Vaccine Safety Curriculum for Medical Residents - American Academy of Pediatrics - Page 8

[slmommy]

OP I just read this article which you had linked to on another thread quite a while back. I think it is pretty relevant  to recent discussion.

http://www.vaccinationnews.com/20110921TheAttemptedHijackingGottsteinS

Quote:

Those who unquestioningly support and promote vaccination while at the same time trivializing vaccine safety concerns have tried to co-opt science as their own private fiefdom.  

Ignoring, dismissing and/or failing to properly study that which contradicts the status quo may be a great way to run a business, but it is no way to conduct science.  The anti-vaccine-safety crowd has some nerve making the unscientific claim that the vaccine-safety issue has been settled.  It is high time for the public to stop falling for such self-serving, deceptive pronouncements.

Edited by slmommy - 5/5/12 at 11:31am

[AbbyGrant]

Originally Posted by slmommy 

Back to original topic...

I find this one to be really bad. This to me, is akin to lying, although nothing is untrue, it is really leaving out a lot of information with a clear agenda.

Mississippi and West Virginia are the only two states that ONLY allow medical exemption.

All other states have religious exemption. I don't know current number for philosophical exemption but here is a map (although some legislation has been changing recently)

http://www.nvic.org/vaccine-laws/state-vaccine-requirements.aspx

Anyone can get religious exemption. 

I posted this on the spin off thread, but I wanted to point out here as well that that answer was not for parents.  It was part of a group discussion for residents.  See page 6 for context.

http://www.scribd.com/doc/65685830/Small-Group-Guide

[AbbyGrant]

      Quote:

Originally Posted by kathymuggle 

Here are few lines from the link in the OP that I think would be counterproductive.  

Challenge them by saying, “Do you really think I would recommend something that I didn’t think was best for your child?”

Aggressive - how is one supposed to answer that question without complying or getting into an argument?

Challenge them by saying, “Do you really think all the pediatricians in the country are conspiring to promote a schedule that we don’t think is safe and the best for children?”

Aggressive - same as above

Both of those were in response to "What can you say to address the concern that the vaccine schedule is a money-fueled conspiracy?" which is a pretty aggressive and argumentative assertion IMO.  See page 3. 

http://www.scribd.com/doc/65685830/Small-Group-Guide

[AbbyGrant]

       Quote:

Originally Posted by kathymuggle 

Ask them why they are taking medical advice from an celebrity, friend, relative, magazine instead of from their child’s doctor

Aggresive - same as above - and a little patronising.  Why assume I am getting information from a celebrity, etc? 

I'm really not trying to convince anyone that this guide is awesome, but I do think context matters. It seems to me they were just advised to ask that of parents that said that's where they got their information since the residents were also told to ask questions and find out why parents felt apprehensive. It would seem ill-advised to ask that of someone who said they spent countless hours reading the CDC pink book and such. 

Question 2: Where do parents with concerns about vaccines get their information?

Answer: Likely sources include web sites (mostly anti-vaccine), blogs, television, popular magazines, playground discussions, relatives

Exercise: Type “Vaccines” into Google and review the first 20 sites quickly. How many could be classified as “anti-vaccine” sites. Read and discuss some of the theories put forth on these sites.
 

Discussion:

How can you point out in a respectful way that the information parents are reading is not scientifically based and is incorrect?

• Point out some of the inconsistencies you find on these sites

• Ask them why they are taking medical advice from an celebrity, friend, relative, magazine instead of from their child’s doctor

• Emphasize the lack of scientific studies and reiterate the basic tenet of science - an observation needs to be repeated by independent groups before we can really have confidence that it is correct. None of the claims about serious problems from vaccines have been reproduced.What are the characteristics of a web site, specific article, or author that gives it/their credibility?

http://www.scribd.com/doc/65685830/Small-Group-Guide    (See page 3)

[purslaine]

Originally Posted by AbbyGrant 

      Quote:

Both of those were in response to "What can you say to address the concern that the vaccine schedule is a money-fueled conspiracy?" which is a pretty aggressive and argumentative assertion IMO.  See page 3. 

http://www.scribd.com/doc/65685830/Small-Group-Guide

I am not sure professionals should greet an aggressive question with an aggressive statement.  Two wrongs don't make a right and all that. From a communication standpoint, reacting aggressively to an aggressive statement does little to further the conversation, which is the goal of the doctor.   Professionals are supposed to act professionally, even if clients don't.  Aggressive responses should not be suggested as a response to an aggressive question. 

