Parents and pediatricians: Do you think a pre-natal discussion about vaccines would help assuage fears?

I have a piece in tomorrow’s Washington Post Outlook section titled “An early cure for parents’ vaccine panic.” It outlines some ideas I’ve been thinking about for a long time. First, if we’re at the point where Andrew Wakefield is speaking at “Master Plan” rallies with 9/11 Truthers and mind-control conspiracists (as he will be doing today in Dublin, Ireland), and parents are still hailing him as a hero, there’s obviously been a systemic communication failure by doctors and public health officials:

Since the autism-MMR canard was introduced by a British doctor named Andrew Wakefield in 1998, there have been dozens of studies by scientists around the world showing that it does not have any validity. But once fear is injected into a population, it can be difficult to eradicate, and some parents are still choosing to delay some vaccines and skip others altogether. For example, between 2005 and 2010, the rates of unvaccinated children doubled in New York and Connecticut and a recent investigation found 200 schools in southern California at risk for outbreaks because of the number of parents who were choosing not to immunize. That the concern about a possible autism-vaccine connection remains so pervasive makes clear that the efforts to combat this misinformation have been inadequate. We need to fix the way we teach parents about vaccinations — and one way to do that is to start before they actually become parents.

I started thinking about this idea almost as soon as I began work on The Panic Virus three years ago — and I’m still perplexed as to why it seems so far-fetched. Could you imagine going in for surgery, getting undressed, and only starting the conversation about the surgery’s benefits and potential risks once the anesthesiologist has an IV in your arm? And yet that’s essentially what we ask parents to do with vaccines. To me, this would make much more sense:

At a prenatal appointment, with no baby to distract or soothe, parents could ask how vaccines work. They could digest the fact that, contrary to some rumors, vaccines are not injected directly into the bloodstream, they do not contain antifreeze, and there is no evidence that children receive “too many too soon.” They could discuss early warning signs for developmental disabilities and review the studies showing that there is no connection between vaccines and autism. They could hear about the dozens of infants who have recently been hospitalized with measles or have died of whooping cough. And they could learn about “herd immunity” — what occurs when enough people in a population are immune to a disease to prohibit it from being spread in the first place.

The piece has only been posted for around 12 hours, and already I’m hearing from doctors who think I’m being preposterous. Some of the reasons I’ve received so far: There’s no insurance code to bill for a prenatal vaccine education appointment; parents don’t come in for prenatal appointments in the first place; ob-gyns don’t know (and shouldn’t need to learn) about all of parents’ concerns about vaccines;  if parents just trusted doctors in the first place none of this would even be an issue.

I’m not trying to say that these are the views of most doctors; believe me, I know the people you’re likely to hear about on any topic are the ones who are most incensed. Still, I admit I’m surprised by the amount of pushback — or possibly defensiveness — regarding what seems to me to be a fairly non-controversial proposal.

So I’m curious: For the parents (or expectant parents) out there: Is this the type of thing that you think would have made you feel more comfortable? And for family doctors, pediatricians, ob-gyns, or anyone else on the health-care side of things: Do you think something like this could be effective — and what do you think the hurdles would be towards implementing it?

I’d like to try to spark a genuine discussion instead of a lot of grandstanding in the comments, so I’m not interested in comments explaining: The reasons everything I said in The Washington Post is a lie; the proof that The Washington Post is part of an international medical-pharma conspiracy; why Andrew Wakefield is a saint; why Andrew Wakefield is a martyr; why Andrew Wakefield is a criminal; why Andrew Wakefield is a moron; why people who vaccinate are stupid; why people who don’t vaccinate are stupid; etc. Anyone interested in reading (or commenting) about any of those things have had plenty of chances to do so in previous posts. For the sake of this discussion, I want to limit input to the questions I posed in the previous paragraph.

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71 Responses to Parents and pediatricians: Do you think a pre-natal discussion about vaccines would help assuage fears?

  1. Pingback: Discussion topic: Would prenatal vaccine conversations help assuage parent fears? | Seth Mnookin

  2. Nathan says:

    Great article, Seth.

    I’m surprised you had so many resposes leaning towards the “preposterous” view. As a general pediatrician, I don’t find it at all difficult to incorporate preliminary vaccine education into prenatal visits. I make a point to tell them that I support immunizations. I have a handout that summarizes the safety and importance of vaccines, which I briefly review with them, and I invite them to e-mail me with any questions or links they come across.

    Some of the concerns are true – relatively few parents come in for a prenatal before delivery in my population, and that is a concern on its own. There’s no billing for prenatal visits at all, at least in my state, but every pediatrician that I know does them. They are important for establishing a good patient relationship.

    I wonder if some providers are tentative about broaching the subject because they are worried they will spark the parent into reading all the misinformation on the internet. I don’t find that to be the case. The literature is pretty clear that parents listen to their doctors the most about this kind of thing. If the doctor is knowledgeable on vaccines, and confident in them, then I think the parent is reassured, and more likely to regard the nonsense out there as the nonsense that it is. At least, that’s the experience I have had.

  3. Mara says:

    I think it’s a great idea! For the record, I went for a preconception appointment with my OB/GYN and I interviewed pediatricians before choosing one. I think those are both great opportunities for doctors to discuss vaccines.

    I don’t recall my OB/GYN doing so, but I believe the pediatrician specifically mentioned their vaccine policy (“do it or find another doctor”, which is why I liked them). Now, since I’m incredibly pro-vaccine, she didn’t need to address any concerns with me, but one hopes she would have.

    I would love for pediatricians and/or OB/GYNs to do this, because I think it would help, as long as it was done properly.

    I don’t blame doctors for being concerned about reimbursement, because it’s a valid concern. However, if they have a code for a preconception appointment (and I would hope they do), then there should be some way to get reimbursed for this.

    • Twyla says:

      Haha “preconception” — a double entendre — meaning you were there to discuss your preconceptions, or there before conception?

      • Mara says:

        ::grin:: I was there to discuss conception :) I swear, that’s what they called it, it’s not my name for it!

        I went in to discuss if I had any risk factors, get tested for immunity to rubella and things like iron levels, and what I might need to do to get healthier and ready for pregnancy.

        I know a lot of women don’t bother with that appointment, but I’m anal retentive like that. My midwife was thrilled to have someone come to her before getting pregnant :)

    • Richard says:

      Good luck on being “incredibly pro-vaccine”. I’m incredibly pro-my daughter’s health, and no way will I allow the drug companies to tell me how to care for her!

      DEATH TOLL LINKED TO GARDASIL VACCINE RISES
      Complications include shock, ‘foaming at mouth,’ convulsions, coma
      “Anaphylactic shock,” “foaming at mouth,” “grand mal convulsion,” “coma” and “now paralyzed” are a few of the startling descriptions included in a new federal report describing the complications from Merck & Co.’s Gardasil medication for sexually transmitted human papillomavirus – which has been proposed as mandatory for all schoolgirls.

      The document was obtained from the U.S. Food and Drug Administration by Judicial Watch, a Washington group that investigates and prosecutes government corruption, and it has details of 10 deaths just since September.

      “Given all the questions about Gardasil, the best public health policy would be to re-evaluate its safety and to prohibit its distribution to minors. In the least, governments should rethink any efforts to mandate or promote this vaccine for children,” said Judicial Watch President Tom Fitton.

      The organization’s work uncovered reports of about one death each month since last fall, bringing the total death toll from the drug to at least 18 and as many as 20. There also were 140 “serious” reports of complications including about three dozen classified as life-threatening, 10 spontaneous abortions and half a dozen cases of Guillain-Barre Syndrome.

      The document reveals the case of an 18-year-old woman who got the Gardasil vaccine, was found unconscious that evening, and died. Another woman, age 19, got the drug and the next morning was found dead in her bed.

      The new documents also reveal a total of 8,864 Vaccine Adverse Event Reporting System records, up from a total of 3,461 that had been reported in a document just last fall.

      WND previously has reported how Merck was lobbying state lawmakers to require the vaccination, but said it would quit the campaign after its activities were unveiled.

