Thursday's New York Times included an alarming piece about climbing measles rates. This is an issue of particular interest in my home state, where we experienced a fairly serious outbreak this Spring.

(Although we are the "most improved" state, Washington State still lags behind in numbers of children receiving all recommended vaccinations.) In the article, public health officials are said to blame growing numbers of parents who believe "vaccines cause autism."

I sincerely doubt "public health officials" put it that plainly, and I also doubt the average non-vaccinating parent puts it as simply as "vaccines cause autism." I'm not a non-vaccinating mom myself, but I have known a few, and typically they've spent more time researching the subject than most people did on their last home purchase. They know it's a serious issue, and had they somehow not gotten that memo they've certainly been lectured by enough health care providers to know.

So why then do parents choose not to vaccinate? Beyond the possible side effects, there's an issue of deep distrust in a system which pats parents on the head, tells them everything will be alright, then passes legislation limiting our ability to recover enormous health care costs should they be wrong.

Take for example the preservative thimerosal, which the New York Times article mentions very briefly. This is the one that really got to me, once a "how can they be so stupid?" pro-vaccination parent. I knew there were risks associated with vaccination, but I thought they were more in the realm of freak .001 percentile reactions. What I didn't realize, what I should have known had I taken the issue seriously enough to listen to anti-vaccination friends, was that at the time my eldest child was born children's vaccines routinely included thimerosal, a preservative that is 49.6% mercury by weight. Thimerosal had been used in vaccines since the 1930s, however babies under 6 months of age were not routinely vaccinated with several doses of thimerosal-containing vaccines until the 1990s, when coincidentally (or not) autism rates began to soar. Looking back a few months later and realizing that I'd let our pediatrician inject my 8 pound, 1 day old daughter with a concentrated dose of mercury, I started to listen a little more. By the time my youngest was born the FDA had prohibited the use of thimerosal in pediatric vaccines. I made sure the stock my pediatrician used didn't still contain the additive, and I decided to take the vaccines on a slower (but still effective) schedule and not give her the Hepatitis B vaccine on her first day of life.

Upon further study it does appear that thimerosal might not have a causal relationship with autism, but it's probably a good idea not to inject newborn infants with mercury and I'm grateful to the parents who fought so hard to have it removed.

The MMR, the vaccine most commonly believed to be associated with autism, actually never contained thimerosol. MMR vaccine was suspected as a culprit because of a British Doctor's suspicion that the vaccine injured a child's intestinal tract and allowed a substance to cross into the bloodstream which might cause autism. The theory became very popular after many parents of autistic children reported that their children became ill and then developed symptoms of autism after receiving the MMR vaccine. Wakefield himself never opposed vaccination, but recommended that each component (measles, mumps, and rubella) be administered separately to reduce the chance of a negative reaction. Pharmaceutical companies and public health experts are quick to point out that none of this research has ever been duplicated, and that parents are noticing two things which both can happen in early childhood (vaccinations and the initiation of autism symptoms) and noting a causal relationship that isn't really there.

OK, then, since the MMR hasn't been definitively shown to cause autism either, why do some parents choose not to vaccinate? Because it isn't what we know about vaccines that is scary, it's what we don't know, and it's the overly simplistic way in which vaccines are presented to concerned parents that turns them off to the idea completely. Public health officials, physicians, and pharmaceutical companies collectively need to realize that as a group they've done a rather poor job of talking to parents on a respectful level about an issue they are right to take seriously. It's time to stop being paternalistic and talk to parents as though they are thinking people working in the best interests of their children.

In the case of measles, it has been a long time since most Americans had to confront this dangerous childhood disease on a daily basis. Statements like "most parents I know will take measles over autism" (from the New York Times article) may sound crass to people like my mother who vividly remember nearly dying from a virus they'd take extreme steps to prevent their own children from experiencing. Truthfully, most of us would take neither, and our public health system ought to agree.

There are simple steps which could be taken to allay parents fears: administering the vaccine components in separate doses, delaying vaccines until after the developmental window for autism, and presenting parents with options other than taking what they are offered or not vaccinating at all. Combining this approach with improved communication about measles risks - its risk not just to our own (hopefully) healthy children but to a neighbor's at-risk infant or an elderly relative - and the protective effect of herd immunity for populations too vulnerable to be vaccinated, many parents might be persuaded to eventually vaccinate their children. Many still won't, but the eye rolling has to stop or measles rates will only continue to grow.