Editor’s note: There is an extra special bonus guest post today in addition to my regular post. It’s by Paul Knoepfler, a stem cell biologist, and it’s about unregulated stem cell clinics. Be sure to check it out!
Last week, I wrote about a rather impressive measles outbreak at the “happiest place on earth,” a.k.a. Disneyland. At the time I wrote that post, the outbreak, which had reached several states, had spread to 17 people. As I sat down to write this, I wasn’t actually sure that this topic needed another post, but then I saw this:
As the number of measles cases continues to rise in Southern California following an outbreak at Disneyland last month, about two dozen unvaccinated students at one Orange County high school have been forced to stay home after a classmate contracted the disease.
In a message to students and parents at Huntington Beach High School on Thursday, Pamela Kahn, health and wellness coordinator at the Orange County Department of Education, said that students “who do not have any documented [measles, mumps and rubella] immunizations will be excluded from attending school until January 29.”
Also, the number of confirmed measles cases has climbed to 52, 46 of them in southern California. In Orange County itself, there were 16 cases as of Friday, ten of them linked to Disneyland, the rest not, a finding that’s led health officials to conclude that “measles has become more widespread throughout the county.” Not surprisingly, health officials in Californian are warning that the number is likely to go higher still. In fact, it’s already happening as “satellite” outbreaks are being reported as children infected at Disneyland come home and infect others.
A South Pasadena woman’s younger sister came down with the measles. Now, federal health officials want her locked down under quarantine, but she is resisting.
Ylsa Tellez is a 26-year-old grad student whose younger sister, 24-year-old Maura Tellez, was one of the confirmed cases of measles caught recently at Disneyland.
“(They were) saying I need to get vaccinated and I need to be quarantined, otherwise I’m going to go to jail or something, or I’m going to get a misdemeanor,” said Ylsa.
Ylsa says she refuses to be a prisoner in her own home despite the possible quarantine order. Ylsa’s mother is also defending her daughter.
“It’s not nice when my daughter is threatened like this because she’s not even sick,” said Myrna Tellez.
No, but she’s been exposed. The reason to quarantine someone who has been exposed is because that person can be infectious before symptoms appear. That’s very reason for quarantines, and always has been, to keep people who have been exposed isolated until health officials can be sure that they aren’t contagious. One comment I saw about this issue (several comments, actually) questioned why we quarantine someone like Tellez but not Ebola patients. When I see a question like this, I want to respond: How is this thing not like the other? Measles is incredibly contagious through respiratory contact. In contrast, Ebola is not. It requires close personal contact with infected bodily fluids. Quarantine can stop the spread of a disease like measles; for Ebola it’s a lot more dicey.
As I discussed last week, the majority of the measles cases thus far have occurred in the unvaccinated. More importantly, the association of this outbreak with Disneyland gives this story legs. It’s drawn international attention of a very negative kind on how the antivaccine movement has spread misinformation and frightened parents, thus contributing to declines in vaccine uptake, which in turn have led to pockets of vaccine uptake sufficiently low as to permit, facilitate even, outbreaks of vaccine-preventable diseases. The heat has come down particularly hard on certain antivaccine-friendly pediatricians in the area, such as our old friend Dr. Jay Gordon in Santa Monica and, of course, Dr. Bob Sears in Capistrano Beach, right in Orange County itself. I took Sears to task last time for having downplayed previous measles outbreaks, treating the parents of his patients condescendingly by basically waving them away and telling them to get the damned shot if they’re worried but stop bugging him.
I exaggerate, but not by much.
What really make up my mind to follow up on this outbreak is that, over the last week, I’ve noticed that the antivaccine movement is pushing back. Stung by the publicity and criticism, they’re pulling out all the stops—or should I say tropes?—to deflect attention. Even “Dr. Bob” has gotten into the act, dropping all pretense of not being antivaccine, as he pulls out an old chestnut, much beloved of antivaccinationists since time immemorial (or at least for the last couple of decades). I like to call it the argumentum ad Brady Bunchium. Sometimes I call it the “appeal to the Brady Bunch” or, more generally, the “appeal to classic television” vaccine fallacy. What do I mean by that?
