The Truth About TTAV Episode Four: Herd Immunity AND MORE!

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Episode Four: Examining Influenza, the HIB and Pneumococcal Vaccines & Herd Immunity

The Cast

  • Ty Bollinger is the producer/creator of this series and a previous The Truth About Cancer series. His films and books are steeped in conspiracy theories and his primary M.O. is to stoke fears about mainstream anything.
  • Dr. Toni Bark is an MD and homeopath who sells chocolate and skincare on her website and travels the country testifying at hearings.
  • Dr. Suzanne Humphries is a nephrologist and homeopath who sells books she’s written.
  • Sayer Ji is the founder of non-evidence based website GreenMedInfo.
  • Robert F. Kennedy, Jr. is an environmental lawyer who remains convinced that the thimerosal that was removed from childhood immunizations is somehow still causing autism.
  • Dr. Larry Palevky is a “holistic” pediatrician who sells supplements at his website.
  • Neil Z. Miller is a conspiracy theorist and author of anti-vaccine books who helped his daughter self-publish a book about how they’ve spoken with aliens.
  • Del Bigtree is a self-proclaimed award winning television producer who has also produced Wakefield’s film VAXXED and a live YouTube show.
  • Barbara Loe Fisher is the founder of the poorly named National Vaccine Information Center.
  • Eric Zielinski is a chiropractor and “Biblical Health Educator” who promotes essential oils at his
  • Dr. Paul Thomas is a pediatrician who sells supplements and anti-vaccine books at his website.
  • Dr. Jack Wolfson is a “holistic cardiologist” who made a name for himself for a particularly vicious attack against vaccinating parents.
  • Robert Scott Bell is a homeopath, a podcaster, and an HIV denialist.
  • Julian Tharpe is a cinematographer.
  • Dr. Janet Levitan is a pediatrician practicing with Dr. Sherri Tenpenny.
  • Thom and Candice Bradstreet are related to Dr. Jeffrey Bradstreet, whose death by suicide they believe to be a murder to stop his disproven autism treatments.
  • Dr. Joseph Mercola runs a highly profitable online supplement store who has violated federal law by making dangerous claims about alternatives to mammograms.

The Claims

Influenza Vaccines Are Terrible

  • The film disputes the CDC’s annual influenza death estimate (typically around 36,000) as inaccurate and misleading
    • The primary dispute is that the total allegedly does not match the numbers reported in the MMWR (Morbidity and Mortality Weekly Report). Influenza, however, is not reportable in people over 18. The CDC uses estimates because influenza has a history of being underreported on death certificates.
    • Another argument is that the CDC does not report the fact that most flu deaths occur in people with preexisting conditions. People with chronic health challenges are at higher risk of developing serious flu complications. However, health people can and do die from influenza.
  • Influenza vaccine is generally ineffective 
    • Sometimes the film throws in science-y sounding sentences like: “Antibody (humoral) immunity stops the body from producing cell mediated immunity.” I don’t understand immunology, but here’s a link.
    • As proof, they cited the CDC’s 2014 statement on the inability of the flu vaccine to prevent flu that year because the virus had mutated. In fact, the changes in the virus were due to antigenetic drift, which rendered the vaccine less effective but not completely ineffective.
    • As more proof, they cite the Cochrane Collaboration (independent group of MDs, scientists, etc.) and the assertion that the flu vaccine is ineffective in their med analysis, and that for every 100 patients told that they have flu, only 7 actually have the flu. The author of this review is Dr. Thomas Jefferson (not this one), who has significant biases against the flu vaccine and has had dalliances with the anti-vaccine community. Multiple studies show that the flu vaccines is effective.
    • They also cited a 2012 study in which groups of study participants were either given the trivalent influenza vaccine or a saline placebo; the incidence of influenza was similar, but the vaccinated group was found to be “4-5 times more likely to contract a non-influenza viral infection.” One important criticism of this study is that the vaccinated group had 69 people, and the unvaccinated 46. It’s an interesting starting place for research, but not a definitive indictment of anything.
  • Influenza vaccine causes mutations at the level of germ cells, including embryos.
      • The film claims that most vaccines have never been tested for mutagenicity or carcinogenicity (causing cancer). This common anti-vaccine claim comes from a misreading of the package insert, as vaccines and their components are tested for mutagenicity and carcinogenicity in pre-clinical testing.
      • The mutations are allegedly due in part of the presence of thimerosal, which is said to be safe in vaccines (because it is) but the film deems dangerous (which is wrong).
  • Thimerosal was removed from some vaccines but added to others
      • They cite a study on pregnant mothers claiming that flu vaccines caused increased circulation of inflammatory immune markers for their babies, including schizophrenic disorder and autism. However, the study in question looked at illness from influenza and increased risk of schizophrenia and autism. Vaccination, of course, could mitigate that risk.
      • The films asserts that amount of mercury in vaccines is a toxic hazard. Thimerosal, which is sometimes used in some vaccines, is an organic mercury compound that metabolizes into ethylmercury—a different type of mercury than that we might be exposed to through fish and breathing. In vitro and in vivo studies have shown that the amount present in vaccines is safe. 
      • Th assertion that the amount of mercury that vaccinated people are exposed to exceeds legal limits set by the EPA is due mostly to the confusion between ethyl- and methyl- mercury.
      • Also, thimerosal was removed from childhood vaccines in the U.S.
  • Influenza vaccine marketing is awful
      • The film claims that the vaccine is linked to kidney failure. While there are some case reports of patients on statins suffering kidney failure after a flu vaccine, this claim is made mostly through the observations of Dr. Suzanne Humphries. If real, it would be exceedingly rare.
      • The assertion that children who have had the flu vaccine are more likely to be infected by pandemic flu is based on a 2010 Canadian study which found an association but did not posit causation.
      • The film also claims that over-vaccinating harms your ability to fight other infections (and increases susceptibility to them). It’s not clear how they would define “over-vaccinating,” There is some evidence to suggest that getting a flu vaccine in multiple seasons consecutively could reduce the effectiveness of the vaccine, but many confounding factors make it difficult to explain why this observed effect is occurring.
      • Flu vaccine is poison, say the film. Of course, the old adage that the dose makes the poison applies, and if you’ve ever watched yourself getting a flu shot, it’s a tiny amount of anything.
      • The film follows up by claiming that getting sick after the vaccine is administered is your body’s way of rejecting the poison. In fact, feeling achey and bleurghy is your immune system’s way of mounting a defense against influenza.
  • Addressed flu requirements for workers
      • The film discusses that many workers who have refused the vaccine have never gotten sick. People used toot wear seat belts and not die in car accidents, too. It’s hard to see why this is a persuasive argument. The average adult over the age of 30 will catch influenza twice each decade. It’s reasonable to believe that healthcare workers exposed to more germs than the average person would be more at risk for catching and passing along influenza.
      • The film also talks about some who have refused but subsequently taken the vaccine for job security have become ill after being vaccinated. Side effects from the flu vaccine can include headaches, fevers, muscle aches, and other feelings of unwellness that are far less severe than actual influenza.
  • Physicians don’t read the science around vaccine safety
      • The film claims that rather than reading their misinformation, doctors blindly follow CDC recommendations and information. Of course, CDC is not the only governmental agency in the world that agrees on vaccine safety. From the UK to Australia to Canada to every corner of the globe, vaccines are promoted as safe. It also must be noted that doctors learn quite a bit during residency and through continuing education when they become providers.
      • The film claims strong financial incentives for doctors to comply with the vaccine schedule
        • The claim that if 63% are not compliant, doctor forfeits a bonus from Blue Cross Blue Shield is a misunderstanding of BCBS policy. Providers pay into a pool and are reimbursed if they meet certain measurements.
        • Of course, the film says that the vaccine schedule is not about the patient, but it’s a money-driven system. For many pediatricians, however, giving vaccines is not a moneymaker.
        • As evidence, they cite Australia’s “no jab, no pay” policy. While this policy has increased vaccine uptake, it’s important to note that the Australian government offers healthcare to everyone and pays for the vaccines given.

