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Blowing the antivaccine dog whistle again

braveheart-freedom

You remember Dr. Bob, don’t you?

I’m referring, of course, to Robert “Dr. Bob” Sears, the Capistrano Beach, CA pediatrician who’s arguably the most famous of the antivaccine pediatricians who have been spreading fear, uncertainty, and doubt (FUD) about vaccines. (Sorry, Dr. Jay, but, regardless of your being Jenny McCarthy’s son’s pediatrician, I’d bet that more people have heard of Dr. Bob than have heard of you.) Dr. Bob has achieved this fame/notoriety based on his book, The Vaccine Book: Making the Right Decision for your Child, which is chock full of exaggerations about the dangers of vaccination and advocates a “delayed” vaccine schedule that is backed up by no scientific evidence. Dr. Bob has basically been cashing in on fear for a long time.

Given that the epicenter of the Disneyland measles outbreak (i.e., Disneyland) and other recent measles outbreaks is uncomfortably close to Dr. Bob’s practice, he’s been feeling the heat lately. Beginning about a year ago during an earlier measles outbreak he started lashing out on social media at the parents of his patients who, quite understandably concerned about the measles outbreak, were calling his office. It began last March, when he downplayed the risk of the measles and told his patients’ parents, “Measles will never go away – it’s always going to be a very small risk. If you aren’t comfortable with that, get the vaccine. If you don’t want the vaccine, accept the risk.” Not long after that, Dr. Bob basically told his parents’ patients, “Don’t worry, be happy, and if you’re worrying and not happy get the vaccine. Just don’t bother me about it anymore. Oh, and you nasty pro-science vaccine supporters out there are big meanies for pointing out that Dr. Bob is irresponsible.” Then, beginning about a month ago, Dr. Bob went on an embarrassing tear on Facebook, condescendingly downplaying the risks of measles-related pneumonia with a jaunty, “Ya, you don’t want those things to happen, but they are treatable” and then whining about it when it was pointed out to him that at no time in his prior rant did he recommend getting vaccinated in the middle of an outbreak. It was the tried-and-untrue antivaccine trope that the measles isn’t dangerous.

There’s a term I coined reading Dr. Bob’s nonsense: The antivaccine dog whistle. In politics, a “dog whistle” refers to terminology that sounds benign to most people but in reality tells those holding objectionable viewpoints that the speaker is sympathetic to them (or even one of them). In other words, most people can’t “hear” the message, and only those for whom it’s intended can “hear” it, recognizing for what it is. Let’s just put it this way. Dr. Bob is very good at antivaccine dog whistling. (So is Rand Paul.) Now, in a “point-counterpoint” pair of editorials, Dr. Bob does it again. Now, don’t get me started on the idiocy of false balance that presenting point-counterpoint editorials represents about a scientific topic like vaccination. Unfortunately, lately false balance has been rising from the grave again. (Apparently, like Michael Myers or Jason Voorhees, it never dies.) Dr. Bob’s editorial is entitled Mandatory vaccination is not the answer to measles and it starts out with some serious dog whistling right out of the box:

Measles. It used to be just a disease. Now it’s become a banner under which politicians gather to threaten one of our most sacred rights – the right to give informed consent for medical treatment.

Whether you are for vaccines, against them, or neutral, allow me to ask this question: Is vaccination a medical treatment which should fall under the protection of informed consent, or does the government have the right to force them on every American?

See what I mean? Right out of the box, Dr. Bob is trying to reframe the debate over a bill being considered in the California legislature that would eliminate non-medical exemptions to school vaccine mandates. I realize that often the editorial writer doesn’t pick the title (usually the editor does), but the very title “mandatory vaccination” helps Dr. Bob frame the issue not as one of public health but rather personal freedom, just as Rand Paul did. Notice how obviously but nonetheless rather cleverly he does it, with a little rhetorical prestidigitation in which he’s saying, “You know, what’s important is not whether you’re for vaccines or antivaccines or “neutral” (whatever that means in this context), it’s that the government can’t take away our FREEDOM!

Of course, this is Dr. Bob, and there’s a whole lot of BS there. For one thing, what Dr. Bob advocates is not really “informed consent,” but rather what I like to call “misinformed consent,” wherein the severity of vaccine-preventable diseases and efficacy of vaccines are very much downplayed and the risks of vaccination exaggerated. It’s one reason why Dr. Bob was so opposed to California Bill AB 2109, because that bill required that real informed consent be given by parents requesting philosophical exemptions to California’s vaccine school vaccine mandate by requiring them to have a physician or other specified health care provider sign an attestation that the parents had been told the risks of not vaccinating.

