In the modern era, some of the greatest threats to humanity in the form of disease had been either eradicated or were on the verge of eradication by virtue of vaccination – polio, smallpox, measles, once a grave fear or a deadly epidemic, were non-existent. But in recent years we have seen, first, a recurrence of whooping cough back in 2011 in California, which was the worst outbreak since 1947. Now it is measles.
The culprit is multifold, but there is an alarming resurgence of parents refusing to vaccinate their kids. It has been called the “anti-vaxxer movment.” It has been fueled by misinformation in the press, the internet and now even from some enterprising politicians.
Republican Speaker John Boehner was forced to emphatically call on all children to be vaccinated against diseases and for the parents to declare that they are not part of the “anti-vaxxers,” after two high-profile Republicans who may run for president – Kentucky Senator Rand Paul and New Jersey Governor Chris Christie — opined that parents should have the choice as to the decision of vaccinating their children.
But one Republican Congressman, John Fleming of Louisiana, countered, “If it’s a personal choice, that would mean you could also dump your sewage and trash in the middle of the street. Of course, you’re not allowed to do that, are you? It’s against the law. Why? Because of public health.”
I very strongly oppose the government’s intrusion into the private lives of citizens. However, the government has the duty to protect public health and people failing to vaccinate their children represent a clear danger to public health.
There is a threshold of vaccinations below which the public is at risk of severe outbreaks. If it were only a matter of the people who willfully made these choices suffering the consequences, then perhaps I would be more sympathetic.
The problem is that the people hurt are largely innocent children – first, the children of parents withholding the vaccination, and, second and perhaps most significantly, infants who are too young to receive the MMR vaccine (measles, mumps, rubella).
What fuels this? A patent misunderstanding of science by parents who are educating themselves based on flawed articles on the internet and word of mouth. Some have been critical of the health care system which has not effectively communicated strong counterarguments.
One study of 1500 parents back in 2011 showed that one quarter of them held the belief that vaccines can cause autism in healthy children.
We have in the past noted the sad state of science education in schools which aids and abets the fundamental misunderstanding of science in critical public issues – from climate change to evolution to mandatory vaccination against childhood diseases.
There is a huge and growing gap between the US scientists and the American public as embodied by a Pew Research Center. In recent years, some have suggested a liberal-conservative split on science, but the Pew Research Center did not denote such a split.
For example, on one end, 87 percent of scientists believe that global warming is anthropogenic, but only half the public believes the same. On the other hand, on what to do about it – 66 percent of scientists favored building more nuclear power plants compared to 45 percent of the public. Eighty-eight percent of the scientists surveyed said it is safe to eat genetically modified foods, while only 37 percent of the public say it is safe, and 57 percent say it is unsafe.
The gap on vaccination is not quite as large. Eighty-six percent of scientists favor mandatory childhood shots while 68 percent of the public do.
But that 68 percent is sufficiently low to cause real health issues.
A 2011 article in Scientific American focused on three recurring themes for those not wanting to vaccinate their children. One group believes that their children are not at risk for certain diseases. Others believe that some diseases like chicken pox and measles are not serious enough to require vaccinations. And then there are those who worry about the safety of vaccines.
They conducted a series of studies and “found that unvaccinated children were roughly 23 times more likely to develop whooping cough, nine times more likely to be infected with chicken pox, and 6.5 times more likely to be hospitalized with pneumonia or pneumococcal disease than vaccinated children from the same communities.”
They conclude, “The parental decision to withhold vaccination places youngsters at greatly increased risk for potentially serious infectious diseases.”
Furthermore, “These results also show the flaws in the ‘free rider’ argument, which erroneously suggests that an unvaccinated child can avoid any real or perceived risks of inoculation because enough other children will have been vaccinated to protect the untreated child.”
In 1998 in the Lancet, one of the most prestigious medical journals in the world, Andrew J. Wakefield and 12 colleagues proposed that the measles vaccine could cause autism in susceptible children. However, after publication other researchers were unable to reproduce his findings or confirm his hypothesis.
As the Scientific American article notes, since then, dozens of studies have shown that vaccination does not cause autism. They note, “It is rare in science that published scientific findings have been so thoroughly, and publicly, disproved.”
More interesting, the Lancet would retract the article in 2010. The co-authors “no longer vouch for the study findings.” And “Wakefield himself was accused of falsifying the data and lost his medical license.”
This was a real scandal, as it turns out (you can read a synopsis in Wikipedia), but sadly the damage was done.
“Despite the complete dismantling of Wakefield’s vaccines-cause-autism hypothesis, public skepticism about vaccination has only increased as new speculative theories have been put forward,” Scientific American continues.
They argue “That this cycle—debunked links followed by ever grander speculation—keeps repeating itself is a clear indication that the scientific community is more reactive than proactive when engaging the public about vaccine safety. Investigating narrow, specific theories about vaccines does not seem to provide adequate reassurance to parents with broad and vague worries about vaccines.”
Senator Richard Pan, just elected to represent West Sacramento and parts of Sacramento in the State Senate and also himself a pediatric doctor, has authored two bills that at least will help.
First, in 2012 he authored a bill that was passed into law in 2013 and took effect in 2014 that requires parents to talk to a licensed health care practitioner before they can exempt a child from school vaccinations. His office believes that has reduced the use of personal belief exemption by 20 percent in short order.
Now Senator Richard Pan and Senator Ben Allen have gone further and taken measures that would repeal the personal belief exemption.
“The high number of unvaccinated students is jeopardizing public health not only in schools but in the broader community. We need to take steps to keep our schools safe and our students healthy,” said Senator Ben Allen.
I completely agree with the senator. This is a public health issue and those withholding vaccinations from their kids are putting many more people at risk.
