Anti-vaccine statistics – back to simple math again

anti-vaccine statistics

One of the age-old tropes of the anti-vaccine statistics world is that kids who have been vaccinated against the measles are more likely to get measles than those who are not vaccinated. I squashed this myth several times; unfortunately, those are old articles with broken links and such.

Now, the anti-vaccine statistics monsters persevere with their alternative facts. So, once more unto the breach, dear friends, once more. We will take down this trope. Continue reading “Anti-vaccine statistics – back to simple math again”

Shingles increase heart attacks – time for the vaccine

Shingles increase heart attacks

Shingles, a reactivated form of the chickenpox virus, is a painful rash that afflicts many people decades after the initial chickenpox infection. Now, we have data that shingles increase heart attacks (myocardial infarction) and strokes. This is more evidence that we need to end chickenpox with the chickenpox vaccine, and reduce the risk of shingles in those who have had chickenpox with the shingles vaccine.

Let’s take a look at shingles and this new study. Continue reading “Shingles increase heart attacks – time for the vaccine”

Anti-vaxxers are crying vaccine tears – Trump breaks promise

anti-vaxxers

Earlier this week, I published an article on the nominee for the Surgeon General, Dr. Jerome M. Adams along  with a potential nominee for CDC director, Dr. Brenda Fitzgerald. Since then, President Trump made it official, and Dr. Fitzgerald will be the next CDC Director. And the delicious salty tears of anti-vaxxers are flowing freely, since both doctors are clearly pro-vaccine.

Some of you may remember that President Trump had tweeted (his only form of communication apparently) his dislike of vaccines prior to being elected President.

Continue reading “Anti-vaxxers are crying vaccine tears – Trump breaks promise”

Anti-vaccine doctors – naming names and listing lists

Anti-vaccine doctors

Recently, the vaccine deniers have pushed a list of anti-vaccine doctors, which gets copy-pasted from one website to another, and are similar to those lists of “scientists” who deny Darwinian evolution or climate change. But is this really made up of respected physicians and researchers? Does it really contain doctors who are experts or authorities on vaccines?

Well, thanks to Zared Schwartz, a senior at the University of Florida studying microbiology, cell science and neurobehavioral, who took it upon himself to look up each of these individuals and see if they’ve got anything to offer in the discussions about vaccines. Guess what? It doesn’t appear so.

So if you run across this list of anti-vaccine doctors and researchers, wondering if any of them speak from authority, just check them out on this list.

Continue reading “Anti-vaccine doctors – naming names and listing lists”

France mandates vaccines – saving children from diseases

France mandates vaccines

During an address to Parliament on Tuesday, Édouard Philippe, who serves as prime minister under new liberal president Emmanuel Macron, stated that starting next year, France mandates vaccines for all children. It will mandate vaccines for young children that are unanimously recommended by health authorities starting next year.

Three vaccines, for diphtheria, tetanus and poliomyelitis, are already mandatory in France. Vaccines that would become compulsory under the new law would be pertussis, measles, mumps, and rubella (MMR) , hepatitis B, Haemophilus influenzae bacteria, pneumococcus and meningococcus C.

Phillipe said, in his speech, that “children are still dying of measles. In the homeland of [Louis] Pasteur that is not admissible.” Legendary scientist Pasteur is one of the founders of the field of bacteriology and invented vaccines for anthrax and rabies.  Continue reading “France mandates vaccines – saving children from diseases”

Trump appointed Surgeon General and CDC director – good for vaccines

Trump appointed Surgeon General

Donald Trump’s record on appointments for science and medical positions has been horrific, at best. His choice of Tom Price for Health and Human Services was terrible for healthcare. Anti-science individuals were also appointed to serve as EPA Director and Secretary of Energy. But recently, Trump appointed Surgeon General and will appoint a CDC director, both of whom appear to be good, though not perfect picks.

