Colorado's Non-Medical Vaccine Exemption Form Ruffles Anti-Vaccine Feathers

Back to school time. Show your child you care about their health.
Image Source: South Florida Caribbean News

Note: see update at the end of the article.
 
School is nearing (or already upon us) in many states. Parents are out buying notebooks, pens and pencils, folders, and new clothes for their children to make sure they're ready for the first day. It's also the time when many parents need to make sure that their children are up to date on their vaccinations in order to attend school. Naturally, this is also a time that anti-vaccine activists absolutely hate, especially in states where public health officials have taken efforts to ensure parents are better informed about vaccines and the diseases they prevent, as well as making opting out of vaccinations closer to the same burden that exists for those who choose to protect their children from diseases.

One of the latest battlegrounds is Colorado. Anti-vaccine activists and organizations, like the National Vaccine Information Center, are really upset with Colorado. Nothing has changed with regard to the law in that state, though. Non-medical exemptions haven't been removed, like they have in California. Parents aren't required to sit through an educational session on the benefits and risks of vaccines and the diseases they prevent. All that changed is this year's vaccine exemption form and the rules around its use.

Who Chooses? Parents' vs. Children's Rights

There's a topic that I've touched on a few times over the years here, but I've never really delved into it. It's something that comes up pretty frequently in discussions of children's health, particularly when talking about vaccines or so-called alternative medicine. It's even something that arises around issues of which real treatment a child should receive. I've mentioned it in passing in posts about vaccines (e.g., when talking about why it actually does matter to others if you vaccinate your child, how anti-vaccine people want to change legislation, or how they oppose what they see as government interference), as well as my discussion about a case involving controversy over competing diagnoses. Others have also written about it in the context of cancer treatment. A common element in all of these topics is autonomy: the right to make decisions about one's own healthcare. More specifically, do parents own their children? Do parents have the freedom and the right to do with their children as they please? Or are parents merely guardians and stewards for their children until they are mature enough to make decisions on their own? Where do parental rights end and the child's rights begin?

Recently, this notion came up again in response to a post on Reddit, in which a mother, who is opposed to vaccines and did not vaccinate any of her children, relates how she discovered her eldest daughter got herself vaccinated in secret, much to the mother's chagrin. She asks if she can take any legal action.

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).

Stand Up for Parents' Rights to Accurate Information on Vaccines

A few years ago, California's legislature took steps to ensure that parents who wished to opt out of getting their children immunized for school or day care understood what their decision meant. Assembly bill AB 2109 required that before a philosophical exemption could be granted, parents had to get a health care provider to sign the exemption form, indicating that the parent received information on the risks and benefits of vaccination. In order for parents to make an informed choice, they ought to have good, science-based information on which to base that choice. SB 2109 seemed like a bill that should have had unequivocal support from the anti-vaccine, sorry, "pro-vaccine-choice" movement. Instead, they vehemently opposed it, led by the National Vaccine Information Center (NVIC). Despite NVIC's lobbying, AB 2109 passed.

The latest unprecedented outbreak of measles, starting in California and up to 132 cases in that state as of March 6, has led several state legislatures to consider bills that would tighten up school vaccine exemptions and improving parent education regarding immunizations. Naturally, this led to claims that government was trying to remove choice and personal belief. Some of those complaints are against bills aimed at removing non-medical exemptions. And some oppose bills similar to AB 2109, like Minnesota's SF380/HF393.

Is the Government Taking Away People's Beliefs?

Measles has been in the news a lot, lately. And it's not surprising, with the unusual 644 cases in 2014 and 154 (as of Feb. 20)  and counting already in 2015. The outbreaks have not only grabbed the attention of the media, but politicians are starting to take notice, as well. Several state legislatures are either already considering or will be introducing bills aimed at improving tracking of vaccine uptake and improving immunization rates overall. Some of these bills require disclosure of immunization rates for each school. Others go much further and would remove philosophical exemptions from school immunization requirements. These latter bills would bring those states more in line with Mississippi and West Virginia, which only allow for medical exemptions for students' school shots (and also just happen to have some of the lowest rates of vaccine preventable diseases).

To say that those who, either in total or just the mandated school-entry immunizations, are opposed to vaccinations are unhappy would be an understatement. Moves to remove non-medical exemptions from school vaccination requirements are met with arguments about personal freedom, that this is no different than what the Nazis did to the Jews during the Holocaust, or that the government is taking away people's beliefs or rights.

So what's going on? Is the government taking away people's beliefs? Are they infringing on our rights as citizens? And what about the children who are affected by all of this?

