Yesterday, I congratulated that bane of anti-vaccine movement and great vaccine scientist, Dr. Paul Offit, for having been accepted into the Institute of Medicine. It’s a huge honor, and one well-deserved. At the time, I contrasted Dr. Offit, who has ascended to the highest heights of his profession through good science, with Dr. Andrew Wakefield, architect (or at least the most important architect) of the anti-MMR hysteria that gripped the U.K. in the late 1990s that’s only now starting to abate, who is reduced to speaking in front of crank physician groups, being feted at anti-vaccine conferences, and appearing at crank anti-vaccine demonstrations pathetic even by the standards of crank anti-vaccine demonstrations. It almost makes me feel sorry for Wakefield. Almost.
In any case, at the time I said I’d try to soldier my way through the video of Wakefield speaking at the annual meeting of the Ayn Randian crank physician group the American Association of Physicians and Surgeons (AAPS). And try I did. I really did. But even alcohol wasn’t enough to get me through all 45 minutes, and, given that it was a work night, I was limited to only one or two beers at most. That’s not nearly enough. Deconstructing this much concentrated, neuron-apoptosing idiocy is a weekend project. Actually, it’s a vacation project, because I’d need to ask one of my partners to cover for me. Wakefield’s just not worth it.
So, I had to find a different way to honor Dr. Offit, and I found it in an article that was just published. It’s by Anna Kirkland at the University of Michigan entitled The Legitimacy of Vaccine Critics: What Is Left after the Autism Hypothesis? I don’t agree with everything in the article, but it’s a good primer on the recent history of the anti-vaccine movement and speculates on what will come next now that the hypothesis that vaccines cause autism has been so thoroughly discredited.
Let’s dispose of one thing right away that I don’t particularly like about the article:
The last dozen years have seen a massive transnational mobilization of the legal, political, and research communities in response to the worrisome hypothesis that vaccines could have a link to childhood autism and other developmental conditions. Vaccine critics, some already organized and some composed of newly galvanized parents, developed an alternate world of internally legitimating studies, blogs, conferences, publications, and spokespeople to affirm a connection. When the consensus turned against the autism hypothesis, these structures and a committed membership base unified all the organizations in resistance. This article examines the relationship between mobilization based on science and the trajectory of legitimacy vaccine criticism has taken. I argue that vaccine critics have run up against the limits of legitimate scientific argument and are now in the curious position of both doubling down on credibility-depleting stances and innovating new and possibly resonant formulations.
While Kirkland gets a lot right in her article, I don’t like the way she writes, “when the consensus turned against the autism hypothesis.” The reason, of course, is that the scientific consensus was never for the autism hypothesis to begin with. In strictly scientific terms, the very most you can say about the vaccine-autism hypothesis is that for a brief period of time scientists considered it not sufficiently implausible (barely) to ignore completely, particularly given that the fear mongering of the anti-vaccine movement was having an effect on public confidence in the vaccine program. Over the last 15 years, numerous studies have been done, and none of them performed by reputable scientists using rigorous methodology have found a hint of a trace of a whiff of an association between vaccines and autism. As I’ve said before, the vaccine-autism hypothesis is no more! It has ceased to be! It’s expired and gone to meet its maker! It’s a stiff! Bereft of life, it rests in peace! If anti-vaccinationists hadn’t nailed it to the perch it’d be pushing up the daisies! Its metabolic processes are now history! It’s off the twig! It’s kicked the bucket, it’s shuffled off its mortal coil, run down the curtain and joined the bleedin’ choir invisibile!! The vaccine-autism hypothesis IS AN EX-HYPOTHESIS!!
To which, the anti-vaccine movement always replies, “It’s pinin’ for the fjords.”
Sorry. I know I use that routine too much, but it’s so appropriate. I try to make sure that there are at least a few months between uses. Of course, an alternate Monty Python analogy for the vaccine-autism hypothesis is that it’s very much like the Black Knight in Monty Python and the Holy Grail, with science playing the role of King Arthur. Kind of like:
Millions and millions of federal research dollars have been spent in response to parents and their advocates’ calls for answers. The mainstream consensus from scientists and the courts has been overwhelmingly against any connection between vaccines and autism. Although all of these expenditures may now seem a waste of resources on a discredited hypothesis, we must remember that uncertainty existed initially and that the question was extremely urgent.
It fairly rapidly became apparent that this hypothesis had lost its arms and legs. After the early 2000s, there was plenty of evidence to conclude quite reasonably from a scientific basis that there was no correlation between vaccines and autism. Arguably, far more money has been spent on this question than actually needed to be spent to answer the question, and more continues to be spent. No doubt anti-vaccine advocates will try to portray this viewpoint contemptuously as “science has spoken” or “the science has been settled,” but in fact science has more or less spoken and the science has been pretty well settled. Scientists have looked and looked and looked for a correlation between vaccines and autism and just haven’t found it. That doesn’t completely rule out a link in rare situations, but it’s pretty persuasive evidence that neither vaccines nor the mercury that was in many childhood vaccines until the end of 2001 are causes of the “autism epidemic.”
What’s more interesting is the question that Kirkland asks next. After a description of the Autism Omnibus, she wonders, “But what should we make of vaccine critics now, who have had such power to activate a research agenda, command political attention, and conduct years of litigation, as the consensus has settled against them?” While it’s easy to be Orac and answer as a bit of a smart-ass that there’s nothing new to make of them because they’ve always been a bunch of promoters of pseudoscience with an extreme hostility towards legitimate science when it doesn’t say what they believe and what they want it to say. However, arguably, there is a change in the anti-vaccine movement now that its best shots have come up short, with study after study going against it and its lynchpin effort (the Autism Omnibus) crashing and burning.
Kirkland then decides to discuss what she considers to be the two most important and influential anti-vaccine groups, the National Vaccine Information Center (the NVIC, Barbara Loe Fisher’s group) and SafeMinds (Sallie Bernard’s group), both of which she describes as the “go-to representatives for vaccine concerns in the policy process” and as having “no real competitors.” I had to chuckle at that passage, because that’s “gonna leave a mark,” as they say, on J.B. Handley and his group Generation Rescue. In fact, I’m half-tempted to e-mail J.B. a copy of the PDF file. Whatever J.B. thinks about being so seriously snubbed, I’m not sure I agree with Kirkland here in virtually completely dismissing Generation Rescue thusly:
This organization is oriented to serving parents much more than it is focused on policy, so it is not as important to this analysis.
Be that as it may, Kirkland accurately describes the increasingly large series of papers that started hitting the medical literature in the early 2000s that failed to find any correlation between vaccines and autism or thimerosal in vaccines and autism. She also concisely describes the fall of Andrew Wakefield, all the way to the General Medical Council of the U.K. stripping of him of his license to practice, appropriately pointing out that he is a “charismatic leader” upon whom the anti-vaccine movement relied too much, such that when his fall came they didn’t know what to do. Pointing out that the MMR vaccine never had thimerosal in it, she writes:
Policy makers and experts in the vaccine program believe vaccines are a lifesaving intervention backed by a proven system of pre-and postlicensure testing and surveillance, and that adverse events are rare. Critics believe that vaccines are damaging on a wide scale and promoted in bad faith by corrupted officials. All the vaccine-critical organizations have doubled down on the autism hypothesis and continue to embrace its discredited expositors (Habakus and Holland 2011; Fisher 2010). This gulf has been unbridgeable.
It’s amusing how Kirkland cites the book by Louise Kuo Habakus and Mary Holland’s book Vaccine Epidemic, as evidence of how the anti-vaccine movement still embraces discredited expositors of the vaccine-autism hypothesis. In any case, it turns out that Kirkland did a lot of her research attending the 2009 NVIC conference in order to see the “scientific leaders” of the anti-vaccine movement up close and personal, eschewing Generation Rescue’s preferred conference, Autism One, as being primarily geared at parents and:
Autism One is also known for excluding journalists perceived to be hostile to the conference’s message, while the NVIC event was explicitly open to the public. My IRB approval does not include any deceptive presentation, nor would I have been comfortable posing as a parent of a child with a disability.
I’m starting to like this Anna Kirkland, even though I don’t agree with all her conclusions. She is more or less accurate, however, in describing what she calls the “typology of vaccine critics.” These include what she terms “activist parents,” whom she notices as tending to be “white and middle to upper income with college degrees.” These parents usually have a child with a disability, these days most frequently autism or a related disorder, and blame vaccines. The next type of “vaccine critic” (I dislike that term; Kirkland should call them what they are: Anti-vaccine) is comprised of allied health professionals with longstanding anti-vaccine views. These included various “alternative medicine” practitioners, chiropractors, vaccine “skeptical” MDs like our old friend Dr. Jay Gordon (whose recent appearance on TV might be blog fodder soon), and others. Kirkland characterizes them as often basing their opposition to vaccines in libertarian (or, as I would have called it, “health freedom”) political view and providing “critical funding and publicity,” along with an air of legitimacy:
These professionals share an antiregulatory political agenda that keeps them in opposition to government regulation of supplements by the U.S. Food and Drug Administration or to heath care reforms like the Patient Protection and Affordable Care Act or the creation of registries and tracking of vaccination rates. The libertarian physicians are opposed to electronic medical records, for example, and no one who shares their perspective would support participation in the public health surveillance that would help to monitor postlicensure safety of vaccines and drugs (e.g., a national vaccine registry). Members of this group hold the most extreme views, such as denying that HIV causes AIDS (Null 2001), so managing the balance between pleasing them and keeping their views from hurting wider credibility is a big challenge.
The AAPS is an organization that fits this description almost perfectly. It embraces many forms of denialism, including vaccine denialism, anthropogenic global warming denialism, and the unsupported claim that abortions cause breast cancer. No wonder it embraced Andrew Wakefield.
Tbe remaining categories include donors, “researchers” (quotation marks mine; I wouldn’t have called the likes of Mark and David Geier “researchers” by any stretch of the imagination), and journalists, bloggers, and other media producers. Many familiar characters are discussed, such as the aforementioned Geiers, David Kirby, Arianna Huffington and her stable of Huffington Post anti-vaccine bloggers and quacks who have turned HuffPo into such a wretched hive of scum and quackery, and the like. She does at least note that the anti-vaccine movement’s “researchers” tend to publish in non-peer-reviewed journals of very low repute.
Putting it all together, Kirkland proposes three different competing underpinnings of anti-vaccinationism. These include “holistic health ontology.” This is, of course, no surprise to anyone who’s been following the anti-vaccine movement as long as I have:
On this view, diseases of the past were actually defeated by sanitation, homeopathy, and nutrition, not vaccines. Attributing their vanquishing to vaccines is part of the orthodoxy of mainstream medicine. The foundational disagreement is whether the germ theory of disease is central to medicine (for a book- length treatment, see Baker 1994, Appleton 2002, and Trebing 2004). As Palevsky (2009) put it in his conference address: “So, in our conventional teaching, there’s this germ theory. And the theory is that microorganisms are the cause of many diseases. . . . Might I say that this is just a theory. Germs may play a role in children getting sick, but they may not be the reason that children get sick.”
Germ theory denialism, anyone?
Then, of course, there is the libertarian “health freedom” perspective:
The vaccine-critical movement is quintessentially neoliberal, blending holistic self-care with the elevation of the individual and the private family over collective goods. Maternal management of every possible risk to her own children becomes paramount (Kaufman 2010).
It has been said that anti-vaccine activists are in essence selfish in that arguments involving social responsibility and herd immunity fall on deaf ears when directed at them. Remember my discussion of how alternative medicine produces the “illusion of control.” The anti-vaccine movement is a perfect example. Many of these parents seem to think that they can prevent all diseases through giving their children the right diet and the right lifestyle. If necessary, they choose when to infect their children (“pox parties”) in order to give them “natural immunity” (as opposed to vaccine-based immunity, which they reject as “unnatural”). They also take umbrage when it is pointed out that their unvaccinated children are potential pools for vaccine-preventable diseases to spread, an assumption seemingly based on their tendency to all-or-nothing thinking. To their way of thinking, if vaccines are 100% effective, then the vaccinated have nothing to fear from the unvaccinated. Would that were true!
Where Kirkland stumbles is in characterizing the last underpinning of the anti-vaccine movement as the “vaccine safety perspective” because, if you really take a close look at claims that, “I’m not ‘anti-vaccine, I’m pro-safe vaccine” or claims of being a “vaccine safety advocate,” you will inevitably find that this is just a smokescreen for anti-vaccine views. Kirkland appears not to understand this and actually takes “pro-safe vaccine” wing of the anti-vaccine movement at their word. Even though she correctly identifies why a randomized “vaccinated versus unvaccinated” study would be inherently unethical, she fails to realize that all these calls for studying “vaccinated versus unvaccinated” populations are in reality both a fishing expedition and a delaying action. She quotes Vicky Debold saying, “We ask that the government begin to fund research that evaluates the effect of vaccination, against no vaccines at all, on biomarkers of immunity, biomarkers for metabolic dysfunction, neuro-developmental outcomes, including autism, immune-mediated illnesses of all sorts, autoimmunity, allergies, asthma, epilepsy, intellectual and learning disabilities, all the things that we know are epidemic in our children. We ask for all of that.” Unfortunately, she doesn’t realize that for a study to be ethical it is also necessary that there be preclinical and epidemiological data supporting the need for such a study, and there just isn’t any such compelling data suggesting that all these biomarker studies would be fruitful or likely to find anything of value, particularly given that there are already plenty of studies failing to find any links between vaccines and autism, learning disabilities, asthma, and adverse neurodevelopmental outcomes. Similarly, Kirkland doesn’t seem to understand that the purpose of calling for studies looking for subgroups that are “hypersusceptible” to vaccine injury serves a similar purpose. They function to create doubt where scientifically there is little or no doubt. They serve to provide the illusion that there is a scientific question remaining.
