By Hilary E. MacGregor
L.A.Times Staff Writer
March 7, 2005
Read Dr. Jay's response to this
article A pregnant mother from Topanga Canyon has brought her toddler son
to Dr. Jay Gordon for a checkup. Her son received all the recommended
vaccinations, but she wonders aloud if she should do the same
for her second child, who is due in a few months.
It's a topic about which Gordon is passionate. Parents from around
Southern California choose Gordon for his outspoken and controversial
stance on vaccinations, driving from as far away as Santa Barbara
and Long Beach.
They know he will lend a sympathetic ear to their concerns about
the possible adverse side effects of childhood vaccinations —
even though several large scientific studies have failed to find
a connection.
His openness to alternative approaches has earned him an avid
following. With thousands of patients, his practice is so busy
that he no longer accepts new patients.
"What is normal for the first year?" asks Robyn Forman,
the pregnant mother, who has been seeing Gordon since her son
turned 1.
"I prefer to give no vaccines or just the DPT during the
first year," Gordon responds. "DPT is relevant because
you can get whooping cough-diphtheria." He rattles off information:
There have been no new polio cases in the U.S. for the last decade;
it's highly unlikely that a young child would contract hepatitis
B; there are only a few dozen cases of tetanus in this country
each year.
"In my opinion, we vaccinate in an unscientific and potentially
dangerous way," he says.
Gordon is not anti-vaccine. He acknowledges the benefits of vaccines,
but prefers to vaccinate later and slower. No one knows for sure
how many other doctors take a similar stance. But it is rare for
a pediatrician to be so outspoken on the subject. Gordon's views
put him at odds with virtually all of his colleagues. Experts
on vaccination consider his attitude socially irresponsible, unscientific
and just plain wrong.
Dr. James Cherry, a pediatrician at UCLA's David Geffen School
of Medicine who has conducted vaccine research since the 1960s,
and who has consulted for vaccine manufacturers, puts it more
bluntly: "He is endangering the lives of children."
In recent years, childhood vaccinations have become a lightning
rod for some parents who are concerned that their children may
develop autism, epilepsy or learning disabilities from certain
immunizations. While there is little or no scientific evidence
to support links between these diseases and vaccines, the issue
has become such a loaded topic between doctors and patients that
the leading professional organization for pediatricians is preparing
a formal statement — due out this spring — to provide
guidance to doctors on how to deal with parents who are resistant
to vaccinating.
Public health officials believe vaccinations are a matter of
social responsibility. If enough doctors, and enough patients,
choose not to vaccinate, it might endanger the public's health
and allow deadly diseases that have been eradicated, or nearly
so, to reemerge as significant threats. Gordon is steadfast in
his controversial stance. He will repeat his views on vaccination
to parents throughout the day. As patients pepper him with questions,
he patiently answers.
"I have 15 to 20 patients from Santa Barbara," he says.
"The reason is, no one will talk to them about vaccines.
They need to talk."
Targeting a dozen diseases
The number of recommended vaccinations for children up to 24
months has nearly tripled since 1988, according to the national
Centers for Disease Control and Prevention. Currently, the CDC
recommends vaccination against 12 diseases. Because some vaccines
must be given more than once, a child could get as many as 23
shots by age 2. While the timing of shots may vary with different
doctors, a child might receive as many as six shots during a single
doctor's visit.
Beyond the inconvenience of frequent doctor visits and children's
fear of needles, the biggest source of parental concern about
vaccines is the claim that these shots might be linked to a rise
in autism rates. Between 1987 and 2002 there has been a more than
six-fold increase in autism cases in California, according to
a 2003 report by the state Department of Development Services.
So far, researchers have been unable to explain the reason for
the increase.
Because autism begins to manifest itself during the same period
when young children are receiving many of their vaccinations,
some parents believe that the vaccinations may have triggered
the disorder. Thousands of parents across the country have filed
lawsuits in the U.S. Court of Federal Claims alleging that thimerosal,
a form of mercury used as a preservative in pediatric vaccines
until 2002, was responsible for their children's autism or other
neurological disorders.
No major scientific study has shown any link between vaccines
and autism, or any other neurological disorder. But anecdotal
stories by parents of what has happened following vaccinations
— often circulated on the Internet — have heightened
many parents' anxiety about shots.
Because some childhood diseases — polio, for example —
are virtually unseen today, some parents are more frightened of
the vaccines than the diseases, experts say. "Immunizations
have been so good, and diseases so rare, that people have forgotten
what they are, the types of damage they can do to children, including
killing them," said Dr. Jay M. Lieberman, who is chief of
pediatric infectious diseases at Miller Children's Hospital in
Long Beach, and who has been a paid consultant to vaccine manufacturers.
