Monday, February 23, 2015

Was I Wrong About Vaccines?

On a recent episode of my podcast, I ranted a little about vaccines. Given the glib nature of the whole thing, I naturally insulted the intelligence of people who choose not to vaccinate their children, and generally lumped the entirety of vaccine holdouts into a single group along with conspiracy theorists, anti-science mystics, and gullible idiots in general. This was rather unfair of me, and I think I realized as much even at the time. However, I've since decided I want to change my tune, largely in response to an article from the Associated Press that made me rethink my position a bit. Could I have been wrong?

In short, no. Far from it. I am not changing my position on the issue. But I do think I got off on the wrong foot. I started this whole thing out taking pot shots at what I thought was a group almost entirely peopled with idiots who consider one or two political talk shows and maybe the word of their pastor to be all the research they need to make sound decisions. But now that I can fully appreciate the truth, that there are in fact a number of reasonably intelligent and healthily skeptical individuals who arrived at the opposite conclusion from mine, my desire to argue the point has actually been reignited.

So with that in mind, I will forego the petty mockery (for the most part) and attempt to defend my viewpoint in earnest. I hope I can still find a way to make it funny now that there are less buffoons to point and laugh at.

First off, to the credit of those with whom I disagree, I will concede the few good points that they make. It's true that dozens of children have died or suffered other serious adverse effects as a result of vaccines. The percentage is minuscule, but it happens. In contrast, the cultural perception that childhood diseases like measles aren't a big deal seems at first glance to be backed up by the fact that the disease has not been directly linked to killing anybody in the United States since its declared eradication, almost 15 years ago now. That's a pretty long losing streak for a supposedly deadly disease.

And of course, while the scientific consensus has been that vaccines are by and large safe and worthwhile to use, people will be quick to point out that the consensus can sometimes be wrong. This is true as well. Physicists can tell you about a time in the last century when the whole of the community was wrong about the mass of an electron. This folly was largely the result of a prominent figure in physics making a simple mistake in their calculations, which was not caught until longer afterward. Other scientists who came up with different numbers for the mass of an electron just assumed they were the ones who made a mistake, because the previously established number was just taken as a given. Scientists are people, after all, and people make mistakes.

So, why then do I still side with the consensus in this matter?

To start with, there is still an unfortunate tendency toward confirmation bias at play here, perhaps on both sides. I was genuinely surprised to learn that there had in fact been no measles deaths in the US since before the year 2000. That is, until I stepped back and considered the larger context. Measles was declared eradicated from the US in 2000. We haven't got a lot of black plague deaths on the books in 21st century America either, but that doesn't make it any less deadly if it comes back.

Hardcore anti-vaccers love that zero-deaths stat because it makes measles sound like nothing to worry about. But that stat is misleading because it fails to take into account any deaths that occurred outside the US since the year 2000, as well as all the ones that took place in the US prior to. If I wanted to make measles sound scary deadly, I could just as easily point to the period from 1989 to 1991, during which time the CDC reported over 100 deaths among some 55,000 cases within the US alone. 55,000 cases and 100 deaths in just three years. That's not even counting areas of the world where vaccines are not readily available or face opposition on cultural or religious grounds.

And what about the fact that most recent measles outbreaks in the US have been associated with importations from other countries? Well, no shit Sherlock. We eradicated measles in this country. Most new cases that happen here will be traceable back to a patient zero who carried it in from another country. Does that knowledge somehow make you safer from the disease? Does it make it any less dangerous or virulent? I'm really curious to know what people who throw that point out are trying to argue. Should we forego vaccination to ward off disease in favor of banning international travel, or just keep our kids away from brown people?

Dan. Dan, Dan, you don't even — you're glib. You don't even know what Measles is.

Fine, sorry. I won't be glib. I promise.

Furthermore, I resent the fact that so many anti-vaccine folks present the choice as a false-dichotomy: vaccinate your child and possibly risk permanent injury or death, or don't vaccinate and maybe risk your kid getting the sniffles. The statistic that measles hasn't killed someone in the US in the past 15 years may be a fact, but the suggestion that measles isn't dangerous is a blatant lie. Even if the fatality rate isn't spectacular, I can't see how risking your child's exposure to a terrible childhood disease is an acceptable risk. Find a friend who had mumps as a kid, or rubella, or chickenpox. Ask them, given the choice, would they rather not have gone through that experience?* Living through those diseases is no picnic. If you're going to potentially expose your child to illness, you'd better be damn sure you know the consequences of what you're doing, and a general distrust of the medical establishment is, in my opinion, not a solid enough foundation for that decision.

