How to annoy your pediatrician with antivaccine nonsense, edition

There are reasons that I’m not a pediatrician. First, and foremost, I like surgery. Indeed, when I first entered medical school, my intent was to become an academic internist, but things didn’t quite work out that way. To my surprise, when I did my surgery rotation I liked it way more than I ever thought I would, even with the then 100+ hour weeks. (This was long before the time of work hour restrictions on residents or medical students.) Then, when I did my internal medicine rotation, I found it far less interesting than I thought I would. So when it came time to apply to residencies, I ended up going for surgery, and the rest is history.

Pediatrics is basically like internal medicine, except for children. I actually liked my pediatrics rotation a bit more than internal medicine, but not enough to be inspired to become a pediatrician. I also note that when I was in medical school, the antivaccine movement was not nearly as big a problem as it is now. It was far less frequent that pediatricians had to deal with antivaccine parents, and they were a lot less sophisticated then. They didn’t have a repertoire like this one described by Marcella Piper-Terry, as described in Preparing for the “Well-Baby” or “Well-Child” Visit if You Don’t Plan to Vaccinate. It’s basically a blueprint describing how to be the sort of parent that drives pediatricians to drink.

Piper-Terry starts out with an almost Rod Serling-like vibe, which would be appropriate given the fantasy that follows could easily have found a home in The Twilight Zone, except that parents 55 years ago desperately wanted more vaccines against infectious diseases that their children suffered from. Maybe it would be appropriate in a revival. The only difference is that, instead of “Imagine if you will...” the story is introduced with “Let’s pretend,” which, I suppose, is also appropriate given that this is fantasy:

I have received a notice from my family doctor (or pediatrician) that it is time to bring my children in for their “well-baby” and “well-child” check-ups. Getting that notice makes me feel sick to my stomach. I know that I do not want to further vaccinate my older child, and I know that I do not want to vaccinate my baby at all.

My decision has not been made lightly. I have spent many hours researching and learning about vaccines, their ingredients, the lack of placebo-controlled studies, and the fact that they have never been studied for safety or efficacy as they are administered according to The CDC’s Childhood Schedule.

See? Fantasy. It’s utter BS that there are no placebo-controlled studies of vaccines. How many would Ms. Piper-Terry like me to list? This link provides a start, as do Dorit Reiss and our scaly friend the Skeptical Raptor.

The bottom line is that not only are individual vaccines tested in randomized placebo-controlled clinical trials when it is ethical to do so, but they are tested over the background of the existing vaccine schedule. Moreover, although it would be unethical to do a randomized, placebo-controlled clinical trial of the whole vaccine schedule because it would leave the control group unprotected against vaccine-preventable diseases, contrary to what antivaccine activists claim there are studies comparing unvaccinated and vaccinated children. Guess what? They find either no difference in health between the vaccinated and unvaccinated, or they tend to find that the vaccinated have better health. The bottom line is that the vaccine schedule is efficacious, safe, and evidence-based, contrary to how antivaccinationists try to portray it.

None of this stops Marcella’s antivaccine fantasy:

I have also prayed about this. A lot.

When I allowed my older child to be vaccinated, I felt a horrible sense of dread every time. I “knew” it was wrong. My mother’s intuition was screaming at me to grab my baby from that table and run out the door… but I didn’t know why… and I didn’t listen to that voice. I realize now that that voice… that “intuition”… is the voice of God. I didn’t listen before, but I am listening now.

And now, I know why vaccinating my babies is not right for my family.

I know better now; so now, I will do better.

OK, for one thing, I don’t care if she prayed a lot. Prayer tells us nothing about scientific issues like vaccination, and, given that pretty much all major Christian religions except the occasional fringe sect strongly support vaccination I doubt that God (if he exists) would tell this woman not to vaccinate her children. Quite the contrary, actually. As for “intuition,” again, so what? Intuition doesn’t overrule decades worth of scientific research.

Because of this vague feeling of unease, the mother in this story, fearful of being “bullied” (yes, antivaccinationists love to portray efforts to persuade them that their pseudoscience is pseudoscience as “bullying” even though it is they who tend to use the most violent rhetoric), comes up with a plan. That plan starts thusly:

  1. Find out exactly what vaccines my children are “due to receive.”
  2. Call the doctor’s office and ask which brands of vaccines they use.
  3. Find out what the ingredients are in those vaccines.
  4. Print the Material Safety Data Sheets (MSDS) for those ingredients.
  5. Print the vaccine manufacturer’s inserts for each vaccine.
  6. Print out the state law regarding school attendance.

Now, oh-so-sensitive antivaccine-sympathetic apologists or just sensitive pro-vaccine advocates might think I’m making fun of a parent here, but the whole lead-up to this parent’s visit with the pediatrician demonstrates that she is not simply a parent who is “on the fence” or frightened because she heard bad things about vaccines. She is clearly a hard-core antivaccinationist. You can tell because of what she writes and how she’s lining up her ducks to use standard antivaccine tropes to try to make her case to her child’s doctor. You can tell, for instance, just from the list above that she’s going to use two mainstays (at least) of antivaccine rhetoric. Regular readers will spot them immediately, but let’s let the writer lead us into them, for the benefit of newbies, to allow me to do a bit of Socratic teaching, and, most importantly, to allow for a bit of Insolent commentary. Remember, this is the same woman who has likened vaccination to rape and argued that measles is good for you.

Ms. Piper-Terry begins by invoking a tool of the Orwellian-named National Vaccine Information Center (NVIC). I know, I know. I called the NVIC “Orwellian-named” just yesterday, but to be honest, I really do think that the NVIC should change its name to the Orwellian-Named NVIC, or ONNIVC, because that is a more accurate description of it. Be that as it may, Ms. Piper-Terry invokes the NVIC Vaccine Ingredient Calculator. It’s a “tool” that’s been around a while, and when I last wrote about it, I referred to it as a disingenuous deceptive instrument of vaccine fear mongering because that’s exactly what it is. It takes some accurate information and presents it in a very dishonest, deceptive manner to make it look as though vaccine ingredients are very dangerous.

No wonder she thinks it’s legitimate to do this:

The following is a partial list of ingredients in vaccines given to infants and children in the U.S. (click each ingredient to view the Material Safety Data Sheet (MSDS):

  • Aluminum Hydroxide
  • Thimerosal
  • Formaldehyde
  • 2-Phenoxyethanol
  • Triton X-100

If you click on each of the above links, you will be taken to the MSDS for that vaccine ingredient. Scroll down and look at the information under Section 3: Hazards Identification. This is where you can learn about:

  • Carcinogenic Effects – the KNOWN ability to cause cancer
  • Mutagenic Effects – the KNOWN ability to cause alterations in DNA (FYI… alterations in DNA cause childhood cancers)
  • Teratogenic Effects – the KNOWN ability to cause harm to a developing fetus in utero
  • Developmental Toxicity – the KNOWN ability to cause harm to children in one or more ways

As an example, Piper-Terry displays the MSDS for thimerosal, which can be found at this link. Of course, I’ve discussed nearly all of these ingredients many times. The problem with looking at the MSDS for chemicals is that they refer to health problems that can potentially occur after exposures working with the chemical. In other words, it’s referring to a much higher exposure than anything that could come about from vaccines. One has to remember that the MSDS is designed as a worker safety tool, not a listing of health hazards that such chemicals in vaccines might pose. OSHA requires laboratories to have copies of the MSDS for each chemical in the laboratory because workers might be exposed to the pure form during handling, storage, or use. Notice on the MSDS for thimerosal how it refers to acute oral toxicity. (Hint: We don’t administer thimerosal-containing vaccines orally), with an LD50 in rat listed at 75 mg/kg, which is a pretty high dose. It refers to inhalation as well. (Hint: We don’t administer vaccines by inhalation.) In other words, she’s using the MSDS for the wrong purpose.

