The world of medicine is like a bubble. A lot of people THINK they know what goes on there, but unless you're down in the trenches it's unlikely you do. So here is my semi-anonymous blog, here to tell you what really goes on in the life of a medical resident.

Sunday, February 04, 2007

Why Can't We All Just Get Along?

As far as doctors go, I consider myself fairly knowledgeable when it comes to alternative therapies. Other doctors consider me somewhat left-wing in my practices and policies although in a generally right-wing profession such as medicine I guess that really doesn't say much. I regularly recommend that my patients try chiropractic, massage therapy, acupuncture, or naturopathic medicine. I am a huge breastfeeding advocate, and support mothers who can breastfeed their babies beyond infancy. I am very anti-circumcision. I appreciate the benefits of such 'crunchy' parenting beliefs as co-sleeping, baby-wearing, and attachment parenting in general.

So because I know few people in real life who think the way I do (not to mention the very real problem of not really having the time to make any friends in the city I've been living in since starting residency), I often rely on the internet for information and to find people with common interests. In particular, I am a fan of message boards. One such message board that I won't mention (it's not my intent to start a war) seemed to be exactly what I was looking for-- there were reviews of cloth diapers, vegetarian and vegan recipes, information on natural health and healing and all kind of great information probably considered 'off the beaten path'. Just one problem.

They hated me.

Well, maybe it wasn't 'me' they hated. After all, I hadn't contributed anything at that point. It was more a matter of hating what I (voluntarily or not) represent. I first realized this when I ventured into a forum on vaccination. Vaccines weren't something I had spent much time thinking about through my medical training-- in emergency medicine, the only vaccine that had a role in the emergency room was the Td booster, which we offered to everyone who came in requiring sutures who hadn't received the vaccine in the past 10 years. I didn't really concern myself with people who refused it-- just explained the indication and documented that it was offered and declined.

In family medicine, however, they became more routine. But still, I hadn't thought much about them. They were routinely given at 2, 4, 6, 12 and 18 months. Only once did a patient take me up on my quick "do you have any questions or concerns about the vaccinations scheduled for today?". He was concerned about the mercury in vaccines. I assured him that vaccines in Canada no longer contained thimerosal with the exception of the flu shot, and he was happy with that. At his next visit, the same father asked about the use of formaldehyde in vaccines. I told him that I didn't know, but that I'd be happy to look into it for him. We delayed his son's vaccinations that day.

The 'Vaccination' forum would have been much more appropriately named the 'Anti-Vaccination' forum. A few clicks was all it took to realize that the nature of the forum went far beyond having evaluated the literature and deciding that the risks of vaccination outweighed the risks of contracting vaccine-preventable diseases. That, I can respect. But instead these people have decided that the entire medical profession is, at best, a bunch of ignorant and obedient pharma shills. At worst, we are voluntary conspirators pushing dangerous interventions on people to benefit our own pockets.

I have to admit that when it comes to something as seemingly benign and beneficial as vaccination, we're probably not as critical as we should be. We know what we've been taught-- and that is that vaccines have been proven safe and effective, that adverse effects are rare, and that the benefits of vaccines far outweigh the risks. It's not 'dogma', it's not a belief system, it's simply presented in the same way as every other one of a million other pieces of medical information that we, as physicians, are expected to know. And as with anything else, we should be prepared to discuss it intelligently with our patients rather than simply shutting down at the suggestion that there may be more to it.

But the anti-medical sentiment runs far deeper than the vaccination forum. Among the opinions presented as fact are:
  • Well baby visits are simply an opportunity to push vaccinations and berate parents who choose not to vaccinate.
  • Well baby visits exist solely for the financial benefit of physicians
  • Physicians receive kickbacks from pharmaceutical companies for prescribing their products
  • Physicians make up statistics to coerce patients to agree to certain interventions
  • Physicians are "unethical liars telling women rubbish to suit their own purposes" in regards to childbirth
  • Obstetricians are "knife-wielding surgeons who are bound and determined to slice you open no matter what your wishes"
It actually makes my stomach hurt. Poll a thousand medical school applicants and I can bet you that not one of them mention the desire to have people accept their word without question or perceive them as superhuman among their reasons for pursuing a career in medicine. But many of them will talk of a desire to feel like they're helping people, and working to better patient's lives. During medical school we are never taught trade names for drugs-- we refer to all medications by their generic names and discuss only broad categories rather than specific therapies (i.e. "use a beta blocker for this condition" rather than "use metoprolol" and certainly never "use Lopresor") and have no contact with the influence of drug companies. Again, unless things are dramatically different in the U.S. the ideas expressed on this board are ridiculous.

But it's a sentiment that goes both ways. Allopathic medicine is slow to accept, let alone endorse, many branches of 'alternative' or 'complementary' medicine. It took years for acupuncture to finally be endorsed by the medical community in spite of years of evidence in support of its benefits. Recently, when my family medicine group discussed a case where a woman came into my colleagues office asking about her opinion on the naturopathic remedies that had cured her condition, my colleague had to admit that she had no idea what to say or how to handle the situation. I suggested having a naturopath come in to speak to our group about some of the principles of naturopathic medicine and alternative healing-- it's something I've always wanted to learn more about and clearly it was an area of weakness for my colleagues as well. Instead my suggestion was met with uncomfortable silence. Instead it was decided by the group that we'll be having an MD give us a talk on alternative medicine. Um... right. Talk about defeating the purpose.