From a purely non-political standpoint, those of us on the science side wanted a few basics in the new Surgeon General and CDC director:

  1. Have a respectable medical and/or public health background.
  2. Provide full-throated support for immunization programs
  3. Don’t belong to the right wing Association of American Physicians and Surgeons (AAPS), which has radical ideas about health care, Medicaid, Medicare and just about any modern healthcare strategy.
  4. Don’t have unscientific ideas about HIV/AIDS, Ebola, Zika virus, and many other contemporary issues in public health.

Sure, it would be nice for our national public health advocates to remind the country that accidental gun deaths is a public health issue, but that’s never going to happen in the current political environment.

Let’s take a look at who President Trump appointed Surgeon General and who he will probably appoint CDC director. Continue reading “Trump appointed Surgeon General and CDC director – good for vaccines”

Gun control regulations and firearms mortality

Gun control regulations and public health.

Firearms mortality, either murder, accidental or suicide, has always been a public health issue in the USA. There have been several good epidemiological studies that have examined whether gun control regulations and firearms mortality risk are related – and the results are surprisingly vigorous.

From recent epidemiological research, there is some convincing evidence that establishes a correlation between state-level gun control regulations and firearms mortality rates. However, the link is not as black and white as one might wish – the relationship between firearms regulations and mortality depends on the quality of the law.

The nation’s leading public health organization, the Centers for Disease Control and Prevention (CDC), is essentially prevented from analyzing and publishing any epidemiological research that would help us understand what, if any, links there are between gun control and firearms mortality. The Republican dominated congress have done everything they can to prevent the CDC from using any funds to study the issue.

Furthermore, because the CDC cannot (or will not) fund research into gun control, it has lead to a chilling effect on gun control research in academia. According to the Washington Post, “young academics were warned that joining the field was a good way to kill their careers. And the odd gun study that got published went through linguistic gymnastics to hide any connection to firearms.”

But maybe because this public health menace can no longer be ignored, a smattering of well done epidemiological research is being published in very high quality medical journals. Let’s look at one.

Continue reading “Gun control regulations and firearms mortality”

Florida vaccine laws – court says church school can ban unvaccinated kids

On 27 June 2017, in a Florida vaccine laws case, a Florida Court of Appeals – The District Court of Appeal of the First District – rejected Patrick Flynn’s appeal against a lower court decision that found that a Catholic diocese had a constitutional right to exclude unvaccinated children if its interpretation of religious law supports doing so. The Court affirmed that the church autonomy doctrine, under which the state will not interfere in a church’s interpretation of religious law, prevents application of state vaccination law to this case.

From a public health perspective, this is a good news/bad news case. On one hand, the case made it clear there is no constitutional right to a religious exemption, and allowed religious private schools to reject non-vaccinated students when that rejection is religiously motivated. On the other hand, it also made it clear that other private schools cannot, under Florida law, reject unvaccinated students if their parents file a religious exemption, and neither can religious schools when their policy is based on secular reasons.

Florida vaccine laws – the case

Patrick Flynn is a Catholic father of eight. All his children were educated in Catholic schools in the Catholic Diocese of St. Augustine, Florida (“The Diocese”). At some point of his life he decided that vaccinating was against his religious beliefs, and began providing a letter expressing his religious objection to vaccine, to fulfill the requirements of Florida’s religious exemption.

After accepting religious exemptions for years, the Diocese, through its leader, Bishop Felipe de Jesús Estévez, decided not to accept them anymore, starting with the 2015-2016 school year. The court decision (pdf) explained that

Bishop Estevez’s legal position as Bishop is that immunizations of children attending Catholic schools is an issue of faith, discipline, and Catholicism which can only properly be determined by the church and not by the civil courts.

The Diocese did not point to any specific tenet that supported its position on immunization – in fact, it did not provide any materials that explained its previous position that allowed exempt children in or its current position that refused them. It did state the basis of its opposition was religious.

Mr. Flynn’s youngest son has just finished Kindergarten in 2015. Mr. Flynn submitted a letter of religious exemption, but under the new policy was refused admission to the school unless his parents vaccinate him.

Naturally, his family was unhappy. The father opened a GoFundMe campaign, and sued the Diocese, first in the trial court and after losing the case there, appealed.

