It's wise to immunize, regardless of what the Web says
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* Barbara Sibbald

Most physicians will have seen headlines about the risks posed by vaccines and their alleged links to asthma and other health problems. Many parents who see the same headlines turn to the Internet for help - and find plenty (see page 737). Unfortunately, quantity doesn't always equate with quality, especially when it comes to information on vaccinations and vaccines.

The difficulty, as with anything on the Net, lies in separating the reliable from the questionable. The information provided may be well written and sound professional, but that does not mean it is correct. And when it comes to a volatile issue like immunization, the proliferation of questionable sites is truly disheartening. In fact, parents who surf the Web for information on immunization will be offered more anti-immunization propaganda than medically verifiable information.

Sites described as "supporting the right of every individual to make informed vaccine decisions" - [www.thinktwice.com](http://www.thinktwice.com) is an example - are gateways to a series of anonymous and frightening testimonials associating childhood vaccination with sudden infant death syndrome, chronic fatigue syndrome, seizure disorders and generalized reduced immune response. Thinktwice Global Vaccine Institute purports to offer the "world's largest selection of *uncensored* information on childhood shots and other immunizations." With this site, some censoring would have helped.

Health World Online ([www.healthy.net](http://www.healthy.net)) advocates self-managed care and touts itself as "the most comprehensive global health network on the Internet," with a "strong focus on time-tested systems of traditional health care." It promises to give people the resources they need to make choices, yet the immunization information it provides is decidedly antivaccination. The principal article - "Shoot 'em up: the debate over childhood immunization" by Lauri Aesoph, a doctor of naturopathy - begins by stating that one-third of 4 million US babies born every year are not vaccinated by age 2. It then focuses on information about the negative ramifications of vaccination but says nothing about the implications of failing to have children vaccinated. Not surprisingly, Aesoph does not recommend immunization. She suggests "homeopathic immunization," though "the final choice is up to you." But it's difficult to make an informed decision when the 12 items in the site's library of immunization articles include 2 by Richard Moskowitz and 5 by Harris Coulter - both well-known antivaccine advocates. (Figure)

![Figure1](http://www.cmaj.ca/https://www.cmaj.ca/content/cmaj/161/6/736/F1.medium.gif)

[Figure1](http://www.cmaj.ca/content/161/6/736/F1)

Figure. "Nature spontaneously keeps us well. Do not resist her!"

## Some reliable sites

Fortunately, there are some reliable sites too, and physicians may want to recommend them to patients to help counter the plethora of antivaccination Web sites. One of the leading Canadian resources is the Canadian Paediatric Society (CPS) site ([www.cps.ca](http://www.cps.ca)). Its 27-item question-and-answer section in the Caring for Kids section addresses questions about whether immunizations can "wear out" the immune system or cause seizures, brain damage, cancer, multiple sclerosis, chronic fatigue, Crohn's disease or sudden infant death syndrome.

The CPS site also features pages entitled Myths and Facts, and Facts about Immunization. The latter features information about how and when to immunize children, side effects and schedules. (The CPS also publishes a guide by Dr. Ronald Gold of Toronto's Hospital for Sick Children, *Your Child's Best Shot: a Parent's Guide to Vaccination.*)

Another rich source of information for parents is found at the CMA Web site, [www.cma.ca/cpgs/pediat.htm](http://www.cma.ca/cpgs/pediat.htm) (go to number 24). The "burden of suffering" of the disease versus the vaccine is reviewed here, and excellent historical information about each disease and the effectiveness of the current vaccines is provided. This site is intended for physicians but it is also appropriate for literate parents.

American sources can provide an interesting frame of reference. In 1994 the American Academy of Pediatrics published the 23rd edition of its *Red Book: Report of the Committee on Infectious Diseases.* It also maintains a Web site ([www.aap.org](http://www.aap.org)) with information about immunization schedules and the latest research.-

*Barbara Sibbald,* [sibbab@cma.ca](http://sibbab@cma.ca), *with files from Susan Pinker*