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When it comes to H1N1 vaccine, some doctors are just saying no

By Rob Stein and Michael Laris
Washington Post Staff Writer
Sunday, November 8, 2009; A03

The biggest frustration facing many doctors is the dearth of swine flu vaccine for their patients. But not Paula Soghomonian's pediatrician at Pediatric Village in the District. She is not recommending the shots -- or the nasal spray.

"The senior doctor there doesn't believe in it and doesn't want it for her patients," Soghomonian said. "I think the feeling was it's just too new."

Soghomonian's doctor is one of a small cadre of outliers who remain skeptical about the government's unprecedented immunization campaign, citing doubts about the risks presented by the H1N1 virus or the safety of the vaccine, despite the fact that no worrisome reactions have been reported.

"My feeling is that this is all being over-hyped," said Laurence J. Murphy, a pediatrician in Burke who also will not inoculate his patients. "Most people who get this virus do beautifully. I believe the vaccine hasn't been tested enough. I just think the benefit of it at this point is not outweighed by the possible risk."

Such contrarian voices, through the megaphone of cable news or in the quiet of exam rooms, have forced federal health officials to play defense as well as offense in their campaign to encourage immunization.

Public health leaders are at a loss to explain the skeptical minority, except to say that it mirrors the chronically low percentage of health-care workers who get the seasonal flu vaccine every year. Officials worry that these doubters could have a disproportionate influence in an already frustrating and confusing situation, and stress that the studies conducted so far and the intensive monitoring underway indicate that the vaccine is as safe as any flu vaccine.

"I am very disappointed, deeply puzzled and very disturbed by this," said William Schaffner, president-elect of the National Foundation for Infectious Diseases. "The people for whom these doctors are not recommending this vaccine are clearly high-priority patients who could have very adverse outcomes if they get infected with the virus."

'Not enough data'

Although no one has surveyed doctors' views on the vaccine, polls show that people look to their physicians when deciding whether to get the shots or nasal spray. A nationally representative survey of 1,042 adults in September found that 68 percent said they trusted the advice of their doctor or their child's pediatrician on this issue, far more than those who said they trusted top federal health officials and medical groups.

"People rely very heavily on their physician's judgments about whether or not they should take a vaccine," said Robert J. Blendon, a professor of health policy at the Harvard School of Public Health who conducted the survey. "They are at the top of the charts."

As a result, the naysayers have left patients torn between a doctor's long-respected advice, their own judgment and official recommendations.

"It's like total confusion for me to try to figure out what to do," Soghomonian said as she lined up with her 3-year-old daughter, Ally, on a recent morning at a District flu clinic.

"It's really been very frustrating and very scary," said Soghomonian, who eventually left after deciding to give her daughter only the seasonal flu vaccine. "I just want someone to tell me what to do, you know?"

Cheryl F. Edmonds, founder of the practice where Soghomonian takes her children, declined to be interviewed. But a member of her staff, who spoke on the condition of anonymity, characterized her concerns this way: "Her thing is there's just not enough data."

Murphy, the Burke pediatrician, said he has no reason to think the vaccine is unsafe -- he, like many of the skeptics, said he generally supports vaccinations. But he wonders whether it was tested enough.

"They just didn't have the time to do that properly. They mean well and they are not doing anything to mislead people in any direct way. The reality is no one knows. I'm not pretending to know. I don't think they should pretend to know," he said.

'Jumping on the bandwagon'

Murphy is not alone. A smattering of obstetricians, family practice doctors, internists and other physicians nationwide who harbor doubts about safety of the vaccine or the danger the flu poses raise questions on blogs and during interviews, and counsel their patients not to get the immunization.

"What bothers me is pretty much every doctor in the country is jumping on the bandwagon and saying, 'This vaccine is completely safe' -- even for the pregnant woman and the unborn baby," said Bob Sears, of Orange County, Calif. "But they can't give you a single study that backs up that statement."

Officials repeatedly have stressed that while no vaccine is completely safe, there is no reason to believe the swine flu immunization would pose any unusual risks, and so far no problems have emerged.

"I can understand the hesitancy and reluctance to take a vaccine that appears to be new and different. All we can do is provide the facts," said Thomas R. Frieden, director of the federal Centers for Disease Control and Prevention. "The facts are that this is the same manufacturing process, the same manufacturers, the same factories, the same safeguards as the seasonal flu vaccine that has been used for more than 100 million doses each year for many years and which has an excellent safety record."

But Meryl Nass, an internist in Bar Harbor, Maine, still has doubts, especially given that most people who become infected get only mildly ill.

"In this situation, when there's very little data, I don't think people -- and children in particular -- should be asked to bear the burden of being experimental subjects," said Nass, who has been blogging about her doubts. Nass also questions the assertion that the vaccine is safe for women in all stages of pregnancy.

"The CDC is telling women in all trimesters to go out and get vaccine. To my mind, this is reckless," said Nass, who is advising her patients to consider receiving the vaccine only in their second or third trimesters.

'Behind the curve'

Some doctors hear echoes of politics in the reactions to their concerns.

"You come out and offer some caution about the safety of the vaccine, and it becomes very political: Are you with us or are you against us?" said Kent Holtorf, whose Southern California practice specializes in treating chronic conditions. "It's almost like Republicans and Democrats, and no one wants to toe the middle ground, because it could help the other side."

Giuseppe Lancellotti, a pediatrician from Ephrata, Pa., argues that the vaccine has arrived too late to make a difference anyway.

"We're just way behind the curve," he said.

Government officials counter that it remains far from clear whether the second wave of infections currently sweeping the country has peaked. Even if it has, people will continue to become infected for months and another wave could hit later.

"The risk of not getting the vaccine is much greater than the risk from getting it," said Anthony S. Fauci, who is leading the government's ongoing testing of the vaccine at the National Institutes of Health.

Soghomonian was finally forced to make a snap decision when her husband took her 5-year-old son to get a seasonal flu shot and discovered the swine flu vaccine was available, too.

"I called him and said, 'Just do both,' " she said. He did, but Soghomonian was still uneasy. "There was a moment of panic, like: What did I do?"

Nevertheless, Soghomonian was among the first few dozen people to line up last week at Wilson High School in the District to finally get her daughter vaccinated.

"It's your pediatrician. Your children have been there since Day One. You feel like they know and you should listen to their advice. And here I'm going against it," she said.

"Ultimately, you have to make your own decision."

Staff researcher Madonna Lebling contributed to this report.

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