Should Pharmacists Administer Vaccinations? - Mothering Forums
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#1 of 23 Old 08-11-2013, 02:44 PM - Thread Starter
 
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Here's a peek at the debate ensuing in Pennsylvania:

 

http://www.yorkdispatch.com/breaking/ci_23797331/groves-vaccination-bill-aims-expand-parents-options

 

On one side, you hear the argument that pharmacists are perfectly qualified to administer vaccines.  Opening up pharmacies for vaccination will provide low-cost, accessible vaccination without the usual hurdles of time, money, distance, transportation, etc.

 

A group of doctors, however, oppose laws that allow this to happen, claiming that only physicians are equipped to deal with emergencies that could arise from adverse reactions to vaccination.

 

What do you think?

 

Do you agree with the Pennsylvania Medical Society's position?

 

Quote:
"Children do have adverse reactions to immunizations, and the prospect of a severe reaction occurring in a department store pharmacy is pretty disturbing," he wrote. "Further, some adverse reactions are delayed, raising the very real prospect that a pediatrician could get an urgent call in the middle of the night from a frantic parent about an immunization the physician didn't even know had been administered."

 

 

 

Or are vaccine reactions are so "miniscule" and "exceedingly rare" (to quote a couple of regulars) that it is acceptable for pharmacies to expand vaccination services?

Or do you agree with this more cynical take from the National Vaccine Information Center's Facebook page?

 

 

Quote:

Only when their income is at stake do medical trade groups admit that vaccines can cause both immediate and "delayed adverse reactions.

 

I know we have at least one pharmacist participating in our discussions, but I'm curious to hear from everyone else, as well. Thoughts?

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#2 of 23 Old 08-11-2013, 03:40 PM
 
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I think there are situations where it could be okay, (if the pharmacist already has a professional relationship with the patient, and is aware of the medical history, etc...) the problem is how to word the regulations.  I'd definitely be more comfortable getting my kids vaccinated by my regular pharmacist than at a clinic held at a school, or at the grocery store, etc...  I don't think the average doctor is any more informed on vaccines than a pharmacist would be.

 

I love that this has led some doctors to openly discuss the risks of vaccinations!

 

How common is it for pediatricians to answer middle of the night calls from patients?

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#3 of 23 Old 08-11-2013, 04:00 PM
 
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I love that this has led some doctors to openly discuss the risks of vaccinations!

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How common is it for pediatricians to answer middle of the night calls from patients?

 

We see a family doctor in a larger practice, but someone is always on call and will get back to us, even in the middle of the night, if we need them.

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#4 of 23 Old 08-11-2013, 04:16 PM
 
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My computer is broken so I am only going to make a brief reply.

I called my doctors office in the middle of the night after my sons 4 month shots because he spiked a fever and I am a first time mom and I was worried. It wasn't a severe reaction and he was fine the next day. I'm sure this is what they mean by middle of the night calls, not that they are getting calls frequently from terrible reactions. The nurse was able to pull up which shots he had taken and what his weight was etc because they had been administered there.

In any case, if money was all that the doctors cared about wouldn't more of them be open to a delayed schedule like sears? Since more visits= more money.

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#5 of 23 Old 08-11-2013, 04:43 PM
 
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I'm going with income protection on this one.

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#6 of 23 Old 08-12-2013, 01:49 AM
 
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Doctors have always mentioned the risk of serious (if rare) side effects, and anyone claiming otherwise is misrepresenting the truth.

In the uk we are advised to wait in the doctors office for 15 mins following vaccination in an attempt to catch the worst of the serious allergic reactions. I personally think administering vaccines in CVS or wherever is happens is a bad idea.

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#7 of 23 Old 08-12-2013, 04:33 AM
 
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Originally Posted by prosciencemum View Post

Doctors have always mentioned the risk of serious (if rare) side effects, and anyone claiming otherwise is misrepresenting the truth.

In the uk we are advised to wait in the doctors office for 15 mins following vaccination in an attempt to catch the worst of the serious allergic reactions. I personally think administering vaccines in CVS or wherever is happens is a bad idea.

 

While doctors have always admitted that there are rare serious side-effects, it is frequently something that is admitted in a reluctant tone, after stating that "vaccines are safe and effective", and is often a detail that is neglected unless the "safe and effective" statement is challenged.  The tone of the statement quoted in the OP is different from the usual one; there is no reluctance, there is an enthusiasm about discussing reactions.

 

It's interesting how doctors' approaches to vaccinations vary, I've never been asked to wait 15 minutes.

