Helping families make decisions about their child’s health takes training, expertise, and experience. The training is standardized (medical school, residency, fellowship), and the expertise confirmed by passing board examinations and maintaining yearly CME (continuing med education). But the experience piece is ultimately unique for each physician. With each day in clinical care, patients teach, instruct, and shape how we understand wellness and illness. Through individual experiences with patients, physicians ultimately become who they are in the exam room. In medicine, despite the huge push to standardization everything from centralized phone calls to how much (or little) time we get with patients, individual doctors will fortunately remain unique. As patients, we still get to enjoy our physicians as people helping us through illness and injury.
This week has been intense. Wednesday, I spent the morning as a patient in the care of my incredible doctor. (I’m fine). She’s entirely instructive for me as a patient and as a physician; her bedside manner astounds. I believe she’s just very good at her job, partly because she’s uniquely experienced. I believe her experience being a nurse for many years before becoming a doctor really colors how she provides care–she gets it.
The week has also been intense because of this series. I’ve been thinking about immunizations, reading comments here on the blog, writing, and witnessing my patients’ responses. I’ve received many e-mails. Yesterday, I was at clinic for over 10 hours and like most days, immunizations were a huge part of my day. But I said things I’ve never said before…True synergy between my clinical self (doctor) and my writer self (Mama Doc), this experience is shaping who I am, in and out of the exam room.
Of course, experiences in clinical care (and living on planet earth) shapes how all pediatricians discuss and listen to families when discussing immunizations. Here’s the final segment in my series on asking pediatricians if they “believe” in vaccines. The 20 or so pediatricians who responded, talked about their experiences in representing vaccines. Additional comments are included in part 1 (emotion) and part 2 (evidence).
Experience:
Dr Kronman, a pediatrician and infectious disease fellow:
We don’t see these diseases anymore. I work at a premier tertiary/quarternary care facility for children. I have seen children die of influenza (seasonal, H1N1), pneumococcus, meningococcus, the late sequelae of measles, pertussis; I have seen Hib meningitis, tetanus, severe debilitating outcomes with varicella, cervical cancer caused by HPV, and severe rotavirus. This list goes on. But most people haven’t seen these things anymore. People don’t have to panic about their children in the summer becoming permanently paralyzed from polio, because we don’t see it anymore. And the reason? Vaccines.
Dr Natasha Burgert, a general pediatrician in Missouri said
In other parts of the world where I have briefly practiced medicine, I have seen the faces of grieving families whose children have died from vaccine preventable diseases. Those families did not have the equal opportunity that you have for your family.
Dr Natalie Vogel, a general pediatrician:
With patients in clinic, and when thinking about immunizations, I come back to thinking about how hesitancy is about a person’s personal perception of risk. Understanding risk is so complicated and personal! It pits fact and epidemiology (“science”) right up against emotion. My sense of risk is very different from the next person’s. Addressing that sense is crucial in a discussion of vaccines with a tentative family.
One comment, from Alison Buttenheim, PhD MBA, a researcher working with Dr Flaura Winston furthers what Dr Vogel mentions. Dr Buttenheim discusses her experience and research focused on improving pediatricians’ skill in discussing immunizations:
These clinical interventions are likely to be marginal. We recently completed 23 in-depth interviews with parents in a high-SES [socio-economic-status] urban neighborhood, most of whom I would classify as hesitant but ultimately adherent (lots of requests for spaced schedules). One clear take away from this qualitative research is that parents know what they want to do long before the first well-child visit. Among the more hesitant parents in our sample, the choice of a pediatric practice was based in part in finding a provider who would accommodate an alternative schedule. I think we need to focus our research on parental decision processes outside of the MD office, and how they are shaped by media, peers, etc. Attention to cognitive heuristics and biases (such as how we interpret risk and look for confirming but not disconfirming evidence) should reveal promising opportunities for communications and policy interventions.
