Kathy Morningside is a 32-year-old woman who presents with her daughter, Amelia, for her 2-month checkup visit. Amelia is Kathy’s first and only child. Though Kathy is a bit “older” in terms of maternal age for first children, her pregnancy was uncomplicated and Amelia was born by spontaneous vaginal birth at full term with no problems. She has been a happy and active baby since then, and is meeting or exceeding all appropriate developmental milestones. Kathy lives with her husband Connor, and the family could not be happier with their new baby. Kathy works as an accountant and financial planner with the Louisville city government and has been heavily involved in a number of high-level city development projects.
As part of today’s visit, they complete an online pre-visit 2-month baby checkup questionnaire, in which Kathy indicates no problems or concerns. There are no specific medical issues to address today, and Dr. Caine the pediatrician anticipates discussing some routine well-baby issues, giving the 2-month vaccines, and finishing the visit. Dr. Caine did not provide prenatal care for Kathy, but met her very briefly when she was about 35 weeks pregnant when Kathy signed up with Dr. Caine as their pediatrician. They get along well and have a good working relationship.
As Dr. Caine begins discussing the vaccines, Kathy says (as she is holding and rocking Amelia), “Doctor, I know there’s a lot of information out there about vaccines. I’ve read about autism and the other safety issues, and to be honest I think that some of the people on both sides are a little too biased. Frankly, my sister is one of them; my nephew has autism, and Krista swears it’s from his MMR vaccine. She showed me some old study from 20 years ago that I think was withdrawn by the journal, so I don’t know what to make of that.
“I want to do what’s right for Amelia, and I know that the vaccines are important. I just have some concerns about their safety, and it’s really hard to know what to believe any more. I trust you and I know you’ll give me good information, and I’ll go along with what you recommend. I just want to know what’s really medically true. I have no idea what goes on with the development and creation of these vaccines, or what’s going on with medical research, and I just want to make sure that Amelia is going to be safe.”
It has been over 20-years since the original “study” purporting an association between the MMR vaccine and development of autism was first published in the Lancet journal. Since then there have been hundreds of publications, including clinical studies as well as a vast number of editorials and opinion pieces, related to this topic. The social and medical ramifications of differing beliefs about the risks of vaccinations continue to this day, and physicians still have to regularly address patient beliefs and concerns about vaccines. One aspect of this discussion is the significantly greater number of childhood vaccines that are required for children born in the 2010s than for children born in the 1990s. Some physicians have to make decisions about whether to continue seeing patients and families who refuse vaccines.
The goal of this session is to reinforce concepts of clinical study design and evidence-based medicine by delving deeply into the actual studies regarding vaccine safety in general, and the MMR vaccine and autism in particular, and to let students make rational decisions about this topic based on science alone, setting aside issuses of belief, bias, and preconceived ideas.
There is one recommended article for this PBL: