"Beware of Vaccine Bullies"--Malkin column

"JG" wrote in message ...
"abacus" wrote in message
om...
(Jonathan Smith) wrote in message
om...

HBV horizontal transmission in
children is possible and does happen.

Just curious. Been watching the thread. I don't dispute that
horizontal transmission in children is possible, but it does seem
quite rare. If no other risk factors are apparent, is the risk of the
disease (probability of contracting the disease multiplied by the
average *cost* of having the disease) worth the risk of vaccination
(probability of suffering an adverse reaction multiplied by the
average *cost* of the adverse reaction)?

I'd include the actual (direct) cost of the 3-vaccination series.

Yes, that would be appropriate. However, from my perspective, it's
really not a major consideration anymore than the minor side effects
of the vaccination are. It's the possible major adverse effects of the
disease and the vaccination that I tend to weigh most heavily - i.e.
death or major impairment. Neither are terribly likely, but neither
risk is zero either.

Final decision point for me - current risk of the disease is quite low
for my child (we don't engage in 'high risk' behaviors and don't send
our kids to daycare or to school). While the risk of the vaccination
for Hep B is also low, the vaccine might be improved in the next
decade or so (in fact, it has been improved since my child was a
newborn and I refused the vaccine for him so that has already proved
to be the case.) Since the risk of the disease is unlikely to rise
until my child is a teen and the risk of the vaccination is unlikely
to rise but might fall during the intervening time, it makes sense to
me to delay vaccination for that particular disease.

Just what 'facts' are being
used to make this determination? Isn't family history an appropriate
consideration to take into account in making that determination?

Family "lifestyle" certainly would/should be.

Thank you for trying to turn the focus of the discussion to the question
of whether it's necessary (from a risk/benefit perspective), or even
proper, to mandate hepatitis B vaccination.

Your welcome. Doesn't seem to have much effect though.

On Wed, 11 Feb 2004 13:54:22 -0700, "JG"
wrote:

"PF Riley" wrote in message
...

On Tue, 10 Feb 2004 16:10:10 -0700, "JG"
wrote:

Asian immigrants/adoptees?

Only one of them. You and Roger seem not to understand that white
people get hepatitis B, too, you know.

Sure, but Asian American kids have *20 times* more risk for infection
from HBV than other American children. (Watson, B. "Hepatitis B
Immunization of Asian Pacific Islanders in the United States"; The
Pediatric Infectious Disease Journal; Volume 17(7) supplement,
pp.S38-S42; 1998)

I'm not disputing this, but what's your point? Are you trying to
support your implication that we don't need hepatitis B vaccine for
children as long as you simply avoid Asian kids?

PF

On Wed, 11 Feb 2004 19:56:07 -0700, "JG"
wrote:

The bottom line is that horizontal transmission between/among
schoolkids, assuming it does occur, is extremely rare--so rare that
using it as a rationale for mass vaccination is ridiculous.

Except when you're dealing with a country with a population of
millions upon millions, even rare occurences are bound to happen.

What makes me laugh is when anti-vacs acknowledge a risk of infection
but claim that because it's so small, it should be ignored, yet by the
same token they complain about a nearly negligible, almost
immeasurable risk of intussusception from a clearly beneficial vaccine
for a common, frequently deadly disease, and find it unacceptable.

PF

On 12 Feb 2004 08:33:34 -0800, (Jonathan
Smith) wrote:

"The behaviors most strongly associated with prevalence of HBV were
sharing of bath towels (OR = 3.1, 95% CI 2.1-4.5), sharing of chewing
gum or partially eaten candies (OR = 3.4, 95% CI 2.3-5.0), sharing of
dental cleaning materials (OR = 2.5, 95% CI 1.3-4.6), and biting of
fingernails in conjunction with scratching the backs of carriers (OR =
2.5, 95% CI 1.6-4.3)."

It's a good thing that the prevalence of Hep B in the US is as low as
it is. Then again, the immigrant population goes to the same school
as your kids, Roger and JG.

Well, just remember, for Roger and JG, it's simple. Skip the vaccine,
inspect your child daily for any wounds, contact parents of culprits
and demand serology results, run to the doctor or school nurse for
antibody shots if/when injuries occur, and, above all, do NOT play or
associate with Asians!

PF

On Wed, 11 Feb 2004 13:54:05 -0700, "JG"
wrote:

"PF Riley" wrote in message
...

3. And, most importantly, never let your child play with Asian kids.

Low blow, PF; shame on you.

Huh? You were the one who mentioned race to begin with. If it wasn't
to imply that you can minimize your risk of hepatitis B by avoiding
such "high risk" racial groups, then what was your point?

PF

"PF Riley" wrote
Sure, but Asian American kids have *20 times* more risk for infection
from HBV than other American children. (Watson, B. "Hepatitis B
Immunization of Asian Pacific Islanders in the United States"; The
Pediatric Infectious Disease Journal; Volume 17(7) supplement,
pp.S38-S42; 1998)
I'm not disputing this, but what's your point? Are you trying to
support your implication that we don't need hepatitis B vaccine for
children as long as you simply avoid Asian kids?

