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DISCUSSION on the era of the anti-vaccinationists was raised at a recent law and medicine conference by world renowned Australian virologist Professor Ian Gust.
Australia has a small but vocal anti-vaccination movement, which is active on the internet. Last year the NSW Health Care Complaints Commission took action against one anti-vaccination group after a complaint from a family whose young child had died from whooping cough.
Australia maintains generally high levels of childhood immunisation, but there are pockets of ideological opposition, especially among people who believe that their children have been harmed by immunisation.
While we know that not all vaccines are 100% effective and they can, rarely, cause serious complications, the majority of this alleged vaccine-related harm is not supported by medical evidence.
Why, then, is there such vocal opposition to one of the most successful public health measures of modern times? Why are developing countries crying out for vaccination, while a group of middle-class people in developed economies reject it?
There are several influences at play, including the fact that modern medicine is a victim of its own success.
Not many people who can recall the days of children in callipers from polio, or infant graves in cemeteries, are opposed to vaccination. It is a luxury of a safe and wealthy society.
In the same way that our community no longer tolerates child death, it doesn’t tolerate any adverse events from preventive therapy.
Then there is the influence of the mass media, which emphasises events and opinions that sell news, not messages that promote health.
However, the biggest question is this: what has led a small but vocal section of our community to be so suspicious of the motives of medical practitioners?
We have better health outcomes and longevity than ever before. We train doctors in communication skills and emphasise the need to provide good information to patients.
To add insult to injury, some homeopaths sell the pseudoscience of “homeopathic immunisation”. Using the concepts of immunity and immunisation from orthodox medicine, they then use totally discordant principles in treatment.
With people moving in droves to seek the help of “alternative” health practitioners, the question of why a growing proportion of our population are more convinced by practitioners who don’t offer scientific evidence needs to be addressed. Is there something about the communication style of these “alternative” practitioners that orthodox practitioners can learn from? Or is it just human nature to want simple solutions?
If immunisation and its protection of the “herd” were not so important, perhaps we could just ignore the anti-vaccinationists. What we need to know is why so many people are turning to pseudoscience despite the fact that the body of evidence-based medicine continues to grow.
Dr Sue Ieraci is a specialist emergency physician with 25 years’ experience in the public hospital system. Her particular interests include policy development and health system design, and she has held roles in medical regulation and management. She also runs the health system consultancy SI-napse.
Posted 15 August 2011
A good overview of this topic can been found in books like Bad Science, Trick or Treatment and Suckers, all of which have been published in the past few years and which concern the rise of non-evidence based medicine. Also websites like quackwatch.com and devicewatch.org list many dubious treatments. The basis of these books is that unproven or disproven therapies are attractive because of people’s need to believe in something as it gives them a feeling of control over their lives. Mao Tse Tung’s personal physician, for example, is quoted as saying that although he did not believe in Chinese traditional medicine himself, he thought that it was a great idea, as it was able to be rolled out to the masses and fulfilled the promise of healthcare for all following the Communist’s ascent to power in 1949. This has since been largely replaced in China by more evidence-based therapies. When you add that to the fact that “alternative” therapies are often very profitable, with $16 billion per year being spent on supplements in the US alone, then you have the basis for an industry. There is also an overlying theme that what is natural is good ass. Superficially there is some plausability to this idea. For example, our current high fat, high sugar diet is highly unnatural in evolutionary terms and also very unhealthy ass in terms of things like the burgeoning rates of obesity and diabetes in our society in the past 30 years. However, it does not follow that what is alternative is therefore good. This is simply magical thinking. There can never be any substitute for hard evidence.
Ray T put it in a nutshell. I would add that it is often a social pressure as well, a desire to be welcomed into a perhaps new group of people that one finds attractive. I can only speak from my own experience and admit that back then I was at least slightly delusional. Charismatic individuals with their own agenda are often masters at drawing people into their “Trip”
A good overview of this topic can been found in books like Bad Science, Trick or Treatment and Suckers, all of which have been published in the past few years and which concern the rise of non-evidence based medicine. Also websites like quackwatch.com and devicewatch.org list many dubious treatments.
The basis of these books is that unproven or disproven therapies are attractive because of people’s need to believe in something as it gives them a feeling of control over their lives.
