When Dr Wakefield interviewed on Good Morning America today, an injustice occurred. For children, I mean. And it occurred inadvertently I suspect. But I believe this injustice happens all the time when it comes to childrens’ health and wellness. What the media covers really changes how we think and feel about protecting and parenting our children. The media’s effort to inform and educate, just like that of physicians and nurses, social workers and ancillary staff, researchers and students, can get lost and misconstrued. ABC worked hard to inform us of the accusations against Dr Andrew Wakefield with a 2 minute introduction by Dr Richard Besser, a pediatrician and medical editor/correspondent. Yet when the interview was over, I was left remembering the myth.
Today I awoke to the boys asking for breakfast. After getting them to the table with a bowl of Life (always strange to offer a cereal named after our existence), I poured milk in my own bowl. Suddenly I realized that I needed to get the recycling and garbage to the curb. I donned my boots and a coat, ready to haul the can and a number of collapsed boxes to the curb. But just as I headed out of the door, the phone rang. It’s when the day went from the typical day (“making” breakfast and moving garbage) to a day steeped in really trying to understand. My mom was calling, she said Andrew Wakefield was about to be on Good Morning America. I hit my personal fast forward button, flew to the curb with the garbage, and got back inside with enough time to hear the complete interview.
Dr Wakefield interviewed on GMA with George Stephanopoulos who later labeled the interview “combative.” Mr Stephanopoulos was given a terribly difficult task: he was interviewing Wakefield on one of the most complex, emotional, and loaded quandaries of the last few decades: vaccine-hesitancy and Wakefields’s purport linking vaccines to autism. When Wakefield failed to deny any allegations and failed to discuss the significant research that refutes his own work, Mr Stephanopoulos had to defend science. Alone. George Stephanopoulos isn’t gaining popularity (read the comments) with the anti-vaccine crowd and even some who doubt what Dr Wakefield claims. Yet ultimately, the 7 minute interview with Stephanopoulos and Wakefield simply stirs the pot. I trust it will have huge viewership. I worry that this is, in part, why it was done.
We need to discuss immunizations in the context in which decisions about immunizations are made. At this point, interviewing Wakefield alone does not serve children or our public well. His myth and legacy regain power with each second he’s on the news. We need to have discussions about immunizations that reflect the fear that has arrived on parents’ doorsteps because of Wakefield’s work. We needed a general pediatrician, a parent of immunized children (the majority of parents, of course), and a vaccine expert in the interview, too. Having Dr. Besser in the interview can be a great start. We need voices of reason. We need to frame issues surrounding immunizations truthfully. Although Dr Wakefield made claims that he didn’t want others to stop immunizing for diseases like whooping cough (Pertussis), his work is at the core of hesitancy in The United States for all vaccines. George Stephanopoulos needed to make that point clear. Although Wakefield now defends and talks about one vaccine (MMR), he fueled millions of parents to distrust all of them. In the office, when parents who are hesitant about immunizations talk about their worry, they point to Wakefield’s claim.
This interview today is illustrative of his power. Seven minutes alone in front of millions is power.
In Dr Besser’s introduction, there were some micro-interviews (sound-bites) of Dr Paul Offit (vaccine expert and pediatrician) and Seth Mnookin (author of a new book, The Panic Virus). Neither were given the time and exposure Wakefield received. What we learned from Dr Offit and Mr Mnookin about immunizations could easily be forgotten by the time the interview with Wakefield is over.
Continuing to wage a war between those who want to immunize and those who don’t, isn’t working. Parents are increasingly more confused, not more informed, after interviews like today. Although some bloggers are declaring vaccine-hesitancy dead since the information in BMJ on Wakefield’s fraud was published, I think we’re far from seeing the end of vaccine-hesitancy. Distrust in our physicians and nurses only increases when stories and interviews occur in this fashion. I believe I will be listening to and helping families concerned about immunizations for the rest of my clinical pediatric career.
Let’s change how we report and discuss issues around vaccine-hesitancy and the “controversy” in vaccine research. We need to realign patients with the physicians and nurse practitioners who care for our children. Our children deserve better than to force parents to do “research” online about immunizations, as Dr Wakefield suggests.
