How is it that antivaccine pediatricians keep their medical licenses?

By oracknows on August 11, 2017.

One of the most important responsibilities pediatricians have to assure the health of the children they take care of is to make sure they are vaccinated. Over the last 100 years, childhood mortality has plummeted such that it is no longer common to lose a child (or children) to infectious disease.

Indeed, it is now very uncommon, if not rare, to lose a child to the diseases that were the scourges of prior generations of children, largely thanks to vaccination. Diseases like polio, whooping cough, smallpox, diptheria, the measles, and several more, that once were the scourges of children everywhere. Even in my father's generation, childhood mortality was not uncommon. Indeed, my father lost siblings to what are now vaccine-preventable diseases.

In part, that's why one of the most disturbing aspects of the antivaccine movement to me is how many pediatricians have betrayed their profession and their duty to children by pandering to antivaxers or even becoming antivaccine themselves. It's particularly frustrating because MDs and DOs should know better. Their training should have, if you'll excuse the term, immunized them against the pseudoscience, misinformation, and lies of the antivaccine movement. However, pediatricians are humans too, and humans are prone to the same sort of cognitive issues that lead others to confuse correlation with causation and as a result become mired in confirmation bias in which they remember every case or bit of information that reinforces their preexisting views and ignore or dismiss cases or bits of information that contradicts those views.

We've seen this phenomenon many times, dating back to the very origins of this blog and earlier. Perhaps the most famous example of a pediatrician who's betrayed his patients by becoming antivaccine (or at least pandering enthusiastically to the antivaccine movement) is Dr. Robert Sears, better known to his fans as "Dr. Bob." Another pediatrician "star" among antivaxers is Dr. Larry Palevsky, who appeared in an antivaccine movie. So did Dr. Rachel Ross, a family practice doctor who used to be on the daytime fluff medical show The Doctors and has now hitched her wagon to the antivaccine propaganda movie VAXXED. Indeed, after her "enlightenment" to the "evils" of vaccines, she even went so far as to write a letter of apology for having vaccinated so many children in her practice for so long and, in her mind, having caused so much harm.

Speaking of VAXXED, that's how I found out about the latest traitorous pediatrician who's gone antivax. Her name is Dr. Cornelia Franz, and she's doing videos with antivaccine activist Polly Tommey and the VAXXED crew:

Notice how in the interview she wears her stethoscope. I note that doctors who appear on television or in videos frequently wear the trappings of their profession in order to assert their authority. Think Dr. Mehmet Oz wearing scrubs on his TV show to shout to the audience, "I'm a surgeon, ma-an! Respect my authoritay!" Think, well, The Doctors, where the emergency room doctor also wears scrubs and some of the other doctors sometimes wear lab coats.

Dr. Franz doesn't quite go full flea by wearing a white coat and draping her stethoscope around her neck, mainly because most pediatricians don't wear white coats when seeing patients because it can scare their young patients. So wearing a stethoscope around her neck serves the purpose. You know from the very fact that she agreed to be interviewed by Polly Tommey and featured on the VAXXED YouTube channel that Dr. Franz is not going to issue a full-throated defense of vaccines, to put it mildly, and she doesn't. In fact, she parrots a whole bunch of the usual antivaccine tropes.

For instance, she parrots the trope that kids today are sicker than they've ever been. Let me put it this way: Even if that were true (and, other than the elevated prevalence of obesity in children and its attendant complications, it's arguable whether it is true or not), there's no evidence that it's vaccines that caused it.

Yet Dr. Franz assumes that it is vaccines:

As more time went on, I started seeing truly vaccine injured kids. I started seeing a lot of autistic children, and their parents all said the same thing. They said: My child was fine till they got this shot and then within a week, we lost him. …They quit having eye contact, they lost language. And I heard that so often, and so then I started doing research. And the more I started researching, the more I found that the ingredients were also toxic.

I can tell you today, having been in clinic practice for over 30 years, that the children I see today are sicker than they were when I was a resident. It’s like they’re genetically weaker. And we give four times, quadruple, the number of vaccines that we did when I started practice. …

There’s a sign …that says by the time your kids is five, they get 81 different vaccines. It’s really 117, and it’s not really vaccines, but it’s antigens. So like a DTP is diphtheria, tetanus, and whooping cough, and there are three ingredients. So you get diphtheria, tetanus, whooping cough—you get five of those total. So you get 15 different components there. Hib has three separate strains, so you get four times three, you get 12. Prevnar has 13 strains of pneumococus, so you get four times thirteen, 52. When you add all that up, leaving out the flu vaccine, you get 117 different vaccine antigens by the time they’re five.

When I started practice, they got 30 to 33. So it’s huge. What I can tell you is from clinical practice because my field is clinical practice, not research. I’ve just seen so many vaccine injured kids. It’s over and over and over.

