Letters: Dear Doctor - Dear Parent

The Thinking Moms' Revolution blog (not to be confused with the very useful Thinking Person's Guide to Autism) is written by a number of mothers who strongly believe in "healing" their children's (vaccine-induced) autism. Overall, they seem to be very angry, which is beautifully reflected in a recent post - "The letter I wish I could send to my old pediatrician". There is, of course, no reason why the poster could not send that letter, although her chances of the pediatrician actually reading it might go up, if she find another address than "Dear Dr. Asshat". Orac does a good job in taking the fallacies in the letter down, however, as often the case, one of the commentators takes the cake with a response letter, which deserved to be showcased:

Dear Ignorant Parent:

We are well aware that you pulled your child out of our practice, since we've seen a marked decrease in the volume of ignorant questions that our nurses have had to answer as of late. Trust us, you won't be missed.

Will we lose an ounce of sleep over you deciding the vaccines are wrong for your child? No. However, if your young, and unvaccinated little one comes down with measles, mumps, whooping cough, polio, or rubella then we would wager that you will. We've treated all of them in our tenure as doctors and be assured, while modern medicine can reduce the risk to your child after infection, the results can still be daunting.

Blindness, paralysis, deafness, and even death are some of the results of not vaccinating your child from diseases that once killed millions around the world. By not allowing us to vaccinate you are saddling your child with plenty of risks, none of which he should or need bear.

We all understand that the internet is a treasure trove of information. The problem with that is that not all the information is correct. Certainly you can find information claiming vaccines cause autism and a host of other developmental problems. Guess what else you can find? People that believe the earth is flat and that nobody has ever been to the moon. You claim there's evidence to support your claim? How nice. So do the people that believe the earth is flat. A cursory internet search on vaccines being bad does not make you an expert. Years upon years of medical training does, and that learning process is ongoing.

If you thought we were curt with you when you started asking these questions then it's most likely because we've been inundated by questions from you. Asking the same thing a hundred times but slightly changing the wording isn't going to get you a different answer. You decided long ago that vaccines were evil and now you simply want to try to get us to go along with you. We aren't going to. When we rolled our eyes at you for citing a study that was twenty years old it was because there was twenty years of newer information that supported our point of view.

Your claims that we broke your child are ludicrous. When you showed us an outdated study that linked autism with vaccination we showed you a dozen that did not. Our data was somehow tainted in your mind because you believe that we're all in the pocket of some shadowy conspiracy group. We aren't. Your claims that we're running a business and that we make money off vaccinations are also completely unfounded. Be assured that treating a child who has contracted the mumps is going to be a lot more lucrative than simply vaccinating against it. Yet, that's what we do. The Hippocratic Oath says do no harm, you like to say that, but there is another important part of that oath you missed, where is states that prevention is preferable to cure. In our tenure as medical professionals we have come to believe in that statement after treating scores of children permanently harmed by diseases the should never have been stricken with but for their parent's misguided good intentions.

We wish you the best of luck with your family and hope only for the best for you all. We also hope nothing bad comes of your decision.

I am not sure that time could mend the communication breakdown between mothers who think of their doctors as "asshat" and doctors who think of their patients' mothers as "ignorant", but lack of communication is one of the main reasons why parents take their children (or adult patients themselves) to charlatans. We know that time with the patient/parent influences continuity in care (i.e. how long the patient will stay with a health care provider), there are good recommendations in the literature how to address the concerns of parents who refuse vaccination, which also have time as an essential component to build trust and establish and maintain communication channels. More and more physicians dismiss non-vaccinating parents from their practices. They perceive the risk for their other patients as too high. This does mean though that the children of these parents are likely to end up in suboptimal medical care reinforcing their unrealistic views of vaccine dangers. Do you think an insurance-reimbursed hour per new child in a pediatrician's practise would be a solution?

Thank you American Airlines, for not spreading anti-vaccine lies

After fast and furious consumer protest and the petition that Paul Gallagher started raising over 2500 signatures in under two days, it appears American Airlines has seen the light of day and will not give vile anti-vaccine lies a platform in the in-flight "infotainment". Thank you American Airlines - thank you all who wrote, tweeted and signed!

ETA (26/4/2012) - the local (Australian) newspaper have apparently picked up on this and correctly identify the AVN as anti-vaccine on their first page:

Australian AntiVaccination Network to advertise on American Airlines

The CDC reported a couple of days ago, that 90% of the US' 2011 record 222 measles cases were associated with imports from other countries, nearly 90% of patients were unvaccinated or with unknown vaccination status; and of those eligible to have received the vaccine, a whopping 76% had a non-medical exemption. These numbers stress the significant risk of vaccine refusal. Measles imports into the United States come at substantial medical risk and cost, about $10000 per measles case and over $700 in income loss and other costs per quarantined family. Recent outbreaks in California, Utah, Minnesota and Arizona have cost the health system/hospitals between $130000 and $800000 to contain.

