SECOND OPINION | VACCINES | BCBS | Full Episode

SECOND OPINION | VACCINES | BCBS | Full Episode


♪♪ ANNOUNCER 1: Behind every
heartbeat is a story we can learn from. ♪♪ As we have for over 80 years,
Blue Cross and Blue Shield companies are using the
knowledge we gained from our members to better the health
of not just those we insure, but all Americans. Some call it responsibility,
we call it a privilege. Second Opinion is funded
by Blue Cross Blue Shield. ANNOUNCER 2: Second Opinion
is produced in conjunction with UR Medicine, part of
University of Rochester Medical Center,
Rochester, New York. ♪♪ [applause] Welcome to Second Opinion, where
each week a panel of medical experts comes together
right here to discuss a real-life case. I’m your host,Dr. Peter Salgo. I want to thank
everybody for being here, our guests up here, and our
live studio audience as well. We have some
great experts today. We’ve got author Susan Senator,
Beth Hoffman from the University of Pittsburgh
School of Medicine, primary physician Dr. Lou Papa
from the University of Rochester Medical Center, and Dr. Todd
Wolynn from Kids Plus Pediatrics in Pittsburgh. This is just great. Now, I know you’re
in private practice, you’re in private practice. You’ve got so
much to talk about, discuss. DR. PAPA: So, Dr.
Todd, it’s interesting, you have a large
pediatric practice, you’re the CEO of that practice. And you do something very
different in that practice with regards to outreach
and communications, correct? Correct, yeah, we do. We’re, I think, fairly different
from a lot of practices because we have, one, a
communications director. We built out–and he’s
been there for ten years. We built out a production
studio about four years ago. We have a community engagement
space in each of our offices, three offices. And we even have a breastfeeding
center inside of each of our offices, so it’s
really practicing evidence-based medicine. DR. PAPA: Wow. That is very
progressive, amazing. Now, you also had, in
the process of doing this, this communication, you had a
great idea of trying to improve HPV vaccination, literally a
life-saving cancer preventing vaccine, correct? Yeah, we’ve really doubled down
in this concept of communication internally within
the practice and externally. And to the point on
the HPV messaging, we created a video
called “We Prevent Cancer”, and it was about the
use of the HPV vaccine. So, I understand in the
process of doing this, in putting the
HPV vaccine online, something unintended happened. So, we posted
it on our YouTube channel, and our Facebook channel, we
did this in August 23 of 2017, and it had the intended effect. Over and over
parents were praising it, they were making appointments,
they were bringing their kids in, it was wonderful. A few weeks later, though, I
think it was September 15, we then had a
different effect that we weren’t planning, which was a
coordinated global anti-vaccine attack on our practice. So, over 800 people
posting over 10,000 times to our Facebook page,
with a global coordinated attack also on our Yelp, on
our Google ratings. And yeah, it was the real deal. How did you get
involved in all of this? Did they just call you? What happened? So, actually, well, Pittsburgh,
despite being a relatively large city, is sort of two
degrees of separation, and my advisor in my public
health degree is a Kids Plus parent, and knows Chad,
their communications director, very well. And so, Chad had reached out to
her asking if she knew of anyone who did social media research
or was interested in this topic, and she thought of me. So, I was lucky
enough to get on board. And where I work at the
Center for Research and Media Technology and Health, my one
coworker has done some work with what’s called
social network analysis. So, trying to look at,
you know, how these people know each other. And so, it was really
just the perfect fit. DR. SALGO: So, you were drilling
down into the cracks and the intricacies in the Internet. Yes. DR. SALGO: And what did
you find about this attack? You published a paper about it. Yeah, so, a couple of
really interesting things came out of it. So, one, I went into this
research thinking what I think a lot of people do,
that, you know, people who are against vaccines
are all motivated by this concern of the MMR
vaccine causing autism. And what we saw is that
while that is a concern for some parents, it’s much
more broad than that. And that actually when we
did this network analysis, we found that the people we were
looking at and the topics they were posting at
were really clustered into these four groups. What were they? So, the first group was trust,
so lack of trust in the medical profession, government in
terms of mandatory vaccination, big Pharma. The second was alternatives,
so a belief in homeopathic remedies, not just for
vaccine preventable diseases, but kind of across the board. The third was safety, where we
saw the concerns about vaccines and autism, but we saw actually
more people posting that vaccines cause Sudden
