Why parents refuse vaccines

The Pediatric Insider

© 2009 Roy Benaroch, MD

Ask 98% of my patients, and they’ll tell you they’ve gotten all of their kids’ vaccines, without qualms or hesitation. Ask the other 2%, and you’ll hear all sorts of reasons why they’ve skipped them. What makes some people look at vaccinations so differently than the rest of us?

Along with clean food and water, vaccinations are generally accepted as one of the greatest public health triumphs of the modern world. We are safe from diseases like polio and measles, which once ravaged millions. We no longer, really, have to worry about most kinds of bacterial meningitis, and we’re able to even prevent some kinds of cancer. Newer vaccines in development include protection against HIV and malaria. At the same time, immunizations are very safe, compared to just about any other medicine or medical intervention. Yet despite their incredible effectiveness and well-documented safety, suspicions remain. Many families choose to skip some or all vaccinations.

We know that vaccine refusers tend to be wealthier, and come from more socially advantaged communities. There also seems to be a neighborhood effect, where people from one small area tends to follow each others’ lead in vaccinating or not vaccinating. But these observations don’t tell us much about the psychology and thinking that leads individual parents to refuse vaccination.

Based on my own observations and conversations with parents who refuse vaccinations, and also with parents who are more eager for vaccines, I’ve come up with my own list of “profiles” of the kinds of parents who are most steadfast in their refusal. I don’t think this list is likely to be complete, and there’s a lot of overlap between the groups. But I think this is a good starting point to understand just where people are coming from. Hopefully, better understanding will lead to improved trust and better decisions for children.

If you are a vaccine refuser, please join in the comments. Does one of these profiles fit you? Have I neglected to understand perhaps your own reasons for refusing vaccines? What sort of information is missing that can help guide parents along this decision? My goal here isn’t to belittle anyone, but to understand and appreciate the concerns of parents. I welcome any comments.

Profile #1: The Government Distruster

I certainly understand that some people feel the government doesn’t always make the best decisions for us. The two parties bicker, and special interests and money seem to have more influence on decisions than the needs of ordinary people. Look at the Clowns in Congress, or service reps at the post office, or IRS telephone screeners– there’s no doubt that government and government employees are not always paragons of virtue and judgment.

Decisions on vaccine recommendations aren’t only made by government employees at the CDC. There is input from all of the major medical associations—pediatricians, family practitioners, internal medicine physicians, obstetricians, and infectious disease specialists are all involved. Specific recommendations are made by the CDC’s Advisory Committee on Immunization Practices, which is comprised of 15 vaccine experts from various fields. There are also vaccine recommendations made by government and health agencies around the world, including the United Nation’s World Health Organization. It is difficult to believe that all of these organizations and experts reviewing the studies and making recommendations have gotten the facts entirely wrong. Though there are some differences in the exact recommendations from country to country, by and large vaccine schedules and recommendations are identical throughout the world.

Some people believe not only that the government is irresponsible and incompetent, but that it’s actually twisted and evil. Like people who believe that the US government itself planned the 9/11 attacks, some people sincerely believe that vaccinations are a great threat to mankind, deliberately put in place by malevolent forces within the government to harm us. To believe this, you have to believe that evil pervades every step throughout government, from the statisticians and analysts at the CDC and university medical centers, all the way up to the surgeon general and president himself. Furthermore, you’d have to believe that this whole vast conspiracy has somehow been successfully hushed up, because there’s no actual evidence for this whatsoever. Is this even remotely possible?

#2 The Science Distruster

Science itself is not a series of facts, or a group of people wearing white coats. It’s a system meant to discern how the natural world behaves, in a way that allows us to predict what will happen in the future. Key features of science include:

  • Natural law. There are rules about how things happen, and these rules can’t change. For instance, when a force acts on an object, it’s going to move in a predictable direction, in a predictable way. Natural laws are developed based on observations of real things that happen in real, measurable ways. They can then be tested, to make sure the predictions work accurately and consistently. If an observable case doesn’t fit what we thought of as the natural law, then the law has got to be refined and improved. Though we certainly don’t know how everything works, we’re very reluctant to accept propositions that fly in the face of natural law. You claim you have a machine that extracts energy out of perpetual motion? I want to see it before I believe it. Things that are beyond natural law—the “supernatural”—cannot be part of any scientific theory.
  • Testing hypotheses Science relies on experiments. You can’t just say you think something is right, or that something ought to be true based on scientific knowledge. Anything that’s worth knowing through science is testable, and can be tested, and ought to be verified. Things that are not testable (or “unfalsifiable”, a more precise word) are not things that science can support or substantiate. Something like “Michelangelo was a better painter than Da Vinci” isn’t a question that science could test.

Some people who are deeply religious have a distrust of science, but it doesn’t have to be that way. There are many important questions facing mankind for which science may not provide an answer. Why are we here? How should be treat each other? Questions of law, ethics, morals, and aesthetics may not lend themselves to scientific study, and other manners of investigation of these issues are more appropriate. Science is one tool to help us understand their world, but it isn’t the only tool. Trusting science does not have to mean turning your back on religious or other convictions.

