Measles, Disneyland, and a Renegade Pediatrician in the New York Times
I've been closely following, as I'm sure most of you have, the scores of recent measles cases originating from exposures at Disneyland. I wrote about this the other day (and included some information about a lesser-known measles outbreak in a small South Dakota town). Since then, reported cases of measles have climbed. As of the writing of this post, 88 measles cases have been reported and linked directly or indirectly to the initial exposures at Disneyland.
It's too soon to know the vaccination history of every person who has developed measles, but usually what we see in measles outbreaks is that the great majority of cases are completely unvaccinated. A smaller number will have had one vaccine (not the recommended two), and an even smaller number will have been fully vaccinated. This is no surprise: the measles vaccine is highly effective at preventing disease, but 2-5% of individuals vaccinated once do not respond to the vaccine. So, some vaccinated individuals will remain unprotected.
Consequently, vaccine non-receipt is generally the biggest problem in these outbreaks. I was reminded of this most unpleasantly over my morning coffee last week when I read an article on the Disneyland measles situation in the New York Times. After quoting anti-vaccine provocateur Barbara Loe Fisher, the reporters quote another thorn in the side of immunization advocates:
A handful of doctors seem sympathetic to [Fisher's] views. Dr. Jay Gordon, a Santa Monica pediatrician who has cautioned against the way vaccines are used, said he had “given more measles vaccines” than ever before but did not like giving the shot to younger children.
“I think whatever risk there is — and I can’t prove a risk — is, I think, caused by the timing,” he said, referring to when the shot is administered. “It’s given at a time when kids are more susceptible to environmental impact. Don’t get me wrong; I have no proof that this vaccine causes harm. I just have anecdotal reports from parents who are convinced that their children were harmed by the vaccine.”
These are definitely not mainstream medical or public health opinions. And at first I was shocked that the reporters quoted Gordon, thus offering him a platform for his renegade views. Then I began to reconsider. On the one hand, quoting Gordon perpetuates the idea that there really is a debate about MMR safety. On the other hand, it is useful to know why people are not vaccinating, and the quotations from Dr. Gordon make that clear that certain pediatricians are complicit in those decisions.
I decided to poll some of my physician colleagues on their opinions, both about whether the New York Times was justified in providing Gordon a space to promote his ideas, and about Gordon's statements in general. Here's what they thought:
Bennett Lorber, MD, is a Temple infectious diseases physician and past president of The College of Physicians of Philadelphia. Dr. Lorber said, “Doctors like Jay Gordon who, as reported in the New York Times, are ‘sympathetic’ to the views of anti-vaccine advocacy groups, should be ashamed. They are ill-informed and perpetuate myths that are potentially harmful to their patients and the public.”
Joseph Camardo, MD, is on the industry advisory board to History of Vaccines and is Senior Vice President for Celgene Corporation. He said, "This is not a time to be debating the need for vaccination. Measles can be fatal and we have the tools to prevent its spread. MMR has been used in practice for many years; there is a tremendous amount of information about it, and the facts have been analyzed and scrutinized repeatedly by scientific experts, regulatory authorities, and the manufacturers. The benefit is proven and we have a huge amount of knowledge about the risks. We need to be very careful to assure that decisions are not based on misinformation or, in one case, fraud. Physicians and other health professionals have to be informed advocates for public health measures and at the top of the list are childhood vaccines."
Pediatrician Andreas Bollmann, MD, PhD, took on the issue of why the New York Times quoted Gordon. It did not strike him as a dutiful nod to “journalistic balance.” He said, “The quotation from Dr. Gordon is so inarticulate and comical that it ends up looking like a farce. It’s certainly not a stringent argument against MMR vaccine.” He suspects that the reporter included Gordon’s opinion to expose the weakness of arguments against vaccination.
I admire Dr. Bollmann's optimism both about the reporter's intention and about the layperson's ability to understand that Dr. Gordon's opinions are highly suspect.
Image from Schamberg JF. Diseases of the Skin and Eruptive Fevers. Philadelphia: WB Saunders; 1921. JA 137c. The Historical Medical Library of The College of Physicians of Philadelphia.