Reconsidering vaccination- a book review

So, I was first surprised, then puzzled, then alarmed at the number of parents who reject vaccination for their children, and adults who decline immunizations for themselves. Some people now fear the vaccines more than the diseases they prevent and we physicians must consider this to help people stay well instead of treating them when sick.

This information is current as of the date of original publication or update. It may have changed by the time you read this. I invite you to fact-check what you read here.

This information is not intended for diagnosis or treatment. Before making health decisions, discuss with your physician or other qualified healthcare provider to decide what is right for you.

In 1961,  my mother and I went to my school on a Sunday afternoon to receive the newly released oral polio vaccine. She along with other parents eagerly sought a way to prevent a dreaded disease that had the potential to cripple or even kill their children.

In medical school I learned about diphtheria, a painful throat infection due to a bacteria, Corynebacterium diphtheriae. Once a common cause of severe illness and death, a vaccine had rendered it rare. I saw no cases of diphtheria in medical school, nor have I since.

As a young physician I welcomed the introduction of the H.Flu vaccine (Haemophilus influenzae bacteria, not the virus) in 1985. At that time, any infant or toddler with a fever was a potential victim  of  meningitis due to H.Flu, which could be deadly or leave the child with neurological damage.

Similarly, the Hepatitis B vaccine made healthcare a less risky occupation; Hepatitis B is a blood borne infection contracted from contact with infected blood.

VACCINE-PREVENTABLE DISEASES
FROM THE CDC, UPDATED JANUARY 2016– follow link for detail

So, I was  first surprised, then puzzled, then alarmed at the number of parents who reject vaccination for their children, and  adults who decline immunizations for themselves. Some people now fear the vaccines more than the diseases they prevent and we physicians must consider this to help people stay well instead of treating them when sick.

I was intrigued when I heard of a book, by a physician,that seems to promote a compromise-

The Vaccine-Friendly Plan

The Vaccine-Friendly Plan is published by Ballantine Books,  2016

The Vaccine-Friendly Plan by Paul Thomas, M.D., a pediatrician  and Jennifer Margulis, Ph.D.a science journalist.

It is based on his pediatric practice, Integrative Pediatrics,  as well as their extensively noted references. The book’s subtitle summarizes the contents accurately-

“Dr. Paul’s Safe and Effective Approach to Immunity and Health- from Pregnancy through your Child’s Teen Years.”

The book discusses pregnancy, infant and  child care in general, not just vaccination, although that is a major emphasis.There is a chapter about pregnancy and for each stage of child development through adolescence.

The first chapter discusses a popular health topic now- toxins. (As an aside, I don’t know when we started calling poisons  “toxins”) . This should grab your attention-

“Toxins, Toxins, Toxins: Raising Healthy Children in a Poisoned World”.

Anything can be “toxic” if misused, overused,or abused  but they concentrate on these toxins in particular- acetaminophen, aluminum, aspartame, fluoride, methanol, mercury, and what they call endocrine disruptors(this includes pesticides).  They state “environmental toxins are likely contributing to the autism epidemic” as well as other neurodevelopmental and mental disorders in children.  They base their conclusion on an extensive list of review articles from the medical and scientific that support their view (obviously) and also from Dr. Paul’s medical practice of 11,000 children who he calls “among the healthiest in the world.” While I suspect  families who are already health conscious tend to select a physician who is health oriented, this claim sounds impressive.

I agree with some of the advice the authors offer. For example this advice for pregnancy is hard to argue with-

  • Eat a whole foods, organic, non-GMO diet 
  • Skip the soda
  • Drink filtered water
  • Minimize stress
  • Get treatment for addiction
  • Join a support group

But in addition, they recommend declining all vaccinations during pregnancy, certainly not mainstream medicine advice.

