MOCK 18: Refusal to vaccinate

[Guest macdaddyeh]

I recently had a friend tell me this one came up in a discussion. I know interviews are winding down, but I thought this one "injected" (no pun intended) some serious ethical pondering. Actually, I think a similar topic may even be found somewhere on this post.

Here goes:

 

An increasing number of people are refusing to vaccinate themselves and/or their children citing that the preservatives are deadly, that it increases the case of SIDS, autism, or that it is simply unnecessary. Many say they are not doing it for religious reasons, but for "health" reasons, stating that they don't wish to be injected with chemicals. How do you approach this situation?

[Guest IRNBRUD]

Along the same lines...just wondering what people thought of the refusal of some healthcare workers to receive flu vaccines this past season.

I for one have never had a flu vaccine, have yet to be struck down by flu (despite some interesting communal living experiences) and am considered to be insane by friends and family due to my refusal.

Thoughts......

My own? I believe that it is one's right to make decisions regarding one's own medical care as long as one is considered legally competant and has made a well informed choice.

I wonder if the question is what is well informed in this case??

Nice topic.

IB

[Guest misagh]

As for how I would approach this situation as a health care worker, I would want to make sure the individual is not mis-informed about the risks and the chances of nasty side-effects. An effort must be made to make sure the person understands both the risks associated with vaccination and the risks associated with _not_ vaccinating. If, according to the physician, the risks associated with not vaccinating outweigh the risks of vaccination (or vice versa), this must also be intimated to the person. Of course, if it seems that the person is making a well-informed and competent decision ('competent' according to your professional judgement) to vaccinate/not vaccinate, despite the higher risk in doing so, then I suppose I would convey my disapproval in a professional manner to the patient but in the end respect their wishes.

 

The situation may change slightly if it's a parent who doesn't want their child to be vaccinated. I'm not sure if a precedant has already been set in this type of case. The way I see it, the same rules apply as above. If as a physician I see that there is considerable risk in vaccinating/not vaccinating, I may seek legal aid in securing a legal way to have the child vaccinated/prevented from being vaccinated.

 

A physician must do what is best for the patient, and as a physician I must make that objective clear to the parents and/or the person.

[Guest macdaddyeh]

Misagh:

 

You raised some interesting points. This topic piqued my interest even more because some (but not all) of my immediate family members are VEHEMENTLY opposed to any and all vaccination. Having discussed this with them, I am extremely surprised at their level of knowledge of both sides of the vaccination debate. Unlike what you posted, I think that people who are opposed to vaccination are even MORE informed than those who blindly accept doctor's orders.

 

I recall from my public health policy course that there are three types of doctor-patient models: paternalistic, shared and informed consent. The first simply doesn't hold any water any more; compliance and docility from the younger crowd especially is not typical (but hopefully respect for doctors still is:rolleyes .) More and more "patients" are entering the doctor's office with serious and specific demands and questions (this could be the subject of even nother post). My family members, for example, said they went to the doctor with CMAJ and New England Journal or Medicine articles in their hands to substantiate their points to the physician.

 

One family member even said that one of her doctors was "in the closet" so to speak in that the pediatrician was extremely opposed to vaccination and would always support a patient who came in and did not want to vaccinate; she just simply could not offer that option in the first place as a representative of the medical community.

 

One more note, in reply to your post, is that because withholding vaccination is not a life-threatening event to a child, physicians can not pursue legal action against a parent who refuses vaccination. You may think this is paradoxical, but it is even considered discriminatory under Canadian Law (if required, a parent simply signs a "conscientious objection" form to refuse vaccination). In fact, my hard-core family members have even told me that a patient can pursue legal action against a physician if that physician does not read the manufacturer's insert and/or record the lot number of the vaccine before pursuing vaccination.

 

My brother has been diagnosed as autistic. Within 24 hours of receiving the MMR vaccine, his demeanour, facial expression and vigour for life all changed..He was just over two years old (hence my intimate knowledge of all the foregoing issues).

 

In the end I'm neither for nor against vaccination; it must be an informed choice, and as you stated well, one must weigh the risks, both positive and negative and make the decisions for themselves and their children and their bodies.

