Thursday, February 25, 2010

one last thing about this and i promise i will stop

I was posting this in the comments section, but it was starting to get rather long, and in any event, my browser ate it, so I thought I would just post it here as a follow-up to the post yesterday.

First off, I want to extend an invitation to those people who are reading who are anti-vaccine to talk about why they don't vaccinate. I think we are overall very civil here, and if the concern is not about the so-called link to autism (as one of our commenters noted), then what is the concern? Some vague unease about "chemicals"? Concerns about "overwhelming" baby's immune system? Seriously, I want to know, not being snotty. It is hard to have a conversation about this without coming to (virtual) blows, so I would love to be able to talk about it rationally here, not even just to try to convince one side or the other, but just to visit the other side's perspective. (Obviously this need not be said, since we are all grown-ups here, but if anyone is brave enough to present their personal concerns about vaccines in what seems to be a very pro-vaccine forum, we all should play nice.)

The second thing I wanted to address was the fact this topic never fails to make me as both a mother and physician so enraged--not annoyed, not puzzled but actually angry, like I'm taking people's anti-vaccination sentiments as a personal affront--and I wonder why. After some thought, I have come up with this: I am taking it personally. And here is why.

As someone who works in healthcare, with sick patients, I see every day the injustice and horror that is illness. Preventative healthcare is a wonderful thing, perhaps the best kind of medicine that we can practice. Along with a healthy lifestyle, protecting against preventable illness is a big part of that. As a doctor, it's quite simply the very best that we know how to do.

When I go go onto these internet parenting boards, to read this anti-vaccination literature and hear the rhetoric, we see people who are not only rejecting we have to offer, but who vilify doctors and other healthcare workers--people who have devoted decades of their lives to caring for children and families--for working their hardest and giving the very best of what modern science has to offer, it quite frankly hurts my feelings. It's not paternalism, it's not about me wanting to tell patients what to do and for them to comply mindlessly, it's about me wanting to do my job and provide the best; and then feeling like people reject my efforts and recast my motives as somehow evil, greedy, or just plain ignorant. It hurts my feelings.

So yeah, I take it personally. I respect a parent's intuition and I respect the fact that no one feels great, myself included, about bringing their baby in, making them cry by jamming them with needles filled with seemingly mysterious antigens and preservatives. I know first hand that the desire to protect your children from all real or potential harm is beyond conscious thought, it is instinct.

But I respect science, too, and I have based my life around that. In lieu of religion, I have science. And the impulse to prosthelytise is equally strong. And just like people who prosthelytise about religious faith, I am doing so not to force you to be like me, not to scorn or humiliate you for possibly being of a different faith, but because I care about you and your children and families, and I want what all best evidence I have points to being the most effective way to stay out of my hospital.

The other thing that would have enraged me, by the way, with all the fury of a mother bear protecting her cubs, would be if Mack had somehow gotten the measles from an un-immunized kid before he was old enough to get his own vaccine. Luckily we he got his first MMR last week, so at least that's one less thing to worry about.


  1. Dr. Au, I'm a veterinarian, and I have the same feelings especially when clients tell me they don't want me to vaccinate their pet because it's "toxic" or "causes autoimmune disease" or even because their friend's dog got autism from a vaccine (yes, someone told me that). I also have three kids, and of course worry about their exposure to unvaccinated members of the herd, to the point that I did in fact tell a close relative that if she went through with her plan to not vaccinate her kids, then our kids would not be socializing together. It's such a difficult subject, and I for one do not understand why the anti-vaccine people refuse to evaluate the evidence.

  2. Michelle, that sums up exactly why I hated my pediatrics rotations.

  3. yay!!! I finally get it. I am a pharmacist (aka drug dealer) and I have always gotten quite angry about people not vacinating their children. I am not to blame for autism, neither are the drugs/vaccines that I push.

    I wish I could explain the concept of herd immunity to people. Note to anti-vacine folks...the more people you convert to your side the more likly your kid will be to catch one of these diseases someday. Vacines depend on 85% of the population being vaccinated to keep illnesses at bay.

  4. Anonymous7:53 PM

    Dr. Au, that's exactly what makes me so upset. The vilification. I spend so much of my life working so hard, going overboard for so many people and the vilification I read. It makes me angry. I respect that people don't understand, I respect that peoiple worry for their kids - I respect that people research. None of this is a problem for me. It's the immediate knee-jerk reflex that I MUST be in the pocket of the drug companies, that I MUST be trying to hurt children.

    That hurts.

    That really, really, really hurts. And it is so hard to get past the anger that generates.

    Aussiedoc (a GP in Australia)

  5. Anonymous8:14 PM

    I receive my MD in May & I agree with you about vaccinations. I am such a big advocate for vaccines; it is a marvel of modern medicine, people. Ignorance about vaccinations & those so-called "chicken pox parties" added fuel to the fire when I decided not to pursue pediatrics. SO FRUSTRATING!


  6. Sharon8:16 PM

    I am in medical school, and my mom is always reading books with titles like, "10 Things Doctors Do Wrong," "25 Things Your Doctor Is Not Telling You," "Why Western Medicine is Evil." She's always pushing these books on me and can't understand why I wouldn't want to and then thinks I am being ignorant. wtf

  7. So my coworker's kid got pertussis at 6 days old from an unimmunized...someone, probably at the hospital. I work in autism research, my colleague works in autism research, we both shared the frustration of parents who sometimes blamed vaccines for their child's conditions, and I have to say that his restraint was admirable. Had our roles been switched, I would have been a raving maniac.

    Suffice it to say: I consider myself extremely pro-vaccine, and I get very, very, very angry when I consider the risks posed by the unvaccinated to others who are not yet vaccinated or failed to mount a sufficient immune response. HOWEVER, I do wonder (and this is only wondering) - I have an autoimmune disease, and a very active one at that. I am pregnant, and my baby is dealing with my overactive immune system. Is it an insult to his system to vaccinate him with multiple things upon birth? I don't know. I don't have the medical expertise. But that is what I'd be asking my pediatrician, not other moms.

    That might explain a little bit...of the anti-vaccine rhetoric. But other arguments (and I've asked those who have chosen not to vaccinate) make NO sense to me. And as someone with a background and commitment to public health, I see it as a corporate responsibility, not a personal choice, frankly.

    1. So what's the problem - go ahead and vaccinate all you want.

  8. Peds NP8:21 PM

    I work in pediatric oncology and have been frustrated by what I see as the selfishness of parents who chose not to immunize. If you have ever watched the suffering of an immunocompromised patient (and their family) as they battle a preventable childhood illness, you would want to do everything in your power to eradicate the cause. These children can and do die as a result of what were once common childhood infections. These are infections that are easily prevented through current immunization programs.

    Parents who say they do not need to immunize their children because they do other "natural" interventions to boost their child's immune system (often unneccesary nutritional supplements or other unproven immune boosters) fail to take into account that it is not just child who suffers if their child becomes infected. It is frustrating to see a child beat cancer, only to lose their life to a chicken pox infection.

  9. Rachel,

    Good point, I have heard this argument a few times from people who suffer from rheumatologic disease, the concerns about overamping a possibly already amped immunologic system. My question is (and this is a real question, I don't know the answer), what is the difference between the antigen load of a vaccine versus the antigen load of just being a baby? At least in the case of my kids, they crawl on the ground, put things in their mouths, lick the dog's butt, play in the grass, eat raw fruits and vegetables, and that's just over the course of the average day. Wouldn't the antigen load of a vaccine necessarily be less than the antigen load of life?

    Dunno, if there are any immunologists out there, please weigh in. This is not my field of expertise so any opinions I express about antigens and the immune system are purely at least partly conjecture.

  10. Just wanted to chime in on the level of general nastiness on the parenting boards. I looked at some of the anti-vax rhetoric for a project and the vitriol directed to anyone connected with the medical profession is unbelievable, especially coupled with the complete faith in anything natural/CAM. Also the hubris that a couple hours of googling makes you an expert in ANYTHING let alone complex subjects like immunology.

  11. Darth Offit told our med school class that the total number of antigens from vaccines is something like 24. And yes, we are exposed to far more than that from life on a daily basis. I suppose we don't inject ourselves with them.... but I'll stop here. Don't want to give anti-vaxers more fodder.

  12. Karlei9:26 PM

    I get angry too and I am not a medical professional. I think it's because those who don't vaccinate are relying on those of us who do, while often being nastily judgmental about it to boot.

