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A highly misguided concern about California SB 277 and cracking down on nonmedical vaccine exemptions

It never ceases to amaze me how very smart people can miss some very obvious points. Now, as most of my readers know, I was at NECSS over the weekend. Because I was busy giving a talk, doing panels, and then enjoying other speakers’ talks, I wasn’t paying much attention to some of the issues that had consumed my blogging in the couple of weeks before NECSS. Also, as I mentioned here yesterday, science communication was a big issue as well, which is why I appreciated Julia Belluz’s suggestions for how the media should cover pseudoscience and quackery.

There was, however, one point where I didn’t entirely see eye-to-eye with her, and that was her concern about making martyrs of quacks like Andrew Wakefield with critical coverage. Consider today’s post a follow up on that idea, although it’s more a variation on the same theme. This time around, the complaint comes from Brendan Nyhan at the New York Times’ The Upshot in a post entitled Why California’s Approach to Tightening Vaccine Rules Has Potential to Backfire. Yes, I could could tell from the title that the content of this post would cause my back teeth to start grinding, and, predictably, it did. Oh, did it ever.

First, a little background. There’s a bill wending its way through the California legislature, starting in the Senate. It’s sponsored by State Senators Richard Pan and Ben Allen and only became possible in the wake of the recent Disneyland measles outbreak, which started, as its name implies, at Disneyland and spread all over the country, although most cases were in California. As a result of that outbreak, legislators in some states started getting a bit of backbone and have tried to curtail nonmedical exemptions to school vaccine mandates. Unfortunately, they failed in Oregon. They might succeed in California, because the bill, SB 277, would if passed eliminate nonmedical exemptions. Predictably, the antivaccine movement has reacted to this as if it were mandating a government takeover by fascistic jackbooted thugs, who would immediately dispatch their Vaccine Gestapo to bust down doors and stick big scary needles into their children while destroying, Truth, Justice, Freedom, and the American Way. Indeed, right before I left for NECSS, Robert F. Kennedy, Jr. himself was in the state throwing around Holocaust analogies as though his brain had been chomped by the Hitler Zombie. (Remember him?)

So what irritated my about Nyhan’s post? Let’s take a look:

In a number of states, parents are allowed to opt out of legal requirements to have their children vaccinated before entering school by claiming a “personal belief” or “philosophical” exemption. These provisions have raised a great deal of concern since the Disneyland measles outbreak, including in California, where it began. Unfortunately, the blundering approach state legislators there have taken shows how direct attacks on exemptions can rally the anti-vaccine cause.

So, in other words, it’s the legislators’ fault that the antivaccine movement is letting its freak flag fly and going into full mental jacket meltdown over SB 277. If only legislators would be more…reasonable. After noting what I mentioned above, namely RFK, Jr.’s Hitler Zombie-worthy spewing of Holocaust analogies, plus some other antivaccine activity in California, such as an antivaccine group from Minnesota airing a television ad showing an infant having a seizure. Nyhan also noted the ridiculous antivaccine claims being made in testimony to the Health committee and how antivaccine activists jeered vaccine advocates from the audience.

Nyhan’s preferred solution to such a polarizing issue? This:

A smarter approach would be to retain a narrow personal belief exemption in states that already have one and avoid the kind of polarizing fight that California is now having. These states could tighten exemption rules as experts recommend to more appropriately strike the balance between parental choice and the health needs of the community. Given the potential risks that unvaccinated children pose to the community, the process of obtaining an exemption can be rigorous and demanding. Until a recent change in the law in California, for instance, it was easier to obtain a personal belief exemption than to document that a child was fully vaccinated, which gets the burden of proof precisely backward.

Yes, wouldn’t it be reasonable to tighten vaccine exemption rules while retaining nonmedical exemptions. Where have we seen this strategy before? I wonder…? Yes, we have indeed seen it in California just a couple of years ago. Nyhan, however, seems blissfully unaware of what happened when California tried to pass a bill to tighten nonmedical exemptions.

Let’s take a brief trip in the Orac TARDIS. (Come to think of it, wouldn’t a crossover between Doctor Who and Blakes 7 be awesome?) The year was 2012. The bill was AB 2109. The idea behind the bill was to make nonmedical exemptions to school vaccine mandates more difficult for parents to obtain, given that before AB 2109 all the parents had to do was to sign a form. In many ways, back then it was easier to claim a personal belief exemption to school vaccine mandates than it was to go to the trouble of getting your children vaccinated. So Richard Pan tried to do something about it. He introduced AB 2019, which required parents to receive counseling, in essence informed consent, from pediatrician or other named health care professional, who would inform them of the risks of not vaccinating. A signature from a pediatrician or other listed health care provider was then required on the exemption form.

I wonder what happend. Surely, if Nyhan is correct, the reaction of the antivaccine movement must not have been nearly as batshit crazy in 2012 in response to AB 2109 as it is in 2015 in response to SB 277. I mean, all Senator Pan was proposing back then was to add one little step, one relatively minor hoop that parents had to jump through in order to prove their dedication to wanting a personal belief exemption to school vaccine mandates. It shouldn’t have been such a big deal to them, should it? Surely they wouldn’t trot out Nazi and Holocaust analogies, the way RFK, Jr. just did last week, would they?

Of course they would.

