Sep 23 2012
The problem of nonmedical exemptions to school vaccine mandates
It’s that time of year again, namely flu vaccine time. My very own cancer institute will be offering the flu vaccine for its staff beginning October 1, and I plan on getting mine just as soon as I get back from the American College of Surgeons Clinical Congress in Chicago early next week. In the meantime, it’s always great to read Mark Crislip’s take on the yearly flu vaccine kerfuffle, particularly this part:
I have little (actually none) respect for HCW’s [health care workers] who do not get vaccinated. We have a professional and moral obligation to place our patients first. I think those who do not get vaccinated, except for a minority with a valid allergy, are dumb asses.
Preach it, Dr. Crislip!
However, this time of year is also a vaccine time of year for another reason (well, actually it was about a month ago). That’s because in late August or early September, depending on your state, the little kiddies (and not-so-little kiddies) return to school and therefore have to be up to date on their required vaccines or face not being able to go to school. No wonder the antivaccine movement goes nuts this time of the year, given the double whammy of antivaccine parents trying to avoid vaccinating their children before going to school by hook or by crook and the yearly promotion of flu vaccines and mandates that health care workers get them. (For the record, my cancer center requires it, and if there’s one thing the administration of my hospital has done that I fully support it’s the yearly vaccine requirement. We’re a cancer hospital, fer cryin’ out loud, and we have lots of immunosuppressed patients that we take care of!) The only other time of year when antivaccinationists are even close to this actively ridiculous is every April, which is Autism Awareness Month, when they start trying to tar attempts to highlight autism and autism research with demands that antivaccine pseudoscience be thrown into the mix like the proverbial cow pie added to the apple pie.
Since Mark’s already covered the flu vaccine so well, let’s talk about the topic of nonmedical exemptions to school vaccine mandates. This topic came up when I noticed that the bloggers and denizens of that most wretched hive of antivaccine scum and quackery, Age of Autism, have swarmed over to a news story about how Washington State has made it harder for parents to obtain nonmedical exemptions to school vaccine requirements:
Washington State is home to Bill and Melinda Gates, champions of childhood vaccines across the globe. Its university boasts cutting-edge vaccine research. But when it comes to getting children immunized, until recently, the state was dead last.
“You think we’re a cut above the rest,” said Dr. Maxine Hayes, state health officer for Washington’s Department of Health, “but there’s something in this culture out West. It’s a sort of defiance. A distrust of the government.”
The share of kindergartners whose parents opted out of state immunization requirements more than doubled in the decade that ended in 2008, peaking at 7.6 percent in the 2008-9 school year, according to the state’s Health Department, raising alarm among public health experts. But last year, the Legislature adopted a law that makes it harder for parents to avoid getting their children vaccinated, by requiring them to get a doctor’s signature if they wish to do so. Since then, the opt-out rate has fallen fast, by a quarter, setting an example for other states with easy policies.
Good going, Washington! It’s about time. Over the last several years, Washington has become known as a state with such low vaccine uptake rates that it was fast on its way to becoming the capital of vaccine-preventable diseases; that is, if it could beat California, which is currently considering its own similar bill (AB 2109) that would require a doctor’s signature on vaccine exemptions certifying that the parents have been counseled and given true informed consent about the risks of not vaccinating. (This is, of course, in contrast to the misinformed consent, in which vaccines are blamed for autism, asthma, autoimmune diseases, sudden infant death syndrome, and more by antivaccinationists in order to provide a false picture of the balance of risks and benefits of vaccines that make vaccines look like the riskiest thing you can do to your child. Such are the lies of the antivaccine movement.) Indeed, Rob Schneider, of all people, has arisen as a new celebrity leader of the antivaccine resistance to AB 2109 on par with the idiocy of Jenny McCarthy on vaccines, even going so far as to claim vaccines are a violation of the Nuremberg Code.
In the U.S., certain vaccines are required before children can enter school, and there is a wide range of how tightly these vaccine mandates are enforced. In two states (West Virginia and Mississippi), for instance, no non-medical exemptions are permitted: only children with legitimate medical reasons can be exempted from the school vaccine mandate and then only with a letter from their doctor attesting to a condition or diagnosis that is a contraindication to vaccination. The other 48 states allow some form of non-medical exemptions to vaccine mandates. Twenty of these states allow “philosphical” or “personal belief” exemptions.
Non-medical exemptions are a delicate topic. On the one hand, there’s overwhelming evidence that such exemptions lead to more children remaining unvaccinated and more children at risk for potentially deadly vaccine-preventable diseases, thus degrading herd immunity and contributing to outbreaks. In the U.K., the MMR scare has been particularly devastating, leading to a massive resurgence of the measles over the last 14 years, as MMR uptake fell to as low as 50% in some parts of London. On the other hand, in the U.S. in particular, there is very much a theme of extreme resistance to being told what to do by the government. We’re actually seeing that in play right now, as I believe that much of the resistance to the Patient Protection and Affordable Care Act (colloquially known as “Obamacare”) derives from just that resistance.
Which brings us to the letter in the NEJM that I mentioned above and that also happens to be mentioned in the NYT article. It’s unusual for a letter to a journal, even the NEJM, to make the news, but this one, by Saad B. Omer, M.B., B.S., Ph.D., Jennifer L. Richards, M.P.H., Michelle Ward, A.B., and Robert A. Bednarczyk, Ph.D. from Emory University, entitled Vaccination Policies and Rates of Exemption from Immunization, 2005–2011, was mentioned in the NYT article, and it was featured on Good Morning America:
The report states:
An increasing number of parents are getting state approval to allow their children to opt out of school-mandated vaccinations for non-medical reasons, according to a new analysis published Wednesday.
Dr. Saad Omer, author of the correspondence published in the New England Journal of Medicine, warned that this trend is leaving large populations of children at risk for developing potentially deadly illnesses that haven’t been seen in the United States in many years.
“Rates of exemption are substantially higher today than several years ago,” said Omer, assistant professor of global health, epidemiology and pediatrics at Emory University in Atlanta. “Previously, rates were only rising in states with easy exemption policies, but now they are even rising in states that make it more difficult.”
Basically, what Omer et al. found is what I like to call a “Well, duh!” result, but sometimes “Well, duh!” results are important. In this case, Omer’s results were not the least bit unexpected, but the reason for him to do the study is (1) to determine whether “common wisdom” about vaccine exemptions is correct (it turns out that it is) and (2) to quantify the effect, which is what Omer et al. tried to do. Common sense and an understanding of human nature tell us that if something’s easy to get more people will take it and that if something’s harder to get fewer people will take it.
What Omer et al. found is that during the study period, nonmedical vaccine exemptions were 2.54 times as high in states that allowed philosophical exemptions as they were in states that allowed only religious exemptions. Omer et al. then categorized states allowing nonmedical exemptions by the degree of difficulty in obtaining such exemptions. Categories of difficulty were based on several factors, including whether completion of a standard form was permissible, as opposed to a letter; where the parent has to get the form (school versus health department); whether the form needed to be notarized; whether a physician needs to sign it; and the like. The results were, as I pointed out, predictable:
During the study period, unadjusted rates of nonmedical exemptions in states with easy exemption policies were 2.31 times as high as rates in states with difficult exemption policies (IRR, 2.31; 95% CI, 1.39 to 3.85). By 2011, the nonmedical exemption rate in states with easy exemption criteria increased to 3.3%, an average annual increase of 13% (IRR for change per year, 1.13; 95% CI, 1.05 to 1.21) (Figure 1, and Table S1 in the Supplementary Appendix). In contrast, nonmedical exemption rates in states with difficult exemption criteria increased by 8% annually to 1.3% in 2011 (IRR for change per year, 1.08; 95% CI, 1.02 to 1.14). In states with exemption criteria of medium difficulty, rates increased by 18% annually to 2.0% in 2011 (IRR for change per year, 1.18; 95% CI, 1.10 to 1.26). For all analyses, adjusted results were qualitatively similar to unadjusted results.
In other words, as one would expect, the easier it is to get nonmedical exemptions from school vaccine mandates, the more parents there will be who will take them. Citing their previous work that examined exemptions from 1991 to 2004, in which they found an increase in nonmedical exemptions only in states where philosophical exemptions were permitted and comparing their previous results to their current results, Omer et al. found a troubling trend. Even in the states with philosophical exemptions, the rate of increase in nonmedical exemptions was less in the preceding period than it was from 2005 to 2011. Worse still, the rate of increase of nonmedical exemptions appears to be accelerating and spreading to states with only religious exemptions. There are potentially disastrous consequences if this trend continues unabated. There is, after all, evidence that lax exemptions policies correlate with a higher incidence of pertussis and measles.
So what is the answer? From a strictly scientific standpoint, the answer is easy. Get rid of nonmedical exemptions. However, this is a situation where the ideal could well be the enemy of the possible. On a strictly political basis, even a lot of people who accept that vaccines are safe and effective and know that the only thing nonmedical exemptions achieve is to degrade herd immunity and increase the likelihood of outbreaks of vaccine-preventable diseases have a bit of a problem with mandates that don’t allow for religious and/or philosophical nonmedical exemptions. In a nation in which the elimination of all nonmedical exemptions to school vaccine mandates will not be possible for the foreseeable future, the next best thing is to make exemptions harder to get. However, even this tactic can run into thorny issues, particularly religious exemptions, if the state tries to make sincerity of belief a criterion.
Personally, I reluctantly accept that eliminating nonmedical exemptions is politically toxic. Recent experience in Vermont, California, and even Washington tell us this. Indeed, in California, an unholy alliance of antivaccinationists and Tea Party activists put up a strong fight against AB 2109, which only sought to make it harder to obtain nonmedical exemptions. Even now, although the bill passed both houses of the California legislature and is sitting on Governor Jerry Brown’s desk for his signature, he hasn’t signed it yet. It is not clear why, but there is considerable pressure on him from antivaccinationists teaming up with “health freedom” activists to veto the bill. Given these difficulties in passing bills that go even a short distance in making nonmedical exemptions easier than the parent’s just signing a form, tightening up the process for obtaining nonmedical exemptions is at this time probably the best that we can hope for.
Unfortunately, the antivaccine movement has been very successful in framing the issue of nonmedical exemptions to vaccine mandates not as an issue of medicine and protecting children, but rather as an issue of “parental rights,” in which an overweening state is portrayed as overstepping its power, crushing the rights of parents, and forcing children to be vaccinated. (One can almost hear the jackboots marching, given the liberal use of overblown and historically ignorant Nazi analogies by opponents of such bills.) Perhaps that’s one reason why antivaccine views tend to appeal to Tea Party activists as much as they do to crunchy, pharma-hating people at the opposite end of the political spectrum. Amusingly (well, in some ways), antivaccine activists will even co-opt the political language used so frequently in the 2012 election, as when Barbara Loe Fisher actually had the temerity to claim that those promoting tightening up or eliminating nonmedical exemptions based on personal belief are “waging class warfare.” I kid you not. To Fisher, it’s class warfare against the well-off:
A hilarious exerpt:
It is getting uglier and uglier out there, as angry, frustrated doctors inside and outside of government work overtime to foster fear and hatred of parents making conscious vaccine choices for their children. The latest political dirty trick is to brand parents, who send their children to private schools, as selfish and a threat to their communities because some private schools have higher vaccine exemption rates.
It is, of course, true that many private schools have higher vaccine exemption rates. Waldorf schools come to mind, given that the entire philosophy upon which they are founded includes a medical philosophy that explicitly rejects vaccines. It is also true that many antivaccine parents are well-off and highly educated. It is, as I’ve pointed out before, the arrogance of ignorance, and their higher level of education makes them better at motivated reasoning, resulting in what is sometimes called the “smart idiot” effect. Apparently, to Fisher, pointing that out is “class warfare”:
When doctors politicize vaccine exemptions in order to engage in class warfare, they are crossing a line that reveals more about who they are than the families they are trying to stereotype and marginalize. Dr. Pan, who has assumed the mantle of lawmaker, and Dr. Omer, who enjoys six federal vaccine research grants funded by the CDC or NIH, [12] and Dr. Halsey, who has funding from SmithKline Beecham and the Gates foundation,[13] likely are not struggling to pay the rent or pay for groceries.
Ah, yes. The pharma shill gambit coupled with specious accusations of class warfare. Fisher is nothing if not consistent.
Finally, it’s impossible for me to discuss this issue without addressing the elephant in the room: religious exemptions.
In the states that allow only religious exemptions, religion is being privileged above all other belief systems in being the only legally acceptable basis for parents to opt out of vaccine mandates. That’s why I’m of the opinion (which has on occasion gotten me into little tiffs with fellow travelers in the battle against antivaccine lunacy) that, if a state is going to permit nonmedical vaccines, it should allow both religious and philosphical exemptions. To do otherwise is to give undue privilege to religious belief over nonreligious belief and discriminates against nonbelievers. Antivaccinationists take advantage of religious exemptions anyway, promoting them and even telling parents how to lie about their religious beliefs in states that only allow religious exemptions. So, if a state is going to allow nonmedical exemptions, it should allow personal belief exemptions for any reason or not allow them at all (preferably not at all).
Unfortunately, it is almost certainly completely unrealistic to get rid of philosophical exemptions (to me that includes religious exemptions) to vaccine mandates altogether. The reason is that, in the U.S. at least, there is a long history of being wary of government mandates, particularly in health care. As I’ve said before, compulsory “anything” laws tend to be very politically unpopular, as has been so thoroughly demonstrated by the political resistance to the Patient Protection and Affordable Care Act (or, as its opponents sneeringly refer to it, Obamacare). Vaccine mandates that go too far politically, as scientifically justified as they may be, have the potential to provoke major backlashes against vaccine programs, as compulsory vaccination laws for all children did in the 1800s in England, Europe, and the U.S. Going too far, even for public health, risks a very real backlash, and even supporters of mass vaccination campaigns (myself included) worry about government overreach and intrusion into personal medical issues.
In this political climate, the best we can hope for is probably to limit nonmedical exemptions as much as will be tolerated and, at the very least, make them harder to get, which is why I tend to think trying to eliminate them altogether is probably a lost cause that takes up energy that could be better used for other aspects of what is necessary to promote vaccine science. It’s true that overall the national vaccine uptake rate is high and nonmedical exemption rate low, but that’s changing. The increase in nonmedical exemptions is concerning, and in some areas it’s leading to pockets of vaccine resistance such as Vashon Island in Washington, where the exemption rate approaches 25%.
In the meantime, laws should be passed that make nonmedical exemptions rare by requiring parents to do more than just sign a form. It is a battle that was recently won in Washington, is still being bitterly fought in New Jersey and in California, where a concerted campaign is being waged to persuade Governor Jerry Brown to veto AB 2109, but lost in Vermont.
220 Responses to “The problem of nonmedical exemptions to school vaccine mandates”
Having peculiar substances injected into one’s bloodstream is a profound violation of all of the defenses the human body possesses. Government and society claim many rights of way in our lives. There should be some limit to how far the dominion of government and society can reach. Even if a majority consider vaccinations a good idea, from a human rights standpoint, forcing them on people when they can be quite harmful is a bad one. Not even getting into the strange formulations the pharmaceutical companies put together, the mercury and aluminum are dangerous substances in the human brain. That these neurotoxins are routinely squirted into the bloodstreams of infants and children is truly bizarre. The bloodstream has full access to every organ, even the brain, and mercury has well known, lifelong damaging effects on the brain.
There has got to be some point where a person’s individual rights supersede any demands government, society, and corporations make on them. Certainly our skin would inviolate.
The medical establishment places themselves beyond question, as if they were incapable of error. This is hubris. Many people have good reason to believe that vaccinations are often harmful, and decide after study and consideration not to have them. It is no coincidence that better educated people lead the way. Educated people are fleeing vaccinations because they go to the trouble of studying this issue.
quest4fire’s ignorance is showing. He repeats a number of anti-vaccine myths that have been thoroughly debunked. He even appears to be under the misconception that vaccines still contain mercury and are injected into the blood stream! But I have a proposal for people who prefer to believe anti-vaccine propaganda than to understand reality. I’m willing to give them the right to make their own decisions and not vaccinate. But they should give me the right not to have my health endangered by their decisions. The simple solution is for those who reject vaccines to quarantine themselves and live in separate communities. No, I guess that’s not such a good idea, because it would endanger their innocent children, whose individual rights ought to supersede any demands their parents make on them.
quest4fire:
So, exactly which vaccines are administered intravenously? And, do, please tell us, which vaccines in the present American pediatric schedule are only available with thimerosal. Do not mention influenza, because of the eight approved for use in children at least four do not contain thimerosal.
Prove to us you are “educated.”
@quest4fire:
“Having peculiar substances injected into one’s bloodstream is a profound violation of all of the defenses the human body possesses. Government and society claim many rights of way in our lives. There should be some limit to how far the dominion of government and society can reach.”
Which vaccines are injected in “one’s bloodstream” quest4fire? “Society” through our elected representatives have enacted laws to protect the public welfare and our public health. If you don’t agree with long-standing public health laws, find yourself another society, where anarchy prevails.
“Even if a majority consider vaccinations a good idea, from a human rights standpoint, forcing them on people when they can be quite harmful is a bad one.”
Have you the capability to determine if vaccinations are a good idea? Didn’t you read what Dr. Gorski stated that parents are “opting out” of vaccinating their children? Which vaccines are “quite harmful” and show us which particular vaccine is any way more “harmful” than the actual disease it prevents. Citations from a first-tier peer reviewed medical journal that shows that an unprotected individual or unprotected populations fare better during an outbreak, would suffice.
“Not even getting into the strange formulations the pharmaceutical companies put together, the mercury and aluminum are dangerous substances in the human brain. That these neurotoxins are routinely squirted into the bloodstreams of infants and children is truly bizarre. The bloodstream has full access to every organ, even the brain, and mercury has well known, lifelong damaging effects on the brain.”
But we want you to “get into” these formulations. Which vaccines contain mercury? Is it organic or inorganic mercury? About the “aluminum” which is an adjuvant…you do know what an adjuvant is, don’t you? Again which vaccines are “squirted into the bloodstreams of infants, children…or adults? Show us any study that confirms your opinions…not just your simple cop-out statement “well-known……….”.