—David M. Greenwald reporting
And let’s not forget that Obama and Hillary Clinton were concerned about autism and the effects of vaccines during their 2008 Presidential run.
http://www.nydailynews.com/news/politics/obama-hillary-questioned-vaccines-2008-elections-article-1.2102004
BP
“Both President Obama and Hillary Clinton were cautious in 2008 regarding vaccines and their connection to autism, a much different tone than the pair put forward on Tuesday.”
While I am disgusted that this issue has become a political football, since you have chosen to attempt to make this a partisan issue by bringing up the Clinton’s 2008 position, I would like to clarify the timeline.
1. 1998 – Lancet publishes Wakefield’s article linking the MMR vaccine to autism and some intestinal conditions.
2. 2004 – A contributor to the Sunday Times identifies a possible conflict of interest involving Wakefield’s research. This triggers further investigation into Wakefield’s medical practice and publications.
3. 2010 – The General Medical Council found, amongst other findings, 4 counts of dishonesty and the statutory tribunal ruled that Wakefield had “failed in his duties as a responsible consultant” and had acted both against the best interests of his patients and “dishonestly and irresponsibly” in his published research. The Lancet then fully retracted his article noting that elements had been falsified. Again, this did not occur until 2010.
Therefore, while it would have been reasonable to take a cautious stand in 2008, subsequent information has made it highly unreasonable and irresponsible to take that same stand today. Fortunately there are members of both parties who are doing the right thing and encouraging vaccination. This includes most of the Republican leadership.
interesting that bp went there when david clearly had given props to boenhner and fleming for pushing back against christie and paul. he was clearly arguing this wasn’t a republican argument. but bp wanted to turn it partisan. don’t get it.
Um, it looks like David made it a political issue:
I’m just inserting a little balance here is all. Have a nice day.
in fact, he tried to make it not a partisan case by quoting two republicans on his side of the issue rather than quoting christie or paul. you’re completely wrong.
Really, Boehner was forced……..
I guess your read of it is a little different from my read of it.
Forced by whom BP?
Forced by Christie and Paul.
A little more balance. http://www.nytimes.com/politics/first-draft/2015/02/03/where-do-potential-2016-presidential-candidates-stand-on-vaccines/
BP
I am having a lovely day, thank you. You also ?
My comment was not about “who started it”. My comment was that I do not appreciate public health issues being turned into political footballs to play to one’s constituents whether their views are scientifically sound or not. To me, it doesn’t matter which side is doing the manipulating of information, it is that manipulation occurs and I dislike this use of “science”. I actually believe that you undermine your own point when you post information without regard to the relevant timeline and that this does not represent “balance” but is misconstruing the information.
A patent misunderstanding of science by parents
It’s also fueled by a woman’s mistrust of her doctor’s advice. My mom was told repeatedly by her beloved doctor that thalidomide was safe. She was also convinced to try D.E.S. My older sister has to have special testing for the rest of her life, because she is a D.E.S. baby. My mother in law was told with absolute certainty that she would live only another three years, tops, with her bone marrow cancer. She beat all odds and lived seven years. When my ninety five year old mom slipped, hit her head, and was in a medically induced coma, the doctors at Marin General advised me it was time. She had signed a D.N.R. Then my daughter came to visit, I told my mom she was coming into the room, and my mom turned her head in the direction of the door. I don’t know what to believe any more.
I did choose to vaccinate.
I just don’t completely trust what the experts tell me. Oh, yeah, and my pals in college were told the copper IUD was perfectly safe, too. Shall I tell you which ones are now sterile? My friends were advised that their son’s anti depressants were safe for a teenager. I don’t want to talk about that anecdote.
Tia, I have great respect for you. But please tell me why your expert opinion is right and trustworthy this time. Thank you.
sisterhood
“Tia, I have great respect for you. But please tell me why your expert opinion is right and trustworthy this time. Thank you.”
What I will tell you is what I tell all of my patients. First, I never tell them that I am “right”. What I tell them is that I am providing them with the best available current evidence based information in my field. I also inform them that what I am providing may change over the years as more studies are done and more information acquired. So what a patient may interpret as “mixed messages” is actually advancement in the field.
When I post here, I often cite Up to Date when I am commenting on subjects outside my specialty. This is because I do not, and do not pretend to read the original articles outside my specialty and therefore rely on the continuously updated information provided by the reviewers from the specialty in question.
What I have found over the years is that when what I say is that there is a 99% chance that there will be a given outcome, what people hear is that I said it would absolutely occur. They interpret what I have said is a guarantee or a promise which I almost never make.
It is very important when making medical decisions to understand that there are very few absolute guarantees due to individual physiologic variation. And there can be misunderstandings based on different degrees of medical understanding. For example, I guarantee that a woman who has had a hysterectomy will never again have a period ( meaning a shedding of the lining of the uterus). However, this does not guarantee that she will never again have any vaginal bleeding since the uterus is not the only genital organ that can bleed.
So with all the above disclaimers I will now tell you why I believe that vaccination is the safest course of action not only for the individual, but also for the society.
1. These diseases are disabling or potentially lethal.
The viral diseases for which we have effective vaccines and which are readily transmissible by inhalation ( measles, mumps, rubella in the MMR), and pertussis are not “benign” as is commonly claimed made by some of the anti vaccination activists. Another common comment made is that they are “natural”. Well, so are heart attacks, cancer, pneumonia, diabetes and a whole host of other diseases that can kill or permanently disable. People frequently confuse the word “natural” with “desirable”. Very few of us want our children to die or become permanently disabled from a “natural” cause.
2. Vaccination is effective prevention
The statistics on the decrease and in the case of measles, near eradication of the disease as posted in previous statistics by Don is undeniable. What those who argue against vaccination are missing when they state that the incidence is so low as to be negligible is the underlying reason. It was the policy of nearly universal vaccination that allowed the numbers to be as low as they have been. Stop vaccinating and the incidence of the disease will rise as we have just seen.
