Shot of Prevention

It’s encouraging to see what can be accomplished when we insist on accurate vaccination messages.   

Earlier this week, a concerned parent who frequently comments on our Vaccinate Your Baby Facebook page, alerted us to an article on The Discovery Channel’s TLC site entitled “5 Things to Consider When Deciding to Vaccinate Your Child”.  Unfortunately, the article contained numerous inaccuracies and ignored a great deal of scientific evidence regarding vaccines.   Since the average parent is not especially well-versed on this issue, the concern was that this type of reporting could misled readers into forming negative opinions of vaccines based on false information.  Every Child By Two shared their concern with various health related organizations and their consensus was that something needed to be done to correct the false information and ensure parents received scientifically accurate evidence about vaccines.  The AAP offered to draft a letter of concern and multiple organizations signed on in support.

The letter that they delivered to The Discovery Channel last night read as follows:  

One of the most important decisions parents make to ensure their children’s health is the decision to vaccinate them against potentially deadly, vaccine-preventable diseases. To do so, parents need accurate, complete information about immunizations – which they often look for online. So we were astounded when we found an article on a Discovery Company website that perpetuates dangerous myths and untruths about vaccines. We cannot understand how a company that celebrates the latest in scientific achievements would feature an article so inaccurate and wholly biased against science.

The article, “5 Things to Consider When Deciding to Vaccinate Your Child” by Josh Clark begins with the claim that medical science has already “conquered” diseases like polio and pertussis, or whooping cough. Polio is still endemic in parts of the world, and pertussis is killing infants here in the United States. Several states have declared epidemics of pertussis this year. Measles, too, is making a comeback, with more cases in the U.S. in 2011 than in 15 years. These diseases pose real threats to children who are unprotected by vaccines.

As with all medications, vaccines do carry some risks, most commonly fever and pain at the injection site. These risks are tiny compared to vaccines’ benefits. But instead of an honest discussion of the facts, Josh Clark perpetuates false and misleading notions. A few errors were corrected in the second version of the article posted May 16, but we cannot understand how they ever made it through your review process. It would have been easy, for example, to learn that the vaccine that protects against measles, mumps and rubella does not and never did contain thimerosal, and thimerosal has been removed as a preservative from all other childhood vaccines in the United States, except for some influenza vaccines.

The fallacies don’t stop there. Read more…

Not enough can be done to ensure people are educated about the dangers of pertussis (also known as whooping cough).  That’s why I wanted to highlight a few of this week’s articles that focus on issues related to pertussis.

Brady’s Battle Proves Pertussis Can Present in Unexpected Ways

CommonHealth writer, Rachel Zimmerman, was familiar with Brady’s story that we highlighted on Shot of Prevention last week.  She recently wrote an article (located here) which addresses specific questions regarding whooping cough with detailed responses from the CDC.  She also included highlights from a recent interview she conducted with Dr. Ben Kruskal, a pediatrician and director of infection control and travel medicine at Harvard Vanguard and director of infectious diseases at Atrius Health.   When she asked what clinicians should do when confronted with infants like Brady, who had contracted pertussis, but didn’t exhibit the “classic” violent cough or whooping sound, Dr. Kruskal said this:

“Actually it turns out that most people who have whooping cough don’t show the classic signs of whooping cough. It’s really a substantial minority but still a minority of people who have it who have the classic clusters of cough that are so closely spaced that the patient has to take in this deep breath at the end of this cluster which produces the characteristic whoop.”

Accurate Diagnosis of Pertussis is Challenging

It’s probable that many cases of pertussis go undiagnosed and unreported, which  makes this particular disease difficult to identify and therefore difficult to manage.  Since this particular bacterial infection often presents like a bad cold many people simply don’t realize they are infected, and they unknowingly expose others to this contagious disease.  While the symptoms may linger, which is why pertussis is often referred to as ”the 100 day cough”, most people will eventually recover.  However, whooping cough is especially devastating for infants and young children, whose small bodies have difficulty fighting off the persistent bacteria.

So when should you seek help for a cough?  You’ll want to bookmark today’s post on the PKIDS (Parent’s of Kids with Infectious Diseases) blog.  It has been written by Dr. Kristen Feemster, who is not only an Assistant Professor of Pediatrics at the Pereleman School of Medicine at the University of Pennsylvania, but also an attending physician in the Division of Infectious Diseases at The Children’s Hospital of Philadelphia.  She provides a thorough analysis of pertussis to include a detailed background of the disease, what symptoms parents should look for in infants, young children, adolescents and adults, as well as details about testing. Read more…

Week after week, I read about doctors who are refusing patients who refuse vaccines.  It’s an ongoing debate that has drawn a great deal of commendation and criticism.

On the one hand, doctors are admired for taking a strong stand in support of timely immunizations.  They typically make these policy decisions based on a number of different reasons.

• They understand that there is no scientific reason to deny vaccines or even delay them.
• They don’t want to see their patients at risk of contracting a preventable disease if they remain unvaccinated.
• They don’t want to put other patients at risk in their waiting rooms.

But until yesterday, I hadn’t even considered that doctors may also want to protect themselves from both liability and disease.

