Parents’ Voices Matter: Informed Consent & Vaccine Choice

Host: Dr. Elizabeth Mumper | Guests: Dr. Paul Thomas and DeeDee Hoover

A parent who will argue with a school principal, challenge a coach, or switch dentists over a disagreement often goes silent in a pediatrician’s office. The setting changes something. The white coat carries weight. The questions stay in your head instead of coming out of your mouth, and you leave the appointment wondering why you didn’t say what you came to say.

That silence isn’t a character flaw. It’s the product of a medical system built on hierarchy, a cultural expectation that doctors know best, and exam room policies that leave little room for real conversation. For parents navigating vaccine decisions, the gap between what they want to ask and what they feel allowed to ask can be enormous.

In this episode of the IMA Weekly Webinar, Dr. Elizabeth Mumper sits down with Dr. Paul Thomas and DeeDee Hoover, co-authors of Vax Facts: What to Consider Before Vaccinating at All Ages and Stages of Life, to talk about what informed consent should actually look like, what happens when it doesn’t, and how parents can walk into the exam room prepared.

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1. Why the Exam Room Can Feel Hostile

Medical training is built on hierarchy. Medical students defer to interns, interns to residents, residents to attendings. By the time a pediatrician enters practice, that top-down authority is deeply internalized, and it follows them into patient interactions whether they realize it or not.

Dr. Thomas, who practiced pediatrics for over 35 years, describes the dynamic from the inside:

“As a pediatrician, boy, I thought I knew more than anybody until I realized I didn’t, until I had so many parents come in with so much more information than I had.” — Dr. Paul Thomas

On the other side, parents are conditioned to trust the doctor’s expertise. Many walk in believing they don’t have the credentials to question a medical professional, especially on a topic as charged as vaccines. When practice policies compound that pressure, including offices that mandate the full CDC schedule and will dismiss families who decline, the exam room can feel less like a partnership and more like a formality.

Dr. Mumper draws a distinction that matters: the difference between a physician who assumes an authoritarian role and one who works within a collaborative role. The first tells you what to do. The second helps you decide. Knowing which kind of relationship you’re in changes everything about how the conversation goes.

2. What Happens When Parents Aren’t Prepared

During the episode, Thomas and Hoover demonstrate the difference through a live role play: two versions of the same six-month well-child visit, same pediatrician, same scenario, two very different outcomes.

In the first version, a parent walks in with questions but no firm position. The doctor uses fear of disease, appeals to authority, and implicit practice policy to move the conversation toward compliance. The parent’s concerns are acknowledged briefly and then redirected. The visit ends with the parent deferring.

In the second, the parent arrives having done her research. She states her position clearly, doesn’t engage in a back-and-forth debate, and holds her ground when the pressure comes.

The difference isn’t personality. It’s preparation. A parent who has thought through their position before the appointment is far harder to pressure than one making the decision in real time under a doctor’s authority. The role play illustrates a simple principle: the exam room rewards clarity. If you know what you want before you walk in, the conversation changes.

3. What Informed Consent Actually Requires

True informed consent has three elements: the benefits of a proposed intervention, the risks, and the alternatives. According to Dr. Thomas, most pediatric vaccine conversations deliver one of the three.

“Three key elements: you need to be given the pros, the cons, and the alternatives. And what tends to not happen is the alternatives.” — Dr. Paul Thomas

The benefits are well-rehearsed. The risks are where the conversation gets thin. Thomas argues that the safety picture parents receive is incomplete, pointing to several issues in how vaccine trials are designed:

• No true placebos: Many vaccine trials compare a new vaccine against another vaccine or an adjuvant, not against an inert placebo.
• Short trial durations: Some trials last only days or weeks, too brief to capture longer-term adverse events.
• Relative vs. absolute risk reduction: Effectiveness numbers presented to parents often reflect relative risk reduction, which can make a small absolute benefit look dramatic.

Parents rarely hear about these limitations in the exam room.

The third element, alternatives, is the one most often missing entirely. Declining or delaying vaccines is a legitimate option, but it’s seldom presented as one. For many families, the first time they hear that they can say no is when they find a practitioner who tells them so.

Dr. Mumper adds a compassionate layer to the problem. Physicians who built their professional identity around vaccination face genuine cognitive dissonance when evidence challenges what they were taught. Empathy for that position doesn’t mean accepting incomplete information, but it explains why even well-meaning pediatricians struggle to have this conversation openly.

4. Practical Strategies for Parents

The panel offered concrete guidance for parents at different stages of the decision-making process:

• If you’ve decided: State your position clearly at the appointment. Don’t open a debate. Bring a partner or support person with you.
• If you’re undecided: Do your research before the appointment, not during it. A high-pressure exam room is the worst place to weigh complex information for the first time.
• If you need more time: Tell the doctor you’re still researching and need to think it through. Most offices won’t push back on a request for more time, especially if you frame it as an ongoing process.
• Before you book: Call the office ahead of time and ask whether they accept families who choose not to vaccinate. If they require the full CDC schedule, that tells you everything about whether a real conversation is possible there.
• Consider your options: Family medicine clinics, nurse practitioners, and integrative practices may offer more collaborative approaches than a traditional pediatric office.
• In the hospital: If vaccines come up during an acute care visit, redirect: “I’m here to take care of my child right now. Can we discuss vaccines later?”

Dr. Mumper closes with the simplest strategy of all:

“My friends frequently remind me that the word ‘no’ is actually a complete sentence.” — Dr. Elizabeth Mumper

For parents who aren’t ready for a definitive “no,” Dr. Thomas offers a simpler approach: ask for more time, revisit at the next visit, and keep revisiting until you’re confident in your decision.

5. What Vax Facts Argues About Risk

Thomas and Hoover’s book, Vax Facts: What to Consider Before Vaccinating at All Ages and Stages of Life, walks parents through each vaccine on the childhood schedule, examining the disease risk, the vaccine risk, and the available evidence. Several of its arguments draw on Thomas’s own clinical data, published in the International Journal of Public Health, comparing vaccinated and unvaccinated children in his practice. Among the findings:

• Neurodevelopmental issues: Significantly lower rates of ADD, ADHD, and learning disabilities in unvaccinated children.
• Chronic conditions: Lower rates of allergies, autoimmunity, eczema, and asthma in unvaccinated children.
• Infections: Unvaccinated children experienced fewer and less severe common infections.

Dr. Mumper notes that approximately 11 to 12 subsequent studies have found similar patterns.

The book also examines SIDS, which Thomas argues functions as a catch-all diagnosis: a label applied when a baby dies without clear explanation. The temporal proximity between vaccine administration and many SIDS cases, he argues, warrants closer examination. Whether vaccines contribute to some portion of SIDS deaths remains open and contested, but the authors make the case that the question deserves more scrutiny than it receives.

More broadly, Vax Facts argues that the actual risk of serious harm from most vaccine-preventable illnesses in the U.S. today is lower than public health messaging implies, and that individual risk depends heavily on factors like nutrition, sanitation, and access to care rather than a single statistic applied uniformly.

The Conversation Is Yours

The exam room is shifting. More parents are asking questions, more practitioners are open to individualized approaches, and resources like Vax Facts and IMA’s pediatric education programming exist to help families close the information gap. A collaborative relationship with a physician who respects parental decision-making isn’t a luxury. It’s what informed consent was always supposed to look like.

Related Reading

• Post: What’s Changed: The CDC’s Updated Childhood Vaccine Schedule Explained
• Post: IMA Launches Parents’ “Back to School” Healthcare Bill of Rights
• Guide: Parent’s Guide to Childhood Immunizations
• Resource: Kids First 4 Ever