Combating Vaccine Refusal

Using The “D” Word to Explain the “P” Word

Yesterday I read an interesting post on the Moms Who Vax blog.  It has been inspiring to follow along on this new blog and hear how moms from Minnesota have sprung into action to combat vaccine preventable diseases that are making a comeback in their communities.   They have become the “boots on the ground” in campaigning for better parent-to-parent communication and supporting stronger immunization legislation in their state.

I commend them, not just because of the advocacy they stand for, but because they are moms using their voices to influence neighbors, doctors and public health.  And I, for one, can appreciate that effort.

In yesterday’s post, there was a comment about the fact that many doctors refrain from using the “D” word. (The “D” word, in this case, is Death.)  The suggestion was that it is an appropriate term to use when discussing the risks of vaccine preventable diseases.

It was a total “Ah, hah!” moment for me.  The writer had hit the nail on the head.

Not only have doctors been trained to avoid the “D” word, they are also expected to be sensitive to patient’s fears and feelings.  While it’s understandable to accommodate patients to a certain extent, it’s also imperative that health care decisions are not dictated be a “customer is always right” mentality that other “businesses” must succumb to in today’s competitive economic environment.

The point was made in a very upfront, no-nonsense manner, with the tone of a seasoned mom:

“…it’s all in the delivery, I reminded them. You don’t get the James Mason God-voice and boom “Death!” You say, gently, that you are ethically obligated to let them know that the risk of not vaccinating includes serious disability or death. ‘Nuff said.”

I thought about how relevant this was to a personal experience I had many years ago.  I wasn’t very familiar with vaccine advocacy at the time, but I was committed to vaccinating  my children in order to protect them from dangerous and sometimes deadly diseases. Unfortunately, I didn’t fully understand the risks of pertussis at the time.

So the story goes like this…

I was at the doctor’s office and he asks if I would like to get a Tdap booster (which stands for tetanus, diphtheria, and pertussis vaccine).  While I don’t recall if I was in the office for a sick call or a well visit, I do recall that I had several tired, hungry and active children with me and a long list of things I needed to accomplish before both the children and I went into meltdown mode.  (I remember this because it is fairly typical of every other day during this 10 year period of my life when I was working, raising 5 children and dealing with a frequently deployed husband.) I knew that if I were to agree to get a shot that day, I would most definitely be held up in that busy office for much longer than I could sanely afford.

What I didn’t know were the dangers of the “P” word. (In this case, the “P” refers to pertussis.)

It’s hard to admit this now, but I refused this shot, not because I was concerned about the safety of the vaccine, but simply because I was a busy stressed out mom, with lots to do and no real understanding of pertussis and the risk I was posing to myself or others by not vaccinating.

Here’s the part that could kill me – literally.

My doctor simply walked away.

He never asked me why I was declining the vaccine.  He never explained what diseases the vaccine would help immunize me against.  He didn’t even explain that if I got pertussis, I could be putting children – too young to be vaccinated – at risk for hospitalization or even Death (and yes, I spelled it with a capital “D”).

I just didn’t know and he just didn’t tell me.

Perhaps a simple discussion with my doctor may have resulted in a different outcome.  Perhaps my doctor felt like I did – he just didn’t have the time.  Or perhaps he felt like most everyone else I know – he didn’t like to be confrontational. I may never know, as we have moved and have a new doctor.

But how many times does this exact scenario play out in hospitals and clinics all over the country?

I’m going to guess…far too many times.

So, the lesson is, vaccine refusal doesn’t necessarily mean that a parent is concerned about the safety of vaccines.  It can simply mean that a parent doesn’t know why they should be getting immunized, or what terrible things may happen if they don’t get immunized. 

Communication is key and it’s up to parents, as well as doctors, to be open to it.

On the Moms Who Vax blog, the post ended with a real-life example of how a couple, with a newborn baby, had been influenced by their non-vaccinating family members.  The glimmer of hope was that a doctor had taken the time to talk with these parents.  What’s equally important is that the parents also took the time to listen, learn, and now –thankfully- vaccinate.

There are plenty of ways that parents are trying to communicate with other parents.  On the Moms Who Vax blog, on our Vaccinate Your Baby Facebook page, on the Shot By Shot website and in this explicit video.  Here a parent shares images of their child suffering with pertussis in order to help others to identify the symptoms and prevent fatal outcomes.  This kind of awareness is not intended to generate fear, but to educate about the very real risks of something as dangerous as pertussis.  If only I had seen something like this years ago…

Please take a moment to watch this video and then pass the word that adult Tdap boosters can help prevent this kind of suffering.   

