As a second-year pediatric resident, I went to India to work in a hospital in Mumbai. There, among the rows of sick, poor children, were ones dying from vaccine-preventable diseases. Among them, most starkly, was a 9-year-old boy in the most severe stage of tetanus -- every muscle in his body was locked in spasm, the sides of his face pointed upward in a grimaced smile -- "risus sardonicus," as it's known in pediatric textbooks.
His mother's eyes were filled with terror and hopelessness as she sat next to her son, day after day, feeding him drops of fluid with an old spoon to keep him from starving to death. She was poor, uneducated and without access to the preventive care so many of us take for granted here. The boy spent several weeks in the hospital before, by some miracle, he started getting better.
It wasn't my first lesson about the importance of vaccines. That had happened a year earlier, when I was an intern at Cedars-Sinai Medical Center, half a world away. One night, we admitted a 9-month-old girl who was having trouble breathing. She arrived with her parents -- Mom in tears and Dad tense with worry. Her parents were movie stars from a Hollywood borough who, unlike that mother from a Bollywood slum, needed nothing. In a way, they had chosen "nothing" for their daughter from the time she was born -- refusing all vaccines for her.
My resident called the pediatric intensive care unit as I stuck a needle deep into the child's wrist, drawing blood from her radial artery to find out just how severe her respiratory failure was.
Her condition, as it turned out, wasn't grave enough to require us to hook her up to a ventilator. Other tests showed that she had an RSV infection, a common, but serious, cause of wheezing in babies.
But she didn't follow the usual course of recovery for children. We began to worry about other serious infections. We called for an infectious disease consultation and ordered another round of tests: We stuck more needles into her tiny veins, and her doctor performed a spinal tap to make sure she didn't have bacterial meningitis.
Late that week, as she was on the mend, we found out that in addition to being infected with RSV, this little girl had whooping cough -- a vaccine-preventable disease.
In truth, it's hard to know which was the biggest culprit, the RSV or the pertussis. My feeling is that if she had only RSV, then she would have gotten better faster than she did, which is what led us to evaluate her further.
But that combination -- being very sick and unvaccinated -- had led this child to the edge of respiratory failure, confined her to the hospital for a week, subjected her to many invasive tests and left her parents sleepless and scared. To top it all off, every person who had been in contact with her in the hospital was forced to take preventive antibiotics so we wouldn't get sick and spread whooping cough.
In the decade since that episode, vaccine refusal has become a trend in many places, including Southern California. As a recent Times article shows, that trend is particularly marked in affluent areas.
By now, most people know that many parents are refusing to vaccinate their children because they're scared that vaccines cause autism. They've heard the public rants of people who form a small but vocal and well-financed minority in the autism community and been frightened by them. Actress Jenny McCarthy, for example, who has had her share of appearances on "Larry King Live" and "The Oprah Winfrey Show," has screamed (literally) that she would rather children get measles than autism. At best, that's a false choice; at worst, it's a sick, horrible wish for her or anybody else's child.
You may be a parent reading this, unsure of what to believe when it comes to vaccines. I've had parents break down crying because they simply didn't know what to do.
And you know what? You have every right to be confused.
That's because doctors like me haven't been very good at communicating with you. For a long time, many of us blew off questions and concerns about vaccines. By the time we did start listening, sometime around the middle of this decade, we were way behind the curve. "Investigative reports," such as those produced by author David Kirby and environmental attorney Robert F. Kennedy Jr., condemned vaccines and the doctors who recommended them. .
We doctors, in contrast, were unsure of ourselves, even as a growing body of studies proved, time and time again, that vaccines (and things in them) were not causing autism. We clumsily scared the public by abruptly taking thimerosol out of vaccines in 2001, even though there was no science to support such a move. When McCarthy first showed up on "Oprah" and "Larry King" in 2007, we responded with coldly worded, bureaucratic statements.
But slowly, and surely, we doctors have started to find our voice. In 2008, Larry King had McCarthy on his show again, but this time she sat next to American Academy of Pediatrics President David Tayloe and UCLA pediatrician Harvey Karp, both of whom calmly rebutted her anger and expletives. We've launched campaigns to give parents some straight talk about vaccines, such as Why I Choose and Every Child by 2. We've written books -- "Autism's False Prophets" and "Do Vaccines Cause That?!" -- that have exposed some ugly truths about the anti-vaccine community.
Most important, we now have more than 30 studies vouching for the safety of vaccines, with more on the way.
Despite all of this, though, you may still be confused and worried. That's because vaccine opponents keep shifting their hypothesis as to what actually causes autism.
In the early part of the decade, it was the MMR vaccine itself. But multiple studies demonstrated its safety. Then anti-vaccine folks moved to thimerosol, a preservative in vaccines. This too was discounted in many studies, including one early last year that showed that even though thimerosol is out of vaccines, autism rates continue to rise. Now the opponents are stuck somewhere between blaming other components of vaccines or the number of shots in the schedule. After we spend millions of your healthcare dollars to disprove these hypotheses, they'll move the target to something else.
And as they run out of ingredients to blame, they've turned their ire against pediatricians, painting them as some monolithic group of people who march to the beat of drug companies, both parties bent on making profits from vaccines at the expense of children.
That notion reeks of absurdity. First, pediatricians live in, and care for children in, communities all over the country. Our profession, in fact, rose with the advent of public health in the early 20th century. At that time, countless children lived in disease-infested tenements. Mass vaccination became a bedrock of our strategy to save their lives and give them a chance to grow up, and it worked beyond our wildest hopes. Second, for many doctors, the mere cost of buying vaccines is outstripping profits from administering them.
Over the years, we doctors haven't given you a lot of reasons to trust us. But if there's one subject we are right on, it's vaccines -- they're safe and effective. Like all things in medicine, they have side effects. But autism isn't one of them.
So please, talk with your pediatrician. Yes, we are stressed out and hurried in modern medical practice. But I can bet you that any of us would rather slow down to help you make the right decision than slow down because you bring your child into our office dying from bacterial meningitis, something that happened earlier this year in Minnesota.
It's a hot, flat and crowded world, one in which vaccine-preventable diseases can spread by a weekend drive down the 405 or, as in the case of the recent San Diego measles outbreak, by a trip to Europe.
For those who do choose to vaccinate, thank you for choosing health. Not just for your child and your family, but also for your community as well.
Parikh, a Walnut Creek, Calif., physician, writes the Vital Signs medical column for Salon.com. He has no financial relationships to drug or vaccine manufacturers. www.rahulkparikh.com