Not immune to criticism
February 15, 2012 1:53 PM   Subscribe

Vaccinate, or begone. Some pediatricians are refusing to see children whose parents refuse to allow vaccination.
posted by bitmage (344 comments total) 31 users marked this as a favorite

 
As patients have become savvier and more willing to challenge doctors, physicians have become increasingly reluctant to deal with uncooperative patients

Every business has to figure out how to deal with uncooperative customers, and refusing to put up with them seems fair to me. We all only have so many hours in the day.
posted by ThePinkSuperhero at 1:57 PM on February 15, 2012 [53 favorites]


People who believe that not vaccinating your kids is less dangerous than vaccinating them have been looking at/given horribly inaccurate information.
posted by ZaneJ. at 1:58 PM on February 15, 2012 [30 favorites]


Good.
posted by wuwei at 1:58 PM on February 15, 2012 [83 favorites]


I don't know. Seems to punish the poor kids even more, doesn't it?
posted by Think_Long at 1:59 PM on February 15, 2012 [7 favorites]


About fucking time.
posted by kmz at 1:59 PM on February 15, 2012 [4 favorites]


If you really want to get the anti-vaxxers in a tizzy you make them pay higher premiums for refusing to get MMR and Polio vaccinations.
posted by Burhanistan at 2:00 PM on February 15, 2012 [121 favorites]


"Hey, our waiting room full of sick kids? Come on, bring your unvaccinated children in here."

Nah.
posted by Pope Guilty at 2:00 PM on February 15, 2012 [27 favorites]


Yeah, really don't see a problem with this.
posted by Oktober at 2:01 PM on February 15, 2012


Seems to punish the poor kids even more, doesn't it?

You either punish them, or the other kids in the waiting room.
posted by Horace Rumpole at 2:01 PM on February 15, 2012 [24 favorites]


Seems to punish the poor kids even more, doesn't it?

What? How? The move to not vaccinate is a political/misinformation campaign. It has nothing to do with rich vs. poor. In fact, some champions of anti-vaccine things are rich celebrities ala Jenny McCarthy.
posted by OnTheLastCastle at 2:01 PM on February 15, 2012 [5 favorites]


I don't know. Seems to punish the poor kids even more, doesn't it?

This is a protection for their other patients who can't be vaccinated.
posted by Mitheral at 2:01 PM on February 15, 2012 [17 favorites]


Seems to punish the poor kids even more, doesn't it?

It punishes all children, to a degree, if some are deliberately unvaccinated. Perhaps to a greater extent.
posted by Blazecock Pileon at 2:01 PM on February 15, 2012 [5 favorites]


What? How? The move to not vaccinate is a political/misinformation campaign. It has nothing to do with rich vs. poor.

Poor as in unfortunate not as in lacking money.
posted by Mitheral at 2:02 PM on February 15, 2012 [11 favorites]


So the doctors are refusing to deal with patients who absolutely refuse their medical advice? Good for them --- after all, why bother trying to deal with people who
a)will not cooperate with the doctor, but will complain if their children get sick, and
b)endanger the cooperative patients by refusing to be vaccinated and then bringing their (avoidable) illness into the doctor's waiting rooms.
posted by easily confused at 2:02 PM on February 15, 2012 [6 favorites]


This makes me uneasy in the same way that pharmacists refusing to fill birth control scrips makes me uneasy.
posted by logicpunk at 2:02 PM on February 15, 2012 [11 favorites]


Dr. Diekema wrote the AAP's policy on working with vaccine refusers, which recommends providers address the issue at repeated visits, but respect parents' wishes unless it puts a child at risk of significant harm.

Yeah I'm pretty sure leaving your kids wide open to catching diseases we haven't had to deal with since the Model T is putting them at risk of significant harm.
posted by griphus at 2:02 PM on February 15, 2012 [21 favorites]


I have mixed feelings about this. It's less than ideal in terms of public health (you want to keep people in the health system, even if their participation isn't always ideal), but the potential harm to patients who can't be immunized (due to age or immune status) also has to be considered.
posted by rtha at 2:04 PM on February 15, 2012 [4 favorites]


This makes me uneasy in the same way that pharmacists refusing to fill birth control scrips makes me uneasy.

If you're concerned about spreading measles/mumps/polio/whatnot to kids who can't be vaccinated for legitimate medical reasons, it's either this or build a separate, hermetically sealed office for the anti-vax'ers.
posted by Holy Zarquon's Singing Fish at 2:05 PM on February 15, 2012 [26 favorites]


Don't public schools insist on all kids being immunized?
posted by crunchland at 2:05 PM on February 15, 2012 [1 favorite]


Good for them.

I can't express how frustrating it is as a care provider when people refuse to vaccinate, especially given that (in my limited experience) it tends to be more educated, zealous parents who are most likely to pose problems -- people who should know better, in other words, but have somehow been taken in by the abundance of anti-vacc FUD out there in the world.
posted by killdevil at 2:05 PM on February 15, 2012 [1 favorite]


This makes me uneasy in the same way that pharmacists refusing to fill birth control scrips makes me uneasy.

Unless you can demonstrate that those pharmacists are refusing to fill birth control because they're worried about patients' health, that doesn't make sense.
posted by kmz at 2:06 PM on February 15, 2012 [40 favorites]


Don't public schools insist on all kids being immunized?

No, religious freedom exemptions are widespread in the U.S.
posted by killdevil at 2:06 PM on February 15, 2012 [2 favorites]


This makes me uneasy in the same way that pharmacists refusing to fill birth control scrips makes me uneasy.

Are the two other unrelated thing that also make you uneasy because of a very loose, metaphoric connection?
posted by Bunny Ultramod at 2:07 PM on February 15, 2012 [7 favorites]


I don't know. Seems to punish the poor kids even more, doesn't it?

That's not what "punish" means. The responsibility for children's well-being lies with parents or legal guardians. If they choose to be profligate in their responsibilities by not vaccinating their children, that's gross neglect, not punishment; and if doctors refuse to endanger other patients by having unvaccinated people in their waiting rooms, they're simply protecting their own patients, as is their professional responsibility. The kids aren't being punished but they sure are getting screwed, and their parents are the ones responsible.
posted by clockzero at 2:07 PM on February 15, 2012 [12 favorites]


Oh, I see what you were saying now, think_long. Sorry.

This makes me uneasy in the same way that pharmacists refusing to fill birth control scrips makes me uneasy.

Not really the same situation at all. Here the doctors are saying, your children are at risk and a danger to others, and the parents are refusing to acknowledge that. The doctors are concerned with the patients health.

In the abominable birth control refusals, the pharmacist is refusing to provide legally available preventative care. The pharmacist here isn't concerned with the patients health.

So we're not on a slippery slope. The world before we could vaccinate for these diseases and illnesses was much worse than it is after we gained this power.
posted by OnTheLastCastle at 2:07 PM on February 15, 2012 [18 favorites]


pharmacists refusing to fill birth control scrips

This happens?
posted by Summer at 2:08 PM on February 15, 2012 [1 favorite]


It's not at all your fault, bitmage, because I should have known better, but I'm afraid I will always hold your posting of this article against you as it led me to the comments below it.

Please, for the love of God, let my mental well-being be the only casualty today, and don't follow my lead. I feel like Willow's girlfriend after Glory zapper her brain.

Rather than a pharmacist refusing to fill a script they find morally problematic, I think the more accurate metaphor would be: "I can't help you if you're going to keep using the hard drugs you are using the way you are using them," as I've known a doctor to say. And he was right and within his rights to refuse. I look at these doctors in the same way. Fucking heroes who care more about helping people than cashing a check.
posted by MCMikeNamara at 2:08 PM on February 15, 2012 [10 favorites]


tends to be more educated, zealous parents who are most likely to pose problems -- people who should know better, in other words

There are even doctors who are anti-vax...
posted by wildcrdj at 2:09 PM on February 15, 2012


Personally, we gave our child all the vaccines except for Hep B when she was a baby. She got it when she turned old enough to potentially be exposed to it through sex or drugs. This annoyed my doctor, who turned out to be a big Hep B supporter. By the way, my brother, a doctor specializing in infectious diseases, also waited until his kids were older before he gave them Hep B vaccines. I'm not an autism nutjob, just didn't want to give my kid a vaccine that appeared to be unnecessary at her age. I'm pro-vaccine, but I don't think all doctors are always right, either.
posted by kozad at 2:10 PM on February 15, 2012 [5 favorites]


pharmacists refusing to fill birth control scrips

This happens?


Unfortunately. :( It has happened in more conservative, often small town type situations.

Article on bills proposed allowing refusal on moral grounds. I have no idea if they came to pass anywhere.
posted by OnTheLastCastle at 2:10 PM on February 15, 2012 [1 favorite]


Well, shit. This even makes me feel bad about forgetting to get a flu jab.

But yeah, good. Would that more doctors did it and that might drum out this ridiculous (and ridiculously dangerous) fad.
posted by supercres at 2:11 PM on February 15, 2012


This happens?

Happened at an Eckerd's Drugstore up the street from me when I lived in Denton, TX — a rather high profile case.

So high profile, in fact, that I believe it was one of the reasons there are no more Eckerd's Drugstores.
posted by kaseijin at 2:11 PM on February 15, 2012 [8 favorites]


Our side, growing a spine?

REJOICE!
posted by Slackermagee at 2:11 PM on February 15, 2012 [8 favorites]


> She got it when she turned old enough to potentially be exposed to it through sex or drugs.

First time I read this, I figured you meant she got the disease, not the vaccine (heaven forbid).
posted by blue t-shirt at 2:12 PM on February 15, 2012 [1 favorite]



Personally, we gave our child all the vaccines except for Hep B when she was a baby. She got it when she turned old enough to potentially be exposed to it through sex or drugs

A significant percentage of children get it through casual contact while they're growing up, IIRC (meaning through sharing food, toothbrushes, or the like). I'll see if I can find the cites for that. Not to criticize your decision, but it's a lot more complicated than a doctor being wrong or right.
posted by the young rope-rider at 2:16 PM on February 15, 2012 [15 favorites]


It has happened in more conservative, often small town type situations

I'd heard of refusing the morning after pill, but contraceptive?
posted by Summer at 2:16 PM on February 15, 2012


This makes me uneasy in the same way that pharmacists refusing to fill birth control scrips makes me uneasy.

It shouldn't. Pharmacists refusing to fill birth control (or abortion pill) scrips are doing so for reasons that are external to the practice of their profession, which is what makes their reasons problematic, at best.

A doctor refusing a patient who won't vaccinate is refusing service to someone who's trying to pick and choose the advice and expertise they're being given. The doctor's reasons are internal to her profession, and part of doing her job conscientiously.
posted by fatbird at 2:18 PM on February 15, 2012 [2 favorites]


No, religious freedom exemptions are widespread in the U.S.

Mandatory Immunization Laws and the Role of Medical, Religious, and Philosophical Exemptions [PDF]
...A number of state courts have applied this reasoning in holding
that mandatory vaccination of school children does not interfere
with the right to religious freedom. As the Arkansas Supreme
Court noted in one such instance, "In cases too numerous to
mention, it has been held, in effect, that a person's right to exhibit
religious freedom ceases where it overlaps and transgresses the
rights of others."

While it is widely agreed that states do not have a constitutional
obligation to enact religious exemptions, it is somewhat less settled
whether states have the constitutional authority to enact them in the
vaccination context. The Mississippi supreme court has held that
religious exemptions to compulsory vaccination violate equal
protection of the laws under the Fourteenth Amendment inasmuch
as the exemptions "require the great body of school children to be
vaccinated and at the same time expose them to the hazard of
associating in school with children exempted . . . who had not been
immunized as required by the statute." Mississippi is one of two
states that do not permit non-medical exemptions
(as of 7/1/02).
One of only two states. :o

Speaking of 19th-century disease outbreaks...
posted by lemuring at 2:19 PM on February 15, 2012 [2 favorites]


A friend of mine is a pediatrician and her practice has been doing this since my 10-year-old was a baby. They have a sign by the check-in desk that says they will give you a certain amount of time to get into compliance, and if you don't they'll give you 30 days to find another doctor--during that 30 days, they will treat for illnesses and emergencies but not do routine checkups. I have a number of acquaintances who don't vaccinate, and for the decade I've been a parent, they've always had trouble finding doctors for their kids.

I also have mixed feelings about it. One thing I see happening is that my acquaintances who don't vax all end up seeing the same one or two marginal nutjob practitioners, driving half an hour or 45 minutes to do it. So they don't have a local doctor, and their kids are being cared for by doctors who have very unconventional theories about medicine. In one case, on a local e-mail list, people were talking enthusiastically about a doctor about 30 miles from here who, I had recently read, had been fined for all kinds of ethics violations. On the other hand, I'm not a pediatrician dealing with this all the time, and while I'd prefer that people's kids could stay in the practices of better doctors, I don't know that I can blame a doctor for getting fed up and just not being willing to do it anymore.
posted by not that girl at 2:19 PM on February 15, 2012 [7 favorites]


Well, shit. This even makes me feel bad about forgetting to get a flu jab.

Not to derail but I've never thought about flu shots ~~ vaccinations with regards to other's risk factors. I don't get flu shots because they tend to make me feel like total crap. I'm personally ok with running the risk of getting the flu and feeling marginally worse, but with a less than 100% incident rate. Anyway, am I, by proxy, helping infect others? I mean, I just don't equate a smallpox vaccine with a flu shot with regard to implications for the general populace/exposure. Bonus points for hard data since that would be really interesting to look at...

If it matters, I isolate myself when, every third or fourth year, the symptoms show up and I get sick with that year's strain and don't leave home until I'm completely over it + 1 day. I'm also in an age/health group that means I'm at low risk for complications. Oh and I don't have kids or visit the elderly or pregnant populations either...
posted by RolandOfEld at 2:20 PM on February 15, 2012 [2 favorites]


On a related note.
posted by jason says at 2:21 PM on February 15, 2012


(I should have said early 20th-century disease outbreaks. Please don't derail.)
posted by lemuring at 2:24 PM on February 15, 2012


I'd heard of refusing the morning after pill, but contraceptive?

Story from USA Today from November of 2004. So this has been going on for a while.
For a year, Julee Lacey stopped in a CVS pharmacy near her home in a Fort Worth suburb to get refills of her birth-control pills. Then one day last March, the pharmacist refused to fill Lacey's prescription because she did not believe in birth control.
posted by mephron at 2:26 PM on February 15, 2012


I'd heard of refusing the morning after pill, but contraceptive?
There have been at least a couple of cases, yeah. Here's an article about one of them, which I think prompted the whole movement to allow pharmacists to opt out of filling birth control prescriptions.
posted by craichead at 2:27 PM on February 15, 2012


I think the unease comes from the idea that: a) the published best practice is to continue to work with families and educate them. And: b) these families are just a pain in the butt and the waiting room concern is a retroactive rationalization. Both the kid with the anti-vacc parents and the kid with the legit inability to be vaccinated are subject to unhealthy forces outside of the child's control and both kids are equally potential vectors.
posted by Skwirl at 2:29 PM on February 15, 2012 [2 favorites]


God Darwin works in mysterious ways.
posted by HuronBob at 2:29 PM on February 15, 2012 [5 favorites]


I wonder if insurance companies will start to refuse to pay for the care required due to illnesses that could have been prevented via vaccines? Or a rider for those parents to pay more on their insurance?
posted by stormpooper at 2:30 PM on February 15, 2012 [9 favorites]


You know what, now that I think about it, there is an analogy between antivax and moral crusader pharmacists: both antivax parents and those pharmacists are people with power denying medicine to vulnerable people.
posted by kmz at 2:30 PM on February 15, 2012 [17 favorites]


Maintaining herd immunity is a valid practice, based on well known, long established fact, and there is plenty of research on the subject. It has nothing to do with moral grounds. It's not the same argument.

Not to mention the fact that children are being subjected to the beliefs of their parents - there are a number of cases where the parents were subject to criminal prosecution for denying children medical care.
posted by Xoebe at 2:31 PM on February 15, 2012 [4 favorites]


I totally agree with the reasons for not wanting the unvaccinated in a pediatrician's office. If the office is in a city full of doctors, then it probably doesn't affect the parents all that much if a handful of pediatricians refuse to treat their kids - maybe it's a hassle to drive a few extra miles, but ultimately no big deal. On the other hand, if it's the one pediatrician in the entire county, that becomes a problem. Is it okay for a pediatrician to refuse to treat a kid because of the parents' stupid beliefs when there's no other way for the kid to get medical attention? Seems like no.
posted by logicpunk at 2:37 PM on February 15, 2012


I understand why a doctor would feel driven to this, but I find it hard not to be disturbed at the idea of blameless children being made still further isolated from sane medical practices. I don't buy the "danger to the waiting room" thing at all. Doctor's offices are hardly the only places unvaccinated and unvaccinatable children come into contact, and the illnesses vaccines protect against are not the only medical risks waiting rooms pose to vulnerable children.
posted by two or three cars parked under the stars at 2:41 PM on February 15, 2012 [2 favorites]



I wouldn't want an unvaccinated kid, sitting next to a kid who's too young to be vaccinated. That's the big issue here. If you've decided not to vaccinate, okay (actually, not okay, but I only have enough strength to fight my battles 5 at a time), but you don't have the right to let your kid give an infant or a vaccine allergic kid, mumps, or measels or what all.

Bells should be going off for you. If 99% of medical professionals favor vaccination, and you're finding it harder and harder to get a good doctor for your kid, doesn't that tell you that perhaps the wackadoodle vaccine thing is maybe not a good idea?
posted by Ruthless Bunny at 2:44 PM on February 15, 2012 [12 favorites]


This is a really complicated issue, and although I sympathize with all those here who are applauding doctors who refuse to see anti-vaccine patients and their unvaccinated children, I don't think I quite agree with them.

logicpunk: “This makes me uneasy in the same way that pharmacists refusing to fill birth control scrips makes me uneasy.”

First off, I'm not really uneasy with this. We should note that this is a somewhat separate issue from the issues pharmacists face. Doctors already unquestionably have this freedom. A doctor can refuse to see Mormon patients, or refuse to see Republican patients, or refuse to see poor patients. These things happen all the time; and this freedom doctors have is commensurate with the fact that they are free human beings, and can treat people on whatever terms they choose.

That doesn't mean they're doing the best thing for their patients if they charge $100,000 for a vaccination, or whatever.

supercres: “But yeah, good. Would that more doctors did it and that might drum out this ridiculous (and ridiculously dangerous) fad.”

I really don't think this is true. In fact, I think this is likely to make the problem worse in the long-term.

The problem is this: a small but vocal group of parents have for some years become paranoid, equating vaccines with doctors and doctors with pharmaceutical companies and pharmaceutical companies with corporate greed that endangers the welfare of patients. Their paranoia is somewhat well-placed as far as the pharmaceutical companies bit is concerned; but the trouble is that they generalize that to wonder if all vaccines are destructive and might cause terrifying diseases. This is uninformed paranoia, and I think we're all pretty clear on that.

So what's the solution to this problem?

I would say there is really only one valid solution to this problem: intelligent, thoughtful doctors who take it upon themselves to educate their patients and show them that their paranoia is unfounded. This is in particular the purview of pediatricians and family doctors.

Now, I realize that lots of doctors will respond that this isn't really their job. And I grant that, for some doctors, having to educate people and spend all that time overcoming bias and uninformed paranoia is a waste of time and might be a distraction from patients that need them more. And, again, I don't think it's really the duty of doctors to try to bring every patient they see around to the light side.

However, as a doctor friend of mine (who is in her residency as a family doctor) once put it: if she turned away everybody that had uninformed and sometimes paranoid-delusional opinions about medicine, she'd probably turn away every patient that walked into her offices. She sees it as her job, first, to try to educate patients; and second, to try to help them as much as she can. She says that patients are always going to do stupid things, and it's not on her if they do that when they walk away from her, but she's going to do everything she can when they're in her office to convince them to approach medicine in the most healthy way possible.

I think that's a pretty good way to deal with it. I'm not a doctor, but I do believe that it's only through doctors carefully educating the public that we'll ever be rid of the anti-vaxxer nonsense.
posted by koeselitz at 2:45 PM on February 15, 2012 [6 favorites]


My pediatrician has a big sign on the door that says in all caps and bold letters "If your child has a rash, do not come into the lobby. Ring the bell and come around to the back." Refusing to see unvaccinated kids seems a logical extension of that. Ideally, it might result in some parents who re-considering their position.

But I'm a bit hardcore on the idea, I think the religious exemption for public schools is idiotic. If you don't want to vaccinate, you get to homeschool. (Kids who are unable to be vaccinated for medical reasons exempted, of course.)
posted by ambrosia at 2:46 PM on February 15, 2012 [3 favorites]


Not to derail but I've never thought about flu shots ~~ vaccinations with regards to other's risk factors.[...] Anyway, am I, by proxy, helping infect others?

Can't help you with hard numbers but in BC if you live with or care for someone with a weakened immune system; or with a fairly extensive list of conditions you qualify for the flu shot. Conditions include asthma and pretty well any heart or lung condition. Theory being that if they get the flu it is so bad that it is better to take all reasonable steps to prevent transmission.
posted by Mitheral at 2:46 PM on February 15, 2012 [3 favorites]


This happens?

According to this article, "The issue of pharmacies refusing to fill prescriptions for contraceptives came to light in 1996... when a pharmacist was fired from a Cincinnati Kmart after refusing to fill a prescription due to her own religious beliefs. Refusals have been documented in 19 other circumstances in several states, including Texas, Wisconsin and Massachusetts. The problem, while perhaps not routine, is no longer unusual."

It probably goes without saying, but any successes by the "Personhood" movement will open the doors wide open on this. Here's PersonhoodUSA.com spokesman Wayne Hoye on NPR's Diane Rehm show:
HOYE: Any birth control that ends the life of a human being will be impacted by this measure.

REHM: So that would then include the IUD [intra-uterine device]. What about the birth control pill?

HOYE: If that falls into the same category, yes.

REHM: So you’re saying that the birth control pill could be considered as taking the life of a human being?

HOYE: I’m saying that once the egg and the oocyte come together and you have that single-celled embryo, at that point you have human life, you’ve got a human being and we’re taking the life of a human being with some forms of birth control and if birth control falls into that category, yes I am.
PersonhoodUSA's pledge to these ends has been signed by Gingrich, Santorum and Paul (with an addendum). Romney says he supports it but that it's a state-level issue, so hasn't signed it... and there are a lot of right-wingers who are not too happy about that.

It seems to me that there is a real distinction between the consensus of scientific medical opinion on what supports the greatest possible health of patients, in the case of vaccination... and a religiously-motivated judgment call by a pharmacist that is at odds with the (current, knock wood) law.
posted by argonauta at 2:49 PM on February 15, 2012 [5 favorites]


I guess my concern is this bit:
As patients have become savvier and more willing to challenge doctors, physicians have become increasingly reluctant to deal with uncooperative patients, said Arthur Caplan, a bioethics professor at the University of Pennsylvania. In addition, doctors may feel financial pressure to see more patients and so have less time to contend with recalcitrant ones.
I think anti-vaxxers are nutcases, and I have a hard time sympathizing with them. But I have been a recalcitrant patient, and I've had doctors attempt to bully me into taking medication that fucked with my body and that I wasn't convinced I needed. (In my case it was steroids for something that did, in fact, turn out not to be autoimmune. And my doctor really did treat me like shit in an attempt to humiliate and bully me into taking them. For instance, he implied that I was vain and that my opposition was just because I didn't want to gain weight and get acne, not because steroids fuck with one's body in all sorts of non-cosmetic ways.) And while it's all much more complicated when there are kids involved and when it's a communicable disease, I'm not 100% sure I love the idea of doctors using the power to "fire" patients to coerce them into following treatment plans that the patients reject. It's my body, and I maintain that I have the right to have final say about what happens to it. And that doesn't negate my right to get medical care.
posted by craichead at 2:51 PM on February 15, 2012 [11 favorites]


Anti-vaxxers are not just nut cases. They cause illness (and eventually death) of innocent children. They should be locked up.
posted by patrick54 at 2:57 PM on February 15, 2012 [4 favorites]


craichead, there's a big difference between being an adult, engaged in their own medical treatment, who is occasionally recalcitrant/difficult/whatever, when the only person bearing the consequences is yourself, and anti-vaxers, who externalize the costs of their decisionmaking onto innocent bystanders.

I don't see this as bullying. I see this as an attempt at placing the costs of choosing not to vaccinate their kids on the people making the decision.
posted by ambrosia at 2:57 PM on February 15, 2012 [13 favorites]


First, regarding herd immunity and vaccines: I am a strapping (relatively) young healthy man - pretty much the lowest risk category for flu causing significant morbidity or mortality that there is. However, I spend every day with people who have HIV/AIDS and believe that it would irresponsible for me not to get the flu shot because of the herd immunity. Ditto every other vaccine that is reasonably transmittable. I am not likely going to get the disease, but my patients are very likely to. Herd immunity is critical.

Second, I hear consistently that people believe that pediatricians are hawking immunizations for children in order to make money. This is patently absurd in so many ways. First reason is that the average payment for administering a vaccine is $19.64. This doesn't even cover the cost of the visit if that is the only reason the patient is in the office. Second, most pediatricians receive the majority of their vaccinations through the Vaccines for Children program, which prohibits a markup on the vaccines.

On a personal note, I kind of feel about vaccine refusers like I do people who ascribe to some sort of creationist view of our origins; specifically I wish them all the best but completely fail to understand how their world view has so overtaken their ability to apply deductive reasoning.
posted by jason says at 2:58 PM on February 15, 2012 [42 favorites]


craichead: “And while it's all much more complicated when there are kids involved and when it's a communicable disease, I'm not 100% sure I love the idea of doctors using the power to "fire" patients to coerce them into following treatment plans that the patients reject. It's my body, and I maintain that I have the right to have final say about what happens to it. And that doesn't negate my right to get medical care.”

Well – in the United States, I can say that this isn't really a point of contention. Doctors are free to treat whom they choose. There are rules about whether a doctor can turn away patients in an emergency room or things like that, but outside that realm doctors can refuse to treat people for any reason they choose.

I know this can seem disturbing, but when you think about it a bit, it's a fact that's built into the system. Most plastic surgeons and dermatologists "refuse" to treat poor people. They're totally allowed to. They can charge whatever they want, no matter how prohibitive the cost. The idea is that there will be somebody who can pick up patients in a free market and treat them even if some doctors won't.

But I have to admit that I wonder what it's like in a society where the government runs health care. In the UK, can a doctor refuse to treat a patient on personal or religious grounds? I imagine there must be some protocol for this there, but I'm sure it's different from the US "free market" paradigm.
posted by koeselitz at 3:00 PM on February 15, 2012


Well – in the United States, I can say that this isn't really a point of contention. Doctors are free to treat whom they choose. There are rules about whether a doctor can turn away patients in an emergency room or things like that, but outside that realm doctors can refuse to treat people for any reason they choose.
Sure, but doctors are governed by ethical obligations, some of which are enforced by licensing bodies and some of which are a matter of convention. Sadly, as a society we've determined that it's ethical for doctors to turn away patients because they're unable to pay. We haven't yet come to a consensus on whether it's ok for doctors to deny treatment to patients who don't submit wholesale to doctors' authority. Many doctors think that such patients are evil or stupid, but many doctors are assholes with God complexes. And I would like it if, as a society, we maintained the principle that people didn't have to surrender the right of self-ownership in order to get medical care.
posted by craichead at 3:05 PM on February 15, 2012 [2 favorites]


It's my body, and I maintain that I have the right to have final say about what happens to it.

Sure, but your decision not to follow your doctor's treatment plan didn't put anyone else's health at risk. The entire problem with anti-vaxxers, from a social standpoint, is that their choice necessarily and knowingly puts other kids (and immunocompromised adults) at risk for serious illness and even death.

I had a cousin who died during a measles outbreak about 20+ years ago, due to his lowered immunity following successful cancer treatment. When I was going through chemo last year, knowing that measles outbreaks are even more common now than they were then -- due entirely to the refusal of rich people to engage in the social contract vis-a-vis vaccinations -- scared the shit out of me as much as having cancer did.
posted by scody at 3:06 PM on February 15, 2012 [49 favorites]


craichead: “Many doctors think that such patients are evil or stupid, but many doctors are assholes with God complexes. And I would like it if, as a society, we maintained the principle that people didn't have to surrender the right of self-ownership in order to get medical care.”

This is absolutely true, and it bears repeating: doctors aren't perfect.

And as I said above, I don't think refusing patients really helps the situation at all. Doctors are free to do what they like, but in my mind, if you refuse anti-vaxxers and other 'troublesome' patients, you're taking the easy way out.
posted by koeselitz at 3:10 PM on February 15, 2012


That seems like an argument for legally requiring parents to vaccinate, though, or for requiring unvaccinated individuals to be permanently quarantined, not for creating a precedent for doctors refusing to treat recalcitrant patients. Refusal of medical services isn't a good way to enforce social policy.
posted by craichead at 3:10 PM on February 15, 2012 [2 favorites]


Don't public schools insist on all kids being immunized?

No, religious freedom exemptions are widespread in the U.S.


To add to this, parents who refuse to vaccinate their children are often abusing those exemptions and deserve extra scorn for it, in my book, since they're making it more difficult for those with real objections to have their objections believed.
posted by hoyland at 3:11 PM on February 15, 2012 [4 favorites]


I have mixed feelings about this.

