The Saatchi Bill, or, How England Could Become Quack Paradise

"Hi. I'm Lord Maurice Saatchi, and I'm trying to help quacks."

The other day, I wrote an open letter to members of the various state legislatures in the United States about so-called "right to try" laws. These laws purport to make it easier for terminally ill patients to seek out and obtain treatment with experimental drugs. The reality is that the laws leave patients in the lurch. State right to try laws simply create false hopes for patients and leave them to take on incredible risks while giving up some of their rights to legal redress. So far, five states have passed right to try laws without any serious critique by legislators. To some degree, I don't blame them. Who wants to deny a patient the right to try anything to prolong their life? Yet those legislators who pass these laws are being far more cruel than any who vote these laws down.

But if you think state right to try laws in the United States are bad, take a look at the United Kingdom's Medical Innovation Bill (HL Bill 48 [full text]), also known as the Saatchi Bill, after its sponsor, Lord Maurice Saatchi. As with right to try laws, the intent of the Saatchi Bill is well-meaning, but the end result is likely to be far more harmful for patients than imagined by the bill's supporters.

An Open Letter to State Congress Members on Right to Try Laws

Dear Members of Congress,

"Right to try" laws, that is, laws designed to purportedly make it easier for terminally ill patients to gain access to unapproved, experimental drugs, have been in the news quite a bit recently. Several state legislatures have overwhelmingly supported these types of bills, with little or no opposition, let alone serious, critical examination. Although advocates of these laws claim to have the rights and interests of terminal patients in mind, much of the legislation, and the long-term consequences, are likely to do more to benefit unscrupulous companies and hucksters while doing little to help, or even increasing the harm to, patients in great need, not to mention legitimate companies.

The driving premise behind right to try laws is that terminally ill patients have nothing to lose by trying unproven treatments, and that they ought to have the right to gain access to those treatments without undue burden. A dominant view among right to try proponents is that the Food and Drug Administration, and the various regulations they enforce, create inappropriate barriers to the timely release of potentially life-saving drugs. Advocates believe that earlier access will save lives, coupled with the belief that the government should not interfere with a patient's right to decide what treatments they wish to pursue.

While right to try laws seem, on their surface, to do nothing but benefit patients, they will very likely fail to do so, and perhaps even harm patients, for a number of reasons.

To Talk, Perchance to Understand

I  try to keep an open mind about things, try to keep the mindset that no matter how sure I might be about what I believe, there's always the possibility that I could be wrong. Maybe I misinterpreted something. Maybe I don't have enough evidence, yet, that I'm missing some key bit of data. Along with that, I try to be open to honest discussion, even if I don't necessarily agree with my interlocutor. In fact, that's something that people tend to remark about to me. I have the patience of a saint, they say, because I tend to stay engaged in dialogue well beyond the point that most people would just throw their hands in the air in frustration. It's really because I view those traits as ideals that I should live up to, if I want to be able to call myself a skeptic. Sometimes I'm more successful than at other times, but I try.

What got me thinking about this, about talking with others, and especially with those with whom you disagree, was a brief exchange I had on Twitter. While doing a quick perusal of blog mentions, I came across a comment made by an individual who claimed that Occam's razor says that vaccines cause autism, and any studies that say otherwise are flawed. I saw this as a great opportunity to engage this person in discussion about Occam's razor, what it is and how it applies to the vaccine-autism question. It struck me that perhaps this person did not really understand Occam's razor, viewing it more as a buzz word to prop up their argument than truly getting how it would apply. Here was an opportunity to talk about the issue, to try to share my thoughts with them and to learn why they thought Occam's razor supported their position.

My efforts weren't exactly fruitful.

Brian Hooker's Paper on Increased risk of ASD in African American Boys Retracted

Just a very quick post to let my readers know a bit of recent news about that whole Hooker-MMR-CDC coverup nonsense. The journal that originally published Brian Hooker's paper originally issued a statement of concern about the conclusions and possible undeclared conflicts of interest. Yesterday, October 3, 2014, the journal fully retracted Hooker's paper. Here is their statement regarding the retraction:

The Editor and Publisher regretfully retract the article [1] as there were undeclared competing interests on the part of the author which compromised the peer review process. Furthermore, post-publication peer review raised concerns about the validity of the methods and statistical analysis, therefore the Editors no longer have confidence in the soundness of the findings. We apologise to all affected parties for the inconvenience caused.

I sent an email to the journal asking for more details. If I get a response, I will update this post accordingly.

When Vaccine Injury Isn't Vaccine Injury

A couple weeks ago, I wrote about an incident in Syria in which it was reported that a large number of children had died after receiving the measles vaccine. As I noted, the anti-vaccine community went wild, pointing to this as an example of vaccines being dangerous. This, of course, was before many details were known. I speculated that the vaccine itself was not the cause of the injuries. It was an educated guess, based on the very, very good track record of the measles vaccine. After all, the risk of a serious reaction, like a severe but non-fatal allergic reaction, has a roughly 1 in 1 million chance of occurring. The chances of one child dying after MMR were slim. The chances of dozens in that short a time frame? Next to zero.

The most likely cause was some sort of contamination. One guess floating around at the time was that the vaccines were intentionally poisoned by Syria's Bashad al-Assad as a way to subvert the rebellion. Given the situation in that country, it was not that crazy of an idea. Some suggested bacterial infection with Staphylococcus aureus. Only lab tests would confirm the presence of the bacteria. Another guess was that the vaccines were expired. If that were the case, however, the vaccine would simply have been less effective, not more likely to cause an adverse reaction. And then there were preliminary reports that there was a mixup, with the muscle relaxant Atracurium being used instead of the sterile diluent.

Now we have an interim report from the World Health Organization.

Massachusetts Nurses Association Sues for Right to Endanger Patients

Yesterday, I wrote about how comedian Rob Schneider not only does not know anything about vaccines, but does not seem to understand the Constitution very well, either. Schneider was recently dropped by State Farm Insurance because of his vocal opposition to vaccinations. Understandably, a company that, in part, focuses on public health would not want to be associated with someone who argues against measures aimed at improving public health. The "Makin' Copies" guy has no business going anywhere near health related issues.

As a celebrity, Rob Schneider uses his fame to spread misinformation about vaccines, frightening people away from one of the most successful health measures ever devised. His notions regarding immunizations put others at risk. Public figures, particularly those with some measure of fame, ought to be careful when they speak out on matters of science and medicine. They might think that they are well-informed, but not infrequently, their rhetoric is based on lies and misunderstanding. Though they may seek to help others, they only serve to increase risk. Schneider is but one of the latest actors speaking out on issues for which he has absolutely no qualifications. But he's not the only one who ought to leave well enough alone when it comes to people's health.

