Articles

I refute it thus

Reality is one honey badger. It don’t care. About you, about your thoughts, about your needs, about your beliefs. You can reject reality and substitute your own, but reality will roll on, eventually crushing you even as you refuse to dodge it. The best you can hope for is to play by reality’s rules and use them to your benefit. Combined with a little luck (nothing quite as beneficial as being a white, middle class male in the US) you might have a reasonably healthy health.

The most reliable way to understand reality is science and the scientific method. Used wisely you may have a shot at minimizing morbidity and mortality. Deny or ignore it and reality don’t care. Reality will get us all.

We all have our biases, recognized and unrecognized. I often see the world in terms of infectious diseases. When I read Team of Rivals: The Political Genius of Abraham Lincoln I enjoyed the politics and personalities but I was struck by how people constantly died young of infectious diseases. We don’t see mortality in the young anymore for a variety of reasons: better nutrition, an understanding of the pathogenesis of disease, clean water, flush toilets and vaccines.

Vaccines have helped pushed many diseases into obscurity that were once common. It has been 30 years since I graduated medical school and I have never seen a case of measles or diphtheria. I have seen one case mumps, one of polio, one of tetanus and one of German measles. And lots and lots of pertussis.

Most people have not lived in a time of plagues or remember their effects. Most people do not read history or look at the morbidity and mortality of vaccine-preventable illnesses in the third world. But the reality is that vaccine-preventable illness are still there and the barriers to prevent their return are surprisingly fragile. It doesn’t take much thinning of herd immunity to allow vaccine-preventable illnesses to come storming back. We are always skating close to the edge of infectious outbreaks and not aware of the danger. But reality don’t care if we think vaccines do not work or cause autism or that we give too many too soon. Stop vaccinations and it is not if but when we will see the infections return. We think we are safe from vaccine-preventable illness. We are not.

There have been many natural experiments that demonstrate how little it takes for infections to gain a toehold once they find a susceptible population. The current brouhaha ha ha is over the megachurch in Texas where it was de rigor to trust in God rather than vaccinations to prevent infections:

To get a vaccine would have been viewed by me and my friends and my peers as an act of fear — that you doubted God would keep you safe. . . . We simply didn’t do it

So far 21 people have developed measles, 16 of them unvaccinated (I just finished a zombie trilogy and I tend to think of the word ‘unvaccinated’ like the word ‘undead’).  Measles has not escaped into the wild. Yet. But that is not the first nor is it likely to be the last outbreak of a vaccine-preventable illness.

When I first became active in SBM I was surprised as I looked back on my education on how little emphasis was placed on vaccines. In part it is because I am an adult ID doc (who I treat, not necessarily how I behave), in part I suspect that the benefits of vaccines, like fresh water and sterile technique, were a given.

The first large outbreaks of vaccine-preventable illness in previously-vaccinated populations occurred after the collapse of the USSR. Russia made most of the vaccine and for economic and other reasons the diphtheria and other vaccine rates plummeted in the old Soviet Union as supplies fell. As a result diphtheria went ballistic, from 200 cases a year to widespread disease in only 4 years:

The diphtheria epidemic began in 1990 in the Russian Federation, spread to Ukraine in 1991, and spread to 12 of the 13 remaining NIS during 1993–1994. In 1994–1995, the peak of the epidemic,>98,000 cases and 3400 deaths were reported in the NIS.

The disease was slowly controlled in part by re-instituting the vaccine program.

I remember thinking at the time what a tragedy it was that so many children had to suffer or die from such an easily-preventable illness, but that would never happen in Oregon or the industrialized nations.

But outbreaks keep happening whenever the vaccination rates decline. Why vaccination rates fall varies from county to country and from vaccine to vaccine. Some rational, some political, some kind of wackaloon. What ever the reason, reality don’t care why the population is susceptible and infections move in.

In 1993 the MMR vaccine was withdrawn in Japan due to high rates of aseptic meningitis from the mumps component. This was followed in 1994 by removal of the vaccine requirements to attend school. The result? A marked increase vaccine-preventable illness. 11,991 cases of rubella in the first six months of 2013 with 10 cases of congenital rubella. 76% of cases were in the unvaccinated.  For comparison:

2004–2012, 79 cases of rubella and six cases of CRS were reported in the United States; all of the cases were import-associated or from unknown sources.

Part of the reason the epidemic spread is that the Japanese only vaccinated females, so males have been a vector to allow the spread of disease. Not trying for herd immunity, they lost the ability to control the spread of infection. The only case of rubella I have seen was in 1999 when I visited a friend who lived in Tokyo who became ill with rubella the day I landed.

In 2007 to 2008 the Japanese had 27,000 cases of measles and they are trying to play catch-up with the vaccine. In 2012 the US had 222 cases of measles, 90% of which were imported and often occurred, like Texas, in communities with low or nonexistent vaccination rates.

Similar problems are occurring in Europe. There have been thousands of cases of measles, mumps and rubella that followed the decline in vaccination rates, with at least 78% of the measles cases in the unvaccinated.

Poland, Chile, Argentina, and Brazil, following the Japanese example of avoiding herd immunity, targeted only females for rubella vaccination and outbreaks continue in the male population, jumping to females with resultant cases of congenital rubella.

Nigeria, for complex reasons, including the belief that vaccines were being used to sterilize children, boycotted the polio vaccine. Reality don’t care why there was no immunity to polio and polio came back.

In the US most outbreaks of vaccine-preventable illness have been focused in communities, like the congregation in Texas, where vaccine-induced immunity has declined. The main exception is pertussis where the current acellular vaccine is not as effective as the older vaccine, although it has fewer complications.

Do you see a consistent pattern? Vaccinations are protective and when individuals are not vaccinated their risk for vaccine-preventable illness increases. When enough individuals are no longer immune, communities are have outbreaks. If you are not immune, for whatever reason, reality don’t care. If exposed you will likely get infected and pass it on.

I tend to be a booster of all things Oregon. It is almost the perfect place to live. Almost. Oregon does lead the US in unvaccinated children at 6.4%. Go Oregon. When you add to that the number of those who do not respond the the vaccine, I would bet the at-risk population is greater than 10%, although the unvaccinated tend to cluster in pockets i.e. schools, perhaps increasing the risk for disease amplification in the community. Diseases don’t care what granfalloon you are a member of. It may get a jumpstart in a group of the unvaccinated but it will not be contained there.

Infectious diseases, as I have mentioned in the past, is similar to birding, except that it is actually interesting. I have a life list, those infections I have seen or expect to see in my career. I had never expected to see a case of measles or diphtheria or rubella or mumps. This is probably about to change.

Every time I walk the rat warrens of Chicago O’Hare or similar hub I think “what an excellent place to spread measles, rubella, smallpox or the contagion that brings on the zombie apocalypse“. All the vaccine-preventable infections are a red-eye flight away from the US. It is small world with fragile defenses against infections, a thin red line of immunoglobulins.

The number of unvaccinated are creeping up in the US and in the formerly-great state of Oregon and with it the potential for more outbreaks. And it is not if. It is when. Reality don’t care.


http://www.samueljohnson.com/refutati.html

Posted in: Epidemiology, Public Health, Science and Medicine, Vaccines

Leave a Comment (526) ↓

526 thoughts on “I refute it thus

  1. duggansc says:

    Thank goodness that the military still requires complete vaccination. Could you imagine some podunk terrorist group taking out entire military bases by the virtue of sending a few itchy tourists through to sneeze on doorknobs?

  2. Bobby Hannum says:

    Somewhat related to this post, though mostly tangential: the anti-science trolls have come out of the woodwork this morning on the SBM Facebook group. If anyone has time, it might help balance the force to respond to their nonsense…if you can figure out what they’re actually saying.

    1. Egstra says:

      Sorry – I gave up on the facebook page some time ago. The anti-science trolls were bad enough, but the organization of the page simply defeated me.

      1. Bobby Hannum says:

        Oh…how so?

  3. windriven says:

    “and spread to 12 of the 13 remaining NIS”

    NIS = Newly Independent States.

    “[Oregon] is almost the perfect place to live.” Many of the best restaurants west of the Mississippi, Beervana, No Pro Football Team*, outdoors paradise, home of the last great independent bookstore**, generally literate and engaged populace. The only downsides are lots of pinot noir***, pretty high income taxes****, and a political culture along the coast that makes San Francisco look pretty moderate ;-)

    *I’m sorry but grown men playing childrens’ games for stupid amounts of money while turning their brains into Chobani is idiotic. Hurrah for bread and circuses!
    **Powell’s City of Books – two main buildings, one covering most of a city block. The other devoted entirely to technical books. But Michael Powell is unmarried and, to the best of my knowledge, has no heirs. And the business climate for booksellers is bleak. Shop now.
    ***Pinot noir grows well in the PNW. But to my palate the land would be put to better use growing butter beans. Pinot noir: wine for those who don’t really like wine.
    ****Fairly high income taxes but no sales tax. Oregon takes liberalism seriously (occasionally to a fault) and that is reflected in their progressive approach to taxation.

    1. WilliamLawrenceUtridge says:

      I notice no mention of fluoridation in your discussion :P

      Though of all the woos, antifluoridation is generally an insult to the intellect only. It’s pretty low-harm, healthwise.

      1. stanmrak says:

        Fluoride is fine as long as you don’t mind growing up dimwitted!

        http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3491930/

        1. WilliamLawrenceUtridge says:

          Wow, that does sound like a problem. In that study, to determine “high fluoride”, their cut-off is roughly, what, 4mg/L, or 4ppm? Yup, that’s a lot of fluoride. Man, that would seem to be a big problem. Particularly considering the level of fluoridation recommended in order to reduce cavities is 10 ppm…oh, hold on, no it’s not. It’s a maximum of 1ppm. In fact, communities with fluoride levels over 1ppm in the first world would actually remove fluoride, because scientists (unlike you, you deceptive troll) understand that the dose makes the poison. Did you notice the crucial table in which every single study included was performed in China, Mongolia or Iran? That’s because you can’t find fluoride levels that high in the first world.

          So the real point of the meta-analysis you cite is not “fluoride makes you stupid”, the real point is “four times the maximum safe dose of fluoride makes you stupid”. Stan, that’s akin to not being able to tell the difference between having a cool, refreshing drink of water, versus drinking a litre of it.

          You are either stupid, or you are a deliberate, conscious, and malicious liar, in the same boat as creationists, climate change deniers and birthers. Enjoy your company, you can probably win a lot of arguments with peers like these.

          1. Jinzang says:

            Four times the recommended dose is not an adequate safety margin for a chemical added to the water supply.

          2. Chris says:

            jingzang:

            Four times the recommended dose is not an adequate safety margin for a chemical added to the water supply.

            Citation needed.

          3. Chris says:

            From Jinzang’s weblink:

            I maintain the web site of the Baltimore Homeopathic Study Group, an associated study group of the National Center for Homeopathy.

            Success that request for the citation to your comment!

          4. Chris says:

            Oh, crud, I wondered why the spell corrector did not alert me. I had used a real word.

            I meant to say “Succuss that request for the citation to your comment!”

        2. windriven says:

          “Fluoride is fine as long as you don’t mind growing up dimwitted”

          Gee, I’m so sorry stanmrak. How did you come to overdose?

      2. And Portland, Oregon is the city that recently rescinded a much belated effort to finally fluoridate the water, by referendum (let the people be heard!) :-((

      3. windriven says:

        @WLU

        I said literate and engaged, not bright. :-)

        1. WilliamLawrenceUtridge says:

          Truth be told, fluoridation is one of the issues I can’t get too upset over. Yes, it’s safe and effective. Yes, it best helps the least able to afford dentistry. But there is now a lot of fluoride in other sources, particularly toothpaste, to the point that even dentists are starting to say there is less and less reason to include it in the water supply. It’s still irksome to see quacks and loons pulling out the idiocy that stan regularly slaps down like a pus-covered rotten banana peel as if it justified their lunacy. It’s annoying to see the populace at large rejecting it due to chemophobia, scientific illiteracy and distrust of doctors and dentists (are dentists doctors?), but frankly I’d rather the efforts of scientific leaders be directed at vaccination.

    2. I’m with you on all the *’s, especially wine and football. Only**** isn’t so bad–the taxes are much higher (state income, property and sales) in Wisconsin, for example, and there are no mountains or ocean (a nice huge lake, though), but luckily we are getting back to our (German) beer roots. :-)

      1. windriven says:

        @irene

        I didn’t mean to suggest that the taxes there are astronomical, only higher than in WA. People decide what level of state services they want; taxes are what pays for those services. The Swedes and Danes have very high tax rates but most of their citizens are happy with the value proposition.

    3. mcrislip says:

      I agree with the Pinot Noir comment. It is the Kool-Aid of reds. Also, for our 27th anniversary we are going to try Navarre sometime this weekend in part on your comment once upon a time. See? We listen here at SBM. But if I get noro….
      And I always seem to go into moderation and I am an editor. Dr. Gorski still doesn’t trust me :)

      1. windriven says:

        I really hope you enjoy Navarre. If it disappoints, dinner is on me.

      2. Chris says:

        Well I guess that explains why the French dad of a friend served it to us for her 21st birthday. It is was gateway wine for all of us. The next one was “chablis.” Okay it was over thirty years ago, and I don’t even remember what Pinot Noir tastes like!

        Though some is apparently arriving tomorrow as part of a wine club shipment from a Chelan winery. It is about half the price of the Merlot that is included.

        At least Chelan is at the same latitude of the middle of France. Oregon is more Spain and southern France. Yes, I am sitting next to a globe.

    4. Ray says:

      Back in the day (’80s) we would travel to Eugene with our track athletes from Langley, BC. Graffiti spray-painted on a highway overpass: “Welcome to Eugene” made me smile.

  4. Firstly, I think my family who prides themselves on being literary would scoff (or disown me, if they could) at me for my shallow taste, but I love zombie movies and books. Sadly, I don’t have much tolerance for violence, so I can’t sample all the selection. But my favorites, Shaun of the Dead, Warm Bodies and I just recently finish a zombie/dystopia/romance book called Reboot by Amy Tintera that was fun.

    Secondly, I was actually kinda shocked that 6.4% was leading the national unvaccinated rate. To me (a layman) that seems pretty low. Humans are so very bad at doing the stuff they should do to prevent long term harm. I swear to God, if we didn’t turn blue and faint when we stopped breathing, some people would abstain from that.

    It seems to me, that human nature and our evolved tendency to under estimates threats that are not immediately – well theatening, is just as much a factual inevitability as the spread of disease. If we need people to change their behavior, we have to figure out which strategies are most effective in insuring that change.

    There you go. You guys are the scientists…should be easy enough to figure that one out. ;)

    Thirdly, Windriven – I’m a fan of a good Pinot Noir AND wine. My definition of a good Pinot Noir is one that smells green like freshly mown grass. It’s like a mouthful of summer. That is just the best experience, IMO. Sadly, it’s hard to find one like that in my typical price range Also, red wine is one of the things that make my face red and itchy, so it really has to be good to be worth the risk of that unpleasantness.

    1. windriven says:

      @mouse

      I’d like to introduce you to a good Barolo or Meritage or Cotes du Rhone. That said, the biggest problem with pinots is that everybody out here grows the grape and smooshes it into wine-like fluid. I have had a few deep and interesting pinots but the memory fades under the tsunami of overpriced vin ordinaire.

    2. windriven says:

      Seriously, judging by your description you should try one of the better Chenin Blancs. Many of the South African Chenin Blancs deliver that ‘mouthful of summer’ without the issue of being red.

      1. I’m writing that down, Windriven. That sounds fabulous, Thanks!

    3. Ken Phelps says:

      You must watch the movie “Sideways” ( Paul Giamatti, Thomas Haden Church, Virginia Madsen ). It’s about a Pinot-driven road trip and well worth the time.

  5. Kathy says:

    I wonder what the antivaxxers’ response will be when (again, not if!) some really serious plague evolves and spreads? We’ve had a few shots across the bows but have so far not had any 21st century equivalent of the Black Death. I bet when it comes the once-true-believers will be the first to storm the hospitals and doctor’s offices, demanding that they be protected and wanting to know why the government isn’t doing more to develop/grow more vaccine.

    1. windriven says:

      “I wonder what the antivaxxers’ response will be when (again, not if!) some really serious plague evolves and spreads? ”

      It will be that BigPharma manufactured the epidemic to sell more drugs. Also that doctors are money-grubbing lice with lousy bedside manner and that all would be right if naturopaths controlled public health.

      Just sayin’.

    2. WilliamLawrenceUtridge says:

      I wonder what the antivaxxers’ response will be when (again, not if!) some really serious plague evolves and spreads?

      To occupy the overlapping area of two circles – memetic and genetic evolution?

  6. Gerardo says:

    Just one little correction (not so pedantic I hope), the name of the country is Chile, not chili which is a delicious food of tex-mex invention :P

    Have a ncie day

  7. Jay Gordon says:

    Mark, they have measles.

    Not the plague, not glioblastomas, not ebola.

    Measles.

    And 1/4 of the patients were vaccinated.

    I do agree that these types of religious fanatics are dangerous. Just not deserving of millions of words on the Internet.

    1. Chris says:

      Tell that to Ophelia Dahl. I am sure she will campaign Partners in Health to suspend all vaccinations in Haiti. Though I am sure she will not do in memory of her oldest sister.

    2. WilliamLawrenceUtridge says:

      So what if it’s “just measles”? Even if it’s fatality rate were lower than the roughly 3/1,000 that’s still 3/1,000 that deaths that can be prevented 95-99% of the time. Of course, that’s only in the first, well-nourished world, in the third world it’s more like 300/1,000, but who gives a fuck about poor babies, right Dr. Jay? So long as we respect people who think God will protect them, despite God not giving a shit about all the Christians who died before the invention of vaccination, right?

      Dr. Jay, what’s an acceptable number of preventable deaths, how many people can die unnecessarily before it’s a blip in your radar? If it’s just, say, 10 people who die from a vaccine-preventable disease, that’s OK? Or is it 100? Maybe 1,000? Or does it not matter as long as it’s not your kid, or grandkid, or one of your patient’s kids?

      Do you know what’s more unnerving to me than religious fanatics? Pediatricians who don’t support vaccination.

      3/1,000 is about 900,000 deaths in the US, with a population of 300,000,000. Is 900,000 preventable deaths enough? What about 21,000,000, that’s 3/1,000 for the world’s 6 billion people. Is that enough bodies for you support vaccination? Now, that’s assuming people are well-nourished with access to first-world health care, we can increase those figures by probably 5 if we account for third world countries. But let’s stick with twenty-one million people, dead because you can’t be arsed to change your mind. How many dumpsters would all those dead bodies fill Dr. Jay? How many swimming pools of dead babies would it take for you to whole-heartedly support vaccination for something with a fatality rate of “just” 0.3%?

    3. lilady says:

      Wow, just wow…Dr. Jay. Are there vaccines to prevent the plague, glioblastomas and Ebola virus?

      When are you going to restore your “Links” section about vaccine-preventable-diseases with links to the CDC, the California Department of Public Health and the AAP, rather than your whale.to references?

    4. Carl says:

      Oh boy are you a short-sighted one. Yeah, just measles. And what next? It’s not like they carefully chose to get measles and nothing else.

      And why exactly do you note that 1/4 were vaccinated?

    5. Alia says:

      Yup, it’s just measles. My mother (who was born before the times of universal vaccination and got only the ones mandated at her workplace, which probably did not include MMR) caught it when she was 60+ and we were all worried about her. Fortunately, I didn’t catch it from her, because it would mean several weeks out of work in the busy period of exams (and at that time I was the only certified examiner at my school).

      And then there’s “it’s only varicella”. Last year we had an outbreak at my school (students ages 16-20, varicella vaccine is not mandated over here and quite expensive). Several students were affected and 1 month out of school when you are preparing for your final exams can be a huge problem, don’t you think? But the person most affected was our deputy head teacher, in her 40s, we were seriously worried about her.

    6. AnObservingParty says:

      Measles, perhaps, for you or I.

      But what about the 4 month old? Risk of complication or not, I shudder at the thought of a 4 month old needlessly ill with a preventable illness, not least of which one that can cause SSPE. I’m shocked, as a pediatrician, you wouldn’t too.

      But, since you bring up glioblastoma, what if a member of that church was undergoing treatment for a glioblastoma? Or any other cancer? It may not just be measles for them.

      Or for the ones who develop pneumonia. Or the “benign” ear infections. Even if they are benign, I will state as an adult who continues to suffer chronic ear infections, I wouldn’t risk even the most benign one on my worst enemy. Well, maybe my worst enemy. But I remember the misery of them from when I was a child not too long ago, the misery until my ear drum finally ruptured. Then not being able to hear for weeks after. I still don’t hear well out of my right ear. And surely you know, not all measles-related ear infections are as benign as that. Some do result in deafness. My best friend is deaf, from a preventable illness. Granted, she’s deaf because she suffered from N. meningitis when she was 16. Do you “support” that vaccine?

      I don’t care what it is, your flippant attitude over something that has a mortality rate of 1/1000 is disgusting. That’s not just a number, you know, it’s a human life. Usually a child, but perhaps the like of an immunocompromised individual. Somebody with asthma or another comorbidity. Or maybe it was just someone who drew the short straw. A doctor of all people should know and respect that.

      I’ve read further below, so I know this has been mentioned but I feel it bears repeating: your comparison to plague is nothing short of ridiculous, being 1) it can be easily treated with antibiotics, and 2) usually isn’t airborne (save pneumonic). Like measles. No amount of cleanliness will protect one from measles. But again, you should know this.

      You may be willing to be flippant about it with yourself and your patients, but do you not realize that you’re also being flippant about it with others who may not come through it after a week of fevers and rash? They do deserve a million, and more, words.

      I think it bears repeating, vaccination isn’t to protect yourself. It’s to protect the people around you.

    7. Nathan says:

      The fact that 1/4 of the patients were vaccinated is a huge part of the problem. If the other 3/4 had been vaccinated, the likelihood is that *no one* would have gotten measles. Because so many people weren’t though, there was a local outbreak, which affected even those people who had taken the vaccine but did not respond to it. Achieving herd immunity – as described in the post – solves the problem of vaccines not being 100% effective, but it only works if the majority of people get vaccinated.

  8. Todd W. says:

    @Jay Gordon

    Not the plague

    Interesting choice of comparison. You see, measles is actually quite a bit worse than the plague, since plague can be easily treated with antibiotics and is not airborne. Measles, on the other hand, is much more easily transmitted and cannot be treated (other than trying to make the patient comfortable).

    Measles also has significant risks associated with it, your protestations that it’s nothing to worry about notwithstanding. For example, roughly 33% of patients will have one or more complications, the most common being diarrhea, ear infection and pneumonia. There is also (medically speaking) a rather decent chance of something more serious, like a 1 in 1,000 chance of encephalitis, seizures or death. And then there is the, thankfully, rare risk of SSPE, in which the patient appears to recover just fine, but then, anywhere from weeks to years later, slowly deteriorates as the virus destroys their neurons, eventually killing them.

    It truly amazes me that, despite so many outbreaks and demonstrations that measles is nothing to sneeze at, you still take the flippant “Oh, it’s just measles” attitude.

    1. elburto says:

      Yeah but Todd, aren’t you forgetting something? Repeat the anti-vax credo after me:

      ‘Tis better to be dead than disabled or defective

      Transplant recipients, cancer patients, people with illnesses or disabilities that compromise their immune systems, new babies, the elderly – so what if measles thins out their numbers a bit? As long as the moneyed worried-well are fine, and as long as their children aren’t made impure by vaccination, then all’s right with the world!

      It’s not as if those children could be carriers, or get a mild case of it and infect say.., a doctor’s waiting room, a place full of sick people, old people, infants going for Well Baby visits,

      If only there was some sort of resource comparing the relative risks of the vaccinations to the VPDs they’re meant to prevent…

      http://www.cdc.gov/vaccines/vac-gen/6mishome.htm#risk

  9. Jay Gordon says:

    Hi Todd–

    No I didn’t say, “Oh, it’s just measles,” but it’s just not worth millions of words.

    1. windriven says:

      No, it isn’t worth millions of words. But it is worth millions of vaccinations.

    2. David Gorski says:

      No I didn’t say, “Oh, it’s just measles,” but it’s just not worth millions of words.

      It’s a good thing that Dr. Crislip only used 1,443 words, then, isn’t it? (That’s actually probably about half or two-thirds the length of a typical Crislip post, BTW.)

    3. MadisonMD says:

      JG: Are you for real? I for one would GLADLY write a million words to save one life. Why do you put such a low value on life? Are you really a physician?

    4. Todd W. says:

      Jay,

      True, you did not write the words “It’s just measles”, but you most certainly implied it. Your attitude, as I said, is flippant.

  10. lizditz says:

    Excellent post as always Dr. C.

    Hey, there’s good news for reducing vaccine preventable disease in Oregon!

    Oregon’s vaccine exemption law strengthened

    ” A new law signed by Oregon’s governor Wednesday will make it more difficult for parents to enroll unvaccinated children in school.

    Parents who decline vaccines for their kids will have to visit a doctor or prove they watched an educational video before sending the children to school or daycare, under the new requirement that goes into effect immediately. Previously, parents could seek nonmedical exceptions by signing a form and citing a religion or system of beliefs.

    California passed a similar law which takes effect in January 2014, so we won’t be able to gauge the effect until California publishes the vaccine uptake statistics sometime in the spring of 2015.

    California’s law was so lax that all a parent had to do was sign an affidavit (pre-printed on the school vaccination record) that they had a philosophical objection to vaccination.

    Surprise! Jay Gordon MD opposed the bill.

  11. Chris Hickie says:

    If it’s “just measles”, I’d like to see him inoculate himself with it just to show us how measles isn’t dangerous.

  12. calliarcale says:

    Y’know, Jay, we do in fact have bubonic plague in the US, and as Todd pointed out, its fatality rate with modern antibiotics is very low. The fact that it’s spread by fleas helps immensely; control the fleas (or the rodents they live on) and you control the pathogen. That’s always the way — if you can control the vector, the disease becomes no issue.

    With measles, the vector is humans. Only humans. To control the vector, then, we must render as many potential carriers as possible immune to the virus. And for measles, the only realistic way to do that is vaccination.

    It is true that 1/4 of the patients who caught measles had received at least partial vaccination at some point in their lives. Given that likely at least 90% of the congregation had been fully vaccinated, don’t you think that’s remarkable? That less than 10% of the population could represent over 75% of the cases?

    1. lilady says:

      I couldn’t find a reference to your statement that 1/4 of the measles patients had received at least one vaccine…could you provide it? Thanks

  13. jay gordon says:

    Hi Calli–I don’t have a problem with measles vaccination. I did once, but I’ve drifted in Orac’s orbit and I think that people who vaccinate late (after age two years) and slowly (one vaccine at a time) are minimizing risk and shouldn’t be terrified of vaccines. We’ve had a miserable year at our house for itchy dogs including the discovery of fleas on our two little canines yesterday. We’ll do non-toxic flea control and yell at the rats who try to invade our neighborhood. As the next couple years go by, we’ll gain more evidence that some kids with genetic susceptibility have diseases triggered by vaccines. .1%? 1%?? I don’t know. Neither does anyone else, by the way. And, of course, unvaccinated kids will get measles at a much higher rate than vaccinated kids. I didn’t realize that the vaccination rate in that church was so high. Thanks for telling me.

    Hi Chris–I had measles before you were born and was exposed dozens of times during med school and residency. My blood is probably a commercially viable anti-infectious fluid without being spun and pooled.

    Hi Liz–I also contributed to Dr. Pan’s re-election campaign (!!) because I think he’s a good-hearted man and I’d like more pediatricians in our legislatures. Between the unpredictable ACA implications for primary care docs and AB2109, I have no idea what will happen to my private pediatric practice in 2014. If parents really meet the stiff opposition that peds say they’re planning, I’ll need a bigger office to accommodate those thrown out of those practices. I think that most docs will cave and sign because they don’t want to lose business.

    1. calliarcale says:

      Actually, I’m giving the benefit of the doubt with the 90% rate. It has to be lower than the 95% required for herd immunity, or they wouldn’t have a pocket of problems, and it must not be too far below that or the problem would be worse than it is. I suspect most of the adults are vaccinated, having gone through that many years ago, before this church was even founded, so it would only be the youngest members who are likely to be unvaccinated. (Hmm. I just realized in my SWAG, I wasn’t considering those too young to have been vaccinated.)

      “I think that people who vaccinate late (after age two years) and slowly (one vaccine at a time) are minimizing risk and shouldn’t be terrified of vaccines.”

      How do you figure that’s minimizing risk? As far as I can tell, it doesn’t make the vaccines any safer; it just increases the duration of vulnerability.

    2. Chris says:

      So what? You survived. Obviously it is all about you and your experience. Before the 1960s between 400 to 600 Americans died from measles, and thousands more were permanently disabled.

      Obviously you have no idea why Olivia Dahl cannot say the same as you. She was born just a couple of years older than me.

    3. DrDuran says:

      Dr. Jay

      ” As the next couple years go by, we’ll gain more evidence that some kids with genetic susceptibility have diseases triggered by vaccines.’