Less than a year ago, an unvaccinated infant, returning from India, exposed passengers of American Airlines flight AA3965 from Chigaco to Des Moines to measles. As a consequence of this measles import, 100 persons had to be contacted about their exposure, 25 had to be quarantined.

American Airlines seem to have a very short memory. Apparently, they are planning to feature the notorious Australian anti-vaccine campaigner Meryl Dorey of The Australian Vaccination Network (AVN), via it's in-flight "Executive Report" media and "American Way" magazine, from July to August 2012. The interview (transcript) is clearly intended to discourage parents from vaccinating, which we know will lead to resurgence of deadly diseases, like measles and pertussis. I am not sure that disease is what American Airlines means to "give back to our communities".

You don't think deadly disease should be encouraged by advertising? There is a petition - sign it!

ETA (24/04/2012): see fab update!

The Beginning of Something Much Larger (or not)

Every once in a while, I see something that makes my jaw drop



Mom thinks her daughter has measles, she wants to take her daughter to see her (vaccine friendly negligent) doctor in the morning. Instead of debating quarantine, a discussion about oatmeal/baking soda baths ensues.

So, what is likely to happen? There are no reports of measles in Kentucky at the moment (yes, I asked). Most likely and the best case scenario, the OP's daughter has some other viral rash and will not have measles at all. She'll recover, mum and friends will retain their "measles are not a big deal if you just do the right thing" (oatmeal/baking soda baths, it appears) smugness.

Hopefully, mum will sober up and call the practise with her suspicion before going there. There is a reason that there are elaborate regulations to prevent measles transmission in a medical setting.

If this turns out to be measles and mum did indeed take her daughter to a doctor's practise this morning, I predict we are going to see more cases, like for example here, here and here. The worst case scenario is that an infant will be infected in the waiting room (more likely in practices tolerant of non-vaccinating families), and ultimately dies, like we have previously described.

A Retraction of Sorts

On 22 March 2012, Dr. Bob Sears wrote a piece for the Huffington Post entitled, "California Bill AB2109 Threatens Vaccine Freedom of Choice".  If Dr. Bob isn't bad enough at science and medicine, he now tries his hand in a spectacular display of ineptness at the topics of public health policy and politics.  However, this post isn't about Dr. Bob's trifling about in another area where he has no expertise particularly since others have gone into depth about CA Bill AB2109.  It is about the exchange that took place in the comments section of the Huffington Post piece between Dr. Bob and others that aren't me nor Catherina.  It involves the blogpost I wrote last year, 2008: Measles in Dr. Bob Sears' Waiting Room and Seth Mnookin's report that the index case in that outbreak was, in fact Dr. Bob's patient:

I went on to write about how Sears’s downplaying of vaccine-preventable diseases was particularly ironic given what occurred in San Diego in 2008, when “a seven-year-old boy who was later revealed to be one of Sears’s patients returned from a family vacation in Switzerland with the measles.” Eventually, 11 other children were infected and dozens more were quarantined (some for up to three weeks); it ended up being the largest outbreak in California in almost two decades and cost well over $100,000 to contain.

Sears’s involvement with patient zero was not some sort of secret: It was also reported in a December 19, 2008 episode of This American Life, in the middle of an interview with Sears himself. (You can hear that part of the broadcast—”That’s Dr. Bob Sears. … Dr. Bob, as people call him, is also the doctor for the non-vaccinating family that went to Switzerland”—here. For people interested in the whole show, Sears comes in just before the the 34-minute mark.) It was also reported in Sears’s hometown newspaper, The Orange County Register. 

Several commenters on The Huffington Post asked Dr. Bob about his involvement with that outbreak and if the index case was in his waiting room. But he dodged:

Of course I remember the show, and her comment. BUT, she wasn't accusing me of being the pediatrician that the measles patient went to see when he had measles and sat in his waiting room. She simply stated that that child was my patient (which is correct, but they didn't come to see me during the measles illness). She was baiting me, and suggesting that the fact that that family had decided against the MMR vaccine long before they ever became my patients was MY fault. I wasn't about to give her the satisfaction of acknowleding her comment.

What I was referring to by the statement "I had no idea" was that I never knew anyone, much less a supposedly respected reporter, was spreading the FALSE rumors that I was the pediatrician involved in the outbreak. I have simply been the family's pediatrican over the years, but I practice far away from them, so they went to a local ped for THIS problem. Anyone who has written or suggested otherwise printing false information.

