Monthly Archives: March 2009

A premature reply-turned-post, breastfeeding style

I haven’t read the original article, “The Case Against Breastfeeding” in the Atlantic. I am not sure if my stress levels can handle it. I am started with a link to it on Alas, a blog. I am planning on thoroughly enjoying a critique of the Rosin article and her manipulation and misquoting of statistics on the U.S. Food Policy blog. From what I have read (I would have to look this stat up again) there are hundreds of studies a year published that confirm the advantages of breastfeeding. It is easy to hand pick a few with the weakest results and say the evidence is “thin”.

But, that didn’t stop me from posting a reply on the post I did read on Alas, a blog:

One of the main problems I have with a lot of the discussion about breastfeeding is that it is a health care decision. It is not a lifestyle decision or a social decision. Of course, as in any other health decision, there are many cultural and social aspects involved. But, whether one is a stay at home mom or works is not in the Healthy People 2010 goals. Increasing breastfeeding rates is, for a good reason.

There are absolute, irrefutable health benefits to breastfeeding for the mother and infant(s) (congrats on the twins!) that are not on the same level as “talking about the advantages of breastfeeding makes me, a formula feeding mom, feel guilty”. (See Mommy Wars Bingo). Breastfeeding is and should be the way that one is supposed to feed infants, barring any health issues that are contraindications. Just like a vaginal delivery is the healthiest way to deliver a baby, barring any health reasons that are contraindications. Of course there are complications and exceptions, but that is true for every health decision, from aspirin to knee replacement surgery.

It is of course relevant to discuss the greater social aspects of breastfeeding, but it seems like the conversation is always dominated by this topic, and whenever it is brought up as a health discussion, people want to negate that aspect of the discussion by saying the social aspects are more important.


I found an even better reply! This is from the US Food Policy post:

Hanna Rosin did not quote from the wide body of literature on the risks of formula feeding. Breastfeeding is the normal state of feeding an infant. It confers no benefits — it is the norm. The risks and costs of alternatives are what need to be assessed.

First, she uses sleight of speech to disparage a wide body of doctors who contributed to the American Academy of Pediatrics Policy Statement on Breastfeeding and the Use of Human Milk. She provides no evidence whatsoever to support her statement about these doctors have an agenda. Conflict of interest in the medical arena usually involve payments of large sums of money from those who have commercial interests to those who are making statements. No one pays doctors to make positive statements about breastfeeding.

Second, if you look at the American Academy of Pediatrics statements, she avoids the conditions for which there is solid evidence that there is an increased risk from formula use including bacterial meningitis, bacteremia, diarrhea, late onset sepsis in preterm infants, necrotising enterocolitis, urinary tract infections, and postneonatal mortality. Solid — meaning lots of credible studies. Since I started an MHS at Hopkins in 1983 through completing a doctorate in Nutritional Sciences at Cornell in 1993, I literally read THOUSANDS of credible studies — and there are tens of thousands out there. I have stacks of meta-analyses under my desk and I reach very different conclusions

What she tackles in her article one condition among the many conditions of the “suggestive” research that is very hard to prove. This is the realm of SIDS, asthma, diabetes I and II, overweight and obesity, hypercholesterolemia, Hogkins, lymphoma and leukemia. These conditions are multicausal. It is very easy to design a study poorly and not see results and very hard to design a good study to find the causal links because the many of the effects are modified by other effects.

But even if all of this suggestive research turns out to not be so suggestive, what about the solid research? And she did not even site the risks to women when they don’t breastfeed.

Now, why is it that someone like Hanna Rosin with no science background at all can call into question what is a huge body of research by mentioning one little sideline of the many studies that show an increased risk of disease from use of formula? Does she have better qualifications than MDs that have no conflicts of interest that wrote the policy statement?

As for the economic analysis of a breastfeeding, the World Bank tried such an approach many years ago with their Disability Adjusted Life Years. I worked on the protein energy malnutrition section. This approach was deeply flawed in that there was no way to include the fact that some interventions provide multiple benefits. Those interventions that addressed a single disease showed up better than those that addressed many diseases and had multiple benefits because the economic models were inadequate to deal with multiple benefits.

