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Antivaccine nonsense Autism Medicine

Vaccine injury and compensation

The comment thread for my post last week about how philosophical vaccine exemptions in California are endangering herd immunity is rapidly approaching 500 comments as I write this and may well surpass that number by the time this post “goes live” in the morning. I mention this because buried in the comment thread are a number of comments by our old “friend,” that anti-vaccine-sympathetic pediatrician to the stars, Dr. Jay Gordon doing what Dr. Jay does best and basically making a fool of himself on matters of vaccine science through his preference for anecdote over sound epidemiology and clinical trials, his utter insistence that his 30 years of clinical experience trump the aforementioned sound epidemiology and clinical trials (hint to Dr. Jay: they don’t), and going about his usual job of insisting that vaccines cause autism and that, despite his extreme distrust of vaccines, his advocacy of not vaccinating for some common childhood diseases because he imagines the vaccines to be more dangerous than th disease, and his consorting with leaders of the anti-vaccine movement like Jenny McCarthy, he really and truly is “not anti-vaccine.”

His denials fool no one, least of all me.

The reason I bring up Dr. Jay is because, round about comment #389 in the seemingly endless thread, Dr. Jay wrote:

Just tweeted: AND today’s brand new judicial decision must not be exaggerated to the detriment of calm discussion either: http://bit.ly/9kZFhm

Correlation does not prove causation even if I agree with this individual MMR decision. I just think that side-effect-denialists need to calm down, too.

I’ll give Dr. Jay credit for “talking the talk” when it comes to giving lip service to the mantra of “correlation does not necessarily equal causation,” but unfortunately he never seems to be able to “walk the walk” and stop asserting baldly that “vaccines cause autism” or likening vaccine manufacturers to tobacco companies. Leaving aside for the moment my intense desire, barely held in check, to mock Dr. Jay for his transparent and laughably inappropriate attempt to hijack the term “denialist” for the side of pseudoscience, an attempt so hilariously inapt that I really did laugh when I read it, it turns out that over the last couple of days Dr. Jay is not alone in seemingly wanting to rub my nose in this particular decision, which was reported in the U.K.’s The Daily Mail over the weekend. Basically, it is the story of a young man named Robert Fletcher in the U.K. who is severely disabled and has been awarded £90,000 in compensation by the governement’s Vaccine Damage Payment Unit for having been injured by the MMR vaccine back in the early 1990s.

Before I discuss the case in more detail, I’m going to say something that may surprise some who read here. I don’t have much a problem with this ruling. Not really. In fact, the main problem I have with this ruling is not that it was made, but rather that it took so damned long to make it and the payout was paltry. You see, Dr. Jay is laying down what I like to refer to as a steamy, drippy turd of an argument when he claims that there is a such thing as a “vaccine injury denialist.” None of us who make it our business to refute the pseudoscience claiming that vaccines cause autism deny that vaccines can on occasion cause actual injury. Rather, what we argue, based on good science and strong clinical trials data, is that such injuries are rare and that they do not include among them autism, asthma, and the veritable panoply of various conditions that anti-vaccine zealots claim to be due to “vaccine injury.”

Not that science has any persuasive effect on anti-vaccine zealots and their fellow travellers (like Dr. Jay), who would have you believe that being vaccinated is extremely dangerous and that it causes all sorts of problems, the worst of which is autism. As I’ve discussed on this blog hundreds of times over the last five years, sometimes in utterly nauseating (to some) detail, neither vaccines nor their various components, have been linked to autism. They just haven’t, and it’s not as though a link hasn’t been sought by real scientists and physicians in multiple large epidemiological studies over the last dozen years. Researchers have looked for such a link and haven’t found it. More than a decade later, there is still no credible scientific or clinical evidence (and Wakefield’s or Hewitson’s execrable “science” doesn’t count) that vaccines cause or are correlated with autism and a lot of credible evidence that they are not, Dr. Jay’s confident pontifications notwithstanding.

However, there can be (and are) vaccine reactions. No one is denying that. And because vaccination is in essence a social pact, in which by vaccinating we all take an infinitesimally small risk for a very large benefit, when a child suffers an adverse reaction there should be compensation. Indeed, that’s just what we have here in the U.S. with the Vaccine Court, which I’ve written about many times before. As I’ve pointed out (for example, here), because of rising litigation that jeopardized the vaccine program and threatened to drive pharmaceutical companies out of the vaccine business, Congress passed the National Childhood Vaccine Injury Act of 1986 (Public Law 99-660), which created the National Vaccine Injury Compensation Program (VICP). The idea was to create an alternative to the tort system through which people injured by vaccines could be quickly compensated through what is in essence a no-fault system. True, litigants claiming vaccine injury, if denied compensation by the Vaccine Court, can still sue in conventional courts, but all claims for compensation for vaccine injury in the U.S. must first go through the VICP and the Vaccine Court. In addition, the standards of evidence in the Vaccine Court of the VICP are arguably lower than what would be required to obtain compensation through conventional federal courts. For example, in the Vaccine Court the Daubert rules for the admission of scientific testimony from expert witnesses do not apply. Virtually all scientific testimony is allowed, which is, by the way, how such awful testimony was allowed in the Autism Omnibus test cases on behalf of the complainants.

Further streamlining of the system occurred in 2005, when the United States Court of Appeals for the Federal Circuit ruled that an award should be granted if a petitioner either establishes that a “Table Injury” of injuries that are generally accepted as potentially being caused by vaccines) occurred or proves “causation in fact” by proving the following three prongs:

  • a medical hypothesis causally connecting the vaccination and the injury;
  • a logical sequence of cause and effect showing that the vaccination was the reason for the injury; and
  • a showing of a proximate temporal relationship between vaccination and injury.

Compensation is virtually automatic for so-called “table injuries” (i.e., known injuries that science attributed to vaccines listed on the Vaccine Injury Table) within the correct time frame. Also, compensation can be awarded if plaintiffs can meet a standard of evidence showing a 51% or greater chance that the plaintiff was injured by the vaccine in question. Indeed, as one lawyer who represents cases in front of the vaccine court put it:

“There is a difference between scientific proof and legal proof,” Conway said. “One is 95 percent certainty, and the other is . . . 50 percent and a feather.”

