ANY truth to the vaccine debate?

[tiedyeddog]

It's also important to be considerate to the other, compliant, patients. I know I would be pissed if I had a child with congenital rubella syndrome (assuming wife fell into the unimmunizable category for whatever legitimate reason) due to another mom refusing to immunize her child and passing rubella to my pregnant wife in the waiting room.

Couldn't agree more. The whole problem with refusing immunizations, especially on the grounds of pseudo-science, is that it corrodes herd immunity. I guess it sucks, but if one patient isn't compliant about things that have to do with only themselves I don't think it's grounds to fire a patient. Like stuffing down big macs or dipping? That's fine, we can work on it. Do something that compromises the health of everyone else and won't listen to my advice? I'll refer you to someone who thinks that's alright.

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[dr zaius]

Yes, but how does retaining the non vaccinators as a patient fix this?

I was agreeing with you. I would get rid of them as well after a hard attempt at swaying their decision.

 

[SpecterGT260]

Ah. Gotcha. IMO its a hard call but 1) I'd rather wash my hands of someone's irresponsibly and 2) doing so will create outward pressure on these people. It's dirty.... But I think it's what works for me. I'm not entirely interested in a 1 step forward 2 steps backward approach and I think people have as much (more....) responsibility with their health than doctors do. If I had a patient that simply wouldn't comply I'd have to level with them "listen, this will only work if you work with me.... And now you have a choice to make...."

 

[Zoopeda]

Or you can accept that people are free to decide what to inject themselves and their children with and what not to and that you can at least provide the best care possible for every unique patient, regardless of the decisions they make--understanding that the beauty of this country is that no one is going to make all the same decisions you do. For example, I was very grateful when I told our pediatrician that I was uncomfortable with the sheer number of shots she was recommending for my nursing, non-travelling, non-day care 9-month-old. I explained that since we're not going to India any time soon, perhaps we should wait on Polio, etc. She understood this position and worked within our family comfort level to both honor her responsibilities to public health and our individual needs as patients in a very low risk, low exposure environment.

I think the extreme vaccine schedule is pushing more and more folks out into the extreme non-vaccine position. Heb B on the baby's birthday? Good grief, Heb B is mainly transmitted sexually and through needles! Test the moms, and leave the rest of the babies alone for a while. It's a shame there isn't more of a balance between the so-called Public Health regiment and the health concerns of individual families who do not all handle their kids in the same ways (nutrition, day-care, nursing, etc).

 

[SpecterGT260]

had a big thing typed out but deleted it...


basically.... nothing that has been said bars the notion that I or anyone else on this side of the fence doesnt "accept" peoples "right" to inject yadda yadda. nor has it even been implied that these people will not be provided the "best" care. as I (or future me anyway... ) am not the only doctor on this planet, in this country, in my state, or even in my community, your primary concern here is irrelevant.

it's typical pre-med though... itchy trigger finger on the idealistic response.... to be fair that will probably help you with your interviews. but it gets old after about a month of classes when half of your classmates still have vestigial cookiecutter personalities from interviews.

 

[SpecterGT260]

that may have been a little harsh.... but it is easy to be idealistic when we forget that the "right" to choose what gets injected can endanger the lives and health of others.

 

[Zoopeda]

Somewhat idealistic and/or naive, perhaps. I've not yet been through med school. But having just finished a series of courses in immunology and guided my daughter through the first two years of life, I've probably educated myself more than the typical pre-med on the subject without falling in any particularly extreme direction.

My one response for you beyond a highly qualified concession is that I also notice young doctors and med students to have an "itchy trigger finger" with vaccines or other (relatively) invasive procedures in general before they experience them first-hand or have kids of their own. The bottom line is that there's still a fair amount of mystery around regarding vaccines. Most kids do fine, but some do not. My neighbors infant died of the very disease she was vaccinated against (meningitis), one week after receiving the vaccine. She was given 5 vaccines that day and an apology a week later. Given my careful research as a premed, a student of science, and a father, I'm seeing a need for caution and not extremism in either direction...

 

[SpecterGT260]

extremism in the "pro" camp would be a lack of testing before distribution. something crazy like oh.... lets make something up... chicken pox pops? the irony of these things is that the perpetrators are guilty of the very thing they fear.

I'm sorry to hear about your friend's loss, but anecdotal evidence like this is exactly what we are supposed to avoid. "number to treat" and "number to harm" are always (or should always be) taken into account before using a treatment. If 1 child dies in association (note: not "because") with a vaccine that a million others have had no ill effect with we have no reason to avoid the treatment. especially in cases like meningitis when we know what the effects the opposite way are.
vaccines have a much higher chance of simply not invoking the immune response we want as opposed to actually causing the disease they intend to prevent. There is a better chance that your friend's child didnt gain immunity and contracted the disease - which is only vaccinated against because of the high probability of contracting it in certain groups. It is easy to use a direct cause-effect analysis when something bad happens. but with vaccines, more often than not, i get the sense that people are reacting in the opposite direction than they should

 

[SpecterGT260]

meningococcus is not even indicated for infants..... source just says most under the age of 6 don't need it..... I wonder why your neighbor's kid got it

 

[dr zaius]

meningococcus is not even indicated for infants..... source just says most under the age of 6 don't need it..... I wonder why your neighbor's kid got it

It was probably HiB vaccine.

At any rate, the child would have contracted meningitis without the vaccine. The vaccine doesn't work in 100% of children either. It's something like 95% of infants are protected after 2 or 3 injections. I'd take a 95% chance of my child having immunity in spite of the ~30% or so chance of developing some pain and redness at the injection and a lower chance of developing a fever.

I also wouldn't consider vaccination invasive.

 

[tiedyeddog]

My one response for you beyond a highly qualified concession is that I also notice young doctors and med students to have an "itchy trigger finger" with vaccines or other (relatively) invasive procedures in general before they experience them first-hand or have kids of their own. The bottom line is that there's still a fair amount of mystery around regarding vaccines. Most kids do fine, but some do not. My neighbors infant died of the very disease she was vaccinated against (meningitis), one week after receiving the vaccine. She was given 5 vaccines that day and an apology a week later. Given my careful research as a premed, a student of science, and a father, I'm seeing a need for caution and not extremism in either direction...

