Ideas have consequences

Tell any reasonable person out there that there are some ideas that should be controlled, and they will likely have some sort of an opposing reaction to your statement. Especially here in the West, we detest the idea of controlling who says what and where. There is the cliché of not yelling “fire!” in a crowded theater, of course. But, for pretty much other ideas and forms of speech, we very much like it when the government stays out of our way. I certainly would not like it if they shut down this blog.

But being free from government interference does not mean that you are free from the consequences of your thoughts and actions. For example, the idea that a child is “lost” or “dead” due to autism can and has had serious consequences. When a mother and a caretaker viciously murdered an autistic boy, they were defended by certain individuals to the point where the murder was whitewashed. They tried to reason that the mother and the caretaker had no choice but to, in a sense, put the boy out of his misery. Only that, it wasn’t the boy that was in misery, per se. It was the mother and caretaker. They couldn’t take the hand that they were dealt and they committed a most brutal act of savagery. Who knows if they thought their actions were justified because, hey, the autistic boy was already “good as dead”.

Today I read yet another story where someone was fed an idea and they acted on it:

“An Oregon mom has been accused of beating her 4-year-old son until his intestines ripped in two places — just because she thought he was gay.

Prosecutors say Jessica Dutro, 25, repeatedly subjected three of her children to traumatic beatings at the Washington County homeless shelter where they lived. But little Zachary Dutro-Boggess bore the brunt of his mom’s volatile temper, Oregon Live reports.

She thought her 4 year-old was gay, so she killed him? Yes, and she left plenty of evidence:

“In a Facebook message that is now being used as evidence against her, Dutro reportedly told her 24-year-old boyfriend Brian Canady that Zachary had made her mad. The boy was “facing the wall” as punishment.

Using a slur, Dutro wrote that her son was going to be gay.

“He walks and talks like it. Ugh,” the mom wrote.”

Now, where would someone get an idea like that? An idea that states that a child of that age could display homosexual tendencies? An idea that states that a homosexual person is less of a human being than the rest of us and, thus, killing them is justified?

Well, unfortunately for us as a society, those ideas are out there, and they’re loud and well-propagated. James Dobson, a so-called “Christian”, has pushed the idea that children can display homosexual tendencies at a young age:

“In one study of sixty effeminate boys aged four to eleven, 98 percent of them engaged in cross-dressing, and 83 percent said they wished they had been born a girl.
The fact is, there is a high correlation between feminine behavior in boyhood and adult homosexuality. There are telltale signs of discomfort with . . . boys and deep-seated and disturbing feelings that they [are] different and somehow inferior. And yet parents often miss the warning signs and wait too long to seek help for their children. One reason for this is that they are not being told the truth about their children’s gender confusion, and they have no idea what to do about it.

Perhaps you are concerned about your child and his or her “sexual development.” Maybe your son or daughter is saying things like, “I must be gay,” or “I’m bisexual.” You’ve found same-sex porn in his room or evidence that he has accessed it on the Internet. You’ve found intimate journal entries about another girl in her diary. The most important message I can offer to you is that there is no such thing as a “gay child” or a “gay teen.” [But] left untreated, studies show these boys have a 75 percent chance of becoming homosexual or bisexual.”

Ah, my bad. There is no such thing as a “gay child” in this man’s understanding, but children who act “that way” have a high chance of being homosexual or bisexual when they grow up. Maybe the mother in question feared for her child’s future? Because, you know, being gay is a horrible, horrible thing:

These kids often recognize very early in life that they are “different” from other boys. They may cry easily, be less athletic, have an artistic temperament and dislike the roughhousing that their friends enjoy. Some of them prefer the company of girls, and they may walk, talk, dress and even “think” effeminately. This, of course, brings rejection and ridicule from the “real boys,” who tease them unmercifully and call them “queer,” “fag,” and “gay.” Even when parents are aware of the situation, they typically have no idea how to help. By the time the adolescent hormones kick in during early adolescence, a full-blown gender-identity crisis threatens to overwhelm the teenager. This is what Mark was experiencing when he wrote. And it illustrates why even boys with normal heterosexual tendencies are often terrified that they will somehow “turn gay.””

