How to Deal with Anti-Vax Individuals

[NecrotizingFasciitis]

I've become incredibly conflicted on how to handle this issue lately.. especially after reading an article a friend, who shares my frustration on this, sent me:

Article: Scientists, Stop Thinking Explaining Science Will Fix Things. It Won’t.

I found the article a bit disheartening.. but interesting.

In the past I haven't had much success addressing anti-vaxxers. It seems that, from my experience, no matter how many peer-reviewed studies and thorough explanations you have saved up, they just ignore it all and adhere to their ignorance. So when I read the above linked article, I resonated with it a bit.

1.) Thoughts/strategies on how to effectively deal with this issue?

2.) Med students/residents/physicians: how often do you find you have to discuss this with patients? How does the conversation typically go?

3.) In medical school, do they discuss how to have discussions like this with patients?


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[NurWollen]

Well, the anti-vaxxers will just claim that the scientific consensus is tainted and 100% unreliable because of big pharma. Ironic then that when you can actually get them to list some research that supports their beliefs, they list a bunch of articles from the same fee authors printed in pay-to-publish foreign journals. (If that, usually they just spew some crap about 'the truth is out there but you have to discover it yourself.') Their illogic is unassailable.

Also Trump ordered the FBI to raid the CDC don't ya know. If it's on Infowars it must be true.
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[DO2015CA]

Well, the anti-vaxxers will just claim that the scientific consensus is tainted and 100% unreliable because of big pharma. Ironic then that when you can actually get them to list some research that supports their beliefs, they list a bunch of articles from the same fee authors printed in pay-to-publish foreign journals. (If that, usually they just spew some crap about 'the truth is out there but you have to discover it yourself.') Their illogic is unassailable.

Also Trump ordered the FBI to raid the CDC don't ya know. If it's on Infowars it must be true.
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this is what makes "dealing with them" a problem. In my experience while working in peds, it starts off as a cool headed conversation because they think they can "win" the argument like they do with their medically uneducated friends. But once they realize theyre getting backed into a corner, the conversation becomes a screaming match on their part. This is only worsened when the pediatrician drops studies on them.

 

[Jinxapotato]

I would just leave them to their own belief....No vaccine = lesser chance of offspring survival, just wait till Darwinism kicks in and voila problem solved.

BTW I recently saw an anti-vax thread on FB, some of the comments are out right hilarious...And they are STILL using the autism trick!

 

[NontradCA]

As far as patients go, everyone's going to handle this in their own way. Generally, you'd be non-confrontational while explaining the risks and benefits as you would with anything else. If people don't want your help, you have to focus energy on those that do. This applies to non-compliant patients as well.

 

[Staphylococcus Aureus]

This addressing who? patients, friends?
For patients, Paul Offit has some good responses on caring for their child too much to offer substandard care (dropping studies on them is unlikely to work).

For non-patients, I usually don't engage in debate and call them out, usually a one sentence "If you have that conclusion it's not worth discussing because I know you don't understand how to read the evidence."

 

[EmergDoc2B]

You have to be passive and try and point them in the right direction with literature. If you attack their viewpoint they will double down on their beliefs. It's more psychology than I can explain. Here is a great article on the subect.

Throwing Science At Anti-Vaxxers Just Makes Them More Hardline

 

[Scrubs101]

For non patients:

Educating them on how to be scientifically literate is usually what i go for.

For example the guy who is known for starting the anti-vaxx trend and making that connection to autism had his credentials stripped for falsifying data. But even if didnt, his n was = 12 or something in the teens cant remember.

Theres a plethora of data out there showing that vaccines dont cause (or even correlate with) autism with n's > 1million data points.

(I understand that different types of studies require different n's to be statistically significant, i just think this is an easy thing to get for people that dont get it)

This is also the route i usually go for people that post bs "fake news" stories that are clearly fabricated, click bait, or lack journalistic integrity. Point out the flaws in what they say, explain to them where their/that argument goes wrong and how to understand what makes a valid article/news piece/scientific literature

To be honest it usually never works with the people i know, i just hope that doing a little bit of educating from time to time will help or change someone one day. But so far no matter how hard i stress to people to actually read into these things, they will just stick to what they want to believe


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[IsWhat]

Good science is always corrupted by politics. This is why the climate change/vaccination debates will live on until the end of time. It's your job as the physician to point your patients towards the good science. If they still don't believe? See ya.

