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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.

Tuesday, April 16, 2019

Measles Wildfire

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.

During his campaign for the White House, Trump met with British physician Andrew Wakefield—whose 1998 article claiming a link between vaccines and autism has been thoroughly debunked—and also with prominent anti-vaxxer Robert F. Kennedy, Jr., who reported that Trump was planning to appoint him chair of a new “vaccine safety commission.”

Fortunately, that never happened. And Trump has gone quiet about vaccinations, which is better than repeating falsehoods about them... But it’s hard to work together when the guy in charge is checked out. A single tweet from Donald J. Trump—VACCINATE YOUR KIDS!—would do more than anything else to protect American children right now. Let’s hope he can summon the courage and decency to send it.

In just the first three months of 2019, there have been more than 110,000 measles cases reported worldwide, a figure that is up nearly 300% from the same period last year. And these numbers will represent just a fraction of all the cases that occur. By the time you finish reading this, we estimate that at least 40 people -- most of them children -- will be infected by this fast-moving, life-threatening disease.
We're worried not only because measles can be so severe -- it still causes over 100,000 deaths every year -- but also because it is extremely contagious.
n those who are not immune, measles will infect approximately 9 in 10 people exposed to it. And since it is so infectious, it may be the first disease to appear where children are not getting the vaccines they need to keep them safe. And the presence of measles can point to a pocket of unvaccinated children and a possible dysfunction in the health system.
In short, measles is the canary in the coalmine of vaccine preventable illnesses.
From January 1 to April 11, 2019, 555** individual cases of measles have been confirmed in 20 states. This is the second-greatest number of cases reported in the U.S. since measles was eliminated in 2000.
The states that have reported cases to CDC are Arizona, California, Colorado, Connecticut, Florida, Georgia, Illinois, Indiana, Kentucky, Maryland, Massachusetts, Michigan, Missouri, Nevada, New Hampshire, New Jersey, New York, Oregon, Texas, and Washington.
Trends in Measles Cases: 2010-2019

Monday, April 15, 2019

Tight-Knit Communities and Vaccine Hesitancy

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.

Sumathi Reddy at WSJ:
In 2017 it was a Somali community in Minnesota. In 2014 it was the Amish in Ohio. This year, it is Orthodox Jewish communities in New York and Eastern Europeans in Washington state.
Insular and close-knit religious or cultural groups have seen some of the worst measles outbreaks in the U.S. in recent years.

About 75% of measles outbreaks over the past five years—defined as three or more linked cases—took place in such tightknit communities, says Nancy Messonnier, acting director of the CDC’s Center for Preparedness and Response, and an expert on immunization and respiratory diseases. Such groups share the same culture and are often somewhat isolated from the larger community.
In Ohio, when a measles outbreak hit an Amish community in 2014, they were willing to get the MMR vaccine when they saw the effect the disease was having, says Michael Brady, associate medical director at Nationwide Children’s Hospital in Columbus. The issue wasn’t the vaccine, he says, but their philosophy of not accepting anything from the government.

In Washington state where a measles outbreak has been contained, advocates and health experts say there is documented vaccine hesitancy in the Ukrainian and Russian-speaking populations.
Tetyana Odarich, a family medicine physician in Portland, Ore., sees many patients from the Ukrainian and Russian community in the area and says roughly half don’t want to get their children vaccinated.

Sunday, April 14, 2019

PEACH: Language and Tactics of an Antivax Group

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.

Claudia Koerner and Julia Reinstein at Buzzfeed:
PEACH, formally known as Parents Educating and Advocating for Children’s Health, has been circulating magazines and pamphlets since at least 2014 that claim vaccines are in opposition with Jewish religious law, (falsely) link vaccines to autism, and recount anonymous horror stories of children being irreparably harmed by vaccines.

