Why this pediatrician makes the MMR vaccine mandatory in his practice

Vaccines have been a hot topic among parents, pediatrician and in the media for many years.  Recently, there have been many news stories about pediatricians who will not care for families who either choose not to vaccinate their children or who do not follow the recommended schedule.   These policies are based on knowledge about the safety of vaccines, the effectiveness of the recommended schedule and concern about the spread of a vaccine-preventable disease in the community.  No pediatrician wants to see a child suffer from a condition that could have been prevented, and we certainly do not want those illnesses to be spread in our offices.

My practice is in Marin County, California – an area that is known for high rates of vaccine delay and vaccine refusal.  After much thought and careful consideration, my partners and I recently decided to change our policy related to immunizations.  Starting this spring, we will require that all patients age 2 and older be immunized with the measles, mumps, rubella (MMR) vaccine in order to remain patients of our practice.  We have a responsibility to protect the health of all of the children in our practice, and decrease the risk of vaccine-preventable diseases in our community. We have chosen to require the MMR vaccine because we are extremely concerned about the possibility of a measles outbreak in our community.

Vaccine preventable diseases are still a threat to the health of our children and our community.  In 2010, the pertussis (whooping cough) epidemic in California affected children in Marin County at eight times the rate seen in California overall, in part because of low immunization rates.  There was recently a case of mumps in a school-aged child in our county, and last year there was an outbreak of mumps in a dormitory at the University of California at Berkeley.  There have been measles cases and outbreaks associated with the 2012 Super Bowl, and in recent years in San Diego, Quebec, Indiana and Minnesota.  In 2011, there were 222 reported cases of measles in the US, the highest rate in 15 years.  Ninety percent of these cases were associated with air travel, but not all cases were in travelers.  Measles has become much more common in Western Europe, Africa, Asia and the United Kingdom due to dropping vaccination rates.  The CDC is already warning us that with the Summer Olympics in London and the Eurocup Soccer Championship in the Ukraine, the possibility of a US traveler to these countries coming back with measles is high.  Because of this, we are concerned that Marin County is at risk for a measles outbreak.

Because measles is so easy to spread, in order for a community to be protected from an outbreak, 95% of the population must be immunized.  Right now, the number of kindergartners in our county who are up to date on all of their vaccines is 83%, and there are schools and communities in Marin County where less than 50% of kindergarten students have had all of their required vaccines.   Certain areas in our community are clearly at risk of a measles epidemic.  In our practice, we have many children who are too young to receive the MMR vaccine as well as many children who have chronic illnesses that compromise their immune system and put them at risk.  This policy is meant to protect not only these children, but also our entire community from a measles outbreak.

We respect that the parents in our practice have the ultimate responsibility for making decisions about their children’s health care, but we have to weigh their personal decisions against the available data and the needs of our community.   In our practice, we feel strongly that communicating and collaborating with our patients and their families is the best way to provide excellent care.  We also feel strongly that vaccines save lives and that this policy protects our patients and our community from a preventable disease and all of its repercussions.

Nelson Branco is a pediatrician who blogs at Survivor: Pediatrics.

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  • David Hanson

    If I were a parent of a young child, I would say a quick goodbye to this doctor and his friends.  They may even by correct but it is NOT their decision to make.

    • http://twitter.com/#!/CloseCall_MD Close Call

      Sure it’s their decision to make.  They have to look out for the safety of ALL of their patients.  That unvaccinated child is putting other children and newborns in the waiting room at risk.

      Glad to see this movement among doctors is growing.  Anecdotally, I’ve heard of two other mid-sized group practices in my area doing this.

      • Sev Wilder

        They have an obligation to the patients, regardless if they choose not to have certain vaccinations. If your child is sick and the doctor will not see you because you choose not to vaccinate, then that person is not true doctor or a healer. They will probably get their license revoked, or at least should have.

        • http://twitter.com/#!/CloseCall_MD Close Call

          Nope.  Not how it works.

