A fascinating article was published in the July 2007 issue of Pediatrics, the journal of the American Academy of Pediatrics, regarding physician knowledge of vaccine concerns among parents. The purpose of the study was to evaluate the effectiveness of a tutorial program intended to improve physicians' knowledge about parents' resistance to vaccines and the physicians' attitudes toward these parents. The very existence of this study and project reveals that the medical community has recognized the growing conflict between parents and physicians concerning vaccination.
It is interesting and noteworthy that the impetus for concern over vaccine safety in the medical community arises from parents' refusal to accept the recommendations for standard vaccinations, rather than from the compelling scientific evidence of vaccine dangers. The title of the article, Addressing parents' concerns about childhood immunizations: A tutorial for primary care providers, led me to expect another propaganda piece dismissing parents' concerns and fears as irrational. Happily that was not the case. Although the intent of the study was to educate and inform pediatricians about the need to reassure parents and continue the campaign for universal vaccination, the tone of the article and the results of the study were refreshingly respectful of parentsï¿½ intelligence.
The author Benjamin H. Levi is professor of humanities and pediatrics at Penn State. He is the director of the Penn State Immunization Project. His stated goal for the Penn State Immunization Project is ï¿½to develop a model to help primary care providers transform what can be a volatile confrontation over parentsï¿½ concerns into a genuine, educational dialogue.ï¿½
Here is the description of the Penn State program that reveals the biases and goals of the author to promote vaccines.
Penn State Immunization Project
The project examines parents' resistance to routine childhood immunizations and explores the ethical, legal, and scientific dimensions of the issue. It has two components: 1) an educational tutorial for primary care clinicians to help them better understand and more effectively and respectfully address parents' concerns about routine childhood immunizations; 2) a relational database that identifies allegations raised against routine childhood immunizations, and traces them back to their original source data--the goal being to create a conceptual map, a matrix, for understanding how allegations are amplified and perpetuated throughout society.
In the introduction to his study, Dr. Levi states that he has reviewed the articles in the medical literature and the informational materials (presumably the books) available to parents and professionals that question the safety of vaccines. Perhaps this reading has led him and others in his group to a more realistic and respectful view of the sophistication level of parents as consumers of vaccines. But perhaps Dr. Levi might address the concerns about vaccine safety a bit more objectively than attempting to trace the amplification of the allegations through the society. His assumption that vaccinations are a ï¿½safe and effective toolï¿½ reveals his own conclusions that the ï¿½allegationsï¿½ are misinformed.
Back to the study. A 45 minute tutorial was prepared for the study and administered to 122 pediatric and family medicine residents in 7 training programs. They were each administered a pre- and posttest questionnaire regarding their knowledge of vaccine safety and their attitudes toward parents who resist or oppose vaccines. The author acknowledges the growing number of parents who resist vaccines, and the alarming number of pediatricians who refuse care to these parentsï¿½ children (up to 40 percent of pediatricians in one study). He also recognizes and deplores a situation where these children may then have no place to go for medical care.
The results of the study show some remarkable changes in physician attitudes as a result of the tutorial. Physicians were asked to agree or disagree with the following statements before and after taking the tutorial.
ï¿½It is understandable that many parents are concerned about the risks of vaccination.ï¿½
Prior to the tutorial 81 percent agreed with this statement, and after the tutorial 98 percent agreed (29 percent of the physicians changed their response). I suspect because the material presented in the tutorial informed physicians of the alarmist and vocal call of vaccine opponents, not because the tutorial presented the alarming dangers of vaccines.
ï¿½Parents receive mixed messages about routine childhood immunizations.ï¿½
On the pretest 78 percent of physicians agreed, and on the posttest 99 percent agreed. Ditto.
ï¿½Most adverse reactions to routine childhood immunizations are insignificant by any measure.ï¿½
To give credit to this tutorial, 69 percent of the physicians changed their response. Only 30 percent disagreed pretest and 76 percent disagreed posttest, which shows that these doctors did change their mind about the possibility that vaccines can cause significant, and reportable, adverse reactions.
ï¿½Most parents who resist/oppose vaccinating their children are unreasonable.ï¿½
Again 61 percent of the doctors changed their response. Only 49 percent disagreed pretest and 88 percent disagreed posttest. At the least, parents are gaining respect for their views (at least in the eyes of Dr. Levi and in the way he conveys their sentiments.)
ï¿½Physicians are professionally justified in refusing to care for children whose parents oppose routine childhood immunizations.ï¿½
The pretest response of the residents was consistent with most other pediatricians in the field. Only 68 percent disagreed with this statement. However after the tutorial, 85 percent disagreed. Well, thatï¿½s something at least. A total of 45 percent of the doctors changed their response.
Perhaps all pediatricians should take the tutorial. Children might then have the benefit of medical care again. And this study and the tutorial may also serve to give parents the credit they deserve.
Dr. Levi states in no uncertain terms, ï¿½It is a parentï¿½s right (and responsibility) to decide what is in their childï¿½s interests, including immunization.ï¿½ If this study garners more respect for parents who have made an informed decision about vaccination, then it has served a valuable function.
Reference: Levi BH. Addressing parentsï¿½ concerns about childhood immunizations: A tutorial for primary care providers. Pediatrics 2007, July; 120:18-26.