 

[hallowmann]

The most effective (and I use that term loosely) tool that I've seen used is anecdotes. Study after study will be ignored and explained away. Telling them about your friend that didn't get their baby vaccinated and then the baby got pertussis and was hospitalized and intubated scares some of them into at least acknowledging that some vaccinations are helpful for babies.

To be honest though, I've never seen a hardcore anti-vax parent change their mind until they were basically forced to when their kid started school (thats assuming they don't shop around for a doc that will claim their kid is "allergic" or give them some other kind of excuse). And the catch up schedule is terrible. The kid gets tons of shots in relatively quick succession basically every time they're at the doctor. Its way better gradually and spread out when they're scheduled.

As far as having the discussion with people regarding getting vaccinations for themselves, I wouldn't even try to argue with them. They can choose to do what they want. If they'd rather get shingles and possibly post-herpetic neuralgia as opposed to Zostavax, so be it. Its only really worth it if you're dealing with kids.

 

[realmadrid23]

The best approach is just to vaccinate them when they aren't looking then talk to them in 20 years when they haven't died from a preventable disease

 

[NecrotizingFasciitis]

You have to be passive and try and point them in the right direction with literature. If you attack their viewpoint they will double down on their beliefs. It's more psychology than I can explain. Here is a great article on the subect.

Throwing Science At Anti-Vaxxers Just Makes Them More Hardline

I think this article put it a lot more eloquently than mine did. Good read.

For non patients:

Educating them on how to be scientifically literate is usually what i go for.

For example the guy who is known for starting the anti-vaxx trend and making that connection to autism had his credentials stripped for falsifying data. But even if didnt, his n was = 12 or something in the teens cant remember.

Theres a plethora of data out there showing that vaccines dont cause (or even correlate with) autism with n's > 1million data points.

(I understand that different types of studies require different n's to be statistically significant, i just think this is an easy thing to get for people that dont get it)

This is also the route i usually go for people that post bs "fake news" stories that are clearly fabricated, click bait, or lack journalistic integrity. Point out the flaws in what they say, explain to them where their/that argument goes wrong and how to understand what makes a valid article/news piece/scientific literature

To be honest it usually never works with the people i know, i just hope that doing a little bit of educating from time to time will help or change someone one day. But so far no matter how hard i stress to people to actually read into these things, they will just stick to what they want to believe


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This is exactly how it's been for me! Whenever I see the articles you mention shared on FB by the anti-vaxxers, I want write a novel of a comment pointing out flaws. Anytime I have tried pursuing this avenue though, I am met with more and more of these ridiculous articles. The ones that seem to be most gung-ho anti-vax definitely seem to further polarize into their position when met with attempts to prove them wrong using published work and reasoning.

The most effective (and I use that term loosely) tool that I've seen used is anecdotes. Study after study will be ignored and explained away. Telling them about your friend that didn't get their baby vaccinated and then the baby got pertussis and was hospitalized and intubated scares some of them into at least acknowledging that some vaccinations are helpful for babies.

To be honest though, I've never seen a hardcore anti-vax parent change their mind until they were basically forced to when their kid started school (thats assuming they don't shop around for a doc that will claim their kid is "allergic" or give them some other kind of excuse). And the catch up schedule is terrible. The kid gets tons of shots in relatively quick succession basically every time they're at the doctor. Its way better gradually and spread out when they're scheduled.

As far as having the discussion with people regarding getting vaccinations for themselves, I wouldn't even try to argue with them. They can choose to do what they want. If they'd rather get shingles and possibly post-herpetic neuralgia as opposed to Zostavax, so be it. Its only really worth it if you're dealing with kids.

I love the idea of an anecdotal approach. I could see people being more receptive to a story invoking an emotional response of some kind rather than being drowned in peer-reviewed literature.

The best approach is just to vaccinate them when they aren't looking then talk to them in 20 years when they haven't died from a preventable disease

 

[Mr Roboto]

The most effective (and I use that term loosely) tool that I've seen used is anecdotes. Study after study will be ignored and explained away. Telling them about your friend that didn't get their baby vaccinated and then the baby got pertussis and was hospitalized and intubated scares some of them into at least acknowledging that some vaccinations are helpful for babies.