There has got to be some point where a person’s individual rights supersede any demands government, society, and corporations make on them. Certainly our skin would inviolate.
That statement doesn’t even make sense. You always have the option to leave this country which has an excellent public system for another society where “our skin would inviolate”.
“The medical establishment places themselves beyond question, as if they were incapable of error. This is hubris.”
And you have the ability to discern what is wrong with the medical establishment that includes the collective knowledge of scientists, researchers and epidemiologists?
“Many people have good reason to believe that vaccinations are often harmful, and decide after study and consideration not to have them. It is no coincidence that better educated people lead the way. Educated people are fleeing vaccinations because they go to the trouble of studying this issue.”
What are those “good reasons” to believe that vaccinations are often harmful” Where are those studies? Are you representing yourself as one of those “better educated people” who “are fleeing vaccinations” because you went “to the trouble of studying this issue”?
I just remembered where much of this “education” comes from: Eleanor McBean. For some reason some people think this uneducated woman was an expert, and still follow her readings decades after she died. Many claim she has degree in naturapathy and a PhD, but no one knows when or where. So it looks like it was just pulled out of thin air, just like her notions about how vaccines are given.
And people give me a bad time about insisting they provide real citations in the form of title, journal and date of PubMed indexed papers. Even that will produce nonsense, but not as much as quoting a fifty year old book from someone who just makes stuff up.
I’m rather surprised that this “quest4fire” actually took the trouble to register a new account and post such drivel. I do thank this person, however, from so aptly illustrating the problem of “misinformed consent” that we have to grapple with and that frightens parents into opting out of vaccinating their children.
I’m hoping that Jann Bellamy will chime in on this one. The fact is that, where state action is concerned, religious beliefs are privileged. (And I’ve noted this elsewhere, but the next round of this after Washington and California is in New Jersey, which apparently would turn into a dystopia should the measure pass. You know, like New York.)
Quest4Fire: “The bloodstream has full access to every organ, even the brain,”
No it doesn’t. The blood-brain barrier is there precisely to prevent “full access” to make it more difficult for toxins to reach the brain. That’s one of the many difficulties involved in developing medicines for psychiatric disorders.
Actually, I seem to recall her arguing exactly the opposite, namely that privileging religious beliefs over non-religious beliefs or privileging the beliefs of one religion (religions that supposedly have an objection to vaccination) over others that do not could very easily run afoul of the First Amendment in that the state is in essence endorsing one belief system over another by allowing nonmedical exemptions based on religion but not those that are not based on religion. Even more problematic, allowing religious exemptions but not non-religious exemptions can put the state in the position of judging which religious beliefs are and aren’t “sincere” (i.e., a “sincerity” test) or what is or is not an actual religion. If I recall correctly, that sort of concern was part of the rationale for one of the states that do not permit any non-medical exemptions (I think it was Mississippi) for not permitting religious exemptions.
Of course, I might recall this because she might have done it off SBM; I don’t recall if she’s done so on SBM.
Here’s a website where you can read passages from the bible and cast your vote (helpful or not)…if you are trying to come up with a reason for opting out of vaccines, based on a “religious exemption”. Note, the ad to get a degree in theology through on-line courses…
http://www.openbible.info/topics/vaccinations
I also read about the difficulty for an adult to opt out of a vaccine in New York State, when it is a condition for employment in a health care field. The consensus among the posters there, was to claim that G-d communicated with you directly and told you not to get the vaccine.
lilady:
Let me preface with the disclaimer that i am, indeed a bible-believing Christian, but that link is utterly ridiculous. I hate it when fellow “Christians” take obscure and random verses and shoe-horn them into having relevance for whatever argument they want to make. Thanks for the face-palm-inducing, head-shaking, chuckle.
Perhaps; I simply haven’t seen her take on it. Again, though, religious belief is plainly privileged. The feds can bust me if I have a jug of ayahuasca in the pantry; the UDV, not so much.
(I will immediately concede that the RFRA doesn’t apply to the states, though, so I probably should have come up with a better example.)
Anne Dachel is on the move again. She and her sycophants have flooded a blog about the pending New Jersey legislation regarding religious beliefs for opting out of vaccines. I’ve just posted there and could use some support:
http://www.njspotlight.com/stories/12/09/21/parents-troubled-by-bill-to-tighten-up-immunization-exemptions/#comments-container
@ The Dave: I was also raised as a Christian and I’m incensed that my religion has been hijacked by these cranks.
Apparently the first task on the list for the job description for Media Editor of the Age of Autism blog (which is Anne Dachel’s title) is to set up Google Alerts for any term related to vaccines, autism, exemptions, etc., and then to swoop in to spam the comment thread of any news story or blog post about vaccines that is favorable to vaccines, criticizes antivaccinationists, or discusses the politics of exemptions with antivaccine propaganda, misinformation, and pseudoscience. Apparently the second task on the list is to rally the flying monkeys from AoA to do the same. The idea, of course, is to try to bully any blogger who writes a pro-vaccine post and to spray antivaccine propaganda in the comments of any article by mainstream news outlets.
Yes, it is, at least in practice, although it’s debatable whether in this case it should be, even under the First Amendment. My view, though, is that it should not be, regardless of whether under the law it actually is nor not.
Dr. Gorski:
Though she does not seem to come to this blog nor to a couple of other blogs. That is interesting. It is like she and her flying monkeys cannot take actual criticism.
I really don’t mean to drag this out in irritating fashion, but why “this case”? Catholic priests are currently, from the perspective of the IRS, employees of their locals. Nonetheless, trying to sue for sex discrimination under Title VII of the Civil Rights Act if one wants to be a female priest isn’t going to go anywhere.
On the basis of parsimony, I’m not seeing why there’s any reason for a state to have both philosophical and religious exemptions. The latter is effectively a subset of the former, which is to say, if a state is going to simply make school immunizations optional, they might as well not clutter things up.
Whenever I am cut or scratched, blood appears. There seem to be capillaries everywhere under my skin. So even if a vaccine is introduced inches away from a large blood vessel, it will soon be in the bloodstream. Are you saying the vaccines don’t travel through the circulatory system? Isn’t that the point?
I meant to say, “Certainly our skin would be inviolate.” Meaning that I make the decisions regarding what goes in my body and how. And for my child too.
Vaccinations have always been promoted as completely safe and effective. The publicity stirred up by the drive to eliminate exemptions has revealed that vaccinations are increasingly found to be far less effective and more hazardous than before the effort to make them forced. And the legislation to free the vaccine manufacturers from any liability is a red flag for anyone to see.
Band-Aid would prove that vaccinators are stupid SOB.
Not especially, no. Have you ever noticed in your adventures with cuts and scratches that the body has this weird habit of doing things at the site?
You do realize don’t you that parental injections go beyond the site?
Amazingly weird habit of vaccinators.
That’s pretty much what I’m saying. In the case of nonmedical exemptions, the state should either allow a parent to refuse vaccinations for any reason at all, religious or “personal belief,” or it shouldn’t, preferably the latter.
@quest4fire,
“Vaccinations have always been promoted as completely safe and effective. ” No, they haven’t. They have been promoted as safer and more effective than not vaccinating. The switch from DPT to DTaP and the new booster recommendations provide an excellent illustration of how the scientific establishment identified that a vaccine was not “completely” safe and effective and took steps to make it safer and more effective.
You think your skin should be inviolate? I think my body should be inviolate too. It is a violation of my alveoli for another person to risk my health by making me breathe second hand smoke. By rejecting vaccines, you contribute to the reduction of herd immunity that will sooner or later bring those diseases back into the community, introducing contagious bacteria and viruses into my body. Bacteria and viruses that are guaranteed to harm me, in contrast to the minimal risk and hypothetical concerns about vaccines.
quest4fire:
Then you are particularly unlucky, or have abnormal physiology. Do you bleed each time you get a bug bite? You might want to have your lack of blood clotting checked out.
I have lots of thorny roses and am regularly scratched, and even stabbed by them. Sometimes after I come in I will see a tiny splinter sticking out of my skin, pull it out and there is no blood. My immune system is doing its job by causing inflammation to combat the incoming microbes and cutting off the blood, and then healing the wound. The very few times there is blood the wound usually closes up fairly quickly. Even though the thorns of the Polka Climbing roses are over half inch long, none have ever penetrated even a minor blood vessel.
(One time my arm did get scratched by the roses and caused a rash, when I gave blood the next day or so the phlebotomist decided to use the other arm. Oh, and those are big needles!)
The only time I have ever drawn blood is by cutting myself with a knife in the kitchen. Something I try to avoid. But the bleeding is often stopped quickly with a bit of pressure and a bandage. If you bleed with every scratch, I suggest you stay away from knives.
I also make sure my immune system knows how to deal with tetanus by being current with my tetanus boosters. The last time I received a tetanus booster was a Tdap in 2011. It was a small needle that was painless and there was no blood.
“The publicity stirred up by the drive to eliminate exemptions has revealed that vaccinations are increasingly found to be far less effective and more hazardous than before the effort to make them forced.”
That’s your evidence? The say so of self-styled experts? I think that, as these diseases return, there will be a more of a backlash, and these exemptions will be eliminated.
There is no way to determine how unsafe vaccines are because doctors will not report any event as vaccine caused. A child could start screaming an hour after injection, swell up and have diarrhea until he is dead 72 hours later and it would not be blamed on the vaccine.
Herd immunity in regard to vaccines is a misuse of the term.
Wow, quest4fire is dumb.
“doctors will not report any event as vaccine caused.”
Not without evidence, they won’t. When an event is reported to VAERS or elsewhere, the first step is to determine whether there is a true association (more events with vaccines than without). If an association is established, the next step is to determine whether it is a causal association. The experience with Guillain-Barre and the 1976 flu vaccine is a good example of how science works to study association and causation.
“Herd immunity in regard to vaccines is a misuse of the term”
No it isn’t. It refers to having a sufficient level of immunity in a community so that an infectious disease is unable to propagate. It makes no difference whether an individual’s immunity was derived from natural infection or vaccination.
I haven’t dived into VAERS data in a while, but it seemed like something half of the cases reported there it was not possible to find evidence that it ever occurred. And non-medical people can report to VAERS, so you get the people reporting that they fainted DUE to a vaccine (Gardasil, for instance), when in reality they had vasovagal syncope due to being scared of needles.
I trust less than 10% of what a patient tells me when it comes to their medical issues. When I first started, I’d hear their stories about how some doctor mistreated them or didn’t do something right, but 9/10 times, upon investigation, it was the patient who misunderstood their medical condition (and yes, in part because a doctor didn’t explain it well, or because the pt simply doesn’t have the background to comprehend it). “Do you have diabetes?” “No.” “So why are you on metformin..” “Oh, my diabetes is well treated, so I don’t have it anymore.”
Etc, etc.
This isn’t to attack patients, I’m merely stating that Joe Average doesn’t understand medicine and therefore their anecdotes of such are nothing more than slightly interesting stories. This is why I simply don’t care when a chiropractor (who is of questionable intelligence and education) tells their stories of how they helped save a patient one time when an evil doctor ignored them. And this is why it’s hard to care about these stories you hear from a friend of a friend of a friend, who got a vaccine, and then 3 months later got hit by a car and obviously the vaccine caused that.
And again, I’m sure this is true in every field. I can only imagine how stupid I would sound if I tried to explain how a bridge was constructed to a structural engineer, or if I gave my interpretation of how the Large Hadron Collider works to a physicists (some small particles move really fast and collide and make black holes!!!), or even when I try to sketch something out on a piece of paper in front of my wife, who is an artist.
I think our new friend should get that fire thing figured out before tackling immunology.
quest4fire:
There is no way to determine the veracity of anything quest4fire writes. Quest4fire can start typing right after his/her computer fires up, post several arguments of blatant assertion, get more incoherent and laughed out of here and it would not be blamed on his/her intelligence.
“Herd immunity in regard to vaccines is a misuse of the term.”
Yeah? Go on. Do you want to elaborate on that? I could say your intelligence is a misuse of the term too. Does that make it so?
Regarding VAERS, didn’t someone post that the flu vaccine turned them into the incredible Hulk?
One of the links from the OP had this quote:
“It’s also true that no one expects the “makin’ copies” guy to be any more intelligent than Jenny McCarthy”
Somehow this really hit me the right way, comedically…(hey be fair: he was in Hot Chick also…)
Tell me, Quest4Fire, how exactly do you work in education/academia when you have only graduated from a 2 year college:
http://www.okcupid.com/profile/quest4fire?cf=regular
To be fair, The Dave, there are several different people using that particular ‘nym.
I guess that is a valid possibility. How can I delete that comment? It doesn’t actually add to the conversation.
James Laidler.
The Dave, I found several other people using that ‘nym. Including another dating site where the gentleman was younger, much much darker, still in college studying chemistry and definitely single.
Oh, and on VAERS, here is a demonstration of a person outside the USA reporting that a vaccine turned his daughter into Wonder Woman.
I would assume that when the MMR vaccine rates in the UK dropped to 50% that the autism rates dropped by 50% as well? And that there was a huge drop in the number of children under age 2 who died as well?
Oh, no, there was no difference? Really? But vaccines cause autism and kill babies! Don’t they?
I am so very tired of ignorant antivaxxers just making sh*t up. I wish they could all be forced to watch someone infected with tetanus, or polio, or somesuch other totally preventable and horrible disease, suffer and die.
I have relatives who lived during polio outbreaks. They said when the (very first EVER) vaccine came out, they lined up early for it. Bless them!
icewings…Your relatives, I presume, are now old and decrepit
I remember getting Salk polio (the very first EVER) vaccine.
I can’t help but noticed no one touched the point I made about the immunity of the vaccine makers against any liability. Do doctors enjoy that protection, too?
Herd immunity refers to a population with a large proportion of people(about 2/3) who have been exposed to a disease and have a natural immunity. Vaccines do not give this kind of immunity, and in my state the health dept. claims almost 100% vaccine participation is needed to achieve what they call herd immunity. People who have been vaccinated can still catch the disease they are vaccinated for, and what protection is provided is short lived. I got all the childhood diseases in the 50s and have natural immunities. Now kids get shots that will last long enough so they can get those diseases in their teens, when they can do some real damage.
“Herd immunity refers to a population with a large proportion of people(about 2/3) who have been exposed to a disease and have a natural immunity.”
Your own definition?
“People who have been vaccinated can still catch the disease they are vaccinated for, and what protection is provided is short lived.”
Yes they can. Why? How long is the protection? Data needed.
“I got all the childhood diseases in the 50s and have natural immunities.”
We are supposed to believe that you had polio, too? So if you had the diseases, others should get them too? They will all be better off, without sequelae, and without taxing our health system?
“Now kids get shots that will last long enough so they can get those diseases in their teens, when they can do some real damage.”
Another assertion without data to back it up.
“I can’t help but noticed no one touched the point I made about the immunity of the vaccine makers against any liability.”
No vaccine gets approved unless it is proven to be safer than the illness it helps to prevent. For example measles can cause SSPE. The vaccine can as well but the risk is at least 1000 times less than the disease. However, when it occurs after the vaccine, the person vaccinated is entitled to compensation. They can apply for compenstion to a special committee set up just for that purpose. It is actually easier to get compensation through that mechanism than through the courts.
The reason why Pharmaceutical companies are immune from being sued is that they were opting out of vaccine production as a result of being sued. This would mean we would all be back to 1000 times the risk of SSPE through getting measles compared with being vaccinated. So the purpose of giving immunity to vaccine manufacturers was to keep them manufacturing vaccines for the benefit of the public.
(The best evidence is, in fact, that the measles vaccine does not actually cause SSPE)
When lawsuits are such a problem it is because the business is a bad idea. So they get propped up by the government and relieved of responsibility for their questionable products. Sounds like nuclear power- an industry that can’t attract investors, so the government props it up.
About the vaccine manufacturers’ “being immune from claims” as state by “questforfire”, Seth Mnookin just blogged about the whole cell DPT vaccine, the media and the opportunist/grande dame of the anti-vaccine movement Barbara Loe Fisher (founder of the NVIC):
http://blogs.plos.org/thepanicvirus/2012/09/13/the-whole-cell-pertussis-vaccine-media-malpractice-and-the-long-term-effects-of-avoiding-difficult-conversations/
See how she had her “epiphany” about the reported “DPT vaccine injury” to her child…after she viewed the TV documentary “Vaccine Roulette”
“In the days after “Vaccine Roulette” aired, Thompson’s employer provided callers with the phone numbers of other people who’d also called looking for more information about negative information regarding vaccines — and in doing so, helped create the modern-day anti-vaccine movement. Among the parents who met in the days after the airing of “Vaccine Roulette” was Barbara Loe Fisher, who soon formed a group with the Orwellian moniker the National Vaccine Information Center.
At the time, Fisher was a former PR professional who’d become a full-time housewife after she’d given birth to her son Chris four years earlier. When “Vaccine Roulette” aired, it had been more than a year since Chris had started displaying symptoms of what would eventually be diagnosed as a range of developmental disorders. I wrote about Fisher’s reaction to Thompson’s broadcast in my book:”
Now read this about her “recollections” from eighteen months before, when her son received his final DPT vaccine dose.”
“It wasn’t until she saw Thompson’s broadcast that the pieces fell into place. The reactions that Thompson described—convulsions, loss of affect, permanent brain damage—were, Fisher realized, identical to those experienced by her son. Suddenly, Fisher remembered in meticulous detail what had happened one day eighteen months earlier, when Chris had received the final dose of his DPT vaccine:
When we got home, Chris seemed quieter than usual. Several hours later I walked into his bedroom to find him sitting in a rocking chair staring straight ahead as if he couldn’t see me standing in the doorway. His face was white and his lips slightly blue, and when I called out his name, his eyes rolled back in his head, his head fell to his shoulder and it was like he had suddenly fallen asleep sitting up. I tried, but could not wake him. When I picked him up, he was like a dead weight and I carried him to his bed, where he stayed without moving for more than six hours, through dinnertime, until I called my Mom, who told me to immediately try to wake him, which I finally did with great difficulty. But he didn’t know where he was, could not speak coherently and couldn’t walk. I had to carry him to the bathroom and he fell asleep again in my arms and then slept for twelve more hours.