      WND also reported when a key researcher into human papillomavirus, which is targeted by Gardasil, reported it needed more testing, and how even the Centers for Disease Control suggested the vaccine should not be mandatory.

      • Chris says:

        Please cite something verifiable for your claims. What is the WND? Is it peer reviewed and available at a medical school library?

        Plus who discusses a vaccine given at the earliest to children when they are eight years old at a preconception discussion? Or have you already forgotten to stay on topic?

      • Mara says:

        Please tell me you didn’t just quote WorldNet Daily as your source. Pretty please with sugar on top? Because if you did, I think I might cry.

        Y’know, I was going to type a whole long post explaining why you’re wrong about Gardasil, with a side dish of wrong, but then I remembered that this is off-topic for this post. So I shall refrain.

        Okay, to bring this back to the topic of the post, the HPV vaccine is actually an interesting question, because it’s obviously unsuitable as a prenatal topic. There was an interesting study (partially funded by AHRQ, but I don’t recall the journal) that found that a good time to discuss Gardasil was during the mother’s gyn appointment.

        I mean, obviously pediatricians should be discussing it with parents too, but they found that they got a good response when OB/GYNs discussed it during the mother’s appointment.

        • Richard says:

          Why do you say this is off topic? You’re the one who brought up the subject of Gardasil.

          Here are some sources, although you will probably doubt them simply because I am the who cites them.

          http://www.cbsnews.com/stories/2009/02/06/eveningnews/main4781658.shtml?tag=contentMain;contentBody#comments

          In the CBS news cite, please read some of the 148 comments it elicited.

          From your remarks, I assume you don’t believe that CBS News or ABC News have any credibility, and you probably also believe that the JAMA (Journal of the American Medical Association) is some kind of fringe group :-)

          http://jama.ama-assn.org/content/302/7/795.full?home

          “It is of course reasonable for professional medical associations to promote medical interventions they believe in. But did these associations provide members with unbiased educational material and balanced recommendations? Did they ensure that marketing strategies did not compromise clinical recommendations? These educational programs strongly promoting HPV vaccination began in 2006, more than a year before the trials with clinically important end points were published. How could anyone be so certain about the effect of the vaccine?”

          http://abcnews.go.com/Health/CancerPreventionAndTreatment/gardasil-hpv-vaccine-faces-safety-questions/story?id=8356717

          http://www.naturalnews.com/026722_Gardasil_HPV_cervical_cancer.html

          You say “..I was going to type a whole long post explaining why you’re wrong about Gardasil..”

          *I* am wrong about Gardasil? This is not about me. I merely cited sources that have nothing to do with me. I want to see you refute *them* if you think you can.

          • Chris says:

            Where did I cite Gardasil other than saying it is not a subject for a preconception conversation?

            If a kid is walking, talking and even reading, wouldn’t you at least talk to the child about it. Why discuss their future before they are even conceived?

            As a parent of two over twenty and one teenager, I know they are quite a bit different than I imagined before I had children. So throw away your fantasies and embrace reality.

            So, in essence, the HPV is off topic.

            Also, the only relevant reference you posed was an editorial. It did not dismiss the vaccine, it just questioned some aspects. It is best to ignore things written by journalists and others without any medical qualifications.

          • Mara says:

            (Seth, I’m sorry I’m unable to resist taking the bait. My apologies and you can smack me with a wet noodle.)

            ::blink:: I just reread my original comment above and it doesn’t mention Gardasil at all. So why you think I brought it up first, I don’t know.

            I’m going to ignore the non-medical things you cite, because they’re not proof of anything. I’ve just read the JAMA editorial you cite. It’s about two articles appearing in that issue. The first points out some very serious ethical problems in our country and they should be addressed. I absolutely agree that drug companies’ marketing techniques to doctors need to be reined in. However, just because there was a big advertising push, that doesn’t mean the product is dangerous. So far, the medical evidence says no.

            The second article doesn’t prove anything about the dangerousness of Gardasil. It mentions the VAERS reports, discusses the fact that VAERS is a very limited data source, and says we need more research about the effects of Gardasil. And I agree. It’s a new vaccine and public health officials and medical researchers should be following it closely to be sure there aren’t any effects we didn’t see at smaller sample sizes.

            Unless new research comes out in the next five years, I will still be giving my son and daughter this vaccine.

        • Chris says:

          Where did I cite Gardasil other than saying it is not a subject for a preconception conversation?

      • Mary says:

        Good news on the cervical cancer vaccine–a study was just published that shows it is working:

        Cervical cancer vaccine a success, says Lancet report

        Wish it had been available for my mom.

        • Twyla says:

          There have been some extremely serious adverse reactions to Gardasil, including blood clots, paralysis and death.
          http://truthaboutgardasil.org/

          The Judicial Watch report is a perfectly valid account of the reports on VAERS. It’s funny how when we say the tracking of adverse reactions is totally inadequate vaccine defenders say, “What about VAERS?” but when we point to examples of adverse reactions reported on VAERS we are told that data is meaningless because nobody verifies whether these are actually vaccine reactions. So which is it, meaningful data gathered and studied to maintain the safety of our vaccine program, or meaningless random anectdotal stories which should be ignored?

          Dr. Diane Harper, principal investigator for the HPV vaccine trials, has spoken out critically of the HPV vaccines:
          “Pap smears have never killed anyone. Pap smears are an effective screening tool to prevent cervical cancer. Pap smears alone prevent more cervical cancers than can the vaccines alone.
          “Gardasil is associated with serious adverse events, including death. If Gardasil is given to 11 year olds, and the vaccine does not last at least fifteen years, then there is no benefit – and only risk – for the young girl. Vaccinating will not reduce the population incidence of cervical cancer if the woman continues to get Pap screening throughout her life.”
          http://www.huffingtonpost.com/marcia-g-yerman/an-interview-with-dr-dian_b_405472.html

          • Andrew says:

            “So which is it, meaningful data gathered and studied to maintain the safety of our vaccine program, or meaningless random anectdotal stories which should be ignored?”

            It’s a way to catch everything that could conceivably be a problem with a vaccine, but because it’s so open, there will be a lot of false positives (reports of problems that turn out to have nothing to do with vaccines). You could design a system that eliminated false positives, by recording only reactions that were verifiable, but that would risk missing a rare but real problem.

  4. Mary says:

    As I commented over at WaPo, I think this is a really nice and constructive idea. That said, let me relate a conversation that I had with a warrior mom at a CDC meeting. We were discussing sources of information (having gone ’round all the same old arguments already), and she had cast aspersions on peer review, media, pharma, government, and everything already in the conversation.

    I asked her where the information would have to come from for her to trust it.

    To her credit, she answered honestly–she said: I don’t know. And I could tell I reached her a little bit there, she realized that she had become a denier rather than a plain old skeptic. It was an interesting moment for me.

    Yet–it was clear that there was really no source she trusted. And she was a smart, educated, informed, well off Cambridge (US) lefty.

    What I mean by this is that even if the CDC puts together a pamphlet, or the Academy of Pediatrics does, or whoever–it’s all going to be viewed with the same haze that the later information does.

    • Venna says:

      I feel I have to agree with Mary. If a person really wants to believe what they believe regarding vaccines, I don’t think a prenatal discussion with their doctor will make any difference. More often then not it’s possible those who are against vaccines will seek out health practitioners who are in line with their philosophy rather then just go to the doctor down the street because he’s there and convenient.

      When I was first pregnant (back in 1989/90) I didn’t have the luxury of discussing anything regarding my child with a family practitioner or pediatrician prior to her birth. I was going to the county health clinic for my prenatal checks and they were all CNAs or RNs that examined me (which could explain why they all believed I had gestational diabetes and pre-eclampsia the entire time, even when the tests they subjected me to kept coming back negative).

