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Fly the Contagious Skies

Written by Herschel Lessin MD

As a practicing pediatrician and co-lead author of the American Academy of Pediatrics’ national vaccine policy statement, I was horrified when I saw the news that Delta Airlines had accepted an ad broadcast during their in-flight entertainment that was sponsored by the National Vaccine Information Center.

This notorious anti-vaccine group with the deliberately misleading name, paid for a three minute “public service announcement” that is anything but “public service”.

In this commercial, the group tries to hide its virulent anti-vaccine positions behind comments that there are better ways to prevent the flu than a flu vaccine. They grossly misrepresent the results of a recent study on the efficacy of influenza vaccine, making it sound almost worthless, which was clearly not the case nor the conclusion of the authors of the study.

I wonder if anyone asked them why you cannot do both?? That thought would, of course, never cross their minds because it contradicts their scientifically unsupportable and dangerous position that vaccines are bad.

The President of the American Academy of Pediatrics, Dr. Robert Block, has written Delta a strongly worded letter, as have other reputable scientific and medical organizations. Block wrote: Displaying NVIC’s message on Delta flights is, “putting the lives of children at risk, leaving them unprotected from vaccine-preventable diseases.”

He asked Delta to remove it. (This is the same group that put a huge billboard opposing vaccines in Times Square, which was taken down after widespread outrage at its misleading and false statements.)

Air travel in winter, with its increased risk of confinement in a closed space with hundreds of people and their illnesses, using a recycled air supply, is hardly the place I would want to place my children and myself at risk.

Here is the note that I wrote to Delta Customer Service on their website. I encourage everyone who cares about the health and safety of children to do the same.

As a pediatrician and Platinum Delta member, I am utterly appalled by your company’s poor judgment in running an anti-vaccine ad by the National Vaccine Information Center. This group is part of the anti-vaccine fringe who ignore all scientific evidence and promote fear about the totally unsupportable and disproven alleged risks of vaccines. This group and its ilk are responsible for putting countless children at risk for death and damages from vaccine preventable diseases due to their persistent and unsupported opinions about the risks of vaccines. This ad should be removed immediately. You should be ashamed of yourselves for spreading the distortions and mistruths promoted by the zealots running this group.

If you would like to protest Delta Airlines decision to run these ads, take a moment to sign this online petition by clicking on the link below

http://www.change.org/petitions/tell-delta-to-stop-putting-their-passengers-health-at-risk

Dr. Lessin has been a practicing pediatrician in the Hudson Valley since 1982. He is a founding partner and serves as both Medical Director and Director of Clinical Research at the Children’s Medical Group

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Vaccines: Truth and Experience Against False Fears From The Internet

Written by Walter Hoerman MD

Now that I am a “seasoned” pediatrician (greater than 20 years in practice), I have seen many changes all directly related to vaccines.

I used to worry about epiglottis with every child that has a cough. Now it hardly ever crosses my mind. I watched a child die of epiglottis, and I never want to go back there…

I used to have to do lumbar punctures at least a few times a year; now I haven’t done one in years and I am getting rusty (which is a good thing).

I have seen children go deaf from meningitis, have disabilities from meningitis, and even die from meningitis, and I don’t want to go back there…

I have never seen a case of the measles, and might have trouble diagnosing it. I don’t want to have to….

My mother used to tell me about terrible summers made tragic by polio. I don’t want to know it first hand.

These are all things I know personally. And most importantly, I can say I have never seen a child permanently damaged by a vaccine.

This is the message we need to get out.

Dr. Hoerman founded Lilac City Pediatrics in 1996. Since completing Medical School and his Pediatric Residency Training at the University of Connecticut, he has been practicing pediatrics in Rochester since 1988. Dr. Hoerman blogs at Lilac City Peds News

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For Pediatricians, Giving Vaccines Is An Ethical Dilemma

Written by Brandon Betancourt, MBA

One aspect of the vaccine controversy that doesn’t get discussed as often as I would like, is the notion of vaccine economics. Vaccine economics has to do with what I refer to as the distribution, consumption, management and cost of vaccines.

I was happy to see a blog post on the NPR that discusses some of the challenges, with regards to vaccine economics, many pediatricians face. Here is what they had to say:

After looking at what insurers paid more than 1,400 doctors for eight different vaccines, athenahealth concluded that almost half the time the payments weren’t large enough to cover estimated costs.

You don’t need to be an economist to know that loosing money isn’t good for anybody and certainly unsustainable; no matter how altruistic your motives maybe.

The blog post also highlighted that the problem might be worse than the research indicated.