Infant Death Syndrome, or people saying
vaccines cause cancer. And then finally the last
group was conspiracies, and that’s where we saw
things, broad conspiracies, you know, such as the
moon landing is fake, but also such things as the
polio virus doesn’t exist, the government has
sort of conjured that up. DR. SALGO: Susan, there was a
time where you had real concerns about vaccines. Can you tell us a
little bit about that? SUSAN: Right, so I fall into the
category that you mentionec, number three, I guess, the
fear of vaccines causing autism, because my oldest
son has severe autism. And I had a third child who was
born right around the time when that MMR theory was
really coming out. There wasn’t really anything
scientific I was basing that on, but it certainly was something
pervasive in the autism community, so that’s where I got
my support and my information. DR. SALGO: Over the years, that
you were considering all this, you’ve changed. What changed you? First of all, as a journalist, I
was doing a lot of research over the years into, you
know, is this true? The MMR or thermisol
connection, that kind of thing. So, I wanted to know on
that level so I could write about it accurately. But also, you know, just
personally I was afraid that even if it wasn’t true, I was
afraid that my oldest son had gotten autism from his vaccine. There are some terms I think
we ought to put on the table, because they’re out there. They’re the anti-vaxxers,
right, and then the vaccine, I’m getting this precise,
vaccine hesitant. DR. WOLYNN: Yes. What is the difference? So, yeah, it’s really
important to understand this. Again, what got us involved in
this research and all the work we’re doing nationally, and even
internationally may have been the attack, but that’s
really small portion. So, anti vaccine are oftentimes
thought of as people that are pretty much recalcitrant to
evidence-based medicine, to statistics, to data. That’s a really small, but
very loud and vocal, group. Vaccine hesitant–so,
in the U.S. we talk about 75% of people being
vaccine accepting. You make a
recommendation for vaccines, and they’ll accept them. About 20, actually 2, 3%–23%
are considered vaccine hesitant, which means they have questions. And there’s
nothing wrong with that. DR. SALGO: One of
the triumphs, I think, that we’re all justifiably
proud of is vaccination. DR. PAPA: Absolutely. And we had eliminated
some horrific diseases, measles, mumps– Right. –rubella. Small pox. And I thought, I
suspect you thought so, too. We won this one. And then measles popped up. What did you think when you
saw the increasing measles rate? It saddens me, but I have to be
honest, it doesn’t surprise me. Because at the time that
this really was happening, the big concern was we’re going
to lose some herd immunity. DR. SALGO: That is a phrase. We all were taught
this in medical school. And I think to some degree
people who don’t get vaccinated depend on that. What’s herd immunity? DR. WOLYNN: So, herd immunity
is the concept that if enough people, if there’s a
critical mass with a people within a population, or a
herd in this case, but another way we refer to
it now is community immunity. If enough of a percentage
is already immunized, the ability of that disease
to spread is either limited or eliminated. It just depends on the
particular infectious organism you’re dealing with. Unfortunately with measles, it
is so contagious that you need to achieve a herd immunity level
of over 95% of the population to stop its spread. I mean, but you hear all
the time from people who are concerned about vaccines
is–everybody else is vaccinated so my kid is safe. Yeah, and when we were doing our
research and looking at Facebook posts of people who were–who
had attacked the video, we saw it over and over again. And also, misunderstanding
the seriousness of measles. You know, these posts
that measles is just a rash. And I think in some ways vaccine
preventable diseases–vaccines are a victim of
their own success. And you know, my
generation hasn’t seen that. And so, as my
generation is becoming parents, the fear of potential vaccine
side effects seems a lot greater than the fear of measles. SUSAN: I think there’s an
intuitive feeling that lot of parents are going by. That you can kind of
imagine this, you know, gross stuff inside this syringe
that you’re putting into your beautiful baby. I heard a mom say that once. So, there’s this
whole feeling if, I want to keep my baby pure. DR. WOLYNN: Right. And there’s the
bias of inaction, right? That if I’m not doing something
purposeful that might hurt my child, I’m taking a safer path. When in fact not doing
something is not safe. DR. SALGO: All right let’s
take a little break right here, because we’re
going to come back. This is a big topic. You know, every day we hear
about medical innovations that make an impact and hold promise
for improving our healthcare. Take a look at this. ♪♪ DR. TOPHAM: The seasonal flu
is a tremendous health burden. We estimate that influenza