The issue thus reframed, Dr. Bob launches into a list of the horrors of vaccination and the joy of measles. OK, I’m exaggerating, but not by a heck of a lot. It’s the same stuff Dr. Bob’s been spewing all along since the measles outbreaks began, antivaccine tropes about how the measles isn’t that bad and how vaccines are “dangerous,” all in the form of bullet points. For example:

  • About 2,000 severe reactions are reported to the CDC each year which result in prolonged hospitalization, permanent disability, or death. Most reactions aren’t even reported, so the true number may be even higher. Yet, because they can’t be proven, the medical community denies that they can happen.
  • Over $3 billion have been paid out to victims of vaccine reactions. Not $3 million. Not $30 million. Not even $300 million. But $3 billion. Are we paying that much money to victims of pretend reactions? I think not.

Dr. Bob should change that last sentence from “I think not” to “I don’t think,” as in “I don’t think,” a general statement of Dr. Bob’s intellectual prowess with respect to vaccines. I’m guessing that 2,000 severe reactions a year is probably referring to the > (VAERS) database, which, as regular readers here know, is an open database to which anyone can report any “reaction” to vaccination, whether it’s actually related to a vaccine or not. VAERS is not authoritative, and the adverse events are not generally verified. Indeed, as has been reported before, one pro-vaccine blogger, Dr. Jim Laidler, reported that the influenza vaccine turned him into the Incredible Hulk. True, the VAERS staff did contact this blogger and ask him about it, but, as he noted, if he had refused to remove the entry, it would still be there. Another pro-vaccine blogger, Kevin Leitch, verified that VAERS lets you enter basically anything by reporting that a vaccine had turned his daughter into Wonder Woman. That’s why VAERS is the antivaccinationist’s favorite database, and I like to refer to dubious correlations reported from VAERS as dumpster diving. Not surprisingly, antivaccine lawyers have made the database almost worthless as a source of information over the incidence of adverse events due to vaccines by encouraging their clients to enter all sorts of reports, in particular reports claiming that vaccines caused autism. Most recently, the Toronto Star completely misinterpreted how VAERS data should and shouldn’t be used in its utterly botched story falsely linking all sorts of horrific reactions to Gardasil.

Then Dr. Bob lists a bunch of bullet points, all consisting of tired antivaccine misinformation that was old when Dr. Bob was in medical school, including (my favorite) the claim that measles isn’t dangerous, a claim rebuked by medical science. For instance:

  • It has killed no one. It can kill about 1 person in every 1000 cases. Will someone die of measles in the United States in the years to come? Maybe. But it hasn’t killed anyone in the past 15 years or more.
  • The last time measles hit us hard was 25 years ago. Not last year, not this year, yet.
  • It’s measles, people. It’s not the plague. It’s not polio. It’s not Ebola. It’s measles. If the plague hits, let’s force everyone to vaccinate. But measles? Measles? We need something a lot more dangerous than that if we are going to rob each and every patient of the sacred right of informed consent.

So, measles is no big whoop, even though it can kill one out of a thousand children who get it. Of course, Dr. Bob neglects to note other, more common, complications of the measles that can be very serious, such as pneumonia (which he at least mentioned in his earlier rants) and he very much failed to mention how about one in four victims of this year’s measles outbreak have had to be hospitalized.

But notice the overall construction of Dr. Bob’s argument. To him, measles isn’t serious (which he explicitly states multiple times) and the vaccine is dangerous (which he implies with his listing of “severe complications” of vaccination in general); so to him it follows that “forcing” vaccination is an unacceptable affront to freedom:

Let’s stop panicking over what measles might do and calmly examine what it is doing. It has a small and intermittent presence in our country. It makes people sick, then they get over it. It has complications, but rarely so. Vaccination is important and protective. But it cannot be forced; a parent must give consent.

If you would rather make your own medical decisions within the sacred confines of the doctor/patient relationship, then let Sacramento know now. If you would rather give politicians the power to make medical decisions for you, then give them your support. But you better hurry; the outbreak is winding down, and so is the fear. Give them the power before it’s too late. I’m sure they’ll make plenty of other wise medical decisions for you in the years to come.

Rand Paul couldn’t have said it better. Do you hear the dog whistle? Vaccine “choice” is freedom for parents, the health of their children and yours be damned.

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]

189 replies on “Blowing the antivaccine dog whistle again”

If his patients were actually “informed” about vaccines, he’d quickly lose them….conversely, if he came out and admitted vaccines were effective and necessary, he’d lose his patients too…..

So, he’s backed himself into a corner – he can’t change his mind or allow his patients to change their minds, because if that happened, he’s quickly go out of business.

@ Orac

his patients’ parents

I appreciate the precision of this.
Many forget that, while the parents foot the bill, it’s their children which are concerned by a pediatrician’s advice and actions.

It’s one thing to make questionable medical decisions for your own care; it’s a bit more concerning when you claim the right to do so for your children.
This issue is not just about “medical freedom”.

