an inconvenient truth?

For a while now it's been getting worse. Parents asking about immunizations, are they necessary, what diseases are they preventing, how effective are they, and #1 on the hit parade - what's my opinion on immunizations and autism? Anyone who knows me knows that my opinions are usually pretty wordy to say the least, so I'm going to have to come up with a concise statement on this subject in general and this question in particular. It's not going to be easy, but I'm going to try to "flesh it out" here on the blog and compile my thoughts and put them into manageable piles.

Al Gore gets credit or crap for a lot of stuff, but he certainly is the poster child for global warming. And global warming is a good example of the effect of media/internet hype on a controversial topic. A subject where both sides have impressive information and both can wow you with their glitz and glamorous proponents. Admittedly, the vaccine controversy doesn't have quite the red carpet support as global warming but lately Jenny McCarthy has been one of the more visible celebrity faces of the vaccine/autism question, and Doug Flutie before her was one of the first, though since he appealed to guys, his effect was not as profound. In our media saturated and influenced culture, science takes a back seat to celebrity. "Don't confuse me with the facts" is a phrase I hear (and use) often. Gut feeling and quasi common sense have replaced data and expert opinion. I'm not immune to this, as I've alluded to above.

It has been said that the louder and longer one says something the more people will believe it's true. Especially if the ones saying it are pretty, famous, pretty famous, or wealthy (that never hurts).  Take evolution as an example. You might think, evolution? That's a done deal, right? We learned it in school, it is understood that it is true, except by some wacky fringe element. Well, go back 150 years and that's not the case. Even 100 years. Evolution was the global warming of the early 20th century, and Charles Darwin was Al Gore. Or something like that. Consider, if you believe in biblical Creation, by God, in 6 days or 6 million years, or if you believe in intelligent design even, the "lite" version of Creation, you are bombarded by conflicting information daily, even hourly, and you even may fall prey to this at times. I use "survival of the fittest" as a metaphor quite often, and "natural selection" rolls off my tongue like any other solid method of reasoning out some line of thinking. We are creatures of our culture, and like it or not, it influences us at many levels.

So, we buy a hybrid to decrease our "carbon footprint" despite the people who tell us that the factories that make the batteries that make our cars "green"  are emitting more pollutants than the semi that just passed you on the highway. Tradeoffs are a given in our world.

Unfortunately, the question of vaccines affects children, and that means it affects me. Global warming means I bought a Prius and had less guilt. Giving vaccines with the possibility that they cause autism or other problems is a difficult thing. Not giving vaccines with the possibility that the diseases prevented will reoccur and cause untold agony? A less likely evil? As long as most people still vaccinate their kids? The concept of "herd" immunity. Where it is said that if most of the "herd" is immune to a particular disease, the rest benefits from this protection.

So...global warming, evolution, vaccines cause autism. Which is true? Which is just media hype? Are these questions with absolute answers of yes or no? In the case of evolution, I am a strong believer in Creation by God in however long He decided to take to do it, He says 6 days and a day off on the 7th, so I'm going with that. Slam dunk yes. Global warming? Vaccines? I'm less certain that there is a black "yes" and a white "no" on either topic. Unfortunately, most of the "easy" yes and no questions have been settled - not always the same for everyone, but they're settled in the minds of the people. Are we affecting our environment with carbon fuels and pollution? But does the good outweigh the bad? Does the ability to travel by car or plane make our lives easier and is the tradeoff worth it? Is technology worth it? Are we giving our kids chances that previous generations didn't have by vaccinating against killer diseases? Are we causing problems that are worse by preventing unlikely but deadly infections? There are few people still alive who have experienced polio firsthand,  but even someone my age, in medicine, remembers Hemophilus influenza, type B. The ten or more days in the hospital on IV antibiotics. The great possibility of deafness if the child survived. 