Mao Tse Tung’s personal physician, for example, is quoted as saying that although he did not believe in Chinese traditional medicine himself, he thought that it was a great idea, as it was able to be rolled out to the masses and fulfilled the promise of healthcare for all following the Communist’s ascent to power in 1949. This has since been largely replaced in China by more evidence-based therapies.
When you add that to the fact that “alternative” therapies are often very profitable, with $16 billion per year being spent on supplements in the US alone, then you have the basis for an industry.
There is also an overlying theme that what is natural is good.
Superficially there is some plausability to this idea. For example, our current high fat, high sugar diet is highly unnatural in evolutionary terms and also very unhealthy in terms of things like the burgeoning rates of obesity and diabetes in our society in the past 30 years.
However, it does not follow that what is alternative is therefore good. This is simply magical thinking. There can never be any substitute for hard evidence.
To respond adequately to the points raised by “Anonymous” 22.08.2011 would take some time. The first point is very important: effective vaccines are added to the Immunisation Schedule for a good reason; the infections they are designed to protect against, are harmful and maybe fatal. Smallpox was eradicated by vaccination. Polio was eradicated from the Western Hemisphere, but has been re-introduced periodically from polio infected countries (eg to USA twice from Holland among members of a religious sect who do not immunise). When USSR broke up and public health immunisation was not carried out, diphtheria broke out in the NIS and Russian Federation in 1990 with over 100,000 cases and at least 3022 deaths. I suggest you read the leading article in the Medical Journal of Australia “… a World Without Polio” 1994 vol 160 p459 (18 April 1994), in which these matters are discussed. We must keep our community highly immunised or these diseases will return to Oz from o’seas and some of our children will needlessly die of preventable infections.
Questions: 1) is it now reasonable to not vaccinate so extensively (this does not translate to stopping altogether) since many of the diseases have been removed or minimised?
2) is it possible that, by removing one disease, another may occur in a more virulent state, ie by vaccinating for Mening.C, and thus removing its significant presence in the bacterial world, could this allow more virulence or activity of B?
3) Do some diseases with lower M & M rates (ie, mumps) possibily confer some protection say, via the immune system being activated and therefore may best be left to infect? (ie, as they have found parasites in childhood may confer immunological maturation)?
Maybe, just maybe, the antivaccination activists could be placated with a more flexible or compromising argument for some vaccinations?
I have, in the past, sat down in the ED room with the parents of unvaccinated children who have come in with wounds and explained how and why their children will not gain immunity to tetanus in their day to day lives. Some have then accepted vaccination. Don’t tar with the same brush all antivaccination people, many may have been bitten unfairly by grandiose, disordered medicos who believe their own press releases (causes just as much damage).
Australian Skeptics has been challenging Merryl Doorey and the Australian Vaccination Network for many years with numerous complaints lodged to State Health Dept, etc. These health departments either do not have legislative backing or are unwilling to take on the task of controlling the sort of misinformation that comes from the AVN. Even the recent ruling which came after the investigation by the HCCC seems to have been toothless with Ms Doorey playing the role of the persecuted crusader and continuing her opposition to immunisation. Surely her continued postings should attract significant penalties.
In the decade 1926-1935 there were 4073 deaths from diphtheria in Australia. The population at that time was about 6 million. Immunisation was introduced during that decade. Deaths fell steadily; there were 2 diphtheria deaths in 1976-1985, and NONE in 1986-1990 in a population doubled. One can convince reasonable people with facts, mostly, but many do not respond to data or reason, especially anti-vaccinationists. Those of us who treated diphtheria, polio, tetanus, pertussis etc, will never forget them.
To convince unbelievers, we need to show what these diseases actually do and are, and the distress of children (and parents), suffering them.
I do have footage of a number of such illnesses in living colour and sound, and showing these to doubters has a salutary effect – they have their children vaccinated.
If the College of GPs or other medical body, eg, paediatricians would like to prepare DVDs from such material to distribute to their members, to antenatal clinics, or to the interested public, I would be happy to assist.
“Modern medicine is a victim of its own success.” It’s also a victim of its own nonsense! Medical schools started preaching about “alternative therapies” being actual therapies some 20 years ago. That’s when the rot started. The attitude seemed to be the good ol’ “if you can’t beat ’em…” ! Now we have doctors doing acupuncture and pharmacists not only stocking, but advocating the use of homeopathy. If actual health professionals cannot, or will not, distinguish between science and nonsense, how can we blame the general public?
