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Dealing with vaccine hesitancy and refusal

How do we deal with parents who would rather their babies face diseases than vaccines?

How do we deal with parents who would rather their babies face diseases than vaccines?

As long as there have been vaccinations, there has been an antivaccine movement, and as long as there has been an antivaccine movement, there have been parents who refuse to vaccinate. In a past that encompasses the childhood of my parents, polio was paralyzing and killing children in large numbers in yearly epidemics, the fear of which led to the closure of public pools every summer. In such an environment, the new polio vaccine introduced by Jonas Salk in the mid-1950s wasn’t a hard sell. In fact, satisfying the initial demand for it was the problem, not parents refusing to vaccinate their children. Since then, more and more vaccines have been developed to protect more and more children from more and more diseases, to the point where the incidences of most vaccine-preventable diseases is so low that, unlike 60 years ago, most parents today have never seen a case or even known other parents whose child suffered from a case. Even as recently as the 1980s, Haemophilus influenza type B was a dread disease that could cause meningitis, pneumonia, sepsis, and death. Since the introduction of the the Hib vaccine a mere quarter century ago, Hib has been virtually eliminated. Most pediatricians in residency now have never seen a case.

As much of a cliché as it is to say so, unfortunately vaccination has been a victim of its own success, at least in developed countries. Parents no longer fear the diseases childhood vaccines protect against, which makes it easy for antivaccine activists to provide what I like to call “misinformed consent,” by spreading misinformation that vastly exaggerates the risk of vaccines compared to the benefit of vaccinating. Parents who believe the misinformation conclude, based on a warped view of the risk-benefit ratio of vaccines, that not vaccinating is safer. Add to the mix fear mongering against the MMR based on Andrew Wakefield and his dubious 1998 case series that popularized the then-recent idea that vaccines cause autism, and it’s no wonder that parents decide that not vaccinating is safer than vaccinating. If you believe the misinformation, it’s not an entirely unreasonable conclusion. Then add to that the easy availability of “personal belief exemptions” to school vaccine mandates in many states, which include anything from religious exemptions to parents just signing a form that says they are “personally opposed” to vaccination, and it isn’t a huge surprise that vaccine uptake has fallen in some areas to the point where outbreaks can occur. It was happening in California and my own state of Michigan. (more…)

Posted in: Politics and Regulation, Public Health, Vaccines

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Reviewing Andrew Wakefield’s VAXXED: Antivaccine propaganda at its most pernicious

VAXXED

I’ve finally seen it. I’ve finally seen Andrew Wakefield and Del Bigtree’s “documentary” VAXXED: From Cover-up to Catastrophe, and I didn’t even have to pay to see it! Now, having watched Wakefield and Bigtree’s “masterpiece,” I can quite confidently say that it’s every bit as accurate and balanced a picture of vaccine benefits and risks as Eric Merola’s two movies about the quack Stanislaw Burzynski and his Second Opinion: Laetrile at Sloan-Kettering are about cancer and cancer research, The Beautiful Truth is about the Gerson protocol for cancer, Simply Raw: Reversing Diabetes in 30 Days is about diet and diabetes, Expelled! No Intelligence Allowed is about evolution, and The Greater Good is about…vaccines! Of course, based on what I knew of the story, saw of the VAXXED trailer (which deceptively edited together statements by William Thompson), and have discussed about the efforts of Andrew Wakefield, Del Bigtree, and Polly Tommey to use VAXXED as a tool in a publicity campaign to try to spread fear, uncertainty, and doubt (FUD) about vaccines using the “CDC whistleblowerconspiracy theory (about which a primer can be found here), I shouldn’t have been surprised, but I was actually surprised (slightly) at the manipulative depths to which this film sinks.

On the plus side, its production values are better than those Eric Merola’s films (although I, with no experience, could probably make a film with better production values than Merola), but that just makes it somewhat more effective propaganda. In my review and discussion of the movie and its claims, I will discuss the claims made by Bigtree and Wakefield as well as the movie as a movie. Unfortunately, there is so much misinformation in this 91 minute documentary that I will only be able to hit the “high” points without going far, far beyond even a Gorski level of logorrhea in this post. Worse, there is a considerable amount of dishonest framing, in which actual facts and events are presented in a deceptive manner to tell a distorted narrative. Before that, though, let’s meet the key players.
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Posted in: Book & movie reviews, Politics and Regulation, Science and the Media, Vaccines

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How low antivaccine “warriors” will go: Of Facebook harassment reporting algorithm abuse and publicly attacking a 12 year old boy

