Unvaxed and Confused

This article originally appeared in U.S. News & World Report on Feb. 11, 2015.

By Shannon Galvin and Juliet Sorensen

Confusion about health facts and the depths of health illiteracy in this country are playing out in discussions from the kitchen to the doctor’s office to the halls of Congress. For instance, President Barack Obama recently opined that there is "every reason" for parents to get their children vaccinated. Later, Kentucky Republican Sen. Rand Paul claimed he knew of “walking, talking normal children who wound up with profound mental disorders after vaccines” and that the choice not to vaccinate was “an issue of freedom.”

New Jersey Republican Gov. Chris Christie (who last fall asserted state power over the public health in quarantining a nurse returning from the Ebola front lines), argued that parents should have “some choice” in vaccinations. His spokesman later clarified that there was “no question” kids should be vaccinated.

This confusion manifests every day in hospitals, doctors offices and homes around the country. At the end of a recent clinic visit after cardiac surgery, one of us offered a patient the influenza vaccine. “Doctor, you know I don’t believe in vaccines," she replied.

Her tone was one of reproach; her use of the verb “believe” was also striking.

Understanding the basic determinants of health is a fundamental component of individual and community well-being. In an era of information saturation, health professionals need to assist people in using that information to make wise health choices. But that is not an easy task.

Faced with an unfamiliar topic, human beings resort to cognitive short cuts, preferring what “feels right” or “makes sense.” Unfortunately, gut instinct can be wrong if it is based on incomplete experience. It takes effort to analyze available evidence, and we don’t often need or want to expend the energy.

A second problem is assessing the trustworthiness of the information source. An Internet search gathers true and false pronouncements indiscriminately. Trust in government pronouncements on health has decreased significantly since the Ebola outbreak. Statements from medical associations may be discredited after a dismal – and all too common – experience of health care delivery.

Constitutional law permits states to impose both quarantines and vaccine exemptions, if there is a reasonable basis for doing so. Reasonable measures can include quarantine and requirements that children attending school be fully vaccinated.

But constitutionality notwithstanding, politicians are well aware that laws mandating health-related behavior are unpopular. Thus, while some states mandate vaccinations subject only to a narrow religious exemption, (such as New York), 20 states allow children not to be vaccinated based broadly on the family’s “personal beliefs.” The community’s right to be free from a preventable infectious disease is then subsumed in favor of an individual’s personal choice.

To add to the confusion, public health and medical facts constantly evolve and are sometimes contradictory. This is due to the wonderful complexity of the human body and the incredible diversity of individuals.

We like our public officials to be unequivocal. However, like most things in life, every treatment or refusal of a treatment has a risk and benefit. It is essential to understand those risks and benefits in order to make a fully informed decision.

The average American wishing to make an informed choice about health care will seek that information from national leadership, not state or local regulations. Thus, we urge the creation of a definitive official online resource, in partnership with respected private health institutions around the country, which answers America’s most frequently asked questions related to public health and science.

This resource should partner with other trusted sources of information, including the Centers for Disease Control and Prevention, as well as reputable media and religious organizations. The content of this resource will include an explanation of how scientific knowledge develops, repeatedly tested from hypothesis to theory to fact. It will provide the evidence for each statement of fact, and highlight areas of certainty and uncertainty.

This online resource will not impinge on the authority of the states or the individual choices of health care consumers, but rather will exist simply to serve the public interest, rising above other information sources. To be sure, it will add one more voice to the information overload – but an authoritative voice speaking truth based on science.

- Shannon Galvin is an assistant professor of medicine at Northwestern University. Juliet Sorensen is a professor of law at Northwestern University.