In common colloquial usage, there is a term known as "gaydar." Basically, it's the ability some people claim to have that allows them to identify people who are gay. Whether gaydar actually exists or not, I don't know, but I claim to have an ability that's similar. That ability is the ability to sniff out antivaccinationists. Over the last decade, I've become very good at it, so much so that it's almost instinctual and rarely wrong. My guess is that it's nothing more than my having internalized all the tactics and tropes that antivaccinationists like to use to the point where I don't need to think about them and can instantly compare the words and behavior of a person with patterns I've learned to identify in antivaccinationists and make an accurate assessment. True, there are the occasional false positives (although these false positives always strike me as people who could easily turn antivaccine in an instant), but by and large, since it's been developed, my instinct for these things has served me well.
All of this is a way of saying that I don't think that Mark Largent is antivaccine. One of the other types of false positives I sometimes get comes from people who are clueless about the antivaccine movement and, in a laudable but misguided effort to be "fair" and give people the benefit of the doubt, end up coming to conclusions that are outrageously wrong. That is the category that Mark Largent appears to fall into, so much so that I've heard from a source I completely trust that he has said in public that Jenny McCarthy is not antivaccine. But I get a head of myself. Who is Mark Largent? He's an academic who recently wrote an Op-Ed that revealed mind-numbing ignorance of the antivaccine movement entitled In the Great Vaccine Debate, Parents' Fears Should be Respected and has apparently just released a book entitled Vaccine: The Debate in Modern America. I haven't read the book (although I might), but I have read the op-ed, and if the book is anything like the op-ed I'm not likely to be pleased. I'll show you what I mean.
In the op-ed, Largent starts out with a fairly standard recounting of how the parents of as many as one in ten children refuse to vaccinate their children with what he refers to as "state-mandated" vaccines and more than a third may delay or refuse "doctor-recommended vaccines" for their children. Personally, I found this part confusing, because pediatricians (unless they're Dr. Jay Gordon or "Dr. Bob" Sears) generally vaccinate according to the CDC-recommended schedule, which also forms the basis of which vaccines the various states mandate for school attendance. He then mentions (of course!) Andrew Wakefield, the MMR-autism scare, and how Wakefield was ultimately refuted and his 1998 Lancet paper retracted. Nothing objectionable there. Here's where Largent goes off the rails:
What are parents really worried about? They are worried about the high number of shots kids get in the first several months of their lives. Today, a fully vaccinated six-year-old will receive nearly three-dozen inoculations, most of them in the first 18 months of life.
The routine vaccination schedule now calls for shots at almost every well-child checkup, including four inoculations at the two-month appointment and five inoculations at both the four- and six-month appointments. As parents scramble to explain their fears, the only explanation available to them is the claim that vaccines might cause autism. But when their anxieties are carefully and respectfully examined, we see that they emerge from a wide variety of often well-informed philosophical and moral concerns parents have about their children’s health.
Uh, no, at least not in most cases. First of all, unlike the claims in Largent's introduction, vaccines were not always "saviors." As long as there have been vaccines, there has been an antivaccine movement. Indeed, back in the 1800s in England, for instance, they were a lot more honest about it, admitting that they were, in fact, antivaccine and even publishing tracts and journals with the word "antivaccine." In any case, back then, there were actual riots after health authorities tried to mandate vaccination against smallpox. So, sure, there's an element of not wanting to be told what to do. However, in reality, there's a huge amount of misinformation about vaccines that is far more readily available than it was in the past, and it has an enormous effect. Not only does it provide ammunition for motivated reasoning against vaccines, but even small doses of this misinformation can sway parents with the least tendency to distrust medicine and, by proxy, vaccines.
So, in a way, although Largent is partially correct in that fear of vaccines isn't always just about the vaccines, he misses the larger issue, namely that of an active, committed antivaccine movement whose leaders actually gloat when they see statistics indicating that vaccine uptake has fallen. That is the agenda, although few in the antivaccine movement will publicly admit it. Indeed, four years ago, Jenny McCarthy led an antivaccine rally in Washington, DC. In the lead-up to that rally, I noticed a distinct tension between the realists, who wanted to proclaim themselves "vaccine safety watchdogs" or "pro-safe vaccines" and antivaccinationists, who wanted to proclaim vaccines to be the equivalent of toxic waste. Anyone who's been fighting the fight against antivaccine information knows this, but apparently Largent doesn't. In fact, he knows so little that he an write something like this with an apparently straight face:
The routine vaccination schedule now calls for shots at almost every well-child checkup, including four inoculations at the two-month appointment and five inoculations at both the four- and six-month appointments. As parents scramble to explain their fears, the only explanation available to them is the claim that vaccines might cause autism. But when their anxieties are carefully and respectfully examined, we see that they emerge from a wide variety of often well-informed philosophical and moral concerns parents have about their children’s health.
"Well-informed" is not the word I would use to describe the sorts of beliefs that lead parents to refuse vaccination. In fact, as I've written about over and over and over again, the concerns of these parents are almost always rooted in pseudoscience, fear mongering, and outright scientific misinformation. If Largent thinks that the concerns about vaccines that lead to Jenny McCarthy, Age of Autism, and the like are "well-informed," he's more clueless than my initial impression of him indicated. After all, what "moral concern" could lead parents to leave their children unprotected against vaccine-preventable diseases, particularly potentially deadly ones? Is it "well-informed" to believe lies about vaccines, such as claims that they are loaded with antifreeze, toxic doses of formaldehyde, and all sorts of other horrific "chemicals"? No, I would argue. It is not.
In the comments, when he is called to task, Largent claims to be more "moderate":
Unfortunately, a 700-word op-ed is far too constrained to explore the many issues surrounding today’s vaccine anxieties. It is my hope that by pressing a more moderate position in this op-ed and in my book Vaccine: The Debate in Modern American (Johns Hopkins University Press) we can get more parents to vaccinate more children against more vaccine-preventable diseases. I firmly believe that the best way to do this is to actually address their concerns, not cast them as ignorant fools who mindlessly follow a celebrity. Wakefield and McCarthy would never have garnered as strong a following had there not already a substantial pool of vaccine-anxious parents whose concerns were not being adequately addressed.
"Address their concerns"? As if pediatricians don't try to do that every time a parent brings her child for a well child visit and balks at allowing her child to be vaccinated! What planet is Largent living on? Does he have any idea how out of touch he sounds? He's confusing blog rants with how pediatricians behave in one-on-one encounters with real parents of real patients in real doctors' offices.
How does Largent think parental concerns should be addressed? Maybe he says so in his book, but he sure doesn't say so in this op-ed, nor does he say in the description of his book, although, I must say, his description of his book doesn't exactly make me all warm and fuzzy with confidence that there will be some sort of grand revelation about how to address parental concerns that pediatricians aren't already doing. In fact, quite the contrary. My reading of it is that it's full of the fallacy of the golden mean, or, as I like to call it, the fallacy of false balance. He even goes so far as to refer to "extremists for and against vaccinations." Really? Really? I'd like to see Largent name a "provaccine extremist," because I've never encountered one. I have, however, encountered many antivaccine extremists.
There are certain people who value compromise and comity above all else. They assume that when people disagree that the "true" answer must be somewhere in between, so much so that they are willing to bend over so far backwards that they twist themselves in pretzels in order to try to paint both sides as being reasonable and "well-informed." In the case of vaccines, nothing could be further from the truth. On the one side, there are pediatricians and scientists showing that vaccines are safe and effective. On the other side, there are the likes of Jenny McCarthy, promoting outright misinformation, pseudoscience, and lies about vaccines. His periodic assertions that "of course I don't Largent falls into the trap of treating them as though they were equally legitimate. He confuses respecting parental concerns with pandering to antivaccine fears.
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Very naively, he also says this:
To me this is wrong on several levels. Largent seems to feel that parental anxieties have sufficient scientific merit for them to be a prime consideration of the makeup of the vaccine schedule. The fact is however that they aren't, and the way to counter this is to vigorously but diplomatically counter this wherever this idea is floated - be it at the paediatrician's office by a parent, or by an antivax lobby raising their "anxieties" [sic] with the media/medical authorities/politicians.
Largent is also naive if he thinks that modification of the schedule in response to these "anxieties" will assuage the rabid antivaccine zealotry. As you yourself repeatedly point out, Orac, it's not about the schedule, its always about the vaccines, and these people will not rest until all vaccines have been wiped off the schedule and our kids return to the dark ages where one in five died in infancy from one of these preventable infections.
Showing "respect" for the antivaxxers "concerns" by radically modifying schedules that have been scientifically honed and optimised with children's best medical interests in mind is not the way to go, IMO.
In other news, UNICEF announces a marked drop in childhood mortality since 1990.
Since most still die in the first 28 days after birth (40%) complications in childbirth still play a large roll.
