Latest / The Birth Lounge Podcast / Ep. 459: The Vaccine Debate Parents Actually Need from their Pediatrician Drs Alok and Joel

Transcript

Ep. 459: The Vaccine Debate Parents Actually Need from their Pediatrician Drs Alok and Joel · The Birth Lounge Podcast

• 0:00
  the majority of parents who have questions about vaccines are not anti-vax.
• That's just the way it is.
• 0:05
  They're vaccine hesitant.
• 0:07
  They may be skeptical about one vaccine or one ingredient, but that doesn't mean that they're anti-science or anti the entire childhood vaccine schedule, and we're not gonna uncover these conversations unless we have them.
• Hello, and welcome back to another episode of The Birth Lounge Podcast.
• Oh, you guys, today's episode is hot and heavy in the best way possible, and also the number one requested topic recently.
• I get blown up in person by friends and family.
• I actually just ran into someone in an airport when I was traveling, and she said, "Are you...
• I'm sorry.
• I don't mean to be weird, but are, are you HeHe by any chance? Are you the, the online childbirth educator?" And I said, "Yes."
• And she goes, "Oh my God, I love you," you know, all this stuff.
• And I was like, "Oh, thank you so much," like, "Thanks for letting..."
• And she goes, "I've got to ask.
• I loved your first vaccine series, but I want to hear two different sides of the story, and I want to hear it in the same episode."
• I get emails about this.
• I get Instagram DMs about this.
• I get text messages from people in our life.
• Our clients are asking about this.
• We wanted a conversation with two doctors who were gonna keep it respectful, were gonna keep it cordial, evidence-based.
• We wanted a transparent conversation.
• I heard you loud and clear.
• I hear you.
• I get it.
• I, too, want that conversation.
• I'm so excited to be having back two voices that you guys already know, you're already familiar with.
• You already trust them.
• And we're gonna do a little introduction.
• As you remember, Dr.
• Joel is a vaccine neutral pediatrician in California, and he is a leader and one of the primary voices today when it comes to medical freedom and honoring parental autonomy when it comes to making decisions for your children.
• And Dr.
• Alok Patel, you may know him from his recurring health and wellness segment featured on ABC News, Patel It Like It Is, or his Instagram, which I'm often sharing bits and pieces from, because he does such a great job of explaining the data and the science behind medical and clinical recommendations while also honoring parental choice and autonomy.
• Now, if you came to the show today thinking that you were gonna get some, you know, ratchet conversation, and yelling, and name-calling, and two opposing polarizing views, then I'm really sorry to inform you today's show is going to fall really short, and you're gonna be disappointed.
• But if you came here today hoping to hear two really well-educated pediatricians who are both spectacular communicators, and they are willing to put their pride aside to have a conversation with someone who seemingly has different thoughts than they do, then today's show is just gonna blow the lid off of everything that you are expecting.
• I know that it did for me.
• And just a little heads-up, I know that you guys are used to hearing me ask questions and lead the conversation, but today's episode is a little different.
• I had a couple of bullet points that I thought I would insert into the conversation, and I had envisioned the conversation come into a natural lull and natural pauses in the conversation, and that never happened.
• So you're gonna hear me right now in the introduction.
• I am going to welcome Dr.
• Alok and Dr.
• Joel onto the show, and I'm gonna toss out one initial question, and then you're not gonna hear from me again until the end of the episode.
• And I giggle a little bit because it's quite funny.
• A, a couple times in the episode, you, you hear them say, like, "Oh, HeHe," like, "I see you nodding along," or, you know, you, you hear them say, like, "Oh, we gotta get it back to HeHe."
• You guys, there was no need.
• There was no need for me to say anything, and so that's why I didn't.
• They take the conversation, and they run with it, and it is a beautiful banter of just really respectful dialogue by two colleagues who at the end of the day see eye to eye on 99% of things even though they work in totally different environment with totally different population, and their approaches are similar but very different.
• And so I, I just wanted to give you that heads-up.
• You're not gonna hear from me very much in this episode, and honestly, I think that is best.
• You're gonna see exactly what I mean.
• Today's conversation is exactly what so many of you are searching for.
• It's transparent, it's honest, it's raw.
• It asks the hard questions, and it keeps you in this safe, held way where you know that we are going to share the answers that not a lot of people are willing to share, and these two providers do a really, really wonderful job of really getting into the nitty-gritty.
• They go into the details.
• They talk about those side subjects that we feel we always have those follow-up questions from the things that we see online or the conversations with our own providers, but we never have a space to ask them.
• Today is that space, and it was genuinely such an honor to have them on the show, and maybe we'll do some future segments about these conversations, and I don't know, we'll see where that takes us.
• I do feel the need to give one little tiny disclaimer that Dr.
• Joel and Dr.
• Alok are healthcare providers.
• They're both pediatricians, but they are not you or your child's healthcare provider, and so nothing in today's episode is obviously to be taken as medical advice or clinical recommendation or diagnosis.
• I mean, as always, nothing in this show is.
• I am a doula.
• I am not a medical provider.
• The people I have on this show, they are talking about their expertise.
• They are sharing questions that you should be asking to your provider.
• They are sharing research and data and information and education that you deserve to know so that you can be an informed consumer.
• But obviously, be sure that you take back the information that you learn today, and take it back to your healthcare team that knows you, that helps you make your decisions.
• And if you feel uncomfortable doing that, or you feel as if you can't do that, or that when you do that, you're dismissed and you don't get your questions answered, you know in true HeHe form, I'm gonna encourage you to maybe look into changing providers if you can, if that's an option for you, because you deserve to be seen and safe and held and heard and supported in the care that you receive, and we want you and your healthcare team to be working in conjunction with one another.
• You want to be partners.
• I want you guys making decisions that feel good to all parties and help you understand that you truly can be in control of your healthcare and the healthcare of your children when you are partnered with the right provider.
• With that being said, obviously, I'd be remiss if I didn't recognize that healthcare deserts in our country are everywhere.
• And so if you live in a place where you don't have that option, just know that so many of us out here are working really hard to close those gaps and to hopefully bring more access to you in a variety of ways.
• All right, you guys.
• Oh my goodness, such a good conversation coming your way And a couple of the things that we are gonna talk about in here are, you know, risk when it comes to vaccines and why not using a one-size-fits-all approach may be the best.
• We're gonna talk about why parents don't trust the system anymore and exactly what these two doctors think created that fracture in the relationship.
• And then, of course, I wanna ask them how they think that we could go about fixing it.
• We're also gonna talk about what is making our kids sicker now than ever before, and do vaccines play a role in that? We're also gonna hit upon the topic of the lack of nuance and how that really harms vaccine education and awareness, and how that leaves room for really the spread of information.
• I also wanna talk about adverse reactions and why we're not studying those, plus what the pros and cons and pitfalls are when we do things like model our healthcare decisions or healthcare structure after countries like Denmark and Japan that have homogenous populations that all look the same, and they have similar backgrounds and similar genetics.
• You know, what, what does that mean when we are a country of a bunch of backgrounds? We are truly a melting pot.
• We have such a variety of people, and cultures, and ethnicities, and access, and health histories that is it really best that we're trying to copy the countries that don't look like us? And then finally, we are gonna be talking about, you know, sensitivities and adverse reactions, and why we're seeing more of those in children, plus the question that's on everyone's mind, I am asking it: Do pediatricians get paid to vaccinate children? And if so, what does that bonus look like? All right, you guys, ah, such a great conversation.
• Without further ado, here we go.
• Dr.
• Joel, Dr.
• Alok, welcome back to the Birth Lounge podcast.
• Thanks for having us on.
• Glad to be here.
• Sorry I'm in my pajamas.
• This is actually a kimono that I'm rocking, a kimono shirt, and, you know, Joel looks a little bit more professional than I do.
• Yeah.
• But glad to be here.
• I just pre- I just pretend, you know, for the f- for the camera.
• Hey, we're all faking it till we make it.
• Is that right? Um, no, truly, you guys, I'm super excited for this conversation.
• This has got to be probably the number one episode that people have hounded me for, um, in the last couple of months.
• And I love to run from things that make me uncomfortable.
• I love to just say, "Yeah, yeah, yeah, I'll get to it.
• I'll get to it.
• I'll get to it.
• I'll get to it."
• And then eventually my team says, "Hey, HeHe, it's time to get to it."
• And so here we are, you guys.
• We're gonna be talking about all the questions that you guys submitted for Dr.
• Joel and Dr.
• Alok, and we're gonna have an honest conversation about vaccination in our country.
• And I think this is really a conversation that a lot of you are looking for.
• And you, you want to have this conversation, and it feels scary, right? You don't wanna ask questions and then be labeled anti-vax.
• You don't wanna go to your pediatrician and say, "I'm having a little bit of hesitancy.
• I'm, I'm, I'm starting to feel a little nervous about things," and then your pediatrician start to look at you different, or maybe even you risk getting different type of care or they're not as kind or compassionate to you as they once were.
• I understand all the hesitancy.
• I understand all those fears.
• I hear it all the time.
• So does Dr.
• Joel.
• So does Dr.
• Alok.
• And so today I hope that you can walk away today's episode feeling supported and heard.
• Those are kind of my main goals.
• But I think a long-term goal for me is that you would actually take this conversation back to your healthcare provider.
• I want to start to bridge that gap that has been eroded over the last couple of years, and I think that is actually everybody's goal.
• I just think that sometimes we don't always approach it with the same way or in the same manner, and sometimes some healthcare professionals can actually erode that trust further.
• And so today I'm hoping that we can bridge that gap.
• So, guys, let's start out with the question that I think can kind of set the stage, and that is when parents say, "I don't trust the system anymore," what do you think is responsible for eroding that trust, fracturing that relationship? And then what can we do to fix that? Can I start with just thanking Dr.
• Patel for being here? I mean, I, I really am so honored that you're doing this.
• Honestly, I, I think it's, it's frustrating sometimes that people don't wanna have conversations, and the last place I ever thought I would be would be having vaccine discussions, you know, 10 years ago when I started in residency, and it's something that people seem to want more and more of these days, and I think you're such a great, uh, representative of medicine and such a great speaker.
• And oftentimes when I even wanna have discussions about this, 'cause I, I don't feel like I know, you know, anything, right? I feel like there's so much to learn.
• There's always so much to learn from really intelligent doctors, and a lot of times practitioners aren't willing to have that conversation or feel like it needs to be a battle or a war or a hard debate where people are gonna throw things at each other.
• And, you know, I've had lots of conversations with doctors, and it's never been mean.
• But, uh, you know, I just wish we could have more of this.
• I'm so honored that you're even just willing to do this, and so I just wanna say thank you before we even get started.
• Ah, Dr.
• Warsh, I appreciate that.
• Do you prefer Dr.
• Warsh, Dr.
• Gator, GW? I don't care.
• What are we, what are we going with? Joel is fine.
• Alok and Joel.
• Whatever, yeah.
• We do this.
• But no, I apprec- I, honestly, I appreciate the words, and I'm honored that you would even put me in the category of intelligent people 'cause I do feel like I'm, I'm right there with you in learning and learning about perspective, which in many ways is just as important as learning textbook academic medicine, is how people receive information and what they're able to do with it given their resources.
• And so I appreciate, I appreciate the conversation, honestly.
• I think that's what it's all about, is being able to ha- sit down, and for us, as people who talk to parents, talk to teens, talk to people who are being overwhelmed by this floodgate of information and helping people shift through things.
• If I can just tee up HeHe's first question, I think part of what has eroded trust is the lack of conversation.
• I think we're doing way better now than we were even as recently as five years ago.
• But even in the beginning of the pandemic, and people hearing things we don't know about, and then hearing scientific fact, and then hearing these plans to do the best we could to fight off a pandemic we didn't know about, and then all of a sudden there were dissenting voices.
• There were so many different opinions.
• I think we really started to see how many fractures there are in our healthcare system, and how social determinants of health change everything, and a lot of people just were left unheard.
• And it kind of all came together, and we are, uh, sometimes it feels we're more divided than ever.
• I don't think that's true.
• I, I'm a little bit more optimistic, but I think just to be succinct, the lack of open conversation has caused a lot of problems on top of an extremely broken healthcare system.
