16 years ago, a doctor published a study

[CMdeux]

Lakeswimr-- I thought it must have been a poorly designed one-off, as well-- except that there have been four or five of them now and they all show the same thing.  The problem is that this tends to be a decision that people make based on fear and a LACK of comprehension of very large and very small numerical values.  At least that is my hypothesis.

So comparing an 0.00002% risk to a 0.001% one, they just don't see one as being WAY more likely than the other, though it is undeniably so.  I've talked to a fair number of these people myself over the years-- and the major problem is that they don't want the information, really.   Information actually makes people LESS likely to get vaccinated for influenza, too-- I know of two studies that looked at that one, as well.  One was an emotional appeal, and the other was dry and fact-based, and EITHER ONE made people in the experimental group less likely to follow through than the control group!! 

So it really isn't just one bad study.  I know it seems impossible that people who are sort of undecided-leaning-no would respond that way, but they do.




Honestly, the arguments made by those who are vaccine-reluctant or just solidly anti-vax remind me VERY much of those put forth by smokers or drunk drivers.

It's MY choice to do this.

Nobody else should have the right to dictate to me...

And truthfully, the relative RISKS of their choices often seem eerily like the rationalizations that I heard as a kid when adults thought little of driving while "just a little bit drunk."   

Well, I can't very well just leave my car there-- it might get hit! (Which totally ignores the risk that they'll pose if they are behind the wheel.)

I won't drive if I know that I've had too many-- I know when I am okay to drive.  (in spite of evidence that they didn't, and that their inability to distinguish impairment was dangerous-- much like the antivaxxer statement that they'll self-isolate if they KNOW that they're contagious...)

What?  WALK home??  Are you crazy?  Do you know how dangerous that is?  (bizarre assessment of relative risks-- their risk of being hit by a car is far lower in reality than their risk of harm to themselves OR to others if they're behind the wheel)

It's always been fine.  It's not like I've ever had a problem.  (until you DO.)



It wasn't until social initiatives created a HUGE stigma around drinking and driving that drunk-driving fatalities started to decrease.  It's only my generation that has internalized the message that if you have even ONE drink-- you're a danger to yourself and to others behind the wheel, and that the only safe amount to drink before driving is nothing.

But it took SHAMING people who used those mind-bogglingly irrational statements in order to make that happen.  It took prosecuting them and RUINING them for the harm they caused others to make the average person think twice about running the risk.  It took pointing out that EVERY fatality caused by drunk driving was ultimately preventable.

It's still not perfect-- there are idiots that still don't buy in, and there are still fatalities.  But we no longer talk about "two sides" to this one.  Because there isn't another side, in spite of one or two drunks who have no doubt been harmed by not getting themselves behind the wheel.  Those narratives in no way overwrite the reality of the statistics on the subject, and thankfully, rather than listening to the emotional appeal, we've quit living in a Mad Men world and woken up enough to sternly say "NONSENSE," when someone tries.

This is why I (and a few researchers who have looked at the psychology behind this) are starting to think that vilifying those who are dangerous and loud may be the ONLY way to get the message across that this is a public health nightmare that a vocal and stupid few are foisting on us all.  Education alone may not do it-- it didn't with chronic drunk drivers, either.  They only stop the behavior when they actually kill someone (often themselves, but occasionally people who were just unlucky enough to cross their paths).

I don't even want to IMAGINE the tremendous-- and pointless-- waste of public health dollars that have been spent on this already in California alone.  That is money that could have been spent improving the lives of a lot of low-income people, and keeping other threats (like MDR-TB) in check.  This just feels stupid because it's entirely preventable.  It's awful that a handful of people can cause such a thing without remorse or repercussions. 

Jan 8-- there were ~20 cases of measles in CA
Jan 11-- the number is hard to know for sure, but about 28-32
Jan 19-- 38 (? again, this is approximate, as county versus state numbers reflect some differences)
Jan 21-- 53
Jan 28-- 78
Jan 30--91


That's not linear, you'll notice.  What do I expect will happen?  I think that this epidemic has hit dry tinder in Sonoma and Marin counties, that's what I think.  Orange county was another enclave, and that has proven to be another hot spot.  My real fear is that in some of the places in WA and OR which also have extraordinarily low vaccination rates, we also have parents that lean libertarian-crunchy, which means that they will do what they can to AVOID identification via the health departments, on the theory that measles is so wonderful and mild that everyone ought to quit freaking out over it... and we may see what it looks like when ZERO efforts at prodromal quarantine happen in a susceptible population.  I was shocked that the case in Eugene didn't apparently result in additional cases, to be perfectly honest. 

