‘vaccines’

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An Extra Wince In The Exam Room

Posted on January 21, 2011 in: Infant, School Age, Toddler26 Comments

Yesterday, results of a survey on beliefs about vaccines circulated on the internet. The survey conducted last week, asked over 2000 adults if they believed vaccines, or the MMR shot, caused autism. I’m not an expert on surveys and I don’t know how reproducible these results are to all parents in the US. But the news caught my eye (along with many others) when they reported: “Just a slim majority of Americans — 52 percent — think vaccines don’t cause autism” That’s a kind-of-odd-double-negative-type way to look at it, I suppose. Or maybe a hopeful one. The results reflect that nearly half of adults in America may suspect or worry that vaccines cause autism; 18% saying they believe a connection exists.

Whew.

The survey reminds us of some of the Why. It seems on some level, it’s a breakdown in our education. While only “69 percent of respondents said they had heard about the autism-vaccination theory — only half (47 percent) knew that the original Lancet study [that linked vaccines and autism] had been retracted, and that some of that research is now alleged to be fraudulent.” And, the details of all the research finding no link between autism and MMR is even more deeply buried, I suspect.

Even so, the numbers surprised me. In light of all the writing in the British Medical Journal this month on the scam behind Andrew Wakefield’s original paper in 1998 making the claim, I’ve been thinking about where we all stand in our understanding of immunizations, science, and trust. More on that next week. But I really wouldn’t have said 1/2 of my patient’s parents believed or suspected in a connection between autism and vaccines. What percentage would you have guessed? Read full post »

The Injustice of Immunization Interviews

Posted on January 17, 2011 in: Doctoring & Healthcare, Infant, School Age, Toddler, Vaccines17 Comments

When Dr Wakefield interviewed on Good Morning America today, an injustice occurred. For children, I mean. And it occurred inadvertently I suspect. But I believe this injustice happens all the time when it comes to childrens’ health and wellness. What the media covers really changes how we think and feel about protecting and parenting our children. The media’s effort to inform and educate, just like that of physicians and nurses, social workers and ancillary staff, researchers and students, can get lost and misconstrued. ABC worked hard to inform us of the accusations against Dr Andrew Wakefield with a 2 minute introduction by Dr Richard Besser, a pediatrician and medical editor/correspondent. Yet when the interview was over, I was left remembering the myth.

Today I awoke to the boys asking for breakfast. After getting them to the table with a bowl of Life (always strange to offer a cereal named after our existence), I poured milk in my own bowl. Suddenly I realized that I needed to get the recycling and garbage to the curb. I donned my boots and a coat, ready to haul the can and a number of collapsed boxes to the curb. But just as I headed out of the door, the phone rang. It’s when the day went from the typical day (“making” breakfast and moving garbage) to a day steeped in really trying to understand. My mom was calling, she said Andrew Wakefield was about to be on Good Morning America. I hit my personal fast forward button, flew to the curb with the garbage, and got back inside with enough time to hear the complete interview.

Dr Wakefield interviewed on GMA with George Stephanopoulos who later labeled the interview “combative.” Mr Stephanopoulos was given a terribly difficult task: he was interviewing Wakefield on one of the most complex, emotional, and loaded quandaries of the last few decades: vaccine-hesitancy and Wakefields’s purport linking vaccines to autism. When Wakefield failed to deny any allegations and failed to discuss the significant research that refutes his own work, Mr Stephanopoulos had to defend science. Alone. George Stephanopoulos isn’t gaining popularity (read the comments) with the anti-vaccine crowd and even some who doubt what Dr Wakefield claims. Yet ultimately, the 7 minute interview with Stephanopoulos and Wakefield simply stirs the pot. I trust it will have huge viewership. I worry that this is, in part, why it was done. Read full post »

Do You Believe in Vaccines? (Part III: Experience)

Posted on December 3, 2010 in: Infant, Reader's Picks, School Age, Toddler17 Comments