A later chapter also offers sound advice:

“ The Best Ways to Support your Child’s Immune System” 

  • Breast feed
  • Enjoy cuddling
  • Laugh a lot
  • Relax often
  • Rock your body
  • Stay hydrated
  • Eat a variety of foods
  • Maintain social connection
  • Read
  • Get Dirty
  • Be cautious but not afraid
  • Choose vaccines based on real science, your family’s needs and common sense
  • Sleep enough
  • Trust your children
  • Trust yourself

He offers an interesting list  Ten Questions to Ask When Looking for a Pediatrician (which I assume would apply if you use a family physician for your child’s care).

As a physician, I have never liked the idea of being “interviewed” by a potential patient; I  want a relationship with patients, not a job. But I think pediatricians routinely offer “get acquainted” visits so you may find it helpful. Some of the questions seem more appropriate to explore  in a long term relationship with a physician, not quick answers in a short visit, like “What would you like me to know in order to keep my family healthy?”

An appendix compares the CDC immunization schedule of 1983 to the current 2016 version, illustrating  many more vaccines and doses are now recommended.

Of course the list is longer since several new vaccines have been developed in the past 30 years and the CDC recommends those considered necessary for the public health. Most areas of medical care have changed dramatically in the past 30 years, we have a lot more of everything-drugs, procedures, etc- so this should not be a surprise.

vaccines
CDC Immunization Schedule– follow link for detail

Also in the appendix is Dr. Paul’s Vaccine Plan at a Glance, which is a much abbreviated version of the CDC recommendations. The plan is offered free at his web site drpaulapproved.com by signing up to receive his newsletter. (There is also a “store” on the web site offering an assortment of vitamins, minerals, probiotics and melatonin.)

The authors describe themselves as “pro-vaccine”, have received vaccines themselves and vaccinated their children. But they also believe that physicians and parents should have a choice and make informed decisions about immunization and other procedures. 

Universal vaccination is recommended , but there are individual circumstances where the routine schedule might need to be altered due to a child’s particular medical circumstance, but not for some vague concern that vaccination might not b e “safe”. Neither is infectious disease.

If  you are a parent who has  rejected vaccination for your children,  please read this book soon.

Also, read another review of this book by  Vincent Iannelli, MD , a pediatrician and Fellow of the American Academy of Pediatrics.
Sonia Shah, a science journalist, also wrote about vaccination in her book
Pandemic – Tracking contagions from cholera, to Ebola, and beyond
Read my review at this link 

Pandemic- a book review

Pandemic by Sonia Shah

another post on this topic

Vital questions you should ask about immunization

This coronavirus pandemic is serious. We don’t yet have a vaccine or effective treatments. To protect ourselves, our familes, and our entire communities we should all be practicing social distancing and other hygiene measures as we wait for a safe, effective vaccine and treatments.

exploring the HEART of preventing disease

a stethoscope, a red heart and a heart ekg tracing
exploring the HEART of HEALTH

Dr. Aletha

6 smart facts about antibiotics

You may think of antibiotics as safe, harmless drugs with no potential for serious effects. Usually antibiotics are well tolerated and safe. But serious side effects are possible and dangerous, though rare.

Antibiotics save lives.

“The discovery of penicillin in 1928 by Alexander Fleming was one of the greatest scientific achievements of the 20th century. It’s hard to imagine a world before the development of what many consider to be miracle drugs; however, just 90 years ago antibiotics weren’t available.”

CDC website

Prior to the discovery of penicillin, infectious diseases frequently caused death, probably the most common cause prior to the mid-20th century.  Now they have been surpassed by heart disease, cancer and trauma.

We are less likely to from an infectious disease because of immunization, improved hygiene, sanitation, safe food and water, improved nutrition, and antibiotics. However, changes in our environment and genetic changes in bacteria and viruses create opportunity for infectious diseases to become new and deadly threats.

digitally colorized photomicrograph, of a number of Streptococcus pneumoniae bacteria
This digitally colorized photomicrograph, reveals the presence of a number of Streptococcus pneumoniae bacteria in cerebrospinal fluid (CSF) after the patient had begun treatment with 5 units of penicillin. public domain courtesy CDC/ Dr. M.S. Mitchell

Antibiotics are used to treat infections caused by bacteria.

