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Warning: I felt nauseous and cried putting together some of this material.
First, let’s review Facebook’s definitions of violence and hate speech:
I’d like to know how the below comment, on Meryl’s links to Big Oil and Big Pharma (she sells tupperware and cosmetics, the former made from oil, and L’Oréal owns (owned?) a “big pharma” company, Sanofi-Aventis), can be considered hate speech or a threat.
Of course, that’s not the first time that Meryl’s made frivolous complaints to get material removed. But, moving on to more serious matters, I recently became aware of one member of the anti vaccination (antivax)/antifluoride/other conspiracy theory community making threats by private message:
When the person the message was sent to had done little more than post polite responses to antivax people on public Facebook pages. Yet, after Facebook reviewed a complaint about that message, they found it didn’t breach their “community standards”. Some community if that’s acceptable.
Even more worrying, is that Facebook allows a group for the promotion and discussion of child abuse to stand. First, let me make a few things clear:
I do not consider antivax people in general to be child abusers. Misguided, certainly, but there is usually no intent to cause harm to a child—they simply believe that vaccines are ineffective and dangerous, which is not true, but still, that’s what these people believe. And most are otherwise taking on board other measures, often useful. Example:
What I do consider child abuse is when parents, some of whom are happy to be vaccinated themselves, want to deliberately infect their children with diseases that they know full well are at best very unpleasant, and worse carries the risk of serious complications, including death. These parents have intent to harm their children, no matter how much they want to brush aside the risks of complications.
Before we jump in to look at this child abuse group that Facebook considers to meet “community standards”, let’s review a few extra facts on a couple of diseases and the vaccinations for them.
Here’s a primer on Chicken Pox (Varicella), and, particularly in high risk groups (which includes infants), it carries risk of complications. Measles is also nasty, and even in otherwise health people carries the following complications:
About one out of 10 children with measles also gets an ear infection, and up to one out of 20 gets pneumonia. About one out of 1,000 gets encephalitis, and one or two out of 1,000 die. Other rash-causing diseases often confused with measles include roseola (roseola infantum) and rubella (German measles).
No, Vitamin C (or E) won’t help you, and vitamin supplements have a long history of health myths. Nor are better nutrition and hygiene alone responsible for the reduction in disease. Compared with the risks of the MMRV vaccine that prevents both measles and varicella (chicken pox) along with mumps and rubella (German measles), the benefits (outlined in articles above) are huge. Vaccines aren’t linked to an increase in allergies, or cœliac disease or in autism.
Stats and science are important, but somewhat pale in comparison with these descriptions of cases in ICU from an Intensive Care Specialist:
I am an Intensive Care Specialist. Although it was a while ago now, I do remember my first job in Intensive Care (ICU). During my first week I admitted a young man onto ICU with chicken pox. He was 18-19, a young, fit, healthy, tradie. He liked football (soccer – it was England), and had never had any major illnesses before. He was fully vaccinated according to the schedule of the day (this was in the late 1990′s). This was in the days before there was a vaccine for chicken pox. He had chicken pox pneumonia, and was in respiratory failure as a result of this. He was struggling to breathe, and working really hard just to get the air in and out of his lungs. We had to give him an anaesthetic, and put him on a ventilator to try and keep him alive. At that time I had no idea that chicken pox could be so dangerous. I knew it was contagious, I mean, although I had escaped with mild disease when I was a kid, I remember that 26 of my class of 28 kids were off school at the same time with it. I hadn’t remembered learning specifically about it at med school, but I certainly did some reading during that first week on ICU.
It is not unusual, or rare, for it to cause pneumonia of such a severity that it requires hospital care. Not all that get it survive. He was ventilated for a couple of weeks. He, and his family, suffered terribly during that time. He was lucky though. He did survive. His lungs will be permanently scarred though, and I’m not sure he’ll ever play football again. He was the first patient I looked after in ICU with a vaccine preventable disease. The first of so many. The last was only this week, when I tried to help a gentleman with shingles. Shingles is excruciatingly painful, and also caused by the varicella virus. Thankfully, both these diseases are now preventable by vaccination.
