Friday, May 18, 2012

Letters: Dear Doctor - Dear Parent

The Thinking Moms' Revolution blog (not to be confused with the very useful Thinking Person's Guide to Autism) is written by a number of mothers who strongly believe in "healing" their children's (vaccine-induced) autism. Overall, they seem to be very angry, which is beautifully reflected in a recent post - "The letter I wish I could send to my old pediatrician". There is, of course, no reason why the poster could not send that letter, although her chances of the pediatrician actually reading it might go up, if she find another address than "Dear Dr. Asshat". Orac does a good job in taking the fallacies in the letter down, however, as often the case, one of the commentators takes the cake with a response letter, which deserved to be showcased:

Dear Ignorant Parent:
We are well aware that you pulled your child out of our practice, since we've seen a marked decrease in the volume of ignorant questions that our nurses have had to answer as of late. Trust us, you won't be missed.
Will we lose an ounce of sleep over you deciding the vaccines are wrong for your child? No. However, if your young, and unvaccinated little one comes down with measles, mumps, whooping cough, polio, or rubella then we would wager that you will. We've treated all of them in our tenure as doctors and be assured, while modern medicine can reduce the risk to your child after infection, the results can still be daunting.
Blindness, paralysis, deafness, and even death are some of the results of not vaccinating your child from diseases that once killed millions around the world. By not allowing us to vaccinate you are saddling your child with plenty of risks, none of which he should or need bear.
We all understand that the internet is a treasure trove of information. The problem with that is that not all the information is correct. Certainly you can find information claiming vaccines cause autism and a host of other developmental problems. Guess what else you can find? People that believe the earth is flat and that nobody has ever been to the moon. You claim there's evidence to support your claim? How nice. So do the people that believe the earth is flat. A cursory internet search on vaccines being bad does not make you an expert. Years upon years of medical training does, and that learning process is ongoing.
If you thought we were curt with you when you started asking these questions then it's most likely because we've been inundated by questions from you. Asking the same thing a hundred times but slightly changing the wording isn't going to get you a different answer. You decided long ago that vaccines were evil and now you simply want to try to get us to go along with you. We aren't going to. When we rolled our eyes at you for citing a study that was twenty years old it was because there was twenty years of newer information that supported our point of view.
Your claims that we broke your child are ludicrous. When you showed us an outdated study that linked autism with vaccination we showed you a dozen that did not. Our data was somehow tainted in your mind because you believe that we're all in the pocket of some shadowy conspiracy group. We aren't. Your claims that we're running a business and that we make money off vaccinations are also completely unfounded. Be assured that treating a child who has contracted the mumps is going to be a lot more lucrative than simply vaccinating against it. Yet, that's what we do. The Hippocratic Oath says do no harm, you like to say that, but there is another important part of that oath you missed, where is states that prevention is preferable to cure. In our tenure as medical professionals we have come to believe in that statement after treating scores of children permanently harmed by diseases the should never have been stricken with but for their parent's misguided good intentions.
We wish you the best of luck with your family and hope only for the best for you all. We also hope nothing bad comes of your decision.

I am not sure that time could mend the communication breakdown between mothers who think of their doctors as "asshat" and doctors who think of their patients' mothers as "ignorant", but lack of communication is one of the main reasons why parents take their children (or adult patients themselves) to charlatans. We know that time with the patient/parent influences continuity in care (i.e. how long the patient will stay with a health care provider), there are good recommendations in the literature how to address the concerns of parents who refuse vaccination, which also have time as an essential component to build trust and establish and maintain communication channels. More and more physicians dismiss non-vaccinating parents from their practices. They perceive the risk for their other patients as too high. This does mean though that the children of these parents are likely to end up in suboptimal medical care reinforcing their unrealistic views of vaccine dangers. Do you think an insurance-reimbursed hour per new child in a pediatrician's practise would be a solution?


  1. Do you really believe that spending any amount of time could convince this person of anything. This individual hold a religious like antivaccine point of view. Those open to legitimate discussion might benefit from some additional time with their pediatrician. ... a very small percentage. I have found addressing issues about vaccines at Q&A sessions at PTA meetings, church groups and daycare cares to be the most efficient method to reach out and address concerns and questions. Most important of all however is having good resources (ie, Internet references) to which refer parents.

  2. thank you Anon - so you'd think rather than tackling the drastically vaccine-opposed in the practise, you'd go and contribute in the community to spread evidence-based information about vaccines, answer questions etc? Would the ped do that? Or a nurse?