Helping families make decisions about their child’s health takes training, expertise, and experience. The training is standardized (medical school, residency, fellowship), and the expertise confirmed by passing board examinations and maintaining yearly CME (continuing med education). But the experience piece is ultimately unique for each physician. With each day in clinical care, patients teach, instruct, and shape how we understand wellness and illness. Through individual experiences with patients, physicians ultimately become who they are in the exam room. In medicine, despite the huge push to standardization everything from centralized phone calls to how much (or little) time we get with patients, individual doctors will fortunately remain unique. As patients, we still get to enjoy our physicians as people helping us through illness and injury.

This week has been intense. Wednesday, I spent the morning as a patient in the care of my incredible doctor. (I’m fine). She’s entirely instructive for me as a patient and as a physician; her bedside manner astounds. I believe she’s just very good at her job, partly because she’s uniquely experienced. I believe her experience being a nurse for many years before becoming a doctor really colors how she provides care–she gets it.

The week has also been intense because of this series. I’ve been thinking about immunizations, reading comments here on the blog, writing, and witnessing my patients’ responses. I’ve received many e-mails. Yesterday, I was at clinic for over 10 hours and like most days, immunizations were a huge part of my day. But I said things I’ve never said before…True synergy between my clinical self (doctor) and my writer self (Mama Doc), this experience is shaping who I am, in and out of the exam room.

Of course, experiences in clinical care (and living on planet earth) shapes how all pediatricians discuss and listen to families when discussing immunizations. Here’s the final segment in my series on asking pediatricians if they “believe” in vaccines. The 20 or so pediatricians who responded, talked about their experiences in representing vaccines. Additional comments are included in part 1 (emotion) and part 2 (evidence).

Experience:

Dr Kronman, a pediatrician and infectious disease fellow:

We don’t see these diseases anymore. I work at a premier tertiary/quarternary care facility for children. I have seen children die of influenza (seasonal, H1N1), pneumococcus, meningococcus, the late sequelae of measles, pertussis; I have seen Hib meningitis, tetanus, severe debilitating outcomes with varicella, cervical cancer caused by HPV, and severe rotavirus. This list goes on. But most people haven’t seen these things anymore. People don’t have to panic about their children in the summer becoming permanently paralyzed from polio, because we don’t see it anymore. And the reason? Vaccines. Read full post »

Do You Believe in Vaccines: (Part II: Evidence)

Posted on December 1, 2010 in: Infant, Reader's Picks, School Age, Toddler, Vaccines21 Comments

I asked a group of 33 pediatricians what they would say to the question, “Do you believe in vaccines?” while standing in line for coffee. I asked for their help in thinking about an effective, 2 minute answer.

This is part 2 in a series. For detailed information behind the why, read part I (emotional responses) or watch the video explaining how this came to be. As I said, I’m not a believer in scripts. I’m not attempting to suggest there is one, 2 minute segment for every family that will help. Part of the reason I started this blog was that in practice, I realized when I told families what I knew and learned in training, they listened. When I told them what I did for my own children and how I felt, they made decisions. Telling my story seemed essential.

(This is going to sound familiar) I don’t want to increase the divide between those parents who are worried or skeptical of the possible harms of immunization, and those parents, doctors, and experts and who believe in the benefits. Rather, I want to regain our similarities.

Today I’ve included responses from pediatricians that mentioned things that I experienced as “evidenced.” But rather than talk to you about numbers, causality, rates of autism, and the absence of thimerisol in all childhood vaccines (except multi-dose flu shots), these comments focus on the evidence that helps physicians discuss immunizations with families. There was a paucity of numbers in the responses from these physicians.