It’s an incredibly moving story, and one that Fisher has told to congressional panels, federal committees, and state legislatures, and at national press conferences for more than twenty-five years. In all that time, she’s almost never been questioned about the specifics of her narrative—and there are parts that, if nothing else, certainly are confounding.~ Fisher, as she told an Institute of Medicine (IOM) Immunization Safety Committee in 2001, is “the daughter of a nurse, the granddaughter of a doctor, and a former writer at a teaching hospital” who viewed herself as “an especially well-educated woman when it came to science and medicine.” How was it that her only response to finding her unresponsive son displaying symptoms associated with heart attacks, strokes, and suffocation was to carry him to bed and leave him alone for six more hours? And if Chris’s reaction to his fourth DPT shot was so severe that it transformed an ebullient boy into a sluggish shell of his former self, why had he been fine after receiving the first three doses?”
IMO, she either embellished Chris’ reaction greatly giving false sworn testimony or, she was an incredibly incompetent coldhearted parent, whose child should have been brought to a hospital emergency department for these severe reactions.
“Shortly after the formation of Dissatisfied Parents Together, Fisher founded the National Vaccine Information Center. Since then, she’s played an essential role in organizing a movement that’s targeted the press, politicians, and the public in equal measures. The result has been a steady erosion of vaccine requirements and a steady increase in the percent of the population skeptical of vaccine efficacy.”
Recently, genetic studies of some of the claimant/children whose parents claimed they suffered severe adverse events, following administration of the whole cell DPT revealed that they had an undiagnosed rare genetic disorder:
http://pediatrics.about.com/b/2011/08/15/dravet-syndrome-an-alternative-explanation-for-vaccine-encephalopathy.htm
Every purchaser (doctors, clinics, governments) of every vaccine, pays into a fund that is put aside to pay for severe adverse events following a vaccination, where the Federal Court of Claims-Vaccine Court, renders a plaintiff’s verdict. The fund also pays all costs for the plaintiff (attorneys fees, expert witness fees and other expenses), for every claim that goes through the Vaccine Court…even for those cases which are denied. It’s a nifty practice for attorneys…like money in the bank. Unlike civil courts, where the attorney makes money only if the plaintiff prevails. No decision in plaintiff’s favor…no attorney fees.
The purchaser of the vaccine pays an additional $ 0.75 per separate antigen/disease that the vaccine prevents. Each dose of MMR vaccine costs the purchaser an additional $2.25 that is placed in the Vaccine Court’s compensation fund.
The burden of proof in the Vaccine Court is much lower than civil court’s burden of proof (50 % and “a feather”). There are “Table Injuries” and all the plaintiff must prove is that a serious adverse event happened within 15 days of having received an immunization.
Here’s the interesting part, the anti-vaccine groupies love to point out that several thousand claims were awarded since the Vaccine Court was established by enactment of the National Childhood Vaccine Injury Act in 1986. How many claims for injuries would have paid out in civil courts…with the much higher burden of proof?
If the plaintiff does not prevail in the Vaccine Court, they have the option of suing in civil courts. How many of the failed cases have opted to sue in civil court and how many have prevailed?
Are you disputing the statement that vaccine manufacturers are immune to liability for their products? As I understand, the US government pays for the damages.
lilady quoted “When we got home, Chris seemed quieter than usual. Several hours later I walked into his bedroom to find him sitting in a rocking chair staring straight ahead as if he couldn’t see me standing in the doorway. His face was white and his lips slightly blue, and when I called out his name, his eyes rolled back in his head, his head fell to his shoulder and it was like he had suddenly fallen asleep sitting up. I tried, but could not wake him. When I picked him up, he was like a dead weight and I carried him to his bed, where he stayed without moving for more than six hours, through dinnertime, until I called my Mom, who told me to immediately try to wake him, which I finally did with great difficulty. But he didn’t know where he was, could not speak coherently and couldn’t walk. I had to carry him to the bathroom and he fell asleep again in my arms and then slept for twelve more hours.”
Well you obviously already covered it but, even to non-medical folks like myself.. It’s pretty clear she is either a liar or a f@*king idiot, because what parent sees their child unresponsive with blue lips AND doesn’t take them to the ER immediately?
If she is being honest, she shouldn’t be in front of congress she should be in front of CPS.
quest4fire:
Sure, I’ll dispute it.
First off, though, it isn’t the US government who pays for damages in the Vaccine Injury Compensation Program. Rather, a tariff is placed on every vaccine dose. The money from that is put into a fund which is used to pay compensation via the VICP.
Secondly, VICP doesn’t make vaccine manufacturers immune to liability for their products. It indemnifies them, but that’s a different thing. It’s like indemnifying yourself against liability for car accidents by buying car insurance; if you rear end somebody, you would legally be liable to pay for the damage to their bumper, but because you bought insurance, instead your insurance company will pay for the damage; the idea isn’t to immunize you from prosecution or liability but to make it less costly for you. (This has a bonus in that not only does it make it easier on you, it also makes it more likely your victim will receive compensation; in the days before mandatory collision insurance, most people who got hit were basically out of luck because you can’t collect more money from a person than they actually have.) The person you hit can actually still sue you, though. They’re just much less likely to go to the bother since they’ve already gotten what they needed with much less effort.
Vaccines are similar to that. If you get a vaccine, and then suffer a serious allergic reaction to it, requiring treatment for anaphylaxis or similar, you have just had to spend a bunch of money for something that wasn’t your fault. The manufacturer should pay, right? So you go make a claim under VICP, the vaccine court looks at your evidence (you had vaccine X on day Y and then had an allergic reaction documented by hospital Z), and they send you a check. More or less. If you weren’t satisfied with that, there is nothing stopping you from suing the manufacturer directly. However, if you do choose to do that, you will need to follow the evidentiary rules of civil court, which are higher than in the VICP. You will need to prove that your injury which wasn’t compensated by VICP really was caused by the vaccine, or that you injury that *was* compensated really deserved more compensation than you got, or possibly both. In VICP, just having an injury is enough; if you get GBS, you’ll be compensated. In civil court, you have to convince the judge of a connection, and since GBS occurs even in unvaccinated people (pretty much any immune reaction can theoretically trigger it, which would include things like colds), that would be much more difficult.
So VICP is a good thing. It was the brainchild of an antivaxxer, but that doesn’t make it bad. It is good for both victims and manufacturers — a rare example of a win-win situation.
BTW, I’d also like to speak momentarily to the question of the government forcing people to be vaccinated.
Unless we were in a truly desperate situation (like some hostile foreign power having just deonated a smallpox bomb in all the major cities of the US), I would abhor the notion. It contravenes everything I love about this nation, and goes against medical ethics too — you don’t give a person a medical intervention without their informed consent. (Or, in the case of small children, their parents’ consent.) And, happily, we don’t have the government forcing anybody to get vaccinated.
The CDC, a government agency, does publish recommendations for vaccines, but these are just that: recommendations. It’s entirely up to you (and whatever medical professionals you might hire to vaccinate you) to decide which vaccines to get and when. You can even go totally unvaccinated. And actually, there is no exemption needed — nobody is forcing you to get vaccinated.
What we’re talking about here isn’t national vaccination campaigns. We’re talking about school entrance policies, and because classrooms are confined spaces and getting more and more crowded all the time as budgets diminish, schools have a vested interest in making sure they have herd immunity in effect. For this reason, in all 50 states, public schools have vaccination policies. They will not force you to be vaccinated, but they may not allow your child to attend if your child is not current on certain vaccines. None requires the entire CDC schedule; their requirements are always compatible with it, but much looser. (I’ve never heard of a school requiring influenza, for instance, but the CDC continues to recommend it.) The policies are usually set at the state level, and generally apply only to public schools. Private schools frequently echo the policies, but not always. Most states allow only a medical exemption; some also allow a religious and/or philosophical exemption — that is, you can be excused from some or all of the vaccines and still attend school, although you might be asked to stay home if there is an outbreak of a vaccine-preventable disease, for your own protection. One loophole to this is that most states don’t require any form of documentation; they just ask you for the dates of the vaccinations and take your word for it. Medical exemptions are also often done on the honor system. So, if you feel this is the government forcing the corruption of your child’s perfect skin, be glad that you have lived such a free life that this feels like oppression.
Great post, cause it advocates the more-hoops-to-be-exempt, cause it admits that making it without any exemption will be politically impracticable, and the clarity of the religious/philosophical lack-of-distinction. On the last point I certainly don’t want the government making tests of what is and what is not a religion, or which ones are acceptable, or whether I am genuine in testifying about my beliefs – that’s so ridiculous, requiring inquisitors.
Calli’s last comment was pretty good at adding some details (like just faking medical exemptions).
I thought in a previous round of this, people had examples of private schools (perhaps jewish) where there were only medical exemptions, so their demands were stronger than state law. Private schools can do that.
Stop putting your ignorant uniformed opinions forward and stating that they are facts, quest4fire. Stop accusing me of avoiding questions and stop playing word games with me.
Here, another example of your making statements that are simply untrue and that have been addressed in my post just upthread…
” quest4fireon 24 Sep 2012 at 8:34 am
Are you disputing the statement that vaccine manufacturers are immune to liability for their products? As I understand, the US government pays for the damages.”
You posed that question before about vaccine manufacturers “not being held responsible” and Billy Joe at 6:33 AM gave you the short answer why the government stepped in with legislation so that funds could be available to pay claims for vaccine adverse events.
“The reason why Pharmaceutical companies are immune from being sued is that they were opting out of vaccine production as a result of being sued. This would mean we would all be back to 1000 times the risk of SSPE through getting measles compared with being vaccinated. So the purpose of giving immunity to vaccine manufacturers was to keep them manufacturing vaccines for the benefit of the public.”
See if you can slog you way through this paper to find this section:
http://iom.edu/~/media/Files/Activity%20Files/Disease/VaccineFinancing/FineBackgroundPaper.pdf
“The U.S. Experience: Safety Concerns Reshape the Market in the 1980s
In the U.S., while public concerns about the safety of DTP gained momentum starting in the 1970s, it was not until the early 1980s that the issue exploded domestically. Three related sets of events converged to reshape the U.S. market for DTP and for childhood vaccines more generally: (1) dramatic increases in media coverage of potential adverse effects of DTP; (2) exponential growth in product liability lawsuits brought by consumers against pertussis manufacturers, and (3) exiting of manufacturers from the market. More specifically, television documentaries such as Vaccine Roulette, which aired in 1982,helped to sensitize the public and policy makers to safety concerns. Between 1981 and 1982, the number of news stories covering pertussis more than tripled, from fewer than 30 to over 100.
Product liability suits saw an even greater increase: From 1978 through 1981, a total of nine product liability lawsuits were filed against DTP manufacturers in the U.S.. For the single year 1982, however, 17 DTP lawsuits were filed; and by 1986, the number of pertussis product liability suits filed during the year reached an all-time high of 225 (Sing and Willian, 1996).
During a six-month period in 1984, in response to the growing liability crisis, two of the three manufacturers distributing DTP in the U.S. market B Wyeth and Connaught B dropped out, leaving Lederle as the sole supplier in the U.S. (CDC, 1984).”
I expanded on Billy Joe’s comment with next post…which you obviously did not read…or you are unable to understand due to your abominable, next-to-non-existent reading comprehension skills. Please read how the purchaser of the vaccines, including doctors, clinics and the government pay into a fund for awarding of damages through the Federal Court of Claims-Vaccine Court.
Any more moronic questions…that you want me to reply to, quest4fire?
While often said, I don’t believe this is true. I refer in particular to Bruesewitz v Wyeth. Unless I’m completely misreading that case (entirely possible; IANAL), the grounds for suing in civil court are very limited. Essentially you can only pursue such a case for improper manufacture or labeling. Side effects from a properly prepared and labelled vaccine may not be pursued outside the VICP.
rork — the private Montessori which my daughters attended before moving to the public school had stricter requirements, although they retained the medical exemption. I think ADA would pretty much obligate them to retain that exemption. (Which I think is perfectly fine, BTW. If a kid’s allergic to eggs, that’s not his fault.)
quest4fire:
Do tell us how that worked out for oldest child of Roald Dahl and Patricia Neal.
While you are at it, tell us exactly how the MMR vaccine used in the USA is more dangerous than measles. Do try using something a little more convincing than argument from assertion. Perhaps actually providing some real citations. Here are some examples:
The Clinical Significance of Measles: A Review
Vaccine. 2012 Jun 13;30(28):4292-8. Epub 2012 Apr 20.
The combined measles, mumps, and rubella vaccines and the total number of vaccines are not associated with development of autism spectrum disorder: The first case-control study in Asia.
BMC Public Health. 2011 May 19;11:340.
Congenital rubella syndrome and autism spectrum disorder prevented by rubella vaccination–United States, 2001-2010.
Pediatr Infect Dis J. 2010 May;29(5):397-400.
Lack of association between measles-mumps-rubella vaccination and autism in children: a case-control study.
PLoS ONE 2008; 3(9): e3140 doi:10.1371/journal.pone.0003140
Lack of Association between Measles Virus Vaccine and Autism with Enteropathy: A Case-Control Study.
Pediatr Infect Dis J. 2006 Sep;25(9):768-73.
Encephalopathy after whole-cell pertussis or measles vaccination: lack of evidence for a causal association in a retrospective case-control study.
J Infect Dis. 2005 Nov 15;192(10):1686-93. Epub 2005 Oct 12.
Subacute sclerosing panencephalitis: more cases of this fatal disease are prevented by measles immunization than was previously recognized.
Arch Pediatr Adolesc Med. 2005;159:1136-1144.
Economic Evaluation of the 7-Vaccine Routine Childhood Immunization Schedule in the United States, 2001
JAMA. 2000 Dec 27;284(24):3145-50.
Individual and community risks of measles and pertussis associated with personal exemptions to immunization.
lilady- I have tried to be civil in the face of, at times, extreme rudeness. When I first saw this site I knew I was venturing into a place much like the Free Republic. But your last post is particularly insulting. There is no need to get personal. I know there is a lot of money, perhaps $39 billion dollars at stake in the vaccination industry, and that anyone in allopathic medicine has a huge stake in vaccinations. An MD degree costs a lot of money and family connections. Is this a private club for MD’s, or is it a forum for challenges and discussion? Or are some of you just aggressive people who have a stake in the enormous and expanding vaccination juggernaut?
Gosh lilady, I think we might do better to just keep educating quest4fire ala Harriet Hall, rather than resort to the tone of your latest entry. Quest is obviously misinformed, but aren’t we here to try to counter that in a rational way? Quest is spouting anti-vax talking points and we can easily take them apart and provide valid referrals and present rational arguments, even repeatedly, but I see no reason to shout at him/her to “stop”. I was rather enjoying the combined effort to logically refute the arguments he/she presented. The more often I read them, the better I get at talking with people like Quest when I encounter them–which is more frequent than I would like.
quest4fire, are you too insulted to tell me how the oldest child of Roald Dahl and Patricia Neal did after getting measles?
@quest4fire,
“anyone in allopathic medicine has a huge stake in vaccinations”
Yes, we do, but not for the reasons you think. I practiced in the military where I was on straight salary. Now I am retired from the practice of medicine. I never charged for vaccines or for my services in giving them. I had no financial interest in recommending them. Vaccines and vaccine manufacturers have never put a penny in my pocket or even a pen with a drug company logo. I do, however, have a huge stake in vaccinations: I want the best medicine and the best in public health for myself, my children, and for other people.
“An MD degree costs a lot of money and family connections”
It does cost a lot of money, but that has nothing whatsoever to do with the question of the efficacy and safety of the currently recommended vaccine schedule. As for “family connections,” I can’t imagine what you’re thinking of.
quest4fire:
I would love for you to educate me on vaccine economics. You can start by telling me what number is to the left of the word “Vaccines” on page 30 of this report. And do tell me which numbers to the right of that row mean. You might want to adjust the location of your decimal point.
Please tell me which is cheaper: providing two MMR doses for each child, or having every child get measles by the time they are fifteen years old?
The present measles outbreak has put one out of four persons reported to have measles in the hospital. According to this article, Pediatric hospital admissions for measles. Lessons from the 1990 epidemic., more than 19% of the reported cases of measles required hospital care, costing at least $18 million. About two thirds paid by Medi-Cal, that state’s insurance for low income families that is funded by taxpayers.
Here is some more literature on the costs of preventing measles:
J Infect Dis. 2004 May 1;189 Suppl 1:S131-45.
An economic analysis of the current universal 2-dose measles-mumps-rubella vaccination program in the United States.
So, do tell us how much we can save by denying children the MMR, and just letting them get measles. Explain how much healthier they will be, especially the one in a thousand who get encephalitis.
And don’t forget to tell me about Roald Dahl’s oldest child. Please tell us exactly how much healthier she is now.
Yes, the ruling in Bruesewitz is that state design-defect torts are preempted, making the NCVIA compensation and appeal system the only option if this would be one’s theory, § 300aa-21(a) notwithstanding.
I believe that is indeed the case, Narad, but I would think that if there was real harm you could sue for damages on the grounds of defective labeling — to whit, the labeling failed to indicate that a particular harm could occur, and you have evidence it did occur. IANAL, though, and couldn’t speculate on how effective this theory would be.
I think the “improper labeling” bit means “different than the FDA-approved label.” (Page 13 of the majority opinion in particular seems to indicate this.)
@ quest4 fire: I posted my lengthy explanation about the levy paid by each purchaser of each dose of vaccine which is placed in the fund for payments for vaccine adverse events at 8 AM this morning…which was an expansion of the comment made by another poster…
“Every purchaser (doctors, clinics, governments) of every vaccine, pays into a fund that is put aside to pay for severe adverse events following a vaccination, where the Federal Court of Claims-Vaccine Court, renders a plaintiff’s verdict. The fund also pays all costs for the plaintiff (attorneys fees, expert witness fees and other expenses), for every claim that goes through the Vaccine Court…even for those cases which are denied. It’s a nifty practice for attorneys…like money in the bank. Unlike civil courts, where the attorney makes money only if the plaintiff prevails. No decision in plaintiff’s favor…no attorney fees.
