How do (would) you handle moms against vaccines

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shane_doc

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I belong to another website and this discussion came up among some mothers. I was suprised about the number of parents against vaccines. Also, Oprah was discussing autism today and there was a crying mom on there talking about how vaccines were not proven to be safe. Man, medical offices are going to be overflowing with parents asking about vaccines and autism in the next few months!! So I ask all the pediatricians (future and current), how do you deal with parents refusing vaccines?

Here are some websites that the moms were sharing with one another. Not all the information was accurate, some of it out of date. But I must admit, some of it I hadn't heard of it before, like the use of aborted fetus to produce vaccines.



http://www.informedchoice.info/cocktail.html

http://www.medalerts.org/
http://www.vaclib.org/

http://www.mothering.com/discussions/forumdisplay.php?f=47

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I know a couple of primary care practice groups in my area refuse to have kids as patients if the parents won't allow them to be vaccinated. I think it's irresponsible of parents not to vaccinate -- they are putting their kids at risk of serious diseases, and they're creating the conditions for outbreaks of serious diseases in the community, thereby putting others at risk.

I understand the emotional appeal of 'blaming' autism on some identifiable factor, like MMR vaccine, but this is NOT supported by the best available scientific data.
 
I'm not a pediatrician, so I won't answer the question you posed. However, I am a pharmacist & I give immunizations altho not to children & I'm constantly amazed at the amount of misinformation there is about vaccines.

However, I firmly believe in a parent's right to choose and there is no amount of convincing that individual who feels strongly. Given that, though, I do want to comment on your mention of abortions and immunizations. I apologize in advance for the length of this comment.

Bacterial vaccines can be grown in simple laboratory cultures. Viral vaccines cannot because they cannot reproduce on their own. They require a living host. Manufacturers have few options for viral culture because of pharmaceutical & human safety concerns. For example, varicella dos not grow well in most cells derived from species other than humans. Likewise, human cells are preferred becuase animal organs can carry viral pathogens harmful to humans.

Human diploid cells are batches of human cells grown in a laboratory. Two different strains of human diploid cell cultures made from fetuses have been used for vaccine production for decades. One was developed in the US in 1961 (WI-38) & the other in the UK in 1966 (MRC-5).

WI-38 came from lung cells of a 3 mo old female fetus & MRC-5 was from lung cells of a 14 wk male fetus. Both were intentionally aborted, but not for the purposes of obtaining diploid cells - for medical reasons of the mother or fetus.

These two strains have been growing in laboratory conditions for more than 35 years. These cells strains do not and cannot develop further. There is no need to abort additional fetuses to sustain the culture supply. These two strains of cell cultures have been used to prepare hundreds of millions of doses of rubella, hepatitis A, varicella and rabies vaccines..

The rubella vaccine was developed from tissue of a fetus from a mother infected with a wild-type rubella virus which caused birth defects in the fetus. This wild-type rubella virus was isolated and cultured in WI-38 cells. Other, non-human cells were tried, but did not produce antibody stimulus. These cells are still used in the manufacture of the only rubella vaccine available in the US & used in most of the world. Again - no further human cells are necessary.

In the future, it may be possible to manufacture these vaccines using molecular tools that do not require human cell culture. Hepatits B vaccines are made using these molecular biologic techniques that do not require animal cells at all, but for now, it is not possible to prepare most viral vaccines this way. RabAvert is a brand of rabies vaccine made by Chiron that is not grown in human diploid cells and it will eventually replace the old rabies vaccine.

Molecular biologists continue to attempt a way to use non-human methods to derive many types of drugs beyond just vaccines (insulin for example). But, to be clear - for these vaccines, the human diploid cells did indeed come from 2 aborted fetuses and the live virus from one, however, these abortions were not done for the purpose of drug discovery or development. They were done for medical reasons, related to the mother or fetus.
 
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that was really interesting stuff. Thanks!
 
I agree. Informative post sdn1977!

TiredPigeon, most of the pediatricians that I have worked with used that approach, but I'm worried that we will have to deal with more and more patients like this. I just think that pediatricians need to be better informed about vaccines. I guess what I'm trying to say is that I know how important vaccines are, but I want my patients to know as well. I want to be better prepared if I ever come across someone against vaccines. I've read the aap statement, but it sounds too general.
 
The problem with the argument of MMR leading to autism is that it is an argument you often cannot win. Bear with me on this...

There have been a number of large studies set up to compare vaccinated and non-vaccinated children and the subsequent rates of autism- the best one I am aware of is from NEJM 2002 ("A population study of MMR vaccination and autism) which compared relative risk of autism in vaccinated and unvaccinated children (sample size of 500,000 over 8 years) and found no difference b/w the two groups. See the cdc site for more studies (there are over 10 that specifically address this issue).