Some people refuse vaccines because they do not trust science, or because they feel it is more “natural” to suffer infections. If these infections weren’t good for us, why would they be here on earth? Though “Why do people suffer?” is not a question for science, I personally don’t think that God would have given us the intellect and wisdom to find answers if He didn’t want us to us those answers.

Another potential knock against science: scientists don’t know everything, and don’t pretend to. The very nature of science is to question and to allow new knowledge to replace old. When you read in the paper that a medicine has been found to have a new side effect, that isn’t a failure of science—it means that science did what it was supposed to. Question, learn, repeat; question, learn, repeat. Some people feel more comfortable with absolute truths, but that really isn’t what science is all about.

Which brings us to another problem with science: the language. Scientists use “science terms”—like “This study fails to confirm any link between vaccines and autism,” or “This study adds to the evidence that vaccines are not a cause of autism.” What parents want to read is an unequivocal “Vaccines don’t cause autism.” But it is impossible to completely rule out a negative statement using the tools of science. We can say that the odds against this are very, very small, and getting smaller, but we cannot prove with absolute certainty that it could not possibly in any circumstance at any time be true. Those language of science is exact, but can sound “weaselly” to many people, leading to distrust.

Profile #3: The Big Pharma Distruster

Big Pharma is The Big Boogeyman on the anti-vaccine web sites, and perhaps they do deserve some distrust. Basically, their duty is to their shareholders: to make a profit. Their business is to develop and sell medicines and vaccines, and to make money doing so. Vaccines and medicines create billions of dollars of profit. Does that mean that drug companies cannot be trusted?

It’s wise to view promotional material from drug companies as you would advertising from any other company: with great skepticism. Advertisers want to sell you things, as do drug companies. But most patients don’t buy their drugs or get a vaccine because of ads from the drug companies, but rather because of the advice of their physicians. Distrusting the drug companies because they make money by selling drugs is sort of like distrusting the tire manufacturers for selling you tires, or the paint people for selling paint, or … well, anyone for selling anything. Sure, the computer guy wants you to buy a more expensive computer, and sure, the grocery store wants you to buy more groceries. That doesn’t make people who sell tires or groceries evil or twisted. People who buy things should be wary of salesmen, but c’mon now. Just because a profit is involved doesn’t mean that drug companies are to be trusted less than any other company. If their product is good, you benefit, and they benefit, and everyone wins.

Profile #4: The Doctor Distruster

As I said, most people don’t buy medicines or get vaccines because of the promotional efforts of drug companies, but rather based on the recommendations of their physicians. But can physicians be trusted? Couldn’t we be but shills of the drug and vaccine manufacturers?

There are doctors who’ve accepted quite a bit of money from drug companies, as “experts” or “thought leaders.” Some of them travel around the country, giving talks to other doctors to convince them to use a certain drug or vaccine. I think this is a violation of the trust patients put in their physicians, and I won’t do it. Furthermore, the truth is that the vast majority of physicians are never offered such perks. We’re in the trenches, doing our work, and most of us just don’t attract that kind of fawning attention from the drug companies.

Is it possible that the pharmaceutical companies have fooled the doctors into blindly trusting their vaccines? I don’t think so. Most of us have seen diseases disappear once a vaccine is introduced, and most of us have seen vaccine-preventable diseases in unimmunized kids. Personally, I saw my last case of pneumococcal meningitis kill a patient of mine in 1996, right before the vaccine came out. I would prefer to never see that again.

Physicians as a group are intelligent and motivated—or we wouldn’t have made it this far. We’re certainly not monolithic, single-minded thinkers; many doctors harbor opinions of health issues that are far outside the mainstream. Yet with vaccinations, it’s only a very small handful of fringe doctors who are leery of established immunizations. There is a reason why so many pediatricians are so pro-vaccine.

It’s certainly not the money. Pediatricians actually lose money on some of the vaccines we give; for the majority of them, it’s pretty much a wash. They’re very expensive for us to buy and store, yet we do it because we know it’s best for our patients.

Looking at the trust issue from another angle: I have a mechanic I’ve known for years. When I bring him my car, he tells me what’s wrong, and I pay him to fix it. I know nothing about cars, and I seldom question his advice. Sure, if he suggested something really weird, I’d go elsewhere—but I’ve known him a long time, and he’s earned my trust. Likewise, I’ve seen my own patients for years and years. Parents ask for and want my advice on all sorts of things: feeding, sleeping, school issues, medical problems. I prescribe medications, and we talk about the side effects and risks and benefits, and we make our decisions. I would say that most patients trust my advice—or they’d find another pediatrician. Yet for some reason, for some families, vaccines seem to be a very separate issue. Sure, mom has trusted me as a source of information on everything else, yet immunization issues seem to be “off the table.” Mom would rather make vaccine decisions based on advice from random people she doesn’t know posting on the internet than based on information from me. Why am I perceived as an expert on health and childcare, but not as a trusted source of vaccine information? And if I can’t be trusted for that kind of advice, why are you depending on my judgment for anything else?

Profile #5: Paging Dr. Google

Everyone knows that the internet is a wild place. It’s full of all sorts of information, some great, some outdated, and some wildly misleading. No one believes that a Nigerian price wants to give you millions if you help him transfer assets, yet web sites that spread misleading lies about vaccines have somehow become a leading source of (mis)information for parents.