In other words, the award of compensation does not mean that a scientific link was found, only that a court of law thinks it more likely than not that a specific set of health problems is due to vaccine injury, no more, no less. A legal finding of causation does not necessarily imply a scientific finding of causation, no matter how much anti-vaccine activists trumpet rulings compensating children for vaccine injury as vindication of their pseudoscientific views that vaccines cause autism. Indeed, this ruling doesn’t even “prove” that MMR can cause brain damage, a contentious scientific question whose answer is not at all clear.

Finally, the VICP will reimburse plaintiffs for legal fees and court costs even if they lose in Vaccine Court. Indeed, certain unscrupulous lawyers (cough, cough, Clifford Shoemaker) have taken advantage of this feature of the Vaccine Court and racked up some very impressive billings representing complainants in front of the Vaccine Court. In other words, here in the U.S. at least, as little as the anti-vaccine movement believes it and would prefer to believe a conspiracy theorist view in which they are the downtrodden speakers of truth to power beaten down by The Man, the entire system bends over backwards to give complainants the benefit of the doubt. That the complainants for the test cases for the Autism Omnibus could not prevail, even in the relatively friendly venue of the Vaccine Court, should be evidence enough of just how weak their cases were, particularly given that the test cases were presumably the strongest cases the Omnibus lawyers could come up with. That point was driven home recently when the appeal for the first test case, that of a child named Michelle Cedillo, to the Federal Circuit Court, was denied, a ruling that was not unexpected and in which I take no pleasure but that was completely appropriate.

Now back to Robert Fletcher’s unfortunate case. As his mother told The Daily Mail:

Robert is nearly 19 but mentally he is like a 14-month-old toddler. He can’t stand unaided and he is doubly incontinent.

‘He can’t speak except to say “Hi, Mum” or “Hi, Daddy”.

‘We chop up his food and have to anticipate all his needs. He is prone to various illnesses and last week suffered around 40 severe epileptic seizures.

‘In April this year, we thought we’d lost him. He contracted a chest infection and had to go to hospital for several days.

‘He is such a lovely boy. When he’s not ill, he’s so cheerful and seems to take everything on the chin. In between seizures he says “Hi, Mum” and tries to kiss me.

My heart goes out to the Fletchers; it must be incredibly trying to have to deal with such a set of disabilities day in and day out. Moreover, I have no problem with the government finding legal causation. It’s almost irrelevant if on a strictly scientific basis the MMR vaccine caused Robert’s condition. There’s enough of an appearance that it did that, on a legal grounds and a societal basis, he should be given the benefit of the doubt and compensated. In fact, I agree with Mike Stanton that compensation took far too long and that the amount awarded was far too little. Mike makes a rather fascinating comparison between the U.K.’s vaccine compensation system and that of the U.S. The results are not favorable to the U.K.:

Again, the contrast with the USA could not be greater. Statistics about vaccine claims, verdicts and compensation paid are readily available on government websites. The UK government admitted to paying £3.5 million in compensation over the previous 8 years in 2005. The USA has paid out nearly $2 billion to 2,472 claimants over the past 21 years. They meet the legal costs of all claims whether upheld or not. The American Way seems to be to admit that vaccine injuries are a rare but unfortunate occurrence and to make the no fault compensation programme as transparent and user friendly as possible. By contrast the UK government is secretive, mean spirited and places obstacles in the path of potential claimants in a misguided attempt to bolster the vaccination programme. But insisting that vaccines are safe rather than being honest about the risks and benefits has not led to greater vaccine take up. On the contrary, whenever the government dismisses people’s fears instead of taking them seriously its “we know best” attitude merely reinforces people’s doubts.

Of course, the cost of the American system is widespread abuse by certain lawyers, who know they’ll be paid, win or lose. To me that is an acceptable price to pay to make the compensation system fair and relatively fast. True, some lawyers are not satistified because they can’t ever expect the truly large “lottery jackpot”-sort of pay-off from a Vaccine Court ruling. That’s the reason why some of them are arguing that the pre-emption of regular courts in vaccine cases by the Vaccine Court is unconstitutional.

Mike also makes a rather provocative observation that, had Jackie Fletcher been compensated in a timely fashion back in the 1990s, perhaps Andrew Wakefield would not have found such fertile ground for his anti-vaccine pseudoscience. Remember, Jackie Fletcher is the woman who formed JABS, which is in essence the British version of the NVIC or Generation Rescue. Whether this is true or not is, of course, impossible to say. Alternate history scenarios are fun to argue but impossible to prove one way or the other. It does, however, appear undeniable to me that the British system is neither fair nor transparent, and that can’t help but decrease confidence in the vaccination system, regardless of how safe vaccines are. After all, only 100% safety, which is unachievable for any intervention, would guarantee that there will not be the occasional child who suffers an injury due to vaccination. Like both Mike Stanton and Kev Leitch, I believe that such children deserve prompt, fair compensation.

Predictably, the anti-vaccine movement is crowing over this ruling, citing it as vindication. The anti-vaccine crank propaganda blog Age of Autism, for instance, has two stories up already, one entitled UK Vaccine Injury Win: MMR Caused Brain Damage and Vaccine Injury: The Fletchers and Cedillos – a Tale of Two Families. In one of these posts, Teresa Conrick struggles mightily to try to argue that, really and truly, the Fletcher decision means that vaccines cause autism after all:

Jacki and John Fletcher are warrior parents who have persevered in their care and legal case for Robert, now 18 years old. Jackie, in a recent email to Anne Dachel, here at Age of Autism, revealed that Robert suffers from a severe seizure disorder, with an inflamed oesophagus, brain damage and has some minor autistic traits. The award stressed epilepsy as the result of his injury. That is great news but for the thousands still waiting with children and teens also injured by the MMR, the lack of the word, “autism”, is baffling. Welcome UK parents, to our world, too. Here in the states, we also have heard those words, “but not autism.”

Whether it is severe autism or minor autism, isn’t “autism” a set of behaviors?

Uh, no. Nice try, though.