  1. June 17, 2011 at 4:19 pm

    Keep up the good work, Moms Who Vax and Shot of Prevention!

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  2. June 17, 2011 at 7:36 pm

    Oh, thank you so much for this illuminating post and for the shout out!

    Moms Who Vax

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  3. Ophelia
    June 20, 2011 at 1:22 am

    For what it is worth – I am betting the Dr just didn’t push because he knew you had your reasons & overall that you were a vaxing mom. I know that your heart is in the right place as is the moms who are pushing to get Drs to be more confrontational, but I am not sure it is actually needed. I am a non-vaxer & as such belong to a group of moms online that don’t vax & I can think of not one member there that hasn’t been scolded, berated & threatened with the “D” word as you put by Dr’s, nurses, family & friends. So as much as I know you *think* they aren’t being pushy enough now, I am betting they are. It’s just that the answer is still no for me & my family no matter how hard you push. My real concern in this well meaning approach is that it is not uncommon to have new moms that feel completely browbeaten by Dr’s to come into our group & admit (in an embarrassed way – how long it has been since their little one has been to the Dr because they don’t want to take the child in for a well visit just to be scolded & basically told what a crappy mother they are for simply believing in a different medical approach for their own family. So you can take it for what it is worth – but I think asking Dr’s to be more pushy is likely to end up with more harm than good overall for everyone.

    I hope you don’t think I am trying to butt in & tell anyone else what they should be doing in regard to vaxing, as they isn’t at all my point or my intent. I think you should do what you feel is best for you & yours. My only intent on posting is that perhaps I can shed some light from a side you are likely not terribly familiar with. I come from the side that has been dropped by Dr’s & told they & they are children can no longer come to a particular clinic for care since mom won’t comply with the Dr’s wishes…moms (including myself when I was newly postpartum) that have left the Dr’s office only to get to the car & break down & cry from the exhaustion & frustration of yet another appointment where you have been lectured, etc, etc. I think Dr’s overall seem to be doing quite well at pushing the pro-vax stand overall. I don’t think that is lacking as far as I can see. If you want to increase vax rates it seems to me the best way to do it is to push for better testing before vaxes hit the market AND believe it or not to quit making them all compulsory. A lot of non-vaxxing moms would be interested in delayed & selective vaxes but in their state it is an all or nothing exemption – so they don’t have a legal right (in relationship to school exemptions, etc) to choose to take some & refuse others – so they opt out of all of them. So perhaps changing the requirements would be a better place to start. It would seem to me like pro vaxers would rather a mom be allowed to take all of the vaxes & opt out of the Chicken Pox vaccine rather than have that mom refuse all vaccines just so she can still get the exemption she needs to get her kids in school. Maybe I misunderstand what the pro-vax side would want though – I don’t know.

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  4. June 20, 2011 at 7:50 pm

    Ophelia, you sound like a nice woman, but calling the choice not to vaccinate an “alternative” medical path is not a fair description for your choice. Your choice not to vaccinate doesn’t just affect your family; it affects other people’s families as well, including parents who have lost children to vaccine-preventable diseases transmitted by unvaccinated children. Perhaps people who don’t vaccinate see a question from a concerned doctor as “browbeating” but I find it hard to believe that lots of doctors refuse to see children who aren’t vaccinated or are obnoxious about it. If anything, they are too lax. In fact, it was national news when a group of doctors in Colorado chose not to see unvaccinated children in their waiting rooms because whooping cough had been transmitted to several infants in California by an unvaccinated infected child in a waiting room. Ten infants died in that outbreak. Most doctors feel they have a better chance of changing minds by continuing to see unvaccinated children, despite the risk these children pose to infants at the same clinic.

    As far as your last point, I’m not sure I understand what you’re saying. As it stands, vaccines are not compulsory in any state. You can opt-out for religious or non-religious reasons in all states. I personally wish the conscientious objection loopholes were abolished. I don’t want to force you to vaccinate, but I don’t want your children in my school. My deal is that choosing not to vaccinate should remain just that: a choice. However, it’s a choice that needs to come with consequences, just like many other choices we must make in our lives. It is currently a consequence-free choice. And running across a doctor now and then who won’t see unvaccinated children is hardly a consequence. By the way I’d love to get those doctors’ names. I’m trying to find a vaccine-only practice for my kids.

    Anyway, I rarely take the time to already non-vaccinating parents, but you seem very good-natured, even though I disagree with you. Best of luck to your family.

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  5. 4mula1
    June 20, 2011 at 9:37 pm

    “currently, nine out of ten experimental drugs FAIL in clinical studies because we cannot accurately predict how they will behave in people based on laboratory animal studies” said health and human services secretary mike leavitt. animal research has NEVER been validated (pcrm.org). also… does your charity fund animal research? (humaneseal.org).

