"Beware of Vaccine Bullies"--Malkin column

On Mon, 09 Feb 2004 16:50:20 GMT, "Roger Schlafly"
wrote:

"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.

And not such a bad idea after all, since some fat lazy dead smoker's
asshole family just sued his doctor and won, claiming the doctor
didn't do enough to prevent his fatal heart attack.

It all could have been avoided had there been a signed statement in
his chart reading: "I understand that being fat, smoking, and getting
no exercise is bad for me and may lead to a potentially deadly heart
attack at a relatively young age, yet I prefer to continue to smoke
and eat bacon cheeseburgers."

PF

On Tue, 10 Feb 2004 05:23:07 GMT, "Roger Schlafly"
wrote:

"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.

Gosh, and 4 of them happen to be my patients? Wow!

PF

On Sun, 8 Feb 2004 21:38:46 -0700, "JG" wrote:

"PF Riley" wrote in message
...

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

If you can find a verified, documented case of "recess transmission,"
please point me to it.

Well, a possible case of "daycare transmission" is cited elsewhere on
this thread, at least.

Certainly if an instance of "blood swapping" did occur, post-exposure
prophylaxis could be considered/initiated.

Except the chronic hepatitis B carriers who attend public school that
I know keep it a secret, even from the school.

Hey, I have an idea! Instead of expecting daycare providers to protect
your child from any physical conflict with other children, and
expecting any hepatitis B carriers at school to wear a fluorescent ID
bracelet so that you can run to the school nurse for an antibody shot
should you contact his or her body fluids, why not have everyone get
an easy three-dose vaccine series when they're babies and you can
relax a little about it! Or, better yet, let's use Roger's "logic:"
Have everyone get the vaccine so that no one has to!

By the way, the Malkin article is crap, because both she and her
doctor are idiots. Reading the article is like watching two retards
argue.

I have no problem skipping hepatitis B and polio vaccines for babies
of parents who really don't want them. (My families from India who
travel there frequently with their young infants would theoretically
be an exception, although they know better.) Most of them end up
getting those shots later, anyway. To me, however, a parent telling me
they don't want DTaP, Prevnar, or Hib is like telling me they don't
use an infant car seat. ("Oh, I'll just make sure he's not around
anyone with any baaaaad diseases!" is like saying "Oh, I'll just hold
him REAL TIGHT if we crash!")

PF

"Roger Schlafly" wrote in message
. net...
"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.


And if another kid had Hep B, how do you think the other parents would know,
especially if (s)he were a carrier? How many parents introduce kids as
"That's Bobby. He is 3 1/2 and is a Hepatitis B carrier?" Not many.

Jeff

On 9 Feb 2004 15:04:47 -0800, (abacus) wrote:

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?

Particular vaccination, maybe. All of them, no. If I were a
pediatrician and I had patients that much at odds with what I know to be
the current state of the research, I'd bet that I would prefer not to
have the liability of that family and would discharge the patient. I
believe that's what my youngest's pediatrician's office does, and I
can't blame them a bit.

Unless the doctor is bound by contract to serve all who seek care, I
don't think the doctor owes the patient to keep him or her in the
practice (absent a month or so to find another doctor), any more than I
think a patient has an obligation to stay with a particular doctor.

"Roger Schlafly" wrote in message .net...
"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.

The question was - are there any documented cases of horizontal
transmission in children. The answer is - YES.

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?

Look - I don't know. The data are reported in a medical journal.
Whether or not you believe it is of no consequence.

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.

Unlikely? Hey - I'm not putting any OR stats to it. It can happen
and it has happened.

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.

Huh? Your statistical acumen is a legend on this NG - thanks for
reinforcing it.

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

But it has happened - horizontal transmission, Roger, between children
on the playground. That's what JG asked and that's what I provided.

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.

IOW - it can happen, Roger. It did happen, Roger. It will happen
again.

