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Welcome back, my friends, to the show that never ends: The Jenny and Jim antivaccine propaganda tour has begun


As hard as it is to believe, 2009 started out very promising from the perspective of actually countering the misinformation of the antivaccine movement. Antivaccine hero Andrew Wakefield, who with the help of the credulous and sensationalistic media started the entire MMR-autism scare in the U.K. a decade ago, was revealed as not just having been in the pocket of trial lawyers suing vaccine manufacturers and having been an incompetent scientist but as a scientific fraud, thanks to the investigative tenacity of Brian Deer. Thanks to Wakfield, the measles, once declared conquered in the U.K. in the mid-1990s, has come roaring back to the point where it has been declared endemic again by the ealth Protection Agency (HPA), the public health body of England and Wales. This was rapidly followed by the rejection by the Special Masters of the Vaccine Court of the claims of all the test cases in the Autism Omnibus case. It was a one-two body blow to the antivaccine movement.

Unfortunately, the antivaccine movement is nothing if not resilient. After all, the science has consistently been against each of its favorite claims, namely that the mercury in the thimerosal used as a preservative in vaccines or that the MMR vaccine causes autism. They simply move the goalposts and pivoted effortlessly to much harder to falsify ideas, such as blaming “toxins” in vaccines or proclaiming that our current vaccine schedule is “too many too soon.” After scientific setback after scientific setback that have revealed the antivaccine movement to be nothing more than the 2009 equivalent of creationists or the flat Earth movement, why would it matter to them that Andrew Wakefield has been thoroughly discredited and their signature legal action, the Autism Omnibus, has gone donw in flames? It doesn’t. Certainly it didn’t stop David Kirby from duping Keith Olbermann into chastising Brian Deer for nonexistent conflicts of interest; a group proclaiming loudly “We Support Dr. Andrew Wakefield” with a petition; David Kirby, Generation Rescue, and Robert F. Kennedy, Jr. from trying to distract attention from the defeat of the antivaccine movement in the Autism Omnibus ruling; or Andrew Wakefield himself from “complaining” to a press board about Brian Deer’s alleged misbehavior and errors. After all, science doesn’t matter to the antivaccine movement.

So, right on schedule to coincide with the start of Autism Awareness Month, as it has done every year since at least 2007 the antivaccine movement has begun a propaganda tour in order to coopt the term “autism awareness” for its own purpose of blaming vaccines for autism and proclaiming that various forms of quackery can “cure” autism. Indeed, this movement clearly wants to corrupt the term “autism awareness” to mean “antivaccine awareness,” and unfortunately it appears to be succeeding. Key to this effort in 2009 is a brand spankin’ new book by Jenny McCarthy and her “biomedical” guru Dr. Jerry Kartzinel, entitled Healing and Preventing Autism: A Complete Guide. The media blitz started even before Autism Awareness Month began, and I’ve already alluded to the despicable new message that appears to have become Jenny’s mantra (and thus that of the antivaccine movement for which she is the spokesmodel), namely, “It’s not my fault if vaccine-preventable diseases come back; it’s the pharmaceutical companies’ fault for not making ‘safer’ vaccines. Oh, and, by the way, we decide what’s ‘safe.’” Never mind that what makes vaccines “unsafe” to Jenny is based on a discredited idea that scientific study after scientific study has roundly refuted, namely that they cause autism.

Unfortunately, that isn’t all. As the U.K. media aided and abetted the MMR scare in the late 1990s until today, the U.S. media is aiding and abetting the antivaccine scare being promoted by Generation Rescue through its celebrity spokespersons Jenny McCarthy and Jim Carrey. The TIME Magazine interview to which I referred was just the beginning. Get a load of her on Larry King Live last Friday, along with Dr. Kartzinel and J.B. Handley, the same venue where almost exactly a year ago, in her arrogance of ignorance, McCarthy shouted down vaccine scientists on the air, yelling “bullshit!” at them three times. Truly, Larry King is as credulous as they come. The transcript is here, and J.B. Handley wrote a guest post for the Larry King Live blog, entitled Autism is Preventable and Reversible.

There is so much misinformation in the interview and in J.B. Handley’s blog post that it’s hard to know where to start. In fact, I could write a whole series of blog posts, like co-blogger Kimball Atwood, on just this interview and the new misinformation added to the old misinformation being peddled by the antivaccine movement; instead, I’ll be more selective, and readers should feel free to chime in with anything I’ve missed. Now, let’s start with two of the antivaccine movement’s favorite propaganda points:

KING: But you had a major effect, big story in the “L.A. Times” last week, the number of kids not being vaccinated in the public schools in Los Angeles. However at the same time, doctor friend told me today. Mumps are up and measles are up.

CARREY: We are not saying don’t vaccinate. That’s the thing we want to get really clear right now with …

KING: Let’s make it clear.

MCCARTHY: Yeah, we’re not.

CARREY: This is the thing. There’s a lot of misdirection going on. We hear the Campbell Browns and people like this that are saying, you can’t not vaccinate. No one has ever suggested not vaccinating.

MCCARTHY: Go back to 1989 schedule when shots were only 10 and the MMR was on that list. I don’t know what happened in 1990, there was no plague that was killing children that we had to triple the amount of vaccines.

CARREY: What happened back in 1989 that warranted 26 more vaccines?

MCCARTHY: Greed.

CARREY: Are all of them absolutely necessary?

KING: Because they want to make money?

MCCARTHY: Of course.

The first antivaccine propaganda point is the claim that Generation Rescue, Jenny McCarthy, Jim Carrey, and J.B. Handley (and by association, the entire antivaccine movement) are not “antivaccine.” That is easily demonstrated to be false (1, 2, 3). Another thread arguing for the disingenuousness of Jenny and Jim in proclaiming themselves to be “not antivaccine” is how the mouthpiece of Generation Rescue (excuse me, “Jenny McCarthy and Jim Carrey’s Autism Organization“), the Age of Autism blog, has such a major, unrelenting focus on vaccines. Indeed, Age of Autism blogger Kim Stagliano recently rejoiced on that very blog that vaccination rates are falling in other parts of the world, crowing that “an educated consumer may be a vaccine company’s worst customer.” (More like a miseducated consumer is the antivaccine movement’s best dupe.) In a similar vein, another Age of Autism blogger, Kent Heckenlively, today asks “Are We Winning the Vaccine-Autism War?” and concludes that the antivaccine movement is winning, as he, like Stagliano, rejoices that the pockets of high levels of vaccine resistance recently reported in Sonoma and Marin counties in California occur in areas where the population is educated and aflluent. Both he and Stagliano seem to labor under the common delusion that education and affluence somehow guarantee an understanding of science; sadly, they do not. They also seem blissfully unaware that the Bay Area is a hotbed of New Age woo and that credulous acceptance of “alternative medicine” appears to be highly correlated with antivaccine views. Even more notably, in his discussion Heckenlively doesn’t even bother to repeat the usual Age of Autism/Generation Rescue mantra that “we are not antivaccine”; rather, he appears to embrace his inner antivaccinationist, in essence equating antivaccine views with the educated and affluent..

Finally, there’s the old “big pharma greed” gambit. No one here at SBM, arguably least of all me, believes that big pharma is on the side of angels, but I can’t help but make one observation. If vaccines are such a huge profit source, then one wonders why the number of pharmaceutical companies manufacturing vaccines has fallen so precipitously over the last two decades. It couldn’t be the low profit margins and fear of litigation, could it, a large part of that fear having been fueled by the antivaccine movent? Perish the thought! And if vaccination rates fall, big pharma is a convenient scapegoat. Perish forbid that anyone would blame the falling vaccination rates in parts of the country on the efforts of Jenny and her merry band of antivaccinationists:

KING: Isn’t the problem here, Jenny, that people sometimes listen with one ear are going to panic. And not vaccine at all?

MCCARTHY: Probably. But guess what? It’s not my fault. The reason why they’re not vaccinating is because the vaccines are not safe. Make a better product and then parents will vaccinate.

CARREY: We’re not the problem. The problem is the problem.

“The problem is the problem”? How Zen of Carrey.

Actually, the problem is Mr. Carrey and Ms. McCarthy, who are both so full of the arrogance of ignorance that they think they understand the science and medicine of autism and vaccines after studying at Google University; indeed, they seem to think they understand it better than scientists who have spent their entire adult life studying such questions. They’re also completely unwilling to take responsibility for their actions.

Clearly, we’re going to be hearing a lot more of this, as this appears to be the standard Generation Rescue talking point for Jenny to parrot whenever anyone asks her if she feels any responsibility for declining vaccination rates, which in California has produced pockets of vaccine noncompliance that are poised to result in huge outbreaks of vaccine-preventable disease. That’s why this is a mantra that needs to be rebutted at every opportunity. To a large extent, the declining vaccination rate is Jenny’s fault, and J.B. Handley’s fault and Jim Carrey’s fault and Andrew Wakefield’s fault and that of every other antivaccine activist who uses misinformation, pseudoscience, and logical fallacies to frighten parents into thinking that vaccines cause autism. The only reason they try to deny that it is is because they are finally realizing that their actions have consequences and that one of those consequences will be to be seen as the cause of the return of vaccine-preventable disease. Truly, renaming the antivaccine movement to the pro-disease movement sounds more and more appropriate to me.