In terms of the costs of breastfeeding, what we are really talking about is the costs of caregiving. Babies need contact and interaction. Breastfeeding is but one way to provide this while at the same time providing food. What unfortunately has happened during the years when women were discouraged from breastfeeding is that we adopted feeding modes that are unhealthy for infants. I would love to work with exclusively formula feeding mothers to assist them to do what I do with mothers that have had breastfeeding problems — that is “mimic normal infant feeding” and “mimize risk”. The culture has adopted unrealistic expectations for the frequency and length of infant feeding as well as the amount of interaction that is really needed. In the past, women were in communities where sharing of childrearing with close kin members was far more common. Woman also did their productive activities in close proximity to their children so the displacement to feed their infants while working was not as much of a problem. Now women are expected to do it all on their own and conduct their income generating activities in a separate environment from their infants. The segregation of mothers from their infants does come at a cost.

Finally, the real clincher that everyone forgets about is that we had a healthier alternative in the past. Wet nursing was acceptable and available. Your sister could feed your infant to give you a break and no one would bat an eyelash at the practice. Now, in our super sterile environment where we confuse an infant’s normal food with yucky body fluids — such an idea is usually met with shock and horror.

Yet, human donor milk has been shown in many studies to be less risky than formula.

As for her assumption that only formula feeders are given a hard time, I beg to differ. If you took a sample of 1000 women, I am dead certain that 100% of that sample would say that their infant feeding choice has been criticized, regardless of what choice they made. If you took a sample of 1000 women on any parenting issue, you would find the same results. BUT, there is a false equivalency in this statement. If you looked at the degree of negativity in the “criticism” you would find that the most negative, disgusting comments are reserved for women who nurse in public. There is a huge degree of Lactaphobia in the culture due to the sexualization of the breast. You would never get away with saying that African Americans, homosexuals, the elderly, Jews, Muslims or any other group would have to eat in the bathroom. Yet, routinely, women are told that the only place their infants can eat normally is in the bathroom.

Hanna Rosin doesn’t have the credibility to debunk the vast body of literature that I have read with her brief skimming of a few choice articles. She merely follows formulaic rules for justifying a billion dollar industry that took away choice from women for several generations and wants to perpetuate myths the risks of their product.

A better analogy than smoking is diabetes. Would you give insulin to someone without diabetes? No. Would you tell someone with diabetes that they are just as healthy as someone without it? No. Would you hesitate to give insulin to someone with type I diabetes? No. Would you tell them it was poison. No. Would you try to get someone with type II diabetes to eat better and excercise? Yes. If they still needed insulin, would you give it to them? Yes. Would you still work to help them overcome barriers to diet and exercise? Yes. Would you call health care practitioners that spoke frankly about diabetes “fanatics” or “nazis”? No.

Most of the discussion of infant feeding is highly irrational and overly emotional.

In the meantime, I will continue to assist women with pragmatic solutions to mimic normal and minimize risks of feeding their infants tailored to their own specific situations.

Susan E. Burger, MHS, PhD, IBCLC, RLC


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My conscience clause comment

My comment to the Department of Health regarding the proposed rescission of the Bush era conscience rule. For information on making your own comment, please visit Rachel at Women’s Health News.

This comment is in regards to the rescission proposal.
I am a medical student, a future ob/gyn, a mother, and a concerned citizen. I think there was no current need for the new conscience clause ruling. The former HHS secretary, Mike Leavitt, purposefully mischaracterized the state of licensing for ob/gyns in order to forward a political ideology. The American Board of Obstetrics and Gynecology publicly demanded that the HHS show even one case of discrimination against a practitioner who exercised his or her right to refuse to participate in an abortion, and Secretary Leavitt was unable to produce even a single example.

The Obama administration states that it is committed to changing the unfortunate recent history of overlooking science and truth in order to advance political ideology in health policy. In fact, most of these decisions have been based on opinions that only represent a minority ideological belief of the citizenry. The rescission of this ruling is imperative to reestablish faith in our national health policy.

The current conscience legislation is already too overreaching. I am concerned that requiring health care entities to pre-certify that they do not discriminate in hiring, specific to conscience refusal, will hamper the ability of certain organizations to fulfill their mission statements. For example, in my high risk area, South Florida, the Department of Health has family planning clinics established and funded for the sole purpose of providing birth control to the underserved. With the climate encouraged by this recent legislation, it is entirely plausible that these facilities would be forced to hire employees that are opposed to birth control.