Could they be terrified because people like Dobson (and his “Focus on the Family” group) have made homosexuality sound like a curse, a disease? Could it be because there are others who say things like:

I’m guessing the majority of American parents don’t want their little boys turning into sodomites, at this point. if you were to interview, stick a microphone in front of most parents dropping their kids off at the average K-6 school in Colorado where they’re sporting their GLSEN signs everywhere, but if you just interview them and you ask them: “Is your vision for this little 6-year-old boy, 8-year-old boy, 9-year-old, 10-year-old boy that he turn into a sodomite?” My guess is that 60 to 70 percent of them would say, “that would be my worst nightmare.””

That would be their worst nightmare? Not that their child may be dragged away and beaten to a pulp in a field because of something they cannot control? If that’s the case, then I don’t want to live in that society.

Thankfully, we don’t live in that society much anymore. People in the United States are coming around and accepting of people who are not completely heterosexual. Unfortunately, homophobia is on the rise in other parts of the world like Russia and in some countries in the African continent. And for what? What is the fear? That we’ll all turn gay?

We’re all a little gay:

I hope that Pedro (not her real name) and I are the kinds of parents who would not be “shocked and depressed” if one of our children turned out to be gay, because real parents don’t do that. Real parents make the home the safest place for their children, a place where their children can be anything and anyone and not have to fear the big bad world out there. It’s already a scary world as it is.

A different definition of “fiction”

I was talking to a friend who works in a psych unit the other day, and he asked how I was dealing with the anti-vaxxers and other denialists. I told him that it was a little frustrated at times that there are so many people willing to ignore reality for fiction. He told me about a psychological concept called “fiction”. This is not fiction in the traditional sense. This is fiction in that a person has created a sort of reality around them that is real to them, maybe even tangible, even if all the evidence points to the contrary. You have probably seen examples of this in women who go to deliver a child and had convinced themselves all the time that they were not pregnant, even going on public record and saying that they had no clue (never mind the belly, the lack of a menstrual period, and other indicators of what reality was). You also see it too often in men who cheat on their wives and have convinced themselves that what they are doing is not wrong, or that there will be no consequences.

My thoughts went to the “Weirdo” John Stone of Age of Autism. He is convinced that I am someone else, someone employed by “Big Pharma”, and that I am in cahoots with a whole bunch of other people who are pro-vaccine. I’ve offered to him to become my “friend” on Facebook and get to see pictures of myself and my family, where I am working, and even my telephone number, but he has not agreed. Why? Because he is convinced that I am “despicable”. That, or he doesn’t want the fiction that he has created about me to be torn down. After all, if I turn out to be just a random guy and not who he thinks I am, there is no more boogeyman, no monster under his bed.

The Weirdo is not the only one, of course. There are plenty of leaders and followers in the anti-vaccine camp that have created a fiction around their lives. To many, their children were not autistic until the minutes or hours following their childhood vaccines. Even when they are shown videos of their children exhibiting autistic behaviors before vaccination, their fiction will not allow them to accept this. Their fiction dictates that vaccines and only vaccines cause autism, not their genes, not anything else. (Although some would concede that maybe the environment had something to do with it.)

In many, and very heated, discussions about vaccines (and even about science in general), public health officials and workers (and anyone in any way associated with the pharmaceutical industry) get compared to the Nazi regime which ruled Germany in the 1930′s and 1940′s. To take in and understand why that analogy is flawed, you have to understand what happened during that time in Europe. I won’t bore you with the history class, but I will tell you that public health working to save the lives of children today is nothing at all like what happened under the Nazi regime. We are not arbitrarily picking children and killing them en masse. We are not tying anyone down and performing medical experiments on them. We don’t believe that one ethnic or religious group is to blame for all of society’s ailments.

