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Vaccination

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It looks like a combination of the top and low ends of the socioeconomic distribution, Geographic clusters of underimmunization identified in Northern California:

Underimmunization ranged from 18 percent to 23 percent within clusters, compared with 11 percent outside clusters. Between 2010 and 2012, geographic clusters of underimmunization were found in:

  • the East Bay (Richmond to San Leandro);
  • Sonoma and Napa counties;
  • a small area of east Sacramento;
  • northern San Francisco and southern Marin counties; and
  • a small area of Vallejo.

“Shot limiting,” in which parents limit the number of injections or antigens that children receive during a pediatric visit to two or fewer, was found to cluster in similar areas.

Vaccine refusal ranged from 5.5 percent to 13.5 percent within clusters, compared with 2.6 percent outside clusters. Between 2010 and 2012, geographic clusters of vaccine refusal were found in:

  • the East Bay (El Cerrito to Alameda);
  • Marin and southwest Sonoma counties;
  • northeastern San Francisco;
  • northeastern Sacramento County and Roseville; and
  • a small area south of Sacramento

The paper is not live, but it will be here at some point. In Southern California most of the resistance has been in affluent areas, and in some of these areas the fraction immunized is definitely below the herd immunity threshold. Though this trend looks like it may finally have levelled off in California.

 
• Category: Science • Tags: Anti-Vaccination, Vaccination 
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vaccine_rateBystate-UPD-01

Credit: Mother Jones

Over at Mother Jones Tasneem Raja and Chris Mooney have a rather alarming article up, How Many People Aren’t Vaccinating Their Kids in Your State? This is no joke. I’ve talked earlier about the fact that during my wife’s pregnancy we were confronted by rather strong anti-vaccination sentiments within the community. Because of our generally scientific bent it had no effect on us, but we saw how persuaded, or persuadable, many of our friends and acquaintances were. Without a scientific background people often rely on authorities, and those authorities can lead them astray.

One issue that has come up on occasion is the political orientation of the anti-vaccination movement. Many have assumed that it has a Left-liberal bias. I’m actually moderately skeptical of a strong political association (e.g., Michele Bachmann). But the map above suggested to me that we should test the proposition that there’s at least a state level correlation between exemptions and vote for Obama in 2012. The data was easy to get.

The raw Obama vote % and vaccination exemptions correlated at 0.08 (p-value 0.59). Pretty much nothing. But, I thought it might be more interesting to look at Obama vote for whites. Here the correlation was 0.25 (p-value 0.09). This is still a modest correlation, but it does suggest a political tinge. But rather than a standard Left-Right axis, I think we’re seeing a “crunchy counter-culture” sentiment. Here’s a scatterplot with state labels for what it’s worth….

Rplot02

 
• Category: Ideology, Science • Tags: Anti-Vaccination, Vaccination 
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Preventable

If you have not read Julia Ioffe’s story about getting whooping cough at the age of 31 (also see follow up), you might want to. Here’s some further context, Vaccine Refusals Fueled California’s Whooping Cough Epidemic. This topic has been covered and dissected in great detail by many writers and scientists, so I won’t repeat what you already know in regards to herd immunity. There’s no point in preaching to the choir.


Rather, I want to offer a personal perspective. Over the past few years I’ve become much more aware of cultural streams in public health, and the public’s reaction to that health advice, because I have become a father. More specifically, when my wife was pregnant with my daughter, and after she was born, we encountered major pressure from peer networks to not vaccinate. In the social circles in which we were embedded, “progressive,” “crunchy,” and “alternative,” vaccinating one’s child was the heterodox decision. It was rather obvious to us that one of the major reasons that many people do not vaccinate their children is that many of their friends, and vocal people whom they trust, do not vaccinate their children. We were able to resist and rebuff any peer pressure rather easily because we have a much stronger scientific background than most Americans, but it isn’t hard to imagine being ignorant and trusting those in whom you normally put your trust.

In some ways I am not totally unsympathetic to the skepticism that some in the public have toward the medical establishment. Modern scientific medicine is a genuine miracle, but most of its gains arguably occurred in the first half of the 20th century through public health campaigns, vaccination and antiobiotics. Though the decline in heart disease is a major result which we should celebrate, it is arguably less significant than the sharp reduction in deaths of the young due to numerous infections (heart disease tends to effect the old). Additionally, diseases such as cancer are subject to the problem of what Jim Manzi terms “high causal density”. Cancers, like many diseases of late life, can have many triggers and factors impacting their likelihood, so solving the problem at the root may not be so simple. In reaction to this complexity and uncertainty I do believe that on occasion the medical profession and the public health establishment have unduly emphasized their certainty.