Take the story of pediatrician Dr. Lori Breaux in yesterday’s USA Today article.  Tennessean writer Tom Wilemon explains how Dr. Breaux  had to admit her own 2-week-old infant into an intensive care unit with whooping cough after she had treated a patient with the disease.  Upon reading this I realized that I had never stopped to think about the risk to the doctors.  Not only do they treat patients with preventable diseases, but they can easily bring them home to young or vulnerable family members.

That’s not to say that doctor’s shouldn’t treat these patients.  Of course, that is what is expected.  However, in the case of preventable diseases, I can now understand why a doctor may want to minimize the risk in the same way that Dr. Breaux has done.  She makes parents sign a waiver every time they bring an unvaccinated child in for treatment, because it’s not just about her own personal health, but also about the direct impact that is made upon others when one parent decides not to vaccinate their child.

While it is a doctor’s prerogative as to whether they will treat patients who refuse vaccines or not, I found it interesting to also consider another moral  perspective on this debate.

Just yesterday, Art Caplan from the Department of Medical Ethics and Health Policy at the University of Pennsylvania Perelman School of Medicine posted a piece on Medscape that urged doctors not to dismiss patients who won’t vaccinate.  He explains,

“…you may have a chance at persuading them to vaccinate their children. I am going to argue that it is important to try hard to not dismiss these people but stick with them to see if you can persuade them.”

Dr. Caplan suggests that there are two reasons that parents hesitate about vaccinations; Read more…

Last week, there was quite a lot of discussion about a YouTube video entitled, “Why This Nurse WON’T Vaccinate” that was posted by a woman who refers to herself as the “Patriot Nurse”.  I wrote a blog post here on Shot of Prevention that included the video, along with a point by point commentary from a vaccinating nurse who I refered to as the Canadian Nurse.  Since the Patriot Nurse didn’t allow comments on her YouTube video, my intent was to generate an open discussion here on Shot of PRevention, where we are proud to allow differing views in our comments.  As you can see, the post received quite a few comments and since it’s never been our policy to censor them, you can understand the debate that this video has sparked.

Well today I want to update you on some recent developments with The Patriot Nurse.

It appears that the statements made in the video by The Patriot Nurse were troubling to many people, including blog writer Martine O’Callaghan who writes for Autismum and Nerditorial. She too wanted to write about this video and bring it to the attention of her readers. However, she first tried to verify the identify of The Patriot Nurse, in order to establish her educational and occupational background and experience. That prompted her to write a letter to a birthing center in TN where she believed Ms. Greene (aka The Patriot Nurse) has been employed.

Ms. O’Callaghan explains in her recent blog post that she was in no way calling for the dismissal of The Patriot Nurse.  She simply wanted to verify whether this person representing herself as a nurse on the video was currently working for the birthing center.  She also inquired as to whether the Patriot Nurse’s views on vaccination coincided with the policies of the birthing center.  After all, if a member of the birthing center’s staff has opted out of vaccination, shouldn’t the pregnant women giving birth there be informed of this?  After all, there are dangerous vaccine preventable diseases that can be life threatening to an infant who is still too young to be vaccinated and many cases where infants have died as a result.

It appears that since our last posting, The Patriot Nurse took down the YouTube video and has since made a statement on her Facebook page that suggests that her employer had some questions for her in regards to it.

Certainly, there is nothing wrong with a woman sharing her personal opinions regarding vaccines on YouTube, right?

Unless you are a nurse who attempts to speak as an authority on the subject of vaccines and you happen to have direct contact with pregnant women and newborns, is that it?

So, where exactly does the line get drawn?   What are the ethical implications here?  What are the consequences to these actions?  And what should they be? 

I’m curious to hear what you think in regards to this topic?    However, I feel it is only fair to start off with a comment we received from the Canadian Nurse who first attempted to correct some of The Patriot Nurse’s misinformation.  She commented for Shot of Prevention as follows:

Good morning angry supporters of The Patriot Nurse (TPN).

No one is debating your RIGHT to choose whether or not to vaccinate. But if you have the right to NOT vaccinate, then a patient – especially parents who …will be giving birth to a vulnerable neonate under your care – should have the right to choose whether or not you act as their nurse.

NO one is after The Patriot Nurse’s job. A science writer for a legitimate science zine contacted her work to verify her identity. Which is exactly what a responsible writer does before publication – verifies a source.

Non-vaccinating nurses at other hospitals have to take isolation per-cautions(gloves, gown, mask). This is to protect them and protect the patients. Regardless of whether YOU think vaccines work – science sure thinks that they do, and the employers have a right and a duty to protect those under its care.

The Patriot Nurse is a sham. She states in her video that saying this comes as a great cost to her as a nurse. If she so firmly believes in her anti-vaccination rhetoric – so much so that she would post it online AND STATE THAT SHE WAS A NURSE – then she should be well aware of the potential consequences.

All of you crying “free speech” are being deceived. The Patriot Nurse has deleted EVERY SINGLE comment that was not entirely supportive of her. You can’t claim that her free speech is in jeopardy while she refuses that right to others.

