When I am not taking care of my children, and heck, even when I am, I write. But I will do whatever I can to avoid actually writing. My kids' clothing is perfectly laundered, folded, and organized; the dishwasher doesn't go more than five minutes of being full before I run it; and more than one crumb in the dining room is cause to vacuum the entire house. I have also started to compulsively submit my work, so if you or anyone you know works at an obscure, or not-so-obscure, literary journal, chances are I've heard of their publication and they will soon receive a brown envelope full of lame writing from yours truly. I jump at the chance to make comments and have debates on facebook about whatever: grammar, reality television, vaccinations. I should probably get a job. In the meantime, after reading and posting a friend's article in Slate magazine about the dangers to other people of neglecting to vaccinate our children, I got involved in a few stimulating discussions on facebook. One friend had posted the same article on her facebook page. I may be the only who thinks this, but the conversation spurred by the article and her posting of it was fascinating and important, and hey, at least I can get a blog post (which masquerades these days as a valid piece of writing in my book--no pun intended) out of it.
Please note that I have edited the conversation of meaningless personal banter and have done some light copyediting. I also have only supplied the initials of some of the participants to protect the privacy of those besides myself, Cedar Riener, and the original author of the article, Stephanie Tatel.
Here it is:
S.L.: After doing a lot of research, my partner and I decided not to get most of the traditional vaccines for our kids. I am more than a little put off by the author's dismissive tone when she attributes decisions like ours to "fear" and "unproven danger." I am exceedingly sorry that her son has leukemia, but can't begin to understand why she thinks I should take that into account when deciding what is best for my children.
Rachel Levy: Well, um, with all due respect, I think the bigger point is that when deciding what's best for the health our children, some of the decisions we make affect others while some don't. For example, I could decide not to brush my kids' teeth or get them fluoride treatments at the dentist's office. That's probably ill-advised, but I could do it without putting anyone else's health at risk. Unfortunately, when people decide not to vaccinate their kids, it does put the health of those in their community and greater society, especially those who are younger, older, weaker, and more vulnerable, at risk. And I 'm sorry, but I haven't seen any research that adequately proves that taking that risk is medically necessary or ethically acceptable (with the exception of the risks vaccines pose to those with weak or non-existent immune systems).
E.M.: Just as living in society means obeying rules (red is stop, go is green) it also involves being responsible--herd immunity is not a myth.
Cedar Riener: I think what Stephanie is referring to in the "fear and unproven danger" is that the scientific data is resoundingly in support of vaccines being worth the very small risk that they pose. Maybe "fear" is an emotional exaggeration of the decision process of those who do not vaccinate. However, if you re-frame that decision as "doing one's research and coming to the conclusion that the risk associated with taking the vaccine is greater than the risk of not taking it" then you still have to somehow describe it as rejecting the data and evaluation of the scientific and medical community in favor of some other source of evidence. Whether you apply emotional words such as fear or distrust, or others that might be more neutral, what a decision to not vaccinate amounts to is a rejection of the modern scientific method and an acceptance (and prioritizing) of other evidence, whether it be an ideology, or anecdotal evidence. In other cases, this rejection of scientific consensus (say, with evolution and intelligent design) does not have direct consequences on the safety of our community, but this does. What's more, the more people that reject the scientific consensus, the more dangerous it is for the rest of us. I don't see how there is any doubt in that. Perhaps the better analogy is environmentalism and climate change. Many who reject environmentalism also doubt the science, as well as the importance of considering common goods in individual decisions. In this way, I don't see how the logic of environmentalism differs in any important ways from the logic of vaccination.
S.L.: First of all, thank you for a mutually respectful discussion. I wish the author of the article in question had a similar approach.
What I hear you saying is that vaccines should be mandated in the name of public health. That suggests that the risk posed by those of us who decide not to use certain vaccines is so dire that parental rights should be overridden. Clearly, I disagree.
Some vaccines we get for our kids, some we don't. We did not make this decision because of something Jenny McCarthy said on Oprah, or even based on discussions with friends and family. We did our own research and had long conversations with our family practitioner. We read accounts both in support and against the notion of vaccinations and made, what I believe to be, informed decisions.