Dr Richard Besser has extensive experience caring for children in practice and an impressive history of leadership in academia and at the CDC. He did a wonderful job summing up the state of where we are on vaccine-hesitancy in this country. But Besser’s introductory segment wasn’t enough. We leave the interview with Wakefield and go back to our cereal thinking about the “war” (see PBS last year) over vaccines. The interview this morning accelerates vaccine-hesitancy in the United States rather than illuminating what science holds. The interview was a near fistfight, demonstrating our differences as parents rather than our similarities.
We must regain our similarities; we all want what is best for our children. Pediatricians and researchers are parents, too.
George Stephanopoulos had an opinion as the interview began; he stated he had read Dr Wakefield’s book and made it clear that he didn’t believe what Dr Wakefield was saying when responding to statements. I agree with the commentary on the ABC blog that he had seemingly made his decision prior to the start of the interview. This is sensible; science really goes against what Andrew Wakefield has claimed. Dozens of large studies have refuted the claims Wakefield made long ago. His research has been retracted by the Lancet. His co-authors have backed away from their words and affiliations. We already knew all this.
It can take only seconds to create a myth. It can take decades to rebuild the truth and refute the myth. That’s where we find ourselves today.
The editorial in the BMJ uncomfortably put Wakefield back into the spotlight. His message, although rebuked, gained more power today. Regardless of the “truth” held in science that vaccines have not been found to cause autism, Wakefield “won” the interview today. Hands down. Arm wrestled George to the floor. His message is memorable. And he puts the onus again on our shoulders as parents and physicians.
We are left remembering Dr Wakefield’s name, we know the title of his book, and his take. He instructed, “My recommendation for parents is to read, there is extensive information out there.” He alienates us from the pediatricians, family doctors, and nurse practitioners who care for our children. Should we imply he doesn’t want us to trust physicians or scientists? He leaves the work up to parents. But this controversy sells.
Viewership is the economy of television. If you’re going to get people to watch, putting Dr Wakefield in the hot seat is a great way to start. But that’s where the injustice occurs. Instead of clarifying, we are left more confused. And those at risk? Our children.
- Did you see the interview?
- What did you think?
- Do the segments leave you feeling vaccines are safe or did it leave you distrusting medicine even more?
As in politics, fear and controversy rage on, it seems.
When parents continue to believe what Dr. Wakefield managed to have published fraudulently by the Lancet, I feel two things are happening: 1) They are ignorant/suspicious of science, and/or, 2) They don’t trust authority of any kind. But, it seems to me that ignorance is the true foundation of the problem. Of course, the solution to ignorance is education, but when a person’s basic understanding of a subject is couched in BELIEF instead of TRUTH – they will resist to their dying day to be educated, and thus remain ignorant. And when their child dies of whooping cough (which is on the rise due to the fraud perpetrated by “Dr.” Wakefield) they will declare that God works in strange ways.
This whole topic seems to be rooted so much deeper than vaccines or autism itself. I watched a video posted by Phil Plaitt on a Canadian news show Marketplace showing how the business of selling homeopathic medicine is a huge con by large corporate manufacturers. But when I reposted it on my Facebook many acquaintances defended the homeopathy manufacturers and how I “just didn’t understand” and “you don’t need science to explain everything” (which I agree with in general but not where medicine is involved).
I find it so strange that the same people who claim that vaccines are harmful and the government is in the pocket of large pharmaceutical corporations that are conning all of us, will jump to defend large homeopathic corporations that really are conning them and the science is there to prove it. I’ve been thinking all day about what causes that leap in reasoning. Is it fear of traditional authority? Is it the underdog mentality that homeopathy isn’t as readily accepted so it is the underdog and therefor better? Or does just being non-mainstream give it an innocence in their eyes that something their parents used like Western medicine lacks?
Chris Johnson says
I take your point to be a variant of the old adage that there is no such thing as bad publicity, because all publicity is useful — people recall your name, not the bad review you got. You’re probably right about that.
I think the media are not terribly interested in science as scientists understand it; rather, the media are interested in getting viewers, and controversy attracts viewers. They take special delight in false equivalency. As long as they can find somebody, anybody, with letters after their name to claim that accepted science is wrong, the reporting on scientific issues will manufacture controversy where none exists. See global climate change, for example. The vaccine controversy is just another example. Or:, “Shape of the Earth — opinions vary. Details on news at 11 tonight.”
