Latest / Wellness, Actually with Emily Oster & Perry Wilson, MD / All About Vaccines: Why they’re important, and how to make them more tolerable for your child

Transcript

All About Vaccines: Why they’re important, and how to make them more tolerable for your child · Wellness, Actually with Emily Oster & Perry Wilson, MD

0:00
Speaker 1: I'm Emily Astor. This is parent data and today, if
0:05
Speaker 1: I say going to the doctor and getting shots, what
0:09
Speaker 1: is your first response?
0:10
Speaker 2: I hate them?
0:13
Speaker 3: Are you scared of shots at all?
0:15
Speaker 2: The ones that hurt, the tetanus ones hurt, But other
0:18
Speaker 2: than that.
0:19
Speaker 3: Not really.
0:20
Speaker 4: My only memories I have of needles is just being fearful,
0:24
Speaker 4: and going to the doctor was always really stressful. I
0:28
Speaker 4: distinctly remember kicking my pediatrician.
0:31
Speaker 5: I totally had a fear of needles when I was
0:34
Speaker 5: a kid. I think the famous story about me was
0:38
Speaker 5: that I hid under one of the chairs in the
0:41
Speaker 5: doctor's office and it took my mother, the receptionist, and
0:47
Speaker 5: the doctor to pull me out from under the chair
0:52
Speaker 5: so that they could give me my shot.
0:55
Speaker 2: So when I see the needle, I always get freaked out.
0:59
Speaker 2: I mean, it's a metal stick being entered into your
1:03
Speaker 2: arm with fluid that stings like it's not enjoyable.
1:08
Speaker 4: I really don't like the feeling of something being like
1:11
Speaker 4: injected into me, and then that kind of like heaviness
1:14
Speaker 4: in my arm, Like it just feels invasive.
1:18
Speaker 2: It feels like someone's pinching you the hardest they can
1:24
Speaker 2: pinch for about three seconds. It doesn't hurt that much,
1:28
Speaker 2: but it's definitely like a little thing. It's like getting
1:31
Speaker 2: your ears pierced.
1:32
Speaker 3: Like it's not that bad.
1:33
Speaker 5: I still can't look And as soon as I like
1:36
Speaker 5: smell the rubbing alcohol, yeah, turn my head and look
1:40
Speaker 5: away and like scrunch my eyes a little bit, and
1:45
Speaker 5: it's yeah, it's a funny thing. It's like it brings
1:47
Speaker 5: you back to being that age.
1:50
Speaker 3: I can recognize.
1:51
Speaker 4: It's completely psychological, like I will cry on my way
1:55
Speaker 4: to the doctor's office knowing I'm going to get a
1:57
Speaker 4: need all. I think it's gone easier to the point
2:00
Speaker 4: I haven't kicked a doctor as an adult.
2:03
Speaker 3: Is it enjoyable to know that you were brave?
2:07
Speaker 2: After when I know, oh my god, that it wasn't
2:10
Speaker 2: that bad, I'm like, oh, I did it. I'm awesome.
2:19
Speaker 1: Vaccines are never a fun conversation with your kids. For
2:22
Speaker 1: many years, before every doctor visit, my kids would ask,
2:26
Speaker 1: are their shots? I never wanted to commit to a no,
2:30
Speaker 1: even when I thought they were not, so I always hedged, oh,
2:34
Speaker 1: I'm not sure, asked the doctor, which led to all
2:37
Speaker 1: visits starting with the kids accosting our lovely pediatrician, are
2:41
Speaker 1: there shots today? As soon as she came into the room.
2:46
Speaker 1: Even if you are enthusiastic about vaccines, the experience of
2:49
Speaker 1: holding your kids as they get them is not usually
2:52
Speaker 1: a high point of parenting, and in the present moment,
2:55
Speaker 1: the conversation about vaccines is increasingly fraught, and not just
2:59
Speaker 1: because our kids are sometimes afraid of Neil's. We're living
3:02
Speaker 1: in a moment where vaccines, long one of the most
3:06
Speaker 1: trusted and studied preventive medical treatments in existence, are suddenly
3:11
Speaker 1: being viewed with skepticism. Debunk theories about their relationship between
3:16
Speaker 1: vaccines and autism, for example, are taking center stage on
3:20
Speaker 1: Instagram and on Facebook, but also in congressional hearings. I
3:26
Speaker 1: think that part of the problem we're facing is a
3:28
Speaker 1: lack of understanding. People don't know quite how vaccines work,
3:33
Speaker 1: or why there are more now than in the past,
3:36
Speaker 1: or how we can know that they are safe. I've
3:39
Speaker 1: been writing about this in parent Data over the past
3:41
Speaker 1: few months, and today I'm bringing that conversation to the podcast.
3:45
Speaker 1: My guest is doctor Adam Davis. Adam is a pediatrician
3:49
Speaker 1: in the Bay Area, and he was my medical editor
3:51
Speaker 1: for the book Cribsheet, and he has a lot to
3:54
Speaker 1: say about vaccines from the perspective of someone who gives them.
3:58
Speaker 1: In the conversation, we talk talk about our theories on
4:01
Speaker 1: why the COVID vaccine sped up a slow growing movement
4:04
Speaker 1: around vaccine skepticism. We talk about the role of vaccines
4:08
Speaker 1: play in public health and how to explain that. We
4:11
Speaker 1: talk about what it's like for doctors to deal with
4:13
Speaker 1: vaccine skeptics in their own practice, and what people can
4:17
Speaker 1: and can't be talked into or out of. And because
4:22
Speaker 1: it's a parenting podcast, some hacks forgetting your kids through
4:25
Speaker 1: vaccines without too much drama. Adam is here to help
4:29
Speaker 1: cut through some of the noise and help us generate
4:32
Speaker 1: some real understanding. After the break, doctor Adam Davis. Adam Davis,
4:50
Speaker 1: thank you for joining me on the podcast.
4:53
Speaker 3: Thanks for having me. Emily. Great to be here.
4:56
Speaker 1: So do you want to go ahead and introduce yourself, sure.
5:00
Speaker 3: Adam Davis. I'm a community pediatrician in San Francis called
5:03
Speaker 3: SFBA Pediatrics. I also have the honor of being the
5:07
Speaker 3: medical editor of Emily's second book, Crib Sheets, and I'm
5:13
Speaker 3: here today to chat with her.
5:15
Speaker 1: Yeah, all right, I'm super excited to have you as
5:18
Speaker 1: you said you were the medical editor on cribsheet, and
5:21
Speaker 1: so if anyone's noticed any mistakes, they're Adam's fault and
5:25
Speaker 1: will be you know, discussing them later. But I really
5:29
Speaker 1: loved I loved working with you on that. That was
5:32
Speaker 1: was very fun to write, and it was interesting. It's
5:35
Speaker 1: always very interesting for me because I come from a
5:39
Speaker 1: place that is so data and is not seeing patients
5:44
Speaker 1: to work with someone and talk to someone about these
5:47
Speaker 1: same ideas, but from the standpoint of like someone who
5:50
Speaker 1: doesn't spend their whole day thinking about causality but does
5:53
Speaker 1: actually see people. And of course people are a bit
5:56
Speaker 1: more complicated than data, even though data is people, so
6:00
Speaker 1: those perspectives they come together.