      You’re psychic now? How could you possibly know that “we” will find out diseases triggered by vaccines? Oh, I forgot, you’re the All Knowing Know It All™!

      Again I’ll say to you the same thing I did in RI when you opined about Laser Eye Surgery:

      Fuck You Dr. Jay.

  14. jay gordon says:

    I have a question: I posted, refreshed and saw that my post was “awaiting moderation” and now the post is gone completely. Please enlighten me about the workings of this blog.

    Thanks

    1. calliarcale says:

      That means it’s in the moderation queue and will appear once a moderator has approved it. It happens to me from time to time to, depending on whatever algorithm the software uses to decide a post needs personal attention.

    2. WilliamLawrenceUtridge says:

      It’s messed up. The mods, editors and commenters have stated this repeatedly. Callia has repeatedly stated that her (his?) posts always go into moderation no matter their content. You aren’t being censored, you’ll just have to wait for it to show up.

      I think that people who vaccinate late (after age two years) and slowly (one vaccine at a time) are minimizing risk and shouldn’t be terrified of vaccines.

      On what basis do you think this? Why do you think this, when the experts on pediatric immunity who put together the conventional vaccination schedule find no such reason for concern? How did you, a lone, practicing pediatrician, manage to arrive at such a dramatic conclusion so at odds with the group of full-time academic experts responsible for the current vaccine schedule?

      1. That’s an excellent question and I hope Dr. Jay has a thoughtful answer.

        1. WilliamLawrenceUtridge says:

          Sadly, that’s the very definition of false hope. I don’t believe Dr. Jay has ever responded to this or similar questions, despite me asking it multiple times.

      2. elburto says:

        Y’know what’s funny WLU? That a doctor allied with a movement fond of shrieking about how science-based paediatricians and vaccine manufacturers are “Moneygrabbing shills” who like to “torture babies”, is now advocating for one vaccination per office visit.

        So the doctor gets to bill for however many more office visits, and the toddlers get to experience multiple traumatic office visits over a period of months (years?).

        The irony is fuc|<ing delicious.

        Of course parents will have no problems at all paying for multiple appointments, multiple journeys to/from the appointments, time off work, someone to watch their other children, etc. Then again, who cares what happens to poor kids, eh? As long as the privileged children of the Muesli Mummy set are okay then that's all that really matters, no?

    3. windriven says:

      Don’t feel alone. I commented suggesting a commenters’ wall of shame in these pages complete with a plan to make it an educational tool as well as a forum for humiliating the most bone-headed commenters. But POOF!

      Someday in a galaxy far, far away some intelligence will read these errant missives – yours and mine and all the rest – and they’ll say, “small wonder their species died out!”

    4. OY! That happens to mine too. Everything of mine goes through moderation. I’ve found that generally if you get an “into moderation” message the post will appear at some point, even if it goes through a disappeared phase. If you don’t get that message and it disappears, start typing, cause it’s gone daddy gone.

      I try to think of it as an exercise in acceptance, serenity prayer and all that.

    5. Chris says:

      Some of us are in permanent moderation. I posted a comment to you ‘September 6, 2013 at 7:29 pm”… apparently EDT. It is now 9:17 PDT (12:17 EDT, on Sept. 7th), and it is still showing “In moderation.” I have learned to be patient.

    6. David Gorski says:

      We’ve been having technical difficulties today. I have approved all comments that were in moderation during the several hours involved, including yours.

  15. Lucario says:

    Didn’t know you were a Civil War buff, Mr. Crislip. Join the club ^_^.

    Anyway, that’s one of the things that strikes me the most about life back in those times: not only could infectious diseases strike you down at a young age (and indeed, killed more soldiers during the Civil War than bullets), easily-treatable or preventable diseases like heart disease could strike you down before your Biblically-alotted threescore and ten.

    Makes me thank the DOYC for the miracle that is modern medicine – and makes me shame those all the more who would deny children vaccinations.

  16. Rob Cordes, DO says:

    21 developed measles, 16 not immunized – what do we know of the other 5? Full, partial or unknown immunization status?

    I was just in Oregon a month ago. Columbia River Gorge and a little bit of Portland. I did not know about the book store or I could have gone there while my wife & kids stood and an insanely long line at Voodoo Donuts. While I do not like beer nor Pinot Noir Oregon is the second place I’ve visited that I thought “I could live here”. (Maui the other) Public electric car chargers ! Oregon just needs a full season minor league baseball team. Sounds like as a pediatrician who does immunization education I could find a job.

    I have seen one case of measles (med school 1990 Philadelphia) far too much pertussis and far too much meningococcus (only a handful but ever patient either seized , died or both)

    1. windriven says:

      Yeah but you have to do Voodoo donuts. Just don’t touch anything! The donuts are, I’m sure, fine but the public side of the counter is a microbiology experiment gone rogue.

    2. enkidu says:

      “I have seen one case of measles (med school 1990 Philadelphia)”

      My sister had measles in Philly in 1990. She was 13 years old and missed almost a month of school. She told me at the time she wanted to die, she was so sick. This was before the recommended measles booster so we both only had a shot at 1 year old. Mine was good enough to protect me, hers not. We have no idea how she was exposed. (I got a booster once she was diagnosed)

  17. Chris Hickie says:

    Hi Jay,

    I’d like to thank you for helping to add to the two cases of pertussis in the school district in which my practice is smack in the middle of. It sounds like neither was vaccinated and I’m sure they’ll thank you and Dr. Bob for this, maybe with a lawsuit if there is any justice for your idiocy.

  18. jay gordon says:

    Chris–Very illogical statement.

    If you have all the facts at hand, and I believe you do, why were you and your local colleagues unable to convince parents to vaccinate their children? Because of two doctors in California expressing ambivalence and even opposition to giving six vaccines to a six-week-old??

    I have supported countless hundreds of parents in their eventual decision that the DTaP is safe and effective even when they initially planned on giving their children no vaccines at all! You and your local colleagues can’t do this? Strange, Dr. Hickie, very strange.

    1. WilliamLawrenceUtridge says:

      why were you and your local colleagues unable to convince parents to vaccinate their children? Because of two doctors in California expressing ambivalence and even opposition to giving six vaccines to a six-week-old??

      Yes. At least in part because pediatricians like you refuse to admit you were wrong and that there is little reason to believe vaccines present substantial unappreciated risks. “Celebrity” doctors carry far more weight in the public imagination, and thus far more blame, than the thousands of PhD researchers who clearly and unambiguously summarize the rather unequivocal nature of the scientific literature. Your hedging, your “too many, too soon” and your unscientific support for parental fears is indeed a source of many difficulties for pediatricians. Consider repudiating it.

      I have supported countless hundreds of parents in their eventual decision that the DTaP is safe and effective even when they initially planned on giving their children no vaccines at all!

      How are you doing with convincing your patients to get MMR? Why not come out publicly in favour of all vaccines and the CDC vaccination schedule? Why not be the Mark Lynas of the antivaccination movement? Why not publicly admit you were wrong and that there’s no reason to fear vaccines?

      You and your local colleagues can’t do this? Strange, Dr. Hickie, very strange.

      Do you spend a lot of time pandering to your patients’ fears about vaccines?

    2. David Gorski says:

      I have supported countless hundreds of parents in their eventual decision that the DTaP is safe and effective even when they initially planned on giving their children no vaccines at all! You and your local colleagues can’t do this? Strange, Dr. Hickie, very strange.

      That’s a mighty strange choice of words, there Dr. Jay. You say you “supported” the parents in their “eventual decision”? You didn’t persuade them or counsel them that the DTaP is safe and effective? Your choice of wording suggests to me that you didn’t actually have any role in these parents coming around to the right choice with respect to DTaP for their children. This is of a piece with your previous statements on another blog years ago that you “supported” parents who wanted to vaccinate. To me, there seems to be an implication that you only reluctantly gave the vaccines.

      In general, doctors usually say they “support” a patient in their decision when they disagree with the decision the patient is making (or are at least quite unenthusiastic about it). Otherwise, they say something like they “counseled” or “persuaded” the patient to undertake appropriate treatment. For instance, when a woman wants a mastectomy for a tiny breast cancer, I will eventually support that decision—but only after I’ve tried to talk the woman out of it, because I hate to remove a whole breast when it’s so obviously not medically necessary. However, since medically it’s still not wrong to do a mastectomy for a small tumor (just old-fashioned), I will support such patients once I’m sure that a mastectomy is really what they want.

    3. cphickie says:

      You two f***heads (you and Sears) who don’t deserve to be called pediatricians have literally poisoned the well for immunization in the US. Your counseling is BS. You happily go on TV to tell parents not to vaccinated their children until they are 4-5 years old in the face of a measles outbreak just to the north of you and you have the atrophied testicles to act like you are not to blame in the least? That is flipping incredible. Parents who mean well see you online and on the air tell them all sorts of lies about vaccines and because you are a pediatrician, they believe you, especially since the d**kless coward who run the AAP don’t have the balls to call you out for the frauds you are. Your eventual demise will come in the form of a lawsuit by a parent who followed your medical advice and had a child get hurt or die from a vaccine preventable disease. The only part that will sadden me when I see your *ss get hung out to dry is that kids had to get hurt or die to make it happen.

      I will spend up to 40 minutes beyond a 20 minute well check trying to convince parents to vaccinate, but they believe as*wipes like you because you get tv time and no one bigger than you will oppose you publicly like they need to. But you know what Jay? I’m done with parents who are fooled by your narcissistic money grubbing schtick. My practice is in the process of telling the nonvaccinating parents to either vaccinate or go elsewhere. It is not worth seeing a baby in my waiting room get measles or pertussis because some older patient of mine has parents who won’t vaccinate. The AAP is full of crap on this when they tell me not to kick out those nonvaccinating parents but then won’t go to bat for me and kick your sorry butt publicly out of the AAP. So screw both you and the morons running the AAP.

      Your are damn well at fault for this, Gordon. It’s too bad you don’t have the guts to fess up about how stupidly wrong you are about this, but that’s who you are, as we all know (again, I’ll give Sears credit for being smart enough to shut his gob, whereas you are like a 3 year old who just can’t stop talking).

      Go to hell, Gordon. That’s where you belong.

  19. lilady says:

    There’s a recurring theme here that “one-quarter” of the confirmed 21 measles cases that have been reported, are individuals who were vaccinated against measles. According to Dr. Crislip’s link, that is not so:

    http://www.washingtonpost.com/national/measles-cases-put-texas-megachurch-under-scrutiny/2013/08/31/6dfa8e1e-128a-11e3-bdf6-e4fc677d94a1_story.html

    “…Of the 21 people who contracted measles linked to the church, 16 were unvaccinated. The others may have had at least one vaccination but had no documentation…”

    So Dr. Jay, when are you going to provide links to the CDC, the California Department of Public Health and the AAP, instead of whale.to and mercola.com on your website, for your patients to get reliable information about childhood vaccines?

  20. Chris says:

    Dr. Jay:

    I did once, but I’ve drifted in Orac’s orbit and I think that people who vaccinate late (after age two years) and slowly (one vaccine at a time) are minimizing risk and shouldn’t be terrified of vaccines.

    How are they minimizing risk from pertussis, tetanus (yes, 18 month old kids encounter dirt and rusty nails!), measles, rotavirus, HepB, Hib, etc. They still live in the community. Some are even in group daycare situations where as toddlers they interact with the fluids of other toddlers (Hib, rotavirus, pertussis, measles, HepB, etc).

    I really hope you are saying they should not be afraid of vaccines, and are actively encouraging the parents to protect their kids!

    1. nancy brownlee says:

      Rusty nails?

      1. Chris says:

        Yes. Back when I was a kid we were told we would get lock jaw from rusty nails. Actually tetanus is in the environment, and toddlers do encounter dire, bugs, sticks and even rusty nails. It is even documented, in Philosophic Objection to Vaccination as a Risk for Tetanus Among Children Younger Than 15 Years is this table.

        Take note that at least a couple of rusty nails, and there is even a bug bite.

        1. nancy brownlee says:

          I do understand that tetanus is a feces/urine-borne bacterial disease. We were told the same thing about tetanus and rusty nails- about 60 years ago. I do regularly encounter adults who still believe it. Some of them still believe it after I explaine about Gram-positive bacteria and the horse I saw in spasm who developed the disease after multiple punctures from a barbed wire fence. I just thought it odd to see the myth referenced on SBM.

          1. Chris says:

            Except, it is not really a “myth” if it actually happens, as the paper I posted shows. Other bit of trivia is that Henry David Thoreau’s brother, John, died of tetanus after cutting himself shaving. Why should not believe getting cuts from nails, etc. cannot cause tetanus? I know it is not the rust, but the reason that it could be rusty.

            The point I was trying to make was that eighteen months old toddlers do move, and get around, may encounter many pathogens. This kind of flies in the face of his rather idiotic remark “I think that people who vaccinate late (after age two years) and slowly (one vaccine at a time) are minimizing risk and shouldn’t be terrified of vaccines.”

            His remark was only slightly saner than “Why should I let the child walk on the dirt when there is a dry concrete pavement next to it? A toddler would readily know which is the safe path to take even without the knowledge of C. tetani, but I am just fascinated how parents are offering very poor choices (or lack thereof).

            ;-)

    2. Alia says:

      Which reminds me – when I was a kid, I had several accidents, like stepping on a broken glass or hitting myself on the leg with garden rake. But since I was up-to-date on my tetanus vaccine (we call it DiPerTe over here), nobody made a big fuss. Just clean the wound and bandage it, and that was all.

  21. some guy says:

    Hi Mark,

    Have you seen a case of Guillain-Barre’?

    I am not a doctor, but I have seen a case of Guillain-Barre. I was soaking in it. And because of it, the CDC tells doctors not to vaccinate me.

    Even so, my kids were all vaccinated based on researched, informed, decisions made between my wife and I and the kids’ doctor.

    I rely on herd immunity, I encourage you to get vaccinated, but because I have had Guillain-Barre, I would never mandate any vaccine unless the disease it targeted

    + could strike and kill or maim before most people could get to their doctors (meningitis for example)
    + was a danger to pregnant mothers and their infants
    + could spread so fast it could become an unchecked epidemic

    In particular, I would not mandate, in an opt-out form, vaccines targeting diseases that are probable, but not likely to be had for years or decades.

    Based on my experience with other medical technologies, medicine evolves so quickly, that waiting is often a better strategy than moving in early with brand new technologies.

    In the early 80s I had a heart issue discovered in college. My cardiologist told me wait. Wait until I truly need it. And 25 years when I really needed it, mortality rates of the operation had decreased from 20 – 25% to less than 5%, and a long recovery had turned into up and walking the next day, and a far easier recovery.

    Doctors and scientists should respect a patient or parents right to make an informed decision, and even to opt-out of vaccines.

    It should be countered with education, low costs, easy availability, and never by shaming or with laws.

    I rely on herd immunity, but except for the cases I mentioned above, I would never want a parent to be forced to vaccinate their children or themselves except where they can make informed decisions and have a chance to opt out.

    1. elburto says:

      You really don’t appear to understand herd immunity and how it works. If your bizarre anti-vax sounding guidelines were put into place then herd immunity wouldn’t exist.

      I also love, by which I mean I’m seriously p¡ssed off at, the fact that your suggestions are apparently only designed with your situation in mind. This “I’m alright Jack” mentality is a prime example of those who not only lack any sense of a social contract, but also completely misunderstand how and why vaccination protects people. You’re infected with a disease for a while before symptoms emerge. So, anyone infected can walk freely around the community looking fine, shedding virus everywhere, passing it on to others. Once you have it it’s too late for the potentially lifesaving immunisation. By the time your symptoms appear you could have infected thousands of people, who will also go on to do the same… unless herd immunity is in place and the virus can’t get a foothold.

      What about people who can’t be vaccinated, babies too young to be immunised, people with cancer, or on immune-suppressing drugs or who have impaired immune systems, or the elderly? The irony is that you’d be screwed if everyone thought like you. Your attitude, redolent of every anti-vaccination proponent (who you’ve apparently been reading) is shocking in someone who relies on community immunity. You do realise that the same people whose arguments you’re spouting believe that people like you are just collateral damage, don’t you? That they’ll readily admit that they believe it’s better to die from vaccine preventable disease than to be chronically ill or disabled?

      They hide behind the mask of “Not anti-vaccine, just pro safe vaccines”, something you appear to be parroting.

      So, which vaccines do you believe are unnecessary or unsafe, and why? Which vaccines. have a higher risk than the diseases they’re trying to prevent?

      Please provide citations to back up your claims. Pubmed indexed articles are where you’ll find the facts.

  22. Abe says:

    You sound like a wholesale proponent of vaccines. The problem is that the science just isn’t there to support the wholesale adoption and utilization of them. Sure, some vaccines are safe and highly effective and thus should be widely adopted, but others have questionable benefits, high risks, and little science to support their adoption. As parents, we’re tasked with the mammoth task of separating out science from fiction–and unfortunately for every doctor who says “go vaccines!” there are others who say exactly the opposite. And all too often, neither camp knows what the heck they’re talking about. Just because you have an MD doesn’t make you motivated to keep up-to-date on medical science, nor does it make you skilled at digesting dense scientific journal articles. For instance, you seem to be saying “go vaccines!” in the extreme. A more moderate perspective comes from Dr. Sears whose The Vaccine Book offers a far more balanced look at the risks and benefits provided by various vaccines.

    Lastly, it’s one thing to say that everyone should be vaccinated against everything regardless of the personal risks (i.e., put the good of society before the individual) but when it’s your own child who bears significant risk of “side-effects” from a vaccine that doesn’t protect them against anything, but only indirectly protects others…it’s hard to see the benefit. If you want to vaccinate your own children and risk ill-effects to them, go ahead, but there are plenty of parents choosing otherwise.

    Furthermore, your argument in support of herd immunity is flawed. Herd immunity only protects those who are unvaccinated. Which is to say, that if people decide not to vaccinate their children and this leads to a re-emergence of various diseases then that’s just the natural consequence of not vaccinating their children. Those who have been vaccinated should still be protected. I don’t see the benefit in forcing people to protect themselves against everything under the sun. If they want to go without vaccinations and risk contracting a disease, so be it. What is the goal of complete eradication of some of these nasty diseases? A gold star in the history books? A slap on the back and a “good job! We did it!?”

    Personally, my wife and I are on board with those vaccines which are proven safe (some are out there for which supporting evidence is–at best–mixed and inconclusive and risks high) and provide effective personal protection against disease. We are not supportive of those vaccines which have risks which outweigh the benefits, or where the benefits are only social and the personal risks too high.

    And yes, this means we are taking some risks. But we are taking some risks with extensive knowledge of current research on the subject.

    1. davdoodles says:

      “You sound like a wholesale proponent of vaccines. The problem is that the science just isn’t there to support the wholesale adoption and utilization of them. Sure, some vaccines are safe and highly effective and thus should be widely adopted, but others have questionable benefits, high risks, and little science to support their adoption.”

      “…and little science to support their adoption.”….

      That’s awesome that you have this information, because we all benefit from knowing about pseudo-scientific snake-oil bull-crap which is, as you probably know, as pervasive as it’s ever been.

      And if one quack remedy has slipped through the usually rigorous scientific method and made its way onto the market, then it’s vital that you alert us.

      So, give us the science.

      I, for one, am all ears.
      .

    2. davdoodles says:

      “Herd immunity only protects those who are unvaccinated”

      “Only”:

      Every baby,

      and those with compromised immune systems,

      and the old,

      and the ill-with-another-disease

      and those didn’t develop antibodies in response to their exposure,

      and pretty much everyone with cancer,

      and the, um, third world.

      But, yeah,

      With luck, provided enough other people (sorry, “suckers”) shoulder the miniscule risk you’re not willing to take, your particular kid will hopefully never get polio.

      But math wasn’t really your strong point, was it?
      .

    3. David Gorski says:

      You sound like a wholesale proponent of vaccines.

      You say that as though it were a bad thing! (Hint: It’s not. Being antivaccine is.)

      The problem is that the science just isn’t there to support the wholesale adoption and utilization of them. Sure, some vaccines are safe and highly effective and thus should be widely adopted, but others have questionable benefits, high risks, and little science to support their adoption. As parents, we’re tasked with the mammoth task of separating out science from fiction–and unfortunately for every doctor who says “go vaccines!” there are others who say exactly the opposite. And all too often, neither camp knows what the heck they’re talking about. Just because you have an MD doesn’t make you motivated to keep up-to-date on medical science, nor does it make you skilled at digesting dense scientific journal articles. For instance, you seem to be saying “go vaccines!” in the extreme. A more moderate perspective comes from Dr. Sears whose The Vaccine Book offers a far more balanced look at the risks and benefits provided by various vaccines.

      Then you’ve been led astray. Dr. Sears is antivaccine-sympathetic (at least). He also is clueless about vaccines, and his book is a dangerous font of vaccine misinformation and fear mongering:

      http://www.sciencebasedmedicine.org/cashing-in-on-fear-the-danger-of-dr-sears/
      http://www.sciencebasedmedicine.org/paul-offit-takes-on-robert-sears/

      Furthermore, your argument in support of herd immunity is flawed. Herd immunity only protects those who are unvaccinated. Which is to say, that if people decide not to vaccinate their children and this leads to a re-emergence of various diseases then that’s just the natural consequence of not vaccinating their children. Those who have been vaccinated should still be protected.

      It never ceases to amaze me how often commenters make such statements cribbed straight from antivaccine websites. Like any other medical intervention, no vaccine is 100% effective. The MMR, for instance, is over 90% effective (less if the child doesn’t get the full series), but that still leaves roughly 10% who are not. They, too, are protected by herd immunity. I do, however, like your—heh—callous disregard for those who for medical reasons (cancer, or something else) can’t be vaccinated. Screw ‘em, you say. Very typical of the antivaccine movement, as we see in your next statement:

      I don’t see the benefit in forcing people to protect themselves against everything under the sun. If they want to go without vaccinations and risk contracting a disease, so be it. What is the goal of complete eradication of some of these nasty diseases? A gold star in the history books? A slap on the back and a “good job! We did it!?”

      I suppose that saving potentially millions of lives and untold suffering from vaccine-preventable diseases counts for nothing with you. I mean, geez, it’s not like that’s a worthwhile goal or anything, is it? It’s not like smallpox didn’t kill and disfigure millions before it was wiped out. It wasn’t as though polio didn’t kill thousands and cripple hundreds of thousands right here in the US alone. (The CDC estimates that during the early 1940s and early 1950s polio crippled 35,000 a year.) It’s not as though eradicating it with vaccination programs stopped that sort of suffering and carnage in the developed world and is on the verge of potentially stopping it worldwide (that is, if antivaccinationists don’t have their way). I mean, geez. It’s not like those are noble goals just for sheer humanitarian reasons, is it?

      Personally, my wife and I are on board with those vaccines which are proven safe (some are out there for which supporting evidence is–at best–mixed and inconclusive and risks high) and provide effective personal protection against disease. We are not supportive of those vaccines which have risks which outweigh the benefits, or where the benefits are only social and the personal risks too high.

      Let’s see where the rubber hits the road here. Which vaccines are “proven safe” and “provide effective personal protection against disease”? For which vaccines do the risks outweigh the benefits. Show your work; explain why. Note that I want references from the peer-reviewed scientific/medical literature to support your arguments. Links to Dr. Sears or various “vaccine skeptical” websites do not count in a serious scientific discussion.

      Which vaccines have you given your children?

      And yes, this means we are taking some risks. But we are taking some risks with extensive knowledge of current research on the subject.

      Google “Dunning-Kruger effect” and “motivated reasoning.”

      I highly doubt that your self-proclaimed “extensive knowledge of current research on the subject” is actually as good as you think it is. It’s almost certainly a superficial understanding that has little depth, mainly because few lay people have the detailed scientific and medical background to apply the information. It’s often a matter of knowing facts, but not having the scientific experience, understanding of mechanisms, or sophistication to put them in context or to apply them to the situation properly. Let’s just put it this way. “Extensive knowledge of the current research on the subject” does not necessarily mean extensive understanding of the current research on the subject. Your statements about herd immunity tells me that in your case this is so.

      1. WilliamLawrenceUtridge says:

        I swear to Dog and Raptor Jesus that I wrote my comment before I read Dr. Gorski’s. It’s possible I spend too much time on this website…

    4. WilliamLawrenceUtridge says:

      others have questionable benefits, high risks, and little science to support their adoption.

      Which ones? Surely you have some sort of sophisticated, pubmed-indexed-article support for your assertion. And you obviously understand the scientific process that goes into the reviews of vaccine safety and efficacy. I mean, you couldn’t think that vaccine approval and selection is based on a dartboard or gut-check, right? You must appreciate that vaccine approval is based on the publicly-available peer-reviewed literature.

      As parents, we’re tasked with the mammoth task of separating out science from fiction–and unfortunately for every doctor who says “go vaccines!” there are others who say exactly the opposite.

      No you’re not. As parents, it’s your duty to protect your children. Doctors and public health officials are the ones with that task – and they are universal in their agreement except for the few, like Dr. Jay and Dr. Sears, who misrepresent (or don’t bother to cite) the scientific literature in favour of their personal experience and telling parents what they want to hear. As a writer of fantasy, speculative fiction and TV shows, what qualifies you to undertake the assessment of the scientific literature that is anywhere near equal to that of the CDC panel made up of pediatric immunologists and vaccination experts? Do your days spent writing about imaginary people leave you sufficient time to match their decades of experience reading, writing and interpreting the scientific literature?

      A more moderate perspective comes from Dr. Sears whose The Vaccine Book offers a far more balanced look at the risks and benefits provided by various vaccines.

      Dr. Sears is an idiot whose parenting recommendations are based on the parts of his own childhood he didn’t like. He’s got the gall to make universal recommendations to all parents regarding how to raise their children based solely on “my mommy didn’t hug me enough, so make sure you have literally constant physical contact with your baby at all times”. As to his incorrect recommendations regarding vaccination, you appear to be falling for the logical fallacy of “the appeal to moderation“, which assumes that the correct answer is always the middle path. Well, sometimes it’s not. Sometimes the middle path is simply wrong. There is no correct, “moderate” path regarding creationism and evolution, or holocaust denial, or antivaccination. There is a correct, scientifically-justified and accurate side, and a wrong side. 2+2 does not equal 3, it equals 4.

      when it’s your own child who bears significant risk of “side-effects” from a vaccine that doesn’t protect them against anything, but only indirectly protects others…it’s hard to see the benefit.

      The CDC has a list of who should not get vaccinated. Everyone else should be vaccinated. The side effects are normally small and short-term, far,far less than the side effects of actual infection. And I predict a failure to understand herd immunity in 3…2…1…

      Furthermore, your argument in support of herd immunity is flawed. Herd immunity only protects those who are unvaccinated.

      There it is. Herd immunity protects everyone. It protects people who can’t be vaccinated, people for whom the vaccine didn’t take, and more. I urge you, strongly, to read that article. The consequences of vaccination and vaccine-preventable diseases are not borne solely by those who refuse to vaccinate.

      Personally, my wife and I are on board with those vaccines which are proven safe (some are out there for which supporting evidence is–at best–mixed and inconclusive and risks high) and provide effective personal protection against disease. We are not supportive of those vaccines which have risks which outweigh the benefits, or where the benefits are only social and the personal risks too high.

      If you’re sooooo educated, sooooo knowledgeable about vaccines – surely you can list those that are “proven safe” (scientific fail by the way, science does not prove safety), and list the peer-reviewed literature to support your position. Which vaccines present more risk than benefits, aside from the live oral polio, smallpox and whole-cell pertussis (though the latter is now questionable given the obvious failings of the acellular version). And if you post a link to Dr. Sears execrable book, you’re just proving that you don’t know what you are talking about.

      But hey, as long as you and your babies are protected (and they are, right? You had their antibody titres checked, right? Because vaccines don’t always protect even if the vaccine schedule is followed exactly; be a real shame if your child ended up deaf, sterile or dead because the vaccine isn’t perfect) then it’s all good, right? Who cares about anyone else? Who cares about your elderly relatives, your neighbours, strangers on the bus, children who can’t be vaccinated, cancer patients, newborns, who cares about all of them, as long as you are protecting your precious fluids and your child having a sore arm, right? I’m sure your arrogance is totally justified.

    5. Chris says:

      Abe:

      Furthermore, your argument in support of herd immunity is flawed. Herd immunity only protects those who are unvaccinated. Which is to say, that if people decide not to vaccinate their children and this leads to a re-emergence of various diseases then that’s just the natural consequence of not vaccinating their children.

      One of those infected in the Texas church was just four months old. Do tell how the vaccine is supposed to protect someone before they are eligible to get it after their first birthday? Do you think perhaps that all babies be left with their mother in a room where they have contact with no one until the child can get an MMR vaccine?

    6. Chris says:

      Abe:

      Furthermore, your argument in support of herd immunity is flawed. Herd immunity only protects those who are unvaccinated. Which is to say, that if people decide not to vaccinate their children and this leads to a re-emergence of various diseases then that’s just the natural consequence of not vaccinating their children.

      One of those who got measles at the Texas church was four months old. The MMR vaccine is only given after a child’s first birthday.

      What is your grand plan to protect babies under a year from measles?