NOTE: Anyone who has seen several derogatory articles about me on the web and is curious about what the real story is, please read this and this.
Marco Arturo

I was going to write about something else this week, but events over the last several days led me to change my mind. The first was the reaction of a pseudonymous antivaccine “warrior” going by the ‘nym Levi Quackenboss to a viral video posted by a 12-year-old boy named Marco Arturo. The second was my learning that other antivaccine “warriors” had resumed abusing the Facebook reporting algorithm to get pro-science advocates supporting vaccines banned from Facebook for periods up to 30 days and thereby silence them. I wrote about this latter tactic a couple of years ago, when the Australian antivaccine group the Australian Vaccination Network (AVN), or AVN (which was forced to rename itself the Australian Vaccination Skeptics Network in 2014), started abusing Facebook’s algorithm for reporting harassment and abuse in order to get members of the skeptic group Stop the Australian Vaccination Network (SAVN) temporary Facebook bans. It’s a tactic that has continued, with a fresh batch of temporary bans issued by Facebook in response to bogus complaints over the last few days.

I’ve frequently written about how often the preferred tactic of antivaccinationists and others pushing medical pseudoscience is not to answer criticism with evidence, science, and rational argument, but rather to respond with attacks and attempts to intimidate and silence. The reason, of course, is that they do not have any of that to support their beliefs. At some level, I suspect that many of them know it. Be that as it may, those of us who lament how few physicians and scientists, even those sympathetic to scientific skepticism, are willing to publicly speak out and call the quacks to task know that the consequences of doing so are often quite unpleasant: Online attacks, poisoning of one’s Google reputation, attempts to get one banned from Facebook, and, of course, the antivaccinationists’ favorite: Harassment through one’s job by complaining to one’s bosses. To illustrate these hazards, I’ll start with the story of Marco Arturo, before moving on to a more organized effort. (If you read my not-so-super-secret other blog, you’ll have heard of Marco’s story before, but I’ll summarize here as well.) Then I’ll update you on how Facebook continues to allow its reporting algorithms to be abused to silence pro-vaccine voices there. I’ll finish up with examples of what we at SBM have experienced and some thoughts on what can be done. (more…)

Posted in: Computers & Internet, Health Fraud, Vaccines

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Does your antivax doctor have another agenda?

A witch placing a scorpion into a potSeveral weeks back, I wrote a piece in praise of Michigan’s Fresh Air Camp’s decision to admit only properly vaccinated children. Predictably, there was a bit of a backlash from people who, despite the obvious benefits, oppose vaccinations.

I can’t fault a parent for the decisions they make for their kids. We all work from the gut when it comes to our children, and this can make us see risks incorrectly. But I cannot forgive people who should know better. Medical professionals should all support basic public health such as vaccination, just as they should support healthy eating, physical activity, and clean water. I feel strongly enough about this that I have called for pulling the licenses of doctors who oppose vaccination.

As usual when I write about vaccines, I got plenty of hate mail and disturbing blog comments – no biggie. That’s part of standing up for the truth. What really disturbed me was a local doctor, here in the same community that the camps serve, coming out publicly against the new policy. When a medical professional weighs in on a matter of public health, people listen. (more…)

Posted in: Science and Medicine, Vaccines

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Nobody licenses quacks in my state! HB 4531 and the licensing of naturopaths in Michigan

Just as nobody steps on a church in Peter Venkman's Manhattan, nobody licenses quacks in my state...I hope.

Just as no giant marshmallow man steps on a church in Peter Venkman’s Manhattan, nobody licenses quacks in my state…I hope.

Over the years, I’ve taken care of women with locally advanced breast cancer so advanced that it’s eroded through the skin, forming huge, nasty ulcers filled with stinky dead cancer tissue that’s outgrown its blood supply, leaving the patient in chronic pain. If the patient is fortunate, her cancer has not metastasized beyond her axillary lymph nodes (the lymph nodes under her arm), and her life might still be saved by a combination of chemotherapy, radical surgery, and radiation. If the patient is not fortunate, either the cancer has metastasized and she is doomed or hasn’t metastasized yet, but it’s invaded into the chest wall and the nerves in her axilla (the structures under the arm), making it impossible to remove surgically but not likely to kill her any time soon. In the latter case, chronic pain, infection, and blood loss is what the patient will look forward to until the cancer either metastasizes or invades a vital structure. Fortunately, I’ve only seen a handfull of these patients over the last 20 years. Fortunately, the number of such patients I’ve seen and taken care of has been small.

