“How can you believe something so stupid?!? I care about your kids! Why don’t you!?!” OR Why It’s So Hard for Pediatricians to Talk about Vaccine Hesitancy

If you’re here, you probably know that I’m a pediatrician. Why? Because I write about it a lot. You also probably also know that I feel that pediatricians are the nicest people in the world. Why? Because we just ARE, okay? Look, pediatricians take care of kids all day, and if you don’t start out your day being nice, you probably will be by the end of the day. Why? Because, to paraphrase Cindy Lauper, Kids just wanna have fun! Even when they’re sick, kids are still looking for a spark of fun and goofiness and, well, kid-ness in the people who take care of them. And let’s face it, kids are pretty darn irresistible. So even on my worst got-a-flat-tire, stepped-in-dog-crap, ripped-out-the-seam-of-my-pants-damn-you-Häagen-Dazs® day, I will still invariably end up with a smile on my face for most of the day, sometimes despite myself.

So why can pediatricians turn into such raging jerks when a parent expresses some concern about vaccines? Why is it not uncommon for them to say some variant of, “How can you believe something so stupid? I care about your kids. Why don’t you?” Well, I feel that this Jekyll-and-Hyde-ness comes down to a few things, mostly what we believe and why we believe it.

So what do pediatricians (and all doctors and nurses and therapists and PAs and NPs and pretty much anyone who delivers health care) believe? Well, science. Scientific knowledge, painstakingly built up over years of trial and error, observation and experimentation, has brought us to where we are in terms of caring for the sick and maintaining health. We all know that there is more to learn, and we eagerly seek that out. We know that the science around vaccination is well-established and has been thoroughly researched.

And because we in health care believe in the primacy of science, we make the logical leap that everyone else does too.

I certainly think that the public discourse on such topics as climate change and GMOs over the past few years makes it clear that this is a naïve hope. Our interpretation of scientific evidence is invariably colored by beliefs and notions that carry huge emotional baggage and can lead us to conclusions that have more to do with our outrage over what we see as obscene and rapacious corporate profits rather than with the proven benefits that this science produces. I may be very unhappy with the price that the pharmas charge for their vaccines, but that doesn’t mean that these vaccines are not also essential and lifesaving. It means that I have to keep advocating in the public policy realm to assure that vaccines are available and affordable for all.

And while we are on the subject of science, there is nothing that pisses off doctors more than someone who subverts and perverts science for their personal gain. If you’re at a party with a doctor and you want to watch their blood pressure instantly rise about 30 points, there is one name that will do it:

Andrew Wakefield

He is the doctor whose 1998 paper in The Lancet sparked the modern anti-vaccine movement. His thesis? Based on as series of 12 patients Wakefield concluded that something about the combined measles-mumps-rubella (MMR) vaccine caused a change in the brains of children leading many of them to develop autism soon after getting the MMR vaccine. He suggested that if the vaccine were split into three separate vaccines, this would not occur. Here’s the problem:

The entire paper is a lie.

Here are just a few of the things Wakefield did NOT disclose to the editors of The Lancet:

* Wakefield was hired in 1996 at £150/hour by a lawyer working to bring a lawsuit against vaccine manufacturers.

* Wakefield filed for a patent for a “safer” single measles vaccine in the UK in June 1997. In other words, if the recommendation in his paper to split MMR into three separate vaccines had been taken seriously, he would have made a boatload of money from the royalties on his vaccine.

* Patients included in the study were recruited from anti-MMR groups; the study was funded for planned litigation.

* Records of the 12 children in the study showed that at least 5 had documented pre-existing developmental problems.

* Children who were portrayed as having their first behavioral concerns within days of MMR did not in fact begin having symptoms until months later.

* In other words, despite Wakefield’s postulating a causal relationship between the MMR vaccine and developmental problems, there was not even a temporal association.

* Wakefield obtained blood samples for controls at his child’s birthday party — without their parents consent — paying each child £5 for participating.

Don’t take my word for it. The British journalist Brian Deer has investigated Wakefield for years and had his reports published in the British Medical Journal and The Times of London. I’ll put the link to his website in the first Comment.

I will give Wakefield credit for being quite canny in implicating autism as a horror of vaccines because at the time of this paper doctors had little to no idea about what led to the condition. As a result, many doctors repeated now discredited theories about distant or hostile parenting. I vividly remember a scene in the 2010 HBO film, “Temple Grandin,” an Emmy-winning biopic about an autistic woman who has become one of the top scientists in the humane livestock handling industry starring Claire Danes in the title role. In an early scene, Julia Ormond, who plays her mother, is pleading with her child’s doctor about why her daughter (played as a child by Jenna Hughes) has this condition, and the doctor says something like, “Well, we’re not sure, but we think it has to do with bad parenting.” The mother protests, saying, “But I am always there for her! I love her!” The doctor says, “I’m sorry, but you’re doing something wrong,” and walks away. She is, of course, devastated.

I do think, then, that many of us in the medical profession laid fertile ground in which this lie could grow. Wakefield happened to be the huckster to bring it to full bloom.

So those of us in health care know that we’re smart. We wouldn’t have made it through school and into our professional life if we weren’t. But we are also good people. We would not continue in it if we weren’t.

Has there ever been a medical school applicant essay that didn’t include, in answer to the question, “Why do you want to become a doctor?” some version of the sentence, “Because I want to help people.” There are, of course, other reasons — societal respect, job security — but at the core is that spark of altruism. There are a lot easier and quicker ways to make lots of money, but there are few ways a person can have such a positive impact on people’s lives day after day. And frankly, because physicians are involved in some of the most intimate, significant changes in the lives of their patients, the emotional toll can be so great that if we couldn’t say we are doing some good for some people at least some of the time, we could not go on.

So considering all this, what does a doctor hear when a parent says, “I’ve been reading some stuff about vaccines, and I’m really concerned that they could hurt my child.”? What we hear is that you think I am either stupid or evil. Stupid because I am somehow unaware of significant research about the dangers of vaccines. Evil because I DO know about such terrible outcomes and choose to recommend your child get something dangerous to line my own pocket, despite the consequences.

Or both.

So yeah, it hits me at my core when I get that question, and part of me wants to yell, “How can you believe something so stupid?! I care about your kids! Why don’t you?!”

So, my fellow pediatricians and family practitioners and other docs and nurses and NPs and PAs and public health workers, believe me, I get your frustration. I share it. I need to take a few deep breaths before I go into a room where I know a parent is going to challenge me on vaccines.

I do feel very strongly, however, that for parents this is not about Stupidity but about Fear. I have to remember that to have a child is to fall into Love and into Fear in ways that people never imagined possible. Those emotions will always be intertwined, and too often, those of us in the health care realm don’t appreciate that. We believe in science, and we have very good reasons for doing so. And so we go right to Facts, thinking that they, by themselves, will be persuasive.

In fact, parents are coming to us with Love and with Fear. All emotions are valid, even if they are based on wildly erroneous information. If we don’t honor that Fear and recognize that it comes out of and is bound to Love, we will never be able to get to Facts because parents will silently say to themselves, “You really don’t see me. You really didn’t listen to me.” It is imperative that we meet people where they are, not where we wish they were.

Because if we don’t do that, we can never have a true conversation and find common ground. Only then can we move forward, by showing these parents respect and compassion in this place, not just by telling, but by showing, that we want exactly the same thing they do: for their children to be healthy and happy. At this point, more often than not, they will finally nod and say, “All right. Go ahead.”