The Saatchi Bill, or, How England Could Become Quack Paradise

"Hi. I'm Lord Maurice Saatchi, and I'm trying to help quacks."

The other day, I wrote an open letter to members of the various state legislatures in the United States about so-called "right to try" laws. These laws purport to make it easier for terminally ill patients to seek out and obtain treatment with experimental drugs. The reality is that the laws leave patients in the lurch. State right to try laws simply create false hopes for patients and leave them to take on incredible risks while giving up some of their rights to legal redress. So far, five states have passed right to try laws without any serious critique by legislators. To some degree, I don't blame them. Who wants to deny a patient the right to try anything to prolong their life? Yet those legislators who pass these laws are being far more cruel than any who vote these laws down.

But if you think state right to try laws in the United States are bad, take a look at the United Kingdom's Medical Innovation Bill (HL Bill 48 [full text]), also known as the Saatchi Bill, after its sponsor, Lord Maurice Saatchi. As with right to try laws, the intent of the Saatchi Bill is well-meaning, but the end result is likely to be far more harmful for patients than imagined by the bill's supporters.

An Open Letter to State Congress Members on Right to Try Laws

Dear Members of Congress,

"Right to try" laws, that is, laws designed to purportedly make it easier for terminally ill patients to gain access to unapproved, experimental drugs, have been in the news quite a bit recently. Several state legislatures have overwhelmingly supported these types of bills, with little or no opposition, let alone serious, critical examination. Although advocates of these laws claim to have the rights and interests of terminal patients in mind, much of the legislation, and the long-term consequences, are likely to do more to benefit unscrupulous companies and hucksters while doing little to help, or even increasing the harm to, patients in great need, not to mention legitimate companies.

The driving premise behind right to try laws is that terminally ill patients have nothing to lose by trying unproven treatments, and that they ought to have the right to gain access to those treatments without undue burden. A dominant view among right to try proponents is that the Food and Drug Administration, and the various regulations they enforce, create inappropriate barriers to the timely release of potentially life-saving drugs. Advocates believe that earlier access will save lives, coupled with the belief that the government should not interfere with a patient's right to decide what treatments they wish to pursue.

While right to try laws seem, on their surface, to do nothing but benefit patients, they will very likely fail to do so, and perhaps even harm patients, for a number of reasons.

Massachusetts Nurses Association Sues for Right to Endanger Patients

Yesterday, I wrote about how comedian Rob Schneider not only does not know anything about vaccines, but does not seem to understand the Constitution very well, either. Schneider was recently dropped by State Farm Insurance because of his vocal opposition to vaccinations. Understandably, a company that, in part, focuses on public health would not want to be associated with someone who argues against measures aimed at improving public health. The "Makin' Copies" guy has no business going anywhere near health related issues.

As a celebrity, Rob Schneider uses his fame to spread misinformation about vaccines, frightening people away from one of the most successful health measures ever devised. His notions regarding immunizations put others at risk. Public figures, particularly those with some measure of fame, ought to be careful when they speak out on matters of science and medicine. They might think that they are well-informed, but not infrequently, their rhetoric is based on lies and misunderstanding. Though they may seek to help others, they only serve to increase risk. Schneider is but one of the latest actors speaking out on issues for which he has absolutely no qualifications. But he's not the only one who ought to leave well enough alone when it comes to people's health.

MNA - Working to increase patient risk

The Massachusetts Nurses Association (MNA) apparently shares some of Schneider's misguided ideas of personal liberty at the expense of patients.

Package Inserts - Understanding What They Do (and Don't) Say

With the whole twitter tantrum over a supposed coverup revealed by an alleged whistleblower that really is much ado about nothing, a topic arose that I realized I hadn't written about before, other than in passing. It came up again last week when anti-vaccine activists tried to hijack the Twitter hashtag #vaccinesNOVA by astroturfing it with tons of copy-pasted tweets, rather than actually watching the excellent NOVA episode Vaccines - Calling the Shots and having a mature conversation about vaccines. It's the same tactic they used with the #CDCwhistleblower hashtag. They merely copied and pasted from a list of prepared tweets, rather than offering any original thoughts of their own, because they are convinced that they already know everything and have nothing to learn from a very informative program. If there's even a whiff of pro-vaccine message to a show or post, count on anti-vaxxers to rail and scream, rather than actually watching or reading, let alone understand.