So, without further ado, here’s the group for people (currently 482 members) who want to deliberately infect their kids with chicken pox (and in some cases as you’ll see, measles):
Here’s a selection of the discussion I recently obtained from this closed group:
This next one is hugely worrying. Not only are they planning on trying to get a 5 month old infant infected with chicken pox (recall: one of the high risk categories for complications), they are also planning on giving said 5 month old chiropractic treatment to help manage the disease. Not only do they quote the disproven (and nonsensical) vitalistic theory behind false chiropractic claims; there is no evidence that any chiropractic treatment is of value in children and carries with it the risk of spinal injuries (which can lead to death).
Dr Pappas said he was concerned the decision was an endorsement of chiropractic treatment for infants when there was no scientific evidence to support it.
”I think they have put the chiropractor’s interests before the interests of the public,” Dr Pappas said. ”[Treating infants] is inappropriate and it carries a very small but real risk of causing damage, and in some cases, devastating damage.”
A review published in the Pediatrics journal in 2007 also found serious adverse events relating to spinal manipulations in children, including a brain haemorrhage and paraplegia.
and, despite warnings in the group description and from members (who seem more concerned by the illegality than the public health hazards), those who still seem keen on sending chicken pox via the frigging postal system and provide strategies on minimising detection (presumably the US post are on the lookout for licked lollipops alone):
Also noteworthy is this discussion, bearing in mind the extra risks to pregnant mothers and unborn children from chicken pox. At least the mothers have naturally acquired immunity (unless for some reason they didn’t—these cases do occur).
Even if you disagree with me that the above is child abuse, there is still no clear category to report child abuse discussion on Facebook:
and Facebook thus decide that the Chicken Pox Party group meets their “community standards”:
Come on Facebook, lift your game.
I am reading How Animals Grieve by Barbara J. King, and it’s quite a moving, yet scientific, read. King obviously cares very deeply about animals, and presents her research and that of others, as well as a number of moving stories, yet is very clear about studies vs anecdotes (and the proper use of them), making clear what is on solid basis and what is speculation / uncertain. I’m still part-way through the book, but wanted to get a bit of a review out there as it’s such a great book; I will update this post with any more thoughts if I have them while reading the rest. Any corrections / comments to this post are as always, most welcome.
As an academic with a science/engineering background, I couldn’t help but ponder a few of the statements:
- The author writes “Death-related behavior in these insects is, as far as we can tell, driven purely by chemicals. While it’s possible that entomologists just don’t know how to recognize displays of insect emotion, I’m comfortable in hypothesizing that ants don’t feel grief for their dead comrades.” As that section stands, though, it’s more of a generalisation; for it to be a hypothesis it must make some sort of prediction, which we don’t get to until King then presents definitions of love and grief and how they are intertwined, a key point of this book, in particular the part “the animal who loves will suffer in some visible way. She may refuse to eat, lose weight, become ill, act out, grow listless, or exhibit body language that conveys sadness or depression.” So to link the two sections of text, and make it a hypothesis: we do not expect ants to show any behaviour that carries some detriment to the individual.
- King writes “The key to success for at least some nonhuman animals seems not to be pure brain power, but instead a lengthy period of mutual attunement with humans. Thanks to their history of domestication, dogs have had extensive “practice” reading the movements of human companions. DNA science, together with archaeological research, tells us that dogs and humans initiated this process over ten thousand years ago, maybe even as early as fifteen thousand years ago.” Whilst perhaps our ancestors selected dog ancestors to be those who were particularly attuned, perhaps it’s more a case of simply an exaptation of existing behaviour, modified by the nurturing process of raising a dog in a household? This is a bit of a nature vs. nuture debate; I’m not denying there is some selective pressure I just think the ball may lie more firmly in the nuture side.
