“Anti-vaccine.”
I regularly throw that word around — and, most of the time, with good reason. Many skeptics and defenders of SBM also throw that word around, again with good reason most of the time. There really is a shocking amount of anti-vaccine sentiment out there. But what does “anti-vaccine” really mean? What is “anti-vaccine”? Who is “anti-vaccine”? Why? What makes them “anti-vaccine”?
Believe it or not, for all the vociferousness with which I routinely go after anti-vaccine loons, I’m actually a relative newcomer to the task of taking on the anti-vaccine movement. Ten years ago, I was blissfully unaware that such a movement even existed; indeed, I doubt the concept would even have entered my brain that anyone would seriously question the safety and efficacy of vaccines, which are one of the safest and most efficacious preventative medical interventions humans have ever devised, arguably having saved more lives than any other medical intervention ever conceived. Even six years ago, although I had become aware of the existence of the anti-vaccine movement by that time, when I considered anti-vaccine loons at all, I considered them a small bunch of cranks so far into the woo that they weren’t really worth bothering with. Yes, I was a shruggie.
All of that changed not long after I started the first iteration of this blog back in December 2004. Approximately six months later, to be precise, is when everything changed. That was when someone as famous as Robert F. Kennedy, Jr. published an infamous screed simultaneously in Rolling Stone and Salon.com entitled Deadly Immunity that was so full of misinformation, pseudoscience, and conspiracy mongering that it altered the course of my blogging forever, beginning when I called it the “biggest, steamingest, drippiest turd” I had ever seen. Although I had already been becoming less and less of a “shruggie” about the anti-vaccine movement before RFK’s propaganda piece, “Deadly Immunity” resulted in a significant percentage of my blogging turning to discussions of the anti-vaccine movement and the scientifically-discredited myth that vaccines cause autism.
Anti-vaccine, not pro-safe vaccine
Before I try to define “anti-vaccine” in more detail, I should take a moment to point out that, if there’s one thing I’ve learned in nearly six years blogging about vaccines and the pseudoscience used to attack them, it’s that no one — well, almost no one — considers himself “anti-vaccine.” This is very easily verifiable in the outraged reaction elicited from people like J.B. Handley, Jenny McCarthy, and Dr. Jay Gordon when they are described as “anti-vaccine. Jenny McCarthy, for instance, will reliably retort, “I’m not ‘anti-vaccine.’ I’m pro-safe vaccine.” An alternative response is, “What I really am is ‘anti-toxins’ in the vaccines.” Meanwhile, Dr. Gordon will say the same thing while simultaneously saying that he doesn’t give a lot of vaccines and foolishly admitting in the comments of a blog post that some parents have actually had to persuade him to vaccinate “reluctantly.”
The rule that those holding anti-vaccine views will rarely admit that they are anti-vaccine is a good one, although there are exceptions. It is not uncommon to find in the comments of anti-vaccine propaganda blogs like Age of Autism and anti-vaccine mailing lists comments proclaiming explicit anti-vaccine views loud and proud, with declarations that “I am anti-vaccine” and that we should stop all vaccines. This dichotomy has at times caused problems for the more P.R.-savvy members of the anti-vaccine movement, as demonstrated two years ago at Jenny McCarthy’s “Green Our Vaccines” rally, where images of vaccines as toxic waste and weapons of mass destruction were commonplace. Even so, the “Green Our Vaccines” slogan and coopting the “vaccine safety” mantle have been very effective for the anti-vaccine movement. In particular, Barbara Loe Fisher has successfully portrayed her National Vaccine Information Center (NVIC) as being a “vaccine safety watchdog” group looking out for parents’ rights, this despite hosting an online memorial for vaccine victims and a deceptive and disingenuous vaccine ingredient calculator (deconstructed by yours truly here).
“I know it when I see it”
In a concurring opinion in Jacobellis v. Ohio, regarding possible obscenity in a movie, Justice Potter Stewart once famously wrote:
I shall not today attempt further to define the kinds of material I understand to be embraced within that shorthand description [“hard-core pornography”]; and perhaps I could never succeed in intelligibly doing so. But I know it when I see it, and the motion picture involved in this case is not that.
From my perspective, defining what is “anti-vaccine” is a lot like defining obscenity: I know it when I see it. However, as in the case of pornography, even though it’s quite true that what is anti-vaccine is in general easily identifiable to those of us who pay attention to such matters, it’s much more difficult to define in a way that those who don’t pay attention to the issue can recognize. This difficulty is complicated by the fact that there are a number of different flavors of anti-vaccine views ranging from (I kid you not) the view that vaccines are a tool of Satan to depopulate the earth to much milder views. It’s also important to realize that most parents who buy into anti-vaccine views do so out of ignorance, because they have been misled, rather than due to stupidity. When I “go medieval” on anti-vaccine activists, my ire is almost always reserved for the leaders of the anti-vaccine movement, who spread misinformation.
When I’m actually in an exchange with someone whom I suspect of having anti-vaccine views, one rather reliable way of differentiating fear from real anti-vaccine views is to ask a simple question: Which vaccines do you think that, barring medical contraindications, children should receive? If the answer is “none,” then I’m pretty much done. I know I’m almost certainly dealing with an anti-vaccinationist. Be aware that this question may require some pushing to get an answer. Rarely am I able to get a definitive answer on the first try, because most anti-vaccine advocates are cleverer than that. They realize that I’m trying to get them to admit that they are anti-vaccine. Even so, if I ask something like, “If you had it to do all over again, would you vaccinate your child?” or “If you have another child, will you vaccinate that child?” I will usually get the candid response I’m looking for.
“Vaccines don’t work”? “Vaccines are dangerous”? They’re both! (a.k.a. “Tastes great, less filling!”)
If you look at the types of arguments used to oppose vaccination, they will almost always boil down to two different flavors, either that vaccines don’t work or that vaccines are somehow dangerous. Of course, we discuss the latter argument here all the time when we point out studies that refute the alleged link between vaccines and autism. Like the slogan “Tastes great, less filling,” both of these claims often co-exist to differing degrees, with some anti-vaccinationists arguing that both are true: Vaccines don’t work and they are dangerous.
This being the real world, one has to remember that vaccines are not perfect. They are not 100% effective, and there can be rare serious side effects. What differentiates anti-vaccine cranks from, for example, scientists who deal with issues of efficacy versus side effects and potential complications all the time, is exaggeration far beyond what the scientific data will support. For example, if the influenza vaccine is less efficacious than perhaps we would like (which is true), then it must be useless. This is, in essence, the Nirvana fallacy, wherein if something is not perfect it is claimed to be utterly worthless. Part and parcel of this approach involves the complement, namely vastly exaggerating the potential side effects and complications due to vaccines to paint them as being far more dangerous than the diseases they prevent. In addition, anti-vaccine activists frequently attribute harms to vaccines that the existing scientific data definitely don’t support as being reasonable or legitimate. The claim that vaccines cause autism is the most famous, but far from the only one of these sorts of claims. It’s not uncommon to hear fallacious claims that vaccines cause autoimmune diseases, asthma, and a general “weakening” of the immune system, among others.
One of the most famous examples of exaggerated harm or nonexistent risks is the infamous “toxin” gambit. This fallacious argument claims that there are all sorts of scary chemicals in vaccines. Of course, there are all sorts of chemicals with scary names in vaccines, just as there are all sorts of chemicals with scary names in almost everything, from food to clothing to household cleaners, among others. The dose makes the poison, and the amounts of these chemicals, such as formaldehyde, are tiny. As we’ve pointed out time and time again, for instance, the amount of formaldehyde in vaccines is so tiny that it’s overwhelmed by the amount of formaldehyde made as a byproduct of normal metabolism. Then, of course, there are the chemicals claimed to be in vaccines that are, in fact, not in vaccines. The most famous of these is undoubtedly the infamous “antifreeze in vaccines” gambit. Finally, there is the claim that there are “aborted fetal parts” in vaccines. This particular claim comes from the fact that, for some vaccines, the viruses used to make the vaccines are grown in a human cell line derived from an aborted fetus.
Overall, the “tastes great, less filling”-type anti-vaccine claims that vaccines are dangerous and don’t work, can be differentiated from scientifically valid concerns about the efficacy and safety of vaccines on the basis of how evidence is treated and the types of arguments that are used. Scientists, of course, tend to be a lot more measured and express the level of uncertainty in their claims; anti-vaccine activists are under no such constraints. When, for example, scientists debated how to respond to the H1N1 pandemic last year, there was considerable uncertainty about how to do it, when to do it, and how to formulate the vaccines. Which adjuvants? Should we use squalene in order to decrease the amount of antigen used? Contrast this to the anti-vaccine arguments, which tended to argue that H1N1 wasn’t harmful, that the vaccine was toxic and wouldn’t work, and even that it was a New World Order plot.