  13. Anonymous9:28 PM

    Dr. Au,

    I am completely in awe of how eloquently you've expressed your perspective on the pro-vaccine argument. You took the thoughts right out of my 3rd year med student brain, plus added the valuable insight of being both a mother and a doctor. That this is even up for debate is mind-boggling to me.

    Oh and don't worry, Jenny McCarthy is back, and this time SHE has (single-handedly) CURED the autism that her son may, or may not have even ever had:

  14. Anonymous9:32 PM

    Thank you for bring up this topic. I remember reading every single comment (over 100) posted on the Globe & Mail in response to their article about The Lancet's retraction of the infamous "paper". I was angry and appalled.

    I think that a lot of the anti-vaccine people don't understand that association is not causation. A parent fixates on the fact that his son acted differently shortly after his immunization. Therefore vaccines are evil!!! As poignant at the connection may seem, would anyone say that junior high causes menstruation, or high school causes smoking in some kids, because they started to get their period when they started junior high, or because some kids start to smoke in high school? That's ridiculous! Again, association is not causation.

    I don't even know why to call this "Vaccine and Autism" thing a debate. Debate implies legitimacy to both sides. We don't have "The Earth is Flat" debates, or "Gravity Doesn't Exist" debates, do we? This whole argument stemmed out of a poorly-motivated, poorly-designed, poorly-executed, and poorly-interpreted experiment that passed for research once upon a time, but no longer (the paper was retracted).

    I think there was steam coming out of my ears when a nurse (an RN working on an osteoarthritis team, luckily not in a pediatrics setting) started spewing off anti-vaccine rhetoric. She snapped at me when I said that I didn't understand the conspiracy theories: "It's not a conspiracy theory when it's the truth!"

    But really, I don't understand the conspiracy theory about vaccines. If vaccines are so useless and so harmful, and are being pushed by Big Pharma, then I ask you how did they get the cooperation of the public health docs, the pediatricians, the family docs, the government etc? I won't deny that Big Pharma has deep pockets. But if there are any financial rewards to doctors for immunizing the children, the I certainly am unaware of them.

    As a family medicine resident, I can assure you that giving 4 immunizations to a 1 year old is not my most favourite part of the day. Drawing up the vaccines, reconstituting them, placating the mom or dad who is about to cry, holding down the kid, listening to the shrieks and bandaging up the injection sites... This does not give me joy. But I do it because it is important. And I don't think we get paid for giving immunizations. If there is a tiny incentive fee (to increase immunization rates), then I'm sure it does not cover the cost of the needles, bandages, bribery-item (toy, sticker, whatever), and refrigeration of the vaccines.

    So yeah, I'm glad to hear that I'm not the only one who get angry and insulted when it's implied that my actions to prevent disease are viewed the mindless actions of an evil and greedy minion of Big Pharma.

    - Another Michelle, Family Medicine Resident in Canada

  15. I am a Mom with no medical background who opted to vaccinate.

    Those who do not immunize have the "luxury" of making that choice because others step up and make that responsible decision.

  16. I'm really intrigued by the prosthelytizing element of things - some doctors have utterly failed to treat me as an individual because I'm fat, and I think that the prosthelytizing + public health focus explains many of the reasons why. The discomfort I felt around those docs was eerily similar to the discomfort I felt around some very aggressively Baptist friends, and I'm going to think about this some more.

    As for vaccinating, I'm throwing in my 2¢ as a non-parent, but my plan for when we do have kids is to stagger vaccinations, largely due to the concerns about overwhelming the immune system. Speaking as a layperson, my perspective is that I *want* my kids to be exposed to antigens, both from eating dirt and from vaccines. However, since vaccines are specifically designed to provoke a significant immune response, I'd prefer it if their bodies could go through the reactions sequentially, rather than simultaneously.

    I personally can't understand the folks who won't vaccinate at all. My response isn't as visceral, but is more of a frustration with freeloaders and recklessness. I'm one of the folks who really doesn't have an understanding of what life was like pre-vaccines, and I can't imagine that the non-vaccinaters will gain enough ground to threaten things significantly. For those of you who have no problem imagining (or recalling) such a scenario, I can understand why your reactions are much more heated.

  17. Yes! Mark me down as another idealistic physician (and yes, I'm in peds) who takes it *very* personally. I also agree with the peds onc commenter above - it's not just the parent's kid who is affected by their decisions. I felt similarly about people who decried the push for healthcare workers to get the H1N1 vaccine. I work with sick kids - how could I in good conscience *not* get vaccinated?? Whether they're battling cancer or on a vent in the NICU or just coming in for a well-child visit, I can't justify knowingly increasing the chance of exposing my patients to that virus. I take it as my personal duty, and it surprises me when folks lose sight of that and put principle (I'm not gonna get a shot just because The Man says I have to!) ahead of patient safety.

    But yeah, you put words to the feeling I get too. I'm with you.

  18. Alice, diseases like measles and pertussis have already started making a comeback over the past several years. One of the physicians at my hospital got pertussis and was quite ill for a long time; his illness sparked a commitment to promoting pertussis booster vaccination in our hospital. The threat of non-vaccinators has already reached a point where herd immunity begins to break down. The question is how far it will go.
    We also have an Amish population here; they do not always vaccinate. I'll just say yes - I can imagine the consequences because I've seen those kids get sick. Some of them die. Terrible.

    Sorry for two comments in a row, but I wanted to address that.

  19. Sara - no problem about 2 in a row. I was actually coming back here because I followed one of the links and saw that nearly 6% of kids in Marin County are unvaccinated. That's mind-boggling to me, and definitely changes my perspective on 'oh, they're just a teensy minority' to 'holy shit, REALLY?' That's pretty terrifying.

  20. Anonymous10:34 PM

    Hi Michelle-

    I hesitated to respond, but decided that I would share my thoughts. I have an infant drooling on me, so forgive me if my comment is more stream-of-conciousness than well-composed essay. Please pardon any typos as well. No time to edit!
    I hope that my words will be received respectfully.

    I have two kids. We will vaccinate, but have chosen to delay. It took me a long time (3 years) to come to that decision.

    Why? I needed to learn more. I am an educated person and try to learn as much as I can before making important decisions. I was never really worried about autism, but I take the responsibility of being a parent very seriously, like all parents do, of course, and wanted to make sure that I understood the history, benefits, side-effects, and politics of vaccinations before I agreed to have my kids vaccinated.

    I have had some really bad experiences with doctors (and pharmacists, btw) over the years and have found many to be arrogant, dismissive, rude, condescending, etc. (Please, I know words on the computer come across harsh, it is not my intention to lump all medical providers into one category. No offense intended to any. Just relating my experience.) This has worn me down and helped to foster a deep distrust in the American medical system.

    There is a lot that I can say, but I think for many, including me, it comes down to trust and transparency. "Do we/I trust the CDC/Medical establishment/pharmaceutical companies?" "Do I feel that potential side-effects are being swept under the rug?" "Do I feel like my concerns are being glossed over? If yes, then why?"

    While I will do most vaccinations, ultimately, (I decided that the benefits outweigh the potential side effects for most vaccinations-- not doing Hep B or Varicella at this point. Perhaps I will change my mind later.) I only have so much trust in these institutions...BTW, I also try to avoid other medications to the extent necessary; I am a balanced person.

    It's scary to hear about corruption in the pharmaceutical business and how the profit motive and lobbyists **might*** influence medical advice and policy matters. I am sure that many will have points to refute what I am saying, but I just wanted to share what I am thinking about and how I know others are thinking.

    I humbly submit that if medical professionals want parents to vaccinate that they be patient with their (our) questions, be open about the benefits and potential side-effects, offer as much information as possible, and don't be dismissive of concerns.

    I understand that people are worried about the public-health consequences of those who don't vaccinate...but please know that most are trying to do the right thing for their families and care about society. MORE serious education is the key.

    Thanks for listening!

    Best to all.

  21. I'm not personally offended when people make a decision for their own child that I don't agree with -- that is their prerogative.

    What DOES offend me is that in this case they're NOT just making the decision for their own child. By not vaccinating they are risking the lives of others, particularly very young children, It is more than selfish, it is criminally negligent manslaughter.

  22. Anonymous11:00 PM

    I hope we never get to a point where we criminally punish people for not vaccinating their children.

  23. Anonymous1:37 AM

    Varicella vaccination is in a way safer than getting chicken pox "naturally". I suppose one can opt for the natural course of disease which will run for maybe 14 days and infect people around them (fingers crossed do no harm and murder none - the child included), because this provides an additional gift to the child of a live virus lurking dormant in the body waiting for an opportunity to turn into superbly painful shingles when they grow up. If they have shingles, they'll need to take even more chemicals to counter the pain - antivirals and very strong pain relief medications.