So, what mystery are you talking about. Can you link some pubmed articles sourcing these "mysteries" we don't understand? Do people get Guillain-Barre? Rarely, yes. Do the vaccines offer total protection? No.

It appears you don't really understand the meningitis vaccine, so read this: http://www.cdc.gov/meningitis/vaccine-info.html It's a two shot, then booster deal. If the infant was on the first shot there would be little immunity developed. GBS is usually the most feared thing associated with these vaccines. There has been 26 reported cases within 6 weeks of giving one of the shots. There have been over 15 million doses administered. http://children.webmd.com/vaccines/meningococcal-vaccine?page=3

Also, one week is usually not enough time for long term vaccine induced immunoresistance. Neither of the meningitis vaccines are live-virus vaccines, so the vaccine itself didn't cause the infection. http://children.webmd.com/vaccines/meningococcal-vaccine I could not find anything in the literature stating that giving five vaccines at once is harmful (and by literature, I mean on pubmed or the CDC website, not webmd. )

The vaccine will not protect you against all sources of meningitis. I have no idea what the exact circumstances were for that infant, but it is suggested some infants within a high risk category get the MCV4. http://www.cdc.gov/vaccines/vpd-vac/mening/who-vaccinate-hcp.htm#infants-children

One last point. Based on this: http://www.census.gov/compendia/statab/2012/tables/12s1106.pdf more than 24,000 automobile occupants died in car accidents and over 2,000,000 were injured in some way. I am betting those rates of death/injury are similar if not worse than those for vaccines. Do you not drive your kid around in a car, either? 10-15% of children that have bacterial meningitis die, even with antibiotic treatment. I know you think you're doing the best thing for your kid, but most of the medical community doesn't agree with you. We're all smart people, we just don't drink the kool-aid. There is a reason for this stuff.

 

[ijn]

I almost died as an infant from HiB because I couldn't get the vaccine on schedule (due to an ongoing viral infection). You vaccine deniers can go die in a fire. You are damaging herd immunity with your ignorance.

Vaccines aren't 100%. Maybe the kid had a relatively immature immune system, which means capsular polysaccharides vaccines like HiB are less likely to provide strong immunity. You can be 100% sure that vaccine didn't cause meningitis. It's a piece of ****ing sugar attached to a diptheria toxoid (a protein), another thing that I am 100% sure cannot cause meningitis.

A lot of kids are alive today because the #1 former cause of infantile meningitis is no longer the #1 cause. You've got to have some balls to claim that a vaccine that has done more than anything else to lessen the amount of meningitis in kids is the cause of meningitis.

 

[phltz]

Or you can accept that people are free to decide what to inject themselves and their children with and what not to and that you can at least provide the best care possible for every unique patient, regardless of the decisions they make--understanding that the beauty of this country is that no one is going to make all the same decisions you do. For example, I was very grateful when I told our pediatrician that I was uncomfortable with the sheer number of shots she was recommending for my nursing, non-travelling, non-day care 9-month-old. I explained that since we're not going to India any time soon, perhaps we should wait on Polio, etc. She understood this position and worked within our family comfort level to both honor her responsibilities to public health and our individual needs as patients in a very low risk, low exposure environment.

You're railing against a straw-man. No one is advocating that a pediatrician should turn away a family that misses or delays even a single vaccination. However, I think it's well within the bounds of reason for a pediatrician to not want a child who has missed vaccines for, say, MMR, chickenpox, whooping cough, etc, in their waiting room. The pediatrician has a responsibility to other people's children too, and part of that responsibility includes not allowing walking health hazards to hang around at the clinic indefinitely. It's a judgement call on the doctor's part, where to draw the line. Your (and I would guess almost all) doctor seems to have drawn that line in a sensible place.

 

[ijn]

It was probably HiB vaccine.

At any rate, the child would have contracted meningitis without the vaccine. The vaccine doesn't work in 100% of children either. It's something like 95% of infants are protected after 2 or 3 injections. I'd take a 95% chance of my child having immunity in spite of the ~30% or so chance of developing some pain and redness at the injection and a lower chance of developing a fever.

I also wouldn't consider vaccination invasive.

We also can't vaccinate against all forms of infantile meningitis. The infant may very well have had complete immunity to HiB, but would still be susceptible to S. pneumonia, N. meningitidis, etc.

Agreed - vaccines invasive? Okay. I'll make sure to let my patients know that going out into the world in the absence of a plastic bubble is also invasive.

 

[Socrates25]

The vaccine issue? I'll put it this way: I have 2 kids and they are both fully vaccinated. I'll admit that on 'shot days' at the pediatrician's, I do secretly have my fingers crossed, which unless you're a parent you may not fully understand. I do think the chickenpox vaccine may be a little over the top, though.

Varicella caused over 10k hospitalizations every year before the vaccine was introduced, which resulted in a 70% decrease. Kids with compromised immune systems can have severe complications from it. I know you probably dont think your child has any contact with immunosuppressed kids, but you'd be surprised. Kids with leukemia go to school too, and they dont always wear a mask.

Vaccines arent always about saving lives per se; its also about morbidity and cost.

With the low complication rate of the varicella vaccine, its absurd to advocate skipping a $2 dose and take the risk of exposing someone else to a 20k hospital stay instead.

 

[Socrates25]

Yes, but how does retaining the non vaccinators as a patient fix this?

the reason you keep them in your practice is the same reason you shouldnt kick smokers out of your practice.

every time you talk to them about it, it slightly increases the chances of them seeing the "right side."

I've got several families in my pediatrics panel that refuse vaccines; even if they wont accept all of them, I've been successful in getting them to do at least 2-3 of them. If I had just fired them from the practice, the kid doesnt get any medical care at all or they find a quack; at either rate they stay unvaccinated.

Keeping these guys in your practice (and sequestering them from the rest of your patient panel) is in the best interests of the child.