6:03
Speaker 3: Yeah, it was a lot of fun, and you know,
6:06
Speaker 3: it was great timing for me too. I was making
6:08
Speaker 3: a job transition from being a hospitalist and taking care
6:11
Speaker 3: of patients of children in the hospital that were very ill,
6:16
Speaker 3: to doing primary care and deep diving into the data
6:20
Speaker 3: and really helped hone my abilities as I moved to
6:24
Speaker 3: outpatient medicine and primary care. So it was it served
6:28
Speaker 3: us both really well.
6:30
Speaker 1: So before we were going to talk today about vaccines,
6:32
Speaker 1: everybody's favorite topic, but I'm actually curious when you made
6:37
Speaker 1: that move, So you move from working with quite sick
6:39
Speaker 1: kids to working with presumably a mostly healthy population. I'm
6:44
Speaker 1: curious about what was what was the hardest thing about
6:46
Speaker 1: that move?
6:48
Speaker 3: Yeah, I mean the hardest thing was dermatology. So like, honestly,
6:54
Speaker 3: in the hospital, I like, I mean, there were like
6:56
Speaker 3: three types of rash. I would care about it all,
6:59
Speaker 3: you know, have like blister or like dying skin. And
7:04
Speaker 3: then you get into the outpatient world that everybody wants
7:06
Speaker 3: to talk about acne or this, like these red bumps
7:09
Speaker 3: and you're like, I don't know. And so it took
7:11
Speaker 3: a little while to re review that. But luckily most
7:14
Speaker 3: rashes and kids are quite transient, and I think.
7:17
Speaker 1: Mostly the answer like what a lot of it? Like,
7:20
Speaker 1: rashes are fine?
7:21
Speaker 3: Yeah, who knows a funny story. So one of my
7:24
Speaker 3: partners in my outpatient clinic is doctor Alan Johnson, and
7:28
Speaker 3: he's now in his eighties. He retired like a year
7:30
Speaker 3: and a half ago. He started in the practice in
7:34
Speaker 3: nineteen seventy four, which was a year before I was born.
7:38
Speaker 3: And so you know, when I just started back in
7:42
Speaker 3: primary care, he told me, anytime you want just come
7:46
Speaker 3: come grab me out of a patient if you have
7:47
Speaker 3: any question. So there was a rash, and like I
7:50
Speaker 3: knew what I wanted to do with it. I knew
7:52
Speaker 3: that some steroids and some moistroizer were going to get
7:54
Speaker 3: rid of the rash. And I knew it wasn't a
7:56
Speaker 3: worrisome rash. I just didn't know like the medical terminology,
7:59
Speaker 3: the last and root of what to call it. And
8:03
Speaker 3: so I went and I invited Alan into the room
8:07
Speaker 3: and he looks at it. He goes, it's rash. And
8:11
Speaker 3: I was like, wait, that's all, that's all you have
8:13
Speaker 3: to say. And he's like, yeah, like it will get better.
8:18
Speaker 3: It's like some irritation, you know, Like he's like, if
8:21
Speaker 3: it gets worse, then we'll figure it out. But like
8:23
Speaker 3: and I was like, it sort of relieves some of
8:25
Speaker 3: the tension for me because one of the nice things
8:27
Speaker 3: about ambilatory medicine versus impatient medicine is often you have
8:31
Speaker 3: that longer sort of time period, right Like in acute
8:35
Speaker 3: medicine you need to figure out what's going wrong and
8:37
Speaker 3: correct it shortly, but rash you can say, well, let's
8:40
Speaker 3: do this for a week, and you know, if it's
8:43
Speaker 3: getting much worse, we can call a friend or we
8:46
Speaker 3: can and that's true for a number of things that
8:48
Speaker 3: can happen in the inblatory world.
8:50
Speaker 1: I like that dermatology okay, Germa, Yeah, I mean I'm
8:54
Speaker 1: often calling I'm often texting pictures of rash is to
8:56
Speaker 1: my pediatrician and she does. She's usually like she's like, yeah,
9:00
Speaker 1: that's that's that's rash.
9:02
Speaker 3: Ye yeah, put them to totally. It can be really
9:08
Speaker 3: and the pictures make it even harder, like, uh, you
9:11
Speaker 3: know because of the quality of the iPhone pictures.
9:13
Speaker 1: With the flagg in.
9:18
Speaker 3: What body part is that it's off to the next
9:20
Speaker 3: question exactly, but that that was like the hardest. Medically,
9:23
Speaker 3: there's like a whole different like rhythm to being an
9:27
Speaker 3: ambulatory doc, both in terms of your individual days you're
9:30
Speaker 3: seeing many more patients than you do impatient, but also
9:34
Speaker 3: in terms of the what you're doing with them. I
9:37
Speaker 3: remember I actually I sent I posted on Facebook to
9:41
Speaker 3: my friends, like because at the beginning I felt a
9:45
Speaker 3: little bit like an imposter. People would come in with
9:46
Speaker 3: their well child for a well child exam. You know,
9:49
Speaker 3: we'll get into it, but I would give them vaccines,
9:51
Speaker 3: but if they were due for them, and I talked
9:53
Speaker 3: to them about like their activities at school, like like
9:56
Speaker 3: all your listeners have experienced with their PEDUTRICI And I
9:59
Speaker 3: was like they left. I was like, what do they
10:01
Speaker 3: look like? What was the value of that for the
10:04
Speaker 3: for the families? And it was actually really really starting,
10:07
Speaker 3: So I sent that. I actually asked my friends. I
10:09
Speaker 3: was like, can you tell me, like do you feel
10:12
Speaker 3: value because from going to see on your well children
10:15
Speaker 3: when you knew your child was you know, thriving in
10:18
Speaker 3: preschool or or elementary school or whatever, and like you
10:22
Speaker 3: didn't really have a big concern, And they universally were like, yes,
10:25
Speaker 3: a ton of value of like the reassurance and like
10:29
Speaker 3: having that relationship with the pediatrician. And and over the years,
10:33
Speaker 3: I mean now it's been seven years that I've been
10:35
Speaker 3: doing this, I feel that every day. Like it's a
10:38
Speaker 3: really special honor to have somebody a family identify you
10:42
Speaker 3: as their child's pediatrician. It's a huge amount of trust,
10:45
Speaker 3: it's a huge it's a very unique relationship. It's really
10:48
Speaker 3: special in a lot of different like times in the
10:52
Speaker 3: child life, like when they're born obviously, but also when
10:55
Speaker 3: you're like those sort of teen years when you're transitioning
10:58
Speaker 3: from being like mostly talked to the parents to mostly
11:01
Speaker 3: talking to the kid. And you're trying to preserve that
11:04
Speaker 3: relationship with the parents, but also know that the kid
11:07
Speaker 3: can be in some rebellion and you want to you
11:10
Speaker 3: want to be on their side as well, and so
11:12
Speaker 3: it's humbling that way, and it's really special.
11:15
Speaker 1: That's amazing. Okay, let's talk about vaccines. Yeah, so let
11:20
Speaker 1: me start with the most basic question, which is what
11:23
Speaker 1: is your what is your stance on vaccines?
11:26
Speaker 3: I mean, there's very few things in pediatrics medicine that
11:29
Speaker 3: have as good evidence as vaccines, period, right, Like, you know,
11:34
Speaker 3: people think that a lot of things that doctors do,
11:38
Speaker 3: and you've talked about this in a number of different
11:40
Speaker 3: venues and a number of different things are based on
11:43
Speaker 3: these really great studies all the time, and often they're not.
