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"Beware of Vaccine Bullies"--Malkin column



 
 
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  #21  
Old February 9th 04, 05:25 PM
Mark
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Default "Beware of Vaccine Bullies"--Malkin column

"Roger Schlafly" wrote in message .net...
"JG" wrote
Huh? Her "entire thesis" is that parents are pressured to get what, for
them, are unnecessary vaccines! (A subthesis is that pediatricians are
unthinking parrots.) She didn't say anything about "unfairness."


And Mark's attitude supports her point. Mark is one of those
peds who gets personally offended when a patient asks for the facts,
instead of just shutting up and blindly taking his orders.



Not at all. But when I give the facts and parents still refuse to
protect their kids, I'm forced to think that they either think I'm
lying to them, or they have preconcieved notions that no amount of
"factual intervention" will affect.

I have a patient whose Mom refused *all* immunizations because she had
a younger brother who, 30 years prior, had contracted meningitis and
died a month or two after having recieved his immunizations. I didn't
kick the kid out of my practice, but I also never fail to mention
vaccines when I see her.

I also made her sign a paper stating that I had informed her of the
risks of not immunizing her child, and that she understands she's
putting him at risk.

Mark, MD
  #22  
Old February 9th 04, 05:48 PM
Roger Schlafly
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Default "Beware of Vaccine Bullies"--Malkin column

"Jonathan Smith" wrote
[quoting CDC article]
We investigated two situations involving hepatitis B virus exposure
among children in day care. In the first a 4-year-old boy who attended
a day care center developed acute hepatitis B; another child at the
center, who had a history of aggressive behavior (biting/scratching),
was subsequently found to be a hepatitis B carrier. No other source of
infection among family and other contacts was identified and no other
persons at the center became infected.


Possible, but not very convincing. Did the boy bite or scratch
the kid who got infected? Did he draw blood? If others were
bitten or scratched, why weren't they infected? Could the family
have been concealing other contacts because it was suing the
day care center?

In the second situation a
4-year-old boy with frequently bleeding eczematous lesions was
discovered to be a hepatitis B carrier after having attended a day
care center for 17 months. Testing of contacts at the center revealed
no transmission to other children or staff (representing 887 person
months of exposure).


So transmission is unlikely, I guess.

Nationwide surveillance data showed that for the
period 1983 to 1987, 161 children 1 to 4 years of age were reported
with acute hepatitis B. After children with known hepatitis B risk
factors were excluded, 25% (7 of 28) of children with known day care
status were reported as day care attendees, a percentage comparable to
national estimates of day care attendance by this age group.


If HBV was being transmitted in day care, then we would expect
that the set of kids with HBV would have a higher percentage of
day care attendees. Instead, these figures suggest that HBV
infection in uncorrelated with day care status.

Notice how small the numbers are. This was before the universal
HBV vaccination program was started, so the numbers are even
smaller now.

This is
the first reported case of hepatitis B virus transmission between
children in day care in the United States. Although it appears that
day care transmission of hepatitis B is infrequent, further studies
are needed to define the risk more accurately.


IOW, the risk is too small and hypothetical to measure.


  #23  
Old February 9th 04, 05:50 PM
Roger Schlafly
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Default "Beware of Vaccine Bullies"--Malkin column

"Mark" wrote
I also made her sign a paper stating that I had informed her of the
risks of not immunizing her child, and that she understands she's
putting him at risk.


I had a physician once tell me that he had a similar policy for fat
patients who refuse to cut back on dietary cholesterol.


  #24  
Old February 9th 04, 06:25 PM
JG
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Posts: n/a
Default "Beware of Vaccine Bullies"--Malkin column

"Jonathan Smith" wrote in message
...
"JG" wrote in message

...
"PF Riley" wrote in message
...
On Sun, 8 Feb 2004 10:32:03 -0700, "JG"

wrote:

Hep B is transmitted via body fluids; ergo, diligent parents will

make
sure their infant/child isn't engaging in unprotected sex,

sharing
needles, or
being exposed to the body fluids of others (of unknown hep B

status)
in
other ways.