In fact, these studies are nothing more than moving the goalposts. When studies failed to find a relationship between thimerosal in vaccines and autism, anti-vaccinationists started invoking the “toxin gambit” in which they point to every single scary-sounding chemical in vaccines and claim that they have to be studied for safety. Or another good example is how after studies failed to link vaccines to autism anti-vaccine activists pivoted effortlessly to claim that it was “too many too soon” that were “overwhelming” the immune system as a rationale for delaying vaccines. No matter what scientific studies come out failing to support the anti-vaccine hypothesis du jour, anti-vaccine activists always–always–find a way to shift the goalposts to a new hypothesis. These are not legitimate “vaccine safety” activists. In fact, I highly doubt that such a creature exists, at least not affiliated with organizations like the NVIC or SafeMinds. Moreover, there is always one characteristic in all of the hypotheses of autism causation that these groups propose. Like the “fixed point in time” in the last couple of seasons of Doctor Who, the fixed point in time and space in the anti-vaccine universe is that, whatever reason for autism causation anti-vaccinationists think of, vaccines will always somehow be involved as a cause. Always. Because to them, it’a always about the vaccines.
None of this stops Kirkland from ending with a plea:
There will no doubt continue to be a vaccine-critical movement composed of all the parts described here, but it will be interesting to see how different components manage this new context of diminished scientific resonance for the claims of the last decade. One view of the role of advocacy groups in democratic government is that they play a critical role in keeping important items on the agenda, synthesizing information for the general public, and promoting accountability. Vaccine safety is a critically important public concern, but I fear we have not been well served by leading groups who currently own the issue. My hope is that vaccine safety advocates will reorient themselves toward critical yet epistemically responsible collaboration with vaccine policy makers. Unfortunately, that route looks increasingly difficult because of the alliances that have held the movement as a whole together.
“We have not been well-served” by SafeMinds and the NVIC? Ya think?
To be fair, we all hope that vaccine safety advocates, if there are any left affiliated with the anti-vaccine movement, will dissociate themselves from the cranks and become a force for science-based vaccine policy. I’m just not going to hold my breath waiting. Kirkland gets a lot right in her post. Unfortunately, she falls into the same trap that a lot of people naive to the movement tend to fall into, namely the trap of not realizing that the anti-vaccine movement is an anti-science movement that promotes pseudoscience and is unrelentingly opposed to vaccines. People dedicated to actual science don’t associate themselves with the anti-vaccine movement; hence, these fantastical “reasonable” activists who are “pro-vaccine safety” are not to be found in or associated with groups like SafeMinds, the NVIC, or Generation Rescue. Such people might have existed at one time (indeed, Barbara Loe Fisher probably originally fit the description of a “vaccine safety advocate” back in the 1980s when she got started but long ago devolved into anti-vaccine crankery), but in the anti-vaccine movement of the last decade or so? Not so much. It’s a shame Kirkland apparently didn’t realize that, but on the other hand she did an excellent job of pointing out how marginalized the anti-vaccine movement has become. It’s rapidly on its way to joining creationists far out on the fringe.
Of course, perhaps it only seems that she falls into this trap because you can’t explicitly call a crank a crank in academic literature. Let’s hope so. In the meantime, the anti-vaccine movement, having had the last shred of its already underwhelming scientific credibility reduced to nothing, is descending further and further into denialism and pseudoscience.
REFERENCE:
Kirkland, A. (2011). The Legitimacy of Vaccine Critics: What Is Left after the Autism Hypothesis? Journal of Health Politics, Policy and Law DOI: 10.1215/03616878-1496020
165 replies on “Whither the anti-vaccine movement?”
I agree the term “vaccine critics” is a convenient euphemism when all scientists are critics – we try to make things better and discover new things while assessing published work.
I also wish folks writing reviews like this would reinforce the distinction between science and belief: I don’t believe in science and data – I accept it.
Some anti-vaccinationists just cannot get enough of that toxins gambit.
Our awesome Dr Rachael Dunlop wrote a wonderful and easily accessible article for an Australian website, Mamamia, to highlight vaccine myths for a wider and general readership. The article has gone gangbusters.
http://www.mamamia.com.au/news/vaccination-myths-busted-by-science-cheat-sheet-on-immunisation/
A follow up episode was aired on the Mamamia weekly TV panel, produced on Sky News Australia. This is really worth watching for the bravery of the McCaffery Family, and the reactions from the panel. Dr Rachie appears on this program. Segment starts at 12:50:
http://www.mamamia.com.au/news/mamamia-on-sky-news-episode-11-vaccination-debates-real-victims/
Meryl Dorey, aforementioned anti-vax loon, decided she was going to counter Dr Rachie’s article with a series of nine blog posts, each ending with the exclamation “MYTH BUSTED”. This is simply embarrassing:
http://avn.org.au/nocompulsoryvaccination/?p=1143
Meryl Dorey chants triumphantly “WHY HASN’T DUNLOP REPLIED TO MY POSTS?”
The audience shifts uneasily in their seats, and coughs sometimes not politely.
Oddly, yet true to form, Dorey has not followed through with myth-busting posts 4 – 9.
There is one group of anti-vaxers that is older and left out of this blog. I don’t know if there are widespread in the US, but in the Netherlands there were also people (in the socalled bible belt) who refused vaccines out of religious reasons. This caused an outbreak of polio in 1971.
http://en.wikipedia.org/wiki/Staphorst
I think you have chosen a good way to honour Dr.Offit..
“Vaccine critics, some already organized and some composed of newly galvanized parents, developed an alternate world”
Kirkland certainly got that part right.
@Hank, The Reasonable
Dorey’s argument against Dr. Rachie…
I tried several times to leave comments on her blog that, yes, vaccines contain those ingredients, but they are not “toxic” at those concentrations. Thus, the vaccines do not contain toxic ingredients, only ingredients that – just like chocolate – are toxic at high concentrations. Of course, asking for her to be honest and truthful to the people she places in danger by misinforming them on vaccinations is like asking my two year old cat to sing me “Nessum Dorma”.
I see the core anti-vaxxers, after being dismissed by the mainstream media, becoming more dependent upon the woo-meisters for a ready-made audience ( Jenny et al used to appear on CNN; now that channel’s Anderson Cooper is vilified): this sounds a lot like what I hear from the usual suspects- the media is corrupt and in cahoots with BigPharma/ Government.
So they seek other routes: lobbying governments for changes in vaccine requirements for schooling, seeking legal solutions ( notice the number of lawyers involved US/UK ), and expanding their venue to include other complainers against the System ( the Canary Party’s list of ailments caused by the evils of society/corporations goes far beyond autism); some even set their sites upon the OWS crowd.
These adjustments will probably take them further out of the mainstream to that place where there is a vast nearly- untapped reservoir of crazy: I think that this propensity has always been there- they draw from the same wells- alt med, because it is not based upon science and research, doesn’t set limits and bleeds into other areas of spurious inquiry. We should never forget that there is another natural ready-made audience : television like Dr Oz’s show integrates woo seamlessly into stories about SBM as well as the natural foods movement, which is becoming BigBusiness itself.
Renate–
We have some of those people in the United States, including (but almost certainly not limited to) Christian Scientists. A friend of mine was raised by Christian Scientists, and has had almost none of the standard vaccines. She had none at all when she was a child; as an adult, she has been vaccinated against yellow fever (required for a visa to visit Africa) and I think had a tetanus shot. Rationally, she doesn’t accept the Christian Science doctrines, but there’s been no impetus for her to go back and get things like an MMR shot.
As if to illustrate my point: Mike Adams( today @ NaturalNews) rails against anti-depressants, the gold-standard Pharma-poison, then provides natural solutions ( e.g, spend more time with Nature; fish oils).
Both he and anti-vaxxers share a similarly jaundiced view of pharma products ( as do some people with SMI): the former believes that they destroy society, the latter that they ( in the form of vaccines) destroy children. Mike’s bus would be an easy one for anti-vaxxers to board.
That summary by Dr. Dunlop is really excellent–thorough and even in tone. I’m going to save it for future ammunition against the usual crap. Thank you for the link!
How funny! Over 20% now believe vaccines cause autism. Over 40% of parents 35 and younger feel vaccines are not safe. In the last five years 60% have changed their minds about vaccines (for the worst). CVS pharmacy just announced that 42% will not get a flu vaccine (despite the mega pr push)no matter what. This is happening despite being out-spent a $billion to one. You living in a cave Orac?
Since when was truth decided by democratic vote, Penelope? “American Idol” is not a valid model of epistemology.
And, of course, why bring up the fact that they’re parents? Parents are still human beings like everyone else. They are not gods with infallible senses of causation. There’s a reason we use the scientific method, you know.
@Penelope: citation needed, please. IIRC (can’t find the post right now), you are cherry picking numbers.
Germ theory of disease is “just a theory”
I love that!
Even if we assume Penelope’s numbers are accurate (which I doubt), that’s like saying humoral/allopathic bloodletting worked because it was popular, but it stopped working when it stopped being popular.
The only thing the anti-vaxxers have going for them is shameless spin, propaganda tactics (like the previously linked Bandwagon Fallacy) and marketing. Of course, the success of spin is emphatically NOT an indicator of truth. I’d rather know the truth than voluntarily give up control of my life to propagandists.
I think we need a new name for libertarianism. I propose: The New Irresponsibility.
I think Penelope is a hit and run troll. She left nasty comments over on LBRB on the Paul Offit post, too. Just another Thingy or Augie wannabe. I sincerely doubt she will be back to give the citation.
@Bronze Dog: it will drive me nuts, but I know I read about those numbers somewhere recently. Can’t find it now (hard to search on the iPad) but the 20% figure she quotes, IIRC, were those who either currently or once thought vaccines caused autism. However, IIRC, the numbers who currently firmly believe that were lower…about 13%. Still high, but not 20%. Wish I could find the reference.
Penelope (#11) crows:
To put this “factoid” into perspective, 25% of people polled (Gallup, 11 Feb 2009) don’t “believe” in evolution (only 39% do, the rest are undecided) and 33% “believe” that extraterrestrials have visited the Earth (Scripps Survey Research Center, May 2008).
Compared with that, the “fact” that 20% of people “believe” that vaccines cause autism isn’t all that remarkable. There’s almost nothing so silly that you can’t find a percentage of people who will believe it.
That’s just one of the reasons that science doesn’t operate by polling the population.
Remember the “Galileo gambit” that so many alt-med promoters like to hide behind? You know, the “They laughed at Galileo, too!” whine (although the truth would be that “they” didn’t laugh at Galileo – “they” were quite worried about his “heresy” spreading and put him under house arrest). Well, that is a tacit rejection of popular belief as a guide for scientific reality.
I realise that consistency isn’t the “alt-med” proponents’ strong suit, but you’d think that there would be a little awareness of this inherent contradiction in their “message”. If scientific consensus isn’t valid (according to the “alties”), how would popular consensus be any better?
Prometheus
from Thomson Reuters-NPR Health Poll 9/30/11:
26.6 % express concern about vaccine safety
21.4 % believe vaccines can cause autism
30.8 % of parents with children under 18 are most concerned
18.5 % people over 65 express concern (least)
I miss you, too.
When I was I on TV??
Been really busy these past months but I make a point of reading “RI” every day.
I continue to read and learn but just don’t have the time or energy to fight right now. By the way, I am giving more vaccines than I used to to older kids. I am a vaccine schedule critic, not “anti-vaccine” and the dialogue could proceed from there. No thanks?
Best,
Jay
How funny! Over 40% of American adults believe in extra-sensory perception, 37% believe that houses can be haunted, 26% believe in astrology, and, over all, 76% believe in some paranormal phenomenon. Forty-one percent of Americans believe that Jesus Christ definitely (23%) or probably (18%) will return to earth — that is, that the world will end— within the next four decades.
Since so many people believe such things, they must be true. Argumentum ad populum, and all that.
http://www.gallup.com/poll/16915/three-four-americans-believe-paranormal.aspx
http://pewresearch.org/databank/dailynumber/?NumberID=1043
We ask that the government begin to fund research that evaluates the effect of vaccination, against no vaccines at all, on biomarkers of immunity, biomarkers for metabolic dysfunction, neuro-developmental outcomes, including autism, immune-mediated illnesses of all sorts, autoimmunity, allergies, asthma, epilepsy, intellectual and learning disabilities
“We ask for a study with no hypothesis-driven endpoints, where we data-mine such a mass of biomarkers that we can find one or two that are correlated with vaccination, by chance, in the group we choose to study, and that we can then make some spurious negative correlations for based on irrelevant in vitro data and wax histrionic about.”
“We furthermore ask that the government suspend mathematics and allow us to present our data without correcting for multiple comparisons.”
I’m guessing that a Bonferroni correction of the resulting data would render it all but meaningless. One of the reasons (out of many) that studies limit the variables they study is so they don’t get hammered into irrelevance by multiple comparisons.
Prometheus
Penelope:
Sanity is not statistical. There is reality, and we don’t vote for it like American Idol.
@Prometheus
You know they’ll convince themselves of something like this as soon as they realize they need an excuse. The same goes for Duncan’s multiple range test. Kolmogorov and Smirnov were obviously Communist agents. The Kruskal-Wallis test cannot apply to my methods, etc. All else fails, they’ll add math denial to their arsenal. Numerals are all just a Western cultural convention, man.
Yuck.
Scott @ 25
You win teh internets today with your scathing statistical sarcasm.
Jay Gordon says:“By the way, I am giving more vaccines than I used to to older kids. I am a vaccine schedule critic, not “anti-vaccine” and the dialogue could proceed from there. “
“Dialogue” with Dr. Jay. How we’ve missed it.
Dr. I-am-not-anti-vaccine has previously said “I donât give a lot of vaccines.” “I give them later and far slower than most doctors.””I gave a half dozen vaccines today. I gave some reluctantly but respected parents’ wishes to vaccinate.”
So while Jay doesn’t have time to “fight” with anyone here, one wonders if he’s still fighting with those few parents in his practice who want vaccines to protect their kids.