MNA - Working to increase patient risk

The Massachusetts Nurses Association (MNA) apparently shares some of Schneider's misguided ideas of personal liberty at the expense of patients.

Rob Schneider, Censorship and Free Speech...and Measles

What is it with the anti-whatever mindset and claims of censorship? It seems to be a feature of these types of people, that they claim their free speech rights are being infringed upon when other criticize what they say or call for them to face reasonable consequences for their actions. I've written about this before, in the case of Jenny McCarthy, when she was being considered to join The View. Jenny McCarthy, as regular readers will know, was, for a time, the celebrity face of the anti-vaccine movement. She held rallies, gave interviews and was all around a very vocal proponent of anti-vaccination tropes. When the news came out that she was going to be on The View, many in the health and science community were concerned that she was being given a platform on which to spew her nonsense, lending her a legitimacy that she had not earned or deserved. They made their opinions known to the producers of the show. The anti-vaccine community, predictably, went into a frenzy, accusing science advocates of infringing on McCarthy's free speech rights and trying to censor her.

The latest D-list celebrity face of anti-vaccinationism is comedian Rob Schneider. He has not been shy, at all, about voicing his opinions on how bad he thinks vaccines are, whether on Twitter or in radio interviews. His public pronouncements on vaccines recently came back to bite him in the butt. And, once again, the tired old false arguments about free speech were trotted out and dusted off.

Happy Talk Like a Pirate Day!

Arrr. Ahoy there, mateys! It be Talk Like a Pirate Day. Time t' hoist the jolie rouge. Avast, ye wee creepies, for ye'll have no quarter.

Arsenic and Old Lace Does Not Vaccine Injury Make

Arsenic and Old Lace

In 1939, playwright Joseph Kesselring wrote a play titled Arsenic and Old Lace, which was made into a film released in 1944. The basic plot of the comedy surrounds a family whose members are insane killers, including two elderly aunts who give their elderly male guests elderberry wine laced with arsenic, strychnine and cyanide, then bury the bodies in the basement. It is a classic piece of theatre and film, whose events may have been inspired by the sort of real life events discussed in Deborah Blum's book, The Poisoner's Handbook.
While the events of the play set the stage for a dark comedy, the real-life equivalents are no laughing matter. In fact, as recently as 2010, someone in Maine poisoned members of their church by lacing coffee with arsenic. Sixteen people tried the coffee, complaining of its bitter taste. Symptoms came on quickly, causing thirteen of the coffee drinkers to seek medical attention, with eight of them requiring hospitalization. One person died from acute arsenic poisoning. The perpetrator committed suicide five days after the event. It's an example of the deliberate contamination of something normally benign to inflict serious injury and death. No reasonable person would look at this incident and claim that coffee is harmful and should be avoided.

Anti-vaccine activists, on the other hand, aren't exactly reasonable people.

Package Inserts - Understanding What They Do (and Don't) Say

With the whole twitter tantrum over a supposed coverup revealed by an alleged whistleblower that really is much ado about nothing, a topic arose that I realized I hadn't written about before, other than in passing. It came up again last week when anti-vaccine activists tried to hijack the Twitter hashtag #vaccinesNOVA by astroturfing it with tons of copy-pasted tweets, rather than actually watching the excellent NOVA episode Vaccines - Calling the Shots and having a mature conversation about vaccines. It's the same tactic they used with the #CDCwhistleblower hashtag. They merely copied and pasted from a list of prepared tweets, rather than offering any original thoughts of their own, because they are convinced that they already know everything and have nothing to learn from a very informative program. If there's even a whiff of pro-vaccine message to a show or post, count on anti-vaxxers to rail and scream, rather than actually watching or reading, let alone understand.

At any rate, I engaged one of those tweeting easily disproved nonsense to #vaccinesNOVA. This individual brought up vaccine package inserts, pointing out that one vaccine insert actually mentions "autism" in the adverse events section. They linked to the insert for Tripedia, which protects against diphtheria, tetanus and pertussis (whooping cough). In their mind, this was ironclad proof that even vaccine manufacturers admit that vaccines cause autism. Of course, this person ignored the other bits in the paragraph that mentioned autism (emphasis added):

Adverse events reported during post-approval use of Tripedia vaccine include...autism...Events were included in this list because of the seriousness or frequency of reporting. Because these events are reported voluntarily from a population of uncertain size, it is not always possible to reliably estimate their frequencies or to establish a causal relationship to components of Tripedia vaccine.

In other words, autism was included because it was deemed either serious or was frequently reported, not because there was any causal relationship found between the vaccine and autism. It is far from being the slamdunk "gotcha!" that my interlocutor thought it was. But it prompted me to consider how many people probably do not understand just what the package insert for a vaccine (or any other drug) actually is or what its contents mean.

So here we go, a primer on drug package inserts and what they mean for a lay audience.

Integrity and Honesty, Part 2

J.B. Handley

Integrity and honesty are pretty important to me. If someone gives their word about something, I expect them to keep it. If, through no fault of their own, they fail to follow through on their word, that's one thing. But if they make a promise to do (or not do) something and then break that promise, well, let's just say that it does not reflect well upon them. Even worse when that breach of trust comes amidst other comments that demonstrate a disregard for ethical conduct.

I try to give people the benefit of the doubt unless I have really good evidence otherwise. Even if I disagree with someone, my first response, in general, is to assume that they have good intentions and mean well. Perhaps it's a naive approach, but I would rather approach others how I would like to be approached. I don't want to be prejudged, so I try not to do so to others. But that can only last so long in the face of contradicting evidence.

Such is the case recently with J.B. Handley, founder of Generation Rescue.

MMR, the CDC and Brian Hooker: A Guide for Parents and the Media

The anti-vaccine community has been in a tizzy lately over a supposed "CDC whistleblower", Dr. William W. Thompson, who, according to them, revealed fraud at the United States Centers for Disease Control and Prevention (CDC). To bolster their claim, they point to a new study from one of their own, Brian S. Hooker, that purports to show evidence of an increased risk of autism among African American boys who receive their first MMR vaccine late. However, the claims appear to be hollow and unfounded, and so they have chosen to rely on emotional arguments that may sound convincing to those who are not familiar with the issues and people involved. In a truly egregious fashion, they have erroneously and cynically compared this whole thing to the Tuskegee syphilis study, and equated the CDC with Adolf Hitler, Josef Stalin and Pol Pot, combined.

With that in mind, here is a brief FAQ for parents, news media and others to help them understand what the claims are and what the evidence actually says. The questions below have been raised or implied by anti-vaccine activists. Hopefully, this will prevent inaccurate reporting and help parents feel reassured about the MMR vaccine.