To be a person of science, and someone who believes in science, we cannot have the luxury of creating fictions around our lives. Sure, we may create mini-fictions to understand why someone like the weirdo or the kid may hate us with such a passion, but we pretty much accept reality for what it is. Personally, I believe the weirdo just has a psychosexual obsession with me, but that’s just me, and I’m no psychologist. That’s a very minor personal fiction compared to what he fantasizes believes about me, maybe. And I’ve told you about his obsession with Dorit Reiss as well. On the contrary, we need to live and accept the evidence and do something about it. Even those among us who believe in a higher power, I’m yet to find a true person of science who falls to their knees and prays instead of taking evidence-based action.

So how do you deal with a person or a group who is/are cocooned in their own fiction? With some, it will be just a matter of breaking down that fiction with facts. With others, there will be absolutely nothing you will be able to do. What they see as reality looks, feels, and even tastes like reality, so there cannot be anything else. In the case of the weirdo, it will not matter how many times I explain to him that I am not who he thinks I am, and that I’m not at all interested in him in the way that he seems to think I am interested in him… Which sends shivers down my spine.

In case you were not aware of autism, there’s autism out there

In case you may have missed it, there are autistics out there, and autism organizations want you to be aware of it this April. But only April, okay? The rest of the year, ignore the needs of those with autism who require special accommodations and assistance to live meaningful lives. Heck, if you believe some so-called “pro-autism” groups, you can even relieve yourself of that “burden” of a child and kill them and be held totally innocent by them. (Thankfully, not by the law.)

Okay, maybe I’m being too cynical. The intent of an autism awareness month is good because you always want to bring to the attention of the country/world something that afflicts between 1% and 3% of the population. (Contrary to the shrieks of horror at the “1 in 68″ statistic, that number is a prevalence number, and prevalence is not indicative of an outbreak situation.) As I see it, the thing about autism and an autism awareness month, is that the subject has gotten too political, too nasty. Just the other day, I told you about anti-vaccine activists and their followers celebrating a mock story about Dr. Paul Offit being sick. I don’t know about you, but people who have “porno fantasies” of Dr. Offit being injured in any way really don’t have much of a moral leg to stand on when they demand for autism to be investigated:

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You do not want the anti-vaccine, anti-science crowd to be the ones to promote an autism awareness anything, not even a special at Chili’s.

Instead of this whole “awareness month” thing, why not make it a point to be “aware” of the social and biological problems of autistics (and those with other neurologic conditions) year-round? Why have a whole month punctuated by constant infighting between autism organizations, fighting between pro-vaccine and anti-vaccine groups, and pompous declarations from elected officials? What does that help? Has any of that brought relief to the families of autistics with manifestations of their autism so severe so as to require special care and assistance? If it has, I’d like to see the citation, please.

I’m not much of a public policy guy, though I’ve been told that I need to be if I plan on moving up in the world. You don’t see a lot of epidemiologists be in front of cameras and such when it comes to policy, but we are in the background. We’re always advising people with more charisma and better faces for television and voices for radio than us. Just the other day, one of my friends got to go and brief a US Senator on BPA toxicity from water bottles. Another friend is going to her state congress in a few weeks to talk about vaccine exemptions. Both of them epidemiologists, but neither of them making a lot of hay about it. (Public Health Week is coming, by the way.)

Anyway, instead of this autism awareness month thing, I propose autism awareness year-round. I propose that we each find a reputable, reasonable organization that helps children and adults with neurological conditions live meaningful, productive lives, and that we volunteer our time with them. For that one or two hours a week or a month, let that time be our own “autism awareness” time. I bet we can do way more than we can by putting on a tee shirt or going to a restaurant to eat crappy food… Or lighting up our house blue. (What’s all that about?)

Some things are no joke

I grew up with strict grandparents and parents. There were plenty of things that us kids could make fun of. We could make fun how other people looked. We could make fun of how other people spoke. We could make fun of each other for doing dumb things. But there was one thing that my elders absolutely did not tolerate: Making fun of other people’s suffering or making fun of someone else’s death, even if the death itself was a joke. Any kind of joking around about that and we were in for a world of hurt.