To be honest though, I've never seen a hardcore anti-vax parent change their mind until they were basically forced to when their kid started school (thats assuming they don't shop around for a doc that will claim their kid is "allergic" or give them some other kind of excuse). And the catch up schedule is terrible. The kid gets tons of shots in relatively quick succession basically every time they're at the doctor. Its way better gradually and spread out when they're scheduled.

As far as having the discussion with people regarding getting vaccinations for themselves, I wouldn't even try to argue with them. They can choose to do what they want. If they'd rather get shingles and possibly post-herpetic neuralgia as opposed to Zostavax, so be it. Its only really worth it if you're dealing with kids.

I know someone who claims her kids are allergic to vaccines because after DTAP the son "had diarrhea for a week!"

 

[AnatomyGrey12]

Unfortunately it will probably take an outbreak of some previously eradicated disease that kills lots of unvaccinated people and kids to show them how important vaccines are. I have a family member who is anti-vax... if I have to hear the word "Autism" one more time.... But no, big pharma has clearly tainted any scientific study ever done on the topic and mommy bloggers clearly have this great coup all sniffed out.

 

[ScottTenorman54]

If you'd like to prime yourself on some of the common to-and-fro you'll get with anti-vax folks, check out this blog:

Vaccines Caused My Son's Autism - The Thinking Moms' Revolution

Written by a devout anti-vax crusader three years ago and to this day she continues to defend her position in the comments.

Excerpt: "
So here is the reason we no longer vaccinate… We followed all the “rules” vaccinated our older 2 on time and they got it all. We were never very comfortable with it but that’s what “everyone” did and what the professions said to do. Then by our 3rd child we were more uneasy about them. Plus were busy with the other 2. So we were late on all his and he never finished. Kiddo #4 got maybe 2 sets late and that’s it. Well fast forward 7+ years. We now have 8 (age 13-11mos)children. All FULL (same Mom and same Dad) siblings and ONLY our 2 oldest kids are sick!!!! Both have allergies and one has asthma!! None of the others show any symptoms of either. Explain to me how that is hereditary?!!
I have been on both sides and did my own research. I have proof in my own children. I don’t care what people with vested interests think or what people that don’t do their own research (more than reading a Big Pharma pamphlet or talking to a dr) think! If others want to believe in vaccinating go ahead but don’t call me crazy. If you believe vaccinations work, then you are safe, right?!

I just thank God we stopped when we did! I don’t want to imagine what health issues we would be dealing with now!"

 

[AnatomyGrey12]

Yeah there really is no reason to argue with them because the round about logic is insane. They are the kings of logical gymnastics.

 

[NurWollen]

Side note but it bugs me tremendously when people write dr for doctor in the middle of a sentence and outside the context of a title. Antivaxxers do it a lot.

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[samac]

I don't have any intentions on being a pediatrician but if I did and it's my patient and after discussing the pros with them they still say no I'm gonna say GTFO in the nicest way I can.

 

[NurWollen]

I don't have any intentions on being a pediatrician but if I did and it's my patient and after discussing the pros with them they still say no I'm gonna say GTFO in the nicest way I can.

I am going in to peds and who knows how I'll actually react, but on one of my Sub-Is when admitting a patient and I was taking a history and found that the girl wasn't vaccinated, I really didn't end up saying anything. It wasn't pertinent to the reason for admission and I didn't think fighting with a patient's mom would look good on a Sub-I lol. Maybe it'll be different when I am a resident. We'll see in a little over 60 days lol.

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[BorntobeDO?]

I am going in to peds and who knows how I'll actually react, but on one of my Sub-Is when admitting a patient and I was taking a history and found that the girl wasn't vaccinated, I really didn't end up saying anything. It wasn't pertinent to the reason for admission and I didn't think fighting with a patient's mom would look good on a Sub-I lol. Maybe it'll be different when I am a resident. We'll see in a little over 60 days lol.

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I am with you. We see non compliant patients in everything else and don't have a freak out session. Part of the reason this got to this point IMO is too many people drawing lines in the sand. Explain risk/benefits, your professional opinion, and then let them make up their mind, just like you would do for any other treatment. But those of you who want to kick out pts who don't want to vaccinate, by all means go ahead. Someone is getting all those pts, and they are probably concierge care.