There is scientific evidence to suggest that certain vaccines are not worth the associated risk, or are superfluous in modern society, and, yes, there is scientific evidence to suggest that parents like us are nothing more than irresponsible.
My kids are vaccinated against pertussis, but we do not get them flu vaccines. When friends of our son had the chicken pox we sent him over there to play. You might make different decisions for your kids and I respect that.
Are couples who decide to have home births attended by midwives rejecting "modern scientific evidence"? Perhaps you'll say that such a choice may not pose a public health risk, but might traditionalists not argue that it puts the baby's well-being at unnecessary risk?
I believe we all have a responsibility to the society-at-large, but my primary responsibility is to my children. My parenting decisions must be informed by their affect on society, but not dictated by them. As of yet, I have not heard compelling enough arguments, or seen compelling enough data to suggest I am being irresponsible or overly cavalier.
Rachel Levy: Just so we're clear, I am not including flu shots in my discussions. As far as I'm concerned, the jury is still out on their effectiveness and on their benefit to general public health.
I don't think that vaccinations should be mandated. But I do think that those who don't vaccinate (unless they demonstrate a medically necessary reason) should be required to take precautions when coming into contact with the general public and that perhaps they should be prohibited from taking part in public schools.
I'm not sure the associated risks you speak of have been established. If you can cite valid, scientifically rigorous studies that show they have, I would love to read them. Which accounts and studies did you read to inform your decisions? I don't care how many you read--I care about their quality. And I don't trust accounts in lefty versions of Fox News, even if they were written by educated liberals who voted for Obama.
Why are certain vaccines superfluous in modern society? Because we eradicated those diseases by way of vaccination. Those diseases still exist in less developed societies. Unfortunately, thanks to people who don't vaccinate, diseases like polio are making a comeback even in societies where they have been eradicated. Is that really what we want to return to?
I think the homebirth/ mid-wife analogy is not particularly instructive to the vaccination debate. For one, most midwives are professionals who use science/biology/medicine to inform their practices. And I have not read enough evidence that midwife-attended births cause any risk to the baby being born. Even if it does,we're talking about a decision/action that affects the health of population as a whole, so I'd ask before we go further that we stick to that topic or to relevant analogies.
S.L.: I thought I WAS sticking to the topic and citing a relevant analogy. Obviously you disagree. Furthermore, while I did vote for Obama and tend to exist left of center, I do not generally watch TV news, nor do I rely on Rachel Maddow to make my parenting decisions for me.
Since I'm at work and don't have access to my library, I will have to respond later to your question about my research sources. There are two, however, I remember off the top of my head:
1. Our family physician with whom we had numerous extended conversations. I assume he counts as a "professional who use science/biology/medicine to inform [his] practice."
2. One of the books I best remember is Vaccinations: A Thoughtful Parent's Guide by Aviva Jill Romm.
It feels like your position is that there are not two valid sides to this debate.
Clearly, disease is still rampant in underdeveloped nations and I should have clarified my point about "modern society." If my family was living in a place with a much different level of sanitation, infrastructure, medical care, and public health oversight, I'm sure we would have gotten more of the vaccines. As I said, we chose to get some vaccines, but not others.
S.G.M.: S.L.- ALL the arguments you made are on a personal level. You weighed and measured the risks and benefits for your own children and decided not to vaccinate.
What Stephanie writes about in her article, the reason I posted this article and what I believe Rachel agrees with is that there is another element that should be included in our decision to vaccinate. We must think of others and society at large.
In fact, one can even infer from your last paragraph that disease is NOT rampant in the United States. But at various times it was. The reason it isn't now is because of vaccinations. That is why public schools require students to be vaccinated.
I strongly believe that we ALL have a responsibility to think beyond the walls of our own homes.
