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    Nudge the Anti-Vaxxers

    By Michael Maiello on Tue, 02/03/2015 - 5:45pm | Health

    At least on the internet, the anti-vaccine people have become social pariahs.  But, life is not the internet.  Life is more complicated than that. Phil Plait at Slate reminds us that the anti-vaccine movement is not a growing, nationwide phenomenon.  In aggregate, people are getting more vaccines, not less.  But pockets of anti-vaccination sentiment are growing and hardcore pockets can do damage even if overall numbers rise.  Unlike climate change denialism, this one is non-partisan.  Plenty of religious conservatives have their reasons.  Plenty of authority-hating libertarians have their reasons.  Plenty of nature-loving granola crunch liberals have their reasons. Plenty of Whole Foods shopping, holistic-healing believers have their reasons. It runs the gamut.  Some people do not vaccinate because they are poor and have no access to medicine.  Others are relatively well-off and are making choices.

    For the poor who would take it if they could get it, we just need to do a better job.

    For those who are making choices, and they are largely educated people using rational methods to reach an irrational conclusion, the problem is trickier.  I confess to a bit of cynicism here but I wonder if there isn't some sort of chaos mathematics at work here.  Oh, you think you wiped out a disease with your vaccine?  Well, here's a small but influential group of people who refuse to use the darned thing.  As Jeff Goldblum's character said in the original Jurassic Park, "Nature finds a way." If you are a micro-organism, maybe Rand Paul is your way to survive.

    I admit, though, some sympathy with the anti-vaccination people, even if I disagree with their conclusion.  In a lot of ways, I blame the pharmaceutical companies, health insurers, HMOs and all of "big medicine" for undermining its credibility with people in the first place.

    The problem here is that argument and evidence will be ineffective against those who have used rational means to come to the conclusion that they would refuse this medicine either for themselves or for their families.  They view data as corrupt or misleading.  They question the motives of those in authority.  They have become conspiracy theorists.  To wave the evidence in their faces and hope for the best will be no more effective than standing outside a convention of JFK conspiracy theorists with a copy of The Warren Report.

    You could pass a law.  But you might not like enforcing it.  Are police going to march into schools and vaccinate children without their parent's permission?  Are children going to be removed from the homes of refusers and placed in foster care while their parents are charged with child endangerment?  Would those children really be better off?  I think you'll find a law and order approach would be ineffective here, as well as unsightly.  Using the force of law here, which means using the police, would inflame the conspiracy sentiment around this issue.

    Which brings me, regrettably, to an idea I haven't much liked in the past -- Cass Sunstein's nudge.  Sunstein believes that you can get desired social outcomes by using sticks, carrots and rhetorical sleight of hand.  I don't love this because it seems a little anti-democratic, to me.  Rather than let people decide what they want, you manipulate them with incentives.

    Here's how it might work with vaccines:

    1) Provide up-to-date vaccination records in order to claim the child tax credit on your annual income taxes (I stole this from a TPM commenter, it's a great idea).

    2) Pediatricians should refuse to treat non-vaccine kids. They should also use industry groups and private licensing associations to shun and embarass anti-vaccination peers.

    3) Public schools should require it for attendance. (This is already done in a lot of places).

    4) Make it a civil offense to pass a disease onto somebody else if you have chosen not to vaccinate.

    5) Unvaccinated families cannot use the carpool lane, ever.

    Since we've never going to win the argument, we can leave it as a choice.  It'll just be very unpleasant to choose not to vaccinate.

    Topics: 
    Health

    Comments

    Most states have a system of county health departments that offer free vaccinations or at minimal charge.  Many people have their children vaccinated that way.  In this state in order for your child to start school or stay in school later when Hepatitis shots are required, must have a form filled out by a doctor or the health department verifying that the child has been vaccinated. The schools usually send the parents to the health department with the form. The poor comply because they want their kids to stay healthy and send them to school.  They cannot afford not to and keep them at home to home school because both parents work.  


    by trkingmomoe on Tue, 02/03/2015 - 8:58pm

    I read today that repubs are fighting over this.

    Autism vs. death.

    My son has taken the pro-vaccine side.

    His kids have been sick and sore and disabled and he just takes them to the doctor.

