MICHELLE MALKIN DISAGREES WITH ME ON VACCINES: “Is there junk science on the anti-vaccine side? Absolutely. But you can’t address this issue without also addressing the problem with physicians who are unwilling to discuss the full risks of vaccines as well as the benefits.” Read the whole thing.
UPDATE: Steven Den Beste emails:
Vaccination refusal is an example of the free rider problem. That’s because of herd immunity. If everyone except Bridget vaccinates their kids, Bridget’s kids benefit from not ever being exposed to the diseases, but they don’t share the (small but nonzero) risk of being vaccinated.
The problem is that like all cases of free riding, too much of it destroys the system. When a large percentage of the population refuses to vaccinate, then herd immunity no longer functions and the diseases return.
And that can negatively affect those who did vaccinate, too, because vaccination doesn’t always work. People who vaccinated their kids, and thus accepted their share of the risk, might still have their kids become sick.
If no one free rides, the failure rate isn’t high enough to be a problem. Herd immunity protects even the kids for whom vaccination failed.
I’m a big fan myself; I’ve gotten lots of non-mandatory vaccinations.
ANOTHER UPDATE: Dr. William Schmidt emails:
I’m an emergency physician. In the past week I treated two kids who weren’t vaccinated at all (2 and 4 years old). The first child’s parents seemed marginally educated and not well-off (living in a trailer park, on an extended vacation). The second child was from California, had very long hair, and his parents seemed like they came right right from the “stuff white people like” blog. They were young, likely very well-educated, wore trendy expensive clothes, and were uncomfortable when I inquired as to his vaccination status. Somewhat amusingly, he had some cold symptoms and they were worried he might be ill because of the lack of previous vaccinations (they were apparently deathly afraid of the pertussis vaccine).
I agree with the criticism of the “free rider” theory. I don’t know anyone in the medical profession personally who disbelieves in vaccinations (unlike claims made on certain websites). And, in response to Michelle Malkin, many pediatricians don’t have time to waste in their very busy day discussing the “risks” of vaccinating one’s children. From personal experience, many parents, especially in the Google age, have just enough knowledge to turn this into a 5-10′ conversation and will often continue to disagree with you afterwards. Ten minutes may not seem like much to the soccer mom who thinks that noted autism researcher Robert Kennedy is infallible, but it is to the pediatrician who would rather spend that time doing something more useful (like seeing another patient).
I’m hearing this kind of thing a lot from my physician readers. And Chuck Simmins emails:
Glenn, as an EMT and highly interested in not dying, I favor vaccination in general. I got the Hep vaccine, for example, since I am exposed to blood borne pathogens. I got the pneumonia vaccine because I had pneumonia shortly before I did it, and pneumonia is the number one killer in a flu epidemic. I got the mumps vaccine because I never had it as a child and I love my parts that could be affected.
The whooping cough vaccine is about 70% effective. Other vaccines also vary in effectiveness.
That said, several years ago we say a world-wide polio outbreak that was traced to Nigeria. Muslim teachers told their people to refuse the vaccine. One or more of them went to Mecca, and suddenly we saw outbreaks throughout the Moslem world including countries that had been polio free for a decade or more.
Parents, like Michelle, in the West do not have two choices, i.e. take the vaccine or risk the illness. By and large the risk of contracting most of the diseases we vaccinate against in the West is non-existent. So, Michelle’s choice is to risk her child having a reaction, a small but clearly definable risk, or to do without. I understand that thought process.
Medical doctors do a lousy job of explaining risks. For the most part, I suspect, it’s because they don’t have a clear understanding themselves. The companies that make and sell vaccines do as little as required. So, Michelle and other parents are trying to do their best in a world where information either comes from kooks or from experts who aren’t really expert.
I have no answers. When asked, I generally point out that there are loads of people we see every day in urban America who may not have the best health because they are poor or immigrants. Unless your child is never around anyone who could have been exposed to a given disease, you should give serious consideration to vaccination. As witness, this post on leprosy and TB in a small community in Arkansas.
Indeed.
MORE: Dr. Kevin Fleming emails:
I am a physician and I very much doubt any connection between autism and vaccines. However.
Medicine is famous for being dogmatic about things that turn out to be wrong later. For example, the “globus†phenomenon, the sensation you have something in your throat, used to be called “globus hystericus†because it was felt to be anxiety or hysteria. Now it’s often thought to be sign of esophageal reflux, to be treated with Prilosec.
Not too long ago, medicine used to believe in frontal lobotomies for the mentally ill. Since I have been in practice, estrogen therapy has been in then out then in then out of favor as a treatment after menopause. But never was there any doubt expressed at the time.
Bruno Bettelheim, the University of Chicago child psychologist favored the now-discredited “refrigerator mother†theory of autism, which blamed autism on mothers who did not want their children to live. Around 1967, he told my mother that she had rejected my autistic older brother “in the womb†and that was why he was autistic. My folks followed his advice and left him on a farm in Illinois. He almost starved to death there. (My dad rescued him as we left the state, but that’s another story).
The point is, medicine is often dogmatic about things which are as yet unproven or unknown. Do vaccines cause autism? Probably not, for there is very little evidence to support that theory of origin. On the other hand, the market speaks, and many consumers are rejecting vaccines. Are they all wrong? Probably, but the perceived relationship may be a clue. Medicine cannot fully reject the theory when there is no real idea what causes autism in the first place. (Prenatal ultrasounds, mercury exposure from eating fish, and genetics are also blamed.) Are answering “almost certainly not†and “there is no evidence†sufficient for parents wishing to avoid a devastating developmental disorder?
My own kids got their vaccines. What would a libertarian do?
In my case, let people do what they want — but shame them a bit for free-riding based on no actual science. Megan McArdle would be . . . a bit less laissez faire. And I still think McCain needs to take back his dumb remarks on the subject. You don’t want to be making health policy based on Don Imus.
STILL MORE: A followup email from Dr. George Milonas:
For all those people who claim they have no risk factors for HPV (Gardasil) which causes cervical cancer or Hepatitis B which causes liver problems (and more), I have had plenty of moms in my office who have told me that their virgin husbands gave them these diseases on their wedding nights. Here’s a truth for all women: men lie, some men lie all the time. It is far better to protect your innocent daughters from preventable diseases than to blindly trust men.
Here are two links that I think are very useful in the vaccine/autism debate. Please note there is little disagreement amongst clinicians or researchers. The debate involves lay people.
I’ll just note that women have been known to lie about these things too.
AND MORE: Further thoughts from Megan McArdle and Katie Granju.