      When my daughter was born, the doctor on call at the hospital delivered her and sort of adopted us as his patients as he was a family practitioner specializing in OB and peds care. He didn’t discuss much with me regarding vaccines other then what the schedule would be. As a new mom, young and fairly alone as my family was all still back in my home state, I put my trust in him even if I felt his approach could have been a little less hasty or hurried. He almost seemed like he was rushing us through each appointment. Basically, in his practice, vaccines were automatic and since we didn’t seek to go anywhere else, he proceeded with the vaccines.

      I’m not sorry that he did, but it would have been nice to have some type of discussion about it because I had come from a very anti-vaccine background and while I didn’t embrace that way of life myself, I still had concerns or questions about vaccines. It turns out they were groundless, but a little discussion could have gone a long way with me in feeling more confident in him as our doctor and in his decision to vaccinate my children.

  5. Daniel says:

    I just wanted to say thank you for your work- your book and “Deadly Choices” helped our pediatric office in downtown Chicago decide to change our vaccine policies and start to refuse “alternate schedules.” A few parents were upset about this change in policy (and a couple will choose another practice), however, the vast majority of the families in our practice have expressed gratitude and my colleagues feel like we are practicing better pediatric medicine.

  6. Marion Lamb says:

    As a maternal child health nurse and lactation consultant, I wholeheartedly agree that the time to talk about vaccines is prenatally with the pediatric practice you have chosen or are “checking out”. In addition, that is the time to get information about infant feeding…too many women believe that breastfeeding and formula feeding are equivalent. I actually had one mom say it’s ” like choosing between Coke or Pepsi!”. With our emphasis on health prevention, our medical community needs to have these kinds of appointments with expectant parents, but unfortunately, many expectant women don’t have the luxury of meeting with their pediatrician, so the obstetrician needs to take this on. The importance of breastfeeding, vaccinations, safe sleep practices, and more should be covered during prenatal exams. Everyone knows you need to have a car seat for your baby…why not evidenced-base information about lifesaving vaccinations and breast milk? Any ideas on how we could get the insurance industry on board to cover a specific appointment on pediatric health
    promotion?

  7. Gaythia says:

    I appreciate the attitude expressed by Brian Zigmund Fisher here:
    http://umrscblogs.org/2011/01/23/public-health-needs-humility-to-address-vaccination-fears/
    “The public doesn’t need more facts. They need help to make what they know make more sense.

    Public health officials must acknowledge the reality that they can neither compel vaccination nor pretend that there are no arguments against vaccination.

    We must acknowledge that each parent has the right and the authority to make his or her own choices, and that it is our failing (either in the quality of our vaccines or the persuasiveness of our message), not theirs, if we have failed to convince them that vaccination is the better choice.
    We must acknowledge that we have the best chance of convincing a skeptical public when we put the weaknesses of our arguments and the risks of our interventions front and center and acknowledge the fears that they evoke.

    It may seem counterintuitive, but embracing humility may be the best thing we can do. ”

    I think that pediatricians need to realize that for new parents, concerns are new and fresh and questions need answering.

    We have medical care that is forced by private insurance companies into 15 or 20 minute blocks that meet certain codes. Practices have more than likely cut back on support staff such as nurses and physician assistants who could ably handle patient questions. As patients, I think we need to realize that part of the non communication of our physicians arises from the severe stress and constraints that they feel have been placed on their precious time.

    On the other hand, while I would not criticize a doctor who suggests to a patient that rabidly opposes all suggestions that perhaps they’d be happier elsewhere, I am leer of a arrogance that would cause a physician to be upset with patients who didn’t automatically accept the physicians dictates as automatically correct. I am old enough to know that sometimes, the consensus of medical opinion has changed, and a little listening on all sides could be very helpful.

    But most significantly, in the past, we had public health institutions independent of private practices that did much of the community vaccination work. As a society, I think we need to recognize that the network of support provided by public health structures matters to all of us.

  8. RTContracting says:

    I’m not sure that this should fall on the shoulders of doctors. I do agree that it is important that doctors address any vaccine related concerns that parents have, but I really think that this is an issue that needs to be addressed better by public health.

    It seems to me that public health doesn’t do a great job at selling their message. They are competing against a small group of motivated anti-vaccine activists that are VERY good at promoting the anti-vaccine talking points.

    When my wife was pregnant for the first time, we got invited to a “Vaccine Information” Talk given by a local nurse at a friends house. It turned out to be nothing but an anti-vaccine tirade.

    I was aware of some of the anti-vaccine arguments, and left shaking my head with disbelief at some of the arguments and fear mongering that was presented. I couldn’t believe the reactions of some of the other parents I talked to afterwards – some of them took the talk hook, line and sinker.

    I think it would be great if a public health nurse gave similar sessions, only based on science (and reality.) They could talk about vaccines and the benefits of breast-feeding. If parents are given a chance to ask questions and have an open discussion, I think that this would go a long way to make new parents more comfortable with vaccination.

  9. Chris says:

    A pre-pregnancy meeting would also be a good time to get an influenza vaccine, and tested for rubella antibodies.

  10. Seth Mnookin says:

    (I’ll be cross-posting a couple of comments that have appeared on a post on my own site.)

    Small Town Doc says:
    Submitted on 2011/06/12 at 12:53 pm

    Mr. Mnookin, Your plan is fantastic! I am a small town doctor specializing in internal medicine and pediatrics, and I think your idea could have incredible impact if it were to be instituted on a large scale. Thoughts about implementation in a small community: 1. When women think they are pregnant, often their first stop may be the family doctor (or internal med doctor). They obtain a pregnancy test that is a basic test then a blood test to see how far they are into the pregnancy, and are then referred to an OB/GYN or family doc who delivers. During that visit, the woman could receive info about immunizations, breast feeding, etc. 2. Pediatricians could talk to the OB/GYN’s in town about handing out vaccine info packets; packets could have office numbers and names of local pediatricians to contact for further info. Packets could include quotations from local pediatricians/family doctors about why to vaccinate. I think a photo of the local doctors could also be included so that the reader sees the people delivering the information. 3. Perhaps a short video/CD about vaccines could be part of one of the OB/GYN visits: patient could watch the video while waiting for the doctor. Thanks for your ideas. Can’t wait to read your books! – Small Town Doc

  11. Nancy Parmalee says:

    I’ve been thinking a lot about better ways to communicate science in general, and vaccine information in particular. The vaccine issue, as I see it, is a part of a larger problem, and I think we can do better here (I am a scientist). The issue I’ve been turning over in my mind recently is that misinformed ideas take hold and gain ground in response to fear, often legitimate fear in the face of uncertainty, and an absence of information. The information often, perhaps even usually, exists, but if it isn’t delivered when needed, in a palatable form, things go wrong.

    I’ve had several people approach me, either in person, or on twitter, saying that they have concerns about vaccines, but they aren’t sure what to believe. These have been calm discussions with rational people who have reasonable questions. In the best case, there is time to discuss, find sources, find answers to questions, and it’s an ongoing conversation, not a one time thing.

    I’m considering getting friends together in NYC to have these kinds of discussions with people who have the training to find and interpret the literature, find experts, collect questions, and plan to meet again to share answers. I can walk someone through how to interpret a scientific paper. I can contact immunologists and infectious disease specialists for specific questions that are outside of my field of expertise. I would like to see a calm space for discussion and conversation. I think this can be created.

    I agree with the previous commenter who said that some humility would probably be helpful in promoting productive communication. Emotions run high on this topic. I know mine often do. But I think we can get past that.

    I remember getting a vaccine when I was five, and being scared. The idea of being injected with, or swallowing something that was some piece of a really bad disease scared me. Fortunately, my mother (a RN) explained to me calmly that the risk of getting the vaccine was much smaller than the risk of getting the disease. I remember the fear…and I remember having my questions answered to my satisfaction.

    Maybe we need to get my mom involved.

  12. Jonathan says:

    Are you in any way trained in public health and/or have you any scientific training? Just curious.

    • Mara says:

      I dunno. If Seth said yes, would you trust him more or less?

      Just wondering…

      (BTW, if you want people with those qualifications to tell you about the excellent safety record of vaccines, I’d be happy to point you in their direction.)

