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Completing a trio of antivaccine-sympathetic California pediatricians

I appear to have fallen into one of my ruts again. Or maybe it’s not a rut. I just feel as though I’ve been doing too many posts on the antivaccine movement, to the point where I wonder if I’m starting to fall into a rut. In actuality, it doesn’t really matter. If I feel as though I’m getting tired of a topic, then that’s enough. It’s just that the antivaccine movement, even as bottomless a font of stupidity, misinformation, pseudoscience, and quackery as it is, sometimes goes on a tear. When it does that, I have a hard time restraining myself from trying to blog about all of it, as impossible a task as that is. For example, we had antivaccine hero Dr. Bob Sears ranting about his patients’ parents who were justifiably concerned about the ongoing measles outbreak in southern California given that their children are unprotected because they are unvaccinated—not just once but twice. Then we had our old pal, pediatrician to the antivaccine stars’ children Dr. Jay “I’m not antivaccine but I trash them constantly with unscientific nonsense” Gordon “reassuring” the same kind of parents: Antivaccine parents who are getting a bit worried because their children are unvaccinated and the measles outbreak shows no signs of abating yet.

Now we have another antivaccine pediatrician being interviewed in Mother Jones in an article with the truly annoying title My Interview With a Pediatrician Who Thinks Vaccines Are “Messing With Nature”: Is She Right? The interview in question is with a pediatrician named Dr. Stacia Kenet Lansman, founder of a practice known as Pediatric Alternatives. The very name of the practice tells me everything I need to know about it. Well, actually, not entirely. This passage from the Mother Jones article describing it does:

In 1998, she founded Pediatric Alternatives, with the goal of combining Western medicine with nontraditional methods like homeopathy, herbalism, and dietary treatments. This approach, she hoped, would “start children and families out with healthy habits and routines so that they are more likely to stay healthy.” The practice flourished. Today, she and four other physicians at Pediatric Alternatives treat somewhere between 1,500 and 2,000 patients from around the Bay Area.

And here’s the interview:

So, basically, Dr. runs a crunchy “integrative medicine” practice in the Bay Area. Is it any surprise that she’s antivaccine? Not at all! Not only does “integrative medicine” integrate quackery with science-based medicine, but it frequently “integrates” unscientific antivaccine views with science-based medicine. And, boy, does her practice‘s website show it! Check it out:

Integrative medicine is the convergence of ancient healing wisdom with the medical practices of western medicine. At Pediatric Alternatives, through our combined training in western medicine, homeopathy, herbal medicine, naturopathic medicine and nutrition, we are able to treat more illnesses naturally without the use of antibiotics or other prescription medications.

Amusingly, one of the bits of “ancient healing wisdom” offered by Pediatric Alternatives is homeopathy, which isn’t actually ancient (having been invented by Samuel Hahnemann only a little more than 200 years ago) and is actually Western, having been invented in Germany. Regular readers know that homeopathy has two main “laws,” the law of similars, which states that to relieve a symptom you use a substance that causes that symptom in healthy people. It’s a totally unscientific law whose basis is far more rooted in concepts of sympathetic magic than it is in science—or even reality. Then there’s the law of infinitesimals, which states that serially diluting a substance (with vigorous shaking, known as “succussion,” between each step being absolutely essential to “potentize” the mixture) actually makes it more powerful. Unfortunately for homeopaths, they tend to dilute substance far beyond Avogadro’s number. A typical homeopathic dilution is 30C, where C = a 100-fold dilution. So 30C = 30 one hundred-fold dilutions, or an overall dilution factor of 1060. Given that Avogadro’s number is only on the order of 6 x 1023, you can see the problem. Homeopathic remedies are water in which the magical ingredients have been diluted to nonexistence.

Pediatric Alternatives also offers naturopathy, which I’ve described on numerous occasions as a cornucopia of quackery. And so it is. After all, you can’t have naturopathy without homeopathy, because homeopathy is considered what one might call a “core competency” of naturopathy and is a key component of the curriculae of schools of naturopathy. It’s even a major component of the naturopathy licensing examination.

Not surprisingly, pseudoscience like homeopathy and naturopathy goes together very well with antivaccine views, and Dr. Kenet Lansman demonstrates that:

Given all this, it might surprise you to learn that one of Pediatric Alternatives’ policies is extremely unorthodox: It suggests that families delay certain childhood immunizations—in some cases for years past the age recommended by the Centers for Disease Control and Prevention—and forego others entirely. A little less than 20 percent of the families the practice treats choose not to vaccinate at all. The rest use a modified vaccine schedule.

I’m not sure why the author of the article, Kiera Butler, is surprised (or thinks that it is surprising) to learn that Pediatric Alternatives “selectively” vaccinates. Knowing what I know about “integrative” medicine, naturopathy, and homeopathy, I’d have been surprised if the pediatricians there actually followed the CDC vaccine schedule. Shocked actually. It’s totally to be expected that the do not, nor is it surprising that her philosophy about vaccines is very much like that of Dr. Jay Gordon:

Kenet Lansman tells me she would never deny any vaccine to parents who request it for their child. But she does share her personal beliefs with her patients: She fears that vaccines have contributed to the recent uptick in autoimmune disorders and other chronic conditions. “I think we’re just messing with nature, and we really don’t know what we’ve created,” she says. “We’ve reduced or largely eliminated many infectious diseases. But in their place, we have an epidemic of chronic illnesses in children. The incidence of asthma, allergies, and autism spectrum disorders has dramatically increased since the 1990s. And the reason for this we don’t know. But my concern is that vaccines have played a role.”

