Vaccine Fear-mongering

[TMP-SMX]

The 1976 vaccine was associated with an increased risk of GBS of 2/100,000.

Now the risk of vaccine in the only study shown to have an association between influenza vaccine and GBS shows a 1/1,000,000 risk.

You also have to keep in mind that the individuals at risk for GBS can get it from the actual flu illness but more commonly campylobacter jejuni infection among others.

[apumic]

Originally Posted by willen101383

Guess what. I got my H1N1 vacc about 2 hours ago. My arm is a little sore, but shockingly enough I am still alive. I do not think I am developing autism yet....but I will keep you all posted...if I still possess the psychiatric abilities to post on the internet

Haha... I got mine a week and a half ago, so I should be reporting GBS Sx any time...naujaoioowoao sooryy iam havignn torble tpying ub oh. soorty

[musafirah]

sorry for knowing less about biology than most of you guys... i'm aware there's a debate about vaccines possibly inducing auto-immune diseases (this study says a link "can't be ruled out" http://www.ncbi.nlm.nih.gov/pubmed/15196997).. but i want to know if someone already has an auto-immune disease, should they get flu vaccine?
i've gotten immunized for various diseases when i was very young, but only once did i get flu shot.. and i have an autoimmune disease. will it make my immune system act up if i got a flu/h1n1 shot?

[willen101383]

Originally Posted by musafirah

sorry for knowing less about biology than most of you guys... i'm aware there's a debate about vaccines possibly inducing auto-immune diseases (this study says a link "can't be ruled out" http://www.ncbi.nlm.nih.gov/pubmed/15196997).. but i want to know if someone already has an auto-immune disease, should they get flu vaccine?
i've gotten immunized for various diseases when i was very young, but only once did i get flu shot.. and i have an autoimmune disease. will it make my immune system act up if i got a flu/h1n1 shot?

Who knows really. Autoimmune diseases are exceedingly complex. But SDN isnt a place for medical advice. You should discuss this with your physician.

[Depakote]

Originally Posted by musafirah

sorry for knowing less about biology than most of you guys... i'm aware there's a debate about vaccines possibly inducing auto-immune diseases (this study says a link "can't be ruled out" http://www.ncbi.nlm.nih.gov/pubmed/15196997).. but i want to know if someone already has an auto-immune disease, should they get flu vaccine?
i've gotten immunized for various diseases when i was very young, but only once did i get flu shot.. and i have an autoimmune disease. will it make my immune system act up if i got a flu/h1n1 shot?

Talk to your physician about your specific condition.

[musafirah]

oh, i should have been clearer.. i am wondering if anyone is aware of any research articles about it.

[HamMD87]

OK this is getting a little ridiculous... This thread has become mired in so much crap and straw that we should get back to (what I think was) the original debate...whether or not you feel the hearsay around the new H1N1 vaccine is total BS.

Comments like these:

If you need to live-blog your inevitable terrible vaccine reaction, lemme know!

are utterly useless to any sort of meaningful discussion. Congrats, you can come on an internet forum and mock the views of others. Poor contribution, to say the least.

I, personally, can understand the fears and doubts regarding the H1N1 vaccine. Originally, I was quite skeptical about it. After all, it was developed very rapidly, mass produced, and if you look at the big picture, there hadn't been much clinical testing run on it by the time it was being first administered. Now that it has been out for a bit, and more testing is being done, my skepticism is slowly vanishing as there hasn't been anything mind-blowingly disastrous with regards to the vaccine. Soon I too will probably get the H1N1 vaccine.

The point I'm trying to make is that it's natural to be skeptic about something that is new and rushed. As a doctor it seems like that's a critical component of your ability to help advise your patients. You need to evaluate new drugs and treatments critically. Heard of Vioxx?

I'm on the fence about mandating HCPs to get new vaccines like this. I can certainly see the benefit in doing so, but at what point in the lifetime of the vaccine do you mandate it? Immediately? After clinical studies have proven its efficacy? Always leave it optional? I'd have to think about that one...

Sorry for the wall-of-text, I don't post here much and usually watch from the shadows. Please stop derailing the thread and provide something meaningful. I'm interested in hearing what people think.

[Parts Unknown]

Originally Posted by HamMD87

I, personally, can understand the fears and doubts regarding the H1N1 vaccine. Originally, I was quite skeptical about it. After all, it was developed very rapidly, mass produced, and if you look at the big picture, there hadn't been much clinical testing run on it by the time it was being first administered.

That's fairly standard for influenza vaccines. Each year they are based on the most common circulating strains leading up to peak flu season. The strains are selected and the vaccine produced in a matter of months, just like the H1N1 vaccine. If you are going to be skeptical that is fine, but you should apply it evenly to every flu vaccine every year.

On a side note, it's an interesting commentary on human nature that our fear of fatal infections has gotten so low that we now see preventative measures as more worrisome than the diseases we are trying to avoid.

[willen101383]

Originally Posted by Parts Unknown

On a side note, it's an interesting commentary on human nature that our fear of fatal infections has gotten so low that we now see preventative measures as more worrisome than the diseases we are trying to avoid.

I actually had a confirmed flu case my sophomore year of college and it was HORRRRRRRRIBLE. I was the sickest I have ever been before. Who knows....H1N1 could be worse than the typical season flu. I would rather risk a reaction to the vaccine, rather than suffer through that again!

[redsquareblack]

Originally Posted by HamMD87

OK this is getting a little ridiculous... This thread has become mired in so much crap and straw that we should get back to (what I think was) the original debate...whether or not you feel the hearsay around the new H1N1 vaccine is total BS.

Comments like these:

are utterly useless to any sort of meaningful discussion. Congrats, you can come on an internet forum and mock the views of others. Poor contribution, to say the least.

On behalf of the SDN community, welcome!

