When the outbreaks occur, they’ll start in California, 2014 edition

measles

Countering the misinformation regularly promulgated by the antivaccine movement, be it antivaccinationists who are completely off the deep end, like Robert F. Kennedy, Jr., the crew at the antivaccine crank blog Age of Autism, or that epitome of the Dunning-Kruger effect mixed with an annoying self-absorption and coffee klatch vibe (that is when it’s not a wine party), The Thinking Moms’ Revolution, or from seemingly more “reasonable” antivaccine advocates like pediatricians Robert “Dr. Bob” Sears or Dr. Jay Gordon. The reason is simple. Vaccines save lives. They prevent children from suffering from diseases that once devastated communities all across this nation. As a skeptic, I also find the misinformation, tropes, and pseudoscience regularly used by the antivaccine movement to justify their brand of dangerous quackery useful for general skeptical education because they are so full of common misuses of science and evidence, defects in thinking, and, of course, logical fallacies.

These sorts of issues were on full display a month ago when antivaccine guru Andrew Wakefield and former biochemical engineer turned incompetent vaccine epidemiologist Brian Hooker claimed that they had evidence that the CDC had “covered up” evidence that the MMR vaccine increased the risk of autism in certain African American boys by more than three-fold, when in reality he had done nothing more than provide more evidence that Andrew Wakefield was wrong. None of that stopped the ever-intrepid Drinking Thinking Drinking Moms from organizing “Twitter parties” and the antivaccine crankosphere turning the crazy up to 11 because they thought they had “smoking gun” evidence that the central conspiracy of the antivaccine movement, namely that the CDC knows vaccines cause autism and has been hiding data proving it, had been validated and mainstream news, apparently recognizing cranks when they saw them, was not biting despite being begged to cover the story.

Unfortunately, this mindset and these people have real effects. I was reminded of that three weeks ago by a story published in The Hollywood Reporter that noted that communities of the well-off on the west side of Los Angeles had vaccination rates lower than many Third World countries. I had meant to write about this particular article, but, blogging being what it is, somehow I never got around to it. Besides, Steve Novella took it on. However, blogging being what it is and news being what it is, not infrequently another chance presents itself. This time, that second chance came in the form of a CNN report, LA: Where the Rich Don’t Vaccinate:

It’s a story based on the Hollywood Reporter article, and it’s disturbing. Also, our old buddy a Santa Monica pediatrician who caters specifically to those vaccine-fearing west siders in Santa Monica, “Dr. Jay” Gordon, makes an appearance in which he inadvertently reveals the selfish mindset of the antivaccine movement coupled with a denial of the very concept of herd immunity that’s utterly shocking coming from a pediatrician. It just goes to show that, even though Dr. Jay seems to have learned a little bit from his days of mindlessly repeating Jenny McCarthy’s “toxins” gambit about formaldehyde (which he appears no longer to do), he still hasn’t learned anything new about vaccines, other than perhaps more sophisticated ways to spread the antivaccine message while maintaining plausible deniability that he is not “antivaccine.” Make no mistake. He is antivaccine to the core, given the way he likes to compare vaccine companies to tobacco companies.

First, let’s see the wave that Dr. Jay and Dr. Bob and other practitioners and irresponsible pediatricians are riding in California. It’s a wave that’s already started to result in what public health officials have long feared as a result of antivaccine beliefs: A resurgence of certain vaccine-preventable diseases in California, such as pertussis and measles. Worse, pediatricians like Dr. Bob and Dr. Jay take no responsibility for the mess they’ve helped cause. Dr. Bob wrote a two famous Facebook posts in essence berating his patients’ parents for bugging him about whether or not they should get the MMR vaccine for their children and their (*to him) excessive concern about measles outbreaks near his Capistrano Beach office. It was a breathless bit of refusing to take any responsibility, consistent with his history of refusing to take responsibility for declining vaccination rates even though he admits that half of his practice is completely unvaccinated.

So let’s look at what’s going on in LA with respect to vaccination rates, and then we’ll come back to Dr. Jay. According to the CNN story, vaccination rates in some areas, particularly Waldorf Schools are much lower than vaccination rates in Liberia, for instance. The Hollywood Times story puts it into more detail by recording the level of personal belief exemptions (PBEs) at various schools, you know the ability of parents to opt out of school vaccine mandates because of basically any belief at all:

The number of PBEs being filed is scary. The region stretching from Malibu south to Marina del Rey and inland as far as La Cienega Boulevard (and including Santa Monica, Pacific Palisades, Brentwood, West Hollywood and Beverly Hills) averaged a 9.1 percent PBE level among preschoolers for the 2013-14 school year — a 26 percent jump from two years earlier. By comparison, L.A. County at large measured 2.2 percent in that period. Many preschools in this area spiked far higher, including Kabbalah Children’s Academy in Beverly Hills (57 percent) and the Waldorf Early Childhood Center in Santa Monica (68 percent). According to World Health Organization data, such numbers are in line with immunization rates in developing countries like Chad and South Sudan. These two schools aren’t outliers; dozens more — including Seven Arrows, Turning Point and Calvary Christian — report PBE levels that are five times the county average. And THR has found that administrators at many of these facilities are hardly alarmed.

It’s no secret that anti-vaccine sentiments run high on the Westside. But the data reveals a community where ambiguous fears about the perceived threat of immunization have in fact caused a very real threat. This is a hard topic to discuss, especially here in Hollywood. It hinges on parental choices that directly impact your own children and other parents’ kids, too — a dinner-party land mine to be avoided at all costs. Few parents would speak to THR on the record about their decisions for fear of the backlash.