I fear that, before long, I’m going to bee seeing a lot more of them. Leave it to Jann Bellamy to wake me up to that possibility.

I’m referring, of course, to her post last week about yet another attempt by naturopaths to expand their scope of practice. Worse, this is happening in my state through Michigan House Bill 4531, which has been approved by the Michigan Committee on Health Policy and referred to the full House for consideration. Yes, of these patients I’ve seen with horrific neglected breast cancers, at least half of them had relied on naturopaths before they came to the attention of real oncologists and surgeons. The last time I wrote about naturopaths trying to expand their scope of practice in my state was in 2013 in the form of a bill that was not as broad as HB 4531, namely HB 4152. Fortunately, it went nowhere and, in contrast to HB 4531, didn’t even make it out of the Committee on Health Policy.

Although Jann has already ably discussed the bill and occasional Science-Based Medicine (SBM) contributor Peter Lipson has referred to naturopaths as fake doctors in white coats (which is true), as well as why naturopathy is unscientific and how he as a primary care internist not infrequently has to clean up the messes left when local naturopaths treat patients incompetently, this is my state, and I can’t help but chime in myself. What I will try to do is to predict what the potential consequences will be if HB 4531 passes and expands the scope of practice to be nearly as broad as that of MDs practicing primary care medicine. I will do that by looking at real world examples of naturopathic shenanigans and disasters both within our very own state, because these are the people with whom the reins of primary care will be shared if HB 4531 were to pass.
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Posted in: Homeopathy, Naturopathy, Politics and Regulation

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Legislative Alchemy: Michigan House Bill 4531 gives naturopaths a broad scope of practice

Legislative Alchemy

Legislative Alchemy

Michigan House Bill 4531, if passed, would give naturopaths one of the broadest scopes of practice in the U.S., essentially equaling that of a family practice MD or DO. The bill made it through all the necessary House committees and is now before the House for an initial vote determining whether it will proceed further in that body. If it passes there, it will move to the Senate and its committee process.

Most naturopathic licensing bills fail, even in those states where attempts are made year after year. Michigan is no exception. Both David Gorski (a Michigan resident) and I discussed the previous licensing attempts there. In the two states where naturopathic licensing or registration has succeeded in the last few years, they have been able to get only a much more limited scope of practice than the full primary care scope they desire. For example, in Colorado, there are severe limitations on naturopaths’ seeing pediatric patients. They must disclose they are not physicians, recommend to parents that their children have a relationship with a licensed pediatric practitioner, and give parents the CDC-recommended vaccination schedule. All this is to thwart their efforts to talk parents out of vaccinating their children by giving them “balanced” information that is actually full of anti-vaccination dog whistles.

In Maryland, where naturopaths are regulated by the Maryland Board of Physicians, they cannot call themselves physicians or claim to practice primary care. They must have a collaboration and consultation agreement with an MD or DO and attest to the Board that the ND will “refer patients to and consult with physicians and other health care providers.” NDs must also have patients sign a consent form stating that the ND’s practice is limited to the scope of practice allowed by law. They cannot deviate from what is termed “safe care of patients” whether or not actual injury to a patient is established.

If passed, HB 4531 would be a radical departure from that trend. This newfound success in moving the ball forward may be due to an influx of funds from Emerson Ecologics, a company that sells dietary supplements and homeopathic remedies to naturopaths for resale to their patients. The company also sells the sort of dubious diagnostic tests used by naturopaths in their practice. For example, they offer a test for “adrenal stress” (to discover, not just “adrenal fatigue,” but actual “exhaustion”) and a saliva test for hormone levels as an indicator of the need for “bio-identical hormones.” (Neither the test nor “bio-identical hormones,” which is actually a marketing, and not medical term, are recommended in evidence-based medical practice.) In March, Emerson Ecologics announced a “grant” to the Michigan Association of Naturopathic Physicians (MANP) of $10,000 to support the effort to obtain full licensure for naturopathic doctors in Michigan.
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Posted in: Legal, Naturopathy, Politics and Regulation

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Medical exemptions to vaccine mandates for sale after SB277! Get ’em before they’re gone!

NOTE: Anyone who has seen several derogatory articles about me on the web and is curious about what the real story is, please read this and this.

SB277, which eliminates nonmedical exemptions to school vaccine mandates in California, is a very good law, but it's not perfect. Unfortunately, one provision allows the issuance of medical exemptions based on the say-so of doctors using antivaccine misinformation and pseudoscience.