    And it is not like he makes all the decisions. His wife is the educator and they work these problems out.

    My Grandkids are healthy.

    That is all I care about right now.

    I had chicken pox and measles and a host of other problems, but nowadays, my grandkids do not get chicken pox or measles or....

    The only person with mental issues is me. hahahahah

    But you all can tell from my writings.

    I am having probs with linking.

    But Salon and a host of other blogs have underlined that Fox and other right wing posts have

    attempted to make this a political issue; but the conservatives have not come to agreement on this issue at all. And Left wing folks still disagree.

    I agree with my son, and if I could go back three decades or more, I would give my kids all the shots.

    I have witnessed real autism; going back forty years and more.

    I think we have come to another age where fluoride corrupts our youth.

    who knows? Our government is just sending monies to the Pharmacological lobby.

    I have more on this, if I ever remember; but get your kids shots.

    the end 

     


    by Richard Day on Wed, 02/04/2015 - 12:06am

    I just got done reading that Christy and Rand both have back tracked on what they stupidly said. I don't think they got the reaction they wanted and their handlers are trying to smooth things over.  Vaccinations are not a partisan issue for 95% of the country. The older white generation suffered with these diseases and was happy to be able to vaccinate their kids.  I think they heard from that part of their voting base. Neither one of these guys will make it through the first few rounds of primaries.  

    Minnesota is looking at making 7th grade mandatory for Hepatitis shots like the law that is in Florida.  Florida has been doing this for around 10 years. It was the Republicans that passed it as a law in Florida. 

    Mississippi has a 100% compliance in vaccinations because of their laws.  You can get any redder than that in state politics. They have a no child exempt law for healthy kids. I think West Virginia is also like that.  

    Something I discovered while I was ill that my kids and adult grandchildren had no idea how to take care of me. They didn't know how to prepare broth or cream soup for me. They didn't know how to make me more comfortable and fix my bed.  I grew up knowing those things because there was more sickness around then and they had not been around anything required some basic nursing.  I think we have a population that does not know how awful these diseases can be and how much care there is needed at home for recovery.  


    by trkingmomoe on Wed, 02/04/2015 - 1:30am

    Semi-seriously? Scarlet Letter.

    If we're going to cede parents the right to refuse vaccinations (and I don't think we need to cede that, really), we need to give other parents the right to protect their children from unvaccinated people who might be carriers of disease. And that doesn't work unless people can identify the unvaccinated by sight.

    Healthy vaccine refusers should be required to wear, say, a distinctive wristband. Since a lot of the anti-vaxxer movement is fundamentally about group identity, this won't make the core problem any better. BUT it will allow people to avoid anti-vases for their own health. And it will allow businesses like, say, Disneyland, the option of turning the unvaccinated away. Right now anti-vaxxers are free to apply for jobs as cooks, or to mingle in huge crowds, because there's no way to screen them out.

    And vaccine refusers also need to be identified so that they can be sued. Vaccine refusers who infect others should be liable for full medical and punitive damages. If you don't want the state cracking down (and I think the state has a right to crack down to protect public health), you need to allow people who've been endangered by their neighbors to seek redress.


    by Doctor Cleveland on Wed, 02/04/2015 - 1:02am

    I like the idea that the doctors will refuse them as patients.  This keeps them from showing up in the office sick dropping measles all over the place so one of their chronic patients can pick it up and not survive it. This was always a worry for me when I had to take the kids to health department or clinic.  One of them would come up with the flu or a virus a few days later. I didn't always have the option of a sitter for the ones that didn't need to be there. 


    by trkingmomoe on Wed, 02/04/2015 - 1:48am

    The only problem I've seen with this is anti-vaxx doctors.  You'd think there wouldn't be any or many, but they do exist.  Some of them, no doubt, would just see  profit potential, exploiting a niche by agreeing to treat anti-vaxx families.  It would help if insurance companies refused to cover the cost of illnesses that result from being anti-vaxx without medical reason.  Then those doctors would have to work for cash and only very wealthy people would be able to afford them.


    by Michael Maiello on Wed, 02/04/2015 - 7:44am

    Yeah, you would need some scarlet letter for it to work. Which would add to the nudge.  Sorry, no play dates with your kid until you vaccinate them.


    by Michael Maiello on Wed, 02/04/2015 - 7:40am

    And that doesn't work unless people can identify the unvaccinated by sight.