• Yeah, I, I was, I would say the exact same thing.
• I, I think not having these conversations is really what's pushed things forward.
• We have this new, you know, social media, right, which has come out in the, in the last few years.
• It's becoming more and more popular.
• It's where people are getting their information from.
• And we already had a growing distrust, I think, over the last decade or so for many different reasons, and then you had the pandemic, and I think that threw gasoline on a fire that was already burning, and especially when you had things like safe and effective, which was said over and over again.
• Oh, God.
• And I think, you know, uh, what I would have loved to hear from public health would be something like, "Based on the information that we have so far, it seems like this vaccine decreases your risk of death.
• It decreases your risk of, uh, serious disease, and we haven't found any major signals so far.
• It seems like it's safe.
• But we can't know anything in 10 years, and no one expects you to know that."
• But I, I think what people heard was this very definitive stance from public health and, and that just didn't make a lot of sense to people, and it was never gonna be totally safe.
• It was never gonna be fully effective for everybody.
• What happened with the vaccine was the natural course of what's going to happen with the vaccine, but I think that there was a, a lack of willingness to have those nuanced discussions on many topics.
• And I feel like there's some lack of nuance when it comes to medicine, a little bit of a lack of humility, and a little bit of a lack of willing to have a discussion with people that we don't necessarily always agree with.
• And I think parents want that.
• Families want that.
• And, and they take the lack of discussion to be like you're hiding something or, you know, doctors are evil people, and that doesn't make any sense.
• Like, pediatricians literally go in to help kids, and they might- Yes believe in something that you disagree with, but the fact that you're not even willing to have a conversation with somebody who might disagree I don't think leads to great outcomes, and I think we're seeing that.
• We're seeing this increasing distrust, and- I think parents want to see modeled discussions where the questions that they have can be asked and answered to people that they respect and people that they don't respect, and see how they navigate those waters.
• Science isn't definitive.
• The s- we- the scientific method is the best that we have, and it's amazing, but it still needs discussion and debate.
• You have a finding in a study, and different people might look at that study and interpret it in different ways.
• And I think that's totally fine, and I think we should be open to having these discussions and hearing where people's concerns are, so that way we can address those concerns.
• If someone has a concern about vaccine safety, let's hear what those concerns are, and if enough people have it, maybe we can design studies to look into those questions to better answer those questions.
• That, that's where I at least come from, I think.
• For sure.
• Can I add one thing from the pandemic? I, I'm always reluctant to talk about the COVID vaccine in any type of conversation about childhood vaccines.
• We have social science data that shows us parents turn away if we even mention the COVID vaccine.
• Because of the trauma, because of the mistrust, because of what was happening during the pandemic, they hear COVID vaccine and all of a sudden they don't wanna hear about MMR, they don't wanna hear about hepatitis, vi- vitamin K.
• They don't wanna hear about any of it.
• And I look back to 2020, 2021.
• I'm working for news stations and I'm doing medical journalism.
• I'm reading the articles, and then there's a conversation happening, as Joel mentioned, on social media.
• And it was interesting 'cause with the COVID vaccine, the actual clinical trials, the endpoint was dying, and the endpoint was severe injury, and it wasn't whether or not you tested positive from g- after catching COVID.
• It was whether or not you actually had a severe reaction.
• But online, th- it was a different conversation, and there was this gap between what the actual clinical trials were showing versus what the public thought or what the public was being told or what they were interpreting.
• And I think that disconnect was not addressed for a pretty long time.
• And when we h- when we left the information gap to the masses, and all of a sudden people made up their own theories.
• They forgot that scientific method The scientific method is based on consensus, not hard fact.
• It's what does the general consensus tell us? What's the best educated guess we have? And when we're not having those conversations, those nuanced discussions, and all of a sudden people were saying things that are just not founded, such as there's microchips in the vaccines, or mRNA mutates your DNA, and et cetera.
• And I'm, and now all of a sudden we're reactive rather than proactive.
• So I do think we've learned a lot, hopefully, from the pandemic in terms of conveying information.
• I think one of the most tragic sequela in science from the pandemic with respect to the sci- the purely the science, is hearing mRNA funding get get cut and people just looking at the COVID vaccine and saying, "Great, we don't like the COVID vaccine."
• And we're over here saying, "Oh my gosh, but what about the potential for heart disease, for autoimmune disease- for cancer, for pancrea- for pancreatic cancer, for so many other things we can do with mRNA technology?" But the public doesn't wanna hear it.
• That is the fault of science communication, but also we have to look at people who just gave the public an answer a- whether for special interest, politics, or money.
• And anyway, I'm gonna stop rambling right now.
• No, can we talk about sci- But I got a lot of thoughts.
• I got a lot of feelings.
• Yeah.
• I agree with you 100%, and maybe this even comes back to the first question, but talking about science communication, because I think that Somebody like you is the answer.
• Like you, Dr.
• Mike, other people that are out there having discussions.
• I think that really helps a lot of people to have discussions.
• A lot of doctors by nature are not good science communicators.
• We didn't get any training in social media.
• None.
• And you're, you know, you're competing online with people that have millions of followers that have no science background, but are good communicators, and say things that don't necessarily make any sense or, or aren't backed with any sort of research.
• But the people that really know these things the best are not communicating that, are not willing to have discussions, and I think we need to find a way to bridge that gap somehow to help, uh, practitioners, doctors, scientists to get out there and, and get over that fear.
• I think that's one of the biggest issues to me is, is that the people that really do have the best knowledge on these topics are not the ones having discussions, and it's left to influencers or individuals that don't necessarily know what they're talking about or sound really great.
• And I think if you were able to have those discussions and debates, then sometimes it would be very different.
• Like, I- you do hear it sometimes where somebody goes on, let's say Joe Rogan or whatever, and they say, you know, all sorts of stuff.
• And you're like, "Oh, that sounds really convincing."
• And then later on you hear somebody else talk about that same topic that's really educated, and you're like, "Oh, okay."
• Right.
• But you don't, you don't get that other side a lot of the times.
• Well said.
• There, there's an ability to use human emotion.
• People can say what they want about politicians, but some of them are so skilled at crisis communication and telling specific demographics what they want to hear while taking culture and socioeconomics into account.
• And you're totally right.
• We have to be more compelling and engaging and more empathetic.
• Can I ask you a direct question? 'Cause I've heard Dr.
• Offit- Please many times.
• Like, he is, I think, very reluctant to have conversations about vaccines.
• He doesn't wanna debate.
• He doesn't wanna discuss it.
• Many times I've heard him s- you know, speak on podcasts where he said, you know, "The science is what the science is, and therefore, you know, if anybody wants to say anything different, they should publish it in a paper."
• A- and then I've heard, you know, individuals like Dr.
• Bike who kind of disagrees with that somewhat, and he's like, "Well, we actually need to be getting out there."
• And I, and I feel like you are another individual who's getting out there.
• Like, do you...
• Like, what do you think is, like, do you think somebody like Offit should get on and have discussions with, you know, someone like Secretary Kennedy or other people? 'Cause to me, I, I think that they should.
• I, I think that people need to hear the perspective of the smartest people who have the most education on these topics, and right or wrong, not fear having those conversations.
• I think there's this general fear that you're platforming somebody who has a different opinion, or you're, uh, you know, gonna- create all this vaccine hesitancy, but the vaccine hesitancy's already there.
• I think the fact that we're not discussing it is actually, uh, making it grow because people are hearing one side of the story, especially now with somebody like Secretary Kennedy who's in charge of HHS.
• You're hearing his side.
• You hear it more and more, and you're not getting that counter story, uh, and you're not getting a chance to hear that back and forth.
• And, you know, maybe somebody like, you know, Dr.
• Offit or whoever has something to learn from someone like Secretary Kennedy, and maybe Secretary Kennedy has something to learn from something, someone like Dr.
• Offit.
• And maybe if they were able to actually have that conversation, especially with something like COVID.
• You know, I, I've never seen anything that's so polar where you have a whole group of people that think that the COVID vaccine's the best thing ever and everyone should get it, and then another group of people that think it's the most evil thing ever and it's just killing everybody, and you rarely ever see those individuals talk about it.
• And I think most people, like you said, are somewhere in the middle and they wanna hear these conversations.
• They don't get those conversations I love this question, to be honest.
• It's something I think about not only on a daily basis, but I've thought about and have gotten into heated arguments about since my early days in residency, is our place in public discourse, in social media, in the town ha- the modern town hall, if you will.
• I totally agree with you in the sense where the loudest voices right now are kind of, at least in the public sphere, are overtaking some scientific voices.
• And I think the answer, there, I think there's multiple answers for my opinion about why traditional academic physicians and scientists are reluctant, is we've seen these attacks, we've seen these threats.
• People have gotten death threats.
• I've gotten death threats.
• You know, Paul Offit, Peter Hotez, many of us have gotten these, these threats.
• So some people say, you know, I wanna step away from this."
• And I think there's a human element of hearing one side accuse us of taking money from vaccine manufacturers or quote, "Of poisoning children," or people have said things to me such as Nuremberg Trials 2.0,
• and I can see the average person saying, "I am not even gonna engage with this audience."
• But where you and I 100% agree is the majority of parents who have questions about vaccines are not anti-vax.
• That's just the way it is.
• They're vaccine hesitant.
• They may be skeptical about one vaccine or one ingredient, but that doesn't mean that they're anti-science or anti the entire childhood vaccine schedule, and we're not gonna uncover these conversations unless we have them.
• And so I'll tell you, in 2013, I'll never forget this, I had this heated discussion during...
• Joel, you remember good old noon conferences in residency? Oh, I remember.
• Yeah, love a noon conference, right? Try not to fall asleep if you're a post-call.
• It's free food.
• Yeah, free food, that's the best thing.
• And- Except if you're a post-call.
• Yeah, or, or post-call.
• And I remember we had this spirited discussion about refusing families who were not getting vaccines to private practices, and this was in the early days of some clinics doing this, and I was vehemently against that.
• And I remember at the time there was this consensus, especially in some states, saying, "We have the right to refuse families who don't vaccinate," and I was so bothered by it.
• I'm like, well, then how do you have the conversation? If you refuse a family And you then say, "I'm not gonna treat you," they're going to go and find a voice who relates with them, because that is what humans do.
• Mm-hmm.
• If I go to a Starbucks and I say, "I don't like oat milk," and they say, "Ha ha ha, get out of our store," I'm gonna go to Peet's Coffee then.
• It's just how it works.
• And so I think, long story short I wouldn't...
• I have so much respect for Paul Offit, and for the kind of the generation of before us who did a lot of the research.
• I don't necessarily think it's their responsibility to go and have the discussions, but I do really think that the discussions have to be had, and I'm proud that the next generation of physicians I talk with, especially people who are working with large medical organizations and hospitals, want to have the discussion.
• You know, I'm at Stanford, I work for ABC News, I do stuff with the American Academy of Pediatrics, and just the amount of young doctors messaging me and saying, "We gotta have these discussions," not only just about vaccines, but about reproductive rights, about gender-affirming care, about climate change, about war, about violence.
• There's more young people willing to step into the conversation, and I think that's only a good thing.
• It's only gonna be more productive.
• Yeah, I, I would love to see that be a big priority in medicine.
• I think science communication needs to be a big priority, and I think, you know, whether it's the American Academy of Pediatrics or whatever organizations, I would love that to be a big part of their future direction is, you know, promoting that, figuring out the people, the voices that are good communicators, that do wanna do it.
• It doesn't have to be Paul Offit.
• I think he's the most respected doctor in that space, but if, if, you know, he's, he's done his, his part, and if he doesn't wanna have debates, I think that's fine.
• But people need to, and I think that they could work with him, they could learn from him, they could discuss in a way that would do justice to the parents who wanna have these discussions, but at the same time- At least h- at least be open to talking to, you know, other sides and, and just be willing to have those debates.
• And, and I think that's important.
• Just like you, I agree also with, with the fact that I, I think it's really frustrating that doctors, most doctors are not willing to see all patients.
• I, I think that's, it's very odd to me that that's where we've drawn a line, that we won't see unvaccinated kids.
• I mean, I have a lot of kids in my practice that are very hesitant.
• The vast majority do vaccinate.