The attitude that practitioners of alternative medicine have against physicians and the attitude that physicians have towards much of alternative medicine is only hurting the patient in the long run. A recent study showed that 63% of patients over the age of 50 were using some form of complementary or alternative medicine, and nearly 70% of these had not discussed it with their doctor. Many of these women on the anti-vaccination board were advising each other to lie when asked if their child was up to date on their vaccinations to avoid questioning and condemnation. That can't be good for anyone.

Traditional allopathic medicine has much to learn from the world of naturopathic and alternative therapies-- we should be keeping an open mind and ensuring that we have (at minimum) a basic knowledge of the therapies and techniques available. Alternative medicine would gain more acceptance by traditional medicine by shelving the adversarial attitude and through more rigorous scientific testing of their therapies.

It's too bad that each side has to feel so darned threatened by the other.

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40 Comments:

Blogger Liana said...

I agree with you 100% Dr. Couz. I recently posted about this on my blog (my mom is an ICAM practitioner... but I don't think she hates me).

One of the oddest assertions I've ever read was on a site advocating lotus births (not clamping the umbilical cord after brith, and instead allowing the placenta to fall off by itself after a few days). The author of the website claimed that doctors are keen to immediately clamp the cord after birth so that we can harvest and sell the cord blood.

Wow, if only I'd known that it could be so easy to pay off my med school debts.

1:07 PM

 
Blogger Fat Doctor said...

As a student, I did a rotation with a group of nurse midwives in a town that had a big-name-chiropractic training program. We got a lot of patients who were married to chiropractic students, and almost all of them were vehemently opposed to vaccinations. I'm not sure what the reasoning was, but I thought it was pretty scary that there's a large community of like-minded people all living together. One sick contact and...BOOM...polio. TB. Measles. Scary, scary.

But I agree with you that allopathic (and osteopathic) physicians could learn a lot from our holistic counterparts, the naturopaths and chinese medicine practitioners, for example. Accupuncture is the only treatment I know of that has any scientific study behind it. But most of us learn to believe what has been rigorously studied.

Show me the money!

5:33 PM

 
Anonymous grass said...

Great post; as a newly pregnant woman, I'm also interested in alternative care, like midwifery etc. But I find some of the beliefs on certain forums borders on religious fervour.

5:44 PM

 
Blogger ERnursey said...

I'm dismayed by the anti-vacciation fervor. I lived in an Old order Amish community that did not vaccinate and have taken care of infants hypoxic and gasping from whooping cough (1 died) as well as an outbreak of measles in which one 8 year old had severe encephalitis and ended up severly disabled. These parents do not realize that there is a very real chance of losing their precious child to an easily preventable disease such as pertussis or tetnus. Sad.

10:43 PM

 
Anonymous Anonymous said...

It's nice to see that some doctors out there don't completely dismiss alternative medicine. I also hope you know that not all people who use alternatives distrust or dislike doctors. I have all my vaccs and get the flu shot every year, but I also trust accupuncture, massage and some "herbal remedies" to keep me healthy. It's complete craziness what some people will say and I've noticed that often the same people will believe in even crazier conspiracy theories - like: Western governments are forcing birth control on African women so that black don't take over the world. pffff!

12:09 AM

 
Blogger Indian Medic said...

It’s perfectly understandable if patients want to opt for alternative forms of medicine. They have their own benefits. In India the oldest form of medicine practiced is Ayurveda and it is still quite sought after by patients-educated and uneducated alike.

However, the idea of being opposed to Vaccinations is utterly ridiculous. Those parents are not only hurting their own kids but also putting the community as a whole in harms way. Here the WHO in conjunction with the governments worldwide is trying so hard to eradicate or at least control potentially life-threatening infectious diseases, a few people with their ignorant beliefs are bent on undoing it all.

1:05 AM

 
Anonymous Anonymous said...

Vaccines can be both good and bad. The issue I have is the "one size fits all" attitude of the majority of (young) doctors. This is true in alternative medicine as well. Certain vaccines are contraindicated in some populations. Sorry, I'm one of the folks who ended up with a severe pneumonia due to the pneumonia vaccine. (It's one that is normally seen only in the very young, immune compromised, or very old. Of course, living on prednisone in order not to have an allergic reaction at the time might have been a contributing factor.)

Do I blame the doctor who advised the vaccine at the time? Nope. The thing is, the research is very slanted and scant for the most part. Some of it is downright sloppy. There was no way for him/her to know there was even a reason not to give me the vaccine. It is the way of allopathic medicine.

Now calling TCM "alternative" is a wee bit nonsensical since it has a much longer history than allopathic or osteopathic medicine. Allopathic and osteopathic medicine are the new kids on the block. From what I understand of TCM, they actually tend to treat each patient as an individual. This is something allopaths and osteopaths are just now discovering.

I'm glad to hear at least one physician out there is open to learning about "alternative" medicines!

Pax,

MLO

8:48 AM

 
Anonymous Mom to two kidos said...

