The Slippery Slope of Anti-Vaccine Complacency

I got a package in the mail today: my very own (complimentary) copy of Paul Offit’s new book, Deadly Choices; How the Anti-Vaccine Movement Threatens Us All. Needless to say, I can’t wait to read it. Not coincidentally, Dr. Offit has been making the rounds of interviews in the wake of the book’s release. Although I haven’t heard any of them directly, I did see a reference to this NPR interview on the FaceBook page of an old friend, who quoted from it thusly:

IRA FLATOW:  You write that some pediatricians will not see kids who are not vaccinated. Is that a good solution to the problem?

Dr.PAUL OFFIT: I don’t know what’s a good solution to that problem. And I feel tremendous sympathy for the clinician who’s in private practice. On the one hand, and my wife sort of expressed this, she’s a general practitioner, a pediatrician, you know, she’ll say, you know, parents will come into her office and say I don’t want to get vaccines, including, for example, the Haemophilus influenzae vaccine, which is vaccine that prevents what was, at one point, a very common cause of bacterial meningitis.

And, you know, we’ve had three cases or three deaths, actually, from this particular bacterial form of meningitis in the Philadelphia area just in the last couple years.

And, you know, to her, it’s like, you know, let me love your child. Please don’t put me in a position where I have to practice substandard care, which can result in harm, which can hurt your child. Please don’t ask me to do that.

And I certainly understand the sentiment. On the other hand, if you don’t see that child, you know, where does that child go? Do they go to a chiropractor who doesn’t vaccinate?

I think it’s hard because then you lose any chance to really immunize the child.

Italics above are those of my friend. He then offers his take, that of a pediatrician in private practice:

We never hear what the “other hand” is. I fear, for Offit, there is no other hand. Let me suggest what the other hand might be: some pediatricians, such as yours truly, respect the right of parents to make informed decisions on behalf of their minor children. In the absence of a clear and present danger, such as an epidemic, neither I, nor the government for whom I work, can coerce parents into vaccinating if they don’t want to.

Oh, dear.

I, too, have families who are reluctant to vaccinate. No, I don’t dismiss them from my practice, because, as Offit says, then I lose any chance to educate them about the advantages of vaccination and the fallacy of their position. And my old friend is right: none of us can compel reluctant parents. But my responsibility it to their children — my patients! I must continue to make it clear to them that I do not agree with their decision not to vaccinate. Acceding to their demands without clearly communicating my reluctance to do so, what my friend calls “respecting the right of parents to make informed decisions on behalf of their minor children”, is abdicating that responsibility.

What if a family decided that they didn’t want to confine their baby in a car seat? The baby cries whenever they strap him into it, and besides, accidents are rare. They’ve done their research, and they feel the baby is safe enough in the mother’s arms. Would my friend be as sanguine about that decision?

What if parents did their own nutrition research and decided to put their toddler on a low fat strict vegan diet? As doctors, we are well aware that such a regimen would put that child at serious risk of significant malnutrition. Do we still have to “respect the right of parents to make informed decisions on behalf of their minor children” when they’re threatening to stunt their child’s growth? Wouldn’t we make every effort to educate them about more appropriate nutritional choices for their youngster? More importantly, would we ever stop trying to convince them they were wrong?

Where’s the line between “respecting the right of parents to make informed decisions for their minor children” and protecting the children from the consequences of their parents’ poor decisions? I submit that supporting parents’ bad decisions is a very bad decision in and of itself. Just as we can’t convince everyone to get a flu shot, we still have the responsibility to come right out and unequivocally recommend them.

Vaccination is important. Parents’ reluctance to immunize is generally based on flawed information. As physicians, it is our duty to educate our patients and their parents to help them make better decisions, not support their ignorance under the guise of “respect”.