CDC Whistleblower William Thompson Breaks Silence

Things have certainly been progressing quickly in wooville, specifically in the anti-vaccine neighborhood. Earlier this month, anti-vaccine activist and petitioner in the Vaccine Injury Compensation Program, Brian S. Hooker, PhD, published a study in the journal Translational Neurodegeneration titled Measles-mumps-rubella vaccination timing and autism among young african american boys: a reanalysis of CDC data. [Update (10/4/14): Hooker's study has been fully retracted by the journal.] Basically, Hooker took a dataset that was used by CDC researchers DeStefano et al. in their 2004 study looking at whether on-time, slightly late or late MMR vaccination was more common among autism cases than among controls. It was a case-control study that looked at both a large population, as well as a smaller population limited to those who had a Georgia birth certificate. After receiving word from a whistleblower that the DeStefano study found an association among African American males, but did not include that in the finished report, Hooker waded in to find the holy grail of government malfeasance and cover-up. Except, he did not use the same methods to examine the data that the CDC did. Using a dataset designed for a case-control study, he conducted a cohort study, applied statistics inappropriately and reached a spurious conclusion.

Although it made a splash among the conspiracy-minded, it didn't garner much attention right away. Science bloggers held off putting up any immediate posts, opting instead to examine the study to see if Hooker's methods were sound, particularly since his conclusion had no plausible biological basis. In the interim, the British doctor who engaged in research fraud and was stripped of his medical license, Andrew Jeremy Wakefield, put together a video in which he exploited the victims of the Tuskegee syphilis experiment in a cynical attempt at using the race card to drum up outrage at the CDC. At the same time, he said the CDC was actually worse than Hitler, Stalin and Pol Pot. Wakefield also included in his video carefully edited snippets of audio recordings that, presumably, are the whistleblower. He released two versions of that video, one with the whistleblower's name bleeped out and his voice distorted, and one where the audio is unobscured and his name, William Thompson, is plainly stated. Interestingly, anti-vaccine blogger Jake Crosby condemned Wakefield for outing Thompson without Thompson's permission, an allegation that Wakefield strongly denied.

Early this week, science bloggers began posting their analyses of Hooker's study, noting the flaws and questioning the validity of its conclusions. They also pointed out that not one anti-vaccine activist called out Andrew Wakefield for race-baiting, but instead praised and shared his video, the implication of which is that one of the original DeStefano authors was a race traitor.

On Tuesday evening, the Wakefield/Hooker sycophants threw a collective tantrum on Twitter, whining about how no one takes them seriously.

That brings us to the momentous events of Wednesday.

Anti-vaccine Activists Throw Twitter Tantrum

Unlike Kitty, the anti-
vaxxers don't learn.

Last night, in a stunning display of groupthink, a whole bunch (gaggle? swarm? what's the collective noun for a group of loons?) of anti-vaccine activists took to Twitter in a cynical ploy to draw attention to their latest torturing of science and statistics. I'm talking about the recently published paper by Brian Hooker that appears to have used an improper study design and the wrong statistical measures to reach a preconceived conclusion that MMR vaccine is associated with autism, except that it showed there was zero association with any children except for African American boys who were vaccinated off-schedule. They used the hashtag #CDCwhistleblower to do what really amounted to the social media equivalent of a temper tantrum, whining about how the mainstream media is not reporting on the study. It was really a sad display, as they simply all copied and pasted from the same list of talking points, not even adding their own interpretation. And when presented with links to analyses of Hooker's study, they didn't even bother reading. Instead, what we got were the shameless exploitation of victims of the Tuskegee syphilis experiment, implications that one of the DeStefano authors was a race-traitor and whining that no one was taking them seriously, all while posting links to a video in which the CDC is compared to Adolf Hitler, Josef Stalin and Pol Pot. Oh, and accusing the mainstream media that they want to cover the story of being part of the cover-up. And they wonder why people think they're missing a few screws?

Just a short post to let y'all know about the shameful, sad display. Without any actual science on their side, they're left with smearing those they don't like and trying to game the system. I'll leave it at that, as it doesn't warrant a full-length post.

Andrew Wakefield Tortures History

I've written before about how the anti-vaccine movement regularly gets the science wrong (see, for example, here and here). Most often, it involves how they interpret (or, rather, misinterpret) studies that they think support their view that vaccines are the root of all evil, causing all manner of disorders. They regularly misrepresent and torture the scientific literature to fit their agenda. But occasionally, it involves actually attempting to do science themselves, the latest of which being a study [Edited to Add: this study has been fully retracted by the journal.] recently published by Vaccine Injury Compensation Program petitioner, Brian Hooker, PhD and funded by the anti-vaccine group Focus Autism. This study has been examined by an epidemiologist, another epidemiologist, and a cancer researcher. The players have also been examined by a dyslexia consultant and autism advocate (see also here). This study, in addition to being of questionable validity, has spawned quite the brouhaha among anti-vaccine activists. In short, Hooker took a dataset that was analyzed by a group of CDC investigators. Their finding was that age at first vaccination with MMR did not appear to [edited to clarify and correct] affect the risk of be associated with autism [ETA: cases (those with autism) were no more or less likely to have been vaccinated with MMR than controls before 18, 24 and 36 months; the study design could not establish causation, only correlation]. The results of their study were published as a case-control study. Hooker used the same dataset to create a cohort study and found that there was no increased risk of autism in any of the groups (i.e., MMR does not cause autism) except one: African American males, for which he puportedly found a 3.36-fold increased risk of autism when they were vaccinated between 24 and 31 months. Read the two posts by those epidemiologists for why his analysis is suspect.

I'm not going to go into the science behind the studies, because it relies very heavily on statistics, and I'm not a statistician or epidemiologist. As an aside, neither is Dr. Hooker. Instead, I want to focus on some statements made by one Andrew Wakefield, the British doctor who committed scientific fraud, resulting in the full retraction of his 1998 case series study on MMR and the stripping of his medical license. Wakefield boldly added himself to the list of not only torturing science, but now adds to his accomplishments torturing history and ethics (granted, we already knew he was ethically challenged). You see, in his videos (here and here) about the alleged "whistleblower", William Thompson,Wakefield compared the purported "cover-up" to the Tuskegee syphilis debacle. It's a false comparison used simply to inflame people and claim the race card.

For Balance, We Turn To... - Jen Eyer Edition

This seems to be the week for lazy journalists falling for the false balance that is the epitome of sloppy reporting. I had originally planned to write about this particular bit of nonsense yesterday, but the article giving a platform to anti-vaccine bully Becky Estepp took precedence. Also, Dr. Steven Novella and Orac both beat me to the punch. But, there's still plenty of meat in the story to go around.

