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nwhikerJust finished listening to Seth Mnookin's book on the anti-vaccination movement, The Panic Virus and it's excellent.
To be clear, I listened to the book. I have it on hold in book format, because there are parts I want to revisit. The audiobook was excellent, the reader was very good. Two issues. One is that the book appears to have "Notes" at the bottom of the page. These are read with a "Note" blah blah blah blah, but he doesn't indicate when he's going back to text, which confused me a few times. The other issue is the tone. This is a partisan book. It is very obvious that Mnookin isn't too impressed with parents who don't vaccinate because they don't understand the issues and have been hoodwinked by Wakefield and his cronies. The reader conveys contempt of those people in his tone, in a way that is very clear, and at times jarring.
A bit over a year ago I did a review of Autism's False Prophets, and I'd say this is a companion book to that, not totally redundant, but probably not books you'd want to read one right after the other (I have Paul Offit's new book Deadly Choices on hold at the library, so I'll be doing something almost like that.)
Offit's book was remarkable, in my opinion, in that he told the whole story. I knew all the bits and pieces, because all this was happening while I was having kids and getting them vaccines etc, but the book was very good about laying out the timeline, and showing the connections between the various factions and theories. Mnookin's book is even more so.
The books goes in a lot of different directions at first, but doesn't feel disjointed. From the early development of vaccines to the polio vaccine, the Cutter fiasco, and the beginning of vaccine litigation. He talks about the genesis of the anti-vaccine movement, and more about the people and what made them tick.
That is one of the better parts of the book: Mnookin talks about psychology and why we beleive the things we beleive, how we re-enforce those beliefs, and gives a credible shot at explaining how the anti-vaxxers can be so deluded and completely impervious to the evidence, which is pretty clear.
The other strong point of the book was the discourse on the scientific method. I felt Offit, in his book, hadn't paid enough attention to it. Mnookin does, explaining scientific method with concrete examples, talking about the null hypothesis, and the impossibility of proving a negative. I also liked his explanations on the different kinds of scientific studies, how they differ, and how this impacts the reliability and validity of their results.
Mnookin is very clear that the media bears a heavy responsibility for letting the anti-vax crap out there, often without any fact checking or opposing view points. Sad parents make for better radio/TV than sober pediatricians trying to explain things that are complex. We shy away from complex ideas, from bothering to understand the basics in science that we need to evaluate things like risk for example. We've become, I sometimes think, a society in which we all think, like Barbie, that "Math is hard!". Sigh...
Anyhow, the media responsibility, the "mommy instinct" vs hard science, and the callous selfishness of un-vaxxers are all well covered.
A word on Dr Sears. I should say Sears père and Sear, fils. I used Attachment Parenting to raise my kids. There were many things in his Dr Bill Sears's books that make me uncomfortable, and that I disliked but overall, I think he made sense, the concept of making sure a child is well attached, secure that mom/dad/caregiver has their back before sending them out into the world. His son? Is an asshole, an anti-vaxxer pretending to be "reasonable" and pushing his idiotic "alternative vaccine schedule" which is pure bullshit. I'm very sad that this has happened. I practiced AP with my kids, but no longer have much respect for the movement.
Bad to Mnookin and The Panic Virus. One of the issues that the anti-vaxxers have going for them in the media and in the court of public opinion, is that these are devastated parents, whose kids have autism, who have no idea what to do next, and whose lives are difficult, to say the least. On the other, you ave scientists saying that no, ethyl mercury and methyl mercury aren't the same, and no scientific study has show even the slightest causal link etc. The emotional vs the hard science. What Mnookin does is show the emotional other side. The side of the parents whose babies died or almost died because some selfish parent decided their kids were too speshul to be subjected to vaccinations. The stories of children who are injured or killed because of someone else stupid choices need to be told too, and I hope they are, all the while wishing they didn't ever have to be.
To be clear, I listened to the book. I have it on hold in book format, because there are parts I want to revisit. The audiobook was excellent, the reader was very good. Two issues. One is that the book appears to have "Notes" at the bottom of the page. These are read with a "Note" blah blah blah blah, but he doesn't indicate when he's going back to text, which confused me a few times. The other issue is the tone. This is a partisan book. It is very obvious that Mnookin isn't too impressed with parents who don't vaccinate because they don't understand the issues and have been hoodwinked by Wakefield and his cronies. The reader conveys contempt of those people in his tone, in a way that is very clear, and at times jarring.