Let’s step into the TARDIS and look at the reaction of the antivaccine movement to the very reasonable reform proposed in AB 2109. No big surprise, the reaction of antivaccinationists to AB 2109 in 2012 looked very much like the reaction of antivaccinationists to SB 277 in 2015. In 2015, we have RFK, Jr. speaking of a “vaccine holocaust” in response to SB 277 while a group called Californians against SB 277 use photos juxtaposing antivaccine mothers with Jews wearing the yellow Star of David in Nazi Germany. Echos of three years ago! For example, comedian Rob Schneider called the California legislature “Nazis” and likened school vaccine mandates to violations of the Nuremberg code. Then, as now, antivaccine rallies against AB 2109 were ubiquitous (as were Nazi and Holocaust analogies linking SB 277 to incipient fascism) as they are now against SB 277:

Same as it ever was.

Meanwhile, the grande dame of the modern antivaccine movement, founder and president of the Orwellian-named National Vaccine Information Center (NVIC), Barbara Loe Fisher, was saying things like this:

This bill, if passed, would effectively make the personal belief exemption in California another type of medical exemption. Because there is no religious exemption in California, this would make the only exemption option in California one in which a parent has to go through a state approved medical provider that they may not normally use for their child. Many families in California embrace complementary and alternative medicine for their family health care needs and AB2109 clearly discriminates against these families by defining such a limited subset of medical providers.

And this:

  • Especially in California, many families utilize health care providers not reliant on pharmaceutical drugs and vaccines, and only practitioners part of the pharmaceutical paradigm or medicine are allowed to provide the information and sign the form under this bill.
  • AB 2109 discriminates against families utilizing complementary and alternative medicine by forcing them into paying money to a medical practitioner they wouldn’t otherwise use who is already philosophically opposed to the parent’s personal and religious convictions regarding vaccination.

Hmmm. It sounds as though the antivaccine movement reacted to what Nyhan would consider to be a reasonable bill (AB 2109) with the same level of batshit crazy as it is currently doing with respect to SB 277, even though AB 2109 was not Draconian or even particularly onerous. Yet the antivaccine movement reacted to it as though it were a full-on frontal assault against their very freedom. That’s how the antivaccine movement rolls. Any attempt to limit what they perceive as their “freedom” to refuse vaccines for their children, consequences be damned, is automatically viewed as a direct assault on everything they hold dear—nay, on their very identity.

Indeed, “Dr. Bob” Sears was also on the warpath, even going so far as to pen a missive entitled California Bill AB2109 Threatens Vaccine Freedom of Choice. You can read it for yourself, but it contains the usual tropes about “freedom” and how even such a weak requirement as that which was embodied in AB 2109 was an intolerable affront to freedom and an obvious ploy by big pharma to crush any dissent from those who consider vaccines to be dangerous.

Now, I won’t dismiss everything Nyhan has to say. He does have a reasonable concern here:

What’s worse is that most of the votes for the bill so far have come from Democrats, which could politicize a decidedly bipartisan issue. The safety of our children and our communities shouldn’t become a partisan matter, which could spur some people to oppose vaccine requirements as a result of their political views.

Certainly, it is of concern that the thorny issue of vaccine mandates has been politicized more than it should be. On the other hand, it has commonly been assumed that antivaccine views tend to be the province of affluent, hippy-dippy, New Agey left wingers, when such is clearly not the case—and Nyhan knows that. As I’ve said before, antivaccine views are the quack views that are truly bipartisan. Be that as it may, let’s look at the two states that do not permit nonmedical exemptions. These states permit neither religious nor personal belief exemptions to school vaccine mandates. Can anyone guess which two states they are? Mississippi and West Virginia. Neither of these states is exactly what one would call bastions of liberal thought or strongholds for the Democratic Party, although to be fair it must be noted that in the case of West Virginia it wasn’t always that way. West Virginia has fairly recently flipped from blue to red, and it will be interesting to see what happens with its no compromise vaccine laws.

In any case, worrying about the bipartisan support for vaccines rather misses the point, which is that it’s not pushing for laws like SB 277 that undermines the bipartisan support for vaccine mandates. Rather, it’s antivaccinationists who have successfully co-opted the message of “freedom” (as in “health freedom”) in order to link tie vaccine mandates to a narrative of an overweening state seeking to control everything in the lives of its citizens and an affront to parental “choice.” It’s also certain elements of the Republican Party since the Tea Party became such a force. If you want to see detailed explanations and particularly annoying examples of this phenomenon, look no further than the recent bleatings of everyone’s favorite antivaccine pediatrician who claims he’s not “antivaccine,” Dr. Bob Sears, who fuses antivaccine rhetoric with anti-government rhetoric to perfect the antivaccine dog whistle.

Because of this unholy fusion of right wing, libertarian-leaning conservatives aligned with the Tea Party and antivaccinationists, even mainstream Republicans feel as though they need to pander to this group and are learning how to send out antivaccine dog whistles. For instance, Rand Paul is very much against vaccine mandates because, you know, parents own their children, not the state. Yes, I know. Everyone knows that Rand Paul is a perfect example of the apple not falling too far from the tree, but when New Jersey Governor Chris Christie starts tooting that antivaccine dog whistle, even tentatively and then followed by a rapid retreat after criticism, you know that there’s something going on there.