  3. My question is, do you think this parent was *wrong* for the letter? Or better yet, why can't peds, docs, nurses, and other medical professionals admit if and when they are *wrong?*

    Nobody is perfect - no parent, medical professional, CDC, AAP, and doctors surely are not God. Too many medical professionals lack bedside, and ultitmately compassion. I completely "get" that doctors/staff are overworked, underpaid, insurance nightmares, parent non-compliance, etc., but the every-day famialiarity and misgivings of their profession, imo, sometimes jades them.

    So perhaps, if there was a paradigm shift of helping families find a better fit for medically caring for their child, instead of simply dismissing them, it could potentially end ped vrs. parent fight, working together, not writing each other off.

  4. Yes, I think this parent is wrong. She (and her husband) are angry angry angry at the meme (not reality) of the ruthless doctor willfully poisoning a poor child into autism with teh ebil vaccines and denying their child (snakeoil) "healing". This is happening in the family's head. From the letter, the only thing that would have kept communications channels open in their case would have been if the doctor had lowered his voice and told them "I am so sorry, I am being oppressed by evil pharma to push this on you, it is all the fault of them and the evil vaccine overload and if you come after hours, we can start urine/garlic infusions and we can get your little boy back" (hyperbole on my part, but only partly).

    Of course there are bad doctors, as there are are poor practitioners in any profession. Let's assume that this family's doctor is actually a nice and competent guy (he sounds caring, even in the mother's rant) - what do you think would it take to keep communicating with the family, short of lying to them (i.e. telling them that vaccines caused their child's autism and biomedical intervention is going to make him neurotypical)?

  5. That's just it, if many doctors stop assuming that blanket medical care, tx, statements are *perfect* in every situation, for every child, then the lying stops and healing and needed intervention can begin

  6. The idea that doctors assume blanket medical care are perfect in every situation is a strawman.

  7. you misunderstand me - I am saying, the doctor did not lie, but a couple of lies may have kept the parents with him.

  8. To answer your question. I don't think that a 1 hour "setup" appointment would be beneficial as a standard practice. I certainly didn't need 1 hour at the first appointment (and I was still groggy from a difficult birth with excessive blood loss).

    I would like to see more Dr's offices allowing sufficient time to see patients and answer their questions. I have been to offices that are always behind and the time with the Dr always seems rushed. The Ped I am currently with (and the Hospital Midwife's office for my last birth) is great about this. I am almost always seen within 10 min of my appointment time and the Ped always asks if there are any questions or concerns and takes the time to answer them thoroughly. I have occasionally even been seen a few minutes before my appointment time if I get there early.

    I believe that this is also a two way street. If I were to ever have a question that involved a lengthy discussion, I would make a separate appointment for it and would have the scheduler put a note on the appointment with the topic of my question. This would give the Ped enough time to get familiar with the topic and give me the best info possible.

    I do agree with the first Anon that some medical professionals need to be out in the parental sphere. Perhaps giving Peds and Nurses time to attend their own child's activities would be a start. As for the older Drs (or Dr's without children), perhaps some kind of continuing education credit could be given for community education activities. Knowing the concerns of those you are liable to be working with is definitely the kind of education that should be continuing.

    As a side note, it is much easier to follow a conversation if you Anonys would identify yourselves in some way. Even just a screen name would work.

  9. Another though that came to me while I was looking through the links. What if, instead of dismissing patients or explaining the benefits of vaccination, the Ped were to give an illness instruction sheet. This could state the symptoms of all the diseases that are not being vaccinated for and inform the parent that if the child has any of those symptoms there is a special protocol that must be followed when having their child seen by any Dr (since the child is un-vaxed). I realize that many initial symptoms of vax diseases are similar to a cold, but that is part of the point really.

  10. Thank you MR - those are all great ideas!

  11. I didn't do this with my child as she was the third -- her half-brothers were already seeing Pediatrician L -- but I do recommend that prospective parents INTERVIEW pediatricians. Some here in CA in group practices have regularly-scheduled "meet the pediatricians" group appointments for prospective parents, typically available in the 3rd trimester.

    Another type of practice that's common in the US is the "health maintenance organization" HMO -- you don't have a regular pediatrician, you see who is on duty. (This actually varies by clinic, some do have regular patients, others it's like catch of the day)

    I do think that some practices, at least around here, are adopting MR's "how to take care of your unvaccinated child" handouts.

  12. I am saddened that people assume that every drug is 100% safe and effective. I used to believe it too. I believed the doctors when they told me that vaccinating myself and kids was the best thing. My son lost his coordination with his hands and regressed into his own world after his 16 month shots. The doctor told me it was a coincidence. I kept vaccinating my kids. My other son had seizures right after his one year vaccinations. I was told that is a normal reaction and not to worry. However, my son stopped responding to his name. I started questioning vaccinations from that point. It is NOT a coincidence and if it is genetic the tests we had didn't show it. However, bleeding, breathing, and living is genetic so I guess this must be too. I didn't read a conspiracy website or research beforehand. I trusted those who were supposed to "know" what was for "our best." And since I started looking around, I noticed vaccinations just don't add up. I wish I never vaccinated my kids, they would have had a better chance with the disease itself. Yes, I had chicken pox, measles etc and it wasn't as bad as the scare tactics used to promote fear from those diseases.