In fact, some sections of the rule do not refer to abortion at all, and could be construed to apply to any practice that a potential employee finds unethical. Birth control is not abortion according to medical definitions of pregnancy and the methods of action of birth control, but many extremists see forms of birth control as abortion, and the law caters to such a worldview. How long until observant Christian Scientists are applying for jobs at surgery centers with the intent of obstructing surgical procedures? It seems like this rule is likely to increase costly lawsuits. It also seems like health care entities will be almost forced to hire employees that will expressly NOT fulfill their job duties in order to avoid such lawsuits. Where is the pressing need to increase such lawsuits? In actuality, there is a pressing need for more abortion providers and more contraception access, not less. There is a pressing need to reduce health costs, not increase them. There is a need to increase common ground, not accentuate difference and encourage uncooperation when there is already more than adequate provisions protecting conscientious objection in health care.


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Reply turned post, bloggers unite! style

Thanks to a tip from Feministing, I found this column on Mother Jones about the Future of Abortion Providers. I agree with the idea that we need more feminist activists and more abortion providers. I don’t agree that calling feminist bloggers sluts is the way to do it.

Here is the reply:

Blogging and activism are not mutually exclusive. In fact, I blog, I joined Facebook because my medical school class had a group on there, and I am a member of Medical Students for Choice. I am one of those future abortion providers you want so badly. I am also a young (well, not so young, but still…) feminist.

I think the problem with convincing people to become abortion providers is a lack of dialogue on the subject, which makes it easier for medical students (and the rest of the public with whom they interact) to dehumanize women who get abortions. Women most certainly do not talk about it in person, if you haven’t noticed. Do you know the most effective way I get involved in changing the dialogue about abortion? Through blogging and on message boards. I can talk to one medical student at a time, one person at a time face to face. I get hundreds of hits a day on my blog right now.

I agree with your cause. I don’t agree with your methods. Slut-shaming young feminists is not going to create future abortion providers. What are you doing to support MY future as an abortion provider? I am lucky to have my in laws pay for my younger son’s day care, and my mother pays my car bills, and we still struggle for me to stay in medical school. And this is with me taking out the maximum in loans. I will be graduating with about $300,000 in debt. This is not even considering the money I will have to pay in malpractice in ob/gyn on top of my loan payments.

And where is the money come to pay for abortion services? Are YOU fighting for reimbursement of abortion and contraception by insurance and Medicaid? Do you know how I stay informed and fight for issues such as that? On (gasp!) blogs!

Please, find a better way to help me out.

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Vagina Monologues

One of my classmates at mendical school is an amazing amateur photographer. He put up photos of the Vagina Monologues on Flickr. I am the narrator, so I am the pudgy brunette who is sitting on the stool with the music stand in front of her in a lot of the pictures.



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Reply turned post, but what about the CHILDREN?? style

This is one of those three way mirrors kind of posts. I am reply -turned – posting to a reply – turned – post. PhD in Parenting has a post about a post on Blog it out, Bitch about how breastfeeding in public somehow forces disapproving parents to talk about breastfeeding with their children before they are ready and willing.

My response (with a few typo / grammar edits *twitch twitch*):

Great post!

I really have a problem with the idea that breastfeeding in public is forcing parents to discuss something with their children before they are willing. It is the same exact argument being used by parents protesting a host on a British children’s show who has a congenital deformity of one of her arms.

No one can force someone to have a discussion with her child before she is ready. I have an IUD pin on my white coat (I am a medical student who plans to practice Ob/gyn.) . When my son said “You have a pogo stick on your white coat!” I said “Yes I do!” because I didn’t think a discussion on birth control was age appropriate. I make these sorts of judgment calls every day. A parent who doesn’t want to discuss the TV host with the different arm can turn off the TV, say “I don’t want to talk about that” and stick her head in the sand all she wants.

Parents DO get to choose what they discuss and what they ignore. What they cannot control is the entire world around them, and the sooner they learn that, the better. And, the sooner they stop using “But what about the CHILDREN??” as an excuse to cover up their own biases and fears, the better we will all be.