The basis for his appeal was the claim that under Florida’s statute about religious exemptions, that says:

“that immunization requirements do not apply if “[t]he parent of the child objects in writing that the administration of immunizing agents conflicts with his or her religious tenets or practices.” § 1003.22(5), Fla. Stat.” (opinion, p. 4)

Private schools have to accept religious exemptions, and cannot reject unimmunized children exempt under them.

The Ruling

The court of appeals affirmed the trial court’s ruling, which basically held that when the church’s constitutional right conflicts with a parent’s legal right to an exemption, the constitutional right trumps. There were three slightly different decisions in the appeal court (pdf).

Judge Makar wrote the main opinion. It basically said:

  1. The church autonomy doctrine prevents civil courts from deciding matters that involve those courts in theological controversy, church discipline, ecclesiastical governance, or conformity with moral standards set by the church – on those issues, the courts will defer to the highest ecclestial authority. The doctrine is ground in Article I of the United States constitution – both the free exercise clause (it protects churches’ freedom of religion) and the establishment clause (by preventing excessive government entanglement with religion). It gives churches a constitutional right to autonomy.
  2. In Florida, it’s a jurisdictional bar. That means that when a matter that involves one of the issues above – for example, here, stepping into a theological controversy – comes before a court, a court does not have jurisdiction over the issue and may not hear it.
  3. There are limits on the application of the doctrine when it comes to clearly neutral laws that do not require deciding secular matter, but they do not apply here (said with caution by the main opinion, less carefully by the other opinions).
  4. Neutral state laws requiring immunization are constitutionally valid even without a religious exemption. This means that the right to a religious exemption here is created by statute – Mr. Flynn does not have a constitutional right to a religious exemption from the school mandate.
  5. Here, we have a religious debate on immunization. Mr. Flynn is asking the courts to prefer his religious exemption over the Diocese’s – directly to step into a religious disagreement. In the Court’s words:

    “The Diocese has a religiously-based immunization policy with which one of its members disagrees; Mr. Flynn seeks the power of the State to compel the Diocese to depart from its point-of-view and admit his non-immunized son. But doing so would further his own religious views at the expense of the Diocese’s on the topic of immunizations. We are convinced that a secular court should not be making the judgment as to which side’s religious view of immunization is to be respected.” 

  6. Immunization is a basis for religious debates as well as secular ones, which is why most jurisdictions offer a religious exemptions. So this can fairly be seen as a religious debate between the parties, and courts should not step in. That is even more clearly the case here. This is a case where the church autonomy doctrine is in full force.
  7. Mr. Flynn complains that the Diocese did not provide an explanation – but under the jurisprudence of Florida’s courts, private people do not have to explain their religious objections, just state that they have one, and it’s unfair for Mr. Flynn to demand more  from the Diocese than a private person would have to give.

    In the Court’s words:

    Courts are in no more of a position to compel the Diocese to provide a sufficient quantum of passable proof that its view of immunization is consistent with the Catholic faith than to do so as to Mr. Flynn’s personal views of Catholic doctrine on the very same subject. … Mr. Flynn points out that he has no duty to prove that his objection is religious, citing Curry, yet he insists that the Diocese must provide adequate proof that sufficiently grounds its religious viewpoint in specific church tenets. We can’t help but note the incongruity of giving primacy to a parishioner’s religious viewpoint that is contrary to that of his mother-church on the same topic; respectfully, it would be an odd role reversal—a devotee’s tail wagging the corpus of church leadership—to do so.

  8. Even more generally, “the Catholic Church’s governance of its parochial schools is inherently religious, its obvious mission being the transmission of its religious values,” so courts are careful not to interfere in such religious governance.

In short, the statutory right to send a child unvaccinated to any school the parent wants has to give way before the constitutional right of a church to autonomy.

Judge Bilbrey joined the opinion, making it the majority opinion, but added a concurrence – an opinion in agreement that makes additional point – of his own. He wanted to make it clear that the focus here isn’t that it was a dispute between a Catholic member of the Diocese and the Diocese itself. He explained:

All that is required for application of the doctrine is for a church or ecclesiastical body to take a position on religious grounds; it matters not that the opponent of the church have a religious basis in opposition. As Judge Makar observes, “the Catholic’s Church governance of its parochial schools is inherently religious, its obvious mission being the transmission of religious values. . . .” (Maj. Op. at 21). In my view, that is all that is needed in order to invoke the “church autonomy doctrine.””

