Going Viral: How the Internet Plays into the Anti-Vaxx Movement

Be careful, son. Don't want to hear about this on Facebook!

Mommy/Parent Shaming
Back in the day if something terrible happened to a child that event would, at most, be covered by the news and serve as a warning to others to reconsider their parenting practices.Then life would go back to its mix of routine and the unexpected.

Nowadays, if Johnny doesn't have sufficient hand dexterity by the time preschool rolls around it's because his mother didn't create enough 'sensory play' activities in the home. This is a warning sent out in pins, posts, tweets, and e-mails. You name it. And when something truly horrific occurs, the breaking news covering it is only the start of an onslaught of public commentary. Read: Heartless criticism:

Rare tumor? Well, I would never let my kid eat non-organic food, I bet that's why this child got cancer. 

Kidnapped on the way home? I never let my kids go anywhere alone. Ever. 

School shooting? That's what happens when you don't home-school. 

Where was the mother when this child had a freak accident?

And so on.

It's all there on the internet for people to pick apart and most of that turns into finger-pointing straight at the mother. Is it any wonder then that many mothers are absolutely terrified of making a "bad" choice? -- One in which a negative result is possible.

Though extremely rare, there are risks involved with vaccines and as soon as some parents hear that they can't bring themselves to go along with the injection. They are paralyzed by fear and perceived judgement. What if it's their child who is 1 in 17,000,000? They can just see it now:

She actually agreed to stick toxic* chemicals in her baby and now s/he's injured? What kind of mother does that?

Which bring us to our next internet side-effect...

Passivism by way of Naturalism
How do you get out of making tough choices? Keep it natural, baby.

Yes, letting nature take its course is the coping mechanism many parents are opting for today. Because they don't actually see it as a choice (though it most certainly is one). They believe that by abstaining from modern interventions with their children they can wash their hands from blame should something not turn out right.

In other words, if a child gets a rash from elderberry, that's cool. Whatever. That ol' Mother Earth is a tricky one! If the child gets a rash from penicillin, well, the parents took a risk and should have known better.

How did we end up here?

As I said, people were already looking for a way out. A way to distance themselves from the scary things that can happen when you're in charge of tiny precious lives. You take that desire and couple it with an internet fraught with "all natural" promotions telling viewers there's no risk** involved, and BAM. You've got parents who want to believe essential oils can cure anything, it's herbs or nothing (not even prescribed medications), and that immunity by infection is the way to go.

Now listen. If measles becomes commonplace again, it will be ONE HUNDRED THOUSAND TIMES more likely for one's child to have a serious negative outcome from this disease than from getting the vaccine. Let me repeat: ONE HUNDRED THOUSAND TIMES. But that's a gosh-darn-awful risk some people are willing to take to avoid guilt in the one in a MILLION chance something "unnatural" might happen to their child as a result of their decision-making.

Why do some parents throw statistics out the window?

The Paranoia will Destroy Ya'
I have the perfect case study. I know a fellow who runs on fear. He watches the news late into the night and makes decisions throughout the day based on paranoia alone. He'd seen a story on his Facebook feed once about how a child was difficult to extricate from her carseat after the vehicle slipped off the road and into murky water, but luckily the parent had scissors nearby to cut the safety belts. He shared this post multiple times and, sure enough, the next day he had heavy duty shears in the glove compartment and the trunk. He tells me this as he's putting his under-2 year old in a front facing carseat in the front passenger chair of his pickup truck.

CLEARLY car accidents that cause immediate child fatalities -- especially when kids are not properly restrained -- are more common than seat belts causing harm. We all know this. But successful public health recommendations do not garner all the 'Likes.' Sensationalized, rare events do.

What's more, I believe the phrase "What your  fill in the blank  doesn't want you to know" is destroying our society. It too is fueled by paranoia. Specific to this topic, enough people have clicked on articles informing them that their doctor is profiting from each vaccination and that these injections are making everyone sicker for job security. Your local newspaper won't tell you that, but truth-seekers of the inter-webs unite, right?!

DIY Everything
People, we've lost our reverence for the professionals.

