WEBVTT 1 00:00:00.920 --> 00:00:05.440 I'm Emily Astor. This is parent data and today, if 2 00:00:05.480 --> 00:00:08.920 I say going to the doctor and getting shots, what 3 00:00:09.000 --> 00:00:09.920 is your first response? 4 00:00:10.840 --> 00:00:13.480 I hate them? 5 00:00:13.840 --> 00:00:15.160 Are you scared of shots at all? 6 00:00:15.720 --> 00:00:18.720 The ones that hurt, the tetanus ones hurt, But other 7 00:00:18.760 --> 00:00:19.160 than that. 8 00:00:19.120 --> 00:00:19.560 Not really. 9 00:00:20.239 --> 00:00:23.960 My only memories I have of needles is just being fearful, 10 00:00:24.239 --> 00:00:28.320 and going to the doctor was always really stressful. I 11 00:00:28.360 --> 00:00:31.040 distinctly remember kicking my pediatrician. 12 00:00:31.400 --> 00:00:34.040 I totally had a fear of needles when I was 13 00:00:34.080 --> 00:00:38.600 a kid. I think the famous story about me was 14 00:00:38.640 --> 00:00:41.040 that I hid under one of the chairs in the 15 00:00:41.080 --> 00:00:47.559 doctor's office and it took my mother, the receptionist, and 16 00:00:47.760 --> 00:00:51.560 the doctor to pull me out from under the chair 17 00:00:52.159 --> 00:00:54.360 so that they could give me my shot. 18 00:00:55.360 --> 00:00:58.960 So when I see the needle, I always get freaked out. 19 00:00:59.280 --> 00:01:03.639 I mean, it's a metal stick being entered into your 20 00:01:03.840 --> 00:01:08.360 arm with fluid that stings like it's not enjoyable. 21 00:01:08.720 --> 00:01:11.160 I really don't like the feeling of something being like 22 00:01:11.240 --> 00:01:14.480 injected into me, and then that kind of like heaviness 23 00:01:14.480 --> 00:01:18.000 in my arm, Like it just feels invasive. 24 00:01:18.680 --> 00:01:23.920 It feels like someone's pinching you the hardest they can 25 00:01:24.000 --> 00:01:27.800 pinch for about three seconds. It doesn't hurt that much, 26 00:01:28.480 --> 00:01:31.600 but it's definitely like a little thing. It's like getting 27 00:01:31.640 --> 00:01:32.320 your ears pierced. 28 00:01:32.360 --> 00:01:33.360 Like it's not that bad. 29 00:01:33.760 --> 00:01:36.360 I still can't look And as soon as I like 30 00:01:36.520 --> 00:01:40.640 smell the rubbing alcohol, yeah, turn my head and look 31 00:01:40.680 --> 00:01:44.600 away and like scrunch my eyes a little bit, and 32 00:01:45.240 --> 00:01:47.720 it's yeah, it's a funny thing. It's like it brings 33 00:01:47.760 --> 00:01:49.840 you back to being that age. 34 00:01:50.240 --> 00:01:51.040 I can recognize. 35 00:01:51.040 --> 00:01:55.400 It's completely psychological, like I will cry on my way 36 00:01:55.440 --> 00:01:57.720 to the doctor's office knowing I'm going to get a 37 00:01:57.800 --> 00:01:59.920 need all. I think it's gone easier to the point 38 00:02:00.000 --> 00:02:02.000 I haven't kicked a doctor as an adult. 39 00:02:03.560 --> 00:02:06.240 Is it enjoyable to know that you were brave? 40 00:02:07.160 --> 00:02:10.000 After when I know, oh my god, that it wasn't 41 00:02:10.320 --> 00:02:15.680 that bad, I'm like, oh, I did it. I'm awesome. 42 00:02:19.160 --> 00:02:22.880 Vaccines are never a fun conversation with your kids. For 43 00:02:22.960 --> 00:02:26.040 many years, before every doctor visit, my kids would ask, 44 00:02:26.160 --> 00:02:29.880 are their shots? I never wanted to commit to a no, 45 00:02:30.680 --> 00:02:33.960 even when I thought they were not, so I always hedged, oh, 46 00:02:34.000 --> 00:02:37.760 I'm not sure, asked the doctor, which led to all 47 00:02:37.840 --> 00:02:41.639 visits starting with the kids accosting our lovely pediatrician, are 48 00:02:41.680 --> 00:02:46.079 there shots today? As soon as she came into the room. 49 00:02:46.400 --> 00:02:49.680 Even if you are enthusiastic about vaccines, the experience of 50 00:02:49.800 --> 00:02:52.360 holding your kids as they get them is not usually 51 00:02:52.400 --> 00:02:55.360 a high point of parenting, and in the present moment, 52 00:02:55.520 --> 00:02:59.400 the conversation about vaccines is increasingly fraught, and not just 53 00:02:59.400 --> 00:03:02.880 because our kids are sometimes afraid of Neil's. We're living 54 00:03:02.880 --> 00:03:06.280 in a moment where vaccines, long one of the most 