Ep 186: Between a Shot and a Hard Place: A Conversation with Dr. Joel “Gator” Warsh

Episode Transcript
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Unknown (00:00):
Hi everybody, and welcome back to your child is
normal. I'm your host andpediatrician, Dr Jessica
Hochman, so today's episode iswith Dr Joel Gator warsch. Dr
Warsh is an integratedpediatrician, and he's the
author of a brand new book outthis week called between a shot
and a hard place. In this book,he talks about vaccines in
today's world, the importance oflistening to families and what

(00:20):
it means to make healthdecisions in an often polarized
landscape. And before we jumpin, I want to take a brief
moment to share my own personalperspective. So as a
pediatrician, I believe deeplyin vaccines. They are one of the
most important medicaladvancements that we have. They
have saved countless lives andhave prevented serious illness.
Every day I give them in my ownpractice and I trust the science

(00:41):
behind them, and at the sametime, I also believe that
thoughtful conversations andhonest questions are essential.
That's how we build trust, clearup confusion and grow both as
healthcare providers and asparents. So my goal in this
conversation is to stay groundedin science, open to nuance, and
above all else, committed tohelping families make informed,
confident choices about theirchild's health. And if you're

(01:02):
looking for more in depthdiscussions on vaccines from a
scientific and public healthperspective, I encourage you to
check out episodes 180 and 181of your child is normal, where I
spoke to vaccine expert, Dr PaulOffit, those episodes are a
great compliment today'sconversation. Thank you so much
for being here and for listeningwith an open mind. Dr Joel
gidderwarsch, thank you so muchfor reaching out. I'm really

(01:24):
looking forward to having thisimportant conversation
with you. Thank you for havingme on I love chatting with you,
so we've had you on the podcastbefore. It's always been
wonderful conversations, andthis time, I was appreciative
that you reached out, becausewe're going to talk about
vaccines. But in all honesty,I'm also always hesitant and
slightly nervous to talk aboutvaccinations, because they
become this hot topic and theybecome sort of taboo. So

(01:46):
hopefully, my hope with thisconversation is that we can make
people feel more comfortableasking questions and also feel
more comfortable in the space ofvaccines.
Yeah, I think it's so important.
I mean, I just want to say, youknow, for me, even as a doctor,
I never really talked aboutvaccines until more recently,
because it was just,unfortunately, just so
controversial and and throughthe pandemic, and over the last

(02:08):
couple of years, I have seenmore and more parents want to
talk about it, more and morequestions. There's more and more
hesitancy around vaccines. And Ithink the worst thing that we
can do, and the problem thatwe're seeing, is that we just
can't talk about it like thingsare taken down about vaccines.
They're not talked about. Thatdoesn't stop parents questions,
and we're seeing the highestrates of hesitancy ever. The
most kids that are unvaccinated,the most kids are not fully

(02:30):
vaccinated. Before the pandemic,70 plus percent of people
thought favorably of healthcare,and now it's like 40% I mean,
big stats, big studies areshowing that that the trust in
mainstream medicine is gone. Imean, you have a recommendation
like the COVID vaccine for kids,and it's still on the schedule
for six months and above, andyet, like, not even 10% of

(02:51):
people are doing it, and thatspeaks to like, a huge
disconnect between ourestablishments and what parents
are doing. And that is a bigconcern to me as a patrician,
because we can't pediatrician,because we can't trust our
establishments. We can't trustthe CDC, we can't trust what
they're saying, or you feel likeyou can't that's a problem. I
mean, that's going to run into abig issue later. And I'm not
against vaccines at all. I thinkthat's where we have to start.

(03:13):
Like I'm not against them atall. I have had many vaccines in
my life. Patients in my officeget vaccines. I just think we
need to have conversations. Andthat's why I wrote my recent
book between a shot and a hardplace, because I wanted to try
to bridge the gap between what Ifeel like is two different
worlds. And I don't have a goalof getting more people to
vaccinate or people to notvaccinate. I want people to be

(03:33):
able to talk about it. I want tobe able to ask questions. I want
to be able to come on a podcastwith an MD and discuss the
things that parents ask, andjust talk about it, and not to
say that we shouldn't do it,but, but people have questions
we got to talk about. And Iheard you talking to Paul offer,
and I thought that was great. Itwas a great conversation. I have
a ton of respect for Paul offer.

(03:54):
I think he's one of the smartestpeople in medicine, and he
certainly knows more aboutvaccines than anybody does, or
certainly in the top few, but Ithink he has a very specific
viewpoint on vaccines, and Idon't think that he gets a lot
of chance to talk to people thathave other questions. And I
think it's important that wekind of open up these
discussions and conversations,and I hope that over time,

(04:18):
people like Paul Offit will heara little bit more of this. So
that way we can push theresearch to start to answer some
of these questions that parentshave, not to get people not to
vaccinate, just to say, like,Okay, this is what you're
concerned about. Well, let's goget a study on that. Okay, well,
here's what you're concernedabout. Here's the research that
shows that. Or, well, yeah, thatmakes a little sense. Like,
maybe we can have a little bitof a nuance there. Maybe not

(04:40):
everybody needs to do that.
There's nothing wrong with withchanges as we move forward.
What'sinteresting to me is, when you
look at the history of vaccines,there are vaccines where there
have been questions about sideeffects and we've adjusted. You
know, when you look at thehistory of the DTP vaccine, when
you look at the history of therotavirus vaccine, the initial
vaccines aren't the vaccine.
That we use today. I thinkbecause we were more open

(05:02):
minded, do you feel like it'sdifferent now?
I feel like it's very different.
Now. I feel like vaccines havebecome this almost like God,
like creature. It's like thisthing that we worship, and we
forgetting that it's just aproduct. It's a medical product.
It has a purpose, and everythinghas risks and benefits, and have
to weigh the pros and the consfor yourself and for society,
and it's almost like the secondyou mentioned there's a problem