Dr Denise Shushan, a pediatrician in Seattle,
When I’m talking about this with parents in the ER, I always begin by acknowledging the profound mistrust that has developed in the community between vaccine-making companies, physicians and families. I also acknowledge that, while I think that the vast majority of cases of serious events that occur near vaccine administration times are coincidental, there may be a subset of kids in whom the immune reaction generated by vaccine administration stimulates some pre-existing propensity for medical badness (obviously, I don’t say it that way, but my brain is fried after working all night). In my opinion, our job is to research this issue to try and determine if there is such a subset of kids, and if so, to figure out how to identify those kids We trust most parents on their gut feelings on so many other occasions. Yet, as a profession, we are quite dismissive (which seems arrogant to families) of parents who describe a deterioration in their child after immunizations. I don’t think that helps our cause any.
Dr Kronman, a pediatrician and infectious disease fellow:
I HAVE AND WILL CONTINUE TO PROVIDE ALL OF THESE VACCINES FOR MY OWN CHILDREN. I had to go to health center #2 and stand in line for 4 hours last year to get the H1N1 vaccine because [our pediatrician’s office] didn’t have it yet. And standing in that line was certainly a risky proposition in south Philly. But it was the right thing to do. Simply put, immunizing your child protects her.
Dr Doug Opel a bioethicist, pediatrician, and father says
I find myself in your scenario a lot…maybe not with complete strangers but certainly with new-parent family members right before an immunization visit who call me for my ‘opinion’ and from neighbors who stop me walking my dog to ask me where I stand on giving my patients and my own kids the H1N1 vaccine. I usually follow some version of ask-tell-ask. That is, I don’t give them a one-liner “you should do X or do Y” from the get-go. Instead, I let them talk first: “well, let me first hear how you are thinking this through? What are fears? What have you read? What have others told you?” That kind of thing… It’s easier [for parents] because I think it is far more manageable to correct misinformation in 2 minutes than it is to summarize the breadth of the pros and cons of immunizations.
Dr David Hill, a pediatrician in North Carolina wrote,
I’d like to think it helps that I vaccinate my own three children and myself. Sometimes, when I mention this, it does. But sometimes I just get that look that says, “So you drank the Kook Aid, huh?”. What we’re facing with vaccines I fear is but one symptom of a medical reimbursement system everyone knows is crooked. We pay enormous sums for procedures and a pittance for preventive care, so why should anyone think what we do has value? People read every day about psychiatrists who collect huge sums speaking for PHRMA, orthopedists who implant the hardware they’ve invested in rather than what’s been proven best, about laminectomies, meniscal shaving, and arterial stent insertions doctors perform with no evidence whatsoever they work better than placebo. We sold the public hormone replacement therapy, Cox-2 inhibitors, and Baycol. We know what we’re saying can be trusted, but the public often feels they can’t tell.
Dr Hill also said this, which I think I’ve repeated to about 1/2 dozen people since:
I like the quote from the All Things Considered piece on physicians as PHRMA speakers, noting that not only do we teach doctors to think critically in medical school, we teach them that we’ve taught them to think critically. For this reason doctors assume they are impervious to the non-critical-thinking-based persuasion used by drug reps.
Maybe we really need to step back in pediatrics and re-evaluate how we discuss vaccines. Authority and expertise, per se, may not be the right context in which to discuss this. In my practice I talk about the experiences I’ve had with vaccine preventable illness but also the experience of how it feels being a mom when intervening with shots.
Dr Melissa Arca, a general pediatrician says:
Parents, I believe, just want to know that we [as pediatricians] “get it”, we understand where they are coming from. We do, we are parents too and have made these same decisions.
