Your Child is Normal: with Dr Jessica Hochman

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

• Dr Jessica Hochman • Season 1 • Episode 186

Share episode

Send us a text

In this episode of Your Child is Normal, Dr. Jessica Hochman speaks with integrative pediatrician Dr. Joel “Gator” Warsh about his brand-new book, Between a Shot and a Hard Place. They discuss vaccine decision-making in today’s polarized climate, the importance of listening to parents, and how to navigate thoughtful conversations rooted in care and trust.

Dr. Hochman also shares her own perspective as a pediatrician who strongly supports vaccines and believes in creating space for respectful questions and dialogue.

If you're a parent looking to make informed, confident choices about your child’s health—or simply curious about how to talk about vaccines with more nuance—this is a conversation for you.

🔗 Resources & Links:



Dr Jessica Hochman is a board certified pediatrician, mom to three children, and she is very passionate about the health and well being of children. Most of her educational videos are targeted towards general pediatric topics and presented in an easy to understand manner.

For more content from Dr Jessica Hochman:
Instagram: @AskDrJessica
YouTube channel: Ask Dr Jessica
Website: www.askdrjessicamd.com

-For a plant-based, USDA Organic certified vitamin supplement, check out : Llama Naturals Vitamin and use discount code: DRJESSICA20

-To test your child's microbiome and get recommendations, check out:
Tiny Health using code: DRJESSICA

Do you have a future topic you'd like Dr Jessica Hochman to discuss? Email Dr Jessica Hochman askdrjessicamd@gmail.com.

The information presented in Ask Dr Jessica is for general educational purposes only. She does not diagnose medical conditions or formulate treatment plans for specific individuals. If you have a concern about your child's health, be sure to call your child's health care provider.

Unknown:

Hi everybody, and welcome back to your child is normal. I'm your host and pediatrician, Dr Jessica Hochman, so today's episode is with Dr Joel Gator warsch. Dr Warsh is an integrated pediatrician, and he's the author of a brand new book out this week called between a shot and a hard place. In this book, he talks about vaccines in today's world, the importance of listening to families and what it means to make health decisions in an often polarized landscape. And before we jump in, I want to take a brief moment to share my own personal perspective. So as a pediatrician, I believe deeply in vaccines. They are one of the most important medical advancements that we have. They have saved countless lives and have prevented serious illness. Every day I give them in my own practice and I trust the science behind them, and at the same time, I also believe that thoughtful conversations and honest questions are essential. That's how we build trust, clear up confusion and grow both as healthcare providers and as parents. So my goal in this conversation is to stay grounded in science, open to nuance, and above all else, committed to helping families make informed, confident choices about their child's health. And if you're looking for more in depth discussions on vaccines from a scientific and public health perspective, I encourage you to check out episodes 180 and 181 of your child is normal, where I spoke to vaccine expert, Dr Paul Offit, those episodes are a great compliment today's conversation. Thank you so much for being here and for listening with an open mind. Dr Joel gidderwarsch, thank you so much for reaching out. I'm really looking forward to having this important conversation with you. Thank you for having me on I love chatting with you, so we've had you on the podcast before. It's always been wonderful conversations, and this time, I was appreciative that you reached out, because we're going to talk about vaccines. But in all honesty, I'm also always hesitant and slightly nervous to talk about vaccinations, because they become this hot topic and they become sort of taboo. So hopefully, my hope with this conversation is that we can make people feel more comfortable asking questions and also feel more comfortable in the space of vaccines. Yeah, I think it's so important. I mean, I just want to say, you know, for me, even as a doctor, I never really talked about vaccines until more recently, because it was just, unfortunately, just so controversial and and through the pandemic, and over the last couple of years, I have seen more and more parents want to talk about it, more and more questions. There's more and more hesitancy around vaccines. And I think the worst thing that we can do, and the problem that we're seeing, is that we just can't talk about it like things are taken down about vaccines. They're not talked about. That doesn't stop parents questions, and we're seeing the highest rates of hesitancy ever. The most kids that are unvaccinated, the most kids are not fully 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 are showing that that the trust in mainstream medicine is gone. I mean, you have a recommendation like the COVID vaccine for kids, and it's still on the schedule for six months and above, and yet, like, not even 10% of people are doing it, and that speaks to like, a huge disconnect between our establishments and what parents are doing. And that is a big concern to me as a patrician, because we can't pediatrician, because we can't trust our establishments. We can't trust the CDC, we can't trust what they're saying, or you feel like you can't that's a problem. I mean, that's going to run into a big issue later. And I'm not against vaccines at all. I think that's where we have to start. Like I'm not against them at all. I have had many vaccines in my life. Patients in my office get vaccines. I just think we need to have conversations. And that's why I wrote my recent book between a shot and a hard place, because I wanted to try to bridge the gap between what I feel like is two different worlds. And I don't have a goal of getting more people to vaccinate or people to not vaccinate. I want people to be able to talk about it. I want to be able to ask questions. I want to be able to come on a podcast with an MD and discuss the things that parents ask, and just talk about it, and not to say that we shouldn't do it, but, but people have questions we got to talk about. And I heard you talking to Paul offer, and I thought that was great. It was a great conversation. I have a ton of respect for Paul offer. I think he's one of the smartest people in medicine, and he certainly knows more about vaccines than anybody does, or certainly in the top few, but I think he has a very specific viewpoint on vaccines, and I don't think that he gets a lot of chance to talk to people that have other questions. And I think it's important that we kind of open up these discussions and conversations, and I hope that over time, people like Paul Offit will hear a little bit more of this. So that way we can push the research to start to answer some of these questions that parents have, not to get people not to vaccinate, just to say, like, Okay, this is what you're concerned about. Well, let's go get a study on that. Okay, well, here's what you're concerned about. Here's the research that shows that. Or, well, yeah, that makes a little sense. Like, maybe we can have a little bit of a nuance there. Maybe not everybody needs to do that. There's nothing wrong with with changes as we move forward. What's interesting to me is, when you look at the history of vaccines, there are vaccines where there have been questions about side effects and we've adjusted. You know, when you look at the history of the DTP vaccine, when you look at the history of the rotavirus vaccine, the initial vaccines aren't the vaccine. That we use today. I think because we were more open minded, do you feel like it's different now? I feel like it's very different. Now. I feel like vaccines have become this almost like God, like creature. It's like this thing that we worship, and we forgetting that it's just a product. It's a medical product. It has a purpose, and everything has risks and benefits, and have to weigh the pros and the cons for yourself and for society, and it's almost like the second you mentioned there's a problem with a vaccine, everybody takes a big guess, but back or or I think Mike had a reaction to a vaccine, and it's like, no, no, there's no way that could happen. And I don't know how we got here, but we certainly did. We cut to this point where we're putting vaccines on this, this pedestal. And it's not like we haven't had problems with vaccines in the past. So it's like you said, like we we were getting more polio from the polio vaccine than there were polio in America, like from the oral one. So we stopped using it. We use the inactivated polio. That makes sense. We were getting in a susception, bowel blockages from from rotavirus. So we pulled it off the market. We made a newer one, whooping cough vaccine. The original one was causing, allegedly, encephalitis and issues neurologically. So they pulled it and they made a better one. We don't have the best vaccines we're ever going to have for humanity, right? That doesn't make any sense. Like, we should always be trying to make them better. We should always be trying to make them safer, and we should be open to asking questions so that we can if there is an ingredient in the vaccines that say linked to asthma, like, why wouldn't we want to know that? And why wouldn't we want to minimize it, change it, make it better. There's no no doctor wants to make patients sick. They want to