Trust Your Doctor about Vaccines

As a pediatrician, I deal with questions and concerns from parents regarding vaccines.  Despite my best efforts, some patients will not receive the needed vaccines, thereby putting them at risk for serious illness and even death.  Although I present the evidence that show the faulty link between the “MMR vaccine causes autism ” many parents still quote the various reasons of why vaccines cause more harm than good. They range from mercury to formaldehyde to risk of autism and seizure disorder.  

I have parents of premature children who deny vaccines to these young newborns because they feel that the vaccines ‘will overwhelm their system.’  Unfortunately, these small infants will suffer the worst consequences of contracting a preventable disease.  As everyone can see from the news as well as within many of our communities and local school systems, measles, once eradicated in our country, is back with a vengeance. And contrary to what many believe, it is simply not ‘just a rash.’

As a pediatric resident 15 years ago, I saw active measles and meningitis and the sequelae of polio, all here in the United States!  As pediatricians, we follow a vaccination schedule guided by the Center for Disease Control (CDC).  I still remember taking care of a young toddler who had contracted measles and exposed an entire airplane full of people as well as our emergency department. While the City Department of Health had to contact other passengers, we were overall very lucky with only having one care of measles in the entire hospital.  Unfortunately, the child who had contracted measles was not so lucky.  He had a long protracted course with resulting measles keratitis, which adversely affected his vision. 

Unfortunately, as false facts are propagated through social media, what many people don’t see are the harmful effects of this pseudo-science on our youngest victims: children and adolescents. And it not only affects our youngest patients, but adolescents and young adults too. There was another news report of a young woman, who had just started college, who contracted a virulent form of meningitis and ended up dying. That’s it, her short life cut short—by a PREVENTABLE disease.

I implore parents and caregivers, if you have questions/concerns about vaccines, please do not look to the internet. We, as physicians have gone to school for a lot longer than Dr. Google. Trust us as we care for the most precious things in your life: your children.

Natasha Sriraman MD

Dr. Sriraman, MD, MPH, FAAP, FABM, speaks around the country on various topics: breastfeeding, postpartum depression screening in pediatrics, narrative medicine/physician burnout, cultural competency/cultural differences in infant feeding and social determinants of health. She has specialized training in pediatric psychopharmacology. In addition to seeing patients, she is an associate professor of pediatrics at Eastern Virginia Medical School and teaches medical students and residents daily. She also holds a master's degree in public health from the University of Pittsburgh and has designed curriculum for public health training in pediatrics and breastfeeding training. She also serves as Adjunct Lecturer at the College of William & Mary where she teaches a class on health disparities.. Dr. Sriraman is frequently involved with legislative advocacy and has worked with the Governor's office on having May declared as Maternal Mental Health Month in Virginia. She has received numerous awards for her teaching and research. She has also received grants from Health Resources and Services Administration (HRSA), the American Academy of Pediatrics (AAP) and jointly from Williams & Mary College/Eastern Virginia Medical School. She has served on the board of National AAP-Section of Breastfeeding, and VA-AAP Chapter, and Postpartum Support Virginia. She is currently on the Board of Directors for Academy of Breastfeeding Medicine and The Eliza Hope Foundation. 

  10 comments for “Trust Your Doctor about Vaccines

  1. June 4, 2019 at 10:31 am

    Yes, public health is being used as the rationale to dictate medical decisions in minute detail, by people like you, who apparently know that a 95% vaccination rate with Merck’s MMR is necessary to avoid kindling epidemics in which millions will die of resurgent and far more virulent measles. You have no need of citations, but demand them from those who differ, and no doubt would find all of them inadequate. It’s the one who wants to impose his will who should have the burden of proof. Constant claims that “vaccines are safe and effective”–the CDC says so–should not be allowed to override patients’ decisions and doctors’ advice.

    This started out to be about trust in doctors. Patients will not trust doctors who disrespect them and trust and parrot authorities.

    There are risks and benefits to all medical interventions; vaccines are not immune to the need for critical analysis.

  2. June 3, 2019 at 11:46 pm

    My article has a byline–mine. Not “AAPS.”

