Friday, January 11, 2013
Seeking reasons for anti-vaccine vitriol
I must say, I am amazed, and a bit horrified, by the volume and intensity of the anti-vaccine vitriol my prior column has engendered. I knew there was lots of anti-vaccine sentiment in our society, something that tends to be the privilege of societies much less subject than they once were to diseases vaccines prevent. But the fervor and derision in the comments are almost shocking, and warrant a reality check.
1) People who are helped by vaccines don't notice.
If you get a vaccine, any vaccine, and don't get the disease the vaccine prevents, be it pertussis, or diphtheria, or measles, or polio, or flu, nobody notices. There is, in fact, no way to say the vaccine did anything! After all, you might not have gotten sick without it. There is nothing to report, no thanks given, no drama. It's a non-event.
This is exactly why personal observations and anecdotes, however dramatic they may be, cannot determine whether a vaccine is working. Every time an adverse reaction occurs after a vaccine, whether or not due to the vaccine, there will be drama. There will be anger. There will be public commentary. Even if one such adverse event occurs for every 100,000 helped, the one bad outcome will draw attention; the 100,000 non-events will go unnoticed.
This, by the way, is not just true about vaccines. It's true about my field, preventive medicine, in general. When it works, there's nothing to see.
Epidemiology fixes this, by looking at outcomes in the population at large. This is why the CDC and ACIP base their vaccine recommendations on epidemiology, the study of patterns in the population as a whole. It is at the level of population that a clear benefit from many vaccines, including the flu vaccine, is evident.
It makes no more sense to rant against vaccines because you know of someone who had an adverse reaction, or think might have, than it does to advise against walking in general because you've heard about a pedestrian struck by a car. Bad things will at times happen to good people, no matter what we do or don't do. Epidemiology simply helps us choose the path of least harm, most benefit, so they happen to fewer of us.
2) There is no form of prejudice that isn't just prejudice.
We seem to have talked ourselves into the notion that some forms of prejudice are prejudice, and some are public service. That's nonsense. All prejudice is prejudice.
I can be judged for what I say and do, the positions I take. But a summary judgment about me can't be made because I am a doctor, or am affiliated with Yale, any more than because of my skin color. Or the fact that I have a Y chromosome. Or because I live in Connecticut. Or because I was born in Los Angeles.
My career, most details of which are readily available online to anybody who bothers to look, is all about lifestyle as medicine. Yes, I do prescribe medications to those who need them, but I devote most of my clinical efforts to helping people avoid them. It is not coincidental that I am president-elect of the American College of Lifestyle Medicine. It is not accidental that I practice collaboratively with naturopathic physicians in a holistic clinic focused on kinder, gentler treatment alternatives.
I don't push drugs, or vaccines. I don't get compensated when they are used. I am a salaried, academic physician; I do not get fee for service. My day job is helping people use their feet and their forks to prevent disease.
So if I recommend a vaccine, it's because I believe, based on review of the available epidemiologic evidence, that it is the right thing to do. Period.
Disagree with the position if you want. But if you make false allegations along the way, about profit motives and cover-ups, it simply tells the world that you are okay with prejudice, conviction without trial, unsubstantiated conclusions, and a rush to judgment. Which might raise some questions about the reliability of your vaccine-related advice.
In other words, if you want to offer advice against vaccination that reasonable people can take seriously, try being reasonable. Seriously.
I stand by my support for the flu vaccine. Reasonable people might disagree, and when they do, I will listen to them and encourage others to do likewise. Not so those who renounce reason altogether, and in its place offer only vitriol.
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.
Contact ACP Internist
Send comments to ACP Internist staff at firstname.lastname@example.org.
- QD: News Every Day--Virulent flu season on the ups...
- Multitasking and information toxicity--is that why...
- Mammograms over-diagnose breast cancer. Let the ga...
- Outbreak linked to cardiac surgeon
- QD: News Every Day--4 of 10 doctors give in to bra...
- Revisiting the question, are doctors necessary?
- The importance of poopology
- QD: News Every Day--Smartphone app can detect afib...
- RAPID Rescue for a new mnemonic in BLS
- Trying to do right
Members of the American College of Physicians contribute posts from their own sites to ACP Internistand ACP Hospitalist. Contributors include:
Albert Fuchs, MD, FACP, graduated from the University of California, Los Angeles School of Medicine, where he also did his internal medicine training. Certified by the American Board of Internal Medicine, Dr. Fuchs spent three years as a full-time faculty member at UCLA School of Medicine before opening his private practice in Beverly Hills in 2000.
And Thus, It Begins
Amanda Xi, ACP Medical Student Member, is a first-year medical student at the OUWB School of Medicine, charter class of 2015, in Rochester, Mich., from which she which chronicles her journey through medical training from day 1 of medical school.
Zackary Berger, MD, ACP Member, is a primary care doctor and general internist in the Division of General Internal Medicine at Johns Hopkins. His research interests include doctor-patient communication, bioethics, and systematic reviews.
Controversies in Hospital
Run by three ACP Fellows, this blog ponders vexing issues in infection prevention and control, inside and outside the hospital. Daniel J Diekema, MD, FACP, practices infectious diseases, clinical microbiology, and hospital epidemiology in Iowa City, Iowa, splitting time between seeing patients with infectious diseases, diagnosing infections in the microbiology laboratory, and trying to prevent infections in the hospital. Michael B. Edmond, MD, FACP, is a hospital epidemiologist in Richmond, Va., with a focus on understanding why infections occur in the hospital and ways to prevent these infections, and sees patients in the inpatient and outpatient settings. Eli N. Perencevich, MD, ACP Member, is an infectious disease physician and epidemiologist in Iowa City, Iowa, who studies methods to halt the spread of resistant bacteria in our hospitals (including novel ways to get everyone to wash their hands).
db's Medical Rants
Robert M. Centor, MD, FACP, contributes short essays contemplating medicine and the health care system.