                              

                                NON - COMPLIANT ?

                                DIFFERENT 


    by Resistance on Wed, 02/04/2015 - 6:42pm


    by Michael Maiello on Wed, 02/04/2015 - 7:22pm

    # 6)  All people entering the United States shall be checked for vaccination. 

    All who illegally enter the country, thereby evading scrutiny, should be pursued with such vigor, as to discourage non- compliance of the deliberated and established laws. intended to protect the American citizen. 


    by Resistance on Wed, 02/04/2015 - 8:55pm

    There have been 2 major measles outbreaks in the last years - 1 last year among the Ohio Amish community (surprise surprise) and the latest Disney one.

    Otherwise measles infections have been muddling along at 100-200/year for a while. If only there were such serious concern & response to the long-term rise in ASD.

    While I appreciate your bit of sympathy for antivaxxers based on public officials & pharma wearing out credibility - and then you stomp off into attitudes almost worthy of the War on Drugs and Nancy Reagan's Just Say No, where like with chaos theory, smoking a joint in Brooklyn is accessory to murder in Mexico.

    Will we need a Scarlet Letter as Doc suggests for people who don't get yearly Flu Vaccines or the newest of the steadily growing series of recommended/demanded vaccines? If someone delays a shot for a year or two, will they still wear the letter/lose their tax benefit, or will they get a Yellow Letter to wear to signify cautious danger?

    I mentioned the possible Tylenol (acetaminophen) link as frequently administered for MMR fevers and its documented fine line between safe dose & dangerous dose, along with studies showing ADHD, development disorders & ASD, and  the only response I got here was "silly".  Thought the correlation to MMR timing & possible effect on Autism would at least rate an "interesting". As a practical measure, you could simply insist on substituting Tylenol with Ibuprofen which doesn't have the mixed, more dangerous history that Tylenol has. People aren't necessarily trying to make their lives more complicated.

    And of course correlation doesn't prove cause - here's a study noting that countries giving more vaccines have larger infant mortality, but that certainly doesn't prove vaccines cause these deaths.

    When I took my infants for vaccines, the nurse/doctor wanted to give them the shot for sexually transmitted hepatitis - when I asked why, they said "to train them for the later upshot when they're teens" - wow, brilliantly stupid. Kinda like Catholic doctrine of "give us your children until 5, they're ours for life". Of course if you believe that vaccines have absolutely no risk of serious side effects, why not? only a few bucks. If you think that teens respond in lockstep to lessons in infancy, you should start a religion.

    Another vaccine (tetanus?) had risks for children with a history of epileptic fits - one of my kids had, but the nurse of course didn't check medical history or ask any of these questions.

    I spent 2 years with arthritis for the hip that I traced down to another vaccination that was so explicitly associated with arthritis it was on the Congressional list of exempt vaccines for vaccine damage suits. Of course no medical professional informed me of this possibility before or after. Yes, I could have filed paperwork and possibly gotten $500 or so from the fund, if I had the records and what-all gumption to prove it. I guess in a way it was a blessing - got me to the gym to exercise, and fortunately it wasn't too bad.

    We had our ob-gyn furiously claim that all diet supplements in pregnancy were useless. Except Folic Acid. But not the Folic Acid my wife was already taking - only her prescribed Folic Acid. Even the "professionals" latch onto very simple rules-of-thumb and leave their brains at home - prescribe Folic Acid, do a quick ultrasound, charge $400 and send the woman home.

    Being a new parent of infants is a scary time - especially if they have medical problems and you're stuck making a lot of bewildering complicated choices with never enough info and data to be rational.

    There's also a natural conflict between full reporting of drug side effects and encouraging full takeup of the whole series of vaccines. Skepticism there will never disappear, and with the internet it's easy to latch on to bogus hysterical information with a dab of science included, but it's sometimes hard to get serious information from the official sources as well.