Exactly! Why can't we just all get along? Just curious, but if you went to this web site to get "support" for your alternative lifetyle choices, than you should have a great understanding that people have different beliefs and viewpoints. Why can't you be supportive of someone else's right to have an opposing point of view, even when you don't agree with it?

11:28 AM

 
Blogger Couz said...

Um... because the views that I'm bothered by are those directly offensive to me and my profession. My saying that doctors are malevolent and ignorant in general, that is insulting to me. They have made assumptions about me, my opinions and my motivations based on nothing but the fact that I have an MD.

Let's say, for example, that you're a stay-at-home mom. If I sprouted off my 'opinion' that SAHM's are wasting their education, lazy, not contributing anything worthwhile to society, and can't carry on a conversation about anything more interesting than bowel movements and teletubbies, would you be so quick to 'respect my opposing point of view'?

12:50 PM

 
Anonymous Mom to two kidos said...

What if you weren't in the medical profession and your child was "mis-treated" by a doctor or suffered an injury from a vax or died from a vax? Even if it was percieved, not actual neglect or vaccine reaction, wouldn't you be upset at the medical profession? I just wouldn't judge someone until you've walked in thier shoes. And I agree that some of the hostility is unwarrented.

Yes I have had bad experiences with doctors. Yes, I still go to all WBC. Yes, I am a SAHM. Yes, I have been called lazy to my face because I am a SAHM. Yes, people have made comments to me, personally, about making "a contribution" to society. It hurts, but that is their choice to say those things, whether true or not.

And don't take this personally. You sound like a great MD to work with. Honestly, making statements like those above justs adds to the stigma of arrogance that many people see in the medical profession.

1:36 PM

 
Blogger Dr Scott said...

Excellent post, Dr Couz...those sites inspire the same feelings in me as well. I understand and respect that the anti-vaxers are interested in the well-being of their children; but I don't comprehend how they think we MDs are not interested in the same thing (and are instead disingenous, deceitful shills, etc., etc.)

Incidentally, regarding the "pharma kickbacks" that we unethical doctors supposedly get: I always ask where I can get me some of that. To think I've been supporting these vaccines because of the research, and my interest in the well-being of kids, when I could have been getting paid for it!

1:43 PM

 
Anonymous Anonymous said...

"At his next visit, the same father asked about the use of formaldehyde in vaccines. I told him that I didn't know, but that I'd be happy to look into it for him. We delayed his son's vaccinations that day."

Can you share with us what happened after that? Did you research formaldehyde in vaccines? Did you discuss it with him? Did he decide to vax anyway?

If you are willing to "look into" formaldehyde, then why not aluminum, and eggs, and aborted fetal cells, etc.? As a supposedly open-minded physician, why not present better/more accurate facts than the candy-coated VIS that parents are routinely given for vaccination "information"?

There happens to be a doctor on that forum you mentioned, who posts often. Instead of trying to defend herself and the entire medical profession, she listens and considers and shares on the vax board. Her input is welcomed, and she is generally treated with kindness and respect.

It's all in how you put yourself out there.

2:33 PM

 
Blogger Couz said...

Hmm, I didn't realize that I mentioned a board. I actually frequent a few boards, and the experiences noted here are an amalgamation of all three 'alternative' boards that I've found.

Mom to two: You have missed the point entirely. I don't actually feel that way about SAHM's, which I thought I made clear in my reply. I can understand someone having a bad experience with a doctor- I have had a few of them myself. But saying (or implying) that all doctors are evil and arrogant based on one (or several) bad experiences is like saying that all native people are alcoholic simply because you know one who is. It makes YOU look ignorant to make statements like that. So you see, it has nothing to do with 'respecting others POV' if your POV is that 'all doctors are assholes'. KWIM?

And I did look into formaldehyde for the patient I mentioned. And we had a rational discussion about it. He and his wife opted to selectively vaccine their baby-- they opted to give Pentacel but not Prevnar at the following visit. I respected it.

2:51 PM

 
Blogger Pensive said...

Couz, you say We know what we've been taught-- and that is that vaccines have been proven safe and effective, that adverse effects are rare, and that the benefits of vaccines far outweigh the risks.

What do you know about the detail of that? What were you taught at Med School? What do you actually "know" right now?

Obviously you'd missed the formaldehyde bit, but just how much do you know about aluminium in vaccines, why its there, what it does in the body, what safety tests have been done, or not done?

If an informed parent brought to you the peer reviewed, now published study that this article was based on:

http://www.straight.com/Print_Page.cfm?id=16717

And if they wanted to discuss with you these FDA minutes:

http://www.fda.gov/cber/minutes/tox120202.htm

Exactly what sort of factual position would you, as a doctor, be in?

The same as you were in with regard to formaldehyde?

If I asked you to produce all the graphs for death and disease decline for immunable diseases since 1900 (not like the CDC do, since 1960) could you?

If I asked you to discuss with me Why it was that the definition of polio was changed several times, between 1954 - 1960, and the Senate record relating to that, which clearly shows what that covered up, could you?

If I asked you to discuss with me the real reasons why the SALK vaccine was superceded by the SABIN, could you?

If I asked you why it was SALK has always been denied a place in the hall of fame in the National Academy of Sciences, would you know the actual reason why that was?