Hib and Meningococcal vaccines

  • The speakers say that you never see bacterial meningitis or type B anymore. Like since the vaccines. Again, it’s hard to understand why they think this proves anything for them.
  • Hib only causes a handful of serious diseases a year. Again, since the vaccines.
  • The film points to problem with vaccines and the food proteins present within them.
    • The claim that food allergies have boomed since the development of certain vaccines has been studied and found to have no substance.
    • The film asserts that the Hib vaccine has peanut oil and consequently has caused food allergies. This falsehood is belied by the fact that such ingredients are, by law, required to be listed and peanut oil or any derivative of it is listed as an ingredient.

Pneumococcal Vaccines 

  • The film says that previously “harmless” strains of pneumococcal bacteria became vaccine-resistant after 7-valent pneumococcal vaccine was licensed. The strains were actually never harmless, but they become more common after the 7-valent pneumococcal vaccine came to wide use. Theses emerging strains are now covered in the 13-valent vaccine. 
  • The claim that pneumococcal bacteria are immune to the strains that Prevnar 13 guards against is easily rebutted by looking at the drop in incidence of pneumococcal disease.
  • Of course, the cast members claim that the pneumococcal vaccine has never been studied with a true placebo control group, which is incorrect.

Vitamin K and Tylenol

  • It’s important to clarify that the vitamin K injection is not a vaccine.
    • The film asserts that the vitamin K injection has been linked to childhood cancer. Reviews of the original studies making this assertion have not held up, and no study has replicated that finding.
    • The film says the shot is unnecessary because mothers can eat leafy greens to get their babies Vitamin K or babies can take oral supplements. The benefit of the injection is that there is a known quantity of the vitamin the baby’s body absorbs.
    • Another claim is that VKDB (vitamin K deficiency bleeding) is not that common. While the incidence without vitamin K supplementation is between 0.25% and 1.7%, the consequences can be severe, from lifelong neurological difficulties to death.
  • One common anti-vaccine theory is that acetaminophen (Tylenol) prevents children from detoxing and could possibly be the cause of why more boys than girls are affected by autism. The theory hinges on the idea that Tylenol reduces the glutathione levels in a child’s body. The theory was bolstered by a study suggesting a correlation between pregnant women who used acetaminophen and whose children developed autism. A third part of the theory rests on another study suggesting the acetaminophen given after vaccines could render them less effective. Many anti-vaccine theories function this way: stringing together three unrelated studies to come to a new conclusion. However, there’s no association between autism and children being given Tylenol after vaccines.
    • The film claims that incidence of autism and vaccine injury is lower outside of the US because children aren’t required to be vaccinated before age two. In actuality, a number of countries have higher autism rates than the United States. Also, worldwide immunization schedules are not a lot different from the  CDC schedule.
    • The film claims that rates of infant mortality are also lower worldwide than in the U.S. The U.S. rate is due in part to poverty and access to healthcare. Another contributor is preterm birth rates.

Herd immunity is a myth

  • Yes, this is a super common claim. It keeps coming up.
    • First, they say that the DTaP does not prevent illness or transmission in vaccinated people. In the first few years after it is given, the vaccine is about 80% effective. But it is important to note that public health tells people not to rely on herd immunity to prevent pertussis.
    • Doctors don’t know vaccine ingredients and therefore can’t evaluate safety. Next time you go grocery shopping, ask the manager for the chemical makeup of a banana. Refuse to buy it if she cannot list all of them. 
    • We’ve known for a very long time that herd immunity is super real. That’s why disease outbreaks occur where vaccine refusal is high.

Next up, Episode Five: Considering the HPV and Hepatitis B Vaccines, SIDS & Shaken Baby Syndrome

Mandates, Ben Franklin, and Vaccine Injury

On Monday (President’s Day), I flew to Philadelphia to be part of a panel at the Franklin Institute discussing whether or not we should mandate vaccines. The other panelists were Dr. Paul Offit (you may have heard of him) and Dr. David Ropiek. It was an exciting conversation, I learned a ton, and I was grateful to the good people (both for and against mandates) who drove through the evening’s sleet and snow storm to attend.