      1. Chris says:

        Sorry for the duplicate post. I saw the article fine, but then got directed to link farm with questionable links. I was posting just as the DNS spoofing was occurring.

    7. Oh now isn’t that just adorable? A http://www.foundant.com/blog/meet-abe-burnett-data-migrations-specialist/, a guy with a bachelor’s degree in economics, comes to a site named “Science-Based Medicine” and lectures the authors on… well, medicine.

      He’s lecturing Dr. Crislip, an infectious disease specialist, on immunology and vaccinology. He’s also lecturing the other qualified physicians who have commented here, such as Chris Hickie and David Gorski.

      No, it isn’t adorable. Neither is Abe Burnett’s contempt for other people’s health.

      this leads to a re-emergence of various diseases then that’s just the natural consequence of not vaccinating

      Tell that to the families of children too young to be vaccinated against measles, who fell ill with measles and were hospitalized. Tell that to the parents of the children who died of SSPE, because they were exposed to measles by vaccine-refusing parents.

      What is the goal of complete eradication of some of these nasty diseases? A gold star in the history books? A slap on the back and a “good job! We did it!?”

      No, Mr. Burnett, no. The goal is the reduction of human suffering and death. The goal is social justice, in that the burden of vaccine-preventable disease falls unfairly on the poor and the disadvantaged.

    8. AnObservingParty says:

      “What is the goal of complete eradication of some of these nasty diseases? A gold star in the history books? A slap on the back and a “good job! We did it!?”

      Actually, bragging rights is a pretty good reason. I like to brag. Nobody says, “Jonas Salk…that megalomaniac…what did he ever accomplish? Waste of time, that was.” He achieved more than you ever will.

      But I’d go with saving millions of lives, reducing needless suffering from preventing illness, saving money spent treating disease, and supporting any disabilities suffered by survivors in the future, by spending far less on the vaccination that prevents it.

      I’m glad you feel so confident in your and your children’s abilities to survive such illnesses. But, even the worst are only a plane-ride away. What ones have you, in your clearly infinite wisdom, deemed worthy of being vaccinated for?

      1. MadisonMD says:

        What is the goal of eradication? Then we don’t need the vaccine anymore. Your child wasnt vaccinated for smallpox, right? Excuse me for saying…Duh.

        1. MadisonMD says:

          That was in response to Abe not APP.

  23. windriven says:

    “Just because you have an MD doesn’t make you motivated to keep up-to-date on medical science, nor does it make you skilled at digesting dense scientific journal articles.”

    I suggest that you tune into Dr. Crislip’s bimonthly podcast, The Persiflager’s Guide, a review of the infectious disease literature aimed at other physicians. I suspect that his grasp of medical science in general and the ‘dense’ infectious disease literature will compare rather favorably with yours.

    “Herd immunity only protects those who are unvaccinated”

    You might want to stick to selling insurance or whatever it is that you do. You certainly do not understand herd immunity. Herd immunity protects the entire herd by, among other things, denying the infectious agent a reservoir.

    “(some are out there for which supporting evidence is–at best–mixed and inconclusive and risks high) ”

    Specifically which vaccines carry high risks in your professional opinion? Please cite something in the peer reviewed literature to support your assertion.

    “And yes, this means we are taking some risks. But we are taking some risks with extensive knowledge of current research on the subject.”

    Exactly what risks are you taking there, Sparky? And where did you come by your claimed “extensive knowledge” of infectious disease and its prevention? I ask only because your comment reads like the nattering of some yutz who struggled with high school biology.

    ” I don’t see the benefit in forcing people to protect themselves against everything under the sun. If they want to go without vaccinations and risk contracting a disease, so be it. What is the goal of complete eradication of some of these nasty diseases?”

    You see? Comments like that mark you as a wackaloon. We vaccinate against diseases that cause serious illnesses and/or death. The goal is to prevent people from becoming seriously ill and/or dying. Moreover – and you may want to review your notes on herd immunity – by not protecting themselves they are increasing the risk of disease for their neighbors.

  24. David Gorski says:

    You sound like a wholesale proponent of vaccines.

    You say that as though it were a bad thing! (Hint: It’s not. Being antivaccine is.)

    The problem is that the science just isn’t there to support the wholesale adoption and utilization of them. Sure, some vaccines are safe and highly effective and thus should be widely adopted, but others have questionable benefits, high risks, and little science to support their adoption. As parents, we’re tasked with the mammoth task of separating out science from fiction–and unfortunately for every doctor who says “go vaccines!” there are others who say exactly the opposite. And all too often, neither camp knows what the heck they’re talking about. Just because you have an MD doesn’t make you motivated to keep up-to-date on medical science, nor does it make you skilled at digesting dense scientific journal articles. For instance, you seem to be saying “go vaccines!” in the extreme. A more moderate perspective comes from Dr. Sears whose The Vaccine Book offers a far more balanced look at the risks and benefits provided by various vaccines.

    Then you’ve been led astray. Dr. Sears is antivaccine-sympathetic (at least). He also is clueless about vaccines, and his book is a dangerous font of vaccine misinformation and fear mongering:

    http://www.sciencebasedmedicine.org/cashing-in-on-fear-the-danger-of-dr-sears/
    http://www.sciencebasedmedicine.org/paul-offit-takes-on-robert-sears/

    Furthermore, your argument in support of herd immunity is flawed. Herd immunity only protects those who are unvaccinated. Which is to say, that if people decide not to vaccinate their children and this leads to a re-emergence of various diseases then that’s just the natural consequence of not vaccinating their children. Those who have been vaccinated should still be protected.

    It never ceases to amaze me how often commenters make such statements cribbed straight from antivaccine websites. Like any other medical intervention, no vaccine is 100% effective. The MMR, for instance, is over 90% effective (less if the child doesn’t get the full series), but that still leaves roughly 10% who are not. They, too, are protected by herd immunity. I do, however, like your—heh—callous disregard for those who for medical reasons (cancer, or something else) can’t be vaccinated. Screw ‘em, you say. Very typical of the antivaccine movement, as we see in your next statement:

    I don’t see the benefit in forcing people to protect themselves against everything under the sun. If they want to go without vaccinations and risk contracting a disease, so be it. What is the goal of complete eradication of some of these nasty diseases? A gold star in the history books? A slap on the back and a “good job! We did it!?”

    I suppose that saving potentially millions of lives and untold suffering from vaccine-preventable diseases counts for nothing with you. I mean, geez, it’s not like that’s a worthwhile goal or anything, is it? It’s not like smallpox didn’t kill and disfigure millions before it was wiped out. It wasn’t as though polio didn’t kill and cripple thousands and that eradicating it with vaccination programs stopped that in the developed world and is on the verge of potentially stopping it worldwide (that is, if antivaccinationists don’t have their way). I mean, geez. It’s not like those are noble goals just for sheer humanitarian reasons, is it?

    Personally, my wife and I are on board with those vaccines which are proven safe (some are out there for which supporting evidence is–at best–mixed and inconclusive and risks high) and provide effective personal protection against disease. We are not supportive of those vaccines which have risks which outweigh the benefits, or where the benefits are only social and the personal risks too high.

    Let’s see where the rubber hits the road here. Which vaccines are “proven safe” and “provide effective personal protection against disease”? For which vaccines do the risks outweigh the benefits. Show your work; explain why. Which vaccines have you given your children?

    And yes, this means we are taking some risks. But we are taking some risks with extensive knowledge of current research on the subject.

    Google Dunning-Kruger effect and motivated reasoning.

    I highly doubt that your self-proclaimed “extensive knowledge of current research on the subject” is actually as good as you think it is. It’s almost certainly a superficial understanding that has little depth, mainly because few lay people have the detailed scientific and medical background to apply the information. It’s often a matter of knowing facts, but not having the scientific experience, understanding of mechanisms, or sophistication to put them in context or to apply them to the situation properly. Let’s just put it this way. “Extensive knowledge of the current research on the subject” does not necessarily mean extensive understanding of the current research on the subject. Your statements about herd immunity tells me that in your case this is so.

  25. Cynical Pediatrician says:

    Abe, you do know that vaccines don’t just appear on the market like the newest brand of breakfast cereal? First they go through a rigorous testing and approval process. They must be safe and efficacious. Then, after licensure, the experts on CDC’s Advisory Committee on Immunization Practices (ACIP) and at the AAP look at more data to determine the appropriate use, timing, and population for the vaccine. Your average MD doesn’t come up with this stuff on his/her own; they follow the recommendations of infectious disease experts who spend many hours examining the literature and deliberating. And those recommendations are published in the literature for all to read, with the full line of reasoning spelled out, including possible precautions, unanswered questions, and the strength of the evidence behind these decisions. As a matter of fact, anyone–even you!–can read the reports, usually published (online! for free!) in MMWR or Pediatrics.
    But wait–there’s more! Those recommendations are re-examined as new data emerges after licensure and use. Some vaccines are withdrawn (Rotashield!). Others have recommendations changed (Gardasil for boys! Menactra booster dose!). So the experts are continually revisiting their prior decisions to make sure they’re doing the best for children.
    Now Dr Bob, a clinical pediatrician, may be a pretty smart guy. Dr Jay, too. Let’s give them the benefit of the doubt. And they see a lot in their offices. I’m a clinical pediatrician too, so I understand the value of experience. But I also know how to read the literature and know the importance of data, odds ratios, statistical significance, risk-benefit analysis, and these sorts of things. I don’t agree with everything I read. But I have yet to read an ACIP or AAP recommendation that didn’t take into account all the things you think you need to re-discover for yourself, and one that didn’t reach a logical conclusion for use based on the data. I don’t trust the ACIP just because they say they’re experts. I trust them because they’ve proved themselves to be what others consider as experts–deliberate, conscientious, intelligent experts.
    If you want to pit Dr Bob against Larry Pickering, Joe Bocchini, and the rest, then be my guest. But don’t say you haven’t been warned.
    [BTW, even though this wasn't your point, thanks for illustrating Chris' post to Jay just a few lines above.]

    1. davdoodles says:

      Those whose master-plan amounts to “I’ll hide my children (and grandchildren etc) from polio and cervical cancer, amongst the herd, and hope for the best”…

      AND especially those who recommend others to do likewise on public websites…

      …are friggin’ idiots.

      It’s like a “yee-haw survivalist” bill-boarding to the world where his shipping container full of high protein pickled ox-dicks and gram crackers is buried.

      Any way you look at that alternative, it’s a rusty, half-collapsed shipping container full of fetid bovine cocks, fungus, and moldy weevil droppings. Oh, and kids in iron lungs.

      Or, you could grow-the-fu*k up, and science might just help you out.
      .

      1. davdoodles says:

        Sorry, that wasn’t meant to be a reply to Cynical Pediatrician (though you certainly made some sensible points), it was meant to be a general comment.
        .

      2. WilliamLawrenceUtridge says:

        All the parents who refused to get their children vaccinated for HPV (because it’ll turn them into sluts! The only reason girls don’t have sex before marriage is because of fear of cancer in 30 years!), they will probably live long enough to see their daughters develop cervical cancer, and either die or be rendered unable to have children. I hope they think about this when they refuse to vaccinate their children.

        1. duggansc says:

          @WLU regarding HPV vaccine:

          This is one of those areas where I’m of mixed opinion. To me, widespread vaccination against HPV would be like someone finding a vaccine against particular forms of lung cancer and requiring everyone to take it because some people are going to smoke or be around smokers. When commonsense precautions work just as well, why require mass vaccinations at an early age?

          1. Chris says:

            Excuse me, but how is having sex equivalent to smoking tobacco products?

            As for common sense precautions: if my daughter becomes engaged, should I have her fiance tested for HPV infection? Wouldn’t it be easier to just vaccinate her? (which we did when she was in middle school, college age son also got vaccinated last year… at least it is useful for his present, and fourth girlfriend since starting college)

          2. Hi Diggansc.

            The deal with the human papilloma virus is that “HPV is so common that nearly all sexually-active men and women get it at some point in their lives.” Yes, it is true that most people clear the infection without incident, but some will not.

            “In 2007 (the most recent year for which statistics are available), 12,280 women in the United States were told they had cervical cancer, and 4,021 died from the disease.”

            Even if cervical cancer is caught early, the treatment is painful, invasive, and expensive. It’s anecdata, but I am a cervical cancer survivor. I wouldn’t wish the treatment on someone I disliked.

            When commonsense precautions work just as well,

            I don’t know what “commonsense precautions” you are speaking of.

            If you are speaking of the Pap smear, yes it is useful but doesn’t prevent cancer.

            If you are speaking of condom use, yes useful again but not absolutely preventative, as male condoms don’t cover the entire genital area, and the virus might be on areas not covered by the condom. And of course, in order to be protected, condoms must be used during foreplay as well as actual intercourse, every time sex is engaged in.

            why require mass vaccinations at an early age?

            The “early age” part is easy. One, younger girls mount a better immune response than older girls. Two, the vaccine is most effective if given before the onset of sexual activity (remember we’re not necessarily talking about intercourse here, what used to be called “heavy petting” can transmit the virus). Three, most teens are engaging in some form of sexual activity by mid-teens.

            The “mass” part is also fairly easy. Since everyone (male and female) is at risk for being exposed to the virus, universal vaccination of both sexes is a public-health requirement.

            The “requiring” part is a little more difficult. When the vaccine first came out, very few insurance plans covered it, and it is not an inexpensive vaccine. So there was state legislation about having the vaccine covered by insurance.

            I don’t know if you are a USian or a resident elsewhere, but in the US, vaccine policy is set at the state level. As far as I know, only the District of Columbia and the state of Virginia require the vaccine for school entry.

          3. nancy brownlee says:

            What commonsense precautions? Condoms? Condoms don’t cover the base of the penis, and so are little or no protection against genital warts, or for that matter, against herpes.

          4. WilliamLawrenceUtridge says:

            Not everybody will become paralyzed because of polio. Why do we bother vaccinating everyone?

            Also, I would be strongly in favour of your hypothetical lung cancer vaccine. There is nothing wrong with smoking except for the fact that it has health effects. Remove those health effects, and bar the smell I don’t give a crap if people smoke. Smoking is not, in and of itself, an evil. It’s not about having a sense of moral superiority because I don’t smoke – it’s about reducing the number of people who die because of it (lots of hypothetical complications in your hypothetical example, for instance the cardiovascular effects of smoking).

            Not to mention, what is your solution for not transmitting HPV from a male to a female, or vice versa, when the couple attempts to have children – thus eliminating barrier birth control?

            You know what my solution is? Universal vaccination.

          5. Rokujolady says:

            I would happily get vaccinated against lung cancer, even if it just protected smokers, and I’d happily get my kids the shot too.
            People with nasty habits don’t deserve any less consideration because they have what you perceive to be a moral failing.
            I’d also happily pay for universal health care even if it treated fat people who mooch off the system by persisting in their fatness.
            Why? Because I live in a civilised society.

  26. duggansc says:

    @nancy brownlee regarding rusty nails and kids:

    Kids will put anything in their mouths, and their lack of coordination means they’re not likely to notice bits of debris that have been knocked into the grass from the roadside. And, as someone who’s cleaning his deck in between bouts online, there are a /lot/ of rusty nails in any form of construction. Yes, most of those are from rainwater rather than from animal urine, the general vector for tetanus, but it does us right to be cautious.

    1. Chris says:

      Just last week I punctured my foot on a deck nail. It was before the latest late summer storms, so I am sure there was urine on it.

      Some could have been from our outdoor cat who likes to mark all parts of our yard by spraying (along with things in the house), and during the dry weather doors to the deck were open as we varnished them so the indoor incontinent cat wandered on to the porch… AND we often get visited by these guys (my daughter has pictures of them staring through the deck door and hanging off the railing, and no, she won’t share). Oh, and then there was a time I spread some yards of white cloth around to dry on the deck, only to find blood spots on it… which I had to wash out. A bit later I found the remainder of the bird that had been ripped apart by a raptor (there is a bald eagle nest a couple blocks away, and I have seen a peregrine falcon on my neighbor’s house about a dozen feet from my deck).

      By the way, I am a gardener. One thing we are reminded often about is that tetanus is it is in the soil, and it is very important to be current with a tetanus vaccine. I am always getting cuts, most often from the rose bush thorns. Though most recently when my tree saw bounced and caused small lacerations on my arm.

    2. calliarcale says:

      Au contraire; in my experience, toddlers have an almost supernatural ability to detect bits of noxious debris that has escaped multiple sweeps by adults, and promptly stick it in their mouths.

      1. Chris says:

        Ah, yes. One of my favorite memories is of my older son, who had just learned to communicate with sign, running to me signing “baby spider.” So I go to my newly crawling younger son and use my finger to sweep out his mouth. A beetle is flung out. Eww!

        Later, as that same child go older I learned to not allow him chewing gum. Because that would be stuck in odd places around the house (he had already been caught putting dinner veggies in a hole for house stereo wires). When we were outside I noticed he was chewing gum, so I asked him where he got it. He pointed to the sidewalk. Again, ewww!

        Unfortunately, this has not given him super immunity. He teaches small children, and still gets colds from his small students. Well, on the bright side, he will be through most of the 200 rhino viruses by the time he is thirty.

  27. Here’s what i think: Dr. Jay knows that he has been wrong about vaccines, but he feels that he is too invested, socially and professionally, to admit he is wrong. It would be like Pat Robertson admitting that the Bible is not a reliable source for scientific truth, or Dick Cheney apologizing for being pro-torture. Robertson would lose his broadcast empire, and Cheney would have to tell Oprah what a bad boy he has been. I think that Jay wants to come clean, but fears the consequences. He admits that he was wrong when he told McJenny’s angry mob that vaccines have ether and anti-freeze. That’s a start. Now if he can just acknowledge the mountain of research that says following the schedule is safer than not. It’s not too late, Dr.Jay. Turn toward the light.

    1. David Gorski says:

      You know, ANB, I’ve suspected as much for a very long time now. Why else would Dr. Jay have submitted himself repeatedly to the criticism over at Respectful Insolence, for example. I, too, urge Dr. Jay to turn toward the light.

    2. WilliamLawrenceUtridge says:

      +1

      SBM needs an “agree” button.

      1. windriven says:

        Too Rush Limbaugh for my taste (though I often share the desire to indicate my agreement with a particularly striking argument). The thought of the button sends Arsenio Hall-like hoots of woo-woo-woo cascading through my head. Isn’t there already enough woo in the world? ;-)

        Apologies for the mental train wreck of referring to Limbaugh and Hall in the same paragraph.

  28. Jan Willem Nienhuys says:

    I agree with many remarks made by dr. Gorski. Just a few points: smallpox didn’t kill ‘millions’. The estimated number of smallpox deaths in the twentieth century alone was 300 million.

    I question the 3:1000 mortality of measles, at least for nations with advanced health care.
    1. In the time before vaccination almost everybody got measles before the age of 15. As the USA had 4 million births per year and somewhat more that 400 measles deaths (we are talking 1950s and 1960s), the number 1:10,000 is probably more applicable.
    2. A similar ratio between annual births (=annual measles cases) and annual measles deaths held in the Netherlands in the same period.
    3. In 1999/2000 there was a measles epidemic in the Netherlands (in a region where many religiously motivated non-vaccinators huddle together). 3392 cases were reported and three deaths. That would seem to point to a 1:1000 death rate. But later investigations, for example by examining absentee lists in schools, showed that only about 1 in 10 or 11 cases was reported. Lots of non-vaccinators don’t bother to call the physician if their child gets measles. The total of about 30,000 or 35,000 cases corresponded well with the size of the reservoir of unvaccinated kids in these communities.
    4. Right now there is another epidemic going on with until now 1294 reported cases, and again there is vast underreporting, and no deaths yet.

    The number of complications can also be seen from the Dutch data: until now about 14% of reported cases, half of the pneumonia. That’s 1.4% of all cases. I assume that parents who don’t report measles will call the doctor of the child gets pneumonia or otitis.

    In other words, I don’t trust the given US data about deaths and complications. I suspect that either there is underreporting of measles or a serious failure of hospital care for cases of measles complications. Or both.

    Incidentally one favorate antivax argument is that deaths were down long before vaccinations started. But deaths are caused by the complications, mostly pneumonia. And dr Crislip is in the best position to explain how much the treatment of pneumonia has advanced in the last century. Any antivaxer who trots out this argument is a dirty despicale liar, because this has been explained often enough.

    The present Dutch epidemic gives also an idea about how well vaccination protects. The first vaccination protects best if it is given at 15 months (in the Netherlands one has opted for 14 months). Authorities in the Netherlands claim that they reach about 95% protection, i.e. if you measure antibody titers well after the first vaccination 95% of those who have been vaccinated at 14 months have enough antibody to be protected against infection.
    In the Netherlands the second MMR shot is given at age 9. Most of those who were not protected by the first shot, are protected then too. In the 1999/2000 epidemic only one person that was twice vaccinated got sick, opposed to 158 who had only one vaccination. It is of course difficult to estimate how many twice vaccinated have been in contact with measles patients and how many once vaccinated. In the present epidemic about 4 doubly vaccinated people became ill, among them one person who probably was very heavily exposed (taking care of hospitalized measles patients).

    So dr Gorski’s 90% protection seems a bit on the pessimistic side.

    In Germany there recently was a case that showed what herd immunity is about. A son of non-vaccinating parents (‘didn’t think it was necessary’) visited in 1999 a pediatrician with what seemed to be some kind of cold or flu. It was measles (before the rash it looks like a cold and the patiënt is spraying the virus all around him). He infected 6 other kids in the waiting room, three of them babies to young to be vaccinated. Two of these babies developed SSPE, and died October 13, 2011 and June 10, 2013 after a gruesome period of slow deterioriation over the course of years ending in coma.

    To go unvaccinated is like going onto the road in a care without brakes saying: “what do you care, I only risk my own life don’t I, and nothing ever happened to me.” The evil antivaxers think vaccination is a Jewish plot to poison mankind. Rubbish. The real plotters are the antivaxers themselves, spreading sickness, and calling it health.

    The latest that I know is that world wide 158,000 children die because of measles. That is a lot less than 10 or 15 years ago, thanks to a vigorous vaccination drive. But is is 158,000 too many because measles can be eradicated just like smallpox and rinderpest and polio (almost eradicated).

    1. David Gorski says:

      So dr Gorski’s 90% protection seems a bit on the pessimistic side.

      I intentionally chose a slightly pessimistic estimate, because the numbers are easier that way if I have to start doing calculations to followup my point.

    2. Chris says:

      Some if it is due to surveillance:
      Acute measles mortality in the United States, 1987-2002.

      When the numbers are small, it gets dicey. Also remember that the Wales outbreak had a bit over a thousand reported cases, with close to a hundred requiring hospital care and one death.

      Also, with the American 1990 epidemic, the numbers may have been skewed by a couple of churches that refused medical care… and then there is the serious lack of universal health care. It is not so much “serious failure of hospital care”, as lack of access to medical care. This is also an interesting take on the epidemic:
      Pediatric hospital admissions for measles. Lessons from the 1990 epidemic.

      Oh, this is going to moderation, so I’ll just post a third link.

      The 1990 epidemic was due to undervaccination of younger kids. The parents did not bother until it was time for school admission. Hence the creation of Every Child by Two. My third kid was born in 1994, and it was with her that I got flyers from the state’s public health department reminding me to get her vaccinated.

      1. Jan Willem Nienhuys says:

        The article “Acute measles mortality …” explains that in the 1950s there were 550,000 cases reported. But in these years an average of just over 4 million children weren born ( http://www.infoplease.com/ipa/A0005067.html ) every year and assuming that about 90% of all children got measles sooner or later, one would expect about 3.6 million cases. So the ratio actual: reported must have been around 6 or 7 then.

        The article “Pediatric hospital admissions…” contains interesting and worrisoe statistics, compared to the Dutch situation. Take for example otits media.
        This makes up 37% of the complications in the Dutch reported cases, but only 1% (i.e. 1 out 82) in the hospital admissions.
        In the 1990 epidemic it si reported to be 19%.

        In contrast in the Netherlands pneumonia makes up about half of all complications and also about half of the hospital admissions, whereas in the 1990 epidemic only 7% pneumonia is reported.

        In 1990 I see ‘disorder of fluid balance’ which I think means dehydration due to diarrhoea and colitis/enteritis meaning also diarrhoea. This isn’t even listed separately in Dutch statistics, and adequate treatmemt of diarrhoea seems to me something that any family physician can handle.

        Together this gives the impression of many cases of parents that didn’t know how to treat a very sick child and no possibility to ask the family doctor to come and take a look, and that brought their child to the emergency room of a hospital as a last resort when the condition of the child deteriorated. I don’t believe California measles virus produces so little pneumonia and such aggressive otitis media and diarrhoea.

        So it is not actually access to hospitals where the medical care system failed, but access to family physicans and basic public health services. The article says so too: the majority of the cases were Medi-Cal benificiaries or people without health insurance.

        1. Chris says:

          “every year and assuming that about 90% of all children got measles sooner or later, one would expect about 3.6 million cases. So the ratio actual: reported must have been around 6 or 7 then.”

          Actually, it is not quite true. Since it is spread over fifteen years, and there were epidemic years and non-epidemic years.

          The numbers are very hard to count, and many kids had measles but they were not recognized, or they had some other rash disease that the parents thought was measles.

          I just read Big Data that discusses the problems with just basic census gathering though out history. Doing a bit of genealogy work I found out my grandmother and her family were counted twice in the 1910 US Census (first in Yakima, WA, then again in Pasadena, CA).

          And of course, during 1990 measles outbreak there were folks from two churches in Philadelphia hiding their sick kids. Dr. Offit has written about it more than once. For all we know, some of the very evangelical religious families in the Netherlands may be doing the same.

          But it does seem the biggest problem in the USA is a lack of a universal health care system.* This prevent parents from not only getting regular well child check ups, but even creating a relationship with a primary medical care provider.

          At least (I don’t know about the Netherlands) places like Denmark have a comprehensive medical database, where the numbers can be better evaluated. Though there is the NHS in Wales, and the hospitalizations for measles was still quite high (close to 10%). Big Data kind of goes into medical data minine (it was kind a “meh” read, I don’t recommend it).

          *(something I can a very big rant about. Especially since both my father and brother are retired military officers, who are politically conservative and hate the idea of “ObamaCare.” But without batting an eye the were very happy and excited that the “Tricare” medical insurance they get as retired military was absolutely free, and was working very well. I could not pick my jaw of the floor quickly enough that the changes that made it free for them was part of “ObamaCare.”)

          1. Jan Willem Nienhuys says:

            Chris, I disagree with you. The article said “with an average of 550,000 reported cases and 495 deaths reported each year.” If you are dealing with generations of 4 million each, and everyone gets measles sooner or later, then you also get 4 million cases. Now the ones that get measles
            in say 1959 will be born somehere between 1944 and 1959, but the bulk between 1953 and 1958. If the number of births were very different before 1950 you would have a point. They were somewhat lower but relatively not much. Measles came in waves about every three years, but I assume that 550,000 is a true average over 10 years. For the argument it is immaterial whether that ratio is 6 or 5 or 8, it is demonstrably far from 1.

            The religious people in the Netherlands don’t ‘hide’ their kids if they are sick. The children cannot attend school, that certainly is noticed. If a municipal health doctor calls the people (‘Hello, your child isn’t in school, why is that?’) then they don’t lie. But reporting measles means the physician must have seen the patient and the case has to be lab confirmed (unless it is clear that the patient has been infected by a lab confirmed other patient). There is no obligation for the parents to call the doctor. The doctor must report cases he or she has seen, but if the doctor isn’t called by the parents there is no report.

            These people probably consider measles as some kind of flu. Lots of people don’t bother to see a doctor with flu-like symptoms.

          2. Chris says:

            That is okay that you don’t agree with me. I just provided the data that was available. I accept that it is flawed.

            “The religious people in the Netherlands don’t ‘hide’ their kids if they are sick.”

            Citation needed.

          3. Jan Willem Nienhuys says:

            Chris asks (Sep 9) for documentation about ‘parents don’t hide their sick children.’

            The measles epidemic here generates a lot of news and discussions, and nowhere I have seen any reference to parents that try to hide the fact that their child is sick.
            The National Health Institute RIVM emphasizes that there is vast underreporting. In

            http://www.uitzendinggemist.nl/afleveringen/1355207

            you see a report from July 10 about the epidemic. There you see regional public health officer Frits Woonink MD explaining that he calls schools twice a week to ask for the absentee rate and also for the reason of absence. (In that way he only gets information about shool age children, but it is easy to extrapolate, I guess, but I don’t know whether he does so. As the last epidemic in this region was 13 years ago, there are probably not many adult non-immunes, but for pre-schoolers he would have to correct.) The report also has a heart rending interview with a partially paralysed woman who was a polio victim of the polio epidemic in Staphorst (in the northern tip of the Dutch Bible Belt) in 1971. Also an interview with typical representatives of strict believers.

            You can hear them argue that fear of vaccine preventable sickness like measles is selective, because these same people that vaccinate aout of fear are not afraid of driving a car. (Note: getting measles is about as dangerous in terms of death as driving 20,000 km, at least in the Netherlands.)