infects one-third of the population every year worldwide. Seasonal influenza kills way
more people in a given year than any avian strain has. And so, I think we need to
be doing more research to understand how they cause
disease, how we can improve immunization against them, and
then lead to better vaccines. ♪♪ We spend hundreds of millions of
dollars a year doing research to trying to understand how
the current vaccine works, why it doesn’t work, how
influenza causes disease. And we really haven’t made
any progress towards improving things. We might understand
things a bit better, but that doesn’t change the
amount of illness that influenza is causing. So, I think we have to change
our strategy so that we achieve broad, cross-protective immunity
against several influenza antigens or proteins. That will make it much
harder for the virus to escape. But to understand what
those sequences mean, what those mutations
do to the protein, we need to simulate
the protein itself, the shape from the sequence, and
be able to look at that in high resolution and see where the
changes are occurring and how it’s changed the molecular
shape of the protein itself. What we have up now
is influenza virus, hemagglutinin proteins. These are the main targets
of influenza vaccination. Our current vaccines, this–the
hemagglutinin is actually three chains, three colors. It’s got a head
domain and a stalk domain. This part of the protein
is relatively conserved, it doesn’t change very much. This part of the protein up
here changes all the time. And that’s why we have to change
the vaccine every year and your immune system responds to
this part of the protein. That’s good because the receptor
binding the region is up here, the part of the molecule
that sticks to the cell. The problem is
the virus mutates. And that’s not good. So, a universal vaccine would
focus on more conservative parts of the hemagglutinin. So, such as the stalk. So, we’re trying to figure out
ways to either create vaccines that are just include the stalk,
or trick the immune system to responding to the stalk, which
it usually doesn’t respond very well to. ♪♪ Almost every time we
put a new data set up, we make a new discovery, and I
think it’s simply because you can see more of
the data at once, and you can see details that you
can’t see on the small screen, or never mind a piece of paper. The more people
that are vaccinated, if the density is high enough,
we can achieve something called herd immunity. That immunity prevents
viruses from spreading from person to person. So, when you get vaccinated, you
have the opportunity to protect yourself, but you also have
the opportunity to protect the people around you. And I think we all have the
responsibility to do that, especially if you’re
around young children, or elderly parents, or
people with other underlying health conditions. It’s not only a good
idea for yourself, it’s good for the
people you love. ♪♪ And we’re back. Susan, I want to look at
this from the other side. What do you think doctors
need to know about the vaccine hesitant parents out there? They need to know that even
staggering vaccines isn’t recommended, they
have to know why. So, you have to
treat them with respect, asking them what
their concerns are, and then finding out
what you can say to that specific concern. DR. WOLYNN: Well, yeah, and
there’s data showing that if you talk to people that are hesitant
and you start throwing data and facts, it actually
will backfire. SUSAN: Definitely you start from
the point of view of connecting. DR. WOLYNN: Yeah,
and communicating. And that’s where we need to go. And that’s where really the next
step of where we’ve taken things is to leverage
communication science, so there was collaborate work
done between Sanofi Pasture, Angus Thompson is the
researcher that did this, and from Indiana
University, John Parrish Sprowl, and they’ve created a
methodology that is completely based on communication
science and relationship, and the acronym is AIMS. So, it’s A for
announce, I for inquire, M for mirror, and S for secure. What does that mean, though? DR. WOLYNN: Yeah, so… Each of those is a term, I’m
sure has a specific meaning. DR. WOLYNN: Yeah, so
I’ll walk you through it. We know 75% of the
population is vaccine accepting. So, as a matter fact today, say,
Suzie’s going to need her TDAP, her HPV, and her meningitis. And 75% of the people are
going to say, that’s fine. If you actually start
backpedaling and you think, oh, my gosh, maybe there is some
hesitancy and start infusing that on the front
end, you can actually, and the data shows,
create more hesitancy. So, if I know 75% are
interested in just going ahead and getting
it, announce it. If then you say, the mom
comes back and says, you know, the TDAP
and the meningitis, I’m okay with those, I need
those for school for her, let’s hold off on that HPV. That now gives me a
pathway to follow to inquire, can I ask you, what are
your concerns about the HPV, can you give me a
little more information? And if she says, I