I'm talking about the latest verbal vomitus from anti-vaccine activist Mary Tocco, titled No one should be forced to vaccinate their children". Ms. Tocco's letter was in response to a science-based op-ed, "Anti-vaccination movement threatens the health, safety and well-being of Michigan children", by Dr. Anthony F. Ogjnan and Dr. Sandro Cinti. The original letter is well worth the read, particularly for those who live in Michigan and are concerned about their legislators being gulled by the dishonest misinformation campaigns of anti-vaccine groups, like Michigan Opposing Mandatory Vaccines (MOMV - apparently Ms. Tocco is as bad at making acronyms as she is at everything else, since she calls it "MOM", i.e., "Michigan Opposing Mandatory"). Ms. Tocco's response is an exercise in name that logical fallacy and an excellent illustration of how "research" (in anti-vaccine world) is a far cry from actual research in the real world. I'm not going to delve into her letter very much, since Dr. Novella and Orac both covered a good deal of what was wrong with it, but I will point my readers to discussions of how Ms. Tocco she tried to twist the Bible to support her ideology.

What I want to focus on is the person responsible for giving Ms. Tocco space to spew her bile, Michigan Live's Director of Community Engagement, Jen Eyer.

For Balance, We Turn To...

Over a dozen current and former students in the Carlsbad High School broadcast journalism program have found themselves in the middle of a long-running bullies' rights and health debate after they produced the film Tangible Harm. We turn to Candy Wenpigzfly for her armchair report.

The film debuted online more than a year after it was completed. Students say that's largely due to the backlash they've faced, even during the production stage.

Chad Stryker, an intern with this station, worked on the film during his junior year. He said the idea came from the San Diego Traffic Circle Club two years ago. Their members were impressed by the students' previous award-winning documentaries and wanted the journalism class to do one on the topic of bullying victims' health and rights.

"We told the Traffic Circle Club we would do the film, but only on our terms. That meant we would approach the subject with serious journalism and investigation," Stryker said. "We wanted to make sure the story we would end up telling would be unbiased and free of the false balance so common among many media outlets. We would go where the evidence led."

Vermont Coalition for Vaccine Choice Pick Cherries to Sow Fear

If there's one thing that never seems to change, it's that anti-vaccine types just do not understand science. They love to pick and choose from the literature when they think they find something that supports their "vaccines are the root of all evil in the world" ideology, but more often than not, the source actually does not support their viewpoint. Some think, for example, that recent measles outbreaks have occurred predominantly among the vaccinated, when nothing could be further from the truth. To support their position, they cite studies where the majority of cases were unvaccinated, or where none of the cases were vaccinated (and the index case was a patient of an anti-vaccine doctor), or a report of a 30-year-old outbreak occurring under very different conditions than today. More often than not, they latch onto a phrase or a few sentences from a study that they think supports their position without taking into consideration the rest of the study. Some simply copy and paste from other anti-vaccine sites without even reading anything for themselves. The end result is that they make a fool of themselves.

The latest example of this come courtesy of the Vermont Coalition for Vaccine Choice (VCVC), a horribly misnamed offshoot of the even more horribly misnamed National Vaccine Information Center. Though asserting themselves as "pro-safe vaccine", their actions and words reveal them to be fervently opposed to any and all vaccines. I first wrangled with VCVC in the comments on a Vermont news article. Since then, they have accused me of being paid by "Big Pharma", have tried to find out who I am and "out" me (though why I can only speculate) and have contributed to the spread of misinformation about vaccines that has led to the largest outbreak of measles in decades.

Their latest foray into cherry-picking quotes from sources they either do not understand or purposefully misrepresent is similarly about measles. It's a comment on a Portland Press Herald (Maine) titled More Maine families are skipping or delaying childhood vaccines:

Richard Dawkins is Illogical and Insensitive

There's been a bit of a to-do recently in the skeptical community. Usually when something like that occurs, it has to do with women's rights, harassment, sexual abuse, or some combination of those. This time is no different, and it involves an individual who has gotten in trouble on these topics before. He apparently just is incapable of learning. It's like there is some sort of psychological block that comes down, a subconscious censor in his brain sticking its fingers in its ears, going "Lalalala! I can't hear you!", preventing him from really understanding what is explained to him.

Trigger warning: this post is going to discuss rape.

I hadn't planned on writing anything about this, but then I read something by the aforementioned individual that I felt I just had to say something. The person we are talking about is Richard Dawkins. He is a very big name in the skeptical community, and an even bigger name in the atheist community. Certainly, he's done a lot to get people thinking and asking hard questions when it comes to religion, creationism, intelligent design, and the like. But, and here's where skepticism comes in, we need to judge his words for what they are, not because of who said them. And when it comes to rape, he has been found wanting.

Imunization Awarness Month - The Vaccination Chronicles

It's National Immunization Awareness Month! I didn't have time to write up a big, long post, so instead, I thought I would share this video from Richard Saunders. This short documentary, The Vaccination Chronicles, was a personal endeavor by Saunders as an effort to educate the public about the importance of vaccinations. Enjoy.

Case of Justina Pelletier Spawns Dubious Legislation

The intersection of science and politics is a very murky area. While science can and should inform policy and legislation, those who try to legislate science can easily find themselves on shaky ground. To say that politicians ought to exercise great care when introducing legislation that affects the scientific enterprise is, perhaps, a slight understatement. That is especially true when they start trying to dictate what science is and is not allowed. It's even worse when the individual politicians behind the legislation have demonstrated by past behavior that they are, shall we say, science-averse.

That's the case with a recent bill that has been introduced into the House of Representatives by Minnesota's Rep. Michele Bachmann. I won't go so far as to say that Bachmann is crazy or insane, as I'm no psychologist and there's no need to pathologize her particular brand of nonsense, but she certainly has shown that she does not understand science and her conception of the world differs quite profoundly from reality. Whether it's on the subject of evolution, climate change, or vaccines, Bachmann regularly gets the facts wrong. Now she's wading into policy governing research by introducing a bill nicknamed "Justina's Law". In a related vein, Rep. Steve Stockman has introduced what he's calling the "Parental Protection Act". Both bills are vague and stand to do more harm than good.

Massachusetts Steps Closer to Expanding Autism Support

Massachusetts State House
Source: Fcb981/Wikipedia

When someone receives a diagnosis of autism or a related disorder, it profoundly impact the individual and their family. Depending on the severity, they may need only minor assistance or extensive services. Some may be able to live independently, while others require round the clock support. There may be other concurrent medical or mental health conditions, as well. In far too many states, autistic individuals fall through the cracks. It's only recently that states have started to enact legislation aimed at reforming health care coverage for those with an autism spectrum disorder or other developmental disability.

Massachusetts is the latest state that is close to expanding coverage and support for people with developmental disabilities. The state house of representatives unanimously passed a bill (H.4047 - An Act relative to assisting individuals with autism and other intellectual or developmental disabilities) that does a number of things that will hopefully improve the quality of life of those individuals and their families. The senate passed a similar version of the bill (S.2245, reprinted as S.2257), also unanimously. The next step is a compromise bill, then it's off to the governor for signature.