• I mean, sometimes it takes a little bit of discussion.
• Sometimes because I don't force them, it might take a couple extra months, but they might do one at a time.
• They get one, they see that it's totally okay, and then eventually they get all, all their vaccines before they get to school.
• That, that's what usually happens.
• There, there are very few people that don't vaccinate when I don't force them to do it, and there are a lot of people that come in that are, are kinda concerned.
• But just because of the fact that I don't force them, then they trust me more I think.
• And, and I'm not sure that doctors should be forced to give vaccines, but I think more doctors should be open to, uh, having patients in their practice that, that have more questions.
• I think that, that brings a little bit of humility, to have to answer some of those questions and have to have those discussions, and maybe see where some parents are coming from and realize that it's not always some crazy anti-vaxxer person that has questions.
• They...
• A l- lot of times it's somebody who had a kid who, who had a reaction.
• Like, they literally were someone who was very pro-vaccine.
• Their first two kids, they're fully vaccinated.
• Their third kid had this really bad reaction, or at least they blame it on the vaccines.
• And it's not an anti-vaxxer.
• It's a parent who literally went to get a vaccine.
• But I don't know.
• It just feels like more and more doctors are unwilling to have that conversation, and more and more people, at least that I talk to, seem more frustrated in that.
• I don't know what your experience has been.
• Oh, for sure.
• And, you know, I have a quest- I have a direct question for you, and, but I wanna bring up something quickly.
• It's, I've had a lot of families myself who have talked to me about reactions, and it, it's, it's, it's fascinating 'cause sometimes just sitting down and listening to them and listening to their child's onset of allergies or asthma or whatever it may be, and explaining the age at which these diseases usually show up, and the fact that these are also the time when kids get vaccines and sometimes it is just correlation, oftentimes it's just correlation, and it's really hard to tease out.
• Families take a breath, and they're like, "Oh, that actually makes a lot of sense."
• If you plot things over time, organic food sales also track with the incidence of autism.
• And, you know, you have to, like, really sit down and look at the data.
• But I wanted to ask you, Joel, I'm curious, because times are changing, because demographics change, are there certain vaccine questions or misconceptions you hear more often than not today? Are there specific things that you get from more families? I, I would say the biggest concern overall is with chronic disease.
• I think the biggest concern, at least from my perspective, is, are vaccines in some way related to chronic conditions in the long run? So if you took a, a fully unvaccinated kid over 10 years, over 20 years, uh, do they get sick less? Do they have lower rates of chronic disease, lower asthma, allergies, autoimmune conditions, autism? That, I think, is the biggest question that parents feel i- is unanswered.
• And I think that What you're saying about correlation, absolutely true.
• I mean, all sorts of things are gonna pop up at some point, but there are also so many stories, and so many concerned parents, and so many kids who were apparently completely healthy on day one, went in to get a vaccine, and the day after that or that same afternoon had some sort of reaction that their parents blame on vaccines, whether they're right or wrong, could be correlation, could not.
• And I don't think we should be dismissing those stories.
• I think those are the exact stories that we should be listening to, and studying, and trying to tease out what's real, what's not real.
• Uh, 'cause I think, ultimately, if you wanna increase confidence in vaccines, that's the question that people have, is, "If I give my kid a vaccine, is it gonna increase their risk of autism, allergies, autoimmune?" That's what they hear.
• That's what their friends think.
• They, you know, they went in and it's so quickly dismissed in modern medicine and I don't think that parents feel heard.
• And it's much easier to hear those stories online of the kid who was, you know, totally healthy till five, got a bunch of vaccines, next day, uh, developed severe regressive autism, at least in their parents' mind.
• Could be right, could be wrong, but that's what they hear, and I don't think that's been adequately addressed, 'cause I think that conversation gets shut down all too often.
• I do like how you're framing that's what parent- that's what parents hear, because that is such an important piece of this conversation, is parents go online, survivorship bias is obviously a thing.
• Nobody posts on X, the artist formerly known as Twitter- about their healthy, vaccinated children.
• They're posting about their child and then saying, "These are the vaccines my child got," and they find their people, and all of a sudden that story gets amplified.
• And where was I gonna go with this conversation? That was the main, that was the main thing I was gonna, I was gonna say re- regarding, is, is that conversation and that story parents are, parents hearing are hearing is so, is so real.
• I get...
• One thing that really bothers me, and again, I think this goes back down to the narrative we keep hearing, and I'm sure as a pediatrician you share this frustration, at least to some, to some degree is how much of the conversation, you know, RFK Jr.
• and the MAHA influencers have pushed about chronic illness.
• And they really looked at, at least in this administration, vaccines and Red 40.
• That's, that's really what's leading the conversation, and, you know, and obviously conversations about food, but we haven't paid any attention to other social determinants of health, and, you know, healthcare access.
• And yes, we all want children to go outside.
• That is a fact.
• We talk about this.
• I want the mechanisms to help kids go and play in a safe neighborhood, and be able to put screens down and go run around for a bit.
• I want parents to have paid childcare so that they can go and work out outside, and I want school lunches to be free.
• Like, there are so many other elements that have just somehow been ignored.
• Mm-hmm.
• And you have ASIP just saying, "Well, hey, you know, chronic disease is up.
• Let's look at the vaccines."
• And have that discussion, you know, have that discussion with parents.
• I, you know, I've seen a lot of the data.
• And I'm comfortable with where vaccines sit with regards to chronic illnesses, but what about every other aspect of keeping kids healthy, and every other aspect of supporting people? There's...
• Nobody seems to care about gun violence.
• Uh, the MAHA influencers used to be very big on banning glyphosate, but now somehow don't care that their messiah wants to back glyphosate.
• I mean, I- there's somehow...
• We're in a really interesting time of social science, cognitive dissonance, and us versus them.
• And I'm sitting here and banging my head against a wall and saying, "We gotta be able to have these root conversations if we wanna talk about root cause."
• Yeah, I, I think that's probably one of the biggest failures of medicine and just public health in general right now.
• All of us together is, there's an us versus them.
• There is no us versus them.
• We're all on the same team.
• We want healthy kids, and- Team human.
• Team human and the t- we're all, we're all t- if anything, it's us against pharma making a product that harms us.
• But, I mean, like, realistically, the pharma's just people, right? And they're making products, they're trying to create products that are supposed to help us.
• It's not us versus anybody.
• And we should be looking at all the things that are leading to chronic conditions.
• And all the things that you mentioned, they're all important, and vaccines is just one piece of the puzzle.
• I think it's important in medicine that we shouldn't discredit vaccines.
• It should be part of the conversation.
• We should be allowed to talk about it, but that's just one small piece of the hundreds of thousands of different reasons why we could be having or seeing sicker kids.
• And a- all these things should be on the table, and we so often focus on these little things when there are much bigger things to be focused on, like making sure people actually get healthy food, and not defunding healthy food and, you know, programs that actually get those things to, to our kids.
• So I, I agree with you totally on that.
• Uh, but I wanna bring it back to vaccines, 'cause I know we're talking about that more today.
• I, I wanna go back to the discussion that you had.
• You were talking about this a little bit, but maybe we'll go back to it, 'cause this...
• When you were on the podcast last time, I agree with, like, 99% of what you said.
• The one thing I kind of a little bit disag- well, the one thing I disagreed with that you mentioned was talking about the vaccinated versus un-vaccinated study.
• And where we certainly agree with the ethics, I know we kind of were joking about at the beginning, uh, you know, there's certainly a lot of ethical concerns around making people get vaccines that don't want them in a blinded study and having people not get vaccines that would want them, because you're not prot- protecting them against diseases which we have vaccines for.
• My question would be around when y- you had the discussion around an unblinded trial.
• Because to me, as someone who has done a master's in epidemiology, has done research- I am not sure that there is a major ethical concern, at least to be around doing an unblinded, unvaccinated study.
• I-- to me, if we were able to do 10, 15 of those studies around the world, big trials, follow kids forward, that would be the best evidence that I think would help people to make vaccine decisions.
• If you were looking at people who choose to vaccinate, people who choose to unvaccinate, they're always allowed to get a vaccine if they want one.
• Uh, you follow them for a very long time, and you look at their chronic conditions, look at autism rates, look at asthma, allergies, everything.
• Follow them, make sure you're checking they're getting their visits, they're being followed for a long time, so even, you know, the amount of visits doesn't come into effect, which I wanna talk about after.
• That to me would be the, the best evidence for it.
• I think if you had a bunch of vaccinated versus unvaccinated trials and the autism rates were exactly the same, that would be the exact evidence that parents would want to feel more comfortable to do it.
• Same thing with chronic conditions.
• And there are so many studies that we have.
• We have a bunch of retrospective studies.
• We have The ones that come from, you know, the CDC and very pro-vaccine places that tend to find vaccines are the best, and then you have the other studies, you know, retrospective studies, for maybe they're not as good.
• They're people that are a little more anti-vax that find that vaccines cause every sort of problem in the world.
• And so you have these studies versus those studies, and any retrospective study you can adjust in different ways if you want to find what you wanna find.
• You can't really do that with a prospective study.
• So to me, that would be the way we move forward and we have much better evidence or data in 10 years.
• And so to me I would love to know why you feel that is unethical to have a vaccinated versus unvaccinated study, knowing it's not the perfect study 'cause it's not blinded, but it's probably as good as you're gonna be able to get, why you feel that that's un- unethical to do that.
• That's a great question.
• I would say it, I, in, I mean, again, look, I'm gonna be honest with you, I am not an expert when it comes to research design trial or epidemiology or stats.
• I actually hate the term expert.
• Most of us aren't.
• But I, from my perspective, it would have to depend on the specific condition we were looking at with this vaccine.
• And so y- I, I understand why retrospective trials are so important, 'cause we have those for autism.
• We've got millions of children, and it's interesting 'cause I don't know if it would actually solve the issue.
• If you go, kind of looking at one aspect of your, of your argument, it's if we had, we have the retrospective data for autism studies done in multiple iterations.
• I'm sure there'll be more in the future as people look and compare these populations who vaccine versus didn't.
• And somehow Andrew Wakefield's original study, which was terrible, still carries so much weight.
• So I do think even with the studies, there still has to be this nuanced discussion.
• Now, moving forward, I'm looking at which preventable vaccine illnesses would be okay in having the study for, and if you had one that was so rare, you wouldn't have the, you wouldn't have the power in the study to actually prove anything, which is not an ethical consideration, more of a statistical one.
• But I, if I looked at what would the focal points of vaccine studies, of vaccine arguments right now, I don't know if I would feel comfortable in having a cohort of kids not get vaccinated for measles, especially considering if you get the disease under the age of one, I don't know if your kid's gonna develop panencephalitis in seven years.
• Could, could, could, you, you would, you would, you would- I don't, wouldn't feel great about hepatitis B.
• I wouldn't feel great about vitamin K.
• I, I, and I get that, but you wouldn't be having that...
• You'd already be having that.
• Like, they're not getting vaccines.
• These are people that are saying they wouldn't get- They're volunteering to be in the study they're volunteering to do it.
• Oh, I see.
• I see.
• So, so you, I, I wouldn't feel comfortable either.
• I think that there's a lot of ethics around saying, "Okay, you're not gonna get vaccinated for v- measles."
• I mean, that's never gonna happen.
• No one's gonna approve that.
• But I'm saying you would volunteer to study.
• You're saying, "My kids are not getting vaccinated.
• I'm okay to volunteer for this study.
• I'm not gonna v- do vaccines anyways, so I, I'm happy to be a part of this study."
• Like, that, that's the kind of study that I think- my question around I feel like that study's al- that study, I'm, I'm air quoting for anyone who's listening to this and not watching us, but I feel like that study's already happening as we look at the comparison rates versus kids who get an intervention versus those who don't, which is why I'm, for example, I'm able to say babies who don't get vitamin K have an 81 times higher chance of getting vitamin K deficient bleeding, and I'm su- and I'm I hate to say that we may have more of this data in the future with hepatitis B as refusal rates are going up.
• Um, but I'm not...
• So in n- when you frame it that way and looking at people who refuse vaccines now, and can we compare the two of them, I think we're going to.
• I don't think...