However, UNICEF attributes this drop mostly to vaccination campaigns, better hygiene over all and increased access to clean water.
Fuck antivaxxers.
ooo, you scooped me. I intended to blog on this under a "concern troll" heading. What gets me most is that Largent is so bloody lazy (and hides behind the 700 word limit). If the book is anything like that, I don't want to read it.
Here's a newly published book looking at vaccines from a parents' perspective - which doesn't feel the need to find a false "middle ground" between sound science/good medicine and antivax nonsense:
http://www.amazon.com/Your-Babys-Best-Shot-ebook/dp/B008UTQS2M
I'm not sure how one describes the progression of thinking at Age Of Autism. They've gone from floating ideas of what might cause various developmental delays and physical problems to simply asserting there is an "epidemic" of almost everything in children.
"We are the nation of the chronically ill and disabled. It’s not recognized as such, but it’s the truth. My son’s parochial middle/high school has a few hundred kids in it. Several kids have diabetes, lots of them have asthma, and one has a life threatening peanut allergy that’s so bad the other students aren’t even allowed to bring peanut butter sandwiches to school. They don’t have the rooms full of learning disabled kids that they do down the street at the public school, but it’s obvious that things are not like they were back when I was in school.
How did we get this way? No one is even willing to recognize the problem.
What can we do to stop it? No one is interested now because entire careers are built around serving this disabled population." (Anne Dachel)
http://www.ageofautism.com/2012/09/childhood-american-style.html?cid=6a…
I could talk about better health care, earlier detection, better reporting, changes in diagnostic criteria - and when it comes to schools, a LOT of legislated changes that my family and many other families have benefited from. It wouldn't be any use. Their thinking has calcified.
I would ignore AoA completely except they give safe haven for the vaccine avoiders. Some people just want any excuse at all to not vaccinate themselves or their dependents. They do not need more encouragement.
The point about more disabled children in 'normal' schools is easy.
In the past they were just shut away somewhere and forgotten about. These days at least some attempts at proper integration are made.
I informed my older son that I would be making an appointment to get him his flu shot.
"I don't want to! It hurts."
Yeah? How much does it hurt? You bruised your knee this week, will it hurt more than that?
"It hurts a long time!"
How long did your knee hurt?
"A day."
It won't even hurt that long. You can count for me and tell me when it stops hurting.
We discussed anxiety and worrying about impending "stings". I think I'll use a few doses of "How much did it hurt - really?" and talk about how we worry big about little things.
Anything can be a teachable moment.
I read Paul Offit's (pro-vaccine activist) book "Deadly Choices" on the vaccine controversy and watched some videos.
I wonder about something: he makes statements like, you could receive 10,000 vaccines at once and your immune system could handle it, and there are trillions of bacteria on one's skin so from being "vaccinated" by a paper cut, there's an immune system challenge much greater than being vaccinated. I don't remember what the exact statements were, but that's the gist of it.
Yet when I take my dog to the vet to get vaccinated, they always warn that she'll be tired if she gets a lot of shots at once. I asked why she'd be tired and the vet said, getting vaccinated is like being a little sick. I've also heard that kids are sometimes tired and sleepy after being vaccinated.
I don't think someone would get tired and sleepy from a paper cut, so it seems like Dr. Offit is distorting reality a bit.
I live in a little lefty town and surprisingly often, women have brought up vaccine concerns to me, totally out of the blue. Like casually chatting in a locker room, they'll bring it up.
I'm not a parent, but it seems that parents generally live in a state of terrible anxiety that something might harm their children, and they bring up vaccination because they hear the anti-vaccination stuff but aren't sure whether to believe it.
The anti-vaccination movement might serve as a psychological defense. Anyone bearing a child now is bringing them into a dangerous world with many terrible threats that people can't personally do anything about, like nuclear proliferation and nuclear terrorism, global warming, future famines, and more immediately, threats like drunk drivers ... Being anti-vaccine could convert anxiety about those threats into an anxiety one CAN do something about: refusing vaccination.
When I checked out "Deadly Choices" from the library, I saw it hadn't been checked out since last May! That so few people would read a pro-vaccine book, in a town where so many are concerned about vaccination, suggests that somehow being anti-vaccine serves a psychological purpose for them.
@Pris
We've come a long way in detecting and understanding learning disabilities. That plus legislation means more SpEd programs and more students in them. It also means more students succeeding instead of failing.
I suspect that most instances of kids feeling tired after vaccinations is less due to physiologic effects, and more a reaction to stress built up by fear of needles. I've never seen any such effects in my dogs nor been warned about it by the vet.
As for Dr. Offit, he was referencing a study relating to total immune system capacity and not suggesting the desirability of getting thousands of vaccines at one time, which would be problematic for other reasons (I imagine the fluid overload would be impressive, though with all that "antifreeze" you could glide through the entire winter without congealing ;)
Actually, I just had a pertussis booster yesterday (since I am asthmatic and therefore part of the at-risk population) and it HURTS! My arm is all sore today and I am grumpy. So I think that is why children get tired.
BTW - why don't adults get lollipops when we get immunizations? It's age discrimination.
Laura, the paper cut will challenge your immune system just like the vaccination. If you remember the small pox inoculation, that's just a paper cut, and it, for me at least, had a definite reaction. The only difference was the cut came with a new pathogen, not something your body (hopefully) is already trained to take care off (like in your everyday nicks).
In vaccination we want the immune system to get riled up about the new intruder, so that the system recognizes it on contact. For smallpox, a paper cut full was enough to trigger the reaction, other antigens need a much larger dose to get the response needed for a long-term effect.
@I Am Here
Congrats on getting a pertussis booster! Thanks for helping protect your community. And yeah, vaccines with a tetanus component generally hurt a fair bit, though I've found that trying my best to relax my muscles helps mitigate that a good deal.
Perhaps we ought to also distinguish those parents who really have no fixed views - newbies to the topic, as it were, from those "promoting" the ideas, the Jenny McCarthys, etc.? While the claims want addressing, the want to make a decision for their children is understandable - I suspect newbie's struggle with the conflicting information and their parenting instincts.
Compared to the anti-vaccine forums, do you think there is a relative paucity of places where 'newbies' can ask questions (as opposed to read articles) of people who know the field, as few scientists or medics write on-line and many on-line settings are too ‘robust’ for many newbies to want to speak up. Part of the issue is that specialists are, essentially by definition, fewer in number than the population at large. Another is that specialists by nature tend to be busy - few of them commit the sort of time Orac does! Let's face it - maintaining a conversation takes time (and time away from writing the articles). There's more, but either way should we be considering these 'newbies' too?
To add to the booklist, there's Mnookin's Panic Virus too.
Dangerous Bacon @0908: Reports of kids feeling tired after vaccinations is something I wouldn't dismiss out of hand. It could well be psychological, as you say. But it could also be a side effect of the immune system response to the vaccine. We know that with some vaccines experiencing symptoms of the disease in question is an occasional side effect, and fatigue is a symptom of quite a few illnesses (colds and the flu, for instance).
"newbies" = "lurkers" much of the time.
I sometimes post with lurkers specifically in mind, especially when a topic is being discussed in the shorthand that develops when people are very familiar with a subject. Using the slang that a subculture acquires can create efficiency and speed while shutting out newbies who don't know the language.
http://www.giantitp.com/comics/oots0863.html
fifth panel
Enjoy.
OT ( but pandering to vaccine fears is NEVER OT @ RI):
@ Age of Autism, today: EBCALA announces a study from Safe MInds and the Holland Center which has been provoked by fears about the DSM 5 changes in diagnostic categories for ASD; they maintain ( correctly) that 5 studies reveal a reduction in the number of diagnoses of ASD through use of the new criteria. They are asking clinicians "anywhere in the world" who speak English to each submit a few new cases for assessment with DSM 5 .
Their general conspiracy mongering holds that the new criteria were created by the powers-that-be to mask the 'epidemic' of autism unleashed by the surge in the number of vaccines required since 1994** ( which con-incidently, was the last time the DSM criteria were changed).
** sarcasm
@ Laura
Which is, of course getting it exactly ass backwards. Getting the kids vaccinated is a way of protecting them from all of those nasty diseases.
BTW you can count me as your first provaccive extremist: I don't think children should be allowed into places like schools, amusement parks or playgrounds unless they are fully vaccinated or have a valid medical excuse.
Any aspect of "respecting parental concerns" has to be done with respect to how legitimate are those concerns. Otherwise, it is merely an opportunity to create a wedge by those opposed.
As I have mentioned before, the difference between real medical practitioners and quacks and whackaloons is that medical practitioners are honest, whereas the loons lie. So imagine the situation where someone starts a rumor that vaccination causes kids to blow up into blueberries like Violet on Willie Wonka. This gets picked up by an inscrutable resource. A parent reads that and gets worried that their kid will turn into a blueberry.
