Making an Informed Decision

How do you make an Informed Decision?

To make a truly informed decision you need to consider information from both sides of the vaccine debate – pro-vaccine and pro-choice.

You need to consider information from all sides, keep doing you own research and keep asking questions until you are happy with the answers.

To help you access information, see our vaccines resources page. There are pro-vaccine links and pro-choice links on this page.

Own your decision. Make sure it is your decision not someone else’s. Be sure that you are happy with what you decide. Remember, once you vaccinate there is no going back.

Not all information is equal. Consider who is providing the information. In particular consider who is making money out of the information that is provided. If you get as far as reading medical papers – and we encourage you to go back to source material – check to see if there are any conflicts of interest for the authors of a study:

Are they paid by companies that manufacture vaccines?

Do they have associations with pharmaceutical companies?

Was their research funded by pharmaceutical companies?

Conflict of Interest

The burgeoning problem of conflict of interest was discussed in a paper in a 2002 issue of the Journal of the American Medical Association:

“The vast majority of doctors involved in establishing national guidelines on disease treatment have financial ties to the pharmaceutical industry that could potentially sway their recommendations and inappropriately influence thousands of other physicians… 38% of respondents said they had served as employees or consultants for pharmaceutical companies and 58% had received financial support for medical research. In addition, 59% had links with drug companies whose medications were considered in the particular guidelines they authored… 19% said they thought their co-authors’ recommendations were swayed by their relationships and 7% said they thought their own relationships influenced recommendations.”1

On the same topic a Lancet editorial asks just how tainted by commercial conflicts has medicine become? The author concluded that the answer was heavily tainted, and damagingly so.2

A paper published in the British Medical Journal in 2003 found that:

“Research sponsored by the drug industry was more likely to produce results favouring the product made by the company sponsoring the research than studies funded by other sources. The results apply across a wide range of disease states, drugs, and drug classes, over at least two decades and regardless of the type of research being assessed.”3

In another paper, published in the journal Psychological Medicine in 2006, Researchers found that in studies on psychiatric drugs favorable outcomes were significantly more common in studies sponsored by the drug manufacturer (78%) than in studies without industry sponsorship (48%) or sponsored by a competitor (28%).

Another study into bias in reported research on psychiatry drugs in 2007 “confirmed previous findings that industry-funded studies are less likely to report negative findings.” The authors went on to say that their “novel finding is that this effect appears to be largely or exclusively due to the presence of a company employee among the authorship.”4

These are just three of many, many papers on conflict of interest within the pharmaceutical industry and the reporting of drug trial results. Such conflict of interest is so widespread and has become such a significant problem that is has begun to be addressed by the major peer-reviewed medical journals. Many medical journals have initiated stricter ethics codes for publishing research funded by pharmaceutical or medical device-makers, including many journals that have instituted zero-tolerance policies for study authors with financial ties to drug companies.

However, this doesn’t avoid the problem of many studies that produce negative results never being published at all. Added to this is the use of spin to convince readers of a more favorable result.

In a 2009 report, Dr Isabelle Boutron said that more than 40% of studies with negative findings were “spun” and even in trials with favorable outcomes, 49% of phrases considered to be positive “spin” weren’t accompanied by any mention of a statistically significant result.

The researchers defined spin as an attempt to “convince the reader that the treatment is important” even though the trial had nonsignificant findings.5

Another problem can be the mismatch between what is reported in the media from a study, or even between an abstract and the rest of the paper. If possible don’t just rely on reading an abstract as they can mislead and conclusions drawn may not match the actual results of research.

For example, in a 1998 study of the efficacy of the hepatitis B vaccine in Gambia, the researchers found that, 14 years after administration of the vaccine 37.4% of participants in the study in had been infected, and of the uninfected, 36% had undetectable levels of antibodies.6 In total, 61% of the adolescents and young adults had no immunity to hepatitis B only 14 years following vaccination. Incomprehensibly, the authors concluded in the paper and the abstract of the paper that vaccine efficacy was remarkably well maintained. Only by reading the full paper was it clear that the vaccine had a very low efficacy. No refusal to publish here, just conclusions that are diametrically opposed to the facts.

What About Your Medical Professional?

If you think that your own doctor is too low on the ‘food chain’ and is immune to the lure of money, think again.

