Tuesday, June 26, 2012

Anti-vaccine Sympathy

Sometimes I will hear other mothers (usually online) freaking out about vaccinations. Here are some of the comments I've heard recently about vaccines:

1) Worried about autism (despite study being discredited)

2) Want to spread vaccines out, not give them all at once

3) Want to skip certain vaccines (usually varicella) since the diseases aren't actually that harmful

4) Want to postpone vaccines

5) Angry and distrustful of doctor for not knowing all inactive ingredients in a vaccine

I read these comments and I just feel frustrated, both as a mother and a doctor. How could these mothers be so stupid? So selfish? Don't they realize these vaccines are safe? Don't they realize the only reason they can even contemplate skipping a vaccine is because the rest of us "risk" our kids? Don't they realize that the kids who can't be vaccinated or do not achieve full immunity are at increased risk because they fail to vaccinate?

Of course, when I'm at the doctor, waiting for my child to get her vaccines, the thoughts in my head are very different:

"OMG, what if she gets a reaction to these vaccines? What if she gets a fever and is awake all night? What if she's cranky for weeks? What if they KILL her?"

"She's so small... maybe we should postpone the vaccines till she's older."

"Why do we have to get so many vaccines at once? This is cruel and inhuman. Maybe we can spread them out?"

"OMG, what if she now becomes autistic??????"

Ultimately, we always get the vaccines. But I do believe most mothers feel that fear when our kids get their shots. That's why I'm sort of resentful of moms who can't man up and go through with it.

38 comments:

  1. It's hard to watch your kid get stuck multiple times with a needle when they go to the doctor and then watch them cry. It's also hard to watch them cry when they come home because their little legs hurt and they don't feel good. Lots of things about being a parent are hard. Just because it doesn't "feel good" to you as a parent, doesn't mean it's not the right thing for your child. I'm with you, Fizzy -- MAN UP, PARENTS!

    (Ok, off soapbox now.)

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  2. I found this post annoying. Exhorting parents to "Man up" is not very helpful, as this is not about cowardice. I work in health care, and I am not anti-vax. I encouraged my adult son to vaccinate his child, but I understand why they chose to implement an alternative schedule. One of my own children had an intense reaction to his first DPT. Within a few hours, the injection site became red and swollen; and my son spiked a fever and screamed inconsolably for many hours. I chose to have the rest of my children start that vaccination series later, at 6 months rather than 2 months. Though none of them had a bad reaction to the vaccine, I believe it was sensible not to expose a 2-month-old to the risk of a high fever. You may disagree, but perhaps we could disagree without the condescencion.

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    1. As a pediatrician, having watched young babies die or be severely brain injured from pertussis, pneumococcal meningitis, and HIb infections, those early vaccines are exactly the ones I would NOT delay. See this heart-breaking story from a mom trying to raise awareness about pertussis for idea of how terrible this disease is in infants (http://kennethaskorner.weebly.com/)

      These disease are still not uncommon, and young infants are at particular risk of serious outcomes. With my children, I breathed a sigh of relief once they got those 2 month shots in and had at least some protection (although, yes, I was still scared of febrile seizures, autism, the whole nine yards).

      Delay the IPV or Hep B, but don't wait for DTaP or prevnar! It is NOT a sensible choice just to avoid a fever. Also, you should know that the risk of high fever with DTaP is lower now than it probably was when your son got the DTP as an infant.

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    2. The pediatrician said it all. When many parents reject vaccines or want them on a different schedule, often they do so without thinking about the reasons why this schedule is encouraged in the first place.

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  3. FOr us, it is an ethical issue. Many of the vaccines are created from aborted fetuses. Since we are pro-life, we aren't comfortbale with this practice. So, we have taken the list of vaccines that are made from this method and weighed the risk of the disease. The only vaccine that we have refused is the chicken pox. It isn't about manning up.

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    1. Your comment implies that little baby fetuses are ground up in the vaccine slurry and injected directly into babies. That is NOT the case.