I’m going to google the word “vaccine” right now, and take a peek at the top 10 sites. I won’t provide links, because I can’t guarantee that any of the information is accurate, but here’s a quick summary of what I get:

  • 5 sites with good, useful, dependable information—including information from the CDC and well-established medical sites.
  • 2 news stories that more-or-less accurately talk about recent vaccine news. One of the stories has an odd sort of tangent including a brief interview with a well-known anti-vaccine propagandist, who plugs her usual misinformation (that’s irrelevant to the main point of the story, but it’s part of the standard boilerplate for some journalists to interview someone from the short-list of anti-vaccine spokespeople.)
  • 3 sites retelling outlandish, truly bizarre misinformation. One strongly suggests that Americans should not get a flu vaccine because they contain squalene, a chemical that they claim caused Gulf War Syndrome. This is just a flat-out lie; there is no vaccine currently licensed in the USA, flu or otherwise, that contains squalene, which hasn’t been conclusively linked to any health problems anyway. The sites link and re-link to old, long-disproven canards based on tiny, unreproducible studies of questionable authenticity, with no effort whatsoever to present the best, most recent research. These sites explicitly state that I as a physician, in cahoots with government and big business, want to poison your child.

If you want good, accurate information that you can trust about vaccines, side effects, and actual real research into vaccine issues, try these sites first:

Profile #6: The alternative medicine believer

There isn’t an exact definition for “alternative medicine,” (a term I don’t like) beyond “things outside of mainstream medicine.” Most people feel they just know it when they see it. Because it encompasses such a broad array of philosophies and modalities, from acupuncture to chiropractic to massage to energy healing to prayer to herbal supplements to homeopathy, it doesn’t make a whole lot of sense to lump them all together. Nonetheless, some people feel that these sorts of “remedies” are better than what most doctors prescribe, and some alternative health devotees are suspicious of immunizations.

One argument is that the “natural” remedies of the world of alt-med are somehow better, or less dangerous. This doesn’t make a whole lot of sense—the small pox virus is natural; getting bitten by a tiger is natural; falling 60 feet out of a tree or building is natural. Burning and freezing and starvation and pestilence are as natural as can be. Potent poisons from jellyfish or tropical frogs are natural. Many mushrooms and plants are poisonous, and naturally occurring radiation from elements in the Earth and cosmic radiation cause plenty of cancers. There’s nothing inherently more safe about natural things than about “unnatural” things that come from a laboratory. Sure, medications have side effects, and some can be quite toxic—just like many natural plant products. In fact, if someone tells you they’ve got an herb or something with no toxic effects whatsoever, you ought to think again: any biologically active product, whether a medicine or something “natural”, is going to have multiple effects on a complex living organism. Some will be beneficial, some will be harmful. There’s no such thing as a medicine or herb with no side effects or potential for harm, unless that herb or medicine is 100% placebo.

Alt-med proponents also sometimes feel that manufacturers and businesses involved in alternative health products are more ethical or trustworthy than manufacturers of traditional medicines or vaccines. This is a completely unfounded opinion—just take a quick glance at a sampling of this week’s stories from the world of alternative medicine:

  • The FDA has established a web site listing over a hundred bogus products to treat H1N1 influenza. The list currently has 136 (!) specific products, almost all of which are marketed to appeal to alternative-health consumers.
  • Resveratrol is the latest product to be marketed heavily through national magazines as a product to reverse aging. There’s no magic cure for aging, despite what they’re trying to sell to you.
  • A clinical trial was published looking at the “Gonzales Protocol” for treating pancreatic cancer with hundreds of supplement pills, coffee enemas, and a special diet. The treatment failed miserably—patients pursuing this alternative medicine approach died more quickly and had a poorer quality of life.

(These three examples were all taken from the last 2 weekly issues of Consumer Health Digest, a free listserv from Quackwatch and the National Council Against Health Fraud. You can sign up here.)

There have certainly been abuses and violations of trust from the world of conventional medicine, too. But as an unregulated industry, supplement and alternative health providers are more free to commit fraud and rely on questionable marketing tactics than traditional pharmaceutical and vaccine companies, whose products and advertising materials are tightly regulated.

There’s no logical reason to think that “natural” cures are safer, unless they’re just placebo. There’s plenty of evidence showing that alternative medicine companies are more likely to engage in shady marketing and business practices. Yet distrust of traditional medicine, including vaccinations, seems to be more common among users of alternative medicine modalities.

A very small number of alt-med proponents really goes to the extreme of non-scientific thought—they reject the very notion that infections cause disease, and thus reject all medical preventions and treatments for infection. These believers have a cult-like devotion to their ideas, and no amount of scientific evidence is going to sway them. Though from what I’ve seen few people really believe this, their web sites get plenty of hits from people looking for reliable vaccine information. The philosophy and background of people writing web pages isn’t always transparent, and some people with a vastly different worldview—one that many people would reject as ridiculous—are trying to sway your opinion. Beware the “yellow brick road” of alternative medicine, for far down that path are some truly bizarre beliefs.

Profile #7: Me, too!