I expect that in another week, the case numbers in CA may hit 150.  That's my prediction.  With just single cases elsewhere, there are too many variables at work to really say for sure.

THIS is a personal narrative about measles--

http://www.nbcnews.com/nightly-news/ow-ow-ow-childs-bout-measles-makes-parents-glad-vaccine-n297236

Ugh.  A children's museum.  Daycare.  Church.  From a public health standpoint-- ugh, ugh, ugh.  All. those. contacts.

Makes this a whole lot less funny:

http://www.theonion.com/articles/i-dont-vaccinate-my-child-because-its-my-right-to,37839/

[SilverLining]

I'm not sure if this is the right thread to ask this. Point me elsewhere if not.

This outbreak started in Disney.  The first few articles referred to the outbreak being blamed on anti-vaxxers in Disneyland.  Was there a group trip of people who were anti-vaxxers there together? (I'm guessing home schoolers, but don't want to imply all home schoolers are anti-vaxxers.)

Was it one person with measles that infected strangers, or infected part of their own group (or both).

[CMdeux]

The strain has been typed-- it's a strain that is common in parts of the middle east, and in parts of southeast Asia.  Odds are that it was someone who had traveled from the Philippines, Egypt, or Dubai/UAE.


Some less hardcore parents are still concerned (which, as noted, I think that Lakeswimr and I disagree on, since I firmly believe that vaccine safety is something that is so far down the list of things to be "concerned" over at that level that probably it doesn't merit more than about 5 minutes of thought in most children) enough to want to "delay" or "spread out" vaccinations.

http://www.ncbi.nlm.nih.gov/pubmed/19117838

I really cannot recommend that article highly enough-- I picked it because the full text is completely free.  In this Pediatrics review, Dr. Offitt goes through Bob Sears' "recommendations" one by one and lays out very thorough reasoning about why most of them are bad ideas or based on garbage science.



http://www.ncbi.nlm.nih.gov/pubmed/17523694

This is very definitely still a problem.  The longer you extend that vulnerability, the greater the size of the vector population in childhood-- and NOTHING is a disease vector quite like a preschooler.  Nothing-- they are highly mobile, they lack fine/gross motor skills to prevent the spread of body fluids during coughs/sneezing, they are socially inappropriate in terms of contact with others, and they mouth things, etc. etc.  A more perfect spreader of something like measles or pertussis is difficult to imagine.  I mean-- we all know this here by virtue of FEARING those peers in some pretty unique and PTSD-related ways after living through that phase with food allergic kiddos, no?

Also, the reality is that a fair number of parents who have "concerns" (well, this is what they admit to, anyway) about vaccination wind up simply wasting a lot of physician time because nothing that the physician can say will ultimately sway them.

http://www.ncbi.nlm.nih.gov/pubmed/21812165

http://www.ncbi.nlm.nih.gov/pubmed/23900266

(but consider how much TIME this takes physicians when they are dealing with a parent who has been drinking at the Jenny McCarthy fount of dubious wisdom-- and every time they go home to "think about" it more, they keep drinking the KoolAid. )

So the very basic problem is in thinking that there are "two sides" to things to begin with.  I mean, here's the part that I don't get-- if you don't trust your medical provider, then why do you go to that person?  And if you kind-of-do-and-kind-of-don't, well, that I can understand, but why not be looking at highly credible sources like CDC, WHO, AMA, AAP, AAFP, etc. for that kind of information?  Practice parameters?  That kind of thing?

WHY does a parent who innately believes in allopathic medicine wind up diving into the kind of rathole that whale-dot-whatever is in the first place??

I mean, I know what happens once they do-- but what starts that process to begin with?  Why does a parent THINK about whether or not vaccines are safe to start with? 

That is the part that mystifies me.  Because if they aren't, then pretty much 99% of the allopathic medical establishment is in on the vast conspiracy.  Why on earth would an HMO want people to be vaccinated (to the point that they make it FREE!!) if it came with high risks of lifelong medical problems, hmmm?  Those blood-sucking-leeches are out to make money-- hand-over-fist, PILES of money.  Believe me, if vaccinating children COST them more than it SAVED them, they wouldn't be for it.

