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California Bill AB 2109: Real informed consent versus antivaccine misinformed consent

I’ve discussed the concept of “misinformed consent” multiple times before. Quacks in general, particularly the “health freedom” movement proclaim their dedication to “informed consent.” “All we’re asking for,” they will say, “is informed consent.” The antivaccine movement in particular demands “informed consent” about vaccines. Be it Barbara Loe Fisher, the bloggers at the antivaccine crank blog Age of Autism, or any of a number of antivaccine warriors, demanding “informed consent” seems to be every bit as much of the antivaccine arsenal as the “toxins gambit” or ranting about “fetal cells” in vaccines. None of this is to try to say or even imply that informed consent isn’t incredibly important. It is critical to everything we do in medicine, both in clinical practice and research in the form of clinical trials. It is, quite correctly, considered a major failure when adequate informed consent is not given, and when the failure to provide informed consent is intentional or comes about through neglect it’s considered highly unethical. Medical ethics demands that patients be aware of what it is they are getting as well as what the potential benefits are relative to the potential risks, and that they have the freedom to choose to undergo or refuse the proposed therapy.

However, what the antivaccine movement means when its representatives demand “informed consent” resembles true informed consent only by coincidence–and, let’s be frank, not even then. In fact, as Todd points out, the actions of the antivaccine movement are profoundly inconsistent with a real desire for real informed consent. As Todd pointed out, there is a golden opportunity for the luminaries of the antivaccine movement to prove that they support informed consent. This opportunity comes in the form of a proposed law in California, AB 2109. This bill, if passed, would require parents seeking a philosophical exemption from vaccination for their child would have to obtain from their child’s doctor or health care practitioner a signed statement attesting that the the doctor provided them with information on the benefits and risks of vaccines. That’s it. To me that seems to be a pretty low bar to require for a philosophical exemption from vaccination. Right now, all the parents have to do is to sign a form at the school. Personally, I like the idea promoted by Douglas Diekema in a recent issue of the New England Journal of Medicine that obtaining a religious or philosophical exemption should not be less difficult or costly than undergoing vaccination and that it should require at least a visit to the doctor’s office. Right now, in California, getting an exemption is easier than getting one’s child vaccinated, and not just a little easier. It’s way easier. Just sign a piece of paper saying that vaccines are against your personal belief system, and–voilà!–it’s done. As Todd put it, “Parents are still free to put their children and their communities at risk of disease outbreaks based on personal opinions rather than facts. They just aren’t allowed to be quite as lazy about it any more.”

Unfortunately, the antivaccine movement has rallied not for AB 2109, but against it. Barbara Loe Fisher, all her protestations for “informed consent” notwithstanding, has issued what is in essence a call to arms to her fellow antivaccinationists to try to defeat the bill. It’s full of appeals to “personal freedom,” claims that doctors would not sign such forms, and, hilariously, this complaint:

  • Especially in California, many families utilize health care providers not reliant on pharmaceutical drugs and vaccines, and only practitioners part of the pharmaceutical paradigm or medicine are allowed to provide the information and sign the form under this bill.
  • AB 2109 discriminates against families utilizing complementary and alternative medicine by forcing them into paying money to a medical practitioner they wouldn’t otherwise use who is already philosophically opposed to the parent’s personal and religious convictions regarding vaccination.

Barbara says that as though prodding parents who take their children to quacks to take them to a real doctor for just one visit is a bad thing. Of course, it’s “health care providers not reliant on pharmaceutical drugs and vaccines, and only practitioners part of the pharmaceutical paradigm” who tend to promote antivaccine beliefs.

Of course, I expect such nonsense from someone like Fisher. I don’t expect such nonsense from a physician. In fact, call me naive, over-optimistic, or just someone who hangs with his tribe too much, but I don’t even expect nonsense like that from someone like Dr. Jay Gordon.

Or Dr. Robert Sears.

Unfortunately, I was wrong. Dr. Sears has joined Barbara Loe Fisher’s voice against AB 2109 by writing an editorial that was published first on that wretched hive of scum and antivaccine quackery, Mothering.com entitled California Bill AB2109 Threatens Vaccine Freedom of Choice. Not surprisingly, two days later Dr. Sears crossposted his article to that grandmother of all wretched hives of scum and quackery, The Huffington Post. His reasons for being opposed to AB 2109 are virtually indistinguishable from the reasons posted at the NVIC website, right down to Dr. Sears thinking that doctors won’t sign the form:

However, what gravely concerns me is that some doctors will refuse to sign this form. I know how doctors think. Many doctors strongly believe that vaccines should be mandatory, and that parents should not have the right to decline vaccines. Some doctors are willing to provide care to unvaccinated kids, despite this difference in philosophy. But now the power over this decision will be put directly into doctors’ hands. He or she can simply refuse to sign the form. Doctors who oppose vaccine freedom of choice have been frustrated for years over this issue. Finally, they will have the power to impose their beliefs on their patients. Patients will be forced to find another doctor to sign the form, submit to vaccines, or get kicked out of public school.

And, of course, there’s the question of liability fears, which leads Dr. Sears to state that he knows for an “absolute fact” that some doctors will not sign the form “out of principle or fears of liability.” How he knows this “for an absolute fact” he doesn’t say. The only part where Dr. Sears makes a modicum of sense is that some doctors might be reluctant to sign the form for a child based on a single visit, particularly when it’s obvious that that’s the only reason the parents brought the child in to be seen and evaluated. That might be so for some doctors, but how many doctors do sports physicals, insurance physicals, physical exams for workers’ compensation, and the like, even though they know that the patient probably won’t come back to see them again? How many physicians in California, for that matter, refuse to sign medical exemption forms for vaccination? Not very many.