This one frustrates me, but it seems to account for a big percentage of non-vaccinating parents. I ask why they’re reluctant to vaccinate, and the answer is something like “Well, a lot of my neighbors don’t,” or, “I heard that lots of people are scared of vaccines,” or, must frustrating of all, just “Well, you know.”

As momma used to say: “If your friends decide to jump off a bridge, are you going to jump too?”

There is a perception that vaccine refusal is a common phenomenon, though overall rates run in the 1-2% range (some individual communities are much higher, but that’s the usual quoted rate for most parts of the country.) The vast majority of parents get their kids immunized—but they don’t talk about it as much as the non-vaccinators. Refusing some or all vaccines is chic, and the people who do it like to talk about it. You might hear of neighbors who skip vaccines for their kids, but you can bet that you won’t hear about the majority of neighbors who get them on schedule. Don’t let the amount of noise made by anti-vaccine spokespeople hide the fact that they’re a very small minority.

Please, decide for yourself what’s best for your children. Rely on advice from people who know what they’re talking about, people who who’ve trusted for years for reliable health information. These decisions should not be made based on flippant whims and rumors.

Conclusion

Many pediatric practices have chosen to “ban” vaccine refusers from their practice. I can see their point of view—it takes a lot of extra time to talk with parents about these complex issues, and some parents become argumentative and, well, ugly about these things. Who wants a fight? The anti-vaccine lobby seems to create an endless stream of rumors and moving targets that are difficult to keep track of and continually swat back down. Besides, medical offices serve many patients with special health care needs, including newborns who are at special risk for vaccine-preventable diseases. Why put those kids at extra risk by allowing unvaccinated children nearby?

Countering this is my own philosophy, that it’s not the kids fault they’re not vaccinated; and with patience and continuous discussions, I can usually get even the most stubbornly misinformed parents to vaccinate. So finally, with a lot of extra work, the kids get protected. That’s my goal.

There should be no doubt that vaccines are very effective at preventing diseases, and are still necessary to prevent serious illnesses. Just one recent example: a study published in May, 2009 showed that unvaccinated kids were 23 times more likely to contract whooping cough than children who were fully vaccinated. Do not doubt that the diseases that are prevented by vaccines are themselves quite serious and sometimes deadly. There are certainly some side effects of vaccines, as there are with any medical intervention, and serious vaccine reactions, though very rare, do occur. In my judgment and that of every respected health care agency, world-wide, the benefits of vaccinations far ought weigh the risks. Please don’t fall for internet hysterics and unfounded rumors. Protect your kids, and make sure they’re fully vaccinated.

Further resources

An Epidemic of Fear: How Panicked Parents Skipping Shots Endangers Us All. From Wired magazine, 10/2009, about just how unhinged antivaccine groups have become, and how their unjustified influence could affect the health of your children.

A review by me of Paul Offit’s Autism’s False Prophets, a book that reviews the long history of anti-vaccine sentiment, and how a very small number of misguided and sometimes malicious characters have steered parts of the autism community to distrust doctors and shovel their money into pointless and sometimes dangerous quackery. The book also offers promising hope for further discovery into the causes and cures of autism.

John Stewart on the daily show with some humor to illustrate the rampant scaremongering that pervades media attention to vaccines.

From Science-Based Medicine, a very well-referenced resource reviewing all of the evidence and the history of the “controversy” regarding vaccines and autism.

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18 Comments on “Why parents refuse vaccines”

  1. Beverley Tetrick Says:

    Dr Roy, Thanks for your thoughts about this topic. Recently, I found it necessary to part ways with pediatrician that I dearly loved over the issue of vaccinations. I left, not because she disagreed with me, but because she could not or would not provide any assistance in navigating the issue. The practice was uneducated and surprisingly naive about the origins of the vaccines they routinely give to thousands of patients. As a Catholic parent, I have struggled with the dilemma of immunizing my 4 small children with certain vaccines generated from aborted fetal cell lines. I believe it is in the best interest of the common good to use vaccinations, but my conscience is troubled by cooperating with the evil of abortion however far removed one may be from the original act itself. Its a side to the vaccination issue that I’ve found most people, doctors included, don’t know much about. The drug companies have done their best to obscure the information as much as possible, but it’s available if you dig a bit. There are probably many sources for this information, but I’ve found the following website quite useful in keeping up with the issue and monitoring the production and release of ethical alternatives to the those morally unacceptable vaccines currently available. http://www.cogforlife.org/ I think the issue would be more widespread if more parents against abortion knew how these vaccines were generated. The end cannot justify the means, but, as a parent, its still not a black and white issue.

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  2. Dr. Roy Says:

    It is true that viruses used to make certain vaccines (specifically, hepatitis A, chicken pox, and rubella) are grown in cell media that was originally derived from aborted tissue approximately 40 years ago. These cell culture lines have been continually propagated ever since, and are used in laboratories all over the world. To my knowledge, there are no other vaccines in use that are derived from these cell lines.

