Jewish World Review August 23, 2001 / 4 Elul, 5761

Drs. Michael A.Glueck & Robert J. Cihak

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Consumer Reports

School Bells or Jail Cells? -- WILL it be school bells or jail cells for back-to-school this year? That all depends on an important decision you'll be making in the next few weeks and whether some public health official decides to yank your child from school, stick them in a foster home and charge you with neglect if you make the wrong one. Your crime? You refuse to subject your child to an unnecessary medical treatment.

It's happened in Hillary's Village and will again if some officials repeat previous threats. Last fall, a school superintendent in Westfield, New York, threatened to take a 7th grader into state custody because her mom refused to have her immunized against Hepatitis B -- a disease usually spread by drug users and the sexually promiscuous. The girl had a history of bad vaccine reactions, but the superintendent refused to grant a waiver. The story was repeated with 77 middle school children in Utica, New York. Television ads and school posters exhort us to "Be wise -- Immunize." But some public health and school authorities are behaving as if educating kids is less important than forcing mandatory shots on students and their families.

Maybe the motivation is big bucks from a 1993 federal "Immunization Initiative" that gives states more than $400 million in vaccine incentives and a $100 bounty for each child vaccinated with the shots the federal government decided are must-haves. So just how "wise" are you to immunize? How do you decide and what do you do if you defy the school rules? QUACKWATCH WARNING -- we'll say up front, once again, as we did in a January column, "Shots in the dark?":

"Vaccines can and do save lives."

And we'll have to say it again later because too many have an "all or none" approach to the vaccine question. They seem to think that all vaccines are created equal and equally effective and therefore equally desirable.

As with all medicine, vaccines are not perfect. Some vaccinated people still come down with chickenpox despite the vaccination, although not as high a percentage as those who aren't immunized. All vaccines cause reactions, some good and some bad. The good and desired reaction results in immunity from the disease. But there's no absolute guarantee against a bad reaction, such as an allergic reaction or even death. In other words, there are always trade-offs.

Some vaccines are too risky for even the manufacturers. For example, the rotavirus vaccine, originally recommended by federal government officials, causes too many bowel obstructions and has been pulled from the market.

More than $1.1 billion in claims, averaging almost a million dollars each, has been paid out by the National Vaccine Injury Compensation Program. All of these claims had to fit in the program's tight definitions and prove significant damage from one of the vaccines covered by the program.

Again, vaccines do prevent illness and save lives. What we're against is requiring such medical treatment as a prerequisite for going to school.

Most parents will likely find that the benefits of some of the standard vaccines, such as for diphtheria, whooping cough and tetanus, are worth the time, effort and risk involved. But many parents find some of the new vaccines, such as for Hepatitis B, to be too risky for their children. Other vaccines, such as for chickenpox, measles, mumps and rubella have enough benefits and risks require thoughtful consideration of the trade-offs, especially if you child isn't perfectly healthy when "shot day" arrives.

Your school may have sent you some forms about "free" vaccinations and outlined some of the benefits and risks. But, at the same time, they demand that children have their shots. Yet when challenged about the requirement, school and government officials use the very fact that they aren't doctors to slither out of liability. They shouldn't have it both ways. In the end, physicians are legally and ethically responsible for informing patients about the risks, and you as parents are the ultimate decision makers.

As we said above and are saying for the third time, "Vaccines can and do save lives."

Some people are willing to have as many vaccinations as possible because of the unpredictability and severity of possible disease. Others are more comfortable having as few vaccinations as possible because of the possible complications or because of religious objections.

So what's a parent to do when faced with those official school vaccination forms? First talk to YOUR doctor to help you decide what is right for your child. As with many other decisions in medicine or in life, the value of each vaccine should be evaluated for that person. If you need help asking your doctor the right questions, we recommend National Vaccine Information Center's common sense guidelines posted at

So what do you do if you decide that a vaccination, such as Hepatitis B, isn't right for your child but the school requires it?

Despite the federal bounty programs, not all states have mandatory shot laws. Essentially all the other states have philosophical, medical or religious exemptions. Each state has different wording that may be required for an exemption or waiver request. Your state representative should be able to provide you with the laws for your state. The laws are also posted on the Internet.

If a medical problem or medical history puts you or your child at greater risk for a bad vaccine reaction, a written statement from a medical professional may be required. If your application for waiver is based on philosophical or religious grounds, a written request describing your reasons in some detail should be sent to the officials demanding the shots.

If the information on vaccines you received was incomplete and you change your mind based on new information, the written consent you gave on the basis of incomplete information is invalid. For example, if you weren't told that the likelihood of a severe reaction from the Hepatitis B vaccine is three times greater than the likelihood that your child will contract the disease, you might well change your mind about the desirability of that vaccine.

Following your state's procedures will usually work. But if they don't, notarized letters by certified mail to your doctor, the local health department, and the vaccine manufacturer might be needed. You could inform them that you would consent to the shots if they will accept full responsibility for any bad reaction to the shots.

Yes, it takes a lot of work to get all the information to need to make a truly informed decision. And if you want a waiver, it may take some persistence. But don't let school scare tactics intimidate you into a vaccination decision that's not right for your family. You'll probably take some heat, but isn't your child worth it?

Michael Arnold Glueck, M.D., of Newport Beach, Calif., writes on medical, legal, disability and mental health reform. Robert J. Cihak, M.D., of Aberdeen, Wash., is president of the Association of American Physicians and Surgeons. Both JWR contributors are Harvard trained diagnostic radiologists who write numerous commentaries and articles for newspapers, newsletters, magazines and journals nationally and internationally. Comment by clicking here.


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08/10/01: Blood, Guts & Glory: The Stem of the Stem Cell controversy

© 2001, Michael A. Glueck & Robert J. Cihak