Measles, Disneyland, and a Renegade Pediatrician in the New York Times

Measles, Disneyland, and a Renegade Pediatrician in the New York Times

January 27, 2015 Karie Youngdahl

Child with measles, 1920sI've been closely following, as I'm sure most of you have, the scores of recent measles cases originating from exposures at Disneyland. I wrote about this the other day (and included some information about a lesser-known measles outbreak in a small South Dakota town). Since then, reported cases of measles have climbed. As of the writing of this post, 88 measles cases have been reported and linked directly or indirectly to the initial exposures at Disneyland.

It's too soon to know the vaccination history of every person who has developed measles, but usually what we see in measles outbreaks is that the great majority of cases are completely unvaccinated. A smaller number will have had one vaccine (not the recommended two), and an even smaller number will have been fully vaccinated. This is no surprise: the measles vaccine is highly effective at preventing disease, but 2-5% of individuals vaccinated once do not respond to the vaccine. So, some vaccinated individuals will remain unprotected.

Consequently, vaccine non-receipt is generally the biggest problem in these outbreaks. I was reminded of this most unpleasantly over my morning coffee last week when I read an article on the Disneyland measles situation in the New York Times. After quoting anti-vaccine provocateur Barbara Loe Fisher, the reporters quote another thorn in the side of immunization advocates:

A handful of doctors seem sympathetic to [Fisher's] views. Dr. Jay Gordon, a Santa Monica pediatrician who has cautioned against the way vaccines are used, said he had “given more measles vaccines” than ever before but did not like giving the shot to younger children.

“I think whatever risk there is — and I can’t prove a risk — is, I think, caused by the timing,” he said, referring to when the shot is administered. “It’s given at a time when kids are more susceptible to environmental impact. Don’t get me wrong; I have no proof that this vaccine causes harm. I just have anecdotal reports from parents who are convinced that their children were harmed by the vaccine.”

These are definitely not mainstream medical or public health opinions. And at first I was shocked that the reporters quoted Gordon, thus offering him a platform for his renegade views. Then I began to reconsider. On the one hand, quoting Gordon perpetuates the idea that there really is a debate about MMR safety. On the other hand, it is useful to know why people are not vaccinating, and the quotations from Dr. Gordon make that clear that certain pediatricians are complicit in those decisions.

I decided to poll some of my physician colleagues on their opinions, both about whether the New York Times was justified in providing Gordon a space to promote his ideas, and about Gordon's statements in general. Here's what they thought:

Bennett Lorber, MD, is a Temple infectious diseases physician and past president of The College of Physicians of Philadelphia. Dr. Lorber said, “Doctors like Jay Gordon who, as reported in the New York Times, are ‘sympathetic’ to the views of anti-vaccine advocacy groups, should be ashamed. They are ill-informed and perpetuate myths that are potentially harmful to their patients and the public.”

Joseph Camardo, MD, is on the industry advisory board to History of Vaccines and is Senior Vice President for Celgene Corporation. He said, "This is not a time to be debating the need for vaccination. Measles can be fatal and we have the tools to prevent its spread. MMR has been used in practice for many years; there is a tremendous amount of information about it, and the facts have been analyzed and scrutinized repeatedly by scientific experts, regulatory authorities, and the manufacturers. The benefit is proven and we have a huge amount of knowledge about the risks. We need to be very careful to assure that decisions are not based on misinformation or, in one case, fraud. Physicians and other health professionals have to be informed advocates for public health measures and at the top of the list are childhood vaccines."

Pediatrician Andreas Bollmann, MD, PhD, took on the issue of why the New York Times quoted Gordon. It did not strike him as a dutiful nod to “journalistic balance.” He said, “The quotation from Dr. Gordon is so inarticulate and comical that it ends up looking like a farce. It’s certainly not a stringent argument against MMR vaccine.” He suspects that the reporter included Gordon’s opinion to expose the weakness of arguments against vaccination.

I admire Dr. Bollmann's optimism both about the reporter's intention and about the layperson's ability to understand that Dr. Gordon's opinions are highly suspect. 