    The Roman Catholic Church isn’t the final arbiter of ethics, but they do have an established anti-abortion creed. Nonetheless, they have decided that these cells line are not aborted parts, and that using vaccines does not encourage abortion. They concluded in their response to a query from the organization in the link you provided that “There would seem to be no proper grounds for refusing immunization…” Ironically, this response was written under the auspices of then-Cardinal Joseph Ratzinger, now Pope Benedict. More details are available from the Catholic Church on their position on vaccines.

    I do not agree that this information is “hidden” or “obscured.” A quick google search found relevant links on the first page. I do agree that many physicians may not realize where these cell lines originally came from, and I thank you for your post and for sharing this information.

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  3. Dr. Roy Says:

    A very detailed review documenting the safety and effectiveness of influenza vaccinations:

    http://www.sciencebasedmedicine.org/?p=2040

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  4. Amy H. Says:

    I believe that vaccination is important but do not disagree with the ability for the parent to help make the decisions that they are comfortable with especially regarding WHEN to vaccinate. There have even been times when my sons received vaccines, especially early on, that I reluctantly allowed them to occur. These were times when there were several at once. Some of the vax schedules seem so jam packed with too much at once. I know how fragile small babies systems are- even changing one food or formula can throw them into all kinds of negative changes, much less putting more than one vaccine in their bodies at once. From the many, many moms I know and have had discussions with (and yes, I am a part of a large online moms group here in Atlanta), the problems with most parents regarding vaccines is less about getting the vaccines at all, but moreso the accelerated schedule. Since there are only “so many visits and many, many vaccines to get” they are piled on top of each other. If they were more spread out, like one every two months instead of several in one visit, it wouldn’t be so worrisome. And particularly now there is the huge scare of Autism and if vaccines play any role at all- either the cause or the trigger to set off an underlying problem. I am not supporting the theory, but it is often still questioned and supported by many people that have had children diagnosed which is now an alarming amount.
    I do not personally disagree with the vax schedule that your practice uses- I feel that it is done to include them all and accommodate the insurance companies’ willingness to pay for vaccines during the alloted routine visits. And I do not believe that if you or your fellow doctors were concerned about how much was happening at once that you wouldn’t make a change to fix the problem. But these vaccines ARE created for the masses…To protect them and prevent terrible illnesses from endangering them. But as individuals, we cannot discount our own instincts and knowledge of our individual cases and life situations just to appease the masses. As you pointed out, having a good, trusted pediatrician on your side to work together as a team to provide the best care and illness prevention for your children is the ultimate goal. I do believe in science, but I do not believe in “one size fits all”. That is why it is important to make rational, educated decisions together.

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  5. toemizanol Says:

    Dr. Roy,
    I appreciate your time and concern in regards to this matter. I found your site via your brother-in-law’s recommendation. Since you genuinely sound interested in understanding, I’d like to share some of my own psychology behind selectively vaccinating my children (and myself).

    Profile #4 is what started me down this path. Shortly after my oldest daughter turned 1 year old, she had a 30 minute long, stopped by medication, seizure, from a fever caused by Roseola virus. She saw a neurologist, who diagnosed it as an “atypical febrile seizure.” He told us that given her age, the length, and type of seizure, she was very likely to have another one, and that they were life-threatening seizures. About one month later, having seen the neurologists report, her pediatrician recommended she have her 12 month vaccines, which she had missed because she had an ear infection at the time of her well check-up. Unfortunately, my husband and I, very trusting at the time, consented. Nine days later, she had two more seizures. Both the pediatrician (who we saw after the first seizure) and the ER doctor (who we saw after the second seizure) believed these occurred as a result of a fever caused by one or both of the vaccines she had…MMR, and Varicella. That is when it struck me, that perhaps, it was not a good idea to have given her, with the diagnosis she had received, something known to cause fevers. We had reported that with every vaccine she had received in her first 12 months, she had fevers and well as periods of extreme irritability. True, she could actually get the chicken pox, and have a fever from that, certainly, but given that it was expected she would outgrow the seizures, it seemed more logical to risk that, and delay the vaccines. I learned that I needed to question the doctor. I have since given much thought to the psychology (from an admittedly, inexpert mind) behind using, even pushing, vaccines. I suspect sometimes, that it feels good to us to try to control something. I suspect that sometimes, it is easier to just make a blanket rule. I suspect that sometimes, it is safer for a doctor to push an “active” solution, rather than not. As an example, Dr. Mehmet Oz was recently interviewed regarding the H1N1 vaccine to which he was encouraging folks to get it, but then admitted his family would not be, and he said something to the idea of, “when I get home, I’m not Dr. Oz, I’m Mr. Oz.” I suspect, that if he went on and said he had concerns about the vaccine, and discouraged people to get it, and any of those people got seriously ill from H1N1, which statistically, some will, he might get sued, with them stating they followed his advice. But no one would consider suing him if they had an adverse reaction…he was right there with the majority, and he suggested action…to not vaccinate is considered in-action, and it seems to me that action is “safer” at least in regards to lawsuits.

    I also grew very frustrated at not knowing which vaccine had caused the fever…perhaps it was both, or the combo, but it would have been helpful information to me, to know. I began to question the idea of giving multiple vaccines at one time. And while I understand that with some families, the idea is to get the shots in them while you can, I think most pediatrician’s can decipher a family who would be willing to make extra trips in to see a nurse for a shot in order to spread them out. That option isn’t usually given unless a parent requests it, and even then, many offices will not. It seems like a reasonable idea to me, and I question a system that doesn’t consider this a viable option.