In terms of dialogue, I’m intrigued by Jay saying “I give more vaccines than I used to to older kids”. The youngest, most vulnerable ones can still go hang, apparently (the only vaccination Jay has in the past admitted giving to infants or young children is “maybe a DTP” and “very infrequently” a polio shot). But even a miniscule improvement in Jay’s “vaccine schedule” for older kids would be nice.
What is your vaccine schedule now, Jay? And is there any support for it by those who know their stuff, for instance the infectious disease experts at the CDC and American Academy of Pediatrics?
(I know better than to expect a straight answer, but I can’t resist asking anyway).
I tend to accept Penelope’s claims (though maybe not the exact numbers) because of the phrase “parents 35 and younger”. Same with Denise’s stats, which have “parents with children under 18”. There is a strong age/generational correlation to acceptance of the necessity for vaccines, and it’s basically because they are victims of their own success. The people now becoming parents never lost friends or siblings to measles or polio or pertussis or mumps – because their parents and grandparents did so, and got their children vaccinated as soon as the vaccines were available.
I really don’t see how this will change back, until enough people skip vaccines that we have a really bad outbreak of something, and produce another generation that understands the severity of the epidemic diseases.
@Prometheus:
As a far better man than I once said:
Dr. Jay Gordon posts,
“Been really busy these past months but I make a point of reading “RI” every day.
I continue to read and learn but just don’t have the time or energy to fight right now. By the way, I am giving more vaccines than I used to to older kids. I am a vaccine schedule critic, not “anti-vaccine” and the dialogue could proceed from there. No thanks?
Best,
Jay”
Apparently Dr. Gordon has energy to tweet about vaccines. I have been following Dr. Gordon on twitter and here is a small sampling of his tweets:
23 Sept-“Rare but bad outcomes can occur. The flu shot is just not worth much to healthy people.”
23 Sept-“9 m/o old son with asthma. Pulmonologist says get flu shot. What about 3 yr old. Unconvinced about flu shot for almost everyone.”
3 Oct-“I’m hearing of a few cases of chickenpox in town. I think naturally acquired immunity might be better for healthy kids. Can’t prove it tho.”
4 Oct-“Opinion on flu vax for young children (age 3 to 5). I give almost none. Shots supported by inadequate science.”
4 Oct-“Not giving shots supported by inadequate science too tough/no/I must agree. More studies badly needed.”
4 Oct-“Any advice on giving 15 month old prevnar and pentacil shots…should we delay?/I like waiting and separating.”
5 Oct-“Gardasil is not a great vaccine.”
5 Oct-“So you wouldn’t vaccinate your 11 year old daughter? Definitely not. Education, condom awareness, Pap smears later.”
13 Oct-“Torn about getting flu shot-18weeks pregnant. Ob says it’s necessary. Your call not OB’s. I rec. no.”
15 Oct-“Chickenpox vaccine yay or nay. Yes over age 8-10 or for social reasons.”
16 Oct-“Chickenpox rarely dangerous but very unpleasant as kids get older. I give 6-10 yr. olds vax to avoid missed school, fun and travel.”
16 Oct-“Chickenpox vax. Nearly impossible to get kids natural immunity in U.S. Teen or adult pox nasty, could endanger fetus. So vax 10 year olds.”
18 Oct-“CDC schedule has less science than it should. Parents sense this.”
19 Oct-“Wonder how many shots CDC can add to sched before even strongest proponents say ‘maybe this is too much’/Starting to happen.”
19 Oct-“Should a healthy 2 year old in full time child care/never had flu shot get one/flu shot risk small but benefit smaller.”
19 Oct-“If only the fervor doctors devote to shots could be put into breastfeeding support+education. THEN we’d really save lives. No $$ there tho.”
Dr. Gordon is soooo busy to devote time to answer his critics at Respectful Insolence, but not too busy to diagnose kids with asthma and countermand the advice of the child’s pulmonologist through his tweets.
He is also soooo busy, but not too busy to tweet a pregnant woman who is at high risk for contracting influenza disease, to “recommend No…to influeza vaccine”, in spite of the woman’s OB advising her to get the seasonal flu vaccine.
Dr. Gordon states he is giving “more vaccines” now…which is a crock when his tweets undermine the recommendation by the CDC and his fellow credentialed pediatricians.
The last “tweet” is the most insulting of all to health care practitioners. Come on back Jay Gordon to explain your accusation of doctors making money on immunizations to the detriment of their young patients.
@Jenora Feuer
Funny you should mention Columbus. I just had a post up on Oct. 10 in honor of
Brave MaverickColumbus Day (linked in my name).@ Dangerous Bacon: I have a long posting about Dr. Gordon” “tweets”…held in moderation that belie his statements about the vaccines he gives in his practice.
I don’t know how the “pediatrician to the stars” sleeps at night. He really is a public health menace.
My long posting about Dr. Jay Gordon’s “tweets” is out of moderation. Where is the elusive Dr. Gordon to back up his “tweet” about doctors going for the $$ when they provide immunizations to kids, according to the CDC recommendations?:
19 Oct-“If only the fervor doctors devote to shots could be put into breastfeeding support+education. THEN we’d really save lives. No $$ there tho.”
If previous experience is any guide, Dr Jay will be back to hang around for a while. When he’s sufficiently painted himself into a corner, he’ll say somethings snippy. Then someone else will respond in kind, so he’ll point to that comment as evidence of our general incivility and flounce off in a huff. The pattern is common enough that you can simply search his name on this blog and find it in almost any comment thread in which he’s participated.
And in case anyone who’s new to RI thinks that Dr Jay is at all serious, please keep in mind that has claimed here to have invented a hierarchy of scientific knowledge that favors anecdotes. No kidding.
For a moment I thought she disliked those statistics. How naive of me!
I am married to woo, but lucky that none of his sons have ever taken him seriously, even after the middle grandson developed autism. Every grandchild, even the autistic one, has had their vaccinations. I honestly worried for a while about how seriously anyone took his love of all things alternative and conspiracy theories. Now I just wonder if they think I agree with him (I’m a stepmom).
I come from a conservative and Christian family, but luckily was raised in one that believed in science, laughed at conspiracy theories and managed a balance between spiritual and temporal that didn’t require eyes wide shut to make the spiritual side work.
Every epidemic that crops up here and there I read to my hubby and he (honestly!) responds, “Good, they’re getting some good old-fashioned immunity and their parents care enough to not let them end up brain-damaged.”
I wish I knew a good way for people like him to have their attitudes changed. As long as they’re out there they will continue to spread their propaganda as best they know how. I just thank God he isn’t HTML literate!
Summary of Dr Gordon’s position:
I’m not anti vaccine, I’m just generally opposed to most vaccines. (Also I can’t or won’t present any science to back up my position.)
“Next I’ll ram my ovipositor down your throat and lay my eggs in your chest… but I’m not an alien.” Tom Servo from Mystery Science Theater 300 The Movie.
-Karl Withakay
Here is some classic Dr. Jay (emphasis added):
@ madder: Thanks for the link about Dr. Jay’s hierarchy that includes “mommy intuition”.
I’m sure he will be back to post…in fact I’m waiting for him. Talk about going for the $$; hawking his videos on his website and his “guest journalist” spot on the Ho-Po… virtually “trolling for new patients” by appealing to parents who want to opt out of vaccines. I bet he also provides vaccine medical exemption notes to his select group of anti-vax parents.
It’s called chutzpah to offer up opinions about vaccine on his twitter page and encouraging parents to discount the advice of their child’s pulmonologist and encouraging the pregnant woman to not vaccinate against seasonal flu…against her OB’s advice. He really is a public health menace.
lilady cites the following as among Jay Gordon’s twitter gems:
“16 Oct-“Chickenpox vax. Nearly impossible to get kids natural immunity in U.S. Teen or adult pox nasty, could endanger fetus. So vax 10 year olds.”
This is a remarkably foolish position. On the one hand he recognizes that adult chickenpox can be severe* and pose a risk of fetal anomalies (or it can be fatal to the infant if a pregnant women contracts chickenpox around the time of delivery). At the same time Jay laments that “natural” chickenpox is not widespread anymore (to provide “natural” immunity, but which would also expose a lot more expectant mothers to the disease, not to mention causing added danger to the elderly and others at special risk from chickenpox, including the immunosuppressed).
By the way, is Jay “tweeting” about using homeopathic remedies for ear infections if your unvaccinated child gets one as the result of a chickenpox outbreak? (he recommends using homeopathy for ear infections on his website).
*of course, younger kids getting vaccinated for chickenpox are avoiding a miserable illness as well as the low potential for serious complications or death, but that doesn’t seem to matter to Jay either.
@ Chris: I wonder if Dr. Jay is still stuck on the stopped escalator. He’s going to need more than “his hand held device” to defend himself now.
I miss Dr. Jay. I’d like to tango with him again some day.
Some day.
When he gets off the escalator maybe?
No surprise Orac, you remove womens’ breasts for a living. I’m sure you find great joy in doing so. Why all the anger at the vax safety movement? I’m sure you feel the same way about the healthy folks preventing cancer (not by more research on animals)
Orac’s full information can be found here [DELETED].
@ Mrs Woo:
Attitudes can be changed if the person is open to new information. Some of Orac’s adherents started out on the other side of the fence.
Woo serves a purpose: it is a sort of emotional cushioning from the shocks and dangers of living in an unpredictable world that is largely not subject to our personal control or choices. Woo tells us that we *can* take charge : people get ill and die at relatively young ages because they lived
wrong! Uncomfortable facts are dismissed; experts on nutrition and health seem to grow on trees.. naturally. Miracle-performing products are a dime a dozen… altho’ they cost a whole lot more!
Changing attitudes about woo is many faceted: here are a few ideas I like-
Undercut conspiracy thinking by showing how unlikely it is:
too complicated an artifice to be maintained, too many people involved for secrecy.
Show that woo-providers have been wrong about simple facts ( e.g.acid/alkaline); show how they profit from selling you a belief system prior to selling you supplements and/or services ( conflict of interest)
Question them: do you expect me to believe that the entire medical establishment is wrong but some random nutritionist has it all figured out? How can a person with minimal (and suspect) education be an expert in complicated and nearly unrelated subjects like health, psychology, and economics?
Explain why conspiracies are necessary: if you have no data to support your position you can’t say you were dismissed on those grounds!
Plus, hang out @ RI: there are many here in the same boat as you are in and others willing to lend a helping hand.
So with all his talk about the awesome “naturally acquired immunity to chickenpox” I’m assuming Gordon means getting the damn disease, suffering through it, spreading it to others and then possibly suffering with the horror of shingles when you get older. “But isn’t there a vaccine for shingles” you ask. Well Dr. G, are those of us approaching our fifties allowed to get Zostavax shots in your opinion? Or is it “useless” like the flu shots?
Excellent post Karl, Old Dragonpants will love that ovipositor bit!
@ Militant Agnostic:
“By the way, is Jay “tweeting” about using homeopathic remedies for ear infections if your unvaccinated child gets one as the result of a chickenpox outbreak? (he recommends using homeopathy for ear infections on his website).”
That would be affirmative…how do you use placebos on a baby?
@JayGordonMDFAAP Jay Gordon, MD, FAAP
by clarymendez
Placebos for ear infections work well Add elderberry, echinacea and put mullein oil in the ear. Even better http://bit.ly/gu4Dhl
1 Dec via TweetDeck
@ Ren: My dance card is full…but I think I could make room for a tango/tangle with Dr. Jay.
I wonder if Dr. Gordon is still declining to vaccinate against MMR. Congenital rubella syndrome is kind of nasty too.
Dr. Gordon’s comment about natural immunity reminded me or a question that I have.
Some anti-vaxxers assert that children are vulnerable to childhood diseases at much younger ages these days than formerly, and that this is due to the fact that their mothers do not pass on sufficient antibodies, having been vaccinated instead of suffering the disease in the wild.
Assuming it is true at all that infants are more vulnerable these days, my impression is that in the past mothers could pass on more antibodies to a childhood disease, not due to having suffered the disease in the wild, but due to having been occasionally re-exposed to the disease after suffering it themselves. That is, occasional re-exposure would keep their immune systems alert to the disease and thus ensure they had plenty of circulating antibodies.
I hope one of the experts here could tell me if this is correct. If so, would it not logically follow that the way for a prospective mother to ensure that she had plenty of circulating antibodies to pass on to her infant — without requiring anyone else to suffer the disease so as to expose her — would be to get an occasional MMR booster? Maybe every ten years, along with her tetanus shot?
There may be good reasons not to get repeated MMR boosters, but it would surely be even less advisable to get occasional exposures to the wild-type virus.
@lilady
This tweet jumped out at me:
It appears to this lay reader that Jay is giving medical advice without knowing a proper history of the inquirer. He is actively working to persuade the woman not to get the flu vaccine, not knowing what the woman’s OB knows about her and her situation.
That strikes me as, shall we say, unethical, or at least irresponsible.
I concur with Dr. Gordon.
Offtopic, but this quote from an AP news article was too good to pass up:
“SAN FRANCISCO â A new biography portrays Steve Jobs as a skeptic all his life â giving up religion because he was troubled by starving children, calling executives who took over Apple “corrupt” and delaying cancer surgery in favor of cleansings and herbal medicine.”
Has the AP redefined the meaning of the word “skeptic”?
@ LW: I know that Jay Gordon engaged in some Tweeting challenge with Seth Mnookin about the recent Minneapolis Measles outbreak when the case count was at 4 confirmed cases, with a remark “Four cases is a measles outbreak?”
Of course 4 cases of measles is considered an outbreak. By definition it is considered an outbreak when any disease occurs/is confirmed in numbers in excess of what would normally be expected in a defined geographical area. The outbreak was determined to be over June, 2011 and the total confirmed cases were 23 with 14 children requiring hospitalization.