            In the report Frits Woonink says that at that time the most recent report of the RIVM says ’35-40 cases’ in his region, but that from his information the true number is about 400. The report starts with an elementary school that at the moment of interview has 120 children absent because of measles. At the moment the national total was 230 cases.

            One may wonder how one can establish at all that cases are ‘hidden’. Of course, if half the children of a school are sick during a measles epidemic, and a large number of parents don’t say ‘measles’ when the school calls to inquire for the reason of absence and the parents say ‘flu’ or ‘sprained ankle’, then one can suspect that the parents are actively hiding. Such statistical information would make it highly probable that some people are lying. Suppose you usually have 10 children absent because of sickness and during measles epidemic suddenly 40 children are claimed to be absent because of something different from measles, then you know that about 30 parents are lying. It would be obvious to anyone collecting data. From the absence of any such statistical indications of lying PLUS the information that during the last epidemic the computed real number of cases matched the size of the unvaccinated susceptible pool, I conclude that hiding on a grand scale didn’t happen.
            (For this I can find only a statement on tv by the head of RIVM, who said on July 10, 2013 that the real number was 10 or 11 times as large as the reported number.)

            But why should they lie? They consider sickness as given by God. It’s a fact of life.

  29. Tomasz says:

    1. You mention Poland. Please show me your source data. There is no source for nation wide data collection regarding vaccines, epidemiology and adverse effects. There are law
    suits pending, so I’m very interested about your source of knowledge.
    2. What is the mechanism of adjuvants in your opinion? Please explain to me, how it is possible, that specific adjuvant boosts the response of immune system for only one virus/bacteria (from vaccine) and not for the whole potentially allergic pathogens/proteins?
    3. You mention about long term effects – please show me your source data which are relevant to conclusions about whole populations. Do you know for example about any research regarding vaccinations of infants in first day of life with two different vaccines?

    1. mcrislip says:

      the reference is in the essay

      as to 2 and 3, I hate to disappoint but I don’t do requests. That would be a pair of essays that I have not the time to write. Remember, those of who write for the blog do it in our spare time, after work and family and sleep. We are neither medical librarians nor term paper writers.

    2. Chris says:

      Learn to use PubMed.

      1. It took me five seconds to find this (“Poland rubella” as search terms):
      Euro Surveill. 2013 May 23;18(21). pii: 20485.
      Ongoing outbreak of rubella among young male adults in Poland: increased risk of congenital rubella infections.

      2. Again, learn to use PubMed, http://www.ncbi.nlm.nih.gov/pubmed/?term=aluminum+adjuvant+mechanism … or just read the first three chapters of the CDC Pink Book. I hope you understand that when you fall in dirt and get a scrape you will get an immune response, from lots of things. Of course one big component of soil minerals are aluminum.

      3. Okay, what are those vaccines, because I only know of one? But you might be interested in these studies.

    3. Hi Tomasz,

      Do you know for example about any research regarding vaccinations of infants in first day of life with two different vaccines?

      Which two vaccines are you speaking of? I looked up the Polish schedule, which mandates the BCG vaccine within 24 hours of birth and the Hep B vaccine.

      The US mandates neonatal administration of the Hepatitis B vaccine only, and does not mandate the BCG vaccine at all (I am guessing because of low risk).

      In a quick dig through PubMed, I found a few abstracts. I don’t have access to the full papers, so don’t have access to the citations which would lead to more, of course.

      http://www.ncbi.nlm.nih.gov/pubmed/18155811

      http://www.ncbi.nlm.nih.gov/pubmed/19089811

      http://www.ncbi.nlm.nih.gov/pubmed/20619374

      1. Alia says:

        In Poland BCG vaccine is obligatory because tuberculosis used to be a huge problem here (and that’s also why, as a teacher, I had to undergo chest X-ray every 5 years). And since it is resurging just outside our borders (Ukraine, Belarus and particularly Russia) I think this requirement is sensible.

        As for rubella vaccine, I remember that when I was 13 or 14, all girls from my class were ushered into our school nurse’s office to get the rubella vaccine. The nurse explained that only girls get this vaccine because rubella is dangerous only when you’re pregnant, so no need to give it to boys.

        And now I will tell you all a story about why my mother was always sure to keep me and my sister up to date on all mandated vaccines. My maternal grandmother had four children. The oldest and the youngest died of vaccine-preventable childhood infection. My grandmother could not stand it and killed herself, leaving two small children with my grandfather.

    4. WilliamLawrenceUtridge says:

      Adjuvants don’t “boost” the immune system. They are localized irritants or other modifiers, not systematic “boosters”. Squalene, for instance, is basically a thickener, so the antigents aren’t dispersed from the injection site. Each is selected rationally based on the scientific evidence behind them. You would have to look up each adjuvant in the scientific literature, for instance squalene in a RCT. You could also look on the CDC’s website.

      I don’t know where the idea that adjuvants are chosen at random (or to inject nanobots into health freedom activists). They’re there for a reason.

  30. Krebiozen says:

    What is the goal of complete eradication of some of these nasty diseases?

    I have read it, and reread it, but I still have trouble believing that an apparently intelligent person actually posted this question. Extraordinary.

  31. jay gordon says:

    The structure of this blog is just too strange for me. Posts appear, disappear and get held for a day in moderation.

    Dr. Hickie, my pediatric colleague, please relax. Go for a run, have sex, drink a glass of wine. You are truly far too exorcised right now. Also, join the American Academy of Pediatrics and see what good you could do for children.

    AutismBeatNews–Of course I’ve made mistakes. And I’m very invested in my vaccine point of view. That will not keep it from changing as new data and research come my way.

    For a little while, this place felt different that Orac’s den of hooligans. Then the tone trolls came in with the same nasty rhetoric and name calling. (“Idiots” and “fuckheads.” As the saying goes, do you eat with that same mouth, Dr. Hickie?)

    Dave, I support parents’ decisions. Everyone knows my ambivalence and my opposition to the incredibly unscientific and potentially dangerous “routine” schedule. Parents don’t walk into my office and suddenly get blind-sided.

    I think I’ll stay out of here for a while. The tone trolls make me uncomfortable.

    Have a nice weekend, all!

    Jay

    1. DrDuran says:

      Why would new data change your opinion when you ignore the current data?

    2. AnObservingParty says:

      Can I ask what “data” you currently use? Because quite frankly, I’ve read the data, and your “point of view” boggles my mind.

    3. calliarcale says:

      Jay: “Everyone knows my ambivalence and my opposition to the incredibly unscientific and potentially dangerous “routine” schedule.” Well, it is nice to finally hear you admit to being actively opposed to the vaccine schedule, not just “supportive” of your patients’ decisions, and admitting that you evidently tell them about that (since how else would they know?).

      If I walked into your office, not knowing who you are, and asked you to give my child her well-child checkup at a time when a vaccine was due, and you trotted that out, I would feel very blind-sided indeed. When I go to a doctor, I do not expect to to be fed a bunch of malarkey by someone so invested in a viewpoint that he puts it ahead of data, and I definitely do not expect to have “my decisions supported” by a doctor who clearly would rather not bear any responsibility for medical decisions made for a patient under his care. Is that why you went into pediatrics, I wonder? So you could diffuse responsibility between yourself and the parents?

    4. cphickie says:

      I’d also like to now not thank the governor and state legislature of Arizona for recently allowing (by law) foster care children to be placed into unvaccinated foster homes (actually, the law used to read you couldn’t get a foster license without proving everyone in your home was current on their vaccines–now that is no longer a requirement). That’s just insane–if you’re an infant or toddler who just got beaten within inches of your life, you can be now placed into a foster home where you are at much higher risk for diseases that could be the final nail in your coffin if you suffered head trauma or are on a vent or have a g-tube. Just flippin’ wonderful. Coming next, I fear is the question of whether such a foster parent who won’t vaccinate their own biological child has the right to refuse vaccination of a child they are fostering (as legally the state is the legal guardian of a child in foster care, NOT the foster parent). I sure hope not.

    5. WilliamLawrenceUtridge says:

      The tone trolls make me uncomfortable.

      Do you mean “tone trolls”, or people who point out your beliefs appear to be irrational? Or the people who are frustrated by your own inability to engage with the implications of your decision to support the fears of antivaccinationists? Do you desire to return to the good old days of medicine where your opinions as a doctor would never be challenged? That would be an ironic complaint.

      Why do you think the “routine” schedule is unscientific? Do you think your alternative practice is more scientific? On what basis do you judge one to be superior to the other?

      Is that the kind of think you dislike when you talk about “tone trolling”? Because that’s really just applying basic logic to some of the things you say.

      Anyway, you’ve apparently left, but whatever. I didn’t expect a response anyway, you’ve consistently failed to avoid answering my questions every time you show up here.

    6. David Gorski says:

      “Idiots” and “fuckheads.” As the saying goes, do you eat with that same mouth, Dr. Hickie?

      Actually, I need to reinstitute our filter for the f-bomb. I don’t think I reinstalled our profanity filters after the big hack and change in template.

  32. Krebiozen says:

    Dr. jaY,

    You are truly far too exorcised right now.

    I don’t think that’s what you really mean. I don’t think one can truly be too exorcised, unless perhaps a demon or two in possession keeps the spiritual immune system on its toes…

  33. DugganSC – on HPV vaccine “When commonsense precautions work just as well, why require mass vaccinations at an early age?”

    Because common sense precautions don’t work so well. From the CDC website.

    “Who is at risk for HPV?
    Anyone who is having (or has ever had) sex can get HPV. HPV is so common that nearly all sexually-active men and women get it at some point in their lives. This is true even for people who only have sex with one person in their lifetime.”

    http://www.cdc.gov/std/hpv/stdfact-hpv.htm

    Now personally, I don’t expect my children to remain celebate their whole life. For one thing, I’d kinda like to have grandkids, if possible…so, I see no reason NOT to protect my children when they are the appropriate age for the vaccine. We’ve been saving for college since they were babies. This is just another step we need to take in advance to help them start their adult life in the healthiest way possible.

    1. Chris says:

      “Now personally, I don’t expect my children to remain celebate their whole life.”

      Apparently one of my younger son’s friends thought it would be funny to reveal that he had a girlfriend as a college freshman. I just rolled my eyes. Then the friend blurted out that “Whoa they might have had sex.” Again, I rolled my eyes. I just told him that is was not unexpected. (the friend’s parents are both university parents, so he was surprised at our cavalier attitude to normal college life).

      1. Chris says:

        “he had a girlfriend as a college freshman”, was a reference to my younger son. I re-read that, and it did not seem clear.

        By the way, I have decided I don’t need grandchildren. There are many reasons, the major one being that I did not have kids until my thirties, so I will be old. I also want them to live their lives without fulfilling my fantasies.

        Plus, I am pessimistic about our planet’s future. I would rather fewer experience that.

        1. Tanget – For myself, I don’t need grandkids. I just think it would be cool. I’m also an older parent…that’s why I added the caveat “if possible”. I was never pressured to get married and have kids. I wouldn’t want to do that to my kids either. But, I’ve always been sad that my mother never met my kids, cause even if she would have been pretty elderly, she would have enjoyed the heck out of them.

          My daughter has often said she wants to adopt, so I guess she could remain celebate. :) But wouldn’t that be sad. Typical adult lives include a healthy sex life, I really don’t understand the pre-occupation of trying to treat a child like they will never become an adult.

      2. windriven says:

        What is it about kids of a certain age that gives them leave to believe they are the first to figure out what to do with their naughty bits?

        1. Chris says:

          Their youth and lack of experience with the real world?

  34. jay gordon says:

    Tomasz says:
    September 7, 2013 at 1:34 pm
    “1. You mention Poland. Please show me your source data. There is no source for nation wide data collection regarding vaccines, epidemiology and adverse effects. There are law
    suits pending, so I’m very interested about your source of knowledge.
    2. What is the mechanism of adjuvants in your opinion? Please explain to me, how it is possible, that specific adjuvant boosts the response of immune system for only one virus/bacteria (from vaccine) and not for the whole potentially allergic pathogens/proteins?
    3. You mention about long term effects – please show me your source data which are relevant to conclusions about whole populations. Do you know for example about any research regarding vaccinations of infants in first day of life with two different vaccines?”

    Did you all really miss this one?? We have no idea what happens when one vaccinates a baby in the first few hours of life with two “adjuvanted” vaccines. No idea at all.

    Scientists . . .

    1. weing says:

      “We have no idea what happens when one vaccinates a baby in the first few hours of life with two “adjuvanted” vaccines. No idea at all.”
      And that means…….?
      Do we have any idea of what happens when one colonizes a baby with live bacteria and fungi in the first few hours of life outside the womb? Yes.

      Do we have any idea of what happens when the umbilicus becomes infected with C. tetani in the first few hours of life, if the mother hadn’t been immunized? Yes. Do I want to test this in humans? No.

    2. Chris says:

      Dr. Jay:

      Did you all really miss this one?? We have no idea what happens when one vaccinates a baby in the first few hours of life with two “adjuvanted” vaccines. No idea at all.

      Scientists . . .,

      Dear, Dr. Jay, pediatrician to the stars: what policy in the the United States of America requires anyone to vaccinate a newborn with two vaccines?

      It has been established that Tomasz is in another country. Which would have other issues. And none of then you, a pediatrician who does not accept health insurance, would understand.

    3. AnObservingParty says:

      Ok, so here you’ve just demonstrated a gross misunderstanding of the dangers of endemic tuberculosis. What, pray tell, is enough to make a disease significant enough to be vaccinated against? I mean, TB is right up there in the record books with small pox and malaria…and it fairly easily spread, hence the negative pressure and N-95s and the not-leaving-your-house. There;s a reason most healthcare-workers are required to be tested for a baseline every few years (we do every year, in my hospital). Or do you not require TB screening in your office?

      And, also, do to your billing practices and your interesting views, I doubt you see many parents who belong to one of the biggest risk groups for HBV infection: healthcare workers. And last I knew, birth is a blood-bath.

      You seem to be under the impression–like many of your ilk–that vaccines are just tossed out the day after someone thinks of one. You also clearly have no clue about the precarious math game that all medical treatment is, or the very real danger of some of these diseases. Of course, unless it affects your padded little consumer base, I can see how that might me. Perhaps you should visit a cemetery from the turn of the 20th century and examine some of the gravestones. You also seem to be under the impression that vaccines fester and fundamentally mutate the child over time, instrincally different concerns than those for the very rare adverse reactions like anaphylaxis, the intussusception from the first Rotavirus vaccine, or the unfortuate risk of poliomyelitis from the live oral polio vaccine. Interestingly enough, those last two resulted in a change, because there was an actual, demonstrable risk that was presented by that vaccine and that vaccine alone, and there was a safe alternative that still provided benefit out-weighing the risk. You seem to be under the impression that we are not 100% certain of a specific event in the future, it must be off the table. I don’t know what long-term effects will show up from being on long-term sulfamethoxazole-trimethoprim for those chronic ear aches (well, aside from being colonized with MRSA, but who knows if it actually caused it), but you know what? I didn’t die of mastoiditis or sepsis as a child, so I’m gonna say the risk was worth. Do you prescribe any medication for your children? Or is it just with vaccines that the 100% safety record i–oh wait, yeah. Ok. You know, I always forget it, or rather, maybe I repress it, because it’s so disgusting…there really are people who believe it’s better for a child to be dead than disabled. But in the majority of cases that is a moot point anyway, BECAUSE VACCINES DON’T CAUSE AUTISM.

  35. wrysmile says:

    Just a little tip a tone troll is the one complaining about the language not the one spouting the bad language. i.e. you Jay

  36. lilady says:

    I thought you announced you were leaving Dr. Jay.

    “Did you all really miss this one?? We have no idea what happens when one vaccinates a baby in the first few hours of life with two “adjuvanted” vaccines. No idea at all.

    Scientists . . .”

    Scientists have more than “ideas” about what happens when one vaccinates a baby in the first few hours of life with two “adjuvanted” vaccines. The safety and efficacy of BCG AND Hepatitis B vaccines given at birth have been researched, especially by scientists and researchers in those countries of the world which administered both vaccines at birth. Why don’t you explain to us why it is so important to administer the BCG to babies in areas of the world with high endemic rates of latent TB infection and active pulmonary TB?

    It took me about five minutes using my google fu skills to locate an article published in the European Journal of Immunology:

    http://onlinelibrary.wiley.com/doi/10.1002/eji.200838620/pdf

    Safety and efficacy of neonatal vaccination

    Alicia Demirjian

    and Ofer Levy

    Department of Medicine, Division of Infectious Diseases, Children’s Hospital Boston, Boston,
    MA, USA

    Harvard Medical School, Boston, MA, USA

    “Newborns have an immature immune system that renders them at high risk for infection
    while simultaneously reducing responses to most vaccines, thereby posing challenges
    in protecting this vulnerable population. Nevertheless, certain vaccines, such as BCG and
    Hepatitis B vaccine, do demonstrate safety and some efficacy at birth, providing proof
    of principal that certain antigen–adjuvant combinations are able to elicit protective
    neonatal responses. Moreover, birth is a major point of healthcare contact globally
    meaning that effective neonatal vaccines achieve high population penetration. Given
    the potentially significant benefit of vaccinating at birth, availability of a broader range
    of more effective neonatal vaccines is an unmet medical need and a public health
    priority. This review focuses on safety and efficacy of neonatal vaccination in humans as
    well as recent research employing novel approaches to enhance the efficacy of neonatal
    vaccination…..”

    1. elburto says:

      You know he can’t stick the flounce or take the heat, bless him.

      And of course he’s cavalier about TB, his wealthy clients are unlikely to be exposed, and he’s already indicated (in past discussions)that he doesn’t particularly care about poor children, children in developing countries, immigrant children etc.

      One wonders if he’d change his mind if he were exposed to a case of TB, MDRTB in particular. What if one of his towheaded, blue-eyed, pink-cheeked clients ~of the stars~ was taken on holiday to India, or Brazil, or even near the US-Mexico border, and was exposed to TB. What then?

      Oh and Jay, since you’ll be reading this, you’re not so special that people follow you around the internet. Probably half of the regular commenters here also comment at RI, the cross-pollination is wide. We were here first, so keep the paranoia in check OK sparky? It can’t be good for you.

      1. calliarcale says:

        There’s a fantastic series of videos on YouTube by a guy in Australia who caught MDRTB and was placed in quarantine for the duration. His friends brought him a videocamera to give him something to do, so he created a video log of his “adventures” in isolation. His sense of humor is clearly affected. ;-) Look for “The Fully Sick Rapper”.

  37. Whether or not you believe in God or whatever is besides the point of my following comment in relation to the article you posted (specifically the point about the Texas church believing God will protect them from infectious disease rather than get vaccinated), you will all find it hilarious me thinks-

    “Look at these people, thinking I will help them when they are doing something so stupid”
    -God.

    (Also I am pretty sure it was God who brought the plague to Egypt in the Bible, but I am not a religious scholar )

  38. Krebiozen says:

    Tomasz (and Jay too),

    Please explain to me, how it is possible, that specific adjuvant boosts the response of immune system for only one virus/bacteria (from vaccine) and not for the whole potentially allergic pathogens/proteins?

    Short answer: it’s a local effect, not a systemic one. Aluminum adjuvants, for example, adhere to the cell membrane of dendritic cells which stimulates them to pick up antigens. They may also kill cells locally, stimulating the local immune system.

    I. and probably others, have speculated that this mechanism evolved to prevent infections from cuts and abrasions that are contaminated with soil, which contains both pathogens and lots of aluminum.

    What is the mechanism of adjuvants in your opinion?
    We know quite a lot about this, contrary to what you will read on a thousand antivaccine websites. We have a very good idea of how adjuvants work. There’s a good basic explanation of this on Wikipedia. It’s true that we don’t understand this in every detail, but if we didn’t use any kind of technology until we understood it perfectly we would still be back in the stone age.

    Anyway, if adjuvants had the deleterious global effects that antivaxxers attribute to them, we would all be in serious trouble since many of them are ubiquitous in our environment and/or diets.

  39. duggansc says:

    @WLU:
    Lung cancer is one of the negative health effects from smoking. Yes, it would probably be worthwhile to eliminate one negative health effect if it’s cost-effective to do so (one of the things that repeatedly comes up on this blog is that cost-effectiveness is important to consider — spending millions to save one patient versus spending it to save many, spending a little to prevent the disease rather than more to spend it). But to me, widespread use of the HPV vaccine just in case seems like forcing the expense of an anti-lung-cancer vaccine on everyone whether or not they plan on smoking on the idea that if they choose to smoke, they’ll be protected from one aspect.

    *shrug* And yeah, I speak as a non-smoker and someone who avoided sex before marriage, so I’m probably underestimating the force of will it takes not to take up either of those habits.

    1. WilliamLawrenceUtridge says:

      I will admit that the HPV vaccine is not in the same class as polio, (formerly) smallpox and pertussis. Not even chicken pox. But I still think there is good reason to vaccinate. HPV is safe and effective, it prevents some cases of cervical cancer, and there are non-cancer benefits too (warts for instance).

      Would your opinion change if the vaccine cost less? At $360, it’s quite expensive. What if it cost only $5 per shot, or for all 3?

      I’ll also point out that vaccination is always forcing the expense of those who would suffer severe effects onto everyone; most people escape the ill-effects of vaccine-preventable diseases. But you don’t know who will be fine and who will die, so…vaccinate. Any daughters I might have will be vaccinated according to the recommended schedule, and I will pay the cost out-of-pocket quite happily.

      Though this is one vaccine where there is considerably more room to argue and come to different conclusions. However, given the risk and benefit analysis of the vaccine (risk of getting it: sore arm; benefit of getting it: reduced risk of cervical cancer; risk of not getting it: death by preventable cancer; benefit of not getting it: ???) I am quite in favour of vaccination. Ideally universal and publicly-funded.

      1. Chris says:

        WLU: “I will admit that the HPV vaccine is not in the same class as polio, (formerly) smallpox and pertussis. Not even chicken pox.”

        Perhaps, but while chicken pox caused thousands of hospitalizations with about a hundred deaths per year in the USA… the HPV virus does cause a great deal of injury. From an article elsewhere, Why Some Parents Are Refusing HPV Vaccine For Their Children:

        In addition to the 10,300 women who get cervical cancer from HPV infections in the U.S. each year, there are thousands of others in the U.S. diagnosed with other HPV related cancer each year: 2,100 vulvar cancers, 500 vaginal cancers, 600 penile cancers, a combined total of 4,300 anal cancers in both men and women, and 8,400 oropharyngeal cancers in the head, mouth and neck among both men and women.

        In the developing world, the HPV caused cancers are very very high. It would be great to see the price go down and delivered to those countries.

      2. elburto says:

        Duggan’s issue is that he thinks women should have to face the “consequences” of sex. He is anti-choice, unsurprisingly, and of that particular stripe of religious batsh¡ttery that treats women as whorish Jezebels, and sees pregnancy and STIs as god-given punishments for not conforming to a very narrow ideology that insists that women should remain “pure” until their father hands them to a new owner, and then sex is presumably only permitted for procreation.

        Anyone who refers to sex as a “habit” is not exactly sex-positive, and he’s aired his rather judgemental anti-choice viewpoints here at SBM before, under both of his Anyone who refers to sex as a “habit” is not exactly sex-positive, and he’s aired his rather judgemental anti-choice viewpoints here at SBM before, under both of his ‘nyms.

        The cognitive dissonance that must be present in those who believe that sex is a filthy, dirty, evil, disgusting “habit” that you must save for the love of your life, must be debilitating.

  40. jay gordon says:

    I know you think you know how to define “tone trolling.” You’re wrong.

    Tone trolls wander through the Internet looking for mutually beneficial exchanges of information and change the tone of every post to their liking. Usually they change the tone from collegial and informative to nasty, uncivil and profane.

    Calling people “idiots” and “fuckheads” (Dr. Chris Hickie, please answer the simple question I asked: Do you eat with that same mouth and speak to children with the same mouth that called me a fuckhead? Why would you speak to anyone that way? In person or in a blog post?)

    A place like SBM could be a wonderful site for information exchange but when anyone with an opinion different than these sad trolls participates the trolls begin to curse, call names and eliminate meaningful discourse. I recommend a separate website called something like “Perseveration Based Medicine.”

    1. elburto says:

      Nope. The definition of a ‘tone troll’ is someone that says things along the lines of “Your message is worthless because you used naughty words!”. Sound familiar?

      Words have meanings. You can’t just make up your own definitions for terms and expect others to know what’s going on inside your head.

    2. David Gorski says:

      Tone trolls wander through the Internet looking for mutually beneficial exchanges of information and change the tone of every post to their liking. Usually they change the tone from collegial and informative to nasty, uncivil and profane.

      No, Dr. Jay. That is most definitely not the definition of a “tone troll.” You do not get to redefine words to suit your purpose. You are either clueless about what a tone troll is or you are trying to redefine it so that you can make like PeeWee Herman and say, “I know you are but what am I?”

      These are a couple of representative definitions of what a tone troll is:

      http://rationalwiki.org/wiki/Tone_troll
      http://www.urbandictionary.com/define.php?term=Tone%20troll

      Notice that the tone troll is the person calling for more “civility” and bemoaning the “meanness” and “viciousness” of those making arguments he opposes.

    3. cphickie says:

      Calling people “idiots” and “fuckheads” (Dr. Chris Hickie, please answer the simple question I asked: Do you eat with that same mouth and speak to children with the same mouth that called me a fuckhead? Why would you speak to anyone that way? In person or in a blog post?)

      Gordon–you show up here like the type of twit who, if you were religious, would try to trick up your parish priest about eating meat on a Friday by asking if it was ok to do so if you were doing so on a plane as it crosses the international date line. Except the topic you like to mentally masturbate over is immunization and you display a clear and deliberate ignorance of the science behind vaccines, infectious diseases and the vaccination schedule. So, after seeing you post who knows how many of these smarmy, self-serving “questions” you contrive–of which I guarantee you really don’t give a sh*t about the answer, I do have to conclude you are a shithead, etc. When I taught physics lab to premeds when I was in grad school (for my stipend), it was easy to spot your type (thankfully not common)–the pre-med who wants to be a physician, but for all the wrong reasons. I have no patience for your ilk, Gordon, and you deserve every invective that is hurled your way for the awful damage you are doing to US vaccine infrastructure. You know, Gordon, if you quietly ran your little dysfunctional practice, none of us would know of your pathetic existence and you could have your own little pocket of unvaccinated patients probably only known to your local health department. But instead, you (and Sear) have this despicable need for fame and monetary gain from your antivaccine views and thus you have made what you do everyone’s’ business. You chose to be a public figure, go on TV, radio, magazines, blogs, facebook, webinars, newspapers, etc, and you’ve chosen to practice medicine and give medical advice (to the whole world) that is well outside the standard of care, and quite honestly constitutes medical malpractice.

      In summary, you brought this on yourself Gordon and you deserve it. I’ll call you these names in person if ever we meet and you’re still doing and saying the same pitiful rot. You are directly contributing to these outbreaks of vaccine-preventable diseases in the US, and for someone who likes to proclaim their MD, FAAP, for you to say and do the things you do, well, there are no civil words to describe you. I have no sympathy for people who hurt kids, be they child abusers, murderers or medical frauds. The frustrating part about you Gordon, is that as a fraud, you are tougher to flush out because you can still fool some people into thinking that you actually care.

      Chris Hickie, MD, PhD

  41. jay gordon says:

    “Adjuvants don’t “boost” the immune system. They are localized irritants or other modifiers, not systematic “boosters”.”

    Yes, according to the CDC, they affect the immune system. They don’t just cause “local” irritation, although that’s usually the most visible side effect, which may include abscess formation.

    http://www.cdc.gov/vaccinesafety/concerns/adjuvants.html

    http://www.ema.europa.eu/docs/en_GB/document_library/Scientific_guideline/2009/09/WC500003809.pdf

    (This comment will probably be held in moderation for a week.)

    1. AnObservingParty says:

      My understanding from Krebiozen’s comment was that while the adjuvant worked locally, the response itself is systemic, from the immune system, towards that heavily local reaction. Same way my systemic immune system may respond from any other local irritant.

      Please correct me if I’m wrong, Krebiozen. Nobody is saying the immune system doesn’t respond systemically to a local irritant. Much like if I find a single moldy container in my fridge, a localized incident, it will very much prompt me to do an entire clean and keep a better eye out on the entire space for moldy food. Until such time that I forget, of course.

    2. WilliamLawrenceUtridge says:

      Funny, neither of those links included any mention of abscesses.

      Also “affect the immune system” is imprecise; technically, feeding someone through a wood chipper would “affect the immune system”. The effect of the adjuvant is local, allowing the vaccine to be effective with a smaller number of antigen particles. The effect of the vaccine is systemic.

    3. MadisonMD says:

      Jay Gordon:
      Lets forget about all the arguments about language and tone and get to the point.
      From your comments here, I surmise that you estimate the risk/benefit for any vaccine much differently than most scientists and pediatricians. I gather this because of your comments about how measles is not worth a million words, is not as serious as the plague, and that you are very concerned about the risks of adjuvants. Obviously, most individuals here would agree that any medical intervention requires an assessment of risk and benefit. Most public health officials, physicians and societies find that in general the risk/benefit ratio for vaccines is so overwhelmingly positive that a vaccine that is proven safe and effective singly, then it should be implemented. However, you seem to be very concerned about the–apparently theoretical?–risks of early or concurrent administration of vaccines.