Like the reality that the variegated public health concerns we have today, such as type 2 diabetes and cancer, are probably better problems than endemic smallpox, tuberculosis, or scarlet fever, the downsides of having a medical establishment which on occasion oversteps the bounds of its reasonable confidence are overridden by the upsides. We have empirical evidence of this, because there are nations without medical establishments, and they are not flourishing. But that does not change the reality that a population shielded from the brutal knife of infectious disease and plague is somewhat befuddled by the mysteries of the slow and subtle ailments which are the afflictions of modernity.

One response is the liberal individualist one. Though we may bemoan Steve Jobs’ experimentation with alternative therapies for his cancer, it was his individual choice. It gets more complicated what you have children, who are under the control of their parents. Again, I’m not going to go over the controversies over groups like Christian Scientists, whose children have died due to withholding medical treatment. The cultural consensus seems to be that parents have a right to impose all sorts of crazy beliefs and practices upon their children, but not those which may result in death. Then you move to the issue that when it comes to vaccination one can’t seal off individual choice from consequences to the public. It seems entirely likely that for the next decade we may be seeing a conflagration of preventable diseases among certain segments of the American demographic, and those who they live among, because of cultural fashion. The collective choices of parents opting out from vaccination is subject to negative feedback dynamics. Early dissenters can “free-ride” on herd immunity, and indulge their quackery, but beyond a particular threshold disease and death will come back to the fore. But human beliefs are often rather well insulated against falsification for a great deal of time. The AIDS denialst community is a testament to this phenomenon; it persists despite mysteriously (to them) high mortality rates among its most vocal proponents.

So is there a solution? Conscience is a value which Americans pride, even unto death. I do not see the powers that be intervening in these cases. Rather, this groundswell of denialism must be countered by public opprobrium, and yes, shaming. Peer pressure kills, but it can also save lives. As a matter of safety people with small children should investigate rates of vaccination in their community (young infants are not vaccinated, and so are particularly vulnerable to infections which are dampened by herd immunity). They should move when a dangerous critical mass is present. If people ask, those who leave should explain their rationale. Actions can speak louder than words. Where Authorité falls on deaf ears, the judgment of the populace might be heeded.

(Republished from Discover/GNXP by permission of author or representative)
 
• Category: Science • Tags: Medicine, Public Health, Vaccination 
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Apparently Mayim Bialik, Ph.D. neuroscience, is skeptical of vaccination. This just goes to show you that “science education” itself is no guarantee of immunity against acceptance of false propositions. Rather than reason from one proposition to another independently humans operate in an ecology of ideas. Bialik’s general suite of beliefs about mothering and her social milieu make her stance on vaccination rather unsurprising, notwithstanding that she has a doctorate in neuroscience.


I’m mildly familiar with social pressures in regards to vaccination. In some communities on the West coast of the USA which emphasize “consciousness” it is now the dissenting position to accept vaccination as necessary. I myself regularly get flu shots and DPT, and I had no qualms about vaccinating my daughter. On the contrary, I wanted her to be vaccinated. But this is not the default position for many, and over the past six months I’ve seen just how communities of self-reinforcing opinions emerge which deny established science. For someone with a weaker science background I can totally understand why being skeptical of vaccination might be a reasonable decision. Not only is your community validating and encouraging this decision, but there are persons with authority and stature, such as Mayim Bialik, who are also hewing to this position.

Meanwhile, whooping cough is making a comeback. I recall back in the aughts when Americans shook their heads at Thabo Mbeki’s AIDS denialism. But now I can see somewhat how this sort of heterodoxy might flourish and gain traction. The basic logic of herd immunity is simple, but fear for one’s children is a powerful thing.

(Republished from Discover/GNXP by permission of author or representative)
 
• Category: Science • Tags: Vaccination 
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First, if it is clear that you haven’t read the post itself and leave a comment I won’t just not publish it, but I’ll ban you. Second, if you complain about this in the comments, I’ll ban you too. Now that you feel appropriately welcome, I want to explore some of the issues beneath Chris Mooney’s post, Vaccine Denial and the Left:

So I want to further explain my assertion that vaccine denial “largely occupies” the political left. It arises, basically, from my long familiarity with this issue, having read numerous books about it, etc.

