Aliana is dead

Aliana has passed away from SSPE, a severe, always fatal measles complication, this morning - in a short statement on their Facebook page, her father writes:

Our litte angel went on her way this morning. The last months were a hard time, she fought a lot, but sadly she lost. She went from us really peacefully with a beautiful smile on her lips. This is going to be a hard time for us, but Aliana has decided that she will be better where she is now, without suffering and without pain. We thank everyone who supported us until now and are still supporting us. Please light a candle, so we can accompany Aliana on her way to a better place.

I am tired. How often do we need to report on preventable deaths? My thoughts and deepest condolences are with her family. Please light a candle. Please vaccinate your children.

Your freedom of choice - somebody else's baby

I am having discussions with my non-vaccinating friend at the moment, who describes herself as "pro-choice" when it comes to vaccination. What seems absolutely impossible to grasp for vaccine refusers is that their choice makes other parents' children ill, and, potentially, kills them. The parents whose babies contract measles did NOT get a choice, NO say in their children's infection. That is the effect of vaccine refusal:

The below is Mobius - there are 24 hours between those pictures - the photographer, a friend of Mobius' family, Donavan Freberg, describes their feelings (shared from Refutations against Anti-Vaccine Memes page with kind permission of Mobius' mum):

This is Mobius Loop. He is the son of my dear friends Ariel Loop and Christopher Loop. He has measles. It was just confirmed. This is real, this is awful and these two photos are 24 hours apart. The good news? He's getting better. Quarantine ends tonight and the baby seems to be recovering well. The bad news? This was caused by one thing only, total and complete ignorance and selfishness of the anti-vaxxers. Because of people not vaccinating their kids (and when I say "people", I mean much of the upper crust westside of Los Angeles) this little sprout (who was too young to be protected) fell sick to a HIGHLY CONTAGIOUS epidemic that up until recently, had been a thing of the past. This is infuriating, sad and worst of all, needless. The Loops are dear friends, long time photo clients and informed, smart people. Ariel is a nurse. You don't just vaccinate your kids to protect them, you do it to protect other's who are too wee to get the shots. You are doing it as a selfless act. Please send good thoughts and prayers to this little muppet and to his parents, who are truly some of the best people I know.

Side note: I was scheduled to photograph this sweet everlasting gobstopper, but then this happened. I intend to photograph him the moment he has fully recovered and will be donating 100% of my shoot fees to charity to raise awareness of the necessity of vaccines. As a photographer, I must do everything within my power to document this and see that the awareness of this spreads faster than the disease in question. To all people reading this and for those who may be on the fence about vaccinating your kids, please, for Mobius and for all those who are affected by this terrible and PREVENTIBLE disease, DO IT. Vaccinate!!!! Don't even think twice. Just think.

ETA: Mobius' mum, Ariel, also weighs in:

I have a lot of mixed feelings right now, but ultimately I'm relieved that Mobius is doing so well. The horrific cough aside, he's doing way better than anyone expected at this point.
However, I'm furious that we're now part of the problem. While he's up to date with his vaccines, at 4 months he isn't old enough for the one that should have made this whole outbreak almost impossible. During the four days he was contagious before his rash appeared, we went out to eat twice, ran countless errands, and have potentially infected other kids who are too young to have to go through this. That kills me. And might kill one of them.

I understand that vaccines are scary. Having to hold him tight while a stranger hurts him is hard. Having three people hold him still to get the blood to test him for measles, however, was infinitely harder. Even at the time I had this passing thought of, "Am I being paranoid? Am I putting him through more trauma while he's sick for no reason?" I found myself almost hoping it was measles then so at least having to torture him would be "worth it."
It isn't, though. He shouldn't have had to go through any of it. I shouldn't have had to set alarms for myself in the middle of the night to make sure he was still breathing. It's bittersweet--I can't be as comforted by his recovery as it is clouded with guilt and fear that we might put another family through this.
Please, don't put other families through this.

Anniversary

the third anniversary of Angelina's diagnosis. Just before, she had been a completely healthy six year old:


then SSPE, the late and invariably fatal measles complication became overt. This video by the German Association of Pediatricians explains the stages - watch it, you'll get the gist - at first, she is "only" clumsy and falls, then the seizures start, and very few months later Angelina was incapable to doing anything. This is the condition she has been in for the past 2.5 years:




Angelina's mother wonders at the end of this video, why parents do not vaccinate their children, while they are all buckling them up in the car. She does support mandatory vaccination (no shots, no school does not exist in Germany).

I agree with the doctor in this video:

Parents - go get your children vaccinated, especially against measles, mumps and rubella. If you are not immune, talk to your doctor and get yourself up to date.
If you are afraid to vaccinate, talk to your doctor and work with him/her on "unscaring" yourself. Then vaccinate your child/yourself. Thank you.

You are an anti-vaccine activist? Have a careful look at that film clip. It shows the results of not vaccinating. Measles could have long been eradicated, where it not for pro-disease activists like you. Please realise that the risk of infecting a baby with measles is something you cannot control.