Judge Kelsey agreed with the result, but offered a different reasoning. Since his reasoning is not the majority, I’ll just say shortly that he analyzed the theology and found that the church’s position was based in valid religious principles, and courts should not get caught in the religious debate between the Diocese and its believer, under the church autonomy doctrine.

Florida vaccine laws conclusion

This decision means that religious private schools in Florida that refuse to accept unimmunized children on religious grounds are constitutionally protected from having to accept religious exemptions. In that, it protects the right of these schools to require immunization (and protect their pupils – and the community – from outbreaks).

Note the limits, though. This applies only to religious schools; the court made it clear that the law requires private schools, generally, to accept religious exemptions. Private schools that are not religious cannot refuse unimmunized children if their parents file a religious exemption – and the parents don’t even have to explain their religious objections, making it very easy for parents whose opposition is not religious to use this exemption.

Religious schools, too, cannot refuse unvaccinated children unless their reasons are religious. A question arises whether that could incentivize such a school concerned about outbreaks to cloak a secular reason to refuse unvaccinated children in religious language – and whether incentivizing people and religious schools to present secular objections as religious is good public policy.

Nonetheless, upholding the fact that the constitution does not require a religious exemption from immunization requirements, and allowing Catholic schools to keep their schools safe by refusing unimmunized children, do help protect the public from disease.

Chronic Lyme disease treatments – unproven and dangerous

Chronic Lyme disease treatments

More and more people are being misdiagnosed with “chronic Lyme disease,” a medically unrecognized condition that encompasses (pdf) “a broad array of illnesses or symptom complexes for which there is no reproducible or convincing scientific evidence of any relationship to B. burgdorferi infection.” A whole industry of chronic Lyme disease treatments have arisen over the past few years to treat this pseudomedical condition.

There is no evidence that the symptoms of “chronic Lyme disease” are caused by a persistent and hidden B. burgdorferi infection. According to the eloquent Orac, it is simply a “fake disease.”

On the other hand, post-treatment Lyme disease syndrome (PTLDS) describes a set of persistent symptoms that arise after successful treatment of the Lyme disease. The symptoms of “chronic Lyme” are generic and non-specific “symptoms of life.”

Chronic Lyme disease treatments include mostly alternative medicine therapies, especially controversial and harmful long-term antibiotic therapy, particularly intravenous antibiotics. The CDC specifically disputes the effectiveness of long-term use of antibiotics to treat Lyme disease.

A new report from the CDC examined chronic Lyme disease treatments, and found that they are expensive, that they don’t work, and that they can be dangerous. Let’s take a look at that study. Continue reading “Chronic Lyme disease treatments – unproven and dangerous”

Gardasil safety and efficacy – debunking the HPV vaccine myths

Gardasil safety and efficacy

There was an article published in Pediatrics that described how educating either teenagers or their parents about HPV vaccinations had little effect on the overall vaccination rate for the vaccine. Essentially, the researchers found that it was a 50:50 probability that any teen would get the vaccine, regardless of their knowledge of HPV and the vaccine itself. Some of the reasons why the HPV vaccine uptake is so low is a result of several myths about Gardasil safety and efficacy.

So I thought about why that Pediatrics study found that education about HPV and Gardasil didn’t move the needle on vaccination uptake. It’s possible that the benefits of the vaccine is overwhelmed by two factors–first, that there’s a disconnect between personal activities today vs. a disease that may or may not show up 20-30 years from now; and second, that the invented concerns about the HPV quadrivalent vaccine, promulgated by the usual suspects in the antivaccination world, makes people think that there is a clear risk from the vaccine which is not balanced by preventing cancer decades from now. It’s frustrating. Continue reading “Gardasil safety and efficacy – debunking the HPV vaccine myths”