February 13, 2025 • 46 mins
Shots are never a fun experience. Even if you are enthusiastic about vaccines, holding your kids as they get them is not usually a high point of parenting. And right now, the conversation about vaccines is increasingly fraught - and not just because our kids are sometimes afraid of needles.
Because we're living in a moment where vaccines, long one of the most trusted and studied preventative medical treatments in existence, are suddenly being viewed with skepticism. Debunked theories about the relationship between vaccines and autism, for example, are taking center stage on Instagram and Facebook, but also in congressional hearings. Part of the problem is a lack of understanding. People don't know quite how vaccines work or why there are more now than in the past or how we can know that they are safe.
Today on ParentData, we welcome Dr. Adam Davis. Adam is a pediatrician in the Bay Area, and he has a lot to say about vaccines from the perspective of someone who gives them. In the conversation, we talk about our theories on why the COVID vaccine sped up a slow-growing movement around vaccine skepticism, about the role that vaccines play in public health, about what it’s like for doctors to deal with vaccine skeptics in their own practice and what people can and can't be talked into or out of, and, because it’s a parenting podcast, some hacks for getting your kids through vaccines without too much drama.
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Episode Transcript
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Speaker 1 (00:00):
I'm Emily Astor. This is parent data and today, if
I say going to the doctor and getting shots, what
is your first response?
Speaker 2 (00:10):
I hate them?
Speaker 3 (00:13):
Are you scared of shots at all?
Speaker 2 (00:15):
The ones that hurt, the tetanus ones hurt, But other
than that.
Speaker 3 (00:19):
Not really.
Speaker 4 (00:20):
My only memories I have of needles is just being fearful,
and going to the doctor was always really stressful. I
distinctly remember kicking my pediatrician.
Speaker 5 (00:31):
I totally had a fear of needles when I was
a kid. I think the famous story about me was
that I hid under one of the chairs in the
doctor's office and it took my mother, the receptionist, and
the doctor to pull me out from under the chair
(00:52):
so that they could give me my shot.
Speaker 2 (00:55):
So when I see the needle, I always get freaked out.
I mean, it's a metal stick being entered into your
arm with fluid that stings like it's not enjoyable.
Speaker 4 (01:08):
I really don't like the feeling of something being like
injected into me, and then that kind of like heaviness
in my arm, Like it just feels invasive.
Speaker 2 (01:18):
It feels like someone's pinching you the hardest they can
pinch for about three seconds. It doesn't hurt that much,
but it's definitely like a little thing. It's like getting
your ears pierced.
Speaker 3 (01:32):
Like it's not that bad.
Speaker 5 (01:33):
I still can't look And as soon as I like
smell the rubbing alcohol, yeah, turn my head and look
away and like scrunch my eyes a little bit, and
it's yeah, it's a funny thing. It's like it brings
you back to being that age.
Speaker 3 (01:50):
I can recognize.
Speaker 4 (01:51):
It's completely psychological, like I will cry on my way
to the doctor's office knowing I'm going to get a
need all. I think it's gone easier to the point
I haven't kicked a doctor as an adult.
Speaker 3 (02:03):
Is it enjoyable to know that you were brave?
Speaker 2 (02:07):
After when I know, oh my god, that it wasn't
that bad, I'm like, oh, I did it. I'm awesome.
Speaker 1 (02:19):
Vaccines are never a fun conversation with your kids. For
many years, before every doctor visit, my kids would ask,
are their shots? I never wanted to commit to a no,
even when I thought they were not, so I always hedged, oh,
I'm not sure, asked the doctor, which led to all
visits starting with the kids accosting our lovely pediatrician, are
(02:41):
there shots today? As soon as she came into the room.
Even if you are enthusiastic about vaccines, the experience of
holding your kids as they get them is not usually
a high point of parenting, and in the present moment,
the conversation about vaccines is increasingly fraught, and not just
because our kids are sometimes afraid of Neil's. We're living
(03:02):
in a moment where vaccines, long one of the most
trusted and studied preventive medical treatments in existence, are suddenly
being viewed with skepticism. Debunk theories about their relationship between
vaccines and autism, for example, are taking center stage on
Instagram and on Facebook, but also in congressional hearings. I
(03:26):
think that part of the problem we're facing is a
lack of understanding. People don't know quite how vaccines work,
or why there are more now than in the past,
or how we can know that they are safe. I've
been writing about this in parent Data over the past
few months, and today I'm bringing that conversation to the podcast.
My guest is doctor Adam Davis. Adam is a pediatrician
(03:49):
in the Bay Area, and he was my medical editor
for the book Cribsheet, and he has a lot to
say about vaccines from the perspective of someone who gives them.
In the conversation, we talk talk about our theories on
why the COVID vaccine sped up a slow growing movement
around vaccine skepticism. We talk about the role of vaccines
play in public health and how to explain that. We
(04:11):
talk about what it's like for doctors to deal with
vaccine skeptics in their own practice, and what people can
and can't be talked into or out of. And because
it's a parenting podcast, some hacks forgetting your kids through
vaccines without too much drama. Adam is here to help
cut through some of the noise and help us generate
(04:32):
some real understanding. After the break, doctor Adam Davis. Adam Davis,
thank you for joining me on the podcast.
Speaker 3 (04:53):
Thanks for having me. Emily. Great to be here.
Speaker 1 (04:56):
So do you want to go ahead and introduce yourself, sure.
Speaker 3 (05:00):
Adam Davis. I'm a community pediatrician in San Francis called
SFBA Pediatrics. I also have the honor of being the
medical editor of Emily's second book, Crib Sheets, and I'm
here today to chat with her.
Speaker 1 (05:15):
Yeah, all right, I'm super excited to have you as
you said you were the medical editor on cribsheet, and
so if anyone's noticed any mistakes, they're Adam's fault and
will be you know, discussing them later. But I really
loved I loved working with you on that. That was
was very fun to write, and it was interesting. It's
always very interesting for me because I come from a
(05:39):
place that is so data and is not seeing patients
to work with someone and talk to someone about these
same ideas, but from the standpoint of like someone who
doesn't spend their whole day thinking about causality but does
actually see people. And of course people are a bit
more complicated than data, even though data is people, so
(06:00):
those perspectives they come together.
Speaker 3 (06:03):
Yeah, it was a lot of fun, and you know,
it was great timing for me too. I was making
a job transition from being a hospitalist and taking care
of patients of children in the hospital that were very ill,
to doing primary care and deep diving into the data
and really helped hone my abilities as I moved to
(06:24):
outpatient medicine and primary care. So it was it served
us both really well.
Speaker 1 (06:30):
So before we were going to talk today about vaccines,
everybody's favorite topic, but I'm actually curious when you made
that move, So you move from working with quite sick
kids to working with presumably a mostly healthy population. I'm
curious about what was what was the hardest thing about
that move?
Speaker 3 (06:48):
Yeah, I mean the hardest thing was dermatology. So like, honestly,
in the hospital, I like, I mean, there were like
three types of rash. I would care about it all,
you know, have like blister or like dying skin. And
then you get into the outpatient world that everybody wants
to talk about acne or this, like these red bumps
(07:09):
and you're like, I don't know. And so it took
a little while to re review that. But luckily most
rashes and kids are quite transient, and I think.
Speaker 1 (07:17):
Mostly the answer like what a lot of it? Like,
rashes are fine?
Speaker 3 (07:21):
Yeah, who knows a funny story. So one of my
partners in my outpatient clinic is doctor Alan Johnson, and
he's now in his eighties. He retired like a year
and a half ago. He started in the practice in
nineteen seventy four, which was a year before I was born.
And so you know, when I just started back in
(07:42):
primary care, he told me, anytime you want just come
come grab me out of a patient if you have
any question. So there was a rash, and like I
knew what I wanted to do with it. I knew
that some steroids and some moistroizer were going to get
rid of the rash. And I knew it wasn't a
worrisome rash. I just didn't know like the medical terminology,
the last and root of what to call it. And
(08:03):
so I went and I invited Alan into the room
and he looks at it. He goes, it's rash. And
I was like, wait, that's all, that's all you have
to say. And he's like, yeah, like it will get better.
It's like some irritation, you know, Like he's like, if
it gets worse, then we'll figure it out. But like
(08:23):
and I was like, it sort of relieves some of
the tension for me because one of the nice things
about ambilatory medicine versus impatient medicine is often you have
that longer sort of time period, right Like in acute
medicine you need to figure out what's going wrong and
correct it shortly, but rash you can say, well, let's
do this for a week, and you know, if it's
getting much worse, we can call a friend or we
(08:46):
can and that's true for a number of things that
can happen in the inblatory world.
Speaker 1 (08:50):
I like that dermatology okay, Germa, Yeah, I mean I'm
often calling I'm often texting pictures of rash is to
my pediatrician and she does. She's usually like she's like, yeah,
that's that's that's rash.
Speaker 3 (09:02):
Ye yeah, put them to totally. It can be really
and the pictures make it even harder, like, uh, you
know because of the quality of the iPhone pictures.
Speaker 1 (09:13):
With the flagg in.
Speaker 3 (09:18):
What body part is that it's off to the next
question exactly, but that that was like the hardest. Medically,
there's like a whole different like rhythm to being an
ambulatory doc, both in terms of your individual days you're
seeing many more patients than you do impatient, but also
in terms of the what you're doing with them. I
remember I actually I sent I posted on Facebook to
(09:41):
my friends, like because at the beginning I felt a
little bit like an imposter. People would come in with
their well child for a well child exam. You know,
we'll get into it, but I would give them vaccines,
but if they were due for them, and I talked
to them about like their activities at school, like like
all your listeners have experienced with their PEDUTRICI And I
was like they left. I was like, what do they
(10:01):
look like? What was the value of that for the
for the families? And it was actually really really starting,
So I sent that. I actually asked my friends. I
was like, can you tell me, like do you feel
value because from going to see on your well children
when you knew your child was you know, thriving in
preschool or or elementary school or whatever, and like you
(10:22):
didn't really have a big concern, And they universally were like, yes,
a ton of value of like the reassurance and like
having that relationship with the pediatrician. And and over the years,
I mean now it's been seven years that I've been
doing this, I feel that every day. Like it's a
really special honor to have somebody a family identify you
(10:42):
as their child's pediatrician. It's a huge amount of trust,
it's a huge it's a very unique relationship. It's really
special in a lot of different like times in the
child life, like when they're born obviously, but also when
you're like those sort of teen years when you're transitioning
from being like mostly talked to the parents to mostly
talking to the kid. And you're trying to preserve that
(11:04):
relationship with the parents, but also know that the kid
can be in some rebellion and you want to you
want to be on their side as well, and so
it's humbling that way, and it's really special.