As you can imagine, before the event began, it was the sources of some controversy. One chiropractor/blogger went to great lengths to explain why the esteemed Franklin Institute should not provide a forum for such a discussion. Most of her letter, of course, was an exhortation about how awful Paul Offit is and how much she disagrees with his science-based approach to vaccines. Her letter, of course, had no effect on the evening at all, but I mention it because we knew going in to the evening that the audience would include people who were not only opposed to vaccine mandates but also opposed to the very existence of vaccines at all.

As a side note, as much as Paul Offit is vilified, he really does deserve none of it. He is as kind a person as you could imagine, spending the time before the event asking how my children were doing and providing updates about his children. He truly cares about children not in the abstract, but about your children and mine (and his).

Because we were prepared for backlash, no questions were taken live. Instead, people used the Twitter hashtag #TalkFI to submit their questions. And that brings me to the one question I want to answer more completely.

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Tweet: What do you say to parents who do have a vaccine injured child?

To provide a little bit of context, the question was presented to the panel as “What do you say about mandates to parents who say that their child is vaccine injured?” Phrased that way, the question really could have come from anyone–pro-vaccine, anti-vaccine, vaccine-ambivalent. I did not know that I was answering someone who found what we were saying offensive.

So my answer was, in essence, “Vaccines don’t cause autism.” And why was that my answer?

  1. Vaccines don’t cause autism.
  2. 90% of the time, when someone asks me about “vaccine injury,” they mean autism. Parents whose children have had adverse reactions to vaccines that match what the science tells us to expect usually do not refer to their children as “vaccine injured.”

From there, Dr. Offit took up the question and gave a fantastic explanation about what a true adverse effect from vaccination entails and how honestly rare it is. His answer was far more eloquent than my blunt response, and I think it provided parents some real insight into why it really is okay to require that children who attend school are vaccinated.

But what about mandates? The problem with a panel discussion is that often one panelist brings up a point that launches a new discussion before the answer can be completely discussed. So here is what I would say to a parent whose child suffered a real and debilitating adverse event after vaccines.

I am sorry that your child had a reaction to a vaccine. In an attempt to protect your child, a medication caused harm, and that was certainly both unintended and unfortunate. Because your child cannot receive this vaccine, or potentially any vaccines, a medical exemption will keep him in school. I will work very hard to make sure all the children around him who can be vaccinated are vaccinated because if a vaccine can injury your child this way, it is possible a disease can do something much worse.

That’s my complete answer. It’s important to note that parents whose children have suffered real adverse effects confirmed by science and evidence often agree that other children should be vaccinated to protect their children. David Salamone is one such child. He contracted polio from the Oral Polio Vaccine and has been permanently disabled since. And yet, he says:

I’m not against vaccinations. I’m pro-vaccinations. We had thousands of people contracting polio prior to the vaccination. We came out with the vaccination, and that number decreased significantly. So less people are getting sick, less people are getting affected, and that’s a good thing.

None of this, of course, will make any difference to the people who came out to the Franklin Institute to confront Dr. Offit or who wrote letter to them ahead of time protesting the forum at all. At the end of the evening, after trying to refute on Twitter the points we were making, Carol had one last point:

Screen Shot 2016-02-18 at 9.10.12 AM
Tweet: It’s more than one in a million. Don’t allow them to keep lying.

Could I have given any answer to appease her? No. I look at the evidence about vaccines and think, “This makes sense, and we must shape our policies based on what we know and how we can best protect children.” Vaccine opponents like her look at the evidence about vaccines and say, “This evidence doesn’t line up with what I believe, so there must be other evidence people are hiding. We must make policies based on the evidence we cannot see.”

Policies made to appease people who have beliefs that fly in the face of evidence or who have fallen prey to the misinformation of the anti-vaccine movement are unwise. They are policies that appease the fears of adults rather than protect children against the real and dangerous threat of disease. And while fear can be a powerful motivator, protecting our vulnerable must be more powerful.

P.S. Don’t forget to use the hashtag #BeLikeBen this week to highlight Ben Franklin’s commitment to public health. And if you’d like to watch the entire panel discussion, here you go:

You Can Stop Vaccine Hesitancy

Yesterday, while waiting to get his baby’s vaccines at the doctor’s office, Mark Zuckerberg did the one thing we should all be doing to combat vaccine hesitancy:

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And, no, I’m not suggesting you start your own social media empire. That’s not what you need to do.

You need to tell people that you are (or have been) vaccinating your children. You need to tell people publicly. Because if everyone who did vaccinate their children simply posted a photo like this on social media, the anti-vaccine movement would look like that tiny less-than-one-percent that they are instead of a loud, social media enterprise.

It’s called social norming, and it might be more effective than debating other people about vaccines and debunking their misinformation. A simple I VACCINATE statement, when made by everyone, shows just how ubiquitous this decision is, and also just how safe the decision to do so is. Imagine being a new parent and seeing photo after photo of friends saying “Time for vaccines!” on the internet (or heck–in person!). All those babies that you know who are vaccinated and are fine show just how safe immunizing can be.

Because I am so passionate about social norming, I am willing to insist that your duty speak up about vaccinating is just as important as your duty to vaccinate your children. If you truly want to protect your child and your community, it is your responsibility to help stem the tide of vaccine hesitancy. I bolded that because it is important.

In fact, there is evidence that your advice about vaccinating makes a difference. According to research by Dr. Emily Brunson out of Texas State University, “the variable most predictive of parents’ vaccination decisions was the percent of parents’ people networks recommending nonconformity” to the immunization schedule. In other words, the more people who recommend you not vaccinate on-time, the more likely you are not to vaccinate on time. Conversely, if everyone you know recommends you vaccinate on-time, you are unlikely to deviate from the vaccine schedule.

So get out there and tell your friends and family members and FarmVille collaborators that you vaccinate your children, end of story.

The Cancer Kids are Taking Over

I frequent Dr. Tenpenny’s Facebook page because it is amusing but also because it helps me understand the marketing being used to make parents afraid of vaccines. Because I keep tabs on Tenpenny, I’ve also taken note of the revolving websites she has attached herself to, from Vaxxter to All About Breast Health. That’s where I found TruthKings.