Parts Unknown has it right - we've gotten to the point where people distrust medical interventions far more than they're worried about getting sick. You see it with H1N1, seasonal flu, measles, chicken pox, &c., &c., ad nauseam. And the truly chilling thing is that there are people and organizations that prey on people's doubts, who continuously rail against vaccinations for the most baseless of reasons (which, I might add, fly in the face of the now sizable body of research) and arouse the fear of well-meaning, but no less wrong laypeople.

It's depressing and truly sickening. I'm talking about Generation Rescue and Age of Autism especially, though there are others.

I'm sorry if you don't like my contribution, but number one, it was in response to a post that was also in jest. I was merely continuing another person's joke. I realize that sarcasm isn't very recognizable on a forum, so I suppose you couldn't have known, but now you do! Number two, after a certain point, these viewpoints must be mocked. It needs to be shown how patently ridiculous some of the misinformation surrounding vaccinations really is.

Like, for instance, the media darling Desiree Jennings, who, it appeared, developed seizures and dystonia following the seasonal flu shot. However, her admitting neurologist, as evidenced by what is ostensibly her VAERS report, felt that there was a significant psychogenic component to her symptomology. But that didn't stop anti-vaxx organizations from making her a cause celebre for their anti-vaccination efforts. These people are scum, and the misinformation they peddle would be laughable if their efforts weren't so disgusting.

I, personally, can understand the fears and doubts regarding the H1N1 vaccine. Originally, I was quite skeptical about it. After all, it was developed very rapidly, mass produced, and if you look at the big picture, there hadn't been much clinical testing run on it by the time it was being first administered.

Originally Posted by Dr. Anthony Fauci

"The H1N1 pandemic flu vaccine is made exactly the same way by the same manufacturers with the same processing, the same materials, as we make seasonal flu vaccine, which has an extraordinarily good safety record,"

says Dr. Anthony Fauci, director of the National Institute of Allergies and Infectious Disease. In other words, there's almost no difference. It would be, to quote one of my favorite bloggers, like Skittles getting a new flavor. It doesn't make it a completely different candy, it's still a damn Skittle.

What exactly is it that requires such extensive testing for your satisfaction. Or are you honestly suggesting that each vaccine, even the seasonal flu vaccine, ought to come through the drug development pipeline with clinical trials?

The point I'm trying to make is that it's natural to be skeptic about something that is new and rushed. As a doctor it seems like that's a critical component of your ability to help advise your patients. You need to evaluate new drugs and treatments critically. Heard of Vioxx?

Sure, it is natural to be skeptic, but I don't think you and I mean the same thing when we say "skepticism". Vioxx didn't happen because there wasn't enough research; it happened because of obfuscation. But a robust post-marketing research program helped to expose the true risks of the drug. Not entirely sure how this relates, however.

As Jon Stewart said: "We finally contained the swine flu outbreak! But can we contain the doubtbreak?" But in the end, this doubtbreak isn't really based on research or careful thought, but rather a discomfort with things people don't really understand very well, egged on by talking heads on Faux News and the like, who should know better.

And as much as I had conservative commentators, I must also lament the fact that Bill Maher has become quite the voice of insanity on this issue, as well.

Sorry for the wall-of-text, I don't post here much and usually watch from the shadows. Please stop derailing the thread and provide something meaningful. I'm interested in hearing what people think.

Well, I'm honored I've inspired you to de-lurk (why it was me, I don't know).

[7starmantis]

Originally Posted by redsquareblack

Number two, after a certain point, these viewpoints must be mocked. It needs to be shown how patently ridiculous some of the misinformation surrounding vaccinations really is.

Just a matter of fact here. Mocking someone's viewpoint does nothing to show its ridiculous or misinformed. It only implies that you simply can't provide enough solid proof to show its ridiculous and thus actually fuels the false statement. If a statement is so blatantly misinformed that you feel like mocking the person making the claim, there should be a virtual cornucopia (it is November after all) of fact and solid proof to do said damage.

[redsquareblack]

Originally Posted by 7starmantis

Just a matter of fact here. Mocking someone's viewpoint does nothing to show its ridiculous or misinformed. It only implies that you simply can't provide enough solid proof to show its ridiculous and thus actually fuels the false statement. If a statement is so blatantly misinformed that you feel like mocking the person making the claim, there should be a virtual cornucopia (it is November after all) of fact and solid proof to do said damage.

7star, it implies no such thing. Rather, it implies that there's no need. In the words of a far greater scientist, much of this sputtering in re: vaccine safety is so bad it's not even wrong. It's a very popular riposte to say, "Well, if it's so wrong, you should have lots of data to back it up". The problem with this is twofold: 1) It implies that any proof presented would actually change opinion (hint: It probably won't), and 2) it implies that proof is particularly compelling. Unfortunately, the sort of people who are particularly prone to trembling about the safety of vaccines aren't particularly sophisticated when it comes to science. Delving into an exhaustive review of the science (which has been done time and time again, anyway -- does the literature really need to be visited anew every time someone who didn't check it before raises doubts?) isn't very interesting to people without a very good understanding of the background material. That's why sound bites a la Faux News tends to drive public opinion far more effectively than actual science-y stuff.

It's been some time since the publication of Frankenstein, and yet the public's relationship with science hasn't changed all that considerably.

[7starmantis]

Originally Posted by redsquareblack

7star, it implies no such thing. Rather, it implies that there's no need. In the words of a far greater scientist, much of this sputtering in re: vaccine safety is so bad it's not even wrong. It's a very popular riposte to say, "Well, if it's so wrong, you should have lots of data to back it up". The problem with this is twofold: 1) It implies that any proof presented would actually change opinion (hint: It probably won't), and 2) it implies that proof is particularly compelling. Unfortunately, the sort of people who are particularly prone to trembling about the safety of vaccines aren't particularly sophisticated when it comes to science. Delving into an exhaustive review of the science (which has been done time and time again, anyway -- does the literature really need to be visited anew every time someone who didn't check it before raises doubts?) isn't very interesting to people without a very good understanding of the background material. That's why sound bites a la Faux News tends to drive public opinion far more effectively than actual science-y stuff.