This antivaccine trope is a claim that the measles just isn’t that serious a disease, followed by the question or implication: Why are we worrying about it so much? Examples of this fallacy include this video, Measles, Back In The Days Before The Marketing Of The Vaccine:
The video above includes clips from The Donna Reed Show (specifically this episode), The Flintstones, and The Brady Bunch about the measles. It’s a theme repeated by, for example, the antivaccine crank blog Age of Autism (AoA) in posts like this one entitled “Before Fear Sold Vaccines, Children Got Sick… On TV Even” and “Measles and Chicken Pox: Entertainment or Epidemic?” [NOTE ADDED 1/26/2015: And AoA has brought up the “appeal to Brady Bunch” again with A Very Brady Measles.] You get the idea. Back in the days before vaccines for measles and various other childhood diseases, almost everybody got these diseases as a child. For most children, they were usually self-limited diseases and no big whoop, right? Just another childhood disease that most children had to endure, right? After all, Hollywood included bits about measles in sitcoms and cartoons, such that Donna Reed and the Brady Bunch didn’t think it was a big deal. In fact, all the kids were happy not to have to go to school and sat around smiling and playing Monopoly! About the only thing that the writers get right is that the measles is contagious as hell, but that only provided more grist for the comedy mill to make jokes about all the kids coming down with measles, and then Mike and Alice too. Only Carol escaped because, as we learn in the last scene, she had had the measles “years ago.” In fact, for completion’s sake, here’s the entire episode, in case you’re interested:
Of course, I can’t help but see that episode of The Brady Bunch and wonder why Mike and Carol hadn’t gotten at least some of their kids vaccinated. After all, the vaccine was licensed in 1963, and that show first aired in 1969. Not surprisingly, given how effective the measles vaccine has been, by 1969 the incidence of measles had already plummeted dramatically:
Not that one would expect comedy writers to be familiar with vaccine recommendations at the time, but based on past recommended vaccination schedules, it might have been unsurprising that the older kids were unvaccinated, but one would think that the younger children would have been. Also, by 1969, measles incidence had become so much less common, particularly in children under 10, that one can’t help but think some fuzzy-headed and nostalgic writers were a bit behind the times. After all, The Brady Bunch wasn’t exactly a font of scientific knowledge. For instance, I remember an infamous three-part “very special episode” of the show (parts 1, 2, 3) where the family vacationed in Hawaii and Bobby found a tiki statue claimed to cause bad luck. Once the tiki statue was in Bobby’s possession, all sorts of bad things started happening to the family, including a surfing accident and Peter nearly being bitten by a tarantula. In the story, there was a curse that couldn’t be lifted until the tiki was returned to an ancient burial ground. I suppose antivaccinationists would use that The Brady Bunch story as an example of how people understood back in 1972 that there actually do exist tiki statues in Hawaii that confer extreme bad luck on the ones who possess them. That’s the quality of argument here: Silly, vacuous, and a non sequitur.
In any case, the essence of the argumentum ad Brady Bunchium fallacy with respect to vaccines is that measles was no big deal before the vaccine and that pharmaceutical companies and health officials are stoking unneeded fear of measles in order to sell the vaccine, through a combination of desire for profits and ideology. In fact, if you peruse the more stinky cesspits of antivaccine nonsense (such as the comments in AoA), you’ll see commenters, particularly older ones who were children before the measles vaccine was available in the early 1960s and/or who had had the measles themselves sometime during the 1940s-1960s frequently referencing the above YouTube video to argue that measles is nothing, that it’s something “we” all had and did just fine. It’s very much of a piece with curmudgeons of a certain age (which, unfortunately, includes my age) complaining about today’s youth and pointing out how they used to walk to school in the snow and uphill both ways or the occasional equally cranky rants by surgeons trained before work hour limitations (like me) about how they loved being on call every second or third night and spending 100+ hours a week in the hospital, the only problem with every other night call being that you miss half the cases. It’s basically an assertion of superiority and toughness by the older generation over the younger, the sort of thing that’s been going on hundreds of years.