If you think about it, this is kind of a good rule for society. If we were to all the time put those mourning a death through the anguish of listening to joked about their recently departed, we would collectively be no better than the Westboro Baptist not-a-Church. Similarly, if we were to continuously wish for the death of people we disliked, and joked about their death, we would crumble as a society. A person’s death is a serious thing, and making light of it does absolutely nothing to advance us as a society.

It probably shouldn’t surprise you that there are those in the anti-vaccine camp who are particularly vicious in their attacks of people with whom they disagree. For example, you know about the weirdo’s obsession with Prof. Dorit Reiss. You’ve probably come across the kid’s ramblings about “pharma this” and “pharma that”. They can be vicious attacks filled with misinformation and, many times, outright lies. The comments sections of such blogs are no better. Although anti-vaccine blogs claim that they have “strict” moderation rules, you can see time and again that they are quite open to allow certain vicious comments:

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That’s right. Someone who read’s Robert Schecter’s “The Vaccine Machine” blog was happy and could only hope that our friend Ren were dead. Why? What would Ren’s death bring to the world? The story there is that someone with Ren’s exact first, middle, and last names committed suicide in front of dozens of people when he was cornered by police in west Texas. Of course, it wasn’t our friend. Nevertheless, why celebrate such a thing? What kind of mind operates like that?

Comments on Facebook pages don’t get any better. Even without the full ability to hide behind pseudonyms, people will still write some awful things. And they will go after the one man they absolutely despise. I’m talking about Dr. Paul Offit, pediatrician, vaccine developer, and all-around good guy. Like me, he has seen children die of vaccine-preventable diseases. Like anyone with a heart, he became passionate about preventing such deaths and went to work on dispelling myths about vaccines and fighting exemptions from vaccination mandates. And the anti-vaxxers hate him for it.

A few days ago, Reasonable Hank published a blog post where the comment’s section of the National Vaccine (mis)Information Center’s (NVIC) Facebook page were inundated with nothing but threats against Dr. Offit and his family. It turns my stomach to read those comments because these people want to see a man of science suffer and die for saving the lives of thousands, if not tens of thousands, of children.

Yesterday, on April Fool’s Day, it happened again. It was meant as an April Fool’s joke when “The Refusers”, an anti-vaccine organization, decided to publish a fake news story about Dr. Offit dying. The comment’s on Facebook were hideous (click on them to enlarge):

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On the blog itself, Australia’s top anti-vaccine activist showed up and was just as lovely as ever:

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And so on and so forth. They really came out of the woodwork, and they really said some things that would have gotten then taken out to the shed and beaten with a stick by my grandparents… All four of them.

There are some things in life that you just don’t joke about because it holds all of us back from moving forward as a society. People get mad when they’re told that something is not funny or when they are forced to apologize for making light of things like rape and child abuse. Yes, we all have the right to free speech, but none of us have the right to be free from the consequences of our speech. Sometimes those consequences affect all of us.

But it seems to be par for the course for the frontman and others in “The Refusers” to make light of some very serious things, like children dying from vaccine-preventable diseases. The frontman of the group is one Michael Belkin, a well-to-do man from Washington State:

“[A] self-employed financial analyst, he’s got a home office and flexible hours. In his kitchen, he greets his wife Lorna, a willowy portrait painter and stay-at-home mom who’s preparing a crustless quiche for a staff lunch at their kids’ private school, which encourages every child to fulfill his or her “unique destiny.” Belkin rustles around and produces the health-conscious items he gives to his 10-year-old son, Sebastian, and 7-year-old daughter, Viola: fish oil, probiotic supplements, and so-called “perfect food,” made up of grasses and algae. Then he heads downstairs to a daylight basement that allows him to indulge his own creative side. Fifty-seven years old, with a spiky haircut and chunky dark glasses that give him the look of an older Ira Glass, Belkin spent 10 years in Los Angeles trying to make it as a guitarist and songwriter before heading to Wall Street, where he worked for a time at the investment bank Salomon Brothers. Over the past year, he’s built a professional-quality recording studio, with top-notch digital equipment, foam insulation, and a vocal booth, on a little patio outside. From here, he’s been producing a CD by a band he’s put together, in which his son plays drums. His completely unvaccinated son, it should be mentioned. Because the thing that makes Belkin unusual—although far less so than public-health officials would like—is that this suburban dad is a nationally known advocate for what he terms vaccine “choice” and what most others call the anti-vaccine movement.”