Dr Gayle Smith, a general pediatrician in Richmond, VA
I’m one of those people who remembers infantile paralysis. That’s what they called polio when I was a young child. I do believe in vaccines. I remember my great grandmother saying, “Don’t go play over on Shiloh Street because that’s where the little boy died of polio,” and I grew up in Pittsburgh where the initial polio vaccine trials took place. Mothers in my neighborhood had the opportunity to be a part of history, to vaccinate their child with something that might save a life. In the beginning, nobody knew for sure that the vaccine would work without unacceptable side effects. They only knew that too many children died or were left paralyzed by this horrible virus. My great grandmother, who wasn’t afraid of anything, embodied the visceral fear that this germ could claim the life of her grandchild. That memory left its indelible mark.
I do believe in using the body’s natural, God-given ability to save itself from disease. Vaccines give us a way to make immunity without paying the huge price of illness, maybe even death, to get that protection. Yes, I believe in vaccines, and I am grateful for them…just like my great grandmother
Continuing this discussion about immunizations is essential. What’s your take? What do you want to hear more about? How can I help?
Mother in Seattle says
Hi Seattle Mama Doc,
Thanks for posting this series about vaccinations. I found the information very informative and useful to the discussion regarding vaccines. However, I’m still interested in learning more. I’d like to hear more about the research behind the current vaccination schedule, ingredients placed in vaccines, and the the pros/cons of receiving multiple vaccines on the same day vs. spacing them out. I’m convinced that vaccines are beneficial to my child and to society as a whole, but I’m interested in learning more about the method in which we are vaccinating our children. Thanks!
Sarah M says
Thanks for this series! I’ve been wrestling with the vaccine question a lot recently because we have a new baby. My daughter, who is almost 3, has gotten every vax on time. My current hesitation for my son doesn’t stem from concern about the side effects as much as it does with the ingredients of the shots. In principal, I find vaccines to be wonderful. In practicality, it just doesn’t sit right with me to have my son injected with something that contains animal DNA or anything from an aborted human being. While there are some options for a few vaccines (so that we can avoid those ingredients), what’s a parent to do when the choice is to give their child a vaccine that has been created with and contains ingredients that I’m not okay with or not give the vaccine at all. It’s not a choice that I’m liking at all. Any thoughts you or others may have on this are welcome.
Kori says
As a nurse and parent, I whole-heartedly believe in vaccines. My biggest frustration is my vaccinated children are in school and social activities where they are exposed to unvaccinated children. Not every child that has a vaccine will respond and convert. Did my children? I don’t know. Non-converting children in the past were protected by herd effect. But not so much anymore. It makes me…I guess angry…that parents not only chose to put their own children at risk, but also children who have had vaccines but did not respond. In my opinion, it is part of being a responsible world-citizen. BTW, you were right. I do like and appreciate your Blog. Keep it up!
Suzanne Vining, MD says
I got the “do you believe in vaccines” question at the Community Center playdate this week. It came from a father stuck in a marital predicament; his wife had chosen to not vaccinate their child, but he questioned the validity of her sources of information, and he felt that he was not protecting his child. I offered the following sites as good sources of information that they could read together: https://www.aap.org/immunization/families/deciding.html
(Called “Making the Decision”, well-written by the AAP), https://www.immunize.org/concerns/ (Immunization Action Coalition, a fabulous source of immunization information but written for providers),
and of course your blog!
I struggle with the best way to guide the family where there are mixed beliefs. Often, the vaccine-hesitant parent’s decision trumps that of the vaccine-confident parent for the sake of marital harmony, but the children are ultimately the ones to suffer.
Kathy says
I second Sarah M’s question — what do we tell parents (and physicians/health care providers) who have religious philosophies that tell them some vaccines are made with products that go against all their beliefs? In my efforts, I’ve found it’s a topic that proves very difficult to sift through with reliable/unbiased information.
