Tag: ethics

Why Should Medical Exemptions Be Based on CDC Contraindications?

Getting a medical exemption for vaccines isn’t controversial.

Or at least it shouldn’t be.

Why Should Medical Exemptions Be Based on CDC Contraindications?

As many people know though, some people have been taking advantage of the fact that medical exemptions weren’t clearly defined in California’s vaccine law.

Who are the doctors handing out fake medical exemptions in California?
Who are the doctors handing out fake medical exemptions in California?

Are there just a few doctors taking advantage of the California law?

“But at 105 schools in the state, 10% or more of kindergartners had a medical exemption in the school year that ended last month, according to a Los Angeles Times analysis of state data.”

Pushback against immunization laws leaves some California schools vulnerable to outbreaks

Is 10% a lot?

In one recent report, Vaccination Coverage for Selected Vaccines, Exemption Rates, and Provisional Enrollment Among Children in Kindergarten — United States, 2016–17 School Year, the median rate of medical exemptions in the US was just 0.2%, with a range of <0.1 to 1.5%.

In West Virginia and Mississippi, states that don’t allow non-medical exemptions and where criteria for medical exemptions are fairly strict, the rates were 0.1 and 0.3% respectively.

And that’s about what you would expect, as there are very few true contraindications or precautions to getting vaccinated.

So yes, 10% is an awful lot and that’s a good sign that it is more than just a few doctors taking advantage of the law.

“If a child has a medical exemption to immunization, a physician licensed to practice medicine in New York State must certify that the immunization is detrimental to the child’s health. The medical exemption should specify which immunization is detrimental to the child’s health, provide information as to why the immunization is contraindicated based on current accepted medical practice, and specify the length of time the immunization is medically contraindicated, if known.”

Dear Colleague letter regarding guidelines for use of immunization exemptions

Why do most other states have so few medical exemptions?

Mostly because there are very few true medical reasons to skip or delay a child’s vaccines!

They include, but aren’t limited to, the contraindications and precautions listed in the package insert for each vaccine (the contraindications and warnings sections…) and by the Advisory Committee on Immunization Practices.

They don’t include many other things that are “incorrectly perceived as contraindications to vaccination,” such as things in the family medical history of the child, eczema (unless they are getting the smallpox vaccine), colic, sleep apnea, or being a picky eater.

Is everything a vaccine injury?
Is everything a vaccine injury?

It should be obvious.

Medical exemptions for vaccines should be based on CDC criteria because some folks think that everything is a vaccine injury.

More on Medical Exemptions

Where are the Saline Placebos?

Remember when anti-vaccine folks used to say that there were no double-blind, placebo-controlled randomized clinical trials for vaccines?

What happened once they realized that there actually were?

They moved the goal posts…

Where are the Saline Placebos?

Okay, they said.

So you have done double-blind, placebo-controlled randomized clinical trials when testing vaccines, but what placebo did you use?

Was it a pure saline placebo?

“Placebo Control – A comparator in a vaccine trial that does not include the antigen under study. In studies of monovalent vaccines this may be an inert placebo (e.g. saline solution or the vehicle of the vaccine), or an antigenically different vaccine. In combined vaccines, this may be a control arm in which the component of the vaccine being studied is lacking.”

WHO on the Guidelines on clinical evaluation of vaccines: regulatory expectations

Although no guidelines actually call for using a pure saline placebo, that’s all anti-vaccine folks will accept these days.

Why?

That’s there MO – or method of operation.

When one theory or myth gets squashed – they move to another.

They move the goalposts.

It doesn’t matter that there are often ethical and logistical problems with using pure saline placebos, that’s all they want to hear about it.

That they wouldn’t be satisfied and start vaccinating their kids if all vaccine studies started to use saline placebos should be evident when you consider that many vaccine studies have already used saline placebos!

There are many more vaccine studies that have used saline placebos and like other vaccine studies, have found vaccines to be safe and effective.

But how do you know that they used a real saline placebo and not some kind of saline solution with other stuff in it?

If it isn’t clear to you in the methods section of the study, go to the source – the original clinical trials record and it will be listed there.