As for aluminum (it’s safe in vaccines), thimerosal (it doesn’t cause autism or neurodevelopmental disorders), formaldehyde, and Triton X-100 (which is nothing more than a detergent), I’ve discussed all of them at one time or another. It’s all nothing more than a variation of the “toxins” gambit, or, as I like to put it, Why are we injecting TOXINS into our babies? Here's the thing. The dose makes the poison, and none of these chemicals in vaccines are present at a dose that is dangerous. But they do have scary-sounding names, and some of them have a scary MSDS. That's enough for vaccine denialists like Piper-Terry.

Next up:

Another good thing to put in my binder is the Excipient List from the CDC, which lists all of the vaccines, their ingredients, and substances used in their manufacture.

Next, I need the Vaccine Manufacturer’s Inserts for each vaccine.
On each vaccine manufacturer’s insert, I will highlight the part where it says the vaccine should not be given to anyone who has an allergy to any of the ingredients in the vaccine. Given that my child has not been tested to determine if he or she is allergic to any or all of the ingredients, there won’t be any injecting going on just so we can see what happens.

This is what I like to refer to as “argument by package insert” or “appeal to the package insert.” It’s a ploy that ignores the fact that package inserts are not medical documents, but legal documents. They are, to put it briefly, a “CYA” document. As such, they list every adverse event ever reported in any clinical trial, whether the event is related to the vaccine or not.

These are, of course, a profoundly intellectually dishonest ploys, particularly the misuse of the MSDS. Does Piper-Terry actually demand this level of safety for anything her kids eat? For any supplement she gives them? Somehow I doubt it. The sole purpose for this ploy is to delay, delay, delay. It’s also profoundly cruel in a way. If the doctor actually went down this road, it would involve extensive allergy testing in the child, which would mean sticking lots of needles in him. It’s also entirely unnecessary, because it is generally known and assumed by physicians that a “history” of an allergic reaction means a history of a clinically evident allergic reaction that came about from everyday living, not an allergy that was only discovered because the child was subjected to extensive allergy testing. It’s also not referring to just any allergic reaction, but a serious one, an anaphylactic reaction. Given the low prevalence of such reactions, it would be enormously expensive to do this sort of testing, and the yield would be incredibly low. Yet, here, Marcella Piper-Terry thinks parents should demand such testing because she thinks her child is a special flower.

She’s not just intellectually dishonest, though. She’s just plain dishonest:

If, after this discussion, my doctor still wants to grasp at straws and tell me that my child cannot go to school without vaccines, I will calmly point out that (in Indiana, and 46 other states) we have the right to religious exemption from vaccination for school attendance, and that as my children’s parent, I will be exercising that legal right on their behalf.

In other words, she advocates lying about one’s religion in states with religious exemptions.

In California:

If I live in California, I will take advantage of the fact that when Governor Brown signed SB277 into law last year, he expressly stated that the medical exemption from vaccination was completely at the doctor’s discretion, and is not limited to the very narrow criteria for medical exemptions set forth by The CDC.

And it’s true. There are a fair number of “alternative” doctors offering medical exemptions for sale. That, too, is dishonest, but it’s probably unavoidable. A law as strict as the one in West Virginia, for instance, wouldn’t have passed in California. However, the pediatrician seeing this mother doesn’t have to be one of them and, more than likely, won’t be one of them.

Marcella Piper-Terry concludes by fantasizing about going all Donald Trump on her doctor:

If my doctor attempts to bully me after all of this, I will calmly inform him (or her) that I am aware of my rights and I am aware that the only laws regarding vaccination are for school attendance. I will also let him (or her) know that I am aware that physicians are receiving bonuses for meeting benchmarks and having a certain percentage of patients fully vaccinated by age two years. I will let the physician know in no uncertain terms that coercion (threatening to call CPS, for example) is unethical and possibly against the law (look up the definition of extortion), and I will be reporting him (or her) to the state medical board for ethics violations. For good measure, I will probably throw in, “And you’ll be hearing from my attorney,” as I pick up my babies and walk calmly and confidently out of his or her office. For the very last time. The last thing I will say, if it gets to this point?

“You’re fired.”

It’s a fantasy I’ve seen many times before (e.g., here). Also, whatever she’s smoking, I want some. Actually, no I don’t. I don’t smoke anything. She does, however, seem to be smoking something, as no one’s likely to report a parent to CPS just for not vaccinating, and physicians have no power to “coerce” or “bully” other than their words and powers of persuasion.

Here’s the irony. The pediatrician won’t be harmed or even likely that upset by this Brave Mother telling him he’s fired. In actuality, he’ll probably be relieved not to have to deal with her any more. In fact, it wouldn't surprise me if he did a little jig, turned his eyes skyward and whispered "Thank you," or pumped his fist in the air while mouthing the word "Yes!" once out of sight of the mother. The only one who is harmed by the mother’s failure to vaccinate is her child.


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The whole staging of this post is so confrontational, whatever happens, it can't be good for a relationship between the mother and the doctor. They're supposed to be a team working for the child's benefit. Really, if she needs to stage it that way, how can she work with that doctor?

By Dorit Reiss (not verified) on 06 Jul 2016 #permalink

And MSDSs are so interesting.

For example, the vinegar one says:

Avoid contact with eyes. Do not ingest."

For Olive Oil:
"Other Toxic Effects on Humans: Slightly hazardous in case of skin contact (irritant), of ingestion, of inhalation."

Yes, I'm taking these out of contexts. But they do too.

By Dorit Reiss (not verified) on 06 Jul 2016 #permalink

" I realize now that that voice… that “intuition”… is the voice of God. I didn’t listen before, but I am listening now."

Couldn't god have been a little more obvious. Say like setting a pot plant on fire and having it tell her not to vaccine her kids?

So... in essence her entire ramble can be countered by the simple invoking of "the dose makes the poison"?

You're not joking when you're likening anti-vax tropes to slasher villains, Orac. They truly never stay dead.

Well, I consider that the young lady consult with me.
A man that has chronic pain and consumes at least two 1.75 L bottles of distilled booze.
One, also highly experienced with more epidemics than she could name.
Then,she could explain why her projeny should survive, as 've responded through and survived the nightmares that she'd wish upon this planet.
I've personally witnessed polio and measles decimate a population
,Largely, children.
I'd rather die than let anyone else experience such an experience.

Try looking up the SDS (MSDS is no longer used, OSHA has transitioned to the 'new' SDS which match closer in format to the rest of the world) for deionized water. The one from Lab Chem says:
"Personal Protective Equipment
Wear appropriate protective eyeglasses or chemical safety goggles as described by OSHA's eye and face protection regulations in 29 CFR 1910.133 or European Standard EN166.
Wear appropriate gloves to prevent skin exposure."

Wear goggles and gloves to prevent exposure TO WATER.

I remember an old MSDS for DI Water that said to wash with soap and water after exposure TO WATER.

I realize now that that voice… that “intuition”… is the voice of God.

As my mom says, thanks goodness that God has large shoulders. With all the crap we pile on the poor devil...
Speaking of the devil, historically, theologian inquisitions tend to have numerous pointy questions for people claiming to hear heavenly voices.

Top put it another way:

I knew Jeanne d'Arc
Jeanne d'Arc was my friend.
You, Madam, are no Jeanne d'Arc

@ Dorit Reiss

Of course it's confrontational. She has made up her mind and nothing could change it.
In this context, the doctor is an opponent who should be bull-rushed or moved aside. She knows better than him, period.

By Helianthus (not verified) on 07 Jul 2016 #permalink

@ Dorit Reiss:"Really, if she needs to stage it that way, how can she work with that doctor?"

