Saying Goodbye to the Anti-Vaccine Lie

I try to listen to my patients, to be sensitive to their feelings and concerns. I try but, when it comes to parents who don’t want to vaccinate their children, I don’t succeed. There is an attitude in the anti-vaxx movement, an anti-medicine, anti-science, anti-doctor conspiratorial mistrust, that stretches my patience.

I have tried to see things from the anti-vaxx perspective. I have researched the claims of anti-vaccine activists, visited their websites and read their “evidence”. It is hard to wade through their passionate arguments without getting angry. Facts are twisted, science is ignored and evidence is discarded. Even the purportedly “scientific” papers cited in support of their positions are misrepresented, overstated and biased. Not one of the articles I have read would survive critical peer review. They were universally poorly written and scientifically absurd. In spite of the seemingly obvious flaws in these articles, thousands (if not millions) of parents believe these arguments and choose to not immunize their children.

Because I care about the health of children I have debated and argued with dozens of anti-vaccine parents over the years.  Each encounter has left me amazed at the willful ignorance displayed. I say willful, because in order to believe vaccines are harmful one must choose to ignore mountains of evidence about vaccine benefits and to instead believe that we live in an evil society filled with deceived and sinister people who are willing to harm children for the sake of profit.

If vaccines are harmful, the cover up is massive. The CDC has 14,000 employees, 68,000 people work for the pharmaceutical giant Merck, there are over 30,000 pediatricians in the United States, and over 130,000 Family Physicians. If vaccines are truly harmful then there are over 200,000 people in America who are part of a system that is willfully harming children. What an evil world that would be! 

 If vaccines are as dangerous as the anti-vaccine crowd declares then evidence of this harm must exist and should be easy to discover or reveal. Surely there would be at least one well placed whistle blower who could reveal such a conspiracy. Riches and fame would surely await the man or woman brave enough to reveal such an important truth. The fact that no one has come forward with such evidence has only one explanation. The evidence does not exist.

Anti-vaxxers often say that “Big Pharma” is behind the push for vaccines, that vaccine makers are endangering children for the sake of profit. Those who make this argument fail to apply this reasoning to the entities that actually pay for vaccines, the insurance companies. Insurance company vaccine costs are over $2000 per child. There is no profit in paying for useless treatments. In addition, if a child is harmed by a vaccine, insurance companies are on the hook for the cost of treatment. If vaccines are dangerous, then insurance companies are run by very stupid people.

While many of us will chuckle at these facts and dismiss the absurd arguments of anti-vaccine parents the fact remains that millions of children being placed at risk due to the willful ignorance of their parents. One has to ask, “How is it that so many parents are willing to believe such lies and expose their children to preventable illnesses?”

In speaking with anti-vaccine parents one explanation is readily apparent. There is immense psychological reward found in feeling superior to others. Anti-vaxx parents believe that they are smarter than others, more concerned for their children than other parents, more knowledgeable about immunology and vaccines than their doctors. Not only do they refuse to vaccinate their children they look down on those who do. They are crusaders, special and noble warriors in the fight against a greedy and evil society.

It is this attitude that makes dialogue with anti-vaxx parents so frustrating. Since all who disagree with them are either ignorant, misinformed or evil there is no reason for them to listen. My training is irrelevant because the AMA is in the pocket of Big Pharma. My knowledge is insufficient because I have not read the things that they have read. (The fact that they have read none of the reputable scientific research and know nothing about physiology and immunology is dismissed.) I have learned that there is nothing I can say to change their minds.

In spite of their proclaimed commitment to "researching" treatments I have found this commitment selectively applied. Many of these proudly skeptical parents readily embrace unproven and non-scientific therapies. They have no problem with homeopathy, naturopathy, body cleanses, or essential oils, in spite of the lack of studies demonstrating their effectiveness. In the case of some treatments, such as body cleanses, in spite of overwhelming evidence against effectiveness. It sometimes seems that there only two criteria that need be met for them to endorse a therapy. First, some stranger on the internet must say it worked for them. Second, traditional medicine must reject or question it.

It is extremely frustrating to dialogue with those who claim science in one circumstance and then ignore it in another. I can't help but believe that if people applied the same level of doubt and skepticism to alternative medicine as they did to vaccines, alternative medical practitioners would be out of business in a week!

The question of what to do with the anti-vaccine movement is frequently debated in the healthcare community. There have been many studies conducted and many articles written on how physicians can best respond to anti-vaccine parents. I have read many of them and after significant reflection have decided to give up. I don’t argue anymore. If parents want to learn about the overwhelming evidence in support of vaccines it is just a few mouse clicks away. If they choose to believe the anti-vaccine lies and place their child at risk then I tell them to seek care elsewhere. I am not the doctor for them.