          A doctor has 30-90 days to let patient find a new physician who “jives” with their philosophy of non-vaccination.

          Doctors can’t mandate good health habits, but they can take steps to make sure those bad health habits don’t hurt anyone else.  Similarly to how a doctor can make their waiting room “smoke free” (I hope I don’t have to explain why a smoke free environment is good for newborns, asthmatics, kids with lung disease and everyone in general) – a doctor can make a decision to make their office as safe as possible for everyone.  That means not having an early meningtitic, unvaccinated kid sitting next to a precious, beautiful and at-risk newborn in the waiting room.  

          • http://pulse.yahoo.com/_2LRZNHDZS6DU45WQ567LPQ7CMI ninguem

             Close Call, I’ve not seen a jurisdiction that requires more than 30 days.

            Are you aware of geographic areas, insurance contracts, etc., requiring more than 30 days?

            I’d like to know about that.

        • http://pulse.yahoo.com/_2LRZNHDZS6DU45WQ567LPQ7CMI ninguem

           Excerpts from the original Hippocratic Oath:

          “…..I will give no deadly medicine to any one if asked, nor suggest any such counsel; and similarly I will not give a woman a pessary to cause an abortion…..”

          “……In every house where I come I will enter only for the good of my
          patients, keeping myself far from all intentional ill-doing and all
          seduction and especially from the pleasures of love with women or with
          men, be they free or slaves…….”

          There were concepts of right and wrong in the original Hippocratic Oath. The doctor is not a waiter in a restaurant. The doctor can refuse certain services “even if asked”.

          If the doctor enters the patient’s house, the doctor is to behave in certain ethical ways.

          The doctor can also choose not to enter the “house” in the first place.

          If the doctor has a policy of mandatory vaccines, the doctor can choose not to keep that patient who refuses the vaccine. That is perfectly legal and ethical. If the patient objects to the mandatory vaccine policy, that patient has the right to find another doctor.

        • kitten ku’upio

           I disagree with you.  If it is your practice it is YOUR rules. And, frankly, losing a patient is not a huge deal. I think that if a medical emergency were to present itself THAT is a different animal, but as far as taking what patients you want into your practice, that is your business to say what goes and what does not.

        • kitten ku’upio

           An example is this: If I want to get my long haired cat groomed, he has to have proof of a rabies shot.  IF he does not have that, they cannot give him a haircut. So yanno..really? Why is it a problem for rules to be in place for a physicians office?

    • http://www.facebook.com/drrogu George Doc Rogu

      This doctor is correct. Goodbye should be to those people who put other children at sick without even understanding why they do not want vaccines. Thank you Dr Google. Maybe with more comments like this from the medical community the search engines will pick up the real story one day.

  • cnshap

    David Hanson, the doctor has my complete support.  Through your inaction, you put MY children at risk and that is NOT YOUR decision to make….

    • Sev Wilder

      Through your bowing down you put MY child at risk for serious side effects. and that is NOT YOUR decision to make, OR THE DOCTOR’S!!!

      • NewMexicoRam

        After a quick internet search, I found, from the World Health Federation, that the risk of a serious reaction to a vaccine is no worse than 500 out of one million doses.  The risk of a fatal automobile accident in one’s entire lifetime in 1 out of 85.

        Looks like you should spend more of your time crusading against automobile driving than worrying about vaccinations.

  • NormRx

    Good for you.  I grew up during the polio epidemic of the early fifties. I remember the fear of contracting this deadly disease.  We were told not to run, get overheated or swim in the old swimming hole. Then my cousin that lived next door developed polio, she is still paralyzed from the waist down and confined to a wheel chair.  Any parent that does not vaccinate their child is certainly negligent in the care of their child.
    They choose to not vaccinate, then when their child comes down with one of these deadly diseases they will run to the doctor and plead, PLEASE HELP ME.