If you don’t believe me that Dr. Sears is cribbing from the NVIC playbook, though, read this passage:

Natural and alternative health care providers can NOT sign the form; it must be a “regular” medical professional. Some families only see naturopathic or holistic health care practitioners instead of pediatricians. These families will have a difficult time getting the form signed.

Again, Dr. Sears, you say this as though that were a bad thing. Also note how his language is almost indistinguishable from that of the NVIC. Getting kids whose parents are using quacks for their primary care physicians brought in, even just once, to see a real doctor can only be a good thing. Here’s a hint for Dr. Sears: It’s not a good thing when passages of your blog post look as though they’ve been directly cribbed from an NVIC position statement! If you don’t want to be perceived as antivaccine, then don’t use NVIC arguments in language that could fit right in on the NVIC website without raising a single eyebrow of Fisher’s fans. Besides, there are plenty of antivaccine-sympathetic (or even antivaccine-friendly) doctors like yourself, Dr. Janet Levitan (who, it should be recalled, is perfectly happy to encourage parents to lie about their religious beliefs in order to obtain religious exemptions from vaccination for their children), or Dr. Jay Gordon out there, who will probably be more than happy to sign such forms after having provided a heapin’ helpin’ of misinformed consent to the patient.

In fact, it wouldn’t surprise me at all if one result of this law would be the creation of a cottage industry of antivaccine-sympathetic pediatricians advertising their willingness to sign philosophical exemption informed consent forms in California with only the most perfunctory of visits. It could be quite the little cash cow. Unfortunately, requiring that parents see a real pediatrician for real informed consent is no guarantee that they will actually get real informed consent based on science, but it makes it more likely. Certainly it’s far more likely that parents will get something resembling informed consent if they go to a real pediatrician than if they go to a chiropractor, naturopath, or homeopath. Moreover, chances are that insurance will pay for most, if not all, of any visit required to obtain a vaccine exemption informed consent form from a physician. It’s largely a win-win situation, although Dr. Sears doesn’t see it that way. In fact, he doesn’t even seem to agree with the purpose of the bill, namely to try to increase vaccination rates:

The sponsors of this bill may have some good intentions, as their primary “public” reason for the bill is to make sure that parents who don’t vaccinate their children are making an informed medical decision under the guidance of their doctor. But it isn’t difficult to see the REAL reason for the bill: to increase vaccination rates in our state by making it more difficult for parents to claim the exemption.

Again, Dr. Sears, you say that as though that were a bad thing. Or, to put it another way, why don’t you think it’s a good thing to try to increase vaccination rates?

Contrary to Dr. Sears’ paranoia over what he apparently perceives as the dark “real” motivations of the sponsors of AB 2109, I see little evidence that the sponsors of this bill aren’t being straight with us. Of course they’re trying to increase vaccination rates; they’re actually pretty straight about their motivations. They’re intentionally trying to make it a little more difficult to get a philosophical exemption approved. And why not? I agree with Dr. Diekema. It shouldn’t be so incredibly easy to get an exemption compared to actually getting one’s children vaccinated. The hard core antivaccinationists will take that extra step; those who are more lazy than actually committed to not vaccinating their children will probably not. In any case, the real reason that Barbara Loe Fisher, Dr. Sears, and the rest of the antivaccine movement don’t like AB 2109 is exactly because it makes it a little harder to get a philosophical exemption. More importantly, it will require some parents to take their children to a physician and have a talk about vaccines. Dr. Sears points out that by the time a parent has made up her mind to get an exemption that talking to a physician about it will probably not change her mind. That’s probably true, but the current state of affairs in California is that it’s so easy to get a philosophical exemption that it’s much easier than actually bothering to get one’s children vaccinated.

The decision not to vaccinate one’s children is every bit as much a medical decision as the decision to vaccinated, and it needs to be made with adequate informed consent. The real reason antivaccinationists are so opposed to AB 2109 is because they fear informed consent. Their version of “informed consent” is a parody of real informed consent. It is, as I have characterized it many times before, in reality misinformed consent, in which the risks of vaccination are hugely exaggerated while the benefits downplayed to the point that any rational person, if she accepted such “risk-benefit” analyses at face value would decide not to vaccinate her child. Unfortunately, the average person doesn’t have the background knowledge and understanding to see through the misinformation at the heart of misinformed consent. They have a hard time knowing that the claims of people like Barbara Loe Fisher that vaccines cause autism, neurodevelopmental disorders, autoimmune diseases, and so many other ills that they attribute to vaccines are without a basis in science, epidemiology, or clinical evidence. A pediatrician can help them do that by providing them with genuine informed, rather than misinformed, consent.

And that’s exactly what the antivaccine movement fears. So, my readers in California, please be sure to contact your legislators to voice your support for AB 2109. You can be sure the antivaccine movement is trying to pressure them not to pass this bill.

By Orac

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

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

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

To contact Orac: [email protected]

199 replies on “California Bill AB 2109: Real informed consent versus antivaccine misinformed consent”

1. Vaccine-refusing families would need a new signature (a) at kindergarten entry
(b) Every time they change schools (c) entering 7th grade, for the whooping cough booster.

