Technically, there’s more than one “real” reason
For those of you who haven’t seen enough of my opinions about vaccinations, good news! I have more to say about them.
More specifically, a little while ago I wrote a piece about how refusing to vaccinate their kids undermines the relationship that parents might hope to build with their pediatricians, and the nice people at The Daily Beast thought it was worth publishing.
If there is an issue more controversial and fraught with anger and frustration for pediatricians than the question of vaccine safety, I can’t think of it.
Few topics are more apt to send my blood pressure skyrocketing than this. When the United Kingdom looks like sub-Saharan Africa in terms of wholly preventable disease outbreaks, something has gone terribly, tragically wrong.
No contemporary phenomenon confounds and confuses me more than seemingly sensible people turning down one of the most unambiguously helpful interventions in the history of modern medicine.
Yet they do.
Needless to say, I rather tickled that it’s up, and I hope you might indulge me by clicking through and reading it. For many of my esteemed co-bloggers, getting published is old hat by now, but this is a first for me. (Many thanks to Tod for the first read and encouragement, my friend Dan for helping me edit and pitch it the first time round, and especially to Conor for very, very patiently bearing with me as I pitched it again.)
Speaking of the estimable Dr. Williams, I will be doing my best impression of him and ignoring the comments over at Daily Beast. However, since this is the one place in the Internet with comments worth reading, if you have any thoughts about the content of the piece, feel free to share them with me here.
Would you rather we comment here or there? If it is the latter, might I recommend closing comments here to keep a unified discussion?Report
Oh, people can comment wherever they like. As I said above, since this is the only online community where I actually value the comments, I’m going to be ignoring the comments there entirely. (I’ve posted enough about vaccines in the past to assume they will be… not complimentary.)Report
My reading comprehension is sometimes barely above that of my students.Report
Awesome! Congratulations, and I hope they come calling for more stuff from you, because a.) you already write like a pro, and b.) I can be like, “Dude, I used to read him when he was still indie.”Report
Thanks, Chris! I feel a little silly being so chuffed about it, since I share this page with so many professional writers. But I’m really happy about it.
And I am similarly delighted that your absolutely fantastic atheism piece is getting its due attention.Report
I understand completely. I was unreasonably stoked when I was published here and got good comments. The capper was a Twitter callout on it from a writer in the U.K.
Anyway, that was a great piece that really lays it out. Congratulations.Report
Fantastic piece!
When we first met with a representative from our eventual pediatrician group, several months before Mayo’s birth, we broached the subject of vaccinations. “What are your feelings on vaccination?” She said, explicitly, that they absolutely believe that vaccinations are the safest route for children and they recommend them for all patients. That said, they would advise but not pressure families to pursue them if they otherwise weren’t inclined. This was one of a number of questions we asked to determine whether these were people we could trust.
“Will you be forthright with us if you have concerns about special needs or other abnormal development?”
“Yes, though we will also need you to be as honest as possible with what you observe at home*.”
“What are your thoughts on breast feeding vs formula?”
“We recommend breast feeding but recognize that this isn’t the reality for all parents and support you no matter what you choose.”
Etc.
There are actually six or so different doctors and, generally speaking, you don’t make an appointment with a specific doctor and instead get thrown into the hopper. I don’t know if this is normal and we have some mixed feelings about it (we find some doctors’ styles just mesh a bit better with us than others), but overall, we have been happy with the service we’ve received. By chance, the doctor we’ve seen the most has been the one we did the initial consult with, and she has gotten a good read on our personalities. I tend to take Mayo in for appointments (as a result of my work schedule and proximity to the office) and she knows that I’m going to whip out the iPhone with a list of questions from Zazzy and says, “This is what she is going to worry about and this is what you should tell her.” Etc. That is very comforting. It seems to be the essence of trust: I know you, I know your child, and I am confident I know what is best. I can’t imagine such an important relationship taking any other form.
