I wish the same thing had happened to one of my former college classmates. She managed to get a BSN AND get admitted to an NP program, while being strictly and actively anti-vaccination. In fact, she complained when the hospital told the nurses they either had to get the flu vaccine or deal with patients with the masks during flu season. Sigh
Fascinating story. Thanks for sharing. I think that’s a particularly amusing paragraph given how anti-vaxxers are always going on about how so many doctors are secretly anti-vax and don’t really vax their kids. I remember your post about your little one. It was one of the scariest things I’ve ever read. I’m so glad she’s doing well today.
Yeah. I mean this with all due love and respect, but a lot of nurses are fucking idiots.
(As are a lot of teachers, a lot of lawyers, a lot of bus drivers and a lot of politicians. It’s just more depressing and surprising when it’sour most trusted profession that ends up being filled with fallible human beings.)
Not all nurses are idiots. Nurses Who Vaccinate is run by my friend Melody Butler. They have 1,900 likes. Let’s show them a little love on Facebook and give them some more.
Done! Thanks.
I hope you appreciate that lately (in contrast to the usual high standards of your posts) you’ve been sounding almost as nutty as the classical “childhood diseases are harmless” antivaxer. How are you going to convince the parents you see in your practice that it is important to get their kids vaccinated against these diseases when you don’t take at least some of them seriously? Measles exposure in a pediatrician’s office putting an infant in the hospital? Other kids exposed to chickenpox the same way? No biggie according to you. Potential for community disease spread afflicting vulnerable elderly and/or immunosuppressed people? I’ll let you think about that one.
Really? it’s been demonstrated that a high percentage of non-vaccinating parents are financially well-off, and that a pediatric practice that caters to them can be very successful. Jay Gordon and Bob Sears are examples of high-profile antivax pediatricians who’ve done quite well for themselves.
Trying to appear sympathetic to all comers probably has its psychological costs, regardless of the financial rewards.
I think you’re seriously missing the boat on this one. The pediatricians I’ve cited who do not see unvaccinated children could easily say that colleagues who enable parental misbehavior and fail to shield the children in their practices from exposure to dangerous infectious diseases are “shirkers” who fail to uphold the social compact. But I don’t see them doing that. They’re explaining their reasons rationally instead of lashing out at pediatricians who feel differently.
I can only hope that part of our disagreement stems from confusion over out-and-out antivaxers and parents who are worried about vaccines and want to delay some of them. The latter can be reasoned with, and I understand not wanting to lose them. The pediatricians I hear from have not been successful in winning over the diehards to even a semblance of responsible parental behavior.
The last bit sounds a bit true Scotsmanish to me. Of people who come in intending not to vaccinate I win over a fair share over time; therefore those are not the true diehards …
A patient has private insurance. It don’t matter to my recompense whether the parents are investment bankers or janitors none in the least. I get paid the same. If the investment bankers takes up twice as much time, well, not such a good investment. If my quality metrics for hitting combo 3 and combo 10 of vaccince completion by 2 years old (and the share of the incentive funds) are off because of these doofuses, not a good investment either.
How I get people to take the diseases seriously is that I argue with facts and real numbers and reality. I wouldn’t take a doctor seriously who told me that one two day hospitalization over decades across the country, or that an exposure to chicken pox, were, on this scale of analysis, serious events. It would make not trust their advice about anything, very seriously.
Parents hear in plain English that my opinion is that they are putting their child and other children at needless risk of death and they need to sign a form that I have warned them of that and that it is on their head. I make sure they know that there was a conspiracy regarding MMR and it was between Wakefield and the lawers he took money from in advance of their plans to sue the vaccine makers. I make sure they know the facts. I do not pretend that a chicken pox exposure is serious thing for a child or that Hepatitis B is something that a two year old is likely to get.
Yes I am sure that those pediatricians could easily say that. Is that supposed to be convincing somehow? They could also say that Elvis is alive and well and selling mezzuzot in Rome. So? Do you dispute the analysis that the reality is that if all of us mainstream pediatricians refused to care for these families the inevitiable result would be clustering of them in the offices of a few quacks? That the result of that would be none eventually becoming convinced to get any vaccines, more exposures in those clusters, more disease in those kids, spreading to even more disease among the immunized, and other quack care being given to the children whose only sin is the parents they have? Your answer to that is that some would say something else? Are you imagining somehow that dismissal from even all our mainstream offices will force these parents into compliance rather than into lower quality care in general? If so then you are seriously delusional.
Those pediatricians you’ve cited are explaining their rationalizations reasonably but the reasons are not real world. There is documentably no significant increased risk of serious disease to other children in their offices.
The states should be enforcing the requirements and not letting kids in school or daycares with a “philosophic” or made-up “religious” exemption … that is where exposures and most outbreaks occur.
