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Sunday, February 1, 2015

Informing the public: what is the responsibility of scientists and doctors?

 Last year, the U.S. had a record number of measles cases and in January there were over 84 cases in 14 states. According to the Center for Disease Control the majority of these cases were in unvaccinated people. There has been a lot of press coverage of late on the increasing number of people choosing not to vaccinate their children. In California, which has had outbreaks in the last two years, eight percent of kindergartners are not vaccinated against measles, mumps, and rubella (MMR).

A 1998 paper published in a reputable British journal The Lancet, fueled the anti-vaccination movement. The study, led by Dr. Andrew Wakefield, claimed a link between the MMR vaccine and autism and gastrointestinal disease. However the study only looked at 12 children and had no control group. Researchers were not able to replicate the results and numerous studies have not found any link between autism or GI disease and vaccines1,2.

The evidence against the paper and specifically, Wakefield, is clear and damning. An investigation found numerous conflicts of interest: he received research money from lawyers representing parents suing vaccine companies. He patented an alternative measles vaccine that would benefit if the MMR vaccine were found unsafe. In 2010, the paper was retracted by The Lancet and Wakefield was disbarred from practicing medicine in the U.K. because of his intentional falsification in the study and endangerment of children.

A study just published by the Pew Research Foundation found that 68% of American adults say childhood vaccines such as the MMR should be required. In contrast, 86% of scientists thought they should be required3. So – what is a scientist or doctor to do when they still hear the Wakefield paper being bandied about as evidence against vaccination? What is our responsibility when doctors swear an oath and nearly all scientists receive taxpayer dollars?

We are all familiar with the skepticism about climate change so it is easy to dismiss the chasm between scientists and the general public as a conservative problem. But the measles outbreak is occurring in affluent, liberal areas whereas Mississippi has the highest vaccination rate of any state. (Granted, this is because the rest of Mississippi’s healthcare infrastructure is so poor as to necessitate strict vaccination guidelines.) A guest on a last week’s episode of the Diane Rehm Show stated the problem well: mothers who don’t vaccinate their children aren’t uninformed, they are misinformed.

Additionally, in the Pew Research study, the largest gap in opinion was not on climate change, but on a liberal issue: the safety of eating genetically modified (GM) foods. 90% of scientists said it was safe to east GM foods while only 37% of non-scientists did.

Another problem that is often cited by scientists is the public’s mistrust of science. While an attractive theory, because it removes our responsibility to bridge that gap, the Pew study paints a somewhat different picture. 75% of adults polled said government spending on basic science pays off in the long run and 79% of people say science has made life easier, having a positive effect on things like health care.

So if we can’t blame it on Republicans (as academics are sometimes wont to do) and we can’t blame it on blanket mistrust of science, then perhaps, we, as scientists need to look at our role in educating the public. Should we go on to parenting message boards and whenever the Wakefield study is cited – and it still often is – respond with a barrage of rebuttals? While I don’t know what would be most effective at bridging the gap, I think it is important to at least raise the question that we may have this responsibility.

References:
1. Madsen KM, Hviid A, Vestergaard M, et al. (November 2002). "A population-based study of measles, mumps, and rubella vaccination and autism". N. Engl. J. Med. 347 (19): 1477–82.
2. Black C, Kaye JA, Jick H (August 2002). "Relation of childhood gastrointestinal disorders to autism: nested case-control study using data from the UK General Practice Research Database". BMJ 325 (7361): 419–21.

3. Pew Research Center, January 29, 2015, “Public and Scientists’ Views on Science and Society”

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