Yes, doctors know what they’re talking about: Refuting a common anti-vaccine argument.

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“Hieronymus Bosch 053” by Hieronymus Bosch (circa 1450–1516) Licensed under Public domain via Wikimedia Commons – http://commons.wikimedia.org/wiki/File:Hieronymus_Bosch_053.jpg#mediaviewer/File:Hieronymus_Bosch_053.jpg

I usually don’t respond to many comments on my blog, preferring instead to encourage conversation between readers. I also don’t typically close comments on any of my pieces, so conversations and reactions continue for a long time. Sometimes that takes the discussion in an interesting direction. I think that a few recent comments on my “Dear parents…” piece are worth highlighting, as they provide an excellent window into an ongoing discussion of a very common anti-vaccine argument.

Anti-vaccine activists have a problem with medical expertise. They prefer to rely on their own intuition, but it’s hard to measure that gut feeling up against an actual medical degree (much less the experience and knowledge that comes with it). There’s a reason hospitals hire doctors out of medical schools rather than the University of Google.

Anti-vaxxers need to defuse the expertise of real medical practitioners. Simultaneously, they have to grapple with the issue of culpability: if vaccines are harmful, and physicians know about it, they must be acting with deliberate malice to prescribe them to children. But what is their motive? And why would any physician, knowing the dangers, vaccinate his or her own children?

One of the ways the anti-vaxxers maneuver around this problem is by claiming that physicians don’t actually know (or accept) the dangers of vaccines. It’s only those sinister vaccine manufactures and their “shills”, driven solely by profit motives who are fully aware of the dangers (this argument still doesn’t account for why they vaccinate themselves and their children, but anti-vaxxers tend to ignore this problem). According to this line of thinking:

“those people you mention didn’t study the effects on the neurological system, the effects on the kidneys, etc. They’ve only studied a small piece of the puzzle. A very small piece. Ask any primary care physician or family doctor how much time they’ve spent on learning all the ins and outs of vaccines and how they work. It’s a frighteningly small amount of time.”
–A Concerned Mom (extract from comment on November 16, 2014)

To someone who’s actually gone through medical school or graduate school (or knows someone who has), it’s obvious why this is wrong. But if you’re not familiar with the kind of rigorous, even punishing training that physicians receive, it’s harder to see the difference between a serious education and self-study. And for someone who’s emotionally invested in an issue and only has that self-study to justify their position, it’s tempting to put that knowledge on a pedestal and assume it’s as good as, or even better than, traditional schooling and experience. So Concerned Mom’s argument would make a lot of sense, especially to someone who needs to believe that the doctors who disagree with their position somehow don’t know what they’re talking about.

That’s why I was very appreciative of a comment in response to A Concerned Mom, which I highlighted on the Violent Metaphors Facebook page a few days later. (That’s where I post daily, diverse stories about science and science literacy issues. Check it out!).  At a reader’s suggestion, I want to highlight it again here, because I think it does an excellent job of responding to this argument, and the question of false equivalency of expertise in general:

” On 11/25/14, A Concerned Mom wrote:
“Ask any primary care physician or family doctor how much time they’ve spent on learning all the ins and outs of vaccines and how they work. It’s a frighteningly small amount of time.”

So I thought about that and added up time I spent learning immunology and infectious disease in the First Two Years of medical school. Without even counting the related fields of physiology, the respiratory system, gastroenterology, histology, neurology, etc, I came up with 920 hours of graduate education in immunolgy, microbiology, and infectious disease – and that’s before ever hitting the wards in 3rd and 4th years.

And of course that doesn’t even count the time spent in training by Family Practice, Pediatrics, or Internal Medicine residents.

If we presume that my (rather average) medical school was representative, then most doctors spend ~ 920 hours in graduate education in this field before ever being allowed to sit for the Step I Board Exam and, if we passed it, allowed onto wards and into clinics.

