Tag: Richard Pan

Who Should Write Your Child’s Medical Exemption for Vaccines?

Why would anyone go visit a new doctor just to get their child a medical exemption for vaccines?

A medical exemption should be for kids who can't be vaccinated, not just because you don't want your child to be vaccinated.
A medical exemption should be for kids who can’t be vaccinated, not just because you don’t want your child to be vaccinated.

Shouldn’t they just get the medical exemption from their regular pediatrician?

Who Should Write Your Child’s Medical Exemption for Vaccines?

As lawmakers in California debate passage of a new vaccine bill, SB276, which would put help stop doctors from writing fraudulent medical exemptions, we are learning more and more about what are thought to be fake MEs and the doctors who write them.

“The exemption practices of three doctors in the records have already come under investigation by California authorities, and many are on lists of “vaccine-flexible” pediatricians circulated online by anti-vaccine parents. Three exemptions were signed by a doctor in New Jersey, and a fourth by one in Florida.”

California’s vaccine battle: Here are the doctors behind Bay Area students’ medical exemptions

One of these doctors practices at an anti-aging clinic, so it doesn’t seem like they are the regular primary-care physicians for these kids getting exemptions.

“SB277 did not substantially change the granting of medical exemptions by physicians, which expected and anticipated that each child would be evaluated by a physician who regularly cared for that child and receiving the exemption applying the standard of care.

Instead, after passage of SB277, we witnessed physicians who advertised exemptions for cash on social media and the internet. Some parents posted that their child’s physician refused to grant their child a medical exemption, so they bought one from a distant physician.”

Richard Pan SB 276 Assembly Health Committee Testimony

And that’s why a state without non-medical exemptions continues to have schools with fewer than 50% of the kids vaccinated.

Doctors who think that they are “vaccine experts” are granting kids medical exemptions because they think that everything is a vaccine injury. Or that a family history of something that they think is a vaccine injury qualifies a child for a medical exemption.

“I’ll tell you what I do personally is I charge the same amount of money for a patient who I see for a medical exemption as I do for new patients coming in to me for a check up or a consultation. I don’t charge any more. In fact, my medical exemption appointments are actually two appointments. I don’t make any more money from medical exemption appointments as anything else.”

Bob Sears SB 276 Assembly Health Committee Testimony

Most of us don’t make any money from medical exemption appointments…

“And just to follow up – is there some other… back to the idea of a specialist in this. Could there be some other standard in which a specialist could do more of these?”

Chad Mayes SB 276 Assembly Health Committee Testimony

There are certainly situations in which a specialist will be the one writing the medical exemption.

Is your child getting chemotherapy for ALL? Then his oncologist might be the one to write the exemption.

Did your infant get immunoglobulin to treat Kawasaki disease? Then her cardiologist might write a temporary medical exemption for live vaccines.

Does your child have infantile spasms? Then his neurologist might write a temporary medical exemption for DTaP.

Why Are Medical Exemption Visits a Thing?

In most situations though, it would be your pediatrician who would write the exemption.

“When we passed SB 277, again as we mentioned, we didn’t really touch the medical exemption, but what our expectation was is that it’s going to be your child’s regular doctor who knows the child granting them… And what we’re seeing is that actually we have physicians… who are not really the primary care doctor.

I mean I find this idea of having medical exemption visits kind of intriguing because you shouldn’t really have medical exemption visits. Either you’re the doctor or you’re not. If you’re the doctor you should take care of them. You have that relationship and if they have an issue with vaccines, you write them the exemption.

That’s it. That’s what’s supposed to normally happen. People shouldn’t be going out finding other doctors for exemptions. If you happen to see a specialist, and they think you can’t get vaccinated safely, then they either submit the exemption or they tell your primary care doctor, by the way, that child should not get vaccinated, we should get an exemption. That’s how it should normally work.”

Richard Pan SB 276 Assembly Health Committee Testimony

Of course, medical exemptions to get vaccines are not very common though. If your pediatrician refuses to give your child a medical exemption, it is likely because they don’t need one.

It's amazing that they didn't know their child needed a medical exemption until they went to see Dr. Stoller...
It’s amazing that they didn’t know their child needed a medical exemption until they went to see Dr. Stoller

Remember, medical exemptions for vaccines should be for kids who can’t be vaccinated, not just because you’re scared or don’t want your child to be vaccinated.

More on Doctors Writing Medical Exemptions for Vaccines

Why Should Medical Exemptions Be Based on CDC Contraindications?

Getting a medical exemption for vaccines isn’t controversial.

Or at least it shouldn’t be.

Why Should Medical Exemptions Be Based on CDC Contraindications?

As many people know though, some people have been taking advantage of the fact that medical exemptions weren’t clearly defined in California’s vaccine law.

Who are the doctors handing out fake medical exemptions in California?
Who are the doctors handing out fake medical exemptions in California?

Are there just a few doctors taking advantage of the California law?

“But at 105 schools in the state, 10% or more of kindergartners had a medical exemption in the school year that ended last month, according to a Los Angeles Times analysis of state data.”

Pushback against immunization laws leaves some California schools vulnerable to outbreaks

Is 10% a lot?

In one recent report, Vaccination Coverage for Selected Vaccines, Exemption Rates, and Provisional Enrollment Among Children in Kindergarten — United States, 2016–17 School Year, the median rate of medical exemptions in the US was just 0.2%, with a range of <0.1 to 1.5%.

In West Virginia and Mississippi, states that don’t allow non-medical exemptions and where criteria for medical exemptions are fairly strict, the rates were 0.1 and 0.3% respectively.

And that’s about what you would expect, as there are very few true contraindications or precautions to getting vaccinated.

So yes, 10% is an awful lot and that’s a good sign that it is more than just a few doctors taking advantage of the law.

“If a child has a medical exemption to immunization, a physician licensed to practice medicine in New York State must certify that the immunization is detrimental to the child’s health. The medical exemption should specify which immunization is detrimental to the child’s health, provide information as to why the immunization is contraindicated based on current accepted medical practice, and specify the length of time the immunization is medically contraindicated, if known.”

Dear Colleague letter regarding guidelines for use of immunization exemptions

Why do most other states have so few medical exemptions?

Mostly because there are very few true medical reasons to skip or delay a child’s vaccines!

They include, but aren’t limited to, the contraindications and precautions listed in the package insert for each vaccine (the contraindications and warnings sections…) and by the Advisory Committee on Immunization Practices.

They don’t include many other things that are “incorrectly perceived as contraindications to vaccination,” such as things in the family medical history of the child, eczema (unless they are getting the smallpox vaccine), colic, sleep apnea, or being a picky eater.

Is everything a vaccine injury?
Is everything a vaccine injury?

It should be obvious.

Medical exemptions for vaccines should be based on CDC criteria because some folks think that everything is a vaccine injury.

More on Medical Exemptions