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Respecting parental concerns versus pandering to antivaccine fears

In common colloquial usage, there is a term known as “gaydar.” Basically, it’s the ability some people claim to have that allows them to identify people who are gay. Whether gaydar actually exists or not, I don’t know, but I claim to have an ability that’s similar. That ability is the ability to sniff out antivaccinationists. Over the last decade, I’ve become very good at it, so much so that it’s almost instinctual and rarely wrong. My guess is that it’s nothing more than my having internalized all the tactics and tropes that antivaccinationists like to use to the point where I don’t need to think about them and can instantly compare the words and behavior of a person with patterns I’ve learned to identify in antivaccinationists and make an accurate assessment. True, there are the occasional false positives (although these false positives always strike me as people who could easily turn antivaccine in an instant), but by and large, since it’s been developed, my instinct for these things has served me well.

All of this is a way of saying that I don’t think that Mark Largent is antivaccine. One of the other types of false positives I sometimes get comes from people who are clueless about the antivaccine movement and, in a laudable but misguided effort to be “fair” and give people the benefit of the doubt, end up coming to conclusions that are outrageously wrong. That is the category that Mark Largent appears to fall into, so much so that I’ve heard from a source I completely trust that he has said in public that Jenny McCarthy is not antivaccine. But I get a head of myself. Who is Mark Largent? He’s an academic who recently wrote an Op-Ed that revealed mind-numbing ignorance of the antivaccine movement entitled In the Great Vaccine Debate, Parents’ Fears Should be Respected and has apparently just released a book entitled Vaccine: The Debate in Modern America. I haven’t read the book (although I might), but I have read the op-ed, and if the book is anything like the op-ed I’m not likely to be pleased. I’ll show you what I mean.

In the op-ed, Largent starts out with a fairly standard recounting of how the parents of as many as one in ten children refuse to vaccinate their children with what he refers to as “state-mandated” vaccines and more than a third may delay or refuse “doctor-recommended vaccines” for their children. Personally, I found this part confusing, because pediatricians (unless they’re Dr. Jay Gordon or “Dr. Bob” Sears) generally vaccinate according to the CDC-recommended schedule, which also forms the basis of which vaccines the various states mandate for school attendance. He then mentions (of course!) Andrew Wakefield, the MMR-autism scare, and how Wakefield was ultimately refuted and his 1998 Lancet paper retracted. Nothing objectionable there. Here’s where Largent goes off the rails:

What are parents really worried about? They are worried about the high number of shots kids get in the first several months of their lives. Today, a fully vaccinated six-year-old will receive nearly three-dozen inoculations, most of them in the first 18 months of life.

The routine vaccination schedule now calls for shots at almost every well-child checkup, including four inoculations at the two-month appointment and five inoculations at both the four- and six-month appointments. As parents scramble to explain their fears, the only explanation available to them is the claim that vaccines might cause autism. But when their anxieties are carefully and respectfully examined, we see that they emerge from a wide variety of often well-informed philosophical and moral concerns parents have about their children’s health.

Uh, no, at least not in most cases. First of all, unlike the claims in Largent’s introduction, vaccines were not always “saviors.” As long as there have been vaccines, there has been an antivaccine movement. Indeed, back in the 1800s in England, for instance, they were a lot more honest about it, admitting that they were, in fact, antivaccine and even publishing tracts and journals with the word “antivaccine.” In any case, back then, there were actual riots after health authorities tried to mandate vaccination against smallpox. So, sure, there’s an element of not wanting to be told what to do. However, in reality, there’s a huge amount of misinformation about vaccines that is far more readily available than it was in the past, and it has an enormous effect. Not only does it provide ammunition for motivated reasoning against vaccines, but even small doses of this misinformation can sway parents with the least tendency to distrust medicine and, by proxy, vaccines.

So, in a way, although Largent is partially correct in that fear of vaccines isn’t always just about the vaccines, he misses the larger issue, namely that of an active, committed antivaccine movement whose leaders actually gloat when they see statistics indicating that vaccine uptake has fallen. That is the agenda, although few in the antivaccine movement will publicly admit it. Indeed, four years ago, Jenny McCarthy led an antivaccine rally in Washington, DC. In the lead-up to that rally, I noticed a distinct tension between the realists, who wanted to proclaim themselves “vaccine safety watchdogs” or “pro-safe vaccines” and antivaccinationists, who wanted to proclaim vaccines to be the equivalent of toxic waste. Anyone who’s been fighting the fight against antivaccine information knows this, but apparently Largent doesn’t. In fact, he knows so little that he an write something like this with an apparently straight face:

The routine vaccination schedule now calls for shots at almost every well-child checkup, including four inoculations at the two-month appointment and five inoculations at both the four- and six-month appointments. As parents scramble to explain their fears, the only explanation available to them is the claim that vaccines might cause autism. But when their anxieties are carefully and respectfully examined, we see that they emerge from a wide variety of often well-informed philosophical and moral concerns parents have about their children’s health.

“Well-informed” is not the word I would use to describe the sorts of beliefs that lead parents to refuse vaccination. In fact, as I’ve written about over and over and over again, the concerns of these parents are almost always rooted in pseudoscience, fear mongering, and outright scientific misinformation. If Largent thinks that the concerns about vaccines that lead to Jenny McCarthy, Age of Autism, and the like are “well-informed,” he’s more clueless than my initial impression of him indicated. After all, what “moral concern” could lead parents to leave their children unprotected against vaccine-preventable diseases, particularly potentially deadly ones? Is it “well-informed” to believe lies about vaccines, such as claims that they are loaded with antifreeze, toxic doses of formaldehyde, and all sorts of other horrific “chemicals”? No, I would argue. It is not.

