Patient Handout: Immunizations

I suppose this will get me into hot water with the anti-vaccine crowd, but discussing the pros/cons of vaccines is a daily task for me.  I spend a lot of time convincing people that vaccines are safe.  So, to save myself time, I made a handout for this purpose.
Let me just say that I would rather not jump headlong into the debate.  This topic has been covered ad nauseum on various places on the Internet.  The points I make in this post are what I see as being the best scientific information.  Be that as it may, I suspect this post will attract the usual opposition.

Sigh.  I guess I am diving into the mix.  Oh well.

Here goes nothing:

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Immunization Questions and Answers

A lot of our patients have heard a lot of things about immunizations, some of them very frightening. Here are some answers to some common questions.

Are Immunizations Safe?

There is no way that we would ever recommend giving something unsafe to children we care for. All immunizations have been studied extensively by many researchers and even small questions about their safety are passed on to us. We feel that there is no compelling evidence at this time that any of the immunizations we give are unsafe.

How sure are you about this safety?

All of the doctors and staff in our office who have children have given them the appropriate immunizations. Do you think we would take unnecessary risks with our children?

What about the risk of autism?

Despite evidence to the contrary, there continues to be people who insist that immunizations increase the risk of autism. The rate of autism has been rising over the past number of years, but the criteria for making the diagnosis have been changed significantly. What we would not have called autism in the past is being labeled as mild autism. Unfortunately, some people are very vocal about opinions that are not informed by the evidence.

What about the stories about children that make it sound like immunizations cause autism?

This type of evidence is called anecdotal evidence. While this type of evidence is not useless, it takes much better evidence to prove something. Here is how anecdotal evidence can lead to wrong conclusions: if a person gets an antibiotic for a virus infection and then gets better, it does not mean the antibiotic made the infection go away. The person simply got better on their own, and would have done so with or without the antibiotic. In the same way, development of autism after immunizations are given does not prove anything. The fact is, children develop autism right around the age that immunizations are given. It would be equally valid to say that baby food causes autism.

Does Mercury play a role?

Thimerosal is a mercury-containing preservative that used to be added to immunizations. Since the symptoms of autism are similar to that of mercury poisoning, some have suggested that this is what caused some cases of autism. But since thimerosal was removed from vaccines (due to public worry), there has been absolutely no change in the incidence of autism in the US. None of our childhood vaccines contain thimerosal.


What about “herd immunity?”

Herd immunity is the protection that un-immunized children get from the fact that the rest of the population is immunized. While this does confer some protection, with the public fears causing an increasing number of people to decline immunizations, there has been an increase in diseases protected by immunizations (such as measles). Even if protection holds during childhood, the un-immunized person is subsequently at risk of developing the disease as an adult – and many of these diseases are far worse to get as an adult than as a child.

Can I just wait until my child gets older to immunize them?

Since we don’t think there is any danger with the vaccines, we don’t recommend putting them off. At a minimum, however, we strongly urge parents to give their children vaccines for diseases that could cause harm in infancy, including:

  • Prevnar – protects against meningitis and other infections in childhood. Even gives some protection against ear infections.
  • HIB – also protects against meningitis and other infections of childhood.
  • Rotavirus vaccine – this is a vaccine against a common form of diarrhea in young infants. Rotavirus causes many hospitalizations and some deaths.

What about the new Meningitis Vaccine?

The new vaccine against meninigococcus protects against one of the deadliest diseases around. This form of meningitis has a 50% fatality rate, kills within hours, and generally hits healthy young people. Thankfully, it is a rare disease. Obviously, we strongly recommend this vaccine.

What about the HPV Vaccine (the “Cervical Cancer” vaccine)?

Cervical cancer is very strongly associated with the Human Papilloma Virus, which is a sexually-transmitted virus that causes genital warts. The rate of infection is very high in young people in our country. Some parents argue that since this is a sexually-transmitted disease, abstinence will prevent this infection. However, even if a person is abstinent until marriage it is still possible to get HPV if their new spouse was not abstinent earlier in their life. While we do strongly urge abstinence, we strongly urge all young girls to get this vaccine.

Where can I find more information?

The American Academy of Pediatrics Web Site: www.cispimmunize.org

51 thoughts on “Patient Handout: Immunizations”

  1. “Baby food causes autism”?! AACK! I knew there was something wrong with giving mushed up beets to defenseless babies!
    Okay, in all seriousness, this is really good info and I hope it’s okay if I share it with my high school students – they’ll be parents eventually (some sooner rather than later) and the more times they get the message to vaccinate their kids, the better.

