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The Risks of Rejecting Vaccinations:

The New York Times reports on public health concerns about the growing number of parents who refuse vaccinations for their children.

Children who are not vaccinated are unnecessarily susceptible to serious illnesses, they say, but also present a danger to children who have had their shots — the measles vaccine, for instance, is only 95 percent effective — and to those children too young to receive certain vaccines.

Measles, almost wholly eradicated in the United States through vaccines, can cause pneumonia and brain swelling, which in rare cases can lead to death. The measles outbreak here alarmed public health officials, sickened babies and sent one child to the hospital.

Every state allows medical exemptions, and most permit exemptions based on religious practices. But an increasing number of the vaccine skeptics belong to a different group — those who object to the inoculations because of their personal beliefs, often related to an unproven notion that vaccines are linked to autism and other disorders.

Twenty states, including California, Ohio and Texas, allow some kind of personal exemption, according to a tally by the Johns Hopkins University. . . .

In 1991, less than 1 percent of children in the states with personal-belief exemptions went without vaccines based on the exemption; by 2004, the most recent year for which data are available, the percentage had increased to 2.54 percent, said Saad B. Omer, an assistant scientist at the Johns Hopkins Bloomberg School of Public Health.

While nationwide over 90 percent of children old enough to receive vaccines get them, the number of exemptions worries many health officials and experts. They say that vaccines have saved countless lives, and that personal-belief exemptions are potentially dangerous and bad public policy because they are not based on sound science.

"If you have clusters of exemptions, you increase the risk of exposing everyone in the community," said Dr. Omer, who has extensively studied disease outbreaks and vaccines.

It is the absence, or close to it, of some illnesses in the United States that keep some parents from opting for the shots. Worldwide, 242,000 children a year die from measles, but it used to be near one million. The deaths have dropped because of vaccination, a 68 percent decrease from 2000 to 2006.

"The very success of immunizations has turned out to be an Achilles' heel," said Dr. Mark Sawyer, a pediatrician and infectious disease specialist at Rady Children's Hospital in San Diego. "Most of these parents have never seen measles, and don't realize it could be a bad disease so they turn their concerns to unfounded risks. They do not perceive risk of the disease but perceive risk of the vaccine."

Zacharias (mail):
Vaccinations carry risks, so obviously it is smart t o promote vaccinations for everyone else's children. It's also obvious that personal reasons count as much as religious superstition in exempting a child from vaccination!
3.21.2008 11:17am
FantasiaWHT:
I think this is one of the clear cases where the government interest (in vaccinating all or nearly-all children) would survive strict scrutiny.
3.21.2008 11:17am
Qwerty:
Some parents of unvaccinated children go to great lengths to expose their children to childhood diseases to help them build natural immunities.

In the wake of last month's outbreak, Linda Palmer considered sending her son to a measles party to contract the virus. Several years ago, the boy, now 12, contracted chicken pox when Ms. Palmer had him attend a gathering of children with that virus.

"It is a very common thing in the natural-health oriented world," Ms. Palmer said of the parties.


This is the craziest damn thing I've ever heard in my life!
3.21.2008 11:19am
Duffy Pratt (mail):
Qwerty:

Its not crazy at all. With chicken pox, it can be better to get them when you are younger because it can be easier for the parents to control the scratching and eliminate pox marks. For german measles, it can make sense for a couple of reasons -- german measles is much more dangerous to adults than children, and because a parent might want the kids to get the disease while the mother is not pregnant. Not sure on measles.

I had them all as a kid -- measles, chicken pox, mumps, german measles. I don't know if the idea that getting diseases strengthens immune systems is true or not, but its certainly plausible. Have there been any studies on vaccination and susceptibility to allergies?
3.21.2008 11:28am
Waldensian (mail):

"It is a very common thing in the natural-health oriented world," Ms. Palmer said of the parties.

There is no "natural-health oriented world." There is no "alternative medicine." There is evidence-based health care, and then there is health care that is not based on evidence. A large portion of the latter is total and complete BS; and some of that is actually dangerous to your health.

I cannot fathom a person who wants his or her kid to contract measles. I would love to hear her "reasons" for exposing her kid to this dangerous disease.
3.21.2008 11:32am
ChrisIowa (mail):

This is the craziest damn thing I've ever heard in my life!


You must have had a very short or very protected life. I heard of this kind of thing happening in the 1970's and 1980's, and not among people you would think to be wierdos. I think it may have happened in the 1950's with some of my elementary school classmates but my memories of that are suspect 'cause I was just a kid.
3.21.2008 11:34am
Mr. X (www):
I cannot fathom a person who wants his or her kid to contract measles. I would love to hear her "reasons" for exposing her kid to this dangerous disease.


Contracting measles provides greater immunity than the measles vaccine.
3.21.2008 11:35am
ejo:
well, look back at the numbers for people with the diseases in the glorious era before vaccination-actually, you don't have to. you can go to third world countries and see the wonderful world of natural health in all its glory. in an era where the world is smaller than ever and we have undocumented and untested third worlders flooding our country, are parents really so stupid? as to DP, why stop at those diseases, let's throw in polio, another blast from the past.
3.21.2008 11:36am
Dan Weber (www):
It was very common to purposefully expose your kids to things like chicken pox back in the day.

The risks were similar to those of vaccines, including the fact that sometimes the immunity wouldn't take.

I'm not really surprised to hear that it's rich families doing this stuff nowadays. If there's anything they want to avoid, it's their kids being normal. Yuck!
3.21.2008 11:37am
Matt_T:
Duffy Pratt:
Your argument does nothing to strengthen the idea that "measles parties" aren't completely crazy. A measles vaccine will prevent measles as an adult at least as well as exposure to measles as a child. Secondly, the fact that you survived a risky illness without long-term effects doesn't support the idea that everyone will. Measles parties are completely crazy and wrongheaded, as are all medical decisions that ignore the evidence in favor of a safer and more effective alternative.
3.21.2008 11:39am
wekt:

They say that ... personal-belief exemptions are potentially dangerous and bad public policy because they are not based on sound science.

Regardless of the merit (or lack thereof) of declining to vaccinate one's child out of fear of side effects, I think one thing is clear. The belief that the gov't has the authority to forcibly inject someone with foreign material is profoundly un-American and freedom-hating. For the gov't to use force (or the threat thereof) to coerce someone to 'voluntarily' accept such an injection is not as bad, but is still a dangerous and anti-freedom position, IMHO.
3.21.2008 11:41am
Mr. X (www):
A measles vaccine will prevent measles as an adult at least as well as exposure to measles as a child.


You have data for that particular claim?
3.21.2008 11:44am
Roger Schlafly (www):
The article fails to mention that the initial case came in from Switzerland.

As public health concerns go, this is a rather trivial one. 12 kids got sick. A few of them missed a week or two of school. If that seems like a big risk to you, then get a measles vaccination for your kid. Otherwise, it is no big deal.
3.21.2008 11:45am
Waldensian (mail):
Duffy:

You're not contending that intentionally contracting measles (a disease with known and serious, if somewhat rare, risks) is better for your health than having the measles vaccination -- correct?
3.21.2008 11:46am
MDJD2B (mail):

You must have had a very short or very protected life. I heard of this kind of thing happening in the 1970's and 1980's, and not among people you would think to be wierdos. I think it may have happened in the 1950's with some of my elementary school classmates but my memories of that are suspect 'cause I was just a kid.

This happened in the pre-vaccination era. The diseases were thought to be more severe when adults got it. Exposure during childhood was the best strategy, as there was no protection for susceptible adults during epidemics. The danger for adults was certainly true of mumps, in which adults were likely to become sterile. Ditto for polio.

Even in children, severe complications of measles are not rare. Rubella (German measles) generally is mild, even in adults, but is severly teratogenic (causes birth defects).

Those who don't vaccinate their kids are parasites on those who do. The risks of vaccination are negligible, though not zero. To rely on others to assume these risks (and expense) to protect your own kids is despicable.

