The recent outbreak of hantavirus on the MV Hondius cruise ship has churned up fears among the public. These fears have also reignited interest in notoriously dubious treatments from the COVID-19 pandemic, such as the anti-parasitic medication Ivermectin, despite any evidence supporting its efficacy against viral illness. This example is reflective of a broader trend: the growing tendency to substitute anecdote, intuition and emotion for scientific evidence when making healthcare decisions.
As a pediatrician, I worry this approach — what some are dubbing “vibes-based medicine” — is increasingly influencing healthcare policy in ways that may put the children of America at risk for serious and sometimes fatal health complications.
Earlier this year, the Department of Health and Human Services and the Centers for Disease Control and Prevention announced revisions to portions of the childhood and adolescent immunization schedule. Among the notable changes were shifts in recommendation for influenza and hepatitis B vaccines from consensus to conditional. These vaccines were previously recommended for all children and are now recommended to be given based on shared-decision making.
The more narrow childhood vaccine recommendations were designed to be more aligned with those of other countries as well as to hopefully increase vaccine uptake by decreasing overall vaccination burden. Remarkably there was no new evidence to suggest that these specific vaccines are harmful, ineffective or unsafe.
There is, however, a large and indisputable body of evidence supporting how severe influenza infections can be. Every year, otherwise healthy children are hospitalized, admitted to ICUs, put on ventilators and sometimes die from influenza. Some of the sickest kids I’ve cared for so far in my career have been previously healthy children who contracted the virus and were not vaccinated.
A similar dynamic played out when President Donald Trump and Robert F. Kennedy Jr., Secretary of HHS, announced they’d discovered the cause for autism: prenatal acetaminophen (Tylenol) exposure. The evidence they cited? Communities like the Amish who do not use Tylenol have “no autism.”
The actual evidence? Multiple umbrella reviews and meta-analyses demonstrate no clear link between maternal acetaminophen use and autism or ADHD.
There is, however, evidence of a modest association between prenatal maternal fevers, particularly in the second trimester, and autism. The incorrect rhetoric surrounding Tylenol use and adverse fetal outcomes may inadvertently cause an increase in the number of children diagnosed with autism if women are scared to take Tylenol during pregnancy for fevers. It is also important to recognize the potential for increased maternal suffering secondary to fear of taking Tylenol during pregnancy as Tylenol is one of a very limited number of pregnancy-safe medications for women during periods of injury or illness.
In 2023, the FDA approved Nirsevimab (brand name Beyfortus) for prevention of respiratory syncytial virus (RSV) in newborn and infants born during or entering their first RSV season. Beyfortus is actually a monoclonal antibody, not a vaccine, that delivers lab-derived antibodies to the infant that immediately and directly help the immune system fight off the virus. This recommendation was adopted after rigorous clinical trials demonstrated the safety and efficacy of the injection in preventing up to 83% of hospitalizations, almost 70% of ICU admissions and 67% of cases requiring ventilator support from RSV.
Compared to the flu shot I argued for in an earlier paragraph, which prevents 30% to 60% of hospitalizations related to influenza, Nirsevimab is a miracle. In my pediatric practice, I recommend it enthusiastically to all my patients and families and tout it as an excellent example of evidence-based medicine.
It is important to acknowledge that Tylenol and flu shots and Nirsevimab are not risk-free. The flu shot is notably associated with a risk of Guillain-Barre syndrome which is a severe and potentially life-threatening neurologic condition. Anyone who has or had Guillain-Barre syndrome does not get the flu shot. But the point is not that these interventions are risk-free. What matters is that they have demonstrated scientific efficacy. Medicine is full of tradeoffs and the goal is not to eliminate risk entirely — an impossible task — but weigh risks and benefits.
In many situations, evidence is incomplete or evolving. This is where shared decision-making comes into play. But shared medical decision-making must be grounded in evidence. It needs to involve honest discussions of the existing evidence, the remaining unknowns and our confidence in what we do and don’t know. It should never be driven purely by emotion.
Amanda Siedem is a pediatric resident at Dartmouth Hitchcock Medical Center. She lives in Lebanon.