To you, none of the above might mean anything, or even be relevant. But if you knew the answers to all the above, you might be able to see why, to some people, that the above issues are just the dime's tip of a huge iceberg, the dots of which which it seems few doctors have even a rudimentary ability to join.

Therefore, I have to ask the question. Is what you think is "knowledge" knowledge, or is it actually "belief" that all the stuff you don't know, but you hope others do, will stack up on closer scrutiny by yourself?

4:11 PM

 
Anonymous Anonymous said...

"Hmm, I didn't realize that I mentioned a board."


In your original post, you wrote:
"One such message board that I won't mention (it's not my intent to start a war) seemed to be exactly what I was looking for"

9:43 PM

 
Anonymous RDC said...

I am opposed to the practice of vaccination in general. I don't vaccinate my child. However, I do not believe pediatricians are money-hungry baby killers intent on financing a yacht or whatever. I happen to like my pediatrician a great deal. She's somewhat mainstream, as far as I can tell and she does encourage us to vaccinate, but she's not pushy and has never been rude when we declined.

I do wonder, though, how you can claim that the idea that the unshakable believe in vaccines is not "dogma," when you TWICE said that you haven't given much thought to them. You said you didn't give much thought to them in medical school and you said you still hadn't thought much about them in family medicine. How can someone who hasn't given much thought to a topic claim authoritatively that her position is not one of dogma? If you don't even know exactly what your position is about or what science supports your decision, how on earth do you know that the decision is, in fact, supportable? You said you know what you were taught, which is that they are safe and effective. Okay, but how do you know that? Without examining any of the evidence, all you're doing is taking someone's word for it. Surely medical school provided you with more critical thinking skills than that.

If you want to be able to talk rationally and intelligently about the topic, which is what you said you should be able to do, then you have to actually know something about it. I can guarantee you that you would never have talked me into Pentacel after researching formaldehyde. Why? Because I know more about vaccines than you do. Formaldehyde is the least of my concerns.

And to fat doctor, I just followed the link to your blog. In America, BCG is almost never given. That's right - we've got a whole country full of people who've never been vaccinated for tuberculosis. And guess what? No massive TB outbreaks. NO epidemics. Amazing, isn't it? I find it a bit disconcerting that I know more about what vaccines are and are not routinely given in America than a family physician practicing in this very country. Apparently, I also know more about what led to the decreased incidence of tuberculosis, since you seem to be crediting it to the vaccine that has never been routinely recommended here and which therefore could not have led to the decline in tuberculosis incidence. This is exactly the kind of thing that leads people to mistrust physicians. You should know more about me than this, but you don't. Not good.

10:16 PM

 
Blogger Ms.Teacher said...

Wow, seems like you opened up a can'o'worms Couz! :)hee. We still love you, you know where ;)

Tabitha

10:29 PM

 
Anonymous Anonymous said...

Pensive - an interesting article. Not yet peer-reviewed, and this is mice we're talking about, not humans. Normally when studies are done on mice, they can't automatically be transferred to humans. There have been lots of great, exciting studies done on mice only to find there was no effect in humans.

I have a question: If aluminum hexafluoride is supposed to cause a bunch of neurological diseases, why are we not seeing much higher rates of these diseases? If approx. 70% of people have been vaccinated (and higher rates for the Hep vacs) then why are we not seeing higher incidences of these neurological diseases?

Anon 9:43, you do realize that no specific board was mentioned, do you? So the above poster should not assume couz was talking about the board that they frequent.

And rdc: care to post some of the TB info you know about?

1:41 AM

 
Anonymous rdc said...

Anonymous, actually the study in the articles has passed peer review. The abstract is here: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=17114826

Asking why we're not seeing higher rates of neurological diseases seems strange to me. We have autism and learning disorders out the wazoo. We're depressed, we have ADHD and OCD. Before the animals were sacrificed, it was observed that they made about twice as many errors in completing a maze and lost strength. Those don't translate to hugely noticeable effects in human beings, IMO. How would you know that someone is slow at doing a math problem or can't remember directions? It's all about changes that are subtle on the surface, but can hugely impact a person's life. I have two relatives who suffered Gulf War syndrome. They seem fine to people who don't know them. It's not like they've become blundering idiots who can't function. That's the problem: the outward changes are small enough that doctors (and most everyone else) refuse to acknowledge them.

As far as TB is concerned, the main thing everyone needs to know is that BCG (the TB vaccine) is not and never was routinely recommended in the US. Therefore, for a family practitioner in America to make comments about how a large group of unvaccinated people living together could result in a TB outbreak is pretty absurd. She should know better. After all, she just happens to be part of that group of un-TB-vaccinated people, unless she for some odd reason chose to get a vaccine that the CDC itself says is recommended only in very specific circumstances due to its "variable effectiveness."

