My Patient Doesn’t “Do” Vaccines

vaccine2by Danielle Ofri
New York Times

The visit started out ordinary enough: a new patient, a healthy man in his late 30s who hadn’t seen a doctor in years. When we got to preventive health, I recommended the flu shot. He politely declined. “I don’t do vaccines,” he said.

I glanced at the clock, debating whether or not I should wade into those waters. Given that we are knee-deep in flu season, the flu-shot conversation comes up at every single visit every single day, and it can be exhausting.

For those who decline vaccines on principle, I’ve learned from experience that they are unlikely to change their minds no matter what I say. So rather than expend our limited time on this, I simply note their concerns in the chart and move on to other things.

At this visit, however, something caught my interest. I was genuinely curious. “Tell me why you won’t take vaccines?”

“All the toxic stuff in there,” he replied. “You wouldn’t want to put that stuff in your body.”

“What stuff?” I pressed him.

“Those chemicals. Those preservatives.”

I pulled up the C.D.C. website on my computer to show him the information about the preservative he feared, that it was never shown to do harm and was removed from vaccines in 2001.

“Oh,” he said. “But still. That stuff with autism …”

I explained that the single study that linked autism to vaccines was actually retracted because of scientific, ethical, and financial misdeeds. (For example, the study was partially funded by lawyers for parents who were trying to sue the makers of the vaccine.)

“Well, I just don’t want to put those chemicals in my body,” he replied. “There are so many side effects.”

“Vaccines indeed have some side effects,” I agreed, pulling up the Institute of Medicine report on vaccine safety and the most recent vaccine review to show him the data. “But they are minor. Certainly minor compared to the diseases they prevent.” I described how children used to die of asphyxiation when diphtheria closed their windpipes. I talked about the people who are still today paralyzed from childhood polio.

“The vaccines just seem like they overstress your immune system,” he said, shaking his head. “Plus, you don’t know what those companies put in there.”

I showed him the sticker on my ID card certifying that I’ve been vaccinated every year and have survived to tell the tale, but this of course didn’t sway him. “What are you most afraid of?” I finally asked him.

“I don’t know,” he said after a minute’s pause. “The whole thing just seems dicey. Why take a chance?”

I realized that I was never going to get at the heart of the issue because these fears weren’t so much about facts as they were about emotions. The fears themselves are contagious, and have their own emotional epidemiology.

The book “On Immunity” by Eula Biss was helpful to me in understanding the amorphous but tenacious nature of these fears. Having her own baby made Biss feel both powerful and powerless, and it was easy to become fearful of — and work vigorously to control — dangers in the air, the water, the food, the clothes, the environment, everywhere.

Can these fears be countered? A recent study randomly offered parents one of four different approaches regarding MMR (measles-mumps-rubella vaccine): information about the safety of the MMR vaccine, information about the severity of the diseases prevented by MMR, pictures of children suffering from these disease, or a poignant story about an baby who nearly died from measles.

The upshot? None of these worked. In fact, some even backfired. Parents who saw the photos of sick children or read the story of the baby with measles actually voiced more misperceptions about the MMR vaccine.

My patient and I talked some more about the flu shot. Our conversation was amiable and nonconfrontational: he seemed open to hearing what I had to say, and I genuinely wanted to understand the root of his concerns. But we kept going in circles.

The scientist side of me remains dumbfounded when clear and present facts do not convince people. But the other side of me recognizes that it’s not all about facts and that I won’t get anywhere just citing them. I told my patient that I respected his opinion, but that my clinical advice remains that the benefits of vaccines far outweigh the risks.

“The other thing,” I added, “is that even if you yourself only get a mild case of the flu, you could pass it on to your elderly parents, or to a friend’s baby, or to a pregnant co-worker. These are the people who die from influenza.”

He paused and digested that for a moment. Then he stood up, because our visit had come to the end. “I’ll think about it,” he said.

I shook his hand as we parted ways, realizing that this was about as much as I could possibly ask for.   (from the New York Times)