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Wednesday, April 24, 2019

The Wakefield Generation and a Record Level of Measles


Jacqueline Howard and Debra Goldschmidt at CNN:
Measles cases in the United States have surpassed the highest number on record since the disease was declared eliminated nationwide in 2000.
Overall, there have been 681 measles cases across 22 states this year, according to CNN's analysis of data from state and local health departments.
The states reporting measles cases are Arizona, California, Colorado, Connecticut, Florida, Georgia, Illinois, Indiana, Iowa, Kentucky, Maryland, Massachusetts, Michigan, Missouri, Nevada, New Hampshire, New Jersey, New York, Oregon, Tennessee, Texas and Washington.
As of Monday, the US Centers for Disease Control and Prevention reported 626 individual cases of measles confirmed in those 22 states. This includes illnesses reported by state health departments to the CDC through April 19 and therefore does not include cases reported since then.
Soumya Karlamangla at the Los Angeles Times:
Los Angeles health officials warned this week that students and staff at UCLA and Cal State L.A. may be at risk of catching measles, an announcement that has raised questions about universities’ susceptibility to disease outbreaks.

Not only can cramped dorm rooms and crowded classrooms be breeding grounds for contagion, but young adults in California are less likely to be vaccinated than other age groups, experts say. One of the people infected in L.A.’s measles outbreak is a UCLA student, university officials confirmed Tuesday.
People who are now in their early 20s are part of what’s known as the “Wakefield generation,” because they were infants in 1998 when British scientist Andrew Wakefield published a now discredited paper claiming that vaccines cause autism. Scared of the side effects of vaccination, many parents chose to opt out.

Tuesday, April 23, 2019

Measles and Antivaxxers


CDC reports:
From January 1 to April 19, 2019, 626** individual cases of measles have been confirmed in 22 states. This is an increase of 71 cases from the previous week. This is the second-greatest number of cases reported in the U.S. since measles was eliminated in 2000, second only to the 667 cases reported during all of 2014. In the coming weeks, 2019 confirmed case numbers will likely surpass 2014 levels.
The states that have reported cases to CDC are Arizona, California, Colorado, Connecticut, Florida, Georgia, Illinois, Indiana, Iowa, Kentucky, Maryland, Massachusetts, Michigan, Missouri, Nevada, New Hampshire, New Jersey, New York, Oregon, Texas, Tennessee, and Washington.

Trends in Measles Cases: 2010-2019
Alfred Lubiano at The Philadelphia Inquirer:
The rebel forces in America’s latest culture war — the so-called anti-vaxxers — are often described as middle- and upper-class women who breast-feed their children, shop at Whole Foods, endlessly scour the web for vaccine-related conversation, and believe that their thinking supersedes that of doctors. Typically their families earn more than $75,000 a year.

That’s based on findings from various studies, including the National Immunization Surveys conducted by the federal Centers for Disease Control and Prevention’s National Center for Immunization and Respiratory Diseases.
... 
Reports indicate many of the infected weren't vaccinated. The CDC says that the percentage of children who are unvaccinated has quadrupled since 2001. About 25 per cent of parents are delaying vaccinations or allowing only certain vaccines to be used "cafeteria style," said Jennifer Reich, sociologist at the University of Colorado and author of the book "Calling the Shots: Why Parents Reject Vaccines."
...
"Frankly, these Caucasian, suburban, educated parents believe they can Google the word vaccine and get as much information as anybody," said Paul Offit, a professor of pediatrics and director of the Vaccine Education Center at Children's Hospital of Philadelphia.These people are educated just well enough to make terrible decisions for their children."
...
Vaccine resistance has become a “form of privilege,” Reich said. Educated mothers develop a sense of entitlement that helps them decide which vaccines are unnecessary, Reich said, adding, “They focus on organic foods, health-promoting practices at home — ways they see of mitigating disease risk.”

Monday, April 22, 2019

Dental Care

The Politics of Autism discusses health care, and explains that autism services can be complicated, creating difficulties for autistic people and their families. 

David Tuller of Kaiser Health News at The Washington Post:
People with autism, cerebral palsy and other developmental disorders face enormous barriers to adequate and timely dental care — on top of their other challenges. Many dentists either avoid treating these patients or lack the skills needed to do so. Some patients with developmental disabilities are unable to endure even regular dental exams or cleanings without general anesthesia.
But most dentists don’t offer it and getting insurance to cover it for routine dental work is often a struggle.
Because it is difficult for them to get treatment, people with developmental disorders suffer “a high burden of dental disease,” according to a 2012 study of more than 4,700 patients published in the Journal of the American Dental Association. Thirty-two percent of the patients studied suffered from untreated cavities and 80 percent from serious gum infections.