Trau schau wem (a Dr Bob post)

dedicated to Chris Hickie, MD, PhD

It's been a while since we talked about Dr. Bob Sears, the author of The Vaccine Book, in which he advertises his "alternative vaccination schedule" (which almost doubles the number of office visits at $$$). Dr. Bob, as he likes to call himself, has been widely criticised for his anti-vaccine-critical stance, by us and many others. Don't know how people get the idea he could be anti-vaccine, actually - cannot be his staunchly pro-vaccine friends, like Andy Wakefield

It cannot be his absolutely unwavering pro-vaccine activism on Mothering.com:

 

For any parent who decides not to vaccinate, I don't try to talk them into vaccinating. Going unvaccinated is not a dangerous choice. It's a reasonably small risk.

It cannot be his well measured and positive foreword to an unreservedly pro-vaccine book:

.../... blablabla .../...

With so much care not to be mistaken for someone who is actually against vaccination, I must wonder how Dr. Bob Sears ended up one of the administrators of the:

Parents and Others against Vaccinations 

(my emphasis) facebook group. Ever so slightly embarrassing to get caught on that one amongst anti-vaccine's finest:

If I had not done so already, I would seriously seek my vaccine information somewhere else.

*Trau schau wem = watch whom you trust

Insolent demands and reality

There is a measles outbreak in Wales. 1181 cases of measles have been reported since 1 November 2012. Quite impressive for a small country (Wales has about 3 million inhabitants). Public Health Wales have done a stellar job in reporting numbers, breaking them down into the different Welsh regions and they run a Facebook page on which you can ask questions and will get them answered. Countless weekend and in-school clinics were run to get the Welsh youth protected (a lot of teens did not get their MMRs/or MMR booster in the wake of Wakefield's manufactuversy).

Despite PHW's fabulous work, the pro-disease faction have been up in arms. First of all, they abused the fact that not all cases were laboratory confirmed to claim that there is no outbreak, it is fabricated, all to cause panic to increase vaccine uptake (like good vaccination uptake was a bad thing). Never mind that laboratory confirmed cases are catching up with the reported numbers (like they should, those tests take some time to come back); that is part of the conspiracy, too (lowers voice "they noticed that numbers don't match, so they are making new numbers up" - really).

Equally suspicious, according to the anti-vaccine-critical, is that the vaccination status of reported cases is not reported in real time. PHW quite clearly stated on their web site that they'll publish a full report after the outbreak:

and explained on their Facebook page (multiple times) which cases were tested:

many anti-vaccine posters still insist that the delayed publication of numbers was fishy (after all, GPs should know whether their patient has been vaccinated or not) and continually allege that real time reporting was somehow important for their decision.

I call bullshit - there is nothing unique about the Wales outbreak. Last year, just north east of Wales, the Merseyside measles outbreak saw 359 confirmed measles cases, of which, not surprisingly, only 12 (3.3%) had received 2 MMRs. Those hugely relevant numbers (the two outbreaks within a year and 150 miles of each other) are convincing truly hesitant parents:

Meanwhile, I received the following letter from my Health Board:

It seems that although we have been registered with the same GP for many years, and said GP should have all of our children's vaccination records, and I have in writing that they are up to date, their Child Health System has our son down as "not [having] completed the full course of 2 doses of MMR". Obviously, ascertaining vaccine coverage is not quite as trivial as some think.

Thank you PHW for checking before publishing data on vaccine coverage without verification.

Now if you or your child really have not had 2 MMRs - go get them now. MMR is highly effective in protecting you and your loved ones from measles.

Fear mongering and responsibilties - UK private vaccine clinic fuels MMR fears

Wales is currently heading the leader board, unfortunately not in a good way (like for rugby), but for measles infections in the Western hemisphere. Since February, Wales has had nearly 900 reported measles cases, 80 of them hospitalised, and, as feared, now the first suspected death, 25 year old Gareth Colfer-Williams. A lot has been written about responsibility. Obviously, Andrew Wakefield came up as the main culprit, who in turn blamed the government for the outbreak, which they rejected. To be honest, to solely blame Wakefield for the MMR mess would be too much credit to the man. The MMR mess is a media manufactuversy as beautifully summarised by Ben Goldacre. And the greed for the headlines has not stopped, and Wakefield is still given front page coverage by irresponsible papers.

Meanwhile, clinics providing single vaccines for measles and rubella are having a field day. Under the guise of "we are just responding to parental fears" one private provider of single measles vaccines, the Children's Immunisation Clinic (CIC), is advertising their services (£ 50/~US$ 75 registration plus £ 110/US$ 165) playing on the MMR-autism lie, while making totally untenable claims. This starts off with:

A high percentage of the children we vaccinate also have allergies and excema which indicate they may not have a perfectly functioning immune system – and even so we have no recorded adverse reactions.

Wow - that is impressive. I wonder how they do that, given that the Rouvax for example, one of the vaccines that CIC is offering, has the following adverse effects (my bold):

The most common side effects (in more than 1 in 10 subjects vaccinated) seen in clinical trials were irritability/agitation and rhinopharyngeal catarrh.
Other side effects that occurred in more than 1 in 100 subjects vaccinated in clinical trials were fever >38°C, injection site reaction, rash/cutaneous eruptions, conjunctivitis, nausea, vomiting, abdominal pain, diarrhea.

They then post a google link to Hannah Poling:

In October 2008 Hannah Poling an autistic child won a huge payout from a triple vaccine manufacturer, who said that she had a DNA genetic predisposition to become autistic given the MMR vaccine More Info…

 and concluding with this beauty:

In 2009 a Dr Walker in the USA has studied 275 autistic children and found in a large percentage of the cases that these children had the live Measles virus living in their gut after vaccination with the triple MMR .You can see more about this on the Daily Mail online. We do not use the same MMR or Measles virus vaccine in the vaccine we have chosen to use.

At this point already, I know I am never going to entrust my child to this clinic. The Daily Mail as a source for medical information? Honestly? The article they mean is the one previously bemoaned by Liz Ditz to have been posted without time stamp. Everything else is false, too.

Steven Walker's work was presented as a poster at the IMFAR conference in 2006, so no "study", not in 2009 either.

The abstract reports on results of 82 kids, 70 of them supposedly had measles vaccine virus in the gut. They tell us they have samples of >275, but have not analysed them all. Also, we know since Dr Bustin's testimony to the Autism Omnibus proceedings and Hornig et al that measles virus has not and cannot been found in the guts of > 80% of autistic children.

I think this claim "We do not use the same MMR or Measles virus vaccine in the vaccine we have chosen to use" is a lie. We already know that the clinic have not looked at Walker's data, since they misrepresent his findings. There is actually no way the people at the clinic can know what vaccines the children Walker looked at had received, because it is not reported in the abstract and a full paper has not been published since 2006. Given that Arthur Krigsman is the senior author of the abstract and children have been flown to him certainly at least from the UK, it is not clear which measles vaccine strain they had been vaccinated with. The French Rouvax, CIC are offering contains the Schwarz strain, which is also the measles strain used in GSK's Priorix, often used in Europe, the Indian Sii M-Vax, also on offer at CIC contains the Edmonston-Zagreb strain, also contained in the Swiss MMR-Triviraten (Berna) (CIC also import vaccines from China and Russia, if someone knows what vaccine strain is in those, email me).

Now, tell me how you can interpret the above facts and let the clinic appear in a good light. At best, their research was irresponsibly shoddy and they conveniently believed the Daily Mail. At worst, they are intentionally fuelling parental fears to sell their singles with false claims. It gets worse though - on the side bar, on the lower right, the clinic claim:




No Autism in over 10 years and amongst 18000 Patient Record Cards?! That is an outstanding record and it sounds dangerously like a "warranty" (I am not a lawyer, but a lawyer friend of mine pointed this out). Absolutely amazing, especially given that autism/ASD prevalence in the UK has been published to be 1 in 67, so they should be looking at about 282 patients on the spectrum, give or take a few. The reason for their "Clinic Highlight" might be their rather unorthodox method of assessment...  "We [the clinic] ask you [the patient] tell us if you have an adverse reaction within a few days of the vaccine."


They are obviously way out of their depth now, because it is all fine and well to make exaggerated claims when it is "only" about people's money. But now Wales is steering towards breaking the 1000 mark of measles cases (probably by next week), children and young adults are very very sick and one might have died, and the tolerance wears thin. While CIC is still keeping up appearances for the BBC, they seriously lost it in response to a short article in last week's Sunday Times and in the middle of a massive rant (which they really want you to read in its entirety and not quote out of context, so they mention it twice, probably because they know how tedious their rant is) about "offering singles will increase herd immunity" and "not politicising the issue" slip in this paragraph (all typos are [sic]):

9) CIC is not judgmental about parents’ choice of vaccine (any vaccination ,generally ,is better than none) nor does it have any preconceived ideas as to the causes, be they single trigger(s) or perhaps even several different combinations of triggers.
Anecdotally though,  that portion of the parents who tell us their stories , all confirm that there was a dramatic change in behaviour, either with their child ,from their circle of friends , neighbours or work colleagues; and these families make up a significant minority proportion  of our population,
The emotional and financial burden on the family, the limited funding of the UK’s Health sector all point to potential benefit of further timely research into those specific cases which may then be identifiable as being preventable An unencumbered choice for either single or multivalent MMR vaccine options would do less harm  than the current situation of a large portion not willing to engage in any vaccination programme.

Goodness, somebody save them from themselves. CIC are in a hole, they should stop digging. If they wanted to keep up the illusion that they are there "to help" instead of setting up shop in Swansea in the middle of an outbreak and charging full price for their services, maybe they should have offered their singles at cost? Just to maintain the illusion that they weren't hell bent on keeping the MMR autism lie alive for their own business interest? Just an idea.

Big CARma doesn't tell us about boosters

This day has been emotionally exhausting, especially for people in Wales and in the UK in general, so I thought I'd repost something that is not about measles from the brilliant Refutations to Anti-Vaccine Memes, this time taking on the "If your child is vaccinated, why are you worried about them catching anything from my child?" fallacy:

Love it: "when you purchase your first car seat, they don't tell you that boosters are required. Until they make a car sear that lasts a lifetime, I will never buy one". I can just imagine the indignant tone.
Cue someone who points out that car seats are "not injected into the blood stream".

