

I’m a Pediatrician. Should I Treat All Kids, or Just the Vaccinated Ones? - denzil_correa
http://www.slate.com/articles/life/family/2014/03/measles_outbreak_in_new_york_city_should_pediatricians_treat_unvaccinated.html

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AnimalMuppet
Um, Hyppocratic Oath? All of them, of course.

But you should strongly encourage the parents to get them vaccinated...

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conorh
I'm not sure what version of the Hippocratic Oath you are referring to (there
are many of them and they can be very very long), but I think even this could
be construed as legitimate in the framework of some of them. As is explained
in his article, the unvaccinated patients are putting other patients visiting
his office at risk. How should he weigh this? Personally I think this is a
good decision. There are other doctors he can refer his patients to - it is
not as if they will go without care.

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kjs3
A kid with the flu puts other patients at risk. And not every vaccinated kid
acquires full immunity. How about a kid with HIV/AIDS? Pediatricians deal with
this all the time; all of my kids docs have separate "sick" and "well" waiting
rooms to minimize risk. So the whole premise is histrionic and a red herring.
But if his Hippocratic obligation doesn't cover it, not punishing a child
because of the stupidity of his or her parents should.

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conorh
I think it is a combination of transmission risk and consequences of acquiring
the disease. HIV/AIDS, the risk of transmission is _extremely_ low. Flu the
risk is higher, but for (most) strains the consequences are not bad. For some
of these other diseases, the transmission rates are high and the consequences
can be very bad. If a patient is not vaccinated then the risks climb to the
point where I think it is a better decision for them to find care elsewhere
(possibly not at your local pediatricians office, but somewhere better
prepared, most doctors here haven't seen measles _ever_ ).

edit: Also your argument for 'not punishing the child' doesn't makes sense to
me. Couldn't you also say you are punishing the other vaccinated children by
placing them at higher risk?

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kjs3
Measles cases in the US in 2011: 222 Flu cases diagnosed in week 7 alone of
2011 (the peak): ~5500 About 115 kids died of influenza in 2011.

So. You're wrong about the epidemiology. There's not much reason to think
anything handled by vaccines is more transmissive than flu given proper
patient management in the doctors office. And by your logic, the doctor should
be turning away the dangerous influenza patients, since the actual risk of a
child contracting and dying from flu is statistically higher.

P.S. - Of course waiting room transmission of AIDS is almost non-existent. I
threw in AIDS for two reasons: First, during the height of the HIV/AIDS
epidemic, this exact "fuck those sick kids" rationalization was discussed in
exactly these terms, and second, to spot the sort of intellectually dishonest
types who would focus on that and conveniently ignore the rest of the
argument. You win.

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conorh
Our pediatrician asked us not to bring in our infant on a day when she was
treating a lot of flu patients a few years ago, her office has sick and well
areas, but it is hard for her to manage.

Also please, no stooping to name calling (intellectually dishonest), I know
you feel strongly about this, I do too. The wild response to the HIV/Aids
epidemic of course made no rational sense at all, even given the little they
knew then. I think that you might be setting up an argument that I'm not
making, that we should not be treating these patients. I think all patients
should be treated, but for highly transmissive diseases with bad consequences
then perhaps we should be doing it more carefully than is done at your local
pediatrician's office. If you make the choice to go unvaccinated, and thus
increasing the risk for others, then you should expect to be handled
differently.

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eip
[http://www.youtube.com/watch?v=4W2MJbcgn1g](http://www.youtube.com/watch?v=4W2MJbcgn1g)