    The rise in Autism is just one of recent bad trends - obesity and diabetes for kids is another. The rise of corn syrup and saccharin might be a cause, or it might not. The government is unlikely to pursue the connection well, as they're busy giving large corn subsidies to promote exports, especially to an early voting state like Iowa, and the lobbyists know how to get study results watered down if they affect their clients' pocket book. I still don't give my kids corn syrup - is it rational & scientific? Beats me, but seems healthier to me.

    While an estimated 60% of Autism increase may be attributed to changing and better detection methods, that leaves 40% of the rapid increase due to.... something.
    "Autism Spectrum Disorder" further muddies the waters - it maybe runs from slight ADHD to full-blown heavy Autism. It's easy to assume that most cases drift towards the former, what 25 years ago was handled with handfuls of Ritalin, but there's a lot of severe ASD that requires a helluva lot of therapies, experimental drugs, patience, exasperation and huge expense.

    Of course if Republican fucktards were interested in helping deal with the medical and social effects of ASD, that'd be great, but instead they're into "market theories" (except when they're not - some crony giveaway) and slashing healthcare so that their superior monied race can survive (until they need some special exemption).

    I don't think I've addressed your letter well, but I guess I should finish with "I'm so glad that concerns about vaccinations has now become an even more public, dogmatic debate for both parties - I expect a compassionate medically-sound response this side of never".


    by PeraclesPlease on Wed, 02/04/2015 - 2:37am

    Thought the correlation to MMR timing & possible effect on Autism would at least rate an "interesting".

    It is interesting. However, a little bit of research shows:

    1. the MMR timing with autism exists even for children who are not vaccinated; and
    2. removing thimerosal (AKA, thiomersal, which was initially what anti-vaxxers blamed) had no impact on the prevalence of ASD.

    It's a classic case of post hoc ergo prompter hoc. The fact that autism tends to develop shortly after when MMR shots are delivered is an excellent explanation for where the anti-vax fears came from. My wife used to teach at a school for children with autism, and saw all types there. One mother (a doctor), refused to vaccinate her second son, because her first son was diagnosed with autism shortly after his MMR shots. Her second son was diagnosed with autism at about the same age. Her updated explanation is that it was the vaccines that she (the mother) received that is responsible for their autism.

    So, the timing is interesting and is an excellent explanation for where anti-vax sentiments come from. It is not, however, even moderately adequate evidence that the vaccines cause autism.


    by Verified Atheist on Wed, 02/04/2015 - 8:35am

    how does MMR timing exist without vaccination?

    and what does the amount of Tylenol damage look like, or did you ignore the basic point?

    of course these studies don't seek to blame everything in the world on Tylenol either - only some incidence of Tylenol side effects that correlate with learning & behaviroal disabilities, ADHD, etc. But I guess that's too conspiratorial


    by PeraclesPlease on Wed, 02/04/2015 - 4:13pm

    how does MMR timing exist without vaccination?

    I'm saying that there's the recommended age at which MMR is delivered, and it happens to be a little before the age at which autism typically is diagnosed. If pediatricians would only delay MMR for a year, then maybe we could come up with a new theory that autism causes vaccinations!

    what does the amount of Tylenol damage look like, or did you ignore the basic point?

    What does Tylenol damage have to do with your point about MMR timing? You complained that people were ignoring your point about MMR timing. I addressed your point about MMR timing, and not you're complaining that I ignored the "basic point" about Tylenol damage. Tylenol is a drug that should be used very sparingly because the "recommended dose" is just below the unsafe dose. How does that support the "basic point" about vaccines causing autism? You're proposing a completely unresearched hypothesis for how vaccines can (indirectly) cause autism, but if you dig much into that hypothesis, it seems very weak. In the (many) autism cases that I personally know about, no Tylenol (or off-brand acetaminophen) was delivered for dealing with fever. Sure, that's just negative anecdotal evidence, but I don't see any evidence whatsoever supporting your hypothesis. None, zilch, nada. Maybe the real culprit is birthday cakes designed for 3-year-olds!!


    by Verified Atheist on Thu, 02/05/2015 - 8:05am

    If pediatricians would only delay MMR for a year, then maybe we could come up with a new theory that autism causes vaccinations!

