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Pediatricians versus the Dunning-Kruger effect on vaccines

I don’t know if I could be a pediatrician right now.

True, I probably don’t have the personality to be a pediatrician, at least not a primary care pediatrician on the front lines. After all, if I did, I probably wouldn’t have become a surgeon, much less a hyperspecialized cancer surgeon. One reason (among many, of course) is that I don’t have the patience to deal with non-vaccinating parents, particularly parents with massive cases of Dunning-Kruger disease. The same goes for being a pediatric nurse practitioner or nurse, who are also on the front lines in dealing with the antivaccine movement. In any case, you remember the D-K phenomenon, don’t you? It’s the phenomenon whereby people who are unknowledgeable or incompetent about a topic have a falsely elevated estimate of their own knowledge base. In the antivaccine movement, the D-K phenomenon tends to take the form of parents who think that their University of Google knowledge trumps the knowledge of physicians and scientists who have dedicated large swaths of their lives to the rigorous study of conditions such as autism and the question of how vaccines work.

Nowhere is the D-K effect more intense and painful to behold than at blog with a name so arrogantly misplaced that it lights up the planet with its waves of burning stupid. I’m referring, of course, to The Thinking Moms’ Revolution (TMR), where the denizens think so highly of themselves that they refer to themselves as “Thinkers” (yes, capitalized) and dismissively attack (using arguments of pure pseudoscience and nonsense) the medical profession, scientists, and those who follow the science to realize that, no, vaccines don’t cause autism, and, yes, vaccines are effective and far safer than letting children suffer “naturally” from the diseases that vaccines are designed to prevent. The mothers who blog there also give themselves annoying pseudonyms like DragonSlayer, Goddess, Mountain Mama, Sugah, and Professor. So, naturally, the TMR bloggers are the most insufferable non-vaccinating parents you will ever see, and they like to brag about it. I just saw an example of this the other day that caught my attention and made me contemplate at how difficult it must be to be a pediatrician now. Not only is pediatrics one of the worst-reimbursed specialties, but pediatricians have to put up with moms like The Rev (those ‘nyms again!), describing incidents like this description of one of the “Thinkers” telling her fellows about being fired by her pediatrician for not being willing to vaccinate:

Let me set the scene for you.

A bitter cold Friday night in Chicago. Some Thinking moms decide to get together to break up the monotony of a seemingly endless winter. Several bottles of yummy wine lay interspersed among their mostly green, mostly raw, mostly organic food fest. They laugh and talk and enjoy one another’s company. The topic turns to pediatricians.

“I got fired from Dr. * this week.” Says, the youngest one of the bunch. This Thinker has a remarkably healthy child who eats well and is developing normally with no learning disabilities or developmental delays.

“Whaaaaaat did you just say?” We all rubbernecked, saucer-eyed and slack jawed in her direction; our delicate sips turning into large lapping gulps.

“Yep, he sent one letter certified and one to my house . . . Not sure what the point in that was.”

The funny thing is, I totally pictured many of the “Thinking Moms” to be just like this, a crunchy, woo-infused crowd hanging around with each other and getting drunk while they bask in each other’s self- and group-perceived awesomeness and commiserate with each other over glasses of wine, tales “biomedical” quackery to treat autism, and stories of mean and nasty doctors who have the temerity to insist on treating their patients according to the standard of care on vaccines to protect their patients. I realize that this is a controversial issue among pediatricians, and I can see both sides of the argument. Some pediatricians, noting that vaccines are critical to preventing serious childhood diseases and that nonvaccinating parents take up a lot of their time (which is not billable beyond a certain point) and potentially endanger patients in the waiting room, particularly if there are immunocompromised patients there, decide not to deal with the hassle anymore. There’s also an issue of conflict and trust, wherein nonvaccinating parents don’t trust the doctor who is simply trying to do his best for their child, and the doctor doesn’t trust the nonvaccinating parent to do what he recommends. Such doctors might reasonably conclude that it would be better for all concerned if the parents found a different doctor for their child. As one pediatrician put it:

If a family refuses to vaccinate after a discussion of the issue, he tells them “there are so many things we’re not going to see eye-to-eye on.”

On the other hand, some pediatricians, seeing their duty to their patients and feeling very reluctant even to be perceived as abandoning their patients, much less actually “abandoning” them. In any case, contrary to the conspiratorial twaddle peddled by “Thinkers” like The Rev, pediatricians are under an extreme ethical dilemma when confronted with nonvaccinating parents. Evidence-based medicine tells them that it is very important for the child’s health that he receive his vaccines on time. When the parents prevent this (or prevent any vaccination of their child at all), they prevent the doctor from providing what he knows to be the best care for the child. Faced with such compromised care, the ethical dilemma often leads to a choice between keeping the patient and continuing to try to bring the parents around or setting them free to prevent the disruption of his practice and the potential endangerment of his other patients. There’s a third choice that some pediatricians no doubt make, and that’s to give up in weariness and stop mentioning it. Morally, a lot of pediatricians can’t make that choice, and more power to them. Perhaps that’s why there appears to be a trend among pediatricians to “fire” patients, as this young “Thinker” was fired from her pediatrician. One notes that it’s still clearly a minority of pediatricians.