Why is he anti-vaccine?

“The reason Belkin is so passionate on the subject can be discerned from yet another song, “Stole My Baby Away.” It’s about his infant daughter, Lyla, who died a day after receiving the Hepatitis B vaccine shot 13 years ago.”

But there are some holes in that story:

“Like many stories in the anti-vaccine movement, though, Belkin’s is murkier than it may seem to true believers—and he doesn’t make it easy to verify crucial details. For that matter, the movement as a whole is based upon theories that are not only unproven but, in key respects, directly contradicted by the past decade of scientific research.”

What? Read on…

“Talking with Belkin in his Bainbridge Island home, it’s apparent that he doesn’t like to be questioned about his account. Easygoing and welcoming when he picks a visitor up from the ferry, he turns irritable when asked for a fuller version of events. “Going into details is very painful,” he says. Yet it soon becomes even more apparent that there are a lot of unanswered questions about his portrayal of Lyla’s death and its aftermath. Asked, for instance, if he is sure that the medical examiner talked to Merck before switching her assessment of Lyla’s death, he says: “I think so. I told her to.” In other words, Belkin’s allegation is based on nothing more than his own suggestion to the examiner, prompted by his suspicions about the vaccine. He’s also not sure, now that he’s asked about it, whether it was the examiner or, as seems more likely, the police who came to his apartment looking for evidence of child abuse. “I don’t know . . . somebody . . . don’t ask me,” he says. Most crucially of all, Belkin says he doesn’t know where the pediatrician’s notes are that prove that the examiner initially determined that Lyla had a swollen brain. “You have to take my word for it,” he says. Later, asked whether he would consent to having the case file from the examiner’s office released to Seattle Weekly, he declines. “To me, it’s a very invasive and intrusive request,” he says, questioning the Weekly’s “fixation” with Lyla’s death. “To me, it’s not the story.” Back in his home, Belkin is more keen to talk about a series of encounters he had after Lyla died that cemented his belief in a pro-vaccine conspiracy.”

Again, par for the course for anti-vaccine activists. Evidence is something that needs to be put aside, and intuition and feelings and conspiracies and theories are all that matter. And, hey, if you have to wish someone dead or make fun of their loss, that’s just one of those things, right?

Can you imagine if I made fun of Belkin’s daughter’s death? If I made up some fake news story that her pediatrician’s notes had been found and that she was confirmed to not have been killed by the vaccine but, rather, that something more sinister had happened to her? If I ever did something like that, I hope you all stop reading this blog and those of you who know me personally drag me out to a shed and beat me senseless with a baseball bat covered in barbed wire. Because it’s not funny to make fun of the death (real or imagined) of another person. It doesn’t move any discussion along. It doesn’t make us better as human beings. It doesn’t save lives or promote freedom or justice or any of that stuff. And it is particularly telling of how much of a psychopath you may be if you make fun of the death of a child.

Then again, we’re not dealing with people who play by the rules or live by the rules. They cannot be reasoned or bargained with. They have only one thing in their minds, and they lock into that with a passion rivaled only by members of hate groups. These people just, seemingly, want to watch the world burn.

 

 

Another one for Dr. Peter Doshi

It’s been a while since I’ve written to you about Peter Doshi, PhD, the guy who thinks that the flu is not a big deal and who may very well be an HIV-AIDS denialist. He is probably not as prominent now in the anti-science media because he’s busy being the associate editor of the British Medical Journal and calling on drug companies to be more transparent with their data. (Big Pharma is the big fish everyone wants to take down nowadays.) Nevertheless, his work against the stockpile and use of neuraminidase inhibitors (NI) like oseltamivir (aka “Tamiflu”) is still out there. It still gets quoted.

