There are reasons that I’m not a pediatrician. First, and foremost, I like surgery. Indeed, when I first entered medical school, my intent was to become an academic internist, but things didn’t quite work out that way. To my surprise, when I did my surgery rotation I liked it way more than I ever thought I would, even with the then 100+ hour weeks. (This was long before the time of work hour restrictions on residents or medical students.) Then, when I did my internal medicine rotation, I found it far less interesting than I thought I would. So when it came time to apply to residencies, I ended up going for surgery, and the rest is history.

Pediatrics is basically like internal medicine, except for children. I actually liked my pediatrics rotation a bit more than internal medicine, but not enough to be inspired to become a pediatrician. I also note that when I was in medical school, the antivaccine movement was not nearly as big a problem as it is now. It was far less frequent that pediatricians had to deal with antivaccine parents, and they were a lot less sophisticated then. They didn’t have a repertoire like this one described by Marcella Piper-Terry, as described in Preparing for the “Well-Baby” or “Well-Child” Visit if You Don’t Plan to Vaccinate. It’s basically a blueprint describing how to be the sort of parent that drives pediatricians to drink.

Piper-Terry starts out with an almost Rod Serling-like vibe, which would be appropriate given the fantasy that follows could easily have found a home in The Twilight Zone, except that parents 55 years ago desperately wanted more vaccines against infectious diseases that their children suffered from. Maybe it would be appropriate in a revival. The only difference is that, instead of “Imagine if you will...” the story is introduced with “Let’s pretend,” which, I suppose, is also appropriate given that this is fantasy:

I have received a notice from my family doctor (or pediatrician) that it is time to bring my children in for their “well-baby” and “well-child” check-ups. Getting that notice makes me feel sick to my stomach. I know that I do not want to further vaccinate my older child, and I know that I do not want to vaccinate my baby at all. My decision has not been made lightly. I have spent many hours researching and learning about vaccines, their ingredients, the lack of placebo-controlled studies, and the fact that they have never been studied for safety or efficacy as they are administered according to The CDC’s Childhood Schedule.

See? Fantasy. It’s utter BS that there are no placebo-controlled studies of vaccines. How many would Ms. Piper-Terry like me to list? This link provides a start, as do Dorit Reiss and our scaly friend the Skeptical Raptor.

The bottom line is that not only are individual vaccines tested in randomized placebo-controlled clinical trials when it is ethical to do so, but they are tested over the background of the existing vaccine schedule. Moreover, although it would be unethical to do a randomized, placebo-controlled clinical trial of the whole vaccine schedule because it would leave the control group unprotected against vaccine-preventable diseases, contrary to what antivaccine activists claim there are studies comparing unvaccinated and vaccinated children. Guess what? They find either no difference in health between the vaccinated and unvaccinated, or they tend to find that the vaccinated have better health. The bottom line is that the vaccine schedule is efficacious, safe, and evidence-based, contrary to how antivaccinationists try to portray it.

None of this stops Marcella’s antivaccine fantasy:

I have also prayed about this. A lot. When I allowed my older child to be vaccinated, I felt a horrible sense of dread every time. I “knew” it was wrong. My mother’s intuition was screaming at me to grab my baby from that table and run out the door… but I didn’t know why… and I didn’t listen to that voice. I realize now that that voice… that “intuition”… is the voice of God. I didn’t listen before, but I am listening now. And now, I know why vaccinating my babies is not right for my family. I know better now; so now, I will do better.

OK, for one thing, I don’t care if she prayed a lot. Prayer tells us nothing about scientific issues like vaccination, and, given that pretty much all major Christian religions except the occasional fringe sect strongly support vaccination I doubt that God (if he exists) would tell this woman not to vaccinate her children. Quite the contrary, actually. As for “intuition,” again, so what? Intuition doesn’t overrule decades worth of scientific research.

Because of this vague feeling of unease, the mother in this story, fearful of being “bullied” (yes, antivaccinationists love to portray efforts to persuade them that their pseudoscience is pseudoscience as “bullying” even though it is they who tend to use the most violent rhetoric), comes up with a plan. That plan starts thusly:

Find out exactly what vaccines my children are “due to receive.” Call the doctor’s office and ask which brands of vaccines they use. Find out what the ingredients are in those vaccines. Print the Material Safety Data Sheets (MSDS) for those ingredients. Print the vaccine manufacturer’s inserts for each vaccine. Print out the state law regarding school attendance.