As for the right for “informed consent”, no-one here is against it, Mr Bob. On the contrary, we would love for your patients to get a lot more informed.
Funny how Bob Sears mention “2,000 severe reactions are reported to the CDC each year which result in prolonged hospitalization, permanent disability, or death.” but conveniently forget that contagious diseases like measles may have the same outcomes, and with a much higher risk.
I mean, 1 death by measles for 1000 cases, no big deal, eh?

If you don’t like measles vaccination, there’s an easy out:

Eradicate measles.

Granted you have to use vaccination to make that happen, but once it does, no one will ever need to get vaccinated for measles again.

Still trying to wrap my head around the idea of the personal-belief exemption that also incorporates a medical license authorization.

Another to the point, not just of the 1:1000 possible mortality rate, but to the suffering & cost of the 25% hospitalization/admittance rate (I guess you could add also the ER visit, because that’s not a trivial cost, anymore).

If the medical license signs off on the personal exemptions, without using an evidence-based medical reason, there should be some shared liability because of the disease spread causing preventable injury to others.

What’s the defense, vaccines are inherently bad (for everyone) ??

I guess the way the state protocol for personal exemption presented is that it doesn’t matter. There’s really not much oversight in certain states, even if that reasoning causes harm across state lines. I’m probably choir preaching, I guess.

I’m not so keen on forced medical, but there should be some oversight or shared responsibility when acting outside of evidence-based medicine.

I’d add that he’s also wrong when he claims that informed consent is violated by public health measures. it’s not. Your right to refuse a treatment does not mean there will be no consequences – that is in addition to the point about misinformation included above.

When I made my 2004 film about Andrew Wakefield, I interviewed the father of a girl in Ireland who died of SSPE following a measles outbreak.

Unfortunately, our director stayed in London and the person supervising the shoot didn’t remind everyone to turn off their cellphones. Thus, our TV audience didn’t see the girl’s father break down when describing the utter slow-to-die horror of that condition.

I hope there aren’t any cases of SSPE in the United States as the pool of measles-susceptible children and young adults grows year-by-year (as it will). I can’t imagine what it must be like to see your child die from an irreversible and untreatable neurologic condition.

But if there is to be even one such case, let it be a patient of Dr Bob’s, so that this smug profiteer can go to the hospital with the parents, hold their hands and tell them how very, very sorry he is when the machines are turned off.

And then I hope they sue the ass off him.

Brian, much as I would like to see Sears face the consequences of his execrable decision to embrace antivaccinationism, I think he is so arrogant that even if a patient of his died of SSPE, he would refuse to own it.

@Yvette

Same point I was going to make, but it’s even worse than that. In 2003 there were 2 deaths from measles. And if you search the National Vital Statistics System, it returns 10 reported measles-related deaths from 2000-2013.

Also, Bob shows his ignorance about infectious diseases in general. I’m more afraid of measles for this country than I am of plague (by which, I assume he’s referring to bubonic plague). You see, measles can be prevented, but not treated once infected. Plague doesn’t spread very well and is easily treatable with antibiotics without any serious sequelae. Now, if an antibiotic-resistant strain of plague evolved, then I might be more concerned about it. But for now, measles is by far a significantly greater threat to public health.

Okay, I may be slightly flip about plague, admittedly, but at least it can be treated and cured. Measles can’t.

Not to come off like a liberal white dickhead, but only ten deaths? Don’t deaths in the rest of the world count?

@ shay — I think the WHO has about 118K pediatric deaths per year for measles. Overall about 1.5 million pediatric due to vaccine-preventable diseases — which is about 15-17% of the overall mortality for pediatric.

There’s also a history trend graph you can get online, showing morbidity/mortality before the U.S. had a vaccine, and the effect of the vaccine. Basically telling us the disease process is not just exclusively a 2nd/3rd world sanitation problem.

Todd, that’s actually exactly what I was thinking too.

“You’re right, Dr Bob. Measles isn’t the plague. The plague is treatable. Measles isn’t.”

I mean, I think i’ts pretty scary that with even high rates of vaccine compliance, we still saw a hundred measles cases pop up in just a couple of weeks with this outbreak. That’s a testimony to how damn contagious this thing is — if you are not immune, you’re almost guaranteed to catch it if exposed.

Plague, meanwhile, has been endemic in parts of the US for a long time, yet actual cases (much less deaths) are rare.

Plague has a bad rap, but I think I know which I’m more concerned about.

@shay

Of course, but not to people like Dr. Bob or the other anti-vaccine people. Those hundreds of deaths worldwide, according to them, are not because measles is dangerous, but because those people didn’t have good nutrition. Or didn’t breast feed enough. And so on.

Considering there were only 1,243 cases from 2000 to 2013, 10 deaths is a lot. Certainly it’s more than we’d expect.