    We could've avoided the pain in our grownup kid.

    We could've helped the Health Budget by taking up the relatively cheaper option of (prevention) vaccines, rather than the very expensive option of (treatment, longer term) medications.

    Imagine if it wasn't chicken pox. If it were Measles, we could've help reduce the burden on the reduction of resources and expenditure on say... deafness -- hearing assessments, potentially lagging in school and future emploments, hearing aids, cochlear implants (surgery!!), welfare payments... it's endless and has an impact on how well a society does as a united/ combined front.

    If only... if only...
    If only we think beyond our little circle of family.

  24. I'm a peds RN in a little after hours clinic. I am mom to 7 (yes, I said SEVEN) adopted children. Three of them are adopted from Ghana in West Africa. They all came from a place where they were given Polio Vaccine (thank you Rotary International), but weren't given ANY other vaccinations. They walked barefoot through markets that were covered in rusty scrap metal and broken glass. When my 5 year old son cut his shin down to the bone while he still lived there, I had to ask the orphanage director to PLEASE find a place to get him a Tetanus vaccine. It took him 14 hours to do this. Here, it might take you 20-30 minutes.

    Choose to do it, or choose not to do it. I've obviously vaccinated all my kids here now. But, if you choose not to, could you send the money that your insurance company would have spent to my kid's orphanage? The director there would HAPPILY use it to vaccinate the kids that live with him!

  25. Question for people...I haven't researched this because my kiddos are not yet school aged. Aren't vaccines required for children to go to school?

  26. Anonymous10:51 AM

    I will never understand why people don't vaccinate. Never. I am 39 weeks pregnant and am in my last year of anesthesiology residency with plans to do a pediatric fellowhsip.

    I will have all vaccinations given on time. Not late, not delayed, and not being selective, but according to the scheduling guidleines provided by the AAP. There is a reason they have spent so much time and effort to come up with these guidelines. The same reason infant baptism became so popular long ago. These diseases kill babies and children.

    I also don't understand why people don't give Hep B it's due resepct as a disease. Hep B is quite contagious and completely preventable. Any blood transfusion carries the risk of 1:230,000, where as HIV is 1:2 million and Hep C is 1:1 million. It takes 6 months to get the full set. Unfortunately, one cannot plan when to need an emergency blood transfusion. And surely no rational parent thinks they can control who thier child will "share bodily fluids with" later in life. However, an ounce of prevention...

    I have also had bad experiences with physicians and pharmacies/pharmacists, etc. However, it does not make me lack trust in the system and training of everyone! Nor do I think the conspiracy theories are rational. Physicians are not deliberately hurting children or patients. Finally, why do people trust Jenny McCarthy? She is a crazy person (didn't you see her on TV??)and has done a huge disservice to humans. If she could get through medical school, maybe then she would understand!


  27. Anonymous11:51 AM

    Science has had a tendency of not taking into account the larger picture. There are many examples of short term benefits and long term disorders.

    You have to remember it was not long ago, within my lifetime that doctors recommended cigarettes. Well after many of the vaccines were created. How many doctors have really studied vaccines vs taking the regulatory agencies word for it?

    Doctors are the 3rd leading cause of death.
    44,000 people die each year from infections received in the hospital

    That dwarfs pandemics like the 11,000 deaths from swine flu. Pharmaceutical drugs kill multiple times more people each year than illegal drugs.

    Drug companies know their drugs are causing deaths and continue to sell them

    They've been caught faking studies

    Is there are reason to doubt the science? The science is based on the studies released by the companies profiting from their vaccines who have been shown to be very unethical.

    When the regulatory agencies and drug companies are one in the same, exchanging top executives - does this appear to be in the best interest of the citizens?

    Is it possible that over the many thousands of years that viruses have imprinted our DNA, there has been a purpose that we may be missing and that creating antibodies is not the same as having immunity through natural exposure? Vaccines can wear off but immunity lasts a lifetime.

    While there are little hopes either side to this argument will come to a compromise, all that we do ask for is the freedom of choice. Let each individual, each parent, decide for themselves what they believe is right and let's not persecute others for their decisions.

    People die from slight allergic reactions to peanuts, yet vaccines come in a one size fits all form and to question potentialy side effect and harm from vaccines ignites anger from the scientific community. Can we at least identify those that are most prone to have side effects?

    All we ask is that in this country, we remain free to choose what medical procedures our bodies should be exposed to.

    Let's start with Rule #1 from the Nuremberg Code

    1.The voluntary consent of the human subject is absolutely essential.

    And let's not forget that code and how it was established.

  28. Hi! I'm back.

    You know, we also have a dog who goes outside and tracks who-knows-what inside, a house that is not necessarily sterilized (whose is?), and all sorts of other exposures. I am sure there are hundreds of thousands of times more antigens in that cumulative exposure than in one vaccine.

    That being said, the kid that I'm carrying is being gradually exposed to that in utero (whatever crosses the placenta) and will be gradually exposed postnatally - so I guess my question still remains - is the practice of multiple vaccines at one visit something that overloads the system?

    Regardless, as I said, our kid will be vaccinated fully and completely; I don't consider it an option, although I do want it to be done in the safest way possible (but doesn't the AAP, too?). As someone else said, people in developing countries would kill to have this "choice".

  29. As a parent who falls on the delayed/selective spectrum of the vaccination issue, I'm interested in reading this. I respect the viewpoints expressed, but I do wish there could be less assumption that people like me make our decisions based on ideas about conspiracy theories or on Jenny McCarthy. (To be honest, I don't even know who she is - some actress?)

    As I mentioned in the other comments section, it was my own pediatrician who first gave me the notion that some vaccines might not be necessary or could be delayed. She was a very old-school, pro-vaccine MD, in practice 30 years. She said that in her experience, the varicella vaccine was not necessary. And because of her experience, because of her years of seeing sick kids, I trusted her on that. That's what you doctors want us patients to do, after all.

    So when I was pregnant with my second child, I looked into vaccines. With all the hoopla, I wanted to know what was in them, what the risks/benefits were. (It wasn't simply fear of autism, by the way.) I still have my own vaccine record from childhood. It's got something like 4 vaccines listed. Now there are 12. I wanted to understand why.

    I read Dr. Stephanie Cave's "What Your Doctor May Not Tell You About Childhood Vaccinations" - which, despite the title, ends up recommending all of them. I read the CDC statistics. And I decided to space out my kids' vaccines.

    Believe me, I know how nutty the anti-vax crowd can sound. I have been on those parenting boards. I guess what I'd like to emphasize is that not everyone who takes a look at vaccines and comes up with an alternative schedule is a conspiracy-crazed freak. The people I know who go the delayed route have put a lot of thought and research into that decision and not made it lightly.

  30. Anonymous1:00 PM

    I don't understand why this has become such a huge issue in the past 10 years. Most of us adults, including those who are having children now, were vaccinated. It's my understanding that you have to have your vaccines to go to school.
    So what has changed since we were babies or our parents were babies. Why now are vaccines horrible and doctors and scientists lying. Why now can we not trust these vaccines?
    BTW, I agree that some people will have side effects to vaccines and a very small amount will have a severe reaction, but I think that is the next step in vaccine research. To find a way to identify those people who are more prone to side effects than those who are not.
    Lastly, we place are children in far worst risk with daily activities like driving, but no one is screaming for people to stop driving, because we know the benefits far outweigh the risk

  31. Anonymous1:15 PM

    More honesty would be appreciated. Reading the pamphlets of the vaccines is an interesting place to start, how many doctors inform the parents of the risks? Most questioned if they received any information on the vaccine claim to receive very little to no materials.

    The CDC suggests that less than 10% of adverse reactions are reported, those that are can be found on VAERS.

    There certainly are adverse reactions to vaccines, how much work has been done to identify the most at risk groups? Can some testing be established to determine those most at risk?

    Stating that vaccines are scientifically 'safe' is relative, but relative to what? Vioxx was considered safe, Avandia was considered safe

    It's a matter of known and unknown risk. How much has disease been eradicated by sanitation and hygiene improvements, clean water, etc vs vaccines?

    What makes some with no previous exposure able to tolerate a virus and build lifelong immunity to it vs those that are exposed and become severly sick and potentially die?

    To say that science knows that vaccines are beneficial for everyone is being completely negligent.

  32. Kristin1:25 PM

    As an epidemiologist, I also take it personally when I hear people say they'll opt out of vaccinating their children. Years of research and hard work of medical and public health professionals are completely being ignored. It's frustrating for me to hear parents citing bogus research and celebrities like Jenny McCarthy as reasons for not vaccinating when the next day, I'm having to investigate a mumps outbreak. The reason diseases like the mumps were considered a "non-issue" was because we had the vaccine to prevent it. With more and more people opting out of the vaccines, we're seeing a significant resurgence of very preventable diseases. People like Jenny McCarthy are doing a huge disservice to the public. Every time I see her on TV touting her "vaccines cause autism" message, I get angry thinking about how many parents will choose to believe her over hard scientific evidence.

  33. Nikki2:42 PM

    As an immunology grad student (studing vaccina aka the smallpox vacine - the gold standard in vaccination) it drives me up a wall to hear anti-vaccine propaganda. There are lots of ways to make vaccine and not all are created equal...that said, the "risks" associated with most of them are better than your chances if you catch the disease you're vaccinating against.

    As for the anonymous who talked about the varicella vaccine - the studies are too early to tell if those vacinated with vericella will also be protected from shingles. The herpes viruses (yes, chicken pox is not acutally a pox virus, but a herpes virus)latency is not completely understood. But for those of us who had chicken pox there is an approved vaccine for shingles.

    To the anonymous who questioned if, "creating antibodies is the same as having immunity through natural exposure" is comments like these that drive me NUTS! Your B cells (those cells that make the antibodies) don't know or care how they are exposed to antigen...they are programed to recognise their antigen and respond accordingly. A major goal of a good vaccine is an antibody response, but it's not the only goal...there are some viruses and bacteria where a B cell response alone won't clear the infection. Also the statement, "vaccines can wear off, but immunity last a lifetime"...this makes no sense if you understand how the immune system works or how vaccines take advantage of the processes of our immune system. Vaccine "prime" the cells that can and will respond to whatever you are being vaccinated against...this does not mean that you will never be infected once you are vaccinated, only that since your immunce system has been "trained" to recognise that particular pathogen, you will have a much quicker immune response and will most likely never know you were infected. Some immunity last a long time...some needs one is really sure the factors effecting the length of your immunological immunity. But if you are interested, I'd direct you to journals such as Imunity, Nature Immunology and the Journal of Immunology - I think you will get a better appreciation of how complex the questions really are.

    Science is not perfect, but we (and our data) are critically reviewed by our peers...this is not to say that bad science doesn't get out there. Case in point, the vaccine = autism article (subsequently retracted). But Jenny McCarthy and her "experts" are not subject to scrutinization prior to her going on TV or writing a book.

    You don't HAVE to vaccinate your kids, but please don't preach to me about vaccination and the immune system when I've spent the better part of 5 yrs studying it and you've done a few google searches.

  34. Anonymous3:36 PM

    a nurse brought her infant son in to the ED having new onset seizures, and long story short, he ended up with several diagnoses including autism. the interesting thing is that the child was supposed to be vaccinated that day at the pediatrician's office, but had been a little listless so the doctor recommended that they wait until the next visit in case he was coming down with something.

    the mother obviously was very upset, and she admitted to the staff that if he had gotten the vaccines that day and had this event, she would have been one of the loudest supporters of the anti-vaccine movements.

    the first few years of life are rife with opportunities for disease, and we owe it to our children to give them the chance to grow up.

    on a side note, there is an ER physician that works part time in our hospital on the weekend when she's not running her anti-vaccine clinic. she actually chelates young children and prescribes these ridiculous vitamin regimens and spends hours telling anyone who will listen that vaccines are evil. how can she be a doctor and propogate this tripe?

    -docstitchy (ER doc in NY)

  35. Interesting comments everyone, thanks!

    One thing that I wanted to point out is the issue of personal choice. One of the commenters above talked about the fact that patients should be able to decide what treatments to choose for them and their children. Another commenter mentioned something about certain diseases that we immunize against being overall benign and self-limited (I may be paraphrasing) and that perhaps more effort should be made to immunize only those at risk.

    This is a public health issue. Of course, immunization protects your child against measles, mumps and rubella, but that's only part of the picture. The other part of the picture is that immunizing your kid protects other people--people who for one reason or another ARE in an "at risk" population, being immunocompromised for one reason or anther--from getting measles, mumps and rubella.

    For instance, I never got the flu shot before I went to med school. It just wasn't something I had considered getting. Sure I'd had the flu before, but I didn't think it was such a big deal--little fever, little malaise, stay home from school for a few days--and it's not like I got the flu every year or anything. When I started med school and started working in the hospital, I did get the flu shot. I get my flu shot every year now. Not for me, for my patients. It's not a big deal for me to get the flu. For my 90 year old cancer patient, it is.

    I know it's hard to preach that people should be vaccinating not just for the sake of their kids, but for the sake of people they don't even know (and possibly could not care less about), but...that's the truth.

    There is free will, of course--no one is going to hold you down and force you to take a medication or to vaccinate--but taking responsibility for your own decisions works best when you are the only person affected. Sure, maybe it's my right to drink alcohol when I'm driving, but I could hurt other people in the process, so there's a law against that. It is totally in my right to smoke cigarettes if I want to, and if I'm going to do that in my own home, fine. But in a public place, I am inflicting other people with the healcare implications of my choice, so there are laws against smoking in public places. There is no law mandating vaccination, of course, but there are restrictions about unvaccinated children attending schools and whatnot. Heck, we couldn't even drop Cooper (our dog) off at the kennel before we proved she was up to date with her shots.

    Lastly, I would be interested to know the profit margins for vaccine sales. This is an honest question--I don't know how much vaccines sell for, or how much the companies make. But you can pretty much tell how much of a moneymaker a drug is (Lipitor, Viagra, Cialis, all the antidepressants) by how much marketing a drug company puts behind it. My sense is that vaccines, like antibiotics, are viewed as necessary drugs to produce, but hardly cash cows, which is why we have no celebrity spokesperson or mugs and tote bags imprinted with the Prevnar logo.

  36. And again, thank you to everyone who has commented so far, it is really interesting to hear all the different point of views, and so well articulated at that. Seriously, smartest blog readers on the web!

  37. Nikki4:13 PM

    Just skimmed this article and there are no actual $$ numbers, but it seemed pretty interesting:
    "Factors affecting US Manufacturers' Decisions to Produce Vaccines"

  38. Anonymous5:26 PM

    One final fact

    77% of the kids that were infected by mumps were vaccinated. Efficacy stats for mumps anyone?

    You can take in all the data you want to support both sides but in the end it does come down to your choice. Michelle, appreciate your insights as to personal accountability for the health of the herd - but genetically and from an evolution standpoint... we have no idea where we are headed with this.

    Viruses have likely played an important role in our evolution and to say that an injected vaccine with a variety of preservatives and adjuvants will not effect the long term development of us as a species - how can we possibly make this assumption?

    We have evolved with a very sophisticated immune system over tens of thousands of years, it truly is amazing and not completely understood. We've tinkered with it over just a small fragment of our time here, no way of knowing the true implications.

    I've never witnessed sicker kids before in my life, the vaccine schedule over the last 30 yrs has increased like crazy. There is no study comparing vaccinated & unvaccinated over the course of the full recommended vaccine schedule. Nobody can say that the exposure to all these vaccines are safe and the accumulation and constant triggering of the immune system when it is not fully developed can be cleared for everyone.

    The massive health problems in our youth today suggests something is going on. Diet and environment are likely causes, but our youth are in completely terrible health. What we are doing is not working, and for all those dedicating their lives to making these improvements - i'm sorry, but take a step back and let's figure out why.

  39. I agree that kids these days have a higher incidence of things like obesity and Type II diabetes, but why do we think that vaccines are the cause as opposed to all the other environmental exposures that have developed over the past few decades? (Not sure what those exposures would be, just throwing it out there that more has changed in childhood over the last century than the childhood immunization schedule. How food is produced and grown, daily activities, technology and its impact, basically everything. Why do we point the finger at vaccines instead of, I don't know, McDonald's?)

    One thing that I do notice now that I have a kid in preschool is the staggering number of kids that have these serious or even life-threatening allergies to nuts and wheat and whatnot. And I wonder about that. I didn't know anyone with allergies like that when I was in school. Cal has four or five kids with severe food allergies in his class alone. Maybe those of us with more immunology background can chime in on this, but I wonder--in our efforts to protect our children from all the antigens and exposures, are we overdoing it? Are we actually keeping them TOO clean and too much in a plastic bubble so that when they are exposed to everyday triggers (nuts, pet dander, whatever) they just have these overactive, anaphylactoid responses? I don't know the answer, but I wonder if, in our attempts to protect our kids by not exposing them to stuff (not talking about vaccines or wild-type viruses, just talking about exposures in general, like dirt) we are doing more harm than good.

