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 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.
(BEGIN TEXT OF INFOBOX)
A shot in the arm
These are some of the immunizations recommended for children between birth and two years of age.
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
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