* This recently came to pass when I had some concerns about behaviors exhibited by Mayo, which I can best describe as arm flapping and banging his fist against his head. I brought them to the doctor’s attention but, for some reason I did not expect, could not bring myself to say what I was really thinking: autism. Instead, I phrased it as, “These behaviors would concern me greatly in an older child (she knows I teach young kids).” She said, “You’re thinking autism, right?” “Yes.” “Well, those are behaviors we would look for, but rarely will they appear in a child so young. Plus he doesn’t seem to have the other markers… he maintains eye contact, socializes, and responds to affection. Let’s keep watching it and you keep reporting what you see to me. There are other possible explanations.” Anyway, it was a pretty powerful moment that she was able and willing to sense my thoughts and initiate the difficult part of the conversation. I sometimes am on the other side of that table (though I can rarely even infer a diagnosis as I am not trained to do such) and it is hard; many teachers shy away from it, kicking the can down the road. She did not and earned a lot more trust and respect that day.Report
we also used the vaccine question as a marker of trust. our pediatrician looked at us for a second as if saying “not again…” but once we established we were all on team vaccine, it worked out great. miss that guy.Report
We asked a number of pointed questions. Eventually she said, “You’re asking good questions. And nodding during answers that people don’t usually nod during. What do you do for a living.”
“I’m a preschool teacher.”
“I’m a nurse.”
“Okay. This is either going to be great or terrible.”Report
We really do strive to be as respectful as possible during these visits, and see if the refusal to vaccinate is predicated on a concern I might be able to address. Often we can come to an understanding, so long as there seems like room for dialogue. (I feel guilty splitting hairs, but I don’t totally love the headline they gave the piece. The “real” reason we want you to vaccinate your kids is so they don’t get sick.)
But if it’s clear the parents are dead-set against vaccines and have no intention of letting their kids receive them, it’s just not going to work for us.Report
This particular practice might be in a unique situation because of the local Haredi Satmar community, which I believe does not vaccinate. Recently, there was apparently an outbreak of one of the diseases we vaccinate against in the Brooklyn Satmar community, and the doctors posted a sign imploring parents to vaccinate if they planned to visit there and, if they don’t, to avoid travel until the outbreak was controlled.
By the way, I find it highly admirable that you are able and willing to say, “This is a poor fit.” I wish more independent schools were willing to have this conversation when ideological differences emerge. Instead, admissions directors will tell parents whatever they want to hear (especially if enrollment is down) and then teachers are left to bridge ideological differences. And we don’t have the power to say, “This is a poor fit.” Sigh. But now I’ve digressed.Report
So the Good Doctor went into Beast mode. Very nice.Report
Well done doc, you’re fighting the good fight here.Report
The thing that’s always amazing to me is how short such an article must be. How brief the sentences must be. A publication like the daily beast is not looking for a long form essay or a deep think piece, At least not typically. I’m sure it’s not that they want to write articles that are dumbed down, it’s that they want articles that can be read quickly.Report
When my kids were in HS, the English composition of 2 or more pages used to drive me crazy. I’d go in and talk to the head of the English Dept.; this is not helpful writing, it’s easy to write two pages; what’s hard is explaining something complex in 600 words or 2 column-inches. Over and over, I begged them: follow the 2-page essay with the same assignment in 600 words or less, with all the critical points in that short piece.
Never once did a teacher follow through; and it’s too bad. Most modern writing is bent toward that; the news brief or short essay.
Too much of the writing teaching goes to making it longer, finding more to say, which mostly results in puff. Little goes to the horror of shortening. Or the importance.
Killing your babies is a writerly term; it means that cute sentence that you struggled with for hours, that you think so clever, is probably the first thing that should go in the re-writing process. It’s also the potential result if you don’t vaccinate them.
Congrats doc, and thank you for speaking out.Report
@zic
I see your point and concur but there is also value and a different sort of difficulty in being able to write long form and maintain a coherent argument or arguments over many pages and with footnotes.
My “failed academic” heart gives me a slight bias towards long-form.Report
zic,
oh god. I know someone who failed a course because the teacher asked for something to be explained in too short of a space.
Granted, that might have been because he was bringing subatomic physics into a philosophy discussion…Report
Interesting point, zic. I am developing a syllabus for a writing intensive class next fall (my environmental policy class), and based on this comment I am going to experiment with having them take their longer paper and turn it into a 600 word news brief. If the experiment goes all to hell, you’ll have my students to answer to!
(Like New Dealer, my heart is with long form.)Report
@james-hanley, bless you!
From much editing in the writing of news briefs; do them a favor or not, but be aware: they need to rank the elements included in the long-form to help decide what to include in a 600-word brief; and that ranking needs to include charm, not just factoids.Report
Zic,
Thanks. I made a note of that tip for myself, so I’ll remember it next November when that assignment occurs.