So, basically, although it is concerning that, even though antivaccine pseudoscience is the pseudoscience that is as bipartisan as support for vaccines has been, it is concerning that only one political party seems to feel the need to pander to these views, this was happening anyway. Moreover, the only way not to outrage the antivaccine movement is to weaken or eliminate vaccine mandates. Any attempt to strengthen or eliminate vaccine mandates will draw a response like the one we’re seeing now in California. The response was just as vociferous three years ago to a much milder bill, AB 2109, which, by the way, Governor Jerry Brown effectively neutered with a signing statement that ordered the California Department of Public Health to add a line to the exemption that let parents sign for a religious exemption to vaccine mandates without seeing a pediatrician, an utter betrayal of California children and an almost certainly illegal disregard for the legislature’s intent when it passed the bill, not to mention the statutory language that didn’t give him the power to do this. Oh, and Jerry Brown’s a Democrat and used to be known as “Governor Moonbeam” back in the 1970s; so maybe pandering to antivaccinationists isn’t as Republican a phenomenon as Nyhan thinks. After all, even Hillary Clinton and Barack Obama did it briefly back in 2008, along with John McCain.

So, when it comes to vaccines, legislators are right to push for a science-based policy to protect children. In an ideal world, that would mean no nonmedical exemptions to vaccine mandates, but I understand that the most that can often be achieved is tightening of requirements for obtaining vaccine mandates—and even that sort of strategy can get watered down. That’s because, regardless of what legislators do to try to increase vaccination rates, antivaccinationists will go full Godwin and react just as they’re reacting now. So legislators might as well go for broke, because the backlash from antivaccine organizations is not appreciably more intense now than it was three years ago for an incremental solution, and I don’t see the fence sitters or pro-vaccine parents rallying to their side now. Given the opening in the wake of the Disneyland measles outbreak, it might now be politically possible to begin eliminating—or at least making the requirements tighter for—nonmedical exemptions to school vaccine mandates. The time is now.

We might as well go for the policy that will be most likely to prevent future outbreaks. Even if we go for lesser measures, such as tightening requirements for nonmedical exemptions, I guarantee we’ll still see the NVIC paying for “no forced vaccination” advertisements and antivaccine “luminaries” like the banished Jake Crosby trying to link attempts to eliminate nonmedical exemptions to his favorite conspiracy theory.

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]

368 replies on “A highly misguided concern about California SB 277 and cracking down on nonmedical vaccine exemptions”

A look at the recent fierce battle in Colorado – over a bill that would have just added an educational requirement – reinforces your point.

Anti vaccine activists would brutally and fiercely resist any attempt to tighten requirements.

And they oppose anything that could support immunization. If you look at the least of bills and positions, NVIC, for example, also recommends opposing resolutions encouraging higher immunization rates. No mandates, just encouraging. Though the intensity of opposition would hopefully be less for those.
https://nvicadvocacy.org/members/Home.aspx

One thing about Mississippi: remember tgat the lack of nonmedical exemotion there did not come from the political process and this kind of battle. Mississippi’s Supreme Court struck a religious exemption down in Brown v. stone – though the fact that activists were unable to legislate a new one since is telling. See: http://www.publichealthlaw.net/Reader/docs/Brown.pdf

Ugh. I hate those misleading NVIC billboards.

I saw some tweets about Nyhan’s piece. Didn’t get a chance to read the whole thing, but the opening couple of paragraphs made me wonder what he’d propose that wouldn’t be met with similar vitriol by the anti-vaccine movement. Because I can’t think of anything.

Neither can I, other than a state going in the opposite direction and loosening requirements for nonmedical vaccine exemptions. For instance, if Mississippi or West Virginia added a personal belief exemption, you’d see the antivaccine movement going orgasmic. Not something I want to see.

From the article, by Ms. Fisher: “. . . Many families in California embrace complementary and alternative medicine for their family health care needs and AB2109 clearly discriminates against these families by defining such a limited subset of medical providers. . .”

Let me fix that to: “We’d have to go to real physicians, not our chosen anti-vax quacks!” and insert the oft-used link to https://www.youtube.com/watch?v=fxGqcCeV3qk .

I live in Northern CA, and I fully support this bill. It is interesting to me that the people I know that are against SB 277 are people who are all for vaccinations, but buy into the whole “health freedom” and “parental choice” tropes, and are the ones who exclusively homeschool their kids. They are very threatened by this mandate, calling it “too broad”, it’s absolutely NOT, and “scary”. It’s not that either. Personally, I truly hope the state does the right thing and pass this bill.

Wow, these people are really nuts.

http://www.sacbee.com/news/politics-government/capitol-alert/article18533915.html

“Sen. Richard Pan, a Sacramento Democrat who introduced SB 277, said the in-house law enforcement unit has provided him with extra security in recent weeks, after his office began receiving alarming phone calls, e-mails and Facebook comments from opponents of the bill.

“They’re basically trying to silence us,” Pan said. “It’s disturbing.”

The messages range from images depicting Pan as a Nazi to posts on his Facebook page calling for him to be “eradicated” or hung by a noose. Pan said his staff has forwarded all of the threats to the Senate Sergeant-at-Arms office, as is procedure, which has assessed them and responded as needed. Additional guards attended a community forum last month, for example, after bill opponents discussed throwing things at Pan.”

I notice how the reaction to any vaccination enforcement with “freedom” is analogous to the gun control fight. Here in rural Lanaudiere region in Quebec, there was an outbreak in a small, sect-like community who had children go to Disneyland….over 150 measles cases, none vaccinated. So that outbreak became international. And there is another fallacy. The government doesn’t own children, it’s true, but neither do the parents. They’re guardians, but not owners. Nobody owns them, they’re not slaves. Parents have rights and obligations.