11:46
Speaker 3: Often they're based on expert advice or sort of smaller
11:49
Speaker 3: studies that sort of imply something. But and you know,
11:53
Speaker 3: even like how many days do we give advantibiotics for infections,
11:56
Speaker 3: it's all based on like football scores. To me, like
11:59
Speaker 3: it's you know, you either give it for seven or
12:01
Speaker 3: ten days. You never give it. Nobody ever give it
12:03
Speaker 3: for eight or nine, Like there's just like that's just
12:06
Speaker 3: because like a random study that nobody doesn't comparative of
12:09
Speaker 3: these small changes. So a lot of the questions that
12:12
Speaker 3: people can ask me, there's not like a wealth of
12:16
Speaker 3: literature to go to to answer it. But vaccines is
12:19
Speaker 3: the exception there, Like, vaccines are really well studied, and
12:22
Speaker 3: the effects what we call the effects size, right, how
12:25
Speaker 3: many people you have to do something to protect one
12:27
Speaker 3: person is quite small with vaccines. It's like we can
12:31
Speaker 3: really honestly, like in the I mean even if you
12:34
Speaker 3: go outside of like doctors, if you just think about
12:37
Speaker 3: what's improved health over the last century or more, it's
12:44
Speaker 3: hygiene and vaccines, right are number one and number two
12:47
Speaker 3: probably hygiene first and vaccine second. But vaccines has been
12:50
Speaker 3: like life changing for public health. And so I'm a
12:54
Speaker 3: strong believer in so much so that like our practice
12:57
Speaker 3: and not every practice has the benefit of being able
12:59
Speaker 3: to do this, But we have limited capacity to keep
13:04
Speaker 3: patients in our practice who truly refuse vaccines. We won't
13:08
Speaker 3: do that for the long auwe and you know in
13:09
Speaker 3: our state they're required for school.
13:12
Speaker 1: So when you say there is a lot of evidence
13:16
Speaker 1: behind vaccines, which I agree that there is. Can you
13:19
Speaker 1: say a little bit more if you know parent coms,
13:21
Speaker 1: they say, well, what do you mean, there's a lot
13:22
Speaker 1: of evidence like what you know, I've heard blah blah
13:25
Speaker 1: whatever it is like when you talk about evidence there,
13:29
Speaker 1: what does that evidence look like?
13:30
Speaker 3: Well, then you have to get into the individual vaccines
13:33
Speaker 3: because you can't like talk about like I mean overall,
13:36
Speaker 3: what I would say is vaccines are one of the
13:38
Speaker 3: best studied interventions that we have in medicine. But like
13:42
Speaker 3: you know, then you have to talk about individual vaccines
13:45
Speaker 3: and what the evidence is for what they do. And
13:48
Speaker 3: there's different things that vaccines can do. They can prevent
13:50
Speaker 3: you from getting disease. They can attenuate, which means to
13:55
Speaker 3: lessen the strength of a disease, so like you still
13:57
Speaker 3: get the disease, but not as strongly. They can prevent
14:01
Speaker 3: spread of the disease, or you know, in the best cases,
14:05
Speaker 3: they can get rid of the disease from the planet,
14:07
Speaker 3: which we've done once right spa box We've gotten rid
14:11
Speaker 3: of all completely, and we're we were pretty close to
14:15
Speaker 3: polio being you know, gone from the planet, and now
14:18
Speaker 3: it looks like that's not going to happen. In the
14:21
Speaker 3: near future. But so I have an ability to talk
14:24
Speaker 3: about pretty much each vaccine, some of them I know
14:27
Speaker 3: better than others, just because I've goven the speech more times. Right,
14:31
Speaker 3: Like I have less patients to question some vaccines than others.
14:34
Speaker 3: The ones they question more are probably the ones that
14:36
Speaker 3: I have like a more refined sort of speech about.
14:40
Speaker 3: But again, like ultimately, like obviously it's a parent's choice
14:44
Speaker 3: on whether they want to vaccinate their kids, but most parents,
14:47
Speaker 3: after I talked about certainly the routine childhood vaccines, maybe
14:52
Speaker 3: not the annual respiratory vaccines, they do them, and most parents,
14:56
Speaker 3: I mean, honestly still most parents in my community want
14:58
Speaker 3: to vaccinate their kids fullies. So that's a nice benefit
15:02
Speaker 3: of that happens to be the patients that I work with.
15:06
Speaker 1: So when I think about vaccine resistance, which I will
15:10
Speaker 1: say in the populations that I talked to, I feel
15:14
Speaker 1: has noticeably gone up even in the last year, so
15:18
Speaker 1: the number of questions and the sort of post COVID
15:22
Speaker 1: and even more so in the last year, but in
15:25
Speaker 1: the kind of over the last four or so years,
15:28
Speaker 1: I have many more questions from people about routine vaccines.
15:32
Speaker 1: I'm curious if you hear if that's something you get
15:34
Speaker 1: on your team.
15:35
Speaker 3: Also, absolutely, but I will say more for COVID vaccine
15:41
Speaker 3: than the other ones, but all of them in some level.
15:43
Speaker 3: And I have a theory for that. And I actually
15:46
Speaker 3: think of what happened is if, like you know, when
15:50
Speaker 3: vaccines were being developed during COVID, we all were one
15:53
Speaker 3: in like we had a lot of time on our
15:56
Speaker 3: hands at home, and we were all thinking about vaccines
16:00
Speaker 3: because we were all excited about vaccines, and we all
16:03
Speaker 3: wanted a vaccine to be good and come out quickly.
16:06
Speaker 3: And then when they started coming out, we had like
16:09
Speaker 3: comparative analysis like should I get Maderno or Johnson and Johnson.
16:14
Speaker 3: People spent a lot of time thinking about vaccines and
16:16
Speaker 3: trying to get their vaccines. I mean in some communities.
16:20
Speaker 3: Many communities get their vaccines as quickly as they could,
16:23
Speaker 3: and I think they got used to doing a deep
16:27
Speaker 3: analysis of the very minor change differences and cost benefits
16:31
Speaker 3: of different vaccines or different vaccine schedules. You'll remember like
16:34
Speaker 3: people talked about whether you should have it at four
16:37
Speaker 3: weeks afterwards or if you should wait a little bit longer,
16:39
Speaker 3: And there was just a lot of like public discussion
16:42
Speaker 3: of every nuance of giving a vaccine. Before that, I
16:46
Speaker 3: think that most parents sort of mindlessly went to their
16:49
Speaker 3: dock and said, oh, it's vaccine time. Cool, tell me
16:51
Speaker 3: what I need to get, and then they got in
16:56
Speaker 3: the habit of doing their you know, their own analysis
16:59
Speaker 3: on it, which led to you know, more and more questions,
17:02
Speaker 3: which leads to longer conversations, which led to some resistance
17:05
Speaker 3: in some areas, and you know, and specifically with the
17:08
Speaker 3: COVID vaccine. I think there's also like this almost like
17:11
Speaker 3: it's somewhat illogical, but there's almost this thing like I
17:14
Speaker 3: want to be done with the pandemic, and one day
17:16
Speaker 3: being way of being done with the pandemic is just
17:19
Speaker 3: like I'm not doing the vaccine anymore either, because that's
17:22
Speaker 3: part of the pandemic.
