‘Medicine is not political’ — ACP President Goldman discusses charged atmosphere around vaccines

The Advisory Committee on Immunization Practices (ACIP) will meet Dec. 4 and 5, coincidentally concluding National Influenza Vaccination Week, an awareness campaign to remind physicians to encourage their adult patients to get their flu shots.

How will patients respond? How will ACIP members react? What will be future guidance from the U.S. Centers for Disease Control and Prevention and other federal health agencies?

Vaccine advocates, physicians and patients alike, tout the shots as one of the greatest public health triumphs in history. But vaccine skepticism lingers — and has grown in recent years — not least due to health and other concerns around the COVID-19 pandemic.

For years, Health and Human Services Secretary Robert F. Kennedy, Jr., and his supporters have argued the inoculations against disease are causing other serious health issues, especially in children.

American College of Physicians (ACP) President Jason M. Goldman, MD, MACP, sat down with Medical Economics to discuss the current charged atmosphere around vaccines, skepticism about modern medical treatments and research, and other issues across U.S. health care. Dedicated to internal medicine, ACP remains the largest medical specialty organization in the United States with 162,000 members. ACP has advocated for vaccination, has published resources devoted to quashing medical misinformation, and has called for Kennedy’s removal.

This transcript has been edited lightly for length and content.

Medical Economics: In your own words, how would you describe the current state of trust in medicine in the United States? Do you feel like science may be under attack?

Jason M. Goldman, MD, MACP: If I could use one word, I would say polarized. It shouldn't be that way. Science is not political. Medicine is not political. We want to seek truth, we want answers, and we want to take care of patients. Unfortunately, it's become the opposite. It's become polarized. People have gone to their echo chambers. They don't know where to get information from, and it's really impacting the way we're able to take care of our patients. It's impacting the way we deliver health care, and it affects all of us, because especially with vaccines, it can affect the health of not only the individual, but society in and of itself.

Medical Economics: Regarding the Advisory Committee on Immunization Practices, during that September meeting, you said that you'd be willing to debate with members about vaccine studies and what the results show about safety and efficacy. What topics would you like to debate with them about?

Jason M. Goldman, MD, MACP: I'd like them to actually bring up real science, real evidence, real studies, so we can actually have a discussion. The reason why I said the willingness to debate is because the day before, the chairman of the committee made a point in his intro to say that when there's conflicting information, the only people you can trust are those willing to engage in discussion and debate. So I used his own words against him and said, I'm willing to debate and discuss with you, so the public can trust me. The biggest issue I have right now with Secretary Kennedy's advisory committee, is they're not using any rational evidence to recommend framework. They're not using the standard practices that we've always done to come up with good recommendations. What they are doing is presenting conspiracy theories, half-researched or flawed studies that support their theory. They're not backing up any of their claims, but just creating more confusion and innuendo. What I would discuss with them is, let's go back to basics. Let's look at the benefits and harms. Let's look at the facts behind the intervention. Is it a value to the population? Is it feasible to implement? Is it acceptable to the population? What is the benefit to equity and resource use? That's the basic evidence to recommend framework, and then we can start there. So when they bring up, you know, all of these harms or perceived harms, we look at that too normally when we evaluate any information. But what they're not bringing up is, what are the benefits? How are these decisions going to affect the population? And that's really key in any discussion of public health, it's not just pointing out what you think is a problem or a harm, but what are the risks and benefits and what are the benefits of that intervention? And they're failing to do that.

Medical Economics: As a physician who has counseled by now probably thousands of people on vaccines, how does it feel to see the concept of immunization politicized?

Jason M. Goldman, MD, MACP: It is absolutely devastating to public health and to way we practice that we are seeing such a politicization and polarization of even vaccines. The two greatest advances in public health are sanitation and vaccination, because that has really allowed us as a society and a civilization to advance by getting rid of or preventing basic harmful diseases. We look at the bubonic plague, if we didn't get sanitation under control and fleas and rats and learn how diseases were spread, we would still be dealing with the plague. If we didn't have measles vaccination, more people would get sick from measles. Unfortunately, we're starting to see that outbreaks continue because people aren't getting vaccinated. And what is really troubling to me, and what I'm seeing when my patients come in, even patients who previously had no problem with vaccines, are now confused and there's doubt. And what Secretary Kennedy's vaccine committee is doing is creating confusion and doubt where none need to exist. If we know that the world is around, and people keep saying the world is flat, and we show them evidence to the contrary, but they create that confusion, and people keep being unsure of the reality, then it creates that confusion. And so when they come into the office and like, well, I'm not sure anymore, so now I have to spend more time not just counseling them on what is good for them and their risk and benefit and why they should get vaccinated, but we have to go all the way back to basics as to what is even basic science. And so the foundation of those discussions have been pulled out because of the confusion created, and that is so harmful, because patients need their vaccines. That will help protect them from getting very sick, ending up in the hospital, and instead of being able to have that discussion and move on to other things, we are just mired in this confusing disinformation cycle where they don't trust any of the sources of where they're getting their information.