- On a cat who can tell when patients in a nursing home are about to shuffle off this mortal coil, King writes “The explanation for Oscar’s death predictions lies, I believe, with the smell of molecules called ketones as they are released from a dying body.” Now I’m not an expert on the biology of dying, but as far as I understand there are some conditions, namely organ failure, where release of ketones may occur prior to death, and others that don’t, leading to this hypothesis: in those patients who suffer organ failure, Oscar the cat would be able to predict, whereas if someone dies suddenly from a myocardical infarction, then Oscar wouldn’t be able to predict that.
- On the landing of the chimpanzee Ham in his space capsule in the ocean, King writes “Or was he terrified, both because of intense heat and because he was bobbing around untended in the ocean for three hours, not knowing what would happen next? The image is hard for the mind to take, Ham alone in the capsule, with no other being to empathize or to comfort him during what can only have been a truly frightening experience.” Yet I suspect part of the terror in that situation comes from our knowledge that the capsule had holes and was gradually sinking, and our knowledge that that may lead to death. I suspect Ham may have been a bit frightened by the whole experience, landing and water coming in, but not very frightened in the way we feel when we put ourselves in that situation through the act of reading.
Ultimately, the book builds a solid case for both love and grief in a number of different species of animals, according to King’s reasonable and grounded definitions of both. The solid use of narrative makes this a compelling read even for the lay audience it is targeted at, and it’s a deeply moving book with images that I will keep with me for a long time, and make me ponder the beautiful and diverse range of animals that I share this pale blue dot with. If this bit doesn’t tug at your heart strings, and make you realise that animals can show grief, I am not sure what will:
On the following day, before moving on to another part of the Elephant Sanctuary, Sissy made a choice that surprised the people who witnessed it. She placed her beloved tire, her security blanket, on her friend’s grave. There she left it, an elephant memorial offering, for several days.
Tomorrow (and possibly Friday) there is an appeal hearing before the New South Wales Administrative Decisions Tribunal to decide on whether the Australian Vaccination Network’s name is misleading. To illustrate their stance, I note their book on vaccination, recently released for free, contains 27 references to the word “poison” (they are not poisonous), close to 100 mentions of vaccination being ineffective, over 50 on the word danger / dangerous, etc. If that doesn’t illustrate the anti-vaccination stance of the AVN I don’t know what would.
The research shows that up to 53% of Australians have concerns about vaccination. It is important that these parents get their information from a credible source. People need to know that Australian Vaccination Network is a fringe group of hard core vaccine refusers. Their name deliberately seems amibigous in order to present themselves as presenting serious research on both sides. They merely present non-scientific information on the anti-vaccination side. Your doctor is often your best choice when you have questions concerning your health.
I note the comments by New South Wales Fair Trading’s Principal Solicitor in his decision that is being appealed:
All in all, the available information shows, in my opinion, that the AVN is mostly concerned with opposing vaccination and mandatory immunisation. When issues have two sides, it takes just one of them.
One would expect that an organisation with the name ‘Australian Vaccination Network’ would provide comprehensive and credible information on vaccinations in Australia, and a balanced view on what is involved in the processes and benefits and risks involved, as well perhaps on where and how such treatment can be obtained. The AVN does not do this. Its views are anti-vaccination, and it advises against being vaccinated or taking part in immunisation programs. Complaints received by NSW Fair Trading support this view of the AVN. Parents of young children may be particularly interested in learning about issues concerning vaccination and may easily come across the name Australian Vaccination Network in an Internet search, only to find its issue is opposing vaccination. The name does not suggest that it is anti-vaccination.
The issue here is not with the nature, objects or functions of the AVN or what it espouses, but rather with its name. It can adopt another that is not unacceptable. Free speech is not the issue.
- The Australian Vaccination Network Inc’s message is anti-vaccination.
- Its name does not reflect that message or its true nature, objects or functions.
- Its name is likely to mislead the public
As such, the name is unacceptable for registration as a name under the Associations Incorporation Act 2009.
Warning: some pretty grotesque pictures ahead, as well as some really disturbing and sad stories.
