Sunday, January 11, 2009

It's aliiiiiive!

Yes, everyone, ScienceBlogs is back up and running. That means Respectful Insolence at ScienceBlogs is up and running again, too. Consequently, I'm disabling comments again on this blog and putting it back into mothballs as an archive site. Orac's home will be once again at Respectful Insolence at ScienceBlogs. It was fun resurrecting the old blog for a couple of days, but it's time to go back to where everyone knows where to find me:

http://scienceblogs.com/insolence

or

http://www.respectfulinsolence.net (also .com).

Who knows, if ScienceBlogs ever goes down again or gets fed up with me and gives me the boot, this blog may live again.

Saturday, January 10, 2009

An actual pro-vaccine storyline? On ABC?

I don't watch Private Practice. I didn't like Grey's Anatomy, which, every time I caught part of it, struck me as the cheesiest sort of medical soap opera, a General Hospital transplanted to prime time. Given that Private Practice is a spinoff of Grey's Anatomy, I never saw any reason whatsoever to watch. However, on Thursday night an episode aired that royally pissed off the antivaccine contingent, and that has to be a good thing. The episode, Contamination, featured a storyline in which an unvaccinated child shows up in the emergency room with the measles. The parents are antivaccine and totally buy into the myth that vaccines cause autism. They're even totally into a full-on Jenny McCarthy panoply of "biomedical" quackery--I mean treatments, no, I mean quackery--for their autistic child.

The cranks at Age of Autism have mentioned it, but, from a couple of forwarded e-mails I've gotten, it appears that the real mercury militia has gone absolutely bonkers about this quite reasonable storyline. Indeed, in a certain antivaccination mailing list dedicated to a certain journalist's fear mongering book, the loons are out in force. Charges of big pharma conspiracy are running rampant like:
The CDC can't prove with science that vaccines are safe so they have
their PR office use fear to scare people into believing.
As if the CDC can dictate storylines to ABC. Yeah, that worked real well with Eli Stone, which, of course, the vaccine conspiracy mongers loved.

One of the participants even went to the trouble of transcribing the scenes relating to the storyline, for which I thank her. It's rare to see such an unequivocal defense of vaccines worked into a storyline. I wonder if Jenny McCarthy's activities may be producing a backlash. We can only hope. In any case, I think our antivaccine advocate's work should see a wider audience, so here it is for your edification:

Private Practice
Season 2, Episode 1
Original Air Date: Jan. 8th, 2009
"Contamination"
Writer: Fred Einesman
Director: Kate Woods
Unofficial Transcript of Vaccine Storyline
By Christine Heeren
Regular characters: Addison, Pete, Naomi, Cooper, Charlotte, Dell, Sam and Violet (all doctors except Dell)
Additional Cast:
Jillian Armenante as Arlene (the mother)
-has a girl born in 2004

(There was more to this episode, but I'm just writing the info regarding the vaccine storyline)

SCENE ONE: Busy waiting room in doctor's office. Kids throwing a ball around. Three boys and one girl (Betsey). The boys are all brothers, the oldest with autism, Jeffrey. The girl is the daughter of Dell, who works at the practice. The middle boy is Michael, youngest is William.

ARLENE: Oh Dr. Freedman!

COOPER: Arlene, Hi. Oh my god! Is this Michael? Dude, you're a giant. Will, do you remember me? Hi Jeffrey. That's a pretty cool plane. Hey, let's go back. Come on.
(they walk into Cooper's office)

COOPER: So, where have you been? It's been two years.

ARLENE: I moved the boys to Switzerland, for Jeffrey. I found this great experimental program there for autistic children. Nontraditional therapy, megavitamins, diet modification, along with art, music therapy.

COOPER: How's it been going?

ARLENE: Better, I think. His temper's under control, a little more. He's obsessed with airplanes. Sometimes he'll even talk to you.

COOPER: Wow.

ARLENE: As long as it's about planes.

COOPER: Planes are good. Talking about planes... even better.

(Cooper hands Jeffrey a toy airplane from his office shelf)

COOPER: How's his health otherwise?

