A recent episode of the PBS program Frontline was called "The War on Vaccines." The title alone should have been the tip off that the producers' goal was to inflame and incite – to assume this was an entirely adversarial discussion between diametrically opposed viewpoints. But I knew that my colleague Jennifer Margulis, Contributing Editor at Mothering where I am Politics Editor, was interviewed on the program so I felt obligated to watch. I knew also the show would feature pro-vaccine zealot Paul Offit – as famous for his vehement opposition to all questioning of vaccines as he is for the money he takes from vaccine manufacturers.
Imagine I insert an ominous voiceover here. In case you don't have time to watch the entire Frontline report, I can give you a feel for the experience. For all fifty minutes, you are constantly reminded the discussion – oh, just suspend your disbelief and accept there is a discussion – is life or death for every child. Make sure you are really worked up about dying toddlers because the Frontline producers want to make sure you have an opinion about vaccines at the end of the show that is linked to the images you see on the screen and hear in the voiceover. We are moved and motivated by the sights and sounds in film. Having worked in television production I know how this works but I think any discerning viewer can figure that out. If this were not so, we would all just read the paper.
One of the opening scenes in Frontline's "The War on Vaccines" is about a helpless innocent baby coming into the world waiting for mommy to do all she can to keep her safe and healthy. You see through a car windshield the sign for Doylestown Hospital but, if you watch this online, the section is called "A Visit to Ashland, Oregon."
"A new life begins," says the ominous voiceover. Little Rachel Murphy is coming into the world. But wait. Mommy is on her back in an operating room at Doylestown Hospital with a curtain between her and the birth. Yup, she is having a cesarean section. "It's a girl!" says a member of the team pulling Rachel out of her mother's uterus which has been surgically lifted from her body. "AW!" says Rachel's mother who can not see her own child. The very serious narrator comes back and explains that little Rachel had been born into "a world filled with countless germs." Then we have a series of camera shots of Rachel being handled by medical staff, in a cart being wheeled down the hall, getting her first vaccine at an hour old (according to the ominous voiceover) for Hepatitis B (a form of Hepatitis contracted primarily through sexual intercourse or I.V. drug use, so use of this vaccine assumes either Rachel's mother is infected or Rachel has been pretty busy in her first hour outside the womb). Some time more than an hour after all of this has taken place away from Rachel's mother, we finally see a camera view of Rachel and her mother together – her mother still flat on her back post-surgery.
Wow. The joy of birth in America. Strangers will handle you, wheel you around, and pump you full of chemicals – some of which are toxic – before you even get a chance to meet your mother. That world full of countless germs? Well, that would be the hospital. Some of Rachel's protection against these germs have been washed off of her before she can get a whiff of her mother's breast where the colostrum is waiting for her. A hat has been put on her head which she does not need because her mother's body could provide warmth and the exchange of scent between Rachel and her mother could help an already challenged breastfeeding relationship.
Next we have some Centers for Disease Control party line on the benefits of vaccination followed promptly by, with a dark lowering of the voiceover's tone, the announcement that some communities in America are resisting the CDC advice and have much lower rates of vaccination. I could be wrong about what appears to me to be a misleading connection between little Rachel Murphy's birth and Ashland. If you didn't see the hospital sign, you don't know where Rachel was born. I think one could easily think, hearing Ashland, Oregon named as a pocket of vaccine renegades, that Rachel was born in that community. So in case you were confused, here is a little geography lesson Mr. Ominous Voiceover omits.
Doylestown Hospital is in Doylestown, Pennsylvania. Doylestown is about an hour north of Philadelphia. Now I don't necessarily have a preconceived notion about any particular hospital's c-section rate. And I will look carefully if a hospital offers a birthing center. Birthing centers often (though with decreasing frequence nationally) have midwives and lower rates of c-section. However, if you hit the home page link on the Doylestown Hospital website for what purports to be that hospital's "birthing center," you come to a page with a huge graphic of people in white coats and surgical scrubs under the headline "Maternity Care Reinvented." Below the cluster of white coats and surgical scrubs is the tag line, "Doylestown Hospital Welcomes CHOP Newborn Care at Doylestown Hospital." CHOP, for those of you closer to Ashland, Oregon – that renegade town that is 3000 miles away from Doylestown – is Childrens Hospital of Philadelphia, the professional home of … you guessed it, Paul Offit.