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    2. Great idea, skipping out on the chicken pox vaccine. I mean, we all got chicken pox, so what's the difference, right? And either way, your kid will be protected by herd immunity.

      Except it's entirely possible or even likely that in 30 years, your child will visit you while *your* chicken pox has reactivated as shingles. She'll get exposed and since she was never vaccinated, get a severe adult-case of chicken pox, and end up in the ICU or worse. Hope it was worth some theoretical moral issue.

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    3. As a pediatrician who watched a completely normal 5 year old girl struggle with her fight to live for weeks in the intensive care unit due to varicella (chicken pox), i find it increadibly frustrated that people think that chicken pox is no big deal. Varicella Encephalitis and Pneumonitis is serious stuff. I just don't see WHY RISK PUTTING YOUR CHILD IN THAT SITUATION - INTUBATED AND COVERED IN OOZING PUSTULES AND RIDDLED WITH SEIZURES. Regular chicken pox isn't harmless.

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  4. I'm not against this post, but I will say that I am a resident in Family Medicine and I have not yet vaccinated either of my sons against Hep B (yet). I feel there is NO reason in a Hep B negative mom to give these kids this vaccine at the times they are given except that they are getting other shots on that schedule. Last time I checked, my 2 month old wasn't having sex or injecting drugs. I don't think that I will ever give my kids the Hep A vaccine- the vaccine market is just like the drug company market- if you can make a vaccine, they market it as much as possible. The disease burden of Hep A isn't enough to justify giving that shot to them in my mind. Honestly, I've contemplated not doing the polio vaccine-- except that they may want to travel some day to a place where it is endemic. It's GONE in our country, so why do the IPV? I think we should be open-minded and at least listen to reasons why to change the vaccines given instead of being off- putting and automatically dismissing parent reasoning. I often recommend not giving BOTH MMR and Varicella at the same visit (12 months) but do delay one to 15 months (provided the parent will follow-up) b/c these are two live-attenuated and NEW vaccines to the child. When they still used MMR-V in one vaccine, there was a statistically significant increase in febrile seizures (but not when given in 2 shots on the same visit) but still, I think separating them is wise.

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    1. I actually saw a teenager on my rehab unit who was a quadriplegic from polio, having been exposed to someone from another country. And since the vaccine is so risky, I'm sure he forgives his parents for not vaccinating him.

      You say that separating MMR and varicella is "wise" but admit that it doesn't increase the risk of anything. So why is it wise? I agree that it's important to listen to parents' reasons for wanting to separate shots, that it helps you build a relationship and trust, and I'm sure it makes absolutely no difference if one is given at 15 or 12 months. But I think we need to be honest with ourselves if we're doing this for a medical reason or for the parents' peace of mind. If we're doing it for peace of mind, fine.. that's important too. But be honest, at least with yourself!

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    2. Interesting to know about your teenage patient. I have given my kids the IPV- I just mentioned that I had thought about not giving it- and I never recommend to patients NOT to get it. And, you are right. The burden of the disease is much worse than the risk of the vaccine). I'm sorry if I had a tone in my post that put you on the defensive and caused you to feel that you needed to use sarcasm in the phrase about forgiving his parents.

      Anyhow, you missed the reason why I said it was wise to separate the MMR and Varicella- it is that they are two new vaccines to the child and they are both live attenuated.

      Also, I NEVER recommend skipping or eliminating a vaccine to my patients without them bringing it up. The farthest I ever go is to occasionally mention the MMR/varicella thing IF I know they are reliable parents. I feel that part of being a parent is having a stake in what you want to do for your child's health- they have some responsibility too in having some concern/knowledge of the vaccines, and wanting to ask questions about them.

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    3. I apologize for being sarcastic. As I'm sure you know, vaccine talk brings out a lot of strong emotions. I was just surprised to hear that kind of talk from a doctor.... you're the first doctor who sees pediatric patients I've ever talked to who wasn't vehemently in favor of vaccines. Most pediatricians have seen enough bad outcomes from preventable illnesses that they feel very strongly about this topic. Even I see it and i'm not a pediatrician.