  40. Claire6:56 PM

    One thing I think makes the vaccine debate so difficult to resolve is the difference in the way the two sides weigh different levels of evidence. In medical school, I was taught to look for (ideally) well-designed randomized controlled trials, to consider p values and confidence intervals, etc. Vaccination skeptics, on the other hand, tend to produce theories and anecdotes as evidence, and if pressed appeal to the notion that the studies that would prove safety/efficacy (or the lack thereof) to their satisfaction have just not been done.

    I don't know how this discrepancy can be resolved, since they can't convince me that theories and anecdotes are an appropriate basis for "evidence-based medicine," and I can't convince them that the best answers to their questions about vaccination can be found on PubMed. If we can't agree on what constitutes evidence, then how can we come to agree on what the evidence shows?

  41. Claire, I have always wondered why there hasn't been a major study of *completely* unvaccinated vs. vaccinated on schedule kids. (There hasn't, has there?) If it's because not giving kids vaccines would be considered unethical, couldn't they use a group that doesn't vaccinate anyway, like the Amish? Wouldn't the results of such a study be evidence both camps would accept?

  42. A thought for those skipping the chicken pox vaccine with the expectation that their kiddos will get the disease instead...Due to less circlating virus your kids will probally get it later in life than they would have 20 years ago. The older you are, the worse the infection is and the greater risk of serious complications. May still be worth the risk for you but just keep in mind, it may be worse than you expect.

    Now a note about money...the hospital I work at vaccinates hundreds of women and children every month. We don't receive payment for most of these vaccines therefore we lose tens of thousands of dollars/month. It is considered a service provided for the good of the community and therefore we continue to provide the vacines. Maybe someone somewhere is making money off of vaccines but I don't think it's hospitals or doctors offices. (maybe the doctors office if you are paying for a visit for the sole reason of getting vacines but otherwise I beleive it is just paid for as part of the well child office visit.) Public health offices vacinate kids for free, I can't imaging they are turning a profit either. I'm not sure who is maing money off of vaccines but it seems like not enough people to start a conspiracy to make money.

  43. Erin, that's so interesting about the chicken pox, because the doc who told me not to get the vaccine made basically the same argument, but from a different angle. She said that the varicella vaccine doesn't guarantee lifelong immunity, and she was predicting vaccinated kids getting the virus as teens or adults when the immunity wears off and, like you say, having a greater risk of complications then.

    I'm not arguing with you! I can see both points of view. (My kids did catch chickepox at 3years and 8months. I guess there's plenty circulating in my city)

  44. Anonymous8:58 PM

    A few replies to comments:

    1) Your child, as Michelle suggested, is exposed to far more antigens in a day by simply being a baby and breathing air than they are then if they received every single possible vaccine in a single day. The injection, as the immunology student pointed out above, is because unlike the natural virus or bacteria that would infect your child, vaccines are designed to be as self-limited as possible, provoking immune protection without causing the full-fledged disease. This has been well-documented.

    2) The vaccine schedule was not designed in a vacuum. Each shot is tested in conjunction with the others, and is designed around when children are high-risk for catching that disease. Spacing out the schedule on your own time ignores that the CDC analyzes disease trends and specifically chooses when giving the vaccine will have the most benefit. For example, chicken pox seems fairly harmless, and "easy" to skip. But now by having it "naturally" I'm at risk for painful and dangerous reactivation as shingles, especially if I become immunocompromised later in life (I'm thinking cancer, which we're all at lifetime risk for, but feel free to include diabetes, HIV, taking steroids, having an organ transplant). A pregnant woman who comes in contact with your sniffling, German-measles infected child has a high risk of miscarriage, while your kid will be okay. Measles and mumps have a relatively high risk horrific consequences. We think of a lot of childhood diseases as innocent, but that's because most of us did not grow up with them...thanks to vaccines.

    3) The people that use Hep B as an example of an unnecessary, skippable vaccine have never talked to a doctor or nurse. All of us have seen a patient who has contracted Hep B in a way that did NOT include transfusion or sexual contact. It's a smart virus. In countries without routine HBV vaccination, levels of liver cancer are much higher, as Hep B is the #1 cause of liver cancer worldwide. Would you really refuse a vaccine that could prevent cancer in your child?

    4) My patient today in the hospital has H1N1; she did not get the vaccine. We have had two pregnant women in our MICU, intubated, in the last month with H1N1 influenza. All of them refused the vaccine. One was diabetic, two were pregnant, all otherwise healthy. They also were around a fair number of people who also can not afford to catch H1N1. I really don't understand people who had the choice to get this vaccine and did not. If any of you have any friends planning on becoming pregnant soon, please ask them if they've received the vaccine. The virus is still circulating and doesn't seem to be respecting seasons like normal flu.

  45. Amanda, a 2nd yr FM resident and fellow mom.9:43 PM

    Hey Michelle (et al),

    When I was a med student I did my Family Medicine project about vaccines/myths. I can't directly answer your question about antigenicity of living life vs. vaccines, but I can tell you this: our vaccines are actually more effective than in the past (both because they are more targeted and because of adjuvants boosting them) such that *even though* kids receive more TYPES of vaccines now than decades ago, the actual antigen load is much lower. The smallpox vaccine alone contained 200 proteins, now 11 standard vaccines (as of 2007) contained 130 combined!

    ALSO, someone else published theoretical calculation of immune system resource "usage" and found that if you gave all 11 of those same vaccines simultaneously you would use 0.1% of the B-cell capacity of their body. In addition, studies have shown a kid who is already sick (read: their immune system is fighting something else) still mounts the same response to vaccines, suggesting that they don't actually tap out their immune system fighting vaccines.

  46. Amanda again9:48 PM

    Also, to add to what Nikki says about people thinking natural immunity is better: take for example the case of tetanus. The toxin is so potent that the amount required to kill you is LESS than the amount to produce an immune response. So even if you had small doses of the toxin over time you would never develop immunity to it. Our toxOID however, induces immunity without ever giving you those pesky effects (ie death) of the disease.

    Not all immunity can be had naturally, or practically (natural immunity from getting measles and surviving doesn't protect you from SSPE later).

  47. Anonymous11:01 PM

    The question was asked: Why couldn't they use a group that doesn't vaccinate anyway, like the Amish?

    Answer: The assumption that the Amish don't vaccinate is incorrect. Most of them do, in clinics.

  48. Anonymous11:08 PM

    I'm pretty sure that pharma does not make a lot of money off of vaccines--in fact, I've heard that they sometimes have to dump money they make from the more lucrative meds onto vaccine R&D/production. I'm not a fan of big pharma by any means, but it seems their vaccine depts tend to be the more ethically responsible ones.

  49. Anonymous12:24 AM

    I'd like to know anyone's thoughts on GARDASIL.

  50. another immunology grad student chiming in here. I don't think there is any concensus at all concerning why there is an uptick in severe food allergies, even amongst the experts. Are we sensitizing our kids somehow? Or are we failing to allow them to tolerize themselves (hygiene hypothesis)? We simply don't know.

    And along those lines, regarding antigen load from crawling around on the floor vs vaccine... one does have to consider that these things are going by very different routes. Stuff that we ingest can't directly be compared to things injected, this is something that we consider time and time again when we design animal studies

  51. On Gardasil: give it. You can't "take steps back" and look at large, looming pictures without data. Keep in mind that we're always risking adverse effects when administering new vaccines, even if they pass every stage of a clinical trial. However, there is no way to prove that without actually making it available to the public.

    I won't discuss some counties' proposals to mandate the HPV shots here; I have limited knowledge on this and health policy deserves another blog entry.

  52. Right on, Michelle! And I appreciate how all of you health professionals have stepped up and made comments of support for vaccines.

    There will always be dissenters with the vaccine issue but by and large, we have to recognize the invention and usage of vaccines as perhaps the greatest medical advance seen by the 20th century.

  53. Bruce, that's interesting about the Amish. I was misinformed. Well, why don't they choose another group that doesn't vaccinate? Like, oh, half the families in my neighborhood? (Ok, I may be exaggerating there, but really, it's not difficult to find kids from the same population who are and are not completely vaccinated (in my city, anyway). Wouldn't that be a logical study to do?

