Comments on: Should doctors fire young patients if their parents refuse to vaccinate them?

By: Help your kids get along | Parenting help in Oregon

Help your kids get along | Parenting help in Oregon — Sun, 25 Oct 2009 20:55:09 +0000

[...] Should doctors fire young patients if their parents refuse to … [...]

By: Anonymous

Anonymous — Fri, 23 Oct 2009 23:10:40 +0000

Given the ever growing number of people who refuse to vaccinate themselves and/or their children due to believing the various conspiracy theories (autism, thimerosal, squalene, etc.), self-interest makes for an even stronger case to get yourself and your children vaccinated. Especially children in schools, who are infectious disease vectors constantly being exposed to other infectious disease vectors.

How long before diseases that are a distant memory (polio, measles, etc.) come back, make their way through schools, and leave dead or disabled children in their wake?

By: AutismNewsBeat

AutismNewsBeat — Fri, 23 Oct 2009 22:13:34 +0000

I spoke with Dr. Marshall yesterday, and he was very distressed over the MedPage article. The headline is misleading – Marshall did not tell peds they should fire patients. Also, contrary to the story, he said there are reasons not to fire patients – it could drive them to chiropractors or DAN! doctors, which would further jeopardize the children. The AAP communications office called MedPage, and the headline was changed.

By: DrV

DrV — Fri, 23 Oct 2009 17:53:41 +0000

The doctor-patient relationship is a two way street. Doctors have to be comfortable. I might also add that pediatricians have to become involved in creating the information that parents read online. The social space is dominated by antivax propoganda that could easily be countered if every member of the AAP contributed to the discussion.

By: ninguem

ninguem — Fri, 23 Oct 2009 16:14:58 +0000

Personally I don’t fire vaccine-refusing families. I mean the little kid vaccines, of course, not adult flu shots etc.

I tell then I think it’s a lousy idea not to vaccinate the kids, I have my own kids, I vaccinate them…….sometimes personally. I walk the talk. I offer to modify the vaccine schedule, whatever it takes. And document like crazy of course.

All that being said, one thing I really, really feel strongly about, is the physician-patient relationship is voluntary. On both sides.

The Hippocratic Oath stipulates that “whatever house I may enter”……the doctor is supposed to behave in certain ethical ways. Implicit in that is the right to decline to enter the “house” in the first place.

By: Happy Hospitalist

Happy Hospitalist — Thu, 22 Oct 2009 22:24:41 +0000

paynehertze. The fact that physicians are required to give 30 days notice before ending a relationship should answer the question for you.

By: Marya Zilberberg

Marya Zilberberg — Thu, 22 Oct 2009 21:05:12 +0000

Level A1 evidence requires a randomized controlled trial. RCTs are notoriously poor in terms of generalizability and tracking long-term meaningful outcomes. In the case of the flu vaccine, while it is true that the level of evidence is A number 1, the outcome is a surrogate outcome not necessarily related to prevention of the disease.

In the case of the H1N1 pandemic and in the face of general safety of the vaccine, I argue that even marginal effectiveness is adequate. So I believe we are on the same side of the argument here.

And by the way since there is enough Dumb and Dumber in real life, I am not an aficionado of Lloyd Christmas advice.

By: jenga

jenga — Thu, 22 Oct 2009 20:38:44 +0000

The majority of our current recommendations on vaccination are based on Level A-1 evidence. If we are to ignore that based on an editorial in the British Journal of Medicine, we might as well go back to giving patients arsenic, performing all surgeries with instruments in a pail of water and bleeding patients to rid them of evil humours. I wouldn’t risk the lives of my patients in the waiting room that are following level A1 evidence to appease those following the advice of Lloyd Christmas.

By: Squillo

Squillo — Thu, 22 Oct 2009 18:22:09 +0000

I think firing patients based on vaccine rejection is a mistake. These are the parents who will then go looking to places like Bob Sears’ website for so-called “vaccine-friendly” practitioners–many, if not most, of whom appear to be outright quacks.

Better to attempt to maintain a dialogue, and ensure the kids are otherwise getting appropriate care and advice. (Of course, if the parents are resistant to science-based medicine in general, there may be no point in continuing the relationship.)

By: Marya Zilberberg

Marya Zilberberg — Thu, 22 Oct 2009 17:33:09 +0000

Unfortunately, Jenga, the issue of vaccine effectiveness is not nearly as straight-forward as all that. There are no convincing data that the seasonal shot is all that great at preventing flu. There is certainly no data yet on the new vaccine — it has efficacy in that it produces an immune response, and we have to take on faith that it will translate into protection against the flu. However, given the potential for widespread harm from this illness and the general safety of the vaccine, it should certainly be widely used by the MDs.

More on flu vaccine effectiveness here, synthesizing work by the Cochrane Collaborative appearing in British Medical Journal:
http://evimedgroup.blogspot.com/2009/10/shaky-evidence-for-flu-vaccine-policies.html