R.M.: Hi there. Imagine what our society might have to contend with if a majority of children do not receive vaccines. Then, the safety net will have disappeared. In other words, by feeling safe in a choice not to get vaccinated one is relying on the immunity of those who chose to do so. There is some tipping point, however. Is that acknowledged and identified by any of the research relied upon by those choosing not to vaccinate their kids? If, say, 25% of the population is not vaccinated, would it then no longer be considered "safe" not to be vaccinated? Or is it 10%? Or 2%? I'm not an epidemiologist (in fact, I can barely spell it), but I do know that one of the primary reasons the flu is so dangerous every year is because the virus called "the flu" is brand new, every year. We don't possess the antibodies necessary to fight it. And so it spreads from one system to the next, which it must do in order to flourish. (This is the only reason Ebola virus hasn't brought about the apocalypse: its victims don't survive long enough to spread it.) I note this not to support flu vaccines, but to demonstrate what happens when our population is invaded by a virus against which it has no defense. According to the CDC, the flu kills 36,000 people, every year on average, in the U.S., a place where "employees must wash hands."
Hand-washing, sneezing into an elbow crook, soap and other simple measures are invaluable defenses against infectious illnesses. But look out on your left for that un-vaccinated person thoughtlessly sneezing in your direction!
Rachel Levy: My point about lefty versions of Fox News was not meant to put down people with left-of-center views who voted for Obama. (I voted for Obama and my views are much further left of his policies) or even to put down all television news--the News Hour is fantastic. And I like Rachel Maddow. Lately, though, it seems to be trendy among some left-wing educated liberals to eschew things like, oh, the government, public education, science, and vaccinations, which is interesting because Fox News and the people who watch it eschew things like the government, public education,vaccinations, and science, too... (I am meandering illogically off topic, I know).
Back to the topic at hand. I'm not going to pussyfoot around this: it's true, right now, I don't see that there are two valid sides to this debate. I also don't believe there are two valid sides to the Creationism vs. Evolution debate, or the Homosexuality as a Choice vs. Homosexuality as Innate debate, or to the World is Flat vs. World is Round debate, either. And I've never believed that the idea you get could AIDS from hugging or kissing someone who had it was valid. So far, I think that the arguments against and the evidence used to argue against vaccinations are comparably flimsy, cause comparable ignorance, and spread comparable misinformation.
Which is not to say that the vaccination debate shouldn't occur or that that parents should not know about and talk about the risks or side-effects or that they don't exist at all. Or that there shouldn't always be people questioning the necessity and benefits of vaccinations. A healthy society is a skeptical society.
S.L.: I respect the three of you and will give thought to all that you say.
I am no ideologue and don't "eschew" any of our institutions, including science and medicine. I do, however, try to consider all available alternatives as much as it is realistic to do so.
I am aware of the "herd immunity" debate, and suppose that on some level I am taking advantage of it. On the other hand, I have had exactly one flu shot in my adult life. "One" also happens to be the same number of times I've had the flu. I also believe that it was the development of vaccines coupled with advances in sanitation, food safety, preventative care, etc., that has led to a reduction in disease.
I do consider the world outside of my insular family when making decisions and taking actions. It is something we stress to our children and one of the reasons they are at a Jewish preschool. Call it tzedakah, tikkun olam, or just doing what's right and realizing that you are part of a whole. Is our decision regarding vaccinations in opposition to this? I've never thought so. I'm not sure if this conversation will change that, but I will definitely bring it up with my partner.
As my son has gotten older, we have chosen to catch up on some of the vaccines that we skipped when he was little and will probably do the same for our younger children. Perhaps, as I look at this more closely, it is the proscribed schedule of vaccines for the very young and the sheer volume of vaccines to which I object more than the general idea of vaccines.
I also have to admit to being weary of the swine flu cautionary tales. Perhaps, I am over-compensating in reaction to what I see as reactionary. In talking to my doctor regarding whether to get H1N1 vaccines for our kids, he suggested that much of what we are being served is over-hyped.
Rachel Levy: With our third child, we decided to space out the shots a bit more than is normally done. I've been told this wasn't necessary, but it made me feel more comfortable.
