Speaking as a family doc and public health epidemiologist, I find it to be subversive and dysfunctional to apply "shared decision making" to immunization policy. I hope you will discuss this in detail in future posts.
(1) "Informed consent" is always appropriate and the ubiquitous VIF forms and the attendant discussions have contributed greatly to educating families.
(2) "Shared decision making" is a concept beyond informed consent deviously borrowed from clinical medicine (not a public health concept) which is best applied to an individual ill patient's specific clinical circumstances where RX choices are unclear, multiple, risky, of concern to the patient or uncertain.
(3) In fact, as vaccines are intended to be given to healthy people and large populations, they must undergo heightened evaluation for safety. In fact this has been and has been an ongoing process for all vaccines in use. This has led to the (much criticized) delay for COVID vaccines for pregnant women and the discontinuation of some vaccine formulations. Current HHS policy makers have ignored all the evidence in this regard while providing distorted (mis)information. It has been more than unscientific and disingenuous for federal officials to emphasize 10 (as yet unproven) vaccine caused deaths among 130 million vaccine administrations. Even if there were 10 deaths, in the real world of inherent risks in all medical endeavors, this would be a highly regarded proof of excellent safety.
(4) Current policy makers have purposely chosen to avoid looking at immunization as inherently a population-based strategy striving for herd immunity. Sadly this has led to the lack of leadership in the appropriate and proven best response to the still expanding measles epidemic.
(5) It is human nature and unavoidable that during "shared decision making" any (or all) concerned moms would naturally discount the inherent increased value and benefit to the general community of vaccinating her child (even to accept the safe pain from the injection itself). This factor has been overcome in the past by public health policy educating the public on the community value of herd immunity. Current federal officials have deviously destroyed this dynamic.
RFK needs to be impeached for making decisions and policy without scientific data. The head of HHS needs to be qualified in the fields that he/ she runs.
Indeed about shared decision making. In *1972* our daughter's pediatrician started an ongoing discussion about withholding the measles vaccine. She was not yet one year and had spent weeks hospitalized for treatment of a brain condition. Each visit, discussion, including his private questioning of infectious disease specialists/vaccine advocates. When finally deemed safe because of her age and progress, we all breathed a sigh of relief. In the meantime, we all depended on the herd immunity of her peers. And of course the wise counsel and shared decision making of our favorite physician.
Thanks for all this info. The flooding that Marin County experienced sent my brain right back to Fair Oaks in one of those El Niño years. My school district demanded staff go to work. I had to drive slowly and turn around many times to just get out of my neighborhood. You could not see the water filling every low area. When I finally got to flat Greenback Lane (major 4-6 lane artery), I had to drive close behind a big vehicle that parted the foot-deep waters. Terrifying. When I arrived at my school, classes had been cancelled. The local creek had flooded roads and the buses couldn’t manage that level of flooding. Decision-making in a crisis is so important. The bad decision forcing us teachers to risk our vehicles and lives meant we were less likely to obey decisions in the future. Trust was lost.
Speaking as a family doc and public health epidemiologist, I find it to be subversive and dysfunctional to apply "shared decision making" to immunization policy. I hope you will discuss this in detail in future posts.
(1) "Informed consent" is always appropriate and the ubiquitous VIF forms and the attendant discussions have contributed greatly to educating families.
(2) "Shared decision making" is a concept beyond informed consent deviously borrowed from clinical medicine (not a public health concept) which is best applied to an individual ill patient's specific clinical circumstances where RX choices are unclear, multiple, risky, of concern to the patient or uncertain.
(3) In fact, as vaccines are intended to be given to healthy people and large populations, they must undergo heightened evaluation for safety. In fact this has been and has been an ongoing process for all vaccines in use. This has led to the (much criticized) delay for COVID vaccines for pregnant women and the discontinuation of some vaccine formulations. Current HHS policy makers have ignored all the evidence in this regard while providing distorted (mis)information. It has been more than unscientific and disingenuous for federal officials to emphasize 10 (as yet unproven) vaccine caused deaths among 130 million vaccine administrations. Even if there were 10 deaths, in the real world of inherent risks in all medical endeavors, this would be a highly regarded proof of excellent safety.
(4) Current policy makers have purposely chosen to avoid looking at immunization as inherently a population-based strategy striving for herd immunity. Sadly this has led to the lack of leadership in the appropriate and proven best response to the still expanding measles epidemic.
(5) It is human nature and unavoidable that during "shared decision making" any (or all) concerned moms would naturally discount the inherent increased value and benefit to the general community of vaccinating her child (even to accept the safe pain from the injection itself). This factor has been overcome in the past by public health policy educating the public on the community value of herd immunity. Current federal officials have deviously destroyed this dynamic.
RFK needs to be impeached for making decisions and policy without scientific data. The head of HHS needs to be qualified in the fields that he/ she runs.
thank you Matt. I appreciate the reminder about Tamiflu, also Im glad you’re doing videos with the text . it’s easier on my old eyes!
Indeed about shared decision making. In *1972* our daughter's pediatrician started an ongoing discussion about withholding the measles vaccine. She was not yet one year and had spent weeks hospitalized for treatment of a brain condition. Each visit, discussion, including his private questioning of infectious disease specialists/vaccine advocates. When finally deemed safe because of her age and progress, we all breathed a sigh of relief. In the meantime, we all depended on the herd immunity of her peers. And of course the wise counsel and shared decision making of our favorite physician.
Thanks for all this info. The flooding that Marin County experienced sent my brain right back to Fair Oaks in one of those El Niño years. My school district demanded staff go to work. I had to drive slowly and turn around many times to just get out of my neighborhood. You could not see the water filling every low area. When I finally got to flat Greenback Lane (major 4-6 lane artery), I had to drive close behind a big vehicle that parted the foot-deep waters. Terrifying. When I arrived at my school, classes had been cancelled. The local creek had flooded roads and the buses couldn’t manage that level of flooding. Decision-making in a crisis is so important. The bad decision forcing us teachers to risk our vehicles and lives meant we were less likely to obey decisions in the future. Trust was lost.
Thank you!