Of course, Autism is more than just a “set of behaviors,” but even if autism were nothing more than a set of behaviors I would retort that, for example, ADHD is a “set of behaviors” too, but that does not mean ADHD is the same thing as autism. Ditto any number of neurodevelopmental disorders. Claiming that the rare neurologic injuries that can be caused by vaccines are “the same thing” as autism based on such an argument is specious reasoning at best, disingenuous at worst. Still, such posts are revealing. Age of Autism claims that it is all about “autism advocacy,” but in the end its merry band of propagandists are all about the vaccines, and so are its readers. They are anti-vaccine to the core. To them, autism is “vaccine injury,” and that’s it. No amount of science will convince them otherwise.

Injuries and complications that can be scientifically shown to be due to vaccines deserve compensation that is prompt, fair, and not onerous to obtain, even at the cost of letting sleazy lawyers take advantage of the system. Meanwhile, scientists should (and, the pharma conspiracy mongering of the anti-vaccine movement notwithstanding, do) work to make vaccines as safe as possible, so that such injuries are as rare as possible. Unfortunately, there will likely never be such a thing as a vaccine that is 100% absolutely safe; all that can be reasonably requested are vaccines whose benefits and safety far exceed a tiny risk of complications and a system that compensates those injuries. Although the ethical issue of how much risk is acceptable and what frequency of vaccine injuries are tolerable in the vaccination program is complex and difficult, we should not lose site of the fact that vaccines do far more than good.

By Orac

Orac is the nom de blog of a humble surgeon/scientist who has an ego just big enough to delude himself that someone, somewhere might actually give a rodent's posterior about his copious verbal meanderings, but just barely small enough to admit to himself that few probably will. That surgeon is otherwise known as David Gorski.

That this particular surgeon has chosen his nom de blog based on a rather cranky and arrogant computer shaped like a clear box of blinking lights that he originally encountered when he became a fan of a 35 year old British SF television show whose special effects were renowned for their BBC/Doctor Who-style low budget look, but whose stories nonetheless resulted in some of the best, most innovative science fiction ever televised, should tell you nearly all that you need to know about Orac. (That, and the length of the preceding sentence.)

DISCLAIMER:: The various written meanderings here are the opinions of Orac and Orac alone, written on his own time. They should never be construed as representing the opinions of any other person or entity, especially Orac's cancer center, department of surgery, medical school, or university. Also note that Orac is nonpartisan; he is more than willing to criticize the statements of anyone, regardless of of political leanings, if that anyone advocates pseudoscience or quackery. Finally, medical commentary is not to be construed in any way as medical advice.

To contact Orac: [email protected]

325 replies on “Vaccine injury and compensation”

I find it very telling that the UK Vaccine Court stressed that Robert has epilepsy and moderate mental retardation but his mother and AOA just HAVE to say he is autistic. After all, unless they can link the MMR to autism, where would they be?

I’m glad the Fletchers were compensated for what appears to be a possible vaccine injury from the information I have read. It shows the systems for compensation do work.

On the other hand, I also feel sorry for the Cedillos. They can’t face the truth, that vaccines did not cause Michelle’s problems even to the extent that the UK court recognized the possible connection between Robert’s MMR and start of seizures.

First off, I have to second your condolences to the Fletchers and say that it’s about time they received compensation.

Your explanation on how the compensation program works was very well-written and hopefully will clear up some of the misunderstanding that people have about it.

Leaving aside the moment my intense desire, barely held in check, to mock Dr. Jay for his transparent and laughably inappropriate attempt to appropriate the term “denialist” for the side of pseudoscience

Indeed. I’m still trying to get Dr. Jay’s definition of a “vaccine side effect denialist” and some concrete examples of such behavior, since he claimed that it occurs here at RI. Since he probably won’t bother to comment in the other thread, instead focusing his attention here, I’ll copy my questions for him, including a couple regarding his claim that he only vaccinates for HiB individuals that are at “highest risk”.

So, Dr. Jay:

* What is your definition of a “vaccine side effect denialist” (VSED)?
* You say that VSEDs exist here at RI. Please provide a concrete example of VSED behavior.
* What is your definition of “those at highest risk”?
* Am I correct that your recommendation is that except for people who meet that definition, everyone else should not bother with the vaccine?

Brilliant post.

It is a sad fact that anti-vax is simply a faith position, supported by parents and some doctors alike, and the evidence will never change that.

The target of blame has constantly shifted during its course of existence, from the vaccine itself to the ingredients in the vehicles, to the schedule and ‘overload’, I don’t know what the next ’cause’ will be. But there will be a new one, as the others are ticked off as officially not statistically harmful.

A few people come up with the ‘theories’, they spread to receptive minds and are regurgitated and propagated.

It’s just another meme that won’t end and is sadly causing a lot of real damage to innocent people. I cannot believe the amount of ‘measles is harmless’ talk I’ve observed lately, it’s truly shocking.

One thing that I just cannot comprehend is why people like Barbara Loe Fisher (who helped establish the compensation program in the U.S.) want to get rid of the compensation program and vaccine court. They actually want to make it more difficult for families to win claims and receive compensation, thanks to the higher standards of evidence required in the tort system!

Ah. A thought just occurred to me. It’s not that they want to make it harder; that’s just an unfortunate side effect. They want to be able to go directly after the vaccine manufacturers. The stupid thing is that families can still do this! Yes, they need to go through the VICP first, but they can choose to reject the ruling and try their luck in the tort system.

So I’m still at a loss as to what the hell BLF and those like her hope to accomplish by dismantling the VICP.

@Todd

I’m still at a loss as to what the hell BLF and those like her hope to accomplish

Notoriety? The idea that they are doing something? If the likes of BLF and AoA were to accept the status quo, their funding would dry up pretty quick.

I wonder if the thinking is that the potential payout for bringing down a vaccine manufacturer is far greater than what you can reasonably expect to get from the VICP. And the publicity of a jury trial (even one where you lose) is catnip to the AoA and NVIC folks and would keep them flush with donations for years to come.

But for the parents of kids who could reasonably be compensated via the government program, they are far, far better served to stay in the VICP.

