Home > Expert Insights, Preventable Diseases, Testimonials > Doctors Take a Stand for Immunizations

Doctors Take a Stand for Immunizations

Research has indicated that when it comes to immunization information, parents put a lot of trust in what their doctor has to say.  Certainly immunization recommendations are made by medical
professionals because they are confident that vaccination is in the best interest of their patients.  While it is certainly understandable for parents to want to educate themselves regarding the
immunizations recommended for their children, what are doctors to do when patients ignore, or even refuse, the recommendations?

Interestingly enough, NBC’s chief medical editor Dr. Nancy Snyderman aired a segment yesterday on the TODAY Show which explored whether doctors should ban children who are not vaccinated.  Coincidentally, I recently had the opportunity to talk with Dr. Scott Goldstein of Northwestern Children’s Practice in Chicago about his thoughts on this issue.

Dr. Goldstein explained that he takes a very active approach regarding immunization education.  Not only does he talk to parents at length in the exam room, but as a member of the Illinois Immunization Patient Advocacy Leadership Initiative, he invites parents to attend  immunization presentations that he gives every few months at a nearby hospital.

So picture yourself in the shoes of someone like Dr. Goldstein – entrusted with keeping your patients healthy.  You understand that patients who refuse or delay vaccinations are at a greater risk of contracting a vaccine preventable disease.  You realize that by accepting unvaccinated patients that you may be jeopardizing the health of others who share the same waiting and examination rooms.  You know that there are patients in your practice that are either too young to be vaccinated, immune compromised or who, for medical reasons, are unable to be vaccinated or who did not receive full immunity from their vaccines.

Now consider that you are well-versed in the countless studies that illustrate that vaccines are not only safe, but highly effective, and that you have been in the uncomfortable position of seeing someone suffer, or even die, from a vaccine preventable disease.  Imagine that after you do you best to present all the scientific evidence, and address all the questions and concerns, that one of your patient’s will go without vaccinations because their parents have chosen to disregard your advice and professional recommendations.

Unfortunately, situations like these are often a reality for doctors and why they are continuously questioning, and sometimes even altering, their policies.

Take for instance Dr. Goldstein and the other pediatricians in his practice.  They began the year with a “Let’s give them time” approach, deciding that they preferred not to kick patients out.  In Dr. Goldstein’s opinion, the biggest barrier to vaccination was misinformation.

“If parents have the right information, and they understand the overwhelming evidence that supports vaccination, than we feel they will come to understand why we, as doctors, feel so strongly in favor of vaccination,” he explains.

Unfortunately, as the year progressed, the practice began seeing a few cases of pertussis and meningitis, and the doctors grew concerned.

“That really got our attention,” explained Dr. Goldstein.  “There is a difference between people having a choice, and making choices for other parents.”

Additionally, the doctors began realizing that many patients were not adhering to the recommended schedule, but rather picking and choosing vaccines and creating their own schedules.

As Dr. Goldstein explained, “It was getting difficult for the practice to keep track of it all.”  Parents would come in to see the nurse and get a shot that they had initially delayed, but then not remember which shot the child needed.  The staff then had to try to determine which vaccine they were requesting, which was hard to keep track of because it wasn’t according to a set schedule.

“It was consuming a great deal of time and taking our doctors and nurses away from other patients,” states Goldstein.

In an effort to provide the best care possible for their patients, the practice decided to adopt a new policy in June.  They would only see patients who were vaccinating according to the recommended schedule.

In defense of their policy, Dr. Goldstein explains,

“We shouldn’t have to sell something that’s proven. The evidence in favor of immunizations is so overwhelming.”

He goes on to say,

 “All of the available research shows that the safest and most effective way to vaccinate children is on the schedule set by the CDC and AAP.  To go against that schedule goes against proven scientific research and puts patients who do follow the schedule at risk.”

Dr Goldstein is comfortable with this new policy since it reflects the collective convictions of the physicians in the practice.  He reports that their patient response has also been very positive, explaining that parents who were “on the fence” have resolved their concerns and that the strong stand that these doctors have taken has actually helped to boost patient confidence in vaccines.

“If we had so many leaving, we may question this, but we’ve only had about five or six families that I know of that have left the practice out of thousands of patients we see.”

Certainly, not every doctor will take this approach, and some doctors are concerned that there may be negative implications of this type of policy.  But it is important for parents to be aware that these policies may, or may not, be in place at the practice they choose to visit.

While some parents will continue to beleive that immunization is a personal choice, these policies make it clear that doctors are acknowledging that the immunization choices one person makes can  directly impact the health of others.  Parents who choose not to vaccinate their children often argue that they want to retain their right to file an immunization exemption, (which then allows their children to be admitted to school without fulfilling the proper immunization requirements).  If they are granted this choice, isn’t it understandable that doctors should be free to make a choice in their own practice that will best protect their patients?