Approaching the evidence
If there’s one thing that distinguishes science from the way movements like the anti-vaccine movement approach evidence, it’s that the anti-vaccine movement values anecdotes over careful science. If you check out Generation Rescue’s website or any of a number of anti-vaccine websites, you will find numerous stories using the classic post hoc ergo propter hoc fallacy that in essence argues that, because one thing happened before another, that thing must have caused it. Because Generation Rescue preaches that its various forms of biomedical woo can “recover” autistic children, not surprisingly, there are a number of testimonials on its website touting stories of children who regressed after vaccination and then appeared to recover after whatever woo du jour was tried on them. On the surface, these testimonials seem convincing. However, given that millions of children who undergo vaccination each year, the number of vaccinations in the currently recommended schedule, and the fact that approximately 1% of children will eventually be diagnosed with an autistic spectrum disorder, it is not surprising, given the law of large numbers, that there will be a significant number of children who regress in fairly close temporal proximity to a vaccination by random chance alone. Even though such cases are random, though, to a single observer, they appear all the world as though the vaccine caused the regression. What’s difficult for non-scientists (and even many scientists) to accept is that it’s impossible to tell if vaccines are actually correlated with regression unless careful studies are done comparing large populations to determine whether children who are vaccinated really do have a higher chance of autism. Those studies have been done, and the answer is a resounding no. To the anti-vaccine movement, anecdotes trump evidence. Indeed, even physicians, like Jenny McCarthy’s son Evan’s pediatrician Dr. Jay Gordon, fall for touting their own anecdotal experience over careful epidemiology and science.
Perhaps one of the most characteristic aspects of the anti-vaccine movement is the same one that is shared by virtually every denialist movement, be it denying the science of climate change, evolution, or scientific medicine. That is the use of logical fallacies, cherry picking of the evidence, and distortion of the science. Perhaps the best example of cherry picking and distortion of evidence engaged in by anti-vaccine activists is a set of graphs I discovered earlier this year by a man named Raymond Obomsawin, in which he tried to represent as “proof vaccines didn’t save us.” As I pointed out in my response, this was intellectual dishonesty at its most naked. Basically, Obomsawin deceptively conflated mortality and incidence. Worse, he also chose his graphs in a way that parts of the data were left out. Indeed, less than a month ago, the Australian anti-vaccine activist Meryl Dorey approvingly cited Obomsawin’s graphs. When I pointed out how Obomsawin had cherry picked his graphs to deceptive purpose, all with utter contempt for his audience, his response was beyond pathetic:
The software that I was using to create the graph did not allow for the creation of either a blank space or a dotted line between 1959 and 1968. There was no intent to be dishonest about this, and thanks to your blog, I will make it a point to specifically note on the graph that there is an absence of incidence data in this period.
I note that, not only have the graphs not been changed as far as I can tell, but Dr. Obomsawin is going to be giving a webinar tomorrow in which he is apparently going to argue the same nonsense. I’m half tempted to sign up and see what he says. It’d make for more blogging material, and an update to the Obomsawin Technique of vaccine denialism (yes, I named it after him) is probably overdue anyway. After all, I never took on several other of the graphs he included in his collection. My guess is that Obomsawin won’t change his graph. Obomsawin’s deceptive approach to the evidence is mirrored by naturopath David Mihalovic, who wrote the infamous 9 Questions That Stump Every Pro-Vaccine Advocate and Their Claims. Finally, another example of how anti-vaccine activists approach the evidence landed with a huge thud in the blogosphere last year when the Jenny McCarthy-fronted anti-vaccine group Generation Rescue decided to try to discredit the studies that show no link between vaccines and autism. As Steve Novella, Mark Crislip, and I all showed, Generation Rescue’s arguments were fallacious at best and deceptive at worst.
Which brings us to another characteristic of the anti-vaccine movement.
Conspiracy mongering and reaction to criticism
Science is, if you’ll forgive the term, a highly Darwinian process. To be a scientist, you have to have a thick skin, because you’ll need it. Reviewers, mentors, other scientists, and virtually anyone to whom you present your results will be picking away at them, looking for flaws, looking for reasons to invalidate your conclusions. There’s nothing personal in it (usually); it’s how the process of science works. Similarly, those who have an appreciation for science understand that it’s a rough-and-tumble world where scientists have to be able to defend their work. Yes, it’s messy as hell, but it works. It may take a lot longer than we’d like and be a lot more confusing than the public likes, but over time hypotheses that don’t hold up are weeded out, to be replaced by those that do. Scientists understand this, and most know not to become too distressed by criticism. True, scientists are human too and can’t always separate themselves from their science; sometimes they lash out at criticism. However, for the most part, they don’t react the same way as denialists do when criticized. More importantly, contrary to scientists, it’s very rare indeed for an anti-vaccinationist to change his mind due to the evidence.
The anti-vaccine movement shares another characteristic exhibited by a large number of denialists of all stripes, and that’s an intolerance to criticism. Instead of answering it with science (which they can’t do), they tend to answer criticism with vitriol and conspiracy mongering. After all, when it’s all a conspiracy between the government and big pharma to “suppress” the data that allegedly show that vaccines cause autism, then anyone who speaks out for that viewpoint must be a pharma shill. If that critic is a woman, then she must have been the victim of a date-rape drug.
Perhaps the best way of describing how anti-vaccine groups react to criticism is to point out that their first response tends to be to try to suppress criticism rather than to answer it. Usually, this is accomplished through ad hominem attacks and poisoning of Google reputations. One particularly egregious example occurred when Age of Autism Photoshopped the faces of Steve Novella, Trine Tsouderos, Alison Singer, Paul Offit, Amy Wallace, and Tom Insel into a photo of people sitting down to a Thanksgiving feast of dead baby. Yes, likening enemies to cannibals wasn’t going too far. Sometimes attacks on critics can escalate to legal thuggery, which happened when the British Chiropractic Association sued Simon Singh and Barbara Loe Fisher sued Paul Offit. That such lawsuits nearly always fail, at least in the U.S., where the libel laws aren’t as draconian as in the U.K., doesn’t matter. The goal is not to recover damages; it’s to intimidate critics into silence.
The Bottom Line
Distinguishing true anti-vaccine rhetoric from cluelessness is not always easy. To help, I’ll recap the eight characteristics I’ve just discussed:
- Claiming to be “pro-safe vaccine” while being unrelentingly critical about vaccines
- The “vaccines don’t work” gambit
- The “vaccines are dangerous” gambit
- Preferring anecdotes over science and epidemiology
- Cherry picking and misrepresenting the evidence
- The copious use of logical fallacies in arguing
- Conspiracy mongering
- Trying to silence criticism, rather than responding to it
Someone who is anti-vaccine will almost certainly use at least three or four of these techniques. The cranks at Age of Autism use all eight and then some. Indeed, when these eight techniques fail to suffice, they make up more.
One other thing that’s important to mention, particularly since I’ve been guilty of this sin on occasion, is that we have to be careful about leaping to the conclusion that someone is anti-vaccine. That’s where the “I know it when I see it” test can backfire. For example, I was quite distressed at some of the statements coming from Dr. Marya Zilberberg on vaccines, in particular her referring to defenders of the current vaccine schedule as “rabid” and arguments that are reminiscent of the same sorts of arguments that the anti-vaccine movement uses for the HPV vaccine and the chickenpox vaccine, mixed with a question about combinations of vaccines being of concern that sounded uncomfortably like the “Too Many Too Soon” slogan beloved of Generation Rescue. Although I did not explicitly call her “anti-vaccine” in another forum and even went out of my way (as did Steve) to point out that I don’t think she’s anti-vaccine, I did try to point out to Dr. Zilberberg that, if you’re skeptical of some aspect of our current vaccination schedule, it’s important to be aware of how anti-vaccine cranks argue, so that you don’t inadvertently sound like one.
In the end, the anti-vaccine movement is just another denialist movement. It’s very similar to denialist movements that have sprung up around global climate change, science-based medicine, and evolution. As such, it uses many of the same fallacious strategies and distortions of science to promote its agenda and reacts the same way to criticism. Similarly, in the end, the anti-vaccine movement is also far more about ideology rather than science, which is why it remains so stubbornly resistant to reason and science. Finding an effective means to counter its message will likely require developing effective general strategies to counter science denialist movements of all types. The problem is, for all the pontification and bloviation about the issue of science communication, no one really knows what methods work to persuade denialists like anti-vaccine zealots that they are trodding the path of pseudoscience.
116 replies on “What does it mean to be “anti-vaccine”?”
As with the religious, climate change deniers, racists etc. These people don’t seem to work on reason – their narrow definition of “open-minded” means open only to their own views.
Personally, I’m proud that my kids are vaccinated.
The people making connections between age of regression and age of vaccination always remind me of the Pointy-haired Boss getting all worked up that 40% of staff sick-days are taken on Monday and Friday.
There is a ninth characteristic argument of the true Anti-Vaccinationist
Claims that the disease is not that bad/was going away before vaccination.
And the variant that some other disease didn’t exist / was very rare before vaccination, often(?) expressed as vaccines are causing this other disease / condition. And I suppose that has the variant, which seems to tie in with the toxicity nonsense, that too many vaccines over too short period of time causes this, that, and the other thing (all anecdotal, of course).
Anti-funding vaccination programs and free vaccination programs. I’ll bet that, along with other right-wing political and social position plays the biggest role in people going unvaccinated by far. Allowing the production of the anthrax vaccine to be in the hands of one, badly run company wasn’t a good idea. The whole for-profit production of vaccine plays a role too.