It's been some time since the publication of Frankenstein, and yet the public's relationship with science hasn't changed all that considerably.

Naa, I mean lets not hijack the thread, but it certainly doesn't imply there is no need to post factual data. I'll address your two points seperately and briefly.

1.) The issue with your post is that your trying to change opinions. That a loosing battle both as a pre med on an internet forum and as a practicing physician. You can educate and give advice, but opinions are individual and better left to the individual who has them.
2.) Again your trying to change opinions here. What is more compelling than the truth? What are you trying to compel the person to do? The facts, along with logical arguments, speak for themselves. You are always going to have those people who ignore facts and believe what they want. If truth and facts dont change their minds you think your mocking them will?

So let me get this straight. You think sound bite arguments are bad (a la your attack on fox news) but you want to employ the same tactics in your arguments? I understand the "fight fire with fire" idea but there is a reason our firetrucks contain water hoses and not fire hoses. While emotion may shift public opinion faster than an Obama "fire it up" speech, truth is what brings us back to reality. An emotional shift is flighty as we see public opinion is, why would you focus on that as your goal in a discussion? I often forget you guys are young, there is alot of experience to be had.

I agree with you for the most part here and I'm not trying to offend you in any way, I just think you haven't looked at the issue as a whole. Presenting the truth or at least a logical counter argument goes much farther than mocking someone. At least in the long run, maybe not in a closed system like SDN. I just read some of your blog by the way, enjoyed it.

[makeshift123]

http://www.youtube.com/watch?v=cEN5KGwNGeo

[Old Grunt]

Originally Posted by makeshift123

http://www.youtube.com/watch?v=cEN5KGwNGeo

You can always count on the crack reporters at "Inside Edition" to give you the straight scoop.

BTW, did anyone notice that this video was selectively "doctored" around the 2:00 mark?

If you watch the video it says: "Doctors say what happened to Desiree should discourage people from getting flu shots."

But then that statement is out of context with the follow-up comment.

[tigress]

Originally Posted by Old Grunt

The GBS risk remains the same regardless. I firmly believe in vaccines and get them no matter what, but it's false to claim there is no risk with any vaccine and no one disputes that GBS is linked to vaccines which is why the government maintains a slush fund for damages:

www.hrsa.gov/countermeasurescomp/default.htm

Of course GBS is most commonly caused by infection, so it's obviously not just a vaccine thing.

Still, a lot of the comments on here smack of snobbery, and that attitude is not going to serve you well when you start dealing with patients in clinic and ask them if they want a flu or pnuemococcal vax. It's your job to explain the facts, not to coerce people.

Just my opinion, so take it for what it's worth.

That's not true. The "link" between GBS and flu vaccine is definitely disputed.

I agree with the rest though.

Also, I know a lot of mothers who choose not to get their children vaccinated at all, or very little. I strongly disagree with this choice. But talking condescendingly to them or making fun of what they believe is absolutely not what is going to convince them that vaccination is worthwhile. It's quite counterproductive.

[corbis11]

Originally Posted by makeshift123

http://www.youtube.com/watch?v=cEN5KGwNGeo

http://scienceblogs.com/insolence/20...utm_medium=rss

lol

[Old Grunt]

Originally Posted by tigress

That's not true. The "link" between GBS and flu vaccine is definitely disputed.

I agree with the rest though.

Also, I know a lot of mothers who choose not to get their children vaccinated at all, or very little. I strongly disagree with this choice. But talking condescendingly to them or making fun of what they believe is absolutely not what is going to convince them that vaccination is worthwhile. It's quite counterproductive.

Point taken on the vaccine/GBS bit. Though, while it might not be fully established scientifically, the government acknowledges it and pays out damages to people who get GBS after vaccines.

As for the remainder, that was really my point. All the future medical students on this thread, in the course of their education, are going to encounter patients that refuse to listen to good medical advice that results in conseqeunces that are far more disastrous than refusing a vaccine (i.e. refusing to take insulin).

It doesn't serve the profession to mock these people. In the end, they have the autonomy to make decisions, even bad ones, for themselves.

A Doctor's job, on top of diagnosis and treatment, is to educate and advise. It's hard to do that when you have obvious contempt for a non-compliant patient.

[redsquareblack]

Originally Posted by 7starmantis

I often forget you guys are young, there is alot of experience to be had.

Many around here are, yes. Not me, personally. I'm nearly as old as you.

I agree with you for the most part here and I'm not trying to offend you in any way, I just think you haven't looked at the issue as a whole.

To the contrary; I may be painting with far too broad a brush, but I lump this into the same category as I do alt-med "cancer therapies", astrology, &c. I of course allow for the possibility that the approach may be incorrect, but sometimes the greatest strides may be made by ridiculing the opposing argument, exposing how laughably unstable the foundations of a given position really are (NB: It helps if the opposing argument is demonstrably false. Otherwise, I agree with you, and ridicule thus becomes what might charitably be called "a Dick move".).

Though you and I disagree, I feel no need to mock your argument, because it does raise reasonable and thoughtful questions. However, if you were to say that, for instance, homeopathy is a far superior alternative in preventing influenza than the vaccine, well... Homeopathy is laughable on its face, and I personally feel that calmly informing someone that no, in fact, diluting something doesn't make it stronger, here's why, perhaps you should consult an introductory chemistry book, &c., is a waste of time.

Presenting the truth or at least a logical counter argument goes much farther than mocking someone.

I feel that this is a slightly more articulate version of "you'll catch more flies with honey". In some cases, yes. In my experience, however, beliefs are extremely resistant to change, despite mounds of evidence that those beliefs are mistaken. YMMV.