This position is often heart-breaking for me. I have lost many patients over the years as a result of this stance. Just this month I found myself saying goodbye to a family with whom I had shared a long and seemingly close relationship.  I have no doubt that similar partings will happen in the future. As painful as the loss of relationships can be, with each farewell I take comfort in the knowledge that the choice to leave was ultimately made by not by me but by the parents of the child. Parents who did not trust my training, experience and judgment, parents who wanted someone to submit to their faulty conclusions without questioning.  Parents who didn’t want me.

- Bart

Responding to Anti-Vaccine Hatred

“You killed that kid. You are a c---.”

“You are a part of the problem!”

“You should be ashamed of yourself and should not be a doctor at all.”

Since I published my posts on measles the attacks have been vicious and continuous. Multiple emails have flooded my inbox challenging my character and my motives and questioning my ethics and my intelligence, all sent by strangers who have never met me or spoken with me. As I read each one I ask myself, “How should I respond?”

The Barrett in me wanted to fight back, challenge every negative assertion and correct every false claim. I wanted to not just defend myself but to destroy their claims and show them to be the misguided people they were. I didn’t. Something stopped me.

That something might actually be a Someone, for at the time I was dealing with these responses I was also preparing to speak at a church in Burbank. The scripture for that Sunday was from the Sermon on the Mount, the part where Jesus informed His disciples that they were likely to be insulted, persecuted and lied about viciously in the course of following Him. He went on to describe how his followers should respond in such difficult circumstances, “Love your enemies and pray for those who persecute you.”

I must confess that this response was not the first one that entered my mind when I read the hateful emails! How could kindness be the appropriate response to hatred? As I continued to review the passage of Scripture and prepared my talk the answer to that question became clear.  Jesus consistently taught about eternity, about the blessings of the life to come. When the temporary attacks of others are placed in the context of the enduring blessings of faith it is easier to see the attacks for what they are, the responses of lost and broken people, people in need of a relationship with their Creator.  in this eternal context it is also easier to understand the appropriate response, as my goal should not be retribution or punishment but an effort to guide them to truth.

With this in mind I tried to answer every email I received. I avoided argument, instead choosing to acknowledge receipt of their message and suggesting web sites they could visit if they wanted more information. I did not apologize for my stance or affirm theirs, for that would be disingenuous. When there were specific questions I did my best to answer them. I doubt that I changed any minds but I hope that I may have challenged some presuppositions. I did not act in the way they expected. I pray they will reflect on my words and maybe even read other posts on the blog.

As I consider my responses to these strangers I am led to reflect on my responses when hurt and offended by those who are closer to me. I think of patients who have complained or given me negative reviews and of recent employees who unjustly accused me of unfairness. I have concluded that it is much easier to brush off the accusations of a stranger than it is to deal with accusations from someone who you thought knew you better. It is easy in such hurtful circumstances to justify an angry or defensive response. It is easy, but that does not make it right.

I need to learn to not take these slights personally, to respond in kindness whenever possible and to love and pray for those who hurt me, for this is the response that should characterize those who follow Christ. I know this because it was the response of Christ himself when he hung dying on the cross, his prayer for his persecutors, “Father forgive them, for they do not know what they are doing.” What a powerful example

May we all become more forgiving people.

-          Bart

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Autism, Measles, Vaccines and Truth. Protecting the Lives of Innocent Children

He had never been embraced by his adolescent daughter, never heard her say the words “I love you,” never had a conversation with her at all. Autism had stolen all of this from him, her condition was that severe. So moving were his words that as the man testified before congress, the hearing room was uncharacteristically quiet. In addition to being the father of a daughter with autism he was a professor of infectious disease at San Diego Children’s Hospital. While dealing with the challenges of being parent of a severely disabled daughter he continued his duties at the hospital  where he witnessed firsthand the damage brought by measles, polio and other vaccine preventable diseases. I vividly remember his concluding remarks. He told the members of congress that after reviewing the data on vaccine safety and autism, after experiencing the pain of his daughter’s condition every day of her life, and after seeing all of the diseases in question, he was certain. If he had to make the decision again, he would immunize his daughter in a heartbeat.

I was stunned by his testimony. Not only by its power, but by the fact that I had even come across it. I was channel surfing while on vacation and landed on CSPAN by accident right as his testimony began. It seemed almost providential that as a physician dealing with immunizations on a daily basis I would so fortuitously come across such a valuable story.