The Top 5 Ways to Prevent Measles

Measles is pretty damn contagious. In fact, it is one of the most contagious diseases known, infecting about 90% of all susceptible contacts with as little as 0.2 viral units. It can remain active in the environment for up to two hours, in the air and on surfaces. It is remarkably well adapted to spreading from host to host and staying viable long enough to do so. But it's not so well adapted that it can do all that without causing a high rate of complications, whether it's leaving the host open to secondary bacterial infections that may cause pneumonia, ear infections and diarrhea, or invading the brain to cause encephalitis, seizures and permanent neurological injuries, or in rare cases, death.

In 2000, the U.S. eliminated endemic measles transmission, but that may be in jeopardy. This year, we have seen more cases of measles in the first six months than in the last four years. Combined. The majority of the outbreaks have been in the Ohio Amish regions, as well as among vaccine-refusing communities in other states. The common factor among all of the outbreaks is that they started when an unvaccinated individual traveled to another country in the midst of a large measles outbreak, got infected and brought the virus back to be spread around. Another commonality is that the majority of people infected in these outbreaks were either unvaccinated or had unknown vaccination status.

With that in mind, I thought it might be helpful to provide a list of ways (in no particular order) that you and your family can stay safe from this disease.

Pre-Vaccine Declines in Measles Mortality

On Monday, I discussed "pox parties" and "measles teas", social gatherings where parents get their unvaccinated, nonimmune children together with another kid who has a disease, the purpose being to intentionally infect their kids and make them sick. It is a practice that, for at least a hundred years, has been decried by the scientific and medical community as a wretched idea, with one author describing them as "orgies of death". Indeed, in my opinion, these parties are nothing more than child abuse.

While vaccine preventable diseases are not the killers they once were, as I mentioned in passing in that post, they are still quite dangerous; diseases like diphtheria and measles should be avoided and prevented whenever possible. Anti-vaccine activists seem quite enamored with pre-vaccine mortality data. They like to point to the declining death rates from diseases and declare that vaccines not only did not save us from those diseases, but that we didn't need vaccines anyway. There are a couple of things wrong with this way of thinking. First off, it erroneously focuses on disease mortality and pretends that deaths and incidence are somehow the same thing. The implication is that the incidence, that is, the number of cases, was declining before the vaccines. Or they just come right out and say that death rate and incidence are the same:

Measles cases in all developed countries became much milder than in developing countries mainly due to improved diet. Is it logical that deaths associated with measles declined greatly without any corresponding decline in incidence?

That is, quite simply, false, not to mention sloppy thinking. Second, it ignores the non-fatal, but still quite serious, complications of diseases, such as severe dehydration, pneumonia, deafness, blindness, encephalopathy and permanent mental impairment, among others. And, yes, these diseases can still kill, even in developed nations with good healthcare like the United States.

I will readily admit, the measles vaccine did not contribute to the decline in deaths seen before the vaccine was licensed. (Duh!) But while anti-vaccine activists assert that the disease just got less dangerous on its own, they're wrong. Here's why.

Orgies of Death - The Dangerous Tradition of Pox Parties and Measles Teas

The other day, Reuben Gaines, over at The Poxes Blog, shared some information about groups on Facebook for people to arrange for the sociopathic practice of intentionally infecting their children with vaccine-preventable diseases. Groups like Rubella Immunity Network, Vaccine-Free Immunity, Chicken Pox Immunity Network and Montreal Chicken Pox Party, among others, rather than trying to protect children from disease, actively promote giving them diseases. The participants in these groups labor under the false notions that diseases like chickenpox, rubella and measles are completely harmless and that vaccinations are worthless, are more dangerous than the diseases, or both. I'm sure they truly believe that they are doing what is best for their little ones, but unfortunately, they are dangerously wrong. While most children will come through the disease unharmed, not all will. And certainly more are harmed, and die, from disease than are injured by vaccines.

Sadly, this isn't a new thing at all. Groups crop up worldwide:

Opponents of immunization often try to infect healthy children in a controlled way by holding so-called "measles parties" with an infected child at the focus, intending to provide their own children with life-long immunity.

Even as far back as 2001 in the United Kingdom, people were holding measles parties. They're in Germany, too. But as an article in SABC News notes:

There is a considerable variation across Europe, with Finland, Sweden and the Netherlands having high immunization and low death rates, while Germany, France, Italy, Austria and Switzerland have lower rates of immunization and correspondingly more deaths.

It's a tradition that goes even farther back than just 13 years.

Vaccine Resistance

Several weeks ago, while perusing the mental spewings of the Vermont Coalition for Vaccine Choice's Facebook page, I came across a post that actually got me thinking. It wasn't because the Vermont Coalition for Vaccine Choice was actually saying something based in science or reality for a change. Rather, it made me think about what evidence was actually out there on this particular subject. They shared a link to a news story about antibiotic resistant bacteria. The news story itself, A Wake-Up Call on Antibiotic Resistance, wasn't really controversial, being an NPR story about how resistant bacteria are becoming more common and how, if we don't figure something out soon, what once were treatable, relatively benign illnesses could become deadly. But then the VCVC had to tack on this comment: Will over-vaccination cause similar problems?

My initial, knee-jerk thought was, "Of course not!" But then I paused. My skeptical nature kicked in and made me ask, what does the science actually say on the subject? Was it possible? Maybe, but the comparison to antibiotics is flawed, since antibiotics and vaccines work in very different ways. Now, if I were the VCVC, I would have stopped right there. I would have just assumed my presumptions about vaccines being bad in every conceivable way were valid and therefore over-vaccination must inevitably lead to vaccine-resistant strains of bacteria and viruses. But, thankfully, I'm not among the membership of the Vermont Coalition for Vaccine Choice. I actually did go in search of answers, something I presume they did not bother doing, since I haven't seen any followup posts on the subject.

Dear Anti-Vaxers, Thank You

With the recent release of an update on this year's measles outbreaks from the CDC, I thought this would be a good opportunity to write an open letter to all those anti-vaccine activists out there that have made the 20-year record number of measles cases so far this year possible. So here it is. To all of you out there who claim that vaccines are bad, that they cause autism, autoimmune disorders, asthma, and all manner of other maladies, thank you. To those of you who say that vaccines don't actually work or that the diseases prevented by vaccines really aren't that bad, thank you. To those of you who put yourself above everyone around you, who think only of your freedom and don't give a s*** about your family's, friends' or neighbors' health, thank you. To those of you who use religion as a cop-out, to hide behind your religion so you don't have to protect yourself, your children or those around you, thank you. Thank you for contributing to an environment of fear about vaccines. Thank you for spreading misinformation, uncertainty and doubt about vaccines. Thank you for creating regions perfect for the spread of disease. Without you, we wouldn't have been able to reach an amazing 307 cases and counting in the first five months of this year. That's higher than any other year's total number of cases since measles was eliminated from endemic transmission back in 2000. And we haven't seen so many cases so quickly since 1994.