There's so much misinformation and misattribution to unpack there. For instance, our pediatrician apparently has no clue about the age-old concept that the dose makes the poison. Yes, some vaccines contain chemicals like formaldehyde, but formaldehyde is a byproduct of normal metabolism and the amount of formaldehyde in the vaccines is tiny. Similarly, all the other horrible "toxins" that antivaxers cry about in vaccines are present in such low levels that they are not a concern. A pediatrician should know this, but apparently this particularly pediatrician does not, which is a shame.

Also, what the hell is this idiocy about children today being "genetically weaker"? Does she really think that children's genetics could possibly have changed significantly in a mere few generations? No one who has clue one about genetics and evolution would say something so completely ignorant, but Dr. Franz did.

Of course, she also bought into the antivaccine trope of doing whatever it takes to make it sound as though the number of vaccines children receive on the CDC schedule is unreasonably, unscientifically huge. Indeed, the bit about the number of vaccines is well nigh incoherent, but even that's not scary enough. So she starts switching between the number of vaccines and the number of antigens as though the two were interchangeable. Like most antivaxers, she doesn't do the math. Most likely she can't.

The key, of course, is that what she can tell you is from "clinical practice" and that her field is "clinical practice." Does that sound familiar? We've heard another pediatrician with a proclivity for pandering to the antivaccine movement invoke his "30 years of personal clinical experience"? I've pointed out many times before how deceptive "personal clinical experience" can be, particularly if you have a predilection to blame vaccines for all sorts of health problems and even more particularly if you have sufficient arrogance of ignorance and a tendency to fall into the trap of viewing vaccines as "unnatural."

Oops:

My practice is integrative. So we do both traditional and non-traditional. In our practice, our policy is we don’t even start vaccines till age one because it’s not the kid’s immune system until really after six months, and it’s really not strong till 12 months. So we don’t even begin until age one. That way, I don’t have a lot of problems with them early on.

“Many parents come to us because they don’t want to vaccinate the traditional schedule with 5 and 6 shots at a time. We support what they want to do, and it’s turned out really well because these kids seem to be much healthier than previous decades.

And check it out. Dr. Franz's practice offers homeopathy (a.k.a. The One Quackery To Rule Them All). Consistent with that, her entire practice is "integrative medicine," which "integrates" quackery with real medicine. Just peruse her website if you doh't believe me. In fact, it goes well beyond that:

Early on in practice, there were kids that would come back that were ill, and I found myself saying, ‘Oh, it’s a coincidence. Oh, it couldn’t be the vaccine.’ And then one day I stopped and went—because I didn’t believe what was coming out of my mouth. I had to stop and think about it, and I went, ‘This doesn’t make sense.’

“So you start looking, and you start listening, and you listen to the parents: ‘What motivation do you have to lie to me? I need you to tell me what’s wrong with your child, and I need you to make connections.’

“I’m also a homeopath, and so we do homeopathy and one of the big things in homeopathy is ‘Never been well since.’ And it happens very often. People will say, ‘I have never been well since I had the flu.’ ‘I have never been well since I broke my leg.’ ‘I’ve never been well since I had a vaccine.’

“And that has to be real. It’s a very clear point in time.

So Dr. Franz has forgotten everything she was taught in medical school. First of all, she's a homeopath, which means she's an über-quack just because of that. Remember, to be a homeopath, you have to believe that to treat a symptom you need something that causes that symptom and that diluting a remedy makes it stronger, even if you dilute it so far beyond Avogadro's number that the chance of there being even a single molecule of the original starting compound left is vanishingly small. She also forgets about the existence of confirmation bias and selective memory, which are both traps doctors need to avoid when they hear a patient say "I've never been well since..." whatever incident they've come to associate with their illness.

She's also a quack because she practices pediatrics like this:

...We don’t give the measles vaccine till age 3. I won’t even entertain it. I would then ask you what is your problem with measles. What is your fear, what is your concern? I would educate you on that because measles is a virus. It can cause problems. It’s going to cause more deadly problems in people who are vitamin A deficient because we know the measles, mumps, rubella shot drains vitamin A stores, and then that creates a disconnect in the brain, and many kids become autistic after that. …

I try and debunk what is your fear about measles because there are alternative ways to treat it that are equally as safe, that bring you through it with no harm.

So not only does Dr. Franz refuse to vaccinate children with a safe vaccine against a disease that can cause very real complications out of a fantastical fear that it will cause autism, but she tells parents that there are "alternative ways" to treat the measles that are safe and will bring the child through measles with no harm. I don't know which is worse, but that latter claim is utter nonsense, a delusion, pure quackery. There are no such treatments for measles.