ARLENE: Oh Jeffrey's fine. It's Michael actually. He caught a cold on the plane. Probably just some bug. But, you know. I wanted to be safe.

(Cooper lifts Michael up on the exam table)

COOPER: How'd you like Switzerland Michael?

MICHAEL: They had a cable car and there's this one place where you could take a chocolate tour.

(Cooper is feeling the boy's neck)

More joking around with the kids while Cooper does the exam.

COOPER: 102. Does your throat hurt, Michael?

MICHAEL: No.

COOPER: OK. Open up for me, big and wide. Tilt your head back.

ARLENE: (all concerned) Dr. Freedman? What is it? What's wrong? (end of scene)

SCENE TWO: Naomi & Addison are chatting it up in the break room. Cooper comes running in.

COOPER: We have to close the doors.

ADDISON: See, even Cooper realizes Pacific Wellcare is putting us out of business

COOPER: No, we have to close the doors. My patient has the measles and was in reception for half an hour running around. Everyone that was out- all our patients this morning where exposed.

ADDISON: Measles? My pregnant patients and the elderly...

COOPER: All at risk.

ADDISON: We HAVE to close the doors.

COOPER: We have to close the doors.

SCENE THREE: All the doctors in the hallway with about 20 patients.

ADDISON: I'm sorry for the inconvience, but the virus stays airborne for up to 4 hours. We need to make sure everyone who was exposed has been immunized.

PREGNANT WOMAN: Excuse me? Can I get the shot now? I have a lunch at 12:30.

ADDISON: Sorry. It contains a live virus. It's not safe to take when you're pregnant. But, if your blood comes back and your antibodies are low, then we can treat it with immunoglobulin.

WOMAN: And if that doesn't work? Doesn't measles lead to birth defects?

ADDISON: Let's not get ahead of ourselves, okay?

SAM: We need to notify LA County Health. They are going to want to do a complete survey. I know.

Addison gives annoying look

ADDISON: And they are always awful. And if we didn't have enough to do this morning.

SAM: OK. I have a light day. You have to deal with this. I'll speak to the health department. I'm in the mood for a fight.

SCENE FOUR: (back in Cooper's office)

ARLENE: Will's fine.

COOPER: But, he hasn't been vaccinated and he's at risk to get this.

ARLENE: It's the measles. When my parents were growing up everyone got it.

COOPER: And hundreds of people died from it every year. The vaccine changed-

ARLENE: Don't even think of suggesting-

COOPER: There's no proven link between vaccinations and autism.

ARLENE: It's not just me. I have talked to dozens of parents. You vaccinated Jeffrey, and it was like a light went out inside him, and he's living in some parallel world. (They show Jeffrey rocking while playing with cars)

COOPER: Arlene-

ARLENE: You don't live with him. So don't ask me to risk Will too.

Dell walks out of his office with his daughter (about 6 yrs old) and sees Cooper.

DELL: Hey, I can't get a hold of Betsey's Mom. I don't know if she's been immunized.

COOPER: Most kids have been.

DELL: You don't know her mother, okay? She forgot to pick her up. You think she remembered doctor visits? Should I just give her the shot to be sure? I mean she played with that kid for like a half- hour.

COOPER: You have 24 hours to give the vaccine. So wait for the Mom and ask, spare her the needle if you can.

SCENE FIVE (all the doctors together)

ADDISON: Grab a chart. We're checking every patient who was in here this morning for immunization.

SAM: How many of these are we looking at, Coop?

COOPER: How many what?

SAM: These little time bombs- kids coming in without their vaccinations.

COOPER: The vast majority of my practice is pro-vaccine.

NAOMI: Whether or not to vaccinate should not even be open for debate.

COOPER: It isn't. But, I agree with the Academy of American Pediatrics that we shouldn't abandon patients who chose not to vaccinate.

PETE: (holistic type doctor) Cooper's right. You can't kick a kid out just because the parents believe in a conspiracy theory about vaccines.

SAM: The CDC is clear vaccines do not CAUSE autism. They save lives. That's the end of the story.