[lakeswimr]

Thanks for the reply, CM. 

How bad do you think the outbreak will get long term, CM?  Do you think we are back to the days of it just being something some kids get like before the vax was widely used?

I would have to see the other studies but the one you posted is not addressing the concerns of people who do not vax or who question vaxes in a way I think would be effective.  It doesn't not read to me as thought it was designed by people who understand what those concerns are or how those people think or what those people are reading that is making them concerned in the first place.  If I had just seen the design of the study, my prediction would have been that it would not be very effective so I'm not surprised to hear it wasn't.

You could be right that more information does not help but I don't think that would be the case.  The people I know who do not vax are in a group where a newer but well respected member is a vaccine expert, at least as expert as you.  I am seeing him politely point out things to people in the group and people really do listen to him.  He has changed people's long, long held opinions.  He is able to do this because he listens to what they say and does not talk down to them and he has their respect (that counts a lot) and he explains things with facts.  He is good at explaining things clearly but not simplistically as most pro-vax stuff tends to do. 

Recently someone shared an article that was anti vax and he went through it point by point and explained why the article was wrong.  people listened to him.  Treating people this way would be effective in my opinion.  first one would have to know what it is that people who are anti vax or concerned about vaxes are reading and what they think and then they would have to address those things. 

I do not think that mainstream docs have done a good job of this.  As I said, I would have to see the other studies but my guess is they were also designed by people who do not know in detail what people who don't vax read and what and how they think and what their concerns really are. 

I do not think the comparison to drunk driving is a good one.  These are for the most part not irrational people.  These are people who are reading information that I personally think is not always accurate, some of which is from doctors (as you know a small % of doctors are anti-vax), some are patients of these doctors.  They believe what they do for a reason and to not recognize that and dismiss them as like drunk drivers or idiots is going to polarize them and make them defensive and closed off to anything being said to them. 

What I would think before I had thought it all through, when I heard pro vax doctors talk about things (via reading books, websites, hearing DS's doc) was, 'well, I heard/read such and such and this person isn't addressing that at all.  This person must be minimizing the risks.'  It made me feel they were talking down to me.  Had the addressed the things I had hear that were supposed to be risks by saying, 'I know you heard (specific examples) but actually (facts)' that would have been very effective with a person like me.  People can also explain the difference in risk.  If they are good at explaining things they can explain the difference clearly in a way people can understand and relate it to other examples of things in life. 

[CMdeux]

Ahhhh-- but (and I say this recalling many people in the generation older than us) those people who drove drunk back when it was socially just a "personal choice" weren't irrational either.  Not really.

They really believed that they were being rational in what they were basing their decisions upon.

And while I agree that in a perfect world, a physician should be able to take a fifteen page manifesto (which may include everything from fairly nuanced statistical risk modelling to out-and-out bizarre and clearly impossible things) and calmly, patiently address each item one by one, the simple reality is that there is NO TIME for that in modern medicine.

SO yeah-- I'm fine with that solution, but pragmatically, I have to say, okay, but even ONE of those people in a day puts my physician at a place where s/he can't see three other patients.  At least.  What if I have to wait another two MONTHS for an appointment because there are a bunch of those people?

That, too, has costs for others.  Besides, not all physicians are great educators, when you get right down to it, and many of THEM aren't vaccine experts by any means-- but they do read practice parameters and the like.  So can they answer EVERY off-the-wall thing that a patient reads on the internet?  Most certainly NOT-- and even if they go and look it up, or ask an expert, that's yet more time devoted to it.

  So I'm a bit impatient with this nonsense-- because that is what it is. If they have "concerns" after reading at the CDC, etc. then I'm not sure what to say to that.  I guess that I do sort of think they aren't all that bright.  I'm sorry, and I know that seems mean.  But at that point, I do have to sort of shrug and point out that they ought to listen to people who are, and hopefully not waste SO much time in the process that those people spend their entire lives patiently explaining and explaining things that are really fairly obvious.

NONE of the "vaccines are not safe" rhetoric has any backing to it.  So it is a waste of time, when you get right down to it.




Well, darn!  That Pediatrics paper is behind a paywall now, which is a bummer.  Library access, that'd be my recommendation on that one.

[lakeswimr]

I really want to read the article going through Dr. Bob's ideas but it won't let me see the full text.  I registered but still can't see it.  What can I do to read it?

