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The problem of nonmedical exemptions to school vaccine mandates

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220 thoughts on “The problem of nonmedical exemptions to school vaccine mandates

  1. BillyJoe says:

    Dave,

    If that is what SH is saying then why is he disagreeing with me?
    But I don’t think he is saying that. He is saying that he feels it’s justified not to treat some patients at all. I disagree. In my opinion, all generalist doctors should be prepared to treat any patient that comes through the door. And all specialists should be prepared to treat any patient that is referred to him by the generalist doctor, provided that patient falls within his specialty. And I do mean that they should be prepared to do so. I’m certainly not saying that they should be compelled to do so.

    As for rejecting drug addicts: if all doctors had that attitude, where would that patient get any medical treatment for any of his other problems. The specialist in drug addiction will only be treating his drug addiction. Who will take on his other medical problems. Drug seeking behavior by a patient should not be seen as a reason to reject a patient, but should be seen as a challenge as to how to adequately manage that patient.

  2. BillyJoe says:

    Weing,

    “From my understanding, there is no obligation to treat a patient unless it is an emergency. ”

    I’m not talking about obligation. I’m talking about what is the right thing to do.

    “You can always refuse to treat a patient otherwise.”

    And if all your colleagues also refuse to treat that patient, what then? After all they would have as much reason as you to reject that patient.

  3. @BJ,

    Again, your belief that it’s “the right thing to do” is just based on a naive view of medicine. Who are you to say what doctors *should* do?

    And if all your colleagues also refuse to treat that patient, what then?

    You know what? Some people get dealt crappy hands in life. Some people burn every bridge they cross, multiple times. I’ve had tons of patients that didn’t have a single family member or friend as a support system. No one in their family wanted anything to do with them. The patients are physically and mentally disabled, and they end up in basically the worst nursing home that exists. Yes, it sucks, but there’s really nothing that can be done about it. The same may happens for your hypothetical patient that no one wants to take care of.

    Honestly, your naivety of what doctors do, or what some patients are like, is a good thing. It means you are likely rather normal and the fact that certain types of human beings exist is just alien to you. Again, that’s a good thing. Imagine angry patients that end up in jail because they raise hell at doctors offices because something doesn’t go their way. These people have issues that will get them fired from every doctors office. Few, if any, doctors would tolerate patients that threaten their staff. Eventually there will be no one left to see them, and they’ll likely end up back in jail.

    Or drug seeking patients: it’s always very obvious. “Oh yeah, I hurt my back a long time ago. No, I don’t want to go to physical therapy. Oh no, I don’t want Naproxen. Oh, I’m allergic to Ultram. The only thing that worked was something called .. dila… dilahh.. Dilaudid? Oh and Soma too.” These patients get instantly kicked out of clinics, which means that doctor will not see them for any reason.

    And you specifically mentioned my use of the words “high maintenance.” I sure as heck wouldn’t want a CAM-using mother who is going to challenge me on everything I say “Oh, I don’t want to use that antibiotic. It’s not natural.” or “Oh, I don’t want to vaccinate my children, it can cause autism. Oh you should read this website it tells you everything.” or “Oh, I don’t like pills.” or “Oh, I don’t want to do this.” No thank you. I don’t want that kind of patient. It doesn’t suit my personality, and it would not be a good doctor-patient relationship. I can refuse to be this patient’s doctor, and it is perfectly ethical for me to do so, despite your opinion. That doesn’t mean I would terminate my relationship with any patient who uses a CAM modality, but if it interferes with treatment, or patient refuses proven treatment, then, really, what’s the point in continuing a relationship with them? I am too busy to deal with a patient who doesn’t want my help. Let them save their money and go elsewhere.

    … so yeah, ..

  4. weing says:

    “I’m not talking about obligation. I’m talking about what is the right thing to do.”
    Not treating the patient may be the right thing to do. If a patient won’t follow my recommendations, then he is wasting our time. If there is a personality clash, I am sure he can find someone that matches his personality. We are not all alike. If their insurance sucks, you have to make a decision, treat them until you can’t pay your bills and go bankrupt or dismiss them and treat those that compensate you enough to stay in business.

  5. jmb58 says:

    Some examples of times I have declined to treat a patient:

    1. They are verbally abusive to me or my staff.
    2. They broke narcotics contracts.
    3. They refused to lose weight or stop smoking, sabotaging the chance of a successful surgery.
    4. They came for a second elective surgery after not paying a dime towards their first surgery (for which the hospital payed for all hospital costs, I gave them a steep discount on my fee, and offered a monthly zero interest payment plan. We are talking something like $40 bucks a month. Oh, and they had an iPhone).
    5. They were suing one of my partners.
    6. I was too busy.
    7. I didn’t want to do that procedure anymore.
    8. They needed a major operation but refused to receive a blood transfusion. They believe transfusions are wrong, I believe killing someone in the OR is wrong.

    That said, I rarely decline to see or treat a patient. And I never decline to see a patient in the hospital or ER.

  6. jmb58, I’m guessing you’re a general surgeon?

    I just want to point out, for anybody that’s reading, how incredibly lucky we are to have surgeons. These people go through *hell* during residency, only to finally graduate and find themselves in one of the most litigious specialities there are. They, literally, will have patients who have never worked a day in their life, they’ve never made one ounce of effort to take care of themselves, or to do anything good for themselves or for society, never paid a dime in taxes, and have freeloaded their entire life, who get sick and need a procedure that is somewhat (or very) risky, and things don’t go perfectly, so then this useless bag of skin will look at this surgeon as if they are a bank and turn around and sue them. It doesn’t matter that malpractice wasn’t committed – the case may be dismissed or settled – but now this surgeon’s record is dinged, and too many dings and he can’t do surgery any more. All because of some piece of lazy garbage.

    In fact, there is a trend of surgeons refusing to do high risk procedures. And I don’t blame them one bit. Why do something you aren’t intimately comfortable with, or very confident of the success in, if you are only going to be screwed for trying to help someone?

    (jmb, our hospital requires 80% payment up front for self/cash payers. It’s absolutely ridiculous that the hospitals get stuck paying for all this crap.)

  7. Excuse me. By “get sick” I meant suffer from something that is self afflicted. Ie, fat person eats too much, now needs a knee replacement, or a diabetic who refuses to eat healthy or take meds needs an amputation, etc.

    And I don’t mean to sound bitter. I’m just giving real life scenarios. I *really* detest laziness. Almost as much as I detest chiropractors.

  8. BillyJoe says:

    SH,

    Yes, some people get dealt crappy hands in life, but why is that a reason to reject them? Isn’t that kicking the boot in? Really, I don’t understand this attitude from the caring profession. Even if there is nothing you think you can do for them, at least could not reject them. That’s probably something no one has done for them in a long time. But there ARE things you can do for them. Drug addicts suffer from all the conditions that non drug addicts suffer from, from lacerations to diabetes. It just doesn’t make sense to reject them just because they are drug addicts and you can’t or don’t want to treat their drug addiction.

    And there are ways of managing angry or threatening patients. It is possible there are patients with sociopathology that cannot be managed. But they must be a rare exception. Sure there must be many non pathological patients who just have an attitude problem, but the doctor himself might also have an attitude problem which causes him to inflame rather than resolve the situation.

    And the CAM using mother comes to see you for what reason? Maybe she wants real medicine as well? Otherwise why is she there? So why does it matter to you that she insists on using CAM despite you pointing out all the reasons why she should not do so. She is also using real medicine courtesy of yourself. And who knows what you might be able to achieve in the long run? But I don’t get the personality thing. Why should there be a personality clash? Why does personality come into it if you are treating their medical conditions. Surely generalists have to be flexible enough to deal with all sorts of people with all sorts of backgrounds?

    As for insurance, we do not have this problem in Australia. Everyone is covered by public insurance. And private insurance companies have no say in what doctors do. They simply pay the bill (this does not apply to work or traffic insurance however, which is an insight into how crappy your system must be over there).

  9. BillyJoe says:

    SH,

    “By “get sick” I meant suffer from something that is self afflicted. Ie, fat person eats too much, now needs a knee replacement, or a diabetic who refuses to eat healthy or take meds needs an amputation, etc.”

    Nope, I don’t get this attitude. They are still people. Do you think they enjoy being fat, having an arthritic knee, being diabetic, having an amputation? People don’t choose to be lazy and fat. They just are. Most people hate exercise. If they are thin, fine. If they are fat, bad luck.

    There is a family friend who is like this. She is obese, smokes, and eats junk. By thirty five she had diabetes, by forty she had triple bypass, and six months ago she has had her right leg amputated. You could say all her conditions have been self inflicted, but maybe this is just the way things are for her. But the treatment she has received from her generalist and specialists have meant that she is still alive today. And her family and friends are all very grateful for that.

  10. mousethatroared says:

    SkepticalHealth – clearly not the guy to invite to the Jimmy Buffet concert.