 

[samac]

I am with you. We see non compliant patients in everything else and don't have a freak out session. Part of the reason this got to this point IMO is too many people drawing lines in the sand. Explain risk/benefits, your professional opinion, and then let them make up their mind, just like you would do for any other treatment. But those of you who want to kick out pts who don't want to vaccinate, by all means go ahead. Someone is getting all those pts, and they are probably concierge care.

I think everyone has their own personal line in the sand. Everyone has things that they're willing and not willing to do. I don't understand why you would have an issue with that.

 

[DO2015CA]

I am with you. We see non compliant patients in everything else and don't have a freak out session. Part of the reason this got to this point IMO is too many people drawing lines in the sand. Explain risk/benefits, your professional opinion, and then let them make up their mind, just like you would do for any other treatment. But those of you who want to kick out pts who don't want to vaccinate, by all means go ahead. Someone is getting all those pts, and they are probably concierge care.

You cannot compare these things. Treatments affect them, it isn't a public health issue. Your rights end when they start impinging on others' rights. They can make decisions that affect themselves and their children. These parents should not be able to make decisions for other parents' children. Vaccinations affect more than just their kids. That is why it's worth a line in the sand.

 

[Goro]

If you'd like to prime yourself on some of the common to-and-fro you'll get with anti-vax folks, check out this blog:

Vaccines Caused My Son's Autism - The Thinking Moms' Revolution

Written by a devout anti-vax crusader three years ago and to this day she continues to defend her position in the comments.

Excerpt: "
So here is the reason we no longer vaccinate… We followed all the “rules” vaccinated our older 2 on time and they got it all. We were never very comfortable with it but that’s what “everyone” did and what the professions said to do. Then by our 3rd child we were more uneasy about them. Plus were busy with the other 2. So we were late on all his and he never finished. Kiddo #4 got maybe 2 sets late and that’s it. Well fast forward 7+ years. We now have 8 (age 13-11mos)children. All FULL (same Mom and same Dad) siblings and ONLY our 2 oldest kids are sick!!!! Both have allergies and one has asthma!! None of the others show any symptoms of either. Explain to me how that is hereditary?!!
I have been on both sides and did my own research. I have proof in my own children. I don’t care what people with vested interests think or what people that don’t do their own research (more than reading a Big Pharma pamphlet or talking to a dr) think! If others want to believe in vaccinating go ahead but don’t call me crazy. If you believe vaccinations work, then you are safe, right?!

I just thank God we stopped when we did! I don’t want to imagine what health issues we would be dealing with now!"

Americans have a genetic inability to understand the concept of cause and effect, it seems. Also remember that when you're dealing with anti-vaxxers, you're dealing with a belief system. They're not merely irrational, but anti-rational.

 

[BorntobeDO?]

I think everyone has their own personal line in the sand. Everyone has things that they're willing and not willing to do. I don't understand why you would have an issue with that.

I will give you a hypothetical to explain my point. Do you kick smokers out and refuse to care for them just because they smoke and won't quit? They are actively harming everyone around (not just potentially, but actually). Aren't they a more worthy cause to draw the line at? But no one cares that much about it, even tho it is actual harm.

I have no problem with people drawing their own lines in the sand, do whatever you want as long as your not harming. But it still odd to me that most physicians who are so adamantly against non-vaccinating parents are perfectly okay with taking patients who are doing actual harm to themselves and others but refuse to stop. Do I refuse to treat a prostitutes STD because they won't stop their job? How about the Hep B positive IV drug user going around sharing needles? We see them both in the hospital frequently.

If that is wrong to refuse care to someone who is actively engaging in high risk activity's and much more likely to spread disease, then how is it okay to refuse an otherwise healthy patient who doesn't want a particular treatment? The cognitive dissonance is startling. It doesn't make sense to have that point of view to me.

Add in the fact that patients have the right to refuse, and thats how we get here. The mentality of trying to bully parents or marginalize their concerns clearly isn't working. In fact, you are playing right into the anti-vaxxers hands when you do it. I bet half of the so called anti-vaxxers would vaccinate if you let them go off schedule and showed you took their concerns seriously. I think that physicians are just as responsible as Jenny McCarthy for creating this movement with how we have chosen to react by and large.