  13. Anon: I am saddened that people assume that every drug is 100% safe and effective.

    Who thinks that? Please tell us where Science Mom and Catherina have stated that every drug is safe and effective.

    And who also thinks that anecdotes is equivalent to data? My kid had seizures first as a newborn before he ever had a vaccine, and again while suffering from a disease.

    He also has a genetic heart anomaly that there are eighteen known genetic sequences, none of which he has. That is because genetics is still in the data collection stage, so it is often not conclusive. You child may have a genetic sequence related to his symptoms that have not yet been discovered. The first one for my son's heart condition was found five years ago, and about four more were added in just the last year or so.

    Now exactly what actual data do you have that shows seizures occur more often after vaccines than with the diseases (or for no known reason). Just post the title, journal and date of the PubMed indexed papers with that data (not anecdotes!), for example:

    Vaccine. 2012 Jan 5;30(2):247-53. Epub 2011 Nov 12
    Lack of association between childhood immunizations and encephalitis in California, 1998-2008.

    Pediatrics Vol. 126 No. 2 August 1, 2010 (doi: 10.1542/peds.2009-1496)
    Lack of Association Between Acellular Pertussis Vaccine and Seizures in Early Childhood

    Pediatrics. 2010 Jun;125(6):1134-41. Epub 2010 May 24.
    On-time vaccine receipt in the first year does not adversely affect neuropsychological outcomes.

    Pediatr Infect Dis J. 2010 May;29(5):397-400.
    Lack of association between measles-mumps-rubella vaccination and autism in children: a case-control study.

    Pediatr Infect Dis J. 2006 Sep;25(9):768-73.
    Encephalopathy after whole-cell pertussis or measles vaccination: lack of evidence for a causal association in a retrospective case-control study.

    J Infect Dis. 2005 Nov 15;192(10):1686-93. Epub 2005 Oct 12.
    Subacute sclerosing panencephalitis: more cases of this fatal disease are prevented by measles immunization than was previously recognized.

  14. My daughter was damaged by the hep-B vaccine at birth. As it did in Judy Converse's son, it caused four days and nights of endless screaming, vaccine-induced encephalitis, and she was later diagnosed with autism. At least she wasn't killed by it, like Michael Belkin's daughter. I loved the letter to Dr. Asshat, and, like many who commented on it, urged the writer to send it to him, he has to decide how to deal with his guilt at crippling this child for life, just so as not to make waves or trouble for himself. And then, just like our doctor, being against the GFCF diet which really helps! My daughter's doctor didn't have a clue what to do about her extremely severe constipation, just suggesting doubling the Miralax from once to twice a day. It did nothing to help, and she had no further ideas. The GFCF diet stopped her constipation two days after she started it this past March. Doctors have been left way behind in this parent-led movement to discover the ways to prevent and treat autism. All they care about is money, authority, and prestige, while all we care about is our children.

  15. I loved the letter to Dr. Asshat, and, like many who commented on it, urged the writer to send it to him, he has to decide how to deal with his guilt at crippling this child for life, just so as not to make waves or trouble for himself.

    You would love a piece of self-serving drivel like that. Too bad Alison McNeil doesn't have the ovaries to send it. My guess is is that she has made up most or all of it to satisfy her insatiable martyr complex and would probably get a nice letter from a law firm. You are also deluded to believe that a doctor administering a vaccine has knowingly "crippled" a child even if an adverse reaction did occur. Is that what you 'mummy warriors' are calling autistic children these days?

    Doctors have been left way behind in this parent-led movement to discover the ways to prevent and treat autism. All they care about is money, authority, and prestige, while all we care about is our children.

    Cripes you revolting mums are full of yourselves. You don't know how to prevent nor treat autism. You really do believe that Googling a few things make you authorities; your poor children. Your 'care' leaves a lot to be desired.

  16. @ anonymous: Your post sounds *familiar* to me. Have you been to other sites to post about your child and her hepatitis B vaccine-induced-encephalitis...that caused her autism?

    You state that your child encephalitis; your diagnosis or diagnosed by a pediatric neurologist when she was hospitalized in a pediatric intensive care unit?

    Do you think of your autistic child the same way Alison McNeil does?

    "You broke my child. You took a healthy baby boy and by 18 months you left me with a yard sale of medical problems and neurological damage."