Indeed, if you really want to see this sort of approach taken to an extreme, just check out VaxTruth.org the website of Marcella Piper-Terry, a woman who is known for her extreme antivaccine views to the point where she has likened vaccination to rape and has recently been ranting about the “civil rights violations” of quarantine for measles. In a series of posts, Piper-Terry has argued, echoing the argumentum ad Brady Bunchium, that measles is not harmful and that measles is even good for you, citing a rather interesting experiment in which massive doses of the measles vaccine has been used experimentally to treat cancer based on case reports of spontaneous regression of Hodgkin’s lymphoma in children after measles infection.
Piper-Terry even cites an abstract from a fundamentalist Catholic scientist named Theresa Deisher, who through her Sound Choice Pharmaceutical Institute (SCPI), has been trying to prove that DNA from “aborted fetuses” in vaccines is responsible for autism through its ability to recombine with the infant’s DNA. It’s very much of a piece with the same sort of nonsense peddled by Helen Ratajczak in a truly awful “review” article published four years ago that keeps being resurrected, Michael Myers-like, every so often. The sad thing is, Dr. Deisher is a real molecular biologist and really should know better, but apparently does not, at least not any more since she became an “adamant right-to-lifer.” Like the case of Peter Duesberg and his HIV/AIDS denialism, Dr. Deisher has become full-on antivaccine based on the use of cell lines derived from a fetus decades ago to manufacture some vaccines. In some of her posts, she even invokes the intellectually-dishonest gambit beloved of antivaccinationists I dubbed “vaccines didn’t save us.”
Particularly despicable in Piper-Terry’s post is how she zeroes in on 450 people dying each year of the measles in the US in the years before the vaccine was licensed dividing by the entire US population of 189 million at the time, and concluding that only 0.000237% of the US population died of the measles each year. In fact, in the post referenced by Piper-Terry entitled “Putting Measles Into Perspective“, her friend Dawn Babcock Papple even asks rhetorically about the number of people dying of the measles world-wide, “When over 150,000 people die each day total, is 540 people dying of measles each day really that outrageous?”
The entire attitude is that the 450 deaths from measles each year in the US before the licensing of the vaccine and the 197,000 people dying worldwide of measles now are inconsequential. I kid you not. See why I call this attitude so despicable? I suppose according to these two antivaccine warriors, the last major measles outbreak in the US before the current one, in which 55,000 cases and more than 120 measles-related deaths were reported, also wasn’t a big deal. What’s a few hundred dead children, after all, compared to freedom from the evils of vaccines? This is what Dr. Paul Offit spoke about in his talk at TAM last year, and his description of watching children die of the measles was incredibly depressing.
Sadly, “Dr. Bob” has traveled far down the same sort of path as Piper-Terry, at least in terms of echoing her sentiment, and that of many antivaccine activists, that measles is “no big deal.” True, he isn’t as crass or callous about it, expressing sympathy for people outside the US who die of measles, but his arguments, at their core, are very much the same as those of Piper-Terry and Papple, although he at least is not foolish enough to use the “vaccines didn’t save us” gambit. Last week, Dr. Bob posted this update on the Disneyland measles outbreak on his Facebook page entitled “JUST HOW DEADLY IS MEASLES?” In it, Dr. Bob strives mightily to convince his readers that the measles is no big whoop. I’m reprinting the complete text, in case Dr. Bob has second thoughts and sends his Facebook post below down the old memory hole, not to mention for the benefit of those of you who don’t have Facebook accounts:
The full text of Dr. Bob’s little rant follows:
What makes measles so scary? What is it about measles that spreads fear and dread through our population? Three things, in my opinion, set it apart from most infectious diseases that make us afraid: 1. It’s untreatable, and it has a high rate of complications, so we are at it’s [sic] mercy, 2. It’s been virtually eliminated from the U.S., so we aren’t used to it anymore, and 3. It’s potentially fatal.
Now, let’s play two truths and a lie. Two of these statements are true, and one is not. Well, the one that is not is technically true, but it’s not true in all practical terms.
1. Untreatable? Correct. There is no anti-viral medication that will help, so we just have to stand by as the disease runs its course. We are powerless, and that creates fear. We don’t want to take a risk with something which we have no way to mitigate or control. The only thing that may make measles less severe is high dose Vitamin A therapy (which is approved by the WHO). But that’s not an anti-viral med; it just helps us fight it off a little better.
Complications? Ear infection is the most likely complication – treatable. Pneumonia is next – also treatable. Ya, you don’t want those things to happen, but they are treatable. Encephalitis? That’s much worse. Fortunately it’s extremely rare in well-nourished people (see below).