First measles death feared in Wales - updated: man did have measles

Public Health Wales were warning that this would happen, now they are investigating the death of a 25 year old man as the first measles fatality in the current outbreak in South Wales, which hit 808 reported cases yesterday.

Updated (19/4/13 5pm): Public Health Wales have confirmed that the man who died in Swansea yesterday did indeed have measles.

iPhone Apps for Vaccine Record-Keeping

Catherina posted an article about record-keeping and the importance of tracking our children's vaccinations.  Erroneous entries can be made, we move and records can be lost.  Michelle on NannyPro.com has listed several iPhone Apps that can be used to create, track and set reminders for immunisations.  Some are free and some are just a few dollars.  There are even apps for travel vaccinations and general vaccine information so go check them out.

"QUACK" says the Quack, the Board says "NEIGH" - it's quiet now, what do you say?

with apologies to Sandra Boynton

On 22 August 2012, the Maryland State Board of Physicians revoked Mark R. Geier's license to practise Medicine (dare I say "finally"?). This follows almost a year of legal proceedings (covered very well by Todd W. at Harpocrates Speaks, here, and here and by Kathleen Seidel at Neurodiversity.com, here and here) - visually:

On September 15, 2011, the Board charged Mark R. Geier, M.D., with numerous violations of the Medical Practice Act, including: (1) unprofessional conduct in the practice of medicine; (2) willfully making or filing a false report or record in the practice of medicine; (3) willfully failing to file or record any medical report as required under law; (4) practicing medicine with an unauthorized person or aiding an unauthorized person in the practice of medicine; (5) grossly overutilizing health care services; (6) failing to meet appropriate standards for the provision of quality medical care; and (7) failing to keep adequate medical records, under Md. Health Occ. Code Ann. § 14-404(a) (3) (ii), (11), (12), (18), (19), (22), (40), respectively. 

A five-day evidentiary hearing was held before an Administrative Law Judge ("ALJ") ofthe Office of Administrative Hearings in December of 2011. On March 13, 2012, the ALJ issued a Proposed Decision finding that Dr. Geier had violated numerous provisions of the Medical Practice Act and recommending that his license be revoked. Exceptions and responses were filed by both parties. An oral exceptions hearing was held before the full Board on May 23, 2012. This Final Decision and Order is the Board's final administrative decision in this case.

Carole J. Catalfo, the Executive Director of the Maryland State Board of Physicians has had it. Her ruling leaves nothing open to interpretations - she finds (footnotes removed):

(1) Dr. Geier failed to meet basic medical standards for evaluating patients and conducting medical examinations and keeping adequate records of treatments and diagnoses. He failed to conduct an adequate initial evaluation of any of these patients and failed to make an adequate record of an examination for any of these patients. He began treatment often without sufficient information about the patients' physical condition. In many cases, [Dr. Geier] had no information at all about the Patients' physical condition.,

This is consistent with the details that came out in the case of Dr Geier's son David Geier practising Medicine without a license (Justthevax passim). She further finds:

(2) Dr. Geier treated patients with Lupron, a medication that is not approved by the FDA in the absence of precocious puberty. He did not, however, perform an adequate examination to determine whether these patients had precocious puberty, or the cause of these patients' symptoms. ../.
(3) Based on his theory that Lupron therapy is appropriate in certain situations in which its administration is not approved by the FDA or the American Academy of Pediatrics, Dr. Geier purported to treat patients who met his profile with Lupron. With the exception of Patient E, however, none of these patients met even Dr. Geier's profile for Lupron therapy.

This abhorrent practise to "diagnose" any child with "precocious puberty" irrespective of age and physical evidence to be able to prescribe Lupron, a strong hormone modulator, which essentially equals chemical castration is part of Team Geier's proprietary theory. They postulate (I paraphrase - see père et fils Geier here) that excessive testosterone binds mercury from vaccines in the body/brain, and that the administration of Lupron will release the mercury which can than be chelated. That is complete gobbledygook of course, but unfortunately, far too many parents believed them (read Kathleen Seidel's outstanding series on "The Lupron Protocol") - the Geiers claimed to have treated more than fifty children already in 2006. Consequently, following Lupron prescription:

(4) Dr. Geier prescribed chelation therapy to patients who failed to display the need for chelation. He began this therapy without documenting a reason for the treatment and without adequate documented informed consent. He violated the standard of quality care by so doing. He also violated the standard of quality care by prescribing for patients the drug DMPS, a drug not approved for any use in the United States.

(5) Dr. Geier provided a consent form to the parent of Patient I that named an FDAapproved drug and which falsely stated that it was to be used in the chelation treatment when another drug, DMPS, which was not FDA-approved, was to be used (and in fact was used) in the chelation treatment. 

It gets worse:

(6) After prescribing these treatments without an adequate previous medical examination and without adequate informed consent, Dr. Geier then failed to adequately monitor whether these treatments were working.