55 00:03:06.480 --> 00:03:11.239 trusted and studied preventive medical treatments in existence, are suddenly 56 00:03:11.280 --> 00:03:16.080 being viewed with skepticism. Debunk theories about their relationship between 57 00:03:16.120 --> 00:03:20.079 vaccines and autism, for example, are taking center stage on 58 00:03:20.160 --> 00:03:26.520 Instagram and on Facebook, but also in congressional hearings. I 59 00:03:26.520 --> 00:03:28.520 think that part of the problem we're facing is a 60 00:03:28.560 --> 00:03:32.960 lack of understanding. People don't know quite how vaccines work, 61 00:03:33.360 --> 00:03:35.800 or why there are more now than in the past, 62 00:03:36.560 --> 00:03:39.680 or how we can know that they are safe. I've 63 00:03:39.680 --> 00:03:41.520 been writing about this in parent Data over the past 64 00:03:41.560 --> 00:03:44.920 few months, and today I'm bringing that conversation to the podcast. 65 00:03:45.840 --> 00:03:49.360 My guest is doctor Adam Davis. Adam is a pediatrician 66 00:03:49.400 --> 00:03:51.920 in the Bay Area, and he was my medical editor 67 00:03:51.920 --> 00:03:54.200 for the book Cribsheet, and he has a lot to 68 00:03:54.240 --> 00:03:58.400 say about vaccines from the perspective of someone who gives them. 69 00:03:58.760 --> 00:04:01.560 In the conversation, we talk talk about our theories on 70 00:04:01.720 --> 00:04:04.800 why the COVID vaccine sped up a slow growing movement 71 00:04:04.880 --> 00:04:08.560 around vaccine skepticism. We talk about the role of vaccines 72 00:04:08.600 --> 00:04:11.800 play in public health and how to explain that. We 73 00:04:11.880 --> 00:04:13.760 talk about what it's like for doctors to deal with 74 00:04:13.840 --> 00:04:16.840 vaccine skeptics in their own practice, and what people can 75 00:04:17.160 --> 00:04:22.080 and can't be talked into or out of. And because 76 00:04:22.160 --> 00:04:25.360 it's a parenting podcast, some hacks forgetting your kids through 77 00:04:25.440 --> 00:04:29.599 vaccines without too much drama. Adam is here to help 78 00:04:29.680 --> 00:04:32.560 cut through some of the noise and help us generate 79 00:04:32.640 --> 00:04:50.560 some real understanding. After the break, doctor Adam Davis. Adam Davis, 80 00:04:50.600 --> 00:04:52.960 thank you for joining me on the podcast. 81 00:04:53.880 --> 00:04:56.040 Thanks for having me. Emily. Great to be here. 82 00:04:56.360 --> 00:04:59.840 So do you want to go ahead and introduce yourself, sure. 83 00:05:00.080 --> 00:05:02.920 Adam Davis. I'm a community pediatrician in San Francis called 84 00:05:03.080 --> 00:05:07.640 SFBA Pediatrics. I also have the honor of being the 85 00:05:07.760 --> 00:05:13.400 medical editor of Emily's second book, Crib Sheets, and I'm 86 00:05:13.400 --> 00:05:15.039 here today to chat with her. 87 00:05:15.960 --> 00:05:18.039 Yeah, all right, I'm super excited to have you as 88 00:05:18.040 --> 00:05:20.920 you said you were the medical editor on cribsheet, and 89 00:05:21.000 --> 00:05:25.560 so if anyone's noticed any mistakes, they're Adam's fault and 90 00:05:25.880 --> 00:05:29.719 will be you know, discussing them later. But I really 91 00:05:29.760 --> 00:05:32.160 loved I loved working with you on that. That was 92 00:05:32.160 --> 00:05:35.360 was very fun to write, and it was interesting. It's 93 00:05:35.360 --> 00:05:39.320 always very interesting for me because I come from a 94 00:05:39.839 --> 00:05:43.839 place that is so data and is not seeing patients 95 00:05:44.480 --> 00:05:47.159 to work with someone and talk to someone about these 96 00:05:47.200 --> 00:05:50.200 same ideas, but from the standpoint of like someone who 97 00:05:50.240 --> 00:05:53.120 doesn't spend their whole day thinking about causality but does 98 00:05:53.200 --> 00:05:56.040 actually see people. And of course people are a bit 99 00:05:56.040 --> 00:05:59.720 more complicated than data, even though data is people, so 100 00:06:00.360 --> 00:06:02.279 those perspectives they come together. 