(05:24):
with a vaccine, everybody takesa big guess, but back or or I
think Mike had a reaction to avaccine, and it's like, no, no,
there's no way that couldhappen. And I don't know how we
got here, but we certainly did.
We cut to this point where we'reputting vaccines on this, this
pedestal. And it's not like wehaven't had problems with
vaccines in the past. So it'slike you said, like we we were

(05:45):
getting more polio from thepolio vaccine than there were
polio in America, like from theoral one. So we stopped using
it. We use the inactivatedpolio. That makes sense. We were
getting in a susception, bowelblockages from from rotavirus.
So we pulled it off the market.
We made a newer one, whoopingcough vaccine. The original one
was causing, allegedly,encephalitis and issues
neurologically. So they pulledit and they made a better one.
We don't have the best vaccineswe're ever going to have for

(06:08):
humanity, right? That doesn'tmake any sense. Like, we should
always be trying to make thembetter. We should always be
trying to make them safer, andwe should be open to asking
questions so that we can ifthere is an ingredient in the
vaccines that say linked toasthma, like, why wouldn't we
want to know that? And whywouldn't we want to minimize it,
change it, make it better.
There's no no doctor wants tomake patients sick. They want to

(06:30):
prevent disease. That's why theybelieve in vaccines. That's why
we believe in vaccines. That'swhy we're taught about vaccines.
But we live in a differentworld. There are so many
vaccines now, and things aredifferent. It's not like it was
in 1980 or 1990 you know,before, where there were just a
few vaccines, there are more andmore vaccines, and parents have
questions about that. And Ithink it's really interesting,

(06:50):
something like Paul Fitzviewpoint, which you talked
about on your podcast. And I'veread, and I still, I just don't
get this viewpoint. Like, have Italked to him? I would this is
one of the things I'd reallywant to talk to him about,
because I just don't understandhis viewpoint. That you could
just have 10,000 vaccines, oryou could just get unlimited
antigens. That just doesn'texactly make sense to me from an
intellectual perspective. I knowwhere they're coming from when

(07:12):
they say, like, look, we'reeating apple, and you're exposed
to all sorts of bacteria and allsorts of things that makes
sense, like you are. We'reexposed to things all the time,
but something that's in avaccine is a synthetic product.
It's not the same thing assomething that's natural. Even
for something that's natural,like bacteria, if it's on your
skin, it's a good thing, but ifit gets in the wrong place, it
could cause significant disease,right? So if you're injecting

(07:33):
something, it's going into adifferent location, it's not
necessarily meant to be there.
And there's a bunch of otherchemicals and ingredients in a
vaccine that certainly have somesort of upper limit at some
point, right? I mean, you can'tjust, you can't just drink water
forever, like everything has anupper limit. And so I think that
that the argument that you couldjust have vaccines forever
doesn't, doesn't make sense.

(07:55):
Doesn't mean that the amount ofvaccines we're having today is
problematic. I'm just sayingthat brushing that off, brushing
that off, brushing off parentsconcerns around more and more
vaccines, I think isproblematic, because I hear
like, Well, okay, what if we get50 more vaccines? What if we get
100 more vaccines? How manyvaccines on one visit is too
many? I think that's not anunreasonable question for a
parent. SoI totally agree that it's really
important as doctors that westay open and that we don't shut

(08:17):
down questions. That's mypersonal opinion. But where I
struggle is that I think when wewelcome too many questions, I
worry that it leads to too muchconfusion, and that's where I
have that's where I strugglebecause I want to balance
welcoming dialog, but I alsodon't want to fuel distrust of
the current schedule. That makessense. It does. I mean, it makes

(08:38):
perfect sense, and I thinkthat's a struggle that I hear,
you know, Paul often talk abouta lot, and other people like
that is, you know, as soon asyou start to talk about some of
these questions, then peoplemight become hesitant and they
might not want to do it. But wealso live in a different world.
Now. There's social media andthere's an internet and this
information is getting outthere, and people are asking
questions. And I think shuttingdown conversation has the

(09:00):
opposite effect, because thenpeople start to think, well,
they don't want to talk aboutit, then it must be causing a
problem. They're hidingsomething.
Yes. I mean, it's it is truethat in this day and age, there
are conspiracy theories left andright, left and right. Yes.
And I think the solution tothese things, the solution to
conspiracy theories, thesolution to hesitancy, is
understanding that hesitancy andproviding the information and

(09:22):
the data and the research thatparents want. You definitely
don't have research that followspeople forward for a long time.
We don't have vaccinated versusunvaccinated trials. We don't
have long term research forreally any of these vaccines.
And we certainly don't haveresearch on all the vaccines
together, the schedule, how thataffects people, how different

(09:44):
kinds of schedules can affectreactions. And I don't think
it's an unreasonable question tosay something like, Well, if you
get four vaccines on a day, whatif you only got two? Would that
decrease your risk of things?
Would we see lower risks ofcertain conditions if we did
things in a different way? Manycountries do things in different
ways. We're not the only way todo vaccines. And there are
countries that don't startvaccinating till three months.

(10:05):
There are countries that do MMRat two years old. There are
countries that don't do some ofthe vaccines, or don't recommend
them. I mean, it's veryarrogant, I think, in America,
to think that we are the onlyway and the best way, and the
way that we're doing it is theonly possible way that it could
be, and I'm not saying we don'thave the best way. Maybe we do,
but I think these are thequestions, again, that parents
have, and I don't think thatthey're unreasonable to have

(10:26):
discussions. I think the smartdoctors who love vaccines and
who understand the backgroundand the research need to get up
there and have theseconversations with hesitant
parents and have thesediscussions in the open, so that
way they can answer people'squestions, and that way whatever
we don't actually have researchfor, we can work towards getting
more of that research. I thinkthat will go a long way to

(10:47):
helping parents. And I don'tthink that people are just gonna
stop vaccinating just because westart asking questions or
talking about it. Things haverisks. Just because you know
that there are risks from avaccine or more risks than we
know of today, doesn't meanyou're not going to do it. The
question is, what are the risksversus what are the benefits?
And I think we have a very goodunderstanding of the benefits. I
think we understand weunderstand the diseases, we