TannersDad says
It is refreshing to read that some Doctors do not dictate from a pedestal. I really like the fact that some are admitting there is a gap in trust. Nobody can argue that vaccines have not done great things. Nobody should want to go back to an age when diseases were winning and taking lives. On the other hand to argue my son is any less value or any less a member of the herd is where the rubber meets the road. Until, the medical community supports families with services and answers for autism, Families will continue to strike out at anything. Especially, something you can not defend. It happened right before my eyes. TannersDad Tim
Viki says
See my last comment in the 2 minute video thread. I’d love to see a followup of your Tylenol-before-shots post with your thoughts on what to do if your child is the minority who gets a fever >102 or higher. There are many reasons why people don’t start. And many reasons why they delay or stagger shots. I see I’m in a small minority in that we started on schedule, took vitals, observed and thought it was too much for our kid. The CDC and AAP would seem to disagree and advises we manage even high fevers with medication and stick to the schedule. Seems most newborns who have high fevers turn out OK but some don’t.
Wendy Sue Swanson, MD says
Viki,
I don’t know of a study that examines using Tylenol for fever response after immunizations, and the resulting titers or antibody response. Because of that, I tell parents I don’t advise Tylenol before shots or for mild responses afterward (low grade fever 101 or less).
But I really feel like fever is difficult and uncomfortable for children (and for parents!). I recommend using Tylenol if fever is over 101 or if your child is acting like they feel crummy. Acetaminophen (Tylenol) is a great fever reducer and pain reliever and will likely do tons of good.
It should be noted that although the study I wrote the post about discussed how Tylenol use before and at the time of immunization reduced titers (antibodies) in those infants receiving it, we don’t know if those lower levels will translate to more susceptibility to disease.
Ultimately, I think we have to trust our instincts. If our child is uncomfortable, cranky, or extremely sore after immunizations, I say yes to Tylenol.
Viki says
Mother in Seattle,
Here are my thoughts. First, I don’t think a Dr can counsel on such principals because you may not share the same faith / ethical / moral background. Ultimately, you have to decide how important this is to you and how consistent you want to be with your beliefs. Will you deny a transfusion? Will you accept a transplant? Will you take other medications or therapies that involved aborted fetuses and stem cells? Only you can answer these questions. (Great question for a Dr who also studied medical ethics, so I’m not letting Dr Swanson off the hook on this one!)
My humble opinion: I totally regret reading The Vaccine Book and seeing the human and monkey mentions. Turned my stomach. 1) I don’t think the essence of the cell – what makes it human or animals – is transfered whole into vaccine. Hard to define whether that “bit of DNA” is unique to the monkey. We share 94-99% of our DNA with primates depending on the species. That’s what made the primate a great incubation candidate!
The bit about aborted fetuses is truly sad. I don’t believe fetuses are aborted for vaccine research. That fetus’s fate was decided for other reasons and something good is coming out of their sad and untimely end. Also consider that many people willingly risk their lives in hopes of improving medicine. My sister is considering a phase 1 trial of a chemotherapy drug. Phase 1 means that more animals lived than died — to put it very starkly. There’s a chance she will die from the first dose. Whether she lives or dies, she’ll be part of the cure. Tens of thousands of parents took a risk and had their child participate in the vaccine trials, some of them were seriously injured or died.
desiree says
sarah M, i wanted to respond to your comment about vaccine ingredients you’re uncomfortable with. the easier issue (for me anyway) is the animal DNA. you put animal DNA into your body every day when you eat (unless you’re vegan), and that’s ok. and if you’ve ever been bitten by an animal, or scratched by your cat, you’ve probably gotten some under your skin. i think it’s one of those things that sounds really unnatural and wrong when you phrase it one way (injecting my child with animal DNA) and totally natural when you say it in another (damn that mosquito bit me).
the fact that the virus used to make the rubella vaccine was initially isolated from an aborted fetus is uncomfortable for me too. but, i’m catholic, and the catholic church says it’s OK to take the vaccine. their position, in brief, is that the sin is far enough removed from the product, and the product does so much good, that you’re not sinning by taking the vaccine. maybe they’d prefer that the vaccine not be made with this line of virus, i don’t know, but the fact is that changing the source of the virus today wouldn’t change the sin that already happened. thinking of the morality of the issue another way, i think the case could be made that much of human history is the product of sin (war, slave labor, child labor, abuses of all kinds). it’s part of the human lot. you can’t opt out of all of it. what matters most is that your actions aren’t supporting practices that are currently hurting people. and with the case of the rubella vaccine, not taking it is what could hurt innocent fetuses. more fetuses than were hurt by making the vaccine.
i thought about these issues when i was questioning vaccines too, which is why i thought i’d respond.