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  6. Nathan
    June 20, 2011 at 9:48 pm

    I was also confused by several of Ophelia’s points, Moms Who Vax. She seems to be implying that in some states, you cannot get an exemption if you selectively vaccinate. I have never heard of this. In any state I am familiar with that has philosophical or religious exemptions, you can get them regardless of how many vaccines you have refused. I would love to see some evidence that this is not the case in some states.

    (Keep in mind, though, that only around 15 states have philosophical exemptions, and two states, Mississippi and West Virginia, do not allow religious exemptions.
    http://www.hhs.gov/nvpo/law.htm#13.)

    It sounds pretty silly to allow a philosophical exemption for a child who is completely unvaccinated, but not allow it for a child who has had his MMR vaccines and nothing else. I don’t see how loosening vaccine requirements for school would increase vaccination rates.

    Similarly, “push[ing] for better testing” is unlikely to be helpful. Vaccines are already one of the best tested medical products, and the die-hard refusers will not be swayed by any study, no matter how robust. The people who actually have a chance of changing their minds are most likely to be persuaded by their medical providers – that is shown over and over again in research.

    I’m sure that antivaccine boards are littered with stories of parents who encountered pushy doctors or were dismissed from clinics – people with these kinds of stories are more likely to share them than people who had unremarkable interactions in clinics, and people who believe vaccines are bad would be more likely to look unfavorably at their pediatrician who recommends them. But that does not mean that overall, pediatricians are adequately confident in discussing issues with vaccine refusers. Christine’s personal experience is an example of how doctors become apathetic towards vaccine refusal. Pediatricians and other providers definitely have room for improvement in showing their patients and parents how dangerous the choice not to vaccinate can be.

    And, few pediatricians actually dismiss patients fromm their practice for refusing immunizations. A recent study showed that less than 5% routinely did, and 18% sometimes did. And the AAP recommends against doing so.

    http://aappolicy.aappublications.org/cgi/reprint/pediatrics;115/5/1428.pdf

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  7. Ophelia
    June 20, 2011 at 9:55 pm

    We just disagree on a fundamental level about the topic in general – in many ways. And since this is a pro-vax forum I don’t find it to be appropriate for me to get *too* in depth explaining my reasoning or that my non vaxed child isn’t risking anything to anyone else any more than a vaxed child is. As far as the Whooping Cough (Pertussis) outbreak I think many many people misunderstand how Pertussis is spread. The vaccine does not prevent the 1st stage of Pertussis, the bacterial phase. It is meant to address the Pertussis toxin which comes in stage two of the illness. The vaccine is not good at preventing the bacteria from setting in to a vaccinated host. Here is a clip from a small study – but there are plenty of such examples. “Immunization did not result in improved bactericidal activity for any of the individuals, and in two cases immunization caused a statistically significant decrease in complement-mediated lysis. ” (borrowed from pub med http://www.ncbi.nlm.nih.gov/pmc/articles/PMC97836/ ). Here is one from Medscape: “For the past 3 years, the National Foundation for Infectious Diseases (NFID) and the National Coalition for Adult Immunization (NCAI) have spearheaded “The Power of 10” campaign to raise awareness of the importance of revaccinating against tetanus and diphtheria every 10 years.

    Although “The Power of 10” was originally aimed predominantly at consumers (and still has celebrity maintenance man Bob Villa as its spokesman), the campaign is now targeting medical professionals as well.

    Medscape’s Peter Cook interviewed Dr. Susan Rehm — president of NFID until 2004, and now its medical director — regarding the importance of tetanus and diphtheria vaccination rates and what primary care providers can do to encourage patients to revaccinate.

    Medscape: Your campaign is named “The Power of 10″ to remind people to get a tetanus-diphtheria booster every 10 years. Why every 10 years?