Edited by purslaine - 5/5/12 at 5:32pm

[purslaine]

Originally Posted by AbbyGrant 

I posted this on the spin off thread, but I wanted to point out here as well that that answer was not for parents.  It was part of a group discussion for residents.  See page 6 for context.

http://www.scribd.com/doc/65685830/Small-Group-Guide

Still….giving residents the  wrong information during a group discussion is not acceptable.   (and the answer is wrong or gives a wrong impression -  the correct answer to the question is "yes" )

[AbbyGrant]

Originally Posted by kathymuggle 

Still….giving residents the  wrong information during a group discussion is not acceptable.   (and the answer is wrong or gives a wrong impression -  the correct answer to the question is "yes" )

I don't think it gives the wrong impression when it's part of a discussion that asks "What are the school requirements in your state?" and "Can parents avoid immunizations required for school entry on the basis of a religious exemption?" and "How does their religious exemption need to    be       documented?" It is a bit simplistic, but it's just a point in a larger discussion.

[purslaine]

Here is the entire cut and paste.  I would have cut the scribd - but I can't for some reason.  Either way - they are identical.   Feel free to confirm.  

Question 1: What are the school entry requirements in your state?
•
Can parents avoid immunizations required for school entry on the basis of a religious exemption? How does their religious exemption need to be documented?
•
Can parents avoid immunizations required for school entry on the basis of a personal belief exemption? How does that need to be documented?
•
Do all states allow exemptions from school entry requirements?

Answer: Some states only allow medical exemptions. A minority allow exemption based on personal belief.
 

Their answer is incomplete at best, misleading at worst.  They did not answer most of the questions they laid out.  The one question they did answer "Do all states allow exemptions form school entry requirement" they mislead people on.  The correct answer is yes - all state allows some exemptions.  It is a yes/no question.  My suspicion: they deliberately downplayed exemptions because they do not want people to get them.

[AbbyGrant]

Originally Posted by kathymuggle 

Their answer is incomplete at best, misleading at worst.  They did not answer most of the questions they laid out.  The one question they did answer "Do all states allow exemptions form school entry requirement" they mislead people on.  The correct answer is yes - all state allows some exemptions.  It is a yes/no question.  My suspicion: they deliberately downplayed exemptions because they do not want people to get them.

It seems clear to me that the residents were supposed to answer the question about their state exemptions and that these were questions that were part of a discussion.  That one answer was not supposed to be an answer for all the questions. 

http://www.scribd.com/doc/65685830/Small-Group-Guide (see page 6)

[Storm Bride]

Originally Posted by Rrrrrachel 

Measles is one of the leading causes of death of children worldwide. Almost 140,000 children die a year from the measles. Yes, those are mostly in developing countries where they don't have access to the vaccine or proper supportive care, but I don't think it's fair to say that measles isn't a serious illness. Before we had the vaccine here there were 450 or so deaths and around 4,000 cases of encephalitis a year.

It may well have been a serious disease, but the way it's presented these days, and the way it actually was, are two different things. I had measles. I also remember the big measles outbreak when I was in grade 10 (I didn't get it, probably because I'd had it before). Nobody was terrified. A lot of people were frustrated, inconvenienced, and concerned about their kids (not in a panic stricken way - just a "wow - my kid feels like crap, and I wish I could do something about it" way. I hear people talk about what measles and mumps were like pre-vaccine, and wonder what planet they're talking about.