These are notes from a talk presented by Dr Kath Weston, Senior Lecturer in Public Health, Graduate School of Medicine, University of Wollongong. Theses notes were written by me (Dr Matthew Berryman), and are released under the Creative Commons Attribution 3.0 Australian licence.
Kath’s talk was on tales from her time working for the NSW Public Health Division, in the Nepean Blue Mountain (NMB) and Western Sydney (WS) Regions, which were separate, then merged, and are now separate but centrally managed with 2 offices, in Penrith and Parramatta.
The first part of her talk was on measles outbreaks, and listed the following general measures used:
- Urgent testing.
- Assessing the public health risk (based on infectious period)
- Ring fencing of the infection
- Contact tracing: GP waiting rooms, EDs; and follow up preventative measures.
- Prophylactic MMR vaccination can be given within < 72 hrs.
- IG (immunoglobulin) can be given within < 7 days
- Mass clinics
- Provision of information
- Exclusion from school also possible as a strategy, covered under the Public Health Act
The remainder of her talk was a series of case studies.
Wentworth measles outbreak in 2003, case study:
- The index case was a traveller returning from Nepal. Two visits to the ED; isolated on the first attendance but not on the second because he had assured them he was vaccinated.
- Case 2 was the baby of case 3 (the father), only 6 weeks old.
- Case 4 was the child of case 3, 15 months old. The family were conscientious objectors but the mother was immunized as a child, however her immunity wasn’t conferred as temporary immunity via breast milk. The parents refused IG treatment for the 15 month old.
- The child (I presume both? I can’t recall) was taken to a Queensland caravan park with the mother, this was then Queensland Health’s problem.
- Case 5 was an ED staff member, who didn’t realize they had measles.
- Case 6 child attending ED 4 years old.
- Airborne virus so ask for ED lists up to 2 hours after patient was present
- Case 7 another hospital worker.
- Case 8 from case 6 at church.
- Case 9 from case 8 at video store.
- 496 contacts total (excluding the church). Note that these are contacts, not cases.
- 500 contacts at the church (the information provided to church members was in Arabic, I am guessing Christians from Lebanon/Syria??).
- Public Health needed to drive out to contact people in some cases.
- The strain was genotyped as D8(Janakpur NEP/2.99/1).
- In another outbreak there were two genotypes of measles present, so they established that there were 2 outbreaks coinciding.
- None of the cases had a well-documented vaccination history. The ED staff member thought she/he was vaccinated and declined the hospital vaccination on employment.
2006 outbreak via Amma (Mātā Amṛtānandamayī Devī, a Hindu spiritual leader) on her 2006 Australian tour:
- She and her entourage weren’t objectors, and Amma herself didn’t have it, maybe one of the entourage had it.
- Many devotees were, however, objectors, and many around Australia got infected. Contacts refused MMR.
- No secondary cases after follow up.
- High school clinic in WS, many students of Pacific Islander without / with no documented measles vaccination.
- Cost of PHU follow-up of one case of measles: $2433
- $48,000 total cost of outbreak.
Swine Flu ’09:
- Strategies used (in order, with dates given): Alert (pre-24/4), delay (24/4), contain (22/5), protect 17/6, sustain, control with vaccine.
- On June 1 2009 the Pacific Dawn cruise ship arrived in Sydney. Swine flu was confirmed only after people got off the boat, 3 crew members affected.
- On June 3 2009 the State of Origin was held.
- Melbourne had the largest outbreak.
- A woman travelled back to Sydney from Melbourne, and her 10 y.o. son developed symptoms on Tuesday 9 June.
- He attended on 9th and 10th in a large class (75 children, 9 adults) for some event.
- Public Health used the Incident Command System (ICS) to manage people and processes.
- In ICS everyone knows their position (in the case of Kath, she was the boss of her line manager, which didn’t cause any issues), and knows the processes already through training, thus allowing quick action.
- The 75 children had different play times and a lunch time set, and didn’t mix with others in school (wasn’t clear from the talk how this was enforced).
- There was a large role for pharmacists, who were needed to weigh children and mix up the required (liquid) dose of Tamiflu.