 

[SpecterGT260]

i can see that. but i dont think anyone here is suggesting a "zero tolerance" policy for vaccine avoiders. also, child's wellbeing is not a valid point as there are other docs which they can go to. I'm not suggesting emergency or rural clinics start doing this. but as a clinician I can not see a pt who i know wont follow my instructions

 

[gravitywave]

Or you can accept that people are free to decide what to inject themselves and their children with and what not to and that you can at least provide the best care possible for every unique patient, regardless of the decisions they make--understanding that the beauty of this country is that no one is going to make all the same decisions you do. For example, I was very grateful when I told our pediatrician that I was uncomfortable with the sheer number of shots she was recommending for my nursing, non-travelling, non-day care 9-month-old. I explained that since we're not going to India any time soon, perhaps we should wait on Polio, etc. She understood this position and worked within our family comfort level to both honor her responsibilities to public health and our individual needs as patients in a very low risk, low exposure environment.

I think the extreme vaccine schedule is pushing more and more folks out into the extreme non-vaccine position. Heb B on the baby's birthday? Good grief, Heb B is mainly transmitted sexually and through needles! Test the moms, and leave the rest of the babies alone for a while. It's a shame there isn't more of a balance between the so-called Public Health regiment and the health concerns of individual families who do not all handle their kids in the same ways (nutrition, day-care, nursing, etc).

I think it's very difficult to yield any more ground in terms of being aggressive with the "Public Health" regimen when all the available credible evidence suggests that vaccination has been one of the most incredible success stories in medical history. Not to mention the fact that health care professionals have a responsibility to publicly defend vaccinations in the interest of the herd.

Any intervention is going to carry a risk, and ultimately the parents will always have the final say. I absolutely support that right. But I do think that on balance parents owe it to their kids and to their community to have the kids get their shots.

You can't get meningitis from the HiB vax. Frankly, the letter of apology sounds like something that was done on the advice of counsel. How else do you justify apologizing for delivering the standard of care?

 

[facetguy]

Varicella caused over 10k hospitalizations every year before the vaccine was introduced, which resulted in a 70% decrease. Kids with compromised immune systems can have severe complications from it. I know you probably dont think your child has any contact with immunosuppressed kids, but you'd be surprised. Kids with leukemia go to school too, and they dont always wear a mask.

Vaccines arent always about saving lives per se; its also about morbidity and cost.

With the low complication rate of the varicella vaccine, its absurd to advocate skipping a $2 dose and take the risk of exposing someone else to a 20k hospital stay instead.

So the varicella vaccine has been all positive? I'm not convinced. And can anyone speak to whether or not adult shingles cases have gone up since we began administering the chickenpox vaccine to kids? I've "heard" this but honestly haven't done the searching.

 

[gravitywave]

So the varicella vaccine has been all positive? I'm not convinced. And can anyone speak to whether or not adult shingles cases have gone up since we began administering the chickenpox vaccine to kids? I've "heard" this but honestly haven't done the searching.

pretty sure there's still some conflict within the medical community about giving the VZV vax to kids. some would say that the imperative there isn't as strong as with things like diphtheria.

given that shingles is mostly a disease of the elderly, you're going to be waiting a long time for the results of that cohort study....

 

[facetguy]

pretty sure there's still some conflict within the medical community about giving the VZV vax to kids. some would say that the imperative there isn't as strong as with things like diphtheria.

given that shingles is mostly a disease of the elderly, you're going to be waiting a long time for the results of that cohort study....

Ha! No, I think the idea was that adults normally get 'boosters' over the years by coming in contact with kids with chickenpox, but now that kids don't get chickenpox to the same degree, adults aren't getting those varicella exposures and are becoming more susceptible to shingles.

 

[Socrates25]

Or you can accept that people are free to decide what to inject themselves and their children with and what not to and that you can at least provide the best care possible for every unique patient, regardless of the decisions they make--understanding that the beauty of this country is that no one is going to make all the same decisions you do.

Thats exactly what I do as a pediatrician. I never fire patients from the practice. However, I ALWAYS tell them they are making a bad decision for their child.

For example, I was very grateful when I told our pediatrician that I was uncomfortable with the sheer number of shots she was recommending for my nursing, non-travelling, non-day care 9-month-old.

This is a very short-sighted view. I assume you are going to home-school your child all the way thru high school and never let her play with the neighborhood kids? Good luck with keeping your child "unexposed" to other kids.

I explained that since we're not going to India any time soon, perhaps we should wait on Polio, etc.

I hope you never plan to visit Minnesota, Pennsylvania, California, or Texas either. All of them have had polio cases reported in the last 5-10 years.

She understood this position and worked within our family comfort level to both honor her responsibilities to public health and our individual needs as patients in a very low risk, low exposure environment

There's no such thing as a "low exposure" group in the United States. I would bet you some $$$$ that a researcher could analyzse your social circles and fairly quickly find a link to a region of the world with endemic vaccine-preventable diseases. Maybe its the Honduran nanny who takes care of your neighbor's kids. You are not as isolated as you think you are.

I think the extreme vaccine schedule is pushing more and more folks out into the extreme non-vaccine position. Heb B on the baby's birthday? Good grief, Heb B is mainly transmitted sexually and through needles! Test the moms, and leave the rest of the babies alone for a while. It's a shame there isn't more of a balance between the so-called Public Health regiment and the health concerns of individual families who do not all handle their kids in the same ways (nutrition, day-care, nursing, etc).

Although IV drug use and sexual contact remain the biggest risk factors, they are not the only route of transmission. There are several reported cases of transmission with exposure to infected blood on a cut or scratch on the skin.

If I bet my patients families $100 at their child's birth that their future adolescent would be sexually active by their mid-teens, I would win a lot more often than I lose. The HBV vaccine isnt just to prevent transmission to the infant, its to protect them in future years as well. You are naive if you think your child will never be exposed.

 

[gravitywave]

Ha! No, I think the idea was that adults normally get 'boosters' over the years by coming in contact with kids with chickenpox, but now that kids don't get chickenpox to the same degree, adults aren't getting those varicella exposures and are becoming more susceptible to shingles.

a good point that i hadn't even considered

 

[facetguy]

a good point that i hadn't even considered

I didn't express clearly enough.

 

[SpecterGT260]

varicella is required for admission to med school (or at least it was for me). and if it is now a regular for kids that is news to me.... from what i understood they aren't worrying too much about kids who get it. anyone with uptodate want to check out the current peds protocols on this?