In the comments, when he is called to task, Largent claims to be more “moderate”:

Unfortunately, a 700-word op-ed is far too constrained to explore the many issues surrounding today’s vaccine anxieties. It is my hope that by pressing a more moderate position in this op-ed and in my book Vaccine: The Debate in Modern American (Johns Hopkins University Press) we can get more parents to vaccinate more children against more vaccine-preventable diseases. I firmly believe that the best way to do this is to actually address their concerns, not cast them as ignorant fools who mindlessly follow a celebrity. Wakefield and McCarthy would never have garnered as strong a following had there not already a substantial pool of vaccine-anxious parents whose concerns were not being adequately addressed.

“Address their concerns”? As if pediatricians don’t try to do that every time a parent brings her child for a well child visit and balks at allowing her child to be vaccinated! What planet is Largent living on? Does he have any idea how out of touch he sounds? He’s confusing blog rants with how pediatricians behave in one-on-one encounters with real parents of real patients in real doctors’ offices.

How does Largent think parental concerns should be addressed? Maybe he says so in his book, but he sure doesn’t say so in this op-ed, nor does he say in the description of his book, although, I must say, his description of his book doesn’t exactly make me all warm and fuzzy with confidence that there will be some sort of grand revelation about how to address parental concerns that pediatricians aren’t already doing. In fact, quite the contrary. My reading of it is that it’s full of the fallacy of the golden mean, or, as I like to call it, the fallacy of false balance. He even goes so far as to refer to “extremists for and against vaccinations.” Really? Really? I’d like to see Largent name a “provaccine extremist,” because I’ve never encountered one. I have, however, encountered many antivaccine extremists.

There are certain people who value compromise and comity above all else. They assume that when people disagree that the “true” answer must be somewhere in between, so much so that they are willing to bend over so far backwards that they twist themselves in pretzels in order to try to paint both sides as being reasonable and “well-informed.” In the case of vaccines, nothing could be further from the truth. On the one side, there are pediatricians and scientists showing that vaccines are safe and effective. On the other side, there are the likes of Jenny McCarthy, promoting outright misinformation, pseudoscience, and lies about vaccines. His periodic assertions that “of course I don’t Largent falls into the trap of treating them as though they were equally legitimate. He confuses respecting parental concerns with pandering to antivaccine fears.

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]

103 replies on “Respecting parental concerns versus pandering to antivaccine fears”

Very naively, he also says this:

“The only way to effectively address parents’ vaccine anxieties is to admit them and respect the fact that their concerns ought to be considered alongside scientific evidence as we add new vaccines to the modern vaccination schedule.”

To me this is wrong on several levels. Largent seems to feel that parental anxieties have sufficient scientific merit for them to be a prime consideration of the makeup of the vaccine schedule. The fact is however that they aren’t, and the way to counter this is to vigorously but diplomatically counter this wherever this idea is floated – be it at the paediatrician’s office by a parent, or by an antivax lobby raising their “anxieties” [sic] with the media/medical authorities/politicians.

Largent is also naive if he thinks that modification of the schedule in response to these “anxieties” will assuage the rabid antivaccine zealotry. As you yourself repeatedly point out, Orac, it’s not about the schedule, its always about the vaccines, and these people will not rest until all vaccines have been wiped off the schedule and our kids return to the dark ages where one in five died in infancy from one of these preventable infections.

Showing “respect” for the antivaxxers “concerns” by radically modifying schedules that have been scientifically honed and optimised with children’s best medical interests in mind is not the way to go, IMO.

In other news, UNICEF announces a marked drop in childhood mortality since 1990.

Since most still die in the first 28 days after birth (40%) complications in childbirth still play a large roll.

However, UNICEF attributes this drop mostly to vaccination campaigns, better hygiene over all and increased access to clean water.

Fuck antivaxxers.

ooo, you scooped me. I intended to blog on this under a “concern troll” heading. What gets me most is that Largent is so bloody lazy (and hides behind the 700 word limit). If the book is anything like that, I don’t want to read it.

I’m not sure how one describes the progression of thinking at Age Of Autism. They’ve gone from floating ideas of what might cause various developmental delays and physical problems to simply asserting there is an “epidemic” of almost everything in children.

“We are the nation of the chronically ill and disabled. It’s not recognized as such, but it’s the truth. My son’s parochial middle/high school has a few hundred kids in it. Several kids have diabetes, lots of them have asthma, and one has a life threatening peanut allergy that’s so bad the other students aren’t even allowed to bring peanut butter sandwiches to school. They don’t have the rooms full of learning disabled kids that they do down the street at the public school, but it’s obvious that things are not like they were back when I was in school.

How did we get this way? No one is even willing to recognize the problem.

What can we do to stop it? No one is interested now because entire careers are built around serving this disabled population.” (Anne Dachel)
http://www.ageofautism.com/2012/09/childhood-american-style.html?cid=6a00d8357f3f2969e2017744ad9770970d#comment-6a00d8357f3f2969e2017744ad9770970d

I could talk about better health care, earlier detection, better reporting, changes in diagnostic criteria – and when it comes to schools, a LOT of legislated changes that my family and many other families have benefited from. It wouldn’t be any use. Their thinking has calcified.

I would ignore AoA completely except they give safe haven for the vaccine avoiders. Some people just want any excuse at all to not vaccinate themselves or their dependents. They do not need more encouragement.

The point about more disabled children in ‘normal’ schools is easy.

In the past they were just shut away somewhere and forgotten about. These days at least some attempts at proper integration are made.

I informed my older son that I would be making an appointment to get him his flu shot.

“I don’t want to! It hurts.”
Yeah? How much does it hurt? You bruised your knee this week, will it hurt more than that?
“It hurts a long time!”
How long did your knee hurt?
“A day.”
It won’t even hurt that long. You can count for me and tell me when it stops hurting.

We discussed anxiety and worrying about impending “stings”. I think I’ll use a few doses of “How much did it hurt – really?” and talk about how we worry big about little things.

Anything can be a teachable moment.