      Since you have carefully weighed this risk/benefit ratio, I’m hoping you can share this assessment. In particular, I’d like to hear your assessment of risks and benefits of selecting the standard AAP vaccine schedule versus yours (maybe you can tell us what your recommended schedule is–let’s call it JG):
      (a) With JG schedule vs AAP schedule, what in your estimation of the excess in vaccine-preventable deaths or serious injury per 100,000 children?
      (b) With the AAP schedule vs JG schedule, what in your estimation is the excess number of serious vaccine-caused deaths or serious injury per 100,000 children? (And are these risks theoretical or demonstrable?)

      I don’t mean to assign you a major project, but clearly, you have made such a risk/benefit assessment and feel strongly about it. Perhaps it is not too much to anticipate that you have already carefully thought this out.

      1. calliarcale says:

        ” I gather this because of your comments about how measles is not worth a million words, is not as serious as the plague”

        I just had a thought. In the US, we have a few pockets of endemic plague, mostly in the west, and mostly associated with prairie dog towns. We do not have endemic measles; all measles cases in recent years have been traced back to recent international travel. And yet, there are an average of only seven human cases of plague each year in the US. In 2011, there were 222 measles cases.

        There are vaccines in the works for plague; I wonder if they will meet with Jay’s approval.

    4. Chris says:

      Dr. Jay: “I think that people who vaccinate late (after age two years) and slowly (one vaccine at a time) are minimizing risk and shouldn’t be terrified of vaccines.”

      Do you have any evidence that actually works. Japan tried to suspend pertussis vaccination until the child turned two, but that caused the death of over forty infants: Philosophic Objection to Vaccination as a Risk for Tetanus Among Children Younger Than 15 Years.

      You really need to bring more actual data to this conversation.

    1. AnObservingParty says:

      Excellent choice of authors. Todd W. has done a lovely choice of highlighting some conflicts of interest with Shaw and Tomljenovic.

    2. WilliamLawrenceUtridge says:

      Yes, scientists. Like this one, who wrote a paper on the effects, effectiveness and 70-year safety record of aluminum as an adjuvant.

      And I’ll still trust the multiple experts of the CDC to assess the safety and efficacy of the vaccine schedule and ingredients over you, Dr. Jay. You may be more expert than I – but you’re definitely not more expert than they. It’s ever an assymetrical war – on one side, the near-unanimous consensus of relevant experts. On the other, a small number of nonspecialists who do not research, do not publish, base their decisions on anecdotes and instinct, and take their concerns directly to the press and population (and whose waiting room has been identified as a source of spreading contagion of vaccine-preventable diseases). You are like the Westboro Baptist Church, given news time and headlines merely because of your willingness to misrepresent and offend – not because of the merit of your position.

    3. Oh, dear, Jay, you really shouldn’t have chosen either Lucija Tomljenovic or Christopher A. Shaw as “objective scientists”. Either or both.

      Lucija Tomljenovic was the conference organizer for the 2011 “Vaccine Safety Conference” that Matt Carey discussed in detail.

      http://leftbrainrightbrain.co.uk/2011/10/06/the-2011-vaccine-safety-conference-in-jamaica/

      The Albert J. and Lisa Claire Dwoskin Family Foundation was a major funder of that conference; Claire Dwoskin also funded and served as a board member for Barbara Loe Fisher’s “National Vaccine Information Center” (NVIC), one of the major players in the anti-vaccine movement.

      Since about 2010, Tomljenovic’s papers, and Shaw’s papers, have been funding by Dwoskin and two other smaller foundations.

      Objective? Independent? I think not.

    4. Todd W. says:

      @Jay

      As AnObservingParty mentioned, I did happen to write about Shaw and Tomljenovic. Now, their conflicts of interest are not to say that the paper you linked to is invalid, but it does suggest that it’s a good idea to be a bit more demanding of rigor in their methods and data presentation. Taking a look at that abstract, it appears to be a review article. Unfortunately, I don’t have access to the full paper at the moment, so I can’t check to see exactly what they did. Did they simply review the literature? If so, what criteria did they use to select studies to include in their review? Given their history of dodgy research, coupled with their longer history of being funded by and, miraculously, always finding results that support anti-vaccine groups, I would wonder what kind of cherry picking they might be doing.

      All that aside, though, did you really think it would be a good idea to cite them here? Did you expect to be taken seriously?

  42. wrysmile says:

    Sorry you don’t get to redifine what a tone troll is “A tone troll is an internet troll that will effectively disrupt an internet discussion, because they feel that some of the participants are being too harsh, condescending, or use foul language.” In no definition of the phrase is it ever the commenter who uses the foul language etc.

    Maybe this is the problem – you need to just admit when you are wrong sometimes

    1. Jay Gordon says:

      This is incorrect. A tone troll is someone who posts in a disruptive or dissonant tone to take over a conversation.
      There are excellent examples on this page.

      1. David Gorski says:

        My goodness, Dr. Jay. You just don’t give up even when you’re completely wrong (and you are completely wrong about this). I provided you with links with definitions. You blithely ignored them. Hmmm. come to think of it, that’s what you do. It’s the same way you ignore data and studies that we post showing vaccine safety and how vaccines do not cause autism. It’s also the same reaction you have when we show you time and time again how “personal clinical experience” can lead a clinician astray. Yet you continue to assert the supremacy of your “30 years of clinical experience” when it comes to the question of whether vaccines cause autism.

      2. Wrysmile says:

        Oh sorry that definition of tone troll its just like the rest of your assertions – totally made up. Come on Jay just admit your wrong on this one thing at least.

  43. Rob Cordes, DO says:

    Dr Jay,
    You said in an earlier reply “I think that people who vaccinate late (after age two years) and slowly (one vaccine at a time) are minimizing risk and shouldn’t be terrified of vaccines”

    How does one do “one vaccine at a time” when DTaP is three vaccines, IPV is four, pneumococcal (PCV-13) is thirteen vaccine etc?

    The “one vaccine at a time” idea seems to me a marker of someone who does not understand what they are talking about.
    How many antigens are in those vaccines vs the number of antigens from bacteria in our intestinal and respiratory tracts.

    Giving multiple shots does not increase the baby’s stress level over a single shot.

    Ramsay, D. S. and M. Lewis. “Developmental Changes in Infant Cortisol and Behavioral Response to Inoculation.” Child Development 65 (1994): 1491–1502.

    Single injections over multiple visits increases the number of stressful events for a child. It also unnecessarily increases the risk of the child being in a motor vehicle crash and burns more fossil fuel contributing to climate change.

    1. Jay Gordon says:

      Wrong

      1. David Gorski says:

        Evidence, please, Dr. Jay?

      2. DrDuran says:

        Wow! You really put him in his place!

        How about something, anything to back up your crap?

        1. You are obviously referencing an incorrect definition of the word “wrong.” Dr. Jay’s definition is the only one that matters.

      3. WilliamLawrenceUtridge says:

        Children believe in magic, believe that if they insist, if they believe strongly enough, if they clap their hands hard enough, the fairy will come back to life. I expect better of adults than a simple one-word insistence. Coming back with responses like these rather undercuts any credibility you might still have. Confidence and a white coat might work to convince uneducated parents who bring their children into your practice. It does not work in a blog with the word “science” in the url, particularly if the blog actually means it. Please do not expect to be taken seriously with responses equivalent to “I’m going to hold my breath until you change your mind.” You will just asphyxiate.

  44. Krebiozen says:

    duggansc,

    But to me, widespread use of the HPV vaccine just in case seems like forcing the expense of an anti-lung-cancer vaccine on everyone whether or not they plan on smoking on the idea that if they choose to smoke, they’ll be protected from one aspect.

    Huh? Everyone who has any physical contact with other humans is at risk of HPV infection. Sex is by far the commonest but by no means the only means of transmission. It isn’t “just in case”, we know that most people contract HPV, and that in thousands of these people, which of them we have no current way of identifying, it will lead to cancer. Unprotected sex is, after all, necessary if we wish to propagate our species, which some people appear to forget.

    We should of course target high risk people when we can, but in the case of HPV (and hepatitis B) we can’t.

    *shrug* And yeah, I speak as a non-smoker and someone who avoided sex before marriage, so I’m probably underestimating the force of will it takes not to take up either of those habits.

    How does marriage protect anyone from HPV infection? I was infected with chlamydia by my first wife, which was my first clue that she was having an affair. She was my second sexual partner, and I was entirely faithful to her. I could just as easily have contracted HPV. I am by no means the first or last person with “good habits” to have contracted an unexpected STI from their spouse.
    [Note to Jay and other critics of anonymity on these blogs - this is something I would not feel comfortable sharing if I was not anonymous, and I think it's important we talk about these matters, so sometimes anonymity does more than just protect the commenter from lunatics.]

    Some people seem to live in a fantasy world where people don’t have any sexual contact before marriage, and are monogamous for life once they are married. That is not how humans behave in practice .

  45. DugganSC “*shrug* And yeah, I speak as a non-smoker and someone who avoided sex before marriage, so I’m probably underestimating the force of will it takes not to take up either of those habits.”

    First, you said sex. Of course you must have meant that you avoided all contact of a sexual nature, because that can transmit HPV as well.

    Personally, If I was going to assume that my children choose not to have any contact of a sexual nature until they were married, I would still be considering the scenario where they fell in love with and wanted to marry an intelligent, caring, considerate person, who had had a previous partner(s) or marriage. The unfortunate chance that their spouse may have an affair, or of a sexual assault.

    But then again, I wouldn’t assume a scenario where my children do exactly what I’d like…because in my experience children don’t. Teenagers and young adults, even ones with really excellent parents, make mistakes and do things their own way.

    Withholding a vaccination with the expectation that they will live life as you expect, offers more risk for them than benefit.

    1. Chris says:

      “The unfortunate chance that their spouse may have an affair, or of a sexual assault.”

      How would we know that the woman a son of ours would married was a victim of sexual assault and got HPV?

      And being from a step-family due to the death of my mother I know of another scenario:

      There is a chance the victim of a sexual assault could die prematurely from a cancer. This still makes the widower infected, which could infect his next wife.

    2. windriven says:

      I have three daughters. I always expected them to become sexually active at an appropriate age. And while I never had cause to have the specific conversation with any of them, I would have discouraged any of them from marrying someone with whom she had not had sex.

  46. duggansc says:

    @Elbuerto:
    Right. I guess when we get to the name-calling, we’ve run out of things to say. No, I’m one of those people who thinks that sex is cheapened outside of its proper setting. I’m no more anti-woman than doctors preaching vaccines are anti-autistics.

    Eh, in the end, this is one vaccine that I think could have a positive effect, but is better addressed behaviorly. I thank you for those who discussed it civilly with me.

    1. windriven says:

      @duggansc

      I would add two things:

      1. One’s moral compass is not always the best guide for setting public policy;
      2. A woman with a single lifetime sexual partner can easily become infected should her partner be less fastidious, paying the prices as it were for a ‘transgression’ she was not party to.

      On a personal note I do not suppose that you and I share the same sense of the ‘proper setting’ for sex. This goes to point 1 above. Sex is or can be a profound communication in or out of a monogamous relationship. But, at least in my moral landscape, it doesn’t always have to be. Sometimes it is enough just to be a rollicking good time.

      None of that second paragraph is either here nor there. From a public policy standpoint I am at a loss to understand the utility of not vaccinating against any potentially catastrophic disease no matter what route of transmission.

      1. duggansc says:

        I feel we can simply agree to disagree on the moral points. I feel like using an expensive vaccine in the matter is like having surgeons use broad-spectrum antibiotics to protect their patients instead of washing their hands. It’s more convenient in some ways, because you don’t have to depend on people to behave, but I feel like it’s missing the larger underlying problem.

        1. windriven says:

          “I feel like using an expensive vaccine in the matter is like having surgeons use broad-spectrum antibiotics to protect their patients instead of washing their hands.”

          The difference is that your prescription is for humans to avoid a very human activity – at least until marriage. If HPV could be washed off the way a surgeon washes her hands we wouldn’t be having this conversation.

          To press your analogy to a more accurate one, you are asking the surgeon not to wash her hands but to avoid touching anything with her hands outside of surgery.

          “It’s more convenient in some ways, because you don’t have to depend on people to behave, but I feel like it’s missing the larger underlying problem.”

          The larger underlying problem is the transmission of a potentially deadly virus, not the fact that unmarried people bump uglies. I think that transcends our differing moral perspectives.

          “you don’t have to depend on people to behave” is where our differing perspectives collide. I respect your right to behave in accordance with your moral code. I only expect that you accord me the same courtesy.

          1. duggansc says:

            I completely accord such courtesy. My viewpoint on most things based on morality and religion is that unless they directly impact me, it’s live and let live. Or, as I often say, I don’t believe that God put me on this world to judge people, just to collect specimens and return to my home planet. :)

    2. elburto says:

      No, I’m one of those people who thinks that sex is cheapened outside of its proper setting

      Yes, and your idea of the “proper setting” is after a woman has been handed over by her father to her new husband, and pronounced “married” by a priest.

      A very narrow definition of “proper setting” there, one steeped in misogyny and religious patriarchal ideas about sex and relationships.

      Sex does not have a “proper setting” apart from “consensual and fun”.

      Your disdain for women is obvious, and you clearly do believe that sex outside of a heterosexual, christian marriage contract should be punished. Why else would you believe that pregnancy and cancer should be unavoidable, unpreventable consequences of sex for women?

      What about women and girls who are raped or sexually assaulted? What about girls who contract HPV vertically? Don’t they deserve protection against cervical cancer and genital warts? Also, as has been pointed out upthread, HPV can colonise any area of skin or mucous membrane, not just the genitalia. Should people die in agony from oral cancers, anal cancers etc, just because of the narrow-minded beliefs of a small set of people?

      Oh, and you do know that men can get penile cancer as a result of HPV infection, don’t you? I suppose that doesn’t bother you either. I think, if I were a man, that the idea of being able to prevent penile cancer would strike me as something amazing and valuable.

      Oh, and please point out where I called you names? (What are you, five?) I reflected your beliefs back at you. If that touches a nerve then that isn’t my problem.

      This is “Science Based Medicine”. It deals in facts and science, not pre-mediaeval superstitious beliefs. Religion has no place in science whatsoever, and should not affect public health policy either.

      Not to mention that, if I’m remembering my childhood indoctrination correctly, your Jesus had some pretty strong views on judging others, forgiving people, and loving your fellow humans. I’m pretty sure that he never said “If a woman lieth with any man other than her husband, then her punishment shall be a long painful death from cervical cancer”. It just doesn’t sound very Christ-like, y’know? I’m fairly certain that he’d be against committing women to a lifetime of suffering for daring to have sex outside of procreative attempts with the virgin she married, nor would he be chuffed at his followers issuing moral judgements.

      1. windriven says:

        “Oh, and you do know that men can get penile cancer as a result of HPV infection, don’t you?”

        Hopefully without rekindling the smoldering debate surrounding circumcision I will add that circumcision, like HPV vaccination, reduces the incidence of penile cancer (so many Pubmed references I’ll leave it to the interested to play battling citations). I would go on to say that HPV vaccination compares very favorably from a cost standpoint to surgical circumcision while avoiding the issue of what some see as genital mutilation.

        As I live and breathe, I never thought I’d live to see elburto play the ‘What Would Jesus Do?’ card! :-)

      2. duggansc says:

        *sigh* I am sorry that I seem to have offended you, Elburto. I will return back to silence on the subject in interest of avoiding inciting additional discord. I disagree with you on the misogyny of my beliefs, but my experience is that arguing the point will just get you more incensed, so I merely wish you good day.

  47. duggansc says:

    @WLU (since my attempts to reply to comments seem to be showing up all over the place):

    Honestly, yes. A reduction in price would make me feel more favorably toward it. Part of the issue is that it’s an expensive solution to what seems to me to be a simple problem. As I stated in my reply to Elbuerto, I thank you for being willing to civilly discuss such matters with me, even in cases where we disagree. I love this website, but people seem to be getting really touchy these days.

    1. windriven says:

      @duggansc

      “A reduction in price would make me feel more favorably toward [HPV vaccines].”

      Is your objection moral or economic?

      Healthcare Blue Book puts the average price of a total hysterectomy – even with no indication of cancer – at roughly $9300 (surgeon plus hospital plus anesthesiologist). This says nothing of the cost of getting to that point or, perhaps most importantly, the emotional price paid by the woman.

      1. duggansc says:

        *half smile* A bit of both? I do believe that sex is meant primarily for marriage, but I also think that the mass vaccinations doesn’t work out economically. Yes, the cost of treating a disease is expensive. If there’s a cheaper way to prevent it, doesn’t it make sense to follow that route? Especially when it covers more than one virus?

        I know that I have a massive bias on this subject based on my moral beliefs. I try to set that aside in such discussions in acknowledgement that others have different beliefs, but it’s a very difficult thing to set such things aside. Just look at how people here tend to find themselves having to work hard not to jump on anyone who comes in commenting that they have doubts on vaccine efficacy, or stating that they think their massage works on their Multiple Sclerosis symptoms. It’s a hard thing to set aside hard-won beliefs.

        But, as with WLU, thank you for being civil with me.

        1. ebohlman says:

          If there’s a cheaper way to prevent it, doesn’t it make sense to follow that route? Especially when it covers more than one virus?

          The problem is that your “cheaper way” isn’t something that the individual who’s trying to minimize their (or their child’s) risk of HPV-related cancer can do all by him or her self; it only works if everybody does it.

          It’s quite plainly obvious that if nobody drove under the influence of alcohol, nobody would be killed or injured in alcohol-related traffic incidents. Now I’m personally extremely scrupulous about never driving when I have any alcohol in my system. Does that pattern of behavior reduce my chances of being killed or injured in an alcohol-related traffic incident? Of course it does. But does it reduce that chance to trivial or zero? No it doesn’t. Because I can still be killed or injured as a result of someone else driving under the influence. The fact is that everybody else would also have to make the same behavioral choices I did in order to eliminate my exposure to the risk. My own behavior isn’t enough to do that.

          And HPV is just like that. A woman who followed your ideals of “proper sex” would definitely reduce her risk compared to one who had multiple partners, but she couldn’t, all by herself, reduce it to the level that she could by being vaccinated. That would require her to practice lifetime chastity and ensure that she was never sexually assaulted. The first is unrealistic for most people; the second is impossible..

    2. elburto says:

      America =/= The World

      Not every country has a for-profit system that charges for vaccinations.

      Not only is this site not about religion, it’s not about medicine as practiced in the US, to the exclusion of the rest of the World.

      Try broadening your horizons a bit. Take a peek outside of your bubble, you might be surprised at what you see.

    3. MadisonMD says:

      Duggansc: You might be underestimating the seriousness of HPV as a “simple problem.” It causes cervical cancer, head/neck cancers, and less common penile cancers; these are devastating in morbidity and mortality. You might also be underestimating the total cost savings. Have you factored in the cost savings of eliminating pap screening?

  48. Mcmike says:

    Indeed, only nutcases would distrust the FDA and pharma companies. The human species is inherently broken, the only solution is more and more chemicals.

  49. cphickie says:

    Speaking of HPV vaccine, just picking up a current issue of a pediatric trade journal shows what poor editing is all about nowadays: http://imageevent.com/tacieandchrishickie/titleerror?p=0&n=1&m=-1&c=4&l=0&w=4&s=0&z=2

    Yes, apparently HPV prevents cancer (s/o)

    1. windriven says:

      Headline fail!

      I was also struck by the item above it: “Prophylactic Probiotics Reduce C. Diff. Risk.” I wasn’t able to read the text from your jpeg but I’m guessing that it referred to the Quebec study reported by Maziade, et al. But the issue is still controversial. I was surprised to see a blazing headline like that.

  50. This is addressed to dugganSC at 51 and previous.

    You feel that HPV could be controlled “behaviorally”, and previously that HPV can be “prevented”.

    Did you read or process any of I wrote at this comment?

    This is addressed to dugganSC at 51 and previous.

    You feel that HPV could be controlled “behaviorally”, and previously that HPV can be “prevented”.

    Did you

  51. jay gordon says:

    The tone trolling continues. The potential for an intelligent conversation flares up like small sparks from a nearly extinguished fire and then someone begins calling names again and presents ad hominem attacks as the underpinning of a weak argument.

    Tone trolls, go elsewhere.

    One cannot ignore the real medical literature about aluminum as a vaccine adjuvant. And, one certainly cannot ignore the potential danger of diseases which may return if we continue to lie to the public about the absolute safety and efficacy of all vaccines. We must improve manufacture (an “anomaly” Sanofi?) and scheduling of vaccines and must elevate the level of discourse.

    http://www.aafp.org/news-now/health-of-the-public/20130820dtapshortage.html

    1. David Gorski says:

      Dr. Jay, you’re just digging yourself in deeper. It’s quite clear that you really don’t know what you’re talking about with respect to tone trolling. You really don’t. Quite honestly, I’m embarrassed for you. I really mean it. It’s painful to see someone flail so badly because he clearly doesn’t know the commonly accepted meaning of a term and therefore soldiers on, trying to convince everyone that the term doesn’t really mean what it’s meant for a long time. Please stop. You’ll thank me later, although I might be too late to save you some profound embarrassment.

  52. jay gordon says:

    http://anothermrlizard.wordpress.com/2012/08/25/on-tone-trolling/

    “And by a curious coincidence, many of the links that turn up in Google searches for “tone troll” and “tone trolling” are connected to the very same blog, which makes me wonder if it’s really a thing at all, or just a hoax, perpetrated by a small number of authors and commenters, that has somehow caught on.”

    1. David Gorski says:

      Dr. Jay, did you even bother reading those links I supplied for you? Quite honestly, the blogger you cite isn’t saying anything that you couldn’t find right here in the Rational Wiki definition of tone troll, where caution is urged. Check out this excerpt:

      A tone troll is someone who, in the course of a debate, dismisses an opponent’s argument based on perceived crassness, hysteria, or anger. It’s a particularly slimy form of ad hominem attack beloved of Very Serious People, and its sliminess comes of it being quite commonly deployed against opponents lower on the privilege ladder. However, the phrase “tone trolling” itself can be used to excuse verbally abusing one’s opponents, so be careful who you accuse of doing it.

      As a debating technique, it can theoretically be employed honestly (in response to emotional appeal), but it’s not a very good argument because it focuses on style over substance. Rather than addressing the central claims of an argument, it focuses on superficial, “shrill” features of said argument. Tone trolling in practice is almost always dishonest and therefore kind of creates an “appearance of impropriety” situation. Ostentatiously picking their arguments apart in disturbingly calm Spock Speak[1] is probably a more productive approach there. The phrase “tone trolling” itself can be used to excuse verbally abusing one’s opponents, so be careful who you accuse of doing it.

      Emphasis mine.

      Notice the caution, repeated twice, that the accusation of tone trolling can be used as an excuse to verbally abuse an opponent. I don’t think, however, that that is the case with respect to your “contributions” to SBM discussions, because you start complaining about the tone even when the tone hasn’t gotten particularly nasty. In other words, you tend to clutch your pearls and faint just at harsh evidence-based criticism that isn’t even accompanied by profanity or insults. That’s why you keep getting accused of tone-trolling; it’s because you do it.

  53. What are your moral beliefs based on, duggansc?

    1. windriven says:

      @devoutcatalyst

      Would you care to give a hint regarding the characters that comprise your avatar? Aren’t Cyrrilic. Aren’t Hebrew. Aren’t Klingon. If this is some sort of geek IQ test I’ve failed miserably.

      1. @windriven

        I can’t get this thing to thread today, sorry to all others. The word means “How so?” in an obscure Afroasiatic language I study. The script is called Ge’ez. Takes a geek about a week to learn.

        1. windriven says:

          Very cool. I have a real soft spot for the obscure, the uncommon, the obsessions that drive the few. If it takes a geek about a week to learn it would take me an eternity. Languages are not my forte. I can speak enough of a few to get fed and/or slapped in a dozen or so countries. Nothing more.

          So why Ge’ ez rather than Urdu or shanghainese (actually a real language very different from mandarin)? Is that part of a larger cultural pursuit? Not that it is remotely any of my business.

          If you break the code on how to get comments to thread consistently, please share the wealth.

          1. @windriven

            I clicked on the time stamp of your comment, then hit reply. Let’s see if this threads correctly.

            Ge’ez is the name of the script, that part is easy to learn. The language itself is complex, difficult, I’ll give it at least 10 years of daily effort. 2 other languages I study were chosen for practical reasons, but then those reasons vanished, although I stick with them anyway. This one I chose because I like the way it sounds, a feature that which will not vanish. Here’s a brief sample,

            http://firehydrant.org/sample.mp3

            You do sudoku. I do this. My tutor is touched that someone would care about his mother tongue; I believe I won the lottery, having him in my life, that’s how it feels.

        2. WilliamLawrenceUtridge says:

          The language that Ethiopian is written in?

          1. @WLU, I study one of the Omotic languages, you can read about them at Wikipedia. A number of Ethiopian languages have been written in the same script.

    2. duggansc says:

      I’m Roman Catholic by upbringing, largely orthodox (albeit not Orthodox) in beliefs. I do think that the Church is going the wrong direction on condemning homosexuality and contraceptives. Neither are truly directly against the core beliefs in my opinion, just in how you interpret it. Homosexuality doesn’t bar people from raising their children in the church anymore than infertility does. And contraceptives can be used just as the symptothermal method is, to follow the teachings of the church in being open to children, but not having more children than you can properly support.

      Based on prior experience with people asking my faith beliefs in the middle of an argument, I’m guessing we’re going to be picking at details of catechism and the raising of examples of people who’ve failed to live up to it?

  54. windriven “Healthcare Blue Book puts the average price of a total hysterectomy – even with no indication of cancer – at roughly $9300 (surgeon plus hospital plus anesthesiologist). This says nothing of the cost of getting to that point or, perhaps most importantly, the emotional price paid by the woman.”

    This, I assume, is the cost of cervical cancer once it has become established. This doesn’t take into consideration the cost of following up on abnormal pap smears, testing and removal of cervical tissue that is high risk with out-patient surgery, then the follow-up testing, etc. That the whole point of having expert look at cost/benefit for vaccinations. The experts ran the numbers and came up with the result of HPV vaccination being a financial benefit. In other words the cost to encourage prevention and treat when prevention fails exceeds the cost of vaccination.

    1. windriven says:

      We are in total agreement, mouse. My point to duggansc was precisely that, though arguably less elegantly phrased.

  55. One cannot ignore that vaccines don’t use elemental aluminum as an adjuvant.

  56. jay gordon says:

    AutismBeatNews–The medical literature is filled with hundreds of research papers–peer-reviewed, of course–about the negative impact of aluminum in vaccines. This is not a reason to shun vaccines but must be considered.

    David!–I declare you a “tone troll” troll. I define this as someone who changes the conversation by calling someone a “tone troll” and then defining the term as he sees fit according to Wiki and other sources. Then uses the term “tone troll” to denigrate someone who is tired of Dr, Chris Hickie calling him a fuckhead. And tired of other incivility interfering with interesting informative discussions.

    I also declare that being a “tone troll” troll is far worse than actually being a tone troll as you–not I–define it.

    1. David Gorski says:

      David!–I declare you a “tone troll” troll. I define this as someone who changes the conversation by calling someone a “tone troll” and then defining the term as he sees fit according to Wiki and other sources.

      I take your creation of a new term (“tone troll troll”) as a sneaky admission that you’ve finally realized that your definition of “tone troll” was completely wrong. I suppose that’s some progress. It is, however, necessary to point out that defining a term according to Wikipedia, the Rational Wiki, or other credible sources is hardly defining it as “he sees fit.” Defining “tone troll” as you see fit is a far better description of what you did when you tried to redefine it.

      But, seriously, Dr. Jay. A troll almost by definition will derail a comment thread, and you’ve done quite a good job of that. Instead of talking about vaccine safety and the science refuting the link between vaccines and autism, we’ve just spent quite a few comments in this thread arguing about the definition of tone troll. Well done, sir! You’ve successfully derailed the conversation.

      Let’s get back to the topic at hand. I promise to be super nice to you for as long as I can manage it if you would just answer people’s questions about vaccines and provide evidence to support your assertions and conclusions.

      1. Todd W. says:

        Are we really certain that this “jay gordon” is the real Jay Gordon? I mean, that “”tone troll” troll” comment just sounded silly and unlike his usual style.

        1. David Gorski says:

          It sure looks like it’s Dr. Jay to me.

          1. Todd W. says:

            That’s just…sad.

          2. elburto says:

            @Todd W – Tragic, isn’t it? Like a beloved pet dog who used to play fetch and frolic on the beach, but all it can do now is p¡ss on the carpet and wheeze pathetically when it tries to walk.

      2. calliarcale says:

        “I define this as someone who changes the conversation by calling someone a “tone troll” and then defining the term as he sees fit according to Wiki and other sources.”

        I think this is the most hilarious comment in the entire thread. He gets after you for redefinining “tone troll” to something other than his own personal definition. *shakes head*

        1. David Gorski says:

          I agree. The facepalm within that single sentence is epic.

