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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.

Posted in: Politics and Regulation, Vaccines

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220 thoughts on “The problem of nonmedical exemptions to school vaccine mandates

  1. quest4fire says:

    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.

  2. Harriet Hall says:

    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.

  3. Chris says:

    quest4fire:

    Having peculiar substances injected into one’s bloodstream is a profound violation of all of the defenses the human body possesses.

    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.”

  4. lilady says:

    @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”?

  5. Chris says:

    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.

  6. David Gorski says:

    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.

  7. Narad says:

    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.

    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.)

  8. The Dave says:

    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.

  9. David Gorski says:

    The fact is that, where state action is concerned, religious beliefs are privileged.

    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.

  10. lilady says:

    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.

  11. The Dave says:

    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.

  12. Narad says:

    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.

    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.

  13. Narad says:

    (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.)

  14. lilady says:

    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.

  15. David Gorski says:

    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.

  16. David Gorski says:

    Again, though, religious belief is plainly privileged.

    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.

  17. Chris says:

    Dr. Gorski:

    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.

    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.

  18. Narad says:

    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.

    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.

  19. quest4fire says:

    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.

  20. Th1Th2 says:

    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?

    Band-Aid would prove that vaccinators are stupid SOB.

  21. Narad says:

    Are you saying the vaccines don’t travel through the circulatory system? Isn’t that the point?

    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?

  22. Th1Th2 says:

    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.

  23. David Gorski says:

    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.

    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.

  24. Harriet Hall says:

    @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.

  25. Chris says:

    quest4fire:

    Whenever I am cut or scratched, blood appears.

    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.

  26. weing says:

    “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.

  27. quest4fire says:

    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.

  28. Wow, quest4fire is dumb.

  29. Harriet Hall says:

    “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.

  30. Harriet Hall says:

    “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.

  31. 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.

  32. ConspicuousCarl says:

    I think our new friend should get that fire thing figured out before tackling immunology.

  33. Chris says:

    quest4fire:

    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.

    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.

  34. weing says:

    “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?

  35. weing says:

    Regarding VAERS, didn’t someone post that the flu vaccine turned them into the incredible Hulk?

  36. DavidRLogan says:

    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…)

  37. The Dave says:

    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

  38. Chris says:

    To be fair, The Dave, there are several different people using that particular ‘nym.

  39. The Dave says:

    I guess that is a valid possibility. How can I delete that comment? It doesn’t actually add to the conversation.

  40. Narad says:

    Regarding VAERS, didn’t someone post that the flu vaccine turned them into the incredible Hulk?

    James Laidler.

  41. Chris says:

    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.

  42. icewings27 says:

    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!

  43. lilady says:

    icewings…Your relatives, I presume, are now old and decrepit :-)

    I remember getting Salk polio (the very first EVER) vaccine.

  44. quest4fire says:

    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.

  45. weing says:

    “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.

  46. BillyJoe says:

    “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)

  47. quest4fire says:

    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.

  48. lilady says:

    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?

  49. quest4fire says:

    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.

  50. mousethatroared says:

    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.

  51. Calli Arcale says:

    quest4fire:

    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.

    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.

  52. Calli Arcale says:

    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.

  53. rork says:

    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.

  54. lilady says:

    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?

  55. Scott says:

    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.

    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.

  56. Calli Arcale says:

    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.)

  57. Chris says:

    quest4fire:

    I got all the childhood diseases in the 50s and have natural immunities.

    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.

  58. quest4fire says:

    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?

    1. Harriet Hall says:

      @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.

  59. Janet Camp says:

    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.

  60. Chris says:

    quest4fire, are you too insulted to tell me how the oldest child of Roald Dahl and Patricia Neal did after getting measles?

  61. Chris says:

    quest4fire:

    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.

    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.

  62. Narad says:

    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.

    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.

  63. Calli Arcale says:

    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.

  64. Scott says:

    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.)

  65. lilady says:

    @ 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.

  66. jmb58 says:

    @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.

  67. WilliamLawrenceUtridge says:

    Having peculiar substances injected into one’s bloodstream is a profound violation of all of the defenses the human body possesses.

    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.

  68. Narad says:

    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.

    You conveniently omit the possibility is that it might be that the tort system itself is a bad idea in certain domains. The Bruesewitzes would have liked to have a Pennsylvania jury decide whether a better design was available. Does this strike you as a promising approach to vaccine development?

    Sounds like nuclear power- an industry that can’t attract investors, so the government props it up.

    Unfortunately for this attempted analogy, the Price-Anderson Act doesn’t bar state tort law remedies.

  69. Narad says:

    Feh, blew the blockquotes.

  70. lilady says:

    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.

  71. Narad says:

    “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.”

    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.

  72. WilliamLawrenceUtridge says:

    Indeed, Jacobson occurred in the context of a smallpox epidemic

    …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.

  73. Narad says:

    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.

  74. @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.

  75. ConspicuousCarl says:

    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.

  76. mousethatroared says:

    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.

  77. BillyJoe says:

    “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.

  78. mousethatroared says:

    @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.

  79. Jann Bellamy says:

    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/

  80. Scottynuke says:

    @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?

  81. Narad says:

    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.)

  82. aeauooo says:

    “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

  83. lilady says:

    @ 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

  84. aeauooo says:

    @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]

  85. lilady says:

    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. :-)

  86. quest4fire says:

    I have decided to educate myself. I will be gone for a while. I am reading Callous Disregard by Andrew Wakefield.

  87. Chris says:

    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.

  88. jmb58 says:

    @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.

  89. Harriet Hall says:

    @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.

  90. Chris says:

    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.

  91. Narad says:

    I have decided to educate myself. I will be gone for a while. I am reading Callous Disregard by Andrew Wakefield.

    You could also check out this (PDF) when you’re done with Wakefield’s auto-homage. Or that case law, whatever, go crazy.

  92. @BillyJoe

    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.

    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.

  93. weing says:

    “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.

  94. Chris says:

    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.

  95. BillyJoe says:

    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.

  96. elburto says:

    @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.

  97. WilliamLawrenceUtridge says:

    I have decided to educate myself. I will be gone for a while. I am reading Callous Disregard by Andrew Wakefield.

    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.

  98. The Dave says:

    @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.”

  99. weing says:

    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.

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