Perhaps the better question is, "How can that doctor work with HER?"

My intuition is the voice of God... FFS, that's some over-confidence.

Any doctor would be glad to be 'fired' by a parent like that - but as we know it's the kids who are actually bearing the burden of the risk.

I'd just be billing Medicare a 36 (long consult) and a 2713 (Mental health consult).

By Can't remember… (not verified) on 07 Jul 2016 #permalink

I just read the "my intuition is the voice of God" part of this to my other half who said - "Jesus, this idiot is just getting through life by feel."

By Can't remember… (not verified) on 07 Jul 2016 #permalink

On the other hand the MSDSes for sodium chlorite and chlorine dioxide fill me with confidence.

By Mama-Don't-Sleep (not verified) on 07 Jul 2016 #permalink

I realize now that that voice… that “intuition”… is the voice of God.

No, it's the voice of an overweening arrogance.

By Peter Dugdale (not verified) on 07 Jul 2016 #permalink

"Pediatrics is basically like internal medicine, except for children."

And their parents.

I realized early on in med school that pediatrics was probably not for me, but having to deal with parents was the clincher. I have a golden memory of examining an approximately 5-year-old child during my peds rotation and having the brat express his displeasure by pounding on me with his tiny but hard fists (mom looked on, saying nothing but regarding me with extreme suspicion).

Aren't parents like Ms. Hyphenate the ones who pediatricians are actually "firing" from their practices, to protect the other kids from infectious diseases harbored by the unvaccinated?

Looking forward to seeing Dr. Hickie's take on this gem of a parent.

By Dangerous Bacon (not verified) on 07 Jul 2016 #permalink

Given that my child has not been tested to determine if he or she is allergic to any or all of the ingredients, there won’t be any injecting going on just so we can see what happens.

I would dare this lady to be consistent and also keep her children away from:

Except that if she did... I would fear for her poor children.

By Helianthus (not verified) on 07 Jul 2016 #permalink

By the way, there is nothing more Orwellian than the name "VaxTruth".*

*except maybe "The Ministry Of Vaccine Information".

By Dangerous Bacon (not verified) on 07 Jul 2016 #permalink

Given that my child has not been tested to determine if he or she is allergic to any or all of the ingredients, there won’t be any injecting going on just so we can see what happens.

Except she kind of has, as aluminum is literally EVERYWHERE, and your body produces more formaldehyde than is present in any vaccine.

I have a feeling most pediatricians (who don't run with Bob Sears, etc) would be like, "ha, GTFO" if a parent ever said, "You're fired" over vaccinations.

By Frequent Lurker (not verified) on 07 Jul 2016 #permalink

If she's so distrusting of doctors, why allow them to treat her family for anything? Broken bone? Mom better "research" how to deal with it, to make sure the doctors know what they're doing.

Speaking of family, that line, "vaccinating my babies is not right for my family." Anti-vaxxers use that all the time. It's just code for, "we don't want to vaccinate just because."

I got a stomach ache just thinking about her coming to my office. My practice has recently adopted a non-vaccination policy, and those families are asked to leave the practice after 3 refusals to vaccinate.

Why would you see a provider whose philosophy so differs from your own?

I realize now that that voice… that “intuition”… is the voice of God.

It's striking how often God is alleged to want people to do the thing that those people wanted to do anyway.

I really do think that the NVIC should change its name to the Orwellian-Named NVIC, or ONNIVC, because that is a more accurate description of it.

I'm willing to make a deal here: you may continue to call NVIC Orwellian until they stop appearing to use 1984 as an operations manual.

By Eric Lund (not verified) on 07 Jul 2016 #permalink
I realize now that that voice… that “intuition”… is the voice of God.

It’s striking how often God is alleged to want people to do the thing that those people wanted to do anyway.

I have my own intuition, and my intuition, which is also the voice of God, tells me her intuition is complete bullshit.

So now what?

This is the problem with faith-based approaches. Your faith says X. Mine says not-X. We can't both be right. AT LEAST one of our faith-beliefs must be wrong.

That's why we have science, to help us.

By Marry Me, Mindy (not verified) on 07 Jul 2016 #permalink

I hope that those 'who smoke' aren't offended by Orac's comparison of their thinking to that of Piper-Terry,
( I jest I jest).

More seriously: unfortunately, I've read quite few similar diatribes that TMs and others post about the 'net 'educating' parents who can then 'educate' their physicians.

A few TMs describe the 'trauma' of a visit hat includes attempts to vaccinate their child

Some even say 'Do your homework!' to the doctor.

There's also a release form that parents are supposed to give doctors to sign that asks if the physician can guarantee that vaccine are 'safe and effective' with no side effects etc.

By Denice Walter (not verified) on 07 Jul 2016 #permalink

In other news...

an AoA commenter on today's post- featuring Andy- compares VAXXED! to the award winning film, Spotlight.

I'll just sit back and wait for readers' reaction.

By Denice Walter (not verified) on 07 Jul 2016 #permalink

This is really not a new concern for the health care provider. As offered in Orac's last paragraph, good riddance fair maiden....

Heh. She mentions calling CPS like its a bad thing. If only we could get the unfortunate kids away from anti-vax wingnuts that easy...

The most common method of testing or allergies is an IgE skin test. Allergens are
I̶N̶J̶E̶C̶T̶E̶D̶ ̶D̶I̶R̶E̶C̶T̶L̶Y̶ ̶I̶N̶T̶O̶ ̶T̶H̶E̶ ̶C̶H̶I̶L̶D̶'S̶ ̶B̶L̶O̶O̶D̶S̶T̶R̶E̶A̶M̶ er, sorry, introduced into the skin with a
G̶I̶A̶N̶T̶ ̶N̶E̶E̶D̶L̶E̶ ̶O̶M̶Y̶G̶O̶D tiny painless pinprick. Then the site is observed for a reaction ( In the patients skin, not in mommy's behavior)

So she wants her kids to be deliberately exposed to possible allergens, in order to prove they have no allergies to any routine immunizations.

I'd be tempted to ask her if she's read the MSDS for whatever she took before she wrote this.

"I’d be tempted to ask her if she’s read the MSDS for whatever she took before she wrote this."

Or at least on each potential allergen that might be tested.

By Dorit Reiss (not verified) on 07 Jul 2016 #permalink

In reply to by Redblues (not verified)

As Dangerous Bacon asks: what is my take on this "gem" of a mom?

My response is even more predictable than Orac's.

1. This is the AV parent I unhesitatingly fired from my practice starting in 2013 when unvaccinated older kids were coming into my waiting room (during a whooping cough outbreak) floridly coughing pertussis over my unvaccinated newborn patients who then were at grave risk of getting ill. I don't miss this moronic, frothing-at-the-mouth, self-righteous, arrogant, I'm-gonna-show-you-mr-doctor type of parent like this at all.

2. AVers are much more emboldened and "assholistic" today than even a few years ago. This Luddite "Piper-Terry" jerk illustrates this well. I hope her children are able to see how mentally deranged she truly is and not grow up to be like her.

3. As a pediatrician, according to the AAP, I'm not supposed to fire such electively non-vaccinating families from my practice. Well the AAP has their head up their rectum on this, and has for years. Rumor has it the AAP may debate reversing this position at their annual meeting in October, but I wouldn't hold my breath waiting.