The problem is all of these studies fall prey to our scientific method. They can prove there is NO DIFFERENCE b/w the those who received MMR and those who did not...however, you cannot prove that MMR NEVER causes autism b/c that would be a flaw in statistical logic.

Think about it like this: Will some people who get MMR develop autism? Of course. Does that mean MMR causes autism? No- when you compare groups of people who have autism, equal numbers did and did not receive the vaccination. Okay, then prove that MMR NEVER causes autism. Impossible. MMR is not correlated with autism, but to prove that it DOES NOT CAUSE autism would require that NO ONE who received MMR ever developed autism.

The reason we lose this battle is we are too honest! Every good study performed has shown no link b/w MMR and autism, and that is what the scientific and medical communities say. Parents interpret that as meaning that "so far, we haven't found any proof, but they also haven't proven it wrong either." As I said above, we can't prove it wrong!!! Prove to me that breast feeding doesn't cause autism. You can't do it. Prove to me that being raised in America doesn't cause autism. You can't do it. However, show me whether the occurence of autism in breast feeding babies is higher than that in formula fed babies...this we can do.

We need to be blunt and give examples like the one above and we need to explain the results of NEJM study in a language that is more understandable. We need to explain that rates of polio (for example) have increased dramatically in populations who object to vaccinations ( JAMA 2000- those who refrained from measles vaccination were 22.9 times more likely to develop measles than those who received the vaccine).

The sad reality is that many people are scared and fear is illogical. We can attempt to discuss the myths, the reality, and the scientific evidence all we want, but for many people their mind is made up. Unfortunately it is this ignorance which is circulated on the websites you have described- passionate, angry, fearful parents who want something/someone to blame.
 
I agree. Informative post sdn1977!

TiredPigeon, most of the pediatricians that I have worked with used that approach, but I'm worried that we will have to deal with more and more patients like this. I just think that pediatricians need to be better informed about vaccines. I guess what I'm trying to say is that I know how important vaccines are, but I want my patients to know as well. I want to be better prepared if I ever come across someone against vaccines. I've read the aap statement, but it sounds too general.

I agree, and I wonder how I'll handle it when I'm actually confronted with it. Here's a related issue: I'll be in Africa this summer with a patient population that widely believes the vaccines we want to give their kids will cause HIV. Anyone have ideas on how to approach this dilemma in a productive and simultaneously culturally respectful way?
 
Even if there is one day proven to be a minor connection, which has never been found, the risks are FAR lower than the danger of disease and the resulting public health crisis caused by not getting vaccinated. I did a lot of research on this topic for a college course, and during one of the lectures, another student brought this up saying that she didn't vaccinate her kids because of this. I have encountered people like this through work also and I find all there argument to be the result of hype and scientific ignorance.
 
I agree, and I wonder how I'll handle it when I'm actually confronted with it. Here's a related issue: I'll be in Africa this summer with a patient population that widely believes the vaccines we want to give their kids will cause HIV. Anyone have ideas on how to approach this dilemma in a productive and simultaneously culturally respectful way?

I'll point you in a direction which was given to me by a colleague. The fear of HIV is very real for the entire population & is based, similarly to the fear of immunization, on misinformation and cultural as well as educational barriers.

Given that, there are many cultures within Africa & actually both the CDC & WHO have a presence there. You can go to the WHO website & go to the African Region & HIV (I can't remember if you click first on the disease or the region). The initiative is the 3 by 5 initiative, which was to treat 3 million people living in Africa by 2005 (I know - come & gone....). But, this site does have some links which might direct you to the cultural differences within the continent and educational resources used at the time. There is also a link to vaccinations and you can click on the African region, but this is more clinically relevant, not culturally, I believe.

The CDC, although a national organization, does also monitor world wide disease incidence, so its website has some links as well, although not as many as WHO.

Finally, you can check out the Bill and Melinda Gates Foundation website. Although their grant was for malaria prevention in Africa, I believe there are links on their website to nutrition and immunzation as well. This might give you some insight in addition to the other two.

Good luck - an admirable endeavor!
 
It seems that refusing vaccines is the new yuppy thing for internet 'informed' moms to do. I've spent lots of time presenting correct information to moms and discussing their concerns. Very few of them have ever changed their minds. There's always some website talking about the horrors of vaccines, despite our efforts to educate them.