 

Anyways, let's keep the debate alive!

[Guest dangrrgrrl]

I completely agree that the choice (either way) has to be an informed one.

In the case of children:

At this point in time, immunization is not mandatory (in BC anyway). Therefore, a parent--as long as they are informed--may refuse to have their child immunized. (We get a few of these). Public Health calls these people "conscientious objectors". Interestingly, I find that it is common practice for daycares to require immunization of their "charges".

[Guest misagh]

Wow, awesome points! Thanks for the info macdaddyeh

[Guest kellyl20]

healthcare workers in Vancouver also do not have to be vaccinated against the flu, however should these people become ill during the flu season and they were not vaccinated, they will not be paid during their illness from their sick time bank

[Guest Cosmo0]

In my opinion, vaccination is not just a personal yes/no issue where informed consent or consent is NECESSARILY needed. Its complicated by another issue; that of responsibility to society.

 

Issue 1: Person's right to control what gets into their body. As long as the person (or their guardian) is intellectually competent and logical, informed consent should be needed.

 

Issue 2: Herd immunity requires a minimum number of people (in the human herd) to be vaccinated to provide adequate safety against a communicable disease. Each one of us owes the society a contribution toward herd immunity to the "dangerous" pathogens. Such as isolating ourselves if we have contacted a SARS carrier. Otherwise there's no point to one or two citizens isolating themselves or getting vaccinated... might as well walk around exposing ourselves and others to these pathogens. As with SARS, law can be called to make someone (or their children) get vaccinated against their will!

 

However undemocratic it may sound, vaccination (even with force) may be necessary for those who don't weigh the risk of spreading measles, mumps or rubella to the society strongly against the MUCH lower (if at all proven) one of getting autism, arthritis, allergies... Again, only my opinion.

 

Interesting stuff.

[Guest peachy]

Cosmo, I think I don't get your point. People who choose not to get, say, the MMR vaccine benefit from the herd immunity of the rest of the population - they're unlikely to be exposed to mumps, cause everybody else is vaccinated. But how does that affect me adversely as somebody who is vaccinated? My risk of getting ill is not increased by the fact that they choose not to be vaccinated. Well, that's under two assumptions: First, that the vaccines are completely effective, and Second, that we don't expect to be able to wipe out the disease (like smallpox was) anyways. Maybe you don't agree with my assumptions.

 

On the other hand, I think it can be somewhat offensive that people choose not to be vaccinated - nearly everybody is willing to subject their children to the small risks and unpleasantness of being vaccinated. Then those who choose not to get the advantage of _my_ risks without taking any of their own. That's my understanding of the relevance of the herd immunity idea. And it doesn't seem fair, somehow.

 

That said, I strongly feel that people should have the right to refuse a vaccine. Not only because people should be able to make decisions about their healthcare, but because of stories I've read about families where, say, one child had a very strong reaction to a vaccine, and then the families were pressured by their doctors to have subsequent children get the same vaccines, with really bad consequences.

[Guest MayFlower1]

Interesting debate! I personally believe that individuals should have the right to choose or refuse treatment, given they're competent...informed...etc., etc. That being said, morally, and for the good of our species, all people should be immunized.

 

This isn't really related to the topic...but I find it amusing to think about when this discussion comes up. Do we REALLY choose to be immunized? Personally, I don't ever remember being given a choice...no philosophical or academic debate (I think I was quite young ) I remember walking into the doctors office...him pulling out the needle...me indicating in no uncertain terms I didn't want it...looking at my mother...her saying "You have to have it...it won't hurt) and then receiving my injection, of course, followed by what seemed at the time to be significant pain! Somehow, this doesn't seem like any kind of free choice :\

 

Choosing not to immunize, is quite an anti-social act. The reason our population becomes resistant to various diseases and reduces the frequency in the population IS because people have developed immunity through injection or being lucky enough to have developed "natural" immunity and lived to tell about it. People who don't get immunized in our society are very unlikely to get sick...albeit higher chances than me because I'm protected...as the rest of us are immunized...these individuals are riding on the back of the risk that we all took.

