A fascinating study in Pediatrics highlights how pediatricians and family medicine providers feel when parents, against established guidelines and standards of modern medical care, request that their child’s immunizations be spread out and not given simultaneously. The national survey, done in 2012, showed that among physicians who immunize children, 93% had been asked by parents in the last month to spread out vaccines. (I think the other 7% must have been away on vacation!)
The lede to this story, however, is that, despite recognizing that granting such requests endangers the health and well-being of these young children, puts a strain on practices’ office resources (and adds to rising health care costs), risks errors in documentation and reporting, requires trust that the parent will actually return for more vaccines, bruises the egos of those who are painstakingly educated and trained to know better than the parents proposing alternative vaccine schedules, and otherwise diminishes providers’ joy of working in their occupation (40% reported such requests decreased job satisfaction) — despite all those things, most pediatricians and family doctors (74%) will nonetheless give in. Only 18% of providers in this study were repulsed enough to consider discharging families from their practices when parents requested alternative schedules.
Michael Specter acknowledges that parents are placing their pediatricians not up on a pedestal (“Good riddance” to those days, Specter says) but, rather, between a dog and a tree:
Vaccines are the most powerful public-health tool that pediatricians possess. Unfortunately, there are people (a minority, but a dangerous one) who just don’t care.
Many of these people don’t approve of the vaccine schedule set out by the Centers for Disease Control and Prevention, and they seek to spread the shots over a longer time period than the one recommended. This has presented American pediatricians with a stark new challenge to their Hippocratic Oaths. Which does more harm: delaying scheduled vaccines and reducing their effectiveness, or refusing to delay and running the risk that parents will simply not vaccinate their children at all?
Specter goes on to demystify vaccines with facts: the “too many too soon argument” is “demonstrably untrue”; vaccines don’t cause autism (because, you know, science!); and the “shock to the immune system” is a “baseless” concern because of progress in molecular biology:
The number of bacteria that live on the nose of a newborn child or on the surface of his or her throat is in the trillions. “Those bacteria have between 2,000 and 6,000 immunological components and consequently our body makes grams of antibody to combat these bacteria,” Paul Offit, the chief of the infectious-diseases division at the Children’s Hospital of Philadelphia, has written. “The number of immunological challenges contained in vaccines is not ﬁguratively, it is literally a drop in the ocean of what you encounter every day.” Offit has long been one of the nation’s most prominent proponents of vaccines—and he has long been vilified for his stance.
Pediatricians are essentially succumbing to fears that parents won’t trust them if they don’t submit to their misinformed requests, that they will seek care elsewhere, and that they won’t ever immunize their children — all in the face of science and common sense that overwhelmingly supports their positions to immunize all children without a medical contraindication completely, and on time. That worries Specter the most:
But the medical profession’s widespread surrender on vaccines is deeply troubling. And it all but guarantees that preventable illnesses will continue to harm people and put children’s lives in danger. An Internet connection doesn’t make us all experts, and it doesn’t make it easier to distinguish between useful data and lies. That’s why trained physicians and nurses are more essential today than they have ever been. Unfortunately, that is not a truth universally acknowledged—even by doctors.
(Photo: Happy toddler and Sarah Schroeder, M.D., Pediatric Alliance — Fox Chapel Division)