• I, what I meant by an ethical concern is if I were to design a trial and say, "Here is a new..."
• I'm gonna, I'm th- I'm thinking right now of a new vaccine we're gonna come out with.
• "Here is a new RSV vaccine," for example, "and I'm gonna test this versus placebo."
• That is what X wants.
• X wants to see that.
• We, I see it all the time online, people saying, "Where is the placebo trial?" And if it was RSV, for example, like I'm not cool with that, in giving some kids no vaccine versus not.
• But if it was a trial in which we look, we use electronic medical records or whatever it may be, and you compare kids who didn't get the RSV vaccine versus those who did, I think that's totally fair, and I think that happens.
• I wouldn't be surprised if we see more of that data in the future Okay, I'm gonna have a lot of questions.
• So I agree with everything that you said with a vaccine that's already existing.
• I think, let- let's just talk about the vitamin K for a second, 'cause I think that, that's, like, a perfect example of where modern medicine, in general public health, doesn't hear the parent question.
• So you quoted the study- For sure showed the 81 times, right? And I, and I think that's not debated in, in my mind at all.
• Like, I think the vitamin K is, if anything, if you're gonna do one thing for a newborn baby, that's probably the one.
• Uh, you know, that has, by far, the most benefit.
• Illie, totally agree on that.
• I will fight- Oh, no, I listeners that's the one I'd fight.
• So we're three across the board here.
• Joel and I most, I'm, I'm gonna, I'm, I'm not, didn't mean to interrupt you, but of every pediatrician, scientist people I talk to, that is the one we all kind of unify on.
• But, so go ahead.
• Yeah, so I, I don't have any question with that.
• If people are coming in saying, "Which is, if I'm gonna weigh my risks and benefits, which is the one that's gonna have the most benefit?" I would say that one.
• That's not the question, though.
• The question is not, how well does it work? The question is, what long-term effects does it have on kids? We can say that we know that there's a benefit, and I think for most vaccines, pretty much all vaccines, we have a really good understanding of how much the vaccine works, and that's the side that medicine talks about all the time.
• You know, it protects against hepatitis B.
• I don't disagree with that at all.
• I, I think that we have vaccines that work very well.
• We understand how horrible the diseases can be.
• We understand how many kids get sick.
• I don't think every individual understands that because they haven't seen these things these days, but I think modern medicine does, and I think modern medicine doctors who worked in the hospital have seen kids with RSV get really sick, uh, be in the ICU and that's their concern.
• But they're not hearing the other side of the question.
• It's not just about how well it works.
• The parent's question when they're worried about vaccines, "Okay, I understand that it could protect me, but what is the risk?" And I don't think that we have those long-term safety studies looking at that.
• I think that we have, uh, when you look at most of the vaccinated studies, especially the ones that we get from the companies, they do it for a year, maybe two years- Mm-hmm if you're lucky.
• Generally, it's not vaccinated versus unvaccinated.
• Usually against some other vaccine.
• You're not following kids forward for many, many years.
• The methodology which we look at diseases, concerns, chronic conditions, you know, things like, uh, VAERS.
• It's self-report.
• You would never report if you had cancer 10 years from now and relate that to a vaccine, so you wouldn't know that unless you followed kids forward.
• And I think that's where, where some of the research is lacking.
• If there was somewhere we could get better data, that's what I think parents are asking for.
• That's what, to me, is the weakest when it comes to vaccines, 'cause doctors always quote, I mean, h- "Do you want a kid to get hepatitis B? Do you want them to get cancer?" No, nobody does.
• Uh, but the question is not, at least in my mind, does the hepatitis B vaccine work? Does it protect your kid? The question is, on day one, what is your risk of getting hepatitis B in the next couple of months, and what is the risk from the vaccine? And I often hear doctors only talk about the benefit from the vaccine, but are not willing to have the conversation of what that risk might be, and often downplay it, when I think we don't actually always know the answer because we're not studying vaccinated versus unvaccinated kids.
• I...
• Okay, this makes sense now.
• I see what you're saying, 'cause I feel like we have, like, three separate conversations wrapped up within one, but I totally agree.
• And I, and I think this is part of informed consent, which, for the record, we've been having since I trained in my third-year medical school, uh, clinical situations, we trained informed consent.
• This is not something that MAHA made up.
• Just wanna say that to the people who are like, "Doctors should do informed consent."
• We had these conversations, and Joel, I agree.
• I think especially for newer formulations of vaccines, we have to be open with parents.
• We have to explain what clinical trial data we have, how we...
• I don't, I can't tell you in, you know, 20 years from now what a vaccine today could potentially do or not.
• Like, no one can actually say that.
• Correct.
• You know, I think, I think you're great- But that, but that's the concern that parents have, and I think that's what doctors are not addressing.
• That's the con- and not 20, maybe 5 years, 10 years.
• Mm-hmm.
• I think that is the biggest concern, and I don't think doctors are addressing that question, and that's what I think is...
• people are most hesitant about.
• And I think it goes back down, again, t- you, you made this point about, you know, the cost benefit and people saying, "Well, this is acutely what we're treating," versus not.
• But where, where I will say, and I, and I see parents' eyes light up when I say this, is especially 'cause when I get called to newborn nursery, this is probably the biggest example, where I talk to vaccine-hesitant parents, and they say things such as, "Well, I'm worried about this vitamin K shot.
• I'm worried about hepatitis B.
• When my kid is two months, I don't wanna do this."
• Parents, a lot of parents I talk to don't realize how long these vaccines have been around and how some of these shots have been around, in, in actually more dangerous forms, since the '20s, '30s, and '40s, and how MMR has been around since the '60s.
• And so, you know, looking at some of the long-term population data- No I can s- I would say that that should be reassuring.
• I know it's reassuring, 'cause I've talked to families who have said, "I had no idea that MMR has been around since the '60s."
• I'm like, "Yeah, your grandmother got it."
• Like, it's been around for so long.
• And we But you're right, we have to have those conversations.
• This goes back to the point of if we don't stop and just listen to parents, we don't often find these small points of agreement.
• I had a family, uh, about a month ago refuse vitamin K and said, "Well, I read an article saying it's linked to leukemia."
• And I'm sitting here being like, I know exactly where they're going with it, but I didn't want to say anything.
• I wanted to listen.
• And I said, "Can you show me where you got it from?" And they got it from some article that paraphrased a New England Journal of Medicine article from 1993, and in that article, the original one from '93, the authors even stated that, "We found no correlation.
• We found no association."
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• Yeah, and, and, okay, so let, let's talk about hep B, 'cause I think that's been in the news a lot lately, especially the, the newborn hep B.
• So from what I've seen I would say there's no question that the fact that we've given basically everybody hepatitis B vaccine has decreased the risk of hepatitis B.
• It's gone down.
• We don't see the, not the cancer.
• We don't see as many cases.
• So that I don't think is something that needs to be debated, but I think when parents are having discussions, they're not necessarily concerned about that.
• You talk about the five, 10 years.
• What they are seeing five, 10 years later is chronic disease.
• That's what we're hearing about.
• That's what's being discussed about.
• They're seeing asthma, allergies, autoimmune conditions.
• And in a lot of parents' mind, they're worried, "Okay, I have a newborn.
• I tested negative for hepatitis B, so therefore my chance of giving my baby hepatitis B or in the first couple months getting it is really, really small."
• Let's say one in a million, one in seven million.
• It's still technically possible the test could be wrong, right? Uh, they could have been missed.
• Somebody could technically bite your baby or bleed on your baby, but the risk is pretty small in the first couple of months.
• So the question that they would have is, "Okay, then what is the risk from the vaccine?" And that risk is not zero, right? No vaccine risk is zero.
• And I think that a lot of parents don't feel like doctors have that concern in their mind as well of, okay, well, what's the risk of getting a fever and having a full workup, full lumbar puncture, seizure? Could it increase the risk of chronic conditions? Could it be related to autism later on? Could it be related to asthma, allergies? They don't want that, those questions dismissed, and when you have something with such a low benefit in those first couple of months, potentially, not necessarily long-term, but could you wait a couple months to do it? I don't think an unreasonable person couldn't weigh those risks and benefits and say, "Well, you know, I tested negative.
• The risk is pretty low.
• Uh, I'm okay waiting a couple months to do hepatitis B."
• But yet they're demeaned in the hospital, berated.
• They're, they're called an anti-vaxxer even though they get...
• They wanna do all the vaccines.
• They even wanna do it.
• I, I think that's one of the places where we're really missing the mark in medicine because I think it starts the relationship off in this- Totally agree place where there are just so many parents that say, "Oh, well, you know, does my kid...
• Is my kid sexually active? They're not gonna get hepatitis B."
• And it already puts you at odds with vac- vaccines.
• And then you say, "Well, this is what they're saying about this vaccine.
• I can look at the risk.
• I know there's a small risk for them to get hep B, but it's basically zero in these first couple months.
• Why are you making my beautiful one-day-old baby get a vaccine when I could just do it later?" Uh, and I don't think we've explained that very well.
• I think a lot of parents don't agree with getting hep B on day one and we don't address the theoretical risks for vaccines.
• We just, "Ah, this is one in a million risk," but it's not really, right? It's not really just one in a million.
• There's a risk of fever and seizures and, you know, rare complications, but there's a lot of rare complications that are potentially possible, so maybe it's one in a million risk, one in a million benefit.
• But that's the risk-benefit calculation.
• That's informed consent.
• Oh, totally.
• And I, I do- I think it's- I think we're missing the mark if we don't have that conversation with hesitant parents.
• I, I think the hep B conversations is the one I probably have the most now, especially 'cause with- vitamin K, I mean, it's a little bit more straightforward, but the hep B one...
• And it, and to your point, it's not parents saying absolutely not to hep B.
• There's a few who will say, "Absolutely not.
• We're, get out of this.
• I don't trust medicine."
• I'm like, "Well, you delivered in a hospital, so you trust us a little bit."
• But, but with hep B- Yeah you're, you're right, though.
• Parents will, uh, some of the common things I hear is, "I'm hep B negative, and my child's not sexually active, and it's only druggies who get this, you know, who get hepatitis B."
• And, and I, you know, like to sit down and explain some of the data and talk about the majority of hep B cases happen after birth, even to a hep B negative mother, a microscopic drop of blood.
• I mean, stuff you and I know, but the average parent doesn't always realize that it could be a microscopic drop of blood from, you know, s- something on a counter or something on a toy or, you know, an uncle who shared something with whatever and your baby gets it, there's a cut, whatever.
• But I think the conversation we should be having with parents, it needs to be individualized.
• There has to be informed consent.
• But when it comes to that birth dose and parents say, "Can't I wait?" You know, that is a very nuanced discussion because I'm gonna have a different discussion with each parent.
• Like, in my world, like, I enjoy the concept of we've screened, we've gotten the things done that I feel are extremely important in a controlled setting where I know you're gonna be, I know you have follow-up, I know you're going to this pediatrician's office.
• Uh, you're not gonna go to a pediatric chiropractor who's anti-everything.
• Like, I know where your follow-up is.
• And as a, from a population health level, that's where I'm thinking, and I completely respect thinking individually.
• If I had the time and I had my...
• You know, if you and I could, you know, have this operation of 1,000 pediatricians and we all constantly communicated, and we could account for deficiencies in resources and healthcare barriers, I think we would have a different world.
• This also, to, um, not to go on a complete tangent, this is why I hate, I vehemently cannot stand the comparison of the United States and Denmark, which is what everybody wants to do.
• We don't have their healthcare stru- system.
• When people say, "Well, in Denmark, they don't do this," I'm like, guess what? In Denmark, they have universal healthcare, and they have paid child leave, and people know their children are gonna get seen, and I know this child is gonna be taken care of.
• People have se- sent these memes around about Japan and Japan removing infant mandates and say, well, that's why they do so well, and that's why those babies don't have chronic illness.
• I'm like, they have a higher vaccination rate than we do.
• Right.
• But it's, it's this concept of forcing people to do things, I think that shuts the door before we can even have a conversation.
• And so that is another area that the mandates, the forcing, that parents feel like they've lost their autonomy, is where we lose the conversation.
• I couldn't agree more.
• I mean, that's what I've said a million times.