How does a doctor address that concern without coming off as dismissive? The doc takes the high road and says, "Lots of studies have been done and turning into a blueberry has never been associated with vaccination." True, completely legit, but, as we have seen, also completely ineffective. Lots of studies have similarly failed to find a link between vaccination and autism, but that doesn't seem to assuage too many concerns.
Alternatively, the doctor could go on the attack. "The claim that vaccination causes kids to turn into blueberries is completely baseless, and is an example of the type of misinformation that is floating around the internet." The parent hears, "You are an idiot for believing things you read on the internet"
Pretty much any other version I can come up with has the same result. What you want to say is, there are a bunch of a-holes out there who are lying to try to get you to not vaccinate, but then again, you are calling the parents dupes. They are victims of misinformation, but they won't view themselves that way.
But in the end, concerns like "vaccines cause autism" are just as baseless as the blueberry result. I have pointed this out before: what is the basis for the claim that _vaccines_ cause autism? The MMR/autism link was initially suggested on the basis of "He got the shot and BOOM, he became autistic." Which does happen with MMR, because it is given proximal to the time when autism symptoms first get detectable. So you do an investigation of MMR, and discover that, no, in the end, there is no link between MMR and autism. That should address it, right? No, the antivaxxers jump on this, and say, oh, but it's the OTHER vaccines that are doing it. Because if not MMR it must be a vaccine, despite the fact that they do not have any suggested link to autism. There is no "he got the Hib vaccine and BOOM, became autistic" stories, but still, the vaccine gets blamed merely because ... it's not MMR so it must be another vaccine? That doesn't follow in the least.. There is no basis for associating "vaccines" with autism.
I have no vaccine fears. I love me some vaccines. But my arm was sore for a day after getting my flu shot. (Still better than the flu -- or flus.) I don't see the minor pain or inconvenience of getting these shots to be better than avoiding them and exposing myself to the disease.
PLEASE don't compare your dog to your child. Dogs get vaccinated for completely different things, with completely different vaccine compounds. Dogs don't get measles, so they don't get a measles vaccine. Your child will not get a kennel cough vaccine ever or a rabies vaccine unless he's been exposed. The side effects of a vaccine (for a different disease) for a dog (a different animal) cannot be compared to the side effects of a human vaccine for a human illness on a human. I don't know the makeup of the standard vet vaccine schedule for dogs, but they may use more live attenuated viruses, which can cause more "sickness" side effects like fatigue.
I am so glad my OBGYN was not a doctor who followed the "CDC recommended schedule" -- he was more pro-vax than that and was willing to give me my HPV vax even though I was older than the recommended age. Yay for cancer vaccines.
@ Anj:
Re 'thinking at Age of Autism':
Over the past few years, I've seen how they've become more like the natural health fana....*enthusiasts* who frequent sites like Natural News: they believe that 'natural is better', that pharmaceuticals are the devil's own, that "Orthodox" medicine is soul-less and money grubbing et al.
Similarly, an offshoot of AoA, the Canary Party, often sounds exactly like Adams or Null, couching health concerns in politicised language. TMR is another spawn that constantly promotes rebellion against the establishment.
SItes like these emotionally manipulate parents who may be isolated from their peers in the general community: they have been 'set apart' because of a diagnosis of ASD. I think that the anger and disappointment that they feel is channeled into aggression against the experts who hold a privileged position and who delivered the deadly blow ( diagnosis) that forever changed their dreams for their child.
I believe that these sites serve as a misguided attempt at group therapy for devastated people- however unlike SB therapy, UNrealistic views are promoted and encouraged in cult-like fashion.
With very few exceptions, those who run the sites and contribute material are parents ( occasionally grand-parents) of children with ASD. Somehow I place them- because of the emotional turmoil and difficult life they suffer- in a different category from others who have pushed the vaccine-autism agenda- like AJW- purely as an income- and fame- generating engine.
But even though they have an excuse ( of sorts), their mis-information does just as much damage because they make others suspicious of vaccines for no evidential reason.
@Denice Walker
There are already parents showing up at the usual blogs and discussion groups talking about how their child was diagnosed with Social Anxiety Disorder,and how the parent KNOWS it was caused by vaccines.
I do wish that there was either more of an effort to go back and properly diagnose people over the age of thirty who are on the spectrum,or if enough have been properly diagnosed,as I suspect they have been,more of an effort to make the number of these diagnoses known to the greater public.
@AllieP
I think your doctor's approach illustrates how the recommended schedule is not, in fact, a one-size-fits-all straightjacket, like anti-vaccine activists like to claim.
I just might buy the book to see how little Mark Largent knows about vaccines.
My eyes were drawn to those big honking syringes and needles and the amounts of "vaccine" seen on both the editorial page and on the cover of his book. The syringes appear to be 5 ml, the needles 1.5-2.0 inches, and the amounts of "vaccine" is ~ 3 ml. The baby pictured on the editorial is not old enough to be getting any immunization in the upper arm.
Too bad, "I don't do Facebook"...but it looks like the comments about his editorial are on Team Science.
@Denice Walters,
Good points all.
I'm actually tempted to go harder on the parents because it's easier to understand motivations of the greedy and attention seekers than parents who I expect to be working on the best solutions for their children.
OTOH - their need to vent their frustrations must be great, and I understand lashing out at their targets of choice. It makes for lousy group therapy though.
@ Roger Kulp:
I have seen them expand WHAT they believe causes ASDs from one or two malfactors to many (in vaccines and in the general environment) AND also expand the RANGE of ills that vaccines and other devilish modern innovations cause.
So in other words, EVERYTHING causes EVERYTHING. Everything MODERN, actually.
"Let's get back to Nature!"
Right, with sides of diphtheria and malaria.
And a UK study has shown that adults exhibit ASDs at similar rates ( about 1%)to children. There will be more research along these lines I predict.
The very title of the article, I think, betrays the core misconception. These particular parental concerns are not worthy of respect. No more than a child's conclusion that 1+1=11 - it's just wrong, and should be treated as such.
The PERSON can be respected, while still acknowledging false information as illegitimate.
Shots hurt. They hurt for awhile. I would think that if you injected any kind of fluid like that, it would hurt - you're pushing fluid into a space that normally doesn't experience that. The mechanical stress from the injection (piercing the skin, forcing something into tissue) would be enough to account for the pain, not even adding any muscle tension from anticipation. Hell, an IV site hurts afterwards, and that puts fluid into a space evolved to accommodate fluids.
@ AllieP
Very good point. Live-attenuated virus vaccines are causing an infection, after all. Generally short-termed, from a low pathogenic strain, but still, it will take some toll on the body.
Note that for human vaccines, doctors prefer not to give them if you already have some infection.
Actually, isn't one of the reason because a undergoing infection may make the vaccine less efficient?
The vet's practice of spacing out vaccines may also be linked to the rabbie's vaccine reputation to be quite tough on the patient (don't know how much this is true; likely more true for the earlier versions of the vaccine). The precaution may have started with this vaccine and has been extended by force of habit to other vaccines.
Re: Paul Offit's infamous 10000, I was under the impression he was talking about the antigen load more than the volume or number of vaccines - he answered the concern of the baby's ability to deal with all the scheduled vaccines (the "too many too soon" concern) by pointing out that a baby will have to deal with way more antigens from the environment, e.g. following a dirty paper cut.
@Heliantus
Well, according to the CDC's general recommendations on vaccines, a mild to moderate illness is not a reason to delay vaccination until the illness is past.
@ Anj
It annoys me that people appropriate whatever they want under a vast umbrella of crazy just to justify their views. Been reading some stuff recently which talks about higher allergy rates in the cities due to a lack of exposure to diverse bacteria. But hell we have to be a lot cleaner in cities because a lot more people are packed in which makes diseases easier to transmit and spread.
Its an indicment of 'hey its a complex world and no matter what we do there will always be some minor downside' but not a vaccine problem. I sometimes wonder whether people genuinely were happy in these supposed 'good ol non-vaccinated days' or whether with the internet and 24 hours news and every person with a blog networking their opinions whether theres just that much more exposure than their used to be.
@ Heliantus & Todd W.
The CDC Pink Book addresses mild to moderate illnesses as a concern that parents may have to their child receiving vaccines:
http://www.cdc.gov/vaccines/pubs/pinkbook/genrec.html
"Moderate or Severe Acute Illness"
"There is no evidence that a concurrent acute illness reduces vaccine efficacy or increases vaccine adverse events. The concern is that an adverse event (particularly fever) following vaccination could complicate the management of a severely ill person. If a person has a moderate or severe acute illness, vaccination with both live and inactivated vaccines should be delayed until the illness has improved."
And here, regarding a mild illness...