101 00:06:03.560 --> 00:06:06.520 Yeah, it was a lot of fun, and you know, 102 00:06:06.560 --> 00:06:08.280 it was great timing for me too. I was making 103 00:06:08.279 --> 00:06:11.280 a job transition from being a hospitalist and taking care 104 00:06:11.320 --> 00:06:15.560 of patients of children in the hospital that were very ill, 105 00:06:16.000 --> 00:06:19.839 to doing primary care and deep diving into the data 106 00:06:20.120 --> 00:06:24.719 and really helped hone my abilities as I moved to 107 00:06:24.960 --> 00:06:28.600 outpatient medicine and primary care. So it was it served 108 00:06:28.680 --> 00:06:29.520 us both really well. 109 00:06:30.240 --> 00:06:32.719 So before we were going to talk today about vaccines, 110 00:06:32.760 --> 00:06:37.320 everybody's favorite topic, but I'm actually curious when you made 111 00:06:37.360 --> 00:06:39.800 that move, So you move from working with quite sick 112 00:06:39.880 --> 00:06:44.120 kids to working with presumably a mostly healthy population. I'm 113 00:06:44.160 --> 00:06:46.520 curious about what was what was the hardest thing about 114 00:06:46.560 --> 00:06:47.560 that move? 115 00:06:48.400 --> 00:06:53.719 Yeah, I mean the hardest thing was dermatology. So like, honestly, 116 00:06:54.200 --> 00:06:56.880 in the hospital, I like, I mean, there were like 117 00:06:56.920 --> 00:06:58.920 three types of rash. I would care about it all, 118 00:06:59.279 --> 00:07:04.040 you know, have like blister or like dying skin. And 119 00:07:04.320 --> 00:07:06.279 then you get into the outpatient world that everybody wants 120 00:07:06.279 --> 00:07:08.960 to talk about acne or this, like these red bumps 121 00:07:09.000 --> 00:07:11.600 and you're like, I don't know. And so it took 122 00:07:11.600 --> 00:07:14.600 a little while to re review that. But luckily most 123 00:07:14.800 --> 00:07:18.120 rashes and kids are quite transient, and I think. 124 00:07:17.960 --> 00:07:20.400 Mostly the answer like what a lot of it? Like, 125 00:07:20.760 --> 00:07:21.679 rashes are fine? 126 00:07:21.920 --> 00:07:24.760 Yeah, who knows a funny story. So one of my 127 00:07:24.840 --> 00:07:28.440 partners in my outpatient clinic is doctor Alan Johnson, and 128 00:07:28.480 --> 00:07:30.880 he's now in his eighties. He retired like a year 129 00:07:30.880 --> 00:07:34.040 and a half ago. He started in the practice in 130 00:07:34.280 --> 00:07:38.440 nineteen seventy four, which was a year before I was born. 131 00:07:38.800 --> 00:07:42.160 And so you know, when I just started back in 132 00:07:42.160 --> 00:07:45.960 primary care, he told me, anytime you want just come 133 00:07:46.240 --> 00:07:47.600 come grab me out of a patient if you have 134 00:07:47.640 --> 00:07:50.920 any question. So there was a rash, and like I 135 00:07:50.960 --> 00:07:52.520 knew what I wanted to do with it. I knew 136 00:07:52.520 --> 00:07:54.640 that some steroids and some moistroizer were going to get 137 00:07:54.720 --> 00:07:56.880 rid of the rash. And I knew it wasn't a 138 00:07:56.920 --> 00:07:59.640 worrisome rash. I just didn't know like the medical terminology, 139 00:07:59.680 --> 00:08:03.000 the last and root of what to call it. And 140 00:08:03.080 --> 00:08:07.200 so I went and I invited Alan into the room 141 00:08:07.480 --> 00:08:11.000 and he looks at it. He goes, it's rash. And 142 00:08:11.040 --> 00:08:12.920 I was like, wait, that's all, that's all you have 143 00:08:13.000 --> 00:08:17.559 to say. And he's like, yeah, like it will get better. 144 00:08:18.520 --> 00:08:21.120 It's like some irritation, you know, Like he's like, if 145 00:08:21.120 --> 00:08:23.480 it gets worse, then we'll figure it out. But like 146 00:08:23.560 --> 00:08:25.400 and I was like, it sort of relieves some of 147 00:08:25.440 --> 00:08:27.640 the tension for me because one of the nice things 148 00:08:27.680 --> 00:08:31.880 about ambilatory medicine versus impatient medicine is often you have 149 00:08:31.960 --> 00:08:35.440 that longer sort of time period, right Like in acute 150 00:08:35.480 --> 00:08:37.760 medicine you need to figure out what's going wrong and 151 00:08:37.760 --> 00:08:40.880 correct it shortly, but rash you can say, well, let's 152 00:08:40.920 --> 00:08:43.280 do this for a week, and you know, if it's 153 00:08:43.280 --> 00:08:46.560 getting much worse, we can call a friend or we 154 00:08:46.640 --> 00:08:48.880 can and that's true for a number of things that 155 00:08:48.920 --> 00:08:50.160 can happen in the inblatory world. 