4. Meanwhile AV groups (NVIC, the Vaxxed/Wakefield/Dillweed clan, AoA, VaxTruth, GreenMed, Healthnut, Mercola, Natural News, etc) along with an increasing number of mediagenic AV physicians (Gordon, the Sears brothers, Paul Thomas (another FAAP pediatrician now with an AV book of his own coming out), and now Rachel Ross (family doc and "sexologist, from "The Doctors" -- ) continue to become increasingly AV vocal without any large scale public pushbacks (aka the AAP, AAFP, AMA, CDC, etc). As an example, the AAP has not spoken out against Vaxxed and/or Wakfefield. The local Arizona AAP chapter didn't have the guts to publicly speak out against Vaxxed showing in Phoenix and instead wound up looking stupid when it was shown they had quitely written a letter asking the movie theater not to show Vaxxed, rather than growing a spine and publicly coming out against it (which I did ( ) and more should have--WTH is wrong with my colleagues? ) I don't need any expertise, given the anemic efforts of groups that should be publicly pro-vaccine to speak out against AVers, to predict that vaccine rates are going to decline as well-meaning parents are scared out of vaccinating via the AV echo chambers of social media. AVers, of course, love driving down vaccine rates, because then there are vaccine-preventable-disease outbreaks that allow them to claim "vaccines don't work" and them claim "repression" if laws like SB277 are introduced, further making them look like the victims as opposed to the pond scum they are. Since AVers don't care about children dying from vaccine-preventable diseases in the least (look at the love fest between the Vaxxed people and the "parents" of Ezekiel Stephan, the 18 month-old toddler who died from empyema and meningitis because his AV "parents" couldn't be bothered to seek health care during the 2 weeks of his severe illness), this scheme works well for their goals.

5. Meanwhile, about 60 miles from me there is a measles outbreak (since late May) in a detention center due to people (staff of this detention center) not being and refusing to be vaccinated. 22 cases and apparently because this is a Homeland Security/ICE facility the employees may not be bound by any Arizona public health laws and have some sort of federal protections ( which is f****** insane.

So my take? I don't think I'd have become a pediatrician were I in medical school today. Too late for that now, so I wish I could grab some popcorn and pretend I don't care about the illness and death that are going to happen because AVers are dominating the stage with their stupid. But I can't do that. This whole scenario stinks, and I fear what is going to happen next before it gets better.

By Christopher Hickie (not verified) on 07 Jul 2016 #permalink

It kind of cracks me up that this chic thinks a doctor will be hurt by her saying "you're fired". Lol. Yeah, in a country with a huge shortage of pediatricians, I'm sure he won't miss you. And in a country where it costs more for a doctor to talk to patients than they are compensated by Medicaid, Medicare, or insurance companies than he is paying out in overhead and labor expenses, he won't mind losing a patient that fights him on everything. (Pediatricians are the lowest paid specialty and make the bulk of their money on procedures and tests.).

Trust me, little miss know-it-all, he won't miss you or your precious little snowflakes.

@ Misty #26--I sure don't miss this type of parent, but I do fear for their children being at risk for diseases they shouldn't have to be. It's sure not the kids' fault they have a parent who fell off the deep end.

By Chris Hickie (not verified) on 07 Jul 2016 #permalink

@ #25 Christopher Hickie:

I didn't know the AAP was against firing non-vaccinating families.

My pediatrician won't allow patients to deviate from the immunization schedule at all. There are notices up in the office and on their website. I know that most pediatricians in my area are the same.

Why is this loon going to a doctor at all? She should just do the Stephans trick and shun all medical professionals. For ever. Save the doctor a lot of aggravation and potentially give her the result she richly deserves, well except for the dead child.

Dr. Hickie, please don't despair. There are parents out there who have been on the fence (me included) that still trust their Pediatricians and are willing to listen to doctors versus going with their "gut" (I mean, what new parent isn't uneasy about causing their child pain (from the needle stick), even if it is temporary and will help keep them healthy). It still sucks to watch, though it gets easier over time. Though I was never a hard core "anti-vaxer", I did fall into the whole attachment parenting club and read a lot of what Dr. Sears wrote. Luckily, I never went too far down the rabbit hole to go against my Pediatricians recommendation and then found the Skeptics movement that helped me look at the world with more of a critical eye. Please keep up the good work. Though you probably won't convert the true believers, there are plenty of on the fence parents who can be helped.

Today on Figure1 Q&A with Dr. Hicks, director of Mutter Museum and Historical Library, College of Physicians in Philly for over three decades -- "What medical innovation has had the greatest impact? Vaccination. "

I teach science methods and one of the required segments for teacher licensure is instruciton on reading MSDSs. I use the usual elementary school chemicals - vinegar, baking soda, sugar, salt; but, my favorite one is the MSDS for water. Yep, that old evil dihydrogen monoxide.

Ugh. If I were a pediatrician, I think I'd come up with a quiz to administer to parents who claim they've "researched" vaccines. Just some very basic questions like:
1) What is the route of injection for childhood vaccines - ID, IM, or IV?
2) Name one type of antigen-presenting cell.
3) Name the type of cells that produce antibodies.
4) What type of liability are vaccine manufacturers protected from: manufacturing defect, warning defect, design defect, or all of the above?

And so on. If they can pass the quiz (in my office, without looking the answers up on their phones), then I'll accept that they are making an informed decision. When they fail, I've got the perfect opening to explain the correct answers and why they're relevant.

It’s striking how often God is alleged to want people to do the thing that those people wanted to do anyway.

I find that astounding as well, you would think The Almighty would every so often have the balls to tell one of these people to stop being a narcissistic wanker.

Sometimes I think we suffer from a major lack of Godly smiting and Karma doesn't seem to be up to the job nearly often enough.

It's and ironically true policy, Angela given that the AAP allows anti-vaccine pediatricians like Jake Gordon and Robert Sears and Jim Sears and now Paul Thomas who have all profited handsomely from selling anti-vaccine materials such as books and DVDs as well as being very openly and publicly anti-vaccine to remain members of the AAP with no criticism whatsoever from the AAP ( in my opinion these anti-vaccine quack pediatricians should be immediately expelled from the AAP and stripped of their license to practice medicine ) The frustration to me is that parents will come in with materials from these anti-vaccine pediatricians citing them as why they're not vaccinating, yet the AAP will then tell me I need to spend more time in the exam room convincing these parents to vaccinate. The utter hypocrisy of the AAP on this is appalling.

By Chris Hickie (not verified) on 07 Jul 2016 #permalink

"I distrust those people who know so well what God wants them to do, because I notice it always coincides with their own desires." Susan B. Anthony.

By shay simmons (not verified) on 07 Jul 2016 #permalink

AVers are much more emboldened and “assholistic” today than even a few years ago.

That surprises me. I would have thought that the past few years would have had the opposite effect. Or maybe only the most hardened ones remain.

By Julian Frost (not verified) on 07 Jul 2016 #permalink

SDS (MSDS) sheets are not even used by chemists. I've run a chemistry research lab for decades, and although we keep them on hand, as required by law, they are not informative enough to be referred to even once. *Nothing* about how you need to handle a chemical, or how "dangerous" it is, can be learned from them. They are, as Orac says, legal documents, to prove that workers are not being unwittingly exposed, and for emergency personnel to refer to, should there be an accident or major spill.

I have written SDS sheets myself, for chemicals that I invented and first synthesized, and they are legal only, not any actual information that would apply outside OSHA.

Also, my sister, the head of a large pediatric practice, has, like Christopher Hickle, had enough of unvaccinated children exposing infants in their waiting rooms, and banned all unvaccinated patients from their practice. It was such a momentous decision, apparently, that she was interviewed and had articles written, etc. They haven't looked back, and won't.

By Garnetstar (not verified) on 07 Jul 2016 #permalink

A pediatrician posting on a message board in which I participate, made a big deal about how his approach to antivax/vaccine-suspicious parents was much superior to that of less tolerant peds. He was all for accomodating their wishes if he couldn't convince them to vaccinate their kids, accepting no-vax demands or limited vaccination schedules.