Dr Gayle Smith (@MDPartner), a general pediatrician in Richmond, VA says it best:

I’d say how much I wished pediatricians were better ‘rock stars’ with our message of prevention so we could be more effective in the media limelight.  I’d speak my own willingness to touch the hearts of the families I care for, to carry the bag of fear and worry for them, perhaps lessening their load a bit. Read full post »

Do You Believe In Vaccines? (Part I: Emotion)

Posted on November 29, 2010 in: Infant, Reader's Picks, School Age, Toddler, Vaccines69 Comments

I wrote 33 pediatricians an e-mail asking what they would say, while in line for coffee, to the parent of a newborn when asked if they “believed in vaccines.”  I wrote the e-mail not as a gimmick or a way to frame the issue of vaccine hesitancy, but because this happened to me. Rather, this happens to me. Often. When a new father asked me this question while carrying his newborn baby 2 weeks ago, I told him what I thought.  I then ruminated about my response for 24+ hours and wrote a group of colleagues. How do we talk with parents we don’t know, outside of the exam room, to help them understand why we feel so strongly about protecting children with vaccines?

I’m not a believer in scripts. I’m not attempting to suggest there is one, 2 minute segment for every family that will help. I wanted to hear what these expert pediatricians would say to get a sense of their collective insight. I wanted you to see it, as well.  I want to be really good at my job as a pediatrician when helping families understand the science, the evidence, and the emotion behind raising healthy kids and preventing illness with vaccines.

But I also really want families to understand why pediatricians work so hard to vaccinate children. I don’t want to increase the divide between those parents who are worried or skeptical of the possible harms of immunization, and those parents, doctors, and experts and who believe in the benefits. Rather, I want to regain our similarities.

We are all so similar.

We all want to do what is right for our children.  That’s why everyone is so nuts about this. Simply stated, we all care immensely.

This was confirmed when I wrote docs from all parts of the US. I got over 20 responses.

I’ve arranged these pediatricians’ thoughts based on how I experienced their comments:

  • Emotional
  • Evidenced
  • Experienced

These thoughts are not mutually exclusive; you’ll hear evidence in the emotional comments, experience in the evidenced ones, and emotion in the experienced ones. Today’s post includes responses that felt emotional.

As I said in the video, it isn’t just parents who are emotional about vaccines. Read the comments to that post and you’ll see—some 30+ comments, mostly written by pediatricians, full of energy, data, and emotion. Pediatricians (and scientists/public health experts) are ultimately responsible for improving the way families understand immunizations. So this is weighty.

Emotional:

Most of these doctors wrote me about listening more than about talking.  But here’s some of what they said:

Dr David Hill, a pediatrician in North Carolina wrote:

Boy is this an issue on all of our minds! For me this question has particular poignancy, as we all watched our partner’s (a pediatrician) 22-year-old daughter die of H1N1 last year. To see her face-down on a ventilator, bloated and pale and then to have a parent tell me, as one did last week, ‘Everyone knows the flu vaccine causes just as much disease as it prevents.’

Gulp. His response to that parent’s viewpoint: Read full post »

Two Minutes To Represent Vaccines?

Posted on November 19, 2010 in: Infant, School Age, Toddler, Vaccines34 Comments

Last Friday I was in line for a coffee and met a newborn baby. Her father asked me if “I believed in vaccines.” I answered him (hint: I do). But then I got to thinking…how could I have done it better? I wrote some friends…

Don’t Make Promises

Posted on September 7, 2010 in: Doctoring & Healthcare, Parenting4 Comments

Don’t make a promise you can’t keep. Probably something your mother told you. I’m not pointing my finger, but I often tell this to families in anticipation of a pediatrician’s visit, too. Do your best not to promise “no shots” prior to a visit. Although you may think your child is “up to date” on shots, they may not be. Or, the pediatrician may order a blood study (seems like a shot to a child) or injection that you’re not anticipating. And then we’re all in a sticky situation. Trust broken.

Well the same goes for your pediatrician (or for this one), at least. Unfortunately, I’ve been making promises I can’t keep, too.