17:24
Speaker 1: It's interesting. I have a different theory, although your theory
17:27
Speaker 1: is a very interesting one. I think there's a piece
17:30
Speaker 1: here that I totally agree with, which is people got
17:32
Speaker 1: into this habit of like I now, now I'm an
17:35
Speaker 1: epidemiology expert, now I'm a vaccine expert, Like I've spent
17:37
Speaker 1: all my time doing this, and I think that's that happened.
17:42
Speaker 1: And the other thing that happened, which I think is
17:44
Speaker 1: some has a portion of fault to some extent of
17:48
Speaker 1: public health. I've talked about this before, is after that
17:51
Speaker 1: initial vaccine wave, when we then got into these the
17:56
Speaker 1: current state of boosters. I think that peopleeople are feeling
18:02
Speaker 1: attacked when they are raising concerns that they view as
18:06
Speaker 1: very valid and some of which I think are reasonable.
18:11
Speaker 1: So you know, for example, there are a lot of
18:13
Speaker 1: people who would say, now like I don't know why
18:15
Speaker 1: my seven year old needs a fourth booster, Like they
18:19
Speaker 1: already had a bunch of they've had COVID four times,
18:21
Speaker 1: they've had all of the shots. You know, Europe doesn't
18:24
Speaker 1: give boosters, do why is the CDC saying this is
18:27
Speaker 1: so important? And then they feel like, well, I don't
18:30
Speaker 1: really agree with this. It doesn't seem reasonable, And then like,
18:34
Speaker 1: let me think about it, like why do I need
18:36
Speaker 1: the measles vaccine? And I think for me, that's a
18:38
Speaker 1: little bit of a failure because I actually think it
18:41
Speaker 1: should be totally reasonable to say, like, your kid gets
18:43
Speaker 1: the measles vaccine, but also they don't need a fourth
18:45
Speaker 1: booster because the value of that for a healthy kid is.
18:48
Speaker 3: Small, Right, I guess the logical fallacy I see there
18:52
Speaker 3: is they've also had like eight influenza vaccines in their life.
18:57
Speaker 3: So the way I explained it to families is, I
18:59
Speaker 3: think today the logic behind doing the annual resiratory vaccines
19:04
Speaker 3: which are now COVID and flu is the same for
19:07
Speaker 3: each other, right And like there's there's minor differences there,
19:10
Speaker 3: and we can talk through them and why, you know,
19:13
Speaker 3: But but they each do three things, and I think
19:16
Speaker 3: those three things are really important to keep in mind.
19:20
Speaker 3: And I mostly vaccinate for the third. In the case
19:23
Speaker 3: of these like healthy elementary school and high school students. One,
19:28
Speaker 3: you know, they make you a little bit less likely
19:29
Speaker 3: to get the disease, but not a ton less likely,
19:32
Speaker 3: right Like, And it depends a little bit on the timing,
19:34
Speaker 3: and it depends on each individual booster and whether that
19:37
Speaker 3: particular booster matches the particular strain that happens to be
19:40
Speaker 3: around during you know, during the next bump. But it does,
19:45
Speaker 3: you know, and we know that from data two, it
19:49
Speaker 3: attenuates the disease. And again that means still less than
19:52
Speaker 3: the strength of it. And I'll give you a great
19:53
Speaker 3: example that I have just from like two weeks ago.
19:56
Speaker 3: I had and this is from flu. But I had
19:58
Speaker 3: a thirteen year old and a twenty year ol and
20:00
Speaker 3: flu has been brutal to the last few weeks. Yeah, yeah,
20:04
Speaker 3: And I had a thirteen and twenty year old sisters
20:07
Speaker 3: who I knew forever and and really great relationship with
20:11
Speaker 3: their family and loved these two girls. And they both
20:16
Speaker 3: came with fever. The thirteen year old had had fever
20:19
Speaker 3: for one day and actually had was resolved, and she
20:22
Speaker 3: was like laughing at my jokes, and the twenty year
20:24
Speaker 3: old was lying on the exam table mad at me
20:26
Speaker 3: for making her laugh because she was in so much pain.
20:28
Speaker 3: It was their sixth day of like one hundred and
20:31
Speaker 3: four fevers. And it just turned out like that she
20:34
Speaker 3: hadn't got her flu vaccine that year because she was
20:35
Speaker 3: off at college and she forgot to, and her thirteen
20:37
Speaker 3: year old sister had and like not doesn't get into
20:40
Speaker 3: any study, right because from a study standpoint, the outcome
20:44
Speaker 3: for those two kids is neither went to the er,
20:47
Speaker 3: neither were hospitalized, neither endo the ICU, and neither died.
20:51
Speaker 3: But the lived experience of flu after vaccination is office
20:56
Speaker 3: often much less serious, like not serious in terms of
21:01
Speaker 3: like I'm worried about your long term health, but serious
21:03
Speaker 3: that week for you as a family than it is
21:07
Speaker 3: with no vaccination that year. And the same thing can
21:11
Speaker 3: be a said of COVID, right like, so we you know,
21:14
Speaker 3: now COVID seems to be right now, a more mild
21:17
Speaker 3: disease than flu A for kids in general, Like I
21:21
Speaker 3: don't see the high fevers and the really ill. You
21:24
Speaker 3: do seem like really tired and a lot of cough,
21:28
Speaker 3: and the tired is like out of proportion often with
21:30
Speaker 3: the height of the fever, which we you know with
21:32
Speaker 3: fluids seems more sort of aligned. But again, like I
21:39
Speaker 3: think it's hard to measure these things and studies because
21:42
Speaker 3: they're not the outcome. Studies are looking at the second thing,
21:45
Speaker 3: you know, besides longer the risk of getting the diseases
21:48
Speaker 3: and attenuating the disease itself if you get it, and
21:52
Speaker 3: part of the attenuation is just knocking off that tail
21:55
Speaker 3: of the bell curved of this the really bad tale
21:58
Speaker 3: that like, you know, I don't know how to measure
22:01
Speaker 3: because there's such rare outcomes, And so I get it
22:03
Speaker 3: when people are like, well that's probably not gonna happen
22:05
Speaker 3: to me, and you're probably right, but like it does
22:07
Speaker 3: knock down that tail. We know that. But the third thing,
22:09
Speaker 3: and this is incredibly important, and the main reason that
22:12
Speaker 3: I vaccinate, is we know from studies prior to the
22:16
Speaker 3: pandemic that the more kids who are vaccinated with flu
22:20
Speaker 3: vaccine in a community under eighteen, the less elderly people
22:25
Speaker 3: die in that community that season. And we know from
22:29
Speaker 3: COVID studies in the prisons right where they can look
22:33
Speaker 3: at spread really nicely between prisoners that even if a
22:37
Speaker 3: prisoner got COVID, they were less likely to give it
22:39
Speaker 3: to their cellmate if they had the vaccine because the
22:43
Speaker 3: viral load that they were coughing out was lower. And
22:46
Speaker 3: so I do believe, and some again like we'll get
22:49
Speaker 3: more data on COVID over time as these but I
22:52
Speaker 3: do believe, first of all, more COVID deaths still today
22:56
Speaker 3: than flu deaths. Over the course of a year, we
22:58
Speaker 3: have more COVID deaths in this country. And so I
23:01
Speaker 3: do think that we can protect our elderly and are
23:04
Speaker 3: compromise by continuing to have universal vaccination programs. And so
23:08
Speaker 3: I really stress to families just like, look, I don't
23:11
Speaker 3: give any of the kids polio vaccine because I'm worried
23:14
Speaker 3: they're going to get polio. There hasn't been a case
23:16
Speaker 3: of polio in California. Maybe there will be now since
23:20
Speaker 3: New York's had a case last year, but we haven't
23:22
Speaker 3: had a case since the seventies, right, Like, it's very
23:25
Speaker 3: unlikely that they're going to be exposed to polio. But
23:28
Speaker 3: they're part of a larger project, and that project is
23:31
Speaker 3: to rid the world of polio and covid and flu.