        2. ebohlman says:

          Now that I think of it, this behavior reminds me of the way some commenters (Dr. Jay isn’t one of them, as far as I can remember) complain about how epidemiologists don’t use terms like “epidemic” and “pandemic” they way they (the commenters) understand them to mean.

          “Truth ownership” is actually a sign found in several personality disorders (though it’s apparently common enough that some have proposed that it belongs on the standard list of cognitive distortions).

    2. wrysmile says:

      Jay now you’ve turned into your average every day garden variety troll.

      1. What do you call someone who just copies and pastes the same dreck over and over again? A monotone troll?

    3. windriven says:

      @Jay Gordon

      I’ve pretty much stayed away from this thread but your latest entry caught my eye.

      “The medical literature is filled with hundreds of research papers–peer-reviewed, of course–about the negative impact of aluminum in vaccines.”

      I searched Pubmed using the query, “aluminum adjuvant vaccine safety” and got 214 hits. I reviewed the first 20 and found not a single one that linked aluminum adjuvants with any negative consequences, a couple that vaguely suggested further study was in order, and a WHO advisory debunking two Tomljenovic papers linking aluminum to autism.

      I don’t have a dog in this fight but a cursory look suggests that the preponderance of the hundreds of peer reviewed papers do NOT support a link between aluminum adjuvants and negative consequence.

      1. Dr. Gordon has, by his own admission, been known to make mistakes.

        “AutismBeatNews–Of course I’ve made mistakes. And I’m very invested in my vaccine point of view. That will not keep it from changing as new data and research come my way.”

        And now, new data and research has come his way.

        Turn toward the light, Dr. Gordon.

    4. Dr. Jay, I am aware that some vaccines use aluminum salts as adjuvants. But aluminum salts are not the same as elemental aluminum, just as table salt is difference from chlorine gas. Do you have any relevant studies which show that the dose and method of delivery of aluminum salts in vaccines causes more harm than benefit?

    5. WilliamLawrenceUtridge says:

      The medical literature is filled with hundreds of research papers–peer-reviewed, of course–about the negative impact of aluminum in vaccines. This is not a reason to shun vaccines but must be considered.

      Really? The one recent review article I found, linked above, stated rather clearly that aluminum has a rather good safety profile, as well as being quite efficacious at improving the effectiveness of vaccines. What are the adverse effects of getting 4mg of aluminum over the course of several years? What are the sources of these beliefs? Why do you think the general scientific and medical community is unconvinced by these sources?

      Why do you have such a hard time believing that vaccines might actually be harmless, as is predicted from decades of basic research and clinical trials, not to mention billions of doses? Why do you think it’s better to risk death by measles, paralysis by polio or choking to death due to pertussis, all statistical certainties, versus the consistent failure to identify any significant risks associated with vaccines?

    6. Krebiozen says:

      Jay,

      The medical literature is filled with hundreds of research papers–peer-reviewed, of course–about the negative impact of aluminum in vaccines.

      It is? How have I missed all these in my intensive studies of this subject? All I have found is some studies of local irritation (macrophagic myofasciitis) that may be long-lasting, and some poorly supported studies that propose a link between this and myopathy and chronic fatigue, which later studies, for example http://www.ncbi.nlm.nih.gov/pubmed/18281624 do not support.

      I don’t consider Shaw and Tomljenovic as reliable authors, and I consider their theory that aluminum from vaccines can hitch a ride in leucocytes to the brain where it can cause massive inflammation to be not only bizarre but unsupported by any convincing evidence.

      It is clear to me that even a person with renal impairment will easily excrete the small amounts of aluminum salts that slowly leach into the blood from the injection site. It is impossible for aluminum adjuvants to cause toxicity in the normally understood way i.e. by causing elevated blood levels, as these require intake of aluminum to exceed excretory capabilities over a sustained period.

      This means that aluminum in vaccines can only have a negative impact (apart from local irritation) through some unknown mechanism, for which I have seen no convincing evidence at all.

      Perhaps you could point me towards some of these “hundreds of research papers–peer-reviewed, of course” that I have evidently missed.

  57. elburto says:

    I am nothing if not surprising!

  58. Jay Gordon, MD, FAAP (more recognizable with all my initials?) says:

    @AutismNewsBeat–More harm than good? No studies I’m aware of at all. “Monotone troll.” Again, I am not driven (nor windriven) away from here by the tone trolls or tone troll trolls because occasionally something like this is written.

    @Windriven–Firstly, I really like your screen name. I don’t think that aluminum “causes autism.” I do know that one can read countless studies of it’s causing problems.

    @Everybody–aluminum is bad for you, Sanofi-Pasteur has “anomalies” in DTaP production, the MMR has triggered autism in a very percentage of the millions of children who have received it. Vaccine manufacturers lied to me and the public about the whole cell DPT for decades. There’s lots more, but you get the picture.

    And yet . . . I give vaccines every day, have given them to family members and friends, refer to a travel doc/ID specialist every day to give vaccines to my traveling families, and got vaccinated for my trip to Ethiopia.

    You oversimplify things that are too complex for continued use of the words “idiot” and “fuckhead.”

    1. David Gorski says:

      @Everybody–aluminum is bad for you, Sanofi-Pasteur has “anomalies” in DTaP production, the MMR has triggered autism in a very percentage of the millions of children who have received it. Vaccine manufacturers lied to me and the public about the whole cell DPT for decades. There’s lots more, but you get the picture.

      Um, no, the amount of aluminum in vaccines is not bad for you; it’s too small an amount. (Remember the bit about the dose making the poison?) No, there is no credible scientific evidence that the MMR has caused autism in anyone. It also turns out that later studies found that, while whole cell pertussis does cause more febrile seizures, there is no association with any long term adverse consequences. See:

      http://www.ncbi.nlm.nih.gov/pubmed/11547719

    2. Todd W. says:

      aluminum is bad for you

      Citation needed. Give us just a couple good scientific sources, Jay (hint: Shaw and Tomljenovic should probably be avoided). Preferably, your sources should indicate that the amount found in adjuvanted vaccines and administered in the same manner as adjuvanted vaccines cause more harm than the diseases prevented by said vaccines.

      I give vaccines every day

      But only when parents/patients demand them, correct? Do you ever recommend vaccination to your patients who are due for an immunization but are not traveling?

      You oversimplify things

      Wait…are you looking in the mirror as you write this?

    3. AnObservingParty says:

      Until you cite reproduceable data for each of your points, you have absolutely no right to declare any of us “oversimplyfing.” All we want are legitimate answers to our questions. Where is this magic data that only you seem to have access to?

    4. Chris says:

      “the MMR has triggered autism in a very percentage of the millions of children who have received it.”

      Citation needed.

      The MMR with the Jeryl Lynn mumps strain was introduced in the USA in 1971, and was the preferred vaccine for the 1971 Measles Elimination Program. So it was being used in a much larger country than the UK, and for more than decade before they introduced three different MMR vaccines in 1988. If MMR did cause autism, then it would have been noticed in a much larger country using it for a much longer time before Wakefield came on to the scene.

      So where is the evidence dated before 1990 that there was an increase in American autism rates correlated to the use of the MMR vaccine?

    5. Chris Hickie says:

      No, I am not oversimplifying things. You’re only wanking around here counting angels on the head of a pin, since I’m sure you do whatever the heck you feel like (or your parents feel like) anyhow when it comes to vaccinating. Your horrible behavior as a pediatrician has earned you this invective. If you don’t want to vaccinate, you don’t have to be a pediatrician, Gordon. But to be a pediatrician and not vaccinate is inexcusable.

  59. Tracey says:

    Lyme Disease will soon force a huge swath of the world’s population to come face to face with THE PLAGUE OF THE TWENTY-FIRST CENTURY

    1. Chris says:

      Citation needed.

    2. DrDuran says:

      And even if true (a very, very, very remote possibility) what does that have to do with the subject of this post?

  60. Jay Gordon, MD, FAAP (more recognizable with all my initials?) says:

    “Citation needed”

    Gordon,J unpublished observational data, 2013

    I have no proof. Merely the repeated anecdotal evidence that I can’t possibly ignore.

    ALUMINUM:

    http://www.sciencedirect.com/science/article/pii/S0264410X02001676

    http://www.sciencedirect.com/science/article/pii/S0264410X02001664

    http://onlinelibrary.wiley.com/doi/10.1196/annals.1381.035/full

    http://lup.sagepub.com/content/21/2/231.short

    http://link.springer.com/protocol/10.1385/1-59259-083-7:29

    I have five hundred more articles commenting on the harmful or possibly harmful side effects of aluminum. BUT, that’s not a deal breaker. If you need or want vaccines, get them and give them!!

    Just stop pretending that the schedule is optimal and the safest possible. No, I can’t prove that I have a safer schedule but that’s not my job.

    1. Chris says:

      “Macrophagic Myofasciitis” is just a fancy way of saying “sore arm.”

    2. jwalms2 says:

      He’s right. My dad slipped on an aluminum ladder was walking with a limp for a few days. Aluminum is dangerous.

      Walmsley, J. Observational data, some time in the late 90s.

    3. lilady says:

      @ Dr. Jay: So far, you haven’t proved that the vaccine schedule is not optimal. So, are you putting your “beliefs” and your patients’ mommies intuitions which you pander to about vaccines…up against the many scientists, researchers and doctors at the ACIP, the WHO, the CDC?

      From the Childrens Hospital of Philadelphia-Vaccine Information Center, an article written by Dr. Paul Offit, Department Chair of the Infectious Disease Department of the Childrens Hospital of Philadelphia:

      ALUMINUM;

      http://www.chop.edu/service/vaccine-education-center/vaccine-safety/vaccine-ingredients/aluminum.html

      “…Given the quantities of aluminum we are exposed to on a daily basis, the quantity of aluminum in vaccines is miniscule. Aluminum-containing vaccines have been used for decades and have been given to over one billion people without problem. In spring 2000, the National Vaccine Program Office (NVPO) reviewed aluminum exposure through vaccines and determined that no changes to vaccine recommendations were needed based on aluminum content. The Global Advisory Committee on Vaccine Safety, part of the World Health Organization (WHO), has also reviewed studies and found no evidence of health risks that would require changes to vaccine policy…”

    4. AnObservingParty says:

      Actually, it is. If you believe you have a superior method to the set standard–set by experts, mind you–and insist on proselytizing that it is better, the onus is very much on you to “prove it.” Although, that statement, again, highlights how little you understand, seeing as science never really “proves” anything. It can merely disprove or lend support. The support is for the set schedule, which is continuously monitored and updated as new data come to light. Regardless of what you believe, they do that. The world is not one big conspiracy out to lie to you. Set forth the data that support that what you are saying is superior, and that the risk of vaccinating outweighs the risk of disease (remember, in order to fully appreciate the risk of disease, you have to work off rates and risks from before vaccines did a marvelous job of reducing disease) or shut your mouth and let the ones whose job it is do what they do.

      You are nothing but a leech, sponging off the rest of us who do do the responsible, smart, caring thing, and vaccinate based on the evidence. Unfortunately, your little science project is going to hurt someone who has no choice but rely on the rest of us for protection. I would more than likely to survive one of these infections. So, I’d be willing to bet, would most of the people commenting in this thread. Funny story though, I’d still not want to get one of them. I’m young enough that the only VPD I ever suffered through was chicken pox, but I remember it, and I remember how I didn’t understand why I was so miserable. And, 24 years later, my blood titers–drawn for work–showed a waning immunity. Natural infection wasn’t so fool-proof as some would insist. So I did the responsible, smart thing, and got a booster. I’d survive chicken pox if I were to catch it again, I’m fairly certain, and I’d be old enough to mediate the misery better than a child. But I can’t say that for the patients at my facility, or the baby on the plane, or the woman standing next to me at the grocery store. That is who is hurt by the gamble. People like you push me to the breaking point, on your selfishness alone, based on absolutely nothing. Please, take yourself, your tantrums, and your cohort of arrogant, ignorant, self-absorbed “customers” and go live in a community of yourselves. Away from the rest of us.

      Except, that didn’t work so well in Brooklyn. Or Texas. Did it?

      You know, if that madman in England hadn’t decided to cook his books for some coin, this mess wouldn’t be happening. It’s one thing to have a legitimate concern, investigate, find no link, and mediate the damage. But it was based on NOTHING. A lie. And the best part is his delusional disciplines would rather move the goal posts as one by one, their suggestions are shown to amount to nothing. Nobody is denying anything, nobody purposely withheld a truth that only you know. Vaccines have been investigated and changed, but some honestly don’t need it. They listened, they looked, and they spent money on research that could have been spent doing good things to show the safety. Based on a lie. I feel bad for the desperate parents who are taken in, conned and exploited. But you sir, should know better.

    5. windriven says:

      Dr. Gordon, I have a longer response that apparently I failed to send before I left my office. But the bottom line is that I followed the links you gave. What I found was that none of the 5 is an actual study. One is the summation of a lecture series that Chris and jwalms2 have mentioned, one is a text on adjuvants that is not particularly hard on aluminum salts, and the final two are entirely speculative. Some of Dr. Lerner’s speculation seems interesting to a non-specialist but the notion that the speed of light isn’t stable over arbitrarily long periods of time is interesting too – and very likely wrong.

      I’ve said before that I don’t have a position to defend here. I support broad vaccination along the schedules currently in common usage for the obvious benefits they bestow. But I am sensitive to the idea that vaccines may have unanticipated negative consequences for some fraction of vaccinatees. That sensitivity though requires some hard evidence before it will metamorphose into concern.

    6. windriven says:

      “Just stop pretending that the schedule is optimal and the safest possible. No, I can’t prove that I have a safer schedule but that’s not my job.”

      This simple paragraph may underscore the disconnect between Dr. Gordon and many of us here at SBM. I infer that Dr. Gordon is not convinced that the currently used schedule is optimal but cannot offer a schedule that has been scientifically validated to actually deliver better or safer outcomes.

      So the questions become:

      Is there good reason to doubt the efficacy or safety of the existing vax schedule;

      Are there other vax schedules that claim to offer better efficacy or safety than the current;

      Have any of the proposed schedules been scientifically evaluated and found to be better than the existing?

      From my limited knowledge of the subject the answers seem to be: maybe, yes and no respectively.

      To my simple mind that final no carries most of the weight but certainly doesn’t nullify the first or obviate the second.

      Which seems to bring us to the disconnect. Dr. Gordon, I believe, would answer the questions yes, yes and Yes (though I’m waiting for evidence supporting that last). Dr. Gordon seems to argue that the risks of vaccination according to the current schedule outweigh the benefits of immunity. But his evidence seems largely speculative. Giving him the benefit of the doubt he is ‘sinning’ to the side of vaccinating conservatively to minimize potential hazards.

      The SBM take, I think, is that the current vax schedule has a long history of efficacy and safety and offers the optimal balance of immunity and safety given the best data that is currently available. SBM would be ‘sinning’ to the side of aggressive immunization in light of negligible evidence of harm.

      If that accurately summarizes the two positions I still find myself on the SBM side of the line.

      I apologize for the length of this comment. It is pretty much stream of consciousness to examine my own thoughts on the issue. If I have made some egregious error of fact or logic I hope someone will rub my nose in it.

      1. Jay Gordon says:

        Yes
        No
        No

        1. windriven says:

          My second question, to which you answered ‘No’, was:

          “Are there other vax schedules that claim to offer better efficacy or safety than the current;”

          Here is where I draw up short. If there is no competing vax schedule that you believe offers better efficacy or safety, on what basis would you deviate from the current schedule?

    7. Todd W. says:

      You didn’t answer my question, Jay. Here, again, is what I said about the quality of your sources:

      Preferably, your sources should indicate that the amount found in adjuvanted vaccines and administered in the same manner as adjuvanted vaccines cause more harm than the diseases prevented by said vaccines.

      None of those links met those criteria. And, as was pointed out, some of it was mere speculation. Of course, since you regularly engage in fabricating fantasies out of whole cloth, I’m not surprised you would mistake speculation for actual fact.

    8. calliarcale says:

      Jay, you demand we prove that the vaccine schedule is not merely adequate, but *optimal* and the *safest possible* (not merely the best we know of at the moment, but the best *possible*), yet you clearly state you have no intention of doing the same with whatever you encourage your patients to do?

      I think I know why. I don’t think it’s hypocrisy. I think it’s because you don’t have a schedule at all. I’m beginning to suspect that you let your patients’ parents make all of their medical decisions, with you serving as the validation and the licensed person to sign prescriptions and other pieces of paperwork such as medical exemption forms. Of course you cannot then argue you have a better schedule. How could you, when you have no schedule at all?

      Am I right? And if so, I’m curious to know why. Is it because you see no value in vaccinating consistently? Or because you feel the vaccines have no value anyway, so what’s the point keeping them on any sort of a schedule?

    9. Harriet Hall says:

      “Just stop pretending that the schedule is optimal and the safest possible.”

      I call straw man on this statement.
      I don’t think anyone is pretending that. We are only saying that the schedule has been tested and proven safe. And that we don’t know that any other schedule is as good or as safe, much less better or safer.

      1. David Gorski says:

        Harriet, Dr. Jay is very good at attacking straw men like that, as you will discover if he decides to stick around. If he didn’t have straw men to attack, he wouldn’t have anything to attack at all—except for hilarious attempts to make like Humpty Dumpty in Through the Looking Glass from this passage:

        “When I use a word,” Humpty Dumpty said in rather a scornful tone, “it means just what I choose it to mean — neither more nor less.”

        “The question is,” said Alice, “whether you can make words mean so many different things.”

        “The question is,” said Humpty Dumpty, “which is to be master – - that’s all.”

  61. Jay Gordon, MD, FAAP says:

    Dr. Hickie, I get the very strong impression from your vocabulary and syntax that you’re an educated intelligent man. You have serious anger management issues, though.
    By the way, I’m proud of the “FAAP.” You should apply and pass the tests. Work to change things and get rid of Bob and me from within the AAP.

  62. TBruce says:

    No, I can’t prove that I have a safer schedule but that’s not my job.

    Actually, if you are making up your own schedule, it is your job to back it up with scientific evidence rather than hunches. You are not Adam Savage.

  63. lilady says:

    “the MMR has triggered autism in a very percentage of the millions of children who have received it.”

    Really Dr. Jay? How about looking at this PubMed line listing of 361 published studies that find no link between MMR vaccine and the onset of autism?

    http://www.ncbi.nlm.nih.gov/pubmed?linkname=pubmed_pubmed&from_uid=19952979

    How about producing just one study that proves there is a link between the MMR and the onset of autism?

    C’mon Dr. Jay. Show us your stuff.

  64. Chris Hickie says:

    Gosh,wow…I can now die happy knowing someone with little to no business being a pediatrician thinks I might have a brain. That the AAP hasn’t had the balls/guts/duty to haul you out of their ranks is why I quit them and won’t rejoin until you’ve been put in the stocks along with Sears for clear abdication of duty. Learn what rightfully justified anger is, Gordon, and then maybe you’ll understand why it is a good thing in circumstances like this.

  65. Jay Gordon, MD, FAAP says:

    Dr. Hickie, I also note that you’re still a young pediatrician with nine years in business. After 35 years, you’ll feel differently about lots of things.

    Again, seek counseling for anger management and join the AAP. Those two things will serve you in good stead during your career.

    Our differences of opinion are exceeded by our commonly held beliefs about children’s health. I know you’ll find that hard to believe, but it’s true.

    1. DrDuran says:

      Wow, an argument from (personal) antiquity. I haven’t seen that before.

      Your 35 years of experience haven’t helped you learn much there Dr. Jay. Condescension is unbecoming of a supposed man of science & medicine.

  66. Rob Cordes, DO, FAAP says:

    “the MMR has triggered autism in a very percentage of the millions of children who have received it.”

    That may be one of the biggest pieces of bovine meconium I have ever heard. Good enough language for you Dr Jay? Or shall I say “more colorful metaphor”. Wakefield lied or did you miss that one?

    “Gordon,J unpublished observational data, 2013
    I have no proof. Merely the repeated anecdotal evidence that I can’t possibly ignore.”

    And there is your problem.
    May I suggest reading “The Invisible Gorilla” by Chabris and Simons.

    “No, I can’t prove that I have a safer schedule but that’s not my job.”

    I would say it is as you refuse to follow the standard of care.

  67. jay gordon says:

    “Macrophagic Myofasciitis” is just a fancy way of saying “sore arm.”

    No, it’s not.

    1. DrDuran says:

      Then what does it mean? You need to elaborate a bit more instead of just ejaculating these one & two word contradictions.

      1. lilady says:

        It is just a sore arm and not associated with systemic Al toxicity.

        Dr. Jay must have missed this post by Orac:

        http://scienceblogs.com/insolence/2011/12/08/and-global-warming-is-caused-by-the-decr/

    2. Todd W. says:

      The World Health Organization’s view of MMF: http://www.who.int/vaccine_safety/committee/topics/aluminium/questions/en/

      BTW, Jay. Since you express such concern about this condition that may or may not be associated with vaccines, could you tell us the rate that MMF occurs following vaccination?

  68. MadisonMD says:

    Jay Gordon: You want calm, rational scientific discourse. Here is your chance. I’d like to hear your risk/benefit analysis that leads you to recommend a different vaccine schedule than the AAP.
    (1) What exactly is your recommended vaccine schedule?
    (2) When your less-intense or delayed schedule is selected instead of AAP, what is your estimate of the excess in vaccine-preventable deaths and serious illness per 100,000 children?
    (3) When the AAP schedule is selected instead of your less-intense schedule, what is your estimate of the excess in vaccine-caused deaths and serious illness per 100,000 children?

    I conclude you were being facetious in your reference to “Gordon,J unpublished observational data, 2013.” You know you cannot measure risks and benefits of these magnitudes from clinical experience.

    I await your answer. Thanks.

    1. jay gordon says:

      @MadisonMD–I have no “stock” vaccine schedule for all my kids. I have parents who have chosen to give DTaP and polio vaccines at 2 months of age and others who have chosen no vaccines at all. As I mention over and over, I have no proof that an alternative vaccine schedule is safer or better. No investment in Dr. Sears’ schedule or anyone else’s. I give information to parents–most of whom come to my office already very well informed–and discuss vaccines with parents. I tell them that not vaccinating on the usual schedule exposes their children to low incidence but dangerous illnesses. I discuss how miserable pertussis is. I am very comfortable telling them that these are deeply held medical beliefs with no proof: Just personal observation and anecdotal data.

      Neither you nor I could answer question two. In my patient population, the answer for the past 34 years is zero.

      I have never seen a VPD in my office. I last saw bacterial meningitis in my office in 1982.

      I have hospitalized two children for pertussis and none in the past nineteen years. I have seen babies with rotavirus and certainly many I presume have pneumococcal otitis media.

      In the general population access to good medical care varies so widely and general health varies in the same way. Delaying vaccines for everyone would lead to vaccine-preventable deaths and serious illness with no proof that it would either prevent autism or improve health. Parents must consult doctors who them well and decide if the vaccine schedule recommended by the CDC is right for their child. I am very clear and about that in both public and private discussions.

      I give different advice to people planning to travel extensively or planning a trip to areas without good medical care. Most doctors do not have the luxury of the knowing their patients as well as I do.

      The third question is also hard to answer. I believe that we underestimate iatrogenic harm. This includes giving vaccines without adequate family histories and even vaccinating after a CDC/AAP-approved adverse event. I can’t attach a number to this answer. I have had the unfortunate experience of speaking with hundreds of families who sincerely believe that their children have suffered harm from vaccinations. My confirmation bias colors every single thing I do.

      I’m guessing you’re an MD too. We have hard jobs and families rely on us. No one comes to my office not knowing my ideas and my biases. Nonetheless, they do come and I do my best.

      I enjoy calm, rational discourse and invite you to email me.

      Best,

      Jay

      1. AnObservingParty says:

        “We have hard jobs and families rely on us. No one comes to my office not knowing my ideas and my biases.”

        Exactly. You play to their preconceived notions that they are above such things and take their money, with little regards to the larger population as a whole. They would rather the teeny, tiny risk of vaccinating be on the rest of us, and they will benefit from the herd. They come to you knowing you have a license and letters after your name and will validate their arrogance.

        ” Delaying vaccines for everyone would lead to vaccine-preventable deaths and serious illness with no proof that it would either prevent autism or improve health.”

        You’re right…especially since it is well-supported that VPDs kill, and there is ZERO support that vaccines cause autism (FRAUD) or damage health (not dying of a disease is healthier than the alternative). The problem is, your selfish patients do not live in an airtight bubble. They do come into contact with the rest of us lowly mortals, and the herd isn’t as strong as it once was, because of these attitudes.

        You know, I wonder how much of this honestly comes down to “I don’t like being told what to do” and this is an avenue for getting away with that, because the rest of reality doesn’t work that way very often.

    2. MadisonMD says:

      Dr. Jay:
      Thanks for your reasoned answer. It does behoove you to recommend something to your patients. It does behoove you to have a rationale for these recommendations based on a careful assessment of risks and benefits. This is the fundamental basis of medicine. You are a physician. You have extensive medical training and your patients (and their parents) do not. You are in a position to weigh these accurately.

      I understand your concerns about the risks of vaccination, but these seem to be largely unsubstantiated. You are balancing unknown risks versus known benefits (that here vary strongly based on prevalence of disease and vaccination in the community). With any medical intervention, the number of unknowns vastly outnumber the known. If we weigh these unknowns too strongly, we are paralyzed. There are no medical interventions left. One can only take the precautionary principle so far.

      I think you are in an outstanding position to really make a difference in the world on this topic. I am sure that reluctant and ill-informed parents come to you every day to ask your advice on vaccines. You have made public statements in this arena and are trusted by reluctant parents with strange, unsubstantiated, or inaccurate ideas about vaccines. True, some parents will simply not accept your advice–and this is not your fault. But you are a physician. You need to make a recommendation.

      Imagine a future when MMR is not needed because the diseases are eliminated. No risk to any child of disease or vaccination. Will you help us reach this future?

      By the way, I am a physician-scientist, thank you, with 5 children who have and will continue to get AAP-recommended vaccinations up through and including HPV.

      Best,
      MadisonMD

  69. duggansc says:

    Incidentally, for those I’ve been engaged in a conversation with, I’m removing my subscription to the topic because of the hundreds of comments to sort through. I know that I’ve missed a few things people have addressed to me, and I’ve seen others that never even hit my email.

    *sigh* I remain conflicted on the vaccine. I know it’s due to personal biases that are as much emotional as anything else, but that doesn’t make it any easier. That said, I’m not saying that I feel no one should be allowed to take the vaccine. I merely question whether it should be a mandated thing. I also talked things over with my wife and she pointed out how many girls she knew who’d been sexually assaulted. Sadly, few of them would have been helped by this because the assaults happened much earlier than the proposed vaccination schedule. This world is a sick place.

    I thank all of you who debated the matter civilly with me for all that you were probably grating your teeth to do so (I know that’s the way I get when talking with someone who is obviously pigheadedly wrong, but I want to logic them into the light). I apologize if I did not address everyone’s comments (some of which I didn’t see until much later) but be assured that you’ve given me food for thought.

    1. It’s okay if you don’t response DugganSC, but just for other readers. The HPV vaccine is required* in our state for entry into middle school – age 11-12.

      Here’s a link to the Department of Justice Report on Sexual Assault of Children. It includes a table of the percentages of assaults by age. Sad, stuff, but there are definitely many victims over the age of 12. http://www.bjs.gov/content/pub/pdf/saycrle.pdf

  70. elburto says:

    So that’s a “Yes” on the question about rape victims then.

    Nice. I’m not incensed btw, you’re not important enough to make me get that angry. I just get irritated by people who are so narrow-minded that they cannot understand anything outside of their own experience. I also find that people who try and inject superstition into science are the worst kind of hypocrite

    Science and public health policy and “morals” do not belong on the same continent. Objective data and proven health benefits should never be cast aside in favour religious beliefs, or influenced by them. When someone like you tries to force their “morals” into a scientific discussion it’s yet more evidence of your blinkered view, your apparent belief. that your morals are superior to those of everyone else. You do not get to decide who does/doesn’t deserve treatment, or which diseases are worthy of research.

    If you had experienced oppression or marginalisation due to someone else deeming you unworthy of full human and civil rights then I guarantee you would think differently. If you had suffered a breach of the sanctity of your own body because someone felt that their beliefs and needs outweighed yours, then you would not be so quick to judge others.

    It’s easy to punch down when you’re sitting high on a pile of privilege, knowing that you can spout whatever you want and still be judged worthy by society. However, if you’re somewhere near the bottom of the heap, your voice drowned out by the shouting of those above you, life is hard. Sometimes punching upward is all want can do, even though you know it won’t get you anywhere because your opinion will just be written off as “too angry”, without anyone considering why that might be, why their constantly passing judgement on those who do not follow the same hair’s-breadth moral framework might evoke such a negative response.

    Like I said, there’s a whole world outside your bubble, almost seven billion people who aren’t you, who don’t live by your rules, who do not deserve your scorn and disparagement because they play by different rules. Ultimately it’s you who loses out.

  71. lilady says:

    Look here Dr. Jay: An entire article about the safety of aluminum adjuvants in vaccines.