156 00:08:50.760 --> 00:08:53.920 I like that dermatology okay, Germa, Yeah, I mean I'm 157 00:08:54.000 --> 00:08:56.600 often calling I'm often texting pictures of rash is to 158 00:08:56.640 --> 00:09:00.320 my pediatrician and she does. She's usually like she's like, yeah, 159 00:09:00.360 --> 00:09:04.800 that's that's that's rash. 160 00:09:02.360 --> 00:09:08.200 Ye yeah, put them to totally. It can be really 161 00:09:08.440 --> 00:09:11.480 and the pictures make it even harder, like, uh, you 162 00:09:11.480 --> 00:09:13.920 know because of the quality of the iPhone pictures. 163 00:09:13.520 --> 00:09:15.160 With the flagg in. 164 00:09:18.480 --> 00:09:20.320 What body part is that it's off to the next 165 00:09:20.400 --> 00:09:23.640 question exactly, but that that was like the hardest. Medically, 166 00:09:23.880 --> 00:09:27.200 there's like a whole different like rhythm to being an 167 00:09:27.200 --> 00:09:30.439 ambulatory doc, both in terms of your individual days you're 168 00:09:30.440 --> 00:09:34.040 seeing many more patients than you do impatient, but also 169 00:09:34.080 --> 00:09:36.679 in terms of the what you're doing with them. I 170 00:09:37.000 --> 00:09:41.200 remember I actually I sent I posted on Facebook to 171 00:09:41.240 --> 00:09:45.079 my friends, like because at the beginning I felt a 172 00:09:45.080 --> 00:09:46.920 little bit like an imposter. People would come in with 173 00:09:46.960 --> 00:09:49.840 their well child for a well child exam. You know, 174 00:09:49.920 --> 00:09:51.680 we'll get into it, but I would give them vaccines, 175 00:09:51.720 --> 00:09:53.680 but if they were due for them, and I talked 176 00:09:53.679 --> 00:09:56.080 to them about like their activities at school, like like 177 00:09:56.200 --> 00:09:59.520 all your listeners have experienced with their PEDUTRICI And I 178 00:09:59.520 --> 00:10:01.560 was like they left. I was like, what do they 179 00:10:01.640 --> 00:10:04.320 look like? What was the value of that for the 180 00:10:04.559 --> 00:10:07.480 for the families? And it was actually really really starting, 181 00:10:07.559 --> 00:10:09.800 So I sent that. I actually asked my friends. I 182 00:10:09.800 --> 00:10:12.800 was like, can you tell me, like do you feel 183 00:10:12.880 --> 00:10:15.960 value because from going to see on your well children 184 00:10:15.960 --> 00:10:18.199 when you knew your child was you know, thriving in 185 00:10:18.240 --> 00:10:22.400 preschool or or elementary school or whatever, and like you 186 00:10:22.400 --> 00:10:25.880 didn't really have a big concern, And they universally were like, yes, 187 00:10:25.960 --> 00:10:28.880 a ton of value of like the reassurance and like 188 00:10:29.160 --> 00:10:33.120 having that relationship with the pediatrician. And and over the years, 189 00:10:33.280 --> 00:10:35.559 I mean now it's been seven years that I've been 190 00:10:35.600 --> 00:10:38.040 doing this, I feel that every day. Like it's a 191 00:10:38.080 --> 00:10:42.600 really special honor to have somebody a family identify you 192 00:10:42.600 --> 00:10:45.360 as their child's pediatrician. It's a huge amount of trust, 193 00:10:45.440 --> 00:10:48.480 it's a huge it's a very unique relationship. It's really 194 00:10:48.480 --> 00:10:52.679 special in a lot of different like times in the 195 00:10:52.760 --> 00:10:55.400 child life, like when they're born obviously, but also when 196 00:10:55.440 --> 00:10:58.600 you're like those sort of teen years when you're transitioning 197 00:10:58.600 --> 00:11:01.760 from being like mostly talked to the parents to mostly 198 00:11:01.800 --> 00:11:04.079 talking to the kid. And you're trying to preserve that 199 00:11:04.160 --> 00:11:06.920 relationship with the parents, but also know that the kid 200 00:11:07.080 --> 00:11:10.280 can be in some rebellion and you want to you 201 00:11:10.320 --> 00:11:11.800 want to be on their side as well, and so 202 00:11:12.600 --> 00:11:14.520 it's humbling that way, and it's really special. 203 00:11:15.120 --> 00:11:20.360 That's amazing. Okay, let's talk about vaccines. Yeah, so let 204 00:11:20.400 --> 00:11:23.160 me start with the most basic question, which is what 205 00:11:23.280 --> 00:11:25.520 is your what is your stance on vaccines? 