      • Twyla says:

        Perhaps Jonathan’s point is that we parents who raise questions/concerns about vaccines are constantly told that we don’t understand science and medicine and we should leave this in the hands of the experts, since most of us don’t have advanced degrees in science or medicine and are not working as doctors or scentists (though actually some do/are…) Yet Seth had no scientific degrees, and he’s just a journalist, so by that logic everything he says should be disregarded as well.

        Not sure if that’s what Jonathan meant, just guessing.

        • Twyla says:

          oops typo — meant “Seth haS no scientific degrees…”

          Likewise, we are told only to discussed published science from peer reviewed journals. Guess by that logic nobody should bother to read Seth’s book either.

          • Twyla says:

            P.S. Then again, maybe Jonathan was asking another commenter, not Seth.

          • Andrew says:

            It takes an extraordinary amount of knowledge to do science and disprove something for which a lot of verified evidence for. It doesn’t take an extraordinary amount of scientific knowledge to report the results of peer-reviewed papers in terms that laypeople can understand (just a lot of writing skill). Seth does the latter, not the former.

          • Twyla says:

            Andrew said, “It doesn’t take an extraordinary amount of scientific knowledge to report the results of peer-reviewed papers in terms that laypeople can understand.” Yet when parents without MD/PhD degrees and/or sites such as AoA report on results of peer-reviewed papers which support vaccine causation they/we are criticized by vaccine defenders for not being doctors and scientists. Just one of many double standards.

          • Andrew says:

            “Yet when parents without MD/PhD degrees and/or sites such as AoA report on results of peer-reviewed papers which support vaccine causation they/we are criticized by vaccine defenders for not being doctors and scientists. ”

            Were they criticized for not being doctors, or for making errors in their analysis?

            I don’t read AoA because its owner describes it as a place where people are “protected” from opposing views, so I may have missed examples of what you’re talking about.

        • Mara says:

          Twyla:

          The difference is between people with no MD/PhD who we see reporting accurately with an understanding of the issues and the science involved, vs. people with no MD/PhD who we see reporting inaccurately and filled with scare quotes and unverified claims.

          If Seth was claiming that vaccines made men sexier, I’d laugh at him. If he was claiming that vaccines never ever had any side effects whatsoever, I’d roll my eyes and pointing out the errors in his posts.

          In addition, medical professionals have read his book/articles and not noted major inaccuracies, so I believe I can trust him to report correctly and do his research.

          But when I read, say, Joseph Mercola’s site and he claims that VAERS reports are proof that the HPV vaccine kills babies, then I know he either doesn’t know what he’s talking about or he’s mistaken.

          As noted above, VAERS is incredibly important as a collection of possible adverse effects. Used by public health officials to search for possibly related problems, it’s valuable and allows them to pull a vaccine when it proves to have an adverse effect (see: the first rotavirus vaccine). Used as an uncritical source, it’s completely and utterly useless.

          Many of the VAERS reports turn out to be unrelated to vaccines once they’re investigated. But I hope that people continue to report anything that might even possibly be an adverse effect, even if it seems strange. Because without those reports, we’ll never know if there’s a real problem.

          • Twyla says:

            Of course anyone who either does or does not have an MD or PhD degree may be accurate and logical or inaccurate and illogical. But, the point is, often people who speak up about problems with the vaccine program are told that their opinions and experience have no value because they cannot understand anything if they don’t have the proper credentials, and that only the opinions of doctors and scientists count, and only evidence published in a peer reviewed journal counts. So, everything the parents are saying is simply dismissed without real consideration– it is rejected out of hand.

            Part of what you seem to be saying is that if you agree with someone it’s o.k. for them not to have credentials but if you disagree with them their lack of credentials is significant.

            Perhaps the smallpox vaccine would not have been developed if “anecdotal” information was dismissed so readily as it is today. Common uneducated people reported that people who had come down with cow pox did not get small pox. Some farmers even exposed their own families to cowpox to prevent small pox. Scientist Edward Jenner paid attention to these reports rather than simply saying “Don’t confuse correlation with causation!” and further study confirmed that infection with cowpox could prevent smallpox. That became the basis for the smallpox vaccine.

            The point is, new knowledge does not start out as a published peer reviewed study; it starts as disorganized evidence/ observations which are pulled together and used as basis for forming hypotheses and for further study. Parental reports of vaccine-induced autism are evidence and should be studied.

            Regarding VAERS, are you saying it is safe to assume that when we do a search and find a number of reports of certain conditions (such as death, seizures, autism, IBD) we can assume that these reports have been investigated, and if these incidents did not result in any change or headlines or announcements they must have been found to be either inconsequential or just a coincidence? Because I have heard many parents who reported vaccine injuries to VAERS say that there was never any follow up on their child’s condition, never any study to determine what happened and whether it was the result of the vaccination. I have never heard any parent say that they were contacted by any govt agency for further info on their child’s adverse reaction. I have never read a study on adverse reactions reported to VAERS. Perhaps you can point me to something showing that VAERS reports are used in some way? Yes, Rotashield is one example, but there are a whole lot of reports that go to VAERS simply to sit and stagnate.

          • Mara says:

            The point is not whether or not I agree with someone, but whether or not I agree with their methods. I could read an article that said the sky is blue, god doesn’t exist, and vaccines are fabulous (all things I agree with :D ) but if their method involved divination with a ouija board, I’d laugh my ass off and then ignore them.

            Conversely, I just read Dr. Peter Palmieri’s book Suffer the Children, in which he punctured some medical beliefs I’d held for years and pointed out some things I’d completely misunderstood. But he used the scientific method and our current understanding of medicine and physiology. So I had to change my mind about things like alternating doses of acetaminophen and ibuprofen and some uses of antibiotics. Boy, I felt dumb, but the evidence was solid that I was wrong wrong wrong.

            And anecdotes are taken seriously! When researchers began hearing anecdotes about kids getting autism from vaccines, they were very worried that they could have missed something. Around the world, researchers pumped a hell of a lot of money into studying this question, because if it was true, it was a major problem that needed to be addressed.

            But the studies showed overwhelmingly that there was no evidence that thimerasol or adjuvants or viral proteins were causing autism or the dozens of other things turning up anecdotally. There’s that minuscule number of mitochondrial disorders that are exacerbated by vaccines and some other known side effects, but autism? Nope.

            Anecdotes are a starting point but once the hypothesis has been disproven, the anecdotes get in the way of reality.

            I have to admit that I don’t know much about what happens with VAERS reports once they’re made, so I can’t comment on that. Perhaps someone else can do so, because I’m curious!

  13. Katherine says:

    I’m a pediatrician, and I think you have a great idea. I work in a big practice, which I love, except that it takes without question patients whose parents are vaccine refusers. I worry as a result we may be sending mixed messages; we believe strongly in vaccines, but if you want to follow an alternative schedule, we’re happy to work with you to achieve that. May be good customer care, but I worry it may leave patients feeling less secure overall in our own faith in the standard schedule.

    I am limited to 15 min per patient. We often see newborns on the 4th or 5th day of life, and then again on the 14th day of life. I try as often as possible to bring up vaccines during these visits. However, I have often spent 45 minutes talking with parents, going over all their questions and giving my rebuttal to concerns. If I did this for every patient, I would get shockingly behind, and every patient following the newborn would suffer as I try mightily to catch up and keep up with the schedule.

    The other major problem, as it seems you have already heard repeatedly, is reimbursement. It’s easy to say that shouldn’t be an issue, that we should just make this happen. But medicine is also business. Most of us don’t like to think about it that way – and certainly don’t like to practice medicine that way – but that is how our system is structured. Unless and until we set up a system that will reimburse conversations as well as procedures, it will always be that much more difficult to manage any complex situation requiring discussion, explanations, time to address questions, and time to set up follow-up – be it vaccines, diabetes, asthma, or hypertension.

    Thanks very much for the great article and for prompting more discussion!