And all of that is miniscule compared to the amount of education involved for biomedical researchers in the field who are the ones figuring out these principles. We doctors need to know how to understand and apply those principles, since we don’t have to derive the background information ourselves. A PhD in the field would have easily spent 70-80 hrs/week in class, labs, and reading, at least 45 weeks per year, for about 4 years.

That’s 75x45x4= 13,500 hours of graduate education, not including Bachelor’s or Master’s Degrees. For a researcher with 10 years experience, that’s a minimum of 13,500 + (2080 hrs/yr x 10 yrs) = 34,300 hours of education, training, experience.

Is either of those what A Concerned Mom meant by
“a frightenly small amount of time?”

When you say, “They’ve only studied a small piece of the puzzle. A very small piece.” you should expect to be asked how much time was spent studying this topic by the people from whom you are getting your information.

So, I’m asking:
How much time was spent studying these topics by the people from whom you get your information?”–gewisn (from comment posted on 11/27/14, emphasis and paragraph breaks added)

When an antivaxxer tries to defuse this problem of expertise by physicians and medical researchers, I encourage you to show them this post, and ask them the same question.

Many thanks to gewisn, and the other physicians, scientists, parents, and everyone who has contributed so much to the conversations on this blog. You make a big difference.

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34 thoughts on “Yes, doctors know what they’re talking about: Refuting a common anti-vaccine argument.

  1. reissd November 30, 2014 / 3:45 pm

    I’d add that sitting and trying to figure out an article yourself isn’t the qualitative equivalent of getting training from someone with years of experience in the field and getting systematic training in methodology, either. I would expect the other subjects that don’t count as directly related even in this account – statistics, etc’ – also affects the depth of understanding of the person learning.

  2. Son of Sharecroppers November 30, 2014 / 9:23 pm

    Superb post. It is very important to speak clearly about the tremendous benefits of vaccination and the dangers posed by refusing to vaccinate children.

    • Nick D. June 26, 2017 / 4:22 am

      Do know the history of medicine look up the Flexnor report. allopathic reductionism will never cure any disease. David Rockefeller and the Carnegie to name manipulated the education of medicine to drug based not nutrition. Why for the patent and money Rockefellar and Flexnor are not Doctors. Nutrition naturopathic medicine was outlawed at that time as well. Plus there multiple parts of the immune system and most diseases are exposed externally so bypassing the immune system and injecting a virus into the blood stream is ridiculous. Allopathic medicine has its niche but it’s not in prevention. Our kids are the sickest even though their vaccinated and Cancer is the number one cause of death. Vaccines kill the immune system gut flora etc, and through viral shedding disease is spread. Wake up sheep they don’t want you cured they want you sick!

      • Chris June 26, 2017 / 2:29 pm

        “Allopathic medicine has its niche but it’s not in prevention.”

        Please provide a proven way to prevent measles with vaccination. Make sure include PubMed indexed studies by reputable qualified researchers that your method reduces the incidence of measles in an unvaccinated population, do not mention mortality (especially those misleading graphs).

        “Our kids are the sickest even though their vaccinated and Cancer is the number one cause of death. Vaccines kill the immune system gut flora etc, and through viral shedding disease is spread.”

        Citation needed. It needs to be a PubMed indexed study by reputable qualified researchers. Also, what is odd is that the average American lifespan is around eighty years… that means means deaths are of the elderly. Cancer is more often a disease of the elderly, so references to children in that sentence makes no sense.

      • Notnearlyanonymous June 28, 2017 / 1:25 am

        Nick, Let’s cut to the chase.
        If you had any solid evidence for the gish gallop you posted, you’d have already provided.
        You don’t.

        Night, night.

  3. iowadnaproject November 30, 2014 / 10:04 pm

    Very enlightening about the cumulative hours of study. Thanks.

  4. plasmarules December 1, 2014 / 8:45 am

    All of those doctors you’re alluding to who know what they’re talking about, they’re the ones that prescribed Vioxx right?

