Starting fresh - a pediatrician's perspective

[mgrella]

Howdy all - I'm a (male) pediatrician and father in Brookline, MA; I work at a hospital in Boston and am pleased to be part of the community. My interests include ADHD (both sons have) and vaccinations (both sons have).

There's a LOT of information in this forum; much of it going very far back and likely not all of the opinions are still as they were.  I'd like to make myself available to answer general questions regarding vaccinations and to ask some in return.  I'm afraid a lot of my colleagues have gotten scared away from forums like this due to rhetoric and some perceived bullying; I promise not to be although I'm sometimes too busy to respond right away.  Anyway, reply away if you like; stay healthy!

Marc Grella, MD

[emmy526]

How much training did you and your colleagues receive about childhood vaccinations when you were going to medical school?  How indepth was the training about the vaccines and the diseases?  How much has changed in the vaccination policy since you became an MD, and how has it influenced your thinking on the issue?

[rachelsmama]

Many doctors have never seen, or rarely seen cases of certain VPD's.  How much do you think this unfamiliarity, and possible delay in accurate diagnosis, affects the actual risks if a person contracts a VPD? 

What resource would you reccomend to someone who wanted to arm themselves with a good basic understanding of VPD's in the hopes of getting diagnosis and treatment in a timely fashion if it ever becomes necessary?

[Turquesa]

Originally Posted by mgrella 

Anyway, reply away if you like; stay healthy!

Marc Grella, MD

I don't have any questions at this time, but depending on how this thread progresses, we could consider asking the moderators here to "sticky" it so that it's an easily accessible resource.

On vaccinations, this site is pro-informed consent, (a concept that cannot exist without informed refusal) and doesn't allow discussion on the merits of compulsory, exemption-free vaccination. Obviously, there is no excuse for bullying. Due to how emotionally provocative this issue can be, the Vaccinations forum is probably the most well-moderated on MDC. If you ever find a post uncivil, you may click on the little flag icon to notify a moderator.

Dr. Bob Sears, the celebrity doc, is also taking vaccine-related questions in the Ask-the-Experts forum. If your philosophy is compatible with MDC's, you may consider becoming one of the panelists there.

You'll find that some pretty astute women post here. Welcome aboard!

[Jeanna Black]

I have a 15-month-old son and my husband and I are constantly torn with vaccination decisions.  We have tried to do our research, but are overwhelmed with the information on both sides.  We are currently on a delayed schedule which has still been very difficult.  Our son usually has reactions and sometimes, very bad ones.  It is very difficult to feel that we are making him "sick" when all we want to do is protect him.  I am also unclear about my rights as a parent, in the state of Georgia.  I often feel between the pressure of his daycare and his pediatrician, like we have no choice.  

I would love some insight on this topic generally (I know that is hard), specifically about Georgia parent rights, and also about vaccine alternatives.  By alternatives I am referring to specific vaccines that can be avoided while still getting others, preservative free vaccines, or any other ways of protecting children in a safer way.

I realize this is a difficult topic to answer briefly, but every time we try to find answers, we seem to hit a road block.  Any insight on this would be very much appreciated!

Thanks in advance for your help!

Jeanna

[ma2two]

Originally Posted by Jeanna Black 

Our son usually has reactions and sometimes, very bad ones.  

I am also unclear about my rights as a parent, in the state of Georgia.  I often feel between the pressure of his daycare and his pediatrician, like we have no choice.  

Not every child has "very bad" reactions. It seems that your son may be a good candidate for not getting vaccines.

You absolutely have a choice in Georgia. If your pediatrician is pressuring you, find another one. 

Here is exemption info for Georgia childcare and schools.

"If there is a religious exemption, the parent/guardian must give the facility/school a signed and dated notarized statement or affidavit stating that immunizations are against their religious beliefs. This affidavit should be filed instead of the Certificate of Immunization. The affidavit does not expire."

http://health.state.ga.us/pdfs/prevention/immunization/3231instructions.03.pdf (page 2)

If you found a doctor who took your son's reactions seriously, you could get a medical exemption. But they need to be renewed annually, so a religious exemption would probably be much easier to deal with.

[mgrella]

There is no specific course on vaccinations in medical school; the concepts of vaccinology is covered as part of immunology, a 1-semester course.

[mgrella]

It depends on which VPDs you are talking about.  Varicella (chickenpox) is something that we still see a lot; polio is something that we almost never see,  The CDC has information on many transmissible diseases, including symptoms and pictures (CDC.gov). 

[mgrella]

This post seems to me misguided.  "Bad reactions" is a pretty gray term, and the responder who urged this parent to consider deferring vaccination based on this alone seems pretty quick to jump the gun.  In addition, claiming a "religious" exemption in this case would be a lie.  A philosphical exemption is very different from a religious one.  Asking a doctor to lie for you is asking them to commit fraud, which could mean loss of one's license. 

Not trying to provoke controversy, but exemptions in most states are pretty specific and (I would add) for a good reason.

[ma2two]

Originally Posted by mgrella 

This post seems to me misguided.  "Bad reactions" is a pretty gray term, and the responder who urged this parent to consider deferring vaccination based on this alone seems pretty quick to jump the gun.  In addition, claiming a "religious" exemption in this case would be a lie.  A philosphical exemption is very different from a religious one.  Asking a doctor to lie for you is asking them to commit fraud, which could mean loss of one's license. 