 

[DO2015CA]

I think that your argument is that we shouldn't fire the patient because they won't vaccinate, not that it's okay to not vaccinate. The reason we cannot have patients who don't vaccinate is multifaceted but the legal obligation is most likely to resonate with you. In your medical ethics class you have learned that your malpractice case will be compared to standard acceptable care by your peers (key witness from a doc of your board certification). Maybe because I am going to school in Alabama, but we got a case of a civil suit against a pediatrician in the state of Alabama where a family that did not vaccinate. He thought the same as you, he had them sign a refusal form and continued treating the child. The child subsequently died from a preventable disease that we have a vaccine for. They sued him, and because the standard of care is vaccines and he was the expert. The family won the case which for multiple millions of dollars, ruining the pediatrician that was trying to be accommodating.

People will spout of anecdotal, but the fact that it occurred means the laws are written in a way for it to be a plausible outcome.

 

[BorntobeDO?]

I think that your argument is that we shouldn't fire the patient because they won't vaccinate, not that it's okay to not vaccinate. The reason we cannot have patients who don't vaccinate is multifaceted but the legal obligation is most likely to resonate with you. In your medical ethics class you have learned that your malpractice case will be compared to standard acceptable care by your peers (key witness from a doc of your board certification). Maybe because I am going to school in Alabama, but we got a case of a civil suit against a pediatrician in the state of Alabama where a family that did not vaccinate. He thought the same as you, he had them sign a refusal form and continued treating the child. The child subsequently died from a preventable disease that we have a vaccine for. They sued him, and because the standard of care is vaccines and he was the expert. The family won the case which for multiple millions of dollars, ruining the pediatrician that was trying to be accommodating.

People will spout of anecdotal, but the fact that it occurred means the laws are written in a way for it to be a plausible outcome.

Wow, I hope he appealed and fired his lawyer cause there is no way he should have lost. He had a refusal of treatment, he can't make anyone do anything. Shocking. Do you have a link, cause this sounds too crazy to be true. BTW, you are correct about my core argument.

So I tried to look up that story and instead I found a different anecdote with the same basic premise about a doctor in California 'some years ago.' Except it was an adult, not a kid. I believe this might be a bit of a urban legend. Still if someone finds it, I would love to read it.

 

[DO2015CA]

It was in one of my first year lecturers from a lawyer. Let me see if I can find it

 

[BorntobeDO?]

It was in one of my first year lecturers from a lawyer. Let me see if I can find it

Now I know it isn't true, lol. A lawyer lecturing you first year? Your school must be rowdy. Already using a show of force.

 

[ScottTenorman54]

My old pediatrician used to "fire" anti-vac parents. His reasoning was that in the initial conversation about refusing to vaccinate, he often got the impression that these parents were already highly distrustful (bordering on hostile when it came to some of the more militant ones) of him and the medical establishment. That they'd be likely to fight and challenge him on every issue regarding the child's health from that point on, and that it just wasn't worth the stress for both sides. And I think he has a fair point: the smoker who won't quit smoking doesn't believe the doctor has some sinister motives behind making him stop. Many of these anti-vac folks also tend to believe that doctors are in the pockets of big pharma and genuinely prioritize profit > health.

 

[DO2015CA]

Now I know it isn't true, lol. A lawyer lecturing you first year? Your school must be rowdy. Already using a show of force.

We had a few lecturers from a malpractice lawyer group. My guess is to scare us

 

[JustPlainBill]

During an elective peds rotation in 4th year with my children's pediatrician, there was a new patient to the clinic. About the time we stepped into the exam room, Dad promptly handed both of us a copy of an article written by "a doctor" discussing the problems with vaccination and how children should not be vaccinated and if the parents elected to vaccinate, offered an alternative, one at a time schedule. The Dad actually requested that we break up MMR and DTAP. I watched with great interest as the pediatrician (been in the business for almost 30 years at the time with a really nice, solid growing practice, well known and respected around town) told them that they were ok with alternate schedules but could not break up MMR and DTAP. He took the article promising to read it and went from there.

I looked at the article later on -- turns out it was written by an adult cardiothoracic surgeon in the Pacific Northwest. To me, that's like me writing about the complications of a CABG when I'm a pediatrician.

