Friday, September 16, 2011

Vaccinations, the GOP, and Naturopathic Medicine

Michele Bachmann’s recent comments in a Republican debate regarding the HPV vaccine have drawn a lot of attention from both health professionals and the media. For those who haven’t been following the recent events, Rep. Bachmann criticized Governor Rick Perry of Texas for issuing an executive order requiring preadolescent girls to receive the HPV vaccine. Initially, I assumed that her qualm was with the fact that HPV is sexually transmitted, and that vaccinations against HPV (the causative factor of cervical cancer) would somehow remove deterrents against sexual activity for teenagers. However, it turns out that her complaint is that the vaccination can cause mental disorders, a claim she backed up by saying that an audience member at a previous debate had told her that her daughter had developed mental disturbances following the HPV vaccination. Taken in concert with some social conservatives’ denial of the theory of evolution, and the widespread denial of climate change, it’s sparked debate about the Republican party’s, ‘uneasy relationship with science’.

So why bring it up in my column? The question of vaccination has long been a hot button topic for naturopathic doctors, one that causes considerable debate between NDs and MDs, as well as within the naturopathic community. I’ve heard many NDs say that they are asked about their stance on vaccinations as a litmus test to determine whether or not they are ‘real’ doctors. Likewise, I’ve also been present for heated debates between naturopaths on the subject of vaccinations, with some arguing fervently in favor of them, and others aggressively opposed. I guess you could say that the naturopathic community has an, ‘uneasy relationship with vaccines’.

The benefits of vaccination to the general population cannot be denied. Diseases that were once commonplace and had potentially severe outcomes (smallpox or polio, anyone?) are now all but extinct in the US. As a public health effort, then, vaccination as a whole has been hugely successful. Nonetheless, vaccinations are not without risks, and a historically, certain proportion of the population does suffer negative effects from vaccinations. This is not a radical or outlandish statement, but a commonly accepted fact, and indeed the CDC has set up a Vaccine Adverse Event Reporting System to track adverse reactions to vaccines in an effort to make them safer. In fact, vaccines have undergone significant improvements over the past several decades in an effort to make them more effective and reduce negative side effects.

As a naturopathic physician, it is my firm belief that our profession should not continue to court a similar ‘uneasy relationship with science’. Already accused by our critics of being unscientific, I believe it’s important for the naturopathic profession to adopt the stance of helping to improve and expand science, rather than opposing it on points such as vaccination.

By the nature of our profession, naturopathic doctors see a self-selecting group of patients. One significant group of patients that seek out NDs are those who are somehow harmed by traditional medicine, be it vaccines, surgeries or pharmaceuticals. Given our extensive experience with these types of patients, and desiring to protect their patients against negative outcomes, some naturopathic doctors recommend against vaccination. However, I believe that solutions can be developed that take into consideration both the risks and benefits of vaccination, solutions that could draw on the extensive experience of naturopathic doctors who have treated those harmed by vaccination.

Throughout my education and experience, I’ve noted that the tools for predicting adverse reactions, even for established vaccines, are not very strong. Basic guidelines exist, which warn physicians not to administer immunizations in certain circumstances, but nonetheless, these guidelines miss a percentage of patients who then go on to experience adverse events. I think we can do better, and that we can develop algorithms that help to identify patients who are more likely to suffer negative outcomes, based on existing information on vaccines and patient outcomes.

Likewise, naturopathic docs have a great deal of experience in helping those harmed by vaccination to rehabilitate. There is currently little reliable information available for those seeking to recover from chronic or residual negative effects they may have sustained from vaccines. Even at naturopathic school, when vaccines are discussed, we argue back and forth about them, but talk little about how to aid patients who may have been harmed. In this case as well, I think we can do better.

On the whole, vaccination programs worldwide have been remarkably successful, but are not perfect yet – a compromise between the needs of the population and the needs of the individuals hasn’t been finalized yet, but hopefully further research and a better understanding of vaccine reactions can help solve that.