Jacobson and Zucht clearly allow compulsory vacination. The former is based on police power, and the latter on that and parens patriae. The validity of the parens patriae doctrine has been reaffirmed in Priest. Free Exercise challenges have uniformly been rejected by various courts, provided there was no interreligious discrimination. Any religious exemption must be blanket, and not just include well-established sects whose official tenets preclude vaccination (essentially, only Christian Science). So if you are a chiropractor who belongs to the Church of Natural Healing, which only has 5 members, you get a pass. In some states, religious exemption is not privileged unlwss non-religious exemption is also privileged.

Unfortunately, the state of the law has led most states to allow blanket exemptions, rather than requiring blanket vaccination with only health exemptions (a carve-out in Jacobson). I believe that only WV and MS do not allow conscientious objection to vaccination. This allows Mrs. Palmer and Mrs. Carlson (see the original article) to expose my kids and yours to measles, even they know and freely admit that they are endangering them.
3.21.2008 11:54am
Waldensian (mail):

Regardless of the merit (or lack thereof) of declining to vaccinate one's child out of fear of side effects, I think one thing is clear. The belief that the gov't has the authority to forcibly inject someone with foreign material is profoundly un-American and freedom-hating. For the gov't to use force (or the threat thereof) to coerce someone to 'voluntarily' accept such an injection is not as bad, but is still a dangerous and anti-freedom position, IMHO.

As much as I despise the free-riding, idiotic risk-analyzing, people-without-real-problems anti-vaccine nuts......

I am forced to agree with this.
3.21.2008 11:55am
MDJD2B (mail):

The belief that the gov't has the authority to forcibly inject someone with foreign material is profoundly un-American and freedom-hating.


The Jacobson opinion was written by Justice Harlan for a 7-2 court, and was issued in 1905 within 2 months of Lochner. Zucht was written in 1922 by Justice Brandeis, and was a unanimous decision. This was the court that wase writing Pierce, Meyer, and various early free speech opinions. There has never been a serious challenge to compulsory vaccination.

Maybe you are un-American.
3.21.2008 12:01pm
Dan Weber (www):
As public health concerns go, this is a rather trivial one. 12 kids got sick. A few of them missed a week or two of school. If that seems like a big risk to you, then get a measles vaccination for your kid. Otherwise, it is no big deal.

How long has it been since the last measles outbreak? There's a reason this was news.

The no-vaccine crowd is growing. International travel is growing. This is a sign of things to come.
3.21.2008 12:06pm
Qwerty:
Duffy, it is certainly crazy to infect your kid deliberately when a vaccine is available.

ChrisIowa, I grew up well before the vaccine was available, and I never heard of any such craziness, not least because most people I knew got chickenpox naturally, without a party.
3.21.2008 12:08pm
Qwerty:

Regardless of the merit (or lack thereof) of declining to vaccinate one's child out of fear of side effects, I think one thing is clear. The belief that the gov't has the authority to forcibly inject someone with foreign material is profoundly un-American and freedom-hating. For the gov't to use force (or the threat thereof) to coerce someone to 'voluntarily' accept such an injection is not as bad, but is still a dangerous and anti-freedom position, IMHO.


Humbug. Your freedom ends where your ability to infect countless other people begins.
3.21.2008 12:12pm
M (mail):
What you have to recognize is that some of the kids who got sick were immunized. Immunizations rely on "herd immunization" effects, such that it is hard for diseases to successfully transmit from one person to another. By choosing not to get immunized, the 9 kids who got measles, in a very real sense, got the 3 immunized kids sick.

So why not sue the parents practicing negligent, non-evidence based medicine, in tort?
3.21.2008 12:29pm
Fub:
MDJD2B wrote at 3.21.2008 10:54am:
This happened in the pre-vaccination era. The diseases were thought to be more severe when adults got it. Exposure during childhood was the best strategy, as there was no protection for susceptible adults during epidemics. The danger for adults was certainly true of mumps, in which adults were likely to become sterile. Ditto for polio.
Definitely. My grandfather, who lived from the second half of the 19th to the middle 20th centuries, was "vaccinated" against smallpox this way. His mother had contracted, and survived, the pox when he was a young child. In the very late stage of the disease, when the pox had ceased erupting and the old eruptions were healing, she followed the advice of both physicians and "folk medicine" at the time.

She took a scab from a pox eruption, scratched his upper arm, and planted the scab on it.

He had one hella big vaccination scar from it. But he never contracted full blown smallpox.

I think it would be completely nuts to do this today. But in the circumstances of the time and place, it was a rational thing to do.
3.21.2008 12:38pm
FantasiaWHT:

The belief that the gov't has the authority to forcibly inject someone with foreign material is profoundly un-American and freedom-hating. For the gov't to use force (or the threat thereof) to coerce someone to 'voluntarily' accept such an injection is not as bad, but is still a dangerous and anti-freedom position, IMHO.


Your freedom there ends when it threatens the health and lives of others. Especially as the risk of major outbreaks increases exponentially compared to the number of un-immunized.
3.21.2008 12:44pm
Mary Katherine Day-Petrano (mail):
Here's another significant part of the equation: the proliferation of diseases as we increasingly experience abrupt climate change due to global warming. Added to that are the 20 million + pool of illegals in this Country with unknown vaccination status, and the A-B-C-D test taker dumb downs who are not vaccinating their children. All of it creating a very serious future public health crisis for the rest of us.
3.21.2008 12:45pm
Nick P.:
Fub:

FWIW, your grandfather wasn't "vaccinated." He was "variolated" using the actual Variola virus. Variolation has a long history. Yes, it was effective, and yes, it was very dangerous. IIRC, the puritan preacher Jonathan Edwards died as a result of variolation.
3.21.2008 12:49pm
Dan Weber (www):
Humbug. Your freedom ends where your ability to infect countless other people begins.

We let people have freedoms that could be dangerous to other people all the time.

We let them have freedom of speech even though they could incite a riot. We let them have guns even though they could kill people. We let them drink beer even though they could go driving afterwards.

We deal with people abusing their freedoms by not restricting them beforehand, but by punishing them afterwards. It might sound "inefficient," but it's definitely more free.

Why can't we deal with the no-vaccine crowd the same way? Just hold people responsible once they transmit a disease, when they have neglected simple steps to avoid doing so.

(Or is this a case where "won't somebody please think about the children!!!"?)
3.21.2008 1:10pm
A. Zarkov (mail):
Waldensian:

There is evidence-based health care, and then there is health care that is not based on evidence.

Evidence-based medicine is a movement within mainstream medical practice. From Wikipedia:

Using techniques from science, engineering, and statistics, such as meta-analysis of medical literature, risk-benefit analysis, and randomized controlled trials, EBM aims for the ideal that healthcare professionals should make "conscientious, explicit, and judicious use of current best evidence" in their everyday practice.

snip

Evidence-based medicine has demoted ex cathedra statements of the "medical expert" to the least valid form of evidence. All "experts" are now expected to reference their pronouncements to scientific studies.
Strictly speaking most of the medical practice in the world is not evidence based. As I found out, even the doctors at the well-respected Mayo Clinic, do not in general, base their decisions on evidence as described above. Example: for some patients they advocate a "saturation biopsy" of the prostate. They do not know how much the extra needles increase the sensitivity (probability of a false negative) of the test. Obviously the more needles the better, but they do not how much better. Thus they are unable to make the trade off between extra trauma and extra sensitivity.

However the critics of EBM present a good case for not following EBM. You can read them in the Wikipedia article.
3.21.2008 1:11pm
A. Zarkov (mail):
There are few instances where the common good trumps individual rights. We draft people for war. We quarantine people with hyper-infectious diseases like small pox. We sequester certain lunatics deemed a threat to the community. We force people to serve on juries.

Of course determining the "common good" might get difficult and contentious in some cases. The US 1964 Civil Right Act limits certain individual rights, and the benefits mainly accrue to a minority. Is this the "common good" or vote harvesting politics? We stop people from polluting. We make them wear seat belts. We don't let them use certain additive substances.