Like Dr. Jay, Dr. Kenet Lansman apparently won’t vaccinated unless the parents badger her to do so. Of course, parents who want to do the responsible thing and vaccinate their children according to the CDC schedule would be highly unlikely to go to a practice like Pediatric Alternatives; so I’m guessing that the problem of parents demanding appropriate vaccines for their children is a problem that Dr. Kenet Lansman rarely encounters. Come to think of it, I bet that Dr. Jay rarely encounters the problem as well. Parents who want to vaccinate their children are similarly unlikely to seek out a pediatrician like Dr. Jay.

So what vaccines does Pediatric Alternatives administer? At least the practice gives the DTaP shot—which protects against pertussis, diphtheria, and tetanus—during the child’s first year. It’s not clear to me from the interview whether Pediatric Alternatives administers all three doses in the first six months or whether they also give it at 15-18 months, 4-6 years, etc., as the CDC schedule recommends. From the phrasing, I suspect not. The practice also administers the vaccine against meningitis. Predictably, however, given the antipathy towards this vaccine among the antivaccine crowd, Dr. Kenet Lansman doesn’t vaccinated against hepatitis B at all, pulling out the tired old trope about how babies don’t “engage in sex or intravenous drug use.” She also doesn’t administer the varicella vaccine, nor does she appear to administer the polio vaccine. Worst of all, there’s this. She delays the MMR vaccine until age 3, and here’s the reason:

The main reason for the delay, Kenet Lansman says, is that she still believes there could be a link between vaccines and autism. She acknowledges that the scientific community has rejected this theory, yet she says she has seen children from her own practice who begin to show signs of autism shortly after being vaccinated. “My feeling is that if there is any risk that the vaccine is associated with autism, we should delay the vaccine during this vulnerable developmental window,” she says.

Yes, I see a definite resemblance to Dr. Jay here as well. She relies on “personal clinical experience” above scientific studies to tell her what she’s come to believe, that vaccines cause autism. A little confirmation bias, in which she remembers cases that correspond to her pre-existing belief, mixed with some confusing of correlation with causation, and there you have it: A pediatrician who falls for the failed hypothesis that vaccines cause autism. Her belief in pseudoscience comes at a potential cost: Leaving her patients vulnerable to vaccine-preventable diseases like measles longer than other children. She brags in the interview how none of her patients have developed vaccine-preventable diseases—much as Dr. Jay brags that he’s never seen a case of the measles. That is, of course, because both her and Dr. Jay’s patients are sponging off the herd immunity of those who actually do vaccinate. However, given her location in one of the epicenters of antivaccine views in the entire US and how she’s contributing to the number of unvaccinated children, it’s likely only a matter of time before she won’t be able to brag about that any more. On the other hand, I noticed in her interview that she used some rather weaselly words. She didn’t actually say that none of her patients have ever had vaccine-preventable diseases. Rather, she says, “We’ve never had one patient get a serious, life-threatening vaccine-preventable illness because we gave them a vaccine at a later date.”

Hmmm. I bet she has had some patients get vaccine-preventable diseases. If I had been Butler, I would have called her out on that and asked her specifically if she had ever had any cases of measles among her patients? Pertussis? Varicella? My guess is that Dr. Kenet Lansman very carefully chose her words and that she, like many antivaccine pediatricians, dismiss the measles and other vaccine-preventable diseases as not being “serious.” Yes, that appears to be what she is doing.

Not surprisingly, Dr. Kenet Lansman is also big on confirmation bias in other areas. She claims that her office is “quiet during flu season,” which tells us little and that the children in her practice “actually seem healthier than most of their peers.” By what specific, objective measures? How would she know? This sounds suspiciously like the claim made by Mayer Eisenstein about his Homefirst practice in the Chicago area. Eisenstein, as you might recall, doesn’t vaccinate and claims that he’s never seen a single case of autism in his practice. Conveniently enough, he’s never actually published his numbers and can’t (or won’t) produce evidence to support his claims. Anyone want to bet whether Dr. Kenet Lansman can provide any sort of convincing data to support hers, either? I say she can’t, and I don’t blame you for not taking that bet.

Sadly, Butler’s interview, even though she says the right things about vaccines by quoting Paul Offit and other vaccine scientists who point out that there is no evidence that vaccines are correlated with autism or cause autism or that these “alternative” vaccine schedules do anything more than leave children unprotected against vaccine-preventable diseases, falls for “natural” trope:

At the end of my visit to Pediatric Alternatives, I found that I liked Dr. Kenet Lansman. I could tell that she was bright and caring and open-minded, and most impressively, she tried to think creatively about how to keep her patients healthy. She’s right that there is an epidemic of chronic autoimmune illnesses and autism among children, and a mounting body of research suggests that our aggressive pursuit of germs—both in our environment and in the human body—might have something to do with it: When we kill disease-causing germs, the theory goes, we kill beneficial bacteria, as well, making our bodies’ defense systems go haywire.

