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should pediatricians treat un-vaccinated children? sure, but you should add a “surcharge”

I am an extremely strong believer in vaccinations. Vaccinations are low cost, low risk interventions that save millions of lives. After sanitation, you can’t find a procedure that is so effective and so important to our collective and individual well being. Still, there is a growing anti-vaccination movement, which is discussed in a recent Slate article about whether pediatricians should treat unvaccinated kids.

My answer: Sure, but pediatricians should parents of un-vaccinated kids the same way that professionals treat other “difficult” clients – a surcharge for being a difficult and increasing costs. In other words, by exposing other children in the clinic and at school to disease, you are increasing the costs of healthcare.  Thus, the parent should bear the cost of healthcare. If each life of a child who dies from preventable infection is worth, say, a few million dollars, then it wouldn’t be unreasonable to charge a parent a few thousand extra dollars.

Bottom line: People are entitled to their own erroneous beliefs, but when it causes real harm to others, they should bear the cost. To do otherwise is folly.

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Written by fabiorojas

March 27, 2014 at 12:07 am

Posted in current events, fabio

14 Responses

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  1. In tune with ridiculous surcharges, perhaps we should also ask less-intelligent undergraduate students to pay more for tuition, for reducing the quality of the classroom experience for their peers. And college-age alcohol abusers should also pay a ‘peer pressure’ surcharge for spreading alcoholism on campuses….. Yes, people should vaccinate their kids, but as someone who had a niece suffer epileptic fits after vaccination (which went away when future shots of a particular vaccine were discontinued) I can understand where the anti-vax people get their ideas from… I think the authoritarian rather than informational tone of the medical community is one of the forces fueling the (tiny) anti-vax movement, at least in California. As for the slate article, any pediatrician even asking herself whether she should only treat vaccinated kids must have gone through the hippocratic oath just as an initiation chant devoid of meaning

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    sd

    March 27, 2014 at 2:57 am

  2. Irrational behavior by parents upsets me. However charging more unvaccinated children parents Challenges the principle of equality (and might penalize further poor families). What about smokers? or, if the bottomline here is damaging others, what about suicidal persons, drug addicts, drunk drivers…? In some countries vaccinations are compulsory: no vaccination no Public School. I think that is more effective.

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    Tatiana Fumasoli

    March 27, 2014 at 5:42 am

  3. As most readers of this blog, I lack the knowledge needed to discuss the medical side. But there are two points which strike me here.
    1/ I can’t see the problem of “exposing other children in the clinic and at school to disease”. Either those other kids are vaccinated and they are thus not at risk (otherwise, what’s the use of vaccination?). Or they are not, and their parents were ready to take the risk.
    2/ Interestingly, different countries have different lists of which vaccines are mandatory, or recommended. These differences exist also between very similar countries (say, across Europe). I’d be curious to see how this correlates with the presence of local big Pharma companies…

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    Bernard Forgues

    March 27, 2014 at 6:22 am

  4. The answer is not highet charges by pediatricians, but a tax by the government. People who do not vaccinate their children, and do not have a medical exemption, should pay a tax. And the tax should be indexed to their incomes.

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    Philip N. Cohen

    March 27, 2014 at 11:20 am

  5. Bernard- regarding your first point, there are some children who cannot be vaccinated due to age or suppressed immune systems. For instance, children do not receive the vaccine for pertussis, which can be deadly for an infant, until about 3 or 4 months of age. But children do go to the pediatrician (or should be going) several times in the first three or four months of life, putting them in contact with older (potentially unvaccinated) children.

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    Melissa

    March 27, 2014 at 12:52 pm

  6. ^^ OK, I was off about what age the first pertussis shot happens (I blame it on sleep deprivation caused by, of all things, a baby suffering from post-vaccine fussiness) – but vaccination for pertussis still doesn’t occur immediately after birth (and I don’t believe it reaches peak effectiveness until after the series is complete, which takes several doses over several months). So the intent of my post is the same- there is a period of time during which very young children are unable to be vaccinated.

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    Melissa

    March 27, 2014 at 1:11 pm

  7. The issue is not just children but herd immunity to protect those who cannot get vaccines.
    Melissa, the TDAP vaccine, which includes pertussis, is now recommended for pregnant mothers between 27 and 36 weeks gestation in the hopes that this will pass along some immunity and also protect the mother. http://www.cdc.gov/vaccines/vpd-vac/pertussis/tdap-pregnancy-hcp.htm
    In general, it’s recommended that adults check their vaccination records and consult their doctors about whether they need boosters – in reports that I saw on the measles outbreak in NYC, those affected included 2 adults who hadn’t been re-upped on the MMR vaccine but thought they had.
    It has not been that long ago that children regularly died or suffered lifelong complications against diseases that now have vaccines (i.e., polio). Some of us have relatives who lost siblings and children to now preventable diseases.

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    katherinechen

    March 27, 2014 at 2:11 pm

  8. Katherine- yes, that is the recommendation (I was given the Tdap around 34 weeks, I believe) but I have relatives/friends whose doctors did not recommend or offer the booster during their pregnancy, and others that reported they (the mother) were given the shot immediately *after* their child was born, rather than during the pregnancy, so the CDC recommendation is not being followed by all practitioners, which is too bad.

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    Melissa

    March 27, 2014 at 2:28 pm

  9. How about giving a discount to families whose children ARE vaccinated? Incentives for vaccination. And, yes, I do know that they are mathematically equivalent, but there is a huge literature that says they are not psychologically equivalent. Or a tax break for being vaccinated. Our society is full of discounts and tax credits for things something thinks are desirable.

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    olderwoman

    March 27, 2014 at 2:41 pm

  10. Vaccination must be a magic word. If it were another word, like soda, and you found out your government had made it harder for you to sue your soda company, you’d realize the soda company had less reason to worry about producing harmful soda. In other words, however low the risk might plausibly be, the risk to consumer is actually higher due to regulatory atmosphere. So you buy some other soda. In the vaccine world that means doing your research carefully, finding the ones with real track records, and avoiding the ones that came out under this regulatory regime.

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    August

    March 27, 2014 at 3:04 pm

  11. Vaccination resisters…is there a better example of individuals wrestling mightily with “white people problems?”

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    cpox

    March 27, 2014 at 3:45 pm

  12. There are a lot of non-white people in the world who are very afraid of U.N. & N.G.O people running around with syringes.

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    August

    March 27, 2014 at 9:30 pm

  13. @august: Sure, but how does rolling out the noble Arcadians and Scythians make the vaccination resisters the OP is talking about any less caught up in WPP? Apples to apples, comrade, not apples to oranges.

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    cpox

    March 28, 2014 at 12:15 pm

  14. I’d worry less about Jenny McCarthy and a lot more about some idiot pediatrician who wants to punish you. The quality of doctors are seriously down, or maybe they just always sucked and were lucky enough to look professional while all the antibiotics still worked. In any case, encouraging a doctor to be a fascist bastard will cause problems for everybody, while Jenny McCarthy’s problems will remain her own.

    Like

    August

    March 28, 2014 at 1:26 pm


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