Speaker 1 (11:15):
That's amazing. Okay, let's talk about vaccines. Yeah, so let
me start with the most basic question, which is what
is your what is your stance on vaccines?
Speaker 3 (11:26):
I mean, there's very few things in pediatrics medicine that
have as good evidence as vaccines, period, right, Like, you know,
people think that a lot of things that doctors do,
and you've talked about this in a number of different
venues and a number of different things are based on
these really great studies all the time, and often they're not.
(11:46):
Often they're based on expert advice or sort of smaller
studies that sort of imply something. But and you know,
even like how many days do we give advantibiotics for infections,
it's all based on like football scores. To me, like
it's you know, you either give it for seven or
ten days. You never give it. Nobody ever give it
for eight or nine, Like there's just like that's just
(12:06):
because like a random study that nobody doesn't comparative of
these small changes. So a lot of the questions that
people can ask me, there's not like a wealth of
literature to go to to answer it. But vaccines is
the exception there, Like, vaccines are really well studied, and
the effects what we call the effects size, right, how
many people you have to do something to protect one
(12:27):
person is quite small with vaccines. It's like we can
really honestly, like in the I mean even if you
go outside of like doctors, if you just think about
what's improved health over the last century or more, it's
hygiene and vaccines, right are number one and number two
probably hygiene first and vaccine second. But vaccines has been
(12:50):
like life changing for public health. And so I'm a
strong believer in so much so that like our practice
and not every practice has the benefit of being able
to do this, But we have limited capacity to keep
patients in our practice who truly refuse vaccines. We won't
do that for the long auwe and you know in
our state they're required for school.
Speaker 1 (13:12):
So when you say there is a lot of evidence
behind vaccines, which I agree that there is. Can you
say a little bit more if you know parent coms,
they say, well, what do you mean, there's a lot
of evidence like what you know, I've heard blah blah
whatever it is like when you talk about evidence there,
what does that evidence look like?
Speaker 3 (13:30):
Well, then you have to get into the individual vaccines
because you can't like talk about like I mean overall,
what I would say is vaccines are one of the
best studied interventions that we have in medicine. But like
you know, then you have to talk about individual vaccines
and what the evidence is for what they do. And
there's different things that vaccines can do. They can prevent
(13:50):
you from getting disease. They can attenuate, which means to
lessen the strength of a disease, so like you still
get the disease, but not as strongly. They can prevent
spread of the disease, or you know, in the best cases,
they can get rid of the disease from the planet,
which we've done once right spa box We've gotten rid
(14:11):
of all completely, and we're we were pretty close to
polio being you know, gone from the planet, and now
it looks like that's not going to happen. In the
near future. But so I have an ability to talk
about pretty much each vaccine, some of them I know
better than others, just because I've goven the speech more times. Right,
Like I have less patients to question some vaccines than others.
(14:34):
The ones they question more are probably the ones that
I have like a more refined sort of speech about.
But again, like ultimately, like obviously it's a parent's choice
on whether they want to vaccinate their kids, but most parents,
after I talked about certainly the routine childhood vaccines, maybe
not the annual respiratory vaccines, they do them, and most parents,
(14:56):
I mean, honestly still most parents in my community want
to vaccinate their kids fullies. So that's a nice benefit
of that happens to be the patients that I work with.
Speaker 1 (15:06):
So when I think about vaccine resistance, which I will
say in the populations that I talked to, I feel
has noticeably gone up even in the last year, so
the number of questions and the sort of post COVID
and even more so in the last year, but in
the kind of over the last four or so years,
(15:28):
I have many more questions from people about routine vaccines.
I'm curious if you hear if that's something you get
on your team.
Speaker 3 (15:35):
Also, absolutely, but I will say more for COVID vaccine
than the other ones, but all of them in some level.
And I have a theory for that. And I actually
think of what happened is if, like you know, when
vaccines were being developed during COVID, we all were one
in like we had a lot of time on our
(15:56):
hands at home, and we were all thinking about vaccines
because we were all excited about vaccines, and we all
wanted a vaccine to be good and come out quickly.
And then when they started coming out, we had like
comparative analysis like should I get Maderno or Johnson and Johnson.
People spent a lot of time thinking about vaccines and
(16:16):
trying to get their vaccines. I mean in some communities.
Many communities get their vaccines as quickly as they could,
and I think they got used to doing a deep
analysis of the very minor change differences and cost benefits
of different vaccines or different vaccine schedules. You'll remember like
people talked about whether you should have it at four
(16:37):
weeks afterwards or if you should wait a little bit longer,
And there was just a lot of like public discussion
of every nuance of giving a vaccine. Before that, I
think that most parents sort of mindlessly went to their
dock and said, oh, it's vaccine time. Cool, tell me
what I need to get, and then they got in
the habit of doing their you know, their own analysis
(16:59):
on it, which led to you know, more and more questions,
which leads to longer conversations, which led to some resistance
in some areas, and you know, and specifically with the
COVID vaccine. I think there's also like this almost like
it's somewhat illogical, but there's almost this thing like I
want to be done with the pandemic, and one day
being way of being done with the pandemic is just
(17:19):
like I'm not doing the vaccine anymore either, because that's
part of the pandemic.
Speaker 1 (17:24):
It's interesting. I have a different theory, although your theory
is a very interesting one. I think there's a piece
here that I totally agree with, which is people got
into this habit of like I now, now I'm an
epidemiology expert, now I'm a vaccine expert, Like I've spent
all my time doing this, and I think that's that happened.
And the other thing that happened, which I think is
(17:44):
some has a portion of fault to some extent of
public health. I've talked about this before, is after that
initial vaccine wave, when we then got into these the
current state of boosters. I think that peopleeople are feeling
attacked when they are raising concerns that they view as
(18:06):
very valid and some of which I think are reasonable.
So you know, for example, there are a lot of
people who would say, now like I don't know why
my seven year old needs a fourth booster, Like they
already had a bunch of they've had COVID four times,
they've had all of the shots. You know, Europe doesn't
give boosters, do why is the CDC saying this is
(18:27):
so important? And then they feel like, well, I don't
really agree with this. It doesn't seem reasonable, And then like,
let me think about it, like why do I need
the measles vaccine? And I think for me, that's a
little bit of a failure because I actually think it
should be totally reasonable to say, like, your kid gets
the measles vaccine, but also they don't need a fourth
booster because the value of that for a healthy kid is.
Speaker 3 (18:48):
Small, Right, I guess the logical fallacy I see there
is they've also had like eight influenza vaccines in their life.
So the way I explained it to families is, I
think today the logic behind doing the annual resiratory vaccines
which are now COVID and flu is the same for
each other, right And like there's there's minor differences there,
(19:10):
and we can talk through them and why, you know,
But but they each do three things, and I think
those three things are really important to keep in mind.
And I mostly vaccinate for the third. In the case
of these like healthy elementary school and high school students. One,
you know, they make you a little bit less likely
to get the disease, but not a ton less likely,
(19:32):
right Like, And it depends a little bit on the timing,
and it depends on each individual booster and whether that
particular booster matches the particular strain that happens to be
around during you know, during the next bump. But it does,
you know, and we know that from data two, it
attenuates the disease. And again that means still less than
the strength of it. And I'll give you a great
(19:53):
example that I have just from like two weeks ago.
I had and this is from flu. But I had
a thirteen year old and a twenty year ol and
flu has been brutal to the last few weeks. Yeah, yeah,
And I had a thirteen and twenty year old sisters
who I knew forever and and really great relationship with
their family and loved these two girls. And they both
(20:16):
came with fever. The thirteen year old had had fever
for one day and actually had was resolved, and she
was like laughing at my jokes, and the twenty year
old was lying on the exam table mad at me
for making her laugh because she was in so much pain.
It was their sixth day of like one hundred and
four fevers. And it just turned out like that she
hadn't got her flu vaccine that year because she was
off at college and she forgot to, and her thirteen
(20:37):
year old sister had and like not doesn't get into
any study, right because from a study standpoint, the outcome
for those two kids is neither went to the er,
neither were hospitalized, neither endo the ICU, and neither died.
But the lived experience of flu after vaccination is office
often much less serious, like not serious in terms of
(21:01):
like I'm worried about your long term health, but serious
that week for you as a family than it is
with no vaccination that year. And the same thing can
be a said of COVID, right like, so we you know,
now COVID seems to be right now, a more mild
disease than flu A for kids in general, Like I
(21:21):
don't see the high fevers and the really ill. You
do seem like really tired and a lot of cough,
and the tired is like out of proportion often with
the height of the fever, which we you know with
fluids seems more sort of aligned. But again, like I
think it's hard to measure these things and studies because
(21:42):
they're not the outcome. Studies are looking at the second thing,
you know, besides longer the risk of getting the diseases
and attenuating the disease itself if you get it, and
part of the attenuation is just knocking off that tail
of the bell curved of this the really bad tale
that like, you know, I don't know how to measure
because there's such rare outcomes, And so I get it
(22:03):
when people are like, well that's probably not gonna happen
to me, and you're probably right, but like it does
knock down that tail. We know that. But the third thing,
and this is incredibly important, and the main reason that
I vaccinate, is we know from studies prior to the
pandemic that the more kids who are vaccinated with flu
vaccine in a community under eighteen, the less elderly people
(22:25):
die in that community that season. And we know from
COVID studies in the prisons right where they can look
at spread really nicely between prisoners that even if a
prisoner got COVID, they were less likely to give it
to their cellmate if they had the vaccine because the
viral load that they were coughing out was lower. And
(22:46):
so I do believe, and some again like we'll get
more data on COVID over time as these but I
do believe, first of all, more COVID deaths still today
than flu deaths. Over the course of a year, we
have more COVID deaths in this country. And so I
do think that we can protect our elderly and are
compromise by continuing to have universal vaccination programs. And so
(23:08):
I really stress to families just like, look, I don't
give any of the kids polio vaccine because I'm worried
they're going to get polio. There hasn't been a case
of polio in California. Maybe there will be now since
New York's had a case last year, but we haven't
had a case since the seventies, right, Like, it's very
unlikely that they're going to be exposed to polio. But
they're part of a larger project, and that project is
(23:31):
to rid the world of polio and covid and flu.