What are you going to be worried about now?

More on Saline Placebos

Fact Checking an Anti-Vaccine Measles Outbreak Quiz

Anti-vaccine folks have gotten pretty good at pushing propaganda to keep you scared to vaccinate and protect your kids.

Now, they even have quizzes to help test how much of that misinformation you remember!

Fact Checking an Anti-Vaccine Measles Outbreak Quiz

A quiz about measles outbreaks by the ironically named Physicians for Informed Consent was recently promoted by Dr. Bob Sears.

How did Dr. Bob get 12 out of 12 correct if most of the answers are really wrong?
How did Dr. Bob get 12 out of 12 correct if most of the answers are really wrong?

Let’s take a look at some of the questions and the anti-vaccine answers…

There is only so much that better hygiene, sanitation, and nutrition can do, which is why about 400 to 500 people were dying of measles in the 1950s and early 1960s just before the first measles vaccines were developed.
There is only so much that better hygiene, sanitation, and nutrition can do, which is why about 400 to 500 people were dying of measles in the 1950s and early 1960s just before the first measles vaccines were developed.

While mortality rates did indeed decline for most diseases and conditions in the early part of the 20th century because of advancements in living conditions, nutrition, and health care, that effect had plateaued by the mid-1930s.

Being unvaccinated and unprotected is the main reason why people in underdeveloped countries die from measles, not low vitamin A…

It is true that vitamin A deficiency increases the risk for more severe complications and death from measles, which is why it can be more deadly in undeveloped countries where malnutrition is a big problem.

“Because of gaps in vaccination coverage, measles outbreaks occurred in all regions, while there were an estimated 110 000 deaths related to the disease.”

Measles cases spike globally due to gaps in vaccination coverage

Unfortunately, the other big problem in many of these countries is that these kids are unvaccinated because of a lack of access to vaccines.

This child doesn’t appear to have measles…

Immune globulin is a treatment option if you have been exposed to measles, but it is not actually a treatment once you have measles. And high dose vitamin A mainly benefits those with a vitamin A deficiency, which is unlikely in an industrial country, like the United States.

The only benefit of having measles, which you have to earn by having measles and surviving without complications, is that you will have developed immunity to measles.

In addition to having no other benefits, you will then be at risk for SSPE and may have wiped out your immune system for a few years.

While you are at risk for encephalitis and seizures after a natural infection, after getting a dose of MMR, one risk is a febrile seizure, which is typically thought to be benign.

The risk of having a febrile seizure after the first dose of the MMR vaccine is about 1 in 2,500 doses. There is also a small risk of having a febrile seizure if the flu vaccine is given at the same time as a Prevnar or DTaP vaccine.

It is important to note that vaccines are not the only reason that children have febrile seizures. Many infections, including vaccine preventable infections, can trigger febrile seizures, in addition to causing more serious types of non-febrile seizures.

This is not true.

It is very unlikely that any of the kids who develop febrile seizures after a vaccine will later develop epilepsy.

“Febrile seizures can be frightening, but nearly all children who have a febrile seizure recover quickly, are healthy afterwards, and do not have any permanent neurological damage. Febrile seizures do not make children more likely to develop epilepsy or any other seizure disorder.”

Febrile Seizures Following Childhood Vaccinations, Including Influenza Vaccination

Without any risk factors (parent or sibling with epilepsy, having complex febrile seizures, or abnormal development), a child with febrile seizures has the same risk of developing epilepsy has any other child.

Do anti-vaccine folks really read the inserts?

Like many other vaccines, the package insert for MMR does say that it has “has not been evaluated for carcinogenic or mutagenic potential, or potential to impair fertility.” That doesn’t mean that it hasn’t undergone safety studies for its potential to cause cancer, genetic mutations, and impaired fertility though.

Wait, what? Yeah, all vaccines have preclinical toxicology studies, including single and/or repeat dose, reproductive and developmental, mutagenicity, carcinogenicity, and safety pharmacology. If any issues are found, further studies are done.

The only way to think that a natural measles infection is safer than the MMR vaccine is if you believe that all reports to VAERS have been confirmed as being caused by the vaccine (they aren’t) and you don’t think about the fact that relatively few people get measles any more (so you don’t see or hear about many measles deaths) because most folks are vaccinated and protected!

