Vaccinations Are More About Trust Than Science

22.11.2016
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I am going to confess that I am my children’s pediatrician. I have given them every vaccination they have ever had and probably would not trust another provider to do it. I endorse the vaccination schedule recommended by the American Academy of Pediatrics; I believe it is safe and prevents disease.

I completed medical school and three years of pediatric training that helped shape this belief. I have seen death in children from polio, whooping cough, and pneumococcal meningitis.

However, I have chosen to use an alternative vaccination schedule when my vaccine-hesitant families request it. Mine evolved over time to complete most of the required vaccinations by the time a child is 2 years old. It is not “evidence-based”, the catchphrase we use to say something is scientifically proven safe and effective. However, it is rooted in something I value highly as a pediatrician: trust, open communication, and compromise.

My patients and I have a difference of opinion sometimes, whether it is about immunizations, antibiotics, or discipline. That does not mean we cannot or should not keep talking to each other. There are a lot of people out there not vaccinating their children, who may be putting others at risk of contracting disease. Guess what? They love their children as much as I love mine, and you love yours. As a pediatrician, I am going to trust you are doing what you think is best for your children, even if I do not agree with your opinion.

Physicians think that convincing parents to vaccinate their children is mostly about science. I am going to argue discussing and deciding whether to vaccinate your child is more about trust for some parents than science. Anytime we recommend treatment or perform a procedure, we are supposed to discuss the risks, benefits and, alternatives. Somehow, primary care physicians are not supposed venture off the immunization schedule recommended by the AAP and CDC and discuss alternatives. I am not sure how or why we boxed ourselves into this corner.  It does not leave much room for compromise.

We are talking about someone who is hesitant to hand over their 2 month old, 2 year old, or 10 year old for an immunization. They have never seen diphtheria, tetanus, rubella, or measles. They may never have held the hand of a child dying from preventable infectious disease. Are we so far divided from these parents, we are unable to step back and see where they are coming from?

When I first went into practice, I accepted every non-vaccinating patient who walked through my door. After practicing for 15 years in my hometown, I have learned there are two types on non-vaccinating families. Those who want to build a trusting relationship with their primary care physician but are uncomfortable or hesitant to vaccinate. They are always willing to hear me out and vice versa. We have trust and rapport. Some parents eventually do vaccinate, and some do not, the point is we keep discussing it.

Then there are non-vaccinating families who want to talk at me and never with me. Their brows furrow at the mention of vaccinations and their arms cross. They call my office beforehand to remind me they do not want to discuss the subject at all during a well child exam. It causes them too much distress. I feel those individuals are not interested in a trusting relationship with me, involving give and take conversation. There is nothing I can offer them. So about five years ago, I stopped accepting non-vaccinating families into my practice unless I am able to figure out if they are interested in building a trusting relationship with me first.

Some parents trust movie stars who oppose immunizations more than they trust their family doctor or pediatrician. I know that is hard for a health care provider to accept, but it is true. Times have changed, and people do not look only to physicians for answers like they used to, nor should they. Maybe there are things we, in primary care, could do better. Maybe we could stop shoving science down parents’ throats and try a spoonful of compassion and communication to the help the medicine go down.

Image copyright: HolgersFotografie/pixabay/CC0

Article last time updated on 08.02.2017.