This is in my estimation the biggest trait of the anti-vaxer – when confronted with evidence that their view is wrong, they not only don’t bother to respond accurately to it but propogate the same falsehood somewhere else! You see this with the folks that trot out the same old pro-disease arguments, get called out for it, and then a few weeks later appear somewhere else making the same arguments.
I guess if you can’t beat ’em, find a new audience that might be more receptive.
Yeah, you’ll never reach the outliers, what has to be done is to get the ‘mushy middle’ to move by making your case, being open and vocal for whatever cause you are advocating, making it more socially acceptable to be in the supporters of X and less acceptable to be anti-X.
Analogies involving critical mass and autocatalysis could be made I guess.
Brad
“Ten years ago, I was blissfully unaware that such a movement even existed; indeed, I doubt the concept would even have entered my brain that anyone would seriously question the safety and efficacy of vaccines”
Ditto. I found out about it when I had my 3rd child in 2007, 10.5 years after #2. Where has it put us? Well, we just got a letter from my little one’s daycare that there is a suspected case of whooping cough in her center. There are two confirmed cases locally, one in the school district the center is located in and another in a neighboring district. If only I could find out if it’s due to someone not vaccinating without a reason, and I’d be looking for some neck(s) to wring.
There’s one more argument: Vaccine-preventable diseases aren’t all that bad.
“There’s one more argument: Vaccine-preventable diseases aren’t all that bad.”
One classic statement along these lines came from the mom who argued that by eradicating or vastly reducing the incidence of vaccine-preventable diseases, we’re eliminating opportunities for moms to have warm fuzzy interactions with their kids during illness.
And of course these diseases are what God intended for us and we’ll be punished in some way for avoiding them.
It’s essential to understand that denialists, in general, are not motivated by a search for truth. Rather, they are totally invested in their conclusion. They argue, not like scientists, but like lawyers — saying whatever they possibly can to convince the jury. And there is no judge to enforce rules of evidence. Their followers are also invested, for various reasons. For example, creationists are part of religious communities that essentially constitute their entire social milieu. To give that up means exile in the wilderness. Other denialist movements can also, perhaps not to such a totality, become people’s social lives.
For most people, scientific belief, unfortunately, doesn’t bring with it any social networks or particular comfort. Those of us who believe that truth is its own reward are not really fighting on the ground that matters to many others.
The idea that a parent would willfully inflict suffering on their child is beyond my comprehension.
@a-non,
They rationalize it, though, certain that natural immunity is preferable over the toxin-laden, directly-injected-into-the-bloodstream vaccines that are worse than the disease and cause all sorts of problems from SIDS, asthma, eczema, lupus, ms, autism, ADHD, food intolerances, etc. Reality isn’t nearly as important to them as fear is, and many on AoA have admitted that they’d rather lose their child to a disease than to autism (never mind that the child isn’t lost to autism).
@a-non (12)
YES! I agree with you.
Considering the hell my eldest went though when she had chicken pox, I would have jumped on the vaccine if it had been available then. Tell me that a feverish, broken-out-ALL-over-her-body (can’t sit, can’t lie, can’t stand – every position hurts) child isn’t miserable and I’ll call you a liar to your face. Tell me that a parent WANTS to give her child narcotics so the poor kid can get a modicum of relief and I’ll hit you (oatmeal baths, cortisone cream, ANY cream – nothing gave her any relief she was so covered with pox). Tell me that she’ll never get chicken pox again – well, guess what? For her latest job she had to have titers done. They were so low she had to get the vaccine. BUT, she is still at risk for shingles in the future. Yay….NOT.
My kids got every vaccine in the book that they were eligible for and they are determined that if they ever have kids, their kids will be protected too.
MI Dawn
Is it, a-non? Parents often inflict small amounts of suffering on their children. If it’s in the child’s interest (or appears to be), then the parents can justify doing quite a bit.
Vaccinations are absolutely in the child’s best interest, unless the child has a rare contraindication. But they hurt. The child suffers. The child wonders why their parents and the doctor have betrayed them so by having this painful thing done to them. They did nothing to deserve it! Why do we make our children hurt? Well, because it’s not much of a hurt, really, and the alternative is worse. But the kid doesn’t know that, and so it can be quite shocking to them. Or children who are bullied; they may no alternative but to keep going to school, at least in the near term. Why do their parents make them suffer? Well, because they have to go to school. It’s just the way it is. Why do parents punish their children? The whole idea is to make the child suffer at least a little bit to teach them consequences. Some favor time-outs or the confiscation of a favorite toy. It seems benign, but really it’s meant to hurt. It might even go as far as restraining the child or a slap on the hand to stop them touching something dangerous, which is physically painful. Why do parents do it? Because there is an important lesson which the child needs to learn.
Those are all pretty innocuous examples, but the exact same logic is used to justify whipping children, withholding food, withholding affection . . . and giving them infectious diseases on purpose (e.g. chickenpox parties). The parents know the kid will suffer. That’s not the point. They believe the good will outweigh the harm. It is an exceptionally powerful, insidious, and *dangerous* logic, seductive because it is so sensible in other applications. A sane, healthy, loving parent can go from realizing the need for vaccinations despite the tears all the way to locking the child in a closet because the child won’t do homework.
There is another, even more insidious side to this logic. In order to deliberately hurt your child for a greater good, you need to be able to harden your heart. Once you start intentionally blinding yourself to your child’s distress, it can become very easy to go far overboard. Yet we need to do it. When your child begs not to be vaccinated, you have to find a way to get it done anyway. I think a lot of anti-vax proponents actually are not endorsing suffering for their children but instead have been unable to withstand the tears when their child was vaccinated the first time. I can definitely relate; it’s terrible watching your child in pain. If you think the disease isn’t so bad, maybe you’ll think it’s worth taking your chances and let the child escape that brief torment. That’s another slippery slope, in the opposite direction, and it can be just as dangerous.
Parenting isn’t easy. 😉
Is Jenny McCarthy still around? Ever since she split from her money source it seems to have gotten very quiet.
Whenever anti-vaxxers claim to be on the “cutting edge” of science or that they have “new information”, I like to quote my handy, dandy antique woo-cyclopaedia, “The Prevention Method for Better Health”, J.I. Rodale, 1960 **, so in honor of What-the-Vax! week : ” Vaccination is a present-day evil. We believe that a time will come when we will all be so healthy that vaccination will be unnecessary.” ” There is pretty general acceptance at present of the fact that smallpox results from unhygienic (sic) conditions”. ” They cite severe upsets suffered by vaccinated babies and even some deaths attributed to artificial immunization”. “… just as outward sanitation has helped rid us of some of the basic causes of diphtheria, so internal cleanliness of the child’s system would surely take care of the rest of the problem. A clean and healthy bloodstream, achieved by a good diet of unrefined foods, healthful exercise and use of food supplements, has a high immunity of its own to all infections. There is no need then to inject a new immunizing factor to combat each contagious disease, for the body will manufacture its own as the need to defend itself arises.” Sounds like Maher and some others we know.
** a snarky gift from my late father c. 1998. In an odd twist of fate, my relative started working soon therafter for Rodale’s daughter and spouse in a ( thankfully) totally un- woo- related enterprise.
I’m trying to elucidate the anti-vaccine position. Do anti-vaxxers believe that autism is caused only by vaccines, or that vaccines are just part of the problem? In other words, would it be proof against the autism-vaccine link to find an autistic child that had never been exposed to mercury or whatever responsible toxin-of-the-week ?
Whipping children / withholding food, = chickenpox parties. Good joke. Everybody laugh. Roll on snare drum. Curtains
Like a-non said, why would a parent willfully inflict, or allow for such a disease to affect their child? Because it’s God’s will, because my child will be safer that way, by challenging in such a way their immune system? That’s what vaccines are for, to give enough of a challenge without the suffering. It truly blows my mind how these …. idiots “think.” Not only that, but you are choosing to spread and infect others around you because you decided to avoid vaccination. Blows my mind, seriously. Thanks for this piece … I’ll make sure to forward it to some of the nut-jobs I’m bound to find who believe in this “vaccines are evil” scheme.
My daughter is anti-vaccine. She stopped talking to me simply because I was for vaccination. Why? She “didn’t want anyone who supported the government’s eugenics program around her kids”. She’s completely bought into everything that Mike Adams spews, and quotes conspiracy theory websites as fact. Apparently I failed miserably with her education.
We’re not dealing with rational people, here. It’s sad.
Sid — I can definitely respect a Rorshach reference. 😉 (“But doctor, *I* am Pagliacci!”)
To elaborate, chickenpox parties are not equivalent to corporal punishment of minor children. But they exist along the same slippery slope — and it is a slope which includes pretty much all of parenting, so it’s not one anybody can avoid simply by choosing not to step on it. Once you’ve brought the kid home from the hospital, you’re on the slope, and it’s up to you ski it safely. There’s an awful lot of gray in it, and there aren’t many maps — it can be difficult for parents to know just what they’re getting their children into at any given moment. Which trail leads to powder, which one leads to moguls, and which one’s the bunny slope? That gentle meadow might terminate in a chute, for all you know.
Continuing the ski slope metaphor, one of my favorite life lessons comes from a sign commonly found at ski areas: “Unmarked obstacles may exist: ski with caution.”