Shannon says
Thank you for making this a conversation, for providing the voices of experience from those who have seen first-hand the terrible results of contracting a vaccine-preventable disease, and for highlighting the slipperiness of trying to asses risk realistically — especially when emotions are involved.
I’ve written it before in this space but — parents who think their child with autism suffered a vaccine injury should review their video records, journals, & photos — many folks are surprised to realize that their child had autism traits all along; they just didn’t have the tools and information to identify it at the time.
Nate says
The idea of “believing” in vaccines is as preposterous as the notion of “believing” in snow or photosynthesis. It is utterly, totally incontrovertible that vaccines have saved millions of lives, both young and old. Vaccination stands as one of the greatest achievements of modern science, far more important than space exploration, automobiles, or the Internet in terms of human well-being. Anyone who tries to tell you any different is, plainly put, either a liar or an idiot, no exceptions.
People can have their beliefs, whether religious, cultural, or whatever; it is one of the gifts of our free society. However, know that those beliefs are potentially detrimental to public health and the health of children.
We are so lucky to be living in a time and place where formerly fatal diseases are now either routinely prevented or eradicated altogether. It is mind-boggling that there are people who would consciously and deliberately undo that. It really almost reminds one of the mindset of a terrorist, doesn’t it?
Christine from Shot of Prevention says
This entire series is very valuable in that it provides the average parent with responses from many different doctors and specialists. Most often, as parents, we only get to question our own doctors and therefore don’t benefit from the diverse experience and wisdom of the medical field as a whole. It is very common for parents to turn to the internet for answers, but that doesn’t ensure they get the information they need. Hopefully more physicians, like yourself, will recognize the importance of developing a presence on the internet so that they can share their knowledge with those parents who are looking to discuss these issues and who are so desperately seeking answers to their questions. Both parents and physicians recognize that a few minutes in the exam room is not nearly enough time to help parents fell comfortable with their decisions. Thanks again for writing this series and for sharing it on our Shot of Prevention blog.
Dana says
“We don’t see these diseases anymore.”
Yes “we” do. Is it too much to ask themselves WHY we don’t see those diseases here like we did hundreds of years ago —- yet we still see the diseases in underdeveloped nations?
Does disease spread the same in developed nations as it does in nations where people defecate in the same water they drink from???
No, it doesn’t. If you have the ability for logical thoughts – ask yourself why.
“I think we need to focus our research on parental decision processes outside of the MD office, and how they are shaped by media, peers, etc.”
I think you need to focus on the fact that your medical school textbooks are controlled by the pharmaceutical companies. I think you need to question all the lies you’ve been taught. Vaccines did not cure or remove ANY disease. Environment and nutrition did.
Dana says
“What do you want to hear more about?” I would like to hear doctors discussing facts, not hearsay. Like the fact that a baby whose mother is not positive for Hep B, has no symptoms of Hep B nor any friends or family members with Hep B should be giving their baby a Hep B vaccine. Like the fact that by the time that infant *is* old enough to do drugs and have sex, that the vaccine has long worn off, and so have the boosters. There is plenty of peer-reviewed science to back that up.
I would like to hear more about why doctors IGNORE these facts. Why *do* doctors ignore primary and secondary vaccine failures? Why haven’t you demanded a system to track them long ago?
“How can I help?”