I just read some of your blog by the way, enjoyed it.

Thank you, both for reading and for your kind comment. Right now it's more or less an on-again, off-again affair, not particularly well-organized. Hopefully once I can generate a decent amount of material, it will be more focused.

[redsquareblack]

Originally Posted by corbis11

http://scienceblogs.com/insolence/20...utm_medium=rss

lol

Thank goodness someone linked Orac.

[psipsina]

Originally Posted by Old Grunt

Point taken on the vaccine/GBS bit. Though, while it might not be fully established scientifically, the government acknowledges it and pays out damages to people who get GBS after vaccines.

As for the remainder, that was really my point. All the future medical students on this thread, in the course of their education, are going to encounter patients that refuse to listen to good medical advice that results in conseqeunces that are far more disastrous than refusing a vaccine (i.e. refusing to take insulin).

It doesn't serve the profession to mock these people. In the end, they have the autonomy to make decisions, even bad ones, for themselves.

A Doctor's job, on top of diagnosis and treatment, is to educate and advise. It's hard to do that when you have obvious contempt for a non-compliant patient.

Honestly though, none of us are acting as anyone's physician on this board. If someone says something that would be unproffessional in a clinical setting but its on an anonymous message board, especially a premed, who cares?? I think the anti-vaccine movement is stupid and dangerous, I do a great job of patient education when I'm in that setting but that doesn't mean I can't mock that viewpoint if I feel like it in my personal life. The level of paranoia that is involved in most of the anti-vaccine conspiracy theories is mildly disturbing, and usually when I'm disturbed I use humor as my coping mechanism.

[tigress]

The obvious difference between choosing not to use insulin to manage your own diabetes and choosing not to vaccinate your children is that in order for mass vaccination to work, we need to maintain herd immunity. If enough people choose not to vaccinate, herd immunity is compromised. You can see this in recent outbreaks of measles and other vaccine-preventable diseases, particularly in England, where vaccination rates have fallen more dramatically.

I still maintain that patients should be treated with respect. But I do not personally believe that choosing not to vaccinate is the type of decision that I can easily let fall within the autonomy of the individual. When it comes to issues of public health, individual autonomy may be less important than population-wide health. This is more true for some vaccines than for others, and I am not saying I support coerced vaccination. I do, however, think that doctors should make every effort to explain the benefits and purpose of vaccination, while assuaging fears over the risks (while not denying that there are some risks--the benefits simply outweigh them), and attempt to encourage all people to get the majority of routine vaccinations offered.

[redsquareblack]

Originally Posted by tigress

That's not true. The "link" between GBS and flu vaccine is definitely disputed.

I agree with the rest though.

Also, I know a lot of mothers who choose not to get their children vaccinated at all, or very little. I strongly disagree with this choice. But talking condescendingly to them or making fun of what they believe is absolutely not what is going to convince them that vaccination is worthwhile. It's quite counterproductive.

I disagree, and I'll explain why:

When a parent opts not to vaccinate his or her child, but nevertheless insists on that child being included in society at large (e.g., school, parks, other public places, pediatrician's office, &c.), then no matter how well-meaning that parent may be, he or she is inadvertently posing a danger to society through the child. It's irresponsible and dangerous, reckless even, as that parent is essentially saying that the potential for the spread of preventable disease is an acceptable price (borne not by the parent, mind you, but by society as a whole) for their decision.

When a child is behaving dangerously, do you sit him or her down and try to rationally explain all the reasons why that behavior is dangerous? No! It may seem unnecessarily mean-spirited to compare anti-vax parents to children, but in both cases, the behavior is motivated by ignorance and egoism. It angers me that Jenny McCarthy and Jim Carrey are given the platform they are to spout their nonsense, and I think the price for their folly will be measured in bodies. But it is tragic to me that parents actually listen to them, and put the health of their children, and society as a whole, in jeopardy, as a result.

Condescending is only condescending when the the air of superiority is unjustified. In this particular regard, such parents are perfectly entitled to their opinions, but it doesn't make them right, and I don't think society at large ought to pay the price for their arrogance.

Although, your post while I was writing this one seems to me to indicate that I misjudged your position on the matter.

[tigress]

What I'm saying is that the way to get the to vaccinate is absolutely not to be condescending. It's not to talk about how ignorant their choice is. That just makes them more mad and less likely to vaccinate. What you have to understand is that these people are scared. Terrified. They are truly doing what they believe is best for their children.

I'm coming from a perspective where I really understand the anti-vaccination crowd. I interact with them every day. I strongly disagree with the position, but I know where they are coming from and how they got there. And I have no clue how to convince them to vaccinate, but I do know what will NOT work. Ignoring them, belittling them, name-calling, etc. will not help at all.

You know who has been more successful in getting people to vaccinate more than anybody else? The whole Dr. Sears brand (Dr. Sears but really his son, Dr. Sears lol). While you might disagree with some of the pseudoscience that leads to conclusions such as those in The Vaccine Book, I assure you that many people who otherwise would have gone complete unvaccinated are now being at least partially vaccinated as a result of that book. I think there are probably lessons there, in his approach.

[7starmantis]

Originally Posted by redsquareblack

Many around here are, yes. Not me, personally. I'm nearly as old as you. To the contrary; I may be painting with far too broad a brush, but I lump this into the same category as I do alt-med "cancer therapies", astrology, &c. I of course allow for the possibility that the approach may be incorrect, but sometimes the greatest strides may be made by ridiculing the opposing argument, exposing how laughably unstable the foundations of a given position really are (NB: It helps if the opposing argument is demonstrably false. Otherwise, I agree with you, and ridicule thus becomes what might charitably be called "a Dick move".). Though you and I disagree, I feel no need to mock your argument, because it does raise reasonable and thoughtful questions. However, if you were to say that, for instance, homeopathy is a far superior alternative in preventing influenza than the vaccine, well... Homeopathy is laughable on its face, and I personally feel that calmly informing someone that no, in fact, diluting something doesn't make it stronger, here's why, perhaps you should consult an introductory chemistry book, &c., is a waste of time.

lol Get your walker out!