Requiring people to vaccinate their children is another one of those cases where we violate individual liberties for the common good. You can argue that the "good" is not good enough. But you can argue that for lots of other things too.
3.21.2008 1:29pm
MDJD2B (mail):
Right. There isn't evidence to support a lot of decisions that have to be made. And even when there is, the indivisual patient often has unique features that affect the applicability of the evidence, which is based on group trials.

EBM is an approachable, but unreachable goal, like a limit in a calculus problem.
3.21.2008 1:32pm
Qwerty:
We let people have freedoms that could be dangerous to other people all the time.

Because we consider that the "harm" of restricting the freedom outweighs the "good" of letting them have them. In this case, the harm of a vaccination is negligible (it is at most philosophical, not real) whereas the potential harm of an epidemic is real and significant, and no "good" is achieved by allowing people to go unvaccinated.

We let them have freedom of speech even though they could incite a riot. We let them have guns even though they could kill people. We let them drink beer even though they could go driving afterwards.

These are poor analogies. None of these potential harms is comparable to "we allow people to go unvaccinated even though they could start a major epidemic".

We deal with people abusing their freedoms by not restricting them beforehand, but by punishing them afterwards. It might sound "inefficient," but it's definitely more free.

When your "freedom" may harm great numbers of other people, it needs to be restricted beforehand.
3.21.2008 2:02pm
Dan Weber (www):
We quarantine people with hyper-infectious diseases like small pox. We sequester certain lunatics deemed a threat to the community.
The risk in both those circumstances has presented itself. Imminent harm and all that.

An unvaccinated person is no more risky than my neighbor with his gun. The unvaccinated person becomes dangerous when a disease enters the community. My neighbor's gun only becomes dangerous when someone decides to (mis)use it. Until then, I need to get over my fears that something somewhere will go wrong.
3.21.2008 2:13pm
ithaqua (mail):
"An unvaccinated person is no more risky than my neighbor with his gun. The unvaccinated person becomes dangerous when a disease enters the community. My neighbor's gun only becomes dangerous when someone decides to (mis)use it."

Note the italicized word above. If someone decides to misuse a weapon, they're responsible for their actions, and their due punishment acts as a deterrence to those who might decide to do the same thing. Getting sick and becoming contagious is not a 'decision' (unless one is a suicidal terrorist or some such) - even if someone decides to quarantine himself should he catch something contagious, in most cases, the diseased person becomes contagious before he or she even realizes he has the disease. The conscious decision in the former case is to shoot the gun or not shoot the gun, and the law should focus on that point; the conscious decision in the latter is to vaccinate or not to vaccinate, and the law should focus on that point.

Do you think (as an analogy) that someone who leaves their baby sitting in the middle of a six-lane highway should only be charged with a crime if someone actually runs the baby over?
3.21.2008 2:28pm
ithaqua (mail):
Also, there are all sorts of precautions one can take to prevent the guns one owns from being misused. What sort of precautions can one take, on an individual level, to prevent "a disease enter[ing] the community"?
3.21.2008 2:30pm
Dan Weber (www):
None of these potential harms is comparable to "we allow people to go unvaccinated even though they could start a major epidemic".

How many of the immunized crowd will die off? People have posted 5% as the number of immunized folks for whom immunization doesn't take. At a death rate of 1 in 1,000 for measles, we're talking about 15,000 deaths across the US.

Now, while 15,000 deaths is surely nothing to sneeze at, realize that we lose 3 times that many from car crashes every year. Plus, that's assuming a total saturation of the population. When 95% of the population is immune, it will dramatically restrict the ability of the disease to transmit. We won't see vaccinated families wiped out; most won't even get sick.

The disease will fall primarily on the unvaccinated wackos As the outbreak in the NYT said, 3/4 of the people hit in the measles outbreak had explicitly been opted out. The remaining 1/4 should consider suing for damages.
3.21.2008 2:36pm
Visitor Again:
The belief that the gov't has the authority to forcibly inject someone with foreign material is profoundly un-American and freedom-hating. For the gov't to use force (or the threat thereof) to coerce someone to 'voluntarily' accept such an injection is not as bad, but is still a dangerous and anti-freedom position, IMHO.

What do you think about the government forcibly confining someone with tuberculosis or typhoid fever?
3.21.2008 2:40pm
Visitor Again:
Sorry--asked my question before finishing reading all comments and later found it was covered already.
3.21.2008 2:41pm
Dan Weber (www):
Note the italicized word above. If someone decides to misuse a weapon, they're responsible for their actions, and their due punishment acts as a deterrence to those who might decide to do the same thing.

Well, I could also raise the fear-monger of saying "well, what if my neighbor gets all drunk and decides to go on a shootin' spree?" (Because we all know that's what people who own guns are like, right?)

But I do think that we should punish those who consciously forego immunizations and end up transmitting diseases. Won't that serve the same deterrence as punishing people who misuse their guns? (Plus add in the fact that these folks will hardest hit by the next measles outbreak, which is inevitable.)

Do you think (as an analogy) that someone who leaves their baby sitting in the middle of a six-lane highway should only be charged with a crime if someone actually runs the baby over?

No, they are putting the baby at a significant risk of immediate danger.

Do you think a child playing in the middle of the street is just as likely to be hurt as an immunized child playing with an unimmunized child? Do you think those two risks are even within a few orders of magnitude of each other?

Also, there are all sorts of precautions one can take to prevent the guns one owns from being misused.

What can I do to stop my neighbor from misusing his gun?

Answer: Nothing. I just get over it and stop living a life governed by fear.
3.21.2008 2:54pm
Duffy Pratt (mail):
If everything else is equal, then I think it makes sense to vaccinate. There's no reason to risk the complications of the illness if the vaccine can 1) provide the same level of immunity for adults as contracting the disease and 2) does not have any other bad consequences. I'm not sure if either of those is true.

Something is causing the increase in allergic reactions that seems so common with today's kids. When I was growing up, things like the peanut allergies were very rare. That's why I asked whether anyone has tried to do a study linking vaccinations to allergies. Suppose, just for a second, that avoiding these illnesses through vaccination made it that much more likely that your kids would develop severe allergies, so that the mere presence of peanuts put them in danger of going into shock. Would that change your idea of the merits of the vaccinations?

As for chicken pox, I think I would want my kid to be a free rider on this one. By eliminating chicken pox, we're creating an epidemic of shingles. I've had them both. Thankfully the shingles went away after a couple of months, and I really hope I don't get them again. In terms of the pain they cause, shingles are much worse than chicken pox. I've seen studies that suggest that the vaccine makes people more likely to get shingles than having had the disease. So, avoiding the vaccine in a world where lots of people are vaccinated would make it more likely that my kid would not get the virus at all and never have to suffer either chicken pox or shingles.
3.21.2008 3:15pm
Fub:
Nick P. wrote at 3.21.2008 11:49am:
FWIW, your grandfather wasn't "vaccinated." He was "variolated" using the actual Variola virus. Variolation has a long history. Yes, it was effective, and yes, it was very dangerous. IIRC, the puritan preacher Jonathan Edwards died as a result of variolation.
Thanks for the nomenclature information. Makes sense to me that "vaccination" is for cowpox and "variolation" is for variola.

It would also make sense to me that he was actually vaccinated. That is, his mother may have actually contracted cowpox, not smallpox. It happened when he was a small child. I heard the account from my grandparents when I was a small child. So the possibility for some confusion or garbling was present for both generations.

Either way, though, he got a huge rambling scar on his left upper arm. Between that and my father's contracting and (just barely) surviving the 1918 "Spanish flu", the fact that I'm here to have this conversation seems more amazing to me the older I get. And the silly reasons for declining various vaccinations for one's children seem even sillier.
3.21.2008 3:27pm
ithaqua (mail):
Dan Weber: you're missing my point. There's no mens rea involved in either catching or transmitting a disease (except, again, for a handful of twits who do it deliberately); the conscious act is the choice to vaccinate or not to vaccinate, and the appropriate time for the law to step in is there. Punishing only those people who happen to come down with a contagious disease is (1) unjust, because again, people don't choose to come down with, for example, measles, and (2) counterproductive, given that it makes the disease itself the crime and so encourages people to conceal their symptoms and act normally, with unpleasant public health consequences...
3.21.2008 3:29pm
JDS:
This is a law blog. How about this hypothetical case: a parent declines to immunize a son who subsequently contracts measles. An immunocompromised girl in boy's class contracts measles - shown by DNA probles to have come from the boy. The girl spends three weeks in the hospital and emerges blind and neurologically compromised.