    • kitten ku’upio

       Yup the good ol’ American way..and then the next step is to sue the doctor for negligence.  And following that, the decrying of how expensive medical care has become. (then take your vaccines, don’t be dolts!)

  • emtdan

    I as well applaud your choice. You are a private practice, and free to accept or discharge patients at your and your partner’s will. If you feel unvaccinated children are a threat to others in your practice or community, this is a well deserved policy, just make sure it is clearly stated upfront, and enforced consistently.
    Good Luck!

  • DrGetWell

    Childhood immunization is an integral,and essential feature in clinical practice.To “Skip” immunization is to
    betray the mutual trust between the health care provider and reciever.
    The present issue is:How the immunization is administered?,which reflect as side effects on the recieving
    population.In the case of M.M.R.,it was suggested to give each component separately,thus to reduce the chances of side effects(In medicine it is called:Less is More)
    Does M.M.R. contributes to Autism?This is a question that hangs like:Demokles sword in the air(Greek
    Mythology).Is indivdual shots better?It is you to find out.Is immunization a must?Absolutly yes.
    In the meantime we have the population in anxiety and uproar.They vote with their feet.
    It behooves the health care professionals to show more compassion.
    P.S. the same issue exist in the adult population,when,in pre-bootcamp,the recruits are given twenty
    injection-immunization at once.Later we wonder why our soldiers have a higher rate of PTSD.

    • herzigma

      I hope that some of the physicians who read and 

      • DrGetWell

        Please read my note:reply to our collgue,re the issue of “Combo”immunization.

    • http://pulse.yahoo.com/_GXO5UT3MGTPBRYKXHHFG6NCRO4 S

      1: Leaving out the discredited and retracted Wakefield study in the Lancet, NO STUDY has shown a direct link between vaccines and autism. Wakefield’s license to practice has been stripped.

      2: re:  P.S. the same issue exist in the adult population,when,in pre-bootcamp,the recruits are given twenty injection-immunization at once.Later we wonder why our soldiers have a higher rate of PTSD.

      Are you honestly suggesting (with a straight face) that PTSD is related to vaccines as opposed to a decade of war where our brave soldiers are getting deplyed 3,4, or 5 times???/Sheesh.

      3: It is the sword of “Damocles”

      • DrGetWell

        The controversy re:M.M.R. vaccination resulting in Autism,has not faded yet.The public is in doubt and
        concerned,when their love one, present with symptoms of altered cognition,following whatever vaccination.
        In the case of M.M.R.,the scare was hyperinflated following the publishing of the article Re:possible association between M.M.R. vaccination and Austism.In this article Dr Wakefield express his suspicion
        that there is a possible association

        • DrGetWell

          The issue in this blog is patient-doctor relationship and compliance.
          Starting with the question;Is immunization needed?The answer is absolutly and
          categoracly:YES!!!
          It is the issue of none-compliance, that started this argument.
          Today,some parents do not let their children have their immunization.out of fear of side effects.
          The care-giver,the pediatrician,find these people irresponsible,and severes doctors
          patients relationship with them.Is that a correct move on the account of the
          professionals?It is you the professional to answer.
          There are two barriers that cause the professional’s anger to my comments
          1) Combining medication and increments of  its dosage is wrong,as it increases
          the chances to more severe side effects.Today,with the crisis in Medicine:
          Economic and ethic,a call has been issued by the A.M.A.:Less is More
          (Archives of Internal Medicine).”A medication must be a smart bomb,not a cluster
          bomb”said a professional in Cleveland Clinic Journal of Medicine 2008.
          2) Has a proof been found to connect Autism with M.M.R. immunization? Not yet.
          3) Is it possible that there is a connection between M.M.R. vaccination and Autism? You answer please.
          Autism maybe a culmination of multiple trauma that the child sustain since its
          perinatal era.
          Starting with prematurity(We have a lot of them in the U.S. today.Read the article
          in N.Y. Times 5/4/2012 re;Increase prematue delivery).
          One of the major issues with prematurity is the:Perinatal Hypoxia-Ischemic
          Encephalopathy.This affects 2-4 premature neonates. The result is:Cerebral Palsy,
          and other Neuropsychiatric disorders.
          Is this ailment what starts autism?We do not know yet.Is an answer comming
          our way? Yes(Hopefully).
          Today Molecular Medicine is being invented.It replaces the Genomic-Personalized
          Privatized Medicine.Why?It is much more affordable.It is more simple,logic,portable
          and specific.
          Dr.Wakefield  did not say:”No M.M.R.,he said:One at a time.All the three shots together increases the chances to more serious side effects.Period.
          To understand better the mecchaism of Molecular Medicine,expect thepublication of my article:”The Foriegn Molecule Theory Idea and Method in Health and
          Longevity” This is the leading article inthe future published book(Hopefully):
          “Affordable Molecular Medicine”(AKA Unitarian Molecular Medicine
          The time has come for the Medical profession to discover:Innate Immuniy,H.D.L.
          and Niacin(References available)

