Veterinarians vs. Pediatricians on Vaccines
Last Friday’s Huffington Post featured an article I couldn’t help but devour with relish. In it, Dr. Sherri Tenpenny posits the following impressive comparison: Veterinarians are more responsive to vaccination concerns than pediatricians.
It’s a motion I’ll readily second. Physicians seem far less willing to consider immunizations optional. They’re more adamant about its benefits and more stridently supportive of the science that now stingingly refutes most autism claims and many other once-supposed vaccine-related side effects.
Which may be why, as Dr. Tenpenny explains, child care physicians are loath to let you walk out the door without a vax. Consider this illustrative point she makes:
According to a 2005 survey of the American Academy of Pediatrics (AAP), when faced with parents who refuse immunization, pediatricians reported that they always (4.8 percent) or at least sometimes (18.1 percent) tell parents that they will no longer serve as the child's physician. Pet owners, on the other hand, have latitude to discuss their vaccination concerns. In many cases, refusing a vaccination has the full support of their vet.
It’s not that physicians don’t acknowledge the downside of vaccination the way veterinarians do. Both professions well know there’s always a risk to the individual. We also understand that the protection of the population at large is the wider goal. Disease prevention for individuals who receive vaccines is critical, of course, but less so when it comes to vaccine requirements (for public schools, for example). There’s no disparity between professions on this score.
Nor does the cynics’ wisdom hold on this one: Because physicians make little (if any) money when they vaccinate, it’s hard to accuse them of holding firm to their vaccinating ways for financial reasons. In fact, physicians seldom have much of an income-related incentive to vaccinate. Given low reimbursement rates on immunizations, and the inordinate amounts of time required to educate parents and patients on this issue, most docs take a loss on giving vaccines.
Not so with veterinarians. We take a loss when you decline vaccines, if only because, historically, it’s been a big driver of annual visits. So while we’re happy to cave to your vaccine whims, we tend to do so more because we know that:
1. Your pet has already received vaccines that in many cases are effective over a much longer period of time than the manufacturer can prove. This fact can be illustrated in part by a simple test — when we draw blood for an antibody "titer" to demonstrate significant antibody levels at the time of scheduled revaccination.
2. Your pet may not be exposed to a wide variety of other members of his or her species (if any). In these cases, vaccination can safely be waived. The only issue, infection-wise, has to do with possible loss (of your pet), the issue of rabies (it's hard to prove your pet doesn't have rabies when she bites the vet staff or a household visitor) and accidental exposure to other animals.
3. We need to keep you happy to retain you as a client. I suspect that the more competitive nature of retail, fee-for-service veterinary medicine is at least partially responsible for what Dr. Tenpenny calls, the "latitude" pet owners have to comfortably voice their concerns over vaccination. Remember, veterinary clients are paying us at the point of service, not through a third party (i.e, health insurance). This, too, influences how likely we are to value you as a customer.
4. When our patients come down with illnesses they could easily have been vaccinated against, the legal liability of the veterinary practice is in no way comparable to what a human provider would face. Consider a toddler with a nasty, preventable disease. What would the legal repercussions be for a doc who consented, tacitly or otherwise, to this child’s lack of vaccinations? Need I say more?
I hate to say it, but while I agree that my profession is more responsive to vaccination concerns, the above reasons clearly explain why. Not all of it has to do with money and self-interest. Obviously, our willingness to listen to our clients and take the time to individualize our medical approach — to vaccines or anything else — speaks to something that works very well in veterinary medicine.
Sure, the profit motive helps, but I’d like to think there’s more at work here. Despite my reservations and caveats, in the end I’m with Dr. Tenpenny on this one:
If animal doctors can work with owners to individualize vaccination schedules, to avoid over-vaccinating though vaccine titers, and to encourage participatory care, human doctors need to start doing the same. Parents need to demand care that is as good for their children as it is for their pets.
Overstated, perhaps (especially with respect to the reliance on titers), but it’s to the point. One size does not fit all, whether we’re talking human medicine or veterinary medicine.
Dr. Patty Khuly