There are certainly a lot of opinions in regards to this, so we look forward to hearing your thoughts.  Feel free to add your comment below, or join us on our Vaccinate Your Baby Facebook page to add to the conversation there.

  1. Emily
    September 2, 2011 at 6:19 pm

    “There is a difference between people having a choice, and making choices for other parents.”

    That completely sums it up for me; I fully support doctors who require their patients to be fully vaccinated according to schedule. If I bring my baby in for her 2-month-old check up, it is not acceptable to me that there may be a possibility that she will share a waiting room with an unvaccinated child carrying a disease that should have been prevented. You can make the choice for YOUR child to have to suffer through measles, mumps, rubella, or pertussis or whatever else; you CANNOT make that choice for mine.

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  2. JoAnn Maslana
    September 2, 2011 at 7:56 pm

    I agree it is unfair to bring children in to a docotrs office with an illness that should have been prevented by a vaccination

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  3. Elise
    September 3, 2011 at 3:24 pm

    If vaccines truely do what they are “supposed” to do then why worry about an unvaxed child? If you believe in vaccines and believe that they work then even if an un-vaxed child is carrying one of these diseases (that our bodies when given proper nutrition will be able to fight and build natural immunity to) then your child should be just fine since they were vaccinated, right? The difference in a vaccine and getting a disease naturally is you need no booster in the future.

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  4. Nathan
    September 3, 2011 at 4:17 pm

    Several reasons, Elise. Many children are too young to be vaccinated, but can still get the disease. Others have medical contraindications that do not allow them to be vaccinated. And there is a small amount of people in whom a given vaccine might not “take.”

    “The difference in a vaccine and getting a disease naturally is you need no booster in the future.”

    The other difference is that getting a disease naturally is thousands of times more likely to kill you than a vaccine.

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  5. Oliver
    September 3, 2011 at 4:22 pm

    Elise– All you have done in your comment is show your lack of understanding about the science of vaccines. A typical anti-vax comment (“why do you care what I do, if YOU vaccinate?). The reason is explained all the time where accurate vaccine information is available. Here is it (…for the umpteenth time) — we don’t give all these vaccines at birth (except for Hep B, in the U.S., as I understand it, in Canada it is not given at birth). Babies are still susceptible to these illnesses when they are too young too have received their immunizations. There are also children (and adults) with immunocompromised systems, on chemotherapy, fighting cancer… (do we just not care about them because they don’t have the “natural” ability to fight these diseases?). And, let’s not forget that no one has EVER claimed that vaccines are 100% effective, so some will not mount a proper immunity despite being immunized. But 95% effective, does not mean “vaccines don’t work.” It just means that a very small percentage of the time they don’t. These people deserve protection from herd immunity, too. Please review the science of vaccines again (or, for the first time) before posting such silliness– such as outright ridiculous and false statements that proper nutrition is defense enough against tetanus, polio, meningitis, pertussis, measles, rubella, et.al). Please do not continue to spread lies and misinformation. Thank You.

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  6. Oliver
    September 3, 2011 at 4:25 pm

    Nathan, isn’t is also true that even those who received “natural immunity” do not have immunity for life? This is another anti-vax myth, as I understand it.

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  7. Tsu Dho Nimh
    September 3, 2011 at 5:30 pm

    Elise – One of the victims of the San Diego outbreak was an infant that was too young to be vaccinated. That outbreak was caused when an unvaccinated child caught measles in Europe and returned to spread it at his pediatrician’s office.

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  8. Nathan
    September 3, 2011 at 9:43 pm

    Like vaccines, duration of immunity differs from disease to disease. Measles likely grants lifelong immunity from the disease or the vaccine. Pertussis does not, though the duration of immunity from wild pertussis seems to be twice as long or longer than from the vaccine. Not worth getting pertussis or measles for, that’s certain.

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  9. Chris
    September 3, 2011 at 9:49 pm

    That is especially true for many bacterial diseases. Apparently if you survive tetanus, you can get it again. This paper, Duration of immunity against pertussis after natural infection or vaccination., says:

    A review of the published data on duration of immunity reveals estimates that infection-acquired immunity against pertussis disease wanes after 4-20 years and protective immunity after vaccination wanes after 4-12 years.

    It is unreasonable to expect a vaccine to work better than the actual disease.

    I had mumps twice. Apparently I did not become immune the first time around. I have since heard that there are others that have not been able to become immune to mumps from either the vaccine or actually getting the disease.