I read Paul Offit’s (pro-vaccine activist) book “Deadly Choices” on the vaccine controversy and watched some videos.
I wonder about something: he makes statements like, you could receive 10,000 vaccines at once and your immune system could handle it, and there are trillions of bacteria on one’s skin so from being “vaccinated” by a paper cut, there’s an immune system challenge much greater than being vaccinated. I don’t remember what the exact statements were, but that’s the gist of it.
Yet when I take my dog to the vet to get vaccinated, they always warn that she’ll be tired if she gets a lot of shots at once. I asked why she’d be tired and the vet said, getting vaccinated is like being a little sick. I’ve also heard that kids are sometimes tired and sleepy after being vaccinated.
I don’t think someone would get tired and sleepy from a paper cut, so it seems like Dr. Offit is distorting reality a bit.
I live in a little lefty town and surprisingly often, women have brought up vaccine concerns to me, totally out of the blue. Like casually chatting in a locker room, they’ll bring it up.
I’m not a parent, but it seems that parents generally live in a state of terrible anxiety that something might harm their children, and they bring up vaccination because they hear the anti-vaccination stuff but aren’t sure whether to believe it.
The anti-vaccination movement might serve as a psychological defense. Anyone bearing a child now is bringing them into a dangerous world with many terrible threats that people can’t personally do anything about, like nuclear proliferation and nuclear terrorism, global warming, future famines, and more immediately, threats like drunk drivers … Being anti-vaccine could convert anxiety about those threats into an anxiety one CAN do something about: refusing vaccination.
When I checked out “Deadly Choices” from the library, I saw it hadn’t been checked out since last May! That so few people would read a pro-vaccine book, in a town where so many are concerned about vaccination, suggests that somehow being anti-vaccine serves a psychological purpose for them.

@Pris

We’ve come a long way in detecting and understanding learning disabilities. That plus legislation means more SpEd programs and more students in them. It also means more students succeeding instead of failing.

I suspect that most instances of kids feeling tired after vaccinations is less due to physiologic effects, and more a reaction to stress built up by fear of needles. I’ve never seen any such effects in my dogs nor been warned about it by the vet.

As for Dr. Offit, he was referencing a study relating to total immune system capacity and not suggesting the desirability of getting thousands of vaccines at one time, which would be problematic for other reasons (I imagine the fluid overload would be impressive, though with all that “antifreeze” you could glide through the entire winter without congealing 😉

Actually, I just had a pertussis booster yesterday (since I am asthmatic and therefore part of the at-risk population) and it HURTS! My arm is all sore today and I am grumpy. So I think that is why children get tired.

BTW – why don’t adults get lollipops when we get immunizations? It’s age discrimination.

Laura, the paper cut will challenge your immune system just like the vaccination. If you remember the small pox inoculation, that’s just a paper cut, and it, for me at least, had a definite reaction. The only difference was the cut came with a new pathogen, not something your body (hopefully) is already trained to take care off (like in your everyday nicks).
In vaccination we want the immune system to get riled up about the new intruder, so that the system recognizes it on contact. For smallpox, a paper cut full was enough to trigger the reaction, other antigens need a much larger dose to get the response needed for a long-term effect.

@I Am Here

Congrats on getting a pertussis booster! Thanks for helping protect your community. And yeah, vaccines with a tetanus component generally hurt a fair bit, though I’ve found that trying my best to relax my muscles helps mitigate that a good deal.

Perhaps we ought to also distinguish those parents who really have no fixed views – newbies to the topic, as it were, from those “promoting” the ideas, the Jenny McCarthys, etc.? While the claims want addressing, the want to make a decision for their children is understandable – I suspect newbie’s struggle with the conflicting information and their parenting instincts.

Compared to the anti-vaccine forums, do you think there is a relative paucity of places where ‘newbies’ can ask questions (as opposed to read articles) of people who know the field, as few scientists or medics write on-line and many on-line settings are too ‘robust’ for many newbies to want to speak up. Part of the issue is that specialists are, essentially by definition, fewer in number than the population at large. Another is that specialists by nature tend to be busy – few of them commit the sort of time Orac does! Let’s face it – maintaining a conversation takes time (and time away from writing the articles). There’s more, but either way should we be considering these ‘newbies’ too?

To add to the booklist, there’s Mnookin’s Panic Virus too.

Dangerous Bacon @0908: Reports of kids feeling tired after vaccinations is something I wouldn’t dismiss out of hand. It could well be psychological, as you say. But it could also be a side effect of the immune system response to the vaccine. We know that with some vaccines experiencing symptoms of the disease in question is an occasional side effect, and fatigue is a symptom of quite a few illnesses (colds and the flu, for instance).

“newbies” = “lurkers” much of the time.

I sometimes post with lurkers specifically in mind, especially when a topic is being discussed in the shorthand that develops when people are very familiar with a subject. Using the slang that a subculture acquires can create efficiency and speed while shutting out newbies who don’t know the language.

OT ( but pandering to vaccine fears is NEVER OT @ RI):

@ Age of Autism, today: EBCALA announces a study from Safe MInds and the Holland Center which has been provoked by fears about the DSM 5 changes in diagnostic categories for ASD; they maintain ( correctly) that 5 studies reveal a reduction in the number of diagnoses of ASD through use of the new criteria. They are asking clinicians “anywhere in the world” who speak English to each submit a few new cases for assessment with DSM 5 .

Their general conspiracy mongering holds that the new criteria were created by the powers-that-be to mask the ‘epidemic’ of autism unleashed by the surge in the number of vaccines required since 1994** ( which con-incidently, was the last time the DSM criteria were changed).

** sarcasm

@ Laura

The anti-vaccination movement might serve as a psychological defense. Anyone bearing a child now is bringing them into a dangerous world with many terrible threats that people can’t personally do anything about, like nuclear proliferation and nuclear terrorism, global warming, future famines, and more immediately, threats like drunk drivers … Being anti-vaccine could convert anxiety about those threats into an anxiety one CAN do something about: refusing vaccination.

Which is, of course getting it exactly ass backwards. Getting the kids vaccinated is a way of protecting them from all of those nasty diseases.
BTW you can count me as your first provaccive extremist: I don’t think children should be allowed into places like schools, amusement parks or playgrounds unless they are fully vaccinated or have a valid medical excuse.