Our clinic tries to give them correct information, but if they ultimately won't be convinced, then they're asked to find another pediatrician. This is mainly because we can't have their kids with pertussis (which is still prevelent) around our newborns in the waiting room, nor do we want them mixing with the heme/onc clinic which is right next door.

England went through a phase like this about ten years ago, and stopped vaccinating against pertussis. Guess what? Kids started dying of pertussis again.

Other attendings feel that each visit is a chance to change the parent's mind and that making them find another pediatrician is irresponsible. I can understand that, but I also can't deal with the headache of arguing about it at each visit. Not to mention that if they argue about vaccines, then they always argue about every other management decision, whether it's antibiotics or getting a chest x ray.
 
My policy is only hypothetical because as a resident, I'm powerless to implement it. If I were practicing as a general pediatrician I would kick a family out of my practice for refusing vaccinations. I wouldn't be because they were a PITA (pain-in-the-a**). I think its important to make it clear how important you feel. From my perspective, there is nothing I can do to protect their child more than vaccinating them. What advice are they going to listening to? Make sure you have window guards? Test the temperature of your water?

I would like tell them about the neurological devastated children I have cared for that had HIB meningitis as infants. The problem is that they don't have experience seeing that these diseases are dangerous.

Ed
 
There are lots of moms and dads out there who don't do things the way the AAP says they should. Deciding to refuse to be a pediatrician for their children is a right of the doctor (in a non-emergent setting), but may not be the best choice and one should pick ones battles carefully. Refusal to vaccinate may be the battle line, but, perhaps it's worth taking time to decide if a family can work with you on this (and you can help convince them) before sending them to someone else who won't make that effort.

Consider also when making absolute determinations that the situation is very often not an absolute one. Families may be okay with some vaccines and not others, or may wish to delay some vaccines for a while. Delaying Hep B and varicella vaccines may not be ideal but if one can agree to this in exchange for getting other vaccines on time, well, maybe it's not such a bad trade off?

Ultimately, both family and physician have to be comfortable with each others styles. If a family believes in attachment parenting, prolonged breast-feeding and delayed vaccination and you don't, then they might be better off elsewhere. But I think it is worth the effort to see if one can reach a compromise with some of these families, even if they don't do things just exactly the way the Red Book (this years copy) says.
 
OldBearProfessor: I would like to try to work with parents. But I'm worried about the consequences of letting a patient dictate what is considered to be the standard of care. Spreading out vaccinations seems a plausible solution.
 
IMHO,
One of the quirks about being a pediatrician is that you have to face the unavoidable task of telling their parent in one way or another "how to raise their kids". It is a trend old as time that parents know better how to raise their kids than anyone else in the world. The only thing we can do is continue to support an image of a doctor that knows what he is doing and that makes the parents believe we are advocates of their children. It seems that in today's society, the "cool" thing is to doubt everyone and believe we all have an agenda. The problem is that we are not the plumber, the lawyer or the painter. :cool:

:(
 
it is also important to ask the parents why they do not want their kid to be immunized. for example i had a 4 month old for a well child check and the parents didn't want him to receive his immunizations even though he received his 2 month ones. turns out he became so fussy after the first series the dad thought he would have a "nervous breakdown" if he had to go through it again! funny buy true. autism might not be the only factor in play.
 
OldBearProfessor: I would like to try to work with parents. But I'm worried about the consequences of letting a patient dictate what is considered to be the standard of care. Spreading out vaccinations seems a plausible solution.

As a parent and a physician I think we have to be careful about having the attitude that patients can't dictate their own (or their children's) care. It is precisely that benign paternalism that inspires patients to look elsewhere for answers- and often find them on the internet. Without a trusting relationship with their pediatrician, there will be no way for them to filter that information. Historically, the medical community has wholeheartedly embraced standards of care that now seem from the ridiculous to the dangerous, and I don't blame parents for wondering why we are so confident about these vaccines. When concerns come up I try hard to give them the evidence that they need, while also stressing the cases I have seen where children have been very ill from a vaccine preventable disease. I think it also has to be acknowledged that there are vaccine preventable diseases with a low enough prevalence in the community that each individual would be covered by "herd immunity" if they were not immunized (measles, diptheria) and at that point vaccines become a public health issue, rather than a personal health one (now, if they ever travel- like to Boulder CO :), it becomes a different story). As pediatricians we have to advise, not dictate care, unless it becomes truly a child protective issue.
 