As a result, parents have become increasingly assertive about
questioning pediatricians on the need to follow the vaccine schedule.
And, in some instances, parents are refusing their pediatrician's
recommendation to vaccinate.
Parental concern about vaccination has become relatively common,
says Dr. Jeffrey Botkin, professor of pediatrics and medical ethics
at the University of Utah. Surveys have shown that a small percentage
of physicians feel so strongly about the benefits of immunizations
that they refuse to work with patients who will not vaccinate.
"These physicians will dismiss these families from their
practice," says Botkin, who is chairing an American Academy
of Pediatrics bioethics committee that is preparing the statement
on childhood vaccinations.
The academy hopes to encourage pediatricians to be open-minded
about parents' concerns, while at the same time emphasizing the
importance of sticking to the vaccination schedule, Botkin says.
Despite parental concerns, the number of children receiving childhood
immunizations continues to rise in Los Angeles County. In 1998,
70.5% of children between 19 and 35 months had been vaccinated.
By 2003, that number climbed to 80.3%, said Dr. Jonathan Fielding,
Los Angeles County's public health director. One reason behind
the rising rates: Public and private schools require children
be vaccinated before admission.
Today, 18 states, including California, will waive the vaccination
requirement if parents request a "philosophical exemption."
The rate of vaccination exemptions for children enrolling in kindergarten
in L.A. County remains below 1%, though the rate has inched upward
during the last decade, Fielding said.
A homeopathic approach
Gordon's homey Santa Monica office on Montana Avenue, housed
in a Streamline Moderne building across from a school, looks like
any pediatrician's office. Toys are scattered across the waiting
room floor. Pictures of beautiful children adorn the walls. After
medical school at the Medical College of Wisconsin, Gordon did
his residency at Childrens Hospital Los Angeles, and began his
career in the office of Dr. Paul Fleiss, a Los Feliz pediatrician.
It was there that Gordon first encountered patients who were interested
in alternative therapies. These are themes that feature prominently
in his practice today. He is an advocate of homeopathy and encourages
mothers to breastfeed as long as possible and endorses the idea
of parents allowing their young children to sleep with them in
a "family bed."
A quotation taped to the wall by the receptionist reads: "I
don't always go into details about the possible side effects of
drugs. I tell them all drugs are poisons with possible beneficial
side effects."
In 1980, Gordon said he was giving the standard DPT shot to his
patients. "More than occasionally I would get calls from
parents saying, 'Ever since that shot, my child has been a little
different. I can't put my finger on it … but they are different."
Gordon's suspicions would later be confirmed. Many in the medical
community now acknowledge that the old DPT vaccine caused damage
to the brain in rare cases, says Dr. John Menkes, professor emeritus
of neurology and pediatrics at UCLA's David Geffen School of Medicine.
In 1996, a new vaccine with no side effects was introduced.
Gordon said those early experiences helped shape his beliefs
about vaccines. His practice began to subtly shift. He said he
started giving many fewer vaccines. Gordon acknowledges the role
of vaccinations in improving public health and controlling disease.
But he believes that if a child has an underlying neurological
disorder, a vaccination may trigger the disorder to become active.
So for certain shots — polio, hepatitis B for the first
decade of life, Hib (to prevent meningitis) — the risks
outweigh the benefits, he says.
In 25 years of practicing medicine, he says he has seen enough
examples of strange reactions to vaccines that he cannot ignore
them.
Gordon isn't the only doctor who believes that parents' views
about vaccinations should be carefully considered. Dr. Robert
Sears in San Clemente, coauthor of the popular parenting guide
"The Baby Book," says most pediatricians in south Orange
County refuse to accept a child as a patient unless they follow
the vaccination schedule. Sears allows patients to make their
own choices.
"I think it is pretty clear that thimerosal does contribute
to neurologic disorders," he says. "Whether or not that
has truly contributed to autism, I leave that to the public health
officials."
Although Gordon says he has no set of recommendations, he discusses
the risks and benefits of all vaccines with patients and prefers
to vaccinate later and over a longer period. On a recent day,
he advised parents to avoid vaccination during the first year
— with the exception of the DPT — then reassess after
the child's first birthday. If a parent chooses not to vaccinate
at all, he supports that decision. He refuses to vaccinate siblings
in families with an autistic child.
Gordon does not shun the spotlight. He has written five books,
consulted on television scripts, appeared on "Good Morning
America," and been an on-air medical correspondent for ABC's
"Home Show."
