Sunday, May 08, 2011

Evidence, herd immunity, and ‘total assholes’ | The Panic Virus

Evidence, herd immunity, and ‘total assholes’

If there’s any one thing I’ve stressed in my talks over the past three months, it’s that parents of children who believe that their children have been vaccine injured deserve compassion and understanding. (That doesn’t mean they should be pandered to or be allowed to dictate public health policy.) I’ve also said many times that I can’t pretend to know beyond any doubt how I would react if I was in their shoes.

I do, however, know what it’s like to be a parent who feels uneasy when a doctor asks you to take off your newborn’s pants so your child can be injected with a vaccine. It’s scary. I don’t know anyone in the world who likes needles or likes watching  needles pierce their child’s skin. However, the fact that something is scary does not convey a license to blithely deny reality — which is why I find the actions of parents who have simply decided for themselves that vaccines and dangerous and at the same refuse to acknowledge the potential repercussions of not vaccinating on those around them to be morally repugnant. This is not a new position of mine; I wrote about it at length in a chapter of my book titled “Medical NIMBYism and Faith Based Metaphysics”:

The notion that people should base medical decisions on what is “right for them” is particularly problematic in a public health context, where individual choices cannot be cordoned off from each other. Consider the case of Julieanna Metcalf, a fifteen-month-old, fully-vaccinated girl who was taken to the hospital on January 23, 2008 with what her mother thought was a particularly bad case of the flu. It was only after extensive tests that doctors discovered that Julieanna had a compromised immune system that rendered the vaccine for Hib ineffective. By the time she got out of the hospital almost a month later, Julieanna had suffered multiple seizures and had a buildup of fluid in the brain so dangerous it required emergency surgery. She’d also lost all of her motor skills—including the ability to swallow—and will require multiple immune globulin injections each week for the rest of her life.

Even with her weakened immune system, Julieanna might not have caught Hib if everyone around her had had their shots, but the Minnesota community in which she lived was a place where the same ethos emanating from [Dr. Jay] Gordon’s and [Dr. Bob] Sears’s waiting rooms and [Oprah] Winfrey’s couch had taken hold. The outbreak that ensnared Julieanna also resulted in the hospitalization of four other children. One was a baby who was too young to have been vaccinated. The parents of the three others had all chosen not to vaccinate their children; one of those, a seven-month-old girl, died of the disease.

Earlier this year, I gave a talk at the American University School of Communication. At one point, Declan Fahy, the talk’s moderator and an AU assistant professor in health, science and environmental journalism, aired a clip that had originally appeared in a 2010 PBS Frontline series called “The Vaccine War.” The clip focused on Ashland, a politically liberal city in Oregon that is home to a renowned Shakespeare festival and the Ashland Independent Film Festival…and has a vaccine exemption rate of around thirty percent, which is the highest in the country. (The added emphases below are mine; a transcript of the program is available here.)

Dr. JIM SHAMES, Ashland public health officer: When you make that decision [not to vaccinate], which you have a right to do, do you think you may be affecting other children?

AUGUSTINE COLEBROOK, midwife and co-leader of the Rogue Valley Holistic Moms Network: Do I believe that I’m causing harm by not vaccinating my child? No, I don’t, because if the vaccines work, who am I putting at risk?

SHAMES: So let’s talk about that. Now, not everybody can get immunized. That child right there is probably too young to get immunized against pertussis. If your child gets pertussis by not getting the vaccine, and your child passes it onto a delicate newborn –

COLEBROOK: I really don’t believe it. I feel like — first of all, I feel like it would be responsible to then quarantine my child and not expose them to other, you know, potentially fragile populations.*

SHAMES: A lot of diseases are transmitted before you even know you’re sick.

JENNIFER MARGULIS, local parent: It’s my responsibility as a parent to keep my child safe, I think, and I don’t think it’s your responsibility to take a vaccine because I might be at the same party with you and you might cough on her. Honestly. I think your job is to protect your own health. And I mean, maybe I sound — I really don’t mean to be sounding selfish in that way.

At the end of the clip, Fahy asked me how I would communicate with parents like Margulis and Colebrook. Here’s my answer:

Ten children died of pertussis last year [in California]. Nine of them were under six months old [which means they were too young to be fully vaccinated], and to say, you know, ‘Oh this is my, this is something — keep your hands off my baby,’ is something I find so offensive, and I guess what I find most offensive is lack of honesty about the potential repercussions.

If you’re going to say, as they did — I’m clearly not giving advice for how to communicate with them because the way to communicate with them is probably not to say ‘you’re a total asshole,’ but, um, which is what I want to do — if you are going to say, ‘Well, this is my decision,’ you can’t then simultaneously say, ‘And I’m not putting anyone else at risk.’ At least be honest — at least say, ‘This is my decision, and I don’t care if I put other children at risk, and I know [children too young to be immunized are at risk] because it has happened in the last couple of years, that kids may die.’

I find that — I just find it repulsive. Her saying, ‘If you choose to vaccinate your child, that means your child is not at risk’ is also just categorically not true. There’s a child who I write about who was vaccinated against Hib and they only discovered the vaccine was not effective when she was in a coma. She lost all of her motor skills and will need therapy for the rest of her life to deal with that.

Those are harsher words than I usually use. If there’s one thing I hope I can accomplish in this debate, it’s showing parents the difference between verifiable, reliable data and anecdotal, fear-based myths — and, as I said, calling someone a total asshole is probably not the way to convince them to rely on evidence and not emotion. But I’ve spent too much time listening to the stories of people like Kelly Lacek (whose three-year-old spent four days in a medically-induced coma with Hib after her chiropractor convinced her not to vaccinate) and Danielle Romaguera (who held her seven-week old baby in her arms as she died as the result of a pertussis infection) and Toni and David McCaffery (whose four-week-old girl died of pertussis) to have much patience for parents who ignore the science supporting vaccines and also refuse to acknowledge the dangers of infectious diseases. I’ll spend all day talking with people who are willing to listen and to learn. As for the conspiracy theorists and the reality-deniers who act is if they’re living in some virus-free alternate universe…well, the might not be total assholes, but they’re definitely not worth my time.

[*] Even reading that again today makes me feel a little bit crazy. When Colebrook says the “responsible” thing to do if one of her children was infected with pertussis would be to enact a quarantine, I’m not sure where she thinks her child’s infection is going to get diagnosed other than at a pediatrician’s office…and if there’s one place vulnerable infants are pretty-much guaranteed to be, it’s a pediatrician’s office.

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