So, the lie is that measles has a high rate of serious complications. It doesn’t. It CAN, but it rarely does.
2. Eliminated? Virtually. Over the past 20 years we’ve sometimes only had 50 cases a year. Sometimes 150. Nobody knows measles anymore, and when we are ignorant of something unfamiliar, we fear it until we understand it.
Ask any Grandma or Grandpa (well, older ones anyway), and they’ll say “Measles? So what? We all had it. It’s like Chicken pox.” Ask a twenty-five-year-old mom with two young kids, and she’ll scoop up her kids and run away from you for even mentioning the M word.
If you understand measles, you wouldn’t fear it. Respect it.
I do acknowledge that it’s a public health nightmare in that it takes a lot of effort and money to contain these outbreaks. And it causes a lot of people to get tested, quarantined, or treated with preventive immune globulin shots. It’s no joke. But, those efforts are largely because we are trying to contain it, not because it’s going to kill everybody. So, not fear – respect.
3. Potentially fatal? Technically true, but herein lies the lie. It’s been publicized as “the deadliest of all childhood fever/rash illness with a high rate of complications.” Deadly? Not in the U.S., or any other developed country with a well-nourished population. The risk of fatality here isn’t zero, but it’s as close to zero as you can get without actually being zero. It’s 1 in many thousands. Will someone pass away in the U.S. from measles one of these years? Tragically yes. That will likely happen to one person. It hasn’t happened here in at least ten years (or more – I don’t even know how many years we have to go back to find one). When that happens, it will be extremely tragic.
But will it spread through the U.S. and kill people left and right? No. Does measles do that in underdeveloped countries? Sadly, yes. It kills countless people worldwide every year. So, that’s how health officials can accurately say it’s so deadly. They don’t have to tell you the whole truth, just the part of the truth that they want you to believe.
Measles can also be serious for young infants, just as many diseases can. It can also be serious for immunocompromised people, just as all illnesses. It can also cause pregnancy complications, just like many infections can. Measles isn’t unique in these risks. But they are risks nonetheless.
So, fear measles? No. Not in the U.S.. Respect measles? Yes. Take appropriate precautions with it. But don’t let anyone tell you you should live in fear of it. Let’s handle it calmly and without fear or blame.
“Without blame”? As in, “Don’t blame me for the consequences of what I’ve been saying and doing for all these years”? Nice try, Dr. Bob. You’re not getting off that easily, nor will you be so easily allowed to shift the blame to the parents who listened to you rather than your own words and behavior. In fact, Dr. Bob’s reminded me of so much of an antivaccine meme originated at The Vaccine Machine, a virulently and unfortunately popular Facebook page run by the equally virulent and antivaccine Robert Schecter (known on my not-so-super-secret other blog as Sid Offit) that’s dedicated to trashing vaccines and spreading antivaccine pseudoscience that I just had to post it here:
Yes, notice how Dr. Bob even invokes a variant of the “argumentum ad Brady Bunchium” fallacy when he mentions how “grandma and grandpa” poo-poo the measles as being “just like the chicken pox” and dismiss it with, “We all had it,” an attitude that he compares to that of a 25-year-old mother who’s never seen the measles before and therefore fears it because she doesn’t know it. It’s a rather clever inversion of the argument frequently used by pro-vaccine bloggers that points out that the reason parents don’t fear vaccine-preventable diseases anymore—the usual example used being polio—is because they’ve never personally witnessed the death and complications these diseases used to cause. In retrospect, I’m actually a bit surprised Dr. Bob didn’t mention the infamous “measles” episode of The Brady Bunch, actually. Come on, Dr. Bob. Let it out! You know you want to!