I think you and your doctor are right to wonder about the swine flu--it's all so new. We are puzzling over that decision ourselves, although we are leaning towards getting the vaccine, both for swine and the "regular" flu. I found this article on the subject to be helpful and informative:http://www.theatlantic.com
Stephanie Tatel: Hello, friends. I have hesitated to weigh in here, but R.M. asked a really good question about how high vaccination rates must be to provide herd immunity - I have heard that for measles and meningitis, for example, you need at least 95% of the population vaccinated. I am attaching a great article from the CDC website that describes what the consequences would be in our nation if people stopped vaccinating against infectious diseases such as MMR, pertissus, meningitis, polio, among others. It really sends home the message that this is a PUBLIC HEALTH issue, not simply a matter of personal choice. Also, we have to remember that although we enjoy low rates of these infectious diseases in comparison to other countries in particular the developing world, our borders are fluid: Most measles outbreaks in the USA have come from someone getting infected overseas and bringing it back to a community where there is a certain threshold of un-vaccinated people. This is also true for polio. This article will also provide more links to other very informative and reliable articles from the CDC: http://www.cdc.gov/vaccine
J.F.:Hey everyone. My wife and I were just reading this discussion and wanted to weigh in on one part of this debate that hasn't been discussed. I have to second much of what S.L. wrote: the decision to vaccinate, or in our case not fully vaccinate is not one we make lightly or on a whim. The risk of disease for our children and public health is important to us, but there is a risk of injury from vaccines; there's a reason there is a fund that exists to compensate children injured or killed by vaccines. And while many people believe the question has been resolved on whether vaccines play a role in autism, for many in the autism community, the jury is still out because there have not been any/enough valid studies on this issue. We know many parents of children with autism who saw their children regress into autism just days after vaccination. One of our son's doctors informed us that she absolutely believes that our son's seizures were brought on by a particular vaccine (his seizures cause him to stop breathing so they are life threatening if they are not controlled). We believe a major culprit in people's fears over vaccination is the drug companies' role. People are suspicious of companies that profit from mass vaccinations and use dangerous preservatives such as mercury--this has finally been removed from most vaccines, but the fact that it has been removed indicates some admission that it was not safe to use--and it still widely used in the flu vaccine. There are other adjuvants used such as aluminum and formaldehyde which bring up health concerns. My point is, with all that modern science is capable of, blame should not be directed at parents who are legitimately concerned about their child's well-being, but rather at the drug companies who haven't come up with a safer way to vaccinate.
Rachel Levy: Hi J. I am sorry about your child's seizures and about your friends' experience with autism. If one of my own children seemed to be affected negatively by a vaccine, I might be singing a different tune right now. The only thing I can say is that I don't think anyone here is denying that vaccines aren't without their side effects or real dangers. But the children of people who opt not to vaccinate (unless they have a medically solid reason to do so) aren't any more likely to experience those side effects and rare reactions than the children of those who do vaccinate are; we're all taking the same risks. And the main result and side effects of not vaccinating for the major diseases, unfortunately, are contracting the major diseases on a mass scale. And, yes, the drug companies are not always (or even usually) benevolent actors. I can understand why you'd say anger should be directed at them and I can understand that drug companies have done much to erode the public's trust. But don't the people who work for the drug companies get their children vaccinated, too?
I do want to address the mercury concern. I posted this article on my fb page too, which led to another lively comment thread. I learned this: "Thimerosal is ethyl mercury, not to be confused with methyl mercury. Methyl mercury builds up in the food chain, and potentially in your body, and causes neurological damage. Ethyl mercury gets cleared from the body pretty quickly. Also, to put things in perspective, there is 28 mcg of mercury in a tuna sandwich and about 25 mcg in a flu shot." I also learned that The Children's Hospital of Philadelphia has a great website about vaccinations: http://www.chop.edu/servic
S.L.: I've been thinking about this conversation a lot since signing off yesterday. I wonder if the "herd immunity" aspect of it comes down to this: At what point should decisions about the greater community override decisions about one's own family.