 

I have equal confidence in my doctor's and my pharmacist's ability to manage a severe allergic reaction until the ambulance arrives.  I don't really expect either to have a lot of experience, but I bet my pharmacist can find the relevant meds a lot faster! 

 

The argument about doctors getting phonecalls about vaccines they didn't know were administered is easily addressed by making it mandatory to promptly relay information about vaccinations to the relevant doctor's office.

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#8 of 23 Old 08-12-2013, 05:34 AM
 
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Originally Posted by rachelsmama View Post

 

While doctors have always admitted that there are rare serious side-effects, it is frequently something that is admitted in a reluctant tone, after stating that "vaccines are safe and effective", and is often a detail that is neglected unless the "safe and effective" statement is challenged.  The tone of the statement quoted in the OP is different from the usual one; there is no reluctance, there is an enthusiasm about discussing reactions.

 

This is not my experience at all.  My doctor gives me a consent form before the vaccination, with the risks spelled out and enumerated.  She asks if I have questions, and it's usually one of her nurses that actually gives the vaccines. 

 

I'm fine with getting my vaccines from the pharmacy, but I think there are real concerns about children getting vaccines from the pharmacy.  My concern is that, if pediatric vaccines are available at the pharmacy, more kids (particularly low income kids) will wind up never seeing a pediatrician.  They'll get vaxes at the pharmacy, the pharmacy will provide vaccine records for school, that will be that.  Well-child checkups are a front line against a variety of issues that can have major effects on children's health, like severe allergies, cardiac problems, and mental health issues.  Adults can usually be trusted to know if they have allergies, and what they're allergic to, but a child getting first vaccines will have no way to know. 

 

I don't know that doctors in Pennsylvania are making the arguments I would make, or making them effectively, but I see some value in requiring that childhood vaccinations be done by a doctor or a a doctor's office.

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#9 of 23 Old 08-12-2013, 06:38 AM
 
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Perhaps the pharmacists should be asked to sign a version of this form first? 

 

http://preventdisease.com/pdf/Warranty-of-Vaccine-Safety-English.pdf

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#10 of 23 Old 08-12-2013, 07:40 AM
 
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Just chiming in with an anecdote.

 

My youngest recieved one vaccine last year.  I was not informed of the risks by the doctor and we were not asked to wait 15 minutes after the vaccine.  Rachelsmama and I live in the same country, albeit different parts of it, so maybe there are national differences? 

 

In any event, I do not really have any issues with a pharmacist giving out shots, assuming there are guidelines in place.  No shots to under 18's without their parents present, proper screening to ensure no pre-existing conditions and I do not want to be asked as I go to buy whatever if I had my flu shot and would I like one.   A 15 minute wait post vaccine makes sense.

 

I think it is funny that doctors are upset over this, and do agree with the quote in the OP:

 

"Only when their income is at stake do medical trade groups admit that vaccines can cause both immediate and "delayed adverse reactions."

 

I suspect it goes beyond income, however, to power and turf issues. 


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#11 of 23 Old 08-12-2013, 08:09 AM
 
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Originally Posted by MeepyCat View Post

 


 

I don't know that doctors in Pennsylvania are making the arguments I would make, or making them effectively, but I see some value in requiring that childhood vaccinations be done by a doctor or a a doctor's office.

If shots are convenient, more people will get them. 

 

There are people who are undervaxxed because it is too complicated to get to a doctor, including children.

 

Not offering vaccines to them at a pharmacy is a lost opportunity to get them vaxxed.

 

There is a part of me that is fine with this - less kids potentially harmed by vaccines.

 

There is a larger part of me, however, that feels that parents have the right to make health care choices for their kids, even if I feel those are the wrong choice, including vaccines. I demand parental authority over medical decisions as a non-vaxxer.  I want people to avoid vaccines because they do not believe they are the best choice - not because they can't get to them. 


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#12 of 23 Old 08-12-2013, 10:13 AM
 
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Originally Posted by Turquesa View Post

Here's a peek at the debate ensuing in Pennsylvania:

 

http://www.yorkdispatch.com/breaking/ci_23797331/groves-vaccination-bill-aims-expand-parents-options

 

 

 

What do you think?

 

 

It is already happening at several pharmacies now in PA, several where I live advertise this on their signs outside.

 

They have been doing the flu vaccine at pharmacies for years round here and there is a big ad push for the shingles vaccine - the flu they usually give you so many dollars off in store bucks if you do it at their store.

