One of the biggest changes in healthcare in recent times is the emphasis on decision-making. Patients and doctors now work with big menus. It’s mostly a good thing, but a certainty with increased choice is increased conflict.
As a doctor who works in a field–electrophysiology–that is almost exclusively preference-sensitive, I’ve grown increasingly interested in why and how humans choose things. After twenty years of bearing witness to medicine’s wins and loses, I’ve come to realize how little I know about this central theme of doctoring.
The list of mysteries I think about is a long one: Why do doctors beat the drum about drugs that have absolute benefits of less than 1%? How did we collectively (patients, doctors, society) come to ignore the tragedy of death-by-ICU? Why do we assume an 85-year-old benefits from a treatment studied in 50-year-olds? How does a great and proud nation allow itself to spend so much on healthcare and get so little health? You get the picture.
Yet, none of these mysteries are in the same category with the conflict surrounding vaccines. The why and how of where we are with vaccines boggles my mind. So bad is this place that one can hardly write about the topic. Just the word vaccine stirs controversy.
Let’s step back for a moment and look at the issue of public distrust of vaccines. On the one hand is this seemingly unassailable statement from the American Academy of Arts and Sciences:
Vvaccines represent a significant scientific triumph and remain a powerful tool for preventive childhood health.
Despite, or perhaps because of, such ‘triumph’ and ‘power,’ public distrust of vaccines grows stronger. Some childhood infectious diseases, once virtually abolished, have come back. And it’s wealthy well-educated communities (Orange County, CA) that are most affected. Why, and how, did this happen?
Another question: How did this debate got so rancorous? The middle ground is gone.
If you write a post that cites evidence for vaccines, not triumph mind you, just evidence, you can expect harsh rebuke from vaccine doubters.
On the other hand, let’s say you wrote a post on vaccines that also mentioned shared decision-making. Or, you got really courageous and asked how other countries vaccinate less but have better measures of childhood health. Here, you can expect swift and immediate scorn from doctors. A prominent journalist recently messaged this to me regarding mainstream medicine’s view of vaccine distrust: “Every legitimate doubter leads to 10 people who are just off the reservation. So they don’t tolerate dissent.”
So here are some more questions. What’s wrong with the vaccine message? Why does it seem that the more the scientific community pushes vaccine evidence the worse the public distrust gets? Why is that educated people line up to take dubious, risky, and expensive treatments, but many won’t take a vaccine? Why is it that even though Guillain-BarrÃ© syndrome is ten-times more likely after influenza infection than influenza vaccine, people remain squeamish about taking the shot? Social media experts like to talk about the wisdom of crowds; what is it, then, that this many doubters see? Could it be that when push comes to shove (taking the shot), some people care little about population data? Why do celebrity docs, such as Oz, boast millions more followers than any evidence-based doctor? Could Oz and his ilk teach us something about connecting with people?
Finally, don’t you, too, think about what this ‘phenomenon’ will look like ten years from now? I used the big word phenomenon because it fits. The growing distrust in vaccines is indeed “a situation that is observed to exist or happen, esp. one whose cause or explanation is in question.”
The good news is that three smart people, Seth Mnookin (MIT), Barry Bloom (Harvard) and Edgar Marcuse (University of Washington) will lead a multidisciplinary committee of experts drawn from medicine, behavioral science, communications, science history, and journalism, to study the issue of how public perceptions of childhood vaccines are formed. Dr. Mnookin said something impressive in this MIT press release:
In the years after my book, â€œThe Panic Virus,â€Â was published, I was asked to take part in a number of workshops in which the participants discussed strategies for confronting vaccine fears spurred by misinformation. After attending several of these gatherings,Â I realized the approach was somewhat hypocritical: Here were some very smart people essentially talking about their instinctual responses to addressing the fact that some parents rely on instinct rather than data to make decisions about vaccination.
I say it’s about time we look at why and how we got to this place. My hunch is that we are going to learn something useful about decision-making and communication.