Invalid Contraindications to Vaccination
Mild illness
Antimicrobial therapy
Disease exposure or convalescence
Pregnant or immunosuppressed person in the household
Breastfeeding
Preterm birth
Allergy to products not present in vaccine or allergy that is not anaphylactic
Family history of adverse events
Tuberculin skin test
Multiple vaccines
i'm 3 months into my third year of medical school and on my first month of family medicine. i saw a vaccine hesitant couple with a 4 month old. the grandma of the baby has been feeding the parents horror stories of "vaccine injury." i feel more prepared than most of my med school classmates to address these concerns because of RI, SBM, etc. i spent a good 15-20 minutes discussing these concerns (autism and other vaccine injuries, toxic load, the diseases we protect against, etc.). the dad completely followed what i was saying and was ready to vaccinate. the mom was still a bit hesitant but willing. i leave the room to report to the physician that i'm working with. i told him the story and i think he tuned out everything i said except for "vaccine hesitancy." so he goes in and says "i understand you have some concerns about vaccines. would you want to split them up and just do a few today?" mom readily agreed.
GAH!!!! i guess it's not fair to say that all my work was undone, but at least half was. and if the parents fail to return for additional visits to catch up to the regular schedule and the kid ends up getting an infection, then it truly was all for naught. i blame bob sears.
Oops, I submitted the comment...before actually commenting on mild or moderate illness *concerns*.
I have yet to meet a doctor who would dismiss a parental concern about a mild illness with regard to receiving a vaccine. After explaining the CDC recommendation about giving the vaccine, most, if not all doctors, would simply re-schedule the child's vaccine(s) for the following week.
It's not all about "enforcing" strict adherence to the CDC Schedule, it shows the patient that a doctor "allows" a short delay. That's the way doctors build trusting relationships with parents.
If only...that "minor illness" concern...was the only objection to immunizations that doctors encounter in their practices.
@lilady
Exactly the section of the Pink Book I was thinking of. I'm currently rereading it. It's a very good reference that I think more people should read.
@ Todd W. (I've made this suggestion on other science blogs)
As we all know, Federal and State laws require that health care providers give the patient/parent the VIS (Vaccine Information Statement), for each vaccine prior to administering the vaccine.
I believe it would better to provide a packet of all the VISs that are on the Recommended Childhood Vaccine Schedule and a copy of the "Schedule" (scroll down to see second page) http://www.cdc.gov/vaccines/parents/downloads/parent-ver-sch-0-6yrs.pdf In that informational packet, I suggest the addition of a cover letter from the local health department with a telephone number to reach a nurse, who could answer any questions about any of the vaccines...and "other concerns" a new parent might have.
Better still, that informational packet could be provided to new parents before they take their baby home from the birthing hospital/birthing facility.
(In my dreams), the ultimate manner to provide reliable information to expectant parents, is to provide that informational packet during an obstetrics appointment.
Most people gets most of their information about child health and vaccines from the internet. IMO, it should be a public health priority to provide reliable vaccination information and reliable information about vaccine-preventable diseases to parents and expectant parents...as a counterbalance to the pseudoscience anti-vaccine websites.
I suspect Largent has not talked to many true vaccine-hesitant parents...and I do mean hesitant, not refusing. Perhaps he'd like to spend a few days shadowing me, or another pediatrician. These parents are often tragically NOT well-informed. They rely on rumors and third-hand anecdotes; often they don't even know exactly what they're afraid of, other than someone telling them that vaccines are bad. (I've had parents ask if the MMR has mercury in it; I've had at least 2 other parents ask me if it's true that vaccines cause Down syndrome.)
Many of these folks just need my reassurance. The greater problem is the ones that still refuse: in other words, they are in the grips of irrational fear. Key word being IRRATIONAL, e.g., not responding to rational explanations. The increasing distrust of authority and organized institutions, coupled with the ability to find gobs on information on Google, has unfortunately led to a rampant Dunning-Kruger effect. I think that's why more upper-middle class families are hesitating or refusing.
If Largent has a good solution to that, he should enlighten us all. But it sounds like he too suffers from Dunning-Kruger...or maybe just Ivory Tower syndrome.
Cynical Pediatrician:
Oh, wow. That brings up memories. Back in the days when the internets were new, I belonged to a listserv that pertained to my son's severe speech disorder. About the time when people were freaking out about the "Millennium Bug" the first inklings of "did vaccines cause my kid's disorder" started to occur.
I found out shortly that explaining that there could be no relationship, since my kid's seizures were no where near the time a vaccine, that some of those on the list were not reasonable. It happened when one of the more militant of the Mercury Moms emailed me to say that she was told at the Mayo Clinic that vaccines cause Down's Syndrome.
And that was only the beginning of the nasty grams would get from them before I quit that list about five years later.
There's more than one myth about vaccinations. One of the myths seems to be that if parents express any concerns about vaccinations to their pediatrician and their pediatrician is pro-vaxx, then said pediatrician will immediately throw back his or her head and roar with contemptuous laughter, stopping only gaze derisively upon the concerned parent's face and spit out a few scornful admonitions regarding said parent's education, gullibility, intelligence, and general fitness as caretaker. Then, when the beaten-down parent abjectly agrees to vaccinate, the pediatrician will inoculate the child with an especially vicious jab. And laugh again.
Or .... the pediatrician could actually address the parent's concerns in a concerned manner.
Which side are you on, Orac? Hmm? I hope it's the moderate one.
I have read what is available of the introduction of his book and it seems Largent's wife died when their daughter was 19 months old. I will venture out on a limb and say that this is likely to have made him more susceptible to anti-vaccine tales (which he had been researching for a book project at the time). When you have just lost a loved one, one or the other "vaccine-loss" story will resonate, I guess.
@Sastra - I have yet to meet a pediatrician that would fall into that first category. Outside of the diseased minds of anti-vaxxers, I don't think they even exist.
Some parents are hesitant to ask questions because they are afraid that the pediatrician or family physician will dump their child as a patient. Asking questions does not equal refusal. If a parents concerns are addressed in a respectful manner, most vaccine hesitant parents will think about what they have heard and eventually decide to go with the full vaccination schedule. Because they haven't been belittled or made to feel stupid, they feel safe in asking questions. Well informed consumers of healthcare make it hard for the woomeisters to develop a credulous audience. It happens, one parent, one baby at a time, one family at a time. Education helps to overcome belief.
Good gravy, my blueberry scenario suddenly seems less crazy.
Is their a vaccine version of Poe's Law?
Marry Me, Mindy:
Just use Poe's Law. And trust me, from the rantings of that woman on the listserve: it was not a Poe.
AllieP: "Your child will not get a kennel cough vaccine ever...". Oh, really? Ever heard of Whooping cough? Both vaccines are for the Bordetella bacteria. It is a different variety or Bordetella but it is very much like "a kennel cough vaccine". The other diseases are also close to what the puppy or kitten may get vaccinated for, For example, Rabies is a severe form or meningitis. In addition, "[a]s it is a Morbillivirus, the rinderpest virus (RPV) is closely related to the measles and ***canine distemper viruses.***" [ Wikipedia ]. There are many different types of vaccines given to pets and domestic livestock live-attenuated is just one. If there ever is an HIV vaccine we would then have a vaccine similar to what we vaccinate cats for [FIV]. [BTW I DO COMPARE MY DOG TO a child.]
If you think the pet vaccines are vaccines are "very different compounds" verses child vaccines why not get vaccines inserts of several child vaccines verses several pet vaccines? You will find that the compounds are very similar. I worked as a registered licensed veterinary nurse for 20 years; do not try to fool me regarding pet vaccines verses childhood vaccines. Fear-mongering will get you nowhere with me.
Sastra,
I agree, but the anti-vaccine crowd play this up, eh? On that note, we had a current affairs presentation in NZ earlier this year on the influenza vaccination that had one of the current affairs staff pro-vaccine and one ‘unsure’. The doctor was very jolly about the latter parent’s concerns - some said too jolly, that they felt he was ‘laughing away’ their concerns. Whether this was someone ‘playing up’ this thing or sincere I don’t know, but either way I guess it suggests a need to take care over how you talk when you’re talking to a parent coming to a decision, as opposed to those ‘promoting’ anti-vaccine stances. (I’m emphasising the distinction as I like to divide the anti-vaccine crowd into several ‘levels’ and treat each accordingly; the article linked in my earlier comment touches on some of my thoughts on this. Excuse the apparent self-promotion - I’d elaborate here but I’d be repeating myself and this comment would get even longer than it already is!)
Kay,
I've had one little success like that this year - the parent messaged me back to say she was deciding to go with the vaccines. Aside from the amount of time involved, I'm finding little opportunity to do this now as the local anti-vaccine groups have blocked me from commenting. I made a particular point to be polite and developed a policy of not commenting unless someone asked a question, so that I was not pushing anything but following from their lead and helping them. Despite this the 'organisors' of these groups blocked me anyway - as we know for the organisors their groups are not really about free and open discussion.
