Regaining trust after vaccine threat debunked
■ A leading medical journal says MMR vaccine-autism study was fraudulent. Doctors still face a barrage of safety questions from worried parents.
By Kevin B. O’Reilly — Posted Jan. 24, 2011
The tide may be turning in the battle to win parents' trust in the safety of recommended child immunizations.
In early January, the editors of influential British medical journal BMJ said Dr. Andrew Wakefield had perpetrated an "elaborate fraud" with his 1998 article in The Lancet that purported to link autism and bowel disease to the measles, mumps and rubella vaccine.
BMJ editors concluded that Dr. Wakefield "altered numerous facts about the patients' medical histories in order to support his claim to have identified a new syndrome" and "sought to exploit the ensuing MMR scare for financial gain." The editors based their findings on the work of British investigative reporter Brian Deer, the author of a series of articles on Dr. Wakefield that appeared in the journal.
In 2010, Dr. Wakefield's license to practice medicine in Britain was revoked, and The Lancet retracted his article. In 2009, judges in a special U.S. federal court rejected a link between the MMR vaccine and autism. Many studies have rejected any link between autism and vaccines.
These developments come as government officials and physician organizations have improved communicating the benefits of vaccination while addressing safety concerns, doctors say.
Many physicians greeted the BMJ revelations with relief, saying Dr. Wakefield's work caused many parents to doubt the wisdom of immunizing their children. MMR vaccine rates had plummeted in Britain, where cases of the measles and mumps soared into the thousands annually. In the U.S., outbreaks of the measles, pertussis and Haemophilus influenzae type b involved children whose parents opted out of immunization.
"This was a house of cards," said Jay M. Lieberman, MD, referring to Dr. Wakefield's research. Dr. Lieberman is professor of clinical pediatrics at the University of California, Irvine School of Medicine and medical director of infectious diseases at Quest Diagnostics Inc. "It just took a decade to understand what fully happened and to expose the complete lack of science behind it and, indeed, the fraud."
After the articles were published in BMJ, Dr. Wakefield told CNN that his work was "distorted" and that he is the victim of a "ruthless, pragmatic attempt to crush any attempt to investigate valid vaccine safety concerns."
Dr. Wakefield still has defenders, especially among parents of children with autism. J.B. Handley, who co-founded the activist organization Generation Rescue, now headed by celebrity Jenny McCarthy, told CNN that BMJ did "not remotely" discredit Dr. Wakefield's study and merely reprinted Deer's allegations.
The latest news will not dispel every parent's doubts about vaccination, Dr. Lieberman said.
"There's a small, rather hard-core and vocal minority that believes that vaccines are hurting our children," he said. "To the very small minority, no amount of scientific evidence will convince them otherwise. What we'd like to do, as physicians, is reach out to the majority of parents who are simply trying to navigate the information -- and misinformation -- they're getting."
Though parental concerns may persist, physicians can help persuade parents to vaccinate their children by taking time to listen to their worries, directing them to reliable information sources, and advocating for immunization with passion and a personal touch, experts said.
Doctors should go beyond educating patients about the science, said Gary L. Freed, MD, director of the division of general pediatrics at the University of Michigan Health System.
"We should present all accurate available information for parents, including the veracity and the lack of credibility of many of those who have promoted fear of vaccines for their own personal profit and gain," said Dr. Freed, lead author of a March 1, 2009, Pediatrics article reporting that one in eight parents has refused at least one recommended vaccine.
The survey of 1,552 parents also found that 25% agreed with the statement, "Some vaccines cause autism in healthy children."
The delicate conversation about immunization safety can turn sour quickly, said Francesco "Chek" Beuf, MD, a Boulder, Colo., pediatrician.
"Discussing vaccination with certain people is like discussing religion or politics," Dr. Beuf said. "It's a matter of deep feelings, rather than facts.
"I try to educate people. I try not to make them feel like idiots."
Physicians should capitalize on their established relationships with patients, said Doug Campos-Outcalt, MD, the American Academy of Family Physicians' liaison to the Centers for Disease Control and Prevention's Advisory Committee on Immunization Practices.
"The foremost point is that people trust their doctors," Dr. Campos-Outcalt said. "Physicians should talk to patients confidently and answer their questions in a straightforward way and listen to their concerns."
Advocating for health
At All Star Pediatrics in Exton, Pa., a Philadelphia suburb, parents receive a vaccine policy statement expressing the group's belief in the effectiveness and safety of vaccines.
Parents are discouraged from delaying vaccination, and those who refuse to vaccinate are advised to "find another health care provider who shares your views."
The five-physician practice has been using the statement since 2007 to help allay parents' concerns. Still, the questions keep coming at virtually every visit, said Bradley J. Dyer, MD, the group's founder.
Despite telling parents who refuse immunization to go elsewhere, Dr. Dyer describes his conversations with parents as congenial.
"The approach we use is to say, 'There's bad science, or no science, behind the detractors. We want to do what's best for your child. We're on the same team here,' " Dr. Dyer said.
Physicians definitely should steer clear of chastising worried parents, said Ari Brown, MD, an Austin, Texas, pediatrician and co-author of Baby 411: Clear Answers and Smart Advice for Your Baby's First Year.
"Doctors need to remember that these are not bad parents -- they are scared parents, and there is a difference," Dr. Brown said. "Don't make your interactions leave the parent feeling like they are a bad parent for not vaccinating or waiting to vaccinate. ... Parents just want to feel like they are doing all they can to protect their child."
Dr. Brown said concern about vaccines seemed to peak in about 2008 in her practice, and that the tide has begun to turn since then.
"It's been a long decade," she said. "Hopefully, we can close this chapter and move on and have more parents feeling confident in vaccinating their kids."