I guess my point is mostly that we shouldn’t casually condemn parents for wanting their child to experience the disease rather than the vaccine; they aren’t callous, cruel, or mean. For the most part, they are doing it because they love their children. We have the right (and perhaps even the responsibility) to point out that the evidence does not support their choice. But this doesn’t come out of wishing suffering on their children. It actually comes (usually) out of wanting the best for their children.
@ Mu : Jenny has a new book that she’s making the rounds promoting, entitled “Love, Lust,and Faking It”. I assume she ( or her publisher) has decided that it was time to move on from autism, warrioring, and Momism to her roots ( insert blonde joke here) in more sybaritic pursuits.
Addendum to 23: I can make blond jokes ’cause I is also.
Nope. It’s still the vaccines’ fault. For example, Kim Stagliano blames the autism of her completely unvaccinated child on her own vaccinations.
Or sometimes the mercury causing the autism is coming from the air now, instead of in vaccines, but this is STILL somehow the vaccines’ fault. What’s the link in that case? I have no clue. But clearly there is.
You’re trying far too hard to be logical. If you want to understand their thinking, here’s the key. “Vaccines cause all ills.” Take this as an absolute, incontrovertible truth, at least on par with 1+1=2. Once you start from that assumption, then their various shenanigans become somewhat comprehensible.
another group of denialists who are creating an enormous threat to public health are domestic violence denialists. They operate under the frame of “fathers rights” the same way anti-vaxxers operate under the “green our vaccines” banner.
exact same denialist methodology and sadly, they’re very effective in using pseudoscience and cherry picked studies to craft legislation that hurts battered women and children.
please don’t misunderstand, this is not a an anti-father statement, but this is what these organizations do. in fact, these fathers rights organizations prey on fathers fears about their future with their children post divorce the same way antivaxx org’s prey on parental fear.
just thought I’d add one more to the list.
This study presents more evidence that the “increase” in autism is really an increase in diagnosis:
http://www.milwaukeenewsbuzz.com/?p=320557
Add another characteristic of the anti-vaxxer: Making statements of “I’ve researched it,” meaning, “I’ve looked it up on the internet.”
Nope. It’s still the vaccines’ fault. For example, Kim Stagliano blames the autism of her completely unvaccinated child on her own vaccinations.
FWIW, I told this to someone in the “mushy middle,” and she burst out laughing. “Now that’s just bullshit,” she said.
Eventually the goalpost-moving gets beyond the credulity of even the most open-minded person.
This is why Stagliano is such a joke. Almost no one in their right mind can take her seriously, once they learn of her situation.
Most people are smart enough to realize that when she has three kids on the spectrum, two vaccinated and the third not, that it kind of calls into question the whole vaccination connection. But not Super Kim! What kind of alternate universe do you have to live in to get to her place?
On further reflection, there’s a better analogy. And that is to consider it on par with the statement “Christ was the son of God and died for our sins.” It really is pretty much a religious position.
And that’s our real hope, I think. Let them destroy their own credibility. Hopefully they will manage to finish doing so before mass deaths from vaccine-preventable diseases do it for them.
I don’t think credibility is the issue. There’s always going to be a segment of the population that buys into the “government is bad vaccines are evil” nostrum because it fits nicely into their worldview.
The hope is that the damage can be contained to that segment of the population, and not spread to those who might otherwise debunk vaccines=autism as nonsense but give it credibility because celebrities and the mainstream media do.
Barabara Loe Fischer and her ilk refuse to admit one simple fact. No one who reads their websites would vaccinate. No rational human being would conclude that vaccines are good or helpful or useful or efficacious after listening to her and her fellow loons. No one. The pretense otherwise is self serving, deceptive nonsense.
Of course. And they don’t care, because for their purposes healthy debate isn’t what they’re looking for. They want fear. Fear brings in the $$$.
@ a-non:
My point is that, once they’ve sufficiently wrecked their credibility, their impact will be so contained.
Dear Orac:
Completely off-topic, which wholly within your field, is this real, or hype?
Science New Portable, Radio Frequency Scanner Detects Breast Cancer in Seconds, by Tiffany Kaiser, Dailey Tech,- October 27, 2010
http://www.dailytech.com/New+Portable+Radio+Frequency+Scanner+Detects+Breast+Cancer+in+Seconds/article19997.htm
(I’ve seen some articles by Ms. Kaiser that were really, really bad science reporting, but, some others that while looking like hype, were actually quite accurate. Accordingly, an expert’s review appears warranted).
Great discussion of “anti-vax” fallacies, Orac!
The “too many toxins” gambit reminds me of the scene in Amadeus when Emperor Joseph II says (and I paraphrase), “There were too many notes.” about one of Mozart’s operas. Mozart’s reply is “Which notes should I remove?”
That, in essence, is my response to the “toxins” gambit: which components would they remove? Although the “too many toxins” proponents will usually try to slither out of an answer, they will eventually – if cornered – reveal their ignorance of what is actually in vaccines and why they were put there in the first place.
My experience suggests that the vast majority of anti-vaccinistas are simply parroting what they have heard or what they had read on the Internet. Even medically sophisticated anti-vaccinistas (like “Dr. Jay” Gordon) have to be told that “anti-freeze” can’t be taken out of vaccines because it was never in them.
No matter how many of the “toxins” you debunk by showing that they aren’t the “poisons” the anti-vaccinistas think they are (or aren’t even present to begin with), they always have a fall-back position (e.g.“Well, what about viruses? Why are there viruses in vaccines?”). I’ve given up trying to convince the irrational core believers – I’m just trying to keep the disinformation from spreading to people with open minds.
Prometheus
@ wfjag:
While I’m not an expert like Orac, I did spot one huge red flag. Neither the linked article, nor the press release linked from it, mention any publication in a journal. And while there are five hits for “Zhipeng Wu” on PubMed, none of them are about this scanner.
In other words, no actual evidence that the thing works at all.
“Jenny has a new book that she’s making the rounds promoting, entitled “Love, Lust,and Faking It”. I assume she ( or her publisher) has decided that it was time to move on from autism, warrioring, and Momism to her roots ( insert blonde joke here) in more sybaritic pursuits.”
On the other hand “Faking It” is a good description of Jenny’s evidence and logic as applied to the “vaccine-autism connection”.
I’m curious: Is there a vaccine standard of care? As a pediatrician, can you just not do it? Don’t you have to give parents complete and accurate information on the risks involved in deviating from the standard practice? Isn’t he opening himself up for huge lawsuits? Who insures him?
SC asks:
I’m not a lawyer, so I don’t know what his exposure to malpractise lawsuits would be from this advice. However, given the sort of things I’ve heard doctors being sued over, he is at least at risk for having a suit brought – whether the plaintiffs would prevail is another matter.
As I see it, “Dr. Jay” could be responsible for a vaccine-preventable injury or death in one of two ways: [1] an injury to a patient of his who was not vaccinated on his recommendation, and [2] an injury to a child not in his practise who contracted the illness from an un- (or under-) vaccinated child who was under his care. [Note: another possibility would be a child whose symptoms of a communicable disease – e.g. a persistent and severe cough during a pertussis outbreak – was not properly evaluated]
The first is probably the most easily proven, although I’d bet “Dr. Jay” has covered himself by telling the parents “Here’s all the information – you decide whether or not your child should be vaccinated.” Whether or not that version of the “quack Miranda” would hold up in court I leave to the legal experts.
The second would be harder to prove, but potentially more damaging, as both “Dr. Jay” and the parents of the “index case” could be potentially liable for damages (morally, if not legally). Deeper pockets and more of them make lawsuits more attractive. And I’d bet that “Dr. Jay’s” star clientiele (the ones with the deep pockets) wouldn’t appreciate being put in the limelight in that fashion.
“Dr. Jay” has demonstrated his ignorance of epidemiology, microbiology and even physiology on this ‘blog more than once. Recently, he even publicly admitted he was unaware of the current pertussis outbreak in California. Given this level of ignorance, one can only wonder about the accuracy of the vaccination information he provides parents.
Prometheus
Prometheus: Dr. Jay is unaware of outbreaks of vaccine preventable diseases? Wow.
If somebody were an honest believer in “too many, too soon” and that, while germs do cause disease, the risks outweigh the benefits – wouldn’t rates of vaccine preventable diseases be something really, really relevant to pay attention to? If you think that nobody is getting pertussis so it’s safe for most people to not vaccinate, you’d better be ready to vaccine ASAP when that changes.
This sort of lack of internal consistency does point to some logic and rationality issues on their part, I think.
Wow, Callie, a lot of times I think there is some sense to your posts but re. Post 15 you have to be kidding. Parents choosing to not give certain (or any) vaccines really don’t give shit about a prick. They give a shit about EBM (not so much the SBM, Orac).
I’m not sure Jay was really unaware of the pertussis outbreak in CA. I think he was more in denial of it. Since he has never encountered it among his patients***, that means it must not be that bad. Remember, for Jay his experience trumps all.
***Of course he likely DID have a patient infected, he just never bothered to test for it. Therefore, he can deny she had it.
Curious, Jen: haven’t seen much of that evidence around here. Even though people keep asking you for it.