Julia is a troll. She posted that same ridiculous statement about the B. pertussis bacterium being the same/or similar to the Bordetella bacterium that is responsible for most cases of "kennel cough"...on another website.
" I worked as a registered licensed veterinary nurse for 20 years; do not try to fool me regarding pet vaccines verses childhood vaccines. Fear-mongering will get you nowhere with me."
"Registered Licensed Veterinary Nurse" a.k.a. Veterinary Technician...which is one step removed from being a dog groomer:
http://jobs.aol.com/articles/2010/10/23/veterinary-nurse-salary/
I don't have a pet, but I wouldn't trust this troll veterinary tech to take care of a beloved family pet.
@ Chris: Remember this post from Julia/Andrea on that other science blog?
"I work in a vet clinic and had a basic understanding of the dog vaccine for Bordetella (which isn’t very effective), and started out pro-vax for my daughter, but keep coming across valid info causing me to question that stance."
WARNING...JULIA/ANDREA WILL SEND IN ONE OF HER SOCKIES TO POST AGAIN ABOUT KENNEL COUGH
I love it. I'm the fear mongerer because I point out that humans are a different species than dogs. Come on, Julie, you don't need to be a vet technician to understand that different animals are susceptible to different diseases. FIV, despite being similar to HIV, does not vector to humans. Neither does distemper or canine parvo (which is not Fifth's Disease). Kennel cough *may* vector to severely immunocompromised individuals, but does not magically turn into pertussis when it does.
Because I'm now curious. I checked out the exhaustive literature on the subject over at the AAHA: https://www.aahanet.org/Library/CanineVaccine.aspx
Vet vaccines are regulated by APHIS, a division of USDA. The schedule is decided by them, not the CDC and FDA.
So many differences! Wow! Different diseases, different species, different vaccines, different schedules, different government agencies. It's almost like it's ENTIRELY DIFFERENT.
Get your pets spayed and neutered AND vaccinated, folks!
Speaking of which, what happened to rinderpest again?
Anj,
Todd's comment about relaxing his arm reminded me that as a kid I figured that sticking a needle into a tensed up muscle would hurt more than sticking it into a relaxed muscle, so whenever I got a shot I concentrated on relaxing my arm as much as possible. I found that this worked very well indeed. Later in my life I found if you tell kids that the more they relax their arm muscles the less it will hurt it reduces their anxiety and gives them some control over the experience.
Re: comparing children to dogs, they are both small mammals I suppose. Which reminds me of the joke about MDs being vets who only treat one species...
Actually there are a lot of similarities between a vet and a pediatrician, especially in terms of very little babies.
Of course, pedes are still only doing one species
@lilady
B. pertussis (and B. parapertussis) evolved through genome reduction from a common ancestor with B. bronchiseptica. They share many potential virulence factors with a couple of notable exceptions like pertussis toxin (can't really overstate that difference :P).
Of course, the resulting differences are why B. pertussis is restricted to humans while B. bronchiseptica has a much wider host range.
Figure 2 of this paper gives a graphical view on the relatedness of the genomes.
www.nature.com/ng/journal/v35/n1/full/ng1227.html
I don't think it is out of line to note their similarity and I'd consider it not very different from the case of Burkholderia mallei and Burkholderia pseudomallei in that regard.
Take a look at this website for a review by Christian Orlic of Mr. Largent's book:
http://www.skeptic.com/eskeptic/12-09-05/
Take particular note of Orlic's interpretation of Mr. Largent's "classifying" of the diseases that vaccines prevent:
"One of the most important observations made by Largent is that not all vaccines are the same. Some vaccines protect against devastating diseases (MMR, DPT), others protect against dangerous ones (Hep A, Hep B, Hib, rotavirus, PCV) but the likelihood that an infant may be exposed to these is low, and other vaccinations provide protection against diseases with extremely low mortality rates (chickenpox). The distinction between the diseases each vaccine protects from are often forgotten. For example, Largent argues that some of the diseases we vaccinate newly born babies against may be unnecessary, such as HepB, a disease that an infant could only “contract by having sex with an infected person or by sharing contaminated needles with an infected drug addict” could wait (2)."
(PCV is Pneumococcal Conjugate Vaccine)
Did Orlic get it all wrong...or did Largent?
Largent is whining on his facebook page about how mean this post and the comments are. Poor baby.
@ john V: Thanks for that link to Bordetella genomes, however this statement about "parapertussis (which) can also cause whooping cough" is incorrect...
"Bordetella pertussis, Bordetella parapertussis and Bordetella bronchiseptica are closely related Gram-negative beta-proteobacteria that colonize the respiratory tracts of mammals. B. pertussis is a strict human pathogen of recent evolutionary origin and is the primary etiologic agent of whooping cough. B. parapertussis can also cause whooping cough, and B. bronchiseptica causes chronic respiratory infections in a wide range of animals."
Here is the link to the Vaccine Preventable Diseases Surveillance Manual-Pertussis chapter. Whooping cough is not caused by the parapertussis bacterium; nasopharyngeal swabs/PCR testing differentiates between parapertussis and pertussis bacterium. Parapertussis is not a "National Notifiable Disease".
http://www.cdc.gov/vaccines/pubs/surv-manual/chpt10-pertussis.pdf
" Burkholderia mallei and Burkholderia pseudomallei" (?)
I think I recall these two bacteria when I was taking classes on weapons-grade anthrax and bioterrorism...
http://www.upmc-biosecurity.org/website/our_work/biological-threats-and…
Misquoted the comment as well while he was at it. ("Bloody lazy," Mark.)
@ David Rudell...link please, please, to Largent's Facebook page.
Meanwhile, Largent is on sabbatical leave, according to this link:
http://jmc.msu.edu/contact/show.php?id=67
@lilady, ask and ye shall receive:
https://www.facebook.com/marklargent
Dave Rudell..thanks for the link...however "This content is currently unavailable"
Mr Largent, you are obviously "lurking" here. Why don't you provide some comments about your book. If we have misjudged your book, you should be willing to defend that book.
@ lilady:
@ Dave Ruddell:
Oh wait...
Largent? Doesn't that mean MONEY?
Actually, 'l'argent'...
En francais, s.v.p.
lilady, the link works for me. I logged out of FB, and i got the not available message. So, if you want to see his page, you'll need to have an account.
Huh, now I just re-logged in, and he seems to have changed his settings so that we can't read them. I guess he doesn't like it when people criticize him. Dr. Largent, since we know you're reading, what's incorrect about Orac's post? Not the comments mind you, the main post itself.
Re: Antivaccine radar...
A few months ago, I was ranting to my family about emails I get from one of the mothers from our church about how horrible vaccines are, emails riddled with Mercola links. We are Catholic and there are some uber-Catholic families at our church (including the Mercola fan who sent the email) with lots of kids. They all homeschool and don't vaccinate. When I was finished complaining, my teenage daughter, said, "You mean Mrs. X? Yeah, she looks like she doesn't vaccinate."
@ gpmtrixie: Just a suggestion...why not email that parishioner this link?
http://www.immunize.org/concerns/religious.asp
@ Dave Rudell: "But there were false prophets also among the people, even as there shall be false teachers among you, who privily shall bring in damnable heresies, even denying the Lord that bought them, and bring upon themselves swift destruction." (2 Peter 2:1, King James Bible) :-)
@I am here:
Because I'm a government employee - in a health related job no less - I get my vaccinations from the staff nurses. And they always give us lollipops! I'd speak to your vaccination provider if I were you. :)
Perhaps. I'm just getting sustained connect failures to channel.facebook.com space, and I am logged in.
I was one of those "staff nurses" who worked in a county health department. We didn't give out lollipops, but did give out cartoon stickers purchased by us (no budget line for stickers), mostly to kids. Some adults *demanded* a sticker and we gave them stickers, as well.
One of the things I like studying is archaeological reports of Anglo-Saxon cemeteries. You know the biggest age group represented? In just about every case, it's the 0-5 age group. In the reports I've studied, they generally make up a quarter of the cemetery population. It absolutely blows my mind whenever parents express issues with vaccinations, because I bet many of those kids died of vaccine-preventable diseases. Especially when you find 2-3 kids in the one grave, all clearly buried at the same time.
Incidentally, the age group that challenges the 0-5s in the cemetery populations is the women aged between 18-30. Whenever some crunchy natural-birth-is-the-only-way nutjob starts spouting on about the connection she feels to all the women in the past who've given birth, I wonder how many of those 18-30 year old women buried in the cemeteries were screaming in agony and terror before they finally died in childbirth.