  54. Anonymous12:55 PM

    As an older reader, I'd like to post a personal comment on the wonders of vaccination. I remember in 1948 when our parents sent my cousin Barbara and I to the country for the summer to escape the polio epidemic in the city. (And it was not something any of them could afford; it was a major financial sacrifice.)

    My friend Buzz did not escape polio, and was partially paralyzed for life.

    I remember the rejoicing in 1955 when the Salk vaccine became available, and parents flocked to get their kids immunized. It was one of the great triumphs of modern medicine. Thanks to a vaccine, polio has all but been eliminated from the world.

    Smallpox, which once devastated the world, was eradicated by a vaccine. It was a major killer, with hundreds of millions of victims around the world. But not any more, thanks to vaccination.

  55. I think you're right, Dr. Au: the vaccine debate is so polarized because it is so personal. The decision to vaccinate or not is seen as a reflection of everything from parenting ability to intellectual capacity.

    I was raised to be very anti-medical establishment. I had no medical care, even dental, until I was eighteen. I rarely got sick. But I also rarely interacted with groups of people; I didn't even go to school.

    And then I went to college.

    I got chicken pox the first week of my first semester. Then I got influenza, next endless colds. At the end of the semester I got a horrible gum infection and refused to get antibiotics or see a dentist. I ended up in the ER, hallucinating from the fever. But it wasn't over.

    While waiting in the ER, I got sneezed on. By someone who turned out had *diphtheria*. DIPHTHERIA. How "Little House on the Prairie." It was horrible. And it could all have been prevented!

    Needless to say my personal experience makes me very pro-vaccine. And it's this personal experience that makes me so very angry whenever I get pulled into a debate on these issues.

  56. A couple of people have posted about concern over the *other* ingredients in vaccines. It's true, vaccines contain preservatives to keep them from spoiling and some have adjuvants that induce a greater immune response. These ingredients are also found in most foods. And lotion, and toothpaste, and pretty much everything else we put in and on our bodies. Preservatives are unavoidable.
    I love the analogy that we drive our kids around in cars every day even though there's a much bigger risk associated with that than with vaccines. I'll have to remember to share that with my more reluctant parents.
    This is such a great discussion. Michelle, you really do have the smartest readers.

  57. Anonymous7:29 AM

    Bringing the point home.
    I was one of the selfish ones -I have taken the seasonal influenza vaccine, I didn't take the H1N1 vaccine.

    Then I went for mortality round. Saw MRIs of a healthy 4 yr old with H1N1 encephalitis, the amount of destruction within 6 hrs was horrifying. His uncle was H1N1 positive. Discontinued life support last week.Apparently we see one or two devastating CNS complications from Influenza B as well every year. For all that the majority of them behave just like common colds, the possibility of a preventable infectious disease causing such devastation - its tragic.

    I took the Varicella vaccine because I've had a few medical school classmates who got chickenpox as adults - and the symptoms really are worse. One guy had such painful blisters on his scalp that he couldn't even lie on his pillow. The other reason is that one of my tutors in Med School, a pediatric nephrologist, lost a few renal transplant patients to chickenpox and now refuses to allow anyone in her clinic who is not vaccinated or immune.

    The next round of vaccination is coming soon - I'm going.

  58. To those who inquired if vaccinations are required for children to enter school: Most schools will provide a waiver for those who do not vaccinate for religious reasons, and the families that I personally know of who do not vaccinate have used this route.

    For those who delay vaccines, I think that's fine SO LONG AS your child is not in a daycare where they may contract or likewise infect other children. What is scary to me is when groups of non-vaccinating parents put all of their kids together in a daycare or school setting; the potential for an outbreak just gives me the willies.

  59. Anonymous1:54 PM

    The problem with this debate is that it rests on fear...

    fear of the MDs who have seen the heart wrenching effects of these diseases

    and fear of parents who have seen the horror of autism.

    this leads to distrust, hurt feelings, anger, inability to listen on BOTH sides...

    as a (soon to be!) PhD working with people with autism, i can tell you, it is fucking horrifying. there is really no other way to put it. Sometimes daily life for the family and child is torture.

    but as a scientist and wife of MD, I know the importance of vaccines.

    maybe massive education efforts both for the public and for doctors and scientists on how to communicate their knowledge effectively is what's really needed.

  60. Anonymous2:13 PM

    Another trend I'm seeing is the refusal of the vitamin K injection and antibiotic ointment. Very scary to me....totally unnecessary deaths are coming from this trend.

  61. Anonymous5:51 PM

    I am a librarian and can tell you that some of the anti-vaccine physicians and other practitioners have sortof deputized these moms. They go to their blogs and compliment them. They invite them to their speaking venues selling their books and videos. They are recruiting. They tell them the "supposed" medical elites REFUSE to review their papers. They are currently vilifying "The Lancet". The lack of critical thinking annoys me and when I explain how scholarly research really works, they are woefully disappointed. It is very cult-ish. If only preventative medicine had used some of these methods!!

  62. Michelle mentioned this question: "My question is (and this is a real question, I don't know the answer), what is the difference between the antigen load of a vaccine versus the antigen load of just being a baby?"

    As a scientist, this has always been exactly my question. I have not gotten an answer from multiple pediatricians I've asked, including my mother in law at Boston Children's.

    Does anyone have scientific references that address this question? The vague comments don't do much for my pubmed-addicted brain.

    -Haley (with all the free subscriptions of Sloan Kettering at my beck and call)

  63. Brian G12:50 AM

    I'm a 25 y/o male and I am soon to get my second dose of Gardasil. There's no such thing as herd immunity if you ignore half the population. Besides, I'd rather avoid penile or anal cancer as well as genital warts if at all possible.

    I understand some people's fear of Gardasil for the sheer fact that it is a very new vaccine and rare complications aren't known yet, and the payoff is decades into the future (i.e. a shot to prevent cancer 20 years later), but how could you ignore the benefit of a vaccine that has been on the market for decades and prevents death and disfigurement in children? (i.e. almost all of the scheduled childhood vaccinations)

  64. Anonymous6:34 AM

    Dear MJ,

    How can you NOT give your children Hepa B? Do you know the horrible, horrible, symptoms they will get if they don't? I live in the Philippines and I'm a doctor.

    I have seen the ravages of Hepa B in my patients: Liver cancer, liver cirrhosis, and sick children.

    All because their mothers didn't bother to get vaccinated and because the population isn't educated to be vaccinated. Please think on this more thoroughly.

    Before you think about NOT wanting to get a vaccine, research on the disease it's trying to eradicate. The pictures can change your mind.

  65. Anonymous4:04 PM

    I'm not a doctor, but a scientist that does environmental work at Superfund sites. I COMPLETELY understand what you mean when you talk about getting your feelings hurt. I have a Superfund site that I work on that is big and bad but after 20 years of studies and investigations we are confident when we say there are no health risks associated with living within the site boundaries (I actually live within the site boundaries, myself). We've had a couple of public meetings where my collegues and I have been called a lot of unfavorable things, but my favorite to date is that I'm part of a "big government conspiracy" cover up. What I'm allegedly hiding from the public I still don't know.

    It kills me because I spent years studying in college (I know, a pitance compared to the medical community) and 15 years professionally ensuring that I'm not helping polluters cause harm. The idea that I would be part of some sort of "conspiracy" is frankly, frightening.

    Some days it makes me want to just turn off the computer and go home. I can only imagine the feelings I would have if I faced the criticismx you face in healthcare.

  66. Anonymous8:43 PM

    Mumps efficacy stats.
    It's easy enough to find data on the amount of people who have been vaccinated when presenting with disease X. It's harder to postulate how many people would have that disease if no vaccination was available.

  67. Interesting discussion. In regards to two of the previous comments:

    1) Hepatitis B vaccine and Gardiasil (the HPV vaccine) are the only two vaccines that PREVENT CANCER. I have two family members that are chronic Hepatitis B carriers (both acquired during childhood) and their risk of cirrhosis and liver cancer is scarily high, >25%. You can bet I am vaccinating my kid!

    2) Yes, the "un-vaccination rate" in Marin County is 6%. And not surprisingly, we have just had a small outbreak of measles there, including 2 unvaccinated toddlers. And let's not forget the San Diego measles outbreak a few years ago. And the Minnesota and Pennsylvania H. influenzae cases, including kids that died of H. influenzae meningitis. There will be much more of these in the future, especially as herd immunity wanes, and then we will see first-hand all those diseases that no one's seen in the past 20 years--measles encephalitis and H. influenzae meningitis and epiglottitis. Scary and sad. Very sad.