- A parent was required at the clinic that was set up for consent— this was another possible vector.
- Needed to carefully plan the process and layout of the clinic.
- Contain phase looking at high risk (of poor outcomes) groups: ATSI, pregnant, morbidly obese.
- Total cost (for Public Health) was $5m.
- There was a lot of panic, even among GPs.
Other case studies presented:
- Red-bellied black snake at a childcare. No children bitten.
- People attending a medical clinic got a rash when visiting the clinic, it turned out it was hairs mistletoe caterpillars in the tree outside of the clinic shedding. Published in Balit et al. Outbreak of caterpillar dermatitis caused by airborne hairs of the mistletoe browntail moth (Euproctis edwardsi).
- Bats and Australian Bat Lyssavirus, a disease related to rabies and, like rabies, fatal unless treated. Two boys, who found the microbats, and thought they were babies of regular size bats, decided to look after them and took them to the local Coles supermarket to get food for them, however the bats
smelt the fruit in the fruit and veg. section andescaped. The boys and Coles staff were scratched. The boys only told parents after one was starting to get symptoms, and were treated with IG and vaccines. Edit: see the comment by Maddy below, but essentially microbats are carnivorous so it was not the fruit that attracted them, but rather that their bodies had warmed up to break torpor. And no reports of ABLV in NSW; I am not sure on the discrepancy between that and what I heard in the talk. I would welcome anyone who knows where stats on human ABLV infections (even though 0 for NSW) are to be found. Stats on ABLV infections in bats can be found here; thanks to my commenter Maddy for that link.
- An outbreak of Chlamydophila psittaci (birds the vectors) in the mountains. 95 suspected or confirmed cases. Tourism involved as well as usual. Public Health asked for reports of dead birds, one man called up to report he’d ridden his lawn mower over six birds. This outbreak generated lots of hypothesis about contact and other factors that were risk factors. In general, under diagnosis is likely.
- 14 cases of salmonella from fried ice cream at a restaurant. The source: egg farm. The preparation for fried ice cream consists of deep frozen ice cream coated in raw egg, then placed in crumbs, then it’s put back in the freezer, until cooked quickly in hot oil. In this case the oil was not hot enough to properly cook the outer layers (including the egg layer), and patrons reported that it tasted soggy rather than crisp, indicating this was so.
- Scombroad poisoning from fish that have partly decomposed (but are still not “bad” in the sense that they don’t appear off) and contain histamines, so they generate an allergic reaction.
- There were a series of cases of disease that were, after a complex investigation, traced to the lack of autoclaving done at a colonic irrigation clinic; one client tested positive for Hep. C.
- Bindeez beads poisoning: a cheap version of a glue was used by a local distributer, that metabolised into GHB (γ-Hydroxybutyric Acid, a.k.a the date rape drug). Not good for young kids.
- Global warming is changing patterns of bird migration, insects, as vectors of disease.
- Tory Shepherd’s article on Melanie’s Marvellous Measles got a feature, as well as a brief outline of the book itself. The presenter (Kath) thought that Stephanie Messenger was just ill-informed, not crazy. I’ll forward her some of Stephanie’s emails to show her otherwise.
Her talk finished with cases where smallpox samples had turned up in historical records. It’s important to note that, given the dates, it was unclear if this was actual smallpox, or more likely (given the descriptions) Variola minor or Vaccinia (cowpox). The use of Variola minor was banned in 1840s (in England) due to the availability of Vaccinia as a safer alternative (“variolation” carried the risk of transmission of other diseases such as Syphilis).
- A 2003 report of smallpox material found in an 1888 book on civil war. “Scabs from vaccination of W.B. Yarrington’s children”.