This is why politics is so frustrating. You will never see anti-vaxers moderate their demands, so legislators are always being pulled toward an appeal to the middle, which in this case, will always be on the quack side of the argument. The anti-vax movement is driven by fanatics who can rally internet and phone campaigns that get far more attention from legislators than they deserve, and legislators do what they think they are supposed to do: make compromises.

To see the anti-vaxxers’ vile remarks about The Holocaust, go to Jake Crosby’s Epoch Times blog.

Kennedy has already issued an apology…sorta. Perhaps one of his advisers informed him that today is Yom HaShoah (Holocaust Remembrance Day).

Pfft. We had “mandatory” vaccination in Mexico when I lived there. No one worried about it because my parents and their parents (and their parents) remember what it was like before vaccines.
We’ve forgotten those epidemics here in the U.S., and those jerks trying to take us back to those times should not be given the time of day.

That TV ad is — ugh, I can’t even find the appropriate word to describe its awfulness. :/

How about a counter ad with babies stricken with VPDs? And a the odds of an “injury” occurring vs. contracting the VPD? And a comparison of the seriousness of adverse reactions vs. the effects of VPDs? I mean, anti-vaxxers are all about “the truth”, so let’s give it to the people.

Vaccine mandates “discriminate” against antivaxxers the same way that laws against stealing discriminate against thieves,

Brendan Nyhan. It figures. On of my pet outrages lately is that anyone takes his ‘unpersuadable anti-vaxers’ study seriously. It’s utterly worthless claptrap, and this NYT post offers some clues to the baises that led Nyhan’s to foist his unsupported conclusions in Pediatrics where gullible journalists and sbm advocates mistook them for “science.”

The Nyhan (et al) paper floats in a vacuum of ignorance of communication theory, the long history of persuasion studies, and decades of scathing critiques of the methodological nonsense Nyhan’s sort of survey research just assumes as givens… A full elaboration would take an Orac-length post or two, but I’ll note a couple major points (there are lots more down the scale in significance))
• The tested messages are defined only by content, with no regard to form. This is kind of analogous to attempting to find out if a joke is funny, but paying no attention to how it’s told, who’s telling it, etc. When Nyhan gets results that suggest none of the rhetorical strategies yield significant opinion change, he concludes the problem is “no strategies work with anti-vaxers” without controlling for the possibility the CDC just bungled the presentation in a way that reduced them all to the same level of nothingness.
• Most importantly there’s no warrant for the assumption that a single presentation of any message could have a significant effect on belief, opinion or action. On the contrary, DECADES of empirical research, and COUNTLESS studies indicate the opposite. Any sort of stimulus-response direct effect hypothesis is known in the field of Mass Comm research as the ‘the bullet theory’ or the ‘hypodermic model.’ – neither term being uttered without laughter or spitting.

Media persuasion professionals know (and multitudes of research confirm) that mediated messages generally only play a significant role in opinion change via repetition over time. Yet Nyhan’s paper has no lit review of the multitudes of empirical studies in media effects, no recap of the major theoretical positions offered to explain research results, not one citation of an important scholar in the field.

Academia is fragmented enough that researchers inside one disciplinary bubble are sometimes completely oblivious to even major traditions in some other bubble. But given the historic public profile of effects research, and the fact Nyhan’s position is in Political Science, I have a hard time imagining he could be so insulated, and i have to suspect some kind of willful adoption of blinders is at work. But, just from the anti-vax paper and his comments to journalists about it, I’ve not known enough about the guy to even venture a the most tentative guess “Why?”

But reading between the lines of what Orac has quoted, I can begin to come up with some very speculative and fuzzy possibilities. We now have two major public statements from Nyhan, to the effect of “Don’t do that. It will backfire.” Both on VERY shaky grounds. That doesn’t mean he’s necessarily wrong, and there’s evidence for the inverse. Just that he’s talking out of his ass. My clue to motive lies in the statement Orac calls a “reasonable concern”:

The safety of our children and our communities shouldn’t become a partisan matter, which could spur some people to oppose vaccine requirements as a result of their political views.

What kind of political scientist can imagine that policy decisions affecting the safety of children and communities has ever been anything BUT a product of partisan politics? What serious student of American politics could imagine that partisan issues like ‘parents rights’ (for just one example) wouldn’t be dragged up by any public health initiative, pitting powerful social forces into conflict? That progress could ever be made without sometimes bitter and divisive struggles? That opposition is ‘bad,’ rather than a sign you’re doing something right?

Do a substitution test, replace “the safety of our children and our communities” with any other progressive change, and the statement reads as shockingly naive. ‘Racial equality shouldn’t become a partisan matter, which could spur some people to oppose voting rights legislation as a result of their political views.’ Or how about, ‘Science education shouldn’t become a partisan matter, which could spur some people to oppose school curricula as a result of their political views.’

My guess, then, is that Nyhan lives in the fantasy land of Radical Centrism, where anyone with a political passion is a ‘dangerous extremist’, (Nancy Pelosi is the mirror of Ted Cruz), and if everyone would just act sensibly and ‘objectively’ like Dr. Nyhan, we’d all come together, do the practical thing, in consensus without opposition, and sing cumbaya in 3-part harmony. THAT would be your ‘false balance’, fallacy of the Golden Mean, yada yada yada.

