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On 12/16/2018 at 11:27 AM, rev ronin said:

No, yes, maybe (depending on how it was done), and really, how?  Seriously, if anything I've proposed is in any way unlawful, I'd love to hear about it before I actually do any of it.

It is a constitutional right to decide what goes into ones body

who are you to clinically bully an individual be it vaccines or any other treatment? 

this is prejudice being that you deny care to a "subgroup" of people

this extends further

lets say that the majority of "anti vaxxers" are jewish or muslim and refuse vaccination over religious purity beliefs, now you would be considered a racist and even an anti semite.

your above posted view reeks of narcissism

 

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30 minutes ago, JMPA said:

It is a constitutional right to decide what goes into ones body

I would ask that you post the quoted portion of the constitution that states this.

Furthermore, where is the constitutional requirement that I offer my services to any or every person that seeks my services?  This is actually not possible to do - and would 

Also, a religious exception or other similar choices are an entirely different conversation entirely.  They are not stating that vaccines are bad because they cause autism or other ridiculous claims, the positives or negatives of vaccines are irrelevant as it is a religious choice.

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1 hour ago, JMPA said:

It is a constitutional right to decide what goes into ones body

who are you to clinically bully an individual be it vaccines or any other treatment? 

this is prejudice being that you deny care to a "subgroup" of people

this extends further

lets say that the majority of "anti vaxxers" are jewish or muslim and refuse vaccination over religious purity beliefs, now you would be considered a racist and even an anti semite.

your above posted view reeks of narcissism

Do you counsel people to quit smoking repeatedly?  Do you allow them to smoke in your exam room? Your waiting room? How about the chronically and profoundly obese?  Do you encourage them to lose weight more than once?

People pay me to do medicine.  That means I am ethically bound to advocate the right thing for their best interests at each visit. Sometimes, that's a gray area.  Sometimes, I prioritize what gets addressed first.  Yesterday, I told a patient to not stop smoking... yet.  In the context of supporting his opioid tapering, I believe that was the right advice in the totality of circumstances.

If I were ridiculing anti-vaxxers for my own pleasure, that would indeed be bullying.  But when my interest is in promoting the health both of the patient and the public, one can indeed be rude and ineffectively offensive (

comes to mind) but no, bullying isn't the right term for it.

"Denying care" is the patient's choice, not the evidence-based medical provider. When one person completely refuses to lose weight, there isn't the same imperative to remove them from one's practice, because (aside from inopportune falls) obese people only hurt themselves. If I want to keep my practice safe for the very young, the very old, immunocompromised, and those with medical contraindications to vaccination, I can't indefinitely tolerate an arbitrarily large population of vaccine refusers. Terminating their care is as justified as kicking out smokers who won't stop smoking in your clinic: the anti-vaxers carry avoidable risk to your other patients with them.

Your Godwinesque oblique suggestions of anti-semitism are nonsensical and backwards.  Do you actually even listen to anti-vax conspiracy theories?  They are the true antisemites.  Consider their own propaganda (from http://www.stopmandatoryvaccination.com/cdc/cdc-proposes-indefinite-detainment-forced-vaccination-and-unlimited-surveillance-for-travelers/):
tumblr_nkrf5fRASH1tejljjo1_1280.jpg

Notice the shoulder patch on the foreground officer? The folks pushing anti-vax nonsense are the anti-semites, blaming evil Jew doctors for the vast global conspiracy.  As repugnant as their belief systems are, it's not my desire to avoid Nazi sympathizers in my practice that would drive my badgering or excluding them, but keeping them healthy and safe, along with the rest of my patients.

There are plenty of treatment decisions with a gray area, where patient preference plays the decisive part in choosing between multiple options.  Vaccines aren't one of them, just like stopping smoking and maintaining a reasonable weight.  I will gladly, repeatedly, tactfully advocate for each such clear cut correct choices. For anti-vaxxers to be treated as I advocated earlier, the three key elements are:
1) Incontrovertible risk/reward ratio
2) Refusal and rejection of #1, not just a failure of willpower (e.g., weight loss or smoking cessation difficulties)
3) Active risk of harm to the innocent.

So yeah, I'm pretty comfortable with my decisions, although I'm always open for more ways to convince vaccine refusers to do the correct thing.

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Tylenol is safe in pregnancy...o wait now it's linked to ADHD...

Zofran is safe in pregnancy. O wait...