I ran the numbers:

AB 2109 would take effect in 2013. Entering kindergarteners would have been born in 2007; there were about 566,000 kids born in that year. According to The Bay Citizen, the average Personal Belief Exemptions sought are 2.28% of kindergarten enrollment.That’s about 13,000 in the whole state — hardly a huge burden to the state or to pediatricians/family practice doctors.

2. Who can sign the form?

“e) For purposes of this section, “health care practitioner” means a physician and surgeon, licensed pursuant to Section 2050 of the Business and Professions Code, a nurse practitioner who is authorized to furnish drugs pursuant to Section 2836.1 of the Business and Professions Code, or a physician assistant who is authorized to administer or provide medication pursuant to Section 3502.1 of the Business and Professions Code.”

Dr. Sears has not responded to the facts. Such a surprise!

@Orac

Thanks for the links!

@Liz Ditz

1. Vaccine-refusing families would need a new signature (a) at kindergarten entry (b) Every time they change schools (c) entering 7th grade, for the whooping cough booster.

I thought I read in the bill that a copy of the signed, written statement from the physician would be acceptable. That gives me the impression that if they refused the vaccine once and received the statement, they would not need to go to the doctor (or other accepted health care provider) for another signed statement, as long as they had a copy of the original. So if they changed schools, they could submit a copy of whatever statements they had already received, and would only need new ones if there were some other vaccine that they had not yet refused.

You say: “I like the idea … that obtaining a religious or philosophical exemption should not be less difficult or costly than undergoing vaccination….” This implies that you recognize paying for vaccinations, or even getting a day off to take your kids to the doctor and transporting them there and back, is difficult and costly for many in the working (or out-of-work) class, and that economic and time pressures may contribute to some people’s decisions to avoid vaccination. Unfortunately, your solution to that is the negative, punitive one of making sure that not vaccinating is also costly and burdensome.

How about the opposite approach: Make vaccination cheap, or better yet free, and easy, and see what that does to acceptance rates. There is already a strong moral argument to be made that any treatment mandated by government should be paid for by tax dollars. Why shouldn’t every vaccination with a significant public health benefit be free to the parents?

And why should you have to take off work and bus all your kids to a doctor’s office each time one is scheduled for a shot? In third world countries, they can’t run things like that or nobody will get vaccinated. The vaccinations come to you. Well, we are rapidly becoming a third world country and had better learn to start doing things that way. How about making shots available (with prior parental consent) from visiting nurses who occasionally stop by every daycare in town? How about having a van that comes around the neighborhood every so often, or sets up at the branch library or local grocery store?

I bet pediatricians would scream about it, but why, other than to protect their income? The fact is that for any kid who has not already had a problem, the basic vaccines are so safe that a child does not need to have a medical exam before receiving one or be under an MD’s watch afterward. These shots are regularly given in some countries by home-visiting nurses or the equivalent and nobody dies. The pediatricians just love being able to charge for “checkups” on healthy children over and over again.

And why should you have to take off work and bus all your kids to a doctor’s office each time one is scheduled for a shot? In third world countries, they can’t run things like that or nobody will get vaccinated. The vaccinations come to you. Well, we are rapidly becoming a third world country and had better learn to start doing things that way. How about making shots available (with prior parental consent) from visiting nurses who occasionally stop by every daycare in town? How about having a van that comes around the neighborhood every so often, or sets up at the branch library or local grocery store?

Those would be good things to do in addition to making philosophical exemptions more difficult to obtain.

@jane

Why shouldn’t every vaccination with a significant public health benefit be free to the parents?

They should be free to parents. And, most insurance programs do cover the entire cost of an immunization visit. For those without insurance, states have a number of programs to pay for preventive care. Under the current system of pay-for-service insurance, though, there will still be those who get skipped over. I’m completely in favor of universal health care to cover preventive medicine.

And, what a surprise that Sears, Babs and other anti-vaxers are *concerned* that parents won’t be “covered” by their medical insurance carriers or, reimbursed for well-child visits and physicals. Here is the AAP Practice Guidelines (click to enlarge Figure 1. for scheduling chart)

http://practice.aap.org/content.aspx?aid=1599

BTW, if you have medical coverage for your child, your insurance company “covers” all well-child visits and physicals, using the AAP Practice Guidelines Schedule.

jane,
I do think it is sad that vaccines can cost so much in the US. I actually doubt Orac feels much differently about this than you do. Sadly there is a lot of pressure in the US not to change such things. While heathcare coverage in Canada is province by province, so I am unsure of the situation in other provinces, I have happy to see that we cover most vaccines for free.

I was happy to see that this list was expanded last year to include rotavirus, the MMRV vaccine, a second dose of the chicken pox vaccine, and a pertussis for adults.

I remember (through the fog of almost forty(!!) years) getting my inoculations in the public school gym. Darned third-world Canadian socialized medicine!

An OT ASD study alert: Autism Biomarkers!

I think this means that a protein or peptide anomaly is linked to autism. I also believe this pushes the debate over causes further away from vaccines, toxins and the other crap and closer to genetics. Small study, and it doesn’t mention (in any way I can understand) what part or how much of the spectrum can be identified. Cool nonetheless.

Re: #3 @jane

I bet pediatricians would scream about it, but why, other than to protect their income? The fact is that for any kid who has not already had a problem, the basic vaccines are so safe that a child does not need to have a medical exam before receiving one or be under an MD’s watch afterward. These shots are regularly given in some countries by home-visiting nurses or the equivalent and nobody dies. The pediatricians just love being able to charge for “checkups” on healthy children over and over again.