• To me, if we were to get rid of the mandates, I think the temperature in vaccines would drop so significantly.
• I, I think the The biggest concern overall that families have or, or individuals in the vaccine space that are more anti-vax, they're just worried they're gonna be forced to do things.
• They're worried their kid's gonna be forced to do something to go to school.
• They're worried they're gonna be forced in the future, some, the next disease, they're gonna be forced to get a vaccine they don't want, whatever it is.
• And so to me, that is where a lot of the concern stems and a lot of the pushback comes from, because ultimately, around the world, most people do get vaccines.
• You talk about Denmark, Japan, like, yeah, they don't have to force it 'cause everybody just does it.
• I mean, there's a small percentage that don't but other than that most people do it 'cause they just believe in vaccines.
• And, and so for us to just...
• Yeah, I agree.
• I mean, it the whole change in the schedule didn't make any sense to me.
• I mean, if you're gonna make that schedule change and just mimic it against another country and have a few people just discussion, not, not bring in all the parties to actually have a discussion of what should change, where it should change, uh, what you're gonna recommend or not.
• Like, I understand what they were doing, um, but ultimately, it doesn't make a lot of sense 'cause America's America, and we have a lot of really smart people here that have been working on this for a long time, and if we're going to change the schedule...
• And I'm not sure that we, we shouldn't sit down and think about it.
• I mean, may- maybe there are things we could change.
• Maybe there is a discussion to be had that some of the vaccines we don't need as many of.
• Maybe we could do some of them later.
• We could do them at different times.
• I don't, I don't think that's unreasonable.
• I mean, we should always be thinking about this and discussing it and, and being open to changing things, that we're not in, in 1980 anymore, so maybe- Mm you know, th- we're not as worried about diptheria and we don't, we don't need five diptheria vaccines.
• I don't know.
• Maybe there are different things that we could combine or change or say, "Hey, pharma," like, you know, "There, there hasn't been a lot of polio here, so maybe we could...
• We still wanna make sure people get their polio vaccines, but maybe that one doesn't need to be included, or diptheria, or give it later."
• I don't know.
• There are many things that we could discuss and that's, those are for smarter people to d- d- debate, um, you know, sitting in a room together with the best scientists around the world and, you know, certainly from America to discuss these things.
• But We should be open to having those discussions at least.
• I, I totally agree.
• Not in the way that it was done.
• Especially, especially with having the scientists, uh, discussing it and having it be transparent.
• And I, I just wish we could remove all special interests.
• Mm-hmm.
• We could remove all lobbying, you know, whether it's pro or anti-vaccine, I just don't want any more super PAC spending.
• Just have a pure scientific conversation.
• You know, you hear multiple sides saying things such as transparency and, you know, for profit, and it just, I lose so much trust when I constantly see how many pharma dollars get poured into both sides, and anti-pharma dollars, and whatever it may be.
• Um, I, I wanna pose something 'cause I'm curious about your gut reaction to this.
• Joel, this is kind of fun, but it's not fun.
• So during, during the pandemic, and even in modern times, when I would see accounts on social media, especially ones who would really be anti-vaccine, not vaccine hesitant, but anti-vaccine, attack doctors and, you know, say, "Oh, you guys get paid off by pharma," whatever, and I would look at social media bios.
• Oftentime it would say things such as freedom, America first, patriot, these kind of very pro-amonic- Americana terms.
• And my own social experiment would be talking to these individuals and first trying to learn their perspective, but then also telling them, "Hey, George Washington mandated the smallpox vaccine for his army."
• And it's really interesting to see the reactions, because they've built this persona around America, and patriotism, and freedom, and some of these groups actually have George Washington's picture.
• And to me, this is, this is fundamental proof of cognitive dissonance, of us versus them.
• Because when you- Mm-hmm when someone has built this entire argument about being American, and freedom, and we are patriots, and I'm like, "The original patriot mandated the vaccine," it's really interesting to see how people don't wanna hear that.
• They're like, "No, no, no, that was different.
• Smallpox was serious.
• We have to do it to win.
• Leave me alone."
• Your reaction to that.
• Yeah, I c- I mean, it's so weird to me that vaccines have become a political, be- part of the, become a part of politics.
• I mean, it's, it's very odd to me that medical freedom has turned, you know, more, I would say, Republican-ish, and there are more people that are more hesitant on one sphere, and there's, you know, uh, health...
• It's weird to me.
• I, I don't understand any of it.
• I, I, I mean, I'm from Canada, so, like, I'm not political at all.
• Doesn't make any sense to me.
• Oh, are you really? Yeah.
• I grew up in Toronto, so like- Your family, your family has free healthcare.
• Yeah.
• They do.
• Yeah, and I'm like in California, so like, couldn't be any more, uh, you know, I guess liberal if there was someone to come from a liberal place.
• And yet the things that are more willing to have me on are Republican-ish things, pro-freedom things.
• It's very weird to me.
• Like, that doesn't make any sense.
• Like, I've been on The Charlie Kirk Show, and, and- It's a very different world, but it's like, you know, if, if I'm talking about kids and vaccines, I'm trying to answer questions and discuss and, and generally I'm more in the middle than what they would have on and not someone who's just going in there saying, "Vaccines are the worst thing ever, and you should never get a vaccine."
• And so I, I think it's really important to be able to have those discussions, whoever wants to talk about it.
• And I think sometimes it helps to bring things more to the middle, to even put a face to, like, doctor's not evil, 'cause it's...
• Like, almost doctors are seen as evil now, which is weird.
• Like, we were like the, one of the most respected professions, you look at the studies, you know, 20, 30, f- 40 years ago, and it's not like that anymore.
• I mean, there's such a, a hatred sometimes towards doctors, like you said, like getting death threats and things like that.
• It's weird.
• I mean, I'll, I'll get sometimes told from someone who's really anti-vax in the same week as, as someone who's really pro-vax, like, "I'm killing kids."
• Like, I'm way too, way too anti-vax and I'm killing kids because I'm talking about, um, you know, maybe we shouldn't mandate everything.
• And then same thing from, uh, some doctors.
• Like, I can't believe you're even talking about, uh, any sort of side effects from vaccines.
• You're gonna kill kids because, uh, any hesitancy is killing kids."
• And it's like, well, but that's not where most parents are.
• Most parents wanna do vaccines, but they have concerns, and we need to be able to talk about those things to suss that out.
• Uh, and I hate that it's become political.
• I think that's ridiculous.
• Uh, and I wish that we would s- I mean, I wish ACIP would be full-time.
• I don't e- I wish, like, there would be a group of people that would sit down, think about vaccines- Mm-hmm and that would be their job, and, like, and go through this and be really good at being public-facing and have these discussions and talk about it openly.
• Uh, I think that would help a lot of parents make decisions.
• They just don't...
• H- how do you make a decision as a parent right now when ACIP says one thing, CDC says one thing, AAP says another thing, their doctor says another thing, HHS says the complete opposite? It's...
• I don't know how parents are doing it right now.
• It's so difficult to follow when even the major societies can't even agree with each other.
• And when we don't have a consistent surgeon general, we don't have a consistent CDC director.
• We, we don't have USBS, we don't have a surgeon general, we don't have CDC.
• We, like, that is, that blows my mind that that's going on right now.
• I don't care, you know, you pick someone you like or don't like, but having nobody, uh, that's such a big loss.
• I mean, I, I think that that's, that's crazy that there are all these positions that are just sitting unfilled, not happening.
• ACIP's just sitting there doing...
• Like, that's not moving the needle forward at all.
• I, uh, I don't know.
• It's crazy to me.
• I don't wanna I don't wanna point fingers.
• I'm curious about your experience with some of the, you mentioned Republican-leaning podcasts.
• I'm curious if you ever felt they were trying to steer conversation for their audience.
• The reason I ask this is I remember...
• So, at the time I was at CNN, this is early pandemic, and it's fascinating how Fox News in New York City had a COVID mandate for their employees, and the majority of the employees went with it.
• And they said, "This is the data," and then they would go on air and bash it.
• And I, and I always found that so mind-boggling.
• And I'm not gonna...
• Again, I don't wanna point finger or name any names specifically in the building, but yeah, they had a mandate.
• And they would openly be like, "Yeah, we have to get the shot.
• We know it works."
• And then they would go on air at night and say, "What are we doing? How do we mandate this?" Um, Tucker Carlson openly said that it was child abuse to put masks and shots in children.
• Like, it was, that, that difference was, was fascinating.
• So I'm curious, in your experience, have you ever went, and it doesn't have to be Republican, on any podcast, and you felt people were trying to steer the conversation for their audience? Because I do feel like, yes, we have a job to do.
• Our job is to listen to parents, be respectful, and understand everybody's concerns and journeys, but I also feel like the platforms also have a job.
• Stop steering it towards your audience or your funding.
• Uh, always.
• I mean, that- that's always what it is.
• I, I feel like they're, they always have an angle that they want you to go with.
• And that's what's hard with somewhat being in the middle because you're never exactly steered in that direction.
• You kinda wanna bring it back, uh, to somewhere in the middle.
• But I, I, I think most...
• I mean, everybody has an opinion.
• Everyone has their bias.
• I think that's okay.
• But yeah, I mean, the, the direct answer to your question is absolutely.
• I've been on, uh, the most anti-vax things you could possibly be on sometimes, and, and they certainly have an opinion.
• But I've always been surprised, whether it's super pro-vax, super anti-vax, that they're very willing in general to have conversations, usually pretty nice about it, and they are willing to listen.
• They might not agree, but I mean, I've been on Del Bigtree's show.
• I was on, you know, try to...
• Like, I've been on these things once or twice and I'm just very interested to go there 'cause it's a very different world than what I'm used to being a part of.
• Mm-hmm.
• Uh, but they're always very nice, and, and they always have very respectful conversations, and they're willing to listen.
• They don't always agree with everything.
• But I don't think that they often get to hear a different perspective, and I think if everybody did get to hear a different perspective, there's so much of an echo chamber, especially with social media- Yes and you're playing to your audience.
• And then you don't even hear the other side.
• And I, and I, I think if you did hear what other people said from the other direction, you didn't agree, you would, you would see that there are two sides to the story, and we often just get one.
• And that's why I think conversations like this are so important, uh, because the more that you're able to hear these kind of conversations, the more that it models that you can have them and the more that people can actually hear different perspectives.
• And I, I don't know why we have to agree on everything.
• Like, I, I don't understand why you can't go on a show or, you know, on your social media, you can't say something that someone disagrees.
• "I'm not following you anymore."
• You could be following someone for 20 years, they say one thing that you disagree with, like, ah, you're the most crazy person ever.
• Like, we don't have to agree on everything.
• You're not gonna agree with everything that any HHS secretary says or any CDC director says.
• You can agree with some things, and you can say, "Well, I really like that food policy, but I hate that you're doing this other thing."
• That's fine.
• That's always gonna be the case.
• But yet we've really become very tribal, and I don't, I don't like that at all.
• I think that's not serving kids.
• And we are so many tribes in the United States, and we have to understand, you know, HeHe...
• We've completely ignored HeHe, by the way, um, listeners.
• You've been very quiet.
• But you brought up, you brought up such an important point when you were talking about you and your husband having banter over dinner about science and how we would approach, we'll just say vaccine messaging, in different parts of the country.
• And Joel, I feel like we have also...
• We, we...
• I, again, I'm gonna argue and say we're getting better, but back in the day, we would have the same messaging for different parts of the country, not taking into account cultural beliefs, politics, and that lens.
• And I do feel, I do feel hopeful there's more social science data about how different populations receive information.
• You know, we have clear-cut data to show us that saying vaccines are safe and effective does not reach our audience.
• The parents who have questions literally don't care, yet I hear that phrase all the time from my colleagues saying vaccines are safe and effective.
• And I'm not faulting my colleagues, but that term isn't landing because that isn't actually hitting the focal point of what- you know, parents wanna hear about.
• They, they either need to hear their specific concern addressed, or they wanna hear something that is devoid of, of what you mentioned, devoid of the special interest and the politics.
• And sometimes it's a specific...
• Yeah, I'm sure you have these conversations all the time.
• Sometimes it's a specific about the timing of a shot, or the ingredient in a vaccine, or the difference between ethyl and methylmercury.
