It is not easy convincing patients to do the right thing. As healthcare workers, we struggle to keep them on the straight and narrow – “exercise more,” “stop smoking,”“cut down on your salt intake,” “take your medication every morning” and “finish the full course of antibiotics – not just until you feel better.” I also know that changing my own bad habits is hard, so I understand why not all of them follow our advice.
But getting patients to follow recommendations can become even harder when we do not agree – even when it is just a few of us who argue against sound and proven practices. Sometimes scientific data changes dogma, but these major shifts in practice are based on a preponderance of accumulated evidence, new studies or new or emerging therapies. Many aspects of medical care are clearly supported (aspirin for heart attack prevention, chemotherapy for lymphoma, and insulin for diabetes, to name a few), but even minor disagreements among our healthcare ranks leads to confusion among patients. As in all fields this is natural, but in medicine this can also be harmful. In the era of the internet and social media, a loud contrary voice can have a negative effect on medical care. The proverbial “squeaky wheel” gets the clicks.
A perfect example is vaccines.
The overwhelming majority of healthcare workers agree vaccines are both safe and effective. They have been proven time and time again, through innumerous studies, to be of great benefit. Vaccines save lives every year. Yet there continues to be a small group of healthcare workers that remain skeptics or conscientious objectors – those who continue to ignore accepted scientific studies, and instead look to pseudoscience, innuendo, or frankly just “know in their gut that vaccines may be dangerous.” A recent anti-vaccine screed from a physician at a well-respected medical center is just another example. While I assume that we will know more about how this happened in the next few days, and even with an apparent retraction and mea culpa that followed – the damage has been done. I will not reference this article or draw any more attention than it already has. There is no need to add the link as the less focus on such reports the better (read this by my colleagues at University of Washington instead). I would rather focus on the larger issue, noted by Julia Belluz’s take on the situation at www.vox.com (and I paraphrase her here):
“The medical profession has been struggling with how to deal with dangerous doctor talk….and how to deal with its rogue members.”
Such uninformed and fact-less discussion by our own colleagues hurts the profession as a whole. Yes there are those who propose alternate vaccination strategies (and their book), those who espouse their treatment approaches to avoid “toxins” in vaccines, and those who bring up pseudoscience that links vaccines to illness to get more web clicks to their site. And for everyone one, there are hundreds of thousands of other healthcare workers who cringe. However, when one of our own, an academician (someone who teaches the next generation of physicians) makes such incredulous statements – it is truly unconscionable. We have seen it before unfortunately. Such statements seed distrust in the medical community, and make the jobs of protecting our patients even more difficult – particularly for those trying to manage complicated patients in only a 30 minute clinic visit.
Few would argue against surgery for an intestinal rupture, but vaccines are easier to scapegoat because they are a preventative strategy – where the benefits aren’t seen or felt. What we can’t see doesn’t hurt us – and since we don’t see measles, smallpox or diphtheria – we don’t worry. We forget that just a few decades back when our parents were children that a mild summertime illness could lead to life-altering paralysis, or that families lined up to get polio vaccines once they became available. In my experiences working internationally, I have seen people walk for miles to get MMR for their child. Recent episodes like our current outbreak of mumps in Washington state, measles at Disneyland, or pertussis in multiple locations throughout the US, are further reminders of what can happen when vaccination rates slide – but they aren’t enough. Did you know for example that this year we had the first measles death in the US in over a decade (see article by the superb Maryn McKenna @marynmck) – vaccines did that, but few patients know or care about this information. Studies that show major benefits and safety are crucial to those who practice medicine (ref), but many are difficult for patients to wrap their heads around.
As individuals we often see ourselves as an n=1 study.
We must make time to be vaccine advocates. What are the benefits for supporting well documented science and public health positions? How about knowledge that we are protecting our patients. Despite what the anti-vax community suggests, the Centers for Disease Control and Prevention (CDC), the American Academy of Pediatrics and other groups that develop vaccine policies (and the physicians themselves) are not making decision in cahoots with vaccine manufacturers. What is done is based on foundations of science and organized to protect the public good. We need to address such falsehoods. We also need to take time to educate, providing cogent arguments for vaccinations and to have a willingness to tackle questions and concerns. We have vaccines that can prevent cancer after all – our patients deserve to know this information.
As an Infectious Diseases physician working among highly immunosuppressed cancer and transplant patients, I have been vocal about the advantages of vaccines. I have seen first-hand unvaccinated family members pass on life-threatening influenza to their loved ones during treatment, parents who fear sending their post-transplant children to a school where scores of students aren’t vaccinated, and I have personally spent countless hours preparing for the possibility of a case of measles or other vaccine-preventable diseases at a center where such an event could have devastating consequences. For these reasons and because of the solid scientific evidence, I speak about vaccines publicly, take part in pro-vaccine blogs/posts/tweetchats, and participate in research and national committees on vaccines. It is a part of my job I take seriously, to protect our cancer community and patients from preventable infections.
So in response to this anti-vaccine interview, don’t get distracted. Make it a priority to talk about the benefits of vaccines whenever possible – talk to your family, your neighbors, in the local newspaper or even on social media. Talk about the importance of vaccines at work in your ERs, clinics, hospitals and pharmacies, where we as healthcare workers can have the greatest impact on patient decision making. It is our duty to protect our patients and those most vulnerable in our communities. We must continue to promote vaccines, and assure the voices that patients hear are those based on evidence, science and the foundations of public health practice.
Finally, we should see this latest anti-vaccine commentary as an opportunity. It should remind the pro-vaccine community they we must remain united, because patient education and vaccine advocacy are even more important for what may be coming over the next four years.
Published by Steven Pergam, MD, MPH, FIDSA
I am a clinical researcher at Fred Hutchinson Cancer Research Center in the Vaccine and Infectious Disease and Clinical Research Divisions, and faculty member at the University of Washington. I am interested in Infectious Diseases and Infection Prevention, with a focus on epidemiology of major pathogens, antibiotic resistance/usage, development of novel prevention strategies and patient/provider education among immunocompromised patient populations. I currently spend my research efforts on emerging pathogens in transplantation, respiratory viruses, fungal infections, and drug resistant bacterial infections. I currently serve as Director of Infection Prevention at the Seattle Cancer Care Alliance.
View all posts by Steven Pergam, MD, MPH, FIDSA