  11. jmb58 says:

    @billyjoe

    Insurance is just part of the issue. We are trying to convey that there are many reasons to decline to treat someone.

    Regarding my poor attitude (or maybe SH’s bad attitude). You are right, this profession does involve caring. I cared enough to choose it. I’ve cared enough to make a lot of personal sacrifices for my patients, as have my wife and kids. I get to say “no” sometimes. And I don’t feel an ounce of guilt.

    @SH

    Thanks for the shout out.

    Every surgeon I know has wanted to quit at some point thanks to a frivolous law suit. Luckily, it’s just so damn fun cutting people open.

    Equal props to all the great primary care docs out there. Wish we had more of you and less lawyers.

  12. BillyJoe says:

    1. They are verbally abusive to me or my staff.
    Do you and your staff now know how to deal with abusive patients so as to avoid a repeat.

    2. They broke narcotics contracts.
    Did you make another contract and try again? If not, did someone else have a go? Or did everyone just give up?

    3. They refused to lose weight or stop smoking, sabotaging the chance of a successful surgery.
    Or they couldn’t lose weight or stop smoking. There are people who can’t move without getting breathless and who still smoke. If this means surgery is contraindicated so be it. That’s the way it is. There’s no point in blaming the patient.

    4. They came for a second elective surgery after not paying a dime towards their first surgery.
    Fair enough. We don’t have that problem here. Iv they are not insured, they can be referred to a public hospital who pays the specialist’s bills.

    5. They were suing one of my partners.
    That would be difficult, even if your partner was at fault and the patient’s claim entirely legitimate. If you felt that this would interfere with your management of the patient on an emotional level, it would seem reasonable to suggest the patient attends another clinic.

    6. I was too busy.
    No one expects you to work at a level you don’t feel comfortable with. That would compromise your mental health and therefore the care you provide to your patients.

    7. I didn’t want to do that procedure anymore.
    Again, no one expects you to work outside your confort level.

    8. They needed a major operation but refused to receive a blood transfusion.
    If the pros and cons of doing surgery was swayed against doing surgery because of this, then there is really no problem. Patients cannot insist you carry out surgery that is not recommended. Emergency surgery, of course, would be another matter.

  13. @BJ,

    Of course, you missed the entire context of my post: that people who have never done a thing to better themselves in their entire life get sick because of their own choices, and then turn around and sue because someone couldn’t magically put them back together again.

    Obviously, I object to your baseless statement that people are “just fat.” I’m not Einstein or anything, but I feel pretty confident in stating that it takes a certain daily caloric intake to maintain morbid obesity. I’ve never seen an obese person who was starving. You remind me of someone who posted here recently blaming television advertisements for making junk food look so tastey for the obesity epidemic. At some point, we have to look at the person who consumes liters of sugary soda and fast food all day and say “Hey, it’s your fault your fat.” Besides, how are you going to effect change in their life without having them take responsibility for themselves? Your own anecdote is a great example.

    I actually see nothing wrong with saying that some people are lazy and mostly useless and are drains on society. Sure, they have loved ones, but that doesn’t excuse the fact that they are ultimately responsible for their own well being, and that the majority of their health issues are indeed self inflicted. Why is that so bad? Why is it bad to ask a person to take responsibility for their actions? Why do we (you) feel compelled to insist that fat people, who eat terribly and cause cardiovascular and metabolic disease for themselves, aren’t to blame?

    Again, just like your other post, it’s just based in naivety. You certainly are never at a loss for sharing an opinion for something which you know nothing about.

    @MIM,

    I attended a Jimmy Buffet concert on an island while on vacation a number of years ago. He was playing from a dock in the ocean and we all sat on the beach and listened. Phenomenal! :)

  14. BillyJoe says:

    “Regarding my poor attitude (or maybe SH’s bad attitude). You are right, this profession does involve caring. I cared enough to choose it. I’ve cared enough to make a lot of personal sacrifices for my patients, as have my wife and kids. I get to say “no” sometimes. And I don’t feel an ounce of guilt.”

    I understand that completely. And neither should you feel any guilt for wanting a balance between work, family, and leisure. But I’m talking about rejecting certain types of patients. I cannot see how that can be justified (you’re a drug addict, okay out you go, I don’t treat drug addicts, take your diabetes elsewhere).

  15. @BJ

    2. They broke narcotics contracts.
    Did you make another contract and try again? If not, did someone else have a go? Or did everyone just give up?

    3. They refused to lose weight or stop smoking, sabotaging the chance of a successful surgery.
    Or they couldn’t lose weight or stop smoking. There are people who can’t move without getting breathless and who still smoke. If this means surgery is contraindicated so be it. That’s the way it is. There’s no point in blaming the patient.

    (DEEP BREATH, TRYING NOT TO CUSS YOU OUT.)

    You are just clueless. God, every post you make just reveals this. A doctor would be a fool if they give a patient a second chance after they find out their patient is doing something abnormal with their narcotic prescriptions. That exposes a doctor to so much liability. “So, you knew that your patient was not taking his pain medications, but you kept prescribing them anyway?”, or “So, you knew that your patient was getting pain medications from 4 different doctors in the state, but you kept giving them to him?” No way in hell. There are no second chances. Besides this, you are so clueless (not meant as an insult), that you don’t understand *why* a patient breaks a narcotic contract. They’re either drug addicts, or they are selling the pain meds for a profit. Yes, these scumbags that I keep talking about, that you don’t believe exist, abuse the tax payer-funded healthcare and get pain medications for free, and then turn around and sell them on the street.

    And for the #3, how can you not blame the patient? For certain diseases, like COPD, there’s only a handful of things we can do that increase survival. One of them is smoking cessation. How can you not blame the patient if they refuse to stop smoking? Of course that’s their fault. Who else are you blaming there? The cigarette advertisements? Celebrities from the ’60s for making cigarettes look cool? In general medical treatment, of course you’ll still treat them, and offer medications to help them stop smoking, but ultimately the patient is to blame. In surgery, it’s a different world. There are multiple co-morbidities that increase a patient’s chance of mortality during surgery. Smoking, excess weight, poor diabetic control, high blood pressure, peripheral vascular disease, etc, all increase the risk of surgery. How fair is it to ask a surgeon to operate on a very unhealthy patient when it’s only going to increase the likelihood of post-op complications and increase the risk of a lawsuit?

    I just can’t accept this point of view that people aren’t to blame for their own decisions.

  16. BillyJoe says:

    SH,

    Do you allow lawyers to direct your practice of medicine? Do you really assess every patient from the point of view of whether they are likely to sue you and reject those who you think may do so?

    As for rejecting the notion that people are “just fat”, I guess you believe in the notion of free will ;)

    But seriously, there are genetic influences and environmental influences that make everyone what they are. The environment includes other people, including you. What people end up doing is the result of both genetics and environment. What else is there? Some people, as you said yourself, are just dealt a crappy hand. Your influence could make that hand eitheR crappier of better.

    Fortunately for that family friend, the influence of her generalist and specialist was to make her life better, despite the crappy hand she was dealt.

  17. @BJ

    I cannot see how that can be justified (you’re a drug addict, okay out you go, I don’t treat drug addicts, take your diabetes elsewhere).

    That’s because you have zero experience ever dealing with such a patient. When you have a drug addict in your office, the last thing they are going to be interested in is achieving an optimal A1C level for diabetic control. All you will hear about is “Oh my back hurts. I don’t want physical therapy, and I’m allergic to tylenol, advil, naproxen, and ultram. The only thing that works is Lorcet & Soma.”

  18. weing says:

    “Do you really assess every patient from the point of view of whether they are likely to sue you and reject those who you think may do so?”

    I think SH is referring to inappropriate prescribing of narcotics. It’s not a question of being sued but a question of losing your license to prescribe.

  19. BillyJoe says:

    SH,

    Regarding drug addict contracts:

    I don’t know what sort of a system you have over there but, in Australia, there is a department of health hot line for doctors to discuss the management of any patient with a drug adduction problem, or who they suspect has a drug addiction problem. They can be rung at any time and they can issue permits over the phone for treating patients with drugs of addiction. They also scrutinize prescriptions written by other doctors for a patient for whom another doctor holds a permit. It is also illegal for a doctor to prescribe drugs of addiction to any patient who they suspect of having a drug addiction problem. This includes any patient they have not seen before who comes in requesting a prescription for a drug of addiction. In that case they must ring the department and obtain a permit, which will obviously be refused if another doctor already holds a permit.

    So there is no problem giving a patient with a drug addiction problem another chance. All it requires is a phone call. In fact, it is preferred to dismissing the patient and having him going along to see yet another doctor who knows less about him that the original doctor and will likely have even less success managing him.

    I’m talking here about patients with genuine pain who become addicted to narcotics. Otherwise the patient must be treated by a drug addiction specialist who holds a permit to prescribe methadone or suboxone. The aim here is containment. Some do get off narcotics eventually and some die of overdoses, but the aim is the prevention of drug related crime. The aim is to protect the general population against assault and robbery.