Public health officials have called the measles outbreak a crisis, with 180 recorded cases of the disease since last fall in Rockland County and at least 285 in New York City. In both areas, measles has struck particularly hard in Orthodox Jewish neighborhoods, and health officials have worked with rabbis and other community leaders to spread the message: Vaccines are safe, and they save lives.

The PEACH stories and "experts" tell a darker story, one that's been repeatedly debunked by mainstream science, medical professionals, and religious leaders. The pamphlet downplays the danger of diseases such as measles, while pointing to the increase in diagnoses of autism. (Experts say those numbers have risen as parents have become more aware of autism, and doctors now diagnose a range of characteristics as part of the autism spectrum.) The pamphlet accuses pediatricians of covering up the dangers of vaccines for financial gain — another conspiracy theory — when in reality, vaccines are a tiny sliver of the pharmaceutical industry's profits, and individual doctors can lose money on administering vaccines.
"Enriched Parenting is a DBA of Parents Educating & Advocating for Children's Health, Inc. Our organization is not affiliated with Peach magazine. We are an organization that supports religious, philosophical, and medical choice. We are not, nor ever have been 'anti' anything other than coercion and loss of civil liberties," she said in a statement. "We support informed decision making and right of choice for all parents. Our activities are geared toward education and health options on a wide variety of subjects not limited to vaccine information. We are a pro-choice organization."

Saturday, April 13, 2019

Economic Costs of Autism

In The Politics of Autism, I discuss costs and benefits of autism services.

Nicky Rogge and Juliette Janssen have an article at Journal of Autism and Developmental Disorders titled The Economic Costs of Autism Spectrum Disorder: A Literature Review

The abstract:
Autism is associated with a range of costs. This paper reviews the literature on estimating the economic costs of autism spectrum disorder (ASD). More or less 50 papers covering multiple countries (US, UK, Australia, Canada, Sweden, the Netherlands, etc.) were analysed. Six types of costs are discussed in depth: (i) medical and healthcare service costs, (ii) therapeutic costs, (iii) (special) education costs, (iv) costs of production loss for adults with ASD, (v) costs of informal care and lost productivity for family/caregivers, and (vi) costs of accommodation, respite care, and out-of-pocket expenses. A general finding is that individuals with ASD and families with children with ASD have higher costs. Education costs appear to be a major cost component for parents with children with ASD.
From the article:
Based on the studies reviewed, the overall lifetime costs for individuals with ASD are estimated to be situated somewhere between $ 2.4 million (in 2011 US$) (Buescher et al. 2014) to $ 3.2 million (in 2003 US$) (Ganz 2007) for the US and from £ 1.5 million (in 2011 £) (Buescher et al. 2014) to £ 2.4 million (in 1997–1998 £) (J√§rbrink and Knapp 2001) for the UK. As a total figure for the US, Leigh and Du (2015) estimated annual direct medical, direct non-medical, and productivity costs combined to be $268 billion (range $162–$367 billion; 0.884–2.009% of GDP) for 2015 and forecast this cost to be $461 billion (range $276–$1011 billion; 0.982–3.600% of GDP) for 2025. Moreover, as pointed out by some studies, reported cost estimation figures are likely to underestimate true ASD-related costs due to omitted health impacts, omitted economic impacts, omitted impact on social life, and the costs of health actions in other sectors.
[T]he cost of (special) education, EIBI and therapy, individual productivity loss, parental productivity loss, and (supported) accommodation and residential care are among the largest contributors to total lifetime costs for an individual with ASD. The recent anonymous online survey for children and adults with ASD organized across multiple EU-countries in a large-scale project (ASDEU 2018), found similar results, with the cost of special education services being the highest cost component, followed by the costs of tutorial support, especially among younger people with ASD. Medical and healthcare costs related to ASD have been found to constitute only a small part of the total costs for individuals with ASD, with medical costs being higher for adults with ASD than for children with ASD. Estimates also show that smaller out-of-pocket expenses related to ASD, such as travel costs, cost related to making the house more ASD-friendly, purchase of specialised tools or equipment, etc., cannot be ignored when analysing the costs related to ASD. Summed together, all these out-of-pocket expenses can place a significant financial burden on the family budget. As to the costs of ASD-related therapies, due to the differences in therapy categorization and widely divergent cost estimates for ASD therapies, it is difficult to get a clear picture of the costs of therapy and/or EIBI programmes for individuals with ASD. Nevertheless, the studies that assessed the cost-effectiveness of EIBI for (young) children with ASD found that such therapy programmes are cost-effective and can result in cost savings throughout the lifetime of individuals with ASD.