And one of the biggest risk factors for TB is poverty. Here: http://www.ajph.org/cgi/content/abstract/91/9/1487 And here: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=8219945&dopt=Abstract And here: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=10394834&dopt=Abstract And here: http://thorax.bmj.com/cgi/content/full/56/suppl_2/ii23 And here: http://ajrccm.atsjournals.org/cgi/content/abstract/157/4/1016?ijkey=9940d35f55b21032850f705e87d74caddcde21ca&keytype2=tf_ipsecsha

It is accepted that the decline in TB in the US was a result of improved living and social conditions. It was unrelated to BCG, since BCG was never widely used here. And we can see it all in reverse nowadays: As poverty is returning with a vengeance and the gap between the rich and the poor is widening, we're seeing a resurgence of TB in the US. Chance? Not according to all the studies showing the direct correlation between poverty and TB. I could post a million more links, but all you have to do is search google scholar for tuberculosis and poverty.

It's 2:30 am where I'm at, so excuse me if this is a little jumbled. :)

3:27 AM

 
Anonymous Anonymous said...

"Anon 9:43, you do realize that no specific board was mentioned, do you? So the above poster should not assume couz was talking about the board that they frequent."

Oh, geez - gimme a break. I was there. It's not difficult to figure out what "unnamed" board Couz was referring to.

I'm still hoping for the day when MDs (specifically, pediatricians) actually LEARN something about immunity and vaccination in med school.

8:25 AM

 
Anonymous Anonymous said...

Anon 1:41am, the CDC and the AAP came right out and stated in 2004 that 1 in 6 children will be diagnosed with a developmental disorder or a behavioral problem.
http://www.medicalhomeinfo.org/health/Autism%20downloads/AutismAlarm.pdf

1 in 6

rdc is right...we have neurological problems out the wazoo.

I think I'll pass on injecting neurotoxins into my children.

Couz, I'm very interested to hear your responses to pensives questions.

4:39 PM

 
Anonymous Anonymous said...

rdc and pensive:

I don’t think the smug and condescending tone is called for. If you present to your physician with a particular concern and bring evidence that he or she is unfamiliar with, you’re fortunate if you have a physician that is willing to spend some time investigating the matter and get back to you about it, like Couz did. Physicians cannot be encyclopedias. There is simply too much information out there for us to be familiar with the complete evidence for and against every intervention we recommend. People could spend their whole lives trying to hammer out the safety issues just with vaccines, but that’s not the job of the clinician. We have boards and societies that provide us with recommendations and they tell us the level of evidence behind the particular recommendation. It’s not dogma to practice by these guidelines, when we know that the way that they are formed is through synthesizing the best evidence and expert opinion available. It’s very hard, in fact, for a physician to recommend something against the national guidelines, as he or she then becomes a sitting duck for malpractice lawsuits. Of course, a doctor does need to know the basic evidence and reasoning behind the guidelines, the risks and benefits of proposed interventions, and when to break the rules.

Regarding the mice study on aluminum, I agree that it’s concerning, I would just point out that giving a human dose of vaccine to a mouse, which the study seemed to do, is the weight-based equivalent of giving about 150 doses of vaccine at once to a human. Almost all medications or substances, if given in doses too high, will have toxicity.

All physicians know that we don’t use the BCG vaccine in this country, and I’m sure that fat doctor just made her list without thinking it through very carefully. By the way, there has been no overall resurgence of TB in the U.S. The rate of 4.8 new cases per 100,000 in the U.S. in 2005 (down from 52.6 in 1953) is the lowest rate ever. There has been some inner city resurgence, in places like Washington and New York, and although that trend may be associated with poverty, it’s not clearly caused by poverty. (Other likely factors include HIV infection, close living quarters, decreased access to health care, immigration, higher incarceration and homelessness rates.) Streptomycin, the first effective medical treatment for TB (first used in 1944) is one of the developments thought widely to have contributed to the decline of the disease.

10:22 AM

 
Anonymous Anonymous said...

What is so smug and condescending in challenging a physician to consider other research? Couz has freely admitted:

"... when it comes to something as seemingly benign and beneficial as vaccination, we're probably not as critical as we should be. We know what we've been taught-- and that is that vaccines have been proven safe and effective, that adverse effects are rare, and that the benefits of vaccines far outweigh the risks. It's not 'dogma', it's not a belief system, it's simply presented in the same way as every other one of a million other pieces of medical information that we, as physicians, are expected to know. And as with anything else, we should be prepared to discuss it intelligently with our patients rather than simply shutting down at the suggestion that there may be more to it ..."

which makes me hopeful that she is at least open to being challenged to think outside the box of her educational and clinical experience.

If she's really serious about her above statements, I'd love to see Couz address pensive's and rdc's comments in a new post on her blog.

1:01 PM

 
Blogger Couz said...

To all of you here looking for a fight, I'm not giving it to you (regardless of the ever-so-flattering 2 page thread at c2pp dedicated to bashing me).

First, this post was NOT about vaccines. But somehow, some anti-vaxers can manage to make everything come down to vaccination. They've clearly done their research-- and I think the average anti-vaxer is very well-versed in the research against vaccinations.

The last anon commented said much of what I was trying to say (I have been working on a reply for two days, but it's hard to do so when my time at the computer is in 2-3 minute intervals between patients). We don't know every single piece of evidence behind every single thing we do-- to expect us to is ridiculous.

My response to ALL of pensive's questions are the same. With every piece of information that has been brought to me by a patient, my response is the same.