After I graduated and made it through residency, I stopped by just to chit-chat with the pediatrician (so this is like 4 years later) -- at that point, he commented that he was no longer taking anti-vaxers as it was too much of a problem for his practice.

You'll run into all kinds -- I know of physicians that fire patients for this kind of thing but then again, they also fire non-adherent patients with DM/HTN who refuse treatment, no show appointments and other such nonsense. This is no different than the lunatic fringe who insists on doing everything "naturally" -- I usually relate the story of the patient who was admitted to my service in residency who had blown his liver with an OTC bodybuilding supplement from GNC -- put himself on the DILI transplant list and they were trying to keep him alive until he could get a transplant. Sometimes I'll also go into my physician's inner monologue when I'm doing the subsequent exam as I'm ruling out the diseases they haven't been vaccinated for/are refusing treatment for -- usually by the 3rd big, bad evil disease, they ask me to stop and get adherent or go away....

 

[DokterMom]

I'm wondering if announcing a policy of accepting anti-vax families but restricting them to one specified day per month "because they represent too great a danger to the other patients" might be somewhat effective. The inconvenience is not quite so exclusionary that it would, by definition, get the hackles up, and the stated rationale is pretty air tight. Plus, the message would get re-iterated and reinforced every time the parent makes an [inconvenient] appointment.

The other point anti-vaxxers are adament about is that vaccines can cause harm. Quite simply, they can -- and arguing that they don't or can't lacks credibility. Every anti-vaxxer knows or knows of someone who was allegedly harmed by a vaccine. Conceding the point that vaccines can cause harm, but holding firm on the overwhelming ratio of Help:Harm might be more palatable than arguments that don't get heard.

 

[ScottTenorman54]

I usually relate the story of the patient who was admitted to my service in residency who had blown his liver with an OTC bodybuilding supplement from GNC -- put himself on the DILI transplant list and they were trying to keep him alive until he could get a transplant.

what kind of supplement are we talking here?

 

[JustPlainBill]

what kind of supplement are we talking here?

Some plain Jane otc mass building supplement from gnc. Heck I had a guy send himself into a no joke rhoid like psychotic episode from taking 6 (over a 3 hour period) otc male performance enhancers. Bought himself an intubation week in icu complete with 3 random 4 hour periods of priapism.....

 

[SurfingDoctor]

The answer is relatively simple. If you are a pediatrician, refuse to do well child checks or health maintenance unless they vaccinate, if you are a school administration, refuse admission. If a child gets harm, call child protection. Reduction through attrition.

Trying to teach them the benefits of probably the greatest public health intervention since sanitation... it's an utter waste of effort (which you can't bill for).

 

[DO2015CA]

Wow, that is crazy! I cannot believe the family won the case. What more could the doctor have done? He could not have vaccinated the kid without the parent's consent. He was not being negligent or providing substandard care. The parents refused the standard care.

I feel so bad for that doctor. Our courts are so corrupt to rule in favor of the parents.

Ya, I am not sure about all of the details because it was one lecture in first year so Idk if he appealed and won. It was what the malpractice lawyer presented to us during a standard of care lecture

 

[kelminak]

I've become incredibly conflicted on how to handle this issue lately.. especially after reading an article a friend, who shares my frustration on this, sent me:

Article: Scientists, Stop Thinking Explaining Science Will Fix Things. It Won’t.

I found the article a bit disheartening.. but interesting.

In the past I haven't had much success addressing anti-vaxxers. It seems that, from my experience, no matter how many peer-reviewed studies and thorough explanations you have saved up, they just ignore it all and adhere to their ignorance. So when I read the above linked article, I resonated with it a bit.

1.) Thoughts/strategies on how to effectively deal with this issue?

2.) Med students/residents/physicians: how often do you find you have to discuss this with patients? How does the conversation typically go?

3.) In medical school, do they discuss how to have discussions like this with patients?


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In the pediatrician's office that I shadowed in, he had a strict vaccination policy where if you refused to follow the standard schedule in any capacity, he would refer you to another pediatrician rather than take you. Business floods to him because the other parents feel their child is more protected. He usually has a meeting with parents before accepting the child to the practice to ensure that they're on the same page as him (not just about that but it's one of the topics). He had at least one couple come in while I was there and was wanting to follow a modified schedule, to which he couldn't convince them otherwise and had to refer them elsewhere.