As a not so amusing side note, I glanced over at the "birthing center" physicians to see the name of the surgeon who cut my third son out of me at a different hospital. I have two profound memories of that man. One was the frightening tower of formula cases behind him in his office. He was such an unpleasant man I tried to mentally will the boxes to fall and crush him. I asked him about all that formula and whether it wouldn't be better to encourage women to breastfeed their babies rather than assume they will formula feed. He snarled his response: "Would YOU want to nurse quadruplets?" He was a specialist in multiple births (the reason I had been coerced into being seen by him). I replied, "I certainly would want to try." He made a disgusted sound and refused to discuss it with me anymore. The other memory I have of that doctor is what he shouted to me as he was scrubbing in for that dreaded third c-section. "This is a tubal as well, right?" He and I had never had any discussion of his performing a tubal ligation and I had hoped to have more children. "NO!" I shouted back, more than a little frightened that he might have asked this question after I was unable to respond. His response was his usual sneer. "You would do this again?" I think I will remember forever glancing over at the array of scalpels a nurse was counting while I was being prepped, thinking violent thoughts along with "what an asshole."
Back to Frontline.
Jennifer Margulis has written a blog post I highly recommend about what she sees as the failings of "The War on Vaccines" and I highly recommend you read it. At least two of her complaints are mine as well. All of the doctors and government officials shown in the final cut of this Frontline are opposed to any variation from the CDC recommended vaccine schedule. The conclusion one is forced to draw is that there are no physicians – particularly no respected physicians – who challenge the statements made by Offit. Not only is that untrue but if you read Dr. Jay Gordon's blog post concerning this Frontline piece, you find out that he was interviewed for hours as was Dr. Robert Sears. As Gordon describes in great detail, the producers made a deliberate choice to exclude these respected doctors who offer a different viewpoint from either extreme presented by Frontline.
Another dangerous and professionally irresponsible choice made by the Frontline producers was to entirely exclude discussion of the ideological space in between Offit's "all vaccines on the CDC schedule no matter what" position and the "no vaccines ever under any circumstances" position erroneously attributed to Margulis. There are many parents and professionals, like me, who believe that every parent must examine each vaccine and each child and decide whether the benefits of a particular vaccine outweigh the risks. This is called "selective vaccination" and I have been practicing it with my children since my eldest son was a year old.
I allowed doctors to vaccinate my now nearly sixteen year old son on the CDC schedule when he was born. There were many fewer vaccines on the schedule back then, I trusted my carefully chosen pediatrician and did as I was told. But, as is my nature, I did my research and as I read more studies I began to question whether he needed all of the shots and whether he needed them at the times they were being given. Tetanus may have been the first one I questioned. I have a particularly violent physical reaction to the tetanus vaccine so I was worried that he might as well. I researched how one gets tetanus and wondered whether my child, with his access to clean water, disinfectant and a tetanus shot if he has an injury so deep one can't be sure washing alone will protect him – well, why did my son need to risk the reaction I get to the vaccine? Then I read a study about the MMR vaccine. I don't even remember what it was about but I remember it was in Lancet, a journal one's pediatrician should be expected to read. I asked my pediatrician a question about the study and he said he knew nothing about it. I wanted to discuss my concerns with him before making the decision to give the vaccine to my son. The pediatrician was surprised I thought the decision was mine to make. And then he said it. With a patronizing laugh he said, "Your Medline privileges should be revoked." I was not amused. That was the day I decided my children would be selectively vaccinated. I would be the one who decided whether my children needed a particular vaccine at a particular time. I would do something public health officials can't do. I would look at just one child in his own unique environment with his own unique biology and family history. I would assess the risks and benefits of each vaccine for each child.
If you let the imagery and ominous tone of Frontline's "The War on Vaccines" wash over you, you would never know that parents could make intelligent and safe decisions for their own children. You would never know there are doctors who support parents' ability to do this. You would think that I make my parenting decisions based on what I see on YouTube. In fact, I chose selective vaccinating before I had even heard of YouTube. I read peer reviewed medical journal articles and consider the advice of a wide range of medical specialists including Dr. Jay Gordon and Dr. Robert Sears. The Frontline producers would have you believe that parents taking control of the medical care their children receive is a bad thing.