 

[JP2740]

This thread is tight. Keep battling guys.

 

[dr zaius]

I could be remembering incorrectly, but isn't the reason for checking varicella antibody titre/requiring immunization for med school due to the increased mortality of chickenpox in the adult host?

 

[SpecterGT260]

im not really sure.... I just know I had to get poked because I couldnt come up with a record of having it as a kid

 

[Socrates25]

So the varicella vaccine has been all positive? I'm not convinced. And can anyone speak to whether or not adult shingles cases have gone up since we began administering the chickenpox vaccine to kids? I've "heard" this but honestly haven't done the searching.

Did I say it was "all positive"? Of course there are risks. But the benefits clearly outweigh the risks.

Anecdotally, yes, the number of shingles cases has gone up. I'm not aware of any formal study on the matter.

But instead of using that as motivation to throw out the varicella vaccine, the BEST option is to use both the traditional chickenpox vaccine in kids and the shingles vaccine in adults.

 

[facetguy]

Did I say it was "all positive"? Of course there are risks. But the benefits clearly outweigh the risks.

Anecdotally, yes, the number of shingles cases has gone up. I'm not aware of any formal study on the matter.

But instead of using that as motivation to throw out the varicella vaccine, the BEST option is to use both the traditional chickenpox vaccine in kids and the shingles vaccine in adults.

Are we beginning to chase our tails a little bit here with this? We mandate a chickenpox vaccine of questionable benefit and who-knows what % effectiveness, which in turn may be (there must be an answer to this; I thought this was all researched and evidence-based?) increasing the rate of adult shingles cases for which we administer yet another vaccine.

I'm buying shares of Merck tomorrow morning.

 

[dr zaius]

Are we beginning to chase our tails a little bit here with this? We mandate a chickenpox vaccine of questionable benefit and who-knows what % effectiveness, which in turn may be (there must be an answer to this; I thought this was all researched and evidence-based?) increasing the rate of adult shingles cases for which we administer yet another vaccine.

I'm buying shares of Merck tomorrow morning.

8-9/10 that are immunized are protected. Source

 

[SpecterGT260]

Are we beginning to chase our tails a little bit here with this? We mandate a chickenpox vaccine of questionable benefit and who-knows what % effectiveness, which in turn may be (there must be an answer to this; I thought this was all researched and evidence-based?) increasing the rate of adult shingles cases for which we administer yet another vaccine.

I'm buying shares of Merck tomorrow morning.

your logic would work except for all of the assumptions and misinformation in it. I have highlighted a couple of them.

just because YOU question the benefit doesn't mean the benefit is questionable. These things ARE researched. The problem with the people who support the anti-vaccine movement is they throw speculation on top of speculation until they have concocted this horror story and then grab ahold of an anecdote like the one a bit ago with meningitis and scream "A-HAAA!!" .... or.... something else..... but either way there is a grand gesture involved....


The underlying assumptions of your argument are:

1. benefit cannot exist in the presence of any downside or increased risk
2. potential downsides/risks include any chance Lim(1/x) as (x->infinity)
3. lack of evidence is evidence for

these are SEVERELY problematic assumptions (and as you guys get to know me around here you will notice.... I consider irrationality to be the omitted 8th deadly sin).

it all stems from something ive complained about in other threads.... many people have NO working concept of absolute and relative terminology. anyone currently taking EBM should be aware of what I mean.

a vaccine increases your chance of a crippling side effect by 1000% (relative) e-gads! (there really ought to be a face for that one....)

but lets say the initial risk was 1 out of 10 million (.00001%) Now our risk is 1 in 10 thousand (.01%). (absolute)

This is still basically no chance. And even with extreme numbers it isnt worth getting too excited about. so just because we can anecdotally claim an increase in shingles cases.... doesn't really mean we should forgo preventative treatment for the population at highest risk. if in another situaiton the numbers werent so nice we would turn to NNT and NNH analysis and make a judgement call. but at least for now it is blatantly inappropriate to turn to 1 or 2 anecdotal cases halt progress in its tracts.... at the very least if you want to cite anecdote you need to stack stories from the other sides as well. "I got the hep A vaccine and didnt get hep A". every bit as useless in this discussion....

 

[Socrates25]

Are we beginning to chase our tails a little bit here with this? We mandate a chickenpox vaccine of questionable benefit and who-knows what % effectiveness, which in turn may be (there must be an answer to this; I thought this was all researched and evidence-based?) increasing the rate of adult shingles cases for which we administer yet another vaccine.

I'm buying shares of Merck tomorrow morning.

"Questionable" benefit? BS, you dont know what you are talking about. A 30 second internet search would have shown you several studies that show what the clinical efficacy is.

Fine I'll contribute all the work here since you are obviously too lazy to do any of the research yourself.

Vaccine reduced hospitalization greatly in the post-vaccine compared to pre-vaccine era.
http://www.medscape.com/viewarticle/735602

Study of 300+ kids shows 97% vaccine efficacy rate against "severe" varicella disease.
Link: http://www.nejm.org/doi/full/10.1056/NEJM200103293441302

Vaccine efficacy rate is approx 85% across all clinical spectra of disease.
Link: http://www.jpeds.com/article/S0022-3476(01)44558-6/abstract[/URL]

For the small number of vaccinated patients who contracted varicella, their clinical course was much less severe compared to the non-vaccinated group.
Link: http://www.sciencedirect.com/science/article/pii/0264410X9190189D

Seroconversion rates were very high in patient test groups; and again overall clinical efficacy was in the 80-90% range.
Link: http://jid.oxfordjournals.org/content/174/Supplement_3/S330.short

10 year follow-up rate after vaccination showed 95% efficacy; measurable serum antibody was found in all children 9 years after injection.
http://journals.lww.com/pidj/Abstract/2004/02000/Ten_year_follow_up_of_healthy_children_who.9.aspx

20 year follow-up study in Japan shows continued good titer response as well as clinical efficacy
http://pediatrics.aappublications.org/content/94/4/524.short

Markov model of 4 million patients validates benefits of varicella vaccination over risks (including increased risk of shingles).
http://cid.oxfordjournals.org/content/34/7/885.full

 

[D elegans]

i almost died as an infant from hib because i couldn't get the vaccine on schedule (due to an ongoing viral infection). You vaccine deniers can go die in a fire. You are damaging herd immunity with your ignorance.