I am a practicing Pediatrician in Missouri. The Majority of our vaccine is VFC, provided to us at no cost by the state, given by us at no cost to those who qualify for it (uninsured and Medicaid). “Paid” vaccine is bought by our clinic and and charged to the individual or the respective insurance. The physician income derived from these vaccines? $0.00. Some of our underinsured patients go to the Health Department for vaccines where payment is by donation. That is fine with me. I do not care where my patients get their vaccines. I only care that they get their vaccines. Do I get paid for well checks? Yes I do, but with that comes vision, hearing, nutritional, and developmental screening, discussion of safety, behavior, and discipline, and usually a couple of “by the way” issues that I address. Yes, most of the kids I see are healthy, and in hindsight, they didn’t “need” a checkup, just like I’ve never “needed” my own checkups with the doctor, or for that matter, I’ve never “needed” my seatbelt, or “needed” my homeowner’s insurance, but I can tell you that a week does not go past that I don’t identify an issue that needs addressed sooner rather than later on a routine “well” check. I earn my money. I’m not asking for more visits to discuss vaccines with people who don’t want to get vaccines. I’ll do it, because I feel I owe it to the children to try to help parents to work through their fears, and in some cases, stupidity, but it takes time, energy and patience, every time. I guarantee that I could make more money seeing four or five other patients in the time it takes to counsel one of these vaccine questioning parents. But I do counsel them. I give them the best information I can, and if they refuse, I will have them sign a refusal form. Most of the time, however, I am able to allay their fears and answer their questions, so it’s worth it.
Regards

@ jane: how about this citation for reimbursement of physicians who administer vaccines?:

http://pediatrics.aappublications.org/content/124/Supplement_5/S466.full

Have you a clue Jane, about the physician’s costs to purchase vaccine directly from the manufacturers?:

http://www.cdc.gov/vaccines/programs/vfc/cdc-vac-price-list.htm

Jane, these costs do not include “wastage” and vaccines that are discarded upon expiration date. Nor do these costs include the costs of syringes/needles when vaccines are not preloaded with the vaccine, direct from the manufacturer.

Jane, I worked as a public health nurse and I had to adjust my workweek to staff immunization clinics during evening hours and on Saturdays. I was not paid overtime…I adjusted my workday or, in the case of Saturday immunization clinics, took a compensatory day off the following week.

BTW, the VFC (Vaccines For Children) Program covers “underinsured” children whose parents have private medical insurance that does not pay for childhood immunizations.

Plus California has an insurance program for those with low income, Medi-Cal. So there should be no excuses.

I learned about the Medi-Cal program on a paper that discusses the financial hit California had during the 1990 measles epidemic:
West J Med. 1996 Jul-Aug;165(1-2):20-5.
Pediatric hospital admissions for measles. Lessons from the 1990 epidemic.

It says: “Hospital costs amounted to $18 million, two thirds of which was paid for by Medi-Cal.”

The direct cost of the shot itself isn’t the only issue. Taking time off work for the appointment is often a major concern for many poor people. Some may fear they will lose their job if they do, and others simply can’t afford to lose the wages for those hours.

That’s a much harder problem to solve.

How about the opposite approach: Make vaccination cheap, or better yet free, and easy, and see what that does to acceptance rates. There is already a strong moral argument to be made that any treatment mandated by government should be paid for by tax dollars. Why shouldn’t every vaccination with a significant public health benefit be free to the parents?

It’s trivial to find free or low cost vaccination programs; just checking my local area, I found thirteen options. There is a time cost, but it’s not particularly large.

First let me say that all my children were vaccinated on schedule and if I were to change anything it would be that we would wait until they were at the older end of the normal vacination schedule. Doctors are unlikely to be well informed on the pros/cons of vaccinations (like their ignorance of nutrition generally for example). A nurse Practioner would be just fine and cheaper (why make medical costs as expensive as possible? AMA influence?). Walmarts etc. could offer the service economically. Those that get their children vacinated should ALSO be required to be “informed” as well. Finally on a related note, the vacine industry’s special exemption from vaccine failures and damage should be removed.

@Another Joe – your statement that pediatricians aren’t educated on vaccines is farcical (especially since you through in the old nutrition gambit).

You may not know that Barbara Lee Fisher (a prominent anti-vax loon) was instrumental in helping to set up the Vaccine Court & the VAERS database.

“creation of a cottage industry of antivaccine-sympathetic pediatricians ”

Or Dr. Bob could just set up book signings across the state and sign a form when parents buy his book. That’s my guess for how he handles this when AB 2109 passes.

Those that get their children vacinated should ALSO be required to be “informed” as well.

False equivalence, because they already are informed. The reason is that physicians and health care practitioners are already required by medical ethics and law (not to mention also some fear of malpractice litigation) to obtain informed consent before administering vaccines.

Another Joe…you haven’t read the prior posts, have you?

Private doctors who purchase vaccines from manufacturer do not make any money for administering vaccines.

Some states do permit stand-alone Nurse Practitioner practices and many states do permit pharmacists to administer some, but not all, vaccines. No matter which licensed professional administers vaccines, the costs of the vaccines and the costs associated with administering vaccines, result in no net profit (read the comments).

VFC vaccines are available in all 50 states and there are many licensed professionals who are VFC Providers:

http://www.cdc.gov/vaccines/programs/vfc/parents/default.htm

I refuse to comment on your off-topic thread derailing statements,

“Doctors are unlikely to be well informed on the pros/cons of vaccinations (like their ignorance of nutrition generally for example). A nurse Practioner would be just fine and cheaper (why make medical costs as expensive as possible? AMA influence?). Walmarts etc. could offer the service economically. Those that get their children vacinated should ALSO be required to be “informed” as well. Finally on a related note, the vacine industry’s special exemption from vaccine failures and damage should be removed.”