  2. “Baby food causes autism”?! AACK! I knew there was something wrong with giving mushed up beets to defenseless babies!
    Okay, in all seriousness, this is really good info and I hope it’s okay if I share it with my high school students – they’ll be parents eventually (some sooner rather than later) and the more times they get the message to vaccinate their kids, the better.

  3. My pediatrician actually advised against the rotavirus vaccine, saying intussusception is worse than a case of diarrhea.

  4. My pediatrician actually advised against the rotavirus vaccine, saying intussusception is worse than a case of diarrhea.

  5. healthcaretoday.com

    Patient Handout: Immunizations…
    I suppose this will get me into hot water with the anti-vaccine crowd, but discussing the pros/cons of vaccines is a daily task for me. I spend a lot of time convincing people that vaccines are safe. So, to save myself time, I made a handout for this…

  6. I hope, and pray that by the time I finish school that this whole autism link has been settled. Since, I have every intention of working in the autism field, but am a very strong advocate for vaccines … it is a battle I’m willing to take on, but hope I don’t have to.

  7. I hope, and pray that by the time I finish school that this whole autism link has been settled. Since, I have every intention of working in the autism field, but am a very strong advocate for vaccines … it is a battle I’m willing to take on, but hope I don’t have to.

  8. The whole intussusception thing was a big deal with the previous rotavirus vaccine. It has not shown up at all with the new vaccine, so we are giving it.
    Regarding TV watching, I think it is compelling, but no smoking gun yet. You could make the argument that kids with autistic tendencies have a higher rate of TV watching because of their Autism. Whether this is true or not is speculative for sure. I think they are establishing a genetic side to it that is fairly strong, but like most diseases it is probably a combination of genes and environment (which may be TV).

  9. The whole intussusception thing was a big deal with the previous rotavirus vaccine. It has not shown up at all with the new vaccine, so we are giving it.
    Regarding TV watching, I think it is compelling, but no smoking gun yet. You could make the argument that kids with autistic tendencies have a higher rate of TV watching because of their Autism. Whether this is true or not is speculative for sure. I think they are establishing a genetic side to it that is fairly strong, but like most diseases it is probably a combination of genes and environment (which may be TV).

  10. Great handout, Dr. Rob. I work with kids on the spectrum, and live in a part of California where immunization uptake is falling.
    Your readers might want to investigate

    http://www.vaccinateyourbaby.org/

    Vaccinate Your Baby is an awareness campaign that was launched by Every Child By Two, an organization devoted to raising awareness of the critical need for timely immunization and to foster a systematic way to immunize all of America’s children by age two. The site was launched in August of 2008, and features news and information for parents who wish to learn the truth about immunization and how best to protect their children from vaccine-preventable diseases.

    About Every Child By Two

    http://www.ecbt.org/

    Every Child By Two (ECBT) was founded by former First Lady Rosalynn Carter and former First Lady of Arkansas Betty Bumpers in 1991 as a result of the measles epidemic that killed nearly 150 people. Carter and Bumpers have been working on immunizations since their husbands were governors in the early 70’s and have been credited with the passage of laws mandating school-age vaccination requirements in every state. The goals of ECBT are to raise awareness of the critical need for timely immunizations and to foster a systematic way to immunize all of America’s children by age two. To forward its agenda, ECBT enlists the support of elected officials and their spouses, concerned community leaders, and representatives of many national organizations.

  11. Great handout, Dr. Rob. I work with kids on the spectrum, and live in a part of California where immunization uptake is falling.
    Your readers might want to investigate

    http://www.vaccinateyourbaby.org/

    Vaccinate Your Baby is an awareness campaign that was launched by Every Child By Two, an organization devoted to raising awareness of the critical need for timely immunization and to foster a systematic way to immunize all of America’s children by age two. The site was launched in August of 2008, and features news and information for parents who wish to learn the truth about immunization and how best to protect their children from vaccine-preventable diseases.

    About Every Child By Two

    http://www.ecbt.org/

    Every Child By Two (ECBT) was founded by former First Lady Rosalynn Carter and former First Lady of Arkansas Betty Bumpers in 1991 as a result of the measles epidemic that killed nearly 150 people. Carter and Bumpers have been working on immunizations since their husbands were governors in the early 70’s and have been credited with the passage of laws mandating school-age vaccination requirements in every state. The goals of ECBT are to raise awareness of the critical need for timely immunizations and to foster a systematic way to immunize all of America’s children by age two. To forward its agenda, ECBT enlists the support of elected officials and their spouses, concerned community leaders, and representatives of many national organizations.

