Vaccination and the Politics of Fear – THE DOCTOR IS IN!

mACmILLANBy: Dr. Frank MacMillan – March, 2015

Something as important as the health of the nation should be based on good science and not influenced by manufactured fear or be politicized. Politics and debate are tools to decide and prioritize things like how much to spend on a road or bridge, or whether to go to war or fund public education. There are however, public purposes like health that should be based on science, not politics. Science is best applied to things that can be measured, observed and tested using scientific method. Science must therefore be consistent, transparent and reproducible.

I bring up the matter of science because we live in a world that is rich in the fruits of science and technology, yet many of us have a limited understanding of what science really is. Despite near universal literacy, we seem to have trouble telling the difference between what is science and what is belief. A quick look back in history can be helpful in showing how scientific method moved us forward into the modern world and out of the dark ages.

Access to clean water is one of the most important advances in public health in the history of humanity. Dr. John Snow, in mid-nineteenth century England came to believe the cholera epidemics that repeatedly devastated Victorian London came from contaminated water. The prevailing wisdom was that the spread the disease was caused by toxic vapors. Dr. Snow, using scientific method, created a map, plotted the disease occurrences on it, and noted they overlapped with the ground water system. He then tested his hypothesis by removing the handle of the Broad St pump and singlehandedly stopped the cholera epidemic. He is rightfully considered to be the father of modern public health.
Another historic example is Edward Jenner, who observed at the end of the 18th Century that milkmaids who were infected with cowpox did not get smallpox, which was a devastating and often fatal disease with high contagion. Dr. Jenner’s observation and insight led him to intentionally inoculate subjects with cowpox in 1798, and proved that they did not get smallpox when exposed to the disease, the first “vaccination”, derived from Variolae vaccinae, a Latin name, literally “pox of the cow.”

Science has improved our public health and quality of life in so many ways, no more so than in the understanding, prevention and treatment of infectious diseases. Natural cases of smallpox have been eradicated for over a generation. Poliomyelitis has been eradicated in the developed world and only persists in remote war torn areas where there is poor access and understanding of the benefits of vaccination. Measles had been largely eradicated in the United States. In fact, until a few years ago, many younger physicians had never seen a real live case.
Recently, many parents have chosen not to vaccinate their children because of inaccurate and misinformed overestimation of the risks of vaccination.

The now famous story of of Dr. Andrew Wakefield and the false association of MMR (measles, mumps and rubella) vaccine and autism is a cautionary tale. Dr. Wakefield published an article in the prestigious British medical journal Lancet claiming an association between MMR vaccine and autism. Dr. Wakefield’s coauthors withdrew their names and the Lancet retracted the original article when they found that he had accepted compensation from a law firm intending to bring a lawsuit against the vaccine manufacturer. On further review of the original data by the CDC and others, it is widely believed that the data were manipulated to show an association not supported by the evidence.

The damage Dr. Wakefield had done to public health continues due to accumulate worldwide because the public does not have confidence that the scientific community is telling the truth. Science has become politicized and this is a very dangerous. Pay very close attention when you are told that the science is settled on any question that can be addressed by science. A key part of the scientific method is reproducibility of results. If the conclusion cannot stand this scrutiny, then it must be rejected.

Otherwise rational parents are making a choice to not vaccinate their children because of fear, based on discredited junk. These parents have no personal experience on how devastating these diseases can be for some children. While measles may not severely affect older children, it is highly contagious and it can kill up to one third of children under the age of one year. Vaccinating all children protects very young and vulnerable children who are at the most risk of serious and life threatening disease. This is called herd immunity because the whole community resists infection, protecting those who cannot be vaccinated due to very young age or other health problems.

Universal vaccination has now become a political debate, which I believe is unfortunate. The real political issue should be on rights and responsibilities, not the science. Human beings live in communities because it enhances protection from dangers. We organize ourselves under agreements, rules and laws. In our country, we arrive at this agreement democratically and under the protection of a constitution, which limits the coercive powers of government. The government has no absolute right to compel vaccination or violate the integrity of anyone’s body, but the choice to not vaccinate is also a choice that exposes other members of the community to risk. The public health establishments however have a responsibility to protect everyone, and restricting those who are unvaccinated from public accommodations such as schools is not irrational or abusive. Vaccination indeed carries risks, some serious, thought the magnitude of that risk is so small that in most cases the weight of evidence favors vaccination. Not everyone is appropriate for vaccination, but herd immunity requires that those without good reason to not vaccinate, really need to be vaccinated.

My children are all vaccinated because I know that the benefits of vaccination far outweigh the risks. As a parent, I would never withhold such an effective preventative intervention without a really solid good reason. I strongly urge you all to do the same for your children. Also on the topic of prevention, I recently turned 50, and March is National Colon Cancer Awareness month. Don’t forget that a colonoscopy actually prevents colon cancer by removing precancerous growths called polyps. There are very few things in medicine that prevent a cancer, and this is one of them. No, the government should not compel you to get a colonoscopy, but I plan to schedule mine soon because I know how good the science is behind it.

Dr. MacMillan specializes in Gastroenterology and Liver disease and is a member of the North Andover Board of Health. He practices at Holy Family Hospital and currently serves as President of the Massachusetts Gastroenterology Association. Dr. MacMillan was recently reelected as Massachusetts Governor of the American College of Gastroenterology and is a Fellow of the College.