I occasionally teach at noontime conference at Cedars and have many, many meetings with house staff and NICU attendings to talk and compare notes. At the present time, I'm caring for a child with a large staph abscess status post I&D on Clinda and Cephotax pending MRSA report tomorrow. This month, I'm mentoring a summer program for aspiring medical students who spend a day each week in my office seeing patients.

The caricature you paint of me is inaccurate but enjoy it if you must.

I just returned from UCLA where I attended the long hard birth as the family's private pediatrician. I do this fairly often when a family would prefer to have a doctor they've met give immediate care rather than have house staff at the delivery. The residents also like this because it lightens their load a little for that hour or two. I still can intubate when I need to and I do all my own lumbar punctures. In a pinch, I can still start a great subclavian line because I was trained for a year as TPN Fellow in the early days of TPN.
My third hospital today is St. John's Medical Center where I'm caring for two growing premie twins and a premie singlet doing well. Brief rounds only are needed because neonatal staff does a great job and I act as liaison.

My fourth hospital today is Santa Monica/UCLA where I also have premie twins doing great, just growing and requiring very little of my time and energy.

I began my day with phone work after a little hike with my dogs. I then drove a short distance to my office in my (three [edit] year old) car because I like to have it nearby in case I have to be somewhere fast. My new young associate is out on maternity leave so my workload is quite high. I juggle, as you all do, 15 kids in the office, countless phone calls, kids' parents needing referrals, x-ray reports, lab reports, being short-staffed by one because of illness and then a phone call from Larry King's show to appear in a few hours as they discuss Savage's comments about autism and "idiots." I agree to appear and move a patient to Tuesday to eliminate any possibility of an hour off that day.

You know, Dave, I am the closest thing on this board to "anti-vaccine" so if the epithet suits you gentlemen please feel to use it. It's a helluva lot easier than saying "pediatrician who over the past thirty years has realized that vaccines and the schedule could be safer so he minimizes shots for all patients and actually gives no shots at all to many kids even though he believes so much in public health that he's traveling to Africa in late September to bring Five Million tetanus shots to the Ivory Coast because between 100,000 and 200,000 people die from neonatal tetanus in Africa each year."

Calling me "anti-vaccine" is a lot simpler and might even have enough accuracy to stick: I am very much opposed to the way vaccines are formulated with aluminum as the chief adjuvant, thimerosal as a preservative in many if not most influenza vaccines and I truly am "anti" the increasing number of combinations of vaccines. (Edit that well and it becomes:" . . .I am very much . . . anti . . .vaccines . . . " Good enough for certain journalists.)

"Pediatrician to the Stars" Aaah, my favorite appellation. I told you before and I'll tell you now, I think that if I worked in Detroit I'd care for the most discerning and educated autoworkers and in Los Angeles, many medical consumers are discerning and they seek me out because I work really hard and make it my business to know the medical news and treatment best for their families. More than that, I listen when they know just as much—or more—than I do and we reach conclusions about their families' health care as partners. And, yes, there certainly seem to be more than a few actors and directors in my neighborhood. Sometimes I get falsely proud because people who could afford to take their children anywhere for medical care, travel any distance and spend any amount of money choose to trust me.

And yes, I think the slogan ""too many, to soon" is a nice bumper sticker summary of the goal of many vaccine (not anti-vaccine) activists. Better quality medicine for our children, tested well and administered in a more logical fashion.

Orac, Dave . . ., stop calling me names. It no longer hurts my feelings but it diminishes you in public and detracts from the possibility of a discussion. If I scattered the phrase "illogical dickhead" through everything I wrote about you, it doesn't exactly elevate the discussion. By the way, why haven't you ever publicly identified yourself. Step out here and let us talk to a real person rather than a clever nom de . . . guerre.

Long ago, we acknowledged that the immune system matures slowly. I won't discuss the minutia of encapsulated and non-encapsulated bacteria being dealt with differently in infants but we all here know that a newborn's immune system is very different from a one-year-old's and a two-year-old's different still. If you really want me to elaborate on this, I will. But I know you already can crack open the same books I can to verify that what I just said is, while undetailed, correct.

I'm parroting nothing, you dope! (That actually felt good! Dave, you're entitled to call me utterly moronic one extra time.) There are other ingredients in vaccines besides the antigens themselves and they are toxic substances. The FDA, the CDC, the AAP and virtually every other responsible medical body has declared the amount of mercury which was found in shots up until 2001 excessive. The exact same type of calculations have concluded that there's far more aluminum than the government allows. These are facts not parroted speculation and you know it. If you deny these two simple points about quantity—not necessarily causation, just excessive quantity—you are lying and anyone reading this blog who can do simple math will know that you're lying.

Dave, studies have been done and then the data were manipulated. You know the Verstraeten story better than I do and you also know that Bernadine Healy's comments can't be ignored.

http://www.cbsnews.com/blogs/2007/06/15/couricandco/entry2934107.shtml
Orac, stop using pejorative terms like "parroting" and making it sound like anyone who disagrees with you must be an idiot. Sometimes, people just disagree with one another. That doesn't make you an idiot and it certainly doesn't make me one either.
The measles vaccine causes problems. Sometimes, counter to the cliché, the plural of anecdote is data. I've seen post-MMR problems too many times and heard about hundreds more and I believe the people telling the story. I do not claim proof. I merely claim that there's enough evidence to warrant a real investigation into the possibility that the MMR causes autism and other problems in some children.