On the one hand, I HEART SCIENCE and we vaccinate and people who are full of shit about vaccines make me super, super angry.

And I think they are basically tone trolls. If you try to converse with them about this topic they will get all "You have to take my "facts" seriously!" as they quote Dr. Mercola or whale.to, so you can't actually have a reasonable discussion with them, and very few of them, once they've started to "question authority" (barf) will back away from that.

By this I mean: I do understand the argument that we should let people question their doctors, but I think people are REALLY RADICALLY overestimating how much a doctor is going to be able to change the mind of a woman who has been exposed to anti-vaccine dogma by other women, by her peers. There is a really powerful peer pressure/status symbol part to this that I think most writing on this subject ignores. When the status symbol is "I question the doctor", whatever the doctor says is going to be suspect. The status bump is in refusing, in "trusting your instincts", in "doing your own research" (by reading blogs by people who agree with you). So there's no peer reward in saying "Well, I was on the fence, but I talked it over with our pediatrician and we're going ahead with the CDC schedule." - on the contrary, now you're a sheeple.

(I have seen a few women make this turnaround, but they are what I think of as extraordinarily bright, thoughtful people. Very unusual women.)

On the other hand, I get exposed to these people a lot because I am a little bit of a hippie (not about science, just about... you know, I nurse a toddler, we co-sleep, etc.) and I know that what happens when someone can't find a mainstream ped who will take them is generally not "Okay, I guess we'll vaccinate anyway", it's that they tap into the local alt-parenting network, where they will find referrals to the few peds practices that take non-vaxxing families. In my big coastal city (LA) the practices that will do this are also practices that are into other fringe bullshit pseudoscience, like homeopathics, "healing the gut", "toxins", HIV is a lie, etc. So I think there's a risk that by kicking these families out, you force them into the arms of even weirder doctors, and they get more and more extreme.

On the third hand, I don't know what the answer is, either. It's exhausting to watch women (I have mentioned this before here, it is almost always the women. The dads are basically not involved in these decisions, which makes me mad and want to tell dads to get it together and stop letting their ignorant spouses make all the medical decisions.) go down the vaccine rabbithole. They almost never come out again.

This is going to sound crazy, but I find that this issue makes it hard for me to make parent friends. Whenever I meet a woman who seems Kind Of Like Me, I am constantly on guard for the moment when she first mentions that she's going on the GAPS diet.

PS, when our kid was little I started to attempt to understand vaccines so I could make an "informed decision", but after about ten minutes I realized that I am not a scientist and I was not able to actually make informed decisions, so I just decided that it was okay for me to pick a doctor I trusted and then keep trusting them. Because otherwise it was like if I took my car to the mechanic but kept second-guessing everything, even though I couldn't point to the spark plugs if my life depended on it.

There are entire swathes of the mom community where admitting this would be Not Okay. I am not super susceptible to peer pressure, but I distinctly felt it on this topic. The "do your own research" thing is really, really widespread, and pointing out that you are not a scientist and are reading that abstract wrong does not work. There is some kind of rise of the amateur thing happening that is terrifying. It is also strongly tied to women's feelings about female domestic authority/good mothering in a way I can't really fully unpack, but somebody should probably write a massive expose on it so I can read it!
posted by thehmsbeagle at 3:14 PM on February 15, 2012 [101 favorites]


I understand why a doctor would feel driven to this, but I find it hard not to be disturbed at the idea of blameless children being made still further isolated from sane medical practices.

I find it hard not to be disturbed by other blameless children interacting with blameless children who have an exponentially larger chance of having measles or diptheria and not knowing it.

In a related note, my employer sent a note around that two employees have reported their children being exposed to whooping cough. Lovely. Time to check up on when I had my last TDaP...
posted by delfin at 3:15 PM on February 15, 2012


If doctors are private businessmen, then they have the right to refuse service.

However, doctors aren't private businessmen, per se. Licenses to dispense drugs provides them with barriers-to-market entry. Accepting government funds requires certain standards. They're required to provide emergency services, for which they can recoup government funds. Not to mention the spirit of the Hippocratic Oath.

It's ultimately a very interesting question that casts the public/private question into harsher light.

But, really. Fuck these anti-vax kooks.
posted by Cool Papa Bell at 3:16 PM on February 15, 2012 [2 favorites]


In my perfect world, public schools (really, all schools that get government funding) would require vaccinations or a medical exemption. I have said this a number of times, and yet here I am, stuck in this not perfect world.

I don't see what the difference between "parents who refuse to vaccinate their children" and "those with real objections" are.

About doctors: well, the kids are in the worst situations. I would think that "emergencies only, you can't wait in the waiting room" might be an okay compromise, if I were a pediatrician. But if my kid got measles because the pediatrician was cool with letting unvaccinated kids sit in the waiting room, I'd be furious.
posted by jeather at 3:16 PM on February 15, 2012


I would say there is really only one valid solution to this problem: intelligent, thoughtful doctors who take it upon themselves to educate their patients and show them that their paranoia is unfounded. This is in particular the purview of pediatricians and family doctors.

I've done a lot of debating/arguing with certain sorts of historical, scientific and religious denialists, and I would say the chances of that working on anyone who has seriously bought into anti-vax ideology are very low. People who have thoroughly bought into denialist ideologies normally do not, almost by definition, use the same standards of sources and evidence that a doctor would, and are not impressed by the citation of good studies and evidence. Having just had to deal with a creationist who kept citing the same discredited sources over and over again and googling for stuff he hadn't got the faintest clue about from absolutely laughably crack-pot websites, while about half a dozen people all educated to degree/PhD level tried patiently to explain to him what was wrong with the 'evidence' he turned up, and while he ignored all the useful source material which was linked to, the journal reviews, the book citations, the careful explanations of why his latest cut and paste didn't prove what he thought it did or was not a helpful source...

No, doctors can't do that. They certainly can't do it in the normal time available to doctors. The problem is that they aren't even starting from the same premises of what constitutes sound evidence. Then add to that the tendency of people who have bought into heavily-denialist modes of thought to go so far as to demonise most normal sources of reliable evidence as part of some conspiracy. It's just recognising reality for doctors to accept that their chances of educating people out of that in surgery visits are slim.
posted by Flitcraft at 3:22 PM on February 15, 2012 [14 favorites]


I'm not sure why they'd even be going to a doctor that they don't trust on the simplest little things like that.
posted by Stagger Lee at 3:26 PM on February 15, 2012 [1 favorite]


I don't see what the difference between "parents who refuse to vaccinate their children" and "those with real objections" are.

Some children are immunocompromised and cannot be vaccinated. They're exactly the ones that herd immunity is supposed to protect.
posted by Bunny Ultramod at 3:28 PM on February 15, 2012 [11 favorites]


But if my kid got measles because the pediatrician was cool with letting unvaccinated kids sit in the waiting room, I'd be furious.

I'd imagine a good number of parents in that situation would also be litigious, which makes me wonder if insurance companies would start requiring this under malpractice coverage.
posted by rewil at 3:31 PM on February 15, 2012


I wouldn't call parents who don't vaccinate their immunocompromised kids parents with objections to vaccinations, though. An inability to be vaccinated isn't the same as unwillingness to be. (A friend of mine can't be vaccinated for Yellow Fever, but she doesn't have any objections to it or to vaccinations in general.)

I suppose there could be parents who have immunocompromised kids and who also have objections to vaccination, but neither necessarily lead to the other.
posted by jeather at 3:33 PM on February 15, 2012 [1 favorite]


It's my body, and I maintain that I have the right to have final say about what happens to it.

It is your right. The problem is forcing other people (the doctors) to give up their right to not serve you.
posted by Ironmouth at 3:34 PM on February 15, 2012 [1 favorite]


I think that part of the problem w/r/t pediatricians working to educate parents who don't want to vax is that they've been fighting this battle uphill for the past decade or so and the parents they're dealing with simply will not listen because the information that they're getting says specifically "Do not trust doctors." Having met some of these parents in the flesh, I can safely say that there is nothing a pediatrician could tell them to get them to change their minds simply because the pediatrician is automatically wrong, in their view. Modern medicine is the enemy. So, if the doctor is the enemy from the get-go how is s/he supposed to effectively educate this person? It's a very, very different set up from simply being an unruly patient who doesn't *want* to do what the doctor says. It's like trying to treat the Joker for the flu when you're Batman.

As a parent, I definitely feel comfortable with this. I don't know what my pediatric practice's view on vaccine noncompliance is - but if they publicized that they wouldn't take on patients who refused all vaccines, I'd be fine with that. Part of that is that my child isn't old enough to have had all vaccines yet and part of it is that I plan on having more children in the future and don't relish the thought of a newborn sitting in a germ petri dish with sick kiddos in general, so if we can whittle down that group to ones that have had vaccines, I appreciate it.

And lastly, I really feel ok if my pediatrician declines to accept totally non-vaccinating patients as I personally have a vaccine allergy. I'm allergic to the pertussis vaccine, which oh boy, makes me feel warm and fuzzy when I read stories of new cases cropping up. Since I'd rather NOT get whooping cough, I'm pretty grateful that most people who can get vaccinated against it *do.* The ones that don't? Well, I'd be happy if they didn't share it with me if they get it.
posted by sonika at 3:43 PM on February 15, 2012 [6 favorites]


But if my kid got measles because the pediatrician was cool with letting unvaccinated kids sit in the waiting room, I'd be furious.

A couple of months ago a local doctor's office had a suspected case of measles come in, and the PR outreach to attempt to track down everyone who had been through the lobby of a rather large medical building was extensive. Turned out not to be measles, but it managed to freak out a Very Large Number of people. It also reminded me how expensive it is to have a case of measles walk through the door:
To stop a 14-person outbreak that began with one unvaccinated tourist visiting a US emergency room, the Arizona Department of Health had to track down and interview 8,321 people; seven Tucson hospitals had to furlough staff members for a combined 15,120 work-hours; and two hospitals where patients were admitted spent $799,136 to contain the disease.
posted by ambrosia at 3:45 PM on February 15, 2012 [40 favorites]


I'm really uneasy about this because the child is simply not capable of giving their choice in the matter, and so has both their parents and their physician refusing to help them be healthy. I get the need to prevent children who are incapable of receiving vaccines for legitimate reasons from exposure to children of anti-vax parents*, but there have to be better ways to handle this.

BTW, there have been 1st Amendment cases regarding blood transfusions for Christian Scientist patients (and their infant children) where the court have been willing to say that the patient's need for medical care over-rode their religious freedom in the moment (at least for the infant children. Other cases have been fuzzier, such as one where a husband of a patient basically had to get the doctor to say that he was forcing the patient to undergo a transfusion, because if it was "against their will" it wouldn't be a sin, and further and further down the rabbit hole...)

*I don't always agree with Dawkins, but I love his insistence that children not be referred to by the labels of choices their parents have made.
posted by Navelgazer at 3:50 PM on February 15, 2012 [3 favorites]


I'm concerned about this in the same way I'm concerned about the owner of the local delicate glass store refusing to let me in when I'm wearing my swirling spikes of doom jacket.
posted by Joey Michaels at 4:01 PM on February 15, 2012 [8 favorites]


sonika: “I think that part of the problem w/r/t pediatricians working to educate parents who don't want to vax is that they've been fighting this battle uphill for the past decade or so and the parents they're dealing with simply will not listen because the information that they're getting says specifically "Do not trust doctors." Having met some of these parents in the flesh, I can safely say that there is nothing a pediatrician could tell them to get them to change their minds simply because the pediatrician is automatically wrong, in their view. Modern medicine is the enemy.”

I know it's easy to think of the world this way – as though there are set, distinct groups of people, and everyone in each of these groups of people thinks exactly the same. And I even get that, to a lot of doctors (and a lot of us non-doctors) it can really seem that way.

But I don't think this is precisely how things are. There are parents who are on the edge, or who haven't vaccinated yet just because they heard something from an uncle, and were wondering, and haven't really made up their minds completely. Or there are others who simply have a completely wrong idea of the science behind vaccination.

It's true that a lot of people who haven't vaccinated their kids are totally dogmatic and immovable about this. I just don't think that's true of all of them.
posted by koeselitz at 4:02 PM on February 15, 2012


It's true that a lot of people who haven't vaccinated their kids are totally dogmatic and immovable about this. I just don't think that's true of all of them.

At what point then should a doctor abandon attempts at patient reasoning and enforce a policy of "don't come to my waiting room because you endanger the other patients?"
posted by Joey Michaels at 4:04 PM on February 15, 2012


Sadly, until we improve the *education* of people so they can look at the scientific facts and decide for themselves we will continue to be plagued with groups that choose to adhere to non-sense beliefs. Example: putting creationism into science textbooks.
posted by bmorrison at 4:06 PM on February 15, 2012 [1 favorite]


Some children are immunocompromised and cannot be vaccinated. They're exactly the ones that herd immunity is supposed to protect.

Exactly. My little one is one of those unvaccinated-for-good-reason kids (I vented about the issue already once). The key thing here is that the parents are making ill-informed choices that could hurt or even kill their own kids as well as those of other people. For pretty much any situation where the former is in play, it's not allowed (eg., child car seats).

Imagine then if I could not only choose to not put my own child into a car seat, but I could choose to take your child out of one? That's how I feel about non-vaxxers.
posted by Rumple at 4:07 PM on February 15, 2012 [34 favorites]


The Wired article Ambrosia posted above is great.

It reminds me of another thing I find weird and fascinating about the anti-vaccine moms: there is a pervasive denial of not just the possibility, but the risks and costs of outbreaks. There is not just an inaccurate sense of how likely their child is to contract an illness but a very self-centered perspective on what would happen if they did. ("My family has superior genes and Bach remedies, so my child would be fine. I don't care about random pregnant women or newborns.")

I had to finally quit reading a local parenting list when a woman got very huffy about people refusing to play with her unvaccinated kids because they had been exposed (on purpose) to Chicken Pox and then decided to just lie about it, because having to deal with fussy people was a hassle and it wasn't fair to her family.

This was mindboggling to me, because I had always assumed that if someone didn't vaccinate, they would be extra concerned with being very on top of disease transmission and stuff like that. But once I noticed that attitude, I began to see it pop up elsewhere.

Even though I really disagree with where the non-vaccinating parents are coming from, this is a free country and I don't actually believe that vaccinations should be forced upon you. But it has been amazing to me to see that many, many of these parents do not just want to be allowed to make medical decisions for their own kids (okay), they in reality, I honestly believe, think that their family is somehow superior to others and that their health should be prioritized over that of the masses. They are willing to let other peoples' babies take the shot to protect herd immunity so their own kids don't get sick, and they are willing to have their own kids expose others if they do. (Objectivist health, maybe?)

And in a way that is right at the edge of my ability to comprehend, I think that for some of these parents, the... uniqueness? unusualness? of this choice is part of the reward in itself. Sort of like the parent version of "Oh, you like that band? Yeah, I don't listen to mainstream rock, but I guess they're okay."

There is a thing (I theorize) about being edgy and making really distinct, non-mainstream choices that is very satisfying to a certain kind of parent. It is evidence of what a truly excellent parent you are, that you are willing to stand your ground against The Medical Establishment and Big Pharma. Spartaaaaaa!
posted by thehmsbeagle at 4:13 PM on February 15, 2012 [31 favorites]


So long as there's such a thing as a Hippocratic Oath that is invoked in any discussion of why we can't have euthanasia, I have a hard time accepting that doctors have any basis to refuse treatment to a child because its parents happen to be idiots. There's no question that anti-vax parents are doing something irresponsible and potentially deadly to their child and other children in contact with their child, but I don't see that as any reason to shun a sick child and potentially allow them to die of something treatable and/or undiagnosed. Doctors offices have always been full of people who are potentially contagious mingling with people with compromised immune systems. It absolutely sucks that some people would put others at risk by refusing to vaccinate their children, but there has to be a better answer than this.
posted by Hoopo at 4:22 PM on February 15, 2012


Hard ethical dilemma for the MDs. Personally, I'd like to know what the statistical outcomes are for waiting-room transmission before going either way. That said, the anti-vax crowd is getting bolder and crazier, even going so far as to mail communicable diseases to each other so they can expose their kids.

Me, I would make a parent sign a waiver (indicating that they were acting AMA) before I would continue to treat, if they refused to vaccinate. Also, any hints of illegal anti-vax activity would be reported.
posted by nonreflectiveobject at 4:31 PM on February 15, 2012 [1 favorite]


A friend of mine was once told by a fellow mom, "Polio wasn't THAT bad."

What do you say to that?
posted by bq at 4:36 PM on February 15, 2012 [13 favorites]


I have zero sympathy for anti-vax nutjobs. Vaccines work partially on herd immunity, this is one case where Big Government is very much OK. Kids should be vaccinated for common, curable diseases, and if their parents won't do it, the school nurse should could around with a needle on the first day of kindergarten else the kid gets bounced out of school. We need to wipe out all religious exemption law bullshit on this. Public health and 100 years of modern medicine trumps any tinfoil hat argument here, and if these people choose to withdraw from first world society to protect their insane beliefs then they should have to make that choice.
posted by T.D. Strange at 4:36 PM on February 15, 2012 [14 favorites]


This was mindboggling to me, because I had always assumed that if someone didn't vaccinate, they would be extra concerned with being very on top of disease transmission and stuff like that. But once I noticed that attitude, I began to see it pop up elsewhere.

I think it's part of a more pervasive narcissism. These are people who are actively, explicitly hostile to the idea that other people's children matter as much (socially speaking) as their own children. "My child is a special snowflake. Your child can go hang."
posted by scody at 4:39 PM on February 15, 2012 [15 favorites]


"I have a hard time accepting that doctors have any basis to refuse treatment to a child because its parents happen to be idiots."
"In non-emergency situations, a physician is justified in refusing to treat unruly and uncooperative patients. If a patient refuses to follow the physician’s plan of care or to comply with an appropriate treatment regimen, the physician may unilaterally terminate the physician/patient relationship by giving the patient advance notice of the specific reasons for his termination."
Physicians are people too, and I have heard many MDs voice significant frustration in treating patients who are directly acting against their health and the health of the community. Working at an academic medical center, I see a lot of patients who end up at our doors not because they lack insurance, but because private physicians find the idea of treating a patient with cirrhosis who won't stop drinking alcohol as... maddening / a waste / inspiring an urge to quit medicine.

There are also doctors who are more laid back, who will treat COPD and Alcohol and give the due diligence "change your lifestyle" talk every visit, but keep their expectations low. I'm sure some people might see those types of physicians as 'enablers.' It's probably a question everyone has to answer individually.

I imagine there's a similar divide among pediatricians in treating families who are actively sabotaging their children's health. If you can't report the parents to Child Protective services, I don't think it's immoral to fire uncooperative patients in a effort to preserve your own sanity and thus be a better physician for the vast majority of patients who do not suffer profoundly dangerous delusions of vaccine insight.
posted by midmarch snowman at 4:45 PM on February 15, 2012 [4 favorites]


I can understand that midmarch snowman, but the examples you give are for treatment directly and indirectly related to the problem behaviour in question. An unvaccinated kid looking for polio treatment would fall in this category, but not an unvaccinated kid with food poisoning or a high fever or an infected splinter unrelated to the diseases we can vaccinate against.
posted by Hoopo at 4:53 PM on February 15, 2012


A friend of mine was once told by a fellow mom, "Polio wasn't THAT bad."

The across-the-street neighbor lady from my childhood home, let me introduce you to her. She got polio as an adult in the late 50s or early 60s while living in Egypt, spent the rest of her life in a wheelchair.

I think this is the biggest catch-22 of the amazing success of vaccination in the 20th century. At some point, people don't know anyone who had to suffer through the now-rare diseases, and it's hard to imagine what that was like.

My mother lost months of school when she was a little girl - also in the 50s - and had her feet permanently disfigured (?) because she got all the old "childhood illnesses" right in a row, including polio. The doctor wasn't even 100% sure that she'd had (mumps? polio?) because she was just so run-down in general at that point. And all her siblings went through the same routine.

But I don't know anybody who's had any of them in my lifetime. Except for pertussis, which OMG DO NOT WANT; until mr. epersonae got it maybe a decade ago, I'd never heard anybody cough like that. Terrifying.

I've probably said it before, but I have this fantasy about organizing a tour of old cemeteries focusing on preventable diseases.

Or maybe somebody should make some sort of tear-jerker movie; not a documentary, just some heart-strings-tugging historical fiction. (Shoot, didn't the older sister on Little House on the Prairie go blind because of measles?)
posted by epersonae at 4:57 PM on February 15, 2012 [9 favorites]


I think this is the biggest catch-22 of the amazing success of vaccination in the 20th century. At some point, people don't know anyone who had to suffer through the now-rare diseases, and it's hard to imagine what that was like.

That's it exactly. I've heard it described as vaccines being a victim of their own success. The very fact that they've worked so well has removed the mass understanding of why they're necessary.
posted by scody at 4:58 PM on February 15, 2012 [17 favorites]


I understand why a doctor would feel driven to this, but I find it hard not to be disturbed at the idea of blameless children being made still further isolated from sane medical practices. I don't buy the "danger to the waiting room" thing at all. Doctor's offices are hardly the only places unvaccinated and unvaccinatable children come into contact, and the illnesses vaccines protect against are not the only medical risks waiting rooms pose to vulnerable children.

I feel sorry for these kids too - it's not their fault their parents are morons. But doctor's surgeries are pretty much by definition going to see a lot more people that are immuno-compromised or allergic to vaccines; cancer and HIV sufferers especially. They, and children too young yet to have been vaccinated will not generally be mixing with the unvaccinated older children in other places much. It's not fair to put their health at risk because some parents think they too can get a free ride on herd immunity.

The problem with herd immunity is it requires a very high level of participation in vaccine programs in order to be truly effective. In the UK, I saw reports recently that some places have dropped to 70% participation in MMR, with a country wide percentage of 80% down from 95% 10 years ago.

That's not enough. We've already seen cases of measles go up by 3000% in 10 years in the UK. Measles used to be a disease that was very common, and we got it right down to a few dozen cases a year - now it's going right back up again. (Of the 66 cases of measles reported in the U.S. in 2005, slightly over half were attributable to one unvaccinated individual who acquired measles during a visit to Romania. In 1998, there were 56 measles cases in the UK; in 2008, there were 1348 cases, with 2 confirmed deaths).

Most of these diseases kill. Many of them cause much unnecessary pain and suffering, including long term permanent effects. We've come sooo close to eliminating polio, and yet all it'll take is one unvaccinated kid catching it on holiday in india* or africa to bring it back to the polio-free world, and spreading it amongst the unprotected. I don't want to see a return to the iron-lung wards.

And who knows? Maybe some parents seeing how far they have to go into kook-land to get normal medical treatment for their kids might make them reconsider listening to Jenny McCarthy.
posted by ArkhanJG at 4:59 PM on February 15, 2012 [5 favorites]


Good. Now how about adding these parents to the list of people considered potential "Typhoid Mary" carriers?
posted by Old'n'Busted at 5:02 PM on February 15, 2012 [1 favorite]


I agree that not vaccinating your kids is stupid. I'm not comfortable with punishing children for their parents stupidity.
posted by jonmc at 5:13 PM on February 15, 2012 [1 favorite]


By the way, just a note – there are actually other options besides "try to convince the parents" and "refuse to treat them entirely." My significant other, who is a doctor, just came home, and I asked her what she'd do. She didn't hesitate:

"I'd take the parents into the exam room and vaccinate their kid in front of them. And I'd tell them that, if their kid gets autism, they can call me back and we'll talk."

Apparently this is a grey area, but there are a lot of things parents aren't allowed to refuse on behalf of their kids. Blood transfusions are a controversial one in some quarters; but doctors who gave blood transfusions to minors over the protests of parents have generally won out in court. MMR vaccinations seem a bit more important to me than blood transfusions, in certain senses at least; measles is a hell of a thing, and the unvaccinated risk harming lots of people.

So, er – yeah. That's another option for doctors: vaccinate kids without any regard for parental consent.
posted by koeselitz at 5:23 PM on February 15, 2012 [7 favorites]


I agree that not vaccinating your kids is stupid. I'm not comfortable with punishing children for their parents stupidity.

The question becomes, then, are you comfortable with punishing everyone else's children for the parents stupidity instead (by potentially exposing waiting rooms to entirely preventable childhood illnesses)?
posted by Joey Michaels at 5:24 PM on February 15, 2012


So, er – yeah. That's another option for doctors: vaccinate kids without any regard for parental consent.

With all due respect, this seems like a terrible idea. The parent will flip, the child wouldn't understand (or worse), and the liability question is gray at best. Calmly/rationally explaining your position, and then either treating or refusing to treat is the best option.
posted by rosswald at 5:31 PM on February 15, 2012


Good for the doctors. Screw those parents.
posted by ReeMonster at 5:33 PM on February 15, 2012


As both a hippie and an infectious disease epidemiologist, this issue is near and dear to my heart. My hippie mom friends are universally concerned about vaccination, and they have all asked me my opinion.

Because I am also a smart-ass, in addition to being a hippie and infectious disease epidemiologist, I give a small talk about 'job security' and how nice it is that so many people are making real social sacrifices so that my profession will be in higher demand in the States.

How successful this line of conversation has been with regard to winning hearts and minds, I cannot say. All I know is that I usually avoid the 'autism! mercury poisoning! big pharma!' counterpoints. At best, it may cause my friends to make the comparison between where I usually work (sub-Saharan Africa) and where they live (fairly well-to-do USA), and they don't really like the idea that my work would be in increasing demand around the local Montessori. At worst, it confirms I'm a smart-ass.

And damn it, Americans understand arguments from selfishness. Keep up the non-vaccinating, I say, because palindromic wants to get PAID!*

*Not really. Epidemiologists never get paid.
posted by palindromic at 5:34 PM on February 15, 2012 [28 favorites]


I think parents who refuse vaccinations for their children are guilty of child abuse and should lost custody of those children, and go to jail if their negligence causes anyone to get sick, their own or other kids included. Yeah, lost custody and go to jail. I'm 100% in favor of this. We are appalled when we learn of occasional cases where Christian Scientists (or whatever) don't seek standard of care treatment for their sick kids. We call it abuse. We take their kids away from them.

Good for the docs who do this. We need to shame these crazy selfish idiot parents for being sociopathic and dangerous.
posted by spitbull at 5:42 PM on February 15, 2012 [5 favorites]


Oddly enough, the Supreme Court just declined to hear a vaccine-refusal case. The state of West Virginia was found not to have impermissibly impinged on the religious freedom of a woman who wouldn't vaccinate her children when W. Virginia refused to allow them to attend public school without vaccinations. The court said that, regardless of the level of scrutiny applied, "[t]he right to practice religion freely does not include liberty to expose the community or the child to communicable disease or the latter to ill health or death." 419 Fed. Appx. 348, 353 (pdf) I thought it was interesting.

I was actually looking for something that would indicate what would happen to a doctor who forcibly vaccinated a child against a parents' wishes. I would imagine, at a minimum, that doctor's malpractice insurance premiums would rise high enough to end their career, but I couldn't find anything to back that up. Shame, I guess--I worry about a world where vaccination rates continue to drop.
posted by crush-onastick at 5:44 PM on February 15, 2012 [20 favorites]


I'm not comfortable with punishing children for their parents stupidity.

I'm not comfortable bearing the risk of anti-vaxer parents' stupidity, nor with making rumple's daughter bear the risk of anti-vaxer parents' stupidity, nor with any of the other countless children and adults who are being forced to play a game of medical Russian roulette that we didn't sign up for. I'm not comfortable with the idea that we're going to have to return to wards full of iron lungs, or diphtheria epidemics that kill tens of thousands of children every year until these woo-spouting thugs of privilege are stopped.

The anti-vaxers have so far been allowed to create an increasingly dangerous situation because they have been able to count on people not wanting to "punish" their children. And how do they thank the rest of us for accommodating them? By punishing other children and immunocompromised adults (and their own families) with ever-increasing health risks! If this pushback by doctors results in children of anti-vaxers being deprived of medical care, that is entirely, 100%, the responsibility of anti-vaxer parents and their willful negligence. If they are finally forced to bear some consequences of their own (in)actions, then perhaps finally some of them will actually start making the socially and medically responsible choice.
posted by scody at 5:45 PM on February 15, 2012 [27 favorites]


Here's my little story about a parent's right to refuse treatment for their kids. I throw it out there because it boggles my mind every time a discussion like this comes up.

I'll preface by saying I believe in vaccination. I support these doctors.

When I was a few weeks old, I became very malnourished because my well-meaning mother listened to the nurses who said breastfeed oryou're a horrible mother. I was suckling, but I wasn’t' getting anything. Dad weighed me on some old scales my grandfather had in the shed. When he was confident I was losing weight, they took me to the provincial children's hospital.

At some point. a doctor wanted to give me a blood transfusion. My father refused. The doctor asked him why. My dad said I might get AIDS from the blood. The Doctor looked at my father and said, "There's no evidence AIDS is transmitted through blood."

This was in 1983 in Canada. The term “AIDS” was only a year old. My father was 24 years old. He was a carpenter. But he read the paper every day and he watched the news. He stood up to a freaking doctor who probably figured this ignorant lout was going to kill his infant son by refusing a blood transfusion. But dad refused and I pulled through without a transfusion.