23:34
Speaker 3: We're probably not going to rid the world of They're
23:36
Speaker 3: gonna be endemic first, you know, until technology changes dramatically.
23:40
Speaker 3: But if everybody vaccinates themselves, we will have less of
23:44
Speaker 3: a bump every year. We will have less deaths every year,
23:46
Speaker 3: and I think that matters. So that's how I explained
23:48
Speaker 3: it to them, and then I let them make the
23:50
Speaker 3: decision they want to make.
23:51
Speaker 1: But you would keep a patient even if they didn't.
23:54
Speaker 1: They didn't see it.
23:55
Speaker 3: Flu in covid, Yeah, absolutely no, it's only the school
23:59
Speaker 3: required vaccine that we will and part of it is
24:03
Speaker 3: just just a pain in the ass.
24:04
Speaker 1: Right Like, yeah, in order, California has very very sharp
24:10
Speaker 1: guidelines about what you can do to get out of
24:12
Speaker 1: I see.
24:13
Speaker 3: But the way I say that to patients too. Is this, Look,
24:16
Speaker 3: I'm in an area of the country that, like, prior
24:18
Speaker 3: to the pandemic had some of the like Marin County,
24:22
Speaker 3: which is one of the richest counties in country right
24:24
Speaker 3: is very northwest, had some of the lowest vaccination rates
24:27
Speaker 3: in the country before the pandemic, and immediately immediately during
24:31
Speaker 3: the pandemic, it became the most vaccinated county in the
24:34
Speaker 3: entire country for COVID early on. Now, I don't think
24:37
Speaker 3: that that's probably still the same, but like, that's a
24:40
Speaker 3: fascinating thing, and it's fascinating how politics and vaccines have interacted.
24:45
Speaker 3: But what I will say there is that we have
24:48
Speaker 3: doctor practices in the area, both in the city itself
24:51
Speaker 3: and surrounding the city, that are very open to alternative
24:55
Speaker 3: vaccine or no vaccine families. And what I say to
25:00
Speaker 3: this is actually not, hey, you're a horrible person because
25:03
Speaker 3: you're not going to vaccinate your kid, or even you're
25:05
Speaker 3: a pain of the ass. What I say to them is,
25:06
Speaker 3: look like we're building a relationship of trust here, and
25:10
Speaker 3: I want you guys to trust that I'm going to
25:14
Speaker 3: give you the best information I can and that you
25:16
Speaker 3: trust me as sort of a shepherd to help you
25:18
Speaker 3: through this. And if, like, on the thing that I
25:21
Speaker 3: think is most evidence based, you guys are like no,
25:24
Speaker 3: then there might just be a better match for you locally.
25:27
Speaker 3: Like that's what I offer up to them. I'm never
25:29
Speaker 3: like you're bad people. I'm just like, you know, I
25:32
Speaker 3: have a system of beliefs about medicine that you guys
25:37
Speaker 3: don't believe, and so like, why wouldn't you see somebody
25:39
Speaker 3: who matched that better? You know, I also don't do
25:41
Speaker 3: crystal medicine in my practice, right, Like, if they really
25:43
Speaker 3: wanted that, they should seek that out with somebody else.
25:46
Speaker 1: Do you find these conversations frustrating? No, not like this
25:51
Speaker 1: conversation but the people.
25:52
Speaker 3: No, No, totally not always. It can be right if
25:57
Speaker 3: somebody wants to like go line by line about research
26:01
Speaker 3: studies and like play that game, it can be really frustrating.
26:04
Speaker 3: But that like thing that I just did with you, Emily,
26:07
Speaker 3: where I said, here are the three reasons I've vaccinated,
26:10
Speaker 3: it's really the third one, and like often that ends
26:12
Speaker 3: with them still not doing the vaccination. But if I
26:16
Speaker 3: feel they heard my reasoning and they really listen to me,
26:20
Speaker 3: I feel okay about it. And I don't feel upset
26:23
Speaker 3: anymore now when they come in for flue and that
26:26
Speaker 3: kid has a fever to one oh four and it's
26:28
Speaker 3: day three of it, I'm glowedy, right, I'm a little
26:31
Speaker 3: bit like you know how I say it, like really sweet,
26:35
Speaker 3: but like I'm always like, hey, you know one thing
26:37
Speaker 3: that I have to do. Here is a little I
26:38
Speaker 3: told you.
26:38
Speaker 1: So more parent data, including a lightning round on vaccine
26:46
Speaker 1: best practices and vaccine myth busting after the brink, going
27:10
Speaker 1: back to the routine childhood vaccination. You gave what I
27:14
Speaker 1: think is the right answer for the polio vaccine, which is,
27:16
Speaker 1: you know, probably for most people, your kid is not
27:20
Speaker 1: going to be exposed to polio.
27:23
Speaker 3: Or measles or diptheria. Like I mean, so many of
27:26
Speaker 3: the vaccines we give are sort of like in some ways,
27:31
Speaker 3: and I want to word this carefully, like not likely
27:33
Speaker 3: to affect that child, because the people before them laid
27:37
Speaker 3: the groundwork for there not to be that you know,
27:41
Speaker 3: pathogen in our environments.
27:43
Speaker 1: And I think this is this feels to me like
27:46
Speaker 1: a very complicated part of this discussion, and we sort
27:49
Speaker 1: of know what most motivate people. I mean, I have
27:51
Speaker 1: some research where you basically can see when there's a
27:53
Speaker 1: protesters outbreak in the county, in the next year more
27:56
Speaker 1: people get vaccinated for protesters, so you sort of see
28:00
Speaker 1: like the kind of almost the media response of saying, oh,
28:02
Speaker 1: like that's a real disease, we protest. This whooping cough
28:05
Speaker 1: is an example of something where we do see it
28:06
Speaker 1: around and getting vaccinated is a protective of you, of
28:11
Speaker 1: you individually. But I think this is a hard piece
28:13
Speaker 1: of this for people because it feels like wouldn't I
28:16
Speaker 1: just rather free ride.
28:17
Speaker 3: I don't have research, but I think much more effective
28:21
Speaker 3: than me arguing about side effects and effectiveness for their
28:24
Speaker 3: individual is talking about grandmothers and immunocompromise people.
28:28
Speaker 1: The altruistic motivation.
28:30
Speaker 3: Yeah, I think people like at least my experience with
28:33
Speaker 3: it is people are really like, oh, maybe I was
28:36
Speaker 3: getting caught up in like like my house and I
28:41
Speaker 3: had lost track of like what this is all about.