        • kitten ku’upio

           Then again, the public is too easily led by ratings-seeking media.  Most of the people I know do not research any issue, they just vote on the impression given them by cnn or whatever, so pretty much, many are just ignorant about a lot.

    • http://www.facebook.com/brianpcurry Brian Curry

       Compassion, yes. No question about it. But what, exactly, does “compassion” mean, in this context? Can one not be compassionate without capitulating?

  • http://www.facebook.com/drrogu George Doc Rogu

    I too applaud you. I only wish that this was universal policy. I have found recently that many folks are declining vaccine just because they heard that they were bad, and can not even give  one intelligent argument, just that they are refusing vaccines. No one quote the wakefirld study anymore. Now this is very scary. All that I know is that children are just not ill anymore after all of these vaccines.  Sick visits are down across the country and I personally see less acute sick patients today than I did on the same day 15 years ago.

    Children in countries without vaccines still die from the flu!!  So people should really wake up.

    George Rogu M.D.

  • Sev Wilder

    Parents have the right to question what is given to their children. Certain vaccines are not necessary and this can be discussed between the doctor and the parent. For a doctor to pompously say “you will agree to all vaccines or you are not allowed in this practice” is just wrong. Remember you took an oath to help people, so you have an obligation. You are a consultant in the health care of your patients, not god!

    • http://www.facebook.com/brianpcurry Brian Curry

       Sev, yes, parents have a right to question what is given to their children. The idea that they don’t have that right is one I have never seen embraced by any doctor I’ve ever met. A problem emerges, however, when parents conflate the “right to question” with being possessed of a medical knowledge equivalent to that of the pediatrician. You say that “certain vaccines are not necessary”, but offer no examples of such unnecessary vaccines. Unnecessary in what sense?

      Additionally, though I may be biased, I believe that a pediatrician should have the right to protect his or her other patients in the practice by eliminating the possibility that sick children (or their parents and grandparents) will be exposed to vaccine-preventable illnesses because of the misinformed choice of a parent not to vaccinate his or her kid. Seems pretty compatible with the obligation, that “oath to help people”, that you mention, don’t you think? Or does the oath only extend as far as your right not to vaccinate your kid?

  • DrGetWell

    Please read the added comments,recently plaed by me in response to other readers comments.
    Just remember:I support the need for immunization.The issue is:How?

    • http://www.facebook.com/brianpcurry Brian Curry

       Good question! I have an idea: The parent schedules an appointment with the child’s pediatrician at the appropriate time, at which appointment the pediatrician administers the recommended vaccines. The parent, concerned about possible side effects, enquires of the doctor the potential risks of vaccination. The doctor patiently explains them, their relative frequency, and the circumstances in which they are most likely to occur. Barring any special circumstances, the parent recognizes that the degree they got from Google University is not equivalent to the M.D. the pediatrician received, and the child is immunized (or not, in the case of specific circumstances or medical conditions).