(11:08):
understand what the vaccines do,how effective they can be, we
understand the short term risks.
I don't think we reallyunderstand the long term risks
from vaccines very well, becausewe don't have that research and
data, and I think that's a bigmissing piece of the question
that parents have. And I thinkthat the frame of reference for
doctors is very different thanfor parents. Doctors. We worked

(11:31):
in the ICU, we've seen peopledie from some of these diseases.
We've seen kids with RSV, we'veseen kids with bad pneumonia.
We've seen measles cause kids todie like we've seen these things
where parents haven't parentshaven't. Parents see autism,
autoimmune conditions,allergies, asthma, ADHD, that's
what they see every single day.
And they wonder, Do vaccineshave something to do with that?
That is the disconnect betweendoctors and parents. We're

(11:52):
seeing different things. We'reworried about different things.
I thinkI agree with the idea that if
parents ask these questions, andthey're reasonable questions,
and we, if they perceive us tobe shutting down those
questions, I can see how thatwill lead to people looking
elsewhere. And then, if theylook elsewhere and they're not
talking to their doctors, I knowwhat they're going to find on

(12:13):
the internet, and then they'regoing to go down a path where
they're not going to feelcomfortable giving their kids
vaccines. So I totally agreewith the idea that we need to
stay open minded and be open tonuance and having conversations.
But that being said, in my dayto day life, I give vaccines
every day, all day, to kids thatstay on the schedule. And I

(12:33):
don't see it being a problem, tobe honest. You know, I have, I
had kids have side effects tovaccines, yes, but it's more
like, you know, maybe a feverthe next day, or a welt on the
arm from the flu shot, or fromthe fourth DTP shot. And I
think, in my personal opinion, Ithink they're getting overly
blamed for the chronic diseasethat we're seeing. From my
perspective, I think there areother things that are causing

(12:56):
these chronic illnesses withkids,
and that may be. I think that'sa completely reasonable
statement. I think it is. But Ithink that because we can't talk
about vaccines, people blame iton vaccines, and they start to
assume that it is that I wouldagree, at least in the short
term. I've never once seen anysort of super serious reaction
from a vaccine, not in not inthe years that I've worked. And

(13:18):
I agree, because it's just withmy own eyes. I mean, obviously
everyone's, you know, they havetheir own anecdotes, but, but I
haven't seen any super seriousreactions short term that people
are scared of. Do I think ithappens sometimes? Yeah, I do. I
think that happens witheverything. So I think that's
certainly possible. My biggestquestions, and I think the
biggest questions that parentshave, are around the long term
complications and how we wouldeven know if, if they are

(13:40):
related things like asthma,allergies, autoimmune
conditions. You know, therecertainly is some research out
there. I mean, I've read Pauloff, it's books. They're great.
So my favorite Main Streetbooks. And you know, you look in
there and you read the likeasthma allergies section, it
says, No, it's not related. Butthen there are plenty of other
studies out there that are inreasonable journals, big scale
studies that show maybe they dohave something to do with it on

(14:01):
some of these occasions. So I Ithink that you have kind of two
worlds of information that nevertalk to each other. And I think
that's a travesty, because youhave people that are like so pro
vaccine, that they are not openthat they could ever cause a
problem long term. You havepeople that are so anti Vax that
they're never open to the factthat, you know, it just could be
other things. And I think allthese things are super

(14:21):
complicated, and they're verymultifactorial, and there are
many things going on. It'scertainly not vaccines like I
mean, I've seen kids with allthese things that have never had
a vaccine, and it's way toosimple to say it's one thing. I
think that's doesn't make anysense to me. One
thing that you said earlier,that I would quibble with is the
length of time that vaccineshave been out. I know that some
vaccines have been out for shortterm. So for example, the COVID

(14:42):
19 vaccine, the RSV shot thatwe're now giving, the
nirsevimab. But for example, theMMR vaccine that's been out
since, I think it started beinggiven widely in the United
States since 1971 and it'sinteresting to me, because we've
been giving it to millions ofpeople, and they're really the
best, robust studies that havebeen done on the MMR. Vaccine,
don't show it linking toanything concerning. And now,

(15:05):
and now we're seeing measlesoutbreak. So I worry that if we
have too many questions, we'regoing to start seeing outbreaks
of illnesses that we haven'tbeen seeing in years
and years. I completely agree.
Number one, I don't know if Isaid it wrong, but I mean, for
like, something like the measlesvaccine, it's definitely been
out for a long time. I'm talkingabout following it forward for a
long time in terms of research.

(15:25):
So most of the studies that arepre licensure or, you know,
maybe six months, maybe a year.
But to figure out if the MMR,let's say, had anything to do
with asthma, you would need tofollow it for four or five
years. You would need to followit for a long time to look into
some of those, thoseconnections. And we don't really
ever do that with our research.
We have, we have systems, right?
We have, like, we have the VSD,and we have, you know, VAERS,

(15:48):
but those are, you know, mostlyself report, or you'd have to
link that to it. So let's say,for example, hepatitis B vaccine
caused, I don't know, thyroidcancer in 10 years from now.
Let's just say there would be noway to report that link. The
only way to link those thingswould be to follow people
forward and over 1020, years,you're like, Wait, how come all
the kids that are getting thisvaccine have have more of this?

