Fake News in Medicine – or how to get your medical degree from the internet

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A 22 year woman, pregnant for the first time, informed me at her obstetrics appointment this week that she had done “all of her research on the internet” and didn’t want any vaccines for herself or her infant because she is concerned about preservatives. I had a difficult time not asking her what preservative laden food she had eaten the day before. Another patient declined the tetanus/pertussis vaccine that is recommended at 7 months of pregnancy to provide passive immunity against whooping cough to an infant before they become fully vaccinated. This has become recommended due to periodic outbreaks of whooping cough among unvaccinated children. Her reason for declining the vaccine? “My friend told me it is a bad idea”. I spent an extra five minutes explaining why the vaccine is recommended, why contracting whooping cough as a young child can be serious and potentially deadly and that the vaccine has been proven safe in pregnancy. She continued to decline and on her way out the door informed the staff that Dr Jaeger told her that her baby might die.

In the past week in Minnesota there has been an outbreak of measles – 11 children have been affected, 10 of them were not immunized and many required hospitalization. Measles is one of the most contagious of human diseases and it is expected that more cases will be identified. Fortunately, it is very unlikely that any of these cases will be fatal as the children are otherwise healthy and were identified early in the course of the infection. All of these cases occurred in the Somali community, an immigrant population that can be distrustful of western medicine. They are a cohort that is seen as an easy target by the anti-vaccine movement, which spreads its false information via social networks and word of mouth. Studies have documented that Somali parents are more likely to believe that the MMR (measles, mumps, rubella) vaccine causes autism and are more likely to refuse the vaccine than non-Somali parents.

Fake news is defined as false information or propaganda published under the guise of being authentic news. History is replete with medical snake oil remedies to cure disease. But with the widespread acceptance of the internet as a source of information – true or not – the increase in fake medical news has skyrocketed. In an attempt to research what is best for their children, parents can be susceptible to the spread of this false information. Additionally, the anti-vaccine movement is being emboldened by the current Trump administration who has appointed Robert F Kennedy Jr to a task force that purports to investigate the safety of vaccines. Mr Kennedy holds no medical degree, has done no actual research and his intent is to push forward the anti-vaccine agenda with pseudoscience that is difficult for the average American to understand. But when he has the backing of the President of the US, he is given more credibility than he deserves.

Ironically, the anti-vaccine mindset is only possible because medical research and vaccines have almost totally eradicated communicable diseases from the developed world. My patient who declined the pertussis vaccine during pregnancy has never seen a child die of whopping cough, which occurred in 1 out of 5 children in the 1920’s.  As recently as 1980, 2.8 million deaths worldwide were attributed to measles. Global measles deaths have decreased by 79% since widespread immunizations have been implemented. Do we really want to be reminded of what it feels like when you lose a child to a preventable illness?

 

 

Ebola vs Measles: Personal Stories and Statistics

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Personal stories tend to grab readers much more quickly and effectively than statistics. Unfortunately, that phenomena is what is driving the current trend among affluent, educated parents declining to vaccinate their children and the subsequent measles outbreak in southern California. Parents hear a personal story about a child who was diagnosed with autism after receiving a vaccine or they read about it on the internet. Exempting your child from vaccination in many states has become as simple as filling out a conscientious objector statement for school. Personal stories score headlines when politicians make unsupported comments concerning vaccines. Sen Rand Paul recently spoke out saying,  ” I have heard of many tragic cases of walking, talking normal children who wound up with profound mental disorders after vaccines.”  Or Michelle Bachmann in 2011, ” She told me that her little daughter took that vaccine (gardasil), that injection and she suffered from mental retardation thereafter.”  It may be coincidental, but both Paul and Bachmann were competing for the Republican nomination for President at the time of their comments.

This is my personal story. Gavin (pictured above) is the 13 month old son of one of my co-workers. At 8 months he was diagnosed with a very advanced case of Wilm’s or cancer of the kidney. He has spent the past 6 months undergoing chemotherapy and multiple surgeries and is currently cancer free. Because Gavin is still immune compromised due to his recent chemo, he has not had his first vaccination for measles (MMR) and is at risk of contracting the disease if he is exposed. Because he is immune compromised, a measles infection can become fatal rather than a nuisance illness.

The family routine has started to normalize and both of his parents are back to work full-time. This means that Gavin has returned to his daycare center, but also that he is among children that may not be vaccinated due to their parent’s personal objections. Unvaccinated children are the children who become sick during a measles outbreak. The early symptoms of measles are similar to a bad cold – fever, runny nose, sneezing, and a sore throat. Measles, however, is much more easily transmitted than the common cold. The virus can live on surfaces and in the air for up to 2 hours and is spread through coughing and sneezing.  Measles is so contagious that 90% of people who are not immune will become infected when in close contact with an infected person (CDC statement). I would bet that the number is closer to 100% in a daycare center given the amount of coughing, sneezing and drooling that occurs.

And this is the statistics part of my story. In a previous post, I referred to the 2015 Gates Annual Letter detailing the work that they hope to accomplish in the developing world in the next 15 years. Since 1990 they have been able to cut the rate of death in children before age five in half, from 10% to 5%. Immunizations have played a major role in that decline, both in protecting individual children from disease and in decreasing the overall prevalence of disease in the general population. If we could move a vaccine denier and their children to a developing world country, they may be better able to see the benefits of vaccines from the eyes of mothers in that country, who fear that their children have a 1 in 20 chance of dying from pneumonia or diarrhea. Vaccines against these illnesses are currently being developed with financial help from the Gates Foundation.

Finally, let me compare the measles outbreak/vaccine debate to the Ebola outbreak.  Over 100 people were infected in California with measles, whereas there were less than 10 people in the US infected with Ebola and only 2 contracted the disease in this country.  Mass hysteria, both in the private sector and in the healthcare system, ensued with Ebola. Sales of protective gear on the internet soared, hospitals and clinics created policies and education regarding Ebola, immigrants from Africa were stigmatized, to name just a few.  And what mass hysteria have we seen since there have been 10 times as many people infected with measles, a disease which is 100 times more contagious than Ebola?  The majority of the comments from politicians have centered around individual parental rights to vaccinate or not vaccinate their children, not speaking out for what is important for the country as a whole. Compare this to the brave citizens of Liberia who are volunteering to be the first recipients of the newly developed Ebola vaccine. We have no long term data about the possible side effects of the vaccine or how effective it might be. However, these men and women have seen the brutal effects of Ebola in their country and are willing to sacrifice personal safety for a better future for their country. Would American citizens be as Brave?