I see your point and agree about the hypothetical statement about homeopathy 100%. However, I think we disagree on the method of “helping” or “educating” the individual. A logical argument presenting facts can still expose the laughable nature of a statement with out the need for mocking. I find that people are much more open minded when taken seriously (at least respectfully) rather than mocked for their opinion or belief. They might not really know or understand why their belief is ridiculous, you can educate with truth. Just my own persuasion when it comes to dealing with others, everyone is entitled to their own.

Originally Posted by redsquareblack

I feel that this is a slightly more articulate version of "you'll catch more flies with honey". In some cases, yes. In my experience, however, beliefs are extremely resistant to change, despite mounds of evidence that those beliefs are mistaken. YMMV.

Agreed, but are beliefs more acceptable to change when presented with mocking? Maybe the mocking just makes us feel better? YMMV is lost on me, sorry I must be older than you for real. lol

Originally Posted by tigress

The obvious difference between choosing not to use insulin to manage your own diabetes and choosing not to vaccinate your children is that in order for mass vaccination to work, we need to maintain herd immunity. If enough people choose not to vaccinate, herd immunity is compromised. You can see this in recent outbreaks of measles and other vaccine-preventable diseases, particularly in England, where vaccination rates have fallen more dramatically. I still maintain that patients should be treated with respect. But I do not personally believe that choosing not to vaccinate is the type of decision that I can easily let fall within the autonomy of the individual. When it comes to issues of public health, individual autonomy may be less important than population-wide health. This is more true for some vaccines than for others, and I am not saying I support coerced vaccination. I do, however, think that doctors should make every effort to explain the benefits and purpose of vaccination, while assuaging fears over the risks (while not denying that there are some risks--the benefits simply outweigh them), and attempt to encourage all people to get the majority of routine vaccinations offered.

Some good points here and in other posts about vaccinations and “herd immunity”. The only issue I have is that if you do receive the vaccine and you have your children vaccinated, the unvaccinated pose no threat. Sure in the utilitarian aspect of it we need to address the population but I tend to be a little more libertarian in my views here as well.

Bottom line is that it’s a decision each must make and it’s all about risk homeostasis. I’m a big survivalist have been for years and so I apply a lot of science to the “art” of survival. “Risk homeostasis” is something we talk about a lot. Its basically an evolutionary survival mechanism. The theory states that people accept a given amount of risk and while its different for each person, you tend to keep the level of risk your willing to take at the same level. If you perceive conditions as less risky, you’ll take more risk and vice versa (a la Deep Survival by Laurence Gonzales). This applies to mountain climbing in ice or taking medication or vaccines. Peoples lives are basically a closed system that they attempt to retain control of, what they perceive as above their level of beneficial (or comfortable) risk is refused. We can’t change that except by education and acceptance of their autonomy. Again, the “herd immunity” idea begins to break down on an individual level when we talk about risk to those who have already been vaccinated.

Again, just my own thoughts on the matter.

[Old Grunt]

Originally Posted by psipsina

Honestly though, none of us are acting as anyone's physician on this board. If someone says something that would be unproffessional in a clinical setting but its on an anonymous message board, especially a premed, who cares?? I think the anti-vaccine movement is stupid and dangerous, I do a great job of patient education when I'm in that setting but that doesn't mean I can't mock that viewpoint if I feel like it in my personal life. The level of paranoia that is involved in most of the anti-vaccine conspiracy theories is mildly disturbing, and usually when I'm disturbed I use humor as my coping mechanism.

I don't disagree, I am just making the point. Obviously SDN is not real life. However, (as I know I was), I think many of the future med students on this thread are going to be shocked to find that refusing vaccines is just the tip of the iceburg when it comes to patient's adverse health decisions.

I still can't believe that someone would refuse to take insulin even to the point of amputation, but they do.

Some of the posts on this thread reflect that people think it's acceptable or beneficial to treat patients rudely for their bad decisions. I disagree with those sentiments.

[Old Grunt]

Originally Posted by tigress

The obvious difference between choosing not to use insulin to manage your own diabetes and choosing not to vaccinate your children is that in order for mass vaccination to work, we need to maintain herd immunity. If enough people choose not to vaccinate, herd immunity is compromised. You can see this in recent outbreaks of measles and other vaccine-preventable diseases, particularly in England, where vaccination rates have fallen more dramatically.

I still maintain that patients should be treated with respect. But I do not personally believe that choosing not to vaccinate is the type of decision that I can easily let fall within the autonomy of the individual. When it comes to issues of public health, individual autonomy may be less important than population-wide health. This is more true for some vaccines than for others, and I am not saying I support coerced vaccination. I do, however, think that doctors should make every effort to explain the benefits and purpose of vaccination, while assuaging fears over the risks (while not denying that there are some risks--the benefits simply outweigh them), and attempt to encourage all people to get the majority of routine vaccinations offered.

I think physicians do that anyways. The fact remains that there are still going to be a certain percentage of people, who don't give a damn about her immunity or any of the esoteric public health issues, that are going to refuse vaccinations and there is nothing you can do about it.

When that occurs, what can you do? You can't subdue them and give the vaccination, so where does that leave someone? Basically with the knowledge that a patient has a right to make bad decisions, and you have to and mitigate the consequences.

[tigress]

Originally Posted by 7starmantis

The only issue I have is that if you do receive the vaccine and you have your children vaccinated, the unvaccinated pose no threat.

