My father loved new cars. He traded cars every three years or so. While he didn’t work on the cars himself, he was meticulous about cleaning and maintenance. The second owner of one of Dad’s cars would have to look at the odometer to tell that it was not new. Shopping for the next car was part of the enjoyment and could take several weeks of test drives to find the right one. But Dad had one axiom that he held dear–never buy a car in the first year of a new model.
I have found that axiom to be helpful in the ever changing world of medicine. New drugs, new imaging methods, new surgeries–even robots–are rolling out constantly. Some are amazing. Others make lots of money for personal injury lawyers. One of my most important duties as a generalist physician is to sort through the hype and make the best recommendation for my patients, based on their individual needs and circumstances. A reliable track record makes that a much easier task.
The decision to vaccinate against measles is about as close to a slam dunk as you will find in modern medicine. There has been an effective, safe, and reliable measles vaccine available since 1968. In other words, it works and does not have major side effects. Because it is a live, attenuated (weakened) vaccine, it must be used thoughtfully for individuals with lowered immunity. Other than those concerns, everyone should be immunized against measles using the current CDC guidelines.
Yes, I respect the rights of individuals to make decisions about health care for themselves and their families. I also think that rights come with responsibilities. If a someone makes an informed choice to not vaccinate themselves or their children against measles, that person assumes a responsibility to protect their friends and neighbors in other ways: informing contacts about their choice, avoiding crowds, and accepting limited times or isolation practices for seeing their doctor. I cannot refuse to see someone who, despite my attempts to educate them on the benefits of vaccination, chooses to not be vaccinated. I can protect my other patients from a serious contagious disease by restricting the times and circumstances for unvaccinated individuals to be seen for care in my office.
I had measles in 1960. It was unpleasant enough for me to remember the details vividly. I ran a fever, I itched, my throat hurt, I could not watch television because the light hurt my eyes. I was lucky. Measles can cause permanent disability and even kill. When I had my measles booster in 1987 before starting residency, my arm was a little sore for a couple of days.
My father was a really smart man.
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Author’s Note: this was written in February 2015 after an outbreak of measles at Disneyland in California. I had just returned home from a visit to Disneyworld in Orlando where there were fortunately no problems. The article is surprisingly relevent with no edits required other than to put it in context.