A bit over a year ago I did a review of Autism's False Prophets, and I'd say this is a companion book to that, not totally redundant, but probably not books you'd want to read one right after the other (I have Paul Offit's new book Deadly Choices on hold at the library, so I'll be doing something almost like that.)
Offit's book was remarkable, in my opinion, in that he told the whole story. I knew all the bits and pieces, because all this was happening while I was having kids and getting them vaccines etc, but the book was very good about laying out the timeline, and showing the connections between the various factions and theories. Mnookin's book is even more so.
The books goes in a lot of different directions at first, but doesn't feel disjointed. From the early development of vaccines to the polio vaccine, the Cutter fiasco, and the beginning of vaccine litigation. He talks about the genesis of the anti-vaccine movement, and more about the people and what made them tick.
That is one of the better parts of the book: Mnookin talks about psychology and why we beleive the things we beleive, how we re-enforce those beliefs, and gives a credible shot at explaining how the anti-vaxxers can be so deluded and completely impervious to the evidence, which is pretty clear.
The other strong point of the book was the discourse on the scientific method. I felt Offit, in his book, hadn't paid enough attention to it. Mnookin does, explaining scientific method with concrete examples, talking about the null hypothesis, and the impossibility of proving a negative. I also liked his explanations on the different kinds of scientific studies, how they differ, and how this impacts the reliability and validity of their results.
Mnookin is very clear that the media bears a heavy responsibility for letting the anti-vax crap out there, often without any fact checking or opposing view points. Sad parents make for better radio/TV than sober pediatricians trying to explain things that are complex. We shy away from complex ideas, from bothering to understand the basics in science that we need to evaluate things like risk for example. We've become, I sometimes think, a society in which we all think, like Barbie, that "Math is hard!". Sigh...
Anyhow, the media responsibility, the "mommy instinct" vs hard science, and the callous selfishness of un-vaxxers are all well covered.
A word on Dr Sears. I should say Sears père and Sear, fils. I used Attachment Parenting to raise my kids. There were many things in his Dr Bill Sears's books that make me uncomfortable, and that I disliked but overall, I think he made sense, the concept of making sure a child is well attached, secure that mom/dad/caregiver has their back before sending them out into the world. His son? Is an asshole, an anti-vaxxer pretending to be "reasonable" and pushing his idiotic "alternative vaccine schedule" which is pure bullshit. I'm very sad that this has happened. I practiced AP with my kids, but no longer have much respect for the movement.
Bad to Mnookin and The Panic Virus. One of the issues that the anti-vaxxers have going for them in the media and in the court of public opinion, is that these are devastated parents, whose kids have autism, who have no idea what to do next, and whose lives are difficult, to say the least. On the other, you ave scientists saying that no, ethyl mercury and methyl mercury aren't the same, and no scientific study has show even the slightest causal link etc. The emotional vs the hard science. What Mnookin does is show the emotional other side. The side of the parents whose babies died or almost died because some selfish parent decided their kids were too speshul to be subjected to vaccinations. The stories of children who are injured or killed because of someone else stupid choices need to be told too, and I hope they are, all the while wishing they didn't ever have to be.
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no subject
Date: 9 Jun 2011 22:07 (UTC)* The current vaccine schedule pushed by most health-care providers is based on doctor/parent convenience, not what's best for a newborn infant. Seven to nine shots at a time? For a newborn? Are you f*cking kidding me? I wanted separate shots, not cocktail vaccines, because of our family history of allergy/reactions, and the doctor wouldn't do it unless we paid for an entire case of each separate vaccine, which we couldn't afford to do.
* Noah just missed the age cutoff for the rotavirus vaccine (the first recalled version, not be confused with the second recalled version); that recall scared a lot of people, myself included.
* It's kind of unfair to assume people are ignorant and selfish simply because they chose not to vaccinate their children. I believe parents have the right to make that decision, just as they have the right to make many choices I wouldn't make. For example, per a study I found online, the cost of low breastfeeding rates in the U.S. is 911 lives and $13 billion annually. (I can't find any numbers for the cost unvaccinated kids, but I doubt it's that high.) I’d love a world where formula would be available only for medical necessity, but I have to come down on the side of parents' rights.