This is a very unfortunate argument that is used often by anti-vaccination activists. It's simply not true, for a few reasons. First, no vaccine is 100% effective. Some are more effective than others (the pertussis vaccine is notoriously ineffective, for example). This is why we need to maintain high levels of vaccination in a population--for herd immunity, we don't need 100% of the population to be immune, we need some other percentage that limits the ability of the virus to find new hosts and continue to spread. If we were to vaccinate, say, 95% of the population, a percentage of those people would be immune and a smaller percentage would not be immune, but you'd still be able to maintain herd immunity. If only 75% of the population is vaccinated, herd immunity might not be achievable.

Similarly, if my children are vaccinated and yours are not, yours are much more likely to come down with a vaccine-preventable disease, but mine are by no means definitely protected from getting one either. Perhaps one of my children didn't have as strong an antibody response to one of his vaccinations and is still susceptible.

The other important point is that vaccination is meant to protect a population maybe even more than it's meant to protect individuals. The MMR is given sometime between 18 months and 2 years (although that varies and some are now giving it younger; my children get it at 2 years). Measles is a significant risk to infants. NO infants are vaccinated against measles. We rely on all the other children around them being vaccinated to protect our infants. So yes, my vaccinated children ARE at risk from your unvaccinated ones.

[Old Grunt]

Originally Posted by redsquareblack

Condescending is only condescending when the the air of superiority is unjustified. In this particular regard, such parents are perfectly entitled to their opinions, but it doesn't make them right, and I don't think society at large ought to pay the price for their arrogance.

Condescending is condescending period.

It gets you nowhere in patient communication and is detrimental to all the other patient care measures you need to address.

This isn't unique to medicine. People tend to go into a kung fu stance when someone else comes up and tells them they are an idiot.

[redsquareblack]

Originally Posted by Old Grunt

Condescending is condescending period.

It gets you nowhere in patient communication and is detrimental to all the other patient care measures you need to address.

This isn't unique to medicine. People tend to go into a kung fu stance when someone else comes up and tells them they are an idiot.

Well, no, it isn't. Or rather, I suppose it depends upon from which dictionary you get your definition. Either way...

I am absolutely justified in being condescending with regard to my discussion of people who decline to vaccinate their children.

It is quite another matter to be condescending to such people. Even though I think they're being idiotic, I recognize a poor interpersonal strategy when I see one. Don't assume my feelings about anti-vaxxers blinds me to the simple fact that how you interact with others matters.

[psipsina]

Originally Posted by Old Grunt

I think physicians do that anyways. The fact remains that there are still going to be a certain percentage of people, who don't give a damn about her immunity or any of the esoteric public health issues, that are going to refuse vaccinations and there is nothing you can do about it.

When that occurs, what can you do? You can't subdue them and give the vaccination, so where does that leave someone? Basically with the knowledge that a patient has a right to make bad decisions, and you have to and mitigate the consequences.

Patients don't have complete autonomy when it comes to public health issues. If you have TB you can be forcibly kept in the hospital and treated. You can't just wonder out and start coughing on the public spreading something like that. Obviously that is an extreme situation but there is a precedence for ignoring autonomy for the sake of public health.

I personally think that vaccination should come under this umbrella, but I don't think the public will be on board until they see what a real pandemic looks like. When you've never known someone with polio it becomes difficult for some people to use their imaginations and weigh that image against the known risks of vaccination (which exist, but not to the extent the fear mongerers like to present). I think once we've seen a large scale anti-vaccine related outbreak that public opinion will swing back towards protection.

[dantt]

Recent NEJM Piece
http://content.nejm.org/cgi/content/full/NEJMp0910151

Mandatory Vaccination of Health Care Workers
Alexandra M. Stewart, J.D.



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Mandatory vaccination of health care workers raises important questions about the limits of a state's power to compel individuals to engage in particular activities in order to protect the public. In justifying New York State's regulations requiring health care workers who have direct contact with patients or who may expose patients to disease to be vaccinated against seasonal and H1N1 influenza, New York State Health Commissioner Richard Daines recently argued, "[O]ur overriding concern . . . as health care workers, should be the interests of our patients, not our own sensibilities about mandates. . . . [T]he welfare of patients is . . . best served by . . . very high rates of staff immunity that can only be achieved with mandatory influenza vaccination — not the 40-50% rates of staff immunization historically achieved with even the most vigorous of voluntary programs. Under voluntary standards, institutional outbreaks occur. . . . Medical literature convincingly demonstrates that high levels of staff immunity confer protection on those patients who cannot be or have not been effectively vaccinated . . . while also allowing the institution to remain more fully staffed."1

Workers at diagnostic and treatment centers, home health care agencies, and hospices are included in New York's requirement, although workers who can show that they have a recognized medical contraindication to vaccination are exempt. Each facility will have the discretion to determine the steps that unvaccinated health care workers must take to reduce the risk of transmitting disease to patients (see table).

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New York State's Requirements for Influenza Vaccination of Personnel in Health Care Facilities.


Many health care workers believe that the mandate violates fundamental individual rights and public health policy, and some have filed court actions. In response, one judge ordered a delay in implementing the regulation, and New York's governor, David Paterson, suspended the requirement so that the limited supply of H1N1 vaccine currently available can be distributed to the populations most at risk for serious illness and death.

The workers argue, first, that compulsory vaccination violates the Fourteenth Amendment in depriving them of liberty without due process. But in 1905, in deciding the smallpox-vaccination case Jacobson v. Commonwealth of Massachusetts, the U.S. Supreme Court recognized that the "police powers" granted to states under the Tenth Amendment authorize them to require immunization. Police powers are government's inherent authority to impose restrictions on private rights for the sake of public welfare. Thus, health administrators may develop measures that compel individuals to accept vaccinations in order to protect the public's health.