I realize that's a little abstract, just citing numbers, so here's an image for those of you who are more visually oriented:

Soure: CDC

Man. Just look at that steep, steep line for 2014, towering over every other year in the past fourteen years. Take a bow, anti-vaxers, because that is largely your work. Know how I know it's in large part due to your work? Here's how: 200 of the 288 reported in the CDC's media release about the outbreaks were completely unvaccinated, and 58 had unknown vaccination status. And those unvaccinated folks? Ten were too young to have been vaccinated, but would have been protected by herd immunity if not for you. Eleven had missed vaccination opportunities. Again, they would likely have been protected if you hadn't done such a bang-up job jeopardizing public health. The rest of the unvaccinated were unvaccinated because of religious, philosophical or personal belief reasons.

Again, for those of you who prefer visuals, take a look:

The Visible Attacks on Invisible Threat

I've been a bit slow getting around to this post, so the subject is rather old news, in blogging terms. Back at the end of April and early May, the anti-vaccine world went into a tizzy about a documentary developed by chstvFILMS (Carlsbad High School Television), an award-winning broadcast journalism program run by high school students for high school students. They have a teacher adviser and a parent volunteer to help the students, but the students do the work of writing, filming, interviewing and so forth. Several years ago, the students started work on what was intended to be a short (15 minutes or so) documentary on the immune system. What they ended up with was a roughly 45-minute documentary on vaccines, the threat of infectious diseases and the role of vaccine refusal in the spread of disease: Invisible Threat.

Invisible Threat Trailer from CHSTV Videos on Vimeo.

From the moment the students announced the project, anti-vaccine folks attacked it, with comments like this, from Age of Autism's Anne Dachel (Age of Autism, "Reporters - The Next Generation", Sept. 19, 2012):

This class assignment was a HOW-TO GUIDE on how to deceive the public by covering up relevant facts about a major issue...What was produced here was propaganda.

This, of course, without Ms. Dachel having seen the film at all. Unlike AoA's Media Director, I wanted to actually watch the film before I made any comments on it, either for or against it. So, I contacted the film's producer Lisa Posard at InvisibleThreatInfo@gmail.com.

Spurious Correlations

Orac alerted me to a web site that is simply wonderful. You know when you hear someone talk about the increase in the number of shots on the vaccination schedule and how it correlates to the increase in autism diagnoses in the U.S.? Send them to Things that Correlate (aka Spurious Correlations). This is an amazing site that provides all sorts of graphs showing how two completely unrelated things appear to correlate. For example, did you know that the fewer lawyers there are in the Northern Mariana Islands, the lower the divorce rate in Kentucky? It's true:

Credit: tylervigen.com

Clearly there's something going on here. There has to be a connection. I mean, how else do you explain how closely those lines match up? It can't just be coincidence. Or at least, no more coincidence than the number of vaccines on the recommended childhood schedule and autism. I guess if we want to keep couples together in Kentucky, we need to make sure that there are as few lawyers in the Northern Mariana Islands as possible. I mean, the data's right there.

This should, hopefully, illustrate how just because two things appear to be correlated, does not mean they really are, nor that there is any sort of causal connection between the two. You can even look for your own correlations by clicking on the "Discover a new correlation" link. Just pick your starting category, then your first variable and finally your second variable. You can see how close is the correlation by looking at the number in parentheses. The closer to 1, the closer the correlation. The closer to -1, the closer to an inverse correlation. Then just click on "Correlate" to see your graph.

Anti-vaxers and Math Don't Mix

This was going to be a short and quick post, but it got a little bit longer as I went. At any rate, a lot of those opposed to vaccinations will try to convince you that vaccine preventable diseases are harmless rites of passage. They will say that vaccines aren't needed because the diseases are so rare (ignoring the fact that they're rare because of vaccinations). Many also have this odd tendency to focus solely on mortality (deaths), ignoring morbidity (cases) and non-fatal complications. I encountered one such individual yesterday on Twitter. After claiming that measles was never eliminated in the U.S. by citing the number of cases from 2000 to 2014, she then questioned the 1-3 per 1,000 risk of death from the disease (actual estimates range from 1-2 per 1,000 to 1 per 3,000):

Interview with Dr. Paul Offit at NECSS 2014

Source: NIH Record

A couple weeks ago, I shared my review of this year's Northeast Conference on Science and Skepticism (review of Day 1 is here and review of Day 2 is here). While I was there, I had the opportunity to talk with Dr. Paul Offit, Chief of the Division of Infectious Diseases and the Director of the Vaccine Education Center at the Children’s Hospital of Philadelphia. Dr. Offit is the author of a number of books, largely focusing on vaccines and the anti-vaccine movement, most notably Autism's False Prophets and Deadly Choices: How the Anti-Vaccine Movement Threatens Us All. His most recent work, Do You Believe In Magic?, which came out last year, focuses on complementary and alternative medicine.

After a couple shifts around in scheduling, Dr. Offit graciously sat down with me during the lunch break on the first day of the conference. My thanks to Chris Brown and the rest of the NECSS staff for helping arrange this opportunity.

Beware the Wakefraud

The sun set long ago, and outside, the world sleeps. Only the occasional passing car breaks the tranquility of the night. Inside, a lone figure sits before a laptop. The lamp on the desk sheds a soft, if weak, light, nearly drowned out itself by the cold illumination of the monitor. The figure's fingers tap out a few final strokes, then move to the mouse. She drags the cursor across the screen and clicks "Publish". A sudden flash of lightning and thunder, then the room goes dark.

A low, quiet chuckle filters out of the laptop as the screen fitfully flickers back to life. On the screen, four words shed an ominous, baleful glow:

The Wakefraud had struck.

Who Pays for VICP?

There is a lot of misinformation out there about vaccines and, well, pretty much anything related to them. People like myself that take a science-based approach to vaccines to counter myths are "pharma shills" (we're not). Manufacturers have absolutely no liability (they can be sued for some liability claims). If vaccines work, it doesn't matter whether my kid is vaccinated or not (it does matter), or the variation, why do so many outbreaks include the vaccinated (it's a numbers game; see previous link). The government is scared to do a randomized, double-blind, placebo-controlled trial of the vaccine schedule (such a study would be unethical and possible illegal). VAERS is a reliable source for drawing conclusions (it's unreliable for conclusions, but can be a springboard for research ideas).