In between the interviews portraying extreme and irreconcilable views, along with the frightening images of sick children, there is interspersed B roll of children in a gymnastics class. Hmm. Is gymnastics there to lighten the mood by showing happy children at play? Or is it there to suggest the metaphor of risky behaviors parents encourage their children to engage in? After all, the chances of my child dying of chicken pox is far lower than the chance of my child being seriously injured as a gymnast. Or are the producers trying to leave us with that uncertainty – is that child flying through the air going to land safely or break her neck? Regardless, it is just manipulative.
So what do you think? I am not going to give you a poll and don't encourage you to participate in Frontline's two choice poll. On my blog as in life, you have more than two choices. I'd like to hear how you make your decisions about vaccination. If you saw the Frontline episode, I'd like to hear how balanced you think it was. And if you just want to to write about vaccine decision making and/or how media portrays it, let's hear it.
Thanks for this post. I was frustrated to hear myself depicted as a mom who does not vaccinate at all. My children actually ARE vaccinated in a similar way to your children. We chose to vaccinate selectively and we did not follow the CDC guidelines. I describe myself as pro-vaccine, which I am (though that, too, was cut out of the show). I think vaccines have a time and a place. However, I think the current CDC guidelines should not be followed. If they keep adding vaccines to the schedule, they need to start taking some off.
Ironically, I have lived and worked in West Africa and seen firsthand the ill effects of certain diseases, like polio. That experience has led me to be even more clear about my position that vaccines are appropriate for some people in some contexts and not for others. Right now in America we are facing public health problems of crisis proportions. But none of these problems (traffic accidents, asthma, autism, juvenile diabetes, ADHD) have anything to do with the so-called vaccine preventable diseases.
Oh, and the B-roll of gymnastics. My eldest daughter is the one doing the back-hand springs and I think they wanted to pit her against Evan Anderson (the vaccinated Ashlander) at the same venue (the YMCA). She’s a competitive gymnast–she just placed fifth in the state for floor in her age and level. Perhaps the idea there is the unspoken visual that she (the dangerous unvaccinated albeit healthy and beautiful one) may contaminate the rest of the kids (the safe vaccinated ones) at the YMCA…
Jennifer Margulis´s last blog ..Gold Beach is Rich with a Jet Boat Load of Natural Treasures
Twitter: Jakearyehmarcus
It was infuriating to me as well that you were portrayed as someone opposed to all vaccination. I too have traveled a great deal in developing countries where certain vaccines will and do save lives. I know how severe my reaction to tetanus is because I chose to have myself vaccinated prior to a trip to Nicaragua in 1985 where I would spend significant time far from any medical care or clean water. If my children were coming with me to a country with a significant rate of a vaccine preventable disease AND that child had an immune system that was not challenged in a way that increased the risk of the vaccine, I would vaccinate my child for that disease. It is an appropriate risk/benefit analysis.
I don’t know whether to laugh or cry now that I know what that B roll was. There was no way for viewers to know that was your daughter and I don’t even remember the child of the vaccinating Ashland mother being identified. Here I was searching for hidden meaning when the meaning was just omitting entirely. Sheesh!
Twitter: nicolebeth
I’m sorry I didn’t watch the piece. I read Dr. Jay Gordon’s tweets prior to the airing, and decided that I might be too infuriated (and I’m 35 weeks pregnant–I don’t need that right now). I feel similarly to what both of you’re saying: vaccines have a place, but there should not be a one-size-fits-all approach. I say that we “selectively vaccinate” though #1 was vaccinated fully (thought not the pre-K shots), and #2 reacts to any and all shots so that selective with regards to him is becoming more like not vaccinating at all. But, even with him, we would consider certain vaccinations if it made sense to do so. (Though the elimination of the separate M, M, R vaccines makes that less likely.)
I read Dr. Jay Gordon’s response the next day. Both my husband and I were shocked by what had happened to his interview, and how the show was couched. Having watched his DVD, and seen Dr. Bob Sears speak in person at the LLL Conference back in 2007, I would never classify either of them as anti-vaccine. The industry is clearly frightened by thoughtful questioning as it may lead to lower vaccination rates. But, silencing pro-vaccine doctors who have had the “nerve” to question the current schedule (and to allow questioning families in their practice) was inappropriate.
Hep. B at birth, varicella vaccine (ever), the marketing of flu shots (especially H1N1), and the marketing of Gardasil, among others, have made me cynical regarding vaccination. I have gone from someone who would seek out any vaccination recommended to someone who who wants my next child to get very few, if any at all.