How did you do on the quiz?

Did you easily spot all of the anti-vaccine propaganda?

More on Fact Checking an Anti-Vaccine Measles Outbreak Quiz

The Pacific Northwest Measles Outbreak of 2019

Breaking News – There are 2 new cases in Clark County (70 cases), bringing the total case count to 75 cases.

It started with a confirmed case of measles in a child in late December.

The Pacific Northwest measles outbreak on 2019 started when a child exposed others in the area in late December.

There were soon reports of more cases.

The Clark County measles outbreak quickly grew.

And more cases.

The Pacific Northwest Measles Outbreak of 2019

But the measles cases didn’t stay in Clark County.

Two of the unvaccinated kids from Clark County traveled to Hawaii while they were contagious.
Two of the unvaccinated kids from Clark County traveled to Hawaii while they were contagious.

As with other recent large measles outbreaks, cases soon spread to neighboring counties.

As of late January, there are now measles cases linked to this ongoing outbreak in Clark County and King County (Washington) and Multnomah County (Oregon).

The rapid growth of the outbreak led Clark County to declare a local public health emergency and Washington’ governor to declare a State of Emergency in all counties in the state of Washington.

“The measles outbreak and its effects impact the life and health of our people, as well as the economy of Washington State, and is a public disaster that affects life, health, property or the public peace.”

Governor Jay Inslee on proclaiming a State of Emergency

Why so much concern?

Are you familiar with the immunization rates in this part of the country? About the only good thing you can say about Washington’s immunization rates are that they are better than Oregon‘s…

Washington has one of the highest rates of exemptions in the United States.

That’s right.

High non-medical vaccine exemption rates and low vaccination rates. A recipe for very large outbreaks of vaccine-preventable diseases, especially measles which is so highly contagious.

Immunization rates by county in Washington.

And a recipe for disaster. These outbreaks are getting harder to control, are lasting longer, and are getting bigger and bigger.

Also remember that the last measles death in the United States, in 2015, was a woman who got caught up in a measles outbreak in Clallam County. Why didn’t that trigger folks in the area to get Vaccinated?

Pacific Northwest Measles Outbreak of 2019
Clark County (WA)70 cases
King County (WA)1 case
Multonomah County (OR)4 case
 75 cases

How many of them are vaccinated? Anti-vaccine folks are pushing hard to convince folks that everyone in the outbreaks are vaccinated. Don’t believe them!

As in most outbreaks, almost all of the people in this outbreak are unvaccinated.

How many people will get sick in the Pacific Northwest Measles Outbreak of 2019 before it ends?

You will have to make an extra appointment if you followed his immunization plan and left your kids unvaccinated and at risk during this outbreak.
You will have to make an extra appointment if you followed his immunization plan and left your kids unvaccinated and at risk during this outbreak.

Are parents going to keep listening to anti-vaccine folks who push the idea that measles isn’t that bad and make you think that it is riskier to get vaccinated?

Are they going to realize that unless they are malnourished or have a vitamin deficiency, that taking extra vitamin A that you order from someone’s online store will not reduce their risk of severe complications if their unvaccinated child gets measles?

“Please contact your pediatrician or doctor if your child is scary sick, struggling to breathe or unable to eat or very lethargic or otherwise seriously ill. Let them know you are worried they may have measles so they can arrange not to contaminate the waiting room or the whole office.”

Paul Thomas, Integrative Pediatrician

Getting vaccinated can help keep your kids from getting “scary sick” from measles…

“The above recommendations are informational only. Please consult with your doctor before implementing anything you might learn here.”

Paul Thomas, Integrative Pediatrician

The only good advice he gives.

Anti-vaccine misinformation has gotten us to the place where these outbreaks are becoming more common. Vaccinate your kids so they don’t get measles and don’t expose anyone else.