The most important revelation on JJJ’s appearance (Jenny, Jim, and JB’s appearance) on Larry King Live is that Generation Rescue has come up with one more brand new antivaccine propaganda tool. Before I discuss it, I’d like to take a trip down memory lane to an ad that Generation Rescue placed in USA Today in 2008. The ad showed the vaccine schedule in 1983 and compared it to that of 2008, while making the claim that the increase from 10 vaccines to 36 is the cause of the “autism epidemic. My “friend” Orac had something to say about this claim:

A lot of other things have happened since 1983 as well. For example, in the early 1990s, the diagnostic criteria for autism were broadened, and campaigns for greater awareness were begun. Diagnoses of autism in 1983 were made using the DSM-III, where the criteria for an autism diagnosis were much more restrictive than those in the DSM-IV, released in the early 1990s. Moreover, in 1983, categories of Asperger’s and pervasive developmental disorder-not otherwise specified, both of which are lumped into the 1 in 150 figure for 2008, weren’t recognized in the DSM-III. Of course, if I wanted to be snarky (and perish forbid that I would ever be snarky), I could point out that 1981 was the year that the IBM PC was released, followed by the Apple Macintosh in 1984, both of which led to the exponential growth of households owning and using personal computers. That’s it! It must be computer use that led to the increase in autism in the 25 years since 1983! Wait, what about the compact disc? It just so happens that 1983 is the year that the CD was first released in the American market. Ergo, it must be CDs that cause autism.

I could go on, but you get my point. A lot of other things have happened since 1983, but to Jenny McCarthy, J. B. Handley, and their assorted antivax fanatics it has to be those evil vaccines. It just has to be.

I consider Generation Rescue’s new gambit to be simply a cleverer version of the very same fallacy, with a heaping helping of the “correlation equals causation” fallacy thrown in for good measure:

MCCARTHY: The vaccine schedule is too bloated right now. Thirty six shots right now. Back in 1989, the shot schedule was 10 shots given.

CARREY: Ten shots given.

KING: When I was a kid, what did we get, three?

CARREY: It’s twice as many as anywhere else in 30 countries in the Western World. We give twice as many shots as any of those countries. Why is that?

This point is made in more detail in J.B. Handley’s guest post:

Few parents appreciate that American kids are the most vaccinated on the planet. Generation Rescue just released a study called “Autism and Vaccines Around the World” which will surprise many. We looked at the vaccine schedules of 30 other first world countries to compare how many doses of vaccines children receive. What did we find? Compared to our 36, the average for the rest of the first world is 18, or half of the U.S. schedule. Perhaps more shocking, we looked at countries with the lowest rates of mortality for children under 5 (the U.S. ranks a disappointing 34th, behind Cuba and Slovenia). How many vaccines do the 5 countries with the lowest under 5 mortality rates give? Well, Iceland, Sweden, Singapore, Japan, and Norway give 11, 11, 13, 11, and 13 vaccines respectively – all less than 1/3 the number of vaccines the U.S. mandates!

How do autism rates compare in some of these other countries? Iceland’s rate is 1 in 1,000, Finland’s 1 in 700, and Sweden’s 1 in 800. These countries give 1/3 the vaccines we do and have autism rates that are as little as one-tenth of ours? Something isn’t right.

Indeed, this is the very theme of a “study” posted on the Age of Autism blog entitled Autism and Vaccines Around The World: Vaccine Schedules, Autism Rates and Under 5 Mortality. If you look at the actual PDF containing the report, you’ll see that it’s obviously intentionally designed to look very much like an actual research report. The type, the format, and the style very closely mimic that of a real research paper. Of course, it is not anything of the sort, and if it were submitted to any halfway decent peer-reviewed journal of psychiatry or–even more so–of epidemiology it would find its way into the cylindrical file, possibly even before being sent out for peer review. It’s nothing more than the logical fallacy of confusing correlation with causation taken to a ridiculous extreme and then prettied up with all sorts of “science-y”-sounding jargon in an attempt to put the proverbial lipstick on the proverbial pig. Whoever put this “study” together at Generation Rescue clearly has no clue how to write such a study up, much less how to do one.

The first thing that struck me about this “study” was how poorly written it was. It looked slapped together, and, although it states that a “full publication and literature review was completed to determine vaccine schedules and under 5 mortality rates for 30 countries. What, exactly, does that mean? If you read any meta-analysis or serious review, you’ll see a careful and precise description of the criteria used to choose studies to include. No such description is given here. One is left with the distinct impression that a bit of cherry picking is going on here.

The second thing that leapt out at me is that there was absolutely no attempt to control for confounders. Indeed, one commenter on Age of Autism, responding to another commenter who pointed out that zero controlling for confounders was even attempted said:

Confounding factors? Since when is that ever a consideration? Perhaps you watch too much television and, based on dispropotionately biased coverage, think every parent in America whacks their kids on the head then stuffs them in the trunk.

These are babies under five.

Against such ignorance, the gods themselves contend in vain. The very reason it’s so easy to confuse correlation with causation, even in epidemiological studies that are testing a hypothesis rather than trying to support a preordained conclusion, is because of confounders, and, yes, it is completely irrelevant that these children are under five.

The reasons why the U.S. ranks 34th in childhood mortality is a topic of some controversy and considerable study and discussion. Of course, one wonders why Generation Rescue used the UN World Population Prospects The 2006 Revision when the 2008 Revision is easily available. (Apparently Generation Rescue can’t Google). (It couldn’t be because the under-five mortality rate in the U.S. fell from 7.8/1,000 live births to 7.3 between 2006 and 2008, could it?) Be that as it may, while the Generation Rescue “study” appears to be claiming that vaccines don’t have any relationship to overall childhood mortality, that’s completely the wrong question to be asking because vaccines do not prevent anything other than infectious disease. If we take a look, for example, the 2008 State of the World’s Mothers Report issued by Save the Children, we find some very interesting things, among which is the effect of disparities in health care among the poor, mostly black and Native American, and the better off sustaining our high child mortality compared to that of other developed nations. That’s one huge confounder. Another huge confounder is access to health care; many of the nations mentioned in the Generation Rescue report are nations with universal health care. Whether that drives the difference is a matter of controversy (given the politically charged nature of the discussions of universal health care, how coudl it be otherwise?) but it is yet another huge potential confounder. Of course, the biggest confounder of all is that childhood mortality has been falling in the U.S. for the last two decades. Add to that gun violence and other causes of childhood mortality that are elevated in the U.S. compared to other industrialized nations, and there are so many confounders as to make any inference from these raw numbers utterly meaningless. Again, vaccines only prevent death from infectious disease.

There is also at least one curious omission in the last table (Table 3), which was pointed out, surprisingly enough, by a commenter on Age of Autism. (And when a commenter in the antivaccine echo chamber that it Age of Autism points out a glaring hole in a Generation Rescue propaganda release, you know it’s a really huge hole! This commenter also pointed out that there was not even the most rudimentary attempt to control for counfounders. Truly, this propaganda stinkpile of a “study” is too stinky for any but the most brainwashed of Generation Rescue’s adherents.) Specifically, the U.K. was left out, which is listed as requiring 20 vaccines. That is close to France, which is listed as requiring 17 vaccines. One wonders if this omission is because the U.K. has an autism prevalence comparable to that of the U.S., possibly even higher. I wonder why Generation Rescue left the U.K. out of its last table, purporting to show the relationship between the number of vaccines a nation mandates and its autism rate. After all, the paper claims that it picked countries based on “materially lower levels of mandated vaccines and published autism prevalence data.” I could see where it might be hard to find publications with estimates of autism prevalence in, for example, Cuba, but it’s not as though recent estimates of autism prevalence in the U.K. aren’t readily available. Some “complete” literature search! Given the blatant “forgetting” of an example that most definitely does not support the “hypothesis” of the Generation Rescue paper, I also now wonder why only eight out of the 30 countries examined were chosen for inclusion in Table 3. You don’t think that Generation Rescue left the U.K. out of Table 3 because it didn’t fit with its hypothesis, do you? Unfortunately, I didn’t have time to go searching for all the prevalence data for the countries left out, but it wouldn’t surprise me at all if there were a few more U.K.’s in there.

Even curiouser (well, not really) are the sources used for all the prevalence data. Specifically, the dates of the studies are what stood out to me. Many of them are from the 1990s, and most are from before 2001. Given the increases in awareness, the broadening of the diagnostic criteria that occurred in the 1900s, using these prevalence estimates is meaningless. I could also point out that in the 1990s, the U.S. had a vaccination schedules with considerably fewer vaccines. Table 1 shows that! It would appear that Generation Rescue can’t even keep its story straight in its own study. In any case, comparing a vaccine schedule in 2006 (which is what Generation Rescue did in all cases) with prevalence rates from 5 to 10 years earlier taken from a period of time shortly after the diagnostic criteria had been changed is clueless at best and intellectually dishonest at worst, particularly when it’s done in the context of no effort to control for confounders, no statistical analysis, in essence nothing that any scientist or epidemiologist taking a serious look at the question would consider a minimum effort. In essence, because whoever at Generation Rescue passionately believes that (1) vaccines aren’t nearly as protective as we know them to be and (2) vaccines cause autism, this report ignores all other possible explanations for the numbers and, in fact, doesn’t even pick the right numbers to answer the question. I suppose that if these numbers had been properly picked for valid comparisons one might be able to view them as hypothesis-generating, but so many other studies have specifically looked at the question of whether vaccines cause autism using sufficient numbers to have the power to detect even a weak association and the correct epidemiologial and statistical techniques to analyze the data that throwing this sort of whole population data out as though it were “proof” of anything shows nothing more than how completely ignorant of science whoever wrote it is.

