Tuesday, April 15, 2014

Dr. Jay Gordon and "Irrelevant" Vaccines

This past weekend I was at the Northeast Conference on Science and Skepticism (NECSS). This was their sixth year, and the fourth that I've attended. I was going to work on my review of the conference last night, but something popped up that I just had to address. So, the NECSS 2014 review will have to wait a little longer.

I realize that I just wrote about Dr. Jay Gordon back on April 1 when he mistakenly tried to say that the incidence of measles in the latest outbreak in California could be calculated by dividing the cases by the total population of the state rather than by the susceptible population. But I made the mistake of checking Twitter to see if Dr. Jay Gordon had responded to a couple questions/comments I directed to him, as well as to see if anyone else said anything. I've noticed that he's taken to pretty much ignoring me when I point out his mistakes or clarify something he's said, so I wasn't surprised that he hadn't responded to me. What caught my attention, though, was a brief video shared by someone else.

Tuesday, April 1, 2014

Dr. Jay's Magical Math

You would expect pediatricians, especially Fellows of the American Association of Pediatrics, to know at least a little bit about epidemiology and to give others a proper, fact-based picture of what vaccine-preventable diseases can do. At the very least, you would not expect them to get things so spectacularly wrong that you wonder how they ever managed to get their license, let alone their degree. Yet that is exactly what one pediatrician does on a fairly regular basis. In fact, the things I'm about to describe I actually wrote about three years ago. I'm speaking of Jay Gordon, MD, FAAP, and in the time since that 2011 post, he doesn't seem to have learned anything. You'll see what I mean in a bit.

For those who don't know, Dr. Gordon is a California pediatrician who regularly downplays the risks of disease and advocates alternative vaccination schedules, as well as skipping vaccines altogether as "unnecessary". He is a darling of the anti-vaccine movement, since he supports their views that vaccines may be, somehow, dangerous. In fact, he is (or was) the pediatrician for Jenny McCarthy's son. Jenny, as you may or may not known, made quite a name for herself as the celebrity spokesperson for the anti-vaccine group Generation Rescue. Yet Dr. Gordon also appears to desperately crave the acceptance of his science-based peers.

Wednesday, March 26, 2014

Justina Pelletier to Remain in Massachusetts DCF Custody

Earlier this month, I wrote about the case of Justina Pelletier, a teenage girl who has been the center of a year-long-plus custody battle between her parents (Lou and Linda Pelletier) and the Massachusetts Department of Children and Families (MA DCF). The case has drawn national attention and sparked some rather heated opinions. The majority of articles, blog posts and comments have been strongly supportive of the Pelletiers, with most framing the situation as government overstepping its bounds and infringing on parental rights. Few took a more nuanced approach, sticking to the known facts and avoiding speculation.

For a little background, in 2012, Justina was diagnosed with a mitochondrial disorder by Dr. Mark Korson, Chief of the Metabolism Service at Tufts Medical Center. After suffering a bout of the flu in 2013, with subsequent gastrointestinal problems, Dr. Korson recommended she see her former gastroenterologist, who had moved from Tufts to Boston Children's Hospital (BCH). When she was admitted to the ER, the BCH physicians questioned the mito disorder diagnosis and suspected, instead, that she had a somatoform disorder. Justina's parents disagreed with BCH's proposed psychiatric treatment plan and were going to take her out of BCH to continue her mito disorder treatment. Fearing that this would delay proper psychiatric treatment and result in unnecessary medical treatment that would put Justina at increased risk of harm from the drugs prescribed for mito disorder, the BCH physicians called in the Department of Children and Families, fearing medical child abuse.

Thus began a thirteen-month courtroom and media spectacle. The latest development was announced yesterday, March 25.

Thursday, March 20, 2014

A Confession

This post was very hard for me to write. For four years, now, I've been writing this blog. Four years putting out post after post refuting the claims of "anti-vaxers". For several years before that, I was active in the comments of a few different sites, trying to be quick to respond anytime someone questioned vaccines. All this time, so many hours pushing the pro-vaccine angle. But I just cannot, in good conscience, continue. Not any more. The little bit of income I earn for my efforts just isn't worth the guilt. Not after this past weekend.

What happened? What changed my mind? Last weekend, I attended the Pharma-sponsored Midwest Conference on Vaccines. This is the first time I've been to this conference, now in its sixteenth year, and the first time I've met many of my blogging colleagues face-to-face. Normally, all of my dealings with the inner workings of the pro-vaccine machine have been through email or snail mail. I get my orders. I write. I get paid. Simple, easy money. To say that this conference was an eye-opening experience is an understatement.