Im fairly sure some parents wait to vaccinate because they are concerned about potential environmental factors affecting their kids. Nearly 1 in 30 kids are born with autism now in this country; we don't really know why but most authorities on the subject agree that genetic and environmental factors play a role.. Most environmental  factors parents can't control but this they can... I don't blame them for not completely trusting the CDC study... 

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... most authorities on the subject agree that genetic and environmental factors play a role...I don't blame them for not completely trusting the CDC study... 


Are these the same or different "authorities" and how do you decide who is ok to listen to? [emoji848]


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Dr. House does it well. I used to watch the British show Doc Martin, he had an episode where he reacted the same way (couldn't find it to show here). In the news this week there has been two young people who died of the flu, a conservative reporter and the Guatemalan boy. The latest issue is the person with measles flying into Newark Airport. So vaccines are relative to us all. I don't suspect a pandemic, but isolated cases of people dying who didn't have to.

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1 hour ago, YoungH89 said:

Tylenol is safe in pregnancy...o wait now it's linked to ADHD...

Zofran is safe in pregnancy. O wait...

Im fairly sure some parents wait to vaccinate because they are concerned about potential environmental factors affecting their kids. Nearly 1 in 30 kids are born with autism now in this country; we don't really know why but most authorities on the subject agree that genetic and environmental factors play a role.. Most environmental  factors parents can't control but this they can... I don't blame them for not completely trusting the CDC study... 

So you are supporting the idea that vaccines cause autism?  I really hope I'm misunderstanding...especially as you are on this forum and therefore either a PA or in the process of becoming one.

Furthermore the idea of tylenol being linked to ADHD is far from defined, and from my reading it is extensive use (4 weeks or more) that may increase risk.  While more limited use (1 week or less) may actually decrease the risk of ADHD...that sounds far from conclusive.  Bottom line, we are constantly learning about medicine and we ALWAYS try to do what is best.  Making outrageous claims about vaccines is not what is best for medicine.  EVERY (and I do mean every) claim made by anti-vaxxers I have ever come across has been thoroughly researched and completely debunked.

But, I will finish by asking, what is worse: autism from a vaccine, or living (maybe) with the effects of polio, measles, etc.?  And then of course the tremendous amount of data and research that has shown without doubt the lack of any link between vaccines and autism.

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2 hours ago, YoungH89 said:

Im fairly sure some parents wait to vaccinate because they are concerned about potential environmental factors affecting their kids.

 

13 minutes ago, YoungH89 said:

 

 

So you dont think environmental factors could be contributing to the rise in ASD over the past 25 years?

 

What environmental factors are you referring to?  Does our environment have a massive impact on our health in ways that we know, are learning about, and have yet to learn about?  ABSOLUTELY!!!!

But, I would actually say that the most likely cause for the rise in ASD diagnoses over the past 25 years is that we have CHANGED the way ASD is defined, broadening the diagnosis widely, and that we understand the diagnosis much better helping it not to be missed.  It's similar to many types of cancers.  We are diagnosing cancer at blinding rates compared to 100 years ago, even 50 or 25 years ago.  Is it really that these cancers are occurring in younger and younger individuals and at increasing rates?  Maybe, but I think we also have to consider that our detection capabilities are getting better and better making it possible to diagnosis earlier simply because our technology was not capable in the past.

 

But, I must point out that you did not answer my question, which again concerns me.

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The relationship between autism spectrum disorder and vaccines, MMR or otherwise, is among the closest thing to settled science there actually is. Even gravity seems to be undergoing more upheaval. That is genuinely not up for debate on this board: not because the moderators are dictatorial, but because if you genuinely distrust evidence-based medicine to the point where you will deny this, you are self-selecting out of Western medicine and hence, this forum.

At the same time, we are called to deal with a population that does not understand this to an alarming degree: there are plenty of people who do not understand the science and believe this statement, and a frightening number of people who do not understand this science and still disbelieve the demonstrated lack of connection between vaccines and autism. thus, it is our role as educated informed medical professionals to deal with harmful ignorance and misunderstanding, especially to the extent that it harms people.

There are plenty of harmless wrong beliefs. There are also plenty of harmful wrong beliefs, many of which were generally accepted scientific “fact” until proven otherwise. One of the things we have problems with, as a species apparently, are misunderstanding the impact of low frequency, high impact events: We fear plane crashes, and think we might win Powerball.