One thing I noted about this story is the acknowledgement of something I’ve long known. It’s the vaccines. Period. It’s pointed out that, even though Andrew Wakefield’s claim that the MMR causes autism has been thoroughly discredited to the point where even most antivaccine or vaccine-averse parents not in the echo chamber of AoA or TMR don’t take it that seriously, concern has simply shifted:

Despite the debunking, public concerns remain strong. According to more than a dozen area pediatricians and infectious disease specialists THR spoke to, most vaccine-wary parents have abandoned autism concerns for a diffuse constellation of unproven anxieties, from allergies and asthma to eczema and seizures. “If I talk to most of my patients, who are very savvy by the way, they will say they know someone directly or indirectly who felt that their child has not been the same since the vaccine,” says Dr. Lauren Feder, whose pediatrics practice, popular with those leery of immunizations, is based just south of L.A.’s Miracle Mile.

Because, no matter what, it is always, always, always about the vaccines. But why the rich, privileged west siders of LA (and elsewhere)? Why is it that, this time around, it’s more about the well-to-do? As Steve Novella pointed out, a lot of it has to do with power and privilege, coupled with a sense of entitlement. I’d add that there’s also a huge helping of Dunning-Kruger effect, in which such people, catered to and able to buy almost anything they want all their lives, think that with a few hours studying at Google University they know enough to be able to reject the findings of science and the recommendations of physicians, scientists, and public health officials who have spent their lives studying infectious disease and vaccines. It’s the arrogance of ignorance, and who’s more arrogant than the privileged professionals of West Hollywood? The Hollywood Reporter also points out that many of these parents pay cash for concierge practices that don’t take insurance, making them feel as though they can demand of their physicians things that others, whose medical expenses are paid through health insurance or other plans, would not feel entitled to demand, such as no vaccines or “personalized” vaccine schedules designed to cater to the irrational fears instilled in concerned parents by the antivaccine movement. These parents tend to be of the “crunchy” type, wanting what’s “natural” and being prone to falling for the naturalistic fallacy, in which what is considered to be “natural” (whatever that means in practice) is automatically good—or at least better—than what is not.

Not surprisingly, Dr. Jay shows up in both the CNN report and the Hollywood Reporter article, spewing his usual and opining that “parents have a right to participate in the discussion, to decide when and how their children are vaccinated,” as if anyone in public health says that they should not. In the CNN report, Dr. Jay says:

Reporter: Isn’t it [not vaccinating] inherently selfish?

Gordon: Yes, I’m encouraging parents to make a decision that they feel is best for their children while considering public health.

Reporter: Do you feel you’re endangering the public health?

Gordon: No. If vaccines work and everyone else is vaccinated, then there’s no risk to them.

Dr. Jay contradicts himself. He concedes that not vaccinating is inherently selfish but then claims that he’s encouraging parents to do that selfish thing while considering public health. It’s a contradiction that he can’t resolve except by doing what antivaccine advocates everywhere do: Deny that herd immunity exists. So, in an astonishingly ignorant statement for a pediatrician to make, he invokes the old antivaccine trope that “if vaccines work and you’re vaccinated” there’s no risk to you. Of course, given the sloppy way Dr. Jay has constructed his sentence, it could also be reasonable interpreted as saying that if vaccines work and everyone else is vaccinated (i.e., those non-privileged suckers who aren’t as savvy as my cash-paying patients) my patients have nothing to worry about. I know he probably meant the former, which is utterly wrong, but the latter is not an unreasonable interpretation, either. Either way, what about children who for medical reasons can’t be vaccinated? Screw ’em! Dr. Jay is a nice guy and would be appalled that I’m attributing that attitude to him, but what other attitude is there to attribute to him? It’s right there on video! He doesn’t give a rodent’s posterior about children with cancer, for example, his protestations about “public health” notwithstanding.

He also claims that the more information you have about vaccines the less likely you are to follow CDC recommendations, which he intentionally represents in a fashion as scary as possible as the “six vaccines at a time” schedule. Of course, if the information you’re getting is the sort of antivaccine nonsense spouted by vaccine “skeptic” pediatricians like Dr. Jay and Dr. Bob and you don’t have the background in science and skepticism to recognize those arguments for the BS they are, then, yes, it’s reasonable to be afraid. It’s a fear based in ignorance and misinformation, but if all you are hearing are ignorance and misinformation it’s not unreasonable to be afraid. What is needed are science, facts, and reason to counter that misinformation and assuage the fear. Gordon also makes the astounding admission that none of his patients vaccinate according to the CDC schedule. I’m sorry. I know Dr. Jay likes to think of himself as a nice guy trying to do what’s best for his patients and will likely be highly offended when I say this, but that is medical malpractice in my book.

There’s little doubt in my mind that Dr. Jay and Dr. Bob and other crunchy vaccine “skeptic” pediatricians are doing nothing more than clever marketing, capitalizing on the fears instilled in their wealthy, privileged clientele by antivaccine activists. Steve Novella put it quite well:

No amount of money or privilege can buy you better science. It is perhaps for this reason that some people choose “alternative” science. They think they are getting something better than the herd. Ultimately, however, this is just a cleverly marketed deception. In the case of alternative vaccine schedules, all they are buying is higher risk for their children for infectious and potentially serious diseases. Further, they are exporting this risk to others, perhaps with less privilege.

Exactly. Dr. Bob is even highly blatant about it, telling his nonvaccinating parents not to spread it around too much that they don’t vaccinated so that they can “hide in the herd,” taking advantage of herd immunity provided to them by those less privileged and less “savvy” parents who vaccinate their kids.

Yes, as I once said five years ago, when the outbreaks occur, they’ll start in California. Actually, they already have. We just don’t know how bad it’ll get yet.