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  10. September 3, 2011 at 11:58 pm

    I find the article puzzling on many levels. If a baby does have a reaction to a vaccine, will they be ejected from the practice because it isn’t safe for that particular infant to follow the standard schedule?

    What if a baby is very ill when it comes time for recommended vaccines? Can they be delayed or is the schedule absolutely immovable?

    If a vaxed child has pertussis (it happens) can they come to the waiting room and spread the illness and that is okay?

    If a baby gets seven or eight vaccines in one visit and appears to have a reaction, how do they figure out which vaccine caused the problem? Do they keep giving all the vaccines and hope for the best? Eject the baby from the practice for presenting the potential to deviate from the schedule?

    So many questions…

    I’ll admit that my grandchildren are mostly unvaccinated and have used a family practice for medical care for many years. They haven’t spread any illnesses via the doctor’s office because my daughter phones in rather than dragging a sick child out of the house to spread sickness through the community. When they and some other kids had chickenpox the doctor saw them in their cars in the parking lot, not because they needed medical care, but just to document the cases so they wouldn’t be forced to stay home from school if there was an outbreak.

    This family practice has many partially or totally unvaxed kids. Works fine for everyone concerned. Seriously.

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  11. Derek
    September 4, 2011 at 10:42 am

    You’re operating under the assumption that vaccines are 100% effective all of the time. Nothing could be further from the truth. Vaccines have shown over and over again to fail. Just one example is these whooping cough “outbreaks” where almost every case was in a child who had been previously vaccinated. Your precious vaccines are less effective than placebo and actually depress the immune system, not stimulate it. I try to keep my daughter away from vaccinated children because they are ALWAYS sick. Surprise, surprise. The unvaccinated should be the least of your worries.

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  12. Derek
    September 4, 2011 at 10:54 am

    Oliver, Oliver, Oliver, “science of vaccines”? I believe that is an oxymoron. It’s obvious you have no clue of the science of anything. Nutrition is, in fact, the most powerful tool available to fight off disease. Give the body what it needs, nutrition, natural supplements, etc. and it will have the ability to naturally fight off anything you throw at it. A good host(a healthy body) is very inhospitable for bacteria, viruses, fungi, etc. This is exactly why parents who educate themselves and don’t vaccinate usually are the same parents who feed their children well balanced, nutritious meals instead of McDonalds, high fructose corn syrup, candy, milk, and peanut butter all the time.

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  13. Kelly
    September 4, 2011 at 11:02 am

    And despite all this nutrition, unvaccinated children are still more likely to spread vaccine preventable diseases than vaccinated children.

    http://www.immunize.org/catg.d/p2069.pdf

    (Notice how I support my claims with actually science, Derek)

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  14. Derek
    September 4, 2011 at 11:05 am

    95% effective? You obviously pulled that number out of thin air. Show me some evidence that any vaccine in history has ever been 95% effective. I’ll save you some time, because it doesn’t exist. Herd immunity is a myth by the way. What adult do you know has gotten a booster at any point? Zero, so even if the vaccines they received as a child were effective(they weren’t), the artificial immunity would have worn off by now making them effectively” not vaccinated”. So I’ve now disproved herd immunity, the biggest gun in the pro-vaxxers arsenal. Boom!

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  15. Derek
    September 4, 2011 at 11:16 am

    Kelly, please bring some credible research to the table the next time you claim you’re presenting “science”. “Research” by the Immunization Action Coalition(the people that would force you to get immunized at gunpoint if they could) does not count. Obviously, this is junk science. You’re so adorable. You must be new at this.

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  16. Kelly
    September 4, 2011 at 11:48 am

    Derek, the link I provide is to a document that references 14 primary references. I hate to tell you this, but that is what science is.

    By the way, where is the science supporting your claims? Dismissing me by calling me “adorable” and “new at this” while using ad hominem to try to discredit IAC pretty much tells me you don’t have anything to support your side. If you did, you would have presented it.

    So what did you think about this study, Derek, that showed that unvaccinated kids were 23X more likely to get pertussis than vaccinated kids? I think it throws your claims into the toilet and that is just one study of the 14 I posted to the zero you have posted.

    http://www.ncbi.nlm.nih.gov/pubmed/19482753

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  17. Nathan
    September 4, 2011 at 12:29 pm

    You’re operating under the assumption that vaccines are 100% effective all of the time.

    When did she assume that?

    Just one example is these whooping cough “outbreaks” where almost every case was in a child who had been previously vaccinated.

    If you’re referring to California, around 90% were too young to be fully vaccinated.
    http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5926a5.htm
    http://www.cdph.ca.gov/programs/immunize/Documents/PertussisReport2010-12-15.pdf

    Your precious vaccines are less effective than placebo and actually depress the immune system, not stimulate it.