  14. Twyla says:

    I completely agree with you when you say: “Could you imagine going in for surgery, getting undressed, and only starting the conversation about the surgery’s benefits and potential risks once the anesthesiologist has an IV in your arm? And yet that’s essentially what we ask parents to do with vaccines.” I think it’s essential that parents have good information on the risks and benefits of vaccines and communicable diseases in order to make good informed choices about vaccines.

    But it seems to me that what is being recommended here is as if before your surgery you were simply told, “The risks of this surgery are so small you don’t even need to think about them. Just follow the schedule we have set out for you.” That is not informed choice.

    The fact is, we really don’t understand very well the risks of vaccines. Adverse reactions are not adequately tracked. There have been no large scale studies comparing long-term health and developmental conditions in vaccinated vs. unvaccinated populations. We do not have good evidence on how many vaccines can be given safely at once, and how many vaccines can safely be given during the first two years of life. This generation of children has increased rates of a number of immune and cognitive disorders, including autism, ADHD, bipolar, diabetes, asthma, severe allergies, MS, seizures, and IBD — and nobody can explain why. So many parents tell stories of serious vaccine reactions. This can’t simply be dismissed as inconsequential.

    When my son was born in 1991 and our pediatrician said to me, “The CDC now recommends that all newborns receive the Hepatitis B vaccine on the date of birth,” I said, “O.K., sure!” I had total faith in the CDC. I wish someone had explained to me that this vaccine could only possibly be of benefit to my newborn baby if I were a carrier of the Hep B virus, or in the unlikely event of him receiving a blood transfusion or some other kind of exposure via bodily fluids. It would have been good to have this discussion on risks and benefits in advance.

    Discussion of risks and benefits of medical procedures also normally involves discussion of the patient’s family health history. We really don’t have a good understanding of susceptibility factors for vaccine injuries. A family history of auto-immune disorders, allergies, or vaccine reactions may well indicate a need to proceed with great caution.

    Regarding ob/gyns, I can understand why ob/gyns don’t want to discuss vaccines, as it is not their specialty, not their role, and insurance would not reimburse for that time. They have so much to discuss related to pregnancy and birth. Vaccines are a difficult topic, with a lot of controversy and difficult questions, a lot of complexity.

    I do think this should be part of the initial interview with a pediatrician. If the doc’s philosophy is “my way or the highway” (or “the CDC’s way or the highway”) this should certainly be known up front. If the pediatrician has information for the parent this should ideally be given in advance. Not everyone interviews a pediatrician before the baby is born, let alone before conception, but if they do, this would certainly be a good time to discuss vaccines.

  15. Guest says:

    There seems to be a lot of attention focused on the vaccine issue that really seems to be a non-issue. Vaccination rates in the U.S. are at, or near, all time highs. There are some vocal parents who believe their children suffered adverse effects from vaccines and speak out against vaccines, but their message doesn’t appear to be affecting the vaccination-related behavior of parents of young children.

    I just can’t help but think that it’s such a waste of time to give so much attention to the extremely small number of parents (2%) who are vaccine-refusers. We have so many children in this country suffering the effects of living in poverty with insufficient access to healthy, nutritious food and with limited access to healthcare. So many children live in violent homes where their basic emotional needs are not being met. I would much rather our government and media focus on improving the lives of those kids rather than worrying about a handful of kids that are unvaccinated. I suppose it’s a luxury of the affluent and well-educated to have such skewed priorities.

    About 95% of parents said their kids had received all the vaccinations or would get them all, which was a record high, a 2010 survey found. But about 5% of parents said they would decline some vaccines, and 2% said their little ones would receive no vaccines, the researchers said.

    “We are reassured that, overall, parents are vaccinating their kids according to the recommended schedule,” said lead researcher Allison Kennedy, an epidemiologist in CDC’s Immunization Services Division.

    http://yourlife.usatoday.com/health/medical/story/2011/06/CDC-Most-US-kids-get-recommended-vaccines/48286276/1?csp=34news#uslPageReturn

    • Mara says:

      Nobody here thinks that children should be left starving or abused or anything like that. But if nobody argues *for* vaccines, the vaccine refusers are going to keep making loud noises. It won’t take much of a reduction for herd immunity to break down.

      Besides, that 5% figure is an average. There are communities where a much much larger percentage of the kids are not vaccinated. Herd immunity is *gone* in some places, and all it takes is one person from that area traveling overseas and bringing back measles for there to be a large outbreak. We’re already getting smaller outbreaks in various communities.

      This may not be the only issue affecting children. It may not even be the most severe (although I think it’s pretty scary), but it’s not a non-issue.

  16. Michele B says:

    I like your idea because it would get to the women before they are exposed to the play group gossip mills.

    There is a really great essay here that talks about how mothers influence one another into not getting vaccinations, by competitive mothering:

    http://shethought.com/2011/05/25/social-status-and-immunization/

    A lot of the issues brought up in the middle of the essay really seemed to mirror a lot of what I see in my leafy suburb.

    Before I had children I didn’t really talk about parenting issues with my friends who were mothers because it wasn’t relevant to my life. I wouldn’t have known anything about the vaccination wars, and I like the idea of women hearing about it first from someone with an informed opinion, rather than from someone with a strong, well-meaning, and sincere but ultimately incorrect opinion.

    I don’t know if the doctor’s office is the right place, logistically. I seem to remember that we did talk about things like vaccine schedules and among other parenting issues in the birth preparation class. These were actually more or less mandatory at the hospital where I gave birth, so maybe that would be a better forum.

    Also, I seem to remember meeting with the pediatrician before I had my son. This would be a good place for the discussion, too.

    Re: reimbursement, as a former HMO beancounter, it would depend on your contract but lots of pediatricians have risk contracts where they get paid a fixed pool of money. All the patient expenses come out of there, and then the pediatrician gets what is left over in the end (this is similar to the UK model). If you have a risk contract you’d be dumb to worry about reimbursement for a visit if it prevents a hospital stay (e.g. from brain-damaging meningitis).
    Also, those unvaccinated kids could bring measles into your waiting room. If a couple babies get measles … there goes your vacation in Antigua.

    You’d have to work out the probabilities on the cost analysis, but I’d be surprised if it weren’t favorable.

  17. Richard says:

    Probably the most widely cited study on the thimerosal/autism question is the one published by The New England Journal of Medicine on September 27, 2007.with the title “Weight of Evidence Against Thimerosal Causing Neuropsychological Deficits”.
    No doubt hundreds of thousands of people fell for this flawed study (well, the NEJM did too) and believe that this PROVES that mercury is harmless.
    Dr. Wakefiield is accused of conducting a sloppy and (purposely manipulated) study, and this appears to be true, but the study reported by the NEJM is also highly flawed: they shamelessly manipulated the study to get the results they wanted:
    Any child with a preexisting neurological condition was ELIMINATED from the test. However, is it not possible – in fact, probable – that these children are the most at risk from exposure to thimerosal? Any child who developed certain neurological conditions was excluded. These conditions included encephalitis and meningitis. The possibility that thimerosal might cause these conditions was eliminated from consideration.
    Other children were eliminated for various other reasons. One group excluded was children whose birth weight was under 2,500 grams, about 5.5 pounds. How many babies were eliminated for being underweight is not stated. Babies of this weight are hardly rare and they are not excluded from vaccinations. What legitimate reason could be given for this exclusion?
    In the end, only 30% of the originally-selected children were included in the study. The study itself acknowledges that selection bias might have been a factor in the findings. It acknowledged that interventional treatments for neurological deficits were not considered and that parents had not been trained to assess tics, so reports of such abnormalities may not have been made. Finally, the study noted that autism itself – the condition most often connected with thimerosal – WAS NOT CONSIDERED. (my emphasis).
    And look at the egregious conflicts of interest of the researchers:
    Dr. Thompson – the lead investigator – is a former employee of Merck.

    * Dr. Marcy has received consulting fees from Merck, Sanofi Pasteur, GlaxoSmithKline, and MedImmune.