  20. BillyJoe says:

    Weing,

    Nope, SH was taking about being sued:

    “Of course, you missed the entire context of my post: that people who have never done a thing to better themselves in their entire life get sick because of their own choices, and then turn around and sue because someone couldn’t magically put them back together again.”

  21. BillyJoe says:

    SH ,

    “When you have a drug addict in your office, the last thing they are going to be interested in is achieving an optimal A1C level for diabetic control. All you will hear about is “Oh my back hurts. I don’t want physical therapy, and I’m allergic to tylenol, advil, naproxen, and ultram. The only thing that works is Lorcet & Soma.”

    Hence the contract.
    The drug addiction specialist will treat your drug addiction problem. I will treat everything else.

  22. The Dave says:

    All this talk about rejecting drug addicts is ridiculous because BillyJoe obviously has zero understanding about the whole thing. We are talking about people going to the doctor only to try to score more pills. They are not presenting with anything else (diabetes, whatever) They don’t want to be treated for anything, they just want to see if that particular doctor will write him a script for a CII. Of course a doctor is not gonna give them a second chance, and it has nothing to do with being sued. As SkepticalHealth said, the liability of doing that is huge. And it has nothing to do with being sued, but being stripped of your licence and spending time in jail. Pharmacists have the legal right and obligation to refuse to dispense to someone who is suspected of being a junkie. Some states even have an electronic Controlled Substance Database that physicians and pharmacists can access to see if a patient’s identifying info pops up with a hit of possible CS abuse.

  23. weing says:

    BJ,

    Oh, I see what you’re referring to. Unfortunately, there are patients like that.

    “The drug addiction specialist will treat your drug addiction problem. I will treat everything else.”

    That kind of patient is generally a no-show. I fire them from my practice. Maybe they will take their problems seriously with the next doctor. Here, you can get sued for not imparting the seriousness of their illness to them. “My doctor didn’t do anything when I didn’t go for the ordered tests, or didn’t show up for follow up, so I thought they weren’t important. Now look at me. It’s his fault.”

  24. jmb58 says:

    If only we had this wonderful drugs of addiction hotline, all my problems would be solved.

    “Do you and your staff now know how to deal with abusive patients so as to avoid a repeat”

    Yes, we tell them if you are going to be an ass you can leave.

    “If they are not insured, they can be referred to a public hospital who pays the specialist’s bills”

    For elective stuff? Hang on……Ouch, I just pulled an abdominal muscle due to excessive laughter.

    @Billyjoe, in a way I appreciate where your heart is at. I confess to some cynicism, 15 years on the frontlines of medicine will do that to you.

    I’m going to bed. Gotta operate tomorrow on a guy that just couldn’t stop smoking. (seriously)

  25. mattyp says:

    I got my DTaP vaccine yesterday in preparation for my partner to have our second child. This is an issue in Sydney (would you believe), and on the north shore of the harbour, due to poor herd immunity due to lower than normal vaccination rates.
    Jab up people!!!

  26. mousethatroared says:

    SkepticalHealth-I thought the wasting away in Margaritaville theme would do you in…all that laziness.

    wrong again.

  27. mousethatroared says:

    jmb58 2. They broke narcotics contracts.

    BillyJoe “Did you make another contract and try again? If not, did someone else have a go? Or did everyone just give up?”

    The point to having a contract is that there is a clear consequence for breaking it. If the drug addict knows they will continue to get more chances without consequence they will definitely continue using.

    If a doctor in AU can’t prescibe addictive drugs to someone they suspect of addiction, then how are they supposes to preform surgery on that patient? Do they just give the patient a leather strap to bit on for post-op care?

    If they get a permit to prescribe a narcotic to the patient, but the patient is clearly getting drugs elsewhere…on the street or from some off shore website, do they go ahead and schedule the surgery knowing that the patient will have unknown quantities of street drugs floating around in their system and will be augmenting their recovery tylenol with codeine with whatever (meth, oxycontin, heroin, alcohol)?

  28. regit says:

    Is it any wonder that people are reluctant to have their children vaccinated. statistically vaccination can seem to be a good thing, depending on who is projecting their particular point of view. On an individual level perhaps not so. ( all recent cases of polio in the usa are attributable to the vaccine, actual effectiveness of BCG, influenza etc: ). The possibility of helac or other contamination.

  29. mousethatroared says:

    By the way, the addicts I have known generally don’t have a problem getting treatment for non addiction related medical problems such as thyroiditis, if they are keeping thing together enough to seek medical care for the problem. If they are too far gone to take good care of themselves, then what they need is a treatment program or mental health services to help get them back on track. A GP, internist or surgeon doesn’t really have the right skills for that job.

    BillyJoe – you seem to think there is a problem of people being “fired” by multiple doctors then having no where to go for treatment. Just because something could happen, doesn’t mean that it happens or happens enough be a noticeable problem. Do you have any evidence that doctors firing non-compliant, verbally abusive or drug addicted patients results in poorer outcomes? Because as far as I can see, it’s just as likely to result in better outcomes.

    Patient calls Dr. A’s nurse a bad name. Dr. A fires patient. Patient has to go to the trouble to find another doctor and wait for appointment, perhaps trys to be nicer to medical staff as a result, thus possibly gets more out of his medical care due to a better relationship.

    In my mind that is a more likely scenario than a patient verbally abusing every nurse in a 60 mile radius and ending up with no doctor to treat his asthma.

  30. BillyJoe says:

    Okay, here is how I see the situation:

    There are two types of patients with drug addiction problems
    - patients who are simply addicted to narcotics.
    - patients who are addicted to narcotics, or who need narcotics, as a result of a medical condition.

    In Australia, the first group are treated by drug addiction specialists. That specialist is usually a GP who has undergone specific training in the management of patients with drug addiction. He has a certificate that enables him to prescribe methadone or suboxone. When he sees the patient for the first time, he applies for a permit to treat that patient with either methadone or suboxone.

    The second group are treated by GPs. The nature of the underlying medical condition must be documented and the doctor must determine that the drugs of addiction are necessary for the management of the pain associated with that medical condition. When he sees the patient for the first time, if he decides to treat the patient, he applies for a permit to treat that patient with a drug of addiction other than methadone or suboxone.

    GPs also treat the first group of patients for all their other medical problems because the drug addiction specialist treats only their drug addiction problem, just like a surgeon only sees patients who may require surgery.

    So. What is the problem?
    The only problem I see is if too many GPs decide that they will not treat any patients with drug addiction problems. That means those who do with be overburdened with such patients. If then then also opt out, patients with a genuine need for narcotic analgesics will not be able to find a GP to treat them.

    As for breaking contracts, this must happen with every drug addict. You would have to be naive to believe otherwise. So, not giving a drug addict a second chance is tantamount to not treating them at all, because they are all going to eventually break the contract. Just put stricter controls in place. The health department also has a doctor shopper list and and any patient can be put on this list. If another GP prescribes narcotics to this patient, both he and the doctor with the permit is informed of that fact. It is also expected that drug addicts with obtain street drugs. Theres not much than can be done about that, but the thing is, if the patient is obtaining their drug on a regular basis for legal channels, the use of street drugs in minimized. And so is the attendant crime, which is actually the point of treating drug addicts.

    So, the real problem, as I see it, is doctors who opt out of treating these patients.

  31. The Dave says:

    I think I agree with what you say about addicts seeking treatment. They should totally be treated, or refered to a specialist who can. But, the drug addicts we are talking about are not the ones seeking treatment for their drug addiction. We are talking about the ones that are seeking “treatment” just to get another bottle of pills. If they want to be treated, go ahead and try. If they are just looking for a hit, you would be foolish to try to treat them, and, as mentioned earlier, run the risk of disciplinary action.

  32. mousethatroared says:

    SkepticalHealth “I feel pretty confident in stating that it takes a certain daily caloric intake to maintain morbid obesity. I’ve never seen an obese person who was starving. You remind me of someone who posted here recently blaming television advertisements for making junk food look so tastey for the obesity epidemic. At some point, we have to look at the person who consumes liters of sugary soda and fast food all day and say “Hey, it’s your fault your fat.” Besides, how are you going to effect change in their life without having them take responsibility for themselves?”

    I feel this may be an oversimplification of the problem. It is similar to dealing with an anorexic, it’s clear that they are not consuming enough calores to maintain health. But “blaming” or “holding them responsibly” for their decisions only goes so far. Clearly there is often a mental issue that is standing in the way of the anorexic’s ability to make healthy decisions. It seems to me, successful treatment is often a combination of holding the patient responsible AND treating the mental health (or lifestyle) issues that are undermining their success. I’m not sure that we really have a good enough grasp on the diagnoses and treatment of eating disorders to say we can fully support the treatment aspect of that combination. Did an anorexic, drug addict or obese person die because we don’t have effective enough treatments for their mental disorders (or they did not recieve the appropriate treatment) or did they die because they didn’t make enough effort? Maybe all one or the other or a mixture of both.