3. The vaccines are safe
What the statistics also tell us is that the incidence of severe reactions to the vaccines are very small and that most of these are completely avoidable by screening for egg allergy which accounts for nearly 100% of the anaphylactic reactions to vaccines processed with egg albumin. Screen out those with known egg allergy ( which is universally done prior to immunization ) and you avoid this problem.
4. There is no evidence that these vaccines cause or are even related to autism.
As has been pointed out repeatedly, the study done by Wakefield, was at best never been able to be replicated, and at worst is believed to have been totally contrived and has been repudiated by the Lancet and not held to be valid by any pediatrician that I know.
So in summary, what we have is extensive epidemiologic data that demonstrates that rates of these diseases decline when the immunization rates are high ( >92% in the case of measles), and can rapidly increase to epidemic proportions when the immunization rates drop, knowledge that the diseases in question can have permanently disabling or lethal consequences for the most vulnerable, and with the exception of anaphylaxis induced by egg allergy which is completely preventable, no credible linkage to any other serious adverse consequence.
What I cannot guarantee is that any given individual will not have an adverse outcome. What I can guarantee based on the current evidence is that an individual is statistically safer if they choose to be immunized and that our community is much safer and less likely to experience an epidemic if all of those who are eligible for vaccination opt in.
sisterhood
At the risk of sounding nit picking or arrogant, I want to make one small correction to your post in the interest of not misleading anyone about current contraceptive safety.
There was an IUD on the market which was associated with infection and infertility. It was called the Dalkon shield and is no longer on the market. The problem was a design flaw in the type and configuration of strings of the IUD. This led to numerous infections and cases of infertility.
This never occurred with the copper containing IUD known as the Paraguard which is associated with a very low rate of infection, almost invariable associated with poor placement technique and or subsequently acquired STD, and is still on the market. I only bring this up so that no one will confuse the two.
Thank you for correcting me. It was not my intention to spread false information about IUD’s or any other kind of safe contraception.
Even a contraceptive as safe as the sponge had its flaws, somewhat humorously brought to the attention of millions of viewers of Seinfeld repeats! Ya gotta love “Elaine”.
Hope all you guys out there are “sponge worthy”.
By “poor placement technique”, you are referring to the medical professional installing it. They were not installed by the patient, like diaphrams or sponges. A medical professional installed IUD’s in a medical office. So if the IUD was installed incorrectly, it was not the woman patient’s fault, in any way. Maybe I am finger pointing, blaming right now, rather than moving on and collaborating.
Maybe most young moms don’t have direct experience with Thalidomide or D.E.S. or the Dalkon shield or Paraguard or even faulty sponges, that got stuck in one’s upper vagina. But young moms have an older mom or grandmother who probably remembers. So I think a really strong public campaign to educate these women is in order. Even more than we are currently doing with the measles infection. Because some moms are very inquisitive and skeptical of expert medical opinions.
Thank You.
I would like to hear from some Davis parents who have chosen not to vaccinate; what are their reasons?
I strongly believe in vaccination for all the reasons that have been stated, and accept the retraction of the the Lancet article for all the reasons stated at the time…..however I can understand (before the retraction, when it was a ‘credible’ study) why some parents with autistic children, some with more than one, would grasp at the notion that the vaccines caused the condition.
My daughter has OCD and during the time we were struggling with this, a report came out linking untreated strep infections to the condition. I too grasped at the notion; thinking back to any strep infections she may have had, how quickly they were treated, etc. Why? I think partly to understand what was the cause of this bizarre occurrence in our lives and partly to place blame other than with us. Silly I know but ‘if you’ve never been there’ you can’t know completely….so I guess the point of my post is to have compassion for the parents with autistic children, not to agree but to understand and in that way maybe we can affect their decision in a healthier way.
And to ask for others’ reasons, especially in Davis.
If Elizabeth is following along, I would also be interested in her take on this topic. She is the only commenter here of whom I am aware who has background in both traditional western medicine and also in alternative medicine. Any thoughts Elizabeth ?
Tia, I’m afraid I don’t have any particular expertise in the area of vaccine safety and efficacy, and since I don’t treat children, it is not an issue in my own practice. My own children are all fully vaccinated so it is not a personal issue for me either. I do, however, frequently work with parents of autistic children by virtue of my expertise in a particular nutritional protocol that is often used as part of a comprehensive treatment program for autistic children. I can tell you that these parents are overall highly intelligent, articulate and more often than not highly educated. I am impressed and humbled by their complete devotion to their children, often giving up high powered careers to stay at home and devote their lives to the care and treatment of their children. So I have some insights into the passion that these parents have in this particular area. It is not because they are “conspiracy theorists” or “loons” as was recently claimed in the media by a leading pro-vaccine advocate: https://www.youtube.com/watch?v=ytT3xUvuHwI . Their passion comes from their own personal experience, which usually goes something like this: their child was perfectly normal, the child received a certain vaccine (these parents were pro-vaccine at one time), and the child was never the same again, sometimes regressing into a severe autistic state, and their lives have never been the same.
I can share a couple of things that I would encourage you to read to gain some insights into the thinking on the other side of the issue. A physician, Jamie Deckoff-Jones MD, recently posted this overview http://www.x-rx.net/blog/ with links to many articles and studies, in particular, information about the fraud in MMR studies at the CDC which will be the subject of upcoming Congressional hearings. One of the CDC whistleblowers, Dr. William Thompson, was recently granted immunity and will testify before Congress about how he and his colleagues covered up a link between autism and the MMR vaccine in African American boys in the landmark 2004 DeStephano study published in the Journal of Pediatrics. You will also find the link to the latest information about the ongoing litigation against Merck by CDC whistleblowers who allege massive fraud in the MMR vaccine testing program. Also casting doubt on the integrity of the CDC is the revolving door between the pharmaceutical industry and government, the latest being Julie Gerberding, former director of the CDC, who is now head of vaccine safety at Merck. All of these things cause parents and concerned others to be extremely skeptical of the CDC and its recommendations.