In fact, this young “Thinker” described by The Rev has exactly that issue. She goes on and on, asking what will she do if her child gets sick and she doesn’t have a doctor who knows her child and whom she trusts. (Why she trusts a doctor who wants her to vaccinate her child when she doesn’t, who knows?) Leave it to the “Thinkers” to claim that it’s all about the money:

“Well, first off . . .” said my tipsy brilliant Thinker-friend, “There is no way to code ‘baby got weighed and measured, is well fed and perfectly healthy.’ You are taking up their billable time with your healthy baby! Vaccines are what make the ‘well baby’ visit a ‘well baby’ visit. You have every right to challenge your dismissal from their practice.”

This mother is just plain ignorant. First off, the young mother can’t challenge the dismissal of her child from the pediatrician’s practices, at least not if the pediatrician followed the laws of the state in which he practices. She (and the other “Thinkers” who chimed in) also don’t know much about medical billing, either. All it would take would be a look at the list of billing codes to know that well baby visits are indeed billable as routine infant or child health checks, complete with CPT and ICD-9 codes. For those codes, it doesn’t matter if the child gets an immunization or not. My guess is that this young mother probably had an insurance plan for her child that covered well baby visits 100% but required a copay for vaccines, which is likely why she didn’t get a bill for those visits in which her child didn’t get a vaccine, not because the pediatrician didn’t bill for them.

In fact, depending on the practice, vaccines can be money losers for pediatricians. Indeed, a study from three years ago by athenahealth found that in almost half the cases, payments for vaccines weren’t enough to cover the cost of storing and administering them. A study in Pediatrics from 2009 concluded that for privately insured patients pediatricians vaccines produce little or no profit and that when losses from vaccinating publicly insured children (i.e., receiving Medicaid) most pediatrics practices lose money from vaccines. Indeed, a recent news report indicates that it’s gotten so bad that pediatricians have become very dissatisfied with insurance and government reimbursement for vaccines to the point that 10% of pediatrics practices admit to considering not offering vaccines anymore, instead referring their patients elsewhere for them.

Another rather hilarious claim is that “nurses can’t harass” you about vaccines. “Harassment.” You keep using that word. I do not think it means what you think it means. Of course, what these “Thinkers” refer to as “harassment” is no doubt nothing more than the nurse doing her medical duty according to the standard of care to ask the parents which vaccinations the children have had and to suggest trying to get their vaccines up to date. It’s part of the frikkin’ pediatric history and physical, fer cryin’ out loud! That’s why it’s no surprise that nurses, at every visit, will ask the parents about vaccines and suggest to nonvaccinating parents that they start getting their child caught up on recommended vaccines. It’s their job!

What’s really depressing is what The Rev recommends to maintain the health of her children:

It is in our child’s best interest to build a team of healthcare professionals. After all, we all share a common goal: the health of all our child, right? A couple pediatricians, a chiropractor, a whole foods nutritionist (who understands grains and the gut), homeopath, naturopath, and homotoxicologist are all good team members. The pediatricians and healthcare professionals are covered by insurance so you can have as many of these on staff as you want! I enjoy having a few doctors because then I can weigh what one says against the other and decide for myself what the best course of action is for my child. For instance, my daughter had bronchitis three weeks ago. I tried my best to tackle it with essential oils and homeopathy, two methods of preventative and responsive medicine that are often quite effective for my family. They’ve helped assuage eye twitches, nausea, ear infections, minor allergic reactions, bruises, eczema and a myriad of other ailments. But, this bronchitis was nagging despite the fact that she did not have a fever and was still very active. She needed an antibiotic, so I took her to a pediatrician who prescribed one. My children do not get them very often, so I was willing to take the risk, off set them with probiotics, and make some dietary changes for the duration of their use. Days after she got the clean bill of health, she came down with an ear infection. Some Galilean olive oil with a dab of Thieves and she was good to go. Sometimes allopathic medicine is an option. Sometimes, simply educating ourselves about proper nutrition and preventative care is an option, too.

Yes, The Rev recommends trying quackery first, and when that fails acquiescing to those nasty, reductionist pediatricians and their big pharma-produced toxic chemicals. Just hope that the disease isn’t serious enough that, by the time The Rev abandons quackery and chooses real medicine, it’s not too late for her child.