Any aspect of “respecting parental concerns” has to be done with respect to how legitimate are those concerns. Otherwise, it is merely an opportunity to create a wedge by those opposed.

As I have mentioned before, the difference between real medical practitioners and quacks and whackaloons is that medical practitioners are honest, whereas the loons lie. So imagine the situation where someone starts a rumor that vaccination causes kids to blow up into blueberries like Violet on Willie Wonka. This gets picked up by an inscrutable resource. A parent reads that and gets worried that their kid will turn into a blueberry.

How does a doctor address that concern without coming off as dismissive? The doc takes the high road and says, “Lots of studies have been done and turning into a blueberry has never been associated with vaccination.” True, completely legit, but, as we have seen, also completely ineffective. Lots of studies have similarly failed to find a link between vaccination and autism, but that doesn’t seem to assuage too many concerns.

Alternatively, the doctor could go on the attack. “The claim that vaccination causes kids to turn into blueberries is completely baseless, and is an example of the type of misinformation that is floating around the internet.” The parent hears, “You are an idiot for believing things you read on the internet”

Pretty much any other version I can come up with has the same result. What you want to say is, there are a bunch of a-holes out there who are lying to try to get you to not vaccinate, but then again, you are calling the parents dupes. They are victims of misinformation, but they won’t view themselves that way.

But in the end, concerns like “vaccines cause autism” are just as baseless as the blueberry result. I have pointed this out before: what is the basis for the claim that _vaccines_ cause autism? The MMR/autism link was initially suggested on the basis of “He got the shot and BOOM, he became autistic.” Which does happen with MMR, because it is given proximal to the time when autism symptoms first get detectable. So you do an investigation of MMR, and discover that, no, in the end, there is no link between MMR and autism. That should address it, right? No, the antivaxxers jump on this, and say, oh, but it’s the OTHER vaccines that are doing it. Because if not MMR it must be a vaccine, despite the fact that they do not have any suggested link to autism. There is no “he got the Hib vaccine and BOOM, became autistic” stories, but still, the vaccine gets blamed merely because … it’s not MMR so it must be another vaccine? That doesn’t follow in the least.. There is no basis for associating “vaccines” with autism.

I have no vaccine fears. I love me some vaccines. But my arm was sore for a day after getting my flu shot. (Still better than the flu — or flus.) I don’t see the minor pain or inconvenience of getting these shots to be better than avoiding them and exposing myself to the disease.

PLEASE don’t compare your dog to your child. Dogs get vaccinated for completely different things, with completely different vaccine compounds. Dogs don’t get measles, so they don’t get a measles vaccine. Your child will not get a kennel cough vaccine ever or a rabies vaccine unless he’s been exposed. The side effects of a vaccine (for a different disease) for a dog (a different animal) cannot be compared to the side effects of a human vaccine for a human illness on a human. I don’t know the makeup of the standard vet vaccine schedule for dogs, but they may use more live attenuated viruses, which can cause more “sickness” side effects like fatigue.

I am so glad my OBGYN was not a doctor who followed the “CDC recommended schedule” — he was more pro-vax than that and was willing to give me my HPV vax even though I was older than the recommended age. Yay for cancer vaccines.

@ Anj:

Re ‘thinking at Age of Autism’:

Over the past few years, I’ve seen how they’ve become more like the natural health fana….*enthusiasts* who frequent sites like Natural News: they believe that ‘natural is better’, that pharmaceuticals are the devil’s own, that “Orthodox” medicine is soul-less and money grubbing et al.

Similarly, an offshoot of AoA, the Canary Party, often sounds exactly like Adams or Null, couching health concerns in politicised language. TMR is another spawn that constantly promotes rebellion against the establishment.

SItes like these emotionally manipulate parents who may be isolated from their peers in the general community: they have been ‘set apart’ because of a diagnosis of ASD. I think that the anger and disappointment that they feel is channeled into aggression against the experts who hold a privileged position and who delivered the deadly blow ( diagnosis) that forever changed their dreams for their child.

I believe that these sites serve as a misguided attempt at group therapy for devastated people- however unlike SB therapy, UNrealistic views are promoted and encouraged in cult-like fashion.

With very few exceptions, those who run the sites and contribute material are parents ( occasionally grand-parents) of children with ASD. Somehow I place them- because of the emotional turmoil and difficult life they suffer- in a different category from others who have pushed the vaccine-autism agenda- like AJW- purely as an income- and fame- generating engine.
But even though they have an excuse ( of sorts), their mis-information does just as much damage because they make others suspicious of vaccines for no evidential reason.

@Denice Walker

There are already parents showing up at the usual blogs and discussion groups talking about how their child was diagnosed with Social Anxiety Disorder,and how the parent KNOWS it was caused by vaccines.

I do wish that there was either more of an effort to go back and properly diagnose people over the age of thirty who are on the spectrum,or if enough have been properly diagnosed,as I suspect they have been,more of an effort to make the number of these diagnoses known to the greater public.

@AllieP

I am so glad my OBGYN was not a doctor who followed the “CDC recommended schedule”

I think your doctor’s approach illustrates how the recommended schedule is not, in fact, a one-size-fits-all straightjacket, like anti-vaccine activists like to claim.

I just might buy the book to see how little Mark Largent knows about vaccines.

My eyes were drawn to those big honking syringes and needles and the amounts of “vaccine” seen on both the editorial page and on the cover of his book. The syringes appear to be 5 ml, the needles 1.5-2.0 inches, and the amounts of “vaccine” is ~ 3 ml. The baby pictured on the editorial is not old enough to be getting any immunization in the upper arm.

Too bad, “I don’t do Facebook”…but it looks like the comments about his editorial are on Team Science.

@Denice Walters,

Good points all.

I’m actually tempted to go harder on the parents because it’s easier to understand motivations of the greedy and attention seekers than parents who I expect to be working on the best solutions for their children.

OTOH – their need to vent their frustrations must be great, and I understand lashing out at their targets of choice. It makes for lousy group therapy though.