prevent disease. That's why they believe in vaccines. That's why we believe in vaccines. That's why we're taught about vaccines. But we live in a different world. There are so many vaccines now, and things are different. It's not like it was in 1980 or 1990 you know, before, where there were just a few vaccines, there are more and more vaccines, and parents have questions about that. And I think it's really interesting, something like Paul Fitz viewpoint, which you talked about on your podcast. And I've read, and I still, I just don't get this viewpoint. Like, have I talked to him? I would this is one of the things I'd really want to talk to him about, because I just don't understand his viewpoint. That you could just have 10,000 vaccines, or you could just get unlimited antigens. That just doesn't exactly make sense to me from an intellectual perspective. I know where they're coming from when they say, like, look, we're eating apple, and you're exposed to all sorts of bacteria and all sorts of things that makes sense, like you are. We're exposed to things all the time, but something that's in a vaccine is a synthetic product. It's not the same thing as something that's natural. Even for something that's natural, like bacteria, if it's on your skin, it's a good thing, but if it gets in the wrong place, it could cause significant disease, right? So if you're injecting something, it's going into a different location, it's not necessarily meant to be there. And there's a bunch of other chemicals and ingredients in a vaccine that certainly have some sort of upper limit at some point, right? I mean, you can't just, you can't just drink water forever, like everything has an upper limit. And so I think that that the argument that you could just have vaccines forever doesn't, doesn't make sense. Doesn't mean that the amount of vaccines we're having today is problematic. I'm just saying that brushing that off, brushing that off, brushing off parents concerns around more and more vaccines, I think is problematic, because I hear like, Well, okay, what if we get 50 more vaccines? What if we get 100 more vaccines? How many vaccines on one visit is too many? I think that's not an unreasonable question for a parent. So I totally agree that it's really important as doctors that we stay open and that we don't shut down questions. That's my personal opinion. But where I struggle is that I think when we welcome too many questions, I worry that it leads to too much confusion, and that's where I have that's where I struggle because I want to balance welcoming dialog, but I also don't want to fuel distrust of the current schedule. That makes sense. It does. I mean, it makes perfect sense, and I think that's a struggle that I hear, you know, Paul often talk about a lot, and other people like that is, you know, as soon as you start to talk about some of these questions, then people might become hesitant and they might not want to do it. But we also live in a different world. Now. There's social media and there's an internet and this information is getting out there, and people are asking questions. And I think shutting down conversation has the opposite effect, because then people start to think, well, they don't want to talk about it, then it must be causing a problem. They're hiding something. Yes. I mean, it's it is true that in this day and age, there are conspiracy theories left and right, left and right. Yes. And I think the solution to these things, the solution to conspiracy theories, the solution to hesitancy, is understanding that hesitancy and providing the information and the data and the research that parents want. You definitely don't have research that follows people forward for a long time. We don't have vaccinated versus unvaccinated trials. We don't have long term research for really any of these vaccines. And we certainly don't have research on all the vaccines together, the schedule, how that affects people, how different kinds of schedules can affect reactions. And I don't think it's an unreasonable question to say something like, Well, if you get four vaccines on a day, what if you only got two? Would that decrease your risk of things? Would we see lower risks of certain conditions if we did things in a different way? Many countries do things in different ways. We're not the only way to do vaccines. And there are countries that don't start vaccinating till three months. There are countries that do MMR at two years old. There are countries that don't do some of the vaccines, or don't recommend them. I mean, it's very arrogant, I think, in America, to think that we are the only way and the best way, and the way that we're doing it is the only possible way that it could be, and I'm not saying we don't have the best way. Maybe we do, but I think these are the questions, again, that parents have, and I don't think that they're unreasonable to have discussions. I think the smart doctors who love vaccines and who understand the background and the research need to get up there and have these conversations with hesitant parents and have these discussions in the open, so that way they can answer people's questions, and that way whatever we don't actually have research for, we can work towards getting more of that research. I think that will go a long way to helping parents. And I don't think that people are just gonna stop vaccinating just because we start asking questions or talking about it. Things have risks. Just because you know that there are risks from a vaccine or more risks than we know of today, doesn't mean you're not going to do it. The question is, what are the risks versus what are the benefits? And I think we have a very good understanding of the benefits. I think we understand we understand the diseases, we understand what the vaccines do, how effective they can be, we understand the short term risks. I don't think we really understand the long term risks from vaccines very well, because we don't have that research and data, and I think that's a big missing piece of the question that parents have. And I think that the frame of reference for doctors is very different than for parents. Doctors. We worked in the ICU, we've seen people die from some of these diseases. We've seen kids with RSV, we've seen kids with bad pneumonia. We've seen measles cause kids to die like we've seen these things where parents haven't parents haven't. Parents see autism, autoimmune conditions, allergies, asthma, ADHD, that's what they see every single day. And they wonder, Do vaccines have something to do with that? That is the disconnect between doctors and parents. We're seeing different things. We're worried about different things. I think I agree with the idea that if parents ask these questions, and they're reasonable questions, and we, if they perceive us to be shutting down those questions, I can see how that will lead to people looking elsewhere. And then, if they look elsewhere and they're not talking to their doctors, I know what they're going to find on the internet, and then they're going to go down a path where they're not going to feel comfortable giving their kids vaccines. So I totally agree with the idea that we need to stay open minded and be open to nuance and having conversations. But that being said, in my day to day life, I give vaccines every day, all day, to kids that stay on the schedule. And I don't see it being a problem, to be honest. You know, I have, I had kids have side effects to vaccines, yes, but it's more like, you know, maybe a fever the next day, or a welt on the arm from the flu shot, or from the fourth DTP shot. And I think, in my personal opinion, I think they're getting overly blamed for