You know it’s serious…

when the world’s most prestigious medical journal, The New England Journal of Medicine (known affectionately as NEJM), takes up the cause of vaccine advocacy.

In this week’s issue is an article that discusses the history and the development of US national vaccine programs, and also who opts out of those programs, the reasons why, and the likely results (which we are beginning to see, with the return of measles in some areas of the US) stemming from having clusters of unvaccinated children in the country.

Some of the authors’ names should sound familiar to you, especially if you’ve read Autism’s False Prophets. Dr. Walter Orenstein was the director of the National Immunization Program for the CDC at the time of the ‘super secret Simpsonwood conference‘, though he was not present at this meeting; Dr. Neal Halsey was the was head of the American Academy of Pediatrics’ vaccine advisory committee in 1999, and was a major force behind the (in retrospect, ill-conceived) decision to remove thimerosal from infant vaccines.

I was also happy to see that these leading vaccine experts recommend against pediatricians throwing ideologically unvaccinated children out of their practices, and instead take the time to listen to and address their parents’ concerns. I try my best to do this in my own practice, and I have no right to throw anyone out of my practice anyway. Also, persuasion can even work once in a while: a few weeks ago I was subbing for another doctor in a different clinic, and a woman came in with her as-yet unvaccinated 7-month-old specifically to talk about her concerns regarding vaccines (though she ended up vaccinating all her children, it was always with trepidation due to all the stuff she’d heard and read about online). We had a great conversation, and she came away with a list of Internet resources to pursue. I think she’ll be vaxing this baby as well.

So go and read the article, and let me know what you think.

ETA: Via Orac (who is also interviewed in the article): Why Does the Vaccine/Autism Controversy Live On?


13 Responses

  1. Esther, what kind of time constraints do you have with your patient visits? This is a conversation that requires time and I wonder if doctors in the US have the time to have this discussion due to insurance requirements. I really don’t know, but that’s the impression I get. The doctor of says he takes the time to have that conversation, but I wonder what the consequences are with regard to reimbursement.

    My experience with the three doctors I have talked about this with is that they were not really up-to-date on the vaccine denial, delay stuff. When I asked my OB why would I do the Hep B shot at birth, he just because the state pays for it. Well, my insurance covers shots so that doesn’t make a difference to me. When I asked my daughter’s pediatrician she wasn’t really aware that people were being advised (by other parents on mailing lists) to decline or delay a lot of things. Then, I freaked out about a pertussis outbreak in my area went in to my family doc to get the Tdap and I wanted to figure out if I should get an MMR booster, as well. He was really baffled and asked why? And my answer was that I wanted to keep up the herd immunity with all the non-vaxing going on in the area. Sort of absent-mindedly, he said, oh yes, that’s a good idea.

    This is in a pretty crunchy area where this vaccine rejection stuff is pretty substantial, so just in the interest of public health I would think it would be a good idea to be up to date on this stuff. I think even adding, ‘where did you hear that?’ to the discussion would go a long way toward getting a reluctant parent on board.

  2. One thing the anti-vax movement has going for them is that they get a lot of attention. They have an interesting celebrity with an interesting story to tell.

    The pro-vaccination side of this would do well to find parents that have children injured by vaccine preventable diseases and celebrities that do vaccinate.

    Also websites and blogs where internet savvy parents can see the complaints about vaccines specifically addressed help. As a parent, I like seeing the specific arguments addressed.

    • As Dr. Gorski put it well, the medical authorities have finally woken up and are taking steps to counteract the anti-vax nonsense out there. But it’s very, very late in the game, and much damage (possibly irreversible) has been done.

      There are now celebs standing up for vaccines as well, such as Amanda Peet and now J-Lo (watch the video promoting pertussis vaccination).

      • I thought about you and this subject last week, when I was in the pediatrician’s office for the kids’ strep throats, and she had a poster in the exam room for the Offitt book. I was really glad to see her directly advocating against the vaccine-autism scaremongering.

  3. The LA Times has added immunization info to their California Schools Guide (an example here. It’s scary that things have gotten so bad that the newspaper has to keep track of this stuff.

  4. It’s interesting that the article (or the journalist it quoted) attributes the rise of the vaccine/autism scare at least in part to the Internet. I suppose the Internet concentrates things, brings elements together that would otherwise not find each other, and creates a lot of heat that way. But I also think (or hope) that the Internet is self-correcting. Or in any case, that it will become more sophisticated. So, for example, as more vaccine-rejectionists stoke the fires online, eventually vaccine defenders (including Orac) will develop larger online followings until … some day this whole “anti-vax” thing becomes, like, so passe. Something that only Internet novices believe—people who don’t know how to look beyond the “sensational,” kind of like where television news is today. Call me an optimist, I guess.

    • Angela – this post has a great explanation of how the Internet magnifies this phenomenon.