Orac did an entire article about Dr. Gordon (Dr. Jay Gordon’s profound misunderstanding of science-February 18, 2011) and I located this “gem” posted by Dr. Jay:
“Bacon: I give appropriate vaccines when people travel. Usually polio for Asia, Africa, Hep A for exotic travel, yellow fever for the countries which require it. DTaP boosters when indicated. I have also given measles vaccines but not very often. I give malaria prophylaxis when indicated, too. No, I don’t give multiple vaccines in one day. I talk to smart people who understand that different situations mandate different medical interventions. (“Dr. Jay–Practice Confined to the Well and Smart–Gordon”)
Kristen, as passionate as she might be, is a sample size of one. My larger experience with families of kids with autism does not match this.
Posted by: Jay Gordon, MD, FAAP | February 24, 2011 1:30 PM”
In answer to your question about Measles “booster” vaccines…it is not recommended as 2 MMR vaccines (#1 past one year of age and #2 generally given before school entry) in the overwhelming number of kids, confers life-long immunity.
It is not recommended to give this triple antigen vaccine during pregnancy because of the “theoretical risk” of exposure to the developing fetus of the live attenuated weakened rubella antigen and women who contemplate pregnancy should use birth control and not get pregnant within 28 days post MMR vaccination. As far as I am aware the Rubella Registry here in the U.S. and registries in other countries that monitor pregnancy outcomes for women who inadvertently became pregnant during that 28 day window, have never been able to document a case of congenital rubella associated with vaccine administered during the very early stages of pregnancy.
In clinical practice, if a woman arrives at an OB office or prenatal clinic already pregnant and without adequate proof of 2 documented doses of the MMR vaccine, it is noted on her chart that is sent to the delivery hospital and she will received the MMR vaccine after delivery and before she leaves the hospital…so that she is protected for succeeding pregnancies. All women are tested for Rubella IGG antibody as part of their prenatal blood tests as well as the presence of other diseases that may require treatment or treatment of the baby.
There are scientific studies that document higher IGG (immune) titers for measles, mumps and rubella…done on older women who actually had these childhood diseases, became immune and whose immunity was continually “boosted” by exposures to other cases…before the availability of protective vaccines and when these diseases were endemic in the U.S. These three viral illnesses were so prevalent then that young people born before 1957 who went on to college were not required to have proof of immunization or immunity to enter college. Health care workers, no matter when they were born or what there vaccine status is are still required to be tested for IGG immune titers…so that they do not inadvertently infect a vulnerable patient.
As a (general) rule, live attenuated vaccines against viruses are highly effective to confer lifelong immunity. Other vaccines that are not live, given to immunize against other viruses (such as Hepatitis A and B vaccines) also confer lifelong immunity. The reason why seasonal flu virus is recommended each year is the exception to the (general) rule is due to antigenic drift and antigenic shift of the circulating flu viruses each year.
Immunity “wanes” with vaccines formulated to protect an individual against bacterial diseases such as tetanus, diphtheria and pertussis and they require booster shots every 10 years.
The CDC Pink Book “Principles of Vaccination” chapter explains why some vaccines are more effective and confer lifelong immunity and others require vaccine booster shots.
The ACIP (Advisory Committee on Immunization Practices) 2011 General Recommendations on Immunizations is also available on the internet and provides more detail about the individual vaccines.
I concur with Dr. Gordon.
That’s nice, Bob. Maybe you find somebody who’s not familiar with you and could be persuaded to find this of interest.
@ Todd W.
“@lilady
This tweet jumped out at me:
13 Oct-“Torn about getting flu shot-18weeks pregnant. Ob says it’s necessary. Your call not OB’s. I rec. no.”
Todd, it jumped out at me as well. I think I was been very “kind” to Dr. Jay when I labeled it as chutzpah. Truly I do believe it is a form of malpractice to offer an opinion on the internet to a pregnant woman whom you haven’t seen as a patient and to recommend that she not got the flu vaccine. Doctors have been successfully sued when they offer up bad advice to their own patients via a telephone call and when the advice has an impact on her health or the viability of the fetus she is carrying.
“That strikes me as, shall we say, unethical, or at least irresponsible.”
IMO it is unethical AND irresponsible, and it should be reported to the California licensing board and to the hospitals that Dr. Jay is affiliated with.
Somehow pertussis came up in a conversation with some acquaintances today. During the fairly-recent local outbreak, Person A was upset that the ER docs handed him antibiotics to take when they suspected he had pertussis, but his test results wouldn’t be back for a few days. Person B chimed in that *she* got pertussis from Person C who caught it from the booster.
I think it’s more likely that Person C had already been infected, or got infected before the shot was fully effective. At least that’s what I hear about getting the flu after the flu shot.
@Sid
Oh, hi! You showed up. Thought you’d fled the blog, since you fell silent in the other thread about the nonsense of vaccine injury awareness month. There are still some questions that you haven’t answered over there. Here’s the link to refresh your memory.
Dr. Gordon also commented that the hospitalizations in the Minnesota outbreak were “soft” hospitalizations. I’m curious if he still thinks that, since there is evidence otherwise.
That’s what I was referring to — re-exposure to the diseases kept the immune system primed, allowing women to pass on more antibodies to their babies. It seems to me that when anti-vaxxers bemoan the fact that women today don’t get re-exposed to the disease in the wild, an appropriate counter is to suggest that women just get themselves re-exposed to the vaccine. I certainly wasn’t suggesting MMR during pregnancy, though!
“I wonder if Dr. Gordon is still declining to vaccinate against MMR. Congenital rubella syndrome is kind of nasty too.”
Based on what Jay has said here before, he’d likely argue that his patients don’t need/shouldn’t risk the MMR vaccine because rubella is so rare now.
I’m still waiting for Jay to make that giant intellectual leap to the deduction that rubella and other vaccine-preventable diseases are much less common now precisely because of protection by vaccines. Someday it may also occur to him that while he concedes the necessity to give at least some vaccines to patients traveling abroad, unvaccinated visitors from those countries do travel to the U.S. and infect people, and his policy of having his patients free-ride off the immunization status of others won’t always protect them from serious illness.
“his policy of having his patients free-ride off the immunization status of others won’t always protect them from serious illness.”
They don’t even get to free-ride effectively as they are, of necessity, exposed to each other. One unimmunized child patient catching measles, mumps, rubella, or chickenpox, and showing up in his waiting room could set off an outbreak among the rest of his unimmunized patients. Exactly this has happened in schools that cater to antivaxxers.
And, of course, tetanus isn’t contagious; the children that he doesn’t immunize against it get no benefit from their protected peers.
@ LW: As you mentioned, tetanus isn’t transmittable…I would be more worried about the pertussis component of the trivalent DTaP vaccine that he doesn’t immunize against and the chances of transmitting pertussis to an infant in Dr. Jay’s waiting room. All of the 10 deaths from pertussis during the 2010 outbreak of pertussis in California were infants who were too young to be immunized or were not fully immunized.
Dr. Gordon had a comment about these deaths as did Sid Offal. In their opinions the 10 Hispanic infants who died were somehow less important than if they occurred in White children. Was the grief that the parents of the innocent babies who died any less than that experienced by “other” parents?
Two years ago I contracted pertussis, that was identified early in the course of the disease, was put on antibiotics which decreased the time I was infectious and shortened the course of the disease. But, I was still infectious prior to the onset of the cough and fortunately was not exposed to any infants who were unimmunized. I had a steroid inhaler and big bottles of codeine cough medicine to ease the dreadful, painful cough…not funny for a senior citizen.
BTW, welcome to RI Mrs. Woo…I think we are going to all enjoy your postings here.
@baglady
Do you have a citation to support your assertion that antibiotics “shorten the course” of illness
Jay Gordon in a nutshell
Jay thinks X although has absolutely no evidence for it and therefore you should act is if X is true even the scientific consensus favours the opposite. What an arrogant intellectually lazy pratt.
Jay – April is Safe Digging Month. Why don’t you come back then.
Did you seriously just ask that? Are you familiar with tuberculosis? Do you know why it isn’t cutting the lives of writers tragically short anymore?
@63:
No. By definition, trolls are never serious, they just aim to provoke. Starve the beast.
@Gray Falcon
To be fair, I think Sid was asking for a citation that antibiotics shorten the course of pertussis. Antibiotics can shorten the length of the contagious period (by killing off all the bacteria), but the length of the cough itself is not shortened, as it is caused by the toxin released by the bacteria. So, you have a bunch of toxin circulating in your system. You wipe out the bacteria (preventing further toxin production), but the toxin that is already circulating continues to cause symptoms.
This study states:
So, with toxin-mediated illnesses, antibiotics probably won’t do much to shorten the duration of symptoms, but will reduce the duration of the infectious period. Illnesses that are not caused by toxins released by bacteria, on the other hand, would be shortened by antibiotic use.
That said, if antibiotics are started early enough, there is a chance that the course of illness might be affected, according to the CDC Pink Book chapter on Pertussis.
Falcon, it you read the thread you’s know the “illness” to which I was referring is pertussis.
@Todd W. Let me repeat to make sure I understand. The pertussis bacterium generates toxins that cause the symptoms, and the antibiotics destroy the bacteria, but not the toxins. I wasn’t aware of that. Sorry, Sid.
Thanks Todd, No apology necessary Falcon. : )
@Gray Falcom
That’s my understanding of things, yes. Tetanus is a similar thing. The bacteria release neurotoxins that cause the muscle spasms characteristic of the disease. Antibiotics kill of the bacteria, but antitoxin is needed to neutralize the stuff that’ll kill ya.
@Sid
Hey, you actually had a valid point. Now, about those unanswered questions in the other thread…
Todd W — I understand in the case of tetanus, not only do antibiotics not shorten the duration of illness, but it’s not unusual for the bacteria to already be gone before a person gets admitted to the hospital with symptoms. It doesn’t thrive in the human body, but it can be very nasty before it dies.
Other infections may be helped. I have a diverticulum in my bladder which makes me prone to UTIs. Those *definitely* are affected by antibiotic use. If it’s a good choice of antibiotic, I see symptom relief by day two of the antibiotics.
@Calli Arcade, Todd W.: So Sid just gave us a very good reason to get the DTaP shot. Prevention seems much more pleasant than the cure.
@Gray Falcon
Yep. And, whether you get the disease or the vaccine, immunity wanes with time, lasing as long as 20 years or as short as 3, so boosters are important for older children and adults.
@ Offal: Todd W. linked you to the CDC Pink Book Pertussis Chapter…for some reason it “didn’t link”.
If you care to go directly to page 218 of the CDC Pink Book 2011 edition you will find this:
“The medical management of pertussis cases is primarily supportive, although antibiotics are of some value. Erythromycin is the drug of choice. This drug eradicates the organism from secretions, thereby decreasing communicability and if initiated early may modify the course of the illness.”
Offal, I was suspicious about the diagnosis of my case of pertussis during the catarrhal stage of my illness and immediately went to my physician within hours of the onset of a dry (non-paroxysmal) cough. I had the prescription in hand and started the antibiotics after I had a clear chest x-ray and before the naso-pharyngeal swab test results confirmed “my” diagnosis. My years spent in the division of communicable disease control at a large county public health department served me well. Any more questions…Offal?
Weird. The linking appended scienceblogs to the address of the pink book chapter. Let’s try that again. CDC Pink Book Chapter on Pertussis (PDF).
@ Todd W. Thanks for the link.
Still waiting for any comments from Offal about pertussis.
http://www.ncbi.nlm.nih.gov/pubmed/17636756
Although antibiotics were effective in eliminating B. pertussis, they did not alter the subsequent clinical course of the illness.
Todd as I remember, you want me to say there’s a greater risk of hospitalization from the measles than from the MMR. If we assume that’s true, we then have to determine what “hospitalization” really means. On your blog the public health official spoke in broad generalities and I don’t believe she undermined the “soft hospitalization” argument. Then in some cases an ear infection or diarrhea was listed as the reason for the hospitalization. So do I want to hurt a baby by poking it with a needle (not a risk but the actual infliction of pain), risk other side effects and alter the way it’s immune system may develop in order to prevent these inconsequential outcomes? No. Especially when the risks of these side effects are not well studied:
http://www2.cochrane.org/reviews/en/ab004407.html
Authors’ conclusions
The design and reporting of safety outcomes in MMR vaccine studies, both pre- and post-marketing, are largely inadequate.
Additionally one reason the measles may result in more hospitalizations is because now younger children are vulnerable due to inferior maternal antibodies – but you can’t vaccinate that group anyway. Besides an increased risk of severity caused by universal vaccination reduces the absolute risk, so in absolute terms the measles are less risky today.
Finally there are more serious consequences of the measles but they are rare – especially when calculated against total rather than reported cases – and afflict a more vulnerable subset of the population
Todd, I addressed your concerns. The comment is being held however. I should appear presently
It’s my guess that there’s an elephant under the rug causing the bump we call alternative medicine. Something major unknown and badly dealt with by mainstream medicine, which is to some extent addressed by alternative medicine, and to some extent misdiagnosed by alternative medicine. Or perhaps several elephants.
Vaccines causing autism is probably one of those misdiagnoses.
One of the elephants under the rug is poorly-understood immune reactions to food. There’s been a lot of recent research on gluten sensitivity causing or contributing to various psychiatric and neurological conditions. I wrote about it some on my webpage (click on my name).
For example people can have ataxia from gluten, and you could go to mainstream neurologists for ten years and not hear the suggestion to try a gluten-dairy free diet. Some kind of alternative doctor would be more likely to suggest that.
Many people have said their autistic children have food sensitivities and got better when they avoided certain foods. Perhaps food sensitivities cause some cases of autism. Perhaps if children were kept on a diet free of gluten and cow’s milk for the first 5 years of their lives, there would be less autism. I don’t think anybody knows.