the chronic disease that we're seeing. From my perspective, I think there are other things that are causing these chronic illnesses with kids, and that may be. I think that's a completely reasonable statement. I think it is. But I think that because we can't talk about vaccines, people blame it on vaccines, and they start to assume that it is that I would agree, at least in the short term. I've never once seen any sort of super serious reaction from a vaccine, not in not in the years that I've worked. And I agree, because it's just with my own eyes. I mean, obviously everyone's, you know, they have their own anecdotes, but, but I haven't seen any super serious reactions short term that people are scared of. Do I think it happens sometimes? Yeah, I do. I think that happens with everything. So I think that's certainly possible. My biggest questions, and I think the biggest questions that parents have, are around the long term complications and how we would even know if, if they are related things like asthma, allergies, autoimmune conditions. You know, there certainly is some research out there. I mean, I've read Paul off, it's books. They're great. So my favorite Main Street books. And you know, you look in there and you read the like asthma allergies section, it says, No, it's not related. But then there are plenty of other studies out there that are in reasonable journals, big scale studies that show maybe they do have something to do with it on some of these occasions. So I I think that you have kind of two worlds of information that never talk to each other. And I think that's a travesty, because you have people that are like so pro vaccine, that they are not open that they could ever cause a problem long term. You have people that are so anti Vax that they're never open to the fact that, you know, it just could be other things. And I think all these things are super complicated, and they're very multifactorial, and there are many things going on. It's certainly not vaccines like I mean, I've seen kids with all these things that have never had a vaccine, and it's way too simple to say it's one thing. I think that's doesn't make any sense to me. One thing that you said earlier, that I would quibble with is the length of time that vaccines have been out. I know that some vaccines have been out for short term. So for example, the COVID 19 vaccine, the RSV shot that we're now giving, the nirsevimab. But for example, the MMR vaccine that's been out since, I think it started being given widely in the United States since 1971 and it's interesting to me, because we've been giving it to millions of people, and they're really the best, robust studies that have been done on the MMR. Vaccine, don't show it linking to anything concerning. And now, and now we're seeing measles outbreak. So I worry that if we have too many questions, we're going to start seeing outbreaks of illnesses that we haven't been seeing in years and years. I completely agree. Number one, I don't know if I said it wrong, but I mean, for like, something like the measles vaccine, it's definitely been out for a long time. I'm talking about following it forward for a long time in terms of research. So most of the studies that are pre 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 to follow it for four or five years. You would need to follow it for a long time to look into some of those, those connections. 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, but those are, you know, mostly self report, or you'd have to link that to it. So let's say, for example, hepatitis B vaccine caused, I don't know, thyroid cancer in 10 years from now. Let's just say there would be no way to report that link. The only way to link those things would be to follow people forward and over 1020, years, you're like, Wait, how come all the kids that are getting this vaccine have have more of this? I mean, obviously that's hard to do. It's not easy, right? These are difficult questions, but, but this is what I think some parents are talking about when they're saying it's never been, ever been done. And when you're adding more and more vaccines, then it adds to the concerns of parents that maybe there are some of these long term complications that we're seeing more and more of, that maybe they're linked them, and I'm not saying that they are. I'm just saying that's where the parents are coming from. And without that kind of research, you don't really, you don't really know, I agree with you in principle, that we need to have well done studies, especially when we're making recommendations that require interventions on human beings. But I, in all honesty, I think that would be really hard to do. I think taking a group of kids and not vaccinating them that also poses a risk, doesn't it? Well, yeah, but you'd have to take kids where their families are choosing not to vaccinate. There's obviously a lot of ethics around these studies, so it'd make it really tough. You couldn't do a double blind control trial because control trial, because ethically, you couldn't not give kids vaccines. So you wouldn't be able to ever get the best kind of study possible. The real thing is question marks around pre trial, pre licensure. We don't have those things. It was never done. Now, you're not gonna be able to go back and do that exactly, but you could do an open label trial where people choose, and you could follow them forward, and they can choose what they do. And if people are going to choose not to vaccinate, they could still, at least be studied. It's not perfect, 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 and more vaccines, we have more and more concerns. And at least what parents hear I feel, is they feel like profits are prioritized over safety. And I think if the medical establishment said, Look, we don't think these things are happening, but here's what we're going to do, we're going to we're going to invest in the CDC, we're going to invest in the NIH, and we're going to look into, how can we improve them, how can make them better? How can make them safer? Because right now, why would a vaccine company make them better. Why would they study safety? They have no reason to do that. Once a vaccine gets onto the market, you can't sue them. You sue the government. So they don't have any reasons to make them better. They have every reason to just say they're perfectly safe. We as a society, we as doctors, I think, have to say, let's keep check checks and balances on these pharmaceutical companies. We need to make sure that we watch over these vaccines, make sure that they're safe, make sure that they're doing what they're supposed to be doing, see if we can make a better version, see if we can minimize any risks or side effects. I think that's what we need to be doing. And I don't think people feel like we are, even if we feel like we are, and I don't think that would be unreasonable as an establishment to say we believe in vaccines, we believe that they work. We don't believe they're causing these more, these side effects that you're talking about. But here are the research studies that we're going to undertake to look into these questions. And if we do find anything, We'll reevaluate it as we find it. But there is no system to look into long term complications, and that's not from me. I mean, there was a New England Journal medicine article recently that talked about it. Even I've heard many people in the mainstream medicine now talk about how there's not a good safety system. They're talking about redoing theirs, making a better system to catch things we have aI now. So there are better ways and uses of technology where we can look and try to find these signals