First, it is certainly true that environmentalists and Hollywood celebrities have been the loudest proponents of anti-vaccine views. To me, that is evidence, although not necessarily definitive. So is the fact that we see dangerously large clusters of the unvaccinated in places like Ashland, Oregon, and Boulder, Colorado, which are very leftwing cities.

What’s tricky is, there’s not a standard left-right political ideology underlying this. Rather, it seems more associated with a Whole Foods and au natural lifestyle that, while certainly more prominent on the bicoastal left, isn’t the same as being outraged by inequality or abuses of the free market.

This is a tricky issue. There is a stereotype that liberals who reject religion tend to gravitate toward New Age/environmentalist spirituality. “The mind abhors a vacuum” model. I used to accept this, but if you poke around the General Social Survey the reality is more complicated. For example, you can look up attitudes toward genetically modified food and astrology. The results don’t fall neatly into a Left-Right dichotomy. Part of the issue is that there has been aggregation of distinct groups into on catchall category. Consider me. I identify as a conservative, which would indicate a far higher odds of me being a Creationist, but I’m clearly not.

There aren’t any questions about vaccination in the General Social Survey, but there are several about trust and faith in science, or lack thereof. First I pruned all of the questions which were before 1998. So the results below are for the 2000s by and large. After that I had a set of variables to play with, to serve as replicates in terms of observing trends. Below are three tables with my results.

Table #1 is just a set of results which shows how political ideology, party identification, and educational attainment, correlate with attitudes toward science. So in that table the columns add up to 100%. So below 4% of liberals strongly agree while the assertion that “we trust too much in science,” and 21% strongly disagree.

The second table is limited to self-identified liberals. I wanted to query how attitudes toward science vary by demographic among liberals. In this case the rows add up to 100% on the margin (rotated from the first table). So in terms of those who strongly agree that we trust too much in science, 29% are male and 71% female, among self-identified liberals. Remember that in some classes there won’t be a 50/50 breakdown, so look for the variation in relative trends.

Finally, for the third table I have a regression. I now divided the sample into liberal and conservative groups, and ran a set of variables to predict opinions on the questions which I’ve covered so far. The first row has the R-squared, the magnitude of which illustrates how much the listed variables predict variation on the question. Subsequent rows have beta values for the variables, which indicate the direction and magnitude of the effect from that given variable. The questions are all easily numerical, or recoded as numerical (e.g., atheist, agnostic…to total belief in God is 1, 2…6). To get an intuition as to what’s going on, just look at each variable and its value. Those which are bold are statistically significant at p = 0.05. For example, among liberals confidence in belief in god seems to decrease trust in science. Socioeconomic status seems to increase it.

Please note that I’ve omitted some categories for variables where the sample size is too small, so some rows/columns may be less than 100% (e.g., Jews in “religion”). Additionally I’ve removed some response classes where N < 25, as the noise can confuse the trend line.