    It is just a sore arm, Dr. Jay.

    http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3541479/

  72. Say, Jay, I have a question.

    You appear to believe that Macrophagic Myofasciitis is a real thing.

    Do you have any explanation as to why only one research group in France has discovered it?

    1. windriven says:

      It is my (perhaps mistaken) understanding that macrophagic myofasciitis only occurs near the site of malaria vaccination and can be confirmed via biopsy. It is also my understanding that it is self limiting and generally resolves spontaneously. Do I have the basic facts right?

  73. Jay Gordon says:

    Hi Liz–

    The citations from this article appear to include a dozen groups or more. I also assume not many researchers are looking very hard at this.

    http://m.brain.oxfordjournals.org/content/124/9/1821.full

    Jay

    1. WilliamLawrenceUtridge says:

      Dr. Jay:

      You should try plugging some search terms into pubmed and seeing what comes up. It also has a convenient “systematic review/literature review/review” option so you don’t have to rely on cherry-picking only the literature. For instance, the very first article that turned up on pubmed that involved the words “macrophagic myofasciitis” was this one.

      I find it eminently sensible to rely more on review articles than individual articles, since the risk of selection bias is reduced.

      Also, since you are soooooo concerned about aluminum adjuvanted vaccines, perhaps as an alternative you could offer patients nonadjuvanted vaccines, with an order of magnitude higher dose of the antigen instead. Because no matter what – the vaccine is safer than the disease.

    2. AnObservingParty says:

      Interesting, there is no control. Even the article’s authors admit you can’t randomly biopsy the deltoid muscle so they have no control group. And what’s the rate of this disorder in the general population? I can’t even find that information from a respectable site, although one that I will take with a grain of salt said 1 in 2000. Without it, one is unable to compare the risk of vaccination to the risk of infectious disease. If the 1 in 2000 holds, that’s less than the risk of death for even the most benign VPD. Furthermore, most of these were adults. Do you explain the limits of this to your patients when discussing the risks of an aluminum adjuvant?

      1. Todd W. says:

        Funny. WHO also noticed that the studies of MMF didn’t have any controls. But, y’know, they aren’t California physicians with over 30 years of experience, so their scientifically-informed opinion doesn’t count.

        1. AnObservingParty says:

          But they’re lying, you know. He’s been lied to.

          All he does is allow his customers to piggy-back off the rest of us. He takes their cash and tells them it’s ok to be arrogant, selfish parasites, finding the “science” (term used loosely) to fit their preconceived notions. He’s not a doctor, he’s an enabler.

  74. Todd W. says:

    @Jay Gordon

    I have never seen a VPD in my office. I last saw bacterial meningitis in my office in 1982.

    I have hospitalized two children for pertussis and none in the past nineteen years. I have seen babies with rotavirus and certainly many I presume have pneumococcal otitis media.

    These statements seem to be at odds with each other. Which is it? You have never seen a vaccine-preventable disease in your office, or you have seen them (i.e., meningitis, rotavirus, pertussis and pneumococcal disease)?

    And you still have not answered my earlier question. Show us good evidence that aluminum adjuvants cause more harm, when administered in the same amounts and mode of administration as adjuvanted vaccines, than the diseases the vaccines prevent.

    Oh, and also this question: Do you ever recommend vaccination to your patients who are due for an immunization but are not traveling without their bringing up the subject?

    1. jay gordon says:

      Todd–I typed VPD when I meant to type “vaccine preventable death” not “vaccine preventable disease.” My error.

      Aluminum does not do more harm than polio or pertussis or meningococcal meningitis. But it is not a harmless adjuvant as some propose.

      I bring up vaccines, offer vaccines, tell parents which vaccines are due to be given at this particular appointment and discuss the benefits of vaccines at every single visit in my office every single day of my career.

      1. Todd W. says:

        Very good, Dr. Jay. You can answer questions directly and admit that you have no basis to your erroneous beliefs. That’s a step in the right direction.

        Now, since you admit that preventing the diseases via vaccination is better than avoiding vaccines because of fear of aluminum, let me put something else to you: Please show valid and high quality sources showing that aluminum causes harm at a sufficiently high rate to warrant foregoing life-saving vaccination.

  75. cphickie says:

    Any infant who ventures out of the womb should be vaccinated.

  76. WilliamLawrenceUtridge says:

    http://www.sciencedirect.com/science/article/pii/S0264410X02001676

    A poster presentation, or perhaps a summary of two poster presentations.

    http://www.sciencedirect.com/science/article/pii/S0264410X02001664

    Did you read this one? From the “Safety” section:
    [I]n general, vaccines using aluminum adjuvants have a demonstrated safety profile of more than six decades. Aluminum-containing vaccines have been associated with severe local reaction such as erythema, subcutaneous nodules, contact hypersensitivity and granulomatous inflammation [i.e. sore arm]. Some studies with aluminum-adsorbed DTP vaccine have reported fewer reactions than unadsorbed vaccine. Aluminum hydroxide has been reported to attract eosinophils to the injection site, and may increase the levels of antigen-specific and total IgE antibodies that may promote IgE-mediated allergic reactions [emphasis added, and note the complete lack of the word “autism”; at worst, there is a suggestion that they may promote allergies]. On the other hand, aluminum adjuvants have been used for years for hyposensitization of allergic patients without adverse results [or perhaps they don’t cause allergies]. There have also been reports, especially in patients with impaired renal function, of systemic accumulation of aluminum, which has been associated with nervous disorders and bone disease [emphasis added]. Nonetheless, aluminum intake from vaccines is far less than that received from the diet or medications such as antacids.
    From the summary:
    Although there are only a few clinical trials in which a given batch of vaccine, with and without adjuvant, has been tested in comparable populations, aluminum adjuvants have been used in vaccines for many decades, and have been proven to be safe…Other limitations of aluminum adjuvants include local reactions, production of IgE antibodies, and the inability to elicit cell-mediated immunity…Finally, the enhanced antigenicity of some vaccines may be sacrificed if aluminum-containing adjuvants were to be completely removed from these vaccines.
    Why are you citing this article as if it supported your new goalpost location of “aluminum”? The worst that could be said is that there may be associations but the signal obviously isn’t strong enough to rise out of the noise yet – assuming it’s even there. Have you read all 500 of your articles, and how many of them actually contradict your hypothesis that aluminum is a powerful source of harm?

    http://onlinelibrary.wiley.com/doi/10.1196/annals.1381.035/full

    Note my emphasis in the title:
    Aluminum Is a Potential Environmental Factor for Crohn’s Disease Induction
    And did you read even the abstract? The main concerns are over swallowed or inhaled aluminum, which outweigh the amount of aluminum in vaccines many times over, probably by several orders of magnitude. Why are you treating theoretical papers as if they were slam-dunk confirmations that aluminum is dangerous?

    http://lup.sagepub.com/content/21/2/231.short

    Basically the same comments, this is a hypothetical. Note again from the abstract, with again, emphasis added:

    If a cause and effect relationship can be established, the consequences will greatly impact public health and CD prevention and management.

    Not a slam-dunk, a hypothetical.

    How do you match these hypothetical risks (exposure to which is orders of magnitude higher through swallowing rather than injection) of nonfatal, but unpleasant diseases, versus the known fatal and debilitating consequences of vaccine-preventable diseases? How long have you been concerned over the presence of aluminum in vaccines? Was it shortly after the removal of thiomersal? Is it really about the aluminum (which, good luck with attempting to reduce exposure considering its ubiquity in the soil, air, food and water, essentially everywhere on the planet), or is it simply an excuse to raise more concerns about vaccines?

    Just stop pretending that the schedule is optimal and the safest possible. No, I can’t prove that I have a safer schedule but that’s not my job.

    Is there any evidence that your schedule is safer, particularly considering it leaves more children vulnerable to dangerous diseases for longer periods of time?

    Why do you consider your experience to be superior to that of other pediatricians who believe the current schedule is perfectly safe? Why do you consider it superior to the experience and breadth of expertise of the individuals who drafted the current vaccine schedule?

    …and others who have chosen no vaccines at all.

    Do you have a separate waiting room for them? Or are you perfectly comfortable with parents bringing their children to a doctor’s office, with the expectation of healing, and actually getting an increased risk of exposure to dangerous diseases?

    I am very comfortable telling them that these are deeply held medical beliefs with no proof: Just personal observation and anecdotal data.

    How incredibly angering. When I go to the doctor, I don’t want their personal observations and anecdotal data. I expect them to act as an expert guide and gatekeeper to the scientific literature, drawing upon years of training and experience regarding how to read and interpret that scientific literature. If I wanted personal observation and anecdotal data, I’d ask my friggin’ mommy what to do about measles.

    I have never seen a VPD in my office. I last saw bacterial meningitis in my office in 1982.

    Weren’t you the guy whose waiting room was a point of exposure for a vaccine-preventable disease a while back? As a doctor, don’t you realize that not all diseases show symptoms while still being highly infectious?

    I have hospitalized two children for pertussis and none in the past nineteen years. I have seen babies with rotavirus and certainly many I presume have pneumococcal otitis media.

    Are you certain of this? Because human memory is dedicated more to self-justification than accuracy. How many of your patients brought their children directly to an emergency room instead of to your office?

    I can see why you get so little respect at RI, and now here. You consistently place more faith in your own opinion, wisdom, and I would assume celebrity, than on the scientific literature. When you do engage with the scientific literature, it appears to be with remarkable selectivity. You rather clear appear to give superficial lip service to reasonability and open-mindedness – but just as clearly you appear to have drawn your conclusions and are working backwards from there.

    1. calliarcale says:

      “Weren’t you the guy whose waiting room was a point of exposure for a vaccine-preventable disease a while back?” In fairness to Dr Jay, that was his friend Bob Sears.

  77. jay gordon says:

    I typed VPD when I meant to type “vaccine preventable death” not “vaccine preventable disease.”

    1. WilliamLawrenceUtridge says:

      You don’t think that vaccine-preventable death is a statistical inevitability while vaccine-preventable disease exists? How curious…

  78. WilliamLawrenceUtridge says:

    The more I read Dr. Gordon’s comments, the more Robert Todd Carrol’s webpage on Gordon appears to be on the money. He’s Just Asking Questions based on what is In My Experience, and refuses to admit that he’s simply anti-vaccine for no good reason.

    1. DrDuran says:

      The Encyclopedia of American Loons is on Gibson now, I’m thinking Dr. Jay will be getting his own entry very soon.

  79. Jay Gordon, MD, FAAP says:

    Something is wrong again with the site. My responses are not getting through at all.

  80. Lawrence says:

    Yes, it was Dr. Bob that was at the center of the San Diego Measles outbreak….another interesting situation that will arise (with Dr. Bob again & I’m sure Dr. Gordon) is that these infected patients will come to see them & there will be an even greater chance that their mere presence in the waiting area will infect other patients (especially children) because of their unvaccinated status….if anything, these “Pediatricians” are creating their own breeding ground for infectious diseases…..

  81. Jay Gordon, MD, FAAP says:

    Again, the practice of medicine, and pediatrics in particular, carries great responsibility.

    Very few of you above understand what I do. Your comments reflect that. You know statistics and assume that “science” is monolithic and that questions only have one answer.

    That is incorrect.

    Why am I here? Because I have very thick skin, confidence in what I do and I do not want to participate in the echo chamber which might be a far more friendly web site.

    Rene’ has taught me a lot, Callie also, Alain Laurent, and even Tweak. I listen, I learn, I even change. I dismantled most of my website as I looked at it through your eyes.

    It took me far longer than it should have to ignore the most abusive among us, but I’m pretty much there now. Dr. Hickie gets under my skin a little but the worst of the worst no longer do.

    1. David Gorski says:

      Again, the practice of medicine, and pediatrics in particular, carries great responsibility.

      No kidding, Dr. Jay! It’s not as though many of us writing the blog posts for SBM weren’t, oh, you know…actual practicing doctors (or, in the case of Harriet, a retired doctor who practiced many years). It’s not as though some of us commenting right here in this very thread weren’t, oh, you know…also actual practicing doctors. It’s not as though a couple of the commenters are, oh, you know…actual practicing pediatricians. No, no one can possibly understand the complexities of applying clinical trials and epidemiological studies to actual individual patients as deeply as you. We’re not worthy! We’re not worthy! We’re not worthy!

      I know, I know. I’m being a bit sarcastic, which makes me a big meanie in your eyes, a “tone troll troll,” as you so hilariously put it. But it’s hard not to when you serve up such monumentally arrogant—yes, arrogant!—statements like the one above. It’s as though you think you’re the only one who’s thought about these matters or who understands the complexities and shades of gray involved in practicing evidence-based medicine. Except that you don’t understand them. Your comments reflect that. If you don’t like what clinical trials and epidemiology say (for instance, about vaccines), then your confirmation bias-saturated “personal clinical experience” trumps all.

      Very few of you above understand what I do. Your comments reflect that. You know statistics and assume that “science” is monolithic and that questions only have one answer.

      Wow. That’s a burning straw man so huge that it can be seen from space. It dwarfs even the biggest “burning man” display. Here’s the thing, Dr. Jay. There might be multiple “right answers” in a situation, but there are also usually answers that are clearly wrong. Just because it’s hard to apply medical research to individual patients does not mean that you can do any old thing that you feel like. Therein lies one of the biggest traps for physicians: Hubris. You disagree with the current recommended vaccine schedule, but you can’t articulate why based on actual decent scientific, clinical, and epidemiological evidence, nor can you propose a reasonable replacement and support your proposal with evidence. With you, it’s all feelings, confirmation bias, anecdote, and, when pushed, bad studies or studies that you misinterpret. That is not carefully and rationally trying to apply existing scientific and medical evidence to a individual patients. It’s substituting your biases and the biases of the parents of your patient population for evidence-based medicine.

    2. WilliamLawrenceUtridge says:

      It is astonishing to me, astonishing, that you claim “pediatrics carries great responsibility” but you utterly relinquish that responsibility by systematically misrepresenting the risks and benefits of vaccines and the diseases they prevent. You claim to have a thick skin – I think you have more of an unjustified certainty in your own opinions. You never consider that your confidence might be misplaced. You never consider the quality of people who support your reasoning and interventions – former playmates, discredited researchers and actors – and those who oppose it – experts in public health, vaccination and epidemiology.

      It is not abusive to point out that you are simply wrong, or that your certainties are based on extremely tenuous chains of reasoning. It’s not abusive to challenge your citations with other, often better citations. It’s not abusive to point out the flaws in and hypothetical nature of the citations you provide. It’s not abusive to defend the health intervention responsible for saving the most lives and preventing the most suffering of any created by modern medicine.

      I’m still astonished that you appear to believe you can identify those whom are at risk of “vaccine injury”.

      Your arrogance is amazing to me, utterly, utterly unjustified and amazing. I understand where it comes from – it’s pure cognitive dissonance. You think of yourself as smart, and resist disconfirming information. You’ve developed an image of yourself as smart and can’t handle any challenge to that image, so instead you denigrate the abilities and inflate conflicts of interests of your opponents. You seek confirming studies and ignore their tentative nature, their hypothetical language, their limitations and selectivity. You are a case study in cognitive biases.

      But it’s still amazing how deeply you are willing to dig in, just to avoid even considering that masses of scholars, groups of experts, might be right when you are wrong. It’s amazing to me that now that mercury has been so utterly discredited, you will simply switch to grasping at aluminum straws in an effort to maintain your idée fixe, the perils of vaccination, while ignoring the perils of disease.

      Amazing.

    3. Todd W. says:

      Very few of you above understand what I do.

      Perhaps it is because what you do is so at odds with public health.

      You know statistics and assume that “science” is monolithic and that questions only have one answer.

      I’m personally not all that well-versed in statistics. I couldn’t tell you when to use a t-test vs. some other statistical tool. I also do not think science is monolithic. As to questions having only one answer? Depends on the question. As Dr. Gorski noted, some questions have multiple answers. Some have only one. Many have clearly wrong answers.

      Rene’ has taught me a lot, Callie also, Alain Laurent, and even Tweak.

      Aw, thanks for mentioning me. At least, I think you mean me. Guess I haven’t made enough of an impression for you to spell my Twitter handle correctly. Perhaps just a Freudian slip.

      It took me far longer than it should have to ignore the most abusive among us, but I’m pretty much there now.

      Yet, not quite there, as evidenced by your “tone troll” nonsense up-thread. At least you did finally drop that.

      Now, if you could just work on dismantling that arrogance you regularly display, learn humility, learn that (gasp!) you can be wrong (something that you profess to already know, yet consistently seem to forget). It’s admirable, I guess, that you finally got around to removing some of the offensive nonsense on your site, but incredibly shameful that it took years of people telling you about the bad info before you actually did anything about it.

    4. MadisonMD says:

      Dr. Jay: “Again, the practice of medicine, and pediatrics in particular, carries great responsibility.”

      It does indeed. We have the responsibility to recommend safe and effective medical interventions based on an accurate assessment of risks and benefits. We are required to dispel the myths and falsehood that lead to irrational health choices. This is an awesome responsibility indeed. Yet you abdicate it. Why?

      Dr. Jay, there is something more. We are responsible beyond our own patients. ‘Public health’ sounds impersonal. But what it means isn’t. You are responsible for other children. How good it is that none of your patients died yet. But have they passed on their illness to others? How many of the others died?

      One thing more–and I realize that the responsibility is a heavy burden– you are even responsible to the children of tomorrow. If you are equally concerned about vaccine risks and vaccine-preventable illnesses, then you should join the good fight. Some of these illnesses can be eradicated. Let it be done now so that both risks evaporate into history. Can you do just a bit more to help, Dr. Jay?

    5. windriven says:

      “questions only have one answer.”

      A lot of them do. But not all.

      I’ve enjoyed following this thread. Like you, I’ve learned a little. I don’t think it has changed my position in any large scale way but I have examined some of what I accept and why I accept it.

      I am not Dr. Hickie’s spokesman. He is clearly a passionate pediatrician. If I still had kids and lived in his area, I’d want him as my kids’ pediatrician. But I accept that you are just as passionate as he is. Clearly, there are a lot of people who want you as their kids’ pediatrician too. Those of us who see ourselves as rigorous scientists can learn from that.

      I hope you’ll stick around these pages for the long haul. I hope that we’ll* give you some ammunition to further refine your views on vaccination. And perhaps we’ll learn something from you about why thoughtful people sometimes fear vaccinations and the current vax schedule.

      *I recognize that I’m overly generous in using the editorial ‘we’. I am a physicist, not a physician and have nothing of substance to add where clinical practice is involved.

      1. Todd W. says:

        You never know. 35 years from now, perhaps Jay will finally come to accept the 2012 vaccination schedule. Of course, we’ll have moved on since then, and he’ll still be behind the times, but progress is progress, I suppose.

    6. windriven says:

      As an outsider here, I’d like to toss a turd in the punch bowl that many of us are drinking from. Jay Gordon has been a loud and persuasive voice in the ‘other-than-standard-vax-schedule’ community. Yet he’s had the balls to come into the SBM house, take some stiff abuse, and still admit that he has changed some of his thinking.

      Is the purpose of SBM to clap each other on the back and exchange the secret handshake with a wink-wink, nod-nod? Or is it to persuade, to advance the grasp of science on the practice of medicine?

      If Dr. Gordon or some other pediatrician(s) who haven’t commented but have followed the debate return to their practices less skeptical about vaccination it will be because of the strength of the arguments made and the citations offered. It won’t be because somebody called Gordon a dick or a shit.

      And I fear that we will drive some away who tuned in to see the clash of ideas but were put off some of the more personal comments.

      Just a thought.

      And before someone rips me a new one, yes, I see the irony of my position on this.

      1. Todd W. says:

        @windriven

        A lot of the exasperation with Jay stems from many of the commenters here having years of history dealing with him. He typically comes in, makes some comment that is at odds with the vast majority of science (many times demonstrably wrong), then takes the tone troll route when the criticism starts rolling in. The conversation then gradually shifts to him stating how he learns from us and has changed. Those changes are only after years of showing him he’s wrong, and even then are just lip service. Then he’ll leave for a while, come back, and do it all over again. It’s a distinct pattern, and it gets old very quickly. In the past, he’s stuck to Respectful Insolence blog. Interesting shift that he’s decided to start commenting here.

        1. windriven says:

          Thanks for the historical perspective. I don’t have time for blogs beyond SBM and Crislip’s Medscape column so I haven’t followed Insolence.

          Perhaps the change of venue marks a change of heart. Perhaps not.

          1. Todd W. says:

            I have my doubts that it’s a change of heart.

  82. Jay Gordon, MD, FAAP says:

    Have you ever been to Burning Man, David? I’ll resume the discussion above shortly I’d love to know what the experience was like for you. I HAVE to go next year although I hear it’s not as great as it used to be.

  83. Jay Gordon, MD, FAAP says:

    The Doctor Gorski

    Says:

    “Therein lies one of the biggest traps for physicians: Hubris.”

    Dammit! My irony meter broke. Can I borrow yours for a day or two, Dave??

    1. David Gorski says:

      Dammit! My irony meter broke. Can I borrow yours for a day or two, Dave??

      I’m not the one claiming against all evidence that I know the current vaccine schedule, recommended by scores of experts who’ve dedicated their lives to studying vaccines and vaccine preventable diseases, dismissing all that with my own “personal clinical experience” and confirmation bias. Who’s the only one here doing that? Oh, right. It’s you, Dr. Jay. Sounds like hubris to me.

  84. Chris Hickie says:

    I know what you do, Jay, and it is wrong and dangerous. Do you not have a flippin’ clue that this is SCIENCE-BASED MEDICINE, not “Dr. Jay’s made up crap that Dr. Jay pulled out of his hat or other such dark recesses”? If you want to hang around here and talk about your non-science-based medicine, then don’t whine about getting bashed around. You don’t have a leg to stand on, so you’re a sad caricature of the Black Knight in “Monty Python and the Holy Grail”, flailing around with your intellectual limbs all chopped off, trying to pick a fight that you lost a long time ago.

  85. Jay Gordon, MD, FAAP says:

    @WilliamLawrenceUtridge–I’m OK with abuse. Thanks for asking. I reserve the right to complain about the worst of it, but I’m OK.

    “I’m still astonished that you appear to believe you can identify those whom are at risk of “vaccine injury”.

    I can’t!!! That’s the point. Can you?

    My idée fixe is that we know less than we pretend to know and that caution is indicated with all medical interventions.

    Chris!! I love love your cinematic allusions. Between the “Princess Bride” quotes from David and your Monty Python images, we could start a Rotten Tomatoes competitor right here. I promise to stop whining. I might whinge a little, though.

    1. Harriet Hall says:

      We don’t pretend to know that the current schedule is the optimum one. You are the one who is pretending, without any evidence, that you know a better schedule. Caution is indeed indicated: you are not being cautious, you are putting your patients and your community at risk on the basis of speculation and unsupported beliefs.

    2. David Gorski says:

      Chris!! I love love your cinematic allusions. Between the “Princess Bride” quotes from David and your Monty Python images, we could start a Rotten Tomatoes competitor right here. I promise to stop whining. I might whinge a little, though.

      Then you’ll love the zombie movie allusions in my most recent post:

      http://www.sciencebasedmedicine.org/another-antivaccine-zombie-meme-sv40-and-cancer-and-polio-oh-my/

      1. Rob Cordes, DO, FAAP says:

        And yet my Star Trek allusion goes unappreciated. I will console myself by giving an immunization education program this morning

    3. WilliamLawrenceUtridge says:

      I will note that despite you bringing it up repeatedly, I don’t believe anyone here called you a fuckhead. And again, you appear to mistake “challenge” for “abuse”, or people calling you on your illogical, unfactual, unscientific claims as some sort of insult. As if we should have as precious a respect for your experience as you do (despite your apparent complete lack of awareness of how unreliable personal experience is).

      If you can’t identify those at risk of “vaccine injury” (assuming this is even a category), then on a purely statistical basis, we are justified in minimizing overall harm by vaccinating according to the expert-recommended schedule. While we do not know everything about vaccines and all possible responses to them – we know they are orders of magnitude safer than the diseases they prevent. How you can deny this rather basic point, I simply don’t know. How you can pretend that you are the only pediatrician or doctor who exercises caution in vaccination, I don’t know. How you can pretend the vaccine schedule and ingredients are just based on random guesses and fairy tears, I don’t know. It appears to be willful ignorance. You, in your self-selected, upper-class, cash-in-hand, worried-well, confirmation-bias-providing client base, are not smarter, wiser, or more experienced than an entire room full of dedicated experts who live and breathe the scientific research on vaccines, vaccination, pediatric immunology, biochemistry, adjuvants and more. Not only do they collectively have more experience and knowledge than you, individual members have more experience and knowledge than you because they have specialized much more narrowly.

      It’s honestly hard to express how arrogant and smug you come across without using profanity.

  86. MadisonMD says:

    “My idée fixe is that we know less than we pretend to know and that caution is indicated with all medical interventions.”

    A beautiful statement of the precautionary principle mixed with the obvious (‘caution is indicated’). Caution means carefully weighing risks and benefits. If you weigh putative risks more than known benefits, you are paralyzed. If you require parents to weigh them in the absence of medical advice, you are irresponsible. Being a physician must be terribly difficult for you. How can you possibly recommend anything?

  87. Chris Hickie says:

    The problem is, since Gordon isn’t vaccinating and he let’s his patients run the show, he really doesn’t have much to do except slink around here. Maybe his global healthy-spermatogenesis-to-prevent-autism initiative will start to gain traction, especially if it gets a dose of that homeopathic HealthySperm1000.

  88. Nutrition and Measles incidence

    (I refer to the measles data here: http://vicskeptics.wordpress.com/2010/11/08/analysis-of-anti-vax-graphs)

    If you look at the peak infection rates for measles for example, they occurred between the 1930′s and 1950′s. This of course was the period of The Great Depression and World War II. This was a period of time when nutrition levels were very low, and people were starving to death. Also, it “drove the birthrate below the replacement level for the first time in American history”. If the birthrate had have been normal, the spike in infections would have been much, much higher. If people had have had even fewer children during this period, the infection rates could have been the same as those prior, or even lower, so without taking this into account, the data is actually quite meaningless. In New York City in 1931, there were 20 known cases of starvation; in 1934, there were 110 deaths caused by hunger. There were so many accounts of people starving in New York that the West African nation of Cameroon sent $3.77 in relief. http://www.digitalhistory.uh.edu/learning_history/children_depression/depression_children_menu.cfm
    The top tax rate in the US was at least 88 percent until 1963, when it is lowered to 70 percent. We can assume that after this time, the majority of Americans could now afford good nutrition for their families. This, combined with much better sanitation at this period in time, conincides with much lower levels of infection. http://www.hyperhistory.com/online_n2/connections_n2/great_depression.html

    “Cholera, typhoid fever — spread by excrement-contaminated drinking water — and plague, which was transmitted by fleas living on rats who thrived in the filthy conditions. Dysentery alone wiped out ten thousand crusading knights and foot soldiers. During the Crusades, Europeans learned basic aspects of science and hygiene from the Muslims whose culture they sought to destroy.” (Religion taught the West about what was clean, and what was dirty, and some science along the way.)

    By 1910, sewage was being dumped into bodies of water on a grand scale, and cholera abated. Then, cities downstream of dumped waste started experiencing epidemics of typhoid when they piped sewage-laced water to the homes of their citizens. http://greywateraction.org/content/history-sewers

    If there are 100 modern Americans in a room, and 1 has influenza and sneezes, so that everyone is exposed to the virus through inhalation and hand-shaking, approximately 90 of them will become sick and experience symptoms. Interestingly, 10 will not experience symptoms. If you take 100 malnourished people from developing nations and conduct the same experiment, 95-99 will experience symptoms. Their bodies are immunocomprimised through lack of sanitation and nutrition. “In developing countries, influenza imposes a heavy disease burden, especially among populations that are malnourished”. http://www.ariatlas.org/understanding_aris/influenza

    With the right nutrition, our bodies have a much better chance of fighting invaders. For example, you need adequate vitamin B6 to make antibodies, which are markers for invaders so your immune system knows what to attack. Having low vitamin B6 means that you are immunocomprimised.

    Effect of dietary vitamin B6 contents on antibody production “Mice placed on diets extreme deficient in vitamin B6, ovalbumin-dependent antibody productions (IgE, IgG1, IgG2a) were significantly suppressed.” http://www.ncbi.nlm.nih.gov/pubmed/10705972

    Vitamin C has been shown to be effective against tetanus in numerous studies.

    Effect of ascorbic acid in the treatment of tetanus (Bangladesh 1984) http://www.ncbi.nlm.nih.gov/pubmed/6466264
    “none of the patients died who received (ascorbic acid / vitamin C) AA along with the conventional antitetanus therapy. On the other hand, 74.2 per cent of the tetanus patients who received the conventional antitetanus therapy without AA (control group) were succumbed to the infection.” -this is for ages 1-12, who were given 1000mg of vitamin C per day. -older people died – possibly because they were still only given the same amount of vitamin C as the babies and children.

    A tetanus shot was only 25.8% effective for children 1-12, where vitamin C was 100% effective.