    I am not writing a referenced article here, but I see i need to do one. The chart of plummeting mortality from measles and other infectious diseases has been published in many places.

    Who knows, maybe “black measles” could come back, or worse; those nasty viruses can mutate. But vaccinating 95% instead of 92% won’t stop it.

    Yes, I have heard of the post hoc fallacy. But you didn’t suggest any reason for our children being so sick. Giving them adjuvants that send the immune system into overdrive, with each and every one of the 69 vaccine doses, might possibly have something to do with allergic and autoimmune diseases.

    Confining people, fining them, imprisoning them, or excluding them from school ought to have a very serious basis. You can argue about what is a clear and present danger. There’s Ebola, or active TB. But if being unvaccinated is one, against a disease that is currently rare (<1,000 in 350 million) and generally mild, where can it stop?

    Do tell where the 95% comes from. Herd immunity started out at about 68%. Now we probably don't have even that because of short-lived vaccine immunity.

    If the risk of dying or being crippled for life by the vaccine is only 1 in a million, it's still much greater than the risk of dying of measles under current circumstances. If you want to be vaccinated, go for it. But what gives you the right to make that choice for others–and subject them to the leper treatment if they don't do what you want?

    It would be really great to have a rational discussion–impossible to do when the mandate advocates lead with insults, ad hominems, and name-calling. Like "antivaxxers" for anyone who has the same hesitancy about vaccines as about other medical interventions–or for "ex-vaxxer" parents who followed their doctor's advice, have a severely injured child, and get only disrespect and dismissal from physicians.

    • Steve O'
      June 4, 2019 at 8:46 am

      Good, it’s getting a bit more like a discussion here. First off – drawing the line in public health issues is unavoidable. How do we determine the circumstances where the line,
      As Dr. Wayne Elstein stated in your journal’s citation:

      One of man’s most driving motivations is to feel superior. He manifests this in many ways and all too commonly gives advice in a special field in which he has no training. The bookkeeper turns sidewalk superintendent, the doctor issues legal opinions, the elevator operator offers stock market advice, and many persons well-trained in their own fields turn amateur doctors. This seems to be legitimatized in many minds if the doctoring includes or touches upon the social welfare field.

      Indeed, this statement, in a nutshell, is incredibly relevant to the weakening American healthcare. “Public health” and “social welfare” are incredibly dangerous weapons when used to control physicians, and should be enforced only when appropriate. Otherwise, we have the entire political agenda being played out under the guise of medical care.
      The medical encounter is on the verge of a mandate, I suspect, within a year or two, requiring the videotape encounter of all patient/physician interactions: for quality reasons, to preserve privacy, and for national security and every other nonsense that can be trotted in front of the public. That is why all sorts of energy is being spent on the video encounter. It has been well demonstrated that there is not the slightest interest in improving the quality of care in nearly any innovation forced upon the treatment room. But it can be preserved to demonstrate physician “upcoding fraud” and such quality violations. That is a far more terrifying proposal than whether measles vaccination falls under the proper domain of public health. But that’s not what this author brought to us today.
      To have a rational discussion is simply TO HAVE a rational discussion as we are doing in public. That habit has fallen out of society. There is no interest by the public in the boring struggle of making policy. Few people seem to have the insight on how their provocations make the situation worse.
      “parents who followed their doctor’s advice, have a severely injured child, and get only disrespect and dismissal from physicians.” What do you think that this will bring about, other than the regulatory agencies and legislative bodies bringing about a mandatory pre-written paragraph or two to recite to parents, and nothing else? Do want that on abortion, end-of-life issues, and other medical discussions? I suspect that many people endorse this idea, as long as “my side” gets to write the script for the unreal playhouse that the examination room is becoming.
      I am bothered by a person with standing in the medical community offering, on the one hand, certainties which have no substantiation, and on the other hand, raising suspicions without citations:

      But vaccinating 95% instead of 92% won’t stop it (the re-emergence of hemorrhagic measles). …might possibly have something to do with allergic and autoimmune diseases…. Yes, I have heard of the post hoc fallacy. But you didn’t suggest any reason for our children being so sick.