Of course, Generation Rescue isn’t really interested in accurate estimates of autism prevalence, as Sullivan has pointed out:

One of the problems with the vaccines-cause-autism groups is that they really don’t advocate for people with autism. They have abandoned entirely people of low income and minorities (except where they can be used for political gain).

It isn’t just that groups like SafeMinds, Generation Rescue and the rest can’t be bothered to spend the time worrying about minorities or adults. It’s the fact that the data those groups use to support the “epidemic” makes ZERO sense when you consider minorities.

Consider this: the “rate” of autism is 0.3 per 1,000 for Hispanics in Wisconsin, but 10.6 for Whites in New Jersey.

Why isn’t Generation Rescue calling for an investigating the Hispanics of Wisconsin? Shouldn’t they want to know what is “protecting” that subgroup from autism?

They don’t care, they don’t want to bring attention to the Hispanics in Wisconsin (or the under represented minorities across the nation), because it blows a big hole in the “epidemic”. Obviously we still aren’t counting all the people with autism in our prevalence estimates. How can we rely on the historical data that shows an “epidemic” if we aren’t doing a good job even now?

The Generation Rescue “study” is another instance of this very phenomenon, except that it even ignored a wealthy nation (the U.K.) because its autism prevalence data didn’t fit in with its conclusion that vaccines cause autism and that nations with lower numbers of mandated vaccines should therefore have lower autism prevalence. The study also completely ignored the far more likely reason why the United States has such an embarrassing level of childhood mortality: Poverty and disparities in care. That’s because, as Sullivan points out, groups like Generation Rescue are not interested in the poor or minorities, except when they are useful to their cause (Somali immigrants in Minnesota, for instance). All they are interested in is proving that vaccines cause autism. Whenever an antivaccinationist finds differences in autism prevalence, he ignores any other possible cause aside from the vaccines. That’s because, to J.B. Handley, Jenny McCarthy, Jim Carrey, and the rest of the antivaccine movement, first and foremost, it’s still all about the vaccines. It’s always been all about the vaccines. It always will be all about the vaccines. Always.

And when their efforts drive down the vaccination rate leading to outbreaks of vaccine-preventable diseases that cause children to suffer and even sometimes die, antivaccinationists will blame it on the pharmaceutical companies and governments for not having indulged their delusions to their satisfaction.

ADDITIONAL READING (chosen for addressing some of GR’s other canards):

ADDENDUM: A reader was kind enough to point out to me that Bernadine Healy herself pointed out a lot of reasons why comparing childhood mortality in the U.S. with that in various European countries is fraught with confounders, making head-to-head comparisons of dubious value in many cases. The irony! I guess she must have forgotten her Newsweek article from two and a half years ago.

Posted in: Neuroscience/Mental Health, Public Health, Science and the Media, Vaccines

Leave a Comment (95) ↓

95 thoughts on “Welcome back, my friends, to the show that never ends: The Jenny and Jim antivaccine propaganda tour has begun

  1. Khym Chanur says:

    A nit-pick:

    with a heaping helping of the “correlation does not equal causation” fallacy thrown in for good measure:

    That should be “correlation does equal causation” as the fallacy, since “correlation does not equal causation” is true.

  2. Eric Jackson says:

    I’d like to comment on the ‘too many too soon’ bit. Your post is excellent, but I haven’t had a chance to read through it in detail yet.

    At UC Irvine we recently had Dr. Edgar Mercuse visit to give a guest lecture on vaccination refusal. To call it spectacular would be an understatement. One point he mentioned in particular struck me, and I wish I had taken notes on it exactly. He compared the Oral Polio Vaccine to the modern vaccine schedule. The complete modern vaccine schedule, if injected at once has about 1/3rd as many antigens as the OPV alone. Obviously, not the only factor that plays into immunogenicity, but a very important one. I’ve heard even reasonable people, without a science background, boldly state that ‘infants don’t have strong immune systems’ and ‘shouldn’t be exposed to so much’, without realizing that one of the key differences in a newborn’s immune system is that they do not have adaptive immunity, and aren’t generating antibodies to protect from infectious disease – exactly what the vaccines provide.

    Links on Dr. Mercuse’s lecture:
    http://www.today.uci.edu/news/media_advisory_detail.asp?key=455
    http://www.newuniversity.org/main/article?slug=an_immunization_against_public182

    Also, if you haven’t had a chance to read it, Brian Deer’s report on the DPT scare in the 70s is one of the few well written presentations of a medical issue I’ve ever seen in the general media. Definitely worth a look. The parallels to the present situation with Wakefield is uncanny.

    I’m also impressed. Generation Rescue has managed to come up with something -less- scientifically credible that what’s published in the ‘Journal of American Physicians and Surgeons’. That must have taken some superhuman effort.

  3. Th1Th2 says:

    Vaccination is a myth based on superstitious belief. It is unscientific, unethical and thrives on sheer quackery ala Jenner and Pasteur.

    “Currently available vaccines have largely been developed
    empirically, with little or no understanding on how they
    activate the immune system.”
    http://www.who.int/immunization/documents/Elsevier_Vaccine_immunology.pdf

    So what causes autism? Ignorance.

  4. Michelle B says:

    The only reason they try to deny that it is is because they are finally realizing that their actions have consequences and that one of those consequences will be to be seen as the cause of the return of vaccine-preventable disease. Truly, renaming the antivaccine movement to the pro-disease movement sounds more and more appropriate to me.

    Clearly the anti-vaccination, pro-disease (I will always refers to these kooks as pro-disease from now on!) movement is unethical. Ironically, these people actually believe the opposite, that they are ethical, that they are heroic. What a bunch of dangerous, deluded, ignorant, arrogant buffoons they are. They were unethical enough to jump to wrong conclusions; they are unethical enough to admit they were wrong. They are really creepy people. And now kids will run a higher chance of dying from disease that was conquered. These kooks will go down in history as being killers.

  5. Michelle B says:

    Meant they are unethical enough to be unable to admit that they wrong.

  6. Steve Page says:

    So, Th1Th2, how do you explain the efficacy of vaccines? If they’re a myth based upon superstitious belief, perhaps the mechanism is magical, brought about by wishful thinking. On the other hand, perhaps you don’t understand science, have cherry-picked a quote that supports your ignorance, and are happy to demonstrate said ignorance on this blog. You and your paranoid delusional anti-vaccinationist kind would make me laugh, if you didn’t disgust me so.

  7. weing says:

    Methinks they say they are not against vaccinating is because their attorneys told them that they could stand to lose their millions in lawsuits from the consequences of idiots listening to them.

  8. David Gorski says:

    Khym,

    You have a point; so I took a couple of minutes and fixed it.

  9. Mandos says:

    Irrelevant nitpick on SF-based monikers: Isn’t it supposed to be “Khym Mahn”?

  10. Harry says:

    To the Physicians on this board…

    What do you do if you have a patient, a very young child, who’s mother/father/guardian tells you not to vaccinate their child. Assuming a lengthy debate with them over the benefits and risks of vaccination, you are unable to convince them that Jenny and Jim don’t shit rainbows. In this situation, how do you balance the ethical components of Beneficence and Autonomy? Do you fire them as a patient? Do you continue to see them as a patient? Can firing them as a patient cause more harm by leading them to find a different physician, one who is more woo? Do you do the best you can to care for the patient given the constraints of the parent?

    My inclination would be to fire them, but what if that only leads them to a Naturopath or a Homopath?

    -Harry

    Disclaimer- Boulder, Colorado isn’t very far away from where I may end up practicing in primary care.

  11. Prometheus says:

    David,

    You missed the whole point of their presentation!

    You keep seeing this as a scientist would, as an effort to find the way the universe really works. That isn’t how Jenny, Jim and LB see it at all!

    Remember, Jenny and Jim are actors – they make a living by pretending to be people they aren’t and saying words someone else wrote for them to say. Their adult life has been spent in a fantasy world. They have no interest in finding out what really causes autism because the directors (JB, Dr. Jay, etc.) have already told them what to think and what to say.

    JB is a businessman – he’s not interested in “truth” or reality; he simply wants to sell his idea as being better than anyone else’s. Think about most business situations – is Coke really better than Pepsi in some objective way? Does one protein bar really better for you than another in some measurable, repeatable way?

    No! It’s all about selling, and JB is a good salesman. He doesn’t let some vague quibbling about “data” or “objective findings” chart his course – he’s out to make the “Too many, too soon” brand the number-one bestseller in the world!

    Think about those toothpaste advertisements where they say “Four out of five dentists surveyed choose…” You know how they did that – they kept assembling panels of five dentists until they finally had one where four out of five chose their product.

    Seen in that perspective, the GR “study” starts to make sense. They assembled the data in such a way that they couldn’t be accused of actually making it up (it was published data) but made it say what they wanted it to say. This sort of thing is what successful advertising companies do for a living.

    Now, a real scientist like yourself probably doesn’t “get it” – a fact that I find comforting, although JB and his ilk no doubt find laughable. You would never stoop to omitting data that doesn’t fit your hypothesis or juxtaposing data that aren’t actually related, but that’s what advertising is all about.

    It wasn’t a study – although it was dressed up to look like one to the general public – it was an infomercial.

