Docs May Drop Patients Who Refuse Vaccines

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Docs May Drop Patients Who Refuse Vaccines By Steve Mitchellhttp://about.upi.com/products/health_business/UPI-20051003-034424-8197R UPI - More than one-third of pediatricians would cease providingmedical care to a family that refuses all vaccinations, reveals a new surveycoming on the heels of a warning by federal officials that a meningitisvaccine may cause a serious neurological disorder. In recent years an increasing number of parents have become concernedabout the side effects vaccines may cause in their children and have optedout of some or all routine childhood vaccinations. To determine pediatricians' attitudes about such parents, Dr. ErinFlanagan-Klygis of Rush Medical College in Chicago and colleagues surveyed302 physicians. "No one had really looked at this," Flanagan-Klygis told United PressInternational. "Our goal was to start a dialogue about the practice (ofrefusing care to families who opt out of vaccinations) and create anawareness of the practice." About 85 percent of the pediatricians responded that in the last 12months they had encountered a family refusing at least one vaccine and 54percent said they had encountered a parent who refused all vaccines,Flanagan-Klygis and colleagues report in the October issue of the Archivesof Pediatrics and Adolescent Medicine. The pediatricians said the mostcommon reasons parents gave for foregoing vaccination included concernsabout safety, philosophical reasons and religious beliefs. About 39 percent of the pediatricians said they would advise thefamily to seek medical care from another physician if all vaccines wererefused. Approximately 28 percent said they would stop treatment if thefamily refused some vaccines. This did not vary with age of the physician,their sex or their number of years practicing medicine. The reasons the pediatricians gave for dismissing the patientsincluded a lack of shared goals and a lack of trust between the physicianand the family. The findings raise important questions about vaccinations and othermedical issues, Flanagan-Klygis and colleagues wrote, such as whetherrefusing to provide care to families that opt out of vaccines might resultin certain children or groups not receiving inoculations. Another importantquestion is whether this behavior could lead parents to avoid seekingmedical care for other conditions. "Given the changing climate of confidence in childhood vaccination,future research should address these and other potential implications ofpractice dismissal in the face of parental vaccine refusal," the researcherswrote. "The answers obtained may provide insight into the influencephysician behavior has on the health and welfare of children and communitiesfor many years to come." Dr. J.W. Hendricks, of Pediatric and Adolescent Care LLP in Tulsa,Okla., wrote in an accompanying editorial that he handles the situation byhaving parents sign a form stating they have elected to opt out of vaccines,but he continues to provide care. "I feel a straightforward immunization refusal does not by itselfdamage trust, breach shared goals, or necessarily lead to a 'my way or thehighway' confrontation," Hendricks wrote. Flanagan-Klygis said she also thought it would be more advantageousfor pediatricians to continue to provide care for families. "As pediatricians, we're all committed to care of children and any waywe can continue that care would be best," she said. Dr. Edgar Marcuse, a professor of pediatrics at the University ofWashington in Seattle, told UPI he found it "disturbing" so manypediatricians said they would dismiss parents from their practice forrefusing vaccinations. Marcuse said pediatricians should instead work with families toaddress their concerns about the safety of vaccines. "We have to find waysto communicate with people whose perceptions are different from our own," headded. Vaccines can cause minor side effects, but most healthcareprofessionals agree the available scientific evidence demonstrates thechances of serious complications are extremely rare. In addition, thechances of developing serious complications from vaccines are much lowerthan the risks of severe illnesses and death from the diseases they areintended to prevent. The federal government's behavior, however, may have inadvertentlyfueled the vaccine controversy. The Centers for Disease Control and Prevention in Atlanta has refusedto make accessible its database of vaccine-adverse events -- the VaccineSafety Datalink -- to outside researchers, except under restrictedcircumstances. Several groups that question the safety of vaccines circulated apetition last year to open the VSL database to the public, charging it "wasbeing used by federal health officials to cover-up vaccine risks associatedwith mercury preservatives in vaccines." Although studies have failed to find a link between vaccines andautism, some groups have suggested the mercury-based vaccine preservativethimerosal could cause the mental disorder or other illnesses in children.Most childhood vaccines are now available in formulations that contain no oronly trace amounts of thimerosal. Last week the CDC and the Food and Drug Administration issued an alertto consumers and healthcare providers after five cases were reported ofGuillain Barre Syndrome in teens ages 17 and 18 who had received themeningitis vaccine Menactra, manufactured by Sanofi Pasteur. Guillain Barre is a neurological disorder that can lead to muscleweakness, paralysis and difficulty breathing. The agencies said they couldnot determine if the cases of the disease were due to the vaccine, but saidthey were investigating. FDA officials said they have not recommended any changes forvaccination. All five of the patients developed GBS symptoms that includedweakness or abnormal sensations in the arms or legs about two to four weeksafter vaccination. All were said to either be recovering or to haverecovered.