Christine I grew up in Brooklyn New York near to the Flatlands Dutch Reformed Church Cemetery. I used to walk through the cemetery and noticed the gravestones of many infants and young children who died prior to 1900.
http://www.youtube.com/watch?v=e7RgLkS-45g
Re: the sleepy after vaccines thing
This is pure anecdata, but my DD was always sleepy after her vaxes, even before she could "psychologically anticipate" them. My DS on the other hand, well, he seems to get a bit more hyper after vaxes (is harder to put down for naps for about 12 hours).
I think the thing that annoyed my son the most about his shots was having to leave the playground for the 30 minutes to get to/from the dr's office.
His last shot was his MMR at 4, and the nurse gave it to him, he looked up at her, frowned and said, "HEY!"
That was about it for the reaction.
I am no troll I am just autistic and often misunderstand social situations, sarcasm and humor in addition to mis-communicating my intentions. If somehow I communicated that I at all ever wanted to discourage any vaccines at the timeline recommended by pediatricians I totally deny that. I also deny that human microbes are equivalent to animal diseases or are commonly "caught" by humans. I know that Liz Ditz often posts here and she can vouch for me. I merely meant that it is good for both human kids and pets to get their vaccines on time.[I apologize for any confusion or problems I may have causes here. I have no human kids so I am not the same person who said: "...started out pro-vax for my daughter..." And I am quite non-deceptive so sock pups are not my style.] I guess I should just let the adult scientists talk here because they are quite effective in fighting anti-vaccinia without me to muck it up. I fully admire all of you pro-vaccination, pro-skeptic, anti-denial-ism warriors. If only I could delete my embarrassing, screwed-up post , but alas...my shame must be there for all eternity to redden my cheeks. AllieP, I was wrong to say anything that impulsive and misguided to you; I am sorry :'( .
"Largent argues that some of the diseases we vaccinate newly born babies against may be unnecessary"
Gosh. Which diseases *are* necessary?
Hi Julia, - thank you for taking the time to clarify your thoughts. I have noticed that the people here are very understanding. They understand that not everyone is used to writing on science blogs. They understand it takes practice. I am learning as well and they have been very kind to me. I have learnt a lot and plan to keep learning with their help!
I tried to access Dr. Largent's FB page and had no success.
Here's what Dr. Offit said on his website http://www.chop.edu/service/vaccine-education-center/vaccine-safety/#Do…
and in an interview,
How does one square that with dogs and people sometimes getting tired and sleepy after being vaccinated, especially receiving a lot of vaccinations?
I wasn't extrapolating from dogs to people, I looked online and found lots of mentions of babies getting very sleepy after they're vaccinated. It doesn't ALWAYS happen but it seems to be fairly common.
And, I'm sure that many anti-vaxxers also avoid getting their pets vaccinated, and this causes health problems. One is warned about socializing puppies with other dogs before they've gotten enough immunity, because they might be exposed to sick dogs who likely haven't been vaccinated.
Often one hears blithe statements from people who are trying to promote a particular point of view, and then in reality one's experience is different.
So, I was saying that's been somewhat my experience with Dr. Offit's statements, that I have not encountered in reality such a blithe attitude towards the immune response to vaccinations.
If a baby could respond to 10,000 vaccines as he says, and babies sometimes get tired after vaccinations, and getting tired is a consequence of the immune response, could a baby REALLY get 10,000 vaccines at once?
If this is NOT true, one or more of the statements in that logical sequence is wrong.
Perhaps, the vet is wrong in saying that it's the immune response that sometimes makes dogs tired after vaccinations. Maybe it's getting many different shots, and there's something besides immune response that causes tiredness, like some kind of stress caused by several needle-sticks.
I'm sure that one needle-stick could be made to contain 10,000 immunological components.
Perhaps the immune system reacts differently to vaccines contained components relating to awful diseases, rather than everyday microbes.
But hearing something from Dr. Offit, and in reality experiencing something that seems to conflict with it, is likely to discredit his statements with anti-vaxxers or parents who are on the fence, and make him look like a propagandist.
It seems like he is speaking as someone who is in a debate - that when you're in a debate, you don't want to introduce caveats that the opponent might seize on. I'm sure the vets and doctors I see are pro-vaccine, but they aren't in an activist role.
I'd love to hear what Dr. Offit has to say about this.
Dr. Offit's statements are probably literally true, but there seem to be caveats he's leaving out, and this is a possible problem with how he's trying to promote vaccines.
And by the way, another thing I brought up is that people DON'T seem to seek out alternative information. I don't know why the parents who've heard all sorts of anti-vaccination things, don't go to the public library and check out a pro-vaccine book. They don't, they just seem to make decisions based on what other people around them say?
And one can easily go on Medline and type in "MMR autism" and see what comes up. I did, and found nothing at all supporting a link, so far as I had the patience to read through it.
People don't question things for some reason. Maybe they're too busy. But this is something I'd like to ask the anti-vacc parents, or parents who are wondering - it's important, so why don't they read pro-vaccine sources as well as listening to what their friends say?
I always want to hear the other side of arguments I hear.
In the spirit of YMMV, not everyone or everypet gets tired after shots. My son always played normally, after the requisite Complaining About Having Gotten Stuck With A Needle interval. It's possible that certain sensitivities and immune responses just run in families, because I am quite obsessive about remaining up-to-date on all my adult boosters, yet the last time I had any kind of adverse reaction to a shot was at my age 15 tetanus booster (gave me lovely fever-dreams and a swollen upper arm). Nowadays I seldom even feel soreness at the injection site for very long.
There is much, much more to the anti-vaccine movement then just being against vaccines. That is the generalization of what they are about, but really it's to undermine all science based medicine by casting doubt on the ethics of those who practice as a whole and making it out as though only those who practice alternative medicine are trust worthy.
It can even go deeper then this though. Mistrusting your doctor can also be traced to mistrust of the government and that leads back to conspiracy theories. Honestly, if you are going to believe one part of this movement, you have to be willing to jump into the whole, messy, business feet first and sink to the bottom.
Growing up in an anti-vaccine household, and with the majority of my extended family being anti-vaccine, it isn't at all surprising that the family business happened to be, what else: Chiropractics. My own mother was so paranoid about medical doctors, she would not allow my older brother, born with cerebral palsy, to be treated properly as a young child, so now, as an adult, having relied his entire life on chiropractics to 'heal' him, not only has he not matured emotionally beyond the age of about 12, he is nearly immobile due to his muscles and ligaments not being used properly, not to mention that the braces that could have helped his legs grow properly were never put on him.
For many years I was convinced my mother suffered from schizophrenia, now I can't help but wonder if her anti-vaccine fixation and mistrust of medicine and the government in general is all there was to it. It didn't seem like her paranoia spread beyond vaccines, medicine, science and government, but she would really rant about them and had some pretty outlandish theories she would tell us (including about JFK and how he wasn't REALLY killed in Dallas that day.) Yeah, she was even a huge believer in the Illuminati and would tell us spooky stories about it, probably her attempt to enlighten us to things we needed to be wary of, but she would have done better to enlighten us to not speak to strangers, not wander away from home at night, not get in the cars of strange people. Yeah, I did all those things, even starting at a young age (4) because I was not told not to, and in fact that it was rude to not speak when you are spoken to. All that aside, the anti-vaccine movement, again goes much deeper then just vaccines.
Hi Lara...fancy meeting you here and welcome back. We missed you. :-)
@Laura--
You raise a good question, but keep in mind the tiredness may not have to do with the immune response. I'd suspect it's more related to the baby crying and getting worked up and then wanting to rest afterwards--in other words, it's the needle and not what's in it. I don't enjoy making babies cry (sorry, no demonic grin and evil laugh here) but it's a very small--and brief--price to pay for protection from serious disease. Heck, I don't enjoy getting my flu shot, but I know it's the right thing to do.
It jumped out at me when he cited the 700 word limit. When my (antivaccine) English professor had us read an article full of nonsense (on cell phones, not vaccines) that was also poorly written, she responded to my critiques by repeatedly pointing out the limited space in a news article. I'm a writer, and any writer worth their salt knows that if they can't convey their point concisely, they are not writing well. (I tend to be logorrheic myself, but I condense it when I'm not just rambling on blogs.)
Seriously, we are not asking for a dissertation. Just a clear exposition of ideas, preferably free of bovine feces.
@ Lara:
Hmmmm...Why do you think that she schizophrenia *in particular*? Did she have other symptoms of psychosis? Hearing voices? Delusional beliefs? Inability to care for herself? Although those are not a certain indication.You can't diagnose someone without seeing them over time : HOWEVER the actual label is IRRELEVANT if she couldn't function well as an adult and didn't take appropriate care of you and your brother. It's a terrible shame. Fortunately, you had something working for you because YOU seem to function well and acquit yourself admirably here. Perhaps other adults helped you to get along in life. .