So I’m still at a loss as to what the hell BLF and those like her hope to accomplish by dismantling the VICP.

I’m picturing Batman interrogating the Joker (played by Barb Loe Fischer), asking, “What do you want, Joker?”
Yes, what does BLF want? Has she said exactly what she wants, beside the anti-vaccine talking points?

I’m still trying to get Dr. Jay’s definition of a “vaccine side effect denialist”

Mike (and Orac)

Don’t play this game. We all know damn well what Elmer Jay Fudd (“I own a mansion and a yacht”} means when he says “vaccine side effect denialist.” He’s not talking about the extensive list of vaccine side effects that are known for vaccines, that are provided by the manufacturer and given to parents or whoever when vaccines are given, along with how often they are found to occur and what to do about them when they occur.

No, he is talking about autism, and his insistence that, despite all the scientific evidence to the contrary, one of the side effects of vaccines is autism, which he knows, because, damn it, he’s seen it. And anyone who disagrees with him must be in denial, because he knows, and who is anyone to doubt his wonderful analytical skills?

We all know that’s what he means, so stop playing with him. Apparently, he spends so much time around kids that he is acting like them. Next week he’ll be calling Orac “Fatty Fatty Two-by-Four” and Todd will be “4-Eyed Brainiac,” although he will probably dismiss this comment with “I know you are but what am I?”

his utter insistence that his 30 years of clinical experience trump the aforementioned sound epidemiology and clinical trials (hint to Dr. Jay: they don’t)

That’s not even the half of it. He also insists that HIS clinical experience trumps the collective clinical experience of all the other pediatricians in the US.

Truly, he seems to consider himself perfect and utterly infallible.

One caveat to the “paltry pay-out”, the UK has free health care, so the large chunk of “future medical expenses” that are awarded in the US does not apply.

@Pablo

I realize that he probably means denying autism as a side effect, but I want him to provide his definition so that we have something for posterity.

Oh, and those interested in BLF’s take on the VICP, here’s her statement to the Advisory Commission on Childhood Vaccines from 2008.

So by the anti-vax groups metric, all awards for vaccine injury PROVE that vaccines cause autism and denials of claims are vast government conspiracies. Got it.

So I’m still at a loss as to what the hell BLF and those like her hope to accomplish by dismantling the VICP.

@ Todd, let’s think about why the NVICP was instituted to begin with, with the insistence of BLF, no less. BLF wanted easier compensation for those injured or, at least, presumed to be injured by vaccines (fair enough) and the government could not afford to let Pharma get sued out of the vaccine business.

I get the distinct impression that claimants, particularly those involved with the OAP, expected to walk in, offer some testimony and collect their checks. That didn’t happen and now BLF is calling for the NVICP’s head on a chopping block. If that were to happen, manufacturers would be faced with mountains of lawsuits and driven away from the vaccine biz; just what BLF and her band of merry fools would like to see. Even if it would come at the expense of vaccine-injured people. I doubt it is anything more than vindictiveness and certainly myopic on the part of the anti-vaxxers.

So I’m still at a loss as to what the hell BLF and those like her hope to accomplish by dismantling the VICP.

My suspicion is that they want to put all vaccine manufacturers out of business permanently. They can’t get damages big enough to do that via the VICP.

his utter insistence that his 30 years of clinical experience trump the aforementioned sound epidemiology and clinical trials (hint to Dr. Jay: they don’t)

Jay’s assumption that he is so much smarter than the Scientific Consensus is exactly like the climate change denialists. He is of course oblivious to the irony of calling us denialists.

[Science Momma: I get the distinct impression that claimants, particularly those involved with the OAP, expected to walk in, offer some testimony and collect their checks.That didn’t happen and now BLF is calling for the NVICP’s head on a chopping block.]

Respectful insolence is a place where you get to check your critical thinking skills at the door and use whatever emotional logic you wish. While at the same time selectively championing critical thinking and science. It’s hypocritical of the self proclaimed defenders of logic and science. But I understand how easy it is to rationalize why you do it.

It’s tough to stick to just logic, evidence, and science isn’t it, momma?

I find it very sad that they are taking this young man and using him as a tool. Even most of us with autistic children cannot even begin to imagine how difficult life must be for his parents. We deal with plenty, but my heart goes out to this family and their struggles.

That having been said: These people (anti-vaxers) are bottom-feeding slugs of the worst kind! They will minimize the real problems this family deals with to further their agenda. He doesn’t have autism, he has very real problems which likely have been caused by vaccines and his parents have been compensated (not nearly enough IMHO (and dear lord, why did it have to take so long?)). This proves that vaccines can cause serious injury; it doesn’t prove that vaccines cause every problem the anti-vaxers imagine they do.

This case has proved that: 1.) vaccines have risks of serious adverse effects (no surprise to anyone here) and 2.) that parents who’s child has been so injured should be compensated quickly and with as little mental anguish as possible.

Robert’s parents obviously love him very much and I wish them well as they continue to care for his many needs.

Poor Augie, trying to school me on critical thinking skills, particularly when you run screaming like a little girl from information you’re too dim to even attempt to refute. From BLF’s statement that Todd linked to:

We were assured that, unlike a lawsuit in civil court, the federal compensation system would be based on the presumption that a vaccine or combination of vaccines caused the child’s injury or death if no other demonstrated cause could be found. The emphasis was on presumption and there was recognition that this presumption, in the absence of scientific data and certainty, would be in the plaintiff’s favor even if that presumption would result in some children being compensated who were not, in fact, vaccine injured.

The emphasis on presumption was integral to the integrity of a no-fault, expedited vaccine injury compensation system. There continues to be a lack of scientific understanding of the specific biological mechanisms involved in most vaccine-associated injuries and deaths and an absence of pathological profiles to conclusively prove which health problems following vaccination are, in fact, vaccine-induced and which are not. These gaps in scientific knowledge and uncertainty means that a no-fault vaccine injury compensation system must err on the side of presumption of causation rather than proof of causation to offer a viable administrative alternative to a lawsuit.