    What you need to do is come up with an ad campaign of your own, something like “Too many, too soon kills babies twelve ways!” It needs to be catchy – nothing that won’t fit on a bumper sticker – and it needs to be simple and it needs to be said with conviction and – preferably – over and over on prime-time television.

    Or we could just wait for the epidemics to start.

    Prometheus

  12. SF Mom and Scientist says:

    You mention the Bay Area as being a “hotbed of New Age woo”. I generally agree. However, as my son is getting ready for school, I recently looked up the vaccination rates of schools in SF (both public and private). I was thrilled to see that only one school (a Waldorf school) had a very high rate of non-vaccination. Of course, I would prefer that all children be vaccinated, but I expected it to be much worse here. Also, in Berkeley, there were no schools which had high rates of non-vaccination. However, what county had an outrageously high number of schools with high non-vaccination rates? Orange County! I always thought that this anti-vaccination/pro-disease way of thinking was much closer to a right-wing way of thinking.

    btw, I love this blog. However, seeing Jenny and Jim this morning made me almost lose my breakfast.

  13. joseph449008 says:

    That study just can’t be done. For most of those countries you’ll find several prevalence studies. Which one do you use? The ascertainment methods vary a lot, so it doesn’t even make sense to begin with. I wrote about 3 of those countries here:

    http://autismnaturalvariation.blogspot.com/2009/04/one-handley-turd-i-left-out.html

    There’s one analysis the anti-vaxers could do, and I’m surprised they haven’t done it yet. I won’t help them out, though.

  14. Calli Arcale says:

    I haven’t listened to it yet; I don’t want to throw up at work. So I’ve had to content myself with what’s quoted in the article. And that’s bad enough.

    “Go back to 1989 schedule when shots were only 10 and the MMR was on that list. I don’t know what happened in 1990, there was no plague that was killing children that we had to triple the amount of vaccines.”

    Jenny, dear, what happened was they figured out how to protect against more of the plagues that were *already* killing lots of our children. Just because a disease isn’t new doesn’t mean it’s a fine and dandy thing to have around. Smallpox certainly wasn’t a new plague when they started innoculating against it, nor when it was declared eradicated. You’d have to be either an idiot or a real callous bastard not to recognize that.

    I had meningitis when I was a little girl. I almost died. I am *so* happy that they now have vaccines for several pathogens which can cause it, including the dreaded Haemophilus influenzae B. Very contagious. Nasty thing to see in an epidemic.

    There are lots of things they didn’t used to vaccinate against. Chickenpox, for instance. Everybody just hoped, and every year, kids would get it, adults would get it, and some of them would be scarred for life, some would suffer life-long pain that would not respond to analgesic, some would be blind or deaf, some would be brain-damaged, and some would be dead.

    Perhaps what amazes me the most is that, even considering McCarthy’s professed belief that autism is a form of brain damage (it’s not), she essentially wants to trade one form of brain damage for another. The number one cause of mental retardation in the bad old days was infectious disease, especially the diseases which are now prevented by vaccines, such as measles and HiB. Just look at tuberculosis. There’s a tough nut to crack. If scientists can nail down a universal tuberculosis vaccine it’ll change the world. Assuming the McCarthy’s of the world don’t get their way, that is, because they will continue to insist that autism is worse than these infectious diseases.

    That’s what bugs me the most. Even by their own logic, if vaccines really did cause autism, they’d still be choosing the worse path! Blows my mind.

  15. wales says:

    There’s an interesting presentation by Dr. Marcuse (I think it’s the same person referred to above, Edgar Marcuse, not Mercuse?) on the IOM site. He seems to make a fairly balanced presentation with regard to respecting individual autonomy via slides 32, 33, 34, 39

    He lists as one characteristic of the vaccination recommendation process “safeguards against “one size fits all”

    http://www.iom.edu/Object.File/Master/7/440/Marcuse.pdf

  16. storkdok says:

    I think Prometheus nailed it. The segment plays as an “infomercial” with religious overtones. Very slick.

    I think the pediatric neurologist, Dr. W, was very good. Dr. Fisher was also very good. Bernardine Healy was, as usual, very wishy washy, talking about “listening to the parents”. The professionals DO listen. She has really bought into this alternate paradigm.

    Does anyone know where any of the cartoons from JM’s book are on the internet? One review talked about how terribly disparaging to the medical professionals the cartoons in her newest book were. I’d like to look at them, but I hate the thought of going to the bookstore to browse through it.

  17. Peter Lipson says:

    Harry, many of us have written about these issues before, both here and on our own sites.

    If a parent (who is, after all, the appropriate surrogate) declines vaccination, then that’s it. You NEVER vaccinate against the wishes of the patient/parent. It is considered assault to perform unauthorized procedures on people except under very limited circumstances (for example, unconscious patients brought to ERs are assumed to have given implicit consent to save their lives).

    You do your best to educate your patients in the way they are best able to hear the message. That, and educating the public, is all you can do.

  18. weing says:

    Harry,
    I don’t think you want to fire them. Who will they sue if their child gets one of the preventable diseases and ends up disabled or worse?

  19. chicagomd says:

    @ Harry,

    I practice in a small town outside Chicago.

    If I have new parents in the practice who do not wish to vaccinate according to my recommendations (which is essentially the CDC schedule), I ask them to find another physician to care for their child. Obviously, I have an extensive converstaion with them about risks/benefits, etc. prior to making this recommendation. I do this for a variety of reasons, but the main one is for the protection of my other patients.

    Almost as important, however, is the trust a parent must have in you to have to be an effective medical provider for their child. It is, in my personal expereince, exceedingly difficult to develop a substantial and sustainable level of trust with parents who are more willing to accept medical advise from the JB Hadleys and Jennys of the world than from the person they have chosen to care for their children. I have found discussions concerning vaccines in this regard to be fruitless after the first few visits. As such, I dedicate a lot of time during the initial newborn visit to the topic of vaccines and leave it up to the parents if they want to come back for another visit.

    I do worry about the care these children my receive at the hands of other providers, however in these cases I err towards the saftey of my practice in general.

    The AAP published a clincial report in Pediatrics 2005;115;1428-1431 that discusses the issue and some recommendations on how to respond, if you want to look into it further.

  20. skepticat says:

    I don’t have anything to add except that I love this blog.

  21. Kula says:

    @harry: The AAP also has a declination form you can have parents sign if they refuse to vaccinate, because you know it will be your fault if their kid gets a VPD and there is a bad outcome.
    Such is our current legal climate.

  22. hatch_xanadu says:

    Harry, I agree with weing and Kula re: the legal climate. It seems the sorts of parents who are willing to jump on the latest woo train are also the same sorts who’ll sue you in a heartbeat if things don’t go their way. Whatever you decide, documentation, documentation, documentation is of the utmost importance.

  23. estherar says:

    OK, I read that GR “study” and now I’m thoroughly confused. Are they counting the total number of vaccine doses (e.g., 1 DTaP would be 3 doses), or are they talking about the number of needlesticks? Because it seems to me the relatively low number of “mandatory doses” they arrive at when examining the immunization schedules of the various countries is partially because of the widespread use of the 5-valent vaccine (DTaP-Hib-IPV) in Europe and here in Israel, and not necessarily due to any major difference in the vaccine schedules. But I thought combo vaccines are bad news, according to the likes of Jenny McCarthy? And how would the use of separate vaxes a la Dr. Sears not make for even more vaccine doses, and according to their logic, even more autism?

    Not that there seems to be any real correlation between the number of “doses” (which, from my knowledge of the Israeli schedule, are miscalculated) and the prevalence of autism in a given country, anyway. And a much more recent Israeli study (http://www.ima.org.il/imaj/ar09jan-05.pdf) that covered the whole of the country, as opposed to one small area in the reference used, showed the prevalence of autism to be twice as high as reported in the GR “study”.

    You would have to be a complete idiot to draw the conclusions they did from the data presented in that paper, even if you ignored the child mortality data which are an obvious red herring.

  24. Calli Arcale says:

    wales:

    He lists as one characteristic of the vaccination recommendation process “safeguards against “one size fits all”

    I looked at the slideshow. It’s clearly notes to go with a lecture; it’d be interesting to hear the lecture itself, since most of the “meat” is usually in the talk itself and not just in the bullet points.

    It is worth mentioning that “one size fits all” is a bit of a myth concocted by the anti-vaccinationists, who want you to think that uncaring doctors are not even looking at your kid before sticking them. This is not true. There is actually quite a bit of wiggle room in the requirements, especially since they are created mostly for an optimal balance between individual and society health rather than exclusively for individual health, and different clinics will implement them differently.

    That said, there’s usually not a good reason to go too far afield. The recommendations are not arbitrary, and the people for whom the schedule is bad will be rare. They are based mostly on epidemiology, which has more to do with society than with your individual child, and those factors are common to everyone. For instance, requiring certain vaccinations before entering kindergarten is logical, because at kindergarten, the child’s exposure to other children changes dramatically (unless the child has been in a group daycare setting). That’s going to be true no matter what child we’re talking about, unless it’s a child who is being homeschooled, in which case there’s no law forcing the child to be vaccinated anyway.

