Shared Decision Making Between Patients and Doctors Improves Outcomes

PaternalismHenry David Thoreau said: “(if) a man was coming to my house with the conscious design of doing me good, I should run for my life.”

When I was in medical school 30 years ago, one of the doctoring styles most looked down on was that called paternalism. Paternalism in medicine can be defined as the practice by doctors (those in positions of authority) of restricting the freedom and responsibilities of patients supposedly for their own good. It is a “Doctor knows best” approach that denies the patient decision making rights regarding their health care.

I have been horrified in the last few years to see my profession completely turn it’s back on patients and adopt the despicable practice of paternalism when it comes to vaccines. The entire concept of informed consent seems to have been thrown out the window when it comes to vaccines. All doctors are saying now is, “it’s time to do your vaccines,” as they hand patients a CDC glossy that literally glosses over the side effects and negative effects of vaccines while magnifying the horrors of the diseases the vaccine might protect against. The paternalistic doctor would then make some disparaging comment about parents who don’t care enough about their children to decline such a life saving procedure as the vaccine in question. Faced with this, most buckle. Score one for the “doctors know best” and the pharmaceutical company that has masterfully manipulated the data to magnify the benefits of their vaccines while carefully designing studies not to show the side effects that often come years later, or are so rare that they are missed in the small studies.

With paternalism there is a conflict of two important values:

  1. The value we place on the freedom of persons to make their own choices about how they will lead their lives.
  2. The value we place on promoting and protecting the well being of others.


I happen to like helmet laws and seat belt laws. They could be considered paternalistic as it is the state mandating a behavior that really is for your own good. The reason I’m OK with them is that I really can’t find any downside to wearing a seatbelt or helmet. If there were a down side, then I would vote that we leave the decision to the individual.

So, what about smoking, the number one killer in the world? Why don’t we have a paternalistic stance and ban the stuff?

When it comes to medical recommendations, there is almost always a need for informed consent. There are pros and cons to the procedure. This is where paternalism is a very bad thing. This is what I was trained to watch out for, and I’m sure my peers were too. At the top of medical ethics committees are these types of questions: “is it ethical to mandate this treatment?” or “what would the patient decide using common sense and the current knowledge?”

Shared decision making, in which doctor and patient exchange knowledge concerning the patient’s disease and its treatments, discuss treatment options, and jointly choose one, or decide to do nothing, is the gold standard for how we as doctors should approach all decisions. Studies show that patients prefer shared decision making and informed consent when faced with medical decisions. You can read more about this here… and here…

Parents and citizens of the world, we are at risk of losing our medical freedom if we roll over and ignore the assault on these freedoms that is coming in the form of mandated medical care. The most obvious example of this paternalistic medical abuse is in the arena of vaccines. If the medical procedure of vaccines is mandated by the state, then we no longer have medical freedom, we no longer have the freedom to choose our medical care, and we have crossed over into a very dangerous practice of State mandated medical procedures!


Dr. Paul


Is Your Television Killing You?

tvAs a pediatrician, I’m constantly reminding parents to limit their children’s screen time. We try to keep children under two as screen-free as possible. The whole family is better off health wise, especially the children, when non-education video game playing, mindless Internet surfing, and passive solitary TV watching is limited.

Now a recent study, “Causes of Death Associated With Prolonged TV Viewing,” published in the American Journal of Preventative Medicine, suggests that TV watching is bad for grown-ups as well.

A team of researchers from the National Cancer Institute in Bethesda, Maryland, followed nearly a quarter of a million healthy 50 – 71 year olds for an average of 14 years. They found that those adults who watched between three and four hours of television per day were 15 percent more likely to die from any cause than those who watched less than one hour of television per day.

Even more disturbing, adults who watched seven or more hours of TV a day were 47 percent more likely to die than those who watched less than an hour a day. 

Diseases significantly linked to increase TV time include cancer, heart disease, chronic obstructive pulmonary disease, diabetes, influenza/pneumonia, Parkinson’s disease, liver disease, and suicide.

The take-away message: Watching television is bad for your health.