The Lancet put out an article recently about the effectiveness of NIs and their effect on mortality in hospitalized patients. It is a meta analysis. This means that they took together a whole bunch of studies and looked at them in the aggregate. I don’t generally like these studies because it is easy to be biased in the analysis by discounting or ignoring some studies while favoring others. Still, when done well, these studies have more power because they’re looking at more subjects and more outcomes. This particular study took 78 studies done between 2009 and 2011 and looked at the outcomes for treatment while hospitalized. This is what they found:

“We included data for 29 234 patients from 78 studies of patients admitted to hospital between Jan 2, 2009, and March 14, 2011. Compared with no treatment, neuraminidase inhibitor treatment (irrespective of timing) was associated with a reduction in mortality risk (adjusted odds ratio [OR] 0·81; 95% CI 0·70—0·93; p=0·0024). Compared with later treatment, early treatment (within 2 days of symptom onset) was associated with a reduction in mortality risk (adjusted OR 0·48; 95% CI 0·41—0·56; p<0·0001). Early treatment versus no treatment was also associated with a reduction in mortality (adjusted OR 0·50; 95% CI 0·37—0·67; p<0·0001). These associations with reduced mortality risk were less pronounced and not significant in children. There was an increase in the mortality hazard rate with each day’s delay in initiation of treatment up to day 5 as compared with treatment initiated within 2 days of symptom onset (adjusted hazard ratio [HR 1·23] [95% CI 1·18—1·28]; p<0·0001 for the increasing HR with each day’s delay).”

In other words, giving an NI early in the course of the disease is associated with lower mortality, and giving it versus not giving it was also associated with a reduction in mortality risk. Note this: “These associations with reduced mortality risk were less pronounced and not significant in children.” That’s “clutch” right there and something that infectious disease doctors and pediatricians should keep in mind.

NIs are not a magic bullet against influenza. Nothing is, not even the influenza vaccine. But something is better than nothing, and something backed up by evidence is best. Contrary to Dr. Peter Doshi’s assertions about NIs, evidence keeps coming in that it is better to give them than to not give them, and that they actually reduce the risk of death from influenza in some groups. There is both observational and experimental evidence of this.

But you don’t have to just take my word for it.

When another doctor stops behaving like one

Last time, I told you about Robert W. “Bob” Sears, MD, a board certified pediatrician who is an anti-vaccine activist, based on the available evidence and reasonable inferences from his work and his words. I told you how healthcare providers are ethically, morally, and in many cases legally required to act in the best interest of their patients and society based on the available, credible evidence. When there is an outbreak of measles, an ethical and moral person who knows the risks and benefits of vaccinations and the risks of measles would and should recommend the MMR vaccine to their patients. But not Dr. Bob Sears. No, he recommends delaying vaccines and avoiding them as well. He recommends that non-vaccinating people hide among the vaccinated, seemingly because he knows that vaccine-preventable diseases will make a comeback once enough people don’t vaccinate. The funny thing is that he accepts the principle of herd immunity while so many of the co-administrators of the anti-vaccine Facebook group of his vehemently deny that such a thing exists. (They probably think the moon is made out of cheese as well.)

Unfortunately for the medical profession in general and pediatricians in particular, Dr. Robert W. Sears is not the only outspoken pediatrician still in practice that is anti-vaccine. California also has Jay Gordon, MD FAAP. If his name rings a bell, it should. He is a “pediatrician to the stars.” Among his famous clients was (and maybe still is?) Jenny McCarthy’s son. He also wrote the into to a book by TV’s “Blossom”, Mayim Bialik, PhD. I mention her doctoral degree because, although you’d think that degree in neuroscience would allow her to know better when it comes to vaccines. It doesn’t. She’s a believer in the “too many too soon” mantra that anti-vaccine activists are probably required to repeat ten times each morning as the sun rises, while facing west toward California. (Or East, if you’re in Hawaii.)