And then there's something that came up yesterday in a CDC twitter chat about vaccines. The chat (#CDCvax) was crashed by a bunch of anti-vaccine activists spouting all kinds of nonsense, including all of the myths mentioned above. One other claim popped up that I have not written about before. It involves the funding of the Vaccine Injury Compensation Program (VICP). Basically, one anti-vaccine proponent made the oft-repeated, but never correct, claim that taxpayers fund the VICP compensation fund. Here's one example of this claim:

Here's a clue, they aren't.

The short response is: Taxpayers do not pay for vaccine court payouts. But I'll go into a bit more detail.

The NECSS of Thought and Reality - Year 4 (Part 2)

Yesterday, I shared my review of the first day of the Northeast Conference on Science and Skepticism (NECSS), which took place April 12-13 in New York City, a joint effort of the New York City Skeptics and the New England Skeptical Society. The conference is an opportunity to bring together individuals from around the world who share an interest in science and critical thinking. This was the sixth year of NECSS and my fourth year attending.

The first day of the conference covered a wide range of topics, from how to teach kids to be critical thinkers, to the clash between religion and medicine, the neuroscience behind whether or not we have free will to women in science. Always a highlight was the live show of the Skeptics' Guide to the Universe just after lunch, with special guest Dr. Paul Offit. Keynote speaker Lawrence Krauss gave an engaging and informative talk about spherical cows and simplified physics to close out day 1 of the conference. For those who didn't want it to end there, however, the SGU private show gave about 40-50 people the chance for a behind-the-scenes look at the popular science podcast, while others headed to the pub for some casual chatting and socializing over drinks at Drinking Skeptically.

An eventful day and informative start to the two-day conference, I was left contentedly exhausted and looking forward to day two.

The NECSS of Thought and Reality - Year 4 (Part 1)

As I mentioned in my last post, I recently attended the Northeast Conference on Science and Skepticism (NECSS) from April 12-13 in New York City. NECSS is a joint effort of the New York City Skeptics and the New England Skeptical Society, bringing together individuals from around the world who share an interest in science and critical thinking. Speakers and attendees alike have widely varying backgrounds. There are scientists, philosophers, astronauts, teachers, clinicians, activists, bloggers and artists. For their sixth year, the conference attracted over 400 people from 27 different states and 7 countries. This was my fourth year attending. To get a sense of past years, read my reviews of NECSS 2011, 2012 and 2013 (part 1 and part 2).

For those new to the scene, you may be wondering what all this "skeptics" and "skepticism" is about. Most people may think of it as simply doubting or questioning something, and nothing else. But it is a great deal more than that. The skeptical outlook, for me at least, involves critically examining claims and evidence, evaluating their validity, and accepting or rejecting the claim as the evidence warrants. It is the application of critical thought to every aspect of life. The same methods can be applied to figuring out whether or not Bigfoot exists, whether a medical product works or deciding which politician is full of crap and which one is...less so. Skepticism demands that we not only think critically about others, but apply the same unflinching inquiry to ourselves. We may not be comfortable changing our views, but we must go where the evidence leads.

NECSS attracts these types of people. And it's a good chance to reconnect with people you may have met online or at past conferences, as well as meet new people. This year, I met Clay Jones, a pediatrician and contributor to the Science-Based Medicine blog, and documentarian Scott Thurman, director of The Revisionaries. I also got to chat with some of the speakers and see friends from NECSSes past.

But enough about all that. Let's see what this year's conference had to offer.

Dr. Jay Gordon and "Irrelevant" Vaccines

This past weekend I was at the Northeast Conference on Science and Skepticism (NECSS). This was their sixth year, and the fourth that I've attended. I was going to work on my review of the conference last night, but something popped up that I just had to address. So, the NECSS 2014 review will have to wait a little longer.

I realize that I just wrote about Dr. Jay Gordon back on April 1 when he mistakenly tried to say that the incidence of measles in the latest outbreak in California could be calculated by dividing the cases by the total population of the state rather than by the susceptible population. But I made the mistake of checking Twitter to see if Dr. Jay Gordon had responded to a couple questions/comments I directed to him, as well as to see if anyone else said anything. I've noticed that he's taken to pretty much ignoring me when I point out his mistakes or clarify something he's said, so I wasn't surprised that he hadn't responded to me. What caught my attention, though, was a brief video shared by someone else.

Dr. Jay's Magical Math

You would expect pediatricians, especially Fellows of the American Association of Pediatrics, to know at least a little bit about epidemiology and to give others a proper, fact-based picture of what vaccine-preventable diseases can do. At the very least, you would not expect them to get things so spectacularly wrong that you wonder how they ever managed to get their license, let alone their degree. Yet that is exactly what one pediatrician does on a fairly regular basis. In fact, the things I'm about to describe I actually wrote about three years ago. I'm speaking of Jay Gordon, MD, FAAP, and in the time since that 2011 post, he doesn't seem to have learned anything. You'll see what I mean in a bit.

For those who don't know, Dr. Gordon is a California pediatrician who regularly downplays the risks of disease and advocates alternative vaccination schedules, as well as skipping vaccines altogether as "unnecessary". He is a darling of the anti-vaccine movement, since he supports their views that vaccines may be, somehow, dangerous. In fact, he is (or was) the pediatrician for Jenny McCarthy's son. Jenny, as you may or may not known, made quite a name for herself as the celebrity spokesperson for the anti-vaccine group Generation Rescue. Yet Dr. Gordon also appears to desperately crave the acceptance of his science-based peers.

Justina Pelletier to Remain in Massachusetts DCF Custody

Earlier this month, I wrote about the case of Justina Pelletier, a teenage girl who has been the center of a year-long-plus custody battle between her parents (Lou and Linda Pelletier) and the Massachusetts Department of Children and Families (MA DCF). The case has drawn national attention and sparked some rather heated opinions. The majority of articles, blog posts and comments have been strongly supportive of the Pelletiers, with most framing the situation as government overstepping its bounds and infringing on parental rights. Few took a more nuanced approach, sticking to the known facts and avoiding speculation.

For a little background, in 2012, Justina was diagnosed with a mitochondrial disorder by Dr. Mark Korson, Chief of the Metabolism Service at Tufts Medical Center. After suffering a bout of the flu in 2013, with subsequent gastrointestinal problems, Dr. Korson recommended she see her former gastroenterologist, who had moved from Tufts to Boston Children's Hospital (BCH). When she was admitted to the ER, the BCH physicians questioned the mito disorder diagnosis and suspected, instead, that she had a somatoform disorder. Justina's parents disagreed with BCH's proposed psychiatric treatment plan and were going to take her out of BCH to continue her mito disorder treatment. Fearing that this would delay proper psychiatric treatment and result in unnecessary medical treatment that would put Justina at increased risk of harm from the drugs prescribed for mito disorder, the BCH physicians called in the Department of Children and Families, fearing medical child abuse.