The American Academy of Pediatrics came up with estimates for indirect expenses, concluding they range from about 17 percent to 28 percent of the purchase price of vaccines. So at least 17 percent should be tacked onto the purchase price for doctors to have a shot at breaking even, the group concluded.

By that measure, 47 percent of immunizations are money-losers, the athenahealth data show. If the 28 percent figure for indirect costs is used to calculate break even, then it’s an even grimmer picture: 79 percent of vaccination payments fall short.

This puts pediatricians in an ethical dilemma. On one hand, pediatricians will always do what is in the best interest of children. And there is overwhelming scientific evidence that vaccines are among one of the greatest medical innovations of our time.

On the other hand, preventing illnesses like Polio, Rubella and Measles in children cause pediatricians to actually lose money. In other words, pediatricians are in essence subsidizing – at their expense – the wellbeing of children.

The anti-vaccine movement

One of the anti-vaccine movement arguments is that vaccines are a profit center for doctors and that pediatricians are putting profits over the well-being of children. That is simply not true. And the research published by Athenahealth (click here to go the the study) clearly shows that profit is certainly not an issue.

When payment to physicians for vaccines often does not even cover the costs associated with administering those vaccines, this claim is so ludicrous as to be non-sensical.

The benefits of vaccines

  • The rate bacterial meningitis declined by 55%  in the US in the early 1990’s, when the hemophilus influenza type b otherwise know as Hib was introduced. (NEJM 364.21, May, 2011)
  • Varicella mortality declined 88% overall and 96% among subjects younger than 50 years (Pediatrics 128:2, August 2011)
  • Current immunization practice and herd immunity have virtually eliminated many infectious causes of serious morbidity and mortality in the USA.

It’s almost ironic that immunizations have done so much for public health, yet their value has not been recognized.

What is most frustrating to doctors is that immunizations are perhaps most cost effective preventive measure available to the pediatric population; especially when one considers the long term benefit in the equation for payment.

Yet insurance companies, driven by their bottom line, fail to view the long term benefits. For example, they reimburse a doctor for a polio vaccine below the doctor’s cost in an effort to improve the bottom line without considering the cost of a child actually getting Polio.

At what cost?

What would happen if pediatricians, driven by the cost of vaccine and poor reimbursement, decide they can’t immunize children any longer?

The poor and inadequate payment for immunizations could potentially create a public health problem if one considers that the lack of immunizations in children could break our developed herd immunity.

In fact, in the US, we’ve already seen over 150 cases of measles in 2011 and in California there were 9,500 cases of pertusis in 2010; and 10 infant fatalities which are attributed to lower vaccination rates.

As doctor Richard Oken said recently, “immunizations are perhaps the most cost effective preventive measure available to the pediatric population” thus me must consider the “long term benefit in the equation of payment.” Otherwise, “Inadequate payment could force pediatricians to outsource this healthcare benefits and bankrupt our developed herd immunity”

Perhaps more than any other physicians, pediatricians believe in, and focus on, PREVENTION of disease, stopping illness even before it has a chance to strike. If an ounce of prevention is really worth a pound of cure, skimping on spending for prevention today will surely result in spending much more tomorrow–not to mention causing more people, at all ages, to suffer from what are easily preventable diseases.

Brandon manages a pediatric practice in the western suburbs of Chicago. He blogs regularly on practice management issues at PediatricInc.com
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Actually, The Vast Majority of Children Do Get Their Vaccines On Time

Written by Brandon Betancourt

Dr. Ari Brown over at the Baby411 blog had a very interesting post where she looked in to a study, published in a pediatric journal, regarding parent’s attitude towards the vaccination schedule recommended by the American Academy of Pediatrics, The American Academy of Family Physicians and the Centers for Disease Control.

The study concluded that more than 1 of 10 parents of young children currently use an alternative vaccination schedule. In addition, a large proportion of parents currently following the recommended schedule seem to be “at risk” for switching to an alternative schedule.

Dr. Brown had a similar reaction to mine. She thought that the statistics were too high considering that a “vast majority of the families she treats DO follow the recommended schedule.”

In our practice, we too have a very small portion of parents that choose to “alter” the recommended schedule. Certainly well below the 10% mark.

But  Dr. Brown didn’t just settled.  She did what any good pediatrician does, which is, take a look a the data to understand where the numbers are coming from and how the researchers reached their conclusions.

Her findings provide a lot of insight.

She first mentions that the study was done in May of 2010, but it was just now published.

A lot has happened since May 2010 in the vaccine world (besides Michele Bachmann). In the same month that this survey was being done, the British researcher who published the now-retracted 1998 MMR-autism study in the Lancet lost his medical license for questionable practices. With this story, national media sided with modern medicine instead of conspiracy theorists on vaccine safety. That trend has been fairly consistent since then, and I think, has led to fewer parental concerns.

