WP: H1N1 injection (and spray) rejection

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H1N1 injection (and spray) rejection

Some doctors are just saying no to the swine flu vaccine

By Rob Stein and Laris

Washington Post Staff Writer

Sunday, November 8, 2009

The biggest frustration facing many doctors is the dearth of swine flu vaccine

for their patients. But not a Soghomonian's pediatrician at Pediatric

Village in the District. She is not recommending the shots -- or the nasal

spray.

" The senior doctor there doesn't believe in it and doesn't want it for her

patients, " Soghomonian said. " I think the feeling was it's just too new. "

Soghomonian's doctor is one of a small cadre of outliers who remain skeptical

about the government's unprecedented immunization campaign, citing doubts about

the risks presented by the H1N1 virus or the safety of the vaccine, despite the

fact that no worrisome reactions have been reported.

" My feeling is that this is all being over-hyped, " said ce J. , a

pediatrician in Burke who also will not inoculate his patients. " Most people who

get this virus do beautifully. I believe the vaccine hasn't been tested enough.

I just think the benefit of it at this point is not outweighed by the possible

risk. "

Such contrarian voices, through the megaphone of cable news or in the quiet of

exam rooms, have forced federal health officials to play defense as well as

offense in their campaign to encourage immunization.

Public health leaders are at a loss to explain the skeptical minority, except to

say that it mirrors the chronically low percentage of health-care workers who

get the seasonal flu vaccine every year. Officials worry that these doubters

could have a disproportionate influence in an already frustrating and confusing

situation, and stress that the studies conducted so far and the intensive

monitoring underway indicate that the vaccine is as safe as any flu vaccine.

" I am very disappointed, deeply puzzled and very disturbed by this, " said

Schaffner, president-elect of the National Foundation for Infectious

Diseases. " The people for whom these doctors are not recommending this vaccine

are clearly high-priority patients who could have very adverse outcomes if they

get infected with the virus. "

'Not enough data'

Although no one has surveyed doctors' views on the vaccine, polls show that

people look to their physicians when deciding whether to get the shots or nasal

spray. A nationally representative survey of 1,042 adults in September found

that 68 percent said they trusted the advice of their doctor or their child's

pediatrician on this issue, far more than those who said they trusted top

federal health officials and medical groups.

" People rely very heavily on their physician's judgments about whether or not

they should take a vaccine, " said J. Blendon, a professor of health

policy at the Harvard School of Public Health who conducted the survey. " They

are at the top of the charts. "

As a result, the naysayers have left patients torn between a doctor's

long-respected advice, their own judgment and official recommendations.

" It's like total confusion for me to try to figure out what to do, " Soghomonian

said as she lined up with her 3-year-old daughter, Ally, on a recent morning at

a District flu clinic.

" It's really been very frustrating and very scary, " said Soghomonian, who

eventually left after deciding to give her daughter only the seasonal flu

vaccine. " I just want someone to tell me what to do, you know? "

Cheryl F. Edmonds, founder of the practice where Soghomonian takes her children,

declined to be interviewed. But a member of her staff, who spoke on the

condition of anonymity, characterized her concerns this way: " Her thing is

there's just not enough data. "

, the Burke pediatrician, said he has no reason to think the vaccine is

unsafe -- he, like many of the skeptics, said he generally supports

vaccinations. But he wonders whether it was tested enough.

" They just didn't have the time to do that properly. They mean well and they are

not doing anything to mislead people in any direct way. The reality is no one

knows. I'm not pretending to know. I don't think they should pretend to know, "

he said.

'Jumping on the bandwagon'

is not alone. A smattering of obstetricians, family practice doctors,

internists and other physicians nationwide who harbor doubts about safety of the

vaccine or the danger the flu poses raise questions on blogs and during

interviews, and counsel their patients not to get the immunization.

" What bothers me is pretty much every doctor in the country is jumping on the

bandwagon and saying, 'This vaccine is completely safe' -- even for the pregnant

woman and the unborn baby, " said Bob Sears, of Orange County, Calif. " But they

can't give you a single study that backs up that statement. "

Officials repeatedly have stressed that while no vaccine is completely safe,

there is no reason to believe the swine flu immunization would pose any unusual

risks, and so far no problems have emerged.

" I can understand the hesitancy and reluctance to take a vaccine that appears to

be new and different. All we can do is provide the facts, " said R.

Frieden, director of the federal Centers for Disease Control and Prevention.

" The facts are that this is the same manufacturing process, the same

manufacturers, the same factories, the same safeguards as the seasonal flu

vaccine that has been used for more than 100 million doses each year for many

years and which has an excellent safety record. "

But Meryl Nass, an internist in Bar Harbor, Maine, still has doubts, especially

given that most people who become infected get only mildly ill.

" In this situation, when there's very little data, I don't think people -- and

children in particular -- should be asked to bear the burden of being

experimental subjects, " said Nass, who has been blogging about her doubts. Nass

also questions the assertion that the vaccine is safe for women in all stages of

pregnancy.

" The CDC is telling women in all trimesters to go out and get vaccine. To my

mind, this is reckless, " said Nass, who is advising her patients to consider

receiving the vaccine only in their second or third trimesters.

'Behind the curve'

Some doctors hear echoes of politics in the reactions to their concerns.

" You come out and offer some caution about the safety of the vaccine, and it

becomes very political: Are you with us or are you against us? " said Kent

Holtorf, whose Southern California practice specializes in treating chronic

conditions. " It's almost like Republicans and Democrats, and no one wants to toe

the middle ground, because it could help the other side. "

Giuseppe Lancellotti, a pediatrician from Ephrata, Pa., argues that the vaccine

has arrived too late to make a difference anyway.

" We're just way behind the curve, " he said.

Government officials counter that it remains far from clear whether the second

wave of infections currently sweeping the country has peaked. Even if it has,

people will continue to become infected for months and another wave could hit

later.

" The risk of not getting the vaccine is much greater than the risk from getting

it, " said S. Fauci, who is leading the government's ongoing testing of

the vaccine at the National Institutes of Health.

Soghomonian was finally forced to make a snap decision when her husband took her

5-year-old son to get a seasonal flu shot and discovered the swine flu vaccine

was available, too.

" I called him and said, 'Just do both,' " she said. He did, but Soghomonian was

still uneasy. " There was a moment of panic, like: What did I do? "

Nevertheless, Soghomonian was among the first few dozen people to line up last

week at High School in the District to finally get her daughter

vaccinated.

" It's your pediatrician. Your children have been there since Day One. You feel

like they know and you should listen to their advice. And here I'm going against

it, " she said.

" Ultimately, you have to make your own decision. "