DELL: Hey, I was just in the pediatric waiting area with Betsey. This is Michael's Mom's and she left it in the lobby.

(They go on how the family was on another floor)

SCENE SIX (Health Dept. Lady arrives)

SAM: OK. So that's it. Everyone's been immunized. Anybody that was here has been contacted. You can refile all of these immunication records.

HEALTH DEPT. LADY: Oh no you can't (to Dell).

SAM: OK. So that’s it. Everyone’s been immunized. Anybody that was here has been contacted. You can refile all of these immunization records.

SONYA: Oh no he can’t (to Dell). Sonya Nichola. County Health Department. I’m gonna need those.

SAM: Sam Bennet. I, uh, I called you (laughs).

SONYA: Are those all the immunization records?

DELL: Yeah, this is everything

SONYA: Okay, I want the vaccination records of all the patients in your practice, and then after I interview all personnel and review their employment certificates, I’ll need to inspect your isolation facilities.

SAM: Well, we don’t have, isolation facilities per se, uh, but- well- wait. We, uh, we provide for rooms.

SONYA: Are not up to current guidelines?

SAM: We just…

SONYA: Or are you aware of the recent changes in those standards?

Dell shakes his head “NO”.

SAM: This isn’t gonna be very much fun, is it? (laughs and smiles)

SONYA: You want to show me around? (seriously)

SAM: Yeah. All right. This way.

SCENE SEVEN Mom brings Michael into hospital. Cooper is there too looking at child in bed.

ARLENE: His fever was 104 by the time I got home. I couldn’t get it down.

COOPER: How you feeling, Michael?

MICHAEL: I’m really cold and my stomach hurts.

ARLENE: He vomited twice

COOPER: His lungs are congested.

Child starts violently coughing.

COOPER: OK. OK. We got you. It’s OK. (to child) We’re gonna get you some fluids and we’ll bring that fever down and you’ll feel better. (to nurse) I need a nasal cannula at 2 liters, chest x-rays and cultures times two.

ARLENE: I don’t understand. Why is he so sick?

COOPER: Arlene, measles is serious. It can lead to pneumonia, encephalitis, all sorts of other complications. (to nurse) Notify peds ICU. We need an isolation room.


SCENE EIGHT Hospital waiting area right outside of Michael’s room. Arlene is sitting with her two other boys. Jeffrey the one with autism is sitting quietly, playing with an airplane.

COOPER: Michael’s resting now. His fever’s down. But he’s still having trouble breathing.

ARLENE: My husband is- is still in Switzerland. You don’t think he needs to fly back?

COOPER: If it was my son, I’d come.

They show child in bed with his face all red and bumpy.

COOPER: Arlene, we need to talk about Will (other child).

ARLENE: I know. I told you no- no vaccinations.

COOPER: I don’t think you can risk putting Will through what Michael’s going through.

ARLENE: I can’t risk putting Will through what Jeffrey’s gone through. I lost one child to autism. I can’t lose another.

COOPER: Arlene, you won’t.

ARLENE: Don’t you think seeing Michael in there like that… I would do anything for my kids. I can’t. Look at him. (Jeffrey playing with airplane) Don’t you remember when he was 2, that smile? He’s light up the room. And then you vaccinated him and that kid vanished. Those vaccines took him away. I don’t care what you know. I know what I know. I know what I lost. I can’t risk it again.


SCENE NINE Back in the break room- all the doctors talk about the situation- like they usually do.

DELL: I can’t believe the health department lady is making us jump through all these hoops.

SAM: She’s horrible.

ADDISON: How’s Michael? (to Cooper)

COOPER: Not good. And Arlene still won’t let me vaccinate Will.

SAM: You should call family services.

VIOLET: You serious?

(she’s a psych)

SAM: Yes, It’s child abuse. She’s knowingly putting her son at risk for getting really sick.

ADDISON: That’s irresponsible.

VIOLET: It’s a parent’s decision.

DELL: Yeah, well, if I find out that Heather didn’t vaccinate Betsey I’ll report her.