Friday, April 12, 2019

Prevalence Among 4-Year-Olds

In The Politics of Autism, I discuss the uncertainty surrounding estimates of autism prevalence.

It finds that prevalence was higher in 2014 than in 2010 in New Jersey, but was stable in Arizona and Missouri. From the abstract:
The findings suggest that ASD prevalence among children aged 4 years was higher in 2014 than in 2010 in one site and remained stable in others. Among children with ASD, the frequency of cognitive impairment was higher among children aged 4 years than among those aged 8 years and suggests that surveillance at age 4 years might more often include children with more severe symptoms or those with co-occurring conditions such as intellectual disability. In the sites with data for all years and consistent data sources, no change in the age at earliest known ASD diagnosis was found, and children received their first developmental evaluation at the same or a later age in 2014 compared with 2010. Delays in the initiation of a first developmental evaluation might adversely affect children by delaying access to treatment and special services that can improve outcomes for children with ASD.

Public Health Action: Efforts to increase awareness of ASD and improve the identification of ASD by community providers can facilitate early diagnosis of children with ASD. Heterogeneity of results across sites suggests that community-level differences in evaluation and diagnostic services as well as access to data sources might affect estimates of ASD prevalence and age of identification. Continuing improvements in providing developmental evaluations to children as soon as developmental concerns are identified might result in earlier ASD diagnoses and earlier receipt of services, which might improve developmental outcomes.

Thursday, April 11, 2019

With All Deliberate Speed: DeVos and a a Court Order

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

Christina Samuels at Education Week:
Nearly a year ago, the U.S. Department of Education said it was putting on hold for two years the implementation of an Obama-era rule that had the potential to affect how millions of dollars in federal special education dollars could be spent.

Nearly a month ago, a judge reversed the Education Department's delay, saying it was an "arbitrary and capricious" decision.

On Wednesday, Education Secretary Betsy DeVos was pressed by Rep. Donna Shalala, a Democrat from Florida, on the department's plans in the wake of the court decision.
"We are currently reviewing the district court order and deciding on next steps. We are moving toward implementation," DeVos told Shalala—similar to the response she gave when she was asked the same question by Sen. Chris Murphy of Connecticut in late March.
"You've had a month to review the order. The order isn't very complicated," Shalala told DeVos.
 The underlying issue, though, is complex. The Individuals with Disabilities in Education Act requires states to monitor how districts identify minority students for special education, discipline them, or place them in restrictive settings. 

Wednesday, April 10, 2019

New York Emergency

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.