As medical providers, we are translators, stewards of the medical literature and trusted interpreters of what would otherwise be best understood by the laity as gobbledygook. The problem with the anti-vax movement is that it claims to have alternative facts (they’re wrong), and uses a real issue (profiteering in medicine) to strike at our credibility. While we should all be big enough to take the insults and laugh them off, to the extent that our patients are attacking our role, they actually are not our patients anymore, in that they do not trust, and are strongly opposed to, our recommendations. If we can win them over to healthier behavior through evidence, cajoling, and/or increasing pressure, great. As I mentioned multiple times in this thread, strongly held wrong beliefs are not the same as willpower failures, and should not be treated the same.

I would like to be part of the solution to the anti-vax problem through applied intolerance of unacceptable behavior, just like I do not tolerate racist or sexist behavior. I would advocate that all of us should be, but I’m not your conscience.

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What environmental factors are you referring to?  Does our environment have a massive impact on our health in ways that we know, are learning about, and have yet to learn about?  ABSOLUTELY!!!!
But, I would actually say that the most likely cause for the rise in ASD diagnoses over the past 25 years is that we have CHANGED the way ASD is defined, broadening the diagnosis widely, and that we understand the diagnosis much better helping it not to be missed.  It's similar to many types of cancers.  We are diagnosing cancer at blinding rates compared to 100 years ago, even 50 or 25 years ago.  Is it really that these cancers are occurring in younger and younger individuals and at increasing rates?  Maybe, but I think we also have to consider that our detection capabilities are getting better and better making it possible to diagnosis earlier simply because our technology was not capable in the past.
 
But, I must point out that you did not answer my question, which again concerns me.
They didn't answer mine either. I find it odd the poster cites "authorities" believe ASD is caused by "environmental and genetic factors" yet in the same paragraph casts a shadow of doubt in an authority (CDC).

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I personally work in a clinic and don't come across this issue much.  We do come across non-compliance a lot.  My SP has a very low tolerance for non-compliance.  If a patient is a danger to society and does not want to follow the treatment plan I do not see why you cant discharge them.  We will maintenance for one month from release and that is it.  75% percent come back after researching the treatment plan for themselves (either by getting a second opinion or by doing their own research).   If you go to a cardiologist and the do not want a heart cath, then why continue to treat?  Are there any viable alternatives Yes/No?  No?  Then please seek care elsewhere.  What a about a surgeon that needs to do an open appendectomy, but the patient doesn't want any scarring.  You don't ask a surgeon to go through the anus to make the patient happy.  You all can scoff at these examples but I have seen them happen or patient's make these requests.  Personally I feel there is nothing unethical about discharging or refusing care for a patient that does not follow the treatment advice (with the exception of EMTALA).  Let them search for another provider that will tell them what they want to hear.   Health care is not a right and is a privilege in the United States.  We can debate if it should be, but it is not a right.  I only have so much time to help the patient population I see, and I am not going to waste it on non-compliance.  I am also not going to put another patient's life at risk (as in the case with Vaccines) because someone does not want to follow my treatment plan.  A child that is actually allergic to vaccines and is on chemo should not be exposed to another child who's parents "did not want them."  I would submit that should the patient or child's family that is not able to be vaccinated when exposed to a diseased non vaccinated child that could be vaccinated but wasn't, could be considered involuntary manslaughter by the patient's guardians of the other child.  While we in the United States talk about individual rights, what about the safety of society, and those that are the most vulnerable in society?  I would say to the non-compliance issue on a patient (say diabetic), if it only effects the patient only then so be it.  That is his/her personal choice.  But I do not have to watch you self destruct your health as you fail to follow my treatment plan, or even try to follow it.  We are wasting each others time, and I have other people who want healthcare that will follow the treatment plan.  But once the personal choices impact society, then were is the ethical dilemma there?  People with active Ebola have a right to be free as well.  Do we let them run around society or do we quarantine them for the public health?

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On 12/30/2018 at 1:15 PM, GetMeOuttaThisMess said:

All I know is that when one starts to look for something particular, one is more likely to find it.  If you don't look for it, the incidence is most likely to be lower.  If vaccines are the source then why aren't there a boatload of autistic older adults (born in '50's or '60's) that I've somehow failed to run across?

why has it taken so long for JJ to be held responsible for asbestos in the baby powder? Why are there government funds dedicated to people injured by "safe" vaccines? Why was valsartan and losartan recently recalled do to contaminants known to cause cancer? why discharge a non vaxxer but allow your immunocompromised patient to sit in a waiting room with HIV, RSV, TB, ect, ect ect? all straw arguments. A person has a right to refuse substances injected into ones body. You god complex of thinking you should decide whats best for all is poor reasoning at best. People who have that thought process should not be practicing medicine. Vaccination and all of its risks are a personal INDIVIDUALIZED decision that should be respected for all.