We both agree that Wakefield's original study was too small, not well enough done and should never have led to the conclusions which were published. Move on. And please stop attacking the man because he accepted money for testifying. The "other" side does that every single day. I don't know all the details and neither do you, so stop pretending to know so much about his arrangement.

"That Dr. Gordon apparently believes that shoddy pseudoscience does not speak well of him."
I don't support Wakefield's conclusions. I've told you this before but you persist in your dishonest attempt to tie me to the small MMR study. Lots of pilot studies have been done and many lead to larger better studies. This one has not led to the research which we'd all like to see.

There are variations on the cliché "Don't challenge men who buy ink by the barrel." And they apply here. No matter what I say, you own the website and can have the last words. You have gathered a group of true believers who are not really ready to think. Gentlemen, ladies, please realize that sometimes people just disagree.

Hey, Dave, the CDC and the AAP recommend that every single child in the age group you've mention get the flu shots. As of last year, the majority of those vaccines contained 25 micrograms of mercury. And, yes, a child getting a tetanus shot at age seven, nine or ten years would get the same dose and it also is formulated with 25 micrograms of mercury. You knew this but you lied to your readers anyway. Shame on you.

http://www.vaccinesafety.edu/thi-table.htm
Less autism? I sure hope so. But we still have enough other toxic exposure to create problems. I don't know what it is! All I know is that autism is triggered by a variety of environmental chemicals some of which are found in children's medicine and vaccines.
And, yes, there are just "teeny tiny" bits of formalin and other things. But they are injected directly into the blood. I loved the comment about IM shots. Where do you think vaccines and other meds in IM shots go? Directly to the toe nail? They get into the blood stream. We were all trained in medical school that if you couldn't get an IV in during a seizure, get the IM shot in because it might cost another 15-20 minutes but it would get into the bloodstream and stop the seizure.

I do not drive a Mercedes. I have a three[edit]-year-old Lexus Hybrid which I bought because I liked it. I knew I wasn't saving the world or even saving much fuel, but I like the car. I did decide not to replace it as an environmentally sound move. Big deal.
Taken out of context, my ice cream comment looks very silly. Taken in context . . . it still looks dumb. Oh, well.

My point—poorly stated—was that there were lots of public health measures which merit more funding and media attention. I was prescient because the front page of every newspaper the past week is talking about nothing but obesity. You win one. I win one.
Skeptico, nice to see you. Yes, the portal of entry for measles is the nose or throat and the immune response is mediated differently from the response to an IM or SQ injection. I think this causes some of the problems that susceptible families have reported. These probably include autism.

OK, folks, here's the truth, we have an epidemic of something in America and it's not measles. It's obesity in children and adults. It's Type 2 diabetes in ten-year-old kids. The cause: Cheese and Ice Cream. No further analogy will be drawn to vaccines because that didn't work so well the first time, did it? But, ignoring the medical problems with the American child's diet or denigrating my attitude about the dangers of obesity doesn't make you right no matter how nasty or loud you are.

Sessions, I'm not a marketer. My practice has been full since the late 1980s. Call and try to make an appointment. I do what I do and people benefit. I have been at this for almost thirty years. Yes, as people have pointed out, I stepped in dog poop a couple times and paid for it. For thirty bucks you can check my malpractice record and my Medical Board Record. Don't bother. Zero. So far :-) I readily admit that I spend parts of some days out on the fringe of medicine but I really do serve as an effective bridge between those who might never get into the system at all.

Sessions: "Rewards?" Fame and fortune. That's why all of us pediatricians pick this specialty. It's a the short cut to wild fame and great wealth. Plastic surgery? Ophthalmology?? Radiation Oncology?? Naah. You want real money and fame, go into pediatrics. My books? Countless hundreds of them in print! My web page. Ads for a couple baby creams with a firm agreement that I get no compensation. Kinda' funny.
The State Medical Board? I was called up. I told them I wish I had done things differently in the Maggiore case. No action was taken. Again, for $29.95 you can get all the records from my entire career.

I'm getting tired but I just found the comment about my "money grubbing" DVD sales. I lost money. Ask the IRS. This was made to get information out and someday I might see some money. My practice is successful but my profit is far less than those practices which sell lots of vaccines. I have no new baby gift baskets . . . good idea, though! And, if any children had been injured, let alone fatally injured, by the way I practice, you would have heard about it. Nomad, unintelligent, uniformed comment. Your bravado setting is up too high because you're surrounded by all these doctors saying the same thing over and over again. Dial it down before your next keystrokes.

Brian, aluminum should be out. You're right: there are better and safer adjuvants.

Dr. T—yes, I make an absolute fortune off the countless cases of measles, mumps, pertussis and tetanus I see. Incredibly good insight, sir. You have finally stumbled on my motive! I must move on and find another name. I think I'll choose . . . ORAC.

Nomad—Call me an HIV denialist to my face. HIV causes AIDS. I think you protest a bit too much. Swear, Nomad, swear, that you believe the virus causes the disease before us all. Thanks, doofus. Lumping me with that group doesn't serve the discussion.

Nico—not me

Dave/ORAC—Formaldehyde does not cause autism. You are wrong, there.

OK, that's enough. This should give you clones a week's worth of fun.

As I wrote this, I realized two things, firstly, I'm more of an "expert observer of vaccination" than a "vaccine expert." OK? And, I am damn sure that Dave/Orac does not have a real job: It takes hours to write and edit this stuff and mine's nowhere near as good as Orac's!!

Night all.

Jay