    A couple of other points before I go pick up my kid from school:

    * the bulk of the research presented has nothing to do with whether or not the schedule should be imposed universally but is instead a phone-in survey in which people were cold-called and asked their opinions about vaccines

    * it mentions “immune overload”; while I’m not clear where the author was going with that, it’s worth mentioning that there’s no way a vaccine is going to overload your immune system unless your system is so severely screwed up that going out in the world at all cripples you. Indeed, one hypothesis for the increase in autoimmune disorders is the so-called “hygiene hypothesis”, which speculates that because of modern sanitation and medicine, we are now exposed to fewer antigens, resulting in overreactions from our immune system. Vaccines might actually help if that hypothesis proves true, by giving our immune systems a target without actually contracting a deadly disease.

  25. wales says:

    “The recommendations are not arbitrary, and the people for whom the schedule is bad will be rare.”

    How do we screen for the people for whom “the schedule is bad” aside from the obviously immunocompromised individuals with leukemia, HIV, etc.?

    “They [the vaccination recommendations I assume] are based mostly on epidemiology, which has more to do with society than with your individual child….”

    Exactly my point.

    “There is actually quite a bit of wiggle room in the requirements, especially since they are created mostly for an optimal balance between individual and society health rather than exclusively for individual health, and different clinics will implement them differently.” I’m confused, which is it, are vaccine recommendations based upon an “optimal balance between individual and society health” or “more to do with society than with your individual child”

    As state governments mandate the requirements for school entry, so I’m not sure what you mean by “different clinics will implement them differently”.

  26. wales says:

    SF mom and scientist: could you please provide your sources for vaccination rates in the Bay Area? I’m curious, especially about Berkeley and Marin County.

  27. Th1Th2 says:

    Steve Page said:
    “So, Th1Th2, how do you explain the efficacy of vaccines?”

    Vaccines are very effective in promoting diseases (vaccine-induced disease). For example, OPV = VAPP, Mumps vaccine= parotitis, Hib vaccine= early onset Hib disease, IAIV vaccine= flu-like symptoms, PVC vaccine=otitis media etc.

    http://www.merck.com/product/usa/pi_circulars/m/mumpsvax/mumpsvax_pi.pdf
    http://www.vaccineshoppe.com/US_PDF/IPOL_942420_11.06.pdf
    http://www.vaccineshoppe.com/US_PDF/Acthib_5122_10.06.pdf
    http://www.fda.gov/CBER/label/fluzoneLB.pdf
    http://www.wyeth.com/content/showlabeling.asp?id=134

  28. wales says:

    Scratch that request, I see the LA Times database includes all CA counties. I thought it was just So. Cal.

  29. SF Mom and Scientist says:

    Just in case anyone else was interested.

    http://www.latimes.com/news/local/la-me-immunization29-2009mar29,0,4133567,full.story

    They actually consider a school with 7.5% of students with vaccine exemptions to be high-risk. In this case, SF actually has 2 schools that are considered high-risk. However, one of them had a kindergarten population of 25 and 2 kids who had exemptions (8%). I am (optimistically) hoping this is just an anomaly, since it is a small number of children. (By comparison, the Waldorf School had 54% of their kindergartners with exemptions.)

    However, in Orange County, there are 65 schools that are considered high-risk. So Orange County has 4 times the population of SF County, and 32 times the number of schools which are high-risk.

  30. Mark Crislip says:

    Jenny ReDux. It makes just as much sense this way.

    From Time:

    There was not much in Jenny McCarthy’s early career as a Playboy model and MTV star to suggest that she would become a passionate advocate for family issues, children’s health and Irritable Bowel Syndrome (IBS) awareness. But the birth of her now almost 7-year-old son Evan, who developed IBS early in life, changed all of that. McCarthy has become a best-selling author, first of lighter stuff like Baby Laughs and Life Laughs; then of more serious fare, like Louder than Words: A Mother’s Journey in Healing IBS.

    Now, she is releasing her fifth book — co-authored with IBS specialist Dr. Jerry Kartzinel, titled Healing and Preventing IBS. The book is awfully smart when it comes to hardheaded advice for families trying to heal — or at least draw out — an IBS child. But McCarthy goes soft when she starts exploring the causes of IBS, making the usual charges against the usual suspects, including nutrition, environmental toxins and, as always, flush toilets. McCarthy and TIME science editor Jeffrey Kluger sparred over the causes of IBS and the safety of flush toilets. )

    Your book points out that IBS rates between 1983 and 2008 have climbed in lockstep with flush toilet rates, yet childhood obesity, diabetes and even cell-phone use have soared since then, too. Why do you find causation in one and not the others?

    I’m not saying it’s only the flush toilets. But children are given so many flush toilets from the moment they’re born. They get flush toilets all at once, and if they fall behind, doctors put them on a catch-up schedule. Babies get diapers immediately after they’re born and the only way for a newborn to contract that disease is if the mother is a carrier. Why not just screen the mother?

    Most people who blame IBS on flush toilets point to the mercury in the flush toilets, yet mercury has been removed from most flush toilets and IBS rates continue to climb.

    We don’t believe it’s only the mercury. Aluminum and other toxins also play a role. The viruses in the flush toilets themselves can be causing it, too.

    Your collaborator recommends that parents accept only out door toilets. What about the IBS clusters in communities like the Amish in the U.S.? What about the 2004 outbreak that swept across Africa and Southeast Asia after a single province in northern Nigeria banned flush toilets?

    I do believe sadly it’s going to take some diseases coming back to realize that we need to change and develop flush toilets that are safe. If the toilet companies are not listening to us, it’s their f___ing fault that the diseases are coming back. They’re making a product that’s s___. If you give us a safe toilet, we’ll use it. It shouldn’t be cholera versus IBS.

    And yet in many cases, flush toilets have effectively eliminated diseases. Diarrhea is among the top five killers in the world of children under 5 years old, yet it kills virtually no one in the U.S. thanks to flush toilets.

    People have the misconception that we want to eliminate flush toilets. Please understand that we are not an anti flush toilet group. We are demanding safe flush toilets. We want to reduce the schedule and reduce the toxins. If you ask a parent of an IBS child if they want the cholera or the IBS, we will stand in line for the f___ing cholera.

    Many scientists believe we’re simply diagnosing IBS differently now — both overdiagnosing it in kids who don’t have it and spotting it better in kids who do. That makes it look like the condition is on the rise when it’s not.

    All you have to do is find a schoolteacher or principal and ask them that question. They would say they’ve never seen so much, IBS, IBS as in the past. I think we’re overdiagnosing it by maybe 1%. Now you look around and there are five shadows — kids with disabilities — in every class.

    ====
    You are only young once, but you can be immature your entire life

  31. The Blind Watchmaker says:

    @Harry

    “To the Physicians on this board…

    What do you do if you have a patient, a very young child, who’s mother/father/guardian tells you not to vaccinate their child.”

    No, you do not fire the family. We have a handout that we give them to read on the dangers of vaccine refusal. We then direct them to our website to read further on vaccines and an article that I posted on the anti-vaccine movement. We then have them sign the form stating that they read and understand the risks. This is entered into the chart.

    Then, we bring it up again at the next visit. And again. And again.

    This site is a great source for counter-propaganda material.

    Thanks David.

  32. AnthonyK says:

    I agree wholeheartedly about the counter-propaganda that is produced here. I have become somewhat strident if I find parents who have not vaccinated their children. I’m not sure whether it’s effective or not. One friend, who has just given her child MMR, at 12, did not like my approach at all, and was angry with me for suggesting that she had been essentially negligent in not finding out the truth about vaccines years ago. I was also cross when she said she had asked her doctor how much money she got for vaccinating children (the doctor, presumably used to such outrageous claims, simply said that they got an extra practise nurse, which seemed a good answer.)
    I must say though that the whole issue gets me so angry that I am glad I don’t have to deal with it on a day-to-day basis – and if I were in Harry’s shoes I would fire patients who wouldn’t allow their kids to be vaccinated. Not only is it a risk to you and your other patients, it is also saying to you as a doctor “I don;t trust you — you are just a pharma agent paid to hurt my child”. Not a nice dilemma for all you doctors!

  33. wales says:

    The LA Times database has a few shortcomings. First they disclose that they interviewed “most” schools but don’t list the total number of schools for each county. Also they don’t disclose what selection criteria they applied in choosing the schools. Additional information is needed in order to get an accurate idea of what percentage of schools in each county have high exemption rates.

    Los Angeles county dwarfs every other county in the state for number of schools (541 public elementary schools according to LAUSD plus about 150 private schools according to privateschoolreview.com) The LA Times article database lists only 100 total schools for LA County. Their database indicates that the county has a high percentage of schools with exemption rates of 10% and higher, but this is misleading as less than 20% of the schools were included in the database. Are those <20% indicative of the rest of the county? We have no idea.

    Santa Cruz and Marin counties also have high rates of exemption, those hot beds of hippie counterculture. I guess the right-wing theory wasn’t very scientific after all.

    I also don’t understand why an exemption rate of 7.5% was arbitrarily chosen as “high risk”. The generally agreed upon community immunity threshold for measles is 90%, so I would think 10% would be a better estimate for risk of measles anyway, a highly contagious disease.

  34. Calli Arcale says:

    wales:

    How do we screen for the people for whom “the schedule is bad” aside from the obviously immunocompromised individuals with leukemia, HIV, etc.?