Belief in conspiracies in not limited to the delusional: it is a mode of functioning for many people including those who have other problems such as personality disorders: Seth Kalichman believes that some hiv/ aids denialist leaders have Narcissicist Personality Disorder. I think in many cases, a strong belief in woo might be related to cognitive and educational issues as well. Can a person of average intelligence with an average education without any real psychological disorder who didn't grow up entirely disavantaged *really* believe in conspiracies? I don't know. I suspect NOT.
People with low self-esteem may rankle at the so-called elite and professional class and thus need to denigrate scientific consensus and other gauges of privileged status in regard to information. I often detect a hint of jealousy as I read their smears of those who are recognised as experts or leaders in their field. I've even had a little bit aimed at me. I'll bet that you can name a few of their most likely targets as well.
Best wishes to you. How you start out in life is no guarantee of where you're going!
@Denice, My mother was very much like a child in that she would throw tantrums until she got her way. She couldn't handle anyone being better at anything then she was, so she rarely gave compliments to any of us, and if she did, they were guarded and she always said something that sounded a lot like criticism on top of the compliment, but she rarely did anything to improve herself. My siblings and I for the most part raised ourselves and each other. We were expected to take on the responsibilities that any rational person would expect an adult do to (dishes, laundry, cooking, baby sitting infants, etc.) not children barely out of toddler-hood.
When I first started thinking my mom was schizophrenic, it was mostly due to her paranoia and rantings about her beliefs. She became overly emotional about them to the point of screaming and tears. She would also pretend to be light headed and stagger down the hall and conveniently faint on her bed whenever she was required to do something she didn't want to do (see above mentioned chores). At the time I didn't know a lot about schizophrenia, so it was only a guess or assumption based on what I had witnessed in her and the little bit that I knew about it. But come to think of it she did hear voices on a couple of occasions, which she attributed to "The Holy Spirit" as she was deeply religious.
No other adults were around, my mom's older brother and sister and their spouses and their adult children (my mom was 16 and 14 years younger then her older sister and brother, respectively) shunned our family because we were 'welfare children' as they called us. We were only allowed to participate in large extended family gatherings because my maternal grandmother made everyone. When she died, we stopped being invited. Basically, I looked at the adults that I knew and realized, 'this is not the kind of person I want to be.' And I took steps to make that so. I am by no means perfect, but given I had very few tools to start out with in life, I've done fairly well. At least I didn't leave my own children with nothing to fall back on, no confusion, no mixed messages, but, this really isn't about me so I should stop now. Later.
I don't recall it being established that the getting tired is a consequence of the immune response rather than of the injection. I for one generally experience stress from every needle puncture, both those that inject something in and those that draw something out, and when the stress is over, I feel tired.
In any case, Dr. Offit was never trying to argue that we should give a baby 10,000 vaccines at once, or even that 10,000 vaccines represented some sort of precise dividing line between "safe" and "too many." He was trying to point out that a combined antigen load which is smaller than that figure of 10,000 by several orders of magnitude - like the current vaccine schedule - is nowhere near the point where it would be plausible to think "Those vaccines might be overwhelming the baby's immune system through sheer numbers."
Anj:
The Brave Sir Largent has now restricted access to the comments of his Takepart article. You now have to log in to Facebook to even read the comments.
Dr. Largent, do you think your book will be met without criticism? Are you going to run away each time someone points out the flaws in your resoning?
To Laura @ September 14, 9:12 am and parents everywhere:
Do you think you could specify for me exactly when babies aren’t getting sleepy?
The notion of infants being extra sleepy after vaccine appointments (scheduled exactly when versus the infant’s normal nap time?) goes along the same lines as more traumas at the ER on a full moon: yeah, you were just paying more attention to it.
Babies need a lot of sleep. Vaccinated or not.
(Anecdote) Both of my children received whole cell DTP vaccines. My older daughter was very fretful and had high fevers. My son who was six years younger and had a pre-existing seizure disorder had no fever and no change in behaviors.
The rest of the childhood vaccines they received had no impact on them at all. My daughter also was vaccinated against smallpox at one year old...no problems after that vaccine.
Any "caveats" Laura thinks Dr. Offit omitted when making his comment about 10,000 vaccines have been abundantly addressed on the website of the Children's Hospital of Philadelphia (with which Dr. Offit is affiliated).
h_tp://www.chop.edu/service/vaccine-education-center/vaccine-safety/
Note especially the number of antigens (immunogenic proteins and polysaccharides) children were exposed to in the vaccine schedule of the past, compared to today's vaccines - over 3,000 in 1960, compared to about 135 now. This hardly fits in with the idea of children's immune systems being "overwhelmed" by the number of shots on the current vaccine schedule.
Long before Offit ever made his point about theoretical limits of immune system capacity, he was being denigrated and demonized by antivaxers. So it's not like he mobilized them by providing a talking point - they've made up their own for years.
Thanks Dangerous Bacon...I looked (unsuccessfully) for that page:
http://www.chop.edu/service/vaccine-education-center/vaccine-safety/
So, my one year old daughter received more that 3,200 antigens in 1971 from the smallpox vaccination...in addition to a number of other antigens from MMR vaccine.
Olmsted at AoA is off on a major rant about Forbes' Steven Salzburg calling out their pseudoscience doctor/journalist Sheryl Atkisson on her anti-vaccine agenda:
http://www.forbes.com/sites/stevensalzberg/2012/07/23/anti-vaccine-move…
@lilady, “Registered Licensed Veterinary Nurse” a.k.a. Veterinary Technician…which is one step removed from being a dog groomer:"
You have very little knowledge of what a veterinary technician is and does. Please look up NAVTA, then make an effort to explore the profession further.
Vet techs go to school, get certified, registered or licensed, or all of the above, and take the boards. They do everything but surgery, diagnose and prescribe medication (that's the vet's job, techs are regulated just like human nurses). Techs do partial exams, work in labs, give meds, monitor, assist in procedures and surgeries, take excellent care of their patients, educate owners, and follow up on continuing education just like human nurses. Some techs go on to teach, pursue specialties, just like nurses and doctors. The list of duties for a veterinary technician in a working practice are extensive and require a great deal of abilities and professional knowledge and practice.
I hope you don't make a mistake one day by calling a human nurse one step removed from a hairdresser, you're likely to receive a nice slap in the face.
Btw, pets do experience vaccine reactions, some mild, some severe. The most common are lethargy, fever, anorexia, and of course, pain at the injection site - these side effects can last hours to a few days. Some reactions are so severe that without immediate veterinary treatment, the pet could die. Some pets have subsequent vaccine reactions, and can be exempt from further vaccines (given the risk factors). Vaccine-associated-sarcomas occur in cats who have been injected between the shoulder blades, although we don't know which vaccine in particular is suspect (could be the FELV or FVRCP, could also be reaction to any injection given in the area that causes inflammatory reaction). It is theorized (but I'm not sure if proven at this time), that some vaccine could cause immune-mediated anemia in dogs.
Whether Julia is a troll or not, I'd just like to correct her, in that, we do not give FIV injections to cats given the controversy of the vaccine (it can actually cause an FIV-positive on a test when the cat is negative), and is only recommended in cats who have a higher risk due to being exposed to or living in a multi-cat environment like a cattery.
@ outfromlurking: Posting under a new 'nym, sockpuppet, or defending the other veterinary *nurse*, who posted here?
I've looked up NAVTA and I also linked to this site upthread:
Oh look at the salaries for newly minted Vet Techs and the average salaries for Vet Techs:
"Starting salary range: According to the U.S. Bureau of Labor Statistics, starting salaries for veterinary nurses and technicians range from $7.55/hour (Georgia) to $11.84/hour (Rhode Island).
Average salary: Annual salary for veterinary nurses and technicians who have less than one year of experience ranges from $20,356 to $30,677. For professionals with one to four years of experience, the range increases slightly from $21,823 to $33,254. Salary for veterinary nurses and technologists with 10 or more years of experience can reach as high as $44,002 annually.
You can make more money by flipping burgers at McDonalds and increase your skills and your salary by attending Hamburger U.
Now, lets take a look at what *Real Registered Nurses* average salaries in New York City are, for Registered Nurses who are university graduates of B.Sc-Nursing programs:
http://www.indeed.com/salary/q-Nurse-Bsn-l-New-York,-NY.html
"Techs do partial exams, work in labs, give meds, monitor, assist in procedures and surgeries, take excellent care of their patients, educate owners, and follow up on continuing education just like human nurses. Some techs go on to teach, pursue specialties, just like nurses and doctors."
The Registered Nurses that *I know* do full exams, administer vaccines and other shots, set up peripheral and PICC IV lines, dispense medicines in clinics, assist physicians to set up central IV lines, draw blood for every blood test imaginable...including drawing blood for crossmatching; they set up IV lines with filters to hang whole blood and blood components, draw arterial blood for blood gas analyses....and a boatload of other complicated human nursing functions.