Jen–
So, you’re attacking Calli Arcale for pointing out that parents who don’t vaccinate are doing so because they think they’re doing the right thing for their children? I don’t think the post you’re responding to is the post that’s actually under Calli’s name @15.
Vicky, I can’t figure out what you’re talking about. 15 is Callie. She talked volumes about parents being afraid of their kid’s tears and even children begging not to be vaccinated. Most parents have made the decision based on research and, one might say a lack of research. Parenting is tough and I for one don’t need some condescending reminder of that.
Well, compared to my usual posts, I’m not sure it qualifies as “volumes” — I have kind of an Oracian problem in that I tend to ramble. It was meant as one example of why a parent may decline vaccination, and was not to be exhaustive. Nor was it meant to be condescending. I wasn’t aiming it at you, who already knows what it’s like to be a parent; I was responding specifically to the post asking why parents would wish suffering upon their children by wishing they get the disease rather than the vaccine.
My intent in bringing up the pain of a vaccination wasn’t to belittle your reasons for doubting mass vaccination campaigns or suggest any fear of the needle. It was to flip the argument around — if vaccines are ineffective, then it is the pro-vaxxers who are torturing their children for no good reason. I wanted to get him to look at it from a different angle and see that the facile argument of “anti-vaxxers like to torment kids!” can be used the other way too, and arguably with more justification, as a kid who gets vaccinated will definitely get an owie, whereas a kid who doesn’t may get lucky and never catch the illnesses at all.
Bottom line: it’s a bad argument. We’re really all in this together. None of us is pro-autism or pro-disease or whatever. (Except maybe a few weirdos out there.) All of us are concerned primarily about the future of our children, and it’s hard to argue the nobility of that. (Argue the conclusions, argue the interpretation of data, but let’s not argue one anothers’ motivations, and that’s my point.)
One commenter on a Huffington Post article claimed that mass vaccination has caused DNA damage that will take generations to fix.
“We’re not dealing with rational people, here. It’s sad.”
If people believe vaccines can do permanent damage to their children, then the most rational thing they can do is refuse them. Only a fool would think otherwise. The question is why do people think that? I think it has more to do with a general growing distrust of corporate medicine that any particular issue with this potion or that remedy. People’s level of distrust of pharma and corporate medicine is likely in direct proportion to their reticence regarding vaccination. If doesn’t matter how effective the medicine is if the patient doesn’t trust the practitioner enough to take it.
I tell all my patients that I share responsibility for the decision to delay or defer vaccination for their children.
I could give them written waivers and would still share moral, legal and ethical responsibility for the consequences of this decision. I don’t ask for or receive any waivers.
The decision of vaccine administration and timing is very difficult; I give parents my advice and they gather advice from very easily available sources online and in person. They read CDC and AAP information, Dr. Offit’s expert advice and much more. I support and respect the decision they make and accept responsibility for that decision, too.
As occurred in 2006 at at other times, I believe that the bulk of cases of whooping cough are not being caused by B. Pertussis but instead by Parapertussis. Both bacteria are fastidious and labs have a great deal of trouble confirming diagnosis of either.
http://bit.ly/agMaAM
Jay
@Kaessa:
Wait, what? The government is using vaccines to selectively sterilize children?
Typo:
As occurred in 2006 and at other times, I believe that the bulk of cases of whooping cough are not being caused by B. Pertussis but instead by Parapertussis. Both bacteria are fastidious and labs have a great deal of trouble confirming diagnosis of either.
http://bit.ly/agMaAM
Jay
Um, Dr Jay, you are missing something. The CA epidemic HAS laboratory confirmed cases, if you would simply read some of the links people post. NOT the quick test (and who uses only a quick test these days without getting a confirmatory culture? No doctor I know around here. Even quick test strep are confirmed with a true cultures.)
Here’s a little information about the CA epidemic for you, Dr Jay. Shouldn’t take you too long to read it.
http://www.cdph.ca.gov/programs/immunize/Documents/PertussisReport2010-10-26.pdf
So Dr. Gordon “believes” that the current epidemic of whooping cough is not vaccine-preventable, so he will not vaccinate against it, even though experts are urging vaccination. Nice.
And again I forget to sign my posts and Sciblogs uses the Pharyngula name…Oh well. 🙁
MI Dawn
Luckily, however, you know.
What is your divination technique – laying on of hands? Mind/body melding? A harnessing of you mutual psi-energy?
Remarkable. Especially when, I believe, you claimed that when you had a potential case of pertussis you didn’t have the patient tested – is this not a deriliction of duty?
You know, the more I read of your smarmy posts I begin to wonder what exactly a pediatrician actually does do, especially when you don’t seem to see routine childhood disease prevention as part of your remit at all.
Hey, your patients might as well go to a homeopath for all the faith you have in science and medical specialists.
Dr. Jay seems unaware that the diagnosis of B. pertussis in his state is not solely dependent on PCR testing (which can give false positives) but also involves culture and immunohistochemistry as well as clinical case definitions.
The incidence of pertussis in California in 2010 is the highest in 51 years:
http://www.cdph.ca.gov/programs/immunize/Documents/PertussisReport2010-10-26.pdf
Could Dr. Jay share with us his reasons for believing that the current California pertussis outbreak is mostly not due to pertussis, assuming they are based on anything more than wishful thinking? Could Dr. Jay review the data relating to incidence in the link provided and comment on whether he recognizes that the spread of antivax misinformation is likely related to the resurgence of this potentially deadly disease?
And while Dr. Jay is gracing us with his knowledge and insight, could he spare the time to answer a pertussis-related question which he has ignored on multiple previous occasions, namely this:
Jay, you’ve admitted here that you recommend virtually no vaccines for children under the age of 10 except “maybe a DTP”. You later said this meant giving a “series” of vaccinations, but never clarified what that “series” entailed, or whether it meets the AAP/CDC recommendations for a series of five DTaP shots followed by a Tdap booster by the age of 11. Jay, when you “maybe” give the DTaP, is it the recommended number of doses to give full protection, or something less than that, and if less what is your rationale for the incomplete series?
Thanks.
Thanks Scott.
Triskelethecat @ 54:
I don’t know about pertussis (thankfully, have never had a reason to find out how my doctor would diagnose it) but although my regular doctor always orders a culture if the rapid strep test is positive (and actually often if it’s negative as well), I know that the Minute Clinics and Now Care Clinics and similar walk-in clinics don’t always do that. This is probably because they don’t have established relationships with their patients. I did have a Now Clinic actually do a culture when I was in with suspected strep (rapid test was negative) on New Year’s Day, but they never contacted me with the results. They seem to be a little hit-or-miss as far as quality goes.
@ Triskelethecat Midwife of Death: Thank you for the link. I have read it already. Very few cases of pertussis are being confirmed by culture. 76% of the cases and 90% of the fatalities are in the most underserved families in the state. These are families who do not have good access to medical care and may delayed or suboptimal care by the time they get to an emergency room.
@LW: I am giving DTaP vaccines every day. Some to children and some to parents and caregivers. I am telling anyone who asks that itâs a reasonable choice.
@AnthonyK: My primary job as a pediatrician is physical evaluation of newborns, children and teens. I discuss nutrition, anticipatory guidelines, safety issues and nutrition. I spend a great deal of my time discussing vaccination as you might imagine. Many of the families who come to see me have already decided not to vaccinate or to vaccinate slowly and selectively. While they do this, theyâd also like conventional pediatric care and observation of illnesses. I provide this.
@Dangerous Bacon: Your post is inaccurate when you say, âcomment on whether he recognizes that the spread of antivax misinformation is likely related to the resurgence of this potentially deadly disease?â because vaccination rates are at an all time high and yet we still have cyclical whooping cough outbreaks. The most likely explanation is that some whooping cough is pertussis, some parapertussis and some of the diagnoses are long colds and coughs caused by multiple toddler and childhood viruses, one right after the other. Experts acknowledge that,
âThe rise in pertussis doesnât seem to be related to parentsâ refusing to have their children vaccinated for fear of potential side effects. In California, pertussis rates are about the same in counties with high childhood vaccination rates and low ones. And the C.D.C. reports that pertussis immunization rates have been stable or increasing since 1992.â
http://nyti.ms/bEJewi
Thank you all for your comments.
Best,
Jay
I told you all last night, Jay is in denial.
OK, Dr. Jay, one question, which you didn’t answer in your long post at 61:
When a parent comes to you and says “I want my child to have the DTaP vaccination,” how many times do you vaccinate that child, and on what schedule?
Ok, I’m thoroughly confused by what Dr. Jay has posted.
Dr. Jay said,
and he provided a link. I just went to the link, and the author didn’t cite that quote. The author didn’t quote that quote. That was just the author’s opinion, as far as I can tell. But, perhaps the author is an expert in this subject, and I’m not aware of it. So let’s take that into consideration.
One of the author’s commenters is also confused by that statement, and the author followed up with,
However, in the light of these two explanations to the original quote cited by Dr. Jay, the analysis does not match the data provided by MI Dawn @#54, which Dr. Jay said that he has read.
From the article provided by MI Dawn, there are 9.2 cases per 100,000 in people over 18, and 436.9 cases per 100,000 in people 18 and under (with 317.2 of those being under 6 months of age). This data is completely at odds with the assessment Dr. Jay is citing.
