According to a national analysis conducted by an employee at the Vermont-based Physicians Computer Company (PCC), the majority of U.S. pediatricians will turn away patients who refuse to vaccinate their children. The findings come on the heels of California’s ongoing measles outbreak, which has renewed a broader dialogue over vaccine policy, making doctors’ approach to the issue a national concern.
Chip Hart, the company’s Director of Strategic marketing and principal author of the study, discovered that 54 percent of the nearly 500 practices surveyed have some vaccine requirement, and will refuse treatment to parents who don’t comply.
Hart told ThinkProgress that he was surprised the numbers were that high. “I didn’t think it would be a majority,” he said. “My gut feeling was that it would be in the 30-40 percent range.”
PCC brands itself as a consulting firm for pediatricians. Since the early 1980s, the business has offered goods and services to help doctors manage their schedules, pay their bills, and track vital issues like immunization rates. This pre-existing network allowed Hart to mail his survey out to roughly 5,000 pediatricians across the country, of which 497 responded.
“Although it’s possible that we have some selection bias,” he acknowledged, “I think we’ve got a pretty good spread of pediatric practices in the results.”
Since at least one person infected with measles visited Disneyland during the year-end holidays, California has been grappling with an outbreak that has resulted in 123 cases across 12 counties, at least 39 of which have been directly linked to the theme park. The outbreak has put the spotlight back on people who choose to forgo federally recommended vaccines. Although the CDC reported that the United States officially eliminated the measles in 2000, pockets of people resisting vaccination have given the disease a chance to return.
For over a decade now, a small but vocal population of skeptics has painted the pro-vaccine community as enthralled with “Big Pharma.” They claim that mainstream medicine pushes unnecessary and even toxic shots on the general public as a means of generating corporate profit. The measles vaccine has been particularly contentious. While critics maintain that this shot can cause autism, the Centers for Disease Control and the overwhelming majority of medical scientists refute that claim, since it’s been scientifically disproved time and again.
The recent spread of a preventable infectious disease has led California legislators to propose a policy solution: Tightening the state’s personal belief exemptions for childhood vaccines. As it currently stands, parents in this state are able to enroll their children in school without immunizations if they can first prove they’ve visited a doctor. Exceptions are also made based on religious beliefs.
But doctors also have some role to play in the effort to prevent people from skipping out on recommended shots. Considering the fact that waiting rooms are particularly high-risk environments for disease transmission, especially very contagious diseases like measles, some doctors have started refusing to accept anti-vaccine patients.
It’s an unsettled ethical dilemma. According to the American Academy of Pediatrics, “In general, pediatricians should avoid discharging a patient from their practices solely because a parent refuses immunizations for the child.” But some pediatricians have recently spoken out in favor of the opposite position, saying that they need to protect their patients.
As Dr. Eric Bell, a pediatrician in Southern California, told NPR earlier this month, “I have several patients a day who have threatened to leave our practice if we are still going to see patients that are unvaccinated. They do not want to see patients with measles or whooping cough in our waiting room for fear their baby might get sick from it.”
According to Hart’s findings, of the pediatricians who require that patients vaccinate, 98 percent specifically necessitate the MMR inoculation that protects against measles.
Hart also found that, among the practices that made the switch to a vaccine requirement, 58 percent lost a few patients. But 61 percent of practices received a positive reaction from the patients who remained, while only 2 percent noted a negative reaction.
Perhaps the most provocative finding involves parents’ response to doctors taking a stand. Of the practices that switched to a vaccine requirement, 68 percent reported that some new families opted to comply, and 17 percent answered that many new families permitted their children be vaccinated.
“This last bit gets at whether or not a doctor should even begin by assuming that there is a space for questions on vaccinations,” Hart said. “If you advertise that you don’t require vaccines, that solidifies the distrust of them. If you, as a physician say, ‘I’m not going to make you do this’ then the patient thinks it’s just not that important.”
In an interview with CBS last month, Dr. Margaret Van Blerk, a pediatrician in Orange County, California, expressed the frustration that often results when patients are given the option to opt out of vaccines. “It’s just frustrating that they don’t listen,” she lamented, “because they come to us to take care of their children, and yet they don’t trust us.”
While the paternalistic view that doctors know best and should assert their power accordingly is not without controversy, there is some evidence to support the claim. A widely cited study published in the Journal of the American Academy of Pediatrics concluded that, “Refuting claims of an MMR/autism link successfully reduced misperceptions that vaccines cause autism but nonetheless decreased intent to vaccinate among parents who had the least favorable vaccine attitudes.”