    This is entirely imaginary and not supported by evidence.

    try to keep my daughter away from vaccinated children because they are ALWAYS sick.

    And this is just paranoia.

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  18. Nathan
    September 4, 2011 at 12:49 pm

    MV,

    If a baby does have a reaction to a vaccine, will they be ejected from the practice because it isn’t safe for that particular infant to follow the standard schedule?

    Not in any practice that I know of who dismisses vaccine refusers. A child with a medical exemption to vaccines is not dismissed. It seems pretty obvious to me that these articles are referring to families that deliberately refuse vaccination against the doctor’s advice.

    What if a baby is very ill when it comes time for recommended vaccines? Can they be delayed or is the schedule absolutely immovable?

    Same as above. If the doctor does not recommend vaccination, then they are obviously not going to dismiss them from their practice. Did you really think this would be the case or are you just playing games? I’m getting a “deliberately obtuse” sense from your questions.

    If a vaxed child has pertussis (it happens) can they come to the waiting room and spread the illness and that is okay?

    Who said that would be okay? A child with known pertussis should not sit in a waiting room at all. But the reason that some docs are dismissing families who don’t vaccinate is that they are much more likely to bring pertussis into their waiting rooms than a vaccinated person. It can happen if you are vaccinated, but is much less likely.

    If a baby gets seven or eight vaccines in one visit and appears to have a reaction, how do they figure out which vaccine caused the problem? Do they keep giving all the vaccines and hope for the best?

    Depends on the reaction. A fever? Yes, you would probably continue to vaccinate, as this is not a contraindication. An anaphylactic reaction? Then it would be very puzzling, and the patient would likely have a medical reason to be exempt from all those vaccines. And, no, they would not be dismissed in any practice I know of.

    So many questions…

    Fortunately, they are all pretty easily answered, when you put your mind to it.

    I’ll admit that my grandchildren are mostly unvaccinated and have used a family practice for medical care for many years. They haven’t spread any illnesses via the doctor’s office because my daughter phones in rather than dragging a sick child out of the house to spread sickness through the community. When they and some other kids had chickenpox the doctor saw them in their cars in the parking lot, not because they needed medical care, but just to document the cases so they wouldn’t be forced to stay home from school if there was an outbreak.

    I think that’s awesome. And I don’t agree with dismissing unvaccinated patients from practice, personally. I think all those measures can be used, although one problem: some diseases, like measles are contagious before symptoms. Your grandchildren also are much less likely to catch and spread vaccine-preventable diseases because most of the children around them are vaccinated, so that may be contributing to their good luck in this regard. But, I am glad that your particular family has not yet spread any potentially dangerous illness despite their higher potential to do so.

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  19. Chris
    September 4, 2011 at 12:55 pm

    You’re operating under the assumption that vaccines are 100% effective all of the time.

    Please show where anyone has ever asserted that particular falsehood. Show exactly which article on this blog has that claim.

    Further down the thread I linked to a review article that shows immunity from pertussis wains between 4 to 20 years even after getting the actual disease. The vaccine is about 80% effective, and yes it does wane. It is unreasonable to expect it to wain later than getting the disease. It also shows why it is important to keep up boosters, like the Tdap starting in teenagers.

    Please post some evidence that confirms your statement: “vaccinated children because they are ALWAYS sick.” Because the reality is a bit different.

    This paper found that unvaccinated children were 23 times more likely to get pertussis: Parental refusal of pertussis vaccination is associated with an increased risk of pertussis infection in children.. The conclusion:

    Children of parents who refuse pertussis immunizations are at high risk for pertussis infection relative to vaccinated children. Herd immunity does not seem to completely protect unvaccinated children from pertussis. These findings stress the need to further understand why parents refuse immunizations and to develop strategies for conveying the risks and benefits of immunizations to parents more effectively.

    There are more that are vaccinated. So the larger proportion of those who are unvaccinated get pertussis than vaccinated. Take 1000 people where 10% refuse vaccination, and there is an outbreak. If 10% of the 900 vaccinated get sick, that is 90 sick vaccinated persons. If 50% of the 100 unvaccinated get sick that is 50 sick unvaccinated persons. In the future use the percentages, not the raw numbers when claims that the vaccinated are sicker. And be sure it is backed up by real data.

    And then, Vaccination Status and Health in Children and Adolescents found that the only difference between children who were vaccinated and who were not was that those who did not get vaccinated suffered more vaccine preventable diseases. Which is not a surprise. The conclusion:

    The prevalence of allergic diseases and non-specific infections in children and adolescents was not found to depend on vaccination status.

    In the future, before you make any statements that you find a way to support them through the scientific literature. Otherwise we will assume you just made them up.