    I think you've hit the smug know-it-all humor that annoys me with all of this - real people are dealing with a rather horrible disease called Autism - most didn't wake up one morning and just say "I want to be paranoid and anti-science/government", and if our medical measures the last decade had been able to solve the riddle, laymen wouldn't be thrashing around trying to figure out the possible connections themselves.

    Tylenol is a drug that should be used very sparingly because the "recommended dose" is just below the unsafe dose. How does that support the "basic point" about vaccines causing autism? You're proposing a completely unresearched hypothesis for how vaccines can (indirectly) cause autism, but if you dig much into that hypothesis, it seems very weak. In the (many) autism cases that I personally know about, no Tylenol (or off-brand acetaminophen) was delivered for dealing with fever.

    Well, that settles it - the *many* autism cases you've witnessed.

    The links I posted were here: http://dagblog.com/comment/203621#comment-203621 - Google connection between ADHD & Autism/ASD if you need.

    Danish studied 64000+ mothers & births related to Tylenol & ADHD/hyperkinetic disorders, with  "More than half of all mothers reported acetaminophen [Tylenol] use while pregnant. Children whose mothers used acetaminophen during pregnancy were at higher risk ...Stronger associations were observed with use in more than 1 trimester during pregnancy, and exposure response trends were found with increasing frequency of acetaminophen use during gestation for all outcomes...

    Norwegian coauthors studied 48,000 Norwegian children whose mothers answered survey questions about their medication use at weeks 17 and 30 of pregnancy, and again six months after giving birth. Mothers filled out a follow-up questionnaire about their child's developmental milestones three years later. Close to four percent of women took Tylenol for at least 28 days total during pregnancy. Their children seemed to have poorer motor skills than kids whose mothers had taken the drug fewer times or not at all. Tylenol-exposed kids also tended to start walking later, have poorer communication and language skills and more behavior problems.

    It appears that the marked increase in the rate of autism, asthma, and attention deficit with hyperactivity throughout much of the world may be largely caused by the marked increase in the use of acetaminophen in genetically and/or metabolically susceptible children, and the use of acetaminophen by pregnant women. Toxicity of acetaminophen may cause autism by overloading the defective sulfation pathway catalyzed by phenolsulfotransferase, which is deficient in autism, leading to overproduction of the toxic metabolite N-acetylp- benzoquinone imine (NAPQI). Increased levels of NAPQI reduce the ability to detoxify a host of toxic chemicals in the environment, increasing oxidative stress, which leads to protein, lipid, and nucleic acid damage from free radicals. Epidemiological evidence also supports the association of increased acetaminophen usage with autism, asthma, and attention deficit with hyperactivity.

    This of course doesn't say that all Tylenol use leads to ADHD or Autism, or that all MMR coincides with fever that then is treated with Tylenol, or any other 100% statement of anything. I even noted 1 paper that indicated 60% of the rise in ASD was attributable to better detection means - but what about that other 40% of a rather large increase?

     

     


    by PeraclesPlease on Thu, 02/05/2015 - 10:02am

    Peracles has done some good research on Tylenol, ADHD, vaccines and SID. The reality is medical science has a very very long way to go understanding embryology, pregnancy, the biochemical interactions between the mother and fetus, 'safe drugs' in pregnancy and human immunology.

    There is no totally safe drug during pregnancy. Oral Tylenol is indicated and used when pregnant women have fevers, pregnancy with untreated fever has bad consequences.  If they have pain they can use it 'if they really need to', to sleep or eat normally.  Frankly, heaven help them as Tylenol is a pretty damn weak pain killer. 

    We also have a very long way to go understanding our immune systems. We do not know why so many autoimmune diseases develop, even in adults. We don't know why cancers can evade the immune system. We don't know exactly how or why pregnant women's immune system doesn't attack the fetus.

    What exactly goes on in 3-9 month year olds immune systems is even more complex and something of a mystery. We do know that vaccines work, they can prevent terrible diseases. It's also likely that the regimens will change over time, as more is learned on the above.


    by NCD on Thu, 02/05/2015 - 11:32am

    I think you've hit the smug know-it-all humor that annoys me with all of this - real people are dealing with a rather horrible disease called Autism - most didn't wake up one morning and just say "I want to be paranoid and anti-science/government", and if our medical measures the last decade had been able to solve the riddle, laymen wouldn't be thrashing around trying to figure out the possible connections themselves.