(16:09):
I mean, obviously that's hard todo. It's not easy, right? These
are difficult questions, but,but this is what I think some
parents are talking about whenthey're saying it's never been,
ever been done. And when you'readding more and more vaccines,
then it adds to the concerns ofparents that maybe there are
some of these long termcomplications that we're seeing
more and more of, that maybethey're linked them, and I'm not
saying that they are. I'm justsaying that's where the parents

(16:31):
are coming from. And withoutthat kind of research, you don't
really, you don't really know,I agree with you in principle,
that we need to have well donestudies, especially when we're
making recommendations thatrequire interventions on human
beings. But I, in all honesty, Ithink that would be really hard
to do. I think taking a group ofkids and not vaccinating them
that also poses a risk, doesn'tit? Well, yeah, but you'd have

(16:54):
to take kids where theirfamilies are choosing not to
vaccinate. There's obviously alot of ethics around these
studies, so it'd make it reallytough. You couldn't do a double
blind control trial becausecontrol trial, because
ethically, you couldn't not givekids vaccines. So you wouldn't
be able to ever get the bestkind of study possible. The real
thing is question marks aroundpre trial, pre licensure. We
don't have those things. It wasnever done. Now, you're not

(17:16):
gonna be able to go back and dothat exactly, but you could do
an open label trial where peoplechoose, and you could follow
them forward, and they canchoose what they do. And if
people are going to choose notto vaccinate, they could still,
at least be studied. It's notperfect, but it's it's something
you could do. And I think,again, I think it's important to
do it, because we have more andmore vaccines, we have more and
more concerns. And at least whatparents hear I feel, is they

(17:37):
feel like profits areprioritized over safety. And I
think if the medicalestablishment said, Look, we
don't think these things arehappening, but here's what we're
going to do, we're going towe're going to invest in the
CDC, we're going to invest inthe NIH, and we're going to look
into, how can we improve them,how can make them better? How
can make them safer? Becauseright now, why would a vaccine

(18:00):
company make them better. Whywould they study safety? They
have no reason to do that. Oncea vaccine gets onto the market,
you can't sue them. You sue thegovernment. So they don't have
any reasons to make them better.
They have every reason to justsay they're perfectly safe. We
as a society, we as doctors, Ithink, have to say, let's keep
check checks and balances onthese pharmaceutical companies.

(18:20):
We need to make sure that wewatch over these vaccines, make
sure that they're safe, makesure that they're doing what
they're supposed to be doing,see if we can make a better
version, see if we can minimizeany risks or side effects. I
think that's what we need to bedoing. And I don't think people
feel like we are, even if wefeel like we are, and I don't
think that would be unreasonableas an establishment to say we
believe in vaccines, we believethat they work. We don't believe

(18:42):
they're causing these more,these side effects that you're
talking about. But here are theresearch studies that we're
going to undertake to look intothese questions. And if we do
find anything, We'll reevaluateit as we find it. But there is
no system to look into long termcomplications, and that's not
from me. I mean, there was a NewEngland Journal medicine article
recently that talked about it.

(19:03):
Even I've heard many people inthe mainstream medicine now talk
about how there's not a goodsafety system. They're talking
about redoing theirs, making abetter system to catch things we
have aI now. So there are betterways and uses of technology
where we can look and try tofind these signals to make
things safer, and that's it. Whywould we not want them to be
safer? Maybe we have the bestvaccines ever, but we probably

(19:24):
don't, and we can probably makethem better. Why not?
I think what, I think, what'sprobably true, this is, what
I've learned, is that if therewere to be a side effect from a
vaccine, it would usually beapparent within the first one,
two days of administering thatvaccination.
How do you know that? How manymedicines do we give that you
can have a long term side effectyears later, cancer, drugs,

(19:45):
steroids, like all sorts ofthings that that you get,
especially when you're talkingabout cumulative effect, it's
not just one. What if you weregiving 30 vaccines, 40 vaccines,
over and over again, chemicalsin there. So how do you know
that there isn't a long termeffect on some portion of the.
Population. I'm not saying thatwe do, again, not saying that we
do. I'm just saying we weretaught that. But how do we know
that's right?

(20:06):
I mean, I think that's a fairpoint. I think it'd be I think,
I think, to me, the big questionalways is, with vaccinations, do
the benefits outweigh the risksand and I, and I believe that to
be true, that for the vaccinesthat we're offering to families,
that the benefits outweigh anysmall potential risk,
correct? Do you agree with that?
I mean, that is way that I lookat it. And based on the

(20:27):
information that we have, thebenefits outweigh the risks. But
the questions that parents haveare, what if we don't know the
risks? I don't know like, Ithink it's easier for someone
like measles, where we've seenand it's super contagious and
and, you know, can cause seriousside effects. I think that's one
thing. But what about thingslike polio that we haven't seen
in 40 years? What about thingslike Hepatitis B, where we give
it to newborn baby? I mean, youtalked about it with with Paul

(20:48):
Offit, about hepatitis B therisks versus benefits on that
first day vaccine? I thinkthat's a reasonable question to
ask. Yes, I understand from apublic health perspective, why
we're doing it, and yes, we'vedropped the Hepatitis B rates
significantly. But what if thatcauses some long term
complications in some kids? Andwe could just say, Well, you
know, we want to protect againsthep B, but we'll do it at two

(21:10):
years old. I also agree that ifa mother comes to my practice
and she's been screened andshe's negative for hepatitis B,
and she asked, Can she wait alittle bit? I don't have an
issue with that, because thelikelihood of that baby
contracting Hepatitis B is nearzero,
right? And so then the questionis, okay, what are your risks?
And if your risk of itcontributing to autoimmune
conditions is one in 100,000it's not like it can't happen.

(21:32):
We know it's associated withGuillain Barre. We know these
are associated withencephalitis, febrile seizures.
I mean, vaccines cause issues ina small percentage of kids, very
small, but we know it. But whatif it also causes a small
percentage of asthma and ADHDand autoimmune rheumatoid
arthritis? What if each one ofthose is small, but you add them
all up, and that small riskisn't zero, maybe it's one in

(21:53):
100,000 or one in 50,000 orwhatever the number is. I mean,
most kids do fine, right? Butwhat if that's the number? And
what if we recognize that and wesay, well, okay, we don't want
one in 10,000 kids to getasthma. We can decrease that
risk to make it one in 100,000by moving the hepatitis B
vaccine to start at two monthsold. I don't know. I'm just

(22:13):
saying. These are questions thatI don't think are unreasonable
for us as healthcare providersto ask, because our goal at the
end of the day is healthy kids.
We want the healthiest kids.
Want to prevent disease. Andthat's not just infections, it's
not just infections, it's alsochronic disease. And we have a
chronic disease epidemic, and wedon't know why, and so we
shouldn't be blaming it onvaccines, but we also shouldn't