I don’t have personal experience with autism, but some things improved with me when I quit certain foods that are symptoms of Asperger’s. I started to pick up on social cues and I came to think of people as social creatures, rather than expecting them to work according to ideas I had about how they should behave that came from what I needed from them. In many different ways I became less sensitive â less sound and light sensitive, less emotionally reactive. So when I hear parents talking about how their autistic children got better on a gluten-dairy free diet, it has credibility for me.
I never understood that food can have a HUGE psychological effect before my personal experience with it. This was not communicated to me by any mainstream source. Everybody knows that food can cheer you up, comfort you, help wake you up in the morning, help you sleep at night. But that it can have major psychiatric effects â cause severe anxiety or depression or hallucinations – is not generally known.
Critics of alternative medicine like Orac love to talk about psychological reasons for alternative medicine, like the illusion of control, placebo effect, etc. And these criticisms are valid. It’s also important to show how people can be harmed by alternative medicine, so blogs like this are certainly useful. But you get the impression that people like Orac think those psychological reasons are the whole story, and that isn’t true. There are elephant(s) under the rug as well.
I see alternative medicine in a more holistic way: as a branch of humanity’s effort at healing our problems. It’s another kind of investigation, larger in scale but less rigorous than scientific investigation. As if humanity were a large beast investigating the world, and alternative medicine is its efforts to sniff out an answer in a giant mass of speculation; and science is sitting down at a desk and Really Checking your ideas. I think some alternative remedies help people, although not necessarily for their reason they’re said to help.
I suppose Paul knows a little about vaccines … but when it comes to autism …here he is on the “Hidden Horde” theory of autism aetiology.
âIt’s not an actual epidemic. In the mid-1990s, the definition of autism was broadened to what is now called autism spectrum disorder. Much milder parts of the spectrum — problems with speech, social interaction — were brought into the spectrum. We also have more awareness, so we see it more often. And there is a financial impetus to include children in the wider definition so that their treatment will be covered by insurance. People say if you took the current criteria and went back 50 years, you’d see about as many children with autism then.â
It’s not an actual epidemic.
Medical Definition
Epidemic: The occurrence of more cases of a disease than would be expected in a community or region during a given time period.
I think it has fulfilled that criteria.
In the mid-1990s, the definition of autism was broadened to what is now called autism spectrum disorder.
That was 2000 …
Autism Spectrum Disorder is the umbrella term recognised by a registered paediatrician, psychiatrist or neurologist specifying the Diagnostic and Statistical Manual of Mental Disorders, fourth edition, Text Revision (DSM-IV-TR, 2000)”
Much milder parts of the spectrum — problems with speech, social interaction — were brought into the spectrum.
I don’t think I’ll even bother referencing milder parts of the syndrome like speech and social interaction.
We also have more awareness, so we see it more often.
Occam’s razor it’s probably because there is more of it.
And there is a financial impetus to include children in the wider definition so that their treatment will be covered by insurance.
There is ? Apparently this is evidenced by autism diagnoses being stagnant in … well most of Europe , Asia , Australasia and one other rather large country in North America.
“People say if you took the current criteria and went back 50 years, you’d see about as many children with autism then.”
I’m not sure which ‘people’ say (probably militant skeptiks that can’t quite seem to place that mysterious Hidden Horde ….and kind of begs the question how did Professor Sir Michael Rutter the “Godfather” of autism diagnosis and assessment miss a cohort of some 350,000 children. Remembering that ASD is 8 times more prevalent than Downs Syndrome. (Hope they got that right.)
Apparently this is shared by hundreds if not thousands of paediatricians and other professionals with the duty of care to assess children for neurodevelopmental disorders.
What a significant diagnostic oversight. So much for differential diagnosis and clinical evidence.
75% of those people will probably have a mild to severe intellectual impairment (undiagnosed apparently) plus 30% of them will have epileptic seizures. (apparently undiagnosed).
Guess what … I’m particularly underwhelmed when Paul Offit is bought to the table talking about anything to do with Vaccines and Autism.
…and to the nay sayers here’s a conundrum if you believe what does that do to your much vaunted epidemiological evidence … oops.
Wow you really are in a lose / lose situation.
I don’t like to hear talk about alt-med people âmoving the goalpostsâ, because that’s a I-you-they kind of thing.
Like, I protest (righteously and courageously). You complain. She bitches.
When somebody âmoves the goalpostsâ, they’re adjusting their theory in the face of new evidence. It’s a scientific virtue to adjust your theory, not a fault. Perhaps you were partially right, after all.
I’m flexible and open-minded and I pay attention to my intuition. You have a pet idea. He moves the goalposts.
There are lots of reputable scientists who have personal ideas and biases that they cling to. They are an important part of the scientific community. It’s really important to have dissenters, as long as their ideas aren’t pure nonsense.
No it is not. Not at all. It is easily and objectively determined.
WITHOUT CONCEDING THE POINT. That’s the entire definition of it. If you concede the point and adjust your theory, it’s called “adult conversation”.
@Laura:
You really don’t understand how the scientific process works, do you?
A personal bias may get a scientist to approach a problem from a different perspective to arrive at a hypothesis. HOWEVER, the hypothesis is NOT ACCEPTED as a valid theory if it cannot stand up to rigorous, UNBIASED scrutiny.
That RIGOROUS, UNBIASED scrutiny is what the scientific process all about.
“Alt-Med” doesn’t stand up to rigorous, unbiased scrutiny. If any part of it would, that part would eventually be adopted by SBM and become a part of it.
“Alt-med” practitioners have explanations regarding their form of “therapy” which have a tendency to violate known principles (and sometimes even fundamental principles) of physics and chemistry.
Even if you consider that their explanation maybe wrong yet they maybe doing something right – it fails there to. You, see we have methods to determine whether something works or not without actually having a clear explanation for how it works – RCTs. Here too, “Alt-med” fails to have any effect other than a placebo effect.
Being flexible and open minded is good as long as you don’t believe in things which have been proven to be false.
Laura: “I don’t like to hear talk about alt-med people âmoving the goalpostsâ, because that’s a I-you-they kind of thing. Like, I protest (righteously and courageously). You complain. She bitches.
When somebody âmoves the goalpostsâ, they’re adjusting their theory in the face of new evidence.”
I have trouble seeing it as “adjusting their theory”. When a “theory” is repeatedly shot down by good evidence, a reputable scientist will concede it was wrong. Antivaxers (including their limited and shrinking coterie of pseudoscientists) will (after a period of sheer denial featuring personal attacks and conspiracy-mongering) simply ignore the evidence and move on to new, equally (or even more) implausible theories. Take thimerosal, the vaccine preservative long blamed by antivaxers for causing autism. Here’s what a guy many of us know had to say when the thimerosal “theory” was demolished, but antivaxers mostly just switched to blaming other vaccine “toxins”:
“Boiling it all down, the âtoxinâ gambit represents nothing more than moving the goalposts, a tried-and-true technique beloved of all varieties of cranks. Now that thimerosal is increasingly being vindicated by clinical and epidemiological studies that have failed to find a link between its presence in vaccines and autism, antivaccinationists, convinced that it absolutely, positively has to be the vaccines that cause autism and all sort of other problems, have moved on to other ingredients.”
It has been pointed out that the other alleged “toxins” are either not present in vaccines (i.e. “antifreeze”) or not toxic in the minute concentration in which they could conceivably be present in the final product, but the antivax faithful either keep repeating themselves or shift the goalposts to demanding other “proofs”, like an unethical vaccinated-vs.-unvaccinated study.
Having an idée fixe and rejecting all evidence against it while inventing new and ever more improbable explanations, is not “adjusting the theory in the face of new evidence”. It’s a manifestation of delusional obsession. That’s not science, it’s pathologic behavior or cult-like devotion, take your pick.
Laura, the key difference between moving goalposts and changing one’s mind in response to new evidence is that the latter involves an honest effort to reevaluate those beliefs that were based upon or influenced by the beliefs that have now been debunked.
A good example would be the progress of the whole “vaccines cause autism” meme. What started that ball rolling was people hearing stories about “oh, my son was perfectly normal until he got his vaccination and then within 24 hours he was autistic!”, taking those stories at face value, and concluding, “Wow, if so many people are telling stories like this, it’s logical to conclude that vaccines are causing this dramatic upsurge in autism that everyone can detect just by listening to stories!!” That conclusion was honestly come to, even if it was arrived at by naive reasoning (not accounting for the way people’s memories can twist to suit conclusions they have drawn later, to name just one factor) – but it was honest, is the point.
What happened then was that epidemiological studies were done to ask the very question, was there a correlation between vaccination and autism? These studies have been used to detect extremely rare side-effects of medication, rare on the order of only affecting one in 100,000. There is no question that if there was a real vaccine-caused “autism epidemic” on the scale that these people believed there to be, where it could be easily verified even by individuals without any scientific training, not even by making any attempt at scientific polling but just by listening to the stories of others, that dramatic of a correlation would have been detected by these epidemiological studies. But no study showed that correlation.
Honestly re-examining the evidence would have led people to say, “Wow, I would have sworn that there had to be an epidemic, because I heard so many stories that sounded so dramatic. But after all, no one fact-checked those stories I heard, so maybe some of them were being mis-remembered and the rest were due to unfortunate coincidence.” And undoubtedly, some people did react that way, honestly re-evaluating their beliefs in the light of new evidence.
But others said, “Well, just because you proved that vaccines aren’t causing an enormous epidemic of autism doesn’t mean that vaccines don’t ever cause autism! Maybe there’s some extremely rare genetic subgroup that’s super-susceptible to autism caused by vaccines! Your study hasn’t disproved that so until you do, I’m going to continue saying vaccines cause autism!” Now the only reason anyone ever had for thinking there was a vaccine-autism relationship (besides antivaccine prejudice) was the false belief that there was a big visible correlation between the two. Once that big correlation was disproved, there was no reason to go looking for a tiny, microscopic one! But people still did, and that’s what moving the goalposts is: it’s not reexamining one’s beliefs in the light of new evidence, it’s changing as little as possible about one’s beliefs, and only so as to be able to claim no one has produced any evidence against those beliefs.
At the risk of engaging the troll, a correction:
The DSM-IV-TR (Text Revision) was in 2000, but the original publication of DSM-IV, which contains the existing definition and diagnosis of Pervasive Developmental Disorders (PDD), was in 1994 (hence, “mid-1990s”). PDD is “what is now called autism spectrum disorder” – so Dr. Offit is absolutely correct on this point.
You’re assuming the conclusion: Offit is saying that autism is roughly as prevalent now as it has been in the past, just that it has either gone undiagnosed (because of a lack of awareness or more restrictive diagnostic definitions) or because it was diagnosed as something else (like schizophrenia). Your incredulity does not constitute a valid counterargument.
And no, Occam’s razor doesn’t apply here: that only applies to a theory that fits the data. The vaccine hypothesis (if it can even be called that) has, in all its current permutations, been entirely discredited, so it doesn’t even deserve any consideration at this point.
Laura: “It’s my guess that there’s an elephant under the rug causing the bump we call alternative medicine. Something major unknown and badly dealt with by mainstream medicine, which is to some extent addressed by alternative medicine, and to some extent misdiagnosed by alternative medicine. Or perhaps several elephants.”
Interesting metaphor.
It’s my observation that alt med supporters fall down and then claim it’s because they tripped over elephants under the rug. It’s pointed out to them that not only is there no evidence that elephants are under the rug, the idea is extremely implausible. After considerable time is wasted demonstrating to them the absence of elephants, their response is to demand that we shoot the elephants.
Laura says she prefers holistic medicine. Alt med commonly manifests itself as the opposite of what holistic medicine is supposed to be – the consideration of both physical and psychologic components of the patient in treating illness. Alt med tends to overemphasize and enable psychologic foibles of the patient while misinterpreting or ignoring physical manifestations.
A good practitioner of evidence-based medicine is far more holistic in my view.
Yesterday The New York Times reported a 6 case measles outbreak among an Orthodox Jewish community in Brooklyn as reported by the NYC Health Department:
“The health department usually sees four to six cases of measles per year in years when there are no outbreaks, said Susan Craig, a spokeswoman for the department. There were recent outbreaks in 2008, when there were 30 cases, and 2009, with 18 cases. Last year there were six cases. So far this year, there have been 24 cases. Many of the cases this year have been among travelers and were not linked together.
The latest outbreak took place within a close-knit Orthodox Jewish population in Brooklyn, officials said. There have been similar outbreaks among Orthodox Jews in the past. Some of the children had not been vaccinated, perhaps because of a preference within the community to delay vaccination, health officials said.
At least two of the cases are directly related, and it is suspected that all are related, âwith unknown common exposures,â Ms. Craig said.
She said the health department had put out an alert to doctors because it is the middle of a Jewish holiday season, raising the risk that children may be exposed to measles through large gatherings and holiday parties.”
Here’s Dr. Jay Gordon’s “Twitter” opinion of this latest outbreak of measles:
16 hours ago “Spike in Measles Cases in Brooklyn—Not been there in a while. 6 cases. Is Brooklyn a small town?
“Ayn Randian”? I thought Objectivists would be pro-autism.
@ Offal: Do you really know the difference between “contacts” of a case of pertussis and an actual clinical case of pertussis…and the difference between post-exposure contact prophylaxis and treatment of a clinical case of pertussis?
The citation you provided, done by Cochrane Review staff, reviewed studies for post exposure prophylactic contacts…not actual clinical case treatment. And, did you mistakenly (or deliberately) leave out this part of the
citation that you provided:
BACKGROUND:
Whooping cough is a highly contagious disease. Infants are at highest risk of severe disease and death. Erythromycin for 14 days is currently recommended for treatment and contact prophylaxis, but is of uncertain benefit.
OBJECTIVES:
To study the benefits and risks of antibiotic treatment of and contact prophylaxis against whooping cough.
Tacky, tacky…Offal.
I had an actual clinical case of pertussis…I took antibiotics in the very early stages of my illness…I did NOT receive post-exposure prophylactic antibiotics. Big difference there Offal.
