HEALTHSpeaking the language of vaccines (ICAAC and IDSA joint meeting)Easing parents' fears about vaccine safety may mean moving beyond answers couched with scientific caveats.By Susan J. Landers, amednews staff. Dec. 15, 2008. Childhood vaccines are entangled in a vast public controversy, and doctors often find themselves helping perplexed parents sort through misinformation before making a decision on immunization. Mindful of these discussions, a panel of physicians and journalists offered pointers to those on the front lines during the joint meeting of the Interscience Conference on Antimicrobial Agents and Chemotherapy and the Infectious Diseases Society of America, held Oct. 25-28 in Washington, D.C. Panelist Paul Offit, MD, director of the Vaccine Education Center at the Children's Hospital in Philadelphia, believes one way to address parents' fears is for physicians to sharpen their message and stop using the scientific language of the many reports that have found no link between autism and the measles, mumps and rubella vaccine. A developer of the vaccine RotaTeq and author of Autism's False Prophets: Bad Science, Risky Medicine, and the Search for a Cure, Dr. Offit said the language of science can confuse lay people. Instead, physicians should ratchet up the message and state their point emphatically -- that the vaccine does not cause autism, he said. "After you have done 10 studies and spent millions of dollars looking for the association between autism and MMR, I think you can be a little more definitive in your language." One conversation at a timeSimon Dobson, MD, clinical associate professor of pediatrics at British Columbia Children's Hospital in Vancouver, often has what he calls the "eyeball-to-eyeball" conversation with a parent who is concerned about immunizations. He recommends patience and good listening skills. Parents are often worried about something close to home, he said. "If you can nail that family myth or whatever it is that concerns them, the rest is easy."
A drop in MMR vaccination rates in the United Kingdom has led to outbreaks of measles.
Most worried parents relate stories about growing up knowing a child who had autism or another disability. After all, many panelists noted, because of vaccines, measles and other serious childhood diseases have never been seen by parents, or even many physicians, while autism is much more in evidence. But the more difficult cases involve parents who have been "bombarded by the media," Dr. Dobson said. "They just don't know what to do and are paralyzed by indecision." He, too, recommends cutting back on scientific evidence when discussing vaccine benefits. "I would go on and on about the benefits of the vaccine and the risk of the disease, and parents would get a glazed look." Instead, he tries to tap parents' imaginations and urge them to think about what could happen if they forgo vaccines for their children. The anti-vaccine people use anecdotes, he said. "But we get the anecdotes beaten out of us in medical school." Nevertheless, he noted, "I can tell a tragic story. It has a great impact on parents." For example, he asks parents to imagine what might happen if their child grows up to do good works in far-off countries where diseases such as polio are still endemic. If the child is not immunized, he or she could become infected, he relates. "Parents may think of me as pompous -- a windbag in the pay of the government, big pharma and big business -- but they do respect my opinion," he said.
No link has been found between autism and the MMR vaccine.
Also remember the conversations can take place over several office visits, Dr. Dobson said. "You don't need to do it all in one go. This is particularly true in the primary care setting." British journalist Vivienne Parry, who also served on the UK Joint Committee on Vaccination and Immunisation, noted that the drop in the MMR vaccination rate in her country has led to outbreaks of disease. "People are much more afraid of autism than they are of measles." Parry urged physicians to stand up in support of vaccines. "It has distressed me to see Paul Offit out there by himself," she said, referring to Dr. Offit's outspoken defense of vaccine safety, which has made him a target of anti-vaccine activists and the recipient of death threats. "Where are the other physicians supporting him?" Physicians need to engage patients with simple and emotional language, she added. "You need to understand where the problems are coming from. The fears are natural. You need to think about that when you are communicating with patients." Dr. Offit said he would like to see a recasting of the characters in this ongoing drama. Now, the anti-vaccine people are often identified as the only ones who care about children. "I just wish the story was told a different way," he said. As a result of the suspicion being raised that vaccines are connected to autism, "we continue to divert resources away from more promising leads." ADDITIONAL INFORMATION:MRSA on the riseRates of outpatient visits for skin and soft-tissue infections have increased in recent years, mirroring the spread of methicillin-resistant Staphylococcus aureus in the community. Researchers tallied visits to physicians' offices, hospital outpatient departments and emergency departments using data from the National Ambulatory Medical Care Survey and the National Hospital Ambulatory Medical Care Survey, both 1997-2005. Numbers show annual visits per 1,000 population. Abscess and cellulitis are hallmark infections associated with MRSA.
Source: "National Trends in Ambulatory Visits and Antibiotic Prescribing for Skin and Soft-Tissue Infections," Archives of Internal Medicine, July 28 (http://archinte.ama-assn.org/cgi/reprint/168/14/1585.pdf) WeblinkEvents from the joint meeting of the Interscience Conference on Antimicrobial Agents and Chemotherapy and the Infectious Diseases Society of America (www.icaacidsa2008.org) Copyright 2008 American Medical Association. All rights reserved.
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