[lakeswimr]

Ahhhh-- but (and I say this recalling many people in the generation older than us) those people who drove drunk back when it was socially just a "personal choice" weren't irrational either.  Not really.

They really believed that they were being rational in what they were basing their decisions upon.

I don't think those people had books from doctors (MDs) saying why it was good to drive drunk and books and articles claiming statistics showed it made them better drivers.  I do not think the comparison is a good one.  I think even back then if you asked people they knew on some level that driving drunk was not a smart idea.  I think as a whole people did not realize just how dangerous it was just like driving without a seat belt and loads of other things people used to do.

[lakeswimr]

It would not be reasonable for all physicians to address this issue in that much detail but books on the subject and articles should be able to fully address the concerns of those who are not vaxing and the people writing those things should know what those concerns are.  My son's first pediatrician did a great job addressing my concerns with me.  He told me that he had read about the issue widely, that he felt vaccines were safe, that the benefits greatly outweighed the risks, that he used to not push people that hard to vax but changed after one of his patients or maybe just a child in our state died or nearly died (it is a long time ago now so I forget) of a disease preventable by vaccines.  He did not spend a lot of time talking about this with me but enough that I felt heard and I appreciated his answer.  It is common around here for people to interview perspective pediatricians and that is when this type of conversation would often take place.

There are books by MDs that say that some vaccines have more risk than the disease they are designed to prevent so if a lay person reads that and believes it I don't think that makes them an idiot.  I think that attitude will not be helpful in trying to get more people to vaccinate. 

]
And while I agree that in a perfect world, a physician should be able to take a fifteen page manifesto (which may include everything from fairly nuanced statistical risk modelling to out-and-out bizarre and clearly impossible things) and calmly, patiently address each item one by one, the simple reality is that there is NO TIME for that in modern medicine.

SO yeah-- I'm fine with that solution, but pragmatically, I have to say, okay, but even ONE of those people in a day puts my physician at a place where s/he can't see three other patients.  At least.  What if I have to wait another two MONTHS for an appointment because there are a bunch of those people?

That, too, has costs for others.  Besides, not all physicians are great educators, when you get right down to it, and many of THEM aren't vaccine experts by any means-- but they do read practice parameters and the like.  So can they answer EVERY off-the-wall thing that a patient reads on the internet?  Most certainly NOT-- and even if they go and look it up, or ask an expert, that's yet more time devoted to it.

  So I'm a bit impatient with this nonsense-- because that is what it is. If they have "concerns" after reading at the CDC, etc. then I'm not sure what to say to that.  I guess that I do sort of think they aren't all that bright.  I'm sorry, and I know that seems mean.  But at that point, I do have to sort of shrug and point out that they ought to listen to people who are, and hopefully not waste SO much time in the process that those people spend their entire lives patiently explaining and explaining things that are really fairly obvious.

NONE of the "vaccines are not safe" rhetoric has any backing to it.  So it is a waste of time, when you get right down to it.




Well, darn!  That Pediatrics paper is behind a paywall now, which is a bummer.  Library access, that'd be my recommendation on that one.

[Macabre]

I heard this on NPR the other day and I was waiting for the dad tinsay his child with leukemia (I think it's leukemia) has a right to FAPE as part of his argument that unvaxed kids should not be allowed at school.

It's a very interesting story and doesn't take long. What an amazing dad he is.

via npr: To Protect His Son, Father Pushes School To Bar Unimmunized Kids http://n.pr/1yFXlcd

[CMdeux]

This is a really interesting story-- the comments, though-- that is what was truly a fascinating look.   

http://www.nytimes.com/2015/01/31/us/vaccine-critics-turn-defensive-over-measles.html

[lakeswimr]

I read that article yesterday.  Honestly, I think they went out of their way to find people who have very poor reasons for not vaccinating.  I do not think M. Foster is representative of the reason people don't vax.  And nearly all anti-vaxers get tetnus from what I know.  Many who don't vax are not into natural foods or essential oils.  Certainly some are but those things do not all go hand in hand.

I think that article will make anti-vax people feel they have been stereotyped as idiots and painted by wide brush and turned off.

[CMdeux]

Well, possibly-- but do understand that at some locations in the west-- in the locations where measles cases are out in the community, these people DO exist, and they really are that wacky.