  12. I forgot to mention Voices for Vaccines
    http://www.voicesforvaccines.org/

    “The most important goal of Voices For Vaccines is to provide clear, accessible, science-based information about vaccines and vaccine-preventable diseases. Our leadership consists of scientists and concerned individuals who are totally committed to supporting continued efforts to eradicate vaccine-preventable diseases. We accept no funding from governments or vaccine companies.

    Vaccination is a huge responsibility. Simply put, vaccination saves lives. As advocates for immunization, we encourage you to protect your child – yourself – your neighbor – your co-worker – and your community through vaccination.”

  13. I forgot to mention Voices for Vaccines
    http://www.voicesforvaccines.org/

    “The most important goal of Voices For Vaccines is to provide clear, accessible, science-based information about vaccines and vaccine-preventable diseases. Our leadership consists of scientists and concerned individuals who are totally committed to supporting continued efforts to eradicate vaccine-preventable diseases. We accept no funding from governments or vaccine companies.

    Vaccination is a huge responsibility. Simply put, vaccination saves lives. As advocates for immunization, we encourage you to protect your child – yourself – your neighbor – your co-worker – and your community through vaccination.”

  14. LOVE IT! I think it makes a lot of difference for your patients to get something written by you rather than some government agency.
    Fizzy, the rotavirus vaccine that was associated with rotavirus was totally different from the two that are used now. I know that the first of the two current ones, RotaTeq, was tested on 70,000 children (a huge, huge number for a clinical trial) to make absolutely sure there was no indication of a problem with intussusception, and there has been no such indication in postmarketing surveillance. All it does is save babies from having to go to the hospital. (But that’s not the kind of scandalous story that makes the news.)

  15. LOVE IT! I think it makes a lot of difference for your patients to get something written by you rather than some government agency.
    Fizzy, the rotavirus vaccine that was associated with rotavirus was totally different from the two that are used now. I know that the first of the two current ones, RotaTeq, was tested on 70,000 children (a huge, huge number for a clinical trial) to make absolutely sure there was no indication of a problem with intussusception, and there has been no such indication in postmarketing surveillance. All it does is save babies from having to go to the hospital. (But that’s not the kind of scandalous story that makes the news.)

  16. Ehh, Post-marketing surveillance for vaccines is pretty horrible. According to the CDC’s own figures, only 1-10% of ADRs are ever actually entered into VACS and VAERS.
    Some stuff is pretty bogus, like the autism link.

    Other stuff not so much, such as autoimmune reactions (Guillane-Barre, Reflex Sympathetic Dystrophy, and others), or intussusception following Rotavirus (The first iteration of rotavirus vaccine killed 5x as many children as rotavirus itself did…that we’re aware of).

    Underestimating by one or two orders of magnitude is a pretty big deal. Something made worse by the fact that many people (especially with RSD after Hepatitis or other vaccinations) cannot get their doctors to admit it or report it. The first ‘known’ case of Hep B vaccination causing RSD was in 1998 according to the literature. I myself find this kind of fishy since it happened to me in 1997, and every specialist I saw immediately knew the culprit.

    Vaccine usage and safety is especially problematic when we consider lifestyle disease vaccines, like Hep B, or Gardasil.

  17. Ehh, Post-marketing surveillance for vaccines is pretty horrible. According to the CDC’s own figures, only 1-10% of ADRs are ever actually entered into VACS and VAERS.
    Some stuff is pretty bogus, like the autism link.

    Other stuff not so much, such as autoimmune reactions (Guillane-Barre, Reflex Sympathetic Dystrophy, and others), or intussusception following Rotavirus (The first iteration of rotavirus vaccine killed 5x as many children as rotavirus itself did…that we’re aware of).

    Underestimating by one or two orders of magnitude is a pretty big deal. Something made worse by the fact that many people (especially with RSD after Hepatitis or other vaccinations) cannot get their doctors to admit it or report it. The first ‘known’ case of Hep B vaccination causing RSD was in 1998 according to the literature. I myself find this kind of fishy since it happened to me in 1997, and every specialist I saw immediately knew the culprit.

    Vaccine usage and safety is especially problematic when we consider lifestyle disease vaccines, like Hep B, or Gardasil.