Maybe that’s why she concludes her nauseatingly self-congratulatory post by congratulating mothers who have gotten letters firing them from their pediatricians’ practices because they are now “Thinkers”:

If and when that letter from your pediatrician arrives? Consider it a victory. You are now a Thinker, and you have been invited to take an active role in guiding healthcare policy in this country. May I gleefully suggest there are several medical, chiropractic, whole-health physician practices in your urban/suburban areas that will be more than happy to care for your child? Investigative physicians that treat the individual child are out there.

Sorry, Rev. None of what you’ve written above sounds even remotely like thinking, much less “Thinking,” to me.

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]

534 replies on “Pediatricians versus the Dunning-Kruger effect on vaccines”

Some fuel for the fire: This “heartbreaking” primer for new moms is today circulating among a fairly influential network of supporters of newly birthed and breastfeeding moms and was raising vax warnings and flying Naturopath flags. It includes a large section quoting one Heather Zwicky talking specifically about delaying vaccinations, and possibly avoiding pertussis vaccines as “potentially unrequited”.

http://birthbootcamp.com/your-baby-is-born-what-happens-next-might-break-your-heart-guest-post-by-jennifer-margulis/

An interview with Zwickey here

http://wellwire.com/health/vaccines-health/talking-vaccinations-with-dr-heather-zwickey

Quite frankly, I think the pediatricians should get together as a group and make a policy of not allowing sick, at the very least, or any, unvaccinated children in their waiting rooms. They should insist upon seeing those children at home, and they should charge a very significant amount of money for that service, which I would hope would not be covered by insurance. Sometimes there’s nothing like a stab to the wallet to try to get people to change their behavior.

I have seen a similar situation in which doctors who are too lazy to do, and charge for, nasal swabs on their influenza patients send them instead to a hospital outpatient department where, among other things, chemotherapy patients were waiting for their turn in the outpatient infusion unit. The practice was maddening.

When I read this yesterday, I just *knew* that Orac would .. er _enjoy_ it.

Remember of course that the Rev has a history of disparaging medical professionals’ decisions ( see Alex).

TMR produces propaganda that denigrates SBM and simultanously hypes Mother Wisdom ™ and Gaia Think: so many of their posts include a how-to guide to doctoring that celebrates taking matters into their own hands. “If only I had quit believing before vaccination”, they whine.
Because they truly believe that vaccines cause autism.

They express feelings of being an accomplice to the great crime of autism induction by vaccine: they brought the child to the doctor’s office, put him ( usually) on the examining table and stood by whilst the nurse, in effect ‘stole his soul’.

Their own feelings of guilt must be insurmountable so they must of necessity assuage that guilt by blaming others:
they were lied to, forced or charmed into taking these rash actions . It wasn’t THEIR fault: it was a huge conspiracy that has already inveigled THOUSANDS,, even millions of others. And now they have become leaders of a great uprising to destroy these destroyers of children.. ( see websites of Jake and Brian Hooker esp) Obviousl this must make them feel better abouut themselves.

Thus their braggadocio and cavalier attitude towards reality has its roots in believing those who have lied to them. And it ain’t SBM.

I think I may have shared this story here, but I’ll share it again. This one person I know who used to work at a busy family practice had a non-vaccinating family as patients. The mom and dad in the family had been told that they were welcomed to bring their kids to the practice with one caveat: They had to call before they came in so that they would not go into the waiting room and go in the back door and into the far rear room, which also had negative pressure to it. The practice did not want to risk measles or chickenpox in the waiting area because there were several children being seen there who had immune deficiencies. (One had leukemia and was being treated. I forget what the other two had.)

On more than one occasion, the mother showed up with the five unvaccinated children (ages toddler to second grader) into the waiting room and to the front desk. She didn’t call or put masks on the kids. One of those times, she brought in the children because SHE HAD TAKEN THEM TO A CHICKENPOX PARTY AND THEY WERE FEVERISH. I wish I was joking.

The family was discharged from the practice for failing to follow the simple instruction of calling ahead and being seen away from the waiting room. They complained over and over but to no avail. The practice was well within its right to do this after the family had been warned several times. Because the community where this happened is close-knit (with only one other family practice and one pediatric practice), the family had to travel 15 miles up the road to the next town. None of the other practices in town would take them, except for emergencies.

My friend in the practice sent me a letter that the mother wrote on why she didn’t vaccinate. (All identifying info was blacked out, of course.) It really is something to see. All the typical anti-vaccine stuff is in there, with citations to whale, AoA, NaturalNews, and Mercola, of course. Rarely did she cite CDC or WHO, and only to point out that vaccines worked by showing that there were no cases of polio or measles and that other vaccine-preventables were on the decline. Of course, she never acknowledged the roles of vaccines in that little miracle.

So, no, the people who get fired from practices for not doing the bare minimum to take care of their children are not “thinkers”. They’re sheep. They’re the worst kind of sheep because they are ignorant AND they think they know better. I have more respect for blind followers than for blind preachers.