    Dr. Rehm: People need to be revaccinated against tetanus and diphtheria every 10 years because the immunity for both diseases wears off after that time. Surveys demonstrate that over half the adult population in the United States lacks immunity to these diseases. And that’s why we wanted to get the word out. As a matter of fact, the level of immunity wanes with age. Only about a quarter of Americans over 70 years of age are immune to tetanus and diphtheria. ”

    This shows that half the adult population is not even currently immunized for Pertusis – so if you think the non vaxed are spreading the diseases, maybe get upset with adults instead of thinking the non vaxed kids are an issue. Non vaxed kids are a SMALL percentage compared to non vaxed adults. Even if my kids stay out of your schools, your kids would have to stay home 24/7 in order to avoid not coming into contact with a huge populous of unvaxed individuals at every turn where adults are present & adults are highly unlikely to even consider that they may have Pertussis – since they will likely consider it ” just a cough” or think it is bronchitis. I used a provax article here in hopes it would help you see I am not trying to twist stats or facts – but taking it right from the horse’s mouth. (link to full article http://www.medscape.com/viewarticle/504014)

    Anyway – I do not intend to debate with you on & I hope it did not come across as such. I just don’t know how I am supposed to respond or how I am expected to respond when it comes out as if my child is some loaded weapon that is aimed at your kids & that I am just selfish & only care about my kids. That couldn’t be further from the truth. Like I said – it is a medical decision & one that after much careful research & weighing I just came out with a different conclusion than you. I was trying to show that I absolutely read everything – even the current publications & continue to educate myself in case there is anything new. This has been the parenting decision I have done the most research on & weighed the heaviest. The few other non vaxers I know have taken it equally seriously & have not just up & decided “who cares”? It is much more complicated than that & if what you want is to convince people that they should vaccinate, there is no chance you will ever sway anyone’s mind if you don’t actually know WHY they are choosing what they choose.

    If you happen to be in the Michigan area & want an email from me listing the Dr’s that I know are staunchly pro-vax – I will be happy to give you some names & that is a genuine offer. I think there is likely a right fit of Dr for every parent – it’ is just a matter of trial & error. I would think maybe pro-vax parents have a list somewhere you would like to add them to like non vaxing parents try to network to help parents find vaccine friendly Drs. (Wouldn’t that also lend credence to what I was saying about most Dr’s not being okay with delayed/select/non vaxing? If most Dr’s were okay about it – there would be no need to try to compile lists of Dr’s that you can go to when choosing an alternate path). I am not sure why you interpreted what I said to be Dr’s asking non vaxed parents questions about their choice being called browbeating. Of course it isn’t. I anticipate a Dr will talk to me about his/her recommendations & even to feel free to tell me they disagree. If I failed to word it strongly enough – that is not what is happening to novax parents. I was myself held in an office for over an hour where the Dr stepped in between myself & the door several times to block me leaving & repeatedly attempted to undress my baby while I was dressing him, all while putting high pressure on & telling me that I was basically too ignorant to understand that I was risking my child’s life. It was an awful experience & I am certainly not alone in having experienced such a thing. I understand that you won’t be able to understand how non-vaxing parents are treated. That would make sense. I would hardly think pro-vax parents would be the ones to know how non-vaxing parents are treated at the Dr’s office. I imagine there are those that are thrilled that a Dr is pressuring so much…and that is fine. I do not want (or need) empathy. I am just saying that I think this kind of pressure is already occurring & I think as a provax parent you probably have less of an opportunity to know what a trip to the Dr is like when you choose not to vax. Take it for whatever you want. I actually thought it might be insightful.

    Best wishes!

    Ophelia

    I was clear in my last post regarding the school exemptions. The reason religious exemptions are allowed is because some religions won’t even take blood transfusions, let alone items that contain DNA from human & animal tissues. Then there are those that object to the tissue being cultured from aborted fetal tissue. There is very legitimate reason for someone to believe this goes against their religious beliefs. MANY states the ONLY way you can opt out if it is not religious is if it is medical (meaning needing your Dr to say the child is at an unusual risk to take the vax) and in a few states the medical exemption is the only exemption. My state has medical, religious & philosophical, but that is not true everywhere.

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  8. Nathan
    June 20, 2011 at 11:26 pm

    Ophelia,

    I completely agree with you about non-vaxed kids being a small part of the problem of the spread of pertussis – it is the adults with waned immunity that are the significant vectors for that disease now. And, unfortunately, natural pertussis infection does not confer lifetime immunity either.

    As your passage shows, it is vitally important for adults to be up to date to help protect these infants. However, unvaccinated children are still part of the problem, as the outbreak in Colorado demonstrates. And unvaccinated children are far, far more likely to get pertussis than vaccinated children.