I have repeated his story many times over the years in conversations with mothers and fathers about vaccine safety. Over the course of dozens upon dozens of such conversations I have realized that vaccine questions come from two perspectives. There are the honest questions from those who want to protect their children from diseases but are nervous and are seeking reassurance, and then there are the confrontational challenging questions from those who are convinced that vaccines are harmful. The testimony of the San Diego doctor has reassured many in the first group and had no impact at all on the second.

I have often wondered why that is. Why is it that there are some people who seem to feel that 9 years of education, 3 years of training and 20 years of practice add no value to my opinion beyond that of someone with a computer, a web browser and some time on their hands? If my knowledge and experience mean nothing, how do I reach such people?

The answer to the first question, why some people do not respect my opinion, seems to be a cultural one. From the 60’s onward children were taught to question authority and to be wary of placing trust in those in power. Since the 70’s, an emphasis has been placed on self-esteem. Everyone’s opinion matters, everyone’s opinion counts, and to an extent, everyone’s opinion is equal. The end result is that the physician/patient relationship has seen a new dynamic. Gone are the days when doctor’s recommendations were readily accepted and followed. We are having to prove our knowledge, even in common areas of practice such as vaccines.

I cannot trace its rise, but there is another factor as well, the apparent desire of people to be in an elite group, the group that is “in the know.” Knowing something that others don’t, discovering a “truth” that has been hidden, seems to be a powerful elixir. In my discussions with those adamantly opposed to vaccines this attitude has been common. There is an air of “other people may be duped, but I am better than that” that pervades the conversation. This attitude allows for dismissal of any argument I may offer.

The internet has made the situation worse, as misinformation and misapplied data abound. Evidence to support one’s preconceptions is never more than a few mouse clicks away. I have noticed in the anti-vaccine crowd it is never the reputable sites that they quote. Immunize.org, the CDC and the Mayo Clinic are passed over for activist sites that proclaim the “truth.”

What has amazed me the most in my discussions with patients (and in the responses to my blog post) is the emotion and anger associated with the anti-vaccine movement. Physicians and Public Health officials are not simply mistaken or wrong, we are often characterized as evil, deceptive, “in the pockets of Big Pharma,” or motivated by greed and avarice. The most gracious of the anti-vaccine responders express pity, displayed in condescending remarks that suggest I have been duped or am simply unaware. To imply that we physicians would either knowingly harm a child or remain willfully ignorant of information that may benefit a child under our care is an accusation I find difficult to process.

I have had so many conversations and my response to vaccine questions has evolved over the years. As there simply is not enough time in the day to engage in 30 minute discussions with every family about vaccine safety I have reduced my comments to a few simple points.

I tell my parents that life is full of risks. They risked the life of their child when they strapped her in the car seat and drove to my office that morning. A risk free life is not possible. I use the example of seat belts and airbags, reminding them that every year in America people are injured or killed because of seat belts and airbags but that we continue to use them in the knowledge that they save far more lives than they harm. This is the truth about vaccines. In rare cases some children may have a harmful response to an immunization and in exceedingly rare cases the reaction and harm may be severe. The alternative, not immunizing children, is much, much worse to society. One child may get away with it if all of the other parents immunize, but if society follows that path many innocent children will die.

The honest questioners, those with open minds and hearts and who do not believe that the healthcare industry is guided by evil forces, accept my words and have their children immunized. The oppositional deniers try to argue with me. At that point I simply tell them that I cannot provide care for those who do not think I know what I am talking about and who do not trust my judgment, who think I would harm their children. Out of concern for other patients in my practice, I suggest they find care elsewhere.

While this works for my practice society has a more difficult challenge for being unvaccinated does not only place the individual in jeopardy, it carries with it the risk that others may suffer. The recent outbreak arising from Disneyland is a powerful illustration of this risk, as children too young for the vaccine became infected by others. So what do we do?

I am not a politician or a legislator, but difficult decisions need to be made. I am of a bent that places great value on individual liberty and I am reluctant to suggest actions that infringe on parental rights yet I do think an argument can be made to stiffen immunization requirements, especially for school admission and particularly for those diseases that are most contagious. We need to be careful about drawing lines in the sand over contagious diseases which are almost impossible to transmit in a classroom setting but should be willing to make a stand with readily contagious diseases such as measles. We should not expect innocent children too ill or too young to be immunized to be made to pay the price for the decisions of others.

As a culture we need to be willing to say that not all opinions are equal and that our public health decisions will be based on science and not emotion. It is not an overstatement to say that the lives of our children are at stake.

- Bart

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