The problem, of course, is that arguing over the age of the Grand Canyon (or the shape of the earth) doesn’t hurt anybody: the vaccine”controversy” harms children.
Doctor Karen says
I did not see the segment but am quite familiar with Wakefield and his deceit. For all we know, he stipulated that he would only appear if he was interviewed one on one. I would consider that a likely scenario. The network wants to attract viewers. Wakefield is a magnet for lovers and haters alike. Drama sells. Wakefield is high drama. Me, I’m more worried about getting my son’s autism therapies covered by private insurance. There will always be ignorant or stubborn, unteachable people. Sometimes they are the paranoid parents of young children. Sometimes they are state legislators who take money from insurance companies and turn their backs on their most vulnerable constituents. In the meantime, you and I just have to keep on keeping on telling people the facts and standing behind them. I’m a preventive medicine physician. I get recommeded vaccines. So does my autistic son. I don’t believe his autism was caused by vaccines, and I share that with people regularly. And I try not to watch the news on TV. Too stressful.
Dennis summarized it well above: the non-vaccinating parents are skeptical of science and the government in general. On the Science Friday interview with Dr. Paul Offit (7JAN11), the callers to the show stated they were open to listening to scientific evidence, but then refused to listen and instead declared each fact or study cited a lie. It is impossible to have a rational discussion with irrational people. But it doesn’t mean we don’t stop trying, because the important thing is providing the best medical care to children.
Thanks Dr. Karen. I’m a pediatrician with an autistic son. I knew a lot about vaccines before his diagnosis. Unfortunately, I knew very little about the treatment of autism. Now I am well versed in therapy options, behavior options and the educational and insurance hurdles that come with trying to improve my son’s function. My medical training did not help and physicians were minimally useful. I owe much thanks to a few outstanding OTs, Speech therapists, and ABA therapists as well as a handful of parents dealing with similar issues. If you want the Dr. Wakefields to disappear, spend time with these families and point them to good resources. I vaccinate. I also read Jenny McCarthy’s first book. She spends a good deal of time talking about the benefits of ABA and also about feeling enraged that she was on an 8 month waiting list to get into a program. Not all therapists are created equal and early intervention in many states is a joke.
I didn’t see it and won’t. I indulge in the occassional Bravo show online or PBS show with my kid, but otherwise live a TV-free existence. I’ll go ahead and add this post to the long list of reasons why.
I think the bigger picture in the “war” is the wellness movement vs traditional medicine. I didn’t get it till my sister was dx with cancer and I’d hear about vitamins, Gerson diet, etc. It’s this false nostalgia about how robust our immune systems were bwfore the modern era. Measles virus was our friend, a rite kf passage that made us stronger, antioxidants coursed through our veins, our bodies naturally fought cancer and degenerative disease didn’t exist.
Ratings, ratings, ratings. That’s what it’s all about! I think it’s a great point to ask parents to read. But if they don’t discuss the information they find and vet it with their health care professional, there is no point.
After my own research and discussions with our ped on vaccines, I became much more moderate in my views. I was lucky that my ped was willing to hear me and discuss. No judging–just guidance and support.
I understand why parents of autistic children are searching for answers. I would be too. I hope that one day, they get honest ones.
Lisa Duggan says
Thanks for a very measured article on the topic, which you rightfully acknowledge as “one of the most complex, emotional, and loaded quandaries of the last few decades.” Absent from the public discussion and media coverage are conversations with pediatricians who are old enough to have seen firsthand children suffering from one of these dangerous, preventable diseases. Our family pediatrician, Dr. Donald Cotler in Millburn New Jersey, is one. When we had questions about vaccines his answers were informed by two thinsg: his access to and understanding of the evidence supporting vaccines, but also his personal experience. In his residency he had witnessed unvaccinated children who were very ill with diseases we can now prevent. It was not pretty, to say the least.
While resolutely pro-vaccine, Dr. Cotler was also willing to take our concerns seriously and happy to offer a delayed vaccine schedule for our daughter, acknowledging that the number of vaccines now required are drastically different from when my husband and I were kids (born in 1965), and accepted that the evidence for flu vaccine efficacy (which he offers but we have always declined) was contradictory, depending upon where it was being given (England has deleted mandatory flu vaccine for the general population based on studies showing it did not change outcomes for that group).
