Informed choice

Over the past several years, immunizing children has become a hot topic of debate. Many physicians, pediatricians in particular, strongly support vaccinations to curtail the spread of serious diseases. For some parents, though, the risks associated with vaccines serve as a deterrent.

Pediatricians tend to go with the preferences of parents. They just want parents to make informed decisions—not in reaction to sensational media reports, but based on respected scientific research.

One pediatrician with the power to do something about this is Dr. Richard Pan. Pan is a Democratic Assemblyman from the Sacramento area. He authored Assembly Bill 2109, which would permit parents to opt their children out of vaccinations, but only after receiving information about benefits and risks from a health-care professional.

AB 2109 passed the California Assembly and is working its way through the Senate. Among the leading dissenters is North State Assemblyman Dan Logue, a Republican who called it a “nanny state” measure. As Logue explained to television station KQED: “We tell you how much salt to put on your food, what kind of light bulb you should screw in your lamp. The people of California are fed up with a state government that thinks it can run our lives better than they can, and enough is enough.”

Dr. Eric Neal, a pediatrician in Oroville, isn’t necessarily a fan of government mandates, either. However, he supports AB 2109.

“As much as I don’t like government telling us what to do, I think it’s being done for the right reason here,” he told the CN&R. “We’ve had pertussis outbreaks from people not being immunized. We’ve had measles outbreaks in inner cities from people not being immunized.

“I think immunizations are going to go up [as a result of AB 2109] without a mandate requiring people to get immunized.”

The particular mandate in AB 2109 involves counseling—something most parents receive anyway from their children’s doctors. Neal and Dr. Maria Alice Alino, another pediatrician from Oroville, are among the physicians who make counseling a normal part of treating their patients. In fact, for the past decade, both pediatricians have required parents to sign a waiver if they don’t want their children immunized.

So, in a way, AB 2109 is putting a common practice into widespread practice.

“I can’t speak for every pediatrician,” Neal said, “but for the most part that’s true. If a parent has questions, part of our job is to counsel them and let them know the facts.”

Fact is, from his perspective as a science-based physician, “vaccines do work. If we didn’t have vaccines, people would still be in iron lungs from polio. While there are side effects for some of them, the benefit of vaccines far outweighs the risk of vaccine reaction.”

Parents who oppose vaccinations get their information from a variety of sources. Both Neal and Alino attempt to ascertain those sources when speaking with parents.

Some parents have a religious basis for opting out of immunizations. In that case, Alino told the CN&R, she doesn’t have much to say in response because “it’s like challenging their faith.” Philosophical reasons are easier to discuss, as are reports in the media and posts on the Internet.

“If I’m pretty sure they heard something on TV, and it’s from a misguided physician, you have to use science [in counseling parents],” Alino said. “If it’s from an actress in Hollywood, you have to talk personally.

“I am a parent, so I tell them my opinion as a physician and a parent. They ask me, in my heart, what would I do? I tell them, ‘You know what? I vaccinate my kid. I only have one kid, and I can’t afford to make a mistake.’”

Still, some parents elect not to get their children vaccinated. Both Alino and Neal respect that decision, even if they disagree with it. That doesn’t mean they’ll stop asking, however.

“Some physicians feel very strongly about not giving vaccinations; they will dismiss a patient from the practice,” Alino said. “I don’t.” (Nor does Neal.)

“I feel strongly about immunizations,” she continued, “but what if they change their mind in the future? I don’t want to punish a patient because of the parent.”

She also is willing to let parents opt out of specific vaccinations—picking and choosing off a list.

As for pediatricians who do dismiss patients who won’t be immunized, “I don’t scold them for that,” Alino added. “It’s their principle.”

Both Alino and Neal refer parents to trusted resources. Alino is partial to the American Academy of Pediatrics (AAP)—the source of her and Neal’s waiver sheets, as well as a recommended schedule for vaccinations. At their separate practices, they hand new parents an informational packet on various vaccines.

Alino also steers parents with questions or concerns to the AAP site (www.aap.org). “If it’s between me and their Hollywood doctor, I write down ‘American Academy of Pediatrics,’” she said. The Centers for Disease Control and Prevention also has good resources, she added, “but if they don’t trust the government, AAP is an academy run by pediatricians.”

Like Neal, Alino says she supports AB 2109—“It’s essentially what I’ve been doing anyway.” Neal said he appreciates talking with parents about vaccines, and if they decide against immunizations, “I’m OK with that, as long as they’ve made an informed decision.”