The following statement is from the current CDC Guidelines “Recommended Antimicrobial Agents For The Treatment And Post Exposure Prophylaxis of Pertussis (MMWR-December 9, 2005):
Treatment of Pertussis
Maintaining high vaccination coverage rates among preschool children, adolescents, and adults and minimizing exposures of infants and persons at high risk for pertussis is the most effective way to prevent pertussis. Antibiotic treatment of pertussis and judicious use of antimicrobial agents for postexposure prophylaxis will eradicate B. pertussis from the nasopharynx of infected persons (symptomatic or asymptomatic). A macrolide administered early in the course of illness can reduce the duration and severity of symptoms and lessen the period of communicability (35). Approximately 80%–90% of patients with untreated pertussis will spontaneously clear B. pertussis from the nasopharynx within 3–4 weeks from onset of cough (36); however, untreated and unvaccinated infants can remain culture-positive for >6 weeks (37). Close asymptomatic contacts (38) (Box 3) can be administered postexposure chemoprophylaxis to prevent secondary cases; symptomatic contacts should be treated as cases.
Christian
Thanks … your lack of accompanying evidence in any of your arguments is duly noted.
I particularly liked the autism was confused by paeditricians with schizophrenia argument.
@ Offal: I have a comment stuck in moderation regarding your citation…
http://www.ncbi.nlm.nih.gov/pubmed/17636756
Although antibiotics were effective in eliminating B. pertussis, they did not alter the subsequent clinical course of the illness.
@ Offal…Cherry Picking again, eh. Regarding your link to another Cochrane Review about the safety of MMR vaccine…you only quoted the conclusions:
“http://www2.cochrane.org/reviews/en/ab004407.html
Authors’ conclusions
The design and reporting of safety outcomes in MMR vaccine studies, both pre- and post-marketing, are largely inadequate.”
Here in fact are some additional quotations from the Cochrane Review which are very “interesting”…and that you “omitted”:
“Selection criteria
Eligible studies were comparative prospective or retrospective trials testing the effects of MMR compared to placebo, do-nothing or a combination of measles, mumps and rubella antigens on healthy individuals up to 15 years of age. These studies were carried out or published by 2004.”
-I think it is very “telling” that the “Cochrane” reviewers NEWEST safety study was “carried out or published by 2004.” Couldn’t you locate any newer MMR vaccine safety studies?
“Data collection and analysis
We identified 139 articles possibly satisfying our inclusion criteria and included 31 in the review.”
-Offal there are many more recent safety studies, conducted by actual researchers, not the amateur researcher wannabes at the Cochrane Review. I suggest you look at the CDC VSD (Vaccine Safety Datalink) website. The VSD monitors untoward effects after immunizations reported from many HMO providers covering tens of thousands of children immunized with MMR and MMRV vaccines.
You might also check out the MMWR May 7, 2010 “Use Of Combination Measles, Mumps, Rubella and Varicella Vaccine”-Recommendations of the Advisory Committee on Immunization Practices (ACIP). These recommendations are based on studies conducted by real researchers and each of 50 studies are footnoted at the end of the report…95 % of the studies were conducted after 2005.
The ACIP Recommendations for MMR and Varicella vaccines have changed as a result of the 50 post licensing safety studies because of a slight uptick in febrile seizures within 10 days of receipt of the first MMRV vaccine versus the number of febrile seizures when the MMR vaccine and the separate Varicella vaccine are given separately during the same doctor’s visit. (1 additional febrile seizure within 10 days per 2,000 immunizations when the MMRV vaccine was given for the 1st of the 2-dose series)
“Main results
MMR was associated with a lower incidence of upper respiratory tract infections, a higher incidence of irritability, and similar incidence of other adverse effects compared to placebo. The vaccine was likely to be associated with benign thrombocytopenic purpura, parotitis, joint and limb complaints, febrile convulsions within two weeks of vaccination and aseptic meningitis (mumps) (Urabe strain-containing MMR).”
-Urabe strain-containing MMR!!!!
“Exposure to MMR was unlikely to be associated with Crohn’s disease, ulcerative colitis, autism or aseptic meningitis (mumps) (Jeryl-Lynn strain-containing MMR).”
-What a surprise!!!!
“We could not identify studies assessing the effectiveness of MMR that fulfilled our inclusion criteria even though the impact of mass immunisation on the elimination of the diseases has been largely demonstrated.”
-Funny how we have all found more recent studies that assess the effectiveness of the MMR.
“Authors’ conclusions
The design and reporting of safety outcomes in MMR vaccine studies, both pre- and post-marketing, are largely inadequate.”
-Oh no they’re not…but you have to know where to look and you have to have more research abilities than the amateurs at the Cochrane Review.
“The evidence of adverse events following immunisation with MMR cannot be separated from its role in preventing the target diseases.”
-Huh?
Offal, don’t you know that using ancient (or new) Cochrane Reviews as your “reference of choice” shows your lack of a science-based education in immunology and vaccine-preventable diseases? And, your cherry picking from old and new Cochrane Reviews is reprehensible and downright dishonest.
@lilady
But how the antivaxers love to misquote, distort and cherry pick from the MMR Cochrane report.
One thing they do is claim that it concluded the vaccine was unsafe, merely because it commented that there was inadequate reporting of the safety studies and inconsistency between studies methodology to assess safety.
blackheart, you have no room to talk concerning evidence. But on autism and schizophrenia:
A cursory Google search of “schizophrenia autism” will also give you a variety of sources that have found genetic links between the two conditions, although they have enough clinical differences to justify the separate diagnostic definitions in the DSM.
@lilady
Thanks for doing the take down on the Cochrane review and Sid’s cherry picking of quotes.
Sid, as for you, you still did not answer the questions that I had asked. Here they are again, since you decided to answer here rather than in the original thread in which they were asked:
These are very simple questions that do not require a lengthy bit of prose to answer, though I must admit, I do admire how you downplay the hospitalizations, just as Dr. Gordon did. If it were “just an ear infection” or “just diarrhea”, the kids would not have been hospitalized. Hospitalization occurs when the symptoms are bad enough to warrant the supervision of medical staff, such as when the patient has diarrhea so severe that dehydration is a significant risk and IV fluids are needed to prevent further complications or deterioration of health.
While I agree that anti-vaxxers routinely abuse the scientific literature and the use of dated studies can be problematic, I do have to take exception to your characterisation of the Cochrane Collaboration as “amateur researcher wannabes”. They are the gold standard for systematic reviews of the literature and a valuable resource for evidence-based practitioners.
@ Science Mom: I don’t agree with your assessment of the Cochrane Review…not when there is constant monitoring of the safety and efficacy of vaccines of childhood vaccines…and I don’t mean the VAERS system…which has been contaminated by the anti-vaxers.
Monitoring of safety goes on outside the Vaccine Safety DataLink network as well…by local county health department and State health departments.
Apparently The Cochrane Review has defended it reports recently in an article entitled:
“If there are no randomized controlled trials, do we need more research?”
It includes this statement about the MMR vaccine study that Sid Offal “cherry picked”:
“Similar problems are encountered in the Cochrane Review of the MMR vaccine.[4] The objective of the effectiveness part of the review is: “To review the existing evidence on the absolute effectiveness of MMR vaccine in children (by the effect of the vaccine on the incidence of clinical cases of measles, mumps and rubella).”
The inclusion criteria are: “Vaccination with any combined MMR vaccine given independently, in any dose, preparation or time schedule compared with do-nothing or placebo.”
The primary outcome is: “Clinical cases: measles, mumps or rubella.â By using this outcome the authors exclude studies that assess antibody response to the vaccine as a measure of vaccine effectiveness. The question of whether or not antibody response is a good indicator of immunity (and if there is any reason to doubt the practice of measuring antibody response in vaccine studies) is not raised. The authors conclude that: “As MMR vaccine is universally recommended, recent studies are constrained by the lack of a non-exposed control group. This is a methodologically difficulty which is likely to be encountered in all comparative studies of established childhood vaccines.”
Nevertheless, they go on to state that:”We were disappointed by our inability to identify effectiveness studies with population or clinical outcomes.”
And, in the abstract:”We could not identify studies assessing the effectiveness of MMR that fulfilled our inclusion criteria even though the impact of mass immunisation on the elimination of the diseases has been largely demonstrated.”
This is less dramatic than the Laetrile example, but still, in our opinion, not satisfying. As we will (hopefully) never have proper control groups for the MMR vaccine, the review’s conclusions lead to a paradox: how can the effect of the MMR vaccine be proven through population or clinical outcomes (i.e. incidence of disease) when there is no non-exposed control group?”
So they started out with a premise, found they were unable to conduct a vaccinated versus unvaccinated versus placebo study and reported anyway.
Now we all know that during the many recent outbreaks measles we can find some unintended results of studying how many of the “cases” were unvaccinated versus the number of cases who were partially or even completely vaccinated.
No, I don’t believe that the Cochrane Review is a reliable resource for vaccine safety—not when the Vaccine Safety DataLink and the CDC are constantly monitoring the safety of newly licensed vaccines and batches of currently licensed diseases. (I suggest you read the 2010 “Use of Combination Measles, Mumps, Rubella and Varicella Vaccine-Recommendations of the Advisory Committee on Immunization Practices (ACIP) MMWR May 7, 2010). Pay particular attention to the change in recommendation for the 1st MMR and Varicella Vaccines…which were based on monitoring the safety of the MMRV and the MMR and Varicella Vaccines giving in separate injections. You might want to read some of the 50 footnoted studies that caused the ACIP to change their recommendations.
It’s not as if the CDC ever tries to hide safety concerns. A review of the history of the originally licensed Rota Virus vaccine will demonstrate how quickly the CDC acted to remove the vaccine as a small percentage of recipients were reported with incidents of intussusception. It was removed within 18 months for safety reasons.
Offal….My rather long comment about another of your “cherry-picked” citations is finally out of moderation and posted at # 90 above. Stop cherry-picking to “prove your unprovable points”.
@ Lilady, it is one thing to critique the review’s hypothesis and inclusion criteria, which is perfectly valid but quite another to characterise (often) top-notch investigators conducting the reviews as “amateur researcher wannabes”. I agree with Dr. Atwood’s assessment of over-valuing RCTs in Cochrane Systematic Reviews and it appears as though they are paying attention. This is how more rigorous and evidence-based standards can be applied to the valuable reviews that guide practitioners.
The investigators that conduct these reviews are no more “amateurs” than those mining the VSD, save for prats like the Geiers. And that is what I take exception to.
@ Science Mom: Let us agree “to disagree” about the Cochrane Collaboration and their 28,000 “volunteers” who participate in issuing the many Cochrane Reviews. The Cochrane Review that Offal “cherry picked” was conducted by four members (volunteers) of the Cochrane Collaboration’s “Acute Respiratory Infections Group” and I did a PubMed author search on each of the four “volunteers”:
V. Demicheli
T. Jefferson
A. Rivetti
D. Price
None of the four “volunteers” from the Cochrane “Acute Respiratory Infections Group” has ever published a study, according to PubMed.
“I agree with Dr. Atwood’s assessment of over-valuing RCTs in Cochrane Systematic Reviews and it appears as though they are paying attention.”
I too agree with Dr. Atwood’s assessment….”and it appears
as though they are paying attention”…hence my referral to their “explanation” (editorial commentary) of Offal’s cherry-picked Cochrane Review:
IF THERE ARE NO RANDOMIZED CONTROL TRIALS DO WE ALWAYS NEED MORE RESEARCH (March 14, 2011)
“The investigators that conduct these reviews are no more “amateurs” than those mining the VSD, save for prats like the Geiers. And that is what I take exception to.”
Science Mom, are you stating that the researchers in government service, the members of the ACIP and the scientists who conducted the 50 Studies referenced in the revised ACIP Recommendations for the Use of Combination Measles, Mumps, Rubella and Varicella Vaccines (MMWR May 7, 2010) are in the class of the VAERS and the Vaccine Safety Data Link dumpster divers Geiers? If so, you are are sadly mistaken.
A new direction for anti-vaxxers?
A researcher at University of Missouri, Kristina Aldridge, using 3 dimensional computer imaging, has found subtle but significant differences in facial proportions in boys diagnosed with autism compared to non-autistic boys( MSNBC). Since facial development takes places prenatally ( first trimester), new permutations upon the vaccine-autism link must now include either time travel or shape-shifting.
@ Denice Walter: I think that “old” medical slang used “FLK” to describe infants who may have a syndrome:
FLK funny-looking kid (slang reference to dysmorphic features)
I suspect it isn’t used anymore…but was used by the many doctors/specialists in their doctors’ notes who consulted on my very own FLK, born 35 years ago. (He was an adorable child in spite of some dysmorphic facial features).
@Denise Walter and lilady
I seem to recall that there are some physical features that may differ, for example ear size and hand size. This is just recall, though, so I may be remembering incorrectly.
Since facial development takes places prenatally ( first trimester), new permutations upon the vaccine-autism link must now include either time travel or shape-shifting.
Tell that to the WAPFers. It’s the basis of their logo.
@ Todd W.:
IIRC it was more subtle proportional measures like shorter length of middle part of face, wider mouth, etc.
Earlier studies: IIRC about larger head size in particular type of autism.
Of course it’s your prerogative to disagree with me, however doing so based upon literature abuse by Bob Schecter is a disservice to the “volunteers” at the Cochrane Collaboration who produce many high quality reports. Incidentally, the IOM’s Institute of Vaccine Safety members are also on a volunteer basis. And I had no problem finding the four Cochrane MMR Review authors on PubMed (disregard the physics publications for the last two authors that are obviously others):
T. Jefferson: http://www.ncbi.nlm.nih.gov/pubmed?term=%22Jefferson%20T%22%5BAuthor%5D
V. Demicheli: http://www.ncbi.nlm.nih.gov/pubmed?term=%22Demicheli%20V%22%5BAuthor%5D
A. Rivetti: http://www.ncbi.nlm.nih.gov/pubmed?term=%22Rivetti%20A%22%5BAuthor%5D
D. Price: http://www.ncbi.nlm.nih.gov/pubmed?term=%22Price%20D%22%5BAuthor%5D
“The investigators that conduct these reviews are no more “amateurs” than those mining the VSD, save for prats like the Geiers. And that is what I take exception to.”