    That’s your doctor’s job — to identify the rare people for whom changes should be made and make those changes. That’s why they get paid the big bucks. For some people, it may mean giving them *more* vaccinations — the immunocompromised, for instance, may actually need more in order to acquire the appropriate immunity, since for them, it is even more dangerous to get the actual disease. (Some, however, may be so immunocompromised that there’s no point giving them vaccines at all — they won’t take.) It’s not a good idea to vaccinate someone who is already sick, which is why doctors ask how you’re feeling and have the nurse check your vitals first. For others, it may be wise to stack more vaccines on top of each other to reduce the number of times the patient has to go through the immune response. You’ll be extra sore after that, but it might be better for you overall to get it out of the way in fewer visits. (Especially if you have a condition that makes fevers extra dangerous — it may be easier to manage any resulting fevers.)

    Different vaccines have different side effects; someone might be fine with the influenza vaccine but have a tough time with MMR (which uses live, attenuated virus and tends to provoke more of a response). This is why doctors tell you to call if you have any unusual reactions — they need to know so they can plan future vaccinations appropriately.

    People with autoimmune diseases, such as rheumatoid arthritis or a history of Grave’s disease, might want to take extra care. They are not immunocompromised. On the contrary, their immune systems tend to overreact, and have attacked their own bodies before. People taking immune suppressants (eg. transplant patients) also will want to avoid antagonizing their immune system, and so more care will need to be taken. It’s not that their immune system can be overstressed. It’s that their immune system may overreact. It’s very hard to predict who will turn out to have an autoimmune disorder, although it’s a heavily studied area, so unfortunately this tends to be more reactive than proactive — if you’ve had an autoimmune response in the past, that may factor in to the decision for future vaccines. But different autoimmune diseases are very different, so you’d have to consult your doctor.

    Probably the most common reason to avoid certain vaccines is allergies. The egg allergy affects several vaccines, as they may contain egg albumin. I believe most vaccines have moved to non-egg feedstock, but chicken eggs are so convenient (and cheap) that they’re still used to manufacture many of the antigens. It’s not possible to remove all of the albumin, so if you have an egg allergy, it’s vitally important to tell your doctor.

    I’m confused, which is it, are vaccine recommendations based upon an “optimal balance between individual and society health” or “more to do with society than with your individual child”

    It’s a bit of both, really — the vaccine requirements are written from the perspective of protecting all of society, but they have to consider the individual too, both because medical ethics demands it and because society is made up of individuals. A vaccine which kills 50% of the individuals that receive it is obviously no good for society. That’s an absurdly extreme example, but you get the idea.

    It’s sort of like taxes. They don’t require you to pay them for your own good — they require you to pay them for *society’s* good, since the taxes go to fund government, police, fire departments, water and sewage treatment, road maintenance, and other things that society depends upon. Since you’re part of society, you do however benefit, and the tax schedules are written to try to ease the burden on individuals who can ill afford it (though it’s probably an endless argument as to whether or not this has been done well or fairly).

    As state governments mandate the requirements for school entry, so I’m not sure what you mean by “different clinics will implement them differently”.

    The requirements tend to be quite a bit more flexible than people realize. The published ones for my state carry this note: “This schedule may vary a bit, depending on your specific doctor and your child.” They are essentially suggestions only, and include more vaccines than are actually required by law for entry into licensed daycare or public school. I’m not sure where to look up which of them are the required ones, but going from memory, I seem to recall that most of them just say “you have to have had this by age X”, which is a pretty significant amount of wiggle-room. Your doctor is also free to substitute different vaccines for the same pathogen without having to fill out a medical exemption form. The recommendations for my state specify MMR, for instance, but separate measles, mumps, and rubella vaccines would also meet the requirements. I know my doctor’s clinic has a recommended schedule which includes more than are even on the state’s recommended schedule, which itself is more than are actually required.

  35. wales says:

    “the vaccine requirements are written from the perspective of protecting all of society, but they have to consider the individual too, both because medical ethics demands it and because society is made up of individuals…” how thoughtful of them to consider the individual.

    FYI, there aren’t any handy screening kits to screen for all the possible adverse reactions listed in the vaccine package inserts. So our doctors don’t have that tool.

    I think you’re deluding yourself about the “wiggle room” in the state mandated vaccination schedules. If you don’t have a medical exemption that is. The wiggle room is provided by religious and philosophical exemptions, which is why many parents choose them and then proceed to selectively vaccinate.

    By the way, Merck has announced they will no longer produce the MMR constituents separately.

  36. Calli Arcale says:

    By wiggle room, I don’t mean “opting to not get vaccinated altogether”. I mean you can get different vaccines at different times, but you are still required to get them taken care of before you enter certain grades.

    And of course there aren’t handy screening kits to screen for all possible adverse reactions. That would be impossible. Does sunscreen come with a screening kit for all possible allergies? Of course not. The adverse reactions are extremely rare, and most of them don’t have a simple test to screen for them. Can you screen a kid for peanut allergy before first giving them peanuts? No. Same with vaccines. The vast majority will be fine; for the rest, well, that’s why you have vaccines given under medical supervision. Besides, then you get into the risks of excessive screening. There’s an interesting article about PSA screening and whether or not routine screening really makes sense currently on top of this blog.

    Heck, some of the conditions that can result in adverse reactions, such as the one that happened to the little girl in the autism omnibus case (Hannah Poling), are so rare that they are almost unique. How do you develop a screening kit for that? How do you know which kids to test? You couldn’t possibly test them all. Do you let them go unvaccinated, vulnerable to the scourges of years gone by, just because there is a 1 in 100,000 chance of a particular condition?

    It is better to let individual doctors make the medical judgments that they are trained to make, in consultation with patients and their parent/guardians, than to have the government mandate universal screening, IMHO. Otherwise, you’re subjecting an awful lot of kids to needless screening, which is expensive, will involve taking blood and/or tissue samples, which is painful, and will lead to some kids getting treated for conditions which would otherwise lie unknown. Sometimes that’s a good thing. Other times, not so much, since a lot of conditions are actually pretty benign. What’s more, some of the conditions that can cause vaccine reactions don’t always so you may end up avoiding vaccinating a kid who’d do just fine. What if that kid gets exposed to measles in a few years? No. Until somebody invents the medical tricorder from Star Trek, the risk of undervaccination is worse than the risk of accidentally injuring a few children. You can risk thousands dying, or two or three dying. Hard to swallow when it’s your kid, but the risk-benefit analysis is clear. Clear for your kid too — all else being equal, the risk of going unvaccinated is worse for the individual than the risk of possibly getting a serious adverse reaction.

    BTW, I know Merck is planning to phase out the individual MMR constituents. It just doesn’t make good economic sense for them to keep making them, because they aren’t very popular. (Who’d really want to get stuck three times instead of once? The individual ones are also more dangerous than the combined one, mostly because of the arduous dosing schedule that is required.) Vaccine manufacture is not a high-profit-margin area, and it doesn’t take much to drive a manufacturer away from a particular one.

  37. Calli Arcale says:

    Addendum:

    Doctors most certainly do have the tools to judge who is most at risk. It may not be a little kit that they stick a drop of blood in, but they do have tools:

    * patient’s medical history
    * patient’s family history
    * patient’s current vital statistics and medical condition

    If there are any red flags within those three areas, the doctor will know whether or not to order tests or avoid certain vaccines as a precaution. (I know personally several people who have avoided certain vaccines for medical reasons. They did not have to take the vaccines to find out that they were at risk; it was evident from their personal and family histories.) I cannot stress enough how important it is to tell your doctor about your history, especially if you have a new doctor. If you have any particular concerns, the doctor may be able to order tests to allay those concerns, and if the doctor is unable to satisfy you, you can get a second opinion.

    In my opinion, the biggest problem with our medical system is that all that costs money. A laid-off ironworker who can’t afford his COBRA benefits probably can’t pay for two doctor’s visits just to get a second opinion about unresolved vaccine concerns. (Tip: call the clinic ahead of time to find out if there is a way to get subsidized or charity care. If you wait until you see the doctor, it may be too late to qualify. My mom found that out the hard way, and now knows she can get cheaper care next time.) I wish somebody would come up with a good fix for this problem.

  38. AnthonyK says:

    Is it conceivable that vaccine manufacture could cease, in part becausee of the activities of the anti-vax crowd? I know, in part from reading this blog, that vaccines aren’t the cash cow the opponents claim they are – that MMR, say, is out of patent – but am I right to be concerned that Big Pharma might bow out entirely? Who would, or could, do the job? I imagine a large and very sophisticated lab facility is necessary to make anything in this field – so where could it happen?
    Or am I worrying unduly?

  39. wales says:

    calli, “Does sunscreen come with a screening kit for all possible allergies?” Sunscreen, being applied dermally, is not a good analogy for parenterally administered vaccines.

    “The adverse reactions are extremely rare” and “the risk of undervaccination is worse than the risk of accidentally injuring a few children” Statistics cut both ways, it is disingenuous to say VAERS data is statistically insignificant and then to say that disease rates of complication and mortality are not also statistically insignificant.

    Regarding MMR “The individual ones are also more dangerous than the combined one, mostly because of the arduous dosing schedule that is required.” I thought multiple vaccines were safe? How exactly do additional doses make it more dangerous?

    Anthony, you’re worrying unduly. Read the pharmaceutical company financial statements. That’s why the NVICP was created, to help out those poor unprofitable pharmaceutical companies by reducing their liability. Effectively they are being subsidized by the government via NVICP.

  40. wales says:

    I can’t help but ponder this idea that vaccine exemptors are “pro-disease”. Does that mean that gun owners and pro-choice abortion advocates are both pro-death? Does that mean that pro-vaccine groups are also pro-vaccine injury?

