Wednesday, February 24, 2010

that squishing sound

I don't usually link to other blogs (not out of high principle or anything, I think I'm just generally not very plugged into internet "communities" as a whole and also I'M SHY) but I wanted to post this link to the most recent entry on Alice Bradley's blog, "Finslippy" about the vaccine debate. (Warning: video!) The topic of the debate is: who do you trust more, doctors or other parents?

But first, full disclosure: a lot of these so-called "mommy blogs" make me insane. I love "Finslippy" (I think Alice writes incredibly well and with great humor, and she's a Wellesley alum besides) and I think that Julia from "Here Be Hippogriffs" is another blogger who writes beautifully, with humor and nuance) but generally I find myself becoming short tempered with mommy blogs where, shall we say, perspective becomes a little unhinged from reality. I will say no more about this, because when I know I am about to step into a big pile of shit, I do not need to make the shit mound any deeper.

What bothers me particularly about some of these online mommy communities, however (aside from the fact of insisting to use "mommy" as an adjective attached to everything--perhaps this speaks to my own bias, but I feel that it essentially neuters mothers by using a cute diminutive, something akin to calling Frances "Baby" in "Dirty Dancing"), in particular when it comes to debates like whether or not to vaccinate, is the fact that doctors are so often cast in the role of the bad guy. Those evil doctors! Those dumb doctors! Those greedy doctors! They don't know! They don't care! They just want to make money off the booming commercial market that is vaccine production! Anyway, no one knows anything my kid as well as I do! It may not be scientific, but my mommy intuition trumps all!

The thing that drives me nuts about this debate, aside from the anti-vaccine crazies (about which a little more later--enough has been said about this without me needing to add too many words into the ocean of discourse on this topic), is this: sometimes doctors are mothers too. Sometimes doctors and mothers are the same people! Mothers that have gone to medical school! Doctors that have reproduced! The novelty of it all! I know this is hardly the main point to make about this topic, but that's something that has always irked me to no end about this Mothers vs. Doctors debate. (And Alice, thank you for trying to call attention to this, but of couse I'm not surprised that they edited it out. How can there be an "Us vs. Them" if there is no "Them"?)

And look, I'm not saying that doctors know your kid better than you do. Obviously I know my kids better than my Pediatrician does. But loving my kids does not mean that I know everything, nor does it mean that I can protect them from everything bad that could possibly happen, much as I wish I could. Loving my kids does not make me an infectious disease specialist. It does not make me a pulmonologist. It does not make me an immunologist. In the hospital, when I call a consult on a patient, I listen long and hard to what the consult is saying. It behooves me to do so. I know the patient better than they do, but they are the experts in their field while I am the expert in mine. If I am of the mindset that the consult I'm calling is an idiot and maleficent and isn't going to make the right recommendations, why do I call that consult at all?

Look, I don't meant to discredit those who are anti-vaccine by calling them "crazies." The Lancet has taken care of that for me. (Oh, snap.) All I'll say is to repeat something I heard on NPR, which is that it's very easy to scare people, and it's very difficult to un-scare them. Just look at the opinion posited in the video to which I linked, for the mother who refused the MMR vaccine because Jenny McCarthy apparently had such compelling evidence of how it clearly caused her son's autism; but who clamoured for the H1N1 vaccine because it was in the news, all SWINE FLU WILL KILL YOU AND EVERYONE YOU LOVE, OMG, TIME TO START DRINKING PURELL. Easy to scare people, almost impossible to un-scare them. Someone should do a study on that.


  1. pedsdoc7:50 PM

    in private pediatric practice we see this ALL the time....its whatever is on the news. Plenty of patients who refused MMR wanted H1N1...but then also refused seasonal flu.

    I have been accused of promoting vaccination to intentionally increase the rate of autism so that I make more money (not sure how that works) to which I wonder why come and see me? Its so frustrating.

  2. Anonymous8:15 PM

    Maybe this is just my perspective as a mom on her 3rd year peds rotation, but the diseases prevented by vaccines scare me more. For good reason.

  3. Hear hear! Totally agree with you!

  4. The thing that frustrates me the most about the vaccinate/don't vaccinate debate is that any clear, genuine discussion of the subject is drowned out by those who insist on screaming their position at the top of their lungs. Some folks are so polarized and so sure they are correct that they don't even want to listen to what anyone else suggests.

    I've had two pediatricians for my kids due to moving cross country a couple of years ago. Both of them are completely pro-vaccination, and I'm pretty sure they are not the evil tools of the pharma industry. They genuinely care about the health of my children. I trust them. I trust them far more than Jenny McCarthy, who has apparently become a medical expert to the world because her son had autism and she read some books about it. I'll take your med school, residency and board qualifications over that any day of the week.

  5. Anonymous9:38 PM

    Totally agree... OMG, i'm a 3rd year on Peds rotation... i'll been YELLED and HUMILIATED for promoting vaccination. As a med student, I don't get paid for a "cent" for vaccines or watever... it's part of my learning experience but I do believe in vaccines, a bunch of potentially fatal diseases can be prevented by vaccines....

    My favorite part is "I want everything natural for my baby." Wait until your kid gets Hib and get intubated and might die.

  6. Anonymous9:53 PM

    I think one thing the public doesn't really understand is why vaccines are here in the first place. They helped eradicate terrible diseases, and because they did such a good job, most people have no idea what those diseases, i.e. polio, are like.

    Also, something to take into consideration as well is that most people don't understand how vaccines work. It's easy to fear something when you don't understand it.

  7. Anonymous10:05 PM

    Hear hear! Couldn't agree with you more.

  8. I love your blog Michelle, and have read for years though I rarely comment. But this post made me want to reach out and hug you and say "yes!"

    My grandparents spend their summers in the small town in Wisconsin where my grandfather was born. There's a cemetery where my great-grandparents are buried, and I visited it once with my grandpa. He showed me their graves and then we walked around looking at the other headstones. After a while I remarked on how many died young, and he looked at me and said "modern medicine is a miracle isn't it?". He said it was rare to know a single family who hadn't lost a child to a disease we now vaccinate against (to be fair, these were large farming families, but still). I was pregnant at the time and found myself all teary because I was so thankful my baby would be stuck with needles.

    So yeah, my kids are vaccinated, and I'm grateful for it.

  9. (Also, I thought Anon at 9:53 made an excellent second point.)

  10. Anonymous10:57 PM

    Amen, sister. I am a mom and a doctor, and I vaccinate.

  11. Great post. The anti-MMR/clamoring for H1N1 mom was funny. As an OB resident, I try to set expectations prenatally. You WILL breastfeed and you will vaccinate. Starting with yourself, getting seasonal and H1N1 this season, while you're still pregnant. Anyway, great post.

  12. @Anonymous 10:57: Maybe that should be a bumper sticker! Sounds like the "I'm pro-choice and I vote" sticker....

  13. Anonymous12:01 AM

    I agree with you---well said.

    And entirely off topic, what I hate about mommy blogs is calling a persons husband a DH. Who the heck ever refers to their husband is 'dear husband' in real life. Seriously. I think I would assume that someone likes their husband. Write it out or use a fake name or use the real name, but seriously it kills me when when I read DH or DS or DD. God :) I totally love your blog more because you don't do that!

  14. FourthYearOzMed12:43 AM

    That was a great (and validating) post. I'm on paeds rotation, and the anti-vaccination rhetoric amongst parents here (in country Australia) is palpable.
    I have wondered, though - so many of the diseases we routinely vaccinate for are now so rarely seen in the western world- does anyone else think that these parents just don't believe in things like polio? I just spent two months in Nepal and saw a neonate with tetanus, and wish i could have taken that mental image back to the crazies.

    And the 'DH' thing... even more infuriating than "hubby". ugh.

  15. another furious pro-vaccinator.3:45 AM

    when i saw jenny mccarthy going on about vaccines and how evil they were as if it were the truth on the ellen show i was just quite furious. i almost felt like they shouldnt show episodes like these because plenty gullible people would actually take this all seriously. i just wish ppl wont keep trying to find a blame for their children's conditions. !

  16. Anonymous4:58 AM

    Ask me about my city's current mumps epidemic set off by this mindset. And the immunosuppressed kids who suffer from the people who decide to not vaccinate.

  17. I don't know...calling people who have a differing opinion "crazy" isn't going to change anyone's mind.

  18. Did you ever think that Autism is not the only worry of some people with vaccines? This "debunking" hasn't changed my mind whatsoever.

  19. Thank you for this post - I'm not a doctor, but thank you. It's infuriating and terrifying what some people believe.

  20. My great uncle died at the age of 4 of diphtheria in 1904. The doctor's sleigh capsized as he was bringing the anti-toxin and he broke both his legs.

    My friend from high school is deaf in one ear because of Hib meningitis.

    My friend's dad walks with a limp and has an emaciated leg because he had polio.

    Some people need a big reality check. And I personally would like to see civil suits brought against families who refused to vaccinate their children causing babies who are too young to receive the vaccines and immunocompromised children to get sick. In the litigious society we live in today, I'm kind of surprised that hasn't happened already.

  21. The US government admitted a year ago that a series of vaccines caused autism in a young girl with a mitochondrial disorder, and taxpayers will now be paying for her care for the rest of her life. So I'm not getting why anti-vaccine folks are called "crazy" when in this instance it IS clear that vaccines were part of the cause of autism.

  22. Hear, hear, to pretty much all of it (with special attention to the 'it's easier to scare than to un-scare' part of things).

    Doctors who listen and take the time to answer questions are awesome, but no one can ever answer away an irrational fear. At the same time, there are doctors out there who won't take (or make) time to answer their patients' questions, and that creates fertile ground for irrational fears to thrive.

    In the end, I think that we all tend to want the easy way out - to have An Authority Figure tell us what we should do. If their doctors are dismissive and paternalistic, then some people turn to the empathetic, telegenic medical knowledge of Jenny McCarthy. But for any of us with weird health histories (I've got lots of fun AI issues myself), we can't delegate stuff like this, and trying just leads to disappointment at best, public health nightmares at worst.

  23. I had to weigh in here, because I am in the (unfortunately not-too-unique) position of being both a doctor (an anesthesiologist), and a mother of a child with autism.
    We have chosen to vaccinate my son and also his younger sibling, and we are planning on vaccinating baby number 3 when he/she arrives in June. I did quite a bit of research into this and am, for the most part, very comfortable with my decision. However, i must admit that every time the needle goes near my child, I have a twinge of worry that maybe, just maybe, I'm doing the wrong thing.
    When you are presented with the somewhat nebulous diagnosis of autistic disorder in your child, you are suddenly questioning all you did as a parent, all you ate when you were pregnant, whether your spouse is social enough or if his brother's obsession with video games is the genetic clue. We as parents have an overwhelming instinct to protect our children from harm, and as such I think many tend to err on the side of caution. I think the decision to vaccinate a child is often a cerebral one, and the decision to spare your child from any harm often more visceral. When there is someone offering up options that, in a way, reinforce your "gut feeling", they can be hard to ignore, especially when the vast majority of people in the U.S. have had the good fortune not to see the devastation these vaccine preventable diseases can cause.

  24. As someone who gets pummeled on her Facebook page every time she links to something that may infer that Saint Andrew Wakefield was a fraud (gasp!), I applaud this post.

    My frustration with this entire subject is that folks get bound up in their heartstrings and refuse to keep reading, listening, exploring and researching the topic. I have linked to full articles, which were NOT even read, but then have to listen to comments arguing the topic. READ the article, then argue. We have NOT found a cause nor a solution. And Wakefield did the entire community a HUGE disservice by wrongly putting a spotlight on vaccines. Why is the autism community not angry with HIM? The mind boggles.

    I hate having to qualify my arguments, but in this day and age it is necessary, else it leads to finger-pointing of the You Don't Understand variety - my brother and nephew have autism. The heartbreak of is it not unknown to me.

  25. Anonymous12:15 PM

    I get it, I totally understand why Jenny McCarthy feels like its her life's goal to "educate" everyone on the "evils" of Vaccines. She's a mother who wants answers for why her child has this horrible disease. I just wish that other parents would understand that though, noble (because she is coming from a good place), she is completely misguided and not informed enough on the topic to be the spokesperson for autism. But i get it, she wants answers...unfortunately she's convincing people to put there child at even greater risk for other devastating diseases.

  26. Vaccines have been so effective we now have the luxury of worrying about their side effects rather than the diseases themselves. I know that no vaccine is without risk, but I am not willing to lose a child to something I can easily protect him against. Space them out, okay. Forgo them altogether? No way.

  27. We don't have kids (yet) but this whole vaccine debate scares me - not because I am worried about the vaccines, but because i am worried about the 'mommies' out there!

    I am pro-vaccine. I am not a doctor, but I do have a Masters in Public Health. And my husband did his PhD on the MMR debate in England. I think we are pretty well versed in the topic, but I fully understand how such issues can be emotional to some people. But as some people here have said, the diseases that these vaccines prevent are pretty damn scary themselves. Thanks for writing about this stuff. It is interesting to hear about it from the medical side, not just the policy/population health side that I study.

  28. Anonymous2:39 PM

    I was a mom before I was a medical student. I am also a skeptic and do not trust people without question. I was so confused by the vaccine debate that I did not vaccinate my first few kids until they were a year old (sometimes later)- not because I was holding off for philosophical reasons, but because I was still trying to sift through the research. It finally took being in medical school and really understanding the body and the disease processes to finally calm the inner voice that just did not know what to do. I am provaccine now- but I can't judge all the mothers who are just so confused out there. My advice to them is to go to medical school.

  29. When I was a new mother, ten years ago, I had barely even heard of the vaccine debate (I must have been in the wrong parenting circles).

    But my pediatrician (a mother) who was near retirement age and very pro-vax, confided that she thought the chicken pox vaccine was unnecessary, in her experience. And we didn't get it for my kids. So really, it was an MD who made me first think about the whole topic. (My boys got chickenpox in the course of things and did fine.)

    I am not at all anti-vaccine. Heck, I was in the Peace Corps in Africa and willingly bared my arm for whatever they wanted to stick me with. But I don't think there's anything wrong with delaying and spacing them out, which is what we decided to do. I agree with Mary about the polarizing nature of this topic. There are people who will take my delaying vaccines as proof that I'm some conspiracy-crazed loon and others who regard me as a duped tool of Big Pharma because I got them at all.

    Like Anon above, I delayed while researching - and for the record, I didn't depend on other mothers or celebrities for my information, but on books written by doctors.

  30. Anonymous3:47 PM

    There's a great article from Wired magazine about vaccines, Paul Offit and the anti-vaccine movement. Well worth reading.

  31. I am 100% pro-vaccine, but will probably space them out in my kids. I know there's no proof that spacing them out does any good, but it also doesn't seem to cause much harm either. So I guess that's my way of catering to my "head" (getting them vaccinated because I know it prevents the disease) and also catering to my "heart" (the worry that the thimerisol or some other agent in the vaccines contributes to or causes autism).

    I do disagree with the choice to let Jenny McCarthy spout her rhetoric and the screaming voices that take her word over many doctors'. I understand that she wants an explanation for her child's syndrome, but foisting this "explanation" on the general public without actually researching it herself is unpalatable. especially because Wakefield himself just admitted that he faked his results and that the results are therefore unreliable.

  32. If you're interested, I'm actually trying to do research about this stuff. Not getting very far, but hey.

    I have some Some posts about it, like this one:

    Wanna collaborate? Then I can get nowhere faster.

  33. Anonymous7:59 PM

    During my internship with the American Academy of Peds, I was assigned to scope out an anti-vaccination march on the Capitol. They speechified about the vast medical-pharma conspiracy to cover up autism data. I was horrified to think that people actually believe pediatricians hate kids.

    The anti-vax people got off the ground with Jenny McCarthy's endorsement. Maybe what we need is not so much a thousand pediatricians patiently explaining immunology but rather a big celebrity dedicating time to championing vaccines. Michelle O?

  34. Anonymous10:41 PM

    Kari, the Poling case was decided in part based on a journal article written by the father of the patient. He declined to point out this relationship in the paper, of course, nor the fact that there was litigation pending. A decent summary is here: and there are pdfs linked from that page.

    In addition, the VICP decision in no way means that vaccines cause autism. See for a better explanation than I can post here...

  35. Anonymous9:21 AM

    "Those evil doctors! Those dumb doctors! Those greedy doctors! They don't know! They don't care! They just want to make money off the booming commercial market that is vaccine production! Anyway, no one knows anything my kid as well as I do! It may not be scientific, but my mommy intuition trumps all!"

    Sorry, this is nothing to do with the vaccine debate (but I agree with you 100%*) - but substitute doctor with pediatric dentist, and vaccine with almost anything they do.

    *For the life of me, I cannot understand PEERS who refuse to get vaccines.

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