It is useful info if you want to do your own assessment of the risks.
If you are worried about that possible one in a million playground
infection, then it your risks are going to be higher if the school is
full of Asian immigrants.

On Thu, 12 Feb 2004 12:11:30 -0700, "JG"
wrote:

Perhaps we disagree on just what constitutes "bullying." IMO, attitude
and the choice of words, not the core message itself, are the test.
Surely you must agree there's a considerable difference between "I'm
sorry, Mrs. Malkin, but we have a policy that if a parent forgos
immunizations for other than medical (and perhaps religious) reasons, we
ask them to find another pediatrician" and "We think parents who forgo
immunizations are ill-informed and foolishly endangering their child,
and we refuse to keep their kids as patients."

You must know, as an intelligent lady, of course, that your former
hypothetical quotation of the doctor as opposed to the latter may have
been indeed exactly what he said, but that Malkin, upset by her
hospital experience and/or ulterior agenda, got her panties in a bunch
and wrote an angry, unflattering column. We're only hearing one side.

PF

On 11 Feb 2004 11:27:35 -0800, (abacus) wrote:

(Jonathan Smith) wrote in message om...

HBV horizontal transmission in
children is possible and does happen.

Just curious. Been watching the thread. I don't dispute that
horizontal transmission in children is possible, but it does seem
quite rare. If no other risk factors are apparent, is the risk of the
disease (probability of contracting the disease multiplied by the
average *cost* of having the disease) worth the risk of vaccination
(probability of suffering an adverse reaction multiplied by the
average *cost* of the adverse reaction)? Just what 'facts' are being
used to make this determination? Isn't family history an appropriate
consideration to take into account in making that determination?

Family history that is considered is the mother's own hepatitis B
status. If she is is a carrier, it is imperative to immunize the child
AND give an antibody shot within 12 hours of birth. Failing to do so
nearly guarantees that the child will get chronic hepatitis B himself.
Doing so nearly guarantees that the child will not. Few preventive
measures for infectious disease are as cut and dry.

PF

(PF Riley) wrote in message ...
On 11 Feb 2004 11:27:35 -0800, (abacus) wrote:

(Jonathan Smith) wrote in message om...

HBV horizontal transmission in
children is possible and does happen.

Just curious. Been watching the thread. I don't dispute that
horizontal transmission in children is possible, but it does seem
quite rare. If no other risk factors are apparent, is the risk of the
disease (probability of contracting the disease multiplied by the
average *cost* of having the disease) worth the risk of vaccination
(probability of suffering an adverse reaction multiplied by the
average *cost* of the adverse reaction)? Just what 'facts' are being
used to make this determination? Isn't family history an appropriate
consideration to take into account in making that determination?

Family history that is considered is the mother's own hepatitis B
status. If she is is a carrier, it is imperative to immunize the child
AND give an antibody shot within 12 hours of birth. Failing to do so
nearly guarantees that the child will get chronic hepatitis B himself.
Doing so nearly guarantees that the child will not. Few preventive
measures for infectious disease are as cut and dry.

PF


Yes, I haven't heard anyone advocate NOT getting the child the vaccine
in such a situation. But the opposite of your statement would be that
if the mother isn't hepatitis B positive, then the vaccination isn't
imperative (or at least isn't necessarily imperative, it could be so
for other reasons).

What I was thinking of was a family history of adverse reaction to the
vaccine being a factor in deciding whether or not to get the vaccine
for a child. Presume that the mother is NOT hep B positive, since if
she was, as you point out, the vaccine would indeed be indicated.

Kathy Cole wrote in message . ..
On 12 Feb 2004 06:13:15 -0800, (abacus) wrote:

Is the response of the pediatrian described 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?

I don't think it's primarily either. I think it is the kind of behavior
that prompts parents to seek other care, because disrespectful bullying
is not acceptable from any professional who wants my business (as I
think I said in my prior post). I think that the behavior described
will prompt 'What an asshole' and 'I'm beating a trail out of this
practice' out of parents, as it should do. I think it's
practice-limiting behavior (on the doctor's part), and thus eventually
self-correcting.

An excellent answer ma'am, and I quite agree. I wouldn't tolerate
disrespectful treatment from any professional I was seeking advice
from. However, it still evades the point I'm trying to get across.
I'm not, btw, presuming that the doctor was disrespectful in how he
made his point. As you pointed out previously, we really can't know
how the message was delivered, only that Ms. Malkin was offended by
it.

What I'm struck by in this thread is the dichotomy between the idea
that a) parents should investigate, research, and make up their own
minds about vaccinations for their children and b) if, after such
investigation, they come to a different conclusion than that
recommended by their doctor then they are perceived as being a loon,
unwilling to be convinced regardless of the facts, etc. This
perception seems to be unaffected by whether they choose to reject or
delay one vaccination or all.

If medical professionals truly believe that it's best for patients and
parents of patients to research the choices available and make their
own decisions, then they must support whatever decisions their
patients come to after doing that research. Otherwise, it's just lip
service that sounds good but doesn't really mean anything.