I am very confused by this.
You don’t seem to want to acknowledge that overall immunisation rates are high but large, geographical clusters of unvaccinated can and do contribute to the problem of increased cases. Just because it isn’t the sole reason, doesn’t mean it doesn’t exist. Pertussis vaccine uptake in adults is still too low also. I would suggest you start reading some pertussis epidemiology, I recommend J.D. Cherry, a leading authority on pertussis.
http://projects.latimes.com/schools/2008-immunization-exemption-rate/ranking/page/1/
http://www.kqed.org/quest/blog/2010/10/13/health-officials-to-consider-tightening-vaccine-exemptions/
From what Jarred C found, it would appear that Dr Gordon’s link supports pretty much the opposite what he says. Older victims whose immunity is lost are getting sick and infecting babies who have not been immunized yet. Perfect example of why herd immunity is so important. Missing or misleading information on the effectiveness and need to immunize and stay up to date. Goes right against all that mommy science Dr Gordon believes in.
Jay Gordon: “@Dangerous Bacon: Your post is inaccurate when you say, âcomment on whether he recognizes that the spread of antivax misinformation is likely related to the resurgence of this potentially deadly disease?â
From the American Medical News:
“Immunization efforts have been further complicated by parents who are hesitant to have their children vaccinated, Dr. (Sumana) Reddy (a family doctor in Salinas, California) said. “We encounter lots of patients’ families who are pretty clear that they’re suspicious of vaccines. It’s a frustrating issue, because these are often people … who don’t understand the possible effects of going without the pertussis or mumps vaccines.””
http://www.ama-assn.org/amednews/2010/07/26/prl10726.htm
C’mon, Jay – how about telling us what your recommended “series” of DTaP immunizations might be (and if it’s less than recommended by the AAP and CDC, why you think it’s enough to protect children). And while you’re at it, do you follow up by promoting the needed Tdap booster at age 10-11 for your patients (lack of this is cited as one of the problems contributing to pertussis incidence)?
Jay Gordon: “I spend a great deal of my time discussing vaccination as you might imagine.”
We’re sure you do, Jay. When talking to your patients about their children “maybe” getting “a DTP” (or some sort of DTP “series”), do you share figures like these from the CDC’s on relative risks of getting the shots vs. getting the diseases the shots are protective against?:
“Diphtheria
Death: 1 in 20
Tetanus
Death: 2 in 10
Pertussis
Pneumonia: 1 in 8
Encephalitis: 1 in 20
Death: 1 in 1,500
VACCINES
DTaP
Continuous crying, then full recovery: 1 in 1000
Convulsions or shock, then full recovery: 1 in 14,000
Acute encephalopathy: 0-10.5 in 1,000,000
Death: None proven”
Answers, Jay*?
*we’re probably a post or so away from the return of Jay’s favorite memes, including “I can’t waste any more time here, I’ve got a job saving lives”, “No one on the payroll from Big Pharma here, noooooo” and “You’re mean people, can’t we all just get along?”.
Whenever I talk about anti-vaccine, or anti-anything related to safety, I use the seatbelt analogy.
Do you wear your seatbelt? [yes is required for it to work well, if they say no, you have to convince them that a large chance of saving their life is worth a small chance it won’t.]
Why? [Why is it the law? if that’s their answer]
(Because it will probably save my life if I’m in a car wreck.)
And a vaccine will probably protect you from a deadly virus.
(But it might give me some horrible side effect, like autism)
Well not autism, that is demonstrably unrelated, but yes. That’s about as likely as you strangling yourself to death trying to put your seatbelt on, though.
(But this doctor said so!)
And that doctor made a lot of money saying so, because free speech includes lies.
Dr. Gordon linked to an NY Times article by Tara-Parker Pope, I see.
Dr. Gordon, perhaps you can explain why a newspaper article, written by someone who has previously been demonstrated on Respectful Insolence (https://www.respectfulinsolence.com/2010/08/tara_parker-pope_and_the_new_york_times.php) as not adequately understanding the medical literature, is more compelling than official CDC documentation.
Certainly it seems a stretch to call her an ‘expert’ on pertussis & pertussis vaccination. If she’s not the ‘expert’, Dr. Gordon, who is? The CDC? MI Dawn & Dangerous Bacon seem to be honestly presenting the CDC’s viewpoints on this.
Since per Jarred’s comment #64, Tara seems to have got at least some of the details down, perhaps you can explain why we should treat his personal twist on her article as being more compelling than either her actual point or official CDC documentation.
Hmm. Proofreading good. Posting without proofreading not so much.
Oh, I love it when “Dr. Jay” tries to play in my sandbox – microbial ecology.
“Dr. Jay” in his microbiology “Quote of the Week”:
I’ll get to Dr. Jay’s “beliefs” in a bit – first let’s talk about “fastidious” as it pertains to microbial growth. “Fastidious” does not mean “difficult to culture”; it simply means that the organisms have specific nutritional requirements that must be met for them to grow. Let me cite a bit from the “Online Texbook of Bacteriology” (http://textbookofbacteriology.net/pertussis.html):
Unlike, say E. coli (the lab rat of microbiology), Bordetella pertussis (and parapertussis) needs more than “minimal media” to grow. That’s what we mean by “fastidiuous”. Of course, “Dr. Jay” could have looked that up, but I guess he was just too busy saving lives.
While Bordetella parapertussis has been making more of a showing in recent years (due to the fact that the acellular pertussis vaccine – the DTaP – doesn’t cover it at all, unlike the older DTP), it still hasn’t been shown to be the dominant “player” in the California outbreak – and it certainly hasn’t caused the “bulk” of the infections, no matter what Dr. Jay “believes.
Part of this is because B. parapertussis – which has been found to cause about 20 – 30% of clinical “pertussis” doesn’t have any competitive advantage in unvaccinated, undervaccinated and low immunity (vaccinated too long ago) patients. It also causes a much milder illness, since it lacks the pertussis toxin, and so may not be cultured as often (especially if other paediatricians are using the “Dr. Jay” screening algorithm).
As an aside, I seriously doubt that B. parapertussis is selectively targeting the medically underserved, as “Dr. Jay” seems to imply. If we assume that the ratio of B. pertussis to B. parapertussis is the same across socio-economic groups – a reasonable assumption – then the majority of cases – the “bulk”, if you will – in this outbreak are B. pertussis.
An interesting note – if you look at the microbial epidemiology literature, you’ll find studies showing a prevalence of B. parapertussis (compared to B. pertussis) similar to those seen today as far back as 1977 (Linneman and Perry. Am J Dis Child. 1977;131(5):560-563.). For reference, the DtaP – which doesn’t provide protection from B. parapertussis – was introduced in the US in 1991.
Finally, the fact that there is still a “high” level of vaccination coverage in California is rather irrelevant to this outbreak. As I discuss on my ‘blog (“When ‘Too many, too soon’ becomes ‘Too few, too late'”), a change from 96% coverage to 92% coverage doubles the number of susceptible people.
I really don’t mind doing all the work for “Dr. Jay” when it comes to microbial ecology, but I do occasionally wish he’d show a bit more humility when he’s expounding on fields outside his own – especially given how testy he gets when someone else talks about paediatrics.
Prometheus
@vicki “OK, Dr. Jay, one question, which you didn’t answer in your long post at 61: When a parent comes to you and says “I want my child to have the DTaP vaccination,” how many times do you vaccinate that child, and on what schedule?”
I tell them that I prefer to wait until one to two years of age and give a series of three DTaP vaccines spaced 2-3 months apart with a booster at kindergarten.
@Dangerous Bacon: The historical mortality rates you cite for vaccinable illnesses are not applicable to the modern day disease incidence and modern day medical care.
Dangerous Bacon, I’ve made a promise to David and to myself not to be unpleasant or uncivil here. In spite of the fact that we disagree about most vaccine issues, my impugning your motives would be wrong. You post, as do I, because you genuinely believe that your interpretation of the facts and medical literature is the best interpretation for protecting children. I respect your knowledge and have learned a lot from reading your comments. I feel differently and adhere to my interpretations. I might be wrong and continue to proceed with caution and listen here with an open mind.
Best,
Jay
Finally, an answer from Jay about his DTaP series. Oddly, it superficially resembles the schedule recommended by the American Academy of Pediatrics (including the spacing of shots) except that Jay leaves infants unprotected at their most vulnerable (by not vaccinating before age 1-2) and skips two of the five recommended shots.
So Jay gives his patients (or more properly speaking, their parents) a double whammy – the kids get too few shots to protect them, but enough of those vaccine “toxins” (formaldehyde, “antifreeze”, aborted baby parts, monkey snot or whatever else the antivaxers have dreamed up) to worry his clientele. No wonder he’s been reluctant to share details of his DTaP “series”.
Jay, if you’ve got credible information to share which contradicts the CDC on current complication and death rates from the diseases the DTaP protects kids against, please do so. Your personal say-so is unconvincing.
Jay: “I’ve made a promise to David and to myself not to be unpleasant or uncivil here.”
