Pediatrician Dr. David Berger's Letter to Colleagues on Vaccination Safety Concerns

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http://snipurl.com/k9mu2 [Age of Autism]June 16, 2009Pediatrician Dr. David Berger's Letter to Colleagues on Vaccination Safety Concerns By Dr. David Berger Dear Colleagues,Although some of you know me already, I wanted to introduce myself to everyone.  I am a solo practitioner in Tampa. I finished my residency at USF-Tampa General Hospital  in 1997, was in private practice in South Florida until 2005, and went out on my own in 2005 when I moved back to Tampa. I have an integrative pediatric practice, providing primary care for many families with progressive and holistic lifestyles. I also provide biomedical therapies for children with hyperinflammatory and metabolic conditions, including Autism and ADHD. Last fall, I was asked to give a presentation to Governor Crist’s Task Force on Autism Spectrum Disorders on the biological plausibility of a relationship between vaccines and Autism. If anyone is interested in seeing the presentation, it can be viewed (HERE). Many of the concerns I raised surround the interactions between vaccines and the immune system.This spring I was introduced to AAP Past President Louis Cooper by a mutual acquaintance who was having a conversation about which children may be potentially high risk for an adverse event following vaccination.  Based on my review of the literature, I expressed that I felt that a significant family history of auto-immune or hyper-inflammatory disease makes a child potentially high risk. When conditions like asthma, allergies, eczema, thyroid disease, rheumatologic disease, colitis, and diabetes are taken under consideration, this is not a small number of children.I had shared with Louis about my involvement in helping develop and support Florida Senate Bill 242 (The recent vaccine bill which was written based on recommendations made by the Task Force), and he encouraged me to reach out to the leadership of the Florida Pediatric Society and work with them on this issue. Although I still support the intent of the Bill, after communicating with members of the leadership I felt that the issue was complex enough that rushing through the legislation could have immediate undesired consequences. I decided not to advocate for a final push among supporters of the bill, and instead thought that I should continue to engage my colleagues and try to come up with an amicable solution.More and more parents are learning about their vaccine rights as granted by Florida Law, and are choosing to delay and/or split up the vaccines. In my opinion, the best way to maintain a high vaccination rate is to improve the confidence that the parents have in the system. One part of accomplishing this would be to have a standardized, transparent, informed consent with legal protection for both the family and the physician.  Right now it seems that the confidence in the vaccine program is eroding, and if the pediatricians don't do something to increase this confidence, it is quite possibly going to erode further. When a parent hears a pediatrician say that Thimerosal is an inert substance and then read the manufacturer's Material Safety Data Sheet that calls it "highly toxic", or when a parent is dismissed over their concerns about a vaccine reaction despite their reading of the DTP/Asthma or the Hepatitis B/Special Education connections, there is a potential loss of trust in our profession.Most of us entered this specialty not for financial wealth but because we truly care about all children. We feel a genuine responsibility for our patients; perhaps more so than many of our adult colleagues.  This may be why we can become so passionate about the vaccine topic.  Our decisions play a direct role on the health of many children.  Communicating with parents is vital to our ability to minimize illness and disease. We need to be honest and tell the parents what we know and what we do not know, what the studies have taught us, and what still needs to be learned.  As there are so many unanswered questions, we need to put the decision-making responsibility into their hands; to let them assess the risk reward ratio, and thus ultimately assume the risk by using information obtained from good quality studies when available. If they choose to utilize outside resources after we have given them our information then that is their choice. That is the intent of “informed consent”.  By giving them a choice, the parent is less likely to be on the defensive or feel pressured and is more likely to trust the pediatrician and be less concerned of ulterior motives.  Ultimately, hopefully, they will make the right choice for their children, whatever they feel that is. We are at an important point regarding our understanding of the immune system.  There are multiple unanswered questions, and there is a lot of fear surrounding the unknown.  