Remember, Hawaii’s native population was nearly driven to extinction by measles. They had plenty of exercise and good nutrition. What were they missing, then?

I have a plan to eradicate measles that does not involve vaccines.

Year 1: expose everyone on earth over age 2 to measles.
Year 2-5: repeat year 1
Year 6: expose all children to measles on their 2nd birthday.
Year 7-10: repeat year 6
Year 11: evaluate plan effectiveness. If possible, start managing only isolated clusters

Advantages to my plan:
– does not involve vaccines
– can be done with no scary needles

M-O’B, You can do the same thing with rabies. Should solve most (99.9%) of the ‘vaccine problem’ in a year.

Another to the point, not just of the 1:1000 possible mortality rate, but to the suffering & cost of the 25% hospitalization/admittance rate

I haven’t seen much discussion of the economic cost of a measles outbreak vs the cost of vaccination.

We can estimate what the human cost, i.e. death/disability, might be but, what would the economic cost be of a couple of million U.S. kids coming down with measles every couple of years or so as opposed to the cost of vaccination?

I realize that discussing the economic cost associated with a measles epidemic may seem rather crass however, it should be considered in respect of the “benign” nature of measles portrayed by the Dr. Bob types.

Oh if only Roald Dahl were still alive! He was such a great imaginative writer that I think he would use words to destroy the Dr Bob’s of this world. Possibly even better than Orac himself!!

But it hasn’t killed anyone in the past 15 years or more.

As ohters have pointed out, this isn’t quite accurate, but let’s for the sake of discussion assume that it is and think about why this might be the case.

Could it just possibly have something to do with the fact that we started rotuinely vaccinating children against measles more than15 years ago?

MarkN – True that – with rabies, we might not have to go past the second year. Of course, that would not eradicate rabies (unless we exposed every mammal).

Informed Consent soumds like a great idea. Inform me whenever I might get too close to a VPD vector; inform my kids likewise.

We can do this by two simple steps:

(a) require each person who is voluntarily unvaccinated to wear, front and back, a large marker: say a 6-inch scarlett “M” for no-MMR, “P” for no-DTP, “C” for no-chicken pox, etc.

(b) require each such potential vector to leave a notice in each place they’ve been, for the dwell time of infectiousness: two hours or so for no-MMR, for instance. The appropriate form of this notice is a flagman, with the scarlet letter. The flagman can leave, and rejoin the vector after time is up. This will allow the notice to be renewed if, for example, the proprietor of the establishment takes exception to a two-hour void in new customers.
The requirements would not apply to survivors of the VPD.
Thus, I have the opportunity for Informed Consent before I enter a place where I might be exposed to a VPD with my too-young-to-vaccinate greatgrandkid. You have that same Informed Consent.

@ M-O’B — whatever I can do to improve your efficiency rating.
at least we’d know if the vaccine was worth “the risk.”

@Bill Price

Intriguing idea, though I suspect that anti-vaxxers may not be very welcoming of that. Freedumb, and all that, y’know.

@ Bill Price:

I appreciate the creativity of your Hawthornian solution but in SoCal it might possibly become a *de rigeuer* fashion statement in some quarters.

@DGR #19
I don’t think it’s crass at all to talk about the economics. Ultimately many decisions in health come down to money. If you spend research dollars one place you can’t in another. If you pay for some treatments you can’t afford others. If big pharmas lower their drug prices Orac can’t afford a new Ivory back scratcher.

The cost / benefit of a vaccination program is very clear cut. It seems a perfectly reasonable to state it.

Another example popped up recently here:
http://www.bbc.co.uk/news/health-31507861

If Dr Bob was in favor of informed consent and individuals making “medical decisions within the sacred confines of the doctor/patient relationship,” he would have supported AB 2109, which required exactly this.

He did not: he publicly opposed it.

America’s parents, and in particular those of us in California, need to be reminded of that.

Dr. Jay Gordon also had a “problem” with California AB 2109. In fact, he went on a local radio program on March 30, 2012 to disparage the bill (since scrubbed from his website). He also consulted an attorney to find out about advising his patient’s parents about the pros and cons of providing the first MMR II vaccine between 12-15 months of age (his recommendations used to be to get the first MMR II vaccine at 4-6 years of age, for school entry, now he claims he recommends the first MMR II at age three). He’s also bragging now (since the start of the measles Disneyland Parks outbreak) that “he provided 35 MMR II vaccines in one day…more MMR vaccines than he provided during January-December 2014”.

From Dr. Sears “opinion” published on the O.C. Register….

“….Last year’s 640 cases were an anomaly because over 400 occurred in one Amish community in New York and over 100 cases hit an unvaccinated church community in Texas. But for the rest of highly-vaccinated America, last year’s measles was business as usual. This year we are off to a tough start, but it’s slowing down….”