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On 12/29/2018 at 6:28 PM, rev ronin said:

Do you counsel people to quit smoking repeatedly?  Do you allow them to smoke in your exam room? Your waiting room? How about the chronically and profoundly obese?  Do you encourage them to lose weight more than once?

People pay me to do medicine.  That means I am ethically bound to advocate the right thing for their best interests at each visit. Sometimes, that's a gray area.  Sometimes, I prioritize what gets addressed first.  Yesterday, I told a patient to not stop smoking... yet.  In the context of supporting his opioid tapering, I believe that was the right advice in the totality of circumstances.

If I were ridiculing anti-vaxxers for my own pleasure, that would indeed be bullying.  But when my interest is in promoting the health both of the patient and the public, one can indeed be rude and ineffectively offensive (

comes to mind) but no, bullying isn't the right term for it.

"Denying care" is the patient's choice, not the evidence-based medical provider. When one person completely refuses to lose weight, there isn't the same imperative to remove them from one's practice, because (aside from inopportune falls) obese people only hurt themselves. If I want to keep my practice safe for the very young, the very old, immunocompromised, and those with medical contraindications to vaccination, I can't indefinitely tolerate an arbitrarily large population of vaccine refusers. Terminating their care is as justified as kicking out smokers who won't stop smoking in your clinic: the anti-vaxers carry avoidable risk to your other patients with them.

Your Godwinesque oblique suggestions of anti-semitism are nonsensical and backwards.  Do you actually even listen to anti-vax conspiracy theories?  They are the true antisemites.  Consider their own propaganda (from http://www.stopmandatoryvaccination.com/cdc/cdc-proposes-indefinite-detainment-forced-vaccination-and-unlimited-surveillance-for-travelers/):
tumblr_nkrf5fRASH1tejljjo1_1280.jpg

Notice the shoulder patch on the foreground officer? The folks pushing anti-vax nonsense are the anti-semites, blaming evil Jew doctors for the vast global conspiracy.  As repugnant as their belief systems are, it's not my desire to avoid Nazi sympathizers in my practice that would drive my badgering or excluding them, but keeping them healthy and safe, along with the rest of my patients.

There are plenty of treatment decisions with a gray area, where patient preference plays the decisive part in choosing between multiple options.  Vaccines aren't one of them, just like stopping smoking and maintaining a reasonable weight.  I will gladly, repeatedly, tactfully advocate for each such clear cut correct choices. For anti-vaxxers to be treated as I advocated earlier, the three key elements are:
1) Incontrovertible risk/reward ratio
2) Refusal and rejection of #1, not just a failure of willpower (e.g., weight loss or smoking cessation difficulties)
3) Active risk of harm to the innocent.

So yeah, I'm pretty comfortable with my decisions, although I'm always open for more ways to convince vaccine refusers to do the correct thing.

You have a much greater chance of contracting MRSA from infected skin or PNA from an obese person and dying than contracting measles from a healthy non vaxxer. Where does this faulty reasoning arise from? is it do to inherent bias? god complex? belief in totalitarian society? Vaccination should be a personal INDIVIDUALIZED decision based on informed RISKS, benefits and alternatives with the patient choice respected, period. There is no justification to force somebody to have vaccines injected into there body against their will for a theory of herd immunity that does not work, period.

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7 minutes ago, JMPA said:

You have a much greater chance of contracting MRSA from infected skin or PNA from an obese person and dying than contracting measles from a healthy non vaxxer. Where does this faulty reasoning arise from? is it do to inherent bias? god complex? belief in totalitarian society? Vaccination should be a personal INDIVIDUALIZED decision based on informed RISKS, benefits and alternatives with the patient choice respected, period. There is no justification to force somebody to have vaccines injected into there body against their will for a theory of herd immunity that does not work, period.

I agree. Healthy anti-vaxxers don't spread measles.  Once they get it, however...  Also, it's not just about risk to ME, it's about risk to my staff and other patients.  MRSA is contact; measles is airborne.

Ignoring your insults, no one is forced to do anything: I don't force anyone to accept life-saving treatment, I just acknowledge their rejection of a therapeutic relationship.

But the rejection of herd immunity is a fascinating topic that I'd love to hear you expound on more: Do provide some peer-reviewed research justifying your statement, please?