Breastfeeding is in absolutely no way disgusting, sexual, inappropriate, or wrong, and I refuse to defend or accept the defense of someone who tries to pretend it is. Neither is seeing a biracial or homosexual couple together (I am not talking about sex here, but holding hands or in a book or something), a TV host with a differently abled body, or a myriad of other examples of biases people have.

I will judge women who go to restaurants with their breasts, midriffs, thongs or buttcheeks hanging out of their clothes in a sexual manner. (I live near South Beach in Miami. Not only have I seen all this at restaurants, I have seen mothers dropping off their children at school dressed like this. No kidding.) I do not pretend that there won’t be groups of parents who think my breastfeeding in restaurants was obscene, just like there are apparently people who think my judgment of women who walk around like they are auditioning for a porno is some sort of wrong attitude toward a sex positive ideal.

We don’t agree, and I can live with that. I don’t have to defned their point of view, however.


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Wish me leg breakin’

Tomorrow night our medical school’s chapter of the American Medical Women’s Association is putting on a production of the Vagina Monologues. We will be performing in a 500 seat theater, which should be more than half full, at least, and I am going to be the narrator. I am also one of the main organizers.

Wish me luck, or to break a leg, or however it goes!


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This made me tear up

(h/t to Rachel at Women’s Health News, who does her own hat tip. I am glad this beautiful, sad poem is making the rounds, and I want to help.)

From Mamita Mala

Porque No Somos Rihanna

A la mujer the other nite on 63rd Drive and the team of chicas who stepped up that night.

Porque no soy Rihanna, save a few people the night I was left bruised made a big deal of it.
Some told me I needed to leave, now.
Others told me that yes it was a big deal pero that it didn’t mean the end of the relationship.
Others said, plan mujer plan. Stay quiet and plan.
I knew what it meant to me.
I don’t know why I took a picture of the bruise left on one of my arms when I was thrown to the ground.
Somewhere in the back of my head maybe I was planning to call the police.
Perhaps it was for my own remembering, so that I wouldn’t forget.
I still haven’t forgiven.
The whispers were still there, they questions as to why I stayed for so long
as if I had a world of options available to me and my two children
y porque no me llamo Rihanna
the story isn’t one on the front pages of revistas and on bochinche shows
even though it isn’t just my story.
It’s mine and Rihanna’s and millions, millions of others.

Porque no eres Rihanna
no one took pictures of you mujer that snowy March night
even though I counted a dozen people who noticed the way he pushed you om the sidewalk
and yelled obscenities in your face.
Only three teenage girls and I stayed on the street
slowly moving towards you
figuring out if he was some stranger or someone you knew
not that that should matter.

The teenage girls and I would not leave you.
We asked if you were ok and if we could do anything.
You said yes
to call 911.
That he was drunk.
The two of you moved towards the closing doors of the fast food restaurant
where again
people watched
pero did nothing
porque you weren’t Rihanna
no one took a picture.

I stood in between you and him
as he he spit how you were his wifey.
I told him that was no way to treat wifey.

In the end you decided that you didn’t want to wait for the police
that you wanted to go home with him
and you did
and the teenage girls and I watched quietly
motionless in the street
hoping and praying it would all be ok for you.

Pero porque no somos Rihanna
no one talks about the bigger picture
just the tv picture
until now

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B, I, N – G – O

I shamelessly self promote on a few websites, including on Feministe most Sundays. I always try to click through to a few of the other posts. I read this post at eriepressible(tm), and was able to mark off at least two squares on Mommy Wars Bingo. In a nutshell, the link at Feministe complains that Mommy bloggers are “unsupportive” (huh?) of childfree bloggers. Then, when you click through, she proceeds to serve up some rewarmed leftovers of childfree stereotypes that are so predictable they made it on my bingo card. I didn’t see the video she is complaining about, but I don’t feel the need to follow the trail to get to her tired stereotypes.

She is upset that some prominent mommy bloggers “do quite the half-assed job of even pretending to understand.” Understand what? That the simple fact that children exist are a problem to this childfree blogger? I am not defending that one of the mommy bloggers thinks she will change her mind about wanting to have kids. If that was it, there would be no rant here. I have never heard someone say that someone needs to be a parent to learn how to love. If anyone said something that stupid, why make up for it by serving up tired, divisive, angry stereotypes? How hard is she trying to understand what it takes to parent?