(Heather is his ex-girlfriend who he got addicted to drugs)

SONYA: (Health Dept. Worker) Can I see you a moment, Dr Bennett?

SAM: Perfect

(He leaves)

ADDISON: That can’t be good.

COOPER: Sam’s right. I gotta call.

VIOLET: Calling DCFS while her other child is still in the hospital would just be cruel.

COOPER: Cruel? Putting another child in danger is cruel. Exposing a city to measles is cruel.

PETE: Violet’s right. You can’t fault the mother because she chose not to-

COOPER: Of course you’re gonna agree with Violet. You’re sleeping with her.

PETE: I agree with her because she’s right… (they go on about sex)


Then Sam and Sonya talk about protocol. It’s all about setting up a conflict so they can hook up at the end of the show.

SCENE TEN Dell’s office. Dell and his daughter are hanging out. Dell’s ex walks in and talks about a job interview. They go into the hallway to talk alone.

DELL: You couldn’t call? You leave your daughter alone all day and you don’t call?

HEATHER: I forgot my phone.

DELL: Are you using?

HEATHER: No. No. Look. I know you’re mad. But, I knew she was safe with you, OK? I couldn’t leave to make a call. I didn’t want to blow this interview.

DELL: Well, she’s not safe, OK? She was exposed to the measles today and I don’t even know if she’s been vaccinated because I’m not around enough and you…
(they look at the little girl, around 6, playing with her dolls)

DELL: Is she vaccinated?

HEATHER: Um

DELL: You don’t know, do you?

HEATHER: No. (Dell walks back into the room with disgust)

Next scene Pete and Addison are talking about relationships. It’s not about vaccines, but I thought this line was interesting considering the rest of the episode.

PETE: I just think people should be left to decide things for themselves.


SCENE ELEVEN Back to Michael’s ICU room. Charlotte is there. She’s a doctor who once dated Cooper. The mother is stroking Michael’s hair lovingly.

CHARLOTTE: You know what I got here?

COOPER: I’m not in the mood, Charlotte.

CHARLOTTE: Public health notifications, isolation requirements, incident reports, CDC surveys.

COOPER: We all have jobs to do.

CHARLOTTE: I have jobs I’m not able to do because I’m dealing with the mess you made.

COOPER: I have a mom who feels like she lost one son to autism and may be losing another one to measles. And she’s got another one sitting out here exposed. And maybe I’m just not persuasive enough, but he’s vulnerable and she’s not gonna let me do anything about it. So, I’m really sorry if they piled on some paperwork for you, but I don’t need crap from you right now.

Mom comes running out of the room in a panic.

ARLENE: He can’t breath.

Next scene Dell discusses with Heather how he wants full custody to “keep her safe”.

SCENE TWELVE: Michael’s ICU room. Cooper, Charlotte and a nurse are working on Michael. The mother is in the room. They have some breathing thing on Michael’s face. They keep showing the monitor with his heart rate going down.

COOPER: It’s won’t pass. His throat’s too swollen.

CHARLOTTE: Get the fiberoptic scope now. We gotta ventilate him. Heart rate is dropping. Sats are bottoming out.

COOPER: (yells) Where’s the damn scope?

CHARLOTTE: It’s coming Cooper.

COOPER: Open up the surgical tray. I’m gonna cric him. Hold this.

ARLENE: What-What is that? What are you gonna do?
Just wait. Coop. The scope’s coming.

COOPER: His heart’s 40. I’m doing this. Betadine.

CHARLOTTE: Wait. Wait! (guy running into room).
Cooper was about to cut the boy’s throat. They put the thing on him.
Cooper can see down his throat.

CHARLOTTE: Slowly. Easy does it.

COOPER: Almost there. I got it. (he’s breathing now and apb goes up)

CHARLOTTE: Sounds good.

ARLENE: He’s gonna be OK?
Cooper gives the mother a look like “you bitch” and walks out.

COOPER: (to nurse) Set the vent at a F102 of 100, rate of 24. I need a minute.
Cooper leaves the room and walks over to the two other children. He lovingly touches Jeffrey’s head.