The last I heard from him on this subject, he had decided to no longer accept the kids of antivax parents in his practice. It seems that his office was becoming a dumping ground for their kids, as his colleagues had stopped accepting them, and he no longer was willing to accept pushback from other parents given the risk of disease outbreaks from these unvaccinated children filling his waiting room and office.

By Dangerous Bacon (not verified) on 07 Jul 2016 #permalink

I wouldn't bring my kids to a pediatrician who accepted non-vaxxed (or limited vaxxed) patients.

Especially during the newborn/infant days. I would be nervous bringing my newborn into an office with potentially infected children.

We were those parents who asked family get an updated Tdap before seeing our babies.

Of course God didn't want her to vaccinate her kids. Haven't you read the Old Testament? God loves raining down plagues on the innocent. If kids are vaccinated, then God has to develop a new plague. God's got other things to do.

I'm trying to imagine how you would arrange a pediatric practice for anti-vaxxers who are still willing to do the rest of the checkups.
First, no communal waiting room, just a little tiled white room. No toys, of course, but maybe a plastic stool you could bleach every day.
Then, all the doctors and nurses are gowned and masked, somewhere between what you wear in an animal facility and what you wear in a clean lab. (Scary for the kids? Sure. But the only way to stay clean.)
Super bare-bones exam rooms, just a stainless steel table and the bare essential equipment, all shrouded in plastic.
And sadly, the last step would be making the doctors and nurses shower out (every child? every day?).

Of course, to make this work you'd have to charge an arm and a leg to get all the disposables and people willing to put up with all that cleaning.
But it would be safer than letting them be in with the rest of the population.

By JustaTech (not verified) on 07 Jul 2016 #permalink

Justa Tech,

A much simpler method: anti-vaxxers and theirs children are only seen in the parking lot.

This is the AV parent I unhesitatingly fired from my practice starting in 2013 when unvaccinated older kids were coming into my waiting room

Christopher Hickie #26, how is that helpful for the greater community? Isn't it akin to descrimination against the 'religion' of those who don't wish to vax? How does that ban hammering serve society as a whole? Will the undiagnosed, untreated kids just be let loose to infect all manner of the general populace; many of which spend more time at McDonalds than in your waiting room? Some diseases require isolation-- those diseases need professional confirmation; Something that won't happen within the confines of your self-proclaimed buisness model.

You have a back door into the practice, don't you? It may serve to scare the non-vaxxing parents into compliance if they had to wait in a tiled room with quarts-enveloped germicidal uv lights... and waiting in the car before that.

I was chided for mentioning 'let them wait in the car'. The point is Moot as you can't even spare a lacky to go out to the car and give an initial evaluation. You've condemed a class of people mearly over your ideology and possibly let loose a disease on the greater populace at large.

I'd say your modus operandi is intended to be little like genocide of non-vaxxers-- do you intend to weed them out? Well the non-vaxxed are not dying at greater rates than the vaxxed. What do 'null hypothesis' mean???

I have other children who are immune-suppressed… and either cannot be vaccinated or have lost their vaccine immunity from medical treatments.

Sounds plausible. I guess, you can’t just ask them to wait in the car, after all.…

You can't ask them to wait in the car. If all the non-vaccinated can't even wait in the car then how do you get them vaccinated before they are allowed into your practice????

You all sound like the biggest imbeciles I have ever heard gathered in one dark small corner of the internet! If this is any representation of what our approach to medicine and those who support it looks like today we are in for it. One day I hope you realize how idiotic you all sound and ORAC I thought Paul Offit was a monster but you are in a class all your own. WOW. Pukes like yourself should never ever be allowed to be viewed as a person of any knowledge in the field let alone be able to treat anyone. Shame on you. So I say so long since I will be banned like I was from Science Based Medicine since folks like you cant handle the opposition to you Quacks that all stroke each other!

In other news, the Crown is appealing the sentence of the parents of Ezekiel Stephan.

"God loves raining down plagues on the innocent. If kids are vaccinated, then God has to develop a new plague."

We have it: a plague of anti-vaxxers.

On the matter of SDSs, there is substantial variability in quality among manufacturers. It has been a few years since I looked at one from them, but I used to regard those from Baker as significantly better than from other lab or industrial chemical vendors. I used to recommend them to textile artists for common chemicals used in dyeing.
While an SDS that states or implies that deionized water is hazardous is amusing, at the same time I regard it as grossly inappropriate and a black mark against both the company that issued it and any agency that would find it acceptable. It devalues the whole notion of SDSs as sources of viable information. I'd confiscate the crayons from anyone who wrote such a sheet.

Of course the likes of Piper-Terry reading them for "research" simply provides more evidence that those who don't understand fundamentals aren't going to do a good job of assessing details.

Forgot to mention - Triton X-100 and related surfactants are used to kill viruses in the preparation of human blood plasma.

Depending on the volume of product infused and the frequency of infusion, the permitted residual levels of TNBP, Tween 80 and Triton X-100 are generally, 3–25, 10–100 and 3–25 ppm, respectively.

from Guidelines on viral inactivation and removal procedures intended to assure the viral safety of human blood plasma products (WHO, here)
I suppose Piper-Terry would demand raw, unprocessed plasma for her snowflakes. None of that packed, processed stuff for them!

@Nick: If you do get banned it's not because people can't stand dissent, it's because you're a troll. You make aggressive statements based on your belief in a set of "facts" that are simply not true. You make no attempt to engage in debate, you simply hurl abuse, like a creationist at an evolutionary biologist's blog or a climate denier encountering Michael Mann.

The reason that scientists all tend to agree is because they are looking at the same evidence. There is no cabal, no conspiracy, just an overwhelming body of evidence showing that vaccines are effective and safe in preventing deadly diseases.

By Guy Chapman (not verified) on 07 Jul 2016 #permalink

Exactly why Nick was banned. He was an asshole over at SBM calling people morons and imbeciles and contributed nothing of value to the conversation. Banning him was an easy decision. I'll give him a chance here, keeping him on a short leash, but judging from his first contribution I don't think he'll be around long. Who knows? He could surprise me and be a bit more civil.

@#45 Gilbert

It's rich that you would ask "how is [giving the children of AV parents the boot] helpful for the greater community?" Is bending over backwards to serve subscribers to a certain "religion" that routinely practices against the public health really helpful for the greater community?

Anyway if these AV parents are so adept at medicine that they can correctly identify when their children should not be receiving vaccines, they're probably smart enough to diagnose and treat their children at home.

By Benjamin Nagy (not verified) on 07 Jul 2016 #permalink

@ Gilbert #45--you have reasonable points that all have valid refutations

1. Vaccination is THE STANDARD OF CARE. Unless your child has a valid medical reason for not receiving vaccines (and I do have a few patients who have had chemotherapy or organ transplants and those families are not expelled for not vaccinating because that is a valid medical reason), there are really no other reasons a child should not receive vaccines. Thus if you are a parent who electively non-vaccinates, you have abandoned (with no valid reason) the standard of medical care. It is the abandonment of this standard by far too many parents that has led to record-setting outbreaks of pertussis and measles in the US these last few years.

2. Electively not vaccinating your child is far worse for the "greater community" than my not seeing your electively unvaccinated family in my office. But my letting you traipse all your electively unvaccinated children into my office (back doors are nice, but parents often still just bring in their sick child unannounced through the front entrance which defeats this strategy) is far more of a risk to my infants too young to be vaccinated and also children such as in 1 who can't be vaccinated and need herd immunity for protection, including in my office. I will not place my most fragile of patients in that position if I can avoid it, and expelling AVers greatly decreases that risk.

3. My office will not be the reason a vaccine-preventable disease outbreak begins or continues, such as happened in 2008 when an unvaccinated patient of Dr. Bob Sears brought measles into another doctor's office, triggering the 2008 San Diego County measles outbreak. (look it up, read up on it and realize why I despise Sears).