The thing is - Dad was right. There's no guarantee I would've got HIV or Hep-C from that blood, but many did during the 1980s. He refused on the grounds of science, not religion, but he made an informed decision that flew in the face of the doctor's supposed expertise. So yes, anti-vaxers are wackos, and yes, I support courts that force blood transfusions on children of religious parents. But I have a soft spot for people who make informed decisions and at least question doctors. It's not all black and white.
posted by Brodiggitty at 5:46 PM on February 15, 2012 [18 favorites]


Speaking of 19th-century disease outbreaks...

Yeah, it's been interesting to hear the talk show hosts on a local right wing station pretty much deride the parents of those kids. I find it extra interesting in light of the fact that the three state universities all require proof of MMR before students are allowed to register for classes.
posted by fuse theorem at 5:47 PM on February 15, 2012


Even though I really disagree with where the non-vaccinating parents are coming from, this is a free country and I don't actually believe that vaccinations should be forced upon you.

Maximum individual freedom requires some restrictions on individual conduct. No matter how much fun it would be to pinwheel my arms as I walk down the sidewalk, we as a society have decided to make a trade-off. We agree that we are all more free to live the lives we want to live if we trade the freedom to take swings at other people for protection from getting punched.

Mandatory vaccination now.

There are always going to be kids who don't get vaccinated. Some parents will want to codge religious exemptions, for example. However, making it very difficult for a parent to get a child a medically unnecessary exemption from vaccination would reduce the number of kids who go unvaccinated and strengthen herd immunity. It seems wise to me to make it as hard as possible for parents to impose their anti-vaxing on their innocent children.
posted by justsomebodythatyouusedtoknow at 5:55 PM on February 15, 2012 [7 favorites]


If medicine was taught in school as a subject on par with history, science, math, and english, these fruitcakes would vanish in a generation. And more kids would start being vaccinated right now, as children stood up to their parents and argued in favour of their own health. Not all parents would listen, but some would.

It would also improve their comprehension of the other technical subjects.

Medicine isn't really that hard. The average kid can learn the basics of anatomy, physiology, immunology, neurology and so on. You don't have to be a wizard to comprehend that stuff.
posted by clarknova at 6:01 PM on February 15, 2012 [6 favorites]


What I thought was an awful bout of bronchitis in 2010 was most probably whooping cough -- particularly given the times I woke up in the middle of the night, unable to breathe, making what I now know to be the classic "whooping" sound. But it didn't occur to me at all that I would have whooping cough -- I mean, shit: I was vaccinated as a child.

But then I found out that whooping cough (pertussis) is one of the shots that you usually need a booster for. So, a couple of months after I was better, I walked into my local retail clinic and said, "Booster, please!" and the PA -- a very nice lady -- was all "What?" -- who told me that, etc. She had no clue. So I replied: "The CDC." So she looked it up in her system and lo and behold, it was true.

So I got my booster. (And, btw, please get yours.)

The anti-vax people are not going to learn until their children start dying. And it's sad and I wish it could be avoided but it can't.
posted by gsh at 6:03 PM on February 15, 2012 [3 favorites]


If this pushback by doctors results in children of anti-vaxers being deprived of medical care, that is entirely, 100%, the responsibility of anti-vaxer parents and their willful negligence.

I highly doubt a court would reach the same conclusion if a child of an anti-vax parent dies as a result of lack of medical care.
posted by Hoopo at 6:08 PM on February 15, 2012


So what can we do about those sociopaths that don't finish their course of antibiotics?
posted by Obscure Reference at 6:12 PM on February 15, 2012 [5 favorites]


This is a really complicated issue
Not really.

Not giving your kids vaccines (assuming there is no medical reason not to) is like feeding them sugar constantly and not believing in tooth brushing, or when they get lice, just letting it run its course because you're worried about the chemicals in the shampoos. It's selffish, borderline criminal, and the parents should be ostracized.

People who don't vaccinate their kids for dumb reasons are not people I want to be my friends -- they are not people who I need to be sensitive to or pretend that "issues are complicated" to save their feelings.
posted by smidgen at 6:13 PM on February 15, 2012 [4 favorites]


@Hoopo - The doctors firing the drunk cirrhotics and the smoking vasculitis sufferers are also refusing to treat them for unrelated ailments like fevers or heartburn.

I was just making the argument that this isn't an issue of denying children access to healthcare, the issue is the right of physicians to have some control over their patient lists to preserve their own sanity. This is usually accepted as a physician right (the block quote in my post is from the first online journal article of physician rights I could find) under the theory that you're not denying someone access to healthcare... you're just saying your not going to be the one to treat them. I kinda feel like the argument of not having unvaccinated kids in your waiting room being exposed to communicable disease is kinda hang-wringing. In most communities those kids will still hopefully be able to find a pediatrician for regular health care (the article said something like only 30 something percent of doctors actually refused to see anti-vax parents... so hopefully someone in the other 60 percent is accepting patients.

Now people could argue adults are suffering from cirrhosis or small vessel disease because of their choices, but children are inherently innocent. BUT no one is suggesting the adults should have their access to regular, routine care limited because of their choices because that IS immoral. No one is suggesting these kids should not have access to regular routine care either. Whats at stake is the right of individual doctors to refuse to treat patients that drive them crazy.

Now this DOES become a problem when the community's doctors start overwhelmingly refusing treatment to a patient population because of their lack of cooperation. I think the big island in Hawaii has something like 9 pediatrician practices, total. If 5 aren't accepting new patients and 3 refuse to treat anti-vax families, then you better hope you get lucky and that one remaining one isn't a quack.

(sorry if I'm not making sense, been at work for... going on 14 hours...)
posted by midmarch snowman at 6:19 PM on February 15, 2012 [1 favorite]


if a child of an anti-vax parent dies as a result of lack of medical care.

The article is not saying that hospitals would refuse to treat unvaccinated children, so the possibility of that scenario seems quite remote. Besides, it's not entirely clear to me what the cause of action would be.

Far more likely, tragically, is a newborn, a cancer patient, or someone with HIV becoming seriously ill or dying because of contact with the child of an anti-vaxer. But the anti-vaxers aren't legally on the hook for that. Pity, that.
posted by ambrosia at 6:20 PM on February 15, 2012 [1 favorite]


So what can we do about those sociopaths that don't finish their course of antibiotics?
Wow, you got us there. Beheading?

Assuming you can detect them -- and it's done out of principled ignorance rather than simple ignorance of how the treatment works -- the solution seems to be similar -- refuse to "treat" people who don't actually apply the treatment on principle. I have no problem with this.
posted by smidgen at 6:20 PM on February 15, 2012


Brodiggitty writes "He stood up to a freaking doctor who probably figured this ignorant lout was going to kill his infant son by refusing a blood transfusion. But dad refused and I pulled through without a transfusion. "

And if you had died because of a lack of transfusion you wouldn't be here to tell this anecdote.

clarknova writes "If medicine was taught in school as a subject on par with history, science, math, and english, these fruitcakes would vanish in a generation. And more kids would start being vaccinated right now, as children stood up to their parents and argued in favour of their own health. Not all parents would listen, but some would."

It's an obvious good idea but it seems to be having limited effect on creationism.
posted by Mitheral at 6:24 PM on February 15, 2012 [1 favorite]



Or maybe somebody should make some sort of tear-jerker movie; not a documentary, just some heart-strings-tugging historical fiction. (Shoot, didn't the older sister on Little House on the Prairie go blind because of measles?)


I'm Israeli, and like most of us, some time in middle school I read the biography of Itamar Ben Avi, the first native speaker of Modern Hebrew.

The chapter when he lost his siblings to diphtheria was the one time as a boy that I sat down and cried because of a book.
posted by ocschwar at 6:29 PM on February 15, 2012 [2 favorites]


I would say there is really only one valid solution to this problem: intelligent, thoughtful doctors who take it upon themselves to educate their patients and show them that their paranoia is unfounded. This is in particular the purview of pediatricians and family doctors.

It is IMPOSSIBLE to reason with the anti vaccination crowd. Try it once and you will see for yourself. I got involved with a crazy several hundred-comment long Facebook argument with some anti vaccination moms and it was like hitting your head against a wall.
posted by cherrybounce at 6:37 PM on February 15, 2012 [5 favorites]


This thread has made me much more sympathetic to anti-vaxers.
posted by telstar at 6:47 PM on February 15, 2012 [2 favorites]


I am in pediatric primary care rotation. A regular pediatric office. At graduation this spring, I will be a pediatric provider. Everyday, every 10-15 minutes or so, I see a family in exam very worried about their sick kiddo. Worried that something serious is going on, or worried that they have exhausted their own skill set on how to care for their kid at home.

About 98% of these kids are not all that sick and if the family had done nothing, would have made a full recovery on their own. So, what I spend about 98% of my day doing is educating families on how to support their children through extremely common illnesses.

So by this estimation, 100% of parents are unprepared to support their own children through very serious childhood disease, such as those we vaccinate for, even if the child's immune surveillance is high and they contract a relatively minor case. Beyond herd immunity, which is a significant public health and ethical issue, as others before me have so starkly pointed out, not vaccinating is an incomprehensible societal healthcare cost on par with reversing stable economies into developing ones.

Sometimes I work with families for whom the reality of the morbidity and mortality of these diseases is extremely limited. In my education, I do focus on morbidity because families will not hear that they are putting their children at risk to die. The injuries from these diseases are often more concrete, even minor injuries like the significant scarring of varicella, or persistent airway disease from pertussis. Refusing MMR exposes male children to infertility risk, all children to acquired heart defects. Refusing HiB, even if your child does not die from meningitis, will surely result in acquired neurological, cognitive, vascular, and extremity injury once heroic efforts have saved the child from meningitis death. In the case of HiB, many currently practicing providers lived through the complete horror of internship and residency in children's hospitals' meningitis wards where babies were dying all around them that could not be saved. My current attending talks about the weeks when HiB vaccine was, then, introduced and the wards closed up, one by one. And he gets freaking teary-eyed about it, even now. Refusing pneumococcal vaccines like Prevnar opens all of us up for more of the same--the current Prevnar 13, for example, covers for 48% of invasive meningitis.

Families do not believe they are accountable to their own children--that they answer for their scars and acquired disabilities. But they do. Injury from actual vaccine is an incredibly small and fully reported risk. Any parent can go to the CDC site, at any time, and monitor vaccine injury. But the risk of acquiring a preventable childhood disease by refusing to vaccinate is nearly certain in that child's lifetime. It's as if a family made the decision to let their infant lay across the backseat, unbuckled, without a carseat, because they decided they would simply just drive very carefully.

So, my current attending is one of those who does not retain patients who will not vaccinate. He does an intake with every new family, he educates them on his position very patiently, he listens to their concerns, he provides risk and benefit information. But he makes it clear that if he cannot manage the entire herd, he can at least shepherd his own--and there will be no breaks. He's actually not protecting his patience with having the same argument over and over--because my point at the beginning of my post demonstrates that part of the love for primary care is also a love and patience with leading the same kinds of education over and over and over again. He's protecting himself from the devastation of needlessly losing a patient to death or morbidity. Until you've been through that, though needless loss, the needless loss of a child at that, it is almost impossible to argue against these providers who make these kind of unilateral decisions.

So, in my experience, no pediatric provider is "just tired of" having the argument or educating their patients. It's that they became weary of preventible death and injury some time ago.
posted by rumposinc at 6:49 PM on February 15, 2012 [68 favorites]


About 98% of these kids are not all that sick and if the family had done nothing, would have made a full recovery on their own. So, what I spend about 98% of my day doing is educating families on how to support their children through extremely common illnesses.

So by this estimation, 100% of parents are unprepared to support their own children through very serious childhood disease, such as those we vaccinate for, even if the child's immune surveillance is high and they contract a relatively minor case.
I'm not sure I understand how that logically follows....
posted by craichead at 6:53 PM on February 15, 2012


hmsbeagle, I agree with you that a lot of the motivation here is vanity -- "we're not the kind of people who just blindly follow the status quo" -- but I'm not sure that squares with the claim that the non-vaxxers are mostly unreachable by consequences like these. I know one who held out against most vaccinations until her son was age 4, at which point the pediatrician threatened to drop her child as a patient, and she gave in and got caught up. I think there are true moonbats who will never be convinced, and will drive 45 minutes to a doctor who will see their children*, but that there are also a whole lot of mothers who do this for the same reason they buy a Volvo instead of an Acura, and if you make things unpleasant enough, they will yield. (We can always throw them the sop of "spacing" or whatever so that they can maintain their sense of non-conformity.) I'm hoping that we may at some point remove the religious/moral conviction exemptions for vaccinations before admittance to schools, and at that point, if we're truly left with only the mothers who are committed enough to these ideas to home-school their children over it, the group will be small enough that it won't impact herd immunity.

*Not even necessarily a pediatrician; around here, the hard-core anti-vaxxers go to a geriatric specialist who also does family medicine, because he's so supportive of them. My brother-in-law is a pediatric specialist and has tons of stories about this doctor's failure to properly treat routine pediatric cases. On the plus side, he's in his 80s.
posted by palliser at 6:56 PM on February 15, 2012 [1 favorite]


Just out of curiosity, what's up with the "mothers" thing? Do fathers really have no say in vaccination decisions at all?
posted by craichead at 6:59 PM on February 15, 2012 [1 favorite]


Craichead--meaning only that if the 98% who have kids with very minor illness need help from a provider to care for their children, and the other 2% with really sick kids need help, I am then just projecting that all families with kids who contract the diseases we vaccinate for (which are typically more virulent than an everyday virus) would, then, need help from a provider to care for them. So--spendy. Sorry if I tired to get too fancy.
posted by rumposinc at 7:00 PM on February 15, 2012


I'm vaccinating my kids but my older sister didn't. I think part of the problem some mothers have with their doctors is the authoritarian style of conventional medicine doctors (both men and women). That, and the advice they're giving is often wrong and dangerous.

I grew up on Calpol (Paracetamol plus sugar) at my dr's recommendation, for the slightest fever. I have asthma. Probably related.

I don't think the risks from vaccination are high at all, but I am concerned that we are manipulating our immune system to such an extent, and at such young ages. This is all still relatively new (at least the extent to which we are doing it) so it would be arrogant to assume we know all the consequences.

Why are we vaccinating for measles and mumps? I had those as a kid, as did everyone else. No biggie. Getting sick is a very important part of growing up - fighting real disease and winning is what trains our immune system. I am concerned that training our immune system by having it spar with diseases which have both hands tied behind their backs is not the best idea.

I also think most of the serious diseases could be eliminated by improving living conditions and sanitation, but of course vaccination is much much cheaper. Cheaper is not always better.
posted by grubby at 7:03 PM on February 15, 2012 [1 favorite]


The anti-vax people are not going to learn until their children start dying. And it's sad and I wish it could be avoided but it can't.


They kids are already dying, thanks to teh whooping cough.

The antivaxxers are still not learning.
posted by ocschwar at 7:05 PM on February 15, 2012


I don't think the risks from vaccination are high at all, but I am concerned that we are manipulating our immune system to such an extent, and at such young ages. This is all still relatively new (at least the extent to which we are doing it) so it would be arrogant to assume we know all the consequences.

Why are we vaccinating for measles and mumps? I had those as a kid, as did everyone else. No biggie. Getting sick is a very important part of growing up - fighting real disease and winning is what trains our immune system. I am concerned that training our immune system by having it spar with diseases which have both hands tied behind their backs is not the best idea.

I also think most of the serious diseases could be eliminated by improving living conditions and sanitation, but of course vaccination is much much cheaper. Cheaper is not always better.


None of the things you write here is supported by any kind of science, at all.
posted by downing street memo at 7:08 PM on February 15, 2012 [41 favorites]


So, in my experience, no pediatric provider is "just tired of" having the argument or educating their patients. It's that they became weary of preventible death and injury some time ago.

I had such an angry reaction to the comments above that suggested pediatricians were just "fed up" or too lazy to really deal with education, and so decided to take the easy way out. When you're a parent, you meet with the pediatrician for your child's first well-visit. The doctor tells you why your baby is getting vaccinated. If he's old enough, as ours was, he tells you about his experiences as a resident in the 50s. We were under no doubt as to why he wouldn't take patients whose parents refused vaccinations. You want to force someone to watch a baby whose care they were charged with die a completely preventable death? I can barely read about it in the newspapers.
posted by palliser at 7:10 PM on February 15, 2012


Anti-vaccination folks strike me as the worst sort of conspiracy theorists. You know, although the scary Government and even scarier HHS insist there is no evidence that vaccines cause autism, there is the National Vaccine Injury Compensation Program, set up as a no-fault alternative to tort lawsuits for persons claiming injury from vaccines administered after 1988. That *must* mean the government is hiding something, right? That's meant to be sarcastic, by the way. If I were any sort of early childhood health and wellbeing professional, I would not want ant-vaccination evangelists anywhere near the population I was trying to serve--not just for the medical risk, but the risk of the spread of the sentiment, as well as the preservation of my sanity.

Really, the NVICP has nothing to hide. It pretty much compensates for allergic reactions and contracting the disease being vaccinated against. According to their information, in 2001, people began filing claims based on the belief tgar vaccines cause autism. "As of August 2010, over 5,600 cases have been filed, and over 5,000 pending cases are being divided among the three presiding special masters [assigned to the Omnibus Autism Proceeding]. " Only one case claiming autism from vaccination has been compensated under the OAP. Even though the system is explicitly "no fault", the NVICP still takes pains to point out that payment of this one claim does not indicate any evidence that vaccines cause autism.

I wish there were fewer ways for parents to opt out of vaccinations. I wish parents who opted out of vaccinations were shunned by polite society, even though it would make their kids' childhood's miserable. I think doctors, out of concern for their other patients as well as out of concern for their ability to communicate effectively with their patients' parents, should refuse to treat nonvaccinated children outside of emergency situations.

We are all in this world together and anti-vaccination is too selfish to be socially acceptable. I don't have kids and won't/can't ever have kids but there is too much preventable misery in this world to let anti-vaccination gain any more imprimatur.
posted by crush-onastick at 7:11 PM on February 15, 2012 [2 favorites]


Craichead--meaning only that if the 98% who have kids with very minor illness need help from a provider to care for their children, and the other 2% with really sick kids need help, I am then just projecting that all families with kids who contract the diseases we vaccinate for (which are typically more virulent than an everyday virus) would, then, need help from a provider to care for them. So--spendy. Sorry if I tired to get too fancy.
That doesn't logically follow, because you never see the parents who are able to handle their children's diseases on their own. Those parents deal with their kids' illnesses and don't take them to the doctor. You may spend 98% of your day dealing with minor illnesses, but that doesn't mean that 98% of children with minor illnesses go to the doctor.

And that's fine, because we all say illogical shit on occasion. But you might keep in mind that you're fallible next time you expect some patient to defer to you because you're a doctor and they're just some stupid civilian.

(Yes, I've got some issues. Sorry.)
posted by craichead at 7:13 PM on February 15, 2012 [2 favorites]


This thread has made me much more sympathetic to anti-vaxers.

Why? Because it's unseemly to be angry about the unnecessary risks they foist on to the rest of us?

Anti-vaxers helped kill my cousin -- he survived leukemia only to die from measles. They could help kill rumple's child. They could have helped kill me. They actively disregard the real and potentially lethal risks they force upon millions of other people -- all for a completely self-serving, misguided ideology based on entirely disproven "data." Frankly, I think anger and contempt are entirely appropriate responses on behalf of anyone who is concerned about public health and the common good.

I highly doubt a court would reach the same conclusion if a child of an anti-vax parent dies as a result of lack of medical care.

A friend of mine is a scholar in the history of law who researches this question quite a lot; his main concentration is how courts deal with parents who deny children potentially life-saving medical care based on religious or "skeptical" ideology (e.g., parents who refuse chemo for a child with cancer), but a number of these cases have implications for parents who refuse to vaccinate as well. From what I understand, the legal landscape is not particularly unified or clear on this score, and based on some precedents there seem to be legal arguments to be made that parents are responsible for the consequences to their children's health if they are actively in noncompliance with doctors (and that doctors do have the right to refuse to treat in a non-emergency setting due to repeated noncompliance). I'll drop him a line and see if he'd like to comment directly.

Besides, this particular stance being discussed in the article -- pediatricians and other GPs refusing to take on families that don't vaccinate as regular patients -- has nothing to do with refusing children emergency services in the case of a life-threatening illness or injury.
posted by scody at 7:16 PM on February 15, 2012 [12 favorites]


IANA pediatrician, but I did my pediatrics clerkship last year at a site that does not treat unvaccinated children. I had a lot of discussions with the pediatricians that I worked with, because it seemed like a few of the anti-vaccination parents would try to game the group practice and get their kids passed around until finally, there were no doctors left who were unaware that these people didn't vaccinate their kids - then they would hop to another practice. Anti-vax parents fit well into Churchill's definition of fanatics - they don't change their minds and they don't change the subject.

The danger of unvaccinated kids (and the loss of herd immunity) doesn't just extend to the immunocompromised kids in the waiting room, or the immunocompetent babies who are just too young to be vaccinated. How many times has a pregnant mom had to take their children to the doctor for a sick visit or a check-up? Rubella can cross the placenta and kill the fetus, or cause any number of birth defects. Measles, too. And yeah, Hep B is generally thought of as an STD, but it can be spread by salivary contact and contact with broken skin or mucus membranes. Kids are great, but they are microbial cesspools.

On preview: What rumposinc said.
posted by honeybee413 at 7:16 PM on February 15, 2012 [4 favorites]


None of the things you write here is supported by any kind of science, at all.

From the UK Dept of Health: TB and Living Conditions

Not about contracting TB, but about the effect of living conditions on treatment: http://www.ncbi.nlm.nih.gov/pubmed/16837768 (NIH)

Polio:

PBS

From the UK Science Museum, on Polio and other infectious diseases and living conditions:

http://www.sciencemuseum.org.uk/broughttolife/themes/diseases/polio.aspx

Living conditions as risk factor in Whooping Cough: http://pediatrics.med.nyu.edu/conditions-we-treat/conditions/whooping-cough#risk

That's without reiterating the science behind the connection between Paracetamol and asthma.
posted by grubby at 7:19 PM on February 15, 2012 [1 favorite]



Anti-vaxers helped kill my cousin -- he survived leukemia only to die from measles.


damnit. I am so sorry.
posted by sweetkid at 7:21 PM on February 15, 2012


Craichead--Totally. Your issues are valid, and part of my job as a provider is to work in favor of your agency and autonomy--which is why I educate and don't lecture. The goal really is to give patients the knowledge to manage their health in an empowered way and to enter into a working and equal partnership with their provider. I don't want a family to defer, but to use me as a resource which is a distinction (at least for me). And your point does change my numbers, and I appreciate that point (though I would say, at least in pediatrics, that the overwhelming majority of the entire practice's census has extremely mild illness in their chart). Also, I'm not studying to be a doctor, but a nurse practitioner. Thanks for this sidebar to help clear my thoughts up.
posted by rumposinc at 7:25 PM on February 15, 2012 [3 favorites]


me: “So, er – yeah. That's another option for doctors: vaccinate kids without any regard for parental consent.”

rosswald: “With all due respect, this seems like a terrible idea. The parent will flip, the child wouldn't understand (or worse), and the liability question is gray at best. Calmly/rationally explaining your position, and then either treating or refusing to treat is the best option.”

It should be noted that this is not an idle question, and it's one that comes up at some point for most doctors: a parent will refuse scientifically-proven and potentially life-saving treatment for their child. You have to think about this: what do you do in that situation? If a child is actually going to die because of a decision their parent made, what do you do?

It is a point of contention, but as it stands now, doctors are legally allowed to act against the wishes of parents in those cases. And I think that's necessary. If people are minors, they're not old enough to make decisions for themselves. I'm sorry, but just because you're a minor doesn't mean you're cursed to do whatever the people who happen to have popped you out demand, and that certainly doesn't mean you are required to sacrifice your health or even your life for their whim. In the same way that we remove children from abusive homes (even if their parents protest – obviously) we do not allow this abuse-by-proxy whereby parents refuse to allow their child to be healthy or even to live in some cases.

This is a more difficult question when kids get older, and begin to be able to think over these decisions themselves. If a sixteen-year-old is thoughtful enough, they might be at a stage where they're ready to decide that they do not religiously believe in blood transfusions. I grant that. However, if a four-year-old is facing death, the parents have no say. Sorry.

Another point: when my significant other says firmly that she would vaccinate in all cases, it should be noted that she's not talking from the perspective of a family doctor in New Jersey or something. She specializes in rural medicine. Her goal is to work with native populations here in New Mexico. Many of these populations haven't had their MMR shots, not because they're anti-vaxxers, but because they couldn't afford it, or because they didn't have medical care at the right time, or for other reasons. So her reasoning is this: "I am not going to say, 'oh, okay, I won't vaccinate your child,' and then come back in a few months and find that half the village is dead. That is not an option.'

Basically, the point is that most doctors who refuse to serve kids who aren't vaccinated are pushing those kids out into a world where a lot of other doctors are likely to help them, and maybe someday the parents will come around. My significant other faces the possibility that she's the only doctor they'll see for a long, long time. In dealing with populations that have a higher potential for infection because of a much lower herd immunity, it makes sense that she'd be a lot more concerned about letting kids slip through the cracks.
posted by koeselitz at 7:25 PM on February 15, 2012 [2 favorites]


damnit. I am so sorry.

Thanks. It's still a pretty sore point in my family, and has contributed to the general familial panic both times I've gone through cancer treatment myself, to the point where my mom was almost trying to talk me out of chemo last year because she was so terrified I'd catch whooping cough (there was an outbreak in California at the time) and die of that.

Also, in my haste/anger, I mistyped: my cousin was successfully treated for lymphoma, not leukemia, before he died from measles.

posted by scody at 7:30 PM on February 15, 2012


Also, Navelgazer, the quick and dirty explanation (and I mean really quick and dirty, we spend most of my constitutional law class for non-law-students covering this), why the government can force vaccinations over religious objections, but not transfusions, is what we call "scrutiny"--when you are dealing with a fundamental right (like religious freedom) and you have a law or regulation that substantially burdens the fundamental right (like requiring medical intervention does to some folks), the government must be making the least intrusion possible to further a compelling interest. So, vaccinations (which are a minor medical intervention) further an extremely important government interest (the health of most of the population), but requiring a parent to authorize a transfusion does not.

The case I linked above goes into this just a little. Like I said, this is a quick and dirty explanation of why the two (refusing medical care and refusing vaccinations) are distinguishable in an analysis of religious freedom. Coincidentally, I had to do some research into constitutionality and family law this week and it's fairly complex, but vaccination cases tend to squarely put the state's interest ahead of the parents.
posted by crush-onastick at 7:32 PM on February 15, 2012


Actually, the PBS polio link point out that it was excessive hygiene that had compromised the population's immune systems, and caused polio to be more deadly to its hosts. Ironic, that, but it highlights the importance of a strong immune system.

This article from Diabetic Medicine has the conclusion:

" Social mixing through attendance at daycare in early infancy appears to confer protection against the development of childhood diabetes. This may be mediated through exposure to infectious agent(s) as a significant dose–response effect was evident with increasing numbers of child ‘contacts’. These findings suggest early infectious exposure may play a role in the development of immunoregulatory mechanisms which protect against diabetes and further work is warranted."
posted by grubby at 7:33 PM on February 15, 2012 [1 favorite]


Grubby, I don't think anybody is claiming that living conditions play no role in getting an infectious disease. You made the stronger claim, however, that improvements in living conditions *alone* could eliminate diseases like polio. ("I also think most of the serious diseases could be eliminated by improving living conditions and sanitation...").

None of the sources you cite provide proof for that stronger claim - that living conditions alone are enough. In fact, some contradict it. The London Science Museum website says that polio rates were *increasing,*, despite better living conditions that did help with TB, until the introduction of Salk's vaccine:

By the middle years of the century, tuberculosis was in decline. This was due to a combination of improved living conditions, mass BCG vaccination and early diagnosis by X-rays followed by antibiotic treatment. Conversely, polio reached epidemic levels. In 1947 there were nearly 8000 cases - more than 10 times the previous yearly average - and thousands more cases appeared into the 1950s.
posted by dd42 at 7:34 PM on February 15, 2012


A lot of people in this thread are just as clueless about how of why vaccines work as anti vaxers. Your vaccinated kid will NOT get sick from coming in contact with an unvaccinated one. It just does not work that way.
From personal experience, having done two pediatric rotations and having met several parents (mothers, exclusively ) that were reluctant to vaccinate their kids, the most difficult part was not dealing with them on a personal level so much as a sheer irrationality of it all.
It's like, you bring your kid in for a 6th time in 4 weeks because you're concerned about a red spot on his cheek. But you won't give us an opportunity to protect your kid against polio? WTF?
posted by c13 at 7:36 PM on February 15, 2012



Grubby, I don't think anybody is claiming that living conditions play no role in getting an infectious disease. You made the stronger claim, however, that improvements in living conditions *alone* could eliminate diseases like polio. ("I also think most of the serious diseases could be eliminated by improving living conditions and sanitation...").


Annd also, good living conditions are not necessarily forever.

We can slide back to the 19th Century, and given the way the Republicans insist on not leading the country to prepare for oil shortages, that is basically what I am expecting.