- The Bizarre bits exhibition. ‘ “Dear Pa…the piece I inclose is perfectly fresh and was taken from an infant’s arm yesterday…” read the letter. “Dr. Harris says the inclosed scab will vaccinate 12 persons, but if you want more, you must send for it. I will pin this to the letter so that you cannot lose it as you did before.” ’
- A parcel delivered to Public Health in 2011 from the NSW State Archives. The letters enclosed with the unopened sample mentioned smallpox. Patient surveillance for staff at Public Health and State Archives was carried out. PCR on the sample was conducted, and no DNA was detected; there were no infections. The source of the sample was the Parramatta Female Factory (convicts, now in Westmead Hospital) used as a pool of recipients to keep the vaccine going in a population (needed scabs to transfer).
In this paper by Dave Hawkes, Candice Lea, and myself, we addressed some common questions about the HPV vaccine and its use in preventing cancer:
Q1: How do we know the HPV vaccine will prevent cancer?
A1: The first HPV vaccine was registered for use in Australia in 2006. Because of the long lead time from HPV infection to the development of cancer, we are currently unable to definitively measure the success of HPV vaccination in reducing the incidence of cervical, or other HPV linked cancers. However, HPV vaccination has already been shown to reduce both HPV infections and HPV-associated pre-cancerous cervical lesions.
The reason we expect a reduction in the rate of certain cancers is by understanding how the virus works. The HPV virus triggers a series of genetic changes, specifically changes in the genes that regulate additional cancer-causing genes. Over time these cells replicate, leading to pre-cancerous lesions in some cases and cervical cancer in others. HPV is associated with 99.7% of cervical cancers and is considered a necessary causative factor of cervical cancer. This is despite the knowledge that not every HPV infection progresses to CIN and then to cancer.
Q2: Why is the vaccine being given to boys as well?
A2: HPV vaccination of boys has two major benefits; firstly, it will reduce the transmission of HPV to women and secondly, HPV infection is associated with a number of cancers which males are susceptible to, such as; cancers of the penis (40% HPV association), cancers of the anus (90% HPV association), mouth (3% HPV association) and throat (12% HPV association).
Q3:The vaccine only targets some types of HPV? What about the others?
A3: The two most commonly used vaccines target types16 and 18 for Cervarix® or types, 6, 11, 16, and 18 for Gardasil®, which is the vaccine commonly used in Australia. Strains 16 and 18 are the most common types linked to cervical cancer, while types 6 and 11 are linked to genital warts.
The vaccine has also been shown to reduce infection with some cancer-associated HPV types that are closely related to those in the vaccines types we vaccinate against.
Q4: How effective is the HPV vaccine?
A4: The vaccine provides immunity for HPV types 16/18 in 95% of people who take the recommended course of doses. The current evidence does not show a reduction in protection (as measured by immunoreactivity) over time.
Q5: Is the vaccine safe?
A5: Adverse events have been reported following HPV vaccination, but the overwhelming majority of these reactions are minor and largely local injection site reactions (e.g. redness, swelling, pain at injection site). These reactions do include other minor self-limiting reactions such as syncope (fainting episodes), headache, and nausea. In addition to our paper, the CDC has a useful summary of minor to moderate reactions of short duration for both types of HPV vaccines and other vaccines. These are consistent with other vaccinations.
Matters of general vaccine safety have been previously covered in-depth in the Australian Academy of Science’s booklet, The Science of Immunisation: questions and answers, and the paper Vaccine Components and Constituents: Responding to Consumer Concerns.
Q6: What about reported deaths from the HPV vaccine?
A6: In 2009, a study investigated 32 deaths attributed to Gardasil® reported by the public on VAERS (Vaccine Adverse Event Reporting System). Of the 32 deaths, there was not enough information to identify the person and investigate the cause of death in 12 cases. The cause of the remaining 20 deaths were: 2 due to diabetes, 3 due to pulmonary embolism, 6 were cardiac-related, 2 were idiopathic seizure disorders, 4 were unexplained, 1 was due to juvenile amyotrophic lateral sclerosis, 1 case of meningoencephalitis (inflammation of the brain and surrounding membrane), and the final death was related to prescription drug abuse. The authors concluded that statistically these results were not significantly different from what you would expect from a similar sized un-vaccinated population.
For references and more details please refer to the paper. I appreciate the work of my co-authors on both the paper itself and this blog.