      This is bad commentary for people who look to the argument between physicians on these various topics. How do you know that 95% but not 92% is not the number needed to treat, to avoid kindling an epidemic? Why do you invoke the universal “something?” Why should I have to offer something as a counter-proposal to refute the post-hoc fallacy? (After all, you didn’t offer even a mention of the undeniable correlation between Federal bankruptcy and us giving females the permission to vote.).
      Professionals have the duty to argue matters straight-up, not with the cloak-and-dagger shadows of inference and suspicion. One of our colleagues mentioned earlier here showed the “tragic effects and damage upon American medicine that the DPC movement is ushering in.” His rhetorical missive was properly lambasted and taken apart here, fact by fact.
      So step in, discuss how we draw the line in public health between individual freedom and societal compulsion. It’s not “impossible to do when the mandate advocates lead with insults, ad hominems, and name-calling.”

  3. June 2, 2019 at 6:54 pm

    Thanks for linking to my article at Kindly point out any factual errors.

    Mortality was plummeting pre-vaccine. Most of the 4 million cases of measles per year were not reported. Most deaths probably were, giving a death rate of about 1 in 10,000.

    I lived through those bad old days when almost everybody, including me and my sisters, got those “horrible” childhood diseases, and almost everybody did fine. What we did NOT see was kids carrying asthma inhalers and Epi-pens to school, autistic kids, or lots of other kids with neurologic or behavioral disabilities. What happened?

    The $4 billion in damages paid by Vaccine Court are a straw man?

    What’s magic about a 95% vaccination rate, vs the 90+% that we have now? If we just catch those few percent of healthy children, who can’t give anybody measles until they catch it themselves, we will stop measles outbreaks? It hasn’t worked in other places.

    The problem is that some 50% of the population is not immune to measles because their vaccine immunity has worn off. That’s why measles is four times worse when it occurs–the age distribution has changed.

    It would not be a good idea to stop measles vaccination now, because vaccine-based immunity has obliterated most natural, more robust immunity. Everything in medicine is a trade-off.

    We celebrate the eradication of smallpox–except what is in freezers in Atlanta and Moscow-and stockpiled biological weapons. If we had an outbreak, the entire world would be as susceptible as native Americans were when European colonists brought smallpox to America.

    Oh please. Somebody with active TB, coughing up live bacilli, is NOT the same as a perfectly healthy but unvaccinated child. Why do we treat these children as lepers? You can catch measles from a vaccinated child, a vaccinated adult, or anybody who actually has measles (for a couple weeks). You can catch vaccine-strain measles from a recently vaccinated person. But not having gotten a vaccine (a live-virus vaccine,by the way) does not make you the equivalent of a Typhoid Mary for measles for life.

    It is true that our education system is horrible, and many people can’t think logically. But disrespecting parents who ask questions certainly does not inspire trust. Doctors have the duty to assess risks and benefits for each patient, rather than enforcing diktat from on high.

    Here’s a doctor’s perspective from the 1960s:

    Both doctors and patients have the responsibility, and the right, to think for themselves. Society has no right to confine people who are not a clear and present danger, nor to forcibly inject them ever to achieve a hypothetical benefit to someone else.

    We are still at risk of infectious diseases. We need better vaccines, better diagnostics, and better treatment. Not achievable in at atmosphere of coercion and attempts to silence dissent.