So they'll just go to the library instead the playground at

recess?

I dunno; someone here--D.C. Sessions, IIRC--used to claim that there
were documented cases of transmission via paper cuts! g (If you,

or
anyone else, can provide such documentation, I'd love to see it.

D.C.,
or whoever it was that made the assertion, never did when asked.)


Just what goes takes place on your schools' playgrounds, PF?

Orgies?
Group piercings? Tattooing?


Biting?


A child who bites isn't ready for kindergarten.

If you can find a verified, documented case of "recess

transmission,"
please point me to it. Certainly if an instance of "blood swapping"

did
occur, post-exposure prophylaxis could be considered/initiated.



http://www.ncbi.nlm.nih.gov/entrez/q...&dopt=Abstract

[...article excerpt snipped...]

Close; day care isn't exactly school. ;-) (It would be interesting to
know why the staff of the day care center in the first instance cited
didn't control the behavior of a known-to-be-"aggressive" attendee,
though.) Nevertheless, there's no proof that the "passive" child
contracted HBV from the "aggressive" child; heck, the article doesn't
even state whether the passive child was even bitten or scratched! (I'd
hope a wound serious enough to break the skin--esp. a bite, which would
have left a distinctive mark--would be noticed by his parents, at least.
Even if not contemporaneously investigated, you'd think they'd recall it
when questioned by doctors/health officials about possible sources of
their kid's infection.)

The second instance cited--the fact that no one with whom an HBV+ kid
had regular contact became infected--just highlights how (relatively)
difficult it is to transmit HBV.


  #25  
Old February 9th 04, 06:26 PM
JG
external usenet poster
 
Posts: n/a
Default "Beware of Vaccine Bullies"--Malkin column

"Jeff" wrote in message
...

"JG" wrote in message
...
(...)


If you can find a verified, documented case of "recess

transmission,"
please point me to it. Certainly if an instance of "blood swapping"

did
occur, post-exposure prophylaxis could be considered/initiated.


If the kids or adults present realized the danger of the situation,

the
doctors involved agreed, ...


In the type of scenario described (e.g., one kid somehow transferring
blood into another's open wound), it would, first and foremost, be the
*parents'* call. I can't imagine any doctor refusing to provide
treatment (e.g., administering hep B immune globulin [HBIG] and/or the
initiating the "regular" hep B vaccine series) to an otherwise healthy,
though w/o "adequate" HBsAb levels, child (assuming the "source" kid is
HBsAg+, of course). You're grasping, Jeff.

....and weighed the benefits and risks of the
post-exposure prophylaxis and felt that the benefits outweight the

risks.

Unless HBIG or HBV vaccine were contraindicated for the kid, I can't
imagine any physician believing the benefits *wouldn't* outweigh the
risks.

And then, only if the parents agreed and consented.


Ah, so you admit parents *do* have a say (even though you apparently
still think it's subordinate to the doctors')! g

I doubt this would happen much.


Why? Who'd balk? I doubt many parents, knowing that their kid's blood
has been contaminated by that of a HBV+ classmate, would refuse
treatment.


  #26  
Old February 9th 04, 08:12 PM
abacus
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Posts: n/a
Default "Beware of Vaccine Bullies"--Malkin column

(Mark) wrote in message . com...
"JG" wrote in message ...
"Mark" wrote in message
om...
"JG" wrote in message

...

[...]

Scaremonger. The likelihood of an infant/child who has diligent

parents
and is not subjected to to "high risk" persons--e.g., the Malkins'
son--contracting hep B is no doubt so ridiculously small as to be
laughable.


*I'm* the scaremonger? That's a laugh. The other vectors *aren't
identified*. How you know that you're being diligent in protecting
your child against these vectors if you don't even know what they are?


Hep B is transmitted via body fluids; ergo, diligent parents will make
sure their infant/child isn't engaging in unprotected sex, sharing
needles, or
being exposed to the body fluids of others (of unknown hep B status) in
other ways.