“Many individuals with developmental disabilities cannot personally maintain their own dental hygiene,” according to a September study by the California Legislative Analyst’s Office (LAO). “Often, they need extra appointments or special accommodations that dentists are unable or unwilling to provide.”
In many cases, patients need these extra appointments to help them get accustomed to the environment of a dental office, including the equipment, procedures and personnel. This can help minimize their anxiety and reduce the need for deep sedation or general anesthesia.
But sometimes there is no alternative to anesthesia.

Sunday, April 21, 2019

The Church of Bleach

In The Politics of Autism, I discuss autism quackery.  One particularly dangerous "cure" involves bleach.

Chiara Giordano at The Independent:
A self-described “church” is promoting a dangerous miracle cure which claims to eradicate 95 per cent of illnesses including HIV and autism by making people drink bleach.
The quasi-religious organisation called Genesis II Church of Health and Healing was due to host an event in Leavenworth, Washington, on Saturday to push the “effective alternative healing”.

The group asked for payments of between $450 and $800 per person (£346 to £615) for couples attending the event in exchange for a year’s membership to the organisation and packages of bleach, known as “sacraments”.

From FDA:
Products or treatments claiming to cure autism are deceptive and misleading, because there is no cure for autism. The same is true of many products claiming to “treat” autism or autism-related symptoms. Some may carry significant health risks.
The Food and Drug Administration (FDA) plays an important role in warning companies against making improper claims about their products’ intended use as a treatment or cure for autism or autism-related symptoms.
...
FDA Cracks Down on False Claims
The Food and Drug Administration has warned and/or taken action against a number of companies that have made improper claims about their products’ intended use as a treatment or cure for autism or autism-related symptoms. Some of these so-called therapies carry significant health risks. For example,
  • Chelation Therapies.” These products claim to cleanse the body of toxic chemicals and heavy metals by binding to them and “removing” them from circulation. They come in a number of forms, including sprays, suppositories, capsules, liquid drops and clay baths. FDA-approved chelating agents are approved for specific uses that do not include the treatment or cure of autism, such as the treatment of lead poisoning and iron overload, and are available by prescription only. FDA-approved prescription chelation therapy products should only be used under professional supervision. Chelating important minerals needed by the body can lead to serious and life-threatening outcomes.
  • Hyperbaric Oxygen Therapy. This involves breathing oxygen in a pressurized chamber and has been cleared by FDA only for certain medical uses, such as treating decompression sickness suffered by divers.
  • Detoxifying Clay Baths. Added to bath water, these products claim to draw out chemical toxins, pollutants and heavy metals from the body. They are improperly advertised as offering “dramatic improvement” for autism symptoms.
  • Various products, including raw camel milk, MMS (chlorine dioxide) and essential oils. These products have been marketed as a treatment for autism or autism-related symptoms, but have not been proven safe and effective for these advertised uses.
FDA some quick tips to help you identify false or misleading claims.
  • Be suspicious of products that claim to treat a wide range of diseases.
  • Personal testimonials are no substitute for scientific evidence.
  • Few diseases or conditions can be treated quickly, so be suspicious of any therapy claimed as a “quick fix.”
  • So-called “miracle cures,” which claim scientific breakthroughs or contain secret ingredients, are likely a hoax.
If you have a question about treatment, talk to a health care provider who specializes in caring for people with ASD.
The National Institute for Child Health and Human Development has more information about therapies and interventions for ASD, as does the Centers for Disease Control and Prevention.

Saturday, April 20, 2019

Increasing Vaccine Coverage

In The Politics of Autism, I analyze the discredited notion that vaccines cause autism.   This bogus idea can hurt people by allowing disease to spread.

At JAMA, Lawrence O. Gostin, Scott C. Ratzan, and Barry R. Bloom have an article titled Safe Vaccinations for a Healthy Nation: Increasing US Vaccine Coverage Through Law, Science, and Communication."
As summarized by the National Academy of Medicine, large clinical trials, and numerous observational studies, have definitively refuted any connection between vaccines and autism.3 Further, multiple vaccines spaced together, another expressed health concern, pose no greater risk. Two doses of vaccine provide 97% protection for measles. “Herd immunity” requires 95% immunization coverage to provide community protection against measles.
...
Policy makers have clear tools to increase vaccine coverage, thus reducing harm to children and their families. Because vaccines play such a critical role in the health of children, a long-term national health communication campaign to build vaccine literacy, potentially called Safe Vaccines for a Healthy America, could be useful in increasing and restoring faith in the safety and importance of vaccines. The dissemination of evidence-based information should be a key part of the program and should be uncontroversial. ... Pediatricians and obstetricians could also counsel parents, reassuring them about vaccine safety. When parents request vaccine exemptions, states could require a physician’s certificate affirming they have discussed vaccines’ benefits and risks, and indicate that they are aware that false responses have legal consequences.
Public information campaigns compete with a complex web of false information. Public health authorities, therefore, should partner with the private sector to improve the informational environment. Encouragement, and oversight, of major social network organizations is needed to stem the flow of misleading information. Private and publicly traded companies should screen out false antivaccine messages and cease providing a platform for harmful exchange of falsehoods that promote childhood disease, just as they do for sexually explicit, violent, or threatening messages. Social media companies could go further, exercising corporate responsibility by disseminating science-based health information to advance societal well-being and vaccine confidence.