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50 minutes ago, rev ronin said:

I agree. Healthy anti-vaxxers don't spread measles.  Once they get it, however...  Also, it's not just about risk to ME, it's about risk to my staff and other patients.  MRSA is contact; measles is airborne.

Ignoring your insults, no one is forced to do anything: I don't force anyone to accept life-saving treatment, I just acknowledge their rejection of a therapeutic relationship.

But the rejection of herd immunity is a fascinating topic that I'd love to hear you expound on more: Do provide some peer-reviewed research justifying your statement, please?

no intent to insult

" Also, it's not just about risk to ME, it's about risk to my staff and other patients" how about risks of vaccination to the anti vaxxer?

Vaccination is not the only way to prevent the spread of disease. Where have the people originated from in the united states whom have been found to be the cause of outbreaks?

This is a good discussion that needs to be had.

I am not anti vaccine, i offer vaccine multiple times a day to my patients. I do respect there choice after the risks benefits and alternatives have been explained even if i do not agree with there choice.

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5 hours ago, JMPA said:

" Also, it's not just about risk to ME, it's about risk to my staff and other patients" how about risks of vaccination to the anti vaxxer?

Vaccination is not the only way to prevent the spread of disease. Where have the people originated from in the united states whom have been found to be the cause of outbreaks?

Vaccination is the single most cost-effective way to stop the spread of vaccine-preventable diseases.  We have a finite pot of money to spend on health; why divert it to less effective methods?

Sure, border control and good health checks would be another method to reduce external sources of infections, but they're brittle defenses, much like the 1990's where company intranets had complete access from anywhere to anywhere, with only firewalls to protect them from the exterior. The human impact of travel delays and vaccine checks at the border (oh, wait, how else were we going to ensure travelers are low risk?) are non-trivial.

Like I said earlier, people just don't understand the risk of low frequency, high-impact events.  It's not just about vaccines, either, in that many, perhaps most, patients are too mathematically illiterate or emotionally impaired to be capable of making an informed decision.  The balance of risks and harms isn't even close; there aren't any rational justifications for a person without any specific risk factors to refuse a routinely scheduled vaccine, even assuming worst case scenario for both harms and benefits.  The most dangerous part of any non-medically-contraindicated scheduled vaccine administration is the drive to get to the administration point!

I do invite you to support or retract the statement that herd immunity doesn't work. If you mean to parrot arguments you don't hold yourself, It'd be much more helpful if you'd clearly label them as such.

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"It's not just about vaccines, either, in that many, perhaps most, patients are too mathematically illiterate or emotionally impaired to be capable of making an informed decision."

it is this ' god complex" attitude that is offensive and has no place in the practice of medicine. 

You are arguing against the fact that  Vaccination should be a personal INDIVIDUALIZED decision based on informed RISKS, benefits and alternatives with the patient choice respected. This has less to do about vaccination and more to do with you believing that you know best and you should be entitled to make decisions for the masses.

As for herd immunity, have fun: " Vaccination stimulates an artificial, temporary immunity that does not last as long as naturally acquired immunity. Sometimes vaccination does not prevent infection at all but allows infection with few or no symptoms in the vaccinated person, who is still able to transmit the infection to others, which is the case with B. pertussis (whooping cough). At best, it may stave off infections in some vaccinated people for a limited period of time."

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I refused to sign a release into pre-school for an anti-vaxer recently.  The dad was pissed off and I could care less.  There is no way in hells hot flames that I would put my name on a release document sending an un-vaxed kid into a room with 30 other kids.  Not gonna happen.  I would do it again.

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4 hours ago, JMPA said:

"It's not just about vaccines, either, in that many, perhaps most, patients are too mathematically illiterate or emotionally impaired to be capable of making an informed decision."

it is this ' god complex" attitude that is offensive and has no place in the practice of medicine. 

You are arguing against the fact that  Vaccination should be a personal INDIVIDUALIZED decision based on informed RISKS, benefits and alternatives with the patient choice respected. This has less to do about vaccination and more to do with you believing that you know best and you should be entitled to make decisions for the masses.

As for herd immunity, have fun: " Vaccination stimulates an artificial, temporary immunity that does not last as long as naturally acquired immunity. Sometimes vaccination does not prevent infection at all but allows infection with few or no symptoms in the vaccinated person, who is still able to transmit the infection to others, which is the case with B. pertussis (whooping cough). At best, it may stave off infections in some vaccinated people for a limited period of time."