I don’t seem to recall major outbreaks in an Amish community in New York State or in a Texas religious community during 2014.

Dr. Bob Sears…dyslexic or a liar?

If the plague hits, let’s force everyone to vaccinate

So public health does trump personal preferences? Dr Sears seems to have accepted the principle and now is just haggling over the price.
I am puzzled by his enthusiasm for the Yersinia pestis vaccine when its efficacy and safety remain unknown and untested.

This just came up on the New Republic site:

http://www.newrepublic.com/article/121103/anti-vaccinators-unconvinced-science-showing-no-autism-link?utm_source=Sailthru&utm_medium=email&utm_term=TNR%20Daily%20Newsletter&utm_campaign=Daily%20Newsletter%202%2F20%2F15

I don’t recognize the name of the author, who doesn’t appear to be a New Republic regular. The article suggests taking a gentle approach towards anti-vaccine people, while presenting data about large increases in autism. There is a rebuttal of the vaccines vs. autism argument, but not a very good one.

I think that someone should contact the New Republic and request an invited article that treats the subject more seriously.

I suppose that I am one of the few who has actually received a plague immunization (i was visiting prairie dog towns while a biology grad student) and it is not fun. I don’t know whether it was the killed plague bacilli or the phenol preservative, but it made for one sore deltoid muscle..

over 400 occurred in one Amish community in New York

OK, 383 cases in Ohio, but NEAR ENOUGH.

Sears’ point is that all previous outbreaks of measles among under-vaccinated populations don’t count because they were outbreaks among under-vaccinated populations.

herr doctor bimler @39

Sears’ point is that all previous outbreaks of measles among under-vaccinated populations don’t count because they were outbreaks among under-vaccinated populations.

And then he can claim this one doesn’t count either, since it’s also among an under-vaccinated population, at least in California: http://www.cdph.ca.gov/HealthInfo/discond/Documents/Measles_update_2_-_18_-_2015_public.pdf

Among measles cases for whom we have vaccination documentation, 53 were unvaccinated and 15 had 1 or more doses of MMR vaccine.

That’s at least 45% of the total 119 cases in the state.

And why are they unvaccinated, Dr Bob? Because you keep telling them that it’s OK.

“15 had 1 or more doses of MMR vaccine.”

I do wish they would break that down into those who had received all doses and those who hadn’t.

Roadstergal @41

I do wish they would break that down into those who had received all doses and those who hadn’t.

The CDC report ( http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6406a5.htm?s_cid=mm6406a5_w ) has that information using Feb 11th CA numbers:

Among the 110 California patients, 49 (45%) were unvaccinated; five (5%) had 1 dose of measles-containing vaccine, seven (6%) had 2 doses, one (1%) had 3 doses, 47 (43%) had unknown or undocumented vaccination status

And then he can claim this one doesn’t count either, since it’s also among an under-vaccinated population, at least in California

Sears’ goal, I think, is to reassure his readers that measles outbreaks only happen to outgroups — Amish, southern snakehandlers — and pose no threat to *normal* people.

Is it a dog whistle when you publish a newspaper in a kennel? Man, that editorial hits EVERY OC-GOP talking point. Orac said it was point-counterpoint thing. I didn’t see a counterpoint, so I looked back a few days in the register and found:
http://tinyurl.com/mfxvnl6

This is a surprisingly lucid debunking of the autism scare by arch-conservative columnist Thomas Sowell. Sowell is a dedicated Friedmanite/Randian free market libertarian guru. Buddies with El Rushbo, he says Limbaugh is the onlt radio he listens to.

Some say the decision whether to vaccinate should be the parents’ choice. That would be fine if their child would live isolated from other children. But that is impossible.

For a guy like Sowell to to take that position is a really big deal. This is a wedge between the libertarians and the ‘parents rights’ crowd. And it’s admits the libertarian principles require vigorous government protection. Your rights DO stop at my front door, so maybe we need practical means to keep asshates out of my yard without me having to go buy a Bushmaster. Like maybe making your damn kid get a vaccination so the rest of the kids don’t get measles germs sneezed over their transoms.

So how does Sowell play in the OC? He’s a syndicated columnist the Register carries for lassiez faire economics and bashing of Affirmative Action. Since publishing his column, the Register has run two Op-Eds from in house blowing 76 dog whistles against Pan’s initiative. Dr. Bob isn’t a guest columnist at the Register, he’s a “contributing writer”. The there’s this by Adam Summers, “Staff Columnist “:
tinyurl.com/lenmw5y

The headline (remove sharp objects):
“A pox on mandatory vaccinations”

False balance my ass. This paper is screaming anti-vax.