False equivalence, because they already are informed. The reason is that physicians and health care practitioners are already required by medical ethics and law (not to mention also some fear of malpractice litigation) to obtain informed consent before administering vaccines.

Says the one holding a Hemostat?

why the hell would i want the medical communities doses of highly toxic chemicals in my children. read all the research studies done on pubmed.com. its astounding at what these “vaccinations” due to these children and long term as adults. wake up. don’t be so brainwashed by our government that they have your best interests at heart. They could care less. Plus all the diseases that are caught are by vaccinated children, not the unvaccinated. Grow a set people and say no to vaccines.

Orac, may I make a suggestion, that you put the Thing’s comments in the moderation hopper?

It may not prevent Thing from posting Its brain droppings, but it will certainly piss It off, while awaiting you to release It from moderation purdah.

@ Vincent Ianelli, MD:

The way I look at it, the entire “vaccines-cause-autism” so-called community is essentially a massively inter-twined matrix of *cottage industries* ( medical, legal and literary- and I use all of those terms very loosely) which has been bringing in pounds and dollars ( of various types) since about 1995 or so.

Biscuits:

Plus all the diseases that are caught are by vaccinated children, not the unvaccinated.

Citation needed, seriously.

I would ask for citations about the toxins, but that last bit is pretty hilarious, especially in light of the recent measles outbreak in Europe. And make sure that the citation is less than ten years old.

@8 Richard:

“I remember (through the fog of almost forty(!!) years) getting my inoculations in the public school gym. Darned third-world Canadian socialized medicine!”

I got at least SOME of my childhood shots in the school gym, in Pennsylvania. Darned USAmerican socialized medicine!-)

“informed consent” is a joke. What about all the kids out there who were given mercury vaccines without permission at school? This is unlawful and unconstitutional.

Also I have heard of girls being taken from school to abortion clinics with the parents to find out later on.

Actions like this is what gets people beaten with a large hickory stick. And rightfully so. If some punk kidnaps your daughter from school (taking a minor without parental permission is kidnapping and prison time is required)and takes here to a place where she gets an abortion here is what happens:

The personel who kidnapped her gets beaten severely. The abortionist “doctor” get beaten more severely and then they all go tto prison where they are beaten daily. even if you have to biuld your own secret prison somewhere and put them in it yourself.

It is time for parents to start taking a stand and deporting these crimnals at these schools. banishment is a necessary punishment for their crimes. Now if we could banish a few hundrend poltiicians and a few billion liberals, preferrably all to a confined space of 100 feet by 100 hundred feet.

I guess some people lack respect for OTHER people’s kids and sovereignty. Time to teach them a lesson.

The flouride overdosed blueneck fat stalking elf from San Fransicko is back with a new underwear puppet.

The flouride overdosed blueneck fat stalking elf from San Fransicko is back with a new underwear puppet.

Matthew, some kids do get kidnapped from school to get abortions and some injections are given against the will of the parents. That is a crime and crimes must be prosecuted or dealt with.

Hi chris,my stalker, with no chromosomes. Nice to know your intelligence has decreased since my last visit. Must be the gardasil or the flouride. Or both. Then again it could GENETIC!

There is every reason not to get your child vaccinated at least from some of the more dangerous shots like Garadsil and other such nonsense.

Our county health department is racist. Forget going in there and getting anything if you are a white male. They assume for some reason all white people are rich. Must be the democrat subconscious speaking.

The initial rounds of polio vaccine were given in the schools (at least in Chicago). I had a childhood friend who had had polio — it was not a rare thing.

I don’t know the details in California, but in New York City parents can get their children’s vaccinations for school absolutely free, with a relatively short wait if they turn up at 9 a.m. I think they’ll bundle lots of vaccines at once, if the parents ask, though they don’t provide flu vaccines. (I was there for a vaccine of my own, in late August, about ten days before public school started: I arrived at about 8:55, the doors opened at 9, and I was vaccinated, walked 1/3 of a mile, took a crosstown bus another mile, and was at work by 9:30. So, yes, potentially some burden on the parents, but less so than a lot of other things they’ll need to deal with in raising a child.)

Biscuits

its astounding at what these “vaccinations” due to these children and long term as adults.

WTF does this attempt at a sentence mean? Babelfish needs to add a Whackaloon to English translator. Oh well, at least Biscuits was able to find the the shift key halfway through their highly edifying post.

Lawrence

l (especially since you through in the old nutrition gambit).

Is that a Coopertino or have you been reading too many antivaxxer comments?

@lilady 22

“Orac, may I make a suggestion, that you put the Thing’s comments in the moderation hopper? ”

Don’t bother with this guy. Frankly, folks need to just stop attempting to respond to him, and call him what he is: a fucking moron.

@Chris:

Biscuits:

Plus all the diseases that are caught are by vaccinated children, not the unvaccinated.

Citation needed, seriously.

If a large enough majority of the population is vaccinated against disease X, then the majority of the those infected with X will be the vaccinated; it’s simple statistics, based on the fact that vaccines aren’t 100% effective. Of course, Biscuits might be falsely implying that “the majority of the infected are vaccinated” means that the vaccine is ineffective, or even that the vaccine increases the chance of catching the disease. [Cue Th1Th2]

@Militant Agnostic:

Biscuits

its astounding at what these “vaccinations” due to these children and long term as adults.