* There’s often an attitude from doctors and national health organizations of, "Do what we say, without question, or you're a selfish a*****e and your baby will die." I think that's what drove many people away from vaccinating as ordered, along with those medical providers being 100 percent against anything AP. (Example: I took 12-week-old Noah to the pediatrician for a checkup and shots. The doctor said he should be sleeping through the night, which wasn't a problem for me, but he yammered on, telling me about all the gadgets I should buy to make Noah sleep longer, and even suggested rice cereal. After that, he told me we must do the chickenpox vaccine -- which had a U.S. history of about two years -- and warned me Noah could go blind. He was so over-the-top, I wrote him off.)
* If I were to have more children, I'd make my choices in line with the latest research, just as I (thought I) did before. Many of my choices would look different, including a better car seat, better first foods, a sidecar rather than a newborn in the bed, etc. I've always liked the Maya Angelou (?) quote, "You did what you knew how to do, and when you knew better, you did better."
no subject
Date: 10 Jun 2011 06:29 (UTC)no subject
Date: 10 Jun 2011 08:19 (UTC)I debated deleting it, 'cause it's obnoxious to leave a crazy-long response in someone else's blog. (And I trimmed it by about half before posting!) I usually nod along or cheer aloud at your posts, and I do hear what you're saying, but I felt like I needed to toss in an alternate viewpoint this time. I've reserved "Panic Virus" from the library, so I might visit the issue in my blog at some point.
no subject
Date: 12 Jun 2011 21:10 (UTC)Heh. I just made a WHOLE bunch of comments in response to yours, I divided it up to avoid a mess of weirdly-nesting stuff. :-) I plead guilty to the crazy-long.
The things I want to stipulate apply to everything I wrote below.
-- I am aware that some people cannot vaccinate, due to immune issues, or potential egg or other allergies. These are not the people I'm talking about.
-- I am aware that vaccination carries with it a risk.
-- I am also aware that vaccination isn't 100% foolproof and doesn't work 100% of the time for 100% of the people.
Anyhow.
Dude.
Date: 13 Jun 2011 23:27 (UTC)Just kidding, I read it all, and I'd like to see the study on neuro-developmental outcomes (I'm curious, should there be a baby No. 3 for me) for newborns given a cocktail of shots.
My concern about legislating/outlawing parent choice is where it would stop. If U.S. laws were based on sound science, no problem, but several of my core parenting beliefs/choices are illegal or seriously frowned upon in some states, such as laws that equate giving birth at home with child abuse. As far as I know, the research indicates that, except for high-risk pregnancies, outcomes are better or at least equal at home, but the people protesting most against homebirth (at least doing the "yeah, but ..." thing in the press) are part of the medical establishment -- the same ones telling parents to trust the vaccine research. I don't think it's hard to see why that might pose a problem for some people.
Re: Dude.
Date: 14 Jun 2011 06:17 (UTC)The neuro study: here is the abstract (http://pediatrics.aappublications.org/content/early/2010/05/24/peds.2009-2489.abstract) and here (http://scienceblogs.com/insolence/2010/05/no_difference_between_too_many_too_soon.php) is one of the posts that I'd read that discusses it, including limitations and applicability. There was another site that talked about the article, where I got the original link from ,but I cannot find it any longer.
I do hear you on the parenting choices on the fringe... since I've made a few of those myself, though I'm lucky to live in a legal state. Agree about homebirth, and that doctors are desperate to prevent it. I don't, however, see that vaccination falls on that continuum at all, since the science is better established (vs the homebirth or hospital where so many sociological etc biases appear), and it is more carefully studied. In this case, the accepted opinion legally is more likely to be the scientific one.
That said, I was long a member of the homebirth after cesearean community, and finally stopped associating iwth them after a few babies died because the mothers thought they knew better than the "sell-out" midwives and doctors. It was horrible, and I still carry some guilt, since one at least of these births was a train-wreck waiting to happen that eventually did and a baby died. Do I still beleive homebirth is safe? Yup. Do I beleive that all homebirth is safe? Nope.
To me, it really boils down to the fact that not vaccinating puts the child in question at risk and puts all the people in contact iwth said child at risk as well. I look at the science, and it overwhelmingly favours vaccinating vs not.