Dr. Brown highlights that the response rate from the study was only 61%; which could very well represent skewed data.

People who choose to vaccinate may have no interest in spending time answering questions about vaccine safety. People who choose to delay or skip vaccinations may want to share their position. It is hard to know what motivates people to participate in a survey, but it may influence the study results.

The first vaccine that parents refused or delayed was the H1N1 and the second, the seasonal flu.

Although there was outright hysteria regarding the H1N1 outbreak and calls for a rapidly available vaccine to combat it, there was also quite a bit of public anxiety about taking a vaccine that had not been field tested prior to use.

I agree with Dr. Brown when she points out that the seasonal flu should not be placed under the same category as other vaccines because with exception of New Jersey, the  flu vaccine is not required for school entry.

While the CDC and AAP recommend annual flu vaccine, it is never included in the national immunization survey done annually by the CDC she adds.

I love Dr. Brown’s conclusions:

The most effective message I can share with you and my own patients is that I vaccinate my own children to protect them, I wouldn’t do anything differently for yours.

Here lies the problem. This study was picked up by many mainstream media outlets including CNN running with headlines like “More parents think it’s safer to delay vaccines,” “Parents Commonly Deviate from Vaccine Schedule,” and “Many parents opt for “alternative” vaccination schedule.”

But the truth of the matter is, the vast majority of parents in the study vaccinate their children on time.

You may read Dr. Brown’s entire article by clicking here

Brandon is a practice administrator, speaker and blogger. He and his wife, whom is a pediatrician, vaccinate their three children. 

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Vaccines: Why Your Pediatrician May Ask You To Go Elsewhere

The Today Show had a really good piece concerning a growing trend relating to the vaccine debate. The piece talks about how some pediatrician are asking parents that don’t vaccinate their children to find another doctor.

We’ve addressed this issue before here at Survivor Pediatrics in our piece “Vaccine Refusal Endangers Everyone”. Dr. Lessin, author of the vaccine refusal piece says:

Prevention of childhood illness is the heart of a pediatrician’s mission. Immunization refusal violates that mission, putting everyone at risk. If we allow families to remain in our practices unvaccinated, we are giving tacit approval to parents that refusing vaccines is just fine. It is anything but fine.

As you’ll see mention in the piece, the notion is that pediatricians are abandoning their patients. But it isn’t like that all. It is about having trust. Here is what Dr. Lessin had to say:

For me, it comes down to whether you can have a relationship with a family when their choice not to vaccinate goes against pediatric core values and puts so many innocents at risk. I don’t believe that I can have a functioning doctor-patient relationship with parents who aren’t willing to accept my advice about such a critical issue as keeping their children safe from potentially deadly diseases.

Click on the link below for the Today Show piece:

Won’t Vaccinate? Find care elsewhere, some docs say

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Anti-vaccine Stories Sell Papers, Children Suffer

Written by Natasha Burgert MD

A recent Baltimore Sun op-ed headline popped with an eye-catching and concerning title. It read, “We don’t know enough about childhood vaccines.”

After reading the headline, I immediately raised my eyebrows and took a deep breath. As a pediatrician who recommends and administers vaccines during my clinic time with children, I thought

“We don’t?”

I continued to read Ms. Dunkle’s commentary with the goal of learning something new, something relevant. Keeping up-to-date with medical science is an important part of my job. I need to be confident and certain, to the best of my ability, in the recommendations I give my families. As a advocate for the health of children, I owe my patients and their families that dedication. So, if there is peer-reviewed, evidence-based data that challenges or disputes current medical practice, I need to know.

In that framework, the opinion piece by Ms. Dunkle was sorely disappointing. She attempts to report on “new” findings revealed in the Journal of Toxicology and Environmental Health claiming to associate increased vaccination rates with increased rates of autism and speech/language impairments. She attempts to poke and prod at the reader, trying to pick a fight about semantic details; events, doses, shots. Then she quickly turns the corner, bringing up intentionally alarming half-truths about vaccine components, preservatives, and stabilizers.

Ms. Dunkle, however, failed to mention a very important point. The author of the reported study, Gayle Delong, is not a scientist, a medical doctor, or doctorate researcher. Ms. Delong is a economics professor with expertise in “international finance” and “money and banking” (as listed on her public CV.) More importantly, she is also on the executive board of a large, anti-vaccine group. The results obtained by Ms. Delong’s research have been shown to be biased and statistically flawed by additional reviewers. Therefore, the interpretations made from her analysis need, at minimum, recalculation.