COOPER: Hey, I’ll watch’em for a minute. (hospital worker leaves)

COOPER: Hey. Come here. Come here for a second. (puts Will on chair)

COOPER: One second. (starts rolling up Will’s sleeve. Jeffrey is watching)

ARLENE: Get the hell away from my son

WILL: (screams) MOMMY!

ARLENE: You have to stop. (Charlotte grabs mom’s arm and holds her back)

CHARLOTTE: Your son is dying in there.

ARLENE: Get the hell away from me. (to Charlotte)

CHARLOTTE: Mrs. Perkins. Please.

(Will whimpers as Cooper gives him the vaccine)

ARLENE: NO!!!!!!!

COOPER: Good.

Everyone looks at each other.


SCENE THIRTEEN Hospital waiting room again.

ARLENE: Will, are you ok?

Will shakes his head “YES”.

COOPER: The vaccine is safe.

ARLENE: You don’t know!

COOPER: It is.

ARLENE: Look at him and tell me if it is. (speaking of Jeffrey)

CHARLOTTE: Vaccines are the standard of care. Dr. Freedman did something that was medically necessary.

ARLENE: He assaulted my son! And I am going to sue this hospital, so help me, if something happens to him.

COOPER: I did what I felt I had to.

ARLENE: It wasn’t yours to do. It’s wasn’t yours to do.

LOUD SPEAKER: Code blue ICU, Code Blue ICU.
They all go running back into Michael’s room.

SCENE FOURTEEN Michael’s ICU room.
Charlotte and Cooper are working on Michael as Arlene looks on. Michael dies.

CHARLOTTE: Asystole. I can’t find a pulse.

COOPER: Resuming CPR. Around round of epi. (Cooper keeps working on him)

CHARLOTTE: Cooper, we’ve done everything. It’s been over a half hour.

COOPER: Where’s the atropine. Come on! (screams)

CHARLOTTE: It’s time to call it.

COOPER: I’m running the code. I decide when we’re done.

ARLENE: Please… don’t stop.

(Cooper stops)

COOPER: Time of death- 3:37

(they start turning everything off)
Arlene is crying and goes over to Michael.

ARLENE: Michael? He just learned to tie his shoes. He can’t be gone. Not like this. Michael…

She holds him crying hysterically and saying “Oh Michael” over and over.
Emotional piano music playing in background.

SCENE FIFTEEN Cooper and Arlene in waiting room. Charlotte is watching them.

ARLENE: (crying) I thought… It was gonna be… like a cold. I was trying to protect him.

(she looks at 2 other sons- Jeffrey is rocking) Cooper puts his hand on her knee, then back. Arlene gets up, still crying, grabs Will and holds him. Sits next to Jeffrey. Then puts her other arm around Jeffrey and holds both boys at the same time, still crying. Charlotte walks over to Cooper and sits down next to him.

CHARLOTTE: You did everything you could.


I will admit that the part of the story where Cooper forcibly vaccinates the child against her mother's wishes was over the top. However, the rest was about as stridently pro-vaccine as I could imagine. Maybe ABC is finally trying to make up for its sin of Eli Stone early last year.

Friday, January 09, 2009

Respectful Insolence will go dark...

...but only temporarily!

As you may have heard, our benevolent leaders at ScienceBlogs are finally doing a major upgrade of our blog publishing software. That's the good news. I'm hoping the back end is much easier to use and more responsive. The bad news is that the whole ScienceBlogs site is going to locked down. It will still be there. You can still read it and browse every scintillating post, but no one will be able to post, and no one will be able to comment. I'm posting on this old mothballed blog of mine in case anything goes wrong, or, as is entirely possible, the timed posts do not publish on my main blog.

The lockdown period will begin at 1 PM. Unfortunately, it will run at least until Saturday evening. I have a couple of timed posts, but I have no idea if the automatic posting feature will work during the transition.

Personally, I'll take the opportunity to take it easy for a day or two. If my blogging jones must be fulfilled, I still have this old Blogspot blog...