It is crucial that we address this fear openly and explore all sides of the questions, and attack all angles of the issue.  But we must still practice the experimental method using high quality studies, which are peer reviewed, and whose results can be repeated.  Only by doing so-- by continuing to ask questions which then lead to studies and conclusions, which then lead to new questions-- will we be able to continue to advance our science, and provide the best possible care to our children. I am confident that we can come up with a sensible plan that can balance both the protection of the public and the rights of the individual families. This should include properly tracking the under and non vaccinated children. Unfortunately, when these families get discharged by pediatric practices, many do not end up getting cared for by pediatricians at all and fall out of the system. This issue was well discussed in Neal Halsey’s May 7, 2009 NEJM article that stated  “The (AAP’s)  Committee on Bioethics advises against discontinuing care for families that decline vaccines and has recommended that pediatricians "share honestly what is and is not known about the risks and benefits of the vaccine in question."  The committee also recommends that clinicians address vaccine refusal by respectfully listening to parental concerns, explaining the risk of nonimmunization, and discussing the specific vaccines that are of most concern to parents. The committee advises against more serious action in a majority of cases: "Continued refusal after adequate discussion should be respected unless the child is put at significant risk of serious harm. (e.g., as might be the case during an epidemic). Only then should state agencies be involved to override parental discretion on the basis of medical neglect."Below is a copy of the letter I sent out to my email list last month. As I am wishing to have an open and honest dialog with the FCAAP, I wanted you to know what I am putting out there.I am excited to be a member of the FCAAP, and look forward to learning and growing with you.Sincerely,DavidDear Friends,   I would like to thank everyone who had passionately lobbied for the passage of Senate Bill 242, the Vaccine Safety Bill. As I reported last week, The Senate Ways and Means Committee ended without a vote being taken on the Bill. The Bill was not permitted to be put to a full Senate vote, so the Bill did not pass this year.  Despite this, my efforts toward improving the Florida's vaccine policy will continue.    Thimerosal (Mercury) There was much pushback by some legislators and physicians about the outright banning of thimerosal from entering the state. Their argument was that although virtually all vaccines are currently available in a thimerosal-free form, in the case of a health emergency if there was only a thimerosal-containing vaccine available, they wanted to be able to access that vaccine. I see their point, and an amendment was added to the Bill that allowed the Governor to override the ban in the case of such an emergency.  I will continue to press forward in my hope that no person, and no fetus, is exposed to a substance that Sigma, one of the manufacturers of thimerosal, calls "Highly Toxic" in its own Material Safety Data Sheet (HERE) . I remind everyone that I keep an updated list of all current thimerosal-containing vaccines on the "Vaccines" section (HERE) at Wholistic Pediatrics.   A Flexible Vaccine Schedule Upon further reviewing the Florida law, it is apparent to me that the current recommendations and statutes give the family much flexibility in how they may vaccinate their child.  After having spoken with thousands of families over the last few years, it is apparent to me that an overwhelming majority of Florida citizens do not know what their vaccine rights are.  According to information provided by the Florida Department of Health, "If a child has not completed the required immunizations for child care or school, but is in the process of completing the series, the documentation on the Form 680 has a designated place for the health care practitioner to provide a Temporary Medical Exemption". So, to get a child into daycare or school, she/he must have started a vaccine schedule and have a plan in place to complete the schedule. The child does not need to be "up to date" to be enrolled.  The family and heath care practitioner can choose to follow the CDC "Catch-up Schedule" (HERE) to complete the series of vaccines, but it is not mandatory that this catch-up schedule is followed.  There are vaccine recommendations made by the Florida Department of Health, The Center for Disease Control and various physicians groups.  However, there are no mandatory vaccines that must be given at birth or at any checkup.  