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Childhood vaccines are one of the great triumphs of modern medicine. Indeed, parents  whose children are vaccinated no longer have to worry about their child’s death or disability from whooping cough, polio, diphtheria, hepatitis, or a host of other infections.
Ezekiel Emmanuel

If you give us a safe vaccine, we’ll use it. It shouldn’t be polio versus autism. Jenny McCarthy

One of the earliest choices parents have a chance to make is one of whether or not to have their child “get shots.” On day one of life, the medical system is mobilized to prevent Vitamin K deficiency bleeding and liver cancer in the child. For 90% of parents, the response is “Thank you.” For 10% (but a very vocal and increasingly evangelistic 10%) the answer is “could we wait a little while?

Why do they want the delay? Most blame it on a general distrust of the “medical-industrial” complex and a lot of conflicting (and overwhelmingly incorrect) data on the internet regarding vaccine safety. I suspect a large part of the problem is our inherent inability to work with probabilities to understand health risks.

First is our conviction that because we can see a relationship we can extrapolate a cause. Take polio and ice cream. Setting aside the crazies who deny that polio ever existed, there was a time (1952, to be specific) when 50,000 American children came down with paralytic polio. Several folks quickly identifies a striking relationship between ice cream sales and the peak of the polio epidemic. Ice cream was banned in several states before it was determined that summer was the common factor. It is flawed observations like this (leukemia and Vitamin K, autism and MMR vaccine) that have led to some of our problem. Oprah, in a nod to allowing personal observations to be treated as fact, brought on Jenny McCarthy and treated her as an expert on autism because she had “mommy instinct…. She knows what she’s talking about.”

Second, and perhaps more problematic, is our inability as physicians (and a society) to communicate the consequences of a delay. Vitamin K deficiency bleeding, for example, is only a problem very early in the infant’s life. Delaying the shot (only the shot is effective) beyond 2 months of age renders it worthless. You have already placed a bet on your child’s life (or at least risked his or her future ability to function), reducing his or her ability to pass kindergarten by 1:10,000. So what, you say? By making children get out of the pool when there is lightning over a lifetime, the risk of dying of a lightning strike is reduced by approximately the same amount (1:12,000). Why is this? I suspect the difference is folks see the damage lightning causes to trees and fuse boxes so the risk to them is much more real. Who knows, though, maybe there are anti-lightningers as well.

According to the article on vaccine delay, approximately 50% (9 minutes of the 18 minute visit) of the face-to-face time is spent discussing vaccination instead of other, more pressing issues of development and parenting. Brochures alone are not helpful in speeding up the discussion. What we as health professionals need to do is change the discussion. First, we need to be frank and truthful with the parent provide factual data and address the parent’s fears. Parents need to catalog their fears going in but need to be open minded to evidence that these fears are unfounded. Secondly, we need to address risk. Third, the use of motivational interview techniques might help clinicians to get patients to better verbalize their concern.

So, parents, you need to learn to be just as skeptical of the “interwebs” as you are of “big medicine.” Doctors, you need to understand that parents will do the right thing (witness the lack of anti-lightningers) but they gotta believe.

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