Monday, March 3, 2014

The Case of Justina Pelletier Calls for Nuance and Moderation

I've given a fair bit of thought as to whether or not to write this post. I may end up inadvertently offending people who have very firm opinions on the matter. The subject is rather controversial, evoking very strong emotions on both sides of the issue, which has gained national attention. The main problem is that what is known stems predominantly from media reports, with verified facts being unavailable. This is the case of Justina Pelletier, a 15-year-old girl who has been the center of a custody battle for over a year between her parents and the state of Massachusetts. The majority of coverage has taken the side of the parents. Most of the people speaking out do so on behalf of the parents, often quite vehemently decrying the Department of Children and Families (DCF) and Boston Children's Hospital (BCH), which started the ordeal. Articles siding with DCF are almost non-existent, but like their counterparts, take a very firm position based on media reports. Rarer still are measured, nuanced analyses of the story.

The dearth of more neutral approaches, and the vehemence with which people have spoken out about this, prompted me to write. I am not going to make any firm conclusions. I will not take a side. There isn't enough verified, primary source information available for me to do so. Instead, I will summarize the details that have been reported and talk a little about the possible scenarios: that the parents are right and that DCF and BCH are right. It is a complex topic about which I'd like to start a conversation, so feel free to post your thoughts in the comments below, but keep it civil.

Wednesday, February 26, 2014

Let Me Out!

Earlier this month, commuters in the San Francisco area were warned that they may have been exposed to the highly contagious disease measles after a student at University of California, Berkeley attended class and rode the Bay Area Rapid Transit (BART) while contagious. The student, who was unvaccinated, likely contracted the disease while traveling abroad. Take a virus that can remain viable in the air of an enclosed space (like a classroom or subway car) or on surfaces for up to about two hours, a large student population of a university like UC Berkeley, and hundreds of thousands of commuters each day and you have a lot of people that were likely exposed to one of the most contagious viruses known to infect humans. Just look at BART alone, which sees roughly 390,000 riders each day. Of course, not all of those will ride in the same car as the student, but we can expect that at the very least, several hundred people would have been exposed to measles each time he rode. Cars hold about 60-70 people, the virus lingers for a couple hours, lots of people getting on and off during that period, it adds up. We could see additional cases popping up over the next week or two. And that's not the only case that California has seen. As of February 21, there have been 15 cases of measles, with the youngest being only 5 months old, according to a CDPH teleconference. Compare this to last year, when there were only 2 cases by the same date.

Those 15 cases make up the majority of the 24 cases seen nationwide to date, with other cases seen in Hawaii, Massachusetts, New York, Oregon, Pennsylvania, Texas, Washington and Wisconsin. The cases are in those who traveled to other countries where there are current measles outbreaks (e.g., the Philippines) or where measles is endemic (e.g., India) or among those who have had contact with someone bringing the virus back from another country. Since measles was eliminated from circulation in the U.S. in 2000, the outbreaks we have seen since then have been due to importation by unvaccinated individuals, some too young to be vaccinated, and others intentionally unvaccinated. Note that none of the outbreaks in recent years has been started by a fully immunized individual. With the risk posed by importation of the disease, I started to think about what role quarantine might play in mitigating potential harm to the public.

Saturday, February 15, 2014

Forging Potential Harm

In the United States, every school maintains records on the immunization status of its students. Which students are fully vaccinated? Which have medical exemptions? Who get a religious or philosophical exemption for one or more vaccines? In the event of an outbreak of a vaccine preventable disease, these records can be used by the school to figure out which students are at risk and should be kept home until the outbreak is over. Public health officials also benefit from these records, as they can report vaccination rates across the state. This can show which communities may be vulnerable to a disease outbreak and narrow down where investigators need to look for potential index cases or contacts during an outbreak.

I've written before about an instance where parents forged their children's immunization records so they could get into day care. In that instance, the unimmunized children developed chicken pox, creating a small outbreak of the disease that put the other children, as well as two pregnant staff members, at risk of infection. This raised the question of the legal liability to the parents for their actions, handily addressed by The Skeptical Lawyer. No charges were filed in that case, and it's unlikely that any legal actions would have prevailed, according to the Skeptical Lawyer. A couple months after my original post, there was a chicken pox outbreak at a day care center in Alaska's Kenai Peninsula. Just like the earlier case, the parents refused vaccination for their children, ultimately resulting in a small outbreak.