Such measures include immunization requirements for school entry, which have been enacted by all states and the District of Columbia. These mandates have been shown to be the most effective method of increasing rates of coverage among school-age children and have withstood multiple legal challenges. In 1922, in Zucht v. King (a case regarding an immunization requirement for school entry in San Antonio, Texas), the Supreme Court endorsed these ordinances, finding that they "confer not arbitrary power, but only that broad discretion required for the protection of the public health." Opponents of such requirements argue that they are improper on the grounds that they amount to illegal search and seizure under the Fourth Amendment or that they violate either the equal protection clause of the Fourteenth Amendment ("no state shall . . . deny to any person within its jurisdiction the equal protection of the laws") or the establishment clause of the First Amendment ("Congress shall make no law respecting an establishment of religion"). Yet on the basis of the principles outlined in Jacobson, the judiciary has consistently affirmed that an individual's right to refuse immunization is outweighed by the community-wide protection conferred by immunization.

Some health care workers in New York have argued that Jacobson does not apply in the case of influenza because there is no health emergency and because the H1N1 influenza virus is not as serious as smallpox. In 2002, in Boone v. Boozman, an Arkansas court heard from opponents of a school-entry requirement for hepatitis B vaccination, who argued that both Jacobson and Zucht were irrelevant because they were decided during declared smallpox emergencies, whereas hepatitis B presented no "clear and present danger." The court held that "the Supreme Court did not limit its holding in Jacobson to diseases presenting a clear and present danger." Furthermore, "even if such a distinction could be made, the Court cannot say that hepatitis B presents no such clear and present danger. Hepatitis B may not be airborne like smallpox; however, this is not the only factor by which a disease could be judged dangerous." The court concluded that "immunization of school children against hepatitis B has a real and substantial relation to the protection of the public health and the public safety."

Health care workers in New York also argue that because the regulation offers no possibility for religious exemptions, it violates the "free exercise" clause of the First Amendment, which guarantees that government may not interfere with a person's religious beliefs. But individuals may not engage in activities that threaten important societal interests and expect to be shielded by the First Amendment. When reviewing state initiatives that hinder religious expression, courts weigh the importance of a claim of religious exercise against the state interest. Courts have upheld school-entry vaccination requirements against objections that they infringed on individuals' religious principles. States have the discretion to determine whether to permit religious exemptions, and Arizona, Mississippi, and West Virginia do not permit such exemptions. Thus, in the absence of a Supreme Court ruling, it is unlikely that the exclusion of a religious exemption from the New York regulation will be considered to be unconstitutional.

The health care workers also argue that the regulation violates the right to "freedom of contract" between employer and employee, as guaranteed by the Fifth and Fourteenth Amendments. However, states are obligated to protect the public welfare, even when doing so affects economic liberty. Furthermore, the Supreme Court has held that states may promulgate regulations restricting liberty of contract in order to protect community health or vulnerable populations.2,3,4 Although New York's regulation affects employer–employee relationships, it is permissible because promoting patients' health and safety is a legitimate state interest. Health care workers must receive other vaccinations as a condition of employment, yet they have not challenged those requirements.

The health care workers further claim that the regulation violates the Fourteenth Amendment right of competent adults to bodily autonomy and the right to refuse medical treatment. Yet the right to refuse treatment is not absolute. In determining whether the regulation violates the personal autonomy of health care workers, courts will, once again, balance individual rights against state interests. The state's power weakens and the individual's rights strengthen as the degree of bodily invasion increases and the effectiveness of the intervention decreases.5 Courts will consider the extent to which health care workers cause illness and death among patients by exposing them to influenza. Vaccinating health care workers is the most effective means of reducing outbreaks; health care workers are required to submit to the limited intrusion of vaccination in order to protect both themselves and the patients in their care. I believe that the state's right to compel health care workers to receive vaccinations will supersede their individual rights because of the state's substantial relation to protection of the public health and safety.

Certainly, courts must take into account Constitutional guarantees of personal autonomy, freedom of contract, and freedom of religion when reviewing the current lawsuits. These rights, however, have been constrained when they conflict with government measures that are intended to protect the community's health and safety. Health care workers have a profound effect on patients' health. Although they have the same rights as all private citizens, it is likely that courts will continue to make the health and safety of patients the priority in permitting exceptions to individual rights.

[Old Grunt]

Originally Posted by redsquareblack

Well, no, it isn't. Or rather, I suppose it depends upon from which dictionary you get your definition. Either way...

I am absolutely justified in being condescending with regard to my discussion of people who decline to vaccinate their children.

It is quite another matter to be condescending to such people. Even though I think they're being idiotic, I recognize a poor interpersonal strategy when I see one. Don't assume my feelings about anti-vaxxers blinds me to the simple fact that how you interact with others matters.

I suppose I misunderstood you. I thought you meant you would be condescending during your interactions with them.

[Old Grunt]

Originally Posted by psipsina

Patients don't have complete autonomy when it comes to public health issues. If you have TB you can be forcibly kept in the hospital and treated. You can't just wonder out and start coughing on the public spreading something like that. Obviously that is an extreme situation but there is a precedence for ignoring autonomy for the sake of public health.

I personally think that vaccination should come under this umbrella, but I don't think the public will be on board until they see what a real pandemic looks like. When you've never known someone with polio it becomes difficult for some people to use their imaginations and weigh that image against the known risks of vaccination (which exist, but not to the extent the fear mongerers like to present). I think once we've seen a large scale anti-vaccine related outbreak that public opinion will swing back towards protection.

I have to disagree with the idea of forcing vaccinations on people. Few actions would create more animosity towards health care providers.

Although, we do have de facto mandatory vaccinations with the vaccination requirements for school, that's not as overt as forcing an adult patient to get a vaccination when they clearly do not want it.

You are probably right about the public having to see a real pandemic. As someone astutely said previously, it's ironic that we are no longer scared of pathogens and now have become scared of vaccinations.