The Patriot Nurse made a video. A stupid video. In which she makes very very basic scientific errors. She was called to answer to those errors on her page, on this blog, on Orac’s blog and elsewhere. She refused to do so. She is not interested in having a dialogue. She had her little diatribe and that was that. NO ONE is so special that they can make sweeping, erroneous statements without recourse.

I know that you anti-vaccination activists have a lot of other anti-vaccination friends online. But the fact of the matter is that 94% of people are still vaccinating. You’re a blip on the radar. You’re the new “trendy” thing to be against. But when it comes down to it, all but a handful of people are intelligent enough to realize that:

1) there is NOT a global conspiracy of scientists and doctors trying to poison your children

2) a few bad nurses or doctors do not discount the whole of the scientific method; nor are the opinions of a few more valid than the opinions of millions

 3) researching vaccines on Google is NOT equal to going to post-secondary education for 10+ years to be a physician, pediatrician, immunologist or what have you.

The Patriot Nurse is not a martyr. She is a nurse who is expected to uphold the ideals and principles of her nursing organization and employer. And seeing as those things adhere to evidence-based medicine – and she doesn’t – she now has a problem. She brought it on herself. It was her choice not to vaccinate, and it their choice (and DUTY to the public) to deal with her how they see fit.

A Tribute To Bob Keegan, by Amy Pisani

Bob Keegan at ECBT’s 20th Anniversary Gala in October – I was so thrilled to see him after many years.

This past Monday an my old friend, Bob Keegan, succumbed to his battle with cancer.  Since hearing the news, I’ve struggled to find the words to write about his incredibly selfless efforts to save the lives of literally millions of children; partly because I know that he’d be the first to demand that instead I should go out and take a hike with my bike…literally, or grab a beer and toast him instead.  Yet, I can’t help but wonder whether he was aware that in addition to dedicating his own life towards saving the lives of people throughout the world, that he inspired untold numbers of his peers to strive to also make a difference in the lives of others?  Bob Keegan was the type of man who always gave credit to others for the accomplishments that so often he himself envisioned and facilitated.

When Bob was in his early twenty’s he began his 30 year career with the Centers for Disease Control and Prevention (CDC) within the branch that is known as STD control (sexually transmittable disease control) working as a public health advisor in Newark, NJ, New York City and eventually Atlanta, GA – home of the CDC.  He helped to develop the first pre- and post-test counseling for HIV/AIDS during a time when the nation was first coming to grips with what would soon become a sexually transmitted disease epidemic.  He then spent five years coordinating CDC’s efforts to assure that refugees from Southeast Asia were properly immunized and treated for communicable diseases.

In 1991, Bob joined the newly formed Polio Eradication Activity Section of CDC along with five other dedicated individuals and a budget of only $3 million.  As the deputy director of what is now called the Global Immunization Division, the staff grew to 110 with a budget of $150 million.  Since 1988, the number of polio cases reported worldwide declined by 99 percent!  That translates into a disease that once infected 350,000 people every year in South Africa and Asia, now affects 1,000 children each year.  Yet, as I celebrate the writing of that number; I just felt Bob smack me over the head to tell me that 1,000 children is unacceptable when that number is zero here in the U.S.  Of course he is right, and so the charge continues on. Read more…

January has been a busy month here on Shot of Prevention.  We’ve had a parent speak out on the significance of HPV protection for her son, a pharmacuetical employee comment on how proud she is to help ensure the safety of vaccines, we’ve even had a nurse call out the non-vaccinating Patriot nurse for sharing misleading information on YouTube.  Of course, let’s not forget about the return of Andrew Wakefield and his plans to sue for libel. 

Which leads me to a great editorial that appeared this morning in The Huffington Post, entitled Unencumbered By Facts: What Upsets Me Most About the Anti-vaccine Movement.  In this article, Claire McCarthy, M.D, who is a pediatrician at Children’s Hospital Boston, Harvard Medical School, explained why the appearance of Andrew Wakefield on Good Morning American had given her the chills.  (View it for yourself and you’ll see exactly what she is referring to.)

She explains that “My only crusade as a pediatrician is to keep my patients healthy — and vaccines are part of what I use to do just that.”  But she questions how doctors are supposed to help parents understand the enormous benefits and occasional risks of vaccines when “We stick to the facts. But people like Andrew Wakefield don’t.”

Dr. McCarthy does a great job of communicating her frustration and explaining the challenges the medical community has in countering the much publicized anti-vaccine rhetoric.  And while she speaks as one individual pediatrician, I would venture to guess that many others have echoed her views, but are, as she described, often “drowned out” by the headlines and airtime devoted to people like Andrew Wakefield.

She concludes her article by referring to what Wakefield says at the end of the Good Morning America interview;

 ”Wakefield encouraged parents to get educated, and to read about immunizations. He even suggested the CDC website. He said, emphatically, that there are two sides to the story.  I couldn’t agree more. But just one of them is grounded in facts.”

I applaud Dr. McCarthy for speaking out and I encourage you to read her article.  Of course, you are encouraged to not just listen to her opinion, but to get the facts.  Vaccinations save lives!