Chemmomo – they do try to find out who is vaccinated and who isn’t but they require proof to be provided and don’t just accept the cases’ word that they are vaccinated. Most people will say they they’re sure they had their shots, but no records exist. It is a grueling PH process. Plus the unvaccinated have now been instructed to lie to PH investigators and claim they were in fact vaccinated. Gotta love it.

DGR – the economics discussion is entirely valid. In a time of rapidly dwindling PH dollars the bills being racked up during these investigations mounts rapidly. That is the direct cost to PH, but it also hits the hospitals too. Imagine the hit they take to track down all of the patients in a waiting room to find out who is vaccinated, to offer vaccine to those exposed, to verify vaccination status of staff, to lose staff members to voluntary quarantine, etc. Plus, parents and families bear a huge cost. It is no picnic (as some have pointed out on social media) to be informed your infant is exposed and quarantined for three weeks. Particularly if you and your spouse work. Who is staying home with baby? I guarantee most workers don’t have three weeks of paid leave saved up to use, so the household income takes a hit. Or in some circumstances they parent may lose their job. Or be forced to lie and send the baby to daycare (perhaps unlicensed) so they can afford to pay rent. These are the challenges faced and these costs hurt everybody in the community. It should be talked about because explaining that to even some die hard health freedom idiots can cause them to think about the monetary damages that are incurred by the unvaccinated. I like freedom as much as anyone but as the old saying goes, your freedom to swing your fist ends at the tip of my nose.

@ Bob #35
The New Republic article is serious, it’s just dull. It’s what you’d expect from TNR.

The most annoying part to me was the end, where the author fumbled the whole ‘be nice to anti-vaxers’ thing. Sbm critics share some blame here, but journlists ought to fact-check:
• There are very few hard core ANTI-vaxers. They are very loud. There are not enough of them to cause a measles outbreak. They will never listen to reason. Ever. You do not try to persuade them. The ONLY consideration you make when addressing them is how the exchange will be viewed by other people who may be listening in.
• All the data show the loss of heard immunity and the outbreak are a consequence of NON-vaxers. They are not necessarily committed partisans. Many if not most of them can persuaded. They do not have the same psychology as the anti-vaxers.
• There may be no worse strategy than identifying the NON-vaxers and the ANY-vaxers. Treating them as unifed group pushes the former toward the later. The point should be to separate the two. Yes, Mr and Ms. Non, we understand you are decent people, but take a close look at where these ideas are coming from — con men and conspiracy wackos. They are the opposite of you. They are selfish, blind, uncaring of others, unscrupulous and will stop at nothing to advance their batty jihad. It’s not our contempt they deserve, but yours. For they have twisted your good instincts into real harm for innocent kids. Read Roald Dahl’s letter. You’ll understand.

And there’s yet another cite of Nyhan. I can’t go into details hear, but the Nyhan study is just awful, proves absolutely nothing, and shouldn’t be relied on for anything.

To echo all the previous points in response to DGR. Yes the economics case is perfectly valid.

Discussing the economic cost IS crass if that’s what you privilege and that’s all you talk about. This is not a topic for a Freakanomics piece. Wrap the economic cost in the human cost going and coming.

Kiiri hits some of the more immediate human costs above. Phlebas makes the wider case: “If you pay for some treatments you can’t afford others.” Where’s that money to treat all the measles cases going to come from? The same fixed pool of resources. What happens to people who can’t get those resources now devoted to measles? They get sick. They die.

Sears’ goal, I think, is to reassure his readers that measles outbreaks only happen to outgroups — Amish, southern snakehandlers — and pose no threat to *normal* people.

But that strategy is no longer viable, because the current measles outbreak is occurring among “normal” people who have not been vaccinated. If Dr. Bob is persisting in that strategy, he’s even dumber than I thought.

Gray Falcon

Remember, Hawaii’s native population was nearly driven to extinction by measles. They had plenty of exercise and good nutrition. What were they missing, then?

MLM supplement marketing schemes.

Fergus

Oh if only Roald Dahl were still alive! He was such a great imaginative writer that I think he would use words to destroy the Dr Bob’s of this world. Possibly even better than Orac himself!!

It would definitely be shorter at least.

But it hasn’t killed anyone in the past 15 years or more.

Quite apart from being untrue, that’s not exactly an obviously self-justifying cut-off point, is it?

I mean, why the year 2000?

We need something a lot more dangerous than that if we are going to rob each and every patient of the sacred right of informed consent.

I believe that particular right is secular. Actually.

Plus the unvaccinated have now been instructed to lie to PH investigators and claim they were in fact vaccinated. Gotta love it.

Back when I patronized MDC, the rationalization for lying in, oh, the ED, was “they’ve been vaccinated on schedule” – my schedule!.

On the public-health front, though, I distinctly recall people with exemptions that would be jeopardized by selective vaccination being advised to cross state lines and pay cash in order to avoid being captured by a state registry. I suppose that whether this group has any chance of being a significant noise component would have to be looked at state-by-state.