(22:35):
have vaccines not be part of theconversation, because if there
is a portion of it that has todo with it, we should know that
if it has to do nothing withthat great it could be to do
with pest do with pesticides. Itcould be to do with food. It
could be, I agreewith what you're saying, like I
appreciate nuance. I love askingquestions. I think the more we
study, the better I agree with,you know, non pharmaceutical
studies, if we can, if we canhelp it. I love the idea of long

(22:56):
term studies. I love the idea ofmaking VAERS easier, making it
more easy for parents to reportpotential vaccine side effects.
But I do feel, and I alwaysstruggle with this, because I
wonder why vaccines feel like adifferent category to me, and I
think it's because if too manypeople have questions and too
many people opt out, then we'regoing to see diseases like

(23:16):
measles return, which is ahighly contagious illness, and I
worry that if we make vaccinestoo individualized, that it
might unintentionally confusefamilies, it might undermine
public trust, and that mightmake a lot of these illnesses
return, because we need enoughpeople to opt into vaccines to
keep these diseases from comingback.

(23:37):
I get it and look, that point iscorrect. I don't, I don't I
don't even think there's, like,even a question mark that point
is correct. I think the questionmark to me is, but can't we
still have the discussion tomake vaccines better? Because if
people don't think that vaccineswork, then that's going to
happen. That is what'shappening. I have to
say, from my thought when itcomes to the discussion of

(23:57):
chronic disease, I think we areoverly emphasizing vaccinations
as the issue. I think a muchgreater issue is, what are we
eating? How are we living? Arewe moving our bodies the toxins
in our environment, the qualityof food, the over consumption of
food, the obesity epidemic. AndI think those issues, I think,

(24:18):
are harder for people. They'reharder for us to make changes.
And I think it's easier to lookto a vaccine and and point to
vaccinations as potentialexplanations for chronic
disease. And to your point, Iknow we'll never, at this point,
we can't say with 100%certainty, but my sense is that
those other issues are more ofthe risk factors. Maybe
I think that, but that's thequestion. Well, what is it

(24:41):
right? Like, I think that's thequestion, and that's the only
question that I have in my mind.
Like, what is going on? Why arechronic disease rates
skyrocketing? What are we doing?
And it's not good enough for ourkids just to say, I don't know.
Like, we should be researchingthis, and it's not about
vaccines, but I just think weneed to stop having this. Be
taboo. It's a medical productprevents disease. That's great.

(25:04):
Medical Products also have sideeffects. We should be able to
talk about it if people haveconcerns. We should get more
research. We we should alsounderstand that as we get more
and more vaccines, there's morepotential for problems, and so
we need to really make sure thatour manufacturers are making
things in the best possible way,but maybe we do need placebo
controlled trials for some ofthese things. I mean, all the

(25:27):
studies for vaccines, for theregular schedule, they were
placebo controlled trial, butthey weren't inert. Placebo
controlled trial. They weren'tstudied against salt water. They
were studied against othervaccines. So maybe if we have a
new vaccine, then we require itto be inert, placebo controlled
trial. Maybe we require them tostudy for safety for, you know,
one year, and then they have tofollow people for five years

(25:47):
after. I don't know. I mean, Idon't make this, I don't make
the rules, but I think that it'snot unreasonable to require a
little bit more. Again, I goback to, I think if we
acknowledge people's concernsand that we understand that
people are have these worries,and we're taking these steps to
try to do these these studiesand these research, and here's

(26:08):
what's going on, and here's whatthe doctors are doing that's
going to make a lot of peoplefeel better. Everyone
understands that something couldhave a side effect, but they
want to know that you arethinking about that, as opposed
to just paying a pharmaceuticalcompany for a product and
letting a pharmaceutical have nono liability. And people, I hear
that all the time, they justthink that it's that doctors are
just doing vaccines because theywant to make money. I'm like,

(26:29):
Are you kidding me? Like, it'slike, one of the hardest things
to do, you barely make anybody.
You should make somebody. Ifyou're doing vaccines, it's so
much work. But you probably, youknow, if you never had do a
vaccine again, your life wouldbe way easier as a doctor. And
most doctors are salaried, somost doctors don't make any
money when they get vaccines. Idon't know what people are
talking about. Doctors givevaccines because they believe in
them, but I think that we alsogive vaccines because we're
taught to believe in them, andwe're not taught to question

(26:51):
pharmaceutical companies and wewe question them about
everything else, but notvaccines. And I think it's a
doctor's job to be the leadersin health, and to stand up for
both sides, and to say webelieve in vaccines, but we also
believe in safety, and we'reopen to looking at everything
without being so concerned thatpeople are just going to stop
vaccine. They're not they're notgoing to stop vaccinating.

(27:14):
Vaccines are going nowhere.
These diseases will come back ifwe stop vaccinating. But that
doesn't mean we can't make thembetter. We could, and we can
only make them better if westudy them, and if we have an
open mind that maybe they couldbe causing some problems. And I
don't think we're there rightnow. I don't think most doctors
think that they could be causinga problem. I don't think most
people know what the researchis, unless you read it yourself.