  68. Cindy1:09 AM

    One more thing: there are obviously no randomized controlled trials out there, but hey we can use anecdotal evidence too. Here's a link to multiple case reports of preventable diseases in unvaccinated populations:

  69. 2nd year emergency medicine resident here. I have a question that is kind of basic, but not necessarily something I deal with on a daily basis.

    People have alluded to getting vaccinated as a healthcare worker in order to protect immunocompromised patients. I understand that if *I* am sick, my patients are at risk of contacting the flu from me... but are they not also at risk if I have the flu on my stethoscope, or hand, or whatever (having not gotten infected myself, but just being a carrier)?

    Along those lines... people have mentioned not letting their vaccinated child play with unvaccinated children. I would think the risk would be greater for the unvaccinated child in this play scenario. The vaccinated child may carry a virus, but is immune, while the unvaccinated child would theoretically pick up this virus and become ill. What is the risk concern for the vaccinated child? Is it more of a concern to have your child playing with an unvaccinated child who is potentially "coming down with" mumps/measles/etc (and is still in the subclinical phase)? Does exposure to an infected child pose more of a risk to a vaccinated child than does exposure to a vaccinated child just carrying a virus?

    Please explain!

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  71. Heather12:05 AM

    I'm a veterinary professional and a mom. I find it interesting that there are laws REQUIRING vaccination of people's pets against rabies to protect human public health, yet vaccines that can essentially eradicate life-threatening diseases in our children are not required. The majority of our veterinary clients have no concerns or qualms at all about vaccinating their puppies against diseases like canine parvovirus or distemper that remain prevalent due to the unvaccinated population of strays or neglected animals yet don't see the correlation with choosing not to vaccinate their children - essentially building a population to continue getting sick and spreading a preventable disease. It's a tragedy that it will take more and more outbreaks of preventable diseases due to higher and higher numbers of unvaccinated children before some of the anti-vaccine crowd might *finally* see some reason.

  72. Anonymous10:46 AM

    I'd like to post a challenge to Paul Offit, the man who says would could take tens of thousands of vaccines.

    Take 100 HepB and 100 DPT vaccines at once, nowhere near the 'thousands' we could take according to his schedule.

    I'd put my own money up on this one, there would be SEVERE side effects.

    anybody see this one yet?

  73. Elizabeth12:19 PM

    Anybody who thinks that a disease as complex, baffling and complicated as autism could possibly be caused by an injection is a complete and utter jackass. There, I said it.
    I'm a physician and think that people who don't vaccinate their children should all have to go live together on some unvaccinated commune where they can pass their polio and measles back and forth until they all die out from measles-related encephalitis or polio-caused, paralysis-related wound sepsis. This would be Darwinism at its finest.

  74. Anonymous1:23 PM

    I agree w/ Elizabeth above. I'd rather stay w/ the herd immunity over here vs. those-that-are-willing-to-take-the-chance-w/-preventable-diseases over there.

  75. genmed6:59 PM

    Aww, congrats to your sister! I remember it was so exciting to get in, I'm sure she's on cloud 9! She's going to love it too-- it's so different in the Heights now with sushi restaurants, a starbucks, etc.

  76. Anonymous8:11 PM

    I am a family physician and a mother. My son is mostly vaccinated on schedule, but there are a couple I have delayed for now. He's currently 22 months old. He didn't get Hep B at birth and has only gotten 2 of the series (he wouldn't have gotten any yet, except his doctor's office used a combo with it). He hasn't gotten varicella or Hep A. Do I plan to give them to him at some point? Absolutely. And most likely in the next year or so. But I do think we give a lot of vaccines at once and for a few of them, it's less critical to get them right away. Everything else, however, he's gotten on time because I think the timing makes more sense (with the exception of Rotavirus which he never got). I try to give an unbiased opinion to my patients, but I don't really know how well I do.

  77. Anonymous5:05 AM

    Just something that stuck in my head at this comment:

    "I've never witnessed sicker kids before in my life, the vaccine schedule over the last 30 yrs has increased like crazy. There is no study comparing vaccinated & unvaccinated over the course of the full recommended vaccine schedule. Nobody can say that the exposure to all these vaccines are safe and the accumulation and constant triggering of the immune system when it is not fully developed can be cleared for everyone.

    The massive health problems in our youth today suggests something is going on. Diet and environment are likely causes, but our youth are in completely terrible health. What we are doing is not working, and for all those dedicating their lives to making these improvements - i'm sorry, but take a step back and let's figure out why."

    I work as a coordinator for organ and tissue donation, and the bulk of my job is taking calls from hospitals for every death or impending death that they have. The calls for kids are some of the hardest, mainly because if it is not an accidental or external cause of death, they are suffering from what is usually a severe or rare it never fails to make me flinch when I get a call and the given cause of death is something like measles, which can - and has been, for generations - so easily prevented. As far as the overall health of our kids today - society as a whole has never, in our known history, had healthier kids than we have today, where it is the exception, not the rule, if a child does not survive past age 3. If you look back even a mere 50 or 60 years, when polio or smallpox were still a threat, the number of victims of these (now practically extinct) diseases were overwhelming. I remember taking a history class when a professor set us straight about the average life span in centuries past: He said that the average refers to the mean population, not the mode. In short, the average person did not live to be just 30 years old - but 30 or so years was the mean population average age due to the extreme infant mortalilty rates in the past.


  78. What an absolutely perfect posting! I feel exactly the same way. I have three children, and I find myself *defending* my vaccinating them! Even my mother-in-law questioned why I vaccinated my children, when the ladies she was in aerobics class the other day told her that vaccinating was bad. I wanted to scream at her. Instead, I just said that I thought she was getting bad advice.

  79. Anonymous12:16 PM

    Here is what bothers me. the naysayers of vaccines are depending on the herd immunity of the rest of us to protect their children. And it does. They do nothing to assist in herd immunity yet benefit just the same. Their children will not get these illnesses because we had ours vaccinated.

  80. Actually, Anonymous, that's not quite accurate. If you spend time around folks in the anti-vaccine camp you will hear them say that they would welcome childhood illnesses like measles and mumps and regret that due to widespread vaccination, their kids will likely never be exposed to the "wild" viruses. They consider these illnesses no big deal, things that everyone used to get, and they would far prefer their kids to get them and thus aquire natural immunity.

    So, while it is true that these kids won't likely get measles (for example) because of herd immunity, that's not why most of these parents aren't vaccinating.

  81. Anonymous6:16 PM

    I've decided to delay my children's vaccinations. I will eventually get them what they need, but I feel it needs to be done more slowly. I've created my own schedule with my doctor that addresses what can be held off and what he and I feel are more important now.
    I've done this because I feel that there are so man vaccinations that are "required", and it seems that there are more and more every year. If there was an interenational standard I would be less inclined to feel this way.
    Also I see that many of the commenters are doctors, and they see the worst of the worst and I feel it changes perception. Just like I'm a finacial services officer so I am diligent about making sure my finances are in order because I've seen what horrible credit scores can do to someone's life, but not everyone is as anal about it as I am, because they don't see the worst of it, and perhaps I am too picky about it. I know it's a silly argument, but perception changes things.
    I appreciate reading all of these non judgemental comments though, it's changed my outlook. I'll have a much more serious conversation with my doctor at our next appointment.
    Also I feel that Jenny McCarthy and Jim Carry are hurting the non vax movement also, I won't read anything by them, they have no credentials.
    And Google is a proper noun, not a verb. :) (it's also a regular noun, but then it's a number.)

  82. Anonymous4:49 AM

    Nothing against vaccination and in fact we fall on the delay/selection end of the spectrum too - my GP also doesn't push the varicella vaccine and let us off the hook for pneumoccoccal and rotavirus as she's well past the useful age for those. Part of this approach I will admit was a knee jerk reaction to a nurse rushing at my newborn (who had respiratory distres and spent a couple of days in the NICU) with a demand to give her the hepB shot. It seemed to show skewed priorities and to this day I think the (worthy) campaign to eradicate hepB should start WITH THE GROWNUPS not the newborns, because even the most ardent vaccine proponent must admit that an adult is more likely to be exposed than a newborn.

    Anyway, my one concern is this. Vaccines do as I understand it contain various preservative agents (and who knows what else in addition to the antigens - the least scary part of the package in my book). My daughter is highly sensitive to preservatives, colourings and additives however inserted into her system, including in medicines. I doubt a vaccine would cause her any long term issues, but I do wonder how much of the vaccine/autism and vaccine/food intolerance supposed links were triggered because people saw the kind of reaction my daughter typically exhibits to preservative exposure (zoning out, obsessive speech, truly nasty poos and weeing all over the place, not to mention shocking sleep) following a shot?