      I didn't miss the reason why you said to separate MMR and varicella. I understand that they're both new vaccines and both live attenuated, but what I'm asking is what is the evidence that this is dangerous, other than your gut instinct? And why does your gut instinct overrule the recommendations of AAP? Mumps, measles, and rubella are all live attenuated, and are given together. So what makes it okay to give three at once, but not four?

      I've heard about chicken pox outbreaks in my area. If my baby got chicken pox at 13 months old and had a bad outcome, I'd feel awful. Is that likely? Maybe not. But probably more likely than having a bad reaction from the vaccine at 12 months but not at 15 months.

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  5. Calling these mothers (myself included) selfish, stupid, cowards probably isn't going to get much accomplished. Bullying and shaming a patient into any medical decision also doesn't seem very sound.

    Educate the parent, respect the parent and work towards a solid relationship with the parent. Through plain terms explanation and patience, I think you'll find parents are more receptive.

    We are on an alternate vaccinaion schedule. At almost 3 years old, my son is healthy and thriving. He has not infected anyone. He has not died. He has not received MMR or rotovirus. For us, the rotovirus was ridiculous. And we have close friends whose child is extremely ill because of the MMR. I am not a coward because I don't want to see my child endure the horrible lifestyle this young lady endures. I am not stupid because I would rather treat my child for dehydration than a flipped bowel.

    Do not assume we are all tin foil hat wearing, fruit cakes who jumped on the newet trend.

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    1. You missed my point. The title of the post is "anti-vaccine sympathy" not "anti-vaccine animosity." My whole point is that while I judge these parents when I read what they write on the internet, I recognize that I feel the same exact things myself when my own child is getting vaccinated, so I am, in fact, sympathetic. I hate getting my kid vaccinated and it terrifies me. What distinguishes the mothers who feel that fear and vaccinate anyway, and the mothers who feel the fear and don't vaccinate? I don't know. Tin foil hats, I guess :)

      Maybe I am judgmental of parents who vaccinate on an alternate schedule. But if you're honest with yourself, you probably judge parents who DO vaccinate on schedule. Maybe you think they are sheep or they don't love their kids as much as you do.

      You don't have to give me advice for how to treat my pediatric patients who are being vaccinated, because I haven't seen a patient under age 17 in over three years and likely never will again.

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    2. I don't really judge those who choose to vaccinate on schedule, but much like I dislike hearing uneducated moms spout on about "evil vaccines", I very much dislike moms who fight FOR vaccines just because it's what you're supposed to do. I like the science behind it, I want to know the history. And I have tendency to judge those who don't.

      I didn't really mean you in specific, more of a blanket statement. :) I see how you meant it, thank you for clarifying. I feel like a cat when the topic comes up, hackles raised. It's a topic of much stress for many.

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  6. I am a neonatologist that works in a NICU that admits sick term infants up to 2 months of age. I am currently taking azithromycin since I was exposed to an infant with pertussis over the weekend, who was given pertussis by an older, unvaccinated sibling. Such a freakin' waste. And guess who is paying for the infant's prolonged hospitalization, as well as prophylaxis for all of the people exposed to the older sibling? Not the parents that didn't vaccinate their child. Nope, that would be all of us, paying for their choice. Aside from the ill infant, the net is wide and the public health implications are huge.
    And by the way, Polio remains eradicated because we continue to vaccinate against it. It wouldn't be so if we stopped vaccinating. I am appalled.

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    1. I guess for me, it comes down to the fact that even though I'm scared of the vaccines, I'm far more scared of the diseases. I made my whole family get boosters for pertussis when my baby was born, to protect her till 2 months.

      Did you read the comments from the physician above who doesn't agree with all vaccines? That one surprised me most of all. That's the first time I've heard that from a doctor.