On that note, after having read Dr. Bob’s treatise above, I’d like you to go and read Marcella Piper-Terry’s initial response to the Disneyland measles outbreak from January 8 entitled “Measles at Disneyland!” Can you tell the difference? Other than Piper-Terry’s longer post, with calculations designed to make you think that measles was never a big deal, Dr. Bob is using exactly the same arguments without adding the calculations, in particular the key argument being that measles in developed countries is not a threat, only in those “other” people in Third World countries who aren’t as developed as we are because, you know, we’re superior. Measles doesn’t kill very many of us compared to those poor, blighted savages! (I exaggerate, but, I contend, only a little.) He dismisses complications of measles as being “treatable” and therefore of little consequence. In fact, he makes it sound as though a measles-associated ear infection is equivalent to measles-associated pneumonia, dismissing them both as “treatable” with a jaunty, “Ya, you don’t want those things to happen, but they are treatable.” Never mind that many, if not most, cases of measles-associated pneumonia require hospitalization, many also requiring an ICU stay. As Dr. Roy Benaroch sarcastically puts it in his post entitled “Dr. Sears continues to salute our children with his middle finger“, many parents would indeed consider an ICU stay “somewhat of an inconvenience.” (I like Dr. Benaroch’s style.)
Think of it this way. According to the CDC, before the vaccine, 48,000 people a year were hospitalized for the measles; 4,000 developed measles-associated encephalitis; and 400 to 500 people died. By any stretch of the imagination that was a significant public health problem, and the introduction of the measles vaccine in 1963, followed by the MMR in 1971, made it much less so. As Dr. John Snyder reminded us five years ago responding to Dr. Sears making the same arguments in his book, measles is not a benign disease, regardless of what popular culture thought of it 50 or 60 years ago.
Of course, even Dr. Bob has to concede that measles-associated encephalitis is a Very Bad Thing, but he dismisses the risk with an equally jaunty rejoinder that encephalitis is “extremely rare in well-nourished people” (i.e., his well-off patients at whom his Facebook post is aimed). As for death, Dr. Bob’s message is, “Don’t worry, be happy.” After all, according to him, the risk of fatality is “as close to zero as you can get without actually being zero,” or one in many thousands. Funny how Dr. Bob (and the antivaccine activists to whom he panders) dismiss a possibility of death of this magnitude as being of no consequence; yet, a one in a million chance of Guillan-Barre disease after the meningococcal vaccine (or a one in several hundred thousand risk of severe reactions to vaccines in general) is completely unacceptable. Indeed, if you accept at face value Dr. Bob’s grossly-exaggerated estimate for a severe vaccine reaction of one in 100,000, by Dr. Bob’s own definition, the risk of severe reactions to any given vaccine is even lower than “as close to zero as you can get without actually being zero.” Even if you accept Dr. Bob’s even more ridiculously inflated estimate that the risk that “any one child will suffer a severe reaction over the entire, twelve-year vaccine schedule is about 1 in 2600,” I can’t help but note that we’re now in the range of the likelihood of a child with measles dying due to this disease in the United states. To Bob, the risk of these vaccine injuries is unacceptable, but a similar or much higher risk of death if a child catches the measles is just the cost of doing antivaccine business. According to Dr. Bob, yes, sooner or later a child is going to die of the measles—and won’t that be so tragic?—but it’ll likely only be one.
Hypocrisy, thy name is Bob Sears.
If Bob Sears weren’t such a worthless excuse for a pediatrician when it comes to promoting misinformation about vaccines, I’d almost feel sorry for him. Almost. He is, however, a perfect example of what the phrase “hoist with his own petard” means. Dr. Bob has for years made a profitable career for himself as the “reasonable” face of the vaccine-averse, painting himself as not like all those other loony antivaccinationists out there but rather as a reasonable pediatrician taking a “middle way” and “listening to parents.” Now the consequences of the ideas Dr. Bob has promoted are starting to become apparent, with measles outbreaks becoming increasingly common right on his home turf, leading the parents of his patients to ask him what to do now that the low vaccine uptake encouraged by him are facilitating measles outbreaks like the most recent one in Disneyland. They are asking him for guidance, and he’s fobbing off the responsibility on them, telling them just to “get the vaccine” and if you “don’t want the vaccine, accept the risk.” Nice.
I’ve been fearing for a long time that the US was only several years behind the United Kingdom and Europe when it comes to suffering a major resurgence of the measles and that such a resurgence was coming. I hope I’m wrong, but I fear that 2015 might finally be the tipping point when measles really comes roaring back to levels not seen in a quarter century or even more. If that happens, Dr. Bob Sears will have to take his share of the blame for cashing in on fear and driving vaccination rates down. He’s not alone.