And for the anti-vaccine folks who are asking:

  • it isn’t going to be shedding or a vaccine strain that caused the outbreak
  • everyone or almost everyone in the outbreak is going to be unvaccinated
  • the measles vaccine does work against all the different genotypes of measles
  • more people don’t die from getting the MMR or any other vaccine than from the diseases they protect us against
  • whether the death rate of measles is 1 in 1000 or 1 in 10,000 cases, remember that just before the measles vaccine came out, in the early 1960s, nearly 500 people would die of measles each year. And it isn’t that a person dies after 1,000 or 10,000 cases. With more cases, there is just a higher chance that someone will eventually die.

And you are still worried about the MMR vaccine because anti-folks are still scaring you away from vaccinating and protecting your kids.

Vaccines are safe and necessary with few risks. There is no good reason that we should still have outbreaks like this.

More on The Pacific Northwest Measles Outbreak of 2019

Updated March 3, 2019

Why Do Some Folks Wear a Mask During Flu Season?

Wearing a surgical mask is very common when people are sick and want to avoid spreading their germs to others. They are also commonly worn when people are healthy and are just afraid of getting sick.

Why Do Some Folks Wear a Mask During Flu Season?

Is that why you see some folks wearing masks during flu season?

If you are worried about your privacy, why announce something on Facebook?
If you were worried about your privacy, would you talk about it on Facebook?

Maybe, but some folks actually have to wear a mask during flu season.

Well, they have to because they decide they don’t want to get a flu vaccine, but still want to keep their job that could put others at risk if they got sick with the flu. So basically, it is unvaccinated health care personal and others who work around sick and vulnerable people who might have to wear a mask when they are at work.

Why don’t they just get vaccinated and protected against the flu?

That’s a good question…

Some other questions to consider as you think about flu vaccine mandates include:

  • Do unvaccinated health care workers pose a risk to others in the course of their jobs? Of course they do. Health care personal are at high risk to get the flu, since they are often around people who are sick with the flu, and are at higher risk to get the flu if they are unvaccinated.
  • Does wearing a mask protect anyone? – Yes, they actually do and recent studies have concluded that “surgical face masks worn by infected persons are potentially an effective means of limiting the spread of influenza.”
  • Does getting a flu shot prevent you from catching the flu? – Flu shots aren’t the most effective vaccine we have, but they are the best way to avoid catching the flu, being 10 to 60% effective since 2004.
  • Does getting a flu shot prevent you from spreading the flu to others? Yes, and several studies have shown lower rates of nosocomial cases among hospitalized patients as more health care personal get vaccinated!
  • Does getting a flu shot just cause you to have milder symptoms? The flu vaccine does has many benefits besides preventing the flu, but it is certainly not limited to just causing milder symptoms.
  • Does wearing a mask violate your HIPAA rights? No. Unless you announce it, no one knows why you are wearing a face mask. Maybe you have herpes or a cold or are just afraid of getting sick. And the Health Insurance Portability and Accountability Act only protects patients, not employees.

So why don’t all health care personal get a flu vaccine each year?

Most do.

And while some people seem to be against the idea of mandates for health care workers getting flu shots, most think it is a great idea.

“I support this requirement. I think it is a good idea. Ethically, it makes total sense. First, every doctor, nurse, and HCW knows that they are supposed to put patient interests ahead of their own interests. Whatever you think about flu shots, it is good for patients that their healthcare providers are vaccinated against the flu, particularly among patients who cannot themselves be vaccinated, such as some of the elderly, babies, people with immune diseases, and people who just received transplants or are getting cancer treatment. Vaccination does not help them. They are all immunosuppressed.”

Art Caplan on The Law: Get a Flu Shot or Wear a Mask, Healthcare Workers!

In fact, most think that there is both an ethical and a legal rationale for flu vaccine mandates for health care workers.

“Doctors and other healthcare providers have an ethical obligation to make decisions and take actions that protect patients from preventable harm. 5 Many patients are highly vulnerable to flu, so choosing not to be vaccinated is choosing to do harm—a choice that has no place in healthcare.”

Doctors choosing not to be vaccinated is choosing to do harm

It is hard to imagine that some doctors and nurses not only skip getting vaccinated, putting others at risk, but then don’t even want to wear a mask.

More on Wearing Masks During Flu Season