One other thing I should have mentioned (and then I promise I'll shut up!) is that I lived in a third world country from age 10 to 18. I saw kids just a bit older than me -this was the 70s/80s- who'd have polio when they were very young, and who lived with the consequences. I saw a baby die of diptheria, which I mentioned and which was horrible. One of my cousins, also a few years older than me, and whom -who?- I never met died of the measles in 1970. His father was a prominent judge, and he had the best medical care available. This all seriously colours my perception of what these childhood diseases can do. In the US most of us are two generations away from knowing what they were like when they were endemic. Because of living abroad in a country were wide-scale vaccination happened a decade or so after the US, I was a half generation away from that.
no subject
Date: 12 Jun 2011 19:54 (UTC)The Too Many Too Soon argument: studies have shown that the immune response to the vaccines are the same no matter if the vaccines are given at the same time or spaced out. So we're not "using up" the immune system by giving a bunch of shots at the same time (this is something I've read often, I'm not claiming it's your argument). There was also a study that came out last year (I can find the cite if you want to see it) that showed no difference in neurodevelopmental outcomes in children who followed the standard schedule and children who spaced or used Sears's schedule.
If the vaccines are even available one by one... I'm sorry insurance didn't allow you to do what you needed/wanted. That is, as you well know, the US system. Though in this case, you might not even have been able to pay for it, depending on what is manufactured.
The current schedule has two goals: to make sure that the kids get vaccinated for the peak time of danger/susceptibility for the diseases they are protecting for, not just parental and doctor schedules, as well as making sure that all kids get vaccinated.
Convenience does enter into it because if the parents had to bring the child back every three weeks (for example), it would be too expensive for many, both in time and perhaps money, and many children would end up unvaxed, which then endangers herd immunity.
It comes down to looking at the science: there is no data that shows that there is a problem with the current schedule for most kids (obviously all this is null and void for kids with issues etc) and going against that just serves to threaten everyone.
This was a greatarticle (http://www.sciencebasedmedicine.org/index.php/cashing-in-on-fear-the-danger-of-dr-sears/) that I feel addresses many of the issues.
no subject
Date: 12 Jun 2011 20:00 (UTC)The rotavirus thing was really fucked up. Totally with you there. A good case of 'it was fine in studies' but when they put it out to the population problems showed up. This is actually in part why I'm not too concerned about the current vaccines: nothing systemic has really shown up.
I've never had any of the kids get a diarrhea and vomitting disease, but I've heard enough stories to understand why parents would get the shot it if were available, though. Hosptalisation seems to be a much too common end result for infants.
no subject
Date: 12 Jun 2011 20:29 (UTC)You know, I didn't do the chicken pox vaccine. I had thought AC was immune, but she turned out not to be. Anyhow, the kids all got c-pox and it was fucking MISERABLE. 4 weeks of my not leaving the house, an ER visit, hives, pneumonia... and they had mild cases. If I had to do it again, I'd vax, no matter what.
Knowing that the ER doc has diagnosed pneumonia, and the stats on c-post pneumonia vs 'hi, you're tired I'll set up residence' bacterial pneumonia has me in total and utter panic. There were a few times when I seriously wondered if Perry was going to make it, since he was getting sicker and sicker, and it was terrifying. I talked about some of it here (back in October of 08). I seriously feel disgusted with myself for not vaccinating. I had my reasons, that seemed good at the time (I thought AC was immune, and Linnea got minimal shots for a few years after a scary reaction to the flu vaccine. With our doctor's approval, we stepped back on shots for her and skipped a few. She is caught up now.)
That said, I have an excellent family doctor, who always listened to us and whose main regret seems to be that when we figured out that the midwife wasn't going to make it in time to catch Perry (dh did), we should have called her, she'd have been there. Had I thought about it, I would have, she's that awesome. That definitely colours my perspective. She was also fine with us not doing the vaccine that kids really need if they're in daycare.
The only person (*) to have ever pulled the do-what-I-say thing on me was my pro-AP midwife. Which led to AC's being c-section. None of my other providers have ever really done that, and nobody at my doctor's practice (we saw a lot of people for during the c-pox incident) ever said 'you really should have vaccinated', though I suppose that was pretty obvious. Heh.
(*)The exception was the paramedics after Linnea was born, and the neonatologist when she was in the hospital. In retrospect, it was uncalled for from the paramedics, they lied, but VERY much correct in the case for the neonatologist... once he had a diagnosis. Before then, he was grasping at straws, there was a VERY sick baby, and they didn't have a clue yet. He actually had the gall to blame the fact that she was born in like three pushes. Once he knew what was going on, things went much better.