    I also fall into category #3 and #4. As for “Big Pharma”, I wholeheartedly agree with you that, like other companies, they are out to sell something, and in many cases, it is a mutually beneficial deal. However, there are many companies out there, including pharmaceuticals, who are selling things that I don’t need or want to buy, that they are selling for a profit to them, but the product isn’t necessarily, truly beneficial to me. I don’t care how self-conscious they can try to make me be with Brooke Shields suggesting my eye lashes aren’t thick enough, I’m not going to start slathering something on my eyelids to grow more. And while I do think that for the most part, those specific individuals working on vaccines really want to help, there are those within the company that will push for a product at all costs. As for the government connection to this, there has been a time, in our recent history, when information was provided that many intelligent people reviewed, and then made a decision on, a decision to launch our country into a war, and it was later discovered that the information was incorrect and possibly tainted. I *will* question, not the science, but the specific studies, because studies can be manipulated, are not always thorough, and have a history of fallibility.

    I also fall into #6, but not in the sense that I don’t also believe in conventional medicine. I am frustrated that there isn’t more information and action suggested by doctors (in general) and the media, regarding other methods of preventing such things as the flu, rather than so much on the vaccine itself. There are scientifically proven supplements that help boost immunity, for example, things that will help your body fight any kind of infection, and may even help your basic daily functioning. There are lifestyle factors as well, from eating nutrient rich foods, to daily exercise, to drinking plenty of fluids. If people acted more responsibly…by staying home when they are sick, and for 24 hours following a fever, there would be less spreading. You do hear these things, but considering they are options generally available ALL the time (unlike vaccines), and to all people, and with no harm at all, I think they should be suggested, and pushed, just as frequently, if not more. But yet again, I wonder why they aren’t.

    I will also agree with you, on category #7…these people frustrate me as well. They are simply a by-product of those of us who are raising questions and have concerns, and are not choosing to follow the CDC guidelines 100%. But I think there are some of us with valid concerns, and if those concerns could be heard, acknowledged, and addressed in some way, there would be fewer of those in category #7.

    I need for the experts out there to accept that there are individuals for which vaccinations may be counter-productive, even harmful, and that sometimes where to draw that line will be fuzzy, and they need to be willing to accept that it won’t be an easy to follow, hard rule. I need doctors to feel safe sharing their gut instincts. I need reviews of the information provided and/or linked to the companies profiting to be done and done by many, many people (to ensure that those reviewing aren’t tainted in some way). I need to know that everything that can be done, is being done, to ensure that my children are not being used as guinea pigs. Oh, how I wish, that I could just give my kids every shot out there…are you kidding me? To keep them from getting sick, without weakening their immune system, without the risk of harm in some other way? As a parent, who still, 6.5 years after that initial seizure, stays up all night to monitor her feverish child, strong medication at the ready to stop one of her ridiculously long seizures when they do hit, I would LOVE to be able to do that, but there are things that I have to question, that just don’t allow me to fully vaccinate without hesitation.

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  6. Anonymous Says:

    Here’s another one – those without insurance. You will hear the vaccines are “free” – but most clinics require a well-child checkup which can cost between 200-300. A couple hundred dollars for a 10 minute look-see and vaccines. For some people (and not just the very poor!), they may have to choose between eating or vaccinations. So the vaccinations are postponed until they have insurance or the savings to afford it.

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  7. Dr. Roy Says:

    Anon, in my state (Georgia), the county public health clinics offer H1N1 vaccine for free, and almost all other vaccines for a very nominal charge. I took my own kids to the Dekalb County Health Dept on Clairemont Road to get their H1N1 imms, no hassle, no problem, no charge.

    In our practice for the good of the community we plan to offer H1N1 vaccines to everyone, not just people in our practice, and not just people who’ve had a well-check. Now, we haven’t actually gotten any yet to offer– but that’s not our fault, we’re waiting on the county to send us some. And we don’t know how many doses we’ll get. But that’s a different problem!

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  8. Anonymous Says:

    You missed those of us who choose the path because of a history of familial autoimmune disorders (in our case an overreactive system) and related confounding factors, such as being either hyperresponders or nonresponders (which appears to be related to our particular immune disorder-celiac disease, with an occurrence rate of about 1% of the population) to nearly every medication, injection or other pharmacological introduction into our bodies.

    We have chosen a substantially reduced (no Hep B, no HiB, no Varicella, no flu) and delayed to age 6 on the others. We’ve taken precautions (no daycare, no bare feet on the farm) and understand the risks we are taking. But we also understand the risk we are avoiding. When you know your body either has no response or develops every nasty side effect in the book to a vaccinations or medications, your approach with your children is cautious.

    Both parents have celiac disease, both have two disposing genes, between the two parents and their immediate families we have had adverse or hyperresponses to flu vaccinations, Hep B, and pertussis.