Umm, maybe Prof. Nyhan might want to read the news. I’m sure Oscar Grant’s family would be comforted if Nyhan reminded them, ‘Police executions and cover-ups of the murders of African-American men shouldn’t become a partisan matter, which could spur some people to oppose law enforcement reform as a result of their political views.’

The more the rules about vaccine exemptions are tightened, the more parents will go ahead and vaccinate, and the less of an anti-vaccine movement there will be.
It’s ultimately the opinions of the parents that matter, not the statements of anti-vaccine leaders.

I think that a good counter ad to the one showing the baby having a febrile seizure would be one with a split screen–on one side (labeled “MMR vaccine”) we’d see a single image of a child having a seizure, and on theother side (labeled “measles infection) we’d see multiple images of babies having a seizure, in proportion to relative risk.

We could do the same for encephalopathy–on the MMR side we’d have the image of a single child, and on the disease side we’d have the images of 1000 children…

AV’ers are self entitled egoists. They don’t care about anyone other than themselves and their own smug sense of superiority for ‘knowing better’ – which is laughable.

NVIC. Ugh. They’re a seeping pustule sitting on the taint. Annoying as all f*ck and a pain in the a*s to boot.

Anti-vaccine advocates stress how they are ‘just like other parents’- and this is part of their appeal to young parents, the uninitiated and fence-sitters.

HOWEVER they are by no stretch of the imagination _average_. This should be our job, to instruct the public about just how far these people vary from the mean and from reality..

Think about it:
-they support many alt med ideas and conspiracy theories
-they disparage the opinions of professionals in SBM and refer to doctors as ‘@ss hats’, criminals and prostitutes
-they challenge consensus in complex subjects without benefit of an appropriate education
-they parade their personal narratives and carelessly discuss their children’s problems on public display
-they accept many fraudulent practitioners whom most people would suspect
-they reject governmental data and agencies
-they reject most of the media
-unlike most parents, they seem to have a lot of free time to spend on the internet socially and in political manoeuvering.

We can get others to question their motives as well-
they are not as selfless as they portray themselves.
Is it really all FOR THE CHILDREN?
– or is it a way for them to get attention and validation when they appear to have no other means of achieving that?

Would any of the ‘writers’ at AoA get their books published without their association to the movement on vaccines and a publisher who is a fellow traveller ?

“What’s worse is that most of the votes for the bill so far have come from Democrats, which could politicize a decidedly bipartisan issue. The safety of our children and our communities shouldn’t become a partisan matter, which could spur some people to oppose vaccine requirements as a result of their political views.”

So according to this guy, it’s the Democrats and the Bill’s fault that republicans don’t care enough about our community/children’s health to support such a bill?

Here are some of the health-related statistics for Mississippi (MS) and west Virginia (WV), the only two states that have disallowed all non-medical exemptions for nearly 40 years. Both MS and WV are near the bottom in almost every category. Of course, this could be a coincidence (since vaccinations are a great source of coincidences), but had these two states been near the top, the pro-vax folks would have surely advertised these statistics everywhere.

Life Expectancy:
http://en.wikipedia.org/wiki/List_of_U.S._states_by_life_expectancy
MS and WV have the lowest life expectancy at 75.0 and 75.4 years respectively. Hawaii is at the top at 81.5 years (2013-14).

Infant Mortality
http://www.cdc.gov/nchs/pressroom/states/INFANT_MORTALITY_RATES_STATE_2010.pdf
INFANT DEATHS PER 1,000 LIVE BIRTHS (2010)
1. Mississippi 9.62 (highest)
10. West Virginia 7.33
50. Alaska 3.57 (lowest)
United States 6.14

Physical fitness
http://www.cdc.gov/physicalactivity/downloads/pa_state_indicator_report_2014.pdf
See the figure on p.5:
Only MS, WV, and TN have 15%.

And foreigners. Measles may kill a few hundred people per day, but that’s in other countries, so we don’t have to worry about it!

Over a few blogs I have started to note how the reaction to any vaccination encountering with is similar, they are almost every time a few parents who do not want their children to be vaccinated. Parents need to remember that they took a vow when their children were born saying that they will look after their children and give them the proper medicine they need to live a healthy life. Nobody owns anyone, no parent owns their child. A child is a living breathing human being with rights. Parents have responsibilities towards their children’s health which they need to fulfill.
u15031642

Don’t parent care about their children’s health anymore. A child can get measles so easily at school these days, and vaccination will help prevent that….

Victor @22: Yes, and I’m sure that the relative level of poverty in MS and WV have *nothing* to do with those states’ abysmal standings in the rankings of life expectancy, infant mortality and physical fitness.

Not to mention: How do vaccines given in *childhood* affect infant mortality? It’s well understood that infant mortality is most closely related to pre-natal care.

And how do vaccines affect the physical fitness of adults? How is the MMR shot I got when I was 2 impact whether or not my neighborhood has sidewalks?

These things, they are not related the way you seem to think they are.

@ Narad #26:

What “doesn’t work” is citing a crap ‘study’ by a jerk who has no clue how to properly research the topic. Just read the damn thing. The flaws ought to be as plain as the blinking lights on Orac’s case to anyone who can actually practice skepticism.

‘batshit crazy’
Perfectly described. Their behavior is deplorable. Anti-vax cult uses terroristic tactics intended to hijack democratic process. And children will suffer even more if we continue to concede to their batshit craziness.

Thank you for this piece, Orac.