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  20. Chris
    September 4, 2011 at 2:17 pm

    I’m getting a “deliberately obtuse” sense from your questions.

    That is typical for her: response to her short time on the JREF forum:

    Hang on…. are you just pretending you have only just discovered the “Inside vaccines” web site as a result of this JREF thread?

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  21. Oliver
    September 5, 2011 at 10:41 pm

    Derek, when I stated “95% effective does not mean ‘vaccines don’t work’..” …this was just an example of the way that those against vaccines seem to think. If you will notice, I did not refer to a specific vaccine for this data. I was not trying to claim a particular statistic for MMR, Dtap, or any other vaccine for that matter. The point was merely that just because something works most of the time, and does not work a very SMALL amount of the time, doesn’t mean vaccines don’t work or that they are useless and/or ineffective. I’m sorry you do not possess the critical thinking skills required to grasp this point that I was making, or the overall concept. Many vaccines have efficacy in the 90% range, though not all. So, I was not just making up a statistic. Had I been trying to prove the efficacy for a specific vaccine, I would indeed have provided you the link for that statistic.

    And, what exactly is it that makes it “obvious” that I have no clue about the science of anything? Your say so? And, you’ve been such a reliable source up to this point, have you? Do you honestly think you’ve provided any kind of reason for us to believe that herd immunity is a myth? (and, your “Boom!” statement is incredibly amusing and hilarious… you use it after saying you’ve disproved herd immunity. How, again did you do that? Please, do refresh my memory for shits and giggles. Since you did no such thing. You only SAID you did that).

    Can you also show somehow that good nutrition prevents vaccine-preventable diseases (when others have posted links to scientific studies that state otherwise), or that all parents who do not vaccinate avoid McDonalds, and giving their children peanut butter? That’s my favorite. (And, for that matter, perhaps you can present some evidence that those that DO vaccinate simply feed their children fast food and junk somehow believing good nutrition is not important *along* with vaccinating? Or, are you stating/claiming this at all? It seems to be implied).

    I’m also in awe of the fact that you claim that ZERO adults get booster vaccinations. Really? Again (and, it’s truly tiresome asking this of you Derek), please provide reference for this made-up statistic (kind of funny that someone that accuses me of pulling statistics out of thin air, continually makes up lies and presents them as “TROOF.”). To answer your question, I know dozens, upon dozens of adults that have had boosters. Myself being one of them. I’ve had my Tdap booster, as has my husband, sibings, in-laws, and all my co-workers. For family planning purposes, all in my family have been checked for up-to-date status on other immunizations, as well. So, your statistic of “zero” adults getting their boosters is outright absurd and you lose additional credibility (though you didn’t have much to begin with, …even though you did start off by saying my name 3 times, as if that makes you seem more reliable). But, if I add TWO BOOMS after my comment, I guess my points trump yours, and you lose.

    BOOM, BOOM Derek!!!!

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  22. September 6, 2011 at 8:38 am

    Nathan,
    Thanks for your courteous reply. My questions were based on my online experience of hundreds of parents whose children had reactions to vaccines who were told “this is normal”. None of those parents would have been permitted, much less encouraged by their doctors to skip the vaccines their children reacted to. And the majority of these parents ended up either quitting vaccinating altogether or skipping some vaccines or delaying vaccines or doing a combo.

    The original article strikes me as basically saying that anything short of an incredibly extreme and obvious reaction will be denied. Your response confirmed that.

    To give a particular example, a friend of mine has a grandchild who had a “stroke” shortly after they received the MMR which was given around 18 months at that time. The doctors considered that it might be a vaccine reaction, but couldn’t find “stroke” in the list so concluded that it wasn’t. The parents did more research, discovered that brain bleeds have been known to follow vaccination and lost their trust in the doctors and in the vaccine system. This child hasn’t received any more vaccines and the family is now critical of vaccination and has shared their story far and wide.

    True, Chris, I was being sarcastic, just a bit. But the problem I’m describing is a real one. There are many reactions kids have which are more than a bit of fever and less than total collapse. And this whole range of problems are denied.

    Here is another example. Baby gets hives following MMR. Doctor says coincidence. Parent gets hold of product insert and urticaria is right there in black and white. Instant loss of trust in doctor.

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  23. Nathan
    September 6, 2011 at 11:04 am

    MV,

    My questions were based on my online experience of hundreds of parents whose children had reactions to vaccines who were told “this is normal”. None of those parents would have been permitted, much less encouraged by their doctors to skip the vaccines their children reacted to.