The thing is, arsehole doctors or not, the data clearly shows that vaccinations work, are necessary both on the individual and public health level, and the risks are very small, especially compared to other risks we take on a day to day basis with kids.
Part of issue, imo, is based on the theory of loss aversion (better explained here (http://www.drsharma.ca/obesity-why-i-support-bariatric-surgery-part-2.html) than I could. I read a book about it a while back, but don't have it on hand, it was of course a library book.) We value the small risk of vaccine side effects much more highly than the risk of the diseases they protect again.
Part of this, which I will probably adress in Yet Another Comment, is now remote those diseases have become to us now.
no subject
Date: 12 Jun 2011 21:04 (UTC)Here I totally flat out disagree with you.
I beleive parents have the right to make decisions concerning their children, with two caveats: that it not harm the child (see female genital mutilation) and that it not harm anyone else.
Choosing not to breastfeed (not talking about the very real people who couldn't, didn't have the support etc) pisses the snot out of me, and I find it selfish... on the other hand, it doesn't put anyone else at risk. There is a small marginal disadvantage for the baby who doesn't get breastmilk, and even that is showing up to be smaller and smaller as more studies come out.
Not vaccinating does harm everyone.
It harms people who are immune supressed. Babies who are too young to be vaccinated. Women who are pregnant and not immune to rubella.
It harms the children in question. Because while polio is often described by people in the anti-vax movement as "a mild childhood disease", it wasn't. Diptheria? Kills babies, one I remember in particular named Zahra who died in our sitting room, after her mother brought her to my mom who called the doctor. It was too late. I was 9, hiding behind a chair. It was not a pretty death, so say the least. She was too young to be vaccinated, or maybe wouldn't have been because vax were often done in schools. I lived in a third world country, I had freaking cholera, my mother caught Hep B, my siblings all got Hep A at least once, my brother twice, (nobody knows why I didn't). I'd have loved to be vaccinated against of these diseases!
Dividing the comment in two. Next part will talk about why I think it's either ignorance or selfishness. I refuse to even consider malicious intent! :-)
no subject
Date: 12 Jun 2011 21:04 (UTC)Ignorance, also, when you hear statements like "I don't beleive in vaccination". Hello? What the hell? Science isn't something you beleive in or not, ya know?
I know vaccines don't work 100% of the time for 100% of the people, which is why the canard of 'my kid not being vaccinated doesn't hurt your kid' is just that: bullshit. I hope my kids' vaccinations "took", but I can't be sure of it. A friend of mine had her baby daughter, still too young to be vaccinated, spend 3 weeks in the hospital because of whopping caught she caught from her brothers, who were vaccinated, who caught it from some kids who were not. When we stop vaccinating, these things will start to show up more and more. Diseases will be able to spread, whereas now we can rely on them not. There is a reason Dr Sears tells people in his Vaccine Book not to tell anyone else that they're not vaccinating. Because if everyone stopped we'd lose that herd immunity that protects the vulnerable.
And that is where I contrast ignorance with selfishness. If someone choose not to vaccinate, despite understanding herd immunity and the seriousness of the diseases we're talking about, I find this profoundly selfish: they're relying on the rest of the community to take on the small risk of vaccination, to benefit them, and because they're "special" they don't want to? How can that not be selfish? They don't care if their child passes along a disease to a child who cannot be vaccinated, for whatever reason? Or rubella to a pregnant woman who isn't immune and who might go along to have a severely disabled child (when I was living in France, I had a room with a woman whose daughter was profoundly retarded because of the rubella her mother caught. Deaf, legally blind, and living in an institution. We don't see that much any longer.)
I really don't see a third way.
Herd immunity is starting to disappear in places when the rate of unvaccinated children is high: Ashland, OR, Marin County (? I think), and various liberal upper middle educated enclaves.).
Parental and personal rights are important to me, but I don't think parents should be able to put other children and adults in danger. This is why I think talking about kids dying of "childhood diseases" because other parents choose not to vaccinate is important. Right now, because a majority of us choose to vaccinate, the danger is low. As more and more people choose to 'think outside the box', often based on bad data and bad assumptions of risk, that danger is going to go up, and we'll have a different situation on our hands.