You missed (or ignored) my contention that 30-40% of childhood Hep B
infections are NOT found to be linked to blood or body fluid contact.

It might be mosquitoes, but that hasn't been proven yet.

It might be a fecal-oral route, but that hasn't been proven yet.

It might be little green men with invisible hypodermic needles, but
that hasn't been proven yet.

The point is, about a third of childhood Hep B infections have no
identifiable vector, therefore the author's assertion, and yours, that
there is no need of protection is errant.

Mark, MD


It seems to me that the appropriate question to ask isn't "Is there
any risk of exposure?" but rather "Does the risk of exposure justify
the risk of vaccination?"

With approximately 2/3 of childhood Hep B infections having an
identifiable vector, for children without any exposure to known risk
factors, do the remaining 1/3 of infections constitute a high enough
risk of disease to justify the risks of vaccination? That is certainly
something for informed parents to consider when making their decision.
  #27  
Old February 10th 04, 12:04 AM
abacus
external usenet poster
 
Posts: n/a
Default "Beware of Vaccine Bullies"--Malkin column

(Mark) wrote in message . com...
"Roger Schlafly" wrote in message .net...
"JG" wrote
Huh? Her "entire thesis" is that parents are pressured to get what, for
them, are unnecessary vaccines! (A subthesis is that pediatricians are
unthinking parrots.) She didn't say anything about "unfairness."


And Mark's attitude supports her point. Mark is one of those
peds who gets personally offended when a patient asks for the facts,
instead of just shutting up and blindly taking his orders.



Not at all. But when I give the facts and parents still refuse to
protect their kids, I'm forced to think that they either think I'm
lying to them, or they have preconcieved notions that no amount of
"factual intervention" will affect.


So, after giving parents the 'facts', if they disagree with you they
must either a) think you're lying or b) no amount of 'facts' will
convince them?

Have you ever considered the possibility that they simply don't agree
with the conclusion you came to based on the 'facts' available? Do
you not consider it possible that given the 'facts' currently
available, some parents might come to a different conclusion than you
have regarding the risk/benefits of a particular vaccination for their
child?

Has it occurred to you that some parents might come to a different
conclusion regarding the safety of vaccination for their child based
on a family history? Or perhaps they simply don't share your
confidence in the official statistics (i.e. 'facts') regarding risk of
vaccination. That doesn't mean they believe the anti-vac sites are
correct, only that the risks may not be as low as the vaccine makers
claim. Thus, they may come to a different conclusion regarding the
benefit versus the risk of a vaccination.

Truly, your response here does suggest an attitude of taking offense
if the parent of patient doesn't go along with your recommendations.
  #28  
Old February 10th 04, 04:41 AM
Jeff
external usenet poster
 
Posts: n/a
Default "Beware of Vaccine Bullies"--Malkin column


"JG" wrote in message
...
"Jeff" wrote in message
...

"JG" wrote in message
...
(...)


If you can find a verified, documented case of "recess

transmission,"
please point me to it. Certainly if an instance of "blood swapping"

did
occur, post-exposure prophylaxis could be considered/initiated.


If the kids or adults present realized the danger of the situation,

the
doctors involved agreed, ...


In the type of scenario described (e.g., one kid somehow transferring
blood into another's open wound), it would, first and foremost, be the
*parents'* call. I can't imagine any doctor refusing to provide
treatment (e.g., administering hep B immune globulin [HBIG] and/or the
initiating the "regular" hep B vaccine series) to an otherwise healthy,
though w/o "adequate" HBsAb levels, child (assuming the "source" kid is
HBsAg+, of course). You're grasping, Jeff.


No I'm not. The odds that a parent will recognize a potential tranmission of
hep B and do something about it, other than clean a wound is next to nil.

...and weighed the benefits and risks of the
post-exposure prophylaxis and felt that the benefits outweight the

risks.