 

Do I worry much about this issue? Not really, as I truly believe natural selection will sort things out for the species one way or another

 

How would I approach this with a patient? I think the protocol remains consistent. First, develop a professional opinion...next, listen to the patient...seek to understand...there may be very simple things the patient is unaware of...there may be information they are lacking which enables them to hold the position they do...once you understand where the patient is coming from...(and assuming, of course they are competent)...I would present them with the full range of alternatives available to them...the the positive and negative consequences of each. I would then present to them, from a medical perspective, the bits that form the professional opinion...and then, finally, let them choose. My job as a physician is not to judge...it is to evaluate...educate my patients...ensure I understand their needs and desires...keep their best interests in mind and provide professional and high quality care, regardless of whether their decision is not in alignment with my recommendations. The role of a physician, in my opinion, is a facilitator of health...but only one part of the healthcare team (of which the patient is the CEO and major shareholder).

 

My 100 cents.

 

Peter

[Guest cheech10]

Peachy, if a small number of people refuse to vaccinate, that's usually ok, because it's unlikely that they will be exposed to the disease since everyone else is vaccinated. BUT you need a critical proportion of your population (quite high, too) to ensure that your population is not a potential reservoir for infection. And if you let a few people choose not to vaccinate, and many more follow suit, you lose this critical proportion of people vaccinated, and become susceptible as a population.

 

Vaccination is one of those cases where the good of the population quite clearly outweighs the risk to the individual, and it is our responsibility to respect the fact that if we want to be members of our society, it is our duty to be vaccinated.

[Guest peachy]

Cheech10, is that because (a) the vaccine doesn't work completely, so some people that are vaccinated will still become sick if they are exposed or ( because there is a high cost in treating those people who are not vaccinated and become sick?

[Guest Sil]

Although I agree that people have the right to refuse medical treatment, I really think that the majority of people that choose not to get vaccinated do so because they are misinformed. Some points to consider about vaccinations:

 

1. Vaccinations do not cause of autism. The latest study (quoted on time magazine recently) shows absolutely not correlation between vaccines and autism. We are talking large, very large multi site study. This study actually made the original pediatrician that linked autism and vaccines to go back and say that he had to admit that he was wrong. This is because autism is rare and diagnosed during the first year of life (rare because most of us do not get autism) vs most of us get vaccinated during our first year of life (when autism gets diagnosed). So it is easy for people to mistakenly correlate autism to vaccination.

 

2. Health care workers should get vaccinated not to protect themselves but the public. I would feel awful if I gave the flu to a patient receiving chemo. I would be responsible for their death. This goes for society at large we have responsibilities to each other, everywhere there are people immunocompromised and I really feel that if the vaccine is there, is safe and effective we should feel an obligation to protect others. And for those of you that have had the flu you know how awful it feels (had it only once and was that ever no good times!)

 

3. I think people have forgotten the horrors of illnesses such as polio. In the 50s they had entire hospital wards full of children on iron lungs that never, never got off them. The same goes for illnesses like small pox which had a case fatality of 50%!!! (if small pox was threat, I would definitely be getting that vaccine, not a threat right now so the risk of the vaccine is not acceptable). It is because vaccines are so successful that people now blame every ill they have on them. Yes you are unlikely to get polio in Canada (latest case in Canada was from a small religious community that refused to get vaccinated they had a case from abroad and that caused spread).

 

4. Now think of the fact that if you live in a large multicultural city in Canada (Toronto, Ottawa, Montreal, Vancouver, etc), there are immigrants and refugees that arrived daily, if they carry and awful disease like polio or mumps or rubella and you get it you may end up paralyzed or dead (polio), sterile (mumps) or with a child suffering from a severe disability (rubella). All these things preventable.

 

5. In Australia there was a large anti-vaccination groups that lobbied the government successfully to halt vaccinations against H. Influenza (a bacteria causing croup in young children). During the first year that the vaccination project was off , about 20 children died. 20 children may not be much but unacceptable when we have adequate prevention for these illnesses.

 

6. The only good reason that I see for people to refuse to get vaccinated is that they are allergic to some component of the vaccine.