A couple pediatricians, a chiropractor, a whole foods nutritionist (who understands grains and the gut), homeopath, naturopath, and homotoxicologist are all good team members.

I don’t see an acupuncturist on that list, but that covers most if not all of the other major flavors of woo. Crank magnetism at its finest!

“This thinker has a remarkably healthy child who eats well and is developing normally with no learning disabilities or developmental delays”.

The self righteousness and arrogance is astounding. Most children *are* remarkably healthy. Do they think that most other children, especially those who vaccinate, are listlessly walking around in a perpetual state of bad health? The Rev’s own child had bronchitis 3 weeks ago. Reaaalllly stoopid.

B—– hell!, those people are not just downright nuts, they’re dangerously nuts. ‘I tried my best to tackle it with essential oils and homeopathy… Some Galilean olive oil with a dab of Thieves and she was good to go.’ If you submitted a film script with that line in it, you’d be laughed out of Hollywood.

So they’re all sitting around getting loosey-goosey on an ample supply of wine, eh? Sounds like ‘Drinking Moms’ Revolution’ to me.

If getting fired by one’s pediatrician makes one a Thinker, then I suppose getting reported to the police for medical child abuse makes one a Genius. What does it take to become an Einstein, getting a confirmed diagnosis of Münchausen By Proxy syndrome? Or do they have an exclusive club for that, called The Münchies?

As for ‘Chicken Pox Parties,’ why are those not immediately prosecutable as child endangerment? You would think the police (or the Met or the FBI) would want to swoop down on those things as if they were opium dens. Has anyone even tried to prosecute? Or does the ‘belief exemption’ from vaccinations (not to mention the law of gravity) also give parents the right to infect their kids with potentially fatal diseases?

‘Tackling it’ with homeopathy is like throwing a forward-pass to an hallucination.

What does it take to become an Einstein, getting a confirmed diagnosis of Münchausen By Proxy syndrome? Or do they have an exclusive club for that, called The Münchies?

You owe me a computer keyboard. I was drinking my coffee as I read that…

I hardly dare to ask what a “homotoxicologist” is….

I believe I’ve blogged this before. The search box is yours. 🙂

Notice that the olive oil is *Galilean* with *Thieves*?
Is that like J-sus?

@ Mrs Grimble

I hardly dare to ask what a “homotoxicologist” is….

I have no idea either. A form of homeopath?

Since my wife and I both work, I can’t imagine how anti-vax parents handle the idea (or the reality) of taking weeks off from work if their kids come down with a VPD…..

@Helanthius: Yup. They’re called “homotoxicologists” (or sometimes “homeotoxicologists”). Again, the search box should reveal all.

I see that I was all wrong about homotoxicology. I assumed the diagnosis would be done by waving crystals on a string over blood samples and treating with magic water. But No! They diagnose your condition of humoral imbalance by Real Medical Tests!! Then they Treat you with the homeopathic magic water!!! Note, this is Humor, for the snark-impaired!!!! (Hey Orac, did you get the journal article?)

I’m always stunned at the amount of money these “Thinkers” have to burn on chiropractors, naturopaths, and “homotoxicologists.”

Ism: Do they think that most other children, especially those who vaccinate, are listlessly walking around in a perpetual state of bad health?

Yeah, they do. To the point of diagnosing lots of kids, based on a quick glimpse, as having gluten allergies.
I remember one mom taking ”dark under-eye circles’ as an indication of celiac disease; a normal person would have thought ‘reading under the covers disease.’
And they think colds are an indication of an unhealthy immune system. Frankly, if my immune system weren’t chowing down on two or three cold viruses a year, it’d probably turn on me.

All these “Thinkers” IMHO appear to supper from a “ginormous” dose of hubris. If I were a betting man (and I am not), I would bet most of not all have:

1. Little if any medical training
2. Little if any credible medical knowledge
3. No experience in the healthcare industry

Their arguments from ignorance is awe inspiring and makes one ponder if said ignorance should be measured in astronomical terms as miles, kilometers, pounds, kilograms etc do not adequately describe/quantify their level of stupid.

Having worked in the healthcare industry for many years, and 7 of those in pediatrics, the nurses are duty bound to ask about such things by law or risk (in litigation) loss of license for not doing so in the event someone claims (after a purported medical injury) that the medical professional did not adequately inform them of the risks/dangers of their behavior. It is the parents “right” to decline the service/procedure/intervention (which is to me morally reprehensible) but the provider must provide the most accurate and up to date information to that an individual can make an informed decision.

The pediatrics office I worked with (it was a residency program) had a policy of discharging patient’s who’s parents did not want to vaccinate because of the inherent risk it posed to other patient’s who had the right not to be exposed to the preventable communicable disease (as some of the patients could not get vaccines for medical reasons).