Yes indeed, the measles genotype identified in the Disneyland Parks outbreak is the B 3 genotype, not the A strain:

http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6406a5.htm?s_cid=mm6406a5_w#Fig

“….The source of the initial Disney theme park exposure has not been identified. Specimens from 30 California patients were genotyped; all were measles genotype B3, which has caused a large outbreak recently in the Philippines, but has also been detected in at least 14 countries and at least six U.S. states in the last 6 months (1)….”

@#52

Suzanne Humphries did not exactly knock herself out looking for an answer to the question she was raising, btw.

The type was reported as B3 a month ago.

NEVER FORGET: measles outbreak of 2013!
*All 58 confirmed cases were anti-vaxxers!
*Patient “0” picked up genotype D8 measles from LONDON, England.
*No deaths
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6236a5.htm

Here’s what measles vaccine DEVELOPER, Dr. Samuel Katz, had to say about this outbreak:

“”The last surviving member of the team of researchers that developed the measles vaccine 50 years ago believes it is “ludicrous,” however, to get upset over the Center for Disease Control’s December 5 announcement that there were 175 cases of the disease in the United States in 2013, a tripling of the annual average.

Notably, 58 of those cases were among Hasidic Jews in the Brooklyn’s Boro Park and Williamsburg neighborhoods. It was the largest outbreak of measles in the US since 1996.

“It’s ALL SO RELATIVE,” said Katz, who was HONORED last week by the CDC. “True, there were 175 cases in the US so far this year, but there are 3-4 million cases a year worldwide. In Western Europe alone there are 25,000 cases per year.””
http://www.timesofisrael.com/measles-vaccine-developer-warns-jewish-anti-vaxxers/
Ultra-Orthodox communities refusing the 50-year-old vaccine were linked to a third of US measles cases last year
BY RENEE GHERT-ZAND December 11, 2013, 12:16 pm

Ken is another great example of how the anti-vax show their complete ignorance of immunology……how do they expect to claim that they’ve “done their research” if they don’t even understand the difference in genotype vs. serotype?

Isn’t it disturbing that a big part of the anti measles vaccine involves devaluating deaths by the numbers they occur in, and doing so seemingly arbitrarily? If that single death had occurred to a loved one, they would probably have a different view. I don’t understand how 1 versus 100 versus 1000 deaths is any different. They are all human lives, and it is hard to see how people draw those lines.

It is a crap-shoot….if a child is infected & lacks access to basic medical care, then the odds of suffering a severe complication increases dramatically, as does the chance of death.

The “privileged” anti-vaxers forget that poverty is still extremely prevalent here in the States & that access to medical care is not universal…..

Isn’t it disturbing that a big part of the anti measles vaccine involves devaluating deaths by the numbers they occur in, and doing so seemingly arbitrarily? If that single death had occurred to a loved one, they would probably have a different view.

That’s a grim, sad truth for them, poor things. Because, as that LA Times article I posted notes:

Of the 63 measles patients in California with vaccination records, 49 were completely unvaccinated. Twenty-eight were intentionally unvaccinated due to a parent’s personal beliefs, one was on an “alternative plan for vaccination,” and 12 were too young to be immunized, state officials said. Officials did not disclose other reasons patients were not vaccinated.

It’s kind of like watching a car crash in slow motion.

@Lawrence —

It is a crap-shoot….if a child is infected & lacks access to basic medical care, then the odds of suffering a severe complication increases dramatically, as does the chance of death.

The “privileged” anti-vaxers forget that poverty is still extremely prevalent here in the States & that access to medical care is not universal…..

That’s sadly, grimly true, too. But the thing is: Privilege isn’t necessarily a guarantee. (As I’m sure you know; I’m just clarifying.)

Honestly, if I could figure out how to protect haters from themselves, I’d die a happy woman. The lack of a solution to that problem is the cause of all the wars in the world.

And yes, Toto “The Rock.” I do mean you. You’re only hurting yourself. Please stop.

(@R. Mutt — Love your nym, btw.)

And yes, Toto “The Rock.” I do mean you. You’re only hurting yourself.

^^By which I meant: “The only thing you’re accomplishing is damaging to you.”

Because you might also be hurting others, obviously. That just wasn’t the point I was making.

More epistles from Schadenfreudesville;

Dan Olmsted, today:

” it might be time for the vaccine injury deniers to get out of the marketplace of ideas, because everybody, and I do mean everybody, is convinced that they have the expertise and standing to tell the rest of us…

“Zuckerberg … is way too powerful and uninformed for this type of cheap and easy commentary…

” Who’s studying at the University of Google now?

“Snap out of it, fellow journalists, you’re laying down a personal track record that will come back to haunt you..”