  18. Point is well-taken on the VAERS perspective. Perhaps it is not well documented, although I know it was this that got the first Rotavirus vaccine pulled and has brought the combination MMR/Varivax vaccine into question (GBS). I would also like the numbers for the Intussusception killing that many – I heard there were cases, but did not hear about many deaths. Rotavirus deaths are probably also underreported, as they end up being chalked up to dehydration or other more immediate causes.
    Truthfully, I have never heard of nor seen RSD related to Hep B. I know RSD, but have never seen it – and I have immunized tens of thousands of children with this vaccine. I am not meaning to say it is not something that happens – your experience seems to show that clearly – but that perhaps the incidence is not all that high. I heard of GBS and Intussusception right away. There seemed to be no “cover-up” of that – nor did it seem to take long for them to make the connection (Rotashield was pulled after a very short market time and the MMR/Varivax vaccine spent a very short time on the shelf).

    Anyway – thank you for opening the discussion in a thoughtful way.

  19. Point is well-taken on the VAERS perspective. Perhaps it is not well documented, although I know it was this that got the first Rotavirus vaccine pulled and has brought the combination MMR/Varivax vaccine into question (GBS). I would also like the numbers for the Intussusception killing that many – I heard there were cases, but did not hear about many deaths. Rotavirus deaths are probably also underreported, as they end up being chalked up to dehydration or other more immediate causes.
    Truthfully, I have never heard of nor seen RSD related to Hep B. I know RSD, but have never seen it – and I have immunized tens of thousands of children with this vaccine. I am not meaning to say it is not something that happens – your experience seems to show that clearly – but that perhaps the incidence is not all that high. I heard of GBS and Intussusception right away. There seemed to be no “cover-up” of that – nor did it seem to take long for them to make the connection (Rotashield was pulled after a very short market time and the MMR/Varivax vaccine spent a very short time on the shelf).

    Anyway – thank you for opening the discussion in a thoughtful way.

  20. Bravo! Wish there were more pictures of these diseases on the web – seems like I see the same pictures over and over. The kids are either smiling in the picture – not helpful when you’re trying to convince a parent on the fence – or they’re ancient. Meningococcus is a pretty impressive in person and I wouldn’t wish that disease on anyone but I would like to have some pictures to give parents and patients some idea about how devastating these diseases are.

  21. Bravo! Wish there were more pictures of these diseases on the web – seems like I see the same pictures over and over. The kids are either smiling in the picture – not helpful when you’re trying to convince a parent on the fence – or they’re ancient. Meningococcus is a pretty impressive in person and I wouldn’t wish that disease on anyone but I would like to have some pictures to give parents and patients some idea about how devastating these diseases are.

  22. I would add DTaP to the list of vaccines to be given in infancy, especially as I was just exposed to an 8 week old infant with pertussis in our urgent care (contracted from a grandparent.) The baby was admitted for failure to thrive–she was under her birthweight. If she’d been exposed just a few weeks later (after her shots) the illness would likely not have been as severe. The website http://www.vaccineinformation.org/video/pertussis.asp has video of babies with pertussis, and the characteristic “whoop.”

  23. I would add DTaP to the list of vaccines to be given in infancy, especially as I was just exposed to an 8 week old infant with pertussis in our urgent care (contracted from a grandparent.) The baby was admitted for failure to thrive–she was under her birthweight. If she’d been exposed just a few weeks later (after her shots) the illness would likely not have been as severe. The website http://www.vaccineinformation.org/video/pertussis.asp has video of babies with pertussis, and the characteristic “whoop.”

  24. Rob, I’d like to thank you for being so respectful in your reply. It is greatly appreciated.
    A study I read a few years ago said that the old rotavirus vaccine killed 25, as opposed to 5 for Rotavirus. Sorry, no link handy.

    My major concern with vaccines is just like infections themselves, they have the possibility of starting of an autoimmune reaction, or otherwise causing post-infectious syndromes. The way a vaccine works after all is by setting off an inflammatory/immune reaction.

    Some diseases cripple, kill, or injure in such numbers that vaccination is perfectly logical. My mother developed pertussis when she was a child, and to this day any time she gets the least bit sick it’s much much worse for her than any one else.

    But as we vaccinate for viruses with lower and lower morbidity and mortality, and more importantly lifestyle-preventable, we start to approach a point at which the risk from the vaccine approaches or even exceeds the risk from the illness.

    I have pretty much zero risk factors for Hep B. Not promiscuous, not even monogamous for crying out loud. No IV drug abuse. Nothing. On the other hand my girlfriend, many of my female friends, and my various cousins and nieces have no risk factors for HPV. Why vaccinate these people at all?

    I think there’s a place for dissent from vaccine use, not in all of them by any means, but things like varivax, pneumovax, flu vaccine. And I’m afraid that we’re lumping serious illnesses with mild and preventable illness.