      I am ALL for parents being proactive, asking questions, expressing concerns, etc. They demand that their voices be heard, recognized, and validated, and I agree that they should be. It is not only constructive to the relationship, but is also a great way to ensure that a physician doesn’t get trapped by sloppy thinking vis a vis heuristics (as excellently discussed in Groopman’s book, /How Doctors Think/).

      But it should also be a two-way street. Parents need to recognize that the knowledge bases brought to bear in the doctor-patient relationship are not equivalent, and that in the end, when a pediatrician recommends vaccines, he or she isn’t part of some vast conspiracy to give children autism, but rather is practicing good, common-sense preventive medicine. It protects not only the child, but also the population as a whole.

      In other words, a parent should be an advocate for his or her child, to demand that the child receives the best possible care by expressing concerns, asking questions, and trying to be as informed as possible. But a parent should also recognize that the relationship with a pediatrician is a crucial part of that process.

      The sort of inherent distrust of “establishment” medicine on display by many anti-vax parents poisons the relationship from the get-go, and belies the simple fact that, when all is said and done, they’re not looking for a competent, educated partner in their children’s care. They don’t want someone who will set them straight when they’ve gone completely off the rails. They want an echo-chamber, a service relationship where the customer is always right (even when they aren’t), and despite their best intentions (which I genuinely believe they have), are playing a dangerous game, not only with the health of the public at large, but indeed with the health of their own child.

      • sFord48

        If the parent  isn’t qualified to make a choice about vaccines, why explain the risks?  And if it’s ok for a physician to require MMR, what requirement is next?  Where doesn’t the right to refuse medical treatment come in to the equation?

        Before you call me names, I vaccinated my children on schedule.

        • http://www.facebook.com/brianpcurry Brian Curry

          Don’t worry, I’m not about to call you names. Not (usually) my first resort.

          It’s a good question you ask. Explaining the risks helps in a number of ways. First, it is good for the relationship between doctor and parent; I, personally, would be more trusting of a physician that identifies potential risks of a given medical procedure, especially when the patient is my child! It A) prepares me for the possibility of negative outcomes, and B) respects my right to be informed about the care of my kid.

          Second, it helps the informed parent to ask more questions: If, for example, one of the risks is a rare but serious reaction in patients with a certain enzyme deficiency, it allows a parent to rightly ask what assurances exist that his or her child doesn’t have that particular condition. This is good not only for reassurance of the parent, but also to help the thought process of the doctor.

          Third, I think it’s part of due diligence and good medical practice. I, personally, think that pediatricians should be much more proactively open about the risks of vaccination: What the available evidence indicates they are (and, just as importantly, what the available evidence does NOT support [e.g., autism]), how often they occur, who is most at risk of such reactions, etc., and what measures are taken to minimize them. Let’s move away from the one-page handout that no one ever seems to read, and actually have a conversation (maybe this is already done? I dunno, I’m not a pediatrician).

          At the end of the day, I think that parents that tout “parental choice” on vaccines, especially those that try to argue that some of the vaccines aren’t necessary because the diseases are so rare, or aren’t commonly fatal, are committing a huge mental error. But second, and perhaps more importantly, many of the diseases we vaccinate against don’t have a particularly high case-fatality rate, but they may be either very infective (and therefore produce a significant number of deaths), or have potential future complications (SSPE and measles). Lastly, some of the vaccinations aren’t necessarily for the direct benefit of the children, but to avoid exposure of vulnerable populations (e.g., pregnant women, elderly).

          But there’s another element here, and one that is often forgotten, which is that parents don’t really have completely free choice about the care of their child. As an example, a parent doesn’t have the right to refuse life-saving or -preserving standard treatment for his or her child. Me, personally, I think this can easily be extended to cover important public-health preventive measures like vaccination against preventable diseases.

