Dear Editor,
Thank you for publishing the timely article by Geier and Geier [1] that examined the effects of thimerosal-containing vaccines and MMR immunization on the prevalence of autism among young children. In light of the number of current studies that refute a significant link between MMR and autism [2–5], their findings represent what seem to be a minority view, nonetheless they deserve consideration. Granted, the international medical community must be aware of and knowledgeable about research on the now controversial issue of immunization and related debate. However, beyond the need to be informed, health care providers, particularly pediatricians, must be sensitive to the questions of parents who are understandably concerned about the conflicting information regarding the often reported, though largely unsupported by the medical establishment, connection between the MMR vaccine and subsequent diagnosis of autism.
Recently, my daughter asked her son’s pediatrician about the potential risks and side effects related to receiving the MMR vaccine. She also specifically asked the pediatrician about the possibility of administering the components of the MMR vaccine via three separate injections, as recommended by Geier and Geier [6]. As a concerned parent and mindful of the negative publicity surrounding the MMR vaccine, she had read a book written by a physician titled, What your doctor may not tell you about children’s vaccinations [7]. The pediatrician’s initial response to my daughter’s queries was, “I’m just curious, why are you asking me this? Your child hasn’t had any problems with his shots, so don’t worry about it.” She stressed that immunizations in general­ are extremely important and protect children from disease, and in a patronizing tone abruptly stated that there is no relationship whatsoever between the MMR vaccine and autism. The pediatrician then proceeded to explain that she did not routinely administer the MMR as a series and pointed out that this staged approach is cost prohibitive. My daughter assured the pediatrician that she was not going to forego immunizations; she just wanted to do what was in the best interest of her child. The pediatrician responded by saying, “You’re the parent, it is up to you,” to which my daughter replied, “You’re the doctor, that’s why I am asking you. I know you have resources available to you, and I thought you would be knowledgeable about the subject. I want to make an informed decision.” After this encounter, my daughter switched to a pediatrician with an open style of communication, who listens, and encourages parents to ask questions.
For quality care, pediatricians and other health care pro­fessionals involved in the process of providing immunization services for children must assist parents to make educated, informed choices. Moreover, they must avoid being condescending to parents who want to be heard and to feel confident in care decisions that affect the health of their children. Considering that those in the medical field have differing perspectives on the efficacy and safety of the MMR vaccine and its association with autism [8–12] along with the related widespread media attention, is it any wonder that parents are confused and anxious? In today’s consumer-driven and information saturated health care environment, putting off parents by not addressing their concerns and treating them in a nominal way is unacceptable. This kind of physician-client relationship does not instill confidence and trust. On the contrary, parents may perceive that their physicians are not knowledgeable or are withholding information.
Hopefully, the behavior of the pediatrician cited in this letter is not representative of other pediatric specialists. Nevertheless, it’s worth emphasizing the importance of giving voice to parents who are responsible for their children’s health by acknowledging and responding to their questions in an understanding, professional manner. To promote and maintain the immunization status of the population at large­, pediatric physicians and other providers must do their part to effectively and respectfully communicate with those for whom they provide invaluable service and care.

Sincerely,
Hila J. Spear
Professor of Nursing, Director, Graduate Studies,
Liberty University, 1971 University Blvd., Lynchburg, Virginia 24502, U.S.A., e-mail: [email protected]

References:
1.Geier DA, Geier MR: A comparative evaluation of the effects of MMR immunization and mercury doses from thimerosal-containing childhood vaccines on the population prevalence of autism. Med Sci Monit, 2004; 10(3): PI33–PI39
2.DeStafano R, Thompson WW: MMR vaccine and autism: An update­ of the scientific evidence. Expert Rev Vaccines, 2004; 3(1): 19–22
3.Chen W, Landau S, Sham P, Fombonne E: No evidence for links between autism, MMR and measles virus. Psychol Med, 2004; 34(3): 543–53
4.Madsen KM, Vestergaard M: MMR vaccination and autism: What is the evidence for a causal association? Drug Saf, 2004; 27(12): 831–40
5.Honda H, Simizu Y, Rutter M: No effect of MMR withdrawal on the incidence of autism: A total population study. J Child Psychol Psychiatry, 2005; 46(6): 572–79
6.Geier DA, Geier MR: Pediatric MMR vaccination safety. Int Pediatr, 2003; 18: 108–13
7.Cave S, Mitchell D: What your doctor may not tell you about children’s vaccinations. New York, Warner Books, 2001
8.Singh VK, Lin SX, Newell E, Nelson C: Abnormal measles-mumps-rubella antibodies and CNS autoimmunity in children with autism. J Biomed Sci, 2002; 9(4): 359–64
9.Frankel G: Charismatic doctor at vortex of vaccine dispute, experts argue over findings, but specialist sees possible MMR link to autism. Washington Post, 2004; A1, A20
10.Thrower D: MMR and autism: The debate continues. Lancet, 2004; 363(9408): 567–68
11.Harvey P: MMR and autism: The debate continues. Lancet, 2004; 363(9408): 568
12.Murch S: MMR and autism: The debate continues. Lancet, 2004; 363(9408): 568–69

Keywords: Autistic Disorder - etiology, Child, Preschool, Measles-Mumps-Rubella Vaccine - adverse effects, Parents, Pediatrics - manpower, Professional-Family Relations