 

for "some" places they actually will have more of your medical history vs another clinic or medical center/Dr - this a plus in many cases, the cost is also lower making it much more appealing to most - the medical history for me is a plus but they certainly do not  know the current medical conditions vs a real medical visit and if you shop pharmacies (BECAUSE many do  this due to the large discounts) this can mean they are not current on what is really going on with the person.....either way, I don't support it greensad.gif

 

ETA- I also saw a sign the other day at a chain pharmacy that they do "school" physicals - how I don't know but they claim to be doing enough to OK one- again, in PA


 

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#13 of 23 Old 08-12-2013, 10:16 AM
 
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Kathy, I'm pretty sure I've argued exactly those points. I am not sure I'd apply them to children the same way I would to adults.
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#14 of 23 Old 08-12-2013, 10:39 AM
 
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Well, I am a pharmacist, and we give multiple shots in my state, although they are all to adults. For flu we can vaccinate 14+ but for everything else it is 18+. We have to know how to determine which shots are suitable for which patient--we vaccinate under a standing order from a doctor, and we can't give a shot that doesn't meet the criteria for the standing order, unless they get a prescription from their own doc (for example, we can do Tdap for 18-64, but if they are 65+ we would only do Tdap if their doctor prescribed it). We have to give out consent forms and information on the vaccines, we report the vaccines to their primary care doctor, and we're supposed to advise them to stay in the store for 10 minutes after the vaccine (although I know some of my colleagues don't do this if the patient is getting a flu shot and has gotten one before, and I disapprove of this practice). We are trained to handle vaccine reactions, though so far I haven't encountered any immediate reactions. 

 

On a personal level I would just as soon not give vaccines. I don't enjoy sticking needles in people, and the amount of prep work required really derails our process of filling regular prescriptions, particularly during flu shot season. Also I float from store to store and I really hate playing the game of "okay, where does this store keep their paperwork?" I do, however, appreciate the advantages of having the shots widely available. 

 

We don't vaccinate kids in my state (aside from the flu shots for teens) and I am glad. I wouldn't want to be responsible for screening pediatric patients for what shots are appropriate, since the pediatric vaccine schedule is so complicated, nor for actually giving those shots to them. I don't want to stick a needle into a terrified 7-year-old. I don't want a little kid getting one shot from me and one from the pharmacist at my competitor down the street; it just increases the chances of them getting something twice or missing something. I really think kids should be seeing a doctor for this. A lot of the adults we vaccinate either don't have a doctor or their doctor's office doesn't stock these shots, but kids should have a doctor and their doctor should have the shots in stock. 


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#15 of 23 Old 08-12-2013, 11:14 AM
 
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Kathy, I'm pretty sure I've argued exactly those points. I am not sure I'd apply them to children the same way I would to adults.

To me it sounded like you were favouring doctors as a place for vaccination for children as it will ensure kids see a doctor.

 

I do not favour keeping vaccines out of the hands of a pharmacist in an attempt to get kids to see doctors.

 

Perhaps there has been a miscommunication (shrug)

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#16 of 23 Old 08-12-2013, 11:27 AM
 
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 I don't want to stick a needle into a terrified 7-year-old. I don't want a little kid getting one shot from me and one from the pharmacist at my competitor down the street; it just increases the chances of them getting something twice or missing something. I really think kids should be seeing a doctor for this. 

This is a good point.

 

Where I live some vaccines are typically given in the school (Hep B and HPV) and flumists are done at some schools, aren't they?  I wonder how schools are set up to avoid this issue - at least with pharmacists the parent is there and can speak up. 

 

I took a look at the article, and it seems they want to allow vaccines to be given to 7-17 year olds by pharmacists.  In the USA that would include flu, HPV and maybe a tdap.  I am not sure it would be that confusing, given the smaller number of vaccines given in that age group, but I could be wrong.     

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#17 of 23 Old 08-12-2013, 07:19 PM
 
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Doctors have always mentioned the risk of serious (if rare) side effects, and anyone claiming otherwise is misrepresenting the truth.

The extent to which the pediatricians I've visited have mentioned them is by having the parent read a paper with the risks, and then sign a waiver, and initial a bunch of things.  I think a similar thing is done for flu shots that you get at the various pharmacies or workplace.  I've never had a doctor specifically tell me that vaccines are safe, they have given me the papers to read and then the waivers to sign. 

