On the ER episode that aired February 15, 2001 a child died from measles. This episode portrayed the parents' informed choice not to vaccinate as irresponsible and negligent and implicated them in the death of their child. Not coincidentally,

the episode's implication of the parents' negligence was followed immediately by an advertisement for Wyeth-Ayerst Pharmaceutical's Prevnar vaccine.

Surely you have breached your journalistic integrity by aligning the message of your episode with the message of your sponsors. In doing so you have breached the truth. Your transparent and one-sided coverage of a very important issue only fuels belief in the "conspiracy" that your character so vehemently derides.

Your depiction of parents who choose to forgo vaccinations as irresponsible and negligent is simply not borne out in fact. Nor are the numbers of these parents significant. The Institute of Medicine in their 1997 workshop summary Risk Communication and Vaccination stated

"The goal that all parties share regarding vaccine risk communication should be informed decision making Consent for vaccination is truly "informed" when the members of the public know the risks and benefits and make voluntary decisions."

In fact, the "rich" parents you portray do not "free-ride" off the poor. Research at the University of Pennsylvania concluded that parents were more likely to do what everyone else did than to "free-ride" on the perceived immunity of others. It is the inadequate access to health care of the unimmunized poor that is the greater risk to immunization compliance than is the minority of well-informed and health conscious families who do not vaccinate.

Your portrayal of the parents ignored and patronized important vaccine issues. There is no argument that vaccines are effective. The argument is about legitimate safety concerns that parents have about vaccines. And, it is about informed consent, a tradition in American jurisprudence for nearly 100 years. By definition, a parent's right to informed consent means that he or she must not be coerced into making a decision. Your cooperation with Wyeth-Ayerst in coercing the parents of America is unethical. And, your portrayal of doctors who coerce parents into making such decisions violates the standards of the medical profession.

Your portrayal was further compromised by its blatant association with advertising. It is often the case that the medical establishment places stories in the media prior to a major announcement. I'm certain that this recent ER episode was meant to test public opinion for the upcoming American Academy of Pediatrics recommendation of the Prevnar vaccine and its subsequent requirement by the CDC.

I can understand the need for the advance publicity. Prevnar will be marketed to parents as a preventative to ear infections even though it has not been approved for this use. According to Erdem Cantekin, PhD, professor of otolaryngology at the University of Pittsburgh and an international authority on otitis media, "Prevnar will have the same effect that antibiotic abuse currently has....

This vaccine is the perfect example of profit-driven health care with no checks and balances."

Prevnar is one of the most expensive vaccines ever developed and is expected to deliver sales of up to $500 million per year.

Prevnar is made by Wyeth-Ayerst, the same company that made Rhotoshield, a diarrhea vaccine. Rhotoshield was withdrawn from the market in 1999 after reports of numerous cases of vaccine-associated bowel obstruction and amidst claims of conflicts of interest between vaccine manufacturers and governmental agencies that, critics say,knew of the vaccine risks all along.

Your portrayal of the complexity of the vaccine decision was not only one-sided; it was also inaccurate and therefore inflammatory. One character stated that the death rate for measles was one in 500. While this was the death rate in the prevaccine era, the death rate today is one in 5,000. As there are less than 1,000 cases of measles a year in the US, it would be rare for a US hospital to witness a measles death. To terrorize parents with the threat of such a rare occurrence is unconscionable.

A character in the episode also stated that there was no proof that measles vaccine causes autism while, in fact, the evidence that implicates the MMR vaccine in autism is compelling and should be taken seriously if we are genuinely interested in safe vaccines.

It is not uncommon for industry to use its influence in the media to frame stories. Increases in breastfeeding rates, for example, are met with increased stories in the media about the very rare and preventable "insufficient milk syndrome." For example, in July and August of 1994, breastfeeding was widely discredited in the media. During this two-month period, coverage of unusual cases of tragic infant dehydration was included in a cover story in The Wall Street Journal, in Time magazine and on Prime Time Live to name just a few. More recently, a 1998 episode of TV's Chicago Hope and a 2000 episode of Law and Order again implicated breastfeeding in shows about "insufficient milk syndrome."

"Insufficient milk syndrome" is a media euphemism for failure of the medical establishment.

Interestingly, this breastfeeding bashing has not been balanced in the media with public service programming that encourages breastfeeding or portrays breastfeeding advocacy in a positive light. This is particularly ironic in light of the World Health Organization recommendation that all women breastfeed for at least two years. Most babies in the US are weaned by six months.

Likewise, the pronouncement on co-sleeping from the Consumer Product Safety Commission in September 1999 and the publication a few months later of the American Academy of Pediatrics' book on infant sleep were preceded by newspaper articles, and talk shows on the topic.

Most coverage parroted the official viewpoint of the government and medical associations. Increasingly, the responsibility of a watchdog press, and the conscientious actions of a minority of citizens who question the status quo are looked upon as un-American when it is, in fact, the minority viewpoint that the US constitution was written to protect.

The American Academy of Pediatrics minimizes parental concerns about vaccines by labeling them misconceptions. ER suggests that informed choice is criminal. The media and the medical establishment increasingly attack parents who exercise legitimate, informed choice if that choice is controversial. All states, however, grant religious exemptions to vaccination and parents can claim these exemptions based on deeply held personal beliefs as well as on church membership.

As an editor, I advocate for parents to be able to make personal choices regarding the care of their own family. I am for informed choice. None of us is safe to act on our deeply held beliefs if one of us is unsafe. This is not about vaccines. It is about informed consent. Whatever we believe or choose regarding vaccines is irrelevant to the fact that we all want to reserve the right to choose medical care that is appropriate to the needs of our particular family.

Standing by while journalists trample on the freedom of parents is something I will not do.

Citizens are not interested in watching television shows that are so obviously compromised. It is bad enough that television programming on the public airways is a vehicle of advertising for the few, but it is doubly bad when advertising is disguised as programming.

If we are to have any impact on the excesses of materialism, we will have to start by refusing such overt manipulation.

• ER has misused its position of media privilege.

• ER has violated its own standards of artistic excellence.

• ER has violated journalistic integrity by overtly aligning the content of the episode with the interests of the advertisers.

Peggy O'Mara, Editor and Publisher, Mothering

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