Tyler Pager at NYT:
The Vaccine Safety Handbook” appears innocuous, a slick magazine for parents who want to raise healthy children. But tucked inside its 40 pages are false warnings that vaccines cause autism and contain cells from aborted human fetuses.
“It is our belief that there is no greater threat to public health than vaccines,” the publication concludes, contradicting the scientific consensus that vaccines are generally safe and highly effective.
The handbook, created by a group called Parents Educating and Advocating for Children’s Health, or Peach, is targeted at ultra-Orthodox Jews, whose expanding and insular communities are at the epicenter of one of the largest measles outbreaks in the United States in decades.
On Tuesday, Mayor Bill de Blasio declared a public health emergency in parts of Brooklyn in an effort to contain the spread of measles in ultra-Orthodox neighborhoods there. He said unvaccinated individuals would be required to receive the measles vaccine — or be subjected to a fine — as the city escalated its campaign to stem the outbreak.
Delthia Ricks at Governing:
Dr. Aaron Glatt, chairman of medicine at South Nassau Communities Hospital in Oceanside, told Newsday two weeks ago there is nothing in Jewish religion that prohibits vaccination. "The religion was in place long before vaccines were developed," said Glatt, who is also a rabbi.
He blamed the outbreaks on well-meaning parents who have been duped by rampantly spreading pseudoscience, which links the MMR vaccine to autism. Vaccine hesitancy is also common among a growing number of people who aren't Jewish, Glatt added.
"Misinformation is very, very dangerous," Glatt said, "and there is no evidence whatsoever that vaccines cause autism."
A study published last month in the Annals of Internal Medicine involving more than 600,000 people proved again that MMR vaccine does not cause autism. The study was the largest, but one of dozens that have found no links between vaccines and the neurodevelopmental disorder.

Tuesday, April 9, 2019

Trump Budget v. People with Disabilities

In The Politics of Autism, I discuss the issue's role in campaign politics.   In the 2016 campaign, a number of posts discussed Trump's bad record on disability issues more generally.   As his actions as president indicate, he has little use for Americans with disabilities.

From Senator Sherrod Brown (D-OH) and Bob Casey (D-PA):
Director Mulvaney:
We write to address a pernicious theme in the Trump Administration’s Fiscal Year 2020 (FY20) Budget: across multiple agencies and offices, the budget targets people with disabilities. Whether in housing, education, employment, aging, health care, civil rights, transportation, research or any of the other governmental functions that assist people with disabilities and their families, this budget strips the resources that make access and opportunity possible. Any budget proposal by any administration should reflect the goals of the Americans with Disabilities Act: equal opportunity, independent living, full participation, and economic self-sufficiency. Your budget not only doesn’t reflect those goals, it actively inhibits their achievement.

In the Trump Administration’s FY20 budget you have cut funding to:
  • the Traumatic Brain Injury program
  • the Paralysis Resource Center
  • the state Council on Developmental Disabilities
  • the University Centers on Developmental Disabilities
  • the National Institute on Disability, Independent Living, and Rehabilitation Research
  • the Independent Living Centers
  • the Limb Loss Resource Center
  • Gallaudet University
  • the Voting Access for People with Disabilities program
  • the state Assistive Technology programs
  • the Family Caregiver Support Services program
  • the Native American Caregiver Support Services program
  • the Alzheimer’s Disease program
  • the Lifespan Respite Care program
  • the Autism Surveillance program
  • the Interagency Autism Coordinating Committee
  • the Office of Disability Employment Policy
  • Section 811 Housing for Persons with Disabilities
Unfortunately, there are even more examples of cuts to programs that support people with disabilities to work, live in their own homes, get to their jobs, and have access to the opportunities that all Americans enjoy.

We are concerned about all of these cuts to disability programs, but none more so that the proposed cut to Social Security Disability Insurance and Medicaid.

You have proposed $84 billion in cuts, chiefly, to Social Security Disability Insurance. These are funds that support hard working Americans who have developed disabilities over the course of their lives. The workers who would be denied benefits under your cuts are people who have not only contributed to our economy over decades but have also paid into the Social Security Disability Insurance fund. Our government promised American workers that if they work, grow our economy and they develop a disability – we will take the funds they have contributed in their taxes to provide some care, relief, and dignity.

The proposed cuts to Medicaid are an abomination and insult to American values. The 1965 Social Security Amendments Act created Medicaid and in so doing established a contract with Americans that if they met the eligibility requirements for Medicaid their government would provide the health care and supports they need. The proposed cuts to Medicaid, $1.5 trillion over ten years, would break that contract with Americans and leave hundreds of thousands of children, older adults, and people with disabilities without the health care and long-term services and supports they need to be part of our society. In addition to the proposed cuts, the Budget proposes to impose mandatory work requirements as a condition of coverage in Medicaid – a policy that would create unnecessary burdens on individuals with disability and threaten their coverage.