Not trying to provoke controversy, but exemptions in most states are pretty specific and (I would add) for a good reason.

It might be against a mother's religious beliefs to harm her child. In fact, I would certainly hope so.

You're right, doctor. She did not specify what the bad reactions were. It's really up to her what she is comfortable with, and she can make that choice with a religious exemption. For a medical exemption, I did not say anything about asking a doctor to lie.

[Turquesa]

I thought of some!

What kind of formal training in research methodology have physicians undergone?

I'm guessing that some sort of accrediting body determines medical school curricula and requirements. Are there specific course credit requirements targeted toward designing and/or evaluating medical research? If so, how many credits are normally required? Are there commonly CME opportunities for doctors to learn more on this topic?

[mgrella]

My point was that a religious exemption is NOT whatever you like; your religion is NOT the same as your personal beliefs.  This is not a "make your own ending" book.  You are referring to a philosophical set of beliefs and that is NOT the same as a religion. 

If a state allows for a philosophical objection then there would be no issue.  As you quoted,

If there is a religious exemption, the parent/guardian must give the facility/school a signed and dated notarized statement or affidavit stating that immunizations are against their religious beliefs.

This has NOTHING to do with whether one's child has a "bad reaction" to a vaccine - either your RELIGIOUS beliefs allow for vaccinations or they do not.

The larger issue here is that states allow medical exemptions when the risk to a patient of receiving vaccinations is deemed to be greater than the risk to their contacts of them contracting and spreading a disease.  In those states where religious and/or philosophical exemptions are allowed, the state has decided that these freedoms are of greater importance than the public health risk.   

Again, a "bad reaction" is neither.  Period.

Please do not attempt to pursue this with me.  I'm thrilled to have a discussion with anyone and everyone discussing medical and scientific strategies, but you are trying to equate a personal decision made emotionally with religion (NOT) and/or medicine (again, NOT).  Many reactions can be avoided with pretreatment or managed with a predetermined strategy.  Your advice is instead to make a rash decision which might lead to a VPD that could damage a child (and then whom would YOU blame)? 

[ma2two]

mgrella, I was simply answering Jeanna Black's question. You decided to pursue this with me. Regardless of your personal beliefs, she can file a religious exemption in the state of Georgia to opt-out of the vaccines required for daycare and school.

[pek64]

Originally Posted by mgrella 

My point was that a religious exemption is NOT whatever you like; your religion is NOT the same as your personal beliefs.  This is not a "make your own ending" book.  You are referring to a philosophical set of beliefs and that is NOT the same as a religion. 

If a state allows for a philosophical objection then there would be no issue.  As you quoted,

If there is a religious exemption, the parent/guardian must give the facility/school a signed and dated notarized statement or affidavit stating that immunizations are against their religious beliefs.

This has NOTHING to do with whether one's child has a "bad reaction" to a vaccine - either your RELIGIOUS beliefs allow for vaccinations or they do not.

The larger issue here is that states allow medical exemptions when the risk to a patient of receiving vaccinations is deemed to be greater than the risk to their contacts of them contracting and spreading a disease.  In those states where religious and/or philosophical exemptions are allowed, the state has decided that these freedoms are of greater importance than the public health risk.   
Again, a "bad reaction" is neither.  Period.

Please do not attempt to pursue this with me.  I'm thrilled to have a discussion with anyone and everyone discussing medical and scientific strategies, but you are trying to equate a personal decision made emotionally with religion (NOT) and/or medicine (again, NOT).  Many reactions can be avoided with pretreatment or managed with a predetermined strategy.  Your advice is instead to make a rash decision which might lead to a VPD that could damage a child (and then whom would YOU blame)? 

And if she has the child vaccinated again and some serious, lifelong complication occurs, who will she blame?

YOU, because you gave the medical advise based on a few words in a post. How's your malpractice insurance?

[ma2two]

He doesn't need malpractice insurance for anything related to vaccines. The National Childhood Vaccine Injury Act of 1986 completely shields him from liability.

[pek64]

Originally Posted by ma2two 

He doesn't need malpractice insurance for anything related to vaccines. The National Childhood Vaccine Injury Act of 1986 completely shields him from liability.

Things need to change. And I think that's a good starting place. Medical advice is medical advise and should not be given without at least asking for background information. It is unethical to jump to a conclusion based on a couple of words!

[MamaMunchkin]

Originally Posted by mgrella 

Many reactions can be avoided with pretreatment or managed with a predetermined strategy.

Can you please give some examples?

[mgrella]

Sure - if the reaction that a child had to a vaccine is a rash or hives, use of Benadryl in advance would be reasonable.  If instead it was a high fever, one could use acetaminophen or ibuprofen after vaccination and continue using it for the next 2-3 days.  For pain at the injection site I would recommend the same routine.

[mgrella]

What kind of formal training in research methodology have physicians undergone?

I'm guessing that some sort of accrediting body determines medical school curricula and requirements. Are there specific course credit requirements targeted toward designing and/or evaluating medical research? If so, how many credits are normally required? Are there commonly CME opportunities for doctors to learn more on this topic?

Different medical school have structured their curricula in different ways - med students are taught to evaluate studies critically, to look at their design , methodology, statistical significance and conclusions.  This may happen as part of an epidemiology or biostatistics course or wrapped into another larger course that spans a year (or more).

[ma2two]

mgrella, what would you suggest if a baby cried inconsolably for 5 hours following the standard 2 month vaccines?