Does the girl have a case against the boy's family?
3.21.2008 3:33pm
TDPerkins (mail):
Does the girl have a case against the boy's family?


It should be so. The law may be an ass.

Yours, TDP, ml, msl, &pfpp
3.21.2008 3:40pm
Dan Weber (www):
Hm, I think I'm seeing what you're getting at.

I wasn't proposing that being sick be actionable, rather the act of getting someone else sick. Of course, as you point out, it would be difficult to track down who gave a communicable if people are hiding their symptoms.
3.21.2008 3:42pm
John Burgess (mail) (www):
There is no monetary compensation adequate to truly compensate for the loss of a child. What? Pay the funeral expenses?
3.21.2008 3:58pm
theobromophile (www):
I haven't read all the posts, so pardon me if any of this is repetitive.

The Jacobson decision was not a carte blanche for the government to vaccinate whomever they wanted, with whatever they wanted, whenever they wanted, and against any disease. The rationale was based upon the safety of the vaccine, the (then-current) epidemic of smallpox that swept through Massachusetts, and the deadliness of the disease.

Since then, we've vaccinated children (and adults) with pretty much every single thing that pharmaceutical companies will come out with. Chicken pox? Sure! Hepatitis B for infants? Awesome!

We are no longer in an era of inexpensive, well-proven vaccines for deadly diseases. I'm not surprised to see this backlash; I only wish that the parents would at least vaccinate their children against the really bad stuff, while letting their immune systems fend off varicella.

There is also the free-rider issue: most parents assume that if other parents vaccinate their children, their own kids can't contract the disease. It is always safer to not vaccinate than to vaccinate (in terms of vaccine side effects), because even the most minimal side effects are worse than nothing. This breaks down for several reasons (not just the Kantian imperative to act in a manner that produces good results if everyone else did the same); in an era wherein there is increased immigration from countries without routine childhood immunizations, and without quarantine at entry, parents are simply incorrect in assuming that their children will be surrounded with vaccinated kids.

As for allergies and vaccinations: there is a very, very strong correlation between the increase in childhood allergies and the rise in mandatory vaccinations. There is a good graphic here which illustrates this point. IIRC, childhood allergies began to increase (rather dramatically) in the mid-1990s.

Ideally, states would set up a two-tier system for mandatory and suggested vaccines, limiting the mandatory vaccines to deadly, highly communicable diseases. That would at least allow parents who are worried about the development of their child's immune system to opt-out of varicella and the like, while ensuring that their children are protected against polio.

As a final thought, a lot of parents (wealthy or not) do not want to line the pockets of pharmaceutical companies. There are a lot of complaints about Merck's role in pushing for mandates for Gardasil.
3.21.2008 3:59pm
MDJD2B (mail):

The disease will fall primarily on the unvaccinated wackos As the outbreak in the NYT said, 3/4 of the people hit in the measles outbreak had explicitly been opted out. The remaining 1/4 should consider suing for damages.

Problems with above remedy:

There generally is no duty in tort to third parties. If I do not immunize my kid, the person my kid gives measles to is a third party, me and my kid being the first two.

Also, it is hard to prove proximate cause. How do you know which person actually transmitted the disease to the third person.

Finally, now that the third personwho caught the disease (hypothetically) is dead or a vegetable, how much good does the recovery do him or his next of kin? Are monetary damages really a good remedy?
3.21.2008 4:00pm
MDJD2B (mail):

That's why I asked whether anyone has tried to do a study linking vaccinations to allergies. Suppose, just for a second, that avoiding these illnesses through vaccination made it that much more likely that your kids would develop severe allergies, so that the mere presence of peanuts put them in danger of going into shock. Would that change your idea of the merits of the vaccinations?

Prove it, and demonstrate the magnitude of the rise in allergies related to immunization, and there's something to discuss.

I used to have I slide shoeing the correlation between the increase in the number of Pap smears and the decrease in the amount of stomach cancer. The point was to cast doubt on drawing conclusions from the sort of observation that (if the rise in allergic kids is real) you just made.
3.21.2008 4:05pm
theobromophile (www):
How many of the immunized crowd will die off? People have posted 5% as the number of immunized folks for whom immunization doesn't take. At a death rate of 1 in 1,000 for measles, we're talking about 15,000 deaths across the US.

Lower, actually. If 5% of the measles vaccines don't take, that doesn't mean that 5% of the population will contract the disease. There is a critical mass, beyond which the disease does not spread. As a data point, 30-40% of the pertussis (whooping cough) vaccines wear off, but only 1.2 in 100,000 people get that disease every year (yours truly was among the vaccinated persons who did so, back in the 1990s), and most of those are infants.

---

Final note: please consider the cost of the vaccines. I know that when you're talking human life or the very deadly diseases, the cost looks unimportant. Consider, however, HPV. It costs between $360 and $400; prevents, at most, 70% of the viruses that cause cervical cancer; does not prevent cervical cancer from other causes (smoking, childbirth, early intercourse, etc.); and prevents a disease that is between 95% and 99% curable if caught early (i.e. if women get the Pap smears yearly, which they would need to do, vaccinated or not). Oh, yeah, and even now, cervical cancer amounts to about 2/3ds of 1% of the cancer in the U.S. every year. Worth the $400?
3.21.2008 4:07pm
MDJD2B (mail):

The disease will fall primarily on the unvaccinated wackos As the outbreak in the NYT said, 3/4 of the people hit in the measles outbreak had explicitly been opted out. The remaining 1/4 should consider suing for damages.

Oh, yeah-- one other thing. The defendant has to be able to pat the damages, and most people don't have the assets to pay the economic damages associated with a severe case of measles, let alone the pain and suffering.
3.21.2008 4:18pm
Dan Weber (www):
There is no monetary compensation adequate to truly compensate for the loss of a child. What? Pay the funeral expenses?

Finally, now that the third personwho caught the disease (hypothetically) is dead or a vegetable, how much good does the recovery do him or his next of kin? Are monetary damages really a good remedy?

Awesome, let's ban guns. Because your gun might kill my kid, and there's nothing that can undo such a loss! WON'T SOMEBODY PLEASE THINK ABOUT THE CHILDREN!!?!!11one
3.21.2008 4:27pm
theobromophile (www):
I used to have I slide shoeing the correlation between the increase in the number of Pap smears and the decrease in the amount of stomach cancer. The point was to cast doubt on drawing conclusions from the sort of observation that (if the rise in allergic kids is real) you just made.

Stupid question of the afternoon: that wouldn't have anything to do with the fact that Pap smears catch abnormalities long before they turn cancerous, or cancer moves outside the cervix, and stage IV cervical cancer involves the cancer spreading throughout the abdomen?