These “thinking” moms should have to go to the pediatric hospital wards to witness firsthand the heartbreak, death, pain, debilitation suffered by the children who acquire the disease which these vaccines prevent to see how their “morals” stand up to reality. They should also have to be registered with DOH so that (such as those who are diagnosed with TB or Typhoid) were tracked as society as a whole has the right to keep themselves safe as well as their children from these leptons of ignorance. “There is no cure for stupid” Ron White

Timely article Orac as I was feeling bad for you and others who practice adult medicine today. I asked a preschooler who was telling me how cute her baby brother is if she knows she is cute. She told me she is “astounding”. I also got to play with toy trucks and airplanes during well visits.
There are those reluctant parents that I can educate and those I have to tell I cannot be their child’s ped when we reach an impass. As Paul Offit has said to me “We fight the good fight”

My kids went to a chicken pox party, before there was a vaccine. It was called “day care.” I was not amused, and my kids were so miserable. I can’t IMAGINE why any parent would do that to their child deliberately. Idiots.

@lsm

Do they think that most other children, especially those who vaccinate, are listlessly walking around in a perpetual state of bad health?

Yes.

@Lawrence

I imagine that such an idea never enters their thoughts. And if it does happen, they will either snap out of the dumb-induced haze they’ve been wandering through (see, e.g., Megan Sandlin) or they will double-down on the cognitive dissonance and rationalize away the problem, blaming something other than their decision for the reason their kid got sick.

@notation Wherever you are. My son was born in ’69 fully vaccinated acccording to the schedule at the time. He is a very healthy competitive bike racer, treker, surfer, granola cruncher who vaccinated his kids according to a different schedule. I see nothing wrong with that decision and resent having “opinions” shoved down my throat.

@ NH Primary Care Doctor:

I get the impression by reading them daily that several of the TMs ( none specifially identified by me) that- despite their protests of AlWAYS being strapped for cash- have more money than is average and live in posher than average suburbs/ cities.

As one of my relatives notes: ” You have to be rich to be middle class around here”. They’re in a similar position. Plus organic foods, supplements and altie treatments cost.

Days after she got the clean bill of health, she came down with an ear infection. Some Galilean olive oil with a dab of Thieves and she was good to go. Sometimes allopathic medicine is an option. Sometimes, simply educating ourselves about proper nutrition and preventative care is an option, too.

As one of those children unfortunate enough to suffer frequent S. pneumo otitis media–not the viral as this clearly was–complete with ruptures and ER visits in that lovely time period after tubes started to fall out of favor for confirmed bacterial infections but before the Pneumo vaccine was available to kids, I’d like to raise two enthusiastic middle fingers to the Rev. There was a period of time when I was on prophylactic Bactrim. I would have killed for a vaccine, and I shudder to think of what would happened if my mother had gone all natural and tried to treat me with olive oil that’s is exactly the same as the Wegmans’ brand I buy to cook with.

And I have no long-term damage aside from scar tissue, it just sucked that much. Weeks of bronchitis without antibiotics…it terrifies me how much these kids are suffering with things so easily treatable/preventable. And how much money does she spend on all those specialists? Surely they’re all doing it for little cost and out of the goodness of their hearts…

anon @25 —

who vaccinated his kids according to a different schedule.

Good on him for vaccinating!

But it should be noted that the recommended schedules are worked out carefully by people who have forgotten vastly more about infectious disease than most of us will ever know. Why second-guess them?

I get the impression by reading them daily that several of the TMs ( none specifially identified by me) that- despite their protests of AlWAYS being strapped for cash- have more money than is average and live in posher than average suburbs/ cities.

All that homeopathy and other quackery, particularly the “biomedical” quackery to try to “recover” their children costs a lot of money. Just being upper middle class or even a bit more affluent won’t cut it; you’ll still be hurting for money after spending for quackery. Doubly so if you live in an expensive city like Chicago.

I can’t imagine how anti-vax parents handle the idea (or the reality) of taking weeks off from work if their kids come down with a VPD…
That was the main reason my parents still had measles and chickenpox parties – gather all the kids in one location and rotate care as required. Of course, late 60s didn’t have good vaccines available either yet, or I’m sure they’d gladly skipped that.

The anti-vaccination sentiment is clearly ridiculous, but it’s not so obviously ridiculous to try treating simple respiratory and ear symptoms with traditional medicine before rushing to the MD. A kid with a respiratory infection who is very active and has no fever is, firstly, not likely anywhere near sick enough to warrant ominous threats about “hoping “it’s not tooo laaaate”, and secondly, probably doesn’t have a bacterial infection at all so doesn’t “need” and won’t benefit from an antibiotic. If you were less inclined to believe that any cough or earache, save for allopathy, could be certain death, you could rightly have identified her proclamation that the kid “needed” an antibiotic as another instance of [genuine!] Dunning-Kruger effect.