to make things safer, and that's it. Why would we not want them to be safer? Maybe we have the best vaccines ever, but we probably don't, and we can probably make them better. Why not? I think what, I think, what's probably true, this is, what I've learned, is that if there were to be a side effect from a vaccine, it would usually be apparent within the first one, two days of administering that vaccination. How do you know that? How many medicines do we give that you can have a long term side effect years later, cancer, drugs, steroids, like all sorts of things that that you get, especially when you're talking about cumulative effect, it's not just one. What if you were giving 30 vaccines, 40 vaccines, over and over again, chemicals in there. So how do you know that there isn't a long term effect on some portion of the. Population. I'm not saying that we do, again, not saying that we do. I'm just saying we were taught that. But how do we know that's right? I mean, I think that's a fair point. I think it'd be I think, I think, to me, the big question always is, with vaccinations, do the benefits outweigh the risks and and I, and I believe that to be true, that for the vaccines that we're offering to families, that the benefits outweigh any small potential risk, correct? Do you agree with that? I mean, that is way that I look at it. And based on the information that we have, the benefits outweigh the risks. But the questions that parents have are, what if we don't know the risks? I don't know like, I think it's easier for someone like measles, where we've seen and it's super contagious and and, you know, can cause serious side effects. I think that's one thing. But what about things like polio that we haven't seen in 40 years? What about things like Hepatitis B, where we give it to newborn baby? I mean, you talked about it with with Paul Offit, about hepatitis B the risks versus benefits on that first day vaccine? I think that's a reasonable question to ask. Yes, I understand from a public health perspective, why we're doing it, and yes, we've dropped the Hepatitis B rates significantly. But what if that causes some long term complications in some kids? And we could just say, Well, you know, we want to protect against hep B, but we'll do it at two years old. I also agree that if a mother comes to my practice and she's been screened and she's negative for hepatitis B, and she asked, Can she wait a little bit? I don't have an issue with that, because the likelihood of that baby contracting Hepatitis B is near zero, right? And so then the question is, okay, what are your risks? And if your risk of it contributing to autoimmune conditions is one in 100,000 it's not like it can't happen. We know it's associated with Guillain Barre. We know these are associated with encephalitis, febrile seizures. I mean, vaccines cause issues in a small percentage of kids, very small, but we know it. But what if it also causes a small percentage of asthma and ADHD and autoimmune rheumatoid arthritis? What if each one of those is small, but you add them all up, and that small risk isn't zero, maybe it's one in 100,000 or one in 50,000 or whatever the number is. I mean, most kids do fine, right? But what if that's the number? And what if we recognize that and we say, well, okay, we don't want one in 10,000 kids to get asthma. We can decrease that risk to make it one in 100,000 by moving the hepatitis B vaccine to start at two months old. I don't know. I'm just saying. These are questions that I don't think are unreasonable for us as healthcare providers to ask, because our goal at the end of the day is healthy kids. We want the healthiest kids. Want to prevent disease. And that's not just infections, it's not just infections, it's also chronic disease. And we have a chronic disease epidemic, and we don't know why, and so we shouldn't be blaming it on vaccines, but we also shouldn't have vaccines not be part of the conversation, because if there is a portion of it that has to do with it, we should know that if it has to do nothing with that great it could be to do with pest do with pesticides. It could be to do with food. It could be, I agree with what you're saying, like I appreciate nuance. I love asking questions. I think the more we study, the better I agree with, you know, non pharmaceutical studies, if we can, if we can help it. I love the idea of long term studies. I love the idea of making VAERS easier, making it more easy for parents to report potential vaccine side effects. But I do feel, and I always struggle with this, because I wonder why vaccines feel like a different category to me, and I think it's because if too many people have questions and too many people opt out, then we're going to see diseases like measles return, which is a highly contagious illness, and I worry that if we make vaccines too individualized, that it might unintentionally confuse families, it might undermine public trust, and that might make a lot of these illnesses return, because we need enough people to opt into vaccines to keep these diseases from coming back. I get it and look, that point is correct. 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 question mark to me is, but can't we still have the discussion to make vaccines better? Because if people don't think that vaccines work, then that's going to happen. That is what's happening. I have to say, from my thought when it comes to the discussion of chronic disease, I think we are overly emphasizing vaccinations as the issue. I think a much greater issue is, what are we eating? How are we living? Are we moving our bodies the toxins in our environment, the quality of food, the over consumption of food, the obesity epidemic. And I think those issues, I think, are harder for people. They're harder for us to make changes. And I think it's easier to look to a vaccine and and point to vaccinations as potential explanations for chronic disease. And to your point, I know we'll never, at this point, we can't say with 100% certainty, but my sense is that those other issues are more of the risk factors. Maybe I think that, but that's the question. Well, what is it right? Like, I think that's the question, and that's the only question that I have in my mind. Like, what is going on? Why are chronic disease rates skyrocketing? What are we doing? And it's not good enough for our kids just to say, I don't know. Like, we should be researching this, and it's not about vaccines, but I just think we need to stop having this. Be taboo. It's a medical product prevents disease. That's great. Medical Products also have side effects. We should be able to talk about it if people have concerns. We should get more research. We we should also understand that as we get more and more vaccines, there's more potential for problems, and so we need to really make sure that our manufacturers are making things in the best possible way, but maybe we do need placebo controlled trials for some of these things. I mean, all the studies for vaccines, for the regular schedule, they were placebo controlled trial, but they weren't inert. Placebo controlled trial. They weren't studied against salt water. They were studied against other vaccines. So maybe if we have a new vaccine, then we require it to be inert, placebo controlled trial. Maybe we require them to study for safety for, you know, one year, and then they have to follow people for five years after. I don't know. I mean, I don't make this, I don't make the rules, but I think that it's not unreasonable to require a little bit more. Again, I go back to, I think if we acknowledge people's concerns and that we understand that people are have these worries, and we're taking