[tigress]

Originally Posted by Old Grunt

Although, we do have de facto mandatory vaccinations with the vaccination requirements for school, that's not as overt as forcing an adult patient to get a vaccination when they clearly do not want it.

You are probably right about the public having to see a real pandemic. As someone astutely said previously, it's ironic that we are no longer scared of pathogens and now have become scared of vaccinations.

In most states it's not too difficult to get vaccine exemptions for kids in school, though. A few states have straight-up ideological exemptions, for people who just don't want them; the majority of states have religious exemptions; and as far as I know all states have medical exemptions. How hard it is to get this done varies from place to place, but most people are able to obtain them. Usually it's just some paperwork that has to be filled out, and perhaps signed by a doctor in some situations (and yes, there are enough pediatricians that are anti-vaccination or at least ambivalent enough to support not vaccinating).

We are absolutely privileged to live in a country and time where people are even having this discussion. If people had experienced first-hand how awful a pandemic disease situation can be, very few would probably be choosing not to vaccinate. However, a significant number of people who are anti-vaccination actually believe that vaccines are not responsible for the worldwide decrease in vaccine-preventable disease, and have the statistics and circular reasoning to explain it. This is a very irrational group of people we're talking about--but they claim to be the rational ones, which makes having this conversation extremely difficult.

I do see this as something that is quite important to me, as a citizen, a mother, and a future doctor. Hence my repeated posting on this thread

[Old Grunt]

Originally Posted by tigress

In most states it's not too difficult to get vaccine exemptions for kids in school, though. A few states have straight-up ideological exemptions, for people who just don't want them; the majority of states have religious exemptions; and as far as I know all states have medical exemptions. How hard it is to get this done varies from place to place, but most people are able to obtain them. Usually it's just some paperwork that has to be filled out, and perhaps signed by a doctor in some situations (and yes, there are enough pediatricians that are anti-vaccination or at least ambivalent enough to support not vaccinating).

We are absolutely privileged to live in a country and time where people are even having this discussion. If people had experienced first-hand how awful a pandemic disease situation can be, very few would probably be choosing not to vaccinate. However, a significant number of people who are anti-vaccination actually believe that vaccines are not responsible for the worldwide decrease in vaccine-preventable disease, and have the statistics and circular reasoning to explain it. This is a very irrational group of people we're talking about--but they claim to be the rational ones, which makes having this conversation extremely difficult.

I do see this as something that is quite important to me, as a citizen, a mother, and a future doctor. Hence my repeated posting on this thread

I agree with you, and don't take my postings to be that I am anti-vaccine. I am just pragmatic enough to know that there are always going to be patients who refuse to "take their medicine".

When it comes to the national anti-vaccine groups and vaccines-cause-autism cranks, I have nothing but contempt for them. I feel they are dishonest and intentionally spread miss-information.

When it comes to the average patient, I might not agree with their decision, but I respect it.

[7starmantis]

Originally Posted by tigress

This is a very unfortunate argument that is used often by anti-vaccination activists. It's simply not true, for a few reasons.

I apologize for not being clearer in my post, I didn't think anyone would assume I meant vaccines were 100% effective. Problem is, the same argument you just made can be used by those refusing vaccination. Herd immunity also isn't 100% it gets into really twisted logic and all that I have no desire to get into. But unless your talking about total eradication its just going to go back and forth. Besides thats not really the issue. No one is saying people shouldn't get vaccinated, I'm just saying they have the right to not get vaccinated. We don't require the destruction of personal liberty for the good of the many (at least our founding fathers didn't). There is simply no fail proof way to be "immune" to an ID so if we all take personal responsibility for ourselves and stop blaming others for things out of their control (because its really not someone's fault that they become infected with influenza although an argument could be made about non-vaccination but thats shadow thought). I simply don't believe that way as far as personal liberty goes, its beyond my medical or scientific education and into my worldview. Again, I'm all for vaccination I just also believe in liberty enough to support the right of stupid people to make stupid decisions.

Originally Posted by psipsina

Patients don't have complete autonomy when it comes to public health issues. If you have TB you can be forcibly kept in the hospital and treated. You can't just wonder out and start coughing on the public spreading something like that.

Good point but whats on paper and what happens are often far removed from each other. Back in the 80's (a LONG time ago, I know) there was a serious public outcry and fear mongering over AIDS and emotions were extremely high. Even then they failed to restrain a man attempting to spit on people and give them aids as a weapon. They got him restrained but were unable to force treatment. So, in this litigious society that would be a tough sale. Even so, for something that has already been pointed out to be ... less than perfect, I couldn't support forcing it on people. I mean we are really getting into a society of fear if we keep on this route and I just dont live that way.

Originally Posted by tigress

We are absolutely privileged to live in a country and time where people are even having this discussion. If people had experienced first-hand how awful a pandemic disease situation can be, very few would probably be choosing not to vaccinate. However, a significant number of people who are anti-vaccination actually believe that vaccines are not responsible for the worldwide decrease in vaccine-preventable disease, and have the statistics and circular reasoning to explain it. This is a very irrational group of people we're talking about--but they claim to be the rational ones, which makes having this conversation extremely difficult.

I do see this as something that is quite important to me, as a citizen, a mother, and a future doctor. Hence my repeated posting on this thread

I'm glad this was said and it hits at the core of my stance on the freedom to refuse vaccinations. I still believe its a right to have a choice and will protect it to my dying breath. I dont place the burden of my health on anyone but myself. I do what I can (wash hands, get vacs, etc) and take life as it comes, anything else would drive me insane. Great points here as well about people witnessing the effects of diseases, but aren't we the ones who created this situation with our "mediocre" (per Michael Moore) healthcare? I believe we can focus on a campaign of education and help those people make educated decisions and then let the fringe be the 25% of the herd left unvaccinated. No?