    The vaccine exemption phenomenon transcends politics. There are multiple groups of advocates of vaccine exemption rights, each with their own rationale. Religious groups have their reasons. Natural health advocates have their reasons. Then there is the group of parents who fit into neither of those categories, searching for a rational decision amongst all the pro and anti vaccine propaganda. Painting this as a conservative v. liberal issue doesn’t work. It’s more about the right to self determination.

    Perhaps the correlation between affluence and exemption is not about “empowerment at the expense of reason” but more about higher education levels and access to more information.

  41. AnthonyK says:

    Phew! Thankyou. And what abouot the Global Stupidity Epidemic – no problem there either? ;p

  42. AnthonyK says:

    I agree…one of the problems is that our oponents do not understand our evicence, or why it is convincing. Thank heavens for all you doctors getting together and standing up for medicine!

  43. These guys are running a propaganda war using lies, claims, and half-truths. I hate to be so cynical (but, I’ve voted in 9 US elections, so I’m so cynical that I think 2+2 equals some random number that will remain secret until 2015), but propaganda is used to either 1) gain power or 2) make money. Hmmmm.

  44. wales says:

    Not sure what you mean by global stupidity epidemic. That would appear to be largely a matter of subjective opinion, as individuals commonly believe that people with opposing opinions are stupid.

    There is convincing evidence on both sides of the issue, whether one outweighs the other is also subject to opinion.

  45. David Gorski says:

    Not sure what you mean by global stupidity epidemic. That would appear to be largely a matter of subjective opinion, as individuals commonly believe that people with opposing opinions are stupid.

    Uh, no. In science there is such a thing as being objectively incorrect, and the antivaccinationist movement is objectively incorrect about a great many things, specifically their core beliefs about vaccines. It’s also possible to be objectively ignorant about science, and JJJ plus Jenny’s co-author are clearly ignorant about science.

    Moreover, Jenny and Jim are arguably very stupid. They keep repeating stupid things over and over again after being corrected–and not just about vaccines. J.B. Handley, their puppetmaster, is not stupid, but he is (1) incredibly ignorant about science and (2) so wedded to the concept that vaccines cause autism that no amount of evidence will sway him. Prometheus is right; he’s a salesman, not a scientist. He has already made up his mind, and nothing will change it. Now he’s only interested in persuading others that he’s right. Consequently, the JJJ show is nothing more than a sales job.

    Or, as I put it in the title, it’s a propaganda tour.

  46. Calli Arcale says:

    I have to agree with you, wales, about describing anti-vaccinationists as “pro-disease”. I have encountered maybe a couple of people ever who thought disease was a good thing. (They were not nice people.) Anti-vaccinationists, by contrast, usually are anti-disease as well. They just overestimate the risk of vaccines and/or underestimate the risk of the actual diseases.

    “The adverse reactions are extremely rare” and “the risk of undervaccination is worse than the risk of accidentally injuring a few children” Statistics cut both ways, it is disingenuous to say VAERS data is statistically insignificant and then to say that disease rates of complication and mortality are not also statistically insignificant.

    I did not say the VAERS data was statistically insignificant. What I’m getting at is that the rate of vaccine injuries is much lower than the rate of complications and mortalities from the infectious diseases that the vaccines protect against.

    Vaccines are not zero-risk. But neither is not vaccinating. Which risk would you rather take? That’s the basic question. I’m not discounting the risks. I’m saying the risks of not vaccinating are nearly always much higher.

    Regarding MMR “The individual ones are also more dangerous than the combined one, mostly because of the arduous dosing schedule that is required.” I thought multiple vaccines were safe? How exactly do additional doses make it more dangerous?

    Anytime you break the skin there is a risk of infection. That risk is reduced by combining vaccines into single shots so that the skin doesn’t have to be broken as often. With MMR specifically and each of its components, there is a higher risk of causing fever, which can lead to negative consequences though usually is just unpleasant for a while. Since that same risk will exist for each dose, having to take more increases the risk that has to be taken in order to achieve the desired immune response. There’s also something specific to MMR that makes the individual ones more arduous, but I’m not an immunologist (I’m a software engineer) so I couldn’t promise to explain it properly. Plus, of course, extra shots *hurt*.

    It’s not a huge increase in risk, I’ll admit, but personally, with such a simple way of reducing the risk (grouping them together in MMR), I can’t see why anybody would want to break them apart. It’s even cheaper in the combined form, and there’s a pretty good history by which to judge its safety.

  47. wales says:

    Please don’t misrepresent me. I didn’t characterize vaccine exemptors as “pro-disease”, SF mom did.

  48. Calli Arcale says:

    I know; I’m sorry, I should’ve quoted what I was responding to. I was agreeing with your assertion that it was not good to call vaccine objectors “pro-disease”:

    I can’t help but ponder this idea that vaccine exemptors are “pro-disease”. Does that mean that gun owners and pro-choice abortion advocates are both pro-death? Does that mean that pro-vaccine groups are also pro-vaccine injury?

    I think you’re spot-on there. Calling vaccine objectors “pro-disease” is not correct. It’s a cheap shot, and I wish commenters on this blog and elsewhere would take a higher road on that one.

  49. wales says:

    thanks calli and dg for clarification

  50. SF Mom and Scientist says:

    @wales – “The LA Times article database lists only 100 total schools for LA County.”

    That is not true. When you click on “Most unimmunized kindergarteners”, it lists the top 100 school that fit this category. If you click on “Fewest unimmunized kindergarteners”, you get a completely different 100 schools. (In fact, there are more than 100 schools that have zero unimmunized kindergarteners, so they only list the first 100 alphabetically.)

    Also, I never said my thought that anti-vaccination is a right-wing way of thought was a scientific conclusion. It is only a theory, based on the way those who are anti-vaccination think. There is just such a religious-type zeal that people hang onto no matter what data is presented. “Thimerosal causes autism. Um, that was proven wrong. The MMR causes autism. Hmm, ok proven wrong again. Must be something else in the vaccines.”

    Also, I have yet to meet someone with a scientific education that is anti-vaccination. In general, right-wing people are more anti-science than left-wing people.

    I’m sure there are people who consider themselves liberal who are also anti-vaccination. However, this may be leftover from being anti-establishment, just for the sake of being anti-establishment.

    OK, I have to admit that I shouldn’t have called anti-vaxers “pro-disease”. It is just so incredibly frustrating to see people completely ignore the data. As someone else said, a better way to say it is that they over-estimate the risks of vaccines and under-estimate the benefits.

  51. David Gorski says:

    Also, I have yet to meet someone with a scientific education that is anti-vaccination. In general, right-wing people are more anti-science than left-wing people.

    I’m sure there are people who consider themselves liberal who are also anti-vaccination. However, this may be leftover from being anti-establishment, just for the sake of being anti-establishment.

    Actually, It think you’re probably you’re wrong on this. Although antivaccinationism is clearly the woo that is bipartisan, it does seem to be more prevalent on the left than on the right. For one thing, look at all the areas where antivaccine views run rampant; they are highly concentrated in areas of aflluent liberals–such as Marin and Sonoma Counties. Ditto Boulder, CO. Ditto the Pacific Northwest.

    One thing I’ve found is that the reasons for being antivaccine vary according to political persuasion. On the right, it’s often religion, suspicion of government and science, and personal freedom, libertarian rhetoric that drive antivaccine views. On the left, it tends to be “back to nature”-type thinking where vaccines are viewed as somehow being “unnatural” and therefore suspect, coupled with suspicion of big pharma and “conventional” medicine. Whatever political persuasion antivaccinationists are, antivaccine views correlate very highly with believing in “alternative” medicine.

    I’ve said it before, though. I don’t really like politicizing this too much, trying to label the left or the right as being more antivaccine. However, when push comes to shove, I have to admit that it is the left that is probably more prone to these views than the right. I could be wrong about this (it’s hard to come by hard data on this), but it’s my impression from my reading and experience. In any case, there’s nonsense on all ends of the political spectrum. At the risk of generalizing too much, my observation is that in the U.S., at least, the right tends to favor quackery based on Judeo-Christian religious belief, while the left tends to base its quackery on the naturalistic fallacy and New Age woo. There’s overlap of course, and woo-lovers of all ends of the political spectrum share one thing in common: A distrust of modern scientific medicine.

  52. khan says:

    ===I think you’re spot-on there. Calling vaccine objectors “pro-disease” is not correct. It’s a cheap shot, and I wish commenters on this blog and elsewhere would take a higher road on that one.===

    They are pro-disease and they admit it..

  53. Dr Benway says:

    It’s a have-your-cake-and-eat-it-too problem. Of course no one wants disease…

  54. SDR says:

    You couldn’t be more wrong. Anti-vaxers are absolutely pro-disease. Jenny McCarthy admitted so much as CNN.

  55. SF Mom and Scientist says:

    I do see what you are saying. I guess what I meant to say is that I think that this way of thinking is very similar to a right-wing way of thinking (faith instead of reason, similar to choosing creationism over evolution), even if the person otherwise considers themselves liberal.

    I do stand by the first paragraph that you quote. I really have yet to meet a scientist who is anti-vaccination. I’m not saying they don’t exist, but they seem to be hard to find. Also, although I live in San Francisco, everyone I know is pro-vaccination, per the recommended schedule. Of course, we all tend to socialize with people that are similar to us, so I am probably looking at a specific group.