The systematic targeting of people with disabilities, their families, and those who serve them will weaken our nation and hurt our economy. The proposal to cut funding for the Special Olympics, a featured cut in each of this administration’s three budgets thus far, garnered widespread bipartisan backlash causing President Trump to abandon the proposed cut. However, it is evident that this cut is the tip of the iceberg and indicative of a larger-scale assault on the supports for people with disabilities in this country. We urge you to direct each of our Secretaries and Administrators to review their budgets for cuts to disability programs and act to restore the recommendations for funding.

Senator Robert P. Casey, Jr.
Senator Sherrod Brown

Monday, April 8, 2019

Measles: 465

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.

From CDC:
From January 1 to April 4, 2019, 465** individual cases of measles have been confirmed in 19 states. This is the second-greatest number of cases reported in the U.S. since measles was eliminated in 2000.
The states that have reported cases to CDC are Arizona, California, Colorado, Connecticut, Florida, Georgia, Illinois, Indiana, Kentucky, Massachusetts, Michigan, Missouri, Nevada, New Hampshire, New Jersey, New York, Oregon, Texas, and Washington.
Trends in Measles Cases: 2010-2019
Summer Ballentine at AP reports on a Missouri legislative hearing:
Parents testified to lawmakers that their unimmunized children were turned away from daycares and doctors. Republican Rep. Lynn Morris, a pharmacist from southwest Missouri, said parents are being pressured to vaccinate their children.
“Parents are getting bullied,” Morris said. “They’re getting bullied by county health departments. They’re getting bullied by schools. They’re getting bullied by their doctors. They’re being intimidated, and I just don’t think that’s right.”
The Republican’s bill would ban discrimination against unimmunized children in doctors’ offices, daycares, public schools and colleges if families have legal exemptions. Missouri grants exemptions for religious and medical reasons.
Janessa Baake, from the city of Peculiar in southwestern Missouri, cited concern over potential medical risks and told lawmakers Monday that her 3-year-old daughter is unvaccinated. She said after being denied by a Missouri doctor, she now takes her daughter to a Kansas pediatrician.

Another man said his two children developed autism after being vaccinated as toddlers.

“All of the stories and the anecdotes that we heard are very important, but I don’t think that they can be used to refute science,” Ferguson Democrat Rep. Cora Faith Walker said during a break in the hearing.

Multiple studies have debunked claims that measles, mumps and rubella vaccinations increase the risk for autism, and the National Institutes of Health says reports of serious reactions are rare: about one every 100,000 vaccinations. In the U.S., more than 90 percent of the population nationally is properly vaccinated.

Sunday, April 7, 2019

Antivaxxers Hijack the Star of David

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.

In recent months, some anti-vaccine activists (known as anti-vaxxers) have appropriated the yellow Star of David badge, which some European Jews were required to wear during the Holocaust, to symbolize their “persecution” at the hands of government vaccine rules.
The stars, emblazoned with the stylized words “No Vax,” are showing up on social media, especially on Facebook, and at anti-vaccine events. This is a hugely inappropriate use of this enduring symbol of the persecution of Jews by the Nazis during World War II and minimizes and trivializes the experiences of the survivors and victims of the Holocaust.
“The Holocaust was a unique event in human history. European Jews were forced to wear yellow Stars of David by the Nazis as a kind of scarlet letter, a form of persecution and forced exclusion from society,” Jonathan A. Greenblatt, CEO of the Anti-Defamation League, told the Washington Post. “It is simply wrong to compare the plight of Jews during the Holocaust to that of anti-vaxxers. Groups advancing a political or social agenda should be able to assert their ideas without trivializing the memory of the six million Jews slaughtered in the Holocaust.”
The anti-vaccine movement has been gaining momentum in communities across the country, and recent measles outbreaks have moved their campaign back into the spotlight, with some local governments responding by enforcing stricter vaccine requirements.
In Arizona and New York, new vaccine rules have been met with protests, some of which lean heavily on Holocaust analogies. On Facebook, the Star of David imagery is commonly used by anti-vaxxers, who also draw comparisons between vaccine rules and state-sponsored genocide. Facebook recently announced they will no longer support or promote anti-vaccination “news” stories or ads; the crackdown will be carried out in partnership with the World Health Organization and the U.S. Centers for Disease Control and Prevention.