He cites medical studies that he says show some association between
mercury and autism and is critical of doctors who say there is
no link whatsoever between the two. "They could say there
is a tenuous connection, or an improbable connection," but
to say there is no connection is inaccurate, he asserts.
Gordon's theories are considered heretical by many who study
vaccines and infectious disease.
"There is not a single scientific, medical, or public health
group that would endorse such a policy," says Dr. Joel I.
Ward, director of UCLA's Center for Vaccine Research, who has
performed several studies with vaccine manufacturers. "It
is unorthodox, unsanctioned, and in my view, irresponsible. For
those who are not experts in this field to customize the vaccine
schedule is dangerous medicine."
Other vaccine experts say doctors such as Gordon — and
his patients who decide not to adhere to the vaccination schedule
— benefit from the fact that most parents do follow the
rules.
"Many of his patients will be fine with that schedule,"
says Lieberman, of Miller Children's Hospital in Long Beach. "The
reason is, they are relying on the goodwill of others. So when
unvaccinated children are in school, they are still less likely
to get the disease because their classmates have been vaccinated."
How we vaccinate should be based on science, not theories or
anecdotes, says Lieberman.
"Science tells us how safe vaccines are. There are 4 million
infants getting vaccines each year. Why should it surprise anybody
that some of those children develop colds, or fevers, or have
seizures, or even die of SIDS [Sudden Infant Death Syndrome].
But the fact that those events happen following vaccinations in
no way means that vaccines cause that."
Whatever the professional opinion, Gordon inspires intense devotion
from his patients. "There is nobody like him," says
Allyson Sanger, a mother of three daughters, ages 18 months, 4
and 6, who drives from Hollywood to see Gordon. "The information
out there is just so frightening; I couldn't read it any more."
Carly Rodriguez, a mother of a 22-month-old who lives in the
South Bay, said she wanted to be able to discuss her vaccine concerns
with a doctor and be taken seriously. She said she was frightened
by information she read on http://www.909shot.com , a website
produced by the National Vaccine Information Center, an organization
led by parents who advocate reforming the vaccination system,
and stories in Mothering magazine.
"I can't imagine the feeling of horror that a parent must
feel after they take a child for a vaccination and the child begins
to exhibit a reaction like that," she says.
Gordon's way of practicing medicine carries risks. By not following
the recommended vaccination schedule he is going against his profession's
standard of care — and leaving himself open to malpractice
claims.
He acknowledges that his support of delayed vaccinations could
end up harming, perhaps fatally, one of his young patients if
they contract a preventable disease. But he believes the risks
of vaccinating can sometimes outweigh the benefits.
"I would feel horrible," he says, when asked about
the possibility that one of his patients would become seriously
ill or die from a preventable disease. "And yet I would recognize
that both they and I long ago accepted responsibility for the
statistical possibility that these diseases still exist and children
can get them."
Between patients, a nurse hands Gordon the laboratory results
for a family that has come to his office. Two of their children
have tested positive for whooping cough. And the mother is now
coughing. This is a family that has decided against all vaccinations.
"Anybody could hold me liable," Gordon says, before
calling the family. "I can say, 'I told you [there were risks],'
and they could tell me, 'No you didn't. You didn't tell us how
bad it was. You didn't tell us that I would be missing two weeks
of work. You didn't tell us about the anxiety involved.' "
Gordon makes the call. The parents do not blame him. He breathes
a sigh of relief, then heads off to see his next patient.
A shot in the arm
These are some of the immunizations recommended for children
between birth and two years of age.
Birth-6 months
Hepatitis B: 2 doses
Diphtheria, Pertussis (DPT), Tetanus: 3 doses
Haemophilus influenzae type B (Hib): 3 doses
Inactivated poliovirus: 2 doses
Measles, mumps, rubella (MMR): not recommended
Varicella: not recommended
Pneumococcal conjugate: 3 doses
Pneumococcal polysaccharide*: not recommended
Influenza: not recommended
Hepatitis A*: not recommended
Totals: 13 doses
--
12-24 months
Hepatitis B: 1 dose
Diphtheria, Pertussis (DPT), Tetanus: 1 dose
Haemophilus influenzae type B (Hib): 1 dose
Inactivated poliovirus: 1 dose
Measles, mumps, rubella (MMR): 1 dose
Varicella: 1 dose
Pneumococcal conjugate: 1 dose
Pneumococcal polysaccharide*: 1 dose
Influenza: 1 dose
Hepatitis A*: 1 dose
Totals: 10 doses
--
* Vaccines recommended for children and adolescents in selected
states and regions and for certain high-risk groups.
Source: Centers for Disease Control and Prevention |