And both Justice and U.S. Court of Claims officials can refrain from trying to discredit and destroy the reputations of plaintiff’s expert witnesses in what is perceived by parents as an attempt to frighten and discourage doctors from testifying on behalf of vaccine injured children.

And from AoA’s post:

Her lawyers advanced scientific and legal arguments that the combination of her mercury-containing and live virus vaccines substantially contributed to her life-threatening medical conditions. In EBCALA’s view, Cedillo met the required standard of “more likely than not.”

EBCALA has grave concerns regarding a legal process that permitted the admission of critical evidence by the government at the last minute, not only foreclosing Cedillo’s opportunity to challenge it, but unfairly precluding any inquiry into how the Department of Justice obtained the critical piece of evidence in the first place. The court’s failure to inquire into this area raises serious questions regarding the due process and fair play of the VICP. Adding to EBCALA’s concern was the Special Master’s insufficient analysis of Cedillo’s scientific biopsy results. A recent study by leading United States researchers – that the Court of Federal Claims elected not to admit – found no basis to question the reliability of the laboratory results, contrary to the government’s position and the OAP’s finding.

And this is utter bullshit as evidenced by their amicus brief and subsequent decision by the Federal Circuit court. So what part of “I get the distinct impression”, do you have difficulty with little augie? Are you aware that ‘distinct impressions’ can be qualified with what I posted above or do you believe that they are to be qualified with double-blind RCTs?

We can also add misogynistic arsehole to your battery of bigotry fuckwit.

just a note on the judgement here- although I don’t begrudge jackie fletcher her money, this was not a cut and dried case. there were three members of the panel that voted on this, one barrister, and two physicians, one retired for several years. the physician who is still working voted against the award. all three agreed that this certainly was not autism.

It is also worth reminding ourselves that even if the vaccine had caused a spike in body temperature that caused a febrile convulsion that triggered the epilepsy and neurological damage, the risk of febrile convulsion is far greater with measles than with a vaccine side effect. It is still more dangerous to not vaccinate, even if you might be predisposed to this type of fit.

[Science Momma: We can also add misogynistic arsehole to your battery of bigotry fuckwit.]

In your personal opinion, how many kids died from measles before the vaccine?

I am not sure why you all spend so much time engaging Dr. Jay Gordon. His opinions are so far afield … as to be considered embarassing by his peers, the AAP and even residents who train at his hospital.

In my opinion his practice is a money grab at those parents who fear vaccination and are looking for someone with the titles of authority to tell them “It’s OK. Your fears are well founded”. I am well aware that making a lot of money does not invalidate someone’s point of view, but I do wonder how much Dr. Jay is raking in. This seems a valid point, since the anti-vaccine community makes such a BIG point of Dr. Paul Offit’s profiting off the rotovirus vaccine.

Symball “this was not a cut and dried case. there were three members of the panel that voted on this, one barrister, and two physicians, one retired for several years. the physician who is still working voted against the award. all three agreed that this certainly was not autism.”

It’s even less cut and dried than that, one of the 3 members of the panel, pediatrician Professor Sundara Lingam, disagreed with the conclusion reached by the other two and is quoted by the Daily Fail as saying that he believed Robert was ‘genetically predisposed to epilepsy and that the vaccination triggered it rather than caused it.’ and that ‘Robert would have developed epilepsy in any event, even if he had not had the vaccination’.

http://www.dailymail.co.uk/news/article-1307095/Family-win-18-year-fight-MMR-damage-son–90-000-payout-concerns-vaccine-surfaced.html

So it’s clear that the evidence for causality was very weak, though it probably would have been enough to qualify for compensation under the 50% and a feather requirements of the US vaccine court.

Orac is right that this should have been settled years ago, now it will just be used as propaganda by the anti-vaxers wo know that a lot of people have only a vague grasp of the science involved.

A bad day for public health!

I am not sure why you all spend so much time engaging Dr. Jay Gordon.

I would qualify that: I’m not sure why they all spend so much time engaging Jay Gordon _seriously_.

I engage him with all the seriousness that he deserves, meaning like a piece of rat turd that shouldn’t be taken seriously at all.

I like to engage the Blue Jay with snide cracks and childish insults, because, ultimately, despite the grandstanding language he uses, that is the same level of discourse that he uses. He has nothing useful to contribute.

Some people still treat him like he is well-meaning and acting in good faith. I abandoned any such pretense long ago. I consider the guy to be comedic relief more than anything else. Relevant? Not in terms of any serious discussion, no.

I agree that a decision regarding compensation in the Fletcher case should have been handed down far, far more quickly.

It’s not clear from Orac’s presentation or the Daily Mail article on just what basis it was decided that the MMR shot triggered the seizure disorder. The Daily Mail story states that the child’s first seizure occurred ten days after the vaccination and that this was considered a solid temporal link. Was there a marked febrile response to the shot? Was there still significant fever at the time the first seizure occurred?

On the larger issue of the link between fever and febrile seizures in children (and the small risk that the occurrence of “complex” febrile seizure will predispose the child to a chronic seizure disorder), are antivaxers convinced that a potential fever spike due to a vaccine is a horrible risk that should not be tolerated, but “natural” fever spikes due to disease are benevolent?

Well that was just depressing. One of the worst parts about being a parent is that now these types of stories, instead of just being vaguely sad but easy to shrug off as a fact of life, now they scare the shit out of me. heh….

One of the most pro-vaccine people I know has it written on her medical records in big red ink that she is never to be given a pertussis vaccine, because she had a pretty severe reaction to the DTAP (or whatever combo vaccine they gave in the early 80s) as a child. Bad fever, I can’t recall what all else. Obviously she recovered, but it was severe enough to result in the explicit warning in her records.

These things happen. And for those who truly understand the risks and benefits in play, the fact that these things happen ought to make people even angrier towards those who forgo vaccination for ideological or fear-based reasons — my friend is now dependent on everybody else to get the pertussis vaccine, since she cannot safely get immunized against it!

Re: Paul Browne and Dangerous Bacon’s comments… yeah, to be honest I was hoping to see a bit more discussion of the science involved in the case. For one thing, it’s just interesting on its own. For another, engaging the abstract reasoning part of my brain distracts from how freaking depressing the reality of the Fletcher’s situation is.