    Also, coorporations make a great deal of money selling things like soda and hohos. If the sale of those items contribute to a national health problem that costs tax payers money, it seems to me they have some responsibility to those tax payers. I have no problem charging them taxes to offset the negative impact. If they, in turn, increase the price of soda and hohos, then that’s not such a bad thing in my mind. My point being, if you profit from the sale of a product, you should have some responsibility for the effects of that product. The responsibility should not rest only on the buyer.

    But that has little bearing on whether doctor’s should fire patient’s or not. If a doctor dislikes a patient because they think they are irresponsible or lazy, they probably shouldn’t be treating that patient. IMO

  33. mousethatroared says:

    BillyJoe – I don’t think you answered my question. Should a doctor perform non-emergency surgery on a patient that they know or suspect is using an unknown quantity – quality of drugs acquired on the street or online?

  34. Calli Arcale says:

    regit:

    Is it any wonder that people are reluctant to have their children vaccinated. statistically vaccination can seem to be a good thing, depending on who is projecting their particular point of view. On an individual level perhaps not so. ( all recent cases of polio in the usa are attributable to the vaccine, actual effectiveness of BCG, influenza etc: ). The possibility of helac or other contamination.

    The vaccine schedules are written with an eye towards the community’s point of view, but the vaccines are only approved based on the *individual* point of view. We all talk about how it’s important to do your bit for the community by getting vaccinated, and I do think that’s true, but drugs aren’t licensed based on the good they do to the community. They can only be approved if they provide a net benefit to the patient for the licensed indication. That is, you can’t license Gardasil to be given to boys for prevention of cervical cancer (though obviously it will help with that); you can only license it to prevent a disease they might actually be able to get. Consequently, although all the focus has been about community prevention of cervical cancer, the vaccine is actually only given to boys on the basis that it will prevent penile, anal, and throat cancers. (It will also prevent genital warts, but as these are not life-threatening, nobody’s applying for that indication.)

    So. Vaccines *are* beneficial on an individual level, unless the individual has a rare contraindication for the vaccine. For instance, people who are allergic to eggs should not receive the influenza vaccine; it is not individually beneficial to them since it will give them an allergic reaction and possibly a life-threatening one.

    Polio in the US is not caused by the vaccine. It is not possible for the vaccine given in the US to cause polio; it is not a live vaccine. The live vaccine is used in some countries where it is impractical to use the inactivated poliovirus vaccine. Also, the live vaccine is more effective than the inactivated one, especially when polio is still endemic. As it has a small risk of causing polio, all nations with extirpated polio and the resources to provide inactivated polio vaccine have switched over. The US switched over many years ago.

    BCG and influenza effectiveness…. Effectiveness of vaccines is variable. Some are more effective than others, and then there’s the question of what you mean by “effective”. Pertussis is a good example. It’s one of the less effective vaccines, and immunity wanes rather rapidly. (This is also true of immunity due to the actual infection, so part of this is a fundamental problem with pertussis immunity, and a real challenge for vaccine manufacturers to puzzle out.) Today, we use an acellular pertussis vaccine that cannot cause pertussis and consequently is safer than older vaccines; this is safer but also less effective. It’s over 50% effective; it will definitely improve your odds, and on balance is worthwhile for the individual, but don’t expect perfection out of it, and make sure you get boosters whenever you go in for your tetanus boosters. Influenza is another good case to look at. Unlike pertussis, this vaccine is remarkably effective at producing the desired immunity — in healthy subjects, it can be over 90% effective at producing the desired immunity. The problem is that influenza mutates so rapidly that it’s very difficult to tell whether that immunity will actually be particularly useful in the real world. Have you just gotten vaccinated against an influenza that will go extinct in a month, while a totally novel one will pop up and infect you in two months? To combat that, manufacturers usually include three different antigens, for three different strains, and they work with epidemiologists to try to predict which strains are most likely to trigger epidemics in the next year. As with weather forecasting, sometimes their predictions are better than other times. This is also why annual vaccination is recommended; the mix is changed year to year. Some years they repeat last year’s, but usually there’s something new.

    HELAC contamination — you mean HELA cells? These are cell lines used to study cervical cancer and for other purposes. (They happen to be cervical cancer cells, but cervical cancer cells are so much like other cells that they’re useful for lots of stuff.) Immortalized cell lines such as this can also be used as vaccine growth medium. The cells themselves do not get into the vaccine, but obviously some tiny fraction of their material might, just as with chicken egg “contamination” in influenza vaccine. (I put it in quotes because to my mind, that’s not really contamination. It’s an expected component.) I don’t think this is a serious concern. Neither is the concern about possible contamination with monkey kidney cells; some of the immortalized cell lines used for growing vaccine antigens are from monkey kidneys. They don’t keep the whole cells. There would be no reason to.

  35. BillyJoe says:

    Dave,

    As I mentioned before, in Australia, this is not a problem. There is the health department hotline and doctor shoppers list which all GPs can access during the patient consult. If you conmmunicate with the health department and guide your actions accordingly, they are not going to be prosecuting you.

    Also this whole discussion started with SH saying he does not treat patients with drug addiction problems, which includes not treating their other medical problems. I consider this unjustifiable and nothing anyone has said really convinces me otherwise. Maybe the hurdles are greater in the USA, though no one seems to be saying how they are different.

    Drug addicts are still people and, as SH says, they have been dealt a crappy hand in life.
    The medical profession cannot really just toss their hands in the air and not deal with it.

  36. BillyJoe says:

    Michele,

    “If a doctor dislikes a patient because they think they are irresponsible or lazy, they probably shouldn’t be treating that patient.”

    You actually have to wonder at a doctor who lets his emotions or philosophy get in the way of treating a patient.

    As to you question, I didn’t answer it because I couldn’t see how relevant the question was. But I will see where this leads. If a patient needs an operation, he should have that operation, and the fact that he has a drug addiction problem should serve only to take that into account when it comes to post-operative analgesia. There would need to be strict criteria about how much and how long treatment is continued until the patient is referred onto a drug addiction specialist.

  37. mousethatroared says:

    BillyJoe – How do you safely anesthetize someone who is taking an unknown quantity of an unknown drug?

  38. mousethatroared says:

    BillyJoe “You actually have to wonder at a doctor who lets his emotions or philosophy get in the way of treating a patient.”

    Well no. I’d worry about someone who is doing a bad job because their emotions are in the way and is oblivious to the fact. But I’m fine with a doctor that recognized that they’re emotions are in the way and is honest with the patient, thus giving the patient an opportunity to find a doctor they can work with.

    It’s like saying you have to wonder about a doctor who can’t treat a family member because emotions get in the way. Of course emotions get in the way. One just has to find an acceptable way to deal with that.

  39. lilady says:

    @ regit:

    “Is it any wonder that people are reluctant to have their children vaccinated. statistically vaccination can seem to be a good thing, depending on who is projecting their particular point of view. On an individual level perhaps not so. ( all recent cases of polio in the usa are attributable to the vaccine, actual effectiveness of BCG, influenza etc: ). The possibility of helac or other contamination.”

    When was the last case of OPV causing polio in the United States? Why did the United States discontinue the use of OPV…and implement the exclusive use of IPV vaccine?

    When was the last time a child was given BCG vaccine in the United States? Why is BCG vaccine not given to infants in the United States?

  40. @BJ,

    I *NEVER* stated that I wouldn’t treat someone with drug addiction problems. I stated I will not be a doctor for drug seeking patients. I’ve taken care of numerous people in the hospital who are drug and/or alcohol abusers. As long as they aren’t lying to me trying to get narcotics, I’m happy to treat them. Heck, probably 1 in 20 people with chest pain is due to cocaine use.

    The funniest conversations are when you already have a positive urine drug screen, and you say “so, when was the last time you used cocaine?” and they say “I would never use cocaine!!!” :) I always explain “I am not the police. I don’t care what type of drugs you have used recently. I only need to know what you’ve done so that I can figure out what caused you to come in and treat your properly.” And I stand by that.

    … There is a funny… or disturbing… side to health care. We routinely see prisoners brought in with extraordinary problems, only to have their charges dropped when the medical bills start to pile up. Why? A prisoners medical expenses are paid by the state (or county, whatever), so they can simply drop charges and leave the prisoner responsible for the charges. Now, if you think the typical prisoner has health insurance, you’re wrong, and now the hospital will usually end up eating the bill because the prisoner won’t pay. But it’s disturbing nonetheless.

    Anyway, I didn’t really read the rest of your posts, sorry. I’m just not really interested in your beliefs about healthcare, considering you have zero experience in the field.

  41. jmb58 says:

    IV drug users have a high prevalence of Hep C, MRSA, and HIV (although its the Hep C I worry about the most). Often times undiagnosed. That means I am risking my career (should you keep practicing surgery if Hep C positive? probably a discusion for another time), my life, and the lives of my OR staff. Just something to consider.