(27:36):
And when I've gone through theresearch, there's so much on
both sides. It's not just onesided. It's just that when you
read something, it's only onesided, and you have to look at
both sides. Ithink for myself, I want to use
good data to convince parents,or not to convince I want to use
good data to make parents feellike it's the right decision,
because when you think about avaccine, we're doing something

(27:58):
to a kid. You know, we're makingthem feel uncomfortable. It's
uncomfortable to get a shot. Alot, a lot of kids have anxiety
over shots. And I want to, Iwant parents to have trust that
it is the right thing to do. AndI think where I struggled with
COVID 19 was when it came tochildren, there really wasn't a
lot of great data saying that itwas going to keep kids out of
the hospital, that it was goingto prevent spread of the illness

(28:18):
that it was going to keep themfrom getting COVID. And so
that's that was hard for me,because I think it came down to
more feelings and politics,quite frankly, and less about
good data. And I still strugglewith that, because it's still on
the CDC schedule for childrensix months and older. And I
thinkthat's what pushed people back.
That's what pushed people to askthese questions, right? Because

(28:41):
I think a lot of parents said,Well, look, if this is what
they're pushing on me withCOVID, what about everything
else? What about all the rest ofthe vaccines? Where is that
data? And COVID especially,seemed like a very fear based
narrative, and it still is. Imean, you ask the vast majority
of people, most people don'tlike you would never know like
you would never know that he waseven on the kids schedule

(29:01):
anymore. Almost nobody's doingit, and almost no other
countries do it. Almost nobodyelse recommends it. So, you
know, you can't just say thatwe're the only ones that that
know something about health,like the rest of the world is
not doing it.
The reason why that matters somuch to me, honestly, is
because, as you were sayingbefore, I want people to trust
us. I want them to trust ourrecommendations, and if we're
the only country that's offeringit starting at six months, and

(29:23):
people compare the otherschedules that are offered in
other countries, and they don'tsee a difference in the health
benefits to their children, thenI think it's a very reasonable
question to ask, why are westill doing it? Why are we still
recommending it? Right? That'sexactly it, and not saying that
we shouldn't do it, but at leastthat question should be well
received. Very clearanswers. It shouldn't be well
because we said so, because wewe feel like it has to be like,

(29:44):
well, here's why we are doingit. Here is the reason. Here's
evidence in that. And that iswhere we lost people in COVID. I
think safe and effective, safeand effective. And it's like,
no, no. You can't say somethingis safe without having long term
information. You could say the.
Benefits seem to outweigh therisks, based on what we know in
the short term, we'rerecommending it because we feel

(30:05):
like it lowers your risk ofdeath, and from the research, we
feel like it decreases your riskrisk of severe disease. So we
are recommending it. That is anhonest answer. You can't
Yes. And at the time, and Iunderstand at the time, it was
really scary, you know, theworld was shut down, we were
seeing really scary rates ofelderly dying from COVID. So I
understand that at that we wereworking with the best knowledge,
but I think it'sjust tough. We went through

(30:25):
several years where there was alot of not full truths, and
things like natural immunity notcounting when it counts for
everything else. And I thinkthat pushed medicine so far back
because people don't trust usanymore. And I again, go back
to, I've listened to Paul talkso much, and, you know, he talks
about, well, you know, I thinkif you don't have a very clear

(30:46):
message, then you know, peopledon't know what to do. And I get
that, and I know you mentionedit too. But I also think that if
you lie to people and you lieconsistently, then they start to
not know what to trust. And Ialso I just don't think that you
have to lie about those things.
I don't think that you can'ttrust people to say, here is the
information that we have. Werecommend it based on this. We

(31:09):
recommend you should do it. Youdon't have to tell them that
it's going to prevent diseaseforever. When you don't think
that's going to actually happen,you don't have to tell them that
it's safe long term. When youdon't know anything about long
term, you just say you don'tknow that. You don't know
anything. Long term, what weknow it seems safe. There's a
risk to everything. That's notgoing to stop people from doing
it. Maybe some people, butthat's also informed consent.

(31:29):
Like some people choose not todo it because they don't feel
like the benefits outweigh therisks. Then that is how we do
everything. You don't have toforce people to get a vaccine,
especially a new one, right?
Like we don't. We don't forcepeople to do things in medicine.
We inform them based on the bestinformation, and we let them
make decisions. And most peopledo get vaccines. I mean, you
inform people and they getvaccines. Most people in my
practice, they get vaccines.

(31:50):
Most people in the country getvaccines. It's like 1% of kids
that don't get vaccines. Mostpeople do it. They absolutely
do, but that number isshrinking. Can
I ask you, why do you thinkdoctors are so resistant to
having these conversations.
I think they're resistant onebecause we've been taught to
trust vaccines so much. And Ithink that they're concerned
that vaccines are people arejust going to stop doing it, and

(32:11):
they're going to give, I know,talking points to like anti
Vaxxer individuals, or, I don'tknow what it is. I don't know
why we're so afraid of it. Maybeit's censorship. I mean, for me,
we're not talking about it. Iwas worried about talking about
it. I was worried about talkingabout the standard of care,
right? Because the standard ofcare is to give it, and you
start talking about questions,and then you're creating
hesitancy. And especially duringthe pandemic, there were
concerns around kind of beingshut down just for creating

(32:32):
hesitancy. So I think there'sthat kind of messaging. But I
think it's wrong. I think it'ssuper wrong that doctors are not
talking about this topic. Ithink we are literally creating
the problem which we're tryingto prevent. Trying to prevent.
We are creating hesitancy by nottalking about I think there
would be a lot less hesitancy ifwe actually talked about it and
we worked, we worked on focusingour attention back on
pharmaceutical companies andmaking them make the best

(32:55):
possible products, versus antiVax, versus pro vaccine. It
doesn't even make any sense.
You're not anti vaccine becauseyou have questions about
vaccines.
I do think there's a subset ofhuman beings, and I'm not saying
this is wrong. I have some ofthis in me myself, but if you
feel too controlled, yourinstinct is not to go along with
the program. Your instinct is toresist that control and ask

(33:15):
questions. So I think if we, ifwe're perceived in the medical
community as being toocontrolling, not welcoming
questions. We're going to seesome of that resistance. It's
only human nature,and I think that's what's
happening. The vast majority ofdoctors don't take people that
don't go on the regular scheduleanymore. They don't even want to
have conversations. It seemslike they have people coming all
the time to office in tearsbecause they got kicked out of
their office because they hadquestions. I mean, I've seen

(33:37):
patients that their older kid,you know, the older sibling
vaccinated, but the younger onehad a bad reaction, and then the
doctor was forcing them to doit, and even they didn't want
to, and they felt like their kidhad a bad reaction, so they just
wanted to go slow or wait. But Ithink the nuance is gone, I
think, from a lot of practices,and I think that's wrong, like
kids can have reactions. Think,think about amoxicillin. Just a