    Kind of reminds me of the whole statin thing. Where there are now calls to use statins in people with risk factors of risk factors. I saw one editorial calling for guys like me to use statins, despite a nonfasting total cholesterol of 150.

  25. Rob, I’d like to thank you for being so respectful in your reply. It is greatly appreciated.
    A study I read a few years ago said that the old rotavirus vaccine killed 25, as opposed to 5 for Rotavirus. Sorry, no link handy.

    My major concern with vaccines is just like infections themselves, they have the possibility of starting of an autoimmune reaction, or otherwise causing post-infectious syndromes. The way a vaccine works after all is by setting off an inflammatory/immune reaction.

    Some diseases cripple, kill, or injure in such numbers that vaccination is perfectly logical. My mother developed pertussis when she was a child, and to this day any time she gets the least bit sick it’s much much worse for her than any one else.

    But as we vaccinate for viruses with lower and lower morbidity and mortality, and more importantly lifestyle-preventable, we start to approach a point at which the risk from the vaccine approaches or even exceeds the risk from the illness.

    I have pretty much zero risk factors for Hep B. Not promiscuous, not even monogamous for crying out loud. No IV drug abuse. Nothing. On the other hand my girlfriend, many of my female friends, and my various cousins and nieces have no risk factors for HPV. Why vaccinate these people at all?

    I think there’s a place for dissent from vaccine use, not in all of them by any means, but things like varivax, pneumovax, flu vaccine. And I’m afraid that we’re lumping serious illnesses with mild and preventable illness.

    Kind of reminds me of the whole statin thing. Where there are now calls to use statins in people with risk factors of risk factors. I saw one editorial calling for guys like me to use statins, despite a nonfasting total cholesterol of 150.

  26. Kidsdoc: Point well taken. Pertussis also increases risk of Apnea in newborns.
    Indiancowboy: Sad you expected anything but respect. I do understand the caution and it is the exchange of opinions that keeps us honest. Regarding hep B, the decision was more of a public health issue. Hep B is a huge killer in the world and in the US, and the recombinant vaccine was considered safe enough to give to all children. If we wipe out Hep B as a nation (and then worldwide) we will save an incredible number of lives. The “at risk” populations for Hep B are the very ones who won’t come in to get vaccinated, so the decision was made to immunize all. I don’t think it is unsafe to not be vaccinated for most people (my wife is not vaccinated and I am not urging her to do so), but I also think the overall benefit to the world of universal vaccination is well worth the small risk of immunizations.

    Varivax is debatable, as is Hep A vaccine (I have never seen a case of Hep A and yet am vaccinating everyone for this?), but pneumovax and flu vax clearly have a good place in the arsonal (IMO).

    Read my reasoning for HPV in the handout. I know someone who was abstinent until marriage and got HPV from her husband who was promiscuous as a teen but totally cleaned up his act. Men can shed without knowing they have disease.

    I also think it is presumptuous to think we have such control over our kids that they won’t make stupid mistakes. We are all human. The children of very good parents still can make bad choices.

  27. Kidsdoc: Point well taken. Pertussis also increases risk of Apnea in newborns.
    Indiancowboy: Sad you expected anything but respect. I do understand the caution and it is the exchange of opinions that keeps us honest. Regarding hep B, the decision was more of a public health issue. Hep B is a huge killer in the world and in the US, and the recombinant vaccine was considered safe enough to give to all children. If we wipe out Hep B as a nation (and then worldwide) we will save an incredible number of lives. The “at risk” populations for Hep B are the very ones who won’t come in to get vaccinated, so the decision was made to immunize all. I don’t think it is unsafe to not be vaccinated for most people (my wife is not vaccinated and I am not urging her to do so), but I also think the overall benefit to the world of universal vaccination is well worth the small risk of immunizations.

    Varivax is debatable, as is Hep A vaccine (I have never seen a case of Hep A and yet am vaccinating everyone for this?), but pneumovax and flu vax clearly have a good place in the arsonal (IMO).

    Read my reasoning for HPV in the handout. I know someone who was abstinent until marriage and got HPV from her husband who was promiscuous as a teen but totally cleaned up his act. Men can shed without knowing they have disease.

    I also think it is presumptuous to think we have such control over our kids that they won’t make stupid mistakes. We are all human. The children of very good parents still can make bad choices.

  28. Dr. Rob: What is the point of vaccinating newborn babies, who presumably do not even have a mature enough immune system to process the vaccine? My sister refused to have her newborn son vaccinated for hep B the day after he was born and caught a lot of flack for it.
    At what age is a child’s immune system mature enough to process a vaccine to induce active immunity?