206 00:11:26.080 --> 00:11:29.400 I mean, there's very few things in pediatrics medicine that 207 00:11:29.520 --> 00:11:34.400 have as good evidence as vaccines, period, right, Like, you know, 208 00:11:34.559 --> 00:11:38.320 people think that a lot of things that doctors do, 209 00:11:38.559 --> 00:11:40.439 and you've talked about this in a number of different 210 00:11:40.520 --> 00:11:42.920 venues and a number of different things are based on 211 00:11:43.000 --> 00:11:45.640 these really great studies all the time, and often they're not. 212 00:11:46.120 --> 00:11:49.360 Often they're based on expert advice or sort of smaller 213 00:11:49.400 --> 00:11:52.920 studies that sort of imply something. But and you know, 214 00:11:53.000 --> 00:11:56.960 even like how many days do we give advantibiotics for infections, 215 00:11:56.960 --> 00:11:59.040 it's all based on like football scores. To me, like 216 00:11:59.120 --> 00:12:01.200 it's you know, you either give it for seven or 217 00:12:01.240 --> 00:12:03.560 ten days. You never give it. Nobody ever give it 218 00:12:03.640 --> 00:12:06.880 for eight or nine, Like there's just like that's just 219 00:12:06.960 --> 00:12:09.960 because like a random study that nobody doesn't comparative of 220 00:12:09.960 --> 00:12:12.480 these small changes. So a lot of the questions that 221 00:12:12.840 --> 00:12:16.079 people can ask me, there's not like a wealth of 222 00:12:16.240 --> 00:12:19.079 literature to go to to answer it. But vaccines is 223 00:12:19.080 --> 00:12:22.080 the exception there, Like, vaccines are really well studied, and 224 00:12:22.120 --> 00:12:25.520 the effects what we call the effects size, right, how 225 00:12:25.520 --> 00:12:27.800 many people you have to do something to protect one 226 00:12:27.840 --> 00:12:31.640 person is quite small with vaccines. It's like we can 227 00:12:31.760 --> 00:12:34.559 really honestly, like in the I mean even if you 228 00:12:34.600 --> 00:12:37.200 go outside of like doctors, if you just think about 229 00:12:37.200 --> 00:12:43.680 what's improved health over the last century or more, it's 230 00:12:44.120 --> 00:12:47.160 hygiene and vaccines, right are number one and number two 231 00:12:47.559 --> 00:12:50.839 probably hygiene first and vaccine second. But vaccines has been 232 00:12:50.880 --> 00:12:54.200 like life changing for public health. And so I'm a 233 00:12:54.240 --> 00:12:57.400 strong believer in so much so that like our practice 234 00:12:57.400 --> 00:12:59.760 and not every practice has the benefit of being able 235 00:12:59.760 --> 00:13:04.240 to do this, But we have limited capacity to keep 236 00:13:04.240 --> 00:13:07.960 patients in our practice who truly refuse vaccines. We won't 237 00:13:08.000 --> 00:13:09.760 do that for the long auwe and you know in 238 00:13:09.800 --> 00:13:11.800 our state they're required for school. 239 00:13:12.559 --> 00:13:15.560 So when you say there is a lot of evidence 240 00:13:16.080 --> 00:13:19.840 behind vaccines, which I agree that there is. Can you 241 00:13:19.920 --> 00:13:21.680 say a little bit more if you know parent coms, 242 00:13:21.720 --> 00:13:22.920 they say, well, what do you mean, there's a lot 243 00:13:22.920 --> 00:13:25.680 of evidence like what you know, I've heard blah blah 244 00:13:25.840 --> 00:13:28.600 whatever it is like when you talk about evidence there, 245 00:13:29.000 --> 00:13:30.120 what does that evidence look like? 246 00:13:30.800 --> 00:13:32.960 Well, then you have to get into the individual vaccines 247 00:13:33.000 --> 00:13:35.960 because you can't like talk about like I mean overall, 248 00:13:36.120 --> 00:13:38.160 what I would say is vaccines are one of the 249 00:13:38.160 --> 00:13:42.160 best studied interventions that we have in medicine. But like 250 00:13:42.880 --> 00:13:45.640 you know, then you have to talk about individual vaccines 251 00:13:45.640 --> 00:13:47.800 and what the evidence is for what they do. And 252 00:13:48.200 --> 00:13:50.800 there's different things that vaccines can do. They can prevent 253 00:13:50.840 --> 00:13:54.960 you from getting disease. They can attenuate, which means to 254 