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Doctors dropping patients who will not vaccinate

On June 7, the Toledo Blade ran a story about a pediatrician’s office that has notified its patients that they will be dropped if they have not vaccinated their children by June 1, 2015. In a telephone interview on June 10, Examiner spoke with David L. Hill, MD, a Board Certified physician in both pediatrics and internal medicine who practices in North Carolina. The Blade article was the topic of the discussion and he gave his thoughts about the issue.

A dose of measles vaccine is seen at the Miami Children's Hospital on June 02, 2014 in Miami, Florida.
Photo by Joe Raedle/Getty Images

Actions like those taken by the Toledo pediatrician’s office have become "very popular" according to Dr. Hill. In discussions with colleagues about the issue of parents choosing not to vaccinate their children, doctors are finding it "very frustrating" to see science set aside and the specter of preventable illnesses returning. He notes that this approach is not what the American Academy of Pediatrics recommends.

Physicians, Hill believes, should be prepared to answer questions from their patients' parents. He finds that a "fair number" can be reassured about vaccines if the doctor listens to their concerns. Building a strong relationship with parents is important whether or not the final decision is to forgo vaccinations.

The body's immune system is "deeply mysterious" to a lot of people, Dr. Hill said. Most lay people conflate the number of shots that a child receives with the degree of immune activity that the child experiences. They are not related.

He stated that the measure of the challenge to the immune system is the number of antigens that the patient is exposed to. A cold, he explained, exposes a child to between 2,000 and 10,000 antigens at one time. All 18 or so vaccines which are recommended, if given at the same time, Hill said, would expose that same child to 200 to 230 antigens.

There are a small number of children who should not be immunized for medical reasons. Hill talked about children on chemotherapy for cancer. Vaccines that use live cultures, such as the MMR or the varicella vaccine are contra-indicated for those children due to their lowered immune system. He said that any pediatrician would know their patient's status and would not risk the child's health.

Ari Brown, MD, is Board Certified and a Fellow of the American Academy of Pediatrics. She practices in Texas. In a short message to Examiner on Twitter June 10, she used the term "vaccine hesitant" to describe the parents of some patients. Those parents need "reassurance by the MD." She states that doctors do have the right to protect their patients and deny care, as the practice in Toledo is doing, except in an emergency situation.

Both Dr. Hill and Dr. Brown are authors. Dr. Hill is the author of Dad to Dad: Parenting Like a Pro. Dr. Brown is the co-author of the Baby 411 series of books for parents.

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