As a parent and a physician I think we have to be careful about having the attitude that patients can't dictate their own (or their children's) care. It is precisely that benign paternalism that inspires patients to look elsewhere for answers- and often find them on the internet. Without a trusting relationship with their pediatrician, there will be no way for them to filter that information. Historically, the medical community has wholeheartedly embraced standards of care that now seem from the ridiculous to the dangerous, and I don't blame parents for wondering why we are so confident about these vaccines. When concerns come up I try hard to give them the evidence that they need, while also stressing the cases I have seen where children have been very ill from a vaccine preventable disease. I think it also has to be acknowledged that there are vaccine preventable diseases with a low enough prevalence in the community that each individual would be covered by "herd immunity" if they were not immunized (measles, diptheria) and at that point vaccines become a public health issue, rather than a personal health one (now, if they ever travel- like to Boulder CO :), it becomes a different story). As pediatricians we have to advise, not dictate care, unless it becomes truly a child protective issue.

Wonderful response. I agree with it entirely. Even in specialty care or care of sick children, we have to acknowledge the role of informed consent and when we can "force" - or let families know that we are obligated to take legal action if they refuse our "plan", when we can "very strongly" opinion, and when we must recognize that families have a right to say "no" to our view. So too, must we decide when these decisions affect our ability or desire to continue to be care-givers. These are not easy decisions, especially in a hospital setting where it's not simple to "fire" a patient/family!

By the way, in an NICU, it is more common in my experience for a family to demand a therapy we can't give (off-season Syangis for RSV) than to refuse immunization.
 
Authors
Stehr-Green P. Tull P. Stellfeld M. Mortenson PB. Simpson D.
Authors Full Name
Stehr-Green, Paul. Tull, Peet. Stellfeld, Michael. Mortenson, Preben-Bo. Simpson, Diane.
Institution
Department of Epidemiology, School of Public Health and Community Medicine, University of Washington, Seattle, WA, USA. [email protected]
Title
Autism and thimerosal-containing vaccines: lack of consistent evidence for an association.[see comment].
Comments
Comment in: Am J Prev Med. 2004 Jan;26(1):91; reply 91-2; PMID: 14700719
Source
American Journal of Preventive Medicine. 25(2):101-6, 2003 Aug.
Local Messages
WEB ACCESS. PRINT NO LONGER RECEIVED. TW HAS OLDER VOLUMES
Abstract
BACKGROUND: In 1999, concerns were raised that vaccines containing the preservative Thimerosal might increase the risk of autism and/or other neurodevelopmental disorders. METHODS: Between the mid-1980s through the late-1990s, we compared the prevalence/incidence of autism in California, Sweden, and Denmark with average exposures to Thimerosal-containing vaccines. Graphic ecologic analyses were used to examine population-based data from the United States (national immunization coverage surveys and counts of children diagnosed with autism-like disorders seeking special education services in California); Sweden (national inpatient data on autism cases, national vaccination coverage levels, and information on use of all vaccines and vaccine-specific amounts of Thimerosal); and Denmark (national registry of inpatient/outpatient-diagnosed autism cases, national vaccination coverage levels, and information on use of all vaccines and vaccine-specific amounts of Thimerosal). RESUL!
TS: In all three countries, the incidence and prevalence of autism-like disorders began to rise in the 1985-1989 period, and the rate of increase accelerated in the early 1990s. However, in contrast to the situation in the United States, where the average Thimerosal dose from vaccines increased throughout the 1990s, Thimerosal exposures from vaccines in both Sweden and Denmark-already low throughout the 1970s and 1980s-began to decrease in the late 1980s and were eliminated in the early 1990s. CONCLUSIONS: The body of existing data, including the ecologic data presented herein, is not consistent with the hypothesis that increased exposure to Thimerosal-containing vaccines is responsible for the apparent increase in the rates of autism in young children being observed worldwide.
 
Hello...I am responding to the question,"...How do I respond to a mother who does not want her child vaccinated...?".

The most important thing I would do is to honestly step back for atleast one moment from your preconceived notions and evaluate why in fact should she?

I would then begin to research unceasingly the vast amount of information out there on vaccines. ...ESPECIALLY, if this is going to be a topic that you wil be dealing with on a regular basis. As students in the health field it is vital to realize the sources from which you are learning as well as the funding behind the sources. Ultimately, the best way to test the efficiency is if it in fact brings health right? Is it really creating a healthy person. Or is it giving a false sense of health via drugs and immunization?

There are numerous studies to date showing that there was a natural decline in the incidences of many of these diseases, well before the advent of the vaccine. In addition there are numerous studies showing that entire populations that have been vaccinated have had epidemics of the very disease vaccinated against. There are also studies showing that there are also negative side effects.

