Friday, January 24, 2014

Why I Believe ...

This post will tackle a very different topic than most on this blog. However given that this is my only "platform" to share my opinions, it will just have to do ... 

As a physician, I frequently field medically-related questions from friends and family. I recently received an email from a college friend inquiring about the safety of the HPV vaccine, as he is the father of two young girls. He shared a link to an article which highlighted some of these concerns, particularly given that he felt he was generally “skeptical of a lot of vaccines”.

I struggled with how to respond to him, as I am not skeptical of vaccines.

I can provide links and PDFs to reputable news sources and primary scientific literature addressing the safety and efficacy of vaccines; however in this "debate", those sources tend to be quickly dismissed by the mainstream. Instead, the voices of celebrities without college degrees, media outlets looking for ratings and conspiracy theorists believing in a massive, secret genocide campaign by Big Pharma, provide the most reliable information. 

I am no expert on vaccines, but I did go to school for twenty years to embark on a career of lifelong learning. I have learned to critically appraise scientific literature and when possible, to try to use only evidence-based therapies in treating my patients. In my four years of undergrad, four years of medical school and three (of four) years of residency, I have received no kickbacks from any pharmaceutical companies or vaccine manufacturers. In fact, I'm not even allowed to get a free pen from those companies, as to not appear unethical. 

Vaccines are safe. 

Specifically, with regards to the HPV vaccine, there has been tremendous misinformation in the media (see aforementioned article above). One of the scientists whose research helped develop one of the HPV vaccines has expressed some concerns about the time frame for vaccination (not knowing how long protection will last), not the absolute safety of the vaccine, despite claims otherwise. In fact, she co-authored a paper on the efficacy and safety of HPV vaccines in 2011 (Harper DM, Vierthaler SL. Next Generation Cancer Protection: The Bivalent HPV Vaccine for Females. ISRN Obstet Gynecol. 2011;2011:457204), in which it doesn't seem she harbors such serious concerns about the vaccine that she "can't sleep at night". 

The VAERS (Vaccine Adverse Event Reporting System) HPV vaccine death data that is haphazardly tossed around in social media is completely invalid. As of June 2011, there have been 68 deaths reported within 1 year of vaccination. Only 32 of those have been confirmed and none of them have been attributed to vaccination. A 2011 meta-analysis of randomized-controlled trials looked at those that had received HPV vaccine versus placebo (~ 20,000 per group). The placebo group had 15 deaths during the study period as compared to 19 in the vaccine group; side effects were primarily related to local effects from the vaccine. 

We are facing an unprecedented rise in vaccine-preventable diseases in the United States, with frequent outbreaks of pertussis, measles and mumps. And we continue to see the devastating effects of vaccine-preventable diseases in the developing world where the luxury of vaccines frequently don't exist. 


I could continue to cite statistics and data which I truly believe in, but instead I'll share some of the personal reasons I believe in vaccines.

I have cried with parents in the pediatric ICU after their unvaccinated teenage son died from complications of influenza, 
I have sat and grieved with a husband in the medical ICU as he struggled with the decision to withdraw life support from his wife dying of metastatic cervical cancer, 
I have spent hours at the bedside of a critically ill unvaccinated adult patient with septic shock from S. pneumoniae bacteremia, 
I have tossed and turned, unable to sleep, after an after-hours phone call with the mother of an unvaccinated infant with fever - worrying I was missing the signs of early-onset bacterial sepsis, 
I have commiserated with colleagues battling on the front lines against the resurgence of pertussis - working to save the lives of infants too young to be vaccinated,
and I personally have participated in a clinical trial for a human H7N9 influenza vaccine in the hopes of helping to avert another pandemic. 

Vaccines are not perfect, but they are safe. They will not save everyone, but shouldn’t we try? 

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