The only reason that Dr. Franz can get away with practicing this way is because, thanks to the MMR vaccine, measles remains thankfully very uncommon (although pediatricians like her are trying their best to change that through their irresponsible practices) and, fortunately, measles only kills roughly one in a thousand of its victims and produces encephalitis in two or three times that many. Back in the days before the vaccine, there wasn't much anyone could do about those complications, but today the existence of a safe and effective vaccine there means that there is no excuse not to reduce those complications and death to zero.

I'm also confused. Dr. Franz seems to be saying that measles causes autism, which it doesn't (although rubella infections during pregnancy can result in autism in the child), although I suspect that she's just using a relatively incoherent explanation of why she thinks the MMR causes autism because MMR is a live virus vaccine. Then there's this:

I’m very adamant and passionate about not giving Gardasil. I did give it to five girls initially …and all five had bad reactions. Fortunately, none of them were lethal, none of them were long term crippling, but it was enough for me. And then when I did the research on that—the last time I looked at the data, Gardasil had killed 120 girls outright, it has maimed over ten thousand, it is causing premature menopause,…

No, it is doing nothing of the sort. Gardasil does not kill, even though that is a frequent claim of antivaxers. (Some have even published a guide to blaming your child's death on vaccines.) It does not cause premature ovarian failure, even though that is a favorite claim of antivaxers. Gardasil is safe and effective at preventing infection with the most common strains of human papilloma virus associated with cervical cancer. Then, Dr. Franz goes down the fundamentalist Christian rabbit hole:

I actually have an ethical issue with it too. …What happened to teaching our kids values? …Why do you need a shot?

This is one of the stupidest anti-Gardasil arguments out there, but it's frequently repeated by antivaxers. They seem to think that girls think, "Wow. I had a vaccine that will prevent me from being infected with HPV and getting cervical cancer in 20 years. I can now have as much sex with as many boys as much as I want!" Besides the utter implausibility of arguments like this, there is plenty of evidence that Gardasil vaccination does not lead to promiscuity. She's also very suggestible. During her interview, she goes on and on about vaccine injury; yet when Tommey asks her point blank whether she's seen vaccine-injury in her practice, she answers:

Not that I can recall from my own practice. I have received patients who have been injured after age one. Yeah, lots of them actually because that’s when the MMR is, after age one. So in that age group of giving it at 12 to 15 months, I think there’s probably the largest number of problems with autism afterwards.

So wait a minute. She's never actually seen the "vaccine injury" that she's railing against. She's only "received patients who have been injured after age one." Who diagnosed this "vaccine injury"? Or, to Dr. Franz, is any child with autism automatically considered to be "vaccine-injured"? Yet, since stopping vaccinating, Dr. Franz claims she's never seen a case of shaken baby syndrome in her practice and this:

The other thing that I’m seeing, and I don’t have any evidence or numbers to back it up, so this is what they call anecdotal or clinical empirical evidence. I’ve been in practice long enough now that some of my own patients are coming back with their kids. …I can actually tell you that the unvaxxed kids are healthier.

I’ve been in practice long enough that I can also tell you that if the unvaxxed kids are a problem, if my population is a problem, then according to what’s out there, they should have a very high risk and there should be a lot of hospital admissions for my unvaxxed kids getting those things. And I’m seeing the opposite. They’re not. …The children I have who are unvaccinated are across the board, healthier. …

They say that the most dangerous words out of any physician's mouth are "in my experience." In any case, what you see above is pure confirmation bias. She believes vaccines are harmful; therefore, she be far more likely to remember cases that confirm her bias, such as children with chronic illnesses who were vaccinated and healthy children who are unvaccinated, and to forget cases that do not confirm her bias, such as healthy vaccinated children and unvaccinated children with health problems.

As for the reason why there aren't so many admissions of unvaccinated children for various diseases, apparently Dr. Franz doesn't understand the concept of herd immunity. As long as vaccination levels stay high enough, the unvaccinated will have some protection.

However, as I recently discussed, it doesn't take much of a decline in vaccine coverage to lead to large increases in vaccine-preventable diseases.

Seriously, the concentration of stupidity and ignorance in Dr. Franz's interview is black hole density. Whenever I encounter a pediatrician like Dr. Franz, I wonder how she keeps her medical license and board certification.

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Unfortunately, as the strategy of more pediatricians moves to simply firing parents who don't want to fully vaccinate their kids (not that I support pandering to their fears and pushing alternative schedules), you have to wonder if we will see more and more of these holistic and integrative pediatricians.

I wonder how she keeps her medical license and board certification.

Florida men.

I've reported anti-vaccine physicians to state medical boards three times and the complaints have all been dismissed. Only one time did I get an answer as to why: protection under the 1st Amendment for free speech: http://tinyurl.com/q2vl2r4 . I guess, as a physician, you can (with your MD/DO on full display) publicly advocate for anything completely contrary to the standard of medical care and not suffer repercussions even when it's clear your are damaging public health--because there's no doctor/patient relationship between you and the public. To me when a doctor publishes a book/blog or goes on TV as a physician, that has always, to me, been professional speech, which isn't given the same 1st Amendment protections.