@oldmanjenkins #21:

Their arguments from ignorance is awe inspiring and makes one ponder if said ignorance should be measured in astronomical terms as miles, kilometers, pounds, kilograms etc do not adequately describe/quantify their level of stupid.

A solar mass of ignorance? It would fit well with burning stupid.

If you were less inclined to believe that any cough or earache, save for allopathy, could be certain death

Nice Strawman ya got there. Avoid open flames.

@Michael, #2: I wish and dream and hope someday the stodgy , out-of-touch and rather clueless leadership of the AAP will get off their duffs and (1) come out for vaccines as vocally as groups like NVIC speak against them, (2) change their policy which recommends not firing families who won’t vaccinate but was made during a time when vaccination rates were much higher, and (3) Actually kicks anti-vaccine pediatricians like Dr. Bob Sears and Dr. Jay Gordon (who make lots of money selling anti-vaccine books and materials) out of the AAP.

Until then, it’s just depressing as heck to watch the continual increase in vaccine-preventable diseases in the US thanks to non-thinking anti-vaccinationists.

Chris Hickie, MD, PhD

who vaccinated his kids according to a different schedule.

Your son is a pediatrician? An immunologist? An infectious-diseases RN?

(Didn’t think so).

Thinkers reminds me a bit of Brights. Both dumb. As a hospitalist, I deal with anti-vax ideology perhaps not as frequently as an office based pediatrician, but when I do it often forces me to order labs and treatments that a vaccinated kid wouldn’t need. Perhaps it is selection bias, but rarely have parents of unvaccinated or partially vaccinated kids complained about the blood cultures and doses of ceftriaxone. A few have refused a lumbar puncture but that also happens with vaccinated children at times.

There is a sense of learned helplessness with this issue. As well meaning and motivated as pediatricians often are, it is difficult to have to do the antivax talk over and over again. I’ve had many instances where I just ignore it if the kid is in for something unrelated. I need the parents to trust me and be on board with my plans and it sometimes doesn’t seem worth it if their child is admitted for colitis. But when I sense that there is even a small chance of success, I’ll sit in the room for as long as I can and discuss the safety and benefit of vaccines.

I laughed when I read The Rev’s list of self-limited and mild conditions for which her essential oils and homeopathy were effective.

jane,

A kid with a respiratory infection who is very active and has no fever is, firstly, not likely anywhere near sick enough to warrant ominous threats about “hoping “it’s not tooo laaaate”, and secondly, probably doesn’t have a bacterial infection at all so doesn’t “need” and won’t benefit from an antibiotic.

Anecdote alert, but I never had fevers. In fact, one of my ruptures occurred because the school nurse refused to let me go home because I didn’t have a fever. Apparently that meant it wasn’t bad enough. And it usually happened over the course of a few hours. Active, and went to school in the morning.

I am NOT saying all kids should be put on abx for ear infections, most absolutely do not need them and it contributes to resistance problems. However, a trip to the doctor to find out when pain starts can be a good idea. In fact, olive oil would have caused me much more damage, on top of having an ear canal swimming with Streptococcus. And when’s the cut off? Days? Weeks? How long do you let a “nagging” infection go?

On more than one occasion, the mother showed up with the five unvaccinated children (ages toddler to second grader) into the waiting room and to the front desk. She didn’t call or put masks on the kids. One of those times, she brought in the children because SHE HAD TAKEN THEM TO A CHICKENPOX PARTY AND THEY WERE FEVERISH.

So she took them to a pox party where they were infected, then brought them in to a paediatrician’s office that had immune compromised patients.
What is this I don’t even…

AnObservingParty:
“Weeks of bronchitis without antibiotics…it terrifies me how much these kids are suffering with things so easily treatable/preventable.”

It terrifies me too. I frequently had bronchitis and other respiratory tract infections as a child, and it’s miserable enough with the help of modern medicine! You know you’re sick as a child when you don’t even enjoy hearing the doc saying you shouldn’t go to school this week, because you’re just too tired to care.

My children’s pediatrician has a separate waiting room for well-children, but they check-in at the same front desk, use the same doors (into the office and into the back section with the exam rooms) and only have one drinking fountain in the front. Then I think about veterinarians that have an entrance for dogs and an entrance for cats so they never cross paths…

Perhaps pediatricians need to follow this model and have an entrance for non-vaccinators and a separate entrance for fully-vaxed/relying-on-herd-immunity-due-to-vaccine-contraindications…

I had measles, mumps, chickenpox, and rubella as a child. I distinctly remember getting the polio vaccine in Cleveland when I was very young. My dad had polio, without sequelae, fortunately – you can bet we were getting the vax! I recall sitting in our doctor’s waiting room with kids in leg braces.

Do these Nonthinkers vaccinate their children against polio? Tetanus?