@ Roger Kulp:

I have seen them expand WHAT they believe causes ASDs from one or two malfactors to many (in vaccines and in the general environment) AND also expand the RANGE of ills that vaccines and other devilish modern innovations cause.

So in other words, EVERYTHING causes EVERYTHING. Everything MODERN, actually.
“Let’s get back to Nature!”
Right, with sides of diphtheria and malaria.

And a UK study has shown that adults exhibit ASDs at similar rates ( about 1%)to children. There will be more research along these lines I predict.

The very title of the article, I think, betrays the core misconception. These particular parental concerns are not worthy of respect. No more than a child’s conclusion that 1+1=11 – it’s just wrong, and should be treated as such.

The PERSON can be respected, while still acknowledging false information as illegitimate.

Shots hurt. They hurt for awhile. I would think that if you injected any kind of fluid like that, it would hurt – you’re pushing fluid into a space that normally doesn’t experience that. The mechanical stress from the injection (piercing the skin, forcing something into tissue) would be enough to account for the pain, not even adding any muscle tension from anticipation. Hell, an IV site hurts afterwards, and that puts fluid into a space evolved to accommodate fluids.

@ AllieP

but they may use more live attenuated viruses, which can cause more “sickness” side effects like fatigue

Very good point. Live-attenuated virus vaccines are causing an infection, after all. Generally short-termed, from a low pathogenic strain, but still, it will take some toll on the body.
Note that for human vaccines, doctors prefer not to give them if you already have some infection.
Actually, isn’t one of the reason because a undergoing infection may make the vaccine less efficient?

The vet’s practice of spacing out vaccines may also be linked to the rabbie’s vaccine reputation to be quite tough on the patient (don’t know how much this is true; likely more true for the earlier versions of the vaccine). The precaution may have started with this vaccine and has been extended by force of habit to other vaccines.

Re: Paul Offit’s infamous 10000, I was under the impression he was talking about the antigen load more than the volume or number of vaccines – he answered the concern of the baby’s ability to deal with all the scheduled vaccines (the “too many too soon” concern) by pointing out that a baby will have to deal with way more antigens from the environment, e.g. following a dirty paper cut.

@Heliantus

Well, according to the CDC’s general recommendations on vaccines, a mild to moderate illness is not a reason to delay vaccination until the illness is past.

@ Anj

It annoys me that people appropriate whatever they want under a vast umbrella of crazy just to justify their views. Been reading some stuff recently which talks about higher allergy rates in the cities due to a lack of exposure to diverse bacteria. But hell we have to be a lot cleaner in cities because a lot more people are packed in which makes diseases easier to transmit and spread.

Its an indicment of ‘hey its a complex world and no matter what we do there will always be some minor downside’ but not a vaccine problem. I sometimes wonder whether people genuinely were happy in these supposed ‘good ol non-vaccinated days’ or whether with the internet and 24 hours news and every person with a blog networking their opinions whether theres just that much more exposure than their used to be.

@ Heliantus & Todd W.

The CDC Pink Book addresses mild to moderate illnesses as a concern that parents may have to their child receiving vaccines:

http://www.cdc.gov/vaccines/pubs/pinkbook/genrec.html

“Moderate or Severe Acute Illness”

“There is no evidence that a concurrent acute illness reduces vaccine efficacy or increases vaccine adverse events. The concern is that an adverse event (particularly fever) following vaccination could complicate the management of a severely ill person. If a person has a moderate or severe acute illness, vaccination with both live and inactivated vaccines should be delayed until the illness has improved.”

And here, regarding a mild illness…

Invalid Contraindications to Vaccination

Mild illness
Antimicrobial therapy
Disease exposure or convalescence
Pregnant or immunosuppressed person in the household
Breastfeeding
Preterm birth
Allergy to products not present in vaccine or allergy that is not anaphylactic
Family history of adverse events
Tuberculin skin test
Multiple vaccines

i’m 3 months into my third year of medical school and on my first month of family medicine. i saw a vaccine hesitant couple with a 4 month old. the grandma of the baby has been feeding the parents horror stories of “vaccine injury.” i feel more prepared than most of my med school classmates to address these concerns because of RI, SBM, etc. i spent a good 15-20 minutes discussing these concerns (autism and other vaccine injuries, toxic load, the diseases we protect against, etc.). the dad completely followed what i was saying and was ready to vaccinate. the mom was still a bit hesitant but willing. i leave the room to report to the physician that i’m working with. i told him the story and i think he tuned out everything i said except for “vaccine hesitancy.” so he goes in and says “i understand you have some concerns about vaccines. would you want to split them up and just do a few today?” mom readily agreed.

GAH!!!! i guess it’s not fair to say that all my work was undone, but at least half was. and if the parents fail to return for additional visits to catch up to the regular schedule and the kid ends up getting an infection, then it truly was all for naught. i blame bob sears.

Oops, I submitted the comment…before actually commenting on mild or moderate illness *concerns*.

I have yet to meet a doctor who would dismiss a parental concern about a mild illness with regard to receiving a vaccine. After explaining the CDC recommendation about giving the vaccine, most, if not all doctors, would simply re-schedule the child’s vaccine(s) for the following week.

It’s not all about “enforcing” strict adherence to the CDC Schedule, it shows the patient that a doctor “allows” a short delay. That’s the way doctors build trusting relationships with parents.

If only…that “minor illness” concern…was the only objection to immunizations that doctors encounter in their practices.

@lilady

Exactly the section of the Pink Book I was thinking of. I’m currently rereading it. It’s a very good reference that I think more people should read.

@ Todd W. (I’ve made this suggestion on other science blogs)

As we all know, Federal and State laws require that health care providers give the patient/parent the VIS (Vaccine Information Statement), for each vaccine prior to administering the vaccine.