It sounded promising but also slightly frightening. We all know the spurious ways people like Tenpenny use the term truth, after all. But today I noticed a post about why it is okay to endanger the health of vulnerable children undergoing chemotherapy.

Of course, that’s not how my new favorite truthers framed it, though. They titled their post, “Your Child Having Cancer Doesn’t Mean My Child Should Be Forced Dangerous Vaccines.” The title alone is poppycock. Let’s review in bulleted points:

  • No one is forcing vaccines upon anyone. To force a vaccine would mean to hold a child down and physically inject it into a child. Instead, reasonable safeguards are put on schools, including the safeguard against infectious disease. If you don’t want to participate in helping schools be safe from infectious diseases, you bear the consequences.
  • Vaccines are not dangerous. Millions of vaccines are given every day. 95% of parents choose to fully vaccinate their children. If vaccines were dangerous, pretty much every child in this country would be worse off for being vaccinated. Instead, they are free of diphtheria, polio, Hib, measles, and so forth.
  • Of course it is your responsibility to take reasonable precautions to help other children. That’s why you can’t drive drunk or text while driving. In fact, the law books are filled with things you can’t do because it would endanger others. And Laura Bredesen, mother of a cancer patient exposed to measles, will tell you that leaving your child unvaccinated is a direct threat to the children around him/her who are cancer patients.

Why are these TruthKings taking on the ever threatening pediatric cancer patient? What did these cancer kids ever do to them?

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Don’t worry, cancer kids; you aren’t the only threat. It seems that fluoride, GMOs, education, and the Islamics are all taking over. Or at least the Islamics are.

Fear of the other is the most common cause of bigotry and prejudice. For a TruthKing, you are a threat if you are a Muslim or if you are receiving chemotherapy because your existence means that their freedom might be curtailed. Both cancer patients and Muslims are turned into the enemy by refusing to actually get to know anyone who fits those categories.

After all, Ben Bredesen can’t be your enemy once you get to know him because he’s a sweet kid. And he’s a child. How can a kid be an enemy, and on what planet to you refuse to protect a child?

And that’s just my reaction to the headline. In fact, the entire post is a deep conspiracy about how the government is using pediatric cancer patients to take away our freedom. And you and I are apparently part of the conspiracy:

The Government has pulled at the very fibers which inspire you, cause you to be passionate, make you laugh and make you enraged. They’ve convinced you that myself and my child are here on earth to do harm to your child. And they’ve done this as a way to recruit an army of mothers and fathers to take the helm and become soldiers in a way to fight against parental rights.

In this battle, of course, the rights of the parent trump the rights of the child. People who use terms like “truth” and “parental rights” believe that they own their children, that their decisions are paramount whether or not these decisions are wise. They give no consideration to how children have been historically used by those who believe they own them, children who have worked in sweatshops and have been physically abused. The history of children’s rights is expunged in favor of a new liberty for parent/owners of children.

Of course, you ask, the war metaphor is just a metaphor right? (Okay, maybe you didn’t ask that, but you should.) No. Not at all. Remember these are people who think we are on the brink of an Islamic takeover. Their fears are about something sadistic and nefarious:

When you take the bait by the Government to diminish these very basic human, parental rights, you allow the Government to play to your sadness and despair. They have you at your weakest moment, compromised in your soul. When you really consider what they are doing, using your sick child as bait for your impassioned plea to support the army who is going to go door to door and remove rights, you begin to see how disturbing and disingenuous it all really is.

Going door to door to remove your rights. Sounds frightening doesn’t it?

But again, nothing of the sort is happening or is going to happen. At worst, you might be required to homeschool your child, as is now the case in California. Ironically, of course, asking that you opt for homeschooling instead of government-funded schooling is really the opposite of the foot soldiers coming to your door to remove your rights. It is keeping children closer to the adults who have bought into the fear mongering of the anti-vaccine movement.

Of course someone like Tenpenny shares the heck out of TruthKings on her page. This fear-based marketing, stirring distrust in the government and asking people to cloister against some imaginary army. The purpose of this marketing scheme is to sell her own wares. But real people are being harmed with this marketing strategy, whether these people are Ben Bredesen or our Muslim friends and neighbors. It’s unconscionable that a grifter like Tenpenny make them into the enemies in order to turn a profit. She will never change, but we can make sure our friends and family do not fall prey to these cynical strategies.

Why You Shouldn’t Shop for Medical Exemptions

Recently, filmmaker Leslie Manookian wrote a post for vaccine hesitant parents about how to pester physicians into giving them an inappropriate medical exemption. This interest in medical exemptions stems from the newly passed law in California that eliminates all non-medical exemptions. Parents who are now too scared to vaccinate their children are forced to make some tough choices. (Well, tough for them because of their misperceptions of the risks of diseases and vaccines.) They can either vaccinate their children or homeschool them.

Anyone following the anti-vaccine movement can understand how an otherwise reasonable but vaccine-hesitant parent feels about this choice. For them, the choice feels like deciding between certain death or certain economic doom. After creating the fears about vaccines, woopreneurs like filmmaker Leslie Manookian (and Bob Sears) have stepped in to capitalize on this fear by offering parents a way out of the vaccinate-or-homeschool conundrum. Thus Manookian’s “How to Claim a Medical Exemption in CA.”

Of course, the decision to shop for a medical exemption is unwise. To get a greater understanding about medical exemptions and how unwise they are, I asked two friends to weigh in. I talked to Dr. Anna Saporito, a family physician from New York, and Dorit Reiss, a professor of law in California.

Manookian claims:

More and more research is showing that individuals with a variety of conditions and genetic mutations are more susceptible to vaccine reactions.

These conditions and disabilities include already existing or a family history of previous vaccine reaction, eczema, food and environmental allergies, asthma, gut issues such as Crohn’s and IBS, autoimmune disease such as diabetes, lupus, MS, rheumatoid arthritis, ASIA, and others, chronic ear, sinus, strep or other infections, Lyme disease, PANDAS, POTS, learning disabilities, speech delay, ADD, ADHD, autism, seizures, bipolar, schizophrenia, thrombocytopenia, genetic variance, impaired methylation, detoxification impairment, and more.