Looks like Chris Christy has had a change of heart and is supporting mandatory vaccination now :

“New Jersey Gov. Chris Christie (R) on Wednesday expressed his full support for vaccines for children, telling a woman who favors a conscientious belief objection that he “cannot be someone who supports voluntary vaccination.”
“Yeah, no you can’t count on me for that,” Christie said, garnering a round of applause from nearly 300 people gathered at a town hall in Londonderry, New Hampshire. “I would err on the side of protecting public health through vaccine unless that vaccine has proven to be harmful to the public.”

http://www.huffingtonpost.com/2015/04/15/chris-christie-vaccines-new-hampshire_n_7072178.html

@ NZ Skeptic:

I wonder if being middle class might be a risk factor for succumbing to this *alternative vision* because:

if they really had money, they could pay for full time caretakers and not be as involved in day-to-day care themselves- and work or do as they pleased;
if they were more financially strapped, they might need to work outside the home in addition to caretaking, perhaps sharing duties with the other parent/ family members.** Thus, they would be too exhausted to proselytise on facebook or write memoires, quasi- investigative reports ( comme Dachel) or parent guides ( Stagliano).

They expected high achieving children and were disappointed perhaps also.

In addition, they may have had an education and background where they expected to work outside the home in more sophisticated venues than childcare. Their alliance to the movement allows them to be writers, advocates, political operatives, medical experts and social critics rather than merely caretakers.

** I learned that the guys who repair my car – a father and son- share caretaking duties with their wife/mother, respectively, for an adult who has severe autism in the home.
So each works 50 hours or so a week at the repair shop and then go home…Whew!

NZ Skeptic: “It doesn’t help to have people like mad Megan Heimer in the community. I have never read such a complete load of nonsense in my life”

She apparently will also use sock puppets in order to try to show she has support. That is really a pathetic tactic. See:
http://violentmetaphors.com/2014/04/14/the-lies-anti-vaxers-tell-and-why-it-matters/

Then go to the bottom where there is this statement from one of the blogger/moderator:

An update: Megan, the author discussed in the post above, has apparently been commenting on various articles at Violent Metaphors under a variety of names: Megan, Cara, Korrin, and maybe a dozen anonymous comments all come from the same IP address and display the same writing style.

First, that’s dishonest. Using multiple accounts is an attempt to make it appear as if a comment or position has more support than it actually does, without taking responsibility for any statements.

Second, it’s pathetic. Many of those obfuscated comments are thinly veiled boasting, such as the ones above touting Megan’s JD degree and the “thousands” of “likes” for Living Whole. (Not to toot the VM horn, but she’s got a long way to go to seriously compete in terms of quality, quantity, and popularity of content.) A side point, in response to one of those sock puppet comments above: no, your JD is not a “legitimate doctorate” that compares to a PhD or MD when it comes to analyzing scientific issues. And frankly I’m not persuaded you’re a qualified attorney, given the substantive inaccuracies in your scanty legal analyses.

Third, it’s unnecessary. Violent Metaphors doesn’t censor comments as Living Whole does. Just comment under your own name, and be responsible for your own inanities.

Annie: He lies.

I’m beginning to dislike almost all new white parents. Maybe vaccines should just be quietly disappeared from the more affluent suburbs- they’ll never notice. And while we’re at it, there should be a campaign to encourage pediatricians to relocate from non-vaccinating areas and the mayor or local city council should read their letters home at all town meetings.

@PGP:

Is that like a Modest Proposal type thing, or are you being serious? Because I think we’ve been over this a few times before.

I’m beginning to dislike almost all new white parents.

Since you dislike everybody, what difference does that make?

I’m beginning to dislike almost all new white parents.

Since you dislike everybody, what difference does that make?

PGP does not dislike everybody.

PGP dislikes everybody who is in a different demographic than herself.

Well, maybe not dislike. She just thinks that they are less than human, are not worthy of health care, shouldn’t be allowed in her country, and shouldn’t be allowed to have children. But it isn’t because she dislikes them. It’s just easier than thinking of them as people.

PGP does not dislike everybody.

In the sense of recreationally offending people who are exempt from the self-declared “IRL” existentential fraud, or something. Maybe.

No surprise:

“A California vaccination bill (State Bill 277) that has generated intense debates pitting personal rights against public health stalled in the state Senate Wednesday, with lawmakers saying it could unconstitutionally deprive unvaccinated children of an adequate education by barring them from schools.”

“It’s generated such an angry debate that the proposal’s author, Sen. Richard Pan, a Democratic pediatrician from Sacramento, has received added security. In addition to threatening messages sent to his office, opponents of the legislation have posted images online comparing Pan to Adolf Hitler.”

http://bit.ly/1COW4my

In politics, you don’t need to be right, you just need to be very loud and committed.

@ BBBlue:

Today Heckenlively @ AoA compares the proposed legislation to “segregation in the South” and “racial laws” in Germany prior to the war.

Interestingly, he claims that 1100 people showed up to speak in opposition to the law. Is that so?

Liz? Or anyone else who was there?

@Denice Walter: I don’t know the exact number, but there were a lot of opponents. A very, very long line.

They wore red and we wore blue, so everyone – well, most people – were easily identifiable.

@ Dorit Reiss:

Thanks.
re red and blue
Does that have a political significance *a la* red vs blue parties?

Some alties are carping about how the “liberals” are all for vaccination now and are looking to those of a more liberation bent. In other words, nothing new.

PGP does have a point.I wonder if there is some way to publicly shame antivax parents by name.Sort of like the way they use to publish names of those arrested for DWI in local newspapers.Remember them?