Vaccines aren't 100%. Maybe the kid had a relatively immature immune system, which means capsular polysaccharides vaccines like hib are less likely to provide strong immunity. You can be 100% sure that vaccine didn't cause meningitis. It's a piece of ****ing sugar attached to a diptheria toxoid (a protein), another thing that i am 100% sure cannot cause meningitis.

A lot of kids are alive today because the #1 former cause of infantile meningitis is no longer the #1 cause. You've got to have some balls to claim that a vaccine that has done more than anything else to lessen the amount of meningitis in kids is the cause of meningitis.

+111.3

 

[Socrates25]

8-9/10 that are immunized are protected. Source

Your source is the CDC? Didnt you know they are engaged in a massive widespread conspiracy with pediatricians to deceive parents and make pharmaceutical companies rich?

What really makes me laugh is these parents like facetguy who think that pediatricians like me and the thousands of us across the United States would ignore evidence of harm and blindly vaccinate our own children simply because Merck and the CDC told us to.

I work in an academic group of over 50 pediatricians, all of whom vaccinate. Facetguy either thinks he's more informed/knowledgeable than all of us, or he thinks that we're all cronies of the pharmaceutical industry. Either way, its an absurd delusion.

 

[dr zaius]

What really makes me laugh is these parents like facetguy who think that pediatricians like me and the thousands of us across the United States would ignore evidence of harm and blindly vaccinate our own children simply because Merck and the CDC told us to.

I bet if you were dxed with cancer you wouldn't use mega doses of vitamin C or silver colloid either. The Man has you suckling at the teat of big pharma. Sucker

 

[dreamweaver1988]

Or you can accept that people are free to decide what to inject themselves and their children with and what not to and that you can at least provide the best care possible for every unique patient, regardless of the decisions they make--understanding that the beauty of this country is that no one is going to make all the same decisions you do. For example, I was very grateful when I told our pediatrician that I was uncomfortable with the sheer number of shots she was recommending for my nursing, non-travelling, non-day care 9-month-old. I explained that since we're not going to India any time soon, perhaps we should wait on Polio, etc. She understood this position and worked within our family comfort level to both honor her responsibilities to public health and our individual needs as patients in a very low risk, low exposure environment.

I think the extreme vaccine schedule is pushing more and more folks out into the extreme non-vaccine position. Heb B on the baby's birthday? Good grief, Heb B is mainly transmitted sexually and through needles! Test the moms, and leave the rest of the babies alone for a while. It's a shame there isn't more of a balance between the so-called Public Health regiment and the health concerns of individual families who do not all handle their kids in the same ways (nutrition, day-care, nursing, etc).

I've seen that happen - a kid is scheduled for 6 shots and the mom wants to break them up into two separate days, "to not overwhelm the kid's immune system" or for some other b.s. reason. And certainly some vaccines are more important than others - that's why we don't give infants the HPV vaccine.

But I think we're talking about the hardcore crazies, the ones who don't want their kids to get any vaccines (and let's not even get into the "Christian" "Science" cult). Parents have a right to parent, yet society DOES have a right to intervene in order to protect the welfare of the children. I think withholding a vaccine is a form of child abuse, and one of the more egregious forms at that. I believe smoking around a child is also child abuse, as is feeding them an unhealthy diet. I don't want a nanny state, I just want kids to be protected from stupid parents. I am almost at the point where I also think parents should be prevented from indoctrinating their children with various religious mythologies unsupported by any evidence, ever. Not there yet, though.

 

[Zoopeda]

I don't believe anyone is denying the effectiveness of certain vaccines against certain infectious diseases. Nor is anyone taking the stance that we ought not to sacrifice the life of one child to save the lives of one thousand. My initial complaint was with the aggressiveness of the vaccine schedule in the context of our current reality in America. Once a disease is completely eliminated from the continent (ie, Polio), then that vaccine can probably take a backseat to more pertinent vaccines (ie, Tetanus). Nowhere in nature do 5 different fatal infectious diseases infect an individual simultaneously. In my opinion, we simply ought to stretch out the vaccine schedule in order to more accurately mimic the immune confrontation that exists naturally without over-stressing the child's immune system. Allergies and autoimmune diseases among pediatric populations are skyrocketing, and no one knows why. No pharmaceutical company has funded a study to thoroughly investigate the situation, but the million-vaccines-per-visit policy isn't an absurd theory. Furthermore, until further evidence reveals, beyond a shadow of a doubt, that 3 or 4 different vaccines at a given sitting doesn't significantly increase one's risk of autoimmune/allergy conditions, I play the conservative hand by spreading the vaccine schedule over a longer period. If an infant does not travel abroad, why in God's name do we need to give them the Polio vaccine at 2 months? We know for absolute certain that a child's immune system doesn't "mature" until 9-12 months of age (hence the AAP stance on nursing for 1 year). Why mess with a system we only partially understand more than is absolutely necessary? Start Polio at a year, for example. Last summer's California pertussis outbreak affected vaccinated and unvaccinated infant populations equally. Yet, the party line is to inoculate against the disease starting at 3 months. No one denies that vaccinations are the single reason Polio no longer cripples children in the US. But the grand experiment of so many vaccines in one visit is simply unnecessary and way out of control...

 

[SpecterGT260]

tried to read that in 1 breath and nearly passed out

 

[BigRedBeta]

Or you can accept that people are free to decide what to inject themselves and their children with and what not to and that you can at least provide the best care possible for every unique patient, regardless of the decisions they make--understanding that the beauty of this country is that no one is going to make all the same decisions you do. For example, I was very grateful when I told our pediatrician that I was uncomfortable with the sheer number of shots she was recommending for my nursing, non-travelling, non-day care 9-month-old. I explained that since we're not going to India any time soon, perhaps we should wait on Polio, etc. She understood this position and worked within our family comfort level to both honor her responsibilities to public health and our individual needs as patients in a very low risk, low exposure environment.

