Holistic Doula and the measles model

By Helen Petousis Harris 29/08/2013 19


For those like me who didn’t already know, a Doula is someone supports a woman and her family during pregnancy, childbirth and beyond. It is not medical role but rather provides emotional and practical support. Now someone called the Holistic Doula has developed her own model to show how natural exposure to an infection leads to immunity in the community – herd immunity. Apparently the image is doing the rounds.  Unfortunately it is not really a very good reflection of reality. Let me count the ways:

  1. As per holistic doulas model, if this were measles and no one was immune and everyone was 5-9 years old and these 5-9 year olds all lived together without any adults, and none of them moved in or out of the bubble, for the rest of their lives, then hula the doulas model sort of works. The proportion with sequelae needs adjustment but all in all not too bad. Of course around 15 percent or so of infected kids would need to be hospitalised. Not sure if there are any hospitals in this bubble and because our population are 5-9 years old I suspect there are no doctors and nurses to look after them. No mummies and daddies either for that matter. Hmmm.
  2. Holistic doula has 52 little people and points out that nobody died or ended up with long term sequalae – awesome!! Except for the fact that in NZ (for example) there is a population of 4.3 million not 52. In the real world that is 4200 dead, 4200 brain damaged, 630,000 hospitalised, 42 additional dead later on with subacute sclerosing panencephalitis (brain turns to mush and death always ensues) and a myriad of other miseries. The excellent news is that most people survive and remain immune!! Sadly, most of the seriously immune compromised people have died.
  3. Communities do not live in a closed bubble. People come and go so firstly you need to show people moving in and out of the picture.
  4. You can’t have a population of just one cohort of 5-9 year olds in the real world.
  5. Some of the people coming into the picture are new births therefore the non-immune are continually increasing.

Here is said model from Holistic Doula

Houla the Doulas measles

In the absence of an immunisation programme epidemics occur once sufficient non-immune people have accumulated. These epidemics are small or large depending on the proportion of people immune. How many people are seriously adversely affected is purely a numbers game but the risks are always the same. Measles is an easy disease to model and it has been done many times. The morbidity and mortality during epidemics continues to support the models.

I do heartily recommend “Herd Immunity”: A Rough Guide  by some seriously good experts for those interested or even contemplating drawing their own pictures.  And if you really want to simulate measles virus or any other infectious disease there are a range of cool simulators available on line.  Personally I have found Plague inc by NDEMIC creations is about the right level for me!  and have it on all my devices for those times when destroying the earth is required.


19 Responses to “Holistic Doula and the measles model”

  • Holistic doula need only to look at history to see that her model does not reflect reality. Modelling is only as good as it’s underlying assumptions.

    Thanks for addressing this, people shouldn’t take false comfort from flawed studies!

  • hadn’t seen this but good commentary to the usual pseudoscientific bs.
    “in this simulation..(…) no one died. (…)”
    cute.

  • The point of the image was to provide an interesting visual alongside natural infection information. I figured it would be better, and maybe more interesting, to try to apply realistic complication rates to the population in the image, rather than just say that 100% of people contracted it, healed from it, and became immune – because that is TERRIBLY inaccurate. This image was not meant to be a ‘HAH! This is proof that everyone should just get measles instead of the vaccine!”, and had you read the information I provided with the image, you would see that I didn’t really mention vaccines, leave alone the fact I never recommended anyone should choose one form of immunity over the other. Is this considered ‘anti-vaccine’ merely for the fact that I am discussing the affects of NATURAL infection, and for providing realistic information about said disease from sources like the CDC and Merck Manual?

    In response, I suppose:

    1) This is kind of a ridiculous criticism, honestly. The CDC states that, generally, 5-9 year-olds accounted for the majority of cases (over 50%) and that about 90% of people were immune by 15 years old. Maybe I should have used 5-15 year olds, but I am sure that would have faced identical criticism. Maybe this is a classroom setting, it doesn’t seem like you considered that possibility. You tend to remain in the same classroom as people through the year at that age. It could be a classroom of 5 year olds, and account for their older siblings. Adults in a scenario like this are 98% likely to be immune. Like I said before, the image was not the focus of the post, but used as a means to draw attention to the information contained within the post (and, as it turns out, it has been quite successful in its purpose, considering there are blog posts out trying to refute the image).

    2) I would love to see their citations to prove that the majority of the immune compromised population would die from the Measles. I have provided citations for the assertions I made in the complication rates I chose, and not many studies that took place in real life, with immunocompromised populations at a much higher risk of serious complication, in which the majority of them died. Most were under 50% or hovering right around it. I never once suggested that a 50% death rate was anything to sneeze at, but I would absolutely argue the assertion that the majority of immunocompromised people would die from the Measles. I do not think that is at all accurate to say. Especially since there are SOME kinds of immunocompromised people who are at no higher risk for complications from Measles than their immunocompetent peers.