I sure wish there was a state medical board out there willing to set a precedent on this--namely that public speech from a doctor clearly endangering the public health constitutes medical incompetence. (maybe Dorit can present this more concisely than I'm stating it).

"because my field is clinical practice, not research."
That part was true.

I'm on board with Chris Hickie but wonder if it should not be state medical boards, but if instead we need to give powers to public health officials.

@ Vincent Ianelli

Maybe we have to ask what we would think about pediatricians reluctantly accepting that some parents' vaccine fears can't be assuaged, and offering (but not "pushing") alternative schedules under duress. The arguments would be: 1. Delayed schedules are a compromise for these parents, who otherwise might not get their kids immunized at all,
2. If we could turn otherwise un-vaxed kids to just late-vaxed kids, that would benefit community immunity, maybe enough to prevent the next Disneyland type outbreak.
3. If parents are turning to 'holisttic' pediatricians like Cornelia Franz just to get an alternative schedule, that's leading them into full-on comprehensive crapola like homeopathic treatment for serious illness and Gardasil-shaming, putting kids in threat well beyond the delay of the vaccinations.
4. This visits the 'sins' of the parents on the child, so pediatricians who "fire" vax hesitant parents are arguably violating their ethical responsibility to the children in a more profound way than the questionable ethics of delaying immunization.

Note, fwiw, I'm not necessarily taking this position, just trying to frame some issues for discussion...

The last bit is also inconsistent with the first part, because she said what turned her anti vaccine was seeing children with symptoms after vaccines that she first dismiss as coincidence and then didn't.

But if she's a homeopath, expecting her to follow evidence based medicine is a little unrealistic, isn't it?

By the way, Dr. Rachael Ross is a family doctor, not pediatrician.

Family practice doctors take care of children too, but you're right and I forgot.

I’m also a homeopathgullible idiot

FTFY, Dr. Franz. No charge.

Chris@3: Freedom of speech does not mean freedom from consequences of that speech. Though an argument could be made that you have to show the doctors in question are actually acting on their own bad advice and not vaccinating children who can and should be vaccinated. Due to privacy laws, that would be much harder to prove, since the parents of the unvaccinated child are unlikely to complain. Sadly, I think it will take a significant epidemic to change the minds of your state's medical board.

@ Vince #1: I think there are more of these worthless holistic docs out there because there have been no professional repercussions against the founding quack peds such as Sears/Gordon/Pavelsky. There are always going to be some sh*tty docs in every specialty (the ones you and I wouldn't let care for sea monkeys let alone children), but now these crappy ones (who can't make their practice work along the traditional model of taking insurance and fee-for-service) have discovered they can cater (if they set up in the right part of town) to the crunchy holistic parents and make a better salary not even having to take insurance by doing things like "tele consults" and selling supplements and worst of all homeopathy.

The ultimate display of woo docs crawling out of their holes has to be the group "Physicians for Informed Consent" which is an anti-vax doc group hiding behind the faux veneer of "consent" for opposing vaccines. This group would not exist if so many anti-vax docs in the US this last decade hadn't discovered how they can fly their woo flag for fame and profit.

@ Sadmar

pediatricians who “fire” vax hesitant parents are arguably violating their ethical responsibility to the children

Please don't forget in issue framing that pediatricians have an ethical responsibility towards all of their patients, not just the ones whose parents wish for a delayed/lightened vaccine schedule.

Having children of various ages in the waiting room is already complicated, in term of avoiding child A to gave whatever illness it got to child B. If you add children carrying sturdy, highly-transmissible viruses in the fray... The measles virus can survive 2 hours in a room between hosts. By only allowing older children who already got measles, or the measles vaccine, pediatricians can guarantee to the parents of younger children not yet vaccinated that, at least, their child won't catch measles while visiting the facilities.

It may not be a big issue in a small practice, where the pediatrician will only have 2 or 3 families to manage at a given time, but for pediatricians working from inside a specialized clinic...

Like all quack doctors, she simultaneously pretends to be against Big Pharma, while at the same time selling her woo products to strangers and her patients alike.

http://www.thefranzcenter.com/product-category/herbs/professional/

I wonder when the last time she (and any quack like her) saw a patient in the hospital. Since they rarely work with actual sick kids, they are blind to the harm they cause.

Disgusting.

Orac writes,

Notice how in the interview she wears her stethoscope.

MJD says,

I noticed in the interview that Dr. Franz is positioned in front of a black-pillow labelled "VAXXED" and a pink-bag labelled "PRAY BIG".

Q. Is this a subliminal message.

Would it be more effective if the pink bag said "BUY ME"?

@ Orac's minions,

Are there other phrases that would improve such a prop?

