November 1999
Part of every pediatric health care worker's job today is counseling parents. With so much health information available today, they are bound to come into the office with misinformation. One of our jobs is to correct this. Here's how.
First, start by learning something about the parents' belief systems. Focus on identifying what the specific concern is and write it down while listening to the parent so that you can address specific questions directly. Some chiropractic viewpoints in the literature include a belief that proper nutrition can take the place of immunization by strengthening the immune system defenses against disease.
While a nutritious diet certainly is helpful in building the immune system, diet alone cannot prevent disease. Another common belief is that vaccines can overload the immune system. What patients don't realize is that our immune systems are exposed to many antigens every day in food and water. Both of these viewpoints are addressed in a publication by the Centers for Disease Control and Prevention (CDC) entitled The 6 Common Misconceptions about Vaccination and How to Respond to Them, available free through the National Immunization Program (NIP).
Some concerned parents may themselves have had an adverse event following a vaccination, or know someone close to them who has. In this case, be sure to complete a Vaccine Adverse Event Form, which is required for reporting adverse reactions in children under the National Vaccine Childhood Injury Act. The Vaccine Adverse Event Reporting System (VAERS) collects all reports of ill effects following vaccination. Some of these reports to VAERS are caused by vaccination and others are not related, but coincidently happened around the time the vaccine was given. Anyone can report to VAERS, including parents. VAERS can be reached at (800) 822-7967.
Second, identify the source of the concern about immunization that serves as the parents' reference. Is it based on recognized medical or scientific organizations? Point out that several organizations like the American Academy of Pediatrics, the American Academy of Family Physicians and federal health agencies like the CDC are in agreement about the value of vaccines and make recommendations for immunization practices.
In some instances it may be appropriate to intervene with the source, especially if inaccurate or misleading information is made public and published in your local newspaper. A letter to the editor from a local physician can help to set the record straight.
If the source is chiropractic science, one approach is to point out that chiropractors are not in agreement about the value of vaccines. The largest U.S. chiropractic professional organization is the American Chiropractic Association (ACA). The ACA policy on immunization practices states that "the ACA recognizes and advises the public that: Vaccination has been shown to be a cost effective and clinically practical public health preventive procedure for certain viral and microbial diseases as demonstrated by the scientific community." The policy goes on to state that "the use of vaccination is not without risk and that the association supports each individual's right to freedom of choice in his or her own health care based on informed awareness of benefits and possible adverse effects of vaccination (ACA 1996)."
Third, help the patient evaluate the specific concern. Many groups that put out information about vaccines on the Internet may have official-sounding organizational names, when in actuality they are not science- or medical-based organizations and primarily serve to reflect the opinions of individuals. If the topic of concern is published in a journal, point out that it is the weight of scientific evidence or number of studies showing the same result that determines fact from fiction. If only one study suggests an association it cannot be assumed to be factual until it is verified by other researchers. Several recent vaccine safety allegations that some patients may have seen are based on isolated studies that have never been confirmed.
Fourth, don't alienate the patient by simply dismissing their information source or becoming defensive. If you are not familiar with the specific concern, don't try to fake it but use your resources to investigate the question and get back to them or to refer them for more information. You might want to discuss with the parents how the medical and public health systems protect the public and the safety of vaccines. Governmental agencies like the Food and Drug Administration, the CDC, and professional medical associations as well as scientists are continually monitoring and studying the safety of vaccines. The suspension of rotavirus vaccine this summer was a good example of how the system works.
Fifth, use your resources. Every physician who administers vaccines is required under the National Childhood Vaccine Injury Act to supply a Vaccine Information Statement (VIS) to the parent or guardian of the child receiving recommended vaccines. Some concerned patients need other resources to double-check information that they receive from you and others, and an effective intervention on your part is to recognize this need and provide them with additional resources to further gather information. Feel free to share the number for the CDC Immunization Hotline: (800) 232-2522 (English) and (800) 232-0233 (Spanish). The hotline has a knowledgeable staff who is aware of current vaccine safety rumors and facts. The vaccine has since been pulled voluntarily from the market by the manufacturer.
The NIP also has a Web site that includes information about vaccine safety. See www.cdc/nip.gov. For the specific Web page on vaccine safety see www.cdc.gov/nip/vacsafe/. You might also want to pick up for your office the book What Every Parent Should Know About Vaccines by Paul Offit, MD, and Louis Bell, MD.
Sixth, if all else fails, agree to disagree. There are some individuals who have already made up their mind about vaccine risks and benefits. The best thing you can do in these instances is to state your own beliefs about the importance of vaccination and respect their final decision. You might also want to counsel them on specific measures they will need to take if their child comes down with an infectious disease, e.g., keeping their child out of school.
Beth Hibbs, RN, MPH, is with the National Immunization Program, Centers for Disease Control and Prevention.
What Should Physicians Do? |
|---|
| 1. Learn about the parents' belief systems. |
| 2. Identify the source of the concern about immunization that serves as the parents' reference. |
| 3. Evaluate the specific concern. |
| 4. Don't alienate the parent by simply dismissing their information source or becoming defensive. |
| 5. Use your resources. |
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