          • sFord48

            So if I find the risks you describe unacceptable, too bad?

            Take that out of the context of the parent/child scenario.  What if an adult does not want vaccination?

          • http://www.facebook.com/brianpcurry Brian Curry

             Then they don’t have to get vaccinated. No one is making you get a shingles vaccine, and while pneumococcus vaccines are advised in elderly patients, they are not, to my knowledge, required.

          • sFord48

            So you think it’s ok to force children and not adults?  How many people die of the flu?  What if doctors dismissed everyone that didn’t want a flu shot.  

            Better yet, what if medical providers were required to have a flu shot.  Do you want to be forced to have a vaccination?

          • http://www.facebook.com/brianpcurry Brian Curry

             I can tell you that many more people die of flu where vaccine uptake is low.

            More importantly, it’s not about “forcing children”. It’s about whether or not a parent can refuse a particular treatment for their child.

            And many hospitals do force their employees to get flu shots. I worked for one, and received it gladly.

          • kitten ku’upio

             Ok why is it a problem for you to make kids get vaccinated?  They should be vaccinated.  Really, no lie. I am appalled at the amount of parents that think it is alright to forego the vaccines. Will those parents be the first ones crying for help when their little kid gets one of those preventable illnesses?

          • kitten ku’upio

             I believe medical providers in my state, if not required to get one, are strongly urged to get one. Go read a book about the flu pandemic of 1918. that will change your mind. There is one called Influenza.  I have forgotten the author but that one was my favorite.

      • kitten ku’upio

         You would be surprised at how many people think they have more information than the doctors. Everytime there is a tv show that talks about how the doctor made a mistake and the patient was right, (even thought there is a .0000001% chance of that happening) that lodges into their brains and causes them to think they are right…

      • kitten ku’upio

         In the days of the polio epidemic, parents were giving their kids over to be vaccinated in spite of any risk.  Therefore, I think today’s parents are a little on the crybaby side.  No vaccine is 100% safe, but the value it provides to society is worth it.

    • kitten ku’upio

      I think that they should be mandatory. None of this “oh my it is against my religion” stuff. Mandatory or you have to leave the country. I am alright with that.

      • http://pulse.yahoo.com/_VASDMFYUQS65NHE4YH2U22HH4A Frost

         I’m ok with certain religious exemptions.  Like the Amish.  They don’t vaccinate– but they also don’t use public services.  To me, that’s a fair trade-off.  And that’s a religion that is pretty easy to verify legit membership.

  • EatMoreSalmon

    Unfortunately the presently available MMR vaccine is manufactured using strains of aborted human fetal cell culture. So this vaccine, as well as varicella, Hep A and others are no longer an ethical choice. What should and ethical physician do? The manufacturers need to be lobbied to go back to the ethical manufacturing process. There was no need for this in the MMR.

    • http://www.facebook.com/brianpcurry Brian Curry

       You really have not the first clue what you’re talking about. The cell lines were obtained in the 60s and 70s, and have been grown in culture ever since; it isn’t a recent change, and it’s not like manufacturers keep going back to some magical well of aborted fetuses or something.
      Even the Roman Catholic Church has weighed in favor of the public benefit of vaccinations, even despite the provenance of the original cell lines.

      • EatMoreSalmon

        Not true, Brian. The MMR was a completely ethical vaccine. But not any longer in this country. The manufacturing process changed for the rubella component. You can find more information about this at this link: http://www.cogforlife.org/fetalvaccines.htm and here http://bioethics.georgetown.edu/pcbe/transcripts/sept08/deisher_statement.pdf I was a big supporter of vaccinations until I heard what happened with the varicella vaccine. I thought it was only varicella, but I was wrong and the process has spread. It was only after my son told me he had researched the issue with my grandson that I found out about MMR and Hep A.

        • http://www.facebook.com/brianpcurry Brian Curry

           Neither of your, er, “resources” indicate what you seem to think they do.