PLUS, I WOULD LIKE TO THANK YOU, AND SOME OF THE OTHER NEGATIVE COMMENTORS TO MY BLOG, FOR HELPING TO PROVE MY POINT. It seems that when a doctor's patient chooses not to vaccinate, then catches one of the diseases, IT BECOMES THE DOCTOR'S FAULT? SO, WHY WOULD DOCTORS TAKE FURTHER RESPONSIBILITY AND LIABILITY FOR THEIR PATIENTS' DECISION AND SIGN THEIR NAME TO THE EXEMPTION FORM? That's my point; I appreciate you furthering my cause against AB2109.  

He can't keep his pronouns straight and whether there was one or more children that Dr. Brown was referring to.  Here is her comment from the Dr. Oz Show:

"...And as an example, there was a 2008 measles outbreak in San Diego where an unvaccinated child developed measles, was in the doctor's waiting room where other unvaccinated children then got measles.  In fact one of those children was too young to be vaccinated and contracted measles and ended up in the hospital.  And I think those were actually Dr. Bob's patients."

The implication being that the index case and others infected were all Dr. Bob's patients and he acknowledged that they were.  It would also be a hell of a coincidence that these were Dr. Bob's patients but were all in another paediatricians office at the time of transmission.  This is what led me to post the accusation that the children were in his waiting room.  He knew of the blogpost and had numerous opportunities to address the claim as false but he didn't.  However, in the interest of fairness I will post what he has recently stated:

Dr. Bob has now stated outright that the index case was not in his waiting room but that is not the end of it.  He claims that he doesn't know who Seth Mnookin is nor has he have any idea what he could have written.  Not only that but also claims that he had no idea that anyone thought the index case was in his waiting room which is absolutely false since I know that some of his followers have brought this to his attention.  As per Seth Mnookin, he and Dr. Bob had several exchanges in preparation for Mnookin's book, The Panic Virus.  Here is what Mr. Mnookin declared:

When I explained that I was not actually interested in advertising on Sears’s website but wanted to interview him, I was assured that Sears would be in touch in short order. After not hearing back for two more weeks, I emailed again; still, nothing. Finally, on July 14, Sears wrote to me, claiming that he’d emailed me previously but never heard back. (Perhaps he’d been emailing Seth Minooken.) We arranged a time to speak, but he didn’t answer his phone. We arranged a second time to talk, and finally, on July 21, 2009, we conducted our first interview; over the coming months, we spoke one more time and had several email exchanges.

Finally, it seems worth noting that during the entire time I was working on The Panic Virus, never once did a representative from a pharmaceutical company or a government official even obliquely discuss any type of financial arrangement. In fact, there were only two people who did: One of Sears’s office minions and the man Sears is embracing in the picture below: Andrew Wakefield.

That said, Liz Ditz pointed me to a local article that ran regarding the 2008 measles index case along with her report of it.

The index case, the 7 year old traveler, attends a "progressive" charter school in San Diego, which serves grades k-7 and has an enrollment of 358.   At the beginning of the outbreak, nearly 10% of the student body were unvaccinated and were quarantined at home.  Voice of San Diego reported on February 4:

34 unimmunized students at San Diego Cooperative Charter School (SDCC) are stuck at home, said principal Wendy Ranck-Buhr. The students can't come to school until Feb. 21, unless they get immunized against the illness.

By February 12, the 34 had dropped to 17, according to a bulletin from SDCC.
UPI reported that up to 50 children are quarantined, including the Baldwin Academy students, the SDCC students, and unvaccinated students at the Murray Callan Swim School (which has classes for infants as young as three months).

The current measles outbreak in San Diego was sparked by an unvaccinated 7 year old child who acquired the disease in Switzerland, and so far has infected two infants too young to be vaccinated.  The infants both acquired the highly-contagious disease by being at the Children's Clinic in La Jolla at the same time as the virus-shedding 7-year-old.

Dr. Bob is not directly responsible for the 2008 measles outbreak that I had previously reported.

Anti-Vaxx Parents Take their Case to Court

On 8 February 2012, some media outlets announced that two Queens, N.Y. parents were suing the Department of Education in Queens Supreme Court.  The case involves Nicole Phillips, the mother of two children at P.S. 188 forced to miss several weeks of class since November and Fabian Mendoza-Vaca, the father of two students at P.S. 107.  Both have religious exemptions for vaccines and are asking the court to, "nullify a law that would keep their children out of school if classmates are carrying communicable diseases such as measles, mumps, and chicken pox." When Ms. Phillips and Mr. Mendoza-Vaca obtained their religious waivers, they agreed to this:

Title: Section 66-1.10 - Exclusion of susceptibles in event of disease outbreak

66-1.10 Exclusion of susceptibles in event of disease outbreak. (a) In the event of an outbreak of diphtheria, polio, measles, rubella or mumps in a school, the commissioner may order the appropriate school officials to exclude from attendance all students without documentation of immunity, as specified in section 66-1.3 (a) or (b) of this Subpart, including those who have been excused from immunization under section 66-1.3 (c) or (d) of this Subpart.