these steps to try to do these these studies and these research, and here's what's going on, and here's what the doctors are doing that's going to make a lot of people feel better. Everyone understands that something could have a side effect, but they want to know that you are thinking about that, as opposed to just paying a pharmaceutical company for a product and letting a pharmaceutical have no no liability. And people, I hear that all the time, they just think that it's that doctors are just doing vaccines because they want to make money. I'm like, Are you kidding me? Like, it's like, one of the hardest things to do, you barely make anybody. You should make somebody. If you're doing vaccines, it's so much work. But you probably, you know, if you never had do a vaccine again, your life would be way easier as a doctor. And most doctors are salaried, so most doctors don't make any money when they get vaccines. I don't know what people are talking about. Doctors give vaccines because they believe in them, but I think that we also give vaccines because we're taught to believe in them, and we're not taught to question pharmaceutical companies and we we question them about everything else, but not vaccines. And I think it's a doctor's job to be the leaders in health, and to stand up for both sides, and to say we believe in vaccines, but we also believe in safety, and we're open to looking at everything without being so concerned that people are just going to stop vaccine. They're not they're not going to stop vaccinating. Vaccines are going nowhere. These diseases will come back if we stop vaccinating. But that doesn't mean we can't make them better. We could, and we can only make them better if we study them, and if we have an open mind that maybe they could be causing some problems. And I don't think we're there right now. I don't think most doctors think that they could be causing a problem. I don't think most people know what the research is, unless you read it yourself. And when I've gone through the research, there's so much on both sides. It's not just one sided. It's just that when you read something, it's only one sided, and you have to look at both sides. I think for myself, I want to use good data to convince parents, or not to convince I want to use good data to make parents feel like it's the right decision, because when you think about a vaccine, we're doing something to a kid. You know, we're making them feel uncomfortable. It's uncomfortable to get a shot. A lot, a lot of kids have anxiety over shots. And I want to, I want parents to have trust that it is the right thing to do. And I think where I struggled with COVID 19 was when it came to children, there really wasn't a lot of great data saying that it was going to keep kids out of the hospital, that it was going to prevent spread of the illness that it was going to keep them from 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 struggle with that, because it's still on the CDC schedule for children six months and older. And I think that's what pushed people back. That's what pushed people to ask these questions, right? Because I think a lot of parents said, Well, look, if this is what they're pushing on me with COVID, what about everything else? What about all the rest of the vaccines? Where is that data? And COVID especially, seemed like a very fear based narrative, and it still is. I mean, you ask the vast majority of people, most people don't like you would never know like you would never know that he was even on the kids schedule anymore. Almost nobody's doing it, and almost no other countries do it. Almost nobody else recommends it. So, you know, you can't just say that we'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 so much to me, honestly, is because, as you were saying before, I want people to trust us. I want them to trust our recommendations, and if we're the only country that's offering it starting at six months, and people compare the other schedules that are offered in other countries, and they don't see a difference in the health benefits to their children, then I think it's a very reasonable question to ask, why are we still doing it? Why are we still recommending it? Right? That's exactly it, and not saying that we shouldn't do it, but at least that question should be well received. Very clear answers. It shouldn't be well because we said so, because we we feel like it has to be like, well, here's why we are doing it. Here is the reason. Here's evidence in that. And that is where we lost people in COVID. I think safe and effective, safe and effective. And it's like, no, no. You can't say something is safe without having long term information. You could say the. Benefits seem to outweigh the risks, based on what we know in the short term, we're recommending it because we feel like it lowers your risk of death, and from the research, we feel like it decreases your risk risk of severe disease. So we are recommending it. That is an honest answer. You can't Yes. And at the time, and I understand at the time, it was really scary, you know, the world was shut down, we were seeing really scary rates of elderly dying from COVID. So I understand that at that we were working with the best knowledge, but I think it's just tough. We went through several years where there was a lot of not full truths, and things like natural immunity not counting when it counts for everything else. And I think that pushed medicine so far back because people don't trust us anymore. And I again, go back to, I've listened to Paul talk so much, and, you know, he talks about, well, you know, I think if you don't have a very clear message, then you know, people don't know what to do. And I get that, and I know you mentioned it too. But I also think that if you lie to people and you lie consistently, then they start to not know what to trust. And I also I just don't think that you have to lie about those things. I don't think that you can't trust people to say, here is the information that we have. We recommend it based on this. We recommend you should do it. You don't have to tell them that it's going to prevent disease forever. 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 you don't know anything about long term, you just say you don't know that. You don't know anything. Long term, what we know it seems safe. There's a risk to everything. That's not going to stop people from doing it. Maybe some people, but that's also informed consent. Like some people choose not to do it because they don't feel like the benefits outweigh the risks. Then that is how we do everything. You don't have to force people to get a vaccine, especially a new one, right? Like we don't. We don't force people to do things in medicine. We inform them based on the best information, and we let them make decisions. And most people do get vaccines. I mean, you inform people and they get vaccines. Most people in my practice, they get vaccines. Most people in the country get vaccines. It's like 1% of kids that don't get vaccines. Most people do it. They absolutely do, but that number is shrinking. Can I ask you, why do you think doctors are so resistant to having these conversations. I think they're resistant one because we've been taught to trust vaccines so much. And I think that they're concerned that vaccines are people are just going to stop doing it, and they're going to give, I know, talking points to like anti Vaxxer individuals, or, I don't know what it is. I don't know why we're so afraid of it. Maybe it's censorship. I mean, for me, we're not talking about it. I was worried about talking about it. I was worried about talking about the standard of care, right? Because