Jim Carrey's The Bad Tweet

Did you learn nothing from this movie, Jim?

[Update 7/2/15 at 6:30pm: Jim Carrey has removed the tweets mentioned below and replaced them with text-only tweets. He has not tweeted any apologies.]
 
Oh, Jim Carrey. Not content to be a fool on screen, you decide to (continue) to be a fool on Twitter. After the passage and signing of California's SB277, a new law that removes non-medical exemptions to school immunization requirements, Carrey went on a bit of a rant on Twitter, declaring the law fascist (it's not), playing the Pharma Shill Gambit, the toxin gambit, and, like so many other anti-vaccine activists, declaring he's not anti-vaccine. In short, he's just following the anti-vaccine handbook. But he wasn't content to keep it to just being mildly unhinged. But I'll get to that in a bit.

I first became aware of Carrey's anti-vaccine nonsense back in 2009, when Carrey was with anti-vaccine spokesperson Jenny McCarthy. For a while, Phil Plait, aka the Bad Astronomer, had occasionally written about the anti-vaccine movement. Like clockwork, anti-vaccine activists would show up in the comments spouting the same tired tropes over and over. It prompted me to write up a summary addressing the more common myths around vaccines. It's helped some learn the truth and facts about vaccines and exposed many of the lies told about them.

Apparently Jim Carrey didn't bother reading it, or, if he did, he didn't learn a thing. So what has he done this time around that went beyond merely making a fool of himself and showed that he is an opportunistic and insensitive ass that doesn't really care about those affected by autism?

SB277 Signed! Congratulations, California!

June 30, 2015 - A happy day for California children!

This is just a very brief post to celebrate the triumph of science and public health over the fear and lies of the anti-vaccine movement. On June 30, 2015, Gov. Jerry Brown signed SB277 into law. As I mentioned briefly before, SB277 ensures that only medical exemptions will be allowed for school immunization requirements. California has joined Mississippi and West Virginia as the only three states in the country that put children's health above misguided personal and superstitious beliefs.

In his signing statement (PDF), Gov. Brown noted the importance of vaccines and the science that supports their use:

The science is clear that vaccines dramatically protect children against a number of infectious and dangerous diseases. While it's true that no medical intervention is without risk, the evidence shows that immunization powerfully benefits and protects the community...

...Thus, SB277, while requiring that school children be vaccinated, explicitly provides an exception when a physician believes that circumstances - in the judgement and sound discretion of the physician - so warrant.

My thanks go out to Senators Pan and Allen for shepherding this bill through the California legislature, to all of the senators and assembly members who voted for this bill, the parents and activists who supported their efforts, and Gov. Brown for signing it. You have all done an amazing thing to protect the health of California's most vulnerable population.

SB277 Opposition: The Smokescreen of Parental Choice

Humans love to have choices. From early on in our childhood, we like to be able to choose what we want to do. Play with this toy or that one. Eat this food or that. And we don't like having limitations placed on our choices, especially if it involves doing something we don't want to do. Our parents try to teach us that while we are able to choose, sometimes our choices have strings attached. "You need to finish your vegetables if you want dessert." We're given the power to choose what to do: eat the veggies so we can have dessert, or choose not to eat the veggies and miss out on dessert. We might not like the options, we might wish we could choose the dessert without any other limits on our choice, but we have to deal with the reality. Depending on our maturity, we may throw a tantrum when we don't get what we want, when there is even the most minor constraint on our choices.

By the time most people are adults, they're mature enough to realize that every choice we make has some sort of consequences. They may occur prior to getting what we want, or they might follow it; they may be good consequences, or they may be bad. Then there are those who never seem to reach that maturity. They're stuck in the childish dream of wanting their choices to be free from any limitations, unable to accept that their choices may have consequences or that there may be some manner of prerequisite before they can have their choice fulfilled.

We can see this in action in the anti-vaccine movement, in particular as they fight against a bill in California (SB277).

Genotypes, Serotypes and the MMR: Cognitive Dissonance in Action

Many of those who have bought into the anti-vaccine message seem to hold very tightly to their chosen belief. The more emotionally invested they are, the more likely they will go to great lengths to justify or rationalize their position. True, this is not unique to anti-vaccine activists or those closely associated with them, but it quite commonly dictates their reaction to evidence that challenges their beliefs. Evidence that contradicts their worldview, causing cognitive dissonance, leads to different mechanisms to cope with the psychological discomfort that results. The less entrenched individuals may look at the evidence, accept it as valid, and change their prior beliefs to fit with the new evidence. Some may simply ignore the evidence and pretend it doesn't even exist (e.g., "vaccine have never been studied for safety" despite numerous studies doing exactly that). But more commonly, they will invent rationalizations to explain away the contradicting.

The most recent example of this is the current outbreak of measles that started at Disneyland in California, and to a lesser extent last year's historic case count (644 cases) that hasn't been seen in the past 20 years and surpassed the number of measles cases from the previous five years combined. The Disney outbreak has resulted in 125 cases (through February 8) in just over one month (141 cases in two outbreaks as of February 13) resulting in 17 known hospitalizations. The majority (88%) of cases were either unvaccinated (45% of the total) or had unknown or undocumented vaccination status (43% of the total). The unvaccinated have been a significant contributor to the size of this outbreak and the speed with which it has spread. And the media has taken notice, with the majority of outlets putting the blame right where it belongs: on the anti-vaccine movement.

So how have anti-vaccine types responded?

It's Past Time to Pay the Piper

In the story The Pied Piper of Hamelin, the German town of Hamelin suffers from an infestation of rats. When things are looking bleak, along comes a piper dressed in bright colored clothes. He claims that he can rid the town of the rats. The mayor makes a deal, promising to pay a handsome sum of money if the piper should accomplish this feat. At once, the piper sets to the task, playing his magic flute. The rats begin streaming out of the houses and shops, following the piper to the nearby Weser River, where all of the rodents drown. Having held up his end of the deal, the piper goes to collect his due, but the mayor shirks his responsibility. He reneges on the deal and refuses to pay the piper the agreed upon sum. Angry, the piper leaves, vowing to have his revenge. He returns later and once more plays his magic flute. This time, all of the children of the village flood the streets to follow the piper out of the village, never to return.

The story inspired a lovely phrase, "pay the piper", to describe those situations where one must accept the unpleasant or undesired consequences of one's actions. It's a phrase that is particularly appropriate when talking about the anti-vaccine movement, their enablers and the current, and distressing, measles outbreak originating at Disneyland. For years and years, anti-vaccine activists and the handful of physicians who eschew their professional obligations in order to pander to them have downplayed the risks of vaccine-preventable diseases like measles, exaggerated the risks of the vaccines, and done their damnedest to bring down vaccination rates across the country. The natural consequence of this is that we are seeing the return of diseases that we eliminated from endemic circulation.

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.

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.

The New California Personal Belief Exemption Form Unveiled

The anti-vaccine movement is a study in contradictions. They want fewer vaccines, but advocate for actions that ensure vaccines that could be taken off the schedule aren't. They want studies done, and even get involved in their design, but then reject them when the studies produce results they don't like. And they clamor for informed consent, but then raise a stink when efforts are made at improving education and helping parents make informed choices.

That was the case last year when, in March 2012, a bill was introduced in California (AB2109) that would require parents who want to opt out of required school immunizations for their children to get information about the "benefits and risks of the immunization and the health risks of the communicable diseases listed in Section 120335 to the person and to the community" from an authorized health care provider (which was rather broadly defined). These efforts at ensuring parents make informed choices were so objectionable, that anti-vaccine pro-informed choice activists vehemently opposed the bill. Yes, in the twisted world of people like NVIC's Barbara Loe Fisher, a doctor largely responsible for a measles outbreak or certain reality-challenged celebrities, a bill that requires parents be informed tramples on parents' rights to be informed. Yeah, I don't get it either, but supposedly it makes sense to them.

At any rate, AB2109 was signed into law by Gov. Jerry Brown on September 30, 2012, but with a catch. As I wrote at the time, Gov. Brown issued a signing statement with it, stating that he would direct the Department of Public Health to allow for religious exemptions to the whole getting informed piece of the legislation, despite the fact that California does not have any religious exemptions to vaccinations. As I noted at the time, there were significant problems with this, both legal and practical.

Well, the California Department of Public Health has announced the new form and made it available here (PDF).

Parents' School Vaccination Lawsuit in WV Dismissed

This year has seen quite a bit of anti-vaccine sabre rattling when it comes to state laws and rules around school vaccinations. We saw Vermont trying to strengthen public health by eliminating philosophical exemptions, which was met by a fact-challenged tirade from a homeopath. That aspect failed, but requirements were put into place that parents review educational materials and attest to understanding the risks their decisions have not only for their kids, but for the community at large. In California, a bill was introduced requiring that parents get a signed statement from a health care provider indicating that the provider discussed the risks and benefits of vaccination (and vaccine refusal) with parents before a philosophical exemption will be granted. That bill was signed into law, despite anti-vaccine activists erroneously claiming that it violated and removed parental choice, revealing that they really are not in favor of informed consent. There had also been another bill that California Gov. Jerry Brown vetoed that would have required clinic employees to get the flu vaccine or take other reasonable precautions to minimize the risks of influenza in a health care setting. That bill (SB1318) is back with the Senate for consideration of the governor's veto.

And then there was the activity in West Virginia back in August. When I was launching my series of Vaccine Preventable Disease Wanted Posters, I mentioned in passing that a group of parents were suing the West Virginia Department of Health and Human Services (DHHS) over a new requirement that 7th graders and high school seniors get a Tdap booster and meningococcal vaccine. Well, there's been a new development with that.

AB2109 Signed! But Gov. Brown Creates Other Concerns

On Thursday, I echoed Orac in his call for people to support California's Gov. Jerry Brown in signing AB2109 into law. This bill would help strengthen California's school vaccination laws by requiring that parents become informed about the risks and benefits of vaccinating prior to getting a personal belief exemption for their children. Anti-vaccine activists vehemently opposed this bill, showing that they are actually against informed consent. They even recruited comedian Rob Schneider as their new Jenny McCarthy, acting as a celebrity spokesperson to champion their nonsense. And based on my twitter exchanges with him, he's swallowed their tripe hook, line and sinker.

I spent the weekend mostly off-line, so I missed a rather big development in all of this. As user "Unknown" commented on my call to arms, Gov. Brown signed the bill! This is fabulous news, but it's tempered with a bit of, well, if not bad news, at least something a little perplexing.

A Call to Arms

Orac, over at Respectful Insolence, has called on those of a scientific bent to take action on two important issues. First off, investigative journalist, Brian Deer, will be speaking at the University of Wisconsin - La Crosse on October 4 and 5. Brian Deer, you may recall, is a U.K. journalist who has harshly criticized pharmaceutical companies and who uncovered the research fraud committed by Andrew Wakefield. The anti-vaccine activists at Age of Autism have encouraged their followers to rally against Mr. Deer and to support a press conference that Andrew Wakefield will be giving on October 4, also at the University of Wisconsin - La Crosse. Here are the details about both:

Brian Deer's Talks

• "An Elaborate Fraud: The MMR Vaccine & Autism"
• Thursday, October 4 at 5:30pm
• Centennial Hall, Room 1309 

• "Stiletto Journalism: Busting the Vaccine Scare"
• Friday, October 5 at 3:30pm
• Centennial Hall, Room 1309

Andrew Wakefield's Press Conference

• Thursday, October 4 at 1:00pm
• Location to be provided - email info@drwakefieldjusticefund.org for more info

The other item that need your support is AB2109, about which I've written before (here and here). As a quick reminder, this bill would require parents who want a philosophical exemption for their children from school immunization requirements to talk with a medical provider about the risks and benefits of vaccination, and the risks of not vaccinating for both themselves and their community. The bill has passed both the California State Senate and Assembly. It is currently on Governor Jerry Brown's desk, waiting to be signed. A vocal contingent of anti-vaccine activists and Tea Partiers are holding a rally to oppose this legislation tomorrow, September 28 from noon to 2pm on the West Steps of the state capitol. If you live nearby, I urge you to attend in counter-protest to voice your support for this bill. I also encourage you to contact Gov. Brown, asking him to sign AB2109.

If you decide to attend any of these events, please remember to remain civil. Do not be goaded by the anti-vaccine activists you are likely to encounter.

Quick Legislative Update: Vermont and California

I just wanted to give my readers a quick update on where things stand with vaccine exemption-related legislation in Vermont and California. If you'll recall, Vermont's Senate passed a bill that would remove philosophical exemptions from school immunization requirements (leaving in place religious exemptions). California introduced a bill that would require parents in that state to get a written, signed form from a physician, surgeon, nurse practitioner or physician assistant stating that the health care provider gave the parent information about the risks and benefits of vaccines before a philosophical exemption from school immunization requirements will be granted.

The Vermont bill (S.199) was referred to the state's House of Representatives (H.527), where it is currently in committee. I urge any of my readers in Vermont to contact their representatives and ask them to support this bill.

The California bill (AB 2109) is also currently in committee. As with my Vermont readers, I would ask any of my readers in California to please ask your assembly member to support this bill.

The Anti-Vaccine Crowd Shows They Are Anti-Informed Consent

"We want people to have informed choice when it comes to vaccines." These words, or at least something along these lines, are uttered by many anti-vaccine activists, like Barbara Loe Arthur (aka Barbara Loe Fisher) of the misnamed National Vaccine Information Center or the authors at Age of Autism. To hear them speak, you would imagine that they would be completely in favor of any efforts which strive to provide accurate, complete information to parents who are deciding whether or not to have their children vaccinated. Such efforts should be whole-heartedly embraced by these "pro-informed consent" warriors.

Just such an opportunity has arisen in California, with AB 2109. As I recently wrote, this bill would expand on California's philosophical exemptions regulations regarding immunization requirements for day care and school enrollment. If passed, parents seeking a philosophical exemption would need to obtain from a physician or other health care provider a signed statement that the doctor provided them with information on the benefits and risks of vaccines. Physicians are already required by Federal law to provide this information before administering a vaccine. This provision would provide an added opportunity for parents to receive sound information and advice regarding their children's vaccines.

Sounds like something Fisher and company would support, no? Surprisingly, no.

California Assembly Working to Protect Public Health

Efforts to improve public health and revamp vaccination programs seem to be popping up all over the place, lately! First, there were the recommendations from the Alaska State Section on Epidemiology following a chicken pox outbreak at a day care, then there is the bill to eliminate philosophical exemptions from school vaccine requirements in Vermont that has passed that state's Senate and is on its way through the House and will hopefully be signed by the governor.

Actually, even before these two developments, there was last year's step towards improving public health in Washington when they passed a bill (PDF) that would require parents to speak with a physician about the benefits and risks of vaccinations before being granted a philosophical exemption from vaccine requirements.

Well, California has joined the fun.