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What we’re missing in today’s politicized debate over vaccines

What we’re missing in today’s politicized debate over vaccines

Picture of Michael  Hochman
Joe Raedle/Getty Images
Joe Raedle/Getty Images

This month has indeed been a “bruiser in the vaccine wars,” as Ryan White noted in a recent piece for the Center for Health Journalism. First, in an online column, a Cleveland Clinic physician, Dr. Daniel Neides, made unsubstantiated suggestions about a link between vaccine ingredients and neurologic diseases. Then, news broke that President elect Trump might nominate Robert F. Kennedy Jr., who has previously expressed dubious and scientifically unfounded opinions about certain vaccines, to lead a proposed new vaccine safety commission.

The critiques of the Cleveland Clinic physician and the potential Trump nominee have been fast and furious. Cleveland Clinic vocally disavowed the column written by Dr. Neides, and promised he would be “disciplined.” Likewise, numerous media organizations and vaccine experts have written withering critiques of Kennedy’s past statements.

While we do not condone the unsubstantiated statements made by Dr. Neides and Kennedy, we also think it is important that those with scientifically based concerns about vaccine recommendations feel comfortable expressing their views. We fear that, in the current political environment, there is a risk that legitimate concerns about vaccinations may become conflated with more fringe viewpoints.

One important concern that Dr. Neides did raise in his column, and which we share, is that there has been a somewhat alarming explosion in vaccination recommendations in recent years. There are now 15 separate vaccines recommended for healthy children before their 18th birthday, which represents more than twice the number recommended in 1983.  Many of these vaccines — including measles, mumps, rubella, polio, pneumococcus, and Haemophilus influenza — are extremely important, and have led to dramatic improvements in public health.

"We fear that, in the current political environment, there is a risk that legitimate concerns about vaccinations may become conflated with more fringe viewpoints."

But not all recommended vaccines are slam dunks. For example, is it really necessary to administer the hepatitis B vaccination to neonates, at a time when their risk for acquiring the disease is low? Likewise, the benefits of the currently approved shingles vaccine for older adults are modest, and it would be understandable why a patient might opt to decline this injection, particularly considering the cost. Moreover, there are legitimate safety concerns with some vaccines. A few years ago, for example, an older version of the rotavirus vaccine was removed from the market due to safety concerns.

There are also common-sense reasons for worrying about the recent increase in vaccine recommendations. First, like any new recommendation, it creates work and uses clinical time that providers might otherwise spend addressing other issues. We and several other experts recently raised this point when new guidelines were issued recommending an additional pneumococcal vaccine among older adults (note that we support use of this vaccine in young children). These new recommendations may increase the burden of vaccination among already overworked primary care practices, even though there is little high-quality evidence that the new vaccine adds substantial value. Yet as we add more and more vaccinations to the checklist, we necessarily take away focus from other important topics that providers ought to cover.

We also worry that the success and safety of some vaccinations should not automatically imply the efficacy and safety of all vaccinations. This nuance has been lost in the current dialogue. In her thoughtful book on the history of vaccination, “On Immunity,” the poet and critic Eula Biss writes about the complicated historical relationship between forced vaccination and communities that hold deep mistrust for the medical profession. Her thesis is not that recommendations to vaccinate are overly paternalistic; rather, she invites some empathy for those who hold skeptical views. Biss writes: “Even a modestly informed woman squinting at the rough outlines of a compressed history of medicine can discern that quite a bit of what has passed for science in the past two hundred years … has not been the product of scientific inquiry so much as it has been the refuse of science repurposed to support already existing ideologies.”

Overall, we strongly believe public health experts are well-intentioned, and most of the standard vaccine recommendations should be followed. Indeed, individuals who opt not to accept certain key childhood vaccines — such as measles, mumps, rubella, polio, pneumococcus, and Haemophilus influenza — not only put their children at risk but also risk the health of their communities. When raising skeptical viewpoints about vaccines, we need to be cautious to avoid fueling scientifically baseless concerns about vaccine safety.

Nevertheless, because vaccine safety has become so politicized, we also need to be vigilant to ensure that patients, scientists and doctors feel comfortable raising legitimate concerns about vaccine safety. Just like any medical intervention, we need to demand high-quality scientific evidence about vaccine safety and efficacy, and we should continue to question the dramatic recent increase in vaccine recommendations. We should not accept on blind faith that all of these vaccines are necessary.