So it sounds like he probably would have manifested the epileptic symptoms whenever he eventually got a reasonably high fever? Is that what we are looking at?

jay.sweet: If she got a pertussis vaccine in the early 80s, it would have been the DTP with whole-cell pertussis. That vaccine is no longer used, and the DTaP (acellular pertussis) has a much better safety record (IIRC, about half the total payouts the NVICP has issued were for injuries associated with the whole-cell pertussis vaccine).

jay.sweet”So it sounds like he probably would have manifested the epileptic symptoms whenever he eventually got a reasonably high fever? Is that what we are looking at?”

That’s the most likely explanation, there have been cases like this before, for example the Hannah Poling case a couple of years ago that Orac discussed at length http://respectfulinsolence.com/2008/03/the_hannah_poling_case_and_the_rebrandin.php

It’s worth noting that since the Hannah Poling case the vaccine court found in the three Autism Omnibus test cases that vaccines did not cause autism.

http://www.theness.com/neurologicablog/?p=478
http://respectfulinsolence.com/2009/02/will_2009_be_a_very_bad_year_for_antivac.php

Re the science behind the Fletcher case – there is no formal report published about the tribunal’s findings. The 2 doctors disagreed about the issue of causality. The one who thought vaccine caused the damage seems to be a retired Peadiatric urology surgeon. Hardly confidence-inspiring.

@Dangerousbacon #25:
The critical time post MMR vaccination for vaccine-induced convulsions is actually around the 10 day mark, so this would fit with the boy’s case.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC320893/

The point that measles would lead to (in a susceptible child) a far likelier outcome of febrile seizures and possible neurological damage that with just vaccine alone is very apposite.

[science momma:So what part of “I get the distinct impression”, do you have difficulty with little augie? Are you aware that ‘distinct impressions’ can be qualified with what I posted above or do you believe that they are to be qualified with double-blind RCTs?]

“I get the distinct impression” is your disclaimer for “here comes conclusions based in logical error and bias.

Thanks, dt. That’s useful information. And to quote from the linked commentary:

“The serious effects of the illness against which these vaccines protect are well documented and measurable. Encephalitis and resulting encephalopathies from many of the diseases themselves are prevented in as many children (perhaps more) as incur febrile seizures (a relatively benign outcome in the long run) following vaccination. Immunization for pertussis was terminated in Sweden in 1979. Over a 2-year period, over 2000 children were hospitalized with pertussis. Four percent suffered neurologic complications, and three died 4. A serious acute encephalitis caused by measles can occur in approximately 1 out of 1000 cases, and subacute sclerosing panencephalitis, a typically fatal complication of measles, occurs in approximately 1 in 1,000,000 cases. Such occurrences appear to be prevented through vaccination. “

It is rather amazing how rapidly and well Jake demonstrates my points for me. I almost wonder if I should thank him.

In any case, with school starting up again, for his sake I sincerely hope that he doesn’t use the same sorts of research skills to write his term papers as he does to write his AoA screeds.

Fans of Dr Jay might want to ask him why he has declined to meet the Maintenance of Certificate requirements of the American Board or Pediatrics. The ABP recommends that Pediatricians certified before 1988, although granted lifetime certification, periodically demonstrate their competence. Dr Jay has not seen fit to do this. He relies on his original certification from 1981. His expertise, if any, is thirty years out of date.

https://www.abp.org/MOCVerification/jsp/Search.faces

I’m glad the Fletchers were compensated for what appears to be a possible vaccine injury from the information I have read. It shows the systems for compensation do work.
—————————–
90K pounds – 135K USA dollars is hardly compensation

Several months ago, I would have said ‘I get the distinct impression that augustine is an idiot’.

After several months of reading his tripe, I can safely conclude based on the available evidence that he is a **Anglo-Saxon epithet** idiot.

Sid – I would tend to agree, but perhaps standards and conditions are different in the UK than in the USA.

Mephistopheles & Sid,
There is also the universal healthcare available in the UK. As was mentioned earlier, this provides a much higher base onto which the 90k is applied.

MikeMa – that, indeed, was one of those conditions I was thinking of. Thanks.

“are antivaxers convinced that a potential fever spike due to a vaccine is a horrible risk that should not be tolerated, but “natural” fever spikes due to disease are benevolent?”

A lot of anti-vaxers don’t believe that they will ever contract the disease. And even if by some “luck” they do happen to catch it, they believe that their immune systems are superior and will fight it off no problem.

Of course, I once had an anti-vaxer tell me that the fevers associated with vaccines are caused by “chemicals processing through the brain.” (I’m assuming she meant chemicals added to vaccines… you know, the dreaded toxins? I never got clarification on that) So I guess in her eyes, fevers from vaccines are way different and more evil/damaging than fevers from disease.

“I get the distinct impression” is your disclaimer for “here comes conclusions based in logical error and bias.

Impression =/= conclusion. Gah you’re an idiot augie. And that is a foregone, well-qualified conclusion, courtesy of your own tripe.

@ Composer, well said.

[enkidu: A lot of anti-vaxers don’t believe that they will ever contract the disease. And even if by some “luck” they do happen to catch it, they believe that their immune systems are superior and will fight it off no problem.]

I’m not an anti-vaxxer but when you say “superior” what do you mean? Superior to what?

[So I guess in her eyes, fevers from vaccines are way different and more evil/damaging than fevers from disease.]

child gets vaccinated. child goes into convulsions. Pro forced vaccine propagandist masquerading as science defender: “Good thing you got that seizure. Could you imagine what real chicken pox would have done to you? That vaccine just saved your life. The seizure is still not as bad as the risk (not actually getting but the “risk”) of getting real chickenpox. Therefore the benefit still outweighs the risks! Viva la vaccine! Viva la vaccine! Viva la vaccine!

We were assured that, unlike a lawsuit in civil court, the federal compensation system would be based on the presumption that a vaccine or combination of vaccines caused the child’s injury or death if no other demonstrated cause could be found.

They thought that Vaccine Court would be “guilty until proven innocent”? I wonder what gave them that impression.