The purchaser of the vaccine pays an additional $ 0.75 per separate antigen/disease that the vaccine prevents. Each dose of MMR vaccine costs the purchaser an additional $2.25 that is placed in the Vaccine Court’s compensation fund.”
Thirty-four minutes later…you posted back at me…
quest4fireon 24 Sep 2012 at 8:34 am
“Are you disputing the statement that vaccine manufacturers are immune to liability for their products? As I understand, the US government pays for the damages.”
Sorry, if you didn’t think my comment back at you lacked civility…”Stop putting your ignorant uniformed opinions forward and stating that they are facts, quest4fire. Stop accusing me of avoiding questions and stop playing word games with me”.
You have been told a number of times, by a number of posters who have provided a number of links about the compensation program, the legislation that set up the Vaccine Court and the funding source for the monetary damages that are awarded to plaintiffs who prove that an adverse event was caused by an immunization.
Everything you stated in your posts before I posted at 8 AM this morning, and everything you stated in your posts since 8:34 AM this morning, convinces me that you are playing words games, or are deliberately being obtuse, or you lack reading comprehension skills.
@quest4fire
“anyone in allopathic medicine has a huge stake in vaccinations”
What!? Where is my check? This whole time I’ve been missing out. Maybe surgeons don’t get let in on the vaccine profit system.
My brother, a pediatrician, does not accept patients that are not vaccinated. So he loses some patients, therefore he loses money. He also says there is almost no reimbursement for administering vaccines.
Not vaccinating kids would lead to more hospital admissions and more billable care. Shouldn’t “allopathic” doctors be leading the fight against vaccination? Oh wait, we actually want patients to do well. That’s why I’ve given 80+ hours a week for the last 15 years to the field of medicine and to my patients. Do you do anything besides read some internet articles and comment on blogs?
I love the “family connections” statement. You truely have no idea what you are talking about.
What a curious statement. I hope Q4F’s secret to impenetrable skin can be shared because I for one am sick of nicking my fingers when chopping garlic. Of course, if it is only achieved at the expense of completely lacking the ability to respond to invading organisms once the skin is penetrated, I don’t think it’s worth it.
Quest4fire, you live in a time of luxury, when children surviving to adulthood is normal rather than a blessing. I doubt you know what polio or smallpox looks like, I doubt you know anybody with smallpox scars, I doubt you know anyone who walks with braces or a cane due to polio – because of vaccination. I doubt you know anyone who has died of influenza, chicken pox, measles, pertussis or tetanus – because of vaccination. I doubt you know anyone who has had an actual reaction to vaccination. You may think you do, people may have attributed reactions to vaccines, I just doubt the vaccine is ever responsible for much beyond localized inflammation and mild fever. Your repetition of antivaccination talking points indicates you are uninterested in actually learning about the topic – if you were, you would know that these are long-refuted claims and absolutely nothing new.
Feh, blew the blockquotes.
I like to add some additional comments about all 50 States’ Mandates for vaccination before school entry. Each and every State has mandates for entry into public school and for continued participation in education programs as new vaccines or additional doses of vaccine were recommended by the ACIP and the CDC (i.e. Tdap booster vaccine requirement for 11 year olds and the recommendation for the second MMR vaccine dose in 1989).
I’ve only perused several States’ mandates, including New York State’s requirements, for entry into licensed day care, Head Start and pre-school programs and they have strict vaccine mandates, (age appropriate, up-to-date), for enrollment in those programs, as well.
Each States’ Health Departments are responsible for the public health of residents of that state, including the prevention of disease transmission and laws are enacted by state legislatures to enable the Commissioner of the Department of Health and his/her designees (public health doctors, nurses, sanitarians), to enforce the enabling Commissioners’ Regulations based on those public health laws. The Education Law/Regulations strictly follow the Health Laws/Regulations regarding immunizations.
Anti-vaccine groups have tried to override State vaccination laws http://en.wikipedia.org/wiki/Vaccination_policy and have been unsuccessful:
“In the United States, the Supreme Court ruled in the 1905 case Jacobson v. Massachusetts that the state could require individuals to be vaccinated for the common good.”
New York State has very strict vaccine requirements for entry into private schools that receive Federal funds for anciliary services (health care, textbooks, psychological services, services for children with special needs and school busing costs) and for entry into public schools…including the types of physicians immunization records that are “acceptable” proof of completed immunizations. Parents “records” are not acceptable proof.
http://www.health.ny.gov/prevention/immunization/schools/docs/questions_and_answers.pdf
Home schooled children do not require an immunization record, filed with local school districts…unless they participate in programs that are on public school property or within public schools. Private schools can choose to take children into their programs who are not immunized…but then they do not receive the large amount of Federal funds that are “washed through” the State Education Department.
One ought to be cautious in citing 107-year-old cases. Indeed, Jacobson occurred in the context of a smallpox epidemic and revolved around only a monetary fine. School immunizations (smallpox again) were addressed in a mere three paragraphs in Zucht v. King in 1922. And, again, Jacobson was cited in support in the disaster that is Buck v. Bell.
There’s a recent review of Jacobson here. Perhaps closer to the mark in the context of this post is this from 2005, but I’ve only scanned it. Footnote 25 suggests that the concept underlying AB 2109 has been percolating for some time; the Silverman article (PMID 12856460; I think I’m out of links) cited was also referenced by Jann Bellamy here last December (“Vaccination Mandate Exemptions: Gimme That ol’ Time Philosophy”; although not invoking the “informed refusal” language), which I suspect is what Dr. Gorski was referring to above.
…that we no longer need fear because vaccination has eradicated the disease through the applied principle of low-risk, high-benefit interventions. You’re welcome world!
No judgement here, I just like pointing it out.
Well, sure, but I don’t think introducing court decisions about eradicability is going to clarify much of anything.
@jmb58,
I know a pediatrician who practices in a similar manner. He simply doesn’t put up with idiotic parents who don’t want to vaccinate. He just does not accept them as a patient, because, besides the obvious, let’s be honest, any parent who is that stupid, is likely to be high maintenance anyway. Let’s all be honest, any clinician is happy when a patient is low maintenence, wants to get healthy, and understands their role as a patient, and your role as their doctor. It’s no lie that 20% of your patients can take up 80% of your time.
@WLU,
I’ve started using a garlic press.
My wife converted me.
Interesting… quest4fire thinks the FDA is a corrupt puppet for “allopathy”, but has infinite trust in our civil courts and trial lawyers and thinks that they couldn’t possibly be influenced by fools and money.
Regarding pediatrician’s not accepting unvaccinated children.
I can understand a pediatrician who refuses to continue care when a parent won’t vaccinate after a good explaination of the risks and benefits and how those risks and benefits apply to the particular child, but I wonder if refusing patients before that discussion would be a mistake.
When my son was receiving speech services I knew quite a few parents of autistic children who were concerned about vaccines. Most of these children had recently been diagnosed (and at the age where kids seem to need tons of vaccines) and parents were struggling with the diagnoses, with finding appropriate affordable therapy for their children and dealing with school systems and insurance companies both of which can be can be, not only a bureaucratic nightmare, but sometimes even outright dishonest. Parents often had no free time, leisure time, some were not sleeping much and some had children with some extreme behaviors.
Most of these parents were bombarded with bad information from family, friends, neighbors and the press about the causes of their child’s autism. They don’t know what caused they’re child’s autism. How do they know, without an explaination on the specifics of their child, that the child doesn’t have some condition that makes him vulnerable to vaccines?
This is the time that the parent’s haven’t got their feet under themselves…or how to deal with the situation. It is a time when a sensible, thoughtful pediatrician can make a world of difference. If these folks are rejected by local science based pediatrician’s because they won’t vaccinate until their concerns are alleviated, then where will they go? I hope, for the welfare of these kids, that pediatricians will consider those circumstances and reach out to those parents.
I don’t really know much about parents of typical kids that don’t vaccinate. Do they seek out the anti-vax info or do they have it thrust upon them?
I do know that, a number of years ago,when my pediatrician recommended the chicken pox vaccine, I immediately told her I wasn’t sure I wanted that for my daughter, due to some info a friend had told me about immunity running out in the teen years. My normally sweet pediatrician went rather steely on me and told me it was required for entrance to kindergarten. She did listen to my concerns and explain that the use of boosters had resolved the incomplete immunity issue. So in the end all was well and the whole discussion probably took no more than 3 to 5 minutes.
Sorry, rambling, up with the neighbor friend’s cold.
“I can understand a pediatrician who refuses to continue care when a parent won’t vaccinate….”
On the other hand, I don.t think it is ever justified to refuse to treat a patient for any reason other than threat of harm by the patient.
@BillyJoe. – hmmm, that wasn’t really the point of my comment.
But, Pediatrician decline patients all the time. Mostly it is because their practice is full…meaning they have a set number of patients or families they accept so that they can attend to annual exams and sick visits in a timely manner.
Secondly, I really don’t know much about infants, even from a parenting perspective much less a medical perspective, so I’ll let the medical folks support or correct me… But I would think that during a pertussis outbreak, like the one my son’s school sent home a notice about last spring, an unvaccinated child with a severe cough sitting in a pediatrician’s waiting room with a number of infants could possibly be considered a threat of harm to those infants. The pediatrician does have some obligation to provide a safe environment to the more vulnerable patients.
As far as I know, in a pinch, a sick child – vaccinated or unvaccinated can always be seen at the urgent care center or ER.
I’m a bit late to the conversation, but I think I answered the questions posed here about the connstitutionality of mandatory vaccination laws and exemptions in this post:
http://www.sciencebasedmedicine.org/index.php/vaccination-mandate-exemptions-gimme-that-ol-time-philosophy/
@Narad:
Wandering OT, would you care to clarify your Price-Anderson comment? Are you suggesting state law would provide an avenue to sue either the utility or its suppliers if a nuclear power plant accident occured?
That’s what I took away from Silkwood v. Kerr-McGee, 464 U.S. 238 (1984) (“the discussion preceding its enactment and subsequent amendment indicates that Congress assumed that persons injured by nuclear accidents were free to utilize existing state tort law remedies”). What one has is an indemnification scheme with a damages cap per accident–where the money is going to come from, not entirely how it’s going to be obtained. I’d have to look more closely at In re Three Mile Island Litigation, 87 F.R.D. 433 (M.D. Pa. 1980), and Stibitz v. General Public Utilities Corp., 746 F.2d 993 (3d Cir. 1984), to get a feel for the jurisdictional stuff in play, and IANAL, but offhand I’m not seeing a Bruesewitz-style preemption. (As opposed to state safety regulation, which is preempted, devolving from the fact that nuclear technology started as a Federal monopoly.)
“I reluctantly accept that eliminating nonmedical exemptions is politically toxic. Recent experience in Vermont, California, and even Washington tell us this.”
I work in a local health jurisdiction in Washington State. We braced ourselves for an onslaught of complaints from angry parents after SB 5005 was signed by the governor and again when the school year began – it didn’t happen.
The usual suspects turned out in Olympia and went on record as opposing the new law, but that’s all we’ve heard.
Under the new law, religious exemptions require only a parent’s signature. The state has no interest in policing religious exemptions. Parents can declare that they belong to The Church of None of Your Business.
I’ve reviewed the exemption data for our jurisdiction for this school year and there doesn’t appear to have been a substantial increase in the number of religious exemptions compared to previous years.
Before the new law passed, we found that a substantial proportion of personal exemptions in our jurisdiction were convenience exemption; that is, parents did not have their children’s immunization records at the time they registered them for school, so they signed a personal exemption form, sometimes after being prompted by school staff. Many children with personal exemptions were actually fully immunized.
“In two states (West Virginia and Mississippi), for instance, no non-medical exemptions are permitted”
According to the CDC’s National and State Vaccination Coverage Among Adolescents Aged 13–17 Years — United States, 2011, Mississippi has the lowest adolescent Tdap coverage (36.9%). West Virginia is better (60.1%), but still lags far behind most other states.
Why? Neither state requires Tdap for secondary school admission.
http://www.immunize.org/laws/tdap.asp
@ aeauooo
Usually Immunize.org has up-to-date information about States’ vaccines requirements for schools.
I located some updated information from Mississippi and West Virginia and Tdap booster are required for the 2012-2013 school year.
http://msdh.ms.gov/msdhsite/_static/resources/2029.pdf
http://www.dhhr.wv.gov/oeps/immunization/providers/Documents/Section%205/FINAL_082011-%207th_12th_%20School_Entry_Chart%202011-JNJKTW.pdf
@lilady
Thanks! That’s good to know.
I must retract my statement about having seen the exemption data for the 2012-2013 school year – that data has not yet been collected [facepalm]
No facepalm needed. I often refer to Immunize.org for *reliable, current* information.
When I am confronted with a bunch of troll anti-vaccine posters who claim that VPDs are *harmless*, on some other non-science blogs (I’ve been known to post at the Ho-Po), I always link to the photos of the kids and adults infected with *harmless* VPDs, available on Immunize.org…they’re show stoppers.
I have decided to educate myself. I will be gone for a while. I am reading Callous Disregard by Andrew Wakefield.
quest4fire, that is hilarious.
Have you found out how much healthier the oldest child of Roald Dahl and Patricia Neal was after her bout of measles?
And do please tell us how much money we can save if we let every child get measles instead of two doses of the MMR vaccine. I’m am anxious to hear how much cheaper it is caring for one out of five reported cases of measles in the hospital is compared to preventing the disease.
Another question you can answer when you finish that book: What version of the MMR vaccine was Wakefield studying? One of the three used in the UK before 1992, or the one after 1992? Also, since the USA had an MMR vaccine in the USA since 1971, what data did he get dated before 1997 that alerted him to an issue with the American MMR and autism? Do provide the title, journal and date of those PubMed indexed papers that he must have included in his book.
By the way, you should read this review of that book.
@Billyjoe
In my bother’s case he is part of a very busy group that is usually full. Based on their past experiences working with antivax parents they decided to limit their practice in that way.
“I don.t think it is ever justified to refuse to treat a patient for any reason other than threat of harm by the patient.”
Really? I have to take see every patient that wants to see me? I have no say in this?
We are not talking about emergencies here. Those must be seen and treated and always are.
I rarely turn down patients, but I don’t like idea that I am never justified in doing so. I’m not a slave here. I do get to have some choice regarding how much I work. I think 80hrs/week is enough, with plenty of calls at home, middle of the night emergencies, and missing my kids soccer games to operate on people for free.
Well, gotta go. ER just called. Seriously people, don’t drink and drive.
@Chris,
“By the way, you should read this review of that book.”
Thanks. I was going to suggest that, as well as reading Paul Offit’s books Autism’s False Prophets and Deadly Choices.
quest4fire reading Wakefield’s book to educate himself about vaccines is a bit like a creationist reading the Bible to educate himself about evolution.
Dr. Hall, he could learn one answer to my list of questions by reading the dedication at the beginning of Roald Dahl’s book The BFG. Though I sincerely doubt that he even understands the question.
You could also check out this (PDF) when you’re done with Wakefield’s auto-homage. Or that case law, whatever, go crazy.
@BillyJoe
As always, BJ, you are talking completely out of your butt.
Doctors can refuse to accept a new patient based on any number of (almost infinite) reasons. Doctors can refuse to accept a new patient if the patient seems very high maintenance, may be a drug seeker, parent doesn’t vaccinate, personality conflict, beliefs conflict, etc, etc. It’s as simple as saying “I’m sorry, but I don’t believe this is going to be a good fit for you or I. I will not be your physician. You can just leave the office, you will not be billed for this visit.” It’s just like a restaurant, a doctor can refuse service to any new patient, we aren’t forced to be the physician of every patient that comes around. The rules, at least as far as ethics are concerned, are more involved once you’ve established a relationship with a patient.
Furthermore, contrary to your naive, uninformed opinion, a doctor can refuse certain treatment to an established patient even if there is no threat of harm to the patient. For instance, here in the Bible Belt (a particularly religious part of America), there are more than a handful of family doctors who don’t prescribe birth control to females to prevent unwanted pregnancies (of course, there are other reasons to prescribe it.)
@MIM,
I am not a pediatrician (thank god, sorry), but I would support your idea that one of the many reasons a pediatrician wouldn’t want a bunch of super sick, unvaccinated kids around is that they would infect other kids at the office. That’s one of many reasons, but I completely support your idea.
“I have decided to educate myself. I will be gone for a while. I am reading Callous Disregard by Andrew Wakefield.”
Educate yourself in what? Definitely not in clear thinking. Try Nonsense on Stilts instead.
There are several books that are more worthwhile than Callous Disregard. These include Unstrange Minds by Grinker, Goldacre’s Bad Science, and Lies, Damned Lies and Science by Seethaler.
And, of course, the classic Fads and Fallacies in the Name of Science.
SH,
Why do you always mischaracterise my posts?
I gave my opinion about what doctors should do and you countered by saying what they actually do, or are allowed to do. I already know what some doctors do and what they are allowed to do. My opinion is that they are wrong to be selective in this way. All comers welcome!
How do you justify refusing to accept a patient because they are high maintenance? What doctor worth his salt would contemplate doing so? Give me all the easy patients and the let some other doctor handle the difficult ones. How can that be justified?
Also, it’s interesting that you think doctors are no different from a restauranteur in this regard, free to accept or reject customers.
And I’m not saing that doctors should be forced to treat every patient who comes through their door. I am saying that they should want to accept whoever comes through the door, in whatever shape or form they come and with whatever problems they come. I also don’t mean that doctors should treat all of their patient’s conditions. If he is not skilled in treating drug addiction, that is no reason to reject the patient. It is a reason to refer the patient to someone who is skilled in treating the drug addiction side of that patient’s problems and to continue to treat the patient’s other problems.
Finally, if the patient wants to be treated in a way that is against the doctors principles or religion, again that is not a reason to reject that patient, but a reason to refer the patient to someone who will (or at least to inform the patient that they will need to go elsewhere for that treatment) and to reassure them that they are welcome to come back for any other problems they may have.
@SkepticalHealth, wrt:
“Do you have diabetes?” “No.” “So why are you on metformin?”
I actually have this discussion with the local pharmacist every time I pick up my prescriptions or try to buy OTC meds.
I don’t have diabetes, I’ve never had diabetes, but he insists I must be diabetic, and continually questions prescriptions ordered for me. by my GP, even
though said GP has repeatedly told the pharmacist that I don’t have NIDDM.