I think the extreme vaccine schedule is pushing more and more folks out into the extreme non-vaccine position. Heb B on the baby's birthday? Good grief, Heb B is mainly transmitted sexually and through needles! Test the moms, and leave the rest of the babies alone for a while. It's a shame there isn't more of a balance between the so-called Public Health regiment and the health concerns of individual families who do not all handle their kids in the same ways (nutrition, day-care, nursing, etc).

As a pediatrician I can speak with only mild authority.

While I can talk extensively about the benefits/risks of vaccines, I want to point out this issue about HepB.

Your statements, quite frankly, expose a significant lack of understanding about the transfer of HepB and the long term risks.

To quote the AAP Red Book (the Bible of pediatric infectious disease):

The risk of an infant acquiring HBV from an infected mother as a result of perinatal exposure is 70% to 90% for infants born to mothers who are HBsAg and HBeAg positive

Further, a very small number of newborns that acquire the infection will ever clear the virus (fewer than 15%), leaving them significantly more likely to suffer the chronic effects of infection including cirrhosis and hepatocellular carcinoma. It's because of that risk that there is a push to universally and rapidly immunize newborns against HepB. (Besides, isn't it amazing that by 6 months of age we can create lifelong immunity to a virus with potential to cause catastrophic disease?)

The thing is, infants and young children are NOT the same as older children and adults. There are a great many illnesses, infectious and non-infectious alike, which are no big deal in adults but represent critical emergencies in infants or children (similarly, there are things which occur in childhood that are significant issues in adulthood - the classic example being chickenpox).

The current vaccine schedule as recommended from the CDC represents the best evidence based practice as we understand it. The method in which vaccines are given is based on immune response and age associated risk. It's not just some willy-nilly "stick-a-needle-in-'em-because-we-can" set up. Certain vaccines are given because children of that age are at high risk. Others are given because it's been found the best immune response happens at that age. Further, the FDA approval process for vaccines is orders of magnitude more stringent than any other drug.

Trust me, if there's anyone who relishes the opportunity to take care of really sick children (as twisted as that sounds), it's me. I'm going into a pediatric critical care fellowship for a reason. But as much as severe illness interests me, I never want to see a child end up in the PICU needlessly. Vaccines are amazingly successful, cost-effective and worthwhile. I fully believe that they represent the best of modern medicine.

 

[ijn]

Last summer's California pertussis outbreak affected vaccinated and unvaccinated infant populations equally. Yet, the party line is to inoculate against the disease starting at 3 months....

The question is why shouldn't you vaccinate at 3 months? It's a toxoid vaccine. By definition it cannot cause disease. Maternal IgG provided through the placenta is on the downward slope from birth and tapers off by 6 months. Breast milk can only provide mucosal IgA. The only way an infant is going to have a chance against blood borne pertussis toxin is via vaccination that can induce IgG immunity in the blood.

 

[phltz]

I don't believe anyone is denying the effectiveness of certain vaccines against certain infectious diseases. Nor is anyone taking the stance that we ought not to sacrifice the life of one child to save the lives of one thousand. My initial complaint was with the aggressiveness of the vaccine schedule in the context of our current reality in America. Once a disease is completely eliminated from the continent (ie, Polio), then that vaccine can probably take a backseat to more pertinent vaccines (ie, Tetanus). Nowhere in nature do 5 different fatal infectious diseases infect an individual simultaneously. In my opinion, we simply ought to stretch out the vaccine schedule in order to more accurately mimic the immune confrontation that exists naturally without over-stressing the child's immune system. Allergies and autoimmune diseases among pediatric populations are skyrocketing, and no one knows why. No pharmaceutical company has funded a study to thoroughly investigate the situation, but the million-vaccines-per-visit policy isn't an absurd theory. Furthermore, until further evidence reveals, beyond a shadow of a doubt, that 3 or 4 different vaccines at a given sitting doesn't significantly increase one's risk of autoimmune/allergy conditions, I play the conservative hand by spreading the vaccine schedule over a longer period. If an infant does not travel abroad, why in God's name do we need to give them the Polio vaccine at 2 months? We know for absolute certain that a child's immune system doesn't "mature" until 9-12 months of age (hence the AAP stance on nursing for 1 year). Why mess with a system we only partially understand more than is absolutely necessary? Start Polio at a year, for example. Last summer's California pertussis outbreak affected vaccinated and unvaccinated infant populations equally. Yet, the party line is to inoculate against the disease starting at 3 months. No one denies that vaccinations are the single reason Polio no longer cripples children in the US. But the grand experiment of so many vaccines in one visit is simply unnecessary and way out of control...

The toll that a vaccine takes on your body is nothing close to the toll that an actual dangerous infection takes. You mentioned earlier that you're educated on these matters, but you really don't seem to understand how the immune system works. When you get a vaccine, antigens are presented to your B cells, some of which recognize the antigen and proliferate. Some subset of those become memory B cells, providing longlasting immunity. That's it. There's no huge proliferation of neutrophils, there generally won't be massive secretion of inflamatory signals. Your T and B cells have no idea if the antigen they're seeing is a "fatal infectious disease" or not, other than by the sheer volume of antigen it sees and the coincident presence of other damage markers. Given that a vaccine injection does not consist of massive quantities of antigen, and given that there isn't likely to be a coincident infection causing widespread damage to body tissues, getting a vaccine is nothing at all like getting a "fatal infectious disease". It's actually more like getting a bit of crud into a small cut - some antigens show up in your blood. Only safer, because there's negligible risk of it turning into a widespread infection.

Your immune system has evolved to help you survive in a group of illiterate, stone-aged hunter gatherers on the plains of Africa. It is absolutely prepared to handle some crud getting into a little cut. At 6 months, or a year of age, most of your ancestors spent much of their time laying face down in the dirt gnawing on interesting rocks and trying not to roll through too many thorns. That's the kind of environment your immune system is prepared to deal with. Your immune system is a stone-cold badass. Your immune system will not get a case of the vapors and lose its **** because of a MMR combination vaccine or anything like that.

