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Private Practice, Public Health, and the Autism/Vaccine Debate

"Private Practice" - the "Grey's Anatomy" spinoff starring Kate Walsh - may be one of the most poorly written, bad excuse for soft porn shows on TV. But big props to the show for last night's episode/public service announcement, which has already ignited a firestorm on the autism blogs.

The episode featured a mother with three sons, and the oldest was autistic. Blaming the MMR vaccine for her child's autism, she chose not to vaccinate her two other sons. An unvaccinated son picks up measles while the family is in Switzerland seeking autism treatment, exposes the entire practice when he comes in, and dies at the end of the episode.

Think this is implausible? Check out this graph of the growth of measles cases in the UK over the last 12 years, courtesy of the BBC:

And it's not just the UK. During the first seven months of 2008, 131 measles cases were reported to CDC, compared with an average of 63 cases per year during 2000--2007. (On a more local level, in the first four months of 2008, there were 22 measles cases in NYC.)

Parents have the right to make choices for their children, but they don't have an inalienable right to expose other people's children to deadly diseases. And if it takes a bunch of hot faux doctors to get that message out, so be it.

Couldn't agree with this post more. Thanks for blogging about it.

There are some undeniable risks to vaccination, but I love it when people choose not to be vaccinated and try to rely on herd immunity for protection. Guess what happens when people stop being vaccinated?

What about the fact that the doctors on the show went on to vaccinate the other sibling without their parents' consent? Illegal?

What about the fact that only one human in 5000 that contracts measles dies?

Do you have children with autism? Do you know how hard it is?

This show was appalling in its portrayal of parent's ignorance. Most neglectful parents I know (or would stereotype similarly to this show) blindly let doctors shoot up their children with whatever they're told. The anti-vax community is much more self educated than that.

I found the way the two sides of the issue were presented to be very shallow. From some research I did afterwards, it also looks like Cooper's vaccination of the youngest son would have been too late to provide protection, so I'm wondering if they did it primarily so they can have some big blowup with the ethics board.

This hit Scott's blog:
The controversy over student vaccinations where he posed it as a question.

and I did a couple posts on it where the title will telegraph my POV:
Hey, could you stop trying to poach off my family’s immunity?

BUT a much better media source for this story is from This American Life which looked at the real-life Switzerland/San Diego outbreak. Two lessons, NO ONE pro or con on vaccine changed there mind, even with an outbreak, AND more than just the non-vaccinators are affected when we lose herd immunity. Kids late or before their MMR date (2 years old) ended up getting caught up in the outbreak, which I blogged about (with some other stuff) here.

Basically, until folks are sending THEIR children to a school for the deaf or blind, they will delude themselves with notion that measles is a harmless childhood disease (that would be 1 in 1000 for those who like to keep count).

I missed the show (because it's a terrible show) but I can speak from personal experience on this one. Science has yet to find a definitive cause for autism, and until they do the rest of us are forced to make choices based on simple guesswork. Unless you actually have one child with autism and have been faced with the decision on whether or not to vaccinate another (I have) none of you are in a position to comment on the wisdom of another person's choice.

There was a scene early on where the doctors were passing immediate judgement on the non-vaxing mother. The dialog was as canned as the average prescription drug commercial, and probably came straight from http://www.cdc.gov/HealthMarketing/entertainment_education/ .

Eduwonkette, you are advocating the general public educating themselves on important societal pediatric health issues from what is essentially a prime-time soap opera.

I would expect more from a website billed as "Education Week". Education via must-see television drama. That's terrific.

This is a weird entry on your blog. Is this a guest author? The vaccine debate is a pretty serious issue for a one-off focused on the plot of a soap opera episode.

Hi everyone,

Thanks for the comments. Certainly this is a lame tv show and any issue presented within is necessarily lacking in complexity (and intended to generate drama, i.e. the vigilante vaccination of the second son.)

At the same time, the episode is an entry point for a conversation about what is turning out to be a serious public health issue, and a welcome corrective to a lot of misinformation floating around about the relationship between autism and vaccines. No decent study has ever established a link between autism and thimerosal. For example, consider this article published in JAMA, which compared kids exposed to vaccines with and without thimerosal and concluded, “The risk of autism and other autistic-spectrum disorders did not differ significantly between children vaccinated with thimerosal-containing vaccine and children vaccinated with thimerosal-free vaccine.” Or check out this literature review, published in Pediatrics, which also came to the same conclusion. What’s more, autism rates have continued to increase even after thimerosal was removed from kids’ vaccines.

What I appreciated about the episode is that it made clear that individual parents' personal choices have implications for other kids. And that is the public health issue that we are going to be left to deal with if our MMR vaccination rates trend downward.

The MMR is a live vaccine and has never contained thimerosal, so these are two different issues that you're linking.

Hi mom2015, Yes, of course - and I didn't make this clear above by bringing in the larger vaccine debate. For those interested in learning more specifically about the research finding no link between MMR and autism, here are two good places to start:

1) JAMA 2001: http://jama.ama-assn.org/cgi/content/abstract/285/9/1183

2) New England Journal of Medicine 2002: http://content.nejm.org/cgi/content/abstract/347/19/1477

Actually, this is a great topic for discussing two issues central to social stats, correlation vs. causation, and incidence and prevalence. What would it be like comparing risks of autism and complications from measles because looking at incidence and prevalence since they have such different durations?