Well, I actually kind of like Dr. Jay, too, but that doesn’t stop me from ripping into his antivaccine-sympathetic views and his pseudoscience about vaccines. In any event, as I just wrote about the other day, there is no autism “epidemic.” It’s a zombie that just won’t die. Nor is there any evidence that the increase in prevalence of certain autoimmune diseases has anything to do with vaccines. As for the “hygeine” hypothesis, even if it’s correct it doesn’t justify antivaccine views or the use of naturopathy and homeopathy, the latter of which is the so obviously quackery that there’s good reason why it’s a favorite example used by skeptics to teach about quackery. Nor does it justify Dr. Kenet Lansman’s statement in her interview (on the video) that she believes that being exposed to such diseases “strengthens” the immune system and that we don’t need to be afraid of these illnesses. Yes, she’s just as irresponsible as Dr. Gordon and Dr. Sears.

As much as I attack the “tell both sides” meme in journalism when it’s applied ot pseudoscience, alternative medicine, or antivaccine views, at least Butler bothered to point out just how wrong Dr. Kenet Lansman is about vaccines. The problem is, she diluted that criticism by expressing sentiments that buy into the same unscientific world view shared by her subject. In the end, Dr. Kenet Lansman is a a pediatrician dripping with arrogance as she expresses “concern” that children are getting “too many” vaccines at a too young an age based, of course, on no evidence other than her “concern” and her confirmation bias. She then has the temerity to say that she “examined each vaccine individually” and, apparently thinking her judgment to be superior to that of the expert panels who come up with these recommendations.

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]

180 replies on “Completing a trio of antivaccine-sympathetic California pediatricians”

She fears that vaccines have contributed to the recent uptick in autoimmune disorders and other chronic conditions.

I’d actually like to ask a question and I hope an immunologist will answer: is there a real uptick in autoimmune disorders? Or are we just getting better at detecting them?

The incidence of asthma, allergies, and autism spectrum disorders has dramatically increased since the 1990s.

As above, but for allergists: are allergies increasing? Or are we detecting more of them?

She acknowledges that the scientific community has rejected this theory, yet she says she has seen children from her own practice who begin to show signs of autism shortly after being vaccinated.

**facepalm** Post-hoc, ergo prompter hoc fallacy.

She’s right that there is an epidemic of chronic autoimmune illnesses and autism among children…

Is she?
I think that some regulars here should write some letters to Mother Jones.

” I just feel as though I’ve been doing too many posts on the antivaccine movement”

From the perspective of this fan, that is not possible. Thanks for what you do.

The whole “we’re messing with nature” trope infuriates me more than most of quack tropes out there. I don’t like nature very much, it scares me. I survive thanks to dozens of things that are unnatural. Going for “X is wrong because it is unnatural” as an argument should be punished by leaving the person naked in the woods to fend for themselves, fully naturally.

One of my favorite bike routes takes me past a tiny, overgrown country graveyard.

There are two heartbreaking aspects to this little plot of land — a whole lot of young men with death dates in the 1861-1865 range, and, even worse, many headstones of small children. The sorrow that each of those little stones represents is unimaginable.

Messiing with Mother Nature, indeed …

ancient healing wisdom
You’d think that archeologists would have found more skeletons of long-lived ancients.

Re the “against nature” bit.
If there is one thing that nature is good at, it’s controlling the numbers of a species. Most animals do not survive to breed. Those that do can have hundreds if not thousands of offspring because that is the only way to ensure species survival.
“Mother Nature” is a misconception. Nature can be a mother, but in the other sense.

Yeah, we shouldn’t mess with Mother Nature. Well at least until Subacute Sclerosing Panencephalitis necessitates anticonvulsant and antispasmodic drug administration and possibly antiviral (isoprinosine and ribavirin) and immunomodulatory (interferon alpha) drugs on the faint chance that they will work before your child dies. Yeah, just then maybe we might intervene eh Mother Jones?

This “Mother Nature” or “Mother Earth” meme is only possible to people who have little exposure to Nature or Earth as they actually are. Romanticism and stuff about “A host of golden daffodils” are very nice between the pages of a book but otherwise they’re about as real as Peter Pan. Whenever someone enthuses about Mother Nature I strongly suspect one thing about them: they don’t live in it. They live in a heavily humanised country where medicine, internet, good roads and democracy are the norm.

“yet she says she has seen children from her own practice who begin to show signs of autism shortly after being vaccinated.”

Parent brings kid to hippie doc.
Kid shows signs of autism.
There ya go, cause/effect.

Kid caught autism from the hippie doc, perhaps from the office practice of homeopathy. Vapors or fumes of powerful adult homeopathic concoctions, being even more powerful than the undiluted dilutions, overwhelmed the little child’s delicate defenses.

What other conclusion is possible, unless one is a shill for alt-med?

Taking your kids to a pediatrician and giving them access to modern drugs and surgery is one of the worst kinds of tampering with nature.

Dr. Lansman could easily make the argument to parents that they need to have a few extra children in the anticipation that some of the young, weaker ones will die of trauma, burst appendices and the like (no interfering with natural processes permitted). The ones that make it will be too busy fighting off “natural” infections and building naturally strong immune systems to develop autoimmune problems, asthma etc.

Though I worry that those “naturally” strong immune systems will also kill off “good” bacteria (aren’t we told that immunity from disease is always superior to that from immunization)? Won’t this make the problem worse?