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    2. Yes, although there are certainly a few pediatricians in my community that market to attract families that believe in "alternate schedules" or not vaccinating. I don't understand it at all. It seems that being a primary care physician requires some understanding of public health.

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    3. One of my co-workers, who has type I diabetes and asthma, had a terrible cough for weeks. Yesterday he found out he has pertussis. He doesn't work with children or have any kids of his own, and was probably exposed out in the community (grocery store, post office, church, etc.). It's out there. Guess I'm going to find out if the booster I received when I was in college is still effective.

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    4. Just get another booster. If you haven't already gotten cold symptoms it's not too late.

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  7. The decision to not vaccinate is as much a personal decision as deciding to drive drunk in that both have the real and indisputuable potention to bring harm to other members of the community. The mothers that are writing in offended at being called "stupid" etc are missing the point (and no one has called you stupid on this form as far as I can tell) - you are risking our children along with your own.

    If my kid died because you didn't vaccinate your kid, I would want you PUT IN JAIL. No question.

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    1. I totally agree. Vaccines are required for schools, but refusing is not criminalized. But maybe it should be.

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    2. Agreed. My son was a 28 weeker and never got the rotavirus vaccine because he wasn't eligible. If he got rotavirus from an unvaccinated child who could have gotten the vaccine I'm want to hold the parents accountable. My kid is vaccinated on schedule for everything else because I believe in trying to limit harm from preventable diseases.

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    3. Rotavirus is a VIRUS that is highly contagious. Almost all children will contract at least one strain by age 3. The virus causes diarrhea, vomiting and low grade fever. It would be almost impossible to tell if your child contracted rotavirus from a nonvacc child or a vacc child as either can get it. A vaccinated child is less likely to, but is still very susceptible. A child who does contract rotavirus has the above symptoms. The risk of getting it is becoming dehydrated. In severe cases a child would need IV fluids, to rehydrate. Even adults get rotavirus. Of all the vaccines, this one is a bit ridiculous.

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    4. *cont*
      You get it from tiny pieces of fecal matter transfered to your mouth. Your child could pick it up from a shopping cart, a doctor's office, from the pencils at school, again from anyone caring it. If anything, it would be an issue that the adult or child is not washing/sanitizing their hands enough.

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    5. To be fair, my first pediatrician advised me against getting the rotavirus vaccine because he felt the risks were too high. Now the recommendation is to get the vaccine. Probably not as essential as some of the others.

      Universal vaccination does offer some extra protection to the less physically robust children like that 28 weeker above. But I've never known women to be willing to take any minute risk with their own children for the greater good.

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    6. The first rotovirus vaccine that came out was associated with a *slightly* higher risk of intussuception than placebo. Because in the first world deaths from rotovirus are extremely rare, many people we on the fence regarding whether to require the vaccine. In the third world, where death from diahrreal illness is common, the original vaccine was recommended despite the slightly increased risk.

      When the second vaccine came out, a trial recruiting over 70,000 subjects was conducted precisely so they would have the power to detect that particular adverse event (and any other adverse event that was similarly rare). The conclusion of that trial was that the second vaccine is NOT associated with increased risk of intussuception, which is why it is now recommended for all infants.

      Yes, hand hygiene is something we all need to do to prevent the spread of disease. However there is poo everywhere and it is unrealistic that we would ever be able to avoid exposure completely.

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    7. (and I apologize in advance if I spelled intussuception incorrectly)

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  8. I have a very healthy, happy 5 year old. He has been vaccinated on schedule. Received all the recommended vaccines. Nothing wrong with him. Did not, as blondie Jenny "I'm a playboy model therefore I am an expert on vaccines" McCarthy see the life go out of his eyes.
    Pertussis, measles - both are making a comeback. Maybe if some of the fear mongerers had their child have such a disease, they would feel differently, but probably not.