    While some would argue we have a medical reason, I think the people with complex medical concerns like ours are usually lumped in with vaccine refusers because we have a hard time finding pediatricians willing to understand and work with our complex concerns. And sadly, we usually know far more about our condition, its complications, and risk than any doctors we see for treatment. And sadly, few doctors are even aware of the issues of hyperresponder/nonresponders. For the nonresponders the vaccination is pointless, no antibodies develop (we know this is the case with untreated celiac disease and Hep B). For hyperresponders the excessive immune response launched to the presence of the “killed” virus is the same as the real disease, our immune system can’t tell the difference and always overreacts. When you are a hyperresponder it’s a case of pick your misery.

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  9. Leslie Says:

    This is an interesting topic to me because people are often surprised to discover that I DO vaccinate my kids since one of my boys has autism. When he was diagnosed I searched endlessly to find a cause and many articles pointed to the vaccines. However, the evidence is just not there to support that theory. I knew long before his 18 month vaccinations that something was not right, and thankfully, Dr. Patty listened to my concerns and properly diagnosed him. We have had no problems with any of our kids’ vaccinations. No neurological damage was done to our children as a result of their shots. They are happy and disease free thanks to good old western medicine.

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  10. Dr. Alice Says:

    Excellent article! This is a very frustrating issue – and one that worries me quite a bit. In California, we’re seeing a huge increase in pertussis. I hate to speculate about upcoming years. My own daughter is expecting our first granddaughter – I’m asking her to stay away from children. Sad state of affairs!

    I do have photos in my office of those huge rows of young polio victims in “iron lungs.” It’s amazing to recall that this was a part of my childhood – quarantines, widespread fear, and the miracle of the vaccine. How far we are removed from those days… and I wonder if they will come back.

    The problem is that immunization isn’t perfect – it relies on an immunized populace. Between immigration and those vaccine-refusing parents, I’m wondering what changes we’ll see in pediatric acute care. They won’t be good, I’m afraid.

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  11. Anonymous Says:

    Dr. Roy –

    If vaccine effectiveness is based on science, and science is based on evidence proven via testing (double-blind placebo lab studies), why does vaccine testing not adhere to the same strict rules? Most vaccine testing is not performed via double-blind placebo studies. New vaccines are tested against old vaccines, not placebos. Therefore, wouldn’t it be fair to at least admit that vaccine research is not science and stop fooling the general populace?!?

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  12. Dr. Roy Says:

    Anon: Science depends on the best available evidence, but that doesn’t mean that double-blinded placebo lab studies are always necessary or appropriate. In a trial, the effectiveness and/or safety of a tested drug or vaccine is meant to be compared to the “standard of care”– not necessarily a placebo, and not necessarily “nothing.”

    Think about another example: let’s say you have a new antibiotic you’d like to test to see if it’s effective against pneumonia. It would be unethical (and unnecessary) to test that new antibiotic against a placebo group. That would expose the placebo group to unnecessary risk. The placebo group would get a “standard” antibiotic, and the trial group would get the new one.

    Vaccine trials and other medical investigations must be cleared by an “institutional review board” or IRB to ensure that test subjects are not exposed to unnecessary risks, and that the trial is warranted. A contemporary vaccine trial would not clear IRB if it included a group of children who were deliberately withheld from having vaccines, because that puts those children at unnecessary risks. Decades of data and thousands of studies already attest to the safety and effectiveness of current vaccines.

    Nonetheless, there are many studies looking retrospectively or cross-sectionally at vaccinated v. unvaccinated children, some of which include millions of children. Though they’re not prospectively randomized, they offer a tremendous amount of reassurance regarding vaccine safety and effectiveness.

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  13. This is the best article I’ve read about why so many people are refusing vaccines either for themselves or their children.

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  14. tjrogers@uwalumni.com Says:

    We too fall into the group with a strong family history of autoimmune disorders: celiac, type 1 diabetes, asthma, hypothyroidism, hyperthyroidism, arthritis, and sever allergies (also ADHA and autism, but who knows into what category these fall). The data related to the how vaccines affect those with this genetic predisposition is conflicting. Look at the Swedish study that observed how the HiB vaccine may induce type1 related auto-antibodies (Wahlberg et al. 2003) and the conflicting epidemiological studies. And again these large scale epidemiological studies don’t say too much about the risk to susceptibility groups. . .except one Finnish study, but that study didn’t address the statistical significance between the unvax’d cohort and the vax’d with the primary series for HiB. They oddly just compared cohort 1 (unvax’d) to cohort 2 (vax’d with one dose) and then compared cohort 2 to cohort 3 (vax’d with the primary). And I am pretty sure this wasn’t because they were applying the transitive property. The statistical difference between cohort 1 and cohort 3 was actually very significant and let us not even get started on the conversation we could have about “statistical significance” vs. practical significance. And when the IOM declared to link to type 1 they didn’t even look at the HiB. They looked at 8 of the 12.

    I have been pretty frustrated by the lack of good evidence when making vaccine related decisions. Thankfully, we have some good doctors now.

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  15. Dr. Roy Says:

    Rogers makes a number of claims without providing evidence or links, so it’s difficult to specifically refute them.