Related post:

It’s been an unbelievable news cycle in the vaccine wars


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This point of view could not be more timely or more accurate.

“...Even a modestly informed woman squinting at the rough outlines of a compressed history of medicine can discern that quite a bit of what has passed for science in the past two hundred years … has not been the product of scientific inquiry so much as it has been the refuse of science repurposed to support already existing ideologies...”

There is great danger when the rhetoric of debate substitutes for the logic of dialectic.

Too often consensus guidelines are the product of debate, where experts use their stature to influence an outcome biased by their individual ideas, rather than hewing to the logically reasoned truth. Too often policy decisions are based on the same flawed process.

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The challenges in achieving your ideal vision, Dr. Hochman, are two-fold. One, too often those promoting understanding of "common-sense reasons for worrying" about the safety of vaccines are unwilling to denounce debunked vaccine-autism myths as the outright falsehoods they are and the purveyor of such falsehoods as dangerous and liars. I appreciate that here you called such falsehoods "dubious and scientifically unfounded opinions" and "unsubstantiated statements," which you might say are simply more polite ways of calling vaccine-autism myths falsehoods, but your phrasing can leave some readers thinking "oh, gee, unsubstantiated isn't unproven." The vaccine-autism myth is thoroughly debunked and should be called such anytime it's raised (I realize you may not have wanted to focus on that one safety issue, but it's the 800-lb. gorilla in the room, so it's there anyway.) But this wouldn't be that much of a problem were it not for issue number two -- the other side doesn't play be the rules you're espousing, Dr. Hochman. They don't play fair. The vaccine-autism believers such as RFK Jr. do not use carefully selected and nuanced phrasing. They talk about vaccines as "poison" and autism and other neurological problems as "vaccine poisoning." Stick "herd immunity" against that phrasing and gee, guess which one wins more minds and hearts? They talk about the debunked vaccine-autism link as if it has science backing it up. They talk about "government cover-ups" for the vaccine/pharma industry and other wild conspiracy theories. They call scientists who advocate for vaccines "Nazis" and other such names. When scientists and medical professionals speak in the careful terminology of evidence-based medicine, using phrases such as "the majority of evidence weighs against a connection between vaccines and autism," and medical professionals avoid saying they can guarantee that vaccines are 100% safe, the vaccine-autism believers use such phrasing against them. I actually agree with a fair bit of what you wrote, Dr. Hochman, but you're speaking as if we live in an ideal world where everyone will agree to stick to facts, go no further than evidence allows, and avoid wild rhetoric. That ain't the real world.

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Thank you for this article. You are a breath of fresh air in a polarized world.

Journalists have the responsibility to be fair minded and present facts dispassionately. They are supposed to illustrate the issues with examples from both sides providing a 'fair and balanced' point of view. Instead, what we have today is a refusal to even admit that something may be going on. Is it the vaccine schedule? Ingredients in the vaccine? Another virus or bacterial infection at time of vaccination?

The fury espoused by Mr. Sneed, above, is endemic of medicine in general. The victims are attacking the saviors! How dare they? What he doesn't seem to understand is that parents would not be so adamant that a particular vaccine hurt their child if they didn't really believe it. The fury of an attacking press only compounds matters.

Until Medicine, in general, can account for the victimized parents to a reasonable degree, they will forever be discounted as 'pawns of Pharma'. A parent believes their child was 'normal' before the vaccine. Telling them they were wrong, that they missed something, that 'it would have come on later' or things of that nature do nothing to assuage the worry and anger at something they see as an specific onset.

My child was fully vaccinated and everything was fine. But I have friends; educated, non-hysterical people, who are convinced that something happened to change their child. Some of those children I saw daily. Just because my child was lucky does not mean their experiences are any less than mine. That is their experience. Period. Negating these victims, by the very people who profit off those same vaccines, only inflames the victims more.

So, where does the corruption come in?

Until all the vaccine trial results are released, until the vaccine court documents are public notice, until Pharma stops getting judges to gag order whistleblowers, nobody with a shred of gray material between their ears, can possibly think there might not be more to the story.

Study 329 was not an isolated incident. Journalists have been covering ghostwritten studies, pay for play, pharma whistleblowers, and a host of other ethical lapses that lead to retractions and massive lawsuits for decades. To think only vaccines are somehow immune from gamed studies is naive at best and a lapse in judgement at worst.


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