But back to Dr. Jay Gordon.

Dr. Jay Gordon, as I stated above, is in with the anti-vaccine crowd through his association with Jenny McCarthy, his support for her and her organization(s) at their rallies (to the point of speaking at them <– Video), and even posing some pretty interesting thoughts on what makes a healthy child:

“I think that the public health benefits to vaccinating are grossly overstated. I think that if we spent as much time telling people to breastfeed or to quit eating cheese and ice cream, we’d save more lives than we save with the polio vaccine.”

That sound you just heard was Dr. Jonas Salk turning in his grave. And that’s not all he’s said or written.

After the last post I wrote to you, I decided to catch up on Dr. Jay on Twitter, and here’s what he had for us:

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God forbid anyone challenges him on his quest to vilify a life-saving vaccine because that person just might be a Big Pharma shill. But he will swear to you that he’s not anti-vaccine. He’ll also swear that he knows epidemiology:

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The best part of the exchange just above is that I remember seeing an epidemiologist explain time and again to the good doctor what “Todd W.” is trying to explain in that Twitter exchange. In essence, you don’t determine if something is a problem or not by counting the number of occurrences and dividing them by the total population. You count and divide by those at risk. This is why the risk for uterine cancer is not the number of uterine cancer cases divided by the total population. It’s the number of uterine cancer cases divided by the number of women with a uterus.

What we have here is at least two American-trained physicians, board certified in their specialties, who are against vaccines. Think about that for a second. You have two men, Dr. Bob and Dr. Jay, who at one point or another swore to look after children’s health, and they unreasonably question and deny the evidence for vaccines, a medical intervention that has saved millions of lives of children, beginning with James Phipps in 1796. You also have a two physicians with an outbreak of measles in their backyard downplaying it as if they have some inside information that public health doesn’t. How or why the American Academy of Pediatrics has them as fellows is beyond me.

When a doctor stops behaving like one

You’ve probably heard of the Hippocratic Oath, an oath taken in one form or another by the majority of graduating medical students in the United States. One of the major tenets of the oath is the principle of beneficence: do no harm, prevent any harm, relieve any harm. A physician, and basically anyone who has decided to devote their life to medicine, is morally, ethically, and even legally bound by this principle. They must not cause any harm through their medicine, or take reasonable steps to not cause it. They must prevent their patients from being harmed, or take the reasonable steps to prevent said harm. And they must relieve any harm being caused to their patients, or do the reasonable thing to bring about this relief. I threw in the reasonable clauses there because physicians and other healthcare providers can only do so much. Patients are in many ways responsible for their actions, but it is up to the provider to give proper guidance and counseling based on all the available evidence.

All the available evidence on the MMR vaccine (the vaccine against measles, mumps, and rubella) is that it works very, very well and is very, very safe. Any person getting both doses of the vaccine is over 99% likely to be immune against measles. As an epidemiologist, when I’ve investigated outbreaks of measles in the literature, I’ve found that very rarely are there vaccinated people in the group of those who are sick. In my personal experience, I am yet to find a vaccinated person with measles. (Mumps is another thing. The vaccine seems to wane when it comes to mumps.) So the vaccine is 99% effective. But is it safe?

Yes, yes it is. Despite any claims to the contrary, there are no links between the MMR vaccine and any of the ailments exaggerated by the anti-vaccine crowd. It doesn’t cause autism. Very, very few people get more than a local reaction to it. Rarely does it cause encephalitis, but that clears up on its own. In short, the vaccine has prevented measles cases in orders of magnitude greater than any injury it has caused. I will bet my life’s savings on the vaccine any day of the week over a bout of measles. With modern medical technology, measles is less of a killer than it was before the vaccine, but you still don’t want to get it. It can be crippling, incapacitating.