    I’m somewhat doubtful of your use of the word “reactions” here, as it is more likely that you have heard from people whose children have had an event following a vaccine, and they believe it is a reaction, when the reality is that it may not be. And I’m not sure what you are getting at – a fever after a vaccine is a normal reaction, in fact it is a good thing. Anaphylaxis after a reaction is obviously not normal and would be a contraindicatio to vaccination. I’m not sure why a parent would refuse to vaccinate if their child has a normal reaction to the vaccine.

    In additon, I would caution you that an “online experience” is not necessarily a good experience to draw on (even with “hundreds of parents”), especially if this “online experience” is an echo chamber like an antivaccine blog.

    The original article strikes me as basically saying that anything short of an incredibly extreme and obvious reaction will be denied. Your response confirmed that.

    Well, what you have confirmed to me is that you are only interested in confirming your own existing preconceptions, since nothing in the original article, the blogpost, or my response said anything of the sort.

    “Extreme and obvious” is hyperbolic language on your part. Obviously, to be a contraindication to vaccination, an event has to 1.) be actually caused by a vaccine, and 2.) be something bad enough if it occurs again to warrant leaving the child vulnerable to potentially dangerous disease, correct?

    Further, it is still the doctor’s discretion. If a doctor believes that something was caused by a vaccine, even if it is not on “the list,” as you so glibly put it, they can write a medical exemption. This is a clinic-by-clinic decision to dismiss patients who refuse vaccinations. It is not handed down by the CDC or the AAP. The AAP actually has a policy statement in which they do not support the dismissing of patients who do not vaccinated. I agree with that.

    To give a particular example, a friend of mine has a grandchild who had a “stroke” shortly after they received the MMR which was given around 18 months at that time. The doctors considered that it might be a vaccine reaction, but couldn’t find “stroke” in the list so concluded that it wasn’t.

    Yet “the list” is not arbitrary, it is the cumulative knowledge of what is and is not caused by vaccines. And I suspect, as is seemingly always the case with stories like these, that there is more to it that we both don’t know. Certainly a specialist in strokes would be able to tell the family whether it was a possible vaccine reaction without relying on “the list” alone. Not all strokes are the same.

    And I am curious as to why you put “strokes” in quotations. Was it a stroke or not? You seem to be skilled in word games. 🙂

    The parents did more research, discovered that brain bleeds have been known to follow vaccination and lost their trust in the doctors and in the vaccine system.

    So have broken legs. But the research does not support the hypothesis that broken legs or strokes are caused by vaccinations. You have to go to quite a dubious source to support this idea. And he will sell you his BrainGuardMD. It’s unfortunate that parents are taken in by such woo and then put their children at risk of disease because of it.

    And as I said, it would still be the doctor’s prerogative to exempt that child from vaccines even if it something was not on the list. They would not necessarily dismiss.

    Here is another example. Baby gets hives following MMR. Doctor says coincidence. Parent gets hold of product insert and urticaria is right there in black and white. Instant loss of trust in doctor.

    Well, that’s just a bad doctor, because hives are quite definitely a known reaction to vaccines. I would lose trust in him to. Your point?

    Of course, hives occur from other things as well, so perhaps the doctor thought they were not from the vaccine because they occurred to long after vaccination, or occurred after the child consumed something else to which the child is known to be allergic. Who knows. We aren’t the kid’s doctors. But pointing out one case in which a doctor didn’t know vaccines (like almost everything) can cause hives is not a particularly strong point for your argument, unless you are arguing that docs should be more aware of the recognized side effects of vaccines. In which case, I can’t disagree.

    There are many reactions kids have which are more than a bit of fever and less than total collapse. And this whole range of problems are denied.

    You are being quite vague now. No one said anything about “total collapse,” and there are plenty of absolute and relative contraindications that fall in between fever and collapse anyway. There are also things that people believe to be vaccine reactions that have been studied and shown not to be vaccine reactions.

    If you are interested in discussing this topic in honesty, I would appreciate it if you drop the sarcasm and wordplay. It makes it very difficult to address your concerns, and does not make you seem like you are truly interested in learning about this topic.

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  24. Chris
    September 6, 2011 at 11:44 am

    . There are many reactions kids have which are more than a bit of fever and less than total collapse. And this whole range of problems are denied.

    And what are those risks compared to the actual disease? Exactly what are the risks of the MMR (the one presently used in the UK and the USA with Jeryl Lynn mumps strain) compared to measles, mumps and rubella? Be specific with that scientific data, no more stories that you heard on the internets.

    And, yes, sometimes things happen by coincidence shortly after getting a vaccine. Perhaps the child was given something to eat that created hives. My son got hives shortly after a vaccine, but the more likely reason was the strawberries he tried.