 

All that being said I do believe in informed consent and the right to refuse treatment but I have a very pro-vaccination stand on things

[Guest Sil]

Peachy:

Some people that become vaccinated can still develop the illness. We were adviced to think really hard about the specialty we want to go into (ie choose something that does not require you to do invasive procedures) if you were unable to develop antibodies to hepatitis B.

[Guest macdaddyeh]

Sil:

 

Thank you for making that final addendum. MANY people still become ill with X illness even after being vaccinated (chicken pox (varicella) is a typical case in point). I have also heard of a number of people (because I have lived and worked extensively overseas) who have also become infected with hep A (not despite being vaccinated. So again, thanks for noting that people do indeed get infected with a strata of illnesses that they were supposedly vaccinated against (the odd one even gets infected right away as a result of the vaccine).

 

A bizarre case to reinforce this point is when I accompanied a friend who was thinking of putting her friend in day care and she inquired as to what the procedure was for vaccine refusal--the day care replied that it was fine but that her child would not be allowed to come to school when there was a "vaccine-preventable illness outbreak." Alarm bells went off in my head (and I hope in the readers head too). That really piqued my interest..Aren't vaccinated children supposed to be protected from illnesses for which there are vaccines? How would the unvaccinated child, then, be putting other children at risk, as the day care rep. stated? This event, coupled with my autistic brother and MMR, have really piqued my interest in the vaccine debate.By the way, is there really such a thing as a "safe" and "effective" vaccine as Sil stated? Again, I'm neither for nor against, but I've really struggled with this notion of safety and effectiveness!

 

Concerning your note on polio, some family members recently told me that Salk or is it Sulk? who invented the polio vaccine admitted on trial that the live polio vaccine has actually caused more cases of polio than it prevented (because it was a "live" virus).

 

Concering your note on autism, this is the only one that really gets me ticked in general. YES, there is a correlation. How can there not be? As you read the TIME article, so did I--what is fact is that the autism rate has exploded over the last decade. Isn't it a wee too coincidental that those children who were willingly vaccinated with MMR (not any other vaccine-JUST MMR-came down with autism?) I don't necessarily believe there is a conspiracy theory here, but something doesn't seem right. Of course it is in the best interest of the "researchers" to claim there is no link. You may recall this was "substantiated" through a research team at Harvard if I'm not mistaken.

 

Moreover, who is funding the vaccine "research" (dare I call it that) is the bottomline question (Does the Oliveiri scandal sound familiar? How about David Heeley? Erin Brokovitch ring a bell?). These are all cases of exposed companies acting ONLY in the corporate interest (any course in public heatlh policy or medical ethics or medical anthropology would concur with this analysis). Vaccine companies make more money annually than the GDP's of some nations!!! Please tell me you don't actually think they have people's health in mind! I was in the doctor's office recently and was shocked when a pharmaceutical rep came in unnanounced and left a number of "free" samples of product X with his business card and a big poster with leaflets for customers and a wink-wink standing for "we'll be in touch." (these types of unethical drop-in dealings have been outlawed in some places in the US). Profit and health do NOT work well together. Has anyone read the work of Devereau et al from McMaster? How about Dr. Michael Rachlis?

 

Yet another case in point is that at the beginning of this school year, I received a letter from my university urging me to "protect yourself against meningitis for only $90." What do I pay taxes for? What do I pay tuition for? If the university administration (and by extension, the ministry of health, was that concerned about my health then why am I paying for it?) I fired off a letter and a big no-thanks! By, the way, in Ontario if you're "behind" on your HEP B shot, you must also pay!

 

Finally, I disagree entirely with you, Sil, that the unvaccinated population are ignorant or misinformed (most of my family are college and or university graduates -some at the masters level). Many would say that they are not "anti-vaccine" but that they are pro-information, and they typically believe doctors wield too much power, are extremely ill-informed on the role of nutrition in health maintenance (and I sadly agree, having seen a number of horrible med school curricula) and they believe ultimate decision-making authority must lie with them. The only thing that has really irked me is the information that doctors consistently fail to tell patients; ie. this vaccine was prepared using chicken or pig embryo (try telling that to a vegetarian or a muslim) among a whole other host of factors that many consider to be extraneous but aren't.