    I completely understand the parents who are in such a situation. I've gone through something similar, except in my case it was cancer. You start grasping at straws, I get it. That said, we're not doing anybody any favors by pretending that those straws are legitimate scientific theories. Thank you for linking to the studies linking acetaminophen (Tylenol) usage to ADHD, and arguably to autism. It's interesting and suggests just one more reason why this drug should be avoided — it can also harm your liver:

    http://www.webmd.com/pain-management/features/acetaminophen-safety-faq

    ​http://www.fda.gov/ForConsumers/ConsumerUpdates/ucm168830.htm

    http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHuma...

    http://www.forbes.com/sites/alicegwalton/2014/01/16/fda-warns-high-doses...

    That said, if acetaminophen or Tylenol is shown to be connected to autism, then let's say that's the problem, and not blame it on vaccines. (And yes, for a very small number of children, vaccines can actually cause problems.)


    by Verified Atheist on Thu, 02/05/2015 - 11:33am

    That said, if acetaminophen or Tylenol is shown to be connected to autism, then let's say that's the problem, and not blame it on vaccines.

    That was the whole point. If you have Tylenol given after many  MMR shots & parents see changes after the MMR shot but studies show no adverse MMR effects, then 1) they're not crazy - it's a temporal correlation that could lead to mistakenly blaming the vaccine, and 2) the Tylenol could be the real culprit.

    Of course I don't expect everything to be so tidy, whether it's even true or whether it explains X% of ASD, but still, there are other painkillers like Ibuprofen that apparently don't have the negative side effects to add to the pregnancy / infancy risk.


    by PeraclesPlease on Thu, 02/05/2015 - 12:05pm

    Motrin has significant risks, especially in the 3rd trimester.

    Motrin is a NSAID, Tylenol is not, and NSAIDs have known risks during pregnancy.


    by NCD on Thu, 02/05/2015 - 1:44pm

    Most pain medications have risks in pregnancy. The Tylenol risk appears to increase with duration of use. Increased risk was noted after 6 weeks of use with a dramatic risk after 20 weeks of therapy. How many pregnant women are treated for months with Tylenol? The study was not case controlled so direct cause and effect is not clear http://www.m.webmd.com/a-to-z-guides/news/20140224/use-of-acetaminophen-...

    by rmrd0000 on Thu, 02/05/2015 - 2:16pm

    Here is an article that attempts to put things in perspective for laymen. http://blogs.plos.org/publichealth/2014/03/03/tylenol-safe-pregnancy-tri...

    by rmrd0000 on Thu, 02/05/2015 - 2:33pm

    Your link says drug of choice is Tylenol.

    That's why in one of Peracles studies 1/2 the pregnant women in Denmark had taken Tylenol not Motrin. Doc's almost always rec'd Tylenol. My link on Motrin:

    During weeks 1-13 (first trimester), avoid taking ibuprofen because:

    • it may increase the risk of miscarriage
    • your baby could develop a heart defect or other abnormalities, such as defects in their abdominal wall or a cleft palate

    Further research is needed to understand whether ibuprofen used during early pregnancy can lead to these complications or not. Until then, during weeks 14-27 (second trimester), you can take ibuprofen occasionally if you need medicine to relieve pain and reduce inflammation, but opt for paracetamol (Tylenol)  if possible.

    During weeks 28-40 (third trimester), avoid taking ibuprofen because it may:

    • increase the risk of heart problems that cause high blood pressure in your unborn baby's lungs
    • delay your labour
    • reduce the amount of amniotic fluid in which your baby floats

    by NCD on Thu, 02/05/2015 - 2:54pm

    If a pregnant woman is being treated for several weeks for pain, there may be something serious happening that was not reported because it was not the focus of the study. The other thing to consider is that the findings need to be supported by a better designed study using matched controls.

    by rmrd0000 on Thu, 02/05/2015 - 3:22pm

    They talked about eliminating other factors in their analysis.


    by PeraclesPlease on Fri, 02/06/2015 - 12:50am

    The study design pointed out a potential problem. The design of the study did not give a definitive answer pointing to Tylenol as the absolute cause. Most scientists commenting on the study including the original investigators say that more definitive studies are needed. Women should be warned of a potential risk of taking Tylenol in pregnancy. One study investigator would avoid using Tylenol. A physician not involved in the trial sees no reason to stop using Tylenol.

