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On vaccines: scientists can’t stop doing science because of crazy people

The views expressed are those of the author and are not necessarily those of Scientific American.

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Last week, the US Institute of Medicine released a report on the adverse effects of vaccines. And their finding? That vaccinations cause negative reactions in very few people; that vaccines have no connection to autism or type 1 diabetes; overall, that vaccines are safe.

The report was commissioned by the National Vaccine Injury Compensation Program, whose employees bear the task of sorting through a few hundred claims every year made by people who think they have suffered injury from vaccination. But because there had never been a thorough analysis of what vaccines can actually cause what complications under what circumstances, evaluating each claim is slow-going. With the report now released, the office should be able to sort through them more quickly — a benefit for everybody.

When I got the press release for the report in my email, I was nervous: oh great, I thought, here is an opportunity for the press to incorrectly play up the supposed dangers of vaccines (which, I repeat, are limited to a few people with immune problems, as I wrote about in my Nature Medicine blogpost on the subject.) But overall, they didn’t. The press release was entitled “Few health problems are associated with vaccines,” and all news outlets I saw followed this line, even highlighting that they don’t cause autism. (If you did find coverage otherwise in the mainstream media, let me know in the comments.)

So overall I was content and let it pass. But yesterday I read a blog post by science journalist Erika Check-Hayden about how the report missed an opportunity to communicate with the public:

But only someone who is completely out of touch with today’s society would fail to realize that such a report needed to be thought out and presented much more carefully than it was to avoid fueling the anti-vaccine panic that is raging across the country.

I do understand this idea. The 600+ page report is a horrendous read, drenched in jargon and pretty poorly organized, for what it is. If you just glance at the thing, it wouldn’t be hard to get caught up in the length and incomprehensible text and just throw your hands up — “there must be many terrible things in here!”

But, in the end, this is a report about the adverse effects of vaccines. It wasn’t about judging the safety of vaccines. I guess you could say that therein lies the core problem: that refusing to make a statement about their safety is a cop-out. But I don’t know how the panel could have said more and stayed accurate. Adverse reactions do happen, albeit very rarely. The summary for the report says, “overall, the committee concludes that few health problems are caused by or clearly associated with vaccines,” and members noted that these events are very rare, both within the report (“we do want to emphasize [that] many of the adverse events we examined are exceedingly rare in the population overall”) and to the media.

More important than what is actually contained in the report is how it will be used. Yeah, the media reports on it, we can blog about it, but in the end it will be used by those who actually matter: doctors. Yes, the people who do the most to inform patients about their health and health risks, and who, most of the time, have the strongest sway.

The doctors I spoke with about the report were all quite excited about it. The vaccine compensation office doesn’t have a reference guide to vaccine adverse effects; but neither do doctors! When parents and patients come in with questions about vaccines, doctors have to generalize about the safety and risks. They are relieved to now have a resource they can point to — to say “this report came out and there are so few adverse effects, that vaccines are exceedingly safe. But if you want to talk more, here is what we know, and here is what we can do to plan.”

And if doctors are more confident in their statements, the report can only help soothe those on-the-fence about vaccines.

But what upset me more was the suggestion that the report should not have been released in the first place if it wasn’t going to suitably assuage the general public. Check-Hayden finishes her post with:

The Institute of Medicine committee gathered 16 eminent doctors and public health specialists who truly care about protecting the nation’s children against vaccine-preventable diseases. Didn’t any of them realize that it probably wasn’t a good idea to release a report that focuses so myopically on the drawbacks of vaccines in today’s increasingly anti-vaccine climate?

Scientists can’t stop doing their work, including commissioned government reports, so that people won’t freak out. Sure, the committee could have written a better summary in nice language. But if people are going to ignore rationality, and listen to their friends before they listen to their doctors, the problem is deeper than one that can be solved by clearer writing in an Institute of Medicine report.

The sad truth is that the people who are going to freak out about this report probably wouldn’t listen to scientists saying that vaccines are safe anyway. If they were going to listen to scientific evidence, they already would have.

Hannah Waters About the Author: Hannah Waters writes about natural history and the way people think about nature. She lives and works in Philadelphia, PA, but really on the internet. Follow on Twitter @hannahjwaters.

The views expressed are those of the author and are not necessarily those of Scientific American.

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  1. 1. erikahayden 12:33 pm 09/2/2011

    Hi Hannah,

    I agree that the substance of the report is actually good news for vaccine safety (see my Nature news story).

    And I did not suggest that the report “should not have been released in the first place,” as you write. I said that “such a report needed to be thought out and presented much more carefully than it was to avoid fueling the anti-vaccine panic that is raging across the country.”

    For instance, the report contains no context about the benefits and overall relative safety of vaccines, and the report’s emotionally difficult content about vaccine adverse events isn’t balanced out by any similarly emotionally gripping content about the benefits of vaccines. Also, Chapter 13 – “concluding comments” – does attempt to provide at least some risk estimates for a few of the adverse events, but it’s too technically written for non-scientists to work through.

    I also think scientists don’t quite realize how their audience has grown thanks to the Internet. Yes, the report is directed at doctors, who I hope will make good use of it. But the report is now sitting out there on the Internet for anyone to read. You seem to be saying that no one on the general public will bother, but this is a misconception of how people make decisions in their everyday lives these days.

    People want to look at the evidence for themselves. They trust intermediaries (including the media) less and less. They don’t go into their doctors’ offices to passively receive wisdom; they show up to their medical appointments armed with questions that they have researched on the Internet. Scientists have not caught up, and this is part of the reason behind skeptic phenomena like the vaccine skeptic movement.

    If you go to the Internet to find information on vaccine safety, and most of the pro-vaccine information is jargony and unintelligible, while the anti-vaccine information is written in language you can understand, with pictures and anecdotes, you’re going to have an easier time relating to that anti-vaccine information.

    So I disagree with the idea that “the people who are going to freak out about this report probably wouldn’t listen to scientists saying that vaccines are safe anyway.” The people scientists need to reach are not those who can’t be convinced that vaccines are safe. Scientists need to reach the large middle ground of people who now hear anti-vaccine arguments or comments in daily life, from friends, neighbors, or family, and want to double-check these arguments against authoritative, accurate information. (If you have kids, you know how often these casual “I don’t know; I’m just concerned” comments come up about vaccines anywhere that parents congregate.) People in this middle ground are not anti-science; they just don’t know where to go for comprehensive discussion of vaccine safety on a level that is directed at them, not at their doctors and not at public health officials. This is where reports like this Institute of Medicine report have the opportunity to help – or at least to not hurt.

    Link to this
  2. 2. Jbyrne 7:12 pm 09/2/2011

    I think there may have been an opportunity to make a big song and dance about this and very clearly exclaim “looky here, they’re good for you and they will help you and your children.”
    It’s important to provide doctors with the reference material to advise their patients but its also important to fight the media war with that same material to convince everyone. One wonders if a summary page of a long complicated report being sent to media outlets is the right tact. If convincing fence sitting families is what you are trying to achieve then you have to write a better summary targeted at a lay audience and have a big unveiling with press etc. to capture more than the odd print story.

    Link to this
  3. 3. cimi.skywalker 9:48 am 09/5/2011

    Just briefly:
    Any serious scientific enquiry should include an open platform for Dialogue. The title “On vaccines: scientists can’t stop doing science because of crazy people” is a good first step in creating a hostile environment for any such dialogue; and is also a fairly sure indication that the writer of this article is not open to dialogue.
    There are a multitude of issues with vaccinations in general. I have not read this report …yet; and do not know if these are covered. It is also worrying that the report was commissioned by the very Corporation which is championed with determining “compensations”. Who are the authors / researchers, is it independent and unbiased? I would wager that there are equally valid “reports” demonstrating the dangers of Vaccinations. I have yet to see a scientific paper demonstrating the benefits of Vaccinations which is totally independent of the profiteering drug companies or government agencies lobbied by the same.

    Yours respectfully, Cimi Skywalker

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  4. 4. AutismDad 9:33 pm 12/2/2011

    I guess it’s late to comment here, but it seems what I am hearing from scientists who are at least informally affiliated with some of the top researchers is the percentage of autism cases related to vaccines is not really known.
    According to some researchers at the UC San Diego, unknown mitochondrial disease may be a significant factor in autism. They know infections will cause terrible problems in some autistic kids and they don’t really know what percent. They say known mitochondrial disease rates are at least 5% in autistics, which is much higher, at least ten times, than overall population.

    So, this is a very complex picture. On the other hand, even if vaccines are the immediately preceding event, fevers which no one can avoid would also cause this problem.

    Very complex.

    But you have to play the averages, and on average vaccines are neuroprotective, many preventable infectious diseases CAUSE brain damage as well, and the odds are your kid is better off with vaccine.

    Link to this

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