    Fizzy, I think that it's terrible that you had those fears. Do you know why you had those? Because the anti-vax community placed those fears. Their "beliefs" are NOT based on science. At all. Their contentions that vaccines are money makers for the drug companies are ridiculous. Vaccines are pretty natural in that they place a live or dead virus in your body and your body makes the immunity. Awesome science.

    I am not very sympathetic to anti-vaccinators. The babies who get pertussis because they haven't yet had their vaccines and die? They were murdered by those who didn't get their kids vaccinated.

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    1. It's true. Worrying about autism from vaccines is equivalent to worrying about vampires after reading Twilight.

      I've heard moms who were nervous about vaccines later thank their lucky stars they did it when their baby got exposed to pertussis.

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  9. This post definitely hit a nerve (duh, I'm a mother) and I remember how terrified I was to get my son vax'd with the MMR for fear of him becoming autistic (this was just when the whole MMR causes Autism thing was at its peak). I wanted to post-pone, looked online to see if I could get the 3 vaccines separately, scoured the internet for any possible info. Then I took my son the doctor and asked what I should do. He told me that the effects of my son getting measles and ending up with brain damage are much more likely than him becoming autistic, but that he obviously wouldn't force me to do anything. Then when I was driving home, on the news I heard there was a measles outbreak happening at that moment in my city. That's when it became clear to me that I was being incredibly stupid - stupid that I was RISKING my sons life. I made the appointment the very next day. Of course, afterwards, I held my breath and prayed that my son would be ok.

    When the study that showed that the MMR caused autism was discredited, I was so angry. So angry because of this one stupid man, that do many people were making the decision to greatly delay or worse, not vaccinate at all. My blood would boil when I would read about communities where diseases, such as measels would break out and so many children would be affected, all because a bunch of parents had refused to vaccinate their kids.

    Medicine isnt perfect. Neither are vaccines and their schedules. But they are the best option. If your child had cancer, would you really not try chemotherapy just because it is pumping chemicals in to their bodies so strong they could kill them?

    What gets me too is that we are living in an increasingly globalized world. People travel to countries where many of these diseases are rampant every day. Just because a disease is rare in North America doesn't mean it can't come back via one traveller who has been exposed.

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    1. Exactly (to everything). I am still baffled by the doctor-mom above who is considering not giving her child IPV. It still exists in other countries and the vaccine is essentially harmless! Why???? What is to be gained by taking that risk???

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    2. Fizzy- I find your incredulousness over me not being vehemenantly pro-vaccine now somewhat frustrating. In medicine, we all have different opinions/beliefs/takes. Firstly, I never said that I was currently considering NOT giving my child IPV (I said I had considered it -briefly- mostly in a "why do we still do this vaccine?" way)- in the end, it is a disease with a big burden if it happens- both of my children have gotten that vaccine. Also- remember people used to get smallpox vaccines- but now that's not done in the US--granted, it has been declared world-wide eradicated, but still our government worries about it as a bioterrorism weapon. So my reasoning of eradication as a reason not to get the IPV isn't so silly after all. I agree- our "global world" is a reason to give it.

      Secondly, we all take some form of the hippocratic oath, yet there are physicians out there on each side of the abortion fence, euthanasia fence, and end of life issues- why is vaccination any different? I liken what you are doing on this post to me the same as yelling out "look at that!" and pointing and laughing at me. I'm not ashamed of what I have said however. Maybe I'm just the only one you have heard say it. I am for vaccinating. I'm also for knowing about them. For example, DTaP- most studies have shown that it's about 85% effective- you don't find that widely publisized (and no, I'm not anti-DTaP). Gardasil? Guess what- it's only been proven to prevent cervical intraepithelial neoplasia NOT cervical cancer (yet) or cervical cancer mortality (yet)....but I bet if you pole most of the public and most of the doctors recommending it, they'd say that it prevents cervical cancer.
      I'm for asking "why"--why give the Hep A vaccine? I've asked pediatricians about the HepA vaccine and havent gotten a satisfactory answer yet. In my mind, the answer is "because there is a vaccine"
      Guess what? The varicella vaccine is likely going to end up creating a problem that public health hasn't addressed yet. We don't know how many of these girls who have gotten the 2 shot series have converted or keep immunity. What happens when they get pregnant? Uh-oh..are we going to start seeing a resurgence of congenital varicella? I say we start checking titers in pregnancy like we do for Rubella.