Regardless, using anything more than 19th century medicine on children is clearly irresponsible, leading to more cases of diabetes, asthma, autism etc. instead of letting the herd winnow itself out through natural selection.

It figured there were some other rat nests of pediatricians in California who don’t deserve to be pediatricians –just not (at least until now) as vocal as Gordon or Sears. But I suspect these anti-vaccine pediatricians are realizing that Drs. Sears and Gordon have profited very, very handsomely from their very public anti-vaccine antics, so now we will see more of them crawling out of their holes to tell naive reported vaccine lies.

“to tell naive reported vaccine lies.”–should be “to tell naive reporters vaccine lies.”

From the perspective of a pediatrician who sees every day the damage being done to vaccination rates by the increasing numbers of parents being fooled into not vaccinating, some other parts of this interview merit harsh scrutiny:
This scene isn’t the only impressive thing about Pediatric Alternatives. The practice’s five physicians have impeccable credentials, having trained and completed residencies at some of the nation’s top medical schools and institutions. Several are fellows of the American Academy of Pediatrics.
Strange how none of these “impeccable” physicians on their practice web site are willing to state such they are FAAPs. Maybe this group of quack doctors is a little sneakier than Sears/Gordon in hiding from the AAP (not that the AAP has any fortitude when it comes to speaking out against quack pediatricians).
Given all this, it might surprise you to learn that one of Pediatric Alternatives’ policies is extremely unorthodox: It suggests that families delay certain childhood immunizations—in some cases for years past the age recommended by the Centers for Disease Control and Prevention—and forego others entirely. A little less than 20 percent of the families the practice treats choose not to vaccinate at all. The rest use a modified vaccine schedule.
If we had 20% non-vaccination rates everywhere, we’d have measles and whooping cough everywhere, instead we just have measles and pertussis in NoCal and SoCal where these wretched anti-vaccine pediatric practices are. Coincidence? I think not.
While the American Academy of Pediatrics discourages alternative vaccine schedules, it doesn’t forbid them for its members. And the insurers that contract with Pediatric Alternatives—which include Blue Cross, Blue Shield, Aetna, and Cigna—haven’t raised any protest. As Aetna puts it, “We don’t dictate care.” The California Department of Health simply requests that “parents ensure their children are immunized according to the schedule recommended by their physician.” The state of California, meanwhile, makes it relatively easy to opt out of vaccines: Parents are not required to follow the federally recommended schedule, and those who wish to skip shots entirely need only obtain the signature of their child’s pediatrician. (Rules vary in other states. See our map.)
If these top-shelf pediatricians and the regulatory bodies that oversee them are willing to allow customized immunization plans for each patient, then is there a possibility they are onto something? Could it be that much of what we’ve heard about the importance of timely vaccines is wrong?

I so wish the AAP would expel fellows who endorse and promote non-vaccination or any schedule that deviates from the ACIP/CDC schedule, but the AAP doesn’t. And NO, these “top-shelf pediatricians” (more like bottom feeding opportunists) aren’t onto anything other than absolute abandonment of one of the key tenets of pediatrics—prevention of infectious diseases through timely vaccination. –Chris Hickie MD, PhD

Clearly, html is not happy with me today—

From the perspective of a pediatrician who sees every day the damage being done to vaccination rates by the increasing numbers of parents being fooled into not vaccinating, some other parts of this interview merit harsh scrutiny:

This scene isn’t the only impressive thing about Pediatric Alternatives. The practice’s five physicians have impeccable credentials, having trained and completed residencies at some of the nation’s top medical schools and institutions. Several are fellows of the American Academy of Pediatrics.

Strange how none of these “impeccable” physicians on their practice web site are willing to state such they are FAAPs. Maybe this group of quack doctors is a little sneakier than Sears/Gordon in hiding from the AAP (not that the AAP has any fortitude when it comes to speaking out against quack pediatricians).

Given all this, it might surprise you to learn that one of Pediatric Alternatives’ policies is extremely unorthodox: It suggests that families delay certain childhood immunizations—in some cases for years past the age recommended by the Centers for Disease Control and Prevention—and forego others entirely. A little less than 20 percent of the families the practice treats choose not to vaccinate at all. The rest use a modified vaccine schedule.

If we had 20% non-vaccination rates everywhere, we’d have measles and whooping cough everywhere, instead we just have measles and pertussis in NoCal and SoCal where these wretched anti-vaccine pediatric practices are. Coincidence? I think not.

While the American Academy of Pediatrics discourages alternative vaccine schedules, it doesn’t forbid them for its members. And the insurers that contract with Pediatric Alternatives—which include Blue Cross, Blue Shield, Aetna, and Cigna—haven’t raised any protest. As Aetna puts it, “We don’t dictate care.” The California Department of Health simply requests that “parents ensure their children are immunized according to the schedule recommended by their physician.” The state of California, meanwhile, makes it relatively easy to opt out of vaccines: Parents are not required to follow the federally recommended schedule, and those who wish to skip shots entirely need only obtain the signature of their child’s pediatrician. (Rules vary in other states. See our map.)

If these top-shelf pediatricians and the regulatory bodies that oversee them are willing to allow customized immunization plans for each patient, then is there a possibility they are onto something? Could it be that much of what we’ve heard about the importance of timely vaccines is wrong?