It’s getting tiresome after twelve years!
@quest4fire – Wakefield is a joke. Vaccination rates have dropped to fatally low levels (for pertussis at least) here in the UK. Measles and mumps infection rates have, respectively, tripled and quadrupled. Autism diagnosis rates have, not surprisingly, remained on the same upward trend.
@Thingy – “parental injections”?
Another howler from the “medical professional” there.
That’s actually an excellent plan, it’s good to familiarize yourself with the mud-slinging and logically fallacious arguments of Wakefield and his ilk so you can then appreciate what real science looks like. I read Darwin’s Black Box and Darwin on Trial for similar reasons, sending them back to the library heavily-annotated to highlight factual and reasoning errors.
Reading any of those books for actual information value is, of course, the opposite of education.
@BillyJoe:
I think you misunderstand SkepticalHealth. Just because he talks about refusing to treat a patient, doesn’t mean he doesn’t do what you think he should: “…refer the patient to someone…”
And I can see why a doctor wouldn’t want to treat a drug addict. It has nothing to do with not knowing how to treat addiction; it has everything to do with not wanting to deal with a patient who is just there to try to get a prescription for a CII drug “Because my back is killin’ me doc, I swear.”
From my understanding, there is no obligation to treat a patient unless it is an emergency. You can always refuse to treat a patient otherwise. I refer them to the medical society to get a list of physicians. If I refer a patient to someone and they screw up, I can be sued for referring to them.
Dave,
If that is what SH is saying then why is he disagreeing with me?
But I don’t think he is saying that. He is saying that he feels it’s justified not to treat some patients at all. I disagree. In my opinion, all generalist doctors should be prepared to treat any patient that comes through the door. And all specialists should be prepared to treat any patient that is referred to him by the generalist doctor, provided that patient falls within his specialty. And I do mean that they should be prepared to do so. I’m certainly not saying that they should be compelled to do so.
As for rejecting drug addicts: if all doctors had that attitude, where would that patient get any medical treatment for any of his other problems. The specialist in drug addiction will only be treating his drug addiction. Who will take on his other medical problems. Drug seeking behavior by a patient should not be seen as a reason to reject a patient, but should be seen as a challenge as to how to adequately manage that patient.
Weing,
“From my understanding, there is no obligation to treat a patient unless it is an emergency. ”
I’m not talking about obligation. I’m talking about what is the right thing to do.
“You can always refuse to treat a patient otherwise.”
And if all your colleagues also refuse to treat that patient, what then? After all they would have as much reason as you to reject that patient.
@BJ,
Again, your belief that it’s “the right thing to do” is just based on a naive view of medicine. Who are you to say what doctors *should* do?
You know what? Some people get dealt crappy hands in life. Some people burn every bridge they cross, multiple times. I’ve had tons of patients that didn’t have a single family member or friend as a support system. No one in their family wanted anything to do with them. The patients are physically and mentally disabled, and they end up in basically the worst nursing home that exists. Yes, it sucks, but there’s really nothing that can be done about it. The same may happens for your hypothetical patient that no one wants to take care of.
Honestly, your naivety of what doctors do, or what some patients are like, is a good thing. It means you are likely rather normal and the fact that certain types of human beings exist is just alien to you. Again, that’s a good thing. Imagine angry patients that end up in jail because they raise hell at doctors offices because something doesn’t go their way. These people have issues that will get them fired from every doctors office. Few, if any, doctors would tolerate patients that threaten their staff. Eventually there will be no one left to see them, and they’ll likely end up back in jail.
Or drug seeking patients: it’s always very obvious. “Oh yeah, I hurt my back a long time ago. No, I don’t want to go to physical therapy. Oh no, I don’t want Naproxen. Oh, I’m allergic to Ultram. The only thing that worked was something called .. dila… dilahh.. Dilaudid? Oh and Soma too.” These patients get instantly kicked out of clinics, which means that doctor will not see them for any reason.
And you specifically mentioned my use of the words “high maintenance.” I sure as heck wouldn’t want a CAM-using mother who is going to challenge me on everything I say “Oh, I don’t want to use that antibiotic. It’s not natural.” or “Oh, I don’t want to vaccinate my children, it can cause autism. Oh you should read this website it tells you everything.” or “Oh, I don’t like pills.” or “Oh, I don’t want to do this.” No thank you. I don’t want that kind of patient. It doesn’t suit my personality, and it would not be a good doctor-patient relationship. I can refuse to be this patient’s doctor, and it is perfectly ethical for me to do so, despite your opinion. That doesn’t mean I would terminate my relationship with any patient who uses a CAM modality, but if it interferes with treatment, or patient refuses proven treatment, then, really, what’s the point in continuing a relationship with them? I am too busy to deal with a patient who doesn’t want my help. Let them save their money and go elsewhere.
… so yeah, ..
“I’m not talking about obligation. I’m talking about what is the right thing to do.”
Not treating the patient may be the right thing to do. If a patient won’t follow my recommendations, then he is wasting our time. If there is a personality clash, I am sure he can find someone that matches his personality. We are not all alike. If their insurance sucks, you have to make a decision, treat them until you can’t pay your bills and go bankrupt or dismiss them and treat those that compensate you enough to stay in business.
Some examples of times I have declined to treat a patient:
1. They are verbally abusive to me or my staff.
2. They broke narcotics contracts.
3. They refused to lose weight or stop smoking, sabotaging the chance of a successful surgery.
4. They came for a second elective surgery after not paying a dime towards their first surgery (for which the hospital payed for all hospital costs, I gave them a steep discount on my fee, and offered a monthly zero interest payment plan. We are talking something like $40 bucks a month. Oh, and they had an iPhone).
5. They were suing one of my partners.
6. I was too busy.
7. I didn’t want to do that procedure anymore.
8. They needed a major operation but refused to receive a blood transfusion. They believe transfusions are wrong, I believe killing someone in the OR is wrong.
That said, I rarely decline to see or treat a patient. And I never decline to see a patient in the hospital or ER.
jmb58, I’m guessing you’re a general surgeon?
I just want to point out, for anybody that’s reading, how incredibly lucky we are to have surgeons. These people go through *hell* during residency, only to finally graduate and find themselves in one of the most litigious specialities there are. They, literally, will have patients who have never worked a day in their life, they’ve never made one ounce of effort to take care of themselves, or to do anything good for themselves or for society, never paid a dime in taxes, and have freeloaded their entire life, who get sick and need a procedure that is somewhat (or very) risky, and things don’t go perfectly, so then this useless bag of skin will look at this surgeon as if they are a bank and turn around and sue them. It doesn’t matter that malpractice wasn’t committed – the case may be dismissed or settled – but now this surgeon’s record is dinged, and too many dings and he can’t do surgery any more. All because of some piece of lazy garbage.
In fact, there is a trend of surgeons refusing to do high risk procedures. And I don’t blame them one bit. Why do something you aren’t intimately comfortable with, or very confident of the success in, if you are only going to be screwed for trying to help someone?
(jmb, our hospital requires 80% payment up front for self/cash payers. It’s absolutely ridiculous that the hospitals get stuck paying for all this crap.)
Excuse me. By “get sick” I meant suffer from something that is self afflicted. Ie, fat person eats too much, now needs a knee replacement, or a diabetic who refuses to eat healthy or take meds needs an amputation, etc.
And I don’t mean to sound bitter. I’m just giving real life scenarios. I *really* detest laziness. Almost as much as I detest chiropractors.
SH,
Yes, some people get dealt crappy hands in life, but why is that a reason to reject them? Isn’t that kicking the boot in? Really, I don’t understand this attitude from the caring profession. Even if there is nothing you think you can do for them, at least could not reject them. That’s probably something no one has done for them in a long time. But there ARE things you can do for them. Drug addicts suffer from all the conditions that non drug addicts suffer from, from lacerations to diabetes. It just doesn’t make sense to reject them just because they are drug addicts and you can’t or don’t want to treat their drug addiction.
And there are ways of managing angry or threatening patients. It is possible there are patients with sociopathology that cannot be managed. But they must be a rare exception. Sure there must be many non pathological patients who just have an attitude problem, but the doctor himself might also have an attitude problem which causes him to inflame rather than resolve the situation.
And the CAM using mother comes to see you for what reason? Maybe she wants real medicine as well? Otherwise why is she there? So why does it matter to you that she insists on using CAM despite you pointing out all the reasons why she should not do so. She is also using real medicine courtesy of yourself. And who knows what you might be able to achieve in the long run? But I don’t get the personality thing. Why should there be a personality clash? Why does personality come into it if you are treating their medical conditions. Surely generalists have to be flexible enough to deal with all sorts of people with all sorts of backgrounds?
As for insurance, we do not have this problem in Australia. Everyone is covered by public insurance. And private insurance companies have no say in what doctors do. They simply pay the bill (this does not apply to work or traffic insurance however, which is an insight into how crappy your system must be over there).
SH,
“By “get sick” I meant suffer from something that is self afflicted. Ie, fat person eats too much, now needs a knee replacement, or a diabetic who refuses to eat healthy or take meds needs an amputation, etc.”
Nope, I don’t get this attitude. They are still people. Do you think they enjoy being fat, having an arthritic knee, being diabetic, having an amputation? People don’t choose to be lazy and fat. They just are. Most people hate exercise. If they are thin, fine. If they are fat, bad luck.
There is a family friend who is like this. She is obese, smokes, and eats junk. By thirty five she had diabetes, by forty she had triple bypass, and six months ago she has had her right leg amputated. You could say all her conditions have been self inflicted, but maybe this is just the way things are for her. But the treatment she has received from her generalist and specialists have meant that she is still alive today. And her family and friends are all very grateful for that.
SkepticalHealth – clearly not the guy to invite to the Jimmy Buffet concert.
@billyjoe
Insurance is just part of the issue. We are trying to convey that there are many reasons to decline to treat someone.
Regarding my poor attitude (or maybe SH’s bad attitude). You are right, this profession does involve caring. I cared enough to choose it. I’ve cared enough to make a lot of personal sacrifices for my patients, as have my wife and kids. I get to say “no” sometimes. And I don’t feel an ounce of guilt.
@SH
Thanks for the shout out.
Every surgeon I know has wanted to quit at some point thanks to a frivolous law suit. Luckily, it’s just so damn fun cutting people open.
Equal props to all the great primary care docs out there. Wish we had more of you and less lawyers.
1. They are verbally abusive to me or my staff.
Do you and your staff now know how to deal with abusive patients so as to avoid a repeat.
2. They broke narcotics contracts.
Did you make another contract and try again? If not, did someone else have a go? Or did everyone just give up?
3. They refused to lose weight or stop smoking, sabotaging the chance of a successful surgery.
Or they couldn’t lose weight or stop smoking. There are people who can’t move without getting breathless and who still smoke. If this means surgery is contraindicated so be it. That’s the way it is. There’s no point in blaming the patient.
4. They came for a second elective surgery after not paying a dime towards their first surgery.
Fair enough. We don’t have that problem here. Iv they are not insured, they can be referred to a public hospital who pays the specialist’s bills.
5. They were suing one of my partners.
That would be difficult, even if your partner was at fault and the patient’s claim entirely legitimate. If you felt that this would interfere with your management of the patient on an emotional level, it would seem reasonable to suggest the patient attends another clinic.
6. I was too busy.
No one expects you to work at a level you don’t feel comfortable with. That would compromise your mental health and therefore the care you provide to your patients.
7. I didn’t want to do that procedure anymore.
Again, no one expects you to work outside your confort level.
8. They needed a major operation but refused to receive a blood transfusion.
If the pros and cons of doing surgery was swayed against doing surgery because of this, then there is really no problem. Patients cannot insist you carry out surgery that is not recommended. Emergency surgery, of course, would be another matter.
@BJ,
Of course, you missed the entire context of my post: that people who have never done a thing to better themselves in their entire life get sick because of their own choices, and then turn around and sue because someone couldn’t magically put them back together again.
Obviously, I object to your baseless statement that people are “just fat.” I’m not Einstein or anything, but I feel pretty confident in stating that it takes a certain daily caloric intake to maintain morbid obesity. I’ve never seen an obese person who was starving. You remind me of someone who posted here recently blaming television advertisements for making junk food look so tastey for the obesity epidemic. At some point, we have to look at the person who consumes liters of sugary soda and fast food all day and say “Hey, it’s your fault your fat.” Besides, how are you going to effect change in their life without having them take responsibility for themselves? Your own anecdote is a great example.
I actually see nothing wrong with saying that some people are lazy and mostly useless and are drains on society. Sure, they have loved ones, but that doesn’t excuse the fact that they are ultimately responsible for their own well being, and that the majority of their health issues are indeed self inflicted. Why is that so bad? Why is it bad to ask a person to take responsibility for their actions? Why do we (you) feel compelled to insist that fat people, who eat terribly and cause cardiovascular and metabolic disease for themselves, aren’t to blame?
Again, just like your other post, it’s just based in naivety. You certainly are never at a loss for sharing an opinion for something which you know nothing about.
@MIM,
I attended a Jimmy Buffet concert on an island while on vacation a number of years ago. He was playing from a dock in the ocean and we all sat on the beach and listened. Phenomenal!
“Regarding my poor attitude (or maybe SH’s bad attitude). You are right, this profession does involve caring. I cared enough to choose it. I’ve cared enough to make a lot of personal sacrifices for my patients, as have my wife and kids. I get to say “no” sometimes. And I don’t feel an ounce of guilt.”
I understand that completely. And neither should you feel any guilt for wanting a balance between work, family, and leisure. But I’m talking about rejecting certain types of patients. I cannot see how that can be justified (you’re a drug addict, okay out you go, I don’t treat drug addicts, take your diabetes elsewhere).
@BJ
(DEEP BREATH, TRYING NOT TO CUSS YOU OUT.)
You are just clueless. God, every post you make just reveals this. A doctor would be a fool if they give a patient a second chance after they find out their patient is doing something abnormal with their narcotic prescriptions. That exposes a doctor to so much liability. “So, you knew that your patient was not taking his pain medications, but you kept prescribing them anyway?”, or “So, you knew that your patient was getting pain medications from 4 different doctors in the state, but you kept giving them to him?” No way in hell. There are no second chances. Besides this, you are so clueless (not meant as an insult), that you don’t understand *why* a patient breaks a narcotic contract. They’re either drug addicts, or they are selling the pain meds for a profit. Yes, these scumbags that I keep talking about, that you don’t believe exist, abuse the tax payer-funded healthcare and get pain medications for free, and then turn around and sell them on the street.
And for the #3, how can you not blame the patient? For certain diseases, like COPD, there’s only a handful of things we can do that increase survival. One of them is smoking cessation. How can you not blame the patient if they refuse to stop smoking? Of course that’s their fault. Who else are you blaming there? The cigarette advertisements? Celebrities from the ’60s for making cigarettes look cool? In general medical treatment, of course you’ll still treat them, and offer medications to help them stop smoking, but ultimately the patient is to blame. In surgery, it’s a different world. There are multiple co-morbidities that increase a patient’s chance of mortality during surgery. Smoking, excess weight, poor diabetic control, high blood pressure, peripheral vascular disease, etc, all increase the risk of surgery. How fair is it to ask a surgeon to operate on a very unhealthy patient when it’s only going to increase the likelihood of post-op complications and increase the risk of a lawsuit?
I just can’t accept this point of view that people aren’t to blame for their own decisions.
SH,
Do you allow lawyers to direct your practice of medicine? Do you really assess every patient from the point of view of whether they are likely to sue you and reject those who you think may do so?
As for rejecting the notion that people are “just fat”, I guess you believe in the notion of free will
But seriously, there are genetic influences and environmental influences that make everyone what they are. The environment includes other people, including you. What people end up doing is the result of both genetics and environment. What else is there? Some people, as you said yourself, are just dealt a crappy hand. Your influence could make that hand eitheR crappier of better.
Fortunately for that family friend, the influence of her generalist and specialist was to make her life better, despite the crappy hand she was dealt.
@BJ
That’s because you have zero experience ever dealing with such a patient. When you have a drug addict in your office, the last thing they are going to be interested in is achieving an optimal A1C level for diabetic control. All you will hear about is “Oh my back hurts. I don’t want physical therapy, and I’m allergic to tylenol, advil, naproxen, and ultram. The only thing that works is Lorcet & Soma.”
“Do you really assess every patient from the point of view of whether they are likely to sue you and reject those who you think may do so?”
I think SH is referring to inappropriate prescribing of narcotics. It’s not a question of being sued but a question of losing your license to prescribe.
SH,
Regarding drug addict contracts:
I don’t know what sort of a system you have over there but, in Australia, there is a department of health hot line for doctors to discuss the management of any patient with a drug adduction problem, or who they suspect has a drug addiction problem. They can be rung at any time and they can issue permits over the phone for treating patients with drugs of addiction. They also scrutinize prescriptions written by other doctors for a patient for whom another doctor holds a permit. It is also illegal for a doctor to prescribe drugs of addiction to any patient who they suspect of having a drug addiction problem. This includes any patient they have not seen before who comes in requesting a prescription for a drug of addiction. In that case they must ring the department and obtain a permit, which will obviously be refused if another doctor already holds a permit.
So there is no problem giving a patient with a drug addiction problem another chance. All it requires is a phone call. In fact, it is preferred to dismissing the patient and having him going along to see yet another doctor who knows less about him that the original doctor and will likely have even less success managing him.
I’m talking here about patients with genuine pain who become addicted to narcotics. Otherwise the patient must be treated by a drug addiction specialist who holds a permit to prescribe methadone or suboxone. The aim here is containment. Some do get off narcotics eventually and some die of overdoses, but the aim is the prevention of drug related crime. The aim is to protect the general population against assault and robbery.
Weing,
Nope, SH was taking about being sued:
“Of course, you missed the entire context of my post: that people who have never done a thing to better themselves in their entire life get sick because of their own choices, and then turn around and sue because someone couldn’t magically put them back together again.”
SH ,
“When you have a drug addict in your office, the last thing they are going to be interested in is achieving an optimal A1C level for diabetic control. All you will hear about is “Oh my back hurts. I don’t want physical therapy, and I’m allergic to tylenol, advil, naproxen, and ultram. The only thing that works is Lorcet & Soma.”