@Scott:

That’s not even the half of it. He also insists that HIS clinical experience trumps the collective clinical experience of all the other pediatricians in the US.

Actually, I get the impression that he thinks that all the other pediatrician agree with him.

The amount is still pretty paltry, considering the high level of disability this person has, and the amount of resources required to care for a person with that level of impairment. The UK might be very different from Canada, but our health care system does a piss-poor job of caring for those with any kind of special need – physical, psychological, or developmental. If the $135k is a recognition of culpability it is a small one. I’d prefer to see the court order that the bill be picked up for a long-term home care nurse or something of the sort.

Out of curiosity, who pays? Is it the government or the manufacturer?

{For some people, eating peanuts can kill them. Therefore, everyone should avoid peanuts.}

No. The government should mandate that EVERYONE should have to eat peanuts. And they should use propaganda to encourage compliance. All peanut side effects should be trivialized and suppressed to keep peanut compliance high. Peanut anaphylaxis activists should be ridiculed by health authorities and social pressure should be applied to marginalize them. Terms like peanut benefit denialist should be encouraged to indentify dissenters from the plan.

-this statement is endorsed by the peanut farmers of america. All research will be conducted and verified by Planters.

Thomas joseph. Analogy fail.

@augustine:

I’m not an anti-vaxxer but

According to you, vaccines are “prophetic medicine”. So how in the world can you not be anti-vaccine? If you’re not an anti-vaxxer, then, in your own words, how does an individual go about making a rational decision on whether or not to get a particular vaccine?

For some people, eating peanuts can kill them. Therefore, everyone should avoid peanuts.

Yeah, I don’t get this. The most common place I hear this these days is in conjunction with shampoos. The objection is something like, “Some people have allergic reactions to sulfates.” I’m like, and? What does that have to do with me? I’ve been using sulfate-based shampoos for, like, 40 years and haven’t had an allergic reaction. Why should I stop using it because some people are allergic to it?

I mean, if you have an allergic reaction to sulfate shampoo, by all means, don’t use it. But why should that be an issue for me?

Thanks Paul (@24)

I was wondering about that. As far as I know this story, young Master Fletcher did not get encephalitis, “just” the first of many epileptic fits. I wonder whether he has been tested for channel mutations that are common, for example in Dravet Syndrome.

ugh troll, the evidence, consisting of your very own comments on this blog, indicate that you are, in fact, anti-vaccine. The second half of your comment #46 on this post is evidence of your anti-vaccination sentiment (otherwise, you wouldn’t distort the conventional position on vaccination so).

So you are (as has also been demonstrated in the past) a liar as well as an anti-vaccine troll (and, of course, an idiot).

Postscript: I understand that you have taken to twisting my user name into ‘compost’ (hence, the reciprocal effort on my part to refer to you as ‘ugh’ – which is my reaction whenever you and your BS appears on this blog). I do not view this as being as insulting as you no doubt wish. After all, unlike you, compost serves a useful function.

I’m not an anti-vaxxer but when you say “superior” what do you mean? Superior to what?

Augustine, you should really warn everyone when you are going to say something so ridiculous. I am tired of cleaning my laptop, and spitting water all over my computer is not becoming of a lady.

The amount is still pretty paltry, considering the high level of disability this person has, and the amount of resources required to care for a person with that level of impairment.

This is what I was thinking as well. I know from experience that (in the U.S.) insurers whether they be government or private tend to fight to not pay what they don’t deem necessary. There may be various expenses that are not covered.

I am sure the parents are thinking about the future as well (there will be a time they will be unable to care for him) and where he will go. This can be very expensive, especially if they want to be sure he is getting good care. Even if the universal health care system has homes they pay for, these are probably not nearly as good as private (if it is anything like the Medicaid system in the U.S. they are as cheap as possible).*

Not to mention; do they ever get to be alone? Do they ever get to go on a short vacation to regroup and relax? Caring for a disabled person 24/7 gets mentally and physically exhausting.

No, I think this is a drop in a very big, expensive bucket.

*All of this comes from an American who knows almost nothing about the U.K.’s health care.

Ok, honest question from someone who just doesn’t know. I read a past vaccine post of yours and I think this would be a good place to ask.

So, I do Vaccinate, but on a spaced out schedule so that if my son has a allergic reaction I will know which one caused it and hopefully less foreign bodies will mean less of a reaction (since he’s almost 2 and has never had a reaction this second probably matters less since he isn’t allergic to any of the generic ingredients).

Anyways, my only bent with Vaccines is that the studies do seem limited. Mind you I am not a medical profession so it could just be my knowledge that is limited.

What do they do for long term studies? I did hear that one country has a database of all of their citizens (or at least a large number of them) and that they used this against the autism claim and the thermesol (sorry for bad spelling) claim to show that there are no direct correlations. Do they routinely monitor individuals who have received specific vaccines for long term affects? Without some high tech programing this would probably not be easy.

It seems that the studies are all short term. They gave x number of people the vaccine and it didn’t kill them or cause immediate side effects so they send it out. It’s kind of a tough situation since of course if your making a vaccine to protect against something you want to protect against it now and not 10 years from now. But, even if you send out the vaccine to the public it doesn’t mean you can just wipe your hands clean of it and start on the next.

So, long term studies? At least with all of the anti-vac’ers they do have a comparison group. Is anyone taking advantage of this?

ebohlman: Interesting. In any case, given the severity of the reaction, it’s probably a good idea for her not to get the vaccine at this point, just out of an abundance of caution — at least, as long as herd immunity remains strong, that is!

@Desdemona

There are a couple different ways that vaccines are studied long-term. Manufacturers conduct post-marketing surveillance studies, as well as collect reports of adverse events. They are required by law to report these events to the FDA within a specific timeframe depending on seriousness of the event.

Other non-manufacturer researchers (e.g., physicians, universities, etc.) are conducting research as well.

Then there’s the Vaccine Safety Datalink at the CDC.

You can probably find more by searching for clinical trials at clinicaltrials.gov or for published research at places like PubMed.