28:44
Speaker 3: And for the childhood vaccine, it's a little bit different
28:46
Speaker 3: because they're really you're talking about like people like who
28:49
Speaker 3: really is sacrificed by taking the vaccine or to get
28:52
Speaker 3: to the place where it's such low amounts of it
28:55
Speaker 3: out in the community that it's very unlikely to bump
28:57
Speaker 3: into the world and for the rest story of it's
29:00
Speaker 3: a little bit different about sort of this lowering the spread.
29:04
Speaker 3: But you know, it's funny. I do think that in
29:06
Speaker 3: our world right now, like just where the culture is,
29:09
Speaker 3: people feel that they need to protect themselves and protect
29:13
Speaker 3: what they have a little bit more than they did before.
29:16
Speaker 3: And it's sort of a coursier environment. But I think
29:19
Speaker 3: within that when you when you actually say, hey, no,
29:23
Speaker 3: this is actually a community thing and they weren't thinking
29:25
Speaker 3: of that way, it sort of opens up something for them.
29:28
Speaker 3: For a lot of my patients anyhow, my front staff,
29:30
Speaker 3: they have a big joke because there's like I do
29:32
Speaker 3: a lot more vaccinations than a lot of my partners,
29:34
Speaker 3: Like I just do, like we will vaccinate parents for
29:37
Speaker 3: COVID and flu, and I'm just I ask every parent
29:40
Speaker 3: every visit, which is not what most of my partners do.
29:46
Speaker 3: You know, it goes back to that value proposition, what
29:49
Speaker 3: are the things that I can do in the office
29:51
Speaker 3: that are actually going to affect people's health, And getting
29:55
Speaker 3: vaccines into arms is something that really does so, like,
29:58
Speaker 3: you know, I do enjoy that talk and I think
30:02
Speaker 3: that pediatricians really have a strong voice in the room
30:05
Speaker 3: about this. And if we do that talk well and
30:08
Speaker 3: openly and are listening to and not demanding but or
30:12
Speaker 3: rather just talking through our thought process. You know, there's
30:15
Speaker 3: a surprising number of people and just be like, you
30:17
Speaker 3: know what, yeah, you know, or they'll say, let me
30:19
Speaker 3: talk to my husband, And that's probably not like it's
30:21
Speaker 3: the dads who are much more like at that COVI
30:23
Speaker 3: vaccine than the mom's right now. But yeah, it's the worse.
30:28
Speaker 1: So one of the questions that I hear coming up
30:31
Speaker 1: more and more is this question of splitting vaccines. So
30:33
Speaker 1: there are many vaccines, should you know the often many
30:36
Speaker 1: of them are given at the same time people want
30:39
Speaker 1: to space them out. What do you say when people
30:42
Speaker 1: want to space them out?
30:43
Speaker 3: Yeah, So it's a great question, and I get that
30:46
Speaker 3: a lot, and I have a few things I say.
30:50
Speaker 3: One is like, the number of pathogens that we get
30:53
Speaker 3: in vaccines is tiny compared to what we get through
30:56
Speaker 3: like walking through life, and so I don't think there's
31:00
Speaker 3: anything that like causes great harm to children to get
31:04
Speaker 3: six or eight pathogens or instead of like two or
31:07
Speaker 3: four or whatever the number may be. But actually this
31:12
Speaker 3: is a place where I say to them, like, look,
31:14
Speaker 3: I actually think one, there is some evidence about this,
31:17
Speaker 3: and there's some evidence that you have increased level of
31:19
Speaker 3: febrile seizures if you split your vaccines, and I think
31:24
Speaker 3: that data is most likely just you're gonna have you know, fevers,
31:28
Speaker 3: a potential side effect of any vaccine, So if you
31:30
Speaker 3: have fevers more time, you're more likely to have a
31:32
Speaker 3: febril seizure. But you know, I don't know, But it's
31:35
Speaker 3: not the thing I lead with. I don't usually talk
31:37
Speaker 3: about that. What I usually talk about as a child's experience,
31:40
Speaker 3: and what I usually say to them is, look, the
31:42
Speaker 3: day you get vaccine sucks and the next day sucks,
31:46
Speaker 3: and I don't want so many of those days for
31:48
Speaker 3: your child. If we split this day into three days,
31:51
Speaker 3: then three days suck getting the shots and they're gonna
31:53
Speaker 3: and that's more of like a negative, like you know,
31:56
Speaker 3: a negative stimuli for them for this office, for everything.
32:01
Speaker 3: Once they get their first shot, Like while they're crying
32:03
Speaker 3: for their second shot, it's not that big of a
32:06
Speaker 3: deal to them, Like they're still gonna be okay five
32:08
Speaker 3: minutes later, and yes, like there might get a fever tomorrow.
32:12
Speaker 3: But I don't think it's like additive. I don't think
32:14
Speaker 3: if you give five vaccines the fever will be three
32:17
Speaker 3: times as high. And it means if we split it
32:19
Speaker 3: that there's another day they might get fever. And I actually,
32:24
Speaker 3: you know, the other part of it is really trying
32:26
Speaker 3: to help the patient take the vaccine calmly, and we
32:30
Speaker 3: can do a lot of things about that. I mean,
32:33
Speaker 3: so for the little babies, please feed your baby while
32:36
Speaker 3: they're getting the vaccines, like nurse them if you're breastfeeding,
32:40
Speaker 3: give them a bottle if you're not, like it makes
32:43
Speaker 3: a huge difference for the little bit older kids, distract them,
32:46
Speaker 3: put them over your shoulder and put a screen or
32:50
Speaker 3: a bright moving thing behind your shoulder that they can watch.
32:54
Speaker 3: Often kids won't even know they're getting vaccines. With older kids,
32:57
Speaker 3: like anybody four to five above, I play cat swap
33:00
Speaker 3: giving vaccines. I literally I don't give the vaccines. My
33:02
Speaker 3: medical assistant do. But I hold their hands. They look
33:05
Speaker 3: me eye to eye and we go through a favorite
33:07
Speaker 3: thing animals for the younger kids, sometimes sports players for
33:10
Speaker 3: the older kids. And honestly, they sometimes ask me if
33:13
Speaker 3: they've got their vaccines yet. It depends a little bit
33:15
Speaker 3: if they want to concentrate, but like if you can
33:18
Speaker 3: leave some and I don't do like some people do,
33:21
Speaker 3: like the MLA. I think it's a little bit placeble,
33:23
Speaker 3: Like I don't think it matters if you numb the
33:25
Speaker 3: skin a little bit before the vaccine. But the vibration
33:28
Speaker 3: thing like the buzzy bee or the ice, those things
33:31
Speaker 3: all work. But I find that attention is the most
33:33
Speaker 3: important thing, just like getting the intention away from it.
33:38
Speaker 3: And some kids you can't do that. They have panic
33:40
Speaker 3: attacks while they're getting vaccines. And then it's hold tight,
33:43
Speaker 3: hold fast, and go fast, like don't take time.
33:46
Speaker 1: You don't want to do it again next week and
33:48
Speaker 1: next weekend.