Is TV bad in and of itself? The researchers aren’t saying that. But we all know that watching television is a solitary, isolating occupation that keeps you sedentary. Sitting in front of the boob tube reduces the time you have available to exercise, interact with your family, read books, and be outdoors. This new research dovetails with other studies, which have linked excessive TV time to obesity and higher rates of cardiovascular disease.

I’ve been talking to parents about their kids but the most important message may be for parents and grandparents: watching too much television can jeopardize your whole family’s health.

This new study should be a wake-up call to all adults. Stay active. Go outside. Spend time with your spouse and your children with the television off. Read a book and do crossword puzzles to stimulate your imagination and your brain. Reduce your screen time as much as you can.

The National Cancer Institute researchers suggest that watching TV is a public health issue. The price we are paying for our technology-driven lives may be much higher than we previously realized.

Now please excuse me while I switch off the tube.


Dr. Paul




Dr. Paul Thomas, M.D. is a board-certified pediatrician and an addiction specialist. He has over 11,000 children in his integrative practice based in Portland, Oregon. Subscribe to his YouTube channel, and follow him on Facebook.


What Makes For a Lasting Marriage? Gratitude. Keep a Finger on the Pulse of Your Persons’ Emotions

weddingWe all want to have a happy marriage, one that lasts, that endures through the good and the bad, sickness and health, times of plenty and times of hardship. So what is the key to a long and happy marriage?

In the study, “Linking financial distress to marital quality: The intermediary roles of demand/withdraw and spousal gratitude expressions” a few key points become clear.

  • Demanding things, change, and/or withdrawing your love and affection is a negative conflict pattern that harms your marriage.
  • Feeling appreciated and believing that your spouse values you directly influences how you feel about your marriage for the better.
  • Financial distress is a big cause of marital problems
  • Gratitude, saying thank-you has a powerful protective effect that can overcome most negatives in a marriage.

You can read this study here…

I am one of the luckiest men on earth when it comes to marriage. My wife Maiya adores me, she appreciates me, she is always expressing gratitude for our relationship, for me, for things I may do, for what we have as a couple. I feel the same about her. She reminds me how those times when I check on her emotional well-being are so important. I haven’t always done well with complements, they make me nervous. Something for me to work on. Once, after she was showing gratitude when I was genuinely concerned and she felt the love, I responded, “I keep my finger on the pulse of your emotions“. We’ve used that sentiment often.

Be grateful, not just for things done for you, but just for being together. This gets to the heart of the unconditional love that is the glue. I love being with you. Thank-you for holding my hand. Thank-you for loving me. Thank-you for sharing this life journey with me.

Parents- this works for kids too. Show them love and gratitude just for being in your life… and watch them light up!


Dr. Paul


The Measles Epidemic That Isn’t! Infectious Diseases Society of America Seems to Be in The Business of Fear-Mongering

scaredycatIn the press release, “One in 8 children at risk for measles, analysis shows,” (which you can find here… ) the Infectious Diseases Society of America plays with numbers and statistics to promote a sense that we are in some imminent risk of a measles epidemic. They lead off with, “gaps in measles vaccination rates place one in eight children at risk for becoming sick from the highly contagious illness, according to an analysis of national vaccination coverage being presented at IDWeek 2015™. Measles can lead to pneumonia, encephalitis, hospitalization and occasionally, death.”

They present that, “nearly 9 million children – infants through 17 – are susceptible to measles primarily because they haven’t received the measles, mumps, and rubella (MMR) vaccine, or have received only one of the two recommended doses.” Since the first MMR vaccine cannot be given until 12-15 months of age, and the second MMR is given at 4-6 years of age, and we have almost 4 million births a year in the USA, obviously there will be about 4 million who have not had the vaccine each year even when they are following the CDC schedule.

They make a big deal saying, “nearly one in four children aged three or younger are at risk, the study found.” Well if you are looking at those 0-3 years old and you have to be 12 months old to get the vaccine, then it should be 1/3 who are not vaccinated and thus at risk! We know from past studies that one vaccine is 95% effective. This leaves 5% of those who got their first vaccine on schedule at 12 months vulnerable until they get their second vaccine at age 4-6 years. The authors of this study know this, but play with these numbers to make it seem like there is some crisis on the horizon as more parents learn about the risks of the MMR and choose to delay or skip this vaccine.