    @Calli Arcale

    Thanks for the reponse to regit.

  42. BillyJoe says:

    SH,

    That’s okay, I didn’t read your last post at all. :l

  43. BillyJoe says:

    Michele,

    Yes, thats’s even worse.
    But I do wonder about a doctor who lets his emotions or philosophy get in the way of treating a patient,
    Seems to me he should be doing something else.

  44. BillyJoe says:

    Michele,

    “BillyJoe – How do you safely anesthetize someone who is taking an unknown quantity of an unknown drug?”

    Are you saying that patient’s with drug addiction problems never receive elective surgery?
    Can you provide a reference?

  45. mousethatroared says:

    BillyJoe – “Yes, thats’s even worse.
    But I do wonder about a doctor who lets his emotions or philosophy get in the way of treating a patient,
    Seems to me he should be doing something else.”

    Oh well, those statements aren’t contradictory. It’s just a matter of degree. The way SH talks he dislikes all people who have a preventable disease. If he refuses to work on people he dislikes, he might have to find something else to do.

    You know I particularily love it when he says he won’t read people’s comments…because having the opportunity to talk about him when he can’t respond is such a hardship. Perhaps next he’ll start ranting about the number of lives he’s saved.

  46. mousethatroared says:

    BillyJoe – regarding elective surgery and drug addiction. I’m saying that elective surgery on someone who is abusing drugs is probably more risky than elective surgery on someone who is in at least a period of recovery from substance abuse.

    If the drug addict was my family member, there are a lot of scenarios where I would rather see the surgeon refuse to the preform surgery than have them go ahead with a higher risk surgery and recovery.

    You have to consider the risk/benefit for that particular patient at that time. You also have to consider that the patient may go into recovery in 6 month or a year. In fact wanting to have a surgery that elevates pain or discomfort may prompt them to seek help. Finding another surgeon when they are in recovery may be a far safer option for that elective surgery.

    You know, I really feel that SH’s focus on the small percentage of people who are sociopathic and litigious, completely distracted from the idea that folks with active and serious drug addictions are just not good candidates for surgery at that time. And, yes, like jmb58 noted, they can increase risks for those treating them and other patients.

    Like many other serious health conditions it may be better to get that condition under control before preceding with elective surgery. Unlike many other health conditions, it may be difficult or impossible to maintain a constructive relationship with a drug addict until they are stabilized in recovery.

    Of course, I’m not speaking as a medical person. I’m speaking as a sister, aunt, granddaughter and niece of those who have had serious substance abuse problems. (not that it’s genetic or anything :))

  47. BillyJoe says:

    ” Perhaps next he’ll start ranting about the number of lives he’s saved.”

    You must have missed it. :D

  48. mousethatroared says:

    Which time?

  49. BillyJoe says:

    Sorry, I can’t remember where but it was fairly recent. He was complaining about an altmed practitioner boasting how he had picked up conditions missed by the mainstream through his thirty year career. SH boasted he saves lives every day. I’m not saying he doesn’t, of course, I have no way of knowing, but I have to wonder as someone who accuses someone else of lying (I’m referring of course to nybgrus). Sometimes it turns out to be a home truth.

  50. mousethatroared says:

    Sorry BillyJoe – I was being factious. Meaning, he’s referred to the number of lives he’s saved a few times.

  51. I don’t get the notion of religious exemption. Which religion forbids vaccination? All major religions are over 1300 years old, mainstream Protestantism 400. Jenner’s variolation is 200 years old. No religion can possibly forbid it. Unless you are referring to a religion that started in the 19th century, like Theosophy, Christian Science, or Scientology. All of which are rather cultish and not mainstream. And you are going to provide religious exemptions, you are de facto privileging those cults (since Islam, Judaism, Sikhism, … do not forbid vaccination). Oh, and you’re very much discriminating against atheists too.

  52. @Francois,

    I don’t know, but I would guess Jehovah’s Witnesses. That’s a guess, and I’m on my iPad so I don’t want to Google it. They may be fine with it.

  53. Harriet Hall says:

    Christian Science is against vaccination because they don’t believe vaccine-preventable diseases are real and they believe that the illusion of illness can be “healed” by prayer and proper thinking.

    And people have claimed religious exemptions when there was no clear evidence that their particular religion required them. They provide a good “excuse.” There was even a chiropractor who wanted to establish his own religion just so his patients could use it to avoid vaccination.

  54. The Holy Church of the First Subluxation
    Ye who manipulates is one with The Lord.

  55. lilady says:

    @ Harriet Hall: I have to go offline for a few hours. I think you might find this multi-state outbreak of measles, “interesting”..

    http://www.cdc.gov/mmwr/preview/mmwrhtml/00031788.htm

  56. Narad says:

    I don’t know, but I would guess Jehovah’s Witnesses. That’s a guess, and I’m on my iPad so I don’t want to Google it. They may be fine with it.

    It’s been a matter of personal conscience since the ’50s. The house organs were strongly opposed to vaccination before abandoning this position, some would say over concerns about drawing legal attention.

  57. auntie51109 says:

    Perusing these comments makes me eternally grateful that my children are grown and that I no longer have to deal with pompously condescending demeanor of many allopathic doctors. Our children are becoming disabled and dying at alarming rates and you would rather fight with your last breath to insist that you are right rather than look at potential causation. I am grateful every single day that my daughter insisted on doing her own research on Gardasil statistics and side effects instead of blindly following her gyn’s recommendation.
    The majority of recently documented cases of whooping cough are increasingly of those who have been fully vaccinated. That a parent’s sincere concern for the efficacy of this vaccine v. potential harm is met with only a derisive tone does not instill trust or confidence that one may be receiving advice indicative or health or care.

  58. The Jehovah’s Witness sect was also founded in the 19th century, like Theosophy, Mormonism, Christian Science. Well, when you come to think of it, a lot of weird, reactionary stuff came out of the 19th century (homeopathy, modern acupuncture, chiropractic).

    Disclaimer: I am not affiliated in any way with the medical or pharmacological fields. I’m a literary translator and writer (whose field of interest is not even science).

  59. @auntie51109: As I have mentioned, I am not affiliated with the medical and pharma fields, not even remotely (I am even using my real name, which you can Google. The first 19 pages more or less refer to me, with the exception of Jean-François Luong in San Jose, who is a doctor, unrelated to me). What I find interesting is that the anti-vax movement is strongest in the US, where science education is rather insufficient (but also where there aren’t that many regulations), compared to other Western countries where science education is much stronger, like France or Sweden. So my hunch is that much of the antivax movement stems from this scientific illiteracy. Quite frankly, I would rather trust someone who has spent 7 excruciating years getting their medical degree, than someone who “did some research” on Gardasil on the Internet.

  60. Also, after a little bit of “research”, it turns out that Sweden has a DTP vaccination rate of 98%. Same thing for France.

  61. Harriet Hall says:

    @auntie,

    It’s easy to find reports about the statistics and side effects of Gardasil on the Internet. It’s not so easy to understand what those reports (VAERS, etc.) really mean and to put them into context. I “did my own research” too: I read all the pros and cons on the Internet and in the medical literature and I decided to have my daughters vaccinated.

    It’s also easy to misinterpret the information about the recent whooping cough outbreaks. The risk of infection is greater among the unvaccinated than among the vaccinated. The higher number of cases among the vaccinated is only because there are far more vaccinated children. The protection is incomplete and is being addressed by new booster policies and research on better vaccines. http://www.sciencebasedmedicine.org/index.php/whooping-cough-epidemic.

    The unarguable fact is that the risks of vaccination are very small and the risks of not vaccinating are much greater. Parents’ concerns about vaccine efficacy and safety have been respectfully answered over and over. If you perceive “derisive tone,” it is probably derived from frustration that clear evidence has been repeatedly explained but is still not accepted.