    • Steve O'
      June 2, 2019 at 9:14 pm

      If you wish to cite facts, it would be very much appropriate, especially as an editor of a medical publication, to cite your sources, even in informal communication.
      Have you determined why the death rate of measles was plummeting before vaccination, as you claim? Between WWI and WWII, surveys were taken of military camp populations. The declines in measles-related mortality rates in military populations reflected the experiences in civilian populations; the declines preceded the availability of measles vaccine and antibiotics and were not attributable to any specific medical interventions. (see Measles Epidemics of Variable Lethality in the Early 20th Century
      G. Dennis Shanks Zheng Hu Michael Waller Seung-eun Lee Daniel Terfa Alan Howard Elizabeth van Heyningen John F. Brundage
      American Journal of Epidemiology, Volume 179, Issue 4, 15 February 2014, Pages 413–422)
      That journal states that In the 20th century, most measles-related deaths were due to secondary bacterial pneumonias; however, prior to the 20th century, measles often caused lethal gastrointestinal illnesses and sometimes a fatal hemorrhagic illness known as black measles. We physicians today are unfamiliar with the variant presentation of measles nowadays, if we can recognize it at all. On a population basis, it seems to trend towards benignity. That is, obviously, of no use whatever to a particular patient with the measles.
      What we did NOT see was kids carrying asthma inhalers and Epi-pens to school, autistic kids, or lots of other kids with neurologic or behavioral disabilities. What happened? You cite a logical fallacy, that’s what happened. it’s the post-hoc fallacy. For example, the US Budget was always balanced for 150 years, until we let women vote. What happened? We also did not see white children associating with children of color. Isn’t that an epidemiological risk by not segregating the herd? Is that equally relevant?
      I’d say that you are either deliberately using bad logic, or cannot understand logical errors in what you write. You asked, again, “The $4 billion in damages paid by Vaccine Court are a straw man?” That is, itself, a straw-man argument. I will not condescend to imagine you don’t know what I’m referring to. Shame on you.
      Oh please. If you wish to dismiss an argument by feelings, you may do so. You seem unwilling to answer the question – under what circumstances MAY a government take and confine a person who has not committed a crime? If you think that active Tb is a legitimate case for confinement, but measles vaccination is not, please argue for it as an informed physician with knowledge of epidemiology, which you are, and not as Joan Rivers, who is not. It is fine to ask why the person with Tb cannot simply go about with an N-95 mask, which is a reasonable alternative to denying their liberty. Oh Please.
      Thank you for the recitation of the opinion piece of the doctor from 1960. At the time that was published, I was not eligible for the MMR vaccination as I was too young. There is little sense in using old material to discuss new views. Women and people of color not only suffered ridicule in advertising, they also did in Flexner’s infamous Report of 1910. All these things are awful. Nevertheless, the doctor’s opinion, although it might be considered haughty, is understandable.
      You cite the doctor’s opinion, and distribute it as part of AAPS Pamphlet No. 1065. I infer that you would endorse the doctor’s opinion

      Under very special circumstances, mass immunization programs may be proper. My judgment would give me a different answer if we were facing a spreading or imminent epidemic, or if the disease in question had a high instead of low attack rate, or if a sequence of events exposed our community to a definite hazard at this time. These variations do not change the process of the technical judgment-they simply change the weight of the factors-so that my best judgment, under different conditions, gives me a different conclusion.

      What is missing is the willingness today to engage in reasoned debate, and the freedom from bias in those who can be seen as offering some degree of authority in matters. I am concerned that the arguments from AAPS in the ways cited are poorly framed and are thus unacceptable. Things are waved off and not explained – society has no right to confine people who are not a clear and present danger… Clear and present danger is the very point upon which the argument hinges. Even Joan Rivers would agree.

    • Steve O'
      June 3, 2019 at 12:33 am

      PS: I’ve got to add this on.
      Jane said:

      What’s magic about a 95% vaccination rate, vs the 90+% that we have now? If we just catch those few percent of healthy children, who can’t give anybody measles until they catch it themselves, we will stop measles outbreaks? It hasn’t worked in other places.

      Jane, it’s called population biology and predator-prey ecology, and it’s been studied for eons. If you are feigning ignorance of the subject, you’re not being honest in the debate; and if you truly don’t know how they come up with the “magic” 95%, you should educate yourself on this important issue.

  4. Steve O'
    June 2, 2019 at 1:40 pm

    It merits pointing out that Jane Orient MD is the managing editor of the Journal of American Physicians and Surgeons. Her link is to that organization. Her article on vaccination is linked here.

    It would have served the authenticmedicine site well if Dr. Orient had linked directly to her article, summarizing its points. Vaccination began in 1963, at which time the US manifested 450 to 500 deaths annually. While the virus was epidemic in the population, hospitalization occurred in 1 out of 4 cases, encephalitis occurred in 1 per 1,000 cases. That’s the baseline. Ear infections occur in about one out of every 10 children with measles and can result in permanent hearing loss. In 2011, after an uptick in cases, the public health burden of measles care was $2.7-5.3 million in the USA.