    You are also right that pertussis vaccine is more effective at preventing disease than transmission. However, that does not mean that they do not impede transmisson at all – numerous studies much larger and rigorous than the six-person study you cited show that they do, in fact significantly reduce transmission.

    http://jama.ama-assn.org/content/275/1/37.abstract
    “Of the 173 nonvaccinated household contacts, 96 developed typical pertussis, compared with seven of 112 contacts vaccinated with acellular pertussis vaccine. Vaccine efficacy was consequently calculated to be 88.7% (95% confidence interval, 76.6% to 94.6%). Protection did not wane until at least the time recommended for booster vaccination. ”

    http://cid.oxfordjournals.org/content/50/10/1339.short
    “If immunity to pertussis in parents is maintained or boosted, 35%–55% of infant cases could be prevented.”

    http://rspb.royalsocietypublishing.org/content/277/1698/3239
    “Mathematical models suggest that the observed patterns of pertussis periodicity are equally consistent with loss of immunity that is not as rapid as currently thought, or with negligible transmission generated by repeat infections. We conclude that both vaccine coverage and birth rate drive pertussis periodicity globally and that vaccination induces strong herd immunity effects.”

    http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(99)04482-7/fulltext#article_upsell
    “Pertussis immunisation reduces disease frequency, but is not thought to prevent transmission. We show that vaccination has substantially reduced transmission in England and Wales.”

    You said, “Wouldn’t that also lend credence to what I was saying about most Dr’s not being okay with delayed/select/non vaxing? If most Dr’s were okay about it – there would be no need to try to compile lists of Dr’s that you can go to when choosing an alternate path.”

    I agree that most doctors are not “okay with” not vaccinating. They shouldn’t be. Their job is to keep children healthy. But that does not mean they routinely bully or dismiss patients, as you implied above.

    “I would hardly think pro-vax parents would be the ones to know how non-vaxing parents are treated at the Dr’s office.”

    No, but neither are you, because you have only a limited experience with a small number of doctors – perhaps just this one. There may very well be doctors who strongarm parents to the extent that yours did. But you can’t cast that as an overarching feature of doctors without some evidence beyond internet anecdotes. And just because some doctors may go too far, that does not mean that other doctors do not go far enough in helping their patients understand the safety and efficacy of vaccines, and the danger of the diseases. Christine’s doctor did not question her at all on her decision not to get a pertussis booster.

    The AAP statement makes it quite clear that doctors should listen to their patients and not bully them, but provide clear and concise answers. And this blogpost in no way is advocating treating parents in the manner in which you described, or even being “more confrontational” as you wrote. But rather, that they make sure to take the time to communicate the reality of what can happen from these diseases, as some parents refuse vaccination because, like Christine, they simply weren’t informed of the importance of them.

    Because vaccines have so effectively diminished these diseases, parents are increasingly less likely to understand the devastation that they can cause. And yes, that means making sure that the family realizes that leaving their child unvaccinated puts the child at a significantly higher risk of (the “D” words) death and disability.

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  9. Ophelia
    June 21, 2011 at 2:11 am

    Nathan,

    Just to clarify – I’ve been through 8 Dr’s (not one) and I live in a relatively smallish city, so these Dr have been in my town & in 4 surrounding cities. My current Dr is in yet another city even, because I had to travel to find one I could go to without a lecture at every visit. And my experiences with others aren’t just “internet anecdotes” – they are mostly women I know. We converse online more than in person – but who doesn’t these days? I do have boards I read & visit – but my primary experience is with a core of 9 women that are relatively local that I have known for a number of years now both IRL as well as online. It’s funny – the more kids we have the less we see eachother. 😛

    I also agree that the AAP statement says patients should not be bullied or dismissed, but that doesn’t mean they aren’t. Have you ever read the AAP refusal to vaccinate form that many Dr’s tell you that you have to sign if you refuse the vaxes? http://www.aap.org/immunization/pediatricians/pdf/refusaltovaccinate.pdf It more than covers anything a Dr is “supposed” to say in order to be assertive enough. It states that your child may contract an illness that could result in deafness, seizures, etc, etc & death. Every woman in my group has been presented this form at least once & I have come across it talked about repeatedly on non vax sites. It is put out by the AAP – I would think Dr’s would likely be using them. But non vaxing isn’t common. It really isn’t. According to the AAP document I attached, in 12 months time only half of all Drs said they ran across one or more patients in the past year that refused all vaccines & 85% said they ran into one or more patients refusing one or more vaxes. Every Dr I have seen for my kids has told me I was the only non vaxing parent they had (they could be lying I suppose). I was also told that my state law requires an all or nothing exemption – but perhaps that isn’t true either. I guess I should know better than to believe anyone that wants my kids to take the shots because they will also tell parents their kids have to have vaxes to go to school or daycare or imply that it a legal requirement period. The schools also do the same when it comes to misinformation regarding parental legal rights & vaccines. I suppose those people either do not understand the law or believe they are doing a service & even if lying is involved, the ends justify the means. I really can’t say – I just know that it has been like pulling teeth to get the right information regarding such things as what exactly you need for an exemption and then trying to convince others that you do in fact have that right.