    After all that is said, I am still thrilled that very few schools in SF have low vaccination rates.

  56. Dacks says:

    From where I sit, the anti-vaxxers are on the left, alternative end of the scale. Our local Waldorf school is a big magnet for them, as it goes along with a desire to not subject their darling children to the rigors of the public school system.

  57. David Gorski says:

    I do stand by the first paragraph that you quote. I really have yet to meet a scientist who is anti-vaccination. I’m not saying they don’t exist, but they seem to be hard to find.

    Boyd Haley. He was a respectable chemist until he turned to the antivaccine mercury militia crowd.

    Just because one is a scientist does not mean one is immune from unreason and pseudoscience. Heck, look at Linus Pauling, one of the greatest scientists ever. Later in life he turned to “orthomolecular medicine” and the concept that megadose vitamin C was a magic bullet that could cure cancer and the common cold.

  58. SF Mom and Scientist says:

    I still think that, on average, scientists would be more pro-vaccine than someone who has no scientific education. Of course there are outliers. Do you not agree? (Maybe this is just wishful thinking on my part.)

  59. David Gorski says:

    I don’t disagree, but scientists, when they wander outside of their field of expertise, have an annoying tendency to be just as irrational as anyone else.

  60. wales says:

    Regarding the LA Times database, perhaps it contains 200 of the 600+ schools. So that would be just under 34% of the total number of schools. It would be helpful for the sake of accuracy if they divulged how many schools they interviewed for each county.

  61. SF Mom and Scientist says:

    @wales, I’m not sure why you don’t think they included all the schools. For the “Most unimmunized kindergartners”, the 100th school on the list has a 6.7% exemption rate. For the “Least unimmunized kindergartners”, all 100 schools have a 0% exemption rate. They are listed alphabetically, and the 100th school on this 0% list is Broadway Elementary. Since they only got to “B”, there must be at least a few hundred more with a 0% exemptions rate, plus all the schools that are between 6.7 and 0.

    There is no way they left off a significant number of schools, if they left off any at all. Do you know of a specific school you cannot find? (You can also search by name of school, in case you are looking for one that falls between the top 100 and bottom 100.)

  62. AnthonyK says:

    It doesn’t matter whether anti-vax people are right or left-wing they are fucking wrong.
    Evidence – this whole blog,
    And respectful Insolence, And. everything else.;)

  63. AnthonyK says:

    The anti-vax f***wits are not usefully defined as left, or right wing. They are just wrong. Period.
    And this is a place where someone like me comes for information = and gets it. However, accessing this level of clever is very difficutlt for ordinary people to find. It took me monthos of worrk, and even obsession, to find out.
    Here,
    Tough love, I think ;¬y

  64. In general, right-wing people are more anti-science than left-wing people.

    SF Mom, I’m going to have to take a different point of view on that statement. I’m solidly left-wing, and a statistically significant portion of my left-wing friends are anti-science. They’re more prone to following woo than right wingers are. Of course, right wingers follow their own brand of woo in the whole area of evolution denialism and the such.

    I think the one area of science that is more or less divided by political ideology is human-caused global warming.

  65. In general, right-wing people are more anti-science than left-wing people.

    It was supposed to in quotations above, and I messed up the coding.

  66. wales says:

    For anyone who cares, closer examination of the LA Times database reveals that although the search function for the most immunized/most unimmunized limits the results to the top 100 schools for each category, the overall school database is much larger and can be accessed via http://projects.latimes.com/schools/

    What is truly mind boggling is the number of school districts and schools in LA county. 10,225 public and 3,506 private schools with 7,890 of those elementary schools. This makes it a bit harder to discern what we can glean from the fact that the 100th ranked elementary (out of 7,890) for most unimmunized kindergartners has an exemption rate of 6.7%. It highlights the question: what is the selection criteria for the interviewed schools? Also, what percentage of the 7,890 schools were actually interviewed for vaccine exemption? I think I’ll write the paper and ask.

  67. The Ridger says:

    There’s antiscience on right and left, but it’s different. Left goes for woo, right for religion (Christianity, usually) and dogma.

  68. Lame-R says:

    The “pro-disease” comment may have been a low blow, but there are plenty in the anti-vax crowd who contend that the body’s immune system is somehow stronger if it encounters and conquers a disease ‘in the wild.’ In a sense they are pro-disease when it comes to building up the immune system. fwiw.

    This is purely anecdotal, but the high non-vax rates in SoCal may have something to do with the large number of children of Mexican immigrants.

  69. David Gorski says:

    This is purely anecdotal, but the high non-vax rates in SoCal may have something to do with the large number of children of Mexican immigrants.

    I tend to doubt this for the following reason. These were rates of vaccine exemptions, which means that the parent actively had to request a “philosophical” or “religious” exemption for her child to be exempted from the requirements for vaccination prior to starting kindergarten. Mexican immigrants are probably less likely to be aware that such exemptions even exist, given the language barrier and that many of them are not well off.

  70. hatch_xanadu says:

    Yes, and I’ll add that Mexican immigrants tend culturally to do as the doctor says (believe you me, I witness it in my own family daily), whereas (non-religious-based) vaccine exemptions seem to be most popular in households of (white American) privilege.

    Michael’s Insight: I’ll also add that, while right-wingers may be “anti-science” in the sense that they tend to be against, say, items like stem cell research, I’ve found that left-wingers are overwhelmingly subject to falling for “traditional” woo. “Traditional” Chinese medicine, for example — perhaps out of a desire to be culturally open minded.

  71. weing says:

    I think this all has to do with reversion to the mean. It’s nature’s way of limiting the population. The wealthy whites have the luxury of being able to be stupid and decrease their use of available resources through their presence in the gene pool. I’m sure that once the poor Mexicans become wealthy they’ll become just as stupid.

  72. Enkidu says:

    Lame-R: I totally agree with your assessment on “pro-disease.” I’ve encountered many moms on parenting sites who think that it would be awesome to get together for a measles or chicken pox “party” if only they could find these diseases in the wild (damn vaccines ruining their fun!). They think that the “natural” virus is harmless to their superior immune systems. It’s ludicrous.

  73. Aaron S. says:

    Good read, but one nitpick:
    “And when a commenter in the antivaccine echo chamber that it Age of Autism points out a glaring hole in a Generation Rescue propaganda release, you know it’s a really huge hole!”

    I would call that the Defector’s Fallacy. The point is no more valid just because it was by “one of them”. On the other hand, I wasn’t sure if you were just tongue-in-cheek here.

  74. Steve Page says:

    For anyone who’s interested, I’ve started a Facebook group calling for a boycott of anything Jim Carrey related. If you feel the same way, please join and share the link. http://www.facebook.com/group.php?gid=79336789608

  75. AnthonyK says:

    Could I ask a simple question of those of you do work in the vaccination field? What is the worst reaction you have ever seen to a vaccination and how common are adverse reactions generally – from your own experience? Apart from a little soreness, obviously.
    I ask because, now having got myself all obsessed with they issue, I have been arguing with friends that, essentially, there is no – well, say 1 in a million (slightly vaccine-dependent, obviously) – risk to individual children from vaccines alone, so that one should vaccinate one’s own children even if no other child is.
    As pointed out in this thread, doctors do take into-account possible allergies and so on, and will postpone vaccination on children who are “off-colour” to start with, but taking all that into account, what is your personal assessment of the risks based on seeing hundreds or thousands of vaccinated children.
    I take it, of course, that you have had full vaccinations for your own children as not to do so would make your position hypocritical

  76. Calli Arcale says:

    About the “pro-disease” label and why I object to it despite Jenny McCarthy’s disgusting remark about wishing these diseases to come back and the belief among some anti-vax folks that natural immunity is somehow better….

    These people are not in favor of the reality of these diseases. They do not realize what the diseases are really like. They have the risk-benefit analysis all wrong when it comes to vaccines and vaccine-preventable diseases. It’s not that they’re in favor of people becoming ill. It’s that they mistakenly believe that the diseases are nothing to worry about.

    My main concern is that labeling them “pro-disease” will only antagonize them, and convince them even more that their concerns are not being heard, that we’re just writing them off. It’s exactly what happens when pro-life advocates label pro-choicers as “pro-abortion”, or when pro-choice advocates label pro-lifers as “anti-woman”. While there are arguments in favor of the labels for certain individuals, the individuals themselves almost never see themselves that way and will take serious exception to the label. The majority, who are not described by the labels, will take even more exception. And thus the chance for discourse is terminated before it can accomplish anything.

    I think if we want to champion reason, we need to be more careful about our rhetoric. I’m not saying we should back down on attacking Jenny McCarthy, Andrew Wakefield, etc. They’re lost causes — we can’t convince them anyway, and their message is seriously dangerous. But the majority of people with vaccine concerns are probably persuadable if we don’t alienate them ahead of time. We need to show them what reason can do for them.

  77. yeahsurewhatever says:

    “If vaccines are such a huge profit source, then one wonders why the number of pharmaceutical companies manufacturing vaccines has fallen so precipitously over the last two decades. It couldn’t be the low profit margins and fear of litigation, could it, a large part of that fear having been fueled by the antivaccine movent? Perish the thought!”

    I don’t see Merck being sued for Gardasil, though maybe they should. Not on the basis of the aluminum adjuvant or whatever the antivax people will say, but on the basis of false advertising, dubious utility of its effect even if it works properly, and rampant sexism in its application and in the guidelines it told the government to adopt in good faith.

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