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Anti-Vaccine Vitriol: Seeking Reason

By       Message David L. Katz M.D.       (Page 1 of 1 pages)     Permalink

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I must say, I am amazed -- and a bit horrified -- by the volume and intensity of the anti-vaccine vitriol my prior column has engendered. I knew there was lots of anti-vaccine sentiment in our society, something that tends to be the privilege of societies much less subject than they once were to diseases vaccines prevent. But the fervor and derision in the comments are almost shocking, and warrant a reality check.

1) People who are helped by vaccines don't notice.

If you get a vaccine, any vaccine, and don't get the disease the vaccine prevents -- be it pertussis, or diphtheria, or measles, or polio, or flu -- nobody notices. There is, in fact, no way to say the vaccine did anything! After all, you might not have gotten sick without it. There is nothing to report, no thanks given, no drama. It's a non-event.

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This is exactly why personal observations and anecdotes, however dramatic they may be, cannot determine whether a vaccine is working. Every time an adverse reaction occurs after a vaccine -- whether or not due to the vaccine -- there will be drama. There will be anger. There will be public commentary. Even if one such adverse event occurs for every 100,000 helped, the one bad outcome will draw attention; the 100,000 non-events will go unnoticed.

This, by the way, is not just true about vaccines. It's true about my field, preventive medicine, in general. When it works, there's nothing to see.

Epidemiology fixes this, by looking at outcomes in the population at large. This is why the CDC and ACIP base their vaccine recommendations on epidemiology, the study of patterns in the population as a whole. It is at the level of population that a clear benefit from many vaccines, including the flu vaccine, is evident.

It makes no more sense to rant against vaccines because you know of someone who had an adverse reaction, or think might have, than it does to advise against walking in general because you've heard about a pedestrian struck by a car. Bad things will at times happen to good people, no matter what we do or don't do. Epidemiology simply helps us choose the path of least harm, most benefit -- so they happen to fewer of us.

2) There is no form of prejudice that isn't just prejudice.

We seem to have talked ourselves into the notion that some forms of prejudice are prejudice, and some are public service. That's nonsense. All prejudice is prejudice.

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I can be judged for what I say and do, the positions I take. But a summary judgment about me can't be made because I am a doctor, or am affiliated with Yale, any more than because of... my skin color. Or the fact that I have a Y chromosome. Or because I live in Connecticut. Or because I was born in LA.

My career, most details of which are readily available online to anybody who bothers to look, is all about lifestyle as medicine. Yes, I do prescribe medications to those who need them -- but I devote most of my clinical efforts to helping people avoid them. It is not coincidental that I am president-elect of the American College of Lifestyle Medicine. It is not accidental that I practice collaboratively with naturopathic physicians in a holistic clinic focused on kinder, gentler treatment alternatives.

I don't push drugs, or vaccines. I don't get compensated when they are used. I am a salaried, academic physician; I do not get fee for service. My day job is helping people use their feet and their forks to prevent disease.

So if I recommend a vaccine, it's because I believe -- based on review of the available epidemiologic evidence -- that it is the right thing to do. Period.

Disagree with the position if you want. But if you make false allegations along the way -- about profit motives and cover-ups -- it simply tells the world that you are okay with prejudice, conviction without trial, unsubstantiated conclusions, and a rush to judgment. Which might raise some questions about the reliability of your vaccine-related advice.

In other words, if you want to offer advice against vaccination that reasonable people can take seriously, try being reasonable. Seriously.

I stand by my support for the flu vaccine. Reasonable people might disagree -- and when they do, I will listen to them and encourage others to do likewise. Not so those who renounce reason altogether, and in its place offer only vitriol.

 

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David L. Katz M.D., MPH, FACPM, FACP, is the founding (1998) director of Yale University's Prevention Research Center. He received his BA from Dartmouth College (1984; Magna Cum Laude); his M.D. from the Albert Einstein College of Medicine (1988); and his MPH from the Yale University School of Public Health (1993). He is a two-time diplomate of the American Board of Internal Medicine, a board-certified specialist in Preventive Medicine/Public Health, and a clinical instructor in medicine at the Yale School of Medicine. Katz is known internationally for expertise in nutrition, weight management, and chronic disease prevention. He has published roughly 150 scientific articles; innumerable blogs and columns; nearly 1,000 newspaper articles; and 12 books to date, with three more currently in production. He is the editor-in-chief of the journal Childhood Obesity, President-Elect of the American College of Lifestyle Medicine, founder and President of the non-profit  Turn the tide 
foundation  and a blogger/medical review board member for The Huffington Post. Dr. Katz remains active in patient care, and directs the Integrative Medicine Center at Griffin Hospital in Derby, CT. He helped establish, and formerly directed, one of the nation's first combined training program in Internal Medicine and Preventive Medicine, and served as Director of Medical Studies In Public Health at the Yale School of Medicine for eight years (1996-2004). Programming Katz and colleagues have developed -- such as Nutrition Detectives´ú¬ and ABC for Fitness´ú¬ -- has been adopted by thousands of public schools throughout the U.S., and abroad, and is reaching many tens of thousands of children. Katz has five U.S. patents, several patents pending, and is the principal inventor of the Overall Nutritional Quality Index (patents pending) utilized in the NuVal « nutrition guidance program (www.nuval.com), currently offered in over 1,600 supermarkets throughout the United States, from coast to coast, reaching some 30 million consumers. He has been recognized three times by the Consumers Research Council of America as one of the nation's top physicians in Preventive Medicine. He was nominated for the position of U.S. Surgeon General in 2009 by the American College of Physicians, the American College of Preventive Medicine, the Association of Yale Alumni in Public Health, and the Center for Science in the Public Interest, among others. He was the 2011 recipient of the Katharine Boucot Sturgis award from the American College of Preventive Medicine, the most prestigious award the College confers, awarded for illustrious career contributions to the field of Preventive Medicine. Also in 2011, Dr. Katz received the Lenna Frances Cooper Award from the American Dietetic Association (now known as the Academy of Nutrition and Dietetics) for illustrious contributions to the field of nutrition. In 2012, he was the first inductee into the Marketing Disease Prevention in America hall of fame for efforts related to childhood obesity control. Also in 2012, Katz received the annual J. Warren Perry Award and Lectureship at the University at Buffalo and was the Stanley P. Mayers Endowed Lecturer at Penn State University. Dr. Katz is a leading voice in medical media, is quoted almost daily in major news publications, and appears routinely on national TV. He speaks routinely at conferences and meetings throughout the United States, and the world, and has delivered addresses in at least seven countries. Widely recognized as a gifted public speaker, Katz has been acclaimed by peers as the "poet laureate of health promotion."

Dr. Katz and his wife Catherine live in CT; they have five children.

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