We're probably not going to rid the world of They're
gonna be endemic first, you know, until technology changes dramatically.
But if everybody vaccinates themselves, we will have less of
a bump every year. We will have less deaths every year,
and I think that matters. So that's how I explained
it to them, and then I let them make the
decision they want to make.
Speaker 1 (23:51):
But you would keep a patient even if they didn't.
They didn't see it.
Speaker 3 (23:55):
Flu in covid, Yeah, absolutely no, it's only the school
required vaccine that we will and part of it is
just just a pain in the ass.
Speaker 1 (24:04):
Right Like, yeah, in order, California has very very sharp
guidelines about what you can do to get out of
I see.
Speaker 3 (24:13):
But the way I say that to patients too. Is this, Look,
I'm in an area of the country that, like, prior
to the pandemic had some of the like Marin County,
which is one of the richest counties in country right
is very northwest, had some of the lowest vaccination rates
in the country before the pandemic, and immediately immediately during
the pandemic, it became the most vaccinated county in the
(24:34):
entire country for COVID early on. Now, I don't think
that that's probably still the same, but like, that's a
fascinating thing, and it's fascinating how politics and vaccines have interacted.
But what I will say there is that we have
doctor practices in the area, both in the city itself
and surrounding the city, that are very open to alternative
(24:55):
vaccine or no vaccine families. And what I say to
this is actually not, hey, you're a horrible person because
you're not going to vaccinate your kid, or even you're
a pain of the ass. What I say to them is,
look like we're building a relationship of trust here, and
I want you guys to trust that I'm going to
give you the best information I can and that you
(25:16):
trust me as sort of a shepherd to help you
through this. And if, like, on the thing that I
think is most evidence based, you guys are like no,
then there might just be a better match for you locally.
Like that's what I offer up to them. I'm never
like you're bad people. I'm just like, you know, I
have a system of beliefs about medicine that you guys
(25:37):
don't believe, and so like, why wouldn't you see somebody
who matched that better? You know, I also don't do
crystal medicine in my practice, right, Like, if they really
wanted that, they should seek that out with somebody else.
Speaker 1 (25:46):
Do you find these conversations frustrating? No, not like this
conversation but the people.
Speaker 3 (25:52):
No, No, totally not always. It can be right if
somebody wants to like go line by line about research
studies and like play that game, it can be really frustrating.
But that like thing that I just did with you, Emily,
where I said, here are the three reasons I've vaccinated,
it's really the third one, and like often that ends
(26:12):
with them still not doing the vaccination. But if I
feel they heard my reasoning and they really listen to me,
I feel okay about it. And I don't feel upset
anymore now when they come in for flue and that
kid has a fever to one oh four and it's
day three of it, I'm glowedy, right, I'm a little
bit like you know how I say it, like really sweet,
(26:35):
but like I'm always like, hey, you know one thing
that I have to do. Here is a little I
told you.
Speaker 1 (26:38):
So more parent data, including a lightning round on vaccine
best practices and vaccine myth busting after the brink, going
(27:10):
back to the routine childhood vaccination. You gave what I
think is the right answer for the polio vaccine, which is,
you know, probably for most people, your kid is not
going to be exposed to polio.
Speaker 3 (27:23):
Or measles or diptheria. Like I mean, so many of
the vaccines we give are sort of like in some ways,
and I want to word this carefully, like not likely
to affect that child, because the people before them laid
the groundwork for there not to be that you know,
pathogen in our environments.
Speaker 1 (27:43):
And I think this is this feels to me like
a very complicated part of this discussion, and we sort
of know what most motivate people. I mean, I have
some research where you basically can see when there's a
protesters outbreak in the county, in the next year more
people get vaccinated for protesters, so you sort of see
like the kind of almost the media response of saying, oh,
like that's a real disease, we protest. This whooping cough
(28:05):
is an example of something where we do see it
around and getting vaccinated is a protective of you, of
you individually. But I think this is a hard piece
of this for people because it feels like wouldn't I
just rather free ride.
Speaker 3 (28:17):
I don't have research, but I think much more effective
than me arguing about side effects and effectiveness for their
individual is talking about grandmothers and immunocompromise people.
Speaker 1 (28:28):
The altruistic motivation.
Speaker 3 (28:30):
Yeah, I think people like at least my experience with
it is people are really like, oh, maybe I was
getting caught up in like like my house and I
had lost track of like what this is all about.
And for the childhood vaccine, it's a little bit different
because they're really you're talking about like people like who
really is sacrificed by taking the vaccine or to get
(28:52):
to the place where it's such low amounts of it
out in the community that it's very unlikely to bump
into the world and for the rest story of it's
a little bit different about sort of this lowering the spread.
But you know, it's funny. I do think that in
our world right now, like just where the culture is,
people feel that they need to protect themselves and protect
(29:13):
what they have a little bit more than they did before.
And it's sort of a coursier environment. But I think
within that when you when you actually say, hey, no,
this is actually a community thing and they weren't thinking
of that way, it sort of opens up something for them.
For a lot of my patients anyhow, my front staff,
they have a big joke because there's like I do
a lot more vaccinations than a lot of my partners,
(29:34):
Like I just do, like we will vaccinate parents for
COVID and flu, and I'm just I ask every parent
every visit, which is not what most of my partners do.
You know, it goes back to that value proposition, what
are the things that I can do in the office
that are actually going to affect people's health, And getting
(29:55):
vaccines into arms is something that really does so, like,
you know, I do enjoy that talk and I think
that pediatricians really have a strong voice in the room
about this. And if we do that talk well and
openly and are listening to and not demanding but or
rather just talking through our thought process. You know, there's
(30:15):
a surprising number of people and just be like, you
know what, yeah, you know, or they'll say, let me
talk to my husband, And that's probably not like it's
the dads who are much more like at that COVI
vaccine than the mom's right now. But yeah, it's the worse.
Speaker 1 (30:28):
So one of the questions that I hear coming up
more and more is this question of splitting vaccines. So
there are many vaccines, should you know the often many
of them are given at the same time people want
to space them out. What do you say when people
want to space them out?
Speaker 3 (30:43):
Yeah, So it's a great question, and I get that
a lot, and I have a few things I say.
One is like, the number of pathogens that we get
in vaccines is tiny compared to what we get through
like walking through life, and so I don't think there's
anything that like causes great harm to children to get
(31:04):
six or eight pathogens or instead of like two or
four or whatever the number may be. But actually this
is a place where I say to them, like, look,
I actually think one, there is some evidence about this,
and there's some evidence that you have increased level of
febrile seizures if you split your vaccines, and I think
(31:24):
that data is most likely just you're gonna have you know, fevers,
a potential side effect of any vaccine, So if you
have fevers more time, you're more likely to have a
febril seizure. But you know, I don't know, But it's
not the thing I lead with. I don't usually talk
about that. What I usually talk about as a child's experience,
and what I usually say to them is, look, the
day you get vaccine sucks and the next day sucks,
(31:46):
and I don't want so many of those days for
your child. If we split this day into three days,
then three days suck getting the shots and they're gonna
and that's more of like a negative, like you know,
a negative stimuli for them for this office, for everything.
Once they get their first shot, Like while they're crying
for their second shot, it's not that big of a
deal to them, Like they're still gonna be okay five
(32:08):
minutes later, and yes, like there might get a fever tomorrow.
But I don't think it's like additive. I don't think
if you give five vaccines the fever will be three
times as high. And it means if we split it
that there's another day they might get fever. And I actually,
you know, the other part of it is really trying
to help the patient take the vaccine calmly, and we
(32:30):
can do a lot of things about that. I mean,
so for the little babies, please feed your baby while
they're getting the vaccines, like nurse them if you're breastfeeding,
give them a bottle if you're not, like it makes
a huge difference for the little bit older kids, distract them,
put them over your shoulder and put a screen or
(32:50):
a bright moving thing behind your shoulder that they can watch.
Often kids won't even know they're getting vaccines. With older kids,
like anybody four to five above, I play cat swap
giving vaccines. I literally I don't give the vaccines. My
medical assistant do. But I hold their hands. They look
me eye to eye and we go through a favorite
thing animals for the younger kids, sometimes sports players for
the older kids. And honestly, they sometimes ask me if
(33:13):
they've got their vaccines yet. It depends a little bit
if they want to concentrate, but like if you can
leave some and I don't do like some people do,
like the MLA. I think it's a little bit placeble,
Like I don't think it matters if you numb the
skin a little bit before the vaccine. But the vibration
thing like the buzzy bee or the ice, those things
all work. But I find that attention is the most
(33:33):
important thing, just like getting the intention away from it.
And some kids you can't do that. They have panic
attacks while they're getting vaccines. And then it's hold tight,
hold fast, and go fast, like don't take time.
Speaker 1 (33:46):
You don't want to do it again next week and
next weekend.