WTF does this attempt at a sentence mean?

I think s/he’s claiming that vaccination causes chronic diseases.

Matthew Cline, I was actually thinking of recent measles outbreaks. Like the one in Europe where:

The majority of European cases (90%) were amongst adolescents and adults who had not been vaccinated or for whom vaccination history was not reported.

I’d like to see Biscuits now claim that the 10% that were vaccinated are most of those with measles.

The redneck scat-talking troll Rob Hood, from Eupora Mississippi, is back, with a new sock puppet.

Hey, Smarterthanyou, welcome back!

What about all the kids out there who were given mercury vaccines without permission at school?

1) Do you have a citation for this, like a news article or something?

2) Do you mean that the no permission form whatsoever was signed, and the vaccine in question happened to contain mercury? Or that a permission form was signed, but the permission form failed to inform the parents that the vaccine contained mercury?

This is unlawful and unconstitutional.

Unconstitutional? I’d be interested as to what part of the constitution covers a situation like that.

SmartherThanYou:

What about all the kids out there who were given mercury vaccines without permission at school?

Two questions:

1: Please give us a link where children under age thirteen are given vaccines at school without permission. I qualified the age because teenagers do not need parents permission for certain medical procedures.

2: Please tell us which of the vaccines on the American pediatric schedule are only available with thimerosal. Read that carefully, because I do not want you to blurt out “influenza” when there at least four without thimerosal available.

Has our old commenter Smarter Than You returned? We missed your big announcement a few years back. He made this claim a few years ago:

I expect you to laugh at my words, but the funny thing is, I’m not joking. Something has been in the making since 2004 that is going to make many dead people roll over in their graves. It will be completed by about October/November 2010, but it may be a little bit after that when you all become very familiar with it. But once you do, you will all finally see where you went wrong, because you most certainly have, and even the worst of the worst of them, such as Paul Offit, will even finally acknowledge just how wrong he was once and for all.

It has been over a year, what happened to that big reveal?

I was responding to a sock-puppet? Oops, oh well.

Wait, so were the previous two iterations of “Smarter Than You” also Rob Hood?

Oops, it looks like lilady was right, it was the annoying Sir Robin RightWing the ever Morphing Troll. Because now he’s gone!

I am so disappointed that it was not Smarter Than You, because he never did tell us the results of his big project.

Jane, to add to what lilady and Ebeneezer have already said; in Illinois, vaccinations for low-income families are free or very low cost, covered by VFC or the All Our Kids (AOK) program.

For working parents who can’t take time off to bring in their children — our county health department offers at least one weekend and one evening clinic per month, as well as appointments between 0800-1630 most weekdays. I believe most county health departments in this state do likewise. There is also a program that allows a parent to designate in writing a grandparent or other family member to bring the child to the clinic in his/her stead.

There is no reason not to get your child vaccinated.

Matthew Cline:

Wait, so were the previous two iterations of “Smarter Than You” also Rob Hood?

No. Someone I know had the old STY comment to her blog, so she shared the ISP information, he lived in Colorado.

Daran, explain how Gardisil is dangerous. Post actual scientific documentation.

And only one state requires it for public school, and it is not California.

That’s an excuse, Daran. Not a reason.

(btw, my sister the RN informs me that both her sons and her daughter will be getting the Gardasil vaccine).

And I would say that between 30-35% of the children who get immunized by our county health department are white and male. The percentage of white males coming to the HD’s STD clinic is much higher.

@ Chris…the link you provided to Matthew Cline about the French measles epidemic is very informative.

I see that the first of the two dose measles series is administered at 12 months…except for children in day care who should get the first dose at 9 months of age…and then one additional dose to complete the series after 12 months age.

This recommendation is quite different than the USA recommendation. A child age 6-12 month, in special circumstances (exposure to a case of measles or travel to a measles-endemic country), should be immunized, yet that dose “does not count”. The child should receive 2 additional doses of MMR vaccine after one year old.

I located a website that contains immunization schedules for European Countries and it is a fact that French kids in day care should get measles vaccine at 9 months…but only one additional dose to complete the two dose series:

http://www.euvac.net/graphics/euvac/vaccination/france.html

As far as my research goes, maximum protection is provided when a child receives the 2-dose series after one year of age.

I see from Sears’ “‘normal’ medicine” reference to real medicine that the quacks aren’t about to let their iron grip on that terminology victory with the “complementary and alternative medicine” go any time soon.

They try to make this issue more complex but what it really boils down to is that they have no right to endanger the children of others by refusing to comply with measures designed to protect us all, measures that they can’t prove do harm.

How about the “personal freedom” not to have your kid die because he or she got unlucky and didn’t mount a full immune response and some anti-vaxxer kid came along with a disease that no one needs to get anymore. Any government that panders to these people is showing a serious failure in priority assessment.

I would say that’s a pretty important personal freedom right there.

Good lord! I just read Dr Bob’s Huff Po piece (linked above) and he includes this gem:

It’s a waste of everyone’s time and money. At a time when we are trying to decrease health care spending, this bill will add millions of dollars of extra health care visits for families every year.

Coming from a man who advocates spacing out vaccinations into separate office visits? For which his patients will (based on my own experience) get charged separately! What a hypocrite!

I have decent health insurance. Last year I delayed some vaccinations for two weeks when one of my children developed a cold the same day as the well child visit. I had to pay an extra co-pay when we came back in to get the vaccines once my child was completely healthy.