The Star of David trend gathered additional momentum in late March, when anti-vaccine activist Del Bigtree took the stage at a “Parents Call the Shots” event in Austin, Texas, to rail against vaccines.
Bigtree, the chief executive of ICAN (Informed Consent Action Network), quoted from Rev. Martin Niemoller’s Holocaust-era poem “First They Came,” then referred to the Hasidic community in Rockland County, NY, where many parents have refused to vaccinate their children, and which is currently experiencing a measles outbreak. “How will we know if you’re not vaccinated?” Bigtree shouted in a mocking tone, referring to measures the local government is taking to bar unvaccinated children from public spaces.
“How will we know to arrest you? Maybe we’ll do it the same way we did the last time. So for you, for all the Hasidic Jews in New York, who never thought this moment would come, I stand with you! I stand for your religious convictions. We will let you believe in your God.” As the crowd cheered, Bigtree pinned a yellow “No Vax” Star of David to his lapel.

Poland’s Auschwitz Memorial and Museum quickly rebuked Bigtree’s theatrics:
“Instrumentalizing the fate of Jews who were persecuted by hateful anti-Semitic ideology and murdered in extermination camps like #Auschwitz with poisonous gas in order to argue against vaccination that saves human lives is a symptom of intellectual and moral degeneration.” Other organizations, including ADL, weighed in with similar condemnations.
This abuse of Holocaust-era imagery does not appear to have caught on in the white supremacist community, although Roy Batty at the neo-Nazi website Daily Stormer ridiculed the backlash, writing, “Don’t they know that the yellow star is a symbol of Jewish pride and therefore not to be used by the goyim?”
One commenter on Daily Stormer offered this plan to further inflame the situation: “Every minor slight, insult and emotionally jarring event should now be symbolized with the gold star. Dilute the f--- out of its meaning.”

Saturday, April 6, 2019

Autistic Strengths and Weaknesses: Sometimes a False Dichotomy

In The Politics of Autism, I discuss the employment of adults with autism and other disabilitiesMany posts have discussed programs to provide them with training and experience.

At Autism in Adulthood, Ginny Russell and colleagues have an article titled "Mapping the Autistic Advantage from the Accounts of Adults Diagnosed with Autism: A Qualitative Study."  The abstract:
Background: Autism has been associated with specific cognitive strengths. Strengths and weaknesses have traditionally been conceptualized as dichotomous.
Methods: We conducted 28 semi-structured interviews with autistic adults. Maximum variation sampling was used to ensure diversity in relation to support needs. We asked which personal traits adults attributed to their autism, and how these have helped in the workplace, in relationships, and beyond. Data were collected in two stages. Responses were analyzed using content and thematic techniques.
Results: The ability to hyperfocus, attention to detail, good memory, and creativity were the most frequently described traits. Participants also described specific qualities relating to social interaction, such as honesty, loyalty, and empathy for animals or for other autistic people. In thematic analysis we found that traits associated with autism could be experienced either as advantageous or disadvantageous dependent on moderating influences. Moderating influences included the social context in which behaviors occurred, the ability to control behaviors, and the extent to which traits were expressed.
Conclusions: Separating autistic strengths from weaknesses may be a false dichotomy if traits cannot be isolated as separate constructs of strengths or deficits. If attempts to isolate problematic traits from advantageous traits are ill conceived, there may be implications for interventions that have reduction in autistic traits as a primary outcome measure.