Speaker 3 (33:49):
Yeah, that's just retraumatizing the kid. As parents, the thing
I would ask is like, once you make the decision,
make the decision like solid, like don't negotiate with your
five year old of war that you're gonna get back
scenes that day, right, Like they're not able to make
that decision. You need to sort of make that decision
and hold it. But it's funny like I have families
that after they get the vaccines, the kids will be like, oh,
(34:12):
the worst part was thinking about the vaccine beforehand, or
the parents will be like, oh my god, that wasn't
nearly as bad as I thought it would be. So
many parents coming with their own needophobia that they projected
down to their kids. So if you can like take
a moment and think of a strategy to keep your
kid distracted during vaccines, I think that everybody ends up
(34:34):
not hating vaccines as much.
Speaker 1 (34:36):
My kids when they got the first COVID vaccine, there
was this place that they got it, and I don't
know what was the deal with this person, but she
was like a very good vaccinator, and like they still
talk about like how that was the least painful, like
that was their favorite vaccine. Then the place closed, and
they're always like, oh, it's so stun's closed, Like that
person was such a great vaccine giver.
Speaker 3 (34:56):
I've been through this with my own kids, like my
son and his three year old appointment cried because he
was not scheduled to get a vaccine and he thought
that he was getting ripped off at the doctor's office.
My daughter had been one of the more resistant vaccine
receivers that my practice had to the point, like I
mean I was not involved in her vaccines for many
of the years, but she would like run away and
(35:19):
like need to be held down. And like one year
she said, Daddy, I want you to give me the vaccines.
And I'm like, are you sure, Like you know, I
don't do it nearly as off as the medical assessor.
It's like, but if you want, and you know, it's
always a little the joy to give your kid a
little bit negative stimuli after all the things they've done
to you over the years. So I did do it,
and then she's like, never again. And this year I
(35:41):
was so proud of her. She's eleven and in our
office eleven years is you know, you get your three
childhood vaccines plus your two two rest shit five And
she sat there stoically. I was really proud dad. After
I heard about it from the medical assistance, I had
been anxious about what it was going to be. Like,
I mean, one piece of advice I have for parents too,
is like, just because your kid was scared at your
(36:04):
X doesn't mean they'll be scared at your X plus
one or have the same reaction. And you know, allowing
them growth and telling them that they you know, are
getting braver and is really powerful for them. Just like
it would be in any other activity they're part of.
Speaker 1 (36:18):
All right, lightning round short answers. Are you ready? Yeah,
what is your favorite vaccine?
Speaker 3 (36:25):
Oh well it's not a vaccine, but this year I'm
loving the RSV and munichal obulent I mean, so like this,
you know, wow, Like I mean, it's what's cool. And
I'm sorry I naking it too long because I'm not
going to lightning us. But like, you know, there are
three vaccines that weren't available to me when I was
(36:45):
a resident, and that had tons of hospitalizations even when
I was a hospitals and that's new acaucle rotavirus and
RSV and watching diseases like drastically decrease their impact on
kids is really fun and like and so those are
my like, those the ones that have come out since
my training are held a special place for me because
(37:08):
they're they're the kids that I remember spending all that
time taking care of the hospital.
Speaker 1 (37:13):
Excellent, All right, Why do they warn you about egg
allergies when they do some vaccines and then your doctor
is like, it's fine, Actually that's made up. Could you
please say that?
Speaker 3 (37:24):
Yeah. So some of the vaccines over the years have
been made in egg broth because it has proteins and
different enzymes that they can survive, and so the thought
was that like some of those proteins would get into
the vaccine itself. And I'm not an expert on all
of the changes in manufacturing over the years, but it
is true that we are no longer worried about even
(37:45):
people are anaphlexis to eggs for any of our vaccinations.
Although up to like two years ago, we still had
our questionnaire in our office, but I ignore it now.
Speaker 1 (37:56):
Thailan all ibuprofen after vaccines.
Speaker 3 (37:58):
Ibuprofen just better at Lauren fevers and better controlling pain
than the seeamnifin. Let's not prand anything today? Right?
Speaker 1 (38:07):
Okay? Better immunity from vaccines or getting sick?
Speaker 3 (38:11):
Oh, it depends on the individual illness. Right, I'd rather
not get sick. I mean you got polio, you got
great immunity, but you're paralyzed.
Speaker 1 (38:21):
Yes, it's not a good tray off. Have needles gotten
smaller or am I just larger?
Speaker 3 (38:27):
Oh?
Speaker 1 (38:28):
To give you background, I recall vaccine needles from my
childhood being like a PBC pipe and now they seem
very small.
Speaker 3 (38:36):
But I'm yeah, I mean child there was about fifteen
or twenty years ago, I imagine, right.
Speaker 1 (38:41):
So yeah, it was more like twelve years ago. But yeah,
that's fine.
Speaker 3 (38:44):
Yeah, yeah, I don't remember the gauge needles that they
were using. I mean, vaccine needles are pretty small. They're
twenty five gauge needles. They're pretty tiny. But no comment,
no comment.
Speaker 1 (38:58):
Did you go to chicken pox parties when you were
a kid?
Speaker 3 (39:01):
No, but I remember having chicken pox, And that's like
a great example of a vaccine that we get a
little bit of a resistance from because people remember it.
But I like to remind people that a hundred American
kids died every year of chicken pox before we had
the vaccine, and you know ten two hundred times that
or in the hospital with numinitis, which is like an
(39:21):
inflammation of the lungs. But yeah, I have natural munity
to chicken pox.
Speaker 1 (39:27):
I will also say that for me, chicken pox is
a good illustration of what you said at the top
about just like even if things are totally fine, it
like ruins stuff. So my brother had chicken pox on
a family vacation in Greece, and it totally ruined it
because he was incredibly uncomfortable and like, you know, we
couldn't do anything. And it was like this vacation my
parents had planned and it was like a big deal
(39:48):
in their three kids, and they were dragging us to
Europe and we were going to do all this fun
stuff and he had chicken pox the entire time. And
that's you. He was totally fine, but it was definitely
not great.
Speaker 3 (39:58):
Yeah. If you could have timed that, like a sore
arm on a day that he wasn't going to pitch
in a little league game the next day, it would
have been nicer, exactly.
Speaker 1 (40:06):
That's all. What's the vaccine that the people are most
hesitant about, other than the covid flu respiratory.
Speaker 3 (40:14):
Space, I think hept Bee at birth. Yeah, because the
baby's so little.
Speaker 1 (40:19):
What do you tell people about Heppie at birth? That's
what I hear about all the time.
Speaker 3 (40:22):
Yeah. I mean I don't fight it that much because
I think in the population I'm dealing with, it has
universal I mean almost if they didn't have universal prenatal care,
I would fight it. But the reason we give Heppy
at birth we have to like sort of bookend that
is because the reason you can't develop very good immunity
(40:44):
a day zero of life, your your immune stance is
not ready to develop immunity, and so it's not very
effective at building up your long term antibodies. But what
it does do is allows if you have hepatized to
be as a mom, which all ladies who get prenatal
care have been tested for. But if they got it
(41:08):
afterwards or if their DEAK wasn't wrong, then it very
much lowers the risk of transmission. Now, if you actually
had hepatize B, the add giving you hepatized B immuni
globulin as well, which is the proteins that the vaccine
helps your body create to sort of supercharge that immunity.
And we can block vertical transmission of hepatizes B through
(41:29):
that combination, but we can we get seventy percent of
the effect with just the vaccine alone, and most hepatized
B is gotten through vertical transmission between mother and child
in the world. So again on a public health basis
like worldwide, giving it a day zero absolutely makes sense,
right and you know Vietnam is where the major studies
(41:52):
and hepatizes be event we've cut down on liver cancer
in a single generation. Hepatitizes be over time puts you
a high risk liver cancer. We've been able to cut
down on that significantly, like eighty ninety percent of from
a previous generation because I have P vaccine. So on
the other hand, most of my families, the reason they
(42:15):
say no is they're like, oh, this mayby's so tiny.
I'm so worried about them getting a shot. And then
they come to my office because and they also don't
trust the hospital system, but they've already decided they trust me,
so they'll just get it a few days later. And again,
I don't you know, these patients, the likelihood that they
got hepatized B and either test the negative for or
(42:35):
got it in between the time they got tested and
the time they delivered is so low that it's not
when I put a ton of energy in fighting.
Speaker 1 (42:43):
Last question, did you get a flu shot this year?
Speaker 3 (42:47):
I got flu in covid. I gave my kids flu
in covid. I would get too. I like I love vaccines,
you know, I dream about like new vaccines for new things,
like you know, when the rs viva you gotta.
Speaker 1 (43:01):
I wish you wish you had the RSV vaccine.
Speaker 3 (43:03):
Yes, I think that if we didn't have the pandemic
and all the anti vaccine sort of sentiment after the pandemic,
they would have gone for universal RS to vaccine all
of us get RSB at least once a year, maybe twice.
Like I'd get a vaccine just to avoid two colts,
Like that'd be awesome. Like that's like, yeah, it's not
going to change whether I get hospitalized or die, like
it does for elderly patients and little kids. But like,
(43:25):
I don't love being sick, and vaccines are a really
cool way to avoid that.
Speaker 1 (43:35):
That is a great note to end on. Adam, Thank
you so much for being here. It was a delight
and I think that everyone will find it incredibly useful.
Speaker 3 (43:46):
Oh well, thanks for having It was super fun and
hopefully you can talk about a less controversial topic next time.
Speaker 1 (43:51):
Absolutely, next time we can do breastfeeding or starting solids,
something like good, something easy, awesome, best.
Speaker 2 (44:02):
Show to best shine.
Speaker 1 (44:16):
Parent Data is produced by Tamar Avishai with support from
the parent Data team and pir Rex. If you have
thoughts on this episode, please join the conversation on my
Instagram at prof Emily Oster, and if you want to
support the show, become a subscriber to the parent Data
Newsletter at parentdata dot org, where I write weekly posts
on everything to do with parents and data to help
(44:39):
you make better, more informed parenting decisions. For example, last month,
I wrote a beast of an article titled how can
you Know if Vaccines are Safe? Which addressed the top
concerns I hear from parents all the time about vaccine safety.
