Anthrax Vaccine -- posts by Meryl Nass, M.D.

This blog began in 2007, focusing on anthrax vaccine, and later expanded to other public health and political issues. The blog links to media reports, medical literature, official documents and other materials.

Tuesday, July 30, 2019

Doctors can use religious or philosophical exemptions for themselves, but patients should only be allowed medical exemptions to vaccination/ American Medical Association


It is truly amazing to witness the hypocrisy of the largest physician guild in the US.  Doctors have a Code of Medical Ethics that recommends vaccination in dire circumstances, but allows themselves to use philosophical or religious exemptions--and only "absent" an exemption must doctors be vaccinated. 

Yet the AMA House of Delegates passed a measure this year urging that only medical exemptions should excuse patients from being vaccinated.
"The AMA strongly supports efforts to eliminate nonmedical exemptions from immunization, and we will continue to actively urge policymakers to do so."
Yet doctors can avail themselves of philosophical and religious exemptions to vaccination:
Code of Medical Ethics Opinion 8.7
As professionals committed to promoting the welfare of individual patients and the health of the public and to safeguarding their own and their colleagues’ well-being, physicians have an ethical responsibility to take appropriate measures to prevent the spread of infectious disease in health care settings. Conscientious participation in routine infection control practices, such as hand washing and respiratory precautions, is a basic expectation of the profession. In some situations, however, routine infection control is not sufficient to protect the interests of patients, the public, and fellow health care workers.
In the context of a highly transmissible disease that poses significant medical risk for vulnerable patients or colleagues or threatens the availability of the health care workforce, particularly a disease that has potential to become epidemic or pandemic, and for which there is an available, safe, and effective vaccine, physicians should:
(a) Accept immunization absent a recognized medical, religious, or philosophic reason to not be immunized.
(b) Accept a decision of the medical staff leadership or health care institution, or other appropriate authority to adjust practice activities if not immunized (e.g., wear masks or refrain from direct patient care). It may be appropriate in some circumstances to inform patients about immunization status.
Meryl Nass, M.D. at 8:44 PM No comments:
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Wednesday, July 17, 2019

The Centers for Medicare and Medicaid "must empower patients to work with their doctors and make health care decisions that are best for them."

CMS.gov Centers for Medicare & Medicaid Services

"We’re putting patients first."

https://www.cms.gov/

"We pledge to put patients first in all of our programs – Medicaid, Medicare, and the Health Insurance Exchanges. To do this, we must empower patients to work with their doctors and make health care decisions that are best for them.  [Except when it comes to vaccines, apparently--Nass]

This means giving them meaningful information about quality and costs to be active health care consumers. It also includes supporting innovative approaches to improving quality, accessibility, and affordability, while finding the best ways to use innovative technology to support patient-centered care.

But we can’t and we don’t do all of this alone. Learn more about how we are working together to ensure all patients get the very best health care."
Meryl Nass, M.D. at 7:59 PM No comments:
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Saturday, July 13, 2019

AMA ties itself in knots because its own ethical code disputes its current position in favor of mandatory vaccinations




AMA Code of Medical Ethics Opinion 2.2.1
https://www.ama-assn.org/delivering-care/ethics/pediatric-decision-making

As the persons best positioned to understand their child’s unique needs and interests, parents (or guardians) are asked to fill the dual responsibility of protecting their children and, at the same time, empowering them and promoting development of children’s capacity to become independent decision makers. In giving or withholding permission for medical treatment for their children, parents/guardians are expected to safeguard their children’s physical health and well-being and to nurture their children’s developing personhood and autonomy.
But parents’ authority as decision makers does not mean children should have no role in the decision-making process. Respect and shared decision making remain important in the context of decisions for minors. Thus, physicians should evaluate minor patients to determine if they can understand the risks and benefits of proposed treatment and tailor disclosure accordingly. The more mature a minor patient is, the better able to understand what a decision will mean, and the more clearly the child can communicate preferences, the stronger the ethical obligation to seek minor patients’ assent to treatment. Except when immediate intervention is essential to preserve life or avert serious, irreversible harm, physicians and parents/guardians should respect a child’s refusal to assent, and when circumstances permit should explore the child’s reason for dissent.
(a) Provide compassionate, humane care to all pediatric patients.
(b) Negotiate with parents/guardians a shared understanding of the patient’s medical and psychosocial needs and interests in the context of family relationships and resources.
(c) Develop an individualized plan of care that will best serve the patient, basing treatment recommendations on the best available evidence and in general preferring alternatives that will not foreclose important future choices by the adolescent and adult the patient will become. Where there are questions about the efficacy or long-term impact of treatment alternatives, physicians should encourage ongoing collection of data to help clarify value to patients of different approaches to care...
(g) When it is not clear whether a specific intervention promotes the patient’s interests, respect the decision of the patient (if the patient has capacity and is able to express a preference) and parents/guardians.


Meryl Nass, M.D. at 1:47 PM No comments:
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Meryl Nass, M.D.
Most-cited papers of mine include one investigating Zimbabwe's major anthrax epidemic and a review of anthrax vaccine's usefulness in biological warfare. A November, 2001 Congressional testimony in response to the anthrax letters may also be of interest. Below, I've posted photos taken when I'm not at work or in front of the computer. Contact me at merylnass@gmail.com or 207 412-0004 when I'm home.
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