Please read my statement again; it means the exact opposite of what you have attributed. It helps to know that the Geiers obtained access to the VSD years ago.
I know this is a random place to throw out this plea, but it is anti-vaccine related:
Is there anyone out there who is familiar with how school vaccine exemptions work in the state of California? I am looking for information on how they apply to private institutions, but I am going in circles on the state website. If anyone knows where I can find the specific laws that allow the exemptions, could you post links? I’ve already download several large PDFs that haven’t helped me figure out what I need to know.
@Denise Walters: yeah, sure because something as complicated and multifactorial as autism can definitely be boiled down to “FLK” and therefore there is no immune-related cause potential whatsoever post first trimester. I’d like to tell you that you’re a moron. Clearly, immune challenges in mothers in second trimester and third trimester can lead to autism and other conditions like schizophrenia, at higher rates than moms without immune challenge (do a little reading of reputable sources, will you?).
Whether or not early immune challenges (ie vaccines and more importantly certain naturally-occurring infections such as in the first several months of life (note: before the well-studied MMR at twelve mos)) can lead to higher autism rates has not been studied but should be. People like you stand in the way. You’re as bad as the idiot antivaccers. Neither of you have evidence to back up your idiotic claims and you each resort to pretty pathetic arguments. Yours: oh, omg, there’s a study that shows some autism is related to first trimester determinants. That means all autism, of all causes, must be first trimester thus making infection or vaccines irrelevant. Look at me, I can haz do scienz!! Yes, I am equating your intelligence to the lolcats.
Oh, and question for Sid, who said
If we could eradicate measles through vaccination as we did smallpox, that wouldn’t be an issue, would it?
If anyone knows where I can find the specific laws that allow the exemptions, could you post links?
NVIC seems to be the MDC go-to.
I’d like to tell you that you’re a moron.
Hi, Tracy Stewart! Shall your corpus be put into the record?
@ Chemmomo: I checked the CDPH (California Department of Public Health) and found school immunization laws for you:
California School Immunization Law
At that site you can find “Immunization Handbook” that details for school nurses/administrators what the California Education Department and the CDPH require for school entry as well as the paperwork (“blue card”) that is apparently required to be filled out detailing each student’s immunization record.
As you know California permits a PBE (Personal Belief Exemption) and the handbook deals with these PBEs as well.
From my experience in public health in another state, I recall many telephone calls from school nurses in public and private schools about transfer students who were missing an immunization or had no immunization records or records from foreign countries that needed to be translated…but those were in the good old days…when the only kids admitted without immunizations were those with true doctor-verified medical exemptions. I miss those days as now most states (W. Virginia the exception, I believe) allow PBEs, philosophical or “religious” exemptions.
Religious exemptions can include a belief in not “contaminating” the body/temple of God…and so forth.
Religious and Private Schools must comply with State Health Department and Education Department regulations…in order to get financial aid for nurse/doctor services, textbooks, bus transportation and special education services. So they do comply with the “paperwork” to get the goodies from public tax dollars.
It’s been my experience that most private or parochial schools are compliant with these vaccine regulations. There are always private schools that are known to be “welcoming” of parents who chose to take advantage of personal belief, philosophical or religious exemptions.
Let me know if the site I provided to you is helpful.
@ the numbers poster: Do you have any citations to back up your “theories”.
Perhaps you are a geneticist and are working on “other theories”.
I first mentioned FLK because I know that facial dysmorphic features are formed during the first trimester…at least in the human race…maybe the same as in your species as well?
It seems that anytime anyone mentions preconception causes (age of both parents at time of conception, use of prescribed teratogenic medication) or (shudders) prenatal environmental causes and (double shudders) genetic causes of autism…the anti-vax crowd goes ballistic.
W. Virginia the exception, I believe
And Mississippi.
Narad and lilady: thanks – unfortunately links provided lead back to where I’ve already been circling. I’m trying to figure out whether a private institution is required to accept the PBEs. Does the wiggle room in the law go both ways? I’m not sure exactly where to look next.
Chemmomo, as a general rule a private school does not need to require vaccines. Though the rules may get a bit muddy if they accept public funds (like those dealing with disabled children), which is perhaps the problem you have with statute circles.
A private school really only has to abide by certain rules. They do not have to deal with the Individuals with Disabilities Education Act, but they do need to comply with some American with Disabilities Act rules (though they mostly have to do with building codes).
Some private school institutions, like many Catholic parochial schools, do enforce certain rules like immunization requirements, but that is because they are mostly practical and reality based. Catholic schools even teach evolution in their science curriculum (While at the same time espousing transubstantiation, which is why “agnostic” or “atheist” is often synonymous with “ex-Catholic” — like my spouse, and by derivation, me. My kids ask what religion we were, I just tell them “lapsed Catholic”).
Another thing that really makes it difficult is that California actually allows a philosophical exemption, which is often found to exist prominently in certain neighborhoods and in charter schools.
The NY Times had an article about a Waldorf school in Silicon Valley that was reprinted in my local paper. It read like a full page advertisement for the Waldorf educational system. Except it missed a few things…
… Like the problem that it seemed that if a school was closed due to an outbreak of a vaccine preventable illness the chance of it having the name “Waldorf” in it was very high.
Or that the founder of Steiner was a racist with some weird views on reality. Or that kids with special needs end up not being served, since academics were secondary. Much of this is covered in http://waldorfcritics.org/ .
In case no one wants to look it up, “transubstantiation” refers to the flap PZ Myers of Pharyngula got into with “it is just a wafer!”. I have a distinct memory of my rather outgoing mother going on about how those little wafers were supposed to be the bread that represented Christ and how the grape juice at communion was supposed be wine, much less be the “blood of Christ.”
By the way, that is not as weird as Steiner biodynamic farming. Which was covered on this blog here. Have fun.
Chemmomo, as a general rule a private school does not need to require vaccines.
This is not a general rule external to state law.
@ Chemmomo: I have the California State Law for you that covers all public and private schools…as well as day care and developmental centers:
California Health and Safety Code Division 105 Part 2 Chapter 1 Section 120365
Yes, you have to type all this in…you know I don’t know how to link.
At the beginning of this law, reference is made to the “governing bodies” of public and private schools, day care centers and developmental centers…which I suppose means “whoever is in charge” such as school superintendents, school principals and day care and developmental centers.
I think the law is an empowering law for “whoever is in charge” to implement the regulations regarding vaccine requirements and exemptions.
Your question is interesting and I suspect that no private school administrator can “violate” a parent’s right to claim a personal belief exemption for their child and deny admission based solely on a claim of a PBE.
It’s just my opinion and as you know I despise exemptions to vaccinations…other than true medical exemptions. I think a civil rights lawyer would have a good case to sue and compel any public or private school that denies admission because its “governing board” doesn’t like the law.
Sadly, we found the pertinent part of the current CA code: 17 CA ADC § 6025
(I’m not including a link because I don’t know how to shrink it down to something postable)
And what it boils down to is what lilady said: the state has given vaccination opponents a way of getting around the school’s governing bodies.
However, with all this poking around state law I did learn this: the schools can bar the non-immunized from attending when a disease outbreak occurs. It’s a small compensation.
@ Chemmomo: I think I would be quite upset if I had a youngster with temporary treatment related immune-suppression (and my son was was born with congenital immune compromising pancytopenia), to find a parent had legally “opted out” of vaccinating their child. I never had that situation because when he was in a special school for the multiply-disabled, my state did not have these liberal PBE exemptions. Furthermore, the few “religious exemptions” based on silly “temple of God” beliefs were all fought rigorously by school officials and won either at commissioner’s hearings or in court (Don’t forget I worked in the County health department-division of communicable disease control and heard all the stories from all the public and public school nurses as well as State Health Department colleagues).
“However, with all this poking around state law I did learn this: the schools can bar the non-immunized from attending when a disease outbreak occurs. It’s a small compensation.”
Unfortunately, it takes a case of vaccine-preventable disease to bar a student whose parent’s have opted out for a non-medical reason and, unfortunately the child with an impaired immune system is taken out of school as well…because of the selfish acts of these anti-vax parents. Fortunately however, the immune compromise and immune suppressed children are entitled to a home tutor paid for by the school district…and the opted-out child isn’t.
Oftentimes, the parent who has opted out and is barred has a “change of heart” and gets their child immunized, because they are “inconvenienced” by keeping their child home until the time for communicability of the last case of the disease outbreak has run its course.
The school nurses are the real heroes when it comes to safeguarding children’s health. They are the ones who keep great records of schoolchildrens’ immunization status and the ones who act quickly to notify health department officials of the names of the kids who are unimmunized. We got a number of calls from their parents who attempted to “plead their cases”…of course we had public health law authority to keep their kids out of school during an outbreak…they remained barred from the school premises.
These situations arise because of the rise of “health freedom” and “freedom of choice” and “distrust of authority”.
lilady:
Of the Cochrane reviewers, Tom Jefferson is the best known, and he has a formidable publication record. He does approach matters from a rather unusual angle, is quite critical of the politics of vaccination and imho is quite naive about the effects of what he does and says have on general antivax sentiment.
He has gained a huge antivax following because of his scrutiny of vaccine studies, particularly influenza, and his papers are ripe with misquotable snippets that can be used to beat vaccines around the head.
Offal:
Give me strength.
Who does he think he is, Clinton?
@ Tss8432:
Actually, as long-time readers might tell you, I am the commenter @ RI who has continually posted information about both genetic and environmental causation of schizophrenia as well as recent genetic links to autism by pointing to studies when pin-point specific genes (like 22).
As for “standing in the way”: since I am neither a governmental agency nor a non-profit that awards grants I can’t foresee any problems.
Narad:
I don’t believe that there are federal laws governing school vaccination exemptions. I know that IDEA, a federal law, does not extend to private schools. Each state has their own laws, and it as Chemmommo points out, having a philosophy exemption for any school makes it kind of pointless. One thing would be to check the laws of the two states, Mississippi and West Virginia, that do not allow philosophy exemption.
I am reading the book Pox, which may go into the legal federal/state issues. I am mostly familiar with the rules like IDEA, especially when some person tries to tell me private schools our better and I have to shatter their rose colored glasses when I tell them they would never admit my older son because of his disabilities. (I actually did that at a public meeting, some guy starting going on about how horrible the public schools are, and I turned around and said: “Yeah, because they won’t let kids like mine in!” He ran out of the meeting muttering that I did not know anything, while our local legislative representative really wanted to talk to him, since he knew me and my issues already.)
@baglady
Selection criteria
All randomised and quasi-randomised controlled trials of antibiotics for TREATMENT of, and contact prophylaxis against, whooping cough.
What ARE you talking about?
“Sid”, you are aware that you are arguing in favor of the pertussis vaccine, aren’t you?
@baglady
That’s hilarious. Giving more credence to he vaccine salesmen and women at the CDC than to the independent Cochrane Review.
As to “more recent” studies, I would have thought that thirty five years of MMR vaccinations would have given them adequate time to put together some quality studies
Falcon, I don’t know how one CAN argue for a vaccine that provides ~three years of immunity and must be administered countless times throughout the lifespan.
Because if, as you insist, antibiotics don’t do anything for pertussis, then one is better off preventing it. Three years of immunity is better than nothing.
@baglady
The CDC IS pretty funny. Only they could call the doubling of seizure rates a “slight uptick.”
I don’t believe that there are federal laws governing school vaccination exemptions.
There are not. The point that I was making, apparently clumsily, was that “as a general rule a private school does not need to require vaccines” is overbroad and perhaps backward. State law often encompasses private daycare and so forth to boot. Where the federal angle usually comes in is with some canonically cited but peripherally related (unemployment, IIRC) case law in states where there is a religious but not a philosophical exemption (the upshot being that the prohibition on testing the validity of religious beliefs magically makes testing the sincerity of religious beliefs go away). I suppose I should take a wire brush to my mental rust on this.
Careful, Mr. Schecter. One day you may have to be held accountable for your accusations that people at CDC are “he (sic) vaccine salesmen and women”. You know they’re not salesmen, yet a reasonable person may be misguided by your statements. And anyone who knows you personally like we do knows that you intend malice in saying and writing those things.
You know what that constitutes, right, Robert?
@Sid
Because a vaccine that provides 3-12 years of immunity, thus preventing getting sick at all, is better than getting a disease that provides 3-20 years of immunity, with all its potential consequences. Either way, you’re potentially vulnerable to reinfection, but with the vaccine, you don’t get sick in the first place.
Mr. Schecter:
It is stuff like this that should show everyone to not take medical advice from a real estate agent/investor. What that link says is:
Mr. Schecter, the risk of encephalitis, meningitis, disability and even death from measles is still one in a 1000. That is still more than the risk of 2 our of 2300 (or 1 in 1150) of just a febrile seizure. I assume you had the same kind of math education that someone at my bank had, since he wanted me to pay real money to bring my mortgage interest rate down less than 1%, which would have only have lowered my monthly cost by just a few dollars (or less than how much they wanted me to pay to refinance). Needless to say, I am not impressed with his or your understanding of basic arithmetic.
Because of this information the ACIP revised the vaccine schedule recommendations and infants are given the MMR and varicella vaccines separately. That is because when they get evidence they are willing to change their minds, unlike certain numerically illiterate real estate investors who have closed minds.
Mr. Schecter comments (#132):
To put this in perspective, the risk of febrile seizures with the MMR and varicella vaccine given separately is 4.4 per 10,000 (0.044% or roughly 1 in 2,300); the combination vaccine raises that risk to 8.7 per 10,000 (0.087% or roughly 1 in 1,200).