I look at, among other things, what's in the compounds,
why there are so many vaccines, and yes, the question
(45:00):
of vaccines and autism. It's the perfect companion to this
conversation with Adam, and I highly recommend you checking it
out at parent data dot org. There are a lot
of ways you can help people find out about us.
Leave a rating or a review on Apple podcasts, Text
your friend about something you learned from this episode. Debate
your mother in law about the merits of something parents
do now that is totally different from what she did.
(45:22):
Close the story to your Instagram, debunking a panic headline
of your own. Just remember to mention the podcast too.
Rite Penelope right, Mom, We'll see you next time.
Speaker 4 (45:34):
Come out quest shin
Speaker 3 (45:40):
Sh
I'm Emily Astor. This is parent data and today, if
I say going to the doctor and getting shots, what
is your first response?
Speaker 2 (00:10):
I hate them?
Speaker 3 (00:13):
Are you scared of shots at all?
Speaker 2 (00:15):
The ones that hurt, the tetanus ones hurt, But other
than that.
Speaker 3 (00:19):
Not really.
Speaker 4 (00:20):
My only memories I have of needles is just being fearful,
and going to the doctor was always really stressful. I
distinctly remember kicking my pediatrician.
Speaker 5 (00:31):
I totally had a fear of needles when I was
a kid. I think the famous story about me was
that I hid under one of the chairs in the
doctor's office and it took my mother, the receptionist, and
the doctor to pull me out from under the chair
(00:52):
so that they could give me my shot.
Speaker 2 (00:55):
So when I see the needle, I always get freaked out.
I mean, it's a metal stick being entered into your
arm with fluid that stings like it's not enjoyable.
Speaker 4 (01:08):
I really don't like the feeling of something being like
injected into me, and then that kind of like heaviness
in my arm, Like it just feels invasive.
Speaker 2 (01:18):
It feels like someone's pinching you the hardest they can
pinch for about three seconds. It doesn't hurt that much,
but it's definitely like a little thing. It's like getting
your ears pierced.
Speaker 3 (01:32):
Like it's not that bad.
Speaker 5 (01:33):
I still can't look And as soon as I like
smell the rubbing alcohol, yeah, turn my head and look
away and like scrunch my eyes a little bit, and
it's yeah, it's a funny thing. It's like it brings
you back to being that age.
Speaker 3 (01:50):
I can recognize.
Speaker 4 (01:51):
It's completely psychological, like I will cry on my way
to the doctor's office knowing I'm going to get a
need all. I think it's gone easier to the point
I haven't kicked a doctor as an adult.
Speaker 3 (02:03):
Is it enjoyable to know that you were brave?
Speaker 2 (02:07):
After when I know, oh my god, that it wasn't
that bad, I'm like, oh, I did it. I'm awesome.
Speaker 1 (02:19):
Vaccines are never a fun conversation with your kids. For
many years, before every doctor visit, my kids would ask,
are their shots? I never wanted to commit to a no,
even when I thought they were not, so I always hedged, oh,
I'm not sure, asked the doctor, which led to all
visits starting with the kids accosting our lovely pediatrician, are
(02:41):
there shots today? As soon as she came into the room.
Even if you are enthusiastic about vaccines, the experience of
holding your kids as they get them is not usually
a high point of parenting, and in the present moment,
the conversation about vaccines is increasingly fraught, and not just
because our kids are sometimes afraid of Neil's. We're living
(03:02):
in a moment where vaccines, long one of the most
trusted and studied preventive medical treatments in existence, are suddenly
being viewed with skepticism. Debunk theories about their relationship between
vaccines and autism, for example, are taking center stage on
Instagram and on Facebook, but also in congressional hearings. I
(03:26):
think that part of the problem we're facing is a
lack of understanding. People don't know quite how vaccines work,
or why there are more now than in the past,
or how we can know that they are safe. I've
been writing about this in parent Data over the past
few months, and today I'm bringing that conversation to the podcast.
My guest is doctor Adam Davis. Adam is a pediatrician
(03:49):
in the Bay Area, and he was my medical editor
for the book Cribsheet, and he has a lot to
say about vaccines from the perspective of someone who gives them.
In the conversation, we talk talk about our theories on
why the COVID vaccine sped up a slow growing movement
around vaccine skepticism. We talk about the role of vaccines
play in public health and how to explain that. We
(04:11):
talk about what it's like for doctors to deal with
vaccine skeptics in their own practice, and what people can
and can't be talked into or out of. And because
it's a parenting podcast, some hacks forgetting your kids through
vaccines without too much drama. Adam is here to help
cut through some of the noise and help us generate
(04:32):
some real understanding. After the break, doctor Adam Davis. Adam Davis,
thank you for joining me on the podcast.
Speaker 3 (04:53):
Thanks for having me. Emily. Great to be here.
Speaker 1 (04:56):
So do you want to go ahead and introduce yourself, sure.
Speaker 3 (05:00):
Adam Davis. I'm a community pediatrician in San Francis called
SFBA Pediatrics. I also have the honor of being the
medical editor of Emily's second book, Crib Sheets, and I'm
here today to chat with her.
Speaker 1 (05:15):
Yeah, all right, I'm super excited to have you as
you said you were the medical editor on cribsheet, and
so if anyone's noticed any mistakes, they're Adam's fault and
will be you know, discussing them later. But I really
loved I loved working with you on that. That was
was very fun to write, and it was interesting. It's
always very interesting for me because I come from a
(05:39):
place that is so data and is not seeing patients
to work with someone and talk to someone about these
same ideas, but from the standpoint of like someone who
doesn't spend their whole day thinking about causality but does
actually see people. And of course people are a bit
more complicated than data, even though data is people, so
(06:00):
those perspectives they come together.
Speaker 3 (06:03):
Yeah, it was a lot of fun, and you know,
it was great timing for me too. I was making
a job transition from being a hospitalist and taking care
of patients of children in the hospital that were very ill,
to doing primary care and deep diving into the data
and really helped hone my abilities as I moved to
(06:24):
outpatient medicine and primary care. So it was it served
us both really well.
Speaker 1 (06:30):
So before we were going to talk today about vaccines,
everybody's favorite topic, but I'm actually curious when you made
that move, So you move from working with quite sick
kids to working with presumably a mostly healthy population. I'm
curious about what was what was the hardest thing about
that move?
Speaker 3 (06:48):
Yeah, I mean the hardest thing was dermatology. So like, honestly,
in the hospital, I like, I mean, there were like
three types of rash. I would care about it all,
you know, have like blister or like dying skin. And
then you get into the outpatient world that everybody wants
to talk about acne or this, like these red bumps
(07:09):
and you're like, I don't know. And so it took
a little while to re review that. But luckily most
rashes and kids are quite transient, and I think.
Speaker 1 (07:17):
Mostly the answer like what a lot of it? Like,
rashes are fine?
Speaker 3 (07:21):
Yeah, who knows a funny story. So one of my
partners in my outpatient clinic is doctor Alan Johnson, and
he's now in his eighties. He retired like a year
and a half ago. He started in the practice in
nineteen seventy four, which was a year before I was born.
And so you know, when I just started back in
(07:42):
primary care, he told me, anytime you want just come
come grab me out of a patient if you have
any question. So there was a rash, and like I
knew what I wanted to do with it. I knew
that some steroids and some moistroizer were going to get
rid of the rash. And I knew it wasn't a
worrisome rash. I just didn't know like the medical terminology,
the last and root of what to call it. And
(08:03):
so I went and I invited Alan into the room
and he looks at it. He goes, it's rash. And
I was like, wait, that's all, that's all you have
to say. And he's like, yeah, like it will get better.
It's like some irritation, you know, Like he's like, if
it gets worse, then we'll figure it out. But like
(08:23):
and I was like, it sort of relieves some of
the tension for me because one of the nice things
about ambilatory medicine versus impatient medicine is often you have
that longer sort of time period, right Like in acute
medicine you need to figure out what's going wrong and
correct it shortly, but rash you can say, well, let's
do this for a week, and you know, if it's
getting much worse, we can call a friend or we
(08:46):
can and that's true for a number of things that
can happen in the inblatory world.
Speaker 1 (08:50):
I like that dermatology okay, Germa, Yeah, I mean I'm
often calling I'm often texting pictures of rash is to
my pediatrician and she does. She's usually like she's like, yeah,
that's that's that's rash.
Speaker 3 (09:02):
Ye yeah, put them to totally. It can be really
and the pictures make it even harder, like, uh, you
know because of the quality of the iPhone pictures.
Speaker 1 (09:13):
With the flagg in.
Speaker 3 (09:18):
What body part is that it's off to the next
question exactly, but that that was like the hardest. Medically,
there's like a whole different like rhythm to being an
ambulatory doc, both in terms of your individual days you're
seeing many more patients than you do impatient, but also
in terms of the what you're doing with them. I
remember I actually I sent I posted on Facebook to
(09:41):
my friends, like because at the beginning I felt a
little bit like an imposter. People would come in with
their well child for a well child exam. You know,
we'll get into it, but I would give them vaccines,
but if they were due for them, and I talked
to them about like their activities at school, like like
all your listeners have experienced with their PEDUTRICI And I
was like they left. I was like, what do they
(10:01):
look like? What was the value of that for the
for the families? And it was actually really really starting,
So I sent that. I actually asked my friends. I
was like, can you tell me, like do you feel
value because from going to see on your well children
when you knew your child was you know, thriving in
preschool or or elementary school or whatever, and like you
(10:22):
didn't really have a big concern, And they universally were like, yes,
a ton of value of like the reassurance and like
having that relationship with the pediatrician. And and over the years,
I mean now it's been seven years that I've been
doing this, I feel that every day. Like it's a
really special honor to have somebody a family identify you
(10:42):
as their child's pediatrician. It's a huge amount of trust,
it's a huge it's a very unique relationship. It's really
special in a lot of different like times in the
child life, like when they're born obviously, but also when
you're like those sort of teen years when you're transitioning
from being like mostly talked to the parents to mostly
talking to the kid. And you're trying to preserve that
(11:04):
relationship with the parents, but also know that the kid
can be in some rebellion and you want to you
want to be on their side as well, and so
it's humbling that way, and it's really special.