When my teenager was a baby, she had a congested chest, and I took her to the doctor as she had been exposed to sick children, two of whom later developed pneumonia.  They seemed concerned about the rapid development of her chest congestion, and gave her a shot of decadron.  Afterwards, they told me I had to stay in the waiting room for awhile, because they wanted to make sure she didn't have a serious allergic reaction.  They never mentioned this as a possibility, but I should have figured it, since I suppose you can be allergic to anything they give you, but I didn't know what decadron was and I stupidly didn't ask. They didn't warn me about the side effects either, but I mentioned it online, and someone told me. It would have been nice to know.

 

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#18 of 23 Old 08-12-2013, 08:51 PM
 
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Doctors have always mentioned the risk of serious (if rare) side effects, and anyone claiming otherwise is misrepresenting the truth.

Excuse me? What makes you think you know what every doctor has always done? What makes you think you know every parent's experience to the point where you can accuse them of lying if they haven't had an experience identical to yours?

I have NEVER been informed of risk of serious side effects, not from any of my own doctors, and not from pediatricians until AFTER they saw my children HAVE serious reactions. The doctors did not administer the vaccines, nor did they discuss them, other than to say, "______ (fill in nurse's name) will be in to give you your shot(s)." The nurses administered them, but with no discussion other then, "you need to sign this."

I still have the little green sheets of paper which purport to be the "informed consent" that I was asked to sign. They all say (with minor variations), "reactions may include fever, irritability, redness, swelling, and/or tenderness at the injection site. "

The later versions add, "If serious reaction occurs, please call your physician immediately." No mention of what that serious reaction might be, but please do remember that I called in when my child's serious (seizure) reaction, and was told by the nurse that "vaccines don't do that," that I was an over-reacting, hysterical new mother, that the baby was just a little fussy, and that I should put him in his crib and walk away until I could calm down.

So no mention from either doctor or nurse of severe adverse reactions before the shots, and complete denial from the nurse of any possibility of severe adverse reaction after the shots.

Unfortunately, my situation was not unique. I was amazed how many parents have reported similar stories. Perhaps you should ask MDC member Michael Belkin what his experience was?

In fact, adverse reactions to medications are rarely, if ever, mentioned by doctors. My experience with pharmacists, however, has been very different, as they do give out information, and are often able to check the system to see if you have allergies, or are on a med that might interact with the new one.
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#19 of 23 Old 08-13-2013, 05:52 AM
 
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With our experience, doctors and moms differ with their definitions of 'reactions to vaccines'........as a mom we know when our kid is 'off', but doctors 'may' not report the side effect bc it's so common.......when my daughter had a fever (maybe four days after her shot) that lasted about 7 days....I was told it was not related and was not a reaction.......from our experience, doctors will report side effects or reactions ONLY if they are part of an already established list of problems.  AND OF COURSE I CAN'T FIND IT NOW, but in addition to the nurse giving you a form to sign and them telling you about the possible issues, (all things they should be doing) our doctor always gave us a standard flyer from the CDC or vac maker...........and guess what was on that flyer? The number and info for the Vaccine Injury Reporting Hotline............makes you wonder.......So, every mom is different and we will all make different choice for our kids.  And while perhaps it is not the preference for a mom who does vaccinate her kids to bring them into the pharmacy for shots, perhaps this is the only place she can go.........it's not a perfect world and no choice will be perfect. Yes, there are rules and guidelines in place, but YES, not every doctor follows them........(for instance, if you bring your child in for vaccs, if they have had a fever or have been sick in the last few days, they are NOT to get a shot for the risk of complications...but who has ever been told that one? )...........As moms, we are not perfect, and our doctors are not perfect. Mistakes will be made..............


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#20 of 23 Old 08-13-2013, 06:13 AM
 
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With our experience, doctors and moms differ with their definitions of 'reactions to vaccines'........as a mom we know when our kid is 'off', but doctors 'may' not report the side effect bc it's so common.......when my daughter had a fever (maybe four days after her shot) that lasted about 7 days....I was told it was not related and was not a reaction.......from our experience, doctors will report side effects or reactions ONLY if they are part of an already established list of problems.  AND OF COURSE I CAN'T FIND IT NOW, but in addition to the nurse giving you a form to sign and them telling you about the possible issues, (all things they should be doing) our doctor always gave us a standard flyer from the CDC or vac maker...........and guess what was on that flyer? The number and info for the Vaccine Injury Reporting Hotline............makes you wonder.......So, every mom is different and we will all make different choice for our kids.  And while perhaps it is not the preference for a mom who does vaccinate her kids to bring them into the pharmacy for shots, perhaps this is the only place she can go.........it's not a perfect world and no choice will be perfect. Yes, there are rules and guidelines in place, but YES, not every doctor follows them........(for instance, if you bring your child in for vaccs, if they have had a fever or have been sick in the last few days, they are NOT to get a shot for the risk of complications...but who has ever been told that one? )...........As moms, we are not perfect, and our doctors are not perfect. Mistakes will be made..............