Thank you very much for your post.
Twitter: Jakearyehmarcus
@Beth I agree totally that the idea Dr. Sears (the younger) is anti-vax is ridiculous. I spoke at that 2007 LLLI conference as well and it was just after his vaccine book came out. I haven’t looked at it in a while but my feeling at the time was that it was very conservative and didn’t challenge the CDC schedule enough.
I don’t know how long the Frontline piece will be on-line but it is now. You can probably wait until you give birth to watch it if you want to.
I don’t understand why people are so close-minded in their view of parents who SELECTIVELY vaccinate, or vaccinate on a different schedule (me! my kids get nearly every rec’d vax, but on a delayed schedule.). It’s a healthcare decision just like whether or not to give your kid abx for ear infections, or to use tylenol or teething tablets for teething. MOST parents DO vaccinate! I hope that doctors appreciate the fact that it’s better to decision make together so everyone ends up happy, rather than stigmatize parents who differ from the recommended schedule. I’ve been fortunate to have family docs who are comfortable with my “staggered” schedule and who trust me. I have worked hard to establish a positive relationship with them, which means regular WBV even when they seem pointless. I don’t personally agree with no vax, but I respect the right of other parents to make that choice.
What terrifies me about the vaccination thing is the complete and utter lack of critical thought. It is always portrayed as a dualistic “vaccinate or die a hideous death”, without any discussion whatsoever about alternatives. Clear logic is completely lacking, and fallacy and emotional manipulation runs rampant. And it’s deeply scary.
[...] This post was mentioned on Twitter by Jake Aryeh Marcus. Jake Aryeh Marcus said: New blog post: Frontline's War on Selectively Vaccinating Parents http://bit.ly/d7MQlJ [...]
Twitter: blacktating
This is one area where I am woefully uneducated and when my son was born he just got all of the vaccines at his well visits on the recommended schedule. I have seen other pediatric schedules and his was more conservative, although there were definitely times when it he got 3 shots at once. Thankfully he never had any reaction more than a fever for a couple hours. Whenever I have another baby, I am definitely going to have to research this topic more. Honestly last time it made my head spin and I was definitely intimidated by the topic. I am sure a lot of new moms feel that way and decide it’s better to err on the side of caution, even if that’s not necessarily the smartest decision.
Hi Jake–Great post. I didn’t watch the Frontline piece. My husband and I had a rare evening alone (grandparents are in town and they had the kids) and decided we had better things to do than hear the party line. It is disappointing to hear that they interviewed Drs. Sears and Gordon and didn’t even present their views. Why is that?? What is so…dangerous? about letting viewers know that professional disagreement with the CDC schedule?
Anyway–it’s neat to see your blog, I just found out about it. You may remember me from my Reluctant Lactivist days…
Twitter: Jakearyehmarcus
@Lauren and @Laureen, I agree there is a lack of critical thought in these discussions and, I think, particularly an insulting belief that parents aren’t allowed to exercise it on this issue. It is something we as parents have to take back.
@Elita, this issue took me a while as well. When I was pregnant I told my ob/gyn about a cousin who didn’t vax her son at all. The cousin believed that the human immune system must fight disease in order to develop properly (at least partially true). My ob/gyn said he believed she was committing child abuse and that someone should call CPS. While I thought my cousin was doing something wrong (at the time), I was surprised and a bit frightened by my ob/gyn calling it child abuse. While I have never discussed my decision to selectively vaccinate with my cousin, I suspect she thinks I am abusing my children by considering ever vaccinating them for anything. It is, ultimately, a personal decision and differing opinions are okay. The vaccine I decided to give one son, I decided against giving the next. Like so much in parenting, my knowledge grows and evolves. And each child is different.
@Chris! Of course I remember you! Where have you been?