33:49
Speaker 3: Yeah, that's just retraumatizing the kid. As parents, the thing
33:52
Speaker 3: I would ask is like, once you make the decision,
33:55
Speaker 3: make the decision like solid, like don't negotiate with your
33:58
Speaker 3: five year old of war that you're gonna get back
34:00
Speaker 3: scenes that day, right, Like they're not able to make
34:02
Speaker 3: that decision. You need to sort of make that decision
34:05
Speaker 3: and hold it. But it's funny like I have families
34:09
Speaker 3: that after they get the vaccines, the kids will be like, oh,
34:12
Speaker 3: the worst part was thinking about the vaccine beforehand, or
34:16
Speaker 3: the parents will be like, oh my god, that wasn't
34:18
Speaker 3: nearly as bad as I thought it would be. So
34:20
Speaker 3: many parents coming with their own needophobia that they projected
34:23
Speaker 3: down to their kids. So if you can like take
34:26
Speaker 3: a moment and think of a strategy to keep your
34:30
Speaker 3: kid distracted during vaccines, I think that everybody ends up
34:34
Speaker 3: not hating vaccines as much.
34:36
Speaker 1: My kids when they got the first COVID vaccine, there
34:40
Speaker 1: was this place that they got it, and I don't
34:42
Speaker 1: know what was the deal with this person, but she
34:44
Speaker 1: was like a very good vaccinator, and like they still
34:47
Speaker 1: talk about like how that was the least painful, like
34:49
Speaker 1: that was their favorite vaccine. Then the place closed, and
34:51
Speaker 1: they're always like, oh, it's so stun's closed, Like that
34:53
Speaker 1: person was such a great vaccine giver.
34:56
Speaker 3: I've been through this with my own kids, like my
34:59
Speaker 3: son and his three year old appointment cried because he
35:01
Speaker 3: was not scheduled to get a vaccine and he thought
35:04
Speaker 3: that he was getting ripped off at the doctor's office.
35:06
Speaker 3: My daughter had been one of the more resistant vaccine
35:10
Speaker 3: receivers that my practice had to the point, like I
35:13
Speaker 3: mean I was not involved in her vaccines for many
35:16
Speaker 3: of the years, but she would like run away and
35:19
Speaker 3: like need to be held down. And like one year
35:21
Speaker 3: she said, Daddy, I want you to give me the vaccines.
35:23
Speaker 3: And I'm like, are you sure, Like you know, I
35:25
Speaker 3: don't do it nearly as off as the medical assessor.
35:28
Speaker 3: It's like, but if you want, and you know, it's
35:32
Speaker 3: always a little the joy to give your kid a
35:34
Speaker 3: little bit negative stimuli after all the things they've done
35:36
Speaker 3: to you over the years. So I did do it,
35:38
Speaker 3: and then she's like, never again. And this year I
35:41
Speaker 3: was so proud of her. She's eleven and in our
35:43
Speaker 3: office eleven years is you know, you get your three
35:45
Speaker 3: childhood vaccines plus your two two rest shit five And
35:50
Speaker 3: she sat there stoically. I was really proud dad. After
35:53
Speaker 3: I heard about it from the medical assistance, I had
35:55
Speaker 3: been anxious about what it was going to be. Like,
35:58
Speaker 3: I mean, one piece of advice I have for parents too,
36:00
Speaker 3: is like, just because your kid was scared at your
36:04
Speaker 3: X doesn't mean they'll be scared at your X plus
36:06
Speaker 3: one or have the same reaction. And you know, allowing
36:10
Speaker 3: them growth and telling them that they you know, are
36:13
Speaker 3: getting braver and is really powerful for them. Just like
36:16
Speaker 3: it would be in any other activity they're part of.
36:18
Speaker 1: All right, lightning round short answers. Are you ready? Yeah,
36:23
Speaker 1: what is your favorite vaccine?
36:25
Speaker 3: Oh well it's not a vaccine, but this year I'm
36:29
Speaker 3: loving the RSV and munichal obulent I mean, so like this,
36:33
Speaker 3: you know, wow, Like I mean, it's what's cool. And
36:37
Speaker 3: I'm sorry I naking it too long because I'm not
36:39
Speaker 3: going to lightning us. But like, you know, there are
36:41
Speaker 3: three vaccines that weren't available to me when I was
36:45
Speaker 3: a resident, and that had tons of hospitalizations even when
36:49
Speaker 3: I was a hospitals and that's new acaucle rotavirus and
36:53
Speaker 3: RSV and watching diseases like drastically decrease their impact on
36:59
Speaker 3: kids is really fun and like and so those are
37:03
Speaker 3: my like, those the ones that have come out since
37:05
Speaker 3: my training are held a special place for me because
37:08
Speaker 3: they're they're the kids that I remember spending all that
37:11
Speaker 3: time taking care of the hospital.
37:13
Speaker 1: Excellent, All right, Why do they warn you about egg
37:17
Speaker 1: allergies when they do some vaccines and then your doctor
37:20
Speaker 1: is like, it's fine, Actually that's made up. Could you
37:22
Speaker 1: please say that?
37:24
Speaker 3: Yeah. So some of the vaccines over the years have
37:27
Speaker 3: been made in egg broth because it has proteins and
37:31
Speaker 3: different enzymes that they can survive, and so the thought
37:35
Speaker 3: was that like some of those proteins would get into
37:37
Speaker 3: the vaccine itself. And I'm not an expert on all
37:40
Speaker 3: of the changes in manufacturing over the years, but it
37:43
Speaker 3: is true that we are no longer worried about even
37:45
Speaker 3: people are anaphlexis to eggs for any of our vaccinations.
37:49
Speaker 3: Although up to like two years ago, we still had
37:51
Speaker 3: our questionnaire in our office, but I ignore it now.
37:56
Speaker 1: Thailan all ibuprofen after vaccines.
37:58
Speaker 3: Ibuprofen just better at Lauren fevers and better controlling pain
38:03
Speaker 3: than the seeamnifin. Let's not prand anything today? Right?
38:07
Speaker 1: Okay? Better immunity from vaccines or getting sick?
38:11
Speaker 3: Oh, it depends on the individual illness. Right, I'd rather
38:15
Speaker 3: not get sick. I mean you got polio, you got
38:18
Speaker 3: great immunity, but you're paralyzed.
38:21
Speaker 1: Yes, it's not a good tray off. Have needles gotten
38:25
Speaker 1: smaller or am I just larger?
38:27
Speaker 3: Oh?
38:28
Speaker 1: To give you background, I recall vaccine needles from my
38:32
Speaker 1: childhood being like a PBC pipe and now they seem
38:36
Speaker 1: very small.
38:36
Speaker 3: But I'm yeah, I mean child there was about fifteen
38:39
Speaker 3: or twenty years ago, I imagine, right.
38:41
Speaker 1: So yeah, it was more like twelve years ago. But yeah,
38:44
Speaker 1: that's fine.
38:44
Speaker 3: Yeah, yeah, I don't remember the gauge needles that they
38:47
Speaker 3: were using. I mean, vaccine needles are pretty small. They're
38:51
Speaker 3: twenty five gauge needles. They're pretty tiny. But no comment,
38:56
Speaker 3: no comment.
38:58
Speaker 1: Did you go to chicken pox parties when you were
38:59
Speaker 1: a kid?
39:01
Speaker 3: No, but I remember having chicken pox, And that's like
39:03
Speaker 3: a great example of a vaccine that we get a
39:05
Speaker 3: little bit of a resistance from because people remember it.