The blogger complaining about a misbehaving child in a coffee shop wasn’t complaining about all children in public, “…unless said children are behaving like ill-mannered, tantrum-throwing, undisciplined little assholes and their parents aren’t doing jackshit to alleviate that situation. Most of us don’t go around breathing fire on perfectly well-mannered children.”

Why should children be perfectly well-mannered? Adults aren’t! Should I complain about the childfree drunks that used to vomit on the table of the Denny’s when I worked the nightshift and pretend all college students were like that? What about the smokers at my medical school who sit right outside our classroom door and blow smoke on us every time we leave the classroom? I could list an encyclopedia of adult behavior I am not fond of, but I don’t need to make this a child vs. adult issue. Parents CANNOT control every move their child makes. Yes, I have even had a problem with children in a coffee shop before. It was 11 o clock at night, and the kids were running around. But, the parents were visibly drunk, laughing screechingly (much louder than the kids were playing), and had the children out way past their bedtime, which made them ill tempered and out of place. When the parents were confronted by the staff, they got belligerent. Adult behavior problem, not child behavior problem. And an exception, not the rule. Wow, some parent took a kid to a rated R movie at 11 at night. What about the other 60% of the audience or so that behaved responsibly and got a baby sitter? What about the rest of us parents that don’t go to movies very often or at all? PEOPLE can be assholes. Not just parents. Not just people under some magical age with higher standards of behavior or people who are breeders.

I wanted to reply directly to the post, but she requires registration to comment on her blog. I could see the irony of someone with “Mom” in her handle registering to post a comment on this post, so I didn’t.

She predictably blames the mommy bloggers for stereotyping, then pretends that parents screw the childfree “at every turn”, not pulling our weight in the workplace, expecting special treatment as the childfree “constantly pick up your slack.” Excuse me? I get more done than almost every childfree member of my medical school class. I have never, ever asked for more than my fair share, and have yet to see it happen in any of the many workplaces of which I have been a part. Many of my childfree classmates stumble into class late, if at all. They want days off for ridiculous things, like traveling to see their long distance lovers, or to nurse their hangovers, or just to take enough naps. Are they all like that? Of course not, and I would never, ever pretend that they were. But spare me the stereotype that all parents are traipsing off to their children’s ballet recitals constantly and asking for equal pay as their slaving childfree counterparts. My husband and I go to work and school sick occasionally because we 1. have work ethics and 2. don’t get to take our own sick days off, because we used them already for our children. We scramble for our measly support system to help us on early release days and teacher’s work days. People with disabilities, sick adult partners, sick parents who become dependents (oh my GOD the nerve!), other interests, drug habits, etc. can all ask for and need time off from work. Some people come to work and don’t work at all, like the asshole I used to sit next to who would fight with his wife loudly for half of his workday, and spend the rest of his workday looking at pictures of boats. That’s what performance reviews are for.

I can’t tell you how many times my childfree classmates tell me how overwhelmed they are when I try to get them involved in an extracurricular activity, only to proceed to talk about the yoga class they are attending later, or show me their new pedicure. I am on the executive board of three extracurricular clubs and run the HIV testing clinic for a fourth club, on top of seeking a dual degree. The president of the club that is responsible for the HIV clinic (the only club she is involved in, and it never has any activities other than the clinic) told me she didn’t want to “waste her precious free time” getting certified to do the HIV testing. They don’t have time? Fine. We all make our choices with our time. But being a breeder doesn’t make one especially more likely to ask others to pick up our slack. I make my decisions on how to juggle my time, which involves not going to her precious movies at 11 p.m., getting pedicures, or getting my eyebrows threaded. If my childfree classmates want to, good for them. But it makes me angry if one of them wants me to pick up her slack to do it. Will I stereotype all my childfree classmates as self-centered and lazy because of it? Please call me out if I do.

Eriepressible ™, there is a reason people are calling you angry and discriminatory. You sound angry and discriminatory.

I will leave off with this excellent piece from Motherlode about how a mom of a child with autism is seen by judgmental eyes while trying to check out at a register.