As for the contention that there are “no studies” on the other side of this issue, the other side would refer you to this meta-analysis: http://www.ncbi.nlm.nih.gov/pubmed/22336803
and this collection of 86 studies on the subject as an example:
http://www.scribd.com/doc/220807175/86-Research-Papers-Supporting-the-Vaccine-Autism-Link
I believe that there is much more to come on the subject of vaccine safety and efficacy, especially once the Congressional hearings begin and we hear from CDC insiders about what has really been going on there. We desperately need to have government agencies that we can trust before we are ever going to convince people that the recommendations being made are coming from science and are not being driven by profits.
Thanks Elizabeth
I really appreciate your provision of sources from the cautious regarding vaccination camp and wanted to acknowledge your post.
I am in complete agreement with your comment about the intelligence and caring of the parents on both sides of this issue. It is possible to look at a lot of studies and information and come to opposing conclusions, especially if what one is seeking are absolutes ( of which I believe that there are none given that science is an every changing process of data accumulation and interpretation)
I think that much of the controversy on this topic has been generated by the outliers ( those in the “the government doesn’t care about your children and are invariably lying to you” camp and those who either state out right or imply through their statements that those opposing vaccination are “loony”).
I do not know any responsible physicians who adhere to either camp. The question for me is not are vaccines 100% safe as Matt had asked me. The answer is “of course not”. Nothing in life is 100% safe including lying in bed ( check out number of falls from bed resulting in serious injury). The question is which is the safer course both for the individual, and for the society.
What I do know is that both sides are prone to simplify their own positions and vilify the other side. In the few minutes I have before leaving for work, I skimmed the X Rx Blog piece that you posted and just on the quick skim noted that the author accused pro vaccinators of using “sleight of hand” instead of science, and then proceeded to use at least three “sleight of hand” word manipulations in her own arguments.
Given time, I hope to write an article on vaccination that will provide some sense of balance to this very contentious issue.
I look forward to your article, Tia.
Yes, please, compassion. A friend of mine read a report linking vitamin D deficiency with M.S. Since her daughter has M.S., she felt bad about moving their family to cloudy Portland. and letting her kids drink an occasional diet coke rather than 3 glasses of milk every single day. Compassion, please.
SODA
“I guess the point of my post is to have compassion for the parents with autistic children, not to agree but to understand and in that way maybe we can affect their decision in a healthier way.”
I think that this is a very astute observation and I am very glad that you brought up this point. I frequently have to address this issue of the proximity effect which is much more powerful than any statistic that I could ever quote. If a person perceived as “close” has had a bad outcome, that will influence a person’s decision making far more than any medical evidence that I can supply no matter how statistically overwhelming.
If a patient has a friend who had a blood clot while on a birth control pill containing both estrogen and progesterone, I will never even try to convince her that this does not change her risk one iota. What I will point out is that while it would still be statistically safe for her, another option would be to consider a hormonal preparation that does not contain estrogen. Once she has heard her concern validated and has heard that there are other effective options that do not carry the same risk she is much more likely to make a safe and wise decision than if I merely state that she shouldn’t worry or that she is “wrong”.
Add to the proximity effect the issue of perceived guilt ( which as a mother I know only too well) and you have an even greater need to start from a position of empathy, understanding and compassion accompanied by as you point out a consistent adherence to the best available evidence.
Key riced in crinoline. How many kids do you see in iron lungs or wearing bridge trusses on their legs?
That’s how I know the experts are right.
;>)/
Biddlin
“Key riced in crinoline.”
What does this mean ?
“Key riced” = Christ. Crinoline makes it a colloquial alliteration. He’s basically saying “Jesus Christ” as an exclamation. Just as my mother often said “Gee willikers and little fishhooks!” http://www.urbandictionary.com/define.php?term=gee+willikers
Thanks Don.
My mother also used to say “Gee willikers” and I never knew what prompted that either. I also now have learned to check urban dictionary when a quick Google search does not suffice.
The expression of choice in my home was “Judas Priest” … often with an exclamation point.
I’d never take anyone’s lord’s name in vain, Don. That would be the extreme of impertinence. Crinoline, of course, is a popular 19th century, stiff, fabric, used for petticoats.
;>)/
Biddlin, it is my understanding that the fabric industry is experiencing an upsurge of Born Again Crinoline.
Crinoline that is particularly stiff/rigid is often referred to as fundamentalist crinoline.
;>)/
sisterhood
“Even a contraceptive as safe as the sponge had its flaws,”
This is true. There are no completely safe means of contraception. However, what many people fail to realize is that pregnancy itself is not a “safe” condition and is actually statistically more risky than any of the currently available contraceptives.
Just a few of the conditions that have a higher incidence during pregnancy than in the non pregnant state and some which are potentially lethal and unique to pregnancy:
Diabetes, high blood pressure, stroke, pulmonary embolism, kidney infections, toxemia with all of its potential complications, hemorrhage, all placental related conditions, ectopic pregnancy.
So when most people write about the dangers of contraceptives what they are neglecting to consider are the risks associated with not using a contraceptive. This is equally true of vaccination. People who are opposed focus solely on the purported risks of vaccination while not considering or trivializing the risks of not being vaccinated which are far, far greater.
” “…pregnancy itself is not a “safe” condition and is actually statistically more risky…” ”
Hear, hear. Agree.
Do any of you think that the recent measles outbreak will itself “cure” the problem of too many antivaxxers? I’m certain many parents are rethinking their decision to not vaccinate, and future parents will remember this outbreak when they are considering their options. I choose to vaccinate, but I’m a little uncomfortable with the idea of injecting people against their will.
