How much do doctors and nurses know about vaccines?

I recently discovered that an out of work tech guy has started a YouTube channel devoted to spreading antivax rhetoric.  His name is Forrest Maready and he has been doing this for about two months. He has a Facebook page that seems to get a good amount of traffic. His most recent video, How much does medical school teach about vaccines, has had 174,00 views and 6551 shares on Facebook alone in less than a week. According to his Linkedin profile, he is a “creative technologist and opinionator.” He is also an out of work technology officer with a degree in religion and music. Exactly the last person I would expect anyone to take seriously when it comes to advice about health and medicine.

And, yet, his videos are being noticed and questions are arising. Since this is not the first time an antivaxer has questioned how much doctors and nurses learn about vaccines in college, nor will it be the last, I think this is a great topic to debunk.

Here is the nitty gritty of the antivax argument (google it, you will see many AV sites discuss this topic):

 

Truly, this is the crux of this position. The issue of how much doctors and nurses learn about vaccines in college is a minor, cherry-picked detail the way it is presented by antivaxers. Why? Because they are merely counting hours spent on topics or pages in textbooks and this is not how nurses and doctors are trained.

In his video, Forrest takes a pile of medical textbooks (we are not told from which medical school or year they originate) and examines the number of pages devoted to vaccines. Out of 6700 pages total, he found four and a half pages that discuss vaccines. He further looked at a pediatrics reference textbook and found 11 pages of vaccine schedules and three paragraphs of contraindications, out of 5000 pages total.

And from there he surmised that doctors in training spend two hours learning about vaccines. Let that sink in. Two hours.

Um, no. Just no.

If the art and science of being a medical doctor or nurse could be learned solely from textbooks, doctors and nurses would never have to spend any time at all in clinics, doing residencies and fellowships, and pursuing further education into specialties beyond the basic degree. What doctors and nurses learn is far more than what is in their textbooks. And it is more than just one textbook in isolation. Looking the number of pages on vaccines takes the education of nurses and doctors out of context. And this is cherry picking, trying to make an argument based on incomplete information selectively chosen merely to fit one’s agenda.

This survey, from the University of Central Florida College of Medicine, indicates doctors-in-training spend between 1 and 10 hours learning about vaccines. But, I believe that refers specifically to learning about just vaccines.  As this Facebook video from the Insufferably Intolerant Science Nerd explains, “The anti-vaccination movement would have you believe there are no books regarding vaccinations anywhere and that doctors are never taught about vaccinations. This is incorrect. Doctors are taught the knowledge needed to understand vaccinations and the role they play in eradicating disease from Day 1. There is an entire subdiscipline of scientific research “vaccinology” that specifically deals with vaccinations. Our medical knowledge of vaccinations has been built upon the information accumulated from many different disciplines of science – microbiology, virology, bacteriology, bioinformatics, epidemiology, biochemistry and organic chemistry.”  From the Violent Metaphors blog, “without even counting the related fields of physiology, the respiratory system, gastroenterology, histology, neurology, etc, I came up with 920 hours of graduate education in immunology, microbiology, and infectious disease – and that’s before ever hitting the wards in 3rd and 4th years.”

A nurse on Facebook puts it well: I have seen that video, and I find it to be completely bogus. Vaccines are a small topic amongst a wide array of information. It’s kind of like getting mad at a baker for not knowing the composition of an egg when he makes a recipe. It’s kind of a weird abstract. The entire education process about vaccines starts with anatomy and physiology. Learning and mastering the understanding of the immune system is step number one. Next, microbiology comes in when you start to understand and are taught the different types of bacteria as well as DNA and RNA transcription and reproduction. This is very important with understanding viruses as well as different kinds of bacteria. Next, you need to know about pathophysiology. Using pathophysiology, you learn about how the disease process happens, as well as how the different viruses and bacteria are spread. This can also be tied into Epidemiology or Immunology. After that, you have to delve into pharmacology. Pharmacology is a very interesting topic, and with knowledge gained from pharmacology we can understand how different parts of the vaccine as well as any drug are handled by the body and further information about their methods of action, adverse effects, and side effects. Also, we learn about the way drugs are eliminated and disposed of by the body like the liver, kidneys, and intestines. Finally, scientific literacy as well as an understanding of current evidence based practice, helps us understand the current stance as well as scientific standing on vaccines as well as all of their effects and efficacy. Of course we also talk about the schedule and when to give these immunizations, however by taking information from all of the classes mentioned, we can understand vaccines very thoroughly. Vaccines and the knowledge needed to understand them, is not one class. Instead it is an amalgamation of information that we have learned throughout our schooling. Not understanding microbiology or the immune system, greatly hinders and almost eliminates and full understanding of vaccines their uses and why they are given. For me personally, I opened up my textbook really quick for Pediatrics, and there is about 10 pages dedicated to each vaccine preventable illness, 5 pages on administration and contraindications, and another three pages as an overview of scientific research as it stands currently. I’m sure that I can look in my other text books and find other information within them that furthers the understanding of vaccines individually, but as I said it is a compound understanding. My textbook also talks about the Vaccine injury Compensation Program as well as the Vaccine Adverse event Reporting System. We are taught about it, very thoroughly in fact. In summation, we do not focus one class on vaccines. Instead, we take our understanding from previous courses like chemistry, microbiology, pharmacology, anatomy, physiology, pharmacology, and public health to complete one comprehensive picture of what vaccines do, what they are, and how they work.

A doctor on Facebook says In the first place, we don’t get lectures on every drug, but we do get lectures on pharmacology, physiology, and pathophysiology, which helps us understand why and how a drug might be useful for a particular person.  Similarly, we learn about the immune system and microbiology so we can understand how vaccines work. You can’t just study vaccines out of context. That superficial knowledge, which some of our AV friends have, lacks the depth and perspective. As a trivial example, you can read about how live polio vaccine can cause poliomyelitis in rare cases. But you might not know how many people died from polio before the vaccine, or how terrified people became every summer.

On top of this education in classes, doctors and nurses learn a great deal in the field, in their clinics and residencies and fellowships. More to the point, they learn how to prevent and treat disease more outside of classroom than inside. But, more to the point, they are not learning to be experts in drug and vaccine composition. If you want to talk to someone who is an expert in drug ingredients, reactions, side effects, etc, then that person is called a pharmacist. Doctors and nurses do learn about diseases and treatments but it is unreasonable to expect them to be walking pharmacology reference guides. Furthermore, the “expertise” most antivaxers expect doctors and nurses to know off the tops of their heads is usually something they can easily look up in their handheld or laptop or desktop device.

And it is not just in medical school that professionals learn about vaccines. Osteopathic medical school also teaches doctors-in-training a great deal about vaccines. “Today’s students need to know how vaccines work from a microbiological perspective and how vaccination is viewed and implemented from a public and prevention perspective for overall population health. Additionally, they must now be able to use information technology, health care implementation science, and evidence-based data analysis to assess their own skills and ability in educating their patients to make wise health decisions regarding vaccination.”

The bottom line is that doctors and nurses learn a lot about the human body, diseases, treatments, drugs, and vaccines. But, it is mostly learned in context, not all from textbooks. Context. That is the key word here. Context.

And, doctors and nurses who want to learn more can take courses, such as one that might use this textbook:

As always, remember to use your thinking skills when it comes to making healthcare decisions.

 

Kathy