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-   -   Starting fresh - a pediatrician's perspective (http://www.mothering.com/forum/373-selective-delayed-vaccination/1362823-starting-fresh-pediatrician-s-perspective.html)

mgrella 09-08-2012 09:55 PM

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 09-09-2012 04:34 AM

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 09-09-2012 04:59 AM

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 09-09-2012 07:25 AM

Quote:
Originally Posted by mgrella View Post

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!

greet.gif

Jeanna Black 09-09-2012 05:18 PM

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 09-09-2012 08:11 PM

Quote:
Originally Posted by Jeanna Black View Post

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 09-11-2012 04:48 AM

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 09-11-2012 04:52 AM

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 09-11-2012 07:58 AM

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 09-11-2012 11:33 AM

Quote:
Originally Posted by mgrella View Post

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 09-11-2012 05:46 PM

I thought of some! orngbiggrin.gif

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 09-11-2012 05:54 PM

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 09-11-2012 06:03 PM

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 09-11-2012 06:16 PM

Quote:
Originally Posted by mgrella View Post

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 09-11-2012 06:18 PM

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 09-11-2012 06:30 PM

Quote:
Originally Posted by ma2two View Post

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 09-11-2012 07:44 PM

Quote:
Originally Posted by mgrella View Post
Many reactions can be avoided with pretreatment or managed with a predetermined strategy.

 

Can you please give some examples?


mgrella 09-11-2012 08:20 PM

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 09-11-2012 08:26 PM

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 09-11-2012 08:38 PM

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


MamaMunchkin 09-11-2012 08:40 PM

Quote:

Originally Posted by mgrella View Post

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.

 

Edited to clarify.

 

About pretreatment ...

 

What about a newborn getting their very first vax, what is the recommended strategy of pretreatment, when there's no known medical history of any adverse reaction yet?


emmy526 09-12-2012 04:16 AM

But doesn't that contradict the recommendation NOT to give tylenol because it will reduce the efficacy of the vaccines?    What  are your views about delaying breastfeeding til after vaccines, so optimum vaccine response will be elicited?  

Quote:
Originally Posted by mgrella View Post

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.


emmy526 09-12-2012 04:23 AM

What are your opinions on the autism epidemic that seems to be worsening as the years/decades go by?  And more and  more vaccines are added to the childhood schedule it seems every couple years or so?  We are vaccinating not only for the 5 childhood diseases, but it seems like for everything under the sun, they want to vaccinate kids.  How is this going to play out in future generations in regards to health, auto immune disease, long term health, etc......one can only watch, wait, and wonder.......


emmy526 09-12-2012 06:05 AM

what do you think of this article?

 

 


mgrella 09-12-2012 10:19 AM

Since there's no way to know if a baby will have a severe reaction (and most don't) there's no recommendation about this; remember that normally pain relievers are used AFTER vaccinations anyway.


mgrella 09-12-2012 10:20 AM

This applies only to acetaminophen given BEFORE vaccinations; not after.  Also there was a difference in antibody responses in that study but not a huge one; comes down to a judgement call.


Taximom5 09-12-2012 10:34 AM

mgrella, I appreciate your being here, and your willingness to spend time answering questions.

 

But I'm afraid I disagree with your perspective.

 

I do see the sense and logic in your suggestions.

 

But.


(You knew there was a "but" coming, didn't you?)

 

I think you are assuming that, if we medicate in advance to control the fever, there will be no harm done by whatever mechanism would have caused the body's febrile response to the vaccine.

 

And you are assuming that, if we medicate in advance to control allergic reaction, there will be no harm done by whatever mechanicsm would have caused the body's allergic response to by the vaccine.

 

And you are further assuming that, therefore, there will be no harm done by the vaccine.

 

And I really think you're wrong.

 

I agree, you will be diminishing the likelihood of SOME of the harm.  But you're oversimplfying the complexity of the body's reactions. You may be partially addressing ONE SYMPTOM of a very complex set of reactions.  You're not stopping all reaction, and in using medication, you are adding potential for other reactions and cross-reactions.