Suffice it to say, this generation has not suffered the effects of the infectious diseases endured by the previous ages. The proponents of vaccines can show graphs of the prevalence of a disease and the controversy over vaccine and the inverse relationship between the two - i.e., if the disease is common, there is little controversy over the vaccination, and if the disease is seen as historical, the vaccine side effects become the subject of controversy, not the disease. Though I don't want to see it, if a measles outbreak occurs, the whole autism/MMR vaccine issue will be a moot point for a while. But we do need to revisit the issue of vaccines and side effects and whether the good outweighs the bad. There are few people without obvious agendas who are taking sides on this question. That is a huge problem - those with personal involvement weigh in on their particular side and then facts take a back seat to emotion, or at least "spun" facts. Statistics can be "spun" to make anyone's point.

Are we causing harm to our children by immunizing them against diseases that most people have never seen? 

To those who are totally in favor of vaccines, for all diseases, in every kid, at any time, the picture portrayed is of a world where the diseases prevented by immunization are lurking just outside the door, waiting for us to let our guard down and let them back in to kill and maim our beloved children in minutes.

To those who believe that vaccines have caused more problems than solutions, the picture is a world where things would be fine if doctors and vaccines and medicines didn't exist and if people would just eat right and exercise, things would be fine.

OK - neither one is right, which takes me back to the earlier comment about no "black and white" answer.

I find myself sitting on the fence. In terms of diseases, I've experienced HIB meningitis personally and professionally. When I say that the worry caused by a phone call about a child with a fever is much less now that it was 20 years ago, it is an understatement. To say the least. I have put the early years of practice behind me. When, after a 2 A.M. phone call about a child with a fever, my wife would say "do you think it could be meningitis?". And I couldn't sleep after that. That's pretty much gone. As gone as something that used to happen but hasn't happened in a long time can be gone. I wouldn't wish it back in a million years.

So...some doctor can say the same about diphtheria, tetanus, polio, measles, etc. 

We are a society of convenience. We vaccinate against chickenpox because it costs the mother a week off of work and that costs a lot. Of course, there is the justification of MRSA and the secondary infection of the chickenpox lesions that could cause worse problems than just the itchy rash. We would like to see rotavirus disappear. My first rotavirus experience was a funny episode in my first year of med school where my roommate got it and couldn't decide whether to sit on the toilet and throw up in the bathtub or sit on the tub to evacuate his bowels there and vomit in the toilet. It was a one or two day thing. And still is for most kids. But it can mean hospitalization and for God's sake, that's an inconvenience to say the least. Kids in Africa die of rotavirus, but here in the US of A, that shouldn't happen. So we immunize to save lives and to save jobs and lifestyles. Where do we draw the line? 

Reading history, I find that smallpox may have been the deciding factor in the conquering of the New World. We have been taught that it was guns or education or desire or something purposeful or controllable that helped Europe conquer the Americas, but as I read history, it was smallpox. Or some other infectious disease/s. 

So...I'm in favor of immunization. I can be tolerant of parents wanting to spread out the vaccines over a longer period of time, while laughing at the fact that the multiple ingredient vaccines that today's parents are scared of were created to meet consumer demand from 15-20 years ago. 

We; doctors, scientists, researchers, should review the data, devoid of emotion and secondary gain, and come up with a reasonable approach to achieve the necessary coverage for children for diseases that are still present and active, and propose this with acquiescence to those opposed, and win them over with our data and dry information and not with bullying and laws and requirements.

And those who are opposed should look beyond their own personal experience to the big picture and the possibility that they were the victims of cruel fate or divine providence,  or maybe to the power of the almighty dollar and the whims of drug companies.

No one is right. No one is wrong. It's not clear, at least in my mind, like the evolution controversy is clear. God created this world.

But we should begin to face the problem of vaccines and autism with the idea that both sides have reasonable, defensible ideas and data. That there is no one right answer to the question. That both sides together, with cooperation and collaboration, may come up with a safe and effective plan. However, until both sides can discuss the issue without emotion and personal baggage, without millions of dollars helping to decide the outcome, this seems an unlikely dream.

I want to place myself squarely in the middle of this controversy. I see the need, and I see the concern. I'm not smart enough to know everything about everything. I will continue to encourage complete vaccination for every child while respecting the decisions of those parents who do not want to immunize or who want to delay or spread out vaccination. It's uncomfortable up here on the fence.