    • Sullivanthepoop December 1, 2014 / 9:43 am

      Why would it be odd to prescribe vioxx? It was an approved drug. It was not known that there was a small increased risk for heart problems until enough people took it. Then it was pulled. It worked the way it was supposed to. In clinical trials you cannot find very rare side effects because there couldn’t be enough people enrolled. See, this is how people without knowledge in a subject get confused.

      • Anonymous January 12, 2015 / 11:54 pm

        Bingo. It was approved and, gee … Who knew it would have those side effects? Black and white medical opinions don’t serve every patient. Informed decision making, reputable research from MEDICAL professionals and common sense based on experience go further in helping people make decisions about their health, their INDIVIDUAL health. Not the AMA and large pharma cookie cutter prescriptions and treatments.

        • jgc56 January 13, 2015 / 10:00 am

          “It was approved and, gee … Who knew it would have those side effects?”

          No one could have, as it isn’t impossible to conduct clinical trials on sufficiently enough scales to detect adverse events occurring only in small population sub-groups.

          In iVioxx’s clinical trials no significant difference in mortality was found between the cohort receiving Vioxx and the cohort receiving naproxen, and there was no significant difference in the rate of myocardial infarction in patients receiving Vioxx and naproxen attributable to drug treatment.

          That’s why post-marketing surveillance is mandated following FDA approval, and following approval of Vioxx when post marketing surveillance suggested excess cardiac events were occurring the data set had become large enough to find an increased risk associated only with a particular sub-group of patients—those who prior to treatment already met criteria for low-dose aspirin prophylaxis of secondary cardiovascular events (those who had had previous myocardial infarctions, angina, cerebrovascular accident, transient ischemic attack, or coronary artery bypass).

          Certainly there’s no evidence suggesting that the decision making on the part of the developers or the FDA was not informed, that the clinical research was less than reputable, nor that “common sense based on experience” would have detected the problem where extensive pre-clinical and Phase I,II and II clinical trials could not.

    • confusedbylogic December 4, 2014 / 10:13 pm

      ‘Yup. Same doctors.
      Same doctors who prescribed thalidomide for morning sickness in the late 50’s and early 60s’ (though not in the US – because “In July of 1962, president John F. Kennedy and the American press began praising their heroine, FDA inspector Frances Kelsey, who prevented the drug’s approval within the United States despite pressure from the pharmaceutical company and FDA supervisors” https://helix.northwestern.edu/article/thalidomide-tragedy-lessons-drug-safety-and-regulation

      Doctors certainly do not know everything.
      But they almost always know more than those educated only at the University of Google,
      and they generally know to trust when the vast majority of medical researchers in a field (those with 34,300+ hours of education, training, experience) tell them one thing is fact and another is fantasy.
      Dr Oz, Dr Mercola, Dr Amen are exceptions to that rule. You’d have to ask them why.

  5. jgc56 December 1, 2014 / 11:19 am

    Re: Vioxx, are you really trying to arguethat physicians should not have been prescribing the drug at a time it was known to be beneficial but had not been shown to increase risks of cardiac events?

    Might want to google “nirvana fallacy’, plasmarules…

  6. Tsu Dho Nimh December 1, 2014 / 1:42 pm

    And they never let you forget it … with every infectious disease case you see in the wards you have to run through the “why we know what we need to do” for that patient.

    It’s woven through your entire class and case load.

  7. AutismDad December 10, 2014 / 11:55 am

    Hilarious. Trying to counter what’s called anti-vaccine rhetoric with pro-vaccine rhetoric. Its just like a school yard fight and the maturity level isn’t much better. Why get bogged down in how vaccines benefit as an argument against real adverse reactions which VAERS and NVICP and package inserts describe? Oh of course, its the misinformation angle, that deflects discussion toward the positives while trying to distance oneself from the negatives. Gee who ever thought pharmaceutical minions would do that?

    • reissd December 10, 2014 / 1:19 pm

      This post is responding to a specific point: the claim that doctors don’t know about vaccines. It is not a “responding to all anti-vaccine claims” post – here is one of those: http://pediatrics.about.com/od/immunizations/tp/Anti-Vaccine-Myths-and-Misinformation.htm.