Sure would be nice if we drove more of these diseases to extinction before that happens.
posted by ocschwar at 7:37 PM on February 15, 2012


When I was a pediatric resident (2001-2004), I dealt with this on multiple occasions. When I encountered new parents or new families who didn't want to vaccinate, I remained calm, and asked them in a non-judgemental manner what was motivating them to make this decision, what data they were making their decision from. I attempted to provide them with the facts that were available to indicate that there was no causal link between vaccines and autism. Those families who got heated and argumentative in response were, in my opinion, simply not interested in working with me to serve the health care needs of their children, and were instead, more interested in indulging their fears rather than believing scientific and medical reality. Since I saw that as a risk (because residents can be sued, too), I documented, meticulously, the parents decision, but that became cumbersome and time consuming and the parents saw it as passive aggressive, rather than a necessary to protect myself from a claim of "Well, Dr. Blackman never told me that it was fatal!" should their unvaccinated child, say, get whooping cough or Haemophilus meningitis and die.

Fortunately, the American Academy of Pediatrics came up with this great form which I used, but again, parents didn't like the idea of signing something that forced them to admit that their child might die due to being unvaccinated. So I started to protest to the attending physicians who supervised the resident clinic and eventually they were willing to allow those of us who didn't want to care for families who didn't vaccine to "discharge" them to the care of another resident within the clinic.

If I had been the only pediatrician for miles, I'd certainly not abandon a child whose parents refused to vaccinate. But given that there are plenty of pediatricians and pediatric nurse practitioners around in most places, I don't think that refusing to care for an anti-vaccination family puts a child at the risk of not having any medical care.

Long story short : you can't always have your cake and eat it too, as an anti-vaccination family. Your pediatrician isn't a Zithromax-dispensing, earwax-scooping, school-physicial-form-signing automaton. They're a professional trained to use scientific data to promote the health of your child. If you aren't willing to be a partner with your pediatirican in that regard, don't be surprised if they don't want to work with you either.
posted by scblackman at 7:42 PM on February 15, 2012 [22 favorites]


A lot of people in this thread are just as clueless about how of why vaccines work as anti vaxers. Your vaccinated kid will NOT get sick from coming in contact with an unvaccinated one.

I haven't seen people in this thread worrying about their vaccinated children. I've seen people worrying about babies too young to be vaccinated, people undergoing chemo, and other people who are especially vulnerable.
posted by ambrosia at 7:42 PM on February 15, 2012 [21 favorites]


dd42: sure. I went too far with that statement. As I noted, I'm vaccinating my kids. I came out too strong, perhaps as a result of all the rabid reactions against non-vaccinators.

Improving living conditions would go a long way to fixing the problem of infectious disease, and strengthening immune systems seems to be credited as helping to avoid non-infectious disease.

My underlying assumption is that there are no short cuts in life. Vaccinations are probably a necessary evil given the way humans now live, but I wish we were able to live differently so that vaccinations weren't necessary.
posted by grubby at 7:44 PM on February 15, 2012


scblackman: “Fortunately, the American Academy of Pediatrics came up with this great form which I used...”

I'm interested, but unfortunately your link is just to a small thumbnail. Do you have a link to the actual form?
posted by koeselitz at 7:47 PM on February 15, 2012


I haven't seen people in this thread worrying about their vaccinated children. I've seen people worrying about babies too young to be vaccinated, people undergoing chemo, and other people who are especially vulnerable.

If you letting your newborn or immunocompromized kid to come in contact with someone who's sick, with anything, you've got much bigger problems to worry about. Otherwise, unvaccinated kids are not any more contagious than vaccinated ones before or after the disease.
posted by c13 at 7:51 PM on February 15, 2012 [1 favorite]


Vaccinations are probably a necessary evil given the way humans now live, but I wish we were able to live differently so that vaccinations weren't necessary.

Before the diphtheria immunization became common, the United States had some 200,000 cases and 15,000 deaths per year from the disease, 80% of them children. Post-immunization: 41 total reported cases in the US from 1980 to 1995.

Reducing deaths from 15,000 to less than 3 a year is a "necessary evil"? How, precisely, do you propose we "live differently" so that vaccination for diphtheria isn't necessary without returning to the days for 15,000 deaths annually?

If you letting your newborn or immunocompromized kid to come in contact with someone who's sick, with anything, you've got much bigger problems to worry about.

So... all infants should not be allowed into public until they're immunized? And I shouldn't have gone in public -- not to my own doctor's office, not to the grocery store, not to the pharmacy -- for the 14 months I was undergoing treatment?
posted by scody at 7:52 PM on February 15, 2012 [12 favorites]


So... all infants should not be allowed into public until they're immunized?

Do you see a lot of kids with active measles or polio running around in public?
As far as your own condition, think of all the other infectious diseases that we don't have vaccines for to begin with. Were you worried about those when you were getting treatment? Do you think they were more or less likely to harm you?
posted by c13 at 7:57 PM on February 15, 2012


I'm interested, but unfortunately your link is just to a small thumbnail. Do you have a link to the actual form?

Here is that wonderful form again, in all it's full-sized glory.
posted by scblackman at 7:59 PM on February 15, 2012 [5 favorites]


Well, and also, denying kids access to pediatricians will not keep them out of grocery stores.
posted by craichead at 8:00 PM on February 15, 2012


Do you see a lot of kids with active measles

Can you tell?

The index patient was an unvaccinated boy aged 7 years who had visited Switzerland with his family, returning to the United States on January 13, 2008.

...

The boy's measles immunoglobulin M (IgM) positive laboratory test result was reported to the county health department on February 1, 2008. During January 31--February 19, a total of 11 additional measles cases in unvaccinated infants and children aged 10 months--9 years were identified. These 11 cases included both of the index patient's siblings (rash onset: February 3), five children in his school (rash onset: January 31--February 17), and four additional children (rash onset: February 6--10) who had been in the pediatrician's office on January 25 at the same time as the index patient. Among these latter four patients, three were infants aged <12 months. One of the three infants was hospitalized for 2 days for dehydration; another infant traveled by airplane to Hawaii on February 9 while infectious.

Two generations of measles cases were identified. The first generation (eight cases) included the index patient's two siblings, two playmates from his school, and the four children from the pediatrician's office. The second generation cases included three children from the index patient's school: a sibling of a child from the first generation and two friends of one of the index patient's siblings

posted by rtha at 8:09 PM on February 15, 2012 [11 favorites]


Do you see a lot of kids with active measles or polio running around in public?

People with measles are contagious before the rash appears. source
posted by ambrosia at 8:11 PM on February 15, 2012 [3 favorites]


If you letting your newborn or immunocompromized kid to come in contact with someone who's sick, with anything, you've got much bigger problems to worry about. Otherwise, unvaccinated kids are not any more contagious than vaccinated ones before or after the disease.

Hi. Immunocompromised grownup here. I'm sure you don't intend to suggest that my choices should be either dying from lack of treatment for my condition, dying from being needlessly exposed to a preventable disease, or not having left the house since the fall of 2006. Turns out I have much bigger problems to worry about, without also having to contend with parents who fall for some stupid hoax.
posted by Homeboy Trouble at 8:18 PM on February 15, 2012 [15 favorites]


scody - I am so sorry about your cousin. That's my worst nightmare, made real.

I want to add though, that as incandescent this topic makes me, we do need to somehow understand the mindset of the anti-vax parents. As it happens, there is a graduate student doing just that in my department. I don't know the real details because frankly hearing her theorize about the issue just pushes my buttons, but the situation is this (as I understand it):

- There is a very strong cluster of unvaccinated families on one of the local islands (pop. ca 10,000)
- It's spatially concentrated along a single shoreline of the Island
- The parents are, for lack of a better word, "affluent hippies"
- The mothers network primarily through their yoga classes
- And through a single coffee shop they frequent
- It's possible the yoga instructor is the flashpoint

Anyway, to really get back on the righteous path of attempting to actually eliminate these diseases, it's necessary to understand this opposition. The student, when not theorizing, is doing some kind of ethnography of these people. Anthropologically, when confronted with inexplicable behaviour (of which there is much in the world) one does ethnographic research to try to understand. Yes, "cultural relativism" - which does not mean approving of the behaviour, but just trying to understand the dynamics underlying it, starting from the position that it *must* make sense to those involved. That is, not starting from a point of condemnation, but seeking a path of understanding.

It's worthy research that needs to be done. As others have noted, they don't respond to reason. I don't want their kids to be taken away. I just want them to fucking well vaccinate their kids. If I need to breathe deeply and try to understand the behaviour with that end in mind, then ok, I will.
posted by Rumple at 8:28 PM on February 15, 2012 [7 favorites]


If you letting your newborn or immunocompromized kid to come in contact with someone who's sick, with anything, you've got much bigger problems to worry about.

Newborn babies require well-baby checkups a 1, 2, 4, and 8 weeks of age. Explain to me how these are to be done outside of the purview of a doctor's office.

The reason the doctor's office is the point where most parents focus their fears of germ-spreading is that everywhere else you go, there are sick people and well people milling about. You can generally avoid someone who appears ill. In a doctor's office... you have people who are sick and contagious sitting in a small enclosed space with those who are either also sick, or, just there for the ride.

So. Someone is there with a child who has measles. I am there for a well-baby check up with my 2 week old newborn. Neither of us can leave. Is it unreasonable that I would be a bit cheesed off in this scenario? It's bad enough when the kid sitting next to my baby has strep throat and I start panicking a bit.

I'm no germophobe, but I get antsy that my son is going to drag home a cold from his well-baby visits from playing with all the toys that the sick kids just played with. I don't have those same fears about the toys at our playgroup because by and large - moms don't knowingly bring sick kids to playgroup. Do you see the difference?
posted by sonika at 8:29 PM on February 15, 2012 [7 favorites]


People who believe that not vaccinating your kids is less dangerous than vaccinating them have been looking at/given horribly inaccurate information are superstitious, murderous yahoos who are an immediate threat to both my personal safety and the survival of the human species.

FTFY.
posted by sourcequench at 8:42 PM on February 15, 2012 [3 favorites]


Again, the reason that some pediatricians refuse to see anti vaxers is not because of vaccinations per se, but because it is very hard to deal with those people on all levels. They come in to your office already mistrusting you (not just mistrusting, but thinking you're a part of some giant conspiracy that wants to make your kid autistic with vaccines, stupid by adding fluoride into water etc etc), but they still want your opinion and help. They are just as likely to not trust you when you tell them their kid just has a common cold and will be fine in 3 days, as when you tell them about vaccination.
I'm not sure whether refusing to see those people is the answer. On one hand, I certainly appreciate the frustration. But on the other hand, other specialties have similar problems too, but they still see the patients. Think of a psychiatrist dealing with a paranoid schizophrenic for example (Not equating those two conditions, merely pointing out that both of them are frustrating..).

During January 31--February 19, a total of 11 additional measles cases in unvaccinated infants and children aged 10 months--9 years were identified.

Ambrosia, I'm aware of that. That's why I limited my daughter's exposure to "public" before she got her first round of shots. And if I had to take her to the pediatrician, I would make her and her mom to hang out outside of the waiting room at the least and outside the hospital (most preferribly) while waiting to be seen.

Homeboy Trouble, I don't intend to suggest anything. Especially to you and about your condition. I don't know what it is. In some diseases that compromise the immune system, common causes of death are things like PCP pneumonia or candida overgrowth -- stuff that we don't have vaccines for. But that's not the point. The point is, you have strong feelings about anti vax cooks potentially exposing you to a deadly (especially in your case) disease. But the anti vax cooks have equally strong feelings about exposing their kids to something that can (in their opinion) expose their kids to a devastating disease.
What I'm trying to say is that ostracizing them and treating their kids as walking bioweapons is not very conducive to getting them around to seeing your point of view.
Also, like others said before, just because a kid did not get an MMR, does not mean he does not need help with eczema or constipation or common cold..

On preview,

Sonika, I do see the difference. Like I said above, I think the whole peds waiting room is a stupid idea. You bring your kid in for constipation and you leave with common cold. It's retarded. I personally would limit my waiting room to 2-3 chairs, everyone else -- get the hell out and come back at the appointed time. But it has its own logistical difficulties...
I also want to slap those moms at the playground that stand around and yap while their kids are running around covered in snot...
posted by c13 at 8:47 PM on February 15, 2012


People who believe that not vaccinating your kids is less dangerous than vaccinating them have been looking at/given horribly inaccurate information are superstitious, murderous yahoos who are an immediate threat to both my personal safety and the survival of the human species.

And your irrational extremism is just as annoying and hard to deal with as theirs....
posted by c13 at 8:49 PM on February 15, 2012 [1 favorite]


And your irrational extremism is just as annoying and hard to deal with as theirs....

On the plus side, though, it's less likely to kill an innocent bystander.
posted by kagredon at 8:52 PM on February 15, 2012 [6 favorites]


Why are we vaccinating for measles and mumps? I had those as a kid, as did everyone else. No biggie.

Regarding measles, the World Health Organization says:
Measles is a highly contagious, serious disease caused by a virus. In 1980, before widespread vaccination, measles caused an estimated 2.6 million deaths each year.
2.6 million deaths every year. That is hardly "no biggie."
posted by grouse at 8:54 PM on February 15, 2012 [23 favorites]


On the plus side, though, it's less likely to kill an innocent bystander.

How so? Specifically for this discussion, how does telling anti vaxer parent to get lost will reduce your chance of encountering his unvaccinated kid in a grocery store?
posted by c13 at 8:55 PM on February 15, 2012


How so? Specifically for this discussion, how does telling anti vaxer parent to get lost will reduce your chance of encountering his unvaccinated kid in a grocery store?

What? How is expressing anger and annoyance with anti-vaxers have consequences anything like not vaccinating your children for spurious reasons?
posted by kagredon at 8:58 PM on February 15, 2012 [5 favorites]


Aside somewhat from the conversation, no one else has mentioned this and it has me curious:

Surely I can't be the only one who, as a kid, went to a pediatrician's office with separate waiting areas for sick visits and well visits?
posted by rollbiz at 9:00 PM on February 15, 2012 [2 favorites]


(How does. If only my parents had known the effects MMR would have on my proofreading abilities!)
posted by kagredon at 9:01 PM on February 15, 2012 [2 favorites]


grouse: “Regarding measles, the World Health Organization says: ‘Measles is a highly contagious, serious disease caused by a virus. In 1980, before widespread vaccination, measles caused an estimated 2.6 million deaths each year.’ 2.6 million deaths every year. That is hardly ‘no biggie.’”

And it should be noted that measles is by no means eradicated; Wikipedia:
As of 2008, the disease is endemic in the United Kingdom, with 1,217 cases diagnosed in 2008, and epidemics have been reported in Austria, Italy and Switzerland.
posted by koeselitz at 9:02 PM on February 15, 2012


There was an outbreak of whooping cough at one of the elementary schools in our school district recently, and after my kneejerk "really?" response I just had to sigh and pray it didn't make it into my little prone-to-lung-infections sister's school, because, god damn. You can try to explain herd immunity to people (and I have tried) who claim little Johnny is perfectly safe without his vaccinations, who-gets-whooping-cough-anymore-ha-ha-ha only so many times before you snap and start banging heads together. And as someone with a pretty depressed immune response myself, when I do reach that point I am banging heads together extra hard.
posted by clavier at 9:15 PM on February 15, 2012 [1 favorite]


What? How is expressing anger and annoyance with anti-vaxers have consequences anything like not vaccinating your children for spurious reasons?

Well, let me restate that. If you're not a doctor in general and a pediatrician in particular, of course you can bitch and moan all you want. But if you are, you're being counterproductive. First and most obvious of all, kicking antivaxers out of your office is not going to somehow make them change their mind. So whatever chances you might have had -- you just blew them, and you still get to meet them in public.
Secondly, those people can be crazy, but it's not like they have no reasons to be skeptical. When I talk to some of them, I can't quite get the image of my colleagues who participated in Tuskeege trials or who with learned and authoritative demeanor wrote prescriptions for thalidomide out of my mind.
Finally, saying that a small group of unvaccinated yahoos is a danger for survival of human species, species that have built thousands of nuclear weapons and are a cause of the ongoing sixth mass extinction in the Earth's 4.5 billion year history is pretty damn melodramatic.
posted by c13 at 9:15 PM on February 15, 2012 [3 favorites]


c13: Finally, saying that a small group of unvaccinated yahoos is a danger for survival of human species, species that have built thousands of nuclear weapons and are a cause of the ongoing sixth mass extinction in the Earth's 4.5 billion year history is pretty damn melodramatic.

Saying that antivaxers are such a danger is stating a fact. Stating that they are the only such danger, or even the most statistically significant, would indeed be melodramatic.
posted by sourcequench at 9:25 PM on February 15, 2012


Really? Unvaccinated yahoos are a danger for survival of human species? The species that somehow survived hundreds of thousands of years without any vaccines? You're saying that's a fact?
posted by c13 at 9:29 PM on February 15, 2012


This is going all over the place, but I'll do my best.

Well, let me restate that. If you're not a doctor in general and a pediatrician in particular, of course you can bitch and moan all you want. But if you are, you're being counterproductive. First and most obvious of all, kicking antivaxers out of your office is not going to somehow make them change their mind. So whatever chances you might have had -- you just blew them, and you still get to meet them in public.

Leaving aside for a moment that you started this by telling off someone who was venting about non-vaxxers on the internet, rather than a doctor, yeah, you have a point here. But there's also a pragmatic component to this exclusion taht people have already been discussing in detail in this post, and I refer you to them (because most of them said it better than I could.)

Secondly, those people can be crazy, but it's not like they have no reasons to be skeptical. When I talk to some of them, I can't quite get the image of my colleagues who participated in Tuskeege trials or who with learned and authoritative demeanor wrote prescriptions for thalidomide out of my mind.

I will leave this for someone else, because I'm left fucking speechless by the comparison of vaccination to Tuskegee.

Finally, saying that a small group of unvaccinated yahoos is a danger for survival of human species, species that have built thousands of nuclear weapons and are a cause of the ongoing sixth mass extinction in the Earth's 4.5 billion year history is pretty damn melodramatic.

No one said that. There is no contradiction in holding that the anti-vaccination movement is irresponsible, selfish, and directly contributing to unnecessary suffering and death, while also holding that they are not worse than Hitler or whatever straw man you're setting up here.
posted by kagredon at 9:30 PM on February 15, 2012 [4 favorites]


c13: Really? Unvaccinated yahoos are a danger for survival of human species? The species that somehow survived hundreds of thousands of years without any vaccines? You're saying that's a fact?

Yes, I am saying that's p>0 for an extinction-level event. At no point during those hundreds of thousands of years were there either modern population densities nor modern air travel as a mechanism of spread.

Nor was there a mostly-vaccinated population with a small reservoir of unvaccinated yahoos busily breeding vaccine- and drug-resistant strains of what-have-you.

The Stand is a whole lot more grounded in reality than the Wakefield Lancent papers.

Or was that supposed to be a rhetorical question?
posted by sourcequench at 9:40 PM on February 15, 2012 [5 favorites]


s/Lancent/Lancet/

The brain termites are apparently terminal.
posted by sourcequench at 9:42 PM on February 15, 2012


I will leave this for someone else, because I'm left fucking speechless by the comparison of vaccination to Tuskegee.

Heh. You may want to think about it a little bit more. Hopefully you will see that what I'm trying to do is not to compare vaccination to Tuskegee but to a. illustrate to you that some of the antivaxers really believe there is a giant government/medical conspiracy to fuck up their kids by injecting poisons and b. there actually were government/medical conspiracies to fuck up people by injecting poisons.
And unfortunately there is a C -- trying to discuss this matter rationally with you is proving to be as difficult as doing it with them.


Sourcequench, measles? Measles will kill off the entire species? Especially when the "giant epidemic" brings the population back to premodern levels and distribution? Do we have any evidence that something like that could happen? Or is "extinction" used here figuratively?
posted by c13 at 9:46 PM on February 15, 2012


kagredon: "I will leave this for someone else, because I'm left fucking speechless by the comparison of vaccination to Tuskegee."

You're misreading what c13 said, and it's hard to see how you could misread it so badly as to get that meaning from it.

What c13 said was that anti-vaxxers have some cause to be mistrustful of doctors, and that the Tuskegee experiments are proof of that. Does that make sense?

Hell, I'll go further. I agree with the anti-vaxxers about Big Pharma. The phamaceutical companies are greedy, soul-quenching bastards intent on milking every penny they can from sick people. That is vile to me, and there is no shortage of examples today of terrible things pharmaceutical companies have done, from testing deadly medications on natives in Africa to overpricing their most necessary drugs so that poor people can't afford them. These are not only valid concerns; they are concerns many doctors share with the anti-vaxxers.

See, the problem here is that, in the name of feeling superior, a lot of us would like to act as though the anti-vaxxers are simply superstitious rubes with no grasp whatsoever on reality. But this isn't quite the case. At the root of their distrust of medicine isn't a hatred of science but a sense that whole swaths of medicine are driven by greed rather than health of patients. And they're right about that.

Any convincing argument against them has to start from this point of agreement. From there, we can point out that vaccines are in fact not thw purview of pharmaceutical companies in general, and that the general vaccines recommended today like the MMR vaccine have both been tested on millions of people and were created by independent research backed by peer-reviewed study and science-based medicine.
posted by koeselitz at 9:48 PM on February 15, 2012 [13 favorites]


I just wanted to add my own personal anecdote. I work in an agency that gives services/treatment a large amount of children with Austism/Asperger's, etc. There is a significan percentage of the kids who are un-vaccinated, and they still have severe diagnosis of Autism, etc. Even after the parents didn't give them the vaccines, they were diagnosed, and most of the non-vaccine parents STILL won't do it.
posted by Drumhellz at 9:49 PM on February 15, 2012 [1 favorite]


Vaccination is one thing that my wife and I cannot talk about. She sees pharmaceutical company evil in ever vaccination and I see herd immunity and her not wanting to bear the (vanishingly small) risk of an adverse reaction.

It is just not a safe topic in our house.
posted by Danf at 9:54 PM on February 15, 2012


I'm no germophobe, but I get antsy that my son is going to drag home a cold from his well-baby visits from playing with all the toys that the sick kids just played with.

For what it's worth, I was never allowed to play with the toys as a kid or touch things in the waiting room. Kind of annoying for the kid, but it worked, as far as I know. End of random anecdote tangent.
posted by hoyland at 9:57 PM on February 15, 2012


What I always want to ask people who don't believe in vaccination is: do these people believe in an actual science-based medicine? Do they eboieve that it is a thing that exists?

I mean, Danf - does your wife believe all doctors are evil, or is it just pharmaceutical companies?
posted by koeselitz at 9:57 PM on February 15, 2012 [1 favorite]


c13: Sourcequench, measles? Measles will kill off the entire species?

I could kind of use a cite, with a link, to where I said anything about measles specifically. That, or an admission that your straw man is sharing my 'nym. Either one will do, your choice.

Especially when the "giant epidemic" brings the population back to premodern levels and distribution? [...] Or is "extinction" used here figuratively?

A distinction without a difference. Assuming it's "just" premodern levels, I'll personally either be dead or really, *really* wish I were.

Do we have any evidence that something like that could happen?

That disease could play a role in the extinction of a species? I suppose so. Here, let me Google that for you, doctor.
posted by sourcequench at 10:01 PM on February 15, 2012


That seems like a distinction with a pretty big difference, sourcequench. If humanity goes "extinct," but that just means you and a lot of other people die, and everybody here in New Mexico is fine, that doesn't really seem like extinction to me.
posted by koeselitz at 10:09 PM on February 15, 2012 [1 favorite]


It's not commonly known, I don't think, that Measles was one of the biggest epidemic killers of indigenous North and South Americans. Certainly comparable in scope and deadliness to smallpox, and causing massive mortality as recently as the 1960s is some parts of South America.

Not to say that would happen again, but, we had measles down and on the mat and almost out, and it just got saved by the bell. I know nothing about it, maybe the new (residual) measles is tougher, hardier, more virulent, or maybe it could become so. It's certainly a non-trivial disease historically.
posted by Rumple at 10:11 PM on February 15, 2012


Vaccinations are probably a necessary evil given the way humans now live, but I wish we were able to live differently so that vaccinations weren't necessary.

Yeah, jesus, I wish we lived in a world where there were no diseases to combat too but come on grow up already.
posted by xmutex at 10:12 PM on February 15, 2012 [3 favorites]


Not to get off topic, but it seems to me kaseijin, the reason there are no more Eckerd's is J.C. Penny sold-off Eckerd's with about half becoming CVS stores and the other half eventually becoming Rite Aid stores. The Denton case was Feb. 2004 and J.C. Penny announced the sell-off in April 2004. The deal was most likely in the works before the Denton issue became widely-known.
posted by Ranucci at 10:13 PM on February 15, 2012 [1 favorite]


koeselitz: If humanity goes "extinct," but that just means you and a lot of other people die, and everybody here in New Mexico is fine, that doesn't really seem like extinction to me.

With all due respect, and speaking as an escaped New Mexico native myself: "premodern levels and distribution" are kind of a baseline there anyway, nyet?
posted by sourcequench at 10:15 PM on February 15, 2012


Why do both sides of this argument piss me off? Like, both sides, fuck off, now.

I usually pick a side, but on this one, both sides irritate the shit out of me.
posted by roboton666 at 10:19 PM on February 15, 2012


I could kind of use a cite, with a link, to where I said anything about measles specifically.

Well, since we're talking about childhood immunizations, you're free to use any other childhood disease as an example. But please please provide some evidence that any one of them is or ever was deadly enough to kill off the whole species.
As for your links, the first one talks about something that happened on an isolated atoll - a thing that is directly opposite of your "modern population densities nor modern air travel as a mechanism of spread" scenario.
As for the second one:

Extinction - Wikipedia, the free encyclopedia
en.wikipedia.org/wiki/Extinction
Humans can cause extinction of a species through overharvesting, pollution, ..... the extinction of many species of viruses and bacteria in the cause of disease ...


Top 10 Worst Diseases
listverse.com/2007/11/15/top-10-worst-diseases/
Nov 15, 2007 – Malaria is a vector-borne infectious disease caused by protozoan ..... so the disease is considered extinct, but it's not quite extinct because of ...


Dinosaur Extinction: Other Theories
webspinners.com/dlblanc/paleo/dino-colo/extinction/other.php
Also, epidemic diseases may wipe out large segments of a population, but rarely if ever has disease caused the complete extinction of a species, let alone an ...



Thanks, Tiger. If I was a med school, I'd give you a diploma just for your mad google skillz.
posted by c13 at 10:20 PM on February 15, 2012


Why are you guys even derailing into extinction-level events? That's silly and unproductive.

What matters is that contagious diseases, like measles and mumps, used to kill tens of thousands of people, and scarred, disfigured, or sterilized many more for life. (Mumps apparently causes male sterility with reasonable frequency.)

Mass vaccinations are so incredibly effective that modern people have lost their fear of these diseases. They've never seen for themselves just how awful they can be, and the horrific toll they exacted from humanity. It's a program that's so incredibly successful that people are actually wondering if we even need it.

We do. Those diseases are still out there, still contagious, and there are A LOT more of us to catch them these days. Now that herd immunity is waning, and these diseases are re-establishing themselves, it's particularly critical to get your kids immunized. Yourself, too.

And I hope the family of the first kid that medically couldn't be immunized, and who dies from catching something from an anti-vaxer, sues the living shit out of that kid's parents for reckless endangerment. I'm pretty libertarian, but I would manually force every one of those kids to get vaccinated, at gunpoint if necessary. Selfish asshole parents.
posted by Malor at 10:28 PM on February 15, 2012 [17 favorites]


What if kids who can't get treated catch a disease we have no vaccine for, nobody treats them, and they spread that.
posted by Ad hominem at 10:29 PM on February 15, 2012


Selfish asshole parents.

I agree with this, honestly. I don't have the personal loss experiences that some have in this thread, but I'm glad for that. My mom is a doctor who had mumps as a child (in India), and she has no patience for the anti vax crowd. You want your kid to have measles and mumps? No you don't.
posted by sweetkid at 10:36 PM on February 15, 2012


Why do both sides of this argument piss me off?

Because saying things like "Doctors want to give my baby autism by injecting him with mercury" are just as retarded as "ZOMG your unvaccinated kid is going to kill us all" ?

I'm pretty libertarian, but I would manually force every one of those kids to get vaccinated, at gunpoint if necessary.

There is a whole field of medical ethics that deals with these kind of questions. I'm sure they have a pretty good reason why your proposal is a bad idea.
posted by c13 at 10:36 PM on February 15, 2012 [2 favorites]


Malor: Why are you guys even derailing into extinction-level events? That's silly and unproductive.

Malor, you're right. p>0 isn't the same as relevant.

Selfish asshole parents.

Yeah, except this isn't even some kind of prisoner's dilemma where you can sometimes realize a short-term profit by defecting. Stupid asshole parents.
posted by sourcequench at 10:40 PM on February 15, 2012 [3 favorites]


Because saying things like "Doctors want to give my baby autism by injecting him with mercury" are just as retarded as "ZOMG your unvaccinated kid is going to kill us all" ?

There's a pretty huge difference between the "risks" of not vaccinating and the "risks" of vaccinating.

It's called reality.

And your comment was the one that started the extinction derail. I'm really having a hard time not seeing this as trolling.
posted by kagredon at 10:40 PM on February 15, 2012 [4 favorites]


And before you give me "well, anti-vaccine proponents would say that theirs is the real concern": the difference there is evidence.
posted by kagredon at 10:42 PM on February 15, 2012


This may be a dumb question, and if so I'm still interested in why that is: can widespread vaccination in the long term breed (or adjust the competitive environment of) resistant varieties of diseases, in a similar manner to antibiotics? Or, once vaccinated against rubella, is a person thereafter effectively immune to anything that is sufficiently rubella-like to still count as a "variety" of rubella?
posted by aeschenkarnos at 10:52 PM on February 15, 2012



And your comment was the one that started the extinction derail. I'm really having a hard time not seeing this as trolling.