I so wish the AAP would expel fellows who endorse and promote non-vaccination or any schedule that deviates from the ACIP/CDC schedule, but the AAP doesn’t. And NO, these “top-shelf pediatricians” (more like bottom feeding opportunists) aren’t onto anything other than absolute abandonment of one of the key tenets of pediatrics—prevention of infectious diseases through timely vaccination. –Chris Hickie MD, PhD

Oh Orac, please don’t restrain yourself from discussing anti-vax: it truly is a bottomless pit of dangerous nonsense, a cesspit of mutual enablement involving parents and doctors like the three you’ve wriiten up.

Since the announcement of the CDC figures last week and the start of Autism Awareness Month, we’ve witnessed the profusely bubbling vitriol of the AoA and TMR rant factories overflowing its cauldrons. Stagliano, Dachel, Goes, Olmsted, Jameson et al have ramped up their game, why not sceptics as well?

AND Marin County.
I should mention that I adore the place and have spent lots of time and money there. I get away from the cold and damp; it doesn’t rain. there are natural and cultural attractions as well as a laid back attitude without traffic jams. And I traipse amongst the hippies, naturalistas, artisans and new economy types and have a great time- they seem to like me. There are many smart, creative people there: but why oh why don’t they vaccinate their children?

We need to make listening to cranks and charlatans
UNfashionable, UNcool and ANTI trendy. How can being misled by quacks be desirable?

I just want to clarify:
The DtaP schedule is as follows:
2 months, 4 months, 6 months, 12-15 months, 4-5 years old. The Tdap starts at 11 years old.

If one follows the CDC schedule

She acknowledges that the scientific community has rejected this theory, yet she says she has seen children from her own practice who begin to show signs of autism shortly after being vaccinated.

I really find this hard to believe. If you aren’t vaccinating your patients, you aren’t going to see any results of vaccination in your practice. The only results you would see are parents who had their child vaccinated and then switch pediatricians after they think their child was harmed by the vaccination. I’m sure she sees a lot of patients who’s parents think the MMR gave their child autism, but she hasn’t seen it herself.

For a slightly different approach to unorthodox vaccine administration, try this out. A Halifax NS paediatrician took to mixing vaccines to lessen the number of needle pricks (eg mixing the dried MMR with DPTP (a liquid) rather than with the diluent). His license to practice was suspended for two months, he is no longer allowed to give vaccines and this letter was sent out to all physicians:
http://novascotia.ca/DHW/immunization-2013/
If anything that strikes me as a bit harsh, but it sure does encouager les autres to get it right!

@HDB #5

That’s because the “long-lived Ancients’ are still alive. They walk amongst us, guiding humanity and building pyramids. Or something.

““I think we’re just messing with nature”

That’s right. We are. Because nature wants to kill us.

Julian: I’d actually like to ask a question and I hope an immunologist will answer: is there a real uptick in autoimmune disorders? Or are we just getting better at detecting them?

I’m not an immunologist, but I think there are two short answers: one, we probably are better at detecting them, and we’re probably better at keeping immune-deficient kids alive.

Dr. Kenet Lansman doesn’t vaccinated against hepatitis B at all, pulling out the tired old trope about how babies don’t “engage in sex or intravenous drug use.”

I’ve never understood the logic behind vaccinating babies for a STD. While you may consider it a ‘tired old trope’, for many people, it doesn’t make much sense to me to recommend vaccinating babies for Hep B when the parents don’t have it and it’s not recommended for them. Could someone here enlighten me on why it is in the babies best interest to vaccinate for that particular disease so young?

‘and most impressively, she tried to think creatively about how to keep her patients healthy.’

I’m not sure how ‘creative’ I want my GP or other doctors to be – ‘stone cold analytic’ seems a better place to start. I would save ‘creative’ for the ‘you’re dead anyway can we try this?’ scenario,
but I think ‘creative’ in this context is cuddly wooy ‘making it up’ as opposed to the deep, original thinking that advances science (and art)

Beth – because you never know whose child…

Failure of Centers for Disease Control Criteria to Identify Hepatitis B Infection in a Large Municipal Obstetrical Population
MAUREEN M. JONAS, M.D.; EUGENE R. SCHIFF, M.D.; MARY J. O’SULLIVAN, M.D.; MARIA DE MEDINA, M.P.H.; K. RAJENDER REDDY, M.D.; LENNOX J. JEFFERS, M.D.; TAMARA FAYNE, R.N.; KATHRYN C. ROACH, M.T.; and BERNARD W. STEELE, M.D.

Ann Intern Med. 1987;107(3):335-337. doi:10.7326/0003-4819-107-2-335
http://annals.org/article.aspx?articleid=702123

may bite yours at daycare….
Hepatitis B virus transmission between children in day care.
Shapiro C, McCaig L, Gensheimer K, et al.Pediatr Infect Dis J. 1989;8:870–5. [PubMed]

A bite in the playroom: Managing human bites in day care settings
Paediatr Child Health. 1998 Sep-Oct; 3(5): 351–353.
PMCID: PMC2851373

These three pediatricians could be viewed as the antivax Three Stooges (with Jay Gordon screeching “Look at the BART! Look at the BART!”).

@ janerella

Thanks for your response. Transmission via biting from other youngster can occur in daycare centers. I’m not sure how serious that problem is, but it is an exposure route adults wouldn’t be exposed to. Is that the reasoning behind the recommendation?

If so, why is the vaccine recommended for all babies as opposed to being recommended just for those in daycare?