Also, how many more deaths are caused by the flu each year? If you want to pass some legislation, what about imposing fines on people who board planes, go to work, or send their children to school with the flu. A law like that would probably have a bigger impact on the spread of disease in communities than a mandatory measles vaccination.
Well, one way of looking at the current outbreak is that it will affect those whose parents chose not to vaccinate them (among others). They will then gain immunity, and perhaps they will realize that it would be better to vaccinate THEIR children, rather than have their children experience what their parents subjected THEM to. Give it time.
Grant Acosta
You bring up two very good points that are relevant to public health.
1. I choose to vaccinate, but I’m a little uncomfortable with the idea of injecting people against their will.”
I also agree that people should not be injected against their will. Those people who refuse should then agree not to enroll their children in school ( they can be home schooled) or take them to any public venue or on any form of public transportation. Their right to individual refusal should be absolute. The right of the remainder of the population to be protected from them should also be absolute.
2. “how many more deaths are caused by the flu each year? If you want to pass some legislation, what about imposing fines on people who board planes, go to work, or send their children to school with the flu. A law like that would probably have a bigger impact on the spread of disease in communities than a mandatory measles vaccination”
This implies that you believe that precautions against the flu and precautions against measles are mutually exclusive. Why not work on adopting best preventive and protective policies for both diseases ?
The woman who knowingly sent her very sick, feverish five year old to No. Davis and infected my daughter with chicken pox- and my asymtomatic daughter then visited her 88 year old grandmother in an assisted living facility in the bay area, with approximately forty other vulnerable seniors- what should happen to her, in the future? Plz don’t tell me there is now a safe chicken pox vaccine. This is an example only of parents who KNOWINGLY ignore their sick child’s fever and other symptoms because of high income work priorities. Davis parents who could bite the bullet and hire an RN to watch their sick child, for God’s sake? What law would help these narcistic parents? No law.
As to vaccines, a quick check of Web-MD says there is a MMRV vaccine. I know I, my spouse, and all our kids had chickenpox. Recently, got my shingles vaccine. Spouse hasn’t, but considering. Kids are ~ 30 years away from thinking about it.
Where is Frankly when we need him? The solution to this problem is very simple … a market-based solution.
Specifically, health insurance companies should establish their base health insurance premiums with the expectation that non of the insured persons under the policy get vaccinations. The actuarial calculations would use the incidence of the various diseases from the period prior to the discovery/creation of the vaccine for that disease. Treatment costs for the disease would be added to the actuarial projection of healthcare costs used to determine the premiums. When/if the holder of a policy states that they have had a vaccination, a vaccination discount would apply to the monthly premium.
We do this currently in auto insurance policies with drivers education classes. I suspect (but don’t KNOW) that similar discounts apply basd on smoker/non-smoker status.
Insurance is SHARED RISK at work. If a person wants the freedom to willfully accept additional risk then they should share in the cost of that willfully accepted additional risk. Bottom-line, use the marketplace dynamics of the healthcare insurance marketplace.
“…a market-based solution…”
I almost spit water out of my mouth to avoid laughing at this.
market-based rather than imposition-based
choice-based rather than regulation-based
Are you opposed to choice?
You would want to apply the same logic to smokers, the obese, hang gliders, people who jump out of airplanes, competitive athletes, people who drive compact cars, SCUBA divers and cyclist who risk their lives riding in traffic. Insurance is meant to share the risk. The larger the pool the better. Self-employees people have been in a small group for decades, paying very high rates because they could not get into a large group because the free market was free to exclude them regardless of their lifestyle or personal health. Sorry, but a punitive approach isn’t useful.
Matt
Sorry, I see the logic of your market based approach, but am unwilling to risk public safety on whether or not someone is wealthy enough to “buy” their way out of immunization. It only takes a handful of rich non immunizers to put the entire community at risk. Not acceptable from my point of view.
There is precedent for forced compliance with either immunization or isolation.
We do not allow people to drive 200 mph on our freeways regardless of how much they are willing to pay for insurance. Dead is dead regardless of what their premium is. Those who want to risk only themselves by driving 200 mph on their own property are of course welcome to do so.
Tia, your 200 mph example is not exactly correct. People can drive 200 mph on our freeways as long as they are willing to “pay the consequences.”
With that said, what is your response to the people who point out that some vaccinations are not 100% safe?
For the record I have never considered not getting a vaccination … and all my vaccinations are current.
“People can drive 200 mph on our freeways as long as they are willing to “pay the consequences…”With that said, what is your response to the people who point out that some vaccinations are not 100% safe?”
1972 Anaheim Drivers’ Ed taught me, if you are on a safe highway in certain conditions you can legally drive faster than the posted speed limit. You can also get a ticket for driving too far under the speed limit on the freeway.
One can also get a well deserved ticket on the causeway in heavy fog if driving the posted suggested maximum speed limit.
Tia, step back for a moment and do the math. What is your guesstimate of what the annual healthcare costs associated with polio were prior to Jonas Salk and Albert Sabin?
Let’s estimate those costs using the example of the iron lung. in the 1930s, an iron lung cost about $1,500 – about the same price as the average home. The cost of running an iron lung was also very high, as patients were encased in the metal chambers for months, years and sometimes for life: even with an iron lung the fatality rate for patients with bulbar polio exceeded 90%. So if we use current Davis home prices as a proxy, the one time insurance costs for not vaccinating with the polio vaccine would be between $300,000 and $400,000, and on top of that you would have annual operating costs for the iron lung. Someone would have to be very rich to be able to add those costs to their health insurance premium … very rich indeed.