[AbbyGrant]

        Quote:

Originally Posted by kathymuggle 

I am not sure professionals should greet an aggressive question with an aggressive statement.  Two wrongs don't make a right and all that. From a communication standpoint, reacting aggressively to an aggressive statement does little to further the conversation, which is the goal of the doctor.   Professionals are supposed to act professionally, even if clients don't. Aggressive responses should not be suggested as a response to an aggressive question. 

Of course, things shouldn't come to blows at a well child visit, and doctors should keep a professional tone, but I don't think the suggested questions are necessarily aggressive or unprofessional. Saying the vaccine schedule is a money driven conspiracy certainly requires a response, and asking a question to challenge someone to think about what they're saying seems reasonable. I don't see why doctors should have to pussyfoot around when dealing with claims like that. Now if the conversation is going nowhere or escalating, then obviously it would be time to move on. 

[slmommy]

Originally Posted by AbbyGrant 

    Saying the vaccine schedule is a money driven conspiracy certainly requires a response, and asking a question to challenge someone to think about what they're saying seems reasonable. I don't see why doctors should have to pussyfoot around when dealing with claims like that. 

I wonder how many parents go in saying this of the bat though? I think most parents parents say that are not comfortable with vaccinating at the moment or have safety concerns, etc. 

I think there is the assumption that all non/sel/del vaxers are mega conspiracy theorists with no other research or support for their vax concerns than Jenny McCarthy says so, and I find this assumption pretty offensive.

I guess it all depends on how you feel about the standard pedi vax schedule, if you have concerns or don't find value in certain vax, you are going to see this way differently than someone who feels the vax schedule offers benefits more than covering any risks - layperson or dr.

[AbbyGrant]

       Quote:

Originally Posted by slmommy 

I think there is the assumption that all non/sel/del vaxers are mega conspiracy theorists with no other research or support for their vax concerns than Jenny McCarthy says so, and I find this assumption pretty offensive.

I guess it all depends on how you feel about the standard pedi vax schedule, if you have concerns or don't find value in certain vax, you are going to see this way differently than someone who feels the vax schedule offers benefits more than covering any risks - layperson or dr.

I vaccinate on an alternative schedule and skip certain vaccines altogether. I'm not offended by this guide. 

[purslaine]

Originally Posted by slmommy 

I wonder how many parents go in saying this of the bat though? I think most parents parents say that are not comfortable with vaccinating at the moment or have safety concerns, etc. 

I think there is the assumption that all non/sel/del vaxers are mega conspiracy theorists with no other research or support for their vax concerns than Jenny McCarthy says so, and I find this assumption pretty offensive.

I thought this as well.  I cannot imagine myself going in and saying "the vaccine schedule is a money driven conspiracy" and I really doubt many people do this!  

[purslaine]

Originally Posted by AbbyGrant 

       Quote:

I vaccinate on an alternative schedule and skip certain vaccines altogether. I'm not offended by this guide. 

And I am offended by some of it   Others on this thread have been as well. 

If the guide is supposed to encourage good communication, then I suspect it will fail.  I find the tone a bit too aggressive and assumptive overall.    Of course, you cannot please everybody, but I suspect this form of communication would alienate more people than one would normally expect.  

Edited by purslaine - 5/6/12 at 2:40pm

[Turquesa]

Originally Posted by Rrrrrachel 

Herd immunity for pertussis still works in most areas. It does require a higher than usual level of vaccination due to the lower than normal effectiveness. Current suspicions of a mutation aside pertussis is 80% effective. Most vaccines are much better than that, 98-99%.

A couple of corrections:

1. The word "suspicions" needs to be replaced with "science."  (And in a discussion over choices in vaccination, no one should be saying, "Current science aside....." )

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2631860/

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2640897/

http://iai.asm.org/content/67/6/3133.short

http://cel.webofknowledge.com/InboundService.do?SID=2F3fN8133oJ7g1kpna5&product=CEL&UT=000274599000004&SrcApp=CR&Init=Yes&action=retrieve&customersID=Highwire&Func=Frame&SrcAuth=Highwire&IsProductCode=Yes&mode=FullRecord

http://www.jsonline.com/features/health/number-of-whooping-cough-cases-continues-to-grow-in-milwaukee-9e569tf-149151645.html

2. Effectiveness for the pertussis component of DTaP has wide a range of 59-89%.

The DTaP vaccine is 95% effective in preventing all three diseases that it immunizes against—diphtheria, tetanus and pertussis. It is 59-89% effective in preventing pertussis, while the protection rates for diphtheria and tetanus are higher.