    But no, I don't think doctors or big pharma are out to get me. interesting discussion.

  83. Anonymous6:28 PM

    This has been a fascinating discussion. I am pro vaccine. My mother told me stories of how the polio vaccine changed lives.

    I want to give my children every protection possible, and I want to ensure that they don't infect someone else inadvertently.

    I have seen first hand how effective vaccines can be. My son was vaccinated against chicken pox long before it was widely available in Canada. My own physician could not understand my eagerness to get the vaccine (it had been available for only a few months) but sent me off to a pediatrician who offered the shots (for a fee to cover the cost of the vaccine).

    Fast forward to age 2, when he a a down's child were the only two kids in his daycare who did not succumb to chicken pox (because of course the Down's child had received the vaccine too!).

    Weeks off work, sickness, scratching, fever, scarring (i have scars from my own bout with chicken pox), and I can't imagine putting my own child through this (particularly deliberatey!) if it could be prevented.

    And yes, we don't know the long term. But that is only because it is a new vaccine. When I vaxed my kids, it was known that it would last 20 years. Now, it is at least 31 years. If they should need a booster later in life, i consider that cheap protection.

    I too get angry, but it is because lack of vaccinations puts us all at risk.

    Thank you Michelle for a wonderful exchange.

    And I am not bashing the non vaxers, just wished they had access to unbiased information.

  84. Anonymous11:27 PM

    Although an adult may be more likely than a child to contract Hep B, a significant proportion of infected children have no known risk factors (sexual contact, blood transfusion, etc.). So it's impossible to completely 'protect' your child from Hep B without the vaccination. In addition, a child who contracts Hep B is MUCH more likely to develop cirrhosis and liver cancer later in life than an adult who contracts Hep B.

  85. Nikki6:30 PM

    With no kids, I didn't know the CDC recomended schedule...I have to admit I was a bit surprised to see Hep B at days old! Now early immune development isn't my area of immunology research, but from what I've picked up here and there it seems like the T cell response in newborns is skewed to a Th2 response (useful in fighting worms, bad for viruses). The B cell response is known to be underdeveloped in very young kids. And part of me wonders if vaccination that early could even be tollerogenic? The problem is that you can't really do the studies that we'd want to do on human babies (non-human primates are the best alternative). I've got to say, even as an immunologist, I probably wouldn't vaccinate my 1 day old kid.

  86. the Mommy Doc9:06 PM

    a court judged against a family suing vaccine manufacturers today for causing their son's autism. Apparently this was part of 3 test cases that are to represent the 5300 cases that have been brought up to the National Vaccine Injury Compensation Program. The court stated that the family and their witnesses were unable to show a plausible scientific argument that the thimerisol in the vaccines causes autism.

  87. Anonymous9:53 AM

    Nikki, I'm not really sure about this, but newborns carry some immunity from their mothers for a few months. Is it possible that the B cell response in newborns could come from mom, and it's only later (after mom's immunity has "faded") that babies demonstrate reduced B cell activity? Again, this isn't my area of expertise.

  88. We did delayed and selective vax (although we pretty much got them all in the end). I have formally studied the basics of vaccines in a university pathophysiology class. So I get it. But I have also read about how the vaccine 'factories' are not really up to snuff--there are valid quality concerns with the production process as well as conflicts of interest within the industry.

    I also know that nothing is benign and to pretend that vaccines are ALWAYS benign/best is a sure way for a physician to completely ruin their credibility with me. Too often vaccines are presented as no risk to parents.

    However we did vaccinate but on our own schedule.(We refused the hep b shot normally given at birth, but got it later, for instance.) I don't think being flexible in the vaccination schedule threatens herd immunity, but the pro-vax position tends to be rigid and it is off-putting in that regard.

    I also read tons of books and studies and analyzed the vaccine injury cases where the US government actually paid out money to compensate families for a vaccine injury. I actively read from both sides of the issue--spotting logical fallacies in each. In the end, I made sure we got the vaccines that are important for infants such as Hib.

    We never got more than one shot--I cheerfully went for multiple shot visits. I am not sure how happy the ped was about it, but I don't really care. I never allowed a shot if my daughter was ill, which again I am so glad we didn't, as my husband recently got a flu shot while mildly sick and it magnified whatever he had to the point he missed work for the first time in 4 years.

    I am also glad we did not do more than one shot at a time as my daughter had a reaction to MMR. Separating them out made it easier to attribute bad reactions.

    If I am able to have another child, I will handle vaccines the same way, but push the MMR shot back to 3 or 4 years of age.


  89. Another thought..

    The thing is for me, there are real problems with vaccines and the industry that produces them. Truly there are. I was aware of this before children and reading books that were not part of the anti-vax or pro-vax pantheon. They were biological warfare books actually.

    So the fact that physicians are 100% behind vaccines is disturbing to me. There are points on both sides. I can see the concern and I'm just a stupid parent. When physicians can't/don't/won't see it, I start to think there's a bias, perhaps one taught and nurtured in medical school.


  90. As is my habit, I read the comments after I comment. Sorry! But I had some thoughts on previous comments...

    Anonymous said "But now by having it "naturally" I'm at risk for painful and dangerous reactivation as shingles, especially if I become immunocompromised later in life"

    But this is just a half truth. There are vaccines for adults that will prevent shingles. So why is anyone pretending we are DOOOOOMED to DIE from SHINGLES if we don't get the chicken pox vaccine the exact moment experts say we should????

    The truth is, we can delay the chicken pox vaccine or skip it and even should we or our children get the dread pox, we can opt for a shingles vaccine should we choose to do so. Skip the drama, deal in the truth!

    Also, another previous comment pointed out that something like 77% of recent measles outbreaks were in non-vaccinated populations. The link they provided was from a valid source (i.e. untainted by whack jobs from either side) and yet the comments keep coming about how it's all the anti-vax people causing the problem, putting everyone at risk. All those stupid selfish people competing for the Darwin award (and we are surprised when it is so hard to influence the anti-vax people when these are the prevailing attitudes on the pro-vax side? I know anti-vax people can be rude, but they are outnumbered here and pointing out bad behavior in others, doesn't excuse it in ourselves anyway.)

    Anyway, these are great examples of precisely where a doctor will lose credibility with me as a patient/parent and exactly why I don't give their advice much weight on this issue. They are just as biased the anti-vax people.

    The pro-vax argument isn't always based on facts or truth either and until that is rectified, I don't see any headway on convincing the anti-vax contingent to change their stance.


    1. I am posting this so late but hopefully someone will benefit. I the reason that you should vaccinate. I was anaphylatically allergic to DPT vaccines as a child and they were given in divided doses. I did not gain immunity from this. When I was 34 I was working in home health when an outbreak hit. By the time I knew there were an outbreak I was in the prodromal stages which I thought was seasonal allergies and I kept working until the afternoon of the day it really hit. There were some local hospital politics involved and despite requesting it I wasn't swabbed so officially it was persumed, but when you hear that cough you know. I can't begin to describe how very sick I was. I also was a contagious home health worker which meant that sick elderly people were infected. Some of my co-workers developed symptoms similar to what is expected if you catch it but have been immunized. I had to avoid my infant niece for 2 months to keep her safe. And I survived being so very, very ill. I went a week sleeping only minutes at a time because my sats dropped to 83% as soon as I wasn't fully supporting my position. I tried to not spread it. I spent what seemed like forever avoiding being in public and wearing a mask when I did, but if you aren't immunized (or need a booster) you can catch it from someone who has one symptom: clear runny nose.

      Then, when I started long-term inhaled steroids for the asthma that is my souvenier we decided it was probably pointless but a good idea to test for responses to other vaccines since I did work in healthcare. Turned out that I was not immune to chickenpox (that's when we did titers on everything). I did respond to my other vaccines although one was in the low end of normal.

      I've been exposed to chicken pox and shingles many times. I've held children as the rash broke out and shared a room with my pox-ed sister. Yet I have apparently some immune response that doesn't work quite normally. I had one varicella (of 2) and due to a reaction that may or may not have been to the shot have chosen to not do the 2nd.

      So there are people like me out there and we're infecting you. I wish I weren't, but I tried. And because my vaccines didn't succeed numerous elderly people suffered through pertussis. I don't want to infect others, but I can't promise that I am not about to get chicken pox at any moment. (highly unlikely, but I had full blown pertussis as a vaccinated adult so I don't believe unlikely anymore.)

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