SB277, which eliminates nonmedical exemptions to school vaccine mandates in California, is a very good law, but it’s not perfect. Unfortunately, one provision allows the issuance of medical exemptions based on the say-so of doctors using antivaccine misinformation and pseudoscience.

I realize that it’s a cliché to say so, but some clichés are true. Time really does fly. It’s hard to believe that a year ago California—and, by proxy, the rest of the country—was in the throes of a major political war over the bill SB277. SB277, you will recall, was a bill introduced into the California Assembly in the wake of the Disneyland Measles outbreak in early 2015 that eliminated non-medical exemptions to school vaccine mandates beginning with the 2016-2017 school year. Ultimately, SB277 passed and was signed into law by Governor Jerry Brown last July. It was an uncommon victory for science and public health, and already appears to be having a positive effect on vaccine uptake in kindergarten children.

Unfortunately but not unexpectedly, to say that the proposal and passage of SB277 into law drove the antivaccine movement into even greater fits of crazy in response is to put it mildly. It became a common trope on antivaccine websites and blogs to see SB277 compared to fascism, in particular the Holocaust. Robert F. Kennedy, Jr. and “Dr. Bob” Sears explicitly compared SB277 to the Holocaust. Truly, the Godwin was strong in the antivaccine movement. One particularly offensive meme that went around at the time consisted of antivaccinationists suggesting that SB277 was a major step in the direction of requiring unvaccinated children to wear a badge or armband to identify themselves, the way that the Nazis required Jews to wear badges or armbands with a yellow Star of David on them. One, Heather Barajas, even went so far as to be photographed with her children wearing such an “unvaccinated” badge and juxtapose that photo with photos of Jews from the Third Reich wearing yellow Stars of David.
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Posted in: Homeopathy, Politics and Regulation, Public Health, Vaccines

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Vaxxed and the Tribeca Film Festival: How Robert De Niro learned the hard way about Andrew Wakefield and the antivaccine movement

Robert De Niro made a massive mistake last week.

Robert De Niro made a massive mistake last week. Fortunately, he started to make up for it.

One of the disadvantages of only doing one blog post a week here at Science-Based Medicine is that sometimes stuff happens at too fast a pace for me. If something happens on Tuesday, by the time Sunday rolls around and it’s time for me to do my weekly post, it’s often old news, too old to bother with. That’s why it’s a good thing that I have my not-so-super-secret other blog, where I can keep up with such events. On the other hand, the advantage of a once-a-week posting schedule is that there are times I can look back at a story that evolved over the last week and, instead of blogging about it in daily chunks, I can put together a post that tells the whole story and puts it in context. Something like that happened last week. The beauty of it is that I played a major role in bringing the story to public consciousness, followed the story as it evolved, and now can provide a fairly complete recounting. Or so I hope.

First, however, let’s take advantage of another good thing about waiting to blog about a story, namely getting to see the reactions of quacks to what happened. No one can do it better than everybody’s favorite all around quack, crank, and all-purpose conspiracy theorist Mike Adams, who greeted me yesterday morning with this headline: VAXXED film pulled from Robert De Niro’s Tribeca Film Festival following totalitarian censorship demands from pharma-linked vaccine pushers and media science trolls. What on earth is Adams talking about, you might wonder? In case you haven’t been following the news, here’s a link to the New York Times story on the same incident: “Robert De Niro Pulls Anti-Vaccine Documentary From Tribeca Film Festival.” Basically, the 2016 Tribeca Film Festival selected an antivaccine documentary directed by Andrew Wakefield for screening and then thought better of it after a major uproar and a whole boatload of bad press.

I’ll deal with Adams’ post a bit later because it’s so hilariously nutty but also because it is basically the propaganda line that antivaccinationists are putting on this PR debacle brought about by Andrew Wakefield and Robert De Niro. (I never thought I’d use those two names in the same sentence.) Let’s go back a week and see what I mean. (more…)

Posted in: Book & movie reviews, Science and the Media, Vaccines

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Are the recommended childhood vaccine schedules evidence-based?

The vaccine schedule: Safe and efficacious.

The vaccine schedule: Safe and efficacious.