@ Roger Kulp:

Actually, an AoA commenter, Greg ( well-known here) suggests that the solution might be to have vaccinated AND un-vaccinated schools.
I’m not making that up.

@Roger #49

I suspect it will run afoul of HIPAA rules.

It came up when one of the special snowflakes was sent home from school. Of course it was OK for Mom to broadcast the health information all over the news media when complaining that the school did something that might lead some parent to suspect the health information if they figured out that SpecialSnowflake was gone from class during the time one might suspect they would quarantine the child for their own safety.

Don’t feed the hysteria, Roger. Their leaders have already convinced them we’re about to start sewing yellow stars on their clothing.

A proposal I’ve seen going around in various places:

Ration nonmedical exemptions at a level calculated to not impact herd immunity. Establish “public health boards” similar to the military “draft boards” in local communities to rank-order the exemptions and then grant the ones that come to the top of their list. The “public health boards” could rank them any way they choose but have to make their method of rank-ordering public.

Those “public health boards” could be staffed on the basis of at-large elections in each county, or could be appointed, or whatever. Ideal case, they have naturoquacks and the like on them, even a majority. Let anti-vaxers decide which fellow anti-vaxers to say Yes to and which ones to say No to, because in the end the total number would be limited empirically so it’s not a public health risk.

It occurs to me that this might have a side-effect of dispersing some of the geographic nexes of anti-vaxism. Too many people for the allotment of exemptions in Marin County, so you can’t get an approval? Great, move to BlahBlah County where there are few requests for exemptions and your approval will sail through just like a special snowflake on a gust of special winter wind. This isn’t a bug, it’s a feature: it dilutes the anti-vax vote.

Re. Orac @ 4: If W.VA. and MO. enact exemptions, the anti-vaxers there will be proclaiming “Natural and Orgasmic.” Eww.

Injecting aluminum and mercury into our blood streams drinking aluminum fluoride in our water and in our toothpaste, are the main reasons why our world and all creatures great and small are in the most dis-eased state of health in the history of the world

Gee “Dr.” Blake, lemme guess naturoquack or chiroquack? Aluminium and mercury aren’t injected into our bloodstreams and no one is putting “aluminium fluoride” in water nor toothpaste.

@Dr. Blake – so you’re saying that we’re less healthy than say, during the Middle Ages, where the average life expectancy was about 30?

I hope several of his patients bite him. Homeopathy for animals; I mean, really.

our world and all creatures great and small are in the most dis-eased state of health in the history of the world

“dis-eased”. No further comment necessary.

Actually, an AoA commenter, Greg ( well-known here) suggests that the solution might be to have vaccinated AND un-vaccinated schools.
I’m not making that up.

They have them. They’re called Waldorf Schools.

Injecting aluminum and mercury into our blood streams

Who do you believe is doing this, Stephen? vaccines aren’t injected intravenously, and no vaccine formulations incorproate elemental aluminum or mercury.

Some may contain aluminum salts as adjuvants, and multi-dose vials may contain thimerosal as a preservative, but that isn’t the same thing at all, anymore than table salt is metallic sodium which can be expected to react explosively when you add it to your soup.

are the main reasons why our world and all creatures great and small are in the most dis-eased state of health in the history of the world

Citations truly, amdly desparately needed: your evidence that (for example) the people living in the US today are less healthy than those living in the US in the late 1800’s would be…what, exactly? Be specific.

A few important points to consider:
1. The vast majority of the people you call “anti-vaxers” have given their children some vaccines. Very few of the “anti-vaxers” reject all vaccines all of the time. So a better description might be cautious vaccinators. If a parent declines even one of the scheduled vaccines, they fall into the “anti-vaxer” villanous category.
2. Even the medical community agrees, Vaccines sometimes have side-effects and on rare occasions these side effects are much worse than the illness being vaccinated against would be.
3. Every child has a right to receive a puplic education and every parent has the right to make an informed choice about what medicine their child receives. This bill would trample on these rights.
4. It is arrogant to presume that we know everything about the human body and how best to take care of it. Since the number of vaccines given to children has dramatically increased in the last 2 decades, the long-term effects of so many vaccines may not be discovered for another few decades. There have been many mis-steps and cover-ups throughout the history of vaccines. These parental concerns exist for valid reasons.
5. This year parents seeking vaccine exemtions at California schools did have to speak to a medical professional before being allowed the personal belief exemptions (PBE). Also this year the number of PBEs decreased in California. It seems like the system is working just fine. Wy start trampling on parental rights now?

He is a veterinary homeopath

Even worse, he’s had medical education and training.

I know a few people in the anti-vax movement, you are wrong about the opposition to SB 277 and SB 1209 being similar. One was mostly rhetorical. The opposition to sb 277 is much more activist in nature. The number of people showing up at events is gigantic. They are meeting, setting up Facebook groups, exchanging information… This is organizing them in a way they have never been.
Don’t forget that California isn’t the entire world. Even if mandatory vaccines are accomplished in California, the movement will continue in others states and people who never really thought about it much will investigate, and some will end up becoming anti-vaxxers, no matter how little sense it makes. All you need is maybe 0.5% of them across the country, and you now have MORE unvaccinated children. And since this is now shaping to be a left vs right thing, do you really think 0.5% is unreasonable? And this says nothing about skeptics in third world country(there are plenty, more than in the US!), who can now point to this and say “Look, even the Americans have to force their citizens to take them!” And there, the damage caused will be much more devastating.
If all you want is to be right and to show just how darn right you are, go ahead. But if you’re actually concerned with immunity from deadly diseases and the well being of children, this is a very risky direction to go.