People who believe that not vaccinating your kids is less dangerous than vaccinating them have been looking at/given horribly inaccurate information are superstitious, murderous yahoos who are an immediate threat to both my personal safety and the survival of the human species.

FTFY.
posted by sourcequench at 11:42 PM on February 15 [1 favorite +] [!]


Dude, are you for fucking real? Not only have you misstated (or misunderstood) what I said twice, but you can't even follow the thread chronologically?
posted by c13 at 10:52 PM on February 15, 2012


Or, once vaccinated against rubella, is a person thereafter effectively immune to anything that is sufficiently rubella-like to still count as a "variety" of rubella?

Not really. Think of flu immunization. Why do you have to get it every year? Because it mutates. In case of rubella, it's just that it changes a lot slower than flu.
Or think of common cold. Why do you keep getting it every year and why don't we have a vaccine against it? It's because there are 120+ different strains of it...
posted by c13 at 10:56 PM on February 15, 2012


I'm going to go anti-vaccination because DAMNIT I had to get mumps and chickenpox and stuff and now all these young punks don't have to deal? Bullshit. That's some bullshit right there. Look over there, there are teenage girls who'll never understand how lucky they are to be young enough to get an HPV vaccine if they'd stop with the texting for 5 minutes. I'd get it and I'm too old for it to be of much use. You tell me a shot stops me from getting sick? I say stick it in. I've been a medical student's first flu shot on more than one occasion just to get through the waiting room at the clinic faster. Poke poke poke. If I were to ever have a kid the doctor would be suggesting that hey, maybe the hepatitis A/B vaccination isn't needed at 6 months and I'm all WTF are you some kind of medical luddite?

I wouldn't make a good mom, but that's beside the point.
posted by Salmonberry at 11:04 PM on February 15, 2012 [2 favorites]


Malor: "I'm pretty libertarian, but I would manually force every one of those kids to get vaccinated, at gunpoint if necessary."

c13: "There is a whole field of medical ethics that deals with these kind of questions. I'm sure they have a pretty good reason why your proposal is a bad idea."

What? Do you mean because of the gun, I guess?

Yes, there is a field of medical ethics that deals with this. The general consensus there seems to be that vaccination should be mandated by the government.

That doesn't mean they're absolutely correct, and it is completely legitimate if one wants to disagree with them, but don't blithely assume that medical ethics thinks the current policy in the US is just fine without even bothering to check.
posted by koeselitz at 11:12 PM on February 15, 2012 [1 favorite]


Oh, and just to be all mom-like, here is the list of immunizations that you can get for free or at cost in the Province of BC. (PDF). Lists what is recommended for adults as well as kids and seniors.

I believe Pertussis has been added to the Tetanus booster lately, since there have been outbreaks (supposedly caused by non-vaccinated kids, but that's rumour).
posted by Salmonberry at 11:13 PM on February 15, 2012


So, this thread, TL;DR version:

EVERYBODY: Fuck those parents who won't immunize their kids.
ALMOST EVERYBODY: Yeah, and fuck those helpless kids, too!
A FEW PEOPLE: Wait, those kids can't choose not to be immunized, and probably deserve health care, especially considering the craziness of their parents in that regard.
EVERYBODY ELSE: NO! Fuck those kids! Other kids! Boo! Fuck you!

It's almost unheard of that I so rashly disagree with the MeFi general opinion on things, but y'all have gone around the bend on this.
posted by Navelgazer at 11:15 PM on February 15, 2012 [3 favorites]


When you paraphrase somebody else's argument, the odds of misrepresenting it skyrocket.
posted by Bunny Ultramod at 11:16 PM on February 15, 2012 [13 favorites]


c13,

I curious about this claim from earlier in the thread:

A lot of people in this thread are just as clueless about how of why vaccines work as anti vaxers. Your vaccinated kid will NOT get sick from coming in contact with an unvaccinated one. It just does not work that way.

I am not a medical doctor, so I suppose I might be missing something, but I thought that vaccines were not universally effective in the population. Some people -- both children and adults -- who have been vaccinated do not develop immunity. Hence, some vaccinated people are placed at greater risk by being around un-vaccinated people, since the un-vaccinated are more likely to have a relevant disease.

At least, that is the way I read this little passage from the CDC aimed at dispelling a (related) misconception about vaccination.
posted by Jonathan Livengood at 11:16 PM on February 15, 2012 [3 favorites]


Crap ... I am curious ...

That just made me sound caveman-like. Grr ...
posted by Jonathan Livengood at 11:16 PM on February 15, 2012


Bunny Ultramod: that's entirely fair.

But while I've got sympathy out the wazoo for the argument against exposing immunodeficient children to the unvaccinated kids (and would personally prefer that all kids be vaccinated regardless of any non-health-related factors), the callousness towards the well-being of these kids who aren't choosing their parents nor their treatments is astounding to me.

Fuck those parents. Right in the ear. But as far as those kids are concerned, well, they have no more choice about being vaccinated than the kids with legitimate health reasons. And the majority of the comments in this thread (and I don't think I'm exaggerating there) have been happy to self-righteously visit the sins of the father upon the child as regards this issue, and I find that frankly disgusting.
posted by Navelgazer at 11:22 PM on February 15, 2012 [1 favorite]


Navelgazer (and others), if you see palliser's example above, what often happens is that the parents give in and let their children get vaccinated. So it is:

A FEW PEOPLE: Where am I going to find a doctor? All right you win, vaccinate my kid.
EVERYONE ELSE: Your kids and our kids and pregnant mothers are now less likely to get diseases. Everyone wins!

I mention pregnant mothers because I too am old enough to have not been vaccinated as a kid. Our neighborhood was small, but the diseases were rampant and every child got measles, mumps, chicken pox, etc. Some kids got very sick and ended up in the hospital. It was a new neighborhood with young families starting out. I remember at least two cases where a young mother caught one of these diseases and lost her child.

(Hey grubby, you mention that these diseases wouldn't exist if conditions were sanitary. Since you and I both got these diseases when we were young, does that mean that our families and neighborhoods were unsanitary? I'm just trying to follow your logic).

That's your choice. Either way your immune system is going to get hit with the disease: either by catching it, or by the much more benign vaccination. Based on my experience, I feel that you are either in favor of vaccination or you are in favor of killing babies.
posted by eye of newt at 11:34 PM on February 15, 2012


What? Do you mean because of the gun, I guess?

Well, yes. Extremism in general. It's hard to change minds, it's even harder to force people to change minds. A lot of people are irrational if not to say completely crazy. Government puts fluoride in water to make you stupid, puts chemicals into jet engine fuel so that they can do something (not sure what the conspiracy flavor of the month is) by spraying it from stratosphere (forget about things like air movements, diffusion etc etc).
What do you think is going to happen if government will start sending out SWAT teams to take kids to the pediatrician office?
Vaccination is for some reason became a hot topic and it is impossible to discuss it rationally with anti- and pro- vaccination people. Everything degenerates into emotion. Fuck those parents! No, fuck THOSE parents! Shoot the doctors! Shoot the parents..
It's just sad. Especially considering that we've somehow managed to completely eradicate such things as small pox, world-wide. Without resorting to violence, denigration and ridicule , but with patience and dialogue and education.

As far as medical ethics goes, right now the general opinion is that we allow people autonomy when it comes to making decisions about their health in general and we allow them (with very few exceptions, for very good reasons) to make decisions about their underage children. As such, we can certainly try to compel vaccination compliance, but we cannot force it. Reasons for that a numerous and I'm neither qualified, nor particularly interested in discussing them in depth, but just think of where forcing medical treatment on children of unwilling parents may lead. Both in terms of response and in terms of slippery slope..
posted by c13 at 11:37 PM on February 15, 2012


The kids have to be unvaccinated and actually infected to make anyone sick. Mearly being unvaccinated does not make them spread disease, they have to have a disease to spread.

I still think it is a legit health concern if we have a class of people spurned by health care professionals, they could get one of a million things that are treatable but we don't yet have vaccines for and spread those.

If we are willing to go so far as to mandate vaccines for the good of society, we should be willing to mandate that nobody can be refused some level of treatment, if only to establish they don't have yellow fever or dengue or some crazy House shit that is likely to spread.
posted by Ad hominem at 11:37 PM on February 15, 2012 [1 favorite]


And the majority of the comments in this thread (and I don't think I'm exaggerating there) have been happy to self-righteously visit the sins of the father upon the child as regards this issue, and I find that frankly disgusting.

No, I don't think the sins of the parents should be visited upon the children -- not on their children nor anyone else's children. Frankly, I think non-vaccination for anything other than legitimate medical reasons should be considered negligence, and parents should be legally compelled to vaccinate their kids if they refuse to do so on their own. Then, problem solved: no doctor will have to refuse to take them on as patients due to the heightened risk they pose to other patients.

I'll say it again: non-vaxers have gotten away with this, and in so doing have created a public health hazard that is swiftly becoming a national and even international public health crisis, precisely because there have been no consequences to their actions. They are the ones playing with the health and safety of their children, not the rest of society. Society has bent over backwards to accommodate this pernicious nonsense, and should not (and increasingly cannot) indulge their paranoia borne of misinformation and lack of critical thinking any longer.
posted by scody at 11:39 PM on February 15, 2012 [10 favorites]


Ad hominem,

I assume that this -- The kids have to be unvaccinated and actually infected to make anyone sick. Mearly being unvaccinated does not make them spread disease, they have to have a disease to spread. -- is directed at me. I do understand that much; I am trying to evaluate the risk to the population of letting un-vaccinated people receive treatment side-by-side with vaccinated ones. I agree that if we could screen out the infected, contagious, un-vaccinated people, then there would be no problem. But do you disagree with the claim in my earlier post that some vaccinated people are placed at greater risk by being around un-vaccinated people, since the un-vaccinated are more likely to have a relevant disease?
posted by Jonathan Livengood at 11:47 PM on February 15, 2012


What I always want to ask people who don't believe in vaccination is: do these people believe in an actual science-based medicine? Do they eboieve that it is a thing that exists?

It is my experienced that a lot of anti-vaccination types believe that they are the ones who are following science-based medicine and that pro-vaccination people have been brainwashed or duped. You can point out a hundred studies and they'll always have a reason why the science supports them and not you.

Remember, you mostly can't reason people out of positions they did not reach through reason.
posted by Justinian at 11:59 PM on February 15, 2012 [1 favorite]


eye of newt: in my case I got measles, mumps and rubella because my parents sent me round to play at the houses of other kids with the disease. For healthy, well-nourished kids these 3 are rarely a big problem.

In case anyone feels the need for less science and more anecdote I've noticed in my own kids (4.5 and < 1) that they seem to put on a growth spurt immediately after recovering from an illness (usually some un-named fever). I do think it's important for kids to get sick, within reason.
posted by grubby at 12:05 AM on February 16, 2012 [1 favorite]


Grubby, you don't actually understand how vaccines work, do you? Being vaccinated doesn't make your immune system weaker.
posted by Justinian at 12:07 AM on February 16, 2012 [10 favorites]


Your vaccinated kid will NOT get sick from coming in contact with an unvaccinated one. It just does not work that way.

I am not a medical doctor, so I suppose I might be missing something, but I thought that vaccines were not universally effective in the population. Some people -- both children and adults -- who have been vaccinated do not develop immunity. Hence, some vaccinated people are placed at greater risk by being around un-vaccinated people, since the un-vaccinated are more likely to have a relevant disease.velop immunity. Hence, some vaccinated people are placed at greater risk by being around un-vaccinated people, since the un-vaccinated are more likely to have a relevant disease.


Well, I was not precise in that statement. You are correct that no vaccine is 100% effective. For example, from your link, measles is 98% effective. So if you have been vaccinated, but just happen to fall into that 2% (for whatever reason), practically speaking you haven't been vaccinated. Or, better, you have been vaccinated, but haven't been immunized. So you can still get sick. But, just because the person next to you haven't been vaccinated, does not mean that he's a walking bioweapon and you should run for your life. In order to pose a danger to you, he has to have currently active disease. And even then the chances of you getting sick are governed by this particular bug's infectivity. And, of course, whether you die or not depends on the bug -- same measles is pretty bad, but it does not kill everybody it infects, not by a long shot.
All this is of course in no way suggests that vaccinations aren't important or needed. Or that measles isn't dangerous. It's just that when epidemiologists talk about things like immunization, disease spread, infection rates and the like, they are talking about population in general. But parents are mainly concerned about their kids. And you can't quite equate the two. While for epidemiologist effectiveness of the measles vaccine may be 98%, for you specifically it's either 0% or 100%.
As far as , I don't see how you get to this conclusion. They are more susceptible to one, but why are they more likely to have it?

It was a very long and convoluted explanation, I'm not sure if I'm making sense or just rambling. But if I can get only one point across in this whole thread, it is that immunization is a very hot topic which causes a lot of confusion and strong emotions on both sides of the argument. And I believe that my responsibility as a doctor is to immunize as many people as I can. And that kicking them out of my office when they disagree with me does not help me to fulfill my responsibility and actually makes things worse.

posted by c13 at 12:12 AM on February 16, 2012


Justinian, I think I understand as well as most laymen how vaccines are supposed to work. Perhaps not all humans have reached the same complete understanding of the human immune system that you have.

Not to get all woo woo, but it's massive hubris to assume that we understand completely all the ramifications of vaccination on the scale that it has only recently started to be done. We're not even half a human lifetime into mass, multiple vaccination as is now practiced.

And again I come back to Acetaminophen and asthma: oops!
posted by grubby at 12:20 AM on February 16, 2012 [1 favorite]


If there's a good medical reason to separate unvaccinated people from others, then I support doctors refusing to have such people on their lists.

If doctors merely wish to rid themselves of "troublesome" patients who don't always listen to their advice, then they can get stuffed. A doctor's role is to advise and to treat, and unless it is a medical emergency and the person or their guardian incapable, they never get to choose. Fat people, smokers, heavy drinkers, recreational drug takers, and so on, all do things which a doctor might disapprove of, but to cut them off form medical is an abjuration of their professional oath. Good medicine can only come about when a doctor sees themself as a partner in medical care, and not a dictator.
posted by Jehan at 12:30 AM on February 16, 2012 [2 favorites]


As far as , I don't see how you get to this conclusion. They are more susceptible to one, but why are they more likely to have it?

I'm guessing there is something missing here ... probably my claim that being un-vaccinated makes one more likely to have a relevant disease. Let's stick to measles just for concreteness. Here is my reasoning. If you spot a flaw, let me know.

(1) Vaccinated people have, on average, 98% immunity to measles.

(2) Un-vaccinated people have some much lower average immunity to measles. (The CDC passage implies zero immunity, but that can't be right, can it? Some non-vaccinated people are sure to have natural immunity, right?) I don't know a precise number here, but it has to be significantly lower than 98%.

(3) Vaccinated and un-vaccinated people are exposed to disease vectors at the same rate, on average.

(4) Hence, un-vaccinated people are more likely than vaccinated people to have a relevant disease.
posted by Jonathan Livengood at 12:45 AM on February 16, 2012


Anyone who shouldn't be vaccinated for medical reasons, tautological as it is, got that advice from a doctor. So I don't think we need to worry about them (well, not any more than would be warranted in terms of worrying about them having whatever condition makes them not safe to vaccinate.)
posted by aeschenkarnos at 12:46 AM on February 16, 2012 [1 favorite]


Justinian, I think I understand as well as most laymen how vaccines are supposed to work. Perhaps not all humans have reached the same complete understanding of the human immune system that you have.

My understandng isn't complete, of course, but I know that getting measles, mumps, and rubella doesn't make you stronger and isn't a good thing.
posted by Justinian at 12:48 AM on February 16, 2012 [2 favorites]


Sorry ... I intended to be concrete throughout the argument for clarity's sake. I am inventing a number for natural immunity to measles just for illustration. Feel free to replace it was a citation-backed number. Let me try again:

(1) Vaccinated people have 98% immunity to measles.

(2) Un-vaccinated people have 10% immunity to measles.*

(3) Vaccinated and un-vaccinated people are exposed to measles at the same rate.

(4) Hence, un-vaccinated people are more likely than vaccinated people to have measles.

All else being equal, an un-vaccinated person is more likely to have measles right now than is a vaccinated person.

Whether un-vaccinated persons should be shut out of regular doctor's offices then depends on how much that difference in likelihood of having measles (or some other disease, like whooping cough or, God forbid, polio) matters to the health of the community at large.

* Again, the 10% number is made up, whole cloth. I don't know what the real number is.
posted by Jonathan Livengood at 1:04 AM on February 16, 2012


Jonathan Livengood,
1. true
2. true, but again you have to remember that things like "average" are only valid for a population. The guy sitting next to you in the doctor's office does not have measles "on average". He either does, or does not.
3. I don't think so. First of all, you can't just compare the two sample groups, as one is much larger than the other. For example, think of one person with active measles. He would come in contact with a lot more immunized people than unimmunized, simply because there are more of the former that the latter. You have to normalize the samples before you can make a comparison of the exposure rate. To take another example, suppose you have a child born to a cruiser couple on a sailboat. Since they spend most of the time at sea, the infection rate would be extremely low. Conversely, some religious communities refuse vaccinations and live in close quarters, so their rate would be much higher.
4. Again, you're confusing population and individual, as well as immediate vs continuous (for the lack of a better word). Saying that an unimmunized person is more likely to get a disease in his lifetime (true), is not the same as saying that he is more likely to have it at this particular time. For you to be in danger, a)you must fall into the 2% of those in whom the vaccine is not effective, b) the virus has to be sufficiently virulent, c) you have to be in close contact with a person that currently has an active disease. (You meet him earlier - he's got nothing to infect you with, you meet him after he got better - he is effectively immunized against the disease).

Whether un-vaccinated persons should be shut out of regular doctor's offices then depends on how much that difference in likelihood of having measles (or some other disease, like whooping cough or, God forbid, polio) matters to the health of the community at large.

Ok. But if you shut them out of the office, they ain't gonna run to Walmart and buy a vaccine because you scared them straight. All you have done is to antagonize them not only to you, but to other doctors. So the poor kid who's got nothing to do with anything is now even less likely to get care not only for infections but all the other problems little kids have. Remember, we're not talking about doing anything for the parents. Fuck them. It's the kids we're worried about, and we can't help the kids if their parents don't let us.
posted by c13 at 1:21 AM on February 16, 2012


All else being equal, an un-vaccinated person is more likely to have measles right now than is a vaccinated person.

Probably true. For a population. But as far as a guy sitting next to you, I'm not sure there is a way to say anything meaningful.
posted by c13 at 1:25 AM on February 16, 2012


For healthy, well-nourished kids these 3 are rarely a big problem.

Perhaps. But when it is a problem, it's a really, really big one.

I do think it's important for kids to get sick, within reason.

It's important for kids to get exposure to pathogens, as that's how immune system learns. But it is not necessary to get sick.
posted by c13 at 1:31 AM on February 16, 2012 [1 favorite]


This is rolling right along as expected, but I just wanted to share a few of things.

Pure anecdotal stuff.

I had to get an MMR booster when I was a senior in high school because my age group had been given them at apparently the wrong times. I had the 3-day measles the same year I'd also had chicken pox and pneumonia. It was a hard year, and if I'd been in a different school situation, I'm not sure I'd have been allowed to pass the grade. I did a lot of basically independent study at home. Luckily for me, my dad was a teacher at the high school portion of the little Catholic school I attended, so folks knew my parents could teach me the assignments, and there was some sort of arrangement about tests. I had so many high fevers that year, I can't even remember what it was. I do know that I was on an even basis with my class and had turned in all assignments when I would come back to the class room. The only borderline grade was PE because, damn, I was doing well to show up to class that year. Kickball? Uh maybe on a good day. That year, I also played with kids who had mumps, but it seems my dad's side of the family doesn't get them, for which I'm very grateful.

More recently...

I have two kids and have been reasonably up to date with their shots from the time they were born. A couple years ago, there was a whooping cough issue in my area, so my kids needed to get extra boosters. The boosters were required by the school system and cost $5 per kid at the health department. I was talking casually about this to a friend who was trying to integrate her kids, who are the same ages and genders as mine, into the public school system after only homeschooling. I mentioned the DPT booster, and you would have thought I was telling her to give her kids poison. Seriously, there was an audible gasp. This conversation didn't end in any way but, "Well, I've gotten my kids shots and they're doing fine." on my end. She went on a rant and we haven't really had a successful friendship since, which makes me sad. I feel like I'm the one being shunned because I've "given in to the Man." That's the quote.

I even tried to assure her that I had "spaced" the shots, just to try to find a common ground. Now granted, it wasn't intentional on my part. Heck, my son even had a reaction to an MMR shot when he was 5 that mimicked having measles. He broke out in a rash exactly 10 days after, but didn't run a fever. I had to take him to the doc to confirm he wasn't actually sick, since he understandably wasn't allowed at school or the babysitter until cleared. It was still points against me at a job I lost due to missing time. I finally lost that job due to both kids getting pinkeye at their dad's house, but that's a separate rant.

I feel like the point of the second story is that moms tend to be the ones who are expected to miss work with a sick child. As a result, our jobs are considered more expendable.

Also, stay-at-home, homeschooling moms (and it really is generally the moms) tend to network a LOT, and if you don't fit their particular party line, you get excluded. I've never had the opportunity to try it out, but I've observed how it works, granted only in my area, where it's more of a philosophical thing than religious thing. I HAD to have a job and couldn't participate in group share activities because I was a single mother without family and other resources nearby. I made do with my part time job for many years and a smidge of government help with rent, groceries, and health care for the kids. Even then, I'd have probably come under scrutiny because I think vaccinations are a good thing.

The biggest problem I had at the time, when the kids were small, is that my car died and the health department (and their pediatricians' office) was clear across town. Luckily, we have a modest but effective public transit system. It still took about an hour each way. I was also berated by a nurse for waiting too long for my daughter's last boosters before kindergarten. Whatever. We had an adventure and a day of snuggles that she still remembers.

I still work part time at a job I love. My husband of over two years has a job which is the reason I have any health care. We both work for the state, so the kids still get the state-funded health care, which has been more than fine. We haven't had help with food or housing for a while now, which is so liberating.
posted by lilywing13 at 2:28 AM on February 16, 2012 [3 favorites]


But I don't know anybody who's had any of them in my lifetime.

I'm a bit late to the party here, but i know more than i can count sadly, and i'm 41. Classmate of mine had polio, paralyzed from the waist down, in elementary school. My dad had mumps as a child, not so much my lifetime, but he always told stories about it. Several people i forget the names of growing up, various religious (not even the mild type, but the no cutting hair type) parents had kids get various types, and now living in a small college town (12k people), almost every year there is a warning about some of these, measles and whooping cough are the most common ones.

What's sad is that i know a couple who didn't, they make fun of scientologists, but believe that their kid would get autism if vaccinated. I lump them together.
posted by usagizero at 2:29 AM on February 16, 2012


As far as , I don't see how you get to this conclusion. They are more susceptible to one, but why are they more likely to have it?

That depends upon the size of the disease pool in the general population, how virulent the disease is, how transmissible it is, and how long they are infectious for while being symptom free.

If you take polio in a western country as your example, it's pretty much a given that nobody has it as we've eliminated it entirely from the general population in almost all countries now. So if you have an immuno-compromised patient sat next to a unvaccinated kid in a doctor's waiting room, there's pretty much zero chance (for now, anyway) that that kid is secretly harbouring polio.

If you take measles in the UK however; measles is a very infectious disease. It spreads easily and quickly via fluid transfer - sneezes, coughs, saliva left on hard surfaces etc (90% transmission rate in shared circumstances). The incubation period is 9-12 days between infection and visible symptoms; 2-4 of those are infectious to others. There's also a 2-5 day period after the rash appears that the kid is infectious. When you look at measles cases, they come in clusters. One kid gets it - such as from foreign travel where it's more prevalent - then it spreads around to other people they come into contact with. Parents, kids in the same class, friends, other people in doctor's surgeries. Because when they get sick, before or after they show a rash, they're infectious, and can happily spread it around. And where do parents take their kids when they're sick? And where do people who are immuno-compromised go for treatment?

Now, in a population with a very high rate of Measles vaccination, there's nowhere much for it to take hold and spread, so outbreak clusters will be small and short-travelled - most of the vaccinated will not be infected, though as pointed out, not everyone is protected. Herd immunity will protect the vulnerable, by providing a barrier to wide-spread transmission. However, when MMR vaccination rates drop - as it has substantially in the last 10 years in the UK to 80% or less - there are more people vulnerable to the disease, and thus the infection pool is much larger. One person gets it, and it's not just their unvaccinated direct family that gets it, it's literally dozens or hundreds or people who get it, and all of them can spread it around for days while being asymptomatic. Especially given anti-vaxxers tend to cluster together socially for support, given their increasing amount of shunning from schools and by other parents. So now you have a large pool of people in a given area - an epidemic - carrying the disease, and spreading it both before and after visible symptoms for days. And a lot of them are going to the doctor, wondering why their kid has a nasty rash. And they're sat next to that cancer treatment patient, or the pregnant mum, or the baby in for a checkup that's too young to have had a shot. Infection rates for measles have gone up by 3000% in a decade, and that's almost entirely down to the far greater numbers of the unvaccinated providing a place for the disease to take hold and spread. Herd immunity has dropped low enough that there are persistent clusters of measles in the UK now, something like 1500 cases a year and rising. It's far short of the hundred's of thousands that used to catch it annually pre-vaccination, but it's a disease we'd virtually beaten, and its coming back in a big way.

So yes, the unvaccinated do provide a much greater risk to the vulnerable in doctor's surgeries, because they have a much higher chance of being an unwitting carrier of an infectious disease that can kill healthy people, but is especially risky to those who cannot fight the disease effectively on their own. It's not just measles this applies to either. We're seeing drug-resistant strains of TB show up far more, and whooping cough. TB vaccines are making a come-back in london as standard, because of the much higher risk of TB spread in recent years - we almost had it licked in the UK, but again, it's becoming part of the public health risk in the UK. Meningitis can kill healthy young adults and babies in hours, and has done.

Anti-vaxxers kill people. Sometimes their own children, sometimes themselves, and sometimes people who have to rely on herd immunity because they cannot rely on their own immune system. Doctor's offices provide a statistically significant vector for infectious disease, and those who are unvaccinated in the waiting room are far more likely to be carriers, asymptomatic or otherwise, than the vaccinated population for those diseases which are still prevalent in the country.

So yes, it sucks that kids who could be vaccinated, but are unvaccinated by parental choice find it harder to get routine medical treatment. There's an easy solution for that; get vaccinated, and now they're welcome back in with the rest of us. Because it's not just their own health that is being put at much greater risk, it's that of all the people who's only defence is herd immunity. It's not some theoretical, small risk - people have been killed by infectious diseases that would not have spread to them if there wasn't a large pool of willing disease carriers out there.
posted by ArkhanJG at 2:58 AM on February 16, 2012 [16 favorites]


Disclaimer, I am UK based, so far as I know we are essentially free of this madness.

The anti-vaccine parents are, so far as modern medical 'wisdom' is concerned, guilty of wilful neglect and (IMHO) child abuse. The authorities should intervene to place the children away from actual or potential harm.

So far as the doctors are concerned, the patient doctor relationship is a partnership. The doctor's role is to advise and help the patient to maintain best health giving the patient what the patient needs (in the doctor's opinion) not what the patient thinks they want. The patient's role is to follow their doctor's advice, if they can't or won't do that they should find another doctor. Unless the parent is medically qualified, overriding or ignoring the doctor's advice regarding their children is, again wilful neglect/abuse.
posted by epo at 3:02 AM on February 16, 2012


Where are the researchers working on ways to boost our immune systems other ways, either genetically or otherwise? I don't mean this snarkily, i'm honestly curious. It seems more viable long term to do that then keep making vaccines and drugs. I keep hearing how some species have insanely touch immune systems, we should be working on that, if our technology is there yet, and if not we should be working to get there.
posted by usagizero at 3:07 AM on February 16, 2012


Disclaimer, I am UK based, so far as I know we are essentially free of this madness.

I'm afraid you're wrong about that. Wakefield is british, he published his 'research' that MMR causes autism in the lancet, a primarily british medical journal (which has since retracted it). It received extensive coverage in such august publications as the Daily Mail, and MMR vaccination rates in the UK have dropped to distressingly low levels for a wealthy modern country. They are rising again though, thankfully, as more people accept the huge amounts of medical evidence showing there is no link.

Last year, there was a very public call for people to get vaccinated if they had not been against measles, due to the massive growth in infection rates - up by 10x over the same period the previous year. It's not unique to the UK either, there have been large increases in measles cases in france especially, and throughout europe for the same reason - a substantial drop in the MMR vaccination rate below the 95% or so for herd immunity to be effective.
posted by ArkhanJG at 3:18 AM on February 16, 2012 [1 favorite]


Disclaimer, I am UK based, so far as I know we are essentially free of this madness.