I believe it would better to provide a packet of all the VISs that are on the Recommended Childhood Vaccine Schedule and a copy of the “Schedule” (scroll down to see second page) http://www.cdc.gov/vaccines/parents/downloads/parent-ver-sch-0-6yrs.pdf In that informational packet, I suggest the addition of a cover letter from the local health department with a telephone number to reach a nurse, who could answer any questions about any of the vaccines…and “other concerns” a new parent might have.

Better still, that informational packet could be provided to new parents before they take their baby home from the birthing hospital/birthing facility.

(In my dreams), the ultimate manner to provide reliable information to expectant parents, is to provide that informational packet during an obstetrics appointment.

Most people gets most of their information about child health and vaccines from the internet. IMO, it should be a public health priority to provide reliable vaccination information and reliable information about vaccine-preventable diseases to parents and expectant parents…as a counterbalance to the pseudoscience anti-vaccine websites.

I suspect Largent has not talked to many true vaccine-hesitant parents…and I do mean hesitant, not refusing. Perhaps he’d like to spend a few days shadowing me, or another pediatrician. These parents are often tragically NOT well-informed. They rely on rumors and third-hand anecdotes; often they don’t even know exactly what they’re afraid of, other than someone telling them that vaccines are bad. (I’ve had parents ask if the MMR has mercury in it; I’ve had at least 2 other parents ask me if it’s true that vaccines cause Down syndrome.)
Many of these folks just need my reassurance. The greater problem is the ones that still refuse: in other words, they are in the grips of irrational fear. Key word being IRRATIONAL, e.g., not responding to rational explanations. The increasing distrust of authority and organized institutions, coupled with the ability to find gobs on information on Google, has unfortunately led to a rampant Dunning-Kruger effect. I think that’s why more upper-middle class families are hesitating or refusing.
If Largent has a good solution to that, he should enlighten us all. But it sounds like he too suffers from Dunning-Kruger…or maybe just Ivory Tower syndrome.

Cynical Pediatrician:

I’ve had at least 2 other parents ask me if it’s true that vaccines cause Down syndrome.

Oh, wow. That brings up memories. Back in the days when the internets were new, I belonged to a listserv that pertained to my son’s severe speech disorder. About the time when people were freaking out about the “Millennium Bug” the first inklings of “did vaccines cause my kid’s disorder” started to occur.

I found out shortly that explaining that there could be no relationship, since my kid’s seizures were no where near the time a vaccine, that some of those on the list were not reasonable. It happened when one of the more militant of the Mercury Moms emailed me to say that she was told at the Mayo Clinic that vaccines cause Down’s Syndrome.

And that was only the beginning of the nasty grams would get from them before I quit that list about five years later.

“Address their concerns”? As if pediatricians don’t try to do that every time a parent brings her child for a well child visit and balks at allowing her child to be vaccinated! What planet is Largent living on? Does he have any idea how out of touch he sounds? He’s confusing blog rants with how pediatricians behave in one-on-one encounters with real parents of real patients in real doctors’ offices.

There’s more than one myth about vaccinations. One of the myths seems to be that if parents express any concerns about vaccinations to their pediatrician and their pediatrician is pro-vaxx, then said pediatrician will immediately throw back his or her head and roar with contemptuous laughter, stopping only gaze derisively upon the concerned parent’s face and spit out a few scornful admonitions regarding said parent’s education, gullibility, intelligence, and general fitness as caretaker. Then, when the beaten-down parent abjectly agrees to vaccinate, the pediatrician will inoculate the child with an especially vicious jab. And laugh again.

Or …. the pediatrician could actually address the parent’s concerns in a concerned manner.

Which side are you on, Orac? Hmm? I hope it’s the moderate one.

I have read what is available of the introduction of his book and it seems Largent’s wife died when their daughter was 19 months old. I will venture out on a limb and say that this is likely to have made him more susceptible to anti-vaccine tales (which he had been researching for a book project at the time). When you have just lost a loved one, one or the other “vaccine-loss” story will resonate, I guess.

@Sastra – I have yet to meet a pediatrician that would fall into that first category. Outside of the diseased minds of anti-vaxxers, I don’t think they even exist.

Some parents are hesitant to ask questions because they are afraid that the pediatrician or family physician will dump their child as a patient. Asking questions does not equal refusal. If a parents concerns are addressed in a respectful manner, most vaccine hesitant parents will think about what they have heard and eventually decide to go with the full vaccination schedule. Because they haven’t been belittled or made to feel stupid, they feel safe in asking questions. Well informed consumers of healthcare make it hard for the woomeisters to develop a credulous audience. It happens, one parent, one baby at a time, one family at a time. Education helps to overcome belief.

It happened when one of the more militant of the Mercury Moms emailed me to say that she was told at the Mayo Clinic that
vaccines cause Down’s Syndrome.

Good gravy, my blueberry scenario suddenly seems less crazy.

Is their a vaccine version of Poe’s Law?

Marry Me, Mindy:

Is their a vaccine version of Poe’s Law?

Just use Poe’s Law. And trust me, from the rantings of that woman on the listserve: it was not a Poe.

AllieP: “Your child will not get a kennel cough vaccine ever…”. Oh, really? Ever heard of Whooping cough? Both vaccines are for the Bordetella bacteria. It is a different variety or Bordetella but it is very much like “a kennel cough vaccine”. The other diseases are also close to what the puppy or kitten may get vaccinated for, For example, Rabies is a severe form or meningitis. In addition, “[a]s it is a Morbillivirus, the rinderpest virus (RPV) is closely related to the measles and ***canine distemper viruses.***” [ Wikipedia ]. There are many different types of vaccines given to pets and domestic livestock live-attenuated is just one. If there ever is an HIV vaccine we would then have a vaccine similar to what we vaccinate cats for [FIV]. [BTW I DO COMPARE MY DOG TO a child.]
If you think the pet vaccines are vaccines are “very different compounds” verses child vaccines why not get vaccines inserts of several child vaccines verses several pet vaccines? You will find that the compounds are very similar. I worked as a registered licensed veterinary nurse for 20 years; do not try to fool me regarding pet vaccines verses childhood vaccines. Fear-mongering will get you nowhere with me.