Your iron lung analogy reminds me of the days of costly dialysis treatments. And HIV drugs.
sisterhood
I agree that the example that you posted is egregious behavior and put many individuals at risk unnecessarily and selfishly. You are correct that no law can ever be devised which meets all contingencies. However, this is one anecdote, and anecdotal bad behavior should never stand in the way of public policy that can minimize risk. I am unclear regarding your intent with this example. I doubt that you are using it to belittle attempts to minimize risk since you clearly believe that your relatives and other vulnerable individuals were placed at risk. Can you clarify your intent ?
“Plz don’t tell me there is now a safe chicken pox vaccine.”
I am also unclear what you meant by this comment. Of course it would be better if all parents kept their ill children at home and stayed home themselves when they are ill. Since not everyone always follows all the sensible rules, it behooves us as individuals to take those preventive measures that we can. So although you asked me not to do so, here I have posted some information from Up to Date on varicella ( chicken pox ) immunization last updated 6/14, which, yes, is considered relatively although not 100# safe as I posted previously to Matt.
“Impact of vaccine on clinical manifestations — Approximately 20 percent of children who receive one dose of varicella vaccine may develop varicella infection, known as “breakthrough disease”, if exposed to VZV [15,16]. A report on the clinical and epidemiological characteristics of varicella in populations with increasing vaccine coverage between 1997 and 2005 identified the following trends [15]:
●In vaccinated children 1 to 14 years of age, varicella was more often mild and modified than in unvaccinated children (eg, less fever and a lower number of lesions).
●The accompanying rash was significantly more likely to be atypical in nature among vaccinated children (eg, maculopapular).
●Complications were less likely to be reported among vaccinated children than unvaccinated children.
●Neurologic complications (eg, encephalitis) continue to be rare [17].
An adult coworker came down w/ chicken pox & almost died. Maybe if he had chicken pox as a 6 or 7 year old, it would have been better? Do the children who had the chicken pox vaccination have to get a booster shot as an adult? Do the children who suffered the “real” chicken pox need the booster as an adult? What about the ten year pneumonia vaccine? Booster every ten yeas? What about the Tetanus shot?
I’m almost 60. So I need the flu shot, pneumonia shot, and tetanus shot. And chicken pox boosters? Polio booster or is that erradicated?
Thank you.
Matt
And if everyone thought in terms of mathematical models and the actual costs of their behaviors if they encounter an associated bad outcome, I would agree with you. However, in my experience much of human behavior is not driven by a dispassionate and well reasoned cost benefit analysis. If it were we would not see people driving under the influence and thus risking hundreds of thousands of dollars in Emergency Room, Surgical, Intensive Care Unit and both acute and long term rehabilitative services, to say nothing of the life destroying consequences of incarceration if they happen to get convicted of vehicular manslaughter.
I simply am not willing to subject my own well being and/or the health and well being of innocent members of the public to the false assumption that everyone is going to make the best market based decision for themselves, let alone for someone they don’t know and don’t apparently care about at all.
Tia, you use the term everyone above. Just out of curiosity, what is the target vaccination percentage that public health organizations publicly share as the threshold above which the vaccination campaign is considered to be “complete”? Is it 100%?
In a market-based insurance solution you do not need to have distributed calculation of the risks. One central actuarial calculation by the organization (ideally a single payer) providing the healthcare insurance coverage is all that is necessary. If Kaiser were offering a “vaccine premium” at its current base rate levels and a “non-vaccine premium” with the capital and operating costs of an iron lung included on top of the base rate, which do you think 99.99999999999% of the health insurance/coverage buyers would choose? The cheaper one or the more expensive one?
Matt
“People can drive 200 mph on our freeways as long as they are willing to “pay the consequences.”
I frankly don’t care whether they are or are not willing to “pay the consequences”. What I object to is their reckless disregard for the consequences that they may be forcing on others.
“what is your response to the people who point out that some vaccinations are not 100% safe?”
I think that the question is a little silly since nothing, including walking through one’s own home is “100% safe”.* The real question is which is safer, getting the immunization, or not. I have previously posted that I believe this to be an individual assessment and I counseled one patient this year that I felt she was safer not getting the immunization. She rarely leaves her rural home where she lives alone with her immunized husband who goes out to do their shopping. She does not attend church or other social gatherings and rarely has company. For virtually everyone who does not live in almost complete isolation as this woman does, the risk benefit ratio is going to fall heavily on the side of getting the immunization.
*From the CDC ”
There are inherent risks in vaccination, to be sure. But it should be all about a reasonable risk assessment. Statistically the risk from having a bad reaction to a vaccination is far outweighed by the risk of a bad reaction to the disease the vaccination protects you from. IMO, this is how the public needs it explained. The chances of having a reaction to the vaccination is X% and the chances of having a bad reaction to measles is Y%.
According to http://www.aafp.org/afp/2002/1201/p2113.html#afp20021201p2113-t1 there are 1 to 2 deaths per thousand from measles and no deaths from measles vaccine.
According to http://www.health.govt.nz/your-health/conditions-and-treatments/diseases-and-illnesses/measles/measles-frequently-asked-questions#getimmunised
“About one in every 3000 immunised young children may have a fit caused by the fever. This is called a febrile convulsion and can also happen in younger children with a fever due to any cause. The rate of febrile convulsions caused by getting the measles disease itself is much higher at 1 in every 200 children. Fewer than one child in a million develops encephalitis (inflammation of the brain) after the MMR vaccine. However, if a child who hasn’t been immunised catches measles, the chance is much higher at 1 in 1000.”
But one of the problems with all of this is the lack of credibility of medical research, as noted in the following article from the Feb 6, 2015 The Week:
“Bad week for: Believing medical studies, after a Harvard researcher used a random text generator to write a phony study and had the gibberish accepted for publication by 17 medical journals. The study’s title: “Cuckoo for Cocoa Puffs.“
Matt
“Just out of curiosity, what is the target vaccination percentage that public health organizations publicly share as the threshold above which the vaccination campaign is considered to be “complete”? Is it 100%?”