00:13:55.080 --> 00:13:57.360 lessen the strength of a disease, so like you still 255 00:13:57.400 --> 00:13:59.960 get the disease, but not as strongly. They can prevent 256 00:14:01.320 --> 00:14:05.120 spread of the disease, or you know, in the best cases, 257 00:14:05.480 --> 00:14:07.679 they can get rid of the disease from the planet, 258 00:14:07.800 --> 00:14:11.880 which we've done once right spa box We've gotten rid 259 00:14:11.920 --> 00:14:15.120 of all completely, and we're we were pretty close to 260 00:14:15.160 --> 00:14:18.640 polio being you know, gone from the planet, and now 261 00:14:18.679 --> 00:14:21.080 it looks like that's not going to happen. In the 262 00:14:21.080 --> 00:14:24.800 near future. But so I have an ability to talk 263 00:14:24.880 --> 00:14:27.800 about pretty much each vaccine, some of them I know 264 00:14:27.880 --> 00:14:31.120 better than others, just because I've goven the speech more times. Right, 265 00:14:31.240 --> 00:14:34.360 Like I have less patients to question some vaccines than others. 266 00:14:34.640 --> 00:14:36.440 The ones they question more are probably the ones that 267 00:14:36.480 --> 00:14:40.280 I have like a more refined sort of speech about. 268 00:14:40.640 --> 00:14:44.160 But again, like ultimately, like obviously it's a parent's choice 269 00:14:44.240 --> 00:14:47.840 on whether they want to vaccinate their kids, but most parents, 270 00:14:47.880 --> 00:14:52.200 after I talked about certainly the routine childhood vaccines, maybe 271 00:14:52.200 --> 00:14:56.480 not the annual respiratory vaccines, they do them, and most parents, 272 00:14:56.560 --> 00:14:58.800 I mean, honestly still most parents in my community want 273 00:14:58.800 --> 00:15:01.960 to vaccinate their kids fullies. So that's a nice benefit 274 00:15:02.000 --> 00:15:05.680 of that happens to be the patients that I work with. 275 00:15:06.240 --> 00:15:10.640 So when I think about vaccine resistance, which I will 276 00:15:10.680 --> 00:15:14.160 say in the populations that I talked to, I feel 277 00:15:14.280 --> 00:15:18.320 has noticeably gone up even in the last year, so 278 00:15:18.400 --> 00:15:21.240 the number of questions and the sort of post COVID 279 00:15:22.760 --> 00:15:25.880 and even more so in the last year, but in 280 00:15:25.920 --> 00:15:28.120 the kind of over the last four or so years, 281 00:15:28.160 --> 00:15:32.240 I have many more questions from people about routine vaccines. 282 00:15:32.360 --> 00:15:34.920 I'm curious if you hear if that's something you get 283 00:15:34.960 --> 00:15:36.040 on your team. 284 00:15:35.800 --> 00:15:40.960 Also, absolutely, but I will say more for COVID vaccine 285 00:15:41.000 --> 00:15:43.600 than the other ones, but all of them in some level. 286 00:15:43.640 --> 00:15:46.760 And I have a theory for that. And I actually 287 00:15:46.760 --> 00:15:49.800 think of what happened is if, like you know, when 288 00:15:50.000 --> 00:15:53.440 vaccines were being developed during COVID, we all were one 289 00:15:53.680 --> 00:15:56.320 in like we had a lot of time on our 290 00:15:56.360 --> 00:15:59.800 hands at home, and we were all thinking about vaccines 291 00:16:00.000 --> 00:16:03.280 because we were all excited about vaccines, and we all 292 00:16:03.320 --> 00:16:06.240 wanted a vaccine to be good and come out quickly. 293 00:16:06.720 --> 00:16:09.680 And then when they started coming out, we had like 294 00:16:09.720 --> 00:16:14.000 comparative analysis like should I get Maderno or Johnson and Johnson. 295 00:16:14.440 --> 00:16:16.880 People spent a lot of time thinking about vaccines and 296 00:16:16.920 --> 00:16:20.120 trying to get their vaccines. I mean in some communities. 