  62. auntie51109 says:

    @ Francois: The United States has the highest number of mandated vaccines for children under 5 in the world but is 34th in the world for mortality rate of children under the age of 5. That no discussion should be allowed to address the increase of both aspects, I find egregious. I suppose to a writer, data may simply be numbers reflecting information. And data is good to have and should certainly be referenced, of course. I suspect the data becomes more relevant to a parent on the bad side of the percentage. My children are 4 years apart and even in that short time, the vaccination schedule of the second was greatly increased from my first. And yes, the second has learning disabilities that the first does not. Are the two facts related? I honestly don’t know, but that alternative slower vaccination schedules or the particular child’s sensitivities be completely off the table for discussion, I find offensive. As for doctors, I am admittingly biased. Autoimmune diseases seem to run in my family and my experience these past 3 years was less than stellar. All my allopathic docs offered was one drug after another, with no relief of symptoms. I saw my sisters’ struggles with MS, diabetes, Hashi’s, vitilago, and RA as my own future and that was pretty darn depressing. The most recent doc insisted that I was “fine” because my TSH numbers said so. The fact that my symptoms did not improve and that I still felt like crap mattered not one whit to him and the fact that I would not take a cholesterol control medication infuriated him. My doctor fired me! lol
    I can laugh at that easily now because my symptoms improved when 1) I stopped seeing him and stopped taking the pain, sleeping, and depression drugs he was peddling 2) took responsibility for my own health and did my own research and subsequently made specific nutritional changes. The results are that my cholesterol and trigs dropped well into the normal range within two months, I could once again sleep all night, depression and joint pain completely disappeared. My autoimmune numbers, though still elevated, are less than a third what they were and I feel healthier and younger than I did 4 years ago. Do I think doctors are well educated and have access to a wealth of invaluable knowledge? Absolutely. But they cannot all know everything and they all would provide a better service were they to check their egos at the door and not be afraid to listen now and again. Perhaps this would allow us to all learn a bit more together.
    P.S. I have not had a flu shot for three years and haven’t had a cold since I stopped. Actually, I haven’t been ill at all other than a brief bout from food poisoning. But…my office mates that had flu shots all got ill within the week of receiving them. Yes, I know that’s hardly a blind study or volumes of data. But I do find it interesting.

  63. You always know someone is a goober when they start going on how they’ve never been ill. So, auntie, which form of CAM do you practice?

  64. @auntie: Actually, the country with highest number of mandated vaccines is France, where it is very much the law to receive certain vaccines. The official vaccination list from the CDC is not mandatory, it’s only a list of recommendation.

    As for your other comments, I have degrees in Mathematics and English Lit. I am also a father. But that being said, I have a higher level of scientific literacy than the average American. So no, numbers are not obscure data to me.

  65. auntie51109 says:

    I don’t have the faintest idea what CAM is and I didn’t claim I’d never been ill. I was actually quite ill as a child. I said I haven’t been ill in the past three years and I haven’t, barring the food poisoning. Pardon me for being grateful that my chronic symptoms were finally alleviated. So I’m a “goober” to have the audacity to express concern or an opinion…Hmmmm…There’s that derisive tone again, even if on the immature side. Good heavens, I didn’t even go to college and yet attempted to participate in a medical discussion? What was I thinking?! Call me any names you like, if it makes you feel better. Pharmaceutical companies spend a great deal of money lobbying in Washington. I highly doubt that money is invested for altruistic purposes.

  66. ^ lol. I find it interesting that you are so against vaccinations, but you don’t even have a basic science education. Ignorance is bliss, eh?

  67. auntie51109 says:

    @ Francois: So which do you think is more common for kids to have received in the US? The recommended or mandatory list? Serious question, no facetiousness intended. I simply don’t have that data and thought perhaps you would.
    As a parent, do you not find it even a little disconcerting that so few studies were done on the large combinations of vaccinations recommended, but rather only on the individual dosages?
    On the Gardasil note, if I understand correctly, Gardasil was fast-tracked by the FDA and trials were never completed, so they have no long term data to reference. I find this very alarming.
    I don’t deny that some vaccinations can be beneficial, but I am of the mind that our children are not Lowe’s stores. More of Everything is not always the best idea in every circumstance.

  68. auntie51109 says:

    @Skeptical…No, ignorance is not bliss. It’s frustrating and a steep hill, quite frankly. But feeling awful and aged beyond your years can be a helluva motivator. At least I’m trying to learn something new and gather all the information to which I can gain access. Can you say the same? Ahh, but no; that’s not necessary. You’re a doctor, so you already know everything! Voila! C’est magnifique!
    Perhaps that intimidation is effective with your patients. Whatever works, eh? I work with a multitude of PhDs, many of whom couldn’t find their rear end with two hands and a map, so you’ll pardon me if I don’t bow obsequiously in deference to your vastly superior intellect…and charming bedside manner.

  69. @SkepticalHealth: As much as I agree with your position, I think you went too far in mocking auntie51109. There are several possible reasons why she hasn’t gone to college. I don’t think either that her lack of a basic science education is necessarily her fault. It bears reminding that with the demonization of public education in the 1970s and 1980s with Reagan, it’s also science education that has suffered. I tend to think that the antivax movement would have a lot less success if there was more investment in science education in K-12.

    @auntie: All this being said, I am very glad that your symptoms have been alleviated, but are you sure you are directing your anger at the right target? Or that anger is justified in the first place?

  70. @auntie: I am not sure I understand your question. I mentioned a mandatory list that applies only to France. As mentioned the list from the CDC (http://www.cdc.gov/vaccines/schedules/downloads/child/0-6yrs-schedule-pr.pdf) is only a recommended list. But Hib, which is not mandatory in France (it’s only considered recommended there), has a vaccination rate of 97% there).

  71. Chris says:

    auntie51109:

    At least I’m trying to learn something new and gather all the information to which I can gain access.

    Then perhaps you can tell us what information you have gathered on the requirements for Gardisil. This article is about non-medical exemptions to attend public school. Please tell us which school district requires Gardisil to enter kindergarten.

  72. auntie51109 says:

    @Francois: You stated “the official vaccination list from the CDC is not mandatory, it’s only a list of recommendations.” I was wondering if there was any data on which vaccines were most commonly chosen from the recommended schedule (v. which may be mandatory?) in comparison to the mandatory list for France. Apples to apples, if you will.
    You are correct in 70’s science requirements. When I graduated from high school, only one science class was required and I took earth science. The teacher was a wackadoodle. My take away was how to make anise candy with a bunson burner. Seriously. That said, one of my sisters is a nuclear med tech and I spent a good portion of my childhood in the hospital, so I am appreciative of the benefits of modern medicine. BTW-“There are several possible reasons why she hasn’t gone to college.” You do realize how condescending that sounds, right? Do I have less value as a person with no degree? I didn’t go to college because I had no money at all. And at the time, no interest; or at least convinced myself there was no interest since I had no money. One makes do with what one has available. On the upside, I had no student loans to repay.
    As for being angry, I started to say that perhaps frustrated would be a better descriptor, though my initial reaction to this type of discussion is always one of immense relief that my kids are grown so that I am no longer faced with this quandary and that they are both healthy despite having been vaccinated. But you may be right in that I do feel angry at times at the paradigm of presumed infallibility from which so many doctors seem to function. Polarization serves neither side of the discussion and does not cultivate trust.

    @ Chris: I didn’t gather the information, my daughter did. She is an adult and she came to the conclusion that the benefits did not outweigh the risks for her. I’m glad she made the effort and had the choice. BTW, had Rick Perry (R-Texas) been successful, school aged girls in Texas WOULD be required to have the Gardasil vaccine. The fact that you assume an antagonistic stance on this subject is a quintessential example of why the subject continues to be so divisive. You do not seek common ground or even attempt to understand or empathize with parents struggling with this challenging decision. The rate and number of vaccines HAS increased and though studies have been done on the individual vaccines, it is my understanding that thorough studies have not been done on the combination of multiple vaccines or the cumulative effect. Meanwhile, parents see the rates of autism and autoimmune diseases and god knows what else increasing at alarming rates. They believe their child’s very lives may be at stake if they choose certain vaccines and you then have the audacity to question why they do not blindly trust everything you say that has been spoon fed from the very companies that stand to profit from the vaccines. As a parent, I cannot imagine anything more horrible than to think that I may have done something (will intentioned or not) that resulted in my child’s death or permanent disability. Come on. Do you really expect people to believe the medical community or the FDA has never lied to the public? Really?

  73. auntie: I apologize if I sounded condescending to you when I mentioned the reasons why you didn’t go to college. I didn’t mean to offend you. I did think about economic causes, among other things, as the potential reasons why you didn’t go. I do think it is scandalous that in a country as wealthy as the United States, there is no equal access to secondary education. Consequently, what I intended to say was that you not going to college should not be held against you or anyone else. But that is a topic for another conversation.

    As for the data you are referring to, here is what the World Health Organization compiled:
    USA: http://apps.who.int/immunization_monitoring/en/globalsummary/countryprofileresult.cfm?C=usa
    France: http://apps.who.int/immunization_monitoring/en/globalsummary/countryprofileresult.cfm?C=fra
    Sweden: http://apps.who.int/immunization_monitoring/en/globalsummary/countryprofileresult.cfm

    Please note I have no clue how this data was compiled. But vaccinations are mandatory in most European countries (ie, you face judicial penalties for not vaccinating your child, unless you have a medical exemption, such as egg allergies). You face no such penalties in the United States, thanks to religious and “philosophical” exemptions. The exceptions being Mississipi and West Virginia, where such exemptions do not exist.

    As for the “paradigm of (…) infallibility,” it’s not something that is present in modern medicine or natural sciences. Science, in and out of itself, is not dogmatic. Scientists, and by extension doctors, are willing to admit that they are wrong (at least the ones I know or the ones I have read). But they are human too, and can be, rightly or wrongly, exasperated. Or they can have bedside manners. But that doesn’t mean modern medicine is bad in itself.