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  25. Jennifer
    September 7, 2011 at 5:39 pm

    “There is a difference between people having a choice, and making choices for other parents.”

    Dr. Goldstein, do you HONESTLY not hear what you just said? You’re correct, there is a difference. And it’s NOT your right to “make choices for other parents” simply because they don’t agree with you.

    “We shouldn’t have to sell something that’s proven. The evidence in favor of immunizations is so overwhelming.”

    Yes, but do you continue to sell the fact that smoking can kill you, eating fatty foods will cause obesity, heart disease and other illness? Do all of your patients exercise as recommended? Do they get plenty of sleep like you recommend? Are they all at a healthy “recommended” weight? Seriously, do you intend to fire everyone who doesn’t do what you recommend? Because if you do, will you be out of practice within a very short period of time. And if you do not plan to fire everyone who doesn’t follow “Doctors orders”, then this is discrimination at its worst. Shame, shame, shame. Slippery slope you’re on here, Dr. I hope you have a good lawyer…

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  26. Christine Vara
    September 7, 2011 at 9:15 pm

    Jennifer, I just want to try to clarify something, since I was in fact the person who spoke with Dr. Goldstein directly. When he said, “There is a difference between people having a choice, and making choices for other parents,” it was in regard to the fact that a nonvaccinated child could very well be responsible for infecting another child. Take for instance the infant in the waiting room whose parent intends to vaccinate, but their child is just not old enough yet. Or a child who is vaccinated, but has a compromised immune system. Or even the small percentage of patients who are vaccinated but who may not have developed immunity. In this way, the parent who is making a choice not to vaccinate could very well be impacting the choices of other parents who are relying on the benefits of a predominantly vaccinated population. Clearly, he’s not claiming he has a right to make immunization choices for parents, however, he does retain the right to choose not to admit these patients into his practice. I hope that helps explain what many people feel to be a reasonable position for this particular practice, as well as the others who are beginning to adopt similar policies.

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  27. Mahua Mandal
    September 15, 2011 at 11:46 am

    I have a question about the recommended schedule. Dr Goldstein (and I believe some commentators on this forum) have stated (or otherwise implied) that the CDC and AAP recommended schedule is based on evidence. I am guessing this evidence is not in the form of results from clinical or other epidemiological trials (i.e. different groups of people subjected to different vaccine schedules). Is this correct? If the evidence is not based on clinical trials of different groups of people following different schedules, is it based on what immunologists, virologists, and other scientists know of children’s immune response systems? That is, results from clinical trials on Vaccine A + results from clinical trials on Vaccine B + results from clinical trials on Vaccine C, etc. (in addition to, of course, other knowledge gathered over the years about viruses and immune system responses.)

    Additionally, is there a reason to believe that staggering the vaccines (i.e. not receiving 3 or 4 at the same visit) could actually be more effective b/c the child’s body would be able to focus on developing one set of antibodies at a time, and therefore develop more antibodies to that virus? I am thinking in terms of when I come down with the flu, my body is using it’s resources to fight the influenza virus. As a result, I’m extremely tired, and symptoms from my Lyme Disease flair up since my immune response has “shifted gears” a bit (so to speak). Please note, these are genuine questions. I am, actually, a public health researcher – but obviously I don’t have a background in immunology or virology. And please – I am looking for answers that are based on science, not ideology. Thank you!

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  28. Chris
    September 15, 2011 at 12:40 pm

    You could try reading through some of the ACIP minutes where they discuss the data, query the researchers and actually vote on the vaccine schedule:
    http://www.cdc.gov/vaccines/recs/acip/default.htm

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  29. Christine Vara
    September 16, 2011 at 8:54 am

    Mahua, We forwarded your comment to Dr. Goldstein and have included his response below.

    Dear Mahua, Thank you for your response. You raise some interesting questions, and I would like to provide some information to help answer them. I would like to address your concerns in two parts. First, I would like to explain how the vaccine schedule is made. Second, I would like to discuss the common misconception that “spreading shots out” may be better for the immune system. Hopefully in addressing these two issues I will better clarify for you why vaccines are given the way they are.

    The vaccine schedule is developed mainly by a group called the Advisory Committee on Immunization Practices (ACIP), a division of the Department of Health and Human Services. The ACIP’s purpose is to advise government agencies (like the CDC) and private agencies (like the AAP) on which vaccines should be administered and how to most safely administer them. One of the ways in which the ACIP provides advice about safe administration is by recommending intervals between vaccines and by recommending which vaccines may be given at the same time.