I'm not so sure about that. Measles cases in Kent up by ten times. Rise in measles cases in Bristol 'unprecedented'. UK support group for vaccine damaged children.
posted by lucia__is__dada at 3:23 AM on February 16, 2012


Where are the researchers working on ways to boost our immune systems other ways

As much as I applaud the transhumanist impulse, you are talking science fiction. Right now and for the foreseeable future there is no way to ethically re-engineer people. You are asking the biosciences to travel to the moon before they can toddle.
posted by clarknova at 3:37 AM on February 16, 2012 [1 favorite]


@Arkhan, @lucia... thank you for the correction, I was being uncharacteristically optimistic about the collective wisdom of my fellow countrymen.
posted by epo at 4:07 AM on February 16, 2012


Specifically for this discussion, how does telling anti vaxer parent to get lost will reduce your chance of encountering his unvaccinated kid in a grocery store?

If a kid has an active outbreak of measles, he's probably not going to be in a grocery store. Just a hunch. He may, however, go to see his pediatrician for care. Your "grocery store" analogy is flawed as no one is afraid of running into a person who hasn't been vaxed out and about while everyone is well. The fear is that you will run into someone who is actively seriously ill with a preventable disease when you or your child couldn't be vaccinated. The most likely place to run into such a person is in a doctor's office.

I think this idea that those of us who are comfortable with pediatricians refusing to take on non-vaxing parents are saying that those children shouldn't get treatment at all, ever, is a red herring. There are still pediatricians who are taking in such patients. Furthermore, in a true emergency, the ER isn't allowed to turn you away no matter what you may or may not have vaccinated against.

That children are going to die of other causes because they haven't been vaccinated is a total straw man - and this notion that because they won't go to a doctor they're going to somehow *pick up* and start *spreading* a new disease just doesn't even work. Doctors aren't how you avoid getting diseases. They're how you treat the ones you've already got. Going to a doctor to get routine care isn't how you prevent picking up a virus. And if you're talking about viruses for which vaccines do not exist, then there is absolutely no reason why an un-vaccinated person is a greater risk for becoming a vector than a vaccinated one. If no vaccine exists for something, then anyone can be a carrier for it and there's absolutely no reason to put the blame for a resurgence in Scarlet Yellow Hay Fever or whatever onto people who wouldn't vaccinate against measles seeing as the two are in no way related.
posted by sonika at 4:53 AM on February 16, 2012 [1 favorite]


The large pediatric office near us doesn't allow parents to bring in their kids if chicken pox is suspected, something that confuses me to this day. (My kid came down three times with something that appeared to be chicken pox even though she was vaccinated. Two nurse friends who were also moms swore each time that it looked like chicken pox to them.) The argument is that the kid would spread it to other sick kids in the waiting room. So, if my fully vaccinated daughter isn't welcome for her germ-spreading potential, and we're doing all the things we're supposed to, I'm all for banning kids whose parents have made a political choice to risk the health of others. It may sound harsh but the office has to do what's best for its patients.

A little bit of me does wonder though how much of this is a snit fit--the doc thinks, okay, you're not listening to me, begone. What's next? People who don't stay on their diet and go to McDonald's for lunch?
posted by etaoin at 5:18 AM on February 16, 2012


People who believe that not vaccinating your kids is less dangerous than vaccinating them have been looking at/given horribly inaccurate information are superstitious, murderous yahoos who are an immediate threat to both my personal safety and the survival of the human species.

This is not entirely true. If the group of people who aren't vaccinating is small enough, then they're freeriding off the herd immunity that the vaccinators are providing, so they are safe from the vaccine-preventable diseases as well as the very small but not quite zero risk of a vaccine-caused problem. Now that there aren't enough people to get herd immunity (in some locations for some diseases), the calculus changes, but being the lone freerider is not an irrational choice.

And I don't think that children whose parents refuse to vaccinate them (again, this is distinct from children who are medically unable to be vaccinated) should not get any medical care ever.
posted by jeather at 5:25 AM on February 16, 2012


If a kid has an active outbreak of measles, he's probably not going to be in a grocery store. Just a hunch.
Measles has a long incubation period and is contagious for several days before the first symptoms emerge. A child with active symptoms can wait in a separate area of a doctor's office, so I actually think you're probably in more danger from kids who are not yet sick and who are still blithely out and about in the community.

What's more, measles outbreaks continue to be relatively rare. If you're worried about picking something up in the doctor's office, there are a lot of diseases you need to worry about much more. You should be more concerned about flu, for instance, or norovirus. If your doctor doesn't have a policy designed to protect other patients from contagious kids, then that's a bigger problem than having patients who are not vaccinated for measles.

I really think the safety issue is a red herring. This is about punishing bad parents, and it's about doctors not wanting to deal with patients whom they perceive (rightly, to my mind) to be irrational.
I think this idea that those of us who are comfortable with pediatricians refusing to take on non-vaxing parents are saying that those children shouldn't get treatment at all, ever, is a red herring. There are still pediatricians who are taking in such patients.
I'm sure that's true where you live, but it's not true everywhere.
Furthermore, in a true emergency, the ER isn't allowed to turn you away no matter what you may or may not have vaccinated against.
Most people recognize this as a reprehensible argument when it's being made to justify the fact that many Americans don't have medical insurance. I'm not sure why it's suddenly awesome when it's being made about children who you think deserve punishment. Emergency rooms are not set up to provide primary care. Withholding basic medical services is not a just, humane way to punish wrongdoers. Children should not be punished for their parents' wrongdoing.
That children are going to die of other causes because they haven't been vaccinated is a total straw man - and this notion that because they won't go to a doctor they're going to somehow *pick up* and start *spreading* a new disease just doesn't even work. Doctors aren't how you avoid getting diseases. They're how you treat the ones you've already got.
That isn't how pediatricians work. They also, for instance, monitor children's development to make sure it's on track and refer children for services if they're showing signs of developmental problems that could be helped with early intervention.
posted by craichead at 5:30 AM on February 16, 2012


epo: and just for the very latest - Merseyside measles outbreak declared.
posted by edd at 5:31 AM on February 16, 2012 [1 favorite]


But I don't know anybody who's had any of them in my lifetime.

I'm 36 and there was a guy much older than me from Mexico in my school. I was about ten and would have been around 16. He walked with crutches and I remember that his legs were badly mishapen. I can remember my father telling me that that guy had had polio as a kid and then had to explain to me that it was a disease, not a car accident or something like that. So yeah, I've seen polio and it's a terrible, terrible disease. I think it speaks volumes that my parents knew what it was instantly, and I had to be told that a bug can do that.
posted by ob at 5:47 AM on February 16, 2012


Where are the researchers working on ways to boost our immune systems other ways

We already have a safe, effective way of boosting our immune system that has been around since 1796.

As a parent and as a physician who cares for children I wholeheartedly support the idea put forth in the original post.
posted by TedW at 6:07 AM on February 16, 2012 [4 favorites]


My parents are Christian Scientists and I was not vaccinated as a child. I carried a little index card to school each year that said I was exempt from vaccine requirements for religious reasons. I was also "exempted" from health classes, which sort of made me an outcast among my schoolmates.

Now...from a child's perspective: I was frightened that I would get some horrible disease because my parents refused to allow vaccination. I got measles, mumps, and chicken pox. And when I got my first period (which I didn't know anything about and it came on the heels of having the mumps), I knew I was dying.

When I turned 18, I went to the doctor and got the vaccinations I needed. I get a flu shot every fall. My children received vaccinations per the pediatrician's schedule.

And no, I'm not a Christian Scientist.
posted by byjingo! at 6:28 AM on February 16, 2012 [3 favorites]


It is my experienced that a lot of anti-vaccination types believe that they are the ones who are following science-based medicine and that pro-vaccination people have been brainwashed or duped. You can point out a hundred studies and they'll always have a reason why the science supports them and not you.

This.

I am constantly reminded of the argument (stupid of me to get into it) I had with an anti-vaxer which ended with her declaring "well you have your research (links to CDC, WHO etc.) and I have mine (link to woo-blogger who was selling a book) so I guess they just cancel out and we'll have to agree to disagree!"
posted by gaspode at 6:28 AM on February 16, 2012 [1 favorite]


Why are we vaccinating for measles and mumps? I had those as a kid, as did everyone else. No biggie.

Are you kidding? My elderly mother-in-law just got mumps a few months ago and was very, very ill. Thankfully she made it through, but it was scary and frustrating to the men in the family who were advised not to visit her when she was ill because of the risk of sterilization. So....kind of a biggie for our family. Also kind of a biggie for my close relative who is HIV+ and all other people with compromised immune systems (as scody has pointed out several times). Also probably kind of a biggie for kids who legitimately cannot get vaccinations for legitimate health reasons, and therefore rely on herd immunity.

This is what is so mind-bogglingly frustrating about the anti-vaxxers - if it were just your own child that were affected, posing no danger to other people, fair enough.* And I know you said you will vaccinate your children, which I applaud, but your statement above illustrates the thinking of so many people which reveals the shocking failure to grasp that it is not just about you.

*I am not suggesting that children of anti-vaxxers should not receive health care or should suffer because of their parents deluded thinking. I would fully support mandatory MMR vaccination for all children with medical exemptions only. I'm just saying that parents that make decisions that negatively affect their own child and no one else are different than parents who make decisions that negatively affect not only their child, but the public at large.
posted by triggerfinger at 6:48 AM on February 16, 2012 [2 favorites]


(way up the thread:) "Just out of curiosity, what's up with the "mothers" thing? Do fathers really have no say in vaccination decisions at all?"

Moms are much more frequently the driver of parenting philosophy, and many of the anti-vaxxing families are wealthy enough to have one parent in the home, and that parent is almost always the mother. Upper-middle-class parenting culture also places a huge premium on MOM being the perfect parent. Here is a pair of exchanges I have actually had multiple times:

OTHER MOM sees my husband with child in Baby Bjorn: "Boy, your husband is awesome for babywearing your son! I know we're not supposed to compliment dads for regular parenting, but so few fathers are willing to be involved!"

SAME OTHER MOM sees me with child in Baby Bjorn: "OH MY GOD YOU ARE GIVING THAT BABY HIP DYSPLASIA, WHAT ARE YOU, SOME KIND OF SOCIOPATH?"

(Because babywearing is good, but babywearing in a Baby Bjorn makes you a bad mom because Baby Bjorns are evil, as far as I can tell because it's CORPORATE babywearing and POPULAR babywearing, so it's not a good enough sort of babywearing. But it makes you a good dad because you've cleared a minimal hurdle of "being seen in public babywearing your child.")

Anti-vaccine stuff runs through mom culture, not through dad culture. A lot of the anti-vaxxing families I know have mom at home full-time and MOM attachment parents but DAD does not; dad follows orders from mom and if he's unhappy with a particular parenting decision, mom falls back on her mom-network of support to get articles and "data" that support her particular position and insist if he wants to make a different decision that he is HURTING THEIR CHILDREN. I mean, it's weirdly retrograde and heavily gendered, especially for people claiming to be co-parenting egalitarian hippies.

Anyway, I'm actually watching a vaccinate/don't vaccinate dispute between a married couple with an infant with whom I'm loosely acquainted play out on facebook, and I think they might get divorced over it. Dad is insisting on vaccines and mom is insisting their kid will get autism and she keeps appealing to her Facebook network for support on how vaccination is evil and they're starting to talk about court-ordering one another and she's mused about whether it's better if they just get divorced and she seeks full custody because he's trying to harm and abuse their son with vaccinations while she protects him. (And she really, honestly thinks that a judge will agree with her because "everyone knows" vaccines are harmful. She is a college-educated communication professional with a Fortune 500 company in a non-granola part of the country. You can't make this shit up.)

c13: "Do you see a lot of kids with active measles or polio running around in public?"

HAHAHAHAHAHAHAHA. So, one of the non-vaccinating moms (who has a masters' degree) I was friends with on facebook (unfriended after this catastrophe!), yes, took her children out and to mommy-and-me FULL OF INFANTS while they had the chicken pox (which I realize is not as serious as some other vaccine-preventable diseases, at least not in children), for several reasons she put forward: "oops, bad me, took Chance and Danger to mommy-and-me even though I think I see chicken pox on Chance from the pox party we were at! I didn't think they should have to stay home and not have any fun just because they have a couple pox." (In response to furious other mothers:) "Kids will get better immunity from the chicken pox than from an autism-causing vaccine for it" and something along the lines of "of course other mothers want their kids exposed to chicken pox, it's BETTER than the vaccine." When other mothers protested they did not, in fact, want their INFANTS (or other children) exposed to chicken pox, she kept whining that just because they were contagious didn't mean they should stay home. When asked if she would let her kids go out if they had measles, she said of course she would, either kids were vaccinated and therefore ("allegedly") immune or that kids' parents wanted them to get measles to get immune! She refused to acknowledge any risk to infants or the immunocompromised because they're "Just normal childhood diseases" and "not that big a deal" and "how would humanity have survived before vaccines if they were THAT deadly?" She refused to acknowledge that other parents had a right to decide if their kids were exposed to hers. LOTS OF PEOPLE AGREED WITH HER, and people were insisting that wanting children who are contagious to STAY THE HELL HOME is either a) more oppression of "breastfeeding mothers" and all they stand for (???) or b) more oppression of children in general by exiling them from the public sphere. (These people are NOT HELPING those of us who would like to take our non-measles-infected children out in public to stores and things and not get death-glares.)

Why am I FB-friends with these crazy people? First, a bunch of them I am involved in a volunteer group with we've all been with since before were moms and I learned they drank the kool-aid; Second, I a lot of the child-related advocacy and activities I'm involved with -- community gardening, children's museum, that sort of thing -- draw a lot of "granola" moms, and the anti-vaxxing subgroup (which is quite small) is almost entirely contained within the "granola" supergroup (of which I would more or less consider myself a part).

Look, people who make bad decisions about their child's vaccination are also going to make bad decisions about taking those kids out in public when contagious. They are already showing a wild disregard for other people's children and an amazing ability to misapprehend risk. What makes you think that just because their child HAS a disease, they will suddenly become careful of other people's kids and good at assessing risk?

They interviewed a local non-vaxxing mom on the news after the Wakefield trial, and she said she didn't think vaccines caused autism but she didn't vaccinate her kids because, "You hate to see your children suffer and cry like that unnecessarily. I don't think any parent who loves their kids can stand to subject them to painful shots." LET ME TELL YOU ABOUT TEH MEASLES AND "UNNECESSARY SUFFERING," CRAZY BITCH.
posted by Eyebrows McGee at 6:52 AM on February 16, 2012 [41 favorites]


Because saying things like "Doctors want to give my baby autism by injecting him with mercury" are just as retarded as "ZOMG your unvaccinated kid is going to kill us all" ?

Let me get a little selfish here and say I mostly only care that MY kids don't get measles/mumps/pertussis/whathaveyou. I don't want MY kids to be sick, in any way whatsoever. Not even with a cold. My daughter had the H1N1 flu (she got the vaccine just a little late, it seems) and it was one of the scariest times in my life. She had bacterial meningitis as an infant and H1N1 was worse. We thought she might die and she still has issues with her lungs to this day.

Of course I care about other people's children; I'm only human. But when it comes right down to it, I want to keep MY children safe. That's why I don't like anti-vaxers.

And, at the risk of derailment, please stop using the word "retarded" to mean "stupid" or "silly" or "uneducated." It's offensive.
posted by cooker girl at 7:03 AM on February 16, 2012 [5 favorites]


If I had been the only pediatrician for miles, I'd certainly not abandon a child whose parents refused to vaccinate.

But... if you were the only pediatrician for miles around, don't you think it would be especially incumbent on you to ensure that your facility was as safe as possible for the pre-immunized, contra-indicated, and bad-luck-vaccination-didn't-take children under your care?

Which I get doesn't strictly lead to kicking out non-vaccinating families, but some sort of segregation at least?
posted by ROU_Xenophobe at 7:08 AM on February 16, 2012


ROU_Xenophobe: “But... if you were the only pediatrician for miles around, don't you think it would be especially incumbent on you to ensure that your facility was as safe as possible for the pre-immunized, contra-indicated, and bad-luck-vaccination-didn't-take children under your care? Which I get doesn't strictly lead to kicking out non-vaccinating families, but some sort of segregation at least?”

I'm pretty sure that was a nod to my comment about how my significant other, who is in residency as a rural doctor, says she would vaccinate kids even without parental permission. I guess I'm not sure, though.
posted by koeselitz at 7:14 AM on February 16, 2012


Don't public schools insist on all kids being immunized?

But most non-poor white people don't send their kids to public schools anymore. With private charter schools and homeschooling taking over, that's another unintended consequence.
posted by saulgoodman at 7:57 AM on February 16, 2012


Most people recognize this as a reprehensible argument when it's being made to justify the fact that many Americans don't have medical insurance. I'm not sure why it's suddenly awesome when it's being made about children who you think deserve punishment. Emergency rooms are not set up to provide primary care. Withholding basic medical services is not a just, humane way to punish wrongdoers. Children should not be punished for their parents' wrongdoing.

I was speaking of preventing life threatening emergencies in the case of "but then the un-vaccinated children will DIE! of something else!" I was not speaking of primary care. And if the emergency room isn't for a sick child with a life threatening disease, I don't know what it is for.

And y'know, I don't want to punish anyone. Certainly not a child. But I'm not the one doing it. Their parents are. The parents who don't vaccinate are the ones making the bad choice here, not me. I'm simply stating that if my pediatrician decided not to see children who weren't being vaccinated, I'm ok with that. I'm actually pretty ok with saying sometimes people make pretty shitty parenting decisions and I truly, truly wish they wouldn't.

Like it or not, these children are being punished by their parents and I can't stop them. I can't really do anything. I can talk to parents who are on the fence about vaccination and explain why I chose to vaccinate my son and hope that some of it makes sense to them. I can't force anyone to vaccinate. All I can do is support my pediatric practice's choices to encourage vaccination.
posted by sonika at 8:22 AM on February 16, 2012


I see the points about homeschooling have been addressed upthread somewhat, but it just really ticks me off what we're doing to our public education system, which used to be the envy of the modern world, and all the follow-on social costs that so many of my peers seem to be completely oblivious to.

Incidentally, last night, I had to take my son to McDonalds (gak!) for dinner because the teachers from his elementary school were all there flipping burgers as part of a special event to raise money for their school. No kidding! That's what it's come down to, even in a state like Florida with a constitutional requirement that schools be fully funded. Veteran school teachers reduced to the indignity of flipping burgers to raise money just so their schools can scrape enough resources together to perform their basic, core functions. Dignity for the teaching profession? Forget about it. Our leaders have made it perfectly clear what they value. Hell, they're even considering selling ad space on public school buses here! But those are other topics...

The anti-vaccine position is unsupported by science and completely antithetical to modernity and the public interest. It's tragic to see America voluntarily dismantling civil society and heading backwards into the stone ages in so many areas, fundamentally as a consequence of the massive information wars that private sector interests and wealthy ideologues have been waging over the last few decades (and in many cases, even using public broadcasting spectrum to do it).
posted by saulgoodman at 8:24 AM on February 16, 2012 [3 favorites]


Can anyone explain this:
Positive association between vaccines and autism

Studies I'm able to get into like this one on vaccinations that happened within the past ten months, are the kinds of studies most available. Short term studies. These do not satisfy me.

All over the place I see vaccine's mentioned as increasing risks of specific conditions such as inflammatory bowel disease (many of these are pay walled and of course I can't evaluate them for accuracy even when I can get to them)

I'm frustrated by the fact that doctors don't seem to be reading or addressing these kinds of association studies and then saying "Just trust us". I want more research on long term associations between childhood vaccine status and various later conditions. If it's being done, then I wish it were more accessible and that doctors would take the time to make it public including the actual research and how to understand it. Saying "I'm a doctor, I read some research, trust me" does not cut it NOR SHOULD IT.

Science based medicine is often wrong. Entire fields of thought about best treatments can be wrong. Because I've talked in person with Phd's who have told me point blank that soft inheritance was completely proven wrong and impossible and science knows it for a certainty-- and then watched as research seems to be demonstrating that Darwin and Lamarck earlier theories on soft inheritance might NOT have been accurately proven wrong.

I don't feel like doctors want to do an exhaustive amount of research on minor conditions that might be higher represented in vaccinated people because they have already decided that death is worse than minor conditions so they don't want to know. I wouldn't blame them for thinking that way, but it's not honest. If there are long term negative health outcomes for some people associated with vaccines that should matter too.

Damaging some peoples health with vaccines and saying that that damage is ok collateral damage is equally as vile as saying that people whose limbs were permanantly damaged by polio were collateral damage. Neither should just "be ok" for the sake of the other. We need vaccines, but we need to research them dilegently and improve them if there are problems and we need to honor that until doctors start addressing the huge amount of association studies being done that DO point out increases of specific conditions-- it's going to sound like a lie when doctors say "There are absolutely no risks associated with vaccines"

And it probably is.
posted by xarnop at 8:48 AM on February 16, 2012 [1 favorite]


Look, people who make bad decisions about their child's vaccination are also going to make bad decisions about taking those kids out in public when contagious. They are already showing a wild disregard for other people's children and an amazing ability to misapprehend risk. What makes you think that just because their child HAS a disease, they will suddenly become careful of other people's kids and good at assessing risk?


Absolutely nothing. We're in total agreement. I'm must saying that refusing to deal with those people only ensures that will be around with their sick kids in tow.
Look at xarnop's comment. What possible use would it do to just blow off his/her concerns, other than validate his fears?
posted by c13 at 8:59 AM on February 16, 2012


It is not true that 'most non-poor white people don't send their kids to public schools anymore.' For example, I invite you to learn about the importance and dominance of public education in the state of Iowa. You could look at any other midwestern state as well.

In the old pioneer-days cemetery on the outskirts of Central City, Colorado, in 1972 I saw a grave containing the remains of a woman and her five children, all buried together at the same time. All died of diphtheria during the same family-illness-event in the 19th century. There were many infants and children buried there from now-preventable childhood diseases.

My great-great-grandma Meier in Clayton County, Iowa went on a mercy-mission to help a neighbor whose children were sick. After she returned home from helping that family, her own children became sick with diphtheria. Five of her eight children then died of diphtheria in the span of a few weeks. My great-grandpa Charles Meier was one of the surviving three boys.

When a pregnant woman is exposed to Rubella, her fetus can become infected and develop severely debilitating birth defects. The pregnant woman might not even experience any noticeable illness symptoms. Unvaccinated children pose an extreme risk to every pregnant woman who comes near them. For this reason alone, non-medical vaccination exemptions should be illegal. It is society that pays the lifetime medical-care costs of people with severe birth defects. We taxpayers pay it all, for the lifetime of the affected person.

My ex-husband contracted polio at the age of 7 in the 1950's. He described to me his subjective experience of being acutely ill with polio, which for him was a prolonged nightmare state, wherein he thought he was in a place inhabited by terrifying creatures such as huge black spiders, that were attacking him. The physical pain he experienced was extreme, including during his 'recovery' phase. He was severely physically permanently harmed, even requiring an attempt at surgically-reconstructing the muscles around one of his knees so that he could possibly avoid spending his life in a wheelchair. Needless to say, this type of surgery was 'primitive' in the 1950s. The fact is, persons who survived polio as children, later develop what has now come to be called 'post-polio syndrome' when they are in their 50s or 60s. They then become additionally-crippled. It's the horrible disease that just keeps on giving! Anyone who thinks polio 'wasn't that bad' is dangerously delusional.
posted by Galadhwen at 9:01 AM on February 16, 2012 [14 favorites]


Additionally, it is because of vaccination that I am here today. I was attacked by a rabid fox while walking in the woods in northern Illinois in April 1972. I then underwent the Pasteur treatment for rabies, consisting of 21 injections in the stomach region, given in a 14-day period. Thanks to Louis Pasteur I have had my life to live.
posted by Galadhwen at 9:04 AM on February 16, 2012 [3 favorites]


I don't feel like doctors want to do an exhaustive amount of research on minor conditions that might be higher represented in vaccinated people because they have already decided that death is worse than minor conditions so they don't want to know

Which doctors? Your pediatrician? He probably works >60 hrs per week, sees about 40-50 patients per day. You want him to do an exhaustive amount of research on top of that?
Is it bad that the guy wants to sleep sometimes?
posted by c13 at 9:05 AM on February 16, 2012 [2 favorites]


it's going to sound like a lie when doctors say "There are absolutely no risks associated with vaccines"

I don't think anyone reputable says that, xarnop. It's just that, on balance, the risk of immunization is enormously lower than the risk of disease. And if you refuse to vaccinate your kids, you're leeching off their herd immunity, and refusing to contribute your own.

Wanting to improve vaccines is fine; if there are problems there, cool, let's fix them. But the problems are already a couple orders of magnitude less pressing that the disease itself. If you refuse vaccination, you are a freeloader, taking the benefit of other people's risks for yourself. You personally may be a tiny bit safer, but you are externalizing the cost of that safety onto society, and that's just not acceptable.
posted by Malor at 9:07 AM on February 16, 2012 [18 favorites]


xarnop: I can only speak to the first paper you linked, because I read it for my job (I index biomed journals - predominantly neuroscience, neurology, immunology and epidemiology) and that article is an absolutely terrible, terrible article.

The reasons it is terrible are outlined in this blog post (which I have nothing to do with). Scroll about half way through the post to the bit where the article is specifically addressed. It's a pretty comprehensive analysis.
posted by gaspode at 9:09 AM on February 16, 2012 [9 favorites]


Wow, Malor, I don't have the words to describe how well said that was. So just let me say, bravo.
posted by RolandOfEld at 9:09 AM on February 16, 2012 [1 favorite]


Well, it was typoed all to heck, argh. :-) Me no prufreed gud.
posted by Malor at 9:14 AM on February 16, 2012


But most non-poor white people don't send their kids to public schools anymore. With private charter schools and homeschooling taking over, that's another unintended consequence.

[citation needed]
posted by T.D. Strange at 9:15 AM on February 16, 2012 [6 favorites]


For healthy, well-nourished kids these 3 are rarely a big problem.

And this is the attitude that bugs me the most. My kids are healthy and eat organic, MMR won't be a big problem FOR THEM.

It is selfish and it's short-sighted when a significant percentage of kids even here in the wealthy US go without adequate food and healthcare on a regular basis.
posted by the young rope-rider at 9:17 AM on February 16, 2012 [2 favorites]


it's going to sound like a lie when doctors say "There are absolutely no risks associated with vaccines"

And it probably is.


My pediatrician has never, ever said this. Ever. Before each vaccine, there's been talk about the risks - a pamphlet given clearly stating what the vaccine does and does not protect against and what any potential side effects might be, including the website and phone number for the CDC vaccine injury program - and I'm asked at least sixteen times if I have questions before the vaccines are administered.

Never have I heard "this is completely risk-free" about a vaccine, but rather I've been given the opportunity to weigh the evidence and came to the same conclusion that the pediatrician did: that the vaccine is better than the disease it prevents.

Other things my pediatrician has been right about: the benefits of breastfeeding. Antibiotics for ear infections. Lots of rest and fluids for the stomach flu. I trust my son's doctor to have his best interest at heart or I wouldn't be going to her in the first place.
posted by sonika at 9:17 AM on February 16, 2012 [6 favorites]


And on what gaspode just said, it's 100% fine that people like xarnop don't understand medical studies and the associated abstracts, it's people who don't understand the science / statistics behind the studies AND refuse to listen to people who do understand what makes a study good/bad/meh.

If a parent is of the latter bent, I can completely understand why doctors wouldn't see them as an acceptable risk to the other patients in their waiting room. If the parent is simply of the former caste then I can only hope they get a doctor of a like mindset with c13 who is willing and able to explain the science to them even though they're likely overworked and overbooked and mistrusted by the latter group.

I guess I'm lucky, soon-to-be Mrs. Eld is also a soon-to-be PhD from a very focused/serious clinical program and isn't set in any of her ways to the point where she would begrudge a conclusion from a well performed study/analysis. She's my personal sounding board for things like this... her take is that the vaccination-as-the-devil studies is that they're generally really badly done.
posted by RolandOfEld at 9:18 AM on February 16, 2012


c13-- I really understand where doctors are coming from with not doing an exhaustive amount of research. But that's also my point. Doctors are busy. How well to they actually know the research if they are too tired to really spend that much time with it outside of what they learned in school?

I am pro-vaccine's. But I am also pro- addressing ignorance with complete science and diligent research. Obviously if anti-vaxers believe things like "God from on high has told me vaccines are bad!" or "I sense from my wholesome knowledge of the goodness of wholesomeness that vaccines are inherently bad!" (which is how some anti-vax speak comes across to me) then science won't help.

(gaspode thanks for the blog post I was really perplexed by it and frustrated it was paywalled and I couldn't see what was up with it)

But I think there are certainly some anti-vax people who do seem to be interested in research and at least for those who are genuinely interested in the science then I think we should find a way to get better information to the public about what studies are being done on long term associations and how to interperet them. If doctors are too busy and tired to do this, then we should find other ways to get that information accessible to the public.