There have always been snake-oil pushers.
Unfortunately, the power of denial is present even in well-educated people and those looking for physical cures of psychological complaints without addressing the reality of mind/body connection will seek till they find a sympathetic ear, be they conventional or alternate.
Luckily, the complete fraudsters are avoided by most people.
However, we can’t stop the gullible and we, as conventional practitioners, need an educated and profession-wide approach if we are to make any headway against the anti-vaccination, anti-fluoridation, anti-“drug”, soi-disant Natural Therapists.
The level of discourse, the arguments showcase an interesting mix of the superiority complex and sandpit politics.
Perhaps that is why patients are turning to ‘alternatives’.
I certainly don’t feel comfortable with pushing my view on anyone, and it makes me even more uncomfortable knowing there are those out there that don’t have a problem with that. Where do we stop at becoming the dictator versus the healer? Hitler simply shot anybody that didn’t agree with him, calling them a traitor of Germany – great! end of opposition. Some of the comments above – legislation… unsubsidised play groups… Don’t these people also pay their taxes and have a right to have a different opinion? We give subsidised funding to schools of different religion, so surely we could also give funding for subsidised playgroups for un-vaccinated children if parents were so concerned about it. But tell me – if my child were vaccinated, doesn’t that mean my child won’t catch these diseases because they have been immunised against them? Why do I need to oust them from the playgroup in the first place?
In all honesty, Ken, I think the medical community in Australia has done a lot to promote immunisation and its benefits, leading to high overall rates of coverage (except for the pockets I mention above).
Are you now suggesting that the orthodox medical community should mount a specific “campaign” against the misinformation relating to vaccination? Where would you suggest it be placed and who would you target?
My humble thoughts:
Modern medicine is getting too technical for the average lay person and despite our best efforts to simplify things and communicate better, to fully grasp the scientific approach requires one to study, and understand the field of medicine. Consequently, our patients will never feel complete ownership of their health decisions. They may understand the one or two facts we have taught them, however they lack the ability to then apply this understanding in other aspects of their health. Think back to your transformation of understanding from Day 1 at medical school to your current state now.
The alternative health practitioners sell simple, easy to digest ideologies that the patient can understand and digest, scientific incongruence aside. This empowers patients with a sense of true ownership of their illness and health decisions. Additionally, their ‘new ideas’ are mystical and less boring than our message.
Another issue is that we are ethically and morally obliged to tell our patients the truth, according to current medical understanding and guidelines. We can be held legally liable if we were to deliberately do otherwise. Alternative practitioners are not bound by these codes, particularly from a legal perspective, and hence can peddle almost anything they like without consequence.
That doctors generally hail from the upper classes, in contrast to many of our patients, also widens the doctor-patient divide. Those selling their alternative health ideologies are often more so derived from a middle-working class demographic further enhancing the experience for the patient as both parties immediately have more in common.
Patients want to have a better understanding and sense of control over their health. This is natural, they live and feel in their own body. I find it surprising and somewhat ironic however, that in seeking better health, and control of that health, they submit themselves to the alternative health ideology. Would they treat their car in the same way when it started running poorly? People would laugh at a mechanic suggesting they purchase his homeopathic petrol mixture (for $10 per litre!). So why do they spend their days eating apricot kernels to cure the fungating BCC growing across their face, or paying hideous prices for useless potions.
We don’t help our own cause, however, by throwing antidepressants (as one example) at anyone who feels sad (unfortunately it happens more than we probably would like to think). I’ve seem them used so inappropriately over the years, they often don’t work, and it’s no surprise people go elsewhere, particularly somebody who will listen to them for an hour as opposed to a GP billing 15 min consults, or worse… 10 min consults.
No, I don’t mean to generalise, these are just my thoughts and observations. Of course things are not as black and white as I’ve portrayed them above. Feel free to agree or disagree.
I was one of the complainants to the NSW HCCC about the activities of the so-called “Australian Vaccination Network” (AVN). Our complaints led to the HCCC’s investigation of the AVN and the subsequent report. I am also one of the leaders of the group called “Stop the Australian Vaccination Network” (SAVN) who have set out to do just that.