• And when we don't have those conversations, I get so frustrated when we fall behind.
• I think the biggest example, and Joel, I think I heard you mention this on a podcast too, and it's how HHS was celebrating removing thimerosal from vaccines, and the public w- I was getting blasted on social media from people last year being like, "Oh my God, you guys are giving kids thimerosal."
• I'm like, we pulled that out of vaccines over 20 years ago.
• HHS removed it from less than 4% of flu shots and are claiming some type of massive victory.
• But it was a science communication failure because w- that we had that notice coming out, and somehow parents didn't know, or didn't remember, whatever it may be.
• There's a new generation of parents, and so all of a sudden when you have people giving people an answer in a divided world, they're going to listen to that answer It's, it, it, I, I hope, I hope, and I hope science communication becomes a really important integral part of our curriculum in medical school.
• Can we talk about autism for a second? Because I think we'd be doing a disservice if we don't talk about it.
• I think that's- Please a huge question on people's mind.
• And, you know, what you're saying kind of leads into this, because, uh, the thing that you hear, you know, so often is, "The science is settled," um, you know, phrases like that when it comes to autism.
• And when I was in training in the first few years, you know, I really, really thought, "Okay, the science is settled."
• This is what we're hearing all the time.
• There's so much research.
• There's so much vaccinated versus unvaccinated studies when it comes to vaccines and autism, and you even mentioned it, you know, a little bit in passing.
• We were talking about it earlier, about the science on vaccines and autism.
• Do you think that the science is settled when it comes to vaccine autism? Because when I look at the research, I have not found anything in any good study that shows that vaccines do cause autism, but I still think there's a ton of research that needs to be done when it comes to vaccines and autism, because really the majority of the research is MMR versus no MMR in the setting of getting other vaccines.
• It's thimerosal versus no thimerosal in the setting of getting other vaccines.
• There's, you know, the one DeStefano study on antigens, which is really the old DTaP or DTP versus the new DTaP.
• And then really that's the majority of that science.
• There's, you know, other more fringe studies that, you know, maybe show that there's some connection, but they're not the best studies.
• Um, but really with the mainstream studies that, like, let's say, Paul Offit quotes in his book, he...
• You know, even when I was researching for my book, I was l- I was really surprised that there isn't studies looking at all vaccines, vaccinated versus unvaccinated at all.
• So I, to me, the science is not settled.
• They just, we haven't found that vaccines cause autism.
• I think that's a reasonable thing to say.
• I don't think the MMR is specifically linked to, you know, autism.
• I, I think we do have, you know, pretty good studies on that.
• But it's, there's no prospective studies.
• There's no studies that are vaccinated versus unvaccinated.
• And, and to me, I think that's a messaging error in medicine, because people can very easily look that up, and when they hear the science is settled, they tune off, just like safe and effective.
• And I think the better response reasonably, at least in my mind, would be, "We haven't found any specific link between vaccines and autism.
• Uh, we hear that you're concerned about it.
• We're gonna keep researching it."
• Like something like that.
• And I'm curious what your, what your thoughts are and what you've seen in the literature and where you think the literature is on vaccines and autism.
• I think what the, the phrase you're saying is the more empathetic version of what people are trying to say when they say the science is settled.
• 'Cause I agree, I think the science is settled dismisses that nuanced conversation some parents want to have.
• And the more rational way to say it is, you know, based on the volume of research we have, we have not seen any link between MMR in vaccines or, you know, acetaminophen in vaccines, or whatever it may be.
• I think being able to tell parents, like, there is no link according to the research is the way we should be saying it.
• Because again, science is based on, scientific statements are based on a consensus, and this is what the body of research shows.
• So regarding vaccines and autism, I feel very comfortable about the volume of data we have from a lot of those European trials, and if you add them all together, you get these millions of people.
• And yes, there are a few of the trials you mentioned also, but some of them are retrospective, looking at vaccine rates in unvaccinated versus vaccinated children.
• And then where I fe- I agree with you in the sense where I think we do need to be having these conversations with parents.
• We do need to sit down and say, "Here's what the study shows, here's what they don't."
• But the part that seems to be missing is how autism has changed since the '60s, since the '50s, and you know, we, we've come a far way from refrigerator babies, the belief that autism was caused by being cold to your children.
• Yet the largest voices, when they are talking about vaccines and autism, are looping autism together with these Old World definitions.
• And you heard RFK Jr.
• saying things such as, "If autism really was X, Y, and Z, I should see institutionalized adults," or, you know, "This, we don't see these kids running around like we did back in the day."
• And I was like, well, we also didn't include Asperger's in that.
• Now, I think even the most major scientific organizations agree that the rate of autism cannot be explained just by more screening, but you have to take into account the broadening definition of autism, and then you have to take into account these genetic, environmental factors, aging paternal age, which we seem to have dismissed.
• And so while we have the conversation about why I feel comfortable saying that vaccines don't ca- aus- autism, I also wanna push back and ask, why did you stop all the environmental studies? You've defunded the EPA.
• You don't care about glyphosate anymore.
• We have preservative food companies donating millions of dollars, and we've seen the rates of autism, according to definitions, alongside chronic illness, alongside cancer increase since the '90s, but you're not paying attention to any of these factors.
• And so I, I bring all this all up because I do feel like for some people, again, the minority, vaccines have almost become a convenient scapegoat.
• For people who want to say we must blame autism on something, this is what we're gonna blame it on.
• And so while I share the European data, you know, look at Andrew Wakefield's study was crap.
• I don't even know.
• My most anti-vaccine uh, friends also agree that study sucked.
• But we have to have a bro- we can't have this autism vaccine conversation in a silo because autism is so broad.
• No, I couldn't agree more.
• And, and I mean, I always remind people when they go on, uh, the programs that try to really push back on that, I've taken care of kids with autism that never had a vaccine.
• So I mean, you can, you can't blame all autism on vaccines for sure, right? That doesn't even make any sense.
• And, and autism is so complex.
• There are so many factors.
• And I think it's really frustrating when people just blame vaccines on autism, 'cause that doesn't make any sense at all.
• But I also think, on the flip side, it's also really frustrating when doctors dismiss it totally because th- this is so many parents' experience.
• There are thousands, maybe hundreds of thousands of parents that that's their experience.
• Right or wrong, anecdotal or not, they feel like they went in and got a vaccine, and then the next day their child changed.
• Over the next few weeks, their child changed.
• And if you look at the, the studies where they ask parents, "Well, what do you think caused your autism, your child's autism?" They still blame vaccines.
• Even today, you know, 15 to somewhere in 40% range still blame vaccines as the number one cause.
• Whether that's right or wrong, it's still the belief.
• It's still happening.
• And so to me, that is enough that we should never say the science is settled.
• We should say, "This, these are people's experience.
• Let's study it," to me.
• And I think that, that if that is one of the, if not the biggest fear for parents, if you want to increase the rates of vaccination, you have to address that concern, and there's clearly something being missed in modern medicine in terms of the research or the communication or whatever it is that's not landing that message.
• And I feel like it is very possible that you could study that in a way that would give parents more confidence in vaccines, more confidence that vaccines are not having anything to do with that, and I don't think there should be anything controversial about that.
• I think if people want to discuss that, that's just science.
• And to say the science is settled to me really pushes people to say, "Okay, well, they're just hiding it.
• They're just- It really is connected, so therefore it must be that."
• And, and, and I, I don't think that most doctors are saying that.
• I think it's exactly what you said.
• The majority of the research, the, the m- the consensus at this point says X, but the consensus always says X until it says Y.
• There's always some consensus until somebody finds something different, and if that many parents say something, then I think it behooves us to listen to that and acknowledge it, and I don't think medicine does a very good job of hearing that.
• Uh, and I don't think we've done vaccinated versus unvaccinated studies, not from what I've seen.
• I, I, I have looked really hard.
• I, I don't think we've followed kids forward and looked at autism that are totally unvaccinated, not from what I've seen.
• No.
• I, we are, we're on, I think we're totally on the same page about the pa- parent's concerns have to be heard, especially when I've, I've talked to parents and they see this temporal association between when their kids got vaccines and when they first noticed the signs of autism, or when they're able to retroactively look back to a first birthday party, for example, and see my kid was one and got this shot, and I think that conversation has to be had.
• And I agree with you, where something has to change, and whether it is us presenting the research differently or showing what steps are gonna be taken forward, or changing communication, or changing empathy You know, there, there is a reason these m- major autism associations such as, you know, Autism Speaks and, um, the Autism Science Foundation.
• Oh my God, am I blanking on their name? Autism Science Foundation? Is that...
• Yes.
• Yep.
• There's a reason these major organizations, you know, have their stances, and advocates, your parents of autistic children will take strong stances in saying like, "Vaccines don't cause this."
• And I think part of that is the discussion, and part of that is parents feeling heard.
• And so if one parent says, "My vaccine," caused my kid's autism and this individual's dismissed or they're kicked out of a practice, or somebody says, "Well, that's insane.
• My sister-in-law is crazy.
• She believes this," I think that alienates people.
• Mm-hmm.
• And you alienate people, they will go to someone who will listen to them.
• That is basic social science.
• Exactly.
• And so, and we're on the same page on that, for sure.
• I think we are...
• I, I actually don't know a single responsible science communicator who thinks it's a good idea to push people away Like, I'm not gonna convince a flat Earther.
• Like, you're just on your own.
• I'm like not convincing you.
• But there are definitely people who have a experience, and we have to respect that, and we have to sit down and have these conversations.
• I mean, there are people who don't realize how DSM changed for autism.
• I mean, they, they just don't even know that because they've never been told that.
• They've never heard that.
• They just hear RFK Jr.
• talking about how all cases of autism are these extremely severe cases, and this entire part of the conversation's being missed.
• I guaran- There are friends I had growing up with, I guarantee you would have an autism diagnosis.
• I can almost promise you.
• I called my close friends 100% from childhood are autistic, and they just never got one, and guess what? They're fine.
• But- Yeah, I, I, I think that's a huge part of it.
• And, and I, and I say this all the time to patients, I've never once in my career, and it's been over 10 years now, I've never seen a kid that I thought was completely, you know, neurotypical, normal, whatever you wanna call it, get a vaccine and the next day th- were totally different.
• Uh, but I've definitely had families come to me and say that that happened to them before.
• I've never personally seen it, so I...
• It doesn't happen all the time.
• Doesn't happen usually when people get vaccines, but there are enough stories that I've heard from people online or people that I've taken care of that they believe it so strongly that, at least to me, I don't dismiss it.
• I listen to it, and I think that- Yeah medicine sometimes really misses the mark on that.
• And certainly in places like California, where the rules are so strict for school, I think it's really tough on a lot of parents because their experience is they feel like a vaccine caused their child's issue, maybe one of them, and they don't wanna give that kid any more vaccines.
• They're very concerned about it, and they have to make that decision between sending their kid to school, uh, or giving them more vaccines when they feel like their kid had a bad reaction.
• And there's this pressure that kind of forces them to do it if they wanna send their kids to school.
• And I, and I think that, again, pushes people really away because now they start feeling like they're forced to do something and that makes a fight even stronger against vaccines, when maybe they're just the kid that's sensitive.
• I mean, there are always gonna be kids that are sensitive.
• Mm-hmm, mm-hmm.
• And, uh- And the- and, and we, and I think that's an open, that's an openly disclosed risk, is kids who have those severe sensitivities or anaphylaxis, we have to have a conversation.
• And I think the school requirements is super interesting, especially when you hear from people who will say, "I'm anti-mandated vaccines for schools, but my kid has a peanut allergy, so don't you dare put peanuts in that classroom."
• That's a very nuanced example, but it goes back again to this concept of individual versus population.
• Whole other conversation, uh, we can have, but we- you're right.
• We, we've lost, we've kinda lost the message- About why we do these things on a population level.
• And when people talk about the measles vaccine, and they say to me, "Why should I be worried about getting the MMR shot in my child if all of our friends are vaccinated?" Or, you know, "Why should I worry about my vaccinated child if these kids are unvaccinated? My kid's fine."
• And it goes back to, again, to a conversation about population health.
• But I, I wanna empathize.
