Who Does Your Doctor Represent?

This week, the American Public Health Association is holding their annual meeting in Washington, DC. Earlier this week, we wrote about a movie being featured at that meeting. Today, we’d like to talk about another presentation at that same meeting, this time dealing with parental concerns regarding vaccine safety.

As the blurb on the APHA website describes:

Understanding the relationship between the parental concerns and requests for alternative schedules is an important step in designing effective counseling scripts for providers and public health officials. This study describes the prevalence of and relationship between specific concerns and specific alternative schedules in a pediatric practice with many hesitant and refusing parents. Methods: Medical records data were extracted for 168 patients in a solo pediatric practice in a large northeastern city. Data included specific vaccine concerns identified by parents during a vaccine counseling session and the vaccine schedule parents requested (e.g., ACIP, all vaccines but spaced, or decline all vaccines). The prevalence of each of 9 concerns and 7 alternative schedules was calculated. Bivariate associations between concerns and schedules were assessed using Fisher’s exact test. Results: 40% of parents had one or more concerns. Common concerns identified were vaccines overtaxing the immune system (16%), the rareness of vaccine-preventable diseases (10%), a preference for natural immunity (7%), and autism (5%). There was considerable heterogeneity in the relationships between concerns and alternative schedule requests. For example, being concerned about vaccines overtaxing the immune system was significantly associated with a spaced schedule or postponing all vaccines to a certain age but not with declining all vaccines or choosing “Dr. Bob [Sears]’s” alternative schedule. Conclusions: Pediatricians should elicit the specific vaccine concerns that parents have and understand how concerns may be associated with requests for a particular alternative schedule in order to effectively promote vaccine adherence.

In other words, in the study conducted by the presenters, 40% of parents were concerned about vaccine safety, and those who had these concerns were more likely to request spacing out the vaccines given to their child or opting out of vaccines altogether. However, rather than seeing this as a reason to improve the efficiency and safety of vaccines, or even to re-examine the current vaccination schedule, the researchers instead give healthcare providers “scripts” to allay parents’ fears. Which raises the worrying specter that when you try to have an honest conservation with your doctor, what you hear from him or her may be information he or she receives from medical researchers like these, who, well-meaning although they may be, are not themselves medical experts with real knowledge of the issues involved with vaccine safety. In this case, both researchers are not medical doctors, but specialize instead in public health from a more sociological standpoint.

Should your doctor be relying on people who are, in the end, acting basically as marketing experts for vaccines when faced with your concerns? Or should they be open to looking at your research and that of others in the field who have raised important concerns regarding vaccine safety? I know which I would prefer, and doubtless, so do you.

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