Guess what, Dr Bob? Following your stupid “alternative vaccination schedule” is what’s a waste of time and money.

What a freaking hypocrite. I may cross post this comment to thread where lurker’s moaning about how Dr Offit is mean to Dr Bob.

Regarding the claims that it’s unfair to make parents take their children to the doctor to get an exemption from vaccination because that’s just as hard as taking the kids in for their shots…

Are parents really signing off the philosophical exemption form just because they don’t want to take time to get their kids vaccinated? Are they also ignoring the recommended well-child exams?

Even if they are uninsured and skipping preventive care, vaccinations are available outside business hours at drugstores, such as Walgreen’s. I believe they accept Medi-cal as payment for shots for low-income patients (they definitely take Medicare for flu shots and pertussis boosters).

https://www.walgreens.com/pharmacy/immunization/immunization_index.jsp

If I had a job where I couldn’t take any time off to take care of my children’s health, I sure wouldn’t want to risk them catching something that lasts 2-3 weeks–or having to stay home from school 2-3 weeks during an outbreak of infectious disease. That would mean either staying home to care for them, or having to pay someone to come care for them. Assuming I could find someone willing to care for them during a quarantine…

Dave, doctors won’t sign these forms.
It’s a very poorly written law.
The merits or risks of vaccinating or refusing can be left out of this discussion.
The bill is a mess in its present form.
That’s the present issue.
Jay

@ all griping about vaccines not being free…

If you can’t spend a few hundred bucks to protect your kid against all of these diseases for the rest of their life, how the heck are you going to feed them for 18 years?

None of this was a problem before all of the Wakefield BS started. Is our memory so short that we have to invent such problems to blame it on?

Oh yes, adding a few health care visits vs. numerous emergency room vists, hospital stays, lost productivity, etc, etc, etc…..what a bunch of crap Dr. J.

> read all the research studies done on pubmed.com.
> its astounding at what these “vaccinations”
> due to these children and long term as adults.
>
> Posted by: Biscuits | March 23, 2012 5:36 PM

From the fool who wanders the forest without illumination, we should expect no less than a theory on the hazards of trees.

IANAL (I am not a lawyer), but wouldn’t the form say that the provider has talked to the parent, not that they agree/disagree with the anti-vax views? Wouldn’t it be unethical to discuss the pros and cons of vaccines with your patient and then refuse to sign a form that said you did? Isn’t is lying to not sign it? You know, like it’s lying to sign a religious objection form when your objections are due to fear rather than religion?

Just saying.

@Ren:

Here it is:
http://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=201120120AB2109

This is the only part which describes the required doctor’s statement:
“A written statement signed by a health care practitioner that indicates that the health care practitioner provided the parent or guardian of the person, or the person if an emancipated minor, who is subject to the immunization requirements of this chapter with information regarding the benefits and risks of the immunization and the health risks of the communicable diseases listed in Section 120335 to the person and to the community.”

@ Ren:
@ Conspicuous Carl:

Well, that doesn’t sound very complicated to me: aren’t physicians *supposed* to inform parents about general health issues appropriate to the child’s age *as a matter of routine*? Or doesn’t that apply to the US, maybe that’s only in France.
Wouldn’t doctors, in some manner, have to represent the guidelines of the medical association of which they are members?
So what would be so terrible about having to sign a form that states that you are doing your job?
Am I missing something? I *must* be.

Dr Jay Gordon

The bill is a mess in its present form.

You’ve got that wrong. It’s the current law (Section 120365 giving your vaccine-refusing patients the gigantic loophole) that’s “a mess in its present form.”

Orac @50

Really, Dr. Jay? And you know this…how, exactly?

That is such a great all purpose reply to Dr. Jay that everyone should have it in a text file for quick copy paste.

Boy Wonder Ace Reporter posted last night on the Ho-Po on Dr. Sears article about defeating California Bill AB 2109; went completely o/t and is promoting a new autism study.

I just got a post through and requested that Dr. Sears deny that he was the pediatrician who did not immunize the index case against measles, and that his office waiting room was the site of transmitting 4 additional cases of measles…during the recent measles outbreak in San Diego:

http://www.huffingtonpost.com/dr-bob-sears/california-vaccination-bill_b_1355370.html

What are the chances that my post will not be removed?

What are the chances that Sears will answer my questions?

I see that Dr. Jay has weighed in with an inane comment and his “legal” opinion about the pending legislation.

What’s the matter Jay…are you afraid that you will have to lie on a document that you provided accurate information to your *mommies*, about the risk to their child and the risk to other children in your practice…and the wider community?

We have already argued the merits of the legislation and provided information about the availability of VFC vaccine to any parent who wants to protect their child. Why do you assume Dr. Jay, that any child’s doctor would not provide this information and would not comply with the law?

Oh, Bisquits . . . smug, fearful, righteous Bisquits,

How well I recognize that Worried Well dialect in which you so valiantly attempt to express yourself. I really do get it. I used to live in that weird fear of science and medicine, even though I was a total science geek as a small child. Maybe you’re like I was and death hasn’t darkened your door a great deal, not on a personal, in your face level. I’ll also speculate that maybe you’ve never really been sick, sick enough to require hospitalization, or have to battle a chronic illness through pharmaceutical intervention, or watched a dear friend die from HIV denial or measles.