Depending on how many cases of stomach cancer there are every year, I could see how you could arrive at a statistically significant correlation for that reason - although, of course, I'm assuming that stomach cancer is classified as any cancer affecting the stomach, not merely that which originated there.
3.21.2008 4:41pm
Entertained by the Title:
At first glance, I thought it meant something else.
My mom is one of those who "opted out" on some of my vaccines? Crazy woman out to destroy me, or leave me to be run over by a car in the middle of the road? Hardly.
I'm one of those people with idosyncradic (read: bad) reactions. Namely, I became ill after my first set of vaccinations. She checked to see if it was normal. "All kids get sick after their shots," said the doctor. So my mom took me back in for my next set of shots. I became rather ill, with a fever that concerned my mom. She called the doctor to ask about my symptoms. "All kids get sick after their shots," said the doctor. My mom reluctantly took me for my next set, but started asking LOTS of questions. I don't remember the reaction sickness from the last set I got, but I understand it's the only time I had anything that caused my temperature to stay over 105. Fever that high is severe, so my mom called the doctor for treatment. "All kids get sick after their shots," said the doctor. He was NOT willing to consider the possibility that I was having an abnormal reaction, and apparently the staff started acting as if it was something she was doing to me. She decided they were part right: she was taking me to get the shots. Some people have called not taking your kids to get vaccines abuse. Is it child abuse to knowingly take your child into an escalation that may very will kill them the next time they're exposed to it? While I can't say it's a valid thing for everyone to worry about the correlation of random allergies to the shots (I think it has more to do with an immune system not seeing any regular grubby germs anymore with being indoors so much and so overreacting to pollens and dander, personally, but I have no direct proof), would you say she and I have a right to pinpoint the causation of these episodes of increasing severity?
Here's the deal: vaccines are great as a backfire to the forest fire of a rampaging pandemic. But if you force everyone to get one... just as some trees and scrub are forfeit in the backfires, so too would people's lives be in this situation. We're not in a pandemic situation; quarentines and vaccines are the equivalent of fire breaks and backfires and SHOULD be used in such a situation, because the number of people that will die will be fewer that way. But people WILL die from the forced prevention of more people contracting a modern-day plague, some who will make great sob stories: I was a really cute 4 year old. Should I have been allowed to live long enough to post this? I'd like to think so; I never contracted anything other than regular chicken pox, and that only after half my better-vaccinated class got sick with it. If, heaven help us, some monster something got loose, Big Gov't quarantined the big city next door &grounded all flights from the international airport, demanded that all the suburbs get vaccinated, and there was no room for reaction cases like me in the hospitals? I'd tell my family I loved them and update my will. I'm not more important that you. But I won't go out and get a flu shot in a normal year just for your peace of mind, and I will claim any exemption I can for 'standard procedure' that will adversely impact my health. You would, too, wouldn't you?
Sorry if that was a bit longwinded: matters of life and death tend to push buttons.
3.21.2008 5:19pm
Entertained by the Title:
"And what about Medical Exemptions? That's what they're for, right?" I'm sure some of you are thinking. Yes. But the doctor in the previous tale refused to grant us one. Because (see above) all kids get sick after their shots, and if he granted us one, everyone would be wanting one. No, I'm not making this up out of whole cloth. Sometimes and in some places, your selections are limited. And, at least at that time and place, only doctors could grand medical exemptions. I'm really not sure now, but that's probably still true.
3.21.2008 5:25pm
Jim Miller (mail) (www):
FWIW, during the 1950s, when there was no vaccine for German measles (rubella), parents sometimes exposed their daughters to the disease, in order to protect future grandchildren.

I thought then that it was a sensible precaution, and would favor it now, if we did not have a vaccine.
3.21.2008 7:28pm
MDJD2B (mail):

Depending on how many cases of stomach cancer there are every year, I could see how you could arrive at a statistically significant correlation for that reason - although, of course, I'm assuming that stomach cancer is classified as any cancer affecting the stomach, not merely that which originated there.

I meant PRIMARY stomach cancer, not metastatic. And cervical cancer does not metastasize to the stomach anyway. I showed the slide as an example of a correlation in which any showing of causality would be spurious.

Nice try.
3.21.2008 8:06pm
jdgjtr:
I started taking courses leading to a BS in Medical Technology in 2006. I had my vaccinations so long ago, they were considered to be inadequate. I had to get MMR, DPT and had to have a Varicella zoster titer to prove I was immune to Chicken Pox. I am 46 and most vaccines don't "take" after age 35 or so. Did I mention that it was an online program? Did I mention that the University is in Ohio and I live in Mississippi? Do I think mandatory vaccinations are stupid in some cases?
3.21.2008 9:08pm
theobromophile (www):
I meant PRIMARY stomach cancer, not metastatic. And cervical cancer does not metastasize to the stomach anyway. I showed the slide as an example of a correlation in which any showing of causality would be spurious.

Nice try.

Cut the sarcasm. You did not say "primary stomach cancer"; you said "stomach cancer." Oh, yeah, and, as you kindly blockquoted, I even mentioned that assumption. So get out of your snit and stop being the jerk from hell.
3.21.2008 10:45pm
Eli Rabett (www):
A good case for lawyers to look at is the row over the mumps/measels/rubella triple jab in Britain. A 1998 study associated this vaccine with autism. Everything since then said there was no link. Vaccination rates dropped to 80%, although in some cases parents had their kids get single injections. The author of the study that touched this all off, Andrew Wakefield was hauled up in front of the medical licensing authorities
http://news.bbc.co.uk/2/hi/uk_news/6900974.stm

Can;t find the outcome.
3.22.2008 12:07am
neurodoc:
MDJD2B: I meant PRIMARY stomach cancer, not metastatic. And cervical cancer does not metastasize to the stomach anyway. I showed the slide as an example of a correlation in which any showing of causality would be spurious.
theobromophile:Nicetry.

Cut the sarcasm. You did not say "primary stomach cancer"; you said "stomach cancer." Oh, yeah, and, as you kindly blockquoted, I even mentioned that assumption. So get out of your snit and stop being the jerk from hell.

I would tell you that the person you are debating about "stomach cancer" and cancer of the cervix, MDJD2, is an exceedingly well-trained and accomplished academic gynecologic oncologist. And it's not just that he has the credentials to speak authoritatively about cancer, especially cervical cancer, it is that he is right about the medicine and about "correlations" that say nothing about causal relationships. ("Correlation" may support the conclusion that a causal relationship exists, but one can have "a statistically significant correlation" without causation.) So "jerk from hell" is particularly inapt in his case.

BTW, many cancers comonly metastasize to liver, lungs, bones, and brain, few do so to the stomach, and I'll take MDJD2B's representation that cancer of the cervix isn't one of them. When doctors speak of "cancer of the brain" or "brain cancer," at least the informed ones, they usually have reference to primary brains tumors (e.g., gliomas, meningiomas, etc.), not cancers primary to other organs that have metastasized to the brain. And "cancer of the stomach" or "stomach cancer" would be understood by them to mean gastric carcinoma, a very bad cancer to have, or one of the more rare tumors of the stomach, not cancer that had spread to the stomach.

Final note: please consider the cost of the vaccines. I know that when you're talking human life or the very deadly diseases, the cost looks unimportant. Consider, however, HPV. It costs between $360 and $400; prevents, at most, 70% of the viruses that cause cervical cancer; does not prevent cervical cancer from other causes (smoking, childbirth, early intercourse, etc.); and prevents a disease that is between 95% and 99% curable if caught early (i.e. if women get the Pap smears yearly, which they would need to do, vaccinated or not). Oh, yeah, and even now, cervical cancer amounts to about 2/3ds of 1% of the cancer in the U.S. every year. Worth the $400?
Since you are suggesting a cost/benefit analysis where the vaccine is concerned, what is the cost of a year Pap smear, including the costs attendant with the visit and interpretation of the smear? What is the false positive and the false negative rate in good hands, and what in not so good hands? What is the cost to treat an "abnormal" Pap smear? What $ value are you imputing to the life of a young woman? When you take it all into account, is there a $ savings to immunize and prevent 70% of cases, to say nothing of the non-$ costs of those cases that might have been prevented?

"Worth the $400?" Where my daughters are concerned, you couldn't add enough zeros to make it not worth the cost. But having seen the effects that such illnesses have on those affected and those who care about them, as well as the costs of these illnesses, I am hopelessly biased.

theobromophile: The Jacobson decision was not a carte blanche for the government to vaccinate whomever they wanted, with whatever they wanted, whenever they wanted, and against any disease. The rationale was based upon the safety of the vaccine, the (then-current) epidemic of smallpox that swept through Massachusetts, and the deadliness of the disease.
I haven't read Jacobson in many years (it's taught in schools of public health, as well as in law school). Did the Court discuss the "safety of the vaccine"? (It wouldn't have been out of place for them to address that issue.) I will tell you that the vaccine in question, for smallpox, was many, many more times less safe, or more dangerous, than any of the vaccines in common use today. Indeed, tell me if you will, which vaccine(s) in common use today carry any substantial risk of serious injury and what you believe the risk and the possible injuries to be. (I'd rather not get into the Vaccine Injury Compensation Program, because that would entail a very long and detailed discussion of how conflicting medical, legal, public health, and other considerations were accommodated when Congress created it more than 20 years ago. I will just say based on my own detailed knowledge of it that the amount of money paid out over the years is no indication of the risk associated with the covered vaccines.)
3.22.2008 1:15am
MDJD2B (mail):

Did the Court discuss the "safety of the vaccine"? (It wouldn't have been out of place for them to address that issue.)