I’ve been at this a long time by now. I’ve seen the arc of this story. The big pushback against vaccines came when infant HepB was mandated. And honestly I was against mandating that one. People have a right to make what I consider dumb decisions unless there is an imminent public health interest overriding that right (IMHO). HepB in infancy (something I did for my kids, something I think makes sense) does not reach that threshold. Trying to argue that it did lost my side some credibility and once people pushed back they pushed back indiscriminantly.
I can realistically express some compassion for parents who want to blame their child’s autism on vaccines. You have on the one hand people like me telling them mostly genetic (which they hear as “your fault”) and little to do but all this hard work which won’t cure anything, just make the disability a bit more manageable. And on the other hand people telling them it is not “their fault”, the greedy medical industry is to blame, and offering quick false hopes. One side is being stated by a short funny looking bald guy; the other by an attractive woman. Kind of understandable that some will find the woman’s POV also more attractive.
And I understand how people do not understand that when 10% of the year is within 2 weeks of getting one vaccine or another, 10% of of all diseases of no identifiable cause will occur with two weeks of a vaccine. One out of ten cases of whatever being diagnosed within two weeks of being vaccinated is evidence against vaccines being a cause, not for, but many do not get that, or that half of the population is below average. Or that one case of a serious complication over many years across the whole country is an insignificant risk.
It’s our job as the pediatricians to explain those things to them. Stating my way or the highway when people do not yet understand those things and are afraid and misinformed will do a poor job gaining compliance.
You are hearing from me - I win over quite a few of those who intially seem to be diehards to at least delayed compliance for the ones that matter most. It is not ideal. Yes, I am getting burnt out at it and do not expend as much energy on it as I used to. But still each visit is a little extra effort at it. If those pediatricians cannot ever succeed when I sometimes can that is no strong compliment to me; it is however a serious demerit on them. Some success is possible with a) developing a relationship and b) some earned respect and trust.
Thanks WhyNot, that’s an interesting story and it’s a credit to you that you could change your mind when given additional information instead of holding on to your previous opinions. Is your experience typical? I.e. are there a number of “reformed” anti-vaxxers? Were you able to change some opinions yourself?
As someone who has been watching and writing about this issue for well over a decade I think there’s a hardcore group of people you simply cannot convince. But there are also quite a few others you can change. The problem for some of them is that change can only come about if something awful such as the experience of a vaccine preventable diseases happens to them or one of their kids. Someone I know did change her mind on this issue – but only after a serious bout of pertussis and the need to rush her baby to the hospital gasping for air.
She is staunchly pro-vax now to the point where gets her family their flu shots each year. But that’s what it took for her and I’m afraid that’s what it might take for a significant number of people like her. We have to take comfort in knowing that most people are not like that and have no problem vaccinating.
Sigh. The mindset that insists that conspiracy is behind the public policy that mandates vaccination is so much harder to address. You assume that parents will do right by their kids, but enter the conspiracy and truth movements and all best interest goes out the window.
Whenever I have a prescription filled, the list of contraindications, etc is always prefaced by ‘your doctor has prescribed this medication for you because its benefits outweigh the risks’. Can it be this easy for vaccinations or must we wrestle with growing irrationality? Rhetorical, I know. I’m afraid for wee babies.
There are a few people who trust me enough that I’ve been able to convince them that vaccines are safe and effective. There are others who have silently drifted away, and others with whom I argue vociferously and we’re still friends, but I don’t really think I’ll be able to convert them ever.
You know that saying, "You can’t reason someone out of a belief they didn’t reason themselves into? " I think I was able to be swayed because I DID reason myself into my antivaxx belief. I based it on (faulty) reasoning and (faked or misinterpreted) evidence. I think that’s why I was able to be reasoned out of it with better evidence. I think that the subset of antivaxxers like me are the ones that can be reached with education. How big a subset are we? That I do not know. But it’s worth trying to reach us before you write us off.
I’d have trouble taking a doctor seriously who argued that these have been the only exposures ever to vaccine-preventable diseases in a doctor’s office.
Of course, parents assume a certain amount of risk for themselves and their kids by even stepping into a pediatrician’s office/waiting room. I suspect a certain percentage of them would not be happy if their child (who was too young to be immunized or one of the small minority whose immunization(s) don’t “take”) was made seriously ill by an unvaccinated child welcomed into the practice.
I find your contempt for a sizable contingent of your colleagues to be bizarre. Here’s another of those crazy Elvis-is-alive pediatrician “shirkers”:
*"For Allan LaReau of Kalamazoo, Mich., and his 11 colleagues at Bronson Rambling Road Pediatrics, who chose in 2010 to stop working with vaccine-refusing families, a major factor was the concern that unimmunized children could pose a danger in the waiting room to infants or sick children who haven’t yet been fully vaccinated.
In one case, an unvaccinated child came in with a high fever and Dr. LaReau feared the patient might have meningitis, a contagious, potentially deadly infection of the brain and spinal cord for which a vaccine commonly is given. “I lost a lot more sleep than I usually do” worrying about the situation, he said.