    Based on my personal experience with eight Dr’s over 5-6 years (just as Christine is basing this on her experience with that one vaccine), I feel very confident in saying that a Dr not encouraging it is probably more the exception to the rule than not. If the Dr does not push it, it may in fact also be because he knows he will see that patient again soon & they can address it then. I understand you will believe what you believe. That is fine. Like I said I was not in any way trying to be hostile towards vaxers or to disrespect your forum (in fact now I am kicking myself because I like to read all forums related to vaxes but as a rule never post on a provax site out of respect). I just thought I might shed light on what moms who don’t vax experience with Dr’s very often. If my input as a nonvaxing parent who has stood in the office being physically blocked from leaving, etc is not helpful in adding to your understanding, then that is also fine. I shared here because I thought it might be helpful to hear from someone has dealt with this issue a number of times. I don’t assert that most Dr’s dismiss patients, but stats that say 1 in 6 Dr’s have dismissed a patient means it happens & 1 in 20 dismiss all patients who don’t vax. That says nothing to how many more Dr’s are pushy, rude or condescending to their non vaxing clientele to the point that the patient feels unwelcome or is hesitant to go to the office either.

    I have only had one, what I would call severe experience, with that one Dr I mentioned that blocked my leaving & tried to undress my child repeatedly. And seriously – the ONLY way I could have stepped around that Dr would have been to psychically touch her & push her to the side. I asked repeatedly for her to get out of my way to the door to which she just kept talking over me. It was ridiculous and she would not likely think of herself as being out of line, otherwise she would not have done it in the first place, right? I do not think that is normal – but I would say THAT is just as common as a Dr not bothering to tell a vaxing parent they really should take an extra 15 mins & get a booster shot for their kid today. I think Drs treat adults not boostering entirely more lax than they do children & if she had brushed off a vax booster for her child she would have likely gotten a bigger reaction. But that is just my thought on it. I have not once heard of a Dr that has turned out adult patients that refuse boosters…yet I have known it happen to parents. I used to get vaxes myself & I never once got pressure to get boosters…but the minute I had a baby – then they were all over me (same Dr) to vax my kid. Weird shift.

    And thank you to everyone in the discussion for having a very respectful dialogue.
    Ophelia

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  10. Nathan
    June 21, 2011 at 10:39 am

    I think we can agree on a few things. Most pediatricians/FPs do a sufficent job of presenting the risks of not vaccinating. Some doctors go too far, such as the one with which you had the horrible experience. And some, do not take the time to find out why a person is refusing vaccination for themselves or their children. We have examples of all of those things. It is difficult to tell exactly how much of each category exists, based on our limited experiences.

    However, my point is that the blogpost by Christine and by Moms who Vax are discussing the latter group, based on their experiences with doctors who did not question them about their decisions, or did not present them with an adequate picture of the risks. I can’t see anything wrong with addressing this category of providers, even if, in your experience, most providers “lecture” too much.

    I am familiar with the AAP refusal form, but I am not sure of your purpose in bringing it up. It is straightforward about the risks, that is true, but it is not a substitute for the physician addressing the risks for several reasons. First, the research indicates that patients listen to their physicians about vaccinations, not forms. Second, by the time the form comes out, the parent has already decided not to vaccinate. The point is to help the parents understand the risk of the decision they are making before it comes to signing the form. Third, I don’t believe that the AAP form is in widespread use, though it should be. I’m curious – out of the eight or so providers, did they all want you to sign the AAP waiver?

    I disagree when you say “But non vaxing isn’t common. It really isn’t.” 85% of physicians encountering full refusal or selective refusal of at least one patient in the last 12 months seems pretty common to me. The national rate of full vaccine refusal is about one half of one percent, and refusal or delaying of selected vaccines is much higher than that. And a recent survey indicates that those numbers are higher – perhaps 2% for complete refusers and 5% for selective refusers. “Common” is a relative term, but that’s pretty common to me. Dangerously common.

    It does seem that you got quite a bit of misinformation about waivers, which is awful.

    I agree that providers are much poorer about presenting vaccination to adults than to children. You describe it as a “weird shift,” but it makes sense for several reasons. First, the pertussis booster is relatively new. Many providers are not yet familiar with how important it is, or who should receive it, or how often. There are major campagins currently to address this gap in knowledge. Second, providers are simply less likely to question a person making a poor decision for their own health, then they are to question making a poor decision for the health of their child. If you refuse your own life saving cancer treatment, people will certainly try to change your mind, but will respect that decision. But if you refuse your child’s life-saving cancer treatment, you will be brought to court. This does not happen to this extent with vaccines (except perhaps in rare cases where the vaccine is actually treatment, like a hep B shot to the baby of a hep B positive mother), but still, the philosophy remains, that doctors may not be as “pushy” about preventative measures for adults. And, for most vaccine preventable diseases, the children are the primary ones who spread the disease, and are most at risk of death or other complications from the disease.