39:09
Speaker 3: But I like to remind people that a hundred American
39:11
Speaker 3: kids died every year of chicken pox before we had
39:13
Speaker 3: the vaccine, and you know ten two hundred times that
39:17
Speaker 3: or in the hospital with numinitis, which is like an
39:21
Speaker 3: inflammation of the lungs. But yeah, I have natural munity
39:26
Speaker 3: to chicken pox.
39:27
Speaker 1: I will also say that for me, chicken pox is
39:29
Speaker 1: a good illustration of what you said at the top
39:31
Speaker 1: about just like even if things are totally fine, it
39:36
Speaker 1: like ruins stuff. So my brother had chicken pox on
39:39
Speaker 1: a family vacation in Greece, and it totally ruined it
39:41
Speaker 1: because he was incredibly uncomfortable and like, you know, we
39:44
Speaker 1: couldn't do anything. And it was like this vacation my
39:47
Speaker 1: parents had planned and it was like a big deal
39:48
Speaker 1: in their three kids, and they were dragging us to
39:50
Speaker 1: Europe and we were going to do all this fun
39:51
Speaker 1: stuff and he had chicken pox the entire time. And
39:54
Speaker 1: that's you. He was totally fine, but it was definitely
39:56
Speaker 1: not great.
39:58
Speaker 3: Yeah. If you could have timed that, like a sore
40:01
Speaker 3: arm on a day that he wasn't going to pitch
40:02
Speaker 3: in a little league game the next day, it would
40:04
Speaker 3: have been nicer, exactly.
40:06
Speaker 1: That's all. What's the vaccine that the people are most
40:10
Speaker 1: hesitant about, other than the covid flu respiratory.
40:14
Speaker 3: Space, I think hept Bee at birth. Yeah, because the
40:18
Speaker 3: baby's so little.
40:19
Speaker 1: What do you tell people about Heppie at birth? That's
40:21
Speaker 1: what I hear about all the time.
40:22
Speaker 3: Yeah. I mean I don't fight it that much because
40:26
Speaker 3: I think in the population I'm dealing with, it has
40:29
Speaker 3: universal I mean almost if they didn't have universal prenatal care,
40:34
Speaker 3: I would fight it. But the reason we give Heppy
40:37
Speaker 3: at birth we have to like sort of bookend that
40:40
Speaker 3: is because the reason you can't develop very good immunity
40:44
Speaker 3: a day zero of life, your your immune stance is
40:47
Speaker 3: not ready to develop immunity, and so it's not very
40:50
Speaker 3: effective at building up your long term antibodies. But what
40:54
Speaker 3: it does do is allows if you have hepatized to
40:59
Speaker 3: be as a mom, which all ladies who get prenatal
41:03
Speaker 3: care have been tested for. But if they got it
41:08
Speaker 3: afterwards or if their DEAK wasn't wrong, then it very
41:11
Speaker 3: much lowers the risk of transmission. Now, if you actually
41:14
Speaker 3: had hepatize B, the add giving you hepatized B immuni
41:17
Speaker 3: globulin as well, which is the proteins that the vaccine
41:22
Speaker 3: helps your body create to sort of supercharge that immunity.
41:25
Speaker 3: And we can block vertical transmission of hepatizes B through
41:29
Speaker 3: that combination, but we can we get seventy percent of
41:32
Speaker 3: the effect with just the vaccine alone, and most hepatized
41:36
Speaker 3: B is gotten through vertical transmission between mother and child
41:40
Speaker 3: in the world. So again on a public health basis
41:45
Speaker 3: like worldwide, giving it a day zero absolutely makes sense,
41:49
Speaker 3: right and you know Vietnam is where the major studies
41:52
Speaker 3: and hepatizes be event we've cut down on liver cancer
41:56
Speaker 3: in a single generation. Hepatitizes be over time puts you
41:59
Speaker 3: a high risk liver cancer. We've been able to cut
42:01
Speaker 3: down on that significantly, like eighty ninety percent of from
42:07
Speaker 3: a previous generation because I have P vaccine. So on
42:11
Speaker 3: the other hand, most of my families, the reason they
42:15
Speaker 3: say no is they're like, oh, this mayby's so tiny.
42:17
Speaker 3: I'm so worried about them getting a shot. And then
42:19
Speaker 3: they come to my office because and they also don't
42:22
Speaker 3: trust the hospital system, but they've already decided they trust me,
42:26
Speaker 3: so they'll just get it a few days later. And again,
42:29
Speaker 3: I don't you know, these patients, the likelihood that they
42:32
Speaker 3: got hepatized B and either test the negative for or
42:35
Speaker 3: got it in between the time they got tested and
42:38
Speaker 3: the time they delivered is so low that it's not
42:41
Speaker 3: when I put a ton of energy in fighting.
42:43
Speaker 1: Last question, did you get a flu shot this year?
42:47
Speaker 3: I got flu in covid. I gave my kids flu
42:49
Speaker 3: in covid. I would get too. I like I love vaccines,
42:53
Speaker 3: you know, I dream about like new vaccines for new things,
42:58
Speaker 3: like you know, when the rs viva you gotta.
43:01
Speaker 1: I wish you wish you had the RSV vaccine.
43:03
Speaker 3: Yes, I think that if we didn't have the pandemic
43:05
Speaker 3: and all the anti vaccine sort of sentiment after the pandemic,
43:08
Speaker 3: they would have gone for universal RS to vaccine all
43:11
Speaker 3: of us get RSB at least once a year, maybe twice.
43:14
Speaker 3: Like I'd get a vaccine just to avoid two colts,
43:17
Speaker 3: Like that'd be awesome. Like that's like, yeah, it's not
43:20
Speaker 3: going to change whether I get hospitalized or die, like
43:22
Speaker 3: it does for elderly patients and little kids. But like,
43:25
Speaker 3: I don't love being sick, and vaccines are a really
43:29
Speaker 3: cool way to avoid that.
43:35
Speaker 1: That is a great note to end on. Adam, Thank
43:38
Speaker 1: you so much for being here. It was a delight
43:42
Speaker 1: and I think that everyone will find it incredibly useful.
43:46
Speaker 3: Oh well, thanks for having It was super fun and
43:48
Speaker 3: hopefully you can talk about a less controversial topic next time.
43:51
Speaker 1: Absolutely, next time we can do breastfeeding or starting solids,
43:56
Speaker 1: something like good, something easy, awesome, best.
44:02
Speaker 2: Show to best shine.
44:16
Speaker 1: Parent Data is produced by Tamar Avishai with support from
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Speaker 1: the parent Data team and pir Rex. If you have
44:23
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44:39
Speaker 1: you make better, more informed parenting decisions. For example, last month,
44:43
Speaker 1: I wrote a beast of an article titled how can
44:47
Speaker 1: you Know if Vaccines are Safe? Which addressed the top
44:50
Speaker 1: concerns I hear from parents all the time about vaccine safety.
44:54
Speaker 1: I look at, among other things, what's in the compounds,
44:57
Speaker 1: why there are so many vaccines, and yes, the question
45:00
Speaker 1: of vaccines and autism. It's the perfect companion to this
45:03
Speaker 1: conversation with Adam, and I highly recommend you checking it
45:06
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45:28
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Speaker 4: Come out quest shin
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