      • kitten ku’upio

         Wow that makes more sense. 

    • EatMoreSalmon

      Vaccinations were a good thing for many years. The first real problem started with the Varicella vaccine (Chicken Pox shot.)  For many years researchers tried without success to make a safe and effective vaccine with monkey lung cell culture. Researchers in Japan crossed the ethical line and used aborted human fetus lung cell culture and made a vaccine that appears safe and effective. But by crossing the ethical line we have now changed vaccination from being an ethical practice into a practice that is rightfully questioned. We also might well expect that there are going to be serious unforeseen adverse consequences from the use of aborted human fetus lung culture combined with a live attenuated virus like the one in this case. The herpes virus is well known for latency which means that it can rear its ugly head 70 plus years later and cause serious illness. Right now we  do not know what this will mean when this recent cohort of vaccine receipients gets older. The public health authorities don’t tell you about this ethical compromise when you are informed of possible side effects when parental consent is given. This same technique has now polluted the MMR and Hep A, as well as Rabies and others.

    • kitten ku’upio

       Personally I see no problem with using this material. If society says it is alright to abort babies in the first place, why not make use of what their tissue has? If they are not considered human, nor babies, why not?  Same as using fish cells if ask me.

  • DrGetWell

    I said it before,and I will say it again:Immunization is a must!.Having the knowledge that there are side effects from immunization,one have to select the type and method, of immunization that hurts the least.
    As for the question:Which immunization cause Autism,let us remember that brain damage starts in utero.
    Reference:Ming-Chi Lai,Nan Yang:Perinatal Hypoxic-Ischemic Encephalopathy. Review article.Journal of
    Biomedicine and Biotechnology,Volume 2011(2011).Article ID 609813, 6 pages. Hindawi Publishing Corporation.
    It behooves us,the health care providers,to educate ourself first.Our patients deserve a better education,as
    with education one gets collaboration.

    • kitten ku’upio

      I think a larger cause of autism is the surprisingly high number of women who have their first kid in their late 30′s and even later into their 40′s.  I think that is part of theproblem, more so than any vaccine. Face it, the eggs are getting old by that time. In fact, most of the people I know who was born to an old mom, have things wrong with them from the start. Just an observation but why is that so? Some of them have been diagnosed with autism.

  • http://pulse.yahoo.com/_2LRZNHDZS6DU45WQ567LPQ7CMI ninguem

     Close Call, I’ve not seen a jurisdiction that requires more than 30 days.

    Are you aware of geographic areas, insurance contracts, etc., requiring more than 30 days?

    I’d like to know about that.

    • http://twitter.com/#!/CloseCall_MD Close Call

      Ninguem, 
      I’ve heard the 90 days number through certain HMOs (can’t remember which ones).  You’re right that 30 days is the more universal number given.  

      • http://pulse.yahoo.com/_2LRZNHDZS6DU45WQ567LPQ7CMI ninguem

         HMO’s, I understand. They can make up whatever rules they want.

  • http://www.facebook.com/drrogu George Doc Rogu

    Here is a cute little video about diseases long gone .
    It is full of good information that we only read about now in textbooks:

    http://youtu.be/u1xw0Ob5bqs

  • buzzkillersmith

    Not sure how I feel about this one.  On the one hand, you hate to punish kids just because their idiot parents refuse to immunize them.  On the other hand, at some point you might feel you have to make a stand against idiocy–at least in your own practice.  Tough call. 

  • http://twitter.com/Hootsbudy John Ballard

    Wow! Lot’s of comments here. Looks like someone pushed a button.

    I’m not surprised. We are in a time of deep anxiety and fear being fed in no small part by extremists of all kinds but the anti-science crowd deems to have he loudest voice. Forty-plus comments at this site is an unusually large number.

    Thankfully the post was only about vaccinations. If it had included immigration, evolution and global warming heads would be exploding by now.