the standard of care is to give it, and you start talking about questions, and then you're creating hesitancy. And especially during the pandemic, there were concerns around kind of being shut down just for creating hesitancy. So I think there's that kind of messaging. But I think it's wrong. I think it's super wrong that doctors are not talking about this topic. I think we are literally creating the problem which we're trying to prevent. Trying to prevent. We are creating hesitancy by not talking about I think there would be a lot less hesitancy if we actually talked about it and we worked, we worked on focusing our attention back on pharmaceutical companies and making them make the best possible products, versus anti Vax, versus pro vaccine. It doesn't even make any sense. You're not anti vaccine because you have questions about vaccines. I do think there's a subset of human beings, and I'm not saying this is wrong. I have some of this in me myself, but if you feel too controlled, your instinct is not to go along with the program. Your instinct is to resist that control and ask questions. So I think if we, if we're perceived in the medical community as being too controlling, not welcoming questions. We're going to see some of that resistance. It's only human nature, and I think that's what's happening. The vast majority of doctors don't take people that don't go on the regular schedule anymore. They don't even want to have conversations. It seems like they have people coming all the time to office in tears because they got kicked out of their office because they had questions. I mean, I've seen patients that their older kid, you know, the older sibling vaccinated, but the younger one had a bad reaction, and then the doctor was forcing them to do it, and even they didn't want to, and they felt like their kid had a bad reaction, so they just wanted to go slow or wait. But I think 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 very simple example. You give a kid amoxicillin seven days later, eight days later, they have a bad rash. You're not even sure it's from amoxicillin, but you're like, alright, let's never give amoxicillin again. A kid has a vaccine, they have a seizure a week later. And you're like, that's not from the vaccine. It's a very crazy double standard with vaccines that we just assume that something doesn't happen from the vaccine, even though it could. I think some of it comes from the public health. It comes from a well intentioned place where, if not enough of us vaccinate, then we can't protect those that can't get vaccinated, you know, those that are immunocompromised. We should also be protecting the kids that have bad reactions, yes, but both right? Like, I agree with you. Like, I want to protect every kid, but also some kids could have bad reactions or be the more sensitive kids, and we should be figuring out who those kids are. And maybe those are the kids that should go slow. Maybe those are the kids that shouldn't do the regular schedule, but a slower schedule. Maybe we can look and do genetic testing and figure out maybe there's some certain genetics that kids have to make them more susceptible to getting a reaction from vaccines. I don't know there we. So much more technology now than we had 50 years ago. Like if we were open to the fact that it's possible to happen for some kids, or some kids are more sensitive, or some kids have a certain genetics, then we could probably make them better, and the better we can make it, and the safer we can make it, the more comfortable people are going to be to do it, I think. And I think we can. We can do that. We can move in that direction as a medical community, where we strongly believe in vaccines, but also strongly believe in making them safe and not strongly report that every kid's going to do perfectly with every vaccine forever. And we could try to figure out those, that subset of kids that we can protect, or maybe that's the kid that goes slower. I think where I struggle is I want to be, as we've mentioned. I want to be open to questions, but then the more and more people that put off vaccinating, the more and more people that don't do them. I don't ever want to feel like I'm contributing to a greater issue like that. To me is like the perfect question, right? I don't think it's a simple answer, because I think if you, if you just push everybody to get vaccines all the time, then you're still going to get hesitancy. People are going to go the other way, and you actually might be contributing to it. But also, if you are too hesitant about it, and you ask too many questions, then people might not do and you can bring back diseases. So I think if you are a pediatrician that accepts people that are willing to do other schedules, and those are the people that find you, so you end up having a bigger proportion, because there's such a shrinking proportion of doctors that do it, I don't think it's a seriously increasing percentage of the population. I mean, it's certainly growing. It was like 3.3% and that's like 3.6% not full so it's not a huge percentage, but it is. It is growing. I would say, in my practice, by far and away, people vaccinate. It's, it's what I notice more is the questions and the hesitancy, yeah, which is I get, and it's hard. I mean, it takes longer, right? It takes longer questions. People have a lot more questions. But that feels better. As a pediatrician, I want them to feel comfortable asking questions. And like you said, I think there is a big part of us that is worried that all these diseases are going to come back, and I don't know the I don't know the answer. I don't have a good answer for that. I don't have a good 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 discussions around 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's one little easy answer to the whole thing. But I do think that we were just trained to think in one way, and I think the world is moving a different way. And I think these questions are being asked whether we want we like it or not. So either doctors can get behind it and kind of take the reins on the research, I think, or other people are going to do it, and if other people do it, I think that it's not going to be done in the way that doctors want it to be done, and as nuanced as it could be. And I'm worried about that saddest thing to me, I often hear from families that don't speak to other family members because there are differing views about vaccinations. And to me, that is a great example of why, to your point, and to the point of this whole conversation, frankly, why we need to continue to have open conversations. Because if something like this is leading to a breakdown in family relations, that's not healthy. Vaccines are more taboo topic than drugs like so you do. You don't talk about it. You can't talk about it. You can't you couldn't talk about on social media. Your platforms get destroyed. You don't talk about it, you know. And even if you're wrong, even if you disagree with every single thing I said that doesn't matter, you're allowed to. People could talk about these things, and that is how we get to a better place. And if you completely disagree with something, then you give better information. That is how the world has always worked, and it works real well to get to a better place. That's what science is. Science, literally is asking questions, re asking questions, reevaluating somebody goes against the grain. You know, the world's flat until it's not opioids are not addictive until they are smoking doesn't cause lung cancer until it does. You know, bunch of people were crazy, crack lunatics, woo, woo, talking about all these things until they