@Dr Ianelli, you appear to be blaming the hardline actions of paediatricians who fire non-vaccinating families for rising numbers of non-vaccinating patients.
I'm on the side of the doctors who fire patients. Practices have a duty of care to all their patients. Unvaccinated children pose a risk to those who are immunosuppressed (like juvenile cancer patients and organ recipients) and those who are too young to be vaccinated. Allowing "vaccine-averse" families endangers children in these groups.
@sadmar #4, the position you raise for discussion is interesting, but sadly doesn't match with the real world.
Many paediatricians engage with "vaccine-averse" parents for years, and still get nowhere. There comes a point where it is obvious the parent is not going to budge, and allowing the family to be treated there poses the patient groups I mentioned above at risk of getting diseases from the unvaccinated children. Firing parents is typically a last resort, only used when all else has failed.

I searched Science blogs for the term iantrogenic and nothing came up.

I'm not excusing holistic medicine, but aren't you pointing out the speck in their eye, while not seeing the log in your own? Asking for a friend...

Spelling the word "iatrogenic" correctly would be a start.

This woman’s speech is as garbled as the Idiot In Chief occupying the White House (occasionally). It was difficult to wade through the various contradictory and nonsensical claims.

She looks terribly unhealthy as well. I wouldn’t let her near any of my family, including the dog. Thankfully, the new baby in our family just got her shots and Mom (who’s rather crunchy and impressionable) assured me that she knew all about “that horrible British doctor who started all that vaccine-autism stuff”.

Holy crap! The prices she charges for her online stuff! If I was so inclined, I can buy them much cheaper on Amazon. And her gullible parent-clients lap it up and pay her much more then the cost. And the poor children suffer.

@Yvette: her site says "Patients are admitted to the Arnold Hospital for Children and Women" which does not mean she actually has admitting privileges there.

She's a quack of the first order, even if she is an MD, she's put her learning aside to make money and promote quackery: We also recommend and refer to massage therapists, craniosacral therapists, and practitioners in acupuncture and Traditional Chinese Medicine. (source INFO)

Screwed up the link. Sorry. My HTML skills need work. Here it is in long form.
ttps://static1.squarespace.com/static/52dd69b9e4b086a638888be7/t/530222aee4b07059d2119ac9/1392648878475/April+2013+Dr.+Franz+-+Open+Forum.pdf

And the quack said this: "I started doing research. And the more I started researching, the more I found that the ingredients were also toxic."

No Dr. Quack, you did not do "research." Research means designing a study, getting permission from an IRB board, conducting an experiment, analyzing the data, and publishing the results. Your claim to have done "research" is an insult to the thousands of doctors and scientists who actually conduct research, but don't feel the need to promote themselves as being "awake" on YouTube videos.

@Julian Frost "Firing parents is typically a last resort, only used when all else has failed."

The AAP policy statement frames it as a last resort, but that is not the way many pediatricians seem to be using it now and that is my concern.

How can it be a "last resort" if docs don't even accept patients who have questions about vaccines?

It is also not an evidence-based practice.

@Julian Frost "you appear to be blaming the hardline actions of paediatricians who fire non-vaccinating families for rising numbers of non-vaccinating patients."

Pretty sure I was connecting them with the rise of holistic pediatricians. It would be an interesting study. Are there more holistic pediatricians in areas where pediatricians don't accept vaccine-hesitant parents?

@ Sadmar #5: The AAP now (finally) has allowed that pediatricians may fire electively non-vaccinating families from their practices as a last resort ( http://pediatrics.aappublications.org/content/pediatrics/early/2016/08/… ). So w/r/t ethics, it is not unethical and I have done this in the past because seeing unvaccinated older children infecting newborns with pertussis in one's waiting room is a bad thing.

As to pandering to AV fears, letting parents space out vaccines does nothing more than put kids behind on being protected against very preventable diseases with no proven benefit to the child ( https://www.scientificamerican.com/article/delaying-vaccines-increases-… ).

Equating the number of vaccines with the number of antigens is a tactic I hadn't seen before, but Franz ramps up the deception by using the time honored antivaxer formula of counting each dose as a separate vaccine.

This is like telling someone who got a prescription for an antibiotic to be taken twice daily for two weeks, "Omigod! They're having you take 28 antibiotics!!!"

Pro-immunization advocates (if they were similarly prone to lying) could use the antigen ploy to claim that vaccines protect children from thousands of infectious diseases (counting each antigen as a separate disease).

Note: the number of vaccines recommended for all children up to the age of 18 in the AAP-endorsed schedule is 13, not 117.

*"I started doing research" is an altie trope right up there with "I started my healing journey".
**I ran into an online antivaxer yesterday who actually employed the Brady Bunch measles episode as a reason not to vaccinate. I feel like a birder who finally spotted a species in its wild habitat.

@Chris Hickie: Medical boards are arms of the state. There is no "professional speech" exemption to the First Amendment.

On the other hand, practicing the way that Dr. Franz openly says she practices is something state medical boards should be able to look at. However, the problem is almost certainly that state medical boards need a complaint. If no one complains, there's little they can do.

"No Dr. Quack, you did not do “research.”"

To them research means using an internet search engine two or more times.

The replies to my post fail to adequately address the question of relative risk and relative ethics. Of course, we want all children vaccinated on schedule. But a delayed schedule is a benefit to the child if the only other choice the parents will consider is not vaxing at all. Furthermore, a never-vaxed kid is certainly more of a danger to public health than a late-vaxed kid. The key point for dangerous kid-to-kid contact is when they begin school, thus SB277 does actually prevent outbreaks. As long as community immunity remains at a reasonable level, it's unlikely that kids with measles will appear in a waiting room, and sensible cautions can be instituted.

A community would only need one practice where a non-woo physician would offer an alternative schedule "as a last resort". And physicians could still 'fire' vaccine-averse parents who refused to accept that compromise. Again, 'firing' parents who would accept a delayed schedule only helps quacks like Franz build a practice, exposing kids who might be brought to her for the delayed schedule to all other sorts of bad medicine. And some of these alt-docs may be happy to provide bogus medical exemptions to parents who balk even a little at the delayed schedule...

@ Orac #24
I don't know much about medical boards. Can complaints only come from patients reporting some negative thing that happened between them and the doctor? If a third party can't file a complaint based on a bad practice the physician admits to having actually done, why should that be written in stone? Since anything involving these boards growing a pair seems to be pie-in-the-sky, is there some reason they couldn't change their complaint procedures is they were so inclined? Or could the state mandate certain guidelines the board would have to follow, via legislation or otherwsie?

In California complaints can come from third parties, and can even be based on the public health.

But those tend to be taken less seriously, I think.

@ Chris Hickie

I'm not willing to accept the AAP as the final arbiter of ethical responsibility. :-)

Please know I do sympathize with what you go through. I don't think there are any easy answers here. One way or another, this is a dilemma you shouldn't have to face, leading to hurt you shouldn't have to bare.

I wonder if believing in homeopathy in any manner is a prerequisite for becoming an anti-vaxxer?

First of all, it defies logic

but secondly, the belief that very small amounts of a substance are more powerful than larger amounts works because the belief that the tiny amounts of diverse substances within a vaccine ( a small volume in itself) could move about the body wrecking havoc in the GI tract and brain is beyond reason.

For a real poisonous substance to destroys neurons etc would take enough of that substance to go around.
They always compare vaccine 'damage' to Minamoto but seriously - the amounts involved are quite different.

@11 I was all set to purchase 2 oz. of Wonderful Cream - Professional. A face life in a bottle and a bargain for only $90!! Sadly, it's out of stock.

@Dr Ianelli: OK, I'll concede I should have worded things better.

How can it be a “last resort” if docs don’t even accept patients who have questions about vaccines?

In reality, those "questions" all too often aren't. They have been asked and answered hundreds of times before, and very often, the "sceptics" ask the same questions over and over, just rephrasing them slightly.
The bottom line is, I don't blame paediatricians for refusing to accept families who "question" vaccination. As for the rise of doctors who push alternate schedules, I suspect the vaccine averse families would have wound up there anyway.

@sadmar #24:

The replies to my post fail to adequately address the question of relative risk and relative ethics. Of course, we want all children vaccinated on schedule. But a delayed schedule is a benefit to the child if the only other choice the parents will consider is not vaxing at all.

"If". And all too often, a delayed schedule becomes more and more delayed, and more and more spread out.

Sadmar: In my practice we do exactly what you are suggesting. I work very hard to allay vaccine fears in my parents, but as has been discussed here many times, arguing against irrational concerns with rational facts is a fool's errand. Nevertheless, we do have some success in certain areas. In our practice we have had 2 babies die of pertussis over the last several years, which does carry a lot of weight. We have also had a case of disseminated HIB disease. I can usually get DTaP and HIB into my infants. In older kids I lean hard to get MMR and Hep B. I frequently give a speech I call "clear and present danger" which I find to be pretty effective. I would love to get 100% uptake, but if I can get the vaccines that are most important in my area (pertussis, HIB) and start the discussion for the others, I count that a win. Just to put this in perspective, we have a large population of well educated Dunning-Kuger victims and some evangelical antivaxxers making our lives interesting here.

How can it be a “last resort” if docs don’t even accept patients who have questions about vaccines?

Somebody can correct me if I am wrong, but outside of an emergency situation, doctors (like other professionals) have some latitude over whom to accept as clients/patients. As we see from the ongoing White House follies, it is entirely appropriate for a lawyer to decline to represent somebody he reasonably believes will not follow his advice. Why would it not make sense for a doctor to decline to accept a patient who (or in this case, whose parents) would be unlikely to accept the doctor's advice, particularly if the failure to heed such advice might potentially endanger other patients?