FYI, Measles ceased being a "live" vaccine in 1960 (http://tinyurl.com/8yqjdd).

Eduwonkette, the issue is not as settled as you seem to believe. Two clicks away from one of your sources, on the same site at http://pediatrics.aappublications.org/cgi/eletters/123/1/e164 I found an intense discussion via letters among pediatricians and neurologists from this December (2008) and January (2009).

My children are vaccinated, and will continue to receive boosters, but I will not judge parents who have carefully and thoughtfully decided to proceed differently. Their decision does not jeopardize my family's safety. I'll go back to my original post that this issue is too complex to be summarized by a review of a soap opera episode. There are many aspects of the issue that deserve thoughtful consideration before making a summary judgment. For example:

You mention autism, but that is just part of the debate. Vaccine safety and efficacy are studied and touted by those who have financial motives. Mistakes have been made in the past by pharmaceutical companies, with tragic results for families. Why shouldn't the industry be questioned?

Immune disorders are on the rise in this country and we do not know why. Parents are struggling to raise children who may not get measles, but are now facing deadly allergic reactions to common foods. Asthma is increasing alarmingly. Juvenile arthritis (an umbrella term for a number of related rheumatoid immune disorders) is on the rise as is pediatric lupus.

Finally, consider the relatively recent fiasco when states were considering requiring 11-year old young girls to be vaccinated against an STD to attend school.

I don't bring all this up to say that you are wrong. I'm a long time reader who never comments, but I want to point out that if you're going to bring up this issue, it deserves the kind of research and analysis that you do so well on education topics.

I'm a teacher and a fan!

Much of the concern over the MMR vaccine here in the U.S. has absolutely nothing to do with autism and everything to do with the fact that the vaccine is made from a stem cell line that originated from an aborted baby.

There's tremendous controversy within the pro-Life community over whether it's acceptable to use abortion-tainted vaccines like the MMR one. Ultimately, the solution is for a pharmaceutical company to develop a new vaccine from an acceptable source as is the case with many other vaccines. But until they do, it's a tough call and I can totally understand why another Christian parent would make a different decision from the one I have made for my own family.

In Canada the only two vaccines that contain thimerosal are the Hep B and the Flu Shot! My son is autistic and I strongly feel that the flu shot played a major role. The vaccines in the U.S.A. which contain Thimerosal are alot greater and even in the states where they have banned the use of Thimerosal in vaccines it was not required to pull the left over vaccines containing Thimerosal! I was shocked by this episode and I highly recommend that everyone does their own research!!! Can you honestly say you trust your Dr. 100% remember when it was not frowned upon to smoke while being pregnant, things change!!!! Open your mind!!!

thank you for this discussion. i specifically looked for any backlash from the show after seeing it. i was appalled by the blatant propaganda. i personally have one child who i blindly followed the advice of the nurse and another that i carefully selected certain vaccines for after researching them.
just so you know children don't actually have to be immunized to attend school. on the back of the form you can choose to opt out for personal beliefs. it's another form of propaganda when they tell you it's the law.
don't forget that those vaccine companies are big business that have the government on the payroll.
p.s. i am a nurse.

While there are all sorts of theories flying around about vaccines and autism -- the biggest issue that I have with vaccinations in the USA are the time table for them.

The sheer number of vaccinations and the times that they are recommended in the USA differ greatly from the rest of the world that encourages them at later stages of childhood.

It makes sense - you inject a child with a small dosage of a virus and they develop an immunity to it. You do it earlier on and you have a smaller child with a weaker immune system fighting.

I'd like to read statistics that cross several factors including formula fed children vs. breast fed children (who are receiving a far greater amount of antibodies from the mother) -- and would like to see more information on children with pre-existing conditions developing autism.

Perhaps vaccinations are fine and wonderful and great - but they are administered in an irresponsible manner and that's what needs to be addressed.

It reminds me of so many arguments that people feel are black and white - yet the strongest opponents with real reasons are not debating it in black and white. The loudest opponents are.

The graph is lovely. Make another graph of the increase in food allergies and then another for the increase in asthma. Food allergies I have directly related to vaccinations. There are studies that relate the increase in asthma to vaccines.

Vaccines have "secret ingredients" protected by trade law. All the ingredients do NOT have to appear on the package insert.

Peanut allergy has become a big problem in small children since the recommended number of childhood vaccines was increased about 5 years ago. Peanut oil can be used as an ingredient in the vaccine adjuvant. It is highly refined so only a very small amount of peanut protein remains but if your child is the unlucky one to get the vaccine with that trace amount of peanut protein....

What if you had to make a choice between your child not getting measles or the neighbor's child getting "the fatal peanut allergy"?

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Recent Comments

  • bfg: The graph is lovely. Make another graph of the increase read more
  • Chris Hickman: While there are all sorts of theories flying around about read more
  • wren: thank you for this discussion. i specifically looked for any read more
  • mom2 mason: In Canada the only two vaccines that contain thimerosal are read more
  • Crimson Wife: Much of the concern over the MMR vaccine here in read more




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