Of course, most of us recognize this claim as fishing for an exemption. After all, can you imagine asking a doctor to forego vaccines for your child because he is prone to strep throat? (Why isn’t there a vaccine for that?) My supposition about this laundry list was right, according to Dr. Saporito, “There are actually very clear guidelines written by the ACIP and CDC outlining medical contraindications for vaccines.” You’ll notice that almost everything listed in Manookian’s litany is missing from the CDC’s guide to who cannot be vaccinated. In fact, many are actually listed on the CDC’s Commonly Misperceived as Contraindications list, including autoimmune diseases (such as diabetes, lupus, MS, etc.). Other items on her list are not included because learning disabilities and neurodevelopmental disorders are not contraindications to vaccines.

Manookian moves on to claim that parents can demand allergy and genetic testing before being vaccinated (with the assumption that something will pop and be used as reason for a medical exemption.) Again, Dr. Saporito notes that this approach is not warranted:

There is no evidence that genetic testing would provide any useful information in the prediction of vaccine reactions. Allergy testing might make sense, but not genetic testing. (If SCID [severe combined immunodeficiency] is suspected, that should be tested for, but usually that diagnosis is already known.) The American Association of Allergists and Immunologists have great guidelines about allergies and vaccines.

It is important to note that the American Association of Allergists and Immunologists’ document discusses how to test for allergies to vaccines after a vaccine is administered. It is not a standard of care to test children without a history of allergies for possible allergic reactions to vaccines they have never received.

Finally, I asked Dr. Saporito her stance on parents shopping for doctors who are more willing to provide medical exemptions for conditions that are not contraindications and whether or not family physicians are more likely to provide a spurious exemption:

The science is quite clear that vaccines are safe. I have vaccinated myself and my own child for this reason. I find it suspect that the doctors who offer this “service” of vaccine exemptions often do no take insurance. It seems there is more of a profit motive than a motive towards public and personal preventative healthcare, something I signed up for when I took my medical oath. In fact the AAFP [American Academy of Family Physicians] just this month came out against non-medical exemptions for vaccines.

From a medical perspective, the answers about medical exemptions to vaccines are as clear-cut as the case for vaccines themselves. However, I did want to find out about a legal perspective. What could happen, legally, to a parent or a doctor who presents a school district with a spurious medical exemption to vaccine requirements?

Dorit Reiss, who is becoming the foremost legal expert concerning vaccine issues, told me:

Manookian’s post is assuming someone can just pressure or get a doctor to give an exemption on false premises. First of all, I think doctors can and should consider reporting parents who are asking them to act dishonestly. The physician’s signature on a medical exemption should be based on true concerns/facts.

A parent getting a medical exemption based on things that don’t justify it doesn’t deserve the exemption.

But what about the doctors? What issues might they face if they become a mill for false medical exemptions?

The reality is that the doctor can probably get away with some of that. There is no mechanism in place for oversight now, and if doctor only gives a few, no one will look.

If a doctor is suddenly giving a lot of medical exemptions, there are a number of things that can happen. First, the Department of Health can try denying them as unjustified – which will probably be challenged in a court, and the department might lose. Second, the Department can bring a complaint with the medical board – and prove the problem. Third, the law can be changed to provide a penalty for abuse.

The doctor has to specify the conditions for exemptions. If a doctor is found to have lied, that could be a reason for disciplinary action.

Arguably, if a doctor provides an argument based on something that clearly shouldn’t be a contraindication that’s also reason for potential action. Most of the conditions Manookian lists aren’t caused by vaccines and are not contraindications. For example, a doctor choosing to help a parent not to protect a child with asthma from pertussis is arguably violating their responsibility.

The legal issues surrounding inappropriate medical exemptions for vaccine requirements, but there is enough gray area that parents should reconsider shopping for a family physician who will give them an exemption when none is warranted. Of course, the greatest disincentive to seeking an inappropriate medical exemption is the consequence of disease for a child left unprotected.

For a parent who has fallen prey to anti-vaccine scare tactics, skirting ethics and the law might seem a risk worth taking, but the real risk comes from the diseases that have historically sickened, maimed, and killed children.

Faux Pro-Vax Gambit

Anti-vaxxers do not like to be labeled as anti-vaccine. They see it as an ad hominem attack, though it is rarely meant to be. It is meant to describe what they are: against vaccines. As media attention moves away from legitimizing anti-vaccine sentiment and more toward exposing it as a threat to public health, anti-vaxxers have become more sensitive to being labeled as such.

Some have come up with their own labels. The favorites are “pro-vaccine safety” and “pro-choice.” The second is especially maddening because they want to have a choice over whether or not their children are protected against disease and a choice about whether or not their communities have high enough immunization levels to protect the most vulnerable. It is a choice born of privilege and of ignoring the needs of others.

Some simply dismiss it outright. Lucija Tomljenovic, a biochemist who has published papers promoting anti-vaccine myths, made this comment on a BMJ article:

I am NOT anti vaccine, I am anti bad science.
The reason so many dismiss even the possibility that vaccine can cause
damage is because they believe this to be true. This is religion and not
science.

Of course this is complete nonsense. People who promote the science behind vaccines do so because they have followed the science.

A prime example of the pro-science, pro-vaccine camp looking critically at the science is demonstrated in this article by Tara Haelle discussing a study that dubiously connected the Hib vaccine to leukemia protection:

couldn’t find evidence of this dramatic reduction in government health statistics.

When I turned to outside experts, I discovered my confusion was justified.

I asked Dr. Walter Orenstein, associate director of the Emory Vaccine Center, if he could help or recommend others. He sent me to Dr. Art Reingold, head of epidemiology at the University of California, Berkeley, School of Public Health, and Dr. Martha Arellano, an oncologist specializing in leukemia at the Winship Cancer Institute of Emory University. Arellano also suggested I speak with Dr. Edmund Waller, an immunologist and oncologist also at Emory’s Winship Cancer Institute.

Every one of them conveyed the same message: Nothing in this paper proves that the Hib vaccine reduces leukemia risk, much less helps prevent ALL.

Tomljenovic is not alone in eschewing the anti-vaccine label despite evidence that she is. After all, even Dr. Bob says that he “gives vaccines every day,” even though he has aligned himself with the anti-vaccine forces in California.

