Why Paul Offit Isn't Flexible on Vaccines

Last week, I blogged about an article in the Pediatrics journal written by vaccine expert Paul Offit and received a slew of heated comments both defending and attacking Offit's criticism of doctors who take a flexible approach to vaccinations. Vaccines are certainly a heated issue among parents and doctors alike: Witness the mass protests currently going on against a New Jersey law that takes effect this week mandating that preschoolers be vaccinated against the flu before they're allowed to return from winter break to their nursery school or day-care center.

Many of the commenters were concerned about Offit's conflict of interest; he is the co-inventor of the RotaTeq vaccine against rotavirus. Pediatrician Lawrence Rosen, who serves on the complementary medicine advisory board for the American Academy of Pediatrics (publisher of Pediatrics), sent me an E-mail commending me on my blog and included a letter he sent to the journal criticizing the AAP for "discouraging honest and open dialogue about one of the most important public health issues of our times" in not handling flexible vaccination as a debate that has two sides.

Others pointed out that I was too harsh in objecting to Offit's conflict of interest since his academic institution sold the rights to this vaccine so that he no longer personally profits from it. Offit, who could not be reached for comment before I posted my first blog, offered since to tell me why he's so opposed to veering off the government's recommended schedule for vaccinations.

First, he addressed the apparent conflict of interest, an issue he described as "very upsetting to me." "Yes, I'm co-inventor and co-patent holder of the rotavirus vaccine, but I didn't do it for money and I no longer make any money off of it." He added that he's not blind to the risks posed by vaccines just because he invented one. "Vaccines have side effects," he says. "The oral polio vaccine [no longer in use] can cause polio, and the acellular pertussis vaccine can cause seizures. But it could be that those children who develop severe reactions would be even more overwhelmed by a natural infection." Genetic studies are now being conducted to see if this is indeed the case.

Allergies to vaccines are the biggest problems that go unaddressed, he says. The flu vaccine, made using eggs, is unsafe for those with egg allergies, and other vaccines contain gelatin, which is allergenic. "Can we make these vaccines safer? Of course we can," he says. "But we push pharmaceutical companies to do things that don't make them safer like removing thimerosal [a preservative that contains mercury]."

Offit says there's zero scientific evidence that vaccines cause autism and that thimerosal, aluminum, and other metals found in vaccines are in such small quantities that they pose no risk to brain development. He believes there's also no reason to be concerned that vaccines are responsible for the rising rate of autoimmune disorders like asthma—although my colleague Bernadine Healy has pointed to one recent finding that delaying the DPT shot a few months cut the risk of childhood asthma pretty dramatically.

So what should a doctor do when confronted with parents who refuse to give their baby five shots against eight different diseases in a single office visit?

"That's the $64,000 question," he says. "The notion that children are receiving too many shots at once is understandable; kids today get 26 inoculations against 14 different diseases. That's a lot to ask of a population that doesn't see much of these diseases."

But, he adds, doctors can't be asked to participate in what he calls "substandard care." Instead, doctors need to spend some time convincing parents that delaying any shot will be putting their child at risk "without any proven medical benefit. What if he or she gets meningitis while you're waiting to get the shot?"

Still, I press him, what about all those yearly changes to the vaccine schedule? After all, kids weren't getting the flu vaccine up until now, and suddenly they need it because it's so lifesaving? "A kid on my son's Little League team died from the flu last year," he says. "It was my son's first funeral, and it saddens me deeply that this was for a disease that could have been prevented with a vaccine."