Want stats - here's something from a Japanaese university's American
footbaqll team:

http://www.cchi.com.hk/abs_reviews/h...bstract005.htm

The authors conclude that, "All players with acute hepatitis B
belonged to the same training group, which also included the HB(e)Ag
carrier. Our analysis suggests that horizontal transmission of HBV can
occur even in a sports team, probably due to contact with open wounds
during training."

In that same series of papers there is a case of student to teacher
transmission, intrafamilial transmission, the presence of virus in
fluids other then seminal.

Enough evidence to show that it can and does happen. The Japanese
experience is particularly enlightening.

There are dozens of articles that show horizontal transmission is a
risk and does happen. Just because you don't want to believe it
doesn't change the facts.

The epidemiology suggests that the relative risk is proportional to
the underlying population character of the infection - the risk is
higher in populations with higher carrier status. Isn't that
remarkable. That does not suggest that lack of endemic infection is
in and by itself protective.

Go ahead - argue the race card. I really don't care.

The point is clear - horizontal transmission can and does occur
between children and it happens even in the good neighborhoods.

js

"JG" wrote in message ...
"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.

Oh please. There are a lot of kids not ready for kidergarten and some
of them are in third grade.


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. ;-)

Day care is a lot like recess.

(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.

You got what you asked for. Now you want to discount it because you
think it's (relatively) difficult. With 30% or more of cases without
a reasonable chain of evidence as to the source, HBV infectivity is
hardly a well enough described for you to make such a conclusion.
Others have suggested that it seems to be difficult and likely to be
of low

I grant you, it's not easy but it's far from impossible. You wanted
evidence, I gave it - here's another documented case.

Horizontal transmission of hepatitis B in a children's day-care
cent a preventable event.

McIntosh ED, Bek MD, Cardona M, Goldston K, Isaacs D, Burgess MA,
Cossart YE.

Department of Paediatrics and Child Health, University of Sydney.


Using molecular finger-printing, we provided evidence that, in a
children's day-care centre, a known hepatitis B virus (HBV) hepatitis
B e antigen (HBeAg) carrier transmitted HBV to another child (the
index case). The chronic HBV carrier had an exudative skin lesion and
a history of biting. We sought to identify other at-risk children and
prevent further transmission. Blood samples were collected and tested
serologically for HBV. Of the 90 other children, 78 (87 per cent) were
tested and none had serological evidence of HBV infection; 73 (81 per
cent) were of Caucasian background; 38 (49 per cent) had a history of
HBV immunisation with serological confirmation. Therefore, 1 (2.4 per
cent, 95 per cent confidence interval 1.0 to 12.8 per cent) of the 41
known susceptible contacts became infected. The risk of horizontal HBV
transmission in a children's day-care centre is low but not
negligible. Staff and children should be vaccinated when a child in a
day-care centre is a known HBV carrier.
-----

I added a link to my reply to Schlafly that documents more cases. I
was particularly struck by the results from the Japanese university
football team.

Do you know how many kids between 5 and 16 participate in organized
after school athletics? Have you ever observed a group of 10 year
olds on the playground? Do you have children? Have you ever seen a
skinned knee or a bloody lip? How about a nose bleed? There are
plenty of opportunities and plenty of evidence that it can and does
happen.

js

(Mark) wrote in message . com...
(abacus) wrote in message . com...
(Mark) wrote in message . com...

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

Apparently, you get offended when anyone disagrees with you, not just
your patients' parents. This entire post is kind of off on a tangent.
Care to try again? Isn't it possible that someone, such as a
patient's parents, when presented with the same 'facts' you have can
come to a different conclusion without a) thinking you are lying or b)
being completely unreceptive to changing their mind no matter what
'facts' are presented?

As far as your mechanic example goes, it doesn't strike me as being
particularly analagous. Mechanics and car repair businesses... well
the profession is notorious for ripping people off and trying to get
them to pay for unneeded repairs. Personally, I try to go only to
mechanics I have some basis for trusting and when forced to patronize
an unknown mechanic, I try NOT to take their advice regarding
expensive repairs without getting a second opinion.

You do have a valid point regarding lawsuits, but that's a whole
'nuther issue.