3. Every child has a right to receive a puplic education

This is certainly not the case under the U.S. Constitution, so your homework now is find something in Serrano I or Serrano II that would trump California’s interest in public health.

Ration nonmedical exemptions at a level calculated to not impact herd immunity.

That has a strong aroma of equal protection failure to it.

The vast majority of the people you call “anti-vaxers” have given their children some vaccines. Very few of the “anti-vaxers” reject all vaccines all of the time. So a better description might be cautious vaccinators. If a parent declines even one of the scheduled vaccines, they fall into the “anti-vaxer” villanous category.

If it walks like a duck, quacks like a duck; it’s a duck. That is the same stupid argument RFK Jr. makes on his road show. Merely having had your children vaccinated in the past does not suddenly make you in favour of vaccines. Your so-called “cautious vaccinators” employ anti-vaxx talking points to justify their erroneous decisions. People need to just own their actions; they’re anti-vaxx.

Even the medical community agrees, Vaccines sometimes have side-effects and on rare occasions these side effects are much worse than the illness being vaccinated against would be.

Yes there are rare very serious complications accompanying vaccination. But please name one side effect which is worse than any disease complication and rate thereof.

Every child has a right to receive a puplic education and every parent has the right to make an informed choice about what medicine their child receives. This bill would trample on these rights.

Wrong. With rights come responsibilities. Parents aren’t being forced to vaccinate; they have other options for education. Too bad if they don’t like them. Does a child have the right to spew racial epithets at school? Does a child have the right to bring a gun into school? Why not? Those are actually constitutionally-protected acts so if you support your “health freedom” why not these also? These children’s rights are being trampled on so by your logic they should be supported, not just the “rights” that are convenient to you.

It is arrogant to presume that we know everything about the human body and how best to take care of it. Since the number of vaccines given to children has dramatically increased in the last 2 decades, the long-term effects of so many vaccines may not be discovered for another few decades. There have been many mis-steps and cover-ups throughout the history of vaccines. These parental concerns exist for valid reasons.

No what is arrogant is to think that you can have all of the rights and privileges of society with none of the responsibilities or none that you don’t agree with. You obviously don’t know much about vaccines because these “mis-steps” are hiding out in the open and have been used to increase vaccine safety and oversight. Nothing will ever be perfect and it’s delusional to reject something that is beneficial to most simply because of past mistakes and imperfection. Go ahead and apply that to other products and facets in your life. You won’t then have a car, plumbing, electricity, store-bought food, etc.

This year parents seeking vaccine exemtions at California schools did have to speak to a medical professional before being allowed the personal belief exemptions (PBE). Also this year the number of PBEs decreased in California. It seems like the system is working just fine. Wy start trampling on parental rights now?

Whoopdedoo. Have you seen some schools’ vaccine rates? Do you honestly think that the vast majority of parents who aren’t swayed by the new PBE requirement are going to suddenly capitulate? And the requirement is a joke since a religious exemption was tacked on and naturopaths can sign off on a PBE. Even pseudo-physicians like Sears and Gordon just sign off without actually educating their patients.

every parent has the right to make an informed choice about what medicine their child receives. This bill would trample on these rights.

Given that this bill would exclude philosophical exemptions, which only very ill-informed people would view as a justification for non-vaccination, this comment is a total non-sequitor.
As for John Long, that’s a level of concern trolling I’ve not seen in a long time.

That has a strong aroma of equal protection failure to it.

Interesting, how so? I ask because this is something I proposed so I’d like critique.

I applaud Sen. Pan and Allen. If you are in CA and support the bill make sure to thank them (and support them when they are up for re-election).

Not completely off topic. Well, it’s about vaccines.

http://thescientificparent.org/learning-the-hard-way-my-journey-from-antivaxx-to-science/#more-576

A few quotes –

I’m writing this from quarantine, the irony of which isn’t lost on me. Emotionally I’m a bit raw. Mentally a bit taxed. Physically I’m fine. All seven of my unvaccinated children have whooping cough, and the kicker is that they may have given it to my five month old niece, too young to be fully vaccinated.

We had vaccinated our first three children on an alternative schedule and our youngest four weren’t vaccinated at all. We stopped because we were scared and didn’t know who to trust.

For six years we were frozen in fear from vaccines, and now we are frozen because of the disease. My oldest two are getting better, the youngest four are getting worse and fast.

Since the number of vaccines given to children has dramatically increased in the last 2 decades

The total antigen load has decreased considerably. The ‘too many, too soon’ faction should be delighted.

Occasionally, I look at AoA’s comments in the hope that at least one person will say something meaningful. I am usually disappointed. Today is no different.

Under Heckenlively’s post about Dr Pan, someone concocts a conspiracy involving child protective services, “private psychiatric gulags”, foster care and adoption corporations who ALL stand to profit when the government takes children away from their parents. One should look and see exactly who is on these companies’ boards.

Another discusses the NSA.

Still another copies a facebook page wherein Dr Bob dreamt up a tale that imagines the powers-that-be changing education board members in mid-stream. ” This is not democracy” quoth he.

As for John Long, that’s a level of concern trolling I’ve not seen in a long time.

If you strike Antivaxxers down, they shall become more powerful than you can possibly imagine.

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