Should doctors fire patients who won’t vaccinate?

WSJ has an article about the increasing number of pediatricians who fire their patients who refuse to vaccinate:

Pediatricians fed up with parents who refuse to vaccinate their children out of concern it can cause autism or other problems increasingly are “firing” such families from their practices, raising questions about a doctor’s responsibility to these patients.

Medical associations don’t recommend such patient bans, but the practice appears to be growing, according to vaccine researchers.

In a study of Connecticut pediatricians published last year, some 30% of 133 doctors said they had asked a family to leave their practice for vaccine refusal, and a recent survey of 909 Midwestern pediatricians found that 21% reported discharging families for the same reason.

By comparison, in 2001 and 2006 about 6% of physicians said they “routinely” stopped working with families due to parents’ continued vaccine refusal and 16% “sometimes” dismissed them, according to surveys conducted then by the American Academy of Pediatrics.

“There’s more noise among pediatricians, more people willing to argue that it’s OK to do this versus 10 years ago,” said Douglas Diekema, a professor of pediatrics at the University of Washington in Seattle. Dr. Diekema wrote the AAP’s policy on working with vaccine refusers, which recommends providers address the issue at repeated visits, but respect parents’ wishes unless it puts a child at risk of significant harm.

This is an interesting ethical question as there are several issues at play. Since the pediatrician is the child’s doctor, is it wrong to fire the family from the practice just because the parent is misinformed? Or is it a worse practice to tolerate parental medical foolishness and expose other patients in the practice to vaccine-preventable disease? Since vaccination is one of the most important roles of the pediatrician during well-child visits, is there any point at all in having regular pediatrician visits if you refuse vaccination?
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Is Huffington Post no longer a denialist site?

Seth Mnookin has reasons to hope. It has been clear though for years that Huffpo was a clearinghouse for what I would describe as liberal crankery, which includes things like Jenny McCarthy’s anti-vaccine crankery, or Bill Maher’s anti-pharma paranoia.

But now they have a new site, Huffpo Science, and after my head stopped ringing from that particular oxymoron I went and checked it out.
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The Autism/Vaccines Fraud

I have to admit I’m somewhat surprised (even if Orac isn’t). We all knew that Andrew Wakefield’s research was bogus and the link between vaccines and autism was engineered by ideologues who fear vaccines irrationally. But fabrication of data? Sloppy research is one thing, but the need for cranks to be correct, no matter what reality reflects, has resulted in yet another example of egregious dishonesty.

This is in line, however, with what we know about cranks. Mark Crislip recently wrote an interesting piece on mathematics crankery which bears upon just this phenomenon. Mathematics is a wonderful area to study crankery because as Crislip points out, mathematics is a field in which it is possible to distinguish between the possible and the impossible.

In mathematics there are things that are impossible. Absolutely impossible. No ifs, ands, or buts. Impossible. Can’t be done no how no way. In the world of mathematics, things are not only impossible, they are proven truly impossible within the boundaries of the mathematical discipline.

An example of mathematical impossibility is the quadrature of the circle, also called squaring the circle.

It is impossible, using only a straight edge ruler and a compass, to construct a square with the same area as a given circle. It was proved to be impossible in 1882 by Lindeman. Not improbable or unlikely or very, very, very difficult. With in mathematical reality, it is impossible.

But in his review of Mathematical Cranks he hits upon many of the commonalities between cranks we discussed in the Crank HOWTO.

Here is Crislip’s description of the mathematical crank:

1) They are convinced that their opinion is superior to the accumulated opinion of 2000 years of mathematics and mathematicians. That hundreds of mathematicians have worked for hundreds of years on these problems and found no errors in the proof that it is impossible to square a circle is of no consequence. Despite the accumulated mathematical knowledge of uncounted mathematicians, they are convinced that their solution is the right solution. Everyone else for all of history has been wrong. There is a tinge of megalomania in all the correspondence, and some appear to me to be clinically insane.

2) To accommodate their solutions, they are willing to alter reality to fit their proofs. There are solutions to squaring the circle, but they require a value of pi that is different that 3.14159265… Pi, for those that have forgotten, is the ratio of the circumference to the diameter of a circle and is a constant of the universe. For some circle squarers, Pi has a different value and all the mathematics that has confirmed the current value of pi is wrong. Others deny that pi exists or that the definition is meaningless, since they can construct a squared circle with pencil and paper, and send in the (flawed) construction.

3) When errors of math or logic are pointed out, they respond not with understanding, but a redoubling of efforts to prove that their erroneous solution to the problem is actually correct. They are incapable of recognizing flaws in logic, or mathematics, or flaws that are in opposition to mathematical consistency. A crank cannot recognize their error because they cannot recognize that their reality differs from mathematical reality.

4) Cranks are impervious to arguments based on mathematical reality. They do not recognize or understand that their solutions are in error because the solution contradicts known mathematical reality. They do not base their solutions on known mathematics, but on their own flawed understanding of mathematics.

5) Cranks evidently send their ‘solutions’ to multiple mathematical departments and rarely receive a reply. This silence from academia is interpreted not that their solution is worthless, but that there is a conspiracy of Professors of Mathematics to keep their solution secret, to the detriment of human kind. Big Math, out to suppress the truth THEY don’t not want you to know.

It is obvious to me that no matter what the field, the problem is crankery – the defective thought processes that allow people to believe in nonsense, no matter what obstacles reality throws in their path. Every description of every crank in every field ultimately boils down to these same factors. Cranks believe in something contrary to observable reality. They will do anything to prove it. When reality gets in their way, they ignore, subvert, lie, cheat, or obfuscate to create confusion. And when it’s proven beyond all doubt they’re wrong? That’s when the conspiracies come out. The comments on the Huffington Post coverage of the most recent Wakefield dishonesty are an excellent example of this. Wakefield is a victim of Big Pharma, being persecuted by Brian Deer, it’s all a conspiracy against children by doctors and pharmaceutical companies etc.

The more time passes the more I’m convinced that our original thesis on cranks and denialism in general has been confirmed again and again. No matter what the foolish belief the problem the reality-based community is fighting is a defective pattern of thought, an incompetence in evaluating the quality of evidence that afflicts millions of individuals and ultimately is why so many people believe in such stupid things. Wakefield, ultimately, is just another in a long line of cranks. And while biology is never as concrete as mathematics, it is clear that accepting reality was never a part of the the anti-vaccine movement’s ideology. And what do cranks do when reality opposes your world view? They do what Wakefield did. Reject reality, and substitute their own.

Even after all this time I was surprised they would find outright fabrication in Wakefield’s work, but I shouldn’t have been.
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