"Experimental" treatments on human patients will have to undergo review by an institutional review board, which is supposed to advise and control the physicians. The Geiers' review board was made up of family and friends:

(7) Dr. Geier provided drug therapy to Patient I according to a protocol not approved by the FDA after telling the parent that his protocol was approved by an Institutional Review Board, when in fact the Institutional Review Board consisted entirely of persons affiliated with his practice and did not meet the requirements of federal or state law.

The court further finds that Dr Geier had parents sign an "informed consent" form that named the wrong drug (FDA licensed) to be applied, while an unlicensed drug ended up being used on their children (8). He inflated his credentials, claiming an American Board of Medical Specialties certification he did not have (9). The Board also finds that the record keeping of Dr. Geier was too poor to even be suitable for assessing patient progress. Nevertheless, he made decisions to continue or alter medication (10). Dr. Geier falsely made a diagnosis of precocious puberty in patients who did not have this condition and he did not perform the necessary medical examinations to be able to make this diagnosis (11). 

It appears that Mark Geier had objections to Dr. Grossman as an expert witness, saying that she was not a "true peer". Given her impressive list of qualifications, I would almost tend to agree with that notion - the court states:

Dr. Grossman is board certified in pediatrics and developmental-behavioral pediatrics and has been an Associate Professor of Pediatrics, the Director of the Behavioral and Developmental Pediatrics Fellowship Program at the University of Maryland School of Medicine and the head of the Division of Behavioral and Developmental Pediatrics at that institution. She has also held many other positions of great responsibility in her 35-year career in pediatrics. She testified knowledgeably about the standard of care applicable to pediatric patients in general and to these patients in particular. The Board is satisfied that she was appropriately admitted as an expert in this case.

I felt like hugging Carole Catalfo for the following statement:

The fact that she may not have been familiar with the details of some of Dr. Geier's idiosyncratic theories, theories that appear to be supported in large part by literature that he or his son created and which have been rejected to some extent by the Institutes of Medicine of the National Academy of Science, does not detract from the weight of her testimony about the quality of the actual medical treatment provided to these patients, in the Board's opinion.

True that! The deconstruction of Mark Geier continues, as Dr Catalfo observes:

Dr. Geier, however, is not a "trained clinician." He completed only a one-year residency in obstetrics and gynecology, has no formal specialized training in the treatment of autism, and is not Board certified in any medical specialty.

The board also had few good words about the statements of Dr. Jerry Kartzinel (if the name rings a bell that is because you have seen him on this with Andy Wakefield):

The Board also notes that Dr. Kartzinel's testimony on the adequacy of Dr. Geier's physical examinations of these patients was particularly unpersuasive. ../..

He testified that a physical examination of the patients is highly overrated (Tr. 200) and that the physician "generally ... can bide by his eye" (Tr. 148-49) and just try to "get a gestalt," and that it is not even necessary for the physician to document that "gestalt" in the medical record. (Tr. 182) It is sufficient for the physician then to "step back and say, did I get a clinical response that everybody is thrilled with, or was it a swing and a miss," according to Dr. Kartzinel. (Tr. 155) In the Board's opinion, what Dr. Kartzinel describes as an acceptable medical examination and mode of treatment is not acceptable at all, and it is questionable as to whether this conduct can even be described as "medical."

Traurige Gestalt* is more like it. The hubris that those phrases reveal is not untypical amongst the "brave maverick doctors".

In their ruling, the State Medical Board do not speak to the allegation that Dr. Mark Geier let his unqualified son, David, practise Medicine. The Board state that this is being dealt with elsewhere (it has been) and that:

The Board will not make a decision in this case on this same factual issue based upon the less complete record made in this case. In light of the egregious violations of the standard of quality care and the deliberate unprofessional conduct set out in the numbered facts recited above, a decision as to whether Dr. Mark Geier also allowed Mr. David Geier to practice medicine without a license would have no effect on the sanction that the Board would impose on Dr. Mark Geier.

Read the Sanction in full, very slowly, word by word to understand that these proceedings dealt with a high number of unambiguous violations and there is really no room for a "misunderstanding" of what happened:

The ALJ commented that Dr. Geier abused the trust that these patients' families placed in him. "By dissembling, misrepresenting, failing to see his patients for months and years before treating them, applying a protocol-based treatment to children who do not fit the protocol, using non-FDA-approved drugs without fully informed consent, and for all of the other violations found and discussed in this Proposed Decision, he abused that trust. I agree with the State that these actions betray the relationship of a physician to a vulnerable child and his desperate parents."
The Board agrees.
The ALJ proposed that the Board revoke Dr. Geier's license. Dr. Geier has displayed in this case an almost total disregard of basic medical and ethical standards by treating patients without properly examining or diagnosing them, continuing treatment without properly evaluating its effectiveness, and providing "informed consent" forms that were misleading and in at least one case blatantly false. He provided treatments supposedly according to an investigational protocol, but the investigation was approved only by a sham Institutional Review Board, and he applied protocols to patients who did not fit his own profile. He provided treatment by a drug not approved for use in this country while informing parents that a different drug would be used. His actions toward his patients were not those of an honest and competent physician, nor do they appear to be those of an objective and ethical researcher. Dr. Geier made little use of those methodologies that distinguish the practice of medicine as a profession. At the same time, he profited greatly from the minimal efforts he made for these patients. In plain words, Dr. Geier exploited these patients under the guise of providing competent medical treatment. Such a use of a medical license is anathema to the Board. The Board has no hesitation in revoking his medical license.