"I really don't think that I can do this justice in the time we have alloted. I'd like a chance to do more research to discuss this with you fully. May I keep this article/website/pamphlet and have you book another appointment next week? By that point I will have had the time to look at this and do my own research, and I'll be in a better position to discuss it with you.'

I've done it before, on many more topics than simply vaccination.

So instead of coming to every instance where anyone even whispers 'vaccination' with both barrels blazing, maybe you might want to consider that you have as much to learn from our point of view as we do from yours? Or is the 'anti-vax club' above any reproach at all?

But thanks for demonstrating first-hand that the anti-vax movement is more about the anti-physician movement, whether or not it has reason to be.

1:15 PM

 
Anonymous Anonymous said...

Yeah, I haven't read a more moderate, considerate post on vaccination since the start of medical blogs. I can't believe people thought you were being dogmatic.

3:08 PM

 
Anonymous Anonymous said...

I am a nurse practitioner practicing in the US.

My first comment is in response to the person who thinks BCG is an immunization which prevents TB. He or she is confused and needs to learn more about the subject. BCG does not prevent TB in the form most people get it. It has some efficacy in preventing the dissemination of TB to other parts of the body in very young children, because very young children are more at risk for that sort of TB.n It's useless in older kids and adults and the kids who get TB can still get pulmonary TB.

And, naturally, since we do not live in a TB endemic country, and I suppose that is even more true for Canada, that is the reason BCG is only given in certain countries (I don't want to generalize and call them third-world countries, but that would be pretty close).

It's interesting that with the amount of toxins we all have in our bodies which no doubt pass from mother to fetus, which come from our television sets, carpeting, all the formaldehyde released into the air from paper grocery bags and particle board (I defy anyone to say they have none of those in their homes) not to mention that formaldehyde was and possibly still is a component of toothpaste which we all swallow a little of each and every day--it really is comical to blame anything on vaccines!

I have some adolescent patients whose parents would not let them be immunized as infants. They plan to get fully immunized once they reach adulthood. Someday they may wish to travel to Africa or Asia or the former Soviet Union or Mexico or South America where you do stand a pretty good chance of getting measles, mumps, rubella, whooping cough and diphtheria.

3:51 PM

 
Anonymous Anonymous said...

I totally agree. There are so many other hazardous things out there that we should be worrying about instead of vaccines. Vaccination has been pretty prevalent since the 1960's has it not? It seems like it's only in the 90's that we're seeing these neurological problems. Could we be seeing these disorders in kids these days due to other factors like: increased stress; increased estrogen-like substances in our environment due to pesticides, cleaners, and birth control in drinking water; increased use of aerosols; increased use of anti-bacterial sanitizers, increased use of plastics etc, etc...

4:10 PM

 
Anonymous rdc said...

Anonymous, I am well aware that BCG is very ineffective at preventing tuberculosis. VERY well aware. Simplifying it for fat doctor and readers who might be confused by her claim that groups of unvaccinated people living together are in danger of starting a TB epidemic in no way implies that I'm unaware of BCG's extremely low efficacy. So perhaps the person who needs a lecture is fat doctor, not me. She seems confused as to exactly which diseases the unvaccinated in America are in danger of contracting.

I was not smug or condescending. I said as gently as possible that perhaps adhering to a position based upon word of mouth isn't the best way to be assured what one believes to be true *isn't* dogma. I never accused Dr. Couz of being dogmatic, nor was I condescending to her by saying she wouldn't have convinced me to vaccinate or that I know more about the topic than she does. Clearly I DO know more about the topic than she does. Saying so doesn't make me condescending, but spending literally hundreds of hours reading medical literature with the assistance of specialists in immunology and virology does make me more knowledgeable than a person who admittedly hasn't put much thought into it.

Nor am I at all "anti-physician" and I'm not sure how anything I've said could be construed as such. Pointing out fat doctor's glaring mistake about TB as one reason some people don't trust doctors is not anti-physician. It's just commentary on the state of affairs. I like my daughter's pediatrician. I don't have a problem with doctors and I'm certainly not "anti-physician". I just think there's a huge disconnect between the amount of knowledge doctors have on any one given topic and the amount of trust patients are expected to place in them on ALL topics.

Dr. Couz, I think what you don't realize is that almost all of us once *were* in your position, even if not as doctors. Once upon a time, we all trusted the same sources you trust. Once upon a time, we listened to doctors who told us vaccinating was the best, safest, most responsible choice to be made. It isn't that we haven't been there or haven't considered what you have to say. It's that we have *already* considered it. How much considering does a parent have to do before our choice can be respected? This is the first time *you've* dealt with people like *us*, but it's not the first time *we've* dealt with people like *you*. ("People like you" strictly meaning people who believe we need to learn more about why vaccines are recommended or why we should choose to vaccinate or whatever it is you believe we should be learning from you - not any negative meaning.)

I like your blog. I'd never seen it before being told you were posting at a certain somewhere. I'm sorry you felt less than welcome at the places you visited. I think the problem isn't that the majority of people who don't vaccinate hate all doctors. The problem is that the minority who do happen to be louder.

7:12 PM

 
Anonymous rdc said...

Oh, and regarding TB cases in the US. Yes, I misspoke. The number of reported cases increased in California, Illinois and some other inner cities. I should've been more clear about that.