“You feel badly about losing a nice family from the practice,” added Dr. LaReau, but families who refused to vaccinate their kids were told that “this is going to be a difficult relationship without this core part of pediatrics.” Some families chose to go elsewhere while others agreed to have their kids inoculated."*
Outright vaccine refusers based on bad information are still (thankfully) a small percentage of American parents. They’re going to represent potential disease vectors whether in schools, day care centers or at the mall. Enabling transmission through a health care facility which includes (and concentrates) the most vulnerable members of the population seems wrong to me.
Meantime the American Academy of Pediatrics, which while not encouraging the dropping of unvaccinated children from a practice, defends pediatricians’ rights to do so if dialogue fails and there is a lack of trust between parent and physician. There is even mention in the AAP’s position paper on the subject of the potential duty of a pediatrician to inform legal authorities if parents are putting a child at special risk through vaccine refusal (i.e. during an epidemic).
No physician is obliged to take all comers. If a patient consistently refuses proper medical care and espouses quackery, it may well be in the best interest of both the patient and physician to part ways.
Speaking of fallacies, you’re indulging in a doozy of a strawman there. I have never said that I think it’s the duty of all pediatricians to avoid treating unvaccinated/undervaccinated kids. If I had kids in a vulnerable age range I personally would be inclined to avoid a pediatrician with unvaccinated kids in his/her practice. I respect those pediatricians who’ve chosen to say no to antivax parents. You do not.
We’ll just have to differ on that one.
**speaking of “quacks”, it does seem that antivax pediatricians espouse their share of quackery (Jay Gordon, Jenny McCarthy’s kid’s pediatrician, has supported homeopathy for ear infections). Whether such peds’ overall level of care rises (or falls) to the level of quackery is another matter.
Contempt? What contempt? Anger that they are dumping on the rest of us? Yes. Believing that their stated reasons are either misguided or self deluding? Sure. But then I have disagreed with lots that my collegues have done. 14 years ago I found the then current guidelines on work up of pediatric urinary tract infections to be misguided … causing more harms than good … sure it took until this last year for the guidelines to change, for the powers that be to acknowledge that the evidence was never there in the first place … but writing that I think that there are major flaws in a thought process based on poor understanding of the evidence and of risks did not mean that I found those who felt otherwise to be contemptible. Mistaken. Wrong. Yes. And in this vaccine refuser case, lazy. Okay maybe cheaters, very much akin to the parents who want to get the benefit of herd immunity without having their kids get any of the shots. The kids will get taken care of but someone else can do the extra work that they represent.
And who is arguing that those are “the only exposures ever”? Talk about your strawman. I am limiting to the last several decades, a period of time in which 95% plus of our practice populations are compliant, not discussing exposures but documented serious complications of those exposures, and granting a two order of magnitude range of error for undocumented events (and that is an absurd thing to grant), and still finding that to be, on the scale of analysis, a risk below trivial. It’s the parents that are the ones who are usually the ones getting worked up over trivial risks that we need to talk down … no alar does not mean that apples should be avoided … not the docs.
He stayed up at night worrying about his other patients in the waiting room, not about the kid who might have had meningitis? Really? Three major forms of (now vaccine preventable) bacterial meningitis: pneumococcal, Hib, and meningococcal. For none of those would a waiting room contact be considered a meaningful exposure. The closest one is meningococcal: household and close social contacts (room mates, kissing, that level) would warrant chemoprophylaxis … not sitting in the same waiting room, not even in the same classroom. Hib meningitis exposure? Household level exposure and only if there is an incompletely immunized child or otherwise at risk child in the household; again not considered a significant exposure for casual contact like a classroom let alone in a waiting room, unimmunized or not.
He lost sleep over that? Really?
Yes taking care of patients is similar to at will employment. I can fire patients for noncompliance if I want to … and for too many missed appointments and nonpayment of bills or being rude to my staff. I need to give notice and to make sure that they can find other care, even help them do so if such help is required, and take care of them for emergencies for a period of time … but I can do it. I defend that right and believe that exercising that right for vaccine refusal is motivated out of laziness and should be strongly discouraged. The two are not mutually exclusive.
Yes we will have to differ. Difference being that I am the one being dumped on by these other docs and you are the one worrying about risk that has solid evidence of being near zero while unconcerned about the possible harms done by such actions.
I should get a blog but really this is fabulous news about the HPV vaccine. A new study from the Aussies finds it HALVES the risk of developing abnormal cells.
Get it for your girls! I got for my eldest and will get it for my little one when she is of age.
It’s official - we have a measles outbreak in Alberta. Thanks, Jenny and Andrew.
Which is really, really fantastic, as newborns don’t form an immune response to the vaccine, so are completely unprotected in their first months of life, when pertussis is at its deadliest. This seems to suggest that the mother’s immune response if she gets the vaccine in her third trimester is also delivering some antibodies to the fetus, antibodies that live for the first two months of the baby’s life.
If you live in the NYC area, Jenny McCarthy is going to be at a local bookstore on LI tomorrow night:
You do realize that advocating lynchings is illegal, right?
You do realize you’re an idiot, right?