Unless HBIG or HBV vaccine were contraindicated for the kid, I can't
imagine any physician believing the benefits *wouldn't* outweigh the
risks.


In the situation where you know that a kid has been exposed, but how often
does a kid prsent to a doctor with a complaint of exposed to Hep B?

And then, only if the parents agreed and consented.


Ah, so you admit parents *do* have a say (even though you apparently
still think it's subordinate to the doctors')! g


No, I don't think it is subordinate to the doctors'. However, a physician
would not offer at treatment a treatment unless he thought it was in the
best interest of the patient. For example, if a doctor thought that a
patient had a viral infection and there was no need to give antibiotics, he
would not offer antibiotics.

I doubt this would happen much.


Why? Who'd balk? I doubt many parents, knowing that their kid's blood
has been contaminated by that of a HBV+ classmate, would refuse
treatment.


Yet, how often do think that:

1) A parent knows that another kid in class is Hep B+?
2) A parent knows that his kid's blood has been contaminated by that blood?

This would be a very rare situation.

Jeff


  #29  
Old February 10th 04, 05:19 AM
Mark
external usenet poster
 
Posts: n/a
Default "Beware of Vaccine Bullies"--Malkin column

(abacus) wrote in message . com...
(Mark) wrote in message . com...
"Roger Schlafly" wrote in message .net...
"JG" wrote
Huh? Her "entire thesis" is that parents are pressured to get what, for
them, are unnecessary vaccines! (A subthesis is that pediatricians are
unthinking parrots.) She didn't say anything about "unfairness."

And Mark's attitude supports her point. Mark is one of those
peds who gets personally offended when a patient asks for the facts,
instead of just shutting up and blindly taking his orders.



Not at all. But when I give the facts and parents still refuse to
protect their kids, I'm forced to think that they either think I'm
lying to them, or they have preconcieved notions that no amount of
"factual intervention" will affect.


So, after giving parents the 'facts', if they disagree with you they
must either a) think you're lying or b) no amount of 'facts' will
convince them?

Have you ever considered the possibility that they simply don't agree
with the conclusion you came to based on the 'facts' available? Do
you not consider it possible that given the 'facts' currently
available, some parents might come to a different conclusion than you
have regarding the risk/benefits of a particular vaccination for their
child?

Has it occurred to you that some parents might come to a different
conclusion regarding the safety of vaccination for their child based
on a family history? Or perhaps they simply don't share your
confidence in the official statistics (i.e. 'facts') regarding risk of
vaccination. That doesn't mean they believe the anti-vac sites are
correct, only that the risks may not be as low as the vaccine makers
claim. Thus, they may come to a different conclusion regarding the
benefit versus the risk of a vaccination.

Truly, your response here does suggest an attitude of taking offense
if the parent of patient doesn't go along with your recommendations.



That's like me telling my mechanic, "I don't care what you think you
"know" about brakes; I don't care what your precious "NTSB" says
about minimum safety standards for brake pads; I don't want you to
change the brake pads on my car because I once had an uncle who had
that done and then his brakes failed and he had a car crash. Just do
the brakes the way I'm telling you to...and by the way, I'll sue you
if there's a problem."

I'm a doctor, one who specializes in taking care of children, and in
my purview are included having to know about vaccine-preventable
diseases, and knowing about vaccines themselves. Do you think that I
would, in good faith, argue in favor of vaccines for kids when I think
the vaccine poses a greater risk than the disease? If so, STFU
because you don't know much about me or what I do for a living.

And if I were the mechanic in the above scenario, I'd tell the
customer to take a hike and find a different mechanic, one who is
willing to suspend better judgement in favor of not ****ing off a
client.

Mark, MD
  #30  
Old February 10th 04, 06:23 AM
Roger Schlafly
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Posts: n/a
Default "Beware of Vaccine Bullies"--Malkin column

"Jeff" wrote
Yet, how often do think that:
1) A parent knows that another kid in class is Hep B+?


Very rare. There are only a handful of hep B+ kids in the USA.


 




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