I’m truly glad you posted that comment. You may be aware that it’s getting harder and harder to sell people on the idea of a liberal arts education–everyone thinks pre-professional is the way to go because it seems so much more clearly tied to specific career prospects. But I know so many examples of liberal arts folks who have successful careers not tied directly to their fields of study–a U.S. diplomat who was once an English Lit professor, an international shipping executive who studied history and religion, an executive for a major textile company who studied English Lit, a Marine Lieutenant who was a Lit major, a theater guy who became a lawyer (hat tip to New Dealer), and on and on, that I know the liberal arts are a good path, just less obvious.
And we academics sit around and piss and moan about people just not understanding, but we don’t make any damned efforts to educate folks about it. So over the past 6 or 7 years I’ve made a practice of paying attention to what businesses say they’re looking for in college graduates, or the skills that people in different fields say are valuable, and emphasizing any existing linkages between that and what I have students do, or finding ways to add it in when I don’t already do it.
So, yes, academically my heart is with long form. Short news articles about important policy issues irritate me to no end and I hate reading them. But I also know that in exceptionally concise and clear writing there is both an intellectual discipline and a professional skill.
I hope I don’t sound like I’m tooting my own horn here. It’s just that I think the liberal arts are in something of a crisis, and we either have to figure out how to sell our value (and work on increasing it) or continue to dwindle.Report
@james-hanley, I get it.
My sweetie teaches at a music school. A very expensive university specializing in musical education that doesn’t focus on classical music.
so yeah, I get it. A good deal of his class-room time (he teaches in the electronic music dept.) is helping students sort out the real-world applications of what they learn in his classes.
And he’d be the first to add that those short-form writing skills are essential to the portfolio creation that will help his students find work based on those skills.Report
@james-hanley, I don’t know if this is helpful or not, but:
I did a lot of business writing; and writing for and about business is a high-demand skill; probably the easiest writing-niches to crack, because most writers think it’s boring. I thought that business, what people did at work every day, consumed the bulk of their time, and writing about it was a way to tell their stories, so not boring at all.
I was repeatedly asked by the higher-ups in companies I talked to to apply for corporate-PR jobs; a few times, offered jobs outright, often with high salaries and the need to relocate. So I began asking why someone made the offer (after all, that’s what reporters do, ask questions, right?)
And the answers distilled down to a couple of things: first, people who could breath life into business, and not present it as boring are rare. Second, people who could write concisely or at length (so from short form to brief on the same topic) are really rare. Third, people who know how to conduct an interview are rare.
So that would be my other gripe on writing classes; it’s not just book/research reading, it’s finding live sources and getting them to open up and talk. I am particularly good at this. And I am even better at relating what they say fairly; so that even a highly critical piece didn’t feel like a misrepresentation to the people I criticized. Serious writing courses should at least introduce students to the concept of interviewing.Report
Well, in fairness to them, it was already that short when I submitted it, and they often have longer pieces. Wasn’t Tod’s MRM piece at Daily Beast, and pretty in-depth?Report
One of the things that’s galling about the “vaccines can cause autism” gang is the implication buried under their opposition. The implication is, “A dead child is better than an autistic child.”Report
Congragulations. Did they pay you?Report
Nope. It was a freebie.Report
You are getting exposure!Report
Freddie just rolled over in his grave.Report
@north I know. Frankly, I am so utterly unfamiliar with the norms of publishing in this brave new media world, I wouldn’t even know where to begin if I had been expecting payment.Report
Congrats!
Since this is the Daily Beast, they will publish a counter point next week of course 🙂Report
Thanks! And I believe that Andrew Sullivan picked up your comment on Chris’s piece to highlight.Report
He did!
I wish he used my nom de screename but ah wellReport
He linked though so your nom de screename would have been apparent.Report
True!Report
Congrats, Doc!Report
Woo hoo!Report
Also — and I am well aware that it is early, and that the hordes may not yet have been roused and called upon to descend — but the comments over there are almost entirely pretty good.Report
Dare I look?Report
Oh, you know the moment you do…Report
I, for one, think this is a long overdue event. By event, I mean that you’re finally published in the “mainstream” internet. (In shorter words: ’bout f**king time!)
Heartfelt congrats, Doc.
And if there are any number of arguably ‘net savvy parents who ultimately end up making better informed decisions because you’ve now been bumped up to the major league, as it were, then it’s a win all around.