just don’t want that, inquire a little further. Can you give me just
some background, just so, you know, for my understanding? Yeah, you know, my sister-in-law
posted it on her Facebook that that vaccine can sterilize kids. Okay, now, she’s giving me a
real concern of hers. And she trusts me. There’s a relationship. She brought me her kid into my
office for a reason, right? She trusts me. And she’s already willing to
let me do an exam and to give the TDAP and mening. But I can say, okay,
so now I’ve inquired, now I’m going to mirror. So, what you’re saying is, you
actually read this on your sister-in-law’s Facebook page
that this article said the HPV vaccine can
sterilize your child. That would terrify me, right? I’ve now literally moved myself
over in this communication and in this relationship to see
things through her eyes, and actually the
communication science says, you want them to feel felt,
right, that they know that you know how they feel, right? It’s not just that, oh,
don’t worry about that. Here’s the data, just
throw down at them. Let me move myself over to look
at things through your eyes and understand, that would
terrify me as a parent. And now, you’ve
shifted the communication, the relationship. Now you can
actually go back and say, can I share with you
some of the information I have on the vaccine? There’s a much more–a greater
likelihood for them to be willing and open than seeing
that you’re seeing it through their eyes to have
that conversation. BETH: Not all parents, you
know, have the same concerns. And so, understanding, so for
example, if someone is, you know, concerned about
a specific side effect, in this case, you
know, the sterilization. That’s a different conversation
than, you know, what we were talking about earlier with the
general concern of purity. And, you know, but if a parent
is saying, you know, I’m concerned about all
these chemicals, you know, that–there’s a way to build
ground with that in saying, you know, we’re all
concerned about chemicals we put into our body. You know, as a pediatrician,
that’s why I recommend, you know, limiting your child’s
soda consumption. DR. WOLYNN: But if we have
more information on what the concerns are, and then we
can take time and have a conversation, and to leverage
the relationship we’ve built with our families. There’s the real opportunity. And I’ll take you
through one last step, which is the S, right? So, it’s exactly what you
said, there’s the announce, there’s the inquire,
there’s the mirror, and if at the end of it
the family member says, I just don’t want to
get that one today, you secure the relationship. And that’s what the S is for. And so, you can say, look, I
think what we both need to–we’re going to agree to
disagree on that one vaccine, but I think what we can agree on
is we both have Suzie’s health at heart, at best health and our
interest and in our heart. So, let’s do the other things
that we’ve talked about today, and let’s revisit
this at another time. So, you’re securing
the relationship. On a one-to-one level, if
you’re using this AIMS– DR. WOLYNN: Yeah. –I would be willing to bet
you’re seeing better results. Yeah, the data’s
unequivocal here. The most powerful and
impactful person to make the recommendation where the parent
is looking for is their health care provider, and in
this case, the doctor, the pediatrician,
when I’m in the room. 80% of families, even
if they’re hesitant, if given a clear and concise
recommendation will vaccinate that same day based on
your recommendation. Same day? DR. WOLYNN: Same day. DR. SALGO: So,
when you look at this, and we’re talking
about one-on-one, you know, boots-on-the-ground
kind of medicine, this does spill
into public policy. DR. WOLYNN: Yes, right. DR. SALGO: And right now the big
debate in the papers and on the web is what do we do about
legislating that mandatory vaccines, so that we get
herd immunity protected? And what’s driving it right
now is the measles epidemic. What do we do here? Does it make sense
to say, this is it, we’re the government,
everybody’s vaccinating? Or will that just
drive people away? What will it do? DR. WOLYNN: It has the
potential to do both. DR. SALGO: Oh, thanks,
that’s really definitive. [laughter] So, mandates can increase rates. But there’s studies in
literature and research on mandates, showing if you
implement them too early, before there’s consensus,
that there can be a backfiring. That happened early on with
Texas when they tried to mandate the HPV. But once you have the bulk of
people accepting and you’re down to more stragglers,
mandates can be effective. We see them used for
schools, that you know, your child can’t
attend school without them. But, again, it’ll come back to
communication in media as to where the populous is because
there’s people that are opting out of school. I think it’s
important, you know, to remember though, kind of
what we’re talking about, that the very vocal and
people who are anti vaccine, they’re a small–they’re
very vocal– 2 to 3%. Yeah, 1 to 2%.