They seem to be not entirely unrepresentative of the typical variety out west, actually.  I wish that I could say otherwise, but that's also my impression, living where I do.     My DH is already trying to figure out if he can tell a coworker who often has his child with him at work to keep that (unvaccinated, Waldorf) child the hell away from him in the event that we have measles cases in our community...  and we've concluded that such a thing is probably going to be a no-win situation for my spouse, who has an underlying medical condition.    The entire thing is making us EXTREMELY nervous. 


Costs of containment:

Whoahhhhhhh.... ouchie-ouchie-ouchie.

Vaccines just plain work.  And they are actually really, really safe, too.    Repeating this one here.

Okay, okay-- along with the fun cartoon.  I love married to the sea:



In all seriousness, though-- please read that very well-referenced blog post written in April by Scott Gavura, who is a Canadian pharmacist. 


An interesting previous blog post by Scott notes:

Are the anti-vaccine tactics effective?

If we accept that decisions to vaccinate are based on an evaluation of the risks of both commission and omission, then we should ask if exposure to anti-vaccine information has a meaningful impact on perceptions of the safety of vaccines. There is some literature that has studied this question. An interesting paper published earlier this year by Betsch and colleagues set out to prospectively measure the impact of anti-vaccination websites. They recruited 517 internet users (from sites for parents or those interested in medical information) and compared risk judgment and vaccination intentions before and after viewing different websites. (The evaluation was in German and used German websites. ) Users were directed to view a vaccine-critical website, or a neutral website, and then evaluated again.  The authors found that viewing anti-vaccine material for only five to ten minutes increased the perception of risk of vaccination, and decreased the perception of risk of omitting vaccines, compared to viewing neutral websites. It also lowered vaccination intentions.

Overwhelmingly, policy analyses of the anti-vaccine movement have centered on the need to address fears by providing reliable, accurate understandable information. But if H1N1 taught us anything, it's that traditional public health advocacy and messaging is probably insufficient to deal with anti-vaccine tactics used today. We believe that providing the facts alone will be effective, but this tactic is probably ineffective when responding to unfounded fears. Providing factual information, and correcting misinformation needs to be at the core of our advocacy, but it alone does not address the strategies used by anti-vaccine advocates.  It's the reality we need to accept if we're going to effectively counter these messages.

Conclusion

One of the biggest drivers of health behaviors is risk perceptions. Anti-vaccine information effectively shapes this, and science advocates need more effective responses. The opportunity to get a real-time understanding of popular anti-vaccine sentiment could help us improve our responsiveness. But unless we focus on prospectively influencing the key factors that drive decisions about vaccination, we'll continue to struggle.

[LinksEtc]

Evidence of peanut proteins in vaccines

TO anyone reading:  this is what is SO dangerous about looking for information about vaccination on the web-- people like this ABOUND, and most of them have exactly no self-awareness when it comes to the limitations in their ability to accurately read and understand professional literature in proper context.    They fail to understand that just because something is in writing, just because that writing exists within an archive-- does not make it currently the best available explanation.  Sorry, but you really do have to have all that advanced education when you play in the deep end of the pool.  That's a bummer for laypersons wanting to challenge paradigms, I realize-- but there are people who have a few decades invested (who are probably smarter than you), and who regularly invest 50 to 80 hours each week on this stuff, and they do NOT get the same thing out of reading those references.  In fact, they shake their heads over this kind of thing. 

It certainly gives ME a headache.  It's whack-a-mole.    And really, this 2008 blog post about the exact same phenomenon is a good demonstration of the kinds of tactics used here.  While it never gets old for those moles, it sure gets old for those of us holding the mallet.   

Please stop this.  A community whose children are at elevated risk from respiratory diseases, some of which are vaccine-preventable-- a community which has one member who has lost a child to such an agent-- this is just rude. 

[SilverLining]

I love Scott the Pharmacist. I follow him on twitter.

[LinksEtc]

Tweeted by @ScienceBasedMed



Warning - some language in this one ...



"Antivaccine cardiologist Jack Wolfson and the resurrection of false balance about vaccines...again!"
http://scienceblogs.com/insolence/2015/02/02/antivaccine-cardiologist-jack-wolfson-and-the-resurrection-of-false-balance-about-vaccines-again/

Ooops, CNN did it again. Yesterday. In a story by Elizabeth Cohen and Debra Goldschmidt entitled Arizona measles exposure worries parents of at-risk kids CNN couldn't resist giving the vile Dr. Wolfson more national exposure.