    * Dr. Jackson received grant money from Wyeth, Sanofi Pasteur, GlaxoSmithKline, and Novartis. He received lecture fees from Sanofi Pasteur and consulting fees from Wyeth and Abbott. Currently, he is a consultant to the FDA Vaccines and Related Biological Products Advisory Committee.

    * Dr. Lieu is a consultant to the CDC Advisory Committee on Immunization Practices.

    * Dr. Black receives consulting fees from MedImmune, GlaxoSmithKline, Novartis, and Merck, and grant support from MedImmune, GlaxoSmithKline, Aventis, Merck, and Novartis.

    * Dr. Davis receives consulting fees from Merck and grant support from Merck and GlaxoSmithKline.

    The article then states, “No other potential conflict of interest relevant to this article was reported.” One must wonder if it might have been easier to identify researchers who DON’T have a conflict of interest.

    Then, we have the fact that the primary concern about thimerosal, that it might cause autism, is not even addressed by the study in question. In fact, it is SPECIFICALLY NOT INCLUDED!
    When politicians are accused of conflicts of interest, their typical response is indignation: “How DARE you impugn my integrity! Yes, I accepted money from X Corporation (commonly tens or hundreds of thousands of dollars) but this in NO way affected the way I voted on laws affecting that corporation!” Yeah, sure. I would guess that the researchers cited above would respond in like manner.
    http://www.naturalnews.com/022237_thimerosal_Merck_mercury.html
    To limit the question of harm from vaccination to solely mercury and autism is wrong. Why exclude other components such as squalene, aluminum, etc., and other effects such as ADDH?
    Some other useful sources:

    http://www.rense.com/general78/unvac.htm

    “On the Take: How Medicine’s Complicity With Big Business Can Endanger Your Health” by Jerome P. Kassirer, Editor in Chief of the New England Journal of Medicine for more than eight years.

    The review of “Drug Companies & Doctors: A Story of Corruption” by Marcia Angell in the January 15 issue of the New York Review of Books.

    • Richard says:

      Unfortunately I didn’t read the part about limiting posts to only the the question posed by Dr. Mnnookin. My apologies

  18. Sarah says:

    “Is this the type of thing that you think would have made you feel more comfortable? ”

    Yes, with a big ‘if’. IF the doctor could answer my questions,which are basic questions and not full of trickery. So far, every doctor I’ve encountered has basically had to fall back on the “you should just trust me because I am trusting the AAP on this.” They are unable to answer such questions as “which vaccines are live?” They are shocked, for example, when I point out that the efficacy of DTaP actually includes laboratory confirmed cases of pertussis and freely admit to never having actually read the inserts that come with the vaccines. There’s a lot of squirming and eye rolling (from them, not me, I promise). So a doctor who actually understands how vaccines work and what their limitations are, well they may be able to make me and others more comfortable. But one who never cared enough to read much about vaccines in the first place- they should continue to steer clear of the topic as much as possible. Which in my experience they already do.

    For parents who are totally ready to jump into vaccines for their baby but just have some cursory questions to check off: “I’ve heard vaccines can be dangerous, is that true?” “Only very rarely in children who already have something wrong with them.” “Oh good, I’d much rather trust you than an actress, but I had to ask.” Those parents are going to vaccinate anyway, whether they get this little interview out of the way before the baby’s birth or after.

    So in short, a pre-baby conversation may help skeptical parents but should be done by a medical professional who knows what they are talking about and won’t get defensive or dismissive. Their research should be extensive and they should be articulate. They should also be prepared to discuss a real risk/benefit scenario. Insisting that the risks are so small as to be non-existant is not helpful to these parents.

    That may be a tall order.

  19. Garbo says:

    I agree that it’s a good idea to have these conversations and make these decisions before the baby is born. Only, however, if the provider is actually informed enough to answer the questions and is unafraid of providing full disclosure. Prospective parents should be provided with all the vaccine package inserts, the recommended schedule, and adverse event reporting how-to information up front. The doctor should be able to answer questions about contraindications for each vaccine; what type of adverse events to look for and record; whether family history of food allergies, vaccine adverse reactions, autoimmune disorders and mitochondrial dysfunction might warrant a different schedule for the individual child; and what kind of testing might be done before vaccination to ensure the infant is free of those conditions.

    This is the information age. People who were once just movie fans now know the weekend box-office numbers. People who might never have followed politics now know what a calculated cloture vote means. And people who bring their babies to doctors expect them to be up on the latest science and putting the patient first instead of adhering to a one-size-fits-all vaccine policy promulgated by organizations hampered by conflict of interest out the ying yang. Any pediatrician who thinks that a little reassuring AAP-sponsored chat devoid of meaningful substance will reassure well-informed expectant parents, who know what a p value is and have the wherewithal to search VAERS, PubMed, MMWR and FDAble, is deluding themselves.

  20. Lori says:

    I would like to add one point to this idea (which I think is great!).

    One of the growing concerns that I have is that the number of vaccines has increased substantially over the years (I’m in Canada), and that the diseases that they are meant to present are, in my opinion, less life threatening, and less prevalent than the diseases targeted by vaccines in the past. I had no issues giving my daughter a vaccine for Polio & Tuberculosis (having seen and read about the high incidence and ravages of these diseases). But now there are mandatory vaccines for chicken pox (which can have fatal complications, but which is generally a minor illness) and HPV (which has a low incidence in the population, and can be prevented through safe sexual practices). Even my family doctor agreed when we asked questions about each vaccine before it was given, and helped us walk through the pros/cons of each. We ended up giving about 80% of the vaccines suggested by our health authority, and are quite comfortable with this decision. We’re not anti-vaccine, but we do want to understand every medicine we give our child, and we were grateful that our doctor was well informed.

    • Mara says:

      A 2007 study (I read about it here: http://www.cancer.gov/cancertopics/causes/hpv/hpv-prevalence0308) found more than a quarter of women tested positive for HPV. Considering that the virus often clears out after a few years, I would assume that many of those women had already had it. I think that’s a pretty high incidence of disease :) And about 15% was the high-risk kind.

      Cervical cancer is not a minor disease by any stretch of the imagination. I was ready to throw a party when I learned that Gardasil had been approved. In a few years, my daughter will get the vaccine and I can be assured that her chances of cervical cancer will be dramatically lowered. How exciting!

      • Lori says:

        @ Mara

        Thanks for in the information about incidence. I was basing my comment on this quote (from our provincial health office.

        “In Ontario, some 550 women are diagnosed with cervical cancer and 150 die every year”.

        Not to diminish any of these illnesses or deaths, but to vaccinate 100 000 girls per year to prevent that small number of illnesses seems to be a rather large hammer for a rather small nail, at a cost of $39 million. Why not provide safe sex education, and provide medical prevention to boys and girls with a family history that indicates a higher cancer risk? I’m simply challenging the medical community to think of ways to prevent and mitigate illness other than a continual supply of drugs to “the herd”.

        BTW, the minor illness I referred to was the chicken pox.

        • Mara says:

          I also want the medical community to provide safe sex information to kids and prevention for people with a cancer risk! Nobody thinks that vaccines are the only solution, but they’re a damn good addition to our arsenal.

          Oh, and remember that that’s just the cervical cancer rates in your area, but HPV also causes genital warts, warts in the throat, and sometimes other kinds of cancers.

          Forcibly bringing myself sort of back on topic, I hope that pediatricians are giving kids information that will help them be safe from all kinds of diseases as well as giving them vaccines.

      • Chris says:

        Where in Canada is there a high incidence of tuberculosis? The BCG vaccine has never been a routine pediatric vaccine in the USA, and is now not even commonly used in Europe. Presently parts of Canada are having issues with mumps, mostly in those without an MMR or just one dose.

        If you are in British Columbia, you should really not reject the HepB vaccine due to the high immigration from places where it is endemic. It is a myth that it is only sexually transmitted, it can be passed between children.

        The HPV is given when children are at least walking, talking and in elementary school. Hardly a topic of discussion before the child is even conceived. Though, one wonders how to guarantee that the child’s future spouse engaged in “safe sexual practices” prior to the wedding.