A couple of points. First target vaccination rates depend upon a number of variables including the transmissibility of the disease and the estimated effectiveness of the vaccine and probably a number of factors of which I am unaware. For measles I believe that a protective level is estimated to be 92%, but obviously the higher the actual full immunization rate, the lower the actual disease transmission rate will be.
“threshold above which the vaccination campaign is considered to be “complete”? Is it 100%?”
Wow ! I wish we could get even close to a 100% rate. However, this is obviously not the goal since there will always be members of the community who are not eligible such as infants, people with compromised immune systems and people with true allergies for which no alternative vaccine is available.
Although I am no expert in infectious disease or vaccination, I do not believe that “complete” is a term that is used within this field. At least I have never heard it used. So I am a little unclear what you are asking. I can tell you how it actually works in practice. We continue vaccinating until one of the following events occurs:
1. We run out.
2. In the case of seasonal vaccines like the flu, the flu season is determined to be over. In our area this is usually in March. I believe this is determined by some target number below which the number of diagnosed cases has fallen. Obviously we do not want to continue vaccinating when the risk of becoming ill from the particular strains becomes less than the risk of the vaccination. I am only presuming that there is some formula for determining this.
Your response makes my point. Using the 92% you have provided, do you think that if health insurance premiums include the actuarial calculation of treatment in each and every month’s premium, that 8% of the people buying health insurance will choose to avoid vaccinations and pay the higher premium amount?
Matt
I know that you did not direct this to me, but I am going to answer.
“market-based rather than imposition-based
choice-based rather than regulation-based
Are you opposed to choice?”
I am opposed to someone else’s “choice” putting me or others who do not agree with their philosophy at risk. And yes, I think that the anti vaccinators have had lots of opportunity to “make their choice” which would include voluntary self isolation if they choose not to vaccinate, which I have said repeatedly that I believe is their right. They have not chosen to do so, so now it is time to use regulation.
Tia, now apply that logic to the other key choice decision our society wrestles with. How do you reconcile those two disparate approaches to choice.
For the record, when I was personally involved in a choice decision, I chose life … but I also realize that the choice that the choice that Dianne and I made will not be the choice everyone will make.
Matt,
I am making the assumption that you are referencing abortion. Without getting into the nuances of my personal opinion, about which I have written previously, I am sure that you are aware that there is no consistency in belief about when the blastocyst or embryo or fetus attains personhood. Many people define this in many different ways. Just as very few people would call an acorn an oak tree, or a seed a flower, or an egg a chicken, there are many people who do not believe that a fetus, let alone a newly fertilized egg has the same rights as a human being capable of living separately from the mother. However, there are others who believe fervently that this is the case.
I do not believe that there is the same ambiguity about the status of an infant or a child or an adult in our society. Do you ?
I do not believe that these two situations are equivalencies. Perhaps you do. But if that is the case, that would only demonstrate my point since we would then not even be in agreement about what the underlying issue entails. The choice to terminate a pregnancy certainly affects the fertilized egg, or blastocyst, or embryo or fetus, but it does not physically threaten any other human being. Regardless of your position on abortion, it physically affects no one other than the mother and child at what ever stage of development it has achieved. This cannot be said to be true of vaccination which can affect multiple other individuals who may or may not share your beliefs. I think that it is safe to say that the dependent human being whose life is at stake does not yet have any thoughts on the matter. Therefore the situations are not even close to equivalent.
Tia, in the one case you and I are in agreement that any definition of the threshold of “success” is elusive due to the inconsistencies of how “success” might be defined. As a result we find ourselves faced with a binary decision … either we do or we don’t. In the end, our societal structures caused the Supreme Court to weigh all those inconsistencies and make that binary decision for us. In the other case the definition of “success” is not the least bit elusive because, as you have noted in an earlier post, medical science has determined that a vaccination rate of 92% or higher consistently produces “success” in preventing outbreaks of the disease. However, your proposal casts aside those findings of medical science and substitutes the same binary definition of success that the Supreme Court was forced to wrestle with in its deliberations on Roe v. Wade. As a result, I couldn’t agree with you more, the situations are not even close to equivalent, but you insist on enforcing the exact same definition of “success” in both cases … all or nothing.
David claims that 87% of scientists believe that so-called Global Warming is caused by man. Can you please give us your source?
Interesting timing, as The Telegraph in England has just published more instances of scientists / officials manipulating data (lying).
The fiddling with temperature data is the biggest science scandal ever
New data shows that the “vanishing” of polar ice is not the result of runaway global warming
“When future generations look back on the global-warming scare of the past 30 years, nothing will shock them more than the extent to which the official temperature records – on which the entire panic ultimately rested – were systematically “adjusted” to show the Earth as having warmed much more than the actual data justified.”
http://www.telegraph.co.uk/news/earth/environment/globalwarming/11395516/The-fiddling-with-temperature-data-is-the-biggest-science-scandal-ever.html
“David claims that 87% of scientists believe that so-called Global Warming is caused by man. Can you please give us your source?”
I don’t claim that. The Pew Poll that I cited claims that 87% of Scientists in their survey responded that way.
You didn’t cite your source. There are so many unanswered questions which the Warmists / Global Warmers seem to stumble with, and they seem more intent on managing our lives than actually proving their hypothesis.
Warmists get caught in record ice trying to prove that the ice sheets are shrinking (and have to be rescued); a global warming hiatus for 21 years now?; proven lies and manipulated data years ago; new proof of lies and manipulated data (posted earlier today); polar bears thrive; and more.
For years, David, we were told that 97% of scientists believed in man-made global warming, and here was a Washington Times response:
“Heartland Institute President Joseph Bast and climate scientist Roy Spencer, writing recently in The Wall Street Journal, argued that the research by Ms. Oreskes and others to produce the 97 percent figure amounted to ‘science fiction.’