Speaker 1 (11:15):
That's amazing. Okay, let's talk about vaccines. Yeah, so let
me start with the most basic question, which is what
is your what is your stance on vaccines?
Speaker 3 (11:26):
I mean, there's very few things in pediatrics medicine that
have as good evidence as vaccines, period, right, Like, you know,
people think that a lot of things that doctors do,
and you've talked about this in a number of different
venues and a number of different things are based on
these really great studies all the time, and often they're not.
(11:46):
Often they're based on expert advice or sort of smaller
studies that sort of imply something. But and you know,
even like how many days do we give advantibiotics for infections,
it's all based on like football scores. To me, like
it's you know, you either give it for seven or
ten days. You never give it. Nobody ever give it
for eight or nine, Like there's just like that's just
(12:06):
because like a random study that nobody doesn't comparative of
these small changes. So a lot of the questions that
people can ask me, there's not like a wealth of
literature to go to to answer it. But vaccines is
the exception there, Like, vaccines are really well studied, and
the effects what we call the effects size, right, how
many people you have to do something to protect one
(12:27):
person is quite small with vaccines. It's like we can
really honestly, like in the I mean even if you
go outside of like doctors, if you just think about
what's improved health over the last century or more, it's
hygiene and vaccines, right are number one and number two
probably hygiene first and vaccine second. But vaccines has been
(12:50):
like life changing for public health. And so I'm a
strong believer in so much so that like our practice
and not every practice has the benefit of being able
to do this, But we have limited capacity to keep
patients in our practice who truly refuse vaccines. We won't
do that for the long auwe and you know in
our state they're required for school.
Speaker 1 (13:12):
So when you say there is a lot of evidence
behind vaccines, which I agree that there is. Can you
say a little bit more if you know parent coms,
they say, well, what do you mean, there's a lot
of evidence like what you know, I've heard blah blah
whatever it is like when you talk about evidence there,
what does that evidence look like?
Speaker 3 (13:30):
Well, then you have to get into the individual vaccines
because you can't like talk about like I mean overall,
what I would say is vaccines are one of the
best studied interventions that we have in medicine. But like
you know, then you have to talk about individual vaccines
and what the evidence is for what they do. And
there's different things that vaccines can do. They can prevent
(13:50):
you from getting disease. They can attenuate, which means to
lessen the strength of a disease, so like you still
get the disease, but not as strongly. They can prevent
spread of the disease, or you know, in the best cases,
they can get rid of the disease from the planet,
which we've done once right spa box We've gotten rid
(14:11):
of all completely, and we're we were pretty close to
polio being you know, gone from the planet, and now
it looks like that's not going to happen. In the
near future. But so I have an ability to talk
about pretty much each vaccine, some of them I know
better than others, just because I've goven the speech more times. Right,
Like I have less patients to question some vaccines than others.
(14:34):
The ones they question more are probably the ones that
I have like a more refined sort of speech about.
But again, like ultimately, like obviously it's a parent's choice
on whether they want to vaccinate their kids, but most parents,
after I talked about certainly the routine childhood vaccines, maybe
not the annual respiratory vaccines, they do them, and most parents,
(14:56):
I mean, honestly still most parents in my community want
to vaccinate their kids fullies. So that's a nice benefit
of that happens to be the patients that I work with.
Speaker 1 (15:06):
So when I think about vaccine resistance, which I will
say in the populations that I talked to, I feel
has noticeably gone up even in the last year, so
the number of questions and the sort of post COVID
and even more so in the last year, but in
the kind of over the last four or so years,
(15:28):
I have many more questions from people about routine vaccines.
I'm curious if you hear if that's something you get
on your team.
Speaker 3 (15:35):
Also, absolutely, but I will say more for COVID vaccine
than the other ones, but all of them in some level.
And I have a theory for that. And I actually
think of what happened is if, like you know, when
vaccines were being developed during COVID, we all were one
in like we had a lot of time on our
(15:56):
hands at home, and we were all thinking about vaccines
because we were all excited about vaccines, and we all
wanted a vaccine to be good and come out quickly.
And then when they started coming out, we had like
comparative analysis like should I get Maderno or Johnson and Johnson.
People spent a lot of time thinking about vaccines and
(16:16):
trying to get their vaccines. I mean in some communities.
Many communities get their vaccines as quickly as they could,
and I think they got used to doing a deep
analysis of the very minor change differences and cost benefits
of different vaccines or different vaccine schedules. You'll remember like
people talked about whether you should have it at four
(16:37):
weeks afterwards or if you should wait a little bit longer,
And there was just a lot of like public discussion
of every nuance of giving a vaccine. Before that, I
think that most parents sort of mindlessly went to their
dock and said, oh, it's vaccine time. Cool, tell me
what I need to get, and then they got in
the habit of doing their you know, their own analysis
(16:59):
on it, which led to you know, more and more questions,
which leads to longer conversations, which led to some resistance
in some areas, and you know, and specifically with the
COVID vaccine. I think there's also like this almost like
it's somewhat illogical, but there's almost this thing like I
want to be done with the pandemic, and one day
being way of being done with the pandemic is just
(17:19):
like I'm not doing the vaccine anymore either, because that's
part of the pandemic.
Speaker 1 (17:24):
It's interesting. I have a different theory, although your theory
is a very interesting one. I think there's a piece
here that I totally agree with, which is people got
into this habit of like I now, now I'm an
epidemiology expert, now I'm a vaccine expert, Like I've spent
all my time doing this, and I think that's that happened.
And the other thing that happened, which I think is
(17:44):
some has a portion of fault to some extent of
public health. I've talked about this before, is after that
initial vaccine wave, when we then got into these the
current state of boosters. I think that peopleeople are feeling
attacked when they are raising concerns that they view as
(18:06):
very valid and some of which I think are reasonable.
So you know, for example, there are a lot of
people who would say, now like I don't know why
my seven year old needs a fourth booster, Like they
already had a bunch of they've had COVID four times,
they've had all of the shots. You know, Europe doesn't
give boosters, do why is the CDC saying this is
(18:27):
so important? And then they feel like, well, I don't
really agree with this. It doesn't seem reasonable, And then like,
let me think about it, like why do I need
the measles vaccine? And I think for me, that's a
little bit of a failure because I actually think it
should be totally reasonable to say, like, your kid gets
the measles vaccine, but also they don't need a fourth
booster because the value of that for a healthy kid is.
Speaker 3 (18:48):
Small, Right, I guess the logical fallacy I see there
is they've also had like eight influenza vaccines in their life.
So the way I explained it to families is, I
think today the logic behind doing the annual resiratory vaccines
which are now COVID and flu is the same for
each other, right And like there's there's minor differences there,
(19:10):
and we can talk through them and why, you know,
But but they each do three things, and I think
those three things are really important to keep in mind.
And I mostly vaccinate for the third. In the case
of these like healthy elementary school and high school students. One,
you know, they make you a little bit less likely
to get the disease, but not a ton less likely,
(19:32):
right Like, And it depends a little bit on the timing,
and it depends on each individual booster and whether that
particular booster matches the particular strain that happens to be
around during you know, during the next bump. But it does,
you know, and we know that from data two, it
attenuates the disease. And again that means still less than
the strength of it. And I'll give you a great
(19:53):
example that I have just from like two weeks ago.
I had and this is from flu. But I had
a thirteen year old and a twenty year ol and
flu has been brutal to the last few weeks. Yeah, yeah,
And I had a thirteen and twenty year old sisters
who I knew forever and and really great relationship with
their family and loved these two girls. And they both
(20:16):
came with fever. The thirteen year old had had fever
for one day and actually had was resolved, and she
was like laughing at my jokes, and the twenty year
old was lying on the exam table mad at me
for making her laugh because she was in so much pain.
It was their sixth day of like one hundred and
four fevers. And it just turned out like that she
hadn't got her flu vaccine that year because she was
off at college and she forgot to, and her thirteen
(20:37):
year old sister had and like not doesn't get into
any study, right because from a study standpoint, the outcome
for those two kids is neither went to the er,
neither were hospitalized, neither endo the ICU, and neither died.
But the lived experience of flu after vaccination is office
often much less serious, like not serious in terms of
(21:01):
like I'm worried about your long term health, but serious
that week for you as a family than it is
with no vaccination that year. And the same thing can
be a said of COVID, right like, so we you know,
now COVID seems to be right now, a more mild
disease than flu A for kids in general, Like I
(21:21):
don't see the high fevers and the really ill. You
do seem like really tired and a lot of cough,
and the tired is like out of proportion often with
the height of the fever, which we you know with
fluids seems more sort of aligned. But again, like I
think it's hard to measure these things and studies because
(21:42):
they're not the outcome. Studies are looking at the second thing,
you know, besides longer the risk of getting the diseases
and attenuating the disease itself if you get it, and
part of the attenuation is just knocking off that tail
of the bell curved of this the really bad tale
that like, you know, I don't know how to measure
because there's such rare outcomes, And so I get it
(22:03):
when people are like, well that's probably not gonna happen
to me, and you're probably right, but like it does
knock down that tail. We know that. But the third thing,
and this is incredibly important, and the main reason that
I vaccinate, is we know from studies prior to the
pandemic that the more kids who are vaccinated with flu
vaccine in a community under eighteen, the less elderly people
(22:25):
die in that community that season. And we know from
COVID studies in the prisons right where they can look
at spread really nicely between prisoners that even if a
prisoner got COVID, they were less likely to give it
to their cellmate if they had the vaccine because the
viral load that they were coughing out was lower. And
(22:46):
so I do believe, and some again like we'll get
more data on COVID over time as these but I
do believe, first of all, more COVID deaths still today
than flu deaths. Over the course of a year, we
have more COVID deaths in this country. And so I
do think that we can protect our elderly and are
compromise by continuing to have universal vaccination programs. And so
(23:08):
I really stress to families just like, look, I don't
give any of the kids polio vaccine because I'm worried
they're going to get polio. There hasn't been a case
of polio in California. Maybe there will be now since
New York's had a case last year, but we haven't
had a case since the seventies, right, Like, it's very
unlikely that they're going to be exposed to polio. But
they're part of a larger project, and that project is
(23:31):
to rid the world of polio and covid and flu.