        About chicken pox: you might feel differently about it if after finally starting to sleep through the night, your baby got it! My daughter was six months old when the middle child gave it to her, which he got from his preschool (in 1994, a year before the vaccine). I ended up spending two weeks having to sleep with her and comfort her has she work up in pain, and shook her head back and forth as a reaction. I recently looked at a photo of her then, and was shocked at how close the pox was to her eye.

        Of course the other “fun” bit was her six year old brother, who also got it from the middle child, was so sick he started to wet the bed. Changing his bed once or twice in a night in addition to a crying baby just made those two weeks seem like two months.

        But, hey! If you want to spend a month* dealing with itchy miserable kids with a possibility of secondary bacterial infections. Go for it.

        I recommend that you cut their fingernails very short, and use oatmeal that you pulverized in a blender so you don’t go broke buying Aveeno. Also have plenty of Calamine lotion on hand. And do make sure that you protect the mattresses with a leak proof mattress pad. You’ll also want to sign up for home grocery delivery, because you are not leaving the house.

        * Full chicken pox without a prior vaccine lasts about two weeks (vaccinated kids get a milder form). It also starts about two weeks after infection. So if you have two kids, and one kid gets it at his/her school, your other child will get it two weeks later.

      • Garbo says:

        I’m sure it’s pretty to think that Gardasil/Cervarix will actually lower chances of cervical cancer, but please be sure to investigate the effectiveness and side effects before you vaccinate. Evidence from the original clinical trials found that vaccinating those already exposed to HPV actually INCREASED risk, and post-approval surveillance seems to show some cases of abnormal paps and cervical cancer in vaccinated people. If real-world use shows the vaccines are both less effective and more dangerous than indicated in the clinical trials, one must then reconsider the risk analysis.

        Updated VAERS Reports – HPV Vaccines Description Total Female Male Unknown
        Disabled 722 716 2 4
        Deaths 96 80 2 14
        Abnormal Pap 383 383 N/A N/A
        Cervical Cancer 41 41 N/A N/A
        Life Threatening 430 420 8 2
        Emergency Room Visit 8,790 8,609 103 78
        Hospitalized 2,199 2,163 24 12
        Extended Hospital Stay 196 193 3 0
        Did Not Recover 4,497 4,424 36 37
        Adverse Events 21,984 21,176 355 453

        • Mara says:

          I’ve written about why the VAERS is not a reliable source of information for the general public: http://mamamara.wordpress.com/2011/06/01/be-a-careful-consumer-and-dont-be-fooled-by-lies/

          VAERS is very important, but you can’t take raw statistics from there and make broad safety claims.

          • Garbo says:

            Yes, but given record fast 6 month approval process, the woefully inadequate systems of post-marketing surveillance and the refusal to open the VSD to researchers, it’s the best we can do. Under charge from HHS, IOM is reviewing adverse events for HPV vax for inclusion in the VICP injury table, including Juvenile ALS, Gullaine Barre, SLE, seizure and cardiac events. Doubtful they would be considering if there weren’t legitimate events to create AE signals in the system.

          • Chris says:

            Still, what does a vaccine given when the child is walking, talking and even should know how to read appropriate for a preconception discussion?

            “refusal to open the VSD to researchers,”

            What researchers have been denied access to the VSD? The only ones I know of is a doctor whose medical license has been suspended and whose son has been charged with practicing medicine without a license. Surely, it is prudent to make sure only researchers who use the data appropriately have access.

  21. jenne says:

    I have to say that an appointment with any doctor in my anti-vaccine heyday probably wouldn’t have changed my mind. In my hubris, I didn’t believe my pediatrician knew better than me, having been influenced by counter-cultural sources like Mothering magazine, etc. When you buy into what amounts to a faith-based belief in the collusion of “evil” big pharma, the CDC, the AAP, and your local doc in a conspiracy, there’s not a lot of rational arguments or information supplied by those “enemies” that will convince a person.

    Quite honestly, it was mothers slightly ahead of me in their mothering journey (those wise first-time mothers with well-behaved, healthy 1 year olds) who influenced me the most. Friends who had been influenced by who-knows-who.

    My pediatrician would always calmly assure me of the safety and efficacy of vaccines, and the danger of forgoing them. Perhaps that helped put a crack in my beliefs? My own eager quest for knowledge and truth kept me researching the issue, and quite honestly, it was always hard for me to believe that my doctor, and hundreds of scientists were either liars or fools. A lot of research later and with 3 kids, I am very pro-vaccine, but that has a lot less to do with what doctors said to me, and a lot more to do with good science found online (which is sometimes hard to find amidst all the bunk), medical text books on immunology, and Paul Offit’s books.

    I wish that I’d had some wise moms influence me who were pro-vaccine but whom I considered thoughtful and well-read. THAT would have been the strongest positive influence. And that’s who I’m trying to be to younger/newer moms in my circle. I think grass roots is probably going to be more effective.

    But I can’t see such an idea as prenatal vaccine education as hurting things. I trusted my OB, but of course, the subject of vaccines never came up. You know what else wouldn’t hurt? An answer to the emotional stories of vaccine injury (emotional, publicized stories of disease injury), and an appealing celebrity spokesperson or two. Rational arguments will only go so far in what amounts to an emotional topic.

    • Mara says:

      I have this vision now of moms like you and me making the circuit of playgroups and bringing the common sense about vaccines. How do we do that? Because I would love to!

      Some moms aren’t going to be convinced by a doctor, but I think there are a lot of moms-to-be who haven’t been exposed to the wacky yet. And yeah, having the OB add her/his voice would help, since that’s a pre-existing relationship, unlike the one with the new pediatrician.

      • Guest says:

        You might want to keep in mind the results of the CDC’s recent survey that found only 2% of parents of young children choose to skip all vaccines for their kids and only 5% of parents of young children skip one or more vaccines. Ninety-five percent choose to have their children vaccinated with all the recommended vaccines and choose to follow the recommended schedule.

        • Chris says:

          Link please? Sometimes it is different in context.

          Also, it is often noted that those who skip vaccines tend to congregate in groups. Which is why schools that that need to close due to outbreaks are often private.

          • Guest says:

            I was mistaken when I said “young children”. The survey was for kids of all ages.

            http://www.foxnews.com/health/2011/06/09/most-us-kids-get-vaccines-but-parents-still-worry/

            Most children in the United States get recommended vaccines on schedule, but some parents still have misgivings about the shots, questioning whether they are safe or even necessary, U.S. government researchers said on Thursday.

            The survey of 376 U.S. households found most have at least one concern about vaccinating their children, and as many as 5 percent said they plan to skip at least some of their child’s recommended shots.

            snip

            About 2 percent of parents said their children would not get any of the recommended vaccines and 5 percent said their children would only get some of the recommended vaccines.

            In terms of groups, we’ve had a couple of real-life examples this year with the measles outbreaks.

            There was a Waldorf school associated outbreak this year in Charlottesville, VA. One of the school’s students caught measles from an adult who caught measles overseas and then the student spent a day at school while contagious. The school’s staff and students who weren’t known to be immune to measles were subsequently told to isolate themselves and not return to school. Apparently that worked because there was no school-based transmission of measles.

            It looks like there were more than 30 people out of about 200 at the school who hadn’t had two MMR vaccines. I couldn’t find precise numbers.

            http://www2.timesdispatch.com/news/2011/jun/08/TDOBIT02-measles-exposure-to-keep-some-from-return-ar-1092651/

            http://www2.dailyprogress.com/news/2011/may/31/fourth-local-measles-case-reported-ar-1076988/

            Another group with low vax rates for measles are the Somali in Minnesota and one of them contracted measles in Kenya and was sick after returning to the U.S. They ended up with 8 measles cases in their group. Six or seven of those were in kids who had intentionally skipped vaccines and 1 or 2 were in children too young to be vaccinated.