  29. Dr. Rob: What is the point of vaccinating newborn babies, who presumably do not even have a mature enough immune system to process the vaccine? My sister refused to have her newborn son vaccinated for hep B the day after he was born and caught a lot of flack for it.
    At what age is a child’s immune system mature enough to process a vaccine to induce active immunity?

  30. Hey Indian Cowboy: I’m 47 and my LDL was 148, HDL 63, trigs 140, and I pushed for a carotid IMT, which showed significant subclinical vascular disease. Framingham and NCEP do a good job of identifying those with obvious risk factors, but those of us who fall short of the higher risk classification are not necessarily safe. Given the more complete picture, I opted for a statin.
    I think it’s highly individual, but a CIMT can be very informative and is cheap and noninvasive. Not to mention pretty relaxing- dark room, nice music, soft pillow, warm goo…. (“Now entering warm liquid goo phase…”)

  31. Hey Indian Cowboy: I’m 47 and my LDL was 148, HDL 63, trigs 140, and I pushed for a carotid IMT, which showed significant subclinical vascular disease. Framingham and NCEP do a good job of identifying those with obvious risk factors, but those of us who fall short of the higher risk classification are not necessarily safe. Given the more complete picture, I opted for a statin.
    I think it’s highly individual, but a CIMT can be very informative and is cheap and noninvasive. Not to mention pretty relaxing- dark room, nice music, soft pillow, warm goo…. (“Now entering warm liquid goo phase…”)

  32. The reason for newborn Hep B is to protect infants from vertical transmission (from mom to infant). Infants do in fact have a good enough immune system to benefit from this vaccine – it has clearly been shown. It is really not a big deal for parents to refuse it, as long as we are very sure of their Hep B status. Due to the low-risk of this vaccine, we just give to all infants, as it is worth immunizing a bunch to only protect a few. That is my thought process on it.

  33. The reason for newborn Hep B is to protect infants from vertical transmission (from mom to infant). Infants do in fact have a good enough immune system to benefit from this vaccine – it has clearly been shown. It is really not a big deal for parents to refuse it, as long as we are very sure of their Hep B status. Due to the low-risk of this vaccine, we just give to all infants, as it is worth immunizing a bunch to only protect a few. That is my thought process on it.

  34. I wish, as a doctor, that you read the package inserts of the vaccines. Because it is PATENTLY untrue to say that there is no longer thimerisol in all childhood vaccines. In some cases, the amount of thimerisol has only been REDUCED rather than removed. If you check this out, you will see that I am correct on this . . . . It naturally bothers me quite a bit when an MD makes an inaccurate statement on the internet . . . Especially concering such an important issue . . .

  35. I wish, as a doctor, that you read the package inserts of the vaccines. Because it is PATENTLY untrue to say that there is no longer thimerisol in all childhood vaccines. In some cases, the amount of thimerisol has only been REDUCED rather than removed. If you check this out, you will see that I am correct on this . . . . It naturally bothers me quite a bit when an MD makes an inaccurate statement on the internet . . . Especially concering such an important issue . . .

  36. Since the symptoms of autism are similar to that of mercury poisoning, some have suggested that this is what caused some cases of autism.
    I thought that mercury poisoning symptoms were quite different. From wikipedia:

    “Common symptoms include peripheral neuropathy (presenting as paresthesia or itching, burning or pain), skin discoloration (pink cheeks, fingertips and toes), edema (swelling), and desquamation (dead skin peels off in layers).

    Because mercury blocks the degradation pathway of catecholamines, epinephrine excess causes hyperhidrosis (profuse sweating), tachycardia (persistently faster-than-normal heart beat), mercurial ptyalism (hypersalivation) and hypertension (high blood pressure). Mercury is thought to inactivate S-adenosyl-methionine, which is necessary for catecholamine catabolism by catechol-o-methyl transferase.

    Affected children may show red cheeks and nose, erythematous lips (red lips), loss of hair, teeth, and nails, transient rashes, hypotonia (muscle weakness), and photophobia. Other symptoms may include kidney disfunction (e.g. Fanconi syndrome) or neuropsychiatric symptoms (emotional lability, memory impairment, insomnia).

    Thus, the clinical presentation may resemble pheochromocytoma or Kawasaki disease.”

    That really doesn’t sound like autism to me.

    Also, you say “we do strongly urge abstinence.”