But the most maddening are those who come right out and claim that they are pro-vaccine. It’s a gambit meant to disarm the other person in a conversations. It looks like this:

I am a pro-vaccine parent who strongly opposes SB 277.

My child, now 20, received all of her childhood vaccines, with my informed consent.

Her pediatrician and I decided together to delay the hepatitis B vaccine until puberty, because it addresses a disease that is spread via needles and sex, and she was at almost no risk of coming in contact with it.

The above quote demonstrates the crux of the argument. Basically, “I must be pro-vaccine because I vaccinated my children. Except for this one bad vaccine. I didn’t do that because [insert various anti-vaccine myths and follow with lots of conspiracy theories.]”

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Basically, the Faux Pro-Vaccine Gambit is an introduction, a way of distracting you and throwing you off-balance so that when the anti-vaccine myths follow, you might not know what to do. But it’s possibly the worst gambit out there because the person using it has children who are protected against vaccine-preventable diseases to a degree, but wishes to cast fear, uncertainty, and doubt in order to encourage someone else to leave their children fully unprotected.

It’s the ultimate “I care about my children, and I really don’t give a damn about yours.” And it makes me furious.

It is really dangerous, though, when it is coupled with legislation. Advocates should be aware that people are contacting legislators claiming to be pro-vaccine and against legislation that aims to increase vaccination rates. They are liars, and they are muddying the waters.

So what can you do?

If you are online and encounter a faux-pro-vaxxer, ignore the fact that they claim to be pro-vaccine. Engaging in a discussion about immunization means debunking the misinformation, not taking apart the person. Anyone who promotes incorrect information needs to be corrected, especially in public, so that others are not misled by falsehoods.

If you are contacting a legislator, know that others are claiming to be pro-vaccine. If you are working closely with legislators on the matter, you might prepare them for this gambit. Be aware, however, that letting a legislators know that you are pro-vaccine probably does not mean much to them. Be prepared to use other labels for the anti-vaxxers with legislators such as “opponents to the bill” or “opponents to raising immunization rates.” Then, whether or not they vaccinated their children is an entirely moot point.

And know that whatever people claim, if they follow it up with anti-vaccine misinformation, they are not for vaccines. They are against them. In other words, they are simply anti-vaccine.

Doublespeak: A Dr. Bob Special

Dr. Bob Sears is the author of a bunch of books, the salesman of supplements, a Fellow of the American Academy of Pediatrics, and a master of doublespeak about vaccines. According to Dr. Bob, he gives vaccines in his office every day. Why, then, does he work so hard to frighten parents about vaccines and downplay the effects of the diseases they prevent?

His newest venture, a supposed non-profit organization called Immunity Education Group (Do Not Link hyperlink), is a case in point. The website itself says almost nothing useful to anyone, but it appears that the real meat of his work is on the associated Facebook page, co-adminned by self-proclaimed data analyst Melissa Floyd.

The past few weeks, I have been ignoring Dr. Bob’s new Facebook page because sometimes ignoring them makes them wither and fade away. But one post last week drew in my attention (and some of my precious time and efforts):

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Since Dr. Bob is so long-winded, I didn’t screen capture the entire post. But this is the part that caught my attention:

Do you see it now? This press conference wasn’t about disease information; it’s the beginning of a hunt for pockets of vulnerability. And, I gotta hand it to them, the CDC’s answer was sheer brilliance. “No, we’re not the bad guys. We won’t share the data. School vaccine laws and sharing exemption information is a STATE and local matter. We’re are staying out of that.” The quotes are my paraphrase of the CDC answer. But the CDC wrapped it up this this statement (my quotes again, but it’s almost word for word):

“We encourage parents to find out their local vaccine exemption levels so that they can work together to help everyone do what’s good for their community.” Yes, they actually said that. It sounded so righteous, useful, and proper yesterday. But when you look at the whole picture, I worry that it’s a portend of what’s to come.

This is why we must work hard to come together, understand one another, start having conversations, accept one another’s varying medical beliefs, and learn to live together in peace and harmony. The current system is working well; diseases are under control, and we have very high vaccination rates. Less than 1% of families make the medical decision to forego vaccines. Coercion is unnecessary and divisive. The alternative, as laid out by the Centers for Disease Control and Propaganda, almost seems like the beginnings of a which hunt: which kids are unvaccinated in YOUR neighborhood, and what are YOU going to do about it?

– Dr. Bob Sears, Immunity Education Group

In other words, Dr. Bob doesn’t want vaccination rates at the school level (or district level, county level, whatever level) shared because he is afraid that it will turn into a “which hunt” for his patients. Or unvaccinated patients in general.

So much about this caught my attention since I was on that same CDC media call. Here’s a screen grab of my less-alarming notes:

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Yes, I cannot use less than symbols properly when typing quickly.

You’ll note the lack of CDC intimating that parents should go out and harass the parents of their children’s unvaccinated classmates. Since 21 states now offer this information, you would think the anti-vaxxers would be recounting these incidents if they were happening. But they aren’t. In fact, most parents I know who seek out this information want to know their child’s chances of being exposed to measles or chickenpox. Others want their children going to schools with high science literacy.

In fact, I’d venture to guess that most parents looking up immunization rates for their schools are using them far more legitimately than those looking up free and reduced lunch rates at schools. All sorts of data is available to parents in ways that preserves the privacy of students.

At one point on Facebook, Melissa Floyd, who is not a doctor, took over the reins of moderating the thread. And things went downhill.

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At that point, I asked Melissa for a citation showing that the CDC claims that immunity against measles lasts for a maximum of 15 years after MMR. I also pointed out that a woman in Washington died from measles. My comment asking for a citation seems to have disappeared, and Melissa moved on claiming that no school district with high PBEs was part of the measles outbreak and other such fabricated bologna. Fortunately, others asked her for a citation, and Dr. Bob jumped in to correct this piece of misinformation, right?

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Oh dang.

So we know that Dr. Bob isn’t very good at math (by his own admission) or at getting information about vaccines correct. He’s not good at social media, and he’s not good at choosing which side has the larger market base (hint: it’s the side with the 95% of parents who vaccinate).