I assume you would all concede that our first responsibility as parents is to our children. So if one firmly believes that skipping certain vaccines is what is best for one's children, but vaccinating them is what is best for the larger community, then doesn't the community benefit have to be fairly extreme to trump priority one? Can we say that there is now a clear indication of such?
Rachel Levy: It's clear that if over 5% of us stop vaccinating that these diseases will return on a mass scale and cause a massive public health crisis. So, there may not be an extreme community benefit right now, but if over 5% of the population isn't vaccinating, then one will soon be created. The consequences of not vaccinating a certain percentage of the population will be that many, many people will get very, very sick and that many, many people will die.
Yes, some people should be medically and ethically exempt from vaccinations: people with compromised immune systems, those likely to have allergic reactions, those who have already had extreme reactions (like J.'s child) and probably the siblings of those who have had allergic or extreme reactions.
Otherwise, it's not a matter of proven personal necessity--you're deciding that your children are more important than someone else's children. Because beyond the categories I mentioned earlier in this comment (and perhaps some others I've missed), we're all equally likely (or highly unlikely) to experience an extreme reaction to the vaccines. Tell me,why is one child more important than another? Why is one child of more value? How do you decide that? Why does he/she have more of a right to avoid the risks of the vaccine than someone else?
And, your belief, no matter how strong, that your child will be negatively affected by the vaccine doesn't change the actual chance that your child will be negatively affected by the vaccine. The chances stay the same, no matter what you believe. Let's say there's one umbrella for three of us who are outside. Only one person can fit under the umbrella. You say you should get the umbrella because you strongly believe that it's going to rain. It's cloudy. I think it might rain, but I'm not sure. In fact, what we believe doesn't change the actual chance or likelihood that it's going to rain. And if it does rain, I'm going to get just as wet as you are. Let's say that there's a relatively high chance that the third person is going to have some pretty dire consequences if it rains and they get wet, but we wouldn't have any consequences beyond experiencing some discomfort and a very, very small chance that we'll catch a cold, and even smaller chance that we'll catch a cold and then get much sicker. Yes, that third person should be granted the umbrella and the two of us should be willing to get wet and take the tiny risk that some other factors could come together to make us sick.
Cedar Riener: I agree with S.L. in that at some level, this is an instance of the commons dilemma (in which short-term self interest runs counter to long term community interest). However, I think in this case the actual risks and probabilities are crucial. That is, thinking philosophically ignores the importance of the concrete details in this particular matter. The short term personal risk is small and the long term community risk is great. Ultimately a large problem is the disagreement of the scale of these two risks. And despite the fact that I am not in general a fan of drug companies, I am adamant that the source of evidence should be properly conducted studies, not anecdotes, or personal experiences. We can agree that placebo-controlled, double-blind studies are the standard for deciding the safety and efficacy of drugs. The reason for relying on this method is that bad things happen to people on the placebo, and people spontaneously recover on the placebo, and left to our own devices, many people would interpret individual instances as being caused by a placebo, given our penchant for finding patterns where there are none.
Ultimately, the chances of getting autism from a vaccine (which have not been confirmed, despite many studies trying to find a connection) must be compared to the risk of getting the disease that it vaccinates against (like pertussis, which is experiencing a resurgence).
Unfortunately, as J. points out, for many, this does come down to a lack of trust. Scientists, who may be funded by a drug company, do a study on vaccines using data from 100,000 people, use accepted methods and evaluation procedures and publish their findings in a top peer-reviewed journal. Many readers are hung up on the fact that the study was funded by a drug company rather than the methods of the study itself.
I think this issue also cuts deeper than just distrust in drug companies, but also the lack of trust in any journalistic institution. We may decry the rise of Glenn Beck, but if we on the left had a responsible media source that we trusted, we would all vaccinate our kids, because anyone who actually knows the science in this case would tell us that there is no contest, we should vaccinate our kids.
Anyways, I'll sign off, but I'll just add that pseudoscience has always been popular and well-funded, but that is no indication of its grasp of the truth.
