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Why Doctors Give in on Vaccines 医生为何要对接种·疫苗让步
CREDITPHOTOGRAPH BY JOE AMON / THE DENVER POST VIA GETTY
Even in an era defined by profound technologicaladvances, the practice of medicine remains an art as well a science—a fact thatoften frustrates both physicians and their patients. For manyconditions, solutions are not simple and there are rarely easy answers. Thereare exceptions, of course; perhaps the most notable among them has been thesuccess of vaccines. 即便在科技高度发达的时代，药物应用不仅仅是一门科学，也是一门艺术——这让医患双方都感到挫败不已。在很多情况下，问题难以克服，几乎没有简易明了的解决方法。当然，也有例外；也许在这些例外中，最昭然的要算是接种疫苗的成功了。
Until recently, in the United States and other wealthycountries, diseases such as measles, pertussis and rotavirus—which killhundreds of thousands of infants in the developing world each year—hadvirtually disappeared. Both measles and pertussis are now back, largely becauseincreasing numbers of children remain unvaccinated. Vaccines are the mostpowerful public-health tool that pediatricians possess. Unfortunately, thereare people (a minority, but a dangerous one) who just don’t care. 诸如麻疹、百日咳和小儿腹泻等每年夺走发展中国家成百上千的婴儿生命的疾病，在美国和其他发达国家，也是直到近些年才基本消失。可是麻疹和百日咳如今却死灰复燃，这主要是因为越来越多的孩子没有接种疫苗。疫苗是儿科医生所拥有的最强有力的捍卫公共卫生的武器。很遗憾，有那么一些人（虽只一小撮，但危害已经够大了）就是不在乎。
Many of these people don’t approve of the vaccineschedule set out by the Centers for Disease Control and Prevention, and theyseek to spread the shots over a longer time period than the one recommended.This has presented American pediatricians with a stark new challenge to theirHippocratic Oaths. Which does more harm: delaying scheduled vaccines andreducing their effectiveness, or refusing to delay and running the risk thatparents will simply not vaccinate their children at all? 这些人中，很多都不按照疾病防控中心发布的接种疫苗时间表，而是超出最佳接种间隔期才进行接种。这无疑是向美国儿科医生的“希波克拉底誓言”*的挑战。这种行为造成了不小的危害：推迟甚至拒绝接收疫苗而导致疫苗有效性降低，也可能导致家长索性不给孩子注射疫苗的情况的发生。
It’s a terrible choice, forced almost wholly by the notion (which isdemonstrably untrue) that if a child receives “too many vaccines too soon” itcould overwhelm his or her immune system. A study published this week inthe journal Pediatrics provides the best proof yet that a large majority of doctorsagree to the delays. Ninety-three per cent of those surveyed for the studyreported that they had been asked, at least once, to delay vaccines. Thephysicians acquiesce in overwhelming numbers—two thirds said they do so atleast occasionally—even though most of them don’t want to, and even though theyare aware that data clearly show that such delays put their patients (and thosearound them) at increased risk. 这个如此糟糕的选择基本上要归咎于一种观念（明显的无稽之谈）：如果一个小孩过早接种太多疫苗，会摧毁他/她的免疫系统。本周在《小儿科学》期刊上刊载的一篇研究提供了有力的证明：仍然有一大部分的医生允许了延期接种。93%接受访谈的医生说，至少有那么一次他们曾经被请求推迟接种疫苗。选择默许的儿科医生占压倒性的比例——三分之二的人说他们至少偶尔会这样做——即使他们中大部分人都不想这样做，即使他们明白，已有数据清楚说明了延期接种会让他们的病人（及其周围的人）陷入日增的危机中。
Nobody can dispute that the number of vaccines hasgrown significantly. A hundred years ago, children received a single vaccine:smallpox. By 1962, that number had grown to five (diphtheria, pertussis,tetanus, polio, and the M.M.R.). Today, the C.D.C. advisesthat children be vaccinated for fourteen diseases before age six, on arecommended schedule that usually includes twenty-nine shots, sometimes severalat once. Vaccines worry parents, in part because of an old, unfounded, andultimately discredited theory that children who receive measles vaccinesdevelop autism at higher rates than other children. (They don’t, as has beendemonstrated in dozens of studies carried out throughout the world.) 毋庸置疑，要接种的疫苗数量明显增多了。一百年前，儿童们只接种一类疫苗：天花。到1962年，增加了五类（白喉病、百日咳、破伤风、小儿麻痹症、麻疹-腮腺炎-风疹疫苗）。今天，疾控中心建议6岁之前的儿童接种14类疫苗，按照推荐的接种时间表，通常包括29次注射，有时是单次注射几种。父母们对疫苗的焦虑，部分源于“接种麻疹疫苗的儿童的自闭症发生率高于不接种的儿童”这么一个陈旧、没有根据并且终究是靠不住的理论。（世界各地众多研究已证实麻疹疫苗不会导致自闭症。）