Sastra,

I agree, but the anti-vaccine crowd play this up, eh? On that note, we had a current affairs presentation in NZ earlier this year on the influenza vaccination that had one of the current affairs staff pro-vaccine and one ‘unsure’. The doctor was very jolly about the latter parent’s concerns – some said too jolly, that they felt he was ‘laughing away’ their concerns. Whether this was someone ‘playing up’ this thing or sincere I don’t know, but either way I guess it suggests a need to take care over how you talk when you’re talking to a parent coming to a decision, as opposed to those ‘promoting’ anti-vaccine stances. (I’m emphasising the distinction as I like to divide the anti-vaccine crowd into several ‘levels’ and treat each accordingly; the article linked in my earlier comment touches on some of my thoughts on this. Excuse the apparent self-promotion – I’d elaborate here but I’d be repeating myself and this comment would get even longer than it already is!)

Kay,

I’ve had one little success like that this year – the parent messaged me back to say she was deciding to go with the vaccines. Aside from the amount of time involved, I’m finding little opportunity to do this now as the local anti-vaccine groups have blocked me from commenting. I made a particular point to be polite and developed a policy of not commenting unless someone asked a question, so that I was not pushing anything but following from their lead and helping them. Despite this the ‘organisors’ of these groups blocked me anyway – as we know for the organisors their groups are not really about free and open discussion.

Julia is a troll. She posted that same ridiculous statement about the B. pertussis bacterium being the same/or similar to the Bordetella bacterium that is responsible for most cases of “kennel cough”…on another website.

” I worked as a registered licensed veterinary nurse for 20 years; do not try to fool me regarding pet vaccines verses childhood vaccines. Fear-mongering will get you nowhere with me.”

“Registered Licensed Veterinary Nurse” a.k.a. Veterinary Technician…which is one step removed from being a dog groomer:

http://jobs.aol.com/articles/2010/10/23/veterinary-nurse-salary/

I don’t have a pet, but I wouldn’t trust this troll veterinary tech to take care of a beloved family pet.

@ Chris: Remember this post from Julia/Andrea on that other science blog?

“I work in a vet clinic and had a basic understanding of the dog vaccine for Bordetella (which isn’t very effective), and started out pro-vax for my daughter, but keep coming across valid info causing me to question that stance.”

WARNING…JULIA/ANDREA WILL SEND IN ONE OF HER SOCKIES TO POST AGAIN ABOUT KENNEL COUGH

I love it. I’m the fear mongerer because I point out that humans are a different species than dogs. Come on, Julie, you don’t need to be a vet technician to understand that different animals are susceptible to different diseases. FIV, despite being similar to HIV, does not vector to humans. Neither does distemper or canine parvo (which is not Fifth’s Disease). Kennel cough *may* vector to severely immunocompromised individuals, but does not magically turn into pertussis when it does.

Because I’m now curious. I checked out the exhaustive literature on the subject over at the AAHA: https://www.aahanet.org/Library/CanineVaccine.aspx

Vet vaccines are regulated by APHIS, a division of USDA. The schedule is decided by them, not the CDC and FDA.

So many differences! Wow! Different diseases, different species, different vaccines, different schedules, different government agencies. It’s almost like it’s ENTIRELY DIFFERENT.

Get your pets spayed and neutered AND vaccinated, folks!

In addition, “[a]s it is a Morbillivirus, the rinderpest virus (RPV) is closely related to the measles and ***canine distemper viruses.***” [ Wikipedia ].

Speaking of which, what happened to rinderpest again?

Anj,

I informed my older son that I would be making an appointment to get him his flu shot. “I don’t want to! It hurts.”

Todd’s comment about relaxing his arm reminded me that as a kid I figured that sticking a needle into a tensed up muscle would hurt more than sticking it into a relaxed muscle, so whenever I got a shot I concentrated on relaxing my arm as much as possible. I found that this worked very well indeed. Later in my life I found if you tell kids that the more they relax their arm muscles the less it will hurt it reduces their anxiety and gives them some control over the experience.

Re: comparing children to dogs, they are both small mammals I suppose. Which reminds me of the joke about MDs being vets who only treat one species…

Which reminds me of the joke about MDs being vets who only treat one species…

Actually there are a lot of similarities between a vet and a pediatrician, especially in terms of very little babies.

Of course, pedes are still only doing one species

@lilady

B. pertussis (and B. parapertussis) evolved through genome reduction from a common ancestor with B. bronchiseptica. They share many potential virulence factors with a couple of notable exceptions like pertussis toxin (can’t really overstate that difference :P).

Of course, the resulting differences are why B. pertussis is restricted to humans while B. bronchiseptica has a much wider host range.

Figure 2 of this paper gives a graphical view on the relatedness of the genomes.
http://www.nature.com/ng/journal/v35/n1/full/ng1227.html

I don’t think it is out of line to note their similarity and I’d consider it not very different from the case of Burkholderia mallei and Burkholderia pseudomallei in that regard.

Take a look at this website for a review by Christian Orlic of Mr. Largent’s book:

http://www.skeptic.com/eskeptic/12-09-05/

Take particular note of Orlic’s interpretation of Mr. Largent’s “classifying” of the diseases that vaccines prevent:

“One of the most important observations made by Largent is that not all vaccines are the same. Some vaccines protect against devastating diseases (MMR, DPT), others protect against dangerous ones (Hep A, Hep B, Hib, rotavirus, PCV) but the likelihood that an infant may be exposed to these is low, and other vaccinations provide protection against diseases with extremely low mortality rates (chickenpox). The distinction between the diseases each vaccine protects from are often forgotten. For example, Largent argues that some of the diseases we vaccinate newly born babies against may be unnecessary, such as HepB, a disease that an infant could only “contract by having sex with an infected person or by sharing contaminated needles with an infected drug addict” could wait (2).”

(PCV is Pneumococcal Conjugate Vaccine)

Did Orlic get it all wrong…or did Largent?

Largent is whining on his facebook page about how mean this post and the comments are. Poor baby.