Hence the contract.
The drug addiction specialist will treat your drug addiction problem. I will treat everything else.
All this talk about rejecting drug addicts is ridiculous because BillyJoe obviously has zero understanding about the whole thing. We are talking about people going to the doctor only to try to score more pills. They are not presenting with anything else (diabetes, whatever) They don’t want to be treated for anything, they just want to see if that particular doctor will write him a script for a CII. Of course a doctor is not gonna give them a second chance, and it has nothing to do with being sued. As SkepticalHealth said, the liability of doing that is huge. And it has nothing to do with being sued, but being stripped of your licence and spending time in jail. Pharmacists have the legal right and obligation to refuse to dispense to someone who is suspected of being a junkie. Some states even have an electronic Controlled Substance Database that physicians and pharmacists can access to see if a patient’s identifying info pops up with a hit of possible CS abuse.
BJ,
Oh, I see what you’re referring to. Unfortunately, there are patients like that.
“The drug addiction specialist will treat your drug addiction problem. I will treat everything else.”
That kind of patient is generally a no-show. I fire them from my practice. Maybe they will take their problems seriously with the next doctor. Here, you can get sued for not imparting the seriousness of their illness to them. “My doctor didn’t do anything when I didn’t go for the ordered tests, or didn’t show up for follow up, so I thought they weren’t important. Now look at me. It’s his fault.”
If only we had this wonderful drugs of addiction hotline, all my problems would be solved.
“Do you and your staff now know how to deal with abusive patients so as to avoid a repeat”
Yes, we tell them if you are going to be an ass you can leave.
“If they are not insured, they can be referred to a public hospital who pays the specialist’s bills”
For elective stuff? Hang on……Ouch, I just pulled an abdominal muscle due to excessive laughter.
@Billyjoe, in a way I appreciate where your heart is at. I confess to some cynicism, 15 years on the frontlines of medicine will do that to you.
I’m going to bed. Gotta operate tomorrow on a guy that just couldn’t stop smoking. (seriously)
I got my DTaP vaccine yesterday in preparation for my partner to have our second child. This is an issue in Sydney (would you believe), and on the north shore of the harbour, due to poor herd immunity due to lower than normal vaccination rates.
Jab up people!!!
SkepticalHealth-I thought the wasting away in Margaritaville theme would do you in…all that laziness.
wrong again.
jmb58 2. They broke narcotics contracts.
BillyJoe “Did you make another contract and try again? If not, did someone else have a go? Or did everyone just give up?”
The point to having a contract is that there is a clear consequence for breaking it. If the drug addict knows they will continue to get more chances without consequence they will definitely continue using.
If a doctor in AU can’t prescibe addictive drugs to someone they suspect of addiction, then how are they supposes to preform surgery on that patient? Do they just give the patient a leather strap to bit on for post-op care?
If they get a permit to prescribe a narcotic to the patient, but the patient is clearly getting drugs elsewhere…on the street or from some off shore website, do they go ahead and schedule the surgery knowing that the patient will have unknown quantities of street drugs floating around in their system and will be augmenting their recovery tylenol with codeine with whatever (meth, oxycontin, heroin, alcohol)?
Is it any wonder that people are reluctant to have their children vaccinated. statistically vaccination can seem to be a good thing, depending on who is projecting their particular point of view. On an individual level perhaps not so. ( all recent cases of polio in the usa are attributable to the vaccine, actual effectiveness of BCG, influenza etc: ). The possibility of helac or other contamination.
By the way, the addicts I have known generally don’t have a problem getting treatment for non addiction related medical problems such as thyroiditis, if they are keeping thing together enough to seek medical care for the problem. If they are too far gone to take good care of themselves, then what they need is a treatment program or mental health services to help get them back on track. A GP, internist or surgeon doesn’t really have the right skills for that job.
BillyJoe – you seem to think there is a problem of people being “fired” by multiple doctors then having no where to go for treatment. Just because something could happen, doesn’t mean that it happens or happens enough be a noticeable problem. Do you have any evidence that doctors firing non-compliant, verbally abusive or drug addicted patients results in poorer outcomes? Because as far as I can see, it’s just as likely to result in better outcomes.
Patient calls Dr. A’s nurse a bad name. Dr. A fires patient. Patient has to go to the trouble to find another doctor and wait for appointment, perhaps trys to be nicer to medical staff as a result, thus possibly gets more out of his medical care due to a better relationship.
In my mind that is a more likely scenario than a patient verbally abusing every nurse in a 60 mile radius and ending up with no doctor to treat his asthma.
Okay, here is how I see the situation:
There are two types of patients with drug addiction problems
- patients who are simply addicted to narcotics.
- patients who are addicted to narcotics, or who need narcotics, as a result of a medical condition.
In Australia, the first group are treated by drug addiction specialists. That specialist is usually a GP who has undergone specific training in the management of patients with drug addiction. He has a certificate that enables him to prescribe methadone or suboxone. When he sees the patient for the first time, he applies for a permit to treat that patient with either methadone or suboxone.
The second group are treated by GPs. The nature of the underlying medical condition must be documented and the doctor must determine that the drugs of addiction are necessary for the management of the pain associated with that medical condition. When he sees the patient for the first time, if he decides to treat the patient, he applies for a permit to treat that patient with a drug of addiction other than methadone or suboxone.
GPs also treat the first group of patients for all their other medical problems because the drug addiction specialist treats only their drug addiction problem, just like a surgeon only sees patients who may require surgery.
So. What is the problem?
The only problem I see is if too many GPs decide that they will not treat any patients with drug addiction problems. That means those who do with be overburdened with such patients. If then then also opt out, patients with a genuine need for narcotic analgesics will not be able to find a GP to treat them.
As for breaking contracts, this must happen with every drug addict. You would have to be naive to believe otherwise. So, not giving a drug addict a second chance is tantamount to not treating them at all, because they are all going to eventually break the contract. Just put stricter controls in place. The health department also has a doctor shopper list and and any patient can be put on this list. If another GP prescribes narcotics to this patient, both he and the doctor with the permit is informed of that fact. It is also expected that drug addicts with obtain street drugs. Theres not much than can be done about that, but the thing is, if the patient is obtaining their drug on a regular basis for legal channels, the use of street drugs in minimized. And so is the attendant crime, which is actually the point of treating drug addicts.
So, the real problem, as I see it, is doctors who opt out of treating these patients.
I think I agree with what you say about addicts seeking treatment. They should totally be treated, or refered to a specialist who can. But, the drug addicts we are talking about are not the ones seeking treatment for their drug addiction. We are talking about the ones that are seeking “treatment” just to get another bottle of pills. If they want to be treated, go ahead and try. If they are just looking for a hit, you would be foolish to try to treat them, and, as mentioned earlier, run the risk of disciplinary action.
SkepticalHealth “I feel pretty confident in stating that it takes a certain daily caloric intake to maintain morbid obesity. I’ve never seen an obese person who was starving. You remind me of someone who posted here recently blaming television advertisements for making junk food look so tastey for the obesity epidemic. At some point, we have to look at the person who consumes liters of sugary soda and fast food all day and say “Hey, it’s your fault your fat.” Besides, how are you going to effect change in their life without having them take responsibility for themselves?”
I feel this may be an oversimplification of the problem. It is similar to dealing with an anorexic, it’s clear that they are not consuming enough calores to maintain health. But “blaming” or “holding them responsibly” for their decisions only goes so far. Clearly there is often a mental issue that is standing in the way of the anorexic’s ability to make healthy decisions. It seems to me, successful treatment is often a combination of holding the patient responsible AND treating the mental health (or lifestyle) issues that are undermining their success. I’m not sure that we really have a good enough grasp on the diagnoses and treatment of eating disorders to say we can fully support the treatment aspect of that combination. Did an anorexic, drug addict or obese person die because we don’t have effective enough treatments for their mental disorders (or they did not recieve the appropriate treatment) or did they die because they didn’t make enough effort? Maybe all one or the other or a mixture of both.
Also, coorporations make a great deal of money selling things like soda and hohos. If the sale of those items contribute to a national health problem that costs tax payers money, it seems to me they have some responsibility to those tax payers. I have no problem charging them taxes to offset the negative impact. If they, in turn, increase the price of soda and hohos, then that’s not such a bad thing in my mind. My point being, if you profit from the sale of a product, you should have some responsibility for the effects of that product. The responsibility should not rest only on the buyer.
But that has little bearing on whether doctor’s should fire patient’s or not. If a doctor dislikes a patient because they think they are irresponsible or lazy, they probably shouldn’t be treating that patient. IMO
BillyJoe – I don’t think you answered my question. Should a doctor perform non-emergency surgery on a patient that they know or suspect is using an unknown quantity – quality of drugs acquired on the street or online?
regit:
The vaccine schedules are written with an eye towards the community’s point of view, but the vaccines are only approved based on the *individual* point of view. We all talk about how it’s important to do your bit for the community by getting vaccinated, and I do think that’s true, but drugs aren’t licensed based on the good they do to the community. They can only be approved if they provide a net benefit to the patient for the licensed indication. That is, you can’t license Gardasil to be given to boys for prevention of cervical cancer (though obviously it will help with that); you can only license it to prevent a disease they might actually be able to get. Consequently, although all the focus has been about community prevention of cervical cancer, the vaccine is actually only given to boys on the basis that it will prevent penile, anal, and throat cancers. (It will also prevent genital warts, but as these are not life-threatening, nobody’s applying for that indication.)
So. Vaccines *are* beneficial on an individual level, unless the individual has a rare contraindication for the vaccine. For instance, people who are allergic to eggs should not receive the influenza vaccine; it is not individually beneficial to them since it will give them an allergic reaction and possibly a life-threatening one.
Polio in the US is not caused by the vaccine. It is not possible for the vaccine given in the US to cause polio; it is not a live vaccine. The live vaccine is used in some countries where it is impractical to use the inactivated poliovirus vaccine. Also, the live vaccine is more effective than the inactivated one, especially when polio is still endemic. As it has a small risk of causing polio, all nations with extirpated polio and the resources to provide inactivated polio vaccine have switched over. The US switched over many years ago.
BCG and influenza effectiveness…. Effectiveness of vaccines is variable. Some are more effective than others, and then there’s the question of what you mean by “effective”. Pertussis is a good example. It’s one of the less effective vaccines, and immunity wanes rather rapidly. (This is also true of immunity due to the actual infection, so part of this is a fundamental problem with pertussis immunity, and a real challenge for vaccine manufacturers to puzzle out.) Today, we use an acellular pertussis vaccine that cannot cause pertussis and consequently is safer than older vaccines; this is safer but also less effective. It’s over 50% effective; it will definitely improve your odds, and on balance is worthwhile for the individual, but don’t expect perfection out of it, and make sure you get boosters whenever you go in for your tetanus boosters. Influenza is another good case to look at. Unlike pertussis, this vaccine is remarkably effective at producing the desired immunity — in healthy subjects, it can be over 90% effective at producing the desired immunity. The problem is that influenza mutates so rapidly that it’s very difficult to tell whether that immunity will actually be particularly useful in the real world. Have you just gotten vaccinated against an influenza that will go extinct in a month, while a totally novel one will pop up and infect you in two months? To combat that, manufacturers usually include three different antigens, for three different strains, and they work with epidemiologists to try to predict which strains are most likely to trigger epidemics in the next year. As with weather forecasting, sometimes their predictions are better than other times. This is also why annual vaccination is recommended; the mix is changed year to year. Some years they repeat last year’s, but usually there’s something new.
HELAC contamination — you mean HELA cells? These are cell lines used to study cervical cancer and for other purposes. (They happen to be cervical cancer cells, but cervical cancer cells are so much like other cells that they’re useful for lots of stuff.) Immortalized cell lines such as this can also be used as vaccine growth medium. The cells themselves do not get into the vaccine, but obviously some tiny fraction of their material might, just as with chicken egg “contamination” in influenza vaccine. (I put it in quotes because to my mind, that’s not really contamination. It’s an expected component.) I don’t think this is a serious concern. Neither is the concern about possible contamination with monkey kidney cells; some of the immortalized cell lines used for growing vaccine antigens are from monkey kidneys. They don’t keep the whole cells. There would be no reason to.
Dave,
As I mentioned before, in Australia, this is not a problem. There is the health department hotline and doctor shoppers list which all GPs can access during the patient consult. If you conmmunicate with the health department and guide your actions accordingly, they are not going to be prosecuting you.
Also this whole discussion started with SH saying he does not treat patients with drug addiction problems, which includes not treating their other medical problems. I consider this unjustifiable and nothing anyone has said really convinces me otherwise. Maybe the hurdles are greater in the USA, though no one seems to be saying how they are different.
Drug addicts are still people and, as SH says, they have been dealt a crappy hand in life.
The medical profession cannot really just toss their hands in the air and not deal with it.
Michele,
“If a doctor dislikes a patient because they think they are irresponsible or lazy, they probably shouldn’t be treating that patient.”
You actually have to wonder at a doctor who lets his emotions or philosophy get in the way of treating a patient.
As to you question, I didn’t answer it because I couldn’t see how relevant the question was. But I will see where this leads. If a patient needs an operation, he should have that operation, and the fact that he has a drug addiction problem should serve only to take that into account when it comes to post-operative analgesia. There would need to be strict criteria about how much and how long treatment is continued until the patient is referred onto a drug addiction specialist.
BillyJoe – How do you safely anesthetize someone who is taking an unknown quantity of an unknown drug?
BillyJoe “You actually have to wonder at a doctor who lets his emotions or philosophy get in the way of treating a patient.”
Well no. I’d worry about someone who is doing a bad job because their emotions are in the way and is oblivious to the fact. But I’m fine with a doctor that recognized that they’re emotions are in the way and is honest with the patient, thus giving the patient an opportunity to find a doctor they can work with.
It’s like saying you have to wonder about a doctor who can’t treat a family member because emotions get in the way. Of course emotions get in the way. One just has to find an acceptable way to deal with that.
@ regit:
“Is it any wonder that people are reluctant to have their children vaccinated. statistically vaccination can seem to be a good thing, depending on who is projecting their particular point of view. On an individual level perhaps not so. ( all recent cases of polio in the usa are attributable to the vaccine, actual effectiveness of BCG, influenza etc: ). The possibility of helac or other contamination.”
When was the last case of OPV causing polio in the United States? Why did the United States discontinue the use of OPV…and implement the exclusive use of IPV vaccine?
When was the last time a child was given BCG vaccine in the United States? Why is BCG vaccine not given to infants in the United States?
@BJ,
I *NEVER* stated that I wouldn’t treat someone with drug addiction problems. I stated I will not be a doctor for drug seeking patients. I’ve taken care of numerous people in the hospital who are drug and/or alcohol abusers. As long as they aren’t lying to me trying to get narcotics, I’m happy to treat them. Heck, probably 1 in 20 people with chest pain is due to cocaine use.
The funniest conversations are when you already have a positive urine drug screen, and you say “so, when was the last time you used cocaine?” and they say “I would never use cocaine!!!”
I always explain “I am not the police. I don’t care what type of drugs you have used recently. I only need to know what you’ve done so that I can figure out what caused you to come in and treat your properly.” And I stand by that.
… There is a funny… or disturbing… side to health care. We routinely see prisoners brought in with extraordinary problems, only to have their charges dropped when the medical bills start to pile up. Why? A prisoners medical expenses are paid by the state (or county, whatever), so they can simply drop charges and leave the prisoner responsible for the charges. Now, if you think the typical prisoner has health insurance, you’re wrong, and now the hospital will usually end up eating the bill because the prisoner won’t pay. But it’s disturbing nonetheless.
Anyway, I didn’t really read the rest of your posts, sorry. I’m just not really interested in your beliefs about healthcare, considering you have zero experience in the field.
IV drug users have a high prevalence of Hep C, MRSA, and HIV (although its the Hep C I worry about the most). Often times undiagnosed. That means I am risking my career (should you keep practicing surgery if Hep C positive? probably a discusion for another time), my life, and the lives of my OR staff. Just something to consider.
@Calli Arcale
Thanks for the reponse to regit.
SH,
That’s okay, I didn’t read your last post at all. :l
Michele,
Yes, thats’s even worse.
But I do wonder about a doctor who lets his emotions or philosophy get in the way of treating a patient,
Seems to me he should be doing something else.
Michele,
“BillyJoe – How do you safely anesthetize someone who is taking an unknown quantity of an unknown drug?”
Are you saying that patient’s with drug addiction problems never receive elective surgery?
Can you provide a reference?
BillyJoe – “Yes, thats’s even worse.
But I do wonder about a doctor who lets his emotions or philosophy get in the way of treating a patient,
Seems to me he should be doing something else.”
Oh well, those statements aren’t contradictory. It’s just a matter of degree. The way SH talks he dislikes all people who have a preventable disease. If he refuses to work on people he dislikes, he might have to find something else to do.
You know I particularily love it when he says he won’t read people’s comments…because having the opportunity to talk about him when he can’t respond is such a hardship. Perhaps next he’ll start ranting about the number of lives he’s saved.
BillyJoe – regarding elective surgery and drug addiction. I’m saying that elective surgery on someone who is abusing drugs is probably more risky than elective surgery on someone who is in at least a period of recovery from substance abuse.
If the drug addict was my family member, there are a lot of scenarios where I would rather see the surgeon refuse to the preform surgery than have them go ahead with a higher risk surgery and recovery.
You have to consider the risk/benefit for that particular patient at that time. You also have to consider that the patient may go into recovery in 6 month or a year. In fact wanting to have a surgery that elevates pain or discomfort may prompt them to seek help. Finding another surgeon when they are in recovery may be a far safer option for that elective surgery.
You know, I really feel that SH’s focus on the small percentage of people who are sociopathic and litigious, completely distracted from the idea that folks with active and serious drug addictions are just not good candidates for surgery at that time. And, yes, like jmb58 noted, they can increase risks for those treating them and other patients.
Like many other serious health conditions it may be better to get that condition under control before preceding with elective surgery. Unlike many other health conditions, it may be difficult or impossible to maintain a constructive relationship with a drug addict until they are stabilized in recovery.