And, do me a favor. Work on that “understanding” thing you seem to treasure so much from others.


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Happy International Women’s Day!

Today, March 8th, is International Women’s Day. This year’s theme is: Women and men united to end violence against women and girls. I am going to celebrate by distributing fliers and coming up with the program for our medical school’s production of The Vagina Monologues.

The VDAY Foundation is a global movement to end violence against women and girls, so its purpose melds easily with International Women’s Day. 10% of the proceeds of our production will be going to the VDAY foundation, and the rest will go to our local domestic violence shelter, Women in Distress.

If you are a South Florida local, please come to the show! I am going to be the narrator. Which is a lot of fun in many ways, but it ties me to the stage for the entire production. Which makes me unhelpful at the time as a producer, but I have many, many competent women helping me out, and I am sure it will go very well.

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Well, I thought I was only going to be learning new words in medical school. But, here comes the proposal for the “rescission” (I guess that is the act of rescinding?) of the so-called conscience rule that was passed at the end of the Bush administration. The new Department of Health and Human Services (HHS) has released the text of the proposal to rescind the rule.

The recommendation for rescission will be released officially on Tuesday, and the 30 day comment period will begin at that point. I know misinformation is already being spread that this proposal will lead to health care practitioners being fired for refusing to perform abortions. The Christian Medical and Dental Association (CMDA) at my medical school sent out a letter saying just that to its members, and urged them to comment.

I will be posting a link for comment when it is available.

I have to be honest, it is hard to get worked up after reading the proposed rescission or the original rule. It is really a bunch of posturing about multiple previous laws and statutes. The main issue I have with the recently adopted rule is the requirement of health care entities that receive department funds to provide written certification that they will and do not discriminate in employment against people who would exercise a conscience objection to a procedure. It also mentions posting information at these workplaces, much like you see posters describing worker’s compensation rules by time clocks. The biggest danger I can see is in its excessive and vague repetition of what is objectionable. At several points it does not even mention abortion specifically, and these sections of the rule could easily be taken out of context and be used to support costly lawsuits by people who are opposed to many other aspects of health care, from contraception (very plausible) to surgery (not as likely, but still entirely possible).

What I see this doing is further polarizing the two sides of the debate. Eight years of radical anti choice policies by the Bush administration has pushed the conversation about a myriad of reproductive health issues to the far right. The significant need claimed in the Bush HHS rule is nonexistent, but it has succeeded in making a bunch of anti-choice advocates think there is a significant need for this legislation. The American Board of Obstetrics and Gynecology (ABOG), the licensing group for ob/gyns in the United States, was supposedly the reason why former HHS Secretary Leavitt felt the need to create this new legislation. In a released letter (pdf) to Leavitt late last year, ABOG states:

In none of our various communications with you and your Department have you provided the American Board of Obstetrics and Gynecology with “even one” instance of the discrimination of which you have publically (sic) accused it in your Press Release, let alone any supporting documentation. My careful and comprehensive review of the ABOG files does not disclose “even one” instance of a physician who was denied certification or recertification, or whose certification was revoked, because the ABOG allegedly required that physician, as you have charged, to violate his or her conscience by referring patients for abortions.

So, what is left is a group of radical anti-choicers who have been emboldened to fight new fronts in reproductive health as the lines move farther to the right, regardless of the actual need or ethics of such actions. Simultaneous to the origination of the new rule last year was the Pill Kills campaign. The fight for anti-choicers to try to justify to preserve this legislation fuels the fire, especially as Obama is is planning on signing an executive order on Monday to resume funding more lines of stem cell research. I am waiting for an even further shift to the right by anti-choicers. Since all of the various conscience clause laws will still be in effect, even if this latest rule is rescinded, I am predicting the next great front will be vaccines. I would love to see some of these activists who object to vaccines that are made with embryonic tissue start getting their hardline approach to “rabies, some mumps, rubella, chickenpox, hepatitis a, smallpox (some), ipv” more popularized. Imagine if they sue because they want to be hired to work in a pediatric clinic and refuse to administer, discuss, or refer for any of these vaccines. What if they want to work in a school office but want to refuse to handle any health forms certifying that children are up to date on these vaccines?



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