Now, oh-so-sensitive antivaccine-sympathetic apologists or just sensitive pro-vaccine advocates might think I’m making fun of a parent here, but the whole lead-up to this parent’s visit with the pediatrician demonstrates that she is not simply a parent who is “on the fence” or frightened because she heard bad things about vaccines. She is clearly a hard-core antivaccinationist. You can tell because of what she writes and how she’s lining up her ducks to use standard antivaccine tropes to try to make her case to her child’s doctor. You can tell, for instance, just from the list above that she’s going to use two mainstays (at least) of antivaccine rhetoric. Regular readers will spot them immediately, but let’s let the writer lead us into them, for the benefit of newbies, to allow me to do a bit of Socratic teaching, and, most importantly, to allow for a bit of Insolent commentary. Remember, this is the same woman who has likened vaccination to rape and argued that measles is good for you.

Ms. Piper-Terry begins by invoking a tool of the Orwellian-named National Vaccine Information Center (NVIC). I know, I know. I called the NVIC “Orwellian-named” just yesterday, but to be honest, I really do think that the NVIC should change its name to the Orwellian-Named NVIC, or ONNIVC, because that is a more accurate description of it. Be that as it may, Ms. Piper-Terry invokes the NVIC Vaccine Ingredient Calculator. It’s a “tool” that’s been around a while, and when I last wrote about it, I referred to it as a disingenuous deceptive instrument of vaccine fear mongering because that’s exactly what it is. It takes some accurate information and presents it in a very dishonest, deceptive manner to make it look as though vaccine ingredients are very dangerous.

No wonder she thinks it’s legitimate to do this:

The following is a partial list of ingredients in vaccines given to infants and children in the U.S. (click each ingredient to view the Material Safety Data Sheet (MSDS): Aluminum Hydroxide

Thimerosal

Formaldehyde

2-Phenoxyethanol

Triton X-100 If you click on each of the above links, you will be taken to the MSDS for that vaccine ingredient. Scroll down and look at the information under Section 3: Hazards Identification. This is where you can learn about: Carcinogenic Effects – the KNOWN ability to cause cancer

Mutagenic Effects – the KNOWN ability to cause alterations in DNA (FYI… alterations in DNA cause childhood cancers)

Teratogenic Effects – the KNOWN ability to cause harm to a developing fetus in utero

Developmental Toxicity – the KNOWN ability to cause harm to children in one or more ways

As an example, Piper-Terry displays the MSDS for thimerosal, which can be found at this link. Of course, I’ve discussed nearly all of these ingredients many times. The problem with looking at the MSDS for chemicals is that they refer to health problems that can potentially occur after exposures working with the chemical. In other words, it’s referring to a much higher exposure than anything that could come about from vaccines. One has to remember that the MSDS is designed as a worker safety tool, not a listing of health hazards that such chemicals in vaccines might pose. OSHA requires laboratories to have copies of the MSDS for each chemical in the laboratory because workers might be exposed to the pure form during handling, storage, or use. Notice on the MSDS for thimerosal how it refers to acute oral toxicity. (Hint: We don’t administer thimerosal-containing vaccines orally), with an LD50 in rat listed at 75 mg/kg, which is a pretty high dose. It refers to inhalation as well. (Hint: We don’t administer vaccines by inhalation.) In other words, she’s using the MSDS for the wrong purpose.

As for aluminum (it’s safe in vaccines), thimerosal (it doesn’t cause autism or neurodevelopmental disorders), formaldehyde, and Triton X-100 (which is nothing more than a detergent), I’ve discussed all of them at one time or another. It’s all nothing more than a variation of the “toxins” gambit, or, as I like to put it, Why are we injecting TOXINS into our babies? Here's the thing. The dose makes the poison, and none of these chemicals in vaccines are present at a dose that is dangerous. But they do have scary-sounding names, and some of them have a scary MSDS. That's enough for vaccine denialists like Piper-Terry.