The issues raised by those two events came together recently, again in Alaska's Kenai Peninsula. A nurse at a public school forged parent signatures on four immunization documents, noting in one instance vaccine refusal for religious reasons.

Tuesday, February 11, 2014

Weaving Ethical Dilemmas

Imagine, for a moment, that a device existed that could recreate just about any experience a person could have. Not like a television, video game or movie. Not even like a virtual reality simulator. Instead, it interfaces directly with the brain, stimulating specific regions to fire so that the user is, at least temporarily, completely convinced that they experienced whatever event was played. Every sight, sound, smell, taste and touch, even the very emotions evoked, all created by the device in the user's brain. Want to climb Mt. Everest from the comfort of your own home? Just run the right program and when it's done, you'll feel like you have. Want to sit on a tropical beach, lounging with a cool drink in your hand and just admire the majestic ocean, waves rolling in to murmur on the sandy shore? Run a different program, feeling completely relaxed when it's over.

That's the premise of a novella I just finished reading, called The Dream Weaver, by Aaron Simmons, who wrote the story as part of the annual National Novel Writing Month (aka NaNoWriMo). The central character is Eric Bram, a fellow who kicked off the technology and producer of some of the best "weaves" on the market. Bram, however, is wracked with guilt as he learns about the growing issue of addiction associated with the Dream Weaver device, wondering what role he may have played in the spread of the problem. Simmons weaves (excuse the pun) an intriguing tale that hints at far more considerations than could fit in the brief tale. So, I thought I'd explore some of the things that came to mind as I read it. Feel free to add your own thoughts in the comments. If you don't want the book spoiled, I suggest giving it a read before continuing on below.

Thursday, February 6, 2014

Mississippi Parent Group Working to Make It Easier to Get Sick

In the United States, every state has some manner of requirements for immunizations before children are allowed to attend schools or day care. They vary from state to state, with some requiring almost all of the vaccinations on the recommended immunization schedule, while others only require a smaller subset. Each state decides which ones they will require, and which they simply recommend. As with any medical intervention, there may be medical reasons that a person should not receive a vaccine. Usually, this is something like an allergic reaction to a previous immunization or one of the ingredients or because at the time the shot would normally have been given, the patient had an illness which contraindicated the vaccine. In other instances, the child may have a chronic disease or disorder that prevents safe immunization. Because of this, every state allows for medical exemptions to school immunization requirements. Nearly all states allow for a religious exemption, with Mississippi and West Virginia being the odd ones out. A smaller proportion of states allow for a broader sort of exemption: the philosophical (or personal belief) exemption. Like the laws requiring immunization, these exemptions vary by state (a map of which states allow which type of exemptions can be found at the Institute for Vaccine Safety).

As I mentioned, Mississippi and West Virginia are unlike the rest of the country, in that they only allow for medical exemptions from school and day care immunization requirements. However, a recent report in the Clarion Ledger discusses the efforts of one organization to change the law in Mississippi, by trying to pass legislation that would establish a philosophical exemption in that state.

Tuesday, January 28, 2014

VacTruth Alleges Bullying in One-Sided Account of Nurse-Patient Encounter

Anti-vaccine activists have a love-hate relationship with medical providers, be they nurses, doctors, pharmacists, whatever. They love to hate any medical provider that dares to question their anti-vaccine beliefs. When they encounter someone who strongly urges them to get vaccinated or to vaccinate their children, the nurse or doctor is invariably described as a "bully", "ignorant", "ill-informed", "brain-washed", "pharma whores" and so on. They push "propaganda" are paid by "Big Pharma". Any interaction is viewed through this lens, that the parent is right and the medical professional is hopelessly benighted or even downright evil. If they happen to have a poor bedside manner, so much the worse, though given how some anti-vaccine activists respond to science-based feedback, I might be a bit short-tempered, too.

Over the weekend, an anti-vaccine blog called VacTruth.com (why must anti-vaccine groups always use such Orwellian names?) posted a story entitled "Bully Nurse Harasses Parents of Unvaccinated Baby at Michigan Hospital". According to the account, an unidentified couple brought their child to an urgent care center in Madison Heights, MI after talking on the phone with a nurse at their pediatrician's office. Their son, called "Oliver" in the article, had cold symptoms, a low fever and an "acne-like" rash on his face. Following the advice, they reportedly went to the Detroit Medical Center at Madison Heights, where the admitting nurse, if the account is to be believed, suspected the child had chicken pox and subsequently harassed, ridiculed and bullied the parents.