Even if your doctor is not a ‘recruiter’ for drug trials and being paid by the pharmaceutical companies, he or she is still subjected to a considerable amount of pressure from pharmaceutical companies to prescribe their drugs and many are offered financial incentives by their own Departments of Health. In Australia and the UK, GPs get cash bonuses for having a certain percentage of the children in their practices vaccinated. In Australia doctors get paid $12 per patient per year if 80% or more of their child patients are vaccinated; this increases to $14 per patient per year if more than 90% of the child patients are vaccinated (W. Lydall, Pers. comm., 2002).

In the UK GPs get £2000 if 90% of the children in their practice are vaccinated and this decreases to £700 for between 70% and 90%; below 70% the doctors get nothing.7 There have been a number of reports that doctors are striking families with unvaccinated children off their practice registers to ensure that they achieve 90% vaccination rates among the children in their practices.7, 8 Mothers of unvaccinated children have been told to “go to someone else because otherwise the doctor would miss out on his bonus.”8 Concern from both patients and some health professionals over the coersive efforts to get parents to vaccinate their children, and suspension of patients from practice lists in the UK, has led to mounting pressure to have the bonus payments scrapped.9 Financial incentives are also provided to doctors in the Netherlands, France, Japan and Germany.10

While New Zealand doesn’t currently operate such a scheme, offering financial incentives to primary care providers (doctors) for improving vaccination coverage is among the recommendations of the National Health Committee.

Pro-choice Information

Pro-choice information is rarely subject to the same sorts of conflict of interest that pro-vaccine information is. Pro-choicers, by and large, are not driven by money but philosophy or conviction. They do not have ties to the pharmaceutical industry and are not trying to sell a product.

Having said that not all pro-choice material is equal. There are websites and books which contain errors. For example, because the mercury compound thimerosal (used as a preservative in or during the manufacture of some vaccines) and the MMR (measles-mumps-rubella) vaccine have both been associated with autism, some people have written that MMR contains thimerosal. This is not the case and to the best of our knowledge it never has been.

Try to get as close to the original source material (original medical papers). This is why in the IAS book Investigate Before You Vaccinate, there are 632 references, the vast majority of which are original medical papers. Check for references in all claims made. If claims are substantiated with reference to the medical literature, at least you can check it out for yourself. It is much harder to ascertain the truth of a claim if it is not backed up with a reference or some other sort of proof that the writer knows what they are talking about. This is an equally valid an observation for pro-vaccine claims. Just because someone has letters after their name or is entitled to call themselves “doctor” it doesn’t mean they are telling the truth.

You will find that many statements made in the articles on the IAS website are backed up by references to the medical literature.

Making a Decision about Vaccination

Only you will know what is right for your family. Use all the resources you have available, read books and websites, and check arguments from as many angles as you can. Arm yourself with as much information you can and clearly understand why you are making a particular decision. To help you find information you may not have yet come across or may have found difficult to access, we have provided a links page to get you started. This list of online resources is not exhaustive, but we will add to them as we come across more information. Visit the links page regularly to stay up-to-date.

References:

1. Choudhry, N.K., Stelfox, H.T., Detsky, A.S., 2002: Relationships Between Authors of Clinical Practice Guidelines and the Pharmaceutical Industry, JAMA, 287: 612-617.

2. No Author Listed, 2002: Just how tainted has medicine become? Editorial The Lancet, 359, 9313.

3. Lexchin, J., Bero, L., Djulbegovic, B. and Clark, O., 2003: Pharmaceutical industry sponsorship and research outcome and quality: systematic review British Medical Journal, 326:1167-1170

4. Tungaraza, T, and Poole, R., 2007: Influence of drug company authorship and sponsorship on drug trial outcomes, The British Journal of Psychiatry (2007) 191: 82-83.

5. Boutron I, et al, 2009: Spin’ in reports of randomized controlled trials with nonstatistically significant primary outcomes, International Congress on Peer Review and Biomedical Publication.

6. Whittle, H., Jaffar, S., Wansbrough, M. Mendy, M., Dumpis, U., Collinson, A., Hall, A., 2002: Observational study of vaccine efficacy 14 years after trial of hepatitis B vaccination in Gambian children, BMJ, 325: 569.

7. 1999: Greedy GPs vaccine ploy, The Express,  September 13, 1999.

8. 1999: GPs ban frightened parents who refuse triple baby jabs, The Guardian, August 29, 1999.

9. 2002: Scrap GP vaccine payments, BBC News, 26 February 2002.

10. National Health Committee, 1999: Review of the wisdom and fairness of the Health Funding Authority strategy for immunisation of ‘hard to reach’ children, National Advisory Committee on Health and Disability, Wellington.