    Even assuming that you mean “abstinence until legal marriage with a license,” why on earth would you urge it? Humans being who we are, abstinence until marriage leads to young marriage, which leads to divorce. Not everyone will marry – for instance, in the US gay and lesbian people are ineligible for marriage in most states. Many people find general and sexual life experience as a single person essential before selecting an appropriate life partner. On what basis do you urge all your patients to reject sexual contact and experience? (Or to restrict sexual contact and experience to one or two or three legal spouses?)

  37. Since the symptoms of autism are similar to that of mercury poisoning, some have suggested that this is what caused some cases of autism.
    I thought that mercury poisoning symptoms were quite different. From wikipedia:

    “Common symptoms include peripheral neuropathy (presenting as paresthesia or itching, burning or pain), skin discoloration (pink cheeks, fingertips and toes), edema (swelling), and desquamation (dead skin peels off in layers).

    Because mercury blocks the degradation pathway of catecholamines, epinephrine excess causes hyperhidrosis (profuse sweating), tachycardia (persistently faster-than-normal heart beat), mercurial ptyalism (hypersalivation) and hypertension (high blood pressure). Mercury is thought to inactivate S-adenosyl-methionine, which is necessary for catecholamine catabolism by catechol-o-methyl transferase.

    Affected children may show red cheeks and nose, erythematous lips (red lips), loss of hair, teeth, and nails, transient rashes, hypotonia (muscle weakness), and photophobia. Other symptoms may include kidney disfunction (e.g. Fanconi syndrome) or neuropsychiatric symptoms (emotional lability, memory impairment, insomnia).

    Thus, the clinical presentation may resemble pheochromocytoma or Kawasaki disease.”

    That really doesn’t sound like autism to me.

    Also, you say “we do strongly urge abstinence.”

    Even assuming that you mean “abstinence until legal marriage with a license,” why on earth would you urge it? Humans being who we are, abstinence until marriage leads to young marriage, which leads to divorce. Not everyone will marry – for instance, in the US gay and lesbian people are ineligible for marriage in most states. Many people find general and sexual life experience as a single person essential before selecting an appropriate life partner. On what basis do you urge all your patients to reject sexual contact and experience? (Or to restrict sexual contact and experience to one or two or three legal spouses?)

  38. “Abstinence before marriage leads to young marriage which leads to divorce.”
    Well, I may be strange to think so, but I think the studies say that people in committed relationships are less depressed and healthier. Sexually transmitted diseases are rampant in the teenage population (some studies say up to 50% in some populations). Multiple sexual partners is associated with other risk-taking behaviors and has other risks associated with it. Plus, having seen 14 and 15 year old girls being mothers, I have to say that sex has consequences.

    I am married and still am attracted to other women. Does that mean I should listen to my urges? I don’t chastise anyone who chooses other lifestyles, but medically I would be irresponsible to not advise against promiscuity. It’s not a moral pronouncement, it is a medical recommendation. I have seen a number of people remain abstinent and get married in their 20’s.

  39. “Abstinence before marriage leads to young marriage which leads to divorce.”
    Well, I may be strange to think so, but I think the studies say that people in committed relationships are less depressed and healthier. Sexually transmitted diseases are rampant in the teenage population (some studies say up to 50% in some populations). Multiple sexual partners is associated with other risk-taking behaviors and has other risks associated with it. Plus, having seen 14 and 15 year old girls being mothers, I have to say that sex has consequences.

    I am married and still am attracted to other women. Does that mean I should listen to my urges? I don’t chastise anyone who chooses other lifestyles, but medically I would be irresponsible to not advise against promiscuity. It’s not a moral pronouncement, it is a medical recommendation. I have seen a number of people remain abstinent and get married in their 20’s.

  40. So is your medical urging for everyone to be sexually abstinent? Abstinence prevents pregnancy and the transmission of STIs for married people too, so if your recommendation is medically, not morally, based then presumably you, for medical reasons, do not have sexual contact with your wife.
    Or are you advising everyone to be non-promiscuous? This is different from being abstinent. In my understanding, it is entirely possible to have one or more sexual partners in the course of a lifetime without being promiscuous.

    There are ways of being sexually responsible and still have partnered sex ? even with multiple partners. I am probably someone you would consider promiscuous (or having been), but I have been scrupulously responsible and never been pregnant or had an STI of any kind.

    Teenagers are notoriously irresponsible, of course. So people concerned about them need to make sure that they are well-equipped to be responsible and encourage them to delay having sex until they are able to take on the responsibility. But lots of non-teenagers are irresponsible too; so are lots of married people. Realistically, ?encouraging young people to delay having sex? usually means lots of close supervision, which is in conflict with other goals of encouraging young people to be active and to develop their independence.