    The same study concluded: “This was supported by the fact that AA (vitamin C) was found to mitigate the toxic effects of strychnine producing tetanus like condition in young chicks in the present study.”

    Accidental find shows Vitamin C kills Tuberculosis http://www.news.com.au/breaking-news/world/accidental-find-shows-vitamin-c-kills-tb/story-e6frfkui-1226648003516
    There is only 1 vaccine for tuberculosis available, and “its protective effect appears to vary according to geography”. http://en.wikipedia.org/wiki/Bacille_Calmette-Gu%C3%A9rin
    The likely explanation of its ineffectiveness in some areas is that the tuberculosis bacteria infects more people where nutrition is poor. People that live near the coast and are able to eat traditional seafood diet have lower incidence of tuberculosis. (Weston A. Price)

    I acknowledge that vaccines do work, the rotavirus vaccine for example. However, when given to sick, malnourished children, how many of them are harmed or die? There is no reporting. We do not know. The vaccine may be the lesser of two evils. Adequate nutritious food is obviously a better choice, but much more expensive. We know that vaccines can harm and sometimes kill children, (though rarely in the West). That is why the VAERS database in the US exists. The US government also made it illegal for parents to sue a vaccine maker if it harms their child. They are given compensation payments instead. There are many reports by parents on health forums where Doctors have refused to record adverse events saying that “it couldn’t have been the vaccine.”

    If you draw a spline through the average of the points on the graph, you will get a bell curve that peaks around the 1940′s, which is still around 20 years before the introduction of the vaccine.
    http://vicskeptics.wordpress.com/2010/11/08/analysis-of-anti-vax-graphs

    In conclusion, the measles epidemic from the 1930′s to the 1950′s in the US was most likely cause by malnutrition combined with poor sanitation, and started declining after the war as the economy started improving.

    1. Chris says:

      Oh, crud. My comment just disappeared. I hope it returns. I’ll just post some things that are very wrong.

      “Also, it “drove the birthrate below the replacement level for the first time in American history”.”

      Not during the 1950s: http://www.history.com/topics/baby-boomers

      1. “Also, it “drove the birthrate below the replacement level for the first time in American history”.”

        “Not during the 1950s: http://www.history.com/topics/baby-boomers

        The highest rates of measles were in the 1930′s, despite the low birth rate.

        1. Chris says:

          Not the 1950s. You seem to think that was an important decade.

    2. Chris says:

      “In conclusion, the measles epidemic from the 1930′s to the 1950′s in the US was most likely cause by malnutrition combined with poor sanitation, and started declining after the war as the economy started improving.”

      As far as the 1950s, that is very very wrong:
      http://en.wikipedia.org/wiki/Post%E2%80%93World_War_II_economic_expansion
      http://www.nationmaster.com/graph/eco_gdp_per_cap_in_195-economy-gdp-per-capita-1950

      1. “As far as the 1950s, that is very very wrong.”

        Malnutrition combined with poor sanitation may have caused a loss of natural herd immunity.

        In 1657, there was an outbreak of measles in Boston.

        Measles Appears in Boston
        In Boston, John Hull wrote in his diary that “the disease of measles went through the town,” but fortunately there were very few deaths.
        http://www.historyofvaccines.org/content/timelines/measles

        So the measles outbreak of 1657 was not as deadly as was the case in the 1930′s and 1950′s. Sanitation and nutrition were possible differences here.

        The vaccine obviously restored herd immunity after it was introduced.

        1. Chris says:

          Which all the more reason to prevent it with two MMR doses. That way instead of spending money for hospital care, it can be spent on nutrition programs for low income families.

        2. Todd W. says:

          Wait, so are you arguing that sanitation was better in 1657 Boston than it was in 1930s/1950s Boston? I would very much like to see some evidence for that claim.

          Also, I’d like you to expand on your comment that the 1657 outbreak was not as deadly as the 1930s/1950s. How did you come by that conclusion?

          1. Ken says:

            That was obviously not meant to be a factual statement. Science101 is very passionate about spreading disease, and doesn’t feel a need be “right.”

        3. Chris says:

          “So the measles outbreak of 1657″

          Oh, crud, I read that as “1957.”

          Though that still means that my comment that preventing measles with two MMR vaccines is better, since it saves money to provide food programs to low income families.

          And it re-iterates that Science011001 does not know or understand history. Child mortality was several times more three hundred years before 1957.

          1. Ken says:

            It wasn’t much better in England during that time.
            http://chnm.gmu.edu/cyh/teaching-modules/166

            “One measurement of health in early modern England is revealed in the statistics of the number of deaths kept by church parishes. From these records historians have gleaned that infant mortality (death during the first year of life) was approximately 140 out of 1000 live births. The average mother had 7-8 live births over 15 years. Unidentifiable fevers, and the following list of diseases, killed perhaps 30% of England’s children before the age of 15 – the bloody flux (dysentery), scarlatina (scarlet fever), whooping cough, influenza, smallpox, and pneumonia.”

            Health in England (16th–18th c.)
            Lynda Payne, University of Missouri-Kansas City

    3. Chris says:

      From http://www.census.gov/prod/99pubs/99statab/sec31.pdf
      Year…. Rate per 100000 of measles
      1912 . . . 310.0
      1920 . . . 480.5
      1925 . . . 194.3
      1930 . . . 340.8
      1935 . . . 584.6
      1940 . . . 220.7
      1945 . . . 110.2
      1950 . . . 210.1
      1955 . . . 337.9
      1960 . . . 245.4
      1965 . . . 135.1
      1970 . . . . 23.2
      1975 . . . . 11.3
      1980 . . . . . 5.9
      1985 . . . . . 1.2
      1990 . . . . .11.2
      1991 . . . . . .3.8
      1992 . . . . . .0.9
      1993 . . . . . .0.1
      1994 . . . . . .0.4
      1995 . . . . . .0.1
      1996 . . . . . .0.2
      1997 . . . . . . 0.1

      Do explain why measles in the USA fell 90% between 1960 and 1970. By the way, the rate of measles infection in 1935 does show the effect of an economic depression. Do you see the same between 1945 and 1960?

      Also, the USA introduced its MMR in 1971, seventeen years before the UK. It was the preferred vaccine for the 1978 Measles Elimination Program, a full ten years before the UK introduced their MMR vaccines. Now the USA is much bigger than the UK, and had used an MMR for more than two decades before Wakefield’s “study.” If autism was correlated with any MMR vaccine, it would have shown up in a large country using it about twice as long as the UK. Please post the evidence published before 1990 that shows an increase in autism in the USA correlated with the use of an MMR vaccine.

      1. How was measles reported in the 1920s and 30s? Something like one in three Americans worked in agriculture prior to WWII, meaning they many were dirt poor and lived in isolated communities. Is it reasonable to assume that many more cases of measles were treated privately at home and not reported to local health authorities?

        1. lilady says:

          I’m assuming that measles was not a “reportable disease” because every kid had measles, mumps, rubella…and chicken pox, during their childhood…and before the licensing of the single antigen measles, mumps and rubella vaccines. In fact, it is presumed, that anyone born before January 1, 1957 is immune to measles, mumps and rubella:

          http://www.health.ny.gov/prevention/immunization/handbook/section_1_requirements.htm

          (That “presumption” does not apply to older health care workers, born before January 1, 1957, who are required to undergo blood tests to prove that they have positive IGG titers as proof of immunity or proof they have received M-M-R vaccines)

          http://www.immunize.org/catg.d/p2017.pdf

          1. I’m assuming that measles was not a “reportable disease” because every kid had measles, mumps, rubella…and chicken pox, during their childhood…

            Close, but not quite right:

            Reported Cases and Deaths from Vaccine Preventable Diseases, United States, 1950-2011*
            1950:

            http://www.cdc.gov/vaccines/pubs/pinkbook/downloads/appendices/G/cases&deaths.pdf

            1950:

            Diphtheria cases 5,796 deaths 410
            Tetanus cases 486 deaths 336
            Pertussis cases 120,718 deaths 1,118
            Paralytic polio cases 33,300 deaths 1,904
            Measles cases 319,124 deaths 468
            Mumps not reported until 1968; deaths reported starting in 1960
            Rubella not reported until 1966; deaths reported starting in 1960
            Congenital Rubella Syndrome not reported until 1969; cases only reported.
            Hepatitis A not reported until 1966
            Hepatitis B not reported until 1966
            Haemophilus not reported until 1991
            Varicella not reported until 1972

        2. Chris says:

          That is data from the US Census (that particular publication is the one with a special section on 20th century statistics). Back in the day they actually went to each and every household. They also had certain questionnaires that they would try to use, sometimes things not included on the very long forms that the census takers used (which you can download from genealogy sites). The supplemental information was to determine things like economics, education etc. The first page of the link says the diseases were started to be tracked in 1912, things like house hold stuff started in 1940 (like how if the house had indoor plumbing, etc). I just checked, and they have a very cool history section:
          http://www.census.gov/history/www/through_the_decades/index_of_questions/

          Though measles was being measured in the USA prior to 1912:
          A STATISTICAL STUDY OF MEASLES (1914). That is a very interesting read, especially the author’s opinion about those who downplay the seriousness of measles on the last page, it seems quite familiar.

          It was arduous, and sometimes repetitive, especially when people travel. My grandmother’s family is marked twice in the 1910 census. Once in Yakima, WA and a bit later in Pasadena, CA. I read about some of the problems and issues with getting census data in a book called Big Data (interesting, but in a “meh” way, it read like a cheerleader for giant inclusive computer databases).

          And it is still being done. I know someone who works for the US Census, and she goes out and interviews people all the time. Not just every ten years.

          1. Chris says:

            “They also had certain questionnaires that they would try to use, sometimes things not included on the very long forms that the census takers used (which you can download from genealogy sites). The supplemental information was to determine things like economics, education etc.”

            Correction as I read through the history section, they used other surveys and data in their reports, along with some of their own non-census data collection. They rolled this into statistical abstracts:
            http://www.census.gov/prod/www/statistical_abstract.html

            It is complicated.

    4. MadisonMD says:

      Well see, y’all. All we needed were ‘dem Vit-ee-mins. Kind-er cool since de little-pox was eradicated by dem-whachamacalit– Viteemin C. Edward Jenner be damn! Tanks, Meester Science for clooin me in.

      Hey Dr. J: I think you should look reel close heer at Mr. Science’s Post. Neverthemind if cuz its haard to undestand dis genieus. After all science hain’t monolithic.

    5. WilliamLawrenceUtridge says:

      Your point may be trivially true – certainly it is recognized that being in poor health or starving puts you at much greater risk of dying from a disease. But good nutrition is not a panacea, otherwise the first world, where the greatest problem is over-nutrition, nobody would ever get sick. This isn’t the case however, note the propensity for organic sprouts, purchased and consumed by people doubtless extremely well-fed on highly nutritious foods, to sicken people with E. coli. Also, assuming “good nutrition prevents all disease”, it’s unlikely that the kings, queens and nobles of pre-modern civilizations, being generally quite well-fed, would die of infections. This is not the case. The reality is, vitamins are a necessary part of life, but they are not drugs and food is not medicine. There are rarely simple solutions, and this isn’t one of them.

      Regarding TB and vitamin C, much like cancer cells, it’s easy to kill TB in petri dishes. Does it work in humans? What kind of levels would you have to achieve in the lungs and blood to kill off the TB? Would that level be safe in humans? Are there countering-effects that either the body or the TB could use to disable this mechanism?

      The Weston A. Price foundation is not a reliable source.

      You misunderstand the utility and uses of the VAERS database. You also misunderstand the NVICP. You also apparently didn’t read the webpage you link to regarding the graphs you cite, as that page points to SBM which discusses why they are so deceptively used. The measles epidemic was likely the result of normal swings in incidence, and the vaccine caused the incidence to bottom out to almost nothing. And thank Peebles, Enders and Hilleman for that, since parents no longer have to watch their children die of it, or even suffer through it.

    6. cphickie says:

      When people put up this “cut and paste” pseudoscience graph/info proclaiming vitamins and toilets could have wiped out measles, their argument parallels one they could have made for transportation. Namely the average speed of transporting goods and people went up a decent amount when we figured out the wheel and how to hook a horse to a carriage–so…therefore, we really didn’t need to invent planes, trains and automobiles to go even faster, because if we’d just waited, horses would have gotten bigger, faster and stronger by several orders of magnitude and could have been used to overnight express vaccines from North Carolina to my clinic in Tucson by running (or maybe even flying if these woonder horses grew wings like Pegasus) at 500 mph through the night. This extrapolation I’ve given is of course preposterous and would not have happened, and thankfully cars and trains and planes were invented and implemented. It is not at all true that measles rates would have dropped to the rates we have today if we’d simply sat around backslapping ourselves over indoor toilets and chewable 1000 mg Vitamin C tablets. If that had happened, we’d still be having measles at 1960 levels, which would be very unacceptable and dangerous. Thankfully those who invented vaccines back then went ahead and kept inventing and developing vaccines.

    7. windriven says:

      “Vitamin C has been shown to be effective against tetanus in numerous studies.”

      Liar.

      Do a Pubmed search. Here is what a 2008 Cochrane review had to say about the subject:

      A single, non randomised, poorly reported trial of vitamin C as a treatment for tetanus suggests a considerable reduction in mortality. However, concerns about trial quality mean that this result must be interpreted with caution and vitamin C cannot be recommended as a treatment for tetanus on the basis of this evidence. New trials should be carried out to examine the effect of vitamin C on tetanus treatment.

    8. calliarcale says:

      “If there are 100 modern Americans in a room, and 1 has influenza and sneezes, so that everyone is exposed to the virus through inhalation and hand-shaking, approximately 90 of them will become sick and experience symptoms. Interestingly, 10 will not experience symptoms. If you take 100 malnourished people from developing nations and conduct the same experiment, 95-99 will experience symptoms. Their bodies are immunocomprimised through lack of sanitation and nutrition.”

      And yet, the well-nourished, in your own hypothetical, are still at very high risk of contracting influenza. It’s just slightly less high than the malnourished. Why would you be satisfied with a scenario where 90% of people will still get sick? This is an odd example to support a “vitamins are better than vaccines” argument, especially in a hypothetical scenario where you control all the variables.

      Incidentally, I’d love to know how it is proven that vitamin C offers “100%” protection against tetanus. I am amused by your link showing that vitamin C kills the tuberculosis bacterium in a petri dish. Of course it does. It’s an acid. Salt will kill it too, but nobody’s suggesting salt as a curative, are they? Thing is, how are you going to get sufficient concentrations of ascorbic acid to the bacterium? The human body is very efficient at removing the excess from circulation. I also find it interesting you (and the editor who wrote the headline) failed to notice that ascorbic acid wasn’t the only thing they found to kill TB in the lab. Cysteine did too. Yet because that doesn’t have its own panoply of woo behind it already, nobody latched onto it.

      And while nutrition might explain why tuberculosis vaccine effectiveness varies geographically, have you considered that maybe it’s because the organism itself may vary by region? It may be a poorer antigenic match in some areas. If so, that could be fixed with more tailored TB vaccines.

    9. Todd W. says:

      I’m wondering if science011001 is the same person posting as “courageandhope” at this article. Both use the “if X people are in a room” argument.

      1. Nope, not me. I had read a similar argument somewhere else before. Though in hindsight, I agree it was not useful.

  89. Jay Gordon, MD, FAAP says:

    Dr. Hall says: “We don’t pretend to know that the current schedule is the optimum one.”

    Perhaps you don’t but “they” do.

    @BadgerMD: I do the best I can just as you do.
    Antibiotics for otitis? Not for most kids
    Sinusitis? Doubt it.
    Surgery for every apply? I think so. Some disagree.

    The same nutritional recommendations for families with a strong FHx of very early cardiovascular disease as for those without? No!

    The same vaccine schedule for a family with three ASD kids as one without? No.

    Yes, it’s a hard job. No, I’m not paralyzed by it. I enjoy it every day.

    1. David Gorski says:

      Dr. Hall says: “We don’t pretend to know that the current schedule is the optimum one.”

      Perhaps you don’t but “they” do.

      Optimal? I don’t know that that’s how it’s viewed. The best that they could come up with? That’s probably more like it. You clearly have no idea what goes into the process of coming up with consensus recommendations. It’s a lot of looking at studies, arguing about evidence, and then compromising and coming to a consensus on what is the best recommendations they can come up with at that particular time. These recommendations are subject to continual revision as new evidence comes in.

      You, on the other hand, are convinced that you know that the best recommendations panels of national and international experts, hashing out existing evidence and studies, can come up with are not “optimal.” You are perfectly happy if your patients’ parents don’t follow them, because, hey, it’s just a bunch of people making recommendations, and Dr. Jay, all his protestations otherwise notwithstanding, thinks he knows better or doesn’t want to piss off his patients’ parents by pushing for vaccines too hard (or even at all).

      What was that about hubris, again?

    2. MadisonMD says:

      “The same vaccine schedule for a family with three ASD kids as one without? No.”

      Didn’t you say you don’t have a vaccine schedule? Why do you think ASD kids shouldn’t get vaccines? Well, if you do have ASD and non-ASD schedules, please share. How many schedules is your office festooned with?

      Anyway, I am glad to hear you are not paralyzed by fear of unknowns for interventions other than vaccines. It makes sense that you can act to treat but not prevent disease. This is consistent with practicing medicine based on experience than on science.

      1. cphickie says:

        Gordon has repeatedly said he doesn’t want infants vaccinated before 6 months, which is his schedule (and most definitely NOT the AAP/CDC schedule)

        Sears is better known for his “schedule” that he sells with his “vaccine book” that has parents skipping and/or delaying vaccines. Sears has openly told parents that if you have one child with autism, Sears recommends NOT VACCINATING the sibs of that child with autism because of

    3. WilliamLawrenceUtridge says:

      Dr. Hall says: “We don’t pretend to know that the current schedule is the optimum one.”

      Perhaps you don’t but “they” do.

      Actually, the rather crucial point is, despite your enormous confidence in your own judgement – you don’t have anything close to a rational alternative. Your certainty is no substitute for evidence.

  90. There were almost 800,000 reported cases of measles between 1955 and 1960.

    1. Chris says:

      Citation needed. You mucked up the history, so you need to support your assertions.

      Also, what dire economic crisis caused malnutrition recently in Japan? From Measles vaccine coverage and factors related to uncompleted vaccination among 18-month-old and 36-month-old children in Kyoto, Japan:

      According to an infectious disease surveillance (2000), total measles cases were estimated to be from 180,000 to 210,000, and total deaths were estimated to be 88 [11,12]. Measles cases are most frequently observed among non-immunized children, particularly between 12 to 24 months..

    2. Chris says:

      Also, where is that verified evidence published before that the American MMR caused a substantial increase in measles starting from its introduction in 1971?

      Surely it is right there next to your historical files that say the USA was in a depression and had a low birth rate through the 1950s. As you said: “If you look at the peak infection rates for measles for example, they occurred between the 1930′s and 1950′s. This of course was the period of The Great Depression and World War II. This was a period of time when nutrition levels were very low, and people were starving to death.”

      and…

      “In conclusion, the measles epidemic from the 1930′s to the 1950′s in the US was most likely cause by malnutrition combined with poor sanitation, and started declining after the war as the economy started improving.”

    3. Chris says:

      Also, where it the verified evidence showing the MMR is more dangerous than measles? Along with the paper published before 1990 that the use of the American MMR vaccine correlated with an increase in autism?

    4. Krebiozen says:

      As I understand it, measles epidemics occur where the virus is endemic:

      1. When a large enough reservoir of non-immune hosts has built up, through more children being born and losing maternal antibodies and

      2. When the virus is introduced to that population.

      1 is often mathematically predictable, whereas 2 may be random and due to happenstance, or sometimes due to migrations of infected populations.

      I don’t see why malnutrition has anything to do with contracting the virus, as almost every non-immune person exposed to measles will become infected. The virus is very cleverly designed to suppress the immune system in the respiratory tract, allowing it to infect cells and start making thousands more viruses, and to stimulate coughing and sneezing which will spread these viruses to other hosts. I have seen no evidence that any kind of supplement or diet can prevent this.

      Malnutrition will increase the morbidity and mortality, and might even decrease contagion, since a malnourished person with measles is less likely to be walking around infecting others than a well-nourished person.

      I suspect the US epidemics in the 1930s and 1950s may have been due to changes in patterns of population movement, rather than malnutrition.

  91. Lawrence says:

    @Science?- pease explain how better sanitation does anything to prevent the spread of an “Airborne Disease” not to also mention what huge breakthrough in santitation occurred in the United States between 1960 & 1970…..

    What a bunck of bollocks you’ve posted…..

  92. “pease explain how better sanitation does anything to prevent the spread of an “Airborne Disease”
    -Lawrence

    Poor sanitation adversely affects the immune system. For example:

    Intestinal parasitic infections in children can lead to malnutrition, anaemia and retarded growth, depending upon the severity of the infection, in addition to their adverse effects on the immune system. Exposure to helminths and hookworms can be effectively controlled through improved sanitation, hygiene and water supply.
    http://www.who.int/ceh/risks/cehwater2/en/index1.html

    People with a weakened immune systems are more prone to airborne infections such as invasive mould infections (IMI).

    Airborne fungus exposure prior to hospitalisation as risk factor for mould infections in immunocompromised patients.
    http://www.ncbi.nlm.nih.gov/pubmed/21797937
    Hospital-independent fungal sources highlight risk-factors for IMI in severe immunocompromised patients and the rate of community-acquired invasive mould infections (IMI) does increase.

    1. Lawrence says:

      Ummmm…..fungus & mold? How about a real airborne disease like measles – what does sanitation have to do with preventing its spread (since you are talking about post-infection).

    2. Chris says:

      What declination of sanitation caused <a href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1177963/"<measles to return to Japan with over eighty deaths?

      And I am still waiting for the data prior to 1990 that the introduction of the MMR vaccine in 1971 caused autism to rise in the USA.

  93. jay gordon says:

    @BadgerDoctor–
    ““The same vaccine schedule for a family with three ASD kids as one without? No.”

    Didn’t you say you don’t have a vaccine schedule? Why do you think ASD kids shouldn’t get vaccines? Well, if you do have ASD and non-ASD schedules, please share. How many schedules is your office festooned with?

    Anyway, I am glad to hear you are not paralyzed by fear of unknowns for interventions other than vaccines. It makes sense that you can act to treat but not prevent disease. This is consistent with practicing medicine based on experience than on science.

    Vaccines are a very, very likely trigger to genetic predisposition to certain diseases. This is acknowledged by real scientists and you know it. I will not do your homewortk for you. The studies are easy to find.

    I have no set vaccine schedule but vaccinate according to the specifics of a patient’s medical needs. That’s how all medical care should be delivered.

    I am not anonymous like you and my Medical Board and malpractice records are public. I’m good, thank you and my office is festooned with lovely pictures of babies and children. Disease-free, very healthy children.

    You know nothing about what I really do.

    1. Todd W. says:

      Disease-free, very healthy children.

      Except for the ones who come in with rotavirus, pertussis, pneumococcal disease…

    2. Harriet Hall says:

      “I have no set vaccine schedule but vaccinate according to the specifics of a patient’s medical needs.”

      Will you at least admit that your variation in vaccination is based not on any credible scientific evidence, but only on your intuition and guesswork?
      Will you admit that you have no actual evidence that your individualized schedules are as good as, much less better than, the standard schedule?
      And will you admit that delaying vaccination puts infants at risk of catching diseases that they might have been protected from, and that it reduces the herd immunity and thereby impacts everyone’s public health?
      And why do you put the hypothetical “medical needs” of individual patients above the established medical needs of immunosuppressed patients in your waiting room who are exposed to unvaccinated children and put at higher risk of contracting a vaccine-preventable disease?

    3. David Gorski says:

      Vaccines are a very, very likely trigger to genetic predisposition to certain diseases. This is acknowledged by real scientists and you know it. I will not do your homewortk for you. The studies are easy to find.

      Then cite a few of them, please, that show that vaccines are “very, very likely trigger to genetic predisposition to certain diseases.” If they’re so “easy to find,” then it shouldn’t be hard at all for you to find a few such citations, should it?

      I have no set vaccine schedule but vaccinate according to the specifics of a patient’s medical needs. That’s how all medical care should be delivered.

      I provide breast cancer care to my patients according to the specifics of their medical needs, Dr. Jay. Seriously, I do. I take each patient’s clinical situation and do my best to apply the best medical and scientific evidence available to come to a recommendation for her care. Sometimes it’s hard, such as when there is a patient who falls into a bit of a “gray area,” but the uncertainties are recognized and I discuss them with my patients. Nearly everything I do in the clinic is informed by science and evidence.

      But personalizing medical care is tricky. You have to ask yourself some questions and be very clear on the answers before you see the patient and not be changing them after you see the patient. For example, with respect to the vaccination schedule, what specific criteria do you use to determine the “specifics of a patient’s medical needs,” and upon what scientific and clinical evidence do you base each of those criteria? That’s really all what we’re trying to get at here, the answer to that simple question that you keep tap dancing around. It’s all well and good to say that you “personalize” patient care “according to the specifics of a patient’s medical needs,” but what does that really mean? If you don’t have clear set of criteria to determine exactly how you will “personalize” your therapy “according to the specifics of a patient’s medical needs” plus a scientifically validated, reasonable rationale to justify the criteria you use to personalize your therapies, then you’re basically just making it up as you go along.

      1. cphickie says:

        I’ll bet you Dr. Gorski keeps very good track of outcomes for his patients with cancer, especially to help guide future cancer treatment protocols.

        What outcomes are you keeping track of, Dr. Gordon, and what IRB-approved protocol do you work under? And, oh, I can’t seem to find your R01 grant description for your study titled “Random crap I do with vaccines in my clinic based on my lucky mood ring”.

    4. Chris says:

      Dr. Gordon:

      Vaccines are a very, very likely trigger to genetic predisposition to certain diseases. This is acknowledged by real scientists and you know it. I will not do your homewortk for you. The studies are easy to find.

      When you make a claim, you provide the evidence.

      And since the MMR vaccine is considered the real baddy, where is the evidence it caused an increase in autism during the 1970s and 1980s in the USA after it was introduced in 1971?

      1. David Gorski says:

        When you make a claim, you provide the evidence.

        Request seconded. Citations, please, Dr. Jay.

    5. cphickie says:

      My office is festooned with those same sorts of pictures of happy healthy children, and I feel a whole lot better knowing my patients are almost all fully vaccinated (save the loons who come in misguided by you and Sears). I also have pictures of my own happy healthy vaccinated children in my office.

      Vaccine preventable diseases are guaranteed to trigger illness, injury and death in almost everyone in an unvaccinated population.

  94. WilliamLawrenceUtridge says:

    Dr. Jay’s “personalization” of medicine seems to bear more relation to pandering to unwarranted fears and his own unjustified confidence than it does to any particular identified medical need.

    Vaccines are a very, very likely trigger to genetic predisposition to certain diseases. This is acknowledged by real scientists and you know it. I will not do your homewortk for you. The studies are easy to find

    They may be easy to find, but are they worthwhile? The CDC doesn’t seem convinced of a whole lot of reasons to avoid vaccines, and I doubt any of them line up with Dr. Jay’s rationalizations. Why doesn’t the CDC recognize any of these “genetic predispositions” if they are so likely? Is this like the studies you linked to above, where what you are saying doesn’t really bear any relation to the actual scientific literature? Why the resistance to the rather trivial burden of citing a couple PMIDs? Is it because whenever you attempt to provide scientific literature to justify your opinions, review of the articles presented shows that your opinions are in fact not justified at all? Is it, yet again, because you don’t like having your self-perception as a confident and smart doctor challenged by rather trivial observations?

  95. Changing the subject a bit away from Jay Gordon’s philosophy of pediatric practice

    DIscuss

    Diekema DS. Provider dismissal of vaccine-hesitant families: Misguided policy that fails to benefit children. Human Vaccines & Immunotherapeutics 2013; 9:0 – -1

    https://www.landesbioscience.com/article/26284/full_text/#load/info/all

    While frustration over vaccine hesitancy is understandable, the strategy of refusing to allow families into a clinic unless they agree to vaccinate their children is misguided, and the arguments for doing so fail to stand up to close scrutiny. Such a strategy does not benefit the child or the health of the community, and may have a negative impact on both.

    The primary ethical purpose of medical practice is to seek the good of the patient. Refusing to offer one’s services as a health care provider to a child whose parents have refused some or all vaccinations in no way benefits the child, and in some cases may increase risk to the child. These children have their options for health care limited, and in small communities where most or all clinics follow a policy requiring vaccination of prospective patients, these children may be left with no options other than alternative health care providers or the local emergency department. Furthermore, Buttenheim and colleagues have demonstrated that these children may face greater risk of contracting vaccine-preventable diseases, because their contact with other under-vaccinated children is likely to increase by virtue of these families clustering into a small number of clinics or even a single emergency department. Finally, the opportunity to educate families and eventually vaccinate children through respectful dialog may be lost when physicians refuse to work with these families.

    I have to admit I am ambivalent on this issue, from the patient side. On the one hand, I wouldn’t want my [fully-vaccinated for age] grandchildren to be exposed in a pediatric waiting room; on the other hand, I find Diekema’s arguments compelling.

Comments are closed.