A recent article at Slate discussed parent’s irrational fears, and including some discussion of vaccines.

http://www.slate.com/articles/health_and_science/medical_examiner/2014/03/is_formaldehyde_dangerous_no_but_johnson_johnson_removed_it_from_baby_shampoo.2.html

A nice quote regarding oh-so-scary vaccine indredients: The formaldehyde “added” to an infant’s body through vaccines is equivalent to adding a slice of American cheese to the top of a stack of 35 Hummers.”

his mother-in-law is a nurse practitioner.

Really? And her specialty is pediatrics?

A number of the “RI Regulars” posted comments on this recent Daily Beast article about pediatricians who refuse to care children whose parents refuse vaccinations:

http://www.thedailybeast.com/articles/2014/01/30/the-real-reason-pediatricians-want-you-to-vaccinate-your-kids.html

Our old friend Dr. Bob Sears has a list of hundreds of “vaccine friendly” doctors and if you scroll down to California, you’ll find Dr. Jay.

http://www.askdrsears.com/topics/health-concerns/vaccines/find-vaccine-friendly-doctor-near-you

If I had a young infant, I would be interviewing pediatricians to find who have instituted a strict vaccination policy. My babies were precious to me and I wouldn’t want to expose them to deliberately non-vaccinated children, within the confines of a pediatrician’s waiting room.

lilady @47 — yowza. That Daily Beast article seems to have drawn all the usual suspects — yourself and a few other rational voices against a baying horde of thermonuclear-grade stupid.

The great, great Charles Pierce — who many know as a sometime “Wait, Wait, Don’t Tell Me” panelist, and others know from his excellent politics blog on Esquire.com — wrote a fine book entitled “Idiot America”, about how in many circles, passionate belief has become as valued as actual knowledge. Recommended. He’s actually an astute analyst, as well as often being hilarious.

A poster on “The Week” is saying that there is no link between the rate of vaccine exemptions and the vaccine rate, and that vaccine rates are not actually dropping. Lilady, maybe you can weigh in?

Responding to a few thoughts up-thread…

How do parents make the time off from work to look after kids ailiing from VPDs?
Perhaps they should check with the swelling ranks of parents of kids with vaccine induced autism.

Pro-vaxxers such as Offit are fighting the good fight?
And a highly profitable one to boot!

Seriously guys –just curious –when you make your spiels, are you not anticipating these rebuttals? (Hee hee hee)

Since vaccines don’t induce autism, you have no point, Gerd, except for the one on your tin-foil hat.

And Derg weighs in to show, again, how totally stupid he is….thanks Derg…the thread was too highbrow, you needed to drop the IQ level a bit by showing up.

#4 Ren

“So, no, the people who get fired from practices for not doing the bare minimum to take care of their children are not “thinkers”. They’re sheep.”

No, they are wolves adorned as sheepish things.
Bringing five unvaccinated kids straight from a “pox party” into a waiting room full of sick people is an aggressive act, using disguised aggression. It’s sorta like the woman who proudly recalled the number or rear end accidents she’d caused by adopted a calculated strategy of slamming her brakes on full force when traffic bunches up a quarter mile ahead. Her “rationale” was that there’s be an accident behind her, thus she would not herself get rear ended. Provided she doesn’t repeat that in front of a judge there’s nothing the law will do about it.

Same deal with the chickenpox, measles and HIV carriers who gleefully spread virus around to the “weak, genetically defective” individuals who “need to be thinned from the herd”.

They are not victims, they are attacking your patients in a way calculated to leave themselves untouchable.

As far as chicken pox parties, if it was 30 years ago and the vaccine hadn’t been invented yet, and I had a generally healthy child who’d reached the age of nine or ten without catching it, I MIGHT contemplate deliberate exposure, just to prevent a more serious adult case later on. Of course, there IS a vaccine, so it’s still dumb as shit.

And why would you bring your kid to the doctor for suspected chicken pox? Doctor’s not going to do anything unless complications crop up.

@anon, Orac has already discussed this bunch and far more effectively than I can. If you would rather believe TMR than the CDC, I know all I need to know about you.

I’ll snark if I wish. If you don’t like it, tough.

Yet another case of organic being used by quacks. Organic seems to be the starter quackery that leads to homeopathy and all other quacktastic modalities.

lilady and Dorit ought to read the link anon just posted—sounds like the baloney Key Lime Pi was barfing up on Mother Jones.

@ Judy:

Just in case you didn’t know:
‘Fearless Parent’ was founded by LKH and TMR’s MacNeil – Brogan joined in later- and is featured on PRN ( internet radio)
Gracious! The woo doth clump together in heaps.

If you actually go, see if you can take notes.