Kathy Cole wrote in message . ..
On 9 Feb 2004 15:04:47 -0800, (abacus) wrote:

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?

Particular vaccination, maybe. All of them, no. If I were a
pediatrician and I had patients that much at odds with what I know to be
the current state of the research, I'd bet that I would prefer not to
have the liability of that family and would discharge the patient. I
believe that's what my youngest's pediatrician's office does, and I
can't blame them a bit.

Ma'am, this thread started with an account of a pediatrician who had
discharged the patient because the parents objected to a single
vaccination - specifically the Hep B vaccination for their newborn -
not to any and all vaccinations. Specifically, what the article said
was:

In the end, we concluded that some of the vaccines were more worth the
risks than others. At my son's two-month checkup, the pediatrician
expected him to receive a triple-combination shot called "Pediarix"
(consisting of Hep B, inactivated polio, and DTaP, which covers
diphtheria, tetanus and acellular pertussis), as well as HiB (for
certain bacterial infections) and Prevnar (for meningitis and blood
infections). I reiterated my refusal of Hep B, accepted DTaP and HiB,
and asked to put off polio and Prevnar. In response, I received a
threat: Get all the vaccines or get out of our practice.

Do you consider that a reasonable response to a parent who has
obviously done a bit of research and thinking about the issue?

Is the response of the pediatrian described above the kind of behavior
that encourages patients (or parents of patients) to learn about more
about medical procedures and make up their own minds regarding the
risk and benefits or is the the kind of behavior that encourages
patients (or parents of patients) to simply obey their doctors orders
without question?

Unless the doctor is bound by contract to serve all who seek care, I
don't think the doctor owes the patient to keep him or her in the
practice (absent a month or so to find another doctor), any more than I
think a patient has an obligation to stay with a particular doctor.

We are in agreement on this point.

"PF Riley" wrote in message
...

On Sun, 8 Feb 2004 21:38:46 -0700, "JG" wrote:

"PF Riley" wrote in message
...

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

If you can find a verified, documented case of "recess transmission,"
please point me to it.

Well, a possible case of "daycare transmission" is cited elsewhere on
this thread, at least.

Certainly if an instance of "blood swapping" did occur, post-exposure
prophylaxis could be considered/initiated.

Except the chronic hepatitis B carriers who attend public school that
I know keep it a secret, even from the school.

A diligent parent would undoubtedly notice a bite wound, even if the kid
didn't tell him/her about it. If a kid bit my kid, I'd certainly
request that the biter divulge/prove his/her HBV (and HIV, for that
matter) status. If the biter's parents refused, I'd take them to court.

Hey, I have an idea! Instead of expecting daycare providers to protect
your child from any physical conflict with other children, ...

In the case cited, the HBV+ kid *was known* to be "aggressive."

....and
expecting any hepatitis B carriers at school to wear a fluorescent ID
bracelet so that you can run to the school nurse for an antibody shot
should you contact his or her body fluids,

Huh? Why not just assume everyone's *not* a carrier until there's a
need to know (e.g., after a biting incident)?

why not have everyone get
an easy three-dose vaccine series when they're babies and you can
relax a little about it! Or, better yet, let's use Roger's "logic:"
Have everyone get the vaccine so that no one has to!

By the way, the Malkin article is crap, because both she and her
doctor are idiots. Reading the article is like watching two retards
argue.

LOL. That's constructive criticism now, isn't it? g

I have no problem skipping hepatitis B and polio vaccines for babies
of parents who really don't want them. (My families from India who
travel there frequently with their young infants would theoretically
be an exception, although they know better.) Most of them end up
getting those shots later, anyway. To me, however, a parent telling me
they don't want DTaP, Prevnar, or Hib is like telling me they don't
use an infant car seat. ("Oh, I'll just make sure he's not around
anyone with any baaaaad diseases!" is like saying "Oh, I'll just hold
him REAL TIGHT if we crash!")

Gee, a ped who actually discerns the epidemiological differences among
various diseases. Way to go, PF! :-D