You say that until there's evidence to prove that getting several vaccines on the same day is completely safe, you'll play it conservative and assume there's some danger. I could just as easily say that until there's evidence to prove that getting a bunch of vaccines on a bunch of different visits is completely safe, you should play it conservative and get all of the vaccines in one single visit so that you don't have to stretch it out over a long period of time when the immune system is being constantly tweaked. There's just as much logic or evidence to either choice, and the two are diametrically opposed to each other. There is no sound basis for the crap that you're saying.

 

[SpecterGT260]

basically the moral of the story is:

the non-physicians who are against it simply lack the imagination to envision all the various angles physicians have already approached this issue from

 

[Zoopeda]

I could just as easily say that until there's evidence to prove that getting a bunch of vaccines on a bunch of different visits is completely safe, you should play it conservative and get all of the vaccines in one single visit so that you don't have to stretch it out over a long period of time when the immune system is being constantly tweaked.

I don't have time to write essays addressed to every nay-sayer I encounter. I'm also not an expert in the field, just as most of you are not. Hence, my sense of caution. My current immunology professor earned her PhD at Yale pushing forth the theory that vaccines, in fact, pose a great risk to the potential development of childhood autoimmune/allergy conditions. To my knowledge, there isn't a comparable theory suggesting with any sound basis that giving every vaccine at once would decrease this same risk. Again, I'm not anti-vaccine, but to the Hep B gentleman who addressed me as uneducated, I believe you overlooked my suggestion to "test the moms." Indeed, if the infant is exposed to the Hep B virus, consequences are dire. But if we can be certain that an infant is A) not born to a mother with Hep B, b) not sexually active, and c) not sharing needles, then it seems very reasonable to delay this specific vaccine. (Similar cases can be made for other vaccines.) Again, disagreeing with the mainstream on SDN is a hugely time-consuming endeavor, so I'll bow out at this point and thank you all for the productive debate...

 

[BigRedBeta]

My initial complaint was with the aggressiveness of the vaccine schedule in the context of our current reality in America. Once a disease is completely eliminated from the continent (ie, Polio), then that vaccine can probably take a backseat to more pertinent vaccines (ie, Tetanus). Nowhere in nature do 5 different fatal infectious diseases infect an individual simultaneously.

No one is saying that 5 diseases are going to happen at once...that's a ridiculous statement to make and you know it.

In my opinion, we simply ought to stretch out the vaccine schedule in order to more accurately mimic the immune confrontation that exists naturally without over-stressing the child's immune system. at a given sitting doesn't significantly increase one's risk of autoimmune/allegy conditions, I play the conservative hand by spreading the vaccine schedule over a longer period. If an infant does not travel abroad, why in God's name do we need to give them the Polio vaccine at 2 months?

While there's not been a documented wild type polio infection in the US since 2000, the virus is still one of the most highly communicable diseases known, and there's no treatment other than supportive care - which does nothing to prevent the severe consequences/sequelae of infection. Sometimes the need for prevention has more to do with the long term consequences than the absolute risk of infection. For such a well tolerated vaccine why would you risk it?

We know for absolute certain that a child's immune system doesn't "mature" until 9-12 months of age (hence the AAP stance on nursing for 1 year).

Cite a source. To put it bluntly, you're 1)not actually aware of the AAP recommendations, and 2) don't understand what they actually mean in regards to the immune system.
While there's good evidence for a number of different disease processes (including obesity, and food allergy among others), that exclusive breast feeding to 6 months is beneficial, but after that there is limited support. The official policy statement says that breastfeeding should continue until a year but is essentially the same recommendation that formula should be continued to a year before transitioning to cow's milk. Regarding the immune system, the recommendation has little to do with the infants immune system not being mature, and far more to do with the supplementation of immunoglobulins from the mother. It's not that the immune system CAN'T mount a response, just that mom gives a helping hand.

Again, the vaccine schedule is set up in a manner which produces adequately desired immunogenicity for the most likely encountered illnesses at specific ages. This risk assessment is the exact reason why I start Ampicillin/Gentamycin in the NICU, Ampicillin/cefotaxime for my febrile neonates less than 6 weeks of age and only cefotax if they're over 6 weeks and show up with a fever in the ER. Specific infections are much more likely to happen at certain times. Likewise it's why kids over 2 don't get Haemophillus influenza Type B (HiB) injections even if they're behind and why we don't give rotavirus vaccines after 6 months of age whether they never started or never finished the (optional) vaccine sequence - it's a matter of risk assessment and when babies/children are most likely to have the greatest exposure, most benefit from a particular vaccine.

While there has been an increase in juvenile rheumatologic disease, I'd hardly say it's skyrocketing and without a doubt, the hygiene theory of autoimmune disease has a MUCH wider following and evidenced-based support than anything relating to vaccines does.

 

[tiedyeddog]

I don't have time to write essays addressed to every nay-sayer I encounter. I'm also not an expert in the field, just as most of you are not. Hence, my sense of caution. My current immunology professor earned her PhD at Yale pushing forth the theory that vaccines, in fact, pose a great risk to the potential development of childhood autoimmune/allergy conditions. To my knowledge, there isn't a comparable theory suggesting with any sound basis that giving every vaccine at once would decrease this same risk. Again, I'm not anti-vaccine, but to the Hep B gentleman who addressed me as uneducated, I believe you overlooked my suggestion to "test the moms." Indeed, if the infant is exposed to the Hep B virus, consequences are dire. But if we can be certain that an infant is A) not born to a mother with Hep B, b) not sexually active, and c) not sharing needles, then it seems very reasonable to delay this specific vaccine. (Similar cases can be made for other vaccines.) Again, disagreeing with the mainstream on SDN is a hugely time-consuming endeavor, so I'll bow out at this point and thank you all for the productive debate...

You haven't provided one source for anything you're saying. I don't care if your professor is from hahvad or hoboken community college, where's the sources indicating anything you're saying is true?

Here is the vaccine schedule for ages 0-6. http://www.cdc.gov/vaccines/recs/schedules/downloads/child/0-6yrs-schedule-pr.pdf.

Minus Hep B, which I know very little about, I'd say the rotavirus, DTaP, HiB, Pneumococcal, and inactivated polio are pretty important at as young an age as possible. Why do you keep indicating we should delay or spread them out in deliverance? What data do you have saying it's bad to lump them together at an early age?