TRUSTCI We trust too much in science
POLVIEWS Lib Mod Cons
Strongly agree 4 8 10
Agree 16 23 28
Neither 22 30 25
Disagree 37 28 29
Strongly disagree 21 11 8
PARTYID Dem Ind Rep
Strongly agree 7 8 9
Agree 22 23 26
Neither 24 31 27
Disagree 32 24 30
Strongly disagree 14 14 9
DEGREE Non-college College
Strongly agree 9 3
Agree 26 16
Neither 27 23
Disagree 29 34
Strongly disagree 8 24
NEXTGEN Science & tech. give more opportunities to next generation
POLVIEWS Lib Mod Cons
Strongly agree 42 35 40
Agree 48 57 53
Disagree 8 8 6
Strongly disagree 2 1 1
PARTYID Dem Ind Rep
Strongly agree 38 34 41
Agree 54 56 52
Disagree 7 10 6
Strongly disagree 1 1 1
DEGREE Non-college College
Strongly agree 36 45
Agree 55 50
Disagree 8 5
Strongly disagree 1 0
SCIFAITH Believe too much in science, not enough in faith
POLVIEWS Lib Mod Cons
Strongly agree 10 9 15
Agree 32 40 37
Neither 23 28 25
Disagree 24 18 20
Strongly disagree 11 5 3
PARTYID Dem Ind Rep
Strongly agree 11 10 12
Agree 38 38 37
Neither 23 29 27
Disagree 21 18 20
Strongly disagree 7 5 4
DEGREE Non-college College
Strongly agree 13 5
Agree 41 27
Neither 25 27
Disagree 17 29
Strongly disagree 4 11
TOOFAST Science makes our way of life change too fast
POLVIEWS Lib Mod Cons
Strongly agree 10 8 9
Agree 31 42 38
Disagree 48 43 45
Strongly disagree 12 7 8
PARTYID Dem Ind Rep
Strongly agree 10 10 7
Agree 38 42 36
Disagree 43 41 48
Strongly disagree 9 7 8
DEGREE Non-college College
Strongly agree 11 5
Agree 40 31
Disagree 43 50
Strongly disagree 6 14
SCISPEC Science is too concerned with theory and speculation
POLVIEWS Lib Mod Cons
Strongly agree 4 7 6
Agree 23 33 36
Disagree 50 53 52
Strongly disagree 23 7 6
PARTYID Dem Ind Rep
Strongly agree 6 7 5
Agree 29 34 33
Disagree 50 52 53
Strongly disagree 15 7 7
DEGREE Non-college College
Strongly agree 7 3
Agree 35 23
Disagree 51 54
Strongly disagree 7 20

Opinions of science of self-identified liberals. Rows = 100% or less
We trust too much in science
Male Female
Strongly agree 29 71
Agree 42 58
Neither 43 57
Disagree 46 54
Strongly disagree 49 51
White Black
Strongly agree 40 47
Agree 59 28
Neither 77 13
Disagree 80 11
Strongly disagree 86 1
Non-college College
Strongly agree 86 14
Agree 81 19
Neither 72 28
Disagree 64 36
Strongly disagree 40 60
Protestant Catholic None
Strongly agree 65 21 6
Agree 58 25 9
Neither 36 32 22
Disagree 38 27 23
Strongly disagree 30 18 39
Science & tech. Give more opportunities to next generation
Male Female
Strongly agree 41 59
Agree 43 57
Disagree 55 45
White Black
Strongly agree 73 13
Agree 72 18
Disagree 69 20
Non-college College
Strongly agree 59 41
Agree 66 34
Disagree 67 33
Protestant Catholic None
Strongly agree 33 24 29
Agree 40 25 25
Disagree 54 16 27
Believe too much in science, not enough in faith
Male Female
Strongly agree 33 67
Agree 40 60
Neither 39 61
Disagree 39 61
Strongly disagree 53 47
White Black
Strongly agree 52 37
Agree 60 26
Neither 74 16
Disagree 84 7
Strongly disagree 91 2
Non-college College
Strongly agree 84 16
Agree 81 19
Neither 70 30
Disagree 54 46
Strongly disagree 39 61
Protestant Catholic None
Strongly agree 52 21 14
Agree 47 31 10
Neither 34 30 29
Disagree 37 21 28
Strongly disagree 15 6 60

Regression results
TRUSTSCI NEXTGEN SCIFAITH TOOFAST SCISPEC
Liberals
R-squared 0.207 0.026 0.178 0.088 0.149
Age 0.014 -0.004 0.04 -0.05 -0.037
Socioeconomic index 0.279 0.048 0.04 0.159 0.13
Educational attainment -0.047 -0.212 0.107 0.062 -0.019
Vocab score 0.155 0.086 0.112 0.12 0.306
Confidence in belief in God -0.275 0.069 -0.314 -0.083 -0.135
Conservatives
R-squared 0.096 0.02 0.13 0.06 0.087
Age -0.052 0.029 -0.071 -0.11 -0.06
Socioeconomic index -0.017 -0.034 0.032 0.007 0.072
Educational attainment 0.05 -0.036 0.141 0.115 -0.031
Vocab score -0.057 -0.026 0.109 0.145 0.245
Confidence in belief in God -0.327 0.044 -0.266 -0.091 -0.18

(Republished from Discover/GNXP by permission of author or representative)
 
• Category: Science • Tags: Anti-Vaccination, Social Science, Vaccination 
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Razib Khan
About Razib Khan

"I have degrees in biology and biochemistry, a passion for genetics, history, and philosophy, and shrimp is my favorite food. If you want to know more, see the links at http://www.razib.com"