That baseless concern, publicized by activists such asJenny McCarthy, morphed into a movement to spread out the timing of vaccines inorder to protect children from a possible shock to their immune systems. Butthere simply is no such threat. Because progress in molecular biology has madeit possible to create vaccines with fewer antigens, children’s systems are nowexposed to far less of a burden than was the case in the past. The smallpoxvaccine, for example, contained two hundred proteins—all separate molecules.All together, the vaccines that children routinely receive today contain fewerthan a hundred and fifty. 经如珍妮·麦卡锡之类的激进分子的大肆宣扬之下，那些并无理据的担忧已经演变成“保护儿童免疫系统免受攻击而拉长疫苗接种时间”的团体运动。但是疫苗完全没有这样的威胁。分子生物学的进步使“制出更少抗原的疫苗”成为可能。从前由于注册疫苗而在儿童免疫系统产生的过度负担，如今在分子生物学的进步下也远没有这种情况。比如，以前天花疫苗含有两百种蛋白质——全是分离的分子。现在儿童常规接种的所有疫苗中，总数量不超过一百五十种分子。
Thenumber of bacteria that live on the nose of a newborn child or on the surfaceof his or her throat is in the trillions. “Those bacteria have between 2,000 and 6,000immunological components and consequently our body makes grams of antibody tocombat these bacteria,” Paul Offit, the chief of the infectious-diseasesdivision at the Children’s Hospital of Philadelphia, has written. “The numberof immunological challenges contained in vaccines is not figuratively,it is literally a drop in the ocean of what you encounter every day.” Offit haslong been one of the nation’s most prominent proponents of vaccines—and he haslong been vilified for his stance. 一个新生儿鼻子里或喉咙表面的细菌数量数以万亿计。“那些细菌有2000到6000个免疫因子，因此我们的身体会产生数克抗体来抵抗这些细菌。”费城儿童医院传染科主任保罗·奥菲特写道，“疫苗所含的损害免疫系统的因子太少了，你遇到他们的几率如同海底寻针。”长期以来，奥菲特是美国最坚定的疫苗支持者之一——他也因为这样的立场饱受诟病。
Pediatricians spend, on average,less than twenty minutes with each patient—often far less—and they usually haveto cover a lot of ground. Finding the time for a lengthy discussion of vaccinesafety is never easy. Moreover,at least one recent studysuggests that certain efforts to correct falseimpressions about the dangers of vaccines actually make people less likely toget vaccinated. It appears, again for no good scientific reason, that simplyknowing more about vaccines convinces many people to avoid them. 儿科医生在每个病人身上平均所花时间少于20分钟——很多时候还远未达到——他们经常不得不快速地处理。腾出时间来进行漫长的疫苗安全性讨论实在不容易。而且，至少一项近期研究表明：越尽力去纠正人们关于疫苗有危害的错误印象反而会让人们更不愿意去接种疫苗。同样地，没有科学依据地说，似乎人们对疫苗知道得越多，就越会远离。
The days when patients stood byplacidly as doctors told them what to do are over, and good riddance to them.We are far more capable of assembling information and deciding what is best forus or for our children than we ever have been. And we certainly have the energyto devote to our fear of disease. (Anyone who watched as the nation displayedhysteria over “our” Ebola epidemic, in which two people in a nation of threehundred and thirty million died, saw that.) 病人心平气和地遵照医嘱已经过时了，谢天谢地，这也是件好事。我们远比从前有能力去整合信息，并判断出什么对我们或孩子是最好的。我们肯定也有能力去应付患病恐惧症。（人们都会知晓这一点，只要他们看过美国大肆鼓吹“‘我们的’埃博拉病在美国的死亡率达三十万分之二“这一数据。）
But the medical profession’s widespread surrender on vaccines is deeply troubling.And it all but guarantees that preventable illnesses will continue to harmpeople and put children’s lives in danger. An Internet connection doesn’t makeus all experts, and it doesn’t make it easier to distinguish between usefuldata and lies. That’s why trained physicians and nurses are more essential todaythan they have ever been. Unfortunately, that is not a truth universallyacknowledged—even by doctors. 但是医学界对疫苗的广泛让步让人深感不安。而且这使原可预防的疾病继续会伤害人们，也会使其孩子活在危险当中。互联网不会使我们每个人都成为专家，我们也难以分辨出哪些是实际有用的数据，哪些是谬论。因此现在职业内科医生和护士比起以往任何时候都更必不可少。很遗的是，这一事实并不为大众所认同——甚至是医生本身。
注释： 1. 希波克拉底誓言：《希波克拉底誓言》是希波克拉底警诫人类的古希腊职业道德的圣典，是约2400年以前中国孔子时代，向医学界发出的行业道德倡仪书，是从医人员入学第一课要学的重要内容，也是全社会所有职业人员言行自律的要求，而且要求正式宣誓，没有医护人员不知道希波克拉底这位历史名医名言的。
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发表于 2015-9-2 17:43:31