In fact, the Jacobson decision mentioned necessity, arbitrariness, and safety as factors to be considered. It specifically said that if the vaccine would harm the health of the recipient, its use could not be compelled. there was much in that decision that is implied, and I think it is clear from the context that the Court was not talking about rare complications.

Thank you for your nice words on my behalf.

Many of us, and not just Theo, try to use our intelligence to overcome either facts, or to overcome the methodology of another field.

If you don't like the idea of compulsory vaccination, it is much better if you can use an empiric argument that vaccination is-- or may be-- more dangerous than non-vaccination, than to rely on beliefs about the proper role of government which beliefs are shared by a minority. Conversely, if you favor compulsory vaccination, you have a threshhold obligation to show that vaccination offers many more benefits than non-vaccination. After all, the government IS compelling injection into peoples' bodies of a foreign substance.

Be all of that as it may, the idea that tort remedies provide some sort of tikkun olam in these circumstances seems bizarre. Those who have children with disabilites will appreciate that living with a disabled child while sitting on a big stash of money does not make things right.
3.22.2008 11:14am
scooby (mail):
Your freedom there ends when it threatens the health and lives of others.

This is the wrong way of looking at it. Sometimes you simply never *had* a freedom to begin with.

Do we have the freedom to float about in zero-g (freefall if you want to get technical) as astronauts do? Nope, we were born in the Earth's gravity and it is hugely expensive to either go into orbit or construct an apparatus that would enable us to do so. If a few of us do that, it takes resources from everyone else.

Similarly, we never *had* the freedom to ignore infectious viruses because they kill us and our neighbors. It's not the government taking the freedom, it's that nature never gave us that freedom in the first place.
3.22.2008 11:14am
IDM:
I would like to take issue with the contention that there is no medical evidence that shows it is more dangerous to get vaccinated than to refuse vaccination. One extensive collection of studies is here: http://thinktwice.com/studies.htm
We can debate the merits of every individual study, but the real point remains whether each person should be able to form his own opinion on the dangers or if the government should force its views on everyone.

This reminds me of other debates where the government has been pushing out minority views because it was "inconvenient" to allow them in (global warming and other examples). It would be extremely inconvenient to acknowledge that vaccinations are dangerous, wouldn't it? It's much easier to think that the government is only making people do this for their own good and the good of others.

The risks of contracting a disease from an unvaccinated person are low, and if one believes that vaccinations are pretty good at protecting one from the diseases one should not be worried. A person can't have it both ways: argue that vaccinations are very effective and not dangerous and so everyone should have to get them but also argue that because they're not all that effective, it's dangerous if some people choose not to get them.

Based on these facts, I believe it's wrong to impose vaccination requirements for people who view getting vaccinations as immoral, whether their belief is based on religion or science.
3.22.2008 1:24pm
Randy R. (mail):
How about some market soluations to this problem?

If you don't want to vaccinate your children, then if they get sick with one of those diseases, you get NO health care coverage. There is no reason why any of us should have to have our premiums go up because of someone else's negligence or stupidity.

If, however, you vaccinate, you get your regular health care coverage, even if the vaccination caused you problems.

This way, everyone has an economic incentive to vaccinate without gov't forcing anyone to do anything.
3.22.2008 1:41pm
IDM:
Or people who are anti-vaccination could just pay a slightly higher premium and still have coverage. While I don't believe that they are imposing a measurable cost on society, if this is what it takes to get rid of vaccination requirements I believe it's a compromise that most anti-vaccination people would be willing to enter.
3.22.2008 1:51pm
Randy R. (mail):
I'd be happy with that --- higher coverage to pay for the total costs of everyone in their system who gets sick from not getting vaccinated. As long as I'm not affected by your foolishness, go ahead and enjoy your freedoms.
3.22.2008 2:17pm
neurodoc:
The risks of contracting a disease from an unvaccinated person are low, and if one believes that vaccinations are pretty good at protecting one from the diseases one should not be worried. A person can't have it both ways: argue that vaccinations are very effective and not dangerous and so everyone should have to get them but also argue that because they're not all that effective, it's dangerous if some people choose not to get them.
You simply don't understand whereof you speak, that is the protective value of vaccines (never 100%), the concept of herd immunity (its a "collective" thing), and the epidemiology of contagions (often very complex interplay of many factors, as the course over time and place of HIV infections illustrates).
Based on these facts, I believe it's wrong to impose vaccination requirements for people who view getting vaccinations as immoral, whether their belief is based on religion or science.
People who "view getting vaccinations as immoral," "their belief...based on religion or science"?! How might "science" support the view that getting immunizations was immoral?

Christian Scientists eschew medical treatment for themselves believing that healing must come through prayer, that belief based on the writings of Mary Baker Eddy, a woman some neurologists think may have suffered from temporal lobe epilepsy as the result of a head injury. Of Christian Science, I knew someone who uncharitably said it wasn't Christian, and it surely wasn't science.
3.22.2008 3:33pm
neurodoc:
MDJD2B: Many of us, and not just Theo, try to use our intelligence to overcome either facts, or to overcome the methodology of another field.
That would be like trying to fit square pegs (inconvient "facts") into round holes ("ideologies," like libertarianism) by shaving the edges of those pegs? Or relying on what "common sense" or "intuition" tells us most be so, especially when we want it to be so?
MDJD2B: Thank you for your nice words on my behalf.
What "nice words on (your) behalf"? I was just stating what I thought was incontrovertible. You don't deny, do you, that you are "an exceedingly well-trained and accomplished academic gynecologic oncologist," or that you have "the credentials to speak authoritatively about cancer, especially cervical cancer," or that you are "right about the medicine and about 'correlations' that say nothing about causal relationships"? Tell me what I said that isn't absolutely true.
3.22.2008 3:47pm
IDM:
neurodoc: Perhaps I was unclear. I understand that some people may get sick from unvaccinated people, but I am saying that the number is relatively low and very likely lower than the number of people that will get sick with serious adverse reactions if we force everyone to get vaccinated no matter what. Can you show me clear evidence that a change in the number of people who refuse vaccinations from 1% to 3% or whatever the numbers are these days is going to lead to disastrous health results?

Let me also explain what I meant re my "immoral" comment: if someone believes that a vaccine is more likely to harm his child than help him, it would be reasonable for him to view vaccinating his child as wrong/immoral on his part. One doesn't have to be a Christian Scientist to feel that way.

I also think it's an over-simplification to say that the anti-vaccination crowd has just forgotten how awful the diseases are against which vaccinations are supposed to protect. It does not take that much imagination to get that idea, and a lot of the anti-vaccination crowd consists of educated people who did put thought into balancing the different risks.
3.22.2008 6:21pm
Bad (mail) (www):
It's worth noting that though extremely rare, there are some risks involved in vaccinations. Not the risks that the crazies insist there are (autism, etc.) But things like allergic reaction and other complications. That's precisely why the government has a fund devoted specifically to compensation for injury related to vaccination.

Unfortunately, the risk of these complications is blown way way way out of proportion, and nowadays, when the government actually does compensate someone, it's used as huge PR campaign about how vaccination really is horribly dangerous.

Rabett: as to what happened in England, it's worth mentioning as a follow up the results of the drop in coverage: some of these diseases made a comeback, leading to actual, not hypothetical, child mortality.
3.22.2008 6:21pm
theobromophile (www):
Neurodoc, when I explictly mentioned that I was assuming that the cancer in question included secondary stomach cancer, and I got total snark in reply, I will - regardless of intellect of the person - ask them to cut it out. If he's so brilliant, he could take the opportunity to educate someone who asked an honest (and not totally unfounded) question, instead of resorting to "Nice try" and assuming that I should have been able to read his mind.