            The unfortunate thing is there looks like there was an overlap between the Somali group and families living in poverty. Some of the Minnesota cases were in poor and/or homeless children who were from families that, while not opposed to vaccines, had missed getting their kids vaccines. I don’t know if the homeless kids had to be hospitalized in order to isolate them.

            http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6013a6.htm

            http://www.sctimes.com/article/20110609/NEWS01/106090056/Measles-outbreak-has-ended-state-health-officials-say

            You can draw your own conclusions, but I’d be surprised if what we’re seeing with these measles outbreaks in these groups with relatively high numbers of unvaxed individuals will change anyone’s risk/benefit assessment of the vaccine.

            Thanks for the pertussis/Waldorf link. Scary. Luckily that was a tiny school.

            Sounds like Germany has a lot of Anthroposophy/Steiner/Waldorf adherents. Here in the U.S. it would seem that the people with this philosophy are a pretty marginal group and make up part of that 2% who refuse all vaccines.

            I have to say I can’t get a good grasp of what the current science is regarding Pertussis.

            In contrast to diphtheria and tetanus, there is considerable misunderstanding about pertussis epidemiology and disease manifestations in adolescents and adults as well as which pertussis antibodies and their serum levels relate to protection.

            http://cid.oxfordjournals.org/content/51/6/663.short

            Controlling pertussis, commonly known as whooping cough, comes with a number of common public health challenges, such as gathering representative case data and encouraging people to keep their immunizations up to date. However, new and emerging tools, such as the 2005 arrival of a new vaccine that immunizes adolescents and adults against pertussis, could make a dent in the disease’s natural cycle. While pertussis and its prevention is complex, speculations that current outbreaks may be due to vaccine refusal do not hold up, said CDC spokesman Jeff Dimond.

            “The numbers don’t support that argument,” Dimond said. “There’s no cause and effect relationship there.”

            Instead, waning immunity may be part of the problem.

            http://www.medscape.com/viewarticle/730253

            Sorry this post is so long. This is all pretty complicated.

          • Chris says:

            Where is the link to the “CDC survey”? And I mean on the CDC website, not a news channel.

            The Waldorf school I linked to was for pertussis, most the children were not vaccinated for it. Different school.

          • Guest says:

            This isn’t the CDC site, just a link to the journal write-up of the study.

            http://content.healthaffairs.org/content/30/6/1151.abstract#aff-1

            Here’s a link to a more detailed article, as well, with a link to the Health Affairs at the end and the Health Affairs article is cited as the source for the article. It’s from a news site published by the American Medical Association.

            http://www.ama-assn.org/amednews/2011/06/20/hlsa0620.htm

            And I have to correct myself again because it looks like the survey was of parents of younger kids. The participants had to have at least one child 6 or younger.

          • Guest says:

            Make sure to click on the + to open up the author affiliations list on the Health Affairs article. The lead author is an epidemiologist for the CDC and most of the other authors are also with the CDC.

          • Chris says:

            Thanks!

    • Chris says:

      Look above at my chicken pox experience. Do you think that would have an effect? How many new parents realize that it actually lasts a full two weeks (they probably only heard about the mild cases that vaccinated kids get), the kids are in real pain and if you have more than one it can double the length of being home bound?

      • Twyla says:

        Why do you think that people don’t remember what chicken pox is like? The vaccine has only been around for about 15 years.

      • Garbo says:

        I’d have traded a month of oatmeal baths and tears for the 4+ years we’ve spent dealing with lingering aftermath of ataxia/apraxia following the chickenpox vaccine. Cerebellar ataxia is also on the list of adverse events IOM is considering for varicella vax.

        • Chris says:

          How do you know it was from the vaccine? Is there a cite to the case report?

          By the way, my son still has apraxia after his seizures twenty years ago. So I don’t think your anecdote is any better than mine.

        • Chris says:

          Rats! My comment went into the ether.

          Basically I found out from a paper called “Varicella vaccination in Europe – taking the practical approach” that ataxia happens in up to 10% of people hospitalized with chicken pox (about 1 to 4 out of a million cases of chicken pox). Then I had a report called “The Safety Profile of Varicella Vaccine: A 10-Year Review” that there were five case reports (one must have been your kid!) of ataxia out of 55 million doses of varicella vaccine.

          So there the risk of ataxia is about fifty times greater than with the disease than with the vaccine. Add that to increases possibility of secondary bacterial infection, possibility of poxes in eyes (blindness), and other side effects —- it is a bit more than oatmeal baths (which are given because kids are in real pain).

          So really, the issue is the relative risk. Yes, there are risks with any vaccine, but the diseases have more risks.

  22. Alissa says:

    I really think that we need to get the issue into childbirth classes. The first time I heard about Dr. Sears’s vaccination book and alternative vaccination schedules was in my Bradley childbirth class. Until then it had never occurred to me to do anything besides the CDC schedule (which we did anyways with the exception of the last rota-virus because my son had contraindications). There are also childbirth and baby-care classes at most hospitals that could be teaching this. Conceivably, you could get a pediatrician to come talk to these classes about vaccines. If you could somehow manage to get vaccinations into the Lamaze curriculum I think you could convince some fence-sitters (Lamaze does include sections on breastfeeding–so why not something else important for infant health?). If you could somehow get it into other even more anti-medical-establishment themed classes (Bradley, Hypnobirth, etc) it would be even more powerful.

    So many people I know skip HepB because they are convinced it is entirely sexually/blood transmitted, and it drives me nuts. No one seems to bother to tell them that there used to be thousands of cases every year in kids with no known route of transmission. People think the risk isn’t there, and it is. Part of the problem is thinking vaccines are ‘dangerous’ for whatever reason, but another huge part of the problem is people simply think these diseases won’t be their problem. We were told this (along with several other totally wrong things) in my class. I think only half the class ended up vaccinating their babies for HepB. These classes definitely spread vaccine misinformation.

  23. Jennifer says:

    I had the same thought about the prenatal/infant care/childbirth classes. I think the point raised earlier about having people who really can talk the talk of vaccines (not epidemiologists necessarily, but doctors who are super current on the information— anyone who can quote chapter and verse the Offit chapter in Deadly Choices on Bob Sears, for instance) is important and probably not every pediatrician can (or wants to) do this. Some degree of intimacy (not a huge venue with an expert panel) is probably important for people to feel their questions are really heard. Some pediatricians have monthly “meet and greet” types of deals for new patients. It might be a good idea for more practices to do this and to incorporate vaccine discussions into it. They could have someone on hand who can speak in painstaking detail about vaccines. Thus every member of the practice would not need to feel totally on the spot at every visit or caught out at a meet and greet if s/he didn’t happen to have a certain statistic at his/her fingertips. If there were a community resource (an epidemiologist, microbiologist, etc.) so much the better. Perhaps that person could attend a meet and greet at a different practice each month. There is no cost for these meet and greets, so it would take care of the billing issue raised by some and the time issue raised by others.
    I am really interested to hear from people who formerly were anti-vaccine, as you offer compelling ideas for what changes people’s minds. I agree that to some extent it is like arguing to people about anything faith-based. There are staunch opponents to vaccines and then there is the more difficult “I’m not anti-vaccine, but I think they’re dangerous and I forego some/delay some, etc.” types of folks. I think the former group is hard because it’s like arguing about God or evolution with someone who is a true believer of the opposite camp. It seems there is no point to that. The latter group is also difficult because even if you cite sound science, there is always a come back along the lines of “but vaccines aren’t perfect.” And they’re obviously not (the null hypothesis and all that). I’m frankly a bit stumped. But it is a topic I think abou t often. Part of what any educator is up against is the fixed misinformation. It’s not that people are thirsty for new studies and data, necessarily (though some, perhaps more first time parents, might be). It’s that a number of people feel they’ve researched adequately and know as much as they need to, even if what they know is incorrect. I also think the influence of childbirth educators, chiropractors, midwives, doulas, homeopaths, etc. is very strong and those folks often get a first word in. If those players are anti-vaccine, then it’s kind of like trying to get Fox news to retract something— the inaccurasies have currency that the later corrections don’t.
    Some effort in this vein can only be to the good, I think. Some people will have more accurate information as a result. Perhaps they will share this with others.

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