      Nobody should ignore adverse events. Luckily, the evidence is that they are very rare, but each one is no doubt a tragedy to that family. But we need to look at reliable sources to assess them. VAERS is not such a source: VAERS reports do not show causation. Package inserts are not such a source either: as the inserts themselves point out, they list everything reported to them, caused by vaccine or not.

      We have, on the other hand, extensive studies on vaccine safety, showing what adverse events are. They consistently also show they are very rare.

    • jgc56 December 10, 2014 / 11:09 pm

      “Why get bogged down in how vaccines benefit as an argument against real adverse reactions which VAERS and NVICP and package inserts describe?”
      What real adverse vaccine reactions, occurring with what frequency, are you referring to? Those that are common are both minor and transient (soreness at the site of injection, low-grade fever) while those that are serious (encephalopathy) are all but vanishingly rare.

      Addressing the question of relevant risk isn’t to get ‘bogged down’ but is instead the only meaningful measure of vaccine safety: do the risks associated with being vaccinated exceed the risks associated with remaining vulnerable to infection by the diseases they protect against?

      Consider encephalopathy again: the incidence of encephalopathy following MMR vaccination is 1 case in every 1 million individuals vaccinated. Measles, on the other hand, causes 1 case of encephalopathy in every 1000 infections–that’s 3 orders of magnitude more often.

      Clearly if you’re concerned about contracting encephalopathy you’ll want to be vaccinated against measles.

    • reissd February 2, 2015 / 9:00 am

      A. I notice you have not provided any source to your claim about CDC’s announcement that it was foreigners. It’s true that measles tends to be brought into the states either by unvaccinated Americans traveling abroad and bringing it back or by travelers from countries where it’s endemic; but again, it’s two possibilities, and more important, it’s not clear why you think travelers are illegal immigrants rather than tourists. In Disneyland, I’d expect it to be the latter. The evidence does not support the claim that it’s illegal immigrants that bring measles – and see: http://pediatrics.aappublications.org/content/early/2014/06/26/peds.2014-1079.abstract
      http://www.forbes.com/sites/tarahaelle/2015/01/20/five-things-to-know-about-the-disneyland-measles-outbreak/

      B. The Syrian tragedy is horrible. While such things can happen during a civil war, when there are less trained people to help avoid mistakes in administration, it’s horrible. But it isn’t actually a reflection on the vaccine: there was a mistake in administration, with the incorrect substance added. Shouldn’t happen, horrible, sad. http://www.harpocratesspeaks.com/2014/10/when-vaccine-injury-isnt-vaccine-injury.html

    • cleverlyconfused February 2, 2015 / 9:40 am

      Nobody ever doubted that the index case was either a citizen returning home or an international tourist.

      What made an individual case into an outbreak was the percentage of unvaccinated.

      As for Syria, why would anyone be surprised that tainted vaccine would be dangerous? So is tainted milk or tainted meat.

    • jgc56 February 2, 2015 / 10:55 am

      It’s certainly possible that the index case for the Disneyland outbreak may have been a foreign national, but that same foreign national certainly didn’t then travel to multiple other states thereafter to personally infect everyone else who has developed measles as a consequence of this outbreak. That’s a consequence of reduced vaccine uptake (by US citizens) compromising herd immunity.

  8. javalvr February 16, 2015 / 12:24 pm

    It is a fact that some of those who contracted the measles and carried it elsewhere in the US were already fully vaccinated. So did it really matter who was vaccinated and who was not? Do you have real proof that those who contracted the measles was because they were or were not vaccinated? Do you have proof that those fully vaccinated were less likely to spread the disease than those who were unvaccinated? Wow so you do have fully vaccinated people passing along the disease. Hmmmm Did any one die? Why not? I thank God that they did not because then we would have to support a full scale attack on fully vaccinated people for passing along a disease they were supposed to be immune to. Hmmmm. or were they all just unlucky enough to have been at the wrong place at the wrong time.
    ? What if the person who brought the disease to Disney land was fully vaccinated as well. :O? Do we know?