 

Again, I am not anti-vaccine (I wouldn't make a very effective doctor if I was). A friend of mine nearly died after getting tetanus from drinking from a mountain stream in South America (by the way, you CAN'T get tetanus from stepping on a nail, etc.) Nonetheless, I will definitely inform every single patient of the "purported" benefits as well as the dangers, and yes there are dangers--let's not romanticize vaccination-- of receiving a vaccine and not ignorantly tell them that it is the best thing for them and the public.

 

Anyways, I'd still love to hear more about hits hot-button issues, especially from both sides!

[Guest Biochem10]

The only thing that has really irked me is the information that doctors consistently fail to tell patients; ie. this vaccine was prepared using chicken or pig embryo (try telling that to a vegetarian or a muslim) among a whole other host of factors that many consider to be extraneous but aren't.

 

Macdaddey, I must disagree with you completely on this. I don't believe that patients need to know the way a vaccine is made because as advocates of health Doctors are not trying to convince their patients NOT to get vaccinated. There are certain things that patients don't need to know for the sake of public health and this is one of them. If a vegetarian or muslim was extremely concerned, then they could go out and research this information on their own, I wouldn't provide it, unless it was specifically asked by the patient. I think the only obligation the doctor has is to provide the risks and benefits of the vaccine and that should be enough for the patient to make an informed decision.

 

I also wanted to add that I don't know much about the autism studies, but I think it's really too early in the research phase to say that there's a direct linkage between vaccines and autism. I think that there has to be more research done to investigate the possible causes of autism since autism is a fairly new illness (around for awhile, but not fully recognized as an illness). Obviously someone in your situation might not want their children to be vaccinated due to having a brother with autism, but it should also be stressed that autism is a rare disorder and most of the general population is vaccinated--so a physician might want to inform there patient that there is an unknown and very small risk at developing autism. The doctor definetly doesn't have an obligation to discuss this risk, since it hasn't been proven, but should the patient ask they could mention that if it is a risk, it is small.

[Guest Sil]

I will like to make a longer reply but I am on my way out. Yes the cases of autism have exploded over the last 10 years. Why? Becuase we are diagnosing more people. Pleople who in the past would otherwise be labelled weird are now being dianosed as high level autism. This people work and learn amongst us. They have problems relating to other children. They can't understand social clues. Different criteria incluce children with other symptoms = explotion in children labelled as autistic. Once you are med school you will see that medicince is based on evidence, you can't base your practice on hearsay or anecdotal evidence because that is no longer medicine.

 

And yes the last case of small pox in Germany killed 6 our 19 people vaccinated (so case fatality of 30% not 50% compared to without vaccine). So although vaccines are not 100% proof they are better than taking chances (when I don't really need to).

 

The salk vaccine is not recommended for people suffering from HIV as they are immunocompromised and the attenuated virus may still cause trouble in them (also not recommended for other people that are immunocompromised). But the WHO recommends vaccination worldwide, who do I believe more jon smith truth on vaccine website? or the WHO (reputable institution who often trashes pharmaceutical companies for their policies on AIDS in Africa), and I will go with the WHO anytime. By the way because our chances of getting polio are so low (due to the fact that there has not been a Canadian case in years), we now opt for the safer fractionated vaccine (nothing live in it but not as effective as the salk).

 

Yes vaccines are highly effective in preventing disease as one family doc told me he lost $5000 on revenue the year that flu vaccines became free of cost in Ontario. I think that there are pharmaceutical companies working on vaccines, but so are people working for health canada (like some of my profs trying to design vaccines that will be incorparated to foods, especially good for third world countries as they will not need to be kept frozen, etc). It does not mean that because you work for a pharmaceutical that makes you bad. These people truly believe that they are making the world a better place (prolonging life, decreasing mortality). From epidemiological studies one of the things that have been more effective in preventing childhood related death are vaccination programs.