But he’s great at doublespeak.

See, it’s not that measles lasts a lifetime. It’s that the package insert shows antibodies after 11-13 years. Dr. Bob still has antibodies from his MMR. But some adults might not have antibodies. How many adults? Not important. But the vaccine wears off and the CDC recommends boosters for people like pregnant women because of their rubella immunity. Oh, and if you spread misinformation, he will ban you.

It’s almost magnificent, the amount of obfuscation. In fact, he’s saying almost nothing. He is saying both that immunity from measles lasts 13 years, and that it lasts for much longer. He is saying that immunity from the MMR wanes and that it doesn’t for most people. And he is using pregnant women and their need to be immune to rubella as proof that measles immunity…something.

He might as well have posted a William Carlos Williams poem and told people to interpret it as they see fit.

His comment regarding the woman who died in Washington, though, was much clearer. He says we cannot know if she died from measles, and his actions show that he would prefer to believe that she didn’t because then he can’t lull people into believing that protection against death from measles is a matter of nutrition.

But here’s the thing. The coroner and the state department of health think she died from measles:

The death of a Clallam County woman this spring was due to an undetected measles infection that was discovered at autopsy.

The woman was most likely exposed to measles at a local medical facility during a recent outbreak in Clallam County. She was there at the same time as a person who later developed a rash and was contagious for measles. The woman had several other health conditions and was on medications that contributed to a suppressed immune system. She didn’t have some of the common symptoms of measles such as a rash, so the infection wasn’t discovered until after her death. The cause of death was pneumonia due to measles.

Dr. Bob can dissemble and juggle with the truth all he likes, but had this woman not been exposed to measles because of unvaccinated people, she wouldn’t have died.

That one fact, that someone in the United States in the year 2015 has died from an illness we can easily and safely prevent, is not something to ploy coy with. And because of her senseless death, parents want to make sure that their children are in places where such diseases are not spread. And I think that it’s every parent’s right to know how vulnerable their schools are to the spread of preventable disease.

Is Vaccinating a Private Choice?

Last month, the Nursing program at Simmons College contacted me and asked me to respond to this question:

Would you consider vaccines to be a public health issue requiring that they are mandated by the government, or that the issue is a personal choice to be made within the home?

It took me a while to respond because I felt it was a bit of a false dichotomy. However, it is a fair question to ask, and writing a question that balances the idea of rights and responsibilities without making them seem opposed to each other is difficult. Fortunately, along with some other smart people, they did publish part of my answer.

Here is my full, un-edited response:

The primary reason we immunize a child is to protect that child against disease. The science supports the decision to immunize individual children, and vaccines that are not effective for individuals or pose a greater risk than a benefit for an individual are not licensed or are pulled from the market. Because the primary focus of immunization is the individual, it is, in a sense, a personal decision. And we hope that parents and patients make the right decision based on a consultation with their physician where the best medical evidence is used.

However, vaccines also have the intended consequence of community immunity. Immunization is a public health issue that affects not only the individual, but those around him or her who rely on other people vaccinating, either primarily–because he or she cannot be vaccinated–or secondarily–because even the vaccinated benefit from not being exposed to diseases. So vaccines are not a solely private decision. They are a decision that affect entire communities. So public health policy has to be crafted carefully in order to encourage that the best decision is made for the greatest number of people. What the best public health policy is varies from community to community based on many confounding factors.

The question is an intriguing one, and they included some other great answers, and one terrible response from Barbara Loe Fisher that was a rehashing of the word salad I dissected before.

The heart of the question, of course, gets at the nature of rights and responsibilities. Parents have certain rights, but they do not have unrestricted rights when it comes to their children, mostly because their children have rights as well. A child’s right to be healthy and to be protected against harm needs protection. Mostly, we rely on parents to make the correct choices. Usually, I am glad for this liberty because I do like to take my children to get ice cream and let them stay up late and other things that could be seen as potential threats to optimum health.

Disease is different than ice cream, of course, because preventing things like chickenpox, measles, and so forth yields health benefits orders of magnitude greater for a child than saying no to Dairy Queen might. It’s also different because my son’s banana split doesn’t affect the nutritional health of his classmates. Infectious disease is contagious. Brain freeze isn’t.

So parental rights and a child’s right to health are also weighed against community responsibility. Society doesn’t force a parent to vaccinate her child, but it can impose certain consequences for vaccine refusal–restricting access to school being the most severe. Schools, too, have the responsibility to keep students safe and promote good health. My kids can’t buy ice cream at lunch, and they shouldn’t be able to bring chickenpox into the building either.

Ideally, we would live in communities where everyone agrees to these principles and everyone accepts the science behind immunization. But we don’t live in an ideal world, so we each have to do our part to combat vaccine hesitancy.

Menses, Vaccines, and Slacktivism

Reading about the woman who ran an entire marathon menstruating without a tampon made me think of vaccine advocacy. I recognize it is an odd leap, but advocacy shares commonalities no matter the cause.

In case you missed it, People magazine reported that Kiran Gandhi ran a marathon in London last April while blood soaked her pants:

Gandhi let her blood flow freely to raise awareness about women who have no access to feminine products and to encourage women to not be embarrassed about their periods.

The value of what might seem like an odd stunt was debated all over social media. Some felt that it highlighted a real issue while others felt that it solved nothing and amounted to slacktivism. Slacktivism is a form of activism that requires very little effort on the part of the activist and often leads to no real involvement in the issue at hand.

Gandhi being accused of slackvitism hit me. Granted, I work day in and day out trying really, really hard to get people to engage their friends, neighbors, and school administrators in order to raise immunization rates in their communities. For all my work, I have found that people are most comfortable with far lesser forms of activism: sharing Jimmy Kimmel videos on Facebook, wearing a pro-vaccine t-shirt, or Tweeting at Jenny McCarthy. Are their efforts (and mine) worthwhile?

To answer that question, I really need to unpack what the cause is. Even though we bill ourselves as the pro-vaccine movement, we are really, at our heart, anti. We could see ourselves as anti-disease or as anti-vaccine hesitancy. In either instance, we are doing battle against things contagious that threaten public health.