A promise you break repeatedly, in virtually every discussion in which you comment. I believe few here care about your faux civility – we’d just appreciate straight talk, claims backed by evidence and questions answered without prolonged dodging on your part.
Apparently Jay does not realize that being a condescending twit is not very pleasant.
@Dangerous Bacon: I’m not sure what others believe,but I know that vaccines do not contain “formaldehyde, “antifreeze”, aborted baby parts, monkey snot or whatever else the antivaxers have dreamed up” and I will say that on any forum. There is no proof that delaying vaccines, as I recommend, is safer, but my biased impression is that it is.
I’m not contradicting or even doubting the historical CDC data. It’s just that it’s no more valid than discussing surgical mortality rates from the early Twentieth Century and attempting to extrapolate that data to 2010.
Lastly, it’s not “faux civility.” I conduct myself in a civil manner in all other areas of my life and can’t believe I ever thought it was OK to be rude to you or anyone else on this forum. I was wrong.
Best,
Jay
Dangerous Bacon @ 67: Is there a summary page at the CDC website that shows those probabilities or did you cull it from the individual pages?
Dr. Gordon @ 71/74: With regards to pertussis, the relevant CDC pink book chapter (http://www.cdc.gov/vaccines/pubs/pinkbook/downloads/pert.pdf) documents complications at the following percentage rates:
hospitalization 20%
pneumonia 5.2%
seizures 0.8%
encephalopathy 0.1%
death 0.2%
and indicates that these are from data from 1997-2000.
So can you please clarify how that is equivalent to extrapolating mortality from early 20C surgical techniques to today?
Also, the CDC pink book chapter on diptheria indicates the follows with regards to diptheria mortality:
Just in case, I should mention that these figures come from the 2009 11th edition of the pink book (Epidemiology and Prevention of Vaccine-Preventable Diseases).
It really seems to me that saying “I’m not anti-vaccine, I’m against the horrible dangerous toxins that cause autism and asthma and auto-immune disorders in the vaccines” is a little like saying “I’m not anti-Semitic, I’m just against the Jewish banker conspiracy that controls the world’s governments.” Given that the evidence does not exist which would convince an unprejudiced person of the existence of the toxins/conspiracy, to express one’s certain belief in the toxins/conspiracy is practically equivalent to admitting the prejudice that substituted for evidence.
Waitwaitwaitwaitwait…Jay @ 74, did you actually say “There is no proof that delaying vaccines, as I recommend, is safer, but my biased impression is that it is.”? As in, you are gambling with childrens’ lives, both your patients and the people they expose or are exposed to, because of your biased opinion? There is no proof your delayed schedule is safer, and then on the other side of that there have been outbreaks and deaths due to low or no vaccination. Wouldn’t that demonstrate that you’re wrong? That advice like yours is harmful? How on earth can you consider yourself a healer?
Well, you “know” it after this conversation.
Dr. Jay, 2008:
What will you “know,” one wonders, two years from now?…
And if 1997-2000 is still too ancient for Dr Jay to use as a source of pertussis complications, he can use the data from 2001-2003.
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5450a3.htm
The inconsistency here is really quite illustrative. Jay admits to not having proof, but believes it anyway. It’s not a matter of facts or science, but faith. A better illustration of the fact that the antivax movement is fundamentally a cult, I have yet to see.
I wonder, does Jay tell his clients that there is no scientific basis to the idea that delaying vaccination is safer?
I mean, he wouldn’t want to mislead them or make them less than fully informed, right?
I wonder, does Jay tell his clients that there is no scientific basis to the idea that delaying vaccination is safer?
I mean, he wouldn’t want to mislead them or make them less than fully informed, right?
“Dangerous Bacon @ 67: Is there a summary page at the CDC website that shows those probabilities (for pertussis complications) or did you cull it from the individual pages?”
I quoted stats from a CDC link discussing common vaccine misconceptions. You can find them in the section on pertussis vaccine.
Here’s an excerpt from a 2009 emedicine.com article on pertussis and its complications (link not provided due to restrictions on multiple links in a comment – you can find the article by searching under emedicine and pertussis).
“Today, about 10-25% of children younger than 4 years and 2-4% of all persons with pertussis secondarily develop bacterial pneumonia. Approximately 1-2% of infants and 0.3-0.6% of adults develop seizures, which are believed to be a result of hypoxia or cerebral hemorrhage from the prolonged coughing spells. About 0.1% develop encephalopathy.”
So we’re not talking about “early 20th century” risks of pertussis infection, Jay. This is current information.
It’s truly weird (and irony meter-busting) that Jay Gordon complains (without foundation) that information presented here about disease risks is out of date. Yet his website suggests that parents can keep their kids healthy just fine using herbs like astragalus, echinacea and goldenseal* (noting the lack of evidence for their efficacy but relying on historical use). So Jay is ignoring 21st century medicine in favor of 19th century nostrums and fears.
*Goldenseal is currently threatened in the wild because of overzealous harvesting, sad seeing that the evidentiary basis for its use is particularly poor. Jay’s recommended reading list should include articles on how plants and animals are being driven to extinction due to inaccurate historical beliefs about their medical uses.
It just struck me how closely related Jay’s attitude is to Orac’s post at 3:00 yesterday…
@87: You weren’t the only one to notice. I posted a comment to the same effect.
Jay Gordon seems to be the kind of person who chooses words based on expected reaction, rather than meaning. The problem is, we aren’t reacting the way he’s expecting us to. He says “This is all about parent’s choice!” He expects us to back down, saying “No! We can’t get in the way of the parents!” Instead, we go “You can’t make good decisions with the poor information you’re giving them!” He’s not used to being called out on the emptiness of his words.
I notice that Jay still gets it wrong with regard to formaldehyde. Jay, there actually is some formaldehyde in some vaccines. The thing is, though, that it is in such tiny amounts as to be negligible. That, coupled with the fact that your body normally produces significantly more formaldehyde as a product of metabolism, and then uses it in the production of amino acids and proteins, means that the amount found in vaccines is not harmful.
It sucks but I have to defend Dr. Jay on two things. (Not all things.) Just for logical consistency.
First, he’s right that vaccine refusal has, as far as we know so far, nothing to do with the pertussis outbreaks. They said that right over at Science-Based Medicine. Pertussis outbreaks are periodic, and mostly carried among the adult population.
(We now have an adult booster, so we may be able to stop the next outbreak — or blame it on vaccine refusal among adults if we can’t stop it.)
You haven’t found a logical contradiction. There is nothing internally inconsitent with saying “I don’t know X is safer, but I recommend it anyway.” There are lots of things I do during my day that I think make me safer, but have not been proven.
Of course, you can point out evidence that X is actually more dangerous. That would be a valid critique, and I expect someone has already done something quantifying the precise risks of vaccine delay.
I’m not defending the other things he said. Please be aware of that.
Dan said: “First, (Jay’s) right that vaccine refusal has, as far as we know so far, nothing to do with the pertussis outbreaks. They said that right over at Science-Based Medicine. Pertussis outbreaks are periodic, and mostly carried among the adult population.”
Prometheus and Science Mom have already dealt with the issues of spotty vaccination coverage in certain localities/schools and the impact of even “minor” drops in vaccine coverage. I’ll point out that much of the current pertussis outbreak in California is hitting children and adolescents (as opposed to adults); this article notes that the bulk of cases in one of the hardest hit counties (Marin) is in 5 to 17-year-olds. The article further notes that California is a state that doesn’t require a pertussis booster in early adolescence, so only a minority of kids are getting it.
And if we look solely at vaccination rates, we’re missing the potential impact of parents who delay getting their kids vaccinated according to arbitrary, non-science based “schedules” of doctors like Bob Sears and Jay Gordon.
Can we say for sure that the spread of antivax misinformation is responsible at least in part for suboptimal vaccine coverage in California and thus led to its pertussis outbreak? No – but there’s good reason to suspect that it has played a role in the disease’s spread. (it of course doesn’t help that there are people like Jay Gordon who deny the existence of an outbreak and project the impression that parents need not feel any urgency about protecting themselves or their children.)
“There is nothing internally inconsi(s)tent with saying “I don’t know X is safer, but I recommend it anyway.””
I agree with Dan on this. Jay Gordon is not “inconsistent” when he says he has no proof of his delayed vaccine “schedule” being safer but thinks it is anyway. His statement is arrogant, ignorant and demonstrates a lack of understanding of how medicine should be practiced…but it’s not inconsistent. It’s actually quite consistent with the nonsense he’s been promoting all along.
Dangerous Bacon, thanks for the kind response. And I agree with your other characterizations of Jay Gordon’s statement re: proof.
I based a lot of my understanding of the pertussis epidemic on this SBM article by Steven Novella. In particular this quote:
I would certainly say that skipping or delaying pertussis vaccinations for children in the face of this surge is unwise. But I’m not sure it’s a cause of the epidemic.
I notice you attack the messenger, instead of debating the message. In reality, The scientific evidence, not only anecdotal, is overwhelmingly in favor that vaccines are useless and dangerous. It seems that most of your credibility with people in your writing comes from your wit and well-articulated wording, as opposed to any real source of common sense. You come off as smart, so the less educated tend to believe you know more. But in the end, your wrong.