• I want- as a parent, I wanna empathize with every parent who has seen an injury or has seen autoimmune disease or whatever it may be, and be scared, frustrated, and looking for answers.
• That is something, you know, you as a pediatrician, myself, I, I'm p- I'm a hospital medicine, and all of our subspecialists, I think all of us have encountered, if you're working with parents and children, a scared parent who is freaked out and online and looking.
• And I never want to give across the impression that we would be dismissing that emotion.
• I've seen parents who have had, who have been dealing with a mitochondrial, a mitochondrial disease, a congenital abnormality that shows up as, when they're a toddler, autoimmune encephalitis.
• These are horrifying conditions.
• And you're going to, naturally, as a human, search for an answer.
• What did I do? What could I have done differently? What was the variable that changed? And that is a human experience that we have to listen to.
• Yeah.
• A- and it al- it always amazes me, I mean, I'm always s- k- kinda compared to, like, let's say a child who has an allergy to amoxicillin.
• So they get a virus or they get sick.
• They get amoxicillin, they get a bad rash a few days later, and, and in medicine we're like, "Okay, never get amoxicillin again," you know? You, you, you had a reaction.
• We d- we don't need to have that.
• But then, like, a same, a different family, their kid gets a vaccine, they have a seizure a day or two later, and the parent feels like that was the reason, whether it was or it wasn't, and automatically most practitioners say, "Oh, that's just coincidence.
• It has nothing to do with it."
• It's like a very different reaction because it's a vaccine versus anything else.
• And, and I feel like we as a whole treat vaccines so differently than any other medication or any other product, which, I mean, it reasonably is, but at the same time, we listen to parent experience on, on almost anything else, but sometimes very dismiss when it comes to a vaccine reaction, especially when something 20 years ago or 10 years ago.
• It, it just feels like we treat parents very differently, and we sometimes dismiss a parent's lived experience, and I think that's not serving us very well in medicine.
• Well, I mean, I would say we should.
• I mean, at least in my experience, if, if kids have allergies to certain vaccine ingredients or need a preservative-free vaccine, or whatever it may be, that, that should be common practice in the same way it is in, in shots, and we should be able to definitively tell parents, like, you know, based on reactions, based on sensitivities, here what we- here's what we can do, or here is your...
• Because of your child's medical condition, we should not give a live vaccine right now, et cetera.
• Like, we should be taking these- But I guess my question is, how do you know? conversations into account.
• How do you know? Like, a lot of the times you would not know if it's a vaccine, 'cause they- they're qui- it could be coincidence, right? You, you could have a vaccine this morning and have a heart attack this afternoon.
• It has nothing to do with that.
• You were just gonna have a heart attack.
• But it also could be related to a vaccine, and for most reactions, there's no test you could take to say, "Oh, the seizure was because of that.
• Oh, the..."
• You know, you, you...
• It's just a, a clinical decision, I guess, of, well, it happened a few hours after, a day after, so we're gonna say it's the vaccine.
• But you can't actually really know, and I think that's also very difficult because we don't have a test, like strep throat, to say that, oh yeah, it was because of that.
• So I think that's sometimes difficult.
• But I feel like, I feel like you could say that anything, 'cause I could also say, how did you not know it wasn't this preservative you ate, or you would never reaction to the yellow five, or it was a, a ar- an atherosclerotic plaque you didn't know you had, or, uh, you know, like, the, the...
• I don't know- Well, you're right, but- game is so dangerous.
• You're right, but you don't have to take any of those to go to school.
• If, if a parent- Oh, yeah, I see what you're saying.
• You're going back to...
• Yeah.
• So, so a parent, you know, for whatever reason, let, let, let's just take the COVID vaccine for, you know, for adults at work.
• Mm-hmm.
• You could have had a reaction.
• Nobody decided that it was a reaction.
• You know, "Oh, it could be coincidence."
• And then now you, your work said, "Oh, well, you need to get a, a booster."
• Uh, and you're like, "But I had a bad reaction," but you can't prove it, right? And I think the same thing happens with kids, where, you know, maybe after two months, they get their vaccines, they have a, a serious reaction, something, it happens after, whatever it is that the parents deem as a serious reaction.
• They go to the hospital, seizure, whatever it is, and, and nobody definitively blames it on vaccines because you can't, really.
• And now they're at their four-month visit, or maybe it's four years later and they're going to school in, in California, and, and they're, they're six years old, and they say, "Well, my kid almost died when they were two months old.
• I don't wanna give them more vaccines."
• What are those parents supposed to do? I do think those are, I mean, correct me if I'm wrong, those are still few and far between.
• I, I, I agree with you- I think it's, I don't think it's as few- that we should listen to them I don't think it's as few as you think.
• I think there are a lot of parents that feel like vaccines cause some sort of reaction, not like extraordinarily severe- Oh, sorry.
• You, you said almost, "My kid almost died," and I was like, I don't think that's that common, but correct me if I'm wrong.
• Uh, I don't think, "My kid almost died," is that common, but I think parents feeling like their kid had a severe reaction, whatever they define as severe, um- Sure I don't know that's the same that you or I would define as severe.
• Uh, you or I would define almost died as severe.
• Uh, but not, you know, some sort of symptoms that they feel like are severe enough that they don't wanna do vaccines anymore, and they did vaccines on all their other kids, but this kid seems more sensitive to them, and now they're forced to choose between school or their gut instinct, which may or may not be wrong.
• I, I think that's a situation that happens all the time, and, um, there's not a lot of wiggle room or help for those kind of families who are not sure what to do.
• Now, it's been several years later and, and, and maybe it just was a coincidence but they really don't feel like they should do it, but now they feel forced to do it.
• I agree with you there, especially with...
• Sorry, when you had mentioned, "My kid almost died," I was like, whoa, Joel.
• But, but I agree with you.
• I think if parents see a fever or a rash, even a febrile seizure, and it's not explained to them that this can happen, 'cause, like, you know, you and I both see those.
• Like, again, that is so scary for parents.
• I'm, I'm totally with you there.
• I wanna go back to something you mentioned regarding COVID.
• Again, I, I, this is again why I'm like, oh, when we loop COVID into the other vac- vaccine conversations, is there are people who had very valid concerns about the mRNA vaccine, as you and I both remember, and we would see on headlines, whether it was blood clots or myocarditis, and- unfortunate, but also some of those signals were taken into account.
• And people forget.
• I mean, I've h- I've seen people message me and say, "Well, the CDC doesn't listen to VAERS," or, "You doctors, the medical system, doesn't like VAERS."
• I'm like, you know, VAERS is a joint CDC FDA initiative, and those signals are taken into account, and that's the reason the J&J vaccine was pulled, an early signal from the blood clots, and that's the reason we updated all these recommendations regarding the booster shots.
• And a lot of my colleagues, this, I believe it was the second booster for kids, were having that conversation with parents, and they were very, they were very transparent about it in saying, 'Hey, we have learned about this increased risk of myocarditis from an mRNA vaccine in this population.'
• And I want to weigh that versus what myocarditis might look like if your kid were to get COVID, and that's a different conversation in 2021 versus 2025 because we have different incidents, there's different population immunity.
• But just having that conversation, I think built trust in that moment when people were able to say, "Yes, people reported these, uh, situations from an mRNA vaccine, and we have to recognize that, and we have to respect that that's what people felt and look into it."
• You and I are totally on the same page.
• I don't think dismissing things on the individual level does good, but it is so tricky because when we, when that individual conversation then turns into some type of broad fact, and when people all of a sudden see a one in a million reaction as a one in 10, that is just not scientific, accurate, and causes a lot of harm I agree.
• A- and this is why I think you're so good at communicating, right? I, I think this is the difference, right? I, I think if doctors were more like you, in general, and communicated in the way that you communicate, we'd be in a very different place.
• But I just don't hear that very often.
• I mean, you, you hear too many doctors on too many programs being very definitive with statements, not being open to listening, uh, not being empathetic, and I think that's one of the big reasons why people are so turned off by medicine and public health right now.
• And, uh, I feel like if more practitioners spoke like you or more of the people online were like you, we would be in a very different place.
• So I, I think that we totally agree on, on almost everything, and I just think that if people could hear more of this, then we'd be in a much better place.
• And not everyone would agree on everything, but they wouldn't feel forced to do it.
• They would just have a good understanding of the situation so that they could make informed choices, and I think that the vast majority of people would choose to get vaccines.
• They do choose to get vaccines, but they would feel more comfortable doing it.
• And for the very few that don't, maybe they would in the future but there wouldn't be this us versus them mentality.
• And, uh, I, I think for somebody like you, it's, maybe it's hard to even see that because you are such a good communicator, you are empathetic, and you do have nuanced conversations.
• But I don't think a lot of practitioners do, and that's what parents are seeing, and they see these very definitive statements online from doctors or on CNN or whatever it is.
• And, um, I think we're doing a disservice to the future if doctors don't step up and we don't have more practitioners like you speaking, uh, because then otherwise, the influencers and the other people dominate the narrative, and you get a very different narrative than what you're saying here.
• And I think if people heard that, they would, we would be at a different place, but they, they hear a very different narrative because your narrative's not the one that's dominant.
• Joel, you're way too kind.
• I don't think you've heard me at- 2:00 AM being woken up from, you know, in the hospital.
• I'm kidding.
• No, I appreciate that, and I- I think there's a way we can learn to be definitive in our stance.
• Like, the example is, is like I, I'm c- I feel very confident saying vaccines don't cause autism, but that doesn't mean I can't be empathetic, and that doesn't mean that we can't listen to parents, and it doesn't mean we can't truly respect an individual experience.
• And I'm with you, where I really hope that doctors and scientists, uh, are more empathetic listeners, while simultaneously can we hold wellness influencers, you know, bro influencers, and politicians more accountable for spreading misinformation? 'Cause we've had to step up our role a little bit more because of the other side that literally don't have any guardrails or any- I, I, I think you can oath or code of conduct.
• Oh I think you can, but I, I think that the lens that I would like to see is not to stop misinformation but to spread good information and to drown it out.
• Uh, I, I think that it becomes a very slippery slope when you start to say, "Well, this is misinformation," because it's misinformation until it's not, and it's your opinion of misinformation, your synthesis of the research.
• And just like we saw in COVID, you know, it's a very good example of where something is, seems like it's misinformation until it's not.
• And I, I would venture to say the better long-term solution is just making sure that good science communicators are amplified, and the good information drowns out the bad information.
• And someone who is providing what you feel like is misinformation, you provide better information, and people listen to that, and they're like, "Eh, you know what? That guy doesn't know what he's talking about.
• I, I actually trust the doctor.
• He made some really good points.
• He negated the other points, and that seems much more reasonable to me."
• I mean, that, that to me is a much better, more trustworthy long-term solution than trying to dr- you know, trying to say that something's misinformation.
• It's just drowning it out with good information.
• And it's the opposite right now.
• I think what's drowning out is the individuals that don't actually know what they're talking about, and the people that do aren't even on social media, or if they do they, you know, really boring and nobody wants to listen to it, 'cause that's just the way that social media is.
• It, it promotes- engagement.
• Engagement.
• It's not, it's not promoting good science I just wish, I, I'm, in an ideal world, I, I wish that was the case, you know? I wish we could just be better informers, but every now and then you hear something, uh, uh, again, I believe it was the administration, claiming that pediatricians made 50% of our salary from vaccine manufacturers, which is ludicrous.
• And I was like, what? I, I- Yeah, I, I, I fought back against that too, at, to, to the HHS with it I was like, what the...
• But people believed it I, I sp- well, yeah People left and right are like, "Oh, my God."
• Yeah.
• Well, I mean, when you say things like, but that, that's the kind of stuff that needs to have more nuanced conversations, and other practitioners who have a big platform can really easily, I wouldn't even call it debunk it.
• Yeah just talk to, "Okay, but here's really what happens."
• You know, I, I, I saw that too, and I, I spoke to some people that I know at HHS, and I'm like, "What are you talking about?" Like, like where, where is that coming from? Where? Like, that, that doesn't make any sense at all.
• You know, a lot of practitioners would say that the hardest thing that they deal with is vaccines, and, and they barely make money They lose money At least you sort of make a little bit of money, but, like, not comparatively to what you're doing.