I'd consider homelessness, decreased access to healthcare and crowded living conditions all to be symptoms of poverty.

7:39 PM

 
Anonymous rdc said...

Should've been just "inner cities," not "other inner cities." :)

7:48 PM

 
Anonymous Open-minded said...

I appreciate the sentiment of your post. I think sometimes the distrust of MD's is unfounded, but it is sometimes also earned.

And I think that's the fundamental problem - that some dr.'s aren't open minded and willing to listen to patients, some aren't willing to research things that they're not well versed in and some are disrespectful and employ scare tactics to try and get parents or patients to follow their treatment plan. Unfortunately, it's these few that leave a bad taste in the mouth of those who already are inherently distrustful of medical professionals for whatever reason. And whether the initial distrust is warranted or not, when an encounter proves the persons preconceived ideas, it sets a stereotype in stone.

As a parent, I choose not to vaccinate my children. I also have a wonderful relationship with our family doctor who also delivered one of my children. She has been open to me researching and coming to my own decision about vaccination, and while she feels some of the vaccines are more necessary than others, has never pressured me. And I appreciate that. When I deal with her I feel respected and I trust what her opinions and recommendations are because she will have a dialog with me and answer my questions or concerns.

That being said, I have also had encounters that make me distrustful of the medical profession in general. And if this was all I'd ever had, I think I'd fall into the group of thinking all doctor's are money hungry and in the pocket of pharmaceutical companies.

From my interactions online, I do believe the climate of healthcare is very different here in Canada compared to the US. Personally I'm not a huge believer in conspiracy theories - although I also believe that what we're told is never the whole story.

And as you've said, there isn't enough time to personally research everything you're taught. You're taught that vaccines are safe. And as a doctor I think you have to believe that. To not believe it would also mean questioning everything else you've been taught to a greater or lesser extent.

I guess I'm not sure exactly where I'm going with this, other than to say that I'm one of those anti-vaccine people, but I'm also open minded and wouldn't attack somebody like yourself. In fact I have respect for your willingness to consider other viewpoints and wish that there wasn't such an anti-medicine view amongst those who choose not to vaccinate. But for whatever reason that there is, try not to take it personally. You're right that nobody knows you personally or knows how you practice or how you deal with your patients. I'd also venture to say that you don't know how some of their doctors have dealt with them, or what they've personally witnessed their children go through, and maybe their distrust of dr.'s in general is founded - not that that makes it more fair for you.

I know you didn't ask for advice, ;) but if you can find the support you need in other areas of these boards, then perhaps avoiding the forums that create this conflict will allow you to have the support without the conflict. There is a large community of moms out there who also parent naturally, (I prefer this term to attachment parenting,) and while you'll find many who also choose not to vaccinate and would rather trust their bodies to birth without the aid of a medical professional, I'm sure many and maybe even most of them are warm and welcoming and tolerant of other viewpoints. I'm sorry that you've been put on the defensive just because you're a doctor. But perhaps also consider that just because you're a doctor, doesn't make your stance on any one issue right. We're all humans, and our knowledge is only as good as the source. To err is human, and to find facts can be difficult. This applies to life in general, but even moreso to the issue of vaccination. I can think of no other topic that is so hard to find unbiased information on. There are no double blind studies comparing completely unvaccinated children with those who receive a vaccine. So the gold standard of determining the safety of a medical treatment is missing from the vaccination issue. And until it is resolved, the issue will never be put to rest. I think the fact that children are seriously injured and killed by vaccines just adds to the whole issue.

If I might be so bold - don't put all of us who choose not to vaccinate into the category of ill-informed conspiracy-anti medicine folks. By believing the stereotypes of those who don't vaccinate, you also do to me and others what you've had done to yourself - prejudged based on the actions of those you've thus far encountered.

1:13 AM

 
Anonymous Anonymous said...

And actually, now they think they may have found a correlation between the age of the father and neurological disorders. That's one trend that makes sense. Mena re older than they used be when their first child is born.

I just don't think there's enough evidence pointing to vaccines as the culprit. There are too many other possibilities.

4:44 PM

 
Anonymous Sandra said...

I am presently having a struggle with my sons allergist/immunologist regarding his asthma. His asthma was uncontrolable and no one could seem to offer anything that would help prevent some if his attacks. We did everything, cleaned the house, got rid of our cats, got special covers for all the matresses, special pillows, no scented detergent, no smoking, etc. He was at the hospital every month for masks and steriods, sometimes spending up to three days there. They finally referred us to this doctor and he put him on Singulair. We didn't really see a difference though.

Then a friend mentioned that she has asthma and that since she cut wheat out of her diet it changed everything. So we did the same for our son (why not nothing else was working). Not even a month after everything was taken out of his diet we saw incredible improvement. He's been to the hospital once since then (it's been a year this month). But when we mentioned our efforts to his doctor he said they had no proof that was ever a cause and that he would know. That our time shouldn't be wasted. He even tested him for wheat allergies but our son wasn't allergic so he just brushed it aside. Perhaps the wheat just aggravates the condition, who knows. We even tried to re-intergrate wheat food last summer, it only took a few hours and he started coughing again.

What more does this doctor need as proof?