Not only do we think they're hiding things from us left and right, we're no longer impressed with the years of training that went into their careers.

DIY blogs have told us we don't need no education. And I get it, there have been things I learned online that helped me to do simple jobs around the house that I would have otherwise wasted my money on had I hired them out. But I want to think I know where to stop. Like, heavy electrical work. I won't risk getting electrocuted or burning down my house just because some guy is telling me he's got an easier "life hack." I'd much rather call a pro for that.

The same is true for medicine and public health. Unfortunately, so many are caught up in the DIY spirit that they write long, incredibly long blog posts claiming that hours/days/weeks/years on the internet makes them a statistician. But I've yet to read a single one of them use ANOVA analysis, compare t-scores, discuss confounding variables or null hypotheses. If that doesn't sound the alarm like "extra" parts left over from a DIY mechanic job, I don't know what else to say.

Down with the Internet?
No, and I'm sorry if this entry reads like an attack on technology. My goal here is to recognize how the anti-vaxx movement is spreading. Once we see the patterns that perpetuate false information or exploit common fears among parents we need to do what we can to fix this. It's about education and reassurance. It's even about better marketing ourselves. In my own efforts, I've tried adding PubMed articles to my Pinterest page, but there's been little interest in that. But I write an article about Gwyneth Paltrow's vagina and my readership soars. Now I'm just waiting for Kim Kardashian to get a vaccination in her derriere and, my pride aside, you know this blog will run with that.

That's how important this is.

Now SHARE this blog with all your friends or I'll tell everyone you gave your kids non-organic kale... And then tweet about it.

*This is not true. And if you're worried about preservatives, most vaccines do not carry them and where they exist there is often a preservative-free option. 
**This is also false. I've known plenty of people who ended up in emergency rooms after taking herbs without talking with a healthcare provider first. 

Ethics: Religious Exemption from Vaccinations

Source
(from NEJM original)

Where I live, the only way to be truly exempt from vaccinating your children as it pertains to school and day care admittance is to have an actual allergy or receive a waver due to religious beliefs from one's physician. As you can imagine, there's plenty of people who fake a deeply held religious conviction in order to obtain this piece of paper.

The other day I overheard a woman asking her doctor about that exemption. She freely admitted that she claimed religious convictions against vaccines so as not to expose her children to what she perceived as unnecessary risks associated with the injections. But now she's worried. Like everyone else, she's hearing about outbreaks of measles. She said measles didn't seem that bad, but she got to thinking about some of the other preventable diseases like polio. This lady did NOT want her kids getting that crippling disease. So she asked her physician if the religious exemption was an all or nothing setup. In other words, could she make her "religious beliefs" a la carte: MMR is an abomination; the polio vaccine is kosher?

Well, praise God!
Source

I'm not sure what was said in response to this inquiry, but I'm curious to know what you think about vaccine exemptions. I know many are entirely against them. Others will concede that we must still leave room for religious liberty among those who are true in these beliefs. Another might ask, which faith actually preaches this? Important to me from a public health standpoint is the following question:

Is basing exemption on religion keeping people from getting vaccines they would have otherwise requested? 

The ideal is for people to get fully immunized, of course, but I'd rather have them get some than no vaccinations at all. What's your take on this situation now that I've shared with you what some are thinking?

Guillain-Barre' and Vaccines (What Your Doctor WANTS You to Know)

Guillain-Barre' sounds like a fancy Frenchman, the type of guy you'd invite to a party to impress your friends. In reality, Guillain-Barre' (GBS) is a syndrome that can occur without warning, it causes the insulation around the nerves (myelin) to fall apart. Patients often complain of ascending weakness, tingling that starts in the feet or genitals and climbs up their body. If left unchecked, GBS can cause significant disability and even death from paralysis. Prompt diagnosis and treatment are critical to ensuring good outcomes.

So what triggers GBS? A lot of people will tell you it's vaccines. Are they wrong? Not exactly.

All GBS needs is something provocative to get it going. Last week I met a young woman who caught the common cold and this led to GBS. Today I admitted an elderly man who had his GBS triggered by a urinary tract infection. And yes, I've met people who developed GBS after receiving a vaccine.

There, I admitted it, there can be negative side-effects from getting a vaccine. *record screech*

I've said it before, and I'll say it again: This doctor happens to think that if the medical community were to be more open about potential side-effect from vaccines we wouldn't be losing thousands of people to misinformed bloggers leading them astray with a sliver of truth. All it takes is for someone to click on "What Your Doctor Doesn't Want You to Know," learn that - though exceedingly rare - there ARE in fact risks with vaccines, and from then on their trust in modern medicine is broken. They return to the blogs of self-taught internet "scholars" believing they've got the real scoop. And I say we can hardly blame them when doctors continue to take a Wizard of Oz approach: "Pay no attention to those potential side-effects behind the curtain!"

That's one way to practice medicine.

Am I traitor for saying those things? Only if you believe strict paternalism is woven into the fabric of medicine. As you can see, my preference is for more education, presenting the facts and letting people make informed decisions. With so much information (good and bad) available at one's finger tips on the internet, I find this to also be a matter of adaptation and necessity.

Going back to the subject at hand, I wanted to know what's riskier, getting GBS from say, the flu shot, or from the flu itself? I checked the CDC site first and, honestly, it seemed to tiptoe around this. Finally, I found this article in The Lancet that got right down to it. Check out the methods section to see how researchers worked backwards from GBS cases to obtain the data. Suffice it to say, they found that if you're going to develop GBS after getting the flu shot, it will likely happen 2-6 weeks post-injection. In that same amount of time, people who get the flu itself may develop GBS afterward with greater likelihood compared to those who develop it post-vaccination.

What does it all mean? The article suggests that getting the flu is riskier, even ~17x more than receiving the vaccine in terms of getting GBS. That's good news for modern medicine. The trouble is, of course, that the flu vaccine's efficacy (how well it works) changes year to year, and as I understand it this year's strain is coming up short. It follows that you could get the flu shot, still come down with the flu, and yes, develop GBS from either one of those events (though the odds are very much against that).

So, as one with autoimmune disease, what did I do? I simply got the flu vaccine. I took the very remote chance I'd get GBS because to me, the potential benefits far outweighed any risk. Again, I know this year's vaccine efficacy isn't great, but I wanted to make sure I did everything I could to not infect my family and patients. The flu can kill young children, the immuno-compromised, and the elderly. - All of that happens with MUCH more frequency than any lasting vaccine side-effect. And I share that, even as one who is personally taking care of GBS patients right now and watching them struggle to regain strength.

This is a brave new world we're in. We're more closely connected and our decisions don't just affect ourselves. We also no longer have the untouchable, erudite physician entering our homes with the leather tool-case telling us what to do. We have greater access to knowledge now and how we process all that information will determine the medical decisions we make.  I hope whoever's reading this, if they're on the fence about what to do regarding vaccines, will find a physician who will partner with him/her to make informed decisions s/he can feel good about.

Bonne chance!

Was polio going to go away "on its own"?

This chart is misleading.

It makes it appear as though polio was going to disappear without vaccine intervention, and it doesn't take into account morbidity (only mortality). The truth is that spikes in death rates can be "paused" after the bulk of frail patients (infants and the elderly) succumb to the disease. After that, initially healthy patients have a better chance at survival (i.e. don't get tallied into the death number), but they suffer SERIOUS long-term damage. Additionally, the initial spike in deaths prompted aggressive public health interventions including quarantines and the closure of crowded events. That contributed to the drop significantly, but wasn't a long term solution.

Vaccines are the long-term solution. Where polio vaccines are not given, the polio virus comes back rearing its ugly, ugly head.

Addendum: A friend of mine brought up hand-washing. Hygiene definitely improves when a plague is rampant and I'm sure this can be credited with assisting the drop in death rates above. I wish it would stay that way, too. In theory if everyone practiced the aseptic method we'd be rid of all sorts of illnesses. Realistically, however, people become complacent when the threat of disease is not staring them in the face. Also, case in point, my kid just sneezed in my face. Thus proving life and illness happen.