    The ACIP is made up of 15 voting members, each of which is either an expert in public health, vaccine research, immunology, or in assessment of vaccine safety and efficacy. At least one of the members must be an expert in consumer perspectives on immunizations. If a member has been involved in the development of a particular vaccine, he or she may not be involved in voting on that vaccine’s scheduling. The ACIP itself appoints various working groups to help it come up with the agenda for its meetings. The ACIP meets three times each year, and the meetings are open to the public and broadcast on the internet.

    My reason for explaining this is to dispel the myth that the vaccine schedule is set behind closed doors by pharmaceutical companies and government officials with hidden agendas. The ACIP members are some of the brightest, scientifically oriented people in the medical community, and they make and revise their recommendations based on the most current, most valid research.

    Part of this research looks at how far apart certain doses of vaccines should be given in order to induce an optimal response from the immune system. For example, the initial series of DTaP vaccines is usually given at 2, 4, 6, and 12-15 months of age. This has been shown to induce a response from an infant’s immune system that will likely protect him or her from diphtheria, tetanus, and pertussis. The immune response may be perfectly fine if the vaccines are given at 3, 5, and 7 months, or 3, 7, and 9 months, or any of a wide variety of combinations. But you have to remember that the ACIP is trying to recommend the safest, most effective way to vaccinate the largest number of children. As a primary care Pediatrician, it would be very difficult for me to vaccinate my patients if the ACIP just said “vaccinate with 4 doses of DTaP at an interval you choose.”. Babies come for check-ups at 2,4,6, 12 and 15 months – check-ups are an ideal time to give immunizations since the babies are already in the office.

    Other research looks at the safety of giving several vaccines together at one time. Studies may ask the question “Does giving a polio vaccine and a Hib vaccine at the same time reduce the response of either?”, or “If we give the pneumococcal vaccine at the same time as the DTaP vaccine, will we see a significant increase in side effects?”. In answering these questions, the ACIP again looks at what the safest, most effective way of protecting the largest number of children will be. For example, it is now common for infants at the 2,4, and 6 month visits to receive vaccines against DTaP, Hib, Polio, Pneumococcal, Rotavirus, and possible Hepatitis B. Studies reviewed by the ACIP show that it is safe and effective to give these at the same time. This does not mean that it is any safer to give DTaP and Hib at 2 months, Rotavirus and Pneumococcal vaccines at 3 months, and Hepatitis B at 3 ½ months. But we need to remember that most vaccines are given in repeated doses, and the interval between any two doses of the same vaccine has to me a minimum amount of time in order for them to be effective. So when vaccines are given on a schedule that is not the recommended one, it is very easy to create a great deal of confusion for parents and health care providers in terms of what needs to be given when. It may not necessarily be unsafe to go off the schedule (although any time you delay a vaccine you are not protected against a disease), but it is certainly not an effective way to vaccinate a large number of children.

    There are literally an infinite number of permutations of the vaccine schedule. To study each one is unfeasible, and is also unnecessary given that we have a schedule that we know to be safe and effective. There are not enough children, scientists, or doctors in the world to look at each possible variation of the schedule. It is possible that given new information about immune responses and new technology in vaccine development that the intervals or number of doses may change, but the current schedule is the best one that we have right now.

    Your question about the idea of giving less vaccines at one time leading to the immune system being better able to “focus on developing one set of antibodies at a time” is a very common one, and has been given credence by a popular (but medically unsound) book for parents about vaccines. In order to answer this question, we need to look at what “less vaccines” really means.

    When we talk about how much babies immune systems get exposed to from vaccines, we should not look at the number of shots, but rather the number of things that are in the shots that the body has to make an immune response to. Vaccines contain antigens, which are usually parts of viruses or bacteria that provoke a response from the immune system. The amount of virus or bacteria in the vaccines is not enough to cause the disease, but it is enough to make the body think that it had the disease so that if it ever gets exposed to the “real thing” the body is better able to defend itself.

    Currently, if a 2 month old at a routine visit gets vaccinated against diphtheria, pertussis, tetanus, H. influenza, S. pneumonia, rotavirus, and polio the baby will have to make an immune response to about 150 or so proteins. If that seems like a lot for the immune system to do, it is not. In the 1970’s-80’s, there were fewer vaccines, but they contained many more proteins, so a 2 month old may have had to react against 3,000 or so different proteins. If a 2 month old puts a pacifier in their mouth, they may get several thousand proteins that their immune system has to make a response against from a single bacteria! Theoretically, a newborn baby can respond to hundreds of millions of antigens – so 150 is literally a drop in a bucket.

    Babies immune systems are bombarded by antigens every day. There is no reason to think that spreading out vaccines would do anything but keep them from being protected from some of the antigens that are most likely to cause severe illness.

    I know that this response is lengthy, but I hope that it helped to answer your questions.

    Sincerely,
    Scott Goldstein M.D., F.A.A.P

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