–but a minority. So, the same we see with
other contentious issues. You know, we see a
lot of very vocal, you know, anti
whatever sort of advocates. But I think, you know, trying to
make sure that whether it’s physicians, whether it’s
policy makers, understand that even though it’s a vocal
group, it’s a minority. DR. SALGO: Right Also again, doing
better, you know, a better job of
communicating about it. You know, we have laws
mandating seatbelts, and I don’t think we see the
anti seatbelt lobby protesting. You know, it’s–we physicians
sometimes forget is I’m a patient’s
physician, but we’re all public
health officers. And I consider myself a
public health officer. But the problem I have with
the mandate is it is fuel for conspiracy, right? The moment you
come down heavily, it fuels the conspiracy. So, it’s interesting, I think,
the way to get around is that idea of consensus. See–oh, sorry. Go ahead. I was just thinking,
though, what you were saying. And you know, the also
there’s this aspect of– the mistrust seems to be so big
and even if it isn’t a mistrust that’s, you know,
conspiracy level. There are so many, again,
in my community, the autism community,
there’s just so many people who have found that what they were
told when their child was first diagnosed, or
diagnosed way too late, they just started to lose faith. You know, so we’re all told, at
least the older parents like me are told,
neurological, it’s neurological. And then, you start to
hear all this other stuff. So, it’s–there’s this mistrust
that creeps in slowly. DR. WOLYNN: That’s–well, that’s
the point is where they hear it. So, if you put the word vaccine
or immunization into a Google search, or any search engine,
99.9% of the results are going to be fictitious
and pseudo science. And so, one of our mandates, our
pleas to healthcare advocates and researchers and clinicians
is we have to develop our social media voices, whether
you like it or not. No, you’re right. In 2019, if you aren’t, and I
usually pull out my phone at this point, if you aren’t there,
you are not in the lives of at least of the Millennial parents. Because, you know, what we say
is AIMS is awesome when you’re in the exam room face-to-face. But 365 days a year you’re
not face-to-face in that, or they are in another
relationship with their phone, getting information
from other sources. DR. PAPA: I think some of
the trust also gets at, not from the public
health aspect of things is the communication’s very
important, but also public health officials have to
respond to crises. And I don’t think they really
respond to that autism crisis. So, think about do you see
anything about this like heart disease, do you see anything
about this like lung cancer? You don’t because the
science wins there, because we have the science. SUSAN: Right. And I think part of it is that
this is on a different level than what we do at
our level, you know, this is medicine with a big M,
in the sense that how quickly do you respond to
what the public sees, you know. Autism isn’t “killing people”,
right, that’s the thought. But the reality is it’s a
concern for the public. You have to respond to what
the public’s concerns are, otherwise someone will. SUSAN: I don’t know what
to say to that one, you know, what people say,
you know, about autism. I say, you know, yeah,
it’s a hard one. DR. PAPA: Right. But it’s not death, and it’s
not the end of the world. The fact is you can’t pick and
choose what diseases you get. DR. PAPA: Right. What happens to you in life. DR. PAPA: Right. You’ve got three children. And when your third child was
born this question came up. What did you do about vaccines? I wanted to delay them at least,
because even though I knew the facts, I was afraid
that maybe, just maybe it, you know, the MMR caused autism. So, I spoke to my
pediatrician and we had a really close relationship. You know, almost just friends. And I said, can I do this? And she tried to
talk me out of it. And eventually she agreed. And it wasn’t until shortly
after that that I was talking to my sister, who’s a pediatrician. And she said kind of
gently, but firmly, the way my sister does. [laughter] Said, you know, there’s a reason
they bundle those vaccines together and they
give them at this age, and it’s really about triggering
a robust immunological response. You really want to have that, so
it’s actually good to do it that way and not to stagger it. So, hearing it from
her, I could relax. I mean, I’d already delayed, but
after that I felt better about all the rest of the
vaccines that were to follow. So, you’ve actually gone from
one side to the other, really? SUSAN: Yeah, I have. I guess, I was never
vehemently opposed to vaccines, it’s just that I
was afraid, was, you know, kind of in the middle there. But a lot of
parents are like that, too. DR. SALGO: This has just
been a tremendous discussion. Panel, I want to thank
all of you for being here. I certainly want to thank
our live studio audience. It was great to see
you all out there. Of course, I want to thank you
at home for watching us as well. Remember, you can get more
second opinions and patient stories on our website
at SecondOpinion-TV.org. And you can find us
anytime, you know where, it’s social media,
it’s everywhere. I’m Dr. Peter Salgo,
I’ll see you next time for another second opinion. [applause] [applause] ♪♪ ♪♪ ANNOUNCER 1: Behind every
heartbeat is a story we can learn from. ♪♪ As we have for over 80 years,
Blue Cross and Blue Shield companies are working to use
the knowledge we gained from our members to better the health
of not just those we insure, but all Americans. Some call it responsibility,
we call it a privilege. Second Opinion is funded
by Blue Cross Blue Shield. ANNOUNCER 2: Second Opinion
is produced in conjunction with UR Medicine, part of University
of Rochester Medical Center, Rochester, New York. ♪♪

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