[AbbyGrant]

Originally Posted by kathymuggle 

And I am offended by some of it   Others on this thread have been as well.

I gather that.   I was just responding to the assertion that if you have concerns or don't see the value in certain vaccines then you are going to see this guide "way differently" than those who do.  I don't see why there needs to be sides here. It's not non/sel/del on one side and pro-vaxers on the other. 

edited because I left out a word

Edited by AbbyGrant - 5/6/12 at 4:27pm

[Rrrrrachel]

Turquesa, it was my impression that the science on mutations was very preliminary, hence my use of the word suspicions. I stand by my main point, and what you posted seems to affirm it.

[Turquesa]

Once upon a time, I had a short-lived job in commission-based sales (I'm ashamed to say ).  A major part of our training was to learn common objections from customers and how to counter those objections.  We would have to quiz each other and even make a game out of it.  I found myself in so many situation in which--with my boss lurking nearby to check out my performance--I was pushing the product, countering objections, and clearly making somebody feel uncomfortable.  That entire time, I wondered how the heck I was supposed to accomplish closing a sale while putting someone so ill at ease. 

With this in mind.......it is beyond me how the AAP and doctor of their ilk think that these pushy tactics are going to get them anywhere.  Guilting, scaring, and humiliating parents in the fashion?  Yea, really convincing....

KathyMuggle, some of those examples you posted reek of far too much guilt-mongering for my tastes.  And I'm saying this as a Catholic! 

I mean, good grief!  We already know that non-vax-compliant parents are more likely to be well-educated.  (Enter the terms "parents," "vaccines," and "well educated" into your favorite search engine).  So for God's sake, docs, stop talking down to us!  Do you know how to talk to educated people? Hint: It involves using the same tone, syntax, and yes--even "big words"--with which you talk to each other.

As to how to deal with this behavior.... 

I can't count how many people come to MDC wondering: "How can I convince my MIL that homebirth is safe?"  "What research should I show to my dad re: homeschooled kids and socialization?"  "How do I explain to my doctor why I'm not circumsising DS?"  The answer is easy: Don't explain!  Keep your answers polite, firm, and vague.  "Well, Mom, we've weighed this issue carefully, and this is the decision we've come to.  Please pass the bean dip."  "Doctor, right now we're just gathering data but won't be making any decisions today."  "I'm sorry to hear that you don't like our decision, but it is the one we've made, and we'll be proceeding with it."  Or my favorite, "No thank you."  (And when pressed for a reason, you reply, "Just.....no thank you").  You're not going to convert those who disagree with your choices, and you're certainly not going to earn their approval.     

If you're further pressed, it's broken-record time: "Oh, thanks for the info, but we've made our decision."  "We've made our decision.  I'm afraid it's not up for discussion."       

This works like a charm on everyone from the aforementioned doctors to pushy in-laws and salespeople!  :-)   

If you engage these people, by contrast, they're going to counter your objections--often with scripted lines with which they been trained. 

Although I have to confess.....I might have a little fun responding to these doctors with big, Bambi eyes.

"Do you really think that we parents are conspiring to kill our children by disobeying your orders?"

"Do you really think I would do something that I didn't feel is best for my child?"

And if a doctor has decided to believe that I'm stupid enough to look to celebrity websites to make my medical decisions, they simply don't get it.  The conversation--and doctor-patient relationship--ends right there.

[Turquesa]

Originally Posted by Rrrrrachel 

Turquesa, it was my impression that the science on mutations was very preliminary, hence my use of the word suspicions. I stand by my main point, and what you posted seems to affirm it.

Impression based on what?  Did you actually read any of those links?