Should I Get the Shot? The H1N1 Vaccine Dilemma
By Kate Johnson – November 1, 2009
As a medical journalist in Montreal I’ve been fielding calls from friends and family in other parts of the country, asking my advice on whether they should get the H1N1 vaccine. While I am still waiting here, the decision is upon them.
I am not a doctor, I remind them. We’ve already heard our doctor’s advice, they say.
And yet they are still unsure. Why?
It has to do with trust.
Writing in the Vancouver Sun, Peter McKnight argues that the public’s 50/50 reaction to the vaccine dilemma is not about a shortage of facts, it’s that “they don’t believe the people who are providing them with the facts: scientists and public health officials.”
“We live in an era of distrust of authority, including scientific authority,” he continues.
So, why the distrust in medical authority?
Because a few high profile examples can do monumental damage.
I’ve written recently about the pharmaceutical industry’s skills when it comes to marketing.
BigPharma spends more on marketing than on science. The industry is an example of awesome marketing wizardry. The ethics of this are debatable, and too complex to deal with here. I’ve suggested that, as long as we’re aware, and accept that the industry is biased, we can still make informed choices.
But recent evidence suggests that doctors are not always aware of, or on guard against the influence of the pharmaceutical industry.
For example, they prescribed Paxil, and now there are some 600 lawsuits filed against the manufacturer GlaxoSmithKline claiming that the antidepressant causes birth defects. The first case resulted in a $2.5 million judgment against the company.
I’m not saying these doctors deliberately misled their patients. But perhaps they were misled by the marketers.
Another example is the HPV vaccine – targeting human papilloma virus, which can cause cervical cancer. Writing in the Journal of the American Medical Association , Dr. Charlotte Haug points out: “If the potential benefits are substantial, most individuals would be willing to accept the risks.”
She hints that perhaps the risks of the HPV vaccine may actually outweigh the benefits. Yet, the HPV vaccine is now widely recommended for teen girls and young women, after a massive marketing campaign earned GlaxoSmithKline the “brand of the year” for creating “a market out of thin air.”
The H1N1 pandemic is a pharmaceutical marketer’s jackpot. Think of it. Worldwide demand. Universal recommendations for vaccination. Fast-track approval with few questions asked. And a general public that has accepted uncertainty, because it is there – regardless of whether they get the shot or not.
Doctors are recommending the vaccine because other doctors are recommending it. Medical authorities like Health Canada are recommending it because the U.S. Centers for Disease Control and the World Health Organization are recommending it. But when asked personally if they will be getting vaccinated – many doctors say no. Surveys estimate this number could be anywhere from 30% to 60%.
In the end, the decision about the H1N1 vaccine comes down to weighing the risks and benefits, when we are not fully informed about either.
When it comes to scientific information, or gaps in it, society can handle that. “Medical knowledge is typically incomplete and ambiguous,” writes Dr. Haug.
But it’s when strong, unambiguous recommendations for the H1N1 vaccine fail to acknowledge such information gaps that the public’s trust can falter. That is when medicine starts to sound like marketing.
In this context, the “soft sell” tends to sound more convincing. “It’s entirely reasonable to be immunized,” write Dr. Richard Schabas and Dr. Neil Rau in the Globe and Mail. “It’s also reasonable to take a pass. The anticipated benefits from immunization are very small, and the risks are tiny.”
Given the scientific evidence that is currently available, I think I’m likely to get the H1N1 vaccine. But I do wonder about the subliminal influence of marketing.
“When weighing evidence about risks and benefits, it is also appropriate to ask who takes the risk, and who gets the benefit,” Dr. Haug continues. “Patients and the public logically expect that only medical and scientific evidence is put on the balance. If other matters weigh in, such as profit for a company or financial or professional gains for physicians or groups of physicians, the balance is easily skewed.”
There is no evidence of marketing the H1N1 vaccine, though that doesn’t mean it isn’t there. The bottom line is, we don’t know. Under other circumstances, most people would wait until they felt sufficiently informed before making their decision. But time is not on our side. For one thing, H1N1 is already here. For another thing, when the vaccine is offered in your area, it might be your only chance to get it.
My sister, who lives in Ontario, will get the vaccine this week, unsure, but pressured. Like me, she has asthma, and is considered high risk for H1N1 complications like pneumonia. As a Montreal resident, it looks like I still have several weeks to wait. As I field questions from loved ones who are already joining the line-up I find my growing confidence is based on trust. Trust that the medical authorities are aware of marketing pressures and that they are making informed, independent recommendations.