      So, you have said multiple times you can't believe me as if I should be banned from medicine, but do you think that I've not put thought into this?

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    3. As I said above, I was just shocked because I have literally never heard a doctor who treats children question vaccines. Most of them have seen or heard of ill effects from preventable diseases (as the pediatrician mentioned above) and are vehemently in favor of them.

      The smallpox vaccine was not a harmless vaccine. If it had stayed around, it might be safer by now, but there were reasons to avoid getting it if possible. Have you ever heard of a child having a bad reaction to IPV beyond fever? I'm just wondering, when you were considering it, what you were trying to avoid?

      The fact that these vaccines are not fully effective is all the more reason we should push for vaccination, to benefit from herd immunity as well.

      I agree with you that the varicella vaccine may create problems we haven't predicted. We don't know if it will reactivate like chicken pox does, or if immunity is kept. Again, none of this is a reason not to get the vaccine... it's possibly a reason to get a booster later. As I told someone above, there's more reason to get the vaccine than ever, because there's a much smaller chance of "getting it over with" early in childhood, and a greater chance of getting it as an adult.

      I don't doubt you've put thought into this. Everyone who makes decisions about not vaccinating their children has put thought into it.

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  10. I'm loving this heated discussion, so happy I happened up on this blog. I live in Israel, similar vaccine schedule. I was quite surprised that the kids here get Hep A vaccination routinely. (I'm originally from South Africa and I'm pretty sure they don't give it routinely there). I'm interested on more info on Hep A and vaccination if anyone here has.

    I do support the varicella vaccine after hearing many horror stories, and also once most people are vaccinating, as mentioned above, if I don't vaccinate my kids, they probably won't get it as kids, and will be left as adults susceptible to a more severe infection. I'm also on the edge of my seat as what is going to happen in a few years, regarding decisions about boosters and Ashley's interesting suggestion to regularly check titers in pregnant women.

    That leads me to another question, I would love to know your policy (I'm assuming you're from the USA?) regarding testing pregnant women for titres and what you do next? Here the policy is not to test if the woman received two vaccinations as a child, yet everybody checks anyway and I have many vaccinated patients with low titers... Then even more debate begins, our health ministry recommends no extra vaccines after two, our health fund recommends one extra, but for the many patients with low titers after 3 vaccines, we don't do anything...

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  11. Wow, there are some pretty strong pro-vaccine opinions here! A stronger argument might be provided if the author or posters could provide links to some sound, non-biased, empirical evidence to back up their opinions, and not just first hand experiences. However, I do find that any pro-vaccine argument starts to break down when there are suggestions that anyone choosing NOT to vaccinate themselves or their child are akin to being stupid, selfish baby killers, jeopardizing "the whole herd"! Simply put, if most of the herd is vaccinated, then their so-called "immunity" shouldn't actually be at risk, right? Poor logic does not make for sound arguments. While I am neither strongly pro or anti-vaccine, I am pro-informed consent. In Canada, we have the right to informed consent both for ourselves and on behalf of our children, and we have the inherent right to refuse treatment. What I find lacking still in modern allopathic medicine, is full product disclosure of ingredient lists and disclosure of verified safety and efficacy of vaccines by third party sources, as well as direct permission required to treat rather then merely implied consent to treat through uninformed silence. Until I feel truly confident as a consumer as to the safety and efficacy of a product, and until the medical profession uses education and informed consent rather then direct or implied threats, bullying or coercion (as evidenced even in this forum), I will continue to exericse my constituional right to allow my own conscience to guide what's in the best interest of my own, and my family's health at any given time.

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