(34:00):
very simple example. You give akid amoxicillin seven days
later, eight days later, theyhave a bad rash. You're not even
sure it's from amoxicillin, butyou're like, alright, let's
never give amoxicillin again. Akid has a vaccine, they have a
seizure a week later. And you'relike, that's not from the
vaccine. It's a very crazydouble standard with vaccines
that we just assume thatsomething doesn't happen from
the vaccine, even though itcould. I think

(34:21):
some of it comes from the publichealth. It comes from a well
intentioned place where, if notenough of us vaccinate, then we
can't protect those that can'tget vaccinated, you know, those
that are immunocompromised. Weshould
also be protecting the kids thathave bad reactions, yes, but
both right? Like, I agree withyou. Like, I want to protect
every kid, but also some kidscould have bad reactions or be

(34:42):
the more sensitive kids, and weshould be figuring out who those
kids are. And maybe those arethe kids that should go slow.
Maybe those are the kids thatshouldn't do the regular
schedule, but a slower schedule.
Maybe we can look and do genetictesting and figure out maybe
there's some certain geneticsthat kids have to make them more
susceptible to getting areaction from vaccines. I don't
know there we. So much moretechnology now than we had 50
years ago. Like if we were opento the fact that it's possible

(35:03):
to happen for some kids, or somekids are more sensitive, or some
kids have a certain genetics,then we could probably make them
better, and the better we canmake it, and the safer we can
make it, the more comfortablepeople are going to be to do it,
I think. And I think we can. Wecan do that. We can move in that
direction as a medicalcommunity, where we strongly
believe in vaccines, but alsostrongly believe in making them

(35:24):
safe and not strongly reportthat every kid's going to do
perfectly with every vaccineforever. And we could try to
figure out those, that subset ofkids that we can protect, or
maybe that's the kid that goesslower. I think
where I struggle is I want tobe, as we've mentioned. I want
to be open to questions, butthen the more and more people
that put off vaccinating, themore and more people that don't
do them. I don't ever want tofeel like I'm contributing to a

(35:47):
greater issuelike that. To me is like the
perfect question, right? I don'tthink it's a simple answer,
because I think if you, if youjust push everybody to get
vaccines all the time, thenyou're still going to get
hesitancy. People are going togo the other way, and you
actually might be contributingto it. But also, if you are too
hesitant about it, and you asktoo many questions, then people
might not do and you can bringback diseases. So I think if you
are a pediatrician that acceptspeople that are willing to do

(36:08):
other schedules, and those arethe people that find you, so you
end up having a biggerproportion, because there's such
a shrinking proportion ofdoctors that do it, I don't
think it's a seriouslyincreasing percentage of the
population. I mean, it'scertainly growing. It was like
3.3% and that's like 3.6% notfull so it's not a huge
percentage, but it is. It isgrowing. I would
say, in my practice, by far andaway, people vaccinate. It's,

(36:30):
it's what I notice more is thequestions and the hesitancy,
yeah, which is Iget, and it's hard. I mean, it
takes longer, right? It takeslonger questions. People have a
lot more questions.
But that feels better. As apediatrician, I want them to
feel comfortable askingquestions. And
like you said, I think there isa big part of us that is worried
that all these diseases aregoing to come back, and I don't

(36:54):
know the I don't know theanswer. I don't have a good
answer for that. I don't have agood answer for the social
contract of protecting others,because I think that's a very
important part of vaccination,but it still doesn't mean that
we shouldn't have discussionsaround I don't know. I just
think both things can be true,and it's just not simple. I just
don't think it's like there'sone little easy answer to the
whole thing. But I do think thatwe were just trained to think in

(37:17):
one way, and I think the worldis moving a different way. And I
think these questions are beingasked whether we want we like it
or not. So either doctors canget behind it and kind of take
the reins on the research, Ithink, or other people are going
to do it, and if other people doit, I think that it's not going
to be done in the way thatdoctors want it to be done, and
as nuanced as it could be. AndI'm worried about that

(37:39):
saddest thing to me, I oftenhear from families that don't
speak to other family membersbecause there are differing
views about vaccinations. And tome, that is a great example of
why, to your point, and to thepoint of this whole
conversation, frankly, why weneed to continue to have open
conversations. Because ifsomething like this is leading
to a breakdown in familyrelations, that's not healthy.

(38:01):
Vaccines are more taboo topicthan drugs like so you do. You
don't talk about it. You can'ttalk about it. You can't you
couldn't talk about on socialmedia. Your platforms get
destroyed. You don't talk aboutit, you know. And even if you're
wrong, even if you disagree withevery single thing I said that
doesn't matter, you're allowedto. People could talk about
these things, and that is how weget to a better place. And if
you completely disagree withsomething, then you give better

(38:23):
information. That is how theworld has always worked, and it
works real well to get to abetter place. That's what
science is. Science, literallyis asking questions, re asking
questions, reevaluating somebodygoes against the grain. You
know, the world's flat untilit's not opioids are not
addictive until they are smokingdoesn't cause lung cancer until
it does. You know, bunch ofpeople were crazy, crack

(38:46):
lunatics, woo, woo, talkingabout all these things until
they weren't. Yeah,hand, hand washing wasn't
beneficial until not that longago. Then they found it was.
It's not that long ago. So notthat long ago, you know? Yeah,
it's, it is very true that we asphysicians have to be really
careful when we say the scienceis settled, right?
It's not settled. We have a lotof research, and we have a lot
more research to do. That is howscience works. Can

(39:08):
I ask you, before we wrap up,can I ask you a common question
and concern that I hear fromparents just sort of the
elephant in the room when itcomes to vaccines? Do you
believe that vaccines causeautism? What are your thoughts
on that conversation?
I believe, after looking throughthe research, that we need to do
more research. I believe thatthat we don't know whether they