 

I once had to treat a child with something that looked like flesh eating disease a bacterial infection due to complications of chicken pox. If I ever had doubts about vaccinations I no longer do. After the doc was done debulking, I could see this child's tendons, and muscles, and how much plastic surgery he actually needed. So chances of dying from chicken pox perhaps 3%, severe complications 5%, getting it back again as the shingles 10% (some cases end up with sever neurolgical impairments). Chances of dying from vaccination to chicken pox 0.01%. While I am making all of these numbers up, they do reflect some of what I saw while studying vaccins the risk of dying from the vaccine is usually 100 times less than risk of dying from the illness.

 

However, I do believe that if after hearing the information you choose not to become vaccinated then you know your risk and the choice should be yours.

[Guest cheech10]

Just a number of points that I want to address:

 

Peachy - Population-wide vaccination is important because it reduces health care costs related to these illnesses, and helps prevent the exposure of unvaccinated individuals to these illnesses. Also, yes, some people who are vaccinated do not develop large enough antibody titres to be considered immune, and these people are at risk of developing disease. The key is that not getting vaccinated is a danger to others, since you are a potential reservoir of infection, thus I feel that vaccination is important.

 

Lets not forget that vaccination is the ONLY method we've developed to eradicate disease (smallpox, more recently polio - though I'm not sure if the WHO has recognized polio yet since not that long has passed).

 

Vaccinations MAY in part be responsible for the increase in many auto-immune and hypersensitivity reactions (eg. allergies). Current thinking in immunology is that decreased levels of bacterial infection (through sanitation, antibiotics) and vaccine usage (mostly using humoral immunity rather than cell-mediated immunity) have pushed us toward more antibody production and away from cell-mediated immunity, contributing to hypersensitivity.

 

I totally agree that health-care workers should be immunized to protect the population they work for.

 

macdaddyeh - Your example of the varicella vaccine not being effective is interesting. It is only 85% effective (source: CDC) but is also a new vaccine without a large base of vaccinated individuals, and a huge reservoir of infection since most adults have been exposed and carry the virus for life, where it can reactivate. I expect that as more people get vaccinated and the pool of infected individuals gets proportionately smaller, the effectiveness of the vaccine will rise.

 

Also, vaccines are safe and effective. Safe because their side effects are in the vast majority of cases mild, and much more pleasant than the disease, and effective because they have drastically reduced the incidence of immunizable diseases. Despite this, no vaccine is 100% safe or effective, but since we don't require this of ANY of our current medical treatments, how can we hold vaccines to this standard?

 

The Salk vaccine (when properly produced) has not caused any cases of polio since it is NOT a live vaccine (that's the Sabin vaccine). There were some cases of faulty vaccine production that infected about 200 people, but since then things have been ok. The Sabin vaccine has caused some cases of polio since it can revert to wild-type polio, but these are few and certainly much lower in incidence than the original incidence of polio was even in the 50's.

 

You can most definitely get tetanus from stepping on a nail or any other very deep wound (since tetanus is an anaerobe and needs deep wounds for protection from oxygen). It is quite a common organism, in the ground especially. You may not get tetanus if the nail was not colonized by tetanus bacteria.

 

By the way, much of this info is from my undergrad immunology degree, not from "horrible med school curricula" (which I take issue with, since we did have a number of nutrition lectures, and an entire course devoted to community health, prevention, etc.).

[Guest macdaddyeh]

Sil:

 

Thank you for your prompt and informative reply. The only thing I could possible take issue with is your stand on the useless World Health Organization. Any critical political science or anthropology course might look at the power dimensions that this parasitic organization maintains. Like most of the UN, it just serves to perpetuate the very "problems" it purports to be alleviating. Having a thorough understanding of that apparatus via my undergraduate education which focused on international affairs permits me to provide such an analysis. More specifically, I refer you to the following article which you might find informative:

 

reason.com/0201/fe.bd.who.shtml

 

If you want something more academic or "evidence-based" you could find a number of articles as well.

 

Cheech10:

 

First, I appreciate your input from an epidemiological perspective; it was very informative and reminds me of my undergrad epidemiology course. Second, I should have qualified my statement that tetanus can not be found on a rusty nail. Essentially, as you know, the bacterial organism, clostridium tetani, is found in the intestinal tract of most animals and the spores persist in the environment when the animals poop; therefore, it is typically uncommon to get tetanus from a rusty nail except in the event that an animal's poop has been in contact with the nail. Your note on tetanus thriving in an anaerobic environment is particularly relevant.