    The article discusses the question of compulsory treatment of a medical condition for public health interests. This is a political question, not a matter of health statistics. Her article more straightforwardly discusses these questions, balancing individual freedom vs. public health obligation, as well as the details about efficacy of vaccination for the long-term control of the disease.

    Deciding what is best for individual patients is difficult, fraught with danger and full of uncertainties. Doctors may advise, or patients may choose a course that is harmful. But if governmental authorities, imbued with a sense of infallibility, impose their will on everyone, the consequences of a bad choice affect millions.

    Trading freedom—and free speech—for supposed security ultimately leads to a loss of both. And if government can dictate what you must inject into your own children, what limits can be placed on its power?

    This is ultimately a POLITICAL discussion. It should not be conveyed by arguments about the dishonesty of this or that side.

    Is it an unacceptable violation of freedom to place those with active pulmonary tuberculosis in a negative pressure room if they do not want to be there? Of course it is. It is so with any contagious disease which can be spread person to person. If one has prairie dogs on one’s private land, does the government have the right to eradicate them, if there is plague in the area? For those who insist that private property is inviolable, it is harmful for a government to do so. Private property is private property.

    These are political questions. They should not be masked behind the misuse of statistics. The balance of risk vs. benefit is intrinsic to medicine; it is always appropriate to discuss such things as number needed to treat to prevent some disease. But let’s also argue the political side in the open, and not let the argument be distracted by more emotional topics.

  5. Steve O'
    June 2, 2019 at 1:01 pm

    I am unsympathetic towards those who live in freedom, and yet either cannot or will not use reason to guide their decisions.
    Tyranny in free countries does not arise from harsh and violent strife; rather,

    the will of man is not shattered, but softened, bent, and guided: men are seldom forced by it to act, but they are constantly restrained from acting: such a power does not destroy, but it prevents existence; it does not tyrannize, but it compresses, enervates, extinguishes, and stupefies a people, till each nation is reduced to be nothing better than a flock of timid and industrious animals, of which the government is the shepherd.

    de Tocqueville
    Living merely passively and unthinkingly, even in a free society , will not prevent [citizens]from gradually losing the faculties of thinking, feeling, and acting for themselves, and thus gradually falling below the level of humanity. [ibid]
    Jane (above) argues against vaccination by claiming that opposition to vaccination comes about by a rejection of passivity. Skepticism and concern is admirable, and in adults caring for those who cannot think for themselves, merits inquiry into the underlying truths of any position.
    I find that few Americans are either skilled or even interested in rational inquiry in science or any other matters.
    For example, in a strawman argument, Jane asks – Even a 1 in a million risk of such a consequence might make some parents prefer to take their chances with measles. Who are doctors to deny them complete information and the right to choose?
    Who is denying any parent the complete information, or the right to choose? There are some concerns expressed in public health about what to do if the percentage of the immune population slips below the “flash point” of kindling epidemics.
    What passes for argument in the United States in so many places is not rational inquiry, but rather the embracing of whichever tribe gives one the most comfort, and amplifying the dishonest and cruel position embraced by The Opposition. Homo sapiens has lived most of its existence until late in such primitive societies that frequently war against each other. It is sad to find that we are sliding backwards into Paleolithic ways.

  6. June 2, 2019 at 10:43 am

    “Trust me, and take all 69 shots!” is no longer persuading all parents. Especially when the doctor disrespects them as gullible yahoos who believe in “pseudoscience.”

    Are the potential adverse effects in FDA-required package inserts pseudoscience? Are the terribly injured babies mothers bring to hearings feigning their seizures, GI distress, neurological disabilities? Or do they all have conditions that pre-existed vaccination that mothers and pediatricians didn’t notice?

    Even a 1 in a million risk of such a consequence might make some parents prefer to take their chances with measles. Who are doctors to deny them complete information and the right to choose?

  7. PW
    June 2, 2019 at 9:47 am

    The problem is, many people alive today have not seen the devastating consequences these diseases can have, so now the vaccines become the thing to be feared.

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