"I hope you don’t make a mistake one day by calling a human nurse one step removed from a hairdresser, you’re likely to receive a nice slap in the face."
Not likely "outfromlurking". The Registered Nurses that *I know* have an affinity for spotting another Registered Nurse and would never confuse a fellow-nurse with a hairdresser...or a Vet Tech.
BTW, The Registered Nurses that *I know* who are Registered Nurses/Epidemiologists would never confuse the "kennel cough" bacterium with the B. petussis bacterium which causes human "whooping cough".
A really bad idea if your cat gets lost and found by someone else, by the way. I recall that the effectiveness of the FIV vaccine is not too hot, either.
As for the sockpuppetry suggestion, I'm not seeing the similarity in writing styles.
Again, lilady, vet techs also do venipuncture, set up IV's, assist in cross-matching, give injections, dispense medications, all by themselves with little supervision, we certainly do not consider these tasks "complicated", since we possess the necessary skills to perform them. The value of a tech's skills is undermined considerably in comparison to human nursing, not to mention the salary. Would you go so far as to denigrate a veterinarian because he or she makes half as much salary as an MD? I'm sure the vets who contribute comments here can validate that for you if you merely ask.
Way to alienate Orac's readers - insist they are trolls and denigrate anyone who happens to be in a profession that is beneath you. Some of us happen to love the job, love working with and saving the lives of animals, and actually working with cranky people such as yourself. Sure, the wage sucks, but for some of us, our passion for animals and veterinary medicine far outweighs the measly wage.
I lurk here because I enjoy Orac's articles and the scientific debates, the skeptical community and sometimes I learn something valuable. I felt the need to post to defend a profession that you clearly know little about, this isn't the first time I've seen a bit of ignorance about veterinary medicine and animal care here, but this isn't a veterinary blog, thus I have felt no need to contribute, until now. It might interest you however, to learn that there is quackery in veterinary medicine as well, and some of us have an interest in battling quackery in pets who cannot otherwise tell their wayward owners to treat them with effective medicine.
For what it's worth, Julia may be from the UK (or maybe not, I do not know) - in the UK, the term veterinary nurse if often used, while in the US, the term is referred to veterinary technician (if the tech attended a school of technology or possesses the required skills), or, veterinary assistant (non-degreed).
lilady,
I also wanted to point out that Julia is in fact correct in her assertion of the canine bordetella bronchiseptica being a very close cousin to bordetella pertussis (which you first denied), you can find this information with a simple google search. While not generally considered contagious to humans, the canine bordetella could be detrimental to humans with immuno-compromised health.
http://drbarchas.com/kennel_cough
http://www.vetmed.wisc.edu/pbs/zoonoses/Bordetella/bordetellaindex.html
(most veterinary sites make mention of the fact)
https://docs.google.com/viewer?a=v&q=cache:Elf9zdw1140J:www.vet.k-state…
(I don't know how to shorten the url), the above link may be similar to what Julia was implying with vaccine similarities, in that, much is learned between human and veterinary medicine - in this case, studying the similarities and improving vaccines. Hopefully, you understand that we extrapolate from human medicine in daily practice and I suspect, vice versa to some degree.
I remember discussing this with several vets years ago, none of whom could say with certainty if humans could contract bordetella from a symptomatic dog, and some vets still would not have the answer if you asked them today.
In any case, it would be nice if the troll label would be reserved for, well, obvious trolls. I've noticed some of the regulars here often question if this blog and other SBM blogs actually reach lurkers. It, and they do, but I suspect lurkers may be turned off by the argumentative nature of a certain few.
Outfromlurking: You or Julia or a sockpuppet came here, both guns blazing to derail this thread.
Look again where you are posting...see the title of Orac's blog
"Respecting parental concerns versus pandering to antivaccine fears." One of your colleagues...or you...stated succinctly that you were an expert on human vaccines, specifically the B. pertussis vaccine.
Julia
September 13, 5:52 pm
"AllieP: “Your child will not get a kennel cough vaccine ever…”. Oh, really? Ever heard of Whooping cough? Both vaccines are for the Bordetella bacteria. It is a different variety or Bordetella but it is very much like “a kennel cough vaccine”. The other diseases are also close to what the puppy or kitten may get vaccinated for, For example, Rabies is a severe form or meningitis. In addition, “[a]s it is a Morbillivirus, the rinderpest virus (RPV) is closely related to the measles and ***canine distemper viruses.***” [ Wikipedia ]. There are many different types of vaccines given to pets and domestic livestock live-attenuated is just one. If there ever is an HIV vaccine we would then have a vaccine similar to what we vaccinate cats for [FIV]. [BTW I DO COMPARE MY DOG TO a child.]
If you think the pet vaccines are vaccines are “very different compounds” verses child vaccines why not get vaccines inserts of several child vaccines verses several pet vaccines? You will find that the compounds are very similar. I worked as a registered licensed veterinary nurse for 20 years; do not try to fool me regarding pet vaccines verses childhood vaccines. Fear-mongering will get you nowhere with me."
I posted after that to correct some of the inaccuracies in that statement..but also to get the blog back on topic.
Your last post to me, where you claimed you had qualifications equal to the qualifications of a Registered Nurse who has a university conferred degree and who practiced as nurse clinician/epidemiologist, was insulting to me. You just can't substitute the phrase "veterinary tech" with "veterinary nurse" and claim that you have the qualifications to treat humans. That is dishonest...just as dishonest as if a certified nursing assistant or a licensed vocational nurse lied and stated he/she is a registered nurse.
If you have had any experience educating a human mother, who has a human child, who has some concerns about human vaccines and human diseases, then share those experiences with us.
lilady, when you address me specifically, I will respond in kind. It seems your mind is made up erroneously believing I am a sockpuppet, yet a simple IP/location check by Orac can settle your fears. I'm sure he has much better things to do than entertain your fears. Nonetheless, that option is available.
I neither derailed this thread, nor made the statements you argue, I commented on your ignorant statements of a profession and sought to enlighten you - I don't feel you should get away with some inconsistencies yourself, just as you make it your apparent job to do the same with "newbies". It seems it is you who have the guns blazing. Feel free to argue with Julia, but if you're going to argue with me, please provide some substance to your argument.
Please point out to me where I stated I had qualifications equal to a human nurse. I stated veterinary technicians possess the necessary skills and perform the equivalent procedures as human nurses do, because we perform such procedures on animals, that gives you the right to denigrate the profession? Point out to me also where I stated techs perform such procedures on humans. I ask you again, do you denigrate veterinarians because their salary is much less than an MD?
You obviously have given no thought to Orac's audience, it's quite sad to think one must fit your idea of a scientist to participate on this blog.
outfromlurking:
lilady,
I also wanted to point out that Julia is in fact correct in her assertion of the canine bordetella bronchiseptica being a very close cousin to bordetella pertussis (which you first denied), you can find this information with a simple google search. While not generally considered contagious to humans, the canine bordetella could be detrimental to humans with immuno-compromised health.
I didn't refer to veterinary articles when I did case surveillance on a B. pertussis case. This is the case surveillance manual-Whooping Cough chapter, that I linked to upthread. Too bad you didn't read it.
http://www.cdc.gov/vaccines/pubs/surv-manual/chpt10-pertussis.pdf
In addition to B. pertussis, three other Bordetella species can cause disease in humans:
B. parapertussis, B. holmesii, and B. bronchiseptica. B. parapertussis causes a pertussis-like
illness that is generally milder than pertussis because the bacteria do not produce pertussis
toxin. Co-infection of B. pertussis and B. parapertussis is not unusual. Disease attributable to
Bordetella species other than B. pertussis is not reportable to CDC.
Just because you and Julia think you know bacteriology and just because you see "Bordetella", do not assume that we are discussing the human B. pertussis vaccine that is subject of this thread.
If you read about a Mycobacterium causing disease in a patient that has full-blown AIDS...do you automatically think that person has tuberculosis?
http://emedicine.medscape.com/article/222664-overview
This is a *keeper*
"For what it’s worth, Julia may be from the UK (or maybe not, I do not know) – in the UK, the term veterinary nurse if often used, while in the US, the term is referred to veterinary technician (if the tech attended a school of technology or possesses the required skills), or, veterinary assistant (non-degreed)."
In order to be referred to as a *veterinary tech* you *could have attended a school of technology OR POSSESS THE REQUIRED SKILLS*.
Assume much, lilady? I didn't assume anything, and it appears you are still associating my comments with Julia's.
It's called grandfathering in, which occurred quite regularly when there was a technician shortage (and still does, the shortage remains, but perhaps it's due to those awful-beneath- you- wages). OTJ training, as well as (in some cases) paid or partially paid schooling, paid conferences, paid workshops and the like. The peer organization NAVTA sought to require techs are properly accredited, which any good tech would agree with.