In a broad sense, the word antibiotic could refer to any drug that kills or stops germs, or in other words, organisms that cause disease. But we usually reserve it to refer to bacteria type organisms. There are many families of bacteria; two of the most common are the Streptococci, or Strep and the Staphylococci, or Staph (pronounced staff). There are different drugs that work on other infections caused by viruses, fungus, and parasites.

Prevalence of High Level Penicillin Resistance in Streptococcus pneumoniae, United States.
This image was produced, by the Centers for Disease Control and Prevention (CDC) in 1997, It lists the percentages of penicillin resistant S. pneumoniae infections, during 1987, 1991, and 1993-94, based on data collected by both the Morbidity and Mortality Weekly Report (MMWR), The Journal of Infectious Diseases. Note how over this 8-year period, there was a steady increase in the occurrence of high level penicillin resistance. public domain

Ear infections may or may not need treatment with an antibiotic.

Ten years ago we thought all ear infections must be treated with antibiotics. Now we know that some resolve spontaneously, so antibiotic prescribing is not automatic. In some circumstances, they are still recommended

  • Infants less than 6 months old
  • Toddlers under 2 years old with both ears infected
  • A ruptured ear drum (perforated tympanic membrane) with pus draining

In other cases, it may be safe to wait 2-3 days before giving an antibiotic if symptoms have not resolved.

6 smart facts about antibiotic use
graphic created by the Centers for Disease Control, http://www.cdc.gov

A sore throat usually gets better without an antibiotic.

Unless it is due to an infection with the Streptococcus bacteria, “Strep throat”. Greater than 90% of sore throats are caused by viruses, including those which cause colds and influenza. Mono, the “kissing disease”, (infectious mononucleosis) is also caused by a virus called Epstein-Barr. None of these are treatable with antibiotics, although influenza symptoms can be lessened with an anti-viral drug.

Strep throat is usually treated with penicillin but symptoms may not get better any faster than without. The goal in using an antibiotic is to prevent rheumatic fever, a complication of strep which is now rare in the United States.

a man taking his temperature
Photo credit Lauren Bishop-CDC/ National Center for Emerging and Zoonotic Infectious Diseases (NCEZID)

 The color of mucus, pus, or drainage does not determine the need for an antibiotic.

Some infections may cause characteristic colors or odors, but that alone is not used to diagnose or treat bacteria. If there is pus or other drainage, a sample may be collected and sent to a lab for a culture- attempting to grow any bacteria present. Sometimes this is misleading, since our bodies harbor lots of bacteria normally.

a woman taking her temperature
This photograph depicted a woman who was using a modern, battery-powered oral thermometer, in order to measure her body temperature. In order to return an accurate reading, this particular type of thermometer needed to be placed beneath the user’s tongue, for a set amount of time, beeping when the ambient, sublingual temperature was reached. Photo credit-James Gathany, CDC, public domain

Like all drugs, antibiotics have potential risks.

You may think of antibiotics as safe, harmless drugs with no potential for serious effects.  Usually antibiotics are well tolerated and safe. But serious side effects are possible and dangerous, though rare.

Here are some of the potential serious risks of popular frequently used antibiotics

  • Penicillin- anemia (loss of red blood cells), injury to kidneys and nerves
  • Cephalexin- seizures, liver problems leading to yellow jaundice
  • Sulfa- increased sensitivity to sunlight, inflammation of the pancreas
  • Azithromycin (Z-Pak) irregular heart rhythm, injury to liver and pancreas
  • Ciprofloxacin- seizures, depression, rupture of tendons

exploring the HEART of using antibiotics wisely

Dr. Aletha