Which they do:

What do I say? For the moment, I remain very quiet and listen to the weeeeeee sound that the Geiers' descent makes - they have been falling for a while and they have not hit rock bottom yet. It is likely that the repeated practising Medicine without a license and the number of other behaviours that led to this license revocation will have further consequences (like fines or even jail time). I also think that some insurance companies might want to have another look at the diagnosis and prescription practise of Dr Geier. Some parents (especially if they had to pay out of pocket) might want their money back.

Most of all though, as a parent, I am relieved that vulnerable children are safe from unlicensed drugs in uncontrolled treatment of undiagnosed conditions based on untrue hypotheses. My hope is that those who were treated with Lupron will not have sustained permanent damage and will find trained specialists to take care of their (hormonal and other) needs.

*sad figure

Hat tip to Stephen Barrett, MD

ETA: now also very nicely covered by Todd W. on Harpocrates Speaks

Back to school for unvaccinated pupils after measles in Arkansas

Well, colour me surprised - pleasantly surprised. After two pupils came down with measles in Ozark Adventist Academy (Justthevax passim), the other (8?) unvaccinated pupils had to be sent home. After confirmation of those cases, I already had the headline for a blog about subsequent cases written in my head (it had something to do with bears and woods), but herd immunity and quarantine are miraculous things and apparently, no more cases have been reported (see Arkansas Department of Health), so OAA calls their pupils back to school from Monday:

Measles Update
September 13

The measles outbreak has been contained to the original family. All vaccine-exempt students may return to school September 17 if they have their annual filing for vaccine exemption up to date as required by the Arkansas Department of Health.

I am very pleased (it would even be better if those students kept at home had decided to catch up on their MMRs).

Chicken pox vaccination policy in the UK - did it cost Elana's life?

The UK is often cited in discussions about the chicken pox vaccine. After all, they are a perfectly developed country, they even speak (vaguely) the same language as the US and the NHS's chicken pox policy spells out what (US) vaccine critics have known all along: the disease is harmless in children and vaccinating against it will increase the incidence of shingles in the older population.

The chickenpox vaccine is not part of the UK childhood vaccination programme, because experts think that introducing a chickenpox vaccination for children could increase the risk of shingles in older people. ...

Chickenpox is usually a mild illness, particularly in children. 

This view has been repeatedly challenged. The BBC claimed cost as one major reason the NHS doesn't provide the varicella vaccine and cited Dr David Elliman, immunisation expert at the the Royal College of Paediatrics and Child Health (RCPCH), stating that MMR fears need to be overcome in the UK before a further live viral vaccine could be successfully introduced (more suffering due to the Wakefield/MMR/autism manufactuversy):

"The chickenpox vaccine is definitely desirable, and I think it it will happen, but unfortunately I don't think we are ready for the debate yet - not until we get MMR rates back where they need to be. We need to win that one first."

This is particularly cynical since more patients are dying of chicken pox in England and Wales every year than from pertussis, mumps, measles and hib combined.

Mortality from chickenpox is not negligible. During
1995/­7, 81 deaths were recorded by the Office for
National Statistics. However, we received 119 certifi-­
cates that mentioned chickenpox or varicella. After
detailed inquiries, we estimated that at least 75 were
genuine cases of chickenpox. This suggests at least 25
deaths from chickenpox annually. In 1996/­7 there were
seven certified deaths from whooping cough, mumps,
measles, and Haemophilus influenzae type b (Hib) men-­
ingitis in England and Wales compared with 67 from
chickenpox.

In the meantime, children are either protected by a varicella vaccine purchased privately from a travel clinic (if parents are 1. aware of the option and 2. tenacious enough to find a clinic 3. well off enough to afford this), or they have to suffer through chicken pox. Elana had to have chicken pox and while her brother, who had them first, had a mild case, Elana developed pox in her lungs and died. Just like that:

Elana was three years old when she came out in spots on Easter Sunday 2009. She was fit and healthy and, as her brother had fended off a fairly mild dose of chickenpox the week before, I wasn’t worried. What was to follow has changed my family’s lives forever.

That evening, Elana was a bit tired and wanted to curl up in front of the television but she didn’t seem particularly ill – her spots were not even particularly itchy. But as the week progressed, she seemed to get more lethargic and her condition worsened.

By Thursday, the spots had started to crust over and I thought she should have been getting better but there was no improvement. On Friday night I called the emergency GP and went to a community health centre to have her looked at. The doctor diagnosed Elana with possible pneumonia and recommended that we take her straight to the hospital.