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From: MommyDoc
Medicine, Pediatrics
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Vaccines are no different to any other phamaceutical. Efficacy can vary both with the strain used to produce the vaccine and the individual response and different disease vaccines will also vary intheir effectiveness. The strain used in influenza vaccines are not particularly good at producing a strong immune response, but in most cases will offer some protection which is important particularly in the aged. Again like other pharmaceuticals there will always be the likelyhood of an adverse reaction which can be disasterous to the individual but in terms of the general population only a very minimal risk.
#9 at 14.02.2017 from Mr William Bradley (Veterinary)
  1
This Cochrane Reviews study is hardly exceptional. It is one of many studies reaching similar conclusions. 1. Whale, "Technologies and Universities," 4 The Law and Business of Licensing: Licensing in the 1980s G-55 (1983). 2. Patent & Trademark Law Amendments Act, Pub. L. 96-517 (1980). 3. 35 USC §§ 200 et seq. 4. Pulsinelli, Share and Share Alike: Increasing Access to Government-Funded Inventions Under the Bayh-Dole Act 393, 403 (2006). 5. 4 Eckstrom's Licensing in For. & Dom. Ops. § 14:9 (2014). 6. OMB Circular A-124 (Feb. 10, 1982). 7. Federal Grant Practice § 50:15 (2014 ed.) 8. 15 USC § 3710a. Cooperative research and development agreements;. 9. 15 USC § 3710c. Distribution of royalties received by federal agencies. 10. Jefferson T, Rivetti A, Di Pietrantonj C, Demicheli V, Ferroni E. Vaccines for preventing influenza in healthy children (Review). Cochrane Database of Systematic Reviews 2012, Issue 8. Art. No.: CD004879.
#8 at 14.02.2017 from Anthony Murawski (Physician)
  0
THERE IS TRUE CAUSE FOR CONCERN when Cochrane Reviews states of CDC-promoted vaccines: "An earlier systematic review of 274 influenza vaccine studies published up to 2007 found industry-funded studies were published in more prestigious journal and cited more than other studies independently from methodological quality and size. Studies funded from public sources were significantly less likely to report conclusions favourable to vaccines. The review showed that reliable evidence on influenza vaccines is thin but there is evidence of widespread manipulation of conclusions and spurious notoriety of the studies."
#7 at 14.02.2017 from Anthony Murawski (Physician)
  0
Perhaps this is why, for instance, the CDC continues to flagrantly exaggerate the marginal efficacy of flu vaccines and to downplay safety issues, since it profits to an unknown but doubtlessly breathtaking extent from royalties generated by flu vaccine sales (said extent of profit being exempt from disclosure under the Freedom of Information Act as a supposed “trade secret”). I haven’t had a flu vaccination in at least ten years, and don’t plan on having another one, in light of the safety and efficacy data published in several large-scale reviews in recent years by Cochrane Reviews and the British Medical Journal. For instance, according to a Cochrane Reviews--the most reliable source of information out there concerning quality of medical research--in study titled "Vaccines for preventing influenza in healthy children (Review),"[10] the authors provide the caveat that "[t]his review includes trials funded by industry. An earlier systematic review of 274 influenza vaccine studies published up to 2007 found industry-funded studies were published in more prestigious journal and cited more than other studies independently from methodological quality and size. Studies funded from public sources were significantly less likely to report conclusions favourable to vaccines. The review showed that reliable evidence on influenza vaccines is thin but there is evidence of widespread manipulation of conclusions and spurious notoriety of the studies. The content and conclusions of this review should be interpreted in the light of this finding." The review also noted that "[o]ne specific brand of monovalent pandemic vaccine is associated with cataplexy and narcolepsy in children...." [10]
#6 at 14.02.2017 from Anthony Murawski (Physician)
  0
If a vaccine is invented in a government-run lab as a result of a partnership with a government agency and a pharmaceutical company, the latter is typically granted patent rights as long as if it markets the vaccine and shares an undisclosed percentage of its profits from the sales of the vaccine, in the form of royalties, with the government agency whose laboratories and funds were utilized in inventing the vaccine. Under the pretext of trade secret protection, the public is not even permitted to know how much money the CDC, NIH, etc. receives in royalties from vaccine sales. In other words, pharmaceutical companies government agencies are business partners and share the profits from sales of vaccines. The public is not even permitted to know how much money in royalties a government agency receives, because that information is withheld under the pretext of trade secret information.[8][9] This can fairly be characterized as federally‐mandated conflicts-of-interest involving billions of dollars.
#5 at 14.02.2017 from Anthony Murawski (Physician)
  0
Ronald Reagan expanded the Act in a 1983 Memorandum that directed federal agencies to extend the terms and provisions of Bayh-Dole to all government-funded research and development contracts, grants, and cooperative research agreements with private sector entities, permitting large for-profit businesses the right to retain title to their federally funded inventions.[6] Reagan's 1987 Exec. Order No. 12591 required, among other things, that executive branch agencies promote the commercialization of federally funded inventions in accordance with his 1983 Memorandum.[6][7] Soon thereafter, Congress enacted legislation along the same lines.
#4 at 14.02.2017 from Anthony Murawski (Physician)
  0
Until 1980, government agencies retained rights to all inventions made under government grants or sponsorship.[1] The resulting underutilization of research and a wish to enhance the technological capacity and economic competitiveness of United States' firms led to legislation allowing certain private entities to retain ownership of inventions made in projects involving government grants.[2] This legislation, the Bayh-Doyle Act of 1980[3], was designed, among other things, to encourage small businesses (i.e., independently owned and operated, with fewer than 500 employees) and the recipients of nonprofit funding (i.e., recipients of federal funding such as universities, research institutions, nonprofit scientific or educational organizations, hospitals, etc.) to patent the results of government-sponsored research by allowing them to retain title to the inventions if they diligently filed patent applications and promoted commercial development of the inventions.[4][5] (Continued)
#3 at 14.02.2017 from Anthony Murawski (Physician)
  0
The vaccine manufacturing industry and regulatory agencies in the United States have had enormous conflicts of interest since the mid-1980s that cast the objectivity of vaccine research and regulatory agency conclusions about vaccine research into serious doubt. (Continued).
#2 at 14.02.2017 from Anthony Murawski (Physician)
  0
Dear MommyDoc, I was going to read your article, but then I stumbled across the much repeated sentence "There are a lot of people out there not vaccinating their children, who may be putting others at risk of contracting disease.". Shouldn't that read the other way around? I mysef have read countless studies where I disagreed with the conclusion drawn by the result based on the setup, but of course I - like the rest of us - neither have the time or energy to thoroughly read every study. Are we being lulled into believing that we are doing mankind a favour by vaccinating? No matter what the outcome or consequences of both immunizing or not, it's the patient (and the parents) who have to wear them, so I feel we do not have the right to push in one direction or another. We must be careful not to present things as facts that in fact we don't know for certain. I have spent a decade working in the pharmaceutical industry and I certainly don't believe in altrusim of the industry.
#1 at 14.02.2017 from Dr. (I.I.Med.) Helena Pöhlmann (Alternative / Non-medical practitioner)
  2
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