Next up:

Another good thing to put in my binder is the Excipient List from the CDC, which lists all of the vaccines, their ingredients, and substances used in their manufacture. Next, I need the Vaccine Manufacturer’s Inserts for each vaccine.

On each vaccine manufacturer’s insert, I will highlight the part where it says the vaccine should not be given to anyone who has an allergy to any of the ingredients in the vaccine. Given that my child has not been tested to determine if he or she is allergic to any or all of the ingredients, there won’t be any injecting going on just so we can see what happens.

This is what I like to refer to as “argument by package insert” or “appeal to the package insert.” It’s a ploy that ignores the fact that package inserts are not medical documents, but legal documents. They are, to put it briefly, a “CYA” document. As such, they list every adverse event ever reported in any clinical trial, whether the event is related to the vaccine or not.

These are, of course, a profoundly intellectually dishonest ploys, particularly the misuse of the MSDS. Does Piper-Terry actually demand this level of safety for anything her kids eat? For any supplement she gives them? Somehow I doubt it. The sole purpose for this ploy is to delay, delay, delay. It’s also profoundly cruel in a way. If the doctor actually went down this road, it would involve extensive allergy testing in the child, which would mean sticking lots of needles in him. It’s also entirely unnecessary, because it is generally known and assumed by physicians that a “history” of an allergic reaction means a history of a clinically evident allergic reaction that came about from everyday living, not an allergy that was only discovered because the child was subjected to extensive allergy testing. It’s also not referring to just any allergic reaction, but a serious one, an anaphylactic reaction. Given the low prevalence of such reactions, it would be enormously expensive to do this sort of testing, and the yield would be incredibly low. Yet, here, Marcella Piper-Terry thinks parents should demand such testing because she thinks her child is a special flower.

She’s not just intellectually dishonest, though. She’s just plain dishonest:

If, after this discussion, my doctor still wants to grasp at straws and tell me that my child cannot go to school without vaccines, I will calmly point out that (in Indiana, and 46 other states) we have the right to religious exemption from vaccination for school attendance, and that as my children’s parent, I will be exercising that legal right on their behalf.

In other words, she advocates lying about one’s religion in states with religious exemptions.

In California:

If I live in California, I will take advantage of the fact that when Governor Brown signed SB277 into law last year, he expressly stated that the medical exemption from vaccination was completely at the doctor’s discretion, and is not limited to the very narrow criteria for medical exemptions set forth by The CDC.

And it’s true. There are a fair number of “alternative” doctors offering medical exemptions for sale. That, too, is dishonest, but it’s probably unavoidable. A law as strict as the one in West Virginia, for instance, wouldn’t have passed in California. However, the pediatrician seeing this mother doesn’t have to be one of them and, more than likely, won’t be one of them.

Marcella Piper-Terry concludes by fantasizing about going all Donald Trump on her doctor:

If my doctor attempts to bully me after all of this, I will calmly inform him (or her) that I am aware of my rights and I am aware that the only laws regarding vaccination are for school attendance. I will also let him (or her) know that I am aware that physicians are receiving bonuses for meeting benchmarks and having a certain percentage of patients fully vaccinated by age two years. I will let the physician know in no uncertain terms that coercion (threatening to call CPS, for example) is unethical and possibly against the law (look up the definition of extortion), and I will be reporting him (or her) to the state medical board for ethics violations. For good measure, I will probably throw in, “And you’ll be hearing from my attorney,” as I pick up my babies and walk calmly and confidently out of his or her office. For the very last time. The last thing I will say, if it gets to this point? “You’re fired.”

It’s a fantasy I’ve seen many times before (e.g., here). Also, whatever she’s smoking, I want some. Actually, no I don’t. I don’t smoke anything. She does, however, seem to be smoking something, as no one’s likely to report a parent to CPS just for not vaccinating, and physicians have no power to “coerce” or “bully” other than their words and powers of persuasion.

Here’s the irony. The pediatrician won’t be harmed or even likely that upset by this Brave Mother telling him he’s fired. In actuality, he’ll probably be relieved not to have to deal with her any more. In fact, it wouldn't surprise me if he did a little jig, turned his eyes skyward and whispered "Thank you," or pumped his fist in the air while mouthing the word "Yes!" once out of sight of the mother. The only one who is harmed by the mother’s failure to vaccinate is her child.