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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