297 00:16:20.160 --> 00:16:22.560 Many communities get their vaccines as quickly as they could, 298 00:16:23.560 --> 00:16:27.560 and I think they got used to doing a deep 299 00:16:27.600 --> 00:16:31.120 analysis of the very minor change differences and cost benefits 300 00:16:31.480 --> 00:16:34.760 of different vaccines or different vaccine schedules. You'll remember like 301 00:16:34.800 --> 00:16:37.120 people talked about whether you should have it at four 302 00:16:37.120 --> 00:16:39.200 weeks afterwards or if you should wait a little bit longer, 303 00:16:39.440 --> 00:16:42.040 And there was just a lot of like public discussion 304 00:16:42.120 --> 00:16:46.560 of every nuance of giving a vaccine. Before that, I 305 00:16:46.560 --> 00:16:49.080 think that most parents sort of mindlessly went to their 306 00:16:49.120 --> 00:16:51.880 dock and said, oh, it's vaccine time. Cool, tell me 307 00:16:51.920 --> 00:16:56.520 what I need to get, and then they got in 308 00:16:56.520 --> 00:16:59.080 the habit of doing their you know, their own analysis 309 00:16:59.080 --> 00:17:02.480 on it, which led to you know, more and more questions, 310 00:17:02.520 --> 00:17:05.640 which leads to longer conversations, which led to some resistance 311 00:17:05.680 --> 00:17:08.560 in some areas, and you know, and specifically with the 312 00:17:08.560 --> 00:17:11.520 COVID vaccine. I think there's also like this almost like 313 00:17:11.720 --> 00:17:14.159 it's somewhat illogical, but there's almost this thing like I 314 00:17:14.200 --> 00:17:16.760 want to be done with the pandemic, and one day 315 00:17:16.880 --> 00:17:19.760 being way of being done with the pandemic is just 316 00:17:19.840 --> 00:17:22.280 like I'm not doing the vaccine anymore either, because that's 317 00:17:22.359 --> 00:17:23.520 part of the pandemic. 318 00:17:24.480 --> 00:17:27.520 It's interesting. I have a different theory, although your theory 319 00:17:27.560 --> 00:17:30.000 is a very interesting one. I think there's a piece 320 00:17:30.000 --> 00:17:32.280 here that I totally agree with, which is people got 321 00:17:32.320 --> 00:17:35.000 into this habit of like I now, now I'm an 322 00:17:35.040 --> 00:17:37.920 epidemiology expert, now I'm a vaccine expert, Like I've spent 323 00:17:37.960 --> 00:17:42.240 all my time doing this, and I think that's that happened. 324 00:17:42.440 --> 00:17:44.840 And the other thing that happened, which I think is 325 00:17:44.960 --> 00:17:48.440 some has a portion of fault to some extent of 326 00:17:48.760 --> 00:17:51.800 public health. I've talked about this before, is after that 327 00:17:51.880 --> 00:17:56.359 initial vaccine wave, when we then got into these the 328 00:17:56.480 --> 00:18:01.880 current state of boosters. I think that peopleeople are feeling 329 00:18:02.080 --> 00:18:06.440 attacked when they are raising concerns that they view as 330 00:18:06.520 --> 00:18:11.040 very valid and some of which I think are reasonable. 331 00:18:11.320 --> 00:18:13.119 So you know, for example, there are a lot of 332 00:18:13.160 --> 00:18:15.760 people who would say, now like I don't know why 333 00:18:15.520 --> 00:18:19.440 my seven year old needs a fourth booster, Like they 334 00:18:19.440 --> 00:18:21.680 already had a bunch of they've had COVID four times, 335 00:18:21.840 --> 00:18:24.400 they've had all of the shots. You know, Europe doesn't 336 00:18:24.440 --> 00:18:27.280 give boosters, do why is the CDC saying this is 337 00:18:27.280 --> 00:18:30.800 so important? And then they feel like, well, I don't 338 00:18:30.800 --> 00:18:34.000 really agree with this. It doesn't seem reasonable, And then like, 339 00:18:34.119 --> 00:18:35.959 let me think about it, like why do I need 340 00:18:36.000 --> 00:18:38.159 the measles vaccine? And I think for me, that's a 341 00:18:38.200 --> 00:18:41.199 little bit of a failure because I actually think it 342 00:18:41.200 --> 00:18:43.840 should be totally reasonable to say, like, your kid gets 343 00:18:43.840 --> 00:18:45.680 the measles vaccine, but also they don't need a fourth 344 00:18:45.680 --> 00:18:48.120 booster because the value of that for a healthy kid is. 345 00:18:48.080 --> 00:18:52.320 Small, Right, I guess the logical fallacy I see there 346 00:18:52.400 --> 00:18:56.600 is they've also had like eight influenza vaccines in their life. 347 00:18:57.359 --> 00:18:59.720 So the way I explained it to families is, I 348 00:18:59.760 --> 00:19:04.240 think today the logic behind doing the annual resiratory vaccines 349 00:19:04.240 --> 00:19:07.000 which are now COVID and flu is the same for 350 00:19:07.080 --> 00:19:10.920 each other, right And like there's there's minor differences there, 351 00:19:10.920 --> 00:19:12.719 and we can talk through them