The list is way long, but I’ll share just a few…
To start with, you could work towards making the government create a system to track primary and secondary vaccine failures. Eventually we might could get around to also keeping track of vaccine injury. We all know that VAERS is a failure and with technology today – we have the ability to do better. Surely you agree.
Mostly you can help by demanding truth in medicine. Push for education in nutrition, not just in medical school but also in public education beginning as young as Kindergarten. Teach people to eat the right food instead of teaching them industry sponsored LIES. Get rid of the stupid food pyramid and all the lies and misinformation that goes with it.
All doctors need to consider history and use logic when thinking about vaccines. Just listen to yourselves…it’s all about convincing parents that you’re right, and that they and all they have read (including peer-reviewed), is wrong. Did it ever occur to you that those who taught you may have been just a *little* wrong?
From what I can recall, no one in my generation died from any vaccine available diseases and that would be said by the majority of people my age. Ask yourself why. Could it be the way we TREAT measles in 2010 that may be *a little* deadly? Are we creating cytokine storms in the little bodies of children who a hundred years ago would have been cured of measles at home while never even seeing a doctor for measles? (And they got lifelong immunity to boot!)
Some believe that women my generation also got an immunity to some cancers such as ovarian….all because we got the measles when we were children. Humm, maybe our creator knew what he was doing when he created both us and the measles.
Not to mention the fact that when we (my generation) were infants, we were protected from the measles up until around age 2, when the myelin sheath matured and our own immune system began to take over. Vaccinated mothers will not offer that same maternal protection to their young. The CDC didn’t think that measles was this scary in 1967. Ask yourself why.
You can help by reading some MMWR’s from the 40’s, 50,s, 60’s and into the 80’s – take a long look at medicine BEFORE medicine was commercialized.
Most of all, you can help by learning that the human body has an innate ability to heal itself. Once interventions are started, a cascade of other health problems are sure to follow. It’s a lot about money.
Stop ignoring the facts. That’s how you can help.
Face it. Vaccines in 2010 are about greed. Pure and simple. Take your industry away from the greedy and make it your own. Read the peer reviewed literature yourself, take it apart. Find out who published, who designed, who funded…learn what the parents are learning and stand up for what’s right.
“I’d like to hear more about the research behind the current vaccination schedule;;;”
‘Not much to hear.
There is not a single study that takes the current schedule into consideration.
Not one.
The biggest way that doctors can help is to stop ignoring the corruption too. The AAP is not trustworthy. Learn what your parents are learning and you would know that.
I realize that these are not your favorite journals but maybe you want to ask yourself where your opinion of particular journals came from. You’ll never learn the truth if you don’t step outside the box and question the greed.
https://www.medscape.com/viewarticle/710788
https://www.medpagetoday.com/PrimaryCare/Vaccines/16458
https://www.whale.to/vaccine/nz_don.html
https://www.whale.to/m/ibupro.html
https://www.med.umich.edu/1libr/pa/pa_feverpho_hhg.htm
https://www.whale.to/vaccine/tylenol_depletes_glutathione.html
https://www.exploringvaccines.com/?p=36
https://www.springerlink.com/content/v64564q5w2850278/
I have a lot of links regarding fever, these are just a few samples that I hope will make at least some people realize that they don’t have all the facts. I have a friend who showed me her medical school textbook…in it, you will learn that the human body will fry its own brain if you don’t treat the fever. (In not so many words.)
I find it odd that death certificates don’t usually state that the cause of death was *fever*.
Why can’t the medical industry correct misinformation like this? They taught us to stop using aspirin to force a fever down – so why can’t they tell us the truth about ALL antipyretics (sorry ’bout the spelling)?
Fever is how our body deals with virus…and we fight it. How does that make sense?
Dana says
Shannon. When you take a perfectly healthy, babbling baby to the doctor for vaccines and he never babbles again, never makes eye contact again, and begins to have seizures and flap his hands or bang his head (which he never did before) — IT’S NOT ROCKET SCIENCE!