I point out that the SAVN’s complaints to various regulatory authorities were made in the absence of action from most doctors, governments, politicians, and the AMA.
I also point out that on 5 September, 2009, the then NSW Minister for Health promised to lead a national campaign that would “counteract the spread of misinformation about immunisation.”
So what of that campaign? Nothing has been heard of it since.
I accept that on occasion, brave doctors have spoken out, but they are definitely in the minority.
The time to stop pontificating about what to do is over. Get on with it.
In my experience, people with odd ideation, or even marginally delusional thought patterns, tend to find “practitioners” who think the same way, and recommend them to each other and to their acquaintances and families. It then spreads by association, rather like religion, becoming a matter of faith.
I agree with some of the comments above that anti-vaccination is more of an ideology than about access to information. IN contrast to the comment above about lack of internet access, my impression is that it is actually the internet that has become a promoter of anti-vax views to the wider public. The ease of access,combined with the ability to cut-and-paste and access the abstracts of research papers allows mythology to go “viral” around the net, and creates echo-chambers of people re-inforcing each other’s views.
I had father in ED whilst repairing his sons frontal laceration (not wearing a helmet) state he was a “conscientious objector” to vaccination and refused ADT. His boy had not had any childhood vaccinations. Where does the liability sit if that child was to return unwell with tetanus? That child has a right to protection from disease and so do other children around him. It makes my blood boil to think that my kids will be vaccinated but then potentially exposed at preschool/school to diseases that have been all but eradicated. It is only the uneducated minority, with a obviously short memory or no internet search skills, that could breed middle class developed world attitude of complacency or objection to vaccination. Public education regarding the benefits of vaccination of the herd needs to be pushed in order to combat the “antivaccination movement” and expose all its sensationalist banter. I also agree that those children not vaccinated should be excluded from childcare/preschool/school in order for the message to be taken seriously.
Re patients decamping to alternative practitioners, the reasons are simple – we are not good at fixing many of the problems that trouble patients, and the way we practice often leaves patients not feeling heard or respected. People vote with their feet.
The antivaccination issue is more complex, and we should take good care not to conflate that with the broader issue of patients choosing alternative practitioners.
The truth is we live in a free society – and if we believe vaccines are useful then we need to be out there marketing them. This includes somebody doing the dirty work of actually going through all the antivaccination arguments and providing documented, referenced refutations to the antivaccination arguments in a format that is accessible to the average patient. I am certainly not comfortable pushing for compulsion or restriction of individual freedom.
Maybe this is an area that our colleges should be funding. Somebody has to do the work.
Mark McAndrew: Do not conflate anti-vaccination campaigners and pseudo-scientists with left wing social or political ideas. In fact, the opposite is true, most of the cranks are in the conservative camp. Historically anti-vaccination was a religious movement, supported by some wealthy people in the US and many have an individualistic, libertarian attitude to life. Very unlike the communitarian values of most on the left.
Harry (Poodle) is not allowed into Kennels unless he is vaccinated, vaccinations are up to date, and he has a certificate from his friendly family vet to prove it. Surely the same criteria could be applied to Kindergardens; unvaccinated children could form their own little unsubsidised playgroups and happily all come down with mumps/measles/whooping cough together.
It’s not only a matter of them not being bright, some are bright enough. It’s part of a belief system, which will often go along with other crank leftist beliefs, some very commonly held! So I suggest taking a leaf from the addiction treatment “book”, provide the information and don’t argue about it. The conflict should be in the mother’s mind, not between her and her doctor. If she is able to internalise this ambivalence, a “pros v. cons” decision analysis is the next step. Don’t waste your valuable reserves of calm and energy otherwise! 🙂
The anti-vaccinationists would rapidly lose their voice if legislation prevented children who were NOT vaccinated from
being intergrated with those who are………..!!!
The AVN run hard on choices, and deliver skewed science, using the alleged vacc failures, and of course the Andrew Wakefield paper. With regards to the latter, they consider his academic discredit further evidence of the scientific conspiracy.
I have found that the AVN followers are not so bright, and the absence of vaccinatable diseases makes it easy to convince them.
In Tasmania, the school requirement for a complete vacc certificate is highly effective, and I don’t know of any doctors that will sign a bogus medical waiver, so only the rare conscientious objector gets through.
Is it a “right” to refuse vaccination for a child?