I did not like the Frontline piece at all, but not necessarily for the same reasons as others here. I agree that the tone was horrible and it was one-sided. My favorite interviewee on the program (who I was disappointed not to find among the extended transcripts) was Barbara Loe Fisher of NVIC. She is absolutely right that we do not do a thorough job of researching and documenting vaccine injuries. I was disappointed that the program did not mention vaccine injuries (that I noticed), such as the high profile case just a couple of years ago where a girl with a mitochondrial condition was found to have been injured by vaccines. Fisher was also correct that medical professionals need to stop the high and mighty tone and realize that people will not do things just because they say so. Clearly, this is what is happening. That said, everything I know leads me to agree with the conclusions of the piece, which is that we’d all be better off if people followed the standard vaccine schedule. Personally, I share the worry presented in the Frontline piece that as people vaccinate less there will be harms to children who are too young or too sick to be vaccinated, as well as those for whom vaccines don’t confer full immunity (the herd thing). I notice that none of the contributors here mention this, but this was what I took to be the key point of the Frontline piece, however inartfully presented. That is, this debate is not just about a parent’s right to decide what to do for his/her own child, but the effect that those decisions may have on general public health. While there is documented evidence of harms from vaccines (and this should be clearly acknowledged and better researched), there is also documented evidence of harms from the diseases that vaccines prevent, and from what I’ve seen the latter is more of a potential threat to public health.
On pediatricians like Sears and Gordon, my opinion is that people who are nervous about vaccines are too quick to grasp onto the so-called legitimacy given by their medical credentials (while dismissing the same credentials held by people they don’t agree with). They have a vested financial interest as well, in marketing their materials to vaccine skeptics. I find Sears’ views some combination of condescending, manipulative and pandering. From what I can tell, he agrees with the CDC and is pro-vax, but wants to make some pretense of alternatives to get anti-vaxers to vaccinate their kids. He uses the same “some people think” kind of line that my nonreligious brother uses with his kids, to try and respect their mother’s beliefs by avoiding saying what he thinks. Sears should say what he thinks. At least one knows where Offit stands and he offers evidence in support of his statements. I read Sears’ response to Offit’s criticism of the vaccine book http://www.askdrsears.com/thevaccinebook/2008/12/response-to-dr-offits-misleading-and.asp and then the criticism http://pediatrics.aappublications.org/cgi/content/full/123/1/e164 and found Offit more convincing.
There are many people whose intelligence I respect who have decided not to vaccinate, or to do so selectively. While I admit limited time for research, I’ve had less luck on finding good anti-vax info than, say, anti-circumcision info or anti-formula info. I find the pandering kind of pediatricians like Sears who I see as encouraging skepticism while not providing good information (e.g., he acknowledges that some people are nervous about X without having the courage to draw a conclusion himself), a lot of misinformation and outright lies (claims that Dr. Diane Harper, lead researcher on HPV vaccines, has recommended against them), and some true but unbalanced views (just discussing the downsides of vaccines while ignoring the benefits, not acknowledging scientific debate about various ingredients, etc.). As an example of pro-vax, this Frontline piece is also unbalanced and not useful. I would not expect anyone to make a decision based on it. I share Barbara Loe Fisher’s concerns about injuries, but it seems to me that the public health benefits of vaccines are clear. I wish the pro-vax side would find a spokesman other than Offit because he has some obvious conflicts of interest, but I find his claims to be more factually based than Sears, who I see as pandering to make money in his own way. Among my anti-vax friends, I find that they are not as willing to question the motives of someone selling a book, idea or some kind of holistic supplement as they are to question large corporations. In my experience, individuals are just as likely to be wrong or opportunistic as companies.
Twitter: Jakearyehmarcus
I agree with much of what you write here, Jennifer. And I think we agree that there is a global level on which vaccines have been a good thing. But it is the nuance that I think we both are looking for.
Many people (likely the majority of parents) watching that Frontline episode will already know the more global point about vaccines and the positive possibilities for some of them. So what then was the point of repeating the known in this particular way? It is this biased presentation by Frontline that creates fear of those who question the CDC party line.
While I feel obligated to point out Offit’s financial conflict of interest (all the more interesting since the recent disclosures concerning the possible dangers of his Rotavirus vaccine), I agree that we should remember that Robert Sears makes money from his books as well. And I agree with you that his work seems to lack commitment. He is not my first choice as a spokesperson for selective vaccination. I think the decision to leave out any of the interview with Dr. Jay Gordon had great significance.
I am surprised, though, that you feel the available evidence points to following the CDC schedule given your sharing Barbara Fisher’s concerns about vaccine injuries. While I don’t believe vaccines are a black/white issue, I don’t think even Offit has compelling evidence that *all* children can receive *all* vaccines in those quantities without injury.
Frontline purports to be a news program. I think we agree that this program was simply propaganda.