But shouldn't doctors when practicing medicine be held to a different standard than mother's? What happened to "first do no harm"? If my child was harmed by a vaccine administered while they were running a fever or sick, I am not about to shrug my shoulders and say, "mistakes happen". Having said that, I do think parents should take some responsibility for allowing a physician to vaccinate their sick child; but when you have organizations like the AAP and CDC, and the medical personal giving the vaccinations, saying it is fine, it is easier to acquiesce, often against the parent's better judgment.

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#21 of 23 Old 08-13-2013, 06:58 AM
 
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Hi. I don't know how to quote (can someone tell me please) so I cut/pasted

You Wrote:

 

But shouldn't doctors when practicing medicine be held to a different standard than mother's? What happened to "first do no harm"? If my child was harmed by a vaccine administered while they were running a fever or sick, I am not about to shrug my shoulders and say, "mistakes happen". Having said that, I do think parents should take some responsibility for allowing a physician to vaccinate their sick child; but when you have organizations like the AAP and CDC, and the medical personal giving the vaccinations, saying it is fine, it is easier to acquiesce, often against the parent's better judgment.--------

---------------------------------------------
 

 

So.......first do no harm........When a doctor gives your child a vaccine with eggs in it and your child is allergic to eggs, is that harming them? Does it harm your child when they are injected with aborted fetal tissue or chemicals........Is it really the doctor that is harming them or the vaccine company? (just words to ponder). 

 

And who shrugs their shoulders........there are parents who blindly trust their doctors.........OR...are so new to being a parent that they just don't know yet............(I hate to say but sometimes as a mom we learn the hard way).............I know that my child had a reaction (I filed a complaint, etc) but my point was our doctor insisted it was not a reaction bc of the time frame (more than 24 hours after the shot).......and 'fever of over 105 for 7 days' was not one of the recognized reactions so in the end.....my complaint disappeared. Thankfully my child recovered!

 

Hmm, so holding doctors to a different standard...........yes and no--------- As a MOM it's our job to protect our kids. But we also rely on what our doctors tell us...........and they get their info from the CDC who gets their info from the vaccine makers...........BUT yes, it is also the job of the doctor to tell us all the risks ...............but seriously, with appointments that last 10-15 minutes, are all the points covered. But as a MOM (and it's hard being a first time Mom, but by child two or three you've learned the ropes so to speak), ask questions, do research, make your decisions based on Your child ......

 

And referring to mistakes........it's about choices ............If you decide to vacc and your child gets a severe reaction ....mistake? or if you don't and your child gets sick, mistake. Mistakes happen.....no one is perfect. As a Mom we need to be prepared that doctors and moms will make mistakes.

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#22 of 23 Old 08-13-2013, 07:09 AM
 
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I don't want my child to be a 'victim' of someone's mistake which is why I have made it my business to be as knowledgable about health as I can - and I am still learning. This has lead me to reject most of western medicine, and most importantly vaccination. 

 

Yes, as a mother I have made mistakes, not with health matters though. I am not about to rely on the information of a conventional medical practitioner when I know they have extremely limited knowledge. I pick my HCP's very wisely, and never accept what they tell me, because they are 'doctors'.

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"If you find from your own experience that something is a fact and it contradicts what some authority has written down, then you must abandon the authority and base your reasoning on your own findings"~ Leonardo da Vinci

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#23 of 23 Old 08-14-2013, 08:17 PM
 
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Here they have nurses show up at all the schools to vaccinate the children every fall.  If your child goes to a public school, it's generally considered wise to keep them home the day the nurses are there.  Even if you have an exemption on record with the school.  There's always the potential for the accidental, "Sorry we lined your child up with the rest, but they seemed fine when we sent them home."

 

I say, let whoever they want give vaccinations.  The doctors might be irritated they have to share their pharmaceutical bonus checks, but oh well.  Slow economy.  People filling Rx more cheaply from Canada or Mexico... Pharmacists would probably like the extra income stream.

 

People who are going to educate themselves and not vaccinate are going to do so regardless of where they are offered.  People who are going to do what they are told are going to do so regardless of where they are offered.  If it's so safe, why does it matter where it gets done?

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