And why is it recommended at an age before they are able to interact with other children? Maybe that’s changed but I thought it was recommended before children become mobile enough to play with others.

To pile on with janerella–

Beth, most people with Hep B don’t know that they have it. It can be transmitted through “ordinary” contact such as sharing a toothbrush, or through one of the routine cuts and scrapes that accompany childhood. Similarly, we do not force laboring women to be tested for Hep B, and if they do happen to be infected, they can pass the disease to the baby. The birth dose offers good protection against birth transmission.

Unfortunately, if someone offered this “it’s an STD!” argument to you as a reason against Hep B vaccination at birth, they were either parroting information without checking it, or deliberately misleading you. Sexual contact is only one of many ways to get Hep B, and everyone who has contact with humans is at risk.

But thank you for asking- you come across as genuinely interested, so hopefully these and the other responses you’ll get will be helpful.

Meant to include this link to a handy info sheet (PDF):
ht_p://www.immunize.org/catg.d/p4110.pdf
It also points out that the very young are at increased risk of serious complications from Hep B, so early prevention is even more important.

Beth: “I’ve never understood the logic behind vaccinating babies for a STD.”

Because hepatitis b is not just sexually transmitted. So if you start understanding why kids become chronic carriers of hepatitis b, you might start understanding when the vaccine is given. Plus the fact that there are several thousand deaths per year in the USA from the cancer it causes.

Here is where you can go learn about it:
http://www.pkids.org/diseases/hepatitis/pediatric_hepatitis_report.html

Your intelligence should be questioned at every turn. Your anti vaccine propaganda is a true diservice to the children of our world. Shamew on you

So, they’ve got 5 physicians servicing 1500-2000 patients? How much do these people charge? Because I couldn’t run a practice with 400 patients.

Thanks for the links. They were interesting. I’m aware that most (all?) STD’s can be transmitted via contact with blood (i.e. scrapes and cuts) and sometimes other bodily fluids not just sexual activity and sharing needles. I wasn’t aware that the disease was more dangerous when contracted at a young age.

Is that the reason the vaccine is routinely recommended for babies but not their parents?

There’s also the issue that the birth dose is the only way to prevent vertical transmission from the mother. Sure, you can ask the mother if she’s at risk for Hepatitis B, but will she even know? Forgiving for a moment that we know a lot of moms will lie about their past exposure (and that it’s not exactly the best environment to be asking questions like that in anyway), if the mom was infected at birth from *her* mother and became an asymptomatic chronic carrier, the only clue she’s at risk may be relatives having died of liver cancer.

@ Beth:

Also if you vaccinate babies- because most of them are born in hospitals- you get a chance to vaccinate nearly 100% of that population prior to most of the risks for acquiring hep B.
Over years, most people will automatically be vaccinated.

5% to 10% of adults and children older than age 5 with hepatitis B infection go on to develop chronic infection, compared with 90% of infants. Approximately 25 percent of children who become infected with life-long hepatitis B virus would be expected to die of related liver disease as adults.

Since routine Hep B vaccination, was started the number of new infections per year in the US has gone down by 82%.

The greatest drop has been among kids born since 1991, when vaccinating children was first recommended.
(CDC stats)

@ Beth: The reason why all infants (including babies whose mothers are not chronic hepatitis B carriers and who are not at risk for vertical transmission at birth), is because close family members and other caregivers may be chronic carriers of the virus. Certain groups within our society practice “pre chewing” (by the caregiver) of food that is fed to the baby and when a baby (or an adult) is exposed to hepatitis B infected blood, the risks for transmission of the virus is 40 X higher, than being exposed to HIV infected blood:

Here, just a few of the unusual confirmed cases of transmission of the hepatitis B virus:

http://www.immunize.org/catg.d/p2100nrs.pdf

@Beth Also, adults need twice the dose given to children, which increases the cost.

Beth, just dropping in to say that back in 1972, shortly after my daughter was born, all parents received letters from the hospital informing them that their newborns may have been exposed to Hep. B in the nursery, and should be tested. Apparently, the hospital did not think it was solely an STD. As far as I know, all children were OK, but it was very frightening. When I heard, many years later, about the vaccine being routine after delivery, I was very glad and wished it had been available those many years before.

All pregnant women during each of her pregnancies are tested for the presence of hepatitis B virus.

There were problems with certain doctors who mistakenly tested pregnant women for the presence of hepatitis B Surface Antibody, not hepatitis B Surface Antigen. Those doctors made notations in the pregnant women’s charts that were sent to the birthing hospital ~ 6 weeks before the EDCs that the women were negative for Surface Antigen…and infants became infected due to these mistakes:

http://www.cdc.gov/hepatitis/hbv/pdfs/serologicchartv8.pdf

In order to make certain that the correct test was done to determine carrier status, a copy of the actual lab test result is contained within the mothers’ hospital charts.

http://www.health.ny.gov/diseases/communicable/hepatitis/hepatitis_b/perinatal/docs/program_manual.pdf

5 Doctors treating 1500-2000 patients seems like a really low empanellment. Of course you can do that when most or all of your treatments are cash only since insurance will not pay for them.

