Friday, May 4, 2012
Measles: Back to the future of public health
A recent USA Today cover story was "Measles Outbreak Could Hit the USA" as a result of rising rates of measles in Europe, and declining rates of vaccination here.
If measles does make a meaningful comeback, it would imply public health is sliding back as we head into the future. We don't want to go there.
We live in a culture where it is highly fashionable to question all authorities, and to presume guilt rather than innocence with regard to others' motives. There are still those who believe the HIV epidemic was manufactured by the government, and others who believe the CDC's support for flu vaccine is actually an effort to kill lots of people and reduce the population.
This is crazy nonsense, of course. But in the Internet age, crazy, paranoid nonsense and hard-earned, thoughtful, evidence-based expertise have the same megaphone. Anyone can post a blog or video, and it is, in fact, the more radical opinions that are most likely to "go viral," for the very reason that they stand out.
The concept that immunization causes autism went viral, and won't go away, even though the evidence has been thoroughly debunked, and the principal scientist behind it all formally disciplined for fraud.
Why is it we are apathetic about vaccines, and less concerned about the diseases they prevent than with the side effects they do, or even might, cause? For one salient reason: because they work. It may sound paradoxical , but the reason we don't seem to have any love for vaccines is because they are so effective.
In general, when prevention works, there is literally nothing to see. The good results are things that don't happen. This undermines public and political support for prevention, and costs us all, in the currency of both dollars and human potential. I have lamented this before.
But this problem may be epitomized by immunization. When an immunization campaign works, a disease can literally disappear, as smallpox has. And once a disease has been gone a while, you start to wonder why you should put up with the "dangers" of immunization. The disease the vaccine is preventing is invisible, and in contrast, any modest danger associated with the vaccine looms large. It's like wondering why you should pay for an alarm system in a house that never gets robbed, while ignoring the possibility that that the alarm system is the reason the house doesn't get robbed!
There is, admittedly, always some danger associated with immunization. Truly "no risk" options generally do not exist in medicine, and probably don't exist in life. There is some danger in going outside, and some danger in never doing so.
What matters, then, is the ratio of risk to benefit, or how one danger compares to another. Measles is highly infectious, and out of every thousand kids who get it, one to two will die. Any decent vaccine is vanishingly less dangerous.
Our grandparents had to worry about letting our parents go swimming every summer, for fear of poliomyelitis. We are now privileged to be all but free of polio, and have thus become complacent about the vaccine.
And, of course, immunization resulted in the one case of intentional extinction in history: the eradication of smallpox. Smallpox formerly ravaged our species, killing as many as one in three infected.
Measles is not that bad, but it's bad enough.
We are unintimidated by measles because we haven't seen much measles in our lifetimes. We haven't seen much measles because vaccination works.
If measles makes a comeback, it would represent the classic bungle summed up so nicely in a song we all know: "Don't it always seem to go that you don't know what you got 'til it's gone."
The diseases vaccines prevent, measles, polio, influenza and others, pose serious risks, as prior generations knew all too well. Vaccines pose trivial risks in comparison. We need to see the value in what isn't there, and know what we've got before it's gone.
Otherwise, we may well go back, instead of forward, to the future of public health, and pay, quite literally, with some of our lives.
David L. Katz, MD, FACP, MPH, FACPM, is an internationally renowned authority on nutrition, weight management, and the prevention of chronic disease, and an internationally recognized leader in integrative medicine and patient-centered care. He is a board certified specialist in both Internal Medicine, and Preventive Medicine/Public Health, and Associate Professor (adjunct) in Public Health Practice at the Yale University School of Medicine. He is the Director and founder (1998) of Yale University's Prevention Research Center; Director and founder of the Integrative Medicine Center at Griffin Hospital (2000) in Derby, Conn.; founder and president of the non-profit Turn the Tide Foundation; and formerly the Director of Medical Studies in Public Health at the Yale School of Medicine for eight years. This post originally appeared on his blog at The Huffington Post.
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Members of the American College of Physicians contribute posts from their own sites to ACP Internistand ACP Hospitalist. Contributors include:
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