By comparison, the risk of a child having at least one febrile seizure from all causes (primarily bacterial or viral infections) between 9 months and 5 years is 3 – 5% (300 – 500 per 10,000 or roughly 1 in 35 to 1 in 20).
This means that the additional risk of febrile seizure from the combination vaccine is an increase of between 0.9% and 1.4% over the “background” rate. This might be accurately described as a “slight uptick”.
BTW, that phrase – “slight uptick” – wasn’t used in the article Mr. Schecter cited nor was it in the article in Pediatrics.
Prometheus
Prometheus, all the more reason to check the numbers used by real estate agents, car sellers, venture capitalists, lawyers and stock brokers. I have often found that they have trouble with anything that includes “percentage.”
One of the most common fallacies produced by anti-science types is the failure to explain relative risk and absolute risk. (Some journalists are guilty of this as well.)
They’ll tell you that the risk of something doubles, but they won’t tell you that the absolute risk went from 1 in 1,000 to 2 in 2,000. Yes, it’s a doubling, but not as dramatic as, say, 150 in 1,000 to 300 in 1,000.
Perhaps the way baglady incorporated “slight uptick” into her rant made it seems as if it were part of the report. If it wasn’t, the point applies only to baglady and not her heroes at the CDC.
@Chris. Equity and commodities investor not real estate investor. And I can’t even imagine where you got real estate AGENT???
Mr. Schecter, I noticed that you completely ignored the criticism of his glaring math errors. Does that mean you admit that you were wrong?
Prometheus
They/we were comparing one vaccine to another not one vaccine to a “background” rate. But I get your point: Stats can be stated in a way that paints an ominous picture when in reality little risk exists. Like when were told the unvaccinated have a six time greater chance of contracting the measles yet their overall the risk is miniscule.
Falcon
I noticed that you completely ignored the criticism of his glaring math errors
Who’s math errors???
Correction: Mr. Schecter, I noticed that you completely ignored the criticism ofyour glaring math errors. Does that mean you admit that you were wrong?
Mr. Schecter, because I really don’t care. I looked it up, it had something to do with buildings. But I guess you are right up there with Blaxill and Handley on “how ignorant you can be about basic arithmetic.”
Mr. Schecter,
Where did you get the value of six times greater? I supposed that would be true for a single unvaccinated person in a vaccinated population, but you’re advising people in general not to vaccinate. There’s a big difference between one house not up to the fire code and an entire city without one.
@ Offal # 137:
What were YOU reading…from your Cochrane citation:
MAIN RESULTS:
Thirteen trials with 2197 participants met the inclusion criteria: 11 trials investigated treatment regimens; 2 investigated prophylaxis regimens. The quality of the trials was variable.Short-term antibiotics (azithromycin for three to five days, or clarithromycin or erythromycin for seven days) were as effective as long-term (erythromycin for 10 to 14 days) in eradicating Bordetella pertussis (B. pertussis) from the nasopharynx (relative risk (RR) 1.02, 95% confidence interval (CI) 0.98 to 1.05), but had fewer side effects (RR 0.66, 95% CI 0.52 to 0.83). Trimethoprim/sulfamethoxazole for seven days was also effective. Nor were there differences in clinical outcomes or microbiological relapse between short and long-term antibiotics. Contact prophylaxis of contacts older than six months of age with antibiotics did not significantly improve clinical symptoms or the number of cases developing culture-positive B. pertussis.
AUTHORS’ CONCLUSIONS:
Although antibiotics were effective in eliminating B. pertussis, they did not alter the subsequent clinical course of the illness. There is insufficient evidence to determine the benefit of prophylactic treatment of pertussis contacts.
I made the comment that I was NOT a contact of a pertussis case, and that I did receive Erythromycin (a macrolide) in the very early stages of my case of pertussis which did in fact “reduce the duration and severity of symptoms and lessen the period of communicability (35).
Treatment of Pertussis
Maintaining high vaccination coverage rates among preschool children, adolescents, and adults and minimizing exposures of infants and persons at high risk for pertussis is the most effective way to prevent pertussis. Antibiotic treatment of pertussis and judicious use of antimicrobial agents for postexposure prophylaxis will eradicate B. pertussis from the nasopharynx of infected persons (symptomatic or asymptomatic). A macrolide administered early in the course of illness can reduce the duration and severity of symptoms and lessen the period of communicability (35). Approximately 80%–90% of patients with untreated pertussis will spontaneously clear B. pertussis from the nasopharynx within 3–4 weeks from onset of cough (36); however, untreated and unvaccinated infants can remain culture-positive for >6 weeks (37). Close asymptomatic contacts (38) (Box 3) can be administered postexposure chemoprophylaxis to prevent secondary cases; symptomatic contacts should be treated as cases.
(statement is from the current CDC Guidelines “Recommended Antimicrobial Agents For The Treatment And Post Exposure Prophylaxis of Pertussis (MMWR-December 9, 2005)
Offal, I suggest you peruse on the internet the CDC Manual for The Surveillance of Vaccine-Preventable Diseases (5th Edition, 2011). Under the Section “Pertussis” and under the header “Pertussis Case Investigation” You will find that:
Macrolides (Erythromycin) given early (catarrhal stage), do in fact, shorten the course of and severity of pertussis.
Post-exposure prophylaxis of contacts really does prevent transmission of pertussis.
So much for your citations of Cochrane Reviews, Offal.
Stats can be stated in a way that paints an ominous picture when in reality little risk exists. Like when were told the unvaccinated have a six time greater chance of contracting the measles yet their overall the risk is miniscule [sic].
Did you ever get around to coughing up the oscillation period and integrated morbidity and mortality that your brilliant plan of eschewing vaccination until the situation was so bad that your “risk assessment” changed sign would produce?
@ Offal: I have a comment stuck in moderation about your pertussis citation from Cochrane.
Stop the nitpicking…you knew that “slight uptick” were my words. More importantly, did you read the explanation of the math associated with febrile seizures in early childhood from viral or bacterial illnesses (background rate) versus the rate of a seizure 10 days after receiving the MMRV vaccine, provided by Prometheus…or is all “too complicated” for you?
You recall Offal, that we both attended Brooklyn schools and that I told you that I had “heard” that the excellent education I received late 1940s-1961 was no longer being offered. Your silly postings have confirmed what I had “heard”.
The numerically illiterate Schecter:
You know why the overall risk is small? Right?
It is because there is a vaccine called the MMR, which has been used in the USA since 1971. Due to overall high uptake the risk is small due to herd immunity. Except herd immunity does not work when those who spout off anti-vax lies gather together:
Pediatrics. 2010 Apr;125(4):747-55. Epub 2010 Mar 22.
Measles outbreak in a highly vaccinated population, San Diego, 2008: role of the intentionally undervaccinated.
Sugerman DE, Barskey AE, Delea MG, Ortega-Sanchez IR, Bi D, Ralston KJ, Rota PA, Waters-Montijo K, Lebaron CW.
N Engl J Med. 2006 Aug 3;355(5):447-55.
Implications of a 2005 measles outbreak in Indiana for sustained elimination of measles in the United States.
Parker AA, Staggs W, Dayan GH, Ortega-Sánchez IR, Rota PA, Lowe L, Boardman P, Teclaw R, Graves C, LeBaron CW.
Am J Epidemiol. 2008 Dec 15;168(12):1389-96. Epub 2008 Oct 15.
Geographic clustering of nonmedical exemptions to school immunization requirements and associations with geographic clustering of pertussis.
Omer SB, Enger KS, Moulton LH, Halsey NA, Stokley S, Salmon DA.
JAMA. 2000 Dec 27;284(24):3145-50.
Individual and community risks of measles and pertussis associated with personal exemptions to immunization.
Feikin DR, Lezotte DC, Hamman RF, Salmon DA, Chen RT, Hoffman RE.
Note to lurkers:
You might observe that diverse commenters @ RI use the word “statistics” in interesting and creative ways.
I suggest that its usage will be illustrative of the commenter’s background if you catch my drift.
http://www.nejm.org/doi/full/10.1056/NEJMsa0806477#t=article
In a retrospective cohort study in Colorado based on data for the years 1987 through 1998, children with exemptions, as compared with unvaccinated children, were 22 times as likely to have had measles
This one is 22 times rather than six but the concept remains unchanged: insignificant risk made to look significant in order to make vaccines look worthwhile.
Falcon, whom have I advised not to vaccinate? I encourage all of you to go out and get as many shots as you can.
Chris it’s fuuny how you guys change the intent of my posts. When the topic is how the establishment manipulates and misinterprets stats for it’s own purposes you fail to acknowledge that and instead turn the argument into a question about why the measles is rare. How strange.
What math errors???
Hey, Sid. Still waiting on the answers to the following:
What percentage of measles cases in MN this year resulted in hospitalization?
What percentage of MMR vaccines administered in MN this year resulted in hospitalization?
Also, any comment on the fact that in the 2005-2009 period we had 1 measles death, 1 mumps death and 1 rubella death, as well as 1 case of congenital rubella syndrome, while we have had zero deaths or CRS from MMR?
Todd, you’re obsessed. I’ve tried to answer your question on several occasions but you refuse to accept any answer that doesn’t conform to your views about vaccines…
…but I’ll try again. One death in five years = no risk = no reason to vaccinate
@ Chris: We were both mistaken about Offal’s profession…I suppose because we heard of a legal case involving a real estate deal gone bad between Offal and his father.
Offal…Commodities investor? I’ve heard of frozen pork bellies, gold and silver commodities…maybe you are investing in amalgam dental fillings…which contain 22% silver and mercury. Is there a bullsh** commodities market?
@Sid
The problem is that you keep answering questions that I never asked. Go back and read them again and this time, use a dictionary to help you understand the words.
It isn’t misrepresentation at all. If you can’t understand that circumstances change statistics, you’re probably a lousy commodities broker.
One death in five years = no risk =
no reason to vaccinatebetter turn that number upFTFY. Don’t whine when the fact that you don’t have the spine to address the consequences of your advice is pointed out.
Now I’m being nitpicky…Offal could you stop using the term “the measles” and switch to plain English “measles”?
@ Gray Falcon: Offal has the bullsh** and silver amalgam fillings market cornered.
Mr. Schecter, I really don’t understand how I changed the intent of your comments. Perhaps you should try stating the information a bit better, and work on your numerical illiteracy.
You said:
Let me make my point a bit clearer for you: in the 1950s and start of the 1960s a child had over a 19 out of 20 chance of getting measles by their fifteenth birthday. The reason that is no longer is the case is due to the introduction of measles vaccines in 1963, and the MMR in 1971.
Because of fear mongering like you and your friends, the chance of getting measles in the USA has been increasing. It is now endemic in the UK with two deaths, and I believe this paper was pointed out to before: Measles vaccine coverage and factors related to uncompleted vaccination among 18-month-old and 36-month-old children in Kyoto, Japan, which says:
So why should we take your word on anything? Or Blaxill? Or Handley? Are supposed to sit back and let measles return because you guys think you actually know epidemiology?
blackheart: Most current studies show rates of intellectual impairment in autistics to be much lower than 75%, and those rates appear to be declining over time. That’s fairly suggestive of an effect due to broadening of diagnostic criteria (though one researcher—Autism Diva’s old blog had the details—determined that there was never a good basis for the original rate; she mostly found secondary sources citing other secondary sources, and the few primary sources she found had used intelligence tests in ways that their developers had specifically warned against).
@ Science Mom: I stand corrected about the Cochrane authors not being published…and for that, I thank you.
I didn’t quite understand the nuances of your last statement,
“The investigators that conduct these reviews are no more “amateurs” than those mining the VSD, save for prats like the Geiers. And that is what I take exception to.”
In their mind, yes. AND they did one better. They’ve sent off intrepid cub reporter Crosby to have shouting matches with real epidemiologists at George Washington in the hopes that he squeaks through an MPH program in epi so that he can validate all their ideas.
Next, they’ll be sending some other
tfool to medical school to have an MD on their side. Then again, that’s why God made Jay “My Vaccine Schedule” Gordon.But, in fairness, let’s give Bob Schecter, amateur epidemiologist, one more chance. Fill in the blanks, Bob-o:
Number of children hospitalized due to
themeasles in Minnesota this year: _____________Number of children hospitalized due to the measles vaccine in Minnesota this year: ____________
$10 says he brings up some conspiracy bullshit about how “the salesmen and saleswomen” of CDC hide reports of MMR vaccine injuries.
Product info for MMR
https://www.merckvaccines.com/Products/mmr/Pages/product-information.aspx
lara, so what?
@ Offal: Why don’t you answer the questions about the number of children hospitalized with measles in Minnesota…versus the number of children hospitalized due to immunization against measles in Minnesota this past year?
@ Reuben: There is an interesting NEJM article about the current anti-vaccination movement and the type of people who are the leaders and followers of these cults.
NEJM January 13, 2011 Perspective-The Age Old Struggle Against the Antivaccinationists, Gregory A. Poland, M.D. and Robert M. Jacobson, M.D.
“Today, the spectrum of antivaccinationists ranges from people who are simply ignorant about science (or âinnumerateâ â unable to understand and incorporate concepts of risk and probability into science-grounded decision making) to a radical fringe element who use deliberate mistruths, intimidation, falsified data, and threats of violence in efforts to prevent the use of vaccines and to silence critics. Antivaccinationists tend toward complete mistrust of government and manufacturers, conspiratorial thinking, denialism, low cognitive complexity in thinking patterns, reasoning flaws, and a habit of substituting emotional anecdotes for data. Their efforts have had disruptive and costly effects, including damage to individual and community well-being from outbreaks of previously controlled diseases, withdrawal of vaccine manufacturers from the market, compromising of national security (in the case of anthrax and smallpox vaccines), and lost productivity.”
I think the authors stated succinctly the limited intellectual capacity, the lack of rational thinking processes, the collection of anecdata, distrust of research and the sheer lunacy of Offal and his pals.