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Joanna Weiss

Seeking common ground in the autism-vaccine debate

(Istockphoto)
By Joanna Weiss
Globe Columnist / February 27, 2010

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LAST WEEK, my 15-month-old son got his Pentacel shot, which contains vaccines for diphtheria, tetanus, whooping cough, polio, and a form of influenza that can cause bacterial meningitis. By rights, I should have felt relieved: He’s now protected from a pack of dread diseases. But I was nervous for days, watching his every move. Was he still making eye contact? Saying “Hi, Dada’’? Or was this the moment he’d slip away?

Maybe I’ve read too many stories about parents like Doug Flutie, who swears that his child was normal, got some shots, and changed. But I know that few things strike terror into parents’ hearts like the dramatic increase in autism diagnoses, now estimated at one in 100 American children. Some attribute the rise to changes in how the disorder is diagnosed - the child who once would have been labeled “troubled’’ or “odd’’ now falls on the autism spectrum. (Indeed, the bulk of new autism cases involves kids with average and high IQs.)

But the numbers are so stark that many believe the environment plays a part. And because the rise in autism has correlated with a dramatic increase in the number of shots babies get - and vaccines, unlike air, are something a well-meaning parent can control - it’s little surprise that immunization has been the focus of fear, and has caused a rift between some parents and pediatricians.

How much fear? It depends where you look. The majority of parents follow the Centers for Disease Control’s vaccination schedule to the letter; in 2008, 76 percent of 19-to-35-month-olds had received gotten the government’s recommended menu of vaccines, which now begins with a Hepatitis B shot at birth.

But some parents want to avoid vaccines altogether, and doctors report an increasing number that want to delay the schedule or limit the number of shots given at each appointment. The doubters are often educated and affluent: When she practiced pediatrics in inner-city Philadelphia, Dr. Meg Fisher rarely saw parents who questioned vaccines, but in the New Jersey suburbs where she now works, the skeptics are more plentiful. And some of the country’s lowest vaccination rates are in places like Berkeley, Calif., and Boulder, Colo., according to Arthur Allen, the author of “Vaccine: The Controversial Story of Medicine’s Greatest Lifesaver.’’

“It’s sort of where the intellectual hippies meet the black helicopter crowd,’’ Allen said.

That would almost be amusing if the stakes weren’t so high, and if there weren’t so many well-meaning parents Googling desperately for clarity, trying to weigh the risk of disease against the shadowy specter of autism, wading through dueling statistical analyses and ugly barbs. (On the Internet, vaccine advocates are lemmings and shills for the pharmaceutical industry, while skeptics are parasitic cranks who get their science from Jenny McCarthy.)

And new information has done little to change the debate. When the Lancet, a British journal, recently retracted an influential 1988 paper that suggested a link between autism and the Measles, Mumps and Rubella vaccine, the antivaccination forces were more emboldened, saying this was just a move to discredit unpublished research that would prove a vaccine-autism link.

As Allen has written, it will be nearly impossible to quiet the doubts. Many respectable studies have found no link between autism and the ingredients of vaccines. But there has been no definitive non-proof, either - no controlled longitudinal study of children who get vaccines on the current CDC schedule and those who don’t. (Ethics rules and practical considerations, such has how to create a control group, make one virtually impossible.) And for every scientific study that rejects a link, there’s a heartbreaking, unprovable, irrefutable anecdotal story that says otherwise.

So it’s little surprise that parents sometimes react with emotion, and pediatricians sometimes get annoyed. Fisher, who heads the American Academy of Pediatrics’ infectious diseases committee, says about 20 percent of doctors she speaks to refuse to treat children whose parents won’t follow the CDC schedule to the letter. Others have voiced frustration about having to explain and re-explain the importance of vaccines: “I know, I am supposed to be understanding, but I don’t have time to do this anymore,’’ one doctor wrote last year on the website sciencebasedmedicine.org.

The American Academy of Pediatrics urges doctors to work with skeptical patients, but Fisher says that isn’t always easy. Doctors worry that children will get sick or spread diseases to other patients. They don’t want their good intentions to be questioned. And so parents who raise doubts can find themselves treated like nuisances or enemies of science. Some of them walk away.

I’m not arguing against vaccinations, but I do think doctors need to give parents more credit for seeking information, and approaching medicine with some degree of skepticism. History is filled with stories of well-meaning doctors prescribing medicines that turned out to be harmful. In very rare cases, vaccines can cause damage. And while vaccines have been made significantly safer over the years, it’s not irrational to think that, with more study, they could become safer still.

Again, that’s not to say that parents should ignore the threat of infectious disease - anecdotes about children suffering from whooping cough are enough to give anyone pause. But something needs to change in the doctor-patient relationship, too, which is why some pediatricians are preaching compromise.

Perhaps the most famous of them is Dr. Bob Sears, the son of attachment-parenting guru William Sears. In “The Vaccine Book,’’ Sears, the son, promotes an alternative schedule he says urges vaccine coverage for some of the most common and life-threatening diseases for infants - such as meningitis and whooping cough - while giving parents permission to delay other shots.

“Instead of ignoring parents’ worries or blowing them off or telling them they’re wrong to be concerned about their baby, I’ve chosen to understand their concerns, listen to them, and find a way to help them vaccinate,’’ he told me by phone. “By kicking these parents out of our offices, we won’t achieve anything.’’

It’s true that Sears’s schedule is more hunchwork than science - there’s a fair amount of marketing savvy mixed in there, too - which is why he is sometimes rebuked by other doctors. But he ought to get credit at least for trying to keep parents in the vaccination fold, and for encouraging dialogue. Parents might be more open to reason, after all, if they know they’ll be having a conversation instead of girding for a fight. They aren’t questioning because they hate science, after all. They’re questioning because they love their children.

Joanna Weiss can be reached at weiss@globe.com.

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