  74. weing says:

    “immense relief that my kids are grown so that I am no longer faced with this quandary and that they are both healthy despite having been vaccinated.”

    Interesting. You have totally ruled out that they are healthy because of having been vaccinated?

  75. Chris says:

    auntie51109:

    BTW, had Rick Perry (R-Texas) been successful, school aged girls in Texas WOULD be required to have the Gardasil vaccine.

    For kindergarten? Think about it. It was a trick question to see how well you actually thought about about the issues, and actually read the question. How can a vaccine that is only given to children over the age of ten become a requirement to enter kindergarten? How many children are diagnosed with autism after age ten? What evidence shows Gardisil causes autism?

    By the way, Mr. Perry was not successful. Only one state in this country has required HPV vaccination for school attendance after a certain age (and it is not California). Next time you are asked for information, actually try to find the answer. Otherwise we will not think you are serious.

    Show us you are serious and find out what vaccines are required to enter kindergarten in California. Tell us what they are. There will be more specific questions after that.

    And just so you know: in 1989 my son came down with a disease that gave him seizures which may or may not be the source of his permanent disability. That was several years before the vaccine for that disease was available. You really need to get your information in order to explain to me how much more dangerous the vaccines are versus the actual diseases.

  76. auntie51109 says:

    @François Luong: Thank you. And thank you very much for the links and information. Much appreciated. I will digest these when the day has not been quite so long.
    You know, I used to trust implicitly whatever my doctor said. I was very comfortable with doctors knowing what was best for me. I’ve spent a good portion of my childhood with them and I am still alive, so why not? That was my normal. And perhaps it’s not so much that I no longer trust doctors, but rather that I do not trust big pharma even one little bit after my recent health hurdle. Pharma is in control of guiding what doctors are guided to learn, know, and reference and that honestly scares me a great deal. Had I listened to my doctor, I would still feel like crap and be on at least three different medications, of this I am certain. That said, my intention was not to vilify all doctors. I still like to think the primary driver for the majority entering the medical field is to help people and they are, after all, only capable of administering what they have been taught to be right. Perhaps the problem lies is that the field has traveled ever farther away from health and ever closer to medicines. But, that’s just my opinion.
    I have, of course, seen many of the videos of parents grieving for their children who have died or are now permanently disabled from what the parents believe is a severe negative reaction to an immunization. Though I am well aware the internet can offer emotionally persuasive and at times manipulative wrenching stories, I also have two personal dear friends whose children suffered a similar fate and cannot discount the possibility they may be right. Given the amount of money that pharmaceutical companies spend to peddle their wares, I find it incredulous that anyone would assume their objective is one of pure altruism and assume they are faultless. Money is one heckuva driver.

    @weing and all: No, I do not totally rule out that my children are healthy in part due to their vaccinations. This does not preclude me from having sincere concerns for the recent increase in odd ailments and what the source(s) may or may not be. I don’t KNOW and I admit that I do not know and I am relieved that I am no longer in the position to have to make such choices in this age of increased potential cumulative effects. But I don’t think YOU know either and I find it disconcerting that most of you appear to be obstreperously oblivious to the very large elephant in the room.

    @ Chris: Yes, I realize Mr. Perry was not successful. Hence, my past perfect tense verbiage “had he been successful”. Yes, I realized that “school-aged” didn’t mean kindergarten, but you seemed to want to address my comment on Gardasil, so I acquiesced.
    I simply am not convinced that ALL vaccines provide the same level of safety and I do believe cumulative effects should be studied in much greater detail and parents should do their best to be as informed as possible. Nor am I comfortable with blindly trusting that they are ALL good and are all necessary. Both my kids had the chicken pox and did just fine with no vaccine available at the time. I had scarlet fever when I was 6 along with measles and my doctor advised my mother that the prolonged high fever (106) would likely leave me severely retarded, but I’ve never had the chicken pox and have not been vaccinated and do not plan to be. EGADS! Call the vax police! All children are not the same and may not be able to withstand the ever increasing immunization schedules and my guess is it will only get worse with our crappy food supply.

    Google shows the following for which vaccinations are required to enter kindergarten in the state of California. http://eziz.org/assets/docs/IMM-231.pdf Which presents a question to me. If the major contributing factors of contracting Hepatitis B are unprotected sex with multiple partners and intravenous (IV) drug use, why in the world should a 5 year old need this, let alone three doses? I find it less than plausible that this particular vaccine would pass a reasonable cost (to health) v. benefit analysis. I would think the risk factors for Hep A would be more logical; not that I’m advocating for that one either, mind you.

    Chris, I am truly very sorry to hear of your son’s illness and I do sincerely hope you are able to discover a path to restore his health.
    I thank you all for the thought-provoking and lively discussion and the sharing of information.
    Good night and good health to you all.

  77. lilady says:

    Auntie51109:

    You are again making generalizations about *Big Pharma* and physicians without any knowledge of the practice of medicine.

    “I still like to think the primary driver for the majority entering the medical field is to help people and they are, after all, only capable of administering what they have been taught to be right. Perhaps the problem lies is that the field has traveled ever farther away from health and ever closer to medicines. But, that’s just my opinion.”

    And, an ill-informed opinion it is Auntie. The subject of this thread is non-medical exemptions for vaccine requirements for school entry, not your accusations about physicians relying on “medicines”. You do know, that vaccines are a form of preventive medicine, don’t you? All the other medicines that “Big Pharma” develops and manufactures are a poor substitute to actually cure children, once they are infected with vaccine-preventable diseases. Why don’t you look up the invasive H. influenzae bacterium, the S. pneumoniae bacterium and the N. meningitidis bacterium and the vaccines that prevent deadly invasive bacteremia and bacterial meningitis? The very best antibiotic for most of these deadly diseases is IV Ceftriaxone…yet many of these infected children die within hours or days of reaching a hospital for intensive care. Many of the children who survive have to undergo amputations to remove gangrenous limbs, suffer major organ failure and permanent neurological sequelae.

    C’mon Auntie you’re old enough to remember the 20,000 infants who were infected in utero with rubella and were born with congenital rubella syndrome during the rubella epidemic 1964-1965 in the United States. You’re also old enough to remember the beautiful film actress Gene Tierney, who contracted rubella during her pregnancy and her daughter was born with congenital rubella syndrome:

    http://www.hknc.org/Rubella.htm

    “If the major contributing factors of contracting Hepatitis B are unprotected sex with multiple partners and intravenous (IV) drug use, why in the world should a 5 year old need this, let alone three doses? I find it less than plausible that this particular vaccine would pass a reasonable cost (to health) v. benefit analysis. I would think the risk factors for Hep A would be more logical; not that I’m advocating for that one either, mind you.”

    Here…before you go to bed, read this about hepatitis B, why the recommendation was made for the birth dose of the vaccine and timely completion of the hepatitis B vaccine series:

    http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5416a1.htm

    Take special note of the testing of pregnant women for the presence of the hepatitis B surface antigen, during each pregnancy and why there is a special protocol for post exposure prophylaxis with the vaccine and HBIG (Hepatitis B Immune Globulin) within 12 hours of her infant’s birth. This is to prevent “vertical transmission” of the virus.

    Take special note of why the “birth dose” of the hepatitis B vaccine is recommended to be given to each infant before the infant leaves the hospital. This is to prevent “horizontal transmission” of the virus.

    By the way, your comments about your having all the childhood diseases, except chicken pox, and “you survived” is a very typical response from people who get their information about vaccines from crank websites.

    I had all the childhood diseases and I survived as well. My childhood friend was not as “lucky” as you and me. She died from polio, just before the Salk vaccine was developed and available. My older cousin wasn’t “lucky” either; he was left with lifelong neurological deficits after “surviving” measles encephalitis.

  78. Chris says:

    Auntie51109, I specifically asked which school district required Gardisil for kindergarten entry. What part of that did you not understand. Your answer about Mr. Perry showed you were relying on news reports and certain websites and not the actual school district websites.

    And this shows when you do finally find the actual schedule and make factually wrong comments about hepatitis b. It is not just sexually transmitted. It is also transmitted through blood and saliva, something kids seem to often leak. Here is some further reading:
    http://www.pkids.org/immunizations/HBV_kids_infect_kids.html

    Now for your next questions: Pertussis and measles have popped up several times in California (you know, the state under discussion, which does not require Gardisil for school attendance at any age).

    Now please tell us exactly how much more dangerous the MMR vaccine is compared to measles, mumps and rubella. Provide the title, journal and date of the PubMed indexed paper to support your statements. Here is one paper that describes the costs in both money and deaths of children during the 1990 measles epidemic in California: Pediatric hospital admissions for measles. Lessons from the 1990 epidemic.. Make sure your references are on the same level.

    Then tell us exactly how much more risk the DTaP has compared to diphtheria, tetanus and pertussis.