    • reissd February 16, 2015 / 12:31 pm

      A. Out of the Disney outbreak, for those whose vaccination status is known, 7 were fully vaccinated. 49 Completely unvaccinated (not everyone’s status is known). http://www.cdc.gov/mmwr/preview/mmwrhtml/mm64e0213a1.htm.

      This outbreak is small in comparison to pre-vaccine, but still it’s suggestive. We know from other studies that two doses of MMR protect 99% of recipients. 99% is a lot higher than the zero of not vaccinating – so yes, it does matter who is vaccinated and who is not.

      B. We had evidence of a vaccinated person causing an outbreak in 2011 – for the first time: http://news.sciencemag.org/health/2014/04/measles-outbreak-traced-fully-vaccinated-patient-first-time. Generally, it starts and spreads by the unvaccinated.

      C. I am very glad no-one died because I don’t want people to die, personally. But luckily, there have been no deaths yet (we won’t know about SSPE for some years, of course) – among other things since thanks to vaccination rates, numbers are low. But more than 20% of the patients were hospitalized. In Europe, where there were more cases, there have been deaths.

    • jgc56 February 16, 2015 / 1:51 pm

      “So did it really matter who was vaccinated and who was not?”
      Yes, it really does. Those who are unvaccinated are far more likely to become infected and serve as vectors of infection for others than are those that are vaccinated. Surely you wouldn’t similarly argue that because some of those who are involved in automobile accidents are not driving under the influence it doesn’t matter who is and is not driving drunk?

      “Do you have proof that those fully vaccinated were less likely to spread the disease than those who were unvaccinated?”
      Yes: those who are fully vaccinated are far less likely to contract a measles infection than those that are unvaccinated (of 100 fully vaccinated people who are exposed to measles approximately 10 will become infected and be capable of infecting others; of 100 unvaccinated people who are exposed to measles approximately 90 will become infected and be capable of infecting others) and so are far less likely to serve as vectors for disease than are those who are not vaccinated.

      If you’re trying instead to ask “Once infected, is there reason to beleive that someone who had been fully vaccinated is less likely to infect others?” then the answer would be no: the benefit of being vaccinated is less likelihood of being infected in teh first place.

      “Hmmmm Did any one die?”
      Not yet—did you have a point? Surely you’re not trying to argue that unless someone has died we shouldn’t be concerned with preventing an outbreak that to date has resulted in 1 in 4 people infect3d requiring hospitalization.

      “What if the person who brought the disease to Disney land was fully vaccinated as well”
      I’ll bite—what if they were? Surely you’re not arguing that if the index case was vaccinated we would not still benefit from routine measles vaccinations to break the chaing of infections and prevent a disease outbreak from occurring.

  9. April F. April 25, 2016 / 4:35 am

    Anyone care to explain why the FDA recommends no more than 5 mcg of aluminum per kg of body weight, (roughly 15 mcg for a 8 lb baby), yet most vaccines contain over 150. Most contain 250 mcg, and some of the 3-in-1’s contain as much as 800 mcg? So how on earth is a vaccine a One size fits all shot??? A newborn gets more than 150 mcg on just their first day! Why did my 3 lb grandson get the same dose as a 200 lb man? How is this safe????? They’re saying the aluminum in deodorants are giving people cancer, and the aluminum in antacids are killing people’s kidneys. They also say aluminum is contributing to early Alzheimers and dementia.

    • reissd April 25, 2016 / 8:28 am

      I am not sure what your source is for the claim about the FDA maximum aluminum intake, and that makes it hard to respond: is it about elemental aluminum (vaccines only have aluminum salts)? Are you sure that’s their limit?