    3) As stated before, this could be a classroom setting in which there are no newcomers to the population. Considering the image and simulation were not the focal point of my post, I did not see the need to spend more time on the image and simulation than I did the information contained within the post.

    4) It is somewhat annoying that you have literally used the same criticism 3 times, counting it as a new criticism every time. I don’t need to touch on this again.

    5) Considering newborn babies in a scenario like this would be protected by their mother’s natural immunity for the first 6-12 months of life, they would technically be immune during that time.

    All in all, I think you really needed to come and view the full post to see what it was all about. Considering NONE of the statistics or information I have posted with the image have been refuted at all, I will consider my post accurate. Yes, the image/simulation has very obvious flaws, it was not scientifically performed by any stretch of the imagination, nor was it intended to be used as proof that someone should forgo Measles vaccination. The fact of the matter is that most people don’t know ANYTHING about the Measles, and think it is likely to kill most people who contract it no matter how healthy they are. Which isn’t the case at all. People who vaccinate, and people who don’t, BOTH need to know how these diseases look, what the complications are, how to treat them, and when to seek help for them. Vaccination is not a guarantee you will not contract the illness, so if a parent banks on vaccines being guaranteed protection, they could end up having NO IDEA what to do in the event of a vaccine failure in their child. Better to have the knowledge beforehand, than to end up in a situation where you realize you are oblivious.

    Also, a much better definition of what a Doula is, would be “A non-medical person who supports a woman and her family before, during, and after labour and birth, by providing emotional support, physical assistance, and information.” – You’re absolutely right, I am NOT a doctor and I have never claimed to be. Which makes it a very good thing that I have never given medical advice to anyone.

    Take care, and I hope that this helped to clear things up 🙂
    -The Holistic Doula

  • Don’t you think, Holistic Doula, that by promoting your flawed model of measles, that you are in fact promoting (false) medical advice, and that some of your audience may hold you in a position of responsibility, thereby being more vulnerable to this misinformation? I expect by virtue of their personal situations (likely sleep deprived & busy with young babies), that it may not be obvious to those less scientifically inclined, that your model is scientifically flawed.

  • “The point of the image was to provide an interesting visual alongside natural infection information.”

    That’s not how the article reads.

    I read a similar (near identical) excuse in a long response to my pointing out some problems with the model on ‘The Holistic Doula’ page. ‘The Holistic Doula’ then went and deleted my comments then blocked me. (So much for the banner claiming that their page was to encourage people to think! I was polite and on-topic.)

    Here’s what I wrote about ‘The Holistic Doula’s defense at the that time:

    “this was never intended to have anything to do with vaccines, so mentioning them and their potential side effects would have served no purpose.”

    Could you edit your original post to add a clear that statement that “natural” herd immunity is not a valid substitution for vaccination then please?

    You must realise people are making this out to be a demonstration that vaccines are not needed (untrue), so you ought to make it clear that’s not the case.

  • The percent of people who die and are disabled from measles is fairly well established. It’s approximately 1 in 1,000 on both counts. At least 4200 people would die and 4200 would be disabled in New Zealand, assuming no immunity.

    If this is a classroom, that is about a 1 in 12 chance one of those children would die or be disabled. My local elementary school has 500 students- statistically, at least one of those kids would be disabled or would die. Our k-8 school district has 12000 students. That’s approximately 6 dead kids and 6 disabled kids, just in my town. Is that acceptable to you?

  • One of the “holistic doula’s” other assumptions is wrong as well: breastfeeding does NOT protect against measles past the age of six months, even for mothers with a “strong, natural” immunity to measles.

    http://www.ncbi.nlm.nih.gov/pubmed/20483946

    Most of the immunity that a newborn gets to measles is from circulating antibodies acquired in the womb, not ingested IgA or IgM; by the age of six months, most of the circulating antibodies have been broken down, plus the baby’s stomach is acidic enough that most ingested IgA and IgM will be broken down before it is absorbed through the intestinal wall. To rely on breastfeeding for immunity after the age of six months is a real gamble, at best, and completely unreliable.

  • Holistic Doula: You can write rambling essays all day about how it was based on factual info, your intentions, etc. At the end of the day, you made a simplified, graphically attractive image that doesn’t reflect reality and is terribly misleading, whatever your intentions.

    It’s best to stick to pregnancy and labor coaching and leave immunology to those with formal training.