  79. Harriet Hall says:

    @auntie,

    “All children are not the same and may not be able to withstand the ever increasing immunization schedules and my guess is it will only get worse with our crappy food supply.”

    An understanding of the science puts those fears to rest. See http://www.quackwatch.com/03HealthPromotion/immu/too_many.html

  80. The reason childhood diseases are prevalent is because of vitamin deficiency…

    http://www.npr.org/blogs/health/2012/08/06/158201055/vitamin-d-deficiency-in-sick-kids-could-make-them-sicker

    Now new evidence from two studies finds that not only is vitamin D deficiency common among critically ill kids, but it’s also associated with the severity of their illness.

    In one study published today in Pediatrics, researchers at Harvard University tested the vitamin D levels of 511 children, up to 17-years-old, who were admitted to six different pediatric intensive care units between November 2009 and November 2010.

    They found that 40 percent of the sick kids they tested had less than 20 nanograms of vitamin D per milliliter of blood — meaning they were deficient. This led the researchers to conclude that kids deficient in vitamin D were more likely to be sick than kids with sufficient levels of the vitamin. The kids deficient in vitamin D were also more likely to be in the hospital longer than the other kids.

    Vit. A deficiency and measles

    http://www.measlesrubellainitiative.org/mi-files/Reports/Treatment/West%20Nutr%20Rev%202000%2058%282%29S46.pdf

    Supportive care is normally all that is required for patients with measles. Vitamin A supplementation during acute measles significantly reduces risks of morbidity and mortality.

    Vitamin deficiency and mumps

    http://www.go-symmetry.com/health/bakup/mumps.htm

    http://www.measlesrubellainitiative.org/mi-files/Reports/Treatment/West%20Nutr%20Rev%202000%2058%282%29S46.pdf

    My conclusion is children need vitamins to prevent and/or minimize effects of childhood diseases such as measles, mumps, rubella, pertussis, and apparently they’re not getting enough in their diets! I know vaccines seem to be the easy way to go, however, it would not address vitamin deficiency either way..causing/contributing to many other illness. The basics would be Vit. A, C, D..omegas, imo.

  81. There are many things that NPR does well. Reporting on current scientific research is not one of them.

    And that penultimate link you gave is suspicious. It doesn’t provide any source (reliable or not) for the information it is providing.

  82. Chris says:

    RH:

    In one study published today in Pediatrics, researchers at Harvard University tested the vitamin D levels of 511 children, up to 17-years-old, who were admitted to six different pediatric intensive care units between November 2009 and November 2010.

    Which you failed to cite: Vitamin D Deficiency in Critically Ill Children. It is more of a “this looks interesting” kind of study. There is no way to tell what illnesses the children had. It was also only 511 kids out of a total population of what? And it does not claim that vitamins are a substitute for vaccines.

    None of other articles show that nutrition prevents measles or mumps. It gives the reason why children in poor countries who do not get enough food, or certain foods, fare worse than those who live in places like the Europe and North America. Especially since one of them compares how much better children in the UK survived better in 1960 than fifty years before, and those in 1960 Africa.

    Children the USA, Canada and UK do not need more vitamins to prevent measles. They need to be vaccinated.

    Next time actually read the articles you post.

  83. Harriet Hall says:

    @rustichealthy,

    “vaccines seem to be the easy way to go, however, it would not address vitamin deficiency”

    You can argue for correcting vitamin deficiencies, but you can’t argue for using that strategy to replace vaccination.

  84. Chris says:

    Also, eating a balanced diet is better than taking pills. And preventing diseases is better than treating them.

    I recently had a checker at a higher end grocery store ask me what I had against supplements (she over heard me telling my hubby that “Airborne” was a scam). I told her I’d rather eat my veggies than take a pill. She asked me if I had ever had “Superfood.” I once drank a juice mixture called “Superfood” (or SuperGreens) and it was horrible. She protested and there was a supplement capsule that was good for health. I replied I would rather eat my green leafy veggies and not have them processed by drying, grinding them up and shoving them into a capsule. The funny thing is, that grocery store is big on selling fresh produce.

  85. Scott says:

    One of the glaring problems with rustichealthy’s interpretation of the Madden study is that it only established an association (so far as I can discern from the abstract, as I have no access to the full text). In no way does it show that vitamin D deficiency caused the subjects’ illnesses. The other way around is equally consistent with the data (again, so far as I can discern from the abstract).

  86. Dr. Harriet..ok, I am not going to argue vaccines here..but, isn’t it an obvious ..to all..that children not getting proper nutrition do get sick easier? whether they’re in a 3rd world country or right in America..if they’re getting ill..they’re not getting proper nutrition! I’m kind of puzzled as to what “proof”, evidence, studies, need to show that? Perhaps those links are not acceptable to any of you, nevertheless..if children are in hospital..very ill..and all very low in Vit. D..what would be the harm in supporting children get more vitamins? D, C, A, omegas..? You’re more than okay to dose children with vaccines that bring down their immune system atleast temporarily, but not willing to get them vitamins that bring it up? Even if they have the vaccine..what would be the objection.. Actually, I would think you all would be more than happy to hope and say ..”wow..vitamin deficiency..if that’s all it is, or will help the child’s need to fight whatever..let’s try it”? Whether you believe the deficiency caused the illness ..whatever it is..or not? Anyway, hope you all look more into it..maybe find a study that suits you on it. :)

  87. weing says:

    “They found that 40 percent of the sick kids they tested had less than 20 nanograms of vitamin D per milliliter of blood — meaning they were deficient.”

    That also means that 60% of the critically kids were not deficient in vitamin D.

  88. yes weing..and..”The kids deficient in vitamin D were also more likely to be in the hospital longer than the other kids.”

    also, maybe it’s another vitamin then? C, A?.

  89. weing says:

    “also, maybe it’s another vitamin then? C, A?.”

    Or, more likely, not.

  90. BillyJoe says:

    RH,

    “children not getting proper nutrition do get sick easier?”
    “If they’re getting ill..they’re not getting proper nutrition! ”

    You seem to think the above two statements are identical. They are not. Think about it.
    There could be reasons other than not getting proper nutrition, for children getting ill.
    Like not being vaccinated!

    “Let’s try it”

    Nope. Let’s do a clinical trial.

  91. Chris says:

    weing and BillyJoe, it was quite clear that she did not read any of the links she provided. Because at least a couple of them were comparing children in Africa with those in the UK in 1960. Or she just does not understand the difference between living in an industrial country and those who barely get enough food, or what has happened between 1960 and now in both locations (like invention of a vaccine, many political changes in Africa, etc).

  92. BillyJoe..Yes!! then let’s do a clinical trial…and, yes, there may be other reasons..too many toxins..perhaps in processed foods, perhaps in fluoridated water..that’s the one-two punch I believe in..too little nutrients/nutritional real food and/or too much toxicity…from processed foods, water, non-organic food (imo).

  93. weing says:

    She’s a little rusti on that reading part.

  94. jmb58 says:

    @Rustic

    Why..so..many..dot-dots?

  95. Chris, it doesn’t matter whether it’s 1960 or 1860 or 2012, if a child is getting ill, they are lacking nutrients. Not sure what you’re getting at? I’m almost wondering if the pharmas will be revving up for a food vaccine next! What do we need (real) food for! enter gmos! and if that doesn’t work, let’s put it all in a vaccine! hmmmm is that it I wonder : )

  96. jmb..bad habit … sorry :) it’s how I think..talk…chat.

  97. Chris says:

    Rustichealthy:

    Chris, it doesn’t matter whether it’s 1960 or 1860 or 2012, if a child is getting ill, they are lacking nutrients. Not sure what you’re getting at?

    That you have not got a clue about history, especially that of Africa and Europe. And that there is a vast difference between well fed children in an industrial country and those who are poor and malnourished living on farms where their is barely enough food. You are comparing apples and oranges.

    This video explains it in a way you might understand:
    http://www.gapminder.org/videos/population-growth-explained-with-ikea-boxes/

  98. Chris..I know..that would starvation. But, either way, if a child is getting sick, they are malnourished. If a child is eating candy and fastfoods, and pesticide filled/gmo foods, and not enough real food…such as fresh non-chemical filled fruits, vegetables, whole grains, meat/fish without hormones/antibiotics..everyday, then they’re going to be malnourished, and they’re going to have a lowered immune system, and get ill…..maybe not ‘starvation’ but they will be getting ill.

    1. Harriet Hall says:

      @Rusty,

      “if a child is getting sick, they are malnourished.”

      That is simply not true. Well nourished children get sick too. You are just making up your own definitions: if a child gets sick, you assume it means he is malnourished. You assume that a child can only be well-nourished if he avoids all the foods you object to. This is a version of the “no true Scotsman” fallacy.

      Your statement is refuted by history. People got sick long before candy, fast foods, pesticides, GMO, meat with hormones, etc. We have solid evidence of illnesses from prehistoric human remains.

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