      Because the FDA does not think the amounts of aluminum in vaccines are above the limit or dangerous. Here is the last public statement on this, following a study by some of their scientists: http://www.fda.gov/BiologicsBloodVaccines/ScienceResearch/ucm284520.htm

    • JGC56 April 25, 2016 / 10:26 am

      That would be because the your 5 mcg/kg limit for aluminum exposure applies to IV solutions and injectable medications–not to vaccines–because of the possibility that if given for extended periods of time to patients with impaired kidney function cumulative aluminum exposure may be harmful:

      “Aluminum may reach toxic levels with prolonged parenteral administration if kidney function is impaired. Research indicates that patients with impaired kidney function, including premature neonates, who received parenteral levels of aluminum at greater than 4 to 5 micrograms per kilogram of body weight per day, accumulate aluminum at levels associated with central nervous system and bone toxicity.”
      Department of Health and Human Services, Food and Drug Administration, Document NDA 19-626/S-019, Federal Food, Drug and Cosmetic Act for Dextrose Injections

      “Aluminum content in parenteral drug products could result in a toxic accumulation of aluminum in individuals receiving TPN therapy. Research indicates that neonates and patient populations with impaired kidney function may be at high risk of exposure to unsafe amounts of aluminum. Studies show that aluminum may accumulate in the bone, urine, and plasma of infants receiving TPN. Many drug products used in parenteral therapy may contain levels of aluminum sufficiently high to cause clinical manifestations . . . parenteral aluminum bypasses the protective mechanism of the GI tract and aluminum circulates and is deposited in human tissues. Aluminum toxicity is difficult to identify in infants because few reliable techniques are available to evaluate bone metabolism in infants. Although aluminum toxicity is not commonly detected clinically, it can be serious in selected patient populations, such as neonates and may be more common than is recognized”
      Department of Health and Human Services, Food and Drug Administration, Document 02N-0496, Aluminum in Large and Small Volume Parenterals Used in Total Parenteral Nutrition

      The FDA has not set a safe limit for aluminum in vaccines because a harmful cumulative exposure cannot result from vaccines given according to the current recommended childhood schedule, even in children with impaired kidney function.

  10. toffles3344 December 2, 2016 / 11:56 am

    Yes doctor you may be well trained. But you have been well trained by the pharmaceutical Industry with their bias’s and agendas. They have their tentacles in every aspect of your training.
    I am not denying that vaccines have done us a lot of good. But the industry is not the least bit interested in looking at the harm they a have done, or looking at the risk/benefit ratio.
    Check out the Vaccine Injury Compensation Program which is jus the tip of the iceberg.
    There are hundreds of studies showing serious problems from vaccines if you care to look, but anything not put out by big pharma is ignored. Until we admit there is a problem, we will never try to fix it.
    http://www.scientificamerican.com/article/demand-better-health-care-book/
    http://www.nogracias.eu/wp-content/uploads/2014/01/deben-las-revistas-dejar-de-publicar-articulos-de-la-industria-bmj.pdf Every doctor should be made to read this from the BMJ

    -http://psychrights.org/research/Digest/Science4Sale/MedJournalsCoIPlos2010.pdf
    http://www.macleans.ca/education/uniandcollege/future-doctors-demand-boundaries-with-big-pharma/ I can show a hundred more links like this, but you get the idea.

    • reissd December 2, 2016 / 12:09 pm

      I would certainly not want to have to rely on pharma alone for vaccine information, and I agree that pharmaceutical companies have a profit motive and need close supervision.

      But on vaccine science, we do not need to rely on pharmaceutical companies alone. There are tens of thousands of studies from all around the world, from governments, universities, and other research centers. They show that while vaccines do have risks, those risks are very small. This strong body of data, and the close monitoring of vaccines, is why governments all around the world confidently recommend vaccines.

      Certainly, vaccines are not perfect, and there are specific problems that need fixing. We need more effective pertussis and influenza vaccines, for example. But there is not a serious safety problem with modern vaccines generally.

  11. Shader, MS-III December 10, 2016 / 11:32 pm

    Well said. This is awesome. Thank you.

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