Show us some data, we will back off.

 

[facetguy]

your logic would work except for all of the assumptions and misinformation in it. I have highlighted a couple of them.

just because YOU question the benefit doesn't mean the benefit is questionable. These things ARE researched. The problem with the people who support the anti-vaccine movement is they throw speculation on top of speculation until they have concocted this horror story and then grab ahold of an anecdote like the one a bit ago with meningitis and scream "A-HAAA!!" .... or.... something else..... but either way there is a grand gesture involved....



The underlying assumptions of your argument are:

1. benefit cannot exist in the presence of any downside or increased risk
2. potential downsides/risks include any chance Lim(1/x) as (x->infinity)
3. lack of evidence is evidence for

these are SEVERELY problematic assumptions (and as you guys get to know me around here you will notice.... I consider irrationality to be the omitted 8th deadly sin).

it all stems from something ive complained about in other threads.... many people have NO working concept of absolute and relative terminology. anyone currently taking EBM should be aware of what I mean.

a vaccine increases your chance of a crippling side effect by 1000% (relative) e-gads! (there really ought to be a face for that one....)

but lets say the initial risk was 1 out of 10 million (.00001%) Now our risk is 1 in 10 thousand (.01%). (absolute)

This is still basically no chance. And even with extreme numbers it isnt worth getting too excited about. so just because we can anecdotally claim an increase in shingles cases.... doesn't really mean we should forgo preventative treatment for the population at highest risk. if in another situaiton the numbers werent so nice we would turn to NNT and NNH analysis and make a judgement call. but at least for now it is blatantly inappropriate to turn to 1 or 2 anecdotal cases halt progress in its tracts.... at the very least if you want to cite anecdote you need to stack stories from the other sides as well. "I got the hep A vaccine and didnt get hep A". every bit as useless in this discussion....

The world is a different place because of the polio vaccine. The world is not very different because of the chickenpox vaccine.

 

[facetguy]

"Questionable" benefit? BS, you dont know what you are talking about. A 30 second internet search would have shown you several studies that show what the clinical efficacy is.

Fine I'll contribute all the work here since you are obviously too lazy to do any of the research yourself.

Vaccine reduced hospitalization greatly in the post-vaccine compared to pre-vaccine era.
http://www.medscape.com/viewarticle/735602

Study of 300+ kids shows 97% vaccine efficacy rate against "severe" varicella disease.
Link: http://www.nejm.org/doi/full/10.1056/NEJM200103293441302

Vaccine efficacy rate is approx 85% across all clinical spectra of disease.
Link: http://www.jpeds.com/article/S0022-3476(01)44558-6/abstract[/URL]

For the small number of vaccinated patients who contracted varicella, their clinical course was much less severe compared to the non-vaccinated group.
Link: http://www.sciencedirect.com/science/article/pii/0264410X9190189D

Seroconversion rates were very high in patient test groups; and again overall clinical efficacy was in the 80-90% range.
Link: http://jid.oxfordjournals.org/content/174/Supplement_3/S330.short

10 year follow-up rate after vaccination showed 95% efficacy; measurable serum antibody was found in all children 9 years after injection.
http://journals.lww.com/pidj/Abstract/2004/02000/Ten_year_follow_up_of_healthy_children_who.9.aspx

20 year follow-up study in Japan shows continued good titer response as well as clinical efficacy
http://pediatrics.aappublications.org/content/94/4/524.short

Markov model of 4 million patients validates benefits of varicella vaccination over risks (including increased risk of shingles).
http://cid.oxfordjournals.org/content/34/7/885.full

Thanks for doing all that heavy lifting. But what I meant by 'questionable benefit' was not that the vaccine doesn't create an immunological reaction. I was referring to the bigger picture issue of 'did we really need this'. And if it turns out that cases of shingles are increasing as a result, and I think we can all agree that shingles in an elderly person is considerably more problematic than chickenpox in a child, that would be a pretty unfortunate unforeseen complication.

 

[facetguy]

Your source is the CDC? Didnt you know they are engaged in a massive widespread conspiracy with pediatricians to deceive parents and make pharmaceutical companies rich?

What really makes me laugh is these parents like facetguy who think that pediatricians like me and the thousands of us across the United States would ignore evidence of harm and blindly vaccinate our own children simply because Merck and the CDC told us to.

I work in an academic group of over 50 pediatricians, all of whom vaccinate. Facetguy either thinks he's more informed/knowledgeable than all of us, or he thinks that we're all cronies of the pharmaceutical industry. Either way, its an absurd delusion.

The quip about buying Merck shares was an attempt at humor. Note the icon. (Are "academics" like yourself that bereft of humor?) And please don't misrepresent my position on this issue, as I am certainly not anti-vax. I do feel that the chickenpox vaccine is very likely unnecessary, and with all your wisdom you haven't convinced me otherwise.

 

[facetguy]

The toll that a vaccine takes on your body is nothing close to the toll that an actual dangerous infection takes. You mentioned earlier that you're educated on these matters, but you really don't seem to understand how the immune system works. When you get a vaccine, antigens are presented to your B cells, some of which recognize the antigen and proliferate. Some subset of those become memory B cells, providing longlasting immunity. That's it. There's no huge proliferation of neutrophils, there generally won't be massive secretion of inflamatory signals. Your T and B cells have no idea if the antigen they're seeing is a "fatal infectious disease" or not, other than by the sheer volume of antigen it sees and the coincident presence of other damage markers. Given that a vaccine injection does not consist of massive quantities of antigen, and given that there isn't likely to be a coincident infection causing widespread damage to body tissues, getting a vaccine is nothing at all like getting a "fatal infectious disease". It's actually more like getting a bit of crud into a small cut - some antigens show up in your blood. Only safer, because there's negligible risk of it turning into a widespread infection.

Understood, but let's not forget that there are indeed adverse reactions to vaccinations, albeit uncommon. Vaccines aren't magically benign interventions. The trick will be to figure out ahead of time who may be in the 'particularly susceptible to adverse reaction' category and work around them; this research is ongoing currently.