At any rate, I engaged one of those tweeting easily disproved nonsense to #vaccinesNOVA. This individual brought up vaccine package inserts, pointing out that one vaccine insert actually mentions "autism" in the adverse events section. They linked to the insert for Tripedia, which protects against diphtheria, tetanus and pertussis (whooping cough). In their mind, this was ironclad proof that even vaccine manufacturers admit that vaccines cause autism. Of course, this person ignored the other bits in the paragraph that mentioned autism (emphasis added):

Adverse events reported during post-approval use of Tripedia vaccine include...autism...Events were included in this list because of the seriousness or frequency of reporting. Because these events are reported voluntarily from a population of uncertain size, it is not always possible to reliably estimate their frequencies or to establish a causal relationship to components of Tripedia vaccine.

In other words, autism was included because it was deemed either serious or was frequently reported, not because there was any causal relationship found between the vaccine and autism. It is far from being the slamdunk "gotcha!" that my interlocutor thought it was. But it prompted me to consider how many people probably do not understand just what the package insert for a vaccine (or any other drug) actually is or what its contents mean.

So here we go, a primer on drug package inserts and what they mean for a lay audience.

For Balance, We Turn To... - Jen Eyer Edition

This seems to be the week for lazy journalists falling for the false balance that is the epitome of sloppy reporting. I had originally planned to write about this particular bit of nonsense yesterday, but the article giving a platform to anti-vaccine bully Becky Estepp took precedence. Also, Dr. Steven Novella and Orac both beat me to the punch. But, there's still plenty of meat in the story to go around.

I'm talking about the latest verbal vomitus from anti-vaccine activist Mary Tocco, titled No one should be forced to vaccinate their children". Ms. Tocco's letter was in response to a science-based op-ed, "Anti-vaccination movement threatens the health, safety and well-being of Michigan children", by Dr. Anthony F. Ogjnan and Dr. Sandro Cinti. The original letter is well worth the read, particularly for those who live in Michigan and are concerned about their legislators being gulled by the dishonest misinformation campaigns of anti-vaccine groups, like Michigan Opposing Mandatory Vaccines (MOMV - apparently Ms. Tocco is as bad at making acronyms as she is at everything else, since she calls it "MOM", i.e., "Michigan Opposing Mandatory"). Ms. Tocco's response is an exercise in name that logical fallacy and an excellent illustration of how "research" (in anti-vaccine world) is a far cry from actual research in the real world. I'm not going to delve into her letter very much, since Dr. Novella and Orac both covered a good deal of what was wrong with it, but I will point my readers to discussions of how Ms. Tocco she tried to twist the Bible to support her ideology.

What I want to focus on is the person responsible for giving Ms. Tocco space to spew her bile, Michigan Live's Director of Community Engagement, Jen Eyer.

Case of Justina Pelletier Spawns Dubious Legislation

The intersection of science and politics is a very murky area. While science can and should inform policy and legislation, those who try to legislate science can easily find themselves on shaky ground. To say that politicians ought to exercise great care when introducing legislation that affects the scientific enterprise is, perhaps, a slight understatement. That is especially true when they start trying to dictate what science is and is not allowed. It's even worse when the individual politicians behind the legislation have demonstrated by past behavior that they are, shall we say, science-averse.

That's the case with a recent bill that has been introduced into the House of Representatives by Minnesota's Rep. Michele Bachmann. I won't go so far as to say that Bachmann is crazy or insane, as I'm no psychologist and there's no need to pathologize her particular brand of nonsense, but she certainly has shown that she does not understand science and her conception of the world differs quite profoundly from reality. Whether it's on the subject of evolution, climate change, or vaccines, Bachmann regularly gets the facts wrong. Now she's wading into policy governing research by introducing a bill nicknamed "Justina's Law". In a related vein, Rep. Steve Stockman has introduced what he's calling the "Parental Protection Act". Both bills are vague and stand to do more harm than good.

Massachusetts Steps Closer to Expanding Autism Support

Massachusetts State House
Source: Fcb981/Wikipedia

When someone receives a diagnosis of autism or a related disorder, it profoundly impact the individual and their family. Depending on the severity, they may need only minor assistance or extensive services. Some may be able to live independently, while others require round the clock support. There may be other concurrent medical or mental health conditions, as well. In far too many states, autistic individuals fall through the cracks. It's only recently that states have started to enact legislation aimed at reforming health care coverage for those with an autism spectrum disorder or other developmental disability.

Massachusetts is the latest state that is close to expanding coverage and support for people with developmental disabilities. The state house of representatives unanimously passed a bill (H.4047 - An Act relative to assisting individuals with autism and other intellectual or developmental disabilities) that does a number of things that will hopefully improve the quality of life of those individuals and their families. The senate passed a similar version of the bill (S.2245, reprinted as S.2257), also unanimously. The next step is a compromise bill, then it's off to the governor for signature.

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.

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.

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.

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.

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.

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).