  • You know what all this graphic really shows? That in completely unprotected populations everyone gets sick.

  • Lynne,

    There is certainly plenty wrong with T.H.D.’s reply. I started replying but it seems to me that T.H.D. is unwilling to think about what they presented, never mind the message on their banner headline (saying that their site is to encourage people to think).

    I still would like T.H.D. to edit their post, adding to the top a clear statement that ‘natural’ immunity is not a substitute for vaccination. T.H.D. must be aware her simulation model is being used to encourage people not to vaccinate (they will have gotten notifications from Facebook when their post was shared by others) and T.H.D. can’t both say “nor was it intended to be used as proof that someone should forgo Measles vaccination” and not put this right.

    Regards,

    “Considering NONE of the statistics or information I have posted with the image have been refuted at all, I will consider my post accurate”

    In one of the comments of mine that she read then deleted included a point about this:

    “The “best” data in the world used inappropriately (or naïvely) can be misleading, right?”

    Just because no-one has challenged the factoids she presented, doesn’t make her post right. (It’s also a bit of a lie to say that no-one challenged any of them, because I did — but they deleted that from their site.)

  • As stated before, this could be a classroom setting in which there are no newcomers to the population.
    Two reasons why that’s not realistic: kids join classes during the year when their families move house; and they don’t spend 24 hours a day, 7 days a week, in the classroom.

  • Hi Alison –

    T.H.D.’s article refers to “the population” & I think it’s clear they meant a whole population & have offered the classroom as an alternative after-the-fact. As you’re saying, even as a simulation of classroom isn’t realistic.

    If T.H.D. were to offer advice in her line of work, then later realise it was poor advice, you’d hope that they would put it right. I’d be good if they’d put things right about this too.

    In any event, measles vaccines weren’t available until the mid 1960s and there is data up to comparatively ‘modern’ times with reasonable public health showing measles is very epidemic, with only a few years between each epidemic.

  • THD is now saying she will not be addressing any further comments and doesn’t have time to keep explaining her graphic.

    By now she surely recognises there is some discussion about her image, I also would hope that she would put it right, especially as of now, it has been shared 407 times. It’s not simply a case of that commenters don’t understand and need further explanation, it’s that she needs to address the inadequacies of this misleading information she is popularising.

  • I would really ask THD to really ethically consider how her graphic and language is being interpreted as being anti measles immunisation. If THD does not intend to be anti vaccination, then please change the language and graphic as it currently seems very clear that it is trying to discourage people from immunisation. The scientific responses to that are well listed above in this blog. I am unclear if THD wishes to deny the science – to say she is too busy to address further comments but is not prepared to either defend or remove her misleading information seems very unethical to me. There are high stakes here when children could be unncessarily exposed to measles.

  • FWIW, THD has removed another commenter since last night – my recollection is that commenter’s last comments ran on similar lines to comments here.

    A little scouting suggests THD has previously written a blog post that plays that line were they say they’ve not anti-vaccine (in name, label) but then go on to oppose vaccines. The post lists well-known anti-vaccine websites as sources for people to read and doesn’t list any sound sources. Her post tries to talk around the need for the tetanus vaccine. And so on. Her blog post strikes me as a good example of someone who may mean well, but who has fallen for the nonsense on the internet.

    She’s also been defending her post on at least on well-known anti-vaccine group’s site (NVIC), so she’s quite aware that it’s being offered as encouragement not to vaccinate.

    Anyway, the thing is, while I feel THD should have the impact of their piece on their conscious too I’m skeptical that she will do the right thing, but then again she could always surprise us.

  • I’ve just seen THD has now removed my comment, that asks her to put her money where here mouth is and live up to the words on her cover image “I don’t want you to think like me, I just want you to think”.

    For that, my comment was deleted, and I am now blocked from her page.

    Claiming that you are promoting thinking about issues, while censoring comments that don’t support your own view, is a very bad look, but even worse, leads your audience to a very skewed perception.

    It’s a shame THD doesn’t live up to her own standards. Actually, it’s worse than a shame, if one person is hurt by measles through this misinformation, it’s a tragedy.

  • The Holistic Doula –

    I’m never the best at Facebook, but it looks to me as if you have removed the page about your measles simulation – is that correct?

    (Not trying to take a position here, just hoping for a confirmation – thanks.)

  • The Holistic Doula is primarily right. I you re-read her assertations, she is simply indicating the real world effects of herd immunization. There is nothing in facts that are new, and her assertions are true. Also, there is nothing wrong in considering her facts in light of both present day vaccination modes and future, possible better ways to protect mass health.

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