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In Defense of the Other Side

So, vaccines don’t cause autism.  We’ve known that for years, but now that people are actually getting the measles, we’ve started to care.  Enter the news, social media, and talk shows with the “I told you so’s”.  And yes, I shared Jimmy Kimmel’s video of doctor’s sarcastically telling people not to get their health information from celebrities on Facebook.  I must admit, after having daggers shot at me when in a group of other autism parents and admitting I’m pro-vaccine, I felt a little superior when the world at large came around.

Yet, the more I hear the arguments to convince parents to vaccinate their children turn into sarcasm and name-calling, I can’t help but feel angry.  For years, I’ve watched news programs and talk shows present pro- and anti-vaccine arguments as equal, because a good fight on TV is more entertaining than the presentation of accurate information.  I hear parents being called stupid for listening to celebrities instead of their doctors.  As much as I agree, if we shouldn’t listen to celebrities, why are they given air time to discuss health issues? It feels a little like the magician belittling his audience for being fooled by the illusion he created.

The anti-vaccine movement is ultimately fueled by fear, and mistrust of the medical establishment, both emotions which are promoted by the media daily to fuel ratings.  Think about the last promo you saw for the evening news.  Have you ever heard, “Coming up at 5, learn some common sense health information that you may find useful”?.  Chances are, it was something like, “What thing that could kill you is lurking in your pantry?”, or “What are THEY not telling you?”

Believe me, I’m not advocating that the American medical system should be the only, or for that matter the most important expert in regards to health issues.  As a midwife, I remember days when almost every woman who gave birth was given an episiotomy.  When I was born, my mother was administered twilight sleep after insisting that she didn’t want it.  Although the practice of obstetrics has come a long way, I still sometimes disagree with my physician colleagues.  When we disagree, it’s not because THEY are trying to hide something, want a monopoly, or are being paid off by drug companies.  They simply have different education and experience than mine, both are which an important contribution to the women we care for.

There’s a latin expression I heard quoted on my favorite TV show, “The West Wing”:  “Post hoc ergo propter hoc”, which means “after this, therefore, because of this”  This is how the autism/vaccine and most misinformation regarding health care, begins – both things happened therefore there must be a causal relationship.  It’s human nature to believe our own eyes, to believe what seems logical.  But, as my college psych professor would say repeatedly, “correlation does not equal causation”.  The correlation argument is even more difficult to counter when people are desperately searching for meaning.  For example,  I frequently care for women after having a miscarriage, either immediately after, or years later.  The reason I see women with miscarriage so frequently is that unfortunately, it is a common event.  1 in 5 of all pregnancies end in miscarriage.  I’ve so often heard women tell me what caused their miscarriage.  I’ve heard everything from “I was straining to have a bowel movement”, to “I had a pap smear” to the most common one “I was too stressed”.  Sometimes a logical explanation will help women understand that nothing caused their miscarriage; for some, however, once the belief is there, nothing will change it.

So where does one turn to educate themselves?  How do you decipher the volumes of information available  in the internet age?  Obviously I can’t review every source of information available, but there are a few sources to be wary of.  I think you know my opinion about celebrities acting as experts from my comments above.  However, I would also expand that category to include TV doctors.  I’m not saying they’re not real doctors, or even good doctors.  If you had an appointment with Dr. TV in his office, I’m sure you’d get excellent care.  Remember, if a health care professional is on TV, especially if they have their own show, the paycheck is being signed by producers, not a medical establishment.  Although you may come across some useful information, the primary goal is entertainment and ratings, so view the information through that lens.

Second, beware the lawyers!  If you’re on social media, chances are you’ve had a solicitation pop up on your Facebook feed, asking if you took a certain drug and have had A, B or C happen.  What’s not as obvious is if you google something, often the lawyers’ website will pop up and have the appearance of legitimate information from a healthcare organization.  Most law suits against pharmaceutical companies capitalize on the “after this, therefore, because of this” theory.  Often the specific drugs being sued are commonly used, the damages are common ailments, so by the law of numbers, there will be a great deal of clients who have used A and suffered B.  Currently there are dozens of websites by legal firms trying to sue the manufacturers of Zofran, a medication used for severe morning sickness.  They are recruiting women who have used Zofran during a pregnancy in which they carried a child with cleft lip/palate, or a heart defect.  From a business strategy, it’s brilliant.  Many women use Zofran, and those birth defects are two of the most common anomalies.  I’m not about to defend large pharmaceutical companies or tell you that this drug is 100% safe.  As I tell all my patients, we can only tell you anything is safe in pregnancy to the degree that it’s been studied, which is never 100%, and you must weigh the potential risk of taking the drug vs. the risk of the disease you are treating.  My point is that when you see information designed to scare you, consider the source, and share your concerns with your healthcare provider.  If you are not sure who is sponsoring a website, look at two things.  First, what other information is on the website? Does it include other topics with a general theme, like pregnancy, or other medications?  Or does it just contain information about the one topic you just googled, or maybe just a few random topics?  The randomness is usually because it will include other lawsuits they are recruiting for.  For example, on one website, I saw information about Zofran, knee implants, and an antidepressant.  The other tell-tale sign is a number to call.  While there are places on Web MD and other legitimate healthcare sites to type in a question, if there is a phone number it’s usually well hidden, not in bold on every page of the website.

Lastly, beware of who the author is, even on “legitimate” websites.  Often, websites with professional articles, like Babycenter.com, will also have posts from laypeople, and if you search for a particular topic on a website, you may not realize you’re looking at someone’s post, not an article from a professional.  Even when you are aware you are reading posts from the general public, when you see what appears to be a critical mass of people all saying “I did A and then B happened”, it’s difficult to believe that A did not cause B.  You may find information that merits more research, and discussing with your healthcare provider.  Just remember that if both A and B are common, in the world of cyberspace, there will statistically be a lot of people with both A and B.

If you are the type of person that likes to do your own research, there are some ways to go about it.  First, start with the big guns:  websites like WebMD, babycenter.com, and others who are “too big to fail”.  They want to maintain their credibility, and because of their popularity are able to solicit high quality professionals.  Also, look for the main medical organization or society for the field you’re interested in.  Although they mainly exist as a resource for healthcare professionals, they often include information for patients.  For example, the American College of Nurse-Midwives has a website just for women:  http://www.ourmomentoftruth.com.  The American Congress of Obstetrician’s and Gynecologists has a tab for patients: http://www.acog.org/Patients.  Hospital websites are another great source of information.  I frequently use the Boston Children’s hospital website as a resource for parenting my own children.  There’s a search engine where you can find information on any pediatric topic.  http://www.childrenshospital.org  I also love http://womensmentalhealth.org, produced my Mass General Hospital.

In the internet age, people have access to the actual medical journal articles, which in previous years would have been very difficult to come by.  However, health care professionals have taken an entire semester or more just to learn how to read these articles, so even if you can get past the jargon, understanding the meaning can be difficult.  I’ve listed below a few articles which guide the general public on evaluating scientific data.  After cautioning gathering information from personal blogs, I’m about to do just that, so first a disclaimer:  I’ve read these articles and found them helpful, and am in no way endorsing the other material on the website.

In the end, I support everyone’s right to consider options and make healthcare decisions they feel is right for them and their children.  I would only encourage you to consider the source of your information, gather as much information as you can from various sources, and find a health care provider who will collaborate with you as a member of a team.

 

Further reading:

http://www.skepticalraptor.com/skepticalraptorblog.php/how-evaluate-quality-scientific-research/

http://violentmetaphors.com/2013/08/25/how-to-read-and-understand-a-scientific-paper-2/


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