Admittedly, this speculation is projected through the lens of my own time in the ranks of the Worried Well. Arent you just a bit tired of all the magical-thinking and potions required to keep death at bay? If you want to dump the constant Worrid Well anxiety and join the real world, but you’re lucky enough to never have required surgery or daily prescriptions, go volunteer at a hospice or nursing home. Become familiar with, and accepting of, the terrible beauty of death. If you are at all like me (oh noez), it’s fear that animates your reason-crushing animosity toward all things scientific.

For me, watching the courage and grace of acceptance transform several loved ones in the last months and weeks of their lives led me away from fear-based hubris to humility. And in that humility reason stirred unencumbered, and vanquished my existential fear. All at once, I was able to leave the patchouli scented confines of Wooville and deal with my own mortality and accept the fact that I would someday die and that no amount of magic water, or orgone blankets, or liver cleansing would prevent it. Now, whatever time I have left on this miraculous little planet will have its moments of joy and terror, but the gnawing, low grade fear of death that fuels the anti-reality rantings of the Worried Well is gone.

That, and think of all the time youll save when commenting without having to type so many “scare quotes.”

@ Pareidolius:

Oh my! We seem to be ‘on the same page’ on, um… different “pages” ( ” Andy Wakefield exonerated…”)..

Oh well, same page, same MO, same COIs. All in a day’s work.

@lilady

It’s not a study and it’s not new. Jake just wants to bring up that review of cases by some law center, which was lacking in every way possible. I think he’s just polishing up his epidemiologist anti-vaxer abilities by calling “studies” those things which are not. I’d pay good money to see him present that “study” to the professors at GW. Hilarity would surely ensue. One year at GWU, wasted. We’ll see what his second year has to offer.

Yes, Jake, it is my opinion as a professional epidemiologist for 5 years that you calling that review of cases by lawyers and not scientists a “study” and trying to use it to link vaccines to autism shows me that your first year at GW was a waste.

Now, you could reply here, but I should expect an email to the health department (whose opinion I do not represent) instead.

@Sid

In epidemiology, that science you continue to argue against though you know nothing about it though we try very hard to teach you, the “index case” is the first recognized or identified case in a cluster or outbreak of disease. This is not to be confused with “patient zero”, which is the first recognized of identified case ever of a disease or condition.

Really, Bob. I’m disappointed. You were such an avid follower of the Epidemiology Night School.

Dr. Jay claims “the bill is a mess”, but it is considerably more lax that the recommendations from the Pediatric Infectious Disease Society: Position Statement Regarding Personal Belief Exemption from Immunization Mandates from The Pediatric Infectious Diseases Society March 2011 emphasis added

It is recognized that in some states, failure to pass personal belief exemption legislation or regulation could result in public backlash that will erode support for immunization mandates. If legislation or regulation is being considered in this situation, it should contain the following provisions, which are intended to minimize use of exemptions as the “path of least resistance” for children who are behind on immunizations (whereby it would be easier to obtain an exemption than to catch-up the child’s immunizations):
*The personal belief against immunization must be sincere and firmly held.
*Before a child is granted an exemption, the parents or guardians must receive state-approved counseling that delineates the personal and public health importance of immunization, the scientific basis for safety of vaccines, and the consequences of exemption for their child as well as other children in the community who are vulnerable to disease and cannot otherwise be protected.
*Before a child is granted an exemption, the parents or guardians must sign a statement that delineates the basis, strength, and duration of their belief; their understanding of the risks that refusal to immunize has on their child’s health and the health of others (including the potential for serious illness or death); and their acknowledgement that they are making the decision not to vaccinate on behalf of their child.
*Parents and guardians who claim exemptions should be required to revisit the decision annually with a state-approved counselor and should be required to sign a statement each year to renew the exemption.
*Children should be barred from school attendance and other group activities if there is an outbreak of a disease that is preventable by a vaccination from which they have been exempted. Parents and guardians who claim exemptions for their children should acknowledge in writing their understanding that this will occur.
*States that adopt provisions for personal belief exemptions should track exemption rates and periodically reassess the impact that exemptions may have on disease rates.

Annual renewal; state-certified curriculum. I wish Assemblymember Pan had started with the PIDS recommendations and backed down from that.

Oh goodie, Offal our “resident fire science expert” has offered his opinion…

“Index case. That hilarious. It’s the measles not the Andromeda strain.”

Really, Offal…if you have trouble with the phrase “index case”, why don’t you notify the WHO, the CDC and the California health department, to give them your *expert* advice?

http://www.cdc.gov/mmwr/preview/mmwrhtml/mm57e222a1.htm

The opinion of a libertarian anti-vaxer who is clueless about immunology and epidemiology, will be given all the consideration that is warranted.

So Jay’s now giving a legal opinion?

Wasn’t he the one insisting that he did not give opinions outside of his area of expertise, and chastised Orac for discussing vaccines despite not being a pediatrician?

But Jay expects us to accept his opinion that “this law is a mess”?

@Ren

the “index case” is the first recognized or identified case in a cluster or outbreak of disease. This is not to be confused with “patient zero”,

Wiki
“Patient Zero” was used to refer to the index case in the spread of HIV in North America

Back to night school for you, Ren.

Sorry, Bob. I may not be writing in legible English.

Index case – First in a cluster or outbreak.

Patient zero – First ever.

They are not mutually exclusive (nor collectively exhaustive). I know that’s a big term for you. I mean that an “index case” can be “patient zero”. But you can also have many index cases if you have many outbreaks, like with measles.

Is anyone keeping score? Because I think Bob is batting in the single digits. (Watch him correct me about baseball analogies. Such a contrarian libertarian.)

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