I’ve read and re-read Dr. Paul Offit’s WSJ opinion piece, The Anti-Vaccination Epidemic. Dr. Offit is a professor of Pediatrics at a leading hospital in the United States. He is also an author, a scientist, and a vaccine-developer. In short, he is a major physician leader. I’ll come back to that point in just a second.
His piece addresses the problem of pediatric infectious disease in the United States. Context is important here. Data from the CDC show that infectious disease is not in the top-five causes of death in children. In the US, children older than one are ten times more likely die from unintentional injury then they are from infection. Homicide and suicide kill many more young Americans than does infections.
But no one would argue pediatric infectious diseases aren’t important. One tool against infectious disease is vaccines. But for vaccinations to work effectively, populations must be vaccinated. Vaccines require a social contract. In some areas of the US, as in other countries, human beings are deciding to delay or withhold getting vaccines. Dr. Offit points out the curious fact that vaccine abstention clusters in populations of wealth and education.
I find the anti-vaccine movement an interesting human phenomenon. Why would it be that this many people, smart people, thinking people, loving parents, choose not to vaccinate? Why am I, a disciple of absolute benefits and risks, so squeamish about taking the mandated influenza shot? And, I’ve suffered through shingles in the past, but don’t plan to get the shingles vaccine.
Such disquiet is weird because you can’t look at population data on vaccines and not see overwhelming benefit for many diseases. The often fatal infection, epiglottitis, for example, has nearly been eradicated by Haemophilus influenzae type b vaccine. Polio is another example. There are other examples.
You know I don’t have the answers to such a complex human problem. I suspect fear, bias, loss aversion (good health at the moment), mistrust of the medical establishment and an increasingly skeptical population are all components.
But one thing that electrophysiologists know well is that if a strategy (in the EP lab) isn’t working, stop doing it, and try a different approach.
A Deep-dive Into Specialty Pharma
A specialty drug is a class of prescription medications used to treat complex, chronic or rare medical conditions. Although this classification was originally intended to define the treatment of rare, also termed “orphan” diseases, affecting fewer than 200,000 people in the US, more recently, specialty drugs have emerged as the cornerstone of treatment for chronic and complex diseases such as cancer, autoimmune conditions, diabetes, hepatitis C, and HIV/AIDS.
This is where I come back to Dr. Offit and the leadership thing. His tone was condescending and paternalistic. He had the statistics, which were quite clear, so it was unnecessary to euphemistically kick people in the shins. From my perspective, as a doctor who helps (mostly wealthy) people make preference-sensitive decisions about future and present risks, brow-beating and condescension are rarely effective strategies.
I realize I could be completely wrong about this, but I think part of the vaccine backlash relates to the means of delivering the message. It’s easy to blame social media and the Internet and celebrities and even journalists. That’s the fast-thinkers answer.
As medical doctors, professionals in the people business, I’d recommend slower thinking, and a tincture of looking inward.
JMM