With a small amount of fact-checking and investigation into these stories, the intention of the authors quickly become clear. Ms. Dunkle and her analysis is a great example of how anti-vaccine groups create junk studies to promote fear. And how media outposts, eager for a hot headline, will regurgitate this information with complete disregard of the potential effect this propaganda could have on our children.

Anti-vaccine stories sell papers, your child suffers.

In the face of the resurgence of measles and other vaccine preventable illness, it is unfortunate that the editors of the Baltimore Sun allowed this manipulation of its readers.

For an additional response to Ms. Dunkle’s commentary, click here.

Dr. Burgert is a pediatrician. She works at Pediatrics Associates in Kansas City, MO .  She is a distance runner and enjoys road races around the city. She also has a passion for travel that will certainly lead to many memorable family vacations with her husband and two children. And, of course, she bleeds Husker red. Dr. Burgert regularly blogs at kckidsdoc.com

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Six Reasons You May Want to Bring Your Child to the Pediatrician’s Office Instead of a Retail Based Clinic.

Written by Richard Lander MD

Why should I bring my child to the pediatrician when he/she is sick? It is so much easier to run over to the local retail-based clinic (RBC) at the pharmacy where there is lots of parking, I don’t need an appointment and while I’m there I can pick up tissues, milk and medicine. Right?

Here are six reasons why going to a RBC may not be in the best interest of your child’s health.

1 – Most RBCs are not Staffed with Board-Certified Pediatricians

Your child will probably be diagnosed and treated by a nurse practitioner or physician’s assistant. Imagine that you are concerned about your child and therefore a little distracted and forget to mention that your child has allergy to an antibiotic. This could have a bad outcome. If you are at your pediatrician’s office, that allergy information is kept in your child’s chart.

2 – You Can’t Call The RBC in the Middle of the Night

Now imagine that your child’s condition worsens at midnight. The RBC you visited earlier is now closed and so you can’t ask for further advice. On the other hand, had you called your doctor earlier and then required additional help later in the evening, you would be able to receive consistent medical advice because your doctor or a covering doctor is on call 24/7. The American Academy of Pediatrics has always stressed the importance of continuity of care. It’s what I want for my children; it’s what I want for your children.

3 – RBCs Have Age Restrictions

Many RBCs have an age below which they will not treat a patient. What will you do if two of your children are sick — take one to your doctor and the other to the RBC?

4 – RBCs Can’t Handle Complex Medical Issues?

Worse still, the RBC cannot deal with complex medical issues. If you visit the RBC with a problem that is beyond the scope of their training and knowledge, they will tell you to see your doctor or send you to the emergency room.

5 – RBC Provides No Continuity of Care

Let’s think about vaccines. Your child needs a flu vaccine as well as one or two other immunizations. Many of the RBCs are only prepared to give the flu vaccine. If you are receiving the flu vaccine at the RBC and all other immunizations at your pediatrician’s office, no one will complete your [child’s] vaccination record. Again this speaks to a lack of continuity of care. This fragmented record keeping could cause trouble in the future.

6 – An RBC’s Not Your Medical Home

Your pediatrician’s office should be your child’s medical home. Your pediatrician has cared for your child’s physical and mental well being since birth. At your pediatrician’s office you received vision and hearing screening, and we assessed your child’s fine and gross motor skills. Your pediatrician has checked for autism and ADHD, asked you questions relating to your child’s growth and development and if there was a concern, and addressed it. When a behavioral problem at school or home arose, it is your pediatrician who thought about the possible medical conditions that could cause these behavioral changes. Will your RBC help you with your child who is crying out for attention secondary to a new baby at home or to parental discord? Will your RBC talk to your teenager about depression, alcohol, drugs or tobacco use? If your child has a GI problem, a broken arm, a heart condition or a blood disorder, will your RBC recognize the problem and send you to an appropriate specialist? Would you want the recommendation of a competent specialist to come from your RBC or from your doctor who knows you and your family’s medical history?

Your pediatrician provides your children with vaccines after they have looked at the medical research. He/she does not give vaccines because a corporate entity (RBC) made the decision to do so. Your pediatrician went to medical school for four years and then did a pediatric residency for an additional three years and continues to both attend medical conferences and read the medical literature to make ensure that he/she remains current and ahead of the curve. One of the national RBC chains has the tag line “You’re sick, we’re quick.” Is that the kind of medicine your loved ones deserve?

 

Dr. Lander has been practicing pediatrics for 32 years in New Jersey and is the immediate past chairman of the American Academy of Pediatrics Section on Administration and Practice Management.  He says if he had to do it all over again he wouldn’t hesitate to be a pediatrician.