It is a Catch-22; we now have a generation of men and women becoming parents, and who are already parents like myself, who benefit from effective vaccine programs, but don’t share the collective memory of their parents and grandparents—who remember when these childhood diseases were rampant, and killed children—as incentive to comply. Similar to a manic-depressive who stops taking his meds because he feels better.
But vaccine-hesitancy also comes from the as of yet un-answered questions of the causes and increases in autism, which are real and documented, and our growing mistrust with a pharmaceutical industry that has been caught in more than one lie about the safety of their products.
Perhaps a federal campaign, that informs us of the “before-vaccine” death & disease rates would help people gain confidence in vaccines? Or more articles, and TV interviews with, practitioners like yourself.
Seth Mnookin says
This is one of the most level-headed, clear-eyed, forward-thinking discussions of this issue I have ever read. The main point is one I could not agree with more strongly: It’s irresponsible of the media to act like they’re fulfilling their responsibility to the public by giving airtime to any “controversial” theory…and any honest reckoning of the effect of the last several weeks of coverage has to acknowledge that having Wakefield back out on TV will unfortunately cause some people to wonder if what he’s claiming is actually true.
What’s even more impressive here is that this is a post written by a doctor. People want to trust their doctors. They especially want to trust their pediatricians: These are the people we entrust with our childrens’ lives. We also want to have our fears and anxieties taken seriously — even (or perhaps especially) when we know those fears might seem crazy to a medical professional. There are lots of things that could help us move on from this debate — and better journalism is definitely one of them. Another is an awareness on the part of doctors and patients alike that the best way to get past a seemingly intractable problem is to talk it through.
Jen B says
When I first heard the news about Wakefield’s knowing deception of the public- and the incredible harm he has brought to children- the first words out of my mouth were, “This isn’t going to change anyone’s mind.”
In other words, the door has been opened, and parents who truly mean well and love their children strongly believe that vaccines are harmful, and saying “Dr. Wakefield, you knowingly lied” just means that the government/ pharmaceutical companies are trying once again to force harmful substances on little children. While I am a strong proponent of vaccination, I have to admit that in relatively recent history, the U.S. government and other researchers have tested harmful substances on little children. Research ethics have been pretty horrendous in the past. It’s easy for those who are familiar with human subjects research protocols to say, Wow, thank goodness those days are over! Some people are unsure if those days are over.
Also, I consider myself someone whose knowledge is constantly being altered by good scientific research. Yet there are research studies that I have completely ignored because they don’t fall in line with what I believe. I don’t believe in spanking children, and I have recently read a research study with very good methods stating it’s not harmful in the long run, but I disregarded it for the studies that have results that coincide with my beliefs. Recently a study came out saying pets aren’t as good for our health as was once thought… and I get the results, but I don’t believe them! None of us are infallible.
In my experience, a lot of discussion and respect is the only way to explore this with families. Most families who refuse vaccines are happy to discuss their beliefs, and if one is being respectful, listen to the evidence for the other side. Sometimes it changes their minds, sometimes not- but with a good therapeutic relationship, it can be open for discussion again in the future.
This article is very saddening to read. The individual that wrote the article gotta say never read Dr. Wakefields original work. Besides that fails to point out that the Doctor is not against Vaccines. Again lets make this clear DR. WAKEFIELD is not against vaccines. He is for safety first. Obviously many that are commenting on this article and giveing it praise have not been affected by the injuries that vaccines can cause and clearly is stated on the consent form that many parents dont even read, and even after reading it never hits home that it could be there kiddo. 1 in 70 boys has autism in America. Until we know why its on the rise we cant say one way or another, but we know one thing majority of these kiddos have digestive issues, and only answers parents get is it comes with Autism, depending on the doctor.
To do research on this bowel illness that these kiddos are experienceing is in no way harmful, Dr. Wakefields research and work must continue, I know one thing not many doctors out there are willing to lose there license for what they through research find to be a contributor to a major dilema in the world and when asked to be hush hush about it they stand up and refuse to lie to the public. That is a heroic act, which many of the doctors and us would never do in our life time.
How about stand up and take part in the research and help find answers for these many children that suffer, it doesnt matter what the cause is of this, what matters is the safety of our children, many of us that are parents know and understand that. In end let me say that not all smokers or those exposed to second hand smoke have lung cancer, but if you are a smoker or exposed to second hand smoke your are more likely to have lung cancer.
