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Tuesday, October 4th, 2005
Docs May Drop Patients Who Refuse Vaccines
Steve Mitchell/United Press International
More than one-third of pediatricians would cease providing
medical care to a family that refuses all vaccinations, reveals a new survey
coming on the heels of a warning by federal officials that a meningitis
vaccine may cause a serious neurological disorder.
In recent years an increasing number of parents have become concerned
about the side effects vaccines may cause in their children and have opted
out of some or all routine childhood vaccinations.
To determine pediatricians' attitudes about such parents, Dr. Erin
Flanagan-Klygis of Rush Medical College in Chicago and colleagues surveyed
"No one had really looked at this," Flanagan-Klygis told United Press
International. "Our goal was to start a dialogue about the practice (of
refusing care to families who opt out of vaccinations) and create an
awareness of the practice."
About 85 percent of the pediatricians responded that in the last 12
months they had encountered a family refusing at least one vaccine and 54
percent said they had encountered a parent who refused all vaccines,
Flanagan-Klygis and colleagues report in the October issue of the Archives
of Pediatrics and Adolescent Medicine. The pediatricians said the most
common reasons parents gave for foregoing vaccination included concerns
about safety, philosophical reasons and religious beliefs.
About 39 percent of the pediatricians said they would advise the
family to seek medical care from another physician if all vaccines were
refused. Approximately 28 percent said they would stop treatment if the
family refused some vaccines. This did not vary with age of the physician,
their sex or their number of years practicing medicine.
The reasons the pediatricians gave for dismissing the patients
included a lack of shared goals and a lack of trust between the physician
and the family.
The findings raise important questions about vaccinations and other
medical issues, Flanagan-Klygis and colleagues wrote, such as whether
refusing to provide care to families that opt out of vaccines might result
in certain children or groups not receiving inoculations. Another important
question is whether this behavior could lead parents to avoid seeking
medical care for other conditions.
"Given the changing climate of confidence in childhood vaccination,
future research should address these and other potential implications of
practice dismissal in the face of parental vaccine refusal," the researchers
wrote. "The answers obtained may provide insight into the influence
physician behavior has on the health and welfare of children and communities
for many years to come."
Dr. J.W. Hendricks, of Pediatric and Adolescent Care LLP in Tulsa,
Okla., wrote in an accompanying editorial that he handles the situation by
having parents sign a form stating they have elected to opt out of vaccines,
but he continues to provide care.
"I feel a straightforward immunization refusal does not by itself
damage trust, breach shared goals, or necessarily lead to a 'my way or the
highway' confrontation," Hendricks wrote.
Flanagan-Klygis said she also thought it would be more advantageous
for pediatricians to continue to provide care for families.
"As pediatricians, we're all committed to care of children and any way
we can continue that care would be best," she said.
Dr. Edgar Marcuse, a professor of pediatrics at the University of
Washington in Seattle, told UPI he found it "disturbing" so many
pediatricians said they would dismiss parents from their practice for
Marcuse said pediatricians should instead work with families to
address their concerns about the safety of vaccines. "We have to find ways
to communicate with people whose perceptions are different from our own," he
Vaccines can cause minor side effects, but most healthcare
professionals agree the available scientific evidence demonstrates the
chances of serious complications are extremely rare. In addition, the
chances of developing serious complications from vaccines are much lower
than the risks of severe illnesses and death from the diseases they are
intended to prevent.
The federal government's behavior, however, may have inadvertently
fueled the vaccine controversy.
The Centers for Disease Control and Prevention in Atlanta has refused
to make accessible its database of vaccine-adverse events -- the Vaccine
Safety Datalink -- to outside researchers, except under restricted
Several groups that question the safety of vaccines circulated a
petition last year to open the VSL database to the public, charging it "was
being used by federal health officials to cover-up vaccine risks associated
with mercury preservatives in vaccines."
Although studies have failed to find a link between vaccines and
autism, some groups have suggested the mercury-based vaccine preservative
thimerosal could cause the mental disorder or other illnesses in children.
Most childhood vaccines are now available in formulations that contain no or
only trace amounts of thimerosal.
Last week the CDC and the Food and Drug Administration issued an alert
to consumers and healthcare providers after five cases were reported of
Guillain Barre Syndrome in teens ages 17 and 18 who had received the
meningitis vaccine Menactra, manufactured by Sanofi Pasteur.
Guillain Barre is a neurological disorder that can lead to muscle
weakness, paralysis and difficulty breathing. The agencies said they could
not determine if the cases of the disease were due to the vaccine, but said
they were investigating.
FDA officials said they have not recommended any changes for
vaccination. All five of the patients developed GBS symptoms that included
weakness or abnormal sensations in the arms or legs about two to four weeks
after vaccination. All were said to either be recovering or to have
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