• And you're, there's a lot that goes into a vaccine, so it's like, it's such a crazy thing to say.
• But- It's not about debunking misinformation, but just talking like this about, "Okay, well, here's what doctors actually do.
• Here's how it works.
• Here's how payments work."
• Mm-hmm.
• "Oh, okay."
• That's all you need to do.
• Yeah.
• And then the s- that information goes away because people hear that, and they're like, "Okay, well, yeah, that makes way more sense."
• You're right.
• Um, I gotta run soon, but I have a, I have a closing philosophical frustration, and I think, and I'm, I'm so curious to hear your insight on this.
• We're, we're talking a lot about vaccine ingredients and data, and I sometimes feel like it's not even about that at all, and it's about a focal point.
• It's us versus them.
• It's tribal.
• It's parents who now say, "I, I more identify with this group of people rather than this group of people, therefore I'm going to listen to everything they do."
• And w- where, why I started thinking this way is I've heard more people asking about clinical trials.
• Where are the human clinical trials? Where are the strong, controlled trials related to the new RSV vaccine, hepatitis, et cetera, while simultaneously not questioning why there are no clinical trials for peptides, for the IV infusion they're getting, for the other intravenous longevity treatments they're getting.
• And so when I see that, I'm like, it's not about trials at all, 'cause you don't care.
• It's instead about your population, feeling heard, who you identify with, your religion, your culture, like, whatever it may be.
• And so I feel like I have to sometimes zoom out from the data conversation and saying, where is, just for sake of a, of a comparison, where is the longevity community? Where is their loophole where they've gotten people to not care about data at all? Well, their communication- When these people do care about data with everything else.
• B- but it's exactly what you said.
• It's tribal, and I think the people in the longevity space are extraordinary communicators.
• That's literally why they're there.
• I mean, most of them are, have built up a platform because they're really good speakers, they're good at promotion.
• They figured that game out, and, um, that's how they make their money.
• So I, I think that it is about tribalism, but it's also about communication, and I think if the medical community was able to match that, the vast majority of individuals are in the middle and do trust doctors still and do trust doctors a lot more than longevity community and would hear it, but there is no avenue for most doctors to actually get that information out in comparison to the whoever who has 10 million followers or the doctor has 300 or the American Academy of Pediatrics put out a post and 50 people see it, uh, versus whoever and 10 mil- It, it doesn't, it doesn't make any difference if there's no amplification.
• So I think if doctors worked together, amplified the best voices, and kind of built that ecosystem out, that would be something that would be possible, but it's gonna take some work.
• from doctors to kind of y- agree that this is really important, that being out there is important, that we're not gonna shame people for disagreeing with them about talking.
• Like, if we're gonna be out there discussing stuff, you have to be okay with not agreeing with everything, because you're not gonna agree with everything.
• That's being honest.
• And I think we could build up a science communication platform to equal it.
• But right now there's a lot of stigma, even in medicine, around just speaking.
• I mean, a lot of people just don't wanna do it, 'cause they're worried that they're gonna, the doctors are gonna sh- you know, get really mad at them, or you're gonna lose your license or whatever it is for just saying something that we disagree with.
• And you can't build a platform by just speaking the party line all the time.
• You gotta be able to have a conversation.
• I wish we could just open a bar- and just have these conversations while also serving drinks.
• I want people to know that e- even though Joel and I ignored HeHe, she was nodding and agreeing- with us on many of these points.
• But I, listen, circling back to your ver- one of the first things you brought up, I, which I agree with, is, again, this is why I think academic institutions, major medical journals, major medical organizations need to be front and center in social media, funding resources, funding trainings, like, getting doctors out there, because our pa- patients are not reading dense textbooks or medical journals.
• They are not sitting there and translating things.
• They're not looking at the abstract, the methods, or the results.
• They're looking at headlines, whatever the he- and whoever writes the headline, that's what they're looking at.
• So you and I agree.
• I think we've gotta be in the thick of the conversation if we wanna be moving the needle I have a million things I could ask you, but I know you gotta go, so I will let you go in a few minutes.
• I have, I have like five more minutes.
• I think I can push it.
• I have- We can hang on, what did you say? I have one last question.
• Quick question.
• Yes, I do have one last question, and you guys kinda skirted around it, but it was by far the, the number one question that I got.
• Um, and that is, do pediatricians get paid for vaccinating children? So yes, you get paid, right? I mean, you get paid to do anything that you do.
• You put in a code, you get a, you get a vaccine.
• The vaccine maybe costs $100.
• They pay you $120, $105, whatever it is, plus an administration fee.
• But you have to keep in mind that you have to store those vaccines.
• You gotta pay people to do it.
• You gotta spend time talking about it.
• Um, so number one, if you're...
• It's a job, right? I mean, you're helping people, but you have to keep your clinic open, so there should be some sort of payment for all that experience and the, you know, 300 years of school you go to, and all the, you know, liability that you take on.
• But at the same time, you're als- there's also a lot that goes into giving a vaccine, so you make 20 or $30 per vaccine, let's say, above what it costs.
• Um, but there's a lot of costs that go into that, the, the office, the rent, all those things.
• So yes, you make a little bit of money, but it's not any major, uh, factor.
• Certainly and a lot of practitioners would say that they barely make money.
• It's really difficult.
• You have to deal with these things, storing it.
• Like, vaccines are pretty tough to deal with as a practice.
• It's the toughest thing.
• Uh, make sure that you're stocked, make sure that you have them, make sure they don't expire, you order the right amount, uh, you administer it, you gotta talk about it.
• I mean, it's a lot of work that goes into it.
• So yes, you make money, but you should make a little money 'cause it's an important part of what we do.
• And I, as a hospitalist, I make $0 from these conversations about vaccines.
• My funding's different, though, and I've heard from, you know, general practitioners who, as, as Joel mentioned, have lost money.
• What I think is fascinating that people don't pay attention to is we would probably make a lot more money if we didn't vaccinate.
• That is the way the American healthcare system works.
• If we had more sick kids, more kids with RSV filling up ICUs, healthcare would make more money.
• That is not our goal.
• A- and I've said this many times, what people forget is the vast majority of doctors are salaried, right? Most doctors are salaried.
• They work in a big system at this point.
• And so they're, what the amount that that specific doctor makes has nothing to do with the amount of vaccines that they give.
• They're making, you know, whatever.
• Let's say they're making $200,000 in the year, um, or whatever it is.
• It doesn't make any difference if they give zero vaccines or all the vaccines.
• They make different- they make $0.
• The system makes the money, you know, wherever you're working, but you actually literally make nothing.
• So your, your payment has nothing to do with how many vaccines you're giving.
• So I would say that the vast, vast, vast majority, probably all doctors, would give vaccines if they made $0.
• It doesn't make any difference to them.
• They're giving it 'cause they believe in it.
• But it is technically true that you make, there is money being exchanged for a product, just like anything else.
• Yeah This is the snarky thing I enjoy saying on social media, when people message me and say things like, "Oh, you make money off shots."
• And I explain what I just said, but I also will look at their page.
• If they're a wellness influencer and they sell products, I write back and I'm like, "It's so thoughtful that you give away your products for free."
• And they usually disappear.
• Oh.
• Or, or the big, the big bonuses thing, when I'm like, "Who's getting big bonuses?" Yeah, where's my check? Pediatrics is the low- the lowest, especially, payments of, like, any specialty.
• I mean, there are theoretical...
• I mean, I think when they see these, like, the, there are some payments that go, yeah, a couple cents for some places if they give all their kids vaccines in the system.
• Uh, even that, you know, most of the time you don't even have that.
• I mean, I'm not getting any bonus checks or bonus money.
• I don't know who's getting millions of dollars.
• I mean, doctors are the lowest paid.
• So that doesn't make any sense if you look at the numbers.
• I mean, we could, we could get some bonus checks, I guess.
• I don't know.
• Yeah, where's my check? I'm not getting it.
• I'm waiting for my check.
• I'm waiting for my residual payment for the hours I've spent talking to people.
• Oh, my goodness, you guys, this has been such a fruitful and also fulfilling conversation.
• I am still here, listeners.
• I know I didn't say very much, but of course, this is not a conversation you guys came to hear me talk about.
• I'm just really grateful and also honored that both of you joined me.
• I'm really grateful that I have this platform.
• I'm really, really honored that all of you listeners trust me to have this conversation and to platform different people, and that you know that this is a safe space that you can ask these questions and get respectful answers, and have these conversations without feeling demonized or demeaned or ostracized.
• You know you're safe to ask the questions.
• I don't always promise to have the answers, but what I will do is find the people who have those answers.
• So thanks for joining me today, you guys.
• I think that the overarching message today is, you know, when we don't hit that nuance, we leave room for people to latch onto and spread misinformation.
• We leave these gaps that people are going to go search for answers, and the places that they search may not always be trustworthy sources.
• I also think that when we look at trying to imitate other countries, we have to be very careful when we are trying to imitate homogenous populations, so that means populations that all look the same they have very little variation in their populations.
• That is not us.
• The US is a melting pot, on purpose, and thank God we are, but we can't treat our healthcare system the same as you would in a country where everyone looks the same and their health is the same and they have free healthcare.
• And then I also think that there is so much to be said about studying adverse reactions and do we see parents talking about the sensitivity in their children- More now because we are having so many more conversations.
• Are parents more aware of what a, you know, adverse reaction is where they wouldn't have been with a child that is maybe 12, 15, 20 years old, and they are with their child that is three or four now? You know, I just think there's so much of this conversation that I wish we had time for, um, but we don't.
• But today's conversation was so- Part two, part two so good.
• Yeah, part two.
• Um, for sure, we will definitely have you guys back on.
• Um, I think that, again, this was such a conversation that so many people are yearning for, and they don't have a place to land to have these conversations, to hear these answers, and to feel seen and supported in asking these questions.
• So truly, thank you so much.
• Could you both tell my audience one more time, I know they've already met both of you, but where can people find you online, um, your books, your resources, other platforms that you're on to learn from you, work with you, connect with you? My name is Dr.
• Alok Patel.
• So I, I- You can throw it to either of us so anyway, so I'm, I'm in northern California.
• You can find me on, on the socials @AlokPatelMD.
• I truly believe in this crazy world, the one thing we all have is human connection.
• That is all we have at the end of the day, so please feel free to reach out and, and critique me, holler at me, ask me questions.
• In terms of books, you're hearing this first in the public sphere, but I do have a book coming out early 2027 with an imprint of Penguin called, tentatively called Dads on Duty, but here's the one-liner.
• It is an evidence-based guide to raising a baby from zero to one written for new dads, inspired by burned-out moms who want new dads to do more in a world where dads want to do more.
• I love that.
• So exciting.
• Congrats.
• Thank you.
• And you can find me @DrJoelGator.
• My book is Between a Shot and a Hard Place, and I'm on Instagram, X, and, you know, all the platforms.
• So, and thank you again.
• Thank you, Dr.
• Patel.
• I mean, this was fantastic.
• Thank you.
• You're fantastic.
• It was really great.
• Of course, I appreciate it.
• I appreciate the...
• We, these are the conversations we have to have.
• They really are.
• They really are.
• And I think these are the conversations that are gonna move the needle, and it's gonna start to rebuild that trust that has been eroded over the last couple years because we're not gonna get anywhere if we continue to butt heads, and we're not gonna get anywhere if we continue to dismantle the medical system that has gotten us to this place.
• And we obviously have so many fractures in the current system, and I think there are so many things that we could fix.
• Um, and the only way that we're going to fix that is by having these conversations.
• So thank you both for being here.
• All right, you guys, I will see you in the next episode.
• Be sure to follow Dr.
• Joel and Dr.
• Alok on social media, and you can find me @TranquilityByHeHe and at the.birth.lounge.
• Until next time, head to your app store and download the Birth Lounge app for evidence-based childbirth education and data-driven postpartum support delivered straight to your phone.
• Bye.
• Thank you so much for tuning in today.
• I love hanging out with you and it is an honor to be your go-to gal when it comes to preparing for your baby.
• If you've enjoyed today's episode, please leave a five-star review and tell others why they should be listening to the Birth Lounge Podcast too.
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• I'm HeHe and this is the Birth Lounge Podcast.