Image from Schamberg JF. Diseases of the Skin and Eruptive Fevers. Philadelphia: WB Saunders; 1921. JA 137c. The Historical Medical Library of The College of Physicians of Philadelphia.

Comments

Posted by Brenda Magalaner (not verified)

Very good response to a very dangerous situation. My son was among the first wave of children in this country to receive the vaccine. I was urged to do it immediately by my pediatrician who cited a colleague who waited and whose son developed the disease and a complication that had him now permanently institutionalized. That story was enough to scare me. Anecdotal evidence is not hard science. Those of us who lived through the torturous years of polio, summers of no swimming and great anxiety, would doubt the tremendous benefits of the vaccines now available to children. I agree that printing Dr. Gordon's opinion, as vapid as it sounded, was entirely too subtle for the average reader to conclude was not advocating caution in administering the vaccine.

Posted by Anonymous (not verified)

It is wild that people are still under the assumption that "herd immunity" is really going to protect them. This is why we preach immunizations because herd immunity is a very fragile theory. It's unfortunate that the scare about Autism from immunizations has no bearing and I believe, this is why immunizations has stalled so much since the public remains undecided about them. Please immunize people, it saves lives!!!!

Posted by Helen Dixon (not verified)

Very nice and informative post. It's a serious concern that people use to be unaware of the vaccination procedure for measles. and kids suffers a lot from this disease. A proper awareness campaign around the world must be employed to guide the ignorant people.

Posted by Esther (not verified)

It's a great story, one that should get more exposure, especially now that vaccination is receding globally. It's a scary trend and we need a strong information campaign now, preferably nationwide.

Kind regards,
Esther
IRT Foundation website

Posted by Anonymous (not verified)

Sorry, but your doctors are misinformed. Deaths from measles were so rare in this country as to be statistically insignificant, long before the MMR vaccine. The majority of people who contracted measles in the Disneyland outbreak were vaccinated. The incidence of measles infection has RISEN since vaccination, and vaccinated kids are contagious for 2 days after vaccination. Do your homework and look at the science. Don't believe mainstream press or pharmaceutical agendas I did my first research on contagious disease and vaccination programs as an undergrad in Public Health at OSU and what I learned about the lack of care we take about vaccinating our children shocked me. Now I have a PhD and I am more shocked about the coercion (denying schooling) and violation of informed consent. MMR vaccines are created using aborted fetal tissue cells and that may be the issue. We probably can vaccinate safely. But we need to hold the manufacturers accountable for the health of our children. Let's see some long-term safety and efficacy studies and repeal the laws disallowing suing manufacturers for vaccine injury. If vaccination is so safe, why can't Pharmaceutical companies be held responsible? Because they have a conflict of interest, as public companies. Selling more drugs is their mandate, not protecting the health of our country.

Posted by Karie Youngdahl

Hi there,
As to your statement, "The majority of people who contracted measles in the Disneyland outbreak were vaccinated" the CDC clearly states that the majority of 2015 cases were unvaccinated: http://www.cdc.gov/measles/cases-outbreaks.html Regarding the CA measles cases associated with Disneyland exposures, the CDC says this: "Among the 110 California patients, 49 (45%) were unvaccinated; five (5%) had 1 dose of measles-containing vaccine, seven (6%) had 2 doses, one (1%) had 3 doses, 47 (43%) had unknown or undocumented vaccination status, and one (1%) had immunoglobulin G seropositivity documented, which indicates prior vaccination or measles infection at an undetermined time"(from http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6406a5.htm?s_cid=mm6406a5_w ). It is highly likely that most of the individuals whose vaccination status is unknown were vaccinated. But it would only take 7 of the 43 "status unknown" patients to be unvaccinated for the majority of the CA Disneyland cases to be unvaccinated. If you have different information, please share.

Your statement that measles deaths were "so rare ... as to be statistically insignificant" is meaningless: we know that in the decades before the vaccine there were deaths in the hundreds each year from measles. Whether they were "statistically significant" (in the context of what?) is for you to demonstrate, but they certainly caused pain and anguish for the dead individuals and for their families. (And let us not discount morbidity from measles infection which affected many more individuals and their families).

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