You speak of global warming deniers, for example? Get a thermometer and record temperature averages each year. The world is cooling off, that’s why the global warming movement has fallen apart.
As for vaccines? Well, the science is there. The only science supporting vaccines is sponsored by the corporations that produce the vaccines. That tell’s you something.
Dan Weber,
I would use the analogy of a building that violates regulations pertaining to fire safety, and which suffers a blaze because somebody carelessly dropped a lit cigarette. The violations weren’t the cause of the blaze, but if they hadn’t been committed, the blaze would not have been as severe.
All right, who left the troll food out? I’ve told you and told you, if you don’t lock it up, they will all come over. Geez, first Jen on the other thread, and now Clueless Dustin who is giving all the AOA points he can muster.
@Dan Weber: You’re right; Dr Jay isn’t all bad. He’ll occasionally admit his mistakes, unlike Jake; he just doesn’t learn from them.
MI Dawn
Wrong, wrong and wrong.
Wrong and wrong.
No, you’re wrong.
Right, and thankyou.
Then you should have no trouble producing said evidence. PMID references will suffice.
Again, citation needed.
“Vaccine safety” produces 8780 hits on PubMed. “Vaccine efficacy” 15546. I await your demonstration that all of them either do not support vaccination, or were sponsored by vaccine manufacturers.
Aaaaahahahahaha!
Dustin, if vaccines are useless, perhaps you can explain the following:
(1) What happened to smallpox and why.
(2) This graph of historical measles incidence rates in the US.
As requested by Scott, references to peer-reviewed literature on PubMed are preferable.
I eagerly await the “evidence” that Dustin will provide for his point of view, which is to say little to none at all.
Yeah, I’m not exactly holding my breath over here either.
Although, in a spirit of perversity, I AM literally holding my breath as I type this sentence and click ‘Post’.
Dustin, please look that the following table of measles incidence starting in 1912 (which is where the graph Composer99 linked to comes from). Can you please tell me what happened between 1960 and 1970 (and no other decades)? Thank you.
From http://www.census.gov/prod/99pubs/99statab/sec31.pdf
Year…. Rate per 100000 of measles
1912 . . . 310.0
1920 . . . 480.5
1925 . . . 194.3
1930 . . . 340.8
1935 . . . 584.6
1940 . . . 220.7
1945 . . . 110.2
1950 . . . 210.1
1955 . . . 337.9
1960 . . . 245.4
1965 . . . 135.1
1970 . . . . 23.2
1975 . . . . 11.3
1980 . . . . . 5.9
1985 . . . . . 1.2
1990 . . . . .11.2
1991 . . . . . .3.8
1992 . . . . . .0.9
1993 . . . . . .0.1
1994 . . . . . .0.4
1995 . . . . . .0.1
1996 . . . . . .0.2
1997 . . . . . . 0.1
How much of that reduction in measles incidence is due to vaccinations?
Difficult to put an exact number on it. But, note how exactly the huge plummet corresponds with mass vaccination. And also observe that when vaccination rates drop, the disease comes back with a vengeance (see Britain post-Wakefield). Accordingly, we can be highly confident that the great majority of that drop is due to vaccination.
Needlenose:
There are three different years you must find out what happened. The first is 1963. The second is 1971. And the third is 1978. The answers are here.
Now what happened to cause this:
1960 . . . 245.4
1965 . . . 135.1
1970 . . . . 23.2
?
Another quick question, Needlenose, what other mechanisms exist to reduce the spread of a highly contagious air borne respiratory virus? It is obviously not “sanitation” because that would not explain why measles returned with a vengeance to both Japan and the UK.
“Difficult to put an exact number on it.”
An approximate number would do. I ask since with mass vaccination also comes mass awareness, and with awareness comes preventation measures other than immunization. Obviously, over the course of human history infectious diseases have come and gone without vaccinations available so there is a natural life cycle to infectious disease even without vaccinations that can account for variation. Also, how do you know that the reduction in measles after mass vaccination wasn’t due to the placebo effect? Thx.
Needlenose, you must answer the questions asked of you before you get to ask more.
Though, here is a hint: Read the whole series.
“Another quick question, Needlenose, what other mechanisms exist to reduce the spread of a highly contagious air borne respiratory virus? It is obviously not “sanitation” because that would not explain why measles returned with a vengeance to both Japan and the UK.”
The other mechanisms that exist to reduce the spread of a highly contagious air borne respiratory virus would be:
1) Better hygiene
2) Natural life cycles of infectious agents
3) Mutation of pathogen altering its virulence
4) Natural immunity
5) Modification of behavior to reduce infection
There are likely more I am missing but does that answer your question?
Exactly how did those five things happen between 1960 and 1970? Provide something more substantial than wild guesses.
If there was a change of bathing habits and sanitation systems, then provide some documentation. Explain how that reduces an air borne virus by 90%. Remember that Japan and the UK have had a resurgence of measles in the last fifteen years, have bathing habits and sanitation habits changed dramatically in the last two decades?
What do you know about the life cycle of a virus? Is it even alive outside of a host? How many different hosts does the measles virus have?
If the measles virus changed dramatically in those ten years, provide the scientific paper documenting that change.
There is a cycle of epidemics as new children are born, get infected as group and then are immune. Those cycles are about five years, the decade spans ten years. That was explained in the link to a series on measles I provided. Have you read it?
What behavior was so vastly modified between 1960 and 1970 in the USA? Explain how this would reduce incidence of measles by 90%. Provide references to support your answer.
Also, you said
What diseases are those? Explain how they are similar to the measles virus.
Don’t you dare say “bubonic plague”, because that is a bacterial infection that has not gone away. Also, do not include cholera, which is now plaguing Haiti. And no other water born pathogens, stick to air borne viruses. Which also means no diseases that have insect vectors like yellow fever, malaria or typhus.
The reason the bubonic plague is not as prevalent today is because it’s not transmitted person-to-person. The rarer pneumonic plague is transmitted person-to-person, however.
“Exactly how did those five things happen between 1960 and 1970? Provide something more substantial than wild guesses.”
I’ll provide more than wild guesses when you do as well. You are claiming that the reduction in measles was due only to vaccinations and no other factors, and it seems your only proof of this is that I don’t have proof that it was due to something else. Also. how do you know the reduction wasn’t caused by the placebo effect? My doctor is always claiming that any improvement in health through supplements is due to placebo effect so why isn’t the same also true with measles vaccinations?
You’re kidding, right?
No one could possibly be this stupid and be able to breathe.
Needlenose, before I waste anymore time on you, prove that you have actually read the links I have provided. You can do this by answering the question I asked Friday:
What happened in three different years in regards to the control of measles in the USA? The first is 1963. The second is 1971. And the third is 1978.
Just to me nice, I have two more links for you to read:
Efficacy of measles vaccine
and
Measles Control in the United States: Problems of the Past and Challenges for the Future
Now exactly how magic are your placebos?
@113
Unfortunately, there are.
Needlenose, you need to learn about something called the philosophic burden of proof. At one point we had no evidence that a measles vaccination would reduce the incidence of measles; we had a lot of prior plausibility from over a century’s worth of experience with other vaccines, indicating that a successfully made measles vaccine should reduce the incidence of measles, but at that time, before the vaccine entered trials, the burden of proof was on those who thought the vaccine would reduce incidence to prove it.
And over the past forty years, that’s exactly what happened: the accumulated evidence did prove it. The evidence is there; your unwillingness to look at it or inability to comprehend it does not change the fact that it is there. We’ve been doing our best to help you understand the evidence but whether you understand it or refuse to, the proof is there.
Which means that, if you feel like you need to challenge the well-accepted fact that measles vaccination reduces the incidence of measles, the burden of proof falls upon you to assemble a convincing argument to that effect. Our proof that measles vaccination reduces measles incidence is based on forty years of data; if even you admit that “I don’t have proof that it was due to something else” then it’s no wonder that no one is particularly convinced by your suggestion that it was due to something else.
“It’s the placebo effect” is a reasonable hypothesis in certain cases, especially where a) the benefit is entirely subjective or b) the benefit, subjective or objective, could be induced by behavior. An example of the former might be a patient who takes a supplement that is purported to improve their mood, and receives a mood lift, not from the supplement but from their expectation of getting a mood lift from the supplement. An example of the latter would be a patient who takes a supplement that is purported to give them more energy: overjoyed at the prospect of having more energy, they start exercising and when they in fact do wind up with more energy, they attribute it to the supplement … overlooking the fact that exercising itself will give you more energy.
These explanations make no sense, however, when a) the effect is objective and cannot be induced by behavior and/or b) the effect is seen only in those who think they have received the intervention and have received it, not in those who thing they have received the intervention but have only received a placebo. Both of these are true of measles vaccines, which have been tested in placebo-controlled trials: those who receive the vaccine develop high antibody titers, and those who receive the placebo do not. Obviously there is no easily taken behavior which induces a high antibody titer (else we would not have needed to develop a measles vaccine!) but even if there was, there would be no explanation for why only the people in the vaccine groups would have taken that behavior and not those in the placebo group, when no one knew which group they were in.
So for these reasons, the placebo effect makes sense for the kinds of “improvements in health” people typically attribute to supplements but does not make sense as an explanation for the reduction of measles incidence.