(39:29):
do or do not based on theresearch that we
have. What do you think causesautism? I think it's a mixture
of things. I think it's, youknow, genetics, and I think it's
a mixture of environmentaltoxins and multiple exposures. I
don't know whether vaccines haveanything to do with it or not. I
don't know if it lights a fusefor some people, I don't know if
it happens for some people, Idon't know. I've never seen it.
I've seen kids that have autism,that never had a vaccine. But I

(39:54):
don't know if you've ever lookedat the vaccine autism research,
but when you do look at it, wetalk about it being settled, and
that's what we're. Taught. And Idon't know why we're taught
that. I really don't I thinkthere is some really good
research on MMR and some goodresearch on thimerosal, but
that's it. There isn't researchon all vaccines. There are no
studies on all vaccines andautism. Yeah, I thought when I

(40:15):
was going to go do my book, Iwhat I thought was there,
because I never looked at itmyself. I don't know, I was
just, we were taught, like thevaccine science to settle,
right? And I thought there wasgoing to be a huge world of
evidence on autism, and, youknow, showing that it doesn't,
vaccines don't cause autism.
When you go look at theresearch, it's literally just on
MMR, it's not on anything else.
It's not on all vaccines. So Idon't know how you could make

(40:37):
that claim. You could just atleast, what I think we can claim
is nothing has shown thatvaccines do cause autism.
Yeah, I think,I think that there are
multifactorial reasons whythere's autism and why autism is
on the rise. I think for sure,genetics is at play.
Environmental hits may take amay play a role. Older parents
may play a role. They show thatolder fathers play a role in

(41:00):
increased rates of autism.
I just think that when we sayvaccines don't cause autism
because the science is settled,that doesn't make a lot of sense
to me. After looking at theresearch, I think that correct
answer is we should get moreresearch, but
the best available scientificevidence has found no link
between vaccines and autism. Forexample, there was a study done

(41:20):
in 2019 a Danish study, and itfollowed over 650,000 children,
and it showed no link. So weknow that autism is complex, and
it's important to keepresearching its causes, but
based on what we know today,vaccines are not one of those
causes. Yeah,and that's a great study that
there's another one, the MarsMadsen study. Those are great
studies, but it's MMR versus noMMR in kids that got the other

(41:43):
vaccines. So that doesn't answerthe question, Do vaccines cause
autism? That gives you theanswer in a group of vaccinated
kids getting MMR versus not MMRdoesn't seem to change your risk
of autism. It's a differentquestion
that is a different that is anuanced question. I and I
definitely can see that point.
So leading me to figuring outhow to move forward. How do you
think pediatricians can stayopen minded to parent concerns

(42:06):
without without fueling andvalidating the misinformation
that's out there? I thinkthe first step is that we start
talking about it again. I thinkthe word can no longer be taboo.
You know, I think like we need,we need to lean into the real
world. And the real world now isa social media world, and it's
getting drowned out by peoplethat don't know the information

(42:27):
and the data. And I think thatwe have to start talking about
this stuff. We have to get ridof these taboos. We have to have
conversations. We have to haveopen discussions and debates. We
have to have debates with theother side of whatever
conversation that we're having,we can't shy away from that
anymore. I think that's going tobe helpful to people we live in
that world. And the pointthat's resonating with me is

(42:48):
that this is happening anyways,even if doctors, if doctors
don't stay open to theseconversations, we're just going
to continue to push people away.
But how can we protect theindividual choice and maintain
the high level of vaccineparticipation that we need to
prevent disease outbreaks. Andmaybe there's just no maybe
there's no answer to thatquestion.

(43:09):
I think the answer that questionis getting the research that
people want. I think that's theanswer. I think getting being
open to getting more researchand data without saying the
science is settled, and eventhough that takes five or 10
years, and so be it. I mean, westart some studies now, and we
look into things, and we get theresearch that we get, and if
things are found that we don'tlike, then we open to making
changes. And if we find theresearch that backs your

(43:32):
opinion, then that's good data.
I mean, that'll be in the frontpage of The New York Times. You
do, you do a prospectivevaccinated versus unvaccinated
study, and the rates of autismare the same in both groups.
That's going to be front pagenews. You look at Kaiser, and
you get all the kids with thehead vaccines versus no
vaccines, and you look at theautism rates, then that will be
front page news. That's neverbeen done before. We have the

(43:52):
VSD. We have all these we haveall these ways to look at these
things. We could do it. Youknow, have a master's in
epidemiology. Like all thesethings are possible. Just takes
time and money, time, money andpatience, right? But if it's
importantto doctors and vaccines are
important to us, then that'swhere I think we should put our
time, money and patience, intogetting better research and
data, better that people want.

(44:14):
All right? So if there's onefinal takeaway message you want
to leave with families that arelistening, what would it be? And
also make sure and telleverybody where can they find
your book. So I think the finalmessage that I would want to
say, well, first of all, thankyou for talking about this. I
think it's super important, andI know that people listening
this are going to be reallyannoyed and mad at me, and
that's fine. They're alwaysreally annoyed and mad at me.

(44:34):
I'm not against vaccines at all,and never have been, and I won't
be, but I think we should haveconversations and talk, and I
appreciate you doing it. I'mglad people are doing a bit
more, but, but I think we needlots of these. And if you
totally disagree with me, that'sfine. You can send me a mean
message. I'm used to it. And thebook is called between a shot
and a hard place, and you canget it on Amazon or everywhere
that books are sold, or go tothe shopbook.com Well,

(44:56):
thank you so much. Genuinelyappreciate talking to you. I
appreciate. Appreciate having anuanced conversation and and I
agree with you. I hope that wecontinue to ask questions and
have better and better researchso that families feel
comfortable that they're makingthe best, the best informed
decision for the health of theirchild. Thank you. Thank you for
listening, and I hope youenjoyed this week's episode of

(45:18):
your child is normal. Also, ifyou could take a moment and
leave a five star review,wherever it is you listen to
podcasts, I would greatlyappreciate it. It really makes a
difference to help this podcastgrow. You can also follow me on
Instagram at ask Dr Jessica. Seeyou next Monday. You.

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Ep 186: Between a Shot and a Hard Place: A Conversation with Dr. Joel “Gator” Warsh

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