AND there’s even more. He mentions Rolling Stone.

The world must be a blissful place for those who are not equipped with self-awareness.

I’m convinced that the live entirely in an alternate reality universe (of their own creation) – so all of this just makes sense to them & they can’t understand how anyone would disagree with them……

Re: comments 52 – 59, I know its been mentioned before, but I just wanted to add that, while the vaccine and wild type measles are different genotypes, there is only one measles serotype, which is why the vaccine is still protective against wild type measles of different genotypes.

Yup, Olmsted and crew inhabit an alternate reality. It’s constructed from extreme cherry-picking and just making sh!t up, much like the right-wing popular culture bubble, which is why the two are drawing ever more together.

The question is, how many non-vaxers are in that bubble? 37 of 63 measles patients were of age, yet not vaxed, 28 with PBEs. Disneyland being in the OC, and the disease having spread to other low-vax-rate pockets, probably more than a few. But we really don’t know, I think, how far a parent had to be into the bubble pre-Disneyland to seek a PBE.

Most of the public probably inhabit some kind of mixed and contradictory reality-space, I’d guess most non-vaxer realities are mixed and contradictory on this subject. But I’d guess a lot of parents who had not-vaxed, or still have-not-yet vaxed would not want to be in that bubble, and would even find it repulsive if they took a good look inside.

Thus, in the interest of public health, imho it’s crucial to:
1) observe the distinction of who is and isn’t in the bubble,
2) realize failure to vax does NOT necessarily mean parents are in the bubble
3) critique the bubble in ways that separate the out-of-bubble non-vaxers from the in-the-bubble anti-vaxers, driving a wedge between them rather than pushing them together
4) which means centering the attack on the bubble on values likely to appeal to the out-of-bubble non-vaxers.

Which, dear minions, are not matters of scientific truth. Science is the back-up, the check on the validity of a pro-vax reality. But the core is n comments #64 – #67. Disturbing devaluation of others death and suffering, a grim crap-shoot with dice loaded for social and economic privilege, a slow-motion pile-up on an iced-over freeway, sad because it didn’t have to happen and because the chain reaction has only just started and we see the line of drivers in the bumper-to-bumper traffic slamming on their breaks and going into the unstoppable high speed skids into the vehicles in front of them.

Put ‘truth’ in the back seat; ‘pain’ ‘injustice’ ‘lies’ and ‘scams’ (Dr. Bob’s handsome profits as a public health menace) in the front.
_____

BTW, in a real-life skid, take your foot of the brake. Pump ’em if you can, but the more you brake the less you can steer, and your usually your only option is to choose what you steer into.
_____

Trivia question: The signature “R. Mutt” first appeared on what famous work of art?

AND there’s even more. He mentions Rolling Stone.

And demonstrates that he has a poor grasp of the Decalogue.

Infamous history of a famous “pro-vaxxer”……before vaccines.

“James deWolf built a large warehouse on Thames Street made of heavy timbers and large stone blocks which had been imported from Africa as ballast. Here he loaded and unloaded his slavers and privateers. Not far from the warehouse was his large distillery which was capable of converting 300 gallons of molasses to 250 gallons of rum per day at the cost of about ten cents per gallon. In time, James deWolf became Bristol’s most honored and respected man, but this was not the case in 1790. At that time a Federal Grand Jury, in its first session, returned an indictment of murder for jettisoning a female slave who fell victim to small pox. The indictment read:

…James deWolf, not having the fear of God before his eyes, but being moved and seduced by the instigation of the Devil …did feloniously, willfully and of his malice aforethought, with his hands clinch and seize in and upon the body of said Negro woman …and did push, cast and throw her from out of said vessel into the Sea and waters of the Ocean, whereupon she then and there instantly sank, drownded and died.”
http://www.warwickhistory.com/index.php?option=com_content&view=article&id=262:james-dewolf-one-of-the-qgreat-folkq-of-bristol&catid=56:rogues-and-knaves&Itemid=125

Don’t you know? These diseases were brought from Africa with the slave trade. It is the judgement of God. In general, the early slave traders and plantation owners did not have long lives. The practice of inoculation against smallpox came through Cotton Mather’s African slave:

“SLAVES AND SMALLPOX”
http://www.uh.edu/engines/epi518.htm

This was the beginning of our now out-of-control Big Pharma industry.
The vaccines of today carry just as much risk of harm as did the early “inoculation”. Today the risk comes from various vaccine additives coupled with multi-dosing at a very young age, as well as waning immunity. But remember, THE RISK OF HARM OR DEATH FROM SMALL POX bears no resemblance to the relatively benign risk from the so-called “vaccine-preventable” disease. After all, it is all about RISK. For many, the risk of long-term vaccine injury today is greater than risk of injury or death from the current staple of wild-viruses. The goal of eradication is a FALSE one.

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