Again with the insults.  Again the same answer: When I tell patients what's good for them for my own ego, yes, it would be out of place.  When I tell patients what's good for them, putting my own economic livelihood at risk (i.e., they go elsewhere, I lose money) to tell them an uncomfortable truth for their own good, it's much better described as "doing my job."  I am, oh, probably down close to $500,000 in expenses and lost income since 2010 when I left my previous profession to become a PA.  If by doing so I didn't gain (at a minimum) the ability to conclusively tell the people I serve the most basic of medical facts, then I have engaged in a colossal waste of time and money.  God complex? Not a chance.

To the extent there are medical contraindications to vaccination, yes, the risk/benefit equations differ.  I've said that repeatedly and consistently throughout the thread.  But what does not change the health benefit of vaccination is the patient's (or, worse, their medical surrogate's!) opinion.

Patients always have a choice: Stop smoking or find another provider.  Treat your diabetes or find another provider.  Get vaccinated or find another provider.  Of the three, only the last never (or, actually, extremely rarely) involves a lack of willpower sufficient for follow-through.  I tell most my patients facing medical decisions "You are the CEO of you.  I am your consultant; I can give you all the information in the world, but I can't make your decision for you."  If that sounds to you like my running roughshod over patient autonomy, sorry, but it's not.

Where on earth did you get that herd immunity quote?  I'll paypal you $5 if it's from a reputable, peer reviewed journal, because it sure sounds like it comes from a scaremongering anti-vax website. You will have to provide the cite and PM me the paypal account you want me to forward the money to, of course.

The debate is not about whether schedule-recommended vaccines are safe and effective for those without medical contraindications to them, but rather how to convince patients of this truth for their own good. There are vaccines where the cost/benefit may be there for some but not others.  I got Pneumovax as a PA student at my own expense years ahead of recommended schedule after "doing my research."  I did the same thing with Zostavax a few years ago, only thankfully my insurance picked that up even though I wasn't over 50 yet.  Do I badger everyone to get those? Oh, heck no.  I do mention the possibility of Zostavax to those about my age who had chicken pox as kids, but thanks to the varicella vaccine's acceptance and efficacy in the general population aren't getting re-exposed to wild type chicken pox.   Never gotten a rabies shot, though, because it doesn't make sense for me or most people who don't work with potentially infected animals.

So I'm not seeing you saying anything new here--just repeating the same allegations (ignoring patient choice, playing god, yadda yadda...) restated after I've already refuted them.  If you can't add something else, it's probably time to close this out.

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That is more than a quote, it is an indisputable fact. Fact, not theory. Basic entry level immunology 101 fact. My issue is not to vaccinate or not to vaccinate, it is the method of force and coercion that you promote to hold steady to your rhetoric.  If you choose to close the thread so be it. Threads like this open up professional discussion of issues that are frequently misunderstood or never questioned. Where is progress without questions?

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11 hours ago, JMPA said:

 

As for herd immunity, have fun: " Vaccination stimulates an artificial, temporary immunity that does not last as long as naturally acquired immunity. Sometimes vaccination does not prevent infection at all but allows infection with few or no symptoms in the vaccinated person, who is still able to transmit the infection to others, which is the case with B. pertussis (whooping cough). At best, it may stave off infections in some vaccinated people for a limited period of time."

 

1 hour ago, JMPA said:

That is more than a quote, it is an indisputable fact. Fact, not theory. Basic entry level immunology 101 fact.?

I just want clarify your statement of "entry level immunology 101".  I found this exact text: "Vaccination stimulates an artificial, temporary immunity that does not last as long as naturally acquired immunity." on this web site: https://www.nvic.org/faqs/vaccine-safety-immunity.aspx and while it says "National Vaccine Information Center, it has plenty of dubious and incorrect information on it, and the website title leads one to believe it is an official source, which it is clearly not.

Additionally, similar text appears on Mercolas website: "other words, vaccination triggers the creation of vaccine strain antibodies, but since vaccination skips the cell-mediated response, it only confers an artificial temporary immunity."

https://www.google.com/amp/s/articles.mercola.com/sites/articles/archive/2018/06/05/amp/people-losing-trust-in-vaccine-industry.aspx

Personally, I consider Mercola a fellow who spews shit disguised as information, but if you consider this a baseline intro into immunology, then that's up to you.

I'm not saying anything about discharging patients who come in and refuse any of my advice.

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