Juliet K. Mavromatis, MD, FACP, provides a conversation about health topics for patients and health professionals.
Dr. Mintz' Blog
Matthew Mintz, MD, FACP, has practiced internal medicine for more than a decade and is an Associate Professor of Medicine at an academic medical center on the East Coast. His time is split between teaching medical students and residents, and caring for patients.
Toni Brayer, MD, FACP, blogs about the rapid changes in science, medicine, health and healing in the 21st century.
Vineet Arora, MD, FACP, is Associate Program Director for the Internal Medicine Residency and Assistant Dean of Scholarship & Discovery at the Pritzker School of Medicine for the University of Chicago. Her education and research focus is on resident duty hours, patient handoffs, medical professionalism, and quality of hospital care. She is also an academic hospitalist.
John H. Schumann, MD, FACP, provides transparency on the workings of medical practice and the complexities of hospital care, illuminates the emotional and cognitive aspects of caregiving and decision-making from the perspective of an active primary care physician, and offers behind-the-scenes portraits of hospital sanctums and the people who inhabit them.
Ryan Madanick, MD, ACP Member, is a gastroenterologist at the University of North Carolina School of Medicine, and the Program Director for the GI & Hepatology Fellowship Program. He specializes in diseases of the esophagus, with a strong interest in the diagnosis and treatment of patients who have difficult-to-manage esophageal problems such as refractory GERD, heartburn, and chest pain.
Mike Aref, MD, PhD, FACP, is an academic hospitalist with an interest in basic and clinical science and education, with interests in noninvasive monitoring and diagnostic testing using novel bedside imaging modalities, diagnostic reasoning, medical informatics, new medical education modalities, pre-code/code management, palliative care, patient-physician communication, quality improvement, and quantitative biomedical imaging.
William Hersh, MD, FACP, Professor and Chair, Department of Medical Informatics & Clinical Epidemiology, Oregon Health & Science University, posts his thoughts on various topics related to biomedical and health informatics.
David Katz, MD
David L. Katz, MD, MPH, FACP, 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.
Richard Just, MD, ACP Member, has 36 years in clinical practice of hematology and medical oncology. His blog is a joint publication with Gregg Masters, MPH.
Kevin Pho, MD, ACP Member, offers one of the Web's definitive sites for influential health commentary.
Michael Kirsch, MD, FACP, addresses the joys and challenges of medical practice, including controversies in the doctor-patient relationship, medical ethics and measuring medical quality. When he's not writing, he's performing colonoscopies.
Elaine Schattner, MD, FACP, shares her ideas on education, ethics in medicine, health care news and culture. Her views on medicine are informed by her past experiences in caring for patients, as a researcher in cancer immunology, and as a patient who's had breast cancer.
Mired in MedEd
Alexander M. Djuricich, MD, FACP, is the Associate Dean for Continuing Medical Education (CME), and a Program Director in Medicine-Pediatrics at the Indiana University School of Medicine in Indianapolis, where he blogs about medical education.
Rob Lamberts, MD, ACP Member, a med-peds and general practice internist, returns with "volume 2" of his personal musings about medicine, life, armadillos and Sasquatch at More Musings (of a Distractible Kind).
David M. Sack, MD, FACP, practices general gastroenterology at a small community hospital in Connecticut. His blog is a series of musings on medicine, medical care, the health care system and medical ethics, in no particular order.
Reflections of a Grady
Kimberly Manning, MD, FACP, reflects on the personal side of being a doctor in a community hospital in Atlanta.
The Blog of Paul Sufka
Paul Sufka, MD, ACP Member, is a board certified rheumatologist in St. Paul, Minn. He was a chief resident in internal medicine with the University of Minnesota and then completed his fellowship training in rheumatology in June 2011 at the University of Minnesota Department of Rheumatology. His interests include the use of technology in medicine.
Technology in (Medical)
Neil Mehta, MBBS, MS, FACP, is interested in use of technology in education, social media and networking, practice management and evidence-based medicine tools, personal information and knowledge management.
Peter A. Lipson,
Peter A. Lipson, MD, ACP Member, is a practicing internist and teaching physician in Southeast Michigan. The blog, which has been around in various forms since 2007, offers musings on the intersection of science, medicine, and culture.
Why is American Health Care So Expensive?
Janice Boughton, MD, FACP, practiced internal medicine for 20 years before adopting a career in hospital and primary care medicine as a locum tenens physician. She lives in Idaho when not traveling.
World's Best Site
Daniel Ginsberg, MD, FACP, is an internal medicine physician who has avidly applied computers to medicine since 1986, when he first wrote medically oriented computer programs. He is in practice in Tacoma, Washington.
Other blogs of note:
American Journal of
Also known as the Green Journal, the American Journal of Medicine publishes original clinical articles of interest to physicians in internal medicine and its subspecialities, both in academia and community-based practice.
A collaborative medical blog started by Neil Shapiro, MD, ACP Member, associate program director at New York University Medical Center's internal medicine residency program. Faculty, residents and students contribute case studies, mystery quizzes, news, commentary and more.
Michael Benjamin, MD, ACP member, doesn't accept industry money so he can create an independent, clinician-reviewed space on the Internet for physicians to report and comment on the medical news of the day.
The Public Library of Science's open access materials include a blog.
One of the most popular anonymous blogs written by an emergency room physician.