Why are these studies not well known? Perhaps think a minute about the quality of food served in hospitals. My mother in law was offered a cookie and coke after chemo. Cancer thrives in acidic conditions. Think about how many classes on nutrition you are given in pre med and in medical school. Is there more of a focus on drugs than herbs? We are not taught about these more benign and safe ways to help others health. We are not taught about juicing and fasting. We are taught to use drugs. We must realize that it is not like this in every country. Other countries have more of a integration of herbs, acupuncture, etc. Germany has one of the most extensive data bases of herbs and there medicinal value. We on the other hand rank in the thirties in overall health care though we spend the most money. The only way that our health will truly move forward is for the emerging students to learn what in fact builds true inner health and vitality.This is desperately needed in a time where more and more children are afflicted by cancer, obesity, diabetes, cardiovascular issues. We must look for new answers.


Now for the studies....
http://www.whale.to/a/blaylock.html
http://www.whale.to/v/mend.html
http://www.whale.to/vaccines/stewart.html
http://www.whale.to/m/levy1.html

There are also many doctors who have spoken out about vaccines. Some began believing in them yet as learned more and more they changed their opinions. Some important doctors who hold/held this belief include Philip Incao M.D., Russel Blaylock M.D.,Dr. Mendelsohn M.D> a pediatrician for may, many years,Michel Odent http://www.thinktwice.com/sids.htm.....the lsit goes on. It is important to note that most if not all of these are highly successful doctors, who have been in this profession for a long time. They have experience. They are ones that incorporate diet and lifestyle. Philip Incao for instance only sees 4 patients a day so that he can have a 1 and a half hour visit with them. These are not doctors who are ignorant and uncaring. Other doctors have been known to take a more conservative approach...and only give some of the vaccines and to do so when the children are older....as is Dr. Sears M.D> approach. He is a foremost expert on infant care.

My greatest desire is to not simply change people's opinion. My desire is to get people to think and to get the information out there so people can think.To extract oneself from there group of influence and be willing to look outside of the box.People are demanding that this occurs.We HEar of these horrible deaths from these diseases. I live in a more rural area where there is a high percentage of alternatively minded people. There was a breakout of whooping cough. I personally saw a range of responses. ...from using antibiotics given to" prevent any 2nd hand infection" to herbal approachs. The children who used the herbs and nutrition fared teh best.The one on antibiotics has been given multiple antibiotics for numerous things and has a poor diet. SHe has chronic immunity issues. and just keeps going to the doctor.The tragic deaths that we hear about typically occur in lower income families where sanitary condtions as well as dietary requirements, etc, are POORLY lacking and to be sure the amount of deaths is relatively very low.

One last note is that modern medicine has been largely based on Pasteur'sidea of protecting from the outside...protecting us from all of those terrible germs....His rival Antoine Bechamp always said, it is the inner terrain and the strength of this that decides one's health. On his death bed Pasteur changed his mind to agree with Bechamp. Unfortunately, mainstream medicine did not follow suit. We would have much more success if we were to spend the millions and billions of money on organic gardening, excercise programs, stress relief, parental skills,nutrition, and herbal knowledge than on immunization and drug use. SO the next time a mother says that she does not want to immunize perhaps just for a moment realize that she may not be some fanantical health nut but may in fact be on to something. The old time healers such as Norman Walker who lived to well over 100 as well as others all stated that vaccines poisoned the blood and that the blood was the river of life.IN our nation it is normal to live to 70 on multiple drugs....cancer, diabetes, etc, are par for the course. We have to realize that this is not the case. It is good to study long lived cultures and see that those who routinely live long...do not have extensive medical institutions, are not wealthy etc...they instead have pure water, pure food(pesticide free), pure air, excercise, sunlight, reflection, community, etc.....This is what we need for true healing.
 
I'll leave the anti-vaccine post up as it's useful for some to see the way these arguments are developed, but if this turns into a debate about vaccines, it needs to be moved to the "Topics in Healthcare".

Any detailed rebuttal should be there with a link placed to the rebuttal from this thread (or else they'll be deleted). Any future arguments against vaccination will be deleted with a PM to the author to start a new thread in Topics in Healthcare.

My suggestion is to get back to the topic. The pros and cons of vaccination are debated in about 1000 places/square-click on the internet. Let's discuss how pedis should deal with it, not the specifics pro and con.
 
Thank-you. I appreciate your response. My main point is, that it is valid to be ok with not using vaccines and potentially even health affirming. My intention was to support this by showing examples of highly intelligent medical professionals. This is how they deal with a mother that does not want vaccines. They support and validate this decision.It is only logical that our actions stem from what we think is normal,possible and in this case the best thing for the patient's health.
 
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