Tuesday, March 10, 2015

The Truth About Vaccines: A Conversation with Dr. Nina L. Shapiro - A Footnote To The Ignorant!

  Dr. Nina L. Shapiro is the director of pediatric otolaryngology and a professor at the David Geffen School of Medicine at UCLA. A graduate of Harvard Medical School and Cornell University, Shapiro has been honored with several prestigious awards, including the American Society of Pediatric Otolaryngology Awards for Clinical and Basic Science Research, the UCLA Head and Neck Surgery Faculty Teaching Award, and the American Academy of Pediatrics Young Investigators Award, among others. In 2008 and 2012–2014, she was named a “Super Doctor” by Los Angeles Magazine; she is a Castle and Connolly 2014 “Top Doctor” and is listed in Who’s Who in America. She has given over 200 national and international scientific lectures, and written over 80 peer-reviewed journal articles, two medical books, and 16 academic book chapters. Dr. Shapiro is an editor of “50 Studies Every Pediatrician Should Know” (Oxford University Press, 2016), and she is working on a book about hype in popular health advice. Her work and expert commentary have been featured in the Los Angeles Times, The Hollywood Reporter, Time, BBC World, Salon, and on NPR.
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Harris: Thanks for taking the time to speak with me, Nina. There are a few background issues I should mention so that our readers understand the context of our conversation. An article in the Hollywood Reporter attracted a tremendous amount of attention because it revealed that some private schools in Los Angeles and Orange County have vaccination rates similar to those of countries in sub-Saharan Africa. This is true of affluent areas in northern California as well, such as Marin County. Then there was an outbreak of measles, a disease that had once been declared eradicated in the US, which came courtesy of a happy congregation of unimmunized people at Disneyland. This story also became national news, and measles has now spread to at least 17 states.

So my first question is, why aren’t people getting their children vaccinated against preventable and often very serious illness in the year 2015? I have my own thoughts on the topic, but I was wondering if you could comment as a pediatric ENT and surgeon.

Shapiro: I think there are several reasons why people have chosen—and I use the word “chosen” specifically because I think most people now have a luxury of choice when it comes to their medical care—not to vaccinate their children. One is that they haven’t seen these illnesses. Most people with young children have never seen a case of measles; they’ve never seen mumps, rubella, polio, or whooping cough; so these illnesses are just abstractions to them. Their families are healthy, so why should they worry about something they’ve never seen?

And there’s the concern that these vaccines cause autism. No matter how many studies are done to show in hundreds of thousands of children that there is no association between immunizations and the development of autism, there’s still that inkling of fear. Because most people know what autism looks like. They don’t know what measles looks like, but they understandably want to do everything they can to prevent autism.

Another issue—especially in what one would call “health-conscious” communities in California and parts of Colorado—is this notion that vaccines have what people call “toxins” in them. This is a very tricky word, because most non-scientists don’t really know what a toxin is. Vaccines are not toxic. The air we breathe is much more toxic than the vaccines that children receive. They receive more viral and bacterial exposure just by being outside for a few hours than they would from vaccines. But there’s this pseudoscientific idea, “I’m going to keep my children natural and healthy and feed them organic food and protect them from any unnecessary toxic exposure,” that seems to stand in opposition to vaccines.

Harris: I think the fact that most people are totally unfamiliar with the consequences of contracting one of these illnesses plays a huge role here. No current parent of school-age children knows what it’s like to fear that his or her child may come down with polio and have to be placed in an iron lung. The carefree attitude we now enjoy is the result of the success of vaccines. This is why people are no longer dying of smallpox. So we live in a world that has been more or less purged of terrifying, preventable illness because we have used vaccines for generations. Bliss leads to ignorance. People have the luxury of ignoring “herd immunity” (a concept we will talk about) once it has been provided by their neighbors.

I think a few more things are working in the background here. I get the sense, through my personal interactions with people and from what I’ve read in the media, that more or less everyone has lost trust in public institutions. We’ve lost our faith in government in general and bodies like the CDC and the FDA in particular, and we don’t trust the pharmaceutical companies or the media either. In some respects this erosion of trust is understandable, even warranted, because most of us now have a sense that the incentives in these institutions are often misaligned. A pharmaceutical company that spends $1 billion to develop a new drug will often be tempted to ignore any data that suggests the drug shouldn’t be used, whether for reasons of efficacy or for reasons of safety. There’s been enough evidence of corporate malfeasance on this front to suggest that these concerns are often justified. We also have good reason to believe that the government is not competent to police this space effectively, owing to both lack of funding and bad incentives. So the prospect of corruption and just sheer incompetence on this front is galling to everyone.

Another factor is that people are often confused about scientific and statistical reasoning. Even doctors can fail to reason scientifically, and a few prominent pediatricians are failing egregiously to give their patients rational advice about vaccines.

Finally, there may be something at work here that I’m less sure about: the idea that in the very act of trying to protect one’s child—by injecting a substance into her body in the hope of protecting her, and causing pain in the process—one might actually be poisoning her. It’s no fun watching your toddler writhe under the pediatrician’s needle and then howl with pain, and the idea that you might be imposing a risk of injury or death on her in the process is horrible to contemplate. Even when, in reality, you’re imposing much less risk than you often do just for fun. Which is more of a hazard to your child’s health—all the potentially life-saving vaccines she’ll ever receive, or that ski trip you take as a family each year? The time on skis, clearly. But it doesn’t feel that way.

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