weren't. Yeah, hand, hand washing wasn't beneficial until not that long ago. Then they found it was. It's not that long ago. So not that long ago, you know? Yeah, it's, it is very true that we as physicians have to be really careful when we say the science is settled, right? It's not settled. We have a lot of research, and we have a lot more research to do. That is how science works. Can I ask you, before we wrap up, can I ask you a common question and concern that I hear from parents just sort of the elephant in the room when it comes to vaccines? Do you believe that vaccines cause autism? What are your thoughts on that conversation? I believe, after looking through the research, that we need to do more research. I believe that that we don't know whether they do or do not based on the research that we have. What do you think causes autism? I think it's a mixture of things. I think it's, you know, genetics, and I think it's a mixture of environmental toxins and multiple exposures. I don't know whether vaccines have anything to do with it or not. I don't know if it lights a fuse for some people, I don't know if it happens for some people, I don't know. I've never seen it. I've seen kids that have autism, that never had a vaccine. But I don't know if you've ever looked at the vaccine autism research, but when you do look at it, we talk about it being settled, and that's what we're. Taught. And I don't know why we're taught that. I really don't I think there is some really good research on MMR and some good research on thimerosal, but that's it. There isn't research on all vaccines. There are no studies on all vaccines and autism. Yeah, I thought when I was going to go do my book, I what I thought was there, because I never looked at it myself. I don't know, I was just, we were taught, like the vaccine science to settle, right? And I thought there was going to be a huge world of evidence on autism, and, you know, showing that it doesn't, vaccines don't cause autism. When you go look at the research, it's literally just on MMR, it's not on anything else. It's not on all vaccines. So I don't know how you could make that claim. You could just at least, what I think we can claim is nothing has shown that vaccines do cause autism. Yeah, I think, I think that there are multifactorial reasons why there's autism and why autism is on the rise. I think for sure, genetics is at play. Environmental hits may take a may play a role. Older parents may play a role. They show that older fathers play a role in increased rates of autism. I just think that when we say vaccines don't cause autism because the science is settled, that doesn't make a lot of sense to me. After looking at the research, I think that correct answer is we should get more research, but the best available scientific evidence has found no link between vaccines and autism. For example, there was a study done in 2019 a Danish study, and it followed over 650,000 children, and it showed no link. So we know that autism is complex, and it's important to keep researching 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 Mars Madsen study. Those are great studies, but it's MMR versus no MMR in kids that got the other vaccines. So that doesn't answer the question, Do vaccines cause autism? That gives you the answer in a group of vaccinated kids getting MMR versus not MMR doesn't seem to change your risk of autism. It's a different question that is a different that is a nuanced question. I and I definitely can see that point. So leading me to figuring out how to move forward. How do you think pediatricians can stay open minded to parent concerns without without fueling and validating the misinformation that's out there? I think the first step is that we start talking about it again. I think the 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 is a social media world, and it's getting drowned out by people that don't know the information and the data. And I think that we have to start talking about this stuff. We have to get rid of these taboos. We have to have conversations. We have to have open discussions and debates. We have to have debates with the other side of whatever conversation that we're having, we can't shy away from that anymore. I think that's going to be helpful to people we live in that world. And the point that's resonating with me is that this is happening anyways, even if doctors, if doctors don't stay open to these conversations, we're just going to continue to push people away. But how can we protect the individual choice and maintain the high level of vaccine participation that we need to prevent disease outbreaks. And maybe there's just no maybe there's no answer to that question. I think the answer that question is getting the research that people want. I think that's the answer. I think getting being open to getting more research and data without saying the science is settled, and even though that takes five or 10 years, and so be it. I mean, we start some studies now, and we look into things, and we get the research that we get, and if things are found that we don't like, then we open to making changes. And if we find the research that backs your opinion, then that's good data. I mean, that'll be in the front page of The New York Times. You do, you do a prospective vaccinated versus unvaccinated study, and the rates of autism are the same in both groups. That's going to be front page news. You look at Kaiser, and you get all the kids with the head vaccines versus no vaccines, and you look at the autism rates, then that will be front page news. That's never been done before. We have the VSD. We have all these we have all these ways to look at these things. We could do it. You know, have a master's in epidemiology. Like all these things are possible. Just takes time and money, time, money and patience, right? But if it's important to doctors and vaccines are important to us, then that's where I think we should put our time, money and patience, into getting better research and data, better that people want. All right? So if there's one final takeaway message you want to leave with families that are listening, what would it be? And also make sure and tell everybody where can they find your book. So I think the final message that I would want to say, well, first of all, thank you for talking about this. I think it's super important, and I know that people listening this are going to be really annoyed and mad at me, and that's fine. They're always really annoyed and mad at me. I'm not against vaccines at all, and never have been, and I won't be, but I think we should have conversations and talk, and I appreciate you doing it. I'm glad people are doing a bit more, but, but I think we need lots of these. And if you totally disagree with me, that's fine. You can send me a mean message. I'm used to it. And the book is called between a shot and a hard place, and you can get it on Amazon or everywhere that books are sold, or go to the shopbook.com Well, thank you so much. Genuinely appreciate talking to you. I appreciate. Appreciate having a nuanced conversation and and I agree with you. I hope that we continue to ask questions and have better and better research so that families feel comfortable that they're making the best, the best informed decision for the health of their child. Thank you. Thank you for listening, and I hope you enjoyed this week's episode of your child is normal. Also, if you could take a moment and leave a five star review, wherever it is you listen to podcasts, I would greatly appreciate it. It really makes a difference to help this podcast grow. You can also follow me on Instagram at ask Dr Jessica. See you next Monday. You.