    Women can be given the risk profiles of the other pain medications and make a choice to suffer through the pained use Tylenol or another medication. The patient and physician can explore alternatives like meditation or acupuncture. That discussion would have to include the limited data on the benefits and risks of acupuncture in pregnancy.

    The best study would be a forward looking study of pregnant women with pain severe enough to require a pain medication. Some would be randomized to placebo and others to Tylenol. I'm guessing that thousands of women would have to be entered into the trial to get a statistically valid result.

    Isolated studies that the one involving Tylenol are used to get funding agencies to pay for the more detailed studies with higher statistical power.


    by rmrd0000 on Fri, 02/06/2015 - 1:08am

    I'm guessing that thousands of women would have to be entered into the trial to get a statistically valid result.

    64,000 in one, 48,000 in the other - how many do you need for "statistically valid"?


    by PeraclesPlease on Fri, 02/06/2015 - 1:18am

    There is a hierarchy of reliability of the findings of a study based on original study design. That is why there are comments about the need for more research http://guides.mclibrary.duke.edu/c.php?g=158201&p=1036068

    by rmrd0000 on Fri, 02/06/2015 - 8:27am

    It looks like two Democratic legislators in California have had enough of indulging the anti-vaxxers and thereby putting the general population at risk. They are proposing major limitations on opting out of vaccinations.

    http://thedailybanter.com/2015/02/california-lawmakers-anti-vaxxers-weve...


    by rmrd0000 on Thu, 02/05/2015 - 5:44pm

    Amen.


    by Doctor Cleveland on Thu, 02/05/2015 - 6:06pm

    5 babies under the age of 12 months, contracted measles in a Chicago day care.  


    by trkingmomoe on Thu, 02/05/2015 - 7:56pm

    We live with risks everyday. Medications have risks. The benefitis of a given drug has to be weighed against the risks. When a publication points to a possible association between a drug and an adverse effect, this is just the first phase. More detailed studies pairing those exposed to the drug with those who were not exposed to the drug are called for. In the case of Tylenol in pregnant women and ADHD and autism we see an overall low risk to a fetus. The risk, if present, appears to be associated with long term use of Tylenol. When the risks of Tylenol with other pain medications for pregnant patients, the other drugs, including Motrin have a higher risk. We should not rush from falsely blaming vaccines for autism to blaming Tylenol for autism.

    Measles is highly contagious, children too young to be vaccinated, immunosuppressed children, and the 3-5% of children who receive vaccines but do not develop a protective immune response have a 90% chance of developing measles if exposed to an infected person. The public has bowed to the unscientific opinions of anti-vaxxers long enough.


    by rmrd0000 on Thu, 02/05/2015 - 11:18pm

    We should not rush  -

    don't worry, no one's rushing - the last appearance was a single study a year ago - in the latest mainstream debate about vaccines, have you heard 1 other person mention Tylenol or ADHD?

    The first indicative study of problems with Tylenol were in 2008, as noted here. I haven't seen any US studies since (aside from less formal demographics). This is on no one's high priority list. Tylenol stockholders can sleep soundly.

    There's an irony here for me. A falsified study on MMR in 1998 leads to 18 years of panic, but what seem to be repeatable valid concerns about a common drug are ignored. I guess Tylenol has done a great job of marketing - as safe as aspirin.

    As you say, "we live with risks everday" - 30,000 or so are killed in car wrecks. Even if Tylenol is shown to kill as many as measles in 1960 (note the *if*), at least it's our own choice or our doctor's - assuming either knew - not some damn irrational GOP anti-vaxxer Typhoid Mary.


    by PeraclesPlease on Fri, 02/06/2015 - 1:26am

    There don't appear to be any safe pain drugs in pregnancy. The Tylenol problem appears to worsen with duration of therapy. Other than noting the risks of pain medications before prescribing a pain medication to a pregnant woman and limiting the duration of pain therapy, what alternative is there? Is acupuncture inexpensive? Has acupuncture actually been shown to be effective in pain during pregnancy.

