It’s Never Just About the Vaccines

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A colleague once said to me early in my training, “If parents don’t accept something as basic and scientifically sound as a pediatrician’s recommendation on preventative vaccinations, then what other things become a battle?” At the time, I could not fully grasp the impact. Yet, this sage assessment of parents who refuse or delay vaccinations has stuck with me.

Fast forward 10 years: I’m in private practice and our points of view have converged. A recent interaction with a vaccine-skeptical family reinforced my now solidified stance. The family came armed with a list of what vaccines they would accept and when, as well as a list of state-required vaccines by age, seemingly determined to discover the loopholes to enter school sub-optimally vaccinated.

The American Association of Pediatrics (AAP) has traditionally frowned upon dismissal of a family from a practice for refusing to vaccinate. In 2016, however, the AAP softened their language, considering “firing” patients who “persistently refuse vaccination” as an “acceptable option.” I too had previously been more empathetic, arguing against dismissal, but am now less inclined to accept new families into the practice who spurn the standard vaccination schedule. This is particularly timely given the resurgence of measles in Europe, which saw over 40,000 cases in the first half of 2018, including 37 pediatric deaths—all from a preventable disease.

While America is nowhere near Europe in terms of numbers, let’s not forget we have had over 100 cases this year in the U.S. In addition, we have had our own outbreaks domestically in the last few years, making it possible to contract measles as easily as visiting the unvaccinated Amish community or taking a trip to Disneyland.

Vaccine refusal is undoubtedly a threat to public health. On a personal level, it repositions confidence which can have devastating consequences to individual health. If parents and patients are more easily swayed by Facebook groups and anonymous online physician “experts,” doesn’t this erode the critical foundation of doctor-patient trust?

But, as my friend said, it’s not just about the vaccines. Vaccine refusal is intermingled with natural remedies such as essential oils, chiropractic manipulation, apple cider vinegar cleanses, naturopathy drops and countless other attempts at “wellness.” There are families who bring their kids with strep throat to naturopaths when sadly, this is one of the very few hard and fast indications for antibiotics due to the risk of rheumatic fever. Families bring their babies to chiropractors for adjustments for colic and ear infections. There are families who do not vaccinate their children and choose homeopathic salves over antibiotics when they are in fact indicated. There are patients who chose homemade mixtures peddled by their local “consultant” in lieu of scientifically sound medications. I have had more than one patient land in the intensive care unit due to this.

In this age of scientific skepticism, a patient’s own random and untested homemade concoctions somehow become superior by virtue of being “natural.” Parents meet my recommendation for sunscreen with the news that they prefer a homemade balm of essential oils for sun protection. My recommendation on fluoridated toothpaste has been answered with all natural, fluoride-free toothpaste.

The cycle reminds me of Laura Numeroff’s famous children’s book series that started with If You Give A Mouse a Cookie. It usually goes like this:

If you allow a parent to refuse a vaccine,

then they will use essential oils to treat (insert any condition),

See a chiropractor for manipulation of (insert any condition),

While using homeopathic drops to treat (insert any condition)

But absolutely no-thank you on your life-saving vaccines.

Some may argue that doctors fail to “think outside of the box,” particularly regarding those patients on a deep-dive into naturopathy. As a pediatrician, here is my reply: I am willing to think outside the box, just not outside of the evidence based medicine box, especially when it comes to your kid, as it is my duty as a pediatrician to protect their development and health.

For the adults and parents who are leaning too far into the “natural” bucket, it is probably best on both ends to part ways before you both slide down that slippery slope that leaves everyone unhappy.

Dr. Lauren Kuwik is a medicine/pediatrics physician as well as a 2018–19 Doximity Author.

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