Seriously, what the downside? HuffPo trolls? C’mon.Report
Thanks very much for the encouragement. It was definitely a learning experience, and one of these days maybe I’ll even try again!Report
I just read an article recently about a study that concluded that anti-vaxx is actually a bipartisan thing, both the right wing and left wing kooks are into anti-vaccination.Report
Congrats and here is some grist for the mill. Recent research shows liberals are no more likely to believe vaccines are harmful then conservatives. I know the “both sides do it” meme on this is settled, but still, maybe this isn’t the liberal equivalent of conservative heads in the sand on climate change or evolution.
linky goodness to Kevin Drum
http://www.motherjones.com/kevin-drum/2014/01/liberals-finally-cleared-anti-vaccine-madnessReport
That leaves GMOs, obsession with “natural/organic” stuff, and belief in untested natural health care products as the main anti-science trends among the dippier variety of liberals and leftists.Report
Well, and economics denialism.Report
Like, not believing that tax cuts + increased defense spending = balanced budgets?Report
This, as ever, calls for a reference to XKCD: http://xkcd.com/1052/Report
I saw the piece over there too!
I was all, “Hey! I know that man!” (In a completely anonymous internet fashion, of course.)
But you do realize it’s only a matter of time before the AV hordes descend upon that piece, and then feverishly Google-Fu you and come here to annoy the crap out of everyone.
The last ‘discussion’ I got into with someone from the AV loonybin while using my FB profile, they proceeded to try to pinpoint precisely where I live so they could ‘send me a message’.
I hope they don’t do the same to you.Report
Tell them you live on Mercury.Report
I live in hope that the natural Fluoride content of the water in my region will work like garlic to vampires, and keep them away at the border…Report
DON’T worry, they won’t BE ABLE to follow the DIRECTIONS to your HOUSE unless they contain a lot of RANDOMLY CAPITALISED words.Report
@mike-schilling I see what you did there.Report
Way to go, Russell!! Compelling blend of professional perspective and personal narrative. I am raising a glass to your accomplishment this very evening!! Sending love and a big hug to you and yours….Report
Congratulations Doc, it’s great to see you getting exposure, especially on such an important topic.Report
Congratulations, that’s a great piece.
It’s interesting hearing your side of the sussing out between doctor and patient.
My wife and I tend only to go see a doctor when something is wrong – so we see whoever you see at the drop-in clinic that day. So far these interactions have ranged from uninspiring to actively frustrating and alienating. If our pediatrician was in general practice, we’d be in line – she’s excellent and we see eye to eye really well.
We had our own questions in that process, not including vaccination because every pediatrician (right? surely?) is strongly for them, but more around bed sharing, age of weaning, and such.Report
Hmmm.
That’s actually a great idea for another piece.Report
The issue of trusting your physician is a somewhat fraught one.
My wife has had particularly bad luck on that front. When she was pregnant, we were getting ready to travel to the Dominican Republic, and went to the travel immunization clinic, where the nurses were all very knowledgeable on all things vaccine- andworldwide-disease-outbreaks-related. I got my vaccines quickly and easily, but because she was pregnant, the nurses weren’t allowed to issue hers – she had to see a doctor.
The GP she was referred to
– tried to give her an MMR vaccine, despite its being contraindicated in pregnancy
– tried to prescribe her an antimalarial both specifically contraindicated in pregnancy and anyway generally not used for travel in the Americas, since the milder antimalarials still work there
My wife is nothing if not thorough in her research, so she had read Health Canada’s and the US CDC’s recommendations on all these things in advance, and probably a few of the meta-analyses referenced in the footnotes to those recommendations too. In the end she was adamant enough that he eventually gave her what she wanted, which was what the nurses had been saying all along she should get.
There have been a number of similar experiences where she’s had to strongly advocate for herself to get proper medical care.Report
It depends on where you are. Are you, for example, in a country with a reasonable standard of healthcare? if yes, trust the doctor, if no, call a doctor you know who you do trust. Its best if there is someone in the family who has been medically trained in an OECD countryReport
We’re in Canada – My impression is certainly that we have an excellent standard of medical care. And yet.
And yet, when my wife went to see a doctor with what she was pretty sure was strep throat in both herself and our daughter, the doctor did a visual inspection of both their throats, declared it to be viral, and took quite a bit of cajoling before he would take a swab and send it to a lab.
Sure enough, it was strep.
When he called back to tell her this, he at least had the decency to be embarrassed about his dismissive attitude at the time.Report
Didn’t the Batman piece make it to io9? That makes two, right? Good job, Doc 🙂Report
I couldn’t agree more on your post Russell and in fact just saw it posted by a local teacher acquaintance of mine on facebook with her adding “one of the best articles I have read on the subject”.Report
One of those viral moments; wish there was a like button here.Report
Yes it is something we don’t mind going viral.Report
“Viral” is an understatement.
