Professor Art Caplan, from the University of Pennsylvania Perelman School of Medicine, blogged the other day about what doctors should do about the alarming number of patients who refuse vaccination for their child. Since I will probably not be debating the noted medical ethicist in person any time soon, I want to post my reply to his arguments.The vast majority of pediatricians feel that allowing non-vaccinated patients in their office puts the other children at risk for infectious diseases. Also, when such a child becomes ill, the doctor cannot ascertain whether the problem is minor or one of the major preventable diseases and so medical decisions become more difficult. Finally, the rest of the population is at risk because of the reckless choices made by such parents. Dr. Caplan stated his position, the same as that of the AAP, which is that pediatricians should not dismiss patients for this lack of compliance.
“With respect to the safety issue, it isn’t a bad thing for a parent to worry about safety. It’s that they are listening to inappropriate sources.”
As I have written previously in this forum, there are no randomized, prospective, controlled studies (the gold standard of research) that demonstrate the safety of the present vaccine schedule. Heck, that’s what most researchers complain about with alternative medical protocols, yet they do not hold themselves to the same standard. What parent would allow their child to be part of a study in which half of the participants get a thorough evaluation, detailed history including previous vaccination intolerance, fewer vaccines each time and longer periods between the ‘shots’, while the control group gets the present protocol? Um… I pick the study group for my children!
What institutional review board would say that, yes, we should test titers (how immune the child already is, from previous vaccinations) before giving the next doses, so that children only get that which is necessary? I mean, who has the money for that schedule? So, we just do what is ‘safe’ for everybody even if it may not be so for the individual. The ‘herd’ is protected and the good of the one (or of the few) takes a back seat to the good of the many.
From my perspective, which is that of an older, experienced pediatrician, what I have witnessed is a schedule that keeps increasing as far as the number of vaccines and asks that children get vaccinated at younger and younger ages than that which I had been used to. And, evidence is lacking that such a schedule is safe or any more effective than a slower, more conservative protocol. That “there are no studies to show that vaccines cause autism” is merely a truism…there are no studies to show that the way the vaccines are given is safe for every infant and child.
So, I have some advice for Professor Caplan and the rest of the traditional medical community that is much more helpful than merely insisting that concerned parents are misguided or ignorant of the situation.
Listen to why the parents feel that way and address those specific issues. If the child had a significant fever from a previous vaccine or a sibling (or the infant to be vaccinated) has developmental issues, it should be a red flag that causes the pediatrician to be concerned as well.
The office staff has no right to raise their voices in anger or roll their eyes with disbelief when a parent expresses their concern about vaccine safety. I assure you, if they were parenting an autistic child, they would display a much more sympathetic tone.
The pediatrician should take a look at which vaccines are the most important for the reluctant parent and treat the individual infant. The doctor should try to convince parents about the risks of a child getting those diseases that are preventable and cause significant long-term disabilities. A mother who is going to choose to keep her child at home for the first years of life has a pretty low chance of having a child who develops either Hepatitis A or B. When presented in this manner, I have found even the most resistant parent gives a great deal more thought to giving some vaccines, at least.
Ask about the reaction from previous ‘shots’; whether the child needed a great deal of Tylenol or if they seemed to have other problems such as vomiting, diarrhea or feeding problems. In fact, doctors don’t give vaccinations – the office nurse does – so don’t be so sure that particular base is covered. And, filling out a pre-printed form is basically meaningless when the family has real concerns.
Reluctant parents can sometimes be aided by doing ‘titers’ – that is, finding out how resistant the child already is to a disease, and work with the family to address the most important and high risk conditions. In a similar manner, checking the child’s blood count is sometimes helpful. I had one local pediatrician delay giving ‘shots’ because of a markedly decreased white blood cell count in the sibling of an autistic patient. By the way, the package insert on many live-virus products states that it shouldn’t be used if the patient is allergic to eggs. Ever get your kid tested for egg allergy??
Finally, I want to be clear about my personal position. It is not the vaccinations themselves that I find objectionable, it’s the intractable opinions of many medical personnel.