When my daughter was born some of my crunchie friends suggested Dr. Adema in Santee, CA. I took my baby/ toddler there for almost a year when I realized he put her on a “alternative” vaccine schedule without telling me. I was so upset. He also asked me if I belonged to a “good faith group”. Ack! Left him, left cruchie friends…and poor daughter had to get more shots every time I took her to the new doctor so she could be caught up. Can doctors do this legally? just make up a new vaccine schedule without telling a parent?

Is that the reason the vaccine is routinely recommended for babies but not their parents?

“By the early 1990s, accumulating data showed that many children remained at risk for HBV infection because of incomplete maternal screening and because a substantial proportion of infections occurred in children of hepatitis B surface antigen (HBsAg)-negative mothers. Furthermore, hepatitis B surveillance data indicated that adults and adolescents who were at high risk of infection were not being vaccinated and that 30% of cases in adults were associated with no recognizable risk factors.With these data and a growing body of evidence that hepatitis B vaccination was safe, the Advisory Committee on Immunization Practices expanded its hepatitis B immunization recommendations in 1991 to include all infants, primarily to stop HBV transmission among children and eventually also to prevent HBV infections in adolescents and adults.”

The estimate is that there were 16,000 nonperinatal infections in children aged 0–9 annually in the early 1990s.

lilady — “All pregnant women during each of her pregnancies are tested for the presence of hepatitis B virus.” Many women in America still don’t get prenatal care during their pregnancies, so I’d say that “all” needs to come with a qualification. Even if all the doctors are being good about testing properly for Hep B, not all mothers receive care during their pregnancies, and of course the mothers at greatest risk of hepatitis are also the least likely to be getting prenatal care.

So, there’s another thing for new mothers to think about.

liz @45 — a “good faith group”? Can anyone explain what kind of code-speak that is?

I do wonder if health insurance companies might change their tune when they starting having to pick up more tabs for VPD hospitalizations. Many of these parents who won’t vaccinate are educated and middle to upper income, so it is private payer plans that will eat most of those bills.

Comment to Liz and others: If a doctor is doing something that is below the standard of care in the community, then that becomes a potential malpractice if the patient is injured as a result. The problem with this physician and the associated risk to the infants and to the community as a whole sounds real, but I don’t know whether the standard of care rule is strict enough to apply to this situation. However, you would think that the doctor should have an obligation to explain the traditional vaccination schedule and the proposed delay of the schedule, and to make sure that the parent is aware of the difference. It seems to me that this is one of those things that should be reported to the state board of medical examiners, so that the situation can be corrected. At the very least, the infant is being subjected to a substantial variation on the standard of care without the parent having true informed consent.

There are two evasions in

Rather, she says, “We’ve never had one patient get a serious, life-threatening vaccine-preventable illness because we gave them a vaccine at a later date.”

It’s not just what counts as serious: it’s that it is literally true that her patients don’t get those diseases because she gave them a vaccine later. They get them because she didn’t give them the vaccine when she should have. If a child gets measles at age 2, giving them the MMR at age 3 doesn’t retroactively cause measles.

@NH Primary Care Doctor: They can pull it off if they have enough of a nursing staff. I don’t know about California law, but for many years I went to my then nominal PCP’s practice (I’ve since been switched to a different practice), mostly for routine checkups, without actually seeing the PCP (unlike my current PCP, whom I saw on my first visit), so I have reason to believe it’s technically legal in New Hampshire. And it’s much easier to pull off if, as others have implied, they don’t take insurance, because they don’t have to pay staff to deal with insurance claims (a large part of the overhead for a “normal” practice).

@ Calli Arcale: If the pregnant woman arrives at a hospital in labor, there is a protocol in place to administer the hepatitis B vaccine at birth, draw blood to test the mother for the presence of hepatitis B chronic carriage and to provide HBIG to the infant within 7 days of birth, if the mother is a hepatitis B carrier (#1 hepatitis B vaccine and HBIG ideally should be administered within 12 hours of birth).

(Thanks to Liz Ditz for the link to this doctor’s article which appeared in the Pediatric Annals about mommies refusing Vitamin K shots for their infants. Scroll down to see how this pediatrician excoriates Joe Mercola and his crappy science)

http://www.healio.com/pediatrics/journals/pedann/%7Bb5ee598c-213c-4284-86b7-c7055e31f71a%7D/playing-newborn-intracranial-roulette-parental-refusal-of-vitamin-k-injection

Dr. Block is my hero….second behind Dr. Chris Hickie…of course. 🙂

“The whole “we’re messing with nature” trope infuriates me more than most of quack tropes out there. I don’t like nature very much, it scares me. I survive thanks to dozens of things that are unnatural. Going for “X is wrong because it is unnatural” as an argument should be punished by leaving the person naked in the woods to fend for themselves, fully naturally.”

I totally agree with The Smith of Lie, here. Nature can be a cruel bitch, at best it’s indifferent. Or a cruel jerk-face, for a less gender-specific term. It doesn’t care what it tears down, within the human body or on the planet. If anything, we’re better off using our best ideas to outsmart it!

lilady — yeah, but my point is that there are antivaxxers who say “you shouldn’t need to vaccinate my special snowflake because I was tested during my pregnancy and I know I’m clean” when a mother could show up in the next suite with undiagnosed Hep B. Sure, she’ll be tested, but if she’s an antivaxxer as well, she’ll refuse the vaccine for her child and so we’ll have a window of time between the birth and the discovery of Hep B during which it could transmit in the nursery. It’s a pretty small risk, but Hep B has such serious ramifications for a newborn that I think antivaxxers are being Pollyannas when they rely on Hep B testing to decide whose baby gets vaccinated.

ken: “Read the insert from pharma also -for a truly informed decision.”