Of course, I’m not speaking as a medical person. I’m speaking as a sister, aunt, granddaughter and niece of those who have had serious substance abuse problems. (not that it’s genetic or anything
)
” Perhaps next he’ll start ranting about the number of lives he’s saved.”
You must have missed it.
Which time?
Sorry, I can’t remember where but it was fairly recent. He was complaining about an altmed practitioner boasting how he had picked up conditions missed by the mainstream through his thirty year career. SH boasted he saves lives every day. I’m not saying he doesn’t, of course, I have no way of knowing, but I have to wonder as someone who accuses someone else of lying (I’m referring of course to nybgrus). Sometimes it turns out to be a home truth.
Sorry BillyJoe – I was being factious. Meaning, he’s referred to the number of lives he’s saved a few times.
I don’t get the notion of religious exemption. Which religion forbids vaccination? All major religions are over 1300 years old, mainstream Protestantism 400. Jenner’s variolation is 200 years old. No religion can possibly forbid it. Unless you are referring to a religion that started in the 19th century, like Theosophy, Christian Science, or Scientology. All of which are rather cultish and not mainstream. And you are going to provide religious exemptions, you are de facto privileging those cults (since Islam, Judaism, Sikhism, … do not forbid vaccination). Oh, and you’re very much discriminating against atheists too.
@Francois,
I don’t know, but I would guess Jehovah’s Witnesses. That’s a guess, and I’m on my iPad so I don’t want to Google it. They may be fine with it.
Christian Science is against vaccination because they don’t believe vaccine-preventable diseases are real and they believe that the illusion of illness can be “healed” by prayer and proper thinking.
And people have claimed religious exemptions when there was no clear evidence that their particular religion required them. They provide a good “excuse.” There was even a chiropractor who wanted to establish his own religion just so his patients could use it to avoid vaccination.
The Holy Church of the First Subluxation
Ye who manipulates is one with The Lord.
@ Harriet Hall: I have to go offline for a few hours. I think you might find this multi-state outbreak of measles, “interesting”..
http://www.cdc.gov/mmwr/preview/mmwrhtml/00031788.htm
It’s been a matter of personal conscience since the ’50s. The house organs were strongly opposed to vaccination before abandoning this position, some would say over concerns about drawing legal attention.
Perusing these comments makes me eternally grateful that my children are grown and that I no longer have to deal with pompously condescending demeanor of many allopathic doctors. Our children are becoming disabled and dying at alarming rates and you would rather fight with your last breath to insist that you are right rather than look at potential causation. I am grateful every single day that my daughter insisted on doing her own research on Gardasil statistics and side effects instead of blindly following her gyn’s recommendation.
The majority of recently documented cases of whooping cough are increasingly of those who have been fully vaccinated. That a parent’s sincere concern for the efficacy of this vaccine v. potential harm is met with only a derisive tone does not instill trust or confidence that one may be receiving advice indicative or health or care.
The Jehovah’s Witness sect was also founded in the 19th century, like Theosophy, Mormonism, Christian Science. Well, when you come to think of it, a lot of weird, reactionary stuff came out of the 19th century (homeopathy, modern acupuncture, chiropractic).
Disclaimer: I am not affiliated in any way with the medical or pharmacological fields. I’m a literary translator and writer (whose field of interest is not even science).
@auntie51109: As I have mentioned, I am not affiliated with the medical and pharma fields, not even remotely (I am even using my real name, which you can Google. The first 19 pages more or less refer to me, with the exception of Jean-François Luong in San Jose, who is a doctor, unrelated to me). What I find interesting is that the anti-vax movement is strongest in the US, where science education is rather insufficient (but also where there aren’t that many regulations), compared to other Western countries where science education is much stronger, like France or Sweden. So my hunch is that much of the antivax movement stems from this scientific illiteracy. Quite frankly, I would rather trust someone who has spent 7 excruciating years getting their medical degree, than someone who “did some research” on Gardasil on the Internet.
Also, after a little bit of “research”, it turns out that Sweden has a DTP vaccination rate of 98%. Same thing for France.
@auntie,
It’s easy to find reports about the statistics and side effects of Gardasil on the Internet. It’s not so easy to understand what those reports (VAERS, etc.) really mean and to put them into context. I “did my own research” too: I read all the pros and cons on the Internet and in the medical literature and I decided to have my daughters vaccinated.
It’s also easy to misinterpret the information about the recent whooping cough outbreaks. The risk of infection is greater among the unvaccinated than among the vaccinated. The higher number of cases among the vaccinated is only because there are far more vaccinated children. The protection is incomplete and is being addressed by new booster policies and research on better vaccines. http://www.sciencebasedmedicine.org/index.php/whooping-cough-epidemic.
The unarguable fact is that the risks of vaccination are very small and the risks of not vaccinating are much greater. Parents’ concerns about vaccine efficacy and safety have been respectfully answered over and over. If you perceive “derisive tone,” it is probably derived from frustration that clear evidence has been repeatedly explained but is still not accepted.
@ Francois: The United States has the highest number of mandated vaccines for children under 5 in the world but is 34th in the world for mortality rate of children under the age of 5. That no discussion should be allowed to address the increase of both aspects, I find egregious. I suppose to a writer, data may simply be numbers reflecting information. And data is good to have and should certainly be referenced, of course. I suspect the data becomes more relevant to a parent on the bad side of the percentage. My children are 4 years apart and even in that short time, the vaccination schedule of the second was greatly increased from my first. And yes, the second has learning disabilities that the first does not. Are the two facts related? I honestly don’t know, but that alternative slower vaccination schedules or the particular child’s sensitivities be completely off the table for discussion, I find offensive. As for doctors, I am admittingly biased. Autoimmune diseases seem to run in my family and my experience these past 3 years was less than stellar. All my allopathic docs offered was one drug after another, with no relief of symptoms. I saw my sisters’ struggles with MS, diabetes, Hashi’s, vitilago, and RA as my own future and that was pretty darn depressing. The most recent doc insisted that I was “fine” because my TSH numbers said so. The fact that my symptoms did not improve and that I still felt like crap mattered not one whit to him and the fact that I would not take a cholesterol control medication infuriated him. My doctor fired me! lol
I can laugh at that easily now because my symptoms improved when 1) I stopped seeing him and stopped taking the pain, sleeping, and depression drugs he was peddling 2) took responsibility for my own health and did my own research and subsequently made specific nutritional changes. The results are that my cholesterol and trigs dropped well into the normal range within two months, I could once again sleep all night, depression and joint pain completely disappeared. My autoimmune numbers, though still elevated, are less than a third what they were and I feel healthier and younger than I did 4 years ago. Do I think doctors are well educated and have access to a wealth of invaluable knowledge? Absolutely. But they cannot all know everything and they all would provide a better service were they to check their egos at the door and not be afraid to listen now and again. Perhaps this would allow us to all learn a bit more together.
P.S. I have not had a flu shot for three years and haven’t had a cold since I stopped. Actually, I haven’t been ill at all other than a brief bout from food poisoning. But…my office mates that had flu shots all got ill within the week of receiving them. Yes, I know that’s hardly a blind study or volumes of data. But I do find it interesting.
You always know someone is a goober when they start going on how they’ve never been ill. So, auntie, which form of CAM do you practice?
@auntie: Actually, the country with highest number of mandated vaccines is France, where it is very much the law to receive certain vaccines. The official vaccination list from the CDC is not mandatory, it’s only a list of recommendation.
As for your other comments, I have degrees in Mathematics and English Lit. I am also a father. But that being said, I have a higher level of scientific literacy than the average American. So no, numbers are not obscure data to me.
I don’t have the faintest idea what CAM is and I didn’t claim I’d never been ill. I was actually quite ill as a child. I said I haven’t been ill in the past three years and I haven’t, barring the food poisoning. Pardon me for being grateful that my chronic symptoms were finally alleviated. So I’m a “goober” to have the audacity to express concern or an opinion…Hmmmm…There’s that derisive tone again, even if on the immature side. Good heavens, I didn’t even go to college and yet attempted to participate in a medical discussion? What was I thinking?! Call me any names you like, if it makes you feel better. Pharmaceutical companies spend a great deal of money lobbying in Washington. I highly doubt that money is invested for altruistic purposes.
^ lol. I find it interesting that you are so against vaccinations, but you don’t even have a basic science education. Ignorance is bliss, eh?
@ Francois: So which do you think is more common for kids to have received in the US? The recommended or mandatory list? Serious question, no facetiousness intended. I simply don’t have that data and thought perhaps you would.
As a parent, do you not find it even a little disconcerting that so few studies were done on the large combinations of vaccinations recommended, but rather only on the individual dosages?
On the Gardasil note, if I understand correctly, Gardasil was fast-tracked by the FDA and trials were never completed, so they have no long term data to reference. I find this very alarming.
I don’t deny that some vaccinations can be beneficial, but I am of the mind that our children are not Lowe’s stores. More of Everything is not always the best idea in every circumstance.
@Skeptical…No, ignorance is not bliss. It’s frustrating and a steep hill, quite frankly. But feeling awful and aged beyond your years can be a helluva motivator. At least I’m trying to learn something new and gather all the information to which I can gain access. Can you say the same? Ahh, but no; that’s not necessary. You’re a doctor, so you already know everything! Voila! C’est magnifique!
Perhaps that intimidation is effective with your patients. Whatever works, eh? I work with a multitude of PhDs, many of whom couldn’t find their rear end with two hands and a map, so you’ll pardon me if I don’t bow obsequiously in deference to your vastly superior intellect…and charming bedside manner.
@SkepticalHealth: As much as I agree with your position, I think you went too far in mocking auntie51109. There are several possible reasons why she hasn’t gone to college. I don’t think either that her lack of a basic science education is necessarily her fault. It bears reminding that with the demonization of public education in the 1970s and 1980s with Reagan, it’s also science education that has suffered. I tend to think that the antivax movement would have a lot less success if there was more investment in science education in K-12.
@auntie: All this being said, I am very glad that your symptoms have been alleviated, but are you sure you are directing your anger at the right target? Or that anger is justified in the first place?
@auntie: I am not sure I understand your question. I mentioned a mandatory list that applies only to France. As mentioned the list from the CDC (http://www.cdc.gov/vaccines/schedules/downloads/child/0-6yrs-schedule-pr.pdf) is only a recommended list. But Hib, which is not mandatory in France (it’s only considered recommended there), has a vaccination rate of 97% there).
auntie51109:
Then perhaps you can tell us what information you have gathered on the requirements for Gardisil. This article is about non-medical exemptions to attend public school. Please tell us which school district requires Gardisil to enter kindergarten.
@Francois: You stated “the official vaccination list from the CDC is not mandatory, it’s only a list of recommendations.” I was wondering if there was any data on which vaccines were most commonly chosen from the recommended schedule (v. which may be mandatory?) in comparison to the mandatory list for France. Apples to apples, if you will.
You are correct in 70’s science requirements. When I graduated from high school, only one science class was required and I took earth science. The teacher was a wackadoodle. My take away was how to make anise candy with a bunson burner. Seriously. That said, one of my sisters is a nuclear med tech and I spent a good portion of my childhood in the hospital, so I am appreciative of the benefits of modern medicine. BTW-“There are several possible reasons why she hasn’t gone to college.” You do realize how condescending that sounds, right? Do I have less value as a person with no degree? I didn’t go to college because I had no money at all. And at the time, no interest; or at least convinced myself there was no interest since I had no money. One makes do with what one has available. On the upside, I had no student loans to repay.
As for being angry, I started to say that perhaps frustrated would be a better descriptor, though my initial reaction to this type of discussion is always one of immense relief that my kids are grown so that I am no longer faced with this quandary and that they are both healthy despite having been vaccinated. But you may be right in that I do feel angry at times at the paradigm of presumed infallibility from which so many doctors seem to function. Polarization serves neither side of the discussion and does not cultivate trust.
@ Chris: I didn’t gather the information, my daughter did. She is an adult and she came to the conclusion that the benefits did not outweigh the risks for her. I’m glad she made the effort and had the choice. BTW, had Rick Perry (R-Texas) been successful, school aged girls in Texas WOULD be required to have the Gardasil vaccine. The fact that you assume an antagonistic stance on this subject is a quintessential example of why the subject continues to be so divisive. You do not seek common ground or even attempt to understand or empathize with parents struggling with this challenging decision. The rate and number of vaccines HAS increased and though studies have been done on the individual vaccines, it is my understanding that thorough studies have not been done on the combination of multiple vaccines or the cumulative effect. Meanwhile, parents see the rates of autism and autoimmune diseases and god knows what else increasing at alarming rates. They believe their child’s very lives may be at stake if they choose certain vaccines and you then have the audacity to question why they do not blindly trust everything you say that has been spoon fed from the very companies that stand to profit from the vaccines. As a parent, I cannot imagine anything more horrible than to think that I may have done something (will intentioned or not) that resulted in my child’s death or permanent disability. Come on. Do you really expect people to believe the medical community or the FDA has never lied to the public? Really?
auntie: I apologize if I sounded condescending to you when I mentioned the reasons why you didn’t go to college. I didn’t mean to offend you. I did think about economic causes, among other things, as the potential reasons why you didn’t go. I do think it is scandalous that in a country as wealthy as the United States, there is no equal access to secondary education. Consequently, what I intended to say was that you not going to college should not be held against you or anyone else. But that is a topic for another conversation.
As for the data you are referring to, here is what the World Health Organization compiled:
USA: http://apps.who.int/immunization_monitoring/en/globalsummary/countryprofileresult.cfm?C=usa
France: http://apps.who.int/immunization_monitoring/en/globalsummary/countryprofileresult.cfm?C=fra
Sweden: http://apps.who.int/immunization_monitoring/en/globalsummary/countryprofileresult.cfm
Please note I have no clue how this data was compiled. But vaccinations are mandatory in most European countries (ie, you face judicial penalties for not vaccinating your child, unless you have a medical exemption, such as egg allergies). You face no such penalties in the United States, thanks to religious and “philosophical” exemptions. The exceptions being Mississipi and West Virginia, where such exemptions do not exist.
As for the “paradigm of (…) infallibility,” it’s not something that is present in modern medicine or natural sciences. Science, in and out of itself, is not dogmatic. Scientists, and by extension doctors, are willing to admit that they are wrong (at least the ones I know or the ones I have read). But they are human too, and can be, rightly or wrongly, exasperated. Or they can have bedside manners. But that doesn’t mean modern medicine is bad in itself.
“immense relief that my kids are grown so that I am no longer faced with this quandary and that they are both healthy despite having been vaccinated.”
Interesting. You have totally ruled out that they are healthy because of having been vaccinated?
auntie51109:
For kindergarten? Think about it. It was a trick question to see how well you actually thought about about the issues, and actually read the question. How can a vaccine that is only given to children over the age of ten become a requirement to enter kindergarten? How many children are diagnosed with autism after age ten? What evidence shows Gardisil causes autism?
By the way, Mr. Perry was not successful. Only one state in this country has required HPV vaccination for school attendance after a certain age (and it is not California). Next time you are asked for information, actually try to find the answer. Otherwise we will not think you are serious.
Show us you are serious and find out what vaccines are required to enter kindergarten in California. Tell us what they are. There will be more specific questions after that.
And just so you know: in 1989 my son came down with a disease that gave him seizures which may or may not be the source of his permanent disability. That was several years before the vaccine for that disease was available. You really need to get your information in order to explain to me how much more dangerous the vaccines are versus the actual diseases.
@François Luong: Thank you. And thank you very much for the links and information. Much appreciated. I will digest these when the day has not been quite so long.
You know, I used to trust implicitly whatever my doctor said. I was very comfortable with doctors knowing what was best for me. I’ve spent a good portion of my childhood with them and I am still alive, so why not? That was my normal. And perhaps it’s not so much that I no longer trust doctors, but rather that I do not trust big pharma even one little bit after my recent health hurdle. Pharma is in control of guiding what doctors are guided to learn, know, and reference and that honestly scares me a great deal. Had I listened to my doctor, I would still feel like crap and be on at least three different medications, of this I am certain. That said, my intention was not to vilify all doctors. I still like to think the primary driver for the majority entering the medical field is to help people and they are, after all, only capable of administering what they have been taught to be right. Perhaps the problem lies is that the field has traveled ever farther away from health and ever closer to medicines. But, that’s just my opinion.
I have, of course, seen many of the videos of parents grieving for their children who have died or are now permanently disabled from what the parents believe is a severe negative reaction to an immunization. Though I am well aware the internet can offer emotionally persuasive and at times manipulative wrenching stories, I also have two personal dear friends whose children suffered a similar fate and cannot discount the possibility they may be right. Given the amount of money that pharmaceutical companies spend to peddle their wares, I find it incredulous that anyone would assume their objective is one of pure altruism and assume they are faultless. Money is one heckuva driver.
@weing and all: No, I do not totally rule out that my children are healthy in part due to their vaccinations. This does not preclude me from having sincere concerns for the recent increase in odd ailments and what the source(s) may or may not be. I don’t KNOW and I admit that I do not know and I am relieved that I am no longer in the position to have to make such choices in this age of increased potential cumulative effects. But I don’t think YOU know either and I find it disconcerting that most of you appear to be obstreperously oblivious to the very large elephant in the room.
@ Chris: Yes, I realize Mr. Perry was not successful. Hence, my past perfect tense verbiage “had he been successful”. Yes, I realized that “school-aged” didn’t mean kindergarten, but you seemed to want to address my comment on Gardasil, so I acquiesced.
I simply am not convinced that ALL vaccines provide the same level of safety and I do believe cumulative effects should be studied in much greater detail and parents should do their best to be as informed as possible. Nor am I comfortable with blindly trusting that they are ALL good and are all necessary. Both my kids had the chicken pox and did just fine with no vaccine available at the time. I had scarlet fever when I was 6 along with measles and my doctor advised my mother that the prolonged high fever (106) would likely leave me severely retarded, but I’ve never had the chicken pox and have not been vaccinated and do not plan to be. EGADS! Call the vax police! All children are not the same and may not be able to withstand the ever increasing immunization schedules and my guess is it will only get worse with our crappy food supply.