Thus began a thirteen-month courtroom and media spectacle. The latest development was announced yesterday, March 25.

A Confession

This post was very hard for me to write. For four years, now, I've been writing this blog. Four years putting out post after post refuting the claims of "anti-vaxers". For several years before that, I was active in the comments of a few different sites, trying to be quick to respond anytime someone questioned vaccines. All this time, so many hours pushing the pro-vaccine angle. But I just cannot, in good conscience, continue. Not any more. The little bit of income I earn for my efforts just isn't worth the guilt. Not after this past weekend.

What happened? What changed my mind? Last weekend, I attended the Pharma-sponsored Midwest Conference on Vaccines. This is the first time I've been to this conference, now in its sixteenth year, and the first time I've met many of my blogging colleagues face-to-face. Normally, all of my dealings with the inner workings of the pro-vaccine machine have been through email or snail mail. I get my orders. I write. I get paid. Simple, easy money. To say that this conference was an eye-opening experience is an understatement.

The Case of Justina Pelletier Calls for Nuance and Moderation

I've given a fair bit of thought as to whether or not to write this post. I may end up inadvertently offending people who have very firm opinions on the matter. The subject is rather controversial, evoking very strong emotions on both sides of the issue, which has gained national attention. The main problem is that what is known stems predominantly from media reports, with verified facts being unavailable. This is the case of Justina Pelletier, a 15-year-old girl who has been the center of a custody battle for over a year between her parents and the state of Massachusetts. The majority of coverage has taken the side of the parents. Most of the people speaking out do so on behalf of the parents, often quite vehemently decrying the Department of Children and Families (DCF) and Boston Children's Hospital (BCH), which started the ordeal. Articles siding with DCF are almost non-existent, but like their counterparts, take a very firm position based on media reports. Rarer still are measured, nuanced analyses of the story.

The dearth of more neutral approaches, and the vehemence with which people have spoken out about this, prompted me to write. I am not going to make any firm conclusions. I will not take a side. There isn't enough verified, primary source information available for me to do so. Instead, I will summarize the details that have been reported and talk a little about the possible scenarios: that the parents are right and that DCF and BCH are right. It is a complex topic about which I'd like to start a conversation, so feel free to post your thoughts in the comments below, but keep it civil.

Let Me Out!

Earlier this month, commuters in the San Francisco area were warned that they may have been exposed to the highly contagious disease measles after a student at University of California, Berkeley attended class and rode the Bay Area Rapid Transit (BART) while contagious. The student, who was unvaccinated, likely contracted the disease while traveling abroad. Take a virus that can remain viable in the air of an enclosed space (like a classroom or subway car) or on surfaces for up to about two hours, a large student population of a university like UC Berkeley, and hundreds of thousands of commuters each day and you have a lot of people that were likely exposed to one of the most contagious viruses known to infect humans. Just look at BART alone, which sees roughly 390,000 riders each day. Of course, not all of those will ride in the same car as the student, but we can expect that at the very least, several hundred people would have been exposed to measles each time he rode. Cars hold about 60-70 people, the virus lingers for a couple hours, lots of people getting on and off during that period, it adds up. We could see additional cases popping up over the next week or two. And that's not the only case that California has seen. As of February 21, there have been 15 cases of measles, with the youngest being only 5 months old, according to a CDPH teleconference. Compare this to last year, when there were only 2 cases by the same date.

Those 15 cases make up the majority of the 24 cases seen nationwide to date, with other cases seen in Hawaii, Massachusetts, New York, Oregon, Pennsylvania, Texas, Washington and Wisconsin. The cases are in those who traveled to other countries where there are current measles outbreaks (e.g., the Philippines) or where measles is endemic (e.g., India) or among those who have had contact with someone bringing the virus back from another country. Since measles was eliminated from circulation in the U.S. in 2000, the outbreaks we have seen since then have been due to importation by unvaccinated individuals, some too young to be vaccinated, and others intentionally unvaccinated. Note that none of the outbreaks in recent years has been started by a fully immunized individual. With the risk posed by importation of the disease, I started to think about what role quarantine might play in mitigating potential harm to the public.

Forging Potential Harm

In the United States, every school maintains records on the immunization status of its students. Which students are fully vaccinated? Which have medical exemptions? Who get a religious or philosophical exemption for one or more vaccines? In the event of an outbreak of a vaccine preventable disease, these records can be used by the school to figure out which students are at risk and should be kept home until the outbreak is over. Public health officials also benefit from these records, as they can report vaccination rates across the state. This can show which communities may be vulnerable to a disease outbreak and narrow down where investigators need to look for potential index cases or contacts during an outbreak.

I've written before about an instance where parents forged their children's immunization records so they could get into day care. In that instance, the unimmunized children developed chicken pox, creating a small outbreak of the disease that put the other children, as well as two pregnant staff members, at risk of infection. This raised the question of the legal liability to the parents for their actions, handily addressed by The Skeptical Lawyer. No charges were filed in that case, and it's unlikely that any legal actions would have prevailed, according to the Skeptical Lawyer. A couple months after my original post, there was a chicken pox outbreak at a day care center in Alaska's Kenai Peninsula. Just like the earlier case, the parents refused vaccination for their children, ultimately resulting in a small outbreak.

The issues raised by those two events came together recently, again in Alaska's Kenai Peninsula. A nurse at a public school forged parent signatures on four immunization documents, noting in one instance vaccine refusal for religious reasons.

Weaving Ethical Dilemmas

Imagine, for a moment, that a device existed that could recreate just about any experience a person could have. Not like a television, video game or movie. Not even like a virtual reality simulator. Instead, it interfaces directly with the brain, stimulating specific regions to fire so that the user is, at least temporarily, completely convinced that they experienced whatever event was played. Every sight, sound, smell, taste and touch, even the very emotions evoked, all created by the device in the user's brain. Want to climb Mt. Everest from the comfort of your own home? Just run the right program and when it's done, you'll feel like you have. Want to sit on a tropical beach, lounging with a cool drink in your hand and just admire the majestic ocean, waves rolling in to murmur on the sandy shore? Run a different program, feeling completely relaxed when it's over.

That's the premise of a novella I just finished reading, called The Dream Weaver, by Aaron Simmons, who wrote the story as part of the annual National Novel Writing Month (aka NaNoWriMo). The central character is Eric Bram, a fellow who kicked off the technology and producer of some of the best "weaves" on the market. Bram, however, is wracked with guilt as he learns about the growing issue of addiction associated with the Dream Weaver device, wondering what role he may have played in the spread of the problem. Simmons weaves (excuse the pun) an intriguing tale that hints at far more considerations than could fit in the brief tale. So, I thought I'd explore some of the things that came to mind as I read it. Feel free to add your own thoughts in the comments. If you don't want the book spoiled, I suggest giving it a read before continuing on below.