Wendy Sue Swanson, MD says
Thanks for all of these comments. I agree that what is needed for compassionate care is an earnest, open, and thoughtful conversation. The media does want to sell (of course–“ratings, ratings, ratings”) but I sincerely believe there are plenty of producers, reporters, & editors that also want to provide leadership and improve the lives of those in our country. I won’t believe that their work is only about viewership and money. Call me naive; I believe that ultimately people want what is best for our children. And our future health. We simply have to help provide voices of experience, expertise, and opinion to help create good news, fair reporting, and compassionate perspectives. We have to bridge the divide that grows and grows, between doctors/nurses and patients.
The issue of the desired “conversation” between pediatrician and family that many of you mention comes down to the economy of time in the exam room. Pediatricians are the lowest paid medical doctors. Did you know that when a family practice doc sees a child for a check up, they are reimbursed at a higher rate than a pediatrician? Simply because of the department they reside in? It’s nuts.
Reimbursement isn’t based on time, quality, compassion, or knowledge. It’s based on how many you can see in a day. Productivity is the pulse of a community pediatric practice. To keep a practice afloat, so that compassionate docs can provide care and be avail for others, they have to see upwards of 24 patients daily to “survive.” Some docs in our area see over 30-35 patients a day. In the current health care environment with reimbursement based in production, there will never be the time needed to discuss vaccines in the way we’d all like. Our physicians and nurses and scientists will have to create opinions and a presence online. They will have to share their thoughts, findings, and opinions outside of the space in the exam room. But helping them do this is tricky with limitations of time and limited and variant comfort in being online sharing opinions. For many reasons, most physicians are uncomfortable talking in public about their opinions, even (or especially) about vaccines….
For now, I work hard to give families a space to talk about immunizations that is open. I worry it’s not always possible in our limited 15-20 total for a check up with all of the other goals of the visit (doing a complete physical exam, taking a history of a patient, creating a plan and discussing parental concerns outside of vaccinations). Even though I am so compelled to have an open conversation, I recently got a “comment card” that a family felt I “preached” to them about vaccines. It doesn’t feel good to hear that but does help me know that at times I am still missing the mark. We can all improve our perspectives about where we’re coming from on this essential issue.
It’s a tricky balance–listening, sharing knowledge and the insight science holds while couching it in experience is difficult. I still think the most truthful and compassionate thing I end up saying is, “If it were my son, I’d do the flu shot.” And even then, that’s not perfect either.
Keep the comments coming. We’re all learning a ton here.
Doctor Karen says
Thanks for writing about this issue and so obviously caring quite deeply for your young patients. 15 to 20 minutes? Our pediatrican at one of my son’s well child checks spent 7 minutes with us. Needless to say, I felt short changed. A quick personal story that is the basis for my belief in vaccines: my grandfather came down with polio in his later teens. He was a strapping, healthy, successful young athlete whose left leg was permanently paralyzed as a result. He was lucky to have survived. Had he been born a generation or two later, the polio vaccine would have been available. There are still regions of the world where polio has no been eradicated. We are so incredibly fortunate to have the technology available to create vaccines and prevent so many infectious diseases.
Chris Johnson says
Anybody really interested in how the media report health-related issues, especially reports of new therapies, should be reading Gary Schwitzer’s excellent Health News Review, especially the blog that goes with it. He’s a journalism professor at the University of Minnesota who uses a standardized grading system to evaluate how breaking stories about healthcare stand up to scrutiny. Here’s the link:
Lori Buher says
Seattle Childrens saved our son Carl in 2003. Meningococcal Meningitis, a vaccine preventable disease, left him with skin grafts covering 70% of his extremities, both legs amputated below the knees and missing 3 fingers. His injuries are mild compared to many who survive. His miracle is great compared to many who don’t survive. Carl was interviewed by Good Morning America and appeared on a September segment promoting vaccination. While his “airtime” was brief his message is powerful – vaccination saves lives and it saves heart break. Is it a perfect system? No, but as a parent who watched her child suffer unimaginably I will always advocate for vaccination. The autism controversy and the humiliation of Dr. Wakefield exemplifies the power of the media and the importance of vaccination education. Parents need to educate themselves and become responsible for making independent decision regarding their children and vaccination.