They wrote: “The so-called consensus comes from a handful of surveys and exercises in counting abstracts from scientific papers — all of which have been contradicted by more reliable research.”
Read more: http://www.washingtontimes.com/news/2014/jun/17/climate-change-scientists-stand-by-97-percent-figu/#ixzz3RDl7R3ti
So in a few short months we’ve gone from 97% to 87%. Progress.
Can anyone tell me what happened to the increasing ozone hole that was supposed to burn us all alive 20 years ago? Think about it.
Google Montreal Protocol. Oh, heck, I’ll get you started: http://en.wikipedia.org/wiki/Montreal_Protocol
“As a result of the international agreement, the ozone hole in Antarctica is slowly recovering. Climate projections indicate that the ozone layer will return to 1980 levels between 2050 and 2070.[2][3] Due to its widespread adoption and implementation it has been hailed as an example of exceptional international co-operation, with Kofi Annan quoted as saying that “perhaps the single most successful international agreement to date has been the Montreal Protocol”.[4]”
Don, you’re gonna love this… I saw an article which stated that a shrinking ozone hole will speed global warming!
Yahoo: Is the Hole in the Ozone Layer Shrinking Because We Did Something Right?
“A group of scientists from NASA’s Goddard Space Flight Center in Greenbelt, Md., studied the changing chemical makeup of the hole and discovered that the relatively small area of last year’s hole—the second smallest in the past 20 years—was due to a natural variation in wind patterns, not an international agreement to stop using ozone-depleting chemicals.
“We have identified another factor that wasn’t fully recognized before, and that is how much ozone gets brought to the polar regions in the first place, by the winds,” Susan Strahan, a NASA scientist who coauthored the study, said during the annual meeting of the American Geophysical Union in San Francisco last week….”
“While harmful chlorine levels found in CFCs have decreased in the atmosphere by about 3 percentin the Northern Hemisphere and 6 percent in the Southern Hemisphere, it’s too soon to tell if that has contributed to a stronger ozone layer, Strahan says. There’s a long way to go before a full recovery can be identified.
“Ozone holes with smaller areas and a larger total amount of ozone are not necessarily evidence of recovery attributable to the expected chlorine decline,” Strahan said in a statement.
“That assumption is like trying to understand what’s wrong with your car’s engine without lifting the hood.”
http://news.yahoo.com/hole-ozone-layer-shrinking-because-did-something-000349873.html
I actually did cite my source:
More importantly, the global warming figure was not cited for the truth of the matter, but rather to demonstrate the divergence between scientists’ views and those of the public, I then move to vaccination which is the point of bringing up the study.
The bottom line is that this discussion is off-topic.
TBD–choosing the ozone hole phenomena as an example of needless environmental hoopla was a bad choice. This ozone story is one of the biggest scientific, environmental, political success stories ever.
Thru careful research of atmospheric chemistry, chloroflourocarbons were identified as the culprit in observed depletions of the antarctic (and arctic) ozone levels in decades prior to the 1980s; with a concomitant increase in observed ground-level uv exposure near the poles, particularly Antarctica. Measurements demonstrated that the chlorofluorocarbons in the atmosphere were sourced primarily from man-made emissions (the chemical half-life of typical chlorofluorocarbon molecules under typical atmospheric chemical conditions is around 15 years, if I remember correctly). International agreements phased out (by international law) the manufacture of bulk chlorofluorocarbons by the early 1990s. Since that time, atmospheric levels of chlorofluorocarbons have decreased, and concomitantly ozone levels have increased almost exactly according to scientific model predictions that were made in the early 1990s, and the ground-level uv flux at the polar regions has decreased .
The chloroflourocarbon/ozone/uv story is an enormously important historical account, demonstrating that man-made chemicals that are released into the atmosphere can have detrimental effects on most life on the planet (uv light is harmful to most life forms, including humans) , and that thru fundametal scientific understanding of atmospheric physics and chemistry, it may be possible to identify which man-made chemicals are the culprit, and what can be done to mitigate and even reverse the damage.
there is a difference between a scientist and a climate scientist. It is helpful to remember that when you consider those statistics. What difference does it make if a civil engineer or economics professor or a biological research scientist who has no expertise in xlimate science has an opinion on climate change? It is important to limit those being surveyed to those professionals competent to respond.
DavisBurns, good point. Many of those who contributed to the IPCC reports had no or limited expertise, and didn’t agree with all of the other items submitted, only their own little sliver.
Now we have a second major revelation of manipulated data.
Either way, I do think we should make efforts to keep our environment clean, just at what cost and in exchange for what. No solution is perfect, solar is very expensive and unreliable. Nuclear power is one option, so is Natural Gas.
At the end of the day, I’d prefer it to be 1 degree warmer than 1 degree cooler, but we’ve been in a holding pattern for 20 years, so right now it’s moot.
[moderator] Let’s get back to the subject of vaccinations now…
sisterhood
“I’m almost 60. So I need the flu shot, pneumonia shot, and tetanus shot. And chicken pox boosters? Polio booster or is that erradicated?
Thank you.”
I am sorry because I know that this is going to sound like a dodge, which it is, but I cannot give personal advice about immunizations. Having said that :
IMMUNIZATION SCHEDULE FOR HEALTHY ADULTS — Immunization recommendations in the United States result from policies developed by the Advisory Committee on Immunization Practices (ACIP) of the Centers for Disease Control and Prevention (CDC) (figure 1 and figure 2) [12].
ACIP statements are published in the Morbidity and Mortality Weekly Report (MMWR) and may be obtained from the CDC’s Immunization Hotline (1-800-232-2522) or downloaded from the CDC’s website. Additional advice can be obtained from the Division of Immunization at the CDC (1-404-639-8225).