Prior to starting school or daycare, a parent has the right to vaccinate their child in any way that they see fit, although the physician has the right to discharge the patient from the practice if he/she does not agree with the schedule the family would like to follow. I would strongly encourage every family to fully review the vaccine information provided by  the CDC and American Academy of Pediatrics, as well as other sources that provide alternative yet credible views such as the vaccine books authored by Dr. Bob Sears and Dr. Stephanie Cave.There is also clear wording in the Statute as to who can claim a religious exemption. As I am not a member of the clergy, it would be inappropriate for me to comment on who can qualify for this exemption. For a better understanding as to what the law says about the Religious Exemption, detailed information (HERE) , including the actual wording of the statute and the Florida Supreme Court's 1998 ruling on the statute, can be found at We Know Vaccines.   In reality, no one knows how parents will respond once they learn their rights and properly educate themselves. I hope a system can be developed that will be able to track children who are vaccinated accorded to the CDC recommended schedule, those vaccinated by an alternative schedule, and those who are not vaccinated at all. We can then study the incidence of the vaccine preventable diseases and vaccine-associated chronic disease, and perhaps eventually we can identify people who may be at high risk for adverse events following vaccination. Informed Consent I strongly believe in and will continue to fight for a standardized, transparent informed consent system as follows:   A parent/patient should: • Have the right to know the ingredients of the vaccine(s) to be administered. • Have sufficient time to inform and educate themselves by weighing the risks and benefits of vaccinating, not vaccinating or implementing an alternate vaccine schedule. • Render proper, written, legal consent PRIOR to the administration of any vaccine. • Have protection from action being taken against them if a child were to contract a disease that may have been prevented by a vaccine. (*Note: the practitioner should also be protected by law regardless of whether the family is choosing to follow the recommended or an alternative plan.  The provider should not be liable for a vaccine reaction or if the child were to contract a vaccine-preventable disease if the parent chose not to vaccinate.) During my time advocating for Senate Bill 242, I chose to reach out to the Florida Pediatric Society leadership and have had very polite and meaningful conversations with them.  Although they do not agree with all of the positions I have taken, I now have a seat at the table and I am thankful that they are giving me an opportunity to express my views. We agree that we have much common ground, and realize that we can disagree without being disagreeable. Going forward, I hope that I will be able to work with them to create a standardized, transparent informed consent system in the upcoming year. I welcome this opportunity and will send updates as new information becomes available.In the end, each family will have to decide what they feel is in their family's best interest. The infectious diseases that the vaccines are intended to prevent can cause catastrophic illness. I do not want to see a return of diseases that I have never seen as a pediatrician of 15 years. If enough of the population is not vaccinated, we will lose our "herd immunity" and diseases will likely return. But I also have concerns about potential long term effects from vaccinations on the immune system and brain development of some people. Recent studies suggest that there may be a 50% reduction of Asthma (HERE) in infants who had their first DTP vaccine delayed two months, and that there was a nine-fold increase in Special Education services in boys who were vaccinated for Hepatitis B (HERE) (it must be pointed out that these were older versions of the vaccines). Parents need to educate themselves and work with their health care practitioner to implement a plan that works for them.Once again, thank you for all you have done and continue to do to help spread the word as we work together to implement the safest and most transparent vaccine program possible.Take Care,   Dr. David Dr David is a Board Certified Pediatrician who specializes in holistic pediatric primary care, nutritional and detoxification therapies for autism, ADHD and related disorders and immune dysregulation.He graduated from The Medical College of Pennsylvania in 1994 and did his Pediatric Residency at the University of South Florida. He started using holistic therapies at the Tampa General Hospital/USF Pediatric Clinic during his residency. He has served as the team doctor for Tampa Catholic High School, the Medical Director for a summer camp run by the Tampa AIDS Network, and the Medical Liaison for the Palm Beach County Breast Feeding Task Force. He has been in private practice since 1997, and in 2005 he opened Wholistic Pediatrics in Tampa, Florida. Dr. David has been an advanced Defeat Autism Now! (DAN!) Doctor since 1999.

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