 

I'm speaking as someone who has had my own serious reactions to vaccines, and whose children have had widely differing, serious reactions to vaccines.

 

From my perspective, asking me to agree to even one more vaccine for any of my children, with preventative medication, is asking me to agree to far too much of a risk.  It's like asking me to put my child in the front seat of a Yugo, and take them on a busy highway outside fo Boston, after already having been in one failed Yugo crash.  Only this time, you're hoping to prevent problems by adding an air bag.

 

It's not enough.

 

And if I had known that the kinds of serious reactions my children had are so much more common than I'd been led to believe, I would have turned down almost all vaccines, and delayed the few that I consider necessary until they were ready for school.

 

Making that kind of choice should be up to the parent, because, let's face it, an injection is an invasive procedure.  My daughter can't get her ears pierced at the local mall without my permission. Nobody should have the right to attempt to give her a vaccination--which carries FAR, FAR more risk--without my permission.  And the way it's set up with vaccines, it's not the parent giving permission, it's the doctor giving permission for the parent to refuse or delay. Those "informed consent" forms are a joke--they are often not given to the parent until AFTER the vaccine, and they certainly lack complete information. And if the parent refuses to give consent, almost all pediatricians attempt to bully the parent into compliance.

 

And that is so wrong, it's horrifying.


Mirzam 09-12-2012 10:36 AM

1 Attachment(s)
Quote:
Originally Posted by mgrella View Post

This applies only to acetaminophen given BEFORE vaccinations; not after.  Also there was a difference in antibody responses in that study but not a huge one; comes down to a judgement call.

Er, no.

 

http://children.webmd.com/vaccines/news/20091015/tylenol-may-weaken-infant-vaccines

 

http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(09)61208-3/abstract

 

 

 

Quote:

Methods

In two consecutive (primary and booster) randomised, controlled, open-label vaccination studies, 459 healthy infants were enrolled from ten centres in the Czech Republic. Infants were randomly assigned with a computer-generated randomisation list to receive three prophylactic paracetamol doses every 6—8 h in the first 24 h (n=226) or no prophylactic paracetamol (n=233) after each vaccination with a ten-valent pneumococcal non-typeable Haemophilus influenzae protein D-conjugate vaccine (PHiD-CV) co-administered with the hexavalent diphtheria-tetanus-3-component acellular pertussis-hepatitis B-inactivated poliovirus types 1, 2, and 3-H influenzae type b (DTPa-HBV-IPV/Hib) and oral human rotavirus vaccines. The primary objective in both studies was the reduction in febrile reactions of 38·0°C or greater in the total vaccinated cohort. The second objective was assessment of immunogenicity in the according-to-protocol cohort.Interpretation

Interpretation

Although febrile reactions significantly decreased, prophylactic administration of antipyretic drugs at the time of vaccination should not be routinely recommended since antibody responses to several vaccine antigens were reduced.

 

 

Marnica 09-13-2012 01:08 PM

So not only does Tylenol make vaccines less effective should one choose them for their children, it also is a drug known to deplete glutathione which leads to mitochondrial death - which is why if a person whose glutathione levels are already severely depleted through other toxic exposures takes even a normal dose of tylenol they could wind up dead from liver failure.

 

http://www.ncbi.nlm.nih.gov/pubmed/18626887?ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DefaultReportPanel.Pubmed_RVDocSum

 

 

Quote:
 All classes of psychotropic drugs have been documented to damage mitochondria, as have stain medications, analgesics such as acetaminophen, and many others.

 

I find it amazing that any doctor recommends tylenol ever...I personally wont go near it for myself or my children.


rubidoux 09-13-2012 02:34 PM

Quote:
Originally Posted by ma2two View Post

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

I'm curious about this also, but whenit happened to my son he was 2 1/2. He started crying immediately after the injection and continued for close to five hours -- wouldn't nurse and didn't fall asleep on long ride home. Is this a *thing* that happens after faxes? He's nine now and that's the only time he's ever cried that way.


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