We're probably not going to rid the world of They're
gonna be endemic first, you know, until technology changes dramatically.
But if everybody vaccinates themselves, we will have less of
a bump every year. We will have less deaths every year,
and I think that matters. So that's how I explained
it to them, and then I let them make the
decision they want to make.
Speaker 1 (23:51):
But you would keep a patient even if they didn't.
They didn't see it.
Speaker 3 (23:55):
Flu in covid, Yeah, absolutely no, it's only the school
required vaccine that we will and part of it is
just just a pain in the ass.
Speaker 1 (24:04):
Right Like, yeah, in order, California has very very sharp
guidelines about what you can do to get out of
I see.
Speaker 3 (24:13):
But the way I say that to patients too. Is this, Look,
I'm in an area of the country that, like, prior
to the pandemic had some of the like Marin County,
which is one of the richest counties in country right
is very northwest, had some of the lowest vaccination rates
in the country before the pandemic, and immediately immediately during
the pandemic, it became the most vaccinated county in the
(24:34):
entire country for COVID early on. Now, I don't think
that that's probably still the same, but like, that's a
fascinating thing, and it's fascinating how politics and vaccines have interacted.
But what I will say there is that we have
doctor practices in the area, both in the city itself
and surrounding the city, that are very open to alternative
(24:55):
vaccine or no vaccine families. And what I say to
this is actually not, hey, you're a horrible person because
you're not going to vaccinate your kid, or even you're
a pain of the ass. What I say to them is,
look like we're building a relationship of trust here, and
I want you guys to trust that I'm going to
give you the best information I can and that you
(25:16):
trust me as sort of a shepherd to help you
through this. And if, like, on the thing that I
think is most evidence based, you guys are like no,
then there might just be a better match for you locally.
Like that's what I offer up to them. I'm never
like you're bad people. I'm just like, you know, I
have a system of beliefs about medicine that you guys
(25:37):
don't believe, and so like, why wouldn't you see somebody
who matched that better? You know, I also don't do
crystal medicine in my practice, right, Like, if they really
wanted that, they should seek that out with somebody else.
Speaker 1 (25:46):
Do you find these conversations frustrating? No, not like this
conversation but the people.
Speaker 3 (25:52):
No, No, totally not always. It can be right if
somebody wants to like go line by line about research
studies and like play that game, it can be really frustrating.
But that like thing that I just did with you, Emily,
where I said, here are the three reasons I've vaccinated,
it's really the third one, and like often that ends
(26:12):
with them still not doing the vaccination. But if I
feel they heard my reasoning and they really listen to me,
I feel okay about it. And I don't feel upset
anymore now when they come in for flue and that
kid has a fever to one oh four and it's
day three of it, I'm glowedy, right, I'm a little
bit like you know how I say it, like really sweet,
(26:35):
but like I'm always like, hey, you know one thing
that I have to do. Here is a little I
told you.
Speaker 1 (26:38):
So more parent data, including a lightning round on vaccine
best practices and vaccine myth busting after the brink, going
(27:10):
back to the routine childhood vaccination. You gave what I
think is the right answer for the polio vaccine, which is,
you know, probably for most people, your kid is not
going to be exposed to polio.
Speaker 3 (27:23):
Or measles or diptheria. Like I mean, so many of
the vaccines we give are sort of like in some ways,
and I want to word this carefully, like not likely
to affect that child, because the people before them laid
the groundwork for there not to be that you know,
pathogen in our environments.
Speaker 1 (27:43):
And I think this is this feels to me like
a very complicated part of this discussion, and we sort
of know what most motivate people. I mean, I have
some research where you basically can see when there's a
protesters outbreak in the county, in the next year more
people get vaccinated for protesters, so you sort of see
like the kind of almost the media response of saying, oh,
like that's a real disease, we protest. This whooping cough
(28:05):
is an example of something where we do see it
around and getting vaccinated is a protective of you, of
you individually. But I think this is a hard piece
of this for people because it feels like wouldn't I
just rather free ride.
Speaker 3 (28:17):
I don't have research, but I think much more effective
than me arguing about side effects and effectiveness for their
individual is talking about grandmothers and immunocompromise people.
Speaker 1 (28:28):
The altruistic motivation.
Speaker 3 (28:30):
Yeah, I think people like at least my experience with
it is people are really like, oh, maybe I was
getting caught up in like like my house and I
had lost track of like what this is all about.
And for the childhood vaccine, it's a little bit different
because they're really you're talking about like people like who
really is sacrificed by taking the vaccine or to get
(28:52):
to the place where it's such low amounts of it
out in the community that it's very unlikely to bump
into the world and for the rest story of it's
a little bit different about sort of this lowering the spread.
But you know, it's funny. I do think that in
our world right now, like just where the culture is,
people feel that they need to protect themselves and protect
(29:13):
what they have a little bit more than they did before.
And it's sort of a coursier environment. But I think
within that when you when you actually say, hey, no,
this is actually a community thing and they weren't thinking
of that way, it sort of opens up something for them.
For a lot of my patients anyhow, my front staff,
they have a big joke because there's like I do
a lot more vaccinations than a lot of my partners,
(29:34):
Like I just do, like we will vaccinate parents for
COVID and flu, and I'm just I ask every parent
every visit, which is not what most of my partners do.
You know, it goes back to that value proposition, what
are the things that I can do in the office
that are actually going to affect people's health, And getting
(29:55):
vaccines into arms is something that really does so, like,
you know, I do enjoy that talk and I think
that pediatricians really have a strong voice in the room
about this. And if we do that talk well and
openly and are listening to and not demanding but or
rather just talking through our thought process. You know, there's
(30:15):
a surprising number of people and just be like, you
know what, yeah, you know, or they'll say, let me
talk to my husband, And that's probably not like it's
the dads who are much more like at that COVI
vaccine than the mom's right now. But yeah, it's the worse.
Speaker 1 (30:28):
So one of the questions that I hear coming up
more and more is this question of splitting vaccines. So
there are many vaccines, should you know the often many
of them are given at the same time people want
to space them out. What do you say when people
want to space them out?
Speaker 3 (30:43):
Yeah, So it's a great question, and I get that
a lot, and I have a few things I say.
One is like, the number of pathogens that we get
in vaccines is tiny compared to what we get through
like walking through life, and so I don't think there's
anything that like causes great harm to children to get
(31:04):
six or eight pathogens or instead of like two or
four or whatever the number may be. But actually this
is a place where I say to them, like, look,
I actually think one, there is some evidence about this,
and there's some evidence that you have increased level of
febrile seizures if you split your vaccines, and I think
(31:24):
that data is most likely just you're gonna have you know, fevers,
a potential side effect of any vaccine, So if you
have fevers more time, you're more likely to have a
febril seizure. But you know, I don't know, But it's
not the thing I lead with. I don't usually talk
about that. What I usually talk about as a child's experience,
and what I usually say to them is, look, the
day you get vaccine sucks and the next day sucks,
(31:46):
and I don't want so many of those days for
your child. If we split this day into three days,
then three days suck getting the shots and they're gonna
and that's more of like a negative, like you know,
a negative stimuli for them for this office, for everything.
Once they get their first shot, Like while they're crying
for their second shot, it's not that big of a
deal to them, Like they're still gonna be okay five
(32:08):
minutes later, and yes, like there might get a fever tomorrow.
But I don't think it's like additive. I don't think
if you give five vaccines the fever will be three
times as high. And it means if we split it
that there's another day they might get fever. And I actually,
you know, the other part of it is really trying
to help the patient take the vaccine calmly, and we
(32:30):
can do a lot of things about that. I mean,
so for the little babies, please feed your baby while
they're getting the vaccines, like nurse them if you're breastfeeding,
give them a bottle if you're not, like it makes
a huge difference for the little bit older kids, distract them,
put them over your shoulder and put a screen or
(32:50):
a bright moving thing behind your shoulder that they can watch.
Often kids won't even know they're getting vaccines. With older kids,
like anybody four to five above, I play cat swap
giving vaccines. I literally I don't give the vaccines. My
medical assistant do. But I hold their hands. They look
me eye to eye and we go through a favorite
thing animals for the younger kids, sometimes sports players for
the older kids. And honestly, they sometimes ask me if
(33:13):
they've got their vaccines yet. It depends a little bit
if they want to concentrate, but like if you can
leave some and I don't do like some people do,
like the MLA. I think it's a little bit placeble,
Like I don't think it matters if you numb the
skin a little bit before the vaccine. But the vibration
thing like the buzzy bee or the ice, those things
all work. But I find that attention is the most
(33:33):
important thing, just like getting the intention away from it.
And some kids you can't do that. They have panic
attacks while they're getting vaccines. And then it's hold tight,
hold fast, and go fast, like don't take time.
Speaker 1 (33:46):
You don't want to do it again next week and
next weekend.
Speaker 3 (33:49):
Yeah, that's just retraumatizing the kid. As parents, the thing
I would ask is like, once you make the decision,
make the decision like solid, like don't negotiate with your
five year old of war that you're gonna get back
scenes that day, right, Like they're not able to make
that decision. You need to sort of make that decision
and hold it. But it's funny like I have families
that after they get the vaccines, the kids will be like, oh,
(34:12):
the worst part was thinking about the vaccine beforehand, or
the parents will be like, oh my god, that wasn't
nearly as bad as I thought it would be. So
many parents coming with their own needophobia that they projected
down to their kids. So if you can like take
a moment and think of a strategy to keep your
kid distracted during vaccines, I think that everybody ends up
(34:34):
not hating vaccines as much.