Malor- I am vaccinated and have horirble immune system function and pretty much a body that is in pain and dysfunctional in too many ways to describe. Doctors don't know, care what to do with me. Allergies, intestinal problems, infection after infection, liver problems, jaundice, fatigue, cognitive impairment--- it goes on and on. I have no reason to trust doctors, they do nothing but throw medicines at me that are dangerous for people with liver conditions and don't give a crap that I wind up yellow and vomiting. I do not trust doctors to care about "mild" side effects to them because my suffering is clearly irrelevant to their practices. If vaccination added to the conditions I live with I would want to know and I would wish that precautions would be taken to identify people who might be at risk of complications and providing medical exemptions. I think my health would have been terrible anyway so I have no way to know if vaccines contributed, but I also haven't seen research proving to me that in the long term there aren't increased risks for specific people. I think, for example, children born to immune compromised people like me might benefit from a delayed or reduced vaccine schedule. But since I don't trust doctors to care about that (after all they are tired they can't spend time researching new treatment options or learning more than what they learned in school to better treat people they don't have solutions for)--I feel extremely uncomfortable about assuming doctors should be allowed to force treatments.
posted by xarnop at 9:21 AM on February 16, 2012 [1 favorite]


"My kids are healthy and eat organic, MMR won't be a big problem FOR THEM. "

Yeah I think the attitude should be the opposite: "My kids are healthy and eat organic, vaccines shouldn't be a big problem for them"

If you (the parents) have a strong healthy immune system and a history of good health and you are providing a nuturing supportive environment, then any of the mild problems that could be associated with vaccines for a very minute amount of people are least likely to pose a problem to your child--- and therefore doing them for the sake of herd immunity is certainly the better option.
posted by xarnop at 9:25 AM on February 16, 2012 [1 favorite]


How well to they actually know the research if they are too tired to really spend that much time with it outside of what they learned in school?

One anecdata point is not data, as we all know, but doctors and other health care peoples don't just get their degrees and then POOF that's all the learnin' they do.

*All* of the docs and nurse practitioners I know have regular continuing ed classes and things they have to go to and pass in order to keep their licenses. Additionally, all of them read journals and the like in and around their specialties. My friend the NP whose specialty is HIV/AIDS is not going to know the latest research on childhood vaccination schedules because that's not part of her job, but she knows all the latest stuff about HIV/AIDS meds and treatments because that *is* her job.
posted by rtha at 9:29 AM on February 16, 2012


And this is the attitude that bugs me the most. My kids are healthy and eat organic, MMR won't be a big problem FOR THEM.


Many Native Americans were healthy and ate organic.

The measles damn near annihilated them.
posted by ocschwar at 9:31 AM on February 16, 2012 [1 favorite]


but I also haven't seen research proving to me that in the long term there aren't increased risks for specific people.

I understand you want evidence, but be careful that you aren't asking for someone to prove that all swans are white.

It might be a worthy derail for someone to mention what science can/can't do. My other half has spoken to me about it before and I feel a bit under-qualified to speak to the importance of unfalisfiable statements.

posted by RolandOfEld at 9:32 AM on February 16, 2012


I think we should find a way to get better information to the public about what studies are being done on long term associations and how to interperet them. If doctors are too busy and tired to do this, then we should find other ways to get that information accessible to the public.

Agreed. Though I don't know about doctors being too busy or tired - I'm sure that my pediatrician would be happy to discuss medical studies on vaccines. I suppose the answer is to just get a second opinion if your doctor won't discuss it with you - as with just about anything else, really. You should always be able to discuss your treatment options with your doctor.
posted by sonika at 9:33 AM on February 16, 2012


xarnop: I am vaccinated and have horirble immune system function and pretty much a body that is in pain and dysfunctional in too many ways to describe.

You know, you might want to look into 'helminthic therapy', which is a real actual therapy prescribed by real, actual doctors, where you ingest pig whipworm. (They live in your body for some time, but can't reproduce in humans, so you're not infectious.)

The human immune system apparently evolved in the presence of worms; half of the entire thing is designed to find and kill worms. Without any worms at all, that side of your immune system can go crazy and attack other stuff, causing things like allergies (attacking pollens and molds) or diseases like eczema and Crohn's (if it latches onto something in the body itself). If you introduce worms into the system, apparently that half of the immune system usually stabilizes itself and starts attacking what it's supposed to attack. Plus, the worms themselves secrete substances that mediate immune response, so that apparently helps as well.

Considering that you're having both allergy and intestinal problems, vaguely like Crohn's, it might be worth checking out.

I feel extremely uncomfortable about assuming doctors should be allowed to force treatments.

On the whole, I agree with you. Like I said upthread, I'm pretty libertarian. But in this one instance, I think the collective good is measurable and quantifiable. We can put hard numbers on it, it's not just mystical hand-waving. It's a concrete benefit, one so powerful that people can actually think that vaccinations aren't crucial anymore.(!)

There are damn few treatments that I'd be willing to make mandatory, but vaccination is one. If it were mere fiscal benefit to others, ie, making you healthier so you cost less to take care of, I wouldn't be willing to go there, since healthcare benefits are a gift from society that shouldn't come with strings attached. But when you're actually endangering other people's health by not undergoing a treatment, then I'm okay with forcing that treatment on you.
posted by Malor at 9:44 AM on February 16, 2012


It is not true that 'most non-poor white people don't send their kids to public schools anymore.' For example, I invite you to learn about the importance and dominance of public education in the state of Iowa. You could look at any other midwestern state as well.

Well, okay, I'll limit the scope of that initial comment to Florida then. It's definitely a big issue here.
posted by saulgoodman at 9:45 AM on February 16, 2012


xarnop: I can only speak to the first paper you linked, because I read it for my job (I index biomed journals - predominantly neuroscience, neurology, immunology and epidemiology) and that article is an absolutely terrible, terrible article.

A lot of people still just don't seem to really understand there are now countless "foundations" and "think tanks" out there that often have what amounts to a direct pipeline to major media outlets, whose entire reason for existing it is to put out bad, unscientific studies on subjects like this to support the political and economic agendas of various deep-pocketed interests that make political and economic hay out of such controversies. And that there are absolutely no effective, substantive regulations to protect the American public from bad information and outright lies anymore.
posted by saulgoodman at 9:54 AM on February 16, 2012 [6 favorites]


c13-- I really understand where doctors are coming from with not doing an exhaustive amount of research. But that's also my point. Doctors are busy. How well to they actually know the research if they are too tired to really spend that much time with it outside of what they learned in school.

Well, it's all a matter of a degree. Your local practitioner is probably not up at nights reading the latest research. Secondly, absolutely no one can be up on ALL latest research. We saw about 40 patients with different concerns per day during my peds rotation. Why should I spend my time reading up on your (for argument's sake) pet conspiracy theory?
But overall, here's what makes it hard for doctors to deal with patients like quoted above: we don't know everything, but we've spend at least 12 years in college, med school, and residency studying many hours per day. And then there are always board recertifications and the like. So we in fact know a whole lot. And the patients come to us to figure out what's wrong with them. So when someone that can barely read (average american reads at 8th grade level, as I remember) flatly dismisses my answer to his question because I'm not "up on the latest research" (while himself being not only unaware of the latest research, but also of the stuff that has been known for years!), it really can get on one's nerves.
But I will restate what I said earlier: I don't think kicking the patient out of the office is productive, especially for a pediatrician. Because in that case the patient is the kid, not his belligerent parent.
posted by c13 at 10:07 AM on February 16, 2012


I don't approve of them refusing to see the children. I approve of them refusing to see the parents.
posted by Decani at 10:19 AM on February 16, 2012


My mother was one of four kids on her street to contract polio in the summer of 1948. She is the only one who lived.
posted by workerant at 10:20 AM on February 16, 2012 [2 favorites]


When you paraphrase somebody else's argument, the odds of misrepresenting it skyrocket.

O hey, a platitude! Navelgazer's paraphrase seems bang-on with respect to large parts of this thread to me. We're now at the point we're actually seeing people argue with a doctor about the likelihood of human extinction. Even according to the article, the number of doctors turning away anti-vax patients are a small minority. No one is advocating not getting vaccinated here. This thread is ludicrous.
posted by Hoopo at 10:24 AM on February 16, 2012


c13,

true, but again you have to remember that things like "average" are only valid for a population. The guy sitting next to you in the doctor's office does not have measles "on average". He either does, or does not.

I think you are confused about what I am actually claiming. A numeric average, like 2.4 children per family will not obtain for any actual family, sure. But when I say, "The probability that Joe has measles at time t is p," I am saying something perfectly coherent. Either that or you have to deny that any single-case probability statements are meaningful!

Similarly with the other claims that you are disputing. I agree that the vaccinated population is much more likely to be exposed to measles and other diseases because there are a lot more of them. And I agree that individual behaviors might make risk of exposure higher or lower than the generic groups of vaccinated and un-vaccinated. But take an individual at random from each group. What reason do you have to predict that one or the other has higher probability of exposure to measles or another disease in any given time window? Maybe there is some data on this question? I am certainly not going to be convinced by armchair speculation: the expected risk seems the same to me.
posted by Jonathan Livengood at 10:25 AM on February 16, 2012


Just to draw the lines here with an example. Pertussis (whooping cough) is potentially fatal to new babies, who are also too young to be vaccinated. Babies can be exposed to pertussis by their unvaccinated siblings. Older siblings gets sick, newborn baby gets sick and dies.

Or, unvaccinated older child with early pertussis - before it's diagnosed (if it ever is) -- goes to church and spreads it to newborn baby in the next row.

Very very sad. Very very preventable.

Had whooping cough myself a few years ago. Went to the doctor twice and never did get diagnosed until a nurse-co-worker of mine came over and said, "you sound like you have whooping cough" -- given everything I read about it, listening to audio examples of the cough online, given how long I was sick with it, hadn't even known that a booster was available or necessary -- pretty darn sure it was whooping cough.

Frantically searched my mind to find out if I had visited with any babies in the prior few weeks.
posted by vitabellosi at 10:45 AM on February 16, 2012


I really think the safety issue is a red herring. This is about punishing bad parents, and it's about doctors not wanting to deal with patients whom they perceive (rightly, to my mind) to be irrational.

This is such an obnoxious practice -- telling people you know what their motivations really are. It's especially obnoxious when, in this very thread, a pediatric care provider has explained the rationale, and frankly been a whole lot more polite and gracious toward you in doing so than you have been in your aggressive responses. Fine, you think doctors are all liars with god complexes, NOTED.
posted by palliser at 10:48 AM on February 16, 2012 [3 favorites]


ocschwar: “Many Native Americans were healthy and ate organic. The measles damn near annihilated them.”

This is, incidentally, the other reason my SO gives for wanting to be extremely proactive about vaccination among her patients, who are more often than not seeing her at Indian Health here in Albuquerque: as she says, "we already almost wiped them out with measles, both through stupidity and through our own genocidal racism; I am not going to let that happen to another generation of native kids."
posted by koeselitz at 10:53 AM on February 16, 2012 [1 favorite]


"...I am not going to let that happen to another generation of native kids."

Tell her a member of that generation of that population sends his heartfelt thanks.

posted by RolandOfEld at 11:01 AM on February 16, 2012


"The probability that Joe has measles at time t is p," I am saying something perfectly coherent.

I'm saying that from your perspective as a guy sitting next to some other guy in doctor's office, your statement is indeed meaningless. For all practical purposes. The probability you're talking about is based on N specific factors, none of which you have any way of knowing. Hell, you don't even know his immunization status to begin with!
It's fun to talk statistics at times, but when I take my 4 year old to a play gym, the only practical thing I can tell is whether other kids there have measles or not, and only based on outwardly manifesting symptoms of the disease. That's why I prefer to take her to the park and why I make her hang out with mom somewhere before we get called in at the peds office. But I'm not doing it because I'm afraid that my daughter will catch measles from some unvaccinated kid. I just don't want her to get a case of cold or diarrhea when she's getting her flu shot...

What reason do you have to predict that one or the other has higher probability of exposure to measles or another disease in any given time window?

And now you're talking about the probability of exposure, whereas before you were talking about the probability of having a disease. Which probability do you want to discuss? If it's the probability of exposure, the unvaccinated group would be more exposed, I think, simply because they tend to hang around other unvaccinated people (homeschools, religious communities, etc), so the probability of someone having an active case of measles there is higher.

posted by c13 at 11:04 AM on February 16, 2012


Another related recent thread about findings that patient satisfaction with their doctors is negatively correlated to positive health outcomes.

People seem to view doctors less and less as authorities these days, and prefer to have their health care delivered like any other consumer good: shopping around for medicines and diagnoses, with medical professionals telling them exactly what they want to hear, never inconveniencing them, deferring to their personal preferences and judgments on medical choices, etc.

My wife and I have been noticing this a lot with my father-in-law, who recently underwent treatment for both a gigantic (no kidding--10+ centimeter long) aneurysm in his chest and stage 2 lung cancer. Both he and my mother-in-law are constantly complaining about different aspects of the treatment and second-guessing how medically necessary certain steps are.

Maybe it's just because medicine is such a big business in this country that this undermines the public trust. I guess Americans have learned (rightfully) to be skeptical of profit motives. Maybe a true, single-payer public healthcare system is really the only thing that will restore American's faith in the integrity of the medical profession. But then, we've also internalized a deep skepticism of the government's ability to function in the public interest, so maybe we've caught ourselves in a hopeless double-bind here, culturally.
posted by saulgoodman at 11:04 AM on February 16, 2012 [2 favorites]


Ooops. forgot to close the tag somewhere...
posted by c13 at 11:04 AM on February 16, 2012


The measles damn near annihilated them.

Well, actually it was smallpox...
posted by c13 at 11:09 AM on February 16, 2012


"So when someone that can barely read (average american reads at 8th grade level, as I remember) flatly dismisses my answer to his question because I'm not "up on the latest research" (while himself being not only unaware of the latest research, but also of the stuff that has been known for years!), it really can get on one's nerves."

Having followed dillegently what doctors said about my health for years only to find my conditions worsen and then discover I'm much healthier with no pharmeceuticals whatsoever it's hard for me to feel that doctors know how to heal me or that their opinion should be more important than what I find seems to work.
If they know so much they had 20 years to cure me and they couldn't.

I had the first winter of my life with no sinus or lung infection. In almost thirty years of life I had not made it through the winter without numerous sinus/ear/lung infections. Their response was lots and lot's of antibiotics, every winter and other times of the year.

I am pro-vaccine, but what I'm saying is I understand why many people don't trust doctors because doctors are failing them and seem to accept the pharmaceutical model of all disease. In my experience many doctors don't seem to care much about chronic conditions, however debilitating. I know for me diet, lifestyle change, meditation, emotional support and/or placebo was much more affective than what the doctors were doing which sort of makes me wish doctors would take such methods seriously enough to offer them as options to patients and to help them get more accurate information on those options. If people saw doctors as the home base for accurate information about diet, stress, and lifestyle and how these things interact with real disease and health problems--- then I think the "natural parenting" communities might trust what doctors have to say about vaccines in a better way.
posted by xarnop at 11:12 AM on February 16, 2012 [2 favorites]


Well, actually it was smallpox...

Actually, it was both. Smallpox was not the only pathogen introduced into the Americas to kill untold numbers of people.
posted by ambrosia at 11:17 AM on February 16, 2012 [1 favorite]


Xarnop, if you read my earlier posts, you will see that we essentially agree, if not on details then in general.


Actually, it was both. Smallpox was not the only pathogen introduced into the Americas to kill untold numbers of people.

Aha. There was also influenza. And of course they are equally deadly, right?
posted by c13 at 11:24 AM on February 16, 2012


c13,

I am arguing for the claim that an un-vaccinated person is more likely to have a communicable disease than a vaccinated person. And therefore, having more un-vaccinated people in a doctor's office presents an increased risk of disease to the community of patients as a whole.

I gave an argument that has, essentially two premisses: (1) vaccinated people are more resistant to contracting a disease given exposure, and (2) exposure rate and group membership are not statistically associated -- so, being vaccinated or not does not matter, in expectation (or on average), to whether one is being exposed to a given disease. You admit (1) but dispute (2) on the grounds that probability does not make sense in the single case, if I've understood you correctly.

Summary: The claim about exposure rate is a premiss in an argument for a claim about having a disease.

Here is the larger claim, as carefully as I can put it. If you repeatedly pick two people at random (with replacement) -- one from among all vaccinated people and one from among all un-vaccinated people -- you will find a greater frequency of diseased people among the un-vaccinated.

What is the relevance of that claim in this context? It is this. If you sit down next to Joe in the clinic, you are for all practical purposes sitting down next to someone drawn at random from the population. If Joe was drawn from the un-vaccinated, Joe is more likely to have an active disease. Or what amounts to the same thing, if you are a physician and you have two sequences of patients come through your office -- one sequence vaccinated and one not -- the un-vaccinated sequence will have a higher frequency of disease.

Every time you add an un-vaccinated patient to the sequence of patients that comes through your office, you increase the expected number of diseased patients.

I think this follows from the fact that rate of exposure is equivalent in the two groups, while rate of acquisition-on-exposure is not. Now, somewhat bizarrely, you tell me that you think rate of exposure is actually higher among the un-vaccinated. If true, that actually makes my larger claim more likely to be true. That is, you are now saying that (a) vaccinated people have greater individual resistance to acquiring disease given exposure, (b) vaccinated people have a lower individual rate of exposure to disease vectors, and yet (c) individual vaccinated people are no less likely to have a disease!
posted by Jonathan Livengood at 11:36 AM on February 16, 2012


Aha. There was also influenza. And of course they are equally deadly, right?

What is it you're asking?
posted by rtha at 11:54 AM on February 16, 2012


Between the smokers, the IV drug users, the morbidly obese, and the alcoholic cirrhotics, a healthy majority of modern maladies are self-inflicted in one way or another.

We still see these people, counsel them (however futilely), and treat them.

If we flat out refuse to see people, it sure would make our days easier, but I think society as a whole is worse off for it. They'll just find other doctors, at the end of the day.
posted by cacofonie at 11:59 AM on February 16, 2012


xarnop - your experience is valuable because, as I noted above, in the absence of a law which required under pain of penalty for parents to get their kids vaccinated, then the solution here is going to come from a suite of sensitive studies of why and how people may be ambivalent or even hostile to vaccination. This kind of study is what medical anthropologists do, and while it sounds a bit weird from the outside, I do think it will/would have real value - even in a "know thine enemy" way.

koeselitz - did I read you correctly, that your S/O would administer a vaccine to a child without the permission of the parent and in the absence of a legal requirement? Because as invested as I am in this issue, that seems wrong to me.
posted by Rumple at 12:00 PM on February 16, 2012


Here is the larger claim, as carefully as I can put it. If you repeatedly pick two people at random (with replacement) -- one from among all vaccinated people and one from among all un-vaccinated people -- you will find a greater frequency of diseased people among the un-vaccinated.

True

What is the relevance of that claim in this context? It is this. If you sit down next to Joe in the clinic, you are for all practical purposes sitting down next to someone drawn at random from the population. If Joe was drawn from the un-vaccinated, Joe is more likely to have an active disease.

But you seem to be assuming that the sample groups are the same size! Which is completely not true. Antivaxers are very loud and obnoxious, but there aren't very many of them out there. Googling at random: "According to the 2009 National Immunization Survey, about 70 percent of children aged 19 to 35 months in the United States received the full series of 25 recommended vaccines and booster shots. This data excludes the Hib (Haemophilus influenzae type b) vaccine, as a shortage reduced its availability that year. Less than one percent of children went completely unvaccinated. Coverage for mumps, polio, and pertussis (also known as whooping cough) was high nationwide—above 90 percent—but coverage dropped to 50 percent for hepatitis A, rotavirus and the first dose of hepatitis B vaccine at birth. "
So the probability of you sitting down next to an unvaccinated person is much, much lower than sitting next to a vaccinated one.

Now, somewhat bizarrely, you tell me that you think rate of exposure is actually higher among the un-vaccinated. If true, that actually makes my larger claim more likely to be true

Could be. In some situations.

(c) individual vaccinated people are no less likely to have a disease!

From who's perspective!? Epidemiologist's? Of course not. But from your perspective in the waiting room? Taking mumps as an example, vaccination coverage is ~90% (see above). Vaccine failure rate is ~1-5% (random googling). So there are anywhere from 3 to 15 million people that are essentially as good as unvaccinated. (based on population of 300M in US). How many antivaxers are there? According to the above quote, ~3M.
These numbers are unverified and approximate, but do you get my point?
Do you see that all those numbers are of no use to you when you come into the waiting room and look for a free seat?

Every time you add an un-vaccinated patient to the sequence of patients that comes through your office, you increase the expected number of diseased patients.

Yeah. But as a doctor I take it as natural to have diseased patients instead of healthy ones. I'm trying to turn the former into the latter. And I can't quite do it if I kick them our of the office...
posted by c13 at 12:06 PM on February 16, 2012


But you seem to be assuming that the sample groups are the same size!

Are you intentionally misreading me? I've already agreed that the sub-populations are not the same size twice (at least). It's not relevant to my claim. I'm not saying that the guy you're sitting next to is more likely to be un-vaccinated, I'm saying that if he is un-vaccinated, then he is more likely to have a disease than if he were vaccinated.

These numbers are unverified and approximate, but do you get my point?
Do you see that all those numbers are of no use to you when you come into the waiting room and look for a free seat?


No, I don't get your point. I thought we were talking about public policy and whether a doctor is justified on public health grounds to refuse treatment to the children of anti-vaccination parents. If you grant my claim from an epidemiological perspective, then you grant my entire point.

I'm not saying that completely settles the issue of treatment refusal in this case, but I do think it is prima facie justification for refusal of treatment.
posted by Jonathan Livengood at 12:30 PM on February 16, 2012


I realize that not everybody has this choice, but when we had our first child 16 years ago, we spent a fair amount of time researching pediatricians in the area and interviewing several before choosing a doctor. We didn't really spend much time discussing vaccinations in that process, because 16 years ago it wasn't an issue. Of course our child would be vaccinated.

The point is: if I were an anti-VAX parent going through the same process, would I want to choose a doctor who had a fundamental disagreement with me over how to care for my child. Sure, it's hard to find doctors I'm sure would agree with you, but that's telling you something there.
posted by mach at 12:38 PM on February 16, 2012


, I'm saying that if he is un-vaccinated, then he is more likely to have a disease than if he were vaccinated

I'm saying that if we're talking about properties of a spherical horse at STP, we will reach different conclusions than if we talk about a real horse.
IF you sit down next to an unvaccinated guy, and IF he happens to have active disease at that particular time, and IF you're downwind from him, and IF you happen to be in the 2% of vaccine failures, then you have a higher chance of getting sick. How higher? I have no clue. I'm not sure anyone does. But what I'm saying is that there are a whole lot of "ifs" that have to happen in your scenario. It is certainly possible, but I haven't seen a lot of evidence that it actually happens all that frequently to be a threat to humanity. My whole reason in getting into this whole statistics debate was not to show that what you're saying is impossible. It was to show that without thinking about it properly, people tend to get on the other side of the kook spectrum and say things like "unvaccinated kids will destroy the world" (again, you didn't say this, I know).

I thought we were talking about public policy and whether a doctor is justified on public health grounds to refuse treatment to the children of anti-vaccination parents.

We ARE talking about public policy. And I'm saying that a doctor IS NOT justified on public health grounds to refuse treatment. Because his refusal only causes those antivax parents to become even more distrustful and antagonistic to doctors. Doctors in general, not that specific pediatrician. And this refusal does absolutely nothing in terms of reducing the unvaccinated rate. I understand that dealing with those parents is frustrating and dangerous (to whatever degree). But we've done that before, when we eradicated smallpox. I'm sure we can do this again.
An epidemiologist or a doctor, or a public health official does not accomplish his goals by ignoring the patient.
posted by c13 at 12:56 PM on February 16, 2012


It is certainly possible, but I haven't seen a lot of evidence that it actually happens all that frequently to be a threat to humanity.

Did you see the link I posted upthread to the CDC brief on the measles outbreak in San Diego a few years back?
Once ubiquitous, measles now is uncommon in the United States. In the prevaccine era, 3 to 4 million measles cases occurred every year, resulting in approximately 450 deaths, 28,000 hospitalizations, and 1,000 children with chronic disabilities from measles encephalitis. Because of successful implementation of measles vaccination programs, fewer than 100 measles cases are now reported annually in the United States and virtually all of those are linked to imported cases (2,3), reflecting the incidence of measles globally and travel patterns of U.S. residents and visitors. During 2006--2007, importations were most common from India, Japan, and countries in Europe, where measles transmission remains endemic and large outbreaks have occurred in recent years (CDC, unpublished data, 2008). Since November 2006, Switzerland has experienced that country's largest measles outbreak since introduction of mandatory notification for measles in 1999 (1).

The San Diego import-associated outbreak, affecting exclusively an unvaccinated population and infants too young to be vaccinated, serves as a reminder that unvaccinated persons remain at risk for measles and that measles spreads rapidly in susceptible subgroups of the population unless effective outbreak-control strategies are implemented.
Although notable progress has been made globally in measles control and elimination, measles still occurs throughout the world. U.S. travelers can be exposed to measles almost anywhere they travel, including to developed countries. To prevent acquiring measles during travel, U.S. residents aged >6 months traveling overseas should have documentation of measles immunity before travel (4). Travel histories should be obtained and a diagnosis of measles should be considered by physicians evaluating patients who have febrile rash illness within 3 weeks of traveling abroad.

Measles virus is highly infectious; vaccination coverage levels of >90% are needed to interrupt transmission and maintain elimination in populations. The ongoing outbreak in Switzerland, which has resulted in hospitalizations for pneumonia and encephalitis, has occurred in the context of vaccination coverage levels of 86% for 1 dose at age 2 years and 70% for the second dose for children aged <12 years. In the United States, vaccination coverage levels for at least 1 dose of MMR vaccine have been >90% among children aged 19--35 months and >95% among school-aged children during this decade. Although not measured routinely, 2-dose vaccine coverage is extremely high among U.S. schoolchildren because of school vaccination requirements.
(emph. mine)
posted by rtha at 1:09 PM on February 16, 2012


But we've done that before, when we eradicated smallpox.

It certainly wasn't accomplished by accomodating anti-vaxers. Smallpox was ultimately eradicated by literally enforcing (in some cases through martial law) vaccination and quarantines.
posted by scody at 1:11 PM on February 16, 2012 [5 favorites]


If we flat out refuse to see people, it sure would make our days easier, but I think society as a whole is worse off for it. They'll just find other doctors, at the end of the day.

I can sort of relate to this position. But on the other hand, as someone with a new baby girl on the way literally any minute now, I don't want to have to take my baby to a pediatrician's office where there might be un-vaccinated kids in the waiting room because of the increased risk my baby may actually get sick and die from an illness that otherwise would and should be more or less ancient history by now.
posted by saulgoodman at 1:12 PM on February 16, 2012


Point being, at least some pediatricians who make it a policy not to see un-vaccinated kids would be a benefit to people with newborns.
posted by saulgoodman at 1:13 PM on February 16, 2012


Rtha, what are you trying to say? Are you trying to prove to me that measles is a bad thing that should be eradicated? You don't really need to, we're in complete agreement. I'm frankly puzzled...

Point being, at least some pediatricians who make it a policy not to see un-vaccinated kids would be a benefit to people with newborns.

The way the system is set up now, physicians that refuse to deal with antivaxers shift our common burden onto other physicians, who have to see more at risk patients and end up having waiting room situations you describe. In my humble opinion, that ain't cool.
posted by c13 at 1:17 PM on February 16, 2012 [1 favorite]


c13: “I understand that dealing with those parents is frustrating and dangerous (to whatever degree). But we've done that before, when we eradicated smallpox. I'm sure we can do this again.”

This is an interesting question, so I looked up some info on the historical contexts of smallpox eradication. There have indeed been many times that smallpox vaccination was compulsory in various states in the US, and the Supreme Court has found that states have a right to require compulsory vaccination for the public welfare. Here is a pretty good overview of the history of vaccines and of anti-vaccination activism, which started in the 1800s following the experiments of Edward Jenner.

Rumple: “koeselitz - did I read you correctly, that your S/O would administer a vaccine to a child without the permission of the parent and in the absence of a legal requirement? Because as invested as I am in this issue, that seems wrong to me.”

Yes, you read me right. And as I detailed above, part of this is because of her feeling about her position as a rural doctor who has more than the usual amount of responsibility for each patient (since she's the only doctor they're likely to see for long stretches.) But, as she pointed out to me, vaccinating kids contrary to the protests of parents is arguably legal. The courts have generally found in favor of doctors who gave life-saving blood transfusions to children over parental protest; and it seems to me that, while the MMR vaccine may be less likely to be as necessary as those blood transfusions, it can have much more far-ranging consequences if an outbreak of measles occurs in a native population that has less herd immunity simply owing to poverty and nonstandard medical situations.
posted by koeselitz at 1:29 PM on February 16, 2012


But, essentially, the solution to eradicating smallpox was legally mandating everyone get vaccinated whether or not they wanted to and then enforcing it very harshly (on preview, what everyone else said). We can do it again by having the same mandate. (And ensuring it's free for everyone, not free-plus-a-few-hundred-copay.)

I don't think that a measles resurgence is going to kill off the species, but saying that having no herd immunity has no real effect is not supportable.
posted by jeather at 1:33 PM on February 16, 2012 [1 favorite]


Why should I be allowed to choose not to have a medical service that's vital to public health but I'm not allowed to choose a pediatrician that doesn't serve kids that might increase the risk of my baby dying?

Either way, someone's paying the bill for that choice not to get vaccinated--why does it have to be those of us who don't make it?
posted by saulgoodman at 1:35 PM on February 16, 2012


There have indeed been many times that smallpox vaccination was compulsory in various states in the US, and the Supreme Court has found that states have a right to require compulsory vaccination for the public welfare

But we don't have compulsory vaccination NOW. Therefore just getting rid of antvaxers from your own office serves no useful purpose. We don't have a stick and now we're throwing the carrot away...
On a personal level (I'm not a pediatrician), I'd be pretty pissed off if my colleagues in town decided to channel all their problem cases to me. I get tired and irritated too.