*: Incidentally, I was never vaccinated for chickenpox as a kid, I think because it wasn't readily available yet. I got chickenpox when I was little, and that was plenty miserable, but not as miserable as the knowledge we now possess that I am at risk for shingles later in life. Anyone who chose not to give their child the chickenpox vaccine when it became available put their kid at the same risk without even realizing it. So, the "we just don't know for sure what could happen" argument goes both ways.

But the core emotional issue at the heart of this is that parents feel it is their right to make their own decisions about the health and well-being of their child. That in itself is not up for debate; it's a given. I think pretty much every parent feels that same way. In fact, so do those who choose to vaccinate their kids. They're doing it to keep their kids healthy. So, if they find out the school they're sending their kids to has kids running around who aren't vaccinated, that is perceived as someone else endangering the well-being of their child. Because they are. Because that's how infectious diseases work.

Vaccines work best when everybody is using them. The sad reality is they're not 100% effective, and this problem is only exacerbated by individuals in the population who are not vaccinated. The more gaps in the defense there are, the easier it is for a virus to spread and the more a community is opened up to the potential risk of an outbreak.

But again, we keep coming back to the issue that people simply don't trust the research. Anti-vaccine folks have often read the studies, seen the overwhelming consensus, but remain unconvinced and instead point to the few holdouts that suggest their suspicions might be justified. That is confirmation bias in action. I'm all for skepticism and choosing not to accept a claim at face value, but when the scientific consensus says one thing and you say the other based on little more than a hunch, that's not healthy skepticism, it's bordering on denial.

The consensus can be and often has been wrong, but that is not reason to throw away the very notion of consensus. Why on earth would the opinions of hundreds of thousands of experts be less credible than the opinions of one or two? How is that rational decision-making?

Imagine you're at a party, and the 20 assembled people are trying to decide what music to play. 19 of the party-goers want to hear some Bruno Mars. One holdout wants to listen to Mr. Big. I ask you, in this situation, is it reasonable to demand that the 19 others make their argument to convince the single holdout that Bruno Mars is the better choice for the party as a whole? Or would you just say that the one sorry soul who can't let go of the late 80s and early 90s has been outvoted, and understandably so?

Again, the consensus can be wrong. But when a dissenting voice wants to prove the establishment wrong, the burden of proof is on the dissenter, not on the establishment. It is not the job of the scientific establishment to convince every skeptic over and over again. It's the job of the skeptic to find solid compelling proof that the establishment made a mistake.

To date, that solid compelling proof has not been presented. Still, some changes have been made to vaccines over the years in order to make them safer. We actually used to inject children with vaccines that contained traces of mercury. That sounds absolutely terrifying, just as long as you don't know how much mercury a person has to be exposed to before it's actually harmful. Offhand, I'd say I was more at risk from all the arsenic I ingested when my parents gave me apple juice.

My point is, I understand the need to be skeptical about anything you're injecting into your child's body, but until that rock-solid scientific study comes along and passes peer review, it seems like your decisions are being driven less by evidence and more by scary anecdotes and a general unease with pharmaceuticals and anything "unnatural." That general unease is not enough basis to be making a potentially dangerous and life-altering health decision, not only about your child, but all the children they interact with as well.

So, do your research. Opt for prolonged or postponed vaccine schedules for your kids if your pediatrician doesn't have a problem with it. Ask for vaccines without chemical preservatives if it makes you feel safer. But never forget the important role preventative medicine plays in keeping our nation and its people healthy. A child dying or suffering serious injury is a terrible event, but it's also a lot rarer than it used to be, and that's in large part because of the progress our society has made in eradicating diseases that used to kill staggering numbers of children before they reached adulthood.

You want what's best for your child's health? Play it safe. And when I look at the whole cultural context and history of medical science, the safe bet seems pretty clear: vaccinate.

Also, never let your child anywhere near a car. People die in those all the time.

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