    by rmrd0000 on Fri, 02/06/2015 - 8:35am

    …and if acupuncture is effective, has it been shown to be safe? Most doctors assume it's safe because they assume it is effectively a placebo. But if you remove that latter assumption, the former assumption must also be reevaluated, right?


    by Verified Atheist on Fri, 02/06/2015 - 10:12am

    You are correct about acupuncture, it is assumed to be safe and probably is but it hasn't rigorously been explored. The Tylenol situation seems to be that of all the drugs available to treat pain in pregnancy, it appeared to be the safest. After a period of safe use in pregnant women, someone asked the question about risks to the fetus and child and found a possible connection to autism and ADHD. The Denmark study made the question more pointed since there did seem to be an association with duration of Tylenol therapy.

    The question of why there isn't an immediate halt to Tylenol use in pregnancy is what options are available, there appear to be few. The type of study needed to prove a direct link between Tylenol and ADHD or autism is costly. Researchers look for funding from government agencies like the NIH/NIMH. The NIMH seems to be more focuses on basic science according to one of the clinical psychiatrist authors of "Shrink Wrap". To get funding for a multi enter, multi patient study, you need to have data from previous studies indicating a problem. You write a proposal and try to get a funded contract from the NIH or an NGO interested in autism. Big studies are not events created overnight.


    by rmrd0000 on Fri, 02/06/2015 - 10:33am

    As a general gripe about Tylenol and generic acetaminophen, try to find the 'normal' dose size of 325 mg pills. All they usually have is 500mg 'extra strength'.

    Almost impossible to find 325mg in Walgreen, CVS or Wal Mart.

    If there are any it's only one row of a few bottles, bottom shelf. And usually Tylenol brand and much more expensive than same  # of generic 'extra strength' 500 mg pills (they don't often stock generic 325mg).

    It's like they are trying to fry your liver with the stuff. (it is of course a liver toxin if you take enough of it long enough)

    Plus its in the cough syrup and cold remedies.


    by NCD on Fri, 02/06/2015 - 11:13am

    That is interesting because the FDA recommended limiting the dose in Tylenol combos to 325 mg http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHuma...

    by rmrd0000 on Fri, 02/06/2015 - 11:13am

    Yes aceteminophen is a liver toxin. Even in overdose it doesn't display neurological symptoms. So returning to the original topic of autism. Anything is possible so it's possible there could be a link between tylenol and autism but it's extremely unlikely.


    by ocean-kat on Fri, 02/06/2015 - 3:45pm

    I was prescribed oxycodone about six months ago for a rotator cuff injury. In the abuse warning conversation with the doctor I was told the greatest danger of using more than prescribed was because I would be getting too much of the included Tylenol.


    by A Guy Called LULU on Fri, 02/06/2015 - 11:21am

    There are ways that Tylenol metabolism could effect the way oxygen is handled in the body including the brain and possibly cause autism.making a 1:1 correlation between observations in test tubes and human is sometimes difficult. Tylenol might be a factor in autism. We cannot say that it is a factor in autism https://www.vitamindcouncil.org/blog/dr-cannell-on-tylenol-oxidative-str...

    by rmrd0000 on Fri, 02/06/2015 - 4:43pm

    Those babies are too young for the vaccine.

    Which is why all the other children in the day care who are old enough to be vaccinated need to be vaccinated.

     


    by Doctor Cleveland on Fri, 02/06/2015 - 12:00am

    Irony: antivaxx & abortion - conservatives want women to be "educated" by watching horrific images of fetuses being sucked out, as well as apprised of adoption services and what not.

    Where's their need for good education for deciding on vaccines - images of polio and measles deaths, the slow painful onset of tetanus? Selective outrage and methodology as usual. The situations may be different, but the methods & logic shouldn't be.

    Perhaps they'll be protesting vaccine clinics in the future, shaming vaxxers.

    Just a thought that crossed my mind on this lovely morning.


    by PeraclesPlease on Sat, 02/07/2015 - 5:20am

    Merck goes to court for faking Mumps vaccine data - should they be charged with murder for any resulting mumps death, criminal fraud?


    by PeraclesPlease on Sat, 02/07/2015 - 5:55am