least didn’t remember) called SANE Vax. (I include the “Inc.” because SAFE Vax, Inc. itself insists on using it frequently in all its press releases.) If you’ve been in the biz a while, as I have, you can tell right away from the very name of this website exactly where its creators are coming from. Here’s a hint. It’s not the mission that the website claims that it is, which is stated thusly:
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Posted in: Science and Medicine, Vaccines

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Varicella Vaccination Program Success

One of the basic human “needs” is the desire for simplicity. We have limited cognitive resources, and when we feel overwhelmed by complexity one adaptive strategy is to simplify things in our mind. This can be useful as long as we know we are oversimplifying. Problems arise when we mistake our schematic version for reality.

In this same vein we also like our narratives to be morally simple, so there is a tendency to replace the complex shades of gray with black and white. This is perhaps related to cognitive dissonance theory. We have a hard time reconciling how someone can be both good and bad, or how a good person can do bad things. So there is also a tendency to see people as all good or all bad. We can transcend these tendencies with maturity and wisdom, but that takes work.

A good example of the desire for simple moral clarity is the anti-vaccine movement. Their world is comprised of white hats and black hats (guess which one they perceive themselves as wearing), as evidenced by the blog posts and comments over at Age of Autism. There is a certain demand for purity of thought and message that seems to be getting worse over time in a self-reinforcing subculture. Many now see their struggle in apocalyptic terms.

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On the Orwellian language and bad science of the anti-vaccine movement: “SmartVax” versus “MaxVax”?

If there’s one thing that’s true of the human race, it’s that when it comes to persuasion language is has power. Words have power. Just ask the advertising industry or politicians, who rely on their skills manipulating language to persuade for their very livelihood and authority. In the specific bailiwick of this blog, Science-Based Medicine, many of us have spent considerable verbiage describing how advocates of unscientific modalities rebranded as “complementary and alternative medicine” (CAM) and/or “integrative medicine” (IM) are incredibly skilled at the manipulation of language and renaming of terms in order to make them sound more persuasive, particularly to make it sound as though their modalities are scientifically supported or that it’s just another “alternative” to SBM. In fact, Kimball Atwood has made a special study of the language of CAM, even going so far to do an amusing feature that he used to call the Weekly Waluation of the Weasel Words of Woo. Indeed, the very name “integrative medicine” is a masterful term that makes it sound as though they’re just “integrating” the best of scientific medicine and “traditional” or “alternative” medicine when in fact what is happening all too often is the “integration” of quackery with medicine or, as I sometimes like to call it, “integrating” fake medicine with real medicine. Unfortunately, my definition of “integrative medicine” doesn’t appear to be winning, although I was gratified that I got several Tweets during our panel at TAM9 quoting my line about integrating quackery with medicine.

The anti-vaccine movement has been pretty good, albeit not as masterful as, say, Andrew Weil, when it comes to manipulating language to its own end. Who can forget three years ago, when the meme started spreading throughout the anti-vaccine movement that it’s “not anti-vaccine but rather ‘pro-safe vaccine’” and started demanding that the government and pharmaceutical companies “green our vaccines.” The reason is obvious; even anti-vaccine activists know that it’s a public relations loser to be explicitly anti-vaccine, which is Jenny McCarthy and the anti-vaccine groups that participated in her “Green Our Vaccines” rally did their best to downplay and hide their radical anti-vaccine base. They failed. (The signs about vaccines as “weapons of mass destruction” rather undercut the “pro-safe vaccine” message. I’ve dealt with this fallacy before in depth, explaining why it is appropriate to call them “anti-vaccine,” even as they strenuously deny that they are. More recently, the preferred narrative has been “too many, too soon,” which leads me to another term coined by the group SafeMinds and promoted on—where else?—Age of Autism.

Now, the SafeMinds/AoA approach is being dubbed “SmartVax.”
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Posted in: Public Health, Science and the Media, Vaccines

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Anti-vaccine propaganda in The Baltimore Sun

The hypothesis that vaccines cause autism has been about as thoroughly falsified through research as any health hypothesis can be. Even if, by bending over backward into a back-breaking contortionist pose to be “open-minded”, some people will concede that there’s still a bit of room for reasonable doubt about whether there is no link between vaccines and autism in “susceptible” populations, there is no room for reasonable doubt left over whether vaccines caused the so-called “autism-epidemic” of the last two decades. They did not. Similarly, the mercury-containing preservative thimerosal, which used to be in several childhood vaccines until the end of 2001, when thimerosal was removed from all but some flu vaccines, has been about as cleared of being a cause of autism as it is possible for a substance to be. Basically, if thimerosal-containing vaccines were a cause of autism, we would have expected to see a decrease in autism prevalence beginning three to five years after the removal of thimerosal. Epidemiological studies have failed to find such a decline and have also failed to find evidence of correlation. I realize that anti-vaccine activists argue that there are still trace amounts of thimerosal in some vaccines, but, even so, thimerosal exposure in children fell almost overnight to levels lower than the 1980s, which was before the beginning of the “autism epidemic.” At the very least, one would expect autism rates to fall back to 1980s levels if thimerosal in vaccines were a driving force behind this “epidemic.” They haven’t. Quite the contrary, they’ve continued to climb.