      • Hi, Esther!

        Always nice to see people get something out of the stuff that comes out o’ me brain.

        The confirmation bias aspect of the Internet is IMO a huge problem. It is very easy to find people who think like you do. It is very easy to find what looks like information that supports your beliefs. Both of those things, by themselves, aren’t necessarily bad; there are lots of people out there who benefit from knowing that their problems aren’t unique, and finding a supportive community can be a godsend for them.

        The problem is that people, as a class, aren’t terribly motivated to attack their own beliefs. They don’t generally seek out people who *don’t* think the way they do, and they don’t actively seek out information that *doesn’t* support their beliefs, to see if their belief systems ought to be modified.

        Given a choice between believing an inconvenient chunk of evidence that contradicts your personal stance and rationalizing it away, most people (be they conservative, liberal, religious or non-theist, well-educated or no) choose the second path. Particularly in the United States, particularly in the last 25 years, the nature of “public discourse” has been to circle wagons, attack the opposing side’s credibility instead of their position, and weed out anyone inside the wagon circle who is a voice of self-criticism. It’s a sad, sad state of affairs.

  5. Thanks for alerting me to this. Nothing surprising in the article, sadly. (I’d like to get hold of a few of the references on the history of anti-vaccination.)

    I think helping FPs and peds communicate more effectively about vaccination (including reimbursing for extended OV time for counseling) would help some.

    I would like to see an end–or at least a serious tightening– of the philosophical and religious exemptions to school vaccination requirements. We don’t give people such an easy out of other public health and welfare requirements. (Hey, can I opt out of paying my taxes based on my personal or religious philosophy?)

  6. Willa – I have 10 mins. per patient as a rule. In midwinter, this can rarely go down to 5mins. per patient as well. However, in a non-emergent situation (such as a talk about a certain subject) I can ask the patient or their parent to schedule a double visit, which leaves us enough time to talk.

    In this particular case, it was a clinic less busy than mine (usually), and it also was Passover, so there was even less traffic than usual, and plenty of time to talk.

    The population at that clinic, as opposed to mine, is more ‘open’ , so we could discuss Internet resources. As opposed to my clinic, which serves a very ultra-Orthodox population who would never go online anyway. The mostly get their anti-vax nonsense from magazines and books such as this one, put out by an anti-vax organization whose membership numbers about 20, and its founder has long since returned to Britain. Their poison still lingers, however. The booklet is called “Vaccines-an Expose” and covers just about every antivax canard out there, and a few new ones (e.g., vaxes have monkey feces in them, or some such).

  7. Diana Austin, I LOVED the book Vaccine: The Controversial Story of Medicine’s Greatest Lifesaver. It covers the history of vaccination from the earliest variolation against smallpox, through the anti-Jenner movements, right up to the whole-cell pertussis issue and intussussception in Rotavirus vaccines. It’s a great compendium of the history and the science (or lack thereof). The author is pro-vaccine but gladly offers the downsides to vaccines, acknowledges legitimate concerns, and offers sympathy both to those impacted by vaccination and those who weren’t, but whose situation is unfortunate anyway (ie, parents of autistic children). It’s a very fair book and revealing.

    I found it most interesting that the arguments against vaccination have not changed ONE BIT since the original arguments against smallpox variolation in colonial Boston– it’s unnatural, it introduces toxins that weaken the body’s defenses, it harms children and causes long-term damage, etc. The only difference is, then, it was the medical establishment saying all of that…

    • Basoriana–thanks for the recommendation! I actually read “Vaccine” shortly after it was published, and have been following Arthur Allen’s writing on vaccines ever since. misunderstanding of science. Did you catch his debate with David Kirkby?

  8. [“I was also happy to see that these leading vaccine experts recommend against pediatricians throwing ideologically unvaccinated children out of their practices, and instead take the time to listen to and address their parents’ concerns. I try my best to do this in my own practice, and I have no right to throw anyone out of my practice anyway.”]

    I think this is great, I hope more pediatricians learn how to better talk about this issue. I mean, I can’t blame them for taking a defensive position when the other side is claiming doctors are at the center of a conspiracy to conceal risks to their patients in the name of profit. I would be emotional too. This nonsense can wear anybody down.

    I did however see the other side of this when we first took our only child in for his first pediatrician visit. I asked the doctor about anti-vaccination hysteria and he confused us for anti-vaxers. Before we could set him straight his demeanor completely changed and he attacked us with all kinds of hyperbole about dead kids and epidemics. I think for anyone with questions about vaccine safety or those who subscribe to this fabricated “jury is still out” position, I think this experience would have them running into the arms of the of the anti-vaccination activists. Being a new parent can be very intimidating and wading through all of the bad information out there is a lot to ask of anyone. I hope doctors will focus on becoming better at talking about the realities of vaccines while still acknowledging and understanding why parents are so misinformed.

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