and why, you know, 352 00:19:13.240 --> 00:19:16.760 But but they each do three things, and I think 353 00:19:16.840 --> 00:19:19.760 those three things are really important to keep in mind. 354 00:19:20.480 --> 00:19:23.920 And I mostly vaccinate for the third. In the case 355 00:19:23.920 --> 00:19:27.760 of these like healthy elementary school and high school students. One, 356 00:19:28.200 --> 00:19:29.920 you know, they make you a little bit less likely 357 00:19:29.960 --> 00:19:32.080 to get the disease, but not a ton less likely, 358 00:19:32.480 --> 00:19:34.399 right Like, And it depends a little bit on the timing, 359 00:19:34.400 --> 00:19:37.720 and it depends on each individual booster and whether that 360 00:19:37.760 --> 00:19:40.320 particular booster matches the particular strain that happens to be 361 00:19:40.359 --> 00:19:44.919 around during you know, during the next bump. But it does, 362 00:19:45.160 --> 00:19:49.199 you know, and we know that from data two, it 363 00:19:49.280 --> 00:19:52.240 attenuates the disease. And again that means still less than 364 00:19:52.240 --> 00:19:53.680 the strength of it. And I'll give you a great 365 00:19:53.680 --> 00:19:56.159 example that I have just from like two weeks ago. 366 00:19:56.520 --> 00:19:58.639 I had and this is from flu. But I had 367 00:19:58.640 --> 00:20:00.679 a thirteen year old and a twenty year ol and 368 00:20:00.760 --> 00:20:04.320 flu has been brutal to the last few weeks. Yeah, yeah, 369 00:20:04.440 --> 00:20:07.359 And I had a thirteen and twenty year old sisters 370 00:20:07.359 --> 00:20:11.760 who I knew forever and and really great relationship with 371 00:20:11.760 --> 00:20:16.200 their family and loved these two girls. And they both 372 00:20:16.240 --> 00:20:19.440 came with fever. The thirteen year old had had fever 373 00:20:19.520 --> 00:20:22.119 for one day and actually had was resolved, and she 374 00:20:22.240 --> 00:20:24.119 was like laughing at my jokes, and the twenty year 375 00:20:24.119 --> 00:20:26.080 old was lying on the exam table mad at me 376 00:20:26.160 --> 00:20:28.680 for making her laugh because she was in so much pain. 377 00:20:28.760 --> 00:20:31.520 It was their sixth day of like one hundred and 378 00:20:31.560 --> 00:20:33.960 four fevers. And it just turned out like that she 379 00:20:34.000 --> 00:20:35.720 hadn't got her flu vaccine that year because she was 380 00:20:35.760 --> 00:20:37.480 off at college and she forgot to, and her thirteen 381 00:20:37.560 --> 00:20:40.560 year old sister had and like not doesn't get into 382 00:20:40.600 --> 00:20:44.520 any study, right because from a study standpoint, the outcome 383 00:20:44.560 --> 00:20:46.520 for those two kids is neither went to the er, 384 00:20:47.000 --> 00:20:50.040 neither were hospitalized, neither endo the ICU, and neither died. 385 00:20:51.440 --> 00:20:56.040 But the lived experience of flu after vaccination is office 386 00:20:56.520 --> 00:21:01.280 often much less serious, like not serious in terms of 387 00:21:01.320 --> 00:21:03.719 like I'm worried about your long term health, but serious 388 00:21:03.880 --> 00:21:06.760 that week for you as a family than it is 389 00:21:07.840 --> 00:21:11.199 with no vaccination that year. And the same thing can 390 00:21:11.240 --> 00:21:13.879 be a said of COVID, right like, so we you know, 391 00:21:14.000 --> 00:21:17.680 now COVID seems to be right now, a more mild 392 00:21:17.760 --> 00:21:21.680 disease than flu A for kids in general, Like I 393 00:21:21.720 --> 00:21:24.080 don't see the high fevers and the really ill. You 394 00:21:24.119 --> 00:21:27.159 do seem like really tired and a lot of cough, 395 00:21:28.040 --> 00:21:30.560 and the tired is like out of proportion often with 396 00:21:30.640 --> 00:21:32.639 the height of the fever, which we you know with 397 00:21:32.720 --> 00:21:39.080 fluids seems more sort of aligned. But again, like I 398 00:21:39.119 --> 00:21:42.000 think it's hard to measure these things and studies because 399 00:21:42.040 --> 00:21:45.080 they're not the outcome. Studies are looking at the second thing, 400 00:21:45.640 --> 00:21:48.399 you know, besides longer the risk of getting the diseases 401 00:21:48.400 --> 00:21:52.720