Recommendations for Prevnar, a vaccine used in infants and toddlers to protect against pneumococcal disesase, have recently changed. The vaccine is given at 2,4,6, and 12 to 15 months of age to protect infants and children from serious infections like bloodstream infections, pneumonia, or meningitis. Prevnar prevents some more minor infections like ear infections, as well. The vaccine previously (Prevnar 7) covered 7 strains of the bacteria that are most likely to cause serious or invasive disease. This year, the vaccine grew up. Now instead of just 7 strains, the vaccine contains 13 strains of the bacteria to improve protection to infants and children. All infants and toddlers getting their routine shots will get Prevnar 13. But if your child is under age 5 and previously completed their Prevnar series, it’s recommended they get one more catch-up dose. Therefore, don’t be surprised when your pediatrician mentions an additional dose for your preschooler at the next visit.

Clearly, no one likes to get shots, but pediatricians often spend a large part of their day writing orders for them. Prevention is one of the best things we do for children; immunizations are a major pillar. I’ve said to many people, “Outside of connecting and listening to family’s concerns, writing orders for shots is the most important thing I do when I go to work.”

No matter what your profession or job, delivering good news is a cherished part of the work day. I loved telling the parents to 18 month olds, “After shots today, no routine immunizations other than yearly flu shots until the pre-kindergarten shots at age 4.” But I was making promises I can’t keep. So I’m changing my ways. Will you?

If It Were My Child: No MMRV Shot

Posted on June 28, 2010 in: If It Were My Child, Infant, Toddler, Vaccines8 Comments

A study published in Pediatrics today confirms a slightly elevated risk in febrile seizures in children who receive the combo MMRV (Measles-Mumps-Rubella-Varicella) shot between 1 and 2 years of age. If it were my child, I would NOT get the combo MMRV shot, even if the elevated risk of seizure is extremely low. The American Academy of Pediatrics will likely recommend the same. None of us ever want our child to be put at increased risk. Or to be part of a statistic.

This study found children receiving the combo MMRV had double the risk of febrile seizure compared with those children who got the MMR and Varicella (Chicken Pox) shots individually. Data shows 1 in 2300 children could have a febrile seizure after the combo shot. So, like journalist Madonna Behen reported today, I do not recommend the combo.

From the way I see it, both as a mom and as a pediatrician, if the risk is increased, it is meaningful. And, because children who get the 2 shots separately are equally protected against Measles, Mumps, Rubella, and Chicken Pox (Varicella) I recommend the safer route of 2 shots. Read full post »

Mama Doc Cliff Notes? Immunizations, Organic Milk, Formula & Swimming

Posted on June 1, 2010 in: Infant, School Age, Toddler, Vaccines1 Comment

Take a peek at this KCTS video interview for a recap on the science and rationale behind the most recent blog posts. My condensed (well, kind of) thoughts about a few recent studies, an AAP statement, and the news. It’s a little like Cliff Notes for the blog. But you don’t even have to turn any pages…

Links to studies discussed:
Study on immunization and neuropsychological outcome
Study on pesticide exposure

If It Were My Child: H1N1 Shots, Yes!

Posted on December 16, 2009 in: If It Were My Child, Infant, School Age, Toddler, Vaccines6 Comments

O H1N1 shotI heard about the recall of about 800,000 doses of H1N1 shots intended for children 6-35 months today. The news doesn’t scare me at all. Zilch-o. Zippo. Zero. And I scare easily. I jump in the seat in the movie theater when it’s loud or dark or someone does something scary.  Really.

This recall does not affect how I will continue to encourage families to get their children immunized. This is not a recall due to safety concerns.  I strongly remain in support of immunizing all children against H1N1, especially those with infant siblings, those under age 2 years, or those with underlying health conditions.
I heard about the Canadian reports of fever in children after the second dose of H1N1, too. None of this makes me hesitate. The H1N1 shot is produced in the same way that the seasonal flu shot has been produced for 60 years.  Read full post »