    RE: “look at the Swedish study”: I believe the commenter is referring to http://www.ncbi.nlm.nih.gov/pubmed/14679101. This study has been widely criticized for clever statistics (this summary, number 16, just calls them “wrong”: http://www.seminolecohealth.com/services/immunizations/vaccination-myths/.) Also, followup hasn’t shown that late versus early vaccination changes diabetes risk, and the authors of the original report didn’t even refer to their own vaccine data in a later study they did on risks for type I DM: http://www.ncbi.nlm.nih.gov/pubmed/16390388.

    RE: the reference to “conflicting epidemiologic studies”, I know of none that suggest a solid link between vaccines and any of the diseases mentioned in the post. I would be glad to review and discuss any specific studies if the poster would provide links.

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  16. tjrogers@uwalumni.com Says:

    Oh wow, that was a fast reply. Sorry for not giving all the references. I wasn’t sure I would get a reply since the thread was pretty old.

    I did check the seminole site and for #16 there was not any references either. Maybe they were somewhere else in the site. They should reference them next to claims though. We all apparently appreciate that.

    O.K., first off, yes that was the Swedish study I was referring to (I did mention Wahlberg et al.).
    I guess I would argue that your apparent refute of the study: the #16 seminole site claim has an author that is almost certainly referring to the Classen study, http://www.ncbi.nlm.nih.gov/pubmed/12482192, but it is hard to know because he/she doesn’t say. It all addresses timing and such and that relates to Classen’s study, not the Wahlberg et al. So, still what is the alleged problem with the statistics in the Wahlberg et al. study? And even with the Classen study, what were the statistical problems there? And the fact that those in the Wahlberg study didn’t site their previous data doesn’t make their previous data obsolete or invalid. They were addressing other possible causal factors.

    Secondly, the conflicting studies are as follows:
    Those proposing causality:

    http://www.ncbi.nlm.nih.gov/pubmed/12482192/

    http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1116914/

    http://www.ncbi.nlm.nih.gov/pubmed/14679101 (the Wahlberg article)

    Those responding to said causality (the first one is the one that had no comparison between cohorts 1 and 3, those unvax’d and those vax’d with the series:

    http://www.ncbi.nlm.nih.gov/pmc/articles/PMC27850/?rendertyp

    http://www.pediatricsdigest.mobi/content/108/6/e112.full

    And then the IOM looked at 8 vaccines and cleared them. I thought all the evidence (for the 8) was solid. I am sure the IOM will be glad to hear that! That I agree:)

    You can read through the studies if you like. And my statement about conflicting studies and yours about “no SOLID link” seem to be saying the same thing, right? It is CONFLICTING. The burden of proof in science is heavy (like 5% allowance for chance, right?), for good reason. . .that is the methodology; that is what this particular way of knowing demands. However, it leaves us a wide space of time before science can confirm or respectably refute claims. It seems there is A LOT we don’t know. Specifically with groups that have irregular immune system function. Just go to the CDC site and read about further investigating mitochondrial conditions. And how does that all relate to the immune system? And what about these apparent auto-antibodies that attack neurons in the brain? The M.I.N.D institute has found them in some % (sorry I can’t remember what # that is right now) of children with ASD. What is triggering those auto-antibodies? The dramatic rise in autoimmune disease is alarming. Is it necessarily caused by some qualitative difference between vaccines vs. natural immunity or a genetic susceptibility among certain individuals to respond negatively? Maybe not, but who really knows because all the dogmatic pro-vaccine voices want to say is that Wakefield was wrong.

    If we are not looking at the real problem, for whatever reason (poor sample size, ethics limitations, etc.) it leaves those searching for better answers at a loss.

    And don’t take this the wrong way, but I will probably not be back at this site. I only have time to discuss this with our doctor, unless you have some really stellar stuff:) I actually only ended up here on a whim. Good luck in all you do.

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  17. Dr. Roy Says:

    The IOM cleared the 8 vaccines it was tasked to investigate. It wasn’t asked to look at other vaccines, which is why it didn’t comment on them. Insinuating that the IOM only cleared 8 of 12 for some other reason is disingenuous rhetorical trickery. The IOM report: http://www.iom.edu/Reports/2011/Adverse-Effects-of-Vaccines-Evidence-and-Causality.aspx

    Rogers claimed in the first post that there was conflicting epiedemiologic evidence re: vaccine safety. As a followup, three reference links were offered; one was an antibody-titer study that has nothing whatsoever to do with epidemiology, and was discussed in my response. One was a letter to the editor– hardly an epidemiologic study. The other one was a study by vaccine-diabetes gadfly Classen, who is about as reputable a scientist as Wakefield himself. He’s even got his own colorful antivaccine website, offering to sell special licenses to exploit his patents which increase the financial incentives for reporting vaccine adverse events while linking to lawyers to help pursue dubious antivaccine claims. Meanwhile, rigorous research has failed to find any link between vaccines and DM: http://www.ncbi.nlm.nih.gov/pubmed/11731639.

    There has been and continues to be a tremendous amount of good research, as there should be, looking at potential side-effects of vaccines. We need accurate assessments of both risks and benefits to make informed decisions. The data is simply overwhelming that the risks of vaccinations are far, far outweighed by the benefits. Thanks for visiting.

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  18. S Says:

    The vaccine court is troublesome. I’d like to see that addressed.

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