Doctors’ dilemma: To see or not to see un-vaccinated kids

Posted on Aug 13, 2019 in Medical Rewind, Vaccines

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To vaccinate or not to vaccinate. It’s an issue that surfaces again and again, despite evidence on how effective immunizations are in disease control.

The use of vaccines worldwide has eradicated smallpox and done nearly the same for polio. In the United States, diphtheria, bacterial influenza, measles, mumps, rubella, tetanus and others also are close to the brink of eradication.

Yet, there’s been a significant outbreak of measles this year in Oregon and Washington state, with cases reported so far in 2019 in a total of 10 states.

The Centers for Disease Control attributes continuing outbreaks to an increase in the number of travelers who get measles abroad and bring it back the United States, spreading it in pockets of unvaccinated people.

Parents have various reasons for not wanting to vaccinate their children, from fear of side effects to thinking vaccines unnecessary because their children will be protected by herd immunity — in other words, that the risk of infection is small because enough of the population is immunized to prevent most spread of infectious diseases.

In Pennsylvania, children must have a prescribed series of vaccinations to attend public schools, unless a medical or religious/philosophical exemption is granted.

But here’s another factor to consider: You might have trouble finding a pediatrician or family practice doctor who will see your unvaccinated child.

Find another doctor

“My policy in this office, if someone refuses to vaccinate, is that we will ask them to see another doctor,” says Dr. David Wyszomierski, a pediatrician in the Excela Health Medical Group.

Wyszomierski has followed that policy in his Latrobe practice for more than five years.

“As far as I know, there are no pediatricians in Westmoreland County who think it’s OK not to vaccinate, although some may see those patients, because they want to take care of children, no matter the parents’ decisions,” he says.

“Our policy is that, by the age of 2, (our patients) need to be fully vaccinated, and we encourage using the (Centers for Disease Control) schedule,” says Dr. Ned Ketyer of the Allegheny Health Network Pediatric Alliance Chartiers/McMurray Division.

That policy was put into place in 2015.

“If it’s clear that the parents will not do that, we ask them to find another provider,” Ketyer says.

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Why people don’t vaccinate

Anti-vaccination sentiment has been around as long as vaccines themselves, often tied to fear.

Some people think chemicals contained in vaccines are more of a threat to children than the diseases they prevent, claiming side effects such as neurological damage.

Others say unnecessary vaccines are pushed by doctors and pharmaceutical companies in the pursuit of financial profit.

An “anti-vaxxer” movement arose around the turn of the 21st century, spurred by a 1998 paper in The Lancet medical journal, in which Dr. Andrew Wakefield and colleagues claimed there was a link between vaccines and autism — a study since retracted and proved to be fraudulent.

The vaccination-autism link gained traction around 2008 when celebrity Jenny McCarthy claimed her son developed autism following vaccinations. She’s since walked back her stance, saying she was never anti-vaccination but was advocating for safer vaccines and more research on possible effects of vaccines on children with autoimmune conditions.

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Fake experts

“Jenny McCarthy is a fake expert,” Ketyer says. “A lot of anti- science deniers all follow those same ‘experts,’ and those fake experts are a big problem.”

“Vaccines are one of the most efficient, safest strategies for preventing diseases, and there’s no good reason not to have them,” Wyszomierski says. “Parents (who don’t vaccinate) put their child in danger, along with other people in the community.”

“Can we say that there will be absolutely no side effects? That’s impossible,” Ketyer says. “Doctors have to be honest and say it’s not 100 percent safe — but it’s 99.9 percent safe.

“Most parents (who don’t vaccinate) do it out of fear of chemicals, and I’m actually empathetic about that, but I don’t subscribe to that idea,” he says. “We live in a chemical world. But you’re probably exposed to more chemicals crawling around on the floor than you are in getting a vaccine.

“There is going to be someone who has an unforeseen, unfortunate event after immunization, but all vaccines are very well tested and studied for their safety and efficacy,” he says.

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Lack of experience

Ironically, Ketyer says, the effectiveness of vaccines over the years has something to do with people discounting their importance now.

“More and more parents and doctors have never seen a child with measles or meningitis, but I’m old enough to have seen it and to be able to tell you how horrible it is,” he says.

“Some people have the philosophy that what doesn’t kill you makes you stronger and, in the long run you’ll be better off (having the disease), but that’s clearly not true,” Ketyer says. “Having measles can weaken the immune system. We’ve learned the hard way just how terrible these things are.”

“The overwhelming majority of parents do vaccinate, and that’s a good thing,” Wyszomierski says. “A small number, maybe 2 percent, who come into our practice don’t, so I’ve had those conversations with parents. Sometimes I can persuade them, sometimes I can’t.”

“Doctors need to spend more time talking to parents about what concerns them, what they’re afraid of,” Ketyer says. “That really needs to start before birth in the OB-GYN office. The good news, especially in the Pittsburgh area, is that there are a whole lot of really good practitioners doing a really good job caring for the public health.”

Shirley McMarlin is a Tribune-Review staff writer. You can contact Shirley at 724-836-5750, smcmarlin@tribweb.com or via Twitter