S.L.: Cedar, I think that for me there is one other aspect of weariness at work. I feel like there is a tendency in this country to over-medicate our children whether it be antibiotics or ibuprofen and I guess that the plethora of vaccines recommended to us seems like part of the same dynamic. I am in no way adverse to giving my children prescription meds if required, just as we have chosen to get them certain vaccines (pertussis is one example), but there are other lines of defense that seem under-utilized and often ignored.
Cedar Riener: S., I absolutely agree. This is another of my frustrations. There is a wealth of rigorous research on the bad effects of stress, or the influence of diet and exercise on health, but we are constantly looking for a pill to solve whatever ails us. I guess in this case that is why I refer to the medical consensus, which in this case seems to point to many vaccines being more like the prescription meds, but even more so, since the general decision to administer vaccines to the whole population passes through many more levels of consideration and evaluation than one doctor's decision to treat one child with a particular med.
It seems like my personal decision in this case has such clear public health consequences (and a lack of personal consequences), while my preference for local organic food doesn't have quite that direct effect (although there are certainly eventual public health repercusions of our food choices).
E.M.: As a hospital administrator in the NYC public hospital system, I have access to "in the minute" information from the NYC Dept of Health.
I say that because I saw a notice today that there is an outbreak of mumps in a single Brooklyn neighborhood - over 55 cases so far. This is what can happen when herd immunity breaks down!
I don't think people should depend on others to maintain the health of the community - it is a communal responsibility.
Stephanie Tatel: Thanks for that great example of how the herd diminishes. As far as the link to autism, the original Wakefield study that claimed a link has been totally discredited and all of his co-investigators have recanted their statements on that study, and subsequently at least eight valid and reliable studies have come out since then disproving the connection. Now, are vaccines, like ANY MEDICATION, without risks? No, but no one, not even ME, is saying that. Here is a link to the National Vaccine Injury Compensation Program that J. mentions, http://www.hrsa.gov/Vaccin
E.M.: I also want to mention that in 1964 I lost my best friend to German Measles which progressed to encephalitis. She was a teacher who most likely contracted it from one of her students. That was the last big GM outbreak before the vaccine for GM was released. That is what a "harmless" childhood disease can do. As I said, I believe in the effectiveness of herd immunity.
Rachel Levy: What a great and vital discussion this is. I think this will be my last comment on this thread. I am wondering what we can do to get the members of the anti-vaccine movement to listen to the science. I think herbalists know a lot about herbal medicine, which is valid for some medical treatments, but immunologists and other scientists who study infectious diseases are who we should be listening to on protecting ourselves from infectious diseases and on maintaining public health. I have found in these conversations that when I present the science over and over again and hit a wall, I turn to engaging the ethical considerations (hence, the zany umbrella analogy), which I realize can be distracting and unproductive from the primary consideration, which is the science. With vaccination and public health, we have a very small margin of error and only a few people should ethically and medically be allowed to take advantage of that. My question to people who don't vaccinate is why should they be able to take advantage of the safety net? What is their medical reason? And what is their ethical reason? Short-term self interest and exceptionalism do not provide a solid ethical justification. I suppose the problem with that logic is that I am assuming that members of the anti-vaccine movement acknowledge the following: that there is only a small margin of error, that the serious risks associated with vaccinating are infinitesimal, and that in order for us to maintain our current level of public health as many of us as possible must participate in vaccinations. Also, ultimately, in being selfish and not vaccinating, these actors are actually acting in opposition to their own interest, and the interest of their children because if we don't all participate, they will get sick and die too. But in order to truly weigh these ethical considerations, they have to buy into the science first. So, back to my initial question, how do we get people who are in many cases rational, educated, modern people to trust and accept the science?
Because if you're basing these decisions on a belief system (you spiritually believe that the toxins in the vaccines have a high chance of doing your child serious harm) rather than on science and logic (which has proven that vaccines in the vast majority of cases do not do serious harm and that, in fact, not vaccinating on a group scale does do serious harm), then you're adhering to fundamentalism and behaving as a fundamentalist would.
(photo by flickr user tansengming)