Google shows the following for which vaccinations are required to enter kindergarten in the state of California. http://eziz.org/assets/docs/IMM-231.pdf Which presents a question to me. If the major contributing factors of contracting Hepatitis B are unprotected sex with multiple partners and intravenous (IV) drug use, why in the world should a 5 year old need this, let alone three doses? I find it less than plausible that this particular vaccine would pass a reasonable cost (to health) v. benefit analysis. I would think the risk factors for Hep A would be more logical; not that I’m advocating for that one either, mind you.
Chris, I am truly very sorry to hear of your son’s illness and I do sincerely hope you are able to discover a path to restore his health.
I thank you all for the thought-provoking and lively discussion and the sharing of information.
Good night and good health to you all.
Auntie51109:
You are again making generalizations about *Big Pharma* and physicians without any knowledge of the practice of medicine.
“I still like to think the primary driver for the majority entering the medical field is to help people and they are, after all, only capable of administering what they have been taught to be right. Perhaps the problem lies is that the field has traveled ever farther away from health and ever closer to medicines. But, that’s just my opinion.”
And, an ill-informed opinion it is Auntie. The subject of this thread is non-medical exemptions for vaccine requirements for school entry, not your accusations about physicians relying on “medicines”. You do know, that vaccines are a form of preventive medicine, don’t you? All the other medicines that “Big Pharma” develops and manufactures are a poor substitute to actually cure children, once they are infected with vaccine-preventable diseases. Why don’t you look up the invasive H. influenzae bacterium, the S. pneumoniae bacterium and the N. meningitidis bacterium and the vaccines that prevent deadly invasive bacteremia and bacterial meningitis? The very best antibiotic for most of these deadly diseases is IV Ceftriaxone…yet many of these infected children die within hours or days of reaching a hospital for intensive care. Many of the children who survive have to undergo amputations to remove gangrenous limbs, suffer major organ failure and permanent neurological sequelae.
C’mon Auntie you’re old enough to remember the 20,000 infants who were infected in utero with rubella and were born with congenital rubella syndrome during the rubella epidemic 1964-1965 in the United States. You’re also old enough to remember the beautiful film actress Gene Tierney, who contracted rubella during her pregnancy and her daughter was born with congenital rubella syndrome:
http://www.hknc.org/Rubella.htm
“If the major contributing factors of contracting Hepatitis B are unprotected sex with multiple partners and intravenous (IV) drug use, why in the world should a 5 year old need this, let alone three doses? I find it less than plausible that this particular vaccine would pass a reasonable cost (to health) v. benefit analysis. I would think the risk factors for Hep A would be more logical; not that I’m advocating for that one either, mind you.”
Here…before you go to bed, read this about hepatitis B, why the recommendation was made for the birth dose of the vaccine and timely completion of the hepatitis B vaccine series:
http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5416a1.htm
Take special note of the testing of pregnant women for the presence of the hepatitis B surface antigen, during each pregnancy and why there is a special protocol for post exposure prophylaxis with the vaccine and HBIG (Hepatitis B Immune Globulin) within 12 hours of her infant’s birth. This is to prevent “vertical transmission” of the virus.
Take special note of why the “birth dose” of the hepatitis B vaccine is recommended to be given to each infant before the infant leaves the hospital. This is to prevent “horizontal transmission” of the virus.
By the way, your comments about your having all the childhood diseases, except chicken pox, and “you survived” is a very typical response from people who get their information about vaccines from crank websites.
I had all the childhood diseases and I survived as well. My childhood friend was not as “lucky” as you and me. She died from polio, just before the Salk vaccine was developed and available. My older cousin wasn’t “lucky” either; he was left with lifelong neurological deficits after “surviving” measles encephalitis.
Auntie51109, I specifically asked which school district required Gardisil for kindergarten entry. What part of that did you not understand. Your answer about Mr. Perry showed you were relying on news reports and certain websites and not the actual school district websites.
And this shows when you do finally find the actual schedule and make factually wrong comments about hepatitis b. It is not just sexually transmitted. It is also transmitted through blood and saliva, something kids seem to often leak. Here is some further reading:
http://www.pkids.org/immunizations/HBV_kids_infect_kids.html
Now for your next questions: Pertussis and measles have popped up several times in California (you know, the state under discussion, which does not require Gardisil for school attendance at any age).
Now please tell us exactly how much more dangerous the MMR vaccine is compared to measles, mumps and rubella. Provide the title, journal and date of the PubMed indexed paper to support your statements. Here is one paper that describes the costs in both money and deaths of children during the 1990 measles epidemic in California: Pediatric hospital admissions for measles. Lessons from the 1990 epidemic.. Make sure your references are on the same level.
Then tell us exactly how much more risk the DTaP has compared to diphtheria, tetanus and pertussis.
@auntie,
“All children are not the same and may not be able to withstand the ever increasing immunization schedules and my guess is it will only get worse with our crappy food supply.”
An understanding of the science puts those fears to rest. See http://www.quackwatch.com/03HealthPromotion/immu/too_many.html
The reason childhood diseases are prevalent is because of vitamin deficiency…
http://www.npr.org/blogs/health/2012/08/06/158201055/vitamin-d-deficiency-in-sick-kids-could-make-them-sicker
Now new evidence from two studies finds that not only is vitamin D deficiency common among critically ill kids, but it’s also associated with the severity of their illness.
In one study published today in Pediatrics, researchers at Harvard University tested the vitamin D levels of 511 children, up to 17-years-old, who were admitted to six different pediatric intensive care units between November 2009 and November 2010.
They found that 40 percent of the sick kids they tested had less than 20 nanograms of vitamin D per milliliter of blood — meaning they were deficient. This led the researchers to conclude that kids deficient in vitamin D were more likely to be sick than kids with sufficient levels of the vitamin. The kids deficient in vitamin D were also more likely to be in the hospital longer than the other kids.
Vit. A deficiency and measles
http://www.measlesrubellainitiative.org/mi-files/Reports/Treatment/West%20Nutr%20Rev%202000%2058%282%29S46.pdf
Supportive care is normally all that is required for patients with measles. Vitamin A supplementation during acute measles significantly reduces risks of morbidity and mortality.
Vitamin deficiency and mumps
http://www.go-symmetry.com/health/bakup/mumps.htm
http://www.measlesrubellainitiative.org/mi-files/Reports/Treatment/West%20Nutr%20Rev%202000%2058%282%29S46.pdf
My conclusion is children need vitamins to prevent and/or minimize effects of childhood diseases such as measles, mumps, rubella, pertussis, and apparently they’re not getting enough in their diets! I know vaccines seem to be the easy way to go, however, it would not address vitamin deficiency either way..causing/contributing to many other illness. The basics would be Vit. A, C, D..omegas, imo.
There are many things that NPR does well. Reporting on current scientific research is not one of them.
And that penultimate link you gave is suspicious. It doesn’t provide any source (reliable or not) for the information it is providing.
RH:
Which you failed to cite: Vitamin D Deficiency in Critically Ill Children. It is more of a “this looks interesting” kind of study. There is no way to tell what illnesses the children had. It was also only 511 kids out of a total population of what? And it does not claim that vitamins are a substitute for vaccines.
None of other articles show that nutrition prevents measles or mumps. It gives the reason why children in poor countries who do not get enough food, or certain foods, fare worse than those who live in places like the Europe and North America. Especially since one of them compares how much better children in the UK survived better in 1960 than fifty years before, and those in 1960 Africa.
Children the USA, Canada and UK do not need more vitamins to prevent measles. They need to be vaccinated.
Next time actually read the articles you post.
@rustichealthy,
“vaccines seem to be the easy way to go, however, it would not address vitamin deficiency”
You can argue for correcting vitamin deficiencies, but you can’t argue for using that strategy to replace vaccination.
Also, eating a balanced diet is better than taking pills. And preventing diseases is better than treating them.
I recently had a checker at a higher end grocery store ask me what I had against supplements (she over heard me telling my hubby that “Airborne” was a scam). I told her I’d rather eat my veggies than take a pill. She asked me if I had ever had “Superfood.” I once drank a juice mixture called “Superfood” (or SuperGreens) and it was horrible. She protested and there was a supplement capsule that was good for health. I replied I would rather eat my green leafy veggies and not have them processed by drying, grinding them up and shoving them into a capsule. The funny thing is, that grocery store is big on selling fresh produce.
One of the glaring problems with rustichealthy’s interpretation of the Madden study is that it only established an association (so far as I can discern from the abstract, as I have no access to the full text). In no way does it show that vitamin D deficiency caused the subjects’ illnesses. The other way around is equally consistent with the data (again, so far as I can discern from the abstract).
Dr. Harriet..ok, I am not going to argue vaccines here..but, isn’t it an obvious ..to all..that children not getting proper nutrition do get sick easier? whether they’re in a 3rd world country or right in America..if they’re getting ill..they’re not getting proper nutrition! I’m kind of puzzled as to what “proof”, evidence, studies, need to show that? Perhaps those links are not acceptable to any of you, nevertheless..if children are in hospital..very ill..and all very low in Vit. D..what would be the harm in supporting children get more vitamins? D, C, A, omegas..? You’re more than okay to dose children with vaccines that bring down their immune system atleast temporarily, but not willing to get them vitamins that bring it up? Even if they have the vaccine..what would be the objection.. Actually, I would think you all would be more than happy to hope and say ..”wow..vitamin deficiency..if that’s all it is, or will help the child’s need to fight whatever..let’s try it”? Whether you believe the deficiency caused the illness ..whatever it is..or not? Anyway, hope you all look more into it..maybe find a study that suits you on it.
“They found that 40 percent of the sick kids they tested had less than 20 nanograms of vitamin D per milliliter of blood — meaning they were deficient.”
That also means that 60% of the critically kids were not deficient in vitamin D.
yes weing..and..”The kids deficient in vitamin D were also more likely to be in the hospital longer than the other kids.”
also, maybe it’s another vitamin then? C, A?.
“also, maybe it’s another vitamin then? C, A?.”
Or, more likely, not.
RH,
“children not getting proper nutrition do get sick easier?”
“If they’re getting ill..they’re not getting proper nutrition! ”
You seem to think the above two statements are identical. They are not. Think about it.
There could be reasons other than not getting proper nutrition, for children getting ill.
Like not being vaccinated!
“Let’s try it”
Nope. Let’s do a clinical trial.
weing and BillyJoe, it was quite clear that she did not read any of the links she provided. Because at least a couple of them were comparing children in Africa with those in the UK in 1960. Or she just does not understand the difference between living in an industrial country and those who barely get enough food, or what has happened between 1960 and now in both locations (like invention of a vaccine, many political changes in Africa, etc).
BillyJoe..Yes!! then let’s do a clinical trial…and, yes, there may be other reasons..too many toxins..perhaps in processed foods, perhaps in fluoridated water..that’s the one-two punch I believe in..too little nutrients/nutritional real food and/or too much toxicity…from processed foods, water, non-organic food (imo).
She’s a little rusti on that reading part.
@Rustic
Why..so..many..dot-dots?
It reflects her ellipsis like thinking.
Chris, it doesn’t matter whether it’s 1960 or 1860 or 2012, if a child is getting ill, they are lacking nutrients. Not sure what you’re getting at? I’m almost wondering if the pharmas will be revving up for a food vaccine next! What do we need (real) food for! enter gmos! and if that doesn’t work, let’s put it all in a vaccine! hmmmm is that it I wonder : )
jmb..bad habit … sorry
it’s how I think..talk…chat.
Rustichealthy:
That you have not got a clue about history, especially that of Africa and Europe. And that there is a vast difference between well fed children in an industrial country and those who are poor and malnourished living on farms where their is barely enough food. You are comparing apples and oranges.
This video explains it in a way you might understand:
http://www.gapminder.org/videos/population-growth-explained-with-ikea-boxes/
[...] that we don’t still have a problem. After all, “philosophical” exemption rates are going up based on a lot of this sort of misinformation, but at least the media are less insistent on [...]
Chris..I know..that would starvation. But, either way, if a child is getting sick, they are malnourished. If a child is eating candy and fastfoods, and pesticide filled/gmo foods, and not enough real food…such as fresh non-chemical filled fruits, vegetables, whole grains, meat/fish without hormones/antibiotics..everyday, then they’re going to be malnourished, and they’re going to have a lowered immune system, and get ill…..maybe not ‘starvation’ but they will be getting ill.
Then how do you explain the millions of cases of individuals who are sick and have absolutely no vitamin/nutrient deficiencies?
@Rusty,
“if a child is getting sick, they are malnourished.”
That is simply not true. Well nourished children get sick too. You are just making up your own definitions: if a child gets sick, you assume it means he is malnourished. You assume that a child can only be well-nourished if he avoids all the foods you object to. This is a version of the “no true Scotsman” fallacy.
Your statement is refuted by history. People got sick long before candy, fast foods, pesticides, GMO, meat with hormones, etc. We have solid evidence of illnesses from prehistoric human remains.
And adding onto what Harriet is saying, Vitamin/Nutrient deficiencies have very solid presentations. They aren’t a vague miasma that causes a multitude of different diseases with varying pathology.
No C? Scurvy. (And perhaps collagen troubles. That goes along with Scurvy, since Collagen requires Vitamin C.)
No D? Rickets (in children), Osteomalacia (in adults)
The list goes on and on.
RH:
In 1960 UK and West Africa? You still have not read and understood the links you provided.
Now explain why the oldest child of Roald Dahl died of measles in the UK in the early 1960s. Tell us that you have proof she was eating GMOs and fast foods while living on their country estate.
Chris.. enough ‘nutrients’ according to whom? The amount of vitamins/nutrients one needs would be according to their particular condition/circumstance. MDR..minimum daily requirments…is to barely survive..not actually be healthy. If the MMR is 200 mg Vit C, yet I need 1000 Vit C..then the MMR is not enough. Yes before candy and fastfoods there were illnesses..as in scurvy..but, that also was malnutrition. Not having fresh fruits/vegetables available year round would make one malnourished in many vitamins..and therefore prone to many illnesses..not excluding scurvy, or any other disease. Other things also deplete the body of nutrients..weather conditions and poor sanitary conditions also.
Re: Ronald Dahl’s child..she probably wasn’t getting enough Vit. C more than likely, perhaps omegas also, and Vit. D…before the increased knowledge of vitamins, being ‘extracted’ ..it would be understood the unknowing at the time. Linus Pauling started it in a bigger way..and that’s where it began to turn ..we do have all kinds of vitamins/nutrients available in supplement form (I would say the closer to whole food the better)…and, that’s where I’m thankful for technology and studies.
Where is your evidence, RH? You are just making stuff up now.
As I said, it’s the No True Scotsman fallacy. People who are well-nourished don’t get sick, so if someone well-nourished got sick it’s obvious (by definition) that they weren’t really well-nourished. There’s no hope of using evidence or logic to talk Rusty out of a belief when that belief was formed in the absence of evidence or logic.
It actually looks like RusticHealthy is denying that viruses like measles cause disease. Considering that a child of a well-to-do author and actress would not be malnourished by any stretch of the imagination.
So Rusty goes into the ignore pile with Thingy.
I agree with Quest4Fire. Vaccines are much more dangerous than the vaccine-preventable diseases. Parents have an absolute responsiblity to weigh the benefits and risks for each vaccine and disease for their individual child. Children who have close relatives who have any neurological or autoimmune disease are at greater risk of vaccine reaction, and their parents would be acting wisely to refuse some or all vaccines for them. And of course these days nearly all children have such a close relative. This year the acellular pertussis vaccine has been seen to be a very ineffective vaccine, with many thousands of appropriately vaccinated people getting the disease. Most of these people believe that they are safe from getting pertussis themselves and from transmitting it to others, especially those in the only group at much risk of death or permanent damage, newborns. It would be much wiser to let people decide for themselves, with no pressure, if they want to take the risk of the vaccine or just go through the extended period of coughing if they get the actual disease, and emerge with probably permanent immunity. In the case of this remarkably ineffective vaccine, there is no herd immunity for anyone to worry about. Only those whose agenda is to promote vaccination at all costs would refuse to promote the quarantine at home of young infants. Of course it would be inconvenient for many working parents, but if they realized that their baby’s life was at stake, most parents could make arrangements to protect the child. Vaccinating the baby and everyone around him is in many cases not going to be enough, as the parents of the fourteen infants who have died in this year’s pertussis epidemic can tell you. Chris was able to quarantine her son when he was an infant: most other parents could do so as well.
@ CIA Parker:
Fancy meeting you here.
Why don’t you share with us, why you are against childhood immunizations?
Yay! another anti-vaxxer has decided to join the conversation. And yet, still no new claims that we haven’t already heard, and, even more un-surprising, still provides no credible evidence for said claims.
“Vaccines are much more dangerous than the vaccine-preventable diseases.”
Could you please provide some called, hard, facts: How many kids died of polio per year before the vaccine and how many kids die per year because of the vaccine?
Let’s just start with that. I don’t want to overwhelm you.
After a brief Google search, it appears that cia parker might be a psychologist from Maryland that likes to comment on any article (s)he finds about vaccines. Am I right?
@ The Dave:
“After a brief Google search, it appears that cia parker might be a psychologist from Maryland that likes to comment on any article (s)he finds about vaccines.”
“Am I right”….No Dave. CIA Parker mainly posts under that ‘nym at Age Of Autism and other anti-vaccine blogs with her same shtick about about her newborn’s “encephalitis”. Rarely, she posts on science blogs, with that same old “story”.
Scroll down to her third post here…
http://www.boiseweekly.com/boise/cynthia-parker/Profile?oid=2568859
I stand corrected. In my defense, I spent ~30sec in the middle of class.
Well Dave, when you get out of class, make certain to read Parker’s posts…they’re *gems*.
Ah, yes! The same woman who claims her baby got encephalitis but never took the child to get real medical care. Not exactly “mother of the year” material.
By the way, this satire of an Age of Autism media person is a great read.
@ Chris:
I’ve already read that satirical piece. Where do you think I get my “leads” to post on all the blogs, where the “bot” carpet bombs her inanities?
Oh, Cynthia, I see that neither you nor Lowell Hubbs has figured out “The Ballad of Frankie Lee and Judas Priest.” Do provide the basis for your assertion that contracting pertussis yields “probably permanent immunity.”