Seriously guys –just curious –when you make your spiels, are you not anticipating these rebuttals? (Hee hee hee)

What “rebuttals”? Don’t you have an awful backlog of these to provide on the last thread that you ran from with your tail between your legs?

anon: Sorry I’m going to get snarky here. If you don’t like my tone…tough. Find yourself another blog to post your ignorant comments.

Peanut oil was investigated as an adjuvant on volunteers who participated in studies, fifty years ago. No vaccine containing peanut oil was ever licensed by the FDA for use in the United States:

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2130368/

More snark…

Here, for your perusal, photographs of children infected with the invasive and deadly H. influenzaie bacterium. The infant’s gangrenous left hand was amputated after the photograph was taken.

http://www.immunize.org/photos/hib-photos.asp

In the context of firing patients, it is perhaps worth reiterating Gerg’s self-described attitude when dealing with physicians:

[F]rom time to time I do get prolonged colds with coughing, sneezing, running nose, but never a fever….

Usually at my mother-in-law promptings (old people can be such hypochondriacs) I will sometimes go the doctor for these bouts. And, after waiting in the waiting room for an eternity, putting up with the unpleasantness of fellow sick patrons, uncomfortable chairs, really out-dated magazines, etc, I am then ushered in the doctor’s office where I have to wait another eternity. Feeling impatient and checking that they way is clear, I will further kill time by weighing myself or checking my blood pressure.

Eventually the doctor will grace me with his presence: ‘Hi there Mr. (insert Greg’s last name) — what brings you here today?’ I am tempted to mock him and ask, ‘what do you think?’–but I will behave.

After explaining that I have a cold, he runs me through the whole check-up gamut: ‘Open your mouth — cough- breathe–let me examine your eyes.’ And finally, after finishing this routine, he tells me that it looks like I have a bad cold. Aghast, I wonder why he gets paid good money for this.

A nice quote regarding oh-so-scary vaccine indredients: The formaldehyde “added” to an infant’s body through vaccines is equivalent to adding a slice of American cheese to the top of a stack of 35 Hummers.”

Heh, that’s my line. Glad to see it put to such good use.

@ Denice

“If you actually go, see if you can take notes.”

If I actually go, I’ll bring along some cyanide capsules with me. And I did not know about the history of Brogan and TMR.

I do know she and Sayer Ji wrote a woo-filled piece on why vaccines aren’t Paleo on Greenmedinfo. It sounds like a parody by The Onion. Seriously, you can’t make this stuff up. The problem is that her MD and good credentials give the woo some unwarranted gravitas.

This Thinker has a remarkably healthy child who eats well and is developing normally with no learning disabilities or developmental delays.

When I try to imagine myself describing a friend’s baby this way, my mind just hits a wall.

I think of the babies I know socially as people. With, you know, personalities.

They always sound like they’re talking about collectibles or something when they mention their kids: (Near mint, no shelf wear, learning disabilities or developmental delays.)

Freaks me out.

@anon – yeah, what has been said above. Peanut oil is not and has never been utilized for a vaccine on the US Pediatric schedule….anyone that says otherwise is lying.

In fact, as far as I can see, I’ve only suggested it was the result of a phobic, whiny temperament, and/or a hysterical overreaction to the sigh of flyers, and/or a compulsion to rage at women.

Ann: They always sound like they’re talking about collectibles or something when they mention their kids: (Near mint, no shelf wear, learning disabilities or developmental delays.)

Freaks me out.

Yeah, I think that’s a side effect of having a type A personality and giving up the career. They obsessively measure the kids, and implode when the kids don’t measure up.

And I’m going to assume that second comment was supposed to be on another thread where the ‘Void Troll” lurks. My condolences. I’m staying away from that thread; it’s bad for my blood pressure and worse for my tooth enamel. I hope Orac bans that creepy rapist soon.

@ Judy:

Unfortunately, you’re correct: an MD makes their woo appear more feasible – ALTHO’ remember that these people scoff often at doctors and other professionals who AREN’T anti-vax. Brogan has appeared at PRN as a guest of their chief honcho, been published at various anti-vax and altie sites like GMI. LHK has been cycling around anti-vax world for the past few years, editing a book with Mary Holland, working with Focus Autism; she and MacNeil hosted a book signing at last year’s Autism One with Jennifer Margulies, another ‘fearless parent’.

Thus, these folks run in very small circles of closed mindedness: everyone knows everyone else and enables one another EXCEPT when there’s war – as in Jake vs Blaxill.

“remember that these people scoff often at doctors and other professionals who AREN’T anti-vax.”

In other words, 99.9999% of professional. And Brogan isn’t just a contributor at Greenmedinfo……she is the “medical advisor,” right below Sayer Ji himself. So she is blameworth for all the anti-vaxx on that site……and their endorsement of chemtrails too, I guess. I have yet to find a medical conspiracy which that site doesn’t endorse.

http://www.greenmedinfo.com/blog/evidence-atmospheric-aerosol-spraying

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