The federal government should encourage states to end or tighten religious or philosophical exemptions, following the lead of California, which enacted evidence-based policies. If states fail to act, federal authorities have the power to incentivize compliance. They could, for example, condition a portion of Medicaid or Affordable Care Act funding on states tightening their vaccine laws. Conditional funding should not be overly coercive, and Congress should take steps to avoid harming already disadvantaged populations. While the federal government has limited power to compel vaccination, the Supreme Court has affirmed its use of conditional funding. In 1987, the Court upheld a law conditioning national highway funding based on states enacting a minimum drinking age of 21 years. Immunization is a national problem as childhood diseases transcend state borders; vaccine hesitancy, therefore, requires a national solution.

Friday, April 19, 2019

Trump Would Cut Help for People with Disabilities


Tom Ridge, former GOP governor of Pennsylvania and the first DHS secretary, chairs the National Organization on Disability.  He writes at The New York Times about Trump's proposed cuts to programs for people with autism and other disabilities.
Independent living centers, assistive-technology programs, supports for individuals living with brain injuries and family caregiver support services are among those programs and services on the chopping block. So too is the Office of Disability Employment Policy. This office, within the Labor Department, is the only nonregulatory federal agency that promotes policies and coordinates with employers and all levels of government to increase workplace success for people with disabilities.
...
I agree with Senators Bob Casey and Sherrod Brown, who recently wrote to the director of the Office of Management and Budget and said that any budget proposal by any administration should reflect the goals of the A.D.A.: equal opportunity, independent living, full participation and economic self-sufficiency. The exclusion of any group of people from our economy is not only a problem for those who’ve been excluded. It’s a scourge on our democracy that touches us all.

Thursday, April 18, 2019

Special Education Costs in California

In The Politics of Autism, I write about special education and the Individuals with Disabilities Education Act.

Paul Warren, research associate at the Public Policy Institute of California, testified on March 28 before the California State Senate Education Budget Subcommittee:
The committee asked PPIC to help them understand why district special education costs are rising so quickly.
First, some background. The AB 602 formula provides about $500–600 in state special education funds per student in each district, based on average daily attendance (ADA). The number of students with disabilities in a district does not affect state funding amounts. Each year, that amount is increased by the change in ADA and by a cost-of-living adjustment.
In the PPIC report, Special Education Finance in California, my colleagues and I identified several reasons why AB 602 funding has not kept pace with district costs:

  • Changes in the rate and type of disabilities. We estimated that these changes increased annual district costs by around $1.1 billion. The state formula is currently based on average district costs from the late 1990s.
  • Growth in preschool for children with disabilities under the age of 5. This population grew about 10 percent from 2005 to 2015. The AB 602 formula does not adjust district funding for changes in this group, as pre-school children with disabilities do not count toward ADA.
  • Higher district salaries since the Great Recession. The large LCFF [Local Control Funding Formula] increases during the economic recovery shaped salary negotiations. But AB 602 did not adjust to the higher costs for special education teachers and administrators.
In a report from last year, Revisiting Finance and Governance Issues in Special Education, we provide two options for modifying the AB 602 formula:
  • Increase AB 602 by the same percentage amount as LCFF funding. This makes sure that state funding for special education increases at the same rate as LCFF.
  • Increase AB 602 by the actual increase in special education costs. This would hold the state share of special education costs constant over time.
We also recommend caution when considering proposals to base state special education funding on counts of students with disabilities. Differences in district identification practices affect the share of students identified for special education services. We found that the county with the lowest rate of students with disabilities reported that about 8.8 percent of students were in special education. In contrast, the county with the highest rate reported that about 17.6 percent of students were in the program. This disparity strongly suggests that district practices affect district caseloads, and basing state funding on the number of students with disabilities could create financial incentives to identify more students.
Our two options would avoid this identification problem while better aligning state funding for special education with LCFF and district costs.
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