8:38 AM

 
Anonymous Josy said...

Great post.

Couz, I was there on at least one of the boards you showed up to. I was so thrilled to see you post there and hope to see you back there again. We don't get enough visitors like that. Opinion there is probably more divided among the readers of that forum than you think; unfortunately, the anti-vaxers do most of the talking because the rest of us are routinely attacked.

About the aluminum and mice study - the abstract is there on PubMed, sure, but the study itself hasn't been published yet. So the anti-vaxers who are tossing around this supposedly slamdunk study with such confidence might just want to wait a few months until they actually read it for themselves.

10:24 PM

 
Anonymous Anonymous said...

Great post. Unfortunately, it is glaringly obvious that you are discussing the parenting board affiliated with a certain alternative parenting magazine. That said, I am on your side. I no longer post at that site at all due to the condescending meanness some members spout out in the guise of their P.O.V. In the vaccination board in particular, they preach all the time about being open minded but then have shut their minds to the pro vaccination pov so much that they resort to mean, sarcastic and disrespectful comments to weed out anyone who has something to say that opposes them. They ran me out but I am no expert on vaccines. It would be wonderful if someone like you returned to that forum and gave them a run for their money. Their research tends to be weak and based on poor reading of the literature. Or, it is based on conspiracy theory, paranoia, and beliefs like the vaccination industry is really undertaking a global effort in genocide to weed out the weak. I kid you not. This is a belief espoused at this site.

Please return to the site. We all know which one you mean. They deserve to have a knowledgeable doctor read the research correctly and talk to them accurately about vaccination research and medical science in general. Don't let them run you away.

12:43 AM

 
Anonymous Anonymous said...

Great post. Unfortunately, it is glaringly obvious that you are discussing the parenting board affiliated with a certain alternative parenting magazine. That said, I am on your side. I no longer post at that site at all due to the condescending meanness some members spout out in the guise of their P.O.V. In the vaccination board in particular, they preach all the time about being open minded but then have shut their minds to the pro vaccination pov so much that they resort to mean, sarcastic and disrespectful comments to weed out anyone who has something to say that opposes them. They ran me out but I am no expert on vaccines. It would be wonderful if someone like you returned to that forum and gave them a run for their money. Their research tends to be weak and based on poor reading of the literature. Or, it is based on conspiracy theory, paranoia, and beliefs like the vaccination industry is really undertaking a global effort in genocide to weed out the weak. I kid you not. This is a belief espoused at this site.

Please return to the site. We all know which one you mean. They deserve to have a knowledgeable doctor read the research correctly and talk to them accurately about vaccination research and medical science in general. Don't let them run you away.

12:43 AM

 
Blogger Couz said...

Thanks to those of you who posted supportive comments. I am well aware that it isn't hard to figure out what boards I was referring to (particularly after I mentioned one by name!).

I've come to realize that I am unlikely to fit in at the alternative parenting boards. I'm glad to hear that it's simply the vocal minority being so aggressively confrontational, because I suspected that not all anti-vax parents were anti-physician in general.

I am not an expert on vaccines. As I have pointed out previously, I am training to be an emergency physician. There aren't many specialties that have less to do with the administration of vaccines than emerg docs. I started looking into vaccination as a future mother (I hope!) rather than as a physician. And I have made my decisions regarding what vaccination schedules my children will follow. And I am happy with my decisions.

Remaining at these boards would mean either learning to keep my mouth shut when people post things that make my blood boil or actually taking the time to read every article and web site posted (as well as research the pro-vaccine side carefully enough that I am able to provide similar citations). And really, they won't care if I think their studies are flawed, and they will find some reason to discount mine.

I don't have the time or the energy to take on that kind of battle. And as I said before, I don't care if they chose to vaccinate or not. I will selectively vax my own kids and when our "mythical" herd immunity breaks down and outbreaks become more common, or when one of THEIR children develops a serious complication of a vaccine preventable disease, maybe they'll re-evaluate. And maybe they won't.

I'll learn which cloth diaper is the best in friendlier places. :-)

2:31 PM

 
Anonymous Anonymous said...

There is a difference with the pharma companies in the US and Canada.

I have a chronic illness and see my Drs more than most people. Everytime I am seeing on of my Drs at a local research hospital I see pharma reps with their bags heading in or out.

They sometimes give me pens, as they run into me on the elevators quite a lot.

They are great pens but Pharma reps do have more of a presence in our physician's offices than it seems they do in Canada.

I don't think an American physician could really say they do not. if they did, I wouldn't really believe them as I see the phrama reps and see them talking with the Drs and nurses.

I don't think it affects *my* perscriptions as mine are specific to my illness but I don't believe they could have so much presence and not have any sort of influence.

Perhaps you should ask American Drs about this.

8:44 PM

 
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6:36 AM

 
Blogger jokergirl said...

The sad thing is that these days, the skepticism goes both ways - i.e., a physician can't even start to research alternative therapy for fear of criticism and loss of face, and dedicated skeptics such as James Randi (who I rather respect otherwise) are using rather similar arguments as the people they are demonizing when talking about why acupuncture, chiropractics or the alternative treatment of the hour doesn't work. It's a sad time for good science...

8:11 AM

 

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