Third, I still find the fact that you receive "a number of lectures in nutrition" to be very disconcerting and disheartening. This is not a slam to the U of T curriculum; it is universally appauling! However, we are all pursuing a career in allopathic medicine and let's get real--we all know that allopathic medicine supports drugs first and foremost; nutrition is considered to be extraneous and the poorer cousin. I doubt that most doctors tell people with cancer to start eating right; although that is PRECISELY what they should be doing, they would get laughed at all the way to the loss of their license.

 

Finally, whoever rebuked my comment that you should fully disclose the ingredients of a vaccine is a lawsuit waiting to happen! Again, you are assuming that the client is fully informed and as Mayflower said, the foremost role of a doctor is to be a facilitator of information (not a colonial aribiter of the "truth.") This also makes the doctor appear to be omniscient, ompnipotent or conversely, arrogant and stupid!

[Guest Biochem10]

Macdaddey,

 

Actually I said that comment precisely because I am in the midst of reading a text on the Principles of Biomedical Ethics. According to our text (which is used at most medical schools), the doctor does not have to disclose this type of information unless it is explicitly asked by the patient. There would be no grounds for a lawsuit for not disclosing this information and it would just discourage healthy individuals from becoming vaccinated. Therefore the benefits to the public outweigh the rights of disclosure (again, I reiterate, unless the patient explicitly asks "how is this vaccine made")

 

Of course, this is all theoretical, may be a med student can clarify.

[Guest cheech10]

Macdaddyeh,

Although good diet may delay/prevent the onset of cancer, once it has begun, I don't know that diet would help at all. If you have any studies, I'd be interested in reading them.

 

Preventive medicine and healthy lifestyle promotion is a very important and potent technique in medicine today, and I don't think anyone disputes it. However, I think you are being a little unfair in criticising medical school curricula in their teaching of it. My experience so far has been that it was taught and given some emphasis, although granted not enough relative to its importance. I think the bigger problem is systematic and lies with our practice patterns and is reinforced by our fee for service payment model. The fact is that prevention takes too long to be effective, is not remunerated well, and has huge problems in compliance (even less than the often quoted rule of one-third). Recall an earlier post that flu vaccines cost a physician $5000 in revenue. The lost revenue indicates that his patients were healthier this year, but instead of rewarding this physician and the vaccines, the lost income is lamented. It is these aspects that I think should be addressed to allow physicians to focus more time and resources on prevention, not medical school curricula.

[Guest macdaddyeh]

Biochem:

 

First, that sounds like an interesting course (or an interesting book). I think I would really enjoy a course in bioethics. The only thing I have to add to your point is that such a situation as you posed concerning vaccination ingredient disclosure seems incredulous.

Forget the old adage "what you don't know can't hurt you" because indeed it can physically, emotionally and financially, etc. I believe in absolute, full, critical disclosure--ie. you know everything so as to be informed, and thereby empowered as a patient, not a passive recipient of information. If the patient is considered a client, consumer or customer and not just a patient these days then this relationship warrants full disclosure. That's like a doctor saying you "might" be pregnant or I know you have cancer but you don't need to know all the details. No wonder vaccine critics are so informed--I've been innundated by my family of the littany of ingredients that is in them (ie. formaldehyde, thimerosol, bovine, fetal cells, gelatin, and the list goes on and on and on and on--and can be substantiated by vaccine inserts and medical literature). Now, before I look like some anti-vaccine freak, I have had every vaccine imaginable, having travelled to remote and risky places. Time and again, doctors have told me that vaccination according to *risk* is the key--there IS such a thing, therefore, as unneccessary vaccination if you do not have a risk. I would find it extremely unethical therefore giving a patient vaccine advice about something I don' t think they necessarily need, and moreover not telling them what is in it. We med (and premed) students are very critical thinkers, so let's get real and think patient-first (and your own possible litigation proceedings from failing to tell that strict vegan or member of religion X that their were some ingredients they might consider questionable in their vaccine).

