Blog | 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.