@ john V: Thanks for that link to Bordetella genomes, however this statement about “parapertussis (which) can also cause whooping cough” is incorrect…

“Bordetella pertussis, Bordetella parapertussis and Bordetella bronchiseptica are closely related Gram-negative beta-proteobacteria that colonize the respiratory tracts of mammals. B. pertussis is a strict human pathogen of recent evolutionary origin and is the primary etiologic agent of whooping cough. B. parapertussis can also cause whooping cough, and B. bronchiseptica causes chronic respiratory infections in a wide range of animals.”

Here is the link to the Vaccine Preventable Diseases Surveillance Manual-Pertussis chapter. Whooping cough is not caused by the parapertussis bacterium; nasopharyngeal swabs/PCR testing differentiates between parapertussis and pertussis bacterium. Parapertussis is not a “National Notifiable Disease”.

http://www.cdc.gov/vaccines/pubs/surv-manual/chpt10-pertussis.pdf

” Burkholderia mallei and Burkholderia pseudomallei” (?)

I think I recall these two bacteria when I was taking classes on weapons-grade anthrax and bioterrorism…

http://www.upmc-biosecurity.org/website/our_work/biological-threats-and-epidemics/fact_sheets/glanders_melodosis.pdf

Largent is whining on his facebook page about how mean this post and the comments are. Poor baby.

Misquoted the comment as well while he was at it. (“Bloody lazy,” Mark.)

Dave Rudell..thanks for the link…however “This content is currently unavailable”

Mr Largent, you are obviously “lurking” here. Why don’t you provide some comments about your book. If we have misjudged your book, you should be willing to defend that book.

@ lilady:
@ Dave Ruddell:

Oh wait…
Largent? Doesn’t that mean MONEY?
Actually, ‘l’argent’…
En francais, s.v.p.

lilady, the link works for me. I logged out of FB, and i got the not available message. So, if you want to see his page, you’ll need to have an account.

Huh, now I just re-logged in, and he seems to have changed his settings so that we can’t read them. I guess he doesn’t like it when people criticize him. Dr. Largent, since we know you’re reading, what’s incorrect about Orac’s post? Not the comments mind you, the main post itself.

Re: Antivaccine radar…

A few months ago, I was ranting to my family about emails I get from one of the mothers from our church about how horrible vaccines are, emails riddled with Mercola links. We are Catholic and there are some uber-Catholic families at our church (including the Mercola fan who sent the email) with lots of kids. They all homeschool and don’t vaccinate. When I was finished complaining, my teenage daughter, said, “You mean Mrs. X? Yeah, she looks like she doesn’t vaccinate.”

@ gpmtrixie: Just a suggestion…why not email that parishioner this link?

http://www.immunize.org/concerns/religious.asp

@ Dave Rudell: “But there were false prophets also among the people, even as there shall be false teachers among you, who privily shall bring in damnable heresies, even denying the Lord that bought them, and bring upon themselves swift destruction.” (2 Peter 2:1, King James Bible) 🙂

@I am here:
Because I’m a government employee – in a health related job no less – I get my vaccinations from the staff nurses. And they always give us lollipops! I’d speak to your vaccination provider if I were you. 🙂

So, if you want to see his page, you’ll need to have an account.

Perhaps. I’m just getting sustained connect failures to channel.facebook.com space, and I am logged in.

I was one of those “staff nurses” who worked in a county health department. We didn’t give out lollipops, but did give out cartoon stickers purchased by us (no budget line for stickers), mostly to kids. Some adults *demanded* a sticker and we gave them stickers, as well.

One of the things I like studying is archaeological reports of Anglo-Saxon cemeteries. You know the biggest age group represented? In just about every case, it’s the 0-5 age group. In the reports I’ve studied, they generally make up a quarter of the cemetery population. It absolutely blows my mind whenever parents express issues with vaccinations, because I bet many of those kids died of vaccine-preventable diseases. Especially when you find 2-3 kids in the one grave, all clearly buried at the same time.

Incidentally, the age group that challenges the 0-5s in the cemetery populations is the women aged between 18-30. Whenever some crunchy natural-birth-is-the-only-way nutjob starts spouting on about the connection she feels to all the women in the past who’ve given birth, I wonder how many of those 18-30 year old women buried in the cemeteries were screaming in agony and terror before they finally died in childbirth.

Re: the sleepy after vaccines thing

This is pure anecdata, but my DD was always sleepy after her vaxes, even before she could “psychologically anticipate” them. My DS on the other hand, well, he seems to get a bit more hyper after vaxes (is harder to put down for naps for about 12 hours).

I think the thing that annoyed my son the most about his shots was having to leave the playground for the 30 minutes to get to/from the dr’s office.

His last shot was his MMR at 4, and the nurse gave it to him, he looked up at her, frowned and said, “HEY!”

That was about it for the reaction.

I am no troll I am just autistic and often misunderstand social situations, sarcasm and humor in addition to mis-communicating my intentions. If somehow I communicated that I at all ever wanted to discourage any vaccines at the timeline recommended by pediatricians I totally deny that. I also deny that human microbes are equivalent to animal diseases or are commonly “caught” by humans. I know that Liz Ditz often posts here and she can vouch for me. I merely meant that it is good for both human kids and pets to get their vaccines on time.[I apologize for any confusion or problems I may have causes here. I have no human kids so I am not the same person who said: “…started out pro-vax for my daughter…” And I am quite non-deceptive so sock pups are not my style.] I guess I should just let the adult scientists talk here because they are quite effective in fighting anti-vaccinia without me to muck it up. I fully admire all of you pro-vaccination, pro-skeptic, anti-denial-ism warriors. If only I could delete my embarrassing, screwed-up post , but alas…my shame must be there for all eternity to redden my cheeks. AllieP, I was wrong to say anything that impulsive and misguided to you; I am sorry :'( .

“Largent argues that some of the diseases we vaccinate newly born babies against may be unnecessary”

Gosh. Which diseases *are* necessary?

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