4. .Doctors have the right to refuse to see a patient for noncompliance. In this case, electively refusing to vaccinate is a sever form of noncompliance which is a no-brainer for either termination from my practice or refusal to see you in the first place. I do have a duty not to simply "dump" patients, and those families I did terminate were given a contact list of other physicians to whom they could go take their children. Now you might ask what if all doctors refused to see anti-vaxx families? Well, to me that would be just dandy, because it would mean doctors have finally banded together to send a strong message about the importance, efficacy and safety of vaccines.

By Christopher Hickie (not verified) on 07 Jul 2016 #permalink

If pediatricians have to put up with MSDS papers being waved in their face by crunchy moms, they should keep a few copies of the MSDS for sand on hand to give out. Maybe the doctors can even keep a straight face when they recommend all the following personal protective gear for mom and kids for their next trip to the beach: Safety glasses. Lab coat. Dust respirator. Be sure to use an approved/certified respirator or equivalent. Gloves.

By Verna Lang (not verified) on 07 Jul 2016 #permalink

As a pediatrician in practice for 40 years, this isn't difficult. I offer parents my knowledge and experience. I have no interest in confrontation and I don't have time for more than a limited discussion. If a vaccine with the potential to prevent 85% of breast cancer cases were to be approved this year, there would be many, many parents who would never give it to their daughters (too new in first 10 years, unknown long term adverse effects, no family hx of breast cancer, etc.). If it were successful in making breast cancer a rarity, a future generation wouldn't see the need to give it to their daughters.

I do have a duty not to simply “dump” patients, and those families I did terminate were given a contact list of other physicians to whom they could go take their children

Good on you. You mentioned the measles outbreak in a detention center near you? The prisoners have no choice, they are all forcibly vaxxed::

"And so they're actually the ones that are passing along the measles among each other and then going out into the community," Schryer said.…

Shouln't there be some fallback for these 'guards' so that they don't needlessly be mindless 'vectors'?? I'd make them wait in the car for hours because I hate 'authority'. But still....

Nick: "So I say so long since I will be banned like I was from Science Based Medicine since folks like you cant handle the opposition to you Quacks that all stroke each other!"

Nicky, Nicky, Nicky... you were asked multiple times to post evidence for your claims, but you just decided to provide insults. You dismissed the preventable death of Ezekiel Stephan by trying to change the subject to cancer and cholesterol.

Then when you could not post a website that said stupid and wrong things about someone, you resorted to a sockpuppet. The latter being why you were banned.

As far as trolls go: you were incredibly incompetent and silly.

Hey, Nicky, have you figured out why measles incidence dropped 90% in the USA between 1960 and 1970?

@ Gilbert #56: the State of Arizona has legally given theHealth director of the Arizona Department of Health Services the power to quarantine during outbreaks which should include the power to tell the guards at this facility who are unvaccinated or refuse to supply proof of vaccination that they cannot go to work at this facility until the outbreak is over. I would call it waiting at home rather than waiting in the car. They can do it for an outbreak in a school with the unvaccinated children in that school so they should be able to do it for this facility as well, and they need to before this measles outbreak spreads to the neighboring communities including the one I live in.

By Chris Hickie (not verified) on 07 Jul 2016 #permalink

doug: "In other news, the Crown is appealing the sentence of the parents of Ezekiel Stephan."

One of the biggest difference between Canada and the USA... that would not be allowed in the USA. I am not a legal scholar, but I believe that falls under the double jeopardy category.

All I know as someone who lives close to Canada and has several in-laws in Canada, is that their laws are quite different from the USA. Contrary to many expectations, many Canadians (including several of my in-laws) are quite conservative. Just ask Mr. Floatie.

Yes, I do bring up sociable turd when some naive American waxes poetically about "Super Natural British Columbia." Oh, come on! My Canadian in-laws actually listen to Rush Limbaugh on Vancouver Island, and several actually believe him.

Do you think the radio waves cancel out because they cross an imaginary line? (though we have found out that mobile phone signals fail after a few yards from the border crossing in the last few years... now we have plans that work across the border).

I am not a legal scholar, but I believe that falls under the double jeopardy category.

Something something Jose Padilla something.

Narad, seriously? Is that the best equivalent you could come up with? Come on, I know you can come up with better than that.

Couldn't you have at least posted something about the legality of the RCMP surveillance in British Canada to help solve the Rafay Family murder in Bellevue, WA in the USA?

If there is anything that shows the difference between the laws of Canada versus the USA, that is it.

Perhaps you are a better legal scholar than I am. I just know that there is a really big difference in personal freedoms and legal rights when you cross the border. There is no Bill of Rights in Canada. And, yes, I did once annoy a border guard... but only because the restrooms for one side was unavailable, so we did a bit of a walk around (it was in the interior, and we confused a couple of Canadians... and hubby's cousin up the road was very amused).

Gilbert's comment #45 is sticking in my craw.

how is [firing antivaxxers] helpful for the greater community?

It protects those too young to be vaccinated, those who can't be vaccinated, and those who are immunosuppressed, against being exposed to diseases.

Isn’t it akin to descrimination against the ‘religion’ of those who don’t wish to vax?

1) Most religions support, even encourage, vaccination.
2) The Jaguar Religion of South America and the Pagan Religions of Europe both practiced human sacrifice. While it would be unconstitutional to prevent people from practicing those religions, it would not be unconstitutional to prevent them from practicing human sacrifice. Religion, custom and tradition can't be used as justification for harmful or unlawful actions.

How does that ban hammering serve society as a whole?

It serves society by protecting those too young to be vaccinated, those who can't be vaccinated, and those who are immunosuppressed against transmissible diseases that could kill them.

Your entire screed is a long "c'mon be reasonable now" whinge. It forgets the simple truth that those who refuse vaccines for non medical "reasons" are not behaving reasonably or rationally.

By Julian Frost (not verified) on 07 Jul 2016 #permalink

Narad, seriously? Is that the best equivalent you could come up with? Come on, I know you can come up with better than that.

I'm not sure what you're getting at. I don't know whether Padilla's resentencing was a result of an appeal that he initiated or not, but the question – which I'm way too tired to answer right now – is when jeopardy no longer attaches to a case. You were the one who said "that would not be allowed in the USA."

Appeal of sentence is moderately common in Canada. Both the Crown and the convicted can appeal sentences, and it can backfire - sentences can be decreased on appeal by the Crown or increased on appeal by the convicted. Such appeals generally only happen, as far as I've noticed, when the original sentence is near one end or the other of the statutory or generally accepted range for the crime in question. Such appeals do not introduce new evidence, but argue the length or conditions of the sentence only.

It's hot. I think I'll have a glass of lemonade.

Well - maybe not. It seems citiric acid can cause neurological damage and present with tremors and convulsions. Hey, I wonder if it might be a cause of autism?

Routes of Entry: Inhalation. Ingestion.
Toxicity to Animals: Acute oral toxicity (LD50): 3000 mg/kg [Rat].
Chronic Effects on Humans: May cause damage to the following organs: teeth.
Other Toxic Effects on Humans:
Hazardous in case of inhalation (lung irritant). Slightly hazardous in case of skin contact (irritant, sensitizer), of ingestion.
Special Remarks on Toxicity to Animals: LDL[Rabbit] - Route: oral; Dose: 7000mg/kg
Special Remarks on Chronic Effects on Humans: Not available.
Special Remarks on other Toxic Effects on Humans:
Acute Potential Health Effects: Skin: Causes mild to moderate skin irritation. May cause skin sensitization, an allergic reaction, which becomes evident upon re-exposure to this material. Eyes: Causes moderate to severe eye irritation and possible injury. Ingestion: May cause gastrointestinal (digestive) tract irritation with nausea, vomiting, diarrhea. Excessive intake may cause erosion of teeth and hypocalcemia (calcium deficiency in blood). May affect behavior/central nervous system (tremor, convulsions, muscle contraction or spasticity). Inhalation: Causes moderate respiratory tract and mucous membrane irritation.
Chronic Potential Health Effects: Frequent intake of citrated beverages may cause erosion of dental enamel and irritation of mucous membranes.