I don't think that a measles resurgence is going to kill off the species, but saying that having no herd immunity has no real effect is not supportable.

Who says that? Herd immunity is even one of the reasons antivaxers use to justify their position.
posted by c13 at 1:39 PM on February 16, 2012 [1 favorite]


c13, you've obviously never been to mothering.com. Some people certainly think that herd immunity is nonsense.
posted by the young rope-rider at 1:43 PM on February 16, 2012 [1 favorite]


Why should I be allowed to choose not to have a medical service that's vital to public health but I'm not allowed to choose a pediatrician that doesn't serve kids that might increase the risk of my baby dying?

Either way, someone's paying the bill for that choice not to get vaccinated--why does it have to be those of us who don't make it?


Well, why should an anitvaxer accept some risk (however small) of his kid suffering from the side effect of the vaccine (real or imagined), when they get enough protection from herd immunity? Someone's already paid the bill, what's the use of paying again?

Maybe because we live in a society and it's up to all of us to make it livable?
posted by c13 at 1:43 PM on February 16, 2012


Rtha, what are you trying to say? Are you trying to prove to me that measles is a bad thing that should be eradicated? You don't really need to, we're in complete agreement. I'm frankly puzzled...

I was specifically addressing your point that oh it's hard, we can't tell how risky it is to have unvaccinated people around and how many people they might put at risk! We do know, and we can tell. It's pretty much exactly what the CDC does, is figure this stuff out.
posted by rtha at 1:46 PM on February 16, 2012


Maybe because we live in a society and it's up to all of us to make it livable?

So, on the one hand, people should get to have a choice that might kill my baby, but on the other, I shouldn't get to have a choice that would just inconvenience them (by forcing them to have to spend a bit more time seeking out a pediatrician that specializes in treating anti-vax kids)? That doesn't seem like even a remotely fair way to resolve that conflict to me.

I'd love to hear the argument for how someone's momentary convenience should be reckoned worth more than (potentially) someone else's child's life.
posted by saulgoodman at 2:13 PM on February 16, 2012 [3 favorites]


c13, I think you've done a good job of stating your opinion/stance and I think it's a lucid and honorable one, if not one that everyone sees eye-to-eye with.

You've made it clear that there's benefit to be gained, in your opinion (correct me if I'm misinterpreting you), by keeping lines of communications from doctor to patient open with anti-vaxers and that a given doctor's refusal to see them as regular patients is counter productive to the situation in general.

Does that same belief apply to a hypothetical parent who is categorically, can't be persuaded, is not going to vaccinate, communication is useless, against vaccinating their children? For the sake of argument assume there is other pediatric providers in an accessible range.

I'm not saying one answer or the other is better or worse, just curious.
posted by RolandOfEld at 2:13 PM on February 16, 2012


Someone upthread asked about the association between long-term conditions and vaccination status as a child.

My mother has multiple sclerosis. She was recently told by her doctor that childhood measles might be the culprit. Seems like there might be a link.
posted by Summer at 2:13 PM on February 16, 2012


c13, you've obviously never been to mothering.com. Some people certainly think that herd immunity is nonsense.

Some people believe in timecube. Some people believe in an all powerful deity that has created and runs the whole universe with all it's cataclysms, wars, extictions, etc, and at the same time does not want them to touch themselves in inappropriate places. Some people are full blown psychotics. So? We still have to be around them. Again, when you get rid of an antivaxer, the problem does not go away...


Rtha, you missed my posts about the difference between population studies and individuals. I just wrote a couple of paragraphs, but I deleted them because I don't want to discuss it again. It has nothing to do with the topic of the thread and I'm sorry I got into it in the first place.

Does that same belief apply to a hypothetical parent who is categorically, can't be persuaded, is not going to vaccinate, communication is useless, against vaccinating their children? For the sake of argument assume there is other pediatric providers in an accessible range.

What are you accomplishing by offloading them to some other provider? They still live in the same city as you, go to same stores and playgrounds, still need treatment for all the other medical problems unrelated to vaccination. Why should I as a provider accept all the hard referrals? Why should I expose my compliant patients to an increased number of "uncompliant dangerous ones" (all the previous arguments nonwithstanding). Are my patients worth less? To paraphrase saulgoodman's latest comment, should I inconvenience my patients for the sake of some other physician or his patients?
Where does it lead us?
posted by c13 at 2:23 PM on February 16, 2012


What's interesting, c13, is that you seem to be applying the "what if everybody did?" test to yourself as a physician, but not holding parents to the same standard. I think it should apply across the board. In fact, it seems to me that the "what if everybody did?" test is an awfully low bar for judging behavior in a community setting.
posted by ambrosia at 2:34 PM on February 16, 2012


Huh!? I'm asking where this attitude will lead us, not defending it. Are we reading the same thread?
posted by c13 at 2:38 PM on February 16, 2012


ambrosia: “What's interesting, c13, is that you seem to be applying the "what if everybody did?" test to yourself as a physician, but not holding parents to the same standard. I think it should apply across the board. In fact, it seems to me that the ‘what if everybody did?’ test is an awfully low bar for judging behavior in a community setting.”

First of all, I don't think c13 is really doing that; he hasn't said at all that people should not vaccinate their kids. Second of all, I think he's right; "I just refuse to treat children of anti-vaxxers" is the easy way out, and while it's a doctor's right to take the easy way out, the higher standard demands that we take note that there are better ways.
posted by koeselitz at 2:39 PM on February 16, 2012


I'm not sure what's going on. Either I cannot get across a simple thought. In this case I'm sorry. The only reason I'm still in this thread is because I'm trying to rebuild my other computer and I'm distracted.
Or I'm arguing with people that are incapable of understanding a written sentence.

In that case I'm also sorry....
posted by c13 at 2:44 PM on February 16, 2012


should I inconvenience my patients for the sake of some other physician or his patients?

This is a question that the docs who offloaded the non-vaccinating patients must have asked themselves: Should I inconvenience/put at risk my patients for the sake of these other patients? Their answer apparently came up with "No, out go the non-vaccinating folks."

As I said in my first comment, I have mixed feelings about this. It's not ideal public health strategy. But I also understand how some docs got to this place.
posted by rtha at 2:48 PM on February 16, 2012


Who says that? Herd immunity is even one of the reasons antivaxers use to justify their position.

The claim I hear about herd immunity from anti-vaccination people is that it's bullshit, not that it exists so that they can freeride no problems.


and while it's a doctor's right to take the easy way out, the higher standard demands that we take note that there are better ways.

What are the better ways? You have a practice, which includes newborns, pregnant women (many mothers will get pregnant again and have to take their children to the doctor), and immunocompromised children. You have some children who are not vaccinated. You can: refuse to ever see them; see them like everyone else and hope they don't infect anyone in your waiting room; have a separate waiting room for healthy children and not healthy ones and hope they don't infect the kids who are already sick; have a separate waiting room for non-vaccinated kids. None of these seem to even remotely solve the problem.
posted by jeather at 2:50 PM on February 16, 2012 [1 favorite]


But we don't have compulsory vaccination NOW. Therefore just getting rid of antvaxers from your own office serves no useful purpose. We don't have a stick and now we're throwing the carrot away...

On a personal level (I'm not a pediatrician), I'd be pretty pissed off if my colleagues in town decided to channel all their problem cases to me. I get tired and irritated too.


But by the same token, isn't that an argument for doctors banding together to create a united front in refusing to see anti-vaxers for non-emergency purposes? (I mean, until we actually have compulsory vaccination, which I think is the ultimate answer.) If it becomes effectively impossible for the anti-vaxers to go find another doctor to accomodate them, then I would expect a at least a certain percentage (perhaps the soft anti-vaxers, not the hardcore True Believers) will start to comply, which might at least slow the decline in herd immunity for some diseases in some locations.
posted by scody at 2:52 PM on February 16, 2012 [1 favorite]


If it becomes effectively impossible for the anti-vaxers to go find another doctor to accomodate them

Yes, scody. Let's all do that. And while we're at it, let's refuse to treat all borderlines 'cause they are a pain in the ass to work with, let's ship all paranoid schizophrenics to some island since they are making things difficult not only for doctors and nurses, but other patients on the wards. An unvaccinated 2 year old with developmental problems totally deserves growing up retarded, right? Need eyeglasses to be able to learn how to read? Well hell, you ain't getting them from me!
I don't know whether you have kids. I just really, really hope that their pediatrician will never take out his frustration with you on them.
And if you can look a sick 3 year old in the eye and tell him to go fuck himself because his mother is a crazy person.. I just don't know, dude...
posted by c13 at 3:07 PM on February 16, 2012


Well my question was answered with another question but I can read between the lines I suppose. But the answer to "what is accomplished?" with regards to the hypothetical parent in question is a net change of zero in the kid's wellbeing and the doctor in question has safer patients at the cost of another doctor's patients. maybe if doctors stood together on the issue...
posted by RolandOfEld at 3:12 PM on February 16, 2012


c13: “Let's all do that. And while we're at it, let's refuse to treat all borderlines 'cause they are a pain in the ass to work with, let's ship all paranoid schizophrenics to some island since they are making things difficult not only for doctors and nurses, but other patients on the wards. An unvaccinated 2 year old with developmental problems totally deserves growing up retarded, right? Need eyeglasses to be able to learn how to read? Well hell, you ain't getting them from me!”

I just want to point out that c13 isn't shooting blindly into the dark here, either. There are hospitals that refuse to see patients with "psychiatric complications." It sucks, most of all because people with those complications don't deserve to be refused service. There is way too much refusing-service going on in our society as it is. Something needs to be done, and taking the easy way out by refusing to serve children of anti-vaxxers is not it.
posted by koeselitz at 3:13 PM on February 16, 2012


RolandOfEld: “maybe if doctors stood together on the issue...”

Then we as a society would be even more at risk, because there would be a huge block of kids unlucky enough to have been born to anti-vaxxers who would be getting no care at all. Can you imagine how really terrible that would be? It would be much, much worse than things are right now.
posted by koeselitz at 3:14 PM on February 16, 2012


And if you can look a sick 3 year old in the eye and tell him to go fuck himself because his mother is a crazy person.. I just don't know, dude...

Jesus. No one is advocating this.

What, exactly, do you suggest? Should all pediatric practices be required to have separate waiting rooms for sick/well or vax/not-vax? What should docs who live in areas where non-vaccinating parents are in higher concentrations do when weighing the costs (to their other patients) and the benefits (keeping people in the health care system even if they're not compliant in this area)?
posted by rtha at 3:17 PM on February 16, 2012 [1 favorite]


rtha: “Jesus. No one is advocating this.”

No one is advocating using obscenity in talking to a child, but it's effectively exactly the same.

“What, exactly, do you suggest? Should all pediatric practices be required to have separate waiting rooms for sick/well or vax/not-vax? What should docs who live in areas where non-vaccinating parents are in higher concentrations do when weighing the costs (to their other patients) and the benefits (keeping people in the health care system even if they're not compliant in this area)?”

There is no simple answer to this question, and people should know that by now. 'Just refuse to treat children of anti-vaxxers' is the easy way out, but it trades community health for a doctor's convenience, it convinces nobody, and ultimately it makes the problem worse.

People love shouting that anti-vaxxers are not rational human beings, and that nothing can be done to convince them. But if that's true, this is a pointless argument anyway, because there is no solution. We have to try to engage anti-vax people on a real level, to educate them. Lots of people above have said that anti-vax parents believe that they're on the side of evidence. Do you realize what an extraordinary opportunity that represents? That means they actually believe evidence means something! This is not like convincing anti-abortionists that a vague and difficult-to-define thing like 'life' doesn't begin at conception; they can define their way out of that, and besides most of them are acting on faith. Most anti-vax parents are just acting on bad information.

The only way to solve this problem is to educate the community about vaccines and what they mean.
posted by koeselitz at 3:27 PM on February 16, 2012


Jesus. No one is advocating this.

What? There is a "Good" comment at the top of this thread that has accumulated 80 favorites last time I checked. How do you think "create(ing) a united front in refusing to see anti-vaxers for non-emergency purposes" would work in practice?
It's easy to vent and rave about the stupid antivaxers on the internet, but you have to remember that those physicians are refusing to see the kids, not their crazy parents.
It's also easy to paint all those antivaxers as stupid evil uncaring people. But I've met one of them during my peds rotation in Chicago. She brought her kid in every damn week for the tiniest of problems and was quite easily the most doting and caring mother I met there.

In your own post you quoted a study that said: " Because of successful implementation of measles vaccination programs, fewer than 100 measles cases are now reported annually in the United States and virtually all of those are linked to imported cases".
So we should deny medical treatment to several million little kids for anything other than life or death situation because they are unfortunate enough to have crazy parents? All because of less than 100 measles cases a year? Is that rational!?
posted by c13 at 3:33 PM on February 16, 2012


It seems like there are better way to enforce vaccination policies than leaving it to doctors on an ad hoc basis to turn patients away.

Mind you, I'm sympathetic to doctors (as individuals and business professionals) who refuse to treat the kids of anti-vaccination parents. And no doubt just the threat of denying treatment also provides doctors with some leverage (parents who are on the fence might relent).

But it still seems like an ethically awkward position for a doctor to deny treatment under all but the most extreme circumstances. Do we even want doctors conditioning their treatment based on whether or not a patient agrees with certain litmus test treatment recommendations? It's easy enough to agree in the case with vaccines, but what about other treatment recommendations?

And finally, I'm also concerned that it may be counter-productive. It removes children of anti-vaccination parents from doctors who are in favor of vaccinations. If the doctor continued to care for those kids, the doctor and staff would have more opportunities to sell the virtues of vaccinations. (Heck, just requiring all un-vaccinated kids and parents to wear face masks at all times in the waiting room might be social pressure and message enough to convert some opinions). Also, if the parents were split on the issue, it might just be a matter of time before, say, Jim brought the kids in to the doctor and okayed the vaccinations despite Jenna's prior objections.

Also, it makes your individual doctor the enforcer (albeit voluntarily) when it probably makes more sense to have the conflict be between the parents and society (government) as a whole. Let the parents fight city hall, not your local caregiver.
posted by Davenhill at 3:45 PM on February 16, 2012


Yes, scody. Let's all do that. And while we're at it, let's refuse to treat all borderlines 'cause they are a pain in the ass to work with, let's ship all paranoid schizophrenics to some island since they are making things difficult not only for doctors and nurses, but other patients on the wards. An unvaccinated 2 year old with developmental problems totally deserves growing up retarded, right? Need eyeglasses to be able to learn how to read? Well hell, you ain't getting them from me!
I don't know whether you have kids. I just really, really hope that their pediatrician will never take out his frustration with you on them.
And if you can look a sick 3 year old in the eye and tell him to go fuck himself because his mother is a crazy person.. I just don't know, dude...


Yes, by all means, Doc Strawman, that's EXACTLY what I'm suggesting. (I must point out that you forgot to mention the Obamacare Death Panels, on which I have volunteered to serve as Chief Granny Euthanizer for Southern California in 2013. I can't wait!) Dude.

In any case, I can't have kids; I had at least one miscarriage due to cancer, and then the cancer treatment that screwed up my immune system also sent me into premature menopause (but thanks for asking; I'm sure it was in good faith). I do have nephews and young cousins, though, who have parents (my siblings and adult cousins) who are equally frustrated and angry as I am. So on their behalf, I'd like to know what, precisely, you propose to be done to reverse the trend? Do you think mere education is enough? Should anti-vax families be segregated from vax-compliant families in health care settings? Do we return to compulsory vaccination? Or do you think we should just keep letting herd immunity slip? If 100 measles cases isn't a big deal, what about 1000? What about 10,000? What about 100,000?

koeselitz: Lots of people above have said that anti-vax parents believe that they're on the side of evidence. Do you realize what an extraordinary opportunity that represents? That means they actually believe evidence means something!

They're only on the side of the evidence, in my experience, when they feel they can make the evidence fit their theory. This is the direct opposite of the scientific method, in which the theory is made to explain the evidence. This is also why they will keep pointing to completely discredited studies, data, etc. as "proof." If the majority of them actually cared one jot about evidence in the same meaningful way that you and I care about it, the Lancet retraction of Andrew Wakefield's hoax would have settled the question. It didn't.
posted by scody at 3:47 PM on February 16, 2012 [9 favorites]


shouting that anti-vaxxers are not rational human beings, and that nothing can be done to convince them. But if that's true, this is a pointless argument anyway, because there is no solution.

There is a solution, but the solution isn't done at an individual pediatrician level, it's done at a society level, where it becomes much harder to opt out than it is now. I think that doctors are in a difficult position, and I am not convinced that "just refusing them as patients" is as much the easy way out as people claim it is.

Actually, my theory is that a kid will die from measles or pertussis or whatever that they got in a doctor's office from an unvaccinated patient and malpractice insurance premiums will shoot up so that no doctor can afford to have unvaccinated people in the practice. (Alternately, enough kids will get expensive-to-treat but vaccine-preventable diseases that it starts costing insurance companies significant amounts of money, and they start increasing premiums for unvaccinated people.)

you have to remember that those physicians are refusing to see the kids, not their crazy parents.

Perhaps doctors should say they'll see the kids if the parents stay away. This isn't really a fair argument: you cannot really see children without their parents, so refusing to see the parents is pretty much the same as refusing to see the kids.

In 2011, there were over 200 cases of measles, double the "less than 100" cases there used to be. One year is not a trend, but it's also a bad direction.
posted by jeather at 3:48 PM on February 16, 2012 [1 favorite]


All because of less than 100 measles cases a year? Is that rational!?

I don't know. Ask the parents of the baby that had to be hospitalized after it caught measles from the unvaccinated kid whose parents took him to a country where measles in endemic because there's no herd immunity. I'm sure that for them, it's entirely rational to do everything possible to keep measles from becoming endemic here. Again.

You don't want to argue about population vs individual levels of risk. The CDC and public health departments tend to deal with the population-level kind (and it's not cheap: "In Iowa, the public health response to one imported measles case cost approximately $150,000 (9)."), but the pediatricians generally have to wrangle with the individual level kind. The practice that saw that kid in San Diego had a *lot* of vulnerable patients exposed, and a number of them actually got sick.

As I said, again, way up top, I don't think that docs telling non-vaccinating parents to go away is good public health practice.

It's also not good public health practice to just keep on like we're keeping on, regarding this issue. You think barring them from practices sucks, but you don't actually offer any possible solutions that take into account the vulnerable people who *also* have to go to the doctor and can't be vaccinated.
posted by rtha at 3:50 PM on February 16, 2012 [1 favorite]


Scody, you advocated "create(ing) a united front in refusing to see anti-vaxers for non-emergency purposes". If it somehow implies something other than what I said, perhaps you should explain it better.
I don't mean to offend you, but your anger and your issues are completely irrelevant for this argument. If for no other reason than that the a lot of antivaxers are also very angry and frustrated. for their own irrelevant reasons. And because you and your relatives will still come in contact with alienated, untreated kids of antivaxers. If not in doc's waiting room, then in the store, the playground or the subway.

you don't actually offer any possible solutions that take into account the vulnerable people who *also* have to go to the doctor and can't be vaccinated.

Way up top I also made suggestions to remedy the situation. One was keeping the dialogue open ,the other one was to modify the way patients see the doctor in such a way as to minimize contact between the sick and the healthy, as well as between people who are sick with different diseases. There is absolutely no reason why you should spend several hours in a room full of sick kids that are climbing on one another and snotting everywhere just to get a school form filled.

Jeather, you understand the difference between hundreds and millions, right? I know you do, you know I know.. Forest for the trees man, forest for the trees.
posted by c13 at 4:10 PM on February 16, 2012


And because you and your relatives will still come in contact with alienated, untreated kids of antivaxers. If not in doc's waiting room, then in the store, the playground or the subway.

Except the doctor's waiting room is filled with kids who are already sick with something. Hence its far more likely to occur there than anywhere else. I suspect orders of magnitude more likely.
posted by Ironmouth at 4:39 PM on February 16, 2012


already sick with something.
But we are not talking about "something" in general. We're talking about a few specific diseases.

. I suspect orders of magnitude more likely.

Well. You've seen the numbers. Fewer than 100 - 200 measles cases a year for the whole country. As I've mentioned, I don't see how you can come up with meaningful numbers for you as an individual, but I suspect you routinely engage in activities that carry much greater risk of injury or death. Limiting the contact between patients would lower that number even further. Just in case I'm misunderstood again, I'm in no way trying to imply that vaccination is not important and that we shouldn't strive for a 100% vaccination rate.
posted by c13 at 4:50 PM on February 16, 2012


What, exactly, do you suggest? Should all pediatric practices be required to have separate waiting rooms for sick/well or vax/not-vax?
You know, I think pediatricians probably should have separate waiting rooms for sick and well kids, but not because of the threat of measles. The threat of getting measles is negligible. On the other hand, according to the CDC more than 200,000 Americans are hospitalized with the flu every year, and tens of thousands of Americans die of the flu during a normal flu season. If you're worried about your baby getting seriously ill from something he or she picks up in a doctor's office, you should be much more concerned bout influenza than about measles.
posted by craichead at 5:49 PM on February 16, 2012


Way up top I also made suggestions to remedy the situation. One was keeping the dialogue open ,the other one was to modify the way patients see the doctor in such a way as to minimize contact between the sick and the healthy, as well as between people who are sick with different diseases.

But unvaccinated kids can be carriers that don't show any symptoms. I just don't understand why I should have to take my baby into a doctor's office knowing that the doctor isn't actually doing everything in their power to minimize the likelihood of my baby dying of what should be a preventable disease.

Also, I'm not personally saying all doctors should reject un-vaccinated kids. But there should be some medical care option for parents with newborns who sincerely don't think other people's misplaced suspicions about well-established public health issues should be grounds for putting their own children at any increased risk.

I just really don't understand the inverted ideas about social responsibility being expressed here. The responsible parents shouldn't be forced to accept the increased medical risk created by the irresponsible ones if there are alternatives. So what's so wrong with some doctors refusing to see anti-vax patients? If the market works right (ha!) there will always be others willing to see them, as long as there's demand for their services, too. Right?
posted by saulgoodman at 6:52 PM on February 16, 2012 [2 favorites]


If you're worried about your baby getting seriously ill from something he or she picks up in a doctor's office, you should be much more concerned bout influenza than about measles.
Or rotavirus. Our son was vaccinated for it but contracted it anyway from other unvaccinated kids at his daycare. Luckily, his case was much milder than it would have been otherwise, although he still had very bloody stools for weeks. According to our doctor, had he not been vaccinated, his condition would have been much more serious, as full-blown rotavirus infections in can be fatal in unvaccinated kids his age.
posted by saulgoodman at 6:58 PM on February 16, 2012


If the market works right

You made a funny, no?

But there should be some medical care option for parents with newborns who sincerely don't think other people's misplaced suspicions about well-established public health issues should be grounds for putting their own children at any increased risk.

Yeah. You can hire your own personal pediatrician and pay him enough to be able to make house calls. It used to work that way a long time ago. That way you will avoid a whole bunch of very scary things that can kill you child that are common in hospitals and we don't have vaccines for. ( about 2 million people acquire a significant nosocomial infection every year and about 20000 of them die. Compare that with a 100 measles cases)
As things stand now, pediatricians are among the lowest-paid medical specialties -- something that goes further to illustrate where our priorities as a society and hence "teh market" are.

. The responsible parents shouldn't be forced to accept the increased medical risk created by the irresponsible ones if there are alternatives. So what's so wrong with some doctors refusing to see anti-vax patients?

That's just like your opinion, man. I kid, of course. But only partially. Seriously though, I think it's one of those things that, if you don't understand them already, cannot be explained to you. I'm not blowing you off, I just can't say much more that I already said in my previous posts.
posted by c13 at 7:17 PM on February 16, 2012


Yet another study has found no association between vaccines and autism.
posted by homunculus at 11:46 PM on February 16, 2012 [1 favorite]


Some parents view vaccination as an odds game where they bet that enough other parents will vaccinate, thus creating herd immunity and allowing a privileged subset of kids to skate by without enduring the minimal risk of standard vaccinations.

Anti-vaxxing is in vogue among the well off nouveau-hippie and Burner crowds in Seattle, where hardcore free-lovers and strident poly zealots are finally starting families. You'd think this crowd would grok the benefit of herd immunity, but these are some of the hardest headed antivaxxers. They fully believe the rest of the world has covered herd immunity and their precious snowflakes must not experience an ounce of unnecessary risk. In typical progressive fashion, direct conversation (let alone feedback) is cause for offense, so the breadth of the problem isn't really recognized. In Seattle alt communities, vaccination levels for measles, mumps, diptheria, pertussis, rubella and chicken pox are way below what is necessary to prevent an epidemic. It's only a matter of time before one of these awful diseases devastates the community.

The only rational strategy for parents who vaccinate their kids is to visit doctors who won't expose their children to unnecessary diseases. Vaccines aren't 100%, kids with weak immune systems can't have some vaccines, and exposing kids whose parents have done the right thing for preventable illness is a terrible policy. Non-vaccinated kids belong in facilities that are prepared to deal with the epidemic diseases to which they are susceptible, and which do not contain children who truly cannot tolerate vaccines. That reduces risk for immunocompromised children seeking medical care, and it removes the incentive for selfish parents to freeride on herd immunity. Vaccines don't work/cause allergic reaction: normal docs. Special snowflake freeloader parents: measles parties in the waiting room. If that is distasteful, castigate the snowflake parents and quarantine their kids while they are sick. Snowflakes don't get to make decisions for everyone.
posted by SakuraK at 1:35 AM on February 17, 2012 [6 favorites]


When a pregnant woman is exposed to Rubella, her fetus can become infected and develop severely debilitating birth defects.

This happened to Gene Tierney. Horrible, horrible story. (Also, Agatha Christie based one of her murder mysteries on it very closely.)

In June 1943, while pregnant with Daria, Tierney contracted rubella during her only appearance at the Hollywood Canteen. Daria was born prematurely in Washington, D.C., weighing only three pounds, two ounces (1.42 kg) and requiring a total blood transfusion. Because of Tierney's illness, Daria was also deaf, partially blind with cataracts and had severe mental retardation. Tierney's grief over Daria's condition led to many years of depression and may have begun her bipolar disorder.[citation needed] Some time after Daria's birth, Tierney learned from a fan who approached her for an autograph at a tennis party that the woman (who was then a member of the women's branch of the Marine Corps) had sneaked out of quarantine while sick with rubella to meet Tierney at her only Hollywood Canteen appearance. In her autobiography, Tierney related that after the woman had recounted her story, she just stared at her silently, then turned and walked away. She wrote, "After that I didn't care whether ever again I was anyone's favorite actress."
posted by two or three cars parked under the stars at 2:51 AM on February 18, 2012 [4 favorites]


Jonathan Livengood: For example, from your link, measles is 98% effective. [...] (1) Vaccinated people have, on average, 98% immunity to measles.

c13: 1. True [...] For you to be in danger, a)you must fall into the 2% of those in whom the vaccine is not effective,

No! This is WRING. It's is a common misunderstanding (so common, in fact, that the NYT made it a couple months ago when reporting on a malaria vax), but this is not what efficacy means. Efficacy is not the percentage of people "protected" but rather a measure of how much the vaccine changed the incidence of the disease, all else being equal.

Specifically: efficacy of a vaccine is defined as the difference in disease incidence in an unvax'd and a vax'd population with the same exposures, divided by the incidence rate in the unvax'd pop, ie, the % change in incidence when the vaccine is administered.

Alone, efficacy tells us NOTHING about the probability of disease given the vax (or not). For that, we would need to know the incidence rate in the unvax'd pop. Consider: if the incidence rate of measles is 100 cases per thousand people per year and vaccinating drops it to 2 per 1000 per yr, we have an efficacy of (0.1-0.002)/0.1=0.98; likewise, if the incidence of measles is 100 cases in a *million* people per year, we have (0.00001-0.0000002)/0.00001=0.98 -- same efficacy, but a vastly different risk of disease (10% incidence in the 1st example, 0.001% in the second). The 2% left over from the "98% effective" does not mean 2% will get measles, as you can see from this example; nor does it mean 2% of vaccine administrations "fail." It means that the incidence in a perfectly vax'd pop is 2% of what it would have been otherwise, given the same #s of contagious people around.

This is why herd immunity is so important: it keeps those who did not acquire immunity safe by reducing their exposure, by placing them in a population where the incidence rate is vastly reduced -- here, to 2%. This, in turn, spirals exponentially, which is why the incidence rate of measles NOW is not merely 2% of what it used to be, but much MUCH less: given that the risk of a new case is proportional to the prevalence of carriers, cutting the new infections to 2% during the first post-vax "wave" means cutting the number of newly contagious people to 2%, so that on the next wave you now have 2% * 2% = 0.04%, etc etc, to the point that a once ubiquitous disease is unheard of. Those who choose not to vaccinate are cutting into that by effectively mixing an unvax'd pop with the vax'd pop, reducing (and possibly reversing) the exponential decline to disease eradication.
posted by Westringia F. at 5:27 AM on February 18, 2012 [4 favorites]


Er, "wrong." Hand-wringingly so.
posted by Westringia F. at 5:30 AM on February 18, 2012 [1 favorite]


Measles Outbreak Traced to Super Bowl, Anti-Vaccination Fanatics.
posted by Horace Rumpole at 12:35 PM on February 24, 2012


Senior Author of MMR Paper, John Walker-Smith, Wins Appeal
posted by telstar at 6:41 PM on March 7, 2012


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