    ?I have seen a number of people remain abstinent and get married in their 20?s.? I?m sure you have. You have probably also seen a number of people earn medical degrees, and you can attest that medicine is a rewarding career. Do you therefore urge *everyone* to become an MD? Or do you acknowledge the goal of 100% MDness across the entire population to be unrealistic and even undesirable?

    A lifetime of celibacy is good for some people, but we usually think it?s a little sad. However, you apparently recommend it. Marriage in the late teens or early twenties is good for some people, but has drawbacks (less-developed career, immature parenting, higher rate of divorce, impossibility for gays and lesbians). You seem to recommend it for everyone.

    Forming partnerships and families in the late twenties and early thirties is probably sensible for a lot of people, though most people who form a stable partnership at thirty and start building a family have had partnered sex before their wedding day (it would be unrealistic to expect otherwise from someone who has delayed the choice of a life partner until they were mature and experienced enough to choose well). Yet you urge all your patients to avoid this route on medical grounds.

    This is just weird.

  41. So is your medical urging for everyone to be sexually abstinent? Abstinence prevents pregnancy and the transmission of STIs for married people too, so if your recommendation is medically, not morally, based then presumably you, for medical reasons, do not have sexual contact with your wife.
    Or are you advising everyone to be non-promiscuous? This is different from being abstinent. In my understanding, it is entirely possible to have one or more sexual partners in the course of a lifetime without being promiscuous.

    There are ways of being sexually responsible and still have partnered sex ? even with multiple partners. I am probably someone you would consider promiscuous (or having been), but I have been scrupulously responsible and never been pregnant or had an STI of any kind.

    Teenagers are notoriously irresponsible, of course. So people concerned about them need to make sure that they are well-equipped to be responsible and encourage them to delay having sex until they are able to take on the responsibility. But lots of non-teenagers are irresponsible too; so are lots of married people. Realistically, ?encouraging young people to delay having sex? usually means lots of close supervision, which is in conflict with other goals of encouraging young people to be active and to develop their independence.

    ?I have seen a number of people remain abstinent and get married in their 20?s.? I?m sure you have. You have probably also seen a number of people earn medical degrees, and you can attest that medicine is a rewarding career. Do you therefore urge *everyone* to become an MD? Or do you acknowledge the goal of 100% MDness across the entire population to be unrealistic and even undesirable?

    A lifetime of celibacy is good for some people, but we usually think it?s a little sad. However, you apparently recommend it. Marriage in the late teens or early twenties is good for some people, but has drawbacks (less-developed career, immature parenting, higher rate of divorce, impossibility for gays and lesbians). You seem to recommend it for everyone.

    Forming partnerships and families in the late twenties and early thirties is probably sensible for a lot of people, though most people who form a stable partnership at thirty and start building a family have had partnered sex before their wedding day (it would be unrealistic to expect otherwise from someone who has delayed the choice of a life partner until they were mature and experienced enough to choose well). Yet you urge all your patients to avoid this route on medical grounds.

    This is just weird.

  42. Non-promiscuous would be accurate. I am advising based on medical grounds. It would not be a medical statement to say to not have any sex ever. I think you are over-stating what I recommend. I don’t come down on people committed to each other having sex. That is more of a moral choice, which is not my job. I am not my patients’ moral watchdog.
    I really don’t hit this issue very hard. I just want teens to realize the risks of “normal teenage sex.” Irresponsibility is so common in this area. I just think it is wise to understand the horrible consequences not being REALLY careful can have. I do advise them on using protection during sex and for girls to get on birth-control pills. I also tell them that herpes transmission is still near 50% despite condom use.

    Really, this is not a big issue for me. I am surprised that a simple statement has caused such offense.

  43. Non-promiscuous would be accurate. I am advising based on medical grounds. It would not be a medical statement to say to not have any sex ever. I think you are over-stating what I recommend. I don’t come down on people committed to each other having sex. That is more of a moral choice, which is not my job. I am not my patients’ moral watchdog.
    I really don’t hit this issue very hard. I just want teens to realize the risks of “normal teenage sex.” Irresponsibility is so common in this area. I just think it is wise to understand the horrible consequences not being REALLY careful can have. I do advise them on using protection during sex and for girls to get on birth-control pills. I also tell them that herpes transmission is still near 50% despite condom use.

    Really, this is not a big issue for me. I am surprised that a simple statement has caused such offense.

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