A look at countries that have had significantly lower rates of immunizations, such as England in the past couple decades, shows that there are slight increases in the numbers of cases but very few deaths. We are not on the verge of some measles epidemic.

This type of “study” is no more than a ploy to frighten the population into getting the MMR on schedule regardless of your risk factors and regardless of other information that suggests the MMR may be associated with significant risks.

A look at the CDC data found here shows that the “epidemic” of measles that was blamed on Disneyland is over. Measles rates for 2015 have basically returned to baseline. We have had no deaths in the USA the past decade associated with measles infections. The Disneyland epidemic was hardly a blip on the map of measles infections.


One should remember that measles in the 1800’s was epidemic and had a high fatality rate. Prior to the introduction of the MMR in 1963, measles was almost nonexistent in the USA. While the MMR gets most of the credit for the huge reduction in measles, in fact it has been improved nutrition and sanitation that has been responsible for the eradication of measles. The book, “Dissolving Illusions, Disease, Vaccines and the Forgotten History,” by Suzanne Humphries, MD and Roman Bystrianyk provides excellent data and references for those wanting the facts.

I suspect our children and society would be better served to have the MMR being given at age 3 rather than to babies 12-15 months old, and we could then check measles titers (IgG) at age 4-6 years to determine what percentage of children might need a booster dose. This approach would result in far less side effects and probably provide more than adequate herd immunity to prevent measles from spreading through the community.

What we need from our infectious disease experts is a willingness to challenge the status quo when it comes to the vaccine schedule. We need to look at long term comparative schedules, and track immunity and side effects from vaccines. Sadly, vaccines are added, and added, and then more are added to the CDC schedule. There is never a long term analysis of how children do who are unvaccinated, partially vaccinated, or fully vaccinated. Until such studies are done, it seems we are stuck with the best minds being forced to come up with reasons we should continue business as usual and give all the vaccines to all the children.

We hear over and over the mantra, “vaccines are safe and effective”. Of course everyone knows that some children suffer catastrophic side effects. Some are triggered into autism. Some die. Many are suffering from a new syndrome ASIA (Autoimmune Syndrome Induced by Adjuvants). Should we accept this as the cost of doing business?

Who pays the price when a child is damaged by a vaccine? I assure you that it is not the infectious disease experts that make the vaccine schedule recommendations, and not the companies that manufacture the vaccines (they are immune from liability). It is our children and the parents who must care for these children.

I’m a pro vaccine pediatrician. I’m also not a fan of the MMR before age 3. I’ve heard too many times the sad story of a child who was completely normal at age 1 year, who regressed into autism after the MMR vaccine. You’ll read that it’s been proven there is no link. Tell that to the families in my practice who watched this happen before their eyes. Tell that to CDC researcher Dr Thompson (whistle blower) who felt compelled ethically to risk his career and expose that the data that showed no link between the MMR and autism had been manipulated. The data that showed a link was excluded after the study was done, intentionally, to make sure the paper could present data that showed no link.


Measles is not a significant risk here in the USA. We have had no deaths – NONE – caused by measles in the past decade. Meanwhile, back at the farm, we have seen the autism rate jump from 1 in 10,000 to 1 in 67. It’s not just the MMR responsible for this, but what if it is part of the puzzle?

Infectious disease doctors don’t see autism, developmental delays, and the host of chronic disease our children are experiencing. At least they don’t see it as in any way linked to the vaccine schedule they promote. You can’t see what you don’t look for! Studies will come showing the huge improvement in health for the selectively and unvaccinated children. What will be important is that we not throw out the baby with the bath water. Vaccines have been a huge benefit to society and our children. We simply must individualize and selectively vaccinate.

Minimize the injection of toxins, by NOT getting the Tdap while pregnant, and don’t give the Hepatitis B vaccine to infants whose mothers do not have Hepatitis B. Wait until age 3 to give the MMR. Consider delaying the Hepatitis A vaccine until your child is school age, if at all. Only give one aluminum containing vaccine at a time. There are risks and benefits to these recommendations. Discuss them with your physician.



Dr. Paul



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