(b) The exclusion shall continue until the commissioner determines that the danger of transmission has passed or until the documentation specified in section 66-1.3(a) or (b) of this Subpart has been submitted.

They are now complaining that they wish to risk the "chances with these mild childhood illnesses."  But it's not just about their acceptance of the risks, it's about public health overriding their wishes and protecting others for whom cannot be vaccinated for health reasons (who also must stay home in the event of an outbreak) and the larger community.

An attorney representing the parents, Patricia Finn states:

"The regulation violates both state laws regarding vaccination, as well as the free exercise clause of the First Amendment.

 “As it currently stands, the DOE’s policy is unfair to the children being taken out of school,”

"I'd like the judge to strike down the Chancellor's regulation as unconstitutional and order these children returned to school," Finn said. "It defeats the purpose of the state exemption. You can't have someone off applying the rule when they feel like it."

 No it doesn't.  The parents are free to exercise their religious freedom which consists of:

"We don't want anything being put into our bodies at all," said Nicole Phillips, the mother of two children at P.S. 188 forced to miss several weeks of class since November. "We'd rather rely on our natural immune system and our faith in God. This is about my children's rights."
"It is my opinion that resorting to vaccinations demonstrates a lack of faith in God, which would anger God and therefore be sacrilegious," Mendoza-Vaca claims.

There is no violation of their First Amendment rights as they're not being prevented from practising their religion.  Their children are being prevented from becoming infected and also acting as disease vectors in the school community.  There is simply no constitutional protection for vaccine exemptors attending school in the event of an outbreak.  An excerpt from Vaccination Mandates: The Public Health Imperative and Individual Rights (Is There a Constitutional Right to a Religious Exemption from Mandatory Vaccination? pp. 274) states:

Challenges to mandatory vaccination laws based on religion or philosophic be­lief have led various courts to hold that no constitutional right exists to either religious or philosophic exemptions. First Amendmentf free exercise clause Freedom to believe in a religion is absolute under the First Amendment. How­ever, freedom to act in accordance with one’s religious beliefs “remains subject to regulation for the protection of society.”40 The U.S. Supreme Court in the 1963 case of Sherbert v. Verner41 established a balancing test for determining whether a regulation violated a person’s First Amendment right to free exercise of religion. The test, which prevailed until 1990, required the government to justify any substantial burden on religiously motivated conduct by a compelling VACCINATION MANDATES 275 government interest and by means narrowly tailored to achieve that interest (374 U.S. at 406–8, 83 S.Ct. at 1795–6).

In addition, in a case that predates the Yoder decision and enactment of a statutory religious exemption by Arkansas, the Arkansas Supreme Court in Wright v. DeWitt School District 45 held that no First Amendment right existed to a religious exemption given the state’s compelling interest in mandating vac­cination under its police power to protect the public health.g (238 Ark. at 913, 385 S.W.2d at 648). Significantly, the U.S. Supreme Court in Yoder referenced the Wright decision in dicta regarding cases in which the health of the child or
public health are at issue, with the implication that a vaccination mandate pro­viding no religious exemption would meet the compelling state interest test (406 U.S. at 230, 92 S.Ct. at 1540–1).

The lawsuits have been transferred to Brooklyn Federal Court for an emergency hearing that could be decided any day now.

Wakefield's Legal "Justice" Fund

A website has recently been launched so that you can donate to Wakefield's Legal Justice Fund.  A legal fund such as this may be set up as a non-profit, tax-exempt charity.  The questions arise; what can one do with the funds once litigation has concluded and why does he need this fund since he is not impoverished and has also enlisted the legal services of his friend, William Parrish?  Parrish, by the way is not an expert in defamation/libel law but rather an intellectual property and business tort lawyer.

Another question arises and that is, why did the Wakefield camp wait until nearly a year, when the statute of limitations for libel was up if the BMJ series about him was so damaging and defamatory?  The first BMJ report on Wakefield was published 5 January 2011 and Wakefield filed suit on 3 January 2012.  Wakefield has unsuccessfully sued Deer in the UK and was Wakefield's undoing actually because the discovery provided Mr. Deer with the children's anonymised medical records.  A formidable hurdle for Wakefield to clear in his latest debacle is Texas' Anti-SLAPP law which not only may not allow him to present his case to a jury but leaves him vulnerable to court, legal and punitive costs owed to Brian Deer and Fiona Godlee (editor of the BMJ).  Of course this will be interesting to see how it plays out in the end but I don't think it will end well for Dr. Wakefield, although that may be what he intends.

As usual, Liz Ditz is aggregating various media discussions on this topic.