Certainly there are inappropriate reasons to refuse to accept a new patient. Anything based on gender, national origin, or the doctor's religious beliefs would clearly be inappropriate. But it is entirely appropriate for a doctor to consider the welfare of his existing patients. That's his job.

A good pediatrician should be able to tell the difference between having general questions about vaccines, and showing signs of being strongly influenced by anti-vax types. It's fine to ask what the possible side effects are (physicians are supposed to provide that information anyway), or whether something about the child's medical history (whether they have a cold today, or are allergic to eggs, or so forth) suggest that a particular vaccination should be delayed or even omitted. But if the questions the parent asks sound as if they might have been asked by Gen. Jack D. Ripper, that's a bad sign.

Is there a way we can estimate the number of parents who eshew SBM entirely and take their progeny to chiropractors ( as PCP), herbalists, homeopaths, Chinese medicinists,,woo-sters?
Dr Franz ( and others we discuss) may be the tip of the iceberg.

"So wait a minute. She’s never actually seen the “vaccine injury” that she’s railing against. She’s only “received patients who have been injured after age one.”"
___
It's actually more than that, I think. She's making an argument of the following:

A. Vaccination causes many, frequent, and severe injuries
B. I used to vaccinate a lot of kids
C. But despite the fact that vaccination causes these injuries and I vaccinated, no one I ever vaccinated ever suffered any injury
Therefore:
You can't sue me for malpractice

Does anyone actually pay attention to MJD? It appears that he's always talking to himself in these threads. Just asking for a friend...

Who?

I totally ignore him.

Does anyone actually pay attention to MJD?

No. When he is coherent, he tends to be pushing his pet crank theory.

Over at SBM, Clay Jones writes about a Chiro surgeon that does in utero spinal manipulations. What type of mother (or father) would allow such a thing. I hope Orac provide us with his usual insolence on this topic.

It was a satire, Rich.

But satire and real life are becoming one recently.

Chris (#39) writes,

I totally ignore him.

MJD says,

That's not ok, Chris. :-(

I speak to be heard and write to be read.

For example, my latest book is about climate change.

http://www.cambridgescholars.com/patents-and-climate-change

Notice in my biography that there's a reference to this science blog (i.e., Respectful Insolence). :-)

@ Orac,

What do I need to SAY or DO to get the hell out of auto moderation?

Does anyone actually pay attention
Wait, we're expected to pay attention to other people in a comment thread?!
Too late now.

Thanks Jane, my satire meter doesn't work well sometimes. The story read to much like things that really happen,

One of the first things you should do before reading an article by Dr. Jones is to go the bottom and check for the "humor" and "satire" tags.

It's a fine line for pediatrics to dismiss patients when the families don't vaccinate. My feeling has always been that that would be punishing the child for something they have no control over.
I have had a couple of parents get concerned when told we accept unvaccinated children. I tell my staff if an unvaccinated child comes in with fever/rash to room them immediately. We also immediately room all babies up to about 2 months old either sick or well. I have a small office and don't have separate sick/well waiting rooms.
I offer to space out vaccines only if parents express concerns about the schedule.
In 21 years practice, I've seen febrile seizures & mild rashes after vaccines. I think it was in med school, I had one patient who had seizures and developmental delay after DTwP. I've had one patient develop ITP after MMR. I have NEVER had a parent come to me and tell me their child developed autism after a vaccine.

I used to see a chiropractor for my chronic neck and back pain (result of many work injuries and a couple of car accidents). The one I saw in California was fantastic. He kept me mobile and working.

The one I had in North Carolina was more aggressive with my neck than I liked. But when he started going on about how babies need spinal adjustments after birth for "birth trauma" I was done. I quit going and haven't been back since.

Does anyone actually pay attention to MJD? It appears that he’s always talking to himself in these threads. Just asking for a friend…

Sometime, he does provide me with entertainment material.

Alain

Does anyone actually pay attention to MJD? It appears that he’s always talking to himself in these threads. Just asking for a friend…

Sometime, he does provide me with entertainment material.

Yeah, me too. I used to respond and tweak him, but that's loosing it's appeal (too easy), and it's frankly starting to get a little sad. I think it really turned the corner for me a week or so ago when he posted congrats to Jake for getting his MPH.

D'oh!

Dr. Hull: "I tell my staff if an unvaccinated child comes in with fever/rash to room them immediately. "

How does that protect your youngest patients from measles. An airborne virus that will hang around your waiting room and clinic halls for at least two hours.

In looking around the Franz Center I noticed that the person listed for nutrition has the letters MS, CNS, CGP after her name.

Does anyone know if any of those means "dietitian" or do we just have more woo ?