Narad: "I’m not sure what you’re getting at"

The RCMP employed surveillance methods that are not legal in the USA. While they managed to get enough evidence to extradite them back to the USA, once the Canadians were assured that the state of Washington would not employ the death penalty, there was a possibility that evidence would cause a mistrial. And would they literally get a away with murder due to many legal issues.

Sorry, it was a very publicized local case that involved differences in laws over the border, and eventually one lawyer having an affair with a defendant.

Perhaps it would have been better to show the difference in laws across the border to mention how a journalist was detained at the border because they were afraid she would write bad things about Vancouver during the Winter Olympics:…

Because we live in an area where these kinds of stories often happen, and may Americans need to be reminded that the laws are different in Canada. I brought up the one I was most fascinated with. It had a very "The Rope" by Hitchcock vibe, which my very non-legal mind could understand better.

OK. Thx Chris Hickie, Julian Frost #64.

Gilbert’s comment #45 is sticking in my craw.

Ahh, only birds and insects have crops (craw). I do get your sentiments though. I can see that the pediatrician's office may have a disproportionate number of vulnerable persons -- I'm sort of a germophobe myself; Culminating in hating the coughing guy in the traffic court.

But a serious disease undiagnosed may go unquarantined. So the doctor's office will not be exposed but at the peril of the public pool, the fast food joint, the restaurant with the open salad bar, ..., playground, church, school, the grocery store carts and fresh fruit isles.

I get it minimizes the risk for the office. It minimizes but doesn't rule it out completely as the vaccinated can also still catch the disease. At that point, vaxxed or not, the office is still in jeopardy. Oh well,if only the vaxxed are seen then only the vaxxed will get duely quarantined.

What is the absolute value of the real risk between those who catch measles and the 250 million other people who are vaxxed against it? What are the real numbers between adverse reaction to the vaccine compared to a bad outcome from measles?

in rare cases, the vaccine has been linked to seizures, deafness, brain damage, and coma. ...

... In the United States, about two in 1,000 people die from measles annually. In fact, measles is the fifth leading cause of death and sickness in children worldwide

For the potentially infected, unvaxxed (though at this point it does not matter about the vaccination status -- sick is sick) persons just walking through the door, have a buzz in system or drivethrough window for an initial assesment. There are drivethrough vet clinics -- personally, I'd rather visit the window first instead of sitting crammed in with snotty, sneezy sick people; especially if all I initially had was an allergy to ragweed pollen.

Gilbert @56:
According to this story the inmates were not "forcibly" anything:
"One was for the inmates or detainees to become vaccinated," Schryer said. "They all agreed to do that so they are immune and are not passing the disease amongst each other."

By Emma Crew (not verified) on 08 Jul 2016 #permalink

Because we live in an area where these kinds of stories often happen, and ma[n]y Americans need to be reminded that the laws are different in Canada.

I'm aware that Canadian law is different. The answer from doug – including the backfiring part, which is why I mentioned not knowing the origin of the Padilla resentencing – was helpful.

Carrying on about how I was supposed to "come up" with something about RCMP surveillance in a completely unrelated case was not: I was talking about your assertion regarding U.S. law.

My apologies.

detainees have since been vaccinated. Convincing employees to get vaccinated or show proof of immunity has proven much tougher, he said

from the article I linked, I'm not seeing your quote.

They all agreed

So 1200 inmates just 'all agreed'??? Agreed? I think 'threatened' is a better word.

No problem; I was just becoming increasingly perplexed, but I also have a head full of tramadol after some recent rib fractures, so that likely played a role.

Ow, ow, ow! Ribs were my first broken bones (lap belt injury from car crunch). I hope they don't hurt for very long.

I also realize that I have some odd interests.

I have a golden memory of examining an approximately 5-year-old child during my peds rotation and having the brat express his displeasure by pounding on me with his tiny but hard fists (mom looked on, saying nothing but regarding me with extreme suspicion).

Was his name Danny, DB?

[Way Off Topic]
Chris: I don't understand what you mean by the "Rope" vibe. (There's no "The" in the title.) It's not relevant to the point, of course, but I'm just curious.

Rope, loosely based on the Leopold and Loeb case, is a simulated single long-take real-time narrative. Two upper-class young men strangle a friend to death with a piece of rope, purely as a Nietzsche-inspired philosophical exercise. They consider the friend inferior, and seek to prove their intellectual superiority by commiting a 'perfect murder' as a work of art. They've planned the crime to occur just before a dinner party to which they've invited the victim's family and fiance, and also the prep school housemaster (Jimmy Stewart) who's Nietzschen lectures they'd misinterpreted and twisted into inspiration and justification for the murder. They hide the body in a chest, and then use it to lay out a buffet dinner for the guests. Over the course of the dinner party, Stewart's character becomes more suspicious, eventually discovers the crime and alerts the police.

I looked up the Rafay case, and it's been compared to the Menendez murders. The motive was monetary, the killers had established an elaborate alibi, and as you note it took extraordinary surveillance by professional LEO over a long period of time to uncover their guilt – not the suspicions and questions of a former teacher over a little more than an hour.

I don't mean to be critical – we all have vague memories of this movie or that, and relate those memories to real events in often idiosyncratic ways. Rather than trying to enforce a 'correct' interpretation, I'm more interested in the different things people take away from films. So I'm just wondering how/why the Rafay case reminded you of Rope in that vein.

When I allowed my older child to be vaccinated, I felt a horrible sense of dread every time. I “knew” it was wrong. My mother’s intuition was screaming at me to grab my baby from that table and run out the door… but I didn’t know why… and I didn’t listen to that voice.

Fully half of parenting young children is anticipating behaviours. Sometimes you're right, they do or don't do exactly what you expect. Other times, you're just dead wrong and you learn, or in my case, file it away and drink more coffee. There is no special mother's intuition. Passing a child from my vagina did not imbue me with noteworthy instincts.

And now, I know why vaccinating my babies is not right for my family.

I know better now; so now, I will do better.

Can you show us evidence of your tubal ligation?

sadmar, sorry I mucked up the movie title. It was not quite like Menendez murders. Though the motive was financial both Rafay and Burns thought they were smarter than anyone else. They hung out together in their British Columbia high school, and were essentially their own little clique.

There were several comparisons to Leopold and Loeb in the news, in several blogs and the book Perfectly Executed by Peter Van Sant and Jenna Jackson. I have a copy of the latter, I believe it will be my reading material for a cross country road trip*.

There was a true crime website that I think was attached to a cable channel, I think it is now gone. It had a whole section on Leopold and Loeb. It included other crimes that were similar, and one about Rafay and Burns. Which included more details about Burns having an affair with his lawyer.

But I found another that made the same connection:

As it goes I followed this story because it did remind me of TheRope, and because I am fascinated by people who do really off the wall stuff. This is perhaps why I am following the story of the stupid white guy who waved a gun at those participating in a "Black Lives Matter" march in downtown Portland, OR yesterday. He is presently being held with bail at $250,000 (this site has the best comments):…

I forgot to explain the * bit. Okay...