One challenge with longitudinal studies like this, though, is controlling for confounding variables. The longer it goes on, the greater the chance that some other event/thing not accounted for will cause some reaction. Sussing out whether it was the vaccine 15, 20, 30 years before or something else entirely is a rather challenging task.

It should be noted that this reform on health care is still much to improve and that there are millions of people still expect proper care, hopefully helping people who suffer pain really are millions at the country level, to obtain the benefits they need .

Thank you, Jay. I don’t suppose you care to comment on the fact that California is on the verge of breaking a fifty-year record for pertussis cases?

@Todd

Thanks for the comment. I would think that with vaccines, and probably many other biology related topics, the number of variables can be astounding. But it is good to know that they are at least making an attempt. I do vaccinate though since I am more worried about the “long term” effects of some of these diseases!

As a person who has read posts by a lot of anti-vacers (I follow a whole foods diet and am on a food list) the “superior immune system” that some trust in is from giving themselves and their kids really controlled diet. The immune system of their organic/wholesome feed diet kid is, in theory, better than the Vac’d kid next door who eats chicken nuggets and pizza for dinner.

I try to have the best of both worlds 🙂

The immune system of their organic/wholesome feed diet kid is, in theory, better than the Vac’d kid next door who eats chicken nuggets and pizza for dinner.

Even if this were true (I don’t know and I don’t care), so what? It’s a false dichotomy.

Vaccinated kids who eat good diets have better immune systems than non-vaccinated kids that eat good diets.

No one is saying, “If you have vaccinated, you don’t have to worry about taking care of your health.” That’s a complete strawman, not even close to anything real.

Anyone who is trying to tell you something like that, or even implies it, is deceiving you.

[matthew cline: So how in the world can you not be anti-vaccine?]

I have no problem with you taking vaccines. I actually think they should be sold OTC at the grocery store. Out of the hands of the sales person, the doctor. They’re safer than tylenol or aspirin.

Most doctors offices lose money on vaccines, incidentally. In case you were labouring under the impression that family docs and pediatricians are rolling in sweet vax cash.

Desdemona:

The immune system of their organic/wholesome feed diet kid is, in theory, better than the Vac’d kid next door who eats chicken nuggets and pizza for dinner.

Are you often peaking into your neighbors’ windows at supper time? Also, how is my home made pizza with fresh basil, tomatoes, spinach, mushrooms, fresh cheese and fresh dough so unhealthy?

If you want to know how I feel about your judgment of other children’s diets, I would like you familiarize you with a quote I found quite disgusting:

“How come what we offered was not enough to keep her here when children with far less — impatient distracted parents, a small apartment on a busy street, extended day care, Oscar Mayer Lunchables — will happily stay?”

{pablo: Vaccinated kids who eat good diets have better immune systems than non-vaccinated kids that eat good diets.]

So do you think vaccinated kids who eat poor diets have better immune systems than unvaccinated kids who have good diets?

Poor diet kids health outcomes are often compared when trying to scare people into vaccinating. Are you saying a strawman argument is used in favor of getting kids vaccinated when using this tactic?

Chris

I was giving the mind set of others I talk too… not saying that YOU are a horrible parent and feed your kid crap food. It was the random fast food example that came to my head. I was not downing your pizza specifically, that is for sure.

There are plenty of studies, however, that show negative long term effects of a truly fast food diet, which is the diet I was comparing too. I don’t need to peak into anyone’s house when there are studies which compare various feeding habits.

There is also a lot more to raising kids than just food! (in response to your quote). That and kids have different personalities.

[Most doctors offices lose money on vaccines, incidentally. In case you were labouring under the impression that family docs and pediatricians are rolling in sweet vax cash.]

Since you were wondering, that was not the impression. I’m sure peds are on the low end of the economic ladder. But vaccine visits do bring income that is billable. It also establishes rapport for future visits. But, no I was not “labouring” under that impression.

Vaccine doctors sell vaccines. They promote their use for everyone with skin. But you could classify them as agents of the state. Carrying out the will of state policy makers.

@augustine:

I have no problem with you taking vaccines. I actually think they should be sold OTC at the grocery store.

So your definition of “anti-vaccine” is “someone who wants to prevent vaccines from being manufactured”? That’s an extremely narrow definition.

And another question to you: in your opinion, has any decision by any individual to take any vaccine ever been a rational decision?

@64
Thanks for that. I liken my responsibility to vaccinate my patients to having the equivalent of a BMW in my refrigerator. I paid for it, I maintain it, I fix it even if somebody else damages it (e.g. accidentally throwing thousands of dollars worth in the garbage), I pay increased insurance on its account, I keep extensive records on it, but I don’t get to drive it. If I am lucky and my staff functions perfectly, I may get enough reimbursement to break even on it. AND I spend my day trying to explain what is in their children’s interest to people who see me as either part of a conspiracy to hurt their children for profit, or, at best, a dupe of that conspiracy.

@ Chris:

I would read Desdemona’s comment (cited below) as meaning she is pointing out the mindset of anti-vaccine activists who populate her food mailing list rather than stating her opinion (as she pointed out in #66).

Desdemona is free to correct me if I am wrong.

As a person who has read posts by a lot of anti-vacers (I follow a whole foods diet and am on a food list) the “superior immune system” that some trust in is from giving themselves and their kids really controlled diet. The immune system of their organic/wholesome feed diet kid is, in theory, better than the Vac’d kid next door who eats chicken nuggets and pizza for dinner.

Bold section is emphasis mine.

Also, would you describe your home-made pizza as being representative of pizzas consumed by the majority of pizza-eating American children? I would, perhaps, take that into account before taking too much umbrage at Desdemona’s comment.

[Alan kellog: So you’re not anti-vax, you’re anti-doctor.]

No, I’m not anti-doctor.

@68

It always boggles my mind that people think doctors are in it only for the money. Don’t get it twisted – being a doctor is a good gig, eventually. Doctors make a very decent amount of money, eventually. But I don’t know a single one of my med-school buds who went into it because of the lure of an easy buck. My law school and business school friends, that’s another story.

Medical practice is the worst get-rich-quick scheme ever. It’s more like a get-well-off-over-a-number-of-decades scheme.

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