As for the cost of Pap smeears - they are constant, vaccine or no vaccine. As I've mentioned a few times, you are supposed to have them anyway. (Consider the danger inherent in vaccinating young women, reducing their risk of contracting the disease by about 50%, but giving them false confidence in their immunity to cervical cancer, such that they don't get regular Pap smears. Does that count for anything?) The cost is there - it goes on both sides of the ledger when comparing costs of vaccine v. no vaccine. I find it just as easy to ignore constants.

Yes, you say that, with your own daughters, there are not enough zeros to tabulate their lives. I agree. The question, though, is not what you feel is appropriate for you and your own family, but what the state can mandate. $400 for a totally preventable disease that there is only a small chance of contracting anyway? For many people, there are better uses of that money - uses which, arguably, have a better chance of extending their lives.

Consider that some 15% of cervical cancer cases have a genetic link. Those people should certainly be vaccinated. What about the people who are genetically unlikely to get cervical cancer but likely to get another disease? Should the government prevent them from allocating their health care expenditures in a way that makes more sense for them?

It's quite easy to dismiss a cost/benefit analysis as "how much is human life worth?". That ignores the role of government in determining how our money is spent (whether directly or through tax dollars) and ignores the fact - of which I'm certain you are aware - that we could literally spend every cent we have staying alive longer, or cutting our risk of early demise.

Look, this hits home for me. I just dropped several hundred dollars - which, as a student, I don't really have - on my own medical care. Arguably, a lot of other people in that situation would not have spent their money that way, but their own personal and family histories are different. I would be completely pissed off if I happened to be a low risk for the problem but the government mandated that I expend my (very limited) resources that way, or, as a high risk in that area (which I am), I were forced to allocate my limited resources in other areas, leaving me with no money for this problem.

I'm not saying that the HPV vaccine should be illegal, should never have been developed, or should be totally ignored. I just don't see why the government determined that to be the best use of our health care dollars.

As for Jacobson - I read it a few weeks ago and seem to recall a brief discussion of the safety of the vaccine. At least, the Court did include a mention of the fact that Massachusetts allowed a health exception (presumably for immunocompromised persons, those with allergies, or the like).

While the smallpox vaccine was, as you note, not as safe as current vaccines, smallpox is a heck of a lot more dangerous than chicken pox. I would hope that analysis of the safety of a treatment would always be done in light of the disease which it is attempting to prevent and/or treat. We tolerate - indeed, encourage - chemotherapy for those with cancer, but we would be outraged if those side effects were suffered by people seeking to treat a headache.
3.22.2008 9:14pm
Eli Rabett (www):
Bad, yes, and that was one of the reasons the guys who advised against vaccination were brought before the medical licensing board.

How about this one for a hypothetical: A live virus HIV vaccine is perfected one of the effects of which is that those vaccinated shed the virus which is conveyed (let us say during sex) to partners. Although the vaccine is very effective, 1 in a million die. Who gets sued, who wins, who should win. How does this change if the virus is spread by breathing? (I suspect this is not so far from a coming reality)
3.23.2008 12:42am
neurodoc:
The question, though, is not what you feel is appropriate for you and your own family, but what the state can mandate.
If the question is whether the state should mandate HPV vaccination for children, I will take a pass. Clearly, mandating HPV immunizations is very different from mandating immunizations against communicable childhood diseases like measles and mumps, and much harder to defend.
I'm not saying that the HPV vaccine should be illegal, should never have been developed, or should be totally ignored. I just don't see why the government determined that to be the best use of our health care dollars.
Do you know it to be the case that the government underwrote a substantial share of the cost to develop this particular vaccine? I expect that Merck
bore most of the expense to develop this product and bring it to market, though if the government funded a good portion of it, I would not think that at all unreasonable.

(I have my doubts about how some of our tax money is spent on the development of weapons systems, but not so much doubt about health research dollars, having had some experience with their allocation. To be sure, pharmaceutical companies are not innocent lambs we ought never question, but there is far less entanglement between them and federal grantors than between defense companies and those who appropriate the money for weapons. I think fraud and other forms of misconduct in the pharmaceutical realm is generally more "independent" of government and less reflective of misfeasance or malfeasance on the part of government actors than it is in the defense sector with R&D, manufacturing, sales, etc. starting with Congress and going all the way down the line to those charged with testing, evaluation, procurement, oversight, etc. I had a DoD inspector tell me once that they did not bother to investigate cases where they thought there was less than $100M of wrongdoing involved, because they were too busy with cases involving bigger sums!)

As for you and MDJD2B, I see you both as very smart, very thoughtful people, who regularly make valuable contributions to these threads and simply "miscommunicated." I am also quite confident that he intended no "snark."
3.23.2008 1:10am
neurodoc:
<blockquote><b>IDM</b>: neurodoc: Perhaps I was unclear. I understand that some people may get sick from unvaccinated people, but I am saying that the number is relatively low and very likely lower than the number of people that will get sick with serious adverse reactions if we force everyone to get vaccinated no matter what. Can you show me clear evidence that a change in the number of people who refuse vaccinations from 1% to 3% or whatever the numbers are these days is going to lead to disastrous health results?</blockquote>Check out the experience in Britain and Scandavian countries when they stopped mandating pertussis immunizations because of exaggerated fears about the safety of that vaccine and saw much higher morbidity and mortality from pertussis infections as an immediate consequence. That's as good evidence as one could ask for of what can happen. (I see that both <b>Eli Rabett</b> and <b>Bad</b> made mention of the very relevant English experience. And Andrew Wakefield has no credibility as a medical scientist, and is regarded by some as close to a scamster. His undisclosed involvement in litigated cases did not reflect at all well on him either.)<blockquote>if someone believes that a vaccine is more likely to harm his child than help him, it would be reasonable for him to view vaccinating his child as wrong/immoral on his part. One doesn't have to be a Christian Scientist to feel that way.</blockquote>Right, they don't have to be a Christian Scientist to feel that way, though Christian Scientists can at least maintain it as a matter of faith. Others have no excuse other than stupidity for believing that they are right about the risks and the respectable medical community (Institute of Medicine, CDC, American Academy of Pediatrics, etc.) are all wrong about this.<blockquote>I also think it's an over-simplification to say that the anti-vaccination crowd has just forgotten how awful the diseases are against which vaccinations are supposed to protect. It does not take that much imagination to get that idea, and a lot of the anti-vaccination crowd consists of educated people who did put thought into balancing the different risks.</blockquote>You are free to think that, or for anything else you might chose to believe whether rational or not, including that our destinies are influenced by the alignment of the stars in the heaven when we were born. But I wonder how many people you could bring forward who have had meaningful experience of these infectious diseases who would tell you that it is advisable to go unvaccinated. Damn few I expect. And that the "anti-vaccination crowd consists of educated people who did put thought into balancing the different risks" just goes to show how incredibly ignorant those who are "educated" can be. I am always far more impressed how stupid supposedly "smart," especially the arrogant ones, or "educated" (in biologic sciences?) people can be than how stupid those of limited intellectual capacity or limited education show themselves to be. Little is expected of the latter, so they can only surprise us by exceeding our expectations of them, while more is expected of the former and they can truly amaze with their displays of arrant, even malignant stupidity. If I were a pediatrician and there were other pediatricians in town, I think I would invite the dogmatic anti-vaccine types, along with the prosletyzing "chemical ecologists" and other "educated" nutters, to find another health care provider for their children. Why not spend one's time and efforts with those who can benefit from it rather than wasting it on those who won't.
3.23.2008 1:37am
neurodoc:
May I try again:

IDM: neurodoc: Perhaps I was unclear. I understand that some people may get sick from unvaccinated people, but I am saying that the number is relatively low and very likely lower than the number of people that will get sick with serious adverse reactions if we force everyone to get vaccinated no matter what. Can you show me clear evidence that a change in the number of people who refuse vaccinations from 1% to 3% or whatever the numbers are these days is going to lead to disastrous health results?
Check out the experience in Britain and Scandavian countries when they stopped mandating pertussis immunizations because of exaggerated fears about the safety of that vaccine and saw much higher morbidity and mortality from pertussis infections as an immediate consequence. That's as good evidence as one could ask for of what can happen. (I see that both Eli Rabett and Bad made mention of the very relevant English experience. And Andrew Wakefield has no credibility as a medical scientist, and is regarded by some as close to a scamster. His undisclosed involvement in litigated cases did not reflect at all well on him either.)
if someone believes that a vaccine is more likely to harm his child than help him, it would be reasonable for him to view vaccinating his child as wrong/immoral on his part. One doesn't have to be a Christian Scientist to feel that way.
Right, they don't have to be a Christian Scientist to feel that way, though Christian Scientists can at least maintain it as a matter of faith. Others have no excuse other than stupidity for believing that they are right about the risks and the respectable medical community (Institute of Medicine, CDC, American Academy of Pediatrics, etc.) are all wrong about this.
I also think it's an over-simplification to say that the anti-vaccination crowd has just forgotten how awful the diseases are against which vaccinations are supposed to protect. It does not take that much imagination to get that idea, and a lot of the anti-vaccination crowd consists of educated people who did put thought into balancing the different risks.
You are free to think that, or for anything else you might chose to believe whether rational or not, including that our destinies are influenced by the alignment of the stars in the heaven when we were born. But I wonder how many people you could bring forward who have had meaningful experience of these infectious diseases who would tell you that it is advisable to go unvaccinated. Damn few I expect. And that the "anti-vaccination crowd consists of educated people who did put thought into balancing the different risks" just goes to show how incredibly ignorant those who are "educated" can be. I am always far more impressed how stupid supposedly "smart," especially the arrogant ones, or "educated" (in biologic sciences?) people can be than how stupid those of limited intellectual capacity or limited education show themselves to be. Little is expected of the latter, so they can only surprise us by exceeding our expectations of them, while more is expected of the former and they can truly amaze with their displays of arrant, even malignant stupidity. If I were a pediatrician and there were other pediatricians in town, I think I would invite the dogmatic anti-vaccine types, along with the prosletyzing "chemical ecologists" and other "educated" nutters, to find another health care provider for their children. Why not spend one's time and efforts with those who can benefit from it rather than wasting it on those who won't.
3.23.2008 3:03am
IDM:
neurodoc: I've been trying to find data on the British and Scandinavian experience but have been unsuccessful so far - could you send a link? I did find the following data on pertussis in Japan: vaccination rates there fell from 80% to 10% from 1974 to 1976, so a dramatic drop. In 1979, the number of pertussis cases seems to have peaked at 13K (doesn't say how serious, so I can't speak to that) and 41 deaths. Again, it's hard to draw a definitive conclusion without knowing how serious each case was, but 41 deaths does not strike me as being a "disastrous health result." And my question was how much a rise in unvaccinated people from 1% to 3% would affect things, which is what we're realistically facing in the US right now according to the data, so how does the pertussis experience in other countries illustrate your point that it would be disastrous when even the huge change in Japan ultimately didn't lead to all that much morbidity? And of course, that study doesn't (and in some ways can't) tell us how many people's deaths were actually prevented by not receiving the vaccine. We can quibble about some of the details of my Japan example, but I don't think it helps your point. Like I said, feel free to send along links as to Britain/Scandinavia as well, I am happy to read more about it.

Right, they don't have to be a Christian Scientist to feel that way, though Christian Scientists can at least maintain it as a matter of faith. Others have no excuse other than stupidity for believing that they are right about the risks and the respectable medical community (Institute of Medicine, CDC, American Academy of Pediatrics, etc.) are all wrong about this.


I hope you don't expect us to believe that the majority of the medical community is always right. Historically, that has obviously not been the case and the community has had to change its views on a great deal of things. So if you want to believe that any time someone disagrees with the majority of the community, he must be a kook, go ahead, but that doesn't strike me as a reasonable position.

But I wonder how many people you could bring forward who have had meaningful experience of these infectious diseases who would tell you that it is advisable to go unvaccinated. Damn few I expect. And that the "anti-vaccination crowd consists of educated people who did put thought into balancing the different risks" just goes to show how incredibly ignorant those who are "educated" can be. I am always far more impressed how stupid supposedly "smart," especially the arrogant ones, or "educated" (in biologic sciences?) people can be than how stupid those of limited intellectual capacity or limited education show themselves to be.


1) Of course, many people who had contact with those diseases will be biased toward vaccination just like how many people who had awful side effects from the vaccines will be biased against them. My one experience with that sort of disease was a minor epidemic of, I believe, chicken pox at my elementary school. To my knowledge, everyone was fine in a short period of time. On the other hand, I personally had a very negative experience with the tetanus vaccine (and that particular vaccine cannot possibly be defended from the point of view of preventing epidemics; nonetheless, the government mandates it in many contexts).

2) I agree that educated people can be incredibly ignorant. In fact, you would not believe how many ignorant doctors I have met in my life, including at some of the top institutions in the country (I am talking about contexts here that are completely unrelated to vaccination and where the individuals in question were either unaware of fairly basic knowledge in their own fields).
3.23.2008 12:52pm
Bruce Hayden (mail) (www):
This may be urban legend, but I do seem to remember a Denver Post article to this effect. But supposedly, a bunch of parents from Boulder, CO, likely highly educated, opted out of pertussis immunization, due to its risks, and assuming that their kids would be protected by the herd effect. But too many opted out, and guess what? Apparently, it went through that lower school population and did some damage. My memory is that this was some time in the 1990s.
3.23.2008 5:00pm
neurodoc:
IDM, you have too many misconceptions for me to address them all.

The unhappy consequences of decreased immunization rates in other countries as a result of fearmongering and greatly exaggerated notions of the real risks of childhood vaccines (e.g., pertussis) have been documented and discussed in the literature. If you want to read about those experiences for yourself, I'm sure you can find the reports in a medical library, if not accessible to you online. (No, I don't have any links to provide you.)

While it would have been best if those immunizations rates did not fall and there was not so much naturally occuring disease as a result, a bit of good came of it. With a decline in the number of children being immunized, epidemiologists could look to see if there was a corresponding fall in the incidence of autism, a purported complication of mercury-containing vaccines. There was no such decrease in the number of autism cases, providing yet additional evidence against the vaccines-can-cause-autism proposition, which has no good evidence for it.
the number of pertussis cases seems to have peaked at 13K (doesn't say how serious, so I can't speak to that) and 41 deaths. Again, it's hard to draw a definitive conclusion without knowing how serious each case was, but 41 deaths does not strike me as being a "disastrous health result."...even the huge change in Japan ultimately didn't lead to all that much morbidity? And of course, that study doesn't (and in some ways can't) tell us how many people's deaths were actually prevented by not receiving the vaccine.
You clearly have no appreciation of how serious an illness pertussis is. And "morbidity" is the measure of non-fatal complications and illnesses; "mortality" is the number of cases resulting in death.
And of course, that study doesn't (and in some ways can't) tell us how many people's deaths were actually prevented by not receiving the vaccine
Deaths caused by immunizations against pertussis, especially those using the acellular vaccine that has been around for 15 years or more (earlier in Japan, I believe), are more rare than hen's teeth. I say that as someone with considerable personal experience of this. Do you have any reliable to contradict me in this regard? Or just more huffing and puffing, hand-waving nonsense, and arguments that a court would give extremely short shrift, or none at all? (If you think that the number of awards paid out of the Vaccine Injury Compensation Program trust fund contradicts me on this, we can discuss why that isn't so.)
I hope you don't expect us to believe that the majority of the medical community is always right.
No, I don't expect you to believe that, nor that any group, however learned and expert, is "always right." But I'll take what those who are learned and expert over those who are decidedly not every time, and no matter how much money you have and what odds we give you, you will be broke soon enough betting against me. (When you would contradict all the respectable authorities, the burden is yours to produce credible evidence in support of your position. You haven't produce it, and I am very confident that you can't, though you may think your own arguments are convincing, and you may have the anti-vaccine crowd nodding along.)
3.23.2008 11:40pm