    Don’t kick yourself for posting here. The dialogue is important and you have made very good points. And I appreciate your respectful nature as well.

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  11. Melissa
    June 28, 2011 at 5:10 pm

    “…it’s all in the delivery, I reminded them. You don’t get the James Mason God-voice and boom “Death!” You say, gently, that you are ethically obligated to let them know that the risk of not vaccinating includes serious disability or death. ‘Nuff said.”

    And as the parent, my response each time to the doctor is that the risk of vaccinating includes serious disability or death.

    I was under the impression that doctors were to do no harm to their patients.

    ‘Nuff said.

    Like

  12. Chris
    June 28, 2011 at 10:04 pm

    And as the parent, my response each time to the doctor is that the risk of vaccinating includes serious disability or death.

    So what are the relative risks? The risk of serious injury or death from getting measles is about one out of a thousand cases. Now compare that to the risk from serious injury or death from the MMR is one in a million.

    Which one has better odds?

    I was under the impression that doctors were to do no harm to their patients.

    So what about the under age one child in San Diego who was in the doctor’s waiting room and an unvaxed child who ill was also there? That child had just come back from Switzerland, and actually had measles. The baby who was too young to get vaccinated ended up in the hospital. So who harmed that baby?

    Like

  13. Melissa
    June 29, 2011 at 4:20 pm

    ‘Nuff said.

    Chris :

    And as the parent, my response each time to the doctor is that the risk of vaccinating includes serious disability or death.

    So what are the relative risks? The risk of serious injury or death from getting measles is about one out of a thousand cases. Now compare that to the risk from serious injury or death from the MMR is one in a million.
    Which one has better odds?

    I was under the impression that doctors were to do no harm to their patients.

    So what about the under age one child in San Diego who was in the doctor’s waiting room and an unvaxed child who ill was also there? That child had just come back from Switzerland, and actually had measles. The baby who was too young to get vaccinated ended up in the hospital. So who harmed that baby?

    You are comparing apples to oranges. Millions of kids get the MMR each year, thus the rate of risk of injury or death is higher, compared to the amount of measles cases that actually exist. The bottom line is that I am choosing to not purposefully give my child something that could cause harm.

    As far as the doctor’s office – I still blame the doctor. They didn’t provide a setting in which sick children can be in a different waiting room than well children. Also, the under year old child probably wouldn’t have been there if they weren’t there to get a well child exam with vaccinations.

    Like

  14. Chris
    June 30, 2011 at 2:07 am

    . Millions of kids get the MMR each year, thus the rate of risk of injury or death is higher, compared to the amount of measles cases that actually exist.

    Because of the vaccines! The risk of getting measles is lower because kids get the very safe MMR.

    The bottom line is that I am choosing to not purposefully give my child something that could cause harm.

    By depending on the herd immunity by others giving their children the MMR vaccine. You are essentially leeching off of the protection provided by being part of a community. Unfortunately like minded people tend to attend the same schools, which is why the child who visited Switzerland infected kids in his charter school. It is why that same year all eight children of a family in Washington state came down with measles, with three being hospitalized. Some schools have been closed due to pertussis outbreaks.

    Advocating others to not vaccinate further erodes the immunity from the community. This means more outbreaks of measles, which is happening in Europe and is starting to happen in the USA. The chances of your child getting measles is increasing every day.

    Also, the under year old child probably wouldn’t have been there if they weren’t there to get a well child exam with vaccinations.

    Are you now arguing against well child checks? It is because of those regular check up that my son’s developmental issues were picked up and he was given early intervention.

    Like

  15. Melissa
    June 30, 2011 at 8:09 pm

    We could argue for years but perhaps you should just read about what vaccines do to our bodies and then maybe you would change your mind. I don’t believe in the “herd immunity” as the pro-vaccine community pushes it. Non-vaxers are not leeching off of the pro-vaccine community. If we were we wouldn’t so adamantly be trying to get everyone to change their minds about giving their children the vaccines. Instead we would be sitting back and saying haha. We’re not. That should really say something right there. Just because someone has a vaccine does make them immune to the disease. Thus why so many children are still getting pertussis.