To recap so far: Vaccine good. No vaccine bad. Thus, based on the principle of beneficence, healthcare providers must recommend and give the MMR vaccine to their patients to prevent a harm called measles, especially when there is an outbreak of the bug going on in their vicinity.

One physician in the United States who graduated from Georgetown University is Robert “Bob” W. Sears, MD, FAAP. He went through medical school and must have learned about immunology, virology, and maybe even some epidemiology. He is board certified in pediatrics. If I were a betting man, I’d bet that he knows all about the Hippocratic Oath and about beneficence. It’s just that (to me) he acts like he doesn’t, or like he doesn’t understand the things he should have learned in college and medical school, and beyond. Why? Because of his stance on vaccination.

“Dr. Bob” wrote a book called “The Vaccine Book: Making the Right Decision For Your Child“. The title is innocent enough to make you think that maybe he is for vaccines but just wants them spaced out. Maybe he knows something we don’t? After all, he is a board certified pediatrician. The trouble with his book is that he gets a lot of things wrong. Don’t take my word for it. Take the word of Dr. Paul Offit, a pediatrician himself, vaccine researcher and developer:

“Sears wants parents to use the information he has provided to make their own decisions about whether to vaccinate their children. “I have offered you all the information you need to make this decision,” he writes, “but I have held back from actually telling you what to do. I want you to formulate your own decision without letting my opinion sway you one way or the other.” Unfortunately, Sears, who wants parents to make informed decisions, has written a book that will largely misinform them.”

And take the word of the world’s authorities on vaccination science.

Still, you might be inclined to think that Dr. Bob is not anti-vaccine. After all, he’s not saying that you should stop vaccines altogether. He just wants you think that you can delay the administration of them because… Because something. I don’t know why. There’s no real reason to do so; No scientific reason, anyway.

Let’s stop here quick for an update on the return of measles to the United States. According to the California Department of Health, there have been 32 confirmed cases of measles this year, compared to only three last year. Ten of this year’s cases are in Los Angeles alone. If this isn’t an outbreak, I don’t know what is. And I know my outbreaks, I’m an epidemiologist and I’ve taught epidemiology. But Dr. Bob has a different take on this outbreak. To him, it’s not an outbreak at all:

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Here’s the text:

“Measles Epidemic . . . NOT!

Why is it that every time there are a few cases of measles, everyone panics? I just don’t get it. So, here’s the situation in the O.C., where I live and practice. Seven cases. Seven. That’s 7. Not 700, not a million Seven. So, why do people panic? Here’s one reason: the ^$#@*&%&*$# media. News reports go out stating that there are outbreaks of measles, and everyone needs to be concerned. Everyone is quick to blame those who don’t vaccinate, AND those who don’t vaccinate start to panic. We’ve gotten dozens of calls to our office with people wanting to know if they should come in for the vaccine.”

I do wonder if Dr. Robert “Bob” W. Sears is acting like a physician and recommending the vaccine to his patients in a time of a measles outbreak in his state, under the principle of beneficence? What kind of specialized knowledge does Dr. Bob have that the California Department of Health doesn’t to assure his patients that there is no outbreak of measles in the state, though there are ten times more cases right now than this same time frame last year? If anyone has answers to these questions, let me know. I’m not asking them rhetorically. This is a pediatrician, a board certified physician, blowing off information from public health authorities. It is in the public’s best interest to know if one of the physicians charged with taking care of the public’s children is not acting like a physician and more like an anti-vaccine activist.

But, then again, we don’t need to look far to see if Dr. Bob is anti-vaccine:

PAOAV

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Well, if he is not anti-vaccine, then I’m the Prime Minister of Burundi. I mean, he is the administrator of a goddamned anti-vaccine, private Facebook group. So has he been lying when he says he’s not anti-vaccine? Probably. I’d have more respect for the man if just came out of the anti-vaccine closet and proudly proclaimed to be anti-science, like other medically-trained healthcare providers have. Then we wouldn’t have to play this game of exposing Dr. Robert “Bob” W. Sears to the world for the anti-vaccine activist that we see in him.