New book aims to provide vaccine answers: AMNews interviews Martin Myers, MD

Washington -- Vaccines have long been considered one of public health's greatest and most life-saving achievements, yet they continue to spark controversy. In recent weeks, protesters in Washington, D.C., claimed that childhood vaccines are unsafe, while in Albany, N.Y., others rallied against a mandatory vaccine bill in that state.

Parents attempting to do the right thing for their children are often caught in the cross fire.

Now along comes a new book, Do Vaccines Cause That?! A Guide for Evaluating Vaccine Safety Concerns. It summarizes the research findings on vaccines and presents a method for analyzing that research. The book is by Martin Myers, MD, a pediatrician and executive director of the nonprofit National Network for Immunization Information, based at the University of Texas Medical Branch in Galveston, and NNii science writer Diego Pineda. NNii provides information about vaccines on its Web site (link). Affiliates include the AMA, the Infectious Diseases Society of America, the American Academy of Pediatrics and the American Academy of Family Physicians, which support its work. NNii does not accept pharmaceutical company funding, Dr. Myers said.

The authors evaluate the long-running controversy linking vaccines with rising rates of autism as well as claims suggesting vaccines' possible association with asthma. The book also delves into the effects of multiple vaccines on a child's immune system.

Although parents are its intended audience, physicians and others in the health care field can benefit from reading it, according to former Health and Human Services Secretary Louis Sullivan, MD, and Samuel Katz, MD, chairman emeritus of pediatrics at Duke University in Durham, N.C. Together they wrote the book's forward.

"One hopes -- anticipates -- that besides a broad lay audience, health care personnel at every level will take advantage of this book to augment their own perspectives so they can discuss vaccines more comfortably and convincingly with the families for whom they are responsible," write Dr. Sullivan and Dr. Katz.

It remains to be seen whether the new book will answer all queries. "You are going to continue to see parents doing their own research and coming up with a lot of questions," said Barbara Loe Fisher, a frequent critic of vaccines and co-founder of the National Vaccine Information Center, a nonprofit, parent-led organization that seeks to change the mass vaccination process to allow more opt-out flexibility regarding immunizations. She said she looks forward to reading the book but wonders if it will address the issue now being raised about the effect on children's health of recent expansion in the recommended vaccine schedule.

"I've seen the number of vaccines double and the number of doses triple," Fisher said. "No matter what is published in that book, it is still an outstanding question until health authorities give us the answer as to why so many highly vaccinated children are so sick."

AMNews recently talked to Dr. Myers about the book.

AMNews: Why did you write this?

Dr. Myers: For a couple of reasons. The first, and maybe the most important, was that readers of our [NNii] Web site asked us to. They liked the essays on our site and asked us to put them together in a book.

The second was when we went to bookstores to see what was available, we could only find anti-vaccine materials and advocacy books. But we couldn't find a book written to help parents sort their way through conflicting information.

It is meant as a tool to help parents understand what they are hearing and how to evaluate it. We do not advocate. Each section of the book was reviewed by technical experts and parents. We had a panel of parents read the book and tell us whether we were clear or not.

One of my favorite anecdotes concerns a parent who acknowledged that the book was informative but also said it was boring and not the kind of thing a parent is going to read. So we went back and started over.

We hope it's helpful for parents who want more evidence and also to those who need help sorting through the evidence.

AMNews: What's in it for physicians?

Dr. Myers: As Dr. Katz and Dr. Sullivan wrote in the forward to the book, we do review the evidence in some detail. We want to have it all there. They noted that it's something that health professionals should read also, since it's the one place where it is compiled.

A number of physicians at meetings said they were anxious to see the book because they thought it would help them talk to parents.

AMNews: Do physicians and researchers have difficulty communicating clearly to lay people?

Dr. Myers: We use words in a different way. We included a table of words in the book and what they mean to vaccine researchers and what they mean in common English. As we started to compile that table, we kept finding more words.

"Bias" is one of the words. "Plausible" is another. "Significant" to the scientist means it is probably not due to chance, but it could be. But when a parent hears the word significant, it means important.

Then there is the phenomenon of the missing information. If it turns out that a safety concern is caused by the vaccine, like it was with intussusceptions and [the first] rotavirus vaccine [which was withdrawn in 1999], it doesn't take very long to prove it. [Two new rotavirus vaccines were licensed in 2006.] But you can never prove a negative. You have to have lots of studies done by different people, and it might take years until the scientific community says, 'OK, the weight of the evidence is so compelling we think we can reject this.' We used a quote from Einstein that Diego found: 'Many experiments will never prove me right, but one experiment can prove me wrong.'

AMNews: How great is the danger posed by unimmunized children?

Dr. Myers: We have a section in the book called 'community immunity' that addresses how important it is for children to be immunized to protect neighbors. It's an important concept for people to understand that when immunization levels go down, outbreaks can occur.

Attacks of misinformation on vaccine safety can cause that breakthrough. We saw it with whooping cough in the 1970s and 1980s. And we saw it with measles and mumps in the United Kingdom just recently.

AMNews:So are the same vaccine safety debates occurring in other countries?

Dr. Myers: The same discussion on vaccines causing autism was held in England and Europe related to the measles vaccine -- that argument has been discredited now. But as a result, parents became confused and didn't immunize their children, and they had an outbreak of measles and an epidemic of mumps which spread to the United States.