I live in Canada where our medical delivery system differs (cough) slightly from that in the USA. In my limited experience, I have never seen a medical office running a gift store.

Is it even ethical for a doctor's office to run a store? My personal feeling is that it is not but what do I know?

@Chris #52 It would minimize the time the child might be exhaling the virus in the waiting area. This would minimize the likelihood that anyone else would contract it, assuming the child actually has measles, which is highly unlikely given it's current prevalence in our society.

@ Chris 52 and Dr. Hull #47

Bringing the sick unvaccinated child back to a room ASAP decreases the chance of that child spreading whatever illness they have to someone else in the waiting room but it doesn't eliminate it. Ideally, of course, the parent of that unvaccinated child, when calling for that appointment, gave front office staff enough information for them to realize (or at least let the physician know) that a sick unvaccinated child is coming in and needs some isolation protocol applied (even better would be bringing the child in through the back entrance to a room, completely skipping the waiting room, which is something I'll routinely do--if I get the heads up about if from office staff. However, parents don't always describe their child's illness adequately when making an appointment and your office needs some way for staff to be alerted when making the appointment that the child is unvaccinated--which doesn't always happen with a new patient sick visit.

I didn't expel families who spaced out vaccine but stayed on schedule by booking shot only visits between well visits. I did expel completely non-vaccinating families had no valid medical reason not to vaccinate their children.

Speaking of chiropractors (do we have to?) here's another gadget for chiros to profit from (and a classic case of credulous reporting):

http://www.thehour.com/wilton/article/New-Canaan-physician-opens-Laser-…

jrdrideau: I tried looking up the alphabet soup. MS probably means Master of Science. CNS probably Certified Nutrition Specialist (not the same as a registered dietician). CGP I'm not sure about but it doesn't seem diet related. The only health related meaning I could find was "Certified Group Therapist."

The CNS certification seems legit. The sponsoring agency is a member of a reputable accrediting agency. What their scope of practice is compared to an RD I don't know.

Ophthalmologists often sell eyeglasses and contact lenses in their offices. I never buy mine there, because they are always over priced. So I suppose state BOM's don't have a problem with it, though I think it's ethically challenged if not outright unethical.

But then again, doctors used to run their own labs and xray services to increase their revenue until they were forced to stop, so it's not exactly a new idea.

Chris: I agree with Dr. Hickie. Ethically, you're on thin ice for refusing to see a sick child who's already with your practice just because they're not UTD on vaccination, or even completely unvaccinated. The child needs to be seen, and the only other option is to send them to the ER. That's just kicking the can down the road and exposing THOSE patients, some of whom may be quite a bit sicker or have autoimmune problems than the mostly well child population that comes through a pediatrician's office.

Room the sick kid immediately, get him to wear a mask if you can, and let the room sit empty for at least two hours after the kid leaves if you really do think it's the measles or chickenpox (might not be, might be roseola or something benign) is really the safest solution for everyone.

THEN fire the parents if they continue to refuse to vaccinate after pointing out the s*** storm they just caused.

Ophthalmologists often sell eyeglasses and contact lenses in their offices.

There's something I've happily never seen.

@Beth clarkson #55:

... assuming the child actually has measles...

In the hypothetical example, we have an unvaccinated child displaying the clinical symptoms of a Measles infection. As increasing numbers of parents become ""vaccine hesitant", the risk rises.

FYI: Prevalence is the number of existing cases divided by the total population. Incidence is the number of new cases divided by the population at risk. Yeah, we have a low prevalence, but that's the nature of a disease that is not chronic. We have an intolerable incidence rate, though. Intolerable for a developed nation with widely available vaccine.

# 58 Panacea

Thanks for the detective work.

My suspicion, then, is the CNS is a respectable but lesser qualification than dietitian but not woo which sounds okay. Come to think of it, that does not prevent the holder of the designation from recommending green tea and kale smoothies and a puré of dung beetles which would not surprise me at the Franz Clinic.

The CGP may be some kind of throw-away designation.

I just remembered I'm entitled to FD after my name. However Friends of Darwin may not be a very relevant qualification in most places and I probably will not put it on my CV.

It might look good on my Applied Nutritionist business card. Motto: You supply the food, I'll eat it. I had some spare business card stock and printed up a few nonsense cards. A friend of mine is now Manager of F*k Ups. His own request.

I have only had a couple encounters with ophthalmologists, one in a hospital setting (no shop) and another in a clinic and the clinic was not selling anything.

I agree, though, 'It’s ethically challenged if not outright unethical” for a medical doctor to be selling something. It is using the “white coat” to pressure a patient.

#57 Dangerous Bacon
I don't see why you are do disparaging. It looks sciency enough to me. I have a BMI of 21 so I'm on my way immediately to lose some weight.

Are you sure that it reporting and not paid advertising? Sheesh, credulous does not even begin to describe this article.