So why does the manufactroversy that vaccines cause autism persist? There is no longer a scientific controversy; by and large, the question has been asked and answered. Vaccines do not cause autism, as far as we can detect. True, it’s impossible to completely prove a negative hypothesis, but if there is any way that vaccines do cause autism, it’s at a level below the ability of large epidemiological studies with tens or even hundreds of thousands of children to detect. Yet the fear persists.

One reason is that it’s very hard to eradicate a false belief, once entrenched. I’ve discussed many times how difficult it is to change people’s minds, as motivated reasoning leads them to seek confirming evidence and discount all else. Disconfirming evidence can even lead people to harden their beliefs even more. In particular, the hardcore anti-vaccine activists who persist in spreading the vaccine-autism myth have an interest and motivation in this mythology at least as potent as the interest pharmaceutical companies have in defending vaccines—more so, arguably, given the emotional attachment people have for their children. After all, all pharmaceutical companies are interested in, according to this mythology, is profit. If a parent, correctly or incorrectly, somehow comes to believe that something or someone has hurt his or her child, it is among the most potent motivations known to do something about it.

Another reason is that the concept has become entrenched in our culture—or at least parts of our culture—to the point where it appears regularly in the media, thus reinforcing the idea among those who don’t pay attention to the issue or those who do but haven’t decided if they believe that vaccines cause autism that maybe there is something to fear. Maybe there is still a controversy. A perfect example appeared in The Baltimore Sun over the weekend entitled We don’t know enough about childhood vaccines and subtitled Researcher asks: Are 36 doses of vaccine by age 2 too much, too little, or just right? I contend that the editors of The Baltimore Sun, by publishing this anti-vaccine propaganda, which would have been at home on the websites of the anti-vaccine blog Age of Autism or on the website of anti-vaccine groups SafeMinds, Generation Rescue, the International Medical Council on Vaccination or the National Vaccine Information Center (NVIC). Examining this article, written by Margaret Dunkle, described as a “senior research scientist at the Department of Health Policy at George Washington University and director of the Early Identification and Intervention Collaborative for Los Angeles County” and as having “a family member who is vaccine-injured,” is what I would consider a “teachable moment” in analyzing the tactics of the anti-vaccine movement.
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Posted in: Public Health, Science and the Media, Vaccines

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Vaccine Confidence: Attitudes and Actions

Few groups are more hazardous to public health than the anti-vaccine movement — because there’s a body count affiliated with their actions. When vaccination rates drop, communicable diseases re-emerge, and people suffer. While anti-vaccine sentiment will probably persist as long as vaccines are around, we’re fortunate that vaccination rates, on balance, remain very high. In 2009, U.S. vaccination rates for most childhood vaccines were over 90%. And less than 1% are completely unvaccinated. But do high vaccination rates mean that parents have confidence in the safety and effectiveness of vaccines? Most states and provinces maintain public health regulation that require documentation of vaccination status for school or day care admission. So vaccines may be seen as a requirement or obligation which may override lingering concerns. Do concerns remain? That’s what a recent survey undertook to explore. (more…)

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Update on Josephine Briggs and the NCCAM

Dr. Gorski is in the throes of grant-writing, so I’m filling in for him today by following up on a topic introduced a few months ago. It involves a key medical player in the U.S. government: Dr. Josephine Briggs, Director of the National Center for Complementary and Alternative Medicine (NCCAM).

Background

Steve Novella and I first encountered Dr. Briggs at the 2nd Yale Research Symposium on Complementary and Integrative Medicine in March, 2010. I reported here that she seemed well-meaning and pro-science but that she also seemed naive to the political realities of her office and to much of the content of “CAM” (as illustrated by her recommending the NCCAM website, which is full of misinformation; previously I’d noticed her unfortunate innocence of “acupuncture anesthesia,” which is to be expected of most academics but not of the CAM Explicator-in-Chief).

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Posted in: Clinical Trials, Health Fraud, Herbs & Supplements, Homeopathy, Naturopathy, Politics and Regulation, Science and Medicine, Vaccines

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