 

Cheech10:

 

I concur entirely that prevention is the key in anything we do in medicine; it is still however very unfortunate that nutrition and non-chemotherapy management is underemphasized. Let food be thy medicine was one of the early principles of "modern" medicine! Kudos for questioning the FFS structure as well; I think it's time to get rid of that too (but that is another discussion).

 

 

Finally, just as I think any premed or med student should (ideally) take an undergrad course in immunology, for example, so too should every aspiring physician (and current physician) take a course in medical anthropology so as to understand where I have learned some of these notions of power and resistance that are often taken for granted by the biomedical apparatus...how medicine treats women in labour (sexist term) and delivery (as if the doctor does all the work and thereby gets all the credit) is yet another subject that we could examine later...

 

I love this engaging debate; the procrastination, however, is killing me!

[Guest peachy]

Macdaddyeh,

 

I totally agree that patients should be fully informed about what is going on with their medical treatment. But (in my opinion) believing that doesn't eliminate the need for doctors to make intelligent choices about what to tell their patients, rather it makes the choices all that much harder!

 

Doctors spend many years learning their craft. When treating a patient, they can't possibly tell them everything about their treatment - besides the fact that there isn't time, there is no way that a patient can possibly put every piece of information into perspective. I don't need to know exactly what's in a vaccine (nor in any other medication!) I need to know what the relevant risks are. Telling me that there's mercury in my vaccine is WAY too much information, and is going to scare me unnecessarily. It's not going to help me to make an informed desicion, becuase as a layperson, I don't really know what it means for mercury to be going into my body, other than that it's "bad". I (not as a well-informed pre-med university student, perhaps, but as a random patient) just don't have the background to be able to intelligently weigh the risk of mercury exposure against the risk of getting ill. Telling me that studies show that there's a 0.1% risk factor is information that I can use, on the other hand.

 

I mean, should my doctor identify for me whether there was animal testing done on whatever medication I'm going to be taking, every single time I'm prescribed medication? That seems to me to be a huge waste of time with information that's not particularly relevant. I don't see how that's different from whether there are animal products inside vaccines. If somebody is such an animal rights activist, then they are likely to find out that information for themselves.

 

It's the job of my doctor to inform me about my treatment by condensing the information into something that I can understand and put into perspective - listing the ingredients in a vaccine, imho, is NOT something which meets these criteria.

 

peachy

[Guest Biochem10]

Peachy, that's exactly what I was trying to get at. Not all individuals are interested in the ingredients of a vaccine and therefore unless it specifically imposes negative risks to the patient, these ingredients do not have to be disclosed. Some patients would prefer not to be informed at all. One of the most interesting things I have learned in my course is that respect for autonomy means having the choice to be or not to be informed of certain risks etc. So, a patient may autonomously choose not to know certain things because they may negatively affect him/her. For instance, suppose you disclose the ingredients of the vaccine to a patient and then that patient gets the vaccine and experiences some side effect. That patient may start to worry that this side effect is attributed to some ingredient, when in reality it may not be, this negatively affects the patient in terms of stress, anxiety, etc. Just my opinion...

[Guest Sil]

We could engage forever in talking for or against the WHO. I think they try to do a pretty good work (eliminated small pox, trying to eliminate polio, discuss policies regarding not only vaccinations but good health in general). Obviously you have your own believes in things and I am not going to change them. The only thing that I would add, is that the things that are added to vaccines are not dangerous to people in the dosages given to them, so reciting this ingredients would add nothing to the care I would give my patients (unless they are allergic, as I have already said). Once again a very wise old saying it is the dose that makes the poison.

 

Can you imagine if you added the following every time you gave your patient a pill: here is your heart medication, in order to keep it fresh we have added some preservatives (thimerosal, perhaps), we extracted part of this pill from pig or cow and this drug was extensively tested on guinea pigs, rats, dogs, and some monkeys (if you are a vegan please do not take as you would be insulting your believes, although without it you may die). Most patients would not care and it would make all consultations very long. What would be expected is that you say I am giving you this heart medication because I think I will solve problem X, this are the common side effects, these are the serious side effects, this is the dosage.