* I am presently reading The Lost Bank: The Story of Washington Mutual-The Biggest Bank Failure in American History Paperback by Kirsten Grind, which I checked out from the library. I recently saw the movie "The Big Short", and remembered that the bank that held my house mortgage and was the bank my great aunt helped me start my first savings account at because it survived the depression (the Yakima branch, curiously it was Branch #13). It is also the bank that drove me nuts when we refinanced in 2003, and I had to deal with idiots in California even though we were very close to its Seattle headquarters. For a basic thirty year mortgage with an actual verifiable income we went through several circles of Hades. Go figure. At least Chase now sends us statements (though we did have to ask a few times).

I have been screaming at the book in anger over what they put us through. I figured the book about the Rafay Family Murders would be calming. (by the way, I am really upset that he decided to murder both his parents, but also his disabled sister).

By the way, one other way they were different than the Menendez brothers (who both suffered with low grades, and were not super duper bright stars): they got very little money. Oops.

By the way, I have been also abnormally following the Oregon Occupation by Idiots. There will be a fictionalized cartoon book made of it. She the details here:

I hope they don’t hurt for very long.

Nonono. It's the best chance I've had to quit smoking in a long while. The original pain, though, was making it hard for me to breathe, hence a 911 production number and being treated as a drug-seeker after picking the wrong ER (to the point of the nurse – apparently dumbfounded that I was in just as much pain, modulo the cannula, which dried things up a bit – upon my discharge* publicly shouting that "those were old fractures!").

I'm hoping for just tolerable pain to get the job done.

* The "good" checkbox had been ticked in the "patient condition" entry on the paperwork.

@ Narad:

Using illness ( or fear) can be an excellent strategy for quitting smoking. I think that I might have discussed my own series of attempts that ended in eventual success.

I started smoking as an adult - university days- and then worked in a crazy art studio/ ad agency before graduate school and additional pressures. After a few years I decided to use my knowledge of habit and therapy to quit. What really helped was getting bronchitis ( on a New Year's Eve) and taking months to recover. Thus I set about on a regime of self- intimidation ( frightening myself with images and medical reports) and using relaxation and self-hypnosis.

A year later ( after perhaps 10 tries) I had a flu-like illness and lost weight and THEN I was finally able to quit. I only gained back the weight I lost. I also purchased some sort of quit-smoking lozenge with lobeline/ lobelia ? IIRC.

Bon chance.

By Denice Walter (not verified) on 09 Jul 2016 #permalink

In other anti0vax news..

Dan Olmsted ( AoA) continues perseverating about polio and toxic metals in sugar.
Oh wait, that's not news.

By Denice Walter (not verified) on 09 Jul 2016 #permalink

This is how Rod Sterling may have been scripted today:

"Imagine if you will' a time and place where your mind and body is torn apart by leachable-contaminants embedded in a solution of invisible creatures that terrify our daily lives. A time where the fear of a tiny needle piercing the skin can transport your brief existence to a place of no return. A place where some are haunted knowing resistance is becoming more frustrating and futile. Enter the twilight zone...

By Michael J. Dochniak (not verified) on 09 Jul 2016 #permalink

Narad: "The original pain, though, was making it hard for me to breathe,..."

The pain while trying to breathe was what I remember most. Though, unlike you, I had been in a car accident so there was no question at the ER. I ended up with a three day hospital stay.

Gilbert @73 Sorry, I failed to paste in the link, it was a story Chris Hickie posted.

On the other hand, seeing as how the inmates are immigration detainees in AZ, most of them would be from Mexico, where there is much less antivax sentiment. I would not be surprised at all if the vast majority agreed without coercion.

By Emma Crew (not verified) on 09 Jul 2016 #permalink

Thanks, Alain.

By Dorit Reiss (not verified) on 09 Jul 2016 #permalink

In reply to by Alain (not verified)

A time where the fear of a tiny needle piercing the skin can transport your brief existence to a place of no return.

It really does, doesn't it? That irrational fear really does drive certain people completely into the twilight zone.

LW says (#89),

That irrational fear really does drive certain people completely into the twilight zone.

MJD says,

A definition of "Twilight zone" from the Merriam-Webster dictionary: a situation or an idea that is unclear or confusing.

As some posts have suggested, when Safety Data Sheets (SDSs) lose their validity through absurdity we truly live in a vaccine "twilight zone".

What should we do?

Stay respectfully insolent and carry on. :-)

By Michael J. Dochniak (not verified) on 10 Jul 2016 #permalink

Chria: Thanks for the Shawn Biore link. I thought it might be that the killers felt themselves to be 'superior beings' in some way, but the fact Sebastian Burns starred in a school production of the stage version of "Rope" obviously sealed the deal that it would get referenced. I wondered what part he played, and Google revealed that, yup, he played Brandon (John Dall in the movie), the alpha-dog sociopath who leads the more 'weak' Patrick (Farley Granger) into the murder. Also, IRL, Atif Rafay seems to have played Patrick to Burns's Brandon, going along with Burn's in the murder plan, but standing by passively in one room while Burns went through the house bludgeoning the family with a baseball bat.

These similarities are all 'backstory', though, and the action in Rope is quite different from the Rafay case. Which is why I wondered how seeing the film would be recalled by the details of the Rafay murders themselves. But, obviously, I wasn't aware of the connections that had been discussed in the press. Creepy stuff...

You're welcome, sadmar.

I was taken aback when I realized that this happened twenty years ago, and much of the online articles have disappeared. I followed it closely because the psychology was fascinating, with a dash of confounding variables due to an international border.

I have weird interests. At least I know I am not alone. At our latest Skeptic's Meetup there was a presentation on the "Patriot movement" by David Neiwert. He has been reporting on these guys for about thirty years, and is currently contributing to the Southern Poverty Law Center HateWatch blog. I learned at that meeting that I was not only one fascinated by the Oregon Occupation by Idiots:

I just realized that I am fascinated with the Dunning-Kruger effect.

Burns and Rafay thought they could get away with murder and grab some of Rafay family cash (though I suspect Burns convinced Rafay to do this). But they did not have a realistic idea of how estates worked, and how a home's sale price would be affected by its history. Despite being book smart, they were just two adolescents who had no idea how to the adult world worked.

The "patriots" have this very weird interpretation of both the US Constitution and "freedom" (basically they get to do what they want no matter who they hurt) --- and have ignored the actual laws.

One of my "favorite" bits is that they believe they can drive on roads and partake in the use of public property but not have to get a driver's license nor register their vehicle. Fun folks. We know at least a few (including us) who have literally collided with them on the roads. Oh, our insurance companies (and yes, they don't have insurance) are not happy with them!

Unfortunately the "patriot" movement has become global. I have learned through podcasts that "Freeman on the Land" have infested both Norway and Australia! Yikes! And um, sorry from us in the USA where this may have originated.

I don't think we in the USA are solely responsible for the anti-vax fools.

Fun folks.

I block video embeddings, so I didn't see what came after the colon in comment 92, but there's no shortage.

Narad, the video is entertaining (easily found using the search words "ballad of the malheur patriots"). It is by a comedy musical duo that accurately summarizes the Oregon Occupation by Idiots.

Dealing with unlicensed drivers with no insurance --- not so much. Especially one when a vehicle was T-boned less than a week before we had to fly to the Mayo Clinic for son's open heart surgery. Fortunately the driver was not injured, but the car was totaled.

We had to deal with some insurance phone calls in son's hospital room, and it was quite "fun" to find out the driver had no insurance.

We are not fond of these fools.

I especially like that line from the "mother"

"For good measure, I will probably throw in, “And you’ll be hearing from my attorney,”"

Yeah, a doctor has never seen that before. Everyone loves to yell that, but the fact is that most attorneys don't like to lose, so they aren't going to take a nutjob's case like this. Even if they do, they're going to insist on $$ up front since losing means that they're going to have to pay for the doctor's defense(I've seen this more than once)

Thanks A in Ca, I saw the original blog post from Dr. Niyas -- it was posted by a pediatrician friend, but had not seen the BBC coverage.