That is regurgitated bovine excrement. Those are lawyer written bits to cover their posteriors. She has been given much better references to read.

As if…Ken has the reading comprehension skills and science education to understand the big words (more than one syllable), contained in the package inserts.

she says, “We’ve never had one patient get a serious, life-threatening vaccine-preventable illness because we gave them a vaccine at a later date.”

Because, by her definition, none of the vaccine-preventable diseases are “serious” or “life threatening”.

Just to fully recognize the other coast, I was driving down I95 near Newark or Trenton NJ and saw an NVIC billboard promoting anti-vax bullshit. Nearly wrecked the car yelling at it.

Just for you MikeMa…

https://www.facebook.com/national.vaccine.information.center/posts/10151936289557931

Scroll down to see this post. Holy Sh!t are the chiros raising money for Wakefield’s “research”…or to support his lush lifestyle?

“Mindy Allen Judd Hannah, he is working on it. He is just mastering his research, so we will have to give him some time. What he shared with us was so amazing that in about 15 minutes a group of about 300 Chiropractors raised $50,000 to help him in his research journey. Friend me if you would like because as I get information I will be sharing it:)
October 20, 2013 at 7:46pm”

“Dietary” therapies?
I recommend that for all my patients…starting with breast milk then progressing the what I call a modified Mediterranean diet.
Since the vast majority of my patients are under 21 no red wine.

Chris Hickie you have my vote for AAP president.

@Vicki

There are two evasions in
“Rather, she says, “We’ve never had one patient get a serious, life-threatening vaccine-preventable illness because we gave them a vaccine at a later date.”

It’s not just what counts as serious: it’s that it is literally true that her patients don’t get those diseases because she gave them a vaccine later. They get them because she didn’t give them the vaccine when she should have. If a child gets measles at age 2, giving them the MMR at age 3 doesn’t retroactively cause measles.

I think you have that wrong. What she meant by “later” was that the vaccine was given “later than it would usually be using the standard schedule”, and not as you have interpreted it “later on after getting the disease”.

Pediatricians should read the scientific literature. There are dozens of mainstream journal papers showing early adjuvanted vaccines are dangerous, and there are no cogent papers showing they are not. There are hundreds of papers about MMR, but nothing good about early aluminum.

In 2002 the National Vaccine Program Office (NVPO) convened an expert group to study safety issues with adjuvants in vaccines. Among their conclusions:

“pervasive uncertainty [from] missing data on pharmocokinetics and toxicities of aluminum injected into humans… There seems to be abundant data concerning risk levels for ingested aluminum, but scant data about risk levels for injected aluminum. The oral minimum risk level, for example, appears to be in the range of 2–60 mg/kg of aluminum per day but there are no comparable data for injected aluminum.”[1]

Since 2002 there is an extensive literature, and its all bad. For a detailed literature survey, with cites and links to over two dozen mainstream journal articles showing danger:
http://whyarethingsthisway.com/2014/03/08/example-1-pediatrician-belief-is-opposite-the-published-scientific-evidence-on-early-vaccine-safety/

Dingo199:

That is presumably how she meant us to interpret it. My point is that her statement literally says that no child got the disease because she gave them the vaccine; she doesn’t say that the lack of vaccination didn’t lead to the disease. I don’t know whether that’s a deliberate ambiguity, of course, but it would go along with anti-vaxers talking about childhood diseases including measles and pertussis as not being “serious.”

What we don’t have is a statement along the lines of “none of the children for whom we used the modified schedule got measles, mumps, rubella, or pertussis before they were fully vaccinated.” That, if true, would likely still be the result of herd immunity and simple luck, but it would be a stronger and less ambiguous statement.

http://www.plosone.org/article/info:doi%2F10.1371%2Fjournal.pone.0008382

Self-Organized Criticality Theory of Autoimmunity

“Repeated immunization with antigen causes systemic autoimmunity in mice otherwise not prone to spontaneous autoimmune diseases. Overstimulation of CD4+ T cells led to the development of autoantibody-inducing CD4+ T (aiCD4+ T) cell which had undergone T cell receptor (TCR) revision and was capable of inducing autoantibodies. The aiCD4+ T cell was induced by de novo TCR revision but not by cross-reaction, and subsequently overstimulated CD8+ T cells, driving them to become antigen-specific cytotoxic T lymphocytes (CTL). These CTLs could be further matured by antigen cross-presentation, after which they caused autoimmune tissue injury akin to systemic lupus erythematosus (SLE).”
Conclusions/Significance
“Systemic autoimmunity appears to be the inevitable consequence of over-stimulating the host’s immune ‘system’ by repeated immunization with antigen, to the levels that surpass system’s self-organized criticality.”

Anon,

We endure a lot of over-stimulation with actual viruses, bacteria and allergen already present in the atmosphere as compared to the minuscule dose of antigens in the vaccines.

Alain

@Anon: Gee, I guess it’s a good thing we don’t vaccinate kids every five days with the superantigen that causes toxic shock syndrome (Staphylococcal enterotoxin B.) Try reading for comprehension next time – this experiment does not resemble actual vaccination in any way.

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