If we are simply anti-disease, so-called slacktivism is not actually slacking off. The first course of action against preventable disease, after all, is to get your child (and yourself) vaccinated, since vaccines do battle against the diseases directly. The next step is simply to make vaccinating normal so that others will do it, too. Sharing that Jimmy Kimmel video certainly gives an air of “Normal people vaccinate” and might also remind people to check on their immunization status.

Vaccine hesitancy is a different monster, though. Jimmy Kimmel is not going to make a parent who has concerns about vaccines laugh those concerns away. As I wrote earlier, turning the tides of vaccine hesitancy requires people who care about the hesitant addressing concerns with them and sharing stories about why we vaccinate. This person-to-person, retail advocacy is the exact opposite of slacktivism. It is more akin to building a Habitat for Humanity house, except that no one will ever drive past the house and look at it because you cannot drive past outbreaks that never happened and note their lack of existence.

The pro-vaxxers who have vaccine hesitant friends whom they engage are the ones getting their hands dirty with activism. But they aren’t alone. The Washington Post reviewed a study on slacktivism and how to engage activists more deeply:

[T]hose whose initial act of support is done more privately (for example, writing to a member of Congress) are more likely to engage in deeper, more costly forms of engagement later on. Those whose initial support is public (i.e. through posting to Facebook or Twitter) are less likely to engage more deeply. Moreover, the researchers find that most appeals for token engagement “promote slacktivism among all but those highly connected to the cause.”

In other words, those who are engaging in pro-vaccine advocacy primarily through social media might be the people who appear to be the face of the pro-vaccine movement, but they may not be the ones moving the needle (pun intended) on vaccine advocacy. People who are writing legislators, engaging the media, talking to their school administrators, requesting pro-science books added to library collections, and a hundred other mundane, private tasks are pushing their neighbors to confront fears about vaccines in order to raise immunization rates. Their work is both anti-disease and anti-vaccine hesitancy.

Which is not to say that being pro-vaccine primarily on social media is inferior. Of course, there are ways that social media activism can effect real change concerning vaccine hesitancy and the grip the anti-vaccine movement has on Facebook and Twitter. For example, it was through social media that Chili’s was convinced to drop their support of an anti-vaccine organization. I’ve also used social media to prompt pro-vaxxers into private forms of advocacy, writing letters to congress and asking them to cancel a anti-vaccine hearing, for example.

Thus, being engaged in awareness raising does not preclude a person from making a real difference. However, the leap from sharing a funny pro-vaccine meme on Facebook to writing a company or a policymaker is wide, and often people engaging on social media are not ready to make that leap. My past personal experience has shown that in order for pro-vaxxers to take on get-your-hands-dirty activism, they have to be alerted to an immediate need that requires specific, short-term action (such as writing to have a hearing canceled or posting on Chili’s social media page). Between those actions, then, a little so-called slacktivism or awareness raising is necessary to keep people interested.

If you are waiting for me to rule on Kiran Gandhi, you may have waited in vain. While I don’t consider her cause one of those that drives me, I do donate feminine hygiene products to the local food shelf. And I hope that someone reading today’s post might write a letter to a school administrator and ask how the vaccine rates are and what might be done to raise them.

And why not. Here’s Jimmy Kimmel again.

No, There Isn’t a Simple Way to Get Anti-Vaccine Parents to Vaccinate

Everywhere you look, the media is telling you that you can scare anti-vaccine parents into vaccinating by showing them photos of sick kids and telling them stories about diseases. Article after article after article lately is telling us that we can win vaccine debate and change minds–simply! Why didn’t we all think of this before? (Seriously. Click that hyperlink.)

The buzz in the media is based on a new study published in PNAS looking at ways of countering anti-vaccine beliefs. The study looked at over 300 people with varying degrees of vaccine acceptance and hesitancy and presented them with one of three forms of vaccine information: a mother’s story about her child’s measles, facts debunking vaccine myths, or information about birds. The stories, it turns out, had the greatest effect on attitudes about vaccines. As Tara Haelle at Forbes points out:

So, presenting individuals with the dangers of not vaccinating, both in words and in images, seemed to help them think more positively about vaccines. In fact, the effect was most dramatic in those who had the lowest scores – the poorest attitudes toward vaccines – at the start.

Let’s be very clear that this study absolutely did not measure whether or not parents of unvaccinated children then went out to vaccinate their children. Their attitudes simply shifted because the risks associated with not vaccinating were reframed for them in a way that was both relatable and memorable. (In fact, I’m quoted in Haelle’s article saying that.)

I mention this limitation because I do not want pro-vaccine advocates to be lulled into thinking that the way to win debates or get people to vaccinate is to bombard them with pictures of sick kids and stories about suffering children. I can imagine social media arguments where anti-vaxxers make their same tired assertions only to be answered by a well-meaning pro-vaxxer who thinks she can solve it all by posting a photo of an ill child. I’ve been to the rodeo a few times, and while that might get some attention, we aren’t going to solve the issue of vaccine hesitancy that way.

In fact, I have witnessed in person that very technique not working. I was at a screening of the film Invisible Threat, which contains two stories of disease and its awful effects. Afterward, during the Q&A, one woman wanted to talk about how Vaccine Court proves that vaccines are unsafe. See how easy it is to set aside a story in favor of your own entrenched beliefs?

Do you know what actually makes people deconvert from the anti-vaccine movement? Other people who care about them.

I have spoken to and worked with and met many, many people who used to be anti-vaccine and many more who had some degree of fear about vaccines. Understanding the risk of disease through story was vital to them understanding why we prevent those diseases, but it wasn’t the end of their deconversion. Every one of these people I have met has had someone in their life–a doctor, a friend, a new acquaintance, a family member–who cares enough to keep a civil conversation going. And the conversation was not grounded in winning a debate. The conversation was grounded in a sincere and deep concern about protecting children.

So go ahead and tell your stories about your encounters with disease. They are critically important because they remind us that we don’t do all of this for nothing. But ground this conversation in kindness and goodwill, and plan on sticking around for a while. Telling the stories is just the first step. Showing we care enough to keep talking is crucial. And no, it’s not easy.