    Also, I’m not afraid of my children getting a childhood disease. Would it suck? Yeah. Of course it would. But I don’t fear it. Thus, another reason to not vaccinate. Getting an illness gives you natural immunity anyway, and then there really would be nothing to fear. There is no such thing as herd immunity – even the vaccine makers have said that we all need boosters because vaccines are not effective after 10 years, and yet all those that received them in the 60’s and 70’s did not get boosters and they didn’t get the disease. Why? Because the diseases themselves were already losing their momentum before the vaccines even came into existence. So vaccines help? I’m sure they do. But they also harm. And they don’t help ENOUGH to negate the harm that you and other pro-vaxers are doing to your children.

    You’re injecting chemicals and animal cells into their bodies,each time taking the risk that they will have serious harm or death happen to them. You are taking a chance that those vaccines are not causing developmental or learning delays. You are taking a chance that those vaccines will not cause cancer down the road. Guess what? I’m not taking the chance. I’m not putting my children at risk for the rest of their lives because I’m afraid they’ll be one of 80 cases of measles out of the 307 million some people in the US. But I do know they won’t be one of the adverse reactions. CDC estimates that only about 10% adverse reactions are reported each year.

    “VAERS receives around 30,000 reports annually, with 13% classified as serious (e.g., associated with disability, hospitalization, life-threatening illness or death) (CDC VAERS Master Search Tool, April 2, 2008).”

    Also, I’m not opposed to well-child exams. I never said I was. I said that I was guessing the child was probably there for his vaccinations. I am all for preventative medicine – that which comes with exams – not the type where we give our children chemicals on the off chance they might get a disease in the future.

    Like

  16. Chris
    June 30, 2011 at 9:04 pm

    1) Herd immunity exists whether you believe it or not. This is why measles is now endemic in the UK after it had almost vanished between 1988 and 1998. This is why diphtheria returned to the Ukraine and other countries when the Soviet Union broke up and there was an interruption in vaccination programs. This is why mumps has returned to Japan (they had a problem with measles epidemics also, but they resumed measles and rubella vaccines, but not mumps). This is why over 120 Americans died from measles about twenty years ago, which prompted the creation of http://www.ecbt.org/aboutecbt/ .

    2) Immunity from some infections do not confer lifetime immunity. These include tetanus and pertussis. This is also why kids get strep throat over and over again. There is no reason to think that vaccines should provide better immunity.

    3) VAERS is a self selected survey that takes all reports. From http://vaers.hhs.gov/data/index :

    A report to VAERS generally does not provide sufficient basis for concluding that the identified vaccine(s) caused the adverse event described. It only confirms that the reported event occurred sometime after vaccine receipt. No proof that the event was caused by the vaccine is required in order for VAERS to accept the report. VAERS accepts all reports without judging whether the event was caused by the vaccine.

    Like

  17. Nathan
    July 1, 2011 at 12:17 am

    Non-vaxers are not leeching off of the pro-vaccine community. If we were we wouldn’t so adamantly be trying to get everyone to change their minds about giving their children the vaccines. Instead we would be sitting back and saying haha. We’re not. That should really say something right there.

    It does. It says you either do not understand herd immunity, or you are in denial.

    Getting an illness gives you natural immunity anyway, and then there really would be nothing to fear.

    Unless they died or were disabled in the process of getting that immunity. Which is far, far, more likely than a serious vaccine reaction.

    So vaccines help? I’m sure they do. But they also harm. And they don’t help ENOUGH to negate the harm that you and other pro-vaxers are doing to your children.

    Yes, they do. They help way more than they harm. Vaccine harm is extremely rare. Vaccines, on the other hand, have benefitted everyone. They even benefit the unvaccinated.

    But I do know they won’t be one of the adverse reactions. CDC estimates that only about 10% adverse reactions are reported each year.

    That is wrong. The wrong part there is the word “reactions.”

    I’m not putting my children at risk for the rest of their lives because I’m afraid they’ll be one of 80 cases of measles out of the 307 million some people in the US.

    And you have the rest of us to thank for the fact that there are only 80 cases instead of 307 million (or about 3-4 million annually). And you said you weren’t leeching off of us. Well, you are welcome anyway.

    Like

  18. Chris
    July 1, 2011 at 11:14 am

    Correction to first paragraph: it is the erosion of herd immunity that caused the return of diseases to places where they were almost gone.

    Like

  19. 4mula1
    July 7, 2011 at 9:00 pm

    opps, i forgot 1 website, mrmcmed.org

    Like

  20. Chris
    July 8, 2011 at 1:28 am

    I hate flash heavy, content free websites. The “Info” bit is completely worthless. If it is “national” it should say at least which country, and at a minimum have a list of officers and a statement of purpose.

    Like

  1. January 22, 2014 at 10:10 am

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