We write about vaccines a lot here at SBM, and for a very good reason. Of all the medical interventions devised by the brains of humans, arguably vaccines have saved more lives and prevented more disability than any other medical treatment. When it comes to infectious disease, vaccination is the ultimate in preventive medicine, at least for diseases for which vaccines can be developed. We also know that when vaccination rates fall, it opens the door for diseases once controlled to come roaring back. We saw this phenomenon with the measles a year ago in the Disneyland measles outbreak. We’ve seen it around the country, with measles outbreaks occurring in areas where a lot of antivaccine and vaccine-averse parents live. Perhaps the most spectacular example occurred in the UK, where prior to Andrew Wakefield’s fraudulent case series in The Lancet that was used to link the MMR vaccine to autism, measles was under control; it came roaring back as MMR uptake plummeted in the wake of the publicity his research engendered. By 2008, ten years after Wakefield’s case series was published, measles was again endemic in the UK. Measles outbreaks flourished. Although MMR uptake is improving again in the UK, there remains a reservoir of unvaccinated children aged 10-16 who can transmit the virus.

Thanks, Andy.

Fortunately, Wakefield has been relegated to sharing the stage with crop circle chasers, New World Order conspiracy theorists, sovereign citizen cranks, and other antivaccine cranks like Sherry Tenpenny. Unfortunately, the damage that he has done lives on and has metastasized all over the developed world. Given the persistence of the antivaccine movement, which fuels concerns about vaccines in parents who are not themselves antivaccine but are predisposed to the antivaccine message because they distrust government and/or big pharma or have a world view that overvalues “naturalness,” I was quite interested in an article that appeared in The BMJ last week. Basically, it asked the question “Is the timing of recommended childhood vaccines evidence based?
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Posted in: Clinical Trials, Epidemiology, Public Health, Vaccines

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What naturopaths say to each other when they think no one’s listening, part 2

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When last I visited this topic, I started out by making a simple observation, namely by quoting John Wooden’s famous adage, “The true test of a man’s character is what he does when no one is watching.” What I was referring to was a private discussion forum for naturopaths known as Naturopathic Chat, or NatChat for short, and how a leak from the group had revealed the sort of pure quackery that naturopaths talk about when they are among themselves and think that no one else is listening. Basically, NatChat revealed just how quacky naturopaths are, based on the advice they gave each other about patients and their general discussions of what passes for “naturopathic medicine.” I found examples of naturopaths recommending intravenous peroxide, homeopathic drainage therapy, black salve (for a huge protruding breast cancer), and even ozone to treat a postsurgical J-pouch abscess that clearly required the attention of a colorectal surgeon. After naturopaths on NatChat became widely aware that someone on the list had revealed discussions on the list, apparently the moderators, instead of moving to another platform, stayed on Yahoo! Groups.

None of what I’ve described in this brief recap of my first post about NatChat should be surprising to regular readers of this blog, who would also know that we are not particularly fond of naturopaths, even the nice ones, who might be perfectly fine as people. Of course, it is naturopathy we don’t like, mainly because it is, as I like to describe it, a cornucopia of quackery based on prescientific vitalism mixed with a Chinese restaurant menu “one from column A, two from column B” approach to picking quackery and pseudoscience to apply to patients. Indeed, whenever the topic of naturopathy comes up, I like to refer readers to Scott Gavura’s excellent recurring series “Naturopathy vs. Science,” which has included editions such as the Facts Edition, Prenatal Vitamins, Vaccination Edition, Allergy Edition, Diabetes Edition, Autism Edition, Fake Diseases, and, of course, the Infertility Edition. We’ve also described just what happens when a naturopath tries to treat a real disease like whooping cough. The results are, to put it very mildly, not pretty.

Of course, as I’ve pointed out, any “discipline” that counts homeopathy as an integral part of it, as naturopathy does to the point of requiring many hours of homeopathy instruction in naturopathy school and including it as part of its licensing examination, cannot ever be considered to be science-based, and this blog is, after all, Science-based Medicine. Not surprisingly, we oppose any licensing or expansion of the scope of practice of naturopaths, because, as we’ve explained time and time again, naturopathy is pseudoscience and quackery.

Interestingly, what led the Reddit user and naturopathy critic NaturoWhat (who inspired my earlier post regarding NatChat) to give me the heads up as to what’s going on in NatChat again is an incident on the discussion board involving a naturopath who featured in the previous edition of my coverage of NatChat, Eric Yarnell. He’s a naturopath who tried to point out to his fellow naturopaths how black salve is a really nasty treatment because of the way it fries normal tissue just as badly as it fries abnormal tissue. He also appears to be one of those rarest of beasts, a seemingly pro-vaccine naturopath. I say “seemingly,” because whenever I encounter a naturopath billing herself as pro-vaccine (e.g., Erika Krumbeck), a closer examination of his or her views almost always reveals he or she believes in at least some antivaccine misinformation. Surprisingly, Yarnell is the naturopath who comes closest to actually being pro-vaccine that I’ve seen.
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Posted in: Naturopathy, Vaccines

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