Speaker 1 (34:36):
My kids when they got the first COVID vaccine, there
was this place that they got it, and I don't
know what was the deal with this person, but she
was like a very good vaccinator, and like they still
talk about like how that was the least painful, like
that was their favorite vaccine. Then the place closed, and
they're always like, oh, it's so stun's closed, Like that
person was such a great vaccine giver.
Speaker 3 (34:56):
I've been through this with my own kids, like my
son and his three year old appointment cried because he
was not scheduled to get a vaccine and he thought
that he was getting ripped off at the doctor's office.
My daughter had been one of the more resistant vaccine
receivers that my practice had to the point, like I
mean I was not involved in her vaccines for many
of the years, but she would like run away and
(35:19):
like need to be held down. And like one year
she said, Daddy, I want you to give me the vaccines.
And I'm like, are you sure, Like you know, I
don't do it nearly as off as the medical assessor.
It's like, but if you want, and you know, it's
always a little the joy to give your kid a
little bit negative stimuli after all the things they've done
to you over the years. So I did do it,
and then she's like, never again. And this year I
(35:41):
was so proud of her. She's eleven and in our
office eleven years is you know, you get your three
childhood vaccines plus your two two rest shit five And
she sat there stoically. I was really proud dad. After
I heard about it from the medical assistance, I had
been anxious about what it was going to be. Like,
I mean, one piece of advice I have for parents too,
is like, just because your kid was scared at your
(36:04):
X doesn't mean they'll be scared at your X plus
one or have the same reaction. And you know, allowing
them growth and telling them that they you know, are
getting braver and is really powerful for them. Just like
it would be in any other activity they're part of.
Speaker 1 (36:18):
All right, lightning round short answers. Are you ready? Yeah,
what is your favorite vaccine?
Speaker 3 (36:25):
Oh well it's not a vaccine, but this year I'm
loving the RSV and munichal obulent I mean, so like this,
you know, wow, Like I mean, it's what's cool. And
I'm sorry I naking it too long because I'm not
going to lightning us. But like, you know, there are
three vaccines that weren't available to me when I was
(36:45):
a resident, and that had tons of hospitalizations even when
I was a hospitals and that's new acaucle rotavirus and
RSV and watching diseases like drastically decrease their impact on
kids is really fun and like and so those are
my like, those the ones that have come out since
my training are held a special place for me because
(37:08):
they're they're the kids that I remember spending all that
time taking care of the hospital.
Speaker 1 (37:13):
Excellent, All right, Why do they warn you about egg
allergies when they do some vaccines and then your doctor
is like, it's fine, Actually that's made up. Could you
please say that?
Speaker 3 (37:24):
Yeah. So some of the vaccines over the years have
been made in egg broth because it has proteins and
different enzymes that they can survive, and so the thought
was that like some of those proteins would get into
the vaccine itself. And I'm not an expert on all
of the changes in manufacturing over the years, but it
is true that we are no longer worried about even
(37:45):
people are anaphlexis to eggs for any of our vaccinations.
Although up to like two years ago, we still had
our questionnaire in our office, but I ignore it now.
Speaker 1 (37:56):
Thailan all ibuprofen after vaccines.
Speaker 3 (37:58):
Ibuprofen just better at Lauren fevers and better controlling pain
than the seeamnifin. Let's not prand anything today? Right?
Speaker 1 (38:07):
Okay? Better immunity from vaccines or getting sick?
Speaker 3 (38:11):
Oh, it depends on the individual illness. Right, I'd rather
not get sick. I mean you got polio, you got
great immunity, but you're paralyzed.
Speaker 1 (38:21):
Yes, it's not a good tray off. Have needles gotten
smaller or am I just larger?
Speaker 3 (38:27):
Oh?
Speaker 1 (38:28):
To give you background, I recall vaccine needles from my
childhood being like a PBC pipe and now they seem
very small.
Speaker 3 (38:36):
But I'm yeah, I mean child there was about fifteen
or twenty years ago, I imagine, right.
Speaker 1 (38:41):
So yeah, it was more like twelve years ago. But yeah,
that's fine.
Speaker 3 (38:44):
Yeah, yeah, I don't remember the gauge needles that they
were using. I mean, vaccine needles are pretty small. They're
twenty five gauge needles. They're pretty tiny. But no comment,
no comment.
Speaker 1 (38:58):
Did you go to chicken pox parties when you were
a kid?
Speaker 3 (39:01):
No, but I remember having chicken pox, And that's like
a great example of a vaccine that we get a
little bit of a resistance from because people remember it.
But I like to remind people that a hundred American
kids died every year of chicken pox before we had
the vaccine, and you know ten two hundred times that
or in the hospital with numinitis, which is like an
(39:21):
inflammation of the lungs. But yeah, I have natural munity
to chicken pox.
Speaker 1 (39:27):
I will also say that for me, chicken pox is
a good illustration of what you said at the top
about just like even if things are totally fine, it
like ruins stuff. So my brother had chicken pox on
a family vacation in Greece, and it totally ruined it
because he was incredibly uncomfortable and like, you know, we
couldn't do anything. And it was like this vacation my
parents had planned and it was like a big deal
(39:48):
in their three kids, and they were dragging us to
Europe and we were going to do all this fun
stuff and he had chicken pox the entire time. And
that's you. He was totally fine, but it was definitely
not great.
Speaker 3 (39:58):
Yeah. If you could have timed that, like a sore
arm on a day that he wasn't going to pitch
in a little league game the next day, it would
have been nicer, exactly.
Speaker 1 (40:06):
That's all. What's the vaccine that the people are most
hesitant about, other than the covid flu respiratory.
Speaker 3 (40:14):
Space, I think hept Bee at birth. Yeah, because the
baby's so little.
Speaker 1 (40:19):
What do you tell people about Heppie at birth? That's
what I hear about all the time.
Speaker 3 (40:22):
Yeah. I mean I don't fight it that much because
I think in the population I'm dealing with, it has
universal I mean almost if they didn't have universal prenatal care,
I would fight it. But the reason we give Heppy
at birth we have to like sort of bookend that
is because the reason you can't develop very good immunity
(40:44):
a day zero of life, your your immune stance is
not ready to develop immunity, and so it's not very
effective at building up your long term antibodies. But what
it does do is allows if you have hepatized to
be as a mom, which all ladies who get prenatal
care have been tested for. But if they got it
(41:08):
afterwards or if their DEAK wasn't wrong, then it very
much lowers the risk of transmission. Now, if you actually
had hepatize B, the add giving you hepatized B immuni
globulin as well, which is the proteins that the vaccine
helps your body create to sort of supercharge that immunity.
And we can block vertical transmission of hepatizes B through
(41:29):
that combination, but we can we get seventy percent of
the effect with just the vaccine alone, and most hepatized
B is gotten through vertical transmission between mother and child
in the world. So again on a public health basis
like worldwide, giving it a day zero absolutely makes sense,
right and you know Vietnam is where the major studies
(41:52):
and hepatizes be event we've cut down on liver cancer
in a single generation. Hepatitizes be over time puts you
a high risk liver cancer. We've been able to cut
down on that significantly, like eighty ninety percent of from
a previous generation because I have P vaccine. So on
the other hand, most of my families, the reason they
(42:15):
say no is they're like, oh, this mayby's so tiny.
I'm so worried about them getting a shot. And then
they come to my office because and they also don't
trust the hospital system, but they've already decided they trust me,
so they'll just get it a few days later. And again,
I don't you know, these patients, the likelihood that they
got hepatized B and either test the negative for or
(42:35):
got it in between the time they got tested and
the time they delivered is so low that it's not
when I put a ton of energy in fighting.
Speaker 1 (42:43):
Last question, did you get a flu shot this year?
Speaker 3 (42:47):
I got flu in covid. I gave my kids flu
in covid. I would get too. I like I love vaccines,
you know, I dream about like new vaccines for new things,
like you know, when the rs viva you gotta.
Speaker 1 (43:01):
I wish you wish you had the RSV vaccine.
Speaker 3 (43:03):
Yes, I think that if we didn't have the pandemic
and all the anti vaccine sort of sentiment after the pandemic,
they would have gone for universal RS to vaccine all
of us get RSB at least once a year, maybe twice.
Like I'd get a vaccine just to avoid two colts,
Like that'd be awesome. Like that's like, yeah, it's not
going to change whether I get hospitalized or die, like
it does for elderly patients and little kids. But like,
(43:25):
I don't love being sick, and vaccines are a really
cool way to avoid that.
Speaker 1 (43:35):
That is a great note to end on. Adam, Thank
you so much for being here. It was a delight
and I think that everyone will find it incredibly useful.
Speaker 3 (43:46):
Oh well, thanks for having It was super fun and
hopefully you can talk about a less controversial topic next time.
Speaker 1 (43:51):
Absolutely, next time we can do breastfeeding or starting solids,
something like good, something easy, awesome, best.
Speaker 2 (44:02):
Show to best shine.
Speaker 1 (44:16):
Parent Data is produced by Tamar Avishai with support from
the parent Data team and pir Rex. If you have
thoughts on this episode, please join the conversation on my
Instagram at prof Emily Oster, and if you want to
support the show, become a subscriber to the parent Data
Newsletter at parentdata dot org, where I write weekly posts
on everything to do with parents and data to help
(44:39):
you make better, more informed parenting decisions. For example, last month,
I wrote a beast of an article titled how can
you Know if Vaccines are Safe? Which addressed the top
concerns I hear from parents all the time about vaccine safety.
I look at, among other things, what's in the compounds,
why there are so many vaccines, and yes, the question
(45:00):
of vaccines and autism. It's the perfect companion to this
conversation with Adam, and I highly recommend you checking it
out at parent data dot org. There are a lot
of ways you can help people find out about us.
Leave a rating or a review on Apple podcasts, Text
your friend about something you learned from this episode. Debate
your mother in law about the merits of something parents
do now that is totally different from what she did.
(45:22):
Close the story to your Instagram, debunking a panic headline
of your own. Just remember to mention the podcast too.
Rite Penelope right, Mom, We'll see you next time.
Speaker 4 (45:34):
Come out quest shin
Speaker 3 (45:40):
Sh
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