Andrew Taylor Still DO, MD (1828-1917)
If one is to understand a cultural phenomenon, it is important to discover its root cause. The anti-vaccine movement is one such phenomenon. If one delves into this movement myriad roots will be found. One I find particularly intriguing—and misguided—is the belief that contracting illnesses “naturally” (as if it’s natural to be sick) and allowing the body to fight unaided is preferred to availing one’s self of the protection afforded by a vaccine.
Consider for instance, the ridiculous notion of the measles parties (they also come in the chickenpox variety) which California public health authorities had to actually warn people against. I am not certain where this idea originated but it seems to me to be an amalgamation of the cliché “what doesn’t kill you, makes you stronger” with the fact that humans have evolved exquisite immune systems that can dispense with various invaders quite easily. But, our immune systems have limits and, in some cases, drive the pathophysiology of disease when the invading microbe is attacked (see the damage-response framework). Hence the need for vaccines to augment our defenses stems from the attributes of our immune system.
The origins of this line of argument became a question I wanted to contemplate after I watched an excellent Johns Hopkins Bloomberg School of Public Health seminar on measles yesterday. In this seminar, an intriguing bit of data was presented showing that having a doctor of osteopathy (DO) as a primary care physician was associated with higher rates of abstention from vaccination.
This was puzzling to me because in every day life I work side-by-side with DOs, I've trained with them, and I consider them equals. However, I am aware that the origin of the DO pathway in the 19th century began with a break from the approaches of allopathic medicine. Could the disparate philosophical origins of allopathic and osteopathic medicine be playing a role?
To investigate this one facet of the anti-vaccine further, I did some more reading and found several facts that supported the notion of a DO/MD discrepancy (source Salmon, Human Vaccines 2008; Mergler, Vaccine 2013):
· Doctors of vaccinated children are 2.5 times less likely to be DOs
· MDs were found to be 2.8x more likely to have patients whose parents believed vaccines were safe
· DOs were less likely than MDs to have a high confidence in vaccine safety
· DOs were more likely than MDs to agree or strongly agree with the following statements:
o Children get more immunizations than are good for them immunizations do more harm than good
o any of the reports of serious side effects from vaccines are accurate
o CDC/ACIP underestimate the frequency of vaccine side effects
· DOs were less likely than MDs to agree or strongly agree with the following statements:
o Immunizations are one of the safest forms of medicine ever developed
o Immunizations are getting better and safer all of the time as a result of medical research
So why the divergence between DOs and MDs, those who have essentially the same undergraduate and post-graduate training? I hypothesize that the answer lies in the philosophy of osteopathy, articulated by the founder of osteopathic medicine Dr. Andrew Taylor Still (MD). In particular, I am referring to the osteopathic tenet of the body having a natural ability to heal itself—a true statement, but only within a certain context.
It’s important to note that when Dr. Still developed his ideas medicine was still in its infancy and many interventions did more harm than good. In that setting, leaving someone alone rather than bleeding or poisoning them was definitely an improvement. But Dr. Still did not stop there. He went further and attacked the only vaccine available at the time—one which was ultimately responsible for the only eradication of a human disease in history—calling Jenner’s smallpox vaccine a “hopeless failure” and offered many of the same arguments against vaccines that are still heard today.
Sure bones can heal and minor infections like the common cold dissipate on their own but severe infections like measles and smallpox are an entirely different matter.
So where does that leave us today? The osteopathic physicians of today are much different than those of the 19th and early 20th century but clearly the mixed legacy and ideas of Dr. Still persists. This remanant may lend false credibility to those who advocate experiencing dangerous infectious diseases naturally. I know excellent osteopathic physicians in almost all specialties and subspecialties, including infectious diseases. Indeed the American Osteopathic Association has voiced strong support for vaccination. I think it essential that these physicians extoll the benefits of vaccination to their colleagues in primary care and to the schools of osteopathic medicine to give the anti-vaccine movement no refuge.