By 11pm on the Friday night we were in hospital and Elana was very unwell. At 6.04am on Saturday morning she suffered a cardiac arrest. Elana was pronounced dead at 7am.

The UK Department of Health touted the party line:

We wrote to the UK government but the Department of Health says severe cases of chickenpox infection are rare and occur mostly in immuno-compromised children. However, I can say from witnessing it first-hand that my daughter was fit and healthy before she picked up the virus. In fact, Elana only ever needed to see a doctor when she was having routine immunisations. I know some other parents who have had the same experience.  

Elana's mum is now spreading awareness of the potential dangers of chicken pox and the availability of the vaccine. It is striking that in the UK, the vaccine is such a well-kept secret that even she, as a nurse, was not aware of it. So: help her - don't let the death of her precious daughter have been wasted. Talk about the vaccine as a real option, tell your neighbours, your GP, your MP, post it on Mumsnet and other fora.

5 Minutes with Ben Goldacre on what is "bad science" and what is "good science"

Those of you who don't know Dr. Ben Goldacre - go and buy and read his book "Bad Science", now. It may be a bit Britain focussed for the non-Brits out there, but it is a great introduction on how the media and snake oil salesmen and -women take advantage of us and reading the book and understanding its principles will protect you, your health and your wallet. Ben Goldacre takes on the great manufactroversies, like the one about MMR on his blog, his book, in talks he gives, in wonderful short films on health (for example placebo) and in testimony to the British Parliament, and so his debunking work is directly linked to public health (and vaccines). The BBC have interviewed Ben Goldacre in their "5 Minutes with... series" - have a look at the author (and go get the book if you haven't).

Oh, and should you be tempted to comment "pharma shill" or something the like, read one of the below (paperback out on 27 September 2012) on an empty stomach and call me in the morning...

Immunization awareness month is over, immunizations remain important

26 posts in 31 days - not quite what we had aimed for, but a lot better than our previous posting frequency. Thank you to our fabulous commentators who have helped to keep the crazy in check, too. We will try to keep our posting up - amongst ongoing outbreaks of measles and pertussis in the US and Europe, speaking up for vaccination, dispelling myths and exposing fear mongers is important every month of the year.

Measlellaneous

Just a short measles miscellaneous of the day. I often come across the notion that it is "immigrants" that re-import vaccine-preventable infectious diseases to the US and that therefore, areas with a high number of immigrants have the highest risk of such diseases. Doctors apparently (achtung: hear say) also like to use that claim to encourage reluctant parents to vaccinate. Two notices appeared on my google feed a couple of days ago:

Fatal outbreak: Measles kills 2 infants in North Waziristan

An 18-month-old girl and one-year-old boy died of measles pneumonitis in Darpa Khel area of tehsil Miranshah, said Agency Headquarters Hospital Miranshah MS Dr Muhammad Sadiq, adding that 25 more people are admitted at the hospital.
The outbreak of measles started in April across the Agency. Sadiq said that in the past week many patients have come from Darpa Khel and Madakhel because the localities have major sanitation problems. “We started vaccinating children but the disease resurfaced after a gap of one month,” he said, adding that most of the vaccines provided by the government have expired because of high temperatures and prolonged power outages.
.../...
The pediatrician said that most of the patients at the hospital were shifted from Khost, Afghanistan. “The Pakistani government could not vaccinate children from Afghanistan and when the epidemic broke there, patients came to Pakistan for treatment, infecting children here.”

These children are not going anywhere. They will get sick and many will die, right where they are, stuck in the middle of nowhere between Pakistan and Afghanistan (or an equally remote place). They do not have the money to make it to the US. So you guys are safe, right? Wrong: the below are the typical import situations:

Officials suspect measles at Arkansas boarding school

LITTLE ROCK, Arkansas (AP) - The Arkansas Health Department says three siblings have been diagnosed with suspected measles and unvaccinated students at a northwest Arkansas boarding school where two of them are students have been sent home.
The agency said Tuesday that one of the siblings had recently traveled to Romania, Italy, and Switzerland. The youth's two siblings became ill while attending Ozark Adventist Academy near Gentry. (my bold)

Voilà - import of measles into the US is essentially a (white) upper middle class problem. Unvaccinated children, exempt from vaccines at their posh fee paying schools, travel to European countries with very high measles incidence (Switzerland has been battling with measles for years, Romania has been the source for US imports before, too), bring measles back to the US and spread it to their siblings and peers (equally unvaccinated). Interestingly, an analysis of vaccine exemptions in Arkansas has just been published, reporting that since the introduction of the possibility of a "philosophical exemption" from immunization requirements in 2003, exemption rates have increased by 23% per year. There has been a drop in medical exemptions at the same time, calling into question the validity of these before the law was changed, however, the overall increase is still striking:

 Even more striking is the authors' prediction (as published in June 2012):

The increases in philosophic exemptions in Arkansas raise concerns that outbreaks of vaccine-preventable diseases may occur in the future.

Outbreaks of vaccine preventable diseases in the United States are very much a "first world", leisure travel-associated problem and therefore, entirely preventable. Check your vaccination status before you travel abroad!

Australian Anti-Vaccination Network AVN pwned by stopAVN statistician at their own seminar

Since we didn't post anything yesterday, here's a quick post to celebrate Stop the AVN's Scotty Harrison's beautiful talk at the Australian Anti-Vaccination Network's seminar "Vaccination and health - your right to choose" held in Armidale NSW a couple of days ago. I think the audience and organisers were expecting a slightly different take on the issue than they got - have a look and hear the guffaws about 3 minutes in as the penny drops:



Rather small-mindedly, the organisers turned down Scotty's generous offer of coming back for the next seminar the next day to provide some balance. Pwned - just beautiful - cheers mate!

Record measles outbreak in UK's Merseyside hits un- and undervaccinated

it is another bad year for measles - following on the European measles record year 2011, which saw, from January to October, 26'000 cases, with 9 deaths and nearly 7300 hospitalisation, measles are still going strong in UK. Various regions are reporting outbreaks, Wales saw over 100 cases in Gwynedd and Porthmadog. Sussex has seen just over 300 cases of measles this year. The area worst hit is Merseyside, a small county in England's North West, with a population just under 1.4 million. After a single measles case was seen in January, case numbers slowly increased to nearly 360 confirmed and over 150 suspected cases by the end of June. Luckily, there has not been a death so far, but 18% of the confirmed cases had to be hospitalised. Contrary to rumours circulating on the internet, the outbreak was not mostly in fully vaccinated children (it is interesting how pertussis and measles myths and facts mix and make for new vaccine-sceptical tales). The HPA team have now published the break down of measles numbers in this outbreak and of the proportion of vaccinated and unvaccinated patients. Indeed, only 12 of the 359 confirmed cases (3.3%) have had two MMRs*. The associated figure is very telling:

Take a good look at this. All orange and dark blue are unvaccinated, all green and purple are just vaccinated once (the UK recommends the first MMR at 13 months, the second at 41, so all green children were vaccinated age-appropriately only once). Only the light blue had 2x MMR. You may have to search for that stripe a bit, it is quite small. This is particularly interesting, since Merseyside has quite a high vaccine uptake, with 96% of children in Liverpool having had their first MMR. Consequently, the characteristics of this outbreak are very different from one in a largely unvaccinated population (like for example the 2008 outbreak in Salzburg, where 202 cases occurred in a month, largely in a 300 pupil Steiner school with 20% vaccine coverage), propagation of the measles is slow, with cases infecting very few other people. While it is a bit discouraging that the high vaccination coverage amongst young children has not stopped the outbreak entirely, it is clear what can be done.

Coverage for the second MMR needs to be increased. Older pupils, students and adults should check their vaccination records to ensure that they really have had two MMRs, children older than 13 and younger than 41 months could get their second MMR early during an outbreak to reduce the risk.

Consider getting your infant (between 6 and 12 months) vaccinated, if s/he is at "higher risk" (daycare) and there is an outbreak in the area - almost a quarter of cases in this outbreak were in the under one-year-olds, who are at particularly high risk of complications.
Anyone who intends to work/volunteer in the medical sector should have had two MMRs. In this, as in nearly every recent outbreak, transmissions within the medical setting and to medical personnel occurred.

Doctors and nurses need to familiarise themselves with the symptoms of measles, so that they can diagnose them early and limit transmission in the medical setting.

And finally, all parents need to think long and hard before taking their child into A&E or their GP's practice whether their child could be contagious, especially if the child has not had their MMRs and could be carrying a potentially fatal disease. Call ahead, get an "out of hours" appointment or home visit, if at all possible.


* Footnote: instead of complaining about vague language in HPA reports and speculating about the number of fully vaccinated children in this outbreak, people could have just emailed/called the HPA. They do have a presence on Facebook, too and are quite happy to answer any question in depth (I have talked to them through FB, email and phone).

Blogust 2012: be opinionated - save a life!

HT to Chris for reminding me:  Shot at Life had this cool idea - they are running Blogust:

Blogust is a first-of-its-kind blog relay for good that is bringing together 31 of the most influential online voices in the country to change the world through blogging. Each day throughout the month of August, one influencer will post about someone that inspires them and then “pass the baton” to another blogger for the following day. The twist is this: every comment on a Blogust post will initiate a $20 donation to help immunize a child in a developing country.



Your pro-vaccine comment will save a life, but, what is even better, "their" anti-vaccine comment will save a life (by vaccination) as well. So check out their calendar and stir up the discussion.

August is National Immunization Awareness Month

The title says it all, tomorrow, National Immunization Awareness Month starts and Just the Vax will support vaccination awareness by blogging daily on vaccine related issues. Since a daily blog is about 30x the frequency of our usual activity, some posts might just be a "read this today" reference to other people's blogs. So let's warm up with this post by Orac over at Respectful Insolence, who today exposes Joe Mercola's typical anti-vaccine cherry picking and distortion of data:

Joe Mercola attacks vaccinations again. Film at 11.

and as a reminder why immunization awareness is really important - pertussis soars in the UK with 5 dead babies this year to date:

Whooping cough outbreak spreads to very young babies