As of right now, the piece has 79,000 likes on Facebook, and those likes are increasing exponentially right now.Report
Greetings. I wrote the following comment on the original article, and hope you’ll read it and make a slight revision to your stance regarding trust. (I totally agree with you on vaccination, though.) 🙂
[Edited to remove text dump — RS.]Report
I’m so sorry about the text dump above. It looked fine in the comment window, but came out a mess. Once again, here is the text of my comment, hopefully in cleaner form.
—
The author is right, but for somewhat wrong reasons. He treats trust as a prerequisite for establishing a physician-patient relationship, but it’s not, and can’t be. Trust is earned and built *after* interacting for a certain period of time, not given up-front simply out of “respect for (one’s) training and expertise.” Besides, the training and expertise he has simply make him a good consumer of scientific research, and maybe (depending on his skill) a good communicator of scientific findings.
However, other people, including patients/parents, can be good consumers of science as well. For example, without having any medical training whatsoever, I can run an excellent meta-analysis of research findings on side effects of Drug X or Vaccine Y, and use the results to inform my own treatment decisions. OTOH, some people might not want to hear about the details of studies, but just want to base their decisions on the final verdict from the literature, which the physician can convey. We don’t have to trust the author’s judgment to agree with him that we should vaccinate our kids, because it’s not about his judgment. It’s about the science. And we don’t even have to “trust” the author’s knowledge of the science, because staying on top of the medical literature is his job, and it’s the law. It’s a given, as are a tax accountant’s knowledge of the tax code and an architect’s knowledge of local building codes.
What the author should be looking for in prospective patients is a kindred evidence-based mindset: “Are you willing to accept the current scientific evidence as the basis for your decisions on disease prevention and management?” If not, then the patient/parent is probably not willing to accept current scientific evidence as the basis for other, less fundamental decisions. But if so, then there is a meeting of the minds between physician and patient, and the two can expect to embark upon a well-founded physician-patient relationship in which trust can later develop.Report
Doesn’t trust cut two ways?
Isn’t your pediatrician trusting that you won’t infect other patients, too? Some of those patients may be unvaccinated due to allergies or immune problems; and they’re trusting you won’t infect them.Report
And I should emphasize: they’re trusting you won’t infect them every time they take their children out in public.Report
Are you willing to accept the current scientific evidence as the basis for your decisions on disease prevention and management?
The whole point of my piece is that, in the case of vaccine deniers, the answer to this question is demonstrably “no.”Report
Of course. But their denial of scientific evidence has nothing to do with whether or not they trust you as a physician.
Let me give you a real-life example. I’ve had extensive physician-patient relationships with the maternal-fetal medicine specialists in a group practice. On several matters that were ultimately my choice, they showed me the literature, and I followed the recommendations based on those findings. These interactions occurred several times, some very soon after we met. Over the course of my pregnancies, the more we interacted and the more favorable my opinion of them grew, the more I began to trust their judgment, above and beyond their knowledge. When things got hairy and some serious decisions had to be made, all the facts were in front of my husband and me, and we still couldn’t decide, that’s when we turned to them and asked, “what would you do?” THAT is the kind of trust to which I refer. 🙂Report
I didn’t elaborate on this in the piece, but I spent five years in a practice that accepted vaccine refusers. Many of which were my patients.
Every time they came in with their children I tried to change their minds. And not once in five years did a single one do so. Not one. Despite the clear evidence that they otherwise trusted me, insofar as they continued to make me their child’s pediatrician. For all the hours (and I am not kidding about that) I spent citing studies and all but begging them to change their minds, not one did. Perhaps it was a personal/professional failure on my part, but somehow I don’t think so.
They had their minds made up before ever they saw me, and were all too ready to dismiss every piece of evidence I presented. In their estimation, every study I cited was biased/cooked/illegitimate. After five years, I had had enough of that. When I interviewed for my current job, knowing I was joining a practice where I would never have to beat my head against that particular wall again was a major selling point.Report
Just wanted to check in again and say thanks for all the well-wishes, everyone. This is giving me a little bit of vertigo. I kinda thought I’d peaked with the Batman post.